Eyeworld

DECEMBER 2023 | EYEWORLD | 63 C Contact Mah: Mah.Francis@scrippshealth.org Nijm: LMNijm@uic.edu Relevant disclosures Mah: Dompe, Kala Pharmaceuticals Nijm: Dompe be aggressive at early stages to get the cornea to improve as quickly as possible because it's preferable to prevent further progression or a perforation. If these treatment options don't work, Dr. Nijm said tarsorrhaphy is an option. Scleral contact lenses and autologous serum drops are also useful, she said. Patients have to be watched carefully. You need to stop progression of the defect, she said. "Identifying it earlier and being more cognizant of the different treatment options will hopeful- ly decrease the number of patients who reach Stage 3," she said. Corneal neurotization is also an option that may address the underlying concern. "It's a complex surgery that requires dedication from corneal and plastics teams and something that is performed typically only in academic institu- tions," Dr. Nijm said. Dr. Nijm said she will choose to move forward with treatment quickly if the cornea isn't going in the right direction. Neurotrophic corneas often remain neurotrophic; even if the ulcer heals, it's possible that the underlying problem remains. If patients have had neuro- trophic ulcers in the past, they are high risk, so it's important to start treatment right away to prevent further complications. It's also important to educate patients to look for the signs. "They don't have feeling, so they may not be aware of how bad their eye is. It's important for the patient to be aware if their vision gets blurry or if the eye is red," Dr. Nijm said. "We don't want them to wait for a large ulcer to develop." Maintenance therapy is also important. "I make sure all my NK patients have their dry eye well treated, and they continue to use lubri- cants and anti-inflammatories as needed on a long-term basis," she said. "Patient education on preventative care is critically important, as well as the need to come back sooner to the office if they see any changes because they won't feel the changes the same way someone else would." Dr. Mah said NK is becoming transitional in terms of what stage you see because there is so much education out there. "I think 5 years ago, we weren't making the diagnosis as early be- cause there wasn't a specific treatment. There- fore, by the time we made the diagnosis, I was seeing more advanced cases, where patients had some corneal melting or they had the persistent epithelial defect for weeks to months," he said. "Now, because a lot of education is out there, I'm seeing less Stage 3. Patients are being iden- tified, diagnosed, and referred much sooner." He also thinks physicians have become more sensitive to NK earlier. This might include testing patients who don't necessarily have an epithelial defect, such as Stage 1 NK patients who look like they have dry eyes or have a history of unresponsive or recalcitrant dry eye or keratitis. "I think the word has gotten out, and the education has been helping patients in terms of getting identified sooner." As to whether NK can be cured, Dr. Mah said one question to ask is, "Can I get this person healed?" He noted that studies with Oxervate have shown that 70–75% of patients were healed within 8 weeks of their treatment. In terms of more traditional treatments, it's still possible for patients to heal, but the problem is that most treatments—like eliminating preser- vatives—don't address the root cause, Dr. Mah said. "They don't reverse the lack of corneal sensitivity or sensation." He added that in the broader picture of persistent corneal epithelial defects, the success of a product like Oxervate addresses an unmet need, and its success encourages other compa- nies to pursue products to address this. "I think there will be more companies out there looking at the same indication," he said. "Patient education on preventative care is critically important, as well as the need to come back sooner to the office if they see any changes because they won't feel the changes the same way someone else would." —Lisa Nijm, MD, JD

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