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CXL in Pediatric Patients With Keratoconus

A recent study published in AJO International highlights the safety and efficacy of corneal crosslinking (CXL) in pediatric patients with keratoconus and thin corneas (< 400 µm), offering valuable insights for eye care professionals managing this challenging condition. The study included 18 children (21 eyes), with data pulled from the Save Sight Keratoconus Registry in Australia and New Zealand. All patients who underwent CXL were 18 years of age or younger and had corneas with a thickness of 400 µm or less.

Further breakdown of the patients revealed that 66.7% were male, with a median age of 16 and a median follow-up time of 10 months. The average mean Kmax of the patients changed from 70.5 D to 69.3 D, the steep K changed from 60.5 D to 58.6 D, and the minimal corneal thickness changed from 390 µm to 370.5 µm. Three eyes experienced adverse events, with two developing corneal scarring and one developing microbial keratitis, which required a corneal graft.

The researchers stated, “The stabilization of corneal and visual acuity measurements reported in this study provides clinicians with more evidence to formulate treatment strategies for those patients to prevent the visual deterioration associated with keratoconus progression.” They also added that caution should be displayed as “clinicians should be aware of the significant risks of adverse events that may occur with CXL in this group.”

My Two Cents

Once again, this serves as a reminder of the importance of recommending CXL to your patients as soon as possible. For pediatric patients, this means enrolling them in a practice that uses FDA-approved epithelium-off CXL. When we have patients (especially pediatrics) whose corneas are not 400 µm thick, we may question whether CXL is the best move, but if a pediatric patient is already that far along in their keratoconus journey, it’s easy to assume their likelihood of needing a transplant at some point is high. Thus, a strong recommendation for the procedure is our responsibility as eye care providers. I am of the firm conviction that not recommending your patients to a provider who offers FDA-approved CXL as soon as possible is medical malpractice. Remember: The sooner we get these kids crosslinked, the more vision we preserve!

OUTSIDE THE LANE

Be Aware of NB.1.8.1

A new COVID-19 subvariant, NB.1.8.1, is spreading rapidly across the United States and globally, causing concern among health officials due to its distinctive and painful symptoms. This Omicron descendant, first identified in China in January 2025, has been labeled a "variant under monitoring" by the World Health Organization since May 23, indicating its rapid spread, but has not yet been deemed a significant threat.

The variant’s hallmark symptom is an intensely painful sore throat, described by some patients as feeling like swallowing shards of glass; thus NB.1.8.1 is often referred to as "razor blade throat. However, experts note that similar symptoms can also stem from bacterial infections or allergies. Other reported symptoms include a mild cough, fever, muscle aches, fatigue, nasal congestion, and, in some cases, digestive issues such as nausea or diarrhea. The variant’s rise coincides with increased summer travel and waning immunity, as many individuals are 6 months past their last vaccination or infection, heightening susceptibility.

The CDC recommends that everyone 6 months of age and older receive the 2024 to 2025 COVID-19 vaccine, specifically the Moderna or Pfizer-BioNTech versions, which are expected to remain effective against NB.1.8.1. In California, one of the first US cases was confirmed on April 17, and the variant is now widespread, contributing to a nearly 10% rise in hospital admissions in some regions. Health experts emphasize that while NB.1.8.1 spreads quickly, it typically causes mild to moderate illness (aside from the notably severe sore throat). The public is urged to stay vigilant, maintain vaccinations, and monitor symptoms, as the variant’s transmissibility could further drive case numbers during peak travel seasons.

My Two Cents

This new strain is now the second most common strain in the United States, accounting for approximately 37% of the total COVID-19 cases recorded. Whenever a new strain of COVID is discovered, the potential for panic among the public is always present. This strain appears to be relatively harmless, except for the painful sore throat issue, as noted by the World Health Organization, which stated, “Considering the available evidence, the additional public health risk posed by NB.1.8.1 is evaluated as LOW at the global level.”

As members of the medical community, it is our responsibility to be aware of other significant issues occurring outside of our silo. This could be an essential development and would be a good idea to share with your staff and patients.

CAN YOU RELATE

About 3 years ago, one of my favorite patients came in with a chief complaint I couldn’t help him with. He had bags under his eyes, and he was self-conscious about them. I told him I wasn’t aware of any treatments but promised to look into it. As it turns out, there aren’t many options: invasive cosmetic surgery or a cream called Plexaderm, which promises to visibly reduce under-eye bags and wrinkles.

Fast-forward to his next visit a few weeks later, and my patient was ranting and raving about Plexaderm and its almost immediate effect on his eyes. That said, he didn’t like some of the side effects, including an obvious case of contact dermatitis and a burning sensation in his eyes. I knew the product had potential, but it unfortunately contained ingredients that are against the cosmetic industry standards and are on the Tear Film and Ocular Surface Society’s no-no list.

As I sought to find a suitable alternative, every product I found included many of these harmful ingredients, and I knew I couldn’t in good conscience recommend them to my patients (many of whom have ocular surface disease). This was my call to create my own version of an “eye bag reducer.” Now, nearly 3 years after beginning this endeavor, I’m finally ready to release Eye Derm Eye Bag Reducer (website is in the works) to the public!

If you’re in Minneapolis this week for AOA, stop by booth #842 in Aesthetics Alley, where I’ll be showcasing some of my products, including Eye Derm. You can also sign up to receive samples, when stock allows (that goes for those of you who aren’t going to AOA as well; just reach out to me). In addition to the eye bag reducer, we will also offer other cosmetic products that consist entirely of clean ingredients, plus one device designed to help our patients cosmetically. I’m particularly excited about our under eye patches, which produce an instantly hydrated and healthier under-eye area in 15 minutes.

Aesthetics is a crucial aspect of eye care that needs to be embraced by optometry in today’s profession. We need to own the space—not only pertaining to the eye itself, but also the skin around the eye.