Eyeworld

Reporting from the 2017 American Academy of Ophthalmology (AAO) annual meeting, November 11–14, New Orleans EW MEETING REPORTER 84 by warming pairs of corneas at room temperature or at 35 degrees Celsius and taking specular images every hour. Then two masked readers rated them. Those corneas that were warmed to 35 degrees Celsius scored one grade higher and produced bet- ter images. Images obtained after 1 hour at 35 Celsius are comparable to those obtained after 4 hours at room temperature, Dr. Tran added. Editors' note: Dr. Tran's study was funded by Bausch + Lomb (Bridge- water, New Jersey). Dr. Nordlund has no financial interests related to his presentation. Looking to glaucoma's therapeutic future A session at the AAO Glaucoma Subspecialty Day focused on a vari- ety of emerging treatment options, which experts say are long overdue in glaucoma. Gary Novack, PhD, Davis, California, presented nine treatments that were in Phases 1, 2, or 3 as of May 2017, including trabodenoson (Inotek Pharmaceu- ticals, Lexington, Massachusetts) and netarsudil/latanoprost fixed dose combination (Roclatan, Aerie Pharmaceuticals, Irvine, California). The timeline from invention to U.S. Food and Drug Administration approval for an agent can take 10 years, and it's an expensive process, which explains why there aren't more approved glaucoma therapies, other mentors in the cornea field, as well as his practice partners and his residents and fellows. The 2017 Richard C. Troutman, MD, DSc Prize Lecture, which goes to an investigator 40 years old or younger for an original paper, was "Rapid Warming of Donor Corneas is Safe and Improves Specular Image Quality," by Khoa Tran, PhD, Portland, Oregon. The motivation behind his study was based on concerns over the increasing trend of post-keratoplasty fungal infec- tions, strong correlation between eye bank-prepared EK tissues and higher rates of infections, and that the increased rates may be linked to excessive warming times at eye banks. The study looked at eye bank processes and asked what would cause us to excessively warm tissue and what can be done to reduce risk of warming. Dr. Tran explained that exces- sive warming could be caused by the process of obtaining a specular image, as specular image acquisi- tion can require a lot of time—up to 2 hours—and not all corneas are ready at the same time. Sometimes it's necessary to leave some corneas out longer to complete this process or even to put them away and try again later. He has heard from other eye bankers that if you warm the corneas up to 35 degrees Celsius in an incubator, you can get better specular images. Dr. Tran tested this of many of the functions of eye banks today, including recovery, donor eligibility, tissue evaluation, processing, storage, distribution, and record keeping/traceability. It's a collaboration. Surgeons are working with their eye banks, but every eye bank also has a medical director overseeing the processes. Dr. Nordlund highlighted some of the innovations in eye banking. "The reason we've been able to approach surgery differently is because of the willingness of eye banks to advance and innovate and help provide these tissues," he said. People want quality tissue, and they want quality surgery, Dr. Nordlund said. This is the glue that holds eye banks together from both the physician and eye bank side. The EBAA has been overseeing this transformation to ensure there are methods to assess tissue quality. Dr. Nordlund shared his thoughts on some threats on the horizon and why it's important to be aware of what's made eye banking successful. He highlighted consoli- dation, noting patterns of consoli- dation in healthcare. Consolidation does have benefits. You can stan- dardize, and there's market leverage. Disadvantages of consolidation include less diversity risk to innova- tion, increased separation between end user/supplier, and disruption of the feedback loop. Consolidation is going to change eye banking, Dr. Nordlund said. This will make it more important that physicians maintain input in the process and be involved in the EBAA, as well as with their local banks. Dr. Nordlund encouraged attendees to consider locally sourced products. The 2017 Claes H. Dohlman, MD, PhD Award was given to Mark Mannis, MD, Sacramento, Califor- nia. This award recognizes a lifetime of teaching excellence in the field of cornea and external disease and for contributions to the profession. "No award could be more gratifying than an award for teaching," Dr. Mannis said, adding that he owes a debt of gratitude to Dr. Dohlman who "has inspired generations of cornea specialists." Dr. Mannis thanked the members of the Cornea Society and View videos from AAO 2017: EWrePlay.org Kendall Donaldson, MD, discusses how to avoid creating an unhappy multifocal IOL patient and how to manage these patients postoperatively. December 2017

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