Chemical cross linking Cornea

The most fascinating strategy is one-pack self-crosslinking resins that are intended for specific market places. Reformulating polymer resins into useful, cost effective materials is among the most significant regions of polymer science and an extremely active region of industrial research. Polymers might also be crosslinked by way of electron irradiation. Each Ig monomer includes two antigen-binding websites and is supposedly bivalent. Nonspecific crosslinking is simpler to be controlled. Collagen crosslinking might turn into the conventional therapy for progressive keratoconus later on diminishing significantly the demand for corneal transplantation. 1 sort of gel you might be acquainted with is crosslinked polyacrylamide.

CXL can frequently be repeated when treatment isn’t powerful. CXL can be carried out with different procedures, including Intacs or Topography-Guided PRK (TG-PRK) so as to prevent progression and assist with vision. CXL isn’t a cure for eye diseases like keratoconus, but it might improve vision and permit patients to decrease the strength of their eyeglasses prescription and wear softer, more comfortable contact lenses. CXL is a topic that’s been attracting growing interest over the past ten years. In some instances CXL can be done after corneal transplantation. CXL was accepted by the FDA in america in April 2016. CXL is now the most commonly used procedure throughout the world to take care of the progressive vision loss related to keratoconus.


The War Against Crosslinking

PVC is found in all differnet forms of sizes and is typically employed for bigger pipes. PVC pipes are a lot stronger than PEX pipes and are usually utilised in sewer systems and several water systems. A bit of a crosslinked material that has absorbed a great deal of solvent is known as a gel. The UV light section of the treatment typically lasts about thirty minutes. Such a material is referred to as a thermoplastic. The corneal thickness is going to be checked, and then the UV light is going to be applied for as many as half an hour. Hardness is likewise an important property for industrial pigmented metallic coatings.

To work, the crosslinked antibody-toxin has to be stable and equipped to find and target the right cells in vivo. The resulting crosslinks can give a sign of the interactions happening in a cell in an answer to some stimuli. Very good crosslinks connect naturally-related components of the SCP universe with each other to make a larger perspective of the SCP-verse. Crosslinking of collagen denotes the capacity of collagen fibers to form strong bonds with different fibers. Preoperative pachymetry and individual charge of the ultraviolet A-irradiance prior to each treatment are mandatory. Corneal cross-linking is performed to stop vision from getting worse, and in some instances it can prevent the demand for a cornea transplant.

Crosslinking Help!

Epi-on crosslinking has to be accomplished with higher energy levels to create more crosslinking. The objective of CXL is to prevent more deterioration of vision for the majority of patients and to potentially improve vision. Also try to remember that, for patients who have refractive in addition to medical advantages, we must adhere to the coordination of benefits requirements particular to the individual policy. The advantages of CXL treatment can endure for several decades, and clinical studies have revealed that the strengthening effect of the procedure could possibly be permanent.

Some patients could be in a position to have an excimer laser treatment (PRK) to enhance their vision without the necessity for glasses after they’ve healed from the CXL procedure. Every patient differs. He must be seen at least twice during the week following the procedure. Again, in the event the patient doesn’t have coverage for those materials, they will need to pay out-of-pocket in their opinion. Most patients experience a quick period of blurred vision that might be worse than it was before a conventional CXL procedure. They find that for the first few days after the cross-linking treatment, their vision is actually worse than it was before the procedure. The CXL treatment doesn’t remove tissue.

Your Keratoconus treatments are predicted to serve you the remainder of your life. Much like any disease or health concern, it’s better to find treatment in the early stage of the condition. The 30-minute corneal crosslinking treatment is done in the physician’s office. The result is also to extend the duration of the side chain by numerous angstroms. The UV’s effect can result in reactive interactions and lead to DNA and the proteins which are in touch with it to crosslink.

Getting the Best Crosslinking

Based on the individual, the epithelial surface cells may be taken off. In the event the second protein doesn’t have available native sulfhydryl groups, they are sometimes added in a separate prior step utilizing sulfhydryl-addition reagents. Weak binding between the corneal collagen fibers is supposed to be the root cause of keratoconus.

