In this video we're going to review the corneal collagen crosslinking treatment for keratoconus
to do this we're going to head over to meet with one of the world's leading corneal surgeons
for this procedure Dr Mark Lobanoff of OVO Lasik and Lens, where we can break down how
corneal cross linking works what the procedure looks like from both the doctors and the patient's
perspective as well as answering some of the most common questions about the cross-linking procedure
so blink your eyes a few times hit that like button and let's take a look
hello and welcome this is Dr Joseph Allen here from the doctor eye health show and i'm super
excited today because we're here at OVO Lasik & Lens the home base of Dr. Mark Lobenoff a world
renowned corneal specialist and surgeon who specializes in all forms of refractive surgery
including LASIK, specialized cataract surgery, icl implants and corneal collagen cross-linking for
keratoconus, which we're going to be talking about today. So again huge honor for me,
thank you Dr. Lobanoff how are you doing today? I am doing fantastic thank you for coming to visit
us we really appreciate it dr lobanoff you've been working with so many patients uh for so long
with corneal collagen and crosslinking in your own words would you mind sharing with our viewers what
is corneal collagen crosslinking and how does it work? So I had trained in a corneal fellowship
and my specialty was cornea and for years we were treating keratoconus with corneal transplantation
and it worked but it's a big surgery and suddenly we started hearing from our European colleagues
that there was a new treatment a new way of halting the progression of the disease called
corneal crosslinking and for over a decade we were jealous because suddenly they had this new
technology to really treat this disease in a non-surgical way in less invasive way and halt
the progression of that disease finally came to the united states and so we have this here
corneal crosslinking fixes the defect in the cornea so in keratoconus patients have a cornea
that has become weakened it's become thinned and there's a weakness in the structure of that
tissue and as it becomes weaker and thinner it bulges outward into a cone and by bulging forward
it really creates an irregular surface and distorts the vision suddenly glasses don't
work soft contacts don't work anymore and patients really struggle more and more with their vision
so the concept behind crosslinking is to take that weak cornea and make it stronger
form new chemical bonds between the fibers within that cornea strengthening it halting
the disease stopping it now what's really cool about crosslinking is that there are there's
always new inventions new ways to do things and one of the reasons we're here with dr lobanoff
is because he is one of the leading surgeons in the world creating new parts of this procedure to
really help patients so let us know dr lobanoff what are you doing differently when it comes to
cross-linking so for the cross-linking procedure itself again keratoconus cone on the cornea and
if you think about it we want to apply riboflavin vitamin solution we want to saturate that cornea
the weakest part of a cornea with keratoconus is the tip of the cone
so traditionally you put the drop on and the drop would roll off that cone so the part of
the cornea you want to have the riboflavin the most has it for the least amount of time
so I said we can improve on this and so i built a device and it's a silicone well that sits on
the cornea and you can submerge the entire cone and the whole cornea in the riboflavin
and this way you can saturate the cornea in about one third of the time so 10 minutes instead of 30
and you know that critical cone is getting the adequate riboflavin so that's one change
this device is undergoing evolution and one of the things that limits the reaction for crosslinking
is oxygen and so as we apply the ultraviolet light and it starts triggering the crosslinks
it uses up the oxygen in the cornea really fast so the next iteration of this device
is going to be able to pump in 100 pure oxygen while the ultraviolet light is being applied
to help improve that cross-section reaction so that's coming as well wow uh that's just amazing
again you're pushing the envelope and really like changing the future of treatment for keratoconus
probably another big part of this is the beauty of crosslinking is it stops the disease process
it halts it but if all we do is crosslink we have left the cornea in this abnormal shape
so the other area of research that i have is topography guided prk using topography guided prk
to fix this mountain fix this cone with a laser and then lock that in place with the crosslinking
we've been doing this for about six years now 100 of our patients show improvement and uncorrected
and corrected vision with this so we're very excited about it so this is more or less not
just a way to slow down and halt the progression of of keratoconus but you are finding a way to
enhance someone's vision roll back the damage restore clarity division uh get this
eye to see clearly once again and so patients are ecstatic that they can say not only can i
stop my disease but i can see better again that's a really powerful thing to offer well amazing at
what you're doing again huge honor that to be here with you so this is cool thank you guys
now next up is that we have a patient here that's going to be getting the cross-linking procedure
done and he's volunteered to let us videotape it and so dr lobanoff is going to walk us through
some of the major steps of the procedure so that if you a friend or a family member is having this
procedure you know what to expect all right so the first thing we're going to do is we're
going to apply some numbing drops we want to make sure you are as comfortable as possible
and we'll let these soak in our next step we're going to gently move the eyelashes out of the way
and then this device here you're going to feel a little gentle pressure in the lids this gives us a
little space to work in now what we're going to be doing is we're going to be applying the riboflavin
and we want to saturate the cornea with the riboflavin so this device is going to be
applying a little bit of pressure very light and we'll be having this in place now here for a while
so we'll have a countdown for you so we've let the riboflavin sit in place here for 10 minutes
the cornea is fully saturated we've got this great yellow saturation glow that we're looking for now
the critical step is applying the ultraviolet light and it's the ultraviolet light here that's
