Eyeworld.org Articles

Contemplating pars plana procedures for cataract surgeons

Thu, 19 Jan 2012 03:15:19 -0500

Dr. Charles enters the vitreous in very limited circumstances, such as during vitreous loss after posterior capsule rupture (pictured here)
Source: David Allen, F.R.C.Ophth.

Weighing the current wisdom

It is something that remains an area of contention—should anterior segment surgeons be entering the pars plana for procedures such as planned PPV or posterior assisted levitation (PAL)? EyeWorld spoke with two leading ophthalmologists to get their perspectives on this.

Point

Richard Packard, M.D., senior consultant, Prince Charles Eye Unit, Windsor, England, sees the issue of entering the pars plana as one that reflects anterior surgeons' comfort level. "I think that it depends on whether they feel comfortable there and whether they're prepared to do a complete peripheral...

Laser systems for refractive cataract surgery

Thu, 19 Jan 2012 03:15:19 -0500

This month's column discusses the latest in "femto for phaco"

The latest phaco device innovation to come to market or be in development is the advent of the femtosecond laser for refractive cataract surgery. Podium presentations have touted the ability of the lasers to create more precise incisions and capsulorhexis, but a hefty price tag and no long-term data (yet) have continued the debate.
With these devices estimated to cost anywhere from $400,000 to $550,000 and service fees after the first year expected to be about 10% of the purchase price, Jonathan H. Talamo, M.D., associate clinical
professor of ophthalmology, Harvard Medical School, Boston, said relevant indications and regulatory approvals may be crucial for both manufacturers and those debating which system to purchase. Alcon's LenSx (Fort Worth, Texas) has regulatory clearance in the U.S. for capsulotomy, lens fragmentation, relaxing incisions, and cataract incisions. The...

Outside temperatures, sun exposure, gender may trigger exfoliation syndrome

Thu, 19 Jan 2012 03:15:19 -0500

Age, gender, and location influence a patient's risk of developing exfoliation syndrome (ES), which leads to an increased risk for cataract and cataract surgery complications and is a leading cause of secondary open-angle glaucoma.
"Although many studies from around the world have reported on the burden of the disease, some aspects of the basic descriptive epidemiologic features, which may help shed light on the cause, are inconsistent," said Louis Pasquale, M.D., study co-author, and director, Glaucoma Center of Excellence, Massachusetts Eye and Ear Infirmary, Boston, in a press release. "In this study we found that women are more vulnerable to this disease than men, that ES is not a disease of Norwegian descent, and that where you live does matter when it comes to developing the disease."
"Importantly, those with a lifetime residential history of living in the middle tier and south tier of the United States was associated with 47% and 75% reduced...

Implants or lenses in infants?

Thu, 19 Jan 2012 03:15:19 -0500

With relatively even visual outcomes, specialists are not yet convinced one treatment fits all

Congenital nuclear cataract
Source: Jules Stein Eye Institute

The 1-year results from the Infant Aphakia Treatment Study Group (IATS) found little difference in visual outcomes between the IOL and contact lens (CL) groups, but the former needed more additional surgeries.1
Because there were fewer patients in the CL group who needed additional surgery, some physicians believe CLs must be a better option, but Scott R. Lambert, M.D., professor of ophthalmology, Emory University, Atlanta, noted in clinical settings, "insurance companies don't pay for the lenses, and they can be quite expensive," he said. "If people don't have the financial means to pay for the lenses or are not compliant, there's a compelling...

Overlooked conjunctival disease

Thu, 19 Jan 2012 03:15:19 -0500

Conjunctivochalasis and superior limbic keratoconjunctivitis often go unnoticed when presenting with other surface diseases

An example of chemosis
Source: John A. Hovanesian, M.D.

The arrows in this photo indicate where the conjunctivochalasis is occurringSource: John A. Hovanesian, M.D.

Common symptoms of dry eye can sometimes mask other conjunctival anatomic disorders such as conjunctivochalasis (CCh) or superior limbic keratoconjunctivitis (SLK). The former, a
condition where redundant conjunctival tissue overlies the lower eyelid margin or covers the lower punctum, disrupts the normal tear flow. SLK, by contrast, presents as an inflammation of the superior bulbar conjunctiva and typically involves the superior limbus as well.
"These both mimic so many other diseases we routinely...

Making light of corneal repair

Thu, 19 Jan 2012 03:15:19 -0500

New method promises boost over suture use

Ocular surface defects are unfortunately par for the ophthalmic course. While traditionally repair of these has relied on sutures, a new light-activated method for securing amniotic membrane to the cornea promises to make such repairs easier on patients and surgeons alike, according to Min Yao, M.D., Ph.D., instructor, Harvard Medical School, Boston, and professor, Jiao Tong University School of Medicine, Shanghai, China. Dubbed photo-chemical tissue bonding (PTB), results from a study published in the August 2011 issue of Lasers in Surgery and Medicine peg the process as superior to the use of sutures.
The new light-activated method of repair makes use of two commonly used ophthalmic aids—rose bengal staining and green light. It banks on an alteration in the rose bengal. "Rose bengal can be activated by green light that can cause some electron change," Dr. Yao said. Due to this electron change, proteins will link...

