Contact lenses for Keratoconus

Luckily for us, there is a wide choice of contact lenses available for those with keratoconus. Fitting contact lenses on a keratoconic cornea is challenging and time-consuming. You can expect plenty of return visits to fine-tune the fit and the prescription, especially if the keratoconus continues to progress. It’s very unlikely that any lens will fit first time, so patience and perseverance is key.

Here’s a guide to what’s on offer, so you can ask your contact lens fitter what they can offer you:

Custom soft contact lenses

Recently, contact lens manufacturers have introduced custom soft contact lenses specially designed to correct mild-to-moderate keratoconus. These lenses are made-to-order based on detailed measurements of the keratoconic eye(s) and can be more comfortable than gas permeable (GP) or hybrid contact lenses for some wearers.

KeraSoft by Bausch & Lomb lenses can correct up to -30 diopters (D) of myopia and up to -15 D of astigmatism and are available in silicone hydrogel and regular hydrogel materials with high water content (74 to 77 percent). Kerasoft lens are great for early stage Keratoconus and also post graft eyes. KeraSoft IC lenses are designed to fit irregular corneas, including keratoconus, post laser refractive surgery, pellucid marginal degeneration, and other corneal irregularities. Each KeraSoft IC lens is custom-made for your exact needs, and KeraSoft IC lenses can offer increased wear time and improved comfort and are a patented combination of the latest technologies in silicone hydrogel materials using geometries from complex mathematics to offer comfortable wear and excellent vision.

NovaKone lenses (Alden Optical) can correct up to -30 D of myopia and up to -10 D of astigmatism and are available in a hydrogel material with medium water content (54 percent).

Both lenses have a very wide range of fitting parameters for a customized fit and are larger in diameter than regular soft lenses for greater stability on a keratoconic eye.

In a recent study of the visual performance of toric soft contacts and rigid gas permeable lenses for the correction of mild keratoconus, though GP lenses provided better visual acuity in low-contrast situations, soft toric lenses performed equally well in high-contrast acuity testing.

Custom soft toric lenses also can be a good option for part-time wear for people with keratoconus who cannot tolerate wearing gas permeable lenses full-time.

Custom toric soft contacts for keratoconus are significantly more expensive than regular soft contacts

Hybrid contact lenses

Synergeyes hybrid lens

ClearKone® hybrid contact lenses offer all the benefits of rigid gas permeable (RGP) and soft contact lenses without any of the disadvantages for an overall good contact lens experience.

ClearKone® is an NHS approved and FDA-cleared hybrid contact lens specifically designed for the treatment of keratoconus and other corneal irregularities. Using a revolutionary technology, ClearKone® combines the best of both worlds – the crisp vision of a high-oxygen rigid RGP contact lens with the all-day comfort and convenience of a soft lens.

ClearKone® is specifically designed to restore vision to patients with the many types and stages of keratoconus, including post graft lens wear. Because the ClearKone® lens vaults over the cornea, there’s minimal risk of corneal scarring, making ClearKone® hybrid contact lenses a healthy treatment option for keratoconus. In addition, the soft skirt of the ClearKone® design helps to center the contact lens over the visual axis regardless of where the cone is located on the cornea or how large it is, thereby decreasing visual distortions and providing superior vision. The ClearKone® design also prevents dirt from getting under the lens and will not pop out unexpectedly.
Hybrids use soft lens cleaning solutions.

 

Ultrahealth hybrid lenses

UltraHealth, available in 2013, from Synergeyes,  is the only irregular cornea hybrid contact lens with highly breathable, healthy materials and an advanced lens design especially suited for patients with irregular cornea conditions. UltraHealth corrects vision problems, is healthy for your eyes and delivers exceptional comfort, too.

UltraHealth delivers vision benefits only available in hybrid contact lenses. The “rigid” (GP) material optimizes vision; while the soft skirt centers the lens over the cornea, providing enhanced stability and clarity. The soft silicone hydrogel material that surrounds the GP portion of the lens provides longer-lasting comfort for irregular cornea and keratoconus patients. UltraHealth is made with materials that allow very high oxygen transmission. The lens design also promotes tear circulation throughout the day, which delivers even more oxygen to the eye.

