Northwell adds corneal crosslinking, Ned approves

Crossing guard: Northwell Health's state-of-the-art Ocular Surface Center now offers corneal crosslinking, a safeguard against degenerative eye diseases.
By GREGORY ZELLER //

The FDA has seen the light. So has Northwell Health. Now Ned Daily can, too.

Daily, a Long Island-based photographer/videographer, was slowly losing his vision to keratoconus, a common eye disease that damages the cornea. And he was on the table when doctors at Northwell Health’s Ocular Surface Center recently performed a cutting-edge corneal crosslinking treatment – making Northwell the first New York health system to offer the procedure, which the Food and Drug Administration approved in April.

Eye spy: See how they run.

First, some Ophthalmology 101: Light rays enter the eyes through the cornea (the clear front windshield, comprised of collagen, just like skin), which refracts the rays toward the pupil (the opening in the center of the iris), eventually to be projected (sharply, in a healthy eye) into the retina.

In patients with keratoconus, the cornea “bulges,” and its irregular shape is lousy at refracting. Degenerative blurring ensues, along with varying degrees of light sensitivity, “halo” or “ghost” effects around objects, headaches and excessive irritation, among other symptoms.

The corneal crosslinking procedure – which involves the application of riboflavin and ultraviolet light – is meant to slow keratoconus’ progress. It’s not a cure, but the cornea-strengthening procedure has been proven to boost collagen strength and prevent further vision deterioration, and even reduce the need for corneal transplants.

The FDA’s blessing of Massachusetts-based Avedro Inc.’s corneal crosslinking system – also useful for patients with post-LASIK ectasia – followed more than a decade of domestic clinical studies. Several European and Asian health agencies greenlighted corneal crosslinking years ago, while many Canadian ophthalmologists also offer some form of the procedure, which basically saturates the cornea in custom-produced riboflavin drops and blasts it with ultraviolet light, thereby increasing collagen cross-linking and strengthening the cornea against further deterioration.

Even some U.S. doctors have been quietly co-managing patients’ keratoconus symptoms with the procedure, according to the American Optometric Association. With the FDA approval of Avedro’s corneal crosslinking machine, they can now add it to the regular menu.

Avedro’s proprietary system was adopted by the Ocular Surface Center as soon as the FDA approved it, according to Ira Udell, Northwell Health’s ophthalmology chairman, who called keratoconus treatments a “major component” of the Great Neck facility since it opened in 2012.

“We’re one of the few sites in the country that now has the capability of offering the Avedro crosslinking procedure,” noted Udell, also a professor of ophthalmology at Hofstra Northwell School of Medicine.

Daily – among the 1 in 2,000 Americans suffering from keratoconus, according to various online studies, and the first Northwell Health patient to engage the Avedro corneal crosslinking system – responded well to the outpatient procedure, noted Carolyn Shih, an assistant ophthalmology professor at Hofstra Northwell.

The minimally invasive procedure, performed with a topical anesthesia, is designed to be quick and painless, Shih noted, but the benefits for a patient like Daily could be long-term and substantial.

“He’s a perfect example of someone for whom this could be life-changing, in terms of being able to wear the correct prescription and actually being able to see for his job and for his activities of daily living,” Shih said.

He’s also an example of the Ocular Surface Center’s focus on incorporating newer and better treatments, according to Udell.

“We’re capable of treating not only mild cases of keratoconus, but with crosslinking, more moderate cases,” the ophthalmology chairman said. “This may prevent many patients from needing a corneal transplant.”