EPI-ON or EPI-OFF – which is better?

EPI-ON and EPI-PFF are two different methods of performing crosslinking.
We are often asked by our patients which method we think is better.

EPI-OFF Crosslinking

EPI-OFF – the classic and original method of crosslinking.
The corneal epithelium is removed so that the riboflavin can penetrate better into the underlying layers.

The success rate is very high at over 90 percent.
Due to the removal of the ephitel, we nevertheless see some disadvantages in the procedure:

• The top layer of the cornea must heal – longer healing process
• Increased risk of pain, sensitivity to light
• Higher risk of infection due to open corneal surface
• Slight clouding may occur and vision may deteriorate

EPI-ON Crosslinking

The advanced procedure of the classic CXL: EPI-ON Crosslinking.
A comparably effective method with a lower complication rate.

With EPI-ON crosslinking, the corneal epithelium is not removed.
The rest of the procedure is identical to classic crosslinking.
By adjusting the rivoflavin solution and applying an absorption accelerator, the same effect can be achieved.
Continuous research into the method has shown that the success rate with EPI-ON is just as high as with the classic procedure

EPI-OFF is now only rarely used – preferably in patients with very active corneal ectasia.
The removal of the ephitel is intended to achieve the maximum effect in the case of severe ectasia.

Comparable effect, but a lower risk of scarring, infection, less pain and a shorter healing process – these are the main reasons why we usually work with the EPI-ON method.