EyeWorld Asia-Pacific September 2020 Issue

EWAP SEPTEMBER 2020 39 REFRACTIVE are FDA approved, we will decide to use different types of crosslinking for different eyes in different patients,” Dr. Raizman said. EWAP Editors’ note: Dr. Ciolino is associate professor of ophthalmology, Harvard Medical School, Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, and declared no conflicts of interest. Dr. Dupps is professor of ophthalmology, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, and has interests with Glaukos and Cleveland Clinic patents. Dr. Raizman is associate professor of ophthalmology, Tufts University School of Medicine, Boston, Massachusetts, and has relevant interests with Glaukos. corneas have flattened at least back to baseline or further. Flattening can occur beyond this timeframe as well. “One thing that is universally true is that the amount of flattening is not predicable with the typical Dresden protocol,” he said. “It’s true that the vast majority of patients have increased steepening of the cornea at 1 month. It’s also true that nearly all of them are back to baseline by 2–3 months, but from there on, some patients stay right where they are, but others have progressive flattening.” Crosslinking additions, targeting treatment Supplemental oxygen is one of the most widely discussed factors that could improve the reactions in a crosslinking treatment to enhance efficacy. Dr. Raizman said there are compounds other than riboflavin that can be used to create a crosslinking reaction with UV light exposure, as well as chemical methods that don’t need UV light at all for crosslinking (though not currently used). He also said outside the U.S. there are different devices that provide a customized light pattern to the cornea, putting more light energy on the cone itself, with evidence showing better efficacy with this technique. Dr. Dupps said this type of customization backs off other parts of the cornea that are more stable, allowing them to flex in a more favorable manner while the weakest part of the cornea is adequately strengthened. “I think that when we have alternative treatments that