Keratoconus Treatment Options: The Role of Corneal Cross-Linking in Eye Care
Keratoconus is a progressive eye condition that affects the cornea, the clear, dome-shaped surface that covers the front of the eye. In people with keratoconus, the cornea thins and gradually bulges into a cone-like shape, leading to distorted and blurred vision. Keratoconus typically begins in the teenage years or early adulthood and can progress over time, potentially causing significant visual impairment.
According to the Canadian Keratoconus Foundation, keratoconus affects approximately 1 in 2,000 people, making it relatively rare but not uncommon.
The irregular shape of the cornea in keratoconus disrupts the way light enters the eye, causing symptoms such as blurred vision, sensitivity to light, and difficulty seeing at night. In its early stages, glasses or soft contact lenses may help correct vision. However, as the condition progresses, more specialized treatments are often required to manage the disease and preserve vision.
How Do You Get Keratoconus
Image Via: American Optometric Association
While the exact cause of keratoconus is not fully understood, several factors may increase the likelihood of developing this condition:
Genetics: A family history of keratoconus is a significant risk factor. If a close relative has the condition, you may be more likely to develop it.
Chronic Eye Rubbing: Frequent or vigorous eye rubbing can weaken the cornea and contribute to the development or progression of keratoconus.
Certain Medical Conditions: Conditions such as asthma, allergies, and Down syndrome have been associated with a higher risk of keratoconus.
Hormonal Changes: Some studies suggest that hormonal fluctuations, particularly during puberty, may play a role in the onset of keratoconus.
Key Take Away: You should avoid rubbing your eyes and get routine eye exams if you have a family history of this condition.
What Is Corneal Cross-Linking?
Corneal cross-linking (CXL) is a minimally invasive procedure designed to strengthen the cornea and slow or halt the progression of keratoconus.
Similar to how PRK (photorefractive keratectomy) reshapes the cornea to correct refractive errors like nearsightedness or astigmatism, CXL works to improve corneal stability—but with a different goal.
While PRK uses a laser to remove tissue and reshape the cornea, CXL uses riboflavin (vitamin B2) eye drops and ultraviolet (UV) light to create new bonds between collagen fibres within the cornea. This process, known as photo-oxidation, increases the cornea’s strength and rigidity, preventing further thinning and bulging caused by keratoconus.
Like PRK, CXL is performed under local anesthesia and typically takes about an hour. Most patients experience mild to moderate discomfort during recovery, such as light sensitivity or a gritty feeling in the eye, but these symptoms are temporary. The long-term benefits of stabilizing the cornea and preserving vision often far outweigh the short-term discomfort.
According to the Canadian Ophthalmological Society (COS), cross-linking has been shown to be highly effective in slowing or stopping the progression of keratoconus in most cases. Published studies show an almost 95% success rate after 2-year follow-ups.
For more detailed information on corneal cross-linking, you can visit the Canadian Ophthalmological Society’s resource page.
How Cross-Linking Helps
Cross-linking is not a cure for keratoconus, but it is a powerful tool to prevent the condition from worsening. By stabilizing the cornea, the procedure can help patients avoid the need for more invasive treatments, such as corneal transplants, in the future.
It is particularly beneficial for individuals whose keratoconus is progressing rapidly, as early intervention can preserve vision and improve quality of life.
The History of Corneal Cross-Linking
Corneal cross-linking was first developed in Germany in the late 1990s by researchers at the Technische Universität Dresden. The procedure was pioneered by Dr. Theo Seiler, a leading ophthalmologist, and his team.
They discovered that applying riboflavin (vitamin B2) eye drops to the cornea and then exposing it to ultraviolet (UV) light could strengthen the corneal collagen fibres. This process, known as photo-oxidation, created new bonds within the cornea, increasing its rigidity and stability.
The first clinical studies demonstrating the effectiveness of CXL in halting the progression of keratoconus were published in the early 2000s. By 2003, the procedure had gained significant attention in Europe, particularly in Germany and Italy, where it was widely adopted as a treatment for progressive keratoconus.
When Did Corneal Cross-Linking Come to Canada?
Corneal cross-linking was introduced to Canada in the mid-2000s, following its success in Europe. Canadian ophthalmologists and researchers began studying the procedure and its outcomes, leading to its gradual adoption in specialized eye care centers across the country.
In 2008, Health Canada granted approval for the use of riboflavin and UV light systems specifically for corneal cross-linking. This marked a significant milestone, allowing Canadian eye care professionals to offer CXL as a treatment option for patients with progressive keratoconus.
When Did Corneal Cross-Linking Become Approved as a Standard of Care?
Corneal cross-linking gained recognition as the standard of care for progressive keratoconus in Canada over the following decade. By the early 2010s, clinical trials and long-term studies had consistently demonstrated the safety and efficacy of CXL in stabilizing the cornea and preventing further vision loss.
The Canadian Ophthalmological Society (COS) and other professional organizations began endorsing CXL as a first-line treatment for progressive keratoconus. By 2015, it was widely accepted as the standard of care across Canada, supported by robust evidence and clinical guidelines.
Alternative Treatments for Keratoconus
While cross-linking is now considered to be a cornerstone of keratoconus management, other treatments may be recommended depending on the severity of the condition and the patient’s needs. These include:
Specialty Contact Lenses: Rigid gas permeable (RGP) lenses, scleral lenses, or hybrid lenses can help correct vision by providing a smooth refractive surface over the irregular cornea. This may be required both before and after cross-linking.
Intacs: These are small, crescent-shaped inserts placed in the cornea to flatten its shape and improve vision.
Corneal Transplant: In advanced cases where vision cannot be corrected with other methods, a corneal transplant may be necessary to replace the damaged cornea with healthy donor tissue. Patients with corneal transplants often require a specialty contact lens to achieve 20/20 vision.
For more information on keratoconus and its treatment options, the Canadian Keratoconus Foundation offers valuable resources and insights.
Conclusion
Keratoconus is a challenging condition, but advancements in treatment, such as corneal cross-linking, have revolutionized the way it is managed.
If you or a loved one has been diagnosed with keratoconus, it’s essential to seek care from a trusted eye care professional. At Helio Optometry, we are committed to providing cutting-edge treatments and compassionate care to help you maintain your vision and quality of life.
For more information or to schedule a consultation, visit our website or contact us today. Your vision is our priority.
If you have keratoconus, or you’ve had a cross-linking procedure performed. Leave a comment below, we would love to hear how it went.
Disclaimer: The content provided in this blog post by Helio Optometry eye care clinic in West Edmonton is intended solely for informational purposes and does not replace professional medical advice, diagnosis, or treatment by a Licensed Optometrist. No doctor/patient relationship is established through the use of this blog. The information and resources presented are not meant to endorse or recommend any particular medical treatment or guarantee and outcome. Readers must consult with their own healthcare provider regarding their health concerns. Helio Optometry and its optometrists do not assume any liability for the information contained herein nor for any errors or omissions. Use of the blog's content is at the user's own risk, and users are encouraged to make informed decisions about their health care based on consultations with qualified professionals.
