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.
6.
Do not use corneal cross linking for every patient with keratoconus.
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
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.
- 1 In the absence of relevant history, symptoms and signs, ‘routine’ automated visual fields and optical coherence tomography are not indicated.
- 2 AREDS-based vitamin supplements only have a proven benefit for patients with certain subtypes of age-related macular degeneration. There is no evidence to prescribe these supplements for other retinal conditions, or for patients with no retinal disease.
- 3 Don't prescribe tamsulosin or other alpha-1 adrenergic blockers without first asking the patient about a history of cataract or impending cataract surgery.
- 4 Intravitreal injections may be safely performed on an outpatient basis. Don't perform routine intravitreal injections in a hospital or day surgery setting unless there is a valid clinical indication.
- 5 In general there is no indication to perform prophylactic retinal laser or cryotherapy to asymptomatic conditions such as lattice degeneration (with or without atrophic holes), for which there is no proven benefit.
- 6 Do not use corneal cross linking for every patient with keratoconus.
- 7 Do not use topical antibiotics pre or post intravitreal injections.
- 8 Do not investigate systemically well patients with a first, uncomplicated episode of acute anterior uveitis.
- 9 Topical steroids should not be used unless infection has been ruled out in any patient with red eye.