Talk:Keratoconus

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Former featured articleKeratoconus is a former featured article. Please see the links under Article milestones below for its original nomination page (for older articles, check the nomination archive) and why it was removed.
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Archived to do list: Talk:Keratoconus/to do

New Image[edit]

Keratoconus.svg

I added the image to the right to the article, at the signs section, please feel free to move it or remove it in order to keep the featured status, but please notify me at my talk page, thank you Maen. K. A. (talk) 21:51, 28 May 2009 (UTC)

It's a good image, but lens is misspelled. Since it's an SVG image, it should be easy to correct and reload over the orginal. —BillC talk 23:06, 28 May 2009 (UTC)
I've seen this image before, and wondered: isn't the stroma getting thinner in keratoconus? As I remember, it does; then this image might give a false impression of it getting thicker. Best regards, --CopperKettle 06:49, 29 May 2009 (UTC)
I corrected both issues hope its good now??, and thank you both :-) Maen. K. A. (talk) 10:22, 31 May 2009 (UTC)
Thank you! Really appreciate your contribution! --CopperKettle 14:32, 31 May 2009 (UTC)
Thank you too :-) MaenK.A.Talk 16:14, 31 May 2009 (UTC)

All round, Good Work guys, a big pat on the back is in order - RH

A dystrophy or not?[edit]

Coma and keratoconus[edit]

  • Arrived at PubMed: Reinstein DZ, Archer TJ, Gobbe M (2009). "Corneal epithelial thickness profile in the diagnosis of keratoconus". J Refract Surg. 25 (7): 604–10. PMID 19662917. Unknown parameter |month= ignored (help) --CopperKettle 15:54, 12 August 2009 (UTC)

Rizzuti phenomenon[edit]

Found a mention of such phenomenon: "Sharply focused beam of light near the nasal limbus ,produced by lateral illumination of the cornea in patients with advanced keratoconus" --CopperKettle 16:04, 26 August 2009 (UTC)

Partial PRK[edit]

Who put this in to the article? : "In some cases, crosslinking may also be successfully combined with other treatment methods such as partial PRK"

How do you know ? and how do you know the results ? and out of the blue with out a build up of research ? also I keep getting blocked by various people (but it might be one person using different names) what is their problem ? as its for no reason but because they can't discuss anything with me here !! I think this is getting done higher up by the wiki command structure as I have never heard of these peoples names before !! Why for the cloak and dagger stuff ? why not keep[ it fair and clean ?? —Preceding unsigned comment added by 149.254.49.29 (talk) 14:11, 11 October 2009 (UTC)

It was added in early September by an anonymous editor and no-one seemed to have noticed. I have removed the claim from the article. With regard to the blocks you say you have been receiving, there are none currently registered against your IP address above. These may have been against other IP addresses instead. It is is possible that, as an anonymous user, you were experiencing someone else's block due to a revolving IP address. An easy way to prevent this is to register for an account, which is quickly done. If you can provide a link to an IP address that was blocked, we can look into the reason why for you. —BillC talk 21:24, 11 October 2009 (UTC)

You see it was everytime I wanted to write something or when I did, it was removed and then I was blocked, the Ip was the same as I have now. Basically if it was me who added about the partial PRK, it would have been removed quickly and my IP address talked about and then it blocked for months. What is wrong with a discussion I don't know, but it seems to be that "they" feel they will not be able to win any discussion, and so use their under hand tatics to manipulate things. Its just a complete joke ! —Preceding unsigned comment added by 149.254.56.10 (talk) 10:41, 16 October 2009 (UTC)

This is just silly on the article (please read on), its been there for a very very very long time and no ones got the interest or even care to say anything - mini ARK it is an ELECTIVE surgery, just like Laser surgery is for "normal" people is (and why Laser is not offered in the National Health Service of the UK and pretty much EVERYWHERE ! this is the silly line from the article on Mini ark "This technique has yet to go through the official experimentation and follow-up period which is generally required by the Italian National Health Service to accept a new surgery technique before it can be offered to patients." Come on guys wake up ! —Preceding unsigned comment added by 149.254.56.9 (talk) 22:18, 17 October 2009 (UTC)

Can you clarify what you are saying here? Thanks, —BillC talk 13:42, 18 October 2009 (UTC)

Its in plain English —Preceding unsigned comment added by 149.254.56.12 (talk) 16:37, 18 October 2009 (UTC)

Here is some info on Partial PRK - http://www.journalofrefractivesurgery.com/showAbst.asp?thing=43745 - —Preceding unsigned comment added by 208.123.162.2 (talk) 01:50, 19 October 2009 (UTC)

