Recently, Brazil’s top Ophthalmology magazine, Oftalmologica Em Foco, features Prof. Hafezi and Dr. Torres-Netto of the ELZA Institute in Dietikon, Switzerland, exploring the story of how they are making CXL at the slit lamp reality.
Corneal cross-linking (CXL) is the only treatment for corneal ectasias like keratoconus that can slow and even halt the progression of this disease, but at the moment, CXL is performed in the operating room (OR). This has a consequence: cost. Operating rooms sterile and allow patients to sit back on a reclining chair and be cross-linked – but running an OR is an expensive enterprise and this patient is first passed on to the doctor who then passes it on to the patient. But it turns out CXL sterilizes the cornea, and this has one important implication: CXL does not need to be performed in a sterile environment. It can be performed in the surgeon’s office, or a procedure room. In fact, CXL is used to treat corneal infections, so there is an additional good reason not to cross-link in the OR: no surgeon wants to contaminate a sterile area with an active infection.
Returning to the topic of cost, by reducing the amount patients have to pay, this opens up CXL – both for the treatment of ectasia and corneal infections – to more people, particularly those in low-to-middle income countries (LMICs). By having a cross-linking device that is small enough and portable enough to be mounted on a slit lamp, this also means that CXL can be taken outside of hospital settings to anywhere that has a slit lamp – which could mean even the most remote locations in LMICs where patients would have almost no chance of travelling to a large city with a hospital and paying for the procedure to be performed in an OR. Hafezi and Torres call this “democratizing” corneal cross-linking, and they review these topics in the article, plus all of the other issues that have needed to be overcome to make CXL at the slit lamp a reality.