Norfolk and Waveney CCGs will fund Corneal Collagen Cross Linking for Keratoconus on a restricted basis and where there is documented evidence of the following criteria:

Referral guidelines:

Ensure that patients have Pentacam scans and refraction with contact lenses out for a minimum of 2 weeks (RGP) and 1 week (soft).

Inclusion criteria for patients to be treated: (1 or more)

1. Confirmed progression (based on current understanding of Pentacam measurement repeatability limits).

    

2. High risk of progression (1 or more)

• Age < 18 years
• Age 19-30 years (incl.) AND Minimum thickness < 400 μm
• Age 19-30 years (incl.) AND Hydrops/graft fellow eye

   

3. History of progression in referral letter based on serial topography or loss of corrected vision – documentation incomplete AND age < 30 years

    

4. Previous LASIK with ectasia

    

NB. Patients who are unable to come out of contact lenses prior to Pentacam scanning (and therefore ineligible for f/u in EKC) may be offered CXL on pooled list if they are considered at risk of progression (i.e. age<35 years) with continued f/u in Contact lens clinic.

Exclusion criteria

• Active surface disease
• Minimum corneal thickness <375 μm
• Age < 16 years
• Cognitive impairment

Retreatment criteria:

Treatment failure should be considered no earlier than 12 months post-CXL using the same keratometric indices of progression (Kmax, K2, K1). Pachymetry is not a useful indicator of progression post-CXL since corneal thickness measurements may decrease and/or increase up to 24 months after treatment.

Cases for Individual Consideration

On a case to case basis, patients might be eligible for surgical intervention, in consideration of their exceptionality. The requesting clinician must provide information to support the case for being considered an exception, by submitting an individual funding request.