OPPORTUNITIES FOR IMPROVING THE LONG-TERM MANAGEMENT OF KERATOCONUS PATIENTS

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Published: Jul 29, 2024
DOI: https://doi.org/10.22374/jclrs.v8i1.61
Keywords:
keratoconus, dry eye, depression, practice patterns

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Amy Nau
Forefront Eye Care, New England College of Optometry, Eyewell
Cherie Nau
Mayo Clinic
Ellen Shorter
Illinois Eye and Ear Infirmary
Muriel Schornack
Mayo clinic
Jennifer Fogt
The Ohio State University
Jennifer Harthan
Illilnois College of Optometry

Abstract

Background and Objective: This study determined whether practitioners specializing in keratoconus (KC) adhere to published guidelines for disease management and to what extent comorbid conditions of dry eye, contact lens tolerance, and psychological consequences of KC are formally assessed as part of
long-term management.


Materials and Methods: This cross-sectional study used an IRB-approved, Internet-based, REDCap platform. Descriptive statistics are presented.


Results: A total of 222 participants qualified for participation. Most 134 (60%) followed young and unstable patients every 6 months and less frequent follow-up examinations for patients with stable findings, with 142 (64%) recommending annual examinations. Scleral lenses were the preferred optical correction method (36%), followed by corneal gas-permeable lenses (21%). A total of 118 (55%, n=216) participants recommend crosslinking to any patient with documented disease progression regardless of age. Fewer than 25% of patients were referred for surgical correction of KC. Half of respondents, 114 (51%), reported testing for tear film dysfunction, while 108 (49%) never tested. No participants used a depression screening instrument.


Conclusion: Practitioners managing patients with KC largely adhere to current consensus recommendations. This survey identified several potentially high-impact, low-cost improvements to current practice patterns, including screening for dry eye and depression.

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How to Cite
1.
Nau A, Nau C, Shorter E, Schornack M, Fogt J, Harthan J. OPPORTUNITIES FOR IMPROVING THE LONG-TERM MANAGEMENT OF KERATOCONUS PATIENTS. JCLRS [Internet]. 2024 Jul. 29 [cited 2024 Oct. 15];8(1):e37-e46. Available from: https://jclrs.org/index.php/JCLRS/article/view/61
Issue
Vol. 8 No. 1 (2024): JCLRS
Section
Original Article

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Author Biographies

Amy Nau, Forefront Eye Care, New England College of Optometry, Eyewell

Amy Nau is an optometrist residing in Boston Massachusetts. She is currently a Senior Partner at Forefront Eye Care, an adjunct Associate Professor at the New England College of Optometry, and the Co-Founder and CEO of Eyewell, a dry eye clinical and research core entity. Previous experience includes staff optometrist at the Beth Israel Deaconess Medical Center Department of Ophthalmology in Boston, MA, the Director of Optometric Services at the University of Pittsburgh Medical Center Department of Ophthalmology, where she founded the Sensory Substation Laboratory and held a secondary appointment in the Department of Regenerative Medicine.  She volunteers at the leadership level  in many professional organizations, lectures extensively both nationally and internationally and enjoys mentoring young optometrists. She is a Diplomate in the Cornea, Contact Lens and Refractive Surgery section of the American Academy of Optometry.  Her clinical and research interests focus on ocular surface disease and complex contact lens fitting. Financial disclosures: Sight Sciences (advisor), Vital Tears (advisor), Optometric Management (paid speaker)

Cherie Nau, Mayo Clinic

Cherie B. Nau, O.D., has been involved in eye research for over 25 years. At the beginning of her career, she studied glaucoma, aqueous humor dynamics and corneal structures. Dr. Nau's current research focuses on the use of scleral contact lenses for treatment of corneal irregularities and ocular surface diseases. A scleral contact lens is a large, hard contact lens. It rests on the white part of the eye and has a smooth surface. An important aspect of Dr. Nau's current research is investigating the impact of disease and treatment modalities for people who use scleral lenses.

Focus areas
  • Member of the Scleral Lenses in Current Ophthalmic Practice Evaluation (SCOPE) research group. The SCOPE research group has 10 years of foundational research into the use of scleral lenses.
  • Patient experience with treatment for dry eye diseases and burden of care. Dr. Nau studies the special emphasis on ocular graft versus host disease.
  • Evaluation of the potential physiological impact of scleral lenses on the ocular surface. Dr. Nau researches the effect of scleral lenses on intraocular pressure and corneal thickness. She evaluates the potential causes for midday fogging with lens wear.

Ellen Shorter, Illinois Eye and Ear Infirmary

Associate Professor of Clinical Ophthalmology; Contact Lens Service; Director, Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) Clinic

Muriel Schornack, Mayo clinic

The research of Muriel M. Schornack, O.D., involves the study of therapeutic applications for scleral lenses. Scleral lenses are large contact lenses that create tear-filled areas over the cornea. She explores the guidelines, indications, experiences and outcomes in people using scleral lenses for eye problems.

