The ELZA Institute has led an initiative that is leading to the “democratization” of corneal cross-linking (CXL), with the aim of making this sight-saving corneal procedure accessible globally, especially in low-to-middle-income countries (LMICs). A recent article on the International Agency for the Prevention of Blindness (IAPB) features an inteview by ELZA’s Dr. Mark Hillen with Prof. Farhad Hafezi e Dr. Emilio Torres-Netto on exactly this topic. In this article, our surgeons explain that CXL has traditionally been a complex procedure performed in hospital settings. However, advancements by ELZA researchers, including , are revolutionizing this by making CXL portable and affordable.
Prof. Hafezi explains in the article the importance of CXL: “Traditionally, disorders such as keratoconus and infectious required treatment in a hospital. Keratoconus is the leading cause of preventable blindness among children and adolescents worldwide. What happens in is that the cornea becomes increasingly weaker. Because the eye is pressurized, the weakened part starts to bulge outward into a cone shape. As the cone grows, people’s vision gets worse. Historically, the only treatment was a corneal transplant, but for the last 20 years, we’ve been able to strengthen the cornea and stop the disease from progressing using a treatment called corneal cross-linking (CXL) – and CXL has dramatically reduced the number of corneal transplant surgeries required to treat keratoconus.”
Dr. Torres-Netto adds, “The problem is that until relatively recently, CXL has mostly been performed in operating theaters inside hospitals. Operating theaters need to be completely sterile, staffed, and booked weeks in advance, as surgeons compete for theater space. This makes the procedure very expensive. Often the problem is that in LMICs, most of the population lives in rural regions, whereas the hospitals are concentrated in one or two cities. In LMICs, it’s not only the cost of the procedure in the hospital that can be prohibitive, it’s also the cost of the time and travel to the hospital that stops people from receiving the procedure. In extreme cases, many cities or villages don’t even have hospitals or surgical centers, and it can often take days to get there. I’ve had this experience several times traveling through riverside towns in the middle of the Amazon rainforest.”
These advancements allow CXL to be performed outside traditional settings, reducing costs and increasing accessibility. The article highlights that innovative portable CXL devices that can be used with slit lamps are now available, and as slit lamps are near-ubiquitous in eye care, or even in the most remote of locations. This technological leap not only makes the procedure more accessible but also significantly reduces costs, making it feasible for LMICs where healthcare resources are often limited.
ELZA’s efforts align with broader goals of global health equity, addressing disparities in eye care access. The development of these portable devices is seen by the interviewees as a game-changer, enabling more patients to receive timely and effective treatment.
Dr. Torres-Netto: “The UV light delivered during cross-linking does not care whether it is being delivered from above with the patient lying down or sitting upright at the slit lamp. We’ve done the work to show that the riboflavin in the eye does not settle downwards when the patient is sat upright either. We’ve recently shown that CXL at the slit lamp is as effective and as safe as CXL performed in the OR.”
By making CXL portable and affordable, ELZA is paving the way for broader access to essential eye care services, particularly in resource-limited settings.
Dr. Torres-Netto adds, “The problem is that until relatively recently, CXL has mostly been performed in operating theaters inside hospitals. Operating theaters need to be completely sterile, staffed, and booked weeks in advance, as surgeons compete for theater space. This makes the procedure very expensive. Often the problem is that in LMICs, most of the population lives in rural regions, whereas the hospitals are concentrated in one or two cities. In LMICs, it’s not only the cost of the procedure in the hospital that can be prohibitive, it’s also the cost of the time and travel to the hospital that stops people from receiving the procedure. In extreme cases, many cities or villages don’t even have hospitals or surgical centers, and it can often take days to get there. I’ve had this experience several times traveling through riverside towns in the middle of the Amazon rainforest.”
These advancements allow CXL to be performed outside traditional settings, reducing costs and increasing accessibility. The article highlights that innovative portable CXL devices that can be used with slit lamps are now available, and as slit lamps are near-ubiquitous in eye care, or even in the most remote of locations. This technological leap not only makes the procedure more accessible but also significantly reduces costs, making it feasible for LMICs where healthcare resources are often limited.
ELZA’s efforts align with broader goals of global health equity, addressing disparities in eye care access. The development of these portable devices is seen by the interviewees as a game-changer, enabling more patients to receive timely and effective treatment.
Dr. Torres-Netto: “The UV light delivered during cross-linking does not care whether it is being delivered from above with the patient lying down or sitting upright at the slit lamp. We’ve done the work to show that the riboflavin in the eye does not settle downwards when the patient is sat upright either. We’ve recently shown that CXL at the slit lamp is as effective and as safe as CXL performed in the OR.”
By making CXL portable and affordable, ELZA is paving the way for broader access to essential eye care services, particularly in resource-limited settings.
