Specialty treatments · Keratoconus
Corneal cross-linking for keratoconus
Reviewed by Rajesh Khanna, MD
Corneal cross-linking strengthens the collagen in a cornea weakened by keratoconus to slow or stop progression. Khanna Vision Institute offers it as Epioxa, an FDA-approved epithelium-on (epi-on) treatment, with insurance approval only. It does not reverse changes that have already happened; CTAK aims to improve the shape.
How it works
How cross-linking works
In keratoconus the cornea thins and bulges into a cone. Cross-linking uses riboflavin drops activated by UV-A light to form new bonds in the corneal collagen, which stiffens the cornea and helps stop the cone from getting worse.
Epi-off cross-linking removes the cornea’s surface layer (the epithelium) before treatment. Epioxa is epi-on: it leaves that layer in place, which is designed to make recovery more comfortable. Candidacy is decided by a full corneal exam.
Candidacy
Are you a candidate for Cross-linking?
Detailed corneal imaging shows whether your keratoconus is progressing and whether cross-linking fits.
Often a good fit
- Keratoconus that is progressing on corneal maps
- Enough corneal thickness, confirmed by imaging
- Medical insurance that can approve Epioxa
May not be right, or not yet
- Advanced scarring, where other treatment may be needed
- Active eye infection or inflammation
- A goal of improving vision shape rather than stabilizing it (ask about CTAK)
Procedure day
From exam to treatment
Keratoconus exam
Detailed corneal mapping at a $395 VIP lifestyle exam (self-pay) or an annual eye exam through insurance. Bring your medical insurance card.
Insurance approval
We submit your case for Epioxa insurance approval.
Treatment
Riboflavin drops and UV-A light, with the surface layer left in place.
Follow-up
Corneal maps over the following months show whether progression has stopped.
Recovery
Recovery
Epi-on treatment leaves the surface layer in place, which is designed to make recovery more comfortable. You get a written schedule for drops, screens and activities.
First days
Some light sensitivity or scratchiness is possible. Use your drops as directed.
Following months
Repeat corneal maps check that the cornea is stable. Glasses or contacts are updated once it is.
Call the surgical team right away for increasing pain, sudden vision loss, marked redness or discharge.
Benefits and risks
The honest version
Why people consider Cross-linking
- Aims to stop keratoconus from getting worse
- Epi-on: the surface layer stays in place
- FDA-approved Epioxa
- Can be combined in a plan with CTAK, if needed
What no one can promise
Possible risks include temporary discomfort, light sensitivity, corneal haze, infection and, rarely, scarring. Some corneas keep progressing and need further treatment.
Cross-linking is mainly about stabilizing the cornea. Most people still need glasses or contacts, and we cannot promise better vision.
Your surgeon
The technology is advanced. The judgment is personal.
Rajesh Khanna, MD is a UCLA clinical instructor with 25+ years in practice and 25,000+ vision procedures.
At your visit, Dr. Khanna decides whether surgery is the right choice, which procedure fits your eyes, and how to manage the result. The aim is the safest path to the vision that matters in your life, not the newest procedure for everyone.
"I've operated on my own mother, my wife and my son." (Dr. Khanna)
About Dr. KhannaCost and financing
Insurance and exams
Epioxa cross-linking is offered with insurance approval only, and there is no cash price. Patients first submit for Epioxa insurance approval after the keratoconus exam.
If Epioxa insurance is denied, alternatives are decided case by case; please ask the office. Epi-off cross-linking is not a standard option; it may be considered only as a conditional exception if Glaukos approves it in select cases, for example humanitarian cases.
The keratoconus exam is the $395 VIP lifestyle exam for self-pay patients, or an annual eye exam through insurance (covered; insurance rules apply). Ask our team for keratoconus education materials.
We have dropped, and will continue to drop, HMO and optical (vision) insurance plans. For questions about a specific plan, call (310) 482-1240.
Other keratoconus options
- CTAK: to improve the corneal shape
- Specialty contact lenses: scleral or rigid lenses
- Corneal transplant: for advanced scarring
Cross-linking questions
Do you offer cross-linking?
Yes. Cross-linking is offered as Epioxa, FDA-approved epi-on cross-linking, through insurance approval only.
How is Epioxa paid for?
Epioxa requires insurance approval, and there is no cash price. Bring your medical insurance card so we can start the approval process after your exam.
What if Epioxa is denied?
Alternatives are decided case by case; please ask the office. Epi-off cross-linking may be considered only as a conditional exception if Glaukos approves it in select cases.
Can cross-linking improve my vision?
Cross-linking is mainly about stabilizing the cornea. If your goal is to improve the corneal shape, ask about CTAK.
What is the first visit?
The $395 VIP lifestyle exam (self-pay) or an annual eye exam through insurance, with detailed corneal imaging.
VIP consult
Request a keratoconus exam
Tell us whether you’re self-pay or using insurance, and our team will book the right exam.
- Self-pay: $395 VIP lifestyle exam
- Insurance: annual eye exam (bring your medical insurance card)
- Then we submit for Epioxa insurance approval
Beverly Hills: Monday and Thursday · Westlake Village: Tuesday, Wednesday and Friday · 8 AM–5 PM, last appointment 4 PM. Saturday by arrangement only: please call.
Sources
- American Academy of Ophthalmology: Corneal cross-linking
- American Academy of Ophthalmology: Keratoconus
Medically reviewed by Rajesh Khanna, MD (review pending before launch). This page is educational and does not replace an exam. Eligibility, risks, benefits, alternatives and recovery are reviewed with your surgeon. Results vary.