December 11, 2023 • 23 mins
Clearly KC host Dr. Melissa Barnett OD catches up with KC expert Dr. Andy Morgenstern OD who shares that his career in keratoconus was inspired when he first had access to pentacam tomography, a technology that visualizes the back (posterior) of the cornea. He also spoke of a soon-to-be published paper that used tomography to screen Chicagoland students to reveal the prevalence of pediatric KC in the US is much higher than previously predicted.
As co-founder of International Keratoconus Academy for Eye Care Professionals, Dr. Morgenstern shared details of the upcoming IKA symposium for optometrists and ophthalmologists on May 18-19, 2024 in Bethesda, MD. For more information, visit www.gotoper.com/AM-IKA
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Episode Transcript
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(00:06):
Welcome to Clearly KC, a podcast by the National Keratoconus Foundation, featuring information about life with keratoconus.
I'm your host, Dr.
Melissa Barnett, and I am so excited to introduce you to my good friend and colleague, Dr. 4 00:00:20,989.999 --> 00:00:22,320 Andy Morgenstern.
And gosh, we've known each other for so long.
And I was trying to think way back, to how we started working together, but it's been so many years that maybe you can refresh my memory.
(00:33):
Dr.
Morgenstern serves as an optometrist at the Walter Reed National Military Medical Center in Bethesda, Maryland, and concurrently holds the position of director for the American Optometric Association's Evidence Based Clinical Practice Guideline Development Group.
.9995He also holds the distinction of being one of the pioneering principal investigators For epithelium on corneal collagen cross linking in the United States, but beyond his clinical work He co founded the International Keratoconus Academy of eye care professionals alongside. 10 00:01:08,729.9995 --> 00:01:27,120 Dr Barry Aydin who was previously on the Clearly KC podcast and he's made significant contributions to the field through co authoring numerous papers and actively engaging in teaching and educating on keratoconus and ectatic diseases Welcome, Andy.
(01:28):
Thank you so much, Melissa.
I just want to thank you for bringing me on to the podcast.
We've gotten great reviews about it, and I know that NKCF puts this together, and what a great organization the National Keratoconus Foundation is.
.9995I couldn't be more proud to be the next in line as a guest on the Melissa Barnett podcast today. 15 00:01:48,430.0005 --> 00:01:50,273.90022676 Well, thank you so much for here. 16 00:01:51,103.90022676 --> 00:02:02,12.5405 Talk about Keratoconus, and what was that pivotal moment that drew you in to make Keratoconus a focus of your career? It's a really good question. 17 00:02:02,62.5405 --> 00:02:03,702.5405 we're not that old, by the way. 18 00:02:03,782.5405 --> 00:02:06,852.54 I still think we're well in our young thirties right now. 19 00:02:06,852.54 --> 00:02:08,472.5405 So we don't have much experience. 20 00:02:08,672.5405 --> 00:02:09,602.5405 We'll pretend that's great. 21 00:02:09,802.5405 --> 00:02:10,422.5405 We'll pretend. 22 00:02:10,762.5395 --> 00:02:17,762.5375 Earlier in my career, I cut my teeth in optometry and ophthalmology, really in the refractive surgery world. 23 00:02:17,802.5375 --> 00:02:27,192.5375 And since I got out of school, I was in the refractive surgery space and, I was working for a company called TLC Laser Eye Centers, in the Washington, D. 24 00:02:27,192.5375 --> 00:02:27,412.537 C. 25 00:02:27,412.537 --> 00:02:27,862.5365 area. 26 00:02:28,242.5375 --> 00:02:35,312.5375 And in 2005, we obtained a device called a Pentacam, made by Oculus. 27 00:02:35,312.5375 --> 00:02:39,552.5375 And I do have to say that I don't have any financial, income to report from Oculus. 28 00:02:40,2.5375 --> 00:02:41,952.5375 I'm just saying that this is the device that we had. 29 00:02:42,382.5375 --> 00:02:43,762.5375 That was in 2005. 30 00:02:44,707.5375 --> 00:02:45,227.5375 Wow. 31 00:02:45,237.5375 --> 00:02:57,207.5375 Was that a wake up call? At the time in refractive surgery, we were only using a corneal topographer, a placido disc topographer to screen our patients for eligibility of refractive surgery. 32 00:02:57,577.5375 --> 00:03:04,777.5375 And, of course we had a lot of ectatic patients and we didn't know why because we really were not looking at the back surface of the cornea. 33 00:03:05,227.5375 --> 00:03:12,247.5375 Well, when I got my panic cam for the first time in my life, I got to see the backside of the cornea. 34 00:03:12,567.5375 --> 00:03:17,427.5375 And I got to see what elevation mapping was versus just curvature mapping. 35 00:03:17,817.5375 --> 00:03:22,567.537 And we got to learn in real time, before anybody was teaching us. 36 00:03:22,567.537 --> 00:03:24,367.537 We got a box from Germany. 37 00:03:24,937.538 --> 00:03:27,7.538 It was unpacked, plugged into the wall. 38 00:03:27,37.538 --> 00:03:37,97.538 And for all intents and purposes, Yes, it came with a manual, of course, but nobody else around me had a Pentacam, so I couldn't really discuss what I was looking at. 39 00:03:37,117.538 --> 00:03:47,787.5395 And so, between all of us, cornea folks that were playing around with this thing, and obviously learning through some of the engineers at Oculus back in Germany, we really had to teach ourselves what we were looking at. 40 00:03:48,217.5395 --> 00:03:53,597.5395 And oh my gosh, it opened up a whole world of what cornea was and corneal shape was. 41 00:03:54,87.5395 --> 00:04:00,667.5395 And corneal elevation and corneal disease and where the disease of keratoconus really originates from. 42 00:04:01,117.5395 --> 00:04:10,807.5385 I will say it really started putting a lot of pictures together because when I was in optometry school, Heidi Wagner was my cornea contact lens professor at Nova Southeastern. 43 00:04:11,157.5395 --> 00:04:17,207.5395 And she was a main, investigator for the CLEC study, the Collaborative Longitudinal Evaluation of Keratoconus. 44 00:04:17,567.5395 --> 00:04:20,867.5395 And so while I was a student, I didn't even know what CLEC was. 45 00:04:20,867.5395 --> 00:04:25,117.5385 I know I had to be part of it and I knew that we were doing a study for the big professor. 46 00:04:25,167.5385 --> 00:04:32,497.5395 When I got my Pentacam and really started to evaluate this stuff and really started to learn what was going on with cornea, that was my gotcha moment. 47 00:04:32,497.5395 --> 00:04:34,487.5395 And to be honest with you, I've been so. 48 00:04:35,167.5395 --> 00:04:43,517.5395 Enamored with this disease and this disease process and all the diagnostic technical improvements that have happened over the years. 49 00:04:43,987.5395 --> 00:04:57,587.5405 And quite frankly, the excitement of my colleagues like you and all the others that we get to hang out with all the time, it's become a passion and it's become something that I think none of us are in it for, the financial reward. 50 00:04:57,587.5405 --> 00:05:00,537.5395 I think everybody is genuinely in it because they're really. 51 00:05:00,957.5405 --> 00:05:12,437.5415 interested in what this disease is and how our patients are suffering and how we can help them with the right diagnostic technology and treatment methods. 52 00:05:13,177.5405 --> 00:05:21,317.5415 Wow, I completely agree and even now I think that corneal tomography is absolutely mind blowing. 53 00:05:21,887.5415 --> 00:05:33,242.5415 Like to be able to image the posterior cornea and to see Keratoconus just pop out like, oh, it's so obvious because we have corneal tomography versus corneal topography. 54 00:05:33,592.5415 --> 00:05:37,122.5415 I still think it's magical it's absolutely amazing. 55 00:05:37,182.5415 --> 00:05:42,842.5415 And we can measure so many other things too, not just the posterior cornea as you mentioned, but, wow. 56 00:05:42,842.5415 --> 00:05:43,982.5415 2005. 57 00:05:44,312.5415 --> 00:05:44,702.5415 That's amazing. 58 00:05:45,47.5415 --> 00:05:49,597.5415 I wrote my first article, It's Googleable, I guess, in 2007. 59 00:05:49,947.5415 --> 00:05:55,207.5415 And I think the title of the article was Elevate Yourself Above Other ODs. 60 00:05:55,567.5415 --> 00:06:00,207.541 And really it was my wow article that holy cow, this is what you can see on the cornea. 