Corneal collagen crosslinking can be done as an in-office procedure. One clinician describes the process and the logistics.
Reviewed by Kathryn M. Hatch, MD
Office implementation of corneal collagen crosslinking (CXL) requires space and a full staff effort, but it does not compromise practice efficiency and is worthwhile due to its benefits of preserving vision in patients, said Kathryn M. Hatch, MD.
Dr. Hatch has been involved with CXL since 2011 as a clinical trial investigator and has been performing it in her practice since its commercial launch in 2016. She is director, Refractive Surgery Service, Massachusetts Eye and Ear, assistant professor of ophthalmology, Harvard Medical School, Boston.
“CXL is the only treatment available that is able to slow or halt the progression of keratoconus, and corneal ectasia following refractive surgery,” she said.
CXL is performed in a clean room and can be done as an in-office procedure, but the practice needs to have a room available where the patient can undergo the riboflavin loading procedure (riboflavin 5’-phosphate in 20% dextran ophthalmic solution, Photrexa Viscous; riboflavin 5’-phosphate ophthalmic solution, Photrexa T; both from Avedro), and the light treatment (KXL System, Avedro).
Dr. Hatch emphasized the need for an educated support staff to assist with patient scheduling, counseling, care, and reimbursement. She advised designating one staffer as a “CXL champion” to serve as the administrative expert and handle scheduling. The staff member can talk to patients preoperatively, reviewing the steps, and obtaining informed consent.
Dr. Hatch suggested having at least two technicians who are trained to administer the riboflavin, comfortable staying with the patient during the light treatment, and able to review the details about postoperative care.
“I explain to patients that I am in charge of their care, but that they will see me during key steps of their procedure,” she said. “It is important to provide that information because some patients expect that the ophthalmologist will be with them throughout.”
On the day of the procedure, patients are given oral lorazepam when they arrive, about 40 minutes prior to surgery.
Kathryn M. Hatch, MD
E: [email protected]
Dr. Hatch is a consultant to Avedro.