Keratoconus is a common disease that occurs in approximately 1 in 750 Americans. In this condition, the cornea becomes weak, progressively thinner, and irregular in shape which can cause high levels of astigmatism. Instead of a normal, relatively round shape resulting in clear vision, the cornea in keratoconus can become cone-shaped. This can interfere with the ability to see clearly. Often keratoconus patients first require glasses, then contact lenses, and, if the condition progresses to a severe level, a corneal transplant may be required.

No. LASIK is a procedure that reduces or, in some cases, may even eliminate the need for glasses or contact lenses by removing corneal tissue. The CXL treatment does not remove tissue. The purpose of CXL is to prevent further deterioration of vision for most patients and to potentially improve vision. Patients will typically require a lower eyeglass prescription or can have an easier time being fit with contact lenses.

Can I have CXL if I already had a corneal transplant?

Each patient and each patient’s eyes are different. In some cases, CXL can be performed after corneal transplantation.

How long does CXL treatment last?

Based on CXL study results over more than a decade, the beneficial effects of CXL appear to last for many years and there is evidence that this strengthening effect may be permanent.

Corneal collagen cross-linking has been performed since 1999. The results and safety profile of CXL have been very positive in numerous studies throughout the world. In fact, by September of 2006, CXL had been approved by all 25 European Union nations. CXL procedures are now routinely performed on patients as young as 10 years old in Europe to prevent the development of keratoconus.

Does CXL need to be repeated?

In many studies, the majority of patients responded to a single vitamin and light CXL treatment and did not need to have the procedure repeated. CXL can often be repeated when treatment is not effective.

Corneal Cross Linking Treatment in Northwest Ohio

Keratoconus Treatment With Corneal Cross-Linking

Corneal cross-linking is a technique that was first used in 1998 to treat patients with a disease called keratoconus. In keratoconus, the cornea (the front clear window of the eye) can become weak, thin, and irregularly shaped. Instead of keeping their normal round shape, corneas with keratoconus can bulge forward into the shape of a cone causing poor vision. Corneal cross-linking is now being performed for Ohio patients with this condition in approximately 450 centers throughout the world. Through a research study, our practice is now able to provide this investigational treatment to our patients using advanced technology for cross-linking.

Table of Contents

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What Is Keratoconus?

Keratoconus is a common disease that occurs in approximately 1 in 750 Americans. In this condition, the cornea becomes weak, progressively thinner, and irregular in shape which can cause high levels of astigmatism. Astigmatism is when the front surface of the eye (the cornea or clear window in front of the eye) is less round and more irregular in shape so the image won’t focus clearly on the retina in the back of the eye. This can result in poor vision and glare.

Instead of a normal, relatively round shape resulting in clear vision, the cornea with keratoconus can become cone-shaped. This can interfere with the ability to see clearly. Often, keratoconus patients first require glasses, then contact lenses, and, if the condition progresses to a severe level, a corneal transplant may be required.

How Can Corneal Cross-Linking Help?

Normal corneas have crosslinks between their collagen fibers that keep them strong and able to retain their normal shape. In keratoconus, the cornea is weak with too few cross-links or support beams. This weakened structure allows the cornea to bulge outwards. The cross-linking procedure adds cross-links or “cross beams” to the cornea, making it more stable, holding its shape, and focusing power better. These new cross-links help strengthen the cornea which stops the thinning process and further loss of vision.

Many research studies have shown that corneal cross-linking treatment may prevent further vision loss in over 95% of patients and improves vision in 60-81% of patients treated.

Common Questions About Corneal Cross-Linking Treatment

Can Corneal Cross-Linking be performed for everyone with keratoconus?

To qualify for the corneal cross-linking study, patients must be at least 12 years old and their corneas cannot be too thinned or too scarred for the procedure. During your consultation, we will determine if corneal cross-linking treatment might an option for you. Our practice offers a complimentary, no-touch, painless screening test to see whether corneal cross-linking might help you.

Should your relatives be tested for kertoconus?

As you may know, keratoconus is a condition that often runs in families, so it’s important to arrange a screening for all family members of patients with keratoconus. If caught early, there is a good chance that corneal cross-linking can halt the progression of keratoconus and prevent the need for uncomfortable contact lens wear and/or corneal transplant.

Is corneal cross-linking treatment like LASIK eye surgery?