There are many kinds of crosslinking systems. The aforementioned procedure for applying a permanent wave to hair is one particular case of oxidative cross-linking. Alas, many won’t cover the procedure, irrespective of your appeals. The whole procedure generally takes just a few minutes. The CXL procedure can be finished on a single eye in approximately 1 hour. It is crucial to know that only the typical crosslinking technique is FDA-approved.

Bulging eyes Thyroid Keratoconus Eye Disease

Bulging eye

In severe instances of exophthalmos, you might not be in a position to close your eyes properly. When an item should happen to become lodged in the eye, it’s feasible for an infection to form. It is crucial to know that prominent eyes and bulging eyes are two things. Prominent eyes are normally hereditary and in the majority of cases are harmless. They may be a family trait. If both eyes appear different, then a different quantity of eye socket surgery can be done on each individual eye. Pop eye may also be the result of a physical injury, like damaging the eye on tank furniture, or as the effect of a fight with a different fish.

In different instances, the eyes may bulge during a salt treatment together with an organophosphate. It swelling in dogs can be caused by any number of conditions. Bulging eyes can be a sign of something more serious normally. They are not a very good sign.

In the majority of patients, the eyes have a tendency to get somewhat better whenever the thyroid abnormality was treated. Otherwise, the eye should be removed (enucleation). Bulging eyes ought to be checked by means of a healthcare provider immediately. In general, the very first step for any person who notices bulging eyes is to look for medical care.

Finding the Best Bulging Eye

Since the mishap and cataract surgery my vision has been quite poor. If it has been lost in the eye due to pop eye, regardless of how it occurred, however, the fish will remain blind for life. If you’ve got double vision, prism glasses may provide help.

What Bulging Eye Is – and What it Is Not

In young rats, symptoms are somewhat more inclined to be brought on by secondary infection, so they will need to get treated accordingly. If the indicators are severe the fish can be taken out of the aquarium and swabbed with a cloth which has been treated with small sums of povidone iodine or mercurochrome. Signs of ocular proptosis Ocular proptosis is simple to recognize.

Depending upon the reason for the glaucoma, it is sometimes a life-long disease requiring eyedrops or surgery, or it might be a temporary condition, also requiring drops, but for a shorter length of time. Typically it occurs because of an infection of the eye or a trauma, though it can also take place if the hamster is restrained too tightly from the rear of the neck. Infection in eyelid, like an infected stye or chalazion can also bring about periorbial cellulitis. To sum up, thyroid eye disease is a state that is rare, and as soon as it does affect someone, the signs are usually mild and warrant minimal or no therapy. Eye cancer isn’t so common medical condition. In rare situations, eye tumors or other serious infections can get the eye to move weird.

Your health care provider may request laboratory tests should they suspect you’ve got Graves’ disease. Your physician may advise that you have surgery to eliminate all or part of your thyroid gland. Your physician may offer you a little dose of radioactive iodine and gauge the sum of it in your thyroid gland to specify in case you have Graves’ disease. Your physician may suggest a mixture of prescription medications, nicotine replacement therapy, or counseling to help you give up smoking. In mild instances of proptosis, a physician can take measurements with a particular ruler referred to as an exophthalmometer. Being a holistic doctor I’ll never tell any patient to quit taking their prescription drugs.

The challenging role in bulging eye treatment is to determine the underlying cause. The eye disease treatment should be accomplished by means of a healthcare professional. Some of the primary treatments you might be offered in case you have thyroid eye disease are described below.

In extreme situations, surgery may be required. For example, it may be considered to improve the appearance of the eyes if exophthalmos has been in the inactive phase for a few months. You might require hospitalization and a sort of surgery called an iridectomy to stop different attacks if treatments like eye drops to reduce the pressure in the eye don’t do the job. If surgery is essential, your physician may remove your whole thyroid gland to get rid of the probability of hyperthyroidism returning. The quantity of surgery required is affected by the seriousness of disease and level of proptosis. On the other hand, it may not be avoidable if your vision is impaired. In some instances, cosmetic surgery for the eye or surgery to fix the double vision is done.

