AOA 2026: The latest updates in keratoconus treatment advancements

Clark Chang, OD, MSA, MSc, FAAO, specialty lens director in the Corneal Service at Wills Eye Hospital and senior director of Medical and Surgical Operations at EssilorLuxottica, provided a focused update on emerging developments in keratoconus management, highlighting both procedural advances and potential pharmacologic innovations.

He began by revisiting data presented at ESCRS 2025 from a collaborative study with Australian investigators on topography-guided, epi-on corneal cross-linking in progressive keratoconus. While conventional epi-on cross-linking with oxygen supplementation has recently gained FDA approval, this approach introduces a more tailored energy delivery pattern. Rather than applying a uniform ultraviolet (UV) treatment field, the protocol modulates UV energy based on corneal topography—concentrating higher energy over the presumed biomechanically weaker area near the cone apex and tapering outward. Patients with progressive keratoconus were followed for up to 24 months, with outcomes assessed via best-corrected visual acuity, higher-order aberrations, corneal tomography, and corneal biomechanics. Although both the biomechanical device and the topography-guided cross-linking platform are not yet available in the US, the results were favorable: despite an epi-on technique, corneal stability was maintained in this progressive cohort, supporting topography-guided epi-on cross-linking as a promising future option.

Chang then addressed the broader question of less invasive treatment modalities, including the concept of treating keratoconus with an eye drop. He references an early, open-label, proof-of-concept dual-arm study in Australia involving a topical agent reportedly containing transforming growth factor beta 3 (TGF-β3) and demethasone. TGF-β3 is thought to up-regulate collagen production, potentially promoting healthier collagen fiber formation with more robust intermolecular bonding, thereby increasing corneal rigidity and halting disease progression. While still very preliminary, this line of research may represent an important future avenue for non-surgical keratoconus management.

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In addressing what patients misunderstand about keratoconus when first diagnosed, Chang emphasized the importance of patient education and psychosocial support. He noted a recurring and troubling theme: many patients internalize blame after learning about the association between eye rubbing and keratoconus, experiencing significant guilt over past behaviors. Chang stressed that while minimizing eye rubbing and managing contributing factors (such as allergy, dry eye, and other ocular surface disease) is essential, clinicians must clearly communicate that keratoconus arises from a complex interplay of genetics and environment. The goal is to encourage protective behaviors without making patients feel that they have “caused” their own disease. Chang closed by encouraging continued dialogue and future engagement on evolving keratoconus therapies.