Eyeworld.org Articles

Centering attention on presbyopic IOLs

Tue, 01 May 2012 07:09:37 -0400

How to measure the optical center in multifocal lenses

Source: Dimitri Vervitsiotis/Photodisc/Getty Images

Centration is important for any lens, but when it comes to multifocal IOLs, it is more important than ever, according to Eric D. Donnenfeld, M.D., co-chairman, Cornea, Nassau University Medical Center, East Meadow, N.Y. "Modern IOLs have aspheric designs, and if the lens is decentered, the optics of the lens are affected and it induces coma, which causes higher-order aberrations with glare and halo," Dr. Donnenfeld said. "Centering all lenses is important, but for presbyopic lenses it becomes even more important because with their split light, these will be more affected by decentration than a regular lens."
The issue becomes where to most effectively put the lens. Dr. Donnenfeld pointed out...

Food and Drug Administration (FDA) issues recall for Brilliant Blue G; cases of fungal endophthalmitis reported

Tue, 01 May 2012 07:09:37 -0400

Recently, the FDA issued a MedWatch safety alert for four lots of Brilliant Blue G (BBG) ophthalmic solution that were dispensed from a pharmacy in Florida directly to ophthalmologists. The lots have been recalled because of reports of fungal endophthalmitis associated with the use of BBG in vitrectomy. According to the alert, the affected lot numbers are 08232011@80, 10132011@6, 10112011@82, and 10192011@125. Franck's Compounding, located in Ocala, Fla., stated that they notified 22 physicians who received BBG from a batch made in
August 2011 and began an immediate recall, and then subsequently
recalled supplies from an additional 78 physicians. The pharmacy suggests that healthcare practitioners adhere to pharmacy guidelines, use "single-use" vials as directed, and record patient, procedure, site, product lot, and product expiration...

Negative still rules

Tue, 01 May 2012 07:09:37 -0400

Aspheric IOLs remain popular choice among physicians

The Tecnis aspheric lens
Source: Abbott Medical Optics

The AcrySof aspheric lens
Source: Alcon

The ReSTOR lens
Source: Alcon

Despite the loss of the NTIOL (new technology IOL) Medicare reimbursement, negative aspheric IOLs are still a valuable offering in refractive cataract practices.
"I think it became the conventional wisdom at a certain point that aspheric lenses are superior, you get better image quality and better patient satisfaction, so especially for multifocal lenses, I think they made a huge improvement in results with the ReSTOR [Alcon, Fort Worth, Texas] in particular," said Mark Packer, M.D., clinical associate professor of ophthalmology, Casey Eye Institute, Oregon Health &Science...

Going around the capsular block in femtosecond cataract surgery

Tue, 01 May 2012 07:09:37 -0400

Understanding how the laser cataract environment differs from the traditional

An example of posterior capsule rupture
Source: David Allen, F.R.C.Ophth.

It happened without warning—two cases of the very rare capsular block syndrome occurring among the first 50 femtosecond laser-assisted cataract surgeries performed at an Australian center, according to Tim V. Roberts, M.D., consultant ophthalmic surgeon,
Vision Eye Institute and Royal North Shore Hospital, Sydney.
"We were doing phaco the same way that we [typically] had," Dr. Roberts said. The practitioners, who had only just begun to adapt to the femtosecond-assisted procedure, immediately stopped to take a closer at what was occurring. After uneventful combined laser fragmentation, capsulotomy, and corneal incision procedures, things had suddenly...

