What is Keratoconus?

Keratoconus is a progressive condition affecting the cornea of the eye. The cornea is the clear window at the front of the eye. It is a curved structure. The precise shape of the curve allows it to act as a lens, projecting an image into the eye. The cornea is made up of bundles of protein called 'collagen'. These bundles are normally held tightly together by chemical links between the collagen strands. This ensures that the shape of the cornea is constant. In the keratoconic cornea the normal chemical links between collagen strands are deficient, causing the cornea to be unusually elastic. The pressure inside the eye then pushes the cornea into a distorted, conical shape. This spoils the quality of the image projected into the eye, and the vision becomes progressively blurred.

This browser cannot play the embedded video file.

Keratoconus affects about 1 in 3000 people.

How is keratoconus treated?

Glasses may be sufficient in the early stages of keratoconus, but contact lenses are needed when the cornea becomes so misshapen that glasses are no longer effective in correcting vision. 

Gas-permeable hard lenses are not always comfortable and may only be worn for only a limited number of hours each day. However, there are now soft contact lenses and hybrid lenses (a mixture of hard and soft material) that are designed for keratoconus and which can offer better comfort. Mr Bailey offers the latest lenses available in this rapidly changing field.

If the keratoconus is not too advanced, we offer CXL / C3-R (collagen cross-linking with riboflavin), a non-surgical treatment that can stop keratoconus from progressing. CXL stabilises the corneal shape in 97% of cases and can even improve the vision in about 50%. CXL treatment for keratoconus can maintain good spectacle vision, preventing the need for contact lenses, or prevent further deterioration in those already dependent on contact lenses.

In advanced cases of keratoconus, the corneal shape becomes too distorted for contact lenses to work, and scarring may develop that makes the vision clouded. At this stage, a corneal transplant is usually needed. Corneal transplantation is quite major surgery and carries significant risks. The optical outcome is uncertain, contact lenses are still needed afterwards in most cases and the transplant may have to be repeated every 10 to 15 years.

Timely treatment with CXL can prevent the need for corneal grafting.

How does CXL help?

Corneal collagen crosslinking with riboflavin causes the formation of normal chemical links between the collagen protein strands in the cornea. This makes the cornea more rigid and can stop the keratoconus from progressing. The treatment may even cause the keratoconus to reverse to some extent.

CXL may prevent the need for contact lenses if performed early on. Even where contact lenses are already needed, CXL can eliminate the need for corneal transplantation. No other treatment for keratoconus can offer this; CXL is unique.

Current evidence is that the effects of treatment are permanent.

Who is suitable for CXL?

Anyone with progressive keratoconus is potentially suitable. Patients with very advanced keratoconus or whose vision is already spoiled by scarring will usually not be good candidates for the procedure.

The earlier the treatment is done, the better, but CXL can still be beneficial decades after keratoconus has begun to develop. To find out how you might benefit from corneal collagen crosslinking with riboflavin (CXL), contact our London practice today.

How is CXL keratoconus treatment performed?

At our practice in London, CXL keratoconus treatment is a safe, painless, out-patient procedure. Our new method of CXL treatment means that there is minimal discomfort afterwards; maybe a slight feeling of grittiness for the first 24 hours. The treatment involves absorbing riboflavin eye-drops into the cornea and then bathing the surface of the eye in a very specific wavelength of light. The combination of the light and riboflavin causes chemical bonds to form within the cornea, increasing its rigidity and stability.

The whole process takes about one-and-a-half hours. After the procedure, a protective soft contact lens is worn for about 48 hours, and eye drops need to be instilled four times daily for five days and then twice daily for the next four weeks.

The technical specifications of CXL instruments vary, particularly in their ability to provide even illumination at the cornea. Mr Bailey has carefully chosen what he considers to be currently the best equipment for the CXL procedure.

How can I schedule an appointment?

If you have any questions about corneal collagen crosslinking with riboflavin (CXL), please contact our London practice and schedule an appointment to discuss this advanced keratoconus treatment method with Mr Steven Bailey. Please fill out our online form or call Jennie on +44 (0)7973 691727.

C S Bailey BSc FRCS DO CertLRS, 99 Harley Street  London W1G 6AQ. Tel: +44 (0)207 935 1010  Fax: +44 (0)20 7084 7729