Where are we with keratoconus management today and why genetic testing will revolutionize keratoconus diagnosis — and improve refractive outcomes in the process
Elizabeth Yeu | | Opinion
It was not long ago that keratoconus was seen as a rare disease, with a commonly cited paper from 1986 indicating an incidence of 0.054 percent in the US population (1). We now recognize that is not nearly as rare, with keratoconus incidence being different worldwide, more commonly seen in hotter climates and in eye rubbers. As a community, we have accepted the condition is increasingly more commonplace – which is something I see reflected in my own patient population, which is more skewed from the point of view of a corneal specialist. One out of every three corneal consultations in my clinic involves a keratoconus suspect. It seems obvious to say that advanced keratoconus is not difficult to diagnose. You can almost diagnose the condition in a more advanced keratoconus case by reviewing the level of astigmatism in the manifest refraction, coupled with the best-corrected vision that it yields, especially if there is a limitation to the spectacle-corrected vision. You know with more certainty if their topography/tomography demonstrates inferior steepening or irregularly-skewed bowties. But the real problem with diagnosis lies in mild cases. The issue is particularly critical for younger patients who are coming in for refractive surgery consultations, because ophthalmologists run the risk of inducing clinically relevant keratoconus by performing surgery. Also, keratoconus that starts in a younger age is often more aggressive in its progression, and this lends these patients to be more susceptible to requiring corneal transplantation at a younger age.
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