Guest Editorial

Our exploration of the corneal surface

The ocular surface is the most important refractive entity of the eye. Although we’ve know this for decades, our fascination continues and is far from complete.

Last year, CEDARS and TFOS DEWS II provided significant reviews of the state of the art in ocular surface disease. Last month, Ophthalmology Management featured excellent articles on the impact inflammation plays on surgery and the ocular system in general, including the ocular surface.

This month, we delve deeper into the visual system as we provide articles that help you to optimize the cornea and ocular surface from various perspectives.


In addition to dry eye and blepharitis, a multitude of ocular surface anomalies can not only impact vision but also complicate the patient’s cataract surgical outcome.

Christopher J. Rapuano, MD, from Wills Eye Institute, discusses the various “lumps and bumps” that can impact cataract surgery outcomes and turn potential grateful patients into confused and unhappy patients.

Fuchs’ dystrophy is always a delicate situation. Surgeons struggle with when to refer and when to proceed with surgery. Michelle K. Rhee, MD, from Mt. Sinai in New York, presents a logical approach to maximize outcomes for the Fuchs’ patient who has a cataract and deliver on patient expectations.

Descemet’s membrane endothelial keratoplasty (DMEK) has proven to reduce rejection, improve vision and provide reproducible refractive outcomes. However, anyone who has begun the learning curve involved with DMEK can understand the hesitation and denials of superiority from the great masses of corneal specialists who have yet to dive in. Elizabeth Viriya, MD, from NYU, and I produce a step-by-step description of how to transition to DMEK with a review of the literature to make the learning curve less daunting.

Intravitreal injections for macular degeneration have revolutionized the management of, and given hope to, our patients with this potentially devastating condition. However, again, the ocular surface plays a major role in optimizing the outcomes, from reducing the risk of infection and preventing complaints of irritation to preventing epithelial defects. Zaina Al-Mohtaseb, MD, and Mahmood Khan, MD, from Baylor, provide excellent, simple and elegant tips to improve the ocular surface management in a population where every letter counts.

I hope you enjoy this month’s OM and the multiple ways to improve patient experiences and outcomes just by focusing a little attention on the cornea and the ocular surface. OM