Cornea crosslinking is highly effective to halt the progression of cornea ectasia (e.g. keratoconus, post LASIK ectasia, etc). At times, the treatment can be successful in improving cornea shape and vision. Please see the ‘Keratoconus’ section under Conditions to understand more about keratoconus and the treatment options.
Success rate of cornea collagen crosslinking
The success rate of cornea crosslinking depends on a number of variables. Overall, cornea collagen crosslinking success rate in achieving long-term stabilisation of keratoconus is between 85-95%. (REF1 and REF2)
Cornea crosslinking can additional improve cornea shape and vision, in addition to the advantage of stabilising keratoconus.
Even in the the most at risk group (paediatric, i.e. children) where keratoconus is known to be more aggressive, cornea crosslinking can improve and stabilise vision in about 82% of eyes. (REF3)
Risk factors for poor response to cornea crosslinking include: young age, thin cornea (<480um), high astigmatism, poor initial vision and eczema.
Why Harley Vision in London?
Harley Vision is one of the unique clinics in the world offering cornea crosslinking combined with laser surface remodelling to improve the cornea shape and astigmatism. We also offer standalone epithelium-off CXL.
Is my cornea too thin for cornea collagen crosslinking?
Mukhtar Bizrah, the clinical director at Harley Vision, believes that the 400um limit to being able to perform cornea crosslinking is outdated, especially with the advances in technology and understanding of treatment mechanisms. At Harley Vision, we use advanced technology to enable collagen cross-linking of corneas with advanced level of keratoconus.
After comprehensive assessment of the cornea, the eligibility and treatment options for cornea collagen cross-linking will be discussed with you in more detail.
Types of Collagen Corneal Crosslinking
There are various types of cornea collagen crosslinking. These include but are not limited to:
1. Epithlium-off CXL
2. Epithelium-On CXL
3. Standard protocol CXL
4. Accelerated protocol CXL
5. Laser combined with CXL
At Harley Vision, we do not believe that epithelium ‘on’ CXL is an effective treatment, and therefore do not offer this treatment.
Epithelium-off CXL involves removing the topmost layer of the cornea (epithelium), to allow better penetration of the riboflavin drops. This has been shown to be more effective in the long-term than then epithelium ‘on’ CXL.
We offer cornea crosslinking combined with laser surface remodelling to improve the cornea shape and astigmatism. We also offer standalone epithelium-off CXL.
Who is a Candidate for Collagen Corneal Crosslinking Treatment
1. Progressive keratoconus, or other type of progressive conrea ectasia
2. Worsening of keratoconus demonstratable on cornea scans or refraction (glasses prescription)
3. High risk of keratoconus progression
4. Vision correctable with contact lens or glasses to a functional level
5. Subgroup of patients who may be at risk of keratoconus following laser refractive surgery
If you want to ensure your eligibility for Corneal collagen Crosslinking, visit Harley Vision, London, a highly specialist keratoconus clinic for an opinion.
Before corneal crosslinking treatment
Before the treatment, you will need a screening program where the surgeon will do a visual examination using a slit lamp biomicroscope along with checking your visual acuity with or without glasses. Refraction is checked to look for astigmatism. Next, highly advanced corneal diagnostic tests like cornea topography and cornea tomography will be done to evaluate for the presence of cornea ectasia like keratoconus or post laser ectasia.. A fundus evaluation using an OCT scan is usually part of the screening procedure to rule out any retinal or optic disc abnormalities before the treatment. Irrespective of the clinic you visit in London, these would be some common tests before getting started with your corneal collagen crosslinking treatment.
During corneal crosslinking treatment
Corneal Crosslinking steps
Step 01
Topical anaesthetics will be instilled in your eye. The whole procedure should be painless.
Step 02
This depends on whether you are having CXL alone, or combined with laser surface ablation. In standalone CXL, ethanol drops are applied for about 30 seconds, the cornea epithlium is gently removed. If CXL is combined with surface laser ablation, then transepithelial excimer laser is applied directly to the cornea surface, and ethanol is not used.
Step 03
Riboflavin eye drops will be instilled repeatedly for about 10 minutes.
Step 04
The cornea's collagen fibres will be exposed to UV radiation of 370nm for 8-10 minutes.
Step 05
After completion of the procedure, antibiotic eye drops will be instilled in the eye.
Step 06
The surgeon on the treated eye will apply a therapeutic bandage contact lens with good oxygen permeability to allow undisturbed healing of the cornea post-surgery.
When you visit a keratoconus clinic in London, like Harley Vision, your surgeon will explain the cornea collagen crosslinking in detail so that you are well-informed about the procedure.
