Evidence seems to favor epithelium-on for future of cross-linking

The debate over epithelium-on vs. epithelium-off collagen cross-linking for keratoconus and post-corneal refractive surgery ectasia is, in my opinion, similar to the much older LASIK/SMILE vs. PRK competition of the past three decades. Looking at global adoption rates, LASIK/SMILE is the clear winner over time vs. PRK in refractive corneal surgery. With equal efficacy and similar total complication rates, although different complications, patients and their surgeons have voted loud and clear that they prefer the reduced pain and more rapid visual recovery of LASIK/SMILE vs. PRK.
The challenge

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