CrossLinking in Young Patients

Of all who welcomed the FDA ruling on corneal crosslinking, no group may be more comforted by the procedure’s approval than parents of children with keratoconus (KC).

KC is frequently diagnosed during puberty. Published studies conclude that when diagnosed in children, KC is often more advanced than in adults. Progression is more aggressive and frequent in patients less than 18 years of age. Individuals diagnosed at an early age have a higher risk of eventually requiring a cornea transplant.1

International researchers have published several small studies analyzing results of crosslinking (CXL) in the pediatric population. The latest study will soon be published in the journal, Cornea. Doctors at the University of British Columbia analyzed results for 28 patients, between 11 and 18 years of age, who underwent the CXL treatment (39 eyes were treated)2.

One year after treatment, the authors found that disease progression halted for the majority of patients. Corneal thickness, and best corrected and uncorrected visual acuity did not significantly change at the end of one year.

Other studies have shown similar results. In a study of 14 pediatric patients (25 eyes) treated in Ireland, the authors reported that there was no significant difference between the preoperative and one year follow-up uncorrected visual acuity. At the 3 and 6 month follow-up visits, the corneal thickness had decreased on average, but had recovered in all patients at one year after CXL. Corrected visual acuity at one year showed improvement.3

CXL in the pediatric population has been showed to be safe, and without significant complications. For most patients, disease progression slows or stops with the CXL procedure. Eye surgeons, like parents and patients, are looking forward to analyzing U.S. cross-linking data to determine if disease stabilization is long-lasting in patients under the age of 18.

Some eye doctors choose to follow their pediatric KC patients at least six months to document disease progression, while many other eye surgeons are referring their pediatric patients for CXL treatment as soon as the diagnosis of keratoconus is confirmed.

For Matthew Wade, MD, a cornea specialist at UC-Irvine’s Gavin Herbert Eye Institute, the decision is an individual one. “I consider how advanced the keratoconus is when I examine the patient. In some cases, I might send the patient for an immediate referral because of the severity of the disease. In other cases, I am comfortable waiting and following the patient for a period of time.”

If your child has been diagnosed with KC, expect to have a conversation with your eye doctor about the risks and benefits of CXL. Ask your doctor if he or she recommends treatment right away or favors a ‘wait and see’ approach.

1. Leoni-Mesplie, S, et al, Scalability and Severity of Keratoconus in Children. Am J Ophthalmol 154:56-62, 2012.
2. Wise S, et al, Corneal Cross-Linking in Pediatric Patients with Progressive Keratoconus, Cornea, 2016: 0:1-3.
3. McAnena L, et al, Corneal collagen crosslinking in children with keratoconus, J AAPOS, 19:228-232, 2015.