Selective Corneal Crosslinking May Allow for Customized Refractive Treatments

Investigators recently conducted a process called selective corneal crosslinking, in which they applied light and a special solution to either the center or edges of the cornea. They found that the shape of the cornea changed depending on which area was targeted during the procedure. Photo: Glaukos. Click image to enlarge. Earlier this week at ARVO in Salt Lake City, investigators presented the findings of a new study indicating the potential ability to use specific corneal crosslinking (CXL) patterns to tailor vision correction treatments; however, it’s important to preface that this still may be far in the future, as the research reported on used freshly excised pig eyes. In the study, the researchers used wavefront aberrometry, OCT and reverberant optical coherence elastography (OCE) to examine the structural, refractive and biomechanical changes induced via selective CXL patterns.The pig eyes were assigned to one of five groups: central or peripheral CXL, a riboflavin-only control, a central ultraviolet-only control or a peripheral ultraviolet-only control, with six eyes per group. The procedure itself consisted of using 0.1% riboflavin-5-phosphate in 20% dextran and 30 minutes of ultraviolet exposure, with masks restricting ultraviolet rays to either the central 2mm or a 2mm thick peripheral ring.CXL used centrally significantly reduced refractive changes of M, J0, and J45 with a marked increase in total dioptric difference. CXL performed peripherally conversely increased M, J0 and J45, as well as total dioptric difference. The control groups showed minimal changes. Hyperreflective borders were seen with OCT and were localized to either the central or peripheral cornea, corresponding with convexity in the central group and flattening in the peripheral group. What’s more, OCE confirmed stiffness in the regions that were crosslinked, aligning with the refractive and structural changes.The study authors summarize their findings in their ARVO abstract, writing that “central crosslinking enhances corneal convexity for hyperopia correction, while peripheral crosslinking flattens the cornea for myopia correction. OCT and OCE provided complementary evidence of structural and biomechanical changes, supporting the potential of customizable CXL patterns for tailored refractive treatments.”By strengthening the treated areas of the cornea and reshaping it to adjust how light focuses on the eye, the authors believe that “this approach could lead to more customized, noninvasive treatments for vision correction, reducing the need for glasses, contact lenses or surgery.”Original abstract content ©2025 Association for Research in Vision and Ophthalmology. Nikitin PV, Schill AW, Singh M, Aglyamov S, Larin K. Selective corneal cross-linking: structural and functional analysis using OCT, wavefront aberrometry, and reverberant optical coherence elastography. ARVO 2025 annual meeting.