No. LASIK is a procedure that reduces or, in some cases, may even eliminate the need for glasses or contact lenses by removing corneal tissue. The corneal cross-linking treatment does not remove tissue. The purpose of corneal cross-linking treatment is to prevent further deterioration of vision for most patients and to potentially improve vision. Patients will typically require a lower eyeglass prescription or can have an easier time being fit with contact lenses.

Can corneal cross-linking treatment prevent the need for corneal transplants?

Many studies have shown that corneal cross-linking treatment can often prevent the need for a corneal transplant and allow patients to wear contact lenses or glasses more comfortably and safely again.

Can a corneal transplant be done after corneal cross-linking?

If corneal cross-linking treatment does not prevent the need for a corneal transplant, then a corneal transplant can generally be performed.

Can I have corneal cross-linking if I already had a corneal transplant?

Each patient and each patient’s eyes are different. In some cases, corneal cross-linking treatment can be performed after corneal transplantation.

What’s the difference between a corneal transplant and corneal cross-linking?

Corneal cross-linking is an in-office procedure that does not involve surgical incisions into the eye or stitches. It is a relatively non-invasive procedure that is done with vitamin drops and light. Corneal transplants are performed in an operating room, involving incisions into the eye and a lifelong risk of rejection of the corneal tissue.

How long does corneal cross-linking last?

Based on CXL study results over more than a decade, the beneficial effects of corneal cross-linking appear to last for many years and there is evidence that this strengthening effect may be permanent.

Is corneal cross-linking new?

Corneal collagen cross-linking has been performed since 1999. The results and safety profile of corneal cross-linking treatments have been very positive in numerous studies throughout the world. In fact, by September of 2006, corneal cross-linking had been approved by all 25 European Union nations. Corneal cross-linking procedures are now routinely performed on patients as young as 10 years old in Europe to prevent the development of keratoconus.

Does corneal cross-linking need to be repeated?

In many studies, the majority of patients responded to a single vitamin and light corneal cross-linking treatment and did not need to have the procedure repeated. Corneal cross-linking can often be repeated when treatment is not effective.

How is corneal cross-linking treatment performed?

Corneal cross-linking is an outpatient procedure performed in the doctor’s office using only numbing eye drops and a mild sedative, like a Valium tablet. You’ll need to lie flat on your back in a reclining chair and look up at a soft blue light during the treatment. The epithelium, a thin layer of clear, protective tissue (like skin) that covers the cornea is removed for the procedure. Next, vitamin eye drops (riboflavin) are used in the eye and you will be asked to look at a special blue, ultraviolet light while lying comfortably on a reclining chair. It’s generally easy to look at this light because your eyes are numb and we use drops so your eyes won’t feel dry.

What is the transepithelial (or epi-on) corneal cross-linking technique?

In this less invasive treatment method, the surface skin layer (epithelium) of the cornea is not removed so the recovery is much faster than the traditional technique. This less invasive technique can only be done on corneas that are thicker than 400 microns. Your surgeon will be able to determine if you might be a candidate for transepithelial CXL treatment.

How long does the corneal cross-linking procedure take?

If two eyes are being treated at once, the procedure takes approximately an hour and a half. If only one eye is being treated at a time, the procedure takes approximately one hour.

Does the corneal cross-linking procedure hurt?

No, the procedure is painless. Anesthetic eye drops are used to avoid any discomfort during the procedure. Some patients have some discomfort after the procedure and your surgeon can tell you whether you are or are not likely to do so.

Can I have one eye treated at a time?

Yes, your doctor will discuss the advantages and disadvantages of treating one eye or two eyes at a time.

When is the best time to have corneal cross-linking treatment?

As with most conditions, prevention of a problem is better than treatment of a problem. The best time to treat keratoconus is before astigmatism has become severe and vision has been lost. This does not mean that people with very poor vision from keratoconus cannot be helped by corneal cross-linking treatment. However, the results of corneal cross-linking treatment for patients with advanced keratoconus have not been as good as for patients with early disease.

If corneal cross-linking works for me and stops my vision from getting worse, can I have laser vision correction or Intacs afterward?

Some patients may be able to have an excimer laser treatment (PRK) or Intacs to improve their vision without glasses after they have healed from the procedure.

Do I have to stop wearing contacts before having corneal cross-linking?

