Eyeworld

Getting into crosslinking Refractive surgeon sees crosslinking as 'a less invasive way to treat keratoconus and post-refractive ectasia' A s a cataract and refractive surgeon, Phillips Kirk Labor, MD, Eye Consultants of Texas, Grapevine, Texas, learned about crosslinking from the inventor himself, Theo Seiler, MD, PhD. Dr. Labor was in Zurich, Switzerland, visiting Ziemer Ophthalmic Systems (Port, Switzerland) in the early 2000s to learn more about a femtosecond laser he was hoping to bring into his practice in the U.S. and met with Dr. Seiler who was using this laser in refractive surgery. It was then that Dr. Seiler mentioned the work being done in crosslinking. Dr. Labor would go on to become part of the Avedro (Waltham, Massachusetts) clinical trials. "It peeked my interest, coincidental to a visit with Theo Seiler for another reason," Dr. Labor said of crosslinking, seeing it as "a less invasive way to treat keratoconus and post-refractive ectasia, which as a LASIK surgeon is very interesting and important to me, as is keratoconus, which I would see from time to time here." Not having fellowship training in cornea was not a sticking point for Dr. Labor in getting into crosslinking. He thinks ophthalmologists with cornea fellowships might have an edge in some of the intricacies of corneal disease as well as relationships with others in the field who could be useful resources for bringing this procedure to patients, but he doesn't see it as a restrictive point for the general ophthalmologist. "The procedure itself is not particularly difficult, and I think anyone who has a real interest in this could easily get into it," Dr. Labor said. What's more, refractive surgeons might be able to draw on their knowledge from that subspecialty as well. "From the standpoint of understanding what post-refractive ectasia looks like topographically, I think that's important. If you're doing a fair amount of laser vision correction, ultimately you're going to run into that, whether it's your patient or someone else's. The ability to recognize that and follow it to see the degree and rate of progression is important. That same logic applies to keratoconus," Dr. Labor said, adding if you're familiar with PRK, the epithelial debridement for epi-off crosslinking won't be foreign to you. Dr. Labor said he's brought a pain management technique from his PRK protocol into his crosslinking practice, applying what he calls a "balanced salt solution popsicle" on the cornea for a few seconds after the procedure. Dr. Labor said he thinks learning crosslinking has given him "another arrow in the quiver" on multiple fronts, including treating post-refractive surgery ectasia and possibly coupled with refractive surgery in the future. "It gives some degree of reassurance, knowing that if we run up against something like [ectasia,] we can deal with it. I've always been of the opinion that if you're an operating surgeon and you create a complication, you need to be able to deal with that complication, but the qualifier to that is to the extent that it makes sense," Dr. Labor said. He also said he is interested in crosslinking coupled with PRK, but he's waiting to see more results come out with that technique before beginning it in his own practice. EW Editors' note: Dr. Labor has no financial interests related to his comments. Contact information Labor: plabor@eyecontx.com

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