Li Y, Chamberlain W, Tan O, et al. IVMED-80, a twice-daily eye drop for the treatment of keratoconus in development by iVeena Delivery Systems, was recently granted orphan drug designation by the FDA. Treatments for progressive keratoconus include: This procedure, also called corneal collagen cross-linking or CXL, strengthens corneal tissue to halt bulging of the eye's surface in keratoconus. Efficacy of different accelerated corneal crosslinking protocols for progressive keratoconus. Optovue was the first manufacturer whose OCT technology gained FDA approval for epithelial thickness mapping. Treatment options for keratoconus In the early stages of keratoconus, corrective glasses or contact lenses can help the patient. Both technologies facilitate the identification of biomechanically at-risk corneas before any decompensation begins to alter corneal curvature. Because simultaneous treatments were found to produce the best results, we use the following regimen. By contrast, in an ectatic cornea, the epithelial layer exhibits significant thinning over the cone (Figure 1), sometimes surrounded by a “doughnut” of thicker epithelium.¹ This epithelial masking effect on the anterior surface may explain in part why it is easier to detect early ectasia on the posterior surface. Keratoconus Treatment Options. enews. Molokhia S, Muddana SK, Hauritz H, et al. To learn more and to find an eye doctor who prescribes and fit these prosthetic lenses, visit the EyePrint Prosthetics website. Kanellopoulos A. Stulting RD, Trattler WB, Woolfson JM, Rubinfield RS. A potential solution, therefore, would be to combine laser ablation with a strengthening procedure such as CXL. Keratoconus also is associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fitted contact lenses and chronic eye irritation. Keratoconus is a non-inflammatory eye condition in which the normally round dome-shaped clear window of the eye (cornea) progressively thins causing a cone-like bulge to develop. We do not endorse non-Cleveland Clinic products or services. This drug, with its copper-based formulation, is reportedly the first eye drop designed to treat keratoconus without the need for adjunctive laser treatment or surgical intervention. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision. At our clinic, we have been developing a Minneapolis epi-off protocol. Since then, the procedure has been completed more than 18,000 times at more than 300 practices nationwide. 2019 Feb;97(1):e22-e35. Recent research has shown that this approach can shorten epithelial healing times because of the smaller abrasion zone needed and also strengthen the flattening effect.11. It also is being investigated as a way to treat or prevent complications following LASIK or other vision correction surgery. In a first-ever collaboration, 4 supranational cornea societies joined forces in a complex, multistep process to develop the Global Consensus on Keratoconus and Ectatic Diseases. UltraHealth and ClearKone are available in a wide variety of parameters to provide a fit that conforms well to the irregular shape of a keratoconic eye. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. . In the United States, custom soft contacts that are available for the correction of keratoconus include: KeraSoft lenses (Bausch + Lomb). With the sequential approach, CXL is followed 1 to 2 years later by topography-guided PRK (TG-PRK). Comparison of standard and accelerated corneal cross-linking for the treatment of keratoconus: a meta-analysis Acta Ophthalmol . The traditional method is called “penetrating keratoplasty” (PK). Dr. Kanellopoulos found that both methods were safe when the ablation depth was limited to 50 µm, with no patients showing disease progression, but he reported that the simultaneous method resulted in better final visual acuity results.12, Earlier this year, Nattis and colleagues published a study in which TG-PRK was used not only to normalize topography but also to treat refractive error beyond the 50-µm threshold.13 In the study, patients underwent CXL followed by TG-PRK 30 months later on average. Accelerated corneal collagen cross-linking in thin keratoconic corneas. Topography before (A) and after (B) treatment of the left eye in a patient with keratoconus. Customized corneal cross-linking: one-year results. As a treatment for low myopia, Intacs ® corneal implants were a market failure since LASIK provided better, more consistent results with a lower complication rate. Example of epithelial mapping of a keratoconic cornea. 1. Eyeglass temples: How do you know if they're the right length? Tomographic and biomechanical Scheimpflug imaging for keratoconus characterization: a validation of current indices. 