Ideal for Patients with:

  • Irregular cornea
  • Keratoconus
  • Ectasia
  • Intacs®
  • Post-Surgical

Eyebrids

The launch in France of the first range of Hybrid Contact Lenses, combining quality of vision with rigid lens wearing comfort soft lens was announced by the French laboratory LCS (Contact Lens Service) in early 2013. The new patented range of lenses named EyeBrid is the result of four years of research by teams at LCS. These innovative lenses need renewal every 4 months but also offer a high oxygen permeability (Dk strong). This new lens is as comfortable as a soft lens and offers the visual quality of a hard lens.

Gas permeable contact lenses or RGP

By far the most widely used contact lens for keratoconus, with the most popular RGP being the RoseK. it is essential RGP lens are fitted by an expert.
If eyeglasses or soft contact lenses cannot control keratoconus, then rigid gas permeable (RGP or GP) contact lenses are usually the preferred treatment. Their rigid lens material enables GP lenses to vault over the cornea, replacing its irregular shape with a smooth, uniform refracting surface to improve vision.

Rose K was established to market the Rose K lens invented by Paul Rose, an optometrist from Hamilton, New Zealand.  Paul was concerned about what could be done for patients with keratoconus – a progressive condition in which the surface of the cornea becomes cone shaped.  Realising that the problem with traditional contact lenses was that they did not fit unusual corneal shapes or mimic the eye shape well, he sought to develop a contact lens that would be more comfortable for patients, be easier to fit and provide better vision to those with the condition. Paul Rose began developing the Rose K keratoconus lens in 1989.  After testing 700 lenses and 12 different designs, he produced a set of 26 lenses from which all patients are fitted.  A further two years was spent to perfect the lens design before it was launched in the New Zealand market.  In 1995, the Rose K lens gained approval from the Federal Drug Administration (FDA) of America.

Since then advances in technology have resulted in the introduction of the Rose K2 lens, the Rose K2 Irregular Cornea (IC) lens and the Rose K2 Post Graft lens designed for patients with specific conditions.  These conditions include Pellucid Marginal Degeneration, Keratoglobus, Lasik Induced Ectasia and for patients who have undergone Penetrating Keratoplasty.

The Rose K family of lenses are now manufactured in 13 countries, distributed in over 60 countries and have become the most frequently prescribed lenses for keratoconus in the world. RGP contact lenses can be less comfortable to wear than soft contacts, and really need expert fitting and patience. Looked after they are durable and cost effective.

“Piggybacking” contact lenses.

Because fitting a gas permeable contact lens over a cone-shaped cornea can sometimes be uncomfortable for a person with keratoconus, some eye care practitioners advocate “piggybacking” two different types of contact lenses on the same eye.

For keratoconus, this method involves placing a soft contact lens, such as one made of silicone hydrogel, over the eye and then fitting a GP lens over the soft lens. This approach increases wearer comfort because the soft lens acts like a cushioning pad under the rigid GP lens.

Your eye care practitioner will monitor closely the fitting of “piggyback” contact lenses to make sure enough oxygen reaches the surface of your eye, which can be a problem when two lenses are worn on the same eye. However, most modern contacts — both RGP and soft — typically have adequate oxygen permeability for a safe “piggyback” fit.

Scleral or ‘sceral’ lens (spelling)

Many optometrists and ophthalmologists recommend scleral contact lenses for a variety of hard-to-fit eyes, including eyes with keratoconus. The first scleral lenses were made in glass, blown and fashioned into shape by craftsmen in the 1880’s. They were also the only lens available up until the 1950s.

In cases of early keratoconus, a standard RGP lens can be used. However, if the lens does not centre properly on the eye, moves excessively with blinks and causes discomfort, switching to a large-diameter scleral contact lens may solve the problem. Scleral lenses were made in rigid gas permeable (RGP) materials in 1983, and today are highly oxygen permeable.

