Founded in 2009 by Dr. Rubinfeld to serve as a resource for patients and doctors, CXLUSA, LLC, grew to become the world’s largest Crosslinking Research Study Group with 36 Investigators across the USA. Working with the world’s top international scientific experts, this group was instrumental in advancing treatments of those with keratoconus and other ectasias, eventually developing the treatment known as EpiSmart® to avoid the long recovery, pain and risks of the older, more invasive form of crosslinking from 1998 which requires surgical removal of the front layer (epithelium) of the cornea to get the vitamin into the cornea (images below show the older “Epi-Off” procedure).

Images below show typical results of EpiSmart® the day after the procedure and typical results of Epi-Off 4 days after. [For References see Latest Research in Crosslinking tab].
Typical patient experience comparing published EpiSmart® recovery vs. older Epi-Off procedure.
Locations of original CXLUSA study sites