Collagen Cross Linking

Keratoconus is disease in which the corneal surface (the clear covering of the eye) becomes thinner and begins to bulge into a cone-like shape leading to blurred and distorted vision. Spectacles or contact lenses may help, but in severe cases surgery may be needed. So far there has been no effective way to stop the progression of keratoconus. It is estimated that eventually 21% of the keratoconus patients require surgical intervention to restore corneal anatomy and eyesight.

Collagen crosslinking with the help of Ultraviolet A (UVA, 365nm) and the photosensitizer riboflavin phosphate is expected to change the intrinsic biomechanical properties of the cornea, increasing its strength by almost 300%. This increase in corneal strength has shown to arrest the progression of keratoconus in numerous studies all over the world.

cross linking consultation

What is collagen cross-linking?

Collagen cross-linking (C3-R) is a treatment for keratoconus, using a photosensitizing agent, riboflavin (vitamin B2) & Ultraviolet light (UVA, 365nm) exposure. In extensive experimental studies researchers have demonstrated a significant increase in corneal rigidity / stiffness after collagen cross-linking treatment, arresting the progression of keratoconus in treated eyes.

Collage cross-linking information leaflet

Benefits for you

Patients with documented evidence of keratoconus progression can benefit from this treatment. Collagen cross-linking treatment is not a cure for keratoconus; rather, it aims to halt the progression of the condition. This is important to understand. Patients will continue to wear spectacles or contact lenses (although a change in the prescription may be required) following the cross-linking treatment. The main aim of this treatment is to arrest progression of keratoconus, and thereby prevent further deterioration in vision and the need for corneal transplantation. However in advanced keratoconus, wherein the corneal thickness is below 350 microns, this treatment may not be possible. In such a situation other alternatives such as deep anterior lamellar keratoplasty (DALK) should be considered.

Am I eligible?

It may be a suitable treatment for you if:

  • A scan of your corneal shape shows that your keratoconus is getting worse
  • You’re at particularly high risk of your keratoconus getting worse
  • You’re not affected by natural, age-related cross-linking
    It is worth noting that CCL treatment is not often recommended for patients in their mid-30s and above, as keratoconus usually stops getting worse by this age.

At LCVND, we understand that every case is different, which is why it is our corneal surgeon Mr Anandan who will make the final decision on your eligibility. If he finds that cross-corneal linking does not fit your eye health needs, he will be able to offer you more suitable options.

Find out whether CCL is right for you today by booking a consultation with our Corneal Specialist.


This procedure is carried out under a local anaesthetic. The top layer of the cornea is first scraped slightly to help the riboflavin eye drops to be absorbed into the cornea. UVA light is then shone onto the surface of the cornea for about 30 minutes while the eye drops are applied. The aim of the procedure is to halt progression of keratoconus. Eye drops with UVA light strengthen the fibres in the cornea by a process called cross-linkage. While the cornea is healing, the person may be given painkillers, antibiotic eye drops and artificial tears to stop the cornea from becoming too dry.


During preliminary examinations, your eye doctor will measure the thickness of your cornea and make sure you are a good candidate for the procedure. You also will need to have a routine eye exam to assess your visual acuity and general eye health. And your doctor will perform mapping of your cornea (called corneal topography) to determine the level of your eye condition.

The cross-linking procedure takes 20-30 minutes each eye. Your surgeon will place you in a reclining position and remove the epithelial layer from your cornea. Riboflavin eye drops will then be placed.

The corneal thickness will be checked, and then the UV light will be applied.

In some cases, a bandage contact lens will be placed. Topical antibiotic and anti-inflammatory drops will be prescribed.

After care

Keep the corneal surface (epithelium) well lubricated with the drops given. You do not need to use the drops during the night.

Do not rub your eye(s) after the procedure whilst the contact lens is in place. If you accidentally do so and the contact lens comes out, do not put it back in your eye.

You have been given an additional eye drop for use as a painkiller, which should be used sparingly. This drop is called Proxymetacaine and is an anaesthetic eye drop.

Your vision in the first week will vary quite a bit, and you may be sensitive to light as a result of the procedure, so it is recommended that you do not plan too many activities during this period. After three or four days your vision should begin to slowly improve.

Discomfort in the eyes is normal for the first week, and we have provided you with all the eye drops you will need to minimise this discomfort. Your eye(s) may be painful at times, mainly in the first three days. After this, the sensation tends to be that of irritation and grittiness.

If you develop increasing pain and redness please contact the eye department or attend A&E.


Call LVCND for more information and pricing

Contact details

Derby Private Health Royal Derby Hospital Phone: 01332 785200/ 785016
Or Mr Anandan’s Secretary Sue Da Silva on 07900210191 or email

Nuffield Health Derby Hospital. 
Rykneld Road, 
DE23 4SN

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