EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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52 | EYEWORLD | NOVEMBER 2019 C Contact information Name: ORNEA RESEARCH HIGHLIGHT there is a treatment now that can slow or stop progression, Dr. Beckman said. "I think most corneal specialists are aware of it, so I think this will be nice for general ophthalmologists and optometrists," he said. In the U.S., the only regimen that is ap- proved currently is epi-off, which works really well but there are obvious risks of removing the epithelium, Dr. Beckman said. Those risks include pain in creating the epithelial defect, infection, delayed epithelial healing (which may lead to scarring and haziness of cornea), and it's a longer recovery and not a comfortable procedure. Internationally, they're doing epi-on, and that's being investigated in U.S. in a num- ber of protocols, he added. The advantages of epi-on is that by not removing epithelium, you don't have discomfort, you can have quicker visual recovery, much less risk for infection, and potentially less risk for scarring and haze. flattening and improvement in patients who are already advanced. "Myself and a number of other physicians and corneal specialists have taken on the belief that if the cornea is optically clear, and the vision is blurred from steepness and irregularity rather than a central scar, there's a very high likelihood that they can keep good vision with a scleral lens, and the fitting tech- niques are so good that we recommend cross- linking to stabilize and fit with a scleral lens. And you may be able to prevent a transplant," Dr. Beckman said. Financial factors also play a role in cross- linking, he said. Initially, it was not covered by any insurance, its expense made it a barrier to patients. "Now that CMS has recognized this and created a code, insurance companies are starting to pay," he added. This makes crosslink- ing even more accessible to patients. We're trying to create awareness to physi- cians, in general, that this is a real condition and Capturing the best conversations at meetings Subscribe today continued from page 50 Reference 1. Beckman KA, et al. ASCRS Cornea Clinical Committee. Corneal crosslinking: current protocols and clinical approach. J Cataract Refract Surg. 2019;Epub ahead of print.