Journal of Refractive Surgery.

Epi-on Cross-Linking has so far been disappointing in terms of clinical outcomes. It is clearly inferior to the classic epi-off treatment. The June 2016 edition of the JRS published the results of a multicenter trial between Germany (Spoerl, Raiskup), England (O’Brart) and Switzerland (Hafezi).

We tested whether an optimized epithelium-on solution, that had showed promising results in the laboratory, would increase the efficacy of epi-on Cross-Linking. We suspected that this would not be the case, and indeed, the results of our study show that epi-on has a reduced success rate of 70% (95% in epi-off classic CXL).

Therefore, we only perform epi-on Cross-Linking in very selected cases. Classic epi-off Cross-Linking remains the standard of care in 2016. Read the article here.