Corneal Collagen Cross Linking

SoCal Eye and Corneal Cross Linking in Long Beach

Corneal Cross Linking is an FDA approved treatment for Keratoconus and other irregularities of the cornea. These are complex medical conditions that can begin with mild symptoms like nearsightedness and advance over time with symptoms such as blurry vision, distortions and halos, shadows and ghosting. Once detected during the comprehensive eye exam, it is important to seek treatment from a Cornea Specialist. SoCal Eye has a Cornea Specialist and Cornea Surgeon on staff in Long Beach and Los Alamitos. All treatment begins with a Consultation. Schedule an Appointment today at LAKEWOOD (562) 531-2020  | LOS ALAMITOS (562) 598-7728  or send us an Online Consultation Request

Treatment options for Keratoconus and Corneal Ectasia:

Treatment of Cornea conditions such as advanced Keratoconus or Ectasia (which occurs as a result of LASIK or Photo Refractive Keratectomy [PRK] surgery) may require a surgical procedure. Corneal Collagen Cross-Linking (CXL) is one such procedure that is FDA approved and provides some distinct advantages over the traditional Corneal Transplant

What is Corneal Collagen Cross-Linking?

Corneal collagen cross-linking (CXL) is the standard of care for the treatment of early to moderate Keratoconus or Ectasia.1 It is a minimally invasive, outpatient procedure that combines eye drops and ultra-violet A (UVA) light to strengthen a weakened or irregular shaped cornea. In keratoconus and corneal ectasia, disease or previous surgery can damage the collagen in the cornea causing it to lose its shape and begin to bulge. It is the corneal collagen that holds the cornea in “normal” shape. After the cross-linking procedure, new collagen fibers in the cornea are “Cross-linked” with existing fibers for added strength and stability. This is achieved with a combination of Riboflavin (Vitamin B) eye drops and targeted UVA rays.

Since 2016 the procedure has been completed more than 18,000 times but is only offered at 300 practices in the United States. So Cal Eye is one of the few Ophthalmology practices to offer this procedure in Southern California.

 Corneal Collagen Cross-Linking


Corneal cross-linking creates new corneal collagen cross-links. This results in shortening and thickening of the corneal collagen fibrils and leads to stiffening and strengthening of the cornea.


Riboflavin (vitamin B2) is important for body growth, red blood cell production and assists in releasing energy from carbohydrates. Its food sources include dairy products, eggs, green leafy vegetables, lean meats, legumes, and nuts. Breads and cereals are often fortified with riboflavin. Under the conditions used for corneal collagen cross-linking, riboflavin 5’- phosphate, vitamin B2, functions as a photo-enhancer which enables the cross- linking reaction to occur.

Ultra-Violet A (UVA)

UVA is one of the three types of invisible light rays given off by the sun (together with ultra-violet B and ultra-violet C) and is the weakest of the three. A UV light source is applied to irradiate the cornea after it has been soaked in the photo-enhancing riboflavin solution. This cross-linking process stiffens the cornea by increasing the number of molecular bonds, or cross-links, in the collagen.

What to Expect with Corneal Collagen Cross-Linking?

Cross-linking is an outpatient procedure, which means you go home the same day of the surgery. Here’s what to expect:

  • With the patient in a reclined position, eye drops will be administered to numb the eyes. This ensures that no discomfort is experienced throughout the procedure.
  • The Cornea Surgeon will remove a thin outer layer of the Cornea called the Epithelium. This will allow the medication to penetrate deeper into the cornea.
  • Riboflavin (Vitamin B2) eye drops are applied to the cornea for a period of about 30 minutes.
  • UVA light rays are directed at your cornea. The light activates the riboflavin in the cornea and this helps form new bonds between the collagen fibers in your cornea.
  • In order to help the cornea heal, a protective contact lens is placed over the eye for a period of about a week

Recovery from Corneal Cross Linking

A return to normal daily activities after Corneal Collagen Cross Linking (CXL) surgery usually takes about 1-2 weeks. During the first month after CXL surgery, the vision may fluctuate.

One week after surgery it’s important NOT to:

        • use eye makeup
        • be in places that are smoky or dusty
        • touch or rub your eyes
        • get water in your eye (you may shower, but no swimming)

If your bandage contact lens placed on the day of surgery falls out or becomes dislodged, you should not replace it. Throw the contact lens away and contact your physician.

In the unlikely event of severe eye pain, or a sudden change/loss of vision a patient should call their doctor immediately.

Corneal Cross-Linking FAQs

Is Cross-Linking Right for Me?

Patients over the age of 14 who have been diagnosed with progressive keratoconus or corneal ectasia following refractive surgery should ask their doctor about corneal cross-linking.

