Keratoconus treatments:
CXL or CXL+T-PRK
What is keratoconus?
Keratoconus is a progressive eye disease that occurs in 1 in 1,000 people and often begins in adolescence and adulthood. It causes distorted vision because the cornea — which is normally round — begins to thin and bulge into a cone-like shape. LASIK and PRK are not appropriate for patients with keratoconus.
LASIK MD offers two specialized treatments designed for this condition.
Corneal Cross-Linking (CXL)
A non-invasive procedure that strengthens the cornea by "cross-linking" its collagen fibres through the application of Riboflavin drops and exposure to UV-A light. It's the only keratoconus treatment proven to slow or stop the progression of the disease. CXL alone, however, will not improve your vision.
CXL + Topography-guided PRK (CXL+T-PRK)
This dual treatment combines CXL with Topography-guided PRK, an advanced laser procedure that uses a highly-detailed map of the eye to guide extremely precise treatment. The addition of T-PRK provides improved visual acuity that CXL alone cannot achieve.
What are the advantages of combining CXL with T-PRK?
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While corneal cross-linking (CXL) alone is effective at stopping the progression of keratoconus, pairing it with topography-guided PRK (T-PRK) can provide better vision and stronger, more regular corneas. This combined approach treats the underlying disease and helps restore clearer vision that CXL by itself cannot achieve.
- Stops keratoconus progression by strengthening and stabilizing the cornea.
- Improves corneal shape and smoothness, reducing visual distortion.
- Enhances visual clarity, with measurable improvement in both uncorrected and corrected vision.
- Increases comfort with glasses or contact lenses, making them easier to wear and more effective.
- Uses advanced laser mapping technology, available in only a few centres in Canada, including LASIK MD.
Although this dual treatment may not eliminate all visual irregularities caused by keratoconus, it can significantly improve your overall vision quality and stability.
Our clinical team will assess your vision and help determine the option best suited to your eyes.
The Montreal Protocol
LASIK MD's proprietary CXL+T-PRK approach
LASIK MD's surgical team developed a proprietary refinement of the Athens Protocol, using both tomography and topography data to treat the astigmatic portion of the prescription. Validated across data from more than 12 Canadian clinics, this approach has led to significant improvements in visual outcomes.
Signs and symptoms of keratoconus
Early signs
In its early stages, keratoconus can be difficult to detect. You may notice:
- Blurred or distorted vision that doesn’t improve fully with glasses
- Frequent changes in your prescription
- Increased sensitivity to light and glare
- Difficulty seeing clearly at night
If you notice these changes, an eye exam with advanced corneal imaging can help detect keratoconus early.
Advanced symptoms
As the condition progresses, vision may worsen over time. Some patients experience:
- More severe distortion or double vision
- Irregular astigmatism that keeps changing
- A sudden cloudy or hazy vision episode (known as acute hydrops)
- Development of small corneal scars affecting clarity
Even though keratoconus tends to progress slowly, regular monitoring by an eye care specialist is key to protecting your vision.
What to expect during CXL surgery
With Corneal Collagen Cross-Linking (CXL), there are no injections, stitches or incisions. It is performed by a highly skilled surgeon who is a corneal specialist.
CXL begins with the application of topical anesthetic eye drops to numb the eye. The surface or epithelium of the cornea is then gently polished using a rotary epithelial brush.
The eye is treated with an application of Riboflavin eye drops. These must remain on the eye for 30 minutes.
In the next step, UV-A light is administered to the eye for an additional 30 minutes, causing the collagen cross-linking bonds to form.
Finally, a contact lens bandage will be applied by the surgeon and left on the surface of the eye around-the-clock without removal for a period of 5 to 6 days to ensure proper healing. After this initial healing period, the contact lens bandage will be removed at the clinic.
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With the exception of the contact lens bandage applied by the surgeon during CXL, no contact lenses can be worn for several weeks following the treatment. In the first few days following CXL, pain levels vary from patient to patient. Patients can expect to feel moderate discomfort, and a small minority will experience a greater degree of discomfort. We will provide you with a prescription for pain medication which should provide relief.
Following the CXL procedure, patients will still need to wear glasses or contact lenses. If you wear contact lenses, changes to the corneal shape may require a new contact lens fitting or prescription change.
FAQs
How is T-PRK different from standard laser eye surgery?
T‑PRK is a customized laser treatment designed for patients with keratoconus or irregular corneas. Unlike standard laser surgery, it uses advanced imaging — including tomography, topography, and wavefront aberrometry — to smooth corneal irregularities before corneal cross-linking (CXL). This combination helps reduce visual distortion and improve clarity that CXL alone cannot achieve.
What are the risks associated with CXL?
Very few risks are associated with this procedure. Patients should expect some degree of light sensitivity and moderate discomfort as the cornea heals. There is a small risk of mild corneal haze (due to the cross-linking process) which can initially blur vision. However, this usually resolves itself in time.
Alternative treatments for keratoconus
In the early stages of keratoconus, vision can often be corrected with glasses or soft contact lenses. As the condition progresses and the cornea becomes more irregular, specialized rigid gas-permeable (RGP) or custom contact lenses may help improve visual clarity by reshaping how light enters the eye. However, these are temporary solutions that do not stop the disease from progressing.
When contact lenses no longer provide adequate vision correction, corneal cross-linking (CXL) becomes the recommended treatment to strengthen the cornea and prevent further deterioration. Your LASIK MD surgeon will determine the most effective approach for your stage of keratoconus.
Find out if you're a candidate for a keratoconus treatment
The only way to know if you are a candidate for CXL is to complete a free consultation. After a comprehensive eye assessment, a cornea specialist will recommend the most suitable treatment for your eyes.
Procedure availability varies by LASIK MD clinic and is subject to factors such as location, medical expertise, and patient eligibility as determined by a physician. Please contact your local clinic to confirm the availability of a specific procedure.