If you are researching treatment options for keratoconus, you are likely looking for one clear answer: how to stop the condition from getting worse. Corneal collagen cross-linking (CXL) is currently the only proven treatment designed to slow or halt the progression of keratoconus. A newer option, Epioxa, offers an FDA-approved epithelium-on (“epi-on”) approach to corneal cross-linking.
Epioxa represents an important development in keratoconus care, especially for patients who are concerned about comfort, recovery time, or treatment accessibility. This page explains what Epioxa is, how it works, who it may be appropriate for, and how it fits into modern keratoconus management.
What Is Keratoconus?
Keratoconus is a progressive eye condition in which the cornea—the clear, dome-shaped front surface of the eye—gradually becomes thinner and weaker. Over time, this weakening can cause the cornea to bulge forward into an irregular, cone-like shape. When that happens, light no longer focuses properly on the retina, leading to distorted vision.
Keratoconus often begins during adolescence or early adulthood and may progress for many years if left untreated.
Common Symptoms Of Keratoconus
- Blurred or distorted vision
- Increasing astigmatism
- Frequent changes in glasses or contact lens prescriptions
- Glare or halos around lights, especially at night
- One eye worsening faster than the other
Because keratoconus is progressive, early diagnosis and timely treatment are critical to preserving long-term vision.
What Is Corneal Collagen Cross-Linking?
Corneal collagen cross-linking is a medical procedure designed to strengthen the cornea. It works by increasing the number of natural bonds (or “cross-links”) between collagen fibers in the cornea. These additional cross-links make the cornea stiffer and more resistant to further thinning or bulging.
The cross-linking process uses:
- Riboflavin (vitamin B2) eye drops
- Controlled ultraviolet (UV) light exposure
The goal of cross-linking is stabilization, not vision correction. Many patients will still need glasses or contact lenses after treatment, but cross-linking can significantly reduce the risk of continued progression.
What Is Epioxa?
Epioxa is the first FDA-approved epithelium-on corneal cross-linking treatment for keratoconus.
Traditional cross-linking procedures require removal of the corneal epithelium (the thin outer surface layer). Epioxa differs because it is performed without removing the epithelium, which is why it is referred to as “epi-on.”
Epioxa uses a proprietary riboflavin formulation and an oxygen-enhanced process that allows riboflavin to penetrate the cornea while keeping the epithelial layer intact.
Epi-On Versus Epi-Off Cross-Linking
Understanding the difference between epi-on and epi-off cross-linking helps clarify why Epioxa is significant.
Key Differences
- Epi-off cross-linking
- The epithelium is removed
- Longer initial recovery
- More post-procedure discomfort
- Epi-on cross-linking (Epioxa)
- The epithelium remains intact
- Typically associated with improved comfort
- May reduce early recovery challenges for some patients
Both approaches aim to strengthen the cornea. The choice depends on individual corneal findings, progression risk, and clinical judgment.
Who Is Epioxa Approved For?
Epioxa is FDA-approved for the treatment of progressive keratoconus in adults and pediatric patients aged 13 years and older.
Cross-linking is generally considered when:
- Corneal imaging shows documented progression
- Vision is worsening due to corneal shape changes
- The goal is to reduce the likelihood of more invasive procedures in the future
Not every patient with keratoconus requires immediate treatment. Careful monitoring and corneal imaging are essential in determining appropriate timing.
What To Expect During The Epioxa Procedure
While specific protocols vary by practice, the overall process is straightforward and performed on an outpatient basis.
General Procedure Overview
- Numbing eye drops are applied
- Epioxa riboflavin drops are placed on the eye
- Controlled UV light activates the cross-linking reaction
- The patient goes home the same day with post-procedure instructions
Because the corneal surface is not removed, many patients experience less discomfort during the early recovery period compared to traditional epi-off cross-linking.
Potential Benefits Of Epioxa
Patients often ask what makes Epioxa different. Potential benefits include:
- An FDA-approved epi-on cross-linking option
- No removal of the corneal epithelium
- Designed to improve overall patient comfort
- Reduced downtime related to epithelial healing
- Supported by large, randomized Phase 3 clinical trials
It is important to understand that results vary, and no cross-linking procedure guarantees vision improvement. The primary objective is long-term corneal stability.
Safety Considerations And Precautions
As with any medical procedure, Epioxa has potential risks and side effects.
Commonly Reported Effects
- Eye redness
- Light sensitivity
- Temporary discomfort or irritation
- Tearing or dryness
- Transient corneal haze
Important Contraindications
- Known hypersensitivity to benzalkonium chloride (BAC)
- Certain intraocular lens conditions without UV protection
- Caution in patients with a history of herpetic eye disease
A thorough eye examination and medical history review are essential before proceeding with treatment.
Scheduling A Keratoconus Evaluation In Tampa, Florida
If you are seeking information about Epioxa corneal cross-linking in Tampa or need expert guidance for keratoconus treatment, a comprehensive evaluation is the appropriate next step.
Dr. Berger at Bay Area Eye Institute in Tampa, Florida provides detailed keratoconus evaluations, advanced corneal imaging, and individualized treatment planning. During your visit, corneal progression, treatment options, and long-term vision goals are reviewed carefully.
To determine whether Epioxa or another cross-linking approach is appropriate, schedule a keratoconus consultation with Dr. Berger at Bay Area Eye Institute today.
