Keratoconus is a corneal disease with onset typically occurring during puberty or early adulthood. The cornea progressively thins and acquires a cone-like shape which negatively affects visual acuity. In the early stages, visual acuity can be corrected with glasses or contact lenses. In more advanced cases, a corneal transplant is ultimately indicated to restore visual acuity. Corneal cross-linking (CXL) is a treatment given at a relatively early stage that protects patients against deterioration of visual acuity and further corneal deformation in progressive cases of keratoconus. The effectiveness and low complication rates have been demonstrated in multiple randomized controlled trials with long-term follow-up. Since the introduction of CXL in the Netherlands in 2007, the number of corneal transplants for keratoconus has decreased. Since 1 January 2015, the treatment has been included for reimbursement under certain conditions in the basic health insurance package in the Netherlands.