Vision Combining Intacs And

Combining Intacs® and C3-R® in the Treatment of Keratoconus

By Dr. Brian S. Boxer Wachler

Published on August 24, 2007

Halting the Progression of Keratoconus with C3-R®

Patients with keratoconus, a condition in which the cornea becomes conical in shape, are divided into two categories: those with progressive keratoconus and those with a non-progressive, or stable, version of the disorder. Progressive keratoconus is characterized by continuing herniation of the cone, which in turn leads to higher astigmatism and an impaired ability to see clearly, even with spectacles. As the disease progresses, glasses and soft contact lenses are no longer viable vision correction options, leaving gas permeable contact lenses as the only means of achieving functional vision. Fortunately for those suffering from progressive keratoconus, there is now a treatment to halt the progression of the disorder and prevent future deterioration of the cornea: C3-R®.

The corneal collagen crosslinking with riboflavin (C3-R®) procedure increases the amount of collagen in the cornea through the one-time application of riboflavin drops followed by the exposure of the cornea to a low amount of ultraviolet A light. This activates the riboflavin, which then enhances corneal strength and integrity by increasing collagen crosslinking. The effectiveness of the procedure in halting the progression of keratoconus has been demonstrated in clinical tests, and the results have been published in peer-reviewed literature. The in-office procedure requires only 30 minutes, and patients are able to return to work and resume contact lens wear the very next day.

C3-R® therapy is safe, as the riboflavin absorbs the ultraviolet light in the cornea, thereby preventing transmission of light past Descemet’s membrane (the membrane that covers the inner surface of the cornea). The crystalline lens and retina are not exposed to ultraviolet A light, so there are no complications from this treatment. In a three-year study of patients with actively progressing keratoconus, the pattern of increasing topography values was not only halted, but also reversed and flattened by a mean of two diopters. That result persisted over the three follow-up period, during which time there was not a single complication to report.

Using C3-R® to Increase the Effects of Intacs®

As Intacs® are effective in reducing the conical protrusion associated with keratoconus and improving vision, we have found that placement of single-segment Intacs® has advantages over implanting two segments. A single segment placed outside the cone creates a unique effect, flattening the cone below as well as elevating the “overly flattened” cornea in the upper topography area. Because of this effect, we use single segments for peripheral cones (90 percent of keratoconus cases) and two segments for central cones (10 percent of keratoconus cases) due to its global flattening effect.

In order to better evaluate the progress of keratoconus, we devised a new system to describe the degree of corneal irregularity associated with the disorder and named it the “L-U ratio.” L-U characterizes the asymmetry of lower topography and upper topography based on the meridian of the cone. L-U improves upon the original I-S ratio, which is based on the assumption that all cones are located directly inferior but does not account for oblique cones that actually comprise most keratoconus cases. As with the I-S ratio, the higher the L-U ratio, the more advanced the topographic cone.

In a study we performed evaluating the effect of single-segment Intacs® with and without C3-R®, we found that C3-R® added to the improvement in L-U ratio compared to Intacs® alone. This finding showed that even in patients with stable keratoconus, C3-R® increases the effects of Intacs® and enhances the improved corneal shape postoperatively (postoperative L-U with Intacs® alone was 26.1, while it was 16.1 with the combination of C3-R® and Intacs®).

The ability to permanently strengthen an inherently weakened cornea is a major advance in the treatment of keratoconus. C3-R® treatments provide real results for patients with this challenging and life-altering disease. More information about C3-R® treatments and Intacs® for keratoconus can be found at www.keratoconusinserts.com or www.boxerwachler.com. If you have any further questions, please call the Boxer Wachler Vision Institute at 310-860-1900. We would be happy to discuss options for treating keratoconus with you.

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Comments

1

I just visited the Bochner Eye Institute in Toronto for a consultation on INTACS and cross-linking. They have free consultation (I was referred from my eye doctor, so I'm not sure if that matters) and the cost for either procedure is $5400.

Jon
about 2 years ago

2

i live in the quad cities area[ Davenport ia] and wondering if anyone is doing the c3r treatments in the area or around chicago rockford possibly?

Dean
almost 3 years ago

3

. HELLO , I'm a 24 y/o female diagnosed with KC since 17 , i currently wear hard contact but hate them so much because my eyes are contacted irritated. I will pay anything to get my vision back , i just cant see myself going blind at such a young age, i live in fort lauderdale Florida and would like to know if anyone knows a specialist in my area.
Thanks Dena

dena facey
almost 3 years ago

4

Wow, there are a lot of people that need this treatment. Insurance won't cover and fork over $6000 for both eyes. I guess many of patients that suffer from this disease are going to go blind. I don't understand how a 30 minute procedure consisting of drops and light costs so much!

