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4 Questions with a Cross-Linking Expert

Expert Chats

Corneal cross-linking, a minimally invasive, in-office procedure, is the only treatment that can slow or stop the progression of keratoconus—an eye disorder that was once thought to be untreatable. Mass. Eye and Ear cornea specialist Joseph Ciolino, MD, answers four common questions about the treatment option.

What is keratoconus?

Keratoconus is a degenerative eye condition in which the cornea–the outermost layer of the eye–becomes thin and irregularly shaped like a cone. It can affect adults and children as young as preteenagers, and result in progressive vision loss if left untreated.

“Many patients with keratoconus, particularly in the early stages, are able to manage their symptoms with glasses or specially fitted contact lenses,” says Dr. Ciolino. “But if the disease continues to worsen, corneal cross-linking is the best option to stop the progression and preserve the patient’s vision.”

How does corneal cross-linking work?

During the procedure, liquid vitamin B2 is placed in the eyes and exposed to ultraviolet light to reinforce the collagen fiber crosslinks. This strengthens the cornea and helps it to keep its shape.

“Think of the cornea as a trampoline. The collagen fiber crosslinks are like the coils that keep a trampoline tight and flat. When the coils weaken, the trampoline begins to lose its shape—much like the cornea does with keratoconus,” explains Dr. Ciolino. “By strengthening the collagen fiber crosslinks, we’re able to stop the keratoconus from progressing and causing further vision loss.”

Before cross-linking, few treatment options were available to patients,” says Dr. Ciolino. “Today, we’re very fortunate to have a more effective treatment that can help halt vision loss at an earlier stage and dramatically improve our patients’ quality of life.”

What treatment options are available at Mass. Eye and Ear?

Mass. Eye and Ear was one of the first U.S. hospitals to offer corneal cross-linking after it was FDA-approved for keratoconus in 2016. Today, it’s still one of just a few hospitals in New England that performs this outpatient procedure.

“At Mass. Eye and Ear, we have state of the art tools for imaging the cornea – this helps us to confirm the diagnosis of keratoconus, determine disease progression and follow the effectiveness of corneal cross-linking,” says Dr. Ciolino.

Who is a candidate for corneal cross-linking?

“Anyone with keratoconus who is at a high risk for progression is a candidate for corneal cross-linking,” says Dr. Ciolino. “Patients who are diagnosed at an earlier age are more likely to see progression, so doing the procedure sooner helps to preserve their vision.”

Those who are newly diagnosed with keratoconus should visit their ophthalmologists regularly, so that any progression can be closely monitored. Patients who aren’t experiencing disease progression may be prescribed glasses or custom-fit contact lenses to help them see clearly. Patients who have undergone corneal cross-linking may also be prescribed glasses or contacts to help with earlier vision loss.

A consultation may be scheduled with a Mass. Eye and Ear corneal cross-linking specialist by calling 617-573-3202 (Mass. Eye and Ear, Main Campus) or 781-890-1023 (Mass. Eye and Ear, Waltham).

About Our Expert

Dr. Joseph B. Ciolino is a clinician scientist and a member of the Cornea Service at Mass. Eye and Ear. His clinical focus is in corneal transplants, corneal cross-linking and diseases of the anterior segment of the eye. Dr. Ciolino sees patients at Mass. Eye and Ear, Main Campus.

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