Why Cross-Linking is the Life-Changing Solution You've Been Waiting For

Corneal Cross-Linking

Imagine if you could halt the progression of Keratoconus, a condition that progressively worsens your vision. What if we told you there's a state-of-the-art solution available? That's right, since 2016, we've embraced the epi-off corneal cross-linking treatment, a method that's not just innovative but also FDA approved. This isn't just another treatment; it's a transformative approach to reinforcing your cornea and putting a stop to Keratoconus. Think about the possibilities this opens up for your eye. Let's explore how this could be the game-changer you've been searching for.

Key Takeaways

  • Corneal Cross-Linking is a treatment used to treat keratoconus (and other ectasias) to prevent progression of the disease.

  • Early diagnosis and early treatment is crucial.

  • The FDA approved iLink procedure, epi-off cross-linking, can be covered by insurance if progression is shown

Understanding Corneal Cross-Linking

In Keratoconus the cornea thins leading to corneal steepening and eventually can lead to scarring. In mild cases, patients can still wear soft contacts or glasses successfully. Eventually the corneal thinning and steepening leads to irregular astigatism and only specialty contact lenses can help the vision. If progression continues, scarring occurs on the cornea, and one might have no choice but to consider undergoing a transplantation procedure. The problem with a corneal transplant is that they don't last forever as rejection happens in almost all cases long-term. Our goal is to avoid this.

​​​​​​​Consider the incredible potential of acting early against Keratoconus. What if you could stop it in its tracks before it progresses? This is where the power of cross-linking comes into play. When applied to early-stage Keratoconus, it's not just a treatment; it's a preventative strategy. It's about taking control early to prevent your cornea from deteriorating further. Think about the impact this could have on preserving your vision. Let's dive into how this proactive approach could be a game-changer for your eye health.

The Science Behind Corneal Cross-Linking

Cross linking is a unique combination of biology and technology. The procedure, which creates cross-links or bonds in the anterior stromal layer of the cornea, involves the application of vitamin (riboflavin) eye drops, combined with UV light and oxygen.

These aren't just bonds; they're your vision's new bodyguards. They provide unparalleled strength, halt deterioration in its tracks, and maintain the cornea's structural integrity. This isn't just about stopping progression; it's about potentially reducing the need for more invasive surgeries down the road. Think about the peace of mind and vision security this offers.

Conditions Treated with Corneal Cross-Linking

Corneal cross-linking is most commonly used to halt the advancement of keratoconus, an eye disorder occurring in around 1 out of 2,000 people. Symptoms include blurry vision, increased astigmatism, and heightened sensitivity to light brought on by corneal thinning and deformation. Cross-linking can also benefit those patients who have had ectasia after surgery, such as RK, LASIK, PRK, or astigmatic keratotomies.

Evaluating Candidates

Prior to a corneal cross-linking procedure, we will conduct a full eye assessment to identify if a patient is a candidate. Mapping of the cornea is vital to evaluate the severity of the condition and identify any potential risks associated with the treatment. Factors taken into account for these determinations include age, degree of ectasia or keratoconus present, as well as overall eye health status.

Bringing any old exams to the evaluation is crucial in getting insurance approval for the procedure. Any old glasses prescriptions, any old exam notes, or any old corneal mapping scans will be helpful in submitting all the information to the insurance.

Different Corneal Cross-Linking Procedures

There are two types of corneal cross-linking procedures available. The first way is epi off corneal cross linking and the second is epi on corneal cross linking.

iLink - Epi-off Corneal Cross-Linking Procedure vs Epi-On

Epi-off Corneal Cross-Linking Procedure

iLink (aka the FDA approved epi off corneal cross linking procedure) is the most commonly used technique for treating corneal ectasia in the US. It requires the removal of the corneal epithelium to allow the vitamins to get into the cornea. Specifically, this allows the riboflavin access to the anterior stroma, the part of the cornea that needs the most strengthening.

The downside to the epi-off procedure is that it makes the procedure uncomfortable post-operatively for the first few days after the procedure. The upside is it's the most effective way to strengthen the cornea.

The procedure, which is usually done in the office, takes around one hour per eye while using topical anaesthetic. This allows patients to feel no discomfort during the treatment.