Basics of cornea cross linking

Nonspecific crosslinking is simpler to be controlled. Accelerated crosslinking includes the use of a stronger UVA source to supply the exact same crosslinking effect in a briefer time period. It is very important to keep in mind that crosslinking was made to decrease disease progression, not to enhance your vision. Collagen crosslinking isn’t a cure for keratoconus. Collagen crosslinking might grow to be the conventional therapy for progressive keratoconus later on diminishing significantly the demand for corneal transplantation. Corneal collagen crosslinking is a rather new procedure that intends to strengthen the cornea to be able to slow or halt progression in keratoconus. Corneal collagen crosslinking (CXL) is a comparatively new procedure to take care of keratoconus.


The Basics of Crosslinking

CXL isn’t a cure for eye diseases like keratoconus, but it might improve vision and enable patients to decrease the strength of their eyeglasses prescription and wear softer, more comfortable contact lenses. CXL was accepted by the FDA in the USA in April 2016. CXL is now the most commonly used procedure throughout the world to deal with the progressive vision loss connected with keratoconus. Nevertheless, CXL is unable to lessen the noteworthy high purchase aberration of the cornea. Most significantly, epithelial-on CXL is apparently equally as effective as epithelial-off when performed properly.

UV can result in sunburn, inflammation. At the conclusion of procedure a protective contact lens is set on the eye preventively. The cornea consists of lots of layers and the middle layer, referred to as the stroma is made up mainly of collagen fibrils aligned in a way to earn the cornea transparent. It is then irradiated with ultraviolet A light for about 30 minutes.

After you are comfortable, the process is started by creating two small openings at the border of your cornea which is going to be utilized to position the lens. As in the instance of crosslinking, it’s an outpatient procedure that doesn’t need an overnight stay in the hospital. The aforementioned procedure for applying a permanent wave to hair is 1 instance of oxidative cross-linking. The CXL procedure can be finished on a single eye in approximately 1 hour. The full procedure generally takes just a few minutes. If you are experiencing a laser-assisted procedure, the laser part of your surgery will happen at CLEI and you’ll be transported to our outpatient surgery center. An assortment of vision correction procedures after corneal transplantation may be helpful.

Whilst it’s not a cure for the condition, it’s very likely to avoid the demand for more invasive surgery like corneal transplant. While there is absolutely no absolute cure for the disease, EDOW delivers effective therapy options to not just improve symptoms but in addition slow its progression. 1 treatment is typically all that is essential to attain optimal outcomes. Much like any disease or health concern, it’s better to look for treatment in the early stage of the condition. Keratoconus treatment is dependent upon the symptoms patient encounters.

Unfortunately, patients may not understand they have the condition straight away as it isn’t an inflammatory condition and might not create distinct symptoms. Most patients experience a quick period of blurred vision which may be worse than it was before a conventional CXL procedure. Typically, they may return to work one day after the procedure. Since patients with keratoconus have an increased incidence of allergies and atopy, eye rubbing could possibly be an answer to the allergy, which consequently may lead to the maturation of keratoconus.

At the ending of the procedure, a soft contact lens bandage is used. Normally, sutures aren’t necessary and you’ll use drops for 1-2 weeks. Furthermore, the apparatus can be utilized in the preparation of a paper on the model for at least one kind of coating on the base. It is very important to know that only the typical crosslinking technique is FDA-approved.

The majority of the cornea is made of collagen fibres that are arranged in bundles. The material is not as sensitive to web breaks and foam collapse when compared with current materials, leading to a greater material yield during processing. The material to be mixed remains within the mixer based on the job of the weir disks. After that, a gel-like substance is put within your eye to defend the pure lens during ICL placement.

Risk factors related to progression after primary CXL stay unclear. The result is also to extend the distance of the side chain by many angstroms. The capability to influence the full article is minimized. The objective of CXL is to raise the crosslinking of collagen to keep the healthy form of the cornea. Therefore, the accession of additional silica will subsequently influence the stream of the whole aircraft adhesive when Parts A and B are mixed.

Importance of Screening & Early Diagnosis

We have been talking about how cross linking can help patients suffering from Keratoconus. We may’ve a bigger issue to confront. What about before cross linking, what about the diagnosis and screening of Keratoconus. It is important for patients with Keratoconus to be screened as early as possible. The best results with corneal cross linking eye procedure are obtained when the disorder is arrested early. As the disease progresses the loss of visual acuity increases dramatically, and the earlier it is detected the easier and higher possibility that full visual acuity returns. You may want to read some frequently asked questions on keratoconus and cross linking.

