We treat Keratoconus eye disease with Cross-Linking

Keratoconus is a progressive eye condition in which the cornea — the clear front surface of the eye — becomes thinner and gradually bulges outward into an irregular, cone-like shape. This changes the way light is focused onto the retina and can cause blurred or distorted vision. Keratoconus often begins during the teenage years or early adulthood and may progress over time. Dr Zoran Aleksic diagnoses, monitors, and treats keratoconus at his rooms in Sea Point, Cape Town, and Vredenburg on the West Coast, with corneal cross-linking (CXL) performed at Peninsula Eye Clinic (PEC), a dedicated laser suite within Life Peninsula Eye Hospital in Claremont — a separate reception area from the main hospital building.

Symptoms and Risk Factors

Keratoconus can cause blurry or distorted vision, vision that fluctuates and is sometimes worse at night, increased light sensitivity, glare and halos around lights, frequent changes in glasses or contact lens prescriptions, and eye strain. It can affect each eye differently, and early stages may cause few noticeable symptoms — which is why regular eye examinations and corneal imaging matter, particularly if keratoconus is suspected or runs in your family.

The exact cause isn't fully understood, but factors associated with increased risk include a genetic predisposition or family history, frequent or vigorous eye rubbing, allergies and conditions that lead to eye rubbing, and certain connective-tissue or systemic conditions. If you have keratoconus, avoiding eye rubbing and managing allergies or ocular surface irritation are worthwhile parts of protecting your cornea.

How Keratoconus Is Diagnosed

Diagnosis and monitoring typically involve specialised corneal diagnostic tools, which may include:

Corneal topography and tomography — mapping the shape, curvature, and structure of the cornea
Pachymetry — measuring corneal thickness
Keratometry and refraction — assessing corneal curvature and changes in vision
Ocular surface assessment — identifying dryness, inflammation, or other factors contributing to discomfort or eye rubbing

Detailed imaging allows measurements to be compared over time to identify whether keratoconus is progressing. Early diagnosis matters, since treatment may be able to stabilise the cornea before significant progression occurs.

What Is Corneal Cross-Linking (CXL)?

Corneal cross-linking is a minimally invasive procedure designed to strengthen the cornea and slow or stop the progression of keratoconus. It's currently the only treatment available that can stop progressive keratoconus from worsening. Importantly, CXL does not reverse corneal changes that have already occurred, or cure keratoconus — its purpose is to stabilise the cornea and prevent further weakening and bulging, which may help you avoid more invasive treatment, such as a corneal transplant, later on. Glasses or contact lenses may still be needed after treatment, since CXL is a stabilising treatment rather than one designed to improve vision.

How CXL Works

Riboflavin (vitamin B2) eye-drop medication is applied to the cornea, which is then exposed to carefully controlled UV-A light. Together, the riboflavin and UV-A light create additional bonds — cross-links — between the collagen fibres in the cornea, working like support beams to help it stay stable. The procedure is performed under local anaesthetic eye drops, so you remain awake throughout, and typically takes approximately 45–60 minutes per eye, depending on the treatment protocol.

Who May Benefit from CXL

CXL may be recommended when there's evidence that keratoconus is progressing, or is at significant risk of progression. Suitability depends on several factors, including evidence of progression, corneal shape and thickness, the overall health of the cornea, any corneal scarring, and your age and individual circumstances — a detailed examination and corneal imaging will determine whether CXL is appropriate for you. Since keratoconus often affects each eye differently, each eye is assessed and treated individually.

Risks and Considerations

As with any medical procedure, CXL carries potential risks, which may include temporary discomfort or irritation, light sensitivity, blurred or hazy vision during healing, delayed healing of the corneal surface, infection, corneal inflammation, corneal haze (which usually settles within about 2 months), endothelial cell damage, corneal erosion causing pain or prickling, and visual distortion from corneal scarring or increased astigmatism. Your individual risks and the expected benefits of treatment will be discussed with you before the procedure.

