Eyeworld Daily News

ASCRS SYMPOSIA by Lauren Lipuma EyeWorld Contributing Writer considered a prosthetic device, it's often covered by insurance, which helps patients where cost is an issue. Editors' note: Dr. Rajpal is chief medical officer of Avedro. Dr. Prescott has no financial interests relevant to her comments. proved device to support an impaired ocular surface, which can restore vision, support healing, reduce symptoms, and improve quality of life, Dr. Prescott said. The PROSE lens creates a smooth optical surface over an irregular, diseased, or damaged cornea. The lens rests on the sclera and vaults over the cornea, creating a pocket where tear fluid can accumulate. This enhanced tear reservoir provides constant lubrication to the cornea while maintaining the neces- sary oxygen supply. Because the lens is treating hyperopia by crosslinking a donut-shaped portion of the peripheral cornea. The corneal epithelium is a barrier to all three components of the crosslinking reaction: it reduces absorption of riboflavin into the stroma, blocks the UV light, and blocks the oxygen from getting to the site of action. But the PiXL system uses "boost gog- gles" to bring more oxygen to the corneal surface, which benefits the crosslinking reaction and allows the procedure to have a greater effect while the epithelium is on, Dr. Rajpal said. The primary patient popula- tion for this procedure would be emmetropic presbyopes wanting good near vision after cataract surgery, but the population could expand to include slightly myopic or hyperopic presbyopes who want good distance and near vision. A Phase 2 clinical trial for the PiXL procedure is slated to begin this year. Christina Prescott, MD, Bal- timore, discussed the use of con- tact lenses to improve vision and reduce ocular surface discomfort after corneal refractive surgery. Contact lenses are a good treatment option when the patient has residual refractive error, irreg- ular astigmatism, ocular surface disease, neuropathic pain, and poor subjective quality of vision, she said. Often these patients may be on-target in terms of their postop refraction but may still be unhappy with their quality of vision because they have severe ocular surface disease. If the time frame is short— for example, if the cornea is ex- pected to heal or a future surgery is planned, soft contact lenses are a good option. But if the patient needs a long-term solution, Dr. Prescott recommends the PROSE lens (BostonSight) as an option. The PROSE lens is technically considered a prosthetic device, not a contact lens. It's an FDA-ap- T wo technologies offer non-invasive options for treating patients who are unsatisfied with their post-refractive surgery vision, according to speakers at yesterday's "Managing the Unhappy Post-Re- fractive Patient" symposium. Rajesh Rajpal, MD, Mc- Lean, Virginia, discussed how corneal collagen crosslinking could be implemented as a refractive procedure post-cataract surgery in addition to being a treatment for keratoconus. Crosslinking involves using oxygen, riboflavin, and UV light to stabilize the cornea. But the PiXL device (Avedro), which is not yet available in the United States, allows physicians to customize the crosslinking treatment by incorpo- rating corneal topography mea- surements and an eye tracker. The end result is the ability to reshape the cornea by creating a customiz- able area of UV light application, Dr. Rajpal said. Only epithelium-off cross- linking procedures are approved in the United States, but a Phase 3 clinical trial of epithelium-on crosslinking for keratoconus is currently being conducted. This modified crosslinking procedure uses a combination of a different formulation of riboflavin, supple- mental oxygen, and an accelerated protocol to make the procedure non-invasive and could easily be transformed into a standalone refractive treatment, according to Dr. Rajpal. Eye tracking allows the device to selectively activate the ribofla- vin by only shining the UV light on specific areas of the cornea. The device could treat myopia by crosslinking only the central portion of the cornea and for Non-invasive solutions for unhappy post-refractive patients Jessica Ciralsky, MD, serves as one of the moderators at a symposium on managing unhappy post-refractive patients. MAY 7, 2019 | EYEWORLD DAILY NEWS | 41

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