Some symptoms of Keratoconus are blurry vision, increased light sensitivity, eye strain, headaches/general eye pain, eye irritation/excessive eye rubbing. A caution should be noted that these symptoms can also be indications of other eye problems. That is why it i important to see a keratoconus expert. The doc in conjunction with measurement of the curvature of the cornea, a depth map and examining the eyes can identify the disease more early and accurately.

From a doctor’s perspective, as they physically examine the eye with a microscope, the signs they  would be looking for are corneal thinning, Fleischer’s ring, Vogt’s striae, and apical scarring. The measuring of the corneal curvature can be done three different ways: first would be keratometry, second is corneal tomography, and third is a corneal OCT. Though all three should performed for increasing the accuracy of the measurement.     

Now that you have a basic understanding of importance of early detection try our quiz on keratoconus.

Keratoconus treatment and FDA approvals

We have been receiving a lot of questions from patients via social media and telephone calls. People out there are confused regarding the safety and efficacy of the various advertised treatment methods for keratoconus.  This is a quick recap of the currently available interventions to help people suffering from keratoconus eye disease. We have Intacs, Cornea Cross Linking, DALK and Corneal transplant. DALK and Corneal Transplant are surgical techniques and thus are not in the purview of the FDA. Let us confine our discussion today than to Intacs and Cross Linking for keratoconus eye disease.

Intacs for Keratoconus are FDA approved

Yes Intacs are the only intracorneal ring implants approved by FDA. Others like Ferras rings are not approved and cannot be sold in USA. Dr. Khanna is one of the participants in an Institutional Review Board monitoring by Integrview.  This ongoing oversight ensures that the results are safe.

Is Corneal Cross linking FDA approved?

There are three types of Corneal cross linking available in the US today.

  1. FDA approved : There is one and only one FDA approved – KXL device and riboflavin called Photrexa manufactured by Avedro. This means that Avedro did a clinical study to demonstrate the safety and efficacy of their  formulation with their unique device. Data was submitted to the FDA. Federal Drug and Administration studied the reports. They asked questions and requested more data. Once this was reviewed  FDA approved the Avedro method.
  2. Clinical studies : There are clinical studies being performed by different groups like the AECOS and CXL study groups. FDA has not given the green light on them.
  3. God Given: These are devices which doctors cannot explain how they arrived in their offices or surgery rooms. The data from these unexplained devices is not being submitted to FDA nor even peer review. No one knows what drugs are being used.

Which one should you use?

FDA ensures the safety of our eyes. They review the statistical data to keep us safe. Therefore when comparing different treatments it is easier for us to know which is safer.

Since there is only one FDA approved cross linking procedure, choose AVEDRO Cornea Cross Linking.

Learn more about treatment modalities for keratoconus.

Pupil Tracking in Cornea cross linking for Keratoconus.

We have been talking about the advantages of epithelium off cross linking. This from of cross linking has shown to work in numerous studies across the world.

But are all delivery methods the same? Certain machines hope the patient keeps looking at the UV light.  Have you tried staring at something for 30 minutes. As a kid you may have played the stare off game. Its tough to do it especially in Los Angeles with the dry weather.

The solution in this fight against keratoconus is to involve a pupil tracker. In the above video you will see it in action. If the eye moves away from the light, the UV delivery and timer will stop. You  can set how much movement you are willing to allow.

This increases the safety. One can definitely know that 30 minutes was delivered. It can avoid a situation where a fidgety patients moves and receives only 20 minutes of the radiation. Increasing safety also relaxes the patients. Most of the people requiring this intervention against Keratoconus eye disease are teenagers. Pupil tracking rocks.

Line of Demarcation after Cornea Cross Linking

Epithelium off Cornea collagen cross linking (CXL) is not voodoo. We realize that early in new technology a lot of unfounded claims like epi on CXL being Better than epi off might be made. It behooves us clinicians to present proof to peers.

There is a symbiosis between diagnostic technology and treatments. We will take help of Carl Zeiss Ocular coherence tomography to demonstrate the effectiveness of epi off CXL.

Here is a High Density picture of a keratoconus cornea before any treatment. It is early keratoconus in a young girl. This is the best time to intervene to treat Keratoconus. Look how uniform the picture is. The top layer of epithelium can be clearly seen. We remove this layer with laser or as Professor Theo Seiler recommends with ethyl alcohol.

