Keratoconus is a defect of the cornea widely believed to be caused by a congenital defect in the main constituent tissue of the cornea, called “collagen.” Through pains-taking research by experts like Californian eye doctor Brian S. Boxer Wachler, MD, a picture has emerged of what is happening in the eye when a patient suffers from Keratoconus (also known as “pellucid”). The cornea—the transparent lens that covers the front part of the eye—becomes weak and thin, and eventually the normal pressure of the surrounding tissue and of the eye itself causes it to deform into a cone-shape that distorts the light entering the eye. The disease is a progressive one that results in the sufferer eventually losing sight altogether.
It took a great deal of research, but we now have a pretty good idea of what causes Keratoconus in the first place. Around a normal eye, a host of destructive chemicals called “free radicals” accumulate, and the body produces enzymes (with names like Catalase and Superoxide dimutase) that wash these substances away and keep the cornea in good shape. A genetic condition, however, sometimes results in the eye not producing enough of these enzymes or enzymes powerful enough to wash away all the destructive substances. The free radicals attack the collagen of the cornea and weaken it, causing the cornea to deform into the characteristic cone shape.
In the past, eye doctors would prescribe heavy and rigid contact lenses, thinking that would support the cornea, but these were ineffective because the cornea was wasting away right under these lenses, which were also interfering with the eye’s work in ridding itself of the destructive chemicals. Even worse, LASIK surgery (using lasers to do the cutting) was applied to the cornea in the hope of relieving the pressure on it, but this only weakened a deteriorating tissue further. Patients reported that contact lenses (eyeglasses ceased being effective early on) had to be replaced every few months as the cornea continued to waste away and deform.
Based on research and therapeutic work on early pioneering work in Germany and England dating as far back as 1748, and on the landmark work of Swiss ophthalmologist, Johann Horner, who gave the disease its name in an 1869 paper, physicians have traditionally taken a surgical and structural approach to the problem. French and Spanish eye doctors developed contact lenses that strengthened the cornea, if only for a short time (and, as we pointed out, ultimately made things worse). A Spanish ophthalmic surgeon, Dr. Ramon Castoviejo, who did his major work at the Mayo Clinic and at Columbia Presbyterian Hospital in New York, developed the treatment that involved replacing the cornea entirely with another one donated by a cadaver, conducting the first successful such transplantation in 1936.
Usually detected in adolescence, it causes blurring of vision that glasses cannot correct. The resulting problem with distance vision get progressively worse as the cornea deteriorates, eventually causing problems in reading and functional blindness. The incidence of keratoconus has increased four-fold in just the last decade—from 1 in 2000 to 1 in 500. That may be the result of better diagnostic techniques and general awareness of the disease, but since we now know that the deformed corneas are reacting to destructive elements in the ambient atmosphere (that the eye is not able to wash away), the increase of this condition’s incidence may be a result of pollutants and the increase in UV rays to which eyes are subject today.
Only rigid contact lenses have worked in the past to correct this problem. However, lenses are not a perfect solution. Contacts are expensive, difficult to use, and can damage the eye if not properly fit and maintained. If the cornea degradation progresses far enough, problems with night vision may also develop, and a corneal transplant may be warranted. This procedure, however, is invasive, painful and potentially dangerous for the patient. Such procedures typically take two hours and can require a long period of recuperation. And like any tissue transplant, there is always the danger of rejection.
Enter the Holcomb C3-R® Crosslinking System. This is an innovative treatment developed by Dr. Brian S. Boxer Wachler after he read about the possibility of using corneal collagen crosslinking to fight damage caused by Keratoconus without the need to take the invasive track of scraping off the cornea’s epithelium layer, let alone a complete corneal transplant. First used in 2004, the proprietary Holcomb C3-R® Crosslinking System has been proven to be capable, in just thirty minutes of a noninvasive procedure, stabilize the degenerative effects and the damage caused by Keratoconus.
The Holcomb C3-R® Crosslinking system developed by Dr. Boxer Wachler uses Vitamin B-12 (or Riboflavin) to strengthen the molecular structure of the cornea, and then uses protective and preventive measures—wrap-around UV-ray blocking sun-glasses and eye washes—to assist the eye in its house-cleaning. The Holcomb C3-R® Crosslinking procedure is non-invasive and out-patient, taking about 30 minutes—and patients are nearly always seeing and functioning normally the next day or two. The method has been so effective, that Dr. Boxer Wachler has applied it successfully to other eye ailments where a degeneration of tissue is the cause.
The Holcomb C3-R® Crosslinking System gets its name from a patient, Steven Holcomb, who won an Olympic Gold Medal at the 2010 Winter Olympics in Vancouver in the 4-man Bobsled event. As the driver of a bobsled, Steven needed to steer around banked turns at speeds upwards of 90 miles per hour. For someone affected by the vision impairment brought upon by Keratoconus, this feat would be simply out of reach. With the Holcomb C3-R® Crosslinking System, however, Steven and other patients like him were able to reach their full potential, encumbered by neither the visual degeneration of Keratoconus, nor the traditional invasive treatments commonly used.
The Holcomb C3-R® Crosslinking System’s innovative method of corneal collagen crosslinking was developed by Dr. Boxer Wachler over long hours in the lab, working overtime and many nights. It has the potential to get out ahead of ocular degeneration and vision problems before they negatively impact quality of life or advance to the point where they can be treated only by invasive corneal transplants. The method offers promise of possible applications to other areas where a better, faster and less invasive treatment for eye problems would be most welcome. (Dr. Boxer Wachler has even used it to repair damage caused by laser procedures such as radial keratotomy.)
The challenge now is to “get the word out”—to patients and eye-care professionals all over the world that a safer, better, and more effective way exists for treating this disease—and thanks to the success of Olympic champion Steven Holcomb, Dr. Boxer Wachler’s technique is becoming known around the world.