Keratoconus Treatment Options
Corneal Cross-Linking: The First and Only FDA Approved Therapeutic Treatment for Progressive Keratoconus
Corneal collagen cross-linking, or KXL/CXL, is a recently FDA-approved procedure that helps treat keratoconus by stabilizing the cornea, preventing it from becoming weaker and thinner.
What is Keratoconus?
Keratoconus is a condition where the cornea becomes weak and loses its natural shape, becoming steeper like a cone. The condition can cause distorted vision, categorized as high astigmatism. Many patients are diagnosed with keratoconus in their teens or 20s and it is commonly considered a progressive disease. As the condition becomes worse, patients may need a rigid contact lens or even a corneal transplant. Keratoconus can result in severe astigmatism, light sensitivity, and can cause a rapid succession of prescription changes.
What is Corneal Cross-linking?
Corneal cross-linking, or CXL, is the newest treatment for keratoconus. This involves administering Vitamin B2 drops, also known as riboflavin, to the cornea and then exposing the cornea to ultraviolet light. CXL causes bonds in the cornea to strengthen, ultimately stopping the progression of keratoconus. First, the patient will receive anesthetic drops, then the surgeon will gently remove the corneal epithelium, which is the outer layer of the cornea. The Riboflavin drops are then applied for 30 minutes, and a special UV light is administered after for up to 30 minutes. Post procedure, a bandage contact lens will be placed, and the patient will be seen the next morning. Patients can expect to experience mild to moderate pain for the first few days as the epithelium heals. The contact will be removed approximately a week after the procedure, and the vision will most likely be blurry during this time. There is usually fogginess in the vision for the first month, and clarity should return after that. We will treat one eye at a time, and the interval between procedures can be anywhere from 1 to 3 months.
Who is a good candidate for corneal cross-linking?
A good candidate for corneal cross-linking would be a patient with mild-to-moderate keratoconus but has good vision with their current glasses or contacts. The goal for corneal cross-linking is to stop the progression of keratoconus and has been proven successful in over 94% of patients. Cross-linking does not eliminate the need for glasses or contacts. Corneal cross-linking has stopped the progression of this condition in most patients, but it does not return the cornea to its original shape prior to keratoconus. Insurance may cover this procedure if you have documentation of the progression of your keratoconus, but this can differ between providers. If you would like to learn more about cross-linking or find out if you would make a good candidate, please schedule your complimentary eye exam and consultation with us today!
What are INTACS?
INTACS are thin rings that are inserted into the cornea to improve the overall shape. The main goal of INTACS is to stop the progression of keratoconus by supporting the dome-like structure of the cornea, similar to rods in a tent. They do not remove the need for contacts or glasses, but they do STOP the progression of keratoconus. Imagine your keratoconus cornea as a tent with a curved top. If you push the side outwards, the top is slightly flattened, and the dome shape is restored. INTACS in the periphery of the cornea flatten the center by restoring the natural dome shape of the cornea to help improve vision. These INTACS also can “soften” astigmatism and make it easier for the patient to wear contact lenses. INTACS can be combined with cross-linking to help with keratoconus.
Who is a candidate for INTACS?
The ideal candidate for INTACS is a patient with mild-to-moderate keratoconus who is unhappy with their contacts or glasses. Generally, INTACS can reduce astigmatism by half, and stops the progression of keratoconus.
How is the INTACS procedure performed?
The procedure is performed with a mild sedation and a topical anesthesia. The procedure lasts around 15 minutes and are performed on Thursdays. The patient can generally return to work on Monday. There will only be 1 to 2 days of a mild scratchy feeling and some soreness that can be relieved with ibuprofen or Tylenol. INTACS are clear inserts designed to reshape the cornea to allow for corrected vision. They are comprised of a material that has been used in contact lenses and cataract surgeries for over 50 years. INTACS cannot be felt or seen as they are worn below the surface of the cornea. The procedure requires no needles or shots, only numbing drops. INTACS are FDA-approved for keratoconus. The main benefit of INTACS is the potential for improved vision, and the risk potential could be infections, inflammation, and glare, as well as others.