61 00:06:00,647.541 --> 00:06:06,407.541 And this is what our colleagues can't because of this technology not really being mainstream. 62 00:06:06,542.641 --> 00:06:29,822.6415 I think you would agree, Melissa, that part of our mission when we go out and lecture to our colleagues, both in optometry and ophthalmology is to preach the optometric ophthalmological gospel of elevation technology and looking at that back surface of the cornea and trying to identify this disease as early as possible and using the right technology because The only thing it does is help the patient in the long run. 63 00:06:30,962.6415 --> 00:06:31,662.6415 Exactly. 64 00:06:31,932.6415 --> 00:06:35,772.6415 We can do better for our patients, with this amazing technology. 65 00:06:36,902.6415 --> 00:06:48,962.6405 So, what inspired you to start IKA with Barry and why was it so important that you did? iT's a great question because it's really a continuation of what we just spoke about. 66 00:06:48,962.6405 --> 00:06:55,602.6405 Barry and I actually came from two different places within eye care to form IK a. 67 00:06:55,882.6405 --> 00:07:11,492.642 And so what happened was, you have this kind of, mind blown moment of looking at the backside of the cornea, learning more about the disease, learning about the disease ideology and understanding that this technology is available, but not, necessarily tremendously accessible. 68 00:07:11,852.642 --> 00:07:13,682.642 to every one of our colleagues. 69 00:07:13,952.642 --> 00:07:28,382.642 What happened on my end, I went from working at TLC to being asked to join a practice where a doctor, was inventing the first mainstream epi on cross linking device in the United States. 70 00:07:28,542.642 --> 00:07:31,192.642 And, so I became the principal investigator for that. 71 00:07:31,202.642 --> 00:07:33,527.542 That was around 2009 2010. 72 00:07:34,7.642 --> 00:08:08,202.642 What happened was now we had cross linking, which was an actual treatment, as we all know, to either halt or slow down the progression of corneal ectasia, post refractive surgical ectasia, keratoconus, and that family of diseases, and so the technology was outpacing the education and that was a problem because not only do you have a way to Diagnose these patients earlier and earlier and earlier, but the earlier you diagnose it, the earlier you can cross-link someone and stop the disease from getting worse. 73 00:08:08,322.642 --> 00:08:14,142.642 It was almost like having the polio vaccine, but nobody knew that the vaccine was in doctor's offices. 74 00:08:14,422.642 --> 00:08:20,312.642 I wanted to, because I was seeing what was going on early with cross linking, get that information out there. 75 00:08:20,582.642 --> 00:08:29,542.643 So to be perfectly honest with the entire world listening to this podcast, I went me, myself and I went to Baltimore, to the state house and started an LLC. 76 00:08:30,312.643 --> 00:08:42,472.642 I started a corporation called the Optometric Crosslinking Society quite frankly, I didn't want optometry to be held out of the world of crosslinking because I knew it was going to become a very viable option for us one day, which I still think it will. 77 00:08:42,512.642 --> 00:08:53,912.644 We'll discuss that hopefully in the future So I really entered this from the crosslinking side that we wanted optometrists to be a major piece of the puzzle to crosslinking because it seems so optometrically friendly. 78 00:08:54,372.644 --> 00:08:57,222.644 Well, Barry was at the same exact time. 79 00:08:57,632.644 --> 00:09:05,972.644 Looking at keratoconus from the contact lens side, and I know he's a past AOA cornea contact lens chair, and, we're just friends and we got to talking. 80 00:09:05,982.644 --> 00:09:10,772.6435 He said, hey, I've got this group that's working on the contact lens side of keratoconus. 81 00:09:10,772.6435 --> 00:09:14,382.6435 And I said, well, I've got this group that's working with the cross linking side of keratoconus. 82 00:09:14,382.6435 --> 00:09:17,462.643 He said, let's just merge together and work together on all this stuff. 83 00:09:17,782.643 --> 00:09:26,122.642 That was the genesis of IKA, really to look at the disease of keratoconus, not from the optometry side, not from the ophthalmology side, but from both sides. 84 00:09:26,507.643 --> 00:09:28,147.643 Because this is about the disease. 85 00:09:28,147.643 --> 00:09:30,547.643 It's not about the practitioner providing the care. 86 00:09:30,547.643 --> 00:09:32,727.643 It's about the patient in the end. 87 00:09:33,97.643 --> 00:09:45,117.644 And so what we wanted to do was raise the level of education, to both doctors and patients and anybody who wants to listen, quite frankly, about how to best treat and manage this disease. 88 00:09:45,147.644 --> 00:09:46,197.644 And that was 10 years ago. 89 00:09:46,197.644 --> 00:09:49,117.644 That was in 2013 that we formed together. 90 00:09:49,117.644 --> 00:09:50,547.644 We hit our 10 year anniversary. 91 00:09:50,927.644 --> 00:10:00,267.644 And on our 10 year anniversary, we had our first in person two day conference in Scottsdale, Arizona we're having our second one coming up and, it's just been wildly successful. 92 00:10:00,317.644 --> 00:10:10,672.645 We really think that along with your work, Melissa and Mary Pruden's work at NKCF and everybody else, that we've made a difference in educating our colleagues, to help their patients. 93 00:10:12,272.645 --> 00:10:13,502.645 How fantastic. 94 00:10:13,502.645 --> 00:10:17,32.645 So tell us about the IKA KC Symposium that's coming up. 95 00:10:17,222.645 --> 00:10:17,572.645 Awesome. 96 00:10:17,572.645 --> 00:10:19,452.645 I'm so glad you asked. 97 00:10:19,772.645 --> 00:10:24,572.644 We're having our, IKA, International Care Dakotas Academy of Eye Care Professionals. 98 00:10:24,932.644 --> 00:10:31,752.644 Second annual in person and virtual, but in person, if you want to come, today. 99 00:10:32,237.644 --> 00:10:35,927.644 maybe even a little bit more, but we're wink, wink talking about that one. 100 00:10:35,947.644 --> 00:10:37,257.644 See if we can extend it a little bit. 101 00:10:37,597.644 --> 00:10:42,437.645 We're gonna have a two day in person, Karatacona Symposium with really the best of the best of the best. 102 00:10:42,437.645 --> 00:10:46,197.644 And of course, we couldn't have the best of the best of the best without having Melissa Barnett lecture. 103 00:10:46,457.645 --> 00:10:47,767.645 So I know that you'll be at the podium. 104 00:10:48,227.645 --> 00:10:49,97.645 And Mary as well. 105 00:10:49,107.645 --> 00:10:55,692.645 Mary, Pruden from NKCF will be there representing the organization because we need that patient advocacy as well. 106 00:10:56,62.645 --> 00:10:59,632.6445 so it's really, the best and the brightest from, the field of keratoconus. 107 00:10:59,652.6455 --> 00:11:08,672.6455 We have, docs from Baskin Pomeroy Institute, from Wilmer Eye Institute, from Case Western Reserve, from Duke Ophthalmology, from University of Iowa Department of Ophthalmology. 108 00:11:08,932.6455 --> 00:11:10,852.6455 We have great docs from private practice. 109 00:11:11,527.6455 --> 00:11:16,717.6455 We have docs that actually invented some of the software and the hardware on these devices that we use all the time. 110 00:11:17,7.6455 --> 00:11:21,217.6465 we have patient advocates there, our first one, Barry and I were nervous. 111 00:11:21,217.6465 --> 00:11:26,627.647 We didn't know how the reception would be, of course, with anything first, and, we really knocked it out of the park. 112 00:11:26,627.647 --> 00:11:31,487.6475 We had a, packed room and we had tons of people online listening in, and, people waiting for the second one. 113 00:11:31,487.6475 --> 00:11:33,587.6465 So this one is going to be in Bethesda, Maryland. 114 00:11:34,82.6475 --> 00:11:40,562.6475 It was strategically chosen to be in Bethesda, Maryland, because it's close to my house. 115 00:11:42,582.6465 --> 00:11:43,622.6475 That's strategic. 116 00:11:43,672.6465 --> 00:11:48,662.6475 Yes, but I will say, yes, yeah, and great for me, finally, I don't have to travel. 117 00:11:48,892.6465 --> 00:11:53,442.6475 But quite frankly, the reason why it is in Bethesda, Maryland is because, A, it's, a suburb of Washington, D. 118 00:11:53,442.6475 --> 00:11:53,812.6475 C. 119 00:11:54,107.6475 --> 00:11:56,347.6475 We have three airports that serve the area. 120 00:11:56,597.6475 --> 00:11:58,497.6475 we have metro access to get you downtown. 