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Discover Dr. Khanna & the FDA approved corneal cross linking to halt the progression of Keratoconus. Together, we will stop further bulging of your eyes and improve the quality of your vision & life. Dr. Khanna is one of the most experienced Keratoconus surgeons in the Los Angeles area. He will design a personalized treatment plan for you.

Rajesh Khanna, MD has been treating Keratoconus eye disease for over 25 years. He founded Khanna Vision Institute with the idea that untapped visual potential should be realized in everyone.

khanna vision
Keratoconus surgeon Dr.Khanna


Today, the entire passionate Vision Team at Khanna Institute works to remove the barriers keeping you from better vision, whether they be insurance, economic or distance.

Khanna Vision Keratoconus centers are located at Beverly Hills, Westlake Village, Inglewood, Camarillo and Oxnard.

We want to make sure your experience is pain free and pleasant. Contact us and set up a consultation to meet our Keratoconus expert Today!

Links: Toric ICL, PIE, Lasek | DALK & Laser Corneal Transplant | Classification, Causes, Symptoms & Signs | Surgeon | Insurance | Eye Test Game




Keratoconus Eye Disease

A condition in which the clear tissue on the front of the eye (cornea) becomes weak and thin. With Keratoconus, the weak cornea is not able to withstand the internal pressure of the eye and bulges outward in a cone-like shape. Symptoms first appear during puberty or the late teens. Symptoms include blurry vision and sensitivity to light and glare.

Post Lasik Ectasia

People who have had successful Lasik eye surgery may display a weakening of the cornea. This condition is termed post Lasik ectasia, but the disease is similar to Keratoconus eye disease. Keratoconus eye disease may progress faster due to the creation of the Lasik flap because a Lasik flap, whether made by laser or microkeratome, does not contribute to the tensile strength of the cornea.

Keratoconus Treatment

You may be wondering which surgical treatment will be best for your eyes. There are two parts to the answer. First, we have to decide if the Keratoconus is progressing. If the answer to this is yes, then corneal cross linking is necessary. Secondly, we have to see which procedure would be best to improve your vision.

Personalizing Treatment

At Khanna Vision Institute we offer a range of treatments for Keratoconus eye disease. We do not believe in an expensive, unscientific, shotgun approach. We carefully listen to you needs, take your age into account and we match the information with the analytics from our advanced machines. This allows Dr. Khanna to design a personalized plan and goal for you.


Keratoconus Quiz

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Meet the Team

Different Types Of Eye Doctors and Professionals Under One Roof: Founder, Rajesh Khanna MD is the refractive surgeon who founded Khanna Vision Institute (KVI) with a focus on delivering the best vision procedure to a person seeking independence from glasses and contact lenses

Rajesh Khanna

Refractive Surgeon

James Giraldi

Optometrist

Curtis Knight

Optometrist

John Wood

Optometrist

Services

Lasik

Keratoconus

Presbyopic Implant In Eye

Cosmetic Pterygium Surgery

Strategy to Restore Life - Yes, we are teaching computers with artificial intelligence to diagnose Keratoconus eye disease, but we still need real intelligence and human emotion to plan a strategy to restore normal life. Dr. Khanna is very passionate about lifestyle results, which go above and beyond just getting corneal results. If you have a prom to attend or a job interview, vision and confidence play a very important role. Our curative treatments are aimed to help you attain the confidence necessary to succeed.

Treatment

Treatment components for the best Keratoconus treatment in Beverly Hills:

  1. CXL or C3R
  2. Intacs
  3. Visian ICL
  4. PIE
  5. Toric Implants
  6. Combinations

We are always adding new Keratoconus treatments to the options presented to you.

Once Dr. Khanna, the Los Angeles Keratoconus Expert, has all the ingredients needed, he puts them in his magic cauldron and out pops a personalized treatment plan suited for your needs. Let’s go over some situations from previous patients so you can understand the rationale involved in devising the treatment protocol.




An 18 year old, high school junior, is having trouble in school as her glasses prescription is changing frequently. She is apprehensive about getting into college and then doing well once she’s there. We have to tackle two problems right away. Instant improvement of the vision is required and then stabilization. In this scenario, the best option would be to work on one eye at a time while doing Intacs and cornea cross linking with riboflavin at the same time. Once the first eye healed, we would then treat the second eye. This would be the best option to meet her needs.

On the other end, we may have a retired gentleman bothered by declining vision. For Keratoconus treatment in people above 50 years old, the plan would be different. Cross linking may take a back seat and the PIE procedure may be a first choice here.

The permutations and combinations are so many that it is best to seek a Keratoconus Expert in the field of this degenerative disease.

PLEASE CALL US TO SET UP A CONSULTATION TO FIND OUT WHAT IS BEST FOR YOU!

Work

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Videos

This Week - Latest Videos

Kerataconus Patient

Treated with Intacs

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Keratoconus And You

Beverly Hills Keratoconus

Keratoconus Cross linking for thin Cornea

Rajesh Khanna Keratoconus Surgeon

How do Intacs for Keratoconus Work

Pastor

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Happy

CXL patient

 
“I was not performing well in my studies. My vision was hampering my learning experience, but few doctors were able to understand that even though I could see the eye chart, the distortions of letters on books and computers were very difficult to interpret. Driving at night was next to impossible with the dancing headlights.”
Mike Tatum, INTACS
 
“It will be no exaggeration to say that cross linking and Intacs changed my life. I have no pain from the procedures at all and my vision is improved greatly! I'm so grateful to Dr. Khanna and the rest of his team. To anyone considering cross linking and Intacts, I say that you should go ahead and do it! Thank you, again, Dr. Khanna.”
Sarah James, ORNEA CROSS LINKING & INTACS
 
“I travelled all the way from Sacramento to get the vision I have been missing for decades. Now after Intacs in both eyes, and a presbyopic implant in one eye, I can see so clearly. When I give a sermon I am so much more confident. My faith guided me to Dr. Khanna and I strongly recommend that you trust your eyes to his able hands.”
Aaron Graves, INTACS & PIE

Cross Linking

Hi, I am glad you reached this page so that we can partner with you in the fight against Keratoconus Eye Disease. You have, like thousands of our patients suffered from poor eye disease. To add salt to injury, very few people including Doctors may have been able to understand your visual problems.

What is Corneal Collagen Cross Linking with Riboflavin or CXL?

Corneal Collagen Cross Linking with Riboflavin is a relatively newer method to strengthen the weak cornea in Keratoconus eye disease. The Avedro epithelium off (epi-off) method was recently approved by FDA. Some surgeons have abbreviated Corneal Collagen Cross Linking with Riboflavin to C3R. It’s important to remember, though there are many manufacturers of Riboflavin and UV dispensing machines, only Avedro (now Glaukos) has FDA approval based on safety, efficacy and good manufacturing practices (GMP).

Epithelium on (epi-on), where top layer is not removed, is NOT FDA approved. This method has not been shown to be safe or as effective as FDA approved epi-off, which allows 30 minutes of soaking with Riboflavin.

In fact, the FDA approved method, also called Dresden protocol, which is named after the city where it originated, is considered the gold standard of treatment among Keratoconus doctors from around the world. That is the treatment we offer here at Khanna Vision Institute, as we believe in only the best.

