Earlier this year, Glaukos commercially launched the first FDA-approved, noninvasive, epithelium-on corneal cross-linking treatment for keratoconus. Epioxa HD/Epioxa is a topical therapy that is catalyzed by enriched oxygen and light, and is designed to reduce the pain associated with corneal epithelium removal, streamline the procedure, and minimize recovery. 

Performed by an ophthalmologist, the procedure consists of Epioxa HD (riboflavin 5’-phosphate ophthalmic solution) 0.239% and Epioxa (riboflavin 5’-phosphate ophthalmic solution) 0.177% prescription eye drops used in combination with the O₂n System and Boost Goggles.

“The procedure itself is not only proven to slow or halt disease progression but is designed to provide a more rapid visual recovery process, lower the risk of postoperative events thanks to the epithelium being kept intact, and ultimately deliver an effective, more comfortable patient experience,” says Cody McKenzie, vice president of global marketing and commercial strategy at Glaukos.

Mr. McKenzie notes that although cross-linking has been FDA-approved for a decade, far too few keratoconus patients are screened, diagnosed, and treated, and he believes Epioxa marks a pivotal moment to improve earlier intervention, expand access, and help preserve patients’ vision outcomes—supplemented by significant patient support programs.

From an optometrist’s perspective, Mitch Ibach, OD, FAAO, at Vance Thompson Vision in Sioux Falls, South Dakota, says Epioxa reduces barriers to early treatment, such as discomfort and blur during a long visual recovery.

“This new epithelium-on procedure has a favorable safety and tolerability profile and faster recovery, meaning that patients can get both eyes treated without long delays,” he explains.

When to Refer Patients

Dr. Ibach also points out that the labeling for Epioxa doesn’t specify “progressive keratoconus”, which, “should make referrals for a corneal evaluation much more straightforward because we don’t have to wait to show a certain amount of progression over time. Being able to refer as soon as there is any suspicion of keratoconus is a win for patients and we should do our part to get them diagnosed and treated as early as possible,” he says.

Dr. Ibach stresses that when there is any suspicion of keratoconus, the first step should be an urgent referral for imaging. “That could be a referral to a cornea practice or to an optometric colleague who has access to topography to diagnose keratoconus,” he explains. “Suspicion of keratoconus should be triggered by high, changing, or oblique astigmatism, especially if accompanied by visual quality complaints; failure to correct to a crisp 20/20 at the phoropter; or keratometry values of at least 47.” These early warning signs are especially important to note in young patients, because keratoconus can worsen very quickly in teens and young adults, he says.

Once diagnosed, Dr. Ibach stresses that patients should be treated immediately with Epioxa to stabilize the cornea to slow or halt keratoconus from worsening and help preserve vision. Then, the patient can return to their optometrist for vision management.

“I am optimistic that with Epioxa we will see far more young patients treated when they are still able to see 20/20 with glasses or soft contact lenses, so they don’t have to be reliant on more complex vision correction options for the rest of their lives,” says Dr. Ibach.

Posttreatment Care After Epioxa

Dr. Ibach points out that posttreatment care should be significantly easier to manage after Epioxa because there is no epithelium removal. “In the clinical trials, for example, there were no serious ocular adverse events,” he explains. “In our practice, we are still using a bandage contact lens after treatment but only for 1 day, compared to 4 to 7 days with epi-off cross-linking.”

Dr. Ibach adds that other postoperative protocols, including topical medications, may continue to evolve as clinicians gain more experience with the new treatment. “I also expect that we will be able to fit most patients in contact lenses sooner after treatment than we typically could with epi-off cross-linking, which will improve the patient experience and speed up treatment of the second eye, as well,” he concludes.OM