Corneal crosslinking is the standard of care for keratoconus. It is the only method shown to halt the progression of keratoconus. In corneal crosslinking, riboflavin (Vitamin B2) eye drops are placed on the cornea and allowed to soak in. This usually takes about 30 minutes of drop application. After the riboflavin has saturated the cornea, UV light of 385nm wavelength is shined on the cornea for a total energy of 5.4J/cm2. This creates new covalent bonds between the different structures in the collagen matrix of the cornea. The new bonds strengthen the cornea and stop the progression of the keratoconus. The irregular shape will not change back to normal after crosslinking, but many patients do notice an improvement in the vision. The process takes about one hour per eye. It is similar to a sunburn on your cornea, so the post-operative recovery is uncomfortable with temporary burning. The FDA approved protocol for corneal crosslinking requires removal of the corneal epithelium to allow the riboflavin to absorb into the cornea. This is referred to as “epi-off” crosslinking. With improved techniques and technology, corneal crosslinking is now possible without removing the epithelium which is called “epi-on” crosslinking. Epi-on crosslinking is safer with a faster recovering and much lower risk for infection and scarring. The efficacy of epi-on crosslinking has been shown to be as good as epi-off crosslinking in multiple studies. The crosslinking we perform at Waite Vision is epi-on corneal crosslinking. Since it is so safe, we perform crosslinking on both eyes on the same day to allow for a quicker recovery. After corneal crosslinking, patients will still need glasses or contact lenses for best vision. Some patients are good candidates for surgical vision correction after crosslinking. After the cornea is stronger from corneal crosslinking, topography-guided PRK can correct the vision so glasses and contact lenses are no longer needed. PRK is an innovative treatment that can be used for keratoconus since crosslinking makes the cornea strong enough for vision correction. As experts in keratoconus, Waite Vision is proud to offer this procedure to bring hope to our patients. Similar to LASIK, PRK (photorefractive keratectomy) is used to treat nearsightedness, farsightedness, and astigmatism in affected individuals. Topography-guided PRK, which incorporates your unique corneal topography map into the laser procedure can result in better vision than possible before. It reshapes your corneal surface using your unique corneal topography data to enhance your corneal optics and visual performance. In the most severe cases of advanced keratoconus where glasses and contact lenses no longer work, corneal transplantation may be the best method for visual rehabilitation. During a cornea transplant, the misshapen layer of the cornea is removed and replaced with a clear cornea from an organ donor who has passed away. For keratoconus the best method for transplantation is a partial corneal transplant (deep anterior lamellar keratoplasty DALK) where only the front 85% of the cornea is replaced. This results in a lower rejection rate of the new cornea. Fortunately, most patients with keratoconus do not progress to the point where a corneal transplant is needed.