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Bascom Palmer Eye Institute

Corneal Cross-Linking

What is Keratoconus?

Keratoconus is the most common corneal dystrophy in the United States affecting approximately one in every 2,000 Americans. It is the leading indication of full thickness corneal transplantation in the United States and the world. In keratoconus, the cornea, which is the clear “window” into the eye responsible for refracting light to the retina to allow vision, progressively thins and bulges out. That leads to blurred vision, astigmatism, and nearsightedness.

Keratoconus can progress to cause severe corneal distortion and scarring requiring a corneal transplant. The disease gets its name from the cornea bulging outward and forming a cone as opposed to the cornea’s normal symmetric dome-like curvature. This characteristic bulging is from the weakening of the collagen fibers within the stroma of the cornea. Keratoconus typically starts to develop in the patient’s adolescent years. However, it is not abnormal for some patients as old as thirty years to first start developing the disease.

What is Cross-linking?

Keratoconus is typically a progressive condition. At first, the corneal thinning and bulging creates irregular astigmatism that degrades vision. This irregular astigmatism can be corrected by glasses, rigid contact lenses or intra-corneal rings. As the disease progresses, the astigmatism becomes so irregular and severe that the cornea develops scarring. At that stage, the vision is no longer correctable by the aforementioned methods and restoring vision would only be possible using corneal transplantation.

Corneal cross-linking (CXL) is currently the only treatment that can stop keratoconus from progressing. Studies in the United States and the world have shown cross-linking to be highly effective and safe. This FDA-approved method uses ultraviolet light and a photosensitizer, such as riboflavin eye drops to strengthen the collagen in the cornea to halt the progressive corneal bulging.

Bascom Palmer Eye Institute contributed to the study that lead to the approval of the treatment in the United States, and is one of the first centers to offer the treatment to patients in the United States. Following treatment, patients will need continued and close monitoring of the cornea to ensure maximum CXL benefits and no occurrence of adverse reactions.


To make an appointment with a cornea specialist, please call 305-243-2020.