EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/407647
37 T. 800.461.1200 | www.innovativexcimer.com Improved Clinical Outcomes of CXL and PRK with Amoils Epithelial Scrubber Epithelial Removal Has Never Been Easier Corneal Xlinking, PRK & Advanced Surface Ablation • Uniform epithelium removal in only 5 - 7 seconds • Avoid alcohol damage to surrounding tissue • Minimize total procedure time • No need for subsequent scraping This is the third part in a three-part series on dry eye. The first two parts appeared in the September and October issues of EyeWorld, respectively. deficiency, and there are people who have evaporative dry eye, who have irritation with plenty of tears in their eye," he said. "Part of the problem is that I don't think some of the clinical trials have tried to adequately stratify those patients." Another issue is there is a large amount of day-to-day variation for dry eye patients. The drugs have to overcome the normal variation, which could be up to 30% from one week to the next depending on the environment the patient is in, Dr. Pflugfelder said. "That's a pretty high hurdle." Dry eye is a huge problem, and it is likely increasing. It is unfortu- nate that there have not been more therapeutic advances, he said. Dr. Pflugfelder thinks that if multiple tests are done, those with dry eye disease can at least be identified, but treatment is a whole separate issue. EW Editors' note: Dr. Pflugfelder has financial interests with Allergan. Dr. Luchs has financial interests with Allergan, Alcon, Shire, Eleven Therapeutics, Bausch + Lomb (Bridgewater, N.J.), and TearLab. Contact information Luchs: jluchs@aol.com Pflugfelder: stevenp@bcm.edu Using contact lens-assisted continued from page 34 to decrease further intraoperative dehydration that should be avoided in these thin corneas." Early results using this tech- nique have been published in the Journal of Refractive Surgery, Dr. Jacob said, and they are encouraging. "Pa- tients develop a good demarcation line and maintain corneal clarity," she said. "We are still studying the refractive outcomes after CACXL to see if the same amount of flattening of the cornea is obtained as in standard CXL." Concerns With the technique, there is about 90–110 μm of added thickness. Dr. Jacob stressed the importance of using a contact lens that does not have a built-in UV barrier. "This can be checked on the product literature or with a digital UV meter by placing the contact lens under the UV beam of the UV light source," she said. "Contact lenses that block or decrease UV irradiance should not be used." The patients The technique, Dr. Jacob said, has only been used for moderately advanced cases of keratoconus. It has not been used for severe cases. Whether or not a patient needs crosslinking is dependent on a num- ber of factors, she said, including the severity of the disease, the age of the patient, and evidence of progression. It should not be done in all cases. "As the visual and anatomic results that can be obtained by a well-performed DALK far outweigh the results of crosslinking a very de- formed cornea, crosslinking should be performed only for the indicated subset of patients," she said. Dr. Jacob has found that a number of doctors around the world have started to use CACXL and are happy with their results. "This peer acceptance is of course the most important valida- tion of any technique," she said. Dr. Jacob said the technique is now performed in many branches of Dr. Agarwal's group of eye hospitals. EW Reference 1. Wollensak G, Aurich H, Wirbelauer C, et al. Significance of the riboflavin film in corneal collagen crosslinking. J Cataract Refract Surg 2010;36(1):114–120. 2. Jacob S, Kumar DA, Agarwal A, et al. Contact lens-assisted collagen cross- linking (CACXL): A new technique for cross-linking thin corneas. J Refract Surg 2014 Jun;30(6):366–72. Editors' note: Dr. Jacob has no financial interests related to her comments. Contact information Jacob: dr_soosanj@hotmail.com