Eyeworld

MAY 2019 | EYEWORLD | 53 C RESEARCH HIGHLIGHT Contact information Gupta: GUPTAN@smh.ca by Maxine Lipner EyeWorld Senior Contributing Writer graft was the most common indication for full thickness transplant but that partial thickness accounted for two-thirds of all procedures." 2 A few years later, investigators decided to take another look and see where procedures stood. The investigation considered the peri- od from January 2014 to December 2016, Dr. Gupta said. "When we looked at the initial 2012 to 2013 data, we found that the number one partial thickness procedure was DSAEK," she said. "But when we did the new study, we found that DMEK had emerged as the procedure of choice." This was something investigators weren't expecting because technically it's more challenging. "But the studies have reported better visual outcomes with DMEK compared to DSAEK, with lower rates of graft rejec- tion," Dr. Gupta said. "We need to watch to see C orneal transplant techniques continue to evolve. In a recent study, 1 Universi- ty of Toronto investigators examined the types of transplant surgeries per- formed and found that partial thick- ness transplants accounted for 85% of all of their current graft procedures, according to Neeru Gupta, MD. This was up from about 65% a few years earlier. The study initially looked at 2012 when the University of Toronto centralized all of the corneal transplants, which had been at multiple teaching hospitals, into a single center at the Kensington Eye Institute. The idea was to look at current indications and approaches to corneal transplantation during the first year. "This was at a time when partial thicknesses were taking off," Dr. Gupta said. "We found that a failed What's new in corneal transplantation Schirmer test results were significantly associat- ed with lower sleep quality. Two theories emerged regarding the link between sleep and tear secretion. "First, short sleep duration reduces parasympathetic tone, which is believed to stimulate tear secretion. The other possibility is that sleep deprivation influences hormones, such as androgen, that are associated with DED," the researchers wrote. Another potential factor affecting the results is that patients who are anxious may score their DED symptoms as more severe. "An alternative explanation is that the symptoms of DED induce mood orders," the researchers wrote. Clinical pearls Ophthalmologists must analyze possible DED etiology before treating patients. "The etiology may exist locally in the eye or may be due to systemic disease, but it is also very important to consider the sleep quality, mood disorders, and patients' daily life habits," said study co-author Yan Wang, MD. Esen Akpek, MD, found the study inter- esting because although mood disorders are sometimes discussed, sleep quality usually is not. However, patients sometimes mention sleep disturbances. "In general, issues of sleep are discussed more in regard to floppy eyelid syndrome," said Francesann Ford, MD, MBA. "This study seems to suggest we need to add questions regarding sleep to our interviews surrounding dry eye." Attention to both sleep and mental health quality could help both patients and physicians, she added. "Because [dry eye] is such a preva- lent condition, it is easy to quickly brush past the symptoms and move these patients along without really tackling some of the more diffi- cult and significant issues," Dr. Ford said. The study also may bring to light the need for occasional referrals to sleep specialists for these patients, said Dr. Akpek, who has made psychiatrist referrals before with dry eye patients but not to sleep specialists. Dr. Ford's sleep specialist referrals have been limited to floppy eyelid syndrome patients. continued from page 52 About the doctor Neeru Gupta, MD, PhD Professor and Dorothy Pitts Chair, Departments of Ophthalmology & Vision Sciences and Laboratory Medicine and Pathobiology Professor, Dalla Lana School of Public Health University of Toronto References 1. Chan SWS, et al. New trends in corneal transplants at the Univer- sity of Toronto. Can J Ophthalmol. 2018;53:580–587. 2. Le R, et al. Current indications and surgical approaches to cor- neal transplants at the University of Toronto: A clinical-pathological study. Can J Ophthalmol. 2017; 52:74–79. Financial interests Gupta: Allergan continued on page 55

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