Dr. Eric Donnenfeld – Is the Time Right for Cross-Linking?

“As our practices emerge from the global health and financial crisis caused by the COVID-19 pandemic, CXL is a procedure that can begin sooner than some others, given its minimally invasive nature and younger candidate pool.” – Dr. Eric Donnenfeld, Ophthalmic Consultants of Long Island

When iLink™ corneal cross-linking was approved by the FDA in April of 2016, many corneal specialists were early adopters of the new technology. Now, with the majority of commercial health plans in the U.S. covering the iLink procedure, the time may be right for comprehensive ophthalmologists to bring the technology into their practices as well.

Image of Dr. Eric Donnenfeld.

In a recent article published in Ophthalmology Times, Dr. Eric Donnenfeld of Ophthalmic Consultants of Long Island, explains how the barriers to incorporating cross-linking have been significantly lowered and why ophthalmologists can now viably perform the procedure to meet a considerable patient need for treatment.

Dr. Donnenfeld emphasizes that iLink epi-off cross-linking performed with Photrexa® drug formulations [Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution)] and the KXL® System is the only cross-linking procedure approved by the FDA. And, with the majority of commercial health plans —representing more than 95% of commercially covered lives—recognizing cross-linking with the FDA-approved products as a covered service, more patients have access to the iLink procedure, while practices are also getting paid fairly.

Given fewer hurdles for practices to begin cross-linking, as well as financing options and reimbursement support, Dr. Donnenfeld argues that now is the time to invest in cross-linking technology.

Suggestions offered by the physician are based on their experiences using Photrexa® Viscous, Photrexa® and the KXL® System and are their opinion. Medical decisions for your patients are to be based upon their condition and your medical judgement. Glaukos does not recommend or endorse any particular course of treatment or medical choice.

Dr. Eric Donnenfeld is a paid consultant of Glaukos.

Using Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution), Photrexa® (riboflavin 5’-phosphate ophthalmic solution), and the KXL® System, the iLink™ corneal cross-linking procedure from Glaukos is the only FDA-approved therapeutic treatment for patients with progressive keratoconus and corneal ectasia following refractive surgery.*1

[Photrexa IFU/p1/col1/para3/lines1-4]


Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate ophthalmic solution) are indicated for use with the KXL System in corneal collagen cross-linking for the treatment of progressive keratoconus and corneal ectasia following refractive surgery.

Important Safety Information

Corneal collagen cross-linking should not be performed on pregnant women.

Ulcerative keratitis can occur. Patients should be monitored for resolution of epethelial defects. The most common ocular adverse reaction was corneal opacity (haze). Other ocular side effects include punctate keratitis, corneal striae, dry eye, corneal epithelium defect, eye pain, light sensitivity, reduced visual acuity, and blurred vision.

These are not all the side effects of the corneal collagen cross-linking treatment. For more information, go to obtain the FDA-approved product labeling.

You are encouraged to report all side effects to the FDA. Visit, or call 1-800-FDA-1088.

*Photrexa® Viscous and Photrexa® are manufactured for Avedro. The KXL® System is manufactured by Avedro. Avedro is a wholly owned subsidiary of Glaukos Corporation.


1. Photrexa [package insert]. Waltham, MA: Glaukos, Inc. 2016