In the final segment of this 6-part series, Dane Slentz, MD, of Spindel Eye; Alon Kahana, MD, PhD, of Kahana Oculoplastic & Orbital Surgery; Christine Nelson, MD, of the University of Michigan; and Karine Shebaclo, MD, MSc, of the Mayo Clinic in Florida, discuss how they’d like to see the field of oculoplastics evolve.
Dane Slentz, MD:
To kind of conclude the discussion tonight, the last part is where do you see amniotic membrane being used in the future, in the form of oculoplastic surgery?
Alon Kahana, MD, PhD:
Drops. We have serum tears, which we use, that’s a growth factor delivery system. We have platelet-rich plasma. I use that more cosmetically, but that’s been used for decades. It works. It’s again, a growth factor and cellular signaling delivery system. You have nerve growth factor medication that’s FDA-approved. Again, that’s a drop form of a growth factor. Here in umbilical cord, you have all this goodness of anti-inflammatory, pro-regenerative signaling. If you can put that in a drop or in a paste, then you can deliver it for prolonged periods in areas of the body that are not as amenable to suturing or in situations that are not as amenable to placing a physical barrier or a physical patch or physical graft.
I’d like to see that, and I’d like to see the amniotic membrane also become a drug delivery device where it becomes embedded with something that might be useful.
Christine Nelson, MD:
Anti-inflammatory.
Alon Kahana, MD, PhD:
That’s right.
Dane Slentz, MD:
I mean the 3 big realms of oculoplastics being eyelid, orbit, and lacrimal, it’s very frequently used as we discussed in both eyelid and orbit. Do you see any use in the lacrimal system?
Christine Nelson, MD:
If Alon can come up with the drops and maybe right after we’ve done… trying to rescue us from a Jones tube, get those drops going.
Alon Kahana, MD, PhD:
The world is divided into early adopters and those who wait for everything to be figured out and then they’ll do it. The early adopters, you don’t need to do much to convince them to try it. When you give a lecture, they’ll come to you afterward and say, “Hey, that’s a pretty good idea. What suture do you use? What forceps do you use? Okay, I’m going to try it next week.”
But the majority of surgeons are creatures of habit. They are very experienced with what they do. Their goal is to make sure that the patient was well taken care of, and it’s hard to convince them to try something new when most of what they do works and their job is to make sure that their patients are cared for. They’re not doing experiments. Those are the people that we need to convince. When you have a large body of information that is good enough to go to the VA with, that’s what’s going to actually change practice patterns.
That’s why it takes 15 to 20 years to change practice patterns because you have all these clinicians who are waiting for the randomized clinical trials or the large cohort trials, the big retrospective meta-analyses before they’re willing to try that on a patient. I totally get that, and I agree with it. I think that it’s appropriate to have really complex patients like yours be at the cutting edge where you’re trying new things because they don’t have anything to lose, right? They have such a tough situation. But the majority of patients are not like that. Yet, the majority of patients would benefit if you have a breakthrough that you discover and solidify with a really complex patient, and then you start to use it in less complex because it turns out that it’s both safe and effective.
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