Abstract
Purpose :
To highlight the impact of delayed corneal cross-linking (CXL) in patients diagnosed with progressive keratoconus.
Methods :
Patients with progressive keratoconus were identified through retrospective chart review and eyes with a time interval of greater than 6 months between decision to perform cross-linking and treatment were included in analysis. Variables included in analysis were time to treatment, best corrected visual acuity (BCVA), manifest refraction, and tomographic data such as maximum keratometry (KMax) and pachymetry at the apex. A Wilcoxon rank test was used to compare measurements for statistical significance.
Results :
5 eyes of 3 patients were included in analysis. Mean time from decision to undergo crosslinking to treatment was 36±14.63 months. Reasons for delayed crosslinking included lack of insurance coverage, delayed insurance authorization, and lack of access to eye care during the pandemic. In this time interval, the mean change in manifest refraction was -6.051±5.64D (p=0.058), mean change in KMax was 3.94±6.08D (p=0.31), and mean change in pachymetry at the apex was -37.6±28.92μm (p=0.063). BCVA for 2 eyes worsened by 1 or more lines and all patients required the use of either scleral or rigid gas permeable contact lenses to achieve functional vision.
Conclusions :
Keratoconus is characterized by progressive corneal thinning and steepening, and often associated with irregular astigmatism, corneal striae and central scars. Corneal cross-linking (CXL) aims to slow progressive keratoconus, and an FDA approved CXL protocol became available in the United States in 2016. Many barriers to prompt care still exist, however, that negatively impact visual function and quality of life for patients.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.