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Cornea Society News – published quarterly by the Cornea Society 3 Cornea Subspecialty Day 2015 patients with diabetes. "We are in an epidemic of diabetes in this country," he said. This means that a reasonable antic- ipation would be that the donor pool for grafts would be more concentrated with diabetic donors over the coming years. The study did have a few limita- tions. Diabetes was defined by a histor- ical method, which is less accurate, and the study was unable to identify undi- agnosed diabetics. Premortem data is limited, he said, and there is also no way to stratify diabetes based on severity. This raises many important ques- tions for the future. "We feel that the most direct way to answer these ques- tions is by a randomized prospective clinical trial of diabetes and keratoplas- ty," he said. In conclusion, Dr. Greiner said DMEK graft preparation may be more likely to fail when the donor has a his- tory of diabetes. Functional differences in diabetic tissue may reflect structural changes. There is a high prevalence of diabetes among donors, and it's import- ant to use caution with diabetic tissue for DMEK graft preparation. Finally, Dr. Greiner said that further basic and prospective clinical studies are needed to identify tissue at the highest risk. CN continued from page 1 A t the American Academy of Ophthalmology (AAO) Cornea Subspecialty Day 2015, physi- cians emphasized increasing the evidence-based approach in the subspecialty. Serious consequences of delayed diagnosis of Acanthamoeba keratitis Despite delayed treatment producing a 10 times greater risk of not seeing well, the vast majority of Acanthamoeba keratitis patients are treated "for weeks and often months" for other diagnoses, said Elmer Tu, MD, Glenview, Ill. "It is absolutely critical that the clinician understand the risk factors associated with Acanthamoeba keratitis because it can look like just about anything else," Dr. Tu said. Subacute or chronic parasitic infection primarily affecting the cornea masquerades as a non-infectious process. It can appear as other types of subacute infections, including fungi, microsporid- ia, or herpes. Acanthamoeba keratitis is most likely to occur among contact lens wearers and orthokeratology patients, according to the literature. Recognition of the disease is critical because the level of disease was the main prognostic fac- tor to determine patient outcomes, ac- cording to a study Dr. Tu co-authored in 2007. "You had a 10 times greater risk of not seeing well if you did not recognize the disease in its early stages," which makes it very important to understand the risk factors and what the disease looks like in its early stages, Dr. Tu said. Editors' note: Dr. Tu has financial interests with Seattle Genetics (Bothell, Wash.). Early herpes zoster vaccination urged amid timing questions Vaccination of people at the earliest point allowed by regulators may prove beneficial, according to Elisabeth Cohen, MD, New York. Amid a growing incidence of herpes zoster—possibly related to a lack of herd immunity from the varicella (chickenpox) vaccine—the timing of the vaccine for herpes zoster remains very controversial. After first approving the vaccine in 2006, the Food and Drug Administration expanded the approval in 2011 to people in their 50s. The mean age of onset was 52 according to the Centers for Disease Control and Prevention (CDC). However, only about one-quarter of U.S. residents at least 60 years old have received the vaccination. The CDC recommends providing vac- cination to people in their 60s because complications increase with age and the efficacy duration is unknown. However, Dr. Cohen said patients in their 50s may have a longer duration of protection. "Increasing age and not time to vacci- nation has been found to explain the decrease in efficiency in people age 60 and older," Dr. Cohen said. Editors' note: Dr. Cohen has no related financial interests. Get to know patients to prevent KPro infections Preventing infections following Boston Keratoprosthesis (KPro) implantation is closely linked to the level of postop follow-up, said Kathryn Colby, MD, Chicago. "Don't embark on KPro sur- geries unless you want to get to know these patients well and not be terribly surprised if they show up in your office unannounced," Dr. Colby said. It is crit- ical to educate patients to quickly call in if they have problems and regarding the importance of taking their antibiotics. Additionally, diagnosis and management of complications, including persistent epithelial defect and conjunctival ero- sion, will help reduce the incidence of infectious keratitis and endophthalmitis. "Early diagnosis of infiltrates and aggres- sive management of keratitis will ensure that these entities do not progress to infectious endophthalmitis," Dr. Colby said. CN Editors' note: Dr. Colby has no related financial interests. Register today! New Orleans FRIDAY, MAY 6 CORNEADAY.ORG