Corneal cross-linking and other treatments for Keratoconus


Cross-linking, also known as CXL or C3R is a procedure for keratoconus or ectasia – a progressive degeneration of the cornea. The aim of CXL is to prevent the corneal shape from deteriorating in the future and is the only treatment currently available to stop your vision getting worse.

Cross-linking uses ultraviolet light in conjunction with vitamin B2 (riboflavin) drops to strengthen the cornea. When used together they cause fibres within the cornea to bond more tightly, which mimics the normal age-related stiffening of the cornea. This is known as natural cross-linking.

Mr Gore leads the Early Keratoconus and Corneal Cross-Linking Service at Moorfields Eye Hospital. He is an expert on keratoconus and post-LASIK ectasia, an international authority on cross-linking and an opinion leader amongst colleagues.

Ring Implants

If your vision in glasses or soft contact lenses isn't very good, ring implants such as Intacs or Kerarings may be suitable to improve the shape of your cornea. CXL is usually recommended 3 months following ring implant surgery to ensure the new improved corneal shape is ‘locked in.’

As with any procedure, we have to make sure that you are a good candidate and that this is the best way to improve your visual outcome. Advanced ocular scanners including the Ocular Pentacam, Schwind Phoenix and CSO MS-39 are the tools that we use to help us make these decisions.

Book in a consultation today to find out if these treatments are right for you.
Daniel Gore Keraring Keratoconus

Laser eye surgery and other types of CXL

Mr Gore has co-developed the latest Laser Refractive CXL protocols at Moorfields Eye Hospital, in which a more bespoke treatment is performed to sharpen vision with less ghosting and blurring. The focusing ability of the eye is typically improved, often with a reduced prescription in either spectacles or contact lenses. For patients with very mild keratoconus, laser refractive CXL can sometimes improve vision such that spectacles are no longer required. In addition to improved vision, a further advantage of combining CXL with laser eye surgery is the quicker healing time as compared with standard CXL.

Laser isn't the only option however. The new Avedro Mosaic PiXL system also uses new technology to allow reshaping of the cornea without the need for laser. Each treatment is tailored to the individual patient and some of these may not be right for your eyes. For more information, book a consultation today.

Avedro Mosaic

Moorfields Private uses only the very latest Accelerated CXL device: the Avedro Mosaic PiXL system. This incorporates eye tracking technology for enhanced precision in treatment.
Avedro Mosaic Cross-linking system

How much does CXL cost?
Information on prices for all of our procedures can be found on our Prices pages.
How long does the surgery take?
Laser Refractive CXL treatments are programmed based on scans taken during your clinical consultation. When combined with CXL, the laser treatment (lasting approximately 30 seconds per eye) is performed at the start of the procedure. Following this, riboflavin drops are applied before the ultraviolet light is switched on. The total treatment time per eye is 20 minutes.
Does the procedure hurt?
No, anaesthetic drops are used to numb the eyes so that you don’t feel any pain during the procedure. Sedation can additionally be given with either standard or laser refractive CXL to help you stay relaxed.
How long does it take to recover from after cross-linking?
The first 48 hours can be very uncomfortable. You should allow at least one week off work while most of the surface healing occurs, or two weeks if your job involves a lot of computer work, and the treatment is being done on your better eye. Your vision will initially be worse, before recovering over the first few weeks following the operation. Contact lens wear may be resumed once the surface of the eye heals, usually during the second week.
How good will my vision be after cross-linking?

You will still need to use your spectacles or soft contact lenses after Standard CXL.

Laser Refractive CXL improves the likelihood of better vision after treatment. Ring implants (Kerarings) may be recommended prior to CXL in order to improve the overall shape of the cornea. If your vision in spectacles after CXL is good enough for you, Implantable Collamer Lens (ICL) surgery may be able to correct your vision without spectacles.

Do you offer ‘epithelium-on’ CXL
Mr Gore does not perform ‘epithelium-on’ CXL as the evidence currently shows that it is less effective than ‘epithelium-off’ CXL.
My keratoconus has been stable for many years. Will CXL help me?
Because of natural cross-linking with age, keratoconus usually stops getting worse by your 40s, so CXL is not normally beneficial for older patients. CXL is recommended for patients with post-LASIK ectasia (regardless of age) once the diagnosis is confirmed.
Is the CXL procedure safe?
In general, CXL is very safe but, like all operations, your eye needs time to heal and problems can occasionally occur. Around 3% of patients will lose some vision in the treated eye as a result of haze, scarring or infection. Rarely, a corneal transplant is required to restore vision due to complications following CXL, with a risk of approximately 1 in 2000. Without CXL treatment, at least 20% of all patients with keratoconus will eventually require a corneal transplant in order to maintain vision.
Is CXL surgery permanent?
CXL treatment has been available since the mid 2000s, with published clinical studies confirming that the benefits last at least 10 years. Because the cornea naturally gets stronger with age, there is an additional natural protective effect in the years following CXL treatment.

If you have any further questions or would like to arrange a consultation, please do not hesitate to get in touch, either by calling 0203 984 7859, sending an email.
Can I be free from glasses or contact lens after cross-linking?
If you are happy with your vision in spectacles after CXL , Implantable Collamer Lens (ICL) surgery may be able to correct your vision without spectacles. This can be discussed in more detail at both your pre- and post-operative appointments.

Make an appointment today

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