A New Keratoconus Treatment, Stops Keratoconus from Progressing
As a leading cornea specialist in the Washington, DC metro area, Dr. Daniel Sarezky is one of the few eye surgeons in the region to offer Corneal Cross-Linking to patients affected by keratoconus and corneal ectasia following refractive surgery in our state-of-the-art office surgical center.
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The cornea is the window of the eye. Light travels through the cornea past the lens to the retina and then the brain to form a visual image. The normal corneal surface is smooth and aspheric (round in the center, flattening towards its outer edges). Light rays passing through it move in an undistorted manner to the retina to project a clear image to the brain.
Keratoconus is a disorder in which the cornea undergoes progressive thinning. Keratoconus is more common now than ever before. Once thought to occur in 1 in 2000 people, it is now 1 in 500 people (400% more common than in the past). It is more prevalent in teenagers and adults in their 20s. Keratoconus arises when the middle of the cornea thins and gradually bulges outward, forming a rounded cone shape. This abnormal curvature changes the cornea’s refractive power, producing moderate to severe distortion (astigmatism) and blurred vision (nearsightedness). Keratoconus may also cause swelling and sight-impairing scarring of the tissue.
“Corneal cross-linking is beneficial to my patients in that it offers them a therapeutic option to limit the progression of keratoconus and corneal ectasia following refractive surgery,” says Daniel Sarezky, MD. “The FDA approval of corneal cross-linking with Photrexa products and the KXL System offers new treatment options for appropriate patients who, until now, had few options to help with their vision challenges and with little to no therapeutic treatment for these sight-threatening conditions.”
A healthy cornea resembles a clear, round dome. Your cornea is located at the front of your eye and helps you to see by focusing the light that enters through your eye.
However, with keratoconus, the cornea doesn’t have enough collagen fiber cross-links (which serve as a kind of structural support). Without those cross-links, the cornea starts to bulge out in a cone-like shape.
The bulge of the cornea results in blurred, distorted vision as the cornea weakens and thins. Keratoconus can significantly impair vision and can be difficult to treat with glasses or contact lenses. Advanced keratoconus may even require corneal transplant surgery.
Symptoms of keratoconus typically include:
Keratoconus usually affects both eyes. At first, people can correct their vision with eyeglasses. But as astigmatism worsens, they must rely on specialty contact lenses to reduce the distortion and provide better vision. Although finding a comfortable contact lens can be an extremely frustrating and difficult process, it is crucial because a poorly fitting lens could further damage the cornea and make wearing a contact lens intolerable.
One common type of corrective lenses used to treat more severe keratoconus are scleral lenses. Scleral contact lenses, unlike traditional soft contact lenses which rest on the cornea, are designed to sit on the sclera, the white part of the eye, and arch over the cornea without making contact with it. Because they do not touch the irregularly shaped cornea, patients find them to be a comfortable way to manage their condition.
In most cases, the cornea will stabilize after a few years without ever causing severe vision problems. However, in about 10 to 20 percent of people with keratoconus, the cornea will eventually become too scarred or will not tolerate a contact lens. At this point, a surgical procedure may be needed to restore vision. In the past, surgical treatment options were limited and often required long visual recovery time. Now, however, there are new treatment options for patients such as collagen cross-linking with ultraviolet light, INTAC corneal implants, and advanced corneal transplantation techniques. These new procedures are less invasive and have faster visual recovery times.
“Early diagnosis is critical and allows patients to be treated at the onset of the disease,” states Dr. Sarezky, “Patients suffering from progressive keratoconus and corneal ectasia following refractive surgery can now receive a treatment that has been rigorously tested and approved.”
Corneal collagen cross-linking is a non-invasive procedure that combines the use of UV light and riboflavin (vitamin B 2) eye drops. The treatment shortens and thickens the collagen fibers and creates new collagen cross-links, resulting in stiffening and strengthening of the cornea.