Corneal collagen cross linking is an important intervention in the treatment of Keratoconus. The distorted cornea causes various aberrations leading to poor functional vision. In many cases, the cornea can rupture. The only rehabilitation in such cases can be performed with corneal transplants once the cornea has ruptured. The goal of a Keratoconus doctor is to prevent this major procedure. This can be achieved by corneal collagen cross linking by riboflavin, making the cornea stronger to stop the further progression of Keratoconus. The strength of the cornea is measured by Young’s modulus, which is defined as stress/strain. Experiments showed that it took more force or strain to stretch a cornea which had been strengthened by cross linking.

Who is a good candidate for corneal collagen cross linking?

Every young person should be treated with the corneal collagen cross linking with Riboflavin procedure at the time Keratoconus is diagnosed. However, not everyone can be fortunate enough to undergo this process and halt Keratoconus. The thickness of the central cornea has to be above four hundred microns. The shape of the cornea is another determining factor. The effect is best observed when the curvature of the cornea is between 52 and 57 diopters, but it can be performed if the curvature is less than 52. The central cornea should also be free of scars and folds.

Is the CXL surgery painful?

Your eyelids offer the cornea protection. In order to see the world, the cornea has to be uncovered. It is exposed to the elements of nature, meaning there is potential for a lot of damage. The cornea is supplied with a lot of nerve endings and these corneal nerves can be activated before any permanent damage occurs.The nerve endings lie below the top layer (epithelium) of the cornea. This area has the highest nerve endings per millimetre in the entire body.

When we perform corneal cross linking, we have to push riboflavin and UV radiation below the epithelium. We have to traumatize, and even remove this layer. This stimulates the corneal nerves and that can cause pain.

After corneal collagen cross linking is done

A contact lens bandage is placed on the cornea. This prevents the eyelid from irritating the surface of the cornea. Dark glasses and protective shields are also given for your comfort. Specially formulated drops that prevent pain are dispensed to take home. Medication to decrease pain, or analgesics, may be prescribed. We also keep in close communication after you go home. We will call later that same day to see how you are feeling and make sure you don’t have any questions/concerns. You also get the doctor’s cell phone number in case you do need to reach him.

Each Keratoconus center can be different. We want to make sure your experience is pain free and pleasant. Contact us and set up a consultation to meet our Keratoconus expert!

Planning the recovery from corneal cross linking

Corneal cross linkage is an important procedure to preserve sight. It is better to allocate time to recover from this vision preserving procedure. It is best to do while on vacation or over a holiday break. Avoid undergoing this treatment during schools finals/exams or around important meetings or deadlines at work.

You will have a bandage contact lens on your treated eye for between 4 to 7 days. You will also be wearing dark sunglasses. During this time you can expect a foreign body feeling of irritation and watering of the eye. The vision may be blurred with some discomfort and rarely, sharp pain may occur. Increased mucoid discharge and severe pain may indicate infection. That is why you will be instilling antibiotic drops.

After the contact lens is removed you will start putting in steroid drops. The foggy vision may take a few weeks to clear up. It may be a good idea to put lubricating drops in during this phase of healing.

Close supervision by the Keratoconus surgeon will help quicken the recovery and avoid any pitfalls. The doctor can tell the best time to return to wearing your old contacts, or prescribe new ones if need be.

Corneal collagen cross linking combined with PTK and PRK

Cretan protocol plus can improve refractive errors, like astigmatism, on patients with Keratoconus. This will also allow us do the CXL procedure combined with PTK and PRK. This is based on our experience and a study paper published in the Journal of Cataract and Refractive surgery by Dr. Grentzelos from Crete, Greece.

Corneal collagen cross linking, as you may know by now, was invented by Dr. Wollensack. It can halt the progression of Keratoconus. In United States, the FDA has approved the Avedro KXL/Photrexa system to prevent progression in post Lasik ectasia and progressive Keratoconus patients. The major drawback has been that patients are still left with refractive errors, especially astigmatism, and the vision is not optimal in these teens and young adults. Keratoconus surgeons had been hesitant to apply laser energy to the Keratoconus cornea, for fear that additional tissue removal may further weaken the cornea.

Precautions

Corneal collagen cross linking, combined with PTK and PRK, can only be done for minor corrections where the total corneal tissue ablated is less than 50 microns, with at least 350 microns left. Judicial judgment by an experienced Keratoconus and laser surgeon is very important. We usually have restricted to treat astigmatism in the central 6 mm zone, especially when tissue ablated is away from the thinnest zone.

Advantages

Vision can be improved. This combination allows for rapid improvement of vision, avoiding contact lenses. Bonus, there is no additional pain! If the two procedures are done separately, there is discomfort and healing time for each. Another advantage of using the PTK mode for removal of epithelium is it flattens the cone, decreasing higher order aberrations.

Caution

As with any advancement, we have to be careful of potential side effects. PTK can weaken the thinnest, bulging part of the cornea. This may destabilize the cornea. Please consult with your Keratoconus expert to find out if this is a good choice for you.

Indications for collagen corneal cross linking

  1. Progressive Keratoconus
  2. Lasik ectasia getting worse
  3. Pellucid marginal degeneration

An important point we have to consider is what the term “progression” actually means. Various researchers, clinicians and surgeons may define it differently. It may also vary by the machines used for topography or OCT. A Pentacam may show numbers differently than an Atlas topography. This is where the surgeon’s experience becomes important. It may be better to err on the side of caution.

We also need to come up with a standard for defining progression among Keratoconus doctors. Progression in various studies is considered when:

  1. There is an increase in K-max of 1 diopter (D) in 1 year.
  2. Increase in nearsightedness and/or astigmatism ≥3 D in 6 months.
  3. A mean central K-reading change of ≥1.5 D observed in three consecutive topographies in 6 months.
  4. If there is a decrease ≥5 % in mean central corneal thickness in three consecutive tomographies in the last 6 months.

The classification below of corneal cross linking procedure is based on, and similar to, the one proposed by Dr. Hafezi, Dr. Randelmann et al.

  1. Cross linking with Riboflavin (C3R)
  2. Cross linking with Rose Bengal (C3RB)
EPITHELIUM STATUS EPITHELIUM OFF

This is the classic method described by Wollensack et al. Traditionally, the epithelium is removed by a chemical, either tetracaine or ethyl alcohol. Laser epithelium removal (PTK) is a new variant.

EPITHELIUM ON

CHROMOPHORE (RIBOFLAVIN) SOAKING TIME

CORNEA CHANNEL

CHROMOPHORE (RIBOFLAVIN) SOAKING TIME

30 MIN

For epi-on cornea cross linking procedures, a longer soaking time may be needed, up to 60 minutes, and on a rare case it could be longer. The end point is flare in the anterior chamber.

10 MIN

UV RADIATION TIME

OTHER

UV RADIATION TIME

30 MIN

MODIFIERS

10 MIN

MODIFIERS

6 MIN

MODIFIERS

OXYGEN

Learn more about corneal collagen cross linking costs and insurance coverage. We offer FDA approved, Avedro epi-off, classic Dresden protocol conventional corneal cross linking.

IONTOPHORESIS

Learn more about corneal collagen cross linking costs and insurance coverage. We offer FDA approved, Avedro epi-off, classic Dresden protocol conventional corneal cross linking.