Scleral-fixated PCIOLs: In the absence of support

Tue, 01 May 2012 07:09:37 -0400

Study reports complications common in scleral-fixated PCIOLs

In the absence of capsular support when implanting an IOL, a surgeon has three options: anterior chamber implantation of the IOL or posterior implantation of the IOL using either the sutured iris-fixated technique or the scleral-fixated technique.
An unacceptable rate of complications associated with closed-loop anterior chamber IOLs (ACIOLs) in the 1980s brought about a shift
toward scleral fixation of a posterior chamber IOL (PCIOL).
A study published in the Journal of Cataract & Refractive Surgery looked at the long-term visual outcomes and complications of implanting scleral-fixated PCIOLs. Conducted by Australian researchers at Princess Alexandra Hospital, Mater Hospital, and Queensland Eye Institute,
Brisbane, the study reviewed the records of patients who had anterior vitrectomy and scleral-fixated PCIOL implantation between 1993 and 2008 and had a minimum follow-up...

Preservative use in allergy medications

Tue, 01 May 2012 07:09:37 -0400

Although not an ideal situation for allergy sufferers, in most short-term courses of treatment, preservatives will not harm the ocular surface

When one-quarter of the U.S. population is affected by a disease state and 90% of those patients exhibit ocular manifestations, it's safe to say ophthalmologists will see a good number of patients on a fairly routine basis for treatment. When that disease state is allergic conjunctivitis and the most common topical treatments include preservatives known to adversely affect the ocular surface, it's not as clear-cut.
Ocular allergies are usually seasonal or occasionally perennial, but more chronic forms include atopic keratoconjunctivitis (AKC) and
vernal keratoconjunctivitis (VKC), the latter two being more difficult to treat as well. VKC is more typically present in children, with...

Allergic reactions

Tue, 01 May 2012 07:09:37 -0400

According to Dr. Bielory, although numerous adverse reactions to topical medications may occur, only 10% or so are a true allergic
reaction. And even those allergies are typically in response to the active ingredient rather than the preservative, he said. In a recent paper, he cited a study that found even a single exposure to benzalkonium
chloride 0.005% could produce precorneal tear film instability.1
Dr. Udell suggested doing a washout on these patients, with the caveat that physicians should "always try to withdraw medications you think might be the culprit first and see if it makes a difference," he said. Prepare the patient that withdrawal may result in increased discomfort. He's also noted in these situations that it may be necessary to put the
patient on a steroid to get him/her back to the original baseline, "then start adding in drops selectively based on what you think is the least
noxious agent," he said. "Once you...

Linking keratoconus and floppy eyelid syndrome to sleep apnea

Tue, 01 May 2012 07:09:37 -0400

An example of FES
Source: Francis S. Mah, M.D.

A patient with keratoconus
Source: Uday Devgan, M.D.

Does your patient need a sleep study?

Has a patient ever nodded off in the exam chair or perhaps mentioned problems sleeping? Does that patient have keratoconus or floppy eyelid syndrome (FES)? If so, pay attention. Keratoconus and FES are linked to sleep apnea, a dangerous sleep disorder characterized by breaks in breathing that's associated with heart disease, stroke, hypertension, atrial fibrillation, congestive heart failure, and other deadly vascular diseases.
Keratoconus, FES, and sleep apnea exist independently of each other. For example, many keratoconus patients don't have sleep apnea, and many sleep apnea patients don't have keratoconus. But it's not unusual to find...

PUK and systemic autoimmune disease

Tue, 01 May 2012 07:09:37 -0400

Usually considered an ocular manifestation of a systemic autoimmune disorder, peripheral ulcerative keratitis can result in devastating outcomes—including permanent loss of vision

PUK is clearly identifiable in this patient
Source: Sophie X. Deng, M.D.

An example of marginal (limbal) herpes simplex keratitis (mimicking PUK)
Source: Vincent P. de Luise, M.D.

Mooren's ulcer caused this patient's PUK
Source: Vincent P. de Luise, M.D.

Peripheral ulcerative keratitis (PUK) is typically associated with poorly managed systemic conditions such as rheumatoid arthritis (RA accounts for almost one-third of non-infectious PUK), among others. What can cause it?
"VAST CRIMES," said Vincent P. de Luise, M.D., assistant clinical professor of ophthalmology,...

