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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.