Scleral lens are designed to vault the corneal surface and rest on the less sensitive surface of the sclera, so these lenses often are more comfy for a person with keratoconus. Scleral lenses are designed to fit with little or no lens movement making them more stable on the eye, compared with traditional corneal gas permeable RGP lenses.
The newest scleral lens is the ICD 16.5. With only three fitting zones, ICD™ 16.5 is easy to evaluate, consistent in lens performance and is the “go-to” lens for problematic corneas.

Scleral Lenses for Other Eye Problems

In addition to keratoconus, scleral lenses can be used for eyes that have undergone a cornea transplant, and for people with severe dry eyes caused by conditions such as Sjogren’s syndrome, graft-versus-host disease (GVHD) and Stevens-Johnson syndrome.

Large-Diameter Contact Lenses
LENS DIAMETER* CLASSIFICATION EXAMPLES
12.9 to 13.5 mm Corneal-scleral SoClear (gt_eq13 mm; Art Optical, Dakota Sciences)
13.6 to 14.9 mm Semi-scleral Tru Scleral (gt_eq13.5 mm; Tru-Form Optics)
Perimeter (14 or 14.8 mm; Abba Optical)
Dyna Semi-Scleral (gt_eq13.5 mm; Dyna Lenses)
14.5 mm Hybrid
(RGP center with a silicone
hydrogel skirt that rests on
the sclera)
ClearKone – for keratoconus
Duette – indicated for use in healthy eyes, up to ±20 D
sphere, astigmatism of lt_eq –6 D
Duette Multifocal – indicated for healthy presbyopic
eyes (all hybrid examples, 14.5 mm; SynergEyes)
15 to 18 mm Mini-scleral Jupiter† (15 or 18 mm; Visionary Optics, Abba Optical)
Maxim (16 mm; Accu-Lens)
18.1 to 24 mm Scleral Jupiter† (18.8 or 22 mm; Abba)

*Upper and lower boundaries are approximate; sizing and terminology vary among lens makers.
†Manufacturers of RGP materials with FDA-approved lens designs provide the raw material to multiple labs, which produce the lenses under their own brand.

http://www.aao.org/aao/publications/eyenet/201201/feature.cfm?RenderForPrint=1

Lens care

Contact lens case

Whatever lens you wear It is important to clean your contact lenses daily to maintain the highest standards of comfort and visual clarity. Each day after you remove your lenses, you must clean them prior to overnight storage.
Always use the correct solution, never use tap water. Change your contact lens case regularly as bacteria will happily live in the little damp case, that could damage your eyes and cause infections.

Try not to overwear your lens especially in the early days of getting used to them. If they hurt – take them out and clean them, and let your eyes rest. Try to avoid aircon and get fresh air to your eyes when you can. There are various rewetting and comfort drops available from pharmacies and your doctor. Always check that they’re suitable to use with your type of contact lens.

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Corneal Graft – a Positive Experience And A Good Outcome For Tim

Tim from the UK shares his inspiring keratoconus and corneal graft story:

About Me

I’m 27 years old and live with my partner in Swindon, Wiltshire, UK. We are currently planning a wedding for next year, which is really exciting! I run my own IT business for the last 6 years and am a self confessed workaholic.

Working in IT and often on computers for up to 16 hours a day at times has always come with its challenges and having keratoconus, I’ve always tried to not let it affect what I do in life.

So its been nearly 2 months since my Full Thickness Corneal Graft. I thought I would share my experiences so far for anybody waiting for a Graft or considering one and a summary of my journey from when I was first diagnosed.

Of course everyone has a different experience and it will affect each person in different ways.

What Did Keratoconus Mean to Me?

I was diagnosed with Keratoconus in 2009 when I was 20, it was first diagnosed at a routine eye test at a leading UK Opticians. I was given the option for the opticians to fit me with a RGP lens or to be referred to the Hospital. I chose to be referred to the hospital, and this gave me time to read up about the condition myself.

