Corneal Subspecialty Training
Fellowship-trained corneal surgeon with international subspecialty training in corneal disease and keratoconus.
Corneal Cross-Linking in Brisbane
A 30–60 minute day procedure designed to strengthen the cornea and stop keratoconus from progressing — performed by a fellowship-trained corneal subspecialist who has published peer-reviewed research on advanced cross-linking techniques.
What is Corneal Cross-Linking?
Corneal cross-linking (CXL) is a procedure that strengthens the cornea — the clear front window of the eye. Riboflavin (vitamin B2) eye drops are applied to the cornea and then activated with a controlled beam of ultraviolet (UV-A) light. This creates new bonds, called cross-links, between the collagen fibres of the cornea, stiffening it to help stop conditions like keratoconus from progressing.
The treatment acts on the front layers of the cornea and does not involve any cutting or implants. Dr Gunn offers advanced, customised cross-linking using the Mosaic system (Avedro, a Glaukos company) — one of the most advanced cross-linking technologies available in Australia. Rather than treating the whole cornea equally, the Mosaic maps your eye and delivers a tailored, patterned UV-A treatment, directing more energy to the steepest, most distorted part of the cone and less to healthy tissue, to strengthen the cornea while helping make its shape more regular.
Dr Gunn and his colleague Dr Brendan Cronin were the first surgeons in Australia to offer this technology (2019), and Dr Gunn has published peer-reviewed research on advanced epithelium-on cross-linking.
Cross-linking may be recommended if you have:
- Progressive Keratoconus: Corneal mapping showing your keratoconus is getting worse over time — the most common reason for cross-linking.
- A Recent Diagnosis at a Young Age: Keratoconus is most aggressive in teenagers and young adults, so early stabilisation offers the best chance of preserving vision long-term.
- Corneal Ectasia After Laser Surgery: A rare weakening of the cornea after LASIK or other laser procedures, which cross-linking can stabilise.
- Planned Combined Treatment: Cross-linking is often paired with CAIRS or laser regularisation to stabilise the cornea after its shape is improved.
How Cross-Linking Works
Dr Gunn is a fellowship-trained corneal subspecialist at the Queensland Eye Institute. He performs customised, topography-guided cross-linking and has published research on advanced CXL techniques in the peer-reviewed literature.
Riboflavin + UV-A Light
Vitamin B2 drops soak into the cornea and are activated by a calibrated UV-A light. New collagen cross-links form, stiffening the cornea — like adding extra struts to a bridge.
Mosaic Topography-Guided CXL
With the Mosaic system, the UV-A energy is shaped to your corneal map — directing more treatment to the steepest, most distorted part of the cone — to help regularise the cornea, not just stabilise it. Dr Gunn was among the first in Australia to offer it.
Epithelium-On or Off
Cross-linking can be performed with the surface layer of the cornea removed (epithelium-off) or intact (epithelium-on) with supplemental oxygen. Dr Gunn will recommend the protocol best suited to your cornea.
Combined With Reshaping
Cross-linking stabilises but does not substantially reshape. For patients who also need better corneal shape, it is combined with CAIRS or laser regularisation as part of a staged plan.
Why Have Cross-Linking With Dr Gunn?
Published CXL Research
Co-author of peer-reviewed research on oxygen-supplemented, topography-guided epithelium-on cross-linking.
The Full Keratoconus Toolbox
Cross-linking is planned alongside CAIRS, laser regularisation, and specialty lens options — not in isolation.
Why Consult Dr. David Gunn?
"Cross-linking is the foundation of modern keratoconus care: stop the disease first, then improve the shape."
RANZCO Gold Medalist & first surgeon in Australia to perform CAIRS (2021)
Fellowship-Trained Corneal & Refractive Surgeon
What You Can Expect
1. Your Consultation
High-resolution Pentacam corneal mapping to confirm whether your keratoconus is progressing, measure corneal thickness, and plan whether cross-linking alone — or a combined approach — is right for you.
