Crosslinking Procedure

Crosslinking Procedure

Crosslinking Procedure


Q What are the follow up requirements after C3R??

Ans. After C3R the follow up is as follows:

1. First post C3R follow up the next day of procedure and the next one after Day 4. You need to be in Mumbai for these days (4-5 days post C3R)

2. Next follow up check after 3 months during which we check the Topography maps as well. This can be done in your own city.

3. Change of prescription mandatory only if you ‘feel the need’ that there is a change, then only go for it before 3 months. Otherwise, this will keep changing over next 6- 8 months. So some pull on till then.

4. You need to check the topography maps every 6 months till the time they are stable, which means no more change will happen.

Preferably for better comparison, the maps to be done on same topography machine.

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Q What about Intacs for keratoconus?

Ans. Instrastromal corneal rings or Intacs surgery is a procedure in which small plastic polymer ringlets are inserted into the eyes in order to flatten the cone-shaped cornea or keratoconus.

In order to implant the Intacs, the surgeon bores into the collagen-filled center of the cornea, creates an incision carefully avoiding nerves, implants the ringlets within the corneal layering and closes the incision. Intacs, work by holding the cornea in place like a splint and once the implants are removed, the patient will return to pre-surgical conditions. Hence, it does not correct the keratoconus, but just mechanically ‘flattens’ the cornea, that too temporarily.

The two most common complications of Intacs implant surgery are eye irritation and abnormal blood vessel growth. C3R is a more permanent procedure.

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Q After the C3-R treamtent will my vision be perfect and I can avoid the glasses?

Ans There are 2 aspects to keratoconus treatment – first we need to stop progression for which there is only one treatment namely, C3R or crosslinking. Secondly, once the C3R is done, we look at the refractive error 3 months to 6 months after the treatment and see if there is any aid to improve vision. The options include : spectacles, RGP contact lenses, special keratoconus contact lenses, laser, ICL’s etc.

This decision as to what is best suited from the above choices for your eyes can only be taken after we have evaluate you 3 to 6 months after the C3R is done.

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Q If not is there any other treatment can be done to make the vision perfect. I just want to get rid of glasses?

Ans. We need to evaluate you 3 – 6 months after C3R is done. Also, this depends on the level of vision after the keratoconus stabilizes, that is the vision once stable that you should expect. Your visual expectation can be defined when you visit us.We have been able to reduce dependency or eliminate glasses with implantable contact lenses once the cornea shape stabilizes and the numbers do not change further.

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Q What is C3R + Topolink treatment or C3R done with PRK?

Ans. This is a treatment on the surface of your eye (cornea) to treat your powers or spectacle numbers as well as treat the keratocconus.

C3R is not going to help any spectacle correction, but only stabilize the progression of the abnormality viz. keratoconus.

In some cases, who have the possibility (you will know when Dr Anand Shroff, our corneal and refractive surgeon examines you), they are offered a dual treatment, one to correct their keratoconus, other to improve vision (if possibile) – PRK.

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Q I am working in IT and need to be in front of computer continuously. How long will it take for me to join office from the time of operation?

Ans. You may expect to be unable to function on the PC at all for about 3-4 days and then in the first week, work with short intervals, but are able to work for long hours. You can safely resume work on Day 5. Some even join earlier depending on their comfort level.

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Q How long will the vision be blurred after operation?

Ans. This is usually blurred on the first 2 days, however improves thereafter, such that most routine work can be done on Day 3. Specficially we say no driving for 7 days.

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Q How long will the eye be painful after the anaesthesia effect is over?

Ans. This is very subjective, depending on the threshold of tolerance of the person. Usually the first day is ‘tough’, with fair amount of discomeort, but second day onwards improves. We also help you with painkillers and eye drops to tide over this period.

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Q As an IT professional i have to continuously work in front of a computer so will i be able to work on computers immediately after the treatment that is after the first week after the removal of the bandage lenses?

Ans. This depends from person to person. We have had people recover well and back to their office and computer usage after the first week, some take little longer. Using your old glasses, one can sit comfortably for short durations after 5-6 days but as days pass, it gets more comfortable for you. You may have to start with shorter durations of compuetr related activity, but with frequent reaks, this is manageable.

