The first Global
Keratoconus Congress (GKC), which took place from
Jan. 26 to 28 in Las Vegas, NV, drew more than 500
participants including 400 registrants from 30
countries, plus 100 sponsors and exhibitors
representing 31 companies.
Contact Lens Spectrum and the Lippincott,
Williams & Wilkins Health Care Conference Group
hosted the two-and-one-half day meeting that focused
on the latest diagnostic and treatment methods for
keratoconus. GKC provided international insights and
access to the most advanced products and methods
used in treating keratoconus. The educational
program provided information for vision care
professionals in all disciplines with both surgical
and non-surgical options, offering 17.5 hours of
COPE, NCLE and JCAHPO continuing education credits.
The first day of the
educational session focused on fundamentals of
keratoconus. The program began with Jay Krachmer,
MD, discussing how older patients may not continue
to progress in keratoconus due to their cornea
becoming more rigid.
Joe Barr, OD, MS, FAAO,
next discussed keratoconus diagnosis and key
symptoms, touching on data from the Collaborative
Longitudinal Evaluation of Keratoconus (CLEK) study.
He shared his theory that keratoconus is probably
genetic (13.5 percent of CLEK patients had family
history) with eye rubbing as a contributing factor.
Dr. Barr also discussed whether keratoconus is
actually a non-inflammatory disease and that
Fleischer's ring isn't really a ring - the iron
deposition extends out to the periphery.
Tim McMahon, OD, FAAO,
discussed topography analysis of keratoconus. In
addition to explaining different types of topography
maps, Dr. McMahon revealed that keratoconus cones
develop in all shapes and locations, including 10
percent to 12 percent located above the horizontal
meridian. Because of this, he echoed Dr. Barr's idea
that the classical terms nipple, oval and globus may
Eef van der Worp, BSc
Optom, from the Netherlands, moderated a session on
keratoconus lens designs that included Alan P. Saks,
MCOptom, FAAO, of New Zealand, Mark Andr�, FAAO, Pat
Caroline, FAAO, Michael Wyss, dipl. Augenoptiker,
FAAO, of Switzerland, and Michael Ward, MMSc, FAAO.
Dr. Saks reviewed
corneal GP lens designs for keratoconus, suggesting
that practitioners get to know a few keratoconus
designs intimately and stressing that you order your
diagnostic lenses from the same manufacturer that
made your trial set.
Mark Andr� discussed the
somewhat controversial topic of soft lens designs
for keratoconus, indicating that although this isn't
his first choice, it can be the only choice for some
Pat Caroline explained
how to fit hybrid lenses for keratoconus, stressing
that hybrid lens fitting is counterintuitive.
Specifically, the lenses must be fit steep to
prevent lens tightening. He also explained that
hybrids work best for central cones.
Michael Wyss discussed
large diameter GP designs. He recommended that you
avoid apical bearing, make sure that mini scleral
lenses move a little to avoid total adherence and
instruct patients use protein removers when caring
for the lenses.
Michael Ward discussed
fitting piggyback lens systems for keratoconus, even
if used as an aid to GP adaptation. He stressed the
importance of using the highest-Dk combination
Hans Bleshoy, PhD, of
Denmark, Richard Lindsay, BscOptom, of Australia and
Mark Soper, FCLSA participated in a panel discussion
about problem solving in fitting keratoconus
Pat Caroline moderated a
panel discussion among Paul Rose, OD, FNZCLS, of New
Zealand, Frank Widmer, OD, of Germany, William
Winegar, FCLSA, and Christine Sindt, OD, FAAO, on
keratoconus video case histories. The panel members
discussed fitting methods for early to severe
keratoconus, how much apical touch is acceptable,
how to avoid late-onset tightening with semiscleral
designs and when to use piggyback or hybrid designs,
among other fitting considerations. The panel also
debated whether axial or tangential maps are best to
use and whether it's valuable to map the patient in
upgaze to center inferior cones. They furthermore
discussed the use of quadrant specific lens designs,
which are lenses that allow you to customize the
design for each quadrant to better fit the cone and
are currently fit mainly in Europe.
Anthony Nesburn, MD,
moderated the session What Do We Know about
Keratoconus? that included M. Cristina Kenney, MD,
PhD, Yaron Rabinowitz, MD, and Eberhard Spoerl, PhD,
Dr. Kenney presented her
research on corneal cells. She related that
mitochondrial DNA of keratoconus patients has higher
deletions and mutations than that of normal corneas.
She theorized that keratoconic corneas undergo
oxidative stress, which contributes to keratoconus
pathogenesis. Her research also indicates that
keratoconus does have a genetic component, with
multiple genes involved in the common oxidative
Dr. Rabinowitz related
his search for a molecular marker for keratoconus.
He noted that the aquaporin 5 gene, which is a water
transport gene related to wound healing, is
suppressed in keratoconus patients. He said this is
the first molecular defect ever identified in
Dr. Spoerl explained the
use of a combined riboflavin/ultraviolet A (UVA)
treatment for keratoconus. The riboflavin absorbs
the UV radiation to protect the endothelium, and the
treatment increases crosslinking to make the cornea
more rigid and stable. He noted that this treatment
can only stop the progression of keratoconus.
