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Keratoconus/Corneal Collagen Crosslinking (CXL) Specialist

Cohen Eye Institute

Cataract, Refractive & LASIK Surgeons and Cornea Specialists located in Midtown East of Manhattan, Ridgewood of Queens, & Elmhurst, NY and Old Bridge, NJ

As a top ophthalmologist, Dr. Cohen is committed to offering the most advanced treatment options for his patients in New York City and northern New Jersey, including corneal collagen crosslinking (or CXL) to strengthen corneas in patients with ectasia and keratoconus.

Keratoconus/Corneal Collagen Crosslinking Q & A


Corneal Collagen Crosslinking Offers Best Hope Yet for Keratoconus 

If you suffer the effects of keratoconus or corneal ectasia, you’ve been dealing with increasing vision problems every year. The blurriness and distorted vision caused by this mostly genetic disease can’t be fully corrected with glasses, and soft contact lenses may not fit because of the cone-like shape your cornea has acquired over time.

Until recently, the only remedy was to choose from varying types of contact lenses. All very expensive, and an ongoing process.

But now, corneal collagen crosslinking (CXL) has become recognized in research as the only treatment that can prevent progression of keratoconus and other corneal ectasias, including post-LASIK ectasia.

These conditions result from a progressively thinning cornea, which bulges into a cone shape and away from its natural dome shape.

Treatment Is More Effective When Started Early

If you have a thinning cornea caused by keratoconus or corneal ectasia, don’t wait for years to get it looked at by an expert. The longer you wait, the more restricted your treatment options become. Getting CXL sooner also reduces the chances you may need corneal transplants later in life.

Find out more information about keratoconus and corneal collagen cross linking in the Q&A section below.


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Corneal Collagen Crosslinking Q&A

What is corneal collagen crosslinking?

Collagen crosslinking (sometimes called corneal crosslinking) was developed in 1998 to strengthen the cornea by promoting stronger connections among the collagen fibers contained in the cornea.

CXL saturates the deep layers of the cornea with a combination of vitamin B2 (riboflavin) eye drops and ultraviolet light to help encourage stronger bonding, or crosslinking, among the fibers in patients with keratoconus as well as those who experience post-LASIK ectasia.

Both conditions result in a weakened cornea that bulges outward, causing distorted vision. . Ectasia is the hallmark of the eye disease keratoconus, but it can also occur in people following certain types of refractive surgery, including LASIK. 

How is crosslinking performed? 

The crosslinking procedure can be performed in one of two ways:

· Epithelium-off: In this version, the upper layer of the cornea, called the epithelium, is removed to facilitate absorption of the vitamin B2 eye drops

· Epithelium-on: Here, the epithelium remains, and drops are administered for a longer period of time to ensure sufficient absorption

Removing the epithelium speeds up the rate of absorption of B2. But it also means you need to wear a special contact lens for a few days to protect your cornea while the epithelium regrows. A similar lens is worn by patients having PRK for the same reason.

Essentially, your eye needs a bandage while the cornea heals. 

In contrast, doing collagen crosslinking while keeping the epithelium on means the drops must stay on your eyes longer. But the recovery period is shorter, and there’s less risk of infection and discomfort. There is a risk that the treatment will not be as effective if the riboflavin is not absorbed well.

In either method, once the vitamin B2 has flooded the cornea, the eye is exposed to ultraviolet light for about 30 minutes. Then, if using the epithelial-off method, the special contact lens is placed on the eye as a bandage.

Prior to your collagen crosslinking treatment, Dr. Cohen will perform a thorough evaluation of your eye, including measuring the thickness of your cornea to ensure you’re a good candidate for crosslinking. He will also perform corneal mapping, which determines the overall condition of your cornea.

What happens once the procedure is over?

After your procedure, you may need to wear a bandage to protect your eye from particulates, and you’ll get a prescription for antibiotics and anti-inflammatory eye drops to prevent infection and minimize discomfort.

The entire procedure takes between 60-90 minutes.

You’ll come back in a few days to have the contact lens bandage removed. And you’ll return for several more visits over time so Dr. Cohen can ensure your eye is healing properly, and to evaluate how the shape of the eye is changing.

Am I a good candidate for CXL?

The best candidates for corneal collagen crosslinking are those who get treatment before the cornea has become badly misshapen, or before significant vision loss has occurred. Used early enough, CXL can help stabilize your cornea and in some cases, improve the shape of the cornea so your vision improves.

After CXL - Topography-Guided Photorefractive Keratectomy

In cases where CXL is successful in stabilizing the cornea, vision can sometimes be improved using TG-PRK

TG-PRK t begins with a detailed mapping of your cornea, which serves as a guide while a laser works to reshape your cornea and improve your vision.

The goal of TG-PRK isn’t perfect vision, but to remove some of the distortion caused by corneal ectasias. For many people suffering from keratoconus, just being able to wear glasses is a huge breakthrough. 

Learn more about TG-PRK