Guest Editorial

Cornea: our window of opportunity

The eye is the window to the soul. By looking someone in the eye, we can determine if they are telling the truth, and we know their integrity and their emotional state.

The cornea is the window to the eye, and it is important to keep it functioning well and preserve its integrity for optimal vision. This month’s edition of Ophthalmology Management aims to achieve a further understanding of the cornea.


Fuchs’ dystrophy treatment has come a long way. One of my patients recently wrote about his experience with his first corneal transplant in 1985 and the contrast with his recent DMEK under PK in 2019. After the corneal transplant, he spent 2 weeks in the hospital, was at bed rest with a bedside commode and took 2 years to see somewhat OK. He contrasted that to being back to his baseline 2 weeks after a DMEK procedure. Mark Hansen, MD, gives tips on how to move your surgical technique towards endothelial keratoplasty with confidence (page 18).

Keratoconus is a progressive condition that has enormous impact on a patient’s life. Kathryn Hatch, MD, and Karen Zar, OD, give us a concise summary of the impact of corneal collagen crosslinking on keratoconus management (page 23). We already see a reduction in the need for corneal transplantation outside the United States where crosslinking has been commonly used for much longer. As health-care companies increase coverage, we will see a long-term reduction in the cost of care for this young and at-risk population.

John Hovanesian, MD, spent the last several years educating surgeons on the use of amniotic membrane for common eye problems, like pterygium and epitheliopathy. He does a great job of summarizing the use of amnion (page 28).

In the past, neurotrophic keratitis (NK) was a disease of tarsorrhaphy. Even though this surgical procedure can improve the health of the cornea and is often critical, it would be nice to reduce the frequency of tarsorrhaphies needed for NK. Elizabeth Yeu, MD, explains the role of Oxervate (cenegermin-bkbj, Dompé) for management of NK (page 43).

Another recently approved technology is the iris prosthesis. Patients with aniridia can be helped immensely with light sensitivity and visual improvement through this technology. Walter T. Parker, MD, and Michael E. Snyder, MD, describe this technology (page 48).

In a recent Wall Street Journal, a patient that I now care for described his ocular pain as “… like someone is stabbing you in the eye and shaking the knife around …” Because of the increasing attention to neuropathic pain, contributing editor Michelle Dalton interviewed experts who provided education on this difficult to manage problem related to abnormal nerve healing (page 54). It is the fibromyalgia of the eye, and we are just starting to categorize it and work to manage this problem that can take down the heartiest patients.

Any cornea edition would not be complete without an update on presbyopic IOLs — and how they interact with patients with corneal disease. Mark F. Goerlitz-Jessen, MD, and Terry Kim, MD, help us to navigate this tricky area (page 34).


Advances that affect the cornea continue to develop at an exponential rate. Trying to collate and do justice to the amount of information available in one issue of OM is challenging, if not impossible. Hopefully, we have provided you with concise, thought-provoking information that can benefit the patients under your care. OM