Karla Zadnik, OD, PhD,
discussed flat vs. steep fitting GP lenses in
keratoconus, concluding that scarring is more
related to disease severity than to fitting
decisions and that you should base your fitting on
vision, comfort, wearing time and what's happening
to the cornea.
Dr. Barr discussed
corneal scarring and vision in keratoconus. He
reported that the CLEK study shows we can't conclude
that flat fitting lenses cause more scarring, but
lens wear is implicated as a causal pathway for
corneal scarring. Scarring does impact visual acuity
even if it's not located in the line of sight. Dr.
Barr also reported on the use of reverse geometry
lenses for keratoconus in that they can reduce coma
and improve vision.
Tim Edrington, OD, MS,
FAAO, discussed the benefits of using the first
definite apical clearance lens (FDACL) to measure
the cornea and serve as a fitting guide in
A number of presenters
discussed the use of scleral lenses for keratoconus.
Perry Rosenthal, MD, Rob Breece, OD, Henry Otten,
Optometrist BSc, FAAO from the Netherlands and Ken
Pullum, FCOptom, DipCLP from England offered fitting
tips for corneo-limbal, mini scleral and scleral
designs. Emphasis was placed on fluorescein
analysis, given that topography data doesn't extend
out far enough to fit sclerals, and on how to avoid
David Schanzlin, MD,
discussed surgical approaches to keratoconus,
including penetrating keratoplasty, lamellar
keratoplasty and Intacs. He reminded attendees that
the goal of surgery is to strengthen the cornea and
restore the possibility of a good contact lens fit.
Dr. Rabinowitz discussed different methods for
inserting Intacs, and also stressed that patients
need to be counseled about the purpose of the
Buddy Russell, FCLSA,
offered suggestions for how to fit contact lenses
following Intacs inserts, suggesting that piggyback
fits may help with comfort.
OD, MS, discussed contact lens fitting following
penetrating keratoplasty and other surgical
alternatives. She explained how different types of
sutures may affect lens fitting and that you should
be mindful of Dk when fitting such patients.
Carla Mack, OD,
discussed coding and reimbursement issues for
keratoconus. She emphasized that coding is the
practitioner's responsibility and that all
practitioners in a multi-doctor practice should code
Dr. Zadnik discussed the
unique personality characteristics that are common
among many keratoconus patients. She said
practitioners should make it a goal to help such
patients to not think about their keratoconus all
Many of the GKC's
sponsors held seminars to educate attendees about
products and technology available in diagnosing and
managing keratoconus. Sponsor presentations were
given by Blanchard Contact Lens, Contamac, Bausch &
Lomb, SynergEyes, Inc., X-Cel Contacts, Precision
Technology Services, Ltd., Valley Contax, the
Contact Lens Manufacturers Association and the
National Keratoconus Foundation.
Information from the GKC
meeting will appear in greater detail in future
CLS articles. The second
GKC will take place from Jan. 25th to 27th, 2008.
Conference Honors Pioneers
The 33rd Annual
Invitational Bronstein Contact Lens Seminar honored
two pioneers in the contact lens field.
Charles H. May, OD
and Robert B, Mandell, OD,
PhD, were honored at this year's event held
Jan. 26 to 28 in Scottsdale, AZ.
Dr. May was honored for
his work in lens design associated with
orthokeratology, or corneal molding. Dr. Mandell was
recognized for his research in corneal topography,
pachymetry and corneal response to contact lens
The conference is named
after its founder, contact lens pioneer Leonard
Bronstein, OD. It's one of the largest contact
lens-only meetings in the country, if not the world,
according to conference chair John Rinehart, OD.
For the Record
In the January issue, on
p. 9 in the news article CLMA Recognizes Labs,
Practitioners, Blanchard Contact Lens, Inc. and Tru-Form
Optics, Inc. (TX) - 2 locations were omitted from
the list of laboratories awarded the CLMA's
Certificate of Manufacturing Excellence for the
years 2007 and 2008. Both companies received the
recognition concurrently with all other companies.
Also in the January
issue, on p. 26 of the article Contact Lenses 2006,
the text should have said, At the manufacturer
level, the worldwide contact lens market is about
$4.56 billion with about $3.3 billion in spherical
lens sales and $1.26 billion in specialty lens
Contact Lens Spectrum regrets the errors.
Next-Generation Artificial Tear
Allergan, Inc. has
launched Optive Lubricant Eye Drops, an artificial
tear with an advanced dual action formula that works
on both the ocular surface and at the cellular level
to provide long-lasting relief from dry eye
symptoms, according to Allergan.
Optive offers a new
technology platform for the treatment of dry eye
symptoms, said Joe Vehige, OD, Allergan Senior
Director, Consumer Eye Care Research and
Development. While most artificial tears typically
provide moisture to the tear film, Optive Lubricant
Eye Drops is optimally formulated to provide both
lubrication to the tear film and penetration below
the surface of the eye for osmoprotection against