At Stahl we offer a comprehensive approach to keratoconus. Because there is not one solution for everyone, the first step is a thorough examination by our physicians to determine which approach is best for you. And because every eye is different, at Stahl, we are committed to having state of the art technology to provide the services that will best help you. You can read about these approaches below, and your physician will describe them in more detail. As an introduction, cross linking by the Avedro system is a method to stabilize the warpage of the cornea, and in some patients, actually reverse some. Once stabilization is achieved Intacs, placed with our Intralase femtosecond laser, may be used to change the location of your cone. And finally, our contact lens department is very skilled in the fitting of scleral lenses, specialty contact lenses that have the capacity to provide excellent visual acuity. We look forward to working with you to achieve your best vision.
Corneal Collagen Cross-Linking (CXL)
Corneal collagen cross-linking (CXL) is a method used to treat keratoconus. Keratoconus is an eye condition in which the cornea (the clear surface of the eye) becomes thin and bulges outward in a cone-shape, causing blurry vision. This common disease affects about 1 in 750 Americans.
How does CXL work?
In normal corneas, there are crosslinks between the collagen fibers that keep the cornea strong and able to retain its normal shape. With keratoconus, these crosslinks are weakened and unable to keep the cornea shaped properly. This causes the cornea to bulge outward.
The aim of CXL is to strengthen these collagen cross-links, making the cornea more stable and improving focus power. CXL cannot cure or reverse keratoconus, but has been shown to stop the progression of it.
The CXL procedure is fairly simple, and is performed on an outpatient basis. Only numbing drops and a mild sedative will be used. During the procedure, the doctor will apply liquid riboflavin (vitamin B2) to the surface of the cornea, and then apply a controlled amount of ultraviolet light.
There are two basic types of corneal cross-linking:
- Epithelium-off. This type of cross-linking procedure requires the doctor to remove the thin outer layer (epithelium) from the cornea. This allows the liquid riboflavin to better penetrate the inner layers of the cornea.
- Epithelium-on. The outer corneal layer is left intact, needing a longer period of time for the riboflavin to penetrate the cornea.
Corneal Cross-Linking Technology
Stahl Eyecare Experts is one of very few practices in New York to use Avedro’s new KXL® system. This innovative technology is the only FDA approved cross-linking device for keratoconus. After extensive clinical trials, the Avedro KXL® system has proven to be extremely successful in the treatment of keratoconus.
Stahl uses the riboflavin solutions from Avedro, Photrexa Viscous® and Photrexa®, along with the KXL® system. This system offers extreme accuracy and a fully integrated platform.
Doctors at Stahl Eyecare Experts are proud to offer the Avedro KXL® technology as part of their commitment to providing only the best to their patients.
Don’t let your keratoconus worsen! If you are interested in the corneal cross-linking procedure at Stahl Eyecare Experts in Long Island, call today for an appointment.
Intacs® for Keratoconus
Intacs® are micro-thin prescription corneal inserts. These tiny, plastic semi-circular rings were previously used as a type of refractive surgery to treat low levels of myopia. The FDA recently approved Intacs® for the treatment of keratoconus. Since then, thousands of patients with keratoconus have been able to experience clearer vision!
How do Intacs® work?
Intacs® are inserted into the middle layer of the cornea. When inserted, the Intacs® help to flatten the cornea, reducing the affects of keratoconus. The placement of Intacs® aid in the reshaping of the cornea, getting rid of some of the irregularities at are caused by keratoconus.
This outpatient procedure is performed in 15 to 20 minutes, and requires little to no downtime. Your doctor will begin by applying topical anesthetic to numb the eye. A lid speculum is used to keep your eye open – so there is no need to worry about blinking during the procedure.
A single, tiny incision will be made in the surface of the cornea. This can be done either with a mechanical blade or with a laser. The surgeon will then create a “tunnel” in the corneal layers in a semi-circular shape, around the outer periphery of the cornea. The crescent shaped Intacs® are then inserted into the tunnel.
After the surgery, you will need someone there to drive you home. Most patients experience sharper vision the first day after surgery, while others take a little longer to see full results. Final results will vary on the severity of your keratoconus. Some patients may still need to wear glasses for certain activities.
Intacs® are very effective in reshaping the cornea and flattening the “cone-like” shape that blurs vision. In some cases, corneal crosslinking can be used in addition to Intacs® to achieve even better results.
Clinical Trials for Intacs® for Keratoconus
A study was conducted of 58 eyes of 43 patients with keratoconus. After Intacs® implantation, these patients saw an improvement in visual acuity from worse than 20/200 to better than 20/60. This is a huge improvement in those who live with mild to moderate keratoconus.
If you have been diagnosed with keratoconus and are interested in Intacs®, call Stahl Eye Experts in Long Island or request an appointment online!
Scleral Contact Lenses
If you have keratoconus, chances are you have been told that you are not a suitable candidate for contact lenses. While this may be true of soft contact lenses, you still have more contact lens options.
Scleral contact lenses are similar to gas-permeable contact lenses, but cover a larger diameter of the cornea. Scleral lenses cover the entire cornea, including the white part of the eye, called the sclera. Because these lenses cover the entire cornea and most of the sclera, the corneal irregularities that come along with keratoconus are reduced, providing clearer vision.
Scleral Lenses for Keratoconus
At Stahl Eyecare Experts, we recommend scleral contact lenses to our keratoconus patients as a temporary solution to the blurry vision caused by keratoconus. Large diameter contact lenses prevent the movement and discomfort that can happen when wearing small diameter contact lenses as a keratoconus patient.
Scleral lenses “vault” the corneal surface and rest on the less sensitive areas of the eye, making these lenses more comfortable to those with keratoconus. Underneath the scleral lens, there is a liquid reservoir that fills the space between the misshapen cornea and the lens.
Scleral lenses are custom made for each eye, since every person’s corneal irregularities are different.
How do I use scleral lenses?
Even if a patient has worn other types of contact lenses in the past, the process of inserting and removing scleral contact lenses can be tricky. The extra amount of time needed to master these lenses should be taken into consideration during the fitting process. Your doctor at Stahl Eyecare Experts will direct you on how to properly insert your lenses in person.
When inserting your scleral lenses, it is best to sit down in from of a mirror in a well-lit room. Make sure all eye makeup is removed and your hands are clean.
To insert your scleral lenses, place the lens centered on the plunger that was given to you by your doctor. Fill the lens almost to the top with a sterile saline solution. Hold your eyelids open with your index finger and thumb. It may be helpful to look down to the floor to reduce spilling of the saline solution. Place the lens on your eye. Remove the plunger. Blink and check for any bubbles underneath the lens.
To remove your lens, wet the tip of your plunger with saline. Pull your lower eyelid down, if helpful. Place the plunger on the bottom third of the lens. Pull the plunger up and out. As you are pulling the plunger out, it may be helpful to press the eyelid in to release the suction.
Are you interested in scleral contact lenses, contact Stahl Eye Experts in Long Island today. Call us to make an appointment or request an appointment online today!