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Q What is your experience with the 50 patients you have already treated in context with safety, side effects?

Ans. We have performed over 70 C3-R®* treatments and still going on. None have had any complications. Yes, they were all prepared for some days of discomfort as informed. The treatment is very safe and in fact beneficial for Keratoconus as it strengthens the cornea 300%.

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Q Has visual acuity improved after the C3-R®* in patients[if any and in how many patients out of the total?

Ans. The visual acuity improvement is gradual, even taking upto 6 months or longer. This improvement is not dramatic as in LASIK or laser eye surgery, because the aim is not to improve visual acuity but to prevent further deterioration. Our earliest cases have been done in April 2007, hence it is still to early to comment on any significant data. However, all patients have shown arrest and no progress in the condition and some of our patients have had upto 2 lines of improvement in visual acuity. Many have shown actual improvement on their topography maps.

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Q How many days should i take out from my schedule for the treatment to be done and for the later checkups in all?

Ans. We need to do one eye at a time. As some are symptomatic for about a week, we prefer to do the second eye when one is comfortable with the first treatment. This can be spaced between 5-6 days apart. If they are from out of Mumbai, then one plans accordingly.

The days to stay away from work are the first 5-7 days post procedure as the bandage lens is removed on Day 4 and it may take upto another 2 days to be symptom free.

You basically start using your old glasses. Contact lenses can be worn after about 10-15 days.

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Q I am unable to see from my left eye if my right eye is closed, but when both eyes are open, I can see perfectly fine, like a normal person. how is this possible?

Ans. We see from the brain. If one eye is weak, then with both eyes open we are seeing from the dominant eye as the brain learns to suppress the image of the weaker eye.

When one shuts the good eye, it is only then that one can make out the huge difference in the weak eye.

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Q In this kind of a situation, what effect does the desease have on his right eye?

Ans. If we are talking about keratoconus specifically, due to which your left eye’s (weaker) has poor vision, then in most cases keratoconus does become bilateral. But this is not like an infection where the other eye ‘catches it’. It is more the abnormality existing in one or both eyes. If today there is no abnormality or keratoconus in the right eye, it may stay that way, or it may show early signs and progress to become worse like the left one.

A good eye examination with sensitive equipment like the Pentacam – Topolyzer we use helps diagnose even early stages of this disease to help keep it under control and not allow it to worsen.

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Q If there is no discomfort in the daily life of the patient (except for a little irritation) should he go for any kind of medical treatment at this stage?

Ans. This depends on the stage of keratoconus one has, not symptoms as these are often misleading. Unless a drastic change in the ‘cone’ takes place, patients cannot appreciate any change even if the abnormality is leading to a worse stage as these are usually minor changes in numbers. One does need to be aware of any deterioration in vision.

Basically, in keratoconus, having no treatment means always living under a ‘hanging sword’!

The new treatment called ‘C3-R®* or Cross Linking’ also has limitations that it cannot be done on very thin cornea. Since this treatment has produced remarkable results, one does not want to lose the opportunity of missing it. If however, keratoconus is in early stages, the patients not keen on any surgery, then he needs to be very vigilant in his follow ups with the doctor and can wait if the doctor allows it.

If the keratoconus is progressing, then it is better to halt its progress with C3-R®* when one is fit, rather than wait to do a corneal transplant.

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Q Can the patient use any eye drops for the irritation?

Ans. Yes, however, this may be coincidental that he may be having an eye allergy at present. However, no eye drops treat the keratoconus.

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Q How succesful is the cross linking treatment and what will be the position of the patient’s eye after the procedure is done?

Ans. There will be no change in position of the eye. The procedure is done on the ‘cornea’ which is a transparent area just covering the coloured part of the eye.

This treatment when done correctly has excellent results.

Till date (we have been doing this treatment since last year) we have had no failures. All patients have stopped the progress of the cone and many patients have had a ‘flattening’ of the ‘cone’. Dr Anand Shroff, our corneal expert does the pre procedure check, procedures and post procedure checks himself.

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Q What is your best advise for a person suffering from keratoconus and which is the best place to get treatment done from?

Ans. We offer you the best eye services in the country combined with expertise and longest experience (very important in such cases) in C3-R®*. Ours is the only eye hospital in india to have recieved the highest award for healthcare from the Joint Commission USA, this makes us stand apart from the rest. For more details about our Keratoconus Treatment, please click here.