Mooren's ulcer vs. PUK: The difference can mean life or death

Tue, 01 May 2012 07:09:37 -0400

Telling the difference between Mooren's ulcer and early signs of something deadly

An example of Mooren's ulcer

PUK with scleritis in a patient with RA
Source (all): Virender S. Sangwan, M.D.

While Mooren's ulcer is by definition not associated with any systemic autoimmune disorder, it can be confused with corneal ulcers that are early warning signs of life-threatening diseases, said C. Stephen Foster, M.D., founder and president, Massachusetts Eye Research and Surgery Institute, Cambridge, and clinical professor of ophthalmology, Harvard Medical School, Boston.
Therefore, the general ophthalmologist ought to hear alarm bells ring if the peripheral corneal disease has the following characteristics: It is a real ulcer, that is, the epithelium is not intact, there is some loss of stroma, it...

Ophthalmologists can diagnose deadly disease at slit lamp

Tue, 01 May 2012 07:09:37 -0400

Fabry's disease presents with corneal verticillata

A patient with Fabry's disease and a characteristic cornea verticillata

Amiodarone deposition in the cornea
Source (all): W. Barry Lee, M.D.

Imagine looking into the slit lamp and seeing something that, without a doubt, tells you the patient sitting there is
suffering from a debilitating disease that will kill him.
Now, imagine he has no idea.
The patient has several seemingly unrelated symptoms, including a strange skin rash, nausea, unexplained pain, and hypertension.
When an ophthalmologist spots a characteristic cornea verticillata, the patient most likely is suffering from Fabry's disease, also known as Anderson-Fabry disease, angiokeratoma corporis diffusum, and alpha-galactosidase A deficiency. Fabry's disease patients...

Researchers use Nintendo WiiMotes to diagnose ocular torticollis

Tue, 01 May 2012 07:09:37 -0400

A team of researchers in Seoul, South Korea, has developed a novel way for pediatric ophthalmologists to diagnosis children with ocular torticollis. Called the infrared optical head tracker (IOHT), researchers used Nintendo WiiMote controllers to measure the angle of a person's head posture in real time. While it has several possible causes, torticollis can be caused by visual conditions such as visual field defects, nystagmus, or strabismus. "Torticollis occurs in about 1.3% of children," said author Jeong-Min Hwang, M.D., Seoul National University College of Medicine, in a press release. "Accurate measurement of the angle of the abnormal head position is crucial for evaluating disease progression and determining treatment or surgical plans in parties with ocular torticollis."
Dr. Hwang and colleagues tested the IOHT on 20 normal adult subjects between 20 and 37 years of age and compared the results with the Cervical Range of Motion instrument (CROM, Performance...

Eyeing the GI tract for vital vitamins

Tue, 01 May 2012 07:09:37 -0400

Making the gastric bypass connection and beyond

Following gastric bypass, patients may deal with xerophthalmia of the conjunctiva from hypovitaminosis A. The eye here has fluorescein dye pooling in beads on the region of xerosis just prior to Bitot's spot formation

Slit lamp photo showing central corneal haze, scarring, and xerophthalmia of the conjunctiva from hypovitaminosis A following gastric bypass surgery
Source (all): W. Barry Lee, M.D.

A patient with a Bitot's spot characteristic of hypovitaminosis A

It may be the last thing you're thinking of when you see a patient whose main complaint is dry eyes or a touch of night blindness—the idea that the culprit may be a gastrointestinal (GI) problem that's spawning a vitamin A deficiency. But the fact is that this may very well...

Monthly Pulse Keeping a Pulse on Ophthalmology Poll Size: 398

Tue, 01 May 2012 07:09:37 -0400

EyeWorld Monthly Pulse
EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send a 4-6 question online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the current 1,000+ physicians who take a minute a month to share their views, please send us an email and we will add your name. Email ksalerni@eyeworld.org and put EW Pulse in the subject line; that's all it takes.
Copyright EyeWorld 2012

The majority of respondents (77%) feel comfortable medically managing a patient with peripheral ulcerative keratitis (PUK) on their own. In severe cases, surgical management and rheumatologic workup is often required, yet only a minority selected...

