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Welcome to question of the day #350

Eyetool question of the day #350

I work in an area where there is a lot of keratoconus. I don’t have any sophisticated technology. Do you have any tips on how I can detect keratoconus as early as possible?

You don’t need any sophisticated technology to detect early keratoconus.

Here are my favourite techniques using simple ophthalmic equipment for detecting signs of early keratoconus.

Use your retinoscope and/or subjective refraction to look for an increase in myopic astigmatism over a short period of time. For example, a teenager that comes back several times in 12 months complaining of problems seeing with new glasses and needs new glasses because her myopia and astigmatism keep changing magnitude and axis is very likely to have keratoconus.

If you notice that a young person’s astigmatism has changed and the meridians are no longer 90 degrees apart then the patient is very likely to have keratoconus.

If during retinoscopy you notice a red scissor reflex then the patient is likely to have keratoconus.

If during direct ophthalmoscopy of the anterior segment, you notice an oil droplet appearance in the red reflex then the patient is very likely to have keratoconus.

If you have a keratometer and you notice that a patient has distorted mires then they are very likely to have keratoconus.

Using a retinoscope, ophthalmoscope, and keratometer in these ways will ensure you won’t miss any cases of keratoconus.350