AAOpt 2024: Enabling cross-linking to preserve sight for keratoconus patients

Brooke Messer, OD, FAAO, FSLS, an optometrist at Vance Thompson Vision, is advocating for earlier corneal cross-linking in keratoconus management at the American Academy of Optometry meeting. She believes that cross-linking should be performed at the time of diagnosis rather than waiting for the condition to worsen. Messer aims to raise awareness about subtle corneal changes that may indicate progression, allowing for earlier intervention to preserve sight. Additionally, she plans to discuss minor surgical procedures that could improve vision quality for keratoconus patients, potentially reducing their dependency on specialty contact lenses. Messer is lecturing on these topics with colleagues Clark Chang, OD, MSA, MSc, FAAO, Jason Jedlicka, OD, FAAO, and John Gelles, OD, FIAO, FCLSA, FSLS, FBCLA and invites questions and discussion at the event.

Video transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Brooke Messer, OD, FAAO, FSLS:

Hi, I'm Dr Brooke Messer, and I practice in West Fargo, North Dakota, at Vance Thompson Vision. Vance Thompson Vision is an anterior segment ophthalmology-optometry clinic, and we see all things cornea, glaucoma, and refractive surgeries. And I'm here at the American Academy of optometry meeting. This week, I'm participating in a lecture that discusses the controversies around keratoconus management, and one of the things in keratoconus management that I'm particularly passionate about is enabling and allowing and getting our patients with keratoconus to have cross linking done. We know that cross linking stabilizes the cornea. We know that cross linking preserves sight for our patients with keratoconus, and when it comes to our patients being able to access corneal cross linking, we as clinicians have to prove that their corneas are progressing, that their keratoconus is getting worse, despite the definition of keratoconus is that it's a progressive condition. So why do we have to wait for our patients to get worse when we know that it's a progressive condition? So in my opinion, I think patients should be able to have cross linking done without needing and having to wait for their cornea to change in order for them to have cross linking. Why can't we just cross link at the time of diagnosis?

So in my part of the discussion around cross linking in this course, I'm hoping to enlighten others or bring awareness to some of the corneal changes that maybe preclude the typical changes like [Kmax] values or pachymetry. I'm hoping to discuss things that maybe other people could look for in topography and tomography images, so that we can highlight those progressive changes even sooner, so that we can again cross link even sooner in the disease process to preserve sight long term for our patients.

Another thing that we're going to talk about in our lecture is minor surgical procedures for patients with keratoconus to help improve their vision quality, and historically, surgical procedures on eyes with keratoconus have kind of been a big no no. You know, we had things like intacts before, and that didn't really work out like we had hoped, but there are new surgical procedures that can improve vision quality and help patients maybe reduce their dependency on these specialty contact lenses, so that they can have a break on Sunday morning, or they can have a small break during the day to rest their eyes instead of being 100% reliant on their specialty contact lenses. And so again, that's another thing we're going to highlight, is introduce some of these minor procedures that can improve vision quality for patients with keratoconus, so that they too can have a break from their contact lenses, just like the rest of us who wear lenses, we want to have those weekend breaks so that we can wear glasses for a short period to give our eyes a rest. I think that it'll be a really interesting course, and hopefully you come with questions, and we have a great discussion with our team. I'm lecturing with Drs Clark Chang, Jason Jedlicka, John Gelles, and myself, and I hope to see you there on Friday.