Did We Underestimate Pediatric Keratoconus?

HOT TOPIC

Keratoconus More Prevalent in Youth Than Previously Thought

According to a new study published in Eye & Contact Lens: Science & Clinical Practice and supported by the International Keratoconus Academy of Eye Care Professionals and the Illinois College of Optometry, the prevalence of keratoconus in the pediatric population is higher than previously believed. The study used Scheimpflug tomography to examine patients in a limited population between 3 and 18 years of age.

The study separated the participants (n = 2,007) into three categories: 1) those without keratoconus, 2) keratoconus suspects, and 3) those with definite keratoconus based on the final diopter measurement and back corneal surface elevation value measured at the thinnest point. Six participants had keratoconus (prevalence of 1:334) and three were keratoconus suspects (prevalence of 1:669). When these factors are combined, the total prevalence of keratoconus suspects and those with definite keratoconus is 1:223.

These results indicate a substantially higher prevalence of keratoconus in children than has been previously reported, even among adults, which is commonly accepted at 1:2,000. (Some literature reports this adult prevalence can range between 1:50 and 1:750.) The study’s authors advocate for performing this sensitive screening for keratoconus at its earliest manifestation or suspicion as part of a standard pediatric comprehensive eye exam. (Read more here.)

My Two Cents

It’s good that the study’s authors advocate for Scheimplug imaging on children at the earliest possible juncture; however, it’s just not realistic for most kids—or optometry practices. Very few clinics can afford this technology. I can’t imagine everyone rushing out to purchase the equipment to use the machine as a screening test that likely will not be billable. That said, this study points out that keratoconus is much more common than I thought. It’s clear that as technology has allowed us to take a more detailed look at the various aspects of the ocular surface, we are finding more issues that need to be regularly monitored. This study also emphasizes how important it is to refer patients to a clinic with this advanced technology as soon as any suspicion of keratoconus arises.

OUTSIDE THE LANE

Exposure to Bright Lights at Night Could Increase Risk of Stroke, Study Finds

A recent study in China suggests that being around bright outdoor lights at night could increase an individual’s risk of stroke. Researchers found that bright, artificial lights seemingly affect blood flow to the brain in ways that may make a stroke more likely. They found that people with the highest levels of exposure to artificial outdoor light at night have a 43% increased risk of diseases that affect the brain's blood vessels. These include clogged arteries that block the brain’s blood supply and bleeding into the brain, the two leading causes of stroke.

The researchers suggest that continuous exposure to bright light at night can suppress the body’s production of melatonin. Thus, the lights may contribute to stroke risk by impairing sleep quality. The researchers also found that air pollution increases stroke risk and that individuals exposed to the highest levels of particulate pollution in their air had a 41% to 50% increased risk of stroke compared with those least exposed. They also discovered that nitrogen oxide emissions from traffic and industrial power plants increased stroke risk by 31% in those most exposed. (Read more here.)

My Two Cents

In the chorus of Jay-Z’s song “Empire State of Mind” featuring Alicia Keys, they sing about how the big lights of New York City will inspire you, but it looks like they’ll also increase your risk of stroke. Why is this story important? Here’s the connection: Roughly 65% of stroke survivors have vision problems. This might be an interesting point to bring up to any patients who are coaches and have late-night practices or maybe airport employees who work the nightshift and are out on the tarmac for long periods of time.

As someone who isn’t built for the big city, I know that when I’m on the lecture circuit or vacationing in a large city, I have difficulty sleeping with the bright lights outside the window and all the hustle and bustle happening outside. When there is constant stimulation to your brain, it makes sense that you never truly rest. In this same song, they also say, “The city never sleeps, better slip you an Ambien,” which brings up a whole bunch of new issues.

CAN YOU RELATE

My ophthalmologist colleagues are also some of my best friends and are among the most intelligent individuals I know, but sometimes I’m surprised at what they don’t know about our area of eye care.

This past week, one of my good friends (and business partner), who happens to be one of our ophthalmologists, called me in the middle of clinic and cut right to the chase, asking, “Have you heard of these soft lenses that slow down myopia?!?! Is that a thing?” After I assured him that they are indeed a thing, he asked, “Why doesn’t everyone know about these things? Why aren’t you doing it? Why isn’t everyone doing it?” I had to gently remind him that I don’t see many kids and that my focus is on dry eye and specialty lenses for diseased eyes. If someone needs myopia management, we have someone who specializes in this on staff (the incredible Lawrence Pham, OD).

The vast majority of MDs who we refer to love to operate. It’s their passion. It’s what they spend their continuing education hours learning about, what they chat about over a meal, and what drives many of them toward professional satisfaction. Some things we take for granted are things we don’t spend time researching or learning about. It’s our job to continue to be educated on all these areas of eye care, just like our surgeon friends, so we know all the newest IOL options and MIGS procedures that could help our patients. Never forget that eye care is big enough for both of our professions and that we all have niches that can work symbiotically for the betterment of our patients and the health care system.

Now, imagine what happened when I opened up the can of worms with my buddy when I told him there would likely be spectacle lenses approved soon for myopia management. 🤯