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.

Lynn Forest-Smith, Director of Business Development at Saving Sight, with Dr. Jody Summers at ARVO 2019 in Vancouver.

Kansas City, Mo., August 21, 2019 – Jody Summers, PhD, professor of cell biology at the University of Oklahoma Health Sciences Center, studies the extracellular matrix of the sclera and changes associated with myopia development. Myopia is largely regulated by the visual environment. Through her studies, she hopes to understand why myopia interacts the way it does so intervention is possible.

“Nearly 50 percent of the world’s population will be myopic by 2050,” says Dr. Summers. “In some countries, such as those in East Asia, myopia is the leading cause of blindness. It can be completely preventable with how the eye responds to the visual environment if we can learn why.”

As a postdoctoral fellow in ophthalmology, Dr. Summers identified that there was little research with regard to the sclera. “Through research, I discovered that the sclera is not just a static container in the eye. The sclera is actually very active and can alter its compositions to control the refractive state or length of the eye. What happens in myopia is the sclera begins to elongate. Because sclera is a very responsive tissue, we are trying to understand how sclera remodeling happens so we can work to regulate it – which has taken us to this study.”

Saving Sight was honored to be a co-author on a research project at the 2017 Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) with Dr. Summers, titled Isolation and Transcriptome Analyses of Choroidal Retinaldehyde Dehydrogenase-2 (RALDH2) Expressing Cells.

At ARVO 2017, Dr. Summers successfully isolated cells in the choroid (the vascular layer of the eye, located between the sclera and the retina) of both chick and human eyes which have been found to produce the enzyme retinaldehyde dehydrogenase 2 (RALDH2).

“The ARVO abstract was preliminary research to see if we could isolate those cells,” says Dr. Summers. “We first had a pilot study where Saving Sight provided us with two, reduced fee whole globes. This showed we could isolate the retinoic acid in the choroid.”

In summer 2019, Dr. Summers received National Eye Institute at NIH funding to further study the isolated cells through transcriptome analyses. Part of that grant contributes to the fees associated with receiving 10 whole globes or poles (which is the whole eye minus the cornea) from Saving Sight. “This next step is to do it again and do the transcriptome analyses to identify the cells in the choroid that make the retinoic acid.”

Dr. Summers adds that retinoic acid is a powerful chemical and they are interested in identifying the cells that produce it. “If we identify these cell types we can, perhaps, use that information to develop strategy to control the synthesis of retinoic acid,” she says.

Since the human genome has been sequenced, Dr. Summers will be able to sequence the cells from the choroid and compare with the human genome sequence to gather more information as to which cell type is responsible for retinoic acid synthesis.

Collaboration between Researchers and Eye Banks

“I value working with Saving Sight because it was very easy to get the collaboration set up,” says Dr. Summers. “I love that they are interested in research and feel like it’s a two-way relationship. I’m really glad they are available and willing to introduce a new technique or procedure that is compatible for research.”

Dr. Summers adds that one of most valuable connections in eye banks and researchers working together is the ability for Saving Sight to provide human eye tissue for research. “NIH funded research hopes to help humans through the betterment of health. Being able to provide tissue like Saving Sight does under the conditions needed is of value because not many eye banks do that.”

About Saving Sight

Saving Sight is a nonprofit eye bank with a mission to change lives by saving sight. Founded in 1960, Saving Sight has grown to become one of the nation’s leading eye banks and is focused on providing innovative solutions to its clinical and research partners. Saving Sight welcomes customized research collaborations that meet your research tissue needs and strives to advance the field of corneal transplantation through dynamic collaborations with medical centers and researchers. Headquartered in Kansas City, Mo., Saving Sight facilitates eye donation in Missouri, Kansas, and Illinois, serving transplantation and research specialists locally and around the world.

Click here to learn more about Saving Sight’s customized research collaborations.

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