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FAQ about cross-linking

General

How much experience does ELZA have in cross-linking?

We have one of the longest experiences worldwide: since 2002, members of the ELZA Institute have been instrumental in introducing CXL technology into clinical practice. ELZA member Farhad Hafezi has published more than 70 scientific papers on CXL so far and is considered a pioneer of this method. In 2014, he was honored with the ARVO’s prestigious Carl Camras Award for Translational Research, the Association for Research on Vision and Ophthalmology, for his research in this field.

Prof. Hafezi co-founded the international Cross-Linking Congress and co-organized it since its inception in 2006. He is the publisher of the most comprehensive textbook on the CXL: “Corneal Cross-Linking” by Slack, Inc, New York.

In addition to scientific expertise, patients from all continents are treated at the ELZA Institute using the latest scientifically proven CXL technique.

Members of the ELZA Institute were the first to use CXL in the postoperative treatment of ectasia after LASIK / PRK, in very thin corneas and for infectious keratitis.

What is cross-linking?

Cross-linking is a method of mechanically stabilizing the cornea.

Is cross-linking new in medicine?

No. Cross-linking has been used clinically in other areas of medicine since the 1980s (orthopedic surgery, ear, nose and throat surgery, cardiac surgery). In ophthalmology, CXL has been performed since 2001.

Is CXL treatment for keratoconus recognized by the European Community or the FDA?

The CXL treatment for keratoconus is used in over 160 countries, including the EU and the US. The world’s longest experience exists in Dresden and Zurich. CXL is now considered the gold standard for stopping keratoconus.

How does cross-linking work?

Cross-linking leads to an increased number of crosslinks between the collagen fibers of connective tissue of the cornea. This can be compared to a network which receives additional elements and thereby becomes more mechanically stable.

Ist cross-linking (CXL) safe?

Yes. Crosslinking of the cornea is achieved through a combination of UVA radiation and riboflavin eye drops (Vitamin B2). The intensity of the radiation was already determined 20 years ago in numerous experiments, so that no deep eye structures can be damaged. The method has been used clinically since 2001 and Farhad Hafezi from the ELZA Institute is one of the world’s most experienced CXL experts.

What are the biggest risks of cross-linking (CXL)?

The greatest risk is corneal infection in the first few days after cross-linking. But this is minimized by antibiotics after surgery. This risk is less than 0.1% for us.

How safe is CXL in children?

Scientific publications show that CXL has a high safety profile in children, comparable to that of adults.

Is CXL covered by health insurance?

The costs of cross-linking in Switzerland are not yet covered by the Health insurance. Most other European countries refund the cost of a CXL from the primary care.

Which financing options exist?

No child or teenager will be rejected by us because the financial means for treatment are missing. We will help to find a solution.

Patients from abroad

How long do I have to wait?

If we receive enough information from you prior to the examination, the examination may take place on the morning of the operation and the operation in the afternoon. Often patients from abroad arrive on Sunday. We then do the examination on Monday mornings, the surgery on Monday afternoon and see you every day until Friday. You can leave on Saturday.

Can both eyes be operated on in one session?

Yes, this is possible in principle. But after the operation you should stay in Switzerland not for five days, but seven days.

Will I be hospitalized at your clinic?

No, this is not necessary. You can stay in a hotel near us and then come to the after-checks every day. We work with a number of nearby hotels and are happy to help.

How much will the entire treatment cost me, including surgery, preliminary examination and follow-up checks?

We will send you a quote so that you can get an accurate picture.

How do I pay for the procedure?

You can pay in cash, by bank transfer or credit card. Please understand that we will ask that the sum be paid before the operation.

The preliminary exam

What do I have to consider before the appointment?

It is essential that you do not wear your contact lenses for two weeks before the appointment. Only then can we accurately measure the extent of keratoconus and make a statement as to whether the keratoconus is progressive. And this is the only way we can confirm after cross-linking whether the keratoconus has actually come to a standstill. We are aware that this is a long time for mostly young working people, but two weeks is already the bare minimum.

Should I bring old documents?

All older documents are valuable and should be collected as far as possible and brought to the examination: old prescription glasses, old corneal topographies, even old lenses.

Do I really have to not wear contact lenses before the preliminary exam?

See above. Two weeks are the absolute minimum. In principle, contact lenses should be discontinued for a full twelve weeks before the examination in order to obtain an absolutely unadulterated image of the cornea. The two weeks are the bare minimum we need to make a statement.

