In their presentation, “Bridging the Gap: Mastering Corneal Comanagement with Corneal Specialists for Optimal Patient Outcomes” at Global Specialty Lens Symposium (GSLS) 2026 in Las Vegas, Pooja Alloju, OD, of EyeHealth Texas, and Sabari Arcot, OD, of Eye Specialists of Texas, discussed what optometrists need to know when it comes to collaborative management of complex corneal conditions. 

To start, the presenters pointed out that optometry and corneal specialty care naturally complement one another, and that optometrists often serve as the first point of contact for patients experiencing subtle or early corneal changes.

“Our longitudinal relationships allow us to catch progression earlier, intervene sooner, and guide patients through complex treatment paths,” Dr. Alloju explained. “No single provider can cover the entire spectrum of care needed for conditions like keratoconus, infectious keratitis, or dystrophies. Collaborative care ensures that patients move seamlessly between disease stabilization, surgical intervention when needed, and vision rehabilitation.”

Conditions Requiring Referral

The presenters pointed out specific conditions that require referral, which are ectatic disorders, infectious keratitis, dystrophies/degenerations, ocular surface disease, and trauma/scarring (Figure 1).

Keratoconus and ectatic disorders, they said, involves early detection and Scheimpflug imaging interpretation. The referral criteria include corneal cross-linking (CXL) candidacy and progression thresholds. Post-CXL care, they noted, varies depending on epithelial-on vs epithelial-off technique.

In addition, Drs. Alloju and Arcot discussed when to send the patient back for surgical options, as well as long-term co-management. Indications to re-refer, they said, include rapid progression, persistent inability to achieve functional acuity with specialty lenses, development of scarring, thinning, or hydrops, contact-lens intolerance from advanced ectasia or ocular surface disease, and post-surgical complications, such as decentered ablations, recurrent erosions, graft irregularity, or endothelial decline.

Long-term co-management, they said, focuses on annual (or semi-annual) stability checks, serial topographies and tomography, evaluating for late graft rejection, CXL retreatment, recurrent Salzmann’s degeneration (Figure 2a and 2b), or progression, and maintaining a healthy ocular surface to support lens wear. 

Infectious Keratitis

For infectious keratitis (Figure 3), Dr. Arcot noted that optometrists play a crucial triage role. For initial evaluation, she said to identify risk factors and determine if cultures are indicated. For early management, she noted to initiate treatment or coordinate immediate fortified therapy through the specialist. For comanagement for bacterial monitor epithelial closure and scarring; for fungal, co-manage longstanding therapy and watch for recurrence; and for herpetic, balance steroid tapering with antiviral coverage, she said.

Corneal Dystrophies and Degenerations

For dystrophies and degenerations, co-management ensures correct timing of surgical intervention, Dr. Alloju noted. For epithelial basement membrane dystrophy for recurrent erosions, she said, optimize lubrication, bandage CL, and consider superficial keratectomy or phototherapeutic keratectomy (PTK). For Fuchs’ dystrophy, she said to monitor guttae (Figure 4), corneal thickness, morning symptoms, and determine when to refer for Descemet's stripping endothelial keratoplasty (DSEK)/Descemet membrane endothelial keratoplasty (DMEK) (Figure 5). For Salzmann’s nodules, she said to treat ocular surface first, and refer for superficial keratectomy if visually significant.

“Post-operatively, optometrists manage epithelial healing, edema resolution, and refractive rehabilitation,” said Dr. Arcot. “A well-fit contact lens can minimize irregularity, improve surface quality, and delay the need for surgical intervention in many of these cases.”

Refractive Surgery Candidates: LASIK and PRK

For refractive surgery candidates, optometrists determine suitability before patients ever reach the surgical suite. As a result, Dr. Arcot said to identify forme fruste keratoconus, pellucid, or suspicious elevation patterns; treat ocular surface disease aggressively before referral to avoid inaccurate measurements; and post-operatively, manage photorefractive keratectomy (PRK) haze, refractive regression, chronic dryness, and flap striae (laser-assisted in situ keratomileusis [LASIK]).

“We are the long-term managers of refractive patients,” said Dr. Alloju. “They return to us annually, and we are often the first to detect late epithelial ingrowth, ectasia, or regression.”

Pre-Surgical Evaluation and Post-Operative Management

For pre-surgical evaluation, the presenters said to ensure the patient arrives at the surgeon’s doorstep optimized—topography/tomography to confirm stability; pachymetry for surgical candidacy; ocular surface optimization; and counseling patients on realistic expectations, anticipated recovery timelines, and possible need for glasses or lenses post-op.

The presenters noted that post-op responsibilities include possibly removing loose sutures or burping wounds; monitoring epithelial closure, haze, and inflammation; tapering steroids properly to avoid complications but prevent haze, identifying early graft rejection; coordinating enhancements; and supporting ocular surface healing long-term.

“Collaborative vigilance is key. A graft looks good until it doesn’t. That’s why follow-up by both providers matters,” Dr. Alloju stressed.