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There are numerous treatment options available for keratoconus including the use of corneal rings in mild cases or corneal transplants in advanced cases. Corneal cross-linking (CXL) is a treatment for patients with progressive keratoconus which can prevent their condition getting worse. It is successful in more than 90% of cases.
CXL, also known as C3R, uses ultraviolet light and vitamin B2 (riboflavin) drops to stiffen the cornea. Used together, they cause fibres within the cornea to cross-link – or bond more tightly. This treatment mimics the normal age-related stiffening of the cornea, which is known as natural cross-linking.
The treatment is recommended only for patients whose corneal shape scans show that their keratoconus is getting worse, or for those who are at particularly high risk of worsening keratoconus. The procedure is designed to stablise vision but can help improve vision in 40-50% of patients.
What is Glaucoma?
Glaucoma is a disease that damages the nerve at the back of your eye, called the optic nerve. The optic nerve sends the signals to the brain that enables you to see. Glaucoma is associated with increased sensitivity to pressure within the eye. The eye’s aqueous fluid is constantly produced and drained at a balanced rate and forms the intraocular pressure within the eye (IOP). When this drainage is reduced, or if there is too much fluid production, IOP increases and leads to damage of the optic nerve.
Image of the optic nerve showing loss of nerve cells in patients with glaucoma.
Glaucoma typically has no symptoms. Most patients do not experience any issues until they visit their eyecare provider. Untreated glaucoma can cause a gradual loss of vision, usually starting in the periphery which may go unnoticed for long periods of time.
Image showing the effect of loss of sight in patients with glaucoma.
Our Process :
Assessment
Detailed measurements of the eyes are taken for safety and accuracy, and your surgeon will discuss your options. If you wear contact lenses, please leave them out and wear glasses for two full days prior to the day of your assessment.
Meet your surgeon
Your surgeon will thoroughly examine your eye and discuss your keratoconus treatment options including CXL. Our surgeons have published widely on CXL and its benefits.
On the day
You will be at Re:Vision for around two hours. After your procedure which typically takes 30 minutes you will be kept comfortable and can choose from a series of snacks. You will need someone to drive you home.
Check
The recovery following CXL typically takes a few days. Your eye will be sore for about 2-3 days after the procedure. You will be reviewed 3-5 days after the procedure to check how your cornea is healing and to remove the bandage contact lens. Although vision is often hazy at first, most patients can return to work after 5-7 days. CXL treatment will take several months to completely stabilise the improved shape of the eye.
Saving money
The hidden costs: what could you save?
What could that money have done?
The $40,000 you'd potentially spend on glasses and contact lenses over the next 30 years could have given you 15 luxurious holidays.
Est - 15 Holidays
Average holiday cost: $2600
Calculation: 40,000 / $2600 = 15
Saving time
The hidden cost of wearing glasses or contact lenses.
Did you know?
The time you'd spend handling glasses and contact lenses over the next 30 years is enough to have could have taken you around our planet over 30 times!
Est- 526 hours
Cleaning: 3 minutes/day
Finding misplaced glasses: 2 minutes/day
Repair, shopping: 2 hours/year
Total: 526 hours (over 30 years)
Est- 526 hours
Inserting and Removing: 3 minutes/day
Cleaning: 2 minutes/day
Renewing & Check-ups: 2 hours/year
Total: 1,012 hours (over 30 years)
Saving planet
Reducing our carbon footprint
The environmental perspective
Over 30 years, using glasses and contact lenses contributes to 876lb of CO2 emissions. Opt for vision correction and take a stand for our planet!
Est- 876.6 CO2 emissions
Combined plastic waste:
0.525 kg (glasses)+65.7 kg (contact lenses)=66.225 kilograms over three decades.
Total: 66.225 kilograms of plastic×6=397.35 kilograms = 876Lb of CO2 emissions(over 30 years)
CXL benefits
Safe
We use tried at tested crosslinking technology to provide unequalled safety and care.
Fast
With accelerated CXL your treatment will typically be completed in a matter of minutes.
