Eyeworld

70 | EYEWORLD | WINTER 2026 C ORNEA Contact Ayres: bayres@willseye.org Gupta: preeyakgupta@gmail.com Rapuano: cjrapuano@willseye.org Relevant disclosures Ayres: Alcon, Dompé, Glaukos, Sight Sciences Gupta: Alcon, Bausch + Lomb, Dompé Rapuano: None "It shows that you can have that targeted treatment for NK, and if you don't do that, you won't get maximum improvement in your pa- tients," he said. Dr. Ayres was initially skeptical before doing this study because he had not used a lot of dried amniotic membrane transplan- tations (AMTs). "Reviewing all the data chal- lenged me to say, "Am I not using AMTs proper- ly? Could I be using these in earlier stages?" He said this study was to help prove to him- self that using an AMT, particularly the Biovance product, which is a little bit different from some of the other dried membranes, does make a real difference on the neurological and inflammatory level in patients with ocular surface disease and NK. In patients with risk factors for problems, diabetics, patients with viral keratitis, you can make a real difference, he said. In Dr. Ayres' study, corneal epithelial resolu- tion occurred in all eyes with complete follow- up, functional corneal sensitivity improved in a number of patients, abnormal baseline osmolari- ty normalized in a large number of patients, and MMP-9 positively decreased in all groups. "My interest here was trying to almost prove to myself that it wasn't going to work," he said. "You don't need this in less severe patients, but for very symptomatic patients, looking at the data, it shows it's beneficial." The majority were the single layer, decellularized basement mem- branes, and he said that Biovance also makes a triple layer. Some of the patients took several amniotic membranes before there was clinical resolution or improvement. "I was impressed with the data, that it does work," he said. The mission here is in early NK, if it's treated, we may be able to prevent patients from developing downstream complications and becoming Stage 2 and Stage 3. While this is speculative, Dr. Ayres said it's the assumption that if you can get on top of things quickly, it improves their quality of life. "I think once you have treatments, you start making the diagnosis more," he said. While his research specifically looked at the Biovance product, Dr. Ayres said this would potentially ring true with other AMT products as well. "The nice thing about AMT is that you most likely have it in the office. When someone comes in, you can treat them at that moment; it doesn't require patients to use a medication for days or weeks, so we can have this kind of interventional mindset when it comes to ocular surface disease," Dr. Ayres said. He has also used Oxervate for Stage 1 NK and said it's worked very nicely, but it does take a couple of weeks to get the medication approved. "I have had patients denied because they were Stage 1 and didn't have an active Stage 2 or Stage 3 ulcer," he said. "We can reach for an AMT, or in theory, we could use these medications in combination. "This paper really changed my approach and how I think about treating early-stage NK— being more interventional, more proactive," Dr. Ayres said. He said this goes along with the TFOS approach of "if you have the diagnosis, treat that diagnosis." It's less of a step-up ap- proach and more of a targeted disease process approach to treating patients with severe ocular surface disease. continued from page 69 Vance Thompson, MD, EyeWorld Refractive Editorial Board member, commented on new tools, techniques, and challenges in anterior segment surgery: What new tool or technique are you most excited about? Image-guided femtosecond laser cataract/RLE surgery Next generation trifocals Goggles for reducing eye pressure What's the biggest challenge facing anterior segment surgeons today? Meeting patient expectations in an increasing near world Consumer confidence Our ability to measure/quantify just how image-degrading dry eye and floaters are A true understanding of the cause of glaucoma What innovation do you hope to see in the next decade? Growth in optic adjustable implants versus continued growth in cornea adjustable implants Tear lens and vitreous opacity image degradation quantifying technology to the MOON and BACK

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