Prof. Farhad Hafezi standing at a lecture podium presenting a lecture called Frontiers in Corneal Cross-Linking, at the 56th TOD annual meeting of Turkish ophthalmologists

Frontiers in Cross-Linking in Keratoconus at TOD 2022

ELZA’s Medical Director, Prof. Farhad Hafezi has returned from Antalya, Turkey, where he gave a lecture entitled “Frontiers in Cross-Linking in Keratoconus” to the delegates of the largest Turkish Ophthalmological Society (TOD) meetings, which was their 56th National Congress. In addition, Prof. Hafezi was part of the panel that moderated the Cornea & Ocular Surface session.

Prof. Hafezi also wished to thank his hosts from TOD, saying “I was just so overwhelmed by the warm-hearted friendliness and wonderful reception I was given. They took such great care of me, and I want to express my warm thanks and deep gratitude. 

 

Prof. Hafezi’s presentation gave delegates a comprehensive explanation of everything from the basic concepts of corneal cross-linking (CXL), including the basic principles of the photochemical reaction that involves UV light, riboflavin, and oxygen. From this, he went on to explain how thin corneas have been cross-linked historically, but thanks to the work of ELZA’s surgeon, researchers, and collaborators, in not only identifying the role of oxygen in the cross-linking process, but modeling how oxygen, riboflavin, and UV light interacts with the cornea to strengthen it, and the depth of the cross-linking effect. This has enabled his research group to develop a new method of cross-linking thin corneas, called sub400, which only requires the measurement of pre-operative corneal thickness, cross-referencing that thickness with a corresponding UV irradiation time in a look-up table, then irradiation for that specified duration. This modeling also explained why accelerating CXL (delivering the UV energy in a shorter time by using higher intensities) resulted in a poorer strengthening of the cornea than slower, low-intensity protocols: the UV-riboflavin reaction consumes oxygen, and the rate at which oxygen can diffuse into the stroma from the atmosphere is the rate-limiting step.

This understanding has also helped with the development of “epi-on” cross-linking. The epithelium is the top layer of the cornea and acts as a barrier to stop anything from the environment from getting into the eye. However, this is usually removed to enable riboflavin to enter into the layer of the cornea stroma, the structural layer, where the cross-linking reaction needs to occur. The epithelial cells regrow after removal, but this can cause pain that needs to be carefully managed and exposes patients to a very small increase in the risk of corneal infection after the procedure. Ideally, CXL would leave the epithelium in place. Interestingly, through the use of chemical penetration enhancers, or using a process called iontophoresis, it is possible to saturate the stroma with riboflavin, without having to remove the epithelium – but the effects have historically been worse than “epi-off” CXL. Why? The epithelium absorbs around 20% of UV energy, and acts as a barrier to oxygen diffusion into the stroma, hindering the UV-riboflavin-oxygen reaction. But thanks to our model, we have been able to adjust the duration of cross-linking (even slightly accelerating it), and the intensity of UV irradiation, and even utilized pulsed light (to enable oxygen to diffuse into the cornea when the UV light source is off), to get epi-on CXL that strengthens the cornea as well as the so-called “Dresden protocol” – the classic epi-off, slow, 30 minutes of UV irradiation cross-linking method.

Finally, Prof. Hafezi noted how advances in technology have led to the development of smaller, portable, and most importantly, slit lamp-mountable cross-linking devices. He explained to delegates that this can be not only very convenient for both doctor and patient alike, but that this approach does not require expensive operating theaters. This dramatically reduces the costs involved with performing CXL relative to a CXL procedure performed in an operating room. Fortunately, as CXL also happens to effectively sterilize the cornea, this removes the only potential advantage that cross-linking in the operating theater might bring. Given that slit lamps are found wherever eye care service is provisioned, Prof. Hafezi told the audience about how this new generation of portable cross-linking devices has the potential to bring this sight-saving procedure to people who might not otherwise have been able to receive it, such as those living in rural areas of low to middle-income countries.

 

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Zuzana Fecko
Zuzana Fecko
21:48 31 Oct 22
Thank you so much, Dr. Torres and prof. Hafezi. 26 years I was only “dreaming” about the eye surgery due to possible... complications. I was worried ..Thank you for encouraging me to make a decision and thank you for your professionalism, explanations and great work!I wish you all the best, lots of success and only happy patients!read more
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
Michele Aggiato
Michele Aggiato
18:17 10 Jan 20
The day I had Prof Hafezi checking my keratoconus I knew I was finally in the right place after years of searching for... a good ophthalmologist. Prof Hafezi recommended a surgery due to a drastic degeneration of my cornea. The surgery was performed by himself with the assistance of Dr Rodriguez, one more collaborator of Prof Hafezi’s team who got my full trust.read more
Ashley Faulkes
Ashley Faulkes
15:30 21 Mar 16
Professor Hafezi and the team at the ELZA Institute have done an amazing job of creating a first class eye clinic, with... cutting edge technology and support. I went there for a dry eye issue and other issues with my prescription, and they were easily able to help me and put me on the road to better vision! High recommend them to anyone in the Zurich/Aargau area.read more
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