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Do You Really Need Corneal Cross-Linking?

Corneal Cross-Linking (CXL) is a groundbreaking procedure that has been widely used in Europe since 1998 as an alternate treatment for Keratoconus. Also known as CXL, this surgical remedy for Keratoconus was finally approved by the US Food and Drug Administration (FDA) in April of this year. While Keratoconus is being widely treated through a variety of processes such as hybrid, piggybacking, gas permeable and scleral and semi-scleral lenses, what actually sets CXL treatment apart from all other remedial procedures is its capacity to inhibit the spread of Keratoconus.

The human cornea stops changing shape around the age of 30, whether it is in a normal state or suffering from a dysfunction. This acquired permanency of physical state is the biggest hurdle in an effective treatment of any corneal of ophthalmic dysfunction. Therefore, corneal cross-linking is a great treatment only if the cornea is unstable and the Keratoconus is consistently protruding.

Aside from the many benefits and advantages that CXL offers, it also has some associated myths and fallacies that infer it as painful and expensive process, one which is similar to Intacs. It is important to note that corneal cross-linking does not reverse the damage Keratoconus has already brought to the cornea. It stops the protrusion of cornea and prevents it from turning chronic.

All other treatment procedures of Keratoconus are merely oriented towards improving the vision and fail to stop this corneal dysfunction from getting worse. This is why CXL has a greater significance over all other treatments and its recent endorsement by the FDA authorities has brought new hope for Keratoconus patients in the United States.

Types of Corneal Cross-Linking Procedures

Corneal Cross-linking has many alternate brand names such as Corneal Collagen Cross-Linking, C3-R, CCL and KXL. It is primarily classified into two main categories due to a slight difference in the basic technique:

Epithelium-Off CXL

This type of corneal cross-linking requires the removal of the corneal epithelium to allow UV-A rays and riboflavin to completely penetrate and be absorbed by the corneal cells.

Epithelium-On CXL

This process is also known as transepithelial CXL and does not require removing the outermost epithelial layer. Since the epithelium stays intact, the process takes a longer time for riboflavin to fuse into the epithelium.

The Ideal Patient Profile for Corneal Collagen Cross-Linking

As mentioned earlier, Corneal Cross-Linking is the most effective method of treatment for Keratoconus when the corneal protrusion is still active and the Keratoconus is visibly progressing with time. The extent and magnitude of the efficacy of Corneal Cross-linking depends on certain essential factors pertaining to eye health, history of Keratoconus, and the physical state of corneal. Here’s an ideal patient’s profile who is likely to benefit the most from Corneal Cross-Linking Treatment:

  • A patient with Keratoconus or progression diagnosis of over 1-2 years
  • Inferior or central steepening, with the steepest manual K of minimum 47 microns, a consistency in axial topography with corneal ectasia, and a pachymetry range in between 300-400 micron
  • The Keratoconus must have increased by 1 D in terms of the steepest keratometry readings, a myopic incline of minimum 0.5 D, and an increase of more than 1 D in normal astigmatism.