Updates in the Management of Corneal Ectasia

This is the authors' abstract. We don't add key points for this paper.

Keratoconus is a bilateral, noninflammatory, corneal degeneration that results in progressive corneal protrusion and resultant myopia and irregular astigmatism.1 The condition often presents in adolescence or early adulthood and can have a devastating impact on vision and quality of life.2,3 The pathogenesis of keratoconus is unclear but likely multifactorial, with a genetic predisposition and overlying environmental and biochemical factors. The reported prevalence is highly variable, ranging from 0.0003% in Russia,4 0.054% in the United States,5 and 2.3% in India.6 Visual rehabilitation is a major component of keratoconus management. Very early disease can be managed with spectacles and soft contact lenses, however, the majority of patients rely on rigid gas permeable (RGP) lens designs.7 In more advanced disease, RGP contact lenses can become difficult to fit because of positional instability on the cone and discomfort.8 For these patients, scleral contact lenses play an invaluable role. These specialty contact lenses vault completely over the cornea and have greatly expanded the ability to provide visual rehabilitation and postpone or avoid surgical intervention even in very advanced disease.8,9 For those patients who may not have access to scleral contact lenses, or whose corneal contour is otherwise too steep for the contact lenses they have access to, interventions such as surgical placement of intrastromal corneal ring segments (ICRS) can be considered. Inserted into the posterior stroma, these segments exert an “arc-shortening effect” and induce corneal flattening.10 Although there is no gold standard nomogram, insertion of ICRS can result in improved contact lens comfort and visual acuity.11