Study Affirms Long-term Efficacy, Stability of CXL Up to Four Years Post-treatment

Keratoconus was stabilized by epi-off CXL in this study, with the most notable improvements coming within the first two years, particularly in younger patients. Photo: Lily Arendt, OD. Click image to enlarge. A recent California study has documented the long-term stability of epithelium-off corneal crosslinking (CXL) to slow pediatric keratoconus progression. Epi-off CXL has been available in the US since 2016; recently, the epi-on variant received approval as well.Evaluating data from 193 patients (243 eyes) who underwent the treatment between 2017 and 2025, the authors found that CXL was successful in providing “sustained visual and structural improvements.” Data was obtained from patients treated at Stanford University School of Medicine. Patients  were assessed preoperatively and at one, three, six and 12 months post-procedure and then annually thereafter, according to the researchers’ paper in Journal of Cataract and Refractive Surgery. The team analyzed patients with a minimum of 12 months and a maximum of 60 months of postoperative data that included corrected distance visual acuity (CDVA), maximum keratometry, minimum central corneal thickness (CCTmin) and wavefront aberrations. Patients were divided into groups based on age, with 80 in the under-18 group, 54 in the 18-22 group, 59 in the 23-30 group, and 50 in the over-30 group. On average, patients were 24.2 years old and 32.9% of examined eyes were from those under 18. The authors described the cohort as “racially and ethnically diverse,” primarily including patients who were white, Hispanic and Asian.Younger groups demonstrated improvement from CXL treatment at a much higher rate than older ones. Under-18 participants’ CDVA “improved significantly at 12 and 24 months and remained significantly improved through 48 months.” CDVA improved at 12 months in 18-22-year-olds, and at 12 and 24 months with consistent stabilization at 36 months in 23-30-year-olds and over-30-year-olds. CCTmin decreased at 12 months, then remained “below baseline” at 24 months, across all groups. In addition, maximum keratometry improved at 12 and 24 months in every group.Maximum keratometry (Kmax) showed significant corneal flattening, the paper notes, “with the greatest reduction occurring in the first two years.”  Kmax remained significantly reduced through 48 months, “but was no longer significantly different from baseline at 60 months.”Findings indicated that CXL was “associated with stabilization of both visual acuity and corneal topography in keratoconus” at a greater rate in pediatric patients with the condition than in adult patients, but that it nevertheless proved beneficial among all studied age groups. Citing concerns that “research on long-term outcomes of CXL among pediatric patients, particularly in United States populations, remains limited” in the study, the authors advocated for continued use of CXL as a keratoconus treatment.Click here for the journal source. Chen K, Wungcharoen T, Zhao C, et al. Long-term outcomes of corneal crosslinking for keratoconus across pediatric, adolescent, and adult populations in a diverse U.S. population. J Cataract Refract Surg. March 3, 2026. [Epub ahead of print].  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.