Eyeworld

83 EW FEATURE September 2017 • Update on crosslinking Contact information Carlson: alan.carlson@duke.edu Holland: Eholland@holprovision.com more of a central cone, less scar- ring, less severe steepening. There's certainly evidence that long-term contact lens use can induce ectasia." Dr. Holland performs serial to- pography every 6 months post-cross- linking for the first couple of years to make sure there is no change in astigmatism and steepening. In such cases, he would perform a second crosslinking procedure if the patient shows evidence of recurrent ectasia. Further issues Among dietary considerations, Dr. Carlson noted the cornea has the highest concentration of vitamin C, and he has been recommending 500 mg of vitamin C daily for any patients undergoing corneal surgery. The only other issue surround- ing crosslinking patients that Dr. Carlson noted is that it is important to not let them become "corneal cripples." "What I mean by that is that it is common for these patients to have never heard of the disease prior to their diagnosis," Dr. Carlson said. "Then they are told it is genetic, yet only 7% of keratoconus patients have a family member with the same diagnosis. They can feel alone, isolated, and even defined by their disease. It can impact their world view, their job, sports, hobbies, and social interactions. It is extremely important to emphasize that we have major advances surgically and non-surgically that can benefit their condition and quality of life." EW Editors' note: Dr. Carlson has financial interests with TearScience (Morrisville, North Carolina). Dr. Holland has no financial interests related to his comments. Poll size: 102 Regarding patient selection in crosslinking, which statement do you agree with? If my 14-year-old child had keratoco- nus I would want him/her crosslinked immediately versus waiting to show more progression. Crosslinking is approved for age 14 and above but if it were my 12-year-old child with documented keratoconus, I would want him/her treated as soon as possible. Crosslinking does not help older patients as much as younger patients. All of the above Treatment modalities being evaluated to improve effectiveness or expand options in crosslinking that interest me are: Epithelium-off versus epithelium-on crosslinking Higher energy (fluence) treatment options to shorten the duration of crosslinking, which can now take more than an hour to complete Pulsed UV light treatments to allow replenishment of oxygen and improve the efficiency of crosslinking Crosslinking as a refractive surgery procedure All of the above None of the above

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