Corneal collagen crosslinking now FDA approved! - A State of Sight #126

We were very happy to hear this week that corneal collagen crosslinking has just been FDA approved for use in the United States. This procedure has been performed throughout the world for years.

Welcome to A State of Sight, I’m Isaac Porter and this is your update in ophthalmology and eye care from Raleigh. We are very happy to learn that the FDA has approved corneal collagen crosslinking! You can look back at episode #27 of A State of Sight about 4 years ago that covered some of the basics of the procedure. For more details, click the link here: Corneal Collagen Crosslinking.

We’ve been waiting for many years for this FDA approval, so hopefully now collagen crosslinking will become more widely available in the United States. This is a great procedure that is used to treat patients who have keratoconus or other forms of corneal ectasia. In these disorders, the cornea (which is the clear shield in the front of the eye) distorts from its natural shape which should be nice and round.

Corneal collagen crosslinking (CXL) uses riboflavin, which is vitamin B2, that is placed with drops on the cornea. Once the riboflavin solution soaks through the cornea, a UV light is directed onto the cornea. With the vitamin and UV light, the collagen fibers in the cornea become linked together to become more stiff and stable.

In patients with keratoconus, this procedure has shown great results in slowing or stopping the progression of the disease. Without treatment, keratoconus often worsens, particularly when patients are younger. After collagen crosslinking, many patients may be stabilized and avoid needing a corneal transplant later in the future. This may allow them to continue wearing glasses or contact lenses to correct their vision.

Now that it is FDA approved, we will have to wait for insurance companies to begin covering the procedure. When this occurs, we hope that more patients will be able to have crosslinking. Also, we expect that more surgeons will begin offering the procedure, making it more widely available.

Up until this point, CXL had only been available through FDA studies or in other locations used outside of FDA approval. The original method of the procedure takes about 30 minutes of UV light exposure after the cornea has been soaked with riboflavin.

In the future, researchers are studying variations using a stronger, more intense light in order to decrease the treatment time, making the operation quicker and more efficient. Another variation of the procedure is not removing the epithelium or the surface layers of the cornea. It looks like there could be quicker healing with epi-on crosslinking as long as the riboflavin can be soaked into the cornea adequately. Further studies will help ensure that this is just as effective as the original method (epithelium-off).

We are very happy that corneal collagen crosslinking is now FDA approved. If you have any questions about CXL, or if you have keratoconus, please post and we will be happy to answer them. We hope to see you again soon next time on A State of Sight.