Wow one ! very short term too ! —Preceding unsigned comment added by 149.254.56.12 (talk) 01:54, 19 October 2009 (UTC)

Approval status[edit]

European approval is only for the ultraviolet light machine, it does not address epithelium status which is up to the treating ophthalmologist. —Preceding unsigned comment added by 173.55.11.160 (talk) 4:38, 10 December 2009 (UTC)

The reference used for that sentence only mentions the procedure with the epithelium removed. If you have a reliable sources that go into greater detail about the European approval status, feel free to add them to the article, and perhaps that particular sentence needs to be reworded to distinguish the European and US statuses. Thanks. Delicious carbuncle (talk) 15:06, 11 December 2009 (UTC)

Copy-edit required, and potential contradictions[edit]

I've tagged this article as requiring copy-editing. The pre-contents section alone has several clumsy phrasings and strange statements, e.g. "A new procedure is called KXL, which is promising."

Some sections also seem to contradict each other: "A number of patients complain of chronic eye rubbing and also think it as a possible cause to the disease but it is not so" under Pathophysiology seems to contradict the claim under Environmental Causes that "vigorous eye rubbing contributes to the progression of keratoconus". Since I have no medical knowledge, however, I don't feel confident to assess this. Muspilli (talk) 16:05, 8 March 2012 (UTC)

Also, I've noticed some poorly-sourced time-dependent details.[1] Biosthmors (talk) 18:08, 8 March 2012 (UTC)

Speaking of someone with the condition I do rub my eyes constantly mostly when the lights bright due to itching so that might be the photophobic side to the condition QueenAlexandria (talk) 21:19, 9 July 2012 (UTC)

Ghost Images[edit]

As a sufferer the worst contrast for ghost images are traffic lights at night it kind of looks like there are shine rays coming off of them QueenAlexandria (talk) 21:19, 9 July 2012 (UTC)

Add something about relations with Dua's layer[edit]

See Dua's layer and this refs:

"Corneal hydrops, a buildup of fluid in the cornea that is common in patients with keratoconus (a conical deformity of the cornea) might be caused by a tear in Dua's layer. Dua hypothesizes that such a tear would allow water from inside the eye to pass through and cause fluid buildup.", Wikipedia.

Added here, cited the Ophthalmology Journal instead. k18s (talk) 10:18, 7 August 2013 (UTC)

Adding another example picture-Image of a possible fully intact Keratoconic cornea[edit]

There isn't a picture of a Keratoconic cornea that has been removed, "fully intact" within 24 hours of the surgery. I have Stage 4 Keratoconus; I will be having PK (Penetrating Keratoplasty) surgery in this coming May (May 2015). I'm going to ask my ophthalmologist, which will be doing the procedure, if he could either allow me to keep the damaged cornea, or which I think will be more likely, to take pictures of it. I think it's important that a cornea that is was removed as close to when the actual procedure was done be shown in the article . And another reason, which hasn't been given some attention in the entry, is the nature of how Keratoconus progresses.

I was initially diagnosed with it in 2012, and from that time march 2015, the Keratoconus progressed in an extremely fast period of time. o, I happen to be in the small group of persons with Keratoconus where what would be considered a "normal" progression or activity of the disease is very atypical. I subscribe to the journals Ophthalmology & the American Journal of Ophthalmology, which they 2 of the main ophthalmology medical journals in the United States. My subscriptions are of the free access kind, so it means that many of the articles aren't availble full text without a paid or association subscription. I've been trying to look where there are any studies done on the smaller percentage of patients like me, but to no look. So, if anyone cares to try, please do. it would be very helpful, to at least make mention of the fact unique nature of its progression and that there are people like me who are out there, though in a small percentage of Keratoconus suffers. So, I'm able to get pictures of my left cornea, I would like to added it to the entry. Actually, both of my eyes are affected, and my left eye was deemed the "good" eye, as along with Keratoconus affecting my right eye, I also have optic neuropathy with the right eye, which makes me technically blind. My left eye is now the bad eye.

Use way as no way; Use limitation as no limitation (talk) 11:37, 27 March 2015 (UTC)

IQ discussion, and "academic's eye disease", still in several other language versions[edit]

In several language versions of this article as well as of the Pellucid marginal degeneration article, the following sentence is still included, allthough it was deleted from English Wikipedia in 2005:

It is sometimes called the "academic's eye disease" because two-thirds of the people afflicted with it have IQs above 130.[1][2]
  1. ^ Patient-Point organization (2010) "Keratokonus"
  2. ^ Eye Ultimate (2008) "Information Keratoconus: Cause, Symptoms and Treatment"

See Talk:Keratoconus/Archive1#Academic.27s_Eye_Disease talk archive from 2006.

