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.