EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW MEETING REPORTER 86 Reporting from the 2015 ASCRS•ASOA Symposium & Congress, April 17–21, 2015 San Diego Innovators Session highlights the future of corneal endothelial therapy This year's Charles D. Kelman Inno- vator's Lecture was given by Shigeru Kinoshita, MD, PhD, Kyoto, Japan, on the topic of "Novel Treatment Dimensions for Corneal Endothelial Dysfunction." The ultimate goal for surgeries like PK, DSAEK, and DMEK is to obtain a high corneal endothe- lial cell density with good physio- logical function using donor corneal endothelial cells, he said. When we think outside the box in the future, we may need to think of a novel strategy. Possible options for advanced stage treatment are corneal endothelial cell (CEC) sheet transplantation or CEC cell injec- tion. When attempting to test the option for sheet transplantation, Dr. Kinoshita cultivated monkey corneal endothelial cell sheets. This was partially successful but not 100%, he said. He then moved onto trying to use CEC injection instead of sheet transplantation. He tested this in both rabbit and monkey models. He determined possible advan- tages of endothelial transplantation using cultivated corneal endothe- lial cells. Young donor corneas can be used as master cells with good longevity and physiological function. "Also, we could cultivate many, many cells from just one donor cornea," he said. This would also be minimally invasive. Human corneal endothelial cells are difficult to culture, so the key is to establish a cultivation protocol for clinical application, he said. Dr. Kinoshita believes there may be a clinical trial in a couple of years, but a higher quality of the cultivated endothelial cells is still necessary before that happens. There is also the possibility of an eye drop treatment in early stage of disease that can recover corneal endothelial function by stimulat- ing a patient's CEC proliferation by ROCK inhibitory eye drops. Dr. Kinoshita said that future goals for this potential treatment are to elu- cidate clinical indication, optimize ROCK inhibitors for a clinical trial, and investigate anti-apoptotic action for Fuchs' dystrophy. Editors' note: Dr. Kinoshita has fi- nancial interests with Abbott Medical Optics, Alcon, Hoya, JCR Pharmaceu- ticals, Otsuka Pharmaceutical, Pfize , Santen, and Senju. SGR repeal among topics in legislative and regulatory session Nancey K. McCann, ASCRS•ASOA director of government relations, gave an update on legislative and regulatory issues. Ms. McCann began by talking about the recent repeal of the SGR. "Obviously, we've been working on this issue for 12 years," she said. There have been 17 short-term fixes, and now it's repealed, she said. The principles for SGR reform were, first and foremost, to repeal the SGR, Ms. McCann said. H.R. 1470/S. 810 was first introduced to eliminate SGR. Budget offsets and the extension of certain pro- grams were added to this legislation and the bill became H.R. 2, which ultimately passed and was signed into law by the president. There were 2 important issues relating to Medicare entitlement reform in the legislation, which Ms. McCann said was why many conservatives voted for it. Medigap plan coverage will now be limited to costs above the amount of the Part B deductible for new enrollees beginning in 2020, and income-related premiums for Medicare Part B and D under current law are readjusted. Another key provision in the legislation was the rescinding of the CMS finalized policy to transition all 10- and 90-day global codes to 0-day codes. The postoperative visits would have been eliminated from the 10-day codes in 2017 and the 90-day codes in 2018. "It would have affected more than 4,200 codes, and CMS had not developed a methodology to make the transi- tion," Ms. McCann said. You should always be suspect when CMS wants to make changes like this, she said. "In ophthalmology, we have the highest practice expenses of any spe- cialty." These practice expenses are calculated per hour, and there is no way that they'd be able to account for that and the supplies and other procedures that take place, like re- moving sutures, that don't have CPT codes, according to Ms. McCann. CMS had already stated it would develop new postoperative surgical codes that would have a lower value and lower reimbursement. It would have also limited the number. Editors' note: Ms. McCann has no financial interests related to her presentation. May 2015 View all the daily news and photos at daily.eyeworld.org Supported by