The Royal Australian and New Zealand College of Ophthalmologists

Recommendations from the Royal Australian & New Zealand College of Ophthalmologists on visual fields, vitamins, alpha-1 blockers, intravitreal injections & retinal detachment. The Royal Australian and New Zealand College of Ophthalmologists (RANZCO) is the leading medical eye specialist organisation in Australia and New Zealand. RANZCO’s mission is to drive improvements in eye health care through continuing exceptional training, education, research and advocacy.

Do not use corneal cross linking for every patient with keratoconus.

Date reviewed: 27 October 2022

It is indicated when there is clear evidence of progression via change in refraction, anterior and posterior topographical data and tomographic data. In younger patients’ consideration can be given to cross-linking without evidence of progression if there is a strong index of suspicion that progression will occur without intervention.

Supporting evidence
  • Brown, S. E., Simmasalam, R., Antonova, N., Gadaria, N., & Asbell, P. A. (2014). Progression in keratoconus and the effect of corneal cross-linking on progression. Eye & contact lens, 40(6), 331-338.
  • O’brart, d. P. S. (2014). Corneal collagen cross-linking: A review. Journal of optometry, 7, 113-124.
  • Hashemi, H., Khabazkhoob, M., & Fotouhi, a. (2013). Topographic keratoconus is not rare in an Iranian population: the Tehran eye study. Ophthalmic epidemiology, 20(6), 385-91. 
  • Hersh, P. S., Stulting, R. D., Muller, D., Durrie, D. S., & Rajpal, r. K. (2017). United states multicentre clinical trial of corneal collagen crosslinking for keratoconus treatment. Ophthalmology, 124(9), 1259-1270.
  • Witting-Silva, C., Chan, E., Islam, f. M. A., Wu, T., Whiting, M., & Snibson, G. R. (2014). A randomised, controlled trial of corneal cross-linking in progressive keratoconus. Ophthalmology, 121(4), 812-821.
How this list was made How this list was made

RANZCO has undertaken a multi-stage consultation process to ensure that the entire spectrum of medical eye specialists in Australia and New Zealand can contribute to the process of identifying and refining the top five recommendations. The first stage included a survey of fellows to identify possible recommendations, which were then narrowed down and by a dedicated “Choosing Wisely” committee of RANZCO members. A second survey was then sent to all members to provide feedback on the list of five and received a high response rate. Based on the extensive feedback received via the survey, RANZCO’s “Choosing Wisely” committee crafted the final wording of the top five recommendations. Finally, the RANZCO board discussed and approved the recommendations.

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