121 00:11:58,497.6475 --> 00:12:01,37.6475 It's a beautiful hotel and conference center. 122 00:12:01,37.6475 --> 00:12:05,147.6475 There's a walking mall right next door with all the great stuff that everybody can do. 123 00:12:05,177.6475 --> 00:12:07,547.6475 It really is a hub of information in the Washington, D. 124 00:12:07,547.6475 --> 00:12:07,717.6475 C. 125 00:12:07,717.6475 --> 00:12:07,997.6475 area. 126 00:12:07,997.6485 --> 00:12:17,957.6485 We're right down the street from the National Institute of Health, Walter Reed National Military Medical Center, National Library of Medicine, all within a mile or two of where our venue is. 127 00:12:17,957.6485 --> 00:12:19,597.6485 So we thought it was an excellent choice. 128 00:12:19,597.6485 --> 00:12:20,877.6485 We were on the west coast last year. 129 00:12:20,877.6485 --> 00:12:22,347.6485 We want to be on the east coast this year. 130 00:12:22,347.6485 --> 00:12:26,177.6485 We'll probably be moving around so we can share the knowledge with other people in the future. 131 00:12:26,967.6485 --> 00:12:27,557.6485 Oh, fantastic. 132 00:12:27,817.6485 --> 00:12:28,757.6485 Shameless plug. 133 00:12:29,117.6485 --> 00:12:32,547.6485 www dot G. 134 00:12:32,617.6475 --> 00:12:33,77.6475 O. 135 00:12:33,217.6485 --> 00:12:33,557.6485 T. 136 00:12:33,607.6485 --> 00:12:33,927.6485 O. 137 00:12:33,977.6485 --> 00:12:34,267.6485 P. 138 00:12:34,267.6485 --> 00:12:34,457.6485 E. 139 00:12:34,487.6475 --> 00:12:34,957.6475 R. 140 00:12:35,577.6485 --> 00:12:38,207.6485 Forward slash A. 141 00:12:38,207.6485 --> 00:12:38,557.6485 M. 142 00:12:38,607.6475 --> 00:12:39,257.6485 Hyphen I. 143 00:12:39,267.6475 --> 00:12:39,537.6475 K. 144 00:12:39,537.6485 --> 00:12:39,817.6485 A. 145 00:12:39,867.6485 --> 00:12:42,607.6475 Go to per dot com forward slash A. 146 00:12:42,607.6485 --> 00:12:42,957.6485 M. 147 00:12:43,627.6485 --> 00:12:45,187.6485 Slash hyphen I. 148 00:12:45,187.6485 --> 00:12:45,467.6485 K. 149 00:12:45,467.6485 --> 00:12:45,757.6485 A. 150 00:12:46,227.6485 --> 00:12:48,497.6485 But hopefully we could put that on the screen because that was tough. 151 00:12:49,897.6485 --> 00:12:50,317.6485 Excellent. 152 00:12:50,327.6485 --> 00:12:52,657.6485 We'll share the link with this podcast as well. 153 00:12:52,657.6485 --> 00:12:57,467.6485 And I'm so excited for this coming up next year. 154 00:12:58,467.6485 --> 00:12:59,97.6485 Oh, I'm sorry. 155 00:12:59,737.6485 --> 00:13:01,777.6485 May 18th and 19th, 2024. 156 00:13:01,797.6485 --> 00:13:02,447.6485 I forgot to tell you that. 157 00:13:03,967.6475 --> 00:13:05,317.6485 That's a very important piece. 158 00:13:05,317.7485 --> 00:13:06,187.6485 A little important. 159 00:13:06,197.6485 --> 00:13:06,427.6485 Yep. 160 00:13:06,957.6485 --> 00:13:07,267.6485 Yeah. 161 00:13:08,677.6485 --> 00:13:17,617.6485 So Andy, I understand that you're part of a group that has recently submitted a paper for publication on the pediatric prevalence of keratoconus in the United States. 162 00:13:18,267.6485 --> 00:13:24,657.6485 Can you share with us more about why you undertook this study and how the results will impact eye care? Sure. 163 00:13:24,657.6485 --> 00:13:34,197.6485 first off, Melissa, as we always do, I always want to thank my coauthors and acknowledge that I was not the first author on this paper that, Dr. 164 00:13:34,197.6485 --> 00:13:34,987.6485 Jen Harthan. 165 00:13:35,507.6485 --> 00:13:44,417.6485 out of the Illinois College of Optometry, was the first author the entire group did a wonderful job and we have great representation from all of our authors and experts and in their own right. 166 00:13:44,797.6485 --> 00:13:58,207.651 So basically, we talked about the Pentacam, we talked about IKA, and one of the things that I realized pretty early on at my practice at TLC was, We have patients come in and I'm sure this would happen to you as well. 167 00:13:58,487.651 --> 00:14:14,17.65 I know you're in a vibrant, academic institution, tons of patients, lots of specialty clinic patients, you have patient number one comes in and you diagnose them with keratoconus, through some sort of device like a pentacam and you tell the patient stop rubbing your eyes. 168 00:14:14,17.65 --> 00:14:15,637.65 We have to, talk contact lenses. 169 00:14:15,637.65 --> 00:14:17,207.65 We may have to talk cross linking. 170 00:14:17,657.649 --> 00:14:37,122.65 But really what we want to talk about what's most important is that there is a genetic component to this disease and that other family members potentially could either have it and not express it yet or have it and think that they have some other type of refractive error and they're not aware that they have the disease. 171 00:14:37,142.65 --> 00:14:42,572.65 And so one of the things that we did at TLC very early on was to say, Hey, come on in. 172 00:14:42,992.65 --> 00:14:51,482.651 Let's just take a quick panic cam on your biological siblings, or if you're an adult, which most, LASIK patients are because they have to be over 21. 173 00:14:52,422.651 --> 00:14:58,117.651 The average demographic of a LASIK patient at its heyday was about 37, 38 years old and female. 174 00:14:58,347.651 --> 00:15:01,347.651 And generally speaking that they were a mother of two. 175 00:15:01,467.651 --> 00:15:03,387.651 And we looked at those demographics really hard. 176 00:15:03,387.651 --> 00:15:10,747.651 So, we said, Hey, bring those kiddos in here and let's do a quick screening on them to see if they're showing any signs. 177 00:15:10,777.652 --> 00:15:14,267.652 Lo and behold, guess what we found? We found kids with keratoconus. 178 00:15:14,367.652 --> 00:15:25,777.652 But the literature, speaking on behalf of myself, not the young Melissa Barnett, but the elder literature, when I went through optometry school told me that keratoconus was a disease of the second to third decade of life. 179 00:15:26,257.652 --> 00:15:30,157.651 And, well guess what? Now I've got kids in my office with the disease. 180 00:15:30,167.65 --> 00:15:32,337.651 So, therefore, they're wrong. 181 00:15:32,797.651 --> 00:15:33,487.651 and I'm right. 182 00:15:33,847.651 --> 00:15:36,637.652 And because the technology that was used back then. 183 00:15:36,947.652 --> 00:15:39,407.652 was inferior to what we're using now. 184 00:15:39,417.652 --> 00:15:41,707.652 Now we're detecting earlier and earlier and earlier. 185 00:15:42,77.652 --> 00:15:43,67.652 Barry and I through I. 186 00:15:43,77.652 --> 00:15:43,347.652 K. 187 00:15:43,347.652 --> 00:15:43,527.652 A. 188 00:15:43,527.652 --> 00:15:54,537.652 And some of our colleagues like Bill too low and we talked about it with you and John Gellies and Loretta Flynn and Chris sent and the whole bunch of us and some of the ophthalmologists as well. 189 00:15:55,187.652 --> 00:15:57,277.652 We're saying, this disease does take place. 190 00:15:57,797.652 --> 00:15:59,257.652 In the pediatric population. 191 00:15:59,547.652 --> 00:16:04,167.652 But how rare is it? how often does it happen? And so we went a literature searching. 192 00:16:04,267.652 --> 00:16:05,817.652 That's what nerds like us like to do. 193 00:16:05,827.651 --> 00:16:07,557.652 We go looking for the papers. 194 00:16:07,917.652 --> 00:16:13,207.651 And guess what we found? We found nothing in the United States. 195 00:16:13,507.652 --> 00:16:15,577.651 We found maybe one paper in the Middle East. 196 00:16:15,837.652 --> 00:16:18,687.652 it was a good paper, and it started a conversation. 197 00:16:18,697.652 --> 00:16:21,537.652 However, it wasn't as accurate as we wanted it to be. 198 00:16:21,797.652 --> 00:16:37,277.6515 And so what we said, we got to find this out because if we have a cross linking device in this country now that can halt or slow down the progression of this disease and we have kids losing vision, it really is incumbent upon us to be aware of what that population is. 199 00:16:37,587.6515 --> 00:16:46,997.5535 And so we went out and we talked to Oculus and they donated access to Pentacams, through folks like Sandy Block and Jen Harthan at ICO. 200 00:16:47,207.6535 --> 00:16:53,737.6535 We gained access to their population of patients that they have an agreement with in the Chicago public school system. 