Additionally, Dr. Schornack researches the delivery of primary eye care, including assessment of refractive error, screening for ocular problems and management of chronic ocular disease.

Focus areas
  • Descriptions of outcomes of scleral lens wear for management of corneal irregularity and ocular surface disease. Dr. Schornack published some of the earliest reports of the use of commercially available scleral lenses for people with severe eye diseases. Her research has led to an expansion of indications for which scleral lens therapy may be considered.
  • Evaluation of prescription and management practices for scleral lenses. Dr. Schornack conducted multiple survey-based studies that explored prescription and management practices of eye care professionals throughout the world. These studies helped define consensus-based guidelines for the use of these devices.
  • Anatomical and physiological impact of scleral lenses on structures and processes of the eye. Placement of a rigid contact lens on the surface of the eye may positively or negatively impact ocular tissue and physiological function. Dr. Schornack completed studies that examined the impact of scleral lens wear on intraocular pressure, conjunctival tissue and corneal health.
Significance to patient care

People with irregular corneas cannot achieve functional vision with regular glasses or contact lenses. Scleral lenses provide clear vision in these individuals, allowing many to delay or even avoid surgery. Scleral lenses also protect the ocular surface in people with diseases that cause tear film or blink dysfunction.

Dr. Schornack's research expands awareness of the benefits of scleral lens therapy to eye care professionals who treat people with conditions that can lead to ocular surface compromise.

Professional highlights
  • Associate member, International Society of Contact Lens Specialists, 2023-present.
  • Planning committee member, International Congress of Scleral Contacts, 2017-present.
  • Planning committee member, International Forum for Scleral Lens Research, 2017-present.
  • Founder and member, Scleral Lenses in Current Ophthalmic Practice Evaluation, 2014-present.
  • Founding member, Scleral Lens Education Society, 2009.

 

PROFESSIONAL DETAILS Primary Appointment
  1. Consultant, Division of Optometry, Department of Ophthalmology
Academic Rank
  1. Associate Professor of Ophthalmology

Jennifer Fogt, The Ohio State University

director of the Innovation in Vision and Eye care Research Group (iVERG) team, conducting industry sponsored research studies including studies of contact lens design, contact lens solutions, dry eye, ocular pharmaceuticals, and myopia control.  Some of these studies are investigator initiated trials, in which I design a study protocol and acquire funding. These studies may serve as FDA 510k studies for new drugs or devices, such as contact lenses, solutions, or eye drops, or may be used to evaluate already approved devices or drugs.  Additionally, I serve as the Principle investigator for sponsor designed FDA clinical trials, in which the iVERG team serves as one of multiple sites.  These large clinical trials require monitoring to meet the rigors required by the FDA.  The iVERG lab has its own CLIA waiver to meet the requirements of the FDA and study training of investigators is ongoing for all studies. As director of iVERG and PI of multiple active studies, my role includes writing protocols and regulatory documents, obtaining and negotiating contracts, interacting with industry leaders in order to obtain grants, maintaining regulatory documentation, training staff and sub-investigators, and writing reports, abstracts and manuscripts on the results of the studies.

 

I also serve as an Executive Committee member of the Scleral Lenses in Current Ophthalmic Practice Evaluation (SCOPE) group.  This collaborative research group consists of optometrists at Mayo Clinic, Illinois Eye and Ear, Illinois College of Optometry, Korb and Associates, and The Ohio State University College of Optometry.  Research by this group has identified many ongoing concerns in the field of scleral contact lens fitting, both by national and international surveys of best practices and specific cases, and by clinical studies.  Since I have been an active member of the SCOPE group, we have published 7 peer-reviewed manuscripts and 29 peer-reviewed abstracts.

 

I have been a Fellow of the American Academy of Optometry since 2001 and a Fellow of the Scleral Lens Education Society since 2017.  I am a member of the Association for Research in Vision and Ophthalmology, the American Optometric Association, and the Association of Optometric Contact Lens Educators.

Jennifer Harthan, Illilnois College of Optometry

  Why ICO? ICO provides superior didactic and clinical education to all students. The technological advances and the diversity in the coursework and patient population offer students a well-rounded education; so they are well-prepared for practice once they graduate.     Biography

Jennifer S. Harthan, OD is a graduate of the Illinois College of Optometry (ICO). After completing a Residency in Cornea and Contact Lenses at ICO, she became a full-time faculty member. Dr. Harthan is a Professor at ICO and Chief of the Cornea Center for Clinical Excellence at the Illinois Eye Institute. Dr. Harthan is a Fellow of the American Academy of Optometry, Scleral Lens Education Society and serves on the Medical Advisory Board for the International Keratoconus Academy. Dr. Harthan is a founding member of the SCOPE (Scleral Lenses in Current Ophthalmic Practice Evaluation) research team. She has numerous publications on the topics of complex contact lens fits and anterior segment disease. Dr. Harthan is actively involved in ocular surface disease and contact lens research and lectures on these topics at national and international meetings.