Eyeworld

40 | EYEWORLD | JUNE 2022 Contact Azar: dimitri.azar@twentytwenty.com Brown: reaymary@comcast.net Chan: clarachanmd@gmail.com Dell: steven@dellmd.com Hill: hill@doctor-hill.com References 1. Poley BJ, et al. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglau- comatous eyes: Evaluation of a causal relationship between the natural lens and open-angle glaucoma. J Cataract Refract Surg. 2009;35:1946–1955. 2. Brown RH, et al. Clear lens extraction as treatment for uncontrolled primary angle-clo- sure glaucoma. J Cataract Refract Surg. 2014;40:840–841. Relevant disclosures Azar: Santen, Twenty Twenty Therapeutics, Verily Life Sciences Brown: Sight Sciences Chan: Pfizer Dell: Allergan, Bausch + Lomb, Johnson & Johnson Vision, LENZ Therapeutics, Lumenis, Ocular Therapeutix, Optical Express, RxSight, Tracey Technologies Hill: Haag-Streit has been reported in the literature, she noted. Dr. Chan also shared cases where patients came in following the first and second doses of the vaccine with various issues. Dr. Chan said that the mRNA vaccine deliv- ers specific genetic information to host cells to produce foreign proteins, so the immune system is upregulated. Inflammatory events have been reported with all of the COVID-19 vaccines. She said it's important to counsel patients about signs and symptoms of ocular inflammation. Increase topical steroids to QID 2–4 weeks after vaccination before returning to baseline prophy- laxis dose in high-risk grafts or in those with a history of HSV/HZV immune keratitis. Com- pleting the COVID-19 vaccination series prior to corneal transplantation is also recommended. Dimitri Azar, MD, presented "Convergence of roles of physicians and industry in ophthal- mic innovation." Many physicians are part of the leadership of some of the top pharmaceuti- cal companies. All are playing a critical role in this industry that's supporting us and innova- tion, he said. One point that Dr. Azar stressed is the opportunity in digital ophthalmology. He shared a scheme of how to join the digital ophthalmol- ogy revolution, whether a physician has an idea and wants to have their own startup or if they have an interest in joining ongoing programs that are focused on this purpose. Among the drivers of growth in the global digital health market, Dr. Azar said there are several factors including rising smartphone utilization, integration of and connectivity among advanced digital technologies, as well as successful implementation of mobile health technologies for self-management, primarily outside of ophthalmology. Just a couple of decades ago, ophthalmic devices were large and provided scarce data. Time between doctor visits is more relevant for disease prevention, he said. Artificial intelli- gence is big in this. Ophthalmologists will be playing a significant role. There are many re- maining challenges in artificial intelligence, he said, but also a lot of opportunities for anyone who wants to join this industry. cause of post-IOL dissatisfaction. The weak link is often finding the actual corneal power. He then discussed options for late LASIK enhancements. Surgeons know that relifting old flaps is associated with risk for epithelial ingrowth. He suggested a new side-cut only or a larger, deeper flap could be helpful, but these options also have limitations. Most do PRK for late enhancements. Epithe- lial mapping can be extremely useful in these situations, he added. The epithelial thickness in prior laser vision correction patients may be highly variable, and the epithelium itself may make a positive, negative, or neutral contribu- tion to the overall corneal power. Removing the epithelium during PRK may unmask this contri- bution. The degree of lensing effect is somewhat proportional to the amount of the original laser vision correction. What is there to do? Dr. Dell said you could wait and see if the epithelium grows back the same way (which takes many months and is somewhat unpredictable). The best option, he said, may be to split the difference of the epi "lens" effect. This is a common scenario-post IOL. Any PC-IOL strategy must include a bail-out sce- nario. If LVC is fraught, IOL exchange may be preferred in some cases, he added. This is a strong argument for the Light Adjustable Lens (LAL, RxSight). Clara Chan, MD, presented "Are we see- ing more inflammatory corneal events?" She noted some variables to consider because of COVID-19: patients missing follow-up visits, prescriptions not being renewed, fear of ste- roids causing "immune compromise," fear of the hospital, and mass vaccination campaigns with vaccines with novel mechanisms of action. Are we seeing more inflammatory corneal events? She presented cases to demonstrate this and how the COVID-19 vaccine factors in. She shared a case of a DMEK rejection in a 69-year-old Hispanic male. The patient had DMEK for Fuchs dystrophy, and the graft failed in 2019. He had a second DMEK that was un- eventful in 2020. He was doing well postop, but 4 months after surgery, he presented with a red eye that started 3 weeks after his first COVID-19 vaccine. Given his history, Dr. Chan was more aggressive in adding oral steroids and stepped up topical steroids, and the case resolved. Rejection after all forms of COVID-19 vaccines ASCRS NEWS continued from page 38 Dr. Hill delivers the Richard L. Lindstrom, MD, Lecture. Source: ASCRS

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