CROSS-LINKING TREATMENT (CXL)
Corneal cross-linking (CXL) is a treatment for patients with keratoconus which can prevent their condition getting worse. It is successful in more than 90% of cases. After treatment, you will still need to wear spectacles or contact lenses. Your eye will be sore for about one week after the procedure. Although vision is often hazy at first, most patients can resume contact lens wear and return to work after one week. As with all operations, there are risks: CXL is safe, but there is a small chance (about 1 in 30) of worse vision afterwards.
Evidence that Cross-linking works
Collagen cross-linking is the only treatment currently available that appears to stop keratoconus from getting worse. Evidence from three randomised clinical trials one year after CXL showed success in halting keratoconus progression in more than 90% of treated eyes, with more than 45% of eyes also gaining an improvement in corneal shape. Longerterm results (up to five years) from a different study suggest a similarly high success rate in preventing keratoconus progression. Vision is better after treatment than before in about 50% of eyes treated with CXL.
In general, CXL is very safe, but like all operations your eye needs time to heal and problems do occasionally occur. About 3% of patients will lose some vision in the treated eye as a result of haze, scarring, corneal surface shape irregularity or infection. In most cases, this visual loss is potentially reversible with a corneal transplant. Without CXL treatment, at least 20% of all patients with keratoconus will eventually require a corneal transplant. The risk of transplantation for patients with documented disease progression is probably higher.