Avoiding the pitfall of epithelial basement membrane dystrophy
Prepare your patients for success after refractive or cataract surgery
I am again reminding you that optometry has a renewed purpose in the management of our cataract and refractive patients. We don’t actually perform the surgery, although some of my learned colleagues can clean up the capsule. However, we need to evaluate the landscape to avoid pitfalls that may lurk ahead of this refractive journey.
One such pitfall is the existence of epithelial basement membrane dystrophy (EBMD). You may know this abnormal epithelial regeneration of the basement membrane dystrophy as it is often affectionately titled after the amorphous appearance of a map, a dot, or a fingerprint.
Cause and effects of EBMD
EBMD is a spectrum disease, its findings can be subtle, and its true incidence is unknown. Studies have reported rates as high as 40 percent with an increasing incidence corresponding to advancing age.1 The existence of this dystrophy is not realized until patients are in their fourth to fifth decade of life. This has led some to classify this disease as a degeneration of the cornea; however, it is clearly in the genetic makeup of the patient.
This bilateral asymmetrical dystrophy, which affects females greater than males, appears as fine, intracellular microcysts or as linear demarcations most notably in the central cornea. The extra sheets of basement membrane grow into the epithelium. As the epithelium matures, it traps the membrane to create the cysts and lines.
The existence of the dystrophy is disconcerting because it can induce irregularity to the cornea and thus change visual quality.