December 03, 2025
3 min watch
Key takeaways:
- Scissoring reflexes, distorted mires and noninflammatory corneal thinning can help distinguish keratoconus from impostors.
- Access to corneal tomography is important for diagnosing keratoconus.
BOSTON — Differentiating keratoconus from potential impostor conditions is a key factor in making a timely diagnosis for optimal outcomes, according to a presenter.
“It’s really important to know whether it’s truly keratoconus or one of its impostors because the right diagnosis guides everything that follows,” Michelle Chung, OD, FAAO, FSLS, of Princeton Optometry, New Jersey, told Healio at Academy 2025. “Some of these conditions are progressive and need to be treated early to prevent vision loss, or others are a little more stable and can be managed differently.”
Key features to look for in diagnosing keratoconus include scissoring reflexes, distorted mires and clinically noninflammatory corneal thinning, Chung said. She advised not relying “on just one single scan” to diagnose keratoconus and highlighted corneal tomography as “one of the most important tools” for managing the condition.
“It gives us a detailed look at both the front and the back of the cornea,” she said. “Since keratoconus often does begin with very subtle changes in the posterior cornea, tomography helps us catch those early signs that might be missed with other imaging methods.”
If a practice does not have a corneal tomographer, it can be helpful to build relationships with those who do, Chung said.
“For example, refractive surgery centers almost always have a tomographer,” she said. “Asking if you can send those key patients there for scans would be a simple and effective way to access technology even if you don’t have it in your own practice.”
For more information:
Michelle Chung, OD, FAAO, FSLS, can be reached at michelle.chungod@gmail.com.
Sources/Disclosures
Source:
Tullo W, et al. Keratoconus and its impostors. Presented at: Academy 2025; Oct. 8-11, 2025; Boston.
Disclosures:
Chung reports no relevant financial disclosures.
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