The sentence was added to english Wikipedia in 2004, but I can not see that the sources ever were provided here, but in several other language versions. Does anyone have access to the sources, or can you at least give more accurate names of the sources? This piece of information is also spread to seveal other sites, for example [2], but I am not sure it should be considered reliable. It might be a very successful desinformation attempt. I just want to verify that we can delete this claim from other language versions. In at least Swedish the term "academic's eye disease" is a redirect to "Keratoconus". I suppose that the redirected term also should be deleted? I have not seen it in the literature or in any scholarly papers, neither in Swedish nor English. Mange01 (talk) 09:38, 8 July 2015 (UTC)

I have never seen any reference for it, and am tempted to believe that the sentence is flat-out false. —BillC talk 22:09, 30 August 2015 (UTC)

Treatments[edit]

User:Doc James has removed the most useful parts of the article about about its treatments and replaced the whole Cross-linking section with a short and insufficient section at the bottom of the article, citing this recently published review study. although I appreciate his contributions here, I am sure all the involved editors, optometrist, ophthalmologist and KC patients would agree with me that Cross-linking is one of most important subjects in this article and should not be ignored like this.

I restored a trimmed-down version of the Cross-linking section. however, restoring some of the other removed information (Keraflex/microwave thermoplasty, different types of lenses, and corneal implants) may require further discussion. k18s (talk) 18:16, 31 August 2015 (UTC)

We appear to have a large number of paid editors adding poorly referenced and promotional content to this and a number of other articles. Some have already been blocked as sockpuppets.
We have a 2015 Cochrane review that states as its conclusions "The evidence for the use of CXL in the management of keratoconus is limited due the lack of properly conducted RCTs." That you have attempted to summarize this as "Corneal collagen crosslinking with riboflavin is a developing treatment for keratoconus" and to place this before established treatments is concerning. Doc James (talk · contribs · email) 18:27, 31 August 2015 (UTC)
I agree that this and some related articles are the target of some businesses. it is our job to keep it clean and ad free, but that's not a good reason to remove the sections completely.
You placed the Cross-linking section under the Radial keratotomy which I think is very wrong, RK is really not a good choice for KC, but CXL is a widely practiced treatment around the Europe and it is expected to be accepted in the U.S soon. I suggest we contact Samer Hamada (an author who his email address is available on the Cochrane review) by email or Twitter about this matter.
I stand by my opinion that Cross-linking should be regarded as the most important surgical treatment for keratoconus. k18s (talk) 19:23, 31 August 2015 (UTC)
You think "that Cross-linking should be regarded as the most important" while a Cochrane review finds insufficient evidence for it? As you state it is not even accepted in the USA. ANd you want it to go first?
A summary of the content was not removed it was moved to under research. Doc James (talk · contribs · email) 19:46, 31 August 2015 (UTC)
It is accepted in many countries around the world, I guess Wikipedia shouldn't be all about the US and FDA?! CXL is available on the NHS in the UK k18s (talk) 20:06, 31 August 2015 (UTC)
And it isn't. We emphasise the best available evidence which is that Cochrane review. Doc James (talk · contribs · email) 20:07, 31 August 2015 (UTC)

@User:CFCF & User:Doc James: doesn't it look weird to you that the cross-linking section starts by saying that the surgery is "not useful" even before explaining what is it about?! is my edit really not acceptable? k18s (talk) 20:55, 31 August 2015 (UTC)

You don't seem to be familiar with WP:MEDMOS. Generally the first thing we discuss is efficacy, then safety. Jytdog (talk) 21:21, 31 August 2015 (UTC)
Surely you should first say what something is, then describe its efficacy. —BillC talk 23:57, 10 November 2015 (UTC)
One does in the article about the thing in question. Doc James (talk · contribs · email) 02:36, 11 November 2015 (UTC)

What happened to this page, I wonder? It's like being back in the 1990s, when the only common treatment was corneal transplantation...this is ridiculous, honestly. Who scrapped 20 years of successful research? Who modified the Corneal Cross-linking section, making it considerably worse? Who removed the other treatments, which were backed by clinical studies? The international medical community is rapidly abandoning corneal transplantation as a treatment for KC in favour of conservative treatments (CXL, CK, MARK, etc.), but this page seems stuck in a time warp. I suspect that someone with very specific interests has won this edit battle. Problem is, this page is now completely useless, not to say scientifically obsolete and laughable from a medical point of view. — Preceding unsigned comment added by 122.104.66.175 (talk) 00:04, 4 February 2016 (UTC)