Proven
CXL has been around for over 20 years, with numerous studies proving its effectiveness. Our doctors have also published on the safety and efficacy of CXL.
Personalised Surgical Care
Some patients are not suitable for drops or laser therapy and require either cataract surgery, minimally invasive glaucoma surgery or complex glaucoma surgery.
Minimally invasive Glaucoma surgery (MIGS) marks a milestone in the advancement of glaucoma patient care. MIGS are a form of glaucoma surgery which is associated with minimal incisions, and are generally associated with lower risks in restoring normal eye pressure.
Prior to MIGS, treatment options were limited to medications, laser and major glaucoma tube and filtration surgery. Now, with MIGS, our team at Re:Vision have more treatment options which benefits a patient with faster recovery , less surgical risks and less dependence on medications following surgery.
Our surgeon is a leader in MIGS surgery in NZ, with a wealth of experience with iStent -W, Kahook Dual Blade, Hydrus, XEN, Preserflo, micropulse and cyclodiode laser.
MIGS management include:
1) Various treatment options and benefits which are patient centric and individualised
2) Evidence based therapy and
3) Promising outcomes for glaucoma patients.
MIGS can be performed as a standalone procedure or in conjunction with cataract surgery. There are different surgical approaches under the MIGS umbrella, but they generally are designed to allow more fluid to drain out of the eye and hence, reduce intraocular pressure.
a) iStent
The iStent is the smallest medical device ever implanted into humans. The iStent decreases eye pressure by creating a pathway into the eye’s drainage system. The iStent was the first trabecular micro-bypass device approved by the FDA and is the most thoroughly-studied glaucoma device on the market.
Click here to watch video on iStent
b) Kahook Dual Blade
The Kahook Dual Blade goniotomy procedure involves removing a section of the trabecular meshwork (the part which is associated with the greatest resistance in fluid outlflow) and hence increasing drainage out of the eye.
Click here for information on KDB
c) Micropulse Laser Treatment
This procedure decreases the amount of fluid produced by the eye and increases fluid outflow. A probe is placed on the surface of the eye and the surgeon applies laser energy to part of the eye which controls the production of fluid in the eye.
d) Preserflo Stent
The Preserflo drainage shunt is type of microshunt implant used to reduced intraocular pressure by creating a controlled pathway for the drainage of fluid out of the eye. It is made from a specialised biocompatible material called SIBS, which is known for its stability, flexibility and compatibility with the human body, hence minimising tissue inflammation.
Click here for information on Preserflo
Trabeculectomy surgery has been done for more than 50 years, and involves making a separate channel for fluid to filter out of the eye.
A drainage tube is a device inserted into the eye, which acts as straw where fluid can access to drain out of the eye onto the outer coat of the eye. There are several drainage tubes available in NZ which include Molteno drainage tube, Paul drainage tube and Baerveldt drainage tube.
Generally, these surgeries are done once all others have been exhausted and have failed to stop the progression of glaucoma.
Glaucoma is optic nerve damage due to increased pressure sensitivity within the eye while a cataract is a clouding of your natural lens within your eye.
In some patients, the hardening and change in the shape of the lens with the development of cataract, can potentiate the effects of glaucoma, such as angle closure glaucoma. In this situation, we may suggest having cataract surgery as a way to treat your glaucoma.
Some patients can combine glaucoma and cataract surgery (includes patients with open angle glaucoma). MIGS procedures in particular can be performed through the same incision as cataract surgery, providing an efficient way to address two problems at once.
Our Technology:
Sirius Tomographer
Combines Placido disk topography with Scheimpflug tomography of the front of the eye to allow the surgeon to perform the safest version of laser vision correction customised to your eyes. The device provides highly accurate measurements of corneal thickness, curvature, power as well as pupil size measurements and is commonly used for refractive surgery planning and follow-up.
Custom Built Surgical Facility
Re:Vision Laser & Cataract was specifically designed and created by our surgeons to provide maximum safety for patients in need of eye surgery. We are fully accredited by the Designated Auditing Agency (DAA) with an excellent scoring.
