Corneal Cross-Linking

Evaluation

The primary purpose of corneal collagen crosslinking is to halt the progression of corneal ectasia. The best candidate for this treatment is any individual with evidence of corneal or refractive error change and a diagnosis of a corneal thinning condition. While the most common indication is keratoconus, there are a number of other corneal diagnoses that can benefit from corneal stability after cross-linking. Pellucid Marginal Degeneration, Terrien’s Marginal Degeneration, and post-refractive surgery ectasia (such as LASIK, PRK, radial keratotomy, and recurrent keratoconus after corneal transplants).

There is no requirement on level of vision impairment or disease status to warrant a referral for corneal crosslinking. Corneal ectasias are progressive by definition, therefore it is very important to treat younger patients as soon as a diagnosis of keratoconus or other corneal ectasia is made. There are numerous benefits to cross-linking as early as possible in the disease process. Limiting the progression of corneal ectasias increases the chances that the patient will be able to maintain good quality vision with glasses and soft contact lenses and reduces the likelihood of a corneal transplant in the future.

Recently, major medical insurances have begun to recognize the medical necessity for this procedure, and more patients are finding their procedure to be covered by their insurance. When a patient is referred to our clinic for a cross-linking evaluation, previous exam notes are very helpful when submitting for insurance authorizations. In fact, early examination notes are more likely to show change compared to present day, so please include all exams, no matter how old!

Surgery

After topical anesthetic drops and a lid speculum is placed, the corneal epithelium is loosened and then gently removed by the surgeon, similar to a PRK procedure. Riboflavin drops are then instilled into the eye according to the most up-to-date protocols supported by research in order to optimize the efficacy of treatment. The goal of this step is to saturate the corneal stroma with riboflavin, to maximize the number of covalent bonds created between the corneal fibrils. After adequate absorption of riboflavin, UV light delivery begins. During the UV light exposure, the riboflavin drops are continually instilled into the eye according to protocol. Following the procedure, antibiotic drops are instilled and a bandage contact lens is placed on the eye.

Currently, there numerous cross-linking studies being conducted across the world. The wavelength of UV light, exposure times and frequency of riboflavin drop instillation continues to be evaluated. Our research teams diligently monitor for the latest information to ensure patients are receiving the most current treatment regimens.

Post Op

Post op schedule: Day 4, Day 10, 3 month, 6 month

A bandage contact lens is placed by the surgeon immediately following the cross-linking procedure. Post-operatively, these patients will likely experience eye watering and light sensitivity. There will also be some discomfort from burning and a gritty sensation for a few days after the procedure. The post-operative medications may also sting upon instillation. Vision will be blurry afterward until the epithelium heals and smooths across the corneal surface. When the bandage contact lens is removed, around 4-5 days post-op, the vision will continue to improve over the following 1-2 weeks. If the patient would like to get a new glasses or contact lens prescription, we recommend waiting 3 months. Existing contact lens wearers can return to their soft or scleral contact lenses around 2 weeks after the procedure. Patients wearing corneal-sized gas permeable lenses should wait closer to one month to resume contact lens wear.