Keratoconus is a condition where the cornea becomes stretched and thin and begins to bulge into a cone-like shape, causing blurred and distorted vision. The normal physical properties of the cornea are altered, creating refractive error, usually short-sightedness (myopia) and irregular high astigmatism. It usually affects both eyes but sometimes one eye may be badly affected whilst the other eye shows very little sign of the condition. Corneal collagen cross-linking is the only treatment currently available which appears to stop the progression of keratoconus.
AM I SUITABLE?
Corneal cross-linking is usually offered to those who are under 35 whose keratoconus is changing. Suitability is assessed through analysis of the patient’s current and previous prescriptions and the scans carried out during the consultation. Occasionally, patients under 18 may be treated at the time of diagnosis to prevent the worsening of vision. Patients who are 35 and over tend to have stabilised keratoconus and are therefore offered other treatment options including intracorneal ring segments, corneal graft, and contact lenses or spectacles.
Corneal cross-linking (CXL) uses ultraviolet light and riboflavin eye drops (vitamin B2) to stiffen the cornea, mimicking the corneal stiffening that occurs naturally with aging. It cross-links the collagen fibres in the cornea to each other and within themselves. This procedure is often used in combination with intracorneal ring implantation (kerarings), or to treat post-LASIK ectasia. Standard CXL involves 30 minutes of ultraviolet (UV) light treatment. We offer an up-to-date, rapid, and potentially safer, alternative of ‘epithelium-off’ CXL, delivering the same quantity of UV light treatment in just eight minutes. Evidence from three randomised clinical trials one year after CXL showed success in halting keratoconus progression in over 90% of treated eyes, with over 45% of eyes also gaining an improvement in corneal shape. Longer-term results (up to five years) from a different study suggest a similarly high success rate in preventing keratoconus progression.
The soft ‘bandage’ contact lens will remain in your eye for about a week until the surface has healed. If it falls out during this time, please throw it away – do not attempt to reinsert it. The anaesthetic drops applied during surgery will wear off later on in the day of your procedure, and your eye will be gritty, red and sensitive to light for several days. Your vision will be quite blurred at first but will clear gradually over the first few weeks. You will be given eye drops to use after the procedure and wearing sunglasses will help alleviate light-sensitivity. Post-operative pain can differ with individual patients reporting from little to considerable discomfort in the first few days. If you experience increasing pain three of four days after your procedure, please visit A&E to check for infection, although this is relatively rare, affecting less than 1% of patients.
Please note that vision is only improved by the use of spectacles or contact lenses after treatment.
We recommend one week off work, increasing to two if your job includes sustained use of a computer and you have been treated for your best eye. Using your eye for normal activities, such as reading or ordinary use of television or a computer screen will not damage it but you may find it more comfortable to rest with your eyes closed initially after the procedure. Do not rub your eyes following surgery as this can progress the keratoconus. If your eyes become itchy or irritated, you should administer artificial tear drops. Only return to driving when you can read a number plate from 70ft (20m) and then exercise caution until you feel confident.
For the first week:
- Do not wear eye make-up for one week.
- Refrain from any aerobic and gymnastic activities. These might cause injury or cause sweat to run into the eyes.
- Avoid getting water or shampoo in your eyes when washing and dab gently with a towel if you do.
- Do not fly long haul for the first week.
For two to four weeks:
- Avoid dusty environments that can irritate the eyes. Wash any debris from your eye with an eye drop.
- Do not scuba dive or swim in chlorinated water. After this time, wear goggles when swimming.
- Do not play contact sports or practice martial arts.
You will be given an appointment the week after treatment to check your eye is healing properly. It is normally safe to resume contact lens wear once the eye surface skin layer has healed. Detailed advice on aftercare will be made available to you following surgery and, if you are in any doubt, your vision can be checked on the week after surgery to check it is at driving standard.
Moorfields Private Outpatients Centre
9-11 Bath Street
King Edward VII Hospital
5-10 Beaumont St, Marylebone, London
T:0207 566 2603
M:07831 919 634