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74 | EYEWORLD DAILY NEWS | MAY 4, 2019 ONSITE ASCRS ASOA ANNUAL MEETING by Liz Hillman EyeWorld Senior Staff Writer have as great of a flattening effect. Combination treatments, such as Intacs (Addition Technology) and wavefront-guided PRK, can have a benefit as well, he added. "Right now in the U.S., crosslinking is a well-established but still relatively new procedure. I think it's important to get to patients as early as possible, and that's changing paradigms and re- ferral patterns," Dr. Ayres said. Editors' note: This event was supported by educational grants from Avedro, Avellino Labs, Dompe, and Johnson & Johnson Vision. tients must have adequate corneal thickness for the procedure and now, he added, we have to prove progression. Crosslinking early preserves vision and corneal integrity, main- tains options for vision correction, and helps avoid the risks, costs, and adverse effects on quality of life associated with PK. Crosslink- ing is now a covered procedure for more than 90% of patients with commercial insurance, Dr. Ayres said. While the epithelium-off Dresden protocol is the FDA-ap- proved procedure, Dr. Ayres discussed data that suggests transepithelial crosslinking can be effective, though it might not biologic medication in ophthal- mology, Dr. Yeu said. The growth factor in this drug, Dr. Yeu added, plays a crucial role in providing trophic support and in the stromal healing process. In studies, com- plete corneal healing was observed in 72% of patients at 8 weeks. Sonia Yoo, MD, Miami, described new features in corneal diagnostics. Preoperatively, there is now a genetic test available to identify transforming growth factor beta- induced (TGFBI) corneal dystro- phies, which would be contraindi- cations for refractive surgery. The Avellino GENE Detection System Test (Avellino Labs) is a cheek swab test that provides results within 2 to 4 days. Dr. Yoo said the indication for genetic testing includes unexplained stromal opacities and an individual less than 40 years old with Korean or Japanese ancestry, a family history of TGFBI dystrophy, or a family history of corneal transplantation for unspecified reasons. In terms of identifying ectasia risk preoperatively, Dr. Yoo said there are new imaging modalities in epithelial maps and high-resolu- tion OCT looking at the epithelial thickness and other microlayers of the cornea. With these, Dr. Yoo said we can start to develop layered maps to rule out keratoco- nus. Aberrometry maps, Dr. Yoo continued, can help sort out the 20/20 unhappy patient who might have an irregular cornea. Keratoconus has traditionally been treated as an end-stage dis- ease, said Brandon Ayres, MD, Philadelphia, but that's changing. "We want to stop and prevent end-stage problems with kerato- conus, prevent patients from ever needing corneal transplants," Dr. Ayres said. Corneal collagen crosslinking provides the opportunity to stop progression of keratoconus in most cases, Dr. Ayres said, but pa- A n EyeWorld CME Education event Friday morning gave attendees a taste of new approaches in the diagnosis and manage- ment of several corneal disorders. Elizabeth Yeu, MD, Nor- folk, Virginia, discussed neu- rotrophic keratitis, which she described as a rare, progressive condition that is characterized by loss of corneal sensory innerva- tion. It can lead to spontaneous epithelial breakdown, and while it has many possible etiologies, it is more common in patients with HSV, longstanding dry eye disease, and can be associated with drug toxicity. Treatment options for this are often aimed more conserva- tively, Dr. Yeu said. These include healing the defect, closing the lid, eliminating topical preservatives and ocular irritants, optimizing the ocular surface, increasing humidi- ty, and incorporating lid hygiene. A therapeutic bandage contact lens is inexpensive and offers mechanical protection and surface hydration, but these patients do need regular follow-up because of the risk that they wouldn't feel an infection, Dr. Yeu said. Amniotic membrane, she added, can trigger growth fac- tors that can help restore stromal thickness and reestablish epithelial integrity. Eyelid closure, whether a temporary taped tarsorrhaphy or more permanent tarsorrhaphy, can provide protective ptosis and prevent exposure. Cenegermin (Oxervate, Dompe) was FDA approved in 2018 as a novel recombinant hu- man nerve growth factor. It is the first application of a human nerve growth factor and the first topical Update on the diagnosis and management of corneal disorders "We want to stop and prevent end-stage problems with keratoconus, prevent patients from ever needing corneal transplants." —Brandon Ayres, MD Dr. Yeu describes therapies to treat neurotrophic keratitis.

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