JAN 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 61 of 70

January 2013 infections should occur at all— should be of concern to ophthalmologists. Fiona Jane Stapleton, Ph.D., Sydney, looked into the various risk factors affecting the incidence of keratitis. Among the modifiable risk factors Dr. Stapleton examined, she found that using contact lenses six to seven days a week resulted in a six-fold increase in risk; other factors include extended wear, internet purchase, occasional overnight use, poor case hygiene, smoking, daily disposable contact lens use, and failure to hand wash lenses. Nonmodifiable risk factors include the initial six-month extended wear of contact lenses, socioeconomic factors, age less than 49 years, hypermetropia, and male gender. Daily disposable lens use, she said, had the curious effect of increasing the risk of microbial keratitis, but lowering the incidence of severe disease compared with planned replacement daily wear— 50% against the 70% seen in patients using the latter. Dr. Stapleton concluded that incidence has not changed with newer contact lenses, contact lens fluid formulations, and modalities, but that it is possible to limit the severity of the disease by favoring daily disposable lenses and avoiding delay in treatment. Contact lens and lens case hygiene being risk factors, Dr. Stapleton emphasized the need for ophthalmologists to work with industry, regulators, and researchers to establish a standardized set of guidelines for proper product care. Editors' note: Drs. Holland, Sheppard, and Stapleton spoke at a lunch symposium sponsored by Bausch + Lomb. Nov. 29, 2012 The Asia Cornea Society's 3rd Biennial Scientific Meeting continued with sessions that paint closely examined portraits of the cornea, including some surprising architectural details that almost certainly "expand the realm of the possible." Deconstruction, control, restoration Much has been said about the evolution of corneal transplant surgery, the way the procedure has, over the years, rapidly shifted from one paradigm—the wholesale replacement of the full thickness of the cornea—to another: the deconstruction of the cornea with selective lamellar keratoplasty. The current paradigm has most recently led to the development of what may be the ultimate iteration of selective lamellar keratoplasty— Descemet's membrane endothelial keratoplasty (DMEK)—but as the procedure is unrefined, at the moment, cornea surgeons are likely to stay focused on the procedure whose advantages are often touted at cornea meetings: Descemet's stripping automated endothelial keratoplasty (DSAEK). EW MEETING REPORTER 59 But while the advantages—less post-op astigmatism, better UCVA, BCVA, and survival than PK, etc.— are well known, Donald Tan, M.D., Singapore, president of the Asia Cornea Society, asked in his plenary lecture: Can these advantages be adopted in Asia? One major impediment to acceptance, said Prof. Tan, is the cost of the ALTK microkeratome. As continued on page 60

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