C3-R® (collagen crosslinking with riboflavin) is a non-invasive procedure that has been proven 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 the natural "anchors" within the cornea. These anchors are 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 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 is 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. In published studies, such treatments were proven safe and effective in patients. 

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, so there is a good track record for this procedure. Links to these research publications can be found to the right side of this page. It is important to note in these studies that the proper dosages of the components are a very important part of the treatment. When used properly, there were no negative effects.

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.

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 flatten the keratoconus cone even more than with Intacs alone. In these cases, C3-R® treatments stablize keratoconus from getting worse as well as help the Intacs 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.

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. Boxer Wachler 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.

For more information on C3-R, please visit www.KeratoconusInserts.com.