ASCRS News
April 2022
by Eric Donnenfeld, MD
Chief Medical Editor
I always arrive at the ASCRS Annual Meeting excited about the new technologies, mesmerized by the quality of education, and more passionate than ever about being an ophthalmologist. In this issue of EyeWorld, the official member publication of ASCRS, we highlight multiple areas of interest, including a number of sessions to be presented at the Annual Meeting that should not be missed. This issue of EyeWorld also has the true experts in the field educating us on diverse and important topics such as comanagement, IOL power misses, unhappy patients after cataract surgery, eye rubbing, how refractive procedures impact future implant choice, cyclodialysis clefts, SLT, pediatric MGD, varenicline, rosacea, and more. This is quite a diverse collection of topics to read about.
I think one of the most important topics in this issue is the subject of keratoconus. I would like to take a moment to write about the quiet advances in keratoconus management that have taken place over the last 2 decades. The diagnosis, prevention, and treatment of keratoconus is a testimonial to innovation and meeting unmet needs. As a corneal specialist, I have helplessly watched from the safety of my slit lamp as thousands of patients develop keratoconus and slowly progress from glasses to rigid contact lenses then on to corneal transplantation. These patients are generally young, in their teens and early 20s, and they become visually handicapped while I sit by unable to intervene as corneas continue to steepen. Every year, I try to salvage the ruptured globe of a young patient who experienced ocular trauma months, years, and even decades following a penetrating keratoplasty for keratoconus.
The incidence of keratoconus is becoming epidemic. We are now aware that keratoconus induced by eye rubbing, often associated with obesity and sleep apnea, is increasing dramatically. The latest estimates suggest that 1 in 200 of our patients have keratoconus. A decade ago, in 2012, 7,405 Americans required a penetrating or lamellar keratoplasty for keratoconus. In 2019, this number decreased to 2,737. What is responsible for this remarkable decrease in keratoplasty for keratoconus while the incidence is increasing? I think that it is multifactorial. First of all, we are better able to diagnose the disease with improved diagnostic tests such as topography, tomography, posterior corneal steepening, epithelial mapping, and hysteresis. Diagnosing keratoconus is important, but treatment of this disease to prevent progression with riboflavin UV crosslinking when it was approved by the FDA in 2016 was the landmark event that changed everything.
Despite the FDA approval of riboflavin UV crosslinking, we continue to perform thousands of corneal transplantations for this disease on a yearly basis. I routinely see patients referred for initial corneal evaluation when they have keratometries in the 60s and will require a rigid contact lens or surgery. We need to do a better job of diagnosing keratoconus earlier and knowing which patients are at risk. The etiology of keratoconus is multifactorial, but the latest innovation for recognizing patients who have a high-risk profile is a simple buccal swab DNA test from Avellino that analyzes multiple genetic markers. Now patients with family histories, high cylinder, irregular topography, and thin pachymetry can have another data point that supports following them more closely or can be the deciding factor in when to do crosslinking. Hopefully one day soon, with the aid of crosslinking and better diagnostic testing, we will eradicate the need for corneal transplantation for keratoconus. I am very much looking forward to that day.
Article Sidebar
ASCRS Annual Meeting by the numbers
- 4 General Sessions
- 22 symposia
- 91 courses
- 30 skills transfer labs
- 950+ papers and posters
- 170 films and the 40th ASCRS Film Festival
- 3 Subspecialty Day programs
- 5 ASCRS Satellite CME programs
- 200+ companies in the ASCRS Exhibit Hall
*Numbers subject to change
