Why would you want to perform corneal cross-linking at the slit lamp? Well, it is a powerful and versatile therapy, that can not only halt the progression of corneal ectasias like keratoconus but also kill the pathogens present in corneal infections. But corneal cross-linking had a “first world problem”. It is a technique that is performed in an operating room (OR). ORs are wonderful: they are sterile places where surgeons can operate in a comfortable, familiar environment. But ORs are cost and resource-intensive, and they only exist in hospitals, which normally exist in large population centres. This is fine in developed (a.k.a. “first world”) countries, but in low-to-middle-income countries (LMICs), this is a problem. Mose people there live in the countryside, and hospitals are limited to major population centres, which can be prohibitively expensive to travel to or pay for the service once there. Bringing corneal cross-linking to the slit lamp reduces this barrier to sight-saving treatment. Slit lamps are almost ubiquitous in eyecare: they are present wherever someone needs to examine eyes – and this could be in the most remote of locations. This approach “democratises” cross-linking and brings it to large swathes of the population that might previously go untreated.
The importance of the publication of the article describing the cross-linking at the slit lamp technique in the Journal of Refractive Surgery (1) is that ophthalmologists now have the definitive “recipe” for performing cross-linking at the slit lamp, as safely, straightforwardly, and effectively as possible. We’ve shown previously that cross-linking at the slit lamp should be as effective as traditional cross-linking in the lying position (as the UV light and riboflavin aren’t affected by the orientation of the patient ), so the doors are now opened to the era of cross-linking at the slit lamp.
1. Hafezi F, Richoz O, Torres-Netto EA, Hillen M, Hafezi NL. Corneal cross-linking at the slit lamp. J Refract Surg. 2021;37(2):78-82.
2. Salmon B, Richoz O, Tabibian D, Kling S, Wuarin R, Hafezi F. CXL at the slit lamp: no clinically relevant changes in corneal riboflavin distribution during upright UV irradiation. J Refract Surg. 2017;33(4):281.