This treatment is 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 the rationale behind this treatment in keratoconus.

Mukhtar Bizrah believes that the 400um limit to being able to perform this treatment is outdated, especially with the advances in technology and understanding of treatment mechanisms. At the Harley Vision, we use advanced technology to enable collagen cross-linking of corneas with advanced level of disease.

After comprehensive assessment of the cornea, the eligibility and treatment options for cornea collagen cross-linking will be discussed with you in more detail.

About keratoconus and corneal ectasia

DALK or Deep Anterior Lamellar Keratoplasty is a type of partial thickness corneal transplant surgery. Instead of removing the entire layer of the cornea, partial removal of the cornea until the Descemet’s membrane is done. The endothelium is left intact.

DALK was initiated to decrease the risks associated with the complete removal of the cornea, such as cornea graft rejection. DALK is performed in corneal diseases affecting the front part of the cornea, such as keratoconus or cornea scarring.

Types of Collagen Corneal Crosslinking

There are two types of collagen corneal crosslinking- Epithelium-off and epithelium-on corneal crosslinking. Epithelium-off cross linking involves removing the topmost layer of the cornea, the epithelium to allow better penetration of the riboflavin drops. On the other hand, Epithelium-on corneal crosslinking involves leaving the epithelial layer intact during the application of riboflavin. This treatment process is less invasive than epithelium-off and is also called transepithelial crosslinking. But there are other treatment methods like Accelerated corneal crosslinking using UV radiation at an increased rate or contact lens-assisted corneal crosslinking using an ultraviolet barrier-free contact lens soaked with riboflavin for the effects.

Ideal Candidate for Collagen Corneal Crosslinking Treatment

The ideal candidate for collagen

  1. must Be older than 14 years as that is the FDA approved age
  2. Have progressing irregular astigmatism not improving satisfactorily with glasses
  3. Have steadily worsening symptoms of keratoconus like corneal ectasia, blurred vision, and halos around the eyes
  4. Must show a progressively thinning cornea in the Corneal Topography chart towards the center
  5. Have been declared unfit for LASIK surgery and be willing to follow the physician’s instructions required for successful treatment of the cony

If you want to ensure your eligibility for Corneal Crosslinking, visit Harley Vision, London, for a follow-up.

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. A retina evaluation using an ophthalmoscope will be a part of the screening procedure to rule out any retinal abnormalities before the treatment. Next, diagnostic tests like keratometry will be done to determine the overall corneal curvature with an endothelial cell count to evaluate the thickness of the endothelium. Also, you can expect corneal topography and pachymetry to evaluate the overall shape and thinning of the cornea. Irrespective of the clinic you visit in London, these would be some common tests before getting started with your corneal crosslinking treatment.

During corneal crosslinking treatment

The basic treatment procedure of corneal crosslinking involves the use of riboflavin solution and UV radiation. But a number of other procedures with slightly different variations in technique can be used as well. Some of the popular corneal crosslinking procedures are Epithelium-off crosslinking, Epithelium-on crosslinking, CXL with hyperosmolar riboflavin solution, Lontoporesis crosslinking, Topography guided corneal crosslinking and Intrastromal Corneal ring segments, and CXL corneal crosslinking. Depending on your corneal condition owing to keratoconus and possibility of other procedures required, if any, decides the type of corneal crosslinking treatment plan you need.

Corneal Crosslinking steps

Step 01

Topical anesthetics will be instilled in your eye.

Step 02

Depending on whether it is an Epithelium-off or Epithelium-on corneal crosslinking, the epithelial layer will be removed for better permeability of the riboflavin about to be instilled next.

Step 03

0.1% riboflavin five phosphate drops in combination with other eye medications will be instilled continuously for 30 minutes.

Step 04

The cornea's collagen fibers will be exposed to UV radiation of 370nm simultaneously in combination with the riboflavin drops for 30 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 an ideal clinic in London, your doctor will explain all these procedures in detail before signing you up for the corneal crosslinking treatment.

