Event Updates

The American Academy of Ophthalmology (AAO) annual meeting was held in San Francisco this October. This meeting is the world’s largest association of eye physicians and surgeons, bringing together leaders from around the world.

Our Saving Sight Team attends each year to learn about new trends in eye banking and ophthalmology, and to let our partners know innovations we are exploring. Attending also allows us to be a resource to our partners in sharing information to those who couldn’t attend or might have missed part of the meeting. This experience allows us to learn together side-by-side and be a stronger support to our partner surgeons in their work.

In case you missed AAO, or if you want a refresh, here are our top takeaways from the conference and presentations:

1. Congratulations to Dr. Shahzad Mian on being awarded the R. Townley Paton Award at AAO 2019! This award is the Eye Bank Association of America’s highest honor for corneal physicians and is presented annually to an ophthalmologist in recognition of his/her outstanding contribution to eye banking and EBAA. Dr. Mian presented his R. Townley Paton Lecture entitled, Defining Competency for Cornea Surgeons: Fellowship and Beyond. During the lecture, Dr. Mian highlighted the goals of cornea fellowship in training physicians to provide the best care to patients. As the field of corneal transplantation continues to evolve, so too must training models and continuing education. His passion for education is clear, and our Saving Sight team was privileged to host Dr. Mian in St. Louis at our last DMEK wet lab in 2018. Saving Sight thanks Dr. Mian for his contributions to our DMEK wet lab and to the eye banking industry as a whole.
2. During AAO, there was continued talk about the use of antifungals in Optisol. The EBAA reported a primary graft failure even with the use of antifungals. Some eye banks are increasing the concentration in hopes of improving efficacy. Many physicians are concerned about the possible toxic exposure to the tissue. This remains a controversial topic and few eye banks are adopting the use of antifungals.
3. During the Cornea and Eye Banking Forum, an interesting lecture on the Comparison between Preloaded and Non-Preloaded Descemet Membrane Endothelial Keratoplasty was presented. This was pertinent for our partners who are considering DMEK and preloaded DMEK. The conclusion outlined that preloaded DMEK “showed good efficacy with similar visual outcomes, reduced graft detachment and a significantly lower rebubbling rate, compared with non-preloaded DMEK.” In addition, the study showed preloaded DMEK surgery time was significantly shorter than non-preloaded DMEK, improving efficiencies in the operating room. Another presentation of interest during the Cornea and Eye Banking Forum was DSAEK Failure in Eyes with Pre-Existing Glaucoma. The study looked at risk factors for DSAEK failure in glaucomatous eyes. The conclusion suggests glaucoma is strongly associated with a greater risk of Descemet’s stripping automated endothelial keratoplasty (DSAEK) failure.
4. Several interesting articles were presented during Cornea Subspecialty Day, as well. Chief among them was EK Alphabet Soup: Which Flavor to Choose. This article by Dr. Marjan Farid provided a great summary on endothelial keratoplasty procedure choices, including DSAEK, DMEK, PDEK, and DWEK/DSO. The conclusion showed that EK is the standard-of-care for endothelial disease. In addition, DMEK provides better visual recovery; DSAEK is of value in complex eyes; and DWEK shows promise in central Fuchs-related cases. Cornea Subspecialty Day also had an interesting talk by Dr. Audrey Talley Rostov on an Update on Medical and Surgical Management of Dry Eye Disease. Dry eye disease affects more than 16 million people. One topic touched upon under pharmacologic management of dry eye is the use of serum tears. As co-founder and processor of Vital Tears autologous serum eye drops, this talk was very informative for Saving Sight to listen to. It allows us to see how Vital Tears and other techniques can be an asset to our physician partners.

Dr. Dan Polla, ARVO 2019

Previous studies in the field of corneal transplantation have determined the importance of endothelial cell density in the health of corneal tissue grafts in terms of graft success rate. According to new research presented this week at the 2019 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) in Vancouver, differences in the storage media solutions can have an effect on endothelial cell density.

Through the study, a retrospective analysis was conducted on a donor database from the Kansas City-based nonprofit Saving Sight to compare eye bank donor corneal endothelial cell density (ECD) after storage in Optisol GS and Life4°C solutions. The data analyzed included 24,581 donated eye bank corneas from 2011 through 2017 stored in Optisol GS or Life4°C solutions.

This project was led by Daniel Polla, MD, Ophthalmology Resident at Montefiore Medical Center and the Albert Einstein College of Medicine Department of Ophthalmology and Visual Sciences, in collaboration with Saving Sight.