9. It's the only keratoconus treatment proven to slow or stop the progression of the disease. In this case, eye drops containing low levels … Paul Hammond, OD, FAAO. Keratoconus Diagnosis and Treatment - American Academy of Ophthalmology Keratoconus diagnosis include a comprehensive eye exam and tests to determine your corneal shape. 4. A New Zealand team of researchers has developed a tissue-engineering approach to treating keratoconus. We do not endorse non-Cleveland Clinic products or services. This article highlights promising recent advances in keratoconus management. With this strategy, known as epi-off CXL, come patient discomfort and the risks of delayed epithelial healing, infection, sterile infiltrates, and stromal haze. Retinal detachment: Symptoms, causes and treatment. Keratoconus affects men and women equally, about 1 in 500 to 2,000 individuals overall, and 5-15% of individuals born with Down Syndrome. Seiler TG, Fischinger I, Koller T, et al. Both lenses have a very wide range of fitting parameters for a customized fit and are larger in diameter than regular soft lenses for greater stability on a keratoconic eye. In 2016, however, the FDA approved cross-linking surgery as a treatment for keratoconus and recommended that a registry system should be set-up to evaluate the long-term treatment effect. Keratoconus can occur in one or both eyes and often begins during a person's teens or early 20s. The aim of corneal cross-linking is to strengthen the cornea by increasing the number of "anchors" that bond collagen fibers together. 13. Supported by the National Keratoconus Foundation, this safe, minimally invasive outpatient procedure works by stiffening the weakened cornea to slow or halt progression of the disease. Recently, contact lens manufacturers have introduced custom soft contact lenses specially designed to correct mild-to-moderate keratoconus. For progressive keratoconus, only Avedro's corneal cross-linking procedure is FDA approved and widely covered by insurance. 18 While the “Dresden protocol” with epithelial removal is an established standard, some corneal surgeons are now performing variations of CXL, including trans-epithelial (epi-on) application of riboflavin drops. The aim of this procedure is to strengthen an already weak cornea by ‘cross linking’ the collagen fibres found in the cornea. Even after a transplant, you most likely will need glasses or contact lenses for clear vision. The idea is to maximize the CXL effect in the weakest region of the cornea, usually inferiorly, and to apply weaker amounts of irradiation in concentric rings expanding out from the cone. Medicaid: Eligibility and Vision Benefits. The use of any drug or drugs other than Photrexa Viscous and Photrexa or any device other than the KXL System for corneal cross-linking is not FDA approved, except as part of an investigational new drug study. The market for keratoconus treatment was around USD 322.7 million in 2016 and is expected to reach USD 427.5 million by 2023 which is a projected CAGR of 4.1%. Epi-off versus epi-on corneal collagen cross-linking in keratoconus patients: a comparative study through 2-year follow-up. Advantages include less risk of infection, less discomfort and one-day visual recovery. 3. Using a combination of corneal crosslinking and Intacs implants also has demonstrated promising results for treating keratoconus. Because of the precise nature of the back surface fit, high quality and individualized optics can be placed on the front surface of the device. These are large-diameter gas permeable contacts — large enough that the periphery and edge of the lens rest on the "white" of the eye (sclera). Custom toric soft contacts for keratoconus are significantly more expensive than regular soft contacts, but vision insurance may cover some of the costs associated with contact lenses for keratoconus. Cifariello F, Minicucci M, Di Renzo F, et al. What happens to FSA dollars at the end of the year? Ophthalmologists have long believed that they should never perform PRK or LASIK on an eye with ectasia because of the risk of worsening the condition. Ophthalmologist, North Suburban Eye Specialists, Coon Rapids, Minnesota, Financial disclosure: Owner and Developer (Phorcides Software); CEO (American Corneal Consultants); Consultant (Alcon), Coming Soon: Presbyopia-Correcting Eye Drops, Joshua Davidson, OD, FSLS, FAAO; and Paul Kimbro, OD, Myopia Control With Multifocal Contact Lenses, Roxanne Achong-Coan, OD, FAAO, FIAOMC, FSLS, © 2021 Bryn Mawr Communications, LLC. 2020;61:2587. At A Glance. Are contact lenses a good choice for kids? While keratoconus can be a challenging condition, it can be managed effectively when detected early. Corneal crosslinking without epithelial