I was referred to the hospital and after various scans and tests was advised that I should see the contact lens fitter to get a lens for my bad (Left) eye initially. I attended various appointments with the fitter and after the 5th-6th appointment was feeling frustrated, I could not get the lens in my eye myself without discomfort and a long 30-40 minutes of trying, the fitter also struggled to get a lens in my eye because of my natural bodily response to pull away every time she tried.

I found her attitude towards me and lack of sympathy towards the difficulties I was having very unprofessional. At the time I gave up and just left it how it was. I managed the next 5 years with the condition by making do and ignoring the problem. I urge anyone not to do the same! KC requires patience and time to sort out properly.

Next Steps

In 2014 I realised things were getting worse and asked for a referral again, this time to Bristol eye hospital. This meant a hour and a half journey but I hoped that the journey would pay off.

I was seen in October 2014 by a consultant after scans and tests his response was that a Graft was now the only option for my bad eye and it had progressed to far for any other treatment. His words were that he ‘rarely sees Keratoconus as advanced as mine especially with so much scarring on the cornea‘. I was put on the waiting list for a transplant and referred to a Lens fitter for my good eye.

Firstly my experience with the new lens fitter was 100 percent better. On my first visit they were able to fit a lens within minutes without problems, and the way that they approached the fitting I was made to feel a lot more comfortable and things were explained very well. I am still in the progress of  fine tuning a lens but I am getting better and being able to fit a lens myself and feel a lot more confident with the whole process!

Corneal Transplant Time

My cornea transplant was scheduled in for the 17th December 2015. I found the built up and the waiting the worse part of the whole experience.

The  2-3 months prior when i was given a date was awful. The biggest stress was having the time off work. For me as I own my own company, having to have time off means having to employ people to cover me, so it was a lot of preparation and long days followed by long nights. I was told that i should only need 2 weeks for recovery, as I don’t have a very physical job.

I must have asked this question to different people during the process several times for reassurance. In the lead up to the operation i was asked to  take part in a study by the hospital, they are currently carrying out a study to investigate the causes of Cornea transplant rejection. This involved me having further tests (bloods and tear samples) at the pre-op and additional tests carried out on various follow up appointments for the next 5 years.

Giving Something Back

I agreed to this in the hope that they can make future transplants more successful and I felt like I was giving back a little bit having just accepted a donated cornea. I also decided to become an organ donor myself, I had not really thought about this much before but I realised that if I am prepared to take I would be a hypocrite to not offer up my body when I die. (Did you know even recipients of donated corneas can donate these, and all parts of the eye can be used after you have passed?)

So the 17th of December came and at 5 am I was awake and getting ready for the travel to Bristol for a 7:30 arrival time. When I arrived at the hospital I was directed straight to the ward and checks were carried out, I met with the surgeon and the process was explained again measurements were taken and an arrow drawn on my head to indicate which eye they were to work on!

IMG_9751

First on The List

I was the first on the list for the morning and shortly after seeing him I was taken down to theatre. This was my first operation and so the experience was rather daunting, however all the staff were very calming and very professional.

I woke up from the anaesthetic a couple of hours later with an eye patch over my eye just feeling a little tired still. I was taken back to the ward and was up and walking within about half an hour, I ate and drank in the hope that I could persuade them to let me home the same day. I had been previously told that I would be staying in overnight….. I must have been the youngest person on the entire ward at 27 and with the gentleman whistling Christmas carols I knew I had to get out of there.

I asked if it was safe and was I able to go home for the night and after checking with the consultant was given the all clear. I returned the next day to have the eye patch removed and the smile from the consultant when he removed it allowed me to take a sigh of relief and I was told that it all looked very good and advised to come back in a weeks time.

Since the op

Since the operation I have had 2 follow up appointments with another in a couple of weeks. During my recovery time until now I personally experienced no pain, I would describe the worst feeling during the experience was of my eyes being very tired for the first couple of weeks and a very dry feeling and itchy eye.

