Collaborative Approach to Pediatric Keratoconus Delivers Positive Patient Outcomes

Christina Twardowski, OD, FAAO, and Erin D. Stahl, MD, share highlights from their discussion, “A Collaborative Approach to Pediatric Keratoconus,” which they presented at the 2022 meeting of the American Academy of Optometry .

The 2022 meeting of the American Academy of Optometry takes place this year in San Diego. Drs. Christina Twardowski and Erin Stahl share with optometry time® key highlights from their discussion, “A Collaborative Approach to Pediatric Keratoconus,” which they presented at the meeting.

Christina Twardowski, OD, FAAO, is program director for the Children’s Mercy Pediatric Optometry Residency Program, as well as clinical assistant professor of ophthalmology at the University of Missouri-Kansas City School of Medicine, and Erin D. Stahl, MD, a pediatric ophthalmologist who is division director of ophthalmology and associate chair of surgery at Children’s Mercy Kansas City, as well as a professor in the department of ophthalmology at the University of Missouri – Kansas City School of Medicine.

What are the main lessons of the presentation?

  1. There is no bad reference – Often doctors think they have to keep a patient until a diagnosis can be confirmed. Pediatric keratoconus can progress rapidly, which means waiting for certainty of diagnosis can lead to permanent vision loss. Any suspicion of keratoconus warrants a referral.
  2. Use your retinoscope – Doctors often try secondary tests to help confirm the diagnosis of keratoconus. When it comes to children, testing attempts are often unsuccessful due to patient cooperation. Retinoscopy is a tool that we all have and that can confirm the diagnosis of keratoconus in any elderly patient.
  3. Optical treatment AND medical treatment are necessary – Being able to provide your pediatric keratoconus patients with both treatments is imperative for successful vision and eye health outcomes. Collaboration between optometry and ophthalmology is essential to meet family expectations and ensure the success of long-term vision.

Why is this so important for optometrists to address?

Optometrists tend to be the first to see and diagnose patients with keratoconus. Pediatric keratoconus may not be a diagnosis that comes to your office every week, but understanding the severity of the condition and the treatment required for these patients will help guide your decisions going forward.

What does this mean for patient care?

Early detection and treatment are key to avoiding severe visual impairment. Corneal cross-linking offers a true treatment for keratoconus, halting corneal changes and avoiding the full range of visual rehabilitation options. Pediatric patients with keratoconus require early diagnosis, careful examination, and early intervention with CXL to ensure a positive visual prognosis.

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