Calming allergic conjunctivitis

Tue, 01 May 2012 07:09:37 -0400

How to treat and diagnose ocular allergies

A patient with SAC
Source: Ira J. Udell, M.D.

April showers bring May flowers and endless misery to those suffering from seasonal and perennial conjunctivitis caused by pollen, mold, and grasses. 'Tis the season for red, itchy eyes, so EyeWorld spoke with two experts about diagnosing and treating patients with these ocular issues.

Seasonal or perennial?

The differences between seasonal and perennial allergies are limited, said Leonard Bielory, M.D., Springfield, N.J. Other than their frequency, primary differences are severity of symptoms and root cause. Seasonal allergies occur during the spring and fall months and are typically caused by pollen, grass, and ragweed. The intensity of seasonal allergic conjunctivitis (SAC) can...

Combination drops are first-line therapy for allergies

Tue, 01 May 2012 07:09:37 -0400

Most practitioners agree that combination drops are the go-to therapy for SAC (pictured here)
Source: Andrea Leonardi, M.D.

Many ocular allergy suffers first try to quash symptoms by self-medicating with over-the-counter drops, but different classes of medications, especially combination antihistamine/mast cell stabilizers, are quite effective treating the irritating condition, according to several practitioners who spoke to EyeWorld.
More than 90% of patients with ocular allergy symptoms are affected by either seasonal allergic conjunctivitis (SAC) or perennial allergic conjunctivitis (PAC), with swelling and itching being hallmark symptoms.
Drop therapies available today attempt to stave off allergic conjunctivitis by focusing on the characteristic mast cell degranulation that is associated with the condition. Mast...

Torics: A viable premium option for glaucoma patients

Tue, 01 May 2012 07:09:37 -0400

Source: Stockbyte/Stockbyte/Getty Images

A glaucoma patient, especially one who has significant visual field loss, likely won't be able to take advantage of multifocal lens implants during cataract surgery.
Toric lenses, on the other hand, are a viable premium option and commonly used, according to two surgeons who spoke to EyeWorld.
"I place several toric lenses every week because of the great advantage they bring patients, regardless of whether or not they have glaucoma," said Steven R. Sarkisian Jr., M.D., clinical associate professor of ophthalmology, Dean McGee Eye Institute, University of Oklahoma College of Medicine, Oklahoma City.
Toric lenses play a unique role in patients with glaucoma because of the astigmatism that can be induced by glaucoma surgery, Dr. Sarkisian said.
"Conventional...

SLT rising to the pseudophakic occasion

Tue, 01 May 2012 07:09:37 -0400

How use of the technology fares after cataract surgery

Source: Lifesize/Thomas Northcut/Getty Images

Pseudophakic glaucoma and ocular hypertension patients who underwent selective laser trabeculoplasty (SLT) experienced treatment delays when compared to their phakic counterparts, according to Tarek A. Shazly, M.D. Results e-published in Clinical Ophthalmology in 2011 indicated that while long-term results were equivalent, IOP reduction at the 2-week mark was 7.6% greater in phakic patients.
"The point of the study was to evaluate and to determine if pseudophakia affects the outcome of SLT because there's a common concept that SLT doesn't work in pseudophakic patients as well as phakic patients," said Dr. Shazly, fellow at the time of study publication, Massachusetts Eye and Ear
Infirmary, Harvard...

Are preservatives essential in glaucoma medications?