PENTACAM TOPOGRAPHY
2. The Procedure
A day procedure under anaesthetic eye drops taking 30–60 minutes. Riboflavin drops are applied to the cornea, then activated with UV-A light. A soft bandage contact lens protects the eye afterwards.
DAY PROCEDURE
3. Recovery & Results
Expect a gritty, light-sensitive eye for the first few days — generally milder and quicker to settle with the epithelium-on protocol. Most patients return to light activities within 3–4 days. Vision may fluctuate for several weeks to a few months as the cornea settles, and follow-up mapping tracks your corneal stability over time.
LONG-TERM STABILISATION
Corneal Cross-Linking FAQs
Will cross-linking improve my vision?
The main goal of cross-linking is to stop keratoconus from getting worse, not to improve vision. Some patients experience a small amount of corneal flattening over time, but vision generally stays similar to before the procedure. If improving corneal shape and vision is also a goal, cross-linking can be combined with other treatments such as CAIRS or laser regularisation.
How successful is corneal cross-linking?
Cross-linking is the established, evidence-based treatment for stopping the progression of keratoconus. In a landmark Australian randomised controlled trial (the Melbourne CXL study, Wittig-Silva and colleagues, published in Ophthalmology in 2014), treated eyes stabilised — and on average flattened slightly — over three years, while untreated eyes continued to steepen. A small proportion of eyes can still progress after treatment, which is why ongoing corneal mapping is part of your follow-up.
What are the risks of cross-linking?
Cross-linking is a well-established procedure with a strong safety record, but like any surgery it carries some risks. These include temporary blurring of vision while the cornea heals, corneal haze (usually mild and settling over time), and — less commonly — infection, sterile inflammation, or slow healing of the corneal surface. Very thin corneas may need a modified (epithelium-on) protocol or may not be suitable for treatment. Dr Gunn measures your corneal thickness and discusses the specific risks for your eyes before you decide whether to proceed.
What is the difference between cross-linking and CAIRS?
They do different jobs. Cross-linking stiffens and stabilises the cornea to stop keratoconus progressing, but does not substantially change its shape. CAIRS (corneal allogenic intrastromal ring segments) reshapes the cornea to improve its contour and visual quality. Many patients benefit from both: CAIRS to improve the shape, and cross-linking to lock in stability. Dr Gunn was the first surgeon in Australia to perform CAIRS and will advise which combination suits your eyes.
Is cross-linking painful?
The procedure itself is performed with anaesthetic eye drops, so you should feel pressure but not pain. It is normal for the eye to feel gritty, watery, and sensitive to light for the first 2–3 days while the surface heals, and pain relief is provided for this period. Most patients return to light activities within 3–4 days.
Is cross-linking covered by Medicare, and what does it cost?
Yes. Corneal cross-linking for keratoconus with documented progression attracts a Medicare rebate (MBS item 42652), and most private health funds contribute to the hospital costs depending on your level of cover. To be eligible, your corneal maps need to show the keratoconus is getting worse over time. For patients without private health insurance, Dr Gunn can often perform cross-linking as an in-clinic (in-rooms) procedure under anaesthetic eye drops rather than in hospital — this avoids hospital and theatre fees and can reduce the overall cost. You will receive a written quote covering all fees before booking your procedure.
At what age should cross-linking be done?
As soon as progression is documented. Keratoconus tends to be most aggressive in teenagers and young adults, so cross-linking is often recommended promptly in younger patients with progressing disease. In older patients, the cornea naturally stiffens with age, so treatment is only recommended when corneal mapping shows genuine progression.
Worried your keratoconus is progressing?
The earlier progressive keratoconus is stabilised, the more vision is protected. Book a corneal assessment with Dr Gunn to find out whether cross-linking is right for you.
Book Your Cross-Linking Assessment
Written and reviewed by Dr David Gunn FRANZCO, FWCRS — Corneal, Cataract and Refractive Surgeon.
Last reviewed: 27 July 2026