PRESCRIBING FOR astigmatism is fairly predictable, though not always simple. Prescribing for astigmatism typically takes the form of glasses, contact lenses, or specialty contact lenses.

But does prescribing for astigmatism ever take the form of patient education? This may seem unlikely, until we consider a common habit eyecare providers observe almost daily: eye rubbing.

Eye rubbing by patients is concerning because it has shown an association with keratoconus (Moran et al, 2020). A recent, large study with adults reported that 99.5% of patients who had keratoconus admitted to eye rubbing. The correlation was significant, particularly when eye rubbing was done with the knuckles (Moran et al, 2020).

Keratoconus often presents clinical treatment challenges as it is characterized by increasing thinning and steepening of the cornea, which may result in irregular astigmatism and decreased visual acuity (Santodomingo-Rubido et al, 2022). Eyecare providers are aware of the prescribing challenges for keratoconus patients, as the severity treatment continuum typically follows a pathway of glasses, then contact lenses, scleral contact lenses, and possibly corneal surgery (Santodomingo-Rubido et al, 2022).

Patients who have keratoconus are often challenged with less-than-optimal comfort and vision. In addition, young adults have reported decreased quality of life with activity limitations and ocular discomfort symptoms, even with a mild form of keratoconus (Gothwal et al, 2022).

IS THERE ANY GOOD NEWS?

Patient education may be effective in the stabilization of keratoconus. Patients in a recent study were thoroughly informed of their keratoconus pathology and were instructed to stop rubbing their eyes (Mazharian et al, 2023). Patients were then followed regularly for at least a three-year period and the importance of stopping at-risk behaviors—such as eye rubbing and incorrect sleep position—was reinforced at each visit.

The study found that of the 26 eyes with keratoconus progression, 25 were associated with continued at-risk behaviors. The authors concluded that a significant number of keratoconus patients are likely to remain stable with careful monitoring and firm stoppage of at-risk behaviors (Mazharian et al, 2023).

Patient education is important and effective and may be a very useful tool in prescribing for irregular astigmatism (Figure 1). CLS

References

1. Moran S, Gomez L, Zuber K, Gatinel D. A Case-Control Study of Keratoconus Risk Factors. Cornea. 2020 Jun;39:697-701.
2. Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review. Cont Lens Anterior Eye. 2022 Jan;45:1-26.
3. Gothwal VK, Gujar R, Sharma S, Begum N, Pesudovs K. Factors affecting quality of life in keratoconus. Ophthalmic Physiol Opt. 2022 May;42:986-997.
4. Mazharian A, Flamant R, Elahi S, Panthier C, Rampat R, Gatinel D. Medium to long term follow up study of the efficacy of cessation of eye-rubbing to halt progression of keratoconus. Front Med (Lausanne). 2023 May; 1-10.