Eyeworld

JUNE 2022 | EYEWORLD | 85 C continued from page 84 After the 1-month check, the patient should be seen after about 3–4 months, then after 6 months, she said, noting that she typically arranges to see the patient the same day as the optometrist if the patient lives far away. If all is well, she will see the patient yearly after that. In many cases, Dr. Jacobs likes to set up a schedule so the optometrist is seeing the patient annually and she is as well, with visits spaced 6 months apart. Dr. Mian said it requires good communica- tion, as with any comanagement situation. He said it's important to ensure that the doctors you're partnering with recognize the extent of Corneal sweep test for recurrent corneal erosion N ew diagnostic techniques are often developed when a need in the clinic or OR arises. That is what led D. Brian Kim, MD, to develop the cor- neal sweep test and a new diagnostic tool to identify recurrent corneal erosion. Several years ago, Dr. Kim noticed that after draping the eye at the start of cataract surgery, some patients would have an area of loose corneal epithelium. Patients don't feel it because the eye is numb, but it seemed strange because they never had corneal epithelial disease, he said. He also noticed that some patients after seemingly uneventful cataract surgery would develop a persistent ocular pain syndrome. These observations led Dr. Kim to use the back end of a corneal spud, often used to pull out foreign bodies stuck in the cornea, to sweep the corneal surface of these patients. He did this on the post-cataract surgery patients who were having persistent symptoms, foreign body sensation, burning, irritation, and sharp pain, after having tried and failed stan- dard dry eye and blepharitis therapy. Dr. Kim called this method the "corneal sweep test," adding that after finding these ar- eas of loose epithelium, he would often treat by debriding with superficial keratectomy, and he discovered that it would improve the symptoms. One reason that Dr. Kim thinks the corneal sweep test is needed is because of the current way to diagnose recurrent corneal erosion. This is done using slit lamp biomicroscopy and vital stains such as fluorescein dye to inspect the surface of the cornea and to look for negative staining or irregularities on the cornea. "If there's nothing there, we're taught to say that there is no recurrent corneal erosion, and that's the gap in our teaching," he said. Dr. Kim realized that he would need to use a different instrument to test for these recurrent corneal erosions, especially if he wanted to encourage others to do the same. This led to the development of an instrument with Katena called the Kim Corneal Sweeper de- signed specifically for this purpose. Dr. Kim described the instrument as "an M&M candy on a stick." It's curved and smooth all around, but it has sidedness; one side is flatter. "You can sweep the cornea and because it's rounded, it's atraumatic, and because of the thin profile, you can see what's happening as you're indenting the cornea," he said. Since adopting this technique in 2017, Dr. Kim has performed a retrospective chart review that has been published in the journal Cornea. 1 This includes his data from July 2018–June 2020 and highlighted 58 eyes of 51 patients. In Dr. Kim's experience, 49 of the eyes needed the corneal sweep test in some form to help confirm the diagnosis. His data determined that 34 of 58 eyes had completely normal About the physician D. Brian Kim, MD Private Practice Professional Eye Associates Dalton, Georgia by Ellen Stodola Editorial Co-Director continued on page 86 the medical problems the patient has. Whether it's dry eye, autoimmune disease, ectasia, LSCD, or neurotrophic issues, these need to be clearly communicated, and there needs to be follow-up communication both ways so the patients' needs are met. One thing that has changed in the last 5–10 years, Dr. Mian said, is that this has become its own specialty in optometry, so there are residency programs where optometrists learn to do specialty fits. "Someone who has gone through an extensive training program for these lenses would be a good person to part- ner with because they're better trained to help patients," he said.

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