Look after your sight with keratoconus treatment in Brisbane

How corneal cross-linking works

Healthy corneas are able to retain their shape due to strong bonds (cross-linkage) between collagen fibers. When keratoconus occurs, these cross links, or support beams, break down, weakening the cornea and causing the tissue to bulge outwards. Corneal cross-linking uses riboflavin eye drops and ultraviolet light to increase the amount and strength of the collagen bonds, therefore strengthening the cornea and preventing further loss of vision.

Advantages and disadvantages

Advantages

• Improved vision: Up to 81% of patients who undergo CXL will be able to see more clearly after treatment.¹Miamikeratoconus.com. 2021. What is Cross Linking (CXL)?. [online] Available at: <https://www.miamikeratoconus.com/site/what-is-cross-linking-cxl.htm> [Accessed 24 June 2021].
• Minimally invasive: As opposed to a corneal transplant, which requires a surgical procedure, CXL is minimally invasive.
• Long-lasting results: Studies have concluded that the results of CXL can last for years and that the strengthening effect may be permanent.²Years, C., 2021. CXL Eyes Stable After 10 Years. [online] American Academy of Ophthalmology. Available at: <https://www.aao.org/eyenet/article/cxl-eyes-stable-after-10-years> [Accessed 24 June 2021].
• Shorter recovery: Recovery following a corneal transplant can often be a lengthy process. In contrast, CXL allows patients to return to normal activities within days.

Disadvantages

In general, cross-linking is very safe,³Clark Chang, M., 2021. Your Top 12 Crosslinking Questions—Answered!. [online] Reviewofoptometry.com. Available at: <https://www.reviewofoptometry.com/article/your-top-12-crosslinking-questionsanswered#footnotes> [Accessed 24 June 2021].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.⁴Hull University Teaching Hospitals NHS Trust. 2021. Corneal Collagen Crosslinking (CXL) for Keratoconus | Hull University Teaching Hospitals NHS Trust. [online] Available at: <https://www.hey.nhs.uk/patient-leaflet/corneal-collagen-crosslinking-cxl-for-keratoconus/> [Accessed 24 June 2021].

In most cases, we can reverse any visual loss with a corneal transplant. Without cross-linking treatment, at least 20% of all patients with keratoconus will eventually require a corneal transplant.⁵Hull University Teaching Hospitals NHS Trust. 2021. Corneal Collagen Crosslinking (CXL) for Keratoconus | Hull University Teaching Hospitals NHS Trust. [online] Available at: <https://www.hey.nhs.uk/patient-leaflet/corneal-collagen-crosslinking-cxl-for-keratoconus/> [Accessed 24 June 2021].

Corneal cross-linking risks

In general, CXL is very safe,⁶Hull University Teaching Hospitals NHS Trust. 2021. Corneal Collagen Crosslinking (CXL) for Keratoconus | Hull University Teaching Hospitals NHS Trust. [online] Available at: <https://www.hey.nhs.uk/patient-leaflet/corneal-collagen-crosslinking-cxl-for-keratoconus/> [Accessed 24 June 2021].but like all operations, your eye needs time to heal, and problems do occasionally occur.

About 3% of patients will lose some vision in the treated eye as a result of haze, scarring, corneal surface shape irregularity, or infection.⁷Hull University Teaching Hospitals NHS Trust. 2021. Corneal Collagen Crosslinking (CXL) for Keratoconus | Hull University Teaching Hospitals NHS Trust. [online] Available at: <https://www.hey.nhs.uk/patient-leaflet/corneal-collagen-crosslinking-cxl-for-keratoconus/> [Accessed 24 June 2021]. In most cases, this visual loss is potentially reversible with a corneal transplant.

Without CXL treatment, at least 20% of all patients with keratoconus will eventually require a corneal transplant. The risk of transplantation for patients with documented disease progression is probably higher.⁸Hull University Teaching Hospitals NHS Trust. 2021. Corneal Collagen Crosslinking (CXL) for Keratoconus | Hull University Teaching Hospitals NHS Trust. [online] Available at: <https://www.hey.nhs.uk/patient-leaflet/corneal-collagen-crosslinking-cxl-for-keratoconus/> [Accessed 24 June 2021].

Options and alternatives

We can combine cross-linking with intracorneal or intrastromal rings to flatten the keratoconus bulge even more. The rings stabilise keratoconus which prevents it from getting worse.

Corneal cross-linking steps

Step 1: We numb the surface of the eye, so you feel no pain.

Step 2: We remove the epithelial cell layer from the central part of the cornea, and apply the riboflavin eye drops.

Step 3: Once the eye drops have penetrated the cornea, we focus the UV light onto the central area of the cornea for 10 minutes.

Step 4: Finally, a bandage soft contact lens is applied. The contact lens is worn for up to 2 weeks until the surface epithelial cell layer has regrown.

Corneal cross-linking results

Cross-linking is currently the only available treatment that appears to stop the worsening of keratoconus.⁹WebMD. 2021. What Is Corneal Cross-Linking?. [online] Available at: <https://www.webmd.com/eye-health/corneal-cross-linking-for-keratoconus> [Accessed 24 June 2021].

Clinical trials based on outcomes one 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.¹⁰Aldo Caporossi, Cosimo Mazzotta, Stefano Baiocchi, Tomaso Caporossi, Rosario Denaro, “Age-Related Long-Term Functional Results after Riboflavin UV A Corneal Cross-Linking”, Journal of Ophthalmology, vol. 2011, Article ID 608041, 6 pages, 2011. https://doi.org/10.1155/2011/608041 A separate study over five years 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.¹¹Christopher Kent, S., 2021. Cross-Linking: Asking the Tough Questions. [online] Reviewofophthalmology.com. Available at: <https://www.reviewofophthalmology.com/article/cross-linking-asking-the-tough-questions#:~:text=so%2C%20for%20whom%3F-,Dr.,some%20flattening%20after%20cross%2Dlinking.> [Accessed 24 June 2021].