May 29, 2026 · 41 min · 10 segments
Neda Shamie, MD, and Neda Nikpoor, MD, are joined by Eva Kim, MD, for a practical conversation on vision correction in patients with keratoconus and postrefractive ectasia. They discuss the evolving…
Eva KimGuest
Neda NikpoorHost
Neda ShamieHost
So touch on Epiixa, what your thoughts are on that, and then let's dive into how do you correct vision for these keratoconic eyes that have been stabilized using collagen cross-linking.
So we, um, have yet to officially start Epiixa, um, epithelium on, um, cross-linking.
Um, we probably perform about anywhere from five to 10 cross-linking procedures every week, um, kind of spread between myself and two other cornea specialists, but I would say that's the average.
And so we're, we're fairly busy, um, as a group, and probably of our four regions, we do, all of our regions do perform cross-linking, but we might be the, the busiest.
And, um, I'm, I'm excited about Epiixa because anything that's going to make it easier for our patients, I'm all for it.
Um, and I am eager to hear from a colleague who is in my city who has already started Epiixa.... frankly how reimbursement is going for, for him.
Uh, not that that's the primary reason in any way that we do it, but I'm just curious about that part, and so to be continued.
I'm wondering if you guys have heard about how that's going for colleagues of yours in your cities, or is it too early to say?
Um, several of us is, are, have already ordered and/or received our units, but we haven't actually gotten any payers to cover anything yet.
But I think Glaucus has done a really good job of getting ahead of it, and they've, you know, like their head of medical affairs, she's been, you know, meeting with all the insurance companies, and I think they've been doing a really good job of trying to explain the logic to both doctors and payers.
And even at the level of explaining it to our staff and to referring doctors, I think it's, you know, there's always sticker shock when the price is 10 time, 20 times what it was with Epi off when we're talking about a drug.
But, you know, I think it is controversial and people have mixed opinions about it, but I think it's, it makes sense that their logic is that they really are trying to find all the patients that have gone without treatment, and, you know, they're really tackling it from every front.
Like, they're creating a handheld topographer that's gonna make it easier for pediatricians, optometrists, everybody who can't necessarily invest in an actual topographer, tomographer, you know, just trying to find patients, do peer-to-peer education, do direct-to-consumer education, doing all of the things like having a patient access program.
I think they've been really, you know, thoughtful in how they're approaching it, so I'm hoping that all the f- legwork they've done on the front end is also gonna make it easier for patients to get coverage.
Um, but so I'm interested to hear, it sounds like you've been doing cross-linking for a long time, just like I have, and, um, you know, the percentage of patients who have keratoconus who can afford a vision correction procedure is limited, but having done so many cross-linking over the years, I'm sure you have experience where, okay, now let's say a patient's stabilized.
At what point do you consider them stable? Is it a year? Is it two years? And then what's your preferred way of treating their vision? I know what my preference is, but I'm curious to hear what you think as the expert.
I've been cross-linking for, I would say, almost the entire 20 years of my practice.
Um, I think part of that is that, yes, I definitely see keratoconics, you know, young, young men, you know, late teens, early 20s, who have keratoconus.
So touch on Epiixa, what your thoughts are on that, and then let's dive into how do you correct vision for these keratoconic eyes that have been stabilized using collagen cross-linking.
So we, um, have yet to officially start Epiixa, um, epithelium on, um, cross-linking.
Um, we probably perform about anywhere from five to 10 cross-linking procedures every week, um, kind of spread between myself and two other cornea specialists, but I would say that's the average.
And so we're, we're fairly busy, um, as a group, and probably of our four regions, we do, all of our regions do perform cross-linking, but we might be the, the busiest.
And, um, I'm, I'm excited about Epiixa because anything that's going to make it easier for our patients, I'm all for it.
Um, and I am eager to hear from a colleague who is in my city who has already started Epiixa.... frankly how reimbursement is going for, for him.
Uh, not that that's the primary reason in any way that we do it, but I'm just curious about that part, and so to be continued.
I'm wondering if you guys have heard about how that's going for colleagues of yours in your cities, or is it too early to say?
Um, several of us is, are, have already ordered and/or received our units, but we haven't actually gotten any payers to cover anything yet.
But I think Glaucus has done a really good job of getting ahead of it, and they've, you know, like their head of medical affairs, she's been, you know, meeting with all the insurance companies, and I think they've been doing a really good job of trying to explain the logic to both doctors and payers.
And even at the level of explaining it to our staff and to referring doctors, I think it's, you know, there's always sticker shock when the price is 10 time, 20 times what it was with Epi off when we're talking about a drug.
But, you know, I think it is controversial and people have mixed opinions about it, but I think it's, it makes sense that their logic is that they really are trying to find all the patients that have gone without treatment, and, you know, they're really tackling it from every front.
Like, they're creating a handheld topographer that's gonna make it easier for pediatricians, optometrists, everybody who can't necessarily invest in an actual topographer, tomographer, you know, just trying to find patients, do peer-to-peer education, do direct-to-consumer education, doing all of the things like having a patient access program.
I think they've been really, you know, thoughtful in how they're approaching it, so I'm hoping that all the f- legwork they've done on the front end is also gonna make it easier for patients to get coverage.
Um, but so I'm interested to hear, it sounds like you've been doing cross-linking for a long time, just like I have, and, um, you know, the percentage of patients who have keratoconus who can afford a vision correction procedure is limited, but having done so many cross-linking over the years, I'm sure you have experience where, okay, now let's say a patient's stabilized.
At what point do you consider them stable? Is it a year? Is it two years? And then what's your preferred way of treating their vision? I know what my preference is, but I'm curious to hear what you think as the expert.
I've been cross-linking for, I would say, almost the entire 20 years of my practice.
Um, I think part of that is that, yes, I definitely see keratoconics, you know, young, young men, you know, late teens, early 20s, who have keratoconus.
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