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February 14, 2019
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The Case for Early Cross-linking

Corneal cross-linking (CXL) is only treatment that is FDA-approved to stop the progression of KC. During the procedure, the KC-affected eye is saturated with riboflavin (vitamin B2) and exposed to UV light to strengthen the cornea through the creation of new collagen bonds. Typically, a person must demonstrate progression of KC in order to qualify for this procedure. However, some doctors have started to consider the possibility that it may be best to not delay CXL treatment.

Because CXL stops the progression of KC, many doctors now believe that it is best to treat patients recently diagnosed with KC with CXL so that no further vision will be lost. According to Dr. Kenneth A. Beckman, Director of Corneal Surgery at Comprehensive Eyecare of Central Ohio, “delaying treatment, as many ophthalmologists and optometrists suggested patients do in the past, is no longer the best course of action. It is important to halt progression of the disease as soon as possible, before it begins to affect a patient’s vision.” Proponents of early CXL argue that there is no reason to wait for progression of KC to treat a patient, especially considering the fact that CXL can stabilize the cornea and allow a patient to maintain good visual acuity. Additionally, early CXL can lead to positive corneal remodeling that may help a patient avoid or delay a corneal transplant. If a corneal transplant is in fact needed in the future, the early CXL may highly increase the chance of success of the surgery.

Many other doctors still maintain the point of view that progression of KC should be documented before a patient is treated with CXL. Dr. Peter Hersh, the founder of The Cornea & Laser Eye Institute states that “the FDA-approved [CXL] indication is for progressive keratoconus. The best candidate for cross-linking is a patient with documented progression of disease.” Also, there are other factors besides progression that must still be considering when deciding if a patient can undergo CXL, such as cornea thickness. Furthermore, the FDA has only given approval for CXL for progressive KC. If a patient does not have documentation of progression, they likely will not be able to obtain insurance coverage for CXL and will have to pay out of pocket. However, many patients experience rapid progression of KC, so if they wait a few months to undergo CXL, they can obtain proof of progression and insurance coverage.

If you are a KC patient who is considering CXL, talk to doctor to your doctor about your treatment options. Your doctor will be able to assess your medical history to determine if CXL is right for you.

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