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YOUR VISIOn IS OUR MISSIOn—PRESERVE, PROTECT, RESTORE

CORNEAL CROSS-LINKING (CXL) FREQUENTLY ASKED QUESTIONS USC ROSKI INSTITUTE SERVICE The Corneal and External Diseases Normal Cornea contact . Patients with advanced disease can have Service provides treatment and man- agement of the full spectrum of corneal CXL, but vision may be less than ideal with glasses or soft and external eye diseases. contact lenses necessitating the use of rigid contact lenses. Available Treatments for: Why does the ultraviolet light treatment time vary • Bullous Keratopathy from clinic to clinic? • • / The original treatment protocol in Europe was the use • (Pink Eye) of ultraviolet light for 30 minutes at an energy level of • Corneal 3mw/cm2. This is the only treatment protocol that is • Corneal Dystrophies currently FDA-approved in the US, but some practitioners • Corneal Infection () use different treatment protocols. • Corneal Scarring • • Dry Eye Fuchs Is Corneal Cross-linking (CXL) a new treatment? Can vision be improved with CXL? • Endothelial Dystrophy • Herpes CXL was recently approved in the United States in 2016 Although the main goal of CXL is to stabilize the cornea, based on randomized clinical trials performed in the US 60 percent of patients have a mild improvement in their in 2008. However, CXL was introduced in Europe more vision. This is a result of the corneal surface becoming SERVICE FACULTY than 15 years ago where the procedure was pioneered. more regular after CXL. There are many long-term studies that demonstrate the efficacy and safety of the procedure. Can the corneal epithelium be left intact or does J. Bradley Randleman, MD it have to be removed? Professor of What is the main goal of CXL? Clinical studies have shown that best results are obtained Director, Cornea, External The purpose of the treatment is to prevent progressive when the epithelium is removed prior to treatment. Early Disease and bulging and thinning of the cornea that can interfere research on leaving the epithelium intact has been positive, with vision. With a stronger and more stable cornea but long-term results are still needed. the risk of requiring a corneal transplant is reduced. What is required after the treatment? What is the success rate of CXL After CXL a soft bandage contact is worn for 5 to 7 Charles W. Flowers, Jr., MD The success rate at preventing progressive bulging days. This promotes healing of the corneal epithelium. Associate Professor of Clinical Ophthalmology and thinning is 98 percent. Many patients have seen An drop and a drop are used for 1 to 2 some modest regression of their corneal bulging, which weeks after surgery. Artificial can be used as can improve proper contact lens fitting and provide needed for comfort. better vision with glasses than before treatment. Is vision better immediately after the procedure? Can CXL be repeated? Usually vision is slightly blurrier during the first month J. Martin Heur, MD, PhD In rare cases (less than 2 percent) where CXL is not and then gradually improves. The is Associate Professor of successful in stabilizing a cornea, a repeat treatment related to the healing of the corneal epithelium. Clinical Ophthalmology KERATOCONUS can be performed. Since very few patients have ever required repeat CXL, less is known about the efficacy How do I know if the treatment is successful? of a repeat treatment, but it has been shown to be Repeat corneal mapping is performed to determine corneal equally safe as initial treatment. stability or flattening. The mapping is typically performed at AND CORNEAL/ 3 to 6 months after treatment and then at regular intervals. Jonathan C. Song, MD Are certain patients not good candidates? Associate Professor of Patients must have sufficient corneal thickness for the What are the potential complications? Clinical Ophthalmology CROSSLINKING -CXL. procedure to be performed. Your doctor will perform The rate and risk of infection is extremely measurements to confirm adequate thicknesss. CXL is low with CXL. Occasionally the healing of the corneal not a good treatment when have significant epithelium is slow, which can delay the return of best vision. central scarring that interferes with vision. TREATMENT When can I start wearing contact lenses? Bibiana J. Reiser, MD Is there an ideal age for CXL treatment? Your physician will determine when you can begin wearing Assistant Professor of Usually, the younger the patient, the greater the chance of contact lenses. Average wait time is usually two weeks Clinical Ophthalmology preserving vision with CXL, but patients at any age may bene- after the procedure. If you have never worn contact lenses fit from CXL, especially if they have worsening keratoconus or need a new fitting, consult with your ophthalmologist or if they have diminished vision correction with glasses or about how long to wait before having lenses fitted.

