Effects of Corneal Collagen Crosslinking on Corneal Topography, Visual Acuity and Contrast Sensitivity

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 Peter Goren

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The Gold Winning Team
 

Jacksonville, Fl. -- March 6th, 2010 -- Just two years ago, U.S. Olympic bobsled team captain and gold medal winner was dealing with eyesight that was so impaired due to Keratoconus it threatened to end his bobsledding career.

 

Team Captain Steve

 

"It got to a point in 2008 where I couldn't see anymore," Holcomb said in an interview with NBC.

 

"They couldn't make contacts strong enough. I went to my coach and told him I had to quit." But that was before Holcomb learned about the Visian ICL (Implantable Collamer Lens) - an implantable lens approved by the US FDA to treat patients with up to -20 diopters of nearsightedness. Holcomb had the Visian ICL implanted in both eyes, and his vision immediately improved from a reported 20/500 (legally blind) to 20/20.

With normal vision restored, Holcomb was able to resume his career and achieve Saturday's historic victory piloting the U.S. Bobsled four-man team to its first Olympic gold medal in 62 years.

The Visian ICL is made of Collamer, a proprietary, highly bio-compatible material that allows the lens to be rolled into a tiny cylinder for insertion into the eye during an outpatient procedure. Once inserted, the lens gently unfolds behind the iris, where it is tucked into place by the surgeon.

 

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Implanted in more than 150,000 eyes worldwide, the Visian ICL offers a far wider treatment range for nearsightedness than LASIK.

Jacksonville Eye Surgeon, Keratoconus specialist and internationally renowned instructor, Dr. Arun Gulani has performed similar breakthrough cases. Surgery experience video of Jacksonville patient, Tony Shelton, who suffered with the identical eye condition as Steve Holcomb, is available below.

 

Tony Shelton & Dr Gulani

 

“This is a Miracle. I am amazed" - Tony

 

Dr. Gulani believes that Visian ICL is a great addition to out current modalities of correcting Keratoconus. Since ICL is used for High myopia, it can be utilized in cases of Keratoconus where the Myopia (nearsightedness) is extreme therewith correcting it without impacting the thin cornea. The ICl can further be combined with CXL/ C3R, INTACS, Lamellar corneal surgery and Laser surgery.

 

 Valeri

 

Keratoconus Member and Founder of the Bulgarian Keratoconus Association

 

 

It's been almost five years since I returned home to Bulgaria from Dresden, Germany, where kind and professional people at the Carl Gustav Carus Faculty of Medicine did the new, at the time, procedure called Crosslinking and where I had my Crosslinking treatment. As Crosslinking is the first ever treatment for Keratoconus and invented at the Technische Universität Dresden, it was Dresden, the natural choice, where long ago I had my Crosslinking treatment.

These where memorable days for me as they changed my life. It was the time that I learned not only from friends from our forum, but also from my personal experience, the subtleties of the condition. It took me two years to realize from research that hard lenses are more dangerous than is usually discussed, and they should be "handled with care” by being used with extreme caution and attention. This was the time in which my eye sight worsened and the cornea's of my eyes distorted, because of the constant rubbing that I experienced with badly fitted hard lenses (which I did not know at the time was happening). I had just found a good optician that fitted me perfectly in hard lenses in Greece, when I contacted German professionals, and after which Corneal Crosslinking was performed to treat my Keratoconus one time.

After the first months passed my vision stabilized. I am glad that after five years I can say that my vision has stayed the same. I was fitted with glasses once my vision had stabilized, and since then I am still wearing glasses when before only hard lenses could correct my vision. Recently the parameters for my glasses were slightly changed; this was because my current optician did a better refraction examination for the fitting of my glasses, not because the eye had changed. To say the least, I am eternally grateful for the vision and the life I have now. I am still using glasses reaching 100% correction from both eyes.

I still sometimes remember that my eyes are not perfect, but also that they are perfect considering the fact I can wear glasses now fully, and this was only due to having Crosslinking alone as a treatment, which was a great bonus in my case. To me able to wear glasses comfortably without the need (or the need to endure the on-going risks) of medical contact lenses is nothing short of an absolute blessing to be able to do, and everyones right to be able to do with out the need for not only invasive contact lenses but also invasive surgery, and the chance for this should be made available for them. I find my eyes are more relaxed while reading than before treatment, with there being now better uncorrected vision also. You know, I stay 9 to10 hours per day in front of the PC at work. I am still trying to change this habit, but work is something which is mandatory for me..

