The Advantages of ‘Epi-On’ Over ‘Epi-Off’ Treatment of Keratoconus | AAO 2025

Keratoconus, a corneal condition, is treated with cornea collagen crosslinking that strengthens the chemical bonds among the fibrils in the cornea. Traditionally it has been done after removing a thin layer of corneal epithelium that covers the very front of the cornea. But there is an alternative “epi-on” approach that leaves the epithelium intact. Kenneth A. Beckman, M.D., a cornea specialist at Comprehensive EyeCare of Central Ohio, presented positive research findings about the epi-on approach at the American Academy of Ophthalmology annual meeting this weekend in Orlando, Florida.

In an interview conducted by Ophthalmology Times on behalf of Managed Healthcare Executive, Beckman listed some of the advantages of the epi-off procedure over epi-on. He said the procedure is quicker and easier on the patients because “you're not scraping the epithelium.”

Postoperatively, there is less pain, according to Beckman, and patients don’t need to wear contact lenses for an extended period of time as they do with the epi-off procedure. Beckman also said there are also lower risks of infection and scarring and delays of visual recovery “so patients can get back to their daily functioning much quicker.”