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.
Dr Por Yong Ming
MBBS, FRCSEd, FRCS, MRCOphth, MMed
38 IRRAWADDY ROAD
#09 - 26/27/28/29 Singapore 329563
In short, the answer is yes.
Collagen cross-linking (CXL) activates collagen fibres in the cornea to cross-link and thereby strengthening the cornea. Laser vision correction aside, CXL is a treatment option for certain progressing cornea weaknesses like keratoconus, keratopathy or keratitis. In these conditions, the cornea is constantly changing in shape or structure resulting in vision deterioration. Potentially, it halts the rapid advancement of such degeneration.
Today, CXL is usually performed together with LASIK as a prophylactic treatment. The aim is to minimise the risk of corneal ectasia, a rare condition whereby the cornea loses its ability to maintain structural integrity thereafter.
One may opt to go for CXL only when there is clinical evidence of worsening in vision due to post-LASIK ectasia. However, by then, it serves to prevent further progression and stabilise the vision. The consequent improvement in vision is unknown.
Though to be fair to LASIK, post-surgical ectasia is rare. It is therefore important to screen for risk factors and understand the options available to you before LASIK. Whether CXL is optional or compulsory at the point of surgery, it is dependent on the eye profile.
Certainly, adding on CXL during LASIK gives the maximum benefit compared to it being carried out as a separate procedure some time after LASIK. In addition to refractive stability, from the investment point of view, you are saving time time to make another trip for a second procedure.
Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS
290 Orchard Road
#07-09 Singapore 238859
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.
Dr Tony Ho
MBBS, FRCS, FRCOphth, FAMS
3 MT ELIZABETH
MOUNT ELIZABETH MEDICAL CENTRE
#03 - 08 Singapore 228510
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