201 00:16:54,127.6535 --> 00:17:03,787.6525 And what we were able to do with a perfectly intact IRB and parent, authorization to screen these kids, we did everything a hundred percent by the book. 202 00:17:04,227.6525 --> 00:17:08,857.6525 We looked at children between the ages of three and 18 years old. 203 00:17:09,202.6525 --> 00:17:11,592.6525 it was largely a black and Hispanic population. 204 00:17:11,592.6525 --> 00:17:25,392.6535 We looked at well over 4, 000, eyes and we use the algorithm set up by Bellin and Ambrosio on what was determined to be a keratoconus patient based on the results of the studies and also a keratoconus suspect. 205 00:17:25,392.6535 --> 00:17:28,742.6535 So we try to identify who was a suspect for keratoconus at that age. 206 00:17:29,7.6535 --> 00:17:31,557.6535 And then who actually had, diagnosable disease. 207 00:17:31,787.6535 --> 00:17:43,47.5545 And we found, a significant prevalence within the pediatric population, this prospective observational study, to the tune of less than 1 in 400. 208 00:17:43,867.6545 --> 00:17:48,977.6545 Kids between the ages of three and 18 years old, had the disease of keratoconus. 209 00:17:49,257.6545 --> 00:17:59,427.6535 And if you combine kids with keratoconus and keratoconus suspects in this population, it was less than one in 200 kids. 210 00:17:59,867.6545 --> 00:18:04,777.6545 Obviously our eyes lit up and were wide open that we said, the intention was to write the paper. 211 00:18:05,147.6545 --> 00:18:07,97.6545 But now that we have the data. 212 00:18:07,532.6545 --> 00:18:43,937.654 And it is submitted, and it was approved, and it's going to be published in a journal called Eye and Contact Lens any day now, if anybody wants to, knock on their door and say hurry up, we'd greatly appreciate it, but it is going to be published out there, and, what we hope it does is really kick down the door for other people to do research on this population as well, and to give the tools to organizations like the National Keratoconus Foundation, and to advocate for kids to get these necessary eye exams so we can detect this disease and treat this disease as early as possible. 213 00:18:44,487.654 --> 00:18:54,347.654 Understanding too that keratoconus in the pediatric population is different in my opinion than it is in the adult population I'd love to hear what you have to say. 214 00:18:54,367.654 --> 00:18:57,287.654 I've been yapping, yapping, yapping this whole time here, Melissa. 215 00:18:57,587.654 --> 00:19:11,172.654 I don't know what you do, but my personal opinion is if I even suspect a kid of having keratoconus, the longest I will let them go before coming back for an additional exam is six months more. 216 00:19:11,322.654 --> 00:19:16,242.653 I lean to the three month side just because the disease is so aggressive in the pediatric. 217 00:19:16,672.654 --> 00:19:17,292.654 population. 218 00:19:17,342.654 --> 00:19:19,962.654 Yes, I completely agree. 219 00:19:20,2.654 --> 00:19:26,632.654 And Dr Marguerite McDonald was on the clearly Casey podcast to talk about age and care to cut us and she agrees to. 220 00:19:26,632.654 --> 00:19:32,472.653 So in, that pediatric population, we really want to monitor our patients very closely. 221 00:19:32,472.653 --> 00:19:35,162.654 So I agree 34 months instead of six months. 222 00:19:35,452.654 --> 00:19:42,22.654 It also depends on how old they are and if we're expecting changes, which oftentimes we do. 223 00:19:42,307.654 --> 00:19:46,207.654 In these kids, but wow, what a fantastic study. 224 00:19:46,217.654 --> 00:20:01,587.653 I'm so proud of all of you for doing this study and bringing this information and sharing it with all of us because it's so important for all kids and everyone to actually evaluate for Keratoconus. 225 00:20:03,97.653 --> 00:20:04,767.654 Yeah, I completely agree with you. 226 00:20:04,807.654 --> 00:20:19,37.555 I'll take it one step further at our last meeting, the IKA symposium in Scottsdale We had Mike Bellin at the podium, and he was obviously talking about his analytic software for the Pentacam, the, Bellin Ambrosio display that he created. 227 00:20:19,607.555 --> 00:20:21,317.555 And I asked the question,, Dr. 228 00:20:21,317.555 --> 00:20:27,837.555 Bellin, in a perfect world, let's say all eye care providers did have a Pentacam or some sort of. 229 00:20:28,202.555 --> 00:20:31,762.555 Chime fluke, posterior elevation technique, even if it's an O. 230 00:20:31,762.555 --> 00:20:31,982.555 C. 231 00:20:31,982.555 --> 00:20:32,282.555 T. 232 00:20:32,292.555 --> 00:20:34,902.555 That can measure the posterior elevation of the cornea. 233 00:20:35,652.555 --> 00:20:54,802.555 Should a child have a screening exam at some point in their life? Should it be mandatory for all kids based on what we think the prevalence of the disease is? Is that a yes or no? Should they have it? And if so, at round what age And his answer was a definitive yes in a perfect world. 234 00:20:54,822.555 --> 00:20:57,452.555 Assuming all I doctors had this great technology. 235 00:20:57,822.555 --> 00:20:58,852.555 He said, absolutely. 236 00:20:58,852.555 --> 00:21:01,982.555 Yes, because the disease is so highly prevalent in the population. 237 00:21:02,402.555 --> 00:21:04,282.554 And kids are not born. 238 00:21:04,302.554 --> 00:21:06,332.554 Babies are not born with keratoconus. 239 00:21:06,912.554 --> 00:21:08,922.555 They develop keratoconus. 240 00:21:08,982.554 --> 00:21:14,382.554 And so, we know right around that puberty age is where the magic happens. 241 00:21:14,382.554 --> 00:21:27,892.554 And so his answer was somewhere between the ages of 10 to 12, 10 to 13 years old, all kids in a perfect world should have some mapping of the backside of their corneas to see if they do, express this disease at its earliest phase. 242 00:21:28,292.554 --> 00:21:33,972.554 That was mind blowing to me, you've heard me and barry say this a ton of times, and I'm sure you've said it a ton of times. 243 00:21:34,42.554 --> 00:21:38,742.554 We do exams on kids that are not high yield result exams all the time. 244 00:21:39,272.554 --> 00:21:42,372.553 Take glaucoma, for instance, and an otherwise healthy child. 245 00:21:42,942.554 --> 00:21:45,242.554 How many times have you done an I. 246 00:21:45,242.554 --> 00:21:45,352.554 O. 247 00:21:45,352.554 --> 00:21:45,622.5535 P. 248 00:21:45,622.5535 --> 00:21:50,872.553 Check on a pediatric patient? The answer is everybody does it all the time. 249 00:21:51,222.553 --> 00:22:01,332.554 Well, how many times have you ever found the disease of pediatric glaucoma and that otherwise healthy population? Most people will say never, and some people say really rarely. 250 00:22:01,592.554 --> 00:22:05,682.553 I'm not saying that you should not check IOP on kids, I'm not saying that at all. 251 00:22:05,922.554 --> 00:22:14,352.555 I'm saying that is a test that is done routinely on almost every kid during a comprehensive annual eye exam that yields no positive disease. 252 00:22:14,992.555 --> 00:22:16,152.555 What we're saying is. 253 00:22:16,152.555 --> 00:22:21,352.555 We want kids to get screened for the diseases that they are more likely to have because we can do something about it. 254 00:22:21,362.555 --> 00:22:25,682.555 And that's why it's so important for this pediatric prevalence study to kind of hit the road. 255 00:22:27,437.555 --> 00:22:31,911.3289259 When I say hit the road, I mean hit the road and everybody read it, not get out of it. 256 00:22:31,911.3289259 --> 00:22:34,124.5952593 Hit the road so we can image all kids. 257 00:22:34,124.5952593 --> 00:22:34,616.4322222 Imagine this. 258 00:22:34,616.4322222 --> 00:22:40,527.9625926 Hopefully this will be the practice in the future where we do image every child, and image their posterior cornea. 259 00:22:41,197.9635926 --> 00:22:50,157.9635926 Well, Andy, gosh, I know that we can talk for eight more hours on this because we are so passionate about the subjects and. 260 00:22:50,382.9635926 --> 00:22:55,982.8635926 I really sincerely want to thank you so much for joining us on the Clearly KC podcast. 261 00:22:55,982.9635926 --> 00:22:57,692.9635926 Thank you all for listening. 262 00:22:57,972.9635926 --> 00:23:07,592.9645926 Please listen to all the episodes on the Clearly KC podcast on Podbean or your favorite podcast app to subscribe and get future episodes. 263 00:23:07,742.9635926 --> 00:23:09,922.9635926 So until next time, I'm Dr. 264 00:23:09,922.9635926 --> 00:23:14,762.8635926 Melissa Barnett and see you soon on the Clearly KC podcast. 265 00:23:14,762.9635926 --> 00:23:15,52.9635926 Bye.
