Corneal Cross-Linking
On This Page
Evaluation
The primary purpose of corneal collagen crosslinking is to halt the progression of corneal ectasia. The best candidate for this treatment is any individual with evidence of corneal or refractive error change and a diagnosis of a corneal thinning condition. While the most common indication for corneal cross-linking is keratoconus, there are a number of other corneal conditions that can benefit from corneal stability after cross-linking. Some of these conditions may include Pellucid Marginal Degeneration, Terrien’s Marginal Degeneration, and post-refractive surgery ectasia (such as LASIK, PRK, radial keratotomy, and recurrent keratoconus after corneal transplants).
Currently, there are no requirements addressing specific visual impairment or disease status to warrant a referral for corneal cross-linking. Examination findings, ocular and family history, environmental factors such as allergies and eye rubbing, frequent or large prescription changes, reduced visual quality, and patient age are all important factors when considering corneal cross-linking. Corneal ectasias are progressive by definition, therefore, it is very important to treat younger patients as soon as a diagnosis of keratoconus or other corneal ectasia is made. There are numerous benefits to cross-linking as early as possible in the disease process. Limiting the progression of corneal ectasia increases the chance the patient will be able to maintain good quality of vision with glasses and soft contact lenses, thus reducing the likelihood of a corneal transplant in the future.
Recently, major medical insurances have begun to recognize the medical necessity for this procedure and more patients are finding corneal cross-linking covered by insurance. When a patient is referred to our clinic for a cross-linking evaluation, previous exam notes are very helpful during the submission of insurance authorizations. In fact, early examination notes are more likely to show change compared to present day, so please include all exams, no matter how old!
Surgery
After instillation of topical anesthetic drops and placement of a lid speculum, the corneal epithelium is loosened and gently removed by the surgeon, similar to a PRK procedure. Riboflavin drops are then instilled into the eye following the most up-to-date protocols supported by research in order to optimize treatment efficacy. The goal of this step is to saturate the corneal stroma with riboflavin, which maximizes the number of covalent bonds created between the corneal fibrils. After adequate absorption of riboflavin, UV light delivery begins. During the UV light exposure, the riboflavin drops are continually instilled into the eye according to protocol. Following the procedure, antibiotic drops are instilled and a bandage contact lens is placed on the eye.
Currently, there are numerous cross-linking studies being conducted across the world. The wavelength of UV light, exposure time, and frequency of riboflavin drop instillation continue to be evaluated. Our research teams diligently monitor for the latest information to ensure patients are receiving the most current treatment regimens.
Post Op
Post-op schedule: Day 4, Day 10, 1 month, 3 month, 6 month, 12 month/annual monitoring
A bandage contact lens is placed by the surgeon immediately following the cross-linking procedure. Post-operatively, these patients will likely experience eye watering and light sensitivity. There will also be discomfort, ranging from a gritty feeling to a burning sensation for a few days after the procedure. The post-operative medications may also sting upon instillation. Vision will be blurry post-operatively until the epithelium heals and smooths across the corneal surface. After the bandage contact lens is removed, typically around 4-5 days post-op, vision will continue to improve over the following 1-2 weeks. If the patient would like to get a new glasses or contact lens prescription, we recommend waiting 3 months. Existing contact lens wearers can return to their soft or scleral contact lenses around 2-4 weeks after the procedure, depending on their healing process. Patients wearing corneal-sized gas-permeable lenses should wait closer to one month before resuming contact lens wear
A Case Study by Dr. Mitch Ibach, "Could it be KC? KC File #1: The Patient Who Corrects to 20/20"