VEW 2023: Predicting the future of keratoconus care

At Vision Expo West in Las Vegas, Justin Schweitzer, OD, FAAO, outlined "Current trends in keratoconus management." He spoke to Optometry Times about what's new and interesting in topography-guided treatments, the importance of early diagnosis, and the future of keratoconus management.

Video transcript

Kassi Jackson:
Hi everyone. I'm Kassi Jackson with Optometry Times and I'm sitting down with Dr. Justin Schweitzer, who presented "Current trends in keratoconus management" at Vision Expo West 2023 in Las Vegas. Welcome Dr. Schweitzer.

Justin Schweitzer, OD, FAAO:
Hey, thanks so much for having me and looking forward to the discussion.

Jackson:
Yeah, always happy to talk with you. So can you tell us a little bit about current trends in keratoconus management?

Schweitzer:
Yeah, you bet. Fun lecture; really focused on helping optometrists identify keratoconus at its earliest stage. We know that there's been a shift in the way that we manage patients with keratoconus, not necessarily with how we rehabilitate their vision—we're still using, you know, specialty contact lenses to help them, sometimes spectacle lenses—but, you know, diagnosing earlier is so important because we have corneal cross-linking available. And so we think of the past, we used to try to identify the disease early, and then we would rehabilitate their vision, but there was not a lot we could do with the progression, and they would continue to get worse. And then eventually, that would lead to a cornea transplant.

And so what my lecture really focuses on is, let's diagnose it early. Once we diagnose it, let's get them to someone that can do cross-linking. And we review some of the data around cross-linking. And then we also talk about that third step after we've stopped the progression, which is rehabilitating the vision. And how are we going to rehabilitate the vision? Yes, contact lenses, yes, spectacle lenses. But we now have topography-guided procedures. We have, you know, CTAK, which is similar to Intacs. It's just using some corneal tissue that we review and talk about. So there's a variety of different ways now that we can rehabilitate the vision that we couldn't do before.

And then we talked about some of the new things that are coming in the cross-linking world. You know, is epi-off still the best? Versus could epi-on supplant that and so we get into that discussion as well.

Jackson:
Wonderful. Yes. So what are some of the key takeaway points from your talk?

Schweitzer:
Well, I think number one, the most important thing is we as optometrists managing these patients, or seeing patients on a daily basis, is we have to catch the condition early. And not all of us have a tomography or topographer. And so I do review some different ways to raise the red flags around how do we catch keratoconus early? So I think that's one big piece.

Then I think the second key takeaway is, once you've diagnosed it, once you've caught it, what do we do next? Where do we send it to? And so finding a practitioner that's doing cross-linking is really the next key factor and then understanding the data around that.

And then I think the part I left out earlier, which is another key piece, is we're going to talk a lot about post-operative management after cross-linking. You know, because as the optometrists, we're going to be dealing with these patients afterwards. What's normal? What should we expect? What's abnormal? What to do when it is abnormal?

And then the rehabilitative vision piece, I think, will be the fourth key takeaway. And we'll go through all those options as well.
Awesome. Are there any tips for implementing the current trends that you have or any pitfalls to avoid?

Yeah, you know, I think every optometrist has the ability to implement this, mainly because we all have the tools that we need: You need a slit lamp, if you have a way to measure Ks, or you have a topography or tomographer, that's going to help. And then just be an investigative about it. If something's not adding up; new amounts of astigmatism, or a patient that was 20/20 that's not 20/20 anymore. These are all things we already have at our disposal. So you don't have to invest in a bunch of new technology to be able to do these types of things.

Jackson:
Great. So how can practice owners leverage this information to better run their clinics?

Schweitzer:
I think it's all about—we gain trust in our patients when we are able to educate them and use the latest and greatest research and technology and follow the literature around current trends in different disease processes. Not just keratoconus, but but any other condition as well. And I think that that word of mouth spreads quickly when they find out that you're a doctor that really is using the most advanced technology talking about most advanced literature on a certain disease type of condition. And as soon as you identify a few of these patients and you catch it early, and you help them, when we're speaking specifically with keratoconus. That spreads quickly. And you gain that trust with these patients, which leads to other patients coming in to see you.

Jackson:
Yeah. Which can go a very long way, I'm sure. What do you think the future of keratoconus care will look like?

Schweitzer:
Well, we're seeing a glimpse of it already. By with you know, not only contact lenses aren't going anywhere we're going to continue to use that. I think the research is going to continue to show us here is there going to be faster ways to do cross-linking but still get the efficacy of the way that we do right now, the FDA-approved way, which is which is epi-off cross-linking? I think the only disadvantage to it is is the length of time that the procedure is. And the fact that you know you have to heal a small epithelial defect. Now are we capable of doing that? Of course we are. But like anything we want to see that evolve, where we can do more patients, do it more quickly, and I think that's really where the future is going to go.

And then we'll continue to see advancements in technology with contact lenses. We've seen it now with an Intac going to practitioner starting to do CTAK. And so all these things are going to continue to change. We went from where you say, "No, you cannot have any type of refractive surgery on the cornea if you have keratoconus" to where we now are doing topography guided PRK on these patients after we crosslink them. And so that will continue to evolve and it's an exciting area and arena.

Jackson:
Awesome. So anything else you want to be sure to add?

Schweitzer:
No, just excited, you know, with Vision Expo, excited to share all this information with my colleagues, and it should be a fun few days.

Jackson:
Wonderful. Well, Dr. Schweitzer thank you so much for taking the time to chat today.

Schweitzer:
Thanks for having me.