AOA 2023: Preparing to conquer keratoconus management in clinical practice

Melissa Barnett, OD, FAAO, FSLS, FBCLA, caught up with Optometry Times to tell us all about her presentation titled, "Caution steep hill ahead: Managing keratoconus in clinical practice: Are you ready to conquer keratoconus?" which she presented at the 2023 AOA Optometry's Meeting in Washington, DC.

Video transcript

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

Hi, I'm Melissa Barnett. I'm the director of optometry at the University of California, Davis. I lectured here at Optometry's Meeting on managing keratoconus in clinical practice. I discussed the importance of early diagnosis of keratoconus and that includes things like genetic testing, corneal tomography, global pachymetry, evaluating the posterior cornea. And this is especially important in patients who have changes in frequent glasses prescription changes or contact lens prescription changes, and an increase in astigmatism including a skew or oblique rotation of that astigmatism.

The importance of diagnosing early is so that we can manage the cornea. We can stabilize the cornea with corneal collagen cross-linking and then rehabilitate the cornea with things like specialty contact lenses or glasses. So in the lecture, we covered a lot about cross-linking, current cross-linking techniques, the FDA-approved cross-linking, and then also future cross-linking techniques. I also covered why corneal transplants are not needed as much as they were before because we do have cross-linking and specialty contact lenses even in advanced keratoconus. And I talked about all sorts of contact lens options: corneal gas permeable lenses, soft lenses for keratoconus, hybrid lenses, piggyback lenses, and scleral lenses.

So some key takeaways are, one, diagnose keratoconus. Look for keratoconus in all of your patients, just like you evaluate for dry eye disease, just like you evaluate for myopia. It's important to rule out keratoconus. We can diagnose keratoconus, without any fancy technology as well. We can use retinoscopy, autokeratometry to look at the mires. And then if you want additional testing and don't have it to collaborate with a colleague who does and then see the patient back. We want to stabilize the cornea with cross-linking and then rehabilitate the cornea with specialty contact lenses.