Corneal Cross-Linking (CXL)

Corneal cross-linking (CXL) is the only known therapeutic treatment that reliably stops keratoconus progression. One type of CXL is FDA approved in the US but a more advanced CXL method is already available in Europe albeit not yet FDA approved. As we know this version is safe, effective, yielding faster recoveries, and better long term visual outcomes; we choose to perform non-FDA approved CXL followed 3-6 months later by topography guided PRK to improve visual quality to the extent possible. Although combo CXL/Topography Guided PRK can’t restore the cornea to its initial shape, it does cement the contour of the cornea; preventing further KCN progression & mending some existing damage. It is best to perform CXL early; before keratoconus progresses and causes 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

Google Reviews

Corneal Cross-Linking in Virginia

How does CXL work?

CXL is a photochemical reaction (not unlike photosynthesis in plants) that strengthens your cornea. It involves instilling riboflavin onto the surface of the eye for ~20 minutes. After checking to make sure there is enough riboflavin, a UV light is shown on the cornea for a period, driving a photochemical reaction between Riboflavin and Oxygen from the air to create oxygen radicals that forge bonds (“cross-links”) between molecules of the corneal stroma. This stops keratoconus progression in most cases, may reverse some damage, & in a best case scenario frees patients of rigid contact lenses. 

What is epi-on and 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 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 albeit this is not FDA approved and not covered by Insurance. We believe it is better to offer patients the best tech rather than performing a sub-par procedure just because the FDA is behind the times! Although our approach costs patients more money, we believe there shouldn’t be any compromises in the quality of procedure we offer and by and large, patients choose to invest in themselves when needed. 

Where does CXL fall on the treatment spectrum?

Cross Linking is a preferred treatment for patients with mild to advanced keratoconus. At any stage along the spectrum of progression, CXL is effective in preventing further worsening. Followup topography guided PRK some months later will at a minimum make Contact Lenses easier to wear and at a maximum eliminate the need for contact lenses (depending on degree of KCN severity at presentation). 

Can I get vision correction if I have keratoconus?

Yes! After CXL has strengthened the structural integrity of the cornea, it becomes safe to proceed with topography-guided PRK to improve vision. In this process we “map” your cornea, design a custom laser treatment unique to you, & then carefully reshape your cornea bringing it as close to a normal curvature as mechanistically and biologically possible based on the severity of KCN you present with. Patients with stronger prescriptions may benefit from ICLs or RLE instead of PRK after CXL. Each case of keratoconus is individual and requires personalized consideration. In some rare cases, KCN patients may not be good candidates for vision correction of any kind and may do better staying with contact lenses. The best approach to vision correction is to first get a comprehensive evaluation with Dr. Singh.

Reasons to choose us for Corneal Cross-Linking.


Corneal Cross-Linking stops progression of keratoconus, preventing the need for a transplant in the future.


It is theoretically possible to have progression after CXL but I’ve not yet had to repeat CXL. 


Your CXL is performed with the most advanced tech and available today, even more advanced then the FDA!


Our CXL pricing includes follow up appts, case management, eye meds and if needed we can repeat CXL at no extra charge.


You will have personable, caring staff throughout your Corneal Cross-Linking procedure and subsequent follow up care.


You’ll meet with Dr. Singh, an expert in post-LASIK ectasia, keratoconus, and pellucid marginal degeneration.

“Corneal Cross-Linking is the only non surgical treatment available that can halt progression of keratoconus, and corneal ectasia...

—Ophthalmology Times

CXL questions? We've got answers.

Is Corneal Cross-Linking Safe?

Yes. Epi-on CXL has a great safety profile with almost no risk of scarring/infection. Of all the CXL I’ve done, one pt who was not taking his drops got an infection. After treatment, he did fine. Everyone else has recovered well.

Does Corneal Cross-Linking hurt?

Anesthetic drops prevent discomfort during your procedure. CXL reaction is a kind of sunburn, so your eyes will burn and feel uncomfortable that evening. But by the next day, these symptoms significantly improve.

Will CXL improve my vision?

Corneal CXL’s main goal is to stop KCN progression and slightly improve vision. Once progression stops, different procedures for vision correction may become possible.  

How long does CXL take?

Corneal CXL takes about 1-hour per eye. We do CXL on the second eye 3-4 weeks later in most cases if it needs to undergo CXL at all. 

Can you see after CXL?

Your vision is blurry immediately after CXL and this will remain the case for 1-2 days using the epi-on treatment method.

When can I return to work after?

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 covered by insurance, are some of 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.). 

What consult time works best?


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 continuously progress. Our CXL patients always wonder why they waited so long to see us.