Diagnosing Keratoconus

Referring to the right specialist for your patients’ conditions is one of the marks of a good doctor. For example, when our patients suffer from a detached retina, we must refer them to a retinal specialist. Similarly, we can recognize the signs of Papillodema, but we’re not the right doctors to treat it, so we send those patients to a Neuro-Ophthalmologist. Similarly, Optometrists and Ophthalmologists throughout Southern California and the country refer their most difficult Keratoconus and corneal dystrophy patients to us at the California Keratoconus Center. So how do you recognize and diagnose Keratoconus and other corneal dystrophies?

Early Signs of Keratoconus and Other Corneal Dystrophies

Your patient may complain of persistent poor vision, despite your best efforts. Undiagnosed Keratoconus is very difficult to treat. So knowing the first signs of Keratoconus can help you arrive at the right diagnosis.

• Frequently changing prescriptions. In its early stages, Keratoconus is a progressive disease, requiring new prescriptions as often as every 3 to 6 months.
• Unexplained poor visual acuity with eyeglasses or standard soft contact lenses. It’s very difficult to write a prescription that the patient will be happy with.
• Poor results with conventional contact lenses. They are extremely difficult to fit, are uncomfortable for the patient to wear, and cause secondary symptoms such as red eyes, eye fatigue, dry eyes, and various refraction issues.
• Difficulty getting a refraction using standard instruments. This is a challenge unless you know what to look for.

If you notice any of the above symptoms in your patients, you should consider testing for Keratoconus or other corneal dystrophies.

Diagnosing Keratoconus

When diagnosing Keratoconus in patients, knowing what to look for is crucial. These examples and images may help.

You likely have a keratometer or topographer in your office, if not both. Irregular mires are an indicator of Keratoconus and other corneal dystrophies. You can use either instrument to see them.

Diagnosing Keratoconus Using a Keratometer

Image A from a Keratometer. The left illustration is a normal cornea, and the right illustration shows distorted mires from an irregular cornea.

Diagnosing Keratoconus Using a Topographer

Image B from a topographer shows the first image with mires of a normal cornea. The mires in the second image indicate nipple-cone Keratoconus.

Image C is a typical Axial Topography of Keratoconus created on a NIDEK OPD III topographer. The first image shows a normal cornea with astigmatism. The second image shows a pellucid-type Keratoconus.

Diagnosing Keratoconus Using a Retinoscope

When using a retinoscope, look for the scissors reflex, which is a scissoring motion during a retinoscopy. Since the scissor’s reflex changes based on the position of your instrument, it is difficult to portray it in a static image. See image D for a static illustration of the scissors reflex.

About the California Keratoconus Center

My name is Dr. Barry Leonard, and I am the Director of the California Keratoconus Center. People call me “The Keratoconus Doctor,” not only because I have been treating Keratoconus for over 35 years but because I also have Keratoconus.

My own Keratoconus was difficult to diagnose back in the 1980s. You’ll recall that when you were in school, you and your classmates were required to refract and diagnose each other’s eyes. When I was in school, no one wanted to try to refract me. No one ever could…until my own professor diagnosed me using the instruments I’ve listed above. He knew what to look for.

After the diagnosis, he called for the class’ attention and shouted, “Leonard’s Got Keratoconus!” I was glad to finally know why my own vision was so poor — much like your patients might be — but the options to treat Keratoconus were crude then compared to what we have now.

Since I was diagnosed, I have committed my life to helping those with Keratoconus to see clearly and comfortably and founded the California Keratoconus Center to provide Keratoconus sufferers and their eye doctors access to the leading Keratoconus specialists and the most advance diagnostic equipment in the greater Los Angeles area.

Treating Keratoconus and Corneal Dystrophy Patients with the cKlear Method™

The California Keratoconus Center is one of only 110 Optometrist practices worldwide and only 70 Optometrists in the USA to have the Eaglet Eye Surface Profiler (the “Keratoconus Machine”). And we may be one of only a half dozen who also have the Zeiss OCT and Nidek OPD III Wavefront Aberrometer, along with cooperative relationships with major lens manufacturers like ZenLens™, BostonSight™, ScanfitPro™ and others.

These are critical components of the cKlear Method™, our cutting-edge Non-Surgical Keratoconus Treatment method.