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Q What are the dangers when you keep your eyes open fixing UVA lights during 30 min as generally one says that UV lights are generally very bad for us !?

Ans. We use Riboflavin which coats your cornea through and through its thickness. The UV light is applied to this are and is absorbed in the cornea itself. Its this combination which actually makes the C3R successful in strengthening the weak crosslinks due to keratoconus. Hence, no harm or damage occurs when this light is applied to the eyes.

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Q Can we lose color vision ? Could our Retina (cones and rods) be damaged?

Ans. Again, since this light does not travel into the eye to the retina, the retina is spared from any such incidents.

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Q How long will I be required to stay in Mumbai after the treatment as I live outside India? When can I travel back?

Ans. If planned well, you need no more than 5 or 6 days for treatment of one eye or 10 days for both.

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Q Is the treatment done on weekends?

Ans. Treatment days are usually as follows:

C3R only treatments – on Tuesdays and Thursdays; C3R with Topolink laser treatments – on Wednesdays and Saturdays.

Not knowing what is neededed for your case, it is best to plan this after your check up.

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Q When can I start driving ?

Ans. Usually after 15 days from day of treatment, depending on your comfort level.

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Q I am a thyroid patient .Will that have any effect ?

Ans. C3R is a therapeutic procedure and needs to be done in all cases of keratoconus. Systemic conditions like Thyroid, Diabetes, do not interfere with the treatment unless not in control. However, best to also inform your physician regarding the same.

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Q Would I be required to come to Mumbai for any future check ups?

Ans. If in Mumbai, we would be happy to examie as we would have your earlier records and would know your improvement by comparing with earlier Topography maps. However, many of our patients are from out of India and do the follow ups with their local ophthalmologist.

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Q Are their any test/investigations which are done before the treatment? Are they done on the same day or I need to come a day before the appointment date for these tests?

Ans. The initial check up or tests are done prior to the treatment date and these include the following:

1. Exact refraction

2. IOP or Intra Ocular Pressure

3. Examination of the entire eye with Slit Lamp and a Retinal check up

4. Specific tests like Topography maps, Pachymetry test

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Q Can I take up air travel after this treatment?

Ans. After the last follow up, you may fly out of Mumbai

 

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Q. Is the C3R an invasive type ie; involving removal of the epithelium and then putting riboflavin and exposure to the laser light

Ans. This method is preferred by Dr Anand Shroff. The transepithelial approach was only to combat the discomfort that lasts for a day or so, but with the flipside that the C3R procedure effectiveness was reduced, healing was uneven. To handle the discomfort, we will give you tablets/ eye drops and use a bandage contact lens to cover the treated area.

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Q. What is the difference between the C3r and Accelerated C3r

Ans. The accelerated version was introduced to improve patient compliance. The traditional C3R requires you to be still and on the operating table for at least one and half hour per eye. Both eyes cannot be treated simultaneously, hence patient compliance decreased. Hence, the accelerated C3R is the more recent and advanced way of treating keratoconus.

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Q. Do you have cashless Insurance.

Ans. In Mumbai, cashless insurance for eye care is not available. However, you will receive all documents necessary for reimbursement

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Is RGP lens or special contact lens better than using spectacles after C3R?

RGP [Rigid Gas Permeable] Lenses seem a good option for many who expect better clarity than spectacles. There are some special lenses also available called Rose K Lenses.

 

Poor vision is on many accounts:

  1. The disease of keratoconus itself which makes the cornea weak. ‘Kerato’ means cornea and ‘conus’ means cone shaped. The cornea in keratoconus cases is ‘wavy’ on the surface. So even if treated by C3R or crosslinking surgey, the basic “waviness” or irregular surface of the cornea does not get treated. Spectacles do not touch the cornea unlike contact lenses which sit on the cornea and flattens it out (hence the science behind use of rigid or special Rose K lenses which has better mechanical pressure compared to soft lenses to flatten out the irregularities). Due to this lenses give better clarity. Although one cannot expect to see extremely well or normally
  2. Also one may be needing cylindrical powers. Such powers in ill fitting or loose spectacles distort vision. So, again lenses are a better option.

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