Corneal Cross-linking in Cleveland, OH

Astigmatism means that the front surface of the eye (the cornea or clear window in front of the eye) is less round and more irregular in shape so the image won’t focus clearly on the retina in the back of the eye. This can result in poor vision and glare.

Normal corneas have crosslinks between its collagen fibers that keep it strong and able to retain its normal shape. In keratoconus, the cornea is weak with too few cross-links or support beams. This weakened structure allows the cornea to bulge outwards. The cross-linking keratoconus surgery adds cross-links or “cross beams” to the cornea, making it more stable, holding its shape and focusing power better. These new cross-links help strengthen the cornea which stops the thinning process and further loss of vision.

As you may know, keratoconus is a condition that often runs in families, so it’s important to arrange a screening for all family members of patients with keratoconus. If caught early, there is a good chance that keratoconus surgery can halt the progression of keratoconus and prevent the need for uncomfortable contact lens wear and/or corneal transplant.

Many research studies have shown that Corneal Cross-linking may prevent further vision loss in over 95% of patients and improves vision in 60-81% of patients treated. 1-11

No. LASIK is a procedure that reduces or, in some cases, may even eliminate the need for glasses or contact lenses by removing corneal tissue. The Corneal Cross-linking keratoconus treatment does not remove tissue. The purpose of Corneal Cross-linking is to prevent further deterioration of vision for most patients and to potentially improve vision. Patients will typically require a lower eyeglass prescription or can have an easier time being fit with contact lenses.

Many studies have shown that keratoconus surgery can often prevent the need for a corneal transplant and allow patients to wear contact lenses or glasses more comfortably and safely again. 1-11

If Corneal Cross-linking does not prevent the need for a corneal transplant, then a corneal transplant can generally be performed.

Each patient and each patient’s eyes are different. In some cases Corneal Cross-linking can be performed after corneal transplantation.

Corneal Cross-linking keratoconus treatment is an in office procedure that does not involve surgical incisions into the eye or stitches. It is a relatively non-invasive procedure that is done with vitamin drops and light. Corneal transplants are performed in an operating room, involving incisions into the eye and a lifelong risk of rejection of the corneal tissue.

Corneal collagen cross-linking has been performed since 1999. The results and safety profile of Corneal Cross-linking have been very positive in numerous studies throughout the world. In fact, by September of 2006, Corneal Cross-linking had been approved by all 25 European Union nations. Corneal Cross-linking procedures are now routinely performed on patients as young as 10 years old in Europe to prevent the development of keratoconus.

In many studies, the majority of patients responded to a single vitamin and light Corneal Cross-linking treatment and did not need to have the procedure repeated. Corneal Cross-linking can often be repeated when treatment is not effective.

In this less invasive keratoconus treatment, the surface skin layer (epithelium) of the cornea is not removed so the recovery is much faster than the traditional Corneal Cross-linking technique. This less invasive technique can only be done on corneas that are thicker than 400 microns12,13. Your surgeon will be able to determine if you might be a candidate for transepithelial Corneal Cross-linking treatment.

If two eyes are being treated at once, the procedure takes approximately an hour and a half. If only one eye is being treated at a time, the procedure takes approximately one hour.

No. The cross-linking procedure is painless. Anesthetic eye drops are used to avoid any discomfort during the procedure. Some patients have some discomfort after the procedure and your surgeon can tell you whether you are or are not likely to do so.

Yes, your doctor will discuss the advantages and disadvantages of treating one eye or two eyes at a time.

As with most conditions, prevention of a problem is better than treatment of a problem. The best time for keratoconus treatment is before astigmatism has become severe and vision has been lost. This does not mean that people with very poor vision from keratoconus cannot be helped by Corneal Cross-linking. However, the results of Corneal Cross-linking for patients with advanced keratoconus have not been as good as for patients with early disease.

Some patients may be able to have an excimer laser treatment (PRK) or Intacs to improve their vision without glasses after they have healed from the Corneal Cross-linking procedure.

We recommend that you stay out of contact lenses for a week or two if possible before your consultation visit to see if you might benefit from the investigational Corneal Cross-linking procedure. This can vary based on how difficult it is for you to see without your contacts. We often suggest patients not wear their lenses for 3 days before their Corneal Cross-linking procedure.

Most patients can return to wearing contact lenses 2 to 6 weeks after having the cross-linking procedure depending on whether you are a candidate for transepithelial Corneal Cross-linking. Your surgeon will determine how long this might take in your case.

Because cross-linking often improves vision, patients find that their old contacts or glasses are too strong for them and they need to be refit with new, glasses and/or contact lenses. Most of the time, patients can wear their old glasses until several months after the procedure when their doctor will prescribe new ones. Because the effects of Corneal Cross-linking occur slowly, patients don’t generally have to change their glasses very often.

With the traditional Corneal Cross-linking procedure, most patients find that immediately after the keratoconus treatment, their vision is actually worse than it was before the procedure. This usually goes on for roughly 3-6 weeks. Patients may start to notice positive effects 4-8 weeks after the procedure and may experience major improvement in vision at least 3-6 months after the investigational procedure. In some studies patients’ vision and astigmatism were still continuing to improve five years after the cross-linking procedure2 so visual improvement is a long process. With the less invasive transepithelial Corneal Cross-linking, some patients found their vision improved as early as several weeks after treatment.

We want to help you be able to work or do other things you need and want to do as quickly as possible. Based on the type of Corneal Cross-linking procedure, your doctor can tell you when you can return to your usual activities. With traditional Corneal Cross-linking, most people can usually do so after 5-7 days. With transepithelial Corneal Cross-linking, most people return to their usual activities the next day.

Because of the regulatory environment in the US, this procedure is investigational so Corneal Cross-linking treatment is not covered by insurance.