February 16, 2020

How Cross Linking Has Changed Keratoconus Treatment


Read the full NZ Herald article here

Treatment of keratoconus has had a huge leap forward thanks to corneal cross-linking. Many professionals state that it’s the most significant development since the introduction of the contact lens, or the introduction of the corneal transplant.

Corneal cross-linking has been used for the past 15 years and was approved by the American Food and Drug Administration (FDA) back in 2016. It has quickly become a standard for the treatment of ongoing keratoconus. Cross-linking, often referred to as CXL, is a process that helps prevent keratoconus from getting worse to help certain patients avoid the need for rigid contact lenses and undergoing corneal transplant surgery.

So how does corneal cross-linking work, and why has it had such an impact? Read on to find out!

How does cross-linking work?

Keratoconus is a condition in which your cornea—the front window to your eye—weakens and loses its symmetrical shape. Over time, it can bulge, becoming more of a cone shape, and this can alter your vision.

CXL uses medication delivered via eyedrops and ultraviolet light (UV-A) to strengthen your cornea. These help the cornea hold its shape better, preventing it from getting any worse. The name—cross-linking—derives from the process by which the cornea gains strength, as it creates more collagen fibres in the cornea and makes already existing collagen fibres work better together. 

This procedure can be carried out fairly easily using sophisticated equipment. First, numbing eye drops are used, followed by riboflavin eye drops, which contain vitamin B2. At Re:Vision, a highly sophisticated laser is used to allow for better absorption of the Riboflavin drops into the cornea. After about 10 minutes of drop use, all you need to do is lie back in the doctor’s chair and look up at a special light. The treatment takes around 30 minutes altogether, and is typically completely painless.

How has cross-linking helped change the world of eye care?

Essentially, since CXL was created to strengthen the cornea in order to prevent keratoconus from continuing, it has given ophthalmologists an option for early prevention, rather than treatment after the fact. Now that primary care optometrists are able to identify the early stages of keratoconus, cross-linking gives patients a chance to avoid surgery later on. 

So long as optometrists continue to be diligent in their checks, it should be possible to manage many cases before they progress to a stage where surgery is the only viable course of action. This means all patients who have reduced vision or unusual refraction in their sight should be tested for keratoconus, in case it can be dealt with early.

This means optometrists and ophthalmologists need to work together closely. Cross-linking has turned the approach to keratoconus on its head—no longer is it a condition that can only be observed until surgery is required. Instead, direct action can now be taken in order to help patients avoid surgery. This is essentially the same way that glaucoma is managed now.

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Note that even though CXL has proven an effective way of halting the progression of keratoconus, with a success rate of over 90 per cent, there are some patients who will still require other treatments. This means that close examination is required both before and after CXL, as there is a chance that the keratoconus will progress after CXL has been implemented.

To learn more about this procedure as it continues to evolve, keep following our blog! If you have other questions about keratoconus treatment or your vision, feel free to get in touch with our friendly team today. If you like, we can also help you organise an assessment! Don’t wait, contact us now!

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