Eyeworld

EW CORNEA 62 July 2017 by Liz Hillman EyeWorld Staff Writer Dr. John provided historical background on the use of amniotic membrane, which dates back to the late 1800s for healing burns and skin lesions. Amniotic membrane pro- motes regenerative healing, rather than scar formation, which Dr. John noted is beneficial for ocular surface conditions. As for its anatomy, the amniotic membrane is the inner-most layer of the placenta. It has a thick base- ment membrane, is avascular, and contains biologically active factors Webinar features evolution of amniotic membrane for various indications in ophthalmology M ore than 150 attend- ees from the U.S. and around the world tuned in to the ASCRS Cornea Clinical Com- mittee-sponsored webinar "Clinical Applications of Amniotic Membrane in the Office and Operating Room Setting" in late March. Moderator Thomas John, MD, clinical associate professor, Loyola University, Chicago, with faculty Elizabeth Yeu, MD, Virginia Eye Consultants, Norfolk, Virginia, and Neel Desai, MD, Eye Institute of West Florida, Largo, Florida, shared information about the science behind amniotic membrane use, its ocular indications, and outcomes with several case examples. "I want to start out by saying that we have a significant move- ment from the operating room to the office setting where we can use amniotic membrane," Dr. John said. "In the past, we did not have the choice, and therefore we had to take patients to the operating room setting. The introduction of amni- otic membrane that is commercially available that can be used in the office setting has created a paradigm shift in the way we treat some of these conditions." Physicians discuss amniotic membrane in spring ASCRS webinar Webinar reporter Bascom Palmer Eye Institute, Uni- versity of Miami, who has frequent- ly researched dry eye among the veterans population, said that Dr. Vehof's work confirms findings she and fellow researchers have made. She thinks it is interesting that Dr. Vehof's work focuses on a mostly female population and her research focuses on the mostly male veter- ans population, and yet both have similar results. Dr. Galor thinks the findings from the current study add to a growing body of work that supports an association between dry eye and pain syndrome in some patients. Some of the patients she has treated have found relief with gabapentin, 900 mg, three times a day, leading to further support of the pain path- ways/dry eye connection. She also has used autologous serum tears as a treatment. "I have seen a number of patients with pristine corneas complaining of dry eye symptoms. I would love to see more studies ex- ploring this topic," Dr. Ozerov said. Practical implications Based on the study results and their own experience, the physicians interviewed for this article shared pearls to better treat dry eye. 1. Recognize dry eye as an entity that can have different manifesta- tions in patients. 2. Form relationships with pain specialists and mental health pro- viders so you can refer to them as necessary, Dr. Galor suggested. 3. Implement more aggressive dry eye screening in patients who have Sjögren's disease. This is something that Dr. Ozerov plans to do as these patients tend to be less symptomatic. She particularly likes tests that look for early mark- ers of the disease. 4. Ask patients about chronic pain syndromes, depression, atopic disease, and diabetes if they have dry eye symptoms but not many signs, Dr. Vehof recommended. "These factors are helpful in understanding why a patient has more symptoms than what you would expect by the clinical pic- ture," he said. 5. Do not rely on dry eye symptoms in older patients in addition to those with Sjögren's and graft-ver- sus-host disease, Dr. Vehof said. EW Reference 1. Vehof J et al. Predictors of discordance be- tween symptoms and signs in dry eye disease. Ophthalmology. 2017;124:280–6. Editors' note: The physicians have no financial interests related to their comments. Contact information Galor: agalor@med.miami.edu Ozerov: iozerov@gmail.com Vehof: jelle.vehof@kcl.ac.uk Dry continued from page 60 In the webinar, Dr. Desai described how to detect conjunctivochalasis and how to use his Tissue Tuck technique with amniotic membrane to treat it. Source: Neel Desai, MD

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