“My project looks at the different storage media solutions that donor corneas were stored in from 2011 to 2017 at Saving Sight. The preliminary findings demonstrate a small difference in endothelial cell density after storage in Optisol GS or Life4°C, with a higher ECD after storage in Optisol GS. The differences found between donor corneas in each of the storage media groups may be due to factors that were not accounted for over time such as changes in processing protocols, equipment used to measure ECD, and variability in specular microscopy. While it is possible that Optisol GS better preserves the endothelium, one potential cause for the small difference in ECD between groups is variation in endothelial cell visualization during specular microscopy due to differences in solution color,” said Dr. Polla.

“This research is important to the field of ophthalmology and corneal transplantation because it may influence the way that corneas are stored and/or evaluated prior to transplantation, ultimately leading to better graft success rates and outcomes for patients.” Dr. Polla added.

Saving Sight Chief Business Development Officer Patrick Gore, RN, CEBT, Director of Business Development Lynn Forest-Smith, and Chief Operating Officer Tina Livesay were co-authors on the study. As an eye bank that facilitates eye donation for transplant and research, the Saving Sight team is proud to support this project and to work in collaboration with Montefiore and Drs. Polla, Rand and Chuck.

“We collect a large amount of data on all of our donor cases and corneas as a part of normal operations. This was a great opportunity to have these data parameters analyzed collectively for this study. As an eye bank, this allows us to help researchers advance the field of corneal transplantation to help honor the gift of sight through better recipient outcomes,” said Tina Livesay, Saving Sight Chief Operating Officer.

This study highlights the importance of collaboration between eye banks, medical centers and researchers in advancing the fields of corneal transplantation and ophthalmology.

Abstract: 

An analysis of donor corneas stored in Optisol GS and Life4°C solutions

Authors: Daniel J. Polla MD, Gabriel M. Rand MD, Patrick K. Gore RN CEBT, Lynn Forest-Smith CEBT, Tina Livesay CEBT, Roy S. Chuck MD PhD

Dr. Gabriel Rand – ARVO 2019

According to new research presented this week at the 2019 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) in Vancouver, several potential risk factors, including donor diabetes mellitus, can lead to damage during Descemet Membrane Endothelial Keratoplasty processing.

There are limited studies identifying risk factors for damage when processing Descemet Membrane Endothelial Keratoplasty (DMEK), which has a high processing failure rate as compared to Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Through a study with lead researcher Gabriel Rand, MD, second year ophthalmology resident at Montefiore Medical Center and the Albert Einstein College of Medicine Department of Ophthalmology and Visual Sciences and Saving Sight, an analysis of potential risk factors was performed. Collaborative research partner, Saving Sight performs a high volume of DMEK processing.

Through the study, a retrospective analysis was completed with logistic regressions on all 385 DMEK tissues processed from 319 eligible donors at Saving Sight from July 2014 to June 2017. The study concluded that eye bank DMEK processing has significant rates of damage and risk factors for processing failure including donor diabetes mellitus, individual technician ability and the technician learning curve.

“Myself, Dr. Chuck and a bunch of us here at Montefiore have been working with Saving Sight to prepare an abstract for ARVO this year,” said Dr. Rand. “The topic of the abstract is the effect that donor diabetes status has on the corneal transplant quality. This is a really important subject because diabetes is a disease that is increasing in prevalence every year and it’s a multisystem disease – it affects every single part of the body, the cornea notwithstanding. There’s really not a tremendous amount of literature on what the potential influences that donor diabetes status has on these cornea transplant tissues. So what our contribution is, is to add to the fund of knowledge and to really examine does a donor diabetes status affect endothelial cell health, does it affect preparation failure rates, things like this, so it’s been a really exciting research project for us.”

Saving Sight Chief Business Development Officer Patrick Gore, RN, CEBT, Director of Business Development Lynn Forest-Smith, and Chief Operating Officer Tina Livesay were co-authors on the study. As an eye bank that facilitates eye donation for transplant and research, the Saving Sight team is proud to support this project and to work in collaboration with Montefiore and Drs. Rand and Chuck.

“It is a privilege for me to work with such a devoted team at Montefiore who want to advance the science of ophthalmology,” said Lynn Forest-Smith, Director of Business Development at Saving Sight. “I have a real passion for the work we do at Saving Sight and teaming up with these folks allows us to take our findings back to the eye banks, apply what we learn to improve our services and ultimately, help more people see.”

This collaborative study helps advance the fields of corneal transplantation and ophthalmology between eye banks, medical centers and researchers and helps identify factors that contribute to better grafts and better outcomes for patients.

Abstract:

Factors associated with eye bank descemet membrane endothelial keratoplasty processing damage

Authors: Gabriel M. Rand MD, Patrick K. Gore RN CEBT, Lynn Forest-Smith CEBT, Tina Livesay CEBT, Roy S. Chuck MD PhD