Advances in the Understanding of Etiology, Evaluation, and Management of Neurotrophic Keratitis

Program Description

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The activity will focus on:

Etiology

• Damage at any level to the fifth cranial nerve, from the trigeminal nucleus to the corneal nerve endings, may lead to the development of NK.
• Systemic diseases that may compromise trigeminal function, such as diabetes, multiple sclerosis, and Leprosy, may lead to the development of NK.
• Wound healing after anterior segment surgery or trauma.

Pathophysiology

• Corneal nerves maintain corneal epithelial integrity, proliferation, and wound healing.
• It has been postulated that corneal sensory nerve damage leads to marked changes in levels of neuromodulators that cause impairment in epithelial cell vitality and metabolism of the epithelial cells.

Evaluation – The hallmark of NK is reduced or absent corneal sensation

• Cochet-Bonnet or no-contact gas esthesiometer
• Slit lamp examination
• Dilated fundus examination

Staging – NK can be classified into three stages according to the Mackie classification.

• Stage 1 – corneal epithelial changes with dry and cloudy epithelium, superficial punctate keratopathy, and corneal edema.
• Stage 2 – recurrent and/or persistent epithelial defects with an oval or circular shape, most frequently localized at the superior half of the cornea.
• Stage 3 – corneal ulcer with stromal involvement that may be complicated by stromal melting and progression to corneal perforation.

Treatment of NK – Treatment of NK depends on disease severity.

• Topical cenegermin – Cenegermin is currently the only medication approved for treating NK; it is approved for all stages.

Other Treatment Options

• Antibiotics
• Autologous Serum Drops
• Contact Lenses – Bandage contact lenses, Scleral lenses
• Tarsorrhaphy – Eyelids are partially or completely closed to protect the cornea and preserve tear fluid, which is used to heal corneal ulcers

Agenda

• Overview of the etiology, pathophysiology, recommended screening, and testing procedures used in diagnosing NK – Walter Whitley, OD
• Discuss the efficacy and clinical utility of current and emerging treatments for early- and late-stage NK – Stephen C. Pflugfelder, MD

Intended Audience

Ophthalmologists, optometrists, and advanced practice providers (physician assistants and nurse practitioners) who manage patients with neurotrophic keratitis

Commercial Supporter

Supported by an unrestricted educational grant from Dompé US Inc.

Learning Objectives

• Summarize the etiology, pathophysiology, recommended screening, and testing procedures used to establish a diagnosis of NK
• Assess the efficacy and clinical utility of current and emerging treatments for the early- and late-stage NK

Accredited Providers

Amedco and MedNet have collaborated to design and execute this activity.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by Amedco LLC and MedNet. Amedco LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. Amedco Joint Accreditation #4008163.

Physicians (ACCME) Credit Designation

Amedco LLC designates this live activity for a maximum of 1.25 AMA PRA Category 1 Credit(s)^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Optometrists Credit

Amedco is accredited by COPE to provide continuing education to optometrists.

Amedco designates this activity for a maximum of 1.25 COPE credit.

Additional Credit Information

Physician Assistants
PAs may claim a maximum of 1.25 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credit^TM from organizations accredited by ACCME or a recognized state medical society.

Nurse Practitioners
The American Association of Nurse Practitioners (AANP) recognizes the Accreditation Council for Continuing Medical Education (ACCME) and the American Nurses Credentialing Center (ANCC) as approved accreditors and allow reciprocity for AANPCP continuing education credit. 1.25 hours.

Disclosures of Relationships With Ineligible Companies Policy

In accordance with the ACCME Standards for Integrity and Independence in Accredited Continuing Education, all faculty, planning committee members, and other individuals, who are in a position to control content, are required to disclose all relationships with ineligible companies* (commercial interests) within the last 24 months. All educational materials are reviewed for fair balance, scientific objectivity, and levels of evidence. The ACCME requires us to disqualify from involvement in the planning and implementation of accredited continuing education any individuals (1) who refuse to provide this information or (2) whose conflicts of interests cannot be mitigated.

Planners’ and Managers’ Disclosures

All relevant relationships have been reviewed and mitigated.

Off-Label Disclosure Statement

Faculty members are required to inform the audience when they are discussing off-label, unapproved uses of devices and drugs. Physicians should consult full prescribing information before using any product mentioned during this educational activity.