Thoughts[edit]

Wondering what people think about

"Keratoconus is relatively rare and largely unknown in the general population, and the practical application of standard treatments has limits. Examples of the difficulties involved in prescribing corrective lenses, especially glasses lenses, and complications that arise from wearing contact lenses are discussed in Taking the Heat - A Steelworker's Story. In this memoir Richard Sarver details the challenges of functioning as a laborer in a steel mill while contending with keratoconus and high myopia. With other career choices limited because of his low vision, Sarver sought employment at a Roanoke, Virginia steel mill, where he has worked for more than 30 years. The corrective lenses available to him have provided only marginal improvement to his vision.[1] "

References

  1. ^ Taking the Heat - A Steelworker's Story, 2012, Flatwoods Press, LLC, pp. 208 - 232.

-- Doc James (talk · contribs · email) 18:30, 10 November 2015 (UTC)

I think it's a single case history which doesn't add to the subject matter. The facts which it does say about it: "relatively rare and largely unknown in the general population", "practical application of standard treatments has limits" are already discussed elsewhere in the text. —BillC talk 23:52, 10 November 2015 (UTC)
Yes my thoughts aswell. Doc James (talk · contribs · email) 02:36, 11 November 2015 (UTC)

Avedro received FDA approval for their crosslinking system[edit]

I guess we can now add more details about crosslinking. keep in mind that this approval only applies to the method used by Avedro, their KXL system and riboflavin solutions. corneal collagen cross-linking should be updated too! k18s (talk) 14:06, 29 April 2016 (UTC)

Press releases are not great sources. Doc James (talk · contribs · email) 14:07, 29 April 2016 (UTC)
This probably has a record on FDA.gov too... but it seems you think FDA's decision isn't important enough... k18s (talk) 14:13, 29 April 2016 (UTC)
Cochrane is better IMO. The FDA approval is still in there. Doc James (talk · contribs · email) 15:53, 29 April 2016 (UTC)

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Misleading lead[edit]

Current lead section is misleading. in KC many of the mentioned surgical options are not necessary, a good fitted contact lens is all needed, corneal graft is the ONLY surgical option that sometime may be really required, and crosslinking just has a different purpose and should not be in one group with others. in my opinion we should remove some of the less studied surgical options from the lead. k18s (talk) 05:53, 5 November 2016 (UTC)

Regarding this edit

These distinctions you are trying to make in the lead are not anywhere in body and are not sourced in the body, or anywhere else. The lead just summarizes the body and content everywhere is based only on reliable sources. Jytdog (talk) 06:00, 5 November 2016 (UTC)

Following was my edit:
In most cases, different types of contact lenses fitted by a specialist are effective enough to allow the person to continue to drive legally and likewise function normally. crosslinking may be used to slow or halt the progression of the disease and several surgical options are also available to correct the vision, including intrastromal corneal ring segments, mini asymmetric radial keratotomy, corneal intrastromal implantation system (CISIS), topography-guided photorefractive keratectomy (PRK), topography-guided conductive keratoplasty, phakic intraocular lenses and, in 25% of cases with further progression of the disease corneal transplantation may be required.
And this is what you prefer, the current one:
In most cases, corrective lenses fitted by a specialist are effective enough to allow the person to continue to drive legally and likewise function normally. Further progression of the disease may require surgery, for which several options are available, including intrastromal corneal ring segments, corneal collagen cross-linking, mini asymmetric radial keratotomy, corneal intrastromal implantation system (CISIS), topography-guided photorefractive keratectomy (PRK), topography-guided conductive keratoplasty, phakic intraocular lenses and, in 25% of cases, corneal transplantation.
Which "distinctions" are you talking about? in the edit which you reverted, I have not actually removed anything yet. I only changed the wording and order of sentences. k18s (talk) 06:08, 5 November 2016 (UTC)
The ones you made here and here among the various kinds of surgical treatments. Jytdog (talk) 06:14, 5 November 2016 (UTC)
I don't understand why you refer to this talk page section as a "reason" for your edit! also please be specific about the parts of my edit which you believe is not right. there is no need to link to the diff as I have included it above.
"Further progression of the disease may require surgery"
The above line is totally misleading as it suggests that the mentioned surgical options are helpful after "further progression". the truth is they are simply alternatives to contact lenses, some of these are not suitable for people with thin corneas and none of them actually slow or halt the progression. corneal transplantation is the only one that should be mentioned after the "further progression". k18s (talk) 06:22, 5 November 2016 (UTC)
where is this discussed and sourced in the body of the article? Jytdog (talk) 06:24, 5 November 2016 (UTC)
Exactly! where is the current one mentioned and sourced in the body of the article? where is it mentioned that any of those surgical options will help more than contact lenses after "further progression". Where are your sources? k18s (talk) 06:28, 5 November 2016 (UTC)
I have created a new sub-section because this discussion is not about removal of content which I suggested above. k18s (talk) 06:37, 5 November 2016 (UTC)
The body mentions contacts and various surgical procedures without prioritizing them except to say that contacts generally are tried first; this is what the current lead does as well. Both your edits somehow try to distinguish cross-linking from other non-contact approaches. There is nothing in the body to support that. Jytdog (talk) 06:46, 5 November 2016 (UTC)
The current lead clearly suggests that once the disease had "further progression", surgical options will help, which is not correct and not mentioned in the body. you are correct about the crosslinking, in my opinion the article should be corrected there too. as per body, only corneal transplant is helpful once the disease "progress to a point where vision correction is no longer possible". k18s (talk) 06:59, 5 November 2016 (UTC)
Also it would have been much easier if you had improved my edit instead of reverting it. interestingly the current lead which you support does not reflect the body at all. the whole following line cannot be found anywhere in the body "corneal intrastromal implantation system (CISIS), topography-guided photorefractive keratectomy (PRK), topography-guided conductive keratoplasty, phakic intraocular lenses" and yet you keep reverting/supprting a wrong version. k18s (talk) 07:05, 5 November 2016 (UTC)
My new edit is a word-by-word copy of the body. Thanks for guiding me to the right direction. k18s (talk) 07:19, 5 November 2016 (UTC)
Agree that lesser studied options belong in the body of the text. As cross linking is controversial does not belong in the lead. Simplified some. Doc James (talk · contribs · email) 09:02, 5 November 2016 (UTC)
@James, controversial, correct, read this editorial top to bottom. but how could you justify the MARK, RK and ICRS articles? according to you, just looking up those two on PubMed should be enough for removing them from the lead or even the article. please don't hate CXL, it is a very important topic for anyone concerned with KC. k18s (talk) 10:31, 5 November 2016 (UTC)
Will look at the underlying literature behind those.Doc James (talk · contribs · email) 12:58, 5 November 2016 (UTC)

Have updated the lead based on the National Eye Institute of the NIH. Doc James (talk · contribs · email) 07:35, 6 November 2016 (UTC)

looks good. Jytdog (talk) 07:37, 6 November 2016 (UTC)
Much better. Thank you James. k18s (talk) 14:41, 6 November 2016 (UTC)

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Advocacy[edit]

@Jytdog: Before making this edit I have checked some other featured medical articles (e.g. Parkinson's disease#Advocacy) and many of them have an Advocacy section. how should we talk about awareness days and supporting organizations? k18s (talk) 22:11, 12 November 2016 (UTC)

The sourcing for that was terrible and itself reflected advocacy. it is maybe ok to have an advocacy section if there are decent sources for it; twitter and the advocacy group's website are unacceptable. Jytdog (talk) 22:14, 12 November 2016 (UTC)
This is NKCF's own website http://worldkcday.com. I could only find one proper third-party source and all other mentions are on social media. is Twitter not acceptable even to show the recognition? how many sources are needed for something like this? k18s (talk) 22:19, 12 November 2016 (UTC)
Would it be okay if I find Twitter, Facebook mentions from verified accounts of third-party organizations? k18s (talk) 22:24, 12 November 2016 (UTC)
diff k18s (talk) 22:24, 12 November 2016 (UTC)
especially for advocacy topics we need independent sources that are solid. exactly because of WP:PROMO which is policy; see also the WP:Advocacy essay. Strong sourcing for this kind of content, please. Jytdog (talk) 23:33, 12 November 2016 (UTC)

Infoboxes[edit]

Infoboxes are supposed to contain simple details. Therefore removed the name of sign which IMO belongs in the body not the lead. Others thoughts.

  • Option 1 "The "cone shaped cornea" that is characteristic of keratoconus"


  • Option 2 "Munson's sign showing a "cone shaped cornea" that is characteristic of keratoconus"


Doc James (talk · contribs · email) 20:19, 23 June 2017 (UTC)

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