The United States Food and Drug Administration (FDA) approved corneal cross-linking for progressive keratoconus and corneal ectasia following refractive surgery in April 2016. Since then, CXL, which uses ultraviolet light to help treat keratoconus, has become a widely accepted and commonly used treatment for these conditions around the world.

What Is Progressive Keratoconus

Progressive keratoconus is a form of keratoconus, an eye condition in which the cornea becomes thin and bulges outward, taking on a cone-like shape. The term “progressive” refers to the fact that the shape of the cornea is worsening over time, with the cornea becoming increasingly irregular, thinner, and steeper. 

Early detection and intervention are crucial for managing progressive keratoconus. Advanced keratoconus can result in progressive refractive error that is difficult to treat with glasses and contacts. If patients are having frequent prescription changes this could be a sign of progressive keratoconus.

Corneal cross-linking (CXL) is a treatment option that can slow or halt the progression of the condition by strengthening the cornea and stabilizing its structure. Regular eye exams are essential to monitor the progression of keratoconus and adjust treatment plans as needed.

What Is Corneal Cross-Linking?

Corneal cross linking or cross linking for keratoconus is an advanced medical therapy that can help patients who have a misshapen cornea from this disease. Corneal cross-linking is abbreviated as CXL and is also sometimes called corneal collagen cross-linking. 

It is a minimally invasive procedure used to strengthen the cornea and slow or halt the progression of certain corneal disorders, such as keratoconus and corneal ectasia. The treatment works by using ultraviolet light to increase the collagen cross-links within the cornea, which helps to stabilize its structure and prevent further thinning and bulging.

Corneal cross-linking is generally considered safe and effective in halting the progression of keratoconus and corneal ectasia, although individual results may vary. Potential side effects and complications include pain, infection, corneal haze, and delayed epithelial healing. It is important to consult with an eye care professional to determine if corneal cross-linking is the appropriate treatment option for your specific situation.

Keratoconus Cross Linking Cost

The cost of corneal cross linking for keratoconus can vary based on where you are located. In general, this procedure is not covered by insurance companies, and is usually an out of pocket expense. On average the out of pocket cost for both eyes is between $3200 and $3800 US dollars. The work up that is needed prior to the surgery may or may not be covered depending on your specific health insurance company.

Is The Corneal Cross Linking Cost Worth It?

In the treatment of keratoconus, this is a popular surgical procedure but the out-of-pocket cost can be hefty. Because of this it is important to decide with your eye doctor if you are likely to have success from it. 

Corneal cross-linking (CXL) is most effective when used to treat progressive keratoconus in its early to moderate stages. Determining the best candidates for CXL is typically based on several factors, and the final decision should be made in consultation with an eye care professional. 

CXL is typically more effective in younger adults, as keratoconus tends to progress more rapidly during adolescence and young adulthood. However, the specific age range for CXL candidates may vary depending on individual factors and the eye care professional’s assessment. Younger patients should be counseled on this treatment option.

Is Corneal Cross Linking A Cure For Keratoconus?

No, CXL is not a cure for keratoconus, but rather a keratoconus treatment that is aimed at preventing further deterioration of the cornea. Some patients may still require vision correction, such as glasses or contact lenses, after the procedure.

Corneal cross-linking (CXL) has shown to be successful in slowing or halting the progression of keratoconus and corneal ectasia in a significant number of cases. However, the success rate of CXL can vary depending on individual factors and the specific criteria used to define success.

Generally, success is defined by the stabilization of the cornea and prevention of further progression of keratoconus. In many studies, CXL has been shown to be effective in achieving this goal in around 90% to 95% of treated patients. Some patients may also experience an improvement in corneal shape and visual acuity following CXL, although this is not guaranteed.

Risk Factors For Keratoconus

Some of the most significant risk factors include a family history of keratoconus, vigorous eye rubbing, atopic conditions such as allergies, asthma, or eczema may have a higher risk of developing progressive keratoconus, and contact lens wear. While contact lenses themselves do not cause keratoconus, poorly fitted or inappropriate lenses can potentially contribute to the progression of the condition by causing mechanical stress or trauma to the cornea.

Diagnosing Keratoconus

An ophthalmologist will perform a full eye exam as well as some testing to determine if you have keratoconus. Some of the key tests and procedures used in diagnosing keratoconus include:

Visual acuity test

This is a standard part of an eye exam that measures the sharpness of your vision, typically using an eye chart with letters or symbols.

Refraction test

During a refraction test, the eye care professional uses a device called a phoropter to determine the appropriate lens prescription needed to correct your vision. Frequent changes in prescription or increased astigmatism may be an indication of keratoconus.

Slit-lamp examination

A slit lamp is a microscope with a bright light that allows the eye care professional to examine the front part of your eye, including the cornea, in great detail. The examination can help identify signs of corneal thinning, scarring, or other irregularities associated with keratoconus.

Keratoconus topography

Corneal topography is a non-invasive imaging technique maps the surface of the cornea, creating a detailed, three-dimensional representation of its shape and curvature. Corneal topography is crucial for diagnosing keratoconus and monitoring its progression, as it can detect subtle changes in the cornea’s shape that may not be visible through a slit-lamp examination.

Corneal Pachymetry

Pachymetry measures the thickness of the cornea using ultrasound or optical coherence tomography (OCT). A thinner-than-normal cornea can be an indication of keratoconus.

Keratometry

Keratometry is a test that measures the curvature of the cornea’s surface, which can help in detecting abnormalities like keratoconus. The instrument used for this test is called a keratometer or an ophthalmometer.

Keratoconus Corneal Cross-Linking Treatment Cost: Summary

The exact cause of keratoconus is not completely understood. It is believed to be a multifactorial condition, resulting from a combination of genetic, environmental, and biochemical factors. Keratoconus specialists can help patients with the progression of the disease through different types of therapy from doing a corneal transplant to using UV light in cross linking procedures.

In most cases, the keratoconus corneal cross-linking cost will not be covered by medical insurance provider or by a vision plan. 

Severe vision problems from this progressive eye disease can happen and that is why surgical treatment with cross linking has become very popular. It is almost always done as an outpatient procedure. Typically, out of pocket rates will vary, but generally cost between three and four thousand dollars. Some patients can use FSA or HSA accounts to pay for this surgery. 

Other keratoconus treatment options include corneal transplantation, deep anterior lamellar keratoplasty, intrastromal corneal ring segments, contact lenses, prescription glasses and observation.