Tue, 01 May 2012 07:09:37 -0400

Source: Echo/Cultura/Getty Images

With the exception of a very small number of unit-dose products, virtually all ophthalmic medications are formulated with preservatives to inhibit microbial contamination. Among the preservatives, benzalkonium chloride (BAK) is the most widely used, being nearly ubiquitous in ophthalmic preparations. BAK is highly effective in inhibiting the growth of bacteria, fungi, and other microbes. But BAK also has some potentially detrimental effects as well. For people with glaucoma and other chronic conditions that require long-term daily eye drop therapy, chronic exposure to BAK can cause significant problems.

BAK and the ocular surface

"Numerous observational studies have demonstrated that the prevalence of dry eye in medically treated glaucoma patients is much higher...

Charity tourism in Honduras

Tue, 01 May 2012 07:09:37 -0400

EyeWorld talks to Crystal Clear Vision about its global charity work

A wet Dr. Choi delivers supplies in Honduras

An example of the living conditions in Honduras where Crystal Clear Vision helps
provide eyecare services for people in need
Source (all): Crystal Clear Vision

Right from inception, charity work was going to be an integral part of LASIK company Crystal Clear Vision's mission to provide premium LASIK technology at an affordable price.
"I want some of the money from every single procedure to go toward that mission, I want patients to be able to contribute to that as well, and I want doctors that we work with, both the optometrists and the surgeons, to be able to contribute," said Jeffery J. Machat, M.D., CEO, Crystal Clear Vision, Birmingham, Ala.
Indeed, at his...

Beyond cataract backlog, India looks ahead

Tue, 01 May 2012 07:09:37 -0400

Three Indian surgeons discuss cataract surgery challenges—and face issues similar to their colleagues in the West

In December 1997, an article appearing in the Indian Journal of Community Health noted that there were more than 12 million people blind due to cataract in that nation.
In January 2010, during a trip to Chennai as part of a Unite for Sight mission to improve eye health in local Indian communities, I learned that the backlog was being eradicated bit by bit.
At Chennai-based Uma Eye Clinic, 66 visual screening camps in 2005 evaluated 8,663 impoverished patients. By 2009, there were 394
organized camps performing 62,899 screenings.
"The backlog can melt like snow if socioeconomic conditions improve," Arulmozhi Varman, M.D., medical director, Uma Eye Clinic, told me at the time. "The backlog occurs because the large population can't access [proper ophthalmic] facilities. If the economy zooms up, the backlog...

Practitioners reach their fill on new labeling vote

Tue, 01 May 2012 07:09:37 -0400

Weighing use of same NSAID bottle in sequential eyes

Source: Stockbyte/Stockbyte/Getty images

Original data from EyeWorld survey, January 2012

It has been the status quo for many practitioners—having patients who are doing cataract surgery in quick succession use the same bottle of anti-inflammatory drops for both eyes. The FDA Dermatologic and Ophthalmic Drugs Advisory Committee, however, voted down a proposal that would allow such a bottle to be openly labeled for administration in both eyes in cataract procedures done within a few weeks of each other, according to Mark Packer, M.D., clinical associate professor of ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, who was at the hearing on behalf of ASCRS. The FDA specifically asked ASCRS...

In The Journal Of Cataract & Refractive Surgery April 2012

Tue, 01 May 2012 07:09:37 -0400

Middle prechop: Fracturing the middle portion of the nucleus
André Berger, M.D., Inara Nogueira Contin, M.D., Graziela Nicoletti, M.D., Paula Fernanda Baltar Pazos, Henrique Santiago Baltar Pazos, M.D.,
José Álvaro Pereira Gomes, Ph.D., M.D.
Investigators here described a technique that helps to reduce the amount of ultrasound power needed for phacoemulsification. The technique, done prior to chopping, fractures the nucleus through the center of the lens. With this technique practitioners first create a continuous curvilinear capsulorhexis. They then inject an ophthalmic viscosurgical device into the anterior chamber. Next, using a back-and-forth movement, two modified cystotomes are inserted into the lens. To fracture the nucleus, a small amount of pressure from opposite sides is applied. The practitioner is then free to perform hydrodissection followed by phacoemulsification.

