Corneal cross-linking offers new treatment option for adolescent patients

The number of subjects in a new study on pediatric keratoconus might be relatively small, but it holds big promise for younger patients.

Historically, when eyeglasses and contact lenses fail, corneal transplants were considered the only other option for treating keratoconus. This was discouraged in adolescents and young adults, as the disease was quite aggressive and there was an increased risk of graft rejection.  

The study, "Accelerated corneal crosslinking for treatment of progressive keratoconus in pediatric patients," was recently published in the European Journal of Ophthalmology and shows the promise of corneal crosslinking as a treatment.  

Keratoconus is typically diagnosed after adolescence, however, its symptoms can show as early as age 10. Most studies have been done on adults, not adolescents. Previously, in adults, corneal transplants were considered the last, best option for keratoconus patients. It was discouraged in adolescents because of keratoconus aggressiveness and the tendency for younger patients to rub their eyes.  

A progressive eye disorder, keratoconus can cause the cornea to thin and bulge out to form a cone shape. This bulging is due to a breakdown of the tiny fibers in the eye (collagen) that normally help the cornea hold its shape. When the collagen fibers weaken, however, the cornea bulges.  

Corneal crosslinking (CXL) is a relatively less-invasive option for doctors of optometry to offer their keratoconus patients. Corneal crosslinking—approved in Aprilf or treatment in the U.S. by the Food & Drug Administration—involves applying ultraviolent light in conjunction with a riboflavin agent to the cornea, preventing further progression of the disease. The purpose of the study was to assess the safety and efficacy of accelerated corneal crosslinking in patients with progressive keratoconus who were 18 years of age and younger.  

Nineteen patients were studied at different intervals over the course of the year.  

"The findings showed that accelerated CXL treatment seems to be effective in slowing or halting the progression of keratoconus and that no permanent complications are noted 6 months after accelerated CXL," wrote the researchers, associated with the Kayseri Education and Research Hospital and Erciyes University, both in Kayseri, Turkey.  

'The throes of keratoconus'

Michael DePaolis, O.D., averages about 700 keratoconus visits a year at his practice in Rochester, New York.  

"I am excited about the results," Dr. DePaolis says, referring to the new Turkish study. "There's no doubt about it. From my perspective, I've watched so many people go through the throes of keratoconus. If I could wave a magic wand over one eye disease and halt it in its tracks, it would be—aside from age-related macular degeneration—keratoconus."  

Dr. DePaolis has seen firsthand keratoconus' frustrating effects as his practice provides care for a wide demographic of keratoconus patients. Patients experience blurred vision, light sensitivity and discomfort. There were few options for doctors and patients, Dr. DePaolis says, other than repeated changes in glasses and contact lenses. Quality of life suffered.

"You always felt like you were along for the ride," Dr. DePaolis says, "as the disease progressed at its own pace. No more. Finally, we have a treatment option that can potentially alter the course of this dreaded disease."

The AOA follows all research closely, including potential treatments for keratoconus and other eye diseases; however, research is continuing on this novel treatment option. For more information or help for better vision, please visit the AOA website.