SCHWIND CXL-365 Vario Corneal Crosslinking System
The CXL-365 vario extension is integrated into the workflow of the SCHWIND AMARIS laser, so that additional adjustment and space are not required.
The CXL-365 vario has three power levels, 3-18 mW/cm2, allowing accelerated treatments of 5 minutes.
The UV beam diameter is adjustable between 7-11 mm. This protects the limbal stem cells and allows for safe crosslinking.
Triton Swept Source OCT
This Swept Source OCT provides a significant improvement over conventional OCT. Due to the optimized long wavelength scanning light (1,050nm), there is better penetration of the deeper layers of the eye. This device takes 100,000 scans per second to provide better accuracy and is able to scan teh entire cornea in a matter of seconds.
Glaucoma Research at Re:Vision
Dr Perumal values the importance of research initiatives and technology in glaucoma. We may invite you to participate in the Save Sight Registry run by the Save Sight Institute, in collaboration with the University of Sydney and Sydney Eye Hospital to fight glaucoma blindness.
The Save Sight Registries is one of the most advanced ophthalmic registries in the world, and is a unique platform for tracking eye disease, interventions and patient outcomes. Its sophisticated design delivers real-world evidence on the risks and benefits of current and new treatments for ocular conditions. This information helps clinicians provide safe, cost-effective and evidence-based solutions for vision impairment and avoidable blindness.
The Save Sight Registries also promotes international scientific research aimed at developing strategies for reducing the incidence of blindness throughout the world.
How much does CXL cost?
CXL costs are usually covered by most insurance companies. Exact costs depend on the type of CXL best suited for you.
By the time I turn 45, I will have spent on contact lenses/glasses :
At Re:Vision, all types of laser vision correction
(LASIK or PRK) cost : $3,599/eye
Get Started
References :
- Angelo L, Gokul Boptom A, McGhee C, Ziaei M. Corneal Crosslinking: Present and Future. Asia Pac J Ophthalmol (Phila). 2022 Sep 1;11(5):441-452.
- Ziaei M, Yoon JJ, Vellara HR, Gokul A, Meyer JJ, Thakur SS, McGhee CN, Patel DV. Prospective one year study of corneal biomechanical changes following high intensity, accelerated cornea cross-linking in patients with keratoconus using a non-contact tonometer. Eur J Ophthalmol. 2021 Dec
- Angelo L, Gokul A, Wadhwa H, McGhee CNJ, Ziaei M. Assessment of Barriers to Accessing a First Specialist Assessment and Follow-up Keratoconus and Crosslinking Service at a Tertiary Referral Centre to Address Health Disparities. Cornea. 2023 Apr 25
- Wadhwa H, Gokul A, Li Y, Cheung I, Angelo L, McGhee CNJ, Ziaei M. Repeatability of Scheimpflug based corneal tomography parameters in advanced keratoconus with thin corneas. Eye (Lond). 2023 Apr 19.
- Al-Mahrouqi H, Cheung IMY, Angelo L, Yu TY, Gokul A, Ziaei M. Therapeutic non-ectasia applications of cornea cross-linking. Clin Exp Optom. 2023 Jan 23:1-11.
- Ashena Z, Doherty S, Gokul A, McGhee CNH, Ziaei M, Nanavaty MA. Flattening of Central, Paracentral, and Peripheral Cones After Non-accelerated and Accelerated Epithelium-off CXL in Keratoconus: A Multicenter Study. J Refract Surg. 2022 May;38(5):310-316.