Long-term architecture of clear corneal incisions using OCT
Li...

Accessing the value of ASCRS information

Tue, 01 May 2012 07:09:37 -0400

Access the ASCRS Media Center on the ASCRS homepage or at www.prolibraries.com/ascrs

Source: the Agency Collection/Abel Mitja Varela/Getty images

The primary role of ASCRS is education. Every year, thousands of presentations on clinical topics such as cornea, glaucoma, intraocular surgery, keratorefractive, pediatric, and retina are made at the ASCRS•ASOA Symposium & Congress, ASCRS Glaucoma Day and Cornea Day, and Winter Update. With all of this information, how can members access it?
The ASCRS Media Center serves as the Society's online educational
library. It is the vehicle by which ASCRS makes much of the educational content it collects over the course of the year available to its members and the ophthalmic community.
As the leading...

Facing interface fluid after LASIK, RD repair

Tue, 01 May 2012 07:09:37 -0400

Surgeon shares how he handled unusual case

Figure 1. A narrow angle at presentation

Figure 2. Both angles at presentation

Figure 3. The cornea with edema in the flap interface at the time of presentation

Figure 4. The iris plastered to the cornea 2 days later

Figure 5. The iris after deepening of the chamber at the slit lamp

Figure 6. This image shows how thin the cornea became right after deepening of the chamber

Figure 7. The patient's atonic pupil with the cataract prior to surgery
Source (all): Steven G. Safran, M.D.

You never know what

challenges certain cases will present. Recently, Steven G. Safran, M.D., Lawrenceville, N.J., handled a case where a 50-year-old female...

Other surgeons weigh in

Tue, 01 May 2012 07:09:37 -0400

Here's what some other surgeons think about
Dr. Safran's handling of this unusual case.

In my personal experience, interface fluid accumulation from high IOP has been in the early healing phases post-LASIK, such as when the IOP goes up secondary to steroid use within the first month post-op. I personally have not seen a case of pressure-induced stromal keratitis 3 years post-op like this case. This shows poor healing of the flap to the residual stromal bed post-LASIK.
The OCT is also very revealing in this case. I have seen photos of this condition, but I have never seen it so well documented as with high-definition OCT.
Michael Wong, M.D.
Princeton, N.J.

When you have a completely air/ gas-filled eye, you cannot see much of anything. The patient may not necessarily have had a gas overfill, but perhaps the patient was not positionally compliant
following her RD repair. Typically, the post-op RD patient is asked...

Anterior segment grand rounds A case for cerclage

Tue, 01 May 2012 07:09:37 -0400

There are many questions here regarding the handling of the cataract surgery and the issue of what to do with the iris.

Roundtable discussion

An image of her eye after receiving 2% pilocarpine

The patient's post-op appearance 1 month after surgery
Source (all): Steven G. Safran, M.D.

Brandon Ayres, M.D., Cornea Service, Wills Eye Institute, Philadelphia, commented: "This is a very interesting case with three major issues: 1) what intraocular lens and power to use for the case given the patient is status post-laser refractive surgery; 2) how to handle the very high likelihood of zonular instability during lens removal; and 3) how to deal with an atonic pupil.
"I traditionally stay away from presbyopia-correcting lenses in complex cases. … My personal preference...

"Inside-out" approach to posterior polar cataracts

Tue, 01 May 2012 07:09:37 -0400

Figure 1. A moderate-sized continuous curvilinear capsulorhexis is created

Figure 2. A central trench is sculpted using the slow motion technique

Figure 3. A dispersive viscoelastic is injected through the side port before retracting the probe to maintain a closed chamber

Figure 4. A specially designed right-angled cannula is introduced through the main incision to reach the central trench

Figure 5. The tip of the cannula is placed adjacent to the left wall of the trench at an appropriate depth

Figure 6. Fluid is injected slowly with minimal force through the left wall of the trench Source (all): Abhay R. Vasavada, M.S.,
F.R.C.S., and Shetal M. Raj, M.S.

