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Cooling the cornea… for better cross-linking

EyeWorld’s Jonathan Kahn (JK) interviews Farhad Hafezi (FH) on a new method that might improve the efficacy of corneal cross-linking: cooling the cornea.


Jonathan Kahn (JK): Good morning from the ESCRS conference in Vienna, Austria. We’re pleased to be here with Dr. Farhad Hafezi from Switzerland. Thank you so much for being with us today.

Farhad Hafezi (FH): Thank you for having me.

JK: I’d like to speak with you this morning about collagen cross-linking, because this is a really fun topic and an exciting topic about which you and I have spoke over the years. But every time we speak, there’s something new and exciting and interesting that comes out that makes it better or more effective than previously. I understand that now you have some good information for us about how temperature can affect cross-linking. Can you tell us what that means?

FH: Yes absolutely. Cross-linking is an established method, but there is always room for improvement. And one major improvement on our understanding of the technology was when back in 2013 my group identified oxygen as an essential element in cross-linking. We know that oxygen supply is needed to drive the entire process, and there are new attempts to improve the oxygen supply to the cornea by having a stream of oxygen flooding over the cornea. But when looking through the literature, our group found an interesting hint which is: if you lower the temperature of the cornea, oxygen diffusion improves. Which means theoretically, if you cool down the cornea, you might have more oxygen present in the stroma and maybe better cross-linking efficacy. And preliminary ex-vivo data are from our lab seem to suggest that, indeed, if you lower the temperature of the cornea, you might have a cooling effect that increases efficacy.

JK: It’s interesting, because in some types of cornea treatment (for example, in PRK), we cool the cornea after the laser treatment in order to sort of stop the inflammatory effects of the laser, or stop the progressive treatment effects of the laser, whereas now we’re talking about perhaps the opposite, about cooling the cornea prior to treatment.

FH: Exactly.

JK: And that’s it that’s an interesting way to think about it.

FH: Yes, this. It might be that cooling it, prior and during the treatment, might improve efficacy. We need to look more into this.

JK: So do you think that perhaps there may be future studies that may start to compare a cool treatment as compared to a room-temperature treatment to see whether or not there are differences in efficacy?

FH: This might be the end consequence. We try to get more solid data out of the lab, and once we confirm this, for sure, then the next step would be to cool down the patient’s cornea.

FH: Quite right.

JK: Well this has been really a terrific look for us into some of the future technologies and future advances in cross-linking (as always). I’m so glad you’re able to share your expertise thank you.

FH: Thank you.


The ELZA Institute

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