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Corneal Collagen Cross Linking In New York City, New York

Collagen Cross Linking In New York City, New York

There’s a new treatment in town, and it could very well help with your Keratoconus symptoms. But first, let’s talk about what Keratoconus is and how it can affect your daily activities.

What Is Keratoconus?

Keratoconus (keh-rah-toe-cone-us) is an eye disorder in which the round dome-shaped cornea progressively thins causing a cone-like bulge to develop. This cone-shaped cornea causes light to be refracted incorrectly, resulting in blurred vision, rendering everyday activities, such as reading and driving, a struggle.

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senior woman with glasses for keratoconus treatment with eye doctor

Keratoconus Treatment Methods in New York City

Keratoconus can be treated in a number of ways

Corneal Transplant

This is a surgical procedure that involves the removal of a damaged cornea, and is replaced with a healthy donor one. Depending on the severity of the condition, an ophthalmologist may perform a partial transplant, only replacing the unhealthy section of the cornea instead of the entire cornea.


Intacs is an FDA-approved device designed to restore proper vision. Intacs are surgically inserted into the patient’s corneal stroma (a thick section of the cornea) and gently flatten the cornea, helping to reshape it into the correct form. In many cases, Intacs can sufficiently repair the Keratoconus rendering a Corneal Transplant unnecessary.

Collagen Cross-Linking

This procedure involves special eye drops and an ultraviolet (UV) light, which when used together, strengthen the corneal tissue. This can flatten the cornea and prevent it from re-developing into a cone-like shape.

Scleral Lenses

Because those with keratoconus have irregular, cone-shaped corneas, glasses cannot conform to the shape of the eyes and thus cannot adequately correct the patients’ vision. A great solution, therefore, is scleral contact lenses, since they sit on the sclera without touching the cornea and deliver maximal clarity while being perfectly comfortable. 

Collagen Isn’t Only For Lip Enhancement

Most people know about collagen's use in cosmetic surgery, such as making the lips appear fuller. What many don’t know is that it’s a protein developed inside the human body and can be found in the skin, muscles, and various ligaments.

The cornea of the eye also contains collagen. It is made up of tiny collagen fibers that lie in an intertwined fashion, ensuring that the cornea remains clear. As mentioned above, Collagen Cross-Linking can be used to treat Keratoconus to improve vision. The procedure is called ‘cross linking’ due to the placement of bonds in between the collagen fibers. These bonds provide support to stabilize the cornea.

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man alone by ocean thinking of treatment for keratoconus

How Does Collagen Cross-Linking Help My Keratoconus?

Collagen Cross-Linking, or CXL, is considered an ideal treatment for Keratoconus because the procedure flattens and strengthens the cornea, helping to reverse its misshapen form back to its correct one. Once the cornea returns to its original dome-like shape, light can once again hit the pupil correctly, providing improved vision.

CXL is most effective in patients who have been recently diagnosed with Keratoconus; the more the condition advances, the more difficult it is to manage. While CLX does not reverse the corneal shape completely, it can slow down the Keratoconus progression. In most cases, the patient will still need some type of vision correction assistance, such as eyeglasses or contact lenses.

The Collagen Cross-Linking Procedure

When a patient is determined to be a good candidate for Collagen Cross-Linking, an ophthalmologist will perform the minimally invasive procedure, which typically lasts between 30-60 minutes. The CXL procedure is done in office, so there is no need for a hospital visit.

First, The Doctor Will Numb The Eye

First, the doctor will numb the eye, so the patient shouldn’t feel any pain during the process. Then, eye drops containing riboflavin (vitamin B2) will be administered. These drops let the cornea absorb light and prepare the eye for the UV light application. The patent sits in a reclining position and looks at the UV light for approximately 30 minutes. The UV light causes an oxygen reaction, which then  develops new bonds in between the collagen fibers.

There are actually two types of CXL procedures. One is called Epithelium-off, and the other is called Epithelium-on. The difference between them has to do with the epithelium, also called “epi”, which is a tissue located on the outside layer of the cornea.


During the Epi-off procedure, the epi is gently removed. This lets the riboflavin drops to be absorbed into the eye more efficiently.


During the Epi-on procedure, the epi stays in place. It is not removed at all. However, it can take more time for absorption of the riboflavin drops.

