EyeWorld Asia-Pacific December 2017 Issue

Patient selection – from page 35 December 2017 38 EWAP SECONDARY FEATURE ditionally, a patient with a very thin cornea could pose a chal- lenge. Dr. Berdahl said if a patient is older, the benefits may not outweigh the risks of the proce- dure because these patients may not be progressing any longer. He stressed that while some of these concerns may make him less likely to perform crosslinking on a patient, none are an absolute contraindication. Impact of crosslinking on corneal transplantation Dr. Garg hopes there will no longer be a need for transplants for keratoconus in the next 10–20 years. Dr. Raizman said he sees less need for transplants. “I think we’re going to be doing far fewer corneal transplants for kerato- conus because we’re going to be preventing the progression to that stage,” he said. Additionally, he added that when penetrating kera- toplasty (PK) is done for keratoco- nus, it’s not unusual for the host cornea to continue to steepen over time, altering the refractive error of the eye. Dr. Berdahl thinks that crosslinking will decrease the need for deep anterior lamel- lar keratoplasty (DALK) and full thickness corneal transplants in the future. “If we can eliminate full thickness corneal transplants, that would be ideal,” he said, not- ing that it’s unlikely that the need for these transplants will be com- pletely eliminated because they may still be required for corneal scars and traumatic damage. “The only concern I have is I think full thickness corneal transplanta- tion is at risk of becoming a lost art,” Dr. Berdahl said, adding that these cases are some of the most complicated. He is doing less than half the full thickness corneal transplants he was 5 years ago, which means that there are fewer cases for fellows to learn from. EWAP Editors’ note: Dr. Raizman and Dr. Berdahl have financial interests with Avedro (Waltham, Massachusetts). Dr. Garg has no financial interests related to his comments. Contact information Berdahl: john.berdahl@vancethompson vision.com Garg: gargs@uci.edu Raizman: mbraizman@eyeboston.com