PROCEDURES

Cross-Linking Treatment
for Keratoconus

FDA-Approved Cross-linking Therapy for the Treatment of Progressive Keratoconus in Utah.
Overview

Keratoconus is a rare condition affecting people between the ages of 10 and 25 and may progress slowly.


Keratoconus occurs when the cornea (the clear outer layer at the front of the eye) becomes thin and gradually bulges outward into a cone shape. This condition causes optical irregularities that affect vision. Symptoms include blurred and distorted vision, astigmatism, double vision, inability to see in dim light, nearsightedness, sensitivity to light, and/or vision loss.

The difference

Normal Cornea vs. Keratoconic
Cornea Vision Simulator

The Importance of FDA-Approved Cross-Linking

In April 2016, the FDA approved Avedro’s corneal cross-linking procedure with the Photrexa drug formulations and the KXL® System to slow or halt the progression of the disease, giving patients an effective, minimally invasive treatment option. Corneal cross-linking is a medical procedure combining the use of ultra-violet (UV) light and riboflavin (vitamin B2) eye drops. The procedure works by creating new corneal collagen cross-links, which results in a shortening and thickening of collagen fibrils that lead to the strengthening of the cornea. Cross-linking, which has been performed in Europe since 2003, is considered the standard of care around the world for keratoconus.

Cross-linking Benefits

  • FDA approved therapeutic treatment available for progressive
    keratoconus and corneal ectasia following refractive surgery.
  • Can limit the progression of the disease by stiffening the cornea.
  • Clinical benefits of reduction in maximum corneal curvature.
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Cross-linking Risks

  • Ulcerative keratitis, and/or a potentially serious eye infection, can occur.
  • The most common ocular adverse events were corneal opacity, punctate keratitis, corneal striae, corneal epithelial defect, dry eye, eye pain, reduced visual acuity, photophobia, and blurred vision.
  • The majority of these adverse events resolved in the first month.
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Common Concerns

Frequent Asked Questions

Who is Eligible?

After surgery, the eye can feel as if it has experienced a scrape or abrasion. To minimize discomfort, a soft “bandage” contact lens is placed on the eye for four to five days to smooth and cover the surface until the epithelium has healed underneath. Vision is usually a little blurry at first but improves after the epithelium or surface has healed. Studies have shown that after three weeks, visual acuity of PRK patients generally matches that of LASIK patients.

What is keratoconus?

PRK is primarily recommended for patients who have thin corneas, have irregularities show up on their topography scans (irregular astigmatism), or are in professions that are not allowed to have LASIK.

What is cross-linking?

Wavefront-optimized treatments help preserve the natural prolate (round) shape of the patient’s cornea after treatment. This reduced an increase in higher-order aberrations that most all other lasers created.

What can I expect during the procedure?

The Wavelight EX500 is the fastest and most precise vision correction laser available in the United States.

What is ultra-violet A (UVA) light?

Wavefront-optimized lasers such as the Allegretto Wave Eye-Q and Zeiss MEL-80 were the first lasers certified by the FDA to reduce nighttime halo and glare, which were among the most common reported side effects of the traditional LASIK procedure.

Does corneal cross-linking require removal of the epithelium?

No. The older generations of laser technology are still FDA approved and are in use all across the U.S. While this technology is still capable of freeing you from glasses and contacts and improving your quality of vision, wavefront-optimized technology maintains the natural prolate shape of the cornea. This results in reduced issues such as nighttime halo and glare when compared to earlier generation lasers. It is important to do your research and select a center that invests in the most advanced technology to ensure yourself the best possible postoperative vision.

Am I awake during the procedure?

LASIK was formally granted final FDA approval in 1999. This marked a new era in surgical vision correction: LASIK had proven far more predictable, safe, effective, and permanent than earlier refractive procedures such as radial keratotomy (RK) and automated lamellar keratoplasty (ALK).

How long does the treatment take?

The first major advance in technology after FDA approval was the introduction of blade-free LASIK, also known as “all-laser LASIK.” Blade-free LASIK uses a computer-guided laser, called a femtosecond laser, to create the flap that was formerly made with an oscillating steel microkeratome blade.

What can I expect after the procedure?

Patients who make the best candidates for LASIK include those who are in good health, are at least 18 years of age, and have healthy eyes with no diseases of the cornea or retina. It is also necessary to have a prescription that has been stable for at least one year.

As with any surgery, risks and complications are associated with the LASIK procedure. Patients uncomfortable with the possible risks and complications and those with unrealistic expectations about how LASIK can improve their vision should consider other treatments that have comparable results. Our qualified surgeons at Hoopes Vision will be able to assess whether you are a candidate for LASIK or another refractive surgery. If you live in Salt Lake City or anywhere else in Utah and beyond, contact Hoopes Vision for a free evaluation.

Will it hurt?

The procedure itself is not painful since medication is administered to make you feel comfortable. Postoperatively, most patients experience little or no discomfort. After the procedure, your eyes may feel scratchy, gritty, or watery. These are temporary symptoms and are not a problem for most patients.

Will it change my appearance?

Yes. Most surgeons operate on both eyes at the same sitting. The results are so predictable and the procedure so safe that most people undergoing LASIK surgery prefer to have both eyes corrected on the same day.

Is cross-linking right for me?

Visual recovery varies from one day to one week. The majority of patients resume normal activities one to two days following surgery but it may take one to two months for your vision to fully stabilize.

How long should I stop wearing my contacts before the procedure?

Because contact lenses can alter the shape of your cornea, you will need to remove your contacts prior to your pre-operative exam. If you wear soft lenses, they should be removed a minimum of five days before your exam. If you wear rigid/gas permeable lenses, remove them at least three weeks prior to your exam. By removing the lenses, the cornea will be restored to a more natural shape before measurements are taken. Following your pre-operative exam, if you are a soft lens wearer, lenses must be out at least five days prior to treatment. If you wear rigid/gas permeable lenses, you may be asked to leave your lenses out until your day of surgery.

Is corneal cross-linking covered by my insurance?

Hoopes Vision offers financing through Care Credit. We have several different payment plans available, including no-interest financing for 18 and 24 months, or extended terms of up to 60 months. Plans are available to make your blade free LASIK fit into nearly any budget.

Next steps

Early diagnosis is critical and allows
patients to be treated at the onset
of the disease.

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