Children: to cross-link or not to cross-link? If a person is going to develop keratoconus, that person is more likely to be a child than an adult. And if a child does have keratoconus, the disease is more likely to progress faster in them than it would in adults. Clearly, children with keratoconus are in even greater need for prompt and effective treatment than their adult counterparts. However, the evidence base for the most effective treatment for keratoconus, corneal cross-linking (CXL) in children is relatively sparse compared with what’s known about CXL in adults.
The debate currently centers around: how safe and effective is CXL in children? Are less-effective (but potentially less painful) cross-linking procedures like epi-off or transepithelial CXL appropriate for treating pediatric keratoconus? What is the likelihood of children needing re-treatment with CXL if they present with an aggressive form of the disease? Should ophthalmologists wait for progression before performing CXL in children?
To try to answer this, Georgios D. Panos of the University of Cambridge, UK, Nikolaos Kozeis and Miltiadis Balidis of the Ophthalmica Institute, Thessaloniki, Greece, Marilita M. Moschos of the National and Kapodistrian University of Athens, Greece, and our own Farhad Hafezi teamed up to review the literature on collagen cross-linking for pediatric keratoconus.