Figure 7. Delineation is produced by the fluid traversing inside-out

Figure...

Phacoemulsification of the rock hard cataract

Tue, 01 May 2012 07:09:37 -0400

The use of trypan blue improves visualization of the anterior capsule and helps make the performance of the anterior capsulotomy easier and more reliable

Placement of a dispersive OVD to push back the posterior capsule and maintain the posterior chamber toward the end of the case helps prevent posterior capsular injury
Source (all): D. Michael Colvard, M.D.

Phacoemulsification of the extremely dense cataract poses challenges for even the most experienced cataract surgeon. The absence of a protective epinuclear layer, the paucity of cortex, the fragility of the capsule, and the laxity of the zonules all increase the risk of injury to the supportive structures of the lens during surgery. Longer phaco times at higher energy levels, moreover, increase not only the risk of corneal endothelial damage but also the risks...

Introducing our public board member medical ethicist John Banja

Tue, 01 May 2012 07:09:37 -0400
Dr. Chang: Tell us about your professional background and how you came to be an academician with a focus on medical ethics.
Dr. Banja: I'm one of those people who stumbled into what eventually became my life's work. I began my graduate studies in philosophy at Fordham University and completed a doctorate degree in 1976. Back then, all I wanted to do was teach academic philosophy for the rest of my life, but I wasn't immediately successful in landing a teaching job. I finally did get some part-time teaching opportunities at a small college in south central Pennsylvania (St. Francis College, now St. Francis University), which had begun a physician's assistant program. They wanted someone to teach medical ethics, which was quite remarkable at a time when medical ethics was just getting underway. So I volunteered to do it—this was in 1980—and have been doing it...

Digitizing practice management

Tue, 01 May 2012 07:09:37 -0400

The biggest technology change in practices in 2012

Data compiled from EyeWorld 2012 Technology Update survey, January 2012

From incorporating electronic health records (EHR) to online patient appointments and social media, a large number of ophthalmology practices is now focused on moving management processes into the digital age.
In a recent survey of ASCRS members conducted by EyeWorld,
almost 70% of the nearly 400 respondents indicated that the biggest technology change in their practice anticipated in 2012 is practice management related.

EHR and getting online

Jordan E. Sterrer, M.D., Eyecare Medical Group, Portland, Maine, said his practice is taking a serious look at several vendors for EHR systems right now.
"We've designed a process and set up committees to look...

Tools for accurate IOL calculations

Tue, 01 May 2012 07:09:37 -0400

Dr. Hill doles out his best advice

Dr. Hill performs free lens constant analysis for the Haigis, Holladay 1, SRK/T, and Hoffer Q formulas through his websiteSource: doctor-hill.com/physicians
/download.htm

Warren Hill, M.D.

When it comes to refractive outcomes, surgeons may not be as good as they think they are. According to EyeWorld Monthly Pulse survey results from March, 57% of 408 physicians polled believe they come within 0.5 diopters of the target refraction during routine cataract surgery at least 90% of the time. But as Warren Hill, M.D., East Valley Ophthalmology, Mesa, Ariz., said, "There is no way in the world that could be accurate."
EyeWorld sat down with Dr. Hill to get his take on physicians' false confidence and how to optimize tools and improve outcomes...

Soothsaying for multifocal IOLs

Tue, 01 May 2012 07:09:37 -0400

Foretelling which
patients will likely need
an enhancement

Source: Dimitri Vervitsiotis/Photographer's Choice RF/Getty Images

When it comes to LASIK enhancements after multifocal IOL implantation, a patient attaining at least driving acuity is a good indication of whether or not he/she will require a touchup, according to Pinakin Gunvant Davey, O.D., Ph.D., associate professor, College of Optometry, Western University of Health Sciences, Pomona, Calif.
Determining who will need an enhancement in such multifocal cases is something that he finds has stymied many ophthalmologists.
"The crux of the problem is that as clinicians, we're in a bind—we know that some individuals have problems after multifocal implantation and they're unsatisfied, and there are some...

