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Corneal Crosslinking

Corneal cross-linking is the surgical procedure which uses UV light to strengthen the collagen within the cornea. The purpose of cross-linking is to stabilize the cornea and prevent progression of thinning. Patients with keratoconus or cornea thinning after refractive (LASIK or PRK) surgery may benefit from cornea cross-linking. Cross-linking is an in-office surgical procedure.

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Corneal Collagen Cross-linking with Riboflavin (CXL) is a treatment for progressive keratoconus. CXL works by increasing collagen cross links which are the natural “anchors” within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular.

During the corneal cross-linking treatment, custom-made riboflavin drops saturate the cornea, which is then activated by ultraviolet light. This process has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea.

Collagen cross-linking is not a cure for keratoconus. The aim of this treatment is to hold progression of keratoconus and thereby prevent further deterioration in vision and the need for corneal transplantation. Glasses or contact lenses will still be needed following the cross-linking treatment but it is hoped that it could limit further deterioration of vision.

This procedure, developed in Germany, has been shown to slow or arrest the progression of keratoconus in published European studies. CXL was approved by the US Food and Drug Administration (FDA) on April 18, 2016. As you may be aware, Dr. Iuorno was a principle investigator in the cross-linking clinical trial and was the first to perform the procedure in Virginia under this FDA-approved study. We are prepared and ready to offer this service to your patients and will be setting up subspecialty-focused clinics to attend to this need for the community.

Cross-Linking Frequently Asked Questions

The ultraviolet light exposure during a cross-linking procedure is comparable to, or even less than, the exposure of the eye to the ultraviolet light in skylight for a full day outdoors in summer. The riboflavin drops are simply vitamin B2, commonly used in foods such as your breakfast cereal.

Thousands of people have had their corneas cross-linked in Europe during the past 13 years. Due to the universal acceptance of the benefits of cross-linking among ophthalmologists, and recent advances in technology, the annual number of cross-linking procedures is expected to increase substantially. Commonwealth Eye Care Associates has been treating cornea ectasia patients with cornea cross linking since September 14, 2012. WEO was the first site in Virginia to offer cross linking to its patients.

Pain in the first 1-2 days, sensitivity to light for several days, haze within the cornea that may cause blurring for up to a few weeks. There are other, more severe and less common, possible complications and side effects Dr. Iuorno can discuss with you. For a more comprehensive list of possible side effects, please see the details of the informed consent.

No. You will be awake for the treatment. You’ll be given relaxing medication and anesthetic drops to numb any sensation or discomfort.

There is some discomfort during immediate recovery but 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 & artificial tears. If pain is severe, oral narcotic medications will be used.

Actual treatment for each eye takes about 20 – 30 minutes but you will be at the office for 1 to 2 hours to allow sufficient time for preparation and recovery before you return to the comfort of your own home.

Individual results vary but most people’s vision returns to pre-operative status and return to driving and work within 1 week. Some degree of cloudiness/ blurriness is expected to last up to one month. Although this procedure is specifically intended to halt the progression of thinning, your astigmatism may reduce as recovery progresses, usually over a 6 & 12 month period after treatment.

Yes, but during the past 13 years a one-time treatment has been shown generally to be enough to treat progression.

Technically yes, but the short term blurring due to the current FDA procedure protocols, this is not possible.

We believe this is the next phase in cornea care for patients with keratoconus or post-refractive ectasia. Insurance coverage based on individual insurance medical policies and qualifications.

Yes. Contact lenses can warp the cornea. It is the goal of cross linking to strengthen the cornea in its natural state. In order to allow for contact lens induced warpage to reduce, patients must come out of CL before the screening visit. Many times, this will require additional visits to achieve stability. Once treated, patients will not be allowed back into contact lenses for one month.

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