Impact of COVID-19 on keratoconus patients waiting for corneal cross linking

Purpose: Royal College of Ophthalmologist recent guidance recommended delaying cross-linking services during the COVID-19 pandemic. This study investigates the effects of such delays in the delivery of cross-linking services in patients with keratoconus progression.Methods: Retrospective observational study of 46 patients with keratoconus progression, whose cross-linking was delayed due to the COVID-19 pandemic. Demographic and clinical details were obtained from assessments on the day of listing, and subsequent review on the day of the procedure. Topographic indices included keratometry of the posterior and anterior corneal surface, maximum keratometry (K-max), thinnest corneal thickness, ABCD progression and progression based on standard criteria recommendations (1.5 D K-max & 20 microns thinning).Results: A total of 46 eyes were analysed with an average time between being listed for CXL and having the procedure done was 182 +/- 65 days. The delay due to COVID-19 was of 3 months. In this time period they had a significant worsening of all keratometric indices and lost almost one line of visual acuity (0.19 +/- 0.19 to 0.26 +/- 0.18 LogMAR, p: 0.03). Thirty two eyes (70%) demonstrated progression in accordance with the ABCD progression criteria, while 18 eyes (39%) showed either an increase in K-max of more than 1.5D or a thinning in corneal thickness of at least 20 mu m.Conclusions: The treatment delay for the keratoconus patients caused further progression and vision worsening. We recommend that corneal collagen crosslinking needs to be considered as a high priority intervention.