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Corneal cross-linking (CXL): how do patients see it?

Poster Details


Co Author(s): S. Hamada                    

Abstract Details


The visual impairment in keratoconus patients has many negative effects on their welfare and quality of life. We examined a previously designed questionnaire to measure the quality of life following corneal crosslinking, and to check the correlation of quality of life (QoL) with objective visual function parameters.


Corneoplastic unit and eye bank, Queen Victoria Hospital, East Grinstead, United Kingdom


A questionnaire which was previously designed by one of the authors was used to assess certain psychometric parameters and vision-related quality of life following CXL for patients with progressive keratoconus. The questionnaire consisted of 50 questions that were divided into 6 domains: Peace of mind, activities of daily living, social relations, ocular pain, knowledge, and understanding. The questionnaire was distributed to 26 patients attending follow-up appointments minimum six months after CXL. Objective measures of Kmax, Kmean, corneal pachymetry were measured on with corneal topography (Pentacam). Quality of life measurements was compared with objective findings to establish a correlation between them.


The questionnaire was sent to 26 patients, of which 84.6% were stable, 15.3% regressed, and no case progressed.Those with visual acuity worse than 6/36 scored better on activities of daily living and social relationships while those with vision 6/24-6/9 felt more confident to drive and lives a normal life. A steep keratometric reading in their best eye >52 diopters (D) was associated with lower scores on the Mental Health, Driving, Dependency, and Ocular Pain scales. There was a positive correlation between keratometric measurement (Kmax, Kmean, and thinnest point of the cornea) and scores across all domains. The correlation was strongest when examining fear of blindness and social relationship (p<0.05). Total score correlated with improvement in primary and secondary outcome measures used to assess the success of treatment (UCVA, BCVA, Km, CCT, and Kmax).


Corneal cross linking has a positive impact on quality of life in patients with progressive keratoconus. We recommend that quality of life measurements should be included in the outcomes measures of CXL in patients with keratoconus.

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