Refractive
April 2022
by Vance Thompson, MD
Refractive Editor
In EyeWorld, we aim to educate in a way that helps all of us in eyecare bring our very best to our patients. If there was ever a top 10 list of issues on which eyecare as a whole could “up its game,” it should include the fact that we all need to be more aggressive about educating patients on the fact that they can create their own self-induced keratoconus by repetitive pressure on their eyes. We also need to be more aggressive about screening for keratoconus.
This is one of the major issues we deal with in eyecare today and is a totally preventable cause of vision loss; we owe it to patients to be as consistent with keratoconus screening and monitoring as we are with glaucoma.
Keratoconus vision loss has many similarities to glaucoma vision loss. Much of glaucoma vision loss, like keratoconus, is preventable. Initial glaucoma screening is a routine part of an eye exam, and if diagnosed, repetitive monitoring is recognized by eyecare as very important; as a result, a lot of glaucoma is caught and treated before irreversible damage to eyesight happens. The amount of vision loss from delayed diagnosis of keratoconus continues to be much too high. Too many patients lose best spectacle-corrected vision prior to being asked if they rub their eyes, a corneal topography being performed, and genetic screening being considered. Thank you to Brandon Baartman, MD, and Michael Greenwood, MD, for contributing to the article on “Greater awareness needed about impact of eye rubbing.” Patients often do not realize they can change their own prescription with eye rubbing and damage their eyes. It is amazing to me how often a patient says they do not rub their eyes, then the second time they are asked, they say, “I rub them more than I realized.” This is one of the major issues we deal with in eyecare today and is a totally preventable cause of vision loss; we owe it to patients to be as consistent with keratoconus screening and monitoring as we are with glaucoma. Eye rubbing and pushing their eyes into a pillow is a checkbox yes or no part of our exam form for every patient. Please ask every single one of your patients.
Thank you to Eric Donnenfeld, MD, and Elizabeth Yeu, MD, for contributing to “The value of genetic testing for keratoconus.” This is a very worthwhile read about a technology that we are using in our practice more and more to supplement diagnostics when trying to figure out relative keratoconus risk so that we can crosslink the patient early and hopefully prevent irregular astigmatism, reduced best spectacle- corrected vision, and permanent vision loss, or prevent a corneal refractive procedure that could accelerate keratoconus.
Finally, I want to thank Bryan Lee, MD, JD, Luke Rebenitsch, MD, and William Wiley, MD, for contributing to “How refractive procedures impact future implant choices.” This is an important article for doctors who educate patients on corneal refractive surgery and how each option impacts future implant decisions in certain ways for when it is time for lens replacement.
This is an exciting issue of EyeWorld, and I trust you will enjoy these articles as much as I did. Thank you for being on this journey with us.
