Is Your Optometrist Screening for Progressive Keratoconus?

As an optometrist, my primary responsibility is to screen for and treat diseases of the eye. When we find a disease or condition that could threaten a patient’s sight, we serve as the central point of contact for care as the patient sees any number of specialists. Additionally, we maintain our patients’ vision with prescription glasses or contact lenses, and monitor for any changes in the diseases we detect.

Keratoconus

One such condition is keratoconus. Keratoconus is a progressive eye disease that, if left untreated, may require a patient to undergo a corneal transplant in severe cases. As keratoconus progresses, a patient’s cornea thins and bulges into a cone shape. Patients with keratoconus experience distorted vision that is not correctable with glasses, and which may worsen as the disease progresses.

Despite advances in diagnostic tools, keratoconus is often diagnosed at a relatively late stage—when vision has already deteriorated. When detected and treated early, progressive keratoconus can be slowed or halted, preserving vision that may have otherwise been lost. Unlike most eye diseases that affect the aging eye, keratoconus typically begins to appear in the teen years, which means it is important to screen young people for the disease. Patients with a family history of keratoconus, high astigmatism, a rapidly changing prescription or vision that isn’t very good even with glasses or contact lenses, ocular allergies, and exposure to smoking are at elevated risk for keratoconus, as are those who often rub their eyes.1,2

In the early stages, keratoconus is painless, and patients with keratoconus often believe that increased blurred vision simply means they need a new glasses or contact lenses prescription. Keratoconus can be detected via a test called corneal topography and by other signs that doctors can see when measuring and evaluating the eye. This screening is standard care for all patients at my offices.

What To Do If Keratoconus Is Detected

You and your family should visit your optometrist annually. This is true even if you don’t wear glasses or contact lenses. We assess and manage your overall ocular health in addition to providing prescriptions for glasses and contact lenses. But how can you be sure that you are receiving the highest level of care from your eye care provider? What details should you communicate to your eye doctor? And what should you do if keratoconus is detected? I advise the following:

• Ask your optometrist if they are performing a comprehensive eye exam that looks at overall eye health and not just vision. Most optometrists have the technology and training to screen for keratoconus, but some doctors place more emphasis on other elements of the examination, and may not be routinely performing corneal topography to scan for early keratoconus. An eye care appointment is not a zero-sum game: your doctor can screen for keratoconus while screening for other ocular diseases. Ask them directly if they’re specifically screening for keratoconus.

• Tell your optometrist about any risk factors you or your children may have. Family history plays a role in keratoconus and other eye diseases. If you have a family history of eye disease—even if you don’t know the specifics—tell your optometrist about it. If you or your children frequently rub your eyes, tell the optometrist that, too: frequent eye rubbing is a risk factor for keratoconus.

• If you or your child are diagnosed with keratoconus, be sure to ask for a referral for corneal collagen cross-linking. There is no cure for keratoconus, but there is a treatment that can slow or halt further progression of the disease by leveraging a technology called corneal collagen cross-linking. While there are multiple procedures that utilize cross-linking, the first and only FDA-approved treatment to slow or halt the progression of keratoconus is called iLink. Patients undergo iLink treatment in the office of a corneal surgeon; your optometrist will refer you to that provider then see you back for your post-operative care. Other forms of collagen cross-linking besides iLink are not approved by the FDA, and therefore may not be covered by your medical insurance. Be sure to ask which treatment is being elected and why, so that you can make an informed decision.

• If you or your child already have decreased vision due keratoconus, be sure to ask your optometrist about Scleral Contact Lenses.  Often, decreased vision from keratoconus cannot be corrected by glasses or standard contact lenses. These patients require rigid gas permeable (RGP) lenses that create a smooth, uniform surface "masking" the irregular corneal shape. At my offices, I prefer to use Scleral lenses. Scleral lenses are large diameter RGP lenses that rest on the sclera (white of the eye) and vault over the cornea. Your natural tears or a saline solution fill in the space between the lens and the cornea that help you achieve your best corrected vision without discomfort.

You owe it to yourself to ensure that you receive the highest quality of care from your optometrist. Advocate for yourself by ensuring that your routine eye exams are comprehensive and include screening for keratoconus and other sight-threatening diseases.

1. Munir SZ, Munir WM, Albrecht J. Estimated prevalence of keratoconus in the United States from a large vision insurance database. Eye Contact Lens. 2021;47(9):505-510.

2. Debourdeau E, Planells G, Chamard C, et al. New keratoconus risk factors: a cross-sectional case-control study. J Ophthalmol. 2022;2022:6605771.

Dr. Anisha Haji received her Doctorate of Optometry from Pennsylvania College of Optometry at Salus University and has particular interests in ocular disease management and specialty contact lens fittings. She owns and operates Atlanta Eye Group, which partners with LensCrafters at five locations across the city. Atlanta Eye Group was voted Best in Georgia in 2021 and 2022 and was inducted into the Kennesaw Business Hall of Fame in 2019, 2020, and 2021. Her clinic in Kennesaw has won Best Optometry Office for the past four years straight.

Dr. Haji is a strong advocate for the profession of Optometry in Georgia. She is currently the President of the Greater Atlanta Optometric Association, a Trustee and Corporate Optometry Chair of the Georgia Optometric Association, and is an active member of the American Optometric Association. Outside of work, Dr. Haji loves traveling, fine dining, and spending time with her husband and two daughters.