EyeWorld India June 2019 Issue

Ón EWAP JUNE 2019 A }ÀœÜˆ˜} ˜Õ“LiÀ œv tools and a better ՘`iÀÃÌ>˜`ˆ˜} œv ŽiÀ>̜Vœ˜Õà >Ài …i«ˆ˜} «…ÞÈVˆ>˜Ã `ˆ>}˜œÃi ̅i progressive disease at earlier stages. º ÕÀÀi˜ÌÞ] ̅i i>ÀˆiÃÌ stage that can be diagnosed ܈̅> Ài>ܘ>Li `i}Àii œv ViÀÌ>ˆ˜ÌÞ ÜœÕ` Li ܅>Ì ˆÃ V>i` ¼ÃÕLVˆ˜ˆV> ŽiÀ>̜Vœ˜ÕÃ]½» Ã>ˆ` Michael Belin, MD ] «ÀœviÃÜÀ œv œ«…Ì…>“œœ}Þ >˜` ۈȜ˜ ÃVˆi˜Vi] 1˜ˆÛiÀÈÌÞ œv ƂÀˆâœ˜>] Tucson, Arizona. “This is true disease and should not be Vœ˜vÕÃi` ܈̅¼ÃÕëiV̽ œÀ ¼vœÀ“ vÀÕÃÌi°½» -ÕLVˆ˜ˆV> ŽiÀ>̜Vœ˜Õà has abnormalities on the «œÃÌiÀˆœÀ VœÀ˜i> ÃÕÀv>Vi œÀ V…>˜}ià ˆ˜ VœÀ˜i> ̅ˆVŽ˜iÃà Vœ“«>̈Li ܈̅ŽiÀ>̜Vœ˜ÕÃ] ÃÕV…>à >L˜œÀ“> «>V…Þ“iÌÀˆV «Àœ}ÀiÃȜ˜° Ì Ài“>ˆ˜Ã subclinical because the anterior ÃÕÀv>Vi Ài“>ˆ˜Ã ˜œÀ“> >˜` the patient retains good visual >VՈÌÞ] À° iˆ˜ Ã>ˆ`° Renato Ambrósio Jr., MD ] >`Õ˜VÌ «ÀœviÃÜÀ œv œ«…Ì…>“œœ}Þ] i`iÀ> 1˜ˆÛiÀÈÌÞ œv ̅i -Ì>Ìi œv ,ˆœ `i >˜iˆÀœ 1 , "®] À>∏] Ã>ˆ` ̅i ÌiÀ“à ºÃÕLVˆ˜ˆV>]» ºvÀÕÃÌi» >˜` º“ˆ`» >Ài Vœ˜vÕȘ} ȘVi ̅i clinical literature applies them to `ˆvviÀi˜Ì Vœ˜`ˆÌˆœ˜Ã° º/…iÀi ˆÃ ˜œ i>ÃÞ >}Àii“i˜Ì œ˜ ̅iÃi `iw˜ˆÌˆœ˜Ã]» À° Ambrósio said. “We have i>À˜i` > œÌ vÀœ“ ̅i ÛiÀÞ >Ãޓ“iÌÀˆV iVÌ>È> 6Ƃ ® V>Ãià ˆ˜ ܅ˆV…œ˜i iÞi «ÀiÃi˜Ìà ܈̅ ˜œÀ“> vÀœ˜Ì ÃÕÀv>Vi ̜«œ}À>«…Þ° œÜiÛiÀ] ܓi œv ̅iÃi 6Ƃ V>Ãià >Ài ÌÀÕÞ Õ˜ˆ>ÌiÀ>° ˜ÌiÀiÃ̈˜}Þ] ܅ˆi ŽiÀ>̜Vœ˜Õà ÌÞ«ˆV>Þ «ÀiÃi˜Ìà >à >˜ >Ãޓ“iÌÀˆV `ˆÃi>Ãi] ̅ˆÃ ˆÃ LÞ `iw˜ˆÌˆœ˜ Lˆ>ÌiÀ>° 7ˆÌ… advanced corneal imaging including the integrated ̜“œ}À>«…Þ >˜` Lˆœ“iV…>˜ˆV> >ÃÃiÃÓi˜Ì] Üi V>˜ `iÌiVÌ ÛiÀÞ “ˆ` `ˆÃi>Ãi ˆ˜ ̅i “>œÀˆÌÞ œv ̅iÃi