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23 EW SHOW DAILY ASCRS•ASOA Symposium & Congress, New Orleans 2016 Surgical indications The indications that Dr. Tamayo looks for when deciding to use CXL include progressive keratoconus, ker- atoconus in young patients, ectasias, and thin corneas. Dr. Tamayo also uses CXL in conjunction with LASIK, which is called LASIK Xtra. Among the contraindications for CXL are low endothelial cell Among published results on the safety of CXL was a 2007 study in Cornea that found that the epitheli- um was a barrier for the riboflavin. "This study, for instance, shows the safety of the endothelium that you really don't touch with this treatment," Dr. Tamayo said. Ten-year results of CXL pub- lished in 2015 in the Journal of Cataract & Refractive Surgery conclud- ed the procedure was effective in treating the progression of keratoco- nus and achieved long-term stabi- lization of the condition. Addition- ally, the study found it was easy to perform, had a good safety profile, and reduced the need for corneal transplantation. The study led Dr. Tamayo to conclude that all eyes with progres- sive ectasia should undergo cross- linking. Advances in crosslinking Emerging research has shown that the strength of the cornea is based in the anterior portion. "You don't need to go down to look for the strength of the cornea," Dr. Tamayo said. Emerging data also has shown that the cornea's strength is greater at the periphery, Dr. Tamayo said. Those findings led to the idea of accelerated crosslinking, which he has performed since 2006. Several studies showed that when riboflavin is used with the higher light energy of an accelerated CXL treatment the riboflavin does not go as close to the endothelium as it does under the original CXL procedure, known as the Dresden protocol. Emerging evidence has shown that uniformity of the beam in accelerated crosslinking is key to avoiding problems in the cornea. "We do not produce damage in the center of the stroma, as the other unit can produce," Dr. Tamayo said. His switch to the faster and higher energy accelerated crosslink- ing procedure stemmed from re- search showing that riboflavin is not needed in the posterior two-thirds of the cornea, a shorter riboflavin induction time allowed limited pen- etration to the anterior third of the cornea, and the key to the efficacy of CXL is the total energy delivered. Research "demonstrated that we can accelerate crosslinking and produce the same results as the old Dresden protocol," Dr. Tamayo said. counts. Accelerated CXL has allowed Dr. Tamayo to treat corneas of 340 µm. If there are scars in the visual axis, Dr. Tamayo urged surgeons to move directly to corneal transplants. Additionally, curvatures greater than 60 D indicate other procedures should be used. The procedure does not appear to work in extremely advanced keratoconus cases, according to Dr. Tamayo. Additionally, although CXL may help, it will not solve a com- plete intolerance of contact lenses. The procedure also is not a re- fractive treatment for use in improv- ing UCVA or to flatten a very steep cornea. EW Editors' note: Dr. Tamayo has financial interests with Avedro. Innovation and craftsmanship that helps you rise above. Haag-Streit vision spans more than 150 years. Our goal is simple: to develop ever more useful tools for the precise understanding of the human eye. At Haag-Streit, you will see the future clearly. 80O.787.5426 haag-streit-usa.com © 2016 Haag-Streit USA. All Rights Reserved. Visit us at ASCRS 2016 Booth #245 FAMOUS FOR SEEING WHAT OTHERS CAN'T. Octopus 600 Reliance FX920 LENSTAR APS Haag-Streit Surgical Hi-R NEO 900 Haag-Streit BQ 900 LED Haag-Streit

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