Center for Keratoconus
Corneal Collagen Cross-Linking
A revolutionary procedure to strengthen the cornea
What is Collagen Cross-Linking?
A major advance in the treatment of keratoconus is Corneal Collagen Crosslinking, a treatment that strengthens the cornea that is weakened by keratoconus so that it does not deteriorate any further. The availability of crosslinking makes early diagnosis extremely important because loss of vision caused by progression can be prevented, and further surgical treatments will typically not be necessary. Corneal Collagen Crosslinking is a quick in-office procedure that only has to be performed once and is effective in stopping the progression of keratoconus and the loss of vision that results from it. Prior to the availability of this treatment, patients wore rigid contact lenses until significant corneal scarring and distortion of vision made a cornea transplant the only option. Contact lenses are still commonly used to help improve the vision of keratoconus patients and significant improvements in the design and materials of these lenses have made them much more comfortable as well. We will work with your referring doctor to achieve the best treatment option(s) for your eyes.
Your ophthalmologist uses a UV light and eye drops containing a specially-compounded Riboflavin solution (Vitamin B2) to strengthen the cornea.
When should I have cross-linking performed?
For most young patients with keratoconus, as they grow into their late 20s, their keratoconus is expected to worsen and deteriorate, along with their vision. Cross-linking is generally recommended for patients in this age range in order to halt progression, and preserve vision.
Once your doctor has diagnosed you with keratoconus that is progressing, in general, a patient should have cross-linking performed as soon as reasonably possible. A patient’s keratoconus (and vision) may further deteriorate while awaiting cross-linking.
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What is the difference between Epi-On vs Epi-Off Cross-Linking?
“Epi-On” Cross-Linking
or “Epithelium-On” cross-linking, also known as trans-epithelial cross-linking, is the preferred technique used in Europe. A special surgical sponge is used to roughen up the surface of the eye to allow for better penetration of the riboflavin solution, without removing or killing the epithelial cells. Riboflavin and UV light are then applied to the surface of the eye for the cross-linking procedure. This allows for a faster, less painful recovery after the procedure, without any difference in therapeutic efficacy.
“Epi-Off” Cross-Linking
or “Epithelium-Off” cross-linking is the variation of the technique approved by the FDA for use in the United States. This is mostly historical, as the original clinical trials done in the United States were performed using this older technique. Therapeutic efficacy of both techniques is the same. During “Epi-off” cross-linking, an alcohol solution is used to loosen up and kill the surface epithelial cells on the eye. A special surgical brushes then use to remove dead cells. Riboflavin and UV light are then applied to the surface of the eye for the cross-linking procedure.
What to expect from the Cross-Linking Procedure?
This procedure is usually done one eye at a time. A bandage contact lens is placed over the eye, and the eye may feel scratchy and sensitive to light for a few days.
The recovery time is about three to five days. With “Epi-On” cross-linking, pain and recovery as usually a little faster, and less painful. Visual recovery takes about four weeks. Some patients may experience a small improvement in uncorrected visual acuity and a decrease in astigmatism. This may result in a change of prescription for contact lenses/glasses.
Does Insurance Cover Corneal Cross-Linking?
At present, corneal cross-linking is a relatively new medical procedure in the United States. As such, many insurance plans do not cover the cost of the procedure. The cost of the procedure can vary between medical offices, insurance networks, and geographical locations. Without insurance coverage, the cost of standard “Epi-off” cross-linking with the FDA-Approved, American Avedro unit may cost around $8000 per eye. Some medical offices will offer Corneal Cross-Linking using the European Avedro unit, and charge an out-of-pocket price that is usually less expensive, around $3000 per eye. In general, the few American health insurances that cover Corneal Cross-Linking will only cover the “epi-off” variant of the technique using the FDA-approved, American Avedro CXL unit. The co-pay for may range between a few hundred to a few thousand dollars.
As this is often a medically necessary procedure, your ophthalmologist will work with you to find an affordable solution in order to undergo the procedure.
Center for Keratoconus
Our mission at the Center for Keratoconus is to provide patients with state-of-the-art keratoconus care from recognized and experienced experts using the latest technology and proven techniques, in a convenient and comfortable Midtown Manhattan setting near Grand Central Terminal and Penn Station. Enabled by a wide range of advanced diagnostic technologies, our specialists will work with you and your eye doctor to arrive at a correct diagnosis as well as a treatment strategy that is aimed at preserving or restoring your eyesight so that you can continue to be productive. The options available for treatment have greatly expanded in recent years including collagen cross-linking, scleral contact lenses, topography-guided laser corneal reshaping, along with advances in corneal transplantation techniques. Our staff of doctors is comprised of leaders in the field of keratoconus treatment, research, and education.
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