Eyeworld

84 | EYEWORLD | SPRING 2026 C ORNEA by Ellen Stodola Editorial Co-Director About the physicians Winston Chamberlain, MD, PhD Affiliate Professor of Ophthalmology Northwest Permanente, P.C. Casey Eye Institute Oregon Health & Science University Portland, Oregon Christopher J. Rapuano, MD Chief of the Cornea Service Wills Eye Hospital Professor Sidney Kimmel Medical College Thomas Jefferson University Philadelphia, Pennsylvania the distortion of the vision." If you look hard enough, many patients have mild, typically peripheral, asymptomatic EBMD changes, but it is still important to know in case they develop symptoms in the future. Most of the time EBMD won't cause visual problems. EBMD can also cause recurrent erosion problems, he said, and that's because the irregu- lar layer of epithelial cells is not cemented prop- erly to the cornea. If it gets very loose or is so loose it comes off, it causes recurrent erosions. Dr. Rapuano said the main symptoms of recurrent erosions range from mild foreign body sensation and short periods of pain to long periods of pain, typically either in the middle of the night or when people wake up in the morning. "We think that's because the eyes are closed overnight, and they tend to dry out, so the eyelid sticks to the surface of the cornea and pulls off this loose epithelium," he said. Sometimes the patient has mild pain when they wake up in the morning, but the EBMD changes can often be hard to see upon exam, Dr. Rapuano said. Other times, it may be more obvious or it looks like a large corneal abrasion. It's important to look at the other eye because sometimes in the "normal eye," you'll see the E pithelial basement membrane dystrophy (EBMD) is a common corneal issue. Winston Chamberlain, MD, PhD, and Christopher J. Rapuano, MD, discussed how this might present in patients and the number of treatment options available to address the condition, with surgeons often needing to use several different strategies. EBMD causes a couple of main problems, Dr. Rapuano said. The first is it can cause irreg- ularity to the surface of the cornea and distort vision. It's less common that it does this than the recurrent erosion, he said, but it's still import- ant to realize that EBMD can cause patients to have decreased vision, and they'll often call it "shadow vision" or "double vision." When some- one comes in complaining of double vision, Dr. Rapuano said the first thing to do is figure out if it's with both eyes open, which means their eyes aren't aligned properly, or if it's with one eye open, in which case it's often a cornea problem, like EBMD. The best way to test for EBMD is by putting fluorescein in and looking for negative staining, he said, which is where the fluorescein runs off the high points in the cornea, and "these little mountaintops stick out, and that causes Treatment options for EBMD and recurrent corneal erosions continued on page 86 corneal endothelial cell therapy by Aurion has provided positive topline results from its Phase 1/2 study. CALEC (cultivated autologous limbal epi- thelial cells) being developed at Mass Eye and Ear has completed a Phase 1/2 study, restoring the corneal surface in patients who had surface damage or limbal stem cell deficiency. Though not a cell therapy but related to regeneration of corneal endothelial cells, work is being done by Trefoil Therapeutics to develop TTHX1114, fibroblast growth factor 1. Phase 1/2 research has been completed with Phase 2 data showing positive regenerative and visual outcomes. Exosomes Dr. Chamberlain brought up exosomes, extra- cellular vesicles that can carry proteins, lipids, or mRNA, which are being explored as a cell- free regenerative therapy that could help with inflammation, wound healing, and more. Some of the companies exploring exosomes for ocular surface conditions at preclinical and clinical stages include Kimera Labs, ExoCoBio, EV Ther- apeutics, and some in academia. "There is a long list of biologics that are used for non-ocular conditions that may be useful for ocular conditions, and we just don't know because we don't use them that often," Dr. Galor said about the ripe future for the field of biologics in cornea. Editors' note: This is not an exhaustive list of all biologic options or companies working on biolog- ics for corneal conditions. continued from page 82

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