MAR 2020

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

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R MARCH 2020 | EYEWORLD | 55 Contact Rocha: rochag@me.com might benefit from intracorneal ring segments at the same time. This was also based on the pioneering work of other colleagues. Dr. Rocha's idea of treating keratoconus with the laser continued to evolve. Already us- ing the femtosecond laser to make channels for the intracorneal ring segments, it occurred to Dr. Rocha to shave off a little bit of the cone with the excimer laser. Dr. Rocha explained that since the epithelium in a keratoconic eye is thinnest at the apex of the cone, the rest of the epithelium could be used as a masking agent. Combining these techniques, Dr. Rocha said physicians began to see not only halting of keratoconus progression but also significant vision improvement. "Many patients were not even wanting contact lenses and were wearing glasses in a minimal way," Dr. Rocha said. Studying combined results A retrospective chart review was used to evaluate this combined procedure. The review included keratoconus patients with a central corneal thickness of at least 440 µm and a ker- atometry reading of less than 55 D, Dr. Rocha said. "We found an improvement in the uncor- rected visual acuity from 0.85 to 0.46 logMAR," Dr. Rocha said, adding that corrected distance visual acuity improved from 0.19 to 0.11. The sphere in the manifest refraction improved from –4.42 to –2.94 D, and there was a re- duction in cylinder of approximately 2.12 D. Those attaining uncorrected vision of at least About the doctor Guillermo Rocha, MD Professor of ophthalmology Max Rady College of Medicine University of Manitoba Winnipeg, Canada Reference 1. Rocha G, et al. Combined phototherapeutic keratecto- my, intracorneal ring segment implantation, and corneal collagen cross-linking in keratoconus man- agement. Cornea. 2019;38:1233– 1238. Relevant disclosures Rocha: Bausch + Lomb Preoperative topography of a 20-year-old patient with keratoconus. For patients with keratoconus, a combined treatment approach can make it possible to not only stabilize vision but improve it. Source: Judy Ku, MD, and David Rootman, MD 20/25 increased from 1.9% to 13.5%, and those who achieved 20/30 acuity went from 1.9% to 30.8%, he reported. Investigators also saw a reduction in higher order aberrations. "Total higher order aberra- tions, coma, spherical aberration, and secondary astigmatism all showed statistically significant improvement," Dr. Rocha said. "The only one that did not improve was trefoil." Dr. Rocha views this as a potential turning point for keratoconus patients. "I think that for years keratoconus patients have been used to hearing, 'You have keratoconus, but at this point we don't have anything to offer,'" he said. While it is now possible to stop keratoconus and improve vision, it's important to assess the patient's goals, Dr. Rocha stressed. Sometimes the goal is simply to stop progression of kera- toconus, while others may want to do away with glasses and contact lenses if possible. In the latter case, it becomes a question of deciding how you are going to rehabilitate the patient's vision. "I think that the idea is to think outside the box and see where we can get that patient," Dr. Rocha said. Overall, Dr. Rocha said it's important to keep an open mind to new techniques, while simultaneously thinking about the benefit to the patient. "I think it's worthwhile when we see that there are different ways of combining treatment to move forward and offer patients a better result than they were expecting," he concluded.

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