ASCRS 2023: Progressive keratoconus in older patients with delayed corneal cross-linking treatment

William Trattler, MD, sat down with Sheryl Stevenson, Group Editorial Director, Ophthalmology Times®, to discuss his presentation on progressive keratoconus in older patients with delayed corneal cross-linking treatment at the ASCRS annual meeting in San Diego

Video transcript

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

Sheryl Stevenson:

So we're joined today by Dr. William Trattler who will be presenting at this year's ASCRS meeting. Welcome to Dr. Trattler. Tell us a little bit about your talk this year on, regarding progressive keratoconus.

William Trattler, MD:

Thank you so much. I love this topic, and of course, I have to give a shout out to my, the doctors I worked with on this paper, including Ali Logan, who's one of the resident I work with, and Nicole Kantor who's a medical student. But the concept was, there's this myth that once you're over the aged 35 or 40, patients don't progress if they have keratoconus. I even hear this from my patients all the time. I hear it in referrals.

But, I found this out to be the case, and so we decided to figure out how can we test this hypothesis that patients do progress? And we realized that we had this group of patients that came to see us for cross-linking under center. But for some reason there's a delay in our cross-linking treatment of at least six months or longer. Sometimes there's insurance issues, or various reasons. And we basically collected on everybody who at least a six-month or longer delay in treatment.

It turned out that as we looked at this group of patients, we had almost 180 patients that had a delay from 2014 to 2022 that we identify these patients. So basically, we're able to look at the change in the pentacam and the Kmax from their original visit to the day of their crossing procedure, [and] see how much these patients progress. Our youngest patient, which just 14 to the 80s. But we decided, for this paper, just to look at our patients that were aged 40 or over, which was about 79, which was 79 patients, and look at their rate of progression.

And we defined progression, you know, we could have a short-term view and say, okay, it's has to be 1 diopter of progression in one year. But in reality, that's pretty rapid progression. So we did make it, it has to be about 1.2 diopters over 2 years because these patients will keep progressing over the next 10-20 years, and we will identify patients that are slowly progressing over time. And we found that in our study that 41% of the patients age 40, or 41% of the eyes of patients aged 40 and older actually progressed to that rate or higher. So it shares the fact that these patients can progress.

We've known this for a lot of reasons, but I guess a good example is this patient I watch for 9 years in my clinic, and she never progressed. She was in her 50s when I first met her, and she's aged 62. And from age 60 to 65, her corneal shape worsened by over 10 diopters of Kmax from age 62 to 65. So we know these older patients can progress. Maybe it they're rubbing their eyes or some other environmental issues, but any patient can progress, and I think the reason why we've come together, put our data together, was to help to educate others that patient needs to be followed year after year. Just because you're age 40, there's a chance you may progress, there's a chance you may not progress. And so, we just want to make sure that people follow these patients carefully over time.