Overall, cross-linking is both safe and effective. Multiple multicenter clinical trials have demonstrated that cross-linking is both safe and effective for keratoconus, as well as corneal ectasia after refractive surgery.

The primary goal of cross-linking is to halt progression of keratoconus and corneal ectasia, and prevent your vision from getting worse. In some cases, the keratometry, or steepness of the cornea, may decrease, which can result in slight improvement in vision.

Transepithelial cross-linking, sometimes known as epithelium-on cross-linking, or simply epi-on cross linking, is a variation Of the technique and treatment protocol used in corneal cross-linking. The standard, or conventional treatment protocol involves scraping and removing the surface layer of skin cells on top of the cornea; the epithelium. This is painful, leads to a longer recovery time, and puts the patient at risk for infection, scarring, and decreased vision.

Transepithelial cross-linking involves using a stronger UV light to penetrate the cornea, without removing the surface epithelium. In doing so, the patient has a fast recovery time, less pain, as well as less risk for infection, scarring, or decrease vision. However, as this is a newer protocol, it has not reached FDA approval as of yet. Our doctors offer both conventional, epithelium-on cross-linking, as well as the newer transepithelial cross-linking.

Research studies show that both protocols are safe and effective for halting the progression of keratoconus.

Health insurance coverage for corneal collagen cross-linking may vary. At present, only a handful of insurance plans will cover the cost, and especially for those with a high-deductible insurance plan, the co-pay may be expensive (~$3000).

Please note, at present health insurance only covers epithelium-off cross-linking.

In general, recovery time is much faster with trans-epithelial cross-linking. Because no epithelium is scraped and removed off the surface of the eye, there no wound that needs to heal afterwards. A patient typically experiences less postoperative pain, and is able to resume exercise and work duties much faster.

With transepithelial cross-linking, most patients are able to go back to work in 1-2 days; they may have mild pain, irritation, light sensitivity, and a foreign body sensation for a week.

With epithelium-off cross-linking, most patients are out of work for about 4 to 6 days, and will have notable pain, irritation, and light sensitivity for week In the operated eye. Many patients are able to resume daily tasks the following day, though because of the pain and light sensitivity, many find that it is easier to wear an eye patch over the eye during the first week.