Corneal Cross-linking: (for Keratoconus)

How does corneal collagen crosslinking work?

Specifically, when the prepared cornea is exposed to a controlled amount of UVA light, covalent bonds (known as crosslinks) form between collagen fibers within the cornea, making them thicker and up to 300% stronger.

By making the corneal collagen fibers more robust and healthier, the cornea becomes stronger and more stable, and thus more resistant to progressive stretching (keratoconus). Long-term studies have shown that, once stimulated, the crosslinking process between collagen fibrils can continue for up to six months. This is good news because the crosslinking procedure not only makes the cornea resistant to future warping but also can actually help address existing corneal bulging and/or astigmatism. 

What does Corneal Crosslinking treat? Am I a candidate for CXL?

If you have been diagnosed with any of the following conditions, you may be a candidate for corneal crosslinking:

• Keratoconus
• Corneal ectasia (forward bulging and thinning of the cornea)   
• Pellucid marginal degeneration
•  Corneal Warpage
•  Irregular Astigmatism
•  Corneal infections with failure to heal

Corneal collagen crosslinking has been most effective on patients experiencing fluctuating vision due to misshapen corneas. This procedure is most successful if it can be performed before the cornea has become too irregularly shaped and significant vision loss has occurred. When performed early, a corneal cross-linking procedure can stabilize and even improve the shape of the cornea, improving patients’ visual acuity and contact lens tolerance.

Occasionally, patients with unstable corneas following prior radial keratotomy (RK) procedures may benefit from corneal crosslinking.

What is keratoconus?

Keratoconus is a degenerative eye disease that affects the cornea, the outermost layer on the surface of your eye responsible for focusing light toward the back of your eye to enable clear vision. In keratoconus patients, the cornea becomes thin and weak and then bulges outward. This causes incoming light rays to bounce in many directions, causing distorted vision. Progressive keratoconus can result in vision problems that may eventually lead to vision loss or require a corneal transplant.

Is there more than one kind of corneal crosslinking treatment? 

There are two basic types of corneal crosslinking treatments. The most common and only version suitable for more advanced cases is known as “epithelium-off” cross-linking and involves removing the thin outer corneal layer (the epithelium) in order to assure significant absorption of the liquid riboflavin deep into the corneal tissue. 

The second type of crosslinking treatment is known as “epithelium-on”, or transepithelial crosslinking, which leaves the corneal epithelium intact. While this approach is not as effective for more advanced cases, it is associated with faster recovery.

What to expect during and after corneal crosslinking?

Once you have undergone an eye exam to assess your vision and general health, your eye doctor will measure your corneal thickness to determine that you’re an appropriate candidate for crosslinking. You will undergo a special imaging study, called a corneal topography scan, to create a finely detailed map of the surface of your cornea. 

You’ll be settled into a comfortable reclining position in the treatment chair and, after your surgeon administers numbing eye drops, the thin outer epithelial layer of your cornea may be gently removed (“epi off” approach). Riboflavin (Vitamin B) drops will then be applied since they are now able to penetrate deeply into the corneal tissue.

Next, a UV light will be applied to your eye for up to 30 minutes. After the light therapy is complete, a medicated thin contact lens may be placed on your eye to promote healing and reduce post-procedure discomfort. You will be prescribed antibiotic and anti-inflammatory eye drops for home use following your treatment.

Most patients’ corneas will remain stable and the progression of their corneal warping will be slowed or arrested. What’s more, many patients experience improvement of their corneal shape and astigmatism and thus, better visual acuity. 

Is corneal crosslinking covered by my insurance?

Corneal collagen crosslinking has now become more widely performed in ophthalmology for the treatment of progressive keratoconus, with most insurances now covering the procedure (Medicare currently serving as an exception). 

Your doctor’s office can assist you in determining if your insurance plan covers corneal crosslinking costs and whether you will be responsible for any out-of-pocket expenses. 

If I do not have insurance, what does corneal crosslinking cost?

If your insurance plan does not cover corneal crosslinking (or you are without insurance), corneal cross-linking can cost between $2,500 to $4,000 per eye.  

Why choose Assil Gaur Eye Institute for corneal crosslinking?

The team of ophthalmologists at AGEI includes experts in corneal disease management. Dr. Assil's leadership in the field of corneal transplantation surgery began decades ago while he was serving on the university faculty in St. Louis, in one of the largest corneal transplant practices in the United States. 

Dr. Assil and his team have performed thousands of corneal transplants and are nationally recognized leaders in the field. They have also performed over 100,000 vision corrective surgeries and can thus expertly determine your best options. At AGEI, you will experience a state-of-the-art health care facility that brings together revolutionary technologies with experienced vision care professionals. Our goal is to help you achieve your personal best vision. 

Please call 866-945-2745 or visit us here to make an appointment online with one of our specialists. 

We are conveniently located near just about everyone in Southern California and the Los Angeles area. Our team of ophthalmologists sees patients at our offices in Beverly Hills and Santa Monica. We’re are easily accessible to those in West Los Angeles, West Hollywood, Pacific Palisades, Marina del Rey, Playa del Rey, Westchester, Malibu, Downtown Los Angeles, Silverlake, Encino, Sherman Oaks, and the entire San Fernando Valley, to name a few. 

At AGEI we take our patients’ safety seriously. That’s why our facility’s Covid-19 patient safety procedures exceed all CDC recommendations