Children and adolescents with keratoconus may have rapid progression between the ages of 8 and 19 years and immediate treatment with corneal crosslinking may stop that progression.
Geneva, Switzerland—Ophthalmologists have struggled with decisions about whether to treat subpopulations of patients with keratoconus differently from the currently accepted approach.
The answer may be “yes,” based on a study that found that the vast majority of children and adolescents aged 8 to 19 years have rapid keratoconic progression after the initial diagnosis is established. To avoid this, immediate treatment may be required.
When corneal crosslinking (CXL) technology was first introduced, clinicians approached its use conservatively.
“When CXL initially began to be used, we always determined that the patient was progressing before CXL was applied to be sure that an emerging technology was used carefully to avoid unnecessary complications,” said Farhad Hafezi, MD, PhD, who was part of the Swiss team that developed the first CXL device.
“However, it is now time to re-visit this strategy considering that CXL is used clinically in more than 100 countries worldwide,” said Dr. Hafezi, professor and chairman, Department of Ophthalmology, Geneva University Hospital, Geneva, Switzerland, and clinical professor of ophthalmology, Doheny Eye Institute, University of Southern California, Los Angeles.
Progression was defined as an increase of more than 1 D of Kmax of the anterior corneal curvature within a 12-month period.
Keratoconus can progress extremely rapidly in young patients and reported a 4-diopter progression in a 15-year-old boy over a period of 12 weeks, he noted.