Reviews Supplements Accelerate Healing of the Ocular Surface Prior to Cataract and Refractive Surgery : Page 1

Roundtable Panel Richard L. Lindstrom, MD (Moderator) , is the founder of and an attend-ing surgeon at Minnesota Eye Consultants as well as adjunct professor emeritus at the University of Minnesota Department of Ophthalmology. Mary E. Davidian, MD, is the founder and medical director of Highland Ophthalmology Associates LLC. She is an associate adjunct professor of Ophthalmology at The New York Eye and Ear Infi rmary and New York Medical College. Scott G. Hauswirth, OD, practices at Minnesota Eye Consultants, where he leads the optometric student externship pro-gram. He is an adjunct clinical professor at four colleges of optometry. John D. Sheppard, MD, MMSc, is president of Virginia Eye Consultants and Professor of Ophthal-mology, Microbiology & Molecular Biology at Eastern Virginia Medical School. Scheffer C.G. Tseng, MD, PhD, is co-founder and chief scientifi c offi cer at TissueTech Inc. and also co-founder of Bio-Tissue. Elizabeth Yeu, MD, is in private practice at Virginia Eye Consultants and serves as an assistant professor in the department of Ophthalmology at Eastern Virginia. O utcomes following cataract and refractive surgery are determined largely by the condition of the preoperative ocular surface. As the following discussion clearly illustrates, patients with dry eye and mild or severe epithelial basement membrane dystrophy risk suboptimal results because preoperative calculations and healing both can be affect-ed by compromised surface health. Superfi cial keratectomy offers an opportunity to truly optimize the ocular surface. However, these procedures are onerous for the surgeon and signifi -cantly unpleasant for patients. This reality is one we need to carefully weigh and one we will explore in depth in the following roundtable discussion. One thing is clear as we begin this conversation: there is a meaningful, unmet need to be able to more effectively prepare or restore the ocular surface prior to cataract and refractive surgery. It is our goal today to de-termine how best to address this often overlooked indication. —Richard L. Lindstrom, MD, Moderator DIAGNOSING EBMD Dr. Lindstrom: It’s been said that EBMD, also known as map-dot-fi ngerprint dystrophy, is the most common corneal dystrophy. 1 What is the exact incidence and prevalence? Scott G. Hauswirth, OD: Although the literature is variable, it may affect as many as 42 percent of all ages worldwide, and about 76 percent over the age of 50. 2 Scheffer C.G. Tseng, MD, PhD: Although these are the reported fi g-ures, because it is so often missed, I don’t think anyone can know the exact number. In many cases, the eye almost looks completely normal. But, histologically, EBMD is charac-terized by an anomalous basement membrane that may extend into the epithelial layer inducing abnormali-ties of epithelial cell morphology and poor adhesion around the basement membrane. 3-10 Dr. Lindstrom: What can we do to ensure we don’t miss the diagnosis? John D. Sheppard, MD, MMSc: One great way to fi nd EBMD is just to look for negative fl uorescein staining defects. Often, I’m con-cerned that these areas may be the source of intermittent symptoms in otherwise unidentifi ed EBMD. Then, when I perform keratectomy, I discover that the defect isn’t limited to that one focal area. Rather, the epithelium is diffusely defective and non-adherent throughout the cornea. Dr. Hauswirth: I fi nd that a careful look with direct beam is often productive, and I agree that look-ing for areas of negative staining is extremely valuable. Mary E. Davidian, MD: I usually like to stain these patients with fl uorescein strips following an ap-plication of proparacaine because it offers a thin application. The thicker Sponsored by

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