PULSED

Learn more about corneal collagen cross linking costs and insurance coverage. We offer FDA approved, Avedro epi-off, classic Dresden protocol conventional corneal cross linking.

COMMON ABBREVIATIONS USED

  1. BCVA: Best-corrected visual acuity
  2. CXL: Corneal cross linking
  3. D: Diopter
  4. DALK: Deep anterior lamellar keratoplasty
  5. ICRS: Intracorneal ring segments
  6. PRK: Photorefractive keratectomy
  7. SE:Spherical equivalent
  8. UVA: Ultraviolet A irradiation
  9. UCVA: Uncorrected visual acuity

How does Corneal Collagen Cross Linking with Riboflavin (CXL or C3R) work?

We will illustrate the problems of Keratoconus eye disease and its cure using CXL with a few simple examples. Imagine there is a room filled with water with a wooden door that is strong and able to hold back the water. Now imagine the door has been replaced with a plastic sheet. Plastic is not as strong as wood. What is likely to happen? The outward pressure from the water is going to push on the plastic sheet, causing it to bulge outward and gravity is going to pull this bulge downward. If we want to reverse this trend and strengthen the plastic door we can polymerize the plastic door by adding chemicals and activating them with ultraviolet radiation.

This is exactly what transpires in Keratoconus eye disease and CXL. The collagen fibers in the cornea are shorter and stubby and get pushed to the periphery. This make the center of the cornea thin and the fluids inside the eye exert outward pressure on this weakened area of the cornea, making it bulge. Pressure is equal to force divided by the area. As the fibers are pushed to the periphery, the pressure is more severe on the central, thinner area. This trend is paused and reversed by cornea cross linking. CXL forms linkages between the fibers, preventing them from moving away and instead bringing them closer.This is the difference between breaking a single twig versus many twigs tied together. It is easy to break a single twig, but it becomes nearly impossible to break many of them together.

Another fun way to look at it to visualize beautiful colorful butterflies flying around. There are only strings hanging from the ceiling but no wall. Outside there are birds waiting to devour them. If we tied horizontal strings to the vertical ones it would form a net and hold the butterflies back. Likewise, crosslinking keratoconic eyes’ cornea holds back the eye fluids.

Procedure and the steps in corneal collagen cross linking with Riboflavin

The top most layer of the clear part of the cornea is termed the epithelium. It prevents fluids and bugs from entering the cornea. This has to be removed to allow the Riboflavin to penetrate the cornea. The two main stars of the procedure are Riboflavin (Vitamin B2) and ultraviolet A irradiation (UVA). Riboflavin is the photosensitizer in the photopolymerization chemical reaction. UVA irradiation excites free radicals to form intrafibrillar and interfibrillar carbonyl-based collagen covalent bonds. Riboflavin is applied and is left to soak for 30 minutes. It is then activated by UVA radiation for 30 minutes.

There are two phases of the process, an early aerobic phase and later anaerobic. In the oxygen dependent aerobic phase, molecules of riboflavin are excited to a single or triplet state and reactive free oxygen radicals are liberated. These interact with collagen in the later anaerobic phase, when oxygen is depleted. As a result of this murky process, corneal rigidity is increased and collagen fiber becomes thicker and more resistant to enzymatic degradation. There is decreased permeability and swelling of the cornea, especially in the anterior stroma.

How to decrease pain with corneal collagen cross linking for Keratoconus?

The unknown is the basis of fear. Knowledge and awareness decreases fear. At our Keratoconus center, we invest time in explaining each step of the procedure. We also diligently go over risks, benefits and consent forms, which allows most doubts and fears to be removed. We offer communication with previous patients who underwent collagen cross linking for Keratoconus. This can done by either reading written accounts, watching videos or personal interaction with the patients.

A multitude of methods are used to make the procedure as an enjoyable experience as possible. We play music of your choice to relax you and further relaxation is achieved with yogic deep breathing. The staff talks with you, explaining each step of the procedure before it happens and instills pain free drops.

Corneal Cross Linking Recovery

Epithelium off recovery requires the epithelium to regenerate. It takes 48 to 72 hours for the epithelium to grow back and cover the area from which it had been removed. During this time there can be pain and photophobia. This is overcome by employing various painkilling drops. As the cornea in Keratoconus patients is not “normal”, the healing process can be delayed. It is important the doctor keeps a close watch on the healing eye. There is a possibility of contracting infection. Vision can be blurry for a few days to weeks. Therefore it is wise only to do one eye at a time.

Epithelium on CXL is not as effective as epi-off. Some Keratoconus surgeons prefer this method as the healing is quicker, however there is a higher risk of complications. The agitated epithelium may die and fall off leading to corneal abrasion which may cause pain and blurry vision.

Corneal Cross Linking on a Thin Cornea

We know that with Keratoconus the corneal collagen fibers are decreased in number and volume. This decreases the tensile strength of the cornea to hold back the internal pressure of the eye. We can increase the Young’s modulus, or the rigidity, of the cornea with corneal cross linking. This intervention is more challenging in extremely thin corneas. We need to protect the inner cornea and the inside of the eye from the UV radiation we apply. If the cornea is thinner than 400 microns we need to develop a different strategy. When doing epi-off corneal cross linking we remove the top 5o microns when we discard the epithelium. This is why the cornea has to be more than 450 microns to start safely. It is common knowledge among Keratoconus surgeons that epi-off corneal cross linking is more effective than epi-on corneal cross linking. In thin corneas, epi-on CXL may be used because the 50 microns of epithelium adds a barrier to the UV light.

What about extremely thin corneas, where even the epithelium protection is not enough? A novel strategy has been devised – contact lens assisted CXL. A 300 micron contact lens is soaked in riboflavin and then placed over the bare cornea. It helps the cornea to swell, as well as prevents UVA radiation from penetrating deeper.

Basic principles, science and research of corneal collagen cross linking

The main aim of corneal cross linking is to halt the increase in the bulging of the cornea and make the cornea stronger and resistant to the internal pressure of the eye. The secondary aim is to flatten the cornea and improve the vision.

Science research results

Even with our modern technology it is difficult to demonstrate the exact working and effect of cross linking on the human cornea. We do have indirect evidence of the success of CXL. Young’s modulus, or stress/strain ratio, is increased with CXL and is the hallmark to demonstrate the effectiveness in the lab. The strengthening is increased if there is a higher content of collagen present.

Corneas develop more collagen fiber thickness after CXL. This treatment makes the cornea more resistant to degradation processes mediated by pepsin, trypsin and collagenase with increase in collagen turnaround time.

Standard procedure of collagen corneal cross linking

The procedure for corneal cross linking is simple. First the epithelium or the top layer is modulated. It may be totally removed for a circumference of 9 mm. The epithelium may be removed by a variety of methods. Diluted ethyl alcohol is usually employed. Laser epithelium removal is another choice. It may also help in flattening the cone. These methods where epithelium or the top layer of the cornea is totally removed is called epithelium off CXL, or epi-off CXL. If the epithelium is only agitated, but not removed, then it is called epithelium on CXL, or epi-on CXL. The standard Dresden protocol, also called conventional collagen corneal cross linking, was described by Wollensask. It requires epithelial removal (epi-off), the instillation of 0.1 % Riboflavin solution for 30 minutes, followed by 30 minutes of UVA irradiation, with a wavelength of 370 nm and power of 3 mW/cm2 (5.4 J/cm2).

