Friday was Subspecialty Day at the ASCRS annual meeting, with full schedules of programs aimed at corneal, glaucoma and refractive surgeons. Some highlights of the Cornea Day educational program, chaired by Francis Mah, MD, and Marjan Farid, MD, include:

• Topical insulin drops can be an effective treatment modality for neurotrophic keratitis, said Sarah Nehls, MD, a cornea, cataract and refractive surgeon and professor of ophthalmology at the University of Wisconsin-Madison. She discussed two patients who showed “immense improvement” after 14 and 25 days, respectively, on insulin drops. The insulin is believed to act as a growth factor in corneal wound healing, explained Dr. Nehls, by increasing sensation, activating corneal insulin receptors, reducing inflammatory cytokines and regulating oxidative responses. Compounded insulin drops can be obtained through many pharmacies, although there is little standardization, she noted. The price for these drops is considerably lower than the cost of recombinent human nerve growth factor topical drops, such as cenegermin (Oxervate; Dompé), which can cost $60,000 to $70,000 a year.
• Saama Sabeti, MD, MPH, FRCSC, discussed amniotic membrane transplantation (AMT) as a treatment for patients with keratitis. In the first case, a 36-year-old patient with a history of epithelial and stromal keratitis presented with a new epithelial defect and corneal thinning; optical coherence tomography (OCT) showed loss of epithelium down to 75 µm. “Three months after treating with AMT, the patient was stabilized and OCT showed thickening of the stroma and re-epithelization,” said Dr. Sabeti, a cornea, cataract, and refractive surgeon at Precision Cornea Centre in Ottawa, Canada. She also reviewed several techniques for securely affixing transplanted tissue. The amniotic membrane stimulates wound healing and supports regeneration through growth and mitogenic factors, as well as anti-inflammatory and anti-fibrotic properties, she explained.
• Ocular surface disease (OSD) reduces the reliability of keratometry measurements by as much as 0.25 D to 0.50 D, and needs to be addressed prior to cataract surgery to ensure the best result, said Mitchell P. Weikert, MD, MS, ABO, a professor of ophthalmology at Baylor College of Medicine in Houston, Texas. In one case he discussed, a 70-year-old man referred for cataract surgery in his right eye saw a sharp reduction in his astigmatism measurement after one week of treatment for OSD with artificial tears (four times/day), warm compresses and eyelid cleaning. “Small ocular surface changes can have large effects on biometry and vision,” said Dr. Weikert. “Pay attention to biometry metrics.”
• The afternoon program Anterior Segment and Cornea Surgical Video Roundup was very well attended, with videos shared by Winston Chamberlain, MD, Leela Raju, MD, Kavitha Sivaraman, MD, Sabrina Muktar, MD, and others.