Eyeworld

113 EW CORNEA March 2018 in the disease can stop the progres- sion. The approach is necessitated by their lack of access to anti-fungal medication. "It's a judgment call also based on the severity of the infection and the location of the infection," Dr. Amescua said. "It's very different if it's in the center of the cornea ver- sus the periphery because if it's in the periphery, you may have to do a larger graft. It will depend on the organism, the location, and how ag- gressive the organism is behaving." The key consideration for Dr. Mah is based on the spread pattern for fungal keratitis—it seems to spread deeper, rather than broadly, while bacterial keratitis generally spreads width-wise, not depth-wise. "For fungal keratitis, even when the cornea looks relatively healthy and the width of the ulcer does not seem to have progressed significant- ly, most likely you have fungus at various levels of the corneal stroma and maybe even down to Descem- et's," Dr. Mah said. Dr. Mah operates if he lacks good control of the fungal keratitis —to the point of at least stopping the progression and starting the healing—by the time it reaches half- way into the cornea. "The key thing for bacteria is to try to wait a couple of weeks to make the cornea sterile," with anti- microbials, Dr. Mah said. Crosslinking role? The treatment of fungal infections with collagen corneal crosslinking (CXL) has shown mixed results in the published literature. In Dr. Amescua's research, the use of riboflavin and UV light has not consistently killed fungi in vi- tro. However, he and his colleagues' use photodynamic therapy (rose bengal activated by a green light), and this has shown the ability to kill every kind of fungus seen in clinical practice. They have started to study that approach in human subjects. "There may be a role but in fungal infections, the results are not great with regular crosslinking," Dr. Amescua said. Infection control One of the continuing challenges for fungal keratitis patients is the best way to control inflammation when it is recommended such pa- tients avoid steroids. "Much of it is reassurance, coaching, trying to get the patients to trust your management," Dr. Mah said. "You can give an oral agent, like nonsteroidals. You can try topi- cal nonsteroidals, although I would be cautious because in the face of collagenolysis they can accelerate it." HOW DOES YOUR EMR COMPARE? According to the 2015 ASOA EHR Satisfaction Survey Results* • EYEMD EMR HEALTHCARE SYSTEMS SCORED HIGHER ON OVERALL SYSTEM FUNCTIONALITY THAN ANY OTHER VENDOR! • USERS EXPERIENCE LESS HIDDEN COSTS WITH EYEMD EMR THAN ANY OTHER VENDOR! • USERS ARE MORE LIKELY TO RECOMMEND EYEMD EMR OVER ANY OTHER VENDOR! EyeMD EMR is the complete solution designed specifically for ophthalmologists. It has all the features and functionality you need, and it includes built-in DICOM imaging, diagnostic machine integrations, server monitoring, and no-cost, seamless integration with more than 80 practice management systems. All with no hidden costs! Call 1-877-2-EYE-EMR to schedule your free demo today! OR VISIT EYEMDEMR.COM/COMPARE TODAY TO SEE HOW YOUR EMR COMPARES TO EYEMD EMR! ON E O F T H E F AS TES T GRO W I N G P R I VA TE CO M P A N I ES I N T H E U SA T H R EE YEAR S I N A RO W ! 2015 ASOA EHR Satisfaction Survey Results* 1. EyeMD EMR scored higher on Overall System Functionality than any other vendor. 2. EyeMD EMR users report experiencing less hidden costs than any other vendor. 3. Users are more likely to recommend EyeMD EMR than any other vendor. * Based on recent customer satisfaction survey conducted on behalf of the AAO/AAOE & ASCRS/ASOA. Survey results represent opinion only, and are not in any way intended for use as a ranking tool. https://www.aao.org/eyenet/article/what-do-ophthalmologists-think-of-their-ehrs www.EyeMDEMR.com | (877) 2 EYE EMR WE ARE THE IN EMR FOR OPHTHALMOLOGY! *Based on HIGH user satisfaction reported on EHR Satisfaction Surveys conducted by AAO™ & ASCRS/ASOA AAO/AAOE & ASCRS/ASOA do not endorse any products. IRREFUTABLE LEADER HOW DOES YOUR EMR COMPARE? ON OVERALL SYSTEM Visit Us At Booth #2802 At The 2018 ASCRS-ASOA Annual Meeting C M Y CM MY CY CMY K continued on page 114

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