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NOA 2023: Corneal injuries, dystrophies, and catastrophes—oh my!


Pierce Kenworthy, OD, gives the crowd at NOA 2023 an in-depth look at the cornea and all the dangers that could befall it. He details what clinicians should look for and when to refer to an ophthalmologist for surgery.

At the National Optometry Association 2023 Convention in Fort Lauderdale, Florida, Pierce Kenworthy, OD, presented 2 courses: "Eyelid and conjunctiva growths and degenerations: From benign to terrifying" and "Corneal injuries, dystrophies, and catastrophes: From annoying to destroying." He met up with Optometry Times to give us some insight into his presentation on injuries, dystrophies, and catastrophes.

Video transcript

Editor's note: This transcript has been lightly edited for clarity.

Pierce Kenworthy, OD:
My name is Pierce Kenworthy. I'm an associate professor at the Arizona College of Optometry, and I'm super excited to be here at the National Optometric Association.

Very excited. There's been so many great topics here at NOA. I'm really fortunate to talk about anterior segment in particular, and we've got a great 2 hours about the cornea in particular.

We're going to look at it kind of anatomically, starting anterior epithelium going through Bowman's [layer] and stroma, and all the way back into the posterior endothelium. There's some really interesting topics to discuss, including anterior recurrent corneal erosions and the best ways to manage those. With the stroma, we get changes to the shape of the cornea from conditions like keratoconus.

And there's a really exciting new surgeries that are happening, like CAIRES, for example, these corneal allogenic intrastromal ring segments. And these are a great new way to try to normalize the shape of the cornea. And then when we get all the way to the back of the cornea, we're dealing with the endothelium that's our pumps. And when those become dysfunctional from disease or from Fuchs' dystrophy, for example, we look for different treatment strategies. Sometimes it's topical medications, but sometimes we have to refer to ophthalmology for transplants, like a DMEK or DESAEK. But there's more exciting surgeries to discuss also like DSO, Descemet's stripping only, and a lot of other really exciting topics. And we'll finish off talking about keratitis caused by bacteria, Acanthamoeba fungus, you name it, we'll talk about it.

I hope that all the optometrists—me included, I'm constantly learning—that we can all take at least a couple of pearls about the cornea; how best to help our patients because the cornea really is the clear front window of our eye. And if our patients have problems with that, then they're going to lose a lot of their transparency and their vision. So we're on the front lines as optometrists to try to take care of our patients and make sure their vision is excellent.

So I'm hoping that we can gain a greater appreciation for not only the resilience of the cornea, but also its fragility. It's a very fragile structure. And we can be on the defensive trying to help out our patients' corneas.
And there's a couple of pearls to think about. For one, I think when we look at the cornea, we can sometimes get lost and a lot of conditions look very similar to one another. So having somewhat of a treatment strategy, and sort of a evidence-based medicine way of taking care of our patients if they come in with a large corneal ulcer. What is our protocol? How do we take care of that? For example. Or maybe a patient says they want LASIK, but you look at their eye and they have actually a Fuchs' dystrophy. So how do we coach them on those sorts of scenarios, and find the best, the best timeline, the best chronology to take care of our patients? And also working comanagement with ophthalmology is incredibly important with the cornea.

I've just gained a greater appreciation for the cornea over the years and, you know, being able to teach the students about it. They get nervous if they see any white thing in the cornea, and they should be nervous because some of those white things can be very benign boring things like maybe a Salzmann nodule, but they could also be very serious things like Ancanthamoeba keratitis. So there are a lot of ways that the just simple looking things in the eye can go a lot of different directions. So I think that's very important to be aware of those things.

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