At the end of the case, a bandage contact lens is placed on the surface to help with the discomfort for the next 2-3 days and to aid the healing process.

The benefit in epi-off is that it has been shown in multiple studies outside the United States to work and actually work better than epi-on CXL.

Epi-on CXL

There is current research being done on Epi-On CXL. It currently is not FDA approved in the US. This can only be done in a research study in the US. The thought is that Epi-On CXL will help with the discomfort patients usually experience for 2-3 days after the procedure. The question is going to be, how effective will this be?

Advanced Corneal Cross-Linking Techniques

Currently there is only one FDA approved technique to do corneal cross linking. However, many more are being studied. Potentially doing it quicker, having a customized light treatment, or even doing an epi-on.

One thing that currently could be considered during cross-linking is combining it with a vision correction procedure. Corneal Cross-linking will strengthen the cornea, so now we could try and correct the vision. This can be done with specialty contact lenses and often times, other surgical procedures could help.

Topography-guided PRK

In some patients, topography guided PRK can be used to smooth out the front cone surface of the eye. This has the ability to reduce the irregular astigatism, regular astigmatism, and even the prescription of the eye. By doing topography-guided PRK, patients have the ability to gain visual acuity or clarity if they are a candidate. Topography-guided PRK is not for everyone. PRK removed corneal tissue from the eye, so one must have enough corneal thickness for the procedure to be done.


If a patient has too high of a prescription, needs a faster visual recovery, or has too thin of a cornea, then EVO ICL might be the better procedure to combine with corneal cross linking. EVO ICL is a lens that is made from collagen, which is found in our bodies. This lens has the ability to correct extreme amounts of myopia and myopic astigmatism. The other benefit, this procedure corrects vision closest to the nodal point, which could gives us the ability to have better vision. If someone wants to have their vision corrected, but not have laser on the weak cornea, then EVO ICL could be the better solution. A scan is needed to measure the anterior chamber depth of the eye to see if you are a candidate.

The Corneal Cross-Linking Procedure

Now that we’ve looked into the preparation involved, let’s dive deeper and understand more about corneal cross linking. Understanding this procedure can bring patients peace of mind going in for their treatment and contribute to its effectiveness overall.

​​​​​​​Step-by-Step Process

The corneal cross-linking procedure is carried out in two steps. First, anesthetic eye drops are used to numb the patient’s eye and ensure comfort during the process. Following this, the outer layer of the cornea called epithelium is carefully removed so that riboflavin drops can be effectively administered into its tissues for 30 minutes or so. This is followed by controlled exposure to ultraviolet light, which creates new collagen links within it thus preventing the progression of any related ectasia diagnosis (such as keratoconus).

In total, one complete session usually takes up around 1 hour per each affected eye with preparation and recovery time taking another few hours more at most. Yet patients remain awake while treated through using aforementioned anaesthetics along with sedation if needed too respectively.

Duration and Pain Management

Corneal cross linking has become a popular procedure to address eye conditions, yet some patients are wary of potential pain it may cause. To ease these worries and ensure their comfort during the process, anesthetic drops will be applied on the affected eye prior to treatment. There could still be sensations such as pressure or mild discomfort while undergoing this course of action, but they can typically tolerated without great distress. Through utilization of proper measures for handling any discomfort that arises from corneal cross-linking procedures, patient’s needs can easily be met with minimal issues experienced throughout the whole experience.

Most patients bring headphones so they can listen to music or a podcast while the procedure is going.

Post-Procedure Recovery and Care

The crucial importance of correct aftercare cannot be overstated when it comes to achieving the best outcome following corneal cross linking. To make sure they are able to benefit fully from this procedure, patients should adhere strictly to their post-operation instructions provided by the specialist in charge of performing corneal crosslinking surgery.

Now let’s discuss what must be done directly along with methods for managing discomfort and aiding in successful healing during recovery time.

​​​​​​​Immediate Aftercare

Following a corneal cross linking procedure, patients usually take antibiotic and anti-inflammatory eye drops to keep the chance of infection or inflammation low. A special bandage contact lens will be inserted as well in order to protect their eyes and facilitate healing during early stages of recovery.


It’s crucial that the instructions are followed.