Alternatives to Cross-Linking

Depending on the severity of your keratoconus, options may include glasses (which can work well for mild keratoconus), specialty contact lenses such as rigid gas permeable (RGP), hybrid, or scleral lenses (which create a more regular optical surface over the irregular cornea as keratoconus progresses), intracorneal ring segments, or — in advanced cases with significant scarring or thinning — corneal transplantation, which is needed by only a minority of patients. Laser vision correction such as LASIK is not a suitable option for eyes with keratoconus. If you require specialty contact lenses, we can advise on appropriate options and referral where necessary.

What to Expect

Before treatment, you'll have a comprehensive assessment, including corneal topography and tomography, corneal thickness measurement, a detailed eye examination, and assessment of your current vision and ocular surface. If you wear contact lenses, you may need to stop wearing them for a period beforehand so your cornea can return to its natural shape before measurements are taken. Please avoid alcohol the night before, don't wear makeup, and dress comfortably and warmly, as the procedure room is cool. Bring UV-protected sunglasses and arrange transport home in advance, since you won't be able to drive yourself.

On the day, please arrive at Peninsula Eye Clinic reception about 30 minutes before your scheduled time. This is a day procedure with no overnight hospital stay, and you'll be ready to go home around an hour after treatment.

Afterwards, a bandage contact lens is usually placed on the treated eye to aid comfort while the surface heals, and typically stays in place for about a week — please don't remove it until your surgeon advises. Antibiotic and other prescribed eye drops (provided by the clinic, so there's no need to buy them beforehand) are used during recovery. Common side effects in the first few days include light sensitivity, dry eye, haziness or blurred vision, and mild discomfort. Avoid touching or rubbing the treated eye, getting water directly in it, and wearing eye makeup for about a week, and avoid hot tubs, pools, or other untreated water for the same period. Rest well in the first 24 hours, avoid alcohol for 24 hours and strenuous exercise for 1–2 weeks, and expect to take some time off work — we can provide a medical certificate on request. Vision can remain blurry and fluctuate for several weeks as the cornea settles, and your glasses or contact lens prescription is often refitted around 6–8 weeks after treatment.

Follow-up is generally scheduled the day after surgery and again a few days later (both included in your surgery fee), with further follow-ups over the following months — including repeat corneal imaging to monitor stability — which are billed separately.

Medical Aid and Cost

Medical aid cover for corneal cross-linking varies between schemes and plans, so we recommend confirming your specific benefits before treatment. Our rooms can provide the clinical information your scheme may need for your enquiry, and your exact costs will be confirmed at your consultation.

Helpful Resources

For a walkthrough of what to expect, you can watch our cross-linking explainer video or our keratoconus explainer video. You can also read our blog post on keratoconus.

Frequently Asked Questions

Is corneal cross-linking a cure for keratoconus?

No. CXL doesn't reverse or cure keratoconus — its purpose is to strengthen and stabilise the cornea and slow or stop further progression.

Will my vision improve after CXL?

The primary goal of CXL is corneal stabilisation rather than vision improvement. Some patients notice an improvement as the cornea settles after treatment, but glasses or contact lenses may still be needed.

Can I have LASIK if I have keratoconus?

No. Keratoconus is a contraindication for laser vision correction such as LASIK, since the cornea is already thinner and more irregular than normal. Corneal cross-linking, specialty contact lenses, or in some cases corneal transplantation are the relevant options instead.

How long does recovery take?

Initial surface healing generally takes several days, though vision can remain blurry or fluctuate for several weeks and continue stabilising over a longer period. Recovery depends on the treatment performed and your individual healing response.

Can both eyes be treated?

Keratoconus often affects each eye differently, so each eye is assessed individually, and treatment may be performed separately depending on the severity and progression in each eye.

Is CXL covered by medical aid?

Medical aid benefits vary between schemes and plans. We recommend confirming your benefits with your scheme before treatment, and our rooms can provide the relevant clinical information for your enquiry.

If you've been diagnosed with keratoconus, have noticed frequent changes in your glasses prescription, or have a family history of the condition, book a consultation with Dr Zoran Aleksic at The Eye Surgery in Sea Point or Vredenburg. You can also read patient reviews online.