Inaugural IKA symposium shines a light on diagnosing and managing keratoconus

Elizabeth Yeu, MD, cochair and executive board member with International Keratoconus Academy of Eye Care Professionals (IKA), and an ophthalmologist with Virginia Eye Consultants in Norfolk, Virginia, caught up with Optometry Times®’ Group Editorial Director Sheryl Stevenson on what she is looking forward to at this year’s inaugural IKA Keratoconus Symposium: Front to Back and Everything In Between.

The inaugural symposium will promote discussion and education around state-of-the-art diagnosis and management of keratoconus and other forms of corneal ectasia. The conference will take place April 22 and 23 at the Scottsdale Marriott at McDowell Mountains in Arizona.

Video transcript

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

Sheryl Stevenson: We're joined today with Dr. Elizabeth Yeu, who is one of the program co-chairs of the IKA or International Keratoconus Academy Symposium this April in Scottsdale. We're delighted to have you. Could you tell us a little bit about the program this year?

Elizabeth Yeu, MD: Thank you so much for having me. We are so excited at the International Keratoconus Academy. We are having our first live keratoconus symposium with co-chairs including Andy Morgenstern as well as Barry Eiden—two huge leaders within the OD world with regards to managing, on diagnosing ectasia, specifically keratoconus, and then the diagnosis management there of. It really is...this is a bidirectional, an ever-growing field and understanding. But it really does we have lots of great experts.

The name of the game is early detection and having experts talk about how do we identify, how do we identify and treat, and what are the different treatment and management options so that we can delay any kind of allograft transplantation and then what are the best therapeutics that are available today. Ultimately, for the older-aged ectasia patient who needs cataract surgery, etc., what are the best options and technologies that are available to them?

From the OD as well as for the MD audience, this is a combined symposium with plenty of great experts. From the MD side we have Kourtney Houser from Duke, as well as both Renato Ambrosio and Michael Belin—I use their diagnostics all the time for my refractive screening—as well as Uri Soiberman from Wilmer. Bill Trattler is going to be chiming in and talking about... and has he not participated in every single cross-linking trial and has the experience to really provide not only his own personal experience, anecdotally, with all the different clinical trials, but seeing from the pediatric population onwards. He's publicly discussed this taking care of his own daughter, as well as Mary Prudden, who's the executive director of the National Keratoconus Foundation. Many others obviously, but where do contact lenses fit into all this and therapeutic contact lens therapy.

There's so many aspects now that we understand that what we used to believe of keratoconus being a 1 in several 1000 incidence and prevalence, we understand while in certain populations like in the Middle East literature demonstrating it's 1 in 20. It's not nearly probably that common except for certain subsets of populations. Probably in the US, 1 in 250 to 1 in 400 is not that uncommon, and for us early detection in younger patients and in refractive screening for refractive surgery patients this is huge. Especially with the new therapy options that we have available for refractive surgery.

I can now say, understanding and evaluating patients properly with the diagnostics, refractive surgery is an option for you, yes. It's just, is it best for you to have something on the cornea like PRK, SMILE, or LASIK? Or should we be doing a phakic lens implant because—like the EVO ICL, which is currently the only phakic lens implant that's domestically approved—that spectrum now exists where great technology can help our patients so we don't create a secondary ectasia. All of this is available. That kind of education is being brought to us in one symposium for all ODs as well as MDS. It's great to be able to attend live, but we have that virtual platform as well.

Stevenson: That sounds fantastic. A very action-packed program. What sets it apart from other conferences in this space?

Yeu: It's so unique because...the one thing we don't get from the MD perspective. We get great education from surgical training and then understanding certain diagnostics and screening and evaluation. But there is definitely part of how much has evolved in the therapeutic scleral lenses and other contact lens therapies and nuances and diagnostics. And that potential bidirectional cooperative engagement to put patients first and how we can help to take care of our patients best when we are 1) getting the referrals in for does this patient have keratoconus or 2) we know that they have early ectasia but what is the best therapy. Because we know that rubbing and iatrogenic mechanical issues, rubbing, or even contact lens use could potentially exacerbate keratoconus.

