CXL Treatment and Monitoring Practices Vary Among UK-Based Centers

Researchers identified trends in corneal crosslinking (CXL) practice for clinicians practicing in the UK, according to a survey published in Eye. Variations in corneal ectasia monitoring, CXL indications, practice, and postoperative care were noted among participants, the report shows. 

Investigators included ophthalmologists who were members of the UK Cross-linking Consortium from 16 centers in the analysis. Participants from each center completed a brief online survey and provided responses regarding their practice setting, diagnostic evaluation, patient selection, treatment approach, and postoperative care regimens. 

“By identifying the current trends in CXL, this paper aims to stimulate discussion about research-led best practices and the development of a code of best practice for CXL,” according to the study authors. “The baseline data gathered in this study will serve as a point of reference from which future changes in policy and CXL practice may be evaluated.”

The survey data indicated progressive keratoconus (100%; 16/16) was the most common indication for CXL. However, variations in diagnostic evaluation, patient selection for CXL, the CXL procedure itself, and the pre- and post-operative monitoring were noted between the centers.

The most common indication for CXL was the documentation of keratoconus progression by a change in maximum keratometry (Kmax) or equivalent on corneal topography or tomography (88%), according to the report. Epithelium-off CXL was performed by all respondents, while only 13% reported performing epithelium-on CXL. Epithelium-on CXL was exclusively performed for the treatment of thin corneas (<400 μm) in both centers that performed the treatment.

Patients aged younger than 18 years were monitored more frequently compared with individuals who were aged older than 18 years — 75% of respondents reported performing topography or tomography measurements at intervals of 6 months or less for patients younger than 18 years compared with 44% for individuals older than 18 years.

A majority of participants reported performing the procedure in a hospital as the primary setting (94%), while 1 participant reported performing the procedure in a private practice setting. Follow-up duration ranged from 9 months to 10 years according to each center’s standard CXL protocol.

The researchers acknowledge that “[s]ince the advent of CXL, the numerous treatment variations and the lack of consistency in the reporting of CXL outcomes has made it difficult to compare the effectiveness of different protocols.”

Study limitations include a small sample size and the exclusion of data from centers not based in the UK.