Eyeworld

Cornea Society News – published quarterly by the Cornea Society 8 Highlights of Cornea Subspecialty Day 2017 The program took place on November 11 at the American Academy of Ophthalmology (AAO) annual meeting "Corneal infections – Old bugs, new drugs" The first section of Cornea Subspecialty Day highlighted infections. Denise de Freitas, MD, São Paulo, Brazil, presented "Acanthamoeba keratitis: Embracing the challenge." This is a challenging infec- tion for several reasons, she said. It's a parasite, and it comes in two forms. Dr. de Freitas said the form that physicians really need to worry about are dormant cysts because these can be resistant to almost all antimicrobial drugs. Another challenge is delay in di- agnosis. It's important to think of this possible infection in all contact lens wearers. The sooner it can be diagnosed, the better. When diagnosis is delayed, the infection can penetrate more deeply into the corneal stroma, and success- ful therapy can become exceedingly difficult. But with an early diagnosis and treatment, there is a better chance of a good prognosis, Dr. de Freitas said. In relation to contact lenses, the prevalence is higher in soft lenses than rigid lenses. Risk factors include poor lens hygiene and exposure to potentially contami- nated solutions. Clinical findings may include a long history, which usually starts with contact lens intolerance. The patient may or may not experience pain. When treating Acanthamoeba keratitis, Dr. de Freitas said the goal of treatment is rapid eradication of viable organisms and eventual suppression of the inflammatory response. "Keratoplasty – Are we doing the right thing?" In a section focused on keratoplasty, Marian Macsai, MD, Glenview, Illinois, discussed how corneal surgery starts in the eye bank. In the U.S., there are 209 corneas transplanted each day. But where do they come from? Oc- ular donation is a complicated process, Dr. Macsai said, and eye banks can help with this. She mentioned a study from 2006 looking at pre-cut tissue, which found no significant difference in the quality of tissue or patient outcomes. "Pre-cut tissue saves time and money," she said. It can also help reduce a sur- geon's stress in the OR, as well as tissue waste. Another lesson learned from eye banks is that the "S" stamp is valuable. "It has revolutionized the way we do corneal transplants," Dr. Macsai said. Though there is slight damage to endo- thelial cells, Dr. Macsai thinks it's worth it to have that stamp, which is placed on the tissue by the eye bank. She spoke about surgeon misper- ceptions addressed in the Cornea Donor Study. The study found preoperative ECD is not predictive of graft failure caused by endothelial decompensation at 5 years following PKP. Donor age up to 75 years old did not impact PKP outcomes at 5 years, and graft rejection was not associated with donor age. Ad- ditionally, Dr. Macsai said that death to preservation or to surgery is not associat- ed with changes in ECD over time. CN Editors' note: The speakers have no finan- cial interests related to their presentations. The Academy worked with the Cornea Society to secure this designation, which can better position subspecialists in today's value-based healthcare. Winning approval for the cornea code caps more than 3 years of Academy efforts to add taxonomy codes for ophthalmic subspecialists. In addition to cornea, oph- thalmologists in the following subspecialties now have taxonomy codes: • Glaucoma • Oculoplastics • Retina • Pediatrics • Uveitis • Neuro-ophthalmology The AAO hopes that use of taxonomy codes will be adopted beyond Medicare by private insurers. CN Reprinted with permission from the American Academy of Ophthalmology T he American Academy of Ophthalmology (AAO) secured a new code for cornea specialists that can enable your success in federal programs and possibly other insurance company data. The committee has approved the new taxonomy code for cornea and external diseases specialists with the following definition: "An ophthalmologist who specializes in diseases of the cornea, sclera, eyelids, conjunctiva and anterior segment of the eye." The Centers for Medicare and Medicaid Services will include the new taxonomy in the Jan. 1, 2018 release of code-set changes. It will then go into effect on April 1. This is the seventh Academy-developed taxonomy code the National Uniform Claim Committee has accepted. Cornea gains taxonomy code to aid efforts in quality-based healthcare

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