In the early days before I knew not to, I used to rub my eyes using fingers in to my eyes when using the palm of my hands would have been better, now I know its better to avoid any trauma to the eye altogether. During the time I had to use hard lenses - whilst putting them in to my eyes and taking them out, there was plenty of friction and rubbing caused as well. I used to put pressure on my eyes without realizing the damage I was doing. After I changing my attitude, and after my Crosslinking treatment, I managed to stabilize my vision and from that have been able to live a normal life up to now. It is a great feeling to finally being treated and having eyes which are strong now at the front, when previously they where not. What was needed from my side to achieve this was so little and simple. I just started handling my eyes with more care, and by doing so, getting the eye care that was required as equally, and as early and as quickly as I could, which is what reaped its rewards. What I was sure about was since my first report on my treatment, Crosslinking would (and has) become available to patients globally.

There is no way to predict the distant future to come, but reading the news of the latest advances in medicine, I feel very positive that most and hopefully all of us will cope in a certain way with this condition, and we will have the chance to live our lives, full of value.

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Keraflex and Annular Collagen Crosslinking: A New Treatment Modality for Keratoconus

 

Peter S. Hersh, M.D. Cornea and Laser Eye Institute – Hersh Vision Group

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CLEI Center for Keratoconus Professor,

UMDNJ Medical School Visiting Researcher, Princeton University.

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The 5th International Congress of Corneal Cross Linking

 

Medical Vision Professionals from around the world converged for the 5th International (CXL) Congress of Corneal Cross Linking, on the 4th and 5th of December 2009 in Leipzig, Germany.

The congress again created a thriving environment for the disseminate of information about the actual treatment of primary and secondary corneal ectasia; and for their champions around the world to discuss, learn, demonstrate and act on the benefits and lessons learned from Visual Scientists and Medical Vision Professionals in leadership. Their quantum cutting edge medical breakthrough achievements have been of a monumental magnitude, a recountal of legendary standards to be told for generations to come.

Since the safety and efficacy profile of Corneal Crosslinking, the first ever treatment for Keratoconus (KC), has been demonstrated many times over and confirmed as being excellent Internationally from gaining comprehensive and long term results; the Intercontinental cooperation has aligned itself more with wider educational and scientific programs, conceptualized as early as in 2005 during the inauguration of the first International (CXL) Congress of Corneal Cross Linking in December 9-10, 2005 in Zurich, Switzerland. Since then the congress has brought together a multifold, multidisciplinary field-force of Medical Vision Professionals from all corners of the world, representing famous International Hospitals, world-class Institutes to world renowned Universities, all of whom came together to find the best the world can offer - and to which they definately found. This was up-to-date congressional knowledge with precise pinpoint medical accuracy.

Cooperation is made up nowadays of a huge influx of extensive projects and initiatives, launched and implemented by medical academic scholars in their respected specialisms. This natural fostering of high methodical standards in science, and the availability of better options for the emergence of new audiences, makes them unbeatable as Medical Vision Professionals Internationally. The CXL Congress has always been where the our brightest, and the highest caliber of medical delegates have converged to, in order for - Safety, Quality and Teamwork - as never seen before, and which has been always continually constant.

The CXL Congress make things happen which otherwise would not have happened. They are involved with global positive results, which in turn have won robust life long, unsurpassed working relationships internationally, devoted good will, fellowships with rapport, and in return they give back great everlasting memories in humanity, all which transcend absolutely everything as global citizens.

kcglobal

 Biomechanical and Histological changes after Corneal Crosslinking with and without Epithelial Debridement

Gregor Wollensak MD and Elena Iomdina MD

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From the Eye Laser Institute, Department of Ophthalmology (Wollensak), Martin-Luther-University, Halle, Germany, and Moscow Helmholtz Research Institute of Eye Diseases (Iomdina), Moscow, Russia. 

In  anticipation of CXL approval in the USA, ophthalmologists are looking forward to addressing Keratoconus with renewed vigor.

