We are thrilled to announce that EyeCare Center of Orange County is now offering EpiOxa — the first and only FDA-approved epithelium-on corneal crosslinking for keratoconus.
This is the breakthrough our keratoconus patients have been waiting for. For the first time, we can halt disease progression without removing the surface layer of the cornea, which means dramatically less pain and faster healing.
Why We Are Excited
For over 35 years, Dr. Bonakdar has helped hundreds of keratoconus patients restore clear vision with scleral lenses. But scleral lenses correct vision — they don't stop the disease from progressing.
Corneal crosslinking is the only treatment proven to halt keratoconus progression. Until now, though, the only FDA-approved option required scraping off the epithelium (the cornea's protective outer layer), causing days of pain and a long recovery. Many patients — especially teenagers — delayed or avoided it entirely.
EpiOxa eliminates that barrier. The epithelium stays intact. The cornea gets stronger. The patient goes home comfortable.
EpiOxa vs. Traditional Crosslinking: A Quick Comparison
| Traditional (Epi-Off) | EpiOxa (Epi-On) | |
|---|---|---|
| Epithelium removed? | Yes — scraped off | No — stays intact |
| Post-procedure pain | Significant (3-5 days) | Mild discomfort |
| Infection risk | Higher (open wound) | Lower (surface intact) |
| Recovery time | 1+ week off activities | Much faster return |
| Corneal haze risk | Possible | Minimal |
| Effectiveness | Proven | Comparable (Phase III data) |
| FDA approved? | Yes | Yes (October 2025) |
Bottom line: Comparable effectiveness with a significantly better patient experience.
How EpiOxa Works
EpiOxa uses two specialized riboflavin (vitamin B2) eye drop solutions combined with the O2n System and Boost Goggles, which deliver oxygen-enriched UV-A light to the cornea.
This creates new collagen bonds — called crosslinks — that stiffen and stabilize the cornea, stopping the progressive thinning and bulging that defines keratoconus. The entire process happens with the epithelium in place, so there is no open wound and no painful healing period.
What the Clinical Trials Showed
The FDA approved EpiOxa based on two Phase III pivotal trials with over 400 patients. Key results:
- Kmax treatment effect of -1.0 diopter (P <0.0001) — measurable reduction in corneal steepening at 12 months
- No damage to deeper corneal layers — endothelial cell counts were unchanged
- No systemic side effects reported
A separate meta-analysis in PubMed confirmed that epi-on and epi-off crosslinking produce equivalent visual acuity outcomes — but epi-off had higher rates of haze and discomfort.
Who Is a Candidate?
EpiOxa is FDA-approved for adults and patients 13 years and older. You may be a good candidate if:
- You have keratoconus at any stage
- Your corneal maps show progressive steepening or thinning
- You delayed crosslinking because of the pain and recovery concerns
- You are a teenager or young adult — when progression is fastest and intervention matters most
- You are a parent whose child has been flagged for corneal changes
We use the Pentacam corneal tomographer — the gold standard — to map your cornea in detail and determine whether EpiOxa is right for you.
Crosslinking + Scleral Lenses: The Complete Approach
For many keratoconus patients, the ideal treatment plan includes both:
- EpiOxa crosslinking — stops the disease from getting worse
- Scleral lenses — restores clear, comfortable vision (often 20/20)
One stabilizes. The other corrects. Together, they offer keratoconus patients the most complete care available — and we are proud to offer both under one roof, right here in Orange County.
Schedule Your Consultation
If you or a family member has keratoconus, we would love to discuss whether EpiOxa is the right next step.
Call (714) 558-0641 or book online. We serve patients from Santa Ana, Tustin, Irvine, Anaheim, and throughout Orange County.
References
- Glaukos Corporation. FDA Approval of Epioxa. October 2025.
- Epioxa.com — Official product information.
- Epi-On vs Epi-Off CXL: Systematic Review and Meta-Analysis. PubMed.
Medical Disclaimer: This content is for informational purposes only and is not medical advice. The suitability of EpiOxa crosslinking or scleral lenses should be evaluated by a qualified eye care professional based on your individual needs. If you experience sudden vision loss or severe eye pain, seek immediate medical care.
Have Questions About Your Eye Health?
Dr. Alexander Bonakdar and his team are here to help. Schedule a consultation to discuss your specific needs.