After being diagnosed with keratoconus, the first thing many patients do is meet with their doctor to determine the best treatment plan. Corneal cross-linking is one option that often arises during these early conversations.

With an increasing number of insurance companies now covering the only FDA approved corneal cross-linking procedure, it is becoming a more accessible treatment option for many people with progressive keratoconus.

To learn more about the frequently asked questions many people have when considering cross-linking and insurance coverage, we touched base with Dr. Neda Shamie, a cataract, LASIK, and corneal surgeon, who is a  partner at Maloney-Shamie Vision Institute in Los Angeles, California.

Who should receive corneal cross-linking?

Corneal cross-linking becomes medically necessary for a patient who has progressive keratoconus. Patients at risk for this progressive disease are typically younger than 45 years old although there are cases in which keratoconus can progress even in older patients1. Corneal cross-linking is also medically necessary for patients with ectasia post-refractive surgery with documented worsening best spectacle-corrected visual acuity and irregular astigmatism.2

Will my vision improve after the cross-linking treatment?

The expected result of cross-linking is slowing or halting the progressive changes in your keratoconus and/or post-refractive ectasia.

Will getting cross-linking prevent my need for a corneal transplant?

FDA approved corneal cross-linking has been shown to slow or halt the progression of keratoconus, a disease if left untreated, can lead to corneal transplant in about 20 percent cases.3

What is the recovery life after cross-linking?

The recovery is often quick, and the most symptomatic period typically is in the first few days after the procedure, while the epithelium is healing. Patients are given pain medications and a sleeping pill for the first night to help them through the first 24 hours when the discomfort may be at its worse, albeit tolerable. Patients describe feeling as though they have a large scratch on their eye although the bandage contact lens does help alleviate much of the discomfort. As with all post-surgical care, patients need to be seen frequently until the surface epithelium heals and to be monitored for possible signs of infection. I typically see the patient at the post-op day one and again three days later to remove the contact lens and ensure that, as is usually the case, the epithelial defect is fully healed.

The vision may fluctuate over the first month while the cornea is remodeling but stabilization and flattening is appreciated after about 3 months.

What is the difference between the Avedro system and cross-linking treatment from other centers that don’t use Avedro’s?

Corneal Collagen cross-linking that does not use Avedro’s KXL® System, Photrexa Viscous® (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate ophthalmic solution) and the epithelium-off technique are not FDA approved for the treatment of  progressive keratoconus with proven safety and efficacy. Moreover, because the Avedro system is the only FDA approved therapeutic treatment approach, it is also the only cross-linking procedure that can be submitted for insurance coverage, which now is increasingly approved. 

As such, out of pocket cost is minimized with the highest proven safety and efficacy of the treatment.


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Suggestions offered by the physician are based on their experience using Avedro’s KXL® System and are their opinion. Medical decisions for your patients are to be based upon their condition and your medical judgement. Avedro does not recommend or endorse any particular course of treatment or medical choice.

Dr. Neda Shamie is a paid consultant of Avedro.


3 Borderie VM, Boelle PY, Touzeau O, et al. Predicted long-term Outcome of corneal transplantation. Ophthalmology 2009;2354-2360 Eye Bank Association of America Statistical Report, 2016.