Dr. Gulani is a world renowned eye surgeon and Lasik specialist. Former Chief of the Cornea service and Asst. Professor at University of Florida, School of Medicine; he is Founding Director of the Gulani Vision Institute.

Given Dr. Gulani’s approach to Keratoconus involving over 12 surgical approaches and combinations therein, the wide spectrums of applications are only limited by our logic and imagination e.g. Laser followed by CXL, INTACS followed by Laser and CXL, ICL followed by Laser followed by CXL, Cataract surgery with Toric Lens Implant followed by Laser followed by CXL. I also want to point out that by logic, I do mean responsible thinking and knowledge of anatomy, optics and physiology in selecting the most appropriate surgery or surgeries and keeping in mind that they be synergistic towards a visual goal.

Approaching the cornea of a patient with Keratoconus as an asymmetric high irregular astigmatism and by applying specific inclusion criteria, we are not only clear in our head about the treatment as  refractive surgeons but we are helping patients to understand that keratoconus is an approachable condition despite its progressive nature, and that there are surgical options at every stage to help the patient live a continued, productive life.

Applying our classification system we can therefore address practically all presentations of Keratoconus directly for best vision while in some cases, we may need to build the cornea in strength, perform scar removal and tissue replacement such as Lamellar Keratoplasty or Penetrating Keratoplasty and then present for Excimer laser surgery  (Classification system Class I) or in specific cases we can prepare in a cataractous age population to customize their cataract surgery in manipulating the optics intra ocularly (ie. Toric IOL) and then addressing the final refractive residual error on the cornea.

CXL a mandated stage II following the reshaping of Keratoconus?

Dr. Gulani envisions a future wherein a Keratoconic cornea once brought to its desired shape by the Excimer Laser in a PRK / ASA mode, INTACS (Gulani AC. INTACS : A Refractive Surgery to Prepare and Repair. INTACS Round Table. American Society of Cataract & Refractive Surgery Conference, May 2007) or Conductive keratoplasty  or even after corneal building procedures like Lamellar Keratoplasty followed by Excimer PRK/ASA, can then undergo CXL treatment for cross linking into a more stable and long lasting effect.

The use and indications for CXL will only expand as we use it not only for primary treatments but also for solidifying modified shapes as a secondary mandated procedure. For example, applying CXL, can also be done on a Keratoconic cornea treated previously with conductive keratoplasty (Class II e.).

Studies are needed for long term impact to make Stage II CXL a future mainstream application.

These very principles follow the concepts that have been brought together under Dr. Gulani’s concepts of Corneoplastique™ wherein topical, brief, elegant, aesthetically pleasing, least invasive surgeries are used singly or in stages towards a goal of unaided emmetropia. Corneoplastique™ prepares for the final fine tuning using the Excimer Laser towards a visual goal where early rehabilitation and aesthetic outcomes are essential, with promising uncorrected visual acuity.

Safety and individual case selection criteria are mandatory, in such customized approaches to Keratoconic cases.

Dr. Gulani recently published a book chapter on CXL (Ref 2 &3) and has shared his concepts and innovative thoughts for fellow eye surgeons worldwide as the arrival of CXL opens new avenues and consolidates previously configured approaches to effectively address this relentless disease.

New Keratoconus related Publications of Dr.Gulani:

1. Gulani AC, Gulani AC, Holladay J, Belin M, Ahmed I. Future Technologies - Pentacam Advanced Diagnostic. In Experts Review of Ophthalmology - London (in Press).

2. Gulani AC, Nordan L. Advances in Corneoplastqiue: Art of Laser Vision Surgery.

Mastering Corneal Collagen Cross Linking Techniques. Textbook of Ophthalmology. JP Inc. 2009; 56-63, 11.

3. Gulani AC, Boxer Wachler B. ReShaping Keratoconus: laser PRK followed by Corneal Cross Linking. Mastering Corneal Collagen Cross Linking Techniques. Textbook of Ophthalmology. JP Inc. 2009; 120-131, 19.

4. Gulani AC. Irregular Astigmatism: Management in Unstable Cornea

Textbook of Irregular Astigmatism. Slack Inc. 2007; Slack Inc

5. Gulani AC. Laser Vision Surgery for Keratoconus
Textbook of Keratoconus. Slack Inc. 2009; Slack Inc (in Press)