Eyeworld

69 EW FEATURE September 2017 • Update on crosslinking Contact information Hersh: phersh@vision-institute.com Rajpal: rrajpal@seeclearly.com Randleman: JamesBradley.Randleman@med.usc.edu Research presented by European ophthalmologists at European Soci- ety of Cataract & Refractive Surgeons (ESCRS) meetings last year reported positive results in small studies of PiXL for low myopia, according to reports from Avedro. Outside the U.S., there have been studies of LASIK Xtra (Avedro), where CXL is used in conjunction with LASIK or PRK. "There's some evidence that it allows the treatment to be more predictable and perhaps reduce the risk of ectasia," Dr. Rajpal said. Within Avedro's trials, results may come soonest from the PiXL tri- al for low myopia followed by PiXL for presbyopia, Dr. Rajpal said. CXL and infectious keratitis There's some buzz, mostly abroad, about the use of CXL for the treatment of bacterial, fungal, and Acanthamoeba infections. The results appear mixed so far. "Shallower, earlier bacterial infections appear to respond best, while fungal infections also appear efficacious. There's an uncertain impact on Acanthamoeba infections," Dr. Randleman said. "I think the results are some- what equivocal," Dr. Hersh said. "There are some reports that show it's efficacious, and other reports show no difference compared to traditional therapy." Still, he sees a lot of interest and promise in this potential use. Obtaining coverage One challenging area since the introduction of CXL in the U.S. has been insurance reimbursement. As Dr. Hersh pointed out, there are high costs involved with getting a procedure like CXL approved, and there's a relatively small subset of patients who require treatment. "Unlike a drug approval that treats millions, the number of keratoconus and ectasia patients is substantially smaller in the U.S.," he said. He also mentioned the long 8-year peri- od that was needed to reach FDA approval. "It's frustrating to us as ophthal- mologists because this is very valu- able to patients, and we want them to have good access," he said. This quandary has led to the development of the Avedro Reim- bursement Customer Hub (ARCH) program. The program helps with submission to insurance and ap- peals, and it helps patients who may not be able to afford treatment with cost issues, Dr. Rajpal said. EW Editors' note: The physicians have financial interests with Avedro. Now available in the standard software of all Pentacam ® models! Keratoconus progression can now be easily detected taking every single parameter into account, including the evaluation of the posterior cornea and the corneal thickness at its thinnest spot. Contact OCULUS today to schedule a demo! OCULUS Pentacam ® Please note: The availability of the products and features may differ in your country. Specifications and design are subject to change. Please contact your local distributor for details. Toll free 888 - 519 - 5375 ads@oculususa.com www.oculususa.com www.pentacam.com Follow us! NEW! Belin ABCD Progression Display Standard Software Now Includes Keratoconus Progression Display!

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