Chang Reaction: Facts vs Myths in Corneal Cross-Linking

Are you overwhelmed or intrigued by the ever-growing clinical information on corneal cross-linking (CXL)? What treatment options are available for keratoconus patients? And how can your management deliver the highest level of impact to patients’ lives? In this episode of Chang Reaction, Dr. Grace Lytle sits down with Dr. Clark Chang to separate the facts from myths on CXL, which will guide eye care professionals in making evidence-based decision on how to best manage and educate keratoconus patients.

Dr. Lytle earned her Doctor of Optometry and Master of Vision Science degrees from the New England College of Optometry, with research interests in the areas of ocular growth mechanisms and the development of myopia.   After completing residency training in cornea and contact lens through the New England Eye Institute, Dr. Lytle directed contact lens services and practiced optometry in a multi-specialty ophthalmic practice. Additionally, she has served as a course instructor at the New England College of Optometry. In her current role as the VP of Medical Affairs at Avedro, Inc., she provides her scientific and clinical expertise to cross-linking researchers around the world.   

Dr. Lytle interacts with leaders in optometry and ophthalmology to gain insight into CXL outcomes and indications, and to bring that knowledge to researchers striving to develop innovative solutions for patients. She has educated and lectured on CXL topics throughout Europe, Asia, North and South America. Now, tune in to Chang Reaction to hear Dr. Lytle share her latest clinical pearls on corneal cross-linking and keratoconus management!

Dr. Grace Lytle, VP of Medical Affairs at Avedro, Inc.

Dr. Grace Lytle’s Financial Disclosure:

Dr. Grace Lytle is VP of Medical Affairs at Avedro, Inc. Avedro is a privately held pharmaceutical and medical device company advancing the science and technology of corneal cross-linking and refractive correction. Dr. Lytle can be reached at

Avedro’s mission is to produce and deliver innovative, minimally invasive drugs and devices for corneal remodeling to eye care professionals around the world to improve patients’ vision and quality of life.



Photrexa® Viscous (riboflavin 5’-phosphate in 20% dextran ophthalmic solution) and Photrexa® (riboflavin 5’-phosphate ophthalmic solution) are indicated for use with the KXL System in corneal collagen cross-linking (CXL) for the treatment of progressive keratoconus and corneal ectasia following refractive surgery.


The safety and effectiveness of CXL has not been established in pregnant women, women who are breastfeeding, patients who are less than 14 years of age and patients 65 years of age or older.

Photrexa Viscous and Photrexa should be used with the KXL System only.


Ulcerative keratitis can occur. Patients should be monitored for resolution of epithelial defects.


In progressive keratoconus patients, the most common ocular adverse reactions in any CXL treated eye were corneal opacity (haze), punctate keratitis, corneal striae, corneal epithelium defect, eye pain, reduced visual acuity, and blurred vision. In corneal ectasia patients, the most common ocular adverse reactions were corneal opacity (haze), corneal epithelium defect, corneal striae, dry eye, eye pain, punctate keratitis, photophobia, reduced visual acuity, and blurred vision.  

These are not all of the side effects of Photrexa® Viscous, Photrexa® and the CXL treatment. For more information, please refer to Prescribing Information on You should report an adverse event to Avedro by calling 1-844-528-3376, Option 1 or you should contact the U.S. Food and Drug Administration (FDA) directly at 1-800-FDA-1088.

Dr. Clark Chang
Dr. Clark Chang is Director of Cornea Specialty Lenses at Wills Eye Hospital - Cornea Service and Director of Clinical Services at TLC Vision. He has over a decade of clinical research experiences in corneal crosslinking and other advanced treatment methodologies. He publishes extensively in clinical management of keratoconus and other corneal pathologies, innovative uses of specialty contact lenses, and modern applications of refractive surgery technologies. Dr. Chang lectures in educational conferences, both within US and internationally, and he is an advisory board member for International Keratoconus Academy (IKA) as well as Optometric Cornea Cataract and Refractive Society (OCCRS).

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