Those experiencing vision changes or issues with their eyesight usually make an appointment with an optometrist to find out what’s causing the problem. Often, they have an eye exam, are fitted for glasses or contact lenses, and sent on their way. However, if you are living with progressive keratoconus, your story may be a little different. It’s not uncommon that you end up making numerous eye appointments – and seeing multiple physicians – before receiving a diagnosis. 

For those with keratoconus, ophthalmologists and optometrists are an essential part of your diagnosis, treatment, and overall care. While an ophthalmologist can intervene and treat progressive keratoconus with the iLink® FDA-approved cross-linking procedure or a corneal transplant depending on the severity of your condition, an optometrist can help fit you for specialty contact lenses to correct your vision prior to or following the procedure. Together, both eye care professionals play important and collaborative roles in your keratoconus journey. 

Hear From a Keratoconus Expert 

To learn more about the roles optometrists and ophthalmologists play in a progressive keratoconus journey, we recently connected with Dr. Sumit Garg, M.D., Medical Director at Gavin Herbert Eye Institute at the University of California, Irvine. Dr. Garg, who specializes in cornea surgery, is Vice-Chair of Clinical Ophthalmology and Professor in the Department of Ophthalmology at the Institute. 

As you continue reading, Dr. Garg discusses the importance of diagnosing keratoconus early. He specifically touches on why optometrists must be aware of keratoconus so the progressive condition isn’t missed, what should happen when an optometrist refers someone for treatment, and more.  

Why is it important to diagnose keratoconus early?

Having an awareness of keratoconus is most important in order to properly diagnose the condition. It’s key that clinicians know about the condition, are familiar with what to expect, how to educate patients and their families, and understand what kind of care a patient may need. A keratoconus diagnosis has become so important because a lot of treatments affect the impact that the condition will have on someone’s life. The earlier the diagnosis, especially when it comes to progressive keratoconus, the better the condition can be managed with treatments such as the iLink® FDA-approved cross-linking procedure. Today, we have minimally-invasive procedures like iLink® that can help slow or halt the progression of the condition to help preserve vision. Then, we can get someone into a good contact lens or glasses, allowing them to be in a much better position to manage their condition. 

Do you feel it is important that optometrists are aware of keratoconus so the progressive condition isn’t missed?

Optometrists see a lot of eyes with pathology, and they also see a lot of healthy eyes. If keratoconus is on their radar and there is a risk factor, such as the patient is an eye-rubber, there is a family history, or the patient has allergies, they may be a little more heightened in their examination and ancillary testing. Optometrists may work with a colleague to get regular testing (topography/tomography) for that patient. They’ll also often talk to the patient about symptoms of keratoconus and advise on what not to do, such as eye-rubbing. Because optometrists see so many patients, they are uniquely positioned to really impact patients’ lives. They can also ensure that they are following their patients’ progression and looking for any signs indicating keratoconus. All in all, this helps the patient receive a diagnosis earlier, understand their disease and treatment options, get treatment sooner, and ideally prevent irreversible vision loss. 

What steps can be taken to better ensure awareness of the condition?

Keratoconus awareness is incredibly important. Most optometrists know keratoconus like they know the back of their hands, but as we all get busy in our day-to-day, it can become difficult because even patients with “normal” vision experience vision changes. If a patient’s vision is not correctable to 20/20 and imaging or testing is not consistent, that should heighten an optometrist’s suspicion and intuition to explore a little bit deeper. If a patient is an eye-rubber or has a family history, that raises their risk factor, but we also see keratoconus in patients without any risk factors. Therefore, it’s important to keep an open mind and frequently check for keratoconus in the early teens to late 20s (especially in patients with unstable refractions and those with progressive myopia), as those are the ages that are most often impacted. 

When would you recommend an optometrist screen for keratoconus and why is keeping up with eye exams important? 

It’s important for an optometrist to screen for keratoconus anytime they are suspicious – whether there’s a physical exam that’s inconsistent, progressive myopia, or someone has uncorrectable vision or irregular astigmatism. Keratoconus is really patient-specific, so clinical suspicion comes into play. If the patient is referred, it’s important to send him or her with all of their testing and refractions, as this helps determine if the patient’s keratoconus is progressive. This is why keeping up with eye exams is so important, because it helps detect any vision problems, and it can also track any progression. 

Do you believe optometrists and ophthalmologists can/should work together? 

1000%! Keratoconus is a condition that requires both optometrists and ophthalmologists to work together. If it was left to just one specialty or the other, a patient would miss out on various aspects of important care. For instance, most ophthalmologists aren’t contact lens experts, and optometrists can’t perform cross-linking in most states, so optometrists and ophthalmologists working together is key for patients. When I perform FDA-approved cross-linking, I make sure that patients return to their optometrist to be properly fitted for glasses or specialty contact lenses and for ongoing general eye care. 

What is the ideal course of action for a patient when an optometrist suspects or diagnoses someone with progressive keratoconus? Should they immediately be referred for further keratoconus evaluation and treatment? 

It really depends. Keratoconus is not like a corneal ulcer that would require emergency treatment in a few hours or days. Generally, it is important to get that patient in to see an ophthalmologist efficiently – specifically, within a few weeks from the diagnosis or suspicion. If an optometrist suspects keratoconus, ideally he or she will provide the patient with information about the condition and what to expect. It’s also a good idea to determine if the patient’s keratoconus is progressive or not. If an optometrist is unsure, it never hurts to get an ophthalmologist’s opinion. 

Another piece of the puzzle that is important to recognize is that oftentimes keratoconus is asymmetric. The vast majority of patients have keratoconus in both eyes – however, one eye may be progressive and require cross-linking, while the other doesn’t progress and can be monitored. 

Ultimately, one of the key takeaways with keratoconus is catching it early enough so that you can help the patient maintain good vision by slowing or halting the progression of their condition with the iLink® FDA-approved cross-linking procedure, then correcting their vision with a pair of glasses or specialty contact lenses, before the patient loses the opportunity. 

For more information on progressive keratoconus and the iLink® FDA-approved cross-linking procedure, or to hear people’s personal experiences with the condition, visit our website and follow us on Twitter, Facebook, and Instagram.

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Dr. Garg is a paid consultant of Glaukos.

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