Keratoconus Treatment
what is keratoconus?
Keratoconus is a progressive eye disease where the cornea, the clear front part of the eye, gradually thins and bulges outward into a cone shape. This change in shape can lead to blurry and distorted vision and have a major impact on how an individual sees the world, making simple tasks such as driving a car or reading a book very difficult. While the exact cause is unknown, it's thought to be a combination of genetic and environmental factors, with a family history being a potential risk factor. ​
Keratoconus typically first appears in individuals who are in their late teens or early twenties, and may progress for 10-20 years, and then slow or stabilize.
Each eye may be affected differently. In the early stages of keratoconus, people might experience:
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Slight blurring of vision
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Distortion of vision
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Increased sensitivity to light ​
Treatment Options​
​Keratoconus treatment aims to stabilize the condition and improve vision. Treatment options range from corrective lenses to corneal transplants, with the most appropriate option depending on the severity and progression of the condition.
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corneal cross-linking​
Corneal cross-linking (CXL) is a surgical procedure used to strengthen the cornea, the clear front part of the eye, by creating new bonds between collagen molecules. It's primarily used to treat keratoconus and corneal ectasia after LASIK surgery. CXL can help halt the progression of these conditions and prevent further thinning or warping of the cornea.
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corneal cross-linking Frequently Asked Questions
What is keratoconus?
Keratoconus, often referred to as “KC”, is a non-inflammatory eye condition in which the typically round dome-shaped cornea progressively thins and weakens, causing the development of a cone-like bulge and optical irregularity of the cornea. This causes “static” in your vision and can result in significant vision impairment.
What is cross-linking?
Cross-linking is a minimally invasive, FDA approved, outpatient procedure that combines the use of riboflavin eye drops, Photrexa® Viscous, (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution), and ultra-violet A (UVA) light from the KXL® system for the treatment of progressive keratoconus.
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What is riboflavin?
Riboflavin (vitamin B2) is naturally occurring in the body, including the eye. It is a photosensitizer. Riboflavin is non-toxic and is used as an additive in food and pharmaceuticals.
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What is ultra-violet A (UVA) light?
UVA is one of the three types of invisible light rays given off by the sun (together with ultra- violet B and ultra-violet C) and is the weakest of the three.
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Does corneal cross-linking require removal of the epithelium?
Yes, your doctor will apply topical anesthesia to numb the eye prior to the removal of the eipthelium. This process helps to prepare your eye so that the drug can penetrate the tissue of the cornea to have an effective cross-linking procedure.
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Am I awake during the procedure?
Yes, typically you will be awake during the treatment. You’ll be given relaxing medication and numbing anesthetic drops.
How long does the treatment take?
The actual procedure takes about an hour, but you will be at the office for approximately two hours to allow sufficient time for preparation and recovery before you return to the comfort of your own home.
What can I expect during the procedure?
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After numbing drops are applied, the epithelium (the thin layer on the surface of the cornea) is gently removed.
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Photrexa Viscous eye drops will be applied to the cornea for at least 30 min;
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Depending on the thickness of your cornea, Photrexa drops may also be required.
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The cornea is then exposed to UV light for 30 minutes while additional Photrexa Viscous drops are applied.
What can I expect after the procedure?
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You should not rub your eyes for the first five days after the procedure.
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You may notice a sensitivity to light and have a foreign body sensation. You may also experience discomfort in the treated eye and sunglasses may help with light sensitivity.
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If you experience severe pain in the eye or any sudden decrease in vision, you should contact your physician immediately.
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If your bandage contact lens from the day of treatment falls out or becomes dislodged, you should not replace it and contact your physician immediately.
Does it hurt?
There is some discomfort during immediate recovery but usually not during the treatment. Immediately following treatment, a bandage contact lens is placed on the surface of the eye to protect the newly treated area. After the numbing drops wear off, there is some discomfort, often described as a gritty, burning sensation managed with Tylenol and artificial tears. If pain is severe, oral narcotic medications may be used.
Can anyone tell by my appearance that I have had cross-linking?
No. There is no change in the appearance of your eyes following cross-linking.
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Is cross-linking right for me?
Patients over the age of 14 who have been diagnosed with progressive keratoconus should ask their doctor whether they may be an appropriate candidate for corneal cross-linking.
Will I need to be out of my contact lenses for this process?
Yes. Typically, doctors ask their patients to stop wearing contact lenses prior to surgery for up to a period of several weeks. Once treated, patients may not be allowed back into contact lenses for 1 month.
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How much does corneal cross-linking cost?
Please contact our practice for specific pricing information.
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corneal tissue addition keratoplasty (ctak)
Corneal Tissue Addition Keratoplasty (CTAK) is a surgical procedure that addresses corneal irregularities, particularly in cases of keratoconus, by adding a custom-shaped inlay of preserved corneal tissue to the cornea. This inlay is created using a femtosecond laser and placed into a channel also created by the laser. CTAK aims to improve corneal topography, enhance visual acuity, and reduce distortion.
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Benefits of CTAK
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Inlay: CTAK utilizes a specially designed inlay to be placed within the cornea.
