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Corneal Collagen Cross-Linking for Keratoconus

Corneal collagen cross-linking (CXL) is currently the only treatment that may slow down the progression of keratoconus. It is a minimally invasive procedure to strengthen corneal tissue and stabilize the cornea’s shape.

If you have been diagnosed with keratoconus, or if you are concerned that your condition might be deteriorating, contact Dr. Leonard at The Sclerals Center At Coastal Family Eyecare 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 riboflavin (vitamin B2) eye drops and ultraviolet light, the surgical treatment promotes the building of new collagen fiber links within the cornea. In many cases, it helps prevent the 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.

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. Dr. Leonard can assess whether you are a candidate and get you ready for the surgical procedure.

  1. We’ll Evaluate If You Need CXL

At The Sclerals Center At Coastal Family Eyecare, 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 keratoconus progression and corneal thickness. In case you have dry eye, this needs to be treated appropriately before scheduling the CXL procedure.

  1. Connecting You With The Right Surgeon

Following your eye exam and the evaluation of your suitability for CXL, we will connect you with an ophthalmologist to schedule the actual procedure. We at The Sclerals Center At Coastal Family Eyecare work with the finest corneal specialists in the area because we want you to be in good hands.

  1. Pre-Op Exam With Your Optometrist

Just before the surgery, you will have a short pre-op examination at The Sclerals Center At Coastal Family Eyecare. Lens wearers are required to remove their contact lenses a few days prior to this examination so that measurements can be entirely accurate.

Dr. Leonard will gather measurements about visual acuity, refraction, the shape of the corneal surface, and intraocular pressure. 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.

The CXL Procedure

seniors smiling 2 640The ophthalmologist will first apply riboflavin eye drops (vitamin B2) to the surface of the eye. This substance is conducive to photo-enhancing; in other words, it improves light absorption. Next, the practitioner will expose the eye to a specific ultraviolet light to activate the development of new collagen cross-linking. This will cause the collagen fiber to thicken across the entire cornea and reinforce it.

There are two types of corneal cross-linking procedures:

  • Epithelium-on cross-linking or transepithelial cross-linking. In this procedure, the doctor applies the eye drops onto the outer layer of the cornea, called the epithelium.
  • Epithelium-off cross-linking. To allow the riboflavin to penetrate more easily into the lower layers of the cornea, the doctor removes its outer layer before applying the drops. This surgical intervention has a slightly higher risk, as it could cause the disruption of surface cells in the epithelium.

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 The Sclerals Center At Coastal Family Eyecare includes three main objectives, of which the speedy healing of the corneal surface is primary. Generally, patients are prescribed temporary 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, Dr. Leonard 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 rapidly 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.

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 Dr. Leonard at The Sclerals Center At Coastal Family Eyecare for additional information or to schedule an eye exam.

The Sclerals Center At Coastal Family Eyecare serves patients from Pensacola, Orange Beach, Tallahassee, Mobile, and throughout FL.

 

 

Resources:

https://www.allaboutvision.com/conditions/corneal-crosslinking.htm

https://eyewiki.aao.org/Corneal_Collagen_Cross-Linking

https://www.allaboutvision.com/conditions/keratoconus.htm

https://www.nkcf.org/corneal-cross-linking-are-you-a-good-candidate/https://www.eyeworld.org/article-postoperative-management-of-corneal

https://crstoday.com/articles/2017-jul/simplifying-the-preoperative-evaluation/

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Dear Patients,

As of Tuesday evening, March 17th, the CDC has recommended that all routine eye care be deferred until further notice, in order to slow the transmission of COVID-19 through our community.

Please be assured that we are still available to triage all urgent and emergent calls during this challenging time.

We are officially closing our offices effective at 3:00pm today, March 20 th and tentatively plan to reopen on April 1 st . We are rescheduling all routine visits and are available by phone to triage ocular emergencies.

Our phone lines will be open:

Monday the 23 rd and 30 th : 10:00am to 5:00pm

Tuesday-Friday (24 th -27 th and the 31 st ): 9:00am to 3:00pm

What does this mean?

1) If you are scheduled for an annual eye examination we will tentatively reschedule you starting April 1 st

2) If you are running out of a medication please contact us and we can transmit a refill electronically to your pharmacy.

3) If you have an issue which cannot wait for an office visit, contact us and we will schedule a Telephone appointment with one of our doctors. Medicare has temporarily relaxed its telehealth rules to allow this type of communication during the pandemic crisis. Other insurers may follow suit and allow for reimbursement of virtual care costs. The consultation must be initiated at your request.

4) If you have an ocular emergency we are, as always, available to help you at any time. Call 1-850-455-0120 andwait for instructions at the end of the message.

Dr. Leonard or Dr. Charbonneau will discuss your condition by phone and make the best treatment decision for you on a one on one basis.

5) Please remember that 80% of COVID-19 cases are mild and resolve within a week. However, if you feel your symptoms are worsening, call ahead before visiting your doctor’s office or emergency department and tell them you have or may have COVID-19. This will help the office protect themselves and other patients.

The CDC has many wonderful resources. Arming yourself and your family with clear information will help you avoid undue stress.

https://bit.ly/2WxWYIe and https://bit.ly/33FBlXZ

Together we will weather this storm.

With sincerest wishes for your continued good health we remain at your service,

Dr. Clare L Leonard

Dr. Mary Charbonneau