Cost-Utility Analysis of Prophylactic Laser Peripheral Iridotomy for Primary Angle Closure Suspects.

PURPOSE: To assess the cost-utility of prophylactic laser peripheral iridotomy (LPI) for primary angle closure (PAC) suspects (PACS). DESIGN: Economic evaluation. METHODS: Our Markov model randomized PACS eyes to LPI or observation for 40 one-year cycles (100,000 iterations per strategy). Each cycle, an eye remained in its current health state, advanced linearly through PAC, mild, moderate, severe, and end-stage PAC glaucoma (PACG), or died. Transition rates were derived from the literature including the Zhongshan Angle Closure Prevention (ZAP) trial and the Singapore Asymptomatic Narrow Angles Laser Iridotomy Study (ANA-LIS). Eyes with acute-angle closure advanced to either PAC or directly to various PACG severities. A tracker monitored accumulated perimetric decibel reduction to progress PACG through increasing severities, with an annual probability of either stable or severity-dependent perimetry loss. We set a willingness to pay of an incremental cost-effectiveness ratio (ICER) <$50,000/quality-adjusted life-years. RESULTS: At age 50 years, LPI was cost-saving using ZAP data and cost-effective using ANA-LIS data. The ZAP iterations became cost-effective from the societal perspective when the model started at age 55 years and third-party perspective at age 70 years. LPI was no longer cost-effective from the societal perspective using ANA-LIS data at age 80 years or from the societal perspective using ZAP data or third-party perspective with ANA-LIS data at age 85. Probabilistic sensitivity analyses favored LPI until starting age 85. CONCLUSIONS: Prophylactic LPI for PACS is cost-effective across a spectrum of ages and should be considered from a public health perspective.

Semi-Autologous Corneal Transplantation with Simultaneous Bilateral Surgery: A Case Report.

The present report describes a case of semi-autologous corneal transplantation with bilateral surgery using two operating microscopes simultaneously. An 86-year-old man with history of six prior failed penetrating keratoplasties in his right eye presented with decreased vision. His other eye was deeply amblyopic but had a clear 30-year-old Castroviejo-square graft with an endothelial cell count of 803 cells/mm2. A semi-autologous graft was performed from the left eye to the right. Surgery was performed simultaneously on both eyes by two different surgeons using a standard ophthalmic operating microscope as well as a second ENT microscope. Upon trephination of the right failed corneal graft, vitreous opacities were noted and sent for culture. The semi-autologous tissue was directly transferred from the left eye to the right without any storage in preservation media to avoid endothelial cell loss. The semi-autologous graft remained clear in the immediate postoperative period. However, the vitreous cultures grew coagulase-negative Staphylococcus. Despite all efforts, the patient eventually developed a retinal detachment and vision in the right eye decreased to light perception. Autologous penetrating keratoplasty is an option for patients with loss of corneal function in a potentially seeing eye and a clear cornea in a contralateral eye with poor visual potential due to non-corneal disease. This case is unique in that part of the autologous penetrating keratoplasty had an old square graft in the center and corneal transplant surgery was done simultaneously in both eyes. It also highlights chronic indolent endophthalmitis as a potential cause of multiple graft failures.

DESCEMET STRIPPING AUTOMATED ENDOTHELIAL KERATOPLASTY GRAFT IN-THE-BAG POSTERIOR DISLOCATION.

PURPOSE: The purpose of this report was to describe a case of a dislocated Descemet stripping automated endothelial keratoplasty graft retained in-the-bag removed with pars plana vitrectomy (PPV). METHODS: This was a case report. RESULTS: A 69-year-old pseudophakic man who underwent a repeat Descemet stripping automated endothelial keratoplasty due to bullous keratopathy in the setting of multiple previous ocular surgeries presented with a vision of counting fingers. On examination, a Descemet stripping automated endothelial keratoplasty graft was appreciated behind the intraocular lens obscuring the visual axis and presumed to be in the anterior vitreous. The patient underwent a 23-gauge vitrectomy, and after a posterior capsulotomy, the dislocated graft was removed with a 23-gauge vitrector without complications. The best-corrected visual acuity was 20/50 6 months after the PPV. Grafts can dislocate posteriorly between the intraocular lens and the posterior capsule. The dislocated graft can be successfully extricated with a 23-gauge vitrector after a careful posterior capsulotomy, with good visual outcomes. IMPORTANCE: To the best of our knowledge, this is the first reported case of an in-the-bag Descemet stripping automated endothelial keratoplasty graft posterior dislocation. Furthermore, we showed an innovative surgical technique for the removal of the dislocated graft with a 23-gauge vitrectomy and posterior capsulotomy.

