NOV 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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November 2013 Corneal crosslinking Pre-crosslinking treatment EW FEATURE 51 Post-crosslinking treatment. Note the flattening of steep K with stabilization of the cone. Average keratometry is unchanged. Source (all): Sumit Garg, MD sion. This is why patients should know about progressive keratoconus symptoms, such as vision deterioration with increased astigmatism, a change in prescription, contact lens intolerance, and overall poorer visual distortion and vision function. The standard follow-ups at six and 12 months will help verify that keratoconus progression slowed, Dr. Rootman said. Epi-on and epi-off The surgeons interviewed by EyeWorld support their respective surgical approaches as a way to avoid unnecessary complications. Drs. Garg, Raizman, and Rootman use the epithelium-off approach (also called epi-off). "The vast majority of cases and almost all the medical literature relates to treatment with the epithelium off," said Dr. Raizman. "Recent efforts to achieve effective crosslinking without removing the epithelium show that this will likely be successful in the future, but more clinical trials are required to determine the best approach." Higher light energy and enhanced riboflavin delivery to the corneal stroma will be needed to achieve the optimal results obtained with epi-off, Dr. Raizman added. "I have seen several unfortunate young patients who had crosslinking without epithelial removal and then had rapid ongoing progression of their keratoconus. This is almost never seen with epithelium-off crosslinking," Dr. Raizman said. Dr. Pinelli performs the transepithelial technique, which allows CXL to be performed more quickly and does not involve removal of the epithelium. Dr. Pinelli uses the transepithelial technique with ParaCel (Avedro, Waltham, Mass.). EW Editors' note: Dr. Garg has financial interests with Abbott Medical Optics (Santa Ana, Calif.). Dr. Pinelli has financial interests with Avedro. Dr. Raizman has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), Avedro, and Bausch + Lomb (Rochester, N.Y.). Dr. Rootman has no financial interests related to this article. Contact information Garg: gargs@uci.edu Pinelli: pinelli@ilmo.it Raizman: mbraizman@eyeboston.com Rootman: d.rootman@utoronto.ca Poll size: 213 EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send a four-question online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the current 1,000+ physicians who take a minute a month to share their views, please send us an email and we will add your name. Email daniela@eyeworld.org and put EW Pulse in the subject line—that's all it takes. Copyright EyeWorld 2013

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