To schedule an appointment or for more information about this revolutionary treatment, please call 323.442.6335 or visit us online at USCeye.org USCREI_Karatoconus.qxp_Layout 1 2/1/17 12:01 PM Page 2

WHAT IS KERATOCOnUS Keratoconus is a common corneal condition disorders such as Down Syndrome that occurring in more than 1 in 1000 people. The can affect approximately 50 percent of family condition typically starts in adolescence and members. It can also be a random event. It early adulthood with an uncertain cause. affects men and women in equal proportions Progression is unpredictable, but in extreme and is bilateral in 90% of patients. cases, vision deterioration can require corneal transplant surgery. The cornea is the clear SIGNS & SYMPTOMS surface on the front of the eye. It is usually Early signs of keratoconus are usually blurred a regular spherical dome and is responsible vision and frequent changes in eyeglass for focusing images. The cornea consists of prescription, or vision that cannot be corrected layers that are linked to each other by collagen. with glasses. Other symptoms include increased If the collagen cross links are lost due to light sensitivity, and irritation with keratoconus, there is a progressive corneal excessive eye rubbing. Keratoconus symptoms thinning and stretching. Keratoconus causes usually appear during the late teens and the cornea to bulge forward, producing an early twenties. irregular cone shape that distorts how images are focused. Due to the irregular corneal DIAGNOSIS shape it can be difficult to correct vision Early keratoconus can often be overlooked with glasses or soft contact lenses. with a standard eye evaluation, since it’s mild form rarely shows identifiable signs upon RISK FACTORS examination. Advanced corneal topography is Although the cause of keratoconus is unknown, needed to confirm the presence of the disease. it is believed that the risk factors include: It is important to be thoroughly assessed by CORnEAL CROSS-LInKIng TREATMEnT eye rubbing, a family history of keratoconus, a physician experienced in keratoconus genetic predisposition, certain systemic treatments to receive the best care options. What is corneal cross-linking? (cornea) is treated with riboflavin eye drops for 30 What are the risks involved? As is the case with any treatment, there may Corneal cross-linking (CXL) has shown great minutes. The eye is then exposed to UV-A light for Very few potential risks associated with this also be long-term risks that have not yet been success for treating keratoconus. The combination 30 minutes. After the treatment, antibiotic eye treatment have been reported to date. The identified. The increased corneal rigidity induced of riboflavin eye drops and illumination with drops and a bandage contact lens are applied. ultraviolet light dose used is low to prevent may wear off over time and further periodic UV-A light augments the collagen cross-links The bandage lens is removed by the doctor within damage to the important inner layer of the cornea treatments may be required. within the stroma and recovers some of the the week during follow-up visits. or the other structures within the eye. no lens cornea’s mechanical strength. CXL, developed opacities (cataracts) have been attributed to this Schedule a visit with one of our cornea specialists, in Dresden, germany, has been shown to slow Who can benefit from this treatment? treatment in European trials. The treatment involves who will perform a full eye exam along with special or arrest the progression of keratoconus, Collagen cross-linking treatment is not a cure for the outer layer (epithelium) of the cornea, so light corneal testing to determine your eligibility for and in some cases, reverse it. keratoconus, rather, it aims to slow or halt the sensitivity, mild discomfort and blurred vision treatment and help you understand the options progression of the condition. This is important to is common during the first week of recovery. that are best for your vision care. How is the treatment done? understand. The goal of the treatment is to The treatment is performed one eye at a time. prevent further deterioration in vision and reduce Other lesser but more common risks include: The patient lies flat on a surgical bed for the risk of requiring a corneal transplant. Following 1. Inability to wear contact lenses for several To schedule an appointment or for more approximately 60 minutes. The treatment is cross-linking, patients will still need to wear weeks after the treatment. information about this revolutionary performed under topical (using eyeglasses or contact lenses for their best vision. 2. Changes in corneal shape may require a new treatment, please call 323.442.6335 or anesthetic eye drops). The surface of the eye Frequently, a change in prescription is necessary. contact lenses or change in eyeglass prescription. visit us up online at www.USCeye.org

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