Comparison of Horizontal Corneal Diameter Measurements Using Orbscan IIz, OPD Scan III, and IOLMaster 700.

PURPOSE: To compare three automated devices for measuring the horizontal corneal diameter (white to white [WTW]). METHODS: In 65 eyes of 38 patients, the WTW distance was measured independently by three examiners using the following techniques: Orbscan IIz tomography system (Bausch & Lomb), IOLMaster 700 (Carl Zeiss Meditec), and OPD Scan III (NIDEK). We tested for systematic differences in measurements and estimated the limits of agreement (LoA) using linear mixed-effects models. RESULTS: The mean WTW distance was 11.8±0.40 mm with Orbscan IIz, 12.1±0.5 mm with IOLMaster 700 and 12.0±0.4 mm with OPD Scan III. The mean difference between IOLMaster 700 and Orbscan IIz was 0.33 (95% CI, 0.28 to 0.38; P<0.001), between OPD Scan III and Orbscan IIz was 0.24 mm (95% CI, 0.21 to 0.28; P<0.001), and between IOL Master 700 and OPD Scan III was 0.09 (95% CI, 0.05 to 0.12; P<0.001). The 95% LoA for Orbscan IIz versus IOLMaster 700 was -0.69 to 0.03 mm, Orbscan IIz versus OPD Scan III was -0.52 to -0.03 mm, and OPD versus IOLMaster 700 was -0.39 to 0.22 mm. CONCLUSIONS: The data suggest that these devices are not interchangeable for usual clinical practice. Adjustments based on mean differences were not enough to compensate for interinstrument discrepancy in WTW measurements.

Cost-Utility of Anti-Vascular Endothelial Growth Factor Treatment for Macular Edema Secondary to Central Retinal Vein Occlusion.

PURPOSE: To evaluate the cost-utility of treatment for macular edema in central retinal vein occlusion (CRVO) using intravitreal injections of the anti-vascular endothelial growth factor (VEGF) agents bevacizumab, ranibizumab, and aflibercept. DESIGN: Decision analysis model of cost-utility. PARTICIPANTS: Data from study participants in the Lucentis, Eylea, Avastin in Vein Occlusion (LEAVO) study. METHODS: A decision analysis of a disease simulation model was used to calculate comparative cost-utility of intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR), and intravitreal aflibercept (IVA) for the treatment of macular edema associated with CRVO based on data from the LEAVO study. Center for Medicare and Medicaid Services data were used to calculate associated modeled costs in a hospital- or facility-based and nonfacility setting from a third-party payer perspective, and societal costs also were calculated. Cost utility was calculated based on the preserved visual utility during the 2 years of the study and also by estimating utility for the expected lifetime. MAIN OUTCOME MEASURES: Cost of treatment, cost per quality-adjusted life-year (QALY), and incremental cost-effectiveness ratio (ICER). RESULTS: From the third-party payer perspective, the estimated lifetime costs per QALY in the facility and nonfacility settings were $39 325 and $17 944, respectively, for IVB; $114 095 and $92 653, respectively, for IVR; and $78 935 and $63 270, respectively, for IVA. From the societal perspective, the estimated lifetime costs per QALY in the facility setting were $52 754 for IVB, $128 242 for IVR, and $86 262 for IVA. The ICER of IVA compared with that of IVB was $153 633/QALY from the third-party facility setting and $152 992/QALY from the societal perspective. The use of IVB compared with IVR and IVA compared with IVR were cost-saving interventions (ICER, <0) regardless of the perspective or setting. CONCLUSIONS: In the treatment of macular edema in CRVO, IVB yields the best cost utility among the 3 anti-VEGF agents modeled. Intravitreal aflibercept maintains acceptable lifetime cost per QALY while having a favorable cost utility compared with IVR.

Cost-Effectiveness of Preoperative OCT in Cataract Evaluation for Multifocal Intraocular Lens.

