Following a multi-center, phase 3 clinical trial, the Emory Eye Center is awaiting FDA approval for the Avedro KXL Accelerated Cross-linking treatment, a procedure to address corneal problems such as keratoconus (bulging or steepening of the cornea that can lead to scarring) and corneal ectasia (a similar condition that can occur after refractive surgery).
“Cross-linking” works to strengthen the cornea’s collagen fibers to help the cornea retain its normal shape. In the cross-linking procedure, riboflavin is dripped onto the cornea and then exposed to ultraviolet light. The light causes the riboflavin to fluoresce, a process leading to formation of bonds between collagen molecules. The KXL procedure can be performed in just minutes.
“Corneal collagen cross-linking gives us an opportunity to treat a condition that previously we could manage only with visual aids and hope that it would not progress to the point that the patient would need a corneal transplant,” says cornea specialist Brad Randleman. “Now we can prevent such disease progression for the vast majority of patients with keratoconus, if we can diagnose the disease and treat them early enough in their course.
“Cross-linking serves as the cornerstone for other future treatment options, and we are excited about the possibility to offer our patients this expanded spectrum of management options for keratoconus.”
The cornea is the clear or transparent cover to the front of the eye, directly over the iris and pupil. It allows light to enter the eye, and its curvature causes light to bend, providing the eye’s focusing or refractive power. With keratoconus or corneal ectasia, a typical patient has moderate to severe blurred vision from the irregular curves that develop in the cornea. Keratoconus and corneal ectasia together account for 15% of corneal transplants in the United States.
In the past, managing keratoconus has included prescription of corrective lenses (glasses and/or rigid gas-permeable contact lenses). When the condition progresses, corneal scarring may occur and a corneal transplant may be necessary. About half of keratoconus patients have no past effects on their lifestyle other than wearing corrective lenses. The condition may even stabilize. For others, the condition is treated with a corneal transplant. In some cases, keratoconus recurs in the transplanted cornea.