Commentary: Predictors of outcomes after corneal collagen cross linking: Present, and future directions

Corneal collagen -cross-linking (CXL) as we know is a procedure to enhance the biomechanical strength of the cornea, thereby, halting the progression of corneal weakening in Keratoconus (KC). CXL has been in vogue for around two decades now, and along with newer contact lens developments, it has helped considerably in reducing the rates of keratoplasty. CXL is known to have complications such as post-CXL haze or scar, sterile infiltrates, failure, excessive flattening, and endothelial damage, among a few others. A lot of cornea practices across the world are confidently performing CXL as these complications are relatively low. However, in this upcoming era of personalized medicine, there are still a lot of unanswered questions about CXL. Predicting which kind of patients are likely to develop a haze or scarring or excessive or no flattening or failure post-CXL is not possible yet. We do not have the ability to predict the outcomes or complications after CXL to personalize care for different patients.