Management of Keratoconus
A 23-year-old lady was referred to the cornea clinic complaining of progressive visual loss from 8 years ago. Uncorrected visual acuity (UCVA) was 20/100 in her right eye and 20/600 in the left one. She was using rigid gas-permeable (RGP) contact lenses for 4 years and complained of contact lens intolerance especially in her left eye. On slit lamp examination, both corneas were clear but Vogts' striae and Fleischer rings were present in both eyes. Manifest refraction was -3.00-6.00×30 and -7.00-8.00×140 in the right and left eyes respectively with best spectacle corrected visual acuity (BSCVA) of 20/60 and 20/200; visual acuity with best-fitted contact lenses were 20/30 and 20/70 in the same order. Corneal topography and Orbscan maps are shown in Figures 1 and 2.\nHerein we present the opinions of three corneal specialists in the management of keratoconus (KCN) in general, and this case in particular. The following matters will be specifically addressed:\nWhat are the important points in the clinical history and diagnostic evaluation of patients with KCN?\nWhat is the importance of subjective and manifest refraction, and uncorrected and corrected visual acuity?\nIs the topographic pattern of the cornea important and does it affect your treatment plan, for example the type of intracorneal ring?\nIs the topographic pattern of the cone and its location important?\nWhat is your preferred plan for each eye?\nWhat is your opinion about collagen cross linking (CCL) in this case; at which stage would you perform the procedure?\nDo you recommend intracorneal ring segments (ICRS) for this patient? Which type of ring would you choose?\nIf you decide to implant ICRSs, which sites do you prefer for incision and implantation?\nDo you consider corneal transplantation a viable option for this patient?