Keratoconus causes your eyes to take on a pointed, rather than a round, shape. Doctors think that weakness and poor connections are to blame. When the tissues in your eyes are loosely attached to one another, they can drift apart and harden in new configurations. Without treatment, the problem gets worse.
A cross-linking surgery involves:
- Anesthesia. Your doctor will use drops to numb your eye, and you’re given other medications to help you relax.
- Removal. Your eye doctor scrapes away the epithelium of the eye.
- Riboflavin. Your doctor places drops of this substance on your eye.
- Light. A UV light activates the riboflavin. Bonds between the eye’s collagen fibers form and strengthen.
- Bandage. A contact lens protects your eye as it heals.
Expect to spend most of the day with your eye doctor, and plan to spend a few weeks in recovery.
Corneal Collage Cross-Linking Diagram Corneal collagen cross-linking, or CXL, is a revolutionary noninvasive outpatient treatment for progressive keratoconus patients and corneal ectasia patients. This treatment requires a riboflavin-containing solution and an ultraviolet light delivery device to strengthen the cornea. CXL treatments slow or halt progressive keratoconus for about 90% of patients and improve vision in more than half of patients treated.
What is Keratoconus?
Keratoconus, pronounced (KAIR-ah-toh-KOH-nus), is a progressive eye disease that causes the normally round cornea to become thin and bulge into a cone-like shape. Keratoconus can form in one or both eyes and it’s usually diagnosed in younger patients. Many patients are commonly diagnosed with mild astigmatism at the onset of puberty and are later diagnosed with keratoconus in their teens or early 20’s.
How Does Keratoconus Affect my Vision?
Because the cornea is responsible for focusing light into the eye, any abnormalities can cause vision to blur. Common conditions such as nearsightedness, farsightedness, and astigmatism can be caused by the cornea being too steep, too flat or football shaped. Since keratoconus caused the cornea to weaken to bulge into a cone-like shape, vision becomes very blurry and very unstable. This can severely affect vision and make simple everyday tasks such as driving a car, reading a book or watching television difficult or impossible.
How is Keratoconus Treated?
When the disease is initially diagnosed, many patients will require glasses or gas permeable contact lenses in order to maintain clear vision. As keratoconus progressively worsens, Intacs are often required. Intacs are small subcircular rings that are inserted into the cornea that can help the cornea stabilize. If the disease continues to progress, a corneal transplant is required. However, Collagen Cross-Linking or CXL is now available, which has shown tremendous success in slowing or stopping the progression of keratoconus. There are both FDA approved and “Off-Label” versions of CXL available, please ask what specific treatment is being recommended to you and benefits/risks associated with each form of treatment.
How is Corneal Collagen Cross-Linking (CXL) Performed?
CXL is performed as an outpatient procedure. First, your surgeon will instill eye drops, which will help numb the cornea surface to help ensure comfort. Next, an eye speculum is used to help keep the eyes open during treatment and the first series of vitamin B2 (riboflavin) drops are administered. An ultraviolet (UV) light is shined into the eye, which causes the vitamin B2 to activate, which causes the collagen cross-links to form. Additional B-2 drops are placed within the eye during this outpatient procedure, which only last a few minutes.
How Does Corneal Collagen Cross-Linking (CXL) Work?
UV light reacts at a molecular level with riboflavin on the surface of the cornea. Resulting bonds, or cross-links, make the cornea stronger. Strengthening the cornea has shown that collagen cross-linking has been extremely successful in slowing or stopping keratoconus and corneal ectasia. Many patients also have improved vision after undergoing treatment.
Corneal Collagen Cross-Linking Benefits
- Slows or Halts Progressive Keratoconus
- Requires A Single One-Hour Treatment
- No Injections
- No Stitches
- No Incisions
- Good Recovery
Corneal Collagen Cross-Linking Candidacy
- 14 Years of Age or Older
- Prior Diagnosis of Progressive Keratoconus or Corneal Ectasia
- Adequate Corneal Thickness
- Not Be Pregnant
- Ability to Leave Contact Lenses Out for Four Weeks Before and After Treatment
Studies have shown that CXL can last a very long time, and many doctors believe that CXL is permanent. In some cases, CXL may require a second treatment.
Since CXL is a non-invasive procedure, it is very safe. Newer techniques don’t require removal of the epithelium layer and allow for much greater patient comfort. This technique also allows for a faster healing time and reduces the risk of complications.
Many studies have shown that cross-linking can often prevent the need for a corneal transplant and allow patients to wear contact lenses or glasses more comfortably and safely again.
During your consultation, the doctor will determine if cross-linking might be an appropriate treatment option for you.