Corneal Cross-Linking: Optional or Essential? (2025)

Written by Gangnam Brand Eye Clinic

2025.02.20

When visiting a hospital for vision correction surgery such as LASIK, LASEK, or SMILE LASIK (collectively referred to as refractive surgery), patients undergo various eye examinations to assess their eye condition. Afterward, they receive consultation regarding the most suitable surgical method, potential side effects, and expected outcomes.

During this process, many eye clinics recommend corneal cross-linking (CXL) either selectively or as a semi-mandatory procedure based on the patient's eye condition.

So, what exactly is corneal cross-linking, and why is it suggested?

What is Corneal Cross-Linking?

Corneal cross-linking (CXL) is a procedure designed to prevent corneal ectasia and reduce the risk of myopia regression after refractive surgery.

More specifically, the procedure involves applying riboflavin (Vitamin B2) eye drops to the corneal stroma, followed by exposure to UV-A ultraviolet light.

This process strengthens the collagen bonds within the corneal stroma, making the corneal tissue more stable and reducing the likelihood of post-surgical corneal weakening, ectasia, or myopia regression.

Originally developed for patients with keratoconus, a condition where the cornea progressively thins and bulges, CXL is now frequently performed on patients undergoing refractive surgery, especially in cases where corneal stability may be a concern.

Who is Recommended for Corneal Cross-Linking?

CXL is particularly advised for patients who have:

- High myopia or high astigmatism
- Hyperopia correction
- Thin residual corneal thickness before or after surgery
- A family history of keratoconus
- Young age at the time of surgery
- Atopic dermatitis or frequent eye-rubbing habits

Patients with these conditions have a higher risk of post-surgery complications such as corneal ectasia or myopia regression. In such cases, CXL is often recommended as a preventive measure during refractive surgery.

Considerations for Corneal Cross-Linking

- The procedure adds extra time to the surgery and involves the use of UV exposure and riboflavin eye drops.
- Since it requires additional resources and expertise, many clinics charge a significant extra fee for this treatment.
- While not mandatory for all patients, it may help reduce long-term risks and enhance corneal stability in high-risk individuals.

For patients considering refractive surgery, discussing the potential need for CXL with a specialist is essential for making an informed decision.

Corneal Cross-Linking (CXL): A Preventive Measure for Safer Refractive Surgery

When patients visit a clinic for a refractive surgery consultation, they may be recommended corneal cross-linking (CXL) as an additional procedure. In most cases, patients choose to undergo CXL despite the extra cost, as it helps minimize potential complications that could arise after surgery.

Since the biggest concern when deciding on surgery is the fear of complications, many patients opt for CXL to reduce these risks, even if it means an additional financial burden.

Moreover, CXL has no known significant side effects, making it an attractive option for those who think, "It may be expensive, but there’s no harm in doing it."
The main reason for choosing CXL is to reduce the risk of corneal ectasia and myopia regression while also avoiding unexpected post-surgery expenses related to treating complications. If someone were to experience preventable complications simply because they chose not to undergo CXL due to cost concerns, it would be a regrettable situation.

Even for those who are not in a high-risk category, complications like myopia regression or corneal ectasia can occur in anyone. Therefore, adding CXL during refractive surgery can be considered a reasonable preventive measure for all patients.

This article has explored corneal cross-linking, a procedure that effectively reduces post-surgery complications without significant side effects.

For those who are hesitant about refractive surgery due to concerns about complications, I hope this information helps in making a well-informed decision.

View LASIK, SMILE, ICL prices

TOP 5 Eye Clinics in Korea