Pseudo-exfoliation syndrome: An old problem with an updated context

As with most fields within science and technology, ophthalmology continues to make steady progress in our awareness, understanding, detection and management of major eye diseases. This is also the case with pseudo-exfoliation syndrome (PES, often also referred to as PEX) and PES-related ocular pathology. The condition was described more than a century ago and given its current name more than 50 years ago. In addition, recent times have seen major advances in assessing the genetic and biochemical signatures of the condition. As someone with a particular interest in the overlap between complex anterior segment surgery and vitreoretinal procedures, I had to first ask myself whether anything truly useful could be said about this condition at this point? Perhaps starting with a contextual update will provide the necessary perspective.

The skill and art of planning LASIK: Trends in screening

It is generally accepted that the cornea’s shape determines its refractive properties but more recently we have come to understand that the biomechanics of the cornea determine its shape and so in turn the biomechanics determine the refractive properties of the cornea. This gave way to the OCULUS Corvis diagnostic machine which is a dynamic test that involves applying a force, in the form of a puff of air, to the cornea to measure its response to force which can be used to estimate its biomechanical properties. With this we now have an additional screening tool to safeguard against doing refractive procedures on patients who are at risk of developing ectasia after the procedure. There is currently much room for interpretation when it comes to the results of a Corvis Biomechanical Index (CBI) and Topographic Biomechanical Index (TBI) that the OCULUS Corvis gives us. Propitiously we are seeing rapid developments of approaches for interpretation that may soon allow us to have a more definite screening method. At this stage however the OCULUS Corvis test results need to be looked at in the context of other test results to make decisions on the candidate’s suitability for LASIK.

The role of the ocularist in patients who have lost an eye

The ocularist’s domain is the eye socket and blinded phthysical eye. An ocularist manufactures and fits ocular prosthetics for a patient who has lost an eye or eyes through evisceration or enucleation as well as fitting a scleral shell prosthesis over the blind phthysical eye or a blinded eye with an irregular cornea where a coloured contact lens wouldn’t fit effectively. Our eyes are hand-painted and sculpted to fit the socket/eye by taking an impression of the socket and working on a copy of this shape with adjustments to the front surface and into the fornices to manipulate the soft tissue in the socket and lids to enable the best final shape, size, comfort and movement possible. We also utilise prefabricated stock eyes only in dark brown iris shades as the blues and greens are much too expensive to import for the South African market. 


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Ophthalmic Opinion - Vol 5 No 2 - 2022