JUL 2013

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

Issue link: https://digital.eyeworld.org/i/146899

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28 EW CORNEA July 2013 Cornea editor's corner of the world Taking the reins by Clara C. Chan, MD, FRCSC, FACS I t has been a great pleasure to have served as medical editor and cornea section editor for EyeWorld. I was added to the editorial board in 2009, and since that time we have covered major advances in corneal surgery. Corneal transplantation has made a complete paradigm shift from full thickness transplants for virtually all corneal disease to targeted lamellar surgery. For decades, a penetrating keratoplasty was performed for all corneal conditions, no matter the layer of corneal pathology. Now, corneal surgeons aim to replace only the diseased corneal layer with the evolving techniques of endothelial keratoplasty, deep anterior lamellar keratoplasty, and ocular surface transplantation. In addition, keratoprosthetic devices have greatly improved and are now used by many corneal surgeons. Medical cornea has also seen major advances as all clinicians now understand the critical role of the ocular surface, and "ocular surface health" is of interest to all clinicians. It has been our goal to have EyeWorld report on the most current issues facing corneal specialist and anterior segment surgeons. It is with great pleasure that I pass on the cornea editor duties to Clara Chan, MD. Dr. Chan represents the "next wave" of intelligent, talented, and innovative corneal surgeons. She is a skilled surgeon, excellent clinician, and superb teacher. She, along with the other members of the cornea editorial board (Benny Jeng, MD, Barry Lee, MD, Vincent de Luise, MD, and John Hovanesian, MD), will guide EyeWorld to provide our readership with the critical information on the most important topics in medical and surgical cornea. Welcome, Clara. Edward J. Holland, MD, cornea editor This month, we are very excited to announce and welcome Clara Chan, MD, as our new EyeWorld cornea section editor. Clara is a highly respected cornea specialist on the faculty at the University of Toronto, and has been an active contributor on EyeWorld's editorial board. She did her cornea fellowship with and now succeeds Ed Holland, MD, whom we also wish to thank for serving as EyeWorld's cornea section editor for the past two years. As one of the world's foremost authorities in corneal surgery, Ed has done as much as anyone to bring quality cornea clinical education to ASCRS and to EyeWorld. He has been one of the key architects behind our strong collaboration with the Cornea Society, and has held many of the most important leadership roles within ASCRS, including Cornea Clinical Committee chair, cochief medical editor of EyeWorld, and ASCRS president. Ed's editorial leadership has long shaped the unique style and content of EyeWorld, and he graciously agreed to continue to serve as a mentor and section editor when our editorial board was reorganized in 2011. Ed continues to serve on our Executive Committee and now shifts his creative energy and enthusiasm to the key role of ASCRS annual meeting program chair. Congratulations and thanks to Ed on behalf of all ASCRS members and EyeWorld readers! A David F. Chang, MD, chief medical editor SCRS and EyeWorld have been leaders in the education of anterior segment surgeons for many years. A few years ago, EyeWorld formed a section dedicated entirely to cornea topics under the leadership of Ed Holland, MD. I can say with confidence that we have all learned a great deal. The field of cornea continues to become increasingly important to the cataract and refractive surgeon as these three domains further overlap. Lofty patient expectations for cataract surgery and demand for advanced technology IOLs have made it a necessity that cataract surgeons Dr. Chan presents at the 2013 ASCRS•ASOA Symposium & Congress. Source: EyeWorld be attentive to the cornea. Accurately being able to diagnose and treat conditions of the ocular surface is critical to achieving excellent outcomes in cataract surgery. New diagnostic tools have improved our understanding of dry eye and blepharitis. Multiple new treatment options are also coming down the pipeline. Never before have we been this close to finding a cure for blepharitis and dry eye disease. The modern corneal surgeon also needs to be an excellent cataract surgeon as a variety of new "triple procedures" continue to grow in popularity. We can do phacoemulsification with endothelial keratoplasty (EK) or deep anterior lamellar keratoplasty (DALK), or even with keratoprosthesis implantation. Refractive surgery also goes hand in hand as corneal surgeons have the ability to give their graft patients excellent uncorrected vision. We have seen the evolution where corneal surgery targets the diseased portion of the cornea only. Small incision DSEK surgery, where only Descemet's membrane and the posterior stroma are transplanted, has overtaken rates of full thickness penetrating keratoplasty (PK). As instru- mentation and techniques evolve, perhaps DMEK, where Descemet's membrane only is transplanted and a more refractive-neutral procedure, may overtake DSEK in the coming years. The femtosecond laser, a refractive surgeon's best ally, has moved to the forefront of all dialogue—not only in cataract surgery, but also in corneal surgery. Femtosecond laser-enabled DALK has been shown to help create the "big bubble" more reliably, helping to separate Descemet's membrane from the rest of the cornea, a key step in the procedure. For patients with stromal disease only, DALK surgery eliminates their risk for endothelial rejection. Femto-PK with shaped wounds (i.e., mushroom-shaped) can lead to faster visual recovery. Laser vision correction applied to corneal transplants also has excellent results. It is exciting that the merging of corneal, cataract, and refractive surgery can benefit all fields and most importantly our patients. In future issues of EyeWorld, we will draw on the expertise of not only our North American corneal specialists, but also our international colleagues who can share their experience with novel surgical techniques and technologies. Topics will include optimizing the ocular surface for presbyopia-correcting corneal inlays and multifocal toric IOLs, management of challenging corneal infections, expanded indications for corneal crosslinking, and ex-vivo limbal stem cell expansion and transplantation. I am honored to be chosen as the EyeWorld cornea section editor and look forward to the opportunity to provide readers with up-to-date information in the field of corneal disease, especially with the continual evolution of new medical and surgical treatments for corneal disorders. In addition, I welcome your input for ideas and issues that you feel are important for us to discuss in EyeWorld. EW Contact information Chan: clarachanmd@gmail.com

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