Eyeworld

110 | EYEWORLD | DECEMBER 2020 C ORNEA by Liz Hillman Editorial Co-Director Contact Matossian: cmatossian@matossianeye.com Periman: lauraperiman@yahoo.com Tichenor: aablamow@uab.edu T he COVID-19 pandemic has affected all areas of medicine, including eye banking. While much more is known about SARS-CoV-2 and the illness it causes, there are still several un- knowns that continue to be investigated as they pertain to the safety of donor tissue. The reduction of corneal surgeries when elective surgeries were canceled and ongoing social distancing decreased the demand for corneal tissue overall, but it has crept back up. Winston Chamberlain, MD, PhD, said in mid- April that tissue demand was down about 90% nationwide; it's now returned to pre-COVID lev- el in his area. Kevin Corcoran said in June that the U.S. has been fortunate to have a surplus of donor tissue, allowing EBAA eye banks to fulfill requests without delays or waiting lists, but the lack of demand affected every eye bank in the early stages of the pandemic. COVID-19 and its impact on eye banking they swim in them, and they go in the hot tub in them." All of this inappropriate use leads to stress on the ocular surface. Dr. Matossian said she thinks digital devices play a role in dry eye. "This is the first genera- tion to grow up with electronic devices starting when they were toddlers," she said. "It's taking a toll on the ocular surface." She attributes this to a decreased blink rate from approximately 20 blinks per minute to around four. "The upper and lower lids are supposed to 'kiss' each other with each blink," Dr. Matossian explained. This action releases a small quantity of olive oil-like meibum from the meibomian glands to coat the surface of the eye. If there is an inadequate or incomplete blink, the lipid is not released on a regular basis. The meibum congeals to a more viscous consistency and causes impaction of the meibomian gland, leading to permanent dysfunction. Addressing dry eye in teens may involve educating pediatricians to refer them for regular eye examinations, Dr. Matossian said. Unless teens take care of their glands, they may end up with more complications as they reach adult- hood, Dr. Matossian concluded. Cynthia Matossian, MD, cited teens' propen- sity to try the latest beauty trends as troubling. "Lash extensions are very popular these days. The glues that are used to adhere the individual extension onto natural lashes is not good for the ocular surface," Dr. Matossian said. "The fixa- tives may contain latex and other chemicals that can cause surface irritation or allergic blepharo- conjunctivitis." Also, the extreme length of the lashes can be a problem. Instead of repelling debris, these abnormally long lashes can create a reverse air current where pollutants, pollen, and micro-debris get propelled onto the tear film. False lashes are even more damaging since the glued-on lash strip has to be removed on a daily basis. The process of peeling off the false eyelashes along with the weight of the extreme lashes may lead to permanent lash loss and traction alopecia, Dr. Matossian warned. Ingredients in makeup as well as moisturiz- ers and concealers can also dry the eye. "Many of them contain paraben and other ingredients that are very irritating to the ocular surface and tear film," she said. "Teenagers are notorious for overwearing their contact lenses and not properly cleaning them," Dr. Matossian said. "They sleep in them, continued from page 108 However, more stringent screening require- ments have reduced the overall donor pool by 25–30% and may lead to isolated challenges in providing tissue on demand, Mr. Corcoran continued, adding that the association offers an online platform that allows eye banks with surplus supply to offer it to those that might be in need. "Stricter donor criteria and enhanced donor screening are in place to ensure donor tissue is safer," said Clara Chan, MD, explaining that the surgeon has to discuss potential risks with the recipient, similar to how they would with a blood transfusion. "We have done some epide- miological models, which predict a very low likelihood of transmission from donor cornea tissue, approximately <1/109,000 chance. Povidone-iodine is used for 2 minutes twice to clean the ocular surface prior to in situ recovery of corneal tissue."

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