Tooth-in-Eye Surgery, Anyone?

HOT TOPIC

Cataract Surgery Worsens DR in Adults With Type 2 Diabetes, Study Finds

A recent study in Ophthalmology found that cataract surgery performed in adults with type 2 diabetes was associated with an increased risk of worsening diabetic retinopathy (DR). Expressly, this retrospective analysis indicated a higher 1-year risks for proliferative DR (PDR), vitreous hemorrhage, and composite outcome (including PDR, vitreous hemorrhage, and tractional retinal detachment) in both right and left eyes post-surgery. This risk was particularly notable in patients who had diabetes for at least 5 years.

Ahmed Sallam, MD, PhD, and his colleagues highlighted that, although the overall risk of PDR was low, the vast and growing at-risk population make these findings clinically significant. Despite the increased risks, the authors note that cataract surgery provides visual and quality of life benefits in patients with diabetes. The key is being vigilant in postoperative monitoring for retinopathy progression.

It's worth noting that older cataract methods were linked to increased risk of PDR, while evidence about the effect of modern phacoemulsification has been relatively inconsistent. The study used a large dataset and emphasized the need for patient education and frequent postoperative follow-ups. It used data from the TriNetX research network, which covered a large population base from June 2004 to June 2025. (Read more here.)

My Two Cents

I always try to profile studies that could change my treatment paradigms and how I practice optometry; however, this is one will not affect my clinical decision-making. Why profile it, then? I honestly believe its conclusions are worth noting. However, I can’t help but wonder if the timely removal of visually significant cataracts allows doctors to properly monitor and diagnose DR in a way that was not available before surgery. Additionally, it seems possible these patients hadn’t seen an eye care practitioner in many years, and once they were “back in the system,” they were more diligent in their eye care. One factor to consider is that by getting a proper view of the retina and its potential retinopathy, the provider can optimize diabetic control measures and recommend timely anti-VEGF therapy.

OUTSIDE THE LANE

Innovative OOKP Procedure to Restore Sight in Patients With Severe Corneal Blindness

Canada’s first tooth-in-eye surgery—osteo-odonto-keratoprosthesis (OOKP)—is set to restore vision for three patients at Vancouver’s Mount Saint Joseph Hospital. The innovative procedure involves extracting a tooth, fitting it with a plastic lens, and implanting it into the eye to replace damaged corneal tissue. The surgery is particularly suited for patients with severe corneal blindness caused by scarring, autoimmune diseases, or trauma for which traditional corneal transplants have failed.

Greg Moloney, MD

The first patient lost her sight a decade ago due to Stevens-Johnson syndrome, which was triggered by an anti-seizure medication. The second patient, Brent Chapman, lost his vision at age 13 after a severe reaction to ibuprofen. Both patients have undergone numerous unsuccessful ocular surgeries in the past. The OOKP surgery is performed in two stages, beginning with the extraction of the tooth, which is then shaped and fitted with a lens. Next, the tooth is implanted into the patient’s cheek for tissue integration before being transplanted into the eye.

Ophthalmologist and surgeon Greg Molony, MD, leads the surgical team, having previously performed OOKP surgeries in Australia. The procedure offers hope to patients with healthy retinas and optic nerves of regaining full sight. The surgery’s success relies on the unique properties of dentin in the tooth, which houses the plastic lens without rejection.

My Two Cents

My honest-to-goodness first thought after reading this article was, “Oh man, now dentists are for sure going to start doing eye care.” It’s a running joke among me and my eye care friends that dentists keep coming closer and closer to the eyeball, as they have decided that cosmetics (eg, Botox, Juvéderm) are well within their wheelhouses. All joking aside, however, I have a whole host of scleral lens patients who have had numerous unsuccessful corneal transplants. I hope this surgery eventually makes its way to the Bayou State!

CAN YOU RELATE

A few years ago, a major eye care pharmaceutical company invited a group of young(ish) ODs to a small gathering in Chicago. I was lucky enough to be included. The company wanted to know our thoughts about them, how we saw eye care in its current state, where we saw the profession going, and how they could help us get there.

During this meeting, an incredibly smart and well-spoken optometrist from California, Hardeep Kataria, OD, FAAO, said how she felt ocular aesthetics would grow and that it was natural for our profession to embrace it. As someone working in a large group practice that also has a free-standing cosmetics center and is one of the busiest of its kind in the state of Louisiana, I vehemently disagreed with her. I let her and the rest of the group know that I didn’t see ocular aesthetics as something our profession would embrace and felt that it was a flash in the pan. I believe I said something along the lines of, "Patients won’t go to their eye doctor for cosmetic advice! They’re going to go to centers devoted just to that!”

Well, I was wrong, which is nothing new. I’m wrong a lot—ask my team—they’re not afraid to tell me about it each time. Ocular aesthetics is clearly here to stay in our profession. I see more and more eye clinics around the country adding aesthetics or cosmetics services to their websites or even to the name of their clinic. Every day, more and more patients are sitting in my chair, mentioning the bags under their eyes, deepening crow’s feet, wrinkles on the forehead, rosacea issues, etc. This is absolutely an issue that I applaud forward-thinking doctors such as Dr. Hardeep Kataria, Selena McGee, OD, FAAO, and Carly Rose, OD, FAAO, among countless others, for pushing our profession forward and seeing beyond the naysayers like me.

I’m committed. I’m on board. Ocular aesthetics, like dry eye treatment, is something we as a profession need to own!