Corneal allogeneic intrastromal ring segments (CAIRS), while not yet a universal first-line treatment for keratoconus, are becoming an increasingly popular choice for the condition. It was first developed as a technique in 2015 by renowned corneal surgeon Soosan Jacob, MS, FRCS, DNB, MNAMS, as a biological alternative to synthetic intracorneal ring segments (ICRS).

Here, Jacob discusses her American Academy of Ophthalmology (AAO) 2026 instruction course, "Transitioning to CAIRS”, designed to help corneal surgeons navigate the learning curve associated with adopting this new tissue-based technique across a widening range of keratoconus cases.

The following transcript has been edited for clarity.

I'm Soosan Jacob, and I'm here to talk about the course “Transitioning to CAIRS.” This was something that the audience has really been asking for for some time.

Corneal allogeneic intrastromal ring segments has really become popular around the world and everyone wants to do it. Patients want to get it done because they understand the advantages that this procedure gives to them, and surgeons also want to start off on it. But the one key question that pops up into everyone's mind is, "How do I actually start off? I want to do it, but what is the easiest way for me to start off so that my cases go well, and the patients are happy and satisfied?"

This is what our course was focusing on: transitioning to CAIRS, which means that we wanted to make this as easy as possible for ophthalmologists, for cornea surgeons, and even for refractive surgeons who want to treat keratoconus, to be able to understand the basics, eg, Which are the best patients to start off with? How do you start? How do you get your theater organized? How do you plan between the femtosecond suite? How do you cut your segments—using the double-bladed trephine, for example, or the femto-cut segments? Where do you order your tissues from? What are the types of tissues available? What are the nomograms?

When you say all of this, it does sound a little confusing, because there's so many options and not everyone is familiar with everything that's available. So sometimes it can seem a little overwhelming. But what we tried to do was make it as simple as possible so that no one feels overwhelmed. You can get a very good idea of what is available and how you do your initial cases so that you can transition into this beautiful procedure very smoothly and have great outcomes for your patients.

Shady T. Awwad, MD; Jack Parker, MD, and I covered femtosecond-dissected channels. We also discussed manually created channels, which means that even a surgeon who does not have access to any femtosecond laser at all can also start off with CAIRS by just dissecting the tunnels manually on the patient's eye. We also discussed customization of CAIRS, the nomograms; we discussed how to cut the CAIRS segments, whether it's femtosecond cuts or the double-bladed trephines; and the advantages of all of these.

I think this was the reason the audience enjoyed it so much and we really look forward to doing this course again next year. So if you're going to be at AAO next year, do look out for this course and come and attend it. Thank you.