Addressing the Gap in Keratoconus Diagnosis

Early screening and the new Epioxa treatment could transform keratoconus care.

By
Tiffany Andrzejewski, OD
Parag A. Majmudar, MD
July 1, 2026
10 min

Optometric Management

Objective:

To highlight the importance of early screening and diagnosis of keratoconus (KC) to prevent vision loss and address the challenges in current detection methods.

Approach:

Treatment Insights: Reviews the low rates of cross-linking therapy and discusses the significance of the recent FDA approval of epithelium-on, oxygen-enriched corneal cross-linking (Epioxa), which allows for earlier treatment without the need for documented progression.

Key Findings:

About 70% of patients are diagnosed at moderate to advanced stages of KC, highlighting the need for earlier detection.
Only about 12% of newly diagnosed patients receive cross-linking therapy, indicating a gap in treatment access.
Early detection is crucial as changes in vision can be gradual and lead to significant loss if untreated.
Certain groups, such as those with Down syndrome and sleep apnea, have elevated risk for KC.

Interpretation:

The article stresses the critical need for improved awareness and screening for keratoconus to facilitate early diagnosis and treatment, which can significantly alter patient outcomes.

Limitations:

Current screening methods are not widely available in primary care settings, which limits early detection.
Public awareness of keratoconus is low compared to other eye diseases, contributing to delayed diagnosis.