Cross Linking and other methods of treating keratoconus

Hard and hybrid contact lenses

Keratoconus leads to development of irregular astigmatism which significantly affects quality of vision. The only way to correct the refractive error is wearing hard or hybrid contact lenses since eyeglasses do not improve vision. However, it should be kept in mind that contact lenses do not stop progression of the disease, only provide normal vision. The lenses are individually fitted, based on a test called a corneal topography. Precision of lens fitting is extremely important in order to prevent keratoconus compression and corneal irritation. How then do we remove the cause of affliction, not just the symptoms?

Cross Linking

Cross Linking is an innovative method of keratoconus treatment. As a result of this procedure, new crosslinks are formed between collagen fibers in the cornea. This leads to stiffness of the cornea, strengthening it and increasing its resistance to further deformations. Cross-linking procedure is performed under local anesthesia with special eye drops., thanks to which the treatment is completely painless.

To simplify a complex procedure, the treatment is carried out by soaking the cornea with riboflavin (vitamin B2) and exposed to UV radiation of a strictly controlled wavelength. The most exterior corneal layer, the epithelium, is a natural diffusion barrier for riboflavin. Due to this, differing methods of penetrating the epithelium have been created, and therefore different methods of cross-linking.

We can outline two treatment methods: abrasive (removing the epithelium), and non-abrasive.

Abrasive procedures have been used for the longest time as cross-linking methods, and clinical tests show that they have the highest efficacy in halting the affliction progress. Due to this, they are to this day the gold standard in treating keratoconus.

Non-abrasive treatments allow retaining untouched epithelium, which translates into a milder and considerably shorter recovery period post-procedure. An example of a non-abrasive cross-linking is the Megaride method, which utilizes vitamin E in a riboflavin solution.

Deciding on the best method takes place during a consultation with the doctor, which should include the results of specialist corneal tests, as well as the patient’s individual circumstances.

Following the abrasive cross-linking procedures, a compulsory protective lens is placed over the eye, which reduces post-surgery discomfort, and accelerates epithelial regrowth. The lens usually remains on the eye between 3 and 5 days. After the treatment, the doctor determines the date for a control check-up, and recommends the use of specialist eyedrops. The evaluation of the cross-linking’s final effect is possible between 6 to 8 months after the treatment.

An unquestionable benefit of cross-linking is keratoconus stabilization. Post-treatment, the affliction does not progress, or is very limited, ineffectiveness is a rare occurrence. It is a form of safeguard for the patient against the further spread of disease – it permits delaying or outright eliminating serious complications, and therefore the need for a corneal transplant. During a sufficiently early stage of disease, the treatment can also be linked with the Topoguided procedure, which is a laser shaping of the cornea based on its topographical image. Such a treatment combination can give the cornea a more regular shape, which results in reducing irregular astigmatism, and vision improvement.

According to current reports, Cross-linking is the safest and most effective form of keratoconus stabilizing therapy. It is worth noticing that the basis for this safety is the correct qualification of the patient for the treatment. The treatment is most effective among patients in the first of second stage of disease advancement, according to the Amsler classification. Cross-linking can also be performed after a corneal transplant if we observe a keratoconus relapse. There are no age restrictions, as Cross-linking is considered a cornea-saving procedure, and therefore a vision-saving one. It must be remembered that keratoconus may appear in young children, and even at that age the treatment can be performed with a high degree of success.

Topoguided treatment

The Topoguided treatment is performed in order to give the cornea a better shape, and to remove the keratoconus. It is based on a laser levelling of its surface based on the cornea’s topographical image. The treatment aims to give the cornea a more regular shape, and therefore minimalizing astigmatism and improving vision. This treatment is usually accompanied by a Cross-Linking treatment.

Intacs rings

Intacs rings are a method of correcting keratoconus. Intacs rings are chosen dependent on the corneal parameters. The laser makes small incisions in the cornea, after which the surgeon inserts rings into the newly made channels. The implanted rings exert pressure on the corneal curve and flatten its surface. This way, the cornea takes on a more proper shape, and irregular astigmatism is reduced.

You must undergo a qualifying examination of the keratoconus before the doctor decides, whether a surgical treatment is possible. Prior to the examination, you must not wear contact lenses for at least 4 weeks.


Keratoconus treatments

Qualifying examination

350 PLN

Procedure cost

from 2500 PLN