What can I expect after the procedure?
The cornea collagen crosslinking treatment, whether or not it is combined with laser, is a painless procedure. After the procedure, you are expected to develop symptoms such as eye wateriness, pain, sensitivity to light. You will be prescribed eye drops to use, as well as painkillers to minimize pain.
You will be evaluated 5-10 days after the cornea crosslinking to remove the bandage contact lens and ensure the cornea surface has fulled healed.
Advantages and risks of collagen corneal crosslinking
Collagen corneal crosslinking is an effective and safe method of preventing keratoconus from becoming severe. It can help prevent the need to have corneal transplantation. It has been shown to be effective in thin corneas and can be performed on teenagers as well to prevent vision loss.
The primary aim of cornea crosslinking is to stop keratoconus from getting worse, thereby preventing further vision loss. Cornea crosslkining has also be found to result in vision improvement.
Cornea crosslinking risks
Cornea crosslinking may not be fully effective, in a subgroup of patients, may need to be repeated. Cornea inflammation or infection is possible after cornea crosslinking, and it is extremely important to use the eye drops prescribed after treatment. Cornea haze may develop after treatment, although it tends to improve or resolve on its own over time. A significant risk associated with the procedure is that of herpes reactivation. For this reason, candidates with a history of herpes are may not be candidates for treatment. The risk of severe vision loss after cornea crosslinking is rare. Many complications can be treated under the supervision of a cornea surgeon and by the use of regular medications post-surgery. That’s why it is imperative to look for a cornea specialist in London before moving ahead with the rest of the process. In this regard, Harley Vision, London, has a specialist keratocons clinic. We have a team of world-class cornea specialists in London to take care of your keratoconus.
Frequent asked questions (FAQs):
In collagen corneal crosslinking, the surgeon uses riboflavin eyedrops on the eyes. After this, the eyes are treated with a special type of UV radiation. The UVA reacts with the riboflavin to form a reactive oxygen species that react with the collagen fibrils in the corneal stroma. This strengthens the bonds between the collagen fibrils, and hence making the cornea stiffer. The main aim of the corneal crosslinking is to prevent further thinning of the cornea.
Removing the epithelium, manually or by laser, takes up to one minute. Riboflavin eye drops are then applied on the eye for 10 minutes. The eye is then treated with the machine emitting UV radiation for 8-10 minutes. The entire corneal crosslinking procedure takes place under local anaesthesia in about 20-30 minutes.
Yes, you will be awake during the procedure. Topical anesthetics will be installed before the surgery not to feel any pain or discomfort during the procedure.
Cornea crosslining does not hurt because of the topical anaesthetic eye drops instilled in the eyes. The laser is a non-invasive procedure with minimum downtime. After wearing out of the anesthetic effects, there will be discomfort for 2-4 days, but it can be reversed with medications and post-operative care. At Harley Vision, London, we ensure this entire process goes hassle-free for you.
You will need to remove your contact lenses before going for the corneal crosslinking procedure. The contact lenses should ideally be removed 3 days prior to cornea crosslinking treatment. After cornea crosslinking, a bandage contact lens will be applied on the eye for a couple of days. This will then be removed by a specialist. It will take at least a few weeks for you to be able to wear your contact lenses.
As corneal crosslinking treatment is a sight saving treatment, most insurance companies in London cover the cost for collagen cross linking along with the diagnostic tests required for the surgery. Even if you don’t have insurance, clinics in London nowadays are tied up with many financing companies to process loans without any hassle. You can talk to your clinic about the finance options to get some help.
We offer world-class standard of care for cornea crosslinking, including laser-combined cornea crosslinking. Please see our fees section for more information about costs. Once you are assessed in clinic and a custom treatment plan is made for you, an exact cost will be provided.
REF1:
Raiskup F et al. Corneal Crosslinking With Riboflavin and UVA Light in Progressive Keratoconus: Fifteen-Year Results. Am J Ophthalmol. 2023 Jun;250:95-102. doi: 10.1016/j.ajo.2023.01.022. Epub 2023 Feb 1. PMID: 36736417.
REF2:
Maskill D et al. Repeat corneal collagen cross-linking after failure of primary cross-linking in keratoconus. Br J Ophthalmol. 2023 Jun 21:bjo-2023-323391.
REF3:
Polido J et al. Long-term Safety and Efficacy of Corneal Collagen Crosslinking in a Pediatric Group With Progressive Keratoconus: A 7-year Follow-up. Am J Ophthalmol. 2023 Jun;250:59-69.