Glad to hear that you are a suitable candidate for LASIK.
Collagen cross-linking (CXL) has been a treatment for keratoconus for many years with proven benefits in stabilising a patient’s cornea and preventing them from suffering the effects of progressive increase in astigmatism and myopia resulting in the need to wear rigid contact lens.
With the increasing popularity of corneal laser vision correction (LVC) over the last 20 to 30 years, refractive surgeons have been constantly fine-tuning their ability to distinguish between patients who may and may not be suitable for LVC. Much of the effort has been in predicting who may develop keratoconus following LASIK. To be sure, much still depends on the surgeon’s skill, experience and intuition when compiling a risk analysis for the patient and despite all the best efforts, in very rare occasions, keratoconus still occurs.
The role of CXL as a preventative measure for keratoconus in LASIK patients has been available since my days as a Refractive Surgeon in Canada in 2012. In fact the centre I practised in performed the very first CXL with LASIK and PRK in North America. Suffice to say the practice of combining CXL with LVC continues to grow amongst surgeons looking to try to improve long term safety and outcomes for their patients.
What is yet to be determined is the degree in which CXL strengthens the cornea and hence reduce the risk of keratoconus. Many refractive surgeons take the approach that CXL has a fairly low incidence of serious complications and the potential benefits outweigh the consequences of keratoconus in post LASIK patients.
However, as we are still awaiting confirmatory data on the protective effects of CXL, most surgeons including myself will still adhere to the important exclusion criteria for patients are keen to have LASIK or ReLEx SMILE.
Factors that may not permit patients to undergo LVC include:
1. Thin corneas
2. Unstable refractive errors (e.g. myopia, hyperopia & astigmatism)
3. Children
4. Abnormally-shaped corneas
5. Overly high refractive errors
Where patients may be confused is when one surgeon insists on performing LASIK with CXL and another surgeon may tell them that CXL would not be necessary. What patients have to understand is that surgeons are human too. Two surgeons may have different views about risks, with the more “Kiasu or Kiaxi” (risk averse) surgeon preferring CXL. Alternatively, you may find that the less risk averse surgeons tend to steer their patients towards performing LASIK without CXL. Neither surgeons are necessarily wrong.
Suffice to say, I tend to take a zen approach to surgery: I would make my decision about surgery by balancing the risks against the benefits. There is no one size fits all approach to surgery. Patients should work closely with their surgeons to come to the best option available for their own eyes. Alway have a customised approach.