going to trigger the chemical reaction that we want so right above you is a greenish looking
light we're going to be setting this into position we'll just have you continue to watch this light
and there'll be a timer as we count down for this all right we've just finished the application
the ultraviolet light we're going to put in a few drops for you put on a contact lens so that you're
more comfortable as you heal and congratulations you've done a great job all right so now after
the procedure we know so many of you are going to have a lot of common questions as we get them all
the time but let's just run through some of the common q a that we often get so one of the biggest
ones here is first like how long of a procedure is cross-linking what is it going to be like
uh sitting there typically how long does it take so typically crosstalk will think about an hour
and the first step is saturating the cornea with a vitamin solution called riboflavin and then once
that cornea is saturated with the riboflavin the second step is applying ultraviolet light and so
here in the united states typically patients can count on being in the room for about an hour
is it always done with both eyes do you ever do just one eye i usually do one eye
and here's why when i first began doing this i was really excited patients were excited
i did both eyes not realizing that there is a recovery period and the vision can be very
blurry for the first one to two weeks if you do that to both eyes you're really out of commission
you can't see your phone you can't watch tv you can't drive and so what we realize is most
patients prefer to have one eye done we treat the eye we let them heal let them recover their vision
and then when the patient says you know what i'm ready then we tackle the second eye that's
perfect because that also answers that that next question of like what will vision afterward be
like so it's going to be a little blurry for a few weeks it's it's important to set that expectation
we are performing a procedure that is strengthening the cornea we're stopping a disease
but it also means because of that treatment vision's very blurry the first two weeks
you just have to bite the bullet and know yup my visions can be very blurry while it heals
during the first two weeks and then we turn the corner and vision begins improving again
so i know a lot of people will ask me like okay am i gonna be on medications afterward am i using
just eye drops uh what kind of medications are they gonna be using after the procedure
so we start with over-the-counter ibuprofen and we use a fairly good dose of that 800 milligrams
to begin with and then come down to about 600 milligrams taper down to 400 milligrams we also
give prescription pain meds for the first two days we know these patients without that pain
medication there's a chance they're going to be in pain we don't want our patients
to suffer we will cover that pain we want them to know and rest assured we've got their back
beyond the first two days though they really don't need that and over-the-counter pain medications
take care of that we also use prescription drops so patients are on a mixture of drops and
antibiotics prevent infection steroids to prevent inflammation and that also helps with some of the
discomfort uh sometimes we'll use a non-steroidal anti-inflammatory like keto elect drops
and then good old artificial tears just keeping things hydrated now some people do ask you know
what are the complications what are the risks is there is there anything that could go wrong
anything like that in your experience fortunately the risks seem to be pretty low but this is
a procedure and some of the risks that you might want to think about is you can create some corneal
haze so we're taking corneal fibers and we're creating chemical bonds between those fibers and
as the bonds become stronger they pull the fibers closer together in some patients that can create
some haze in the cornea fortunately it's pretty mild most patients don't know they even have it
but in certain cases it can be more intense we're always worried about infection and that's why
we're providing the antibiotics trying to prevent infection but it's important for patients to also
take control that too so making sure they're in a clean environment the first week is probably
not the best time to clean out a dirty garage or dirty bar you want to avoid dust and dirt
you want to help your eye heal now i know this is a tough question but as far as a coverage for this
procedure some insurances are now covering this what's your experience been like it was really
difficult in the early days because this was new to insurance companies they didn't know exactly
how to deal with it now it's more commonplace so i would say the majority of insurance carriers
now do cover this it is a medical condition it helps prevent the progression of a really severe
disease and really helps us head off needing something as large as a corneal transplant so
i think if you are interested in this and you've got insurance one of the good things is that most
insurance companies will cover it i'd say work with your surgeon determine what the cost is in
your part of the country work with your insurance carrier and fortunately we have good coverage for
this now now of course we know that we can't address all of your questions right now but
let us know in the comment section if you do have any questions about the procedure about just your
own experience or if anybody else has already had the procedure let us know in the comments
because this is a good way to get connected with other people that are dealing with keratoconus and
are interested in cordial crosslinking otherwise a huge thank you to you dr lobanoff your staff
our patient today again can't say thank you enough for just helping us out and all of your services
it's our pleasure we're really passionate about this procedure it helps so many patients and
and you helping get the word out is tremendous so thank you now remember the corneal collagen
crosslinking procedure is really meant to slow down and halt the progression of keratoconus
and depending on somebody's condition how advanced the keratoconus is there may be different options
for vision correction to understand what options are out there or what may work for you check out
our next video in the series breaking down all of those vision correction options everything
from contact lenses to glasses even surgical procedures so to learn more about that click or
tap the screen over here to the side or check out the videos in our youtube playlist below in the
description otherwise again thanks for watching keep an eye on it and we'll talk to you soon