When to cross-link?

Corneal cross-linking (CXL) is able to stop the progression of corneal ectsaias – not just keratoconus, but also pellucid marginal degeneration (PMD) and post-LASIK ectasia too. Generally speaking, performing CXL makes sense when the disease is still progressing. The question of when to cross-link is closely linked to the age of the patient – but other factors factor in to the decision making process too.

Adult Patients

Our body consists, to a large extent, of connective tissue. This fabric gives our body strength – it literally keeps you body parts together. 

The cornea is also made of connective tissue – principally collagen, which gets stiffer thanks to cross-linking that occurs naturally with age, and this also happens in the cornea. This stiffening can cause keratoconus disease progression to come to a halt sometime in the course of life. The older you are, the greater the probability is that keratoconus will stop progressing. Typically, keratoconus progression slows at around 35 years of age onwards – and we only rarely see cases with progressive classic keratoconus at age 60. But these are general, not absolute values. Everyone ages at a different rate; the age where keratoconus progression eventually halts varies from person to person.

This means that, in general, we do not operate on adults until progression of the disease has been clearly detected by corneal topography measurements. However, we do have a way of looking into a patient’s past visual history – old spectacles lenses and eyewear prescriptions from opticians can tell is a story. If we see historical changes in astigmatism, then this is an indication that the disease is still active. 

 

Other factors

There are a number of other crucial factors in adults.

Eye rubbing

This is likely to be an enhancing factor in the progression of keratoconus. If you rub the eyes frequently, we will check your corneas more regularly!

Oestrogen

The female sexual organ causes connective tissue in the body to soften – and this includes the cornea. Should a patient with keratoconus become pregnant, special care needs to be taken.

Thyroid hormone

Recent work, largely based on ELZA’s scientific research, has shown that thyroid hormone (particularly low levels of it, known as hypothyroidism) may also play a role in keratoconus and intensify the disease.

Children

The story is rather different in children.

Keratoconus is most prevalent in children, and the disease is most aggressive in children too. In other words, keratoconus progression in children tends to progress at tremendous speed. Our large study in 2012 has already shown (and recently confirmed by others in 2021), that when keratoconus is detected, it is better to progress directly to CXL in children, rather than perform what’s best practice in adults (measure the cornea at repeated visits and wait for progression). This study comes from ELZA’s Medical Director, Prof. Hafezi’s research group, and showed that if a child has been diagnosed with keratoconus, the probability it being active, progressive keratoconus is 88%. In other words, 9 out of 10 children who show keratoconus will worsen if nothing is done. These observations were confirmed by another research group in 2021.

Six years ago, Professor Hafezi recommended that children and adolescents should be directly cross-linked by the age of 20. Most surgeons worldwide have adopted this recommendation.

 

Cross-Linking in children:

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Augeninstitut ELZA
4.7
Based on 101 reviews
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Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
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Augeninstitut ELZA
4.7
Based on 101 reviews
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