A new study reports that patients who have early but stable keratoconus may not experience a significant decline in their vision-related quality of life, while individuals with more advanced stages of the condition may have sociological issues that don’t appear to improve even after corneal crosslinking (CXL). Finding the ideal stage in the disease course to recommend CXL then becomes a challenge, with the implication that earlier is better in hopes of stabilizing vision before psychosocial issues arise.

The team from Germany enrolled 16 emmetropic, 32 myopic and 56 keratoconic participants. In the KC group, 26 patients were stable and 30 were progressing.

The researchers observed a minor decline in vision-related quality of life from emmetropes to myopes to stable keratoconus patients. Differences in social functioning, role difficulties and dependency weren’t statistically significant between the groups. However, in progressive keratoconus patients, the investigators noted a marked decline in all of these sociological areas, which didn’t improve after CXL.

Due to a relatively stable vision-related quality of life in early keratoconus patients and the distinct decline after progression, the researchers suggested reconsidering the current practice of reserving CXL until progression is detected.

Steinberg J, Bußmann N, Frings A, et al. Quality of life in stable and progressive early-stage keratoconus patients. Acta Ophthalmologica. September 10, 2020. [Epub ahead of print].