Keratoconus progression can be halted by corneal collagen cross linking has been established. We thank all our patients who believed and participated in the trials. Now the hot question is which is better- to remove epithelium or to leave it alone.The debate has recently become intense. Various specialists have filed trade marks, patents or invested in a particular technology. Sometimes their opinions seem biased. So where do we turn to if we want to know the true answer?
How about the FDA? They are experts at looking at the data and known for they unbiased opinion. They have the interest of American patients in mind.
They analyzed lot of safety data. Here is what they have approved in USA
Epi off cornea cross linking
So that means so far Epi off is better than epi on or it’s variations like c3R
The epithelium interferes in the seepage of riboflavin i the cornea. It also hinders the uniform transmission of uvA . Therefore it a good idea to remove it
Some may disagree and say FDA process is tedious and hence Epi on is still stuck somewhere. We can than turn to peer reviewed journals. No published study has ever shown that Epi on crosslinking is better than Epi off.
Multiple studies have shown that Epi on Cross linking is the current Gold Stsndard.
So we rest our case
Epi off cross linking is the procedure Keratoconus specialists recommend
Yes what we had been waiting for finally happened. Another arrow in fight against keratoconus . FDA looked at the safety and efficacy of riboflavin activated by uv A radiation in detail. They looked at the data submitted by Avedro. FDA said epithelium removed or epi off is a good option.
This means if you have been waiting to make your cornea stronger the time has arrived. It may also mean your insurance may cover part of the cost. So send your insurance card to our keratoconus center. You may also qualify for no interest 36 monthly payment plan.
Unfortunately they have not approved epi on or c3r and other variants. So invest your money in the technique FDA considers more safe and result oriented.
Come to our Beverley Hills center for keratoconus treatment and get an unbiased opinion.
In this study done in Ibaraki, Japan, keratoconus and cornea researchers wanted to see whether three-dimensional (3D) corneal and anterior segment optical coherence tomography (CAS-OCT) or a rotating Scheimpflug camera combined with a Placido topography system (Scheimpflug camera with topography) was better to study the cornea. They wanted to see how it would be best to detect the signs of early keratoconus disease. Their goal was to asses if normal eyes and forme fruste keratoconus could be separated based on that criteria. They found out that both systems worked equally good. Our own Los Angeles Keratoconus Expert feels an early cornea topography works equally good in the hands of an experienced keratoconus expert.
RESULTS: CLEK Study subjects had a mean age at baseline of 39.3+/-10.9 years. At study entry, 65% of the patients wore rigid contact lenses, and 14% reported a family history of the disease. Subjects exhibited a 7-year decrease in high- (2.03 letters) and low- (4.06 letters) contrast, best-corrected visual acuity, with 19% demonstrating decreases of 10 or more letters in high-contrast, best-corrected acuity and 31% of subjects demonstrating decreases of 10 or more letters in low-contrast, best-corrected acuity in at least one eye. Subjects exhibited an average 8-year increase in corneal curvature of 1.60D in the flat corneal meridian, with 24% demonstrating increases of 3.00D or more. The 8-year incidence of corneal scarring was 20%, with younger age, corneal staining, steeper baseline corneal curvature, contact lens wear, and poorer low-contrast visual acuity predictive of corneal scarring. Data from the National Eye Institute Visual Function Questionnaire suggest that the effect of keratoconus on vision-specific quality of life is disproportionate to its low prevalence and clinical severity.
This study is from Clek or the collaborative longitudinal evaluation of keratoconus. It came from college of optometry in Ohio.
RESULTS: There were no statistically significant differences among the 3 groups (M, HA, and HI) in race, history of atopic disease, family history of keratoconus, or rigid contact lens wear in the right and left eyes. At baseline, there were no significant differences among the 3 groups in high-contrast best-corrected visual acuity, low-contrast best-corrected visual acuity, or steep keratometric reading. Progression of keratoconus, as assessed by changes in these 3 continuous variables, was equal for the 3 groups. M had more corneal scarring than did HA or HI; however, there was no progression of scarring for any of the groups.
CONCLUSION: Keratoconus progressed in both men and women, aged 48-59 years; however, there were no differences among the groups in progression.
So what we learn her is that if you live in Los Angeles and suffer from keratoconus, there is still a chance of scarring even if you are in your fourties. You need to see Los Angeles cornea expert . Dr Khanna has offices in Beverly hills and west lake village and helps residents of Los Angeles with management of keratoconus.