Trends in the Management of Keratoconus in Australia

PURPOSE: Over the past few decades, management options for keratoconus have evolved to include corneal crosslinking (CXL), keratoplasty and advanced contact lenses. This study aimed to describe trends in the use of various keratoconus management techniques in Australia. METHODS: This cross-sectional study extracted data on the use of keratoconus management techniques in Australia from various data sources. Corneal graft and national CXL data were obtained from the Australian Corneal Graft Registry, Medicare Benefits Schedule and Save Sight Keratoconus Registry. Data on the number and proportion of rigid gas permeable (RGP) and scleral contact lenses were collected from the International Contact Lens Prescribing Survey and contact lens manufacturers. The number of RGP and scleral contact lenses, keratoplasty and CXL used for managing keratoconus in Australia were analysed. RESULTS: Corneal grafts for keratoconus decreased from 3170 in 2001-2010 to 2797 in 2011-2020. This coincided with increased use of CXL, as well as RGP and scleral contact lens use. Since 2007, the proportion of RGP lenses sold in Australia has increased from 5% to 18% of all lenses. Over the past three decades, the estimated number of RGP and scleral lenses sold for the treatment of keratoconus has doubled. CXL use has increased and was more common in males and patients aged 15-24 years, with variability in corneal CXL rates across each state. CONCLUSIONS: In Australia, there is a decreasing trend in keratoplasty for keratoconus along with increases in CXL and contact lens use. Future studies should evaluate outcomes associated with the change in keratoconus management patterns.