Hear how the Clek study continues to play a role in today's keratoconus care.
Susan Gromacki, OD, MS, FAAO, FSLS, sat down with Optometry Times®' assistant managing editor Emily Kaiser Maharjan to give an overview of her 2023 American Academy of Optometry meeting presentation, "TD (AS)-09: CLEK at 20: How Optometry’s First NEI Multicenter Study Impact our KC Practices Today." She shared the stage in New Orleans with Louise Sclafani, OD, Karla Zadnik, OD, PhD, and Loretta Szczotka-Flynn, OD, PhD.
Editor's note: This transcript has been edited for clarity.
Emily Kaiser Maharjan:
Hi everyone. I'm sitting down with Dr. Susan Gromacki, who present "How Optometry’s First NEI Multicenter Study Impact our KC Practices Today" at AAOpt in New Orleans. Welcome Dr. Gromacki. Thanks for joining me so much.
Susan Gromacki, OD, MS, FAAO, FSLS:
Thanks for having me.
Of course we're so happy to have you here. First, can you tell us a little bit about your presentation?
Sure. So it was a pleasure to present with such giants in our field and especially in the area of keratoconus. So we had 4 female presenters.
Louise Sclafani, OD, was the moderator. Karla Zadnik, OD, PhD, was our principal investigator representative; she was one of the original PIs of Clek. And then we had Loretta Szczotka-Flynn, OD, PhD, who served as one of the site directors.
And myself, who, I actually was the only employee of Clek back in the days where it was still in the planning grant, and I was actually an optometry student, so I presented it from that perspective. And then I also gave the perspective of a clinician in this day and age because I continue to see keratoconus patients all day every day, and serve them on a very clinical level.
Fantastic. What are some key takeaway points that you want optometrists to take home with them?
Dr. Zadnik presented the findings from Clek. We had it organized by subject matter. So she would present things like the demographics of the study. And for example, the genetic correlations, obviously collected and performing genetic testing, but things like at the onset of Clek, there were over 13% of Clek's subjects who reported a family member or very close family member with a history of keratoconus. And by the end of the study, by the end of the 8 years, that number was up to 17%.
And she mentioned that it could have been because these patients became more aware of their keratoconus, so they may have asked, but it could also just be that perhaps the prevalence wasn't quite known at the beginning. So that was an interesting point.
Then Dr. Szczotka-Flynn went on and talked about what we do know about the genetics of keratoconus, current studies, current testing, things like that, certain populations having higher percentages of keratoconus patients than others; really fascinating stuff.
Yeah, absolutely. And how do the results of this study translate into patient care?
So that was my job was to talk about current keratoconus management. And I basically talked about things like how we fit contact lenses in this day and age. And I did tell the audience that Clek 100% impacted how I practice in fitting contact lenses because one thing that came out of the Clek study, and this was based on [Donald R. Korb, OD, FAAO]'s study years ago in the 1980s, where he found that if corneal GP lenses were fitted too flat, they could cause scarring of cornea.
Now the Clek study—and this was highly emphasized by Dr. Zadnik because this is very important—it was an 8 year observational study, so there was no cause and effect here. But the Clek study, too, did find out that these patients who were fitted not by Clek doctors, but by the doctors that referred them in for the study. And she also pointed out that Clek, investigators did not change the way contact lenses were fit, they merely were observing.
[Zadnik] pointed out very clearly that Clek was an observational study. But with that said, the patients that were fitted flat did tend to have more scarring over that 8 year period than the ones that were fitted without an apical touch. So I related this to my practice how, yes, we still do fit corneal GP lenses, but many of our colleagues have moved into fitting scleral lenses for exactly that reason. It is protective to vault the cornea, rather than push on the cornea, if the patient has known keratoconus.
That's very interesting. And in your opinion, what is the future of treatment for keratoconus?
Certainly corneal collagen cross linking is something that we should all consider, and we should consider it very early, because we know that this is a procedure which can arrest the progression of the disease. So this is very important for all ODs and ophthalmologists, and anyone involved with seeing patients of any kind to diagnose keratoconus early so that we can recommend them for that sort of treatment.
Fantastic. Is there anything else you want to touch on that we haven't talked about yet?
I just want to say I had a blast sharing the stage with these 3 icons of keratoconus and I would love to do it again.
Fantastic, thank you so much for taking the time to chat today, Dr Gromacki, it's been a pleasure.
Oh you're welcome, anytime.