Early detection, advanced imaging, and new treatment options are transforming how eyecare professionals manage keratoconus (KC), according to experts Susan Gromacki, OD, MS, FAAO, FSLS, Dipl AAO, and Clark Chang, OD, FAAO, FSLS, during the Optometry’s Meeting 2026 course “What Every Optometrist Should Know About Keratoconus.”
The presenters reviewed the latest developments in diagnosis, imaging, contact lenses, corneal cross-linking (CXL), and surgical management, and emphasized that earlier intervention than ever before can help preserve vision and improve patient outcomes.
"One of the most common mistakes clinicians make when considering a diagnosis of keratoconus is referring to the wrong provider. They need to refer to a colleague who has a topographer/tomographer and fits specialty contact lenses so they can obtain the diagnosis and help the patient see their best,” Dr. Gromacki told OM. “Also, they need to refer to a cornea specialist who performs CXL. If they refer to anyone else, the patient will continue to struggle to see and their disease will progress while they wait to see the right provider."
Although genetics remain a major risk factor, many patients still go undiagnosed until noticeable visual symptoms emerge. Earlier diagnosis allows clinicians to monitor progression, initiate treatment when appropriate, and potentially prevent irreversible corneal changes.
Imaging Technology
Despite the value that corneal topography has for assessing anterior corneal irregularities, corneal tomography provides 3-dimensional imaging, corneal thickness measurements, and anterior and posterior elevation data. These capabilities mean that tomography can identify disease earlier than other methods because posterior elevation changes often occur before anterior abnormalities become apparent.
The presenters also discussed the role of anterior segment optical coherence tomography, epithelial thickness mapping, corneal densitometry, and progression analysis tools such as the Belin ABCD Progression Display and Belin/Ambrosio Enhanced Ectasia Display.
Contact Lens Options
Specialty contact lenses remain a cornerstone of keratoconus management, and ongoing innovations are improving both fitting success and patient outcomes. New lens technologies and fitting tools are helping practitioners achieve better vision correction and comfort across all stages of disease. Additionally, some tomography platforms now offer scleral profilometry capabilities that can streamline scleral lens fitting.
Corneal Cross-Linking
Since the US Food and Drug Administration approved epithelium-off CXL in 2016 for progressive keratoconus and post-LASIK ectasia, clinicians have had an effective option for slowing disease progression. The presenters reviewed epithelium-on protocols, approved by the FDA in 2025, that use enhanced drug delivery methods, supplemental oxygen, and stronger UV-A irradiation to improve treatment effectiveness. They stressed that delaying CXL treatment can allow progressive corneal changes that may permanently affect vision.
Surgical Options
Although early intervention and CXL have reduced the need for corneal transplantation, surgical management remains important for advanced cases. The course reviewed several procedures that are designed to improve corneal shape and visual function, namely corneal allogenic intrastromal ring segments, corneal tissue addition keratoplasty, and Bowman’s membrane transplantation. Traditional corneal transplantation—including penetrating and lamellar keratoplasty—remains an option for severe disease, though transplant rates for keratoconus continue to decline in the United States after approval of CXL treatments.
Patient Education
Beyond technology and treatment advances, the presenters emphasized the importance of patient communication: Helping patients understand the progressive nature of keratoconus and the value of early intervention can improve treatment acceptance and long-term outcomes.
Resources from organizations such as the National Keratoconus Foundation and the Gas Permeable Lens Institute can help support patient education efforts, Drs. Gromacki and Chang said.
The Bottom Line
The management of keratoconus has evolved dramatically over the past 2 decades, and optometrists are better equipped than ever to detect disease early and preserve vision. The most important opportunity remains early diagnosis—before permanent corneal changes occur.OM