AFTER DETECTION COMES THE PATHWAY.

Screening finds the keratoconic eye; this module plans what happens next — is it progressing, which cross-linking protocol does this thickness allow, do ring segments have a place, and can your femtosecond laser actually cut the tunnel?

PROGRESSION BY CONSENSUS, NOT IMPRESSION

Progression requires at least two of three documented changes — anterior steepening, posterior steepening, pachymetric thinning — per the Global Consensus, which deliberately sets no numerical cut-off.^[2] RLES AI Mobile Interfacelies ≥ 1.0 D of Kmax change over 12 months as its own operational threshold for documented anterior steepening; the final progression judgement remains clinical. Because pediatric keratoconus may progress rapidly, early CXL evaluation is prioritised when documented progression or high-risk features are present; prophylactic CXL without documented progression is not supported. The report states which criteria were met and which data are missing.

THE CXL LADDER, BY THICKNESS AND BY YOUR DEVICE

• ≥ 400 µm → Dresden 3 mW/30 min^[1] or accelerated 9 mW/10 min^[4][5] (equivalent evidence)
• 320–399 µm → hypoosmolar riboflavin or contact-lens-assisted CXL, with intraoperative ≥ 400 µm confirmation before UVA
• < 320 µm → CXL is off the table; the report says so and redirects
• Your CXL device and riboflavin kit are registered once — protocols are then written only in your device’s approved modes and your kit’s soak scheme, never from a generic table

RINGS: BRAND GEOMETRY AND TUNNEL CAPABILITY

CAIRS and ICRS are compared honestly — allograft segments, with extrusion not reported in early series,^[3] versus established synthetic nomograms. Segment planning is brand-specific (Keraring, Ferrara, Intacs geometries differ) and is only produced once the brand is known. The femtosecond tunnel capability of your registered laser is checked against its actual labelling — a device without tunnel capability routes to manual dissection or referral. Beyond the limits (Kmax > 70 D, central scarring), a DALK/PK referral report is produced. Combined ring+CXL sequencing notes that segments placed after CXL act on stiffened stroma with reduced effect.

FREQUENTLY ASKED QUESTIONS