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Corneal Cross-linking: Epi-On vs. Epi-Off Current Protocols, Pros, and Cons

  • Cataract & Refractive Surgery (CE Starr and A Brissette, Section Editors)
  • Published:
Current Ophthalmology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To review the current protocols for corneal cross-linking for the treatment of keratoconus, including a comparison of epithelial off (Epi-off) and epithelial on (Epi-on) treatments.

Recent Findings

After over 15 years of investigation, corneal cross-linking was approved in the USA in 2016. While Epi-off cross-linking is safe and effective, it is also associated with some drawbacks. Therefore, Epi-on is being investigated as a safer alternative. This paper reviews traditional Epi-off cross-linking and the latest Epi-on protocols.

Summary

While Epi-on protocols are being evaluated and have shown potential for success, most studies have shown Epi-off to be more effective. However, the well-known risks associated with Epi-off treatment may be significantly mitigated with Epi-on treatment. Therefore, if Epi-on proves to be as effective as Epi-off, and gains approval, it may become the preferred procedure.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, The Ohio State University, Columbus, OH, USA

    Kenneth A. Beckman

  2. Comprehensive EyeCare of Central Ohio, 450 Alkyre Run Dr #100, Westerville, OH, 43082, USA

    Kenneth A. Beckman

  3. Yale University School of Medicine, New Haven, CT, USA

    Mark S. Milner

  4. Goldman Eye, Palm Beach Gardens, FL, USA

    Mark S. Milner

  5. Hofstra Northwell School of Medicine, Hempstead, NY, USA

    Jodi I. Luchs

  6. Florida Vision Institute, West Palm Beach, FL, USA

    Jodi I. Luchs

  7. Rush University Medical Center, Chicago, IL, USA

    Parag A. Majmudar

Authors
  1. Kenneth A. Beckman
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  4. Parag A. Majmudar
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Corresponding author

Correspondence to Kenneth A. Beckman.

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Conflict of Interest

Kenneth A Beckman is a consultant and speaker and does contracted research for Avedro and Glaukos.

Mark S Milner reports personal fees from Avedro.

Jodi I Luchs reports personal fees from Allegan, Alcon, Sun, Bausch & Lomb, Shire, Glaukos, Avedro, Tear Lab, Omeros, Trefoil, and Eyevance and equity in CXLO, Trefoil, Ocular Sciences, Eyevance, Omega Ophthalmics, and Calhoun Vision.

Parag A Majmudar is a shareholder of CXL Ophthalmics, LLC, and a consultant for Alcon, Allergan, Bausch & Lomb, Bio Tissue, Sun, Dompe, Eyevance, Kala, Novaliq, and Novartis.

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This article is part of the Topical Collection on Cataract & Refractive Surgery

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Beckman, K.A., Milner, M.S., Luchs, J.I. et al. Corneal Cross-linking: Epi-On vs. Epi-Off Current Protocols, Pros, and Cons. Curr Ophthalmol Rep 8, 99–103 (2020). https://doi.org/10.1007/s40135-020-00241-1

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  • DOI: https://doi.org/10.1007/s40135-020-00241-1

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