Longitudinal Changes in Corneal Curvature in Keratoconus

McMahon, Timothy T.; Edrington, Timothy B.; Szczotka-Flynn, Loretta; Olafsson, Harald E.; Davis, Leverett; Schechtman, Kenneth B.

doi:10.1097/01.ico.0000178728.57435.df

Cited by 121 publications

(93 citation statements)

References 15 publications

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“…27 Because of the convincing positive results in the first clinical study of collagen crosslinking, 24 comparison with a control group was ethically unacceptable. This is especially true in light of the Collaborative Longitudinal Evaluation of Keratoconus Study, 22,[28][29][30] which found a significant decline in vision within 8 years, an increase in astigmatism and corneal curvature, subepithelial scarring, and corneal thinning in untreated keratoconic corneas.…”

Section: Discussionmentioning

confidence: 97%

Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: Long-term results

Raiskup-Wolf¹,

Hoyer²,

Spoerl³

et al. 2008

Journal of Cataract and Refractive Surgery

870

641

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Section: Discussionmentioning

confidence: 97%

Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: Long-term results

Raiskup-Wolf¹,

Hoyer²,

Spoerl³

et al. 2008

Journal of Cataract and Refractive Surgery

870

641

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show abstract

“…Younger age and poorer high-contrast, manifest refraction visual acuity at baseline predicted an increased rate of change in corneal curvature (Table 3). [24] Of the 878 patients with at least one unscarred cornea at baseline, the five-year incidence of corneal scarring was 14% (120 of 878) overall, 17% (102 of 609) for contact lens-wearing eyes, and 38% (46 of 121) for contact lens-wearing eyes with corneal curvature greater than 52 D. Multivariate analyses of five-year prospective data from the CLEK Study cohort showed that younger age, baseline corneal curvature, contact lens wear, and corneal staining were predictive of incident corneal scarring (Table 4). [25] The eight-year incidence of penetrating keratoplasty was higher (15%) among patients less than 40 years old compared to patients 40 years old or older (8%).…”

Section: Longitudinal Findingsmentioning

confidence: 99%

Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study: Methods and findings to date

Wagner

Barr

Zadnik

2007

Contact Lens and Anterior Eye

280

205

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Purpose-To describe baseline and longitudinal findings of the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study.Methods-The CLEK Study is an eight-year, multi-center, natural history study of 1,209 patients with keratoconus who were examined annually for eight years. Its goals are to prospectively characterize changes in vision, corneal curvature, corneal status, and vision-specific quality of life.Results-CLEK Study subjects had a mean age at baseline of 39.3 +/− 10.9 years. At study entry, 65% of the patients wore rigid contact lenses, and 14% reported a family history of the disease. Subjects exhibited a seven-year decrease in high-(2.03 letters) and low-(4.06 letters) contrast, best-corrected visual acuity, with 19% demonstrating decreases of 10 or more letters in high-contrast, best-corrected acuity and 31% of subjects demonstrating decreases of 10 or more letters in low-contrast, best-corrected acuity in at least one eye. Subjects exhibited an average eight-year increase in corneal curvature of 1.60 D in the flat corneal meridian, with 24% demonstrating increases of 3.00 D or more. The eight-year incidence of corneal scarring was 20%, with younger age, corneal staining, steeper baseline corneal curvature, contact lens wear, and poorer low-contrast visual acuity predictive of corneal scarring. Data from the National Eye Institute Visual Function Questionnaire suggest that the effect of keratoconus on vision-specific quality of life is disproportionate to its low prevalence and clinical severity.Conclusion-Although we report measures of disease severity and visual function across the CLEK sample, clinicians can begin to envisage the course of keratoconus in individual patients by determining whether factors predictive of disease progression are present in those patients.

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“…Factors predictive of an increased risk of disease progression in keratoconus include young age (r35 years), steep keratometry, high astigmatism, reduced CDVA (irregular astigmatism), ethnicity other than white European, and documented progression in the contralateral eye. [37][38][39] These risk factors for disease progression are often present at presentation, and may be compounded if further disease progression is allowed to occur. Based on this, the proven efficacy of CXL, 14,18,19,21,22 the higher risk of CXL-related visual loss aged 435 years, 22 and the relative safety of transepithelial treatment, 33,34 we believe that there is a rational argument for transepithelial CXL at presentation for patients r35 years of age with keratometric stage II disease (Figures 2 and 3).…”

Section: Transepithelial Crosslinkingmentioning

confidence: 99%

New clinical pathways for keratoconus

Gore

Shortt

Allan

2012

Eye

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Pre-2000, the clinical management of keratoconus centred on rigid contact lens fitting when spectacle corrected acuity was no longer adequate, and transplantation where contact lens wear failed. Over the last decade, outcome data have accumulated for new interventions including corneal collagen crosslinking, intracorneal ring implantation, topographic phototherapeutic keratectomy, and phakic intraocular lens implantation. We review the current evidence base for these interventions and their place in new management pathways for keratoconus under two key headings: corneal shape stabilisation and visual rehabilitation.

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Longitudinal Changes in Corneal Curvature in Keratoconus

Abstract: CLEK patients exhibited a slow but clear increase in corneal curvature. Younger age and poorer high-contrast manifest refraction visual acuity at baseline predicted the rate of change in corneal curvature.

Cited by 121 publications

References 15 publications

Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: Long-term results

Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: Long-term results

Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study: Methods and findings to date

New clinical pathways for keratoconus

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