SoCal Eye is proud to offer patients in our practice the first and only therapeutic products for corneal cross-linking which have been FDA approved to treat progressive keratoconus.

For more information on the corneal cross-linking procedure, visit linking-right-for-me/.

Will I need to be out of my contact lenses for this process?

Yes. Typically, patients are asked by their doctor to stop wearing hard contact lenses prior to surgery for several weeks. Once treated, patients will not be allowed back into contact lenses for 1 month.

How long does the CXL procedure take?

The procedure takes approximately an hour and a half. Expect to be at SoCal Eye for about 2 hours.

Does CXL hurt?

There is some discomfort during the immediate recovery period, but usually not during the treatment due to the anesthetic eye drops. Immediately following the treatment a bandage contact lens is placed on the surface of the eye to protect the newly treated area. After the numbing drops wear off, there is some discomfort, often described as a gritty, burning sensation managed with Tylenol and preservative free artificial tears.

Am I awake during the procedure?

Yes, typically you will be awake during the treatment. You may be given a medication to help you relax, and numbing anesthetic drops to help keep you comfortable.

Can anyone tell by my appearance that I have had CXL?

No. There is no change in the appearance of your eyes following cross-linking.

How effective is CXL?

Research studies have shown that 60-81% of Corneal Cross-Linking patients experienced an improvement in their vision and 95% of patients experienced no further vision loss. In clinical trials, progressive keratoconus patients had an average reduction of the maximum corneal curvature of up to 1.4 diopters in Study 1 and 1.7 diopters in Study 2 at 12-months following the procedure, while the control group had up to 0.6 diopters of corneal steepening at 12-months. Individual results may vary.

Is CXL a good alternative to corneal transplant?

Corneal Cross-Linking is a less invasive alternative to receiving a Corneal Transplant and can eliminate the need for a corneal transplant.  It does not require an operating room, involve incisions into the eye or stiches and eliminates the risk of rejection of the corneal tissue.

How long does corneal cross-linking treatment last?

The benefits of corneal cross-linking appear to last for many years and there is evidence that this strengthening effect may be permanent.

Does cross-linking need to be repeated?

In many studies, the majority of patients responded to a single vitamin and light corneal cross-linking treatment and did not need to have the procedure repeated. Corneal Cross-Linking can often be repeated when treatment is not effective. It is important to not rub your eyes following Corneal Cross-Linking treatment.

When is the best time to have corneal collagen cross-linking?

The results of corneal cross-linking for patients with advanced keratoconus have not been as good as for patients with early disease. It is best administered earlier in the progression of Keratoconus but your SoCal Eye Cornea Surgeon will guide you accordingly.

When can I resume wearing contact lenses?

Typically patients can return to wearing contacts 2-6 weeks after the procedure.

Will I need new glasses or contacts after CXL?

Given that Corneal Cross Linking is found to improve the vision of 60-80% of patients it is not uncommon for eye glasses and contact lens prescriptions to require updating. The prescription will change gradually over the 3-6 months after the procedure and will be detected at a follow up exam.

When can I exercise and return to my usual activities after CXL?

A return to normal daily activities after Corneal Collagen Cross-Linking surgery usually takes about 1-2 weeks. You doctor will notify you if a return to an exercise regimen in appropriate.

Is corneal CXL approved by the FDA?

Yes. This procedure was FDA approved in April 2016 although it has been performed and approved by more than 25 European Union nations for more than 15 years. There are some practices in the United States that offer non-FDA approved cross-linking procedures. The results of this type of cross linking have not been studied. It is important to ask your physician if they use the FDA-approved cross linking system.

Does insurance cover CXL treatment?

Yes. Although not in every case. FDA approved cross-linking is widely covered by insurance. For additional information on insurance coverage and to view the latest list of insurers that are known to have policies that cover cross-linking, visit the Insurance Information page on

How much does corneal cross-linking cost?

Contact our office for specific pricing information. It is best to check with your medical carrier before commencing. SoCal Eye can help you understand your coverage.



  1. Gomes, José P., Donald Tan, Christopher J. Rapuano, Michael W. Belin, Renato Ambrósio, José L. Guell, François Malecaze, Kohji Nishida, and Virender S. Sangwan. “Global Consensus on Keratoconus and Ectatic Diseases.” Cornea 34.4 (2015): 359-69. Web.
  2. Beshwati IM, O’Donnell C, Radhakrishnan H Biomechanical properties of corneal tissue after ultraviolet-A- riboflavin crosslinking. J Cataract Refract Surg. 2013;39(3):451-62. Doi:10.1016/j.jcrs.2013.01.026.