Corneal Collagen Crosslinking FAQs

Q. How does Corneal Collagen Crosslinking (CXL/KXL) work?

A. The combination of UV light exposure to a cornea soaked in vitamin B2, riboflavin, creates new bonds within the cornea causing it to stiffen and become stronger. A single treatment is usually all that is required to achieve this effect and halt the progression of keratoconus.


Q. What is Keratoconus? How do I know if I have it?

A. Keratoconus is a disease of increasing near-sightedness (myopia) and astigmatism (irregular and steep corneal shape) that is due to weakening of the cornea. Over time, the weakened cornea can take on a conical shape, giving this disease its name. This process typically begins in adolescence or young adulthood.

Many patients are unaware that they have the disease, but find that their vision keeps worsening and that they continually need stronger and stronger glasses, or even hard contact lenses to see well. Many experience difficulty with glare and night vision. Eye rubbing is often associated with this condition.

If you are someone who rubs your eyes a lot and has increasing astigmatism, you should be examined to determine if you have this disease. While it can run in families, most patients do not have family members with this condition.

To determine if you have this disorder a corneal topography, or surface map, is needed to examine the shape of the cornea. With such mapping, the diagnosis can definitively be made by your ophthalmologist.


Q. Is Corneal Collagen Crosslinking (CXL/KXL) effective?

A. Multiple clinical studies since 2003 have demonstrated the effectiveness of CXL in halting the progression of vision loss from keratoconus. The technology has been in wide spread use around the world, including throughout Europe where it received the CE Mark of approval in 2006. A decade later, the rigorous stamp of FDA approval was given on April 18, 2016.

Studies show that CXL is effective for the majority of patients in stopping vision loss from keratoconus. Additionally, some patients will experience an improvement in vision due to a decrease in corneal steepening and myopia.


Q. Is Corneal Collagen Crosslinking (CXL/KXL) safe?

A. Yes. However, just like any other treatment there are risks to this surgical procedure. You should have an informed discussion about the safety and appropriateness of this procedure with your ophthalmologist before undergoing the treatment.

A full list of the adverse reactions from the Avedro FDA clinical study can be found in their labeling information here.


Q. Is CXL covered by insurance? Is it safe to wait for insurance coverage? How much does it cost now?

A. No, insurers are not covering this new procedure. Most procedures are covered by insurance within 2-3 years following FDA approval, so we eagerly anticipate that insurers will cover this procedure in the future. However, given the unpredictable nature of keratoconus progression, waiting 2-3 years could result in significant and permanent vision loss.

If you are losing vision from progressive keratoconus, you should have your eye treated as soon as possible. Remember, CXL halts the progression of disease but it cannot fully reverse it. Waiting may result in a permanent change to your cornea that significantly worsens your quality of vision.

Philadelphia Eye Associates is offering CXL for significantly less than the average cost of CXL, which typically runs $3,000- $6,000 per eye. We are able to lower the cost by cutting our own margins because we truly believe that all patients with keratoconus deserve an affordable treatment for their disease and that no one should go blind from this condition.


Q. What should I expect with the CXL procedure?

A. The procedure itself takes approximately 1 hour and is painless. However, there will be discomfort and blurriness during a period following the procedure typically lasting about 5 days (each patient’s experience will vary). Every patient must be seen at least twice during the week following the procedure. During this period, you will be placed in a bandage contact lens and will not be able to wear your own contact lenses in the operative eye.

During your pre-surgical consultation, your surgeon will provide you with more details regarding what to expect with the procedure and the healing period.

To schedule an appointment to determine if you qualify for CXL, call 215-339-8100 and ask for a corneal consultation for keratoconus with Dr. Brad H Feldman

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Five Convenient Locations

South Broad Street

1703 South Broad Street
Philadelphia, PA 19148
Tel: (215) 339-8100


Allegheny Ave

2610 E Allegheny Ave
Philadelphia, PA 19134
Tel: (215) 423-5154


Wills Eye Hospital

840 Walnut Street
Philadelphia, PA 19107
Tel: (215) 339-8100



Willingboro

1113 Hospital Dr
Willingboro, NJ 08046
Tel: (609) 871-1112


Wills Northeast Consultation Office

8025 Roosevelt Blvd.
Philadelphia, PA 19152
Tel: (215) 423-5154