April 26, 2010
Dr Raymond Stein was the invited guest speaker to the prestigious Phillips Eye Institute in Minneapolis, Minnesota to discuss his results of Corneal Cross-linking for Keratoconus.
Dr Raymond Stein was one of the first clinicians in North America to perform CXL using Riboflavin drops and ultraviolet light.
Collagen crosslinking holds promise for treating a number of conditions, including keratoconus, ectasia, infection, and corneal instability caused by radial keratotomy.
View Press Release on Dr Raymond Stein
Led by Raymond Stein, MD, the team at the Bochner Eye Institute started a detailed clinical study on corneal cross-linking (CXL) on radial keratotomy (RK) eyes 22 months ago. Long-term data after RK has shown that some patients develop progressive hyperopia and in addition a high percentage have diurnal fluctuation in vision. Early data in the 15 eyes has been impressive in stabilizing corneas and reducing fluctuation in vision. An interesting case was a patient that was +9 D in both eyes 15 years after RK. He required multiple pairs of glasses during the day and night for driving. Fourteen months after CXL he now feels comfortable with a single pair of glasses and finds his vision to be stable. We need long-term data but at this point we are very encouraged with the outcomes. In general there is a minimal reduction in the degree of hyperopia. Most importantly Dr. Raymond Stein and his team have not seen eyes that have continued to have a progressive hyperopic shift. The surgeon must be gentle in removing the corneal epithelium prior to CXL so the RK incisions do not gape and induce irregular astigmatism. CXL has its major effect on the weakened area of the cornea. In RK eyes the weakened area is in the midperiphery, which leads to progressive central flattening and a hyperopic shift.
The Bochner team believes that when the RK corneas are stable the outcomes will be better with cataract surgery, PRK, phakic IOLs, or refractive lens exchange. Looking back over the past 20 years in dealing with RK outcomes following other procedures the results have not been as good as virgin eyes. The team believes this may be related to unstable corneas.
Raymond Stein MD is respected internationally for his skill and expertise in laser vision correction. Dr. Raymond Stein has performed over 50,000 laser vision correction surgeries, and is a frequent speaker at international eye conventions such as ASCRS (The American Society of Cataract and Refractive Surgery) and AAO (American Academy of Ophthalmology). In addition to being a noted lecturer, Raymond Stein MD is a well-regarded author who has published numerous articles and books pertaining to general eye care, laser vision correction and specialty treatment of disease such as keratoconus.
At the Bochner Eye Institute we were the first in North America to introduce CXL using Riboflavin drops and epithelial removal in January 2008. Over the past 1.5 years we have treated 495 keratoconus eyes with encouraging clinical results.
The main goal of CXL is to halt the progression of keratoconus and thus prevent the need for a corneal transplant.. At the Bochner Institute patients have ranged from 11 to 60 years of age. The earlier the treatment the better the long-term prognosis. We have not seen a case of progressive ectasia post-CXL. Our minimum corneal thickness has been reduced from 400 um to 300 um with the technique of inducing corneal swelling prior to crosslinking.
Dr Raymond Stein was invited to present clinical results at the annual Canadian Ophthalmological Society meeting in Toronto June 2009. The 12 month results of 30 eyes were reported that were followed with a refraction, pachymetry, and Pentacam analysis. Some patients achieved up to 8 diopters of flattening. Topographic difference maps often showed flattening of steep areas and steepening of flat areas to enhance the overall corneal curvature and improve best-corrected spectacle acuity. Sixty percent of eyes showed improvement of one or more lines of vision.
As in Europe which started CXL 11 years ago the procedure is now being rapidly adopted as the preferred treatment for keratoconus eyes with progressive disease. At the Bochner Eye Institute we are continuing to have patients referred from ophthalmologists and optometrist from as far away as Miami, Dallas, and Los Angeles.
If you would like further information on CXL or an opportunity to view a procedure please contact one of our refractive surgery consultants Ms Kristin Mallon (KMallon@Bochner.com), Mr Peter Schilling (PSchilling@Bochner.com, or Ms Lynn Maund (LMaund@Bochner.com).
We are very pleased to be the first centre in North America to offer the revolutionary procedure of Corneal Collagen Crosslinking (CXL) to arrest the progression of keratoconus.
The procedure originated in Europe over 10 year ago. When the clinical results appeared excellent in the scientific literature we acquired all the equipment from Europe and started performing the procedure in January of 2008.
Keratoconus is a degenerative disease of the cornea that comes on in adolescence and tends to progress until patients are in their 40s or 50s. 20% of keratoconus patients in the past required a corneal transplant. With early identification of the disease and treatment this promises to greatly reduce or eliminate the need for a transplant. Of the more then 350 eyes treated to date at the Bochner Eye Institute the patients have ranged from 11 to 55 years of age.
Although the goal of CXL is to arrest the progression of the disease, corneal flattening occurs in a high percentage of patients by 6 months with further improvement at 1 year. In addition to the treatment of keratoconus the CXL procedure can be used to stabilize the vision following radial keratototmy. We are accepting referrals for CXL from patients throughout North America. In addition to patients from across Canada we have treated patients from New York, Pennsylvania, Texas, and California.
To learn more about keratoconus and this leading-edge treatment, please contact Dr. Raymond Stein and the team at Bochner Eye Institute at 416-960-2020, or by using the contact form below.