8/6/2019 An Interview with Nick Dash on the Diagnosis and Treatment of Keratoconus

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Interview with Nick Dash about his passion for the diagnosis and 

treatment of keratoconus 

 

Nick Dash BSc MCOptom, a Clinical Optometrist and Consultant

Why are you so passionate about patients with keratoconus?

“Keratoconic patients are being neglected by the care of the NHS in the UK. Most patients 

are left in limbo between the Hospital Doctors and Optometrists. Techniques such as 

Corneal Cross Linking have proven to be a strategy of managing Keratoconus that is 

effective at arresting the progression of KC and in many cases reversing some of the 

effects.

Every week I see people that could have been helped by appropriate care, but now have to 

live life with substandard vision.” 

8/6/2019 An Interview with Nick Dash on the Diagnosis and Treatment of Keratoconus

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Give me an example?

“Good. Seeing a 17 year old lad who noticed vision deterioration in his left eye. Upon 

questioning he reported a 'stretching of the image' of ‘tail lights at night' (he was learning to 

drive).

These symptoms highlighted the possibility of Keratoconus and so Topographies showed early signs of Keratoconus confirmed with the corneal thinning.

I monitored him for 3 months and results showed progressive changes and so at 17 he had 

cross linking and on his 18th birthday had the second eye cross linked.

He has retained 6/6 vision in his RE and 6/9 in his left (Corrected with a soft contact lens)

He is now looking forward to entering the Police Force! 

Later diagnosis would have restricted his employment opportunities.

EARLY DIAGNOSIS AND TREATMENT HAS PRESERVED THIS YOUNG MANS 

FUTURE.” 

What is the standard level of care for Keratoconus in the UK then?

“The standard of care in the UK is BAD. The “normal” standard of care is to fit contact 

lenses and watch as things get worse.

To illustrate this I have just seen a man aged 29 yrs who is now struggling to get the vision 

for driving with semi scleral contact lenses but he is only able to wear these for 5 hours 

before they become too uncomfortable. Obviously specs don’t correct the vision.

Unfortunately the poor CL fitting he was given and the lack of options about treatment for 

keratoconus has left the corneas scarred and with blood vessel ingrowth that prohibits 

Cross Linking. This poor contact lens fitting and lack of intervention has precluded Corneal 

Cross Linking.” 

What are his options now?

“This is very disappointing. Had he been treated 5 years ago with C3R he would not be on 

the inevitable course of needing a corneal graft, with all that comes with this last chance 

treatment option? The poor contact lens fitting and vascularisation adversely affects the 

graft success.” 

What could have been done differently?

Early diagnosis and treatment is the best care. Retaining quality of vision.

However the norm in the UK is for eye to be fitted with progressively more complex contact 

lenses that become less and less comfortable. As lenses become more complex they 

increasingly impact on the corneal and compromise the treatment options and prognosis.

Contact lenses should be regarded as a conduit to KC not a management strategy.

How should Keratoconus be managed?

“Managing KC” should be to arrest the development of the condition not just let it get worse. The first step should be to consider C3R and then restore vision quality with contact 

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lenses. When possible C3R and T-Cat offers a chance of stopping the progression and 

reversing some of visual/corneal distortions.

To just fit contact lenses is tantamount just sitting and watching whilst things get worse. We 

wouldn’t consider this as a suitable strategy in other pathologies where an effective 

treatment is available.

Unfortunately the NHS has been slow to take up C3R whilst it has proven effective since 

1999, some 11 years ago.

Is there a cure to Keratoconus?

“There is 'no cure' but there are certainly holding strategies such as Cross Linking, Whilst

some patients find improvement in contact lens tolerance it is the aim of cross linking to

arrest the development of Keratoconus. Over the last 6 years of seeing cross linking

patients, all have stopped progressing and around 30% show a slight reversal of the apical

steepening.

I have also seen many cases where C3R and TCat treatments, conducted by Accuvision.

These too have arrested the development of Keratoconus, and many have much improvedcorneal profiles that have made it possible to refit patients from Hard/Gas Permeable

lenses to Soft contact lenses or in many cases can get good vision with spectacles.

Are the types of treatments offered by Accuvision significant?

This is of significant benefit and, patients are extremely happy to be wearing more

comfortable lens options with longer more comfortable vision.

Some patients get significant improvements in best corrected vision, so have returned to

driving standards and have been able to return to work following the TCat and C3R.

Accuvision seem to be championing Keratoconus treatments in the UK.

Thank you Nick.