Gold standard of corneal collagen cross linking for Keratoconus

The inventors of corneal collagen cross linking tried various combinations in the lab and in clinical practice. They found the most effective treatment for the cure of Keratoconus was epithelium off corneal collagen cross linking with riboflavin. This is the current gold standard against which all other methods and variations have to be tested.

Contraindications to undergoing standard CXL treatment:

  1. Corneal thickness of less than 400 microns.
  2. Previous herpetic infection.
  3. Immunological disease.
  4. Severe scarring or haziness of the cornea.
  5. Epithelial wound healing problems.
  6. Severe dry eye or eye surface disorders.
  7. Pregnancy and breast-feeding.

Limits and complications of collagen corneal cross linking (CXL)

  1. In around 8.1–33.3 % of patients CXL may not be beneficial. The central cornea continues to steepen more than 1 D in a year, or vision deteriorates further. The great news is research papers with follow ups ranging from 6 months to 6 years all showed stabilization of Keratoconus, with flattening of the central cornea. There is also documentation of improvement of vision with epic off collagen corneal cross linking.
  2. Infection remains the main problem. Bacteria, fungus, herpes and acantamoeba can all invade the denuded cornea. Clinicians and patient have to be vigilant against this threat.
  3. Corneal haze is quite common. It occurs three weeks to three months later, but the good news is that it resolves on its own. It may be related to keratocyte activation.
  4. Corneal edema may occur.
  5. Watering, tearing, and pain are the most common complications but they do resolve quickly.

Considering cross corneal linking or CXL? Here are a list of questions to ask your eye doctor:

  1. How is Keratoconus treated?
  2. What are my treatment options, and which do you recommend?
  3. What treatment options are covered by insurance?
  4. Is the procedure that you are recommending FDA approved or investigatory?
  5. If the procedure you are recommending is not FDA approved, am I being enrolled in a clinical study?
  6. Is it true some malpractice insurance are not covering doctors performing corneal cross linking?
  7. Are you a Board Certified Ophthalmologist?
  8. Have you been fellowship trained in cornea refractive procedures?
  9. How long have you been performing cornea cross linking with Riboflavin?
  10. Do you have experience in combined Intacs insertion and corneal collagen cross linking?
  11. Are you considered a Keratoconus expert?
  12. Have you had to manage any complications? If so, how did you manage them?
  13. Will I need contacts or eyeglasses after the procedure?

Testimonials

I was diagnosed with Keratoconus several years ago

"I was told my only option was hard contact lenses. I knew that I would never be able to comfortably wear those, so I found Dr. Khanna online and went to meet him in person for a consultation. By the time I left the office, I had other options and I knew I could trust him with my vision. I had surgery last year to have Intacs implanted and this year I'm going back to have cataract surgery. Dr. Khanna is a skilled surgeon and is always up on the latest research, so you know you're going to get what's best for you. I live in Vegas and it's worth the trip knowing I'm in good hands. I would definitely recommend a visit to Dr. Khanna if you're looking for a professional and reputable eye surgeon." - Sam



Keratoconus surgeon Dr.Khanna performing CXL

I was diagnosed with Keratoconus when I was 19 years old.

"I had spotty vision since I was 11, but was able to correct it with contacts and glasses. With the Keratoconus, I was unable to wear any kind of contacts because they were very uncomfortable. I stuck to glasses and just dealt with my bad vision, which got progressively worse.

In 2008, I decided that I had to do something about my Keratoconus. I was browsing the web and found Dr. Khanna and a procedure called Intacs. Within a month (maybe less!) I was having the procedure done.

When one of my Intacs came out a few months later, I was taken care of immediately, and had a replacement Intac put in a few months after that.

Dr. Khanna and his staff are very helpful and knowledgeable. I am always greeted with smiles from the entire staff and Dr Khanna when I go for my follow-up appointments. They're always so friendly and I actually look forward to my appointments.

Getting Intacs was the best thing I have ever done for my vision! I went from "counting fingers" to not needing any contacts or glasses! Heck, the vision in my right eye is 20/20 and my left eye is steadily improving! If you have Keratoconus and want to get Intacs, go to Dr. Khanna. When you're in the waiting room, watching their video, look out for me -- I'm the girl in the red tank top having the Intacs procedure done." - Sandra



Photo 1.CXL | Photo 2.Dr.Khanna adjusting KXL system for UV Radiation | Photo 3. Effects of CXL by increasing crosslinks

Hi my name is Juan, I am 25 years old, and I am from Westminster, CA.

"Four weeks ago I tried to have Lasik surgery in Newport Beach. I was diagnosed with Keratoconus on my right eye. They told me that if I didn't do anything about it, I would lose my vision. They referred me to a specialist that was extremely expensive. I was even considering giving up the chance of saving my eye. As a last hope, I started calling specialists that I found on the web. Thank God that I found Dr. Khanna. About a week ago, he performed the surgery on my right eye to stop the Keratoconus and it was done at a very affordable price. It was so affordable that I also had Lasik surgery on my left eye. I feel very happy because Dr. Khanna saved my vision. The surgery itself lasted between 5 to 10 minutes, and it was painless, plus I found Dr. Khanna very confident and experienced. Before the surgery, I could not read even big letters with my right eye. Now that I have the Intacts implants that lift my cornea to the position where it belongs -- I'm very impressed with the results. It is amazing how much my vision improved with the surgery. If you are looking for a Lasik surgeon, Dr. Khanna is the perfect doctor to trust your eyes with. Visit www.khannainstitute.com for more info about Dr. Khanna. I am sure you will be satisfied too!" - Megan

Intacs

What are Intacs corneal ring segments?

Intacs are small ring segments manufactured by Addition Technology. Intacs aid in the cure of Keratoconus. Intacs come in different thickness, ranging from 210 microns to 450 microns. They have an inner diameter and outer diameter. At the end of the segments are holes, which help in implantation of the Intacs.

Intacs ® Corneal Implants are actually an ocular medical appliance developed for the reduction or elimination of myopia and astigmatism in individuals with Keratoconus (KC). They are used to ensure that the practical vision may be restored and the need for a corneal transplant procedure can possibly be postponed. When placed in the corneal stroma, outside of the patient’s main optical area, the item reduces the cone by flattening the cornea, and for non-central Keratoconus, rearranges the cone centrally. Intacs segments are designed to be put in the periphery of the cornea, at roughly two-thirds depth, and are operatively inserted through a tiny radial laceration in the corneal stroma.

Intacs Corneal Implants are composed of two clear sections, each having an arc size of 150 ° (see layout below). They are manufactured from polymethylmethacrylate (PMMA) and also are readily available in six densities: 0.210 mm, 0.250 mm, 0.300 mm, 0.350 mm, 0.400 mm and also 0.450 mm. In order to minimize the myopia and the uneven astigmatism induced by Keratoconus, 2 Intacs sections ranging from 0.210 mm to 0.450 mm might be implanted depending upon the patient’s preoperative show refraction spherical matching (MRSE), the alignment of the cone as well as the level of uneven astigmatism. The product is designed with a fixed external diameter and also size. Intacs Corneal Implants have two positioning openings, located at each end of the section, to help in surgical control.




