Interventional Keratoconus Management: The Critical Imperative for Early Detection and Treatment.

Keratoconus is an under-diagnosed progressive ectatic degeneration of the cornea associated with significant negative impact on both visual function and quality of life. Historical treatments-including optical refractive correction and penetrating keratoplasty-have significant limitations, the most important of which is that they fail to alter the progressive nature of the disease in some or all of patients. Corneal cross-linking in conjunction with cessation of eye rubbing and mechanical stressors represents a paradigm change in keratoconus therapy that stabilizes the degenerative process and offers both improvement in structural and functional outcomes and long-term stability in both visual function and quality of life. The development of corneal cross-linking and the opportunity to halt keratoconus progression makes imperative the early identification and treatment of subclinical cases when cross-linking offers the greatest long-term benefit. The availability of a less invasive epithelium-on cross-linking option further underscores this imperative. In this perspective, we describe the challenges of detecting early keratoconus and advocate for collaborative partnership with the entire eye care community to implement new and emerging technologies to find patients who would benefit from cross-linking and facilitate early referral to corneal surgeons for definitive treatment.