IKA Keratoconus Symposium to bring "best of the best"

This spring, there is more to look forward to than just warmer weather. The International Keratoconus Academy (IKA) is holding its second annual Keratoconus Symposium, running from May 18 and 19 in Bethesda, Maryland. IKA President and Cofounder Andrew S. Morgenstern, OD, FAAO, FNAP sat down with Optometry Times to detail what's to come at this year's event, as well as shed light on keratoconus and technological advancements to aid in treatments and diagnosis.

One of the studies that will be detailed during the IKA Keratoconus Symposium, entitled "Prevalence of keratoconus based on Scheimpflug corneal tomography metrics in a pediatric population From a Chicago-based school age vision clinic," is coauthored by Morgenstern and was led by first author Jennifer Harthan, OD. Published online in February, following the recording of this interview, the study found a significantly higher prevalence of keratoconus in children than was previously reported. The prospective observational study used Scheimpflug corneal tomography on children ages 3 to 18, with 2206 participants recorded. In light of this finding, the researchers emphasized the importance of sensitive screening for keratoconus as standard in pediatric comprehensive eye exams.¹

Video transcript

Editor's note - This transcript has been edited for clarity.

Emily Kaiser Maharjan:

Hi everyone. I'm here with Dr Andy Morgenstern, president and co founder of The International Keratoconus Academy, or IKA, and cochair of the upcoming IKA Keratoconus Symposium, which will be in Bethesda, Maryland. Welcome Dr Morgenstern, I'm really excited to have you here.

Andrew S. Morgenstern, OD, FAAO, FNAP:
Thank you so much for having me. This is great.

Kaiser Maharjan:
Yeah. So can you tell us a little bit about how keratoconus care has changed over the years?

Morgenstern:
Yeah. I mean, it's a great question to start off with, because the reason why we want to have this keratoconus symposium is because how keratoconus care has really changed over the years and really keratoconus diagnostics, which we'll get into in a little bit. But really, keratoconus in the old days, when I was going to school, was a condition that obviously it's unfortunate to have the disease, but if you did, it was let's get you into some hard rigid contact lenses typically, and let's just cross our fingers that you're not part of that 10-ish percent population that requires a corneal transplant, and then has to live with human-transplanted tissue on your eye for the rest of your life.
So now, obviously, while it is no pleasure to have that condition by any means, and if you look on patient-facing social media sites that patients that do have keratoconus, they've complained, obviously, all the time; it's really significant quality of life issue, but it is much more manageable with our newer medical scleral contact lenses, with early detection, with cross-linking treatment to stop the progression, and quite a few other things and really better understanding by the medical community. I do want to say, on behalf of lots of groups, but a lot with IKA. We've done our job, which was increasing awareness of the disease to both doctors and patients.

Kaiser Maharjan:
Yeah, of course. So IKA is the International Keratoconus Academy. Are there therapies outside of the US that you'd like to see make their way over here?

Morgenstern:
You know, it's funny, I used to think about international being some other magical land on the other side of the ocean that we never get to interact with. The reality is, is that we do interact with these, these doctors and these patients on a very frequent basis, and there are different technologies in different parts of the world and at different phases in their development. Of course, anything that's an advancement on what it is right now, whether it be moving from Epi-Off to Epi-On cross-linking, there are devices outside of the United States where there are cross-linking devices that are mountable right onto the slit lamp so you can treat your patient right at the slit lamp. I'm sure there's going to be other eye drop technologies that I know that they're in the works right now. We hope that those techniques and technologies get better. Really, at the end of the day, all any of us want, whether we're a doctor or a patient, is for the patient to be identified as early as possible, treat it as effectively as possible, so they can kind of move on with their life and forget that they have keratoconus. Whenever technology does it, we're waiting for it, but I know that there's quite a few things in the works. I would love to see that tabletop cross-linking device. There's gonna be many manufacturers that develop or modify what they have as technology changes, and it'll be just more accessible to patients and easier for doctors to provide that treatment.

Kaiser Maharjan:
Yeah, that sounds really, really cool. I'm really excited to hear more about that, too. So what technologies or treatment modalities do you feel are under utilizing in keratoconus care today?

Morgenstern:
If we can change the word treatment to diagnostic, I think that would be really the most important feature to look at because what we've learned through our own study [Prevalence of keratoconus based on Scheimpflug corneal tomography metrics in a pediatric population from a Chicago-based school age vision clinic] that's gonna be coming out really soon in eye-in contact lens on the pediatric prevalence of keratoconus, (we're going to be highlighting it at the conference,) the data is really remarkable in how high the prevalence is. Really, it's detection, and it's early detection, because we know that we have a treatment. The technology that I want, if I can snap my fingers and make it available in everybody's practice is, you know, the best possible technology to identify the disease in a patient as early as possible, so we can start treatment as early as possible. I know, it's not the end of the question that you asked, but I'm going to reroute it a little bit and tell you that that's really the the end game with this disease.

Kaiser Maharjan:
I think it's an acceptable rerouting. I think that that's an important one.

Morgenstern:
As long as I get permission from you, right?

Kaiser Maharjan:
So you are very very passionate about keratoconus and IKA. What is it about this disease that fuels this passion?

