Keratoconus: A Comprehensive Guide for Optometrists and Patients
Keratoconus is a progressive eye condition that affects the cornea, leading to vision distortion and potential vision loss. It is a relatively common condition, with a global prevalence of 8.16 per 1,000 people and affecting one in 84 Australians aged 20 years. Early diagnosis and management are crucial to prevent progression and maintain quality of life.
This article provides a comprehensive guide for optometrists and patients, covering early signs and symptoms, diagnosis, management, and long-term follow-up. It also highlights the importance of patient-reported outcomes and the use of registry data to track and benchmark outcomes.
Early Signs and Symptoms
Keratoconus typically presents with blurred or distorted vision, increased light sensitivity, and frequent refractive changes, particularly progressive astigmatism. Common risk factors include eye rubbing, atopy, family history, and consanguinity, as well as conditions such as trisomy 21 (Down’s syndrome).
Diagnosis begins with history taking and assessment of risk factors, followed by clinical examination and corneal imaging. Corneal findings may be unremarkable in early keratoconus, with clinical signs becoming more apparent as the disease progresses.
Management
Key steps in the management of keratoconus include assessing for and treating progression, visual rehabilitation, and optimising comorbidities. Progression management involves monitoring for signs of progression and implementing appropriate treatment, such as corneal cross-linking (CXL).
CXL is the gold standard treatment for patients with progressive keratoconus or those at high risk of progression. Its efficacy and safety in preventing progression and improving vision have been established in clinical trials. Early referral is crucial for younger patients, those with a family history, and those demonstrating progression.
Visual rehabilitation begins with an assessment of the patient’s visual needs and general status. Non-surgical management may include spectacle correction, contact lenses, and surgical options such as corneal grafting, deep anterior lamellar keratoplasty (DALK), and laser procedures.
Long-term management involves regular follow-up visits, with the frequency determined by the patient’s risk of progression and treatment needs. The Save Sight Keratoconus Registry is a web-based tool that can be used to track and benchmark outcomes, and share data between ophthalmologists and optometrists.
Patient-Reported Outcomes
Keratoconus has multifaceted impacts on a patient’s quality of life. Patient-reported outcomes can be collected using the Keratoconus Outcomes Research Questionnaire (KORQ), which provides a validated assessment of the patient’s functioning and treatment benefits.
Conclusion
The management of patients with keratoconus is rewarding, as clinicians now have a range of treatment options and can prevent progression and deliver improvements in their patients’ quality of life. By staying informed and using evidence-based practices, optometrists can provide effective care for patients with keratoconus.
