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different picture, said Janet Cox, CPC, Director of Billing and Coding at Vance Thompson Vision. Now that there is a specific J-code that became effective in January 2019 for the drug component, more than 95% of commercial insurance covers the iLink procedure and reimbursement has caught up to coverage. That means patients are better able to afford the procedure, and billing and coding for the practice team has been streamlined. Education is a key factor in keratoconus and the cross-linking proce- dure. Michael Greenwood, MD, suggested social media, patient seminars, and events for referring eyecare providers as ways to ensure both doctors and patients have the tools and information they need to address this disease. Russell Swan, MD, stressed the importance of education and early detection in keratoconus. He said that one of the critical points is to help referring doctors in your region understand what to expect in children with astigmatism. It's important to raise awareness about the need to obtain topographies in these patients for early detection, he said. Matt Jensen, CEO of Vance Thompson Vision, also spoke about edu- cation, specifically touching on collaborative care between ophthalmology and optometry. Sending out communications on research, studies, and what's in the pipeline is important. "Corneal collagen cross-linking is an amazing treatment, and it has answered an unmet need to strengthen weak corneas," Dr. Thompson said. "Let's diagnose those corneas before they cause permanent sight damage, and let's ask patients about eye rubbing and help lead behav- ior modification. The more we find these faults in their teens and 20s, the greater visual life they'll have. Let's advocate for early diagnosis, cross-linking, and behavior modification coaching," Dr. Thompson said. To watch the full two-part webinar on EyeWorld Corporate rePlay, go to corporate.ewreplay.org. CORNEAL CROSS-LINKING: Your Practice Your Region Sponsored content A two-part webinar from Vance Thompson, MD, and his colleagues at Vance Thompson Vision covered how to think about cross-linking as a whole and how to fit it into your practice. "Cross-linking is so important in a ker- atoconus patient's care because everything after that is just going to be more and more invasive," Dr. Thompson said. Keratoconus is more common than doctors may think, and early intervention is key. It can't be reversed, but cross-linking can slow or halt progression. According to Mitch Ibach, OD, the management of progressive keratoconus is a much different game now in 2020 then it was in 2010. "Cross-linking has made this a much more interventional disease," he said. Characteristics of keratoconus include an unstable cornea that becomes progressively thinner and steeper, refractive change, increase in myopia and astigmatism, and loss of BCVA. It most commonly presents in the late teens and early 20s. The cross-linking procedure requires three main components: riboflavin, UVA light, and oxygen. In the U.S., there is only one FDA-ap- proved approach, the iLink cross-linking procedure from Glaukos. Daniel Terveen, MD, discussed cross-linking studies from around the world, pointing specifically to the Phase 3 clinical trial in the U.S. for the iLink procedure. The study was well designed and achieved the primary end- point (difference in Kmax value) for both the progressive keratoco nus and corneal ectasia following refractive surgery treatment groups having cross-linking compared to the control group. "Cross-linking can slow or halt progression of corneal ectasia and keratoconus, and that's why it's important to catch and treat these patients early," he said. Brandon Baartman, MD, spoke about the iLink FDA-approved procedure for progressive keratoconus and corneal ectasia following re- fractive surgery. He said you may want to avoid cross-linking in those with severe corneal scarring or opacity, neurotrophic keratitis, autoimmune conditions affecting wound healing, active pregnancy or breastfeeding, and active corneal hydrops. Cross-linking is all about providing corneal stability, he said. John Berdahl, MD, stressed that cross-linking is a safe procedure. From the FDA studies, the adverse events profile was favorable for cross-linking, he said. You can also use different medications post-cross- linking to help manage the risk of any issues. When cross-linking was first approved, there were many challenges to face relating to reimbursement for the procedure. But now, it's a much Vance Thompson, MD Indications Photrexa® Viscous (riboflavin 5'-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5'-phosphate ophthalmic solution) are indicated for use with the KXL System in corneal collagen cross-linking (the iLink procedure) for the treatment of progressive keratoconus and corneal ectasia following refractive surgery. Corneal collagen cross-linking should not be performed on pregnant women. Important Safety Information Ulcerative keratitis can occur. Patients should be monitored for resolution of epithelial defects. The most common ocular adverse reaction was corneal opacity (haze). Other ocular side effects include punctate keratitis, corneal striae, dry eye, corneal epi- thelium defect, eye pain, light sensitivity, reduced visual acuity, and blurred vision. These are not all of the side effects of the corneal collagen cross-linking treatment. For more information, go to www.livingwithkeratoconus.com/ to obtain the FDA-approved product labeling. You are encouraged to report all side effects to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Photrexa® Viscous and Photrexa® are manufactured for Avedro. The KXL System is manufactured by Avedro. Avedro is a wholly owned subsidiary of Glaukos Corporation. ©2020 Glaukos Corporation Copyright 2020 ASCRS Ophthalmic Corporation. All rights reserved. The views ex- pressed here do not necessarily reflect those of the staff and leadership of EyeWorld and ASCRS, and in no way imply endorsement by EyeWorld and ASCRS. Sponsored by MA-02058A

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