The CLEI Center for Keratoconus was created in 2002 as a center of excellence dedicated to the care of the keratoconus patient. Offering the entire range of advanced keratoconus treatment, CLEI also is working to advance KC care in the future. Dr. Peter Hersh is the founder and director of The Cornea and Laser Eye Institute – Hersh Vision Group. He is a graduate of Princeton University, Johns Hopkins Medical School, and the Harvard Medical School ophthalmology residency and corneal surgery fellowship programs.
Dr. Hersh is devoted to keratoconus treatment. In recent years, he has been Medical Monitor Principal Investigator for numerous Corneal Collagen Crosslinking (CXL) FDA clinical trials, exclusively for patients with keratoconus or corneal ectasia. In fact, he was the lead author of the clinical study leading to U.S. FDA approval of corneal cross-linking for keratoconus. The entire staff of the CLEI Center for Keratoconus is dedicated to patient education, evaluation, and treatment for all aspects of KC.
A number of surgical options are available to the keratoconus patient. Since keratoconus can vary widely from patient to patient, the proper recommendation of any of these procedures depends on the individual nature of your problem.
To find out if you are a candidate for any of the techniques described below, please call our office at 201-883-0505 or e-mail, firstname.lastname@example.org, and we can schedule our thorough 3-hour keratoconus initial evaluation with Dr. Hersh and our experienced staff. At the end of your exam, you will meet with Dr. Hersh and, together, can discuss treatment plans, whether it be one of the treatments below, specialty keratoconus contact lenses, or a combination to formulate the right strategy to maximize your vision and future with keratoconus.
Keratoconus treatment options include:
Corneal Collagen Crosslinking (CXL)
Corneal collagen crosslinking (CXL) is a relatively new procedure to treat keratoconus. However, at the CLEI Center for Keratoconus, we have been performing crosslinking since 2008. The goal of CXL is to decrease the progression of keratoconus, a disease where corneal distortion worsens over the years. Crosslinking utilizes riboflavin drops (Vitamin B2) and ultraviolet light which interact with the corneal tissue to create “crosslinks” between corneal proteins. This strengthens the cornea, which is weak in keratoconus, with the goal of decreasing KC progression.
Intacs are implantable intracorneal ring segments (ICRS). If you picture a contact lens, punch a hole through it to make it a doughnut, and then cut it in half. The goal of Intacs is to reshape the cornea in keratoconus in order to make it more regular and, optically, smoother. The clinical benefit varies with your problem. Intacs can help to make contact lens wear easier with better results, improve vision with glasses by decreasing the “visual static” caused by the irregular keratoconus cornea, and improve general vision in some patients.
The size and position of the Intacs segments are chosen based on your individual corneal shape. One or two segments are placed depending on the individual measurements. The Intacs procedure is performed at the Cornea and Laser Eye Institute – CLEI Center for Keratoconus using numbing drops for comfort. The first step uses a special laser, called a femtosecond laser, to create a tract or tunnel within the cornea in which to place the Intacs. Segments are then placed in the proper position within the tunnel. Usually, sutures are not necessary and you will use drops for 1-2 weeks. Typically, patients may return to work one day after the procedure. Intacs are often performed in conjunction with corneal collagen crosslinking.
Topography-guided PRK (TG-PRK, photorefractive keratectomy) is a new method of laser treatment that may be helpful for some patients with keratoconus. The laser is used to smooth the optics of the distorted keratoconic cornea by incorporating your individual corneal topography map into the laser treatment. The goal is to improve the corneal shape in order to improve visual quality with glasses or contact lens fit depending on your problem. Some patients may also note a general improvement in visual quality.
Phakic Intraocular Lens (ICL)
A phakic intraocular lens, known as the ICL, is an artificial lens that is implanted to correct high degrees of nearsightedness in some patients with keratoconus. This can help some KC patients have improved vision without glasses or contacts. Often in patients with keratoconus, Intacs, or TG-PRK will be suggest before ICL placement to give the best ultimate outcome.
Conductive Keratoplasty uses localized spots of radiofrequency energy on your cornea to reshape the corneal optical contour. In keratoconus, we often use CK to enhance the astigmatism-reducing effect of Intacs.
Corneal transplant techniques for keratoconus have evolved over the last several years. In many cases, here at the CLEI Center for Keratoconus, we perform laser-assisted transplants. These use a femtosecond laser to perform the preparation of both the patient cornea and the donor cornea. This allows a meticulous match of the graft and host, with the goal of a more dependable healing process and a smoother corneal contour after surgery. Patterns such as zig-zag and mushroom configurations can be used depending on the shape of the keratoconus cornea to be treated.
Excimer Laser PTK
Excimer Laser PTK and superficial keratectomy (SK): Smoothing procedures can be used to treat corneal nodules, which may develop in keratoconus and to decrease corneal scarring in some cases.