Consider the macula in pre-op cataract patients

Thu, 19 Jan 2012 03:15:19 -0500

Dr. Fung drawing Lucentis (Genentech, South San Francisco)

Dr. Fung consults with a patient

Dr. Fung performs an injection on a patient
Source: Anne Fung, M.D.

Retina specialists offer advice on what to look for in order to attain best vision

Surgical complications arise, even in cataract surgery, which reportedly has one of the highest success rates. Yet despite all the various pre-op tests that are performed to ensure a successful operation—from measuring the eye and cornea to deciding on the best IOL fit—there are always potential problems that may be overlooked during the procedure, especially from the back of the eye.
The most common missed maculopathies that result in unhappy cataract patients are vitreoretinal
interface abnormalities, such as epiretinal membranes and vitreoretinal...

Retinal ramifications on the phaco edge

Thu, 19 Jan 2012 03:15:19 -0500

Considering cataract surgery through the lens of ARMD

In cases of dry and wet ARMD, anterior
segment surgeons and retina specialists may consider teaming up to optimize results
Source: Seenu Hariprasad, M.D.

It is one of those things that can come as a double whammy—an older patient is diagnosed with age-related macular degeneration (ARMD) and also with a cataract. Prithvi Mruthyunjaya, M.D., assistant professor of ophthalmology, Duke Eye Center, Durham, N.C., finds that it is nearly ubiquitous at the time of ARMD diagnosis to also face a cataract. These patients present a unique set of challenges. What is a practitioner with such patients to do?
Dr. Mruthyunjaya usually begins by bringing to light for patients with dry ARMD the differing data that is...

Cataract surgery and diabetic retinopathy

Thu, 19 Jan 2012 03:15:19 -0500

Experts weigh in on timing and treatment

A pre-op view of extensive, proliferative
diabetic retinopathy with tractional macular detachment and somewhat hazy view
secondary to associated cataract

Dr. Mahmoud said these patients need bimanual vitrectomy to segment, delaminate, and remove all the traction. A crisp view is needed for that procedure, and that may necessitate simultaneous or staged procedure with cataract beforehand

A post-op image 1 year after the combined procedure
Source: Tamer H. Mahmoud, M.D.

Diabetic patients can be tough cases for cataract surgeons to work with, and managing diabetic retinopathy in prospective and current cataract patients is just one challenge in an already long line. As new data shows, the problem won't be going away anytime soon...

Evaluating the risks of retinal detachment in cataract patients

Thu, 19 Jan 2012 03:15:19 -0500

An example of a macula-off retinal detachment
Source: David S. Boyer, M.D.

Family history and refractive error are but two risk factors that increase the risk of a retinal detachment. Here, retinal experts discuss when—or if—to treat tears and holes

Retinal detachments (RD) are more likely to occur in patients with higher myopia, and the risk increases if there's a family history of RD or if a patient's fellow eye has had one. In these patients, retinal specialists recommend extra vigilance when looking at the peripheral retina during normal pre-op exams before cataract surgery. Refractive lens exchange patients undergoing an IOL exchange are also at a higher risk. Complicated cataract surgery—cases involving vitreous loss or capsular rupture—also puts the patient at an increased risk of developing an RD. Another...

Preventing and treating CME

Thu, 19 Jan 2012 03:15:19 -0500

Prophylaxis key in avoiding problems

Before (left half) and after (right half) treatment of CME with an NSAID

An epiretinal membrane, which makes it highly likely that the patient will have CME after routine cataract surgery
Source: Uday Devgan, M.D.

Think of prophylaxis for cystoid macular edema (CME) like life insurance, said Keith A. Warren, M.D., chair, ophthalmology department, School of Medicine, University of Kansas, Kansas City.
Hopefully you won't need it, but it can give you some clinical peace of mind.
Uday Devgan M.D., chief of ophthalmology, Olive View–University of California, Los Angeles Medical Center, approaches CME with another analogy: "When CME occurs, it's like a carpet that's flooded. You can repair the carpet, but it's never quite the same," he...

Keeping a Pulse on Ophthalmology Poll Size: 397

Thu, 19 Jan 2012 03:15:19 -0500

It is satisfying to note that over 83% of the responding ophthalmologists recognize the link between high myopia and retinal detachment. The emphasis on the manner of pre-surgical consent was equivocal. While more than half of the respondents (54%) appropriately realized that there was no link between exudative ARMD and cataract surgery, some 23% were unsure and another 24% believed that there was a link. The AREDS Study Report No. 25 revealed no link between developing wet ARMD and cataract surgery. Interestingly, nearly all of the respondents (98%) realized the need for the use of an NSAID following cataract surgery in a patient with a known history of CME. The response suggests that the duration of drug therapy remains unclear and needs further elucidation. Finally, more than half of ophthalmologists would,...

Therapy on the anti-VEGF frontier

Thu, 19 Jan 2012 03:15:19 -0500

Update on retinal sparing drugs for AMD

Anti-VEGF therapy to fight neovascular eye disease recently got a boost when on November 18, 2011, EYLEA (Regeneron
Pharmaceuticals, Tarrytown, N.Y.), also known as VEGF Trap-Eye,
received FDA approval for wet AMD cases. This is one new anti-VEGF gaining ground in