Must the Corneal Epithelium Be Removed for Crosslinking to Work?

Absolutely not. We have been doing crosslinking with intact epithelium (called "epi-on") since 2003 in the United States and still continue to do so. Many doctors around the world have now adopted this technique. Prominent ophthalmologists Dr. Roberto Pinelli in Italy and Dr. Colin Chan in Australia were personally taught Dr. Brian's Holcomb C3-R and are seeing excellent results.  Dr. Brian received the 2010 Jules Stein Living Tribute Award for performing Holcomb C3-R Crosslinking System on U.S. Olympic Bobsled Driver Steve Holcomb that helped restore his vision enabling him to win the Gold Medal at the 2010 Winter Olympics in Vancouver - this was the first Gold Medal for the United States in bobsled in 62 years.

Perhaps you have heard an opinion from someone or your doctor that the epithelium must to be removed for crosslinking to work. Is that correct? Answer: No. Such opinion is probably based on a flawed laboratory study in pig eyes that concluded that riboflavin does not penetrate into the cornea through epithelium. Dr. Brian and colleagues published a letter to the editor pointing out the multiple flaws in the study (see link on navigation bar Presentations and Research Articles). Having earned a world-class reputation as a leader and pioneer in ophthalmology, Dr. Brian would not continue to do the Holcomb C3-R Crosslinking System if it didn't work! Please read his resume on 'Meet Dr. Brian' page on this site and do and Google search on "brian boxer wachler" to learn more about him.

Why do some doctors say you need to remove the epithelium to have riboflavin penetrate? The reason that some doctors say riboflavin does not penetrate the cornea with intact epithelium is because they are using the wrong solution with the riboflavin for it to penetrate. They are using a very thick mixture of Dextran and Riboflavin that has a consistency similar to that of molasses or honey. This molasses-like Dextran carrier holds onto Riboflavin so it can't penetrate through the epithlelium. The correct riboflavin solution for the Holcomb C3-R Crosslinking System is one that has the consistency of water. This thin mixture allows our proprietary Crosslinking Solution (that contains riboflavin and other compounds) to penetrate into the cornea WITHOUT DISRUPTING THE EPITHELIUM.

This is the explanation for differing opinions of the Holcomb C3-R Crosslinking System. Wrong solution = wrong result. If you don't use the right engine oil in a race car, the car won't run well. The correct solution must be used for Holcomb C3-R. Also if the Holcomb C3-R Crosslinking System didn't work, then United States wouldn't have it's first Gold Medal in 4 Man Bobsled in 62 years from the 2010 Winter Olympics in Vancouver!  While your goal may not be to win an Olympic Gold Medal, imagine being able to confidently move ahead in your life to achieve your own goals. 

What are the risks of Epi-on and Epi-Off Crosslinking?

RISKS OF EPI-OFF (CXL) CROSSLINKING: Epi-off crosslinking by definition is invasive. Your corneal epithelium is scraped off, like having a gigantic scratch on your eye which is painful and causes blurry vision during the healing phase. Complications of epi-off crosslinking can be quite serious too: corneal infections/ulcers, corneal infiltrates, corneal scarring, corneal haze, and delayed epithelium healing. These epi-off complications came out from the U.S. Crosslinking Clinical Trial and from IROC in Switzerland at the 2009 American Academy of Ophthalmology Annual Meeting - Refractive Surgery Subspecialty Day. Cornea nerve damage from epi-off crosslinking takes 6 months to recover as reported by the University of Crete at the same meeting.   Another side effect is the significant vision fluctuations for the first 3 to 6 months of healing with epi-off crosslinking due to the extensive epithelium remodeling process that occurs after the epithelium grows back on the cornea surface.

Holcomb C3-R is non-invasive - we have NEVER seen any of the above complications with it.

If someone, including your eye doctor, tells you that C3-R doesn't work and that the epithelium needs to be removed for crosslinking to be effective, simply refer them to this website page to read about the facts of corneal crosslinking. For more detailed information on the latest scientific studies and research, please click on Presentations and Research Articles section.

Keratoconus is the thinning and bulging of the cornea. Treatments include Intacs^®, Holcomb C3-R^®, cornea collagen cross linking, and if keratoconus progresses to a serious level, cornea transplantation. Dr Brian Boxer Wachler is a specialist in keratoconus evaluation and treatment.

Dr. Brian Boxer Wachler of the Boxer Wachler Vision Institute is well known for his contribution to the ophthalmic industry and for his other eye care efforts. Dr Boxer Wachler has helped preserve or improve the vision of many patients. Dr. Boxer Wachler is often asked to lecture, both in the United States and abroad, about his advancements in LASIK and in the treatment of keratoconus. Dr. Boxer Wachler has his private practice in the Beverly Hills area of Los Angeles.