One of the most exciting things to come out of keratoconus research in the past ten years was the discovery that corneal cross linking stopped the disease in its tracks. This treatment has progressed to become the gold standard.
It is popular and effective for progressive keratoconus management (when used appropriately), but there’s a lot involved in the procedure and in the recovery, as this article explores.
What’s involved in corneal cross linking surgery?
If you’re a parent who is eager to have your child undergo this procedure, you need to understand what’s involved in both the procedure and the recovery.  This is not like having your photo taken. It is an invasive procedure that – like all corneal surgery – carries all the usual risks. It is usually performed by a corneal surgeon. You / your child may only need a treatment on one eye, depending on the unique case, but if you are having it on both eyes, they will usually be done at least one month apart.
The treatment is usually done in a hospital or day surgery facility, in a sterile environment. This is essential for minimising the risk of infection. The eye is prepared for surgery by disrupting the top layer of the cornea to allow the treatment to work on the underlying layers. Then a solution of Riboflavin is applied to the eye under UV light from a visor. This is the longest part of the procedure.
Does corneal cross linking hurt?
It shouldn’t hurt during the procedure, as the eye is thoroughly numbed, but it is normal for the eye to be very sensitive afterwards. The first 6-8 hours in particular after surgery are very uncomfortable, so it is really important to know this in advance and be prepared for it.  A special contact lens is usually worn for a few days. This serves a few functions; it protects the eye, it assists with the regeneration of the corneal surface and it reduces discomfort and sensitivity.  Once the top layer of the cornea has replaced itself, the discomfort is greatly reduced. Your surgeon will also provide you with eye drops to manage the discomfort and oral pain-relief medication.
What can I do to help my recovery?
The success of any surgical procedure depends on the recovery just as much as the procedure.
- REST:  The main thing you need to do is rest. Vision will be blurry for a while, so it’s difficult to read or watch TV. Most patients like to sleep or listen to music. Let the eye heal and don’t touch the contact lens.Â
- AVOID INFECTION: Â In order to reduce the risk of infection, it is important to avoid contact with water for the first few days in particular (until your eye has healed). Â Your surgeon will be in the best position to advise you how long you should wait before swimming or performing heavy exercise. It is also essential to use your antibiotic drops as indicated.Â
- MANAGE PAIN: Especially in the first day or two, stay on top of the pain. Use eye drops and take oral analgesics as advised by your surgeon.
What can I expect after corneal cross linking?
It is really important that you understand that cross linking won’t make the vision clearer. In fact, it may be worse due to residual haze in the cornea for up to a year after treatment. Why have it then? You might ask. Good question. The fact is that corneal cross linking has been clearly shown to decrease the risk of corneal transplant. The younger you are when your keratoconus is diagnosed, the more rapidly your disease will progress and the sooner you will need a graft. Any treatment that avoids corneal transplant is good news.  You’ve got to take the long term view here: vision may get temporarily worse, but it will improve slowly over the next year and – if you’ve had an effective treatment – the disease will have been halted or greatly slowed in its progression.
How do I choose a surgeon for cross linking?
Talk to your keratoconus specialist about an expert and experienced surgeon for your treatment. At The Eye Practice, we see keratoconus patients every day and we regularly refer patients for cross linking.
