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C3-R®- Non Surgical Corneal Crosslinking

This Page for Information Purposes Only

C3-R® (collagen crosslinking with riboflavin) is a non-surgical procedure that has the ability to strengthen the weak corneal structure in keratoconus. (see publications/research section in right column).


This method works by increasing collagen cross-linking, which are most of the natural "anchors" within the cornea. These anchors are largely responsible for preventing the cornea from bulging out and becoming steep and irregular (which is the cause of keratoconus).

The figures above show the parallel corneal layers (white) and the collagen cross-linking (red) which are typically increased after C3-R® treatment.

C3-R® is a 30-minute, in-office procedure. During the treatment, custom-made riboflavin eyedrops are applied to the cornea, which are then activated by a special light. This is the process that has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea.

Eye physicians in Germany performed the initial studies of collagen crosslinking to strengthen the cornea. They reported results of treatments done as long ago as 1998. Links to these research publications can be found to the right side of this page. More research studies are at www.KeratoconusInserts.com. It is important to note in these studies that the proper dosages of the components are a key aspect of the treatment.

The below photo shows riboflavin solution (yellow) penetrated through the intact epithelium and into the cornea which is how C3-R® can be done without scraping off the epithelium.  Removing the epithelium creates a painful recovery and significantly increases risk of infection, corneal haze, scarring, and corneal nerve trauma requiring 6  months to recover.  

Our studies and studies of other eye doctors in outside countries have shown patient results are not signficantly different with crosslinking with removal of epithelium vs. leaving epithelium undisturbed in its place.  Therefore, it is not necessary to scrape off the epithelium for crosslinking and is safer without scraping off epithelium. Please visit www.KeratoconusInserts.com for more information on results of epi-on vs epi-off corneal crosslinking. 

The figure above demonstrates almost 10 diopters of corneal flattening in one patient before (left) after this combined treatment (right).

C3-R® treatments can also be combined with Intacs to help flatten the keratoconus cone even more than with Intacs alone. In these cases, C3-R® treatments helped stablize keratoconus from getting worse as well as help the Intacs in part reverse the keratoconus steepening that had already occurred up to the time of the treatment. C3-R® is also showing promise in stabilizing patients after radial keratotomy and reducing vision flucuations during the day.

RIGHT EYE
   
LEFT EYE
   
Natural progression of keratoconus in a patient’s eyes over 1.5 years.  Notice the dramatic lower cone steepening (red) and increased astigmatism over this short period of time.  C3-R® can halt this progression and prevent these progressive distortions in vision.  Note:  not all keratoconus progresses this rapidly.

Dr. Brian is credited as the first doctor in North America to use C3-R® treatments for keratoconus as well as being the first doctor in the world to combine this treatment with Intacs.  Dr. Brian has the longest experience in corneal collagen crosslinking in North America (including Canada) as his reported first treatment was 6 years ago.  Would you trust your precious eyes to someone who just learned how to do the procedure?

For more information on C3-R®, including research studies, please click on www.KeratoconusInserts.com.


Listen to Dr. Howard's story of keratoconus.



Listen to Norris' experience 3 years after treatment.





Click below for videos.




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"MILES AND MILES"
Keratoconic Bobsled Driver Holcomb Sees Better Things Ahead
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PUBLICATIONS/RESEARCH

Study Reveals - Epithelium Removal for Crosslinking is Not Necessary
Ophthalmologists have debated whether epithelium removal is necessary for crosslinking. Dr. Boxer Wachler pioneered the Epithelium-On technique and this study shows that epithelium-on is effective.

The Vision to Win: The Surgical Secret of a Bobsled Champ's Success
Article in Popular Science about how C3-R and Visian ICL allowed Olympic Bobsledder Steven Holcomb overcome Keratoconus. March 2009.

Bobsled Driver Holcomb Sees Better Things Ahead
USA Today article about how Dr. Boxer Wachler cured Olympic Bobsledder Steven Holcomb from Keratoconus.  October 2008.

C3-R Treatment Opens New Frontiers for Keratoconus and Corneal Ectasia
Roberto Pinelli, MD. Eyeworld 2007, 34-36.

Safety of C3-R special light at the Retinal Level and Compared to Outdoor special light Exposure
Leonard Yuen, MD and Brian S. Boxer Wachler, MD

No Progression of Keratoconus 5 Years after C3-R
Wollensak G. Crosslinking treatment of progressive keratoconus: new hope. Curr Opin Ophthalmol. 2006 Aug;17:356-60.

Safety of special light-Riboflavin Cross-Linking of the Cornea
Eberhard Spoerl, PhD, Michael Mrochen, PhD, David Sliney PhD,
Stephen Trokel, MD, Theo Seiler, MD, PhD, Cornea 2007; 26:385-389

The Effect of Inferior Segment Intacs with and without Corneal Collagen Crosslinking with Riboflavin (C3-R) on Keratoconus

Colin C.K. Chan, MD, FRANZCO, Munish Sharma, MD, Brian S. Boxer Wachler MD, J Cataract Refract Surg 2007;33:75-80

Comparison of Single Segment and Double Segment Intacs for Keratoconus and post-LASIK Ectasia

Munish Sharma, MD, Brian S. Boxer Wachler, MD, Amer J Ophthal 2006;141:891-895

Woman with Progressive Keratectasia after LASIK Treated with C3-R® and Wavefront LASEK. Colin CK Chan, MD, Brian S. Boxer Wachler, MD.  Ocular Surgery News 2005 Aprill

C3-R® (corneal collagen crosslinking with riboflavin) increases Effect (lower L-U Ratio) of Single Segment Intacs in post-LASIK Ectasia and Keratoconus
Presented at the American Academy of Ophthalmology Annual Meeting, 2005

C3-R® (corneal collagen crosslinking with riboflavin) for Corneal Stabilization
Presented at the American Academy of Ophthalmology Annual Meeting, 2005

Corneal Collagen Crosslinking with Riboflavin.  A New Treatment to Strengthen the Cornea for Keratoectasia and Keratoconus. Brian S. Boxer Wachler, MD, Cataract and Refractive Surgery Today 2005 January, 73-4.

Collagen Fiber Diameter in the Rabbit Cornea After Collagen Crosslinking by Riboflavin/special light Gregor Wollensak, MD et al. Cornea. 2004 Jul;23(5):503-507.

Stress-strain measurements of human and porcine corneas after riboflavin-special light-induced cross-linking
Gregor Wollensak, MD et al. J Cataract Refract Surg. 2003 Sep;29(9):1780-5.

Riboflavin/special light-induced collagen crosslinking for the treatment of keratoconus
Gregor Wollensak, MD et al. Am J Ophthalmol. 2003 May;135(5):620-7