The recently published study by Soeters and associates compared the clinical effects of transepithelial corneal cross-linking (CXL) with epithelium-off (epi-off) CXL in progressive keratoconus prospectively. This issue has recently been studied intensively by researchers, and this present study provides a valuable contribution to the literature that transepithelial CXL was not recommended because of continued keratoconus progression after 1 year. There are 2 topics involving the controversial aspects of transepithelial CXL treatment. One of them is the formulation of transepithelial riboflavin solutions. It was shown that the presence of dextran in transepithelial solution reduced the passage through the epithelium. However, Soeters and associates used Ricrolin TE, which consists of sodium EDTA 0.01%–TRIS 15% and dextran T500-riboflavin 0.1%. The second topic is the dosage of total ultraviolet-A (UVA) energy. It is well documented that corneal epithelium and Bowman layer decreases the passage of UVA and it was determined that the amount of blockage was approximately 20%–30%. So, the total dose of UVA energy should increase and a 7.2 J/cm ² dose is reasonable for transepithelial CXL. However, Soeters and associates used 5.4 J/cm ² total UVA energy. These 2 controversial topics may be associated with the failure of transepithelial CXL treatment in this present study. Additionally, the study entitled “Epithelial on or Epithelial off Corneal Collagen Cross-Linking: Bilateral Comparison Study” used dextran-free TE riboflavin solutions and 7.2 J/cm ² total UVA energy and showed that both techniques were able to stop progression at the end of 14.1 months (Yuksel E, et al. Epithelial on or epithelial off corneal collagen cross-linking: bilateral comparison study. 19th ESCRS Winter Meeting, Istanbul, Turkey; February 20–22, 2015.)