Eyeworld Daily News

EW SHOW DAILY 48 Meeting Reporter Monday, April 20, 2015 by Ellen Stodola EyeWorld Staff Writer A vedro's (Waltham, Mass.) Saturday night EyeWorld event focused on some of the science behind crosslinking, with a men- tion of continuing to seek approval of crosslinking in the U.S. from the Food and Drug Administration (FDA). The company was hoping for FDA approval before the meeting, said David Muller, CEO of Avedro. Although a recent FDA panel hear- ing voted in favor of approval for 2 different indications, the FDA came back to the company with a request for additional information relating to the areas of the application con- cerning the device. Avedro believes it can provide this information, Dr. Muller said. "We've taken it this far so we will bring it through to the finish," he said. Following Mr. Muller's intro- duction, Vance Thompson, MD, Sioux Falls, S.D., spoke on how crosslinking affects ophthalmol- ogists and how someone could implement it into his or her prac- tice. Dr. Thompson said his true passion is serving the patient. His goal was to bridge what he learned in introducing crosslinking into his practice through the clinical trial to help others prepare for implement- ing it into their practices; however, he said this still has indications for when crosslinking finally does get approved. "We all know the unmet need," Dr. Thompson said. Current treat- ments for keratoconus do not stop it from progressing. With this disease, there is a substantial impact on qual- ity of life for the patient, with both financial and psychological burdens. There is frustration for patients and doctors when the disease progresses after patients are fit with a contact lens. The crosslinking procedure is quite straightforward, according to Dr. Thompson. Equipment needed in the procedure includes pre- and postop medications, epithelial re- moval tools, riboflavin and balanced salt solution, and a crosslinking system. Outside the U.S., there are some exciting things happening with ac- celerated procedures, Dr. Thompson said, mentioning some studies and techniques being developed in other countries where surgeons are already using crosslinking. Additionally, Dr. Thompson said he is excited about topography-guided PRK and poten- tially using this in combination with crosslinking in the future. Corneal crosslinking is the first procedure that may stabilize the progression of keratoconus. Since options for visual rehabilitation remain limited in the U.S., early diagnosis and treatment is critical, Dr. Thompson said. Without FDA approval, patients with progressive disease must seek out clinical trials, travel oversees for treatment, or sit by while their treatment progresses, he said Michael Mrochen, PhD, Zurich, Switzerland, explained the idea of the Brillouin spectroscopy to the audience. This is a new strategy for evaluating crosslinking, which uses light and light scattering to analyze the biomechanical properties. Brill- ouin scattering arises when light is scattered by periodic fluctuations in density that occur as a result of ther- mally exited hyperfrequency sound waves. Study demonstrates that Brillouin spectroscopy could show an effect as a function of depth, and is sensitive enough to detect differ- ences between crosslinking proto- cols, Dr. Mrochen said. William J. Dupps Jr., MD, PhD, Cleveland, highlighted treatment planning using corneal biomechan- ical modeling. The treatment plat- forms offer remarkable versatility and precision in delivering treat- ment features like cuts, ablation, patterned crosslinking, and combi- nations, he said. Corneal imaging systems provide comprehensive 3D representations of individual anatomy and optics, and the inter- action of surgical parameters and patient-specific variables drive the response to surgery and variance in outcomes. An important issue to consider is that conventional planning tools, like nomograms, are retrospective, minimally personalize, or absent. Our tools for treatment planning have not kept pace with our diag- nostic and treatment platforms, Dr. Dupps said. As an alternative, he presented on finite element modeling, which is a tool for structural analysis and prediction in complex systems. You have to test models against clinical reality, Dr. Dupps said, but then this becomes a very powerful tool to use to predict what will happen in a patient you haven't even touched yet. EW Editors' note: This event was sponsored by Avedro. Avedro event highlights crosslinking and its applications by Erin L. Boyle EyeWorld Editor Pearls for social media use in your practice E veryone is doing it. But not everyone is doing it right. The "it" is social media, and Kelsey Vaughan em- phasized the need to keep practice social media content fun and relevant to encourage referrals and patient engagement. "Content that tries to sell doesn't," said Ms. Vaughan, who is account manager at Eyemax, a mar- keting and consulting firm in the refractive eyecare industry. "Content that tries to help does." She taught the ASOA course "The Social Circle: Tapping into Your Most Coveted Referrals," and discussed the use of Facebook, Twitter, Pinterest, Instagram, and YouTube for gaining and keeping referrals. "Social media is a tremendous untapped resource for your prac- tice," she said. "It's important to understand how to use it and how to leverage it." All practices should be on Face- book, she advised. Fifty-six percent of all adults online 65 years and older use the social media network, and Facebook is driving purchasing behaviors as well as engagement Dr. Thompson discusses how physicians might incorporate crosslinking into their practice.

• Cover