EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/276058
eye treated and come back for the second. He added that it is impor- tant to look at more results, and perhaps getting patients crosslinking treatment earlier could prove benefi- cial. EW Editors' note: Dr. Holland has no financial interests related to this article. Contact information Holland: drsimonholland@gmail.com EW REFRACTIVE SURGERY February 2011 77 March 2014 Introducing the Latest Innovation in Single-Use products Beaver-Visitec International, Inc. | 411 Waverley Oaks Road Waltham, MA 02452 USA | BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of a Beaver-Visitec International ("BVI") company © 2014 BVI For more information, call 1.866.906.8080 or visit us at www.beaver-visitec.com Visitec ® Capsulorhexis Forceps Single-Use Solution Reduces risk of cross-contamination Consistent performance with every surgery Sterile and ready to use • Consistent performance • Excellent visibility • Optimum control Designed to fi t a 1.8 mm Micro Incision Available on the shelf as you need it, or in your Readypak™ for every surgery! simultaneous crosslinking W hy combine topography- g uided PRK and crosslinking? Dr. Holland spoke about using t opography-guided PRK with crosslinking and what still needs to be explored. PRK has been used for keratoconus since the introduction of the excimer laser in Canada. However, it was more for nodules that would occur at the apex of the cone in an effort to flatten the cones out so patients could tolerate their c ontact lenses. He said that the worry of an already thin cornea was very prevalent in these types of procedures. With the advent of crosslinking, physicians realized that they could take more tissue off with PRK, knowing that they would have the remaining corneal strength, he said. "We started doing a lot with topog- raphy-guided because that would improve the shape beyond what we could get with the standard treat- ment," Dr. Holland said. Kerato- conus is particularly appropriate for this technique. "This topography- guided technique allows us to im- prove both the shape and the power of the cornea." But it remains a fairly controversial topic. Acceptance of the combination Dr. Holland said that for people to accept the combination of topogra- phy-guided PRK and crosslinking, it needs to be shown that more kerato- conus or ectasia is not being induced by the technique. For some patients, even with crosslinking alone, they continue to progress, but as long as they can show safety, that's the most important aspect, he said. Which patients would benefit most? Dr. Holland said it seems that the earlier a patient is treated with the combination of topography-guided PRK and crosslinking, the better the result. "I think the extreme patients don't do that well," he said, mean- ing that those with a lot of scarring or who have already progressed with keratoconus may not respond as well to treatment. Additionally, for those with very thin corneas, there may not be many options in terms of refractive treatment. "There [are] some patients who can progress quite rapidly." Dr. Holland said that he has been surprised at the rate of progression in some patients who have had one 76-87 Refractive_EW March 2014-DL_Layout 1 3/6/14 3:17 PM Page 77