Over the past 10 years, an increasing number of studies have been conducted on the topic of keratopigmentation, that is, the induced cosmetic pigmentation change in the cornea.
This cosmetic change can be done for therapeutic purposes (eg, for corneal leukomas and blind and disfigured eyes, as well as cases with traumatic aniridia or other problems that affect the eye’s quality of vision).
The topic has been extensively studied and covered in a series of papers that have demonstrated that such techniques are effective, feasible, and very useful for patients.1-16
Following this, the purely cosmetic application of this technique has offered the possibility to change the apparent color of the eye on a voluntary basis. This is purely an aesthetic application that has been obviously disruptive and controversial. My colleagues and I first described this technique,7 and it has been practiced in Europe by a few surgeons on a continual but selective basis. The biotolerance and local toxicity of the pigments used in keratopigmentation have been the subject of extensive experimental studies.2,6,8 In Figure 1, we display the instruments used in the modern keratopigmentation surgical technique.
FIGURE 3. Superficial Keratopigmentation (Images courtesy of Jorge L. Alió, MD, PhD, FEBOphth)
Therapeutic keratopigmentation is indeed a new and relevant type of corneal surgery; however, it is still not in general use, essentially because of the insufficient development of pigments specifically for corneal use. Patients with disfigured corneas and blind eyes, and patients who prefer not to go through the trauma associated with evisceration and enucleation and their potential complications, find this new type of surgery can prove to be a very valuable alternative that can successfully restore their appearance in a less invasive manner.1,10
The pigment may be placed inside the corneal stroma when the superficial cornea is transparent (intrastromal keratopigmentation); (Figure 2). With totally opaque corneas, the technique should be performed by applying the pigment on the corneal surface (superficialkeratopigmentation)9,11; (Figure 3), either manually or using an automatic device (Figure 4). In superficial keratopigmentation, the pigment is injected into the superficial corneal stroma up to the level of 140 mm, after denuding the corneal epithelium (Figure 3).
Superficial leucomas are treated with superficial techniques, whereas deep opacities, aniridias, and other problems that happen in a patient’s eye are better treated by intralamellar techniques.4,5 Surgical instruments and techniques have also been described in detail in other publications.15 (Figures 1 and 4).
When the superficial corneal stroma is transparent, the intrastromal pigmentation technique can be better used. For this purpose, corneal stromal tunnels are created, assisted by femtosecond laser at the adequate corneal depth,4,5 which also creates a dissection to simulate the pupil at an adequate diameter (Figure 2).
Such corneal tunnels may also be created manually using adequately designed instruments (Figures 1 and 2).
The pigment is matched to the color of the contralateral normal eye, whereas the pupil is simulated with black pigment (Figure 5).
The main limitation of this technique is the availability of pigments, which are, as of the writing of this article, limited to a few colors and labeled for corneal use with the CE mark. The use of dermatological pigments probably could be acceptable, but the lack of negative effects has not yet been demonstrated on the normal or diseased cornea, as the pigments are made of compounds that are often reactive when in contact with light; thus, oxidation may occur. This can lead to a change in the color over time and might make outcomes of this surgery unpredictable.
Frequently, severely compromised and blind eyes are associated with other disfiguring features such as squint and ptosis, which can also be successfully corrected at the same time as the keratopigmentation procedure is performed. A high level of patient satisfaction has been reported with the use of such combined surgical techniques12 (Figure 6).
FIGURE 5. Manual Intrastromal Keratopigmentation and Pupil Simulation With Superficial Automated Keratopigmentation. Total corneal leucoma (left) and result after treatment with femtosecond- assisted intrastromal keratopigmentation and superficial automated keratopigmentation for the pupil (right).
FIGURE 6. Keratopigmentation With Strabismus Surgery. Preoperative appearance before keratopigmentation and squint surgery (top) and postoperative result (right). (Images courtesy of Jorge L. Alió, MD, PhD, FEBOphth)
Functional disabilities are caused by iris problems such as aniridia, iris atrophy and iris colobomas.3-5 Some of these cases, whichither have no solution or require extensive and invasive surgeries, may be approached today with intrastromal keratopigmentation. Even intractable diplopias can be solved with keratopigmentation creating a central scotoma through the creation of a simulated pupil of adequate diameter.15,16
Controversial topic
The purely cosmetic use of keratopigmentation is disruptive and controversial because of the voluntary change of color of the eye that intrinsically has this problem. The procedure is elective, can be performed inadequately, and can lead to complications in normal eyes. With respect to this fact, findings from a recent study13 demonstrated that keratopigmentation is, undoubtedly, the best option available for those individuals who wish to change the apparent color of the eye on a voluntary basis. It demonstrates superior safety to and better outcomes than the alternative approaches using iris color prosthesis or laser iris depigmentation procedures, which are affected by myriad severe complications that can lead to severe visual loss and even blindness.14 In particular, the use of prosthetic colored irises should be considered today as a medical malpractice procedure because of the proven severe comorbidities that have been demonstrated to be induced by their implantation in the medium and long terms.
Emerging surgical technique
With this in mind, it should be considered that this emerging surgical technique of keratopigmentation has been refined with the modern development of specific surgical instruments. These include femtosecond lasers and the modern development of pigments. However, the corneal pigments used are considered underdeveloped owing to the main limitation of this technique to be used in general.
Thus, this technique is open to future developments that will be extremely attractive for ophthalmologists, corneal specialists, and cosmetic surgeons. It will also be attractive for patients affected by morbidities that affect the cosmetics of their eyes due to disfiguring corneal leukomas. The procedure will also appeal to patients who desire to change their appearance through the color of their eyes, which should be done for good reason and with appropriate selection by their surgeons.