Steve
almost 3 years ago

5


27 year old vet declared legally blind request assistance to receive c3-r treatment have no money living in Morgantown WV
zip 26505

Matthew Mackay
almost 3 years ago

6

I had C3-R and intacts done two and a half years ago to stop keractasia (LASIK induced) on both eyes with Dr. Boxer in Beverly Hills. I went back 6 months later to him and had PRK to reduce astigmatism and myopia. I am in a lot of debt, but glasses free with managable astigmatism. Wish I could go back to get CK or another laser guided PRK that could enhanced my vision even more. Highly recommend Dr. Brian Boxer Wachler!!

EAP
almost 3 years ago

7

I'm wondering if anyone knows the actual cost of the C3-R. The initial visit for Dr. Boxer is $375.00 which includes test and consultation. I got that infor by calling his office. (310) 860-1900 They DO NOT accept insurance, if you have a PPO you can try to submit after the procedure to see if they'll reimburse you. Sounds like it's worth the investment if you can afford it, wish I could...My Hubby has Keratoconus :(

lORI
almost 3 years ago

8

Does anyone know if C3R treatment is available in Elk Grove, Ca or Sacramento? I can't seem to find anything.

Tiffaney Fomby
almost 3 years ago

9

My Name is Garry I am in Norht Pole Alaska.

I am looking for a speicalist hopefully in the Seattle area that can perform Intacts and C3R procedures to fix my Keratoconus

Garry keller
about 3 years ago

10

My cousin in Israel has been diagnosed with Keratoconus in both eyes, right eye than left eye, high astigmatism.
In this case it was recommended that he undergo a corneal transplant ring in order to delay the development of Keratoconus right eye.
I asked where the best hospital in which we can perform the surgery, the most expert doctor who this procedure?, Some of the surgery costs, including costs of hospitalization?

Amir Lazimi
about 3 years ago

11

I'm a Keratoconos patient for years, I'm interested in finding a specialist in the Ft. Lauderdale, FL area that does C3-R treatment & intacs.

Lucy Toledo
over 3 years ago

12

You cannot get LASIK or similar laser surgeries if you suffer from KC. Since the cornia is already weakened due to the malformation. So yes maybe this procedure is pricey, but what cost do you put on good vision? Especially if it prevents you from having to get a cornia transplant at some point in you life. The FDA needs to step up approval on this proceedure and it will be more readily availible to us in the states. This would also help reduce it's cost.

Keith
over 3 years ago

13

If they are charging you that much, they are thieves...$3000? You can bloody laser surgery for both eyes!

Luke
over 3 years ago

14

Does anyone know the cost of Crosslink treatment for keratoconus....We were quoted $3000.00 per eye..Yikes!!

Linda
almost 4 years ago

15

Hello there,

Anyone knows if someone performs C3R treatment in boston?

Thanks a lot !

jay
almost 4 years ago

16

Canada offers the following procedure for your Keratoconus. It may stop your regression. It is not available in the US. They are doing studies and may be years away. We went to Canada and had the procedure done.
The procedure is called, Corneal Collagen Crosslinking with Riboflavin (CxL) for keratoconus, ectasia, or unstable RK.

Albert Souza
almost 4 years ago

17

im 17 im lookin for a doctor in minneapolis minnesota that can help me with keratoconus that can treat me with c3r i real need help. it hard for me in school and i really want to graduate from high school this up coming year 2010 so if u read this help me out god bless all of yall..

jonny
almost 4 years ago

18

Anybody knows if someone in Houston, tx performs C3-R treatment?

Camilo Gutierrez
almost 4 years ago

19

I live in St Louis, MO and was hoping someone can point me in the right direction for a specialist in Intacs or C3-R for Keratoconus?

Sam
about 4 years ago

20

Can you please help me find a Dr. who can do C3-R in Denver? Thanks!

Kate
about 4 years ago

21

Hello Tim

There is a doctor here in New York his name is Micheal Ehenhaus. Call him at 718 270 1714.

Maurice Moore
over 4 years ago

22

I have keratoconus and would be interested in the current treatments for it. I would appreciate knowing who might be the closest specialist to the La Crosee, Wisconsin area.

Lisa Ibisch
over 4 years ago

23

I'm going to visit the Pioneer that made this procedure possible on October 22rd for an initial consultation. I currently live in New York and I know this is a long distance, but I've been researching Dr. Boxer Wachler over the past 6 Months and found his staff to be extremely helpful to me by answering all my questions as well as submitting all the required paperwork to my insurance company. Just yesterday I was given an authorization code that will enable me to have the fee for this procedure partially paid for by my insurance company. I would reccomend submitting your records for a records review by Dr. Boxer before you make a visit. Hope this helps!

Nancy
over 4 years ago

24

I have Keratoconus and live in Nova Scotia Canada. The only specialist that our province had recently retired and now I'm faced with finding someone that can help me with this condition. I am also a member of the Canadian Armed Forces and fear that if I can't find someone to help me with this condition, that I might be forced to leave my job. I'm running out of options and desperately need some help. Any information you could give me would be a great help.

Thank You
Tim Purcell

Tim Purcell
over 4 years ago

25

I am a disabled veteran who suffers from Keratoconus. I am trying to find a specialist in the Seattle (Renton) area

Neil Foster
almost 5 years ago







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