Followed by a gunky eye for the first week when first waking up. This has subsided after the first 2-3 weeks and I can barely notice the stitches now. My eyes have been bright white 99 percent of the time with people weeks after asking if I had even had the operation.

IMG_9750

Positive Outcome

The feedback so far is very positive at my follow up appointments and the talk of removing stitches has been mentioned in the next 3-4 months if things continue as they are. I can now see the eye board and read the first line fine, with pinhole diagnostic glasses I can see the 4th line down. Prior to the operation I couldn’t even see them holding up their hand! Amazing!

From my experiences and I understand everyone’s is different I would give the following advice based on mistakes I have made:

  • If you are young and a transplant is mentioned as an option, take it before you start to develop a career and build a life. I regretted not getting things sorted sooner as it made it harder for me to adjust my life at the time.
  • If you have a bad experience with a hospital or Fitter/Consultant try another. It may mean travelling an extra distance but for me the difference between 2 different consultants and 2 different hospitals was very different.
  • I would say if you are waiting for a transplant not to worry, as the waiting and build up for me was a lot worse than the actual operation. I felt a little silly afterwards knowing that I had put myself thought months of worrying. However this is normal!

I am now considering CXL in my good eye at a later date once things have healed and feeling very positive about my future vision.

Good luck to anybody considering or waiting for a corneal transplant. I’m prepared for any hiccup along the way, I am staying positive and doing my best to take care of it at the moment!

Tim

You can find Tim and ask him about his Keratoconus journey here 

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Fighting Blindness!

Source: Fighting Blindness!

On the Slopes with Ash Winter

By Ash Winter

I was diagnosed with Keratoconus in 2010. It’s a horrible eye disease and I do see it as a disability but I try not to let it stop me living my life to the full.

DSC_0940

I also feel like my life has changed since then, maybe it’s my Army background but something told me to  and make the most of a bad situation. I was offered the chance to ski in March 2015, I had never skied before so skiing with visual distortion was a bit of a scary thought.

I can ski!

I attended the ski trip with an organisation called BattleBack, they help people who are in the Army who are wounded, injured or sick. I had 1 on 1 tuition for 10 days. The feeling was unbelievable, I could ski. Although it took a lot of concentration, not being able to see what most people can was obviously a hindrance! I am a very emotional person and put my all into this trip, and it came as a shock to me to win the Mitchell Cup, an award for the person who benefited most for the experience.

During the summer of 2015 I was offered the chance to attend a newcomers day for the Armed Forces Para Snowsport team, I got on well and enjoyed it, for the 6 months to now (Jan 16) I have attended training days, race camps, training camps and am well on my way on the performance pathway set out for me.

I ski with a guide and train very hard; I set myself goals and achieve most. I have attended a low key access for all race with Para Snowsport GB and came 3rd.

IMG-20160108-WA0004

As we speak I am in Austria ready for race training and preparation before forerunning in the Army Championships and then going on to compete later on in the season.

Sporting achievements

I also do a lot more sports in the summer, a 24 hour mountain bike endurance race, half marathons, triathlons etc, I am supported by Fitbit, Mygym-buddy.com, Ringtons Tea and am a LifeVenture ambassador.

Vision problems do not stop me

The problems I endure whilst skiing are vast!

Everything is blurred so it is vital I have a guide so I am able to negotiate the course, Flat light means I can’t see definition, I can’t make out the terrain, I get dizzy, I feel sick, at speed I have no peripheral vision, I get floaters, my contacts shrink at altitude, my drops don’t work, I get the kaleidoscope effect meaning no vision at all.

Imagine skiing at about 40mph through a race course with goggles full of water, I have to have 100% confidence and trust in my guide. Thankfully we have a communication system and he wears a high visibility vest.

