What is the first thing you think of when you hear 'keratoconus'? For me, I immediately 'see' a topographic image with the traditional small, semi-central red zone. What I don't realize (enough) is what it means to the patient. Recently, on the radio while I was driving my car (National Public Radio in the US), a reporter announced that they would be talking about corneal transplants for keratoconus in their program. Items such as the NPR broadcast make you realize the patients' perspective - of not even knowing about the disease to experiencing the first (confusing) symptoms to a possible hydrops and options like corneal transplants (and everything in between). In the (R)GP lens field we sometimes are asked (and ask ourselves) - what is the future of the modality? But knowing that we can help these patients with different types of (R)GP lenses and can improve their quality of life, sometimes substantially, makes me realize how important it is that we keep educating today's students about the possibilities that different (R)GP lenses can offer. The lenses and the technology are available, and in better shape than ever. It would be really sad if there was no one to fit them anymore.

Palisades of Vogt in Corneal Limbus   Photo: Hans Kloes

Stem cells may not have the highest priority in clinical contact lens settings at first glance, but practitioners should be aware that the cornea and the renewing of its cells is highly dependent on the limbal stem cells. Limbal stem cell deficiency may be rare, but it is a potentially sight-threatening condition arising from congenital or from acquired aetiologies. A case report in Contact Lens Spectrum shows an example of the latter - limbal stem cell loss secondary to chronic hypoxia and over-wear in a soft lens patient. Katherine Mastrota and Willam Townsend cover the topic of the importance of stem cells in depth in this article. They state the importance of the practitioner's role in the prevention and aid in treatment of limbal stem cell deficiency. Especially in the light of the recent increase in popularity of scleral lenses, this may be of special interest.  

When thinking about pregancy, at first only one sort of ectasia comes to mind. But researchers from Turkey recently reported in 'Cornea' on seven corneal ectasias in four pregnant women in their paper called 'Pregnancy-induced Progression of Keratoconus.' Patients with accompanying systemic and ocular diseases associated with keratoconus, uncontrolled atopic disease, and eye rubbing were excluded from the study. This is a novel finding, but not very well understood. The authors suggest that hormonal changes during pregnancy may negatively affect corneal biomechanics, and pregnancy may be a previously unrecognized risk factor for progression of keratoconus.  

Cornea, September 2011