Welcome to Clearly KC, a podcast by the National Keratoconus Foundation, featuring information about life with keratoconus.
I'm your host, Dr.
Melissa Barnett, and I am so excited to introduce you to my good friend and colleague, Dr. 4 00:00:20,989.999 --> 00:00:22,320 Andy Morgenstern.
And gosh, we've known each other for so long.
And I was trying to think way back, to how we started working together, but it's been so many years that maybe you can refresh my memory.
(00:33):
Dr.
Morgenstern serves as an optometrist at the Walter Reed National Military Medical Center in Bethesda, Maryland, and concurrently holds the position of director for the American Optometric Association's Evidence Based Clinical Practice Guideline Development Group.
.9995He also holds the distinction of being one of the pioneering principal investigators For epithelium on corneal collagen cross linking in the United States, but beyond his clinical work He co founded the International Keratoconus Academy of eye care professionals alongside. 10 00:01:08,729.9995 --> 00:01:27,120 Dr Barry Aydin who was previously on the Clearly KC podcast and he's made significant contributions to the field through co authoring numerous papers and actively engaging in teaching and educating on keratoconus and ectatic diseases Welcome, Andy.
(01:28):
Thank you so much, Melissa.
I just want to thank you for bringing me on to the podcast.
We've gotten great reviews about it, and I know that NKCF puts this together, and what a great organization the National Keratoconus Foundation is.
.9995I couldn't be more proud to be the next in line as a guest on the Melissa Barnett podcast today. 15 00:01:48,430.0005 --> 00:01:50,273.90022676 Well, thank you so much for here. 16 00:01:51,103.90022676 --> 00:02:02,12.5405 Talk about Keratoconus, and what was that pivotal moment that drew you in to make Keratoconus a focus of your career? It's a really good question. 17 00:02:02,62.5405 --> 00:02:03,702.5405 we're not that old, by the way. 18 00:02:03,782.5405 --> 00:02:06,852.54 I still think we're well in our young thirties right now. 19 00:02:06,852.54 --> 00:02:08,472.5405 So we don't have much experience. 20 00:02:08,672.5405 --> 00:02:09,602.5405 We'll pretend that's great. 21 00:02:09,802.5405 --> 00:02:10,422.5405 We'll pretend. 22 00:02:10,762.5395 --> 00:02:17,762.5375 Earlier in my career, I cut my teeth in optometry and ophthalmology, really in the refractive surgery world. 23 00:02:17,802.5375 --> 00:02:27,192.5375 And since I got out of school, I was in the refractive surgery space and, I was working for a company called TLC Laser Eye Centers, in the Washington, D. 24 00:02:27,192.5375 --> 00:02:27,412.537 C. 25 00:02:27,412.537 --> 00:02:27,862.5365 area. 26 00:02:28,242.5375 --> 00:02:35,312.5375 And in 2005, we obtained a device called a Pentacam, made by Oculus. 27 00:02:35,312.5375 --> 00:02:39,552.5375 And I do have to say that I don't have any financial, income to report from Oculus. 28 00:02:40,2.5375 --> 00:02:41,952.5375 I'm just saying that this is the device that we had. 29 00:02:42,382.5375 --> 00:02:43,762.5375 That was in 2005. 30 00:02:44,707.5375 --> 00:02:45,227.5375 Wow. 31 00:02:45,237.5375 --> 00:02:57,207.5375 Was that a wake up call? At the time in refractive surgery, we were only using a corneal topographer, a placido disc topographer to screen our patients for eligibility of refractive surgery. 32 00:02:57,577.5375 --> 00:03:04,777.5375 And, of course we had a lot of ectatic patients and we didn't know why because we really were not looking at the back surface of the cornea. 33 00:03:05,227.5375 --> 00:03:12,247.5375 Well, when I got my panic cam for the first time in my life, I got to see the backside of the cornea. 34 00:03:12,567.5375 --> 00:03:17,427.5375 And I got to see what elevation mapping was versus just curvature mapping. 35 00:03:17,817.5375 --> 00:03:22,567.537 And we got to learn in real time, before anybody was teaching us. 36 00:03:22,567.537 --> 00:03:24,367.537 We got a box from Germany. 37 00:03:24,937.538 --> 00:03:27,7.538 It was unpacked, plugged into the wall. 38 00:03:27,37.538 --> 00:03:37,97.538 And for all intents and purposes, Yes, it came with a manual, of course, but nobody else around me had a Pentacam, so I couldn't really discuss what I was looking at. 39 00:03:37,117.538 --> 00:03:47,787.5395 And so, between all of us, cornea folks that were playing around with this thing, and obviously learning through some of the engineers at Oculus back in Germany, we really had to teach ourselves what we were looking at. 40 00:03:48,217.5395 --> 00:03:53,597.5395 And oh my gosh, it opened up a whole world of what cornea was and corneal shape was. 41 00:03:54,87.5395 --> 00:04:00,667.5395 And corneal elevation and corneal disease and where the disease of keratoconus really originates from. 42 00:04:01,117.5395 --> 00:04:10,807.5385 I will say it really started putting a lot of pictures together because when I was in optometry school, Heidi Wagner was my cornea contact lens professor at Nova Southeastern. 43 00:04:11,157.5395 --> 00:04:17,207.5395 And she was a main, investigator for the CLEC study, the Collaborative Longitudinal Evaluation of Keratoconus. 44 00:04:17,567.5395 --> 00:04:20,867.5395 And so while I was a student, I didn't even know what CLEC was. 45 00:04:20,867.5395 --> 00:04:25,117.5385 I know I had to be part of it and I knew that we were doing a study for the big professor. 46 00:04:25,167.5385 --> 00:04:32,497.5395 When I got my Pentacam and really started to evaluate this stuff and really started to learn what was going on with cornea, that was my gotcha moment. 47 00:04:32,497.5395 --> 00:04:34,487.5395 And to be honest with you, I've been so. 48 00:04:35,167.5395 --> 00:04:43,517.5395 Enamored with this disease and this disease process and all the diagnostic technical improvements that have happened over the years. 49 00:04:43,987.5395 --> 00:04:57,587.5405 And quite frankly, the excitement of my colleagues like you and all the others that we get to hang out with all the time, it's become a passion and it's become something that I think none of us are in it for, the financial reward. 50 00:04:57,587.5405 --> 00:05:00,537.5395 I think everybody is genuinely in it because they're really. 51 00:05:00,957.5405 --> 00:05:12,437.5415 interested in what this disease is and how our patients are suffering and how we can help them with the right diagnostic technology and treatment methods. 52 00:05:13,177.5405 --> 00:05:21,317.5415 Wow, I completely agree and even now I think that corneal tomography is absolutely mind blowing. 53 00:05:21,887.5415 --> 00:05:33,242.5415 Like to be able to image the posterior cornea and to see Keratoconus just pop out like, oh, it's so obvious because we have corneal tomography versus corneal topography. 54 00:05:33,592.5415 --> 00:05:37,122.5415 I still think it's magical it's absolutely amazing. 55 00:05:37,182.5415 --> 00:05:42,842.5415 And we can measure so many other things too, not just the posterior cornea as you mentioned, but, wow. 56 00:05:42,842.5415 --> 00:05:43,982.5415 2005. 57 00:05:44,312.5415 --> 00:05:44,702.5415 That's amazing. 58 00:05:45,47.5415 --> 00:05:49,597.5415 I wrote my first article, It's Googleable, I guess, in 2007. 59 00:05:49,947.5415 --> 00:05:55,207.5415 And I think the title of the article was Elevate Yourself Above Other ODs. 60 00:05:55,567.5415 --> 00:06:00,207.541 And really it was my wow article that holy cow, this is what you can see on the cornea. 61 00:06:00,647.541 --> 00:06:06,407.541 And this is what our colleagues can't because of this technology not really being mainstream. 62 00:06:06,542.641 --> 00:06:29,822.6415 I think you would agree, Melissa, that part of our mission when we go out and lecture to our colleagues, both in optometry and ophthalmology is to preach the optometric ophthalmological gospel of elevation technology and looking at that back surface of the cornea and trying to identify this disease as early as possible and using the right technology because The only thing it does is help the patient in the long run. 63 00:06:30,962.6415 --> 00:06:31,662.6415 Exactly. 64 00:06:31,932.6415 --> 00:06:35,772.6415 We can do better for our patients, with this amazing technology. 