Intacs in pack



Intacs next to a dime to show relative size



Before and After Intacs




Corneal cone before and after Intacs insertion



Intacs improves topography


Are Intacs for everyone?

Intacs were originally used for treatment of myopia. With the advent and popularity of wavefront Lasik, Intacs are rarely used for correcting nearsightedness. Today, they are mainly used for the treatment of Keratoconus.




Intacs in the cornea



Depth-Intacs-OCT-Cornea


Contraindications to implantation of Intacs

Intacs corneal implants for Keratoconus are contraindicated in the following situations:

  1. Individuals who have abnormally slim corneas, or that have a corneal thickness of 449 microns or less at the suggested incision site
  2. People with collagen vascular, autoimmune or immunodeficiency illness
  3. Expecting or nursing women
  4. The presence of ocular problems, such as persistent corneal dystrophy which may increase future complications
  5. People who are taking several of the following drugs – Isotretinoin (Accutane1) or Amiodarone Hydrochloride (Cordarone2)
  6. Patients who have Fuchs’ dystrophy, or have suspicious endothelial cell deficiency are not prospects for Intacs corneal implants

Indications for Intacs Implantation

Intacs ® Corneal Implants are intended for the decrease or removal of myopia, and astigmatism in people with Keratoconus eye disease, who are no longer able to achieve ample vision with their contact lenses or spectacles. The goal is for the vision to be recovered and have the demand for a corneal transplant treatment potentially be deferred. The certain part of Keratoconic patients proposed to be treated with Intacs Corneal Implants are those people:

  1. Experienced a progressive deterioration in their vision, such that they can no longer achieve sufficient practical vision every day with their contact lenses or eyeglasses
  2. Are 21 years old or older
  3. Have clear central corneas
  4. Have a corneal density of 450 microns or better at the suggested laceration website
  5. Corneal transplantation as the only remaining alternative to boost their functional vision

Planning Intacs Implantation

There are 2 primary criteria used in establishing the medical nomogram pertaining to making use of Intacs Corneal Implants for Keratoconus. The initial requirement is whether the cone is centered or uncentered (uneven cone). Keratoconus, which is centrally existing as determined by a topographic map, will certainly require 2 Intacs sections of the same density. The thickness of the Intacs segments to be utilized is figured out based upon the preoperative spherical matching of less than or equal to -3.00 D or above -3.00 D. This would also be put on global Keratoconus in which the Keratoconus is centered but its circumference prolongs beyond 5.0 mm from the center.

As for crooked cones, we need to evaluate the level to which the cone is uncentered. This is done by assessing a topographic map of the cornea. Moderate asymmetry exists when the cone is off-center in placement at the 3.0 millimeter ring on the topographic map. High asymmetric cones are normally 5.0 millimeters or more off-center, as shown on a topographical map. In each of these situations, two various densities of Intacs sections are utilized. The Intacs thicknesses made use of will certainly depend on whether the preoperative spherical matching is less than or equal to -3.00 D or greater than -3.00 D. The thicker Intacs segment is recommended to be positioned inferiorly as well as the thinner Intacs section is to advised be positioned par excellence.

How are Intacs ring segments implanted?

Intacs are inserted into channels created in the cornea. The channels can be created by Intralase laser, the same laser used to make flaps for Lasik. The channels can also be made with the prolate mechanical system. There are two models of Intacs – Classic and SK. How do Intacs work to treat Keratoconus? Keratoconus is central thinning and weakness of cornea. This abnormal cornea is not able to withstand the internal pressure of the eye and bulges forward. This bulging cornea is also acted upon by gravity, therefore the apex of the ectatic cornea falls downward. Intacs are inserted at a distance of 7 mm from the center of the cornea. They push up and stretch the bulging apex of the Keratoconus cornea. This brings the apex up in the line of sight. Can Intacs be removed? Rarely, the Intacs have to be removed but it is a relatively simple procedure if needed. The entry wound is freshened, the holes at the end of Intacs are engaged and the Intacs pulled out.

Intralase laser is a high-energy small burst laser, which can create a channel in the cornea. The surgeon has the control to set the dimensions for this channel. This is a circular path created by the Intralase using special proprietary software from Abbot Medical. The depth of the channel is of course the most important factor and can be set by the Intacs surgeon. Usually with the Intralase method, the Intacs can be placed deeper, at 90% depth of the cornea with 50 to 100 microns left intact below the Intacs. This yields the best chance for the Intacs ring segments to work to treat Keratoconus and the least chance for extrusion from the surface.

The corneal surgeon will also need to set the inner and external diameter for the channel. These dimensions vary based on the thickness of the Intacs ring segments, that is 210 or 350 or 450 microns. Again, the commonly used numbers are 6.8 mm for internal and 7.6 mm for external diameter. Finally, keratoconus surgeon needs an entry into this channel. The software allows the doctor to set the location for this vertical incision. The Keratoconus surgeon, with experience in Intacs insertion, would usually set this at 90 degrees from where he wants the center of the Intacs to be finally placed.

The positioning of the cut will be commonly temporal at the axis of positive cylindrical tube; however, it may differ depending on the location of the cone, as well as the amount of Keratoconus existing in the eye to be treated. The Intacs sections are to be positioned equidistant on each side of the laceration. The Intacs product has been designed to permit substitution of the product for a different thickness or removal, even years later, if desired.

Once the channels are created, the eyes are prepped with betadine and draped. The Intacs are inserted and the incision is sutured. This is one of the latest methods to treat Keratoconus eye disease..


Mr Seymour ready for intralase corneal channels :-)



Intacs ring segment by Keratoconus Surgeon, Dr Khanna


Toric ICL, PIE, Lasek

BEST TREATMENT FOR KERATOCONUS FOR YOUR EYES. Vision enhancement in Keratoconus with Toric ICL, PIE, Lasek

Dr.Khanna is a cornea and refractive surgeon. He uses the latest FDA approved technologies to stop the progression of Keratoconus eye disease, as well as enhance your vision.

The path to good vision begins with a detailed history and a thorough, advanced exam. This includes documenting the power of the eye, the glasses prescription and the contact lenses. A detailed wavefront map of the power of the cornea, as well as the wavefront map of the entire eye is obtained.




Best Treatment for Keratoconus eye disease planner


2020 South California Top Doctor & Rising Stars - Rajesh Khanna

AGE 10 TO 21 YEARS

Cross Linking Essential

Cornea Collagen Crosslinking with Riboflavin

Keratoconus surgeons have a dictum - "If you see a child with Keratoconus eye disease, do epithelial off cross linking with Riboflavin right away.

Intacs

Intacs Corneal Ring Segments

These help decrease myopia and astigmatism. Since they can be exchange or removed, they allow adaptability to a growing eye.

Glassess/Contacts

Glasses, soft contacts, toric contact lenses.

Glasses, soft contacts, toric contact lenses are options for better vision wheile cross linking is being done and the progression of the bulging of the eye is being arrested. Hard contacts need to be avoided. Scleral contact lenses may not be required as flattening induced by cxl will allow sot lens use.

AGE 21 TO 45 YEARS

Cross Linking

CXL OR C3R

The first step of corneal cross linking is to strengthen the cornea and halt the progression of further bulging of the cornea. In advanced cases, rapid intervention is essential. In early to moderate cases, the progression may be documented before doing this procedure. CXL can also be combined with Intacs in a single sitting, but this is usually only done for the patients who come from far distances.