IMG-20160109-WA0010

I am very much looking forward to the future; I have a lot coming up so please follow me on @Ash_Adventure or Instagram @Ash.Adventure

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Three Different Protocols for CXL

Via National Keratoconus Foundation

Corneal collagen cross-linking (CXL) has been shown to be an efficient treatment option to slow or halt the progression of keratoconus. As the US keratoconus community waits patiently (?) for FDA approval of basic corneal crosslinking, researchers in other countries are exploring advanced variations to improve this procedure.

In biological and chemical sciences, crosslinking refers to new chemical bonds formed between reactive molecules. The aim of CXL is to synthetically increase the formation of crosslinks between collagen fibrils in the corneal stroma. While the efficiency of the conventional corneal crosslinking (CXL or C-CXL) protocol has already been shown in clinical studies, it might benefit from improvements in duration of the procedure and removal of corneal epithelium.

In order to provide a coherent evaluation of two new and optimized CXL protocols, researchers in Paris, France studied keratoconus patients who had undergone one of the three CXL treatments:

iontophoresis (I-CXL),

accelerated CXL (A-CXL),

and conventional CXL (C-CXL).
Accelerated crosslinking (A-CXL) is a 6 time faster CXL procedure using a ten time higher UVA irradiance but still including an epithelium removal. Iontophoresis (A-CXL) is a 6 time faster CXL procedure using a ten time higher UVA irradiance but still including an epithelium removal. Iontophoresis (I-CXL) is a transepithelial, non-invasive technique in which a small electric current is applied to improve riboflavin penetration throughout the cornea. Using anterior segment optical coherence tomography (AS OCT) and in vivo confocal microscopy (IVCM), it was conclude that regarding the depth of treatment penetration, conventional CXL protocol remains the standard for treating progressive keratoconus. Accelerated CXL ( A-CXL) seems to be a quick, effective and safe alternative to treat thin corneas. The use of iontophoresis is still being investigated and should be considered with greater caution.
SOURCE: Three Different Protocols of Corneal Collagen Crosslinking in Keratoconus: Conventional, Accelerated and Iontophoresis by Bouheraoua N, Jouve L, Borderie V, Laroche L.Quinze-Vingts National Ophthalmology Hospital; INSERM UMR S 968, Institut de la Vision; Sorbonne Universités, UPMC Univ Paris 06; CNRS, UMR 7210Quinze-Vingts National Ophthalmology Hospital; INSERM UMR S 968, Institut de la Vision; Sorbonne Universités, Pierre and Marie Curie UniversityUniv Paris

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Looking ahead to 2016

How was 2015 for you?

We hope you had a good year and that having KC was not too troublesome. If you would like to share your keratoconus story or chat with other KC’ers in 2015 get in touch with us here, or or one of our social sites:

We believe in positive stories and support not scaremongering and raising awareness for well paid doctors and dubious “cures”.

You can discuss your story with folk who know what it’s like to have keratoconus

Facebook Page https://www.facebook.com/KeratoconusGB

Facebook Group https://www.facebook.com/groups/keratoconusGB/

Twitter – find us at https://twitter.com/KeratoconusGB Follow us @KeratoconusGB

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We now have over 10,000 members right across the world! Join us and get support and learn more about #keratoconus!

We published and shared over 120 keratoconus and eye related blog posts. Over 75,000 people have visited this blog.

Join the original #kcfamily and discover that you’re not alone

 

 

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Bowman’s layer transplantation shows promise for keratoconus

Bowman’s layer transplantation reduced or stabilized corneal ectasia in eyes with keratoconus that were not eligible for corneal collagen cross-linking or intracorneal ring segments, according to a study presented here.

“Historically, the treatment of keratoconus was limited to fitting contact lenses for as long as possible . . . and the patient was normally referred for a PK or [deep anterior lamellar keratoplasty],” Korine Van Dijk, said at World Cornea Congress. “What has been lacking so far is a way to arrest ectasia.”

Crosslinking effect

The technique involves making a scleral tunnel and a mid-stromal pocket. A stained donor Bowman’s layer is positioned onto a glide and inserted into the pocket, unrolled and stretched to the periphery of the cornea, Van Dijk said.

