Eyeworld Daily News

EW SHOW DAILY 24 ASCRS Symposia Monday, April 28, 2014 by Michelle Dalton EyeWorld Contributing Writer New concepts in treating corneal ectasia W hen it comes to treatments for keratoconus, 46% of attendees at a sym- posium on managing corneal ectasias would only consider toric IOLs if the patient did not wear rigid gas permeable lenses (RGP), and 34% would never implant a toric lens in these patients. In practice, 60% of audience respondents perform corneal crosslinking, and 61% prefer the epi-off technique to epi-on. In a patient who had severe ker- atoconus and is contact lens intoler- ant, 47% of audience respondents would opt to perform big bubble deep anterior lamellar keratoplasty (DALK), 33% would perform pene- trating keratoplasty, and 11% would perform femtosecond-assisted DALK. Thomas Harvey, MD, Eau Claire, Wis., noted that any discussion of lenses in keratoconus patients would be off-label, but when others ask him why uses a lens to treat the condition, his response is usually, "Why not?" "As long as there is stability of the corneal shape, and there is a fa- vorable non-corneal anatomy," he said. Several factors should play a role in the decision-making process, he said, including the cornea (consider the astigmatism, elements of irregularity) and the crystalline lens (consider age, amplitude of accommodation, etc.). "Implanting phakic IOLs in patients with keratoconus is not for the faint of heart," he said. "Patients must have a clear lens with good accommodation." Some studies have shown the toric ICL (STAAR Surgical, Monrovia, Calif.) has visual results of 20/25 three years after implantation when used in combination with crosslink- ing. "These are amazing visual results," Dr. Harvey said, "but there was a cumulative 9% endothelial cell count decrease, which may be a result of crosslinking before lens implantation." The literature is full of "small studies, but phakic IOL use in this patient population is a bridge procedure," he said. Surgeons should also consider which formula and target they're using. "The Hoffer Q does not work well in patients with ectasia," he said. Dr. Harvey speaks at the "What's New in the Management of Corneal Ectasias" symposium. He recommended surgeons determine if the patient is going to need a contact lens after any proce- dure, only consider phakic IOLs in those with truly clear lenses, and place sutures in the eye. Contact lenses are useful for "any corneal ectasia," said Deborah Jacobs, MD, Boston. Conventional treatments of corneal ectactic disor- ders are typically spectacles, silicone hydrogel lenses, or RGP contact lenses. "Contact lenses are most effec- tive when the myopia is dominant over the astigmatism," she said. RGP lenses are the only ones that can also address astigmatism, she said. She considers contact lenses a "new field" in the treatment of corneal ectasia because "U.S. oph- thalmologists lost interest in contact lenses" about 20-25 years ago with the advent of the PC IOL. "In countries where MDs still prescribe lenses, more than 50% use RGP for ectasia," she said, citing France and Japan, but in countries where ODs prescribe lenses, "it's under 5%." There are several lenses available for keratoconus, Dr. Jacobs said, including piggyback lenses, hybrids, and sclerals. "There are lenses specifically designed for keratoconus with inno- vative base curves," she said. Sur- geons can piggyback "any hard lens over any soft lens" but these have tended to fail because of hypoxia or lens placement. Hybrid lenses are also not an ideal choice, as they may fail because of juncture breakdown, adherence (suction), or neovascular- ization. "Patients see well even when there is a suboptimal fit," Dr. Jacobs said. EW ASCRS•ASOA Winter Update 2015 ASCRS•ASOA Winter Update will return to Turnberry Isle Miami in Aventura, Fla., next February. N ow in it's 8th year, the program continues to grow and provide pearls that can be immediately implemented into practice. New for 2015, the Physicians Program will run from late afternoon on Thursday, February 12 through Sunday, February 15, providing doctors with more than 20 credits, an intimate and interactive learning experience, and allowing for fewer days out of the office. Understanding ophthalmologists' time is valuable, the sessions are designed to provide in-depth coverage and answer challenging questions in case presentation and interactive formats. The ASOA Program Track for Practice Administrators has been gaining momentum, and the return to Florida allows ASOA to offer its excellent programming in a regional setting. The program will focus on several key issues ophthalmic administrators will face in 2015, providing intensive sessions that will help pave the way for success. Turnberry Isle Miami is a member of the Marriott Autograph Collection and ideally situated for a mid-winter program. Located midway between Miami and Ft. Lauderdale, it is easily accessible to either airport, providing attendees with extensive travel options. Turnberry offers a variety of options for attendees to take advantage of.

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