Intacs

Corneal Support

Intacs are very useful for counteracting myopia and astigmatism> They improve the wavefront diminishing higher order aberrations.

Toric ICL

Yes you can see

This implant is place over the natural lens. it can correct most of the myopia and astigmatism even in thinner corneas. The results are quick and the cortnea can still undergo crosslinking before or after ICL implant.

PARK

A little enhancement

PRK with astigmatism correction is referred as PARK. This technology is employed in very selective cases. Low myopia and most of astigmatism can be treated either at time of cxl or around six months after cxl. This yields great vision with many seeing 20/20.

AGE ABOVE 45 YEARS

PIE

A permanent procedure

PIE, or presbyopic implant in the eye, can correct any error of refraction, including astigmatism. A Symfony IOL, or a Trulign IOL implant (this is more commonly used) is positioned accurately to yield an optimum, glasses free result.

Cross Linking

CXL if necessary

CXL is reserved only if progression is documented by topography or thinning is noticed on corneal pachymetry. This is more likely to occur in Pellucidal Marginal Degeneration.

PARK

Photo Astigmatic Refractive keratotomy

PARK can be used like in the other age group or after PIE.

Intacs

INTACS still an option

INTACS can work to decrease the higher order aberrations allowing people to drive comfortably at night.



DALK & Laser Corneal Transplant

DALK Deep Anterior Lamellar Keratoplasty & Full Thickness Laser Corneal Transplant.


Deep Anterior Lamellar Transplant (DALK)

A cornea transplant for Keratoconus involves the full thickness cornea replacement. Full thickness transplantation is also used for a variety of other corneal diseases like scarring, to restore the normal shape, clarity and therefore the function of the cornea. In all these cases the endothelium, the innermost layer of the cornea, which pumps out fluid from the cornea, is healthy. This gets sacrificed. DALK preserves this functional layer in the patient.

DALK is a newer surgical procedure that selectively removes the diseased, anterior layers of the cornea. DALK retains the healthy, innermost layer (endothelium) and this inner layer is kept. The body gets fooled and does not recognize the donor tissue, therefore there is less risk of rejection.

This surgery requires even more skill than cornea transplantation. It begins by dissecting the Keratoconus cornea and retaining the innermost layer of Descmet’s membrane on which endothelium is attached. Then a donor corneal button is prepared by removing the Descemet’s membrane and endothelium. This button is sutured in place.

Advantages of DALK for Keratoconus are:

DALK is a closed eye surgery

The endothelium is preserved

Full thickness cornea transplant, or PK, can still be performed

Disadvantages of DALK for Keratoconus are:

It is technically challenging

Vision is slower to reach full potential (2-3 months)

Potential of scarring at the interface of the donor cornea and the patient’s Descemet’s membrane




Getting ready for surgery


Full Thickness Cornea Transplant

This method is having a donor cornea replace the patient’s cornea. Among all human transplants, like a heart, kidney or liver transplant, the corneal transplant has the highest rate of success. Corneal transplants are especially successful in the treatment of advanced Keratoconus. The patients undergoing corneal transplants are the patients whose Keratoconus is so advanced that they are not eligible for Intacs or cross linking. Some indications are:

  1. Central corneal opacity
  2. Very thin cornea
  3. Very steep cornea

We are using the latest cutting edge technology for corneal transplants and we have the ability to make the transplants with Intralase laser. This is the same laser we use to make channels for Intacs. We are fortunate to have the only surgery center specifically set up for this in Los Angeles. The Intralase can make a precise donor and recipient edges. The older methods of using blades or trephines were not as accurate and could only cut vertically. The specially designed software on Intralase, for corneal transplants, can cut zigzag or top cap and other patterns. This allows the corneal graft to fit more snugly with the patient’s cornea. It makes healing easier, the resultant scar stronger and therefore the surgery safer. It may also decrease the amount of induced cylinder.

Currently, the top two patterns we utilize with the Intralase are the top mushroom and the zig zag pattern. This part of the treatment for Keratoconus is performed in the laser suite adjacent to the operating room. It is virtually painless.

Classification, Causes, Symptoms & Signs

Keratoconus Eye Disease & Classification, Causes, Symptoms & Signs. Keratoconus eye disorder is also called KC. Recent advances in management have brought a renewed interest in helping patients who had no hope before. We need to understand the disorder to comprehend the best strategy for halting its progression.

What is Keratoconus Eye Disease?

In simple words, Keratoconus eye disease is a defect in the cornea, the clear part of the eye. The cornea is made up of strands of protein called collagen fibrils. The cornea has three main functions. The first function is to keep itself clear. It needs to allow the light to pass through the eye to the retina without distortion. The cornea needs to converge the light to bring it to focus on the macula. The second function of the cornea is to withstand the pressure of the fluidic, internal contents of the eye. Finally, the cornea acts as a protective barrier, preventing physical, microbiological, chemical and radiation hazards from reaching deeper parts of the eye.

Gene abnormalities lead to an abnormal expression of collagen proteins in the cornea, which then makes the collagen fibrils less attached to each other. Its like having slippery noodles and when one tries to pile them up they all slide away. This abnormal cornea is not able to withstand the outward force exerted by the internal liquids of the eye. The fibers start slipping away to the periphery and this starts the bulging of the eye. Gravity now acts as a force on this weakened and bulging cornea, pulling the cone down. The shape of the cornea is altered from a prolate to a cone which then leads to distortion of the incoming light. Instead of the light being focused at one point, it gets scattered and the information brought from the universe is therefore not transferred properly to the brain.

It is a degenerative disease affecting both eyes. It leads to progressive thinning and bulging of the cornea that results in blurred vision caused by irregular astigmatism and visual loss in early adulthood. KC has been the most common cause of corneal transplants in the developed world. The progression may be different in the two eyes. At presentation, one eye may be more advanced with Keratoconus eye disease than the other. This can lead to a mistaken impression that the disease is present only in one eye.

Causes of Keratoconus

  1. Genetic
  2. Is Keratoconus hereditary? This is what research on Keratoconus has produced so far. There is positive family history in 6-8% of the patients presenting with Keratoconus. The various, different research studies have shown that the prevalence in first degree relatives is 15-67 times higher than in the general population. Even unaffected, first degree relatives havea higher incidence of abnormal corneal topography. Linkage mapping and mutation analysis have indicated the location for autosomal dominant inherited Keratoconus.

  3. Inflammatory
  4. Though Keratoconus has traditionally been defined as non inflammatory disease, recent insight into the causes of Keratoconus have shown that inflammation may be involved.

  5. Eye rubbing
  6. This may cause micro trauma. Rubbing may be a response to the inflammatory factors.

  7. Contact lenses causing micro trauma
  8. Atopy or allergies
  9. While research into causes and newer treatments for Keratoconus is progressing, it is important that all family members of Keratoconus patients, including siblings, parents and children should be screened for Keratoconus eye disease. They should also be warned to chose Epilasik procedure over Lasik eye surgery.

    Ventura, Oxnard, Santa Barbara residents may have their screenings in our Westlake Village office. Patients from Beverly Hills, Rancho Cucamonga, Culver City and Santa Monica can book their Keratoconus screenings in our Beverly Hills office located near Cedars Sinai Hospital.


