Home

Visian ICL
Lens

Crosslinking without Epithelium Removal?

Keratoconus (pellucid) is caused by weakening of the cornea. This weakening causes the outward protrusion and thinning of the cornea. It can be thought of as a subtle hernia of the cornea due to the weakness in the corneal tissue.

The cause of the weakening is due to an imbalance of enzymes within the cornea itself that leads to high levels of damaging "reactive species" chemicals. Different types of reactive species include superoxides, hydrogen peroxide, and nitric oxide. These substances essentially are free radicals that cause oxidative damage to the cornea.

Reactive species (free radicals) accumulate		The reactive species cause weakness		The weakness causes the cornea to herniate which leads to keratoconus

Research suggests that patients with keratoconus cannot clear away the normal amount of reactive species that are normally produced. The reason for poor clearance is that the good enzymes (Catalase and Superoxide dismutase) are not functioning properly which leads to the toxic accumulation of the reactive species and eventual damage in the cornea from the buildup of reactive species.

There are some genetic reasons explaining why the good enzymes do not function properly. Non-genetic sources can also increase the reactive species. Such sources include ultraviolet light sun exposure, eye rubbing, poorly fit contact lenses, and chronic eye irritation. All these cause an increase in reactive species (free radicals).

For these reasons, we recommend that all patients with keratoconus protect their eyes by wearing 100% UV blocking sunglasses with the wrap-around design. The wrap-around design minimizes light coming in from the sides. It's also important to avoid eye-rubbing and have a comfortable contact lens fit if contacts are being worn.

The only method to increase corneal strength in patients is with corneal crosslinking treatment.

Patients come to us from all over the United States and often from other countries.  Please click below to listen to patients share in their own words how the process was for them and the ways their lives have been changed.

Keratoconus is the thinning and bulging of the cornea. Treatments include Intacs^®, Holcomb C3-R^®, cornea collagen cross linking, and if keratoconus progresses to a serious level, cornea transplantation. Dr Brian Boxer Wachler is a specialist in keratoconus evaluation and treatment.