Can Corneal Cross-Linking (CXL) still be performed a few months after LASIK, and are there benefits in doing so?
You might want to have a look at some of the answers to these previous questions to get more background information about corneal cross-linking and LASIK:
- Does corneal collagen cross linking with LASIK or ReLEx® SMILE® have benefits?
- Is corneal cross linking necessary to prevent my degree from returning after LASIK?
So first of all, it is unusual to perform corneal cross-linking some months after LASIK.
There are 2 situations I can think of where someone might want to have this done:
- The person has developed corneal ectasia. In this case, provided the cornea is thick enough, doing crosslinking with the full keratoconus treatment protocol can be helpful in stabilising the ectatic process.
- The person somehow decided after their LASIK treatment that they wanted to have the combined LASIK+crosslinking procedure (also called 'LASIK Xtra'), in the absence of any sign of ectasia. Note that in this situation, the crosslinking treatment is not the same as the 'keratoconus treatment protocol' mentioned above. Rather, when LASIK is combined with crosslinking in this way, the crosslinking treatment is a briefer, less intense version to prevent unwanted effects such as possible refractive shifts over time or possible corneal endothelial damage.
Now, it is possible to lift the LASIK flap any time after LASIK, even many years later, and do the crosslinking part of LASIK Xtra.
But it is worth pondering what the point is in going through all this. There is still uncertainty in how much 'LASIK Xtra' can help to prevent corneal ectasia, which is one reason why some people choose to have this added treatment. Some small studies seem to show better stability of spectacle power after LASIK with cross linking, compared with LASIK alone, for certain groups of people like hyperopes or high myopes.
However, do bear in mind that regression, for which it is hoped crosslinking will help to mitigate, is firstly rare for most people who go for LASIK and even in higher risk groups such as those with high spectacle powers, there are multiple factors involved, some of which are not addressed with crosslinking.
To cut a long story short, think about what you want the cross-linking for. Do you have corneal ectasia? Or are you just worried about regression and want to do the crosslinking to reduce this risk?
I believe that in the first instance, with corneal ectasia, full corneal crosslinking treatment would be beneficial.
In the second instance, if it is just to reduce the risk of regression, then the risks versus benefits consideration become more uncertain. I think most people would be better off not disturbing their corneas and corneal flaps, especially if their vision was otherwise good with a good refractive result after LASIK. But do consult with a refractive specialist about your particular situation, because after a full history and examination, more information will be at hand to discuss your unique situation.
While it is possible to undergo CXL a few months after your LASIK procedure, the process will definitely be more troublesome as it will take longer. When not incorporated in your LASIK procedure, CXL will also cost much more.
Since there are no significant added benefits of a delayed CXL treatment, it will be best to incorporate it immediately after your LASIK procedure.
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