REFRACTIVE 18 EWAP JUNE 2022 need to understand that they’re making a lifelong commitment to avoid eye rubbing postop. If a patient has a phakic IO , Dr. reenwood eÝplained that pushing on the anterior surface of the eye could cause the IO to touch the iris or natural lens, causing damage. Patients with allergies and/or dry eye often have low-level inyammation, and eye rubbing can continue the inyammation cascade. Hands aren’t the only culprit putting pressure on the eye. “Face planting into a pillow is also suspected to produce similar mechanical strain to the cornea as an eye rub, and I will most commonly question my grossly asymmetric keratoconus patients about sleeping position. Not infrequently, they admit to sleeping on the side of the more advanced keratoconus eye,” Dr. Baartman said. While there is no direct sign on eÝamination that a patient is an eye rubber, Dr. Baartman said there has been postulation that without eye rubbing, or some form of repetitive mechanical strain placed on the cornea, progressive ectasia would not naturally occur. “For this reason, any patient with either post- A-I or naturally occurring keratoconus is assumed to be an eye rubber, and even if they deny it, they are thoroughly educated on the dangers of eye rubbing and avoidance of planting their face into the pillow at night,” Dr. Baartman said. Dr. Greenwood said he thinks the possible hazards of eye rubbing should be discussed more with the general public. Dr. Baartman thinks eye rubbing has become less frequent in the keratoconus population with continued empowerment of optometric network and general ophthalmologist colleagues. A final tip to help educate patients about eye rubbing, especially when it’s subconscious, is to eÝplain that there is a threat of needing a full-thickness corneal transplant (possibly multiple) if they have keratoconus and continue eye rubbing, Dr. Baartman said. EWAP References 1. Sahebjada S, et al. Eye rubbing in the aetiology of keratoconus: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2021Æ25\2057q20È7. 2. Panikkar K, et al. Progressive keratoconus, retinal detachment, and intracorneal silicone oil with obsessive-compulsive eye rubbing. Oman J Ophthalmol. 201ÈÆ\170q173. 3. Bassily R, et al. Bilateral rupture of the posterior capsule and intraocular lens dislocation from eÝcessive eye rubbing. J Cataract Refract Surg. 2016; {2\32q331. 4. Turner DC, et al. The magnitude of intraocular pressure elevation associated with eye rubbing. Ophthalmology. 201Æ12È\171q172. Editors’ note: Dr. Baartman practices at Vance Thompson Vision, Omaha, Nebraska. Dr. Greenwood practices at Vance Thompson Vision, Fargo, North Dakota. Neither declared any relevant financial interests. therapy development gives is substantial,” Dr. Yeu said. “There are a number of labs today that offer testing for published eye-related genes.” These tests, Dr. Yeu said, are meant to provide guidance and additive information for the clinical decision-making process. “This will help me determine if I do laser vision correction or A-I versus PR or skip the cornea and choose an I Æ it helps determine if crosslinking is war-ranted or what the follow-up schedule should look like for the patient,” she said. Dr. Yeu added that the genetic testing technology has improved so that the sample collection process can be done by a nurse, technician, or trained staff member in the clinic in just a few minutes. “The DNA collection is performed by swabbing the buccal mucosa inside of the cheek, and it’s deposited into a small vial that preserves the sample,” she said. “The DNA sample is shipped to Avellino, and the reports are accessible to the practice via a web portal.” Genetic testing, Dr. Donnenfeld said, is another tool to give the doctor and patient more information. ºIf someone has obvious keratoconus, I don½t need genetic markers,” he said. “What we want to do is look at the patient who looks a little unusual, where the topography isn’t completely normal but not at the point where it’s an easy diagnosis. This gives me that additional information to allow me to make smart decisions.” Dr. Donnenfeld said he will use genetic testing frequently for family members of those who have had transplants. They often want to have all their children checked. He also discussed the ability of this test to diagnose other stromal dystrophies and noted that new genetic markers, particularly for glaucoma, may be included in future testing. ºI think genetic testing is going to be the future of everything we do in ophthalmology, as well as all of medicine, because finding the patients who are at risk for diseases, diagnosing them earlier, and designing a treatment plan that fits their genetic markers is going to allow us to be smarter practitioners and provide better care,” Dr. Donnenfeld said. EWAP Editors’ note: Dr. Donnenfeld practices with the Ophthalmic Consultants of Long Island, Garden City, New York. Dr. Yeu practices with Virginia Eye Consultants, Virginia Beach, Virginia. Both doctors declared interests with Avellino. The value of - from page 16
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