A New Approach to Treating Keratoconus

HOT TOPIC

Study Sees Benefits of Simultaneous Therapy for Keratoconus

A recent systematic review and meta-analysis published in the American Journal of Ophthalmology suggests that combining customized photorefractive keratectomy (cPRK) with corneal collagen crosslinking (CXL) may be a superior treatment for keratoconus compared with CXL alone. The review, which included 731 eyes from 706 patients, demonstrates that the combined approach improves visual acuity, reduces corneal irregularities, and offers enhanced corneal stability.

The researchers collected eight nonrandomized studies from various sources up to September 2024. They concluded that cPRK combined with CXL significantly improved uncorrected distance visual acuity and corrected distance visual acuity while reducing refractive cylinder error. The combination therapy also reduced coma, total higher-order aberrations, coma-like aberrations, mean keratometry, and central corneal thickness.

In addressing safety concerns, the study authors found no significant progression of keratoconus in patients who underwent the combined procedure after a follow-up of at least 39 months. The simultaneous therapies also provided benefits over the sequential approach, including shorter visual rehabilitation time and improved predictability of outcomes. Additionally, no significant differences in endothelial cell count were observed between the two groups. The choice between topography-guided cPRK and wavefront-guided cPRK influenced results, with topography-guided cPRK generally being preferred for patients with pronounced anterior corneal irregularities. In contrast, wavefront-guided cPRK was more suitable for patients with thinner corneas or those at a higher risk of biomechanical instability.

The authors recommended tailoring the choice between the two techniques to the individual patient’s corneal morphology and residual stromal thickness.

My Two Cents

Talk about a two-for-one! This meta-analysis provides strong evidence that supports the use of cPRK with CXL, which combines the procedure’s effectiveness in improving visual acuity and quality while simultaneously arresting the progression of keratoconus. It even has nice long(ish) term data! I’ve already sent this study to a few of our refractive surgeons who are doing PRK and CXL. This could revolutionize CXL around the country!

OUTSIDE THE LANE

More Seniors Hospitalized This Year Due to RSV

In an article from CNN, recently released data from the CDC show that about six out of every 100,000 seniors have been hospitalized with respiratory syncytial virus (RSV). Compared with years before the COVID-19 pandemic, hospitalization rates for seniors were about 10 times lower at this point in the season.

Also commonly associated with children, RSV poses a serious threat to adults and regularly leads to thousands of hospitalizations and deaths annually. It should be noted that the FDA recently approved two RSV vaccines, Arexvy (GlaxoSmithKline) and Abrysvo (Pfizer), for adults 60 years of age and older. Both vaccines show promising results, with 88% and 85% effectiveness rates, respectively, against medically attended lower respiratory tract disease. The CDC has also endorsed these vaccines.

Could we be seeing a more contagious version of RSV? Possibly, according to Ann Falsey, MD, a professor of Medicine and Infectious Diseases at the University of Rochester Medical Center. “I think that older adults were more cautious to continue public health measures like masks and social distance last year because they were still worrying about COVID, but this year, we’re starting to see older people ending up in the hospital again with RSV, because everyone is throwing caution to the wind.”

My Two Cents

Dr. Falsey points out that patients are less concerned about social distancing and public health measures. This uptick of RSV in adults is nothing more than a typical social adjustment back to the standard practices that were occurring before the COVID-19 epidemic. However, it should certainly be monitored. As a reminder, RSV shows up in adults the same way it does in kiddos. It often looks like a common cold and includes a runny nose, decreased appetite, coughing, sneezing, fever, and wheezing. These symptoms typically run their course after a week or 2; however, in some older and immunocompromised adults, it can lead to dehydration, problems breathing, and, eventually, such serious issues as pneumonia and bronchitis.

CAN YOU RELATE

Laissez les bon temps rouler! Translation: Let the good times roll! As I write this, it’s Mardi Gras here in Louisiana, and we are fattening ourselves up with various flavors and types of king cakes and other sweets. A king cake is a sweet, circular pastry associated with Mardi Gras, often decorated with colorful icing and sugar in purple, green, and gold. Traditionally, a small plastic baby is hidden inside, and the person who finds it in their slice is expected to provide the next cake. The cakes are a way to celebrate Mardi Gras, which is the last day before the Christian season of Lent (40 days of fasting, prayer, and penance starting on Ash Wednesday and ending on Easter Sunday to commemorate the time Jesus spent fasting in the desert).

What does any of this have to do with optometry and eye care? Well, nothing, except that I was raised to give up something or make a conscious effort to do something each day during Lent.

This year, I plan to give up eating fast food, work out at least four times each week, and tell my staff daily how much I appreciate something they do for me. I would encourage everyone reading this to think about something you could do every day for the next month to improve yourself emotionally, professionally, or socially. How about starting each morning with a hearty “good morning” to each of your staff members? Or avoiding political talk with your friends and relatives? What about committing to getting a good and healthy lunch each day? Or striving for 8 hours of sleep each night? Or how about dedicating 10 minutes to meditation at the end of the workday?

Consider these next 40 days a small “boot camp” to do something you may have regretfully stopped doing or to create a new healthy habit!

QUOTE OF THE WEEK

“Lent is a time of going very deeply into ourselves... What is it that stands between us and God? Between us and our brothers and sisters? Between us and life, the life of the Spirit? Whatever it is, let us relentlessly tear it out, without a moment’s hesitation.”

— Catherine Doherty, Russian writer