Managing Discomfort and Healing

After the procedure of Corneal Cross-linking, some slight discomfort and blurred vision is normal. It’s advised that patients should take care of their eyes by using sunglasses outdoors. Apply artificial tears to moisturize them as needed, and avoid activities such as eye makeup or swimming for at least a week after the treatment session. Most people can go back to daily life within 7 days. This may vary according to each patient’s situation regarding how they follow these guidelines properly for rapid healing progress in order gain full benefits from cross linking therapy.

Cost and Insurance Coverage

When determining the financial aspects of a corneal cross-linking treatment, it is beneficial for patients to understand what costs are usually associated with this procedure and whether their insurance may cover such expenses. The exact cost is going to be determined by two things. First, is their documented progression? If there is documented progresion then the corneal cross-linking could be billed to insurance. Secondly, it depends on your co-insurance and deductible on your current plan. The two things that the insurance required to be billed is the actual procedure and the vitamin medicine. Having documentation that shows progression and any medical insurance cards will help us get a better idea of what the insurance thinks the exact cost is.

Procedure Costs

We have seen corneal cross-linking cost $0 and other times we have seen patient's pay between $2,500 and $4,000 per eye. We work with financing companies too, in case the insurance plan you picked makes you pay a larger amount. The first step though is a consultation, where we will go over all of this information.

Insurance Considerations

One thing to know is that epi-on is not FDA approved. There are some clinics that are doing epi-on, not as a part of a clinical trial, and bill cash pay for the unapproved procedure. Insurance doesn't cover unapproved procedures. We do not do unapproved procedures.

Choosing a Corneal Cross-Linking Specialist


Finding a suitable corneal cross-linking specialist is essential for successful treatment. Having an experienced practitioner take you through the procedure will enable you to make an informed decision on proceeding with this approach, and assist in reaching optimal visual outcomes.

If you want someone that you can trust, then we would love to see you to see if we could even help. First step is determining is cross-linking right for you? Should we only do cross-linking or consider another procedure? And lastly, is there a better treatment that is coming that will be more beneficial to you?

Finding a Specialist

If you are in another city of state and wanting to come visit us to have a consultation, we do virtual consults. If we determine during the virtual consult that we can help you, there is a way to fly to us for the cross-linking procedure, then you can return to your hometown area to see a doctor that we work with. There are more logistics involved and we would need to hop on a phone call prior to cover the logistics.


Feel free to visit our contact us page, call us, or text us at 830-830-2020.


For individuals suffering from keratoconus and other forms of corneal ectasia, the revolutionary treatment option that is Corneal Cross-Linking can be life changing. It’s important to look into any potential risks before opting for this procedure and getting a consultation is vital to ensure the best possible outcome - but if done properly, it could result in a stronger cornea and even possibly improved vision quality. Comparing all information available concerning benefits, costs associated with treatments like cross linking or cornea related issues should always be taken into account before making a decision.

Frequently Asked Questions

How painful is corneal crosslinking?

The Corneal crosslinking is not painful. However with FDA approved epi-off CXL (aka iLink), there is discomfort for 2-3 days after the procedure. Some people experience minimal pain whereas others feel intensely uncomfortable for the initial 2-3 days. We do give some medicine for the discomfort if needed.

How long does it take to heal from corneal cross-linking?

After a corneal cross linking procedure, the recovery ranged from about one week to one month. Although after the week passes you might experience itching and slight irritation in your eyes for some time. Although the direct result of this particular cross-linking process should pass within seven days, it is possible that its effects, such as dryness, will be felt over an extended period afterward.

What is the main goal of corneal cross-linking?

The main aim of Corneal Cross-Linking (CXL) is to increase the strength of the cornea, thus stopping any advancement in ectasia such as keratoconus and improving vision so that a corneal transplant can be avoided.

Are there any side effects or risks associated with corneal cross-linking?

Cross-linking of the cornea can be a beneficial procedure, but there is still some risk involved. It’s important to have proper follow up with an experienced specialist in order to reduce infection and inflammation as well as potential damage caused by cross linking your corneas. To ensure success, it is critical that you adhere carefully to all aftercare instructions given during this process.

admin none 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM 9:00 AM - 5:00 PM Closed Closed optometrist # # # 237 W Water Street,
Kerrville, TX, 78028