Eyeworld

41 EW CORNEA the CE mark with the company's Mosaic device. As for other protocols that deviate from the standard Dresden protocol, Dr. Raizman said he thinks accelerated treatments can be as effective, and pulsed-light therapy and use of supplemental oxygen probably enhance the effectiveness of crosslinking, perhaps of epi-on treatments as well. It's unknown whether these other protocols will move toward FDA approval, Dr. Raizman said, due to the difficulty and cost of conduct- ing a large-scale clinical trial. "Some things we may be able to do off-label in the United States, but again, it's hard to know," he said. Crosslinking is also undergoing evaluation to eradicate infectious microbes without antibiotics, and Dr. Kanellopoulos said it has been shown to reduce cases of corneal melt where it is very probable. "It appears to make the cornea more resistant to enzymatic digestion," he said. As a final word of advice, Dr. Raizman reiterated how important it is for all ophthalmologists to screen teenagers and young adults for ker- atoconus when they come in with a change in refractive error. "If [crosslinking] is widely recog- nized and widely available, we can diminish the need for transplants for keratoconus and significantly reduce the number of patients who require contact lens fitting. We can keep our patients seeing well with spectacles if we're diligent with screening patients and treating them early on. This will require that this procedure be widely available and provided by a large number of comprehen- sive ophthalmologists and not just limited to small centers and corneal specialists," Dr. Raizman said. Dr. Hersh said in terms of learn- ing the technique, his best advice is to visit a surgeon experienced with crosslinking, but courses offered at the ASCRS•ASOA Symposium & Congress and other meetings can be educational as well. EW References 1. Hersh PS, et al. United States multicenter clinical trial of corneal collagen crosslinking for keratoconus treatment. Ophthalmology. 2017 May 7. Epub ahead of print 2. Kanellopoulos AJ, et al. Revisiting keratoco- nus diagnosis and progression classification based on evaluation of corneal asymmetry indices, derived from Scheimpflug imaging in keratoconic and suspect cases. Clin Ophthal- mol. 2013;7:1539–48. 3. Wittig-Silva C, et al. A randomized, con- trolled trial of corneal collagen cross-linking in progressive keratoconus: Three-year results. Ophthalmology. 2014;121:812–821. 4. Greenstein SA, et al. Characteristics influencing outcomes of corneal collagen crosslinking for keratoconus and ectasia: Implications for patient selection. J Cataract Refract Surg. 2013;39:1133–40. Editors' note: Drs. Hersh and Raizman have financial interests with Avedro. Dr. Kanellopoulos has financial inter- ests with Alcon (Fort Worth, Texas), Avedro, i-Optics (The Hague, the Neth- erlands), Johnson & Johnson Vision (Santa Ana, California), and TrueVi- sion (Santa Barbara, California). Drs. Greenwood and Swan have no financial interests related to their comments. Contact information Greenwood: michael.greenwood@vancethompsonvision. com Hersh: phersh@vision-institute.com Kanellopoulos: ajk@brilliantvision.com Raizman: MBRAIZMAN@eyeboston.com Swan: russell.swan@vancethompsonvision.com The doctor gave me six months… OMG! …to my ne xt visit! Parasol® Six Full Months* of Effective Dry Eye Relief Coming Soon! Extend 180 3 sizes! The Extend 180 ™ Long-Term Dissolvable Implant Indications • Post-ocular surgery or seasonal dry eye • Contact lens intolerance • Dry eye associated with digital eye strain For pre-order introductory pricing 866-906-8080 or customersupport@beaver-visitec.com Beaver-Visitec International, Inc., 411 Waverley Oaks Road, Waltham, MA 02452 BVI, BVI Logo and all other trademarks (unless noted otherwise) are property of Beaver-Visitec International ("BVI") © 2017 BVI * 510(k) Summary K162361 June 2017

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