Cross-linking is shown to:
Cross-linking is performed on one eye at a time, typically 3 to 6 months apart. During this time a surgeon will closely monitor changes in the corneal shape and vision.
Collagen cross-linking treatment is not a cure for keratoconus, rather, it aims to slow or even halt the progression of the condition. This treatment changes the intrinsic biomechanical properties of the cornea and has been shown to strengthen the cornea by around 300%. While the procedure is comparatively recent, research to date indicates that it is very effective in both slowing disease progression and improving vision. The main aim of this treatment is to arrest the progression of keratoconus, and thereby prevent further deterioration in vision and the need for a cornea transplant.
Younger patients are the ideal candidates are in the younger age spectrum — up through their 50s. The FDA has approved the procedure for people ages 14 to 65.
You may not be able to have cross-linking treatment if your cornea is too scarred or too thin, or if you have an active infection or a problem with the surface of your eye, such as severe dry eye.
Until recently, there was no method to change the integrity and strength of the cornea itself for keratoconus patients. The non-invasive treatment of corneal collagen cross-linking riboflavin has been proven to strengthen the weak corneal structure in keratoconus. This method works by increasing collagen cross-linking, which are the natural anchors within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular (which is the cause of keratoconus).
Very few potential risks associated with this treatment have been reported so far. The ultraviolet light dose used is designed to prevent damage to the cells that line the back of the cornea or the other structures within the eye. No lens opacities (cataracts) have been attributed to this treatment in European trials. The treatment involves the outer layer (epithelium) of the cornea. There is, therefore, discomfort and a short-term haze. Other lesser but more common risks include:
As is the case with any treatment, there may also be long-term risks that have not yet been identified. The increased corneal rigidity induced may wear off over time and further periodic treatments may be required.
Though the procedure itself takes approximately 1 hour and 15 minutes, plan to be at our Rockville clinic for up to 2 hours or so to allow time for pre- and post-operative testing and instructions. You will need a driver to take you home.
Topical anesthetic drops will be used to numb the eye, and an eyelid holder will be placed to keep you from blinking. A solution will then be applied to the cornea to help the surgeon remove the epithelium.
Riboflavin (vitamin B 2) eye drops are instilled at determined intervals until the corneal tissue is saturated. During treatment, an ultraviolet (UV) light is turned on, and additional riboflavin drops are instilled.
A contact lens is placed on the cornea immediately following the treatment. An experienced technician will go over all post-operative instructions and expectations. Patients should arrange to have a driver on the day of the procedure and for the one- and four-day post-operative appointments. Our goal is to ensure patients are able to resume normal activities as quickly as possible. This typically ranges from one to seven days.
It is important to understand that corneal collagen cross-linking is not a refractive vision correction procedure. The goal of cross-linking is to stabilize the cornea, stop the progression of keratoconus, and prevent further deterioration of vision. Most patients can expect to still need glasses and/or contacts to correct their vision following the procedure. The cornea may continue to change for many months. During this time, many patients require new glasses or contacts to accommodate the changing shape. Future refractive vision correction procedures can be discussed with your eye doctor once corneal stabilization has occurred.
Until recently, most insurance did not cover Corneal Cross-Linking. However, insurers are beginning to come on board. Currently, in this area, the insurers that now cover CXL are:
In addition, there is now an up to $200 Co-pay Assistance Program available for commercial patients with out-of-pocket costs.
The first step in determining your candidacy for any procedure is to schedule a consultation and experience our comprehensive eye exam. This is the most complete eye exam available today and includes a consultation with one of our experienced surgeons. Utilizing advanced diagnostic technology, our surgeons will not only evaluate your candidacy for a procedure for but will look at the overall health of your eyes and establish a long-term plan for clear vision.
Please help us provide you with the best experience by answering a few quick questions, and one of our surgical counselors will assist you. If you are a current patient and/or have a medical concern or question, please contact us directly at 301.896.0890.