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Lasik Doctors


Corneal Crosslinking

Corneal Collagen Crosslinking with Riboflavin (CxL) for keratoconus, ectasia, or unstable RK.

Nonprofit Lasik laser eye surgery patient advocacy with network of evaluated Lasik doctors and detailed laser eye surgery information.
Keratoconus and ectasia create an irregular cornea that can be treated with Intacs inserts and/or CxL.


UVA light is applied in precise amounts using a specialized goggle with LED lights.


Nonprofit Lasik laser eye surgery patient advocacy with network of evaluated Lasik doctors and detailed laser eye surgery information.
The theory behind CxL treatment is that the fibrils of the keratoconus cornea lose their ability to link to each other.


Nonprofit Lasik laser eye surgery patient advocacy with network of evaluated Lasik doctors and detailed laser eye surgery information.
CxL treatment causes more cross-linking of the fibrils, making the cornea stronger.


Nonprofit Lasik laser eye surgery patient advocacy with network of evaluated Lasik doctors and detailed laser eye surgery information.
The image shows a map of an eye with keratoconus. The off-center red and yellow area shows the forward bulging due to keratoconus.


Nonprofit Lasik laser eye surgery patient advocacy with network of evaluated Lasik doctors and detailed laser eye surgery information.
Intacs are tiny plastic rings surgically added to the cornea.


A developing keratoconus and ectasia treatment is Corneal Collagen Crosslinking with Riboflavin (CxL), that has been proven outside of the US to strengthen a weakened corneal structure. CxL is currently in US Food and Drug Administration (FDA) clinical trials. For more information, visit CxL Clinical Trial.

This method works by increasing collagen crosslinking, which are the natural "anchors" within the cornea. These anchors are responsible for preventing the cornea from bulging out and becoming steep and irregular, consequence of advanced keratoconus.

Keratoconus is a disease of the cornea that makes the cornea become weak and may gradually bulge outward. Most often, this bulging is in the lower half of the cornea and first presents as astigmatism, however not all astigmatism is due to keratoconus. In mild or early stages of keratoconus (forme fruste keratoconus), eyeglasses may correct the astigmatic vision.

The 30-minute corneal crosslinking treatment is performed in the doctor's office. During the treatment, custom-made riboflavin eye drops are applied to the cornea, which is then activated by ultraviolet light. This amazingly simple process has been shown in laboratory and clinical studies to increase the amount of collagen cross-linking in the cornea and strengthen the cornea. In published European studies, such treatments were proven safe and effective in patients.

The abnormal curvature of the cornea due to keratoconus changes the cornea’s refractive error producing moderate to severe blurriness of vision. As keratoconus advances, rigid gas-permeable (RGP) contact lenses maybe the only non-surgical way to achieve clear vision. If keratoconus continues to advance, scarring of the central cornea may occur.

Approximately half of keratoconus patients have no negative lifestyle effects beyond corrective lenses. The cornea stabilizes after a few years without ever causing severe vision problems. For others, the only resolution to keratoconus has been PKP, with a long healing period and unpredictable refractive error. Even after corneal transplant PKP, keratoconus can reoccur in the new donor cornea. Fortunately, there are two new methods to treat keratoconus that are much less invasive than a corneal transplant.

An established treatment for keratoconus is Intacs. Intacs are a medical device approved by the FDA for the correction of 1.00 to 3.00 diopters of myopia (nearsighted, shortsighted) and virtually no astigmatism. Intacs inserts are the only refractive surgery procedure that adds structural integrity to the cornea. This unique attribute made Intacs an ideal treatment for keratoconus.

Intacs are clear small semicircular plastic rings of various thickness that are inserted within the cornea at its outer edges. Insertion of these rings flatten the central area of the cornea and correct myopic refractive error. A major advantage of Intacs is that no tissue is removed and there is no ablation or incision across the visual axis.

Intacs surgery is not truly reversible because of the incision, but the Intacs can be completely removed or exchanged for a different size. Intacs inserts cannot be felt by the patient and are no more visible than a contact lens. After insertion and healing, Intacs require no maintenance.

The placement of Intacs inserts remodels and reinforces the cornea, eliminating some or all of the irregularities caused by keratoconus. Follow-up visits will be required to monitor the healing process and to evaluate the visual benefits of the procedure. Even after a successful Intacs procedure for keratoconus, glasses or contacts may be required, however Intacs have been shown to improve vision and reduce or stop the progression of keratoconus, thereby saving the patient from needing PKP.

Intacs have been approved for the treatment of keratoconus by the FDA under a Humanitarian Device Exemption (HDE) Humanitarian Use Devices (HUDs) are medical devices specially designated by the FDA for use in the treatment of fewer than 4000 patients per year with rare medical conditions.

Corneal crosslinking treatments can be combined with Intacs to flatten the keratoconus cone even more than with Intacs alone. In these cases, corneal crosslinking treatments stabilize keratoconus from getting worse as well as help the Intacs reverse the keratoconus steepening that had already occurred.

If you are ready to choose a doctor to be evaluated for conventional or custom wavefront Lasik, All-Laser Lasik, PRK, LASEK, Epi-Lasik, NearVision CK, RLE, or any refractive surgery procedure, we highly recommend you consider a doctor who has been evaluated and certified by the USAEyes nonprofit organization. Locate a USAEyes Evaluated & Certified Lasik Laser Eye Surgery Doctor.

If this article did not fully answer your questions, use our free Ask Lasik Expert patient forum.

Current Corneal Collagen Crosslinking with Riboflavin
(CxL) Medical Journal News...


Microbial keratitis after corneal collagen crosslinking.

Related Articles

Microbial keratitis after corneal collagen crosslinking.

J Cataract Refract Surg. 2009 Jun;35(6):1138-40

Authors: Pérez-Santonja JJ, Artola A, Javaloy J, Alió JL, Abad JL

Several infiltrates appeared in the upper midperipheral cornea of a 29-year-old woman who had had uneventful corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A light (UVA) for the treatment of keratoconus in the right eye. Staphylococcus epidermidis keratitis was confirmed by microbiological studies, which guided treatment with topical fortified antibiotic agents. Before CXL, the best spectacle-corrected visual acuity (BSCVA) in the right eye was 20/25, the manifest refraction was -0.25 -0.25 x 125, and the anterior segment was normal under biomicroscopy. Five months after the procedure, the BSCVA was 20/22, the manifest refraction was +1.00 -2.50 x 40, and slitlamp examination revealed a mild residual haze in the upper midperipheral cornea. Collagen crosslinking with riboflavin-UVA is a minimally invasive method but traditionally requires epithelial removal, which could be a predisposing factor to bacterial keratitis.

PMID: 19465303 [PubMed - in process]


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Last updated Thursday, February 25, 2010

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