Corneal Cross-Linking (CXL):
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What is Corneal Cross-Linking?

Corneal Cross-Linking (CXL) is a relatively new, non-invasive procedure that has been developed to treat corneal diseases like keratoconus. Keratoconus is a progressive eye condition that causes the cornea to become thin and distorted leading to vision loss.

normal eye drawing
Normal cornea
CXL eye drawing

What is Keratoconus?

The cornea is the outmost clear layer of the eye and acts like a lens. Its shape should be round – similar to the surface of a basketball. Keratoconus results from weakening of the internal collagen bonds within the cornea. This causes the cornea to take on a shape that is more similar to the tip of a football (cone-like). Kerato – means cornea and conus – means cone. Hence, keratoconus is a process that slowly turns the cornea into a cone-like shape. This leads to a significant distortion of vision and if allowed to progress could lead to a need for a corneal transplant.


normal keratoconus vision

Early Keratoconus

early keratoconus vision - slightly blurry letters A

Advanced Keratoconus

advanced keratoconus vision - blurry letter A's

Corneal Cross-Linking is a non-invasive procedure with the goal to strengthen the cornea and prevent it from progressing and becoming more distorted. The procedure can help to stop worsening of the patient’s vision and prevent the need for a corneal transplant.

Dr. Cohen is a cornea specialist and as such is the most qualified surgeon to treat this condition. He was one of the very first surgeons to perform this procedure in New York, before it gained wider acceptance among cornea surgeons.

In this article, we will take a closer look at Corneal Cross-Linking including the reasons for choosing CXL, its benefits, procedure, risks and possible complications, how it can stop worsening of vision, and a comparison to other treatments like LASIK.

Why Should I Choose Corneal Cross-Linking?

If you are suffering from keratoconus, a condition that causes the cornea to become thin and distorted, you will have experienced vision loss and are likely anxious to stop the disease’s progression.

The cornea is the clear outer layer of the eye that helps focus light into the eye. As keratoconus progresses, the cornea becomes more misshapen. It can thin out and bulge, which can cause light to scatter, leading to blurred vision.

The progression of keratoconus can cause acute vision impairment and, in severe cases, even blindness. Corneal Cross-Linking is a procedure that strengthens the cornea and prevents it from becoming more distorted.

CXL has been successful in halting the progression of keratoconus.

Corneal Cross Linking diagram of an eye

How Does Corneal Cross-Linking Work?

CXL is a medical procedure that uses ultraviolet light (UV-A) and Vitamin B2 (riboflavin) to repair and strengthen the eye’s outer layer, the cornea. A Vitamin B2 solution is applied to the cornea which is then exposed to ultraviolet light to trigger a chemical reaction that creates new bonds between the collagen fibers in the cornea.

Before CXL

less crosslinking
Before CXL

After CXL

more crosslinking
Before CXL

This reaction makes the cornea stronger and more stable, and it reduces the risks of further thinning of the cornea while preventing further vision loss.

What Happens During the Corneal Cross-Linking Procedure

The eye is numbed with anaesthetic eye drops to avoid any discomfort and pain.

Then the surface of the cornea is gently roughened to allow for better absorption of the special eye drops used in the procedure. Depending on the specific needs of the patient, Dr. Cohen may choose to leave the epithelial layer intact for increased comfort and faster healing.

Next, the eye is treated with riboflavin (vitamin B2) eye drops, which are absorbed into the cornea.

Following that, ultraviolet light is used to activate the riboflavin, which creates new bonds between the collagen fibers in the cornea.

Dr. Ilan Cohen

Benefits of Corneal Cross-Linking

There are many benefits to CXL, including:

Help stabilize vision – The goal of CXL is to halt the progression of keratoconus, this will help stop the cornea from getting more damaged and thus stabilize vision.

Reduced risk of corneal transplantation – due to the non-invasive nature of CXL and it’s strengthening abilities, it can prevent the need for a corneal transplant, which is a long, painful, and risky procedure.

Strengthening the cornea – CXL helps to stabilize the cornea and prevents it from becoming more misshapen, which can help stop the progression of keratoconus.

Low risk - CXL is a low-risk procedure with a high success rate.

Fast recovery time – as opposed to a corneal transplant.

CXL allows patients to recover within a few days so that they are able to resume their usual activities.

This procedure could be followed by a Topography-Guided PRK to further improve vision.

Long-lasting results - the results of CXL are long-lasting and can often hold the progression of keratoconus and ectasia after LASIK for good.

keratoconus example

Dr. Ilan Cohen Has Performed Over 80,000 Vision Correction Procedures

Dr. Cohen is a fellowship-trained cornea specialist and has devoted his career to fine-tuning and perfecting surgical techniques that can change your vision and your life. This is perhaps the reason that more than 1,000 physicians have chosen him for the correction of their own vision.

How Corneal Cross-Linking Can Stop Progression of Keratoconus

The principle is simple: by strengthening the cornea, CXL can help stop vision from worsening.

The cornea is the clear outer layer of the eye that helps focus light onto the retina. As keratoconus progresses, it thins the clear outer layer of the eye in some areas and bulges in others, which can cause light scatter, leading to blurred vision.
By strengthening the cornea through creating new cross-links between the collagen fibers in the cornea, CXL can prevent it from becoming more misshapen and something help improve vision.

The procedure can also reduce the need for a corneal transplant, which can be a long, painful, and risky procedure.

Could the Vision be Improved After the CXL Procedure?

In short, yes! A procedure called topography-guided PRK can improve vision. The aim of this procedure is to improve vision after the cornea has been stabilized with the CXL procedure, as this procedure is typically done months after the CXL has been performed.

Dr Cohen performing a proceedure

Last Considerations

CXL is a relatively new, non-invasive procedure that is becoming increasingly popular for treating keratoconus. CXL can greatly improve the quality of life for those who suffer from keratoconus. If you are experiencing blurred vision or other symptoms of keratoconus, please contact The Cohen Eye Institute. We are happy to answer your questions and discuss further steps on how we can help you to improve your eyesight.

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