65 00:06:36,902.6415 --> 00:06:48,962.6405 So, what inspired you to start IKA with Barry and why was it so important that you did? iT's a great question because it's really a continuation of what we just spoke about. 66 00:06:48,962.6405 --> 00:06:55,602.6405 Barry and I actually came from two different places within eye care to form IK a. 67 00:06:55,882.6405 --> 00:07:11,492.642 And so what happened was, you have this kind of, mind blown moment of looking at the backside of the cornea, learning more about the disease, learning about the disease ideology and understanding that this technology is available, but not, necessarily tremendously accessible. 68 00:07:11,852.642 --> 00:07:13,682.642 to every one of our colleagues. 69 00:07:13,952.642 --> 00:07:28,382.642 What happened on my end, I went from working at TLC to being asked to join a practice where a doctor, was inventing the first mainstream epi on cross linking device in the United States. 70 00:07:28,542.642 --> 00:07:31,192.642 And, so I became the principal investigator for that. 71 00:07:31,202.642 --> 00:07:33,527.542 That was around 2009 2010. 72 00:07:34,7.642 --> 00:08:08,202.642 What happened was now we had cross linking, which was an actual treatment, as we all know, to either halt or slow down the progression of corneal ectasia, post refractive surgical ectasia, keratoconus, and that family of diseases, and so the technology was outpacing the education and that was a problem because not only do you have a way to Diagnose these patients earlier and earlier and earlier, but the earlier you diagnose it, the earlier you can cross-link someone and stop the disease from getting worse. 73 00:08:08,322.642 --> 00:08:14,142.642 It was almost like having the polio vaccine, but nobody knew that the vaccine was in doctor's offices. 74 00:08:14,422.642 --> 00:08:20,312.642 I wanted to, because I was seeing what was going on early with cross linking, get that information out there. 75 00:08:20,582.642 --> 00:08:29,542.643 So to be perfectly honest with the entire world listening to this podcast, I went me, myself and I went to Baltimore, to the state house and started an LLC. 76 00:08:30,312.643 --> 00:08:42,472.642 I started a corporation called the Optometric Crosslinking Society quite frankly, I didn't want optometry to be held out of the world of crosslinking because I knew it was going to become a very viable option for us one day, which I still think it will. 77 00:08:42,512.642 --> 00:08:53,912.644 We'll discuss that hopefully in the future So I really entered this from the crosslinking side that we wanted optometrists to be a major piece of the puzzle to crosslinking because it seems so optometrically friendly. 78 00:08:54,372.644 --> 00:08:57,222.644 Well, Barry was at the same exact time. 79 00:08:57,632.644 --> 00:09:05,972.644 Looking at keratoconus from the contact lens side, and I know he's a past AOA cornea contact lens chair, and, we're just friends and we got to talking. 80 00:09:05,982.644 --> 00:09:10,772.6435 He said, hey, I've got this group that's working on the contact lens side of keratoconus. 81 00:09:10,772.6435 --> 00:09:14,382.6435 And I said, well, I've got this group that's working with the cross linking side of keratoconus. 82 00:09:14,382.6435 --> 00:09:17,462.643 He said, let's just merge together and work together on all this stuff. 83 00:09:17,782.643 --> 00:09:26,122.642 That was the genesis of IKA, really to look at the disease of keratoconus, not from the optometry side, not from the ophthalmology side, but from both sides. 84 00:09:26,507.643 --> 00:09:28,147.643 Because this is about the disease. 85 00:09:28,147.643 --> 00:09:30,547.643 It's not about the practitioner providing the care. 86 00:09:30,547.643 --> 00:09:32,727.643 It's about the patient in the end. 87 00:09:33,97.643 --> 00:09:45,117.644 And so what we wanted to do was raise the level of education, to both doctors and patients and anybody who wants to listen, quite frankly, about how to best treat and manage this disease. 88 00:09:45,147.644 --> 00:09:46,197.644 And that was 10 years ago. 89 00:09:46,197.644 --> 00:09:49,117.644 That was in 2013 that we formed together. 90 00:09:49,117.644 --> 00:09:50,547.644 We hit our 10 year anniversary. 91 00:09:50,927.644 --> 00:10:00,267.644 And on our 10 year anniversary, we had our first in person two day conference in Scottsdale, Arizona we're having our second one coming up and, it's just been wildly successful. 92 00:10:00,317.644 --> 00:10:10,672.645 We really think that along with your work, Melissa and Mary Pruden's work at NKCF and everybody else, that we've made a difference in educating our colleagues, to help their patients. 93 00:10:12,272.645 --> 00:10:13,502.645 How fantastic. 94 00:10:13,502.645 --> 00:10:17,32.645 So tell us about the IKA KC Symposium that's coming up. 95 00:10:17,222.645 --> 00:10:17,572.645 Awesome. 96 00:10:17,572.645 --> 00:10:19,452.645 I'm so glad you asked. 97 00:10:19,772.645 --> 00:10:24,572.644 We're having our, IKA, International Care Dakotas Academy of Eye Care Professionals. 98 00:10:24,932.644 --> 00:10:31,752.644 Second annual in person and virtual, but in person, if you want to come, today. 99 00:10:32,237.644 --> 00:10:35,927.644 maybe even a little bit more, but we're wink, wink talking about that one. 100 00:10:35,947.644 --> 00:10:37,257.644 See if we can extend it a little bit. 101 00:10:37,597.644 --> 00:10:42,437.645 We're gonna have a two day in person, Karatacona Symposium with really the best of the best of the best. 102 00:10:42,437.645 --> 00:10:46,197.644 And of course, we couldn't have the best of the best of the best without having Melissa Barnett lecture. 103 00:10:46,457.645 --> 00:10:47,767.645 So I know that you'll be at the podium. 104 00:10:48,227.645 --> 00:10:49,97.645 And Mary as well. 105 00:10:49,107.645 --> 00:10:55,692.645 Mary, Pruden from NKCF will be there representing the organization because we need that patient advocacy as well. 106 00:10:56,62.645 --> 00:10:59,632.6445 so it's really, the best and the brightest from, the field of keratoconus. 107 00:10:59,652.6455 --> 00:11:08,672.6455 We have, docs from Baskin Pomeroy Institute, from Wilmer Eye Institute, from Case Western Reserve, from Duke Ophthalmology, from University of Iowa Department of Ophthalmology. 108 00:11:08,932.6455 --> 00:11:10,852.6455 We have great docs from private practice. 109 00:11:11,527.6455 --> 00:11:16,717.6455 We have docs that actually invented some of the software and the hardware on these devices that we use all the time. 110 00:11:17,7.6455 --> 00:11:21,217.6465 we have patient advocates there, our first one, Barry and I were nervous. 111 00:11:21,217.6465 --> 00:11:26,627.647 We didn't know how the reception would be, of course, with anything first, and, we really knocked it out of the park. 112 00:11:26,627.647 --> 00:11:31,487.6475 We had a, packed room and we had tons of people online listening in, and, people waiting for the second one. 113 00:11:31,487.6475 --> 00:11:33,587.6465 So this one is going to be in Bethesda, Maryland. 114 00:11:34,82.6475 --> 00:11:40,562.6475 It was strategically chosen to be in Bethesda, Maryland, because it's close to my house. 115 00:11:42,582.6465 --> 00:11:43,622.6475 That's strategic. 116 00:11:43,672.6465 --> 00:11:48,662.6475 Yes, but I will say, yes, yeah, and great for me, finally, I don't have to travel. 117 00:11:48,892.6465 --> 00:11:53,442.6475 But quite frankly, the reason why it is in Bethesda, Maryland is because, A, it's, a suburb of Washington, D. 118 00:11:53,442.6475 --> 00:11:53,812.6475 C. 119 00:11:54,107.6475 --> 00:11:56,347.6475 We have three airports that serve the area. 120 00:11:56,597.6475 --> 00:11:58,497.6475 we have metro access to get you downtown. 121 00:11:58,497.6475 --> 00:12:01,37.6475 It's a beautiful hotel and conference center. 122 00:12:01,37.6475 --> 00:12:05,147.6475 There's a walking mall right next door with all the great stuff that everybody can do. 123 00:12:05,177.6475 --> 00:12:07,547.6475 It really is a hub of information in the Washington, D. 124 00:12:07,547.6475 --> 00:12:07,717.6475 C. 125 00:12:07,717.6475 --> 00:12:07,997.6475 area. 126 00:12:07,997.6485 --> 00:12:17,957.6485 We're right down the street from the National Institute of Health, Walter Reed National Military Medical Center, National Library of Medicine, all within a mile or two of where our venue is. 127 00:12:17,957.6485 --> 00:12:19,597.6485 So we thought it was an excellent choice. 