CrossLinking for Keratoconus
What is keratoconus?
This is a condition where the central part of the cornea is thinner than normal, causing it to progressively protrude in a conical shape. This interferes with the ability of the eye to focus causing blurred vision. Eventually the cornea could become scarred leading to inability to see.
About 21% of keratoconus patients eventually require corneal graft to replace the scarred cornea and restore eyesight.
What is crosslinking?
Previously there has been no successful way to stop the progression of keratoconus A new treatment for keratoconus known as ‘cross-linking’ has shown great success.
How is crosslinking done?
Crosslinking is performed in the operating theatre under complete sterile conditions. The superficial layer of the cornea is removed, the riboflavin drops applied and the eye is then exposed to ultra violet light.At the end of the procedure a bandage contact lens is applied and left in place for 48 hours by which time the corneal surface will have healed.
• Usually, only one eye is treated in one sitting, the procedure takes about an hour per eye.
• The treatment is performed under topical anesthesia (using anesthetic eye drops).
• There are no injections and the procedure is painless
• The procedure takes about an hour for each eye.
Who can benefit from crosslinking?
Collagen crosslinking treatment is not a cure for keratoconus, it aims to slow or even halt the progression of the condition. By arresting progression of keratoconus we can prevent further deterioration in vision and ultimately prevent the need for corneal transplantation.
One needs to be assessed by an eye doctor and some tests carried out to determine their suitability for crosslinking. Patients may need to continue to wear spectacles or contact lenses after the treatment.
What is the safety profile regarding the use of ultra-violet light and of riboflavin in the eye?
· The ultraviolet light exposure during a crosslinking procedure is comparable to, or even less than, the exposure of the eye to the ultraviolet light in skylight for a full day outdoors.
· The riboflavin drops are simply vitamin B2, commonly used in foods such as breakfast cereals.
Are there any age limits?
Not usually but the ophthalmologist should advice you.
What are the possible complications and side effects of crosslinking?
These are often transient and a part of the healing process and include:
· Pain in the first 1-2 days
· Sensitivity to light for several days
· Haze within the cornea that may cause blurring for up to a few weeks.
· There are other less common possible complications and side effects that the ophthalmologist can discuss with you.
Can crosslinking be redone if needed?
Yes, where necessary retreatment can be done, but a one-time treatment has been shown generally to be enough to halt progression.
One of the goals of crosslinking is to make the cornea more regular, allowing for soft contact lenses to replace the need for rigid gas permeable lenses. Rigid gas permeable lenses are good for vision in Keratoconus, but without warning can cause central scarring and/or can aggravate the condition.
The ophthalmologist will tell you if soft contact lenses are possible after crosslinking and how soon after treatment you may begin wearing them.
The blurring mentioned earlier may affect some people, especially in the first few days after the procedure; it could limit work and driving during that time.
Can anyone tell by my appearance that I have had crosslinking?
No. There is no change in the appearance of your eyes following crosslinking.
Can both eyes be cross-linked at the same time?
Technically yes, but the short term blurring due to the current procedure makes this impractical.
Will other eye treatments be a problem to perform after crosslinking?
No. It has no effect on any future surgery as far has been determined until now.
POST OPERATIVE INSTRUCTIONS AFTER CROSSLINKING1. Use the eye drops as instructed
2. Do not rub or press the eye
3. Avoid water getting into the eyes until the cornea has healed
4. Use the sunglasses provided for protection from the light
5. Do not miss you appointments as scheduled