When needed, some doctors treat a malformed cornea with surgery (either to install Intacs or to perform a corneal transplant). We have found tremendous success with our non-surgical method. The cKlear Method™ results in none of the risks inherent in all surgeries. It requires zero recovery time, provides clear vision almost instantly, results in better-fitting contact lenses, and an all-around better result for your patients.

The cKlear Method is our non-surgical treatment for Keratoconus and other Corneal Dystrophies. And each of the three instruments, the Eaglet Eye Surface Profiler, the Nidek OPD III and the Zeiss Cirrus OCT, play a vital role in its success.

The Eaglet Eye Surface Profiler

The Eaglet Eye Surface Profiler scans the eye and produces a 3D image using 350,000 points of data, including 100% of the cornea and up to 70% of the sclera. We can view, rotate and zoom in on any part of the scan, which helps us to design perfectly fitting custom lenses.

Nidek OPD III

The OPD III measures Auto-refraction, Topography, Pupil Size, and Wavefront Aberrometry to determine the combined Optical Path Difference, which tells us why patients see what they see. We can explain and show which defects come from the cornea, which come from the lens, which come from the vitreous, and more. With the Nidek OPD III, we can determine why a patient doesn’t see 20/20…or why the patient is seeing 20/20 but still has vision issues, including High Order Aberrations (HOA).

Zeiss Cirrus OCT

We use the Zeiss Cirrus OCT at two different stages of the cKlear Method™. The first is during the diagnostic stage, when we scan the cornea to find the Corneal Pachymetry. We then use the OCT again after the lens is designed and on the eye so that we can confirm or evaluate how the lens vaults over the cornea and lands on the sclera. The OCT can show us if there are any areas on the lens that can be modified for improved vision or comfort.

What the cKlear Method™ Means to Your Patients

As you know, few things are more fulfilling than helping patients see clearly and comfortably for the first time or in a long time. But treating Keratoconus, other corneal dystrophies and even High Order Aberrations (HOA) is different and far more complex than treating common vision issues.

We have numerous testimonials from Keratoconus patients who marvel and weep at their new ability to do things as ordinary as seeing the details of leaves on a tree, seeing their spouse and children’s faces clearly for the first time, being able to work all day without discomfort, and even driving at night.

These overwhelming thanks and appreciative comments are why we do what we do and certainly why you do what you do as well. Let’s work together to help your patients see clearly, too.

How We Work with and for You and Your Practice

We help other Optometrists and Ophthalmologists treat their patients with Keratoconus and other corneal dystrophies by working closely with contact lens laboratories and technology companies to conduct seminars in our office or at optometry colleges nationwide. My teaching and instructional credentials include the following:

• Eaglet-Eye Key Opinion Leader
• AOA Contact Lens and Cornea Section
• Adjunct Clinical Professor at Western University College of Optometry
• Adjunct Clinical Professor at Pacific University College of Optometry
• Adjunct Clinical Professor at Salus University Pennsylvania College of Optometry
• Speaker & Trainer for Bausch & Lomb ZenLens
• Collaborating Specialist with BostonSight HOA and FreeForm Lens

We also maintain a set of Keratoconus Resources for Doctors on our website, where you can learn about upcoming training events, the latest in treatment technology and find other resources that might be helpful to you in treating your patients.

After diagnosing Keratoconus in your patients, we are respectful and cooperative when you refer them to the California Keratoconus Center. We understand that each patient you refer is your patient first. As a result, we keep you informed about your patient’s diagnosis, prognosis, and progress. And, if other conditions arise, we always refer the patient back to you for that care.

It’s never our goal to take a patient from a referring doctor. We want to collaborate with other skilled eye care professionals like you to give your patient the best vision possible.

Referring Patients to the California Keratoconus Center

Our goal is to help your patients see clearly. Although we have limited my office hours, we are available to discuss your patients’ cases with eye care professionals like you.

The special doctor-to-doctor email address is ForDoctors@CaliforniaKeratoconusCenter.com.

Or you can call the California Keratoconus Center at 818-891-6711 and ask for one of our specialists. Our Patient Referral Coordinator, Gianny Cardenas, will be sure to connect us as soon as possible.