2925 Lord Baltimore Drive, Suite 300, Baltimore, MD 21244
(410) 324-MDKC (6352)

Corneal Cross-linking (CXL)

Frequently asked questions about CXL

What is CXL?

CXL is a minimally invasive procedure that involves applying formulated riboflavin (vitamin B2) eye drops to the surface of the cornea, followed by treatment with a controlled application of ultraviolet A (UVA) light to strengthen the cornea.  The procedure is designed to stop further progression of corneal ectasia (thinning) and bulging of the cornea, which is typically found in individuals with keratoconus.

Sometimes we choose to combine several techniques together with CXL to achieve the best optical and medical outcome. Our treatment decision is based on several parameters , such as degree of myopia or hyperopia, astigmatism, higher order aberrations (HOA) corneal thickness, tear layer, pentacam /topography measurements, shape/location of cone, best corrected visual acuity (BCVA) and individuals goals.

Types of CXL

Epithelium-Off (Epi-Off)

Epi-off CXL involves removing the corneal epithelium and dropping a formula of riboflavin solution on the cornea for a period of time followed by controlled ultraviolet light exposure.

Epithelium-On (Epi-On)

The epi-on procedure uses a different concentration of riboflavin solutions and different exposure time with ultraviolet light, and does not involve the removal of the corneal epithelium.

Combination Therapy

CXL is sometimes combined with other treatments to improve eyesight: This can range from specialty contact lenses, intrastromal ring implants (Intacs), Topo-guided PRK, phakic IOL implantation, or conductive keratoplasty (CK).

How successful is CXL?

Studies have shown that CXL is highly successful in halting the keratoconus. CXL is a safe and effective procedure.


How do I know if
CXL is right for me?

Our doctors use specialized instruments (Pentacam, Specular Microscope, Topographer, Aberrometer & others) to assess the severity of corneal damage that has occurred and, in some instances, will monitor changes over a period of time. If there is no evidence of progression or if there is already severe corneal shape damage, then CXL may not have any benefit.

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Early Childhood Detection

The goal is to identify and treat the condition in the early stages, before severe corneal degeneration and visual impairment sets in. If CXL is diagnosed and treated early-on, many of these young individuals will not have to suffer from permanent vision impairment.

Corneal Cross-Linking For
Patients with Down Syndrome

One group that especially benefits from Corneal Cross-Linking (CXL) is the Down syndrome community. The incidence of keratoconus in Down syndrome patients is more than 20 times that of the general population.

Improved Quality-of-Life

Many individuals who have received CXL have enjoyed corneal stability (where their condition did not continue to deteriorate further after the procedure).

How much does CXL cost?

Since FDA approval in April 2016, many insurance companies have started covering corneal collagen cross-linking (CXL) for progressive keratoconus and keratectasia.

Are there other treatment options?

The first line of treatment for keratoconus is to stabilize the keratoconus with Corneal Cross-Linking (CXL), then if needed, prescribe either customized contact lenses made specifically for treating keratoconus, or CK. Using a variety of prescribed treatments, many patients have experienced restored vision without the need for a corneal transplant.

We have a passion for treating keratoconus.

Properly and effectively treating keratoconus is a time-consuming process, and thus many doctors are not willing to spend the requisite time. Our team of experts stay current on the latest keratoconus management and treatment options and have the expertise, experience and compassion needed to restore your vision.

After you reach out to us, one of our doctors will:

Contact you personally to discuss your condition


Conduct a comprehensive review of your medical records

Perform a meticulous eye exam to determine the extent of your keratoconus

Determine whether CXL or another treatment plan is best for your eyes

Our doctors have restored vision for keratoconus patients who are:

• Seeking treatment for the first time

• Currently wearing contact lenses that are not comfortable or do not provide improved vision

• Considering medical treatments such as CXL or conductive keratoplasty (CK)

• Considering surgeries such as corneal transplants, or corneal implants (Intacs)

• Suffering from CXL, Intacs, or Corneal Transplant Complications