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Corneal Flattening: The inlay helps to flatten the bulging cornea, which is a characteristic of keratoconus.
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Improved Visual Acuity: By flattening the cornea, CTAK can enhance visual clarity and improve overall vision.
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Increased Corneal Thickness: The procedure can also help to add thickness to the cornea, further stabilizing it and preventing further progression of keratoconus.
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Less Invasive: CTAK is generally considered less invasive than traditional keratoplasty (corneal transplant).
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The CTAK(Corneal Tissue Addition Keratoplasty) Procedure
The Corneal Tissue Addition Keratoplasty (CTAK) procedure involves inserting a custom-shaped, sterilized corneal tissue inlay into a channel created in the cornea using a femtosecond laser. This procedure is designed to reshape the cornea, improve vision, and potentially reduce distortion caused by conditions like keratoconus.
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Corneal Mapping and Tissue Preparation​
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The procedure starts with detailed mapping of the patient's cornea to determine the exact shape and size of the needed tissue inlay.
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A femtosecond laser is used to precisely cut the donor corneal tissue into the customized shape.
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The tissue is sterilized and prepared for implantation.
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Channel Creation:
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The femtosecond laser is used to create a channel within the patient's cornea.
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This channel is designed to accommodate the custom-shaped inlay.
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Inlay Insertion:
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The surgeon uses surgical tools to carefully insert the inlay into the prepared channel.
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The inlay is positioned to flatten the cornea and improve its shape.
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Post-Procedure Care:
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Patients are given eye drops to prevent inflammation and infection.
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A bandage contact lens may be used to protect the eye during healing.
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Follow-up appointments are scheduled to monitor healing and vision.
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Potential Risks
CTAK (Corneal Tissue Addition Keratoplasty) carries potential risks like infection, inflammation, scarring, and unexpected corneal shape. While these risks are minimized with post-operative care (like antibiotics and corticosteroids), they can still occur. Another risk is the possibility of dislocating the added tissue, which can be addressed by removing and reshaping the tissue​​.
Intacs Corneal Implants
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Intacs® Corneal Implants are intended for the reduction or elimination of myopia and astigmatism in patients with keratoconus who are no longer able to achieve adequate vision with their contact lenses or spectacles, so that their functional vision may be restored and the need for a cornea transplant procedure may potentially be deferred.
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The specific subset of keratoconic patients proposed to be treated with intacs corneal Implants are those patients:
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Who have experienced a progressive deterioration in their vision, such that they can no longer achieve adequate functional vision on a daily basis with their contact lenses or spectacles
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Who are 21 years of age or older
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Who have clear central corneas
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Who have a corneal thickness of 450 microns or greater at the proposed incision site and
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Who have corneal transplantation as the only remaining option to improve their functional vision.
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What are the benefits of Intacs® Corneal Implants?
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For the treatment of keratoconus
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FDA approved for the treatment of myopia
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Defer corneal transplants
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Stabilizes & reshapes cornea to more natural state
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Normalized cornea shape allows easier contact lens fittings
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Restores contact lens tolerance
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A reversible procedure with a short recovery period
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Reduces chair time for contact lens fittings
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Frequently Asked Questions
​Will insurance cover this procedure?
While many insurers may reimburse for treating keratoconus, it may still be necessary to work with your physician to supply your insurance company with further information. SightLife Surgical is dedicated to providing continual education to insurers on the Intacs® procedure.
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Are Intacs® right for me?
Consult with your eye care doctor to determine this. Patients who have had the most benefit from Intacs® have been diagnosed with keratoconus, are 21 years old or over, have minimal thinning (no less than 450 microns thick), do not have corneal scarring, and are interested in an alternative to corneal transplant to improve functional vision.
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Will Intacs® cure my keratoconus?
No. There is no current cure for keratoconus. Intacs® can reshape and stabilize irregular corneas to improve functional vision and make contact lens wearing tolerable. It may delay the need for a corneal transplant.
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How long is the Intacs® procedure?
The procedure usually takes about 20 minutes. They are removable and placement can be adjusted if needed.
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How long before I can resume my normal daily activities?
Generally non-contact physical activities within one month are safe. It is recommended that each patient consult with his/her eye care doctor regarding post-op care specific to the patient’s customized procedure.
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Are Intacs® approved by the FDA?
Intacs® was granted approval under the FDA Humanitarian Use Device Exemption (HDE) in 2004.
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Device Description
Intacs® Corneal Implants are an ophthalmic medical device designed for the reduction or elimination of myopia and astigmatism in patients with keratoconus (KC) so that their functional vision may be restored and the need for a corneal transplant procedure can potentially be deferred. When placed in the corneal stroma, outside of the patient’s central optical zone, the product reduces the cone by flattening the cornea and for non-central keratoconus, repositions the cone centrally. Intacs segments are designed to be placed in the periphery of the cornea, at approximately two thirds depth, and are surgically inserted through a small radial incision in the corneal stroma. The placement of the incision will be typically temporal, however may vary depending on the astigmatic axis and the amount of keratoconus present in the specific eye to be treated. The Intacs segments are to be placed equidistant on each side of the incision. The Intacs product has been designed to allow removal or replacement, if desired.​
