Corneal Collagen Cross-Linking

New York Eye and Ear Infirmary of Mount Sinai (NYEE) is one of a few centers in the New York metropolitan area equipped to perform collagen cross-linking (CXL), a breakthrough technique for treating people with keratoconus and corneal ectasia following refractive surgery. Approved by the FDA in April 2016, CXL was used for the first time at the NYEE’s Laser Vision Correction Center in February 2017. Nearly 20 physicians at the center have been trained and certified to perform the minimally invasive procedure.

CXL is a safe, effective, and relatively simple treatment that has the potential to slow the progression of keratoconus by stabilizing the corneal contour and improving visual function in some patients. Specialists at the Laser Vision Correction Center begin the process by numbing the eye and scraping the epithelial cells from the surface of the cornea. Riboflavin (vitamin B2) eye drops are then applied repeatedly for a half hour so that they saturate the corneal stroma. Next, clinicians shine an ultraviolet light on the eye for another 30 minutes while drops continue to be administered. The combination of riboflavin and ultraviolet light strengthens the bonds between collagen fibers and changes the configuration of the collagen, a significant development for individuals with keratoconus whose corneas thin and bulge outward, resulting in blurred or double vision, astigmatism and, in extreme cases, the need for corneal transplants. The 60- to 90-minute cross-linking procedure—performed months apart in each eye—concludes with application of a bandage contact lens on the surface and anti-inflammatory drops during the following month.

Corneal collagen cross-linking is most effective when done in the early stages of the disease, before the cornea has become too misshapen and vision has been compromised. This holds particular significance for teenagers with astigmatism and extreme nearsightedness, which are early warning signs of keratoconus. Pediatric ophthalmologists are well advised to screen these adolescents at an early age through a baseline corneal topography. This way, if the results do show a problem or vulnerability, treatment with collagen cross-linking can begin to halt progression of the disease and vision loss.