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Ask the Experts
There are a number of treatments available for Keratoconus, including glasses, contacts, corneal implants and corneal transplants, depending on the stage and severity of your condition.
However, one verry innovative and highly effective treatment for Keratoconus is Corneal Collagen Cross-Linking. This treatment may be able to stop your vision from worsening, and has even been shown to improve vision in some people.
The full name of the procedure is Corneal Collagen Cross-Linking with Riboflavin, also called CXL for short. It is used to strengthen the cornea in people with Keratoconus. In doing so, Corneal Cross-Linking can stop Keratoconus from worsening. It can also help flatten the central cornea in about 50% of patients, who often experience better vision as a result.
The procedure is relatively simple and highly effective. It’s also very safe, and complications are extremely unlikely.
What is Keratoconus?
Keratoconus is a hereditary condition affecting the cornea (the transparent window at the front of the eye).
Keratoconus occurs as a change within the structure of the cornea making it weaker and thinner, resulting in a ‘cone shaped’ forward bulge. It leads to myopia (short sight) and, if the steepening is uneven, also astigmatism. With Keratoconus, visual distortion can become difficult to correct with spectacles, although contact lenses (usually rigid) can provide more functional visual performance.
At first, the protrusion occurs in the inferior parts (lower half) but later on it also affects the central part of the cornea.
Corneal Cross Linking is recommended for patients whose corneal scans show evidence of worsening Keratoconus, or those judged to be at especially high risk of worsening Keratoconus. As cross-linking naturally increases with age, the progress of Keratoconus usually stops by the mid-30s, so is not normally required for older patients.
Cross linking is currently the only available treatment which appears to stop the worsening of Keratoconus. Clinical trials based on outcomes 1 year after cross-linking show success in the halting of Keratoconus in more than 90% of treated eyes, with more than 45% of eyes also gaining an improvement in corneal shape. A separate study over a 5 year period showed a similar success rate in halting the progress of Keratoconus. Visual improvement after treatment occurs in approximately 50% of cases. However, after treatment you will still need to wear spectacles or contact lenses.
During the Cross Linking treatment our surgeons employ a combination of Riboflavin (Vitamin B) drops and ultra violet light that reacts with the collagen fibers in the cornea, strengthening them by creating more ‘cross-linking’ among them – and mimicking the natural corneal stiffening which occurs with age. The resulting increased strength of the cornea inhibits the progression of Keratoconus. The procedure is usually pain-free.
Corneal Cross Linking will not reverse Keratoconus but in the majority of cases prevents the condition from worsening, and will, in some cases, achieve a visual improvement.
In general, cross linking is very safe, but you should allow time for your eye to heal and problems do occasionally occur. About 3% of patients will experience some loss of vision in the treated eye as a result of haze, infection or other complications. In most cases any visual loss can be reversed with a corneal transplant. Without cross linking treatment, at least 20% of all patients with Keratoconus will eventually require a corneal transplant.
The treated eye is usually painful for 3 to 5 days, however levels of discomfort vary from patient to patient. Recovery time is about one week although most patients may find that it may be slightly longer.
After treatment expect to take up to one week off work and for some patients who experience complications this could be longer. You will not be able to drive for at least a week.
You might also experience severe light sensitivity after the treatment. It is important to rest as much as possible during these days to let the eye heal. If you partake in activities or sport, please ask your doctor when these may be resumed.
Every patient is different, and your ophthalmologist will always recommend the appropriate Keratoconus treatment for you. This could include glasses, contacts, corneal implants or corneal transplant surgery.