Speaker: Patients with keratoconus should be educated on advantages of cross-linking

Issue: December 25, 2015

LAS VEGAS — Cross-linking is the standard-of-care in countries outside of the U.S., and surgeons should educate their patients with keratoconus on its advantages, according to one speaker here.

Perspective from William B. Trattler, MD

“It is important for surgeons in the U.S. to understand that cross-linking is standard-of-care outside the U.S. I think we are in a position where we are obligated to inform our patients or educate them about the availability here or abroad,” Parag A. Majmudar, MD, said at the Refractive Surgery Subspecialty Day preceding the American Academy of Ophthalmology annual meeting.

According to U.S. Eye Bank data, there was a reduction in the number of penetrating grafts that were performed in patients with keratoconus from 2010 to 2014.

“Obviously, a lot of us in the U.S. are not doing cross-linking, so some of the decrease might be due to Intacs, corneal rings and better contact lens technology, but I think that cross-linking may have had a role in this. If you extrapolate that out to the worldwide experience, there would be a significant percentage decrease in the number of penetrating grafts that we are performing,” Majmudar said.

On average, it costs about $24,000 more to treat a patient with keratoconus than a patient with plain myopia, which is attributed to penetrating keratoplasty costs. In addition, the average cost for routine vision care for keratoconus is three times higher, he said.

“I am a firm believer having done cross-linking now for over 5½ years that earlier treatment provides better results, and you will see a much more improved outlook on keratoconus in the future,” Majmudar said. — by Nhu Te

Reference:

Majmudar P. Magnitude and long-term stability associated with changes after cross-linking. Presented at: The Academy of Ophthalmology. Nov. 13, 2015; Las Vegas.

Disclosure: Majmudar reports no relevant financial disclosures.

Perspective

William B. Trattler, MD

Parag Majmudar’s presentation highlights the significant impact corneal collagen crosslinking (CXL) has made for patients with keratoconus both within the U.S. and internationally. CXL has a long track record of being effective at stopping the progression of keratoconus, and in most patients, improving results in corneal shape and vision. During the presentation, Majmudar highlighted that the long-term published studies have demonstrated that CXL should be considered immediately upon diagnosis of keratoconus or post-LASIK ectasia to prevent progression and loss of vision. While CXL is not currently FDA approved in the U.S., there are numerous locations throughout the U.S. that offer CXL as part of clinical studies. The wide availability of CXL within the U.S. appears to have resulted in a reduced need for corneal transplants in the U.S., according to Majmudar. One may also consider that scleral contact lenses also significantly help patients with keratoconus.
One final point that Majmudar made, which is right on target, is that there are currently many options with CXL. For example: epi-on vs. epi-off for the riboflavin loading of the cornea or high energy and short duration UV light exposure vs. the standard 30 minutes of UV light exposure. While there are currently many options, the good news is that regardless of the technique, CXL appears to be effective. Of course, with optimized epi-on administration protocols, one should expect a more rapid visual recovery and lower risk. Overall, CXL is an effective treatment for keratoconus and will continue to make a difference for patients with all forms of ectatic conditions.

William B. Trattler, MD

OSN Technology Section Editor

Disclosures: Trattler reports he has a financial interest in CXLO.