Casey Eye InstituteOregon Health & Science of "Cataract surgery in patients with AMD after University residents' review anti-VEGF therapy"

Tue, 01 May 2012 07:09:37 -0400

This month, I asked the Casey Eye
residents to review this important
paper on cataract outcomes in patients with wet ARMD.

—David F. Chang, M.D.,
chief medical editor

Age-related macular degeneration (AMD) and cataract are common causes of visual impairment in the aging population. Consideration as to whether cataract surgery has an influence on the visual outcome of AMD patients has been an area of continual contention. In "Outcomes of cataract surgery in patients with neovascular age-related macular degeneration in the era of anti-vascular endothelial growth factor therapy," published in the April issue of the Journal of Cataract and Refractive Surgery, Tabandeh and colleagues1 present their review of cases evaluating the visual outcomes, choroidal neovascular complex status, and adverse events in patients with concurrent visually significant cataract and neovascular age-related macular degeneration (AMD) who have...

Outcomes of cataract surgery in patients with neovascular age-related macular degeneration in the era of anti-vascular endothelial growth factor therapy

Tue, 01 May 2012 07:09:37 -0400

J Cataract Refract Surg. (April) 2012; 38:677-682

Purpose: To evaluate the visual outcomes, choroidal neovascular complex status, and adverse events in patients with visually significant cataract and neovascular age-related macular degeneration (AMD) who had cataract surgery.
Setting: Private practices, Beverly Hills, Calif., and New London, Conn.
Design: Case series
Methods: Data were abstracted from the medical records of patients with neovascular AMD treated by anti-vascular endothelial growth factor (anti-VEGF) therapy who had cataract surgery. The main outcome measures were Snellen corrected distance visual acuity (CDVA), perioperative adverse events, and status of the choroidal neovascular complex.
Results: The study enrolled 30 eyes of 28 patients. The CDVA was 20/40 or better in 10% of eyes pre-operatively and 40% post-operatively; 20/50 to 20/100 in...

Treading too lightly

Tue, 01 May 2012 07:09:37 -0400

Natalie Afshari, M.D.
Director, Cornea and Refractive Surgery
Fellowship Program
Assistant professor,
Department of Ophthalmology
Duke University, Durham, N.C.

There are several ways to help the overly timid resident gain confidence in learning cataract surgery. First, you need to make sure that the groundwork has been set prior to stepping into the OR. This can be done by ensuring proper wet lab practice has been
accomplished (ideally with you at the resident's side), by reviewing cataract videos and discussing them with the resident, or by having the resident discuss with you the steps of the surgery, including how to manage any common difficulties.
When you are comfortable that the basic pre-surgical training and preparation have been undertaken, it's very important to make the OR environment as comfortable as possible for...

Life-saving findings from the anterior segment

Tue, 01 May 2012 07:09:37 -0400

In ophthalmology, there are many systemic conditions that have ocular manifestations. For example, diabetic and hypertensive retinopathy along with systemic malignancies may be diagnosed by retina specialists; neuro-ophthalmologists are able to diagnose life- threatening elevated intracranial pressure or brain tumors with findings of optic nerve edema or optic nerve atrophy, respectively; and in cornea, there are a variety of conditions where a spot diagnosis can be made by the clinician that could save a patient's life.
In this month's issue of EyeWorld, we focus on the relationship
between corneal diagnoses and systemic diseases. While there are a myriad of entities to cover, a few select ones will be highlighted. When noticing corneal verticillata, one may immediately associate a patient with being on amiodarone medication. While this is likely to be the most common cause for this corneal finding, in this issue, experts share pearls on how to ensure that a...