Corneal Collagen Cross-Linking

Photrexa® Viscous, Photrexa® and the KXL® System are the first and only therapeutic products for corneal cross-linking which have been FDA approved to treat progressive keratoconus. We, at EyeSight Hawaii, and we are very happy to be introducing and offering this treatment to our patients.

What is Keratoconus?

Keratoconus, often referred to as ‘KC’, is an eye condition in which the cornea weakens and thins over time, causing the development of a cone-like bulge and optical irregularity of the cornea.

A rare condition, keratoconus typically first appears in individuals who are in their late teens or early twenties. Keratoconus can result in significant visiual loss; and may lead to corneal transplant in severe cases. You can find more information from the National Keratoconus Foundation.

About Corneal Collagen Cross-Linking

In April 2016, the FDA approved Photrexa® Viscous (riboflavin 5’-phosphate sodium in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate sodium ophthalmic solution) and the KXL® System for corneal cross-linking, a minimally invasive outpatient procedure that combines the use of Vitamin B2 eye drops and ultra-violet (UV) light.

Corneal collagen cross-linking is a medical procedure that combines the use of ultra-violet (UV) light and riboflavin (vitamin B2) drops. The absorption of UVA by riboflavin generates radical riboflavin and singlet oxygen to form cross-links. The procedure creates new corneal collagen cross-links, results in a shortening and thickening of the collagen fibrils and leads to the stiffening of the cornea.

The approval of Photrexa Viscous, Photrexa and the KXL System offers an effective treatment for patients who, until recently, had no therapeutic options to limit the progression of this sight-threatening disease.

About the Corneal Cross-Linking Procedure

What can I expect during the procedure?

  • After numbing drops are applied, the epithelium (the thin layer on the surface of the cornea) is gently removed.
  • Photrexa Viscous eye drops will be applied to the cornea for at least 30 min;
  • Depending on the thickness of your cornea, Photrexa drops may also be required.
  • The cornea is then exposed to UV light for 30 minutes while additional Photrexa Viscous drops are applied.

What can I expect after the procedure?

  • You should not rub your eyes for the first five days after the procedure.
  • You may notice a sensitivity to light and have a foreign body sensation. You may also experience discomfort in the treated eye and sunglasses may help with light sensitivity.
  • If you experience severe pain in the eye or any sudden decrease in vision, you should contact your physician immediately.
  • If your bandage contact lens from the day of treatment falls out or becomes dislodged, you should not replace it and contact your physician immediately.

How much does this procedure cost?

Aetna now considers epithelium-off corneal collagen cross-linking medically necessary for keratoconus and pays for it. This procedure is currently not a covered benefit by medical insurances other than Aetna and is an out-of-pocket expense.