After corneal cross-linking: follow-up, vision and contact lenses

Cross-linking is done to stop keratoconus getting worse, so you should plan on still needing glasses or contact lenses afterwards and on having eye checks for years. Long-term studies find that most treated eyes stay stable, while a minority progress again and some need a second treatment.

What to expect from your vision

Cross-linking is a stabilising treatment. A Cochrane review found three randomised trials, and their results could not be combined. In the one trial that reported it (94 eyes), treated eyes were on average about two dioptres flatter than untreated eyes a year after treatment and saw about two lines better on the chart without glasses. The reviewers rated this evidence as very low quality [1].

In an eight-year German study, about half of the patients who had the shorter (accelerated) treatment had no change in their best corrected vision. About one in five gained more than one or two lines [2].

The cornea keeps changing slowly. In the same study, the steepest part of the cornea was significantly flatter at three years and at eight years than before treatment [2].

Haze and other side effects

Some clouding of the cornea, called haze, is common in the first months. In the German study, a measure of corneal clouding rose over the first six months and returned towards its starting level between one and three years [2].

A review of 2,025 eyes treated with accelerated cross-linking reported these complications [3]:

• haze in 9.1% of eyes
• treatment failure, meaning the keratoconus kept progressing, in 4.2%
• loss of two or more lines of vision in 2.4%
• slow healing of the surface layer in 1.8%

The Cochrane review described side effects as "not uncommon but mostly transient and of low clinical significance" [1]. Infection after cross-linking was rare in the studies we read. One of 61 patients in the German study developed an early corneal infection or inflammation [2].

A second Cochrane review compared the standard method, where the surface layer is removed, with methods that leave it in place. In four of the trials (221 eyes), removing the surface layer led to slightly more haze or scarring. The reviewers could not say whether either method is better at stopping progression [4].

Your surgeon will tell you which symptoms need an urgent review after the procedure.

How long does the effect last?

• Adults, 10 years. In a follow-up of 19 eyes from the United States trials, about 82% of the keratoconus eyes were still stable on corneal mapping at 10 years [5].
• Adults, 8 years. In the German study, 4 of 16 patients (25%) who had the standard treatment and 5 of 45 (11%) who had the accelerated treatment progressed and needed a repeat treatment.
• Children and teenagers, 10 years. In a study of 175 eyes treated with accelerated cross-linking before age 18, keratoconus progressed again in about 9%. Three eyes had a repeat cross-linking and three had a corneal transplant [6]. A smaller Italian study of 38 eyes found that 34% showed some progression on corneal mapping after 10 years or more, although only about 8% showed a significant change in the front curve of the cornea [7].

The authors of the larger children's study recommend long-term follow-up after cross-linking to look for renewed progression [6]. We did not find a study that tests how often those checks should be. Your surgeon and optometrist will set the schedule for your eye.

Contact lenses after cross-linking

When can I go back to my lenses? There is no agreed answer. The authors of one study note that the ideal time to fit rigid lenses after cross-linking is unknown, and that published suggestions range from one week to six months [8]. In a small study of scleral lens wearers (11 eyes), the lens fit and corneal measurements had not changed significantly on average three months afterwards. The authors suggest that wear could resume one month after surgery [9]. Follow your surgeon's instruction for your own eye.

Will my lenses need changing? Possibly. A study of 53 eyes found that the curve of the rigid lens needed a small adjustment after cross-linking, while vision with the lens was unchanged over 12 months [10].

Will lenses feel different? A small study compared rigid lens wear in 21 cross-linked eyes and 20 eyes that had no cross-linking. How often and how strongly people felt discomfort was similar. The cross-linked group reported more frequent fluctuation of vision and a lower overall comfort rating. Five cross-linked eyes and three untreated eyes stopped lens wear [8]. The study was small.

Does cross-linking reduce the need for a transplant?

Registry data suggest it may. In the Netherlands, about 25% fewer corneal transplants were done for keratoconus in the three years after cross-linking was introduced nationally than in the three years before [11]. In New Zealand, eye bank data to 2020 led researchers to write that cross-linking "may be having an early effect" on transplant numbers for keratoconus [12]. These are observations over time and cannot prove cause.

More about the procedure

Dr James McKelvie's clinic explains how corneal cross-linking is carried out at Eye Surgeons NZ.

This article is general information. It does not replace an examination or personal advice.

Choosing a surgeon: in the Waikato, corneal cross-linking is offered by Dr James McKelvie at Eye Surgeons NZ, Dr Michael Merriman at Hamilton Eye Clinic and Mr Chris Murphy. You are free to choose any of them, or another surgeon, and we will send your results to whoever you choose.

Care at Rose Optometry is provided by our optometrist team: Jagrut Lallu, Jacqueline Rowe, Emilie Lawson, Jason Shen, Jessica Wood, Stella Wong and Anjali Hira.

References

1. Sykakis, 2015, Cochrane Database Syst Rev. DOI PubMed 25803325
2. Ramm, 2025, Int Ophthalmol. DOI PubMed 41441936
3. Çakmak, 2020, Int Ophthalmol. DOI PubMed 32715365
4. Ng, 2021, Cochrane Database Syst Rev. DOI PubMed 33765359
5. Greenstein, 2023, Eye Contact Lens. DOI PubMed 37565471
6. Ahmet, 2024, Eye (Lond). DOI PubMed 38609652
7. Vinciguerra, 2023, Am J Ophthalmol. DOI PubMed 37478962
8. Javaheri, 2024, J Ophthalmic Vis Res. DOI PubMed 39917458
9. Aisien, 2025, Eye Contact Lens. DOI PubMed 39841871
10. Zhao, 2022, Zhonghua Yan Ke Za Zhi PubMed 35391514
11. Godefrooij, 2016, Acta Ophthalmol. DOI PubMed 27213687
12. Chilibeck, 2021, Cornea. DOI PubMed 34267061

This article is general information, not personal medical advice. Most sources were checked against the full published papers in October 2026.