Corneal Collagen Cross-Linking for Keratoconus and Post LASIK Ectasia
iLink ® epi off corneal collagen cross-linking (CXL) is currently the only FDA approved treatment that may slow down the progression of keratoconus and Post LASIK Ectasia. It is a surgical procedure to strengthen corneal tissue and stabilize the cornea’s shape, minimizing the risk of further vision loss.
If you have been diagnosed with keratoconus, or if you are concerned that your condition might be deteriorating, contact our optometrists at Cornea and Contact Institute of Minnesota to evaluate whether CXL is the best option for you.
What Is Corneal Collagen Cross-Linking?
Corneal collagen cross-linking is a surgical procedure performed by a corneal specialist or ophthalmologist to stabilize the shape and firmness of the cornea.
By applying Photrexa ® (riboflavin 5’-phosphate ophthalmic solution) (vitamin B2) eyedrops and ultraviolet light with the KXL ® system, the surgical treatment promotes the building of new collagen fiber links within the cornea.
In many cases, it helps prevent worsening vision, steepening of the cornea and a need for a corneal transplant. Collagen plays a vital role in creating and maintaining the smooth round shape of the eye’s surface. The tightness of the woven collagen fibers determines the strength of the corneal tissue. A weak cornea is prone to deformation, causing keratoconus to progress and vision to worsen.
CXL is also effective in treating corneal ulcers in cases where topical antibiotics did not produce results. Several other corneal infections have also successfully been treated with CXL.
Your Optometrist Prepares You for CXL
A few steps need to be taken before you undergo corneal collagen cross-linking. Our optometrists can assess whether you are a candidate and get you ready for the surgical procedure.
1) We’ll Evaluate If You Need CXL.
At Cornea and Contact Lens Institute of Minnesota, we will inquire into your patient history to determine whether any previous eye surgeries might prevent you from undergoing CXL. We will also examine several other factors, such as corneal curvature, thickness and keratoconus progression.
In case you have dry eye, this needs to be treated appropriately before scheduling the CXL procedure. We will also investigate your insurance coverage for iLink ® FDA-approved cross-linking with the CXL ® System.
Greater than 95% of the commercially insured population has access to this potentially sight-protecting treatment.
2) Pre-Op Exam at CCLIM
About 1 week prior to your procedure, you will have a short pre-op examination at Cornea and Contact Lens Institute of Minnesota where we will go over all forms and expectations.
Our optometrists will gather measurements about visual acuity, refraction, corneal mapping, and thickness. The data generated in this examination will be used for comparison in every future examination and provide background for follow-up should the keratoconus continue to progress after the surgical intervention.
3) Procedure Day at CCLIM
Epi-Off Corneal Collagen Crosslinking currently happens on Friday mornings so your eye can heal over the weekend. Expect to have a driver and the procedure will take about 60 minutes.
4) Post-Op at CCLIM
A series of follow ups will happen in order to make sure your eye is healing appropriately, and that stabilization of keratoconus is occurring.
The CXL Procedure
The corneal surgeon will first remove the top layer of the eye (epithelium) and then apply Photrexa ® riboflavin eye drops (vitamin B2) to the surface of the eye for about 30 minutes. This substance is conducive to photo-enhancing; in other words, it improves light absorption.
Next, your eye will be exposed to a specific ultraviolet light that activates the development of new collagen cross-linking. This will cause the collagen fiber to strengthen across the entire cornea and reinforce it.
There are two types of corneal cross-linking procedures:
a) Epithelium-off cross-linking. To allow the riboflavin to penetrate easily in to the lower layers of the cornea, the doctor removes its outer layer before applying the drops and UV light. You will wear a bandage soft contact lenses the eye heals.
This form of crosslinking is the ONLY protocol that is FDA approved.
b) Epithelium-on cross-linking or trans-epithelial cross-linking is currently NOT FDA approved.
In this procedure, the doctor applies the eye drops onto the outer layer of the cornea, without removing the epithelium and also preforms the UV light over the epithelium. The efficacy of this procedure is still under investigation. Many insurances do NOT cover this non-FDA approved protocol.
We Provide Post-Op Care
The success of the one-hour surgical treatment depends as much on the quality of postoperative care as it does on the procedure itself.
Careful management of eye health is essential for rapid rehabilitation of visual clarity and to reduce the risk of complications. Follow-up care provided at Cornea and Contact Institute of Minnesota include multiple visits (often covered by your insurance), aimed at expediting healing of the corneal surface. Patients are prescribed bandage soft contact lenses to protect the eye surface during the healing process.
The lenses also serve the purpose of minimizing potential pain. To prevent infections, our optometrists will provide topical antibiotics and other medications that may be needed to protect the cornea and ensure a safe and fast recovery.
Who Can Undergo Corneal Collagen Cross-Linking?
The surgical treatment is recommended for patients who have recently been diagnosed with keratoconus and patients with a worsening condition.
The sooner the treatment is applied, the better the chances of strengthening the cornea or even improving its shape. Because CXL does not restore lost vision, early treatment is critical to prevent visual acuity from declining.
This can also increase the chances of wearing traditional contact lenses later on and preventing more complex and expensive contact lens designs necessary for advanced keratoconus. Patients with stable keratoconus, a thin cornea, or a scarred cornea may not benefit from CXL and can potentially delay or avoid the procedure altogether.
Contact Cornea and Contact Institute of Minnesota for a CXL consultation or to schedule an eye exam. It is necessary to have previous corneal scans and exam notes sent to us prior to your appointment so our doctors can review and compare to the scans we will take.
Cornea and Contact Institute of Minnesota serves patients from all over Minnesota, theupper Midwest and internationally, but more specifically from Edina, Maple Grove,Wayzata, Bloomington, Minneapolis and St Paul.