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KC is a rare, progressive, and sight-threatening eye disease1,2

Missing the opportunity to promptly treat KC leads to vision loss1-3

Although KC first presents in adolescence, most cases go undiagnosed for decades

  • Most KC damage occurs between the ages of about 10 to 304
~90% of pediatric patients progress within 12 months without corneal cross-linking treatment5 44% of patients 35+ experience progression despite it being more common in younger patients6
Eye chart

If left untreated, 1 out of 5 eyes with KC will eventually require a corneal transplant7-10

Despite the negative impact of KC on psychological, social, and professional aspects of their lives, many patients do not pursue treatments, such as epithelium-off corneal cross-linking, for various reasons, including11-13:

Illustration of an eye with fear lines

Fear of surgery on first eye 
Illustration of an eye with a diagonal slash through it

Reluctance to treat second eye due to unpleasant experience with first eye 
Illustration of an analog clock with an arrow circling it

Disruption to work and time required for recovery 

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KC is often caught too late2

Despite advances in treatments and guidelines, KC is often diagnosed at a late stage 

Retrospective analysis of 399 patients (722 eyes) newly diagnosed with KC indicated that:

Only 13%

were diagnosed before 18 years of age2

 Approximately 70%

had reached TKC stage 2 (moderate
severity KC) or higher by the time of diagnosis2

In a retrospective cohort study of IRIS registry patients newly diagnosed with KC from 2015-202014:
  • 83% had not received treatment14
  • 5% had received a corneal transplant14
  • 12% had received corneal cross-linking14

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IRIS=Intelligent Research in Sight; KC=keratoconus; TKC=Topographic Keratoconus Classification.

References:

  1. Valdez-Garcia JE, et al. Prevalence of keratoconus in an adolescent population. Rev Mex Oftalmol. 2014;88(3):95-98.
  2. Kreps EO, et al. Diagnostic patterns in keratoconus. Cont Lens Anterior Eye. 2021;44(3):101333.
  3. Jhanji V, et al. Corneal Ectasia Preferred Practice Pattern®. Ophthalmology. 2024;131(4):P205-P246.
  4. Ferdi AC, et al. A systematic review and meta-analysis of 11 529 eyes. Ophthalmology. 2019;126:935-945.
  5. Chatzis N, Hafezi F. Progression of keratoconus and efficacy of riboflavin-ultraviolet A corneal collagen cross-linking in stabilizing the condition. J Refract Surg. 2012;28(11):753-758.
  6. Ozalp O, et al. Progression of keratoconus and efficacy of riboflavin-ultraviolet A corneal collagen cross-linking in stabilizing the condition. Cornea. Published online September 2, 2025. doi:10.1097/ICO.0000000000003979
  7. Deshmukh R, et al. Management of keratoconus: an updated review. Front Med (Lausanne). 2023;10:1212314.
  8. McGhee CN, et al. Contemporary treatment paradigms in keratoconus. Cornea. 2015;34(suppl 10):S16-S23.
  9. McGhee CN. 2008 Sir Norman McAlister Gregg Lecture: 150 years of practical observations on the conical cornea – what have we learned? Clin Exp Ophthalmol. 2009;37(2):160-176.
  10. Rabinowitz YS. Keratoconus. /em>Surv Ophthalmol. 1998;42(4):297-319.
  11. Fan L, et al. Impacts of keratoconus on quality of life: a qualitative study. Eye (Lond). 2024;38(16):3136-3144.
  12. Fournié P, et al. Keratoconus and the impact of treatment on patients’ quality of life: a qualitative study. Ophthalmol Ther. 2023;12(4):1939-1956.
  13. D’Oria F, et al. Corneal collagen cross‑linking epithelium‑on vs. epithelium‑off: a systematic review and meta‑analysis. Eye Vis (Lond). 2021;8(1):34.
  14. Syed ZA, et al. Ophthalmology. 2024;131(8):892-901.

IMPORTANT SAFETY INFORMATION

Contraindications

EPIOXA™ HD and EPIOXA™ are contraindicated in patients with known hypersensitivity to benzalkonium chloride (BAC) or any ingredients in EPIOXA HD and EPIOXA. Epithelium-on corneal collagen cross-linking is contraindicated in aphakic and pseudophakic patients without a UV-blocking intraocular lens.

Warnings and Precautions

Corneal collagen cross-linking should be used with caution in patients with a history of herpetic keratitis due to the potential for reactivation of herpes keratitis.

Adverse Reactions

The most common adverse reaction was conjunctival hyperaemia (31%). Other adverse reactions, occurring in 5% to 25% of eyes included: corneal opacity (haze), photophobia, punctate keratitis, eye pain, eye irritation, increased lacrimation, corneal epithelium defect, eyelid oedema, corneal striae, visual acuity reduced, dry eye, and anterior chamber flare.

Dosage and Administration

EPIOXA HD and EPIOXA are for topical ophthalmic use. NOT for injection or intraocular use.
EPIOXA HD and EPIOXA are supplied in single-dose syringes. Discard opened syringes after use.
EPIOXA HD and EPIOXA are for use with the O2n System and Boost Goggles only.
Refer to the O2n System Operator’s Manual and Boost Goggles User Guide for device instructions.

INDICATIONS AND USAGE

EPIOXA™ HD (riboflavin 5’-phosphate ophthalmic solution) 0.239% and EPIOXA™ (riboflavin 5’-phosphate ophthalmic solution) 0.177% are photoenhancers indicated for use in epithelium-on corneal collagen cross-linking for the treatment of keratoconus in adults and pediatric patients aged 13 years and older, in conjunction with the O2n™ System and the Boost Goggles®.

Please see full Prescribing Information for EPIOXA HD and EPIOXA at www.Epioxa.com.
You are encouraged to report all side effects to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
You may also call Glaukos at 1-888-404-1644.

The information contained in this site is intended for US healthcare professionals only.

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