Keratoconus

Cornea cross linking (CXL) is a new procedure recently FDA approved and now available at the Cohen Laser and Vision Center. CXL is painless and is the ONLY treatment to stop the progression of Keratoconus.

Keratoconus is a cornea disease causing progressive and painless cornea thinning and steepening with gradual loss of vision. It is usually bilateral, and males and females are equally affected. It can manifest itself as early as the teens and can progress through the 5th decade.

SYMPTOMS – Early symptoms include poor vision and inability to see well with glasses or soft contact lenses. As symptoms progress, patients may need to change to a hard or gas-permeable contact lens to achieve their best vision.

TREATMENT – Early on, patients can achieve good vision with glasses or contact lenses. As the cornea begins to steepen, it may become necessary to convert to gas permeable contact lenses. As the cornea continues to change, further treatment may be needed. Scleral Contact lenses, such as the Acculens, can be tried when the cornea becomes too steep to wear gas permeable hard contact lenses.

INTACS – INTACS are plastic rings placed in the middle of the cornea to flatten the cone of the cornea and improve vision. The INTACS procedure is a 15 minute, in-office surgery which is usually covered by health insurance. During the procedure, the patient’s cornea is anesthetized with eye drops. The Intralase femtosecond laser is used to create two circumferential grooves mid- cornea at a depth of 400 microns. After the grooves are created, the INTACS rings are placed. For those patients who do not have insurance, the costs are approximately $3500 per eye. The INTACS rings can remain in the patient’s eye indefinitely and are not felt by the patients. They can also be removed if needed. Please contact your eye care professional for further information.

COLLAGEN CROSS LINKING – CXL is a procedure to manage cornea ectasia (weakening). This procedure is an in-office, 30 minute treatment to restore biomechanical stability to the cornea and prevent further progression. The cornea is soaked with Riboflavin (vitamin B2) and then exposed to ultraviolet A (UVA) light. The riboflavin absorbs the UVA and this reaction causes covalent bonds to form within and between the collagen molecules (crosslinks). These crosslinks stiffen and strengthen the cornea thus diminishing the tendency for thinning, weakening and progression of the keratoconus. The most current and effective therapies combine INTACS with collagen cross linking to treat keratoconus.

ECTASIA after LASIK – Patients who develop Ectasia after LASIK currently have two treatment options: i) RGP contact lenses or ii) a Corneal Transplant. Basic research suggests a new potential treatment option combination:

    1. Cross Linking (to prevent progression)
    2. INTACS (to treat higher order aberrations
    3. PRK to treat residual regular astigmatism

If the patient has regular astigmatism which can be refracted to 20/30 or better, step 2) INTACS can be skipped.

Research on the corneal flap created during LASIK demonstrates that the residual flap does not contribute significantly to the biomechanical strength of the cornea. Additionally, mitomycin can prevent scarring on the flap following PRK, these two findings as well as clinical research and experience suggest that this treatment maybe a good option for patients with ECTASIA after LASIK.

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