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Collagen Cross-Linking

  • Corneal Cross-Linking Video Transcript
    Hi my name is Brandon Ayres I’m from the Cornea service at Wills Eye Hospital and I'm here in the Wills Eye Hospital Alumni Association news room to talk about one of the biggest breakthroughs in Keratoconus technology or Keratoconus treatment called Collagen Cross-Linking.

    No Real Treatment Before Collagen Cross-Linking:

    Now what's so big about this new procedure called Collagen Cross-Linking well for years we've had no real treatments for a progressive disease, seen in younger patients, called Keratoconus. Keratoconus is a condition where the Cornea or the front clear portion of the eye becomes cone shaped and this leads to progressive astigmatism and reduced vision. In many of these patients and some figures are as high as 20% will go on to need corneal transplants and as of a couple years ago we really had no real therapeutic options for this disease. We would simply follow patients and if they needed surgery we would do the surgery.

    Help for Keratoconus Patients:

    But now for the past about 18 months or so we've had a procedure called Collagen Cross-Linking and what this is It's a procedure where we suppose the cornea to riboflavin which is vitamin B2 and then a calibrated UV light source and this stiffens the cornea which stops the progression of the keratoconus. So you gotta understand me this is to stop the progression of a disease not a cure for the disease. Patients who we typically see with keratoconus are younger patients in their teens, twenties maybe early thirties who are noticing progressive changes in their vision. A lot of these patients will go to see a refractive surgeon to see if LASIK can help their vision but LASIK would in fact worsen this condition so they're turned away with no real options. Now with Collagen Cross-Linking we can stop this process from moving forward and causing worsening of vision.

    Collagen Cross-Linking Procedure:

    The procedure itself is relatively simple what we do is we initially make a scratch on the cornea which we call an epithelial defect. After the epithelial defect is made riboflavin drops are placed on the cornea at intervals of about every 2 minutes for a total of 30 minutes. What this is doing is allowing the Riboflavin to soak into the cornea to allow the reaction to take place. We’ll then check the thickness of the cornea to make sure it's thick enough and make sure enough riboflavin has gotten into the cornea to turn on the UV light. We then focus a UV light over the eye and you stare at the light for 30 minutes. Now this protocols may change over time but right now this is the standard protocol for collagen cross-linking.

    What you can expect after the Collagen Cross-Linking Procedure:

    Now the procedure itself is relatively simple but afterwards there is some discomfort. There's going to be a scratch on the eye for about 3 days and that can be uncomfortable. Using cold artificial tears, keeping the lights dim, we’ll often place  a contact lens on the eye to act as a bandage. It's going to help you get through the first couple of days. After about 3 to 4 days the discomfort goes away and then we see a progressive stabilization of the cornea for over approximately a year. Our hope is that by doing Collagen Cross-Linking and catching Keratoconus early we can keep our patients from ever needing that corneal transplant that 20% of them would eventually need.

    Collagen Cross-Linking for post refractive ectasia:

    Now a second indication for collagen cross-linking is post refractive ectasia. This is a slightly different but similar condition where somebody may have had LASIK or PRK, which is laser refractive surgery, years ago and now their noticing a change in their vision. The process looks very similar to Keratoconus. Where for some reason the laser started to change the shape of the cornea and now the cornea is progressively causing worsening astigmatism. Additional laser treatments or enhancements would make this worse and once again we had no real options. Collagen Cross-Linking is also approved to stop progress of post LASIK ectasia again a very similar process but seen sometimes in the older patient population.

    Collagen Cross-Linking Summary:

    In summary we finally have a treatment that can treat keratoconus it stops the progression not a cure so now instead of telling our patients hey there's nothing I can do but we're going to follow this and you might need surgery down the road. We can say I can intervene in this process and keep your disease process from progressing and keep you in your glasses or contact lenses. I am Brandon Ayres, MD from the cornea service at Wills Eye Hospital thanks for watching from The Wills Eye Hospital Alumni Society Newsroom.