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Crosslinking without Epithelium Removal?

The prior section in this website explained the cause of corneal weakening in keratoconus. Until recently, there was no method to change the integrity and strength of the cornea itself for keratoconus patients.

A non-invasive treatment Holcomb C3-R^® (corneal collagen cross-linking riboflavin) treatment has been proven to strengthen the weak corneal structure in keratoconus. (see Presentation and Research Articles link) This method works by increasing collagen cross-linking, which are the natural "anchors" within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular (which is the cause of keratoconus).

The figures above show the parallel corneal layers (white) and the collagen cross-linking (red) which are increased after Holcomb C3-R® treatment.

During the 30-minute, in-office treatment, custom-made riboflavin eyedrops are applied to the cornea, which are then activated by a special light. This is the process that has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea. In published studies, such treatments were proven safe and effective in patients.

Dr. Brian Boxer Wachler invented the non-invasive Holcomb C3-R^® procedure that does not remove (scrape off) the surface epithelium as is done often. This non-invasive approach saves patients from significant discomfort (often pain) and increased blurred vision during the first week that would otherwise occur with removal of the epithelium (it requires about a week for the epithelium to heal back once it is scraped off). 

The below photo shows riboflavin solution (yellow) penetrated through the intact epithelium and into the cornea which is how Holcomb C3-R^® can be done without scraping off the epithelium.

Eye physician’s in Germany performed the initial studies of collagen crosslinking to strengthen the cornea. They reported results of treatments done as long ago as 1998, so there is a good track record for this procedure. Links to these research publications can be found to the left side of this page. It is important to note in these studies that the proper dosages of the components are a very important part of the treatment. When used properly, there were no negative effects.

Holcomb C3-R^® treatments can also be combined with Intacs^® to flatten the keratoconus cone even more than with Intacs alone. In these cases, Holcomb C3-R^® treatments stabilize keratoconus from getting worse as well as help the Intacs^® reverse the keratoconus steepening that had already occurred up to the time of the treatment.

The figure above demonstrates almost 10 diopters of corneal flattening in one patient before (left) after this combined treatment (right).

RIGHT EYE
LEFT EYE
Natural progression of keratoconus in a patient’s eyes over 1.5 years. Notice the dramatic lower cone steepening (red) and increased astigmatism over this short period of time.  Holcomb C3-R® can halt this progression and prevent these progressive distortions in vision. Note: not all keratoconus progresses this rapidly.

This above case of progression occurred in a young woman, but could have been avoided. After consultation with us, she saw another eye doctor in Los Angeles who was misinformed and advised her not to have Holcomb C3-R. The result: significant vision loss from delay of treatment for over 1 year. She came back for Holcomb C3-R which stopped the progression and further vision loss.

Dr. Brian Boxer Wachler is credited as the first doctor in North America to use Holcomb C3-R^® treatments for keratoconus as well as being the first doctor in the world to combine this treatment with Intacs^®. He has been performing Holcomb C3-R^® for over 5 years - the longest of any physician in North America. 

In another study in patients who had RK (radial keratotomy), Holcomb C3-R^® appeared to stabilize progressive farsightedness (hyperopia) changes and reduced visual fluctuations during the day.

The best way to understand how your life can be transformed is to listen to patients just like you. 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.