EyeWorld India December 2017 Issue

history of rigid contact lens wear especially wearing relatively flat lenses over the years. “If someone was crosslinked and went back to the contacts, that could be a potential issue,” Dr. Hol- land said. “I have seen it in patients with a history of long-term rigid lens wear who come in with a later onset of keratoconus. Typically, that cone is different than the ones we see in a young adolescent—it’s more of a central cone, less scarring, less severe steepening. There’s certainly evidence that long-term contact lens use can induce ectasia.” Dr. Holland performs serial topography every 6 months post- crosslinking for the first couple of years to make sure there is no change in astigmatism and steepen- ing. In such cases, he would per- form a second crosslinking proce- dure if the patient shows evidence of recurrent ectasia. Further issues Among dietary considerations, Dr. Carlson noted the cornea has the highest concentration of vitamin C, and he has been recommend- ing 500 mg of vitamin C daily for any patients undergoing corneal surgery. The only other issue surround- ing crosslinking patients that Dr. Carlson noted is that it is important to not let them become “corneal cripples.” “What I mean by that is that it is common for these patients to have never heard of the disease prior to their diagnosis,” Dr. Carl- son said. “Then they are told it is genetic, yet only 7% of keratoconus patients have a family member with the same diagnosis. They can feel alone, isolated, and even defined by their disease. It can impact their world view, their job, sports, hob- bies, and social interactions. It is extremely important to emphasize that we have major advances surgi- cally and non-surgically that can benefit their condition and quality of life.” EWAP Editors’ note: Dr. Carlson has financial interests with TearScience (Morrisville, North Carolina). Dr. Holland has no financial interests related to his com- ments. Contact information Carlson: alan.carlson@duke.edu Holland: Eholland@holprovision.com December 2017 EWAP SECONDARY FEATURE 51 Diamatrix Ad Island size