PURPOSE: To determine the cost effectiveness of an adjunctive screening OCT during the preoperative evaluation of a patient considering cataract surgery with a multifocal intraocular lens (IOL) implantation. DESIGN: Cost-effectiveness analysis. PARTICIPANTS: A 67-year-old man with 20/60 vision undergoing evaluation for first-eye cataract surgery. METHODS: The cost-effectiveness analysis of the reference patient undergoing a preoperative cataract examination with and without a screening OCT was performed, evaluating for vitreoretinal diseases including an epiretinal membrane, age-related macular degeneration, vitreomacular traction, and cystoid macular edema. It was assumed that patients with macular pathologies detected before surgery would receive a monofocal IOL and be referred to a retina specialist for evaluation and management. The Medicare reimbursable cost of an OCT was $41.81. All costs and benefits were adjusted for inflation to 2019 United States dollars and discounted 3% per annum over a 16-year time horizon. Probability sensitivity analyses and 1-way deterministic sensitivity analyses were performed to assess for uncertainty. MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratio and incremental cost-utility ratio (ICUR) measured in quality-adjusted life years (QALYs). RESULTS: Approximately 20.5% of patients undergoing cataract surgery may have macular pathologies, of which 11% may not be detected on the initial clinical examination. In the base case, an adjunctive preoperative OCT was cost effective from a third-party payer and societal perspective in the United States. In the probability sensitivity analyses, the ICURs were within the societal willingness-to-pay threshold of $50 000/QALY in approximately 64.4% of the clinical scenarios. CONCLUSIONS: A preoperative screening OCT during the evaluation of a patient considering a multifocal IOL added to the costs of the cataract surgery, but the OCT increased the detection of macular pathologies and improved the QALYs over time. An adjunctive screening OCT can be cost effective from a third-party payer and societal perspective.

Cost-Effectiveness of Antifungal Supplementation of Corneal Cold Storage Media.

PURPOSE: To evaluate the cost-effectiveness of supplementing hypothermic cold storage media (CSM) with antifungal therapy. DESIGN: Cost-effectiveness analysis (CEA). PARTICIPANT: Base case of a patient with Fuch's endothelial dystrophy undergoing a first eye keratoplasty. METHODS: Cost-effective analysis of the base case with corneal tissue stored in CSM or CSM supplemented with antifungal therapy over a 16-year time horizon. Multiple clinical scenarios were considered, including endothelial keratoplasty (EK) and penetrating keratoplasty (PK); amphotericin B, voriconazole, caspofungin, and combination therapy; and third-party payer and societal perspectives. The incidences were derived from PubMed literature searches and average wholesale prices of medications; all costs were discounted 3% per annum and adjusted for inflation to 2019 US dollars. MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratios (ICERs). RESULTS: In the reference case, a corneal endothelial graft stored in amphotericin B-supplemented CSM was the most cost-effective approach from a third-party payer and societal perspective. Probability sensitivity analysis (PSA) of the societal model for the EK was robust, with 93.5% being below an arbitrary willingness-to-pay threshold (WTP) of $20 000 per fungal infection averted. Voriconazole, caspofungin, and combination antifungals were less cost-effective than amphotericin B. The main factors influencing the CEA were the incidences of postkeratoplasty fungal infections, potential increases in graft failures, and antifungal costs. For grafts intended for PKs, antifungal supplementation was less cost-effective than for EKs. CONCLUSIONS: Antifungal supplementation with amphotericin B for EK grafts was the most cost-effective approach of the studied antifungals; however, the CEA was sensitive to potential changes in graft failure rates, underlining the importance of long-term safety studies. For full-thickness corneal grafts, antifungal supplementation was less cost-effective.

Follow the nevus: the cost-utility of monitoring for growth of choroidal nevi.

AIM: To develop a model to evaluate the cost-utility of choroidal nevi monitoring recommendations with varying clinical risk factors. METHODS: A Markov model was created to evaluate the cost-utility in cost per quality-adjusted life-year ($/QALY) for monitoring patients with choroidal nevus. This probabilistic model was applied both to a hypothetically monitored and unmonitored group of patients beginning at different ages and with varying clinical risk factors of the nevus. Duration of screening was modeled for the remainder of the patients' life expectancy. Best available clinical data on the prevalence and incidence of choroidal nevi/melanoma, and relative risk of nevus transformation were combined with the initial and downstream costs of screening, downstream costs of melanoma-related mortality, and QALY saved by monitoring, to estimate the best monitoring regimen. Main outcome measures were average $/QALY saved by consensus recommended monitoring scenarios for the duration of a patient's remaining life expectancy in comparison with no follow-up, and the cost-utility of modified regimens. RESULTS: The $/QALY of the recommended monitoring scenarios varied substantially based on nevus clinical risk factors, patient age, frequency of follow-up, and objective testing utilized. The $/QALY for the recommended monitoring scenario of a flat nevus without risk factors in a 60-year-old patient was $77 180. The $/QALY for monitoring a nevus with 3 clinical risk factors in a 60-year-old patient was $85 393. The $/QALY values for differently-aged patients were larger, and intermediate degrees of risk factors for nevus growth varied, depending largely upon the specifics of the modeled monitoring scenarios. CONCLUSION: The average $/QALY of currently recommended monitoring scenarios fall within economically acceptable standards and could provide insight for formulating appropriate clinical strategies. Cost-utility could be enhanced by targeting higher risk groups and considering less frequent monitoring for the lower risk groups.

