Request answers from expert doctors:

DxD
DxD

We will distribute this question to expert doctors, and notify you about new answers.





Does corneal collagen cross linking with LASIK or ReLEx® SMILE® have benefits?

Eye Health LASIK

Hi doctors, I am considering going for corneal collagen cross link with my LASIK or ReLEx® SMILE® procedure (still undecided which procedure to choose). Cost is not a concern.

During an eye screening for LASIK earlier this year, I was told that I do not need collagen cross link as my cornea is above average thickness, but I’m still paranoid about thinning of my cornea/keratoconus/corneal ectasia as previously an NUH eye doctor had said my eyeball was elongated, so I was at greater risk for the condition.

So despite my recent normal LASIK eye screening, I still feel that I may be at risk for corneal thinning especially as I have allergies, and like to rub my eyes. I have also read that LASIK weakens the cornea about 20 – 40%, so preventative corneal collagen cross link may help to prevent further corneal thinning, and also prevent regression after LASIK.

In a normal person, does collagen cross linking with LASIK or Relex Smile confer any additional benefits (protective, preventative or otherwise) to my cornea in preventing corneal thinning? Is there a chance that it will improve refractive outcomes, and prevent regression?

Are there any downsides to collagen cross linking in someone who technically doesn’t need it? Really appreciate your advice 🙂

DOCTOR’S ANSWER (2)

Corneal collagen crosslinking with LASIK or SMILE is relatively new, and the true beneficial effects, if any, may not be quantifiable or known for some years yet.

In essence, after the cornea has been reshaped (through LASIK or SMILE), vitamin B2(riboflavin) is applied to soak the cornea, and then ultraviolet light is shone on the soaked cornea. The entire crosslinking process adds about 3 minutes to the entire refractive procedure.

We do know that after crosslinking, the cornea becomes stiffer (stronger in a way). There is no other extra effect known to be caused by the crosslinking. The corneal stiffening may help to reduce the risk of regression, and may reduce the risk of ectasia.

However, it is important to remember that regression is not caused by one single factor, and crosslinking may only address one of several factors.

 

There were some initial concerns that combined corneal crosslinking may affect the predictability/accuracy of laser treatments, but studies so far show that results are equally accurate whether crosslinking was done or not. Some cases get a degree of corneal haze after corneal crosslinking, however, the haze almost always disappears by itself after a while. So perhaps the only real downside to having crosslinking done, when you don’t really need it, is the extra cost.

Finally, all myopic/shortsighted eyes are elongated. But most myopic eyes are not at particular risk for developing post LASIK ectasia. The risk comes mainly from corneas that show subtle signs of pre-existing keratoconus, and sometimes from corneas that are thinned a great deal either because of treatments for very high myopia or pre-existing thin corneas.


Dr Por Yong Ming
MBBS, FRCSEd, FRCS, MRCOphth, MMed

Mount Elizabeth Novena Specialist Centre

38 IRRAWADDY ROAD
#09 - 26/27/28/29 Singapore 329563


2001 views 26 Jan 2018

Collagen cross-linking (CXL) has been used to treat a condition known as keratoconus for many years now. Its purpose is to improve the structural strength of the front portion of the eye known as the cornea.

Keratoconus essentially results in the cornea losing its ability to keep its shape and patients may suffer from increased myopia and astigmatism. Keratoconus may occur naturally or rarely as a consequence of corneal laser vision correction (LVC) such as epi-LASIK, LASIK or ReLEx SMILE.

Due to its effectiveness as a treatment for keratoconus, there has been an increasing trend of laser refractive surgeons now offering CXL at the same time as LVC with the hope that it will reduce the risks of developing keratoconus.

As it is a fairly recent practice, the degree of protection when CXL is done in conjunction with LVC is currently still being studied. Suffice to say it is widely recognised that the cornea structure does strengthen following CXL. The procedure has low rates of complications and side effects, most of which are temporary. Due to the combination of the potential benefits of preventing a serious albeit rare condition and its relatively high safety record many surgeons have adopted CXL into their refractive surgery practice.