- Ziaei M, Yoon JJ, Vellara HR, Gokul A, Meyer JJ, Thakur SS, McGhee CN, Patel DV. Prospective one year study of corneal biomechanical changes following high intensity, accelerated cornea cross-linking in patients with keratoconus using a non-contact tonometer. Eur J Ophthalmol. 2021 Dec
- Chen X, Zhao J, Iselin KC, Borroni D, Romano D, Gokul A, McGhee CNJ, Zhao Y, Sedaghat MR, Momeni-Moghaddam H, Ziaei M, Kaye S, Romano V, Zheng Y. Keratoconus detection of changes using deep learning of colour-coded maps. BMJ Open Ophthalmol. 2021 Jul 13;6(1)
- Li Y, Gokul A, McGhee C, Ziaei M. Repeatability of corneal and epithelial thickness measurements with anterior segment optical coherence tomography in keratoconus. PLoS One. 2021 Jun 18;16(6):e0248350. doi: 10.1371/journal.pone.0248350. PMID: 34143790; PMCID: PMC8213071.
- Li Y, Gokul A, McGhee C, Ziaei M. Repeatability and agreement of biometric measurements using spectral domain anterior segment optical coherence tomography and Scheimpflug tomography in keratoconus. PLoS One. 2021 May 21;16(5)
- Li Y, Lu LM, Gokul A, Ziaei M. Case Report: Successful Corneal Crosslinking in a Patient with Corneal Ectasia Associated with Stevens-Johnson Syndrome. Optom Vis Sci. 2021 Jan 1;98(1):13-17.
- Ziaei M, Gokul A, Vellara H, Patel DV, McGhee CNJ. Measurement of refractive, wavefront, topographic, and keratometric changes attributable to epithelial removal in keratoconus. Can J Ophthalmol. 2020
- Goh YW, Gokul A, Yadegarfar ME, Vellara H, Shew W, Patel D, McGhee CNJ, Ziaei M. Prospective Clinical Study of Keratoconus Progression in Patients Awaiting Corneal Cross-linking. Cornea. 2020 Oct;39(10):1256-1260
- Ziaei M, Gokul A, Vellara H, Patel D, McGhee CN. Peripheral Cornea Crosslinking Before Deep Anterior Lamellar Keratoplasty. Medical Hypothesis, Discovery & Innovation in Ophthalmology, 9(2), 127-134. 2020
- Ziaei M, Gokul A, Vellara H, Lu LM, Patel DV, McGhee CNJ. Measurement of In Vivo Biomechanical Changes Attributable to Epithelial Removal in Keratoconus Using a Noncontact Tonometer. Cornea 2020
- Ziaei M, Gokul A, Vellara H, Patel D, McGhee CNJ. Prospective two year study of changes in corneal density following transepithelial pulsed, epithelium-off continuous and epithelium-off pulsed, corneal crosslinking for keratoconus. Cont Lens Anterior Eye. 2020.
- Ziaei M, Vellara HR, Gokul A, Ali NQ, McGhee CNJ, Patel DV. Comparison of corneal biomechanical properties following penetrating keratoplasty and deep anterior lamellar keratoplasty for keratoconus. Clin Exp Ophthalmol. 2019.
- Ziaei M, Vellara H, Gokul A, Patel D, McGhee CN. Two-Year Outcomes of Accelerated Pulsed Transepithelial Corneal Collagen Cross-Linking for Keratoconus: A Prospective Study. Eye 2019.
- Ziaei M, Gokul A, Vellara H, Meyer J, Patel D, McGhee CN. Prospective two-year study of clinical outcomes following epithelium-off pulsed versus continuous accelerated corneal crosslinking for keratoconus. Clin Exp Ophthalmol 2019.
- Ziaei M, Meyer J, Gokul A, Vellara H, McGhee CNJ. Direct measurement of anterior corneal curvature changes attributable to epithelial removal in keratoconus. J Cataract Refract Surg 2018; 44: 71-77
- Ziaei M, Barsam A, Donnenfeld E, Collagen Crosslinking for Keratoconus, Cornea (4th edition), Mannis & Holland, Elsevier, 2016 Nov.
- Ziaei M, Barsam A, Shamie N, Vroman D, Kim T, Donnenfeld ED, Holland EJ, Kanellopoulos J, Mah FS, Randleman JB, Daya S, Güell J; ASCRS Cornea Clinical Committee. A review of reshaping procedures for the surgical management of corneal ectasia. J Cataract Refract Surg. 2015. 41(4):842-872.
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