Keratoconus treatment has undergone substantial transformation, primarily driven by the introduction and refinement of corneal crosslinking technology. Early detection and intervention now prevent progression that previously required full-thickness corneal transplants. Here, Kendall E. Donaldson, MD, MS, from Bascom Palmer Eye Institute in Miami, Florida, describes this evolution as part of the celebration of ophthalmic innovation for Ophthalmology Management’s 30th anniversary. The below transcript was edited for clarity.
Hi, my name is Kendall Donaldson, and I'm a professor of clinical ophthalmology at the Bascom Palmer Eye Institute in Miami, Florida, where I practice cornea, cataract surgery, and refractive surgery. I do a lot of work with keratoconus patients. And as I reflect over the last really 10 years, it's amazing how care for keratoconus patients has changed so much. And a lot of this change is due to crosslinking. It's amazing for patients who would've gone on to a corneal transplant 10 or 15 years ago, that we're now able to detect them earlier and do crosslinking, stop progression, and then even treat them for visual rehabilitation. And I've been practicing ophthalmology now, for over almost 25 years with residency and fellowship. And these patients were so difficult to treat and so frustrating because a lot of times we would miss the diagnosis. The diagnosis would be made late, and we'd end up doing transplants, usually full-thickness transplants, on these patients.
But now we're doing a much better job of detecting these patients earlier. We're really trying to be proactive and we're working with optometrists to try to get them in so we can identify who would be a good candidate for crosslinking. Now, over the past year, that has changed yet again. We've been doing epi-off crosslinking for some time now, but now epi-on crosslinking was approved this past year. So, we're excited for the upcoming year where we'll have this transition from epi-off crosslinking to epi-on crosslinking. This will be much easier for patients, maybe even someday allowing us to crosslink both eyes on the same day. So, patients will get back to work faster; there will be less down time. Many of these patients, once we are able to stop their progression with crosslinking, now many months later, a lot of times we'll move on to try to perform visual rehabilitation with CTAK, which is something that we've been doing more of over the past couple of years.
This allows patients who potentially wear a scleral lens to potentially get into a soft lens or lower the power and dependency of their scleral lens, which allows them more comfort. It's really a great time to have keratoconus, if you have to have it, because patients are being diagnosed at a much younger age, and we're trying to do a better job at that and better coordination again between optometrists and ophthalmologists. I'm hoping that each year we'll be able to do this better and better and we'll be more proactive because even now, we're only able to treat a small percentage of keratoconus patients, maybe 15% to 20% of those patients who are candidates for crosslinking are getting treated with crosslinking.
So, I have hope that we'll be working with companies, we'll be working with each other and forming collaborations to help patients get identified sooner so we can perform crosslinking because it really is just a miracle for these patients. And we're so lucky to be able to provide our patients with this care and visual rehabilitation to follow.