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Will corneal collagen cross-linking technology affect the performance of surface ablation?
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Cross-linking may boost LASIK safety
 A. John Kanellopoulos |
It is my opinion that collagen cross-linking as a means of modulating corneal biomechanics would definitely affect the prevalence of surface ablation. The main reason surface ablation has made a return is the concern for corneal ectasia. It is clear that the side cut performed even in femtosecond LASIK does reduce the corneal strength and may deteriorate to ectasia. So, if one could reverse that biomechanical change by collagen cross-linking, this would make LASIK a preferable choice even in high-risk corneas for ectasia, such as younger patients with thin corneas or patients who require a significant diopter correction.
We introduced 5 years ago the concept of performing prophylactic collagen cross-linking after routine LASIK procedures, a technique that seems to be gaining global popularity with many manufacturers as well as clinicians.
There are still several issues that we need to learn about collagen cross-linking. For example, what area of the cornea is more efficient to cross-link? How much cross-linking should be done? Should cross-linking be a titratable procedure or a one-shot procedure? Once advanced research that is currently being conducted in many places by many investigators worldwide answers these questions, I think collagen cross-linking will not be a desperate treatment for keratoconus, but it will be a very valuable tool in modulating corneal biomechanics, thus enhancing safety with LASIK, which is by all means the method of preference for laser refractive surgery globally.
A. John Kanellopoulos, MD, is director of the LaserVision.gr Institute, Athens, Greece, and is professor of ophthalmology at NYU School of Medicine. Disclosure: Dr. Kanellopoulos has no relevant financial disclosures.
Cross-linking with PRK may stabilize cornea
 R. Doyle Stulting |
Corneal collagen cross-linking has the potential to increase the number of candidates for corneal laser refractive surgery. We expect it to make surgeons more comfortable operating on patients who are at risk for ectasia following LASIK. In the future, many of these people will undergo cross-linking in conjunction with PRK, rather than LASIK, to minimize the amount of tissue that is removed from the cornea. Eyes that have significant irregular astigmatism from early keratoconus may be rehabilitated by the performance of topography-guided PRK, to improve vision at the same time that the topography of the eye is stabilized by cross-linking.
R. Doyle Stulting, MD, PhD, is an OSN Cornea/External Disease Board Member. Disclosure: Dr. Stulting is a consultant for Topcon.