    Watch Out for Keratoconus! 8 Potential Signs & Symptoms.


    Spectrum of Keratoconus Eye Disease

    The Keratoconus eye disease may have different expressions. Axial corneal thinning (apex cone), inferior corneal thinning (dropped cone, pellucid marginal degeneration), or generalized corneal thinning (keratoglobus). It is unclear as of 2017, whether these are variants of KC or distinct conditions. To complicate diagnosis even further, certain eyes can be thin but may not have KC.



    Structure and Proteomics of Keratoconus Eye Disease

    Let’s look at the cause of defects in Keratoconus eye disease in more detail. A theory suggests that epithelium may be abnormal, releasing enzymes which degrade the collagen in deeper layers. On microscopy there are breaks in Bowman’s membrane and thinning of the collagen layers of the stroma of the cornea. Proteoglycans may be increased in KC eyes, decreased in normal eyes. In eyes with Keratoconus there is up regulation of decorin and keratocan. There are fewer keratan sulfate chains and the volume of collagen is less. There is altered distribution of collagen type III in scarred regions of KC tissue. Other than this, the types of collagen is similar to normal eyes. Examination of the tears or corneal tissues from patients with KC has identified differential expression of proteins, cytokines and enzymes compared with controls.

    Cause, or etiology (we physicians like to impress with our knowledge of Latin), of Keratoconus is under heavy research right now. The history of Keratoconus spans two centuries. It appears so far that there may be more than one cause or that it is multi-factorial (one or many factors acting in concert can lead to Keratoconus).


    Genetics of Keratoconus Eye Disease

    Large family studies and variability between Israel, Mexico and Russia point to a genetic influence. Genome-wide association studies (GWAS) identified a single-nucleotide polymorphism (SNP) within or nearby the following genes/loci; FOXO1, FNDC3B, RXRA-COL5A1, MPDZ-NF1B, COL5A1, and ZNF469.

    Associated Diseases with Keratoconus

    Leber congenital amaurosis, anterior polar cataract, Brittle cornea syndrome, with a 10–300-fold higher prevalence in individuals with Down syndrome and with connective tissue disorders such as Ehlers Danlos syndrome. A thorough eye exam should be performed in all patients of KC to detect other abnormalities.

    Why is there more than one CLASSIFICATION OF KERATOCONUS EYE DISEASE?

    As science is progressing and newer detection instruments and treatment modalities are being discovered there is a constant upheaval in the classification of Keratoconus eye disease.

    Classification of Keratoconus eye disease is an important task. The advantage to classify or grade any disease is to help select the best treatment option. For example, in Keratoconus treatment the doctor needs to determine whether the best treatment option is Intacs surgery or corneal cross linking. If you were comparing the best Keratoconus treatment options between various surgeons, it would be helpful to know the stage your disease. A single treatment option may suffice in the early stages, but in advanced Keratoconus more than one treatment option might be required.

    This also helps compare efficacy of Keratoconus treatment among clinicians and researchers. Sometimes the classification of corneal cross linking is done to standardize reports and claims. Staging also helps in accepting newly discovered treatment modalities.




Symptoms & Signs of Keratoconus

Rubbing of the eye is a hallmark of Keratoconus eye disease. The same genetic factors which cause collagen abnormality also cause a release of a chemical which incites rubbing. These enzymes that weaken the cornea cause irritation, leading to rubbing. As the fibers slide, weird sensations received by rubbing may be produced. Rubbing also lifts the slippery fibers, improving the vision temporarily. Research has even proposed that the disease can be halted by avoiding touching the eye.

Poor vision, headaches, glare and night vision problems are also signs of Keratoconus eye disease.

The genetic expression of abnormal proteins leading to a defective structure yields certain signs. An astute clinician can find scissored reflex on retinoscopy as well as thinning and bulging with Vogt striae on slit lamp examination. The definitive signs are picked up on a corneal topography and pachymetry distribution map.

Suspect Keratoconus

When there are no obvious signs displayed for Keratoconus, but there is high suspicion of subclinical Keratoconus, the eye is labeled as suspect Keratoconus. If both parents and/or siblings have Keratoconus and the person has thin corneas or steep corneas, they then may be suspected to develop Keratoconus later in life.

Unilateral Keratoconus

This means the Keratoconus is present in one eye only. This is very rare. Typically, Keratoconus is a bilateral disease which means that it is present in both the eyes (bilateral Keratoconus). It is an asymmetric disease (one eye is more affected than the other). So initially, one eye may only display signs of frank Keratoconus. It is more common for the less affected eye to display subtle signs on color corneal topography. At this stage it is termed as forme fruste Keratoconus.

Importance of Screening & Early Diagnosis

It is important to note that the goal of treatment for corneal cross-linking patients is to slow or halt the progression of the disease. For these patients, continued progression often results in loss of visual acuity or decreased tolerance to contact lens wear, caused by the ongoing changes in the cornea.

Therefore, the earlier progressive keratoconus is diagnosed, the sooner treatment can be provided that may slow the progression of the disease.

What are the signs I should be looking for?

Early signs of keratoconus may include asymmetric refractive error, high or progressive astigmatism, or reduced best corrected visual acuity. The onset of keratoconus often occurs in teenage years or early twenties but can start at any time.

Patient symptoms may include:
  • Constantly and regularly changing refractive errors
  • Blurry Vision
  • Increased light sensitivity
  • Difficulty driving at night
  • A halo around lights and ghosting (especially at night)
  • Eye strain
  • Headaches and general eye pain
  • Eye irritation, excessive eye rubbing
  • Keratoconus, especially in the early stages, can be difficult to diagnose and all of the above symptoms could be associated with other eye problems



Biomechanics of Keratoconus Eye Disease

Stromal thinning, a hallmark of KC, is caused by a reduction in the number of lamellae of collagen I fibres within the affected region rather than compaction of collagen fibrils. This has been attributed to collagen degradation by proteolytic enzymes or decreased levels of proteinase inhibitors, it has also been proposed that collagen is not lost but simply redistributed within the cornea by slippage between the lamellae X-ray diffraction studies support the redistribution proposal.

The levels of immunoglobin Ig G , Ig M and Ig E are elevated. Other mediators of inflammation like cIL-6, TNF-α, and MMP-9 are higher in Keratoconus patients as compared to patients without Keratoconus. MMP-9 may be involved in corneal inflammation. The cornea is made of collagen fibers, intact collagen compromises 70% by weight. In keratoconus, there is damage to the extracellular matrix associated with a decrease in type 1 and 4 collagen. Collagen degradation products called telopeptides are 3.5 times higher in Keratoconus patients. A “cascade hypothesis of Keratoconus” has been proposed. Enzymes cause a change in corneal proteins predisposing to oxidative damage, leading to cell death, altered signaling pathways, increased enzyme activities and fibrosis. There is evidence that the inhibitors of destructive enzymes – alpha one (α1 proteinase inhibitor, alpha two (α2) macroglobulin, and tissue inhibitor metalloproteinase one (TIMP-1 are decreased in keratoconus corneas; the latter can prevent cell death.

