Keratoconus & Crosslinking

Our very own, Dr. Tyrone McCall explains keratoconus and how to stop the condition from progressing with crosslinking.

"Keratoconus is an inherited warpage disorder of the cornea.  It tends to show up in the early to late teenage years with the onset of progressive nearsightedness and astigmatism.  This is due to the progressive protrusion of the cornea.  The principal mechanism for this is an underlying weakness of the collagen fibers of the cornea.  This leads to progressive worsening of vision. 

Historically, the only treatment was glasses or contact lenses and once these failed, the patient needed cornea transplantation.  We still perform cornea transplants today but try to reserve this for the most advanced keratoconus where there is no other alternative. 

Cornea collagen crosslinking is a revolutionary treatment for keratoconus.  This superlative tends to be overused, but it is not in this situation.  The example I use with patients is hearing loss.  Imagine doctors had the ability to stop progressive hearing loss with an in-office procedure.  It would be unethical to withhold this treatment while continuing to change hearing aids in the face of furthering hearing loss.  (This treatment for hearing loss doesn’t exist unfortunately!)

The same situation applies to keratoconus.  We should do whatever we can to stop the progression of keratoconus, and crosslinking is the way to do this. 

I separate keratoconus into two basic components, the everyday and the long term.  The everyday component is that no matter what we do to stop the progression of keratoconus, patients will still need some correction for their vision, be it glasses or contact lens.  We cannot “roll back” the cornea to a previous state; however, approximately 60% of patients do have some improvement in vision. 

The long-term component is stopping progression of the disease.

Unfortunately, keratoconus nearly always progresses over time (only slowing later in life, typically in a patient’s 50’s or 60’s).  Given this, we recommend crosslinking as soon as possible and not to wait for further progression.  A “wait and see” approach can lead to further vision loss that cannot be recovered, even if crosslinking is performed at a later time. 

The final discussion I have with every keratoconus patient is for them to avoid rubbing their eyes.  Eye rubbing doesn’t cause keratoconus but it makes it worse and it can undo all the benefits of cornea crosslinking. 

Cornea crosslinking is the first line therapy for all keratoconus patients, and we encourage anyone who has keratoconus to contact us for further information for this revolutionary treatment."

Crosslinking is a fairly simple office procedure where drops of riboflavin (vitamin B-12) are placed onto the cornea along with anesthetic drops as the patient lays flat on a reclining chair under a soft blue UV light source. This induces covalent bonds (“crosslinks”) between collagen fibers, therefore increasing the strength and stability of the cornea.  The entire in-office procedure takes about one to two hours, but the healing process often requires several days. Cornea Associates is committed to offering the most advanced corneal and refractive care available. Providing patients with access to corneal crosslinking enables our physicians to slow, and even stop your keratoconus from progressively getting worse. Crosslinking also helps to decrease the steepening of the cornea. We have had a tremendous success rate stopping keratoconus in it's tracks! Give us a call today if you are interested in learning more about keratoconus and how we can stop the progression of keratoconus with crosslinking.