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    CXL demands continuity of care

    Procedure provides opportunity to differentiate eyeMD practices, build optometric networks

    As surgeons who have been involved with collagen corneal crosslinking (CXL) research over the past decade, we were enthusiastic about the approval in 2016 of the first crosslinking system available in the United States (KXL with Photrexa Viscous and Photrexa riboflavin ophthalmic solutions, Avedro).

    CXL provides an opportunity to stop the progressive corneal steepening that can lead to loss of best-corrected visual acuity (BCVA), scarring, contact lens intolerance, and corneal transplant.1 The incidence of keratoconus, as reported in peer-reviewed literature, is about 1 in 2,000.2

    With the advent of advanced technology that enables detection of anterior/posterior corneal irregularity—including corneal tomography—clinicians now have the tools to detect keratoconus earlier and with greater sensitivity. Findings from international studies applying this technology suggest the incidence of keratoconus may be greater than previously reported.3

    Now that there is an effective treatment that may help stop the disease from progressing, it is much more critical to diagnose these patients before visual function is lost. There are inherent challenges in doing so, as patients in the early stages of keratoconus may be comfortably fit in contact lenses or glasses, and may not present with overt slit lamp findings.

    It is incumbent to make sure partners in primary-care optometry are educated about the availability of CXL and the responsibility to refer patients with progressive keratoconus for treatment while they still have the best chance of preserving their vision.

    Insurance coverage for CXL is increasingly available. There are patient-assistance programs available to ensure access by providing the photoenhancing riboflavin solutions (Photrexa Viscous or Photrexa) at no charge to low-income uninsured patients and to minimize out-of-pocket expenses for the riboflavin solutions in cases of insurance denials. Coding, reimbursement, and co-management protocols are all still evolving.


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