KEYNOTE ADDRESS: Keratoconus management update

Abstract

Keratoconus is a non-inflammatory, bilateral, asymmetric, progressive steepening and thinning of the central cornea. Classification of the four stages has evolvedwith inclusion of new criterias such as corneal CCT, sphero-cylindric refraction and mean keratometric values. The currentmanagement strategy of this disease has also largely evolved during the past years with the introduction of new medico-surgical options. Corneal cross linking is now indicated in evolving keratoconus, deep lamellar corneal graft (KLAP) have replaced penetrating keratoplasty (decreasing corneal rejection risk), intra-corneal rings are routinely used in contact lens intolerant patients since femtolaser channels are easily performed for their insertion. Indications and contra-indications of these different medicosurgical treatments will be reviewed. However, corneal GP contact lenses remain the primary visual management for keratoconus and play a major role. New designs allow better mechanical alignment but contact lens tolerance is still an issue for some patients. Up-date materials combinations (hybrid lenses, piggy-backing) and others lens types (silicone softs, sclerals...) are interesting alternatives in such cases to obtain a better lens tolerance and they will be presented and discussed. Lens fitting philosophy of GP corneal lenses, scleral lenses and soft silicone lenses will be largely detailed.Indications in the current contact lens strategicmanagement of keratoconus at different stages of the disease including lens fitting after medico-surgical treatments will be presented.Advancements in care of keratoconus and improvements of lens material and designs science will certainly provide a better quality of vision and quality of life for these patients. This presentation, after the recent classification of the four stages of keratoconus,will focus ondifferent lens types fitted in keratoconic eyes. New medico-surgical treatments are part of care of the disease such cross-linking, lamellar corneal graft, intra corneal rings. However, contact lenses keep a major place in visual rehabilitation and their indications and fitting will be reviewed in non-operated corneas and in operated corneas.