CONFERENCE HIGHLIGHTS ESCRS 2019 Highlights Managing Corneal Disorders in
Cataract and Refractive Patients
by Hazlin Hassan
For refractive surgery patients, new technologies are available for the detection of corneal disorders, thereby potentially improving outcomes.
and posterior corneal surface, lens thickness and opacification, as well as higher order aberrations. High order aberrations of the anterior and posterior corneal surfaces are good indicators for diagnosing keratoconus and for classifying the stage of the disease, with sensitivity and specificity of 98 and 99%, respectively. “The diagnosis of irregular corneas is complex and depends on many factors. One device by itself is not a good predictor of the condition. Predictive models can be obtained in combination with other indicators,” concluded Prof. Kymionis.
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his is among the good news that delegates heard at the 37th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS Paris 2019) during the EuCornea Symposium called ‘Approaches to the Diagnosis and Management of Important Corneal Disorders in the Cataract and Refractive Patient’.
Diagnostic Imaging of the Irregular-Keratoconic Cornea
Diagnostic imaging is the 'cherry on top' for evaluating keratoconus.
Prof. Georgios D. Kymionis of JulesGonin Eye Hospital and University of Lausanne, Switzerland, explained that keratoconus – a disorder where the cornea thins into a cone-shape and distorts vision – occurs in one of 2,000 people, with 7% having family history of the disease. The incidence of keratoconus differs according to geographical location and environmental factors may also contribute to the wide variation in prevalence. Areas with sunshine and hot weather like India and the Middle East have a higher prevalence (2.3%), compared with places with less sunshine such as Finland, Denmark and Russia (0.0003%). “Thus, ultraviolet light-induced oxidative stress may have a role to play,” said Prof. Kymionis. Keratoconus impacts the patient’s quality of life. “Vision-related quality of life was worse in keratoconic patients due to low visual acuity,” he explained, adding that using contact lenses to maintain visual acuity (VA) may improve vision-related quality of life. Keratoconic patients also had significantly lower values in social functioning, mental
health, role difficulties and overall composite scores. Diagnostic imaging technology is essential for corneal analysis, especially in the early stages of disease. It’s used for screening subclinical keratoconus and evaluating the disease’s progression, preoperative screening of refractive (excluding patients with subclinical keratoconus) and cataract patients – especially in those where a premium intraocular lens (IOL) is used. It’s also important in the evaluation of corneal irregularities in postrefractive surgery patients and in the determination of possible retreatment. Diagnostic imaging technology for corneal analysis includes topography, tomography, corneal thickness maps, epithelial thickness maps, aberrometers and artificial intelligence (AI). Comparing corneal topography to tomography, Prof. Kymionis said that corneal topography is limited to evaluating the anterior surface of the cornea and has decreased sensitivity and specificity for patients with subclinical keratoconus. On the other hand, corneal tomography measures the elevation maps of both the anterior
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December/January 2020
New Technologies for the Detection of Corneal Disorders in Refractive Surgery Patients According to Prof. Burkhard Dick from the University Eye Hospital Bochum, Germany, new technologies are now available for the early detection of corneal disorders in refractive surgery patients. “Early detection of keratoconus is a serious need. The lack of affordable tools is holding us back,” he explained. Millions of patients are at risk for keratoconus based on corneal curvature alone, revealed Prof. Dick. There are 309 million patients with >46D corneal curvature or >2D cylinder. Some 90% of these patients live in Asia-Pacific countries, while 60 percent live in India and China. A total of 1.7 million patients are between the ages of 15 and 30-years-old. And while there are 4,000 cornea specialists, around 75% of physicians worldwide do not have topography capability in their offices. This is where the Delphi EyeTopo System – a small, fast and cost-effective smartphone-based topography system at around $1,800 per unit – can help fill the gap. It’s equipped with AI-enhanced, cloud-based analytics and backed by
