Corneal collagen cross-linking now covered under Medicare

I am pleased to report that many Australians with keratoconus will now benefit from a Medicare rebate for corneal collagen cross-linking (CXL) to help stop or slow down progression of their condition.  The Medicare Benefits Schedule (MBS) Item for CXL came into effect on May 1 this year and the rebate amount for the procedure is $1200.  The introduction of the Medicare item for CXL follows many years of lobbying by RANZCO, the Australian and New Zealand Cornea Society, and the patient support association, Keratoconus Australia.  Note that the MBS item is for CXL as first line treatment for progressive keratoconus only – in other words, progression of the keratoconus has to be clearly shown or documented for the patient to be eligible for the Medicare rebate.


Just to recap, corneal collagen cross-linking treatment of keratoconus is a procedure which is aimed at halting the progression of the keratoconus.  The procedure works by increasing collagen cross-linking, which helps to prevent the cornea from becoming more conical and irregular, as it would normally with progression of the keratoconic condition.  This technique was first developed in Germany about 20 years ago.  During the treatment, riboflavin (vitamin B2) eyedrops are applied to the cornea and then activated by UVA radiation.  CXL has now been shown in many clinical studies to increase the amount of collagen cross-linking in the cornea, thereby resulting in a stronger cornea and helping to stop the progression of keratoconus.


One of the most satisfying aspects of CXL is that, by either stopping or slowing down the progression, it has certainly helped to prevent the need for corneal transplant surgery in many patients with keratoconus.  I have certainly noticed this pleasing trend in our practice, and this decreased incidence of corneal graft surgery for keratoconus over the last few years has also been confirmed by the most recent results of the Australian Corneal Graft Registry (ACGR).