Morgenstern:
I really got my start with keratoconus in optometry school. I had amazing professors. They know who they are, they're all great at what they did. I learned a ton and I got to become a pretty decent optometrist because of them. But I had one in particular, her name was Heidi Wagner. Dr Wagner was my cornea contact lens and clinic professor, and at the time I was in school at Nova Southeastern University, she was actually a principal investigator for the CLEK study the collaborative longitudinal evaluation of keratoconus, which was a landmark study. I got to observe that clinical trial, so I learned a ton and I got really excited about keratoconus from there and ultimately, I went into the world of refractive surgery. In refractive surgery when when I started, we we did not have a Pentacam Scheimpflug camera that looked at the backside of the cornea. I was there early in refractive surgery; we had a lot of corneal ectasia cases, and we didn't really know how to diagnose keratoconus the right way and we didn't know how to identify it the right way because we didn't have the right technology, not because we did anything wrong. We just didn't have the best technology that we could have had at the time. Some of those patients that were clear on a corneal topography got through to the operating room, had the procedure, and ended up with a condition called post-refractive surgery corneal ectasia, and that was a problem. It still is a problem, and those patients suffer and we want them to get better, obviously, as quickly as possible.

But we also these days don't want to let those patients get into the operating room in the first place because we have plenty of other options for them. That said, I got my first Pentacam, which is really the gold standard device for identifying keratoconus at its earliest phase, in 2005. I was probably one of the first people in the country to get a Pentacam. Right from the get-go, we were like, "Oh my gosh, I can't believe how many keratoconus suspects there are. I can't believe that there's nothing identifiable on the front surface, but on the back surface, we can easily see the disease." It really changed how we look at the cornea. So that's what got my spark going because we really started learning to see the cornea in a whole different way. That spark for keratoconus was really what led you know, me and Barry [Eiden] and a couple of others to really put together this organization, the IKA, because the technology was completely outpacing the education. Technology was coming out faster than we can educate students and other doctors, so we wanted to provide that resource. That's why we found that IKA, to get that information out to as many people as possible so they can help their patients as quickly and as easily as possible, and effectively as possible because again, at the end of the day, this whole disease, everything that we're talking about is about early identification, treatment, prevention of progression of the disease, and improving quality of life for patients.

Kaiser Maharjan:
Absolutely, and your passion for keratoconus patients for IKA is palpable every time I talk to you.

Morgenstern:
We're trying so hard, you know, we really want to get the message out because we can make a difference. We know how prevalent this condition is. It's a lot more prevalent than a lot of people think it is, and quite frankly, it's a lot more prevalent in populations that we didn't think of before, like the pediatric population.

Kaiser Maharjan:
Shining a light on that education component at the IKA Keratoconus Symposium this year, what do you have lined up that you're really excited to share?

Morgenstern:
What you know, what am I gonna say? It's the best of the best of the best, right? But, you know, because this disease is so important, we really took a different look at developing our conference. What we said was, "Look, you know, let's get our experts in a room, let's talk to them. Let's see, if we were going to make a conference about a disease, what different phases of the disease and what different parameters and aspects of the disease that people need to know about." So we set up our agenda first, and then we said, "We know that these are the things that need to be talked about. Now let's go get the best speakers that we can find on this particular topic." And that's what we did.

So we have a very well rounded approach to learning about the disease of keratoconus, whether you're a beginner or an expert. There's gonna be tons of stuff for you to learn. The speakers that we have, the ophthalmologists and optometrists are from major, major academic institutions like the O'Brien Institute [for Public Health,] to Duke [Department of Ophthalmology,] Bascom Palmer Eye Institute, [University of Miami Health System,] Case Western Reserve, University of Iowa, and it's really optometry and ophthalmology friendly. Every session we we have an OD and an MD working together because that collaborative care is how this disease gets managed the best way possible. There is no optometric-only keratoconus or ophthalmology-only keratoconus. It's a continuum of care because some of our patients end up surgical and some of our patients do not. Patients don't get to decide that, that disease does that for us, and so we have to be on our toes and have the best information possible to help make that proper diagnosis and treatment plan. If it goes one way down the surgical route, we've got that education for you. If it goes down the route of nonsurgical, we've got that education for you as well.

There's a combination of both because sometimes, almost all the time, the surgical patient ends up becoming a nonsurgical medical contact lens patient after they have their surgery. So both of these teams have to work together. That's the way we built our curriculum for the course. It's live, we would love for you to come live. It's a much better experience in-person, in my opinion, and you'll get to really collaborate with the other attendees and especially the presenters that are there. It's online as well, if you need to do that route, great. We encourage you to come via online.

Kaiser Maharjan:
Alright, fantastic. Is there anything else that you want to add that we haven't touched on?

Morgenstern:
Bethesda is the best location in the world to come to a conference, right, and there's not many conferences in our area, but I do want to let the audience know that we have 3 airports that serve the area: [Baltimore/Washington International Thurgood Marshall Airport, or] BWI, [Ronald Reagan Washington National Airport or] DCA and IAD, or Dulles. We are right down the street from NEI [National Eye Institute, and the] Walter Reed National Library of Medicine. It's a medical hub where we are.

The venue is great, the rooms are cheap, there's a great shopping district steps away from it with great restaurants and all that kind of stuff. It's a great place to bring your family. There's a metro, which is our Washington DC subway system, which is about a 3 minute walk from the hotel if you want to go downtown, see the monuments over here, like the Washington Monument. It's a great time of year, it's in the spring in Washington DC. Bring your allergy medicine because we got a lot of pollen, but other than that, it's a great time to be in Washington.

Kaiser Maharjan:
Alright. Well, thank you so much for chatting with me today, Dr Morgenstern. It's been a pleasure to pick your brain about keratoconus and I'm really excited to hear more about the upcoming IKA Keratoconus Symposium.

Morgenstern.
Excellent. We're all looking forward to seeing everybody there.

Reference

Harthan JS, Gelles JD, Block SS, et al. Prevalence of keratoconus based on Scheimpflug corneal tomography metrics in a pediatric population from a Chicago-based school age vision clinic. Eye Contact Lens. 2024 Mar 1;50(3):121-125. doi: 10.1097/ICL.0000000000001072