Latest Advances in Keratoconus Treatment: Spotlight on PACE

Keratoconus is a progressive eye condition that affects the cornea, causing it to thin, bulge, and become irregularly shaped. This distortion can lead to blurred vision and significant visual impairment if not managed effectively. At our specialized ophthalmology practice in Hurlingham, we focus on anterior eye disorders, including keratoconus, and are excited to share insights on the newest treatment making waves in the field: PACE (Phototherapeutic Keratectomy-Assisted Customized Epi-on Corneal Cross-Linking).

Understanding Keratoconus and Its Challenges

Keratoconus typically begins in adolescence or early adulthood and gradually worsens over time. This can result in irregular astigmatism and myopia, causing blurred or distorted vision.

Traditional management often starts conservatively with glasses or contact lenses. For progressive cases, corneal collagen cross-linking (CXL) has been a groundbreaking intervention, strengthening corneal tissue to halt disease progression. However, the original “Dresden protocol” involves removing the outer corneal surface (epithelium), which can cause discomfort and prolong healing.

What is PACE?

PACE is an innovative advancement developed by experts at the ELZA Institute that refines traditional cross-linking. Unlike the conventional “epi-off” approach, PACE uses customized epithelial removal guided by precise corneal mapping with an excimer laser (phototherapeutic keratectomy, or PTK).

This map-driven technique allows selective removal of the epithelium only over the cone area, leaving surrounding tissue intact. The result is a less invasive, faster, and more comfortable procedure.

PACE is an epi-on cross-linking procedure, where enhanced riboflavin drops penetrate the cornea efficiently. Customized UV light is applied to the steepest part of the cornea, maximizing flattening and regularization of its shape.

Benefits of PACE Treatment

• Disease Stabilization: Strengthens the cornea and halts progression of keratoconus.

• Improved Vision: Enhances corneal regularity, improving visual acuity and quality.

• Tissue Preservation: Minimizes stromal tissue removal, supporting long-term corneal health.

• Patient Comfort and Safety: Partial epithelial removal and advanced riboflavin penetration reduce discomfort and infection risk, allowing faster recovery.

• Precision and Personalization: Epithelial mapping and excimer laser technology ensure the treatment is tailored to each patient’s cornea.

How Does PACE Compare to Traditional Treatments?

Traditional cross-linking is effective but can be uncomfortable due to full epithelial removal and long UV exposure times. Other treatments combining laser ablation with cross-linking remove more corneal tissue and carry additional risks.

PACE offers a customized, tissue-sparing solution with shorter procedure time, less discomfort, and enhanced visual outcomes. It represents a shift toward personalized keratoconus care, balancing safety, comfort, and efficacy.

What to Expect During the Procedure

1. Diagnostic Mapping: Advanced imaging maps epithelial thickness and corneal shape to guide treatment.

2. Laser-Assisted Epithelial Removal: Excimer laser selectively removes the epithelium over the cone apex.

3. Riboflavin Application: Specialized drops enhance penetration for effective cross-linking.

4. UV Light Cross-Linking: UV light strengthens collagen fibers in the targeted area.

5. Post-Treatment Care: Recovery involves minimal discomfort, with follow-up to monitor healing and corneal stability.

Who Is a Candidate for PACE?

PACE is ideal for patients with progressive keratoconus, especially those seeking a procedure that halts disease progression while optimizing vision. Patients with thinner corneas or sensitivity to traditional epi-off cross-linking may particularly benefit from this less invasive approach.

The Future of Keratoconus Treatment

PACE demonstrates how innovation is improving outcomes for keratoconus patients. Ongoing research and clinical trials continue to refine these techniques, aiming for even greater precision, safety, and effectiveness. At Dr. Deist's practice, we stay at the forefront of these advancements to offer patients world-class, individualized care.

If you or a loved one are experiencing visual changes suggestive of keratoconus or want to learn more about treatments like PACE, contact us today to schedule a comprehensive evaluation. Early intervention is key to preserving vision and quality of life.

If you are interested or would like to find out more, please drop us a message or contact us on 011 217 7520.