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The DUCK-score: a weighted compound score to improve decision making in cross-linking treatments

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Session Details

Session Title: Cross-Linking

Session Date/Time: Tuesday 10/10/2017 | 14:00-16:30

Paper Time: 15:42

Venue: Room 4.6

First Author: : R.Wisse THE NETHERLANDS

Co Author(s): :    M. van Vossen   B. Muijzer   N. Soeters   D. Godefrooij   C. Koppen   R. Nuijts     

Abstract Details


Crosslinking (CXL) is a well established treatment for progressive keratoconus. The definition of progression however is subject of debate. The current paradgim of 1 Diopter increase in maximum keratometry (kmax) promotes overtreatment and has a negative effect on CXL cost-effectiveness.


Multicenter study. University Medical Center Utrecht, Maastricht University Medical Center. The Netherlands.


The Dutch Crosslinking for Keratoconus (DUCK) score is calculated based on changes in five domains: keratometry, manifest refraction, visual acuity, age and subjective patient experience. 0, 1 or 2 points were assigned per item. Cut-off scores and validation characteristics were calculated based on the retrospective progression analysis of our 01/2012-06/2014 CXL cohort with two year follow-up, matched with all untreated keratoconus patients referred to our institution in the same timeframe. A validation will be performed based on an external treatment cohort.


245 eyes of 161 patients who underwent epi-off CXL and approximately 485 eyes of untreated keratoconus patients were included. When adhering to the DUCK score a reduction of 18% in CXL treatments was calculated and a 13% lower failure rate. 11% of patients who showed topographic progression would have been treated using the DUCK score. Data will be presented regarding the amount of eyes with a Kmax increase >1D and DUCK scores tresholds values, and subsequently compared with the number of eyes that actually underwent CXL treatment.


The DUCK-score will be presented as a straightforward tool to improve clinical decision making in determining CXL eligibility. Including more factors than mere keratometry solodifies the indication of a CXL procedure, and takes the patient's perspective into account. Realistic indications for CXL are needed to prevent overtreatment, and subsequently improve CXL cost-effectiveness by offering this intervention to patients who are likely to benefit most.

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