Risk of Endophthalmitis in Boston Type 1 Keratoprosthesis Combined with Vitrectomy and Silicone Oil Insertion.

PURPOSE: To identify the incidence of endophthalmitis and visual outcomes in eyes with Boston type 1 keratoprosthesis combined with pars plana vitrectomy and silicone oil insertion (KPro + PPV + SOI) as compared to eyes receiving Boston type 1 keratoprosthesis (KPro) alone. PATIENTS AND METHODS: Retrospective chart review of 29 eyes of 27 patients with KPro having at least 12-month follow-up. Thirteen of these eyes had hypotony and/or retinal detachment in addition to corneal pathology and thus received KPro + PPV + SOI. Polymyxin-trimethoprim with a quinolone was used as chronic topical antibiotic prophylaxis in both groups after the first postoperative month. Outcome measures recorded at the 1-, 3-, 6-, 12-, and 24-month follow-up visits included best-corrected visual acuity (BCVA) and rates of postoperative complications. RESULTS: All the patients had completed 24-month follow-up except one case in the KPro group who lost to follow-up after 12-month visit. In the KPro + PPV + SOI group, no eyes had developed endophthalmitis by the 24-month follow-up visit versus 5 eyes of 5 patients in the uncombined KPro group (P=0.048). The 2-year cumulative endophthalmitis incidence was 31.2% in the KPro group versus zero in the KPro + PPV + SOI group (P=0.030). Four of these 5 eyes had vitreous taps with positive cultures; 2 were positive with Staphylococcus aureus, 1 with coagulase-negative staphylococci, and 1 with Streptococcus pneumoniae. Other complications included KPro extrusion (1 in each group), retinal detachment (2 in the KPro and 1 in the KPro + PPV + SOI group), newly developed glaucoma (2 in each group), and retroprosthetic membrane (9 in the KPro and 5 in the KPro + PPV + SOI group). The KPro group had better average preoperative BCVA compared to those of the KPro + PPV + SOI group (-2.29 ± 0.72 LogMAR, versus -2.95 ± 0.30 LogMAR; P=0.004). No statistically significant difference in BCVA was noted in subsequent follow-up visits. CONCLUSION: The addition of PPV and SOI to the KPro implantation in the eyes with corneal pathology, as well as hypotony and/or retinal detachment, is a safe and effective procedure for visual rehabilitation. Pars plana vitrectomy and silicone oil insertion may have a protective effect against the development of postoperative endophthalmitis in eyes receiving KPro.

Cost-Effectiveness Analysis of Descemet's Membrane Endothelial Keratoplasty Versus Descemet's Stripping Endothelial Keratoplasty in the United States.

PURPOSE: To determine the cost-effectiveness of Descemet's membrane endothelial keratoplasty (DMEK) compared with Descemet's stripping automated endothelial keratoplasty (DSAEK) in the United States. DESIGN: Cost-effectiveness analysis in a surgical center in the United States. PARTICIPANTS: Binocular adult patient undergoing endothelial keratoplasty. METHODS: A base case of a 70-year-old man undergoing his first endothelial keratoplasty for bilateral Fuchs endothelial dystrophy. The cost-effectiveness of DMEK was compared with DSAEK over a 15-year time horizon. The incidences and costs of complications were derived from PubMed English literature searches, Medicare reimbursements, and average wholesale prices. All costs were discounted 3% per annum and adjusted for inflation to 2018 U.S. dollars. Uncertainty was evaluated using deterministic and probabilistic sensitivity analyses. MAIN OUTCOME MEASURES: Incremental cost-effectiveness ratios and incremental cost-utility ratios, measured in cost per quality-adjusted life-years (QALYs). RESULTS: Performing a DMEK instead of a DSAEK generated an extra 0.4 QALYs over a 15-year period. From a societal and third-party payer perspective, DMEK was cost-saving when compared with DSAEK in improving visual acuity in the base case. Probabilistic sensitivity analyses with variations in the costs and rebubble rates revealed that DMEK was cost-saving compared with DSAEK in 38% of iterations and was within a societal willingness-to-pay threshold of $50 000 in 98% of models. CONCLUSIONS: From the societal and third-party payer perspectives in the United States, DMEK generated greater utilities and was less costly than DSAEK. Therefore, DMEK was the dominant procedure and was cost-saving with respect to DSAEK. The economic model was robust based on sensitivity analyses.