Amsler-Krumeich Grading – Classification of Keratoconus Eye Disease



STAGEFINDINGS
1Non central Bulging
Nearsightedness, induced astigmatism, or both <5.00 D
Mean central Keratometry <48 Diopter
2Nearsightedness, induced astigmatism, or both from 5.00 to 8.00 D
Mean central Keratometry <53.00 Diopter
No corneal scarring
Corneal pachymetry>400 microns
3Nearsightedness, induced astigmatism, or both from 8.00 to 10.00 D
Mean central Keratometry >53.00 Diopter
No scarring
Corneal Pachymetry 300 – 400 microns
4Unable to refract to improve vision
Mean central Keratometrys >55.00 Diopter
Central corneal scarring
Corneal Pachymetry < 200 microns

Corneal Scarring Grading for Keratoconus (CLEK)

GradeDescriptors for Overall Scarring
1.0Slight but not in center of vision, total area is less than 1.5 mm
2.0Approaching center of vision and more apparent, total area is 1.5 to 2.5mm
3.0In center of vision, dense but translucent, total area is 2.5 mm or more
4.0Dense opaque in center and affecting vision, total area is 2.5 mm or more

BEST Keratoconus Surgeon

Reasons Dr. Khanna is the BEST Keratoconus Surgeon

Passioniate & Caring

Corneal cross linking, cornea transplant and Intacs are FDA approved and are manufactured by Addition Technology, which is in Illinois. They require every surgeon to undergo a didactic training program where a lab is available to practice surgery on non human eyes. Proctoring is essential on the first human cases. Similarly, a trained CXL expert can only impart knowledge to an eye doctor wanting to perform corneal cross linking. Rajesh Khanna, MD is an expert on the only FDA approved Avedro corneal collagen cross linking with Photrexa/KXL system.

Experience & Skill in Management of Keratoconus

The surgeon you will entrust your vision to should have performed numerous surgical treatments of Keratoconus. Evidence of this would be in YouTube video testimonials, written testimonials and online reviews from previous Keratoconus patients. Dr. Khanna has been performing eye surgery for over two decades. As a Keratoconus expert he has helped hundreds of Keratoconus patients achieve better vision and return to active lifestyle.

Knowledge of Research of Keratoconus Eye Disease

An expert in Keratoconus must be up to date with the latest clinical and laboratory research in the subject of Keratoconus. Around the world, people are researching causes and treatment of Keratoconus. One procedure cannot fix all, therefore, rather than only focusing on, or inventing one type of treatment, experts need to be aware of various newer approaches. They must follow the research so that you can save your time and rely on them. The expert has to use their judgment to see which of the newer modalities will turn out to be the best. In the United States, it’s important to work with FDA. Non FDA approaches are not considered to be the right tactic. As will be evident from this website, the apps on Keratoconus and the book on Keratoconus, available on Amazon, Keratoconus Doctor Rajesh Khanna is aware of the latest research and incorporates that research on Keratoconus which emanates from around the world.

Keratoconus Expert serving Los Angeles, Beverly Hills, Westlake Village, Thousand Oaks, Ventura and surrounding areas.

A recognized Los Angeles Keratoconus Expert, and master in the field of corneal cross linking, Rajesh Khanna, MD is available to help you attain better vision and halt the progression of your Keratoconus eye disease. Labeled an expert in Keratoconus, he is passionate to restore an active lifestyle for you.



Keratoconus Doctor

How to choose a Keratoconus Doctor?

Cornea Trained

The Keratoconus doctor should have finished training in an accredited Ophthalmology program. This is basic eye surgery education. Following this, the doctor should have undergone further learning management of corneal diseases. As you may recall, the cornea is the clear, front part of eye. It is also the portion affected by Keratoconus disease. It is necessary the doctor has mastered surgery of this part of eye. Rajesh Khanna, MD is trained in corneal surgery from the University of Cincinnati.

Certification In Keratoconus Procedures

A Keratoconus surgeon has to learn about newer treatment modalities of Keratoconus. They should be trained and certified in Intacs corneal ring segments and they should be experienced in Corneal Collagen Cross Linking procedure. DALK and laser corneal transplantation require special skills too. Dr Khanna performs these cutting edge treatments.

Skillful Surgeon with Steady Hands

No tremors in the hands, eyes like an eagle and heart like a lion. Don’t hesitate to ask the surgeon to show you his hands. We were tempted to put a video of the Keratoconus doctors hands, but it would appear like a still picture.

Compassionate

Keratoconus disease has its onset in the teen years. It is sad to see kids and young adults suffer from this ailment. The doctor needs to be compassionate and help the patient sincerely. We love and care for patients of Keratoconus.

Keratoconus Expert

The doctor should be an expert in the management of Keratoconus and should understand the pathology of Keratoconus. Importance of family history, genetic associations, environmental factors and the natural progression of the disease should be clear to the doctor. Dr. Khanna has been treating patients with Keratoconus for over two decades.

Multiple Surgical Options

The doctor should be able to offer the above mentioned procedures to patients suffering from Keratoconus so the best option for the person can be chosen. Keratoconus doctors at our center offer the latest surgical options.





Board Certified by American Board of Ophthalmology

This implies that peers have vetted the doctor in the field of Ophthalmology, or study of eyes. Dr. Khanna is certified by ABO.

University Affiliation

Universities check the credentials of all doctors working for them. This allows you to choose someone trusted. Rajesh Khanna, MD is a voluntary clinical instructor at UCLA.



Insurance

Medical Insurance Coverage for CXL, Intacs, DALK,Cornea Transplant

Will my insurance cover crosslinking?

Medical insurances are covering FDA approved Avedro technology at Certified Keratoconus centers. Dr. Khanna, at Khanna Vision Institute, is a Certified Keratoconus and cross linking surgeon with a vast experience of nearly a decade performing cross linking. We have successfully billed and received payment from various medical insurance companies. Some of these PPO insurance companies we have worked successfully with are:

  1. Aetna
  2. Blue Cross
  3. Blue Shield
  4. United Healthcare
  5. LA healthcare

It is best for you to send us your insurance card to find out if any deductibles or copays are involved.

We do not accept HMO insurances. Vision insurances like VSP, Eyemed, Spectera and Davis do not cover cross linking, nor does Medi-cal.

Why come to Khanna Vision Institute?

In addition to the excellent service you will receive, the relationship we have with ARCH and Dr. Khanna’s many years of experience of treating Keratoconus eye disease, you will have the team at Khanna Vision Institute ready to help you if the insurance denies you. We have successfully disputed patient qualifications with the medial directors in the patient’s defense to allow coverage for treatment.

What is the process?

It’s as easy as showing up! Khanna Vision Institute has partnered with ARCH to ensure you don’t have to lift a finger.

  1. We will review your insurance information to determine any copays/deductibles.
  2. We will complete a detailed exam and corneal mapping to document increasing curvature or thinning to ensure qualification for insurance criteria.
  3. After submission to ARCH (an independent company that we work with to ensure insurance due diligence) of these tests and any previous physician notes, ARCH then contacts the insurance company to expedite the precertification.
  4. Dr. Khanna will answer all your questions and put any fears at ease, followed by a small amount of paperwork, then it’s Cross Linking Time! You will be on your way to a quick and painless recovery in no time.

Can I qualify for cross linking if I have had Lasik before?

People may think that because Lasik was paid by cash, the complication of Keratoconus in Lasik patients, known as post Lasik ectasia, may not be covered. It is still considered Keratoconus and the same process applies for precertification.


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