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OD Newsletter AECOSIN ASPEN COLORADOPresented by Theodore Perl, M.D.

CornealAssociates.com 3

A CASE STUDYA 34 year-old patient with bilateral BCVA of 20/20 underwent LASIK to correct their myopia of -3.25 + 0.50 x 085 and OS: -3.75 + 0.75 x 097.

One day post-op data conveyed no reported complications. As time went on, the patient returned to the surgeon and had complaints about their left eye being very blurry. The LASIK surgeon lifted the !ap, irrigated the cornea, prescribed topical steroids, antibiotics and arti"cial tears for 1 week, then tapered. However the patients vision worsened and the surgeon referred the patient out for a sec-ond opinion. After seeing several cornea specialists throughout Long Island, treatment options ranged from PTK, relift/irrigate to cornea transplant. The patient’s BCVA was 20/400 OS.

After a lot of unknowns, the patient was referred to Corneal Associates of New Jersey to see Dr. Perl. After examining the patient records, Dr. Perl began to suspect Avellino Corneal Dystrophy (ACD), a rare complication that can arise in people with certain genetic predispo-sitions. ACD can cause blurry vision due to the build up of protein in the cornea while in the healing process. In patients with Avellino corneal dystrophy, a particular protein that is a normal part of the healing process behaves differently than in patients who don’t have this condition. In patients who don’t have this genetic condition, the particular protein appears on the cornea early in the healing process and then disappears completely after it has performed its natural function. However, in patients with ACD, the protein continuously accumulates, and the resulting opacity on the cornea can cause a

decrease in the quality a vision. In severe cases, a signi"cant loss of vision may occur. This condition usually develops slowly but can vary by person, according to a patient’s age, lifestyle and environmental exposures.

Avellino Lab USA has developed the "rst and only commercially available testing system, the Avellino DNA Dual Test for LASIK Safety, for granular corneal dystrophy type 1 (GCD1) and granular corneal dystrophy type 2 (GCD2), also known as Avellino corneal dystrophy (ACD). The company’s proprietary genetic di-agnostics system provides fast, safe and affordable evaluations of an individual’s genetic predisposition to having the GCD1 and / or GCD2 gene mutation. With the Avellino DNA Dual Test, Avellino Lab USA is able to positively identify, with high accuracy, a patient’s GCD status. Based on the test’s results, patients and their physician can make an informed decision when considering vision correction surgery.

BEST COURSE OF ACTIONDr. Perl decided the best course of action would be stromal !ap amputation. This surgery was conducted using the iFS Laser, with 190u of tissue being removed. The dissected tissue was sent to Avellino Lab USA. After testing, the patient tested positive for Avellino Corneal Dystrophy. After treatment the patient has BCVA of 20/40, a major improvement over 20/400 BCVA when the patient "rst arrived at Corneal Associates. More importantly, the patient knows exactly why they weren’t seeing well and is 20/happy.

Our own Dr. Perl of Corneal Associates, presented at the AECOS conference in Aspen Colorado in March. The purpose of his presentation was to educate other doctors on post LASIK complications, using a "rst hand example to demonstrate his point. A few weeks before the meeting, a patient with an extremely rare eye condition came to Corneal Associates of New Jersey to see Dr. Perl.

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