Epidemiology of Persistent Postsurgical Pain Manifesting as Dry Eye-Like Symptoms After Cataract Surgery.

PURPOSE: To evaluate the epidemiology of persistent postsurgical pain (PPP) manifesting as dry eye (DE)-like symptoms 6 months after surgery. METHODS: This single-center study included 119 individuals whose cataract surgeries were performed by a single surgeon at the Bascom Palmer Eye Institute and who agreed to participate in a phone survey 6 months after surgery. Patients were divided into 2 groups: the PPP group was defined as those with a Dry Eye Questionnaire-5 score ≥6 and without PPP as those with a Dry Eye Questionnaire-5 score <6 at 6 months after cataract surgery. RESULTS: Mean age of the study population was 73 ± 8.0 years; 55% (n = 66) were female. PPP was present in 34% (n = 41) of individuals 6 months after surgery. Factors associated with an increased risk of PPP were female sex [odds ratio (OR) = 2.68, 95% confidence interval (CI) = 1.20-6.00, P = 0.01], autoimmune disorder (OR = 13.2, CI = 1.53-114, P = 0.007), nonocular chronic pain disorder (OR = 4.29, CI = 1.01-18.1, P = 0.06), antihistamine use (OR = 6.22, CI = 2.17-17.8, P = 0.0003), antireflux medication use (OR = 2.42, CI = 1.04-5.66, P = 0.04), antidepressant use (OR = 3.17, CI = 1.31-7.68, P = 0.01), anxiolytic use (OR = 3.38, CI = 1.11-10.3, P = 0.03), and antiinsomnia medication use (OR = 5.28, CI = 0.98-28.5, P = 0.047). PPP patients also reported more frequent use of artificial tears (P < 0.0001), higher ocular pain levels (P < 0.0001), and greater neuropathic ocular pain symptoms, including burning (P = 0.001), wind sensitivity (P = 0.001), and light sensitivity (P < 0.0001). CONCLUSIONS: PPP in the form of persistent DE-like symptoms is present in approximately 34% of individuals 6 months after cataract surgery. The frequency of PPP after cataract surgery is comparable to that of other surgeries including laser refractive surgery, dental implants, and genitourinary procedures.

Intracameral moxifloxacin for endophthalmitis prophylaxis after cataract surgery: Cost-effectiveness analysis.

PURPOSE: To determine the cost-effectiveness of intracameral moxifloxacin compared with traditional antibiotic prophylaxis in preventing endophthalmitis after cataract surgery. SETTING: Theoretical surgical center in the United States. DESIGN: Evaluation of technology. METHODS: The incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICUR) were calculated for patients having cataract surgery with traditional antibiotic prophylaxis (perioperative topical antibiotics) compared with perioperative topical antibiotics with intracameral moxifloxacin. The base case was a healthy binocular 73-year-old man having first-eye cataract surgery. The incidences and costs were derived from PubMed English literature searches, Medicare reimbursement rates, and average wholesale prices. All costs and benefits were adjusted 3% per annum and for inflation to 2017 United States dollars. Deterministic and probabilistic sensitivity analyses were performed to assess uncertainty. RESULTS: Compared with traditional prophylaxis, an adjuvant 500 µg intracameral moxifloxacin (for $20) was cost-saving from a societal perspective in the base case; in probabilistic sensitivity analyses, all the values were within the societal willingness-to-pay threshold of $50 000/quality-adjusted-life-years (QALYs), and 6142 (61%) of 10 000 iterations were cost-saving. From a healthcare sector perspective, intracameral moxifloxacin was cost-effective, with an ICUR of $8275/QALY. In cases with posterior capsule tears, a $20 intracameral moxifloxacin was cost-saving. CONCLUSIONS: From a societal perspective in the U.S., a topical perioperative antibiotic with a 500 µg intracameral moxifloxacin costing $22 dollars or less was cost-effective and cost-saving. From a healthcare sector perspective, a $20 intracameral moxifloxacin was cost-effective but not cost-saving. Adjuvant intracameral moxifloxacin had greater effectiveness in improving QALYs than topical antibiotics.

