Keratoconus Treatment

Keratoconus (KC) is a disorder of the eye which results in progressive thinning of the cornea.

Keratoconus treatment

Corneal cross-linking (CXL) is an in-office eye procedure that strengthens the cornea if it’s been weakened by keratoconus, other corneal disease, or (rarely) a complication of LASIK surgery. Alternative and brand names for the procedure include corneal crosslinking, corneal collagen crosslinking, C3-R, CCL and KXL.

The minimally invasive CXL procedure involves applying liquid riboflavin (vitamin B2) to the surface of the eye, followed by treatment with a controlled application of ultraviolet light, to eliminate corneal ectasia.

Corneal crosslinking also can be combined with other procedures for keratoconus treatment. For example, combining CXL with implanting tiny arc-shaped corneal inserts called Intacs has been shown to help reshape and stabilize the cornea in more advanced cases of keratoconus.

What is keratoconus?

Keratoconus, often abbreviated to “KC”, is a non-inflammatory eye condition in which the normally round dome-shaped cornea progressively thins causing a cone-like bulge to develop. This results in significant visual impairment.

The cornea is the clear window of the eye and is responsible for refracting most of the light coming into the eye. Therefore, abnormalities of the cornea severely affect the way we see the world making simple tasks, like driving, watching TV or reading a book difficult.

In its earliest stages, keratoconus causes slight blurring and distortion of vision and increased sensitivity to glare and light. These symptoms usually first appear in the late teens and early twenties.

Keratoconus may progress for 10-20 years and then slow or stabilize. Each eye may be affected differently.

How to treat keratoconus?

Eyeglasses or soft contact lenses may be used to correct the mild nearsightedness and astigmatism caused in the early stages of keratoconus. As the disorder progresses and the cornea continues to thin and change shape, rigid gas permeable contact lenses are generally prescribed to correct vision more adequately. The contact lenses must be carefully fitted, and frequent checkups and lens changes may be needed to achieve and maintain good vision.

In severe cases, a corneal transplant may be needed due to scarring, extreme thinning or contact lens intolerance. This is a surgical procedure that replaces the keratoconus cornea with healthy donor tissue.

The newest, safest and most effective procedure is called Collagen CrossLinking (CXL). Studies have found that 99 percent of patients who had CXL will remain stable or achieve improvement in the corneal shape, which is highly significant for people with progressive keratoconus that otherwise might lead to severe vision loss.

What to expect during the CXL procedure?

During preliminary examinations, we will measure the thickness of your cornea and make sure you are a good candidate for the procedure. You also will need to have a routine eye exam to assess your visual acuity and general eye health. We will also perform mapping of your cornea (called corneal topography) to determine the level of your eye condition.

The crosslinking procedure takes 60 to 90 minutes in most cases.
Riboflavin (vitamin B2) eye drops will be placed. After enough time has passed we will evaluate your eye to ensure that the cornea has sufficient riboflavin present. The corneal thickness will be checked, and then the UV light will be applied for up to 30 minutes.

In some cases, a bandage contact lens will be placed. Topical antibiotic and anti-inflammatory drops will be prescribed.

What to expect after the procedure?

Though corneal-crosslinking may cause some initial eye irritation, the surface of the eye and the tear film appear to fully recover within several weeks. In a recent study designed to investigate potential alterations of the eye’s surface and tear film parameters three months after CXL in progressive keratoconus patients, no adverse effects on the ocular surface and tear function (which are important for visual quality) were found.

Studies have found that 99 percent of patients who had CXL will remain stable or achieve improvement in the corneal shape, which is highly significant for people with progressive keratoconus that otherwise might lead to severe vision loss.