Collagen Corneal Crosslinking: What Your Patients Can Expect

Christopher J. Rapuano, MD


August 21, 2017

Editorial Collaboration

Medscape &

Hi. I'm Dr Christopher Rapuano, chief of the Cornea Service at Wills Eye Hospital in Philadelphia, where I'm coming to you from the Alumni Society Newsroom. I'd like to give a brief update on collagen corneal crosslinking (CXL) and its current use in the United States.

Keratoconus is a fairly common condition in which the cornea (the clear covering of the eye) gets abnormally thin and pointy, thereby causing irregular astigmatism and affecting vision. Keratoconus sometimes runs in families, but one of the main predisposing factors is eye rubbing. The onset of keratoconus tends to occur between the ages of 10 and 25, gets progressively worse up until the age of 35-45, and then stabilizes.

Until recently, we did not have any treatment options to slow down or stop the progression of keratoconus.

CXL is a procedure that was developed in Europe about 15 years ago, became widely used there around 10 years ago and in other parts of the world 5 years ago, and was eventually FDA approved in the United States in 2016.

Many different CXL techniques are used both here and around the world. The FDA-approved technique involves removing the surface layer of the cornea (referred to as the epithelium-off technique), placing riboflavin drops in the eye for between 30 and 45 minutes, making sure that the cornea is thick enough, and if so, then applying ultraviolet light onto the cornea for 30 minutes.

This procedure does not hurt at all, but it is fairly uncomfortable for the first few days after surgery. Patients' vision can be minimally to very blurry for the next few weeks and then tends to go back to baseline after 2-3 months. There's an approximately 95% success rate of slowing down or ideally stopping the progression of keratoconus. There's about a 1% risk for poor healing, infection, scarring, and worsening vision.

The best patients to consider for CXL are those with worsening keratoconus, as this treatment ideally stops the condition from getting worse but does not always make it get better.

[For patients,] if you think your keratoconus is getting worse or are concerned about it, please see an eye doctor. They can perform initial measurements of the corneal curvature, which can then be repeated every 4, 6, to 12 months to see if there is progression—and if so, then CXL could be considered.

I hope this has been good information for you.

I'm Christopher Rapuano from the Cornea Service at Wills Eye Hospital. Thank you.