Eyeworld

EW NEWS & OPINION February 2017 17 after the first 6 months is just like a normal cornea, Dr. Holland said. "Endothelial cell loss in PKs most often limits the long-term survival of this procedure, and endothelial rejection is a significant problem. DALK eliminates these two issues." Endothelial keratoplasty (EK) has become the most performed corneal transplantation procedure, he noted, adding that Descemet's stripping endothelial keratoplasty (DSEK) has also become a mainstay over PK for patients with endothelial failure. "This lamellar corneal proce- dure transformed how we approach corneal endothelial disease. We used to wait until there was moderate to severe stromal edema and visual loss before recommending a PK because of the limitations of the surgical outcomes with this procedure," Dr. Holland said. "Now, with the tran- sition to DSEK, ultrathin DSEK and DMEK, it's possible to recommend surgery for mild edema cases and even in some cases with no edema who are symptomatic from conflu- ent guttata." Another major corneal issue that has changed significantly since EyeWorld's inception is dry eye. "We lacked the ability 20 years ago to accurately diagnose and treat dry eye," Dr. Holland said. "We had artificial tears and ointments, but we had nothing to deal with the pathophysiology of dry eye." Then, 13 years ago came the approval of the topical cyclosporine Restasis (Allergan, Dublin, Ireland). "We had our first therapeutic approved medication for dry eye, and it was a tremendous breakthrough," he said. This was followed by the approval of Xiidra (lifitegrast, Shire, Lexington, Massachusetts) in 2016. "It looks to be a tremendous success, and the clinical trials were well covered by EyeWorld," Dr. Holland said. On the dry eye diagnostic side, back in EyeWorld's early days, the Schirmer's test as well as fluorescein dye were the mainstays, he said. In the last several years, tear osmolari- ty, MMP-9 testing, and meibomian gland imaging have become some of the key tests that have significantly improved accuracy and efficiency in diagnosing dry eye. ing that this lens technology was an important step in improving results for high myopes. "Besides these cornerstones of modern refractive surgery, EyeWorld has covered an endless number of new and promis- ing technologies such as epi-LASIK, corneal inlays, and a multitude of refractive IOLs," he said. In a variety of cases, interna- tional practitioners have taken the lead on using refractive technology. "Due to regulatory issues, interna- tional ophthalmologists often have the advantage of being able to use new technology earlier than our U.S. colleagues," Dr. Knorz said. "Some examples covered in EyeWorld were trifocal IOLs or extended depth of focus IOLs." He cited femtosecond lens surgery as something that was also developed in Europe and Asia but that rapidly because available in the U.S. "SMILE, on the other hand, recently became available in the U.S., while it has been widely used all over the world for many years," he said. Cornea coverage Over the past 20 years, EyeWorld has reported on sweeping changes in corneal issues as well. Edward Holland, MD, director of cornea, Cincinnati Eye Institute, and EyeWorld's first Cornea section editor, reflected on some of the early corneal issues reported on in the magazine. "The first one was the transition to targeted lamellar surgery in keratoplasty," he said, adding that prior to this, penetrating keratoplasty (PK) was performed for all corneal disease. Over the past 15 to 20 years, targeted corneal surgery has evolved. "Now if a patient has severe epithelial disease with limbal stem cell failure, we transplant cor- neal limbal stem cells," Dr. Holland said. "Not only is that the right thing to do for limbal epithelial fail- ure, but the previous approach with PKs for limbal stem cell deficiency failed in all cases." For patients with corneal stromal disease, corneal surgeons have now moved to deep anterior lamellar keratoplasty (DALK), which retains the normal layer of the endo- thelium. Unlike PK, DALK can often last forever because cell dropout AGBC 1347 Rev.C 3360 Scherer Drive, Suite B, St. Petersburg FL 33716 800-637-4346 • Tel: 727-209-2244 • Fax: 727-341-8123 Email: Info@RheinMedical.com • Website: www.RheinMedical.com 1 Developed In Coordination With Juan F. Batlle, M.D. 2 Developed In Coordination With Elie G. Khouri, M.D. 3 Developed In Coordination With Steven L. Maskin, M.D., Patent Pending. 4 Developed In Coordination With David R. Hardten, M.D. 5 Developed In Coordination With James Tearse, M.D. Background, Expressed Lid Image 08-01720 Tearse 5 Meib um Com pression Forceps 08-01718 Batlle 1 Eye lid C om p ression Forceps 08-01719 Khouri 2 Eyelid Squeegee 08-01 7 16 M askin 3 Mei bu m Expressor 08 -01717 H a rdten 4 Eyelid Compression Forceps Meibum Expressors Hardten 4 Tearse 5 Batlle 1 Khouri 2 Maskin 3 continued on page 18

• Cover