Q. Are we witnessing a revolution in keratoconus treatment?
A. We most certain are!
Advances in cross-linking for keratoconus are transforming how eye care professionals manage this progressive corneal disease. As the condition advances, effective treatments become critical to prevent further visual impairment. Corneal cross-linking (CXL) has long been a game-changer in treating keratoconus progression.
Still, recent developments - especially in new Epi-On techniques currently in Phase 3 clinical trials in the U.S. - offer exciting alternatives.
This article will delve into the benefits and risks of both Epi-On and Epi-Off cross-linking techniques and provide actionable recommendations for professionals integrating these methods into their practice.
Phase 3 Clinical Trials: A Look at Promising Epi-On Alternatives
Let’s explore the latest breakthroughs in keratoconus treatment. Advances in cross-linking for keratoconus are reshaping how eye care professionals approach this progressive eye condition, offering patients more options with improved comfort and faster recovery times.
Corneal cross-linking (CXL) has already revolutionised treatment by halting disease progression. However, recent innovations - particularly in Epi-On techniques - are enhancing the safety, effectiveness, and accessibility of CXL.
Here, we present the top 5 advances in cross-linking for keratoconus that transform clinical practice and improve patient outcomes.
1. Epi-On Cross-Linking Techniques: Non-Invasive and Patient-Friendly
One of the most promising advances in cross-linking is the development of Epi-On, or transepithelial, CXL techniques. Unlike the traditional Epi-Off method, Epi-On treatments preserve the corneal epithelium, reducing recovery time and minimizing patient discomfort. Epi-On is particularly beneficial for early-stage keratoconus patients or those sensitive to invasive procedures. With less disruption to the corneal surface, patients experience faster healing and are less prone to infection, haze, and discomfort.
2. Glaukos Epioxa Clinical Trials: Phase 3 Results Show High Efficacy and Safety
The Glaukos Epioxa technique has emerged as a leading innovation within Epi-On treatments. Currently, in Phase 3 clinical trials, Epioxa leverages a novel riboflavin formulation that enhances cross-linking efficiency without the need to remove the epithelium. Clinical results from over 591 patients have shown that Epioxa meets safety and efficacy benchmarks. With one year of data under FDA review, Glaukos Epioxa could soon be available in the U.S., potentially becoming the first FDA-approved Epi-On CXL option.
3. Epion Therapeutics’ EpiSmart Protocol: Cutting Recovery Time and Complication Risks
Another Epi-On technique gaining traction is Epion Therapeutics’ EpiSmart protocol, designed to reduce recovery time and minimize the risks of post-treatment complications like infection or scarring. Currently enrolling over 800 patients in 20 sites across the U.S., the EpiSmart trial is focused on delivering faster recovery with similar long-term stabilization as Epi-Off methods. EpiSmart’s gentler approach makes it a strong candidate for pediatric and younger adult patients, expanding keratoconus treatment options to a broader demographic.
A key advancement in CXL efficacy is chemically enhanced riboflavin solutions, specifically developed to improve stromal absorption in Epi-On treatments. These solutions increase cross-linking strength without requiring epithelial removal, bridging the gap between Epi-On and Epi-Off efficacy. Enhanced riboflavin formulas allow for better patient outcomes in Epi-On procedures by creating a more robust cross-linking effect, potentially leading to long-term stability and fewer follow-up procedures.
5. Reducing the Need for Corneal Transplants with Advanced CXL Techniques
One of the most significant impacts of CXL, including both Epi-On and Epi-Off techniques, is its role in reducing the number of corneal transplants for patients with keratoconus. Long-term studies demonstrate that by halting the progression of keratoconus, CXL greatly lowers the likelihood that patients will reach the advanced stages requiring transplantation. With less invasive CXL options, professionals can treat keratoconus earlier and more effectively, minimizing the need for future transplants and preserving vision quality.
Conclusion: New Horizons in Treatment
These top five advancements in cross-linking highlight how innovation in Keratoconus management continues to offer better patient outcomes. These breakthroughs represent a new era in CXL, from non-invasive Epi-On techniques to enhanced riboflavin solutions and clinical trials promising faster recovery times. For U.S. eye care professionals, staying informed on these advancements allows for more tailored and effective treatment plans, ultimately improving the quality of life for those living with keratoconus.
