Slit lamp cross-linking improves access to care, reduces costs
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SAN FRANCISCO — Performing corneal cross-linking at the slit lamp democratizes access to care and reduces costs, according to a presentation at Refractive Surgery Subspecialty Day at the American Academy of Ophthalmology meeting.
Farhad Hafezi, MD, PhD, said moving to an infrastructure that does not have as many necessities as traditional cross-linking has advantages.
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“The most important advantage is, in many areas of the world there is no steady access to operating rooms,” he said. “We’re talking about countries where the next operating room would be 100 miles away.”
Even in the United States and Europe, where there is more access to operating rooms, performing cross-linking procedures in the office has the potential to reduce costs, he said.
Hafezi uses the C-eye device (EMAGine) to perform cross-linking at the slit lamp. The device attaches to all major lamps and can also be used on patients in traditional cross-linking procedures, he said.
Hafezi said major questions about upright cross-linking have been addressed in his experience with the technique, including the impact of gravity on riboflavin, abrasion, patient fixation and infection risk in epi-off procedures.
Hafezi and colleagues published a protocol for epi-off cross-linking that helps strengthen the cornea in just more than 9 minutes rather than the 30 minutes called for in the Dresden protocol. The shorter duration allows for more people to complete cross-linking procedures at the slit lamp.
The slit lamp procedure also allows patients to undergo epi-on cross-linking, Hafezi said. In his experience, the impact of the epi-on procedure on corneas is just as effective as epi-off, and it has become his go-to procedure.
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Hafezi F. Crosslinking at the slit lamp. Presented at: American Academy of Ophthalmology meeting; Nov. 3-6, 2023; San Francisco.
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