128 00:12:19,597.6485 --> 00:12:20,877.6485 We were on the west coast last year. 129 00:12:20,877.6485 --> 00:12:22,347.6485 We want to be on the east coast this year. 130 00:12:22,347.6485 --> 00:12:26,177.6485 We'll probably be moving around so we can share the knowledge with other people in the future. 131 00:12:26,967.6485 --> 00:12:27,557.6485 Oh, fantastic. 132 00:12:27,817.6485 --> 00:12:28,757.6485 Shameless plug. 133 00:12:29,117.6485 --> 00:12:32,547.6485 www dot G. 134 00:12:32,617.6475 --> 00:12:33,77.6475 O. 135 00:12:33,217.6485 --> 00:12:33,557.6485 T. 136 00:12:33,607.6485 --> 00:12:33,927.6485 O. 137 00:12:33,977.6485 --> 00:12:34,267.6485 P. 138 00:12:34,267.6485 --> 00:12:34,457.6485 E. 139 00:12:34,487.6475 --> 00:12:34,957.6475 R. 140 00:12:35,577.6485 --> 00:12:38,207.6485 Forward slash A. 141 00:12:38,207.6485 --> 00:12:38,557.6485 M. 142 00:12:38,607.6475 --> 00:12:39,257.6485 Hyphen I. 143 00:12:39,267.6475 --> 00:12:39,537.6475 K. 144 00:12:39,537.6485 --> 00:12:39,817.6485 A. 145 00:12:39,867.6485 --> 00:12:42,607.6475 Go to per dot com forward slash A. 146 00:12:42,607.6485 --> 00:12:42,957.6485 M. 147 00:12:43,627.6485 --> 00:12:45,187.6485 Slash hyphen I. 148 00:12:45,187.6485 --> 00:12:45,467.6485 K. 149 00:12:45,467.6485 --> 00:12:45,757.6485 A. 150 00:12:46,227.6485 --> 00:12:48,497.6485 But hopefully we could put that on the screen because that was tough. 151 00:12:49,897.6485 --> 00:12:50,317.6485 Excellent. 152 00:12:50,327.6485 --> 00:12:52,657.6485 We'll share the link with this podcast as well. 153 00:12:52,657.6485 --> 00:12:57,467.6485 And I'm so excited for this coming up next year. 154 00:12:58,467.6485 --> 00:12:59,97.6485 Oh, I'm sorry. 155 00:12:59,737.6485 --> 00:13:01,777.6485 May 18th and 19th, 2024. 156 00:13:01,797.6485 --> 00:13:02,447.6485 I forgot to tell you that. 157 00:13:03,967.6475 --> 00:13:05,317.6485 That's a very important piece. 158 00:13:05,317.7485 --> 00:13:06,187.6485 A little important. 159 00:13:06,197.6485 --> 00:13:06,427.6485 Yep. 160 00:13:06,957.6485 --> 00:13:07,267.6485 Yeah. 161 00:13:08,677.6485 --> 00:13:17,617.6485 So Andy, I understand that you're part of a group that has recently submitted a paper for publication on the pediatric prevalence of keratoconus in the United States. 162 00:13:18,267.6485 --> 00:13:24,657.6485 Can you share with us more about why you undertook this study and how the results will impact eye care? Sure. 163 00:13:24,657.6485 --> 00:13:34,197.6485 first off, Melissa, as we always do, I always want to thank my coauthors and acknowledge that I was not the first author on this paper that, Dr. 164 00:13:34,197.6485 --> 00:13:34,987.6485 Jen Harthan. 165 00:13:35,507.6485 --> 00:13:44,417.6485 out of the Illinois College of Optometry, was the first author the entire group did a wonderful job and we have great representation from all of our authors and experts and in their own right. 166 00:13:44,797.6485 --> 00:13:58,207.651 So basically, we talked about the Pentacam, we talked about IKA, and one of the things that I realized pretty early on at my practice at TLC was, We have patients come in and I'm sure this would happen to you as well. 167 00:13:58,487.651 --> 00:14:14,17.65 I know you're in a vibrant, academic institution, tons of patients, lots of specialty clinic patients, you have patient number one comes in and you diagnose them with keratoconus, through some sort of device like a pentacam and you tell the patient stop rubbing your eyes. 168 00:14:14,17.65 --> 00:14:15,637.65 We have to, talk contact lenses. 169 00:14:15,637.65 --> 00:14:17,207.65 We may have to talk cross linking. 170 00:14:17,657.649 --> 00:14:37,122.65 But really what we want to talk about what's most important is that there is a genetic component to this disease and that other family members potentially could either have it and not express it yet or have it and think that they have some other type of refractive error and they're not aware that they have the disease. 171 00:14:37,142.65 --> 00:14:42,572.65 And so one of the things that we did at TLC very early on was to say, Hey, come on in. 172 00:14:42,992.65 --> 00:14:51,482.651 Let's just take a quick panic cam on your biological siblings, or if you're an adult, which most, LASIK patients are because they have to be over 21. 173 00:14:52,422.651 --> 00:14:58,117.651 The average demographic of a LASIK patient at its heyday was about 37, 38 years old and female. 174 00:14:58,347.651 --> 00:15:01,347.651 And generally speaking that they were a mother of two. 175 00:15:01,467.651 --> 00:15:03,387.651 And we looked at those demographics really hard. 176 00:15:03,387.651 --> 00:15:10,747.651 So, we said, Hey, bring those kiddos in here and let's do a quick screening on them to see if they're showing any signs. 177 00:15:10,777.652 --> 00:15:14,267.652 Lo and behold, guess what we found? We found kids with keratoconus. 178 00:15:14,367.652 --> 00:15:25,777.652 But the literature, speaking on behalf of myself, not the young Melissa Barnett, but the elder literature, when I went through optometry school told me that keratoconus was a disease of the second to third decade of life. 179 00:15:26,257.652 --> 00:15:30,157.651 And, well guess what? Now I've got kids in my office with the disease. 180 00:15:30,167.65 --> 00:15:32,337.651 So, therefore, they're wrong. 181 00:15:32,797.651 --> 00:15:33,487.651 and I'm right. 182 00:15:33,847.651 --> 00:15:36,637.652 And because the technology that was used back then. 183 00:15:36,947.652 --> 00:15:39,407.652 was inferior to what we're using now. 184 00:15:39,417.652 --> 00:15:41,707.652 Now we're detecting earlier and earlier and earlier. 185 00:15:42,77.652 --> 00:15:43,67.652 Barry and I through I. 186 00:15:43,77.652 --> 00:15:43,347.652 K. 187 00:15:43,347.652 --> 00:15:43,527.652 A. 188 00:15:43,527.652 --> 00:15:54,537.652 And some of our colleagues like Bill too low and we talked about it with you and John Gellies and Loretta Flynn and Chris sent and the whole bunch of us and some of the ophthalmologists as well. 189 00:15:55,187.652 --> 00:15:57,277.652 We're saying, this disease does take place. 190 00:15:57,797.652 --> 00:15:59,257.652 In the pediatric population. 191 00:15:59,547.652 --> 00:16:04,167.652 But how rare is it? how often does it happen? And so we went a literature searching. 192 00:16:04,267.652 --> 00:16:05,817.652 That's what nerds like us like to do. 193 00:16:05,827.651 --> 00:16:07,557.652 We go looking for the papers. 194 00:16:07,917.652 --> 00:16:13,207.651 And guess what we found? We found nothing in the United States. 195 00:16:13,507.652 --> 00:16:15,577.651 We found maybe one paper in the Middle East. 196 00:16:15,837.652 --> 00:16:18,687.652 it was a good paper, and it started a conversation. 197 00:16:18,697.652 --> 00:16:21,537.652 However, it wasn't as accurate as we wanted it to be. 198 00:16:21,797.652 --> 00:16:37,277.6515 And so what we said, we got to find this out because if we have a cross linking device in this country now that can halt or slow down the progression of this disease and we have kids losing vision, it really is incumbent upon us to be aware of what that population is. 199 00:16:37,587.6515 --> 00:16:46,997.5535 And so we went out and we talked to Oculus and they donated access to Pentacams, through folks like Sandy Block and Jen Harthan at ICO. 200 00:16:47,207.6535 --> 00:16:53,737.6535 We gained access to their population of patients that they have an agreement with in the Chicago public school system. 201 00:16:54,127.6535 --> 00:17:03,787.6525 And what we were able to do with a perfectly intact IRB and parent, authorization to screen these kids, we did everything a hundred percent by the book. 202 00:17:04,227.6525 --> 00:17:08,857.6525 We looked at children between the ages of three and 18 years old. 203 00:17:09,202.6525 --> 00:17:11,592.6525 it was largely a black and Hispanic population. 