Corneal Collagen Cross-Linking
A revolutionary procedure to strengthen the cornea
What is Collagen Cross-Linking?
Corneal Collagen Cross-Linking (CXL) is a procedure designed to strengthen the cornea. Corneal Crosslinking with Riboflavin is an established treatment for keratoconus, pellucid marginal degeneration, corneal ectasia, and other corneal conditions. For patients with keratoconus, this can be a life-changing procedure and can halt the progression of keratoconus. Your ophthalmologist uses a UV light and eye drops containing a specially-compounded Riboflavin solution (Vitamin B2) to strengthen the cornea by creating cross-links between the collagen fibers in the cornea. This process stiffens and strengthens the cornea, and can prevent the cornea from bulging further. Most ophthalmologists recommended getting this procedure for mild keratoconus in order to prevent it from getting worse.
Your ophthalmologist uses a UV light and eye drops containing a specially-compounded Riboflavin solution (Vitamin B2) to strengthen the cornea.
The goal of CXL is to prevent the cornea from becoming thinner, weaker, and more irregularly shaped. However, CXL cannot reverse the damage that has already been done; the goal of this procedure is to prevent your vision from getting worse. Some patients may have a small improvement in vision. However, you may still need to wear glasses or contact lenses.
If glasses or contact lenses aren’t effective at improving your vision, additional surgery, such as a corneal transplant, may be required.
What is the difference between Epi-On vs Epi-Off Cross-Linking?
“Epi-On” Cross-Linking
or “Epithelium-On” cross-linking, is the preferred technique used in Europe. A special surgical sponge is used to roughen up the surface of the eye to allow for better penetration of the riboflavin solution, without removing or killing the epithelial cells on the corneal surface. Riboflavin and UV light are then applied to the surface of the eye for the cross-linking procedure. This allows for a faster, less painful recovery after the procedure, without any difference in therapeutic efficacy.
“Epi-Off” Cross-Linking
or “Epithelium-Off” cross-linking is the variation of the technique approved by the FDA for use in the United States. This is mostly historical, as the original clinical trials done in the United States were performed using this older technique. Therapeutic efficacy of both techniques is the same. During “Epi-off” cross-linking, an alcohol solution is used to loosen up surface epithelial cells on the cornea. A special surgical brush is then use to remove the cells. Riboflavin and UV light are then applied to the surface of the eye for the cross-linking procedure. A bandage contact lens is then placed over the eye. Recovery is usually a little longer from this variant of the technique, as new epithelial cells need to regrow over the corneal surface.
Dr. Jimmy Hu offers both “Epi-On” and “Epi-Off” Cross-Linking for treatment of keratoconus and corneal ectasias. At your consultation, Dr. Hu will discuss with you which variant of the procedure is best suited towards your needs.
What should I expect from the Cross-Linking Procedure?
This procedure is usually done one eye at a time. A bandage contact lens is placed over the eye, and the eye may feel scratchy and sensitive to light for a few days.
The recovery time is about three to five days. With “Epi-On” cross-linking, pain and recovery as usually a little faster, and less painful. Visual recovery takes about four weeks. Some patients may experience a small improvement in uncorrected visual acuity and a decrease in astigmatism. This may result in a change of prescription for contact lenses/glasses.
When should I have cross-linking performed?
For most patients with keratoconus, as they continue to age, keratoconus is expected to worsen and deteriorate. Vision may also deteriorate. Cross-linking is generally recommended for patients with early, and mild-moderate keratoconus in order to halt progression, and preserve vision. The primary goal, is to prevent keratoconus from getting worse, so that it never gets severe enough to require a corneal transplant.
In general, cross-linking only needs to be performed once, and its effects last for a lifetime.
What is the cost of Corneal Cross-Linking? Does Insurance Cover Corneal Cross-Linking?
The cost of Corneal Cross-Linking (CXL) may vary. At present, corneal cross-linking is a relatively new medical procedure in the United States. As such, many insurance plans do not cover the cost of the procedure. The cost of the procedure can vary between medical offices, insurance networks, and geographical locations. Without insurance coverage, the cost of “Epi-off” cross-linking with the Avedro unit may cost around $6000+ per eye. Some medical offices will offer Corneal Cross-Linking using the European Avedro unit, and charge a price that is usually cheaper, around $3000 per eye. In general, the few American health insurances that cover Corneal Cross-Linking will only cover the “epi-off” variant of the technique using the FDA-approved Avedro CXL unit. The co-pay for may range between less than a hundred to a few thousand dollars.
As this is often a medically necessary procedure, your ophthalmologist will work with you to find an affordable solution for the corneal cross-linking procedure.
An eye exam is the best way to screen for, and evaluate any eye conditions affecting your health, comfort, and quality of vision.