No abstract

Précis: Ocular surface disease (OSD) in glaucoma is an area for improvement in the management of patients with glaucoma. This study explores the knowledge of glaucoma subspecialists toward OSD in glaucoma, then provides a suggested treatment algorithm. Purpose: To assess the attitudes, knowledge, and level of comfort of Canadian glaucoma specialists with respect to the assessment and management of OSD among patients with glaucoma. Methods: Ophthalmologist members of the Canadian Glaucoma Society with fellowship training in glaucoma were contacted to participate in this cross-sectional survey study. Responses were recorded to statements regarding attitudes toward OSD in glaucoma, and assessment and management modalities. These were recorded primarily in the form of a Likert scale rated 1 to 7 from “strongly disagree” to “strongly agree.” Descriptive statistics were generated, and mean and SD for responses on Likert scales. Results: Thirty-six responses were included. All respondents agreed that comprehensive management of OSD could improve quality of life, 97% agreed it could lead to better glaucoma outcomes, whereas only 22% agreed it is presently being adequately managed in glaucoma practices. Respondents were asked to list all treatment modalities they felt knowledgeable about, ranging from 100% for optimizing topical glaucoma therapies to 31% for serum tears. Nearly all respondents (92%) agreed that a suggested algorithm for the treatment of OSD in glaucoma could improve their approach to management. Conclusion: OSD is a common comorbidity of glaucoma. Although respondents overwhelmingly agreed that comprehensive management of OSD may lead to improved quality of life and glaucoma-related outcomes, only a small percentage felt it was presently adequately managed. Increasing knowledge related to the assessment and management of OSD in glaucoma may in the future improve patient care.

Purpose: To utilize Scheimpflug imaging to describe corneal changes in keratoconic patients undergoing collagen crosslinking.Study type: Case series. Study design:Retrospective chart review at two sites: Calgary, Alberta and Brandon, Manitoba, Canada. All patients were diagnosed with keratoconus and had undergone corneal collagen crosslinking. All patients had pre-and post-procedure imaging done with Oculus Pentacam.Results: Sixty-one eyes of 48 patients with 6 months followup and 36 eyes of 27 patients with one year follow-up were included. Average age was 27 ± 12 years (15-48 years). Fiftyone males and 10 females were studied. At 1 year follow-up, all Pentacam indices were found to improve: ISV -4.44 ± 18.6 (p = 0.16), IVA -0.07 ± 0.27 (p = 0.12), KI -0.009 ± 0.082 (p = 0.49), CKI -0.012 ± 0.027 (p = 0.01), IHA -3.87 ± 23.3 (p = 0.33) and IDH -0.062 ± 0.308 (p = 0.24). Keratometry measurements were flatter at the pupil centre by 0.87 ± 2.53 D (p = 0.05). K max and K min were flatter by 0.58 ± 1.37 D (p = 0.02) and 0.33 ± 1.70 D (p = 0.25) respectively. Pupil center pachymetry was thinner by 12.9 ± 21.1 µm (p = 0.0006) at 6 months, as were the corneal apex and thinnest local by 12.9 ± 22.3 µm (p = 0.001) and 21.8 ± 54.6 µm (p = 0.05) respectively. However, all central pachymetry readings were not statistically different from baseline at the one year measurements. Peripheral corneal measurements at 6 mm diameter were no different from baseline at 6 months, however, were significantly thicker at the 1 year follow-up. Conclusion:The data, in this study, points to a more uniform cornea post corneal collagen crosslinking. The inferior cornea becomes flatter and superior cornea steeper with less variation when comparing the corneal curvatures. The peripheral cornea becomes thicker at 1 year post-procedure. Collagen crosslinking stabilizes the cornea.

Purpose To evaluate the effect of riboflavin and ultraviolet- A-induced corneal collagen crosslinking (CXL) on high order aberrations (HOA) up to third-order at 6 months using the iTrace wavefront aberrometer in patients with progressive keratoconus and post-LASIK ectasia. Materials and methods Ongoing retrospective chart review of patients having undergone CXL. The iTrace (Tracey Technologies, Houston, TX) was used to evaluate HOA. Patient data was collected from a single clinical site pre- and 6 months postoperatively. Data collected included logMAR uncorrected distance visual acuity (UDVA), logMAR corrected distance visual acuity (CDVA), manifest refraction, and HOA measurements. Data was analyzed with paired two-tailed student's t-test. Results 18 eyes (9M:4F, mean age 29.2 years, range 16-45) had 6 months of follow-up. Total HOAs, total coma and total trefoil were significantly reduced at 6 months by 16, 33 and 26% respectively (p < 0.05). Nonsignificant trends toward improvement were seen in spherical aberration, secondary astigmatism and UDVA. There were no statistically significant changes in manifest refraction or CDVA. Conclusion Improvement in high order aberration profile is one mechanism by which corneal collagen crosslinking enhances visual function in ectatic corneas. Total HOA and total coma measures are the most commonly reported improvements in HOA measures in previous studies, while total trefoil has only been observed in one other study. The improvements seen in HOAs remain fairly modest which likely accounts for the lack of measureable improvement in high-contrast visual acuity measures, such as Snellen UDVA and CDVA. This study is the first to report HOA outcomes with the iTrace wavefront aberrometer. How to cite this article Muzychuk A, Penner V, Rocha G. High Order Aberration Outcomes of Corneal Collagen Crosslinking in Eyes with Keratoconus and Post-LASIK Ectasia. Int J Kerat Ect Cor Dis 2014;3(3):107-112.

Purpose: To demonstrate clinical outcomes of epithelium-off corneal cross-linking (CXL) in combination with wavefrontguided photorefractive keratectomy (PRK) for the treatment of keratoconuns. Materials and methods:Total, 28 keratoconic eyes of 21 patients were included. The Sirius Wavefront Analyzer (SCHWIND eye-tech-solutions GmbH and Co. KG) was used to evaluate the high-order aberrations (HOAs). The coupled Amaris 750S excimer laser then performed a PRK of no more than 40 μm using the measured HOA. The CXL was then carried out respecting the standard of 400 μm of corneal thickness. Conclusion:Utilizing HOA to guide the laser treatment in combination with CXL resulted in a significant decrease of HOA at 6 months postprocedure. This is a small case series, but demonstrates a promising trend of improved HOA. Considering that keratoconic eyes have very irregular surfaces with significant HOA, reducing these aberrations should improve best corrected quality of vision. Having longer follow-up and greater numbers may demonstrate a clearer improvement.