Postby Lynn White » Wed 21 Sep 2011 9:06 pm
sarkac,
It is difficult to discuss epi off vs epi on CXL as the evidence remains controversial. However, I will try.
First "Holcomb" C3R means CXL without epi removal using a chemical transporter (usually a form of local anaesthetic) to assist the Riboflavin crossing the epithelial barrier. This is the controversial part, as Boxer Wachler claims full transport is attained whereas European researchers say this method does not result in full, proper cross linking.
As a practitioner, I would really REALLY love this to work as it is much less invasive for the patient. However, I cannot ignore European research. I do know of cases where epi on CXL has not fully worked but on the other hand, in some cases, an epi on procedure that has an high percentage possibility of retarding progression may be preferable to a more invasive epi off procedure.
Unfortunately, we are in the "exciting" early experimental phase of CXL rather than the solid evidential phase.
Now to INTACs
You will get different views of this procedure depending on whether you are talking to a surgeon or a CL Fitter. The surgeon will talk about how much better it makes the corneal shape. This can be so, however, the resultant corneal shape is hardly ever "natural" and contrary to surgical opinion, it does NOT necessarily mean it is easier to fit with CLs. In fact, it generally makes it harder.
One problem with INTACs is if they are placed to near to the pupil, they can reduce vision in low light when your pupil dilates.
However, my advice would be: ask your surgeon for a full list of possible side effects of both procedures.
Lynn
Lynn White MSc FCOptom
Optometrist Contact Lens Fitter
Clinical Director, UltraVision
email: lynn.white@lwvc.co.uk