Though CXL does not necessarily permit the surgeons to widen their pool of suitable patients or improve the visual outcomes of LVC, its intended benefit is to offer LVC patients an added layer of corneal protection leading to better long term results following LVC.

Certainly with the added treatment comes increased costs. Though the cost of CXL done in conjunction with LVC is far lower than performing CXL as a standalone procedure.


Dr David Chan
MBChB, MMed, FAMS, MRCS, FRCS

Ophthalmology, Atlas Eye Specialist Centre

290 Orchard Road
Paragon
#07-09 Singapore 238859


2004 views 26 Jan 2018
Not the answer you're looking for? Browse other answers tagged Eye Health LASIK or ask your own question now FOR FREE.
Consult Doctors. FREE.
Real Doctors, Expert Answers
Connect with Facebook Connect with Google For Doctors
By creating an account, you are indicating that you have read and accepted the DoctorxDentist Terms of Use.
Consult Doctors. FREE.
Real Doctors, Expert Answers
By creating an account, you are indicating that you have read and accepted the DoctorxDentist Terms of Use.
Registration Progress
Step 1: Indicate Topics of Interests
Step 2: Follow Relevant Doctors
Complete!
What are your interests?
Please select at least 3 interests.
NEXT
NEXT
Registration Progress
Step 1: Indicate Topics of doctors
Step 2: Follow Relevant Doctors
Complete!
Follow your favourite doctors
We found some doctors you may like. Click continue to follow them.
CONTINUE
CONTINUE
Consult Doctors. FREE.
Real Doctors, Expert Answers
Continue with Facebook Continue with Google

or

Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

Continue with Facebook Continue with Google

Disclaimer: Any answers provided are for general informational purposes only and is not a substitute for professional medical advice. If you think you may have a medical emergency, call your doctor immediately. Always seek the advice of your doctor before starting or changing treatment.

YOUR QUESTION HAS BEEN

SUCCESSFULLY SUBMITTED.

YOUR QUESTION

HAS BEEN

SUCCESSFULLY

SUBMITTED.

YOUR ANSWER HAS BEEN

SUCCESSFULLY SUBMITTED.

YOUR ANSWER

HAS BEEN

SUCCESSFULLY

SUBMITTED.

YOUR QUOTE REQUEST HAS BEEN

SUCCESSFULLY SUBMITTED.

OUR DOCTORS WILL GET BACK TO YOU SHORTLY!

YOUR QUOTE REQUEST

HAS BEEN

SUCCESSFULLY

SUBMITTED.

OUR DOCTORS WILL GET

BACK TO YOU SHORTLY!

YOUR THREAD HAS BEEN

SUCCESSFULLY CREATED.

HEAD OVER TO FORUM PAGE NOW

TO JOIN THE DISCUSSION

YOUR THREAD

HAS BEEN

SUCCESSFULLY

CREATED.

HEAD OVER TO THE FORUM PAGE NOW

TO JOIN THE DISCUSSION!

YOUR REVIEW HAS BEEN

SUCCESSFULLY SUBMITTED.

THANK YOU.

YOUR REVIEW

HAS BEEN

SUCCESSFULLY

SUBMITTED.

THANK YOU.

YOUR EMAIL HAS BEEN

SUCCESSFULLY SUBSCRIBED.

THANK YOU.

YOUR EMAIL

HAS BEEN

SUCCESSFULLY

SUBSCRIBED.

THANK YOU.

YOUR CONSULTATION HAS BEEN

SUCCESSFULLY SUBMITTED.

OUR DOCTORS WILL

GET BACK TO YOU SHORTLY.

YOUR CONSULTATION

HAS BEEN

SUCCESSFULLY

SUBMITTED.

OUR DOCTORS

WILL GET

TO YOU

SHORTLY.

MESSAGES TO