Corneal Collagen Cross-linking Provides a Treatment Option for Patients with Keratoconus Explains Fairfield New Jersey Cornea Surgeon, Theodore Perl, M.D.

Share Article

A New innovative procedure brings hope to those with keratoconus

Corneal Specialist Theodore Perl, M.D.

Corneal Specialist Theodore Perl, M.D.

CXL works by forming new cross-links between collagen fibers, which are the natural ‘anchors’ within the cornea. These anchors are responsible for preventing the weakened cornea from bulging out and becoming steep and irregular.

Corneal Associates of New Jersey, with Board Certified Ophthalmologist, Theodore Perl, M.D., concludes that c orneal collagen cross-linking (CXL), using UVA (ultraviolet) light with riboflavin to strengthen corneal tissue, has shown promising success in stabilizing corneal curvature and thickness. “This is a medical advancement we offer to our patients that require slowing or halting of the progression of keratoconus.” says Dr. Perl. “Based on available data, CXL offers a treatment for a disease that currently has no real treatment other than surgical insertion of plastic implants (INTACS) or corneal transplantation.”

Keratoconus is an abnormality of the eye in which the normally round, dome-shaped cornea weakens and becomes progressively thinner and irregular in shape. The resulting cone-shaped cornea can cause high levels of astigmatism (irregular curvature) and nearsightedness. Keratoconus has been estimated to occur in 1 out of every 1,000 persons in the general population. It is generally first diagnosed in young people at puberty or in their late teens. It is found in all parts of the United States and the rest of the world. It has no known significant geographic, cultural, or social pattern.

The aim of CXL, which utilizes Vitamin B2 (riboflavin) and ultraviolet light, is to arrest progression of keratoconus, and thereby prevent further deterioration in vision and the need for corneal transplantation. It is not a cure for keratoconus. CXL has also been successful in treating patients with corneal ectasia, a steepening of the cornea which occurs as a complication of previous laser refractive surgery.

“Collagen is the structural protein that provides strength and firmness to our corneal tissue,” reports Dr. Perl. “CXL works by forming new cross-links between collagen fibers, which are the natural ‘anchors’ within the cornea. These anchors are responsible for preventing the weakened cornea from bulging out and becoming steep and irregular. The addition of these ‘cross beams’ works as if adding rungs on a ladder to stiffen and strengthen the cornea, allowing it to focus light more efficiently and accurately.”

Collagen Cross-Linking

The CXL treatment is an outpatient procedure. First, the patient is given anesthetic (numbing) eye drops to prevent pain or discomfort. The corneal epithelium, a thin layer of clear, protective "skin" that covers the cornea, is gently removed and vitamin B2 (riboflavin) eye drops are instilled in the eye, one drop every 2 minutes for about 30 minutes. Once the drops have saturated the cornea, a UVA light source will be shined into the patient’s eye to "activate" the riboflavin, which causes the cross-linking of the collagen fibers. The UVA treatment will last approximately 5 minutes. A bandage soft contact lens will be placed on the patient’s eye immediately after the procedure, and antibiotic and nonsteroidal eye drops are then instilled. The patient can generally resume normal daily activities after 3-5 days. Visual improvement is a long process and can generally take 3-6 months.

Many research studies have shown that cross-linking prevents further vision loss in more than 95% of patients, with more than 70% of patients getting improved vision. CXL has been used successfully in Europe and other countries for more than 15 years, and is currently undergoing lengthy FDA clinical trials in the United States. “Although CXL is not yet FDA approved, it is considered a practice of evidence-based medicine decision,” says Dr. Perl. “Corneal Associates of New Jersey is able to provide this treatment to our patients using advanced training and technology required for the procedure.”

About Dr. Theodore Perl, M.D.

Dr. Perl, a Board Certified Ophthalmologist, founded Corneal Associates of New Jersey in 1983. He is fellowship-trained in corneal and refractive surgery, and specializes in the treatment of external eye diseases, LASIK, cataract surgery and corneal transplant surgery. He has performed more than 11,000 corneal and refractive procedures. To contact Corneal Associates of New Jersey, please visit

For more information on CXL, please visit or call 973-439-3937

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Matt Alexander
Visit website