Choosing Between Epithelium-off CXL and Epithelium-on CXL

Posted on Tuesday, July 11th, 2017 by Dr. Binoy Jani

Corneal CrosslinkingClinical trials have shown that corneal crosslinking (CXL) can be very effective in halting the progression of keratoconus. In some cases, the non-surgical procedure has shown to help some patients avoid corneal transplantation, a more invasive option.

An ongoing debate among ophthalmologists is which approach is most effective when performing corneal crosslinking: epithelium-off or epithelium-on? Here, the Fredericksburg and Culpeper eye doctors at Vista Eye Specialists compare the two approaches in detail.

Comparing the Effectiveness of Epithelium-off CXL and Epithelium-on CXL

In epithelium-off corneal crosslinking, the epithelium is removed, allowing the liquid riboflavin to more easily penetrate the corneal tissue. In epithelium-on corneal crosslinking (also known as transepithelial crosslinking), the corneal epithelium tissue is left intact. A recent study compared the effectiveness of the two techniques. The study looked at 36 eyes of 27 patients who were diagnosed with progressive keratoconus. The patients’ ages ranged from 12 to 18. The study found that after 24 months of treatment with the epithelium-off technique, 94.4 percent of eyes either showed less keratoconus or no worsening of the disease. On the other hand, only 66.6 percent of eyes treated with the epithelium-on technique showed less keratoconus or no worsening of the disease. Researchers from the study concluded that the epithelium-on approach is only 70 percent as effective as the epithelium-off approach. However, the epithelium-on approach has proven to have several benefits for patients, including faster healing, less corneal haze, less post-op discomfort and reduced risk for infection.

There are a lot of factors to consider when choosing a technique for corneal crosslinking treatment. For instance, research shows that the epithelium-off approach is more successful in younger candidates (under age 35) than older patients. In addition, corneal crosslinking can be combined with other keratoconus treatment options, depending on the severity of the case. Ophthalmologists should take these factors, and others unique to the patient, into consideration when selecting a technique.

Contact Vista Eye Specialists Today

To learn more about the techniques and technologies used at Vista Eye Specialists, please contact our team by calling 1-888-EYE-JANI (1-888-393-5264) today.