Discuss with Dr. Hollander to determine which version of the CXL treatment is right for your condition. Each one has its benefits and risks in terms of procedure and recovery time.

What Are The Advantages Of Scleral Lenses? It’s All In The Shape!

Scleral Lenses Are More Wearable And Protect Your Eyes Better

Custom designed scleral lenses help patients with corneal irregularities achieve dramatic improvements in visual acuity and comfort. Scleral lenses vault over the cornea and rest on the sclera while avoiding the diseased cornea. This creates a new optical surface instead of the damaged cornea and prevents discomfort by resting on the sclera of the eye. Moreover, the reservoir of pure saline solution between the back surface of the lens and the front of the cornea ensures that the eye is always in a liquid environment - making it optimal for healing. 

Both rigid gas permeable (GP) lenses and scleral lenses provide the eyes with sufficient oxygen. However, scleral lenses provide more comfort and stable vision than traditional GP lenses. In most cases, scleral contact lenses are the optimal choice of treatment for patients with keratoconus and irregularly-shaped corneas.

Enjoy Better Vision

Scleral lenses also provide unparalleled visual acuity by shielding the damaged cornea with a perfect optical surface. Its larger design means the lens is firmly in place, which further enhances vision when compared to traditional lenses. Due to their size and shape, scleral lenses provide greater durability, easier handling and a lower risk for complications. If you are interested in scleral lenses, our eye doctor at the Specialty Contact Lens Center at Sight Improvement Center can help.

grandparents with family after testing for keratoconus

Although radiation caused by UV light can be harmful to one’s health, the amount of UV applied during the CXL procedure does not reach dangerous levels. According to The National Center for Biotechnology Information, a wavelength of 360–370 nm with an accumulated irradiance of 5.4 J/cm2 ensures that the exposure of all structures is below harmful levels.

Additionally, the riboflavin eye drops that the patient receives prior to the UV light application serves as a solid wall of protection against any potential radiation effects.

In April 2016, after conducting rigorous testing and reviewing case studies, the FDA approved the CXL procedure as an effective treatment for slowing down the progression of Keratoconus.

Just as with any medical procedure, there are some things you should know beforehand and some preparation you will need to do. On the day of the procedure, avoid wearing any eye makeup, creams, lotions, perfume, or cologne. The ophthalmologist will perform CXL on one eye at a time. It will affect your vision in the first few hours, so make sure someone can drive you home after the procedure.

Recovery time can be different for each patient, and depends on the type of CXL chosen. For the Epi-off procedure, there may be some pain felt over a few days’ time. As the epi heals, the pain will lessen and eventually fade completely. It may take up to a week and a half to resume normal activities. If the Epi-on version was done, then recovery time tends to be quicker and virtually painless.

Most eye doctors recommend not wearing contact lenses in the first few days following Collagen Cross-Linking. Others suggest waiting several weeks, but this is contingent upon the type of CXL performed on the patient.

Senior Man Wearing Black Eyeglasses before CXL treatment

Collagen Cross Linking Side Effects

Every type of medicine or medical procedure carries the risk of potential side effects. Pregnancy, breastfeeding, over the counter drugs, other medical conditions, and even a patient’s personal lifestyle can conflict with CXL. Because Specialty Contact Lens Center at Sight Improvement Center believes that an informed patient is a smart patient, we encourage you to become aware of the possible side effects of Collagen Cross-Linking. These can include:

Corneal Haze

A condition where the cornea becomes cloudy and blurred, affecting vision clarity. This side effect usually disappears on its own, but if not, steroid eye drops can be provided to treat it.


This is one of the most common side effects of any medical procedure. Infection can be treated with medicated eye drops or topical antibiotics.


Steroid eye drops can prevent scars from forming, but if it occurs despite this, a corneal transplant may be necessary.

Sterile Infiltrates

These are small wounds that appear on the cornea, either colored grey or white, and are usually caused by inflammation.

If you think you may be experiencing any of these side effects, talk to your eye doctor right away.

Remember, Keratoconus is a condition that requires ongoing treatment by a qualified eye doctor. Even after Collagen Cross-Linking has been performed, it’s important that you or a loved one who suffers from this disease find an eye doctor with you are comfortable with and trust to monitor the condition for the long-term.

Are you considering Collagen Cross Linking or would you like to know if it could help your Keratoconus? Speak with Dr. Hollander and the team of helpful staff today.

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