Scleral lenses, etc. are therapies that can help to mitigate and plus collegan cross-linking even utilizing it off-label in younger patients to help delay other more invasive surgeries. That kind of education in gaining and kind of having those discussions. I think those panels and having experts on both sides are very fruitful, and ultimately kind of coming up with a bigger diagnostic tree.

That is one of the pieces of this that we hope to come out of this is how do we create a better clinical flow and algorithm on management of the patient who comes in with irregular astigmatism that we are diagnosing, ruling in, ruling out for keratoconus, aka ectasia. How do we manage them appropriately with what is available. How does genetics fit into all of this, and genetic screening and testing, etc. That educational process, you can't do that in a 1-hour symposium.

To have a day where you can go through this, from A through Z, is a really nice learning experience for everybody who really does care about managing and having a better understanding, especially if this is a bigger piece of your practice.

Stevenson: That actually leads into my next question. What are you most excited to share with attendees in terms of what they can put into practice right away on Monday morning when they return from the conference?

Yeu: My real area of expertise is going to be more on the side of when is cross-linking going to be helpful, when to consider re-treatment. I love that my partner, Albert Cheung, is going to be there. He has seen tons of results of epi-on versus epi-off and what are the best tricks and pearls there. And then, of course, why is deep anterior lamellar keratoplasty (DALK) better than PKP (penetrating keratoplasty) in his hands.

For me, it's cataract surgery and options there. The fact that we have small-aperture technology, and then what kind of monofocals to use and do we cross-link before, after, and that discussion piece. Plus, I think with refractive surgery, and the realm there of and how refractive surgery has evolved for me, especially the screening with the tool of adding genetics in. And then now with more and more experience with phakic implants. I think that surgical realm is my sweet spot.

A lot of it not only has been just commercially available in the last 6 months, but having been an investigator in some of the trials, particularly with the small-aperture technology, that kind of information and being able to use it off-label and seeing those results and being able to kind of share that with my peers. I think that kind of data, that's one example of how I feel that I can contribute in this symposium that will be useful for my peers to be able to take back that Monday morning. But I do hope that everyone gets to enjoy Scottsdale, too, over the weekend while they're there.

Stevenson: Excellent. Absolutely. And is there anything else that you'd like to add that we have not touched upon?

Yeu: I just am thrilled that our field has experienced so much growth in the area of what we can do to diagnose and manage this subset of irregular cornea patients. That's really the name of the game and trying to identify them, manage them, and prevent potentially worsening them but mitigating and halting the disease process. Even as of 2016, there weren't really any options except for some contact lens therapies. Not great diagnostics and then really little understanding of biomechanics or even epithelial mapping. And then there was allograft transplantation.

But now look at where we are. A lot of some of that flourishing information has really happened in the last 2 to 3 years. How all of this fits into kind of that flow chart and how we manage patients, and how much younger can we treat these patients. And really are there best practice therapies for who gets epithelium-on or off. Where are we going with cross-linking and that body of evidence, because even that was controversial enough in its efficacy.

I think we can all safely say that we know that cross-linking the cornea and strengthening the biomechanics of the cornea works, but how can we improve and are there other things on the horizon and pipeline? That I think is the takeaway. There is so much that we are experiencing in the last even 3 years that is so useful to help manage our cataract patients with corneal pathology in this realm, as well as early detection and early diagnosis to management and everyone in between.

This is what makes this inaugural IKA Keratoconus Symposium so exciting, and for us to be in this exact current time. There are such flourishing options in each area for each decade and kind of generation and group of patients. It's a great time I think for this. It's very timely for this symposium to be coming to fruition.

Stevenson: Thank you so much, Dr. Yeu. We are so excited and we look forward to seeing you in Scottsdale.

Yeu: Super excited, too. I'll see you guys soon.

To learn more about or to register for the IKA Keratoconus Symposium: Front to Back and Everything In Between, click here.