Corneal Cross-Linking (CXL)
Corneal cross-linking (CXL) is the only known therapeutic treatment that reliably stops keratoconus. At Singh Vision we combine PRK refractive surgery with Epi-On CXL as practiced in Europe albeit not yet FDA approved in the US. This version is safer and more effective, yielding faster recoveries, and better long term visual outcomes. Although Combo CXL with PRK can’t restore the cornea to its initial shape, it does cement the contour of the cornea; preventing further KCN progression & PRK then mends some existing damage. It is best to perform CXL early; before keratoconus progresses to causing vision loss.
“My initial consultation and follow-visits for corneal cross-linking with Dr. Singh were done with precision and the highest levels of skill I’ve experienced.”
Dr. B
How does Crosslinking work?
CXL is a photochemical reaction that involves instilling riboflavin onto the surface of the eye, checking to ensure enough has penetrated into the eye, and then shining a UV light on the cornea for 10-15 minutes. This light exposure drives a photochemical reaction (like photosynthesis in plants) between Riboflavin and Oxygen to create oxygen radicals which forge bonds (AKA “cross-links”) between the lattice fibers of the cornea. This strengthens the structural integrity of your cornea & stops keratoconus progression. In some cases CXL may reverse previous damage & in a best case scenario, it can free the patient from needing to use rigid contact lenses and allow them to downgrade to soft contact lenses.
Best CXL Eye Surgery Clinic In
Woodbridge VA
“Corneal Cross-Linking is the only non surgical treatment available that can halt progression of keratoconus, and corneal ectasia...
—Ophthalmology Times
What is Epi-On & Epi-Off?
CXL was developed in the 1990’s in Dresden, Germany and tested on pig corneas after removing the corneal epithelium (outer layer of the cornea). This “Epi-Off” practice was then used in human trials but newer riboflavin formulations with better epithelial penetrance have been developed since then. Studies using these formulations found that leaving the epithelium on (“Epi-On”) was safer, lower risk, and allowed for faster recovery with equivalent efficacy.
Singh Vision therefore offers Epi-On CXL and combines it with a PRK excimer laser treatment to best stabilize and then later remodel the cornea, reducing the patient’s need for scleral contact lenses, stabilizing their keratoconus, and improving their vision. Although this approach is not covered by Insurance, in our experience it reliably provides better, more durable outcomes with a faster recovery!
Can I get vision correction if I have keratoconus?
Yes! We perform topography-guided PRK to improve vision as a standard feature of CXL for all our patients. This PRK procedure is performed about 6 mths after the primary CXL procedure has had time to fully strengthen the structural integrity of the cornea. Topography Guided PRK is unique in that we “map” your cornea, design a custom laser treatment unique to you, & then carefully reshape your cornea using an excimer laser to bring it closer to a normal curvature. Of course each case of keratoconus requires personalized consideration. For patients with very high prescriptions CXL + PRK may need to be supplemented with ICLs or RLE to further correct their vision, some KCN patients may be poor surgical candidates and be better off staying with contact lenses. and some may present with such severe keratoconus that first a corneal transplant is required with PRK following 13 months later.
Reasons to choose Singh Vision for Cross-Linking.
01
Corneal Cross-Linking stops progression of keratoconus, preventing the need for a transplant in the future.
02
Dr. Singh is a felloship trained expert in post-LASIK ectasia & keratoconus and performs CXL with the most advanced technology available.
03
Our CXL pricing includes follow up appts, case management, eye meds and if needed we can repeat CXL at no extra charge.
CXL questions? We've got answers.
Yes. Epi-on CXL has a great safety profile. Of all the CXL Dr. Singh has done, only one pt got an infection and it was later noted that he was not taking his amtibiotics. After treatment, he did fine!
Anesthetic drops prevent discomfort during your procedure. CXL reaction is a kind of sunburn, so your eyes will feel uncomfortable that evening. By the next day, these symptoms greatly improve.
Corneal CXL takes about 1-hour per eye. We do CXL on the 2nd eye 3-4 weeks later (in most cases) if it needs to undergo CXL at all.
The purpose of CXL is to stop further progression & NOT to improve vision. CXL is great at stopping progression but sometimes vision improves a bit!
Your vision is blurry immediately after CXL and this will remain the case for 1-2 days using the epi-on treatment method.
Most CXL patients return to work in two days. On procedure day relax at home & use your drops. Your vision may be blurry the next day.
Start with a consult.
If you’ve been diagnosed with Keratoconus, schedule an evaluation with us. Our consultations are the most comprehensive anywhere, and include a suite of diagnostic testing. During your visit, you will meet Dr. Singh to determine the best plan for you given the specifics of your condition (mild vs. severe, etc.), your age, and glasses prescription.
The elegance of Singh Vision.
Singh Vision is housed in a beautiful facility with crisp, clean lines, abundant natural lighting and a stunning view of the Virginia countryside. The moment you enter our reception area, you’ll experience the difference of Singh Vision.
Take the next step to securing your vision.
Don’t delay coming in for a consultation. Corneal CXL is more effective if you get it done sooner. Without it the underlying disorder will progress. Our CXL patients always wonder why they waited so long to see us.