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Off-label corneal cross-linking can be effective for correct patients
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NEW YORK — Corneal cross-linking can slow or stop progression of keratoconus, but choosing the correct patients and deciding when to go off-label can help physicians improve outcomes.
Cross-linking may improve uncorrected and best corrected visual acuity and can lock in disease at its current level, which benefits milder cases more than severe cases. The FDA has approved corneal cross-linking for patients who are 14 years of age and older, who have progressive keratoconus or ectasia after refractive surgery, who are not pregnant and who have corneas that are 400 µm or thicker, Jodi Luchs, MD, said at OSN New York 2018.
“But what about patients who have keratoconus or post-LASIK ectasia who don’t quite fit into all those labeled criteria? Specifically, patients less than age 14 or those with corneas thinner than 400 µm or those without progressive disease or where you can’t document progression. Are those patients eligible for the treatment? Many of us will treat those patients in those categories in an off-label fashion,” he said.
Worldwide reports of cross-linking in patients younger than 14 have yielded “excellent results.” Young patients tend to progress rapidly with keratoconus, so treating them as soon as possible to halt progression is important, he said.
Patients with thinner corneas can have their corneas swelled to greater than 400 µm before treatment with a hypotonic riboflavin, but successful treatment has been reported on corneas as thin as 350 µm, Luchs said.
Additionally, cross-linking can provide benefits to patients who do not have progressive disease, he said.
“Cross-linking can provide many benefits for our patients that go beyond arresting the progression of the disease. By improving corneal shape with time and medications, improving higher-order aberrations and reducing astigmatism, all of these things can improve their uncorrected or best corrected visual acuity, or perhaps improve their contact lens tolerance or improve their overall spectacle corrected vision. All of those things are providing benefits to patients, so I will offer it to patients in that category,” he said.
Patients with inserts, apical scarring and recurrent keratoconus in corneal transplants can also be treated successfully with cross-linking, he said. – by Robert Linnehan
Reference:
Luchs J. Patient selection for corneal crosslinking. Presented at: OSN New York 2018; Sept. 28-30, 2018; New York.
Disclosure: Luchs reports he is a consultant for Avedro and has ownership interest in CXLO.