Monday, May 08, 2006

 

More on Riboflavin treatment

Eye treatment could replace surgery
From: AAP
By Jane BunceApril 16, 2006

A SIMPLE treatment using Vitamin B2 and ultraviolet light could replace major corneal transplant surgery for Australian patients in a revolutionary eye treatment trial.Scientists believe the procedure will save the eyesight of up to 50,000 Australians with the degenerative eye disease keratoconus.
Keratoconus sufferers experience a progressive cone-like distortion of the normally round-shaped cornea, which can initially be corrected with glasses or contact lenses but can lead to blindness and the need for a corneal transplant.
But the new treatment can stop the disease by strengthening the cornea to prevent it changing shape.
German doctor Christin Wittig is in Australia to complete the randomised trial involving 100 patients at Melbourne's Royal Victorian Eye and Ear Hospital over the next year.
Dr Wittig said about 250 patients had undergone the procedure in Germany in the past five years.
It had stopped the progression of the disease in all, and none had suffered serious complications.
"It treats the cause of the disease, not just the symptoms, and stops patients undergoing major surgery, so it's a pretty big step forward really," Dr Wittig said.
She said it was most effective in the early stages of the disease because it could not reverse the deterioration of the cornea.
The treatment involves scraping a layer of skin off the patient's eye, applying Vitamin B2, also called riboflavin, using an eye dropper and exposing the cornea to a measured dose of UVA light.
The light activates the B2 to produce oxygen radicals, which begin a chemical reaction that binds and cross-links collagen fibres in the cornea and thereby strengthen it, Dr Wittig said.
She said the procedure had much less impact on patients' lives than a corneal transplant, was cheaper and quicker and could easily be taken to regional areas.
A single transplant costs around $3000, while the new treatment costs about $2500 for the equipment and about $1000 for riboflavin to treat 60 patients.
Melbourne travel agent Tanya Wilkinson, 26, who has suffered keratoconus since she was 10, had a corneal transplant in her left eye in 2001.
The disease still affects Mrs Wilkinson's right eye, and she could need a second transplant within seven years.
She said she preferred the new procedure because a transplant required 18 months of post-operative care and could be rejected.
"It's a great prospect," she said.
Corneal Unit head Dr Grant Snibson said if the trial appeared successful after six months, and the hospital received ethics committee approval, it would offer the procedure to other patients.
Keratoconus is estimated to occur in one in every 400 to 2000 Australians and usually begins between the ages of eight and 45.
More than 1200 corneal transplants are performed in Australia every year.

We have been inundated with phone enquiries about this promising treatment.

Currently approximately 20% of patients with clinically significant keratoconus will require corneal transplantation. This treatment is still in its infancy but it could be the first line of treatment as soon a diagnosis of keratoconus is made. As long as there are no long term side effects it could be at its most powerful between the ages of 15 - 25 when keratoconus is most likely to progress.

Stay tuned as The Eye Practice is in constant communication with the leading corneal surgeons. We promise that we will keep constantly up to date with the latest advancements in keratoconus.

Visit our website: www.theeyepractice.com.au for more information about keratoconus and other eye issues.

Comments:
hi jim
my name is sandra i was looking at all your information on keratoconus you said you dont go blind,well i am leagally blind i cant see out of one eye and the other eye is not good i have a guide dog
can you please tell me i was told this is because it was not picked up in time my glasses kept getting stronger an stronger i have had get help from my doctor for ten years transplants contacts an glasses lots of ops what is your views on this
thanks jim
sandra
 
hi,
thanks for the info on your blog
i do see however that you've posted these quite a while back

are there any significant advances being made in the crosslinking method?
i've been told that it won't really benefit me at my age, but I'm not really happy with that doc's assesment, i am 41 now and think that any decrease of the condition would be beneficial?
 
Where is cross linking at now. This post is a couple years old. I'd be interested to know more about how it is working currently. Intacs were supposed to be a good thing and that didn't turn out so well.
 
As I have been away for so long from this blog, I think I owe everyone a reply:
1. Sandra
I am so sorry to hear that you are legally blind, which i assume started with keratoconus, progressed to corneal transplants and then poor vision through the transplants. your case is very rare and there are many variables that maybe in hind sight could have been manged better years ago to not leave you in the state you are in now. I assume you have tried contact lenses after the corneal transplant and for some reason they failed. Of all the difficult contact lens fits we have referred to us about 1 in 5 are corneal transplants. We find that given enough time we are successful with the overwhelming majority. I would need to have more information to work out why you have not had success.
 
2. CleverPete
Cross-linking for keratoconus has not really changed that much since inception in Germany about 15 years ago.
A couple of years ago an Australian group led by Dr Grant Snibson (corneal surgeon) did a careful 2 year study using cross-linking on keratoconus and proved saftey and efficacy.
The points to take home about collagen cross-linking for keratoconus are:
1. It at least slows down progression in most cases.
2. There is little point doing the procedure on someone after 30 years of age unless they are showing definite keratoconus progression. This is because the cornea naturally cross-links as we age and naturally gets "stronger". Therefore there is no real advantage for a person over 40 years of age. This great treatment is really at its best between the ages of 15 and 25 years of age when keratoconus is at its worse and in a progressive mode.
More on cross-linking can be found on The Eye Practice blog at:
http://www.theeyepractice.com.au/_blog/optometrist-sydney
 
3. Dr Wallace
I think cross-linking has finally been approved by the FDA in the USA only recently.

As written in the previous post collagen cross-linking is now a mature procedure with definite value in treating young emerging keratoconus patients. It is now part of my treatment paradigm.

You are right about Intacs or Kera Rings, they are a bit hit and miss.

I get many referrals to fit contact lenses after the Intac procedure when it would have been easier for me to fit contact lenses before.
 
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