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.
corneal cross-linking Frequently Asked Questions
What is 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.
What is Epioxa cross-linking?
Epioxa (riboflavin 5’-phosphate ophthalmic solution) is the only FDA-approved, minimally-invasive, epithelium-on, oxygen-enriched, corneal cross-linking treatment for keratoconus (KC).
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.
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.
Does corneal cross-linking require removal of the epithelium?
No, Epioxa treatment does not require the removal of the epithelium, which is the outer layer of the cornea. Epithelium-on Epioxa treatment is designed to improve comfort and recovery time.
Am I awake during the procedure?
Yes, typically you will be awake during the treatment. You may be given relaxing medication and numbing anesthetic drops.
How long does the treatment take?
The procedure is straightforward. You will be at the office for approximately one to two hour 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?
Epioxa treatment has 3 steps:
1. Applying the eyedrops
The doctor will apply the eyedrops for a few minutes
2. Fitting the Boost Goggles® and ensuring oxygen is flowing
Next, the doctor puts the goggles on and turns on the oxygen to
allow it to flow into the goggles
3. Corneal cross-linking with UV light
The special light source delivers UV light that works in
combination with the eye drops and oxygen to strengthen the cornea
What can I expect after the procedure?
Contact your doctor immediately if you experience severe pain in the treated eye or any sudden decrease in vision. You may feel some discomfort in the treated eye. Wearing sunglasses may help if you are sensitive to light after treatment. Go home and rest. Do not rub your eyes. Take any medications prescribed by your doctor.
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.
Is cross-linking right for me?
Patients over the age of 13 who have been diagnosed with 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.
How much does corneal cross-linking cost?
Please contact our practice for specific pricing information.
CTAK (Corneal Tissue Addition Keratoplasty)
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.
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).
CTAK 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.