Current vaccines for the prevention of herpes zoster.

PURPOSE OF REVIEW: To summarize the recent advances in the prevention of herpes zoster. The recent Food and Drug Administration (FDA) approval of an adjuvanted subunit vaccine may have a significant impact on the prevention of herpes zoster ophthalmicus. RECENT FINDINGS: There are currently two commercially available vaccines for the prevention of herpes zoster: a live-attenuated vaccine and a new recombinant subunit vaccine. The latter has been shown to be more effective, have fewer contraindications, but requires two separate inoculations, has higher reactogenicity, and has only short-term postmarketing surveillance. SUMMARY: The adjuvanted zoster subunit vaccine offers several advantages over the previously available vaccine. Following the current treatment recommendations, physicians should recommend vaccination to all patients older than 50 years of age with no contraindications, this should also prevent ophthalmic complications of the disease.

Long-term outcomes of the aphakic snap-on Boston type I keratoprosthesis at the Bascom Palmer Eye Institute.

PURPOSE: To determine the indications, long-term clinical and visual outcomes, and complications of the aphakic snap-on type I Boston keratoprosthesis (KPro). DESIGN: Retrospective, non-comparative case series. METHODS: Forty-five eyes of 43 patients with type I aphakic snap-on KPros with at least 1 year of follow-up were included. The past medical histories, preoperative indications, best-corrected visual acuities (BCVAs), postoperative complications, and retention rates were analyzed. RESULTS: The most common indication for KPro implantation was a failed corneal graft (89%). The mean preoperative BCVA was count fingers-hand motion (2.14±0.45 logarithm of minimum angle of resolution [logMAR]), which initially improved to 20/200 (1.04±0.85 logMAR; P<0.0001). At the last examination, 24 eyes (53%) maintained some visual gain, 22% retained their preoperative visual acuity, and 24% lost vision due to postoperative events and underlying ocular comorbidities. Postoperative complications included retroprosthetic membranes (8/45, 18%), corneal melts (5/45, 11%), glaucoma progression (6/45, 13%), and endophthalmitis or sterile vitritis (6/45, 13%). The KPro retention rate was 89%, with a mean follow-up of 51 months. The mean BCVA at the last visit was 20/1,400 (1.82±0.92 logMAR). CONCLUSION: Most patients experienced improved visual acuity after the implantation of the aphakic, snap-on type I KPro; however, the visual gains were not sustained over time, correlating with the onset of postoperative complications.

Use of Autologous Serum Tears for the Treatment of Ocular Surface Disease From Patients With Systemic Autoimmune Diseases.

PURPOSE: To describe the safety and efficacy of autologous serum tears (AST) in managing ocular surface disease resistant to conventional therapy in patients with systemic autoimmune disease(s). DESIGN: Retrospective, interventional case series. METHODS: Records of patients from 2009 to 2015 with systemic autoimmune disease treated with AST (20%-50%) for chronic surface disease were analyzed. Standardized measures of subjective dry eye symptoms, objective dry eye staining of the cornea, and slit-lamp findings including punctate epithelial erosion (PEE), filamentary keratopathy (FK), and corneal epithelial defects (KED) were compared during first and last visit. We attempted to standardize outcomes by creating a scale from 1 to 4 for subjective and objective components: worsening (1), no improvement (2), partial improvement (3), and complete resolution (4). RESULTS: Fifty-one patients (101 eyes) were included. The mean age was 59.8 ± 13.2 years (72.5% female). Average use of AST was 14.3 ± 11.7 months. Complete objective improvement of initial slit-lamp findings was achieved in 30% and partial improvement in 55% of eyes. Presence of PEE, FK, and KED decreased from 92.1% to 52.5% (P < .001), from 22.8% to 9.9% (P = .02), and from 5% to 2% (P = .44) of the eyes, respectively. Full subjective improvement of symptoms was achieved in 34.6%, partial in 50.5%, and none in 14.9% of patients. No adverse side effects were noted during follow-up. CONCLUSIONS: AST are a safe and effective adjunct therapy in improving both objective signs and subjective symptoms of ocular surface disorders associated with systemic autoimmune disease(s).