Frequently Asked Questions About Corneal Crosslinking

What is keratoconus?

Keratoconus is an eye condition in which the typically round, dome-shaped cornea progressively thins and weakens, causing the development of a cone-like bulge and optical irregularity of the cornea. This can result in significant vision impairment.

What is cross-linking?

Cross-linking is a minimally invasive, FDA approved, outpatient procedure that combines the use of prescription eye drops (Photrexa) and ultra-violet A (UVA) light from the KXL® system for the treatment of progressive keratoconus or post-LASIK ectasia. This treatment stabilizes the cornea to prevent further progression.

What can I expect during the procedure?

• After numbing drops are applied, the epithelium (the thin layer on the surface of the cornea) is gently removed.
• Photrexa Viscous eye drops will be applied to the cornea for at least 30 min.
• Depending on the thickness of your cornea, Photrexa drops may also be required.
• The cornea is then exposed to UV light for 30 minutes while additional Photrexa Viscous drops are applied.
• A bandage contact lens is placed on your eye.

What is ultra-violet A (UVA) light?

UVA is one of the three types of invisible light rays given off by the sun (together with ultra-violet B and ultra-violet C) and is the weakest of the three.

Does corneal cross-linking require removal of the epithelium?

Yes, the FDA approved protocol specifies that the epithelium is removed for the procedure. Your doctor will apply topical anesthesia to numb the eye prior to the removal of the epithelium. This process helps to prepare your eye so that the drug can penetrate the tissue of the cornea to have an effective cross-linking procedure.

Am I awake during the procedure?

Yes, typically you will be awake during the treatment. You may be given a medication to help you relax, and numbing anesthetic drops.

How long does the treatment take?

The actual procedure takes about an hour, but you will be at the office for approximately two hours to allow sufficient time for preparation and recovery before you return to the comfort of your own home.

What can I expect after the procedure?

• You should not rub your eyes for the first five days after the procedure.
• You may notice a sensitivity to light and have a foreign body sensation. You may also experience discomfort in the treated eye and sunglasses may help with light.
• If you experience severe pain in the eye or any sudden decrease in vision, you should contact your doctor.
• If your bandage contact lens from the day of treatment falls out or becomes dislodged, you should not replace it and contact your doctor.

Does it hurt?

There is some discomfort during healing but usually not during the treatment. Immediately following treatment, a bandage contact lens is placed on the surface of the eye to protect the newly treated area. After the numbing drops wear off, there is some discomfort, often described as a gritty, burning sensation managed with Tylenol and artificial tears.

What results can I expect?

In clinical trials, progressive keratoconus patients had corneal flattening of up to 1.4 diopters in Study 1 and 1.7 diopters in Study 2 at 12-months post-procedure, while the control group had steepening of the cornea of up to 0.6 diopters at 12-months. Individual results may vary.

Can anyone tell by my appearance that I have had cross-linking?

No. There is no change in the appearance of your eyes following cross-linking.

Is cross-linking right for me?

Patients who have been diagnosed with progressive keratoconus should ask their doctor whether they may be an appropriate candidate for corneal cross-linking.

Will both eyes be treated on the same day?

If you have progressive keratoconus in both eyes and they both require corneal crosslinking, each eye will be treated on different days. 

Is corneal cross-linking covered by my insurance?

FDA approved cross-linking is widely covered by insurance. For additional information on insurance coverage and to view the latest list of insurers that are known to have policies that cover cross- linking, visit the Insurance Information page on LivingWithKeratoconus.com.

How much does corneal cross-linking cost?

Please contact our practice for specific pricing information.

If you have keratoconus or ectasia following refractive surgery (LASIK), schedule an appointment with our doctors in Glendale or West Covina, California today. Our doctors, Dr. Nicole Fuerst and Dr. David Fuerst are corneal specialists experienced in the treatment of keratoconus and corneal ectasia. Please contact our office with any questions.