Keratoconus Treatment: Corneal Cross Linking & Recovery

Cross-linking is the only procedure known to arrest the progression of keratoconus. Several large randomised control trials have shown it to be safe and effective. Over 90% of people have good outcomes with arrested progression of keratoconus at one year after the procedure. In about 10% of people, they may need a redo procedure to arrest the progression of keratoconus. And that is why it’s important to be monitored for keratoconus. Five year data show that these patients do very well with reduced progression of keratoconus long term. If you were not to have the procedure, it is quite likely that your keratoconus will progress and affect your vision long term.

Cross-linking is a procedure that’s used to slow down or arrest the progression of keratoconus. The procedure takes about 20 to 30 minutes to do. Essentially during the procedure, you have lots of anaesthetic drops to numb your eye. This is followed by removal of the surface layer of the cornea called epithelium. This is usually done with laser. We would then use drops to soak the cornea. These drops are special vitamin B drops. This will be done for about 10 minutes. This is then followed by UV light shown on the eye for another 10 minutes. The UV light activates the vitamin B molecules. This chemical reaction causes the cornea to strengthen and thus reduces the progression of keratoconus long term.

So keratoconus is a progressive condition of the cornea, which is the front glare of the eye, which allows light to go in the eye. In keratoconus, the cornea itself is weakened and starts bulging forwards causing distorted vision and misty vision. Some people also notice ghosting and a glare when looking at bright lights. It’s very important to detect keratoconus early and treat it, otherwise it can potentially lead to severe vision loss.

Keratoconus, at its early stages, is managed with glasses and contact lenses to give you good vision, and the advice is to stop rubbing your eyes. However, despite this, in some people, keratoconus continues to progress. If you have progressive keratoconus or moderate keratoconus, it’s advisable to have a treatment called crosslinking to prevent your keratoconus from getting worse. This can be coupled with laser treatment to improve your vision and give you better quality of vision. In some patients with moderate to advanced keratoconus, they may need a ring segment inserted in their eye to give them good vision, which is then coupled with the crosslinking and laser to enhance the vision outcome. In very advanced stages of the keratoconus, you will need a corneal transplant to give you good vision.

Keratoconus is usually diagnosed during an assessment for laser vision correction procedures, such as LASIK and TransPRK. If you have keratoconus, you should never have LASIK as it will make your keratoconus worse. If you have high or rapidly changing astigmatism, you must be screened for keratoconus. The only way to be a hundred percent sure you do not have keratoconus is to have scans of your cornea. At Oculase, we use AI powered technology to diagnose keratoconus.

Generally, cross-linking is a very safe procedure with excellent outcomes, long term. It is very important to follow your surgeon’s post-operative instructions to ensure you get the best outcomes. Very rarely, patients do experience problems such as infection, haze and poor outcomes from the surgery. This is very often in the order of less than 3%. And usually, we are able to treat these with further laser drops or surgery.

Cross-linking by and large is a very safe procedure with thousands of these having been performed worldwide. However, as with any procedure, there are some risks and side effects that you need to know about. The most important side effect I tell everyone about is the risk of developing pain after the procedure. Everyone will notice that their eyes are in pain for about two to three days after surgery. We always give everyone drops and tablets to combat the pain. During this period of pain, you will notice your vision is not as good and your eyes are swollen and red, but as the pain subsides, your vision will get better and your swelling and redness will settle down. Longterm, there is a risk that the surgery doesn’t work as well as we would expect it to. And you may need to have it repeated. Some patients do notice halos and glare after the procedure, but very often this resolves within a few months. A more rarer risk is developing an infection or haze after the procedure, which can adversely affect your vision, but this is usually combated with the use of anti-inflammatory and antibiotic drops after the procedure.

The main cause for keratoconus is eye rubbing. We have a habit of rubbing our eyes constantly, especially when they’re irritated or dry or itchy. People who have allergies or contact lens wearers are at a higher risk of eye rubbing and therefore developing keratoconus. It is very important to treat this very important risk factor to ensure that you do not develop keratoconus. 

Laser treatment for keratoconus are of two different types, laser PTK and laser TransPRK. We offer both these treatments at Oculase. In laser PTK, the surface layer of your cornea, called the epithelium, is removed. This is followed by cross-linking treatment to strengthen your cornea to prevent your keratoconus from getting worse. In laser TransPRK, PTK is used to remove the surface layer, called the epithelium, after which the inner layers of the cornea are reshaped using the laser to improve your vision. This is then followed by cross-linking to strengthen your cornea. In both cases, you would be expected to continue wearing glasses or contact lenses for good vision after the procedure. At Oculase, we use AI powered technology to guide our treatment, to give you the best outcome with all our keratoconus patients.

Keratoconus itself does not cause total blindness. However, if left untreated, it can lead to near total blindness, which would require a corneal transplant to give you good vision. Therefore, it is very important that you be treated early so that your quality of life and your quality of vision is maintained through life.

Most patients who have treatments for keratoconus, whether that is cross-linking, laser-assisted cross-linking, ring segments such as Intacs or corneal transplants would have to continue wearing glasses and/or contact lenses for good vision. However, if you have had one of these treatments and you have stable keratoconus, which is not progressing, you can have a additional treatment called implantable contact lenses to give you good vision. With this treatment, a tiny implantable contact lens is placed inside your eye, which stays in your eyes for life and gives you good vision without glasses or contact lenses. Your suitability for this procedure is dependent on the health of your eye, your scans, and your general visual needs.