The cross-linking operation

What is the purpose of the operation?

The goal of the surgery is to stabilize the keratoconus. We can not reverse the disease, but we can “freeze” the current condition. In a second step, measures to improve the sight can be made later, for example special contact lenses and / or laser treatment. However, this is only possible in young adulthood.

Do I need to fast beforehand?

No, that’s not necessary.

Who carries out the operation?

All cross-linking operations are performed by Prof. Hafezi.

How do you keep your eyes open during the operation?

The eyes are held open by a lid clamp. This is unusual for the patients, but causes no pain.

Does the operation hurt?

No. You will not feel pain during the operation.

How long does the procedure take?

A total of 45 to 60 minutes.

Can cross-linking be repeated?

Yes, a CXL can be repeated. This is especially necessary if a first CXL has not led to stabilization. This happens in 3 to 10 percent of the operations. In addition, rarely a second CXL after pregnancy and an additional thyroid disease is necessary.

What is the shortest period I need to wait between having each eye treated?

1 week is the shortest distance when performing the operations in a row.

Should I come with someone to the clinic on the day of the procedure?

It is an advantage if you are accompanied, since your vision is limited afterwards and the use of public transport may pose a risk. You should also not drive a car yourself.

Do I need to fast before the surgery?

No, this is not necessary.

After the Operation

When can I wash my hair again?

After 5 days. Then the risk of infection is usually over.

How long will I be off work?

Usually one week, rarely until two weeks.

What can I do (and not do) after CXL?

In the first week you can do almost all activities, eg light fitness, jogging, being in the sun, etc., with one exception: no dirty water should reach the eye (shower water, swimming pool, lake). From a medical point of view, you can safely spend the first few days after surgery in front of a screen, but you will probably get a headache.

How often are the follow-up appointments? For how long?

The controls take place daily for the first 4 days, then after 1 week, 4 weeks, 3, 6 and 12 months, then annually.

When do we know that the disease has stopped?

The cornea reacts very slowly. Only after 6 months can it be clearly judged whether the CXL was successful.

How do I see after the operation?

The first 4-5 days, the view is very blurry, then it gets better with each passing day. After about 14 days the view is about 70-80% of what they achieved before the operation. Then a fine mist appears in the view, which should not frighten you. It comes about through long-term healing and will be noticeable for a few weeks without significantly affecting you. As a rule, vision is restored after 6 months at the latest, just before surgery.

What happens after the operation? Postoperative pain?

Part of the corneal surface is opened during CXL treatment. This is similar to a welder’s mask. The open cornea becomes uncomfortable for about 48 hours, with the symptoms gradually decreasing. The youngest patients treated with this protocol are 9-10 years old.

Will I have dry eyes?

Yes, for up to 6-8 weeks. We will prescribe you artificial tears, which you can use as often as necessary.

How much do I see immediately after the operation?

Your vision will be blurry. However, you should be able to orient yourself in a room at any time.

Can I drive after the operation?

This is not possible for the first week after the operation.

How long will I be off work?

This is usually 7 to 10 days to 100%. If necessary, we will extend it.

Sport / Water / Showers / Make-up?

Sport (except swimming) is possible after 1 week without any restrictions. Please refrain from swimming for 2 weeks. For the first 5 days please do not let shower water get in the eye, so do not wash your hair and face. Showering up to the neck is possible at any time. Make-up is possible after 1 week. Please dab at make-up removal, do not rub firm.

When can I wear my own contact lens again?

As a rule, contact lens wear is possible four weeks after the treatment.

Do I have to stop wearing the contact lenses during the two-weekly follow-upinspection period?

Yes, absolutely for the 6 month inspection. Only then can we tell you if the cross-linking operation was successful, that is, if the keratoconus has come to a standstill.

Will I receive drops / ointment / bandage lenses?

We will give you an exact medication schedule After surgery, a bandage is not necessary because a bandage contact lens protects the eye. To protect against glare, you should wear sunglasses outside.

I lost the bandage contact lens. What now?

Above all, the bandages contact lens is for your comfort and is not necessarily medically necessary. If you should lose them, continue with the drops and, before going to bed, put some of the ointment that you have received from us on the eye. We carry out the check the following day as usual.

When can I fly again?

You can fly again from the third day after the operation. If necessary, the eye should be well moistened because of the dry cabin air.

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