Study showcases benefits of procedure

The discovery of collagen cross-linking (CXL), in my opinion, has led to the greatest paradigm shift in our role in preserving vision, in that it enables us to stop keratoconus in its tracks and, potentially, save patients from visual debilitation and future corneal transplantation.

“Research Spotlight” is a featured section of Corneal Physician dedicated to focusing on a recent study the columnist feels provides great value to cornea physicians. In this inaugural edition, I discuss the study “Corneal crosslinking: Current protocols and clinical approach.”¹

Overview

In this article, authored by the ASCRS Cornea Clinical Committee, a highly esteemed group of our cornea colleagues, evidenced-based studies on CXL for the treatment of ectasia are gathered and reviewed. They highlight that, “Before the advent of CXL, it was estimated that 11% to 27% of [keratoconus] patients would go on to require corneal transplantation.”

Additionally, the authors eloquently describe the process of CXL that occurs in the presence of ultraviolet A radiation of corneal tissue saturated with the photo-mediator riboflavin. The role of oxygen, pulse treatment, riboflavin concentration, and other variables are also explained. Most compellingly, the authors summarize the results of the pivotal clinical trial that led to the FDA approval of CXL for the indication of progressive keratoconus and post refractive surgery ectasia.

Furthermore, they take on the challenging task of reviewing published results of numerous clinical studies regarding treatment efficacy, the complications of the epithelium-off versus epithelium-on procedure and other modifications in technique proposed to expedite the treatment duration and further the clinical effect with each treatment.

Value

In the past, I dreaded a new diagnosis of keratoconus in a young adolescent when the only option I had was hopeful waiting to see how rapidly the disease would progress and whether the patient would need one or multiple corneal transplants (with its related comorbidities) in the future.

That all changed in 2017 when I started offering progressive ectasia patients the potentially sight-preserving option of CXL. The 10+ years of knowledge amassed on this topic from the numerous research efforts and clinical trials has given us the foundation and the confidence to forge ahead and spread the results to mainstream clinical care.

I thank the ASCRS Cornea Clinical Committee for championing the spread of this knowledge, and I urge you to give it a read. Your next keratoconus or ectasia patient will thank you for it! CP

Reference

1. Beckman KA, Gupta PK, et al; ASCRS Cornea Clinical Committee. Corneal crosslinking: Current protocols and clinical approach. J Cataract Refract Surg. 2019;45(11):1670-1679.

DR. SHAMIE is a partner of the Maloney-Shamie Vision Institute in Los Angeles and an educator and international lecturer. In 2017, she received the American Academy of Ophthalmology’s Senior Achievement Award for contributions to the education of other eye surgeons. She reports a relationship with Glaukos.