Corneal Cross linking (CXL)

[ChrisK]

My optometrist is trying to talk me into having this procedure done on my right eye. As I've said in the past, I'm a post-operative corneal transplant patient in my left eye with an 8.25-8.5 diopter astigmatism. I'd like to look into corrective surgery in my left eye to see if I can improve my vision beyond the 20/30 to 20/40 I get today, and there isn't much risk here considering I really can't see out of that eye well to begin with.

My right eye is quite correctable with glasses, and my near and far vision with both eyes is an easy 20/20. This CXL procedure is supposed to halt or eliminate keratoconus in my right eye, as the disease often ends up in the other eye. I've had no real indication of the disease in my right eye so far. Since the procedure is "experimental", it will be several thousand dollars and not covered by insurance. I'm also pretty freaked out doing ANYTHING to my right eye since it works so well and I depend on it so much.

My questions:
- Anyone know of this procedure being done to friends / relatives? What is the recovery like, how soon can I fly after, and are there situations where it made the situation worse?
- What does the FAA think about this?

Thanks!

 

[weilke]

CXL is a treatment for progressive keratoconus. It doesn't sound like your right eye is affected with progressive kc at this time. It would be rather curious why someone would recommend it, I am not aware of it being used as a preventive strategy.

 

[ChrisK]

Here's the office to which I am being referred:

http://www.clevelandeyeclinic.com/site/cornea-center/keratoconus.htm

I guess I can see how it would help if there is a chance of progression in my right eye, but my opinion is to keep monitoring with an ophthalmologist and consider this treatment if my right eye starts to show signs. Maybe by then the procedure will be covered by insurance =)

 

[poadeleted20]

I'm sure Bruce knows what the FAA thinks of it. He should be here to answer reasonably soon.

Personally, the words "experiemental" and "eyes" are not linked together in my thinking. Vision is one thing I absolutely have to have within FAA standards if I'm going to keep flying, and anything with question marks is unacceptable to me. That's the main reason I've never even considered any of these various laser surgery things like LASIK -- even a very small chance of an irreparable problem is too big for me to take at this point. So, if I was in your boots, as long as I could get medical certificate issuance without this experimental procedures, I'd skip it. But that's me, and you may have other thoughts on that.

BTW, Wells Stewart is, IIRC, an ophthalmologist and pilot who posts both here and on the Red Board -- you might try to PM or email him for advice.

 

[bbchien]

Actually if can get it to 20/30, you have a LOT to lose. FAA is only going to care if you lose it from that eye - then you will need the one eyed Operational ride.

Right now you have very little upside, and all downside. I don't see why you would consider optional surgery. Maybe Wells will have nom wisdom.

 

[weilke]

Here's the office to which I am being referred:

http://www.clevelandeyeclinic.com/site/cornea-center/keratoconus.htm

Ask your eyecare provider what if any business relationship he has with the facility he is referring you to.

I guess I can see how it would help if there is a chance of progression in my right eye, but my opinion is to keep monitoring with an ophthalmologist and consider this treatment if my right eye starts to show signs. Maybe by then the procedure will be covered by insurance =)

I'll have to ask the boss, but from what I know about it, it is a procedure for progressive keratoconus. That means a relatively rapid change in your prescription/astigmatism and measurable change in the curvature of your cornea. So yes, cross-linking may be an option in your 'good' eye if it ever starts to progress, but before going that route, I would get a second opinion, and a third......

 

[Unregistered]

Hi. I just happened across this thread today after a visit to an ophthalmologist where I was diagnosed with Kerataconus in my left eye. As this is the fist time I have been to this doctor, and the first time I've had an OCT scan, I'm not sure how degenerative my keratoconus is, but was told I should look into CXL.

I am a corporate pilot and have been passing my 1st class medicals with corrective lenses for the past 14 years since I first went for my student license at 18. It looks like there are some different lens solutions for this that are allowed by the FAA, but nothing other than a corneal replacement to fix it if the problem is degenerative.

CXL looks like a good fix, and is allowed in Cananda and Europe (although not sure if it allowed by their respective aviation authorities), but is in trials here in the US. Since CXL is only in trial stage I am willing to bet it is not allowed by the FAA.

I have worked too hard and too long as a professional to allow something that might be fixable to destroy my career. As of right now I am correctable to 20/20 with contacts, but for how long? I will be looking hard at this option, as it seems to be an even less invasive procedure than LASIK, which I am not a candidate for since my cornea is now too thin at just under 500 microns.

Not really sure what else to do. Any ideas are appreciated.

 

[weilke]

This is what the cornea specialist at the other end of my bed has to say:

'It's complicated'

There are lots of factors that go into whether someone is a good candidate for cross-linking. The best results seem to be in patients that are progressing and it helps to arrest the progressive thinning, at least for a while. The procedure is being performed in europe for about 10 years but in the US it is still in trials.

It sounds like at this point in time, you only have one measurement. As such, it would be difficult to determine progression. Given the certification question surrounding CXL, it would certainly be reasonable to just observe. As you were told, there are contact lens options available for the management of keratoconus, including rigid gas permeable (RGP) lenses. Your eyes are your livelihood, consider getting an opinion from another cornea specialist and ask him/her on his/her opinion on CXL in your situation.

The expert on what you have to expect from the FAA is Bruce Chien who replied above. Unfortunately, someone here really ticked him off and he is taking a vacation from POA. If you are on the aopa board, you can contact him that way. His off-forum web contact is readily available. Bruce Chien, MD Peoria, IL should get you there with 'the google'.