Keratoconus (kehr-uh-toh-koh-nus) is a condition in which the normally round, dome-shaped cornea thins and becomes distorted and irregular. A cone-like bulge develops, resulting in significant visual distortion. With keratoconus, the apex of the cone is usually displaced outwards and downwards and in the line of sight, creating an irregular astigmatism.

Dr. Mozayeni, our fellowship-trained cornea Specialist and LASIK eye surgeon here in Charlotte, has frequently encountered this common disease during his expert exams and consultations.  In the past, these patients with keratoconus typically needed a corneal transplant, but there is an exciting, new, non-invasive treatment on the horizon.

Corneal Cross-Linking: A Keratoconus Treatment Option

Corneal cross-linking (CXL), which has been performed in Europe since 1997, has now been FDA approved in the United States. However, because it took so many years to acquire FDA approval, the methodology used in this FDA-approved version is now outdated. This method of CXL is called Epi-OFF, where the top skin layer of the cornea is removed as part of the CXL procedure for keratoconus treatment.  

The alternative corneal cross-linking method is called Epi-ON or trans-epithelial CXL. With this method, the outer skin layer of the cornea is not removed, which provides many advantages. These advantages include much faster recovery, the ability to have both eyes treated on the same day, less chance of infection and scarring, and much less discomfort during the recovery.

Epi-ON CXL is a relatively non-invasive and low-risk procedure designed to strengthen the corneal tissue of a person’s eye, particularly when keratoconus exists. The goal of CXL for keratoconus treatment is to prevent the corneal tissue from progressively weakening, thereby prolonging or avoiding a riskier and invasive cornea transplant.

Corneal cross-linking can also be used to treat other problems, such as fluctuating vision due to prior Radial Keratotomy (RK) surgery, a procedure that was mostly performed from 1980 to 1995.

How is corneal cross-linking performed?

Corneal cross-linking is performed by applying liquid Riboflavin (one of the B vitamins) to the eye to saturate the cornea followed by a specific amount and duration of ultraviolet light. This combination causes strong bonds to form between corneal fibers, providing strength and stability to the tissue. In some cases, in addition to treating keratoconus, it also reduces the amount of astigmatism for vision to improve. This creates more options for vision correction, such as standard soft or toric contact lenses, glasses, and even LASIK.

When will corneal cross-linking be available?

As a Cornea Specialist, Dr. Mozayeni has been carefully following the development of corneal cross-linking for many years and firmly believes it is in the best interest of patients to undergo the Epi-ON version of this procedure. FDA approval for the Epi-OFF version occurred in the middle of 2016, and is available at some facilities but has since become outdated.

At Providence Eye & Laser Specialists, we intend to offer the safer, more advanced Epi-ON corneal cross-linking procedure to treat diseases like keratoconus in the near future and are currently exploring our options to make this available in our community as soon as medically possible.

Will I be a candidate for corneal cross-linking with keratoconus?

Currently, we are accepting patients with keratoconus in order to establish a baseline examination and assess their problem in detail. Having baseline corneal mapping performed using our sophisticated Pentacam® system is essential to know if you are or will be a candidate for corneal cross-linking in the future. In some cases, where the keratoconus disease is rapidly progressing, and waiting is not recommended, we will refer you to an Epi-ON clinical trial site to consider immediate treatment.

If you have been told that you have keratoconus, now is the time to begin considering Epi-ON corneal cross-linking as a way to halt the disease process and prolong or prevent the need for a cornea transplant.

Contact us today for a complete examination, including corneal mapping, and get established as a candidate for the exciting corneal cross-linking technology that could save your vision.