204 00:17:11,592.6525 --> 00:17:25,392.6535 We looked at well over 4, 000, eyes and we use the algorithm set up by Bellin and Ambrosio on what was determined to be a keratoconus patient based on the results of the studies and also a keratoconus suspect. 205 00:17:25,392.6535 --> 00:17:28,742.6535 So we try to identify who was a suspect for keratoconus at that age. 206 00:17:29,7.6535 --> 00:17:31,557.6535 And then who actually had, diagnosable disease. 207 00:17:31,787.6535 --> 00:17:43,47.5545 And we found, a significant prevalence within the pediatric population, this prospective observational study, to the tune of less than 1 in 400. 208 00:17:43,867.6545 --> 00:17:48,977.6545 Kids between the ages of three and 18 years old, had the disease of keratoconus. 209 00:17:49,257.6545 --> 00:17:59,427.6535 And if you combine kids with keratoconus and keratoconus suspects in this population, it was less than one in 200 kids. 210 00:17:59,867.6545 --> 00:18:04,777.6545 Obviously our eyes lit up and were wide open that we said, the intention was to write the paper. 211 00:18:05,147.6545 --> 00:18:07,97.6545 But now that we have the data. 212 00:18:07,532.6545 --> 00:18:43,937.654 And it is submitted, and it was approved, and it's going to be published in a journal called Eye and Contact Lens any day now, if anybody wants to, knock on their door and say hurry up, we'd greatly appreciate it, but it is going to be published out there, and, what we hope it does is really kick down the door for other people to do research on this population as well, and to give the tools to organizations like the National Keratoconus Foundation, and to advocate for kids to get these necessary eye exams so we can detect this disease and treat this disease as early as possible. 213 00:18:44,487.654 --> 00:18:54,347.654 Understanding too that keratoconus in the pediatric population is different in my opinion than it is in the adult population I'd love to hear what you have to say. 214 00:18:54,367.654 --> 00:18:57,287.654 I've been yapping, yapping, yapping this whole time here, Melissa. 215 00:18:57,587.654 --> 00:19:11,172.654 I don't know what you do, but my personal opinion is if I even suspect a kid of having keratoconus, the longest I will let them go before coming back for an additional exam is six months more. 216 00:19:11,322.654 --> 00:19:16,242.653 I lean to the three month side just because the disease is so aggressive in the pediatric. 217 00:19:16,672.654 --> 00:19:17,292.654 population. 218 00:19:17,342.654 --> 00:19:19,962.654 Yes, I completely agree. 219 00:19:20,2.654 --> 00:19:26,632.654 And Dr Marguerite McDonald was on the clearly Casey podcast to talk about age and care to cut us and she agrees to. 220 00:19:26,632.654 --> 00:19:32,472.653 So in, that pediatric population, we really want to monitor our patients very closely. 221 00:19:32,472.653 --> 00:19:35,162.654 So I agree 34 months instead of six months. 222 00:19:35,452.654 --> 00:19:42,22.654 It also depends on how old they are and if we're expecting changes, which oftentimes we do. 223 00:19:42,307.654 --> 00:19:46,207.654 In these kids, but wow, what a fantastic study. 224 00:19:46,217.654 --> 00:20:01,587.653 I'm so proud of all of you for doing this study and bringing this information and sharing it with all of us because it's so important for all kids and everyone to actually evaluate for Keratoconus. 225 00:20:03,97.653 --> 00:20:04,767.654 Yeah, I completely agree with you. 226 00:20:04,807.654 --> 00:20:19,37.555 I'll take it one step further at our last meeting, the IKA symposium in Scottsdale We had Mike Bellin at the podium, and he was obviously talking about his analytic software for the Pentacam, the, Bellin Ambrosio display that he created. 227 00:20:19,607.555 --> 00:20:21,317.555 And I asked the question,, Dr. 228 00:20:21,317.555 --> 00:20:27,837.555 Bellin, in a perfect world, let's say all eye care providers did have a Pentacam or some sort of. 229 00:20:28,202.555 --> 00:20:31,762.555 Chime fluke, posterior elevation technique, even if it's an O. 230 00:20:31,762.555 --> 00:20:31,982.555 C. 231 00:20:31,982.555 --> 00:20:32,282.555 T. 232 00:20:32,292.555 --> 00:20:34,902.555 That can measure the posterior elevation of the cornea. 233 00:20:35,652.555 --> 00:20:54,802.555 Should a child have a screening exam at some point in their life? Should it be mandatory for all kids based on what we think the prevalence of the disease is? Is that a yes or no? Should they have it? And if so, at round what age And his answer was a definitive yes in a perfect world. 234 00:20:54,822.555 --> 00:20:57,452.555 Assuming all I doctors had this great technology. 235 00:20:57,822.555 --> 00:20:58,852.555 He said, absolutely. 236 00:20:58,852.555 --> 00:21:01,982.555 Yes, because the disease is so highly prevalent in the population. 237 00:21:02,402.555 --> 00:21:04,282.554 And kids are not born. 238 00:21:04,302.554 --> 00:21:06,332.554 Babies are not born with keratoconus. 239 00:21:06,912.554 --> 00:21:08,922.555 They develop keratoconus. 240 00:21:08,982.554 --> 00:21:14,382.554 And so, we know right around that puberty age is where the magic happens. 241 00:21:14,382.554 --> 00:21:27,892.554 And so his answer was somewhere between the ages of 10 to 12, 10 to 13 years old, all kids in a perfect world should have some mapping of the backside of their corneas to see if they do, express this disease at its earliest phase. 242 00:21:28,292.554 --> 00:21:33,972.554 That was mind blowing to me, you've heard me and barry say this a ton of times, and I'm sure you've said it a ton of times. 243 00:21:34,42.554 --> 00:21:38,742.554 We do exams on kids that are not high yield result exams all the time. 244 00:21:39,272.554 --> 00:21:42,372.553 Take glaucoma, for instance, and an otherwise healthy child. 245 00:21:42,942.554 --> 00:21:45,242.554 How many times have you done an I. 246 00:21:45,242.554 --> 00:21:45,352.554 O. 247 00:21:45,352.554 --> 00:21:45,622.5535 P. 248 00:21:45,622.5535 --> 00:21:50,872.553 Check on a pediatric patient? The answer is everybody does it all the time. 249 00:21:51,222.553 --> 00:22:01,332.554 Well, how many times have you ever found the disease of pediatric glaucoma and that otherwise healthy population? Most people will say never, and some people say really rarely. 250 00:22:01,592.554 --> 00:22:05,682.553 I'm not saying that you should not check IOP on kids, I'm not saying that at all. 251 00:22:05,922.554 --> 00:22:14,352.555 I'm saying that is a test that is done routinely on almost every kid during a comprehensive annual eye exam that yields no positive disease. 252 00:22:14,992.555 --> 00:22:16,152.555 What we're saying is. 253 00:22:16,152.555 --> 00:22:21,352.555 We want kids to get screened for the diseases that they are more likely to have because we can do something about it. 254 00:22:21,362.555 --> 00:22:25,682.555 And that's why it's so important for this pediatric prevalence study to kind of hit the road. 255 00:22:27,437.555 --> 00:22:31,911.3289259 When I say hit the road, I mean hit the road and everybody read it, not get out of it. 256 00:22:31,911.3289259 --> 00:22:34,124.5952593 Hit the road so we can image all kids. 257 00:22:34,124.5952593 --> 00:22:34,616.4322222 Imagine this. 258 00:22:34,616.4322222 --> 00:22:40,527.9625926 Hopefully this will be the practice in the future where we do image every child, and image their posterior cornea. 259 00:22:41,197.9635926 --> 00:22:50,157.9635926 Well, Andy, gosh, I know that we can talk for eight more hours on this because we are so passionate about the subjects and. 260 00:22:50,382.9635926 --> 00:22:55,982.8635926 I really sincerely want to thank you so much for joining us on the Clearly KC podcast. 261 00:22:55,982.9635926 --> 00:22:57,692.9635926 Thank you all for listening. 262 00:22:57,972.9635926 --> 00:23:07,592.9645926 Please listen to all the episodes on the Clearly KC podcast on Podbean or your favorite podcast app to subscribe and get future episodes. 263 00:23:07,742.9635926 --> 00:23:09,922.9635926 So until next time, I'm Dr. 264 00:23:09,922.9635926 --> 00:23:14,762.8635926 Melissa Barnett and see you soon on the Clearly KC podcast. 265 00:23:14,762.9635926 --> 00:23:15,52.9635926 Bye.
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