Eyeworld

50 | EYEWORLD | NOVEMBER 2019 C ORNEA RESEARCH HIGHLIGHT Contact information Beckman: kenbeckman22@aol.com Mah: Mah.Francis@scrippshealth.org by Ellen Stodola EyeWorld Editorial Co-Director "Obviously, we've known about keratoco- nus for a long time," said Kenneth Beckman, MD, lead author on the paper. "I don't believe that we realized how common it is and how often it's missed, particularly in young patients. We know that it's progressive and, if left un- treated, particularly in younger patients, it can lead to corneal transplants and a lifetime of maintenance." If a 20-year-old needs a corneal transplant, this might mean they need two or three in their lifetime, and they could also have other complications like cataract and glaucoma. Crosslinking, a treatment plan that's been avail- able internationally for years, just got approved in the U.S. a few years ago, Dr. Beckman said, but one of the problems is people didn't really understand where it fit and what it was, he said. When crosslinking first came out, people thought of it as a rescue treatment instead of a transplant, he said, but that's not the case. "What we now see and recognize is that it's at its best in preventing or slowing progression rather than recovering vision," Dr. Beckman said. "Therefore, an ideal candidate is the young person right upon diagnosis." In this paper, the authors sought to educate ophthalmologists and optometrists that a young patient with early signs of keratoconus can be sent for a crosslinking consultation immediately, rather than being followed for years. Crosslinking is also useful in patients who have progressed, as it can give significant T o correspond with the publication of a new crosslinking paper in November's Journal of Cataract & Refractive Sur- gery, 1 EyeWorld spoke to two surgeons involved with the paper about what it will explore. "The idea of the paper was actual- ly not to be encyclopedic with crosslinking and it was not to suggest what future studies might be done or what the future of crosslinking should entail," said Francis Mah, MD, chair of the ASCRS Cornea Clinical Committee. "Essen- tially it was a much more basic issue." When crosslinking was first approved by the FDA, there was a lot of frustration and misinformation with a lot of questions about the billing and reimbursement aspects, Dr. Mah said. When practitioners were seeking advice, they were getting varied responses, depending on which consultants they were talking to, Dr. Mah continued. So ASCRS, as well as the ASCRS Cornea Clinical Committee, felt that members could really use assistance in this matter. First, ASCRS reached out with AAO and contacted several consultants to come to a consensus on how exactly we should be billing and what CMS is saying to do. With AAO, the Cornea Society, and ASCRS in the room, the groups came an agreement, Dr. Mah said. And then with the assistance of AAO, ASCRS ham- mered out an understanding with CMS for the appropriate codes. The second step was writing a paper with all of the world's literature on the health benefits of crosslinking, trying to support crosslinking as a means for the treatment and management of keratoconus and corneal ectasia following refractive surgery in patients who were candidates before corneal transplants. The paper, he said, focuses more on the "health economics" of crosslinking to show where it can be used in the management of keratoconus and corneal ectasia. Getting the word out and educating members were two major reasons for the paper, Dr. Mah said. New crosslinking paper highlights 'current protocols and clinical approach' continued on page 52 Patient undergoing epithelium-off corneal collagen crosslinking Source: Sumit "Sam" Garg, MD About the doctors Kenneth Beckman, MD Columbus Eye Surgery Center Columbus, Ohio Francis Mah, MD Chair, ASCRS Cornea Clinical Committee Scripps Health La Jolla, California Relevant financial interests Beckman: Avedro Mah: Avedro

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