We recommend that you stay out of contact lenses for a week or two if possible before your consultation visit to see if you might benefit from the investigational corneal cross-linking procedure. This can vary based on how difficult it is for you to see without your contacts. We often suggest patients not wear their lenses for 3 days before their procedure.

When can I resume wearing contact lenses?

Most patients can return to wearing contact lenses 2 to 6 weeks after having the cross-linking procedure depending on whether they are a candidate for transepithelial corneal cross-linking. Your surgeon will determine how long this might take in your case.

Will I need new glasses or contacts after corneal cross-linking?

Because corneal cross-linking often improves vision, patients find that their old contacts or glasses are too strong for them and they need to be refitted with new, glasses and/or contact lenses. Most of the time, patients can wear their old glasses until several months after the procedure when their doctor will prescribe new ones. Because the effects of corneal cross-linking occur slowly, patients don’t generally have to change their glasses very often.

When will I notice any improvement in my vision after corneal cross-linking?

With the traditional corneal cross-linking procedure, most patients find that immediately after the cross-linking treatment, their vision is actually worse than it was before the procedure. This usually goes on for roughly 3-6 weeks. Patients may start to notice positive effects 4-8 weeks after the procedure and may experience a major improvement in vision at least 3-6 months after the investigational procedure. In some studies, patients’ vision and astigmatism were still continuing to improve five years after the cross-linking procedure so visual improvement is a long process. With the less invasive transepithelial corneal cross-linking, some patients found their vision improved as early as several weeks after treatment.

When can I exercise and return to my usual activities after corneal cross-linking treatment?

We want to help you be able to work or do other things you need and want to do as quickly as possible. Based on the type of cross-linking procedure, your doctor can tell you when you can return to your usual activities. With traditional corneal cross-linking, most people can usually do so after 5-7 days. With transepithelial corneal cross-linking, most people return to their usual activities the next day.

Does insurance cover corneal cross-linking?

Because of the regulatory environment in the US, this procedure is investigational so corneal cross-linking treatment is not covered by insurance.

What is the cost of being in a corneal cross-linking study?

You will be charged for the procedure and will still have to pay for the costs of your regular medical care. Since this procedure is investigational, insurance plans typically do not cover the costs of participating. Financing is available to help our patients pay for this investigational procedure. To find out more about costs, ask the study doctor or staff. For more information about keratoconus, and/or our diagnostic screenings and treatments, please call our practice and ask to speak with a corneal cross-linking coordinator or schedule an appointment today.

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References

1. Wollensak G, Spoerl E, Seiler T.; Riboflavin/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus. AJO 2003 May;135(5):620-7
2. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE.; Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results. J Cataract Refract Surg. 2008 May;34(5):796-801.
3. Coskunseven E, Jankov MR 2nd, Hafezi F.; Contralateral eye study of corneal collagen cross-linking with riboflavin and UVA irradiation in patients with keratoconus.
J Refract Surg. 2009 Apr;25(4):371-376
4. Grewal DS, Brar GS, Jain R, Sood V, Singla M, Grewal SP.; Corneal collagen crosslinking using riboflavin and ultraviolet-A light for keratoconus: one-year analysis using Scheimpflug imaging. J Cataract Refract Surg. 2009 Mar;35(3):425-32.
5. Spoerl E, Mrochen M, Sliney D, Trokel S, Seiler T.; Safety of UVA-riboflavin cross-linking of the cornea. Cornea. 2007 May;26(4):385-9.
6. Trattler W, Rubinfeld R, Corneal Collagen Cross-linking; Cataract and Refractive Surgery Today; September 2009
7. Caporossi A, Mazzotta C, Baiocchi S, Caporossi T. Long-term Results of Riboflavin Ultraviolet A Corneal Collagen Cross-linking for Keratoconus in Italy: The Siena Eye Study. Am Journal of Ophthalmology 2010:149:585-593 www.ajo.com/article/S0002-9394(09)00808-3/abstract
8. Raiskup-Wolf F, Hoyer A, Spoerl E, Pillunat LE. Collagen crosslinking with riboflavin and ultraviolet-A light in keratoconus: long-term results. J Cat Ref Surg. 2008
9. Vinciguerra P, Albè E, Trazza S, Seiler T, Epstein D. Intraoperative and postoperative effects of corneal collagen cross-linking on progressive keratoconus. Arch Ophth. 2009
http://archopht.ama-assn.org/cgi/content/abstract/127/10/1258
10. Daley, R. Cornea
Cross-linking vision improvement evidence mounts. Eyeworld, 2010. http://www.eyeworld.org/article.php?sid=5268&strict=&morphologic=&query=Daley, R. Corneal%26%238232%3BCross-linking vision improvement evidence mounts.
11. Rubinfeld RS, Trattler WB, Martin NF, Adi MA and The CXL-USA Study Group: Answering Your Patients’ Questions About Cross-Linking; Advanced Ocular Care. March 2010:25-28
bmctoday.net/advancedocularcare/2010/03/article.asp
12. Boxer Wachler BS, Pinelli R, Ertan A, Colin CKC. Safety and efficacy of transepithelial crosslinking (C3-R/CXL), J CATARACT REFRACT SURG – VOL 36, Pgs 186-187, JANUARY 2009
13. Pinelli R, El Beltagi T, Leccisotti A. Update on Corneal Crosslinking. Cataract and Refractive Surgery Today October 2008: 67-69. http://www.crstodayeurope.com/Issues/1008/1008_19.php

