Latest Research in Epithelium-On Crosslinking (CXL)
See the research on advances in CXL for yourself by reading these key publications and articles involving CXLUSA participating medical practices, physicians, and other world experts.
Conclusion: This [FDA study reporting on 2,238 subjects] examined the response of patients with keratoconus to an “epi-on” CXL procedure using a novel technique… this represents a safer, noninvasive crosslinking to arrest the progression of keratoconus.
Conclusion: Not every hot ophthalmology innovation is built to stand the test of time. Roy Rubinfeld, MD, MA, has seen many come and go over the years. But technological advancements are making epi-on cross-linking a viable and safer alternative to the epi-off procedure.
Conclusion: [No other epithelium-on CXL system has been shown to adequately stop progression of keratoconus]… recent... publications and… basic science research clearly show that optimized transepithelial CXL can stop the progression of corneal ectasia and… keratoconus and that because of the adverse events associated with epithelium removal, transepithelial [epithelium-on EpiSmart] CXL will be ultimately favored.
Conclusion: Epithelium-on CXL using this new protocol halted the progression of keratoconus and ectasia after LASIK. It was safer and provided more rapid visual discovery than CXL without epithelial removal, allowing routine bilateral, simultaneous treatment.
Unique Riboflavin Loading
Conclusion: [Effective novel system gets riboflavin into cornea without removing epithelium.] The test transepithelial [epithelium-on EpiSmart] CXL system achieved corneal stromal concentrations of riboflavin that were… adequate for effective CXL… [and other riboflavin formulation was not]. View the original slides presented at the International CXL Congress in Boston, MA: “Is this the end of the epithelium-on vs. epithelium-off debate? A quantitative analysis reveals trans-epithelial corneal riboflavin loading in epithelium-on CXL.”
Conclusion: Failures of epithelium-on riboflavin loading occurred with all other formulations.
The Effect of Sodium Iodide on Stromal Loading, Distribution and Degradation of Riboflavin in a Rabbit Model of Transepithelial Corneal Crosslinking
Conclusion: The addition of [a unique, proprietary, patented] Nal sodium iodide simple salt to riboflavin solution is associated with increased riboflavin concentration in corneal stroma. [NaI also limits] riboflavin photodegradation [breakdown] during UVA exposure.
Improving Vision with CK
Outcomes of Conductive Keratoplasty Combined with Corneal Crosslinking in Advanced Ectatic Corneal Disease
Conclusion: [I]mproving and stabilizing vision in eyes that had lost substantial vision… due to corneal ectasia. Significant improvements in [vision], the most important metric affecting patient satisfaction, were documented… mean improvement of 3 lines.
Conclusion: Textbook chapter with similar findings of conductive keratoplasty (CK) in conjunction with CXL as treatment to improve vision in advanced keratoconus.
Conclusion: CXLUSA clinical trial offers physicians, including Dr. Richard Lindstrom, the opportunity to treat patients with epithelium-on or epithelium-off CXL and combine those procedures with treatments like conductive keratoplasty (CK).
Myths and Outdated CXL Information
Conclusion: The ideal CXL procedure should be… effective, safe, and standardized and involve minimal patient discomfort and recovery time. Improved safety and patient benefits accrue when the epithelium is not disrupted. A highly effective [epithelium-on-EpiSmart] technique fulfilling these requirements would be a… preferable protocol.
Transepithelial Crosslinking Retreatment of Progressive Corneal Ectasia Unresponsive to Classic Crosslinking
Conclusion: Epithelium-on CXL procedure stopped vision loss in a patient for whom standard epithelium-off CXL caused complications and failed to halt disease progression.
Diagnosing Keratoconus and Measuring Progression
Pachymetric Assessment After EpiSmart Epithelium-On Cross-Linking for Keratoconus and Post-Surgical Ectasia
Conclusion: Corneal thinning [due to death of corneal cells following epi-off CXL] is an important metric in assessing keratoconus progression and safety… after EpiSmart epithelium-on crosslinking, corneal thinning within the first 12 months post-op is not observed.
Published Surgeon Experiences
Conclusion: CXLUSA investigator Richard L. Lindstrom reflects on positive patient outcomes after epithelium-on CXL following two years of research participation.
Conclusion: In a point-counterpoint analysis of epithelium-on CXL, Roy Rubinfeld, MD, MA, argues that epithelium-on reduces risk.
Conclusion: CXLUSA investigator reflects on the progress CXL has made in recent years and the hope of what procedures will be able to accomplish in the future.
Conclusion: CXL experts discuss the current state of corneal crosslinking.
Conclusion: U.S. eye surgeons lead studies to advance CXL in the U.S. CXLUSA study sites offer progress in research of epithelium-on CXL.