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EW SHOW DAILY 46 Meeting Reporter Saturday, April 18, 2015 by Ellen Stodola EyeWorld Staff Writer a variety of different pathological processes," Dr. McGhee said. Most people adhere to the idea of a 2-hit hypothesis, he said, that one factor is genetic and there is a second element. The estimation of the prev- alence of keratoconus varies in reported studies but is thought to be between 8.8 and 54.4 per 100,000. This variation is due to different diagnostic criteria, differing genetic predisposition, and differing expo- sure to co-factors. Physicians are aware of the com- mon techniques for diagnosis, Dr. McGhee said. There are well-estab- lished options for diagnosis like slit lamp and keratometer, refraction, and placido disc imaging. There are also some more contemporary options like using topography or tomography, higher order aberrom- etry, biomechanical assessment, in vivo confocal microscopy, or anterior segment OCT. Topography is a tool that has been used for kera- toconus since 1990, he said. Addi- tionally, indices have been evolving in tomography parameters used for keratoconus. Dr. McGhee discussed the usefulness of screening for keratoco- nus. He said that screening of a population is not yet viable. "It's a relatively low prevalence disease," he said. However, screening of family members of those with ker- atoconus may be useful and could potentially halt the disease progres- sion. Studies suggest that there is a variable inheritance in families, but the exact percentage of those who inherit the predisposition to the dis- ease remains unknown, he said. For those with a prognosis of keratoconus, Dr. McGhee said that the disease usually commences in late puberty. This is often followed by gradual, rapid, or intermittent progression over 10–40 years. In 15–20% of cases, a transplant may be required. "Remember, it never sleeps," Dr. McGhee said about keratoconus. "In New Zealand, we found the highest indication for any keratoplasty is keratoconus." "The movement now is very much to prevent progression of the disease," he said. However, one of the problems with the evidence of keratoconus is that a lot of it is retrospective. Dr. McGhee discussed deep an- terior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) as options for the treatment of keratoconus. He also highlighted some possible future options for the treatment of keratoconus, including the injection of keratocytes into keratoconic tissue. In his conclusion, Dr. McGhee offered conservative, intermediate, and advanced options for dealing with keratoconus. For those with stable or minimal progression with a good BSCVA, spectacles or contact lenses could prove effective, with the possibility of adding crosslink- ing. The intermediate treatment options for confirmed progression of keratoconus included crosslinking with spectacles or contact lenses or possibly intrastromal segments or keratorefractive surgery. And for patients with advanced keratoconus with poor BSCVA, a treatment like DALK, PK, a phakic or toric IOL, or other options may be necessary. A straightforward approach is needed, he said. EW Editors' note: Dr. McGhee has no related financial interests. Keratoconus prevalence, diagnosis, prognosis, and treatments highlighted D uring the World Cornea Congress session focusing on keratoconus, ectasias, DALK, and other lamellar grafts, Charles McGhee, MD, Auckland, New Zealand, gave the keynote talk, titled "Treatment Paradigms in Keratoconus." He high- lighted evidence in keratoconus that helps to guide management, current treatment paradigms, future options, and conclusions on the treatment management paradigm. We've been talking about ker- atoconus for 250 years, but it went by many different names, he said. It was in 1844 that Pickford gave a cautionary note about this poorly understood disease, and it was in 1854 that it was first fully described by Nottingham, he said. More than 150 years later, Dr. McGhee said some of the major points known about keratoconus are that it is a progressive corneal ectasia, it is associated with increasing irregular astigmatism, there is possible scar- ring and hydrops, there are genetic and environmental causes, and there is no curative treatment. However, the exact cause of keratoconus remains unknown. The etiology could be multifactorial. "It may be a final common pathway for 'Keratoconus, Other Ectasias, Deep Anterior Lamellar Keratoplasty, and Other Lamellar Grafts' I n addition to Dr. McGhee's keynote address, "Treatment Paradigms in Keratoconus," these physicians spoke on the following topics: • Renato Ambrosio, Jr., MD, Rio de Janeiro, Brazil, spoke on "Keratoconus Terminology and Differential Diagnosis: Why Current Criteria are Inadequate." • Deborah S. Jacobs, MD, Needham, Mass., spoke on "Contact and Scleral Lenses in the Management of Keratoconus." • Paolo Vinciguerra, MD, Milan, Italy, spoke on "Crosslinking for Corneal Ectasia: Present and Future." • Luis Izquierdo, MD, Rome, spoke on "Corneal Implants for Ectasia: Indications and Outcomes." • Luigi Fontana, MD, PhD, Bologna, Italy, spoke on "Needle and Cannula Deep Anterior Lamellar Keratoplasty: Standard Technique, Outcomes, and Long-Term Graft Survival." • David S. Rootman, MD, Toronto, spoke on "Deep Anterior Lamellar Keratoplasty Management of Complications: You Don't Always Have to Convert." • Rajesh Fogla, MD, FRCS, Hyderabad, India, spoke on "New Frontiers for Deep Anterior Lamellar Keratoplasty." EW Dr. McGhee delivers his lecture on the treatment paradigms in keratoconus.

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