CCS 2025: Corneal crosslinking for keratoconus

Video Transcript:

Editor's note: The below transcript has been lightly edited for clarity.

Peter Hersh, MD:

At the CCS, one of our biggest interests is really how doctors can collaborate in the treatment of our patients. In the kinds of things that we do, in my interest, and our interest here at the CLEI Center for Keratoconus, really focuses on keratoconus. And this is a disease entity where collaboration between optometrists, ophthalmologists, and surgeons is really key. The reason for this is that keratoconus needs to be detected early because there are now treatments for KC. And the two subjects that we really want to touch upon in this CCS symposium this year are new ways to make certain that keratoconus, which is a progressive disease, is treated properly to diminish progression as much as possible. And for this, we're going to be discussing corneal crosslinking.
The second are new surgical interventions that can be used to really improve vision in the keratoconus patient. And here, we're particularly interested in the new CTAK procedure, or Corneal Tissue Addition Keratoplasty for keratoconus. Now, it needs to be remembered that these kinds of interventions for KC really follow several avenues. Number one, we want to improve the prognosis of keratoconus by diminishing its progression. And through this, we are now using a corneal crosslinking. A corneal crosslinking was first introduced almost two or three decades ago as a means to make the cornea stronger and thereby decreasing progression. It was started in the US back in 2000 [inaudible] disclosurized medical monitor of these clinical trials. What we found was that cross-linking, which uses riboflavin eye drops and ultraviolet light, is safe and effective for diminishing the progression of keratoconus in the vast number of patients. Indeed, our findings were that upwards of 93% of keratoconic patients were stabilized, and this was FDA approved back in 2016 for general use in the KC population.

One of the very important things here, I think, to note in the CCS symposium is that keratoconus patients need to be identified as early as possible, because we now have this treatment which will effectively decrease their progression, keep them with stable vision, and keep them from ultimately needing something like a corneal transplant. Since the majority of KC patients should be diagnosed when they are younger, and since many of them are seen by the optometric community, it really is incumbent upon primary care providers of eye care to identify these patients early and to have a close collaboration with ophthalmologists and surgeons in order to treat these patients as soon as possible. Keratoconus doesn't get better by itself, so it is very important to identify early and to treat appropriately. Just looking back over the long term, the first KC patient that we treated with crosslinking here at the CLEI Center for Keratoconus was back in 2008. And over the years, we have found in our patient population very good stability. We're also going to discuss some new applications and new modalities of using corneal crosslinking in patients that I think are very important for everyone to understand.

The other thing that is new for the KC patient is a new and novel intrastromal lamellar keratoplasty procedure called CTAK procedure, or Corneal Tissue Addition Keratoplasty for keratoconus. This is something that we did develop here at CLEIcon, and again, as a disclosure, we're working with CorneaGen in order to make this treatment a real reality for the keratoconus patient. This has been developed by myself, Dr Greenstein, and Dr Gelles, on our symposium today over the past 10 years. What CTAK is—it is an implantation of a custom-designed corneal inlay. It is based on an individual patient's own corneal topography and clinical situation, and it uses preserved corneal tissue, which is prepared on an individual patient basis, based on their own topographic, tomographic, and clinical parameters. Again, I think in this symposium, it is very important to understand that a procedure like CTAK is used adjunctively through a procedure like crosslinking. Here we're looking at two different avenues: crosslinking to decrease progression, a new procedure like CTAK to improve patients' vision. Indeed, with CTAK, in our clinical trials, we have found improvement in uncorrected vision of an average of 6 lines and improvement in corrected distance visual acuity in about 3 lines on average in these patients. And notably, we have found generalized improvement in visual function, and for those patients who are in need of contact lenses, we still find excellent ability to wear contact lenses after the procedure.

The third avenue which is going to be discussed this symposium are the use of contact lenses for keratoconus, which are a very important feature of keratoconus treatment. They really are the mainstay of improving corrected visual acuity in KC. So in KC again, we see 3 avenues. One, crosslinking to diminish progression. Two, contact lenses to give the best possible vision. And indeed, we're going to hear about new contact lenses that are given even better results than we've had in the past. And thirdly, these new surgical innovations, such as the CTAK procedure, which indeed can give the keratoconic patient a much more functional visual acuity to get around for their daily lives.