V>Ãið» *ÀœÃ«iV̈Ûi ÃÌÕ`ˆià >Ài ˜ii`i` ̜ V>ÀˆvÞ Ì…i issue, Dr. Ambrósio said. A. John Kanellopoulos, MD , medical director, LaserVision ˆ˜ˆV> >˜` ,iÃi>ÀV…Þi ˜Ã̈ÌÕÌi] Ƃ̅i˜Ã] ÀiiVi] >˜` Vˆ˜ˆV> «ÀœviÃÜÀ œv œ«…Ì…>“œœ}Þ] iÜ 9œÀŽ 1˜ˆÛiÀÈÌÞ i`ˆV> -V…œœ] iÜ 9œÀŽ]…>à «ÕLˆÃ…i` ˜Õ“iÀœÕà studies on the issue and concluded that in its earliest stages the corneal epithelium ܈ ̅ˆVŽi˜ œÛiÀ>° /…>Ì VœÕ` “i>˜ ̅>Ì > ˜œÀ“>Þ xä‡ Ìœ xӇ“ˆVÀœ˜ i«ˆÌ…iˆ> ̅ˆVŽ˜iÃà “>Þ ˆ˜VÀi>Ãi Õ« ̜ >˜ >ÛiÀ>}i œv “œÀi ̅>˜ xn “ˆVÀœ˜Ã «ÀˆœÀ ̜ creating irregularities. º"ÛiÀ> i«ˆÌ…iˆ> ̅ˆVŽi˜ˆ˜} “>Þ Li >˜ i>ÀÞ È}˜ œv VœÀ˜i> Lˆœ“iV…>˜ˆV> ˆ˜ÃÌ>LˆˆÌÞ° v the ectasia progresses, and as ˆÌ ˆÃ >“œÃÌ >Ü>Þà >ÃÜVˆ>Ìi` ܈̅ۈ}œÀœÕà iÞi ÀÕLLˆ˜}] the epithelium remodels to iÛi˜ÌÕ>Þ ̅ˆ˜ œÛiÀ ̅i >Ài> œv thinning and ‘bulging’ stroma >˜` ̅ˆVŽi˜ˆ˜} >ÀœÕ˜` ˆÌ >à > “i>˜Ã ̜ Žii« ̅i >˜ÌiÀˆœÀ VœÀ˜i> ÃÕÀv>Vi ӜœÌ…>˜` ̅Õà ̅i œ«ÌˆVà œv ̅i iÞi >Ì Ì…iˆÀ LiÃÌ]» À° >˜iœ«œÕœÃ Ã>ˆ`° ˜ ÃÕV…i>ÀÞ ÃÌ>}iÃ] ̜«œ}À>«…Þ >˜` ̜“œ}À>«…Þ V>˜˜œÌ ÞiÌ «ˆVŽ Õ« >˜Þ ˆÀÀi}Տ>ÀˆÌÞ] iëiVˆ>Þ ˆv ̅i iVÌ>È> ˆÃ Vi˜ÌÀ>° ˜ÃÌi>`] epithelium mapping provided LÞ >˜ÌiÀˆœÀ Ãi}“i˜Ì " / >˜`ɜÀ …ˆ}…vÀiµÕi˜VÞ ÕÌÀ>Ü՘` ŜÜà what is normal, what is epithelial `ˆÃÌÀˆLṎœ˜ ˆ˜ `ÀÞ iÞiÃ] >˜` what is epithelial distribution in ŽiÀ>̜Vœ˜Õð º9œÕ ܜՏ` Li ÃÕÀ«ÀˆÃi` …œÜ “>˜Þ «>̈i˜Ìà «>Ãà ܈̅yވ˜} VœœÀà ̅i *>Vˆ`œ `ˆÃV ̜«œ}À>«…Þ >˜` ̅i Obtaining earlier keratoconus diagnoses by Rich Daly Þi7œÀ` œ˜ÌÀˆLṎ˜} 7ÀˆÌiÀ AT A GLANCE • -ÕLVˆ˜ˆV> ŽiÀ>̜Vœ˜Õà «>̈i˜Ìà ÀiÌ>ˆ˜ > ˜œÀ“> >˜ÌiÀˆœÀ ÃÕÀv>Vi >˜` }œœ` ۈÃÕ> >VՈÌÞ° • «ˆÌ…iˆ> “>««ˆ˜} LÞ >˜ÌiÀˆœÀ Ãi}“i˜Ì " / V>˜ `ˆvviÀi˜Ìˆ>Ìi i«ˆÌ…iˆ> `ˆÃÌÀˆLṎœ˜ ˆ˜ ŽiÀ>̜Vœ˜Õð • ˜Ìi}À>Ìi` VœÀ˜i> ̜“œ}À>«…Þ >˜` Lˆœ“iV…>˜ˆVà ܈̅>À̈wVˆ> ˆ˜Ìiˆ}i˜Vi i˜…>˜Vi ̅i >VVÕÀ>VÞ Ìœ `iÌiVÌ “ˆ` iVÌ>È> >˜` «œÃÈLÞ ̜ V…>À>VÌiÀˆâi iVÌ>È> ÃÕÃVi«ÌˆLˆˆÌÞ° • *œÃ̇`ˆ>}˜œÃˆÃ >««Àœ>V…ià V>˜ Li Ì>ˆœÀi` ̜ ̅i «>̈i˜Ì½Ã >}i] VœÀ˜i> ̅ˆVŽ˜iÃÃ] iVÌ>È> ÃÌ>}ˆ˜}] >˜` iÛi œv v՘V̈œ˜ˆ˜}° 'FKVQTUo PQVG &T $GNKP JCU ƂPCPEKCN interests with Oculus, Avedro, and CXL Ophthalmics (Sherborn, Massachusetts). Dr. Ambrósio has ƂPCPEKCN KPVGTGUVU YKVJ 1EWNWU Alcon (Fort Worth, Texas), Carl Zeiss Meditec (Jena, Germany), Mediphacos (Belo Horizonte, Brazil), and Essilor (Charenton-le-Pont, France). Dr. -CPGNNQRQWNQU JCU ƂPCPEKCN KPVGTGUVU with AJKMD Events, Alcon, Avedro, ISP Surgical (Bangkok, Thailand), Tula Medical (Doylestown, Pennsylvania), and Carl Zeiss Meditec. Dr. Trattler has ƂPCPEKCN KPVGTGUVU YKVJ #TE5ECP )QNFGP Colorado), Avedro, Oculus, and CXL Ophthalmics. œ˜Ì>VÌ ˆ˜vœÀ“>̈œ˜ Ambrósio: `À°Ài˜>̜>“LÀœÃˆœJ}“>ˆ°Vœ“ Belin: 7 iˆ˜J>œ°Vœ“ Kanellopoulos: >Ž“`J“>V°Vœ“ Trattler: ÜÌÀ>Ì̏iÀJ}“>ˆ°Vœ“ Surgeons identify keys to earlier diagnosis of keratoconus patients # UWURGEV HQT MGTCVQEQPWU DGECWUG JKIJ KTTGIWNCT CUVKIOCVKUO KU VTWPECVGF 6JG VJKEM PGUU OCRU UWIIGUV MGTCVQEQPWU DWV VJKU KU RTQDCDN[ C XGT[ EGPVTCN EQPG YJKEJ VTKEMU VJG FGXKEGoU CTVKƂEKCN KPVGNNKIGPEG FEATURE This article originally appeared in the March 2019 issue of EyeWorld. It has DGGP UNKIJVN[ OQFKƂGF CPF CRRGCTU here with permission from the ASCRS Ophthalmic Services Corp.