     Excellent  
     Based on 116 reviews 
    
 
 
   
 
 
        
   Erin Riley 
 September 3, 2023
 
 
 Trustindex verifies that the original source of the review is Google. From the very first consultation appointment, all the way to surgery day, I felt complete confidence in the team at Toledo Lasik. Ray is so friendly, kind, and explained everything on the financial side in detail so I knew exactly what to expect. Dr. Jee performed the SMILE procedure on my eyes, and was also very personable and competent. She really made me feel at ease, and I did not feel nervous at all during the procedure. Not even 24 hours post op, I was seeing 20/20, after 33 years of wearing glasses/lenses at a very high prescription (my eye doctor explained that my vision was previously 20/900!) A week post op, I am seeing 20/15…even my eye doctor is dumbfounded at the results I am experiencing, and kept repeating how “truly remarkable” my results are! I am healing well, and I could not be happier!
  
 
       
   Brett Adkins 
 August 14, 2023
 
 
 Trustindex verifies that the original source of the review is Google. This was a very good experience.   Everyone was very friendly and helpful and most importantly I broke up with my glasses.  I havent experienced any pain or anything and about after 2 days of rest i was ready to function again.
  
 
       
   Kirk Mortemore 
 July 18, 2023
 
 
 Trustindex verifies that the original source of the review is Google. I was in and out in less than 45 minutes.  It is insane thats all it takes to fix eyesight.  Less than 10 minutes in the operating room.  Feels weird but mostly painless.  About 3 minutes for each eye.
  
 
       
   LAURA 
 April 15, 2023
 
 
 Trustindex verifies that the original source of the review is Google. Did an amazing job. I got the SMILE lasiks procedure. Staff was nice. Dr. Wiley did an exceptional job. My only complaint is that I wish they would have given me a prescription for the one Valium pill BEFORE the day of my surgery so I could take it before I arrived because it definitely did not kick in until the ride home so I was super anxious during the procedure.
  
 
       
   Haley Wolfe 
 December 16, 2022
 
 
 Trustindex verifies that the original source of the review is Google. I am SO happy that I chose Toledo LASIK Center to conduct my surgery. First off, the staff is extremely nice and knowledgeable, they listen to concerns and questions about the surgery while reassuring you throughout the process. Secondly, the surgeon and tech that conducted my surgery were absolutely amazing. I was really nervous initially but they were there explaining the entire process to me and making sure I was okay/comfortable the entire time.

From the initial consolation to my post-op check up, I have never once regretted my decision to come here.

A special shout-out to Ray for being really kind and understanding, and for reassuring me the day of surgery. He is wonderful and Toledo LASIK Center is lucky to have him.
  
 
       
   Slee Biscuit 
 November 10, 2022
 
 
 Trustindex verifies that the original source of the review is Google. I was once told many years ago because of my significant astigmatism, Lasik was not in the cards. 20 years later I finally had enough of these glasses and having "underwater vision" when off. I consulted with them and was reassured advances in the technique. Going in, of course I was nervous, and the staff was very professional. The procedure took less than 15min. I'm now 3 months post op and have 20/15 vision. Best money I've ever spent. Thank you so much!