Eyeworld

2 | SUPPLEMENT TO EYEWORLD | JANUARY/FEBRUARY 2020 Elizabeth Yeu, MD New therapies for managing neurotrophic keratitis Treatments help promote corneal healing and nerve regeneration N eurotrophic keratitis is a rare, progressive condi- tion characterized by the loss of corneal sensory innervation. Impairment of the trophic supply and trigem- by Elizabeth Yeu, MD respondents, followed by label- ing or regulatory approval sta- tus (40%) (Figure 1). Forty-two percent of non-U.S. surgeons identified a lack of patient population or lack of patient referrals from primary eyecare providers and 33% inadequate or uncertain reimbursement. Corneal topography (39%) and progression of Kmax (32%) are used most often to determine whether cases are suitable for corneal crosslinking. Nineteen percent of respondents use change in tomography. Nearly 70% of respon- dents rely on corneal topogra- phy interpretation to determine candidacy for LASIK based on their risk of ectasia, and 10% or less use point values as determined by the Randleman criteria, percent tissue altered criteria, or other criteria (Figure 2). For patients who need a posterior cornea transplant, 44% had no opinion on wheth- er to perform or recommend a Dr. Kim is a professor of ophthal- mology and chief of the Cornea and External Division and director of the Refractive Surgery Service at Duke University Eye Center, Durham, North Carolina. He can be contacted at terry.kim@duke.edu. Descemet's membrane endo- thelial keratoplasty (DMEK) or Descemet's stripping endo- thelial keratoplasty (DSEK) (46% U.S., 39% non-U.S); 33% preferred DMEK compared with DSEK (23%). This supplement includes insights from noted experts, discussing new therapies for managing neurotrophic kerati- tis, detection and management of corneal disorders in cataract and refractive patients, and evolving protocols for early intervention in patients with keratoconus and ectasia. n inal reflexes leads to a cascade of effects, including epithelial alterations that impede healing and may lead to spontaneous corneal epithelial breakdown. Case report A 60-year-old man had a histo- ry of unilateral herpetic epithe- lial keratitis of the right eye. His right eye was light sensitive and teary for a few days, with min- imal redness. He had no ciliary flush or pain but had occasional foreign body sensation. His last epithelial flare-up was in 2017. His best-corrected visual acuity was 20/25 and uncorrected vi- sion was 20/30+. He uses 500 mg valacyclovir twice daily. continued from page 1 continued on page 3 New approaches to the diagnosis and management of important corneal disorders in the cataract and refractive surgery patient Figure 2 Source: 2018 ASCRS Clinical Survey Do you exclude patients for LASIK based on their risk of ectasia? Nearly 70% rely on topography to determine candidacy for LASIK All U.S. Non U.S. Yes, based on my interpretation of the topography Yes, based on a point value as deter- mined by the Randleman Criteria Yes, based on the Percent Tissue Altered Criteria Yes, based on other criteria No 0% 10% 20% 30% 40% 50% 60% 70%

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