The second day of the refractive subspecialty meeting covered many topics including diagnostic equipment and ectasia. The most exciting developments centered on corneal crosslinking.
In corneal crosslinking (CCL), riboflavin drops are applied to the patient’s corneal surface (there is debate as to whether the epithelium needs to be removed before this step). Once the riboflavin has penetrated through the cornea, noted by anterior chamber flare, UV light therapy is applied. This induces collagen crosslinking, which has been shown in several studies to stabilize corneal ectasia. In few cases, flattening of the Ks with improved visual acuities have actually occurred.
Will this be the end of corneal ectasia? Probably not. There are limitations to the treatment, including the degree of ectasia and cornea thickness. However, it certainly provides a new hope for those unlucky patients with weakened corneas. Unfortunately, this technology is not currently approved for use in the United States.
On that note, I would like to share the results of a small study by Hans Brandl presented at the cornea crosslinking society meeting in Zurich; several patients with keratoconus were instructed to take 20 mg of oral riboflavin every day and spend 2-3 hours outside without sunglasses for eight weeks. Over a follow up period of 2-8.5 years, none of the patients had progression of disease. While his study has several limitations, oral riboflavin poses almost no risk to the patient. Thus, I have been recommending oral riboflavin supplementation for all patients I see with keratoconus or corneal ectasia.