Promising New Procedure for Keratoconus

HOT TOPIC

A Less Risky Procedure for Patients With Keratoconus

A new procedure for keratoconus, called Bowman layer (BL) onlay grafting, has been found to be less risky than corneal transplantation. The procedure is an epi-off transplant technique that involves adding a donor Bowman layer inside a stromal pocket. It is designed for patients with more advanced stages of keratoconus.

Obviously, eye care professionals would prefer to encounter keratoconus in its subclinical state, so that procedures such as corneal cross-linking or intrastromal ring segment implantation can be performed to strengthen the cornea. However, transplants are typically the only option for our most advanced cases. To avoid corneal perforation due to the typically thin cornea in keratoconus, the study authors proposed BL onlay transplantation, where the BL graft is stretched onto the cornea after the epithelium is removed. It is then allowed to dry, after which it is immediately covered with a soft bandage contact lens until the graft fully re-epithelizes. The interventional case series that was conducted using this approach found that it produced acceptable results, while allowing the patient to continue wearing scleral lenses.

In the study, the researchers reported that all surgeries were uneventful, and that there was an overall Kmax change from 76.00 D preoperatively to 72.00 D at 6 to 36 months postoperatively. The researchers concluded that the BL onlay transplantation has “the potential to flatten far advanced keratoconic corneas without the risk of severe intraoperative complications since the technique is completely extraocular and has a diminished risk of allograft rejection due to the acellular character of an isolated BL membrane.” They believe that this technique seems effective for patients with very steep and thin corneas who still have a subjectively acceptable visual performance, namely with scleral lenses.

My Two Cents

Anything we can offer our patients with keratoconus is a massive addition to our armamentarium. There isn’t much from a surgical perspective that we can do for our advanced cones who aren’t candidates for cross-linking. Unfortunately, for these patients, it often involves playing the waiting game, as their corneas continue to thin. It’s exciting that we may have a new treatment option!

OUTSIDE THE LANE

Patient Sites on Cataract Surgery Need Improvement

Researchers at The Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore have determined that the readability and accessibility of various patient-oriented informational health websites for cataract surgery must be improved. This research was published in Ophthalmology and was created because often, when patients are confronted with a medical decision (including cataract surgery), they go online to gain more detailed information to help them make decisions regarding their care. Therefore, patient-oriented websites must be readable to those with reduced visual capabilities and medical knowledge to promote health literacy and better decision-making.

The researchers in this study discovered that the average reading level of the top 100 patient-oriented health websites regarding cataract surgery was approximately 12th grade—substantially more advanced than the American Medical Association-recommended 6th-grade reading level and the average 8th-grade reading level of the US population.

The study’s corresponding author, Wilmer cornea specialist Esen K. Akpek, MD, states that her residents and students encouraged her to perform the research. She says, “… because I sometimes have trouble explaining things without using medical terms too much, to explain using lay language to present an accurate representation of pros and cons and the like.”

The study performed an incognito search for “cataract surgery” using a major search engine. The top 100 patient-oriented cataract surgery websites that first came up were included and categorized as institutional, private practice, or medical organizations based on authorship. The site was then assessed for readability using four standardized formulas that calculate reading grade level. In addition, accessibility was also evaluated through multilingual availability, accessibility-menu availability, and other guidelines for web content accessibility.

My Two Cents

This is a fascinating study, in that it’s something many of us often forget about—where our patients gather their information from when they’re not in our offices. It’s important to have properly vetted handouts to distribute to patients and link to well-crafted, patient-centered websites through our social media and web presence.

CAN YOU RELATE

Thanksgiving is right around the corner! As I think about the fun my family is about to have while together celebrating our blessings, I am reminded of the typical questions I get from family members. Some of my favorites include:

“So, Visine is good for your eyes, right?”
“My idiot doctor said I have dry eyes, but my eyes water all day. Do you have any other doctors that you recommend?”
Then there’s my 70-year-old uncle who every year asks, “So how much is LASIK again? I need to get that done.”
Amongst many, many more.

This year, instead of answering the same questions as we sit around the dinner table, I plan to update everyone on all the exciting things happening in eye care. Most people don’t realize that the Light Adjustable Lens (RxSight) exists, that there is such thing as microinvasive glaucoma surgery during cataract surgery, that they can get contact lenses that adapt to changing light conditions (Acuvue Oasys with Transitions, Johnson & Johnson Vision Care), or that intense pulsed light therapy is a treatment option for their dry eye. Then there are all the other new dry eye treatments and pharmaceuticals, plus countless other innovations.

Are any of you planning to have eye-related conversations at the Thanksgiving dinner table?