HD OCT Cornea in Keratoconus

Epithelium prevents riboflavin from entering the stroma and hinders the UV absorption. Look at the picture below. You can clearly see a haze which ends around 80 % depth as a line of demarcation.

Line of Demarcation after cross linking

The same line of demarcation after cornea cross linking is better highlighted in they colored OCT of the Cornea.

Color line of Demarcation cross linking

If you are suffering from Keratoconus Call 805-283-6520 to see if cross linking of cornea is the best option for you.


Is Corneal Cross Linking experimental?

or Does It really work?

We pose this question as many medical insurances deny patients reimbursement for cornea cross linking to treat keratoconus. Many parents also pose this question as their own optometrists were unaware of the benefits of cross linking the cornea.

We are going to turn to Australia for a peer review objective answer to this question. Our Australian colleagues performed a study which has been vetted by our peers. The Australian keratoconus experts selected 100 eyes with progressive keratoconus eye disease. They divided them into 2 groups. One would receive Conventional cornea cross linking while the other would have no intervention ( like your insurance company would want). They measured various data like vision, cornea thickness, and curvature of the cornea at various intervals over a period of 3 years.

Are you ready for the results? Can you guess what they showed?

Yes Conventional Cross Linking with UV-A applied on riboflavin soaked eyes was able to prevent steepening  of the cornea. It preserved vision both uncorrected and best corrected. It also improved the shape and vision in many instances. We are so convinced by the results we would not be able to repeat it here in the United States. For we would not condemn any kid with keratoconus to be in the control group. The benefits are so obvious. Like society eradicated Polio it is time to wipe away keratoconus eye disease.

Feel Free to print the abstract from the respected Journal Ophthalmology which is attached as an image to show your doubting doc, illogical insurance rep or obstinate optometrist.

Continue reading “Is Corneal Cross Linking experimental?”

Autobahn of Cornea cross linking to treat Keratoconus

BMW on the autobahn is a hair rising experience. Now our German friends want to bring that concept to cxl or corneal cross linking. You may have heard of accelerated cornea cross linking? This is cxl with 10 minutes of UV radiation treatment, In the newest version they propose treatment of only 5 minutes utilizing 18 mw/cm2 of UV radiation.

This would of great benefit to patients. The amount of time they have to stare at the blue light would decrease. Exposure of the cornea to the elements  would be less.

We would like to quote the results of the study here ” The mean follow-up time was 21.7 ± 7.2 months (range, 12-34 months). No statistically significant changes were found in the mean corrected distance visual acuity, corneal astigmatism, Kmean, Kflat, Ksteep, corneal pachymetry (at the apex and at the thinnest point), and corneal densitometry at follow-up. A significant reduction of Kmax, index of surface variance, index of vertical asymmetry, and Km of the posterior corneal surface (Km(B)) was observed (Kmax: P = 0.018; index of surface variance: P = 0.016; index of vertical asymmetry: P = 0.038; Km(B): P = 0.008). No complications were reported during the postoperative follow-up period in this study.”

Our question for the authors are. 1) How deep was the demarcation line?

2) was any comparison made to conventional cross linking?

Other papers or followup studies should be address the questions.

Dr.Khanna is a Keratoconus Expert. These informative blog posts are for information purposes. They should not replace a careful discussion with you Keratoconus Eye surgeon.

Conventional cross linking is still King Kong – say surgeons from Hong Kong

Keratoconus eye disease is no laughing matter. It afflicts teens and can destroy careers. We need to accelerate our fight against this vicious disease. At the same time we have to study scientifically the newer protocols. Accelerated cross linking speeds the treatment by decreasing the time of exposure of UV light. This has recently been studied in pediatric keratoconus.

This landmark study from Hong Kong By Surgeons of Royal college is a landmark one. It shows that accelerated cornea cross linking slows the progress of the bulging eye disease. it is the first one to document that only conventional cornea cross linking with its deep demarcation line can actually flatten the cornea. In essence it means that the 30 min api off intervention can halt the progression as well as reverse some of the effects.

The deeper the demarcation line the more the cornea flattening .

Keratoconus Experts in Los Angles thank the authors to bring new meaningful data for mutual benefit.

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