Evaluation of neuroplasticity of pain pathways and corneal afferent nerve regeneration following corneal crosslinking (CXL) in keratoconus patients using fMRI and corneal In Vivo Confocal Microscopy (IVCM).

Our long-term goal is to evaluate the transition from acute to chronic pain that sometimes occurs following CXL in keratoconus patients. This study will determine whether these changes can be structurally and functionally quantified using functional neuroimaging and in vivo corneal microscopy (IVCM), and whether they can be predicted based on predisposing biological and psychological factors. Our central hypothesis is that CXL produces acute pain through activation of trigeminal afferents, and that post-operative chronic pain outcomes are related to neuroplastic changes in trigeminal circuitry, corneal afferent regeneration, and psychological factors.

Inclusion Criteria:

CXL Group

• Age 8-35 years
• Clinical diagnosis of keratoconus and seeking CXL treatment
• English speaking ability sufficient to comprehend consent with parental assistance
• MRI compatible
• Ability to lie still for an MRI session (60 minutes)

Control Group

• Age 8-35 years
• No diagnosis of keratoconus
• English speaking ability sufficient to comprehend consent with parental assistance
• MRI compatible
• Ability to lie still for an MRI session (60 minutes)

Exclusion Criteria (Both Groups):

• Claustrophobic
• Weight > 285 lbs (weight limit of the MRI table)
• Significant medical history, including:

Current DSM-IV-TR axis I psychiatric disorders. Chronic pain Significant head injury Seizures Brain tumor Cerebrovascular accident Neurological disease aside from migraine HIV-AIDs Prescription medication strongly implicated in causing dry eyes

• Magnetic implants or metal-containing tattoos on their chest or above
• Pregnancy
• History of contact lens wear
• Any allergic response to a numbing eyedrop in the past

The population under study are patients with keratoconus who are undergoing a corneal cross-linking (CXL) procedure. Keratoconus is an eye condition where the cornea progressively develops abnormally into a cone shape, which can lead to distorted vision and irreversible vision loss The CXL procedure is designed to restore and maintain the shape of the cornea to avoid these complications.

All IPD that underlie results in a publication

Starting 6 months after publication, until 5 years after.

Direct request to study personnel via email, letter, phone, or in-person communication. Information will be shared with requesting parties for the purposes of expanding on this research or re-analysis. Neuroimaging data and corneal microscopy data will be shared via secure digital electronic transfer.