CCS 2025: Identifying keratoconus in patients through successful comanagement

Presentations that Peter Hersh, MD, gave at the Collaborative Care Symposium (CCS) 2025 on May 31 focused on keratoconus, a progressive corneal disease that requires early detection and specialized management. He spoke on keratoconus and complex refractive surgery and corneal cross-linking with John Gelles, OD, FAAO, and Steven Greenstein, MD.

Hersh emphasizes the critical importance of identifying keratoconus in younger patients, particularly those diagnosed in their early teens, who are most likely to experience rapid disease progression. Primary eye care providers should be vigilant in screening for keratoconus, recognizing that it is more prevalent in younger populations compared to conditions like glaucoma or retinal disorders. Key diagnostic indicators include patients whose vision cannot be corrected to 20/20 through standard refraction, unusual astigmatism patterns, and irregular keratometric measurements. Advanced diagnostic tools are crucial in identifying keratoconus. Corneal topography and tomography are considered the gold standard for diagnosis, allowing practitioners to detect subtle corneal changes that might indicate the disease's onset. Hersh strongly recommended thorough screening when standard vision correction methods prove ineffective. Interdisciplinary collaboration is paramount in managing keratoconus.

Optometrists, ophthalmologists, and surgeons must work together to ensure comprehensive patient care. This collaborative approach is especially critical for early intervention strategies like corneal cross-linking, which can significantly improve patient prognosis when implemented early. Long-term patient management is another crucial aspect discussed. Keratoconus patients require ongoing monitoring, typically with yearly examinations. Contact lens fitting remains a primary treatment modality, and patients will need specialized care throughout their lives. As patients age, additional challenges emerge, such as difficulty managing contact lenses and preparing for potential procedures like cataract surgery. Hersh highlighted emerging innovative treatments that can enhance patient outcomes, including CTAK and topography-guided PRK. These techniques can improve corneal curvature and optical focus, offering new hope for patients as they navigate the complexities of keratoconus across different life stages.

Ultimately, Hersh underscored the need for heightened awareness, early detection, continuous education, and collaborative medical approaches to effectively manage keratoconus and improve patients' quality of life.