Diagnose, treat, and prevent: What's to come at the 2024 IKA Keratoconus Symposium

For eye care professionals looking to stay up-to-date with keratoconus diagnosis, treatment, and prevention methods, the International Keracotonus Academy (IKA) is bringing the latest updates during its Keracotonus Symposium, to be held on May 18 and 19 in Bethesda, Maryland. IKA President Barry Eiden, OD, FAAO, FSLS details the importance of using modern technology to uncover new findings on keratoconus in an exclusive interview with Optometry Times.

Video transcript

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

Emily Kaiser Maharjan:

Hi everyone, I'm here with Barry Eiden, who is the president of the International Keratoconus Academy or IKA, and the cochair of the IKA Keratoconus Symposium, which is happening this spring just outside of DC in Bethesda, Maryland. He's here to chat about keratoconus research and education. So, welcome Dr Eiden. It's great to chat with you.

Barry Eiden, OD, FAAO, FSLS
Thank you so much. It's really a pleasure to be here again and share some of the most current information and some of the exciting things coming up.

Kaiser Maharjan:
Yeah, it's all good stuff. So, first and foremost, what's the latest in keratoconus research?

Eiden:
Wow, that topic easily can take quite a bit of time, so I'll try to outline at least the way I would see some of the most exciting areas, and there are just so many. I think it all starts with understanding the disease, right? So, for example, what about the pathogenesis of keratoconus? What about the molecular level, the cellular level? I know sometimes that seems a little dry to people, but a better understanding of the disease process itself always leads to better diagnosis, better treatment. So there's a lot of research and understanding keratoconus at that level.

But getting more clinical, I think the next level of research that really is the most exciting to me has been a better understanding of how common this disease is or the prevalence of keratoconus. So, we all know that classically, a number has been thrown around for the prevalence of keratoconus being about 1 in 2000 individuals, but that was based upon a study that was utilizing older technology, diagnostically speaking. So things like using the keratometer for distorted mires, slit lamp findings, or retinascopic findings. Again, not the most current technology. Well, most recently, over the past number of years, more advanced, more sensitive technology's been utilized. We start realizing that the prevalence of keratoconus is much higher, [with] some studies as high as 1 in 300 and some odd individuals; a really common disease. IKA, as an organization, is so excited that we are coming out very soon to be published a seminal paper on the prevalence of keratoconus in the pediatric population. Interestingly enough, without giving too many details, the outcomes were very, very similar to the more contemporary prevalence numbers. So, bottom line is that even in the pediatric population, we're seeing prevalence numbers that are very high, and this has a tremendous implication on our clinical practice patterns. How do we approach pediatric eye care? Maybe it needs to change in terms of things like screening. So that's kind of a summary of the prevalence aspects.

Now, getting into the early diagnosis, which is the next phase, how do we use some of these early diagnostic and very sensitive technologies to make the early diagnosis? Things like corneal topography, corneal tomography, looking at thickness patterns of corneal epithelium, even the biomechanics or strength factors of the cornea itself, all are being developed, all are now clinically applicable and allowing us to make the earliest of diagnoses in keratoconus. The problem is getting this kind of technology into the hands of the masses of eye care professionals. That is a challenge because some of the technology can be expensive. So again, IKA has sort of thrown the gauntlet down to industry to try to figure out how to make some of these technologies accessible to larger numbers of eye care providers at a much more reasonable cost. So that's something that we really want to promote.

A really interesting area of research is in the genetic basis of keratoconus. I think it's widely accepted today that keratoconus is a genetically-based disease that can be influenced by environmental factors; but genetic risk factors really are important. For a few years, we actually had a clinically useful and applicable genetic in-office tests that we can do. You can take a swab of the inner cheek, send the results out, and get a genetic risk score for the development of keratoconus. Unfortunately, the company that developed that has moved out or pivoted into other areas of health care, predominantly in the cancer area, and really has left this kind of hanging and so we no longer have access to those tests. Well, our hope, I'm very hopeful, that other companies might see this as a good investment and take up that particular technology. But on the other hand, there's a lot of research going into developing other, maybe even more sensitive, genetic tests, so that we can use them clinically. We're really excited about some of that research that's going to come down the line, and as we'll talk about at our upcoming IKA symposium, that's going to be a topic of conversation in presentations.

So that kind of covers some of the diagnostic aspects. Let's talk about treatment, because that's so important. It's wonderful to diagnose it early, but if you can't do anything about it, it becomes a moot point, right. So we now know that we have the ability that if we diagnose the disease early enough that we can treat it by halting progression. Predominantly, that's been through the use of corneal collagen cross-linking, which has been approved since about 2016 here in the United States, through what's called the Epi-off procedure, which involves application of riboflavin after the removal of the epithelium. The most current research is going into less invasive, probably safer, and hopefully equally or more effective methods through the intact epithelium or transepithelial, or also known as Epi-on corneal cross-linking. So there's a lot of research going on in there. There's a number of Phase 3 clinical trials going on as we speak. We're going to get information at our meeting shared with our attendees about that as well. Even at a more exciting area, there are some researchers looking at topical treatments where certain types of eyedrops might be able to be used to just place into the eye without any other type of intervention that could control progression. So these are all very exciting.

