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The Light For Sight Protocol

Whereas the technical aspects of corneal cross-linking in children and adolescents are not different from a CXL procedure performed in adults, there are some fundamental differences that need to be respected in young patients up to the age of 20 years:

  • There is ongoing controversy about the duration of the CXL effect, so whenever possible, use the protocol with the best-documented effect (= Dresden protocol, 3 mW/cm2 for 30 minutes, continuous light, epi-off
  • In patients with poor compliance or even absence of compliance, the risk for a severe corneal infection following the surgery is greatly increased. Therefore, we have developed the “Light for Sight” protocol.

Normal compliance

  • perform an epi-off procedure
  • use local anesthesia
  • whenever possible, use slow irradiation (30′)

Reduced compliance

  • perform an epi-on procedure
  • use local anesthesia
  • whenever possible, use slow irradiation (30′)

No compliance

  • perform an epi-on procedure
  • use general anesthesia
  • whenever possible, use slow irradiation (30′)

Why epi-on in patients with reduced to no compliance?

  • Because in this type of patients, the risk of severe postoperative infection due to excessive eye rubbing is very high.

  • Although recent studies indicate that the effectiveness of an epi-on procedure is reduced and approximately 70% ( as opposed to 95% in epi-off), we believe that in these special cases, it is justified to consciously choose the lower effectiveness to reduce the risk for postoperative infection.