What can I expect after the procedure?

After the procedure, there will be symptomatic changes in the eye like inflammation, watering, and mild pain. Medications will be instilled hourly, and the therapeutic contact lens will be evaluated regularly for signs of infection if any. You will be evaluated every 24 hours for the next 4-5 days to monitor the symptoms. After the inflammation subsides, the contact lens will be discontinued, and the vision and other parameters will be regulated to check the effect of the crosslinking procedure.

Advantages and risks of collagen corneal crosslinking

Collagen corneal crosslinking is an effective and safe method of repairing collagen fibers without resorting to corneal transplantation. It proves effective for extremely thin corneas and can be performed on teenagers as well. It provides quicker vision improvement than other procedures and, most importantly, halts the further progression of keratoconus in the process, lessening

The side effects

A significant risk associated with the procedure is that of herpes reactivation. For this reason, candidates with a history of herpes are exempted from the treatment. The risk of sterile infiltrates resulting in inflammation is the main risk associated with the treatment. Apart from that, endothelial thinning and corneal haze, albeit temporary, are other complications associated with the corneal crosslinking treatment procedure. But these can be reversed with the help of a capable surgeon and by the use of regular medications post-surgery. That’s why it is imperative to look for an ideal surgeon in London before moving ahead with the rest of the process. In this regard, AI Vision, London, will be your ideal bet. We have a team of world-class optometric surgeons to take care of your treatment in London with ease.

Frequent asked questions (FAQs):

Collagen corneal crosslinking is a procedure mainly used to treat keratoconus, a condition causing a conical bulging of the cornea. Apart from keratoconus, it is used in general for strengthening corneas. Any condition causing corneal thinning and ectasia like bullous keratopathy, chemical burns, and even corneal infections can be easily treated.

In collagen corneal crosslinking, the surgeon uses riboflavin eyedrops on the eyes. After this, he treats the eyes 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. The main aim of the corneal crosslinking is to repair the thin cornea and prevent further thinning of it.

Post instillation of riboflavin drops takes 30 minutes for the drops to soak in, after which the eyes are treated with the machine emitting UV radiation. The entire corneal crosslinking procedure takes place under local anesthesia in about 30-60 minutes. Multiple sessions may be required for the effective healing collagen fibers.

Yes, you will be awake during the procedure but under the effect of sedatives. Topical anesthetics will be installed before the surgery not to feel any pain or discomfort during the procedure.

It does not hurt because of the topical anesthetics instilled in the eyes and sedatives for relaxing the patient. 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 AI Vision, London, we ensure this entire process goes hassle-free for you.
Even if you go for the best corneal crosslinking treatment plan in London, expect some level of inflammation for a few days after the procedure. You will be advised of therapeutic contact lenses, but the symptomatic effects cannot be ignored. Wearing sunglasses or protective eyewear can hide the symptoms to some extent, but it will be evident from your appearance that you’ve had crosslinking.
You will need to remove your contact lenses before going for the corneal crosslinking procedure. It involves applying laser light with instilling riboflavin drops, either of which can discolor the contact lenses or affect the effectiveness of the laser light during the procedure. Post-surgery, you will be asked to wear bandage contact lenses for quicker healing of the eye. It will take at least a few weeks for you to be able to wear your lenses.
As corneal crosslinking treatment is a medical emergency, most insurance companies in London cover the cost for collagen cross linking along with the diagnostic procedures 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.
The exact cost of your surgery in London will depend upon a lot of factors. For example, it relies on the level of ectasia or corneal thinning caused by the keratoconus, the surgical technique used by the surgeon, the possibility of any additional refractive procedures required during the process, etc. Also, if the clinic is present in one of the busiest streets of London and has the best surgeons to serve the patients, the price will go up. In this regard, you can contact AI Vision, London, to get an approximate cost of your treatment in advance.