A new corneal surgical perspective is now available with a good level of published evidence in support. I envision a promising future that will follow this group of new surgical techniques. This topic will probably progress immensely in the coming years along with the increase in clinician experience and the development of more appropriate, specific, and diverse corneal pigments.
Alió is professor and chairman of ophthalmology at Miguel Hernández University, and founder of Vissum Miranza in Alicante, Spain.
References:
1. Alio JL, Sirerol B, Walewska-Szafran A, Miranda M. Corneal tattooing (keratopigmentation) with new mineral micronised pigments to restore cosmetic appearance in severely impaired eyes. Br J Ophthalmol. 2010;94(2):245-249. doi:10.1136/bjo.2008.149435
2. Sirerol B, Walewska-Szafran A, Alio JL, Klonowski P, Rodriguez AE. Tolerance and biocompatibility of micronized black pigment for keratopigmentation simulated pupil reconstruction. Cornea. 2011;30(3):344-350. doi:10.1097/ICO.0b013e3181eae251
3. Alio JL, Rodriguez AE, Toffaha BT. Keratopigmentation (corneal tattooing) for the management of visual disabilities of the eye related to iris defects. Br J Ophthalmol. 2011;95(10):1397-1401. doi:10.1136/bjophthalmol-2011-300170
4. Alió JL, Rodriguez AE, Toffaha BT, Piñero DP, Moreno LJ. Femtosecond-assisted keratopigmentation for functional and cosmetic restoration in essential iris atrophy. J Cataract Refract Surg. 2011;37(10):1744-1747. doi:10.1016/j.jcrs.2011.08.003
5. Alio JL, Rodriguez AE, Toffaha BT, El Aswad A. Femtosecond-assisted keratopigmentation double tunnel technique in the management of a case of Urrets-Zavalia syndrome. Cornea. 2012;31(9):1071-1074. doi:10.1097/ICO.0b013e318243f6b1
6. Amesty MA, Alio JL, Rodriguez AE. Corneal tolerance to micronised mineral pigments for keratopigmentation. Br J Ophthalmol. 2014;98(12):1756-1760. doi:10.1136/bjophthalmol-2014-305611
7. Alió JL, Rodriguez AE, El Bahrawy M, Angelov A, Zein G. Keratopigmentation to change the apparent color of the human eye: a novel indication for corneal tattooing. Cornea. 2016;35(4):431-437. doi:10.1097/ICO.0000000000000745
8. Amesty MA, Rodriguez AE, Hernández E, De Miguel MP, Alio JL. Tolerance of micronized mineral pigments for intrastromal keratopigmentation: a histopathology and immunopathology experimental study. Cornea. 2016;35(9):1199-1205. doi:10.1097/ICO.0000000000000900
9. Rodriguez AE, Amesty MA, El Bahrawy M, Rey S, Alio Del Barrio J, Alio JL. Superficial automated keratopigmentation for iris and pupil simulation using micronized mineral pigments and a new puncturing device: experimental study. Cornea. 2017;36(9):1069-1075. doi:10.1097/ICO.0000000000001249
10. Alio JL, Al-Shymali O, Amesty MA, Rodriguez AE. Keratopigmentation with micronised mineral pigments: complications and outcomes in a series of 234 eyes. Br J Ophthalmol. 2018;102(6):742-747. doi:10.1136/bjophthalmol-2017-310591
11. Al-Shymali O, Rodriguez AE, Amesty MA, Alio JL. Superficial keratopigmentation: an alternative solution for patients with cosmetically or functionally impaired eyes. Cornea. 2019;38(1):54-61. doi:10.1097/ICO.0000000000001753
12. Balgos JD, Amesty MA, Rodriguez AE, Al-Shymali O, Abumustafa S, Alio JL. Keratopigmentation combined with strabismus surgery to restore cosmesis in eyes with disabling corneal scarring and squint. Br J Ophthalmol. 2020;104(6):785-789. doi:10.1136/bjophthalmol-2019-314539
13. D’Oria F, Alio JL, Rodriguez AE, Amesty MA, Abu-Mustafa SK. Cosmetic keratopigmentation in sighted eyes: medium- and long-term clinical evaluation. Cornea. 2021;40(3):327-333. doi:10.1097/ICO.0000000000002417
14. D’Oria F, Abu-Mustafa SK, Alio JL. Cosmetic change of the apparent color of the eye: a review on surgical alternatives, outcomes and complications. Ophthalmol Ther. 2022;11(2):465-477. doi:10.1007/s40123-022-00458-2
15. Alio JL, Amesty MA, Rodriguez A, El Bahrawy M, eds. Text and Atlas on Corneal Pigmentation. 1st ed. Jaypee Brothers Medical Publishers (P) Ltd; 2015.
16. Laria C, Alió JL, Piñero DN. Intrastromal corneal tattooing as treatment in a case of intractable strabismic diplopia (double binocular vision). Binocul Vis Strabismus Q. 2010;25(4):238-242.
Skinstitut Holiday Gift Kits take the stress out of gifting
Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.
In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.
“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.
There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.
Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.
Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.
In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.
Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.
LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?
It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.
Here’s how you can prepare your digital life for your survivors:
Apple
The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.
For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.
You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.
Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.
Google
Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.
When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.
You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.
There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.
Facebook and Instagram
Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.
When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.
The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.
You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.
TikTok
The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.
Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.
X
It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.
Passwords
Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?
Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.
But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.
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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.
The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.
New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.
The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.
Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.
Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.
“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.
“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”
McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.
But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.
The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.
He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.
“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.
“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.
McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”
McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.
He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.
“Early identification of reading difficulty can truly change the trajectory of a child’s life.”
This report by The Canadian Press was first published Oct. 23, 2024.