removal. As research advances, gold-standard technologies gradually change. Intacs might delay but can't prevent a corneal transplant if keratoconus continues to progress. In 2003, WaveLight developed technology to perform topography-guided excimer laser treatment. We then use the Phorcides Analytical Software designed by Mark Lobanoff, MD, to help plan refractive topography-guided correction of the cornea. Your doctor should monitor defects in the outermost corneal layer of the eye for resolution. SEE ALSO: Answers From An Eye Doctor About Keratoconus >. Vinciguerra R, Ambrósio R, Elsheikh A, Roberts C, Lopes B, Morenghi E, Azzolini C, Vinciguerra P. Detection of keratoconus with a new biomechanical index. OCT epithelial mapping can provide supplemental information that should improve early detection of subclinical keratoconus. The aim of corneal cross-linking is to strengthen the cornea by increasing the number of "anchors" that bond collagen fibers together. Toker E, Çerman E, Özcan DÖ, Seferoglu ÖB. One example are lenses made with the EyePrintPRO process (EyePrint Prosthetics). Several studies have supported this concept of accelerated protocols and have shown similar results in arresting keratoconic progression with illumination times ranging from 3 to 10 minutes.7,8 This approach is becoming more popular with corneal surgeons around the country because it is more convenient for patients and for the surgical team. This treatment uses energy from radio waves, applied with a small probe at several points in the periphery of the cornea to reshape the eye's front surface. View PDF. A recent addition to the analysis of corneal curvature involves mapping the thickness of the corneal epithelium with OCT. Doctors then send the resulting impression to an EyePrint lab for 3-D scanning. These lenses were designed specifically for keratoconus, and the central GP zone of the lens vaults over the cone-shaped cornea for increased comfort. In the mildest form of keratoconus, eyeglasses or soft contact lenses may help. What do the numbers on your eyeglass frames mean? It is a photoenhancer indicated … © 2000-2020 AAV Media, LLC. Other ocular side effects include inflammation, Click here to find a cornea specialist near you. Click here to view your insurance policy. Invest Ophthalmol Vis Sci. Keratoconus (ker-uh-toe-KOH-nus) occurs when your cornea — the clear, dome-shaped front surface of your eye — thins and gradually bulges outward into a cone shape.A cone-shaped cornea causes blurred vision and may cause sensitivity to light and glare. Keratoconic corneas have been found to be softer than healthy corneas, which is why CXL is used for stiffening the tissue to stabilize the disease. More by this author . 72. To decrease patient discomfort and mitigate these risks, researchers and clinicians are interested in a CXL protocol that leaves the epithelium intact while still adequately strengthening the cornea. For the detection of early keratoconus, Placido disc–based topography has been supplanted by Scheimpflug tomography, which can map both the anterior and posterior corneal surfaces. All About Vision and AllAboutVision.com are registered trademarks of AAV Media, LLC. 6. Keratoconus Treatment. Steinberg J, Siebert M, Katz T, et al. Cleveland Clinic is a non-profit academic medical center. The risk for keratoconus is increased in people who have asthma (as reported by the American Optometric Association).More than 23 million people in the US are living with asthma, and the onset of this health disorder often begins in childhood. The most common ocular side effect is haze. August 9, 2019 | By First Eye Care DFW. This imbalance makes the cornea more susceptible to oxidative damage from compounds called free radicals, causing it to weaken and bulge forward. Because eyeglasses and soft contact lenses often cannot provide adequate visual acuity in cases of keratoconus, gas permeable contact lenses usually are the preferred treatment. This is a non-invasive treatment for patients with keratoconus. Brian Boxer Wachler, MD, is an ophthalmologist and refractive surgeon at the Boxer Wachler Vision Institute in Beverly Hills, Calif. 2. Postoperative UCVA was 20/25. It's a non-invasive procedure that strengthens the cornea by "cross-linking" the cornea's collagen fibres through the application of Riboflavin drops and exposure to UV-A light. It involves creating new links between the collagen fibers as well as making them thicker and shorter. "The EyePrint is like a fingerprint—it's completely individual," says EyePrint developer Dr. Christine Sindt, Clinical Associate Professor of Ophthalmology and Visual Sciences at University of Iowa. 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