Our Cornea issue features advice on challenges associated with keratoconus and keratitis.

When I graduated fellowship, I could have never predicted the explosion of complex, comprehensive, imaginative and efficacious technologies in the cornea space. As an avid reader, I look to Ophthalmology Management for a non-biased, comprehensive overview of these ophthalmic advances. So, when I was invited to be guest editor for this month, I was beyond excited to help and was fortunate to work with some of the top experts who continue to shape the knowledge base of our field.

FOCUS ON KERATOCONUS

Challenges in the management of corneal disease, especially keratoconus, come in many forms — whether it is in understanding the intricacies of diagnostics, staging, treatment options (currently approved and emerging) and management of complex/recalcitrant cases.

Keratoconus is a major focus in this issue. Here, we have an expert review of topography and tomography interpretation from Dr. A. John Kanellopoulos (page 16). In our article on corneal crosslinking (CXL) perspectives, Drs. Zaidman, Hovanesian, Donnenfeld, Rosenberg and Lee review diagnosis and management of pediatric and adult populations (page 20). We touch upon another important topic in this article as well: providing access to care for our keratoconus/ectasia patients. Dr. John Berdahl reviews the cost benefits as well as insurance challenges with CXL we face on a day-to-day basis.

As we continue to fight for our patients’ care and vision, these articles provide some insight into our current state and hopeful future outlooks.

Also, Dr. Kenneth Beckman discusses various treatment strategies that may provide the best quality vision in patients with this condition (page 34).

... AND A GUIDE ON KERATITIS

Unfortunately, not all treatments go as planned, and sometimes we encounter difficult-to-treat entities, infectious keratitis being one of them. While diagnostics in culture and sensitivities are of utmost importance here, some infections, such as Acanthamoeba keratitis (AK), still remain elusive in their treatment paradigms. In this issue, Drs. Daniela P. Reyes-Capó and Rahul S. Tonk provide a valuable guide of how to identify and properly manage AK, a disease that can be quite visually devastating (page 38).

Along the lines of other complex corneal issues is neurotrophic keratitis. Here, Dr. Olivia L. Lee brings into focus the use of recombinant human nerve growth factor (Oxervate, Dompé) to aid these corneas that are often recalcitrant to traditional therapies (page 30).

I am so grateful to our contributing authors and their insights into evaluation and management of complex corneal disease. I certainly learned a great deal from reading their articles, and I am sure you will as well. OM

Alanna Nattis, DO, FAAO, is a cornea, cataract and refractive surgeon and director of clinical research, SightMD, Babylon, N.Y. She is also an associate professor in ophthalmology and surgery at New York Institute of Technology, College of Osteopathic Medicine. Disclosures: Dr. Nattis is a consultant to Alcon, Glaukos, Novartis, Ocular Therapeutix, Sight Sciences and Tarsus.