COMMENTARY

5 Key Ophthalmology Takeaways: American Society of Cataract and Refractive Surgery (ASCRS) 2016

Sumit (Sam) Garg, MD

Disclosures

May 25, 2016

New Developments in Keratoconus and Ectasia

In early May, the American Society of Cataract and Refractive Surgery (ASCRS) held its annual symposium in New Orleans. As usual, the meeting was packed with new technologies and interesting studies that have the promise to affect clinical care in both the short and long term.

For cornea specialists like myself, the long wait for corneal collagen crosslinking is finally over! Just prior to this year's ASCRS meeting, Avedro Inc. (Waltham, Massachusetts) received approval from the US Food and Drug Administration (FDA) for its riboflavin formulation and ultraviolet light source. The approval is for the traditional epithelial-off treatment that uses 30 minutes of riboflavin soak followed by ultraviolet exposure for 30 minutes, which is currently indicated for progressive keratoconus patients (14-65 years of age).

In an area related to crosslinking, Dr Doyle Stulting highlighted corneal ectasia in his Binkhorst lecture.[1] Stulting is one of the primary authors of the ectasia risk score system (ERSS). He explained that despite the ERSS's attributes, its sensitivity appears to be reduced by the fact that it does not take newer diagnostics into account. He also stated that, in recent studies, the ERSS performs as well as it used to. Stulting postulates that it is failing because it is actually working. Practitioners are avoiding surgery in high-risk candidates per the ERSS, thereby undervaluing the traditional risk factors of the ERSS. For those who are performing or will be performing corneal crosslinking, identification of patients with progressive keratoconus and those with post-LASIK ectasia will be of utmost importance for proper patient selection.

Emphasis on the Ocular Surface

Ocular surface disease (OSD) is increasingly being diagnosed across all ages. This is particularly important with respect to the perioperative period. As our diagnostics improve, the effect of the tear film and ocular surface becomes increasingly important for accurate measurements with respect to astigmatism and surface regularity.

Inflammation is known to be a long-standing culprit in OSD. Now we have point-of-care testing to evaluate both tear osmolarity (TearLab; San Diego, California) and markers of inflammation such as MMP-9 (RPS; Sarasota, Florida).

Ocular surface inflammation is traditionally treated with low-dose topical steroids or topical cyclosporine. A new compound, lifitegrast (Shire; Lexington, Massachusetts), is awaiting FDA approval. This compound decreases inflammation by reducing the overexpression of intracellular adhesion molecule-1 and, thereby, T-cell activation.

Key takeaways from presentations on this topic include the importance of accurate diagnosis of OSD in the perioperative period and pretreatment prior to making a surgical plan, especially when considering a toric or presbyopia-correcting intraocular lens.

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