Eyeworld

85 EW FEATURE September 2016 • Corneal collagen crosslinking Contact information Hersh: phersh@vision-institute.com Holland: simon_holland@telus.net Kanellopoulos: ajk@brilliantvision.com Stein: Raymondmstein@gmail.com Xtra in hyperopic patients. He and co-authors have reported since 2011 long-term stability of the corneal steepening achieved with hyperopic LASIK in the eyes that had hyperopic LASIK Xtra. The LASIK Xtra eyes proved more stable over the first 2 years following their correction compared with the contralateral eyes that had hyperopic LASIK alone. The latter eyes showed progressive flattening over 1 to 2 years of 1 to 2 D and recurrence of hyperopia. Dr. Stein said he does not perform LASIK and concomitant ad- junct CXL. "The incidence of ectasia is rare today with proper screening that evaluates the anterior curvature, posterior elevation, and a corneal thickness map. On cases of question- able keratoconus in patients over 40 that have thick corneas, I perform PRK and limited CXL," he said. Further studies should focus on the clinical situations in which LASIK Xtra would be most helpful, Dr. Hersh said. CXL and radial keratotomy The use of radial keratotomy (RK) and CXL does seem to provide some stability in diurnal fluctuation, Dr. Kanellopoulos said. "In cases where a through-cornea incision and a large epithelial plug are present, the actual CXL treatment may exagger- ate the hyperopic effect by 'stretch- ing out' the cornea incisions, which may be considered a disadvantage as far as the refractive error," he said. However, the stabilization in diurnal fluctuation can be a first step to fol- low a PRK or LASIK procedure that would further correct the refractive error. Dr. Kanellopoulos acknowl- edged that this can be a challenging patient set. "Our results with follow-up of up to 9 years have been highly variable," Dr. Stein said. "The best outcomes are in patients who have had four to eight incisions. In gener- al, patients with 12 to 16 cuts do not do well with CXL in stabilizing their diurnal fluctuation." The use of RK with CXL is also not approved in the U.S., Dr. Hersh said, and would benefit from further study regarding its potential effec- tiveness. EW Editors' note: Dr. Hersh has financial interests with Avedro. Dr. Holland has financial interests with Alcon, Allergan (Dublin), and Clarion Medical Tech- nologies (Cambridge, Ontario). Dr. Kanellopoulos has financial interests with Alcon, Allergan, Avedro, and other ophthalmic companies. Dr. Stein has no financial interests related to his comments. Reliance products are manufactured in the U.S., using parts and materials from over 150 U.S. suppliers. Our reliance on the American worker, American craftsmanship, and the American work ethic is the reason you're able to depend on Reliance products for unmatched durability, stability, and comfort. And it's why every chair and stool we build, makes America stronger, too. Learn more at BuiltToSupport.com 800-735-0357 © 2016 Haag-Streit USA. All Rights Reserved. EVERY CHAIR WE MAKE SUPPORTS 130,000 U.S. WORKERS. Built to support your patients, your practice and an entire country. Visit us at AAO Booth #2319 R E M A R K A B L E . R E L I A B L E . R E L I A N C E .

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