Corneal crosslinking (CXL) has given clinicians a whole new method to manage keratoconus. However, new research shows that time is of the essence. Patients often have a significant wait before they can undergo the procedure—sometimes three to four months. But in that wait time, many eyes continue to progress, according to the study published in Cornea. The article advocates for a risk stratification score for patients awaiting CXL in place of a first-come-first-serve model to reduce the risk of progression.

The New Zealand-based research enrolled 96 eyes of 96 patients with keratoconus who were on a waitlist for CXL. Of the 96, 39.6% progressed during an average wait time of 153 days (±101 days). These nearly-two-fifths of patients who progressed presented significant differences in preoperative tomographic parameters than their non-progressing counterparts. The parameters include index of surface variance, index of vertical asymmetry, keratoconus index and index of height decentration, all of which they correlated with progression risk during the waiting period.

The team suggested patients should be prioritized based on these tomographic parameters. No significant differences were noted in steepest keratometry, average keratometry, thinnest corneal point or center keratoconus index.

The study also shows racial and ethnic discrepancies in keratoconus progression, as Maori patients are more likely to worsen while awaiting CXL treatment.

Goh Y, Gokul A, Yadegarfar M, et al. Prospective clinical study of keratoconus progression in patients awaiting corneal cross-linking. June 1, 2020. [Epub ahead of print].