Then the third, and last, would be other forms of treatment, and that is for visual improvement. We always talk about patients, how there are numerous aspects of managing keratoconus: diagnosis, stopping or halting progression, and then improving vision for those who've already experienced vision loss. Of course, the mainstay of vision improvement is through the use of contact lenses and that's still a phenomenal alternative. There's still research going on in there, and probably the some of the most exciting research in the contact lens area is addressing some of the more specific distortions of vision to keratoconus, in essence, higher order aberration correction. So although we already have clinical abilities to do so, it's still developing and improving, and through our research, we're going to be able to do so much more. Surgical interventions, like intracorneal ring segment, or, more exciting, are some of the corneal inlays, where donor corneal tissue can be fabricated to be placed into the cornea and have dramatic effects and improving corneal surface shape and, therefore, improving vision. So we're really excited about so many areas. As I said, this topic we could talk about for hours, but I wanted to kind of do a very quick summary for you in that regard.

Kaiser Maharjan:
Yeah, thank you for summarizing, that was absolutely fascinating. Yeah, that's great. Would you say that there's a gap in keratoconus education and eye care? What should optometrists know that doesn't necessarily get mentioned or discussed deeply enough at most major meetings?

Eiden:
Well, sure. Yeah, again, this is a mantra that our organization, International Keratoconus Academy, has in terms of disseminating the most current, the most valuable information to the eye care professions. And surely there is a gap. That gap is closing significantly in bringing some of the most current information to the eye care professions, but also at the level of the educational section, meaning to our optometry students, ophthalmology residents and getting them to understand some of these things about the early diagnosis about management and progression about some of the newer technologies. So again, we at IKA take that very seriously and really feel that we're an important part of that.

Kaiser Maharjan:
Yeah, absolutely. And what resources would you recommend for optometrists to tap into to stay up to date on the latest in keratoconus?

Eiden:

Well, without sounding too self-serving, I would say number 1, I would invite everybody to join us this coming spring for our second annual International Keratoconus Academy Keratoconus Symposium, which will be taking place in May 18 and 19 in Bethesda, Maryland. We'd love to have as many people as possible come join us in-person, but we will also be presenting virtually so one can sign up for virtual attendance as well. We're going to have some of the most well respected clinicians and researchers in the field of keratoconus presenting the most current information on all the topics we talked about. So that's 1 thing. General membership even in our organization in IKA, it's a complimentary thing. There's no cost to be a member at IKA and that kind of connects you with all of the communications that we do. So you can do that by going to our website at www.keratoconusacademy.com and go to our subscription page. As I said, it's complimentary. You become part of the conversation, you'll be part of our sharing of information. Obviously, any of the major eye meetings, especially those organized or related more towards anterior segment of cornea, whether that be in optometry and or in ophthalmology, are great places to hear some of the most exciting and new information as well.

Kaiser Maharjan:
Yeah, absolutely. Thank you for sharing. The IKA keratoconus symposium is an obvious education boon for those who are really interested in keratoconus. So, do you mind sharing a little bit about what's happening this year that you're really excited to share with your peers?

Eiden:
Yeah, it's fantastic. You know, our first meeting last spring in Scottsdale, [Arizona] went so well. We had great attendance, we had great speakers, but we're just taking it to the next level. We're having a few of our return speakers from last time some of the greatest hits of IKA symposium 1, but we're adding a bunch of new speakers as well. All of the topics that we alluded to before are going to be covered: early diagnostic technologies, the biomechanics elements. One of the really exciting areas, we're going to have a talk on the application of artificial intelligence (AI) in the diagnosis and management of keratoconus. AI is such a hot topic, but it really is utilized in a very effective way in keratoconus management. We also are going to have sessions on the patient experience, and that's so important. It's great to have all of the clinical acumen, but understanding how our patients are living with this disease and understanding how we can better communicate is so important. So we're looking forward to that as well.

Kaiser Maharjan:
All right, well, is there anything else you'd like to add that haven't been touched on?

Eiden:
I would just say, we are so excited to be putting on this next IKA symposium. I just hope that everybody will do their best to either join us in person or virtually. We're just thrilled to be able to disseminate this information, so thank you.

Kaiser Maharjan:
Fabulous. Well, thank you so much for taking the time to chat with me today about keratoconus, Dr Eiden, it's been really fun and I'm really looking forward to hearing more as the IKA Keratoconus Symposium approaches.

Eiden:
I greatly appreciate the invitation. Have a great day.