The study included 22 eyes of 19 patients with a mean age of 32 years. Mean preoperative corneal thickness was 332 m.

Mean follow-up was 21 months, and follow-up ranged up to 36 months.

Investigators evaluated complications, endothelial cell density, corneal tomography and best corrected visual acuity.

Intraoperative Descemet’s membrane perforation occurred in two eyes. However, no postoperative complications were reported.

Endothelial cell density and best corrected visual acuity did not change from before surgery to after surgery, Van Dijk said.

“This may indicate that potential candidates for Bowman’s layer transplantation should present with subjectively acceptable vision with their contact lenses,” Van Dijk said. “For these kinds of keratoconus cases, Bowman’s layer transplantation may effectively reduce and stabilize the ectasia, keeping these eyes in their contact lenses with a relatively low risk of complications, and so postpone a potential PK or DALK.”

Corneal flattening occurred after surgery and remained stable for up to 2 years, Van Dijk said. by Matt Hasson

Disclosure: Van Dijk reports no relevant financial disclosures.

Article first appeared here

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Cornea specialist outlines ideal candidate for cross-linking for keratoconus

As corneal collagen cross-linking (CXL) makes its slow way through the USA FDA approval process, a presenter at SECO shared pearls of wisdom for patient selection and explained the procedure’s mechanism of action.

Terry Kim, MD, chairman of the cornea department at Duke University School of Medicine, shared guidelines that he said are based on more than 20 clinical trials.

“Your ideal candidate for corneal collagen cross-linking will have a diagnosis of progression over 12 to 24 months,” he said. “He or she will have an increase of more than 1 D in terms of the steepest keratometry readings, an increase of at least 1 D in regular astigmatism and a myopic shift of at least 0.5 D.

“The patient will have the presence of central or inferior steepening, axial topography consistent with keratoconus/ectasia, the steepest manual K of at least 47 and pachymetry of at least 300 microns to 400 microns at the thinnest point,” he added.

Kim explained that with the corneal collagen cross-linking procedure, the central 7 mm to 9 mm of epithelium is removed. Riboflavin B2 in 20% Dextran is applied 5 minutes prior to the procedure and every 5 minutes during the procedure. UVA (365 nm to 370 nm) is applied for 30 minutes. Patients are treated with a bandage contact lens and topical antibiotics and steroids for 2 weeks.

Kim said that the procedure creates covalent bonds between collagen molecules.

“You’re cross-linking the cornea by this effect,” he said. “We naturally self cross-link our corneas as we get older. A 70-year-old patient is at much less risk of developing keratoconus than a 20-year-old because that cornea has already been cross-linked. It’s debated whether there’s a benefit to treating older patients.”

Kim said a debate also exists regarding removing the epithelium.

“We know that riboflavin B2 penetrates better if you take it off,” he said. “The problem is that some patients have had delayed healing because of epithelial infections or scarring.

“You can apply the riboflavin by doing stromal punctures to help it penetrate,” he continued. ”The issue is: Will you get a sustained and high enough level to have the effect of cross-linking? The other issue is changing the energy. Some use a high fluency treatment.”

Kim explained an alternative treatment.

“Some are treating patients with oral vitamin B2 and asking them to sunbathe to get the same effect,” he said. “A small German study showed some stabilization of keratoconus just doing this. We had a young basketball player a few years ago with keratoconus and we recommended this to him.”

Kim said it is important to convey to patients that keratoconus is a progressive disease.

“We know that eye rubbing has a lot to do with it,” he said. “My Down’s syndrome patients are always rubbing their eyes and they typically have advanced keratoconus. We need to try to stabilize the disease process in this condition that progresses.” – by Nancy Hemphill, ELS, FAAO

Disclosure: Kim has no relevant financial disclosures.

Article first appeared here http://www.healio.com/optometry/cornea-external-disease/news/online/%7Bc481f959-c8b2-4cb7-88b5-4067fd9cefab%7D/cornea-specialist-outlines-ideal-candidate-for-cross-linking

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