How Holcomb C3-R Was Developed

How Holcomb C3-R® Was Developed – Brian S. Boxer Wachler, MD

The first 1998 publication of crosslinking was with epithelium removal and it showed ability to stabilize the disease, but it reported pain in recovery and corneal swelling side effects (future studies would show many more side effects from epithelium-removal crosslinking such as corneal ulcers, cornea haze, very slow recovery, partial loss of vision, etc). Nonetheless after this publication, there was one peculiar thing: no one was performing crosslinking. The publication was out there, but went largely unnoticed by the ophthalmology community and medical societies. It was the equivalent of a “silent shot in the dark.” Not one doctor around the world seemed to notice this publication in 1998, except one doctor: myself.

I was fascinated when I read this study as I was already pioneering the use of Intacs® for Keratoconus as an alternative to invasive corneal transplants that carry significant risks. After my own research into crosslinking, I quickly realized that scaping off the epithelium will cause a lot of pain during the recovery and other potential problems. I thought, “there MUST be a better way!”

How Holcomb C3-R was developedI worked to develop a way to perform crosslinking WITHOUT needing to do the invasive step of scraping off the cornea’s epithelium top layer (aka transepithelial crosslinking).

After many, many nights working on this after hours, I finally discovered a method to obtain successful results. Was it possible to have a completely non-invasive, transepithelial (epithelium-on) procedure that stops Keratoconus in its tracks without the risks that epithelium removal crosslinking inherently carries? The answer was a resounding “YES!” After this discovery, I could hardly sleep that night in 2003.

Dr. Brian Boxer Wachler famous patientI remember very vividly our first patient. He is a very famous movie producer in Hollywood (due to patient privacy, I cannot mention his name, but you would know his movies and the A-list stars of those movies).

He unfortunately had Keratoconus develop after LASIK.  I explained the nature of this new procedure that I invented. (I hadn’t given it a name then). He was open to it and trusted me. The results were incredible: we stopped his Keratoconus from progressing and he was very happy. And best of all: he was back at the work the very next day after the procedure, no discomfort, no time off work, no change in his life. It was amazing, just a one-day recovery.

I discussed with my wife Selina my excitement. On a plane flight with Selina shortly afterwards, I explained the nature of the procedure and that it needed to have a simple name. It would be hard for people to say: riboflavin in the cornea for collagen crosslinking.

A lot of great ideas have been written on the back of a napkin. I suppose we can add the naming of this procedure to that list. Years ago I learned a process to help with creativity. You draw the words of interest in a circle and then keep looking at the words. Usually with time the solution will hit you. On the back of a United Airlines napkin I did this with Selina at my side.

The Idea behind Holcomb C3-RSuddenly, the name of the procedure jumped out like a jack-in-box from the circle of words: C3-R®. There were three words with letter “C” (corneal collagen crosslinking) and one word with “R” (riboflavin). Eventually I obtained a United States Trademark for C3-R®.

Since the C3-R® procedure is distinctly different from invasive epithelium removal crosslinking and other “home grown” epithelium-on crosslinking that some other doctors are trying to do now, I wanted to be sure we protected our established crosslinking C3-R® brand that uses a proprietary Crosslinking Solution (that contains riboflavin and other compounds).

By doing this, the proprietary C3-R® procedure could never be confused with less desirable or unproven crosslinking techniques. C3-R® now has over 10 years behind it. Since 2003, people know and trust C3-R® since it has stood the test of time and has a Gold medal behind it.

Why trademark C3-R®? It’s like with Coke® that is a protected brand owned by The Coca-Cola Company. When you buy a Coke®, you know exactly what you’re getting. You know it won’t taste different from what you expect. You know Coke® is made from the secret formula locked in a vault somewhere deep in The Coca-Cola Company headquarters in Atlanta, Georgia. You know if you buy a Coke, it’s not an unauthentic knockoff from another company – they can’t call their cola “Coke” because The Coca-Cola Company owns the trademark for Coke®. These are all the same reasons that C3-R® is trademarked (and yes, our secret formula for our Crosslinking Solution is also locked in a vault). People know with C3-R® they are getting the “real thing.”

Steve Holcomb and Dr. Brian after winning the Gold MedalIn 2007, our Keratoconus patient Steven Holcomb, the top bobsled driver for the United States team, regained 20/20 vision from C3-R® and Visian ICL and came back from vision-related retirement. He won Gold in 2010 at Vancouver, the first Gold for the U.S. in 62 years.

On April 9, 2010 when Steven and I were on Dr. Phil’s The Doctors television show, I announced the name modification of “C3-R®” to “Holcomb C3-R®” in honor of Steven Holcomb.This marked the first time in history that a treatment for a disease was named after a Gold Medal athlete who made the treatment world-famous.

Because of the massive media exposure about Steven’s accomplishment and his comeback from Keratoconus, people around the world now know there are options besides invasive and painful cornea transplants.

Warmest regards,

Dr. Brian

Dr. Brian’s Keratoconus Patient Experience YouTube Channel

To view videos from our “Keratoconus Patient Experience” YouTube Channel – simply click below.



Many out-of-town patients would like Dr. Brian to do a complimentary review of their medical records and make a preliminary determination of candidacy. This is useful before planning a trip to Beverly Hills.

Some people’s friends ask them, “Why are you thinking of travelling to Beverly Hills for your eye procedure?” They typically answer with, “I deserve the BEST and I want to go to the BEST doctor!”

These are the three easy steps for your complimentary chart review with Dr. Brian:

  • Along with your last 2 or 3 eye exams, please be sure to include a color copy of your corneal mapping. Color corneal mapping is a very important tool, along with your exam history, to determine your candidacy. The last 2 years of your total eye history will be used to make this preliminary determination.
  • Inside the envelope, please be sure to include a cover sheet with your name address, phone number and email address and the words, “Keratoconus Record Review”, so that we may optimize communication with you.
  • Enclose with your letter a copy of your records.

Mail to:

Boxer Wachler Vision Institute
Keratoconus Record Review
465 N. Roxbury Drive, Suite 902
Beverly Hills, CA 90210

Or you can scan your records and email them to