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If you have been diagnosed with Keratoconus, you may wonder what would be the best treatment for the disease. Fortunately, there is a revolutionary procedure available that may prevent the need for a corneal transplant – the surgery used in very advanced cases. Corneal collagen crosslinking – considered one of the most important developments in ophthalmology in recent years – can prevent the condition from worsening.

What is Keratoconus?


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Keratoconus is a disorder of the eye, where the cornea thins and gradually bulges outward into the shape of a cone. This misshapen cornea can cause blurred vision, sensitivity to light, and other symptoms. The condition can progress slowly over a period of 10 years or longer.

What Is Corneal Collagen Crosslinking With Riboflavin?

This procedure is a method that strengthens the cornea, which slows or halts its bulging and prevents further deterioration of vision. Research shows the treatment improves the strength of the cornea by 71.9 percent. This means it can be used to stabilize Keratoconus with two techniques: invasive epi-off crosslinking, and non-invasive epi-on crosslinking.

What Is the Epi-Off Technique?

The epi-off – or CXL – is a procedure that involves the surgical removal of the outer skin layer of the eye. Following this excision, a small dose of ultraviolet light is applied for 30 minutes to the cornea and riboflavin is applied every three minutes. The cornea is strengthened through a reaction of the light with the riboflavin.

What Is the Epi-On Technique?

The epi-on technique – or Holcomb C3-R – doesn't involve the removal of the outer skin layer. A riboflavin crosslinking solution is permitted to soak into the cornea while a small dose of ultraviolet light is applied. Like in the epi-off procedure, the light and riboflavin react in a manner that strengthens the cornea.

How Do the Two Procedures Compare?

The American Keratoconus Association reports that the epi-off has greater risks, including corneal haze and infection as well as pain and light sensitivity during healing. The hazy vision can linger from one to 12 weeks following the procedure, and the moderate-to-severe pain can persist for one week. Mild-to-moderate light sensitivity can last up to a month in some patients. Normal activities – such as driving and going to work – can resume in four to 10 days.

Since no surgery is associated with the epi-on procedure, the aftereffects are minimal and recovery is rapid. For the remainder of the day following the technique, patients may have hazy vision and experience a foreign-body sensation in their eye. No pain occurs, and normal activities can be resumed the next day.

As the epi-on procedure is effective without risks or appreciable adverse effects, it is the preferred treatment. This modern technique offers hope to those afflicted with Keratoconus that was not available 25 years ago.

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