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Today's Practice | Mar 2009

5 Questions With Ewa Mrukwa-Kominek, MD, PhD

Assistant Professor Mrukwa-Kominek practices and teaches in the Department of Ophthalmology at Silesian Medical University in Katowice, Poland.

1. Of the research that you have done, what are you most proud of?
I have been performing cataract and anterior segment surgery, particularly corneal and refractive surgery, for many years. Since 1990, when I performed my first PRK, I have been interested in corneal healing and how pharmacologic agents affect the healing process. For example, I have investigated the prevention of corneal haze after PRK, the use of mitomycin C in refractive surgery, and the effect of mitomycin C on the structure and healing of the cornea as well as on the outcome of the procedure.

My research on therapeutic surgery of the cornea and phototherapeutic keratectomy for corneal pathologies has been the most challenging pursuit. During my postdoctoral research, I developed my own methods for management of recurrent erosion and corneal dystrophies. The results of my research have been published in Poland; I am in the process of preparing an article in English on this subject. I am proud that my research has led to the development of surgical techniques that ensure patients with recurrent corneal erosions can achieve satisfactory postoperative function.

With these surgical techniques, a corneal transplant can be avoided or considerably delayed in patients with corneal dystrophy or degeneration.

2. In what ways do you think refractive surgery will evolve in future years?
The femtosecond laser will be increasingly important for corneal refractive surgery in the future. Due to its efficiency and precision—which is impossible to achieve with standard manual procedures—the device has won a growing number of users. If more detailed nomograms are devised and incision quality improved, the femtosecond laser will become a standard in modern eye surgery, despite the high costs of refractive and therapeutic interventions.

A perfect laser ablation treatment profile is still being sought (eg, customized ablation addressing astigmatism, corneal aberrations, and patient preferences). Nevertheless, refractive surgery will continue to be an important component of ophthalmic surgery. Ophthalmologists and patients frequently perceive cataract surgery as a refractive procedure. Due to progress in medicine, lifespan has increased and so have the expectations of society. Presbyopic patients want to enjoy good distance, near, and intermediate vision without glasses, and this is what they expect opthalmologists to provide them with. Consequently, they also expect us to suggest the optimum treatment method. It is difficult to predict which of the available procedures will prevail; however, the main purpose is to improve patients' quality of vision.

In my opinion, a customized lens adjusted for individual astigmatism, corneal aberrations, or preferences is undoubtedly the future. Such a lens should help achieve a patient's optimum visual acuity through contrast enhancement as well as significantly reduce halos and glare. Nonetheless, the importance of accommodating lens research must not be underestimated.

3. What do you think are the most promising developments in optical coherence tomography technology?
The most promising developments in optical coherence tomography (OCT) technology are anterior segment OCT (AS-OCT) and 3-D OCT. These technologies' capacity for better fixation results in shorter capture time, and high-resolution images ensure better measurement accuracy.

AS-OCT allows morphologic and biometric evaluation of the anterior segment to the level of the iris pigment epithelium. The images produced by AS-OCT are detailed and repeatable, and its high resolution ensures the detection of the subtlest pathologies of the cornea. In the past decade, closed-angle glaucoma has been the main cause of blindness worldwide. Thus, prompt diagnosis is key in reducing the risk of glaucoma progression. I hope that AS-OCT will become a screening tool for the detection of early-stage pathologies of the corneoscleral angle structures.

The 3-D OCT, both for anterior and posterior segments, provides high-resolution images for various clinical cases. It allows 3-D imaging of the eye structure with the possibility of enlarging areas of eye tissue for evaluation. These images can also be rotated so that 360° gonioscopic data can be obtained. Also, good quality images can be captured with simple operations.

4. What is different about practicing ophthalmology in a medical university setting versus a private practice?
Medical university settings require doctors not only to treat patients but also to engage in the educational process. Passing one's knowledge on to medical students and junior colleagues (ie, residents) is a unique opportunity. In Poland, developing research interests and expertise is easier to pursue in a university center than in a private practice setting. Also, complex medical cases are referred to university hospitals, which are specialized centers capable of carrying out the diagnostic process and the subsequent required therapy. Private practices are profit-making entities and do not always have access to the most recent scientific advancements.

5. If you could live anywhere in the world, where would it be?
Although there are many places in the world that I like, and even though I have been offered several employment opportunities at research centers abroad, I would never move to another country. I feel most happy in my home country and with my patients. I am privileged to work in an ophthalmology department in Poland that is equipped with a wide range of state-of-the-art diagnostic and therapeutic facilities. Also, Silesian Medical University cooperates with many well-known ophthalmic research centers throughout the world. This allows me to closely follow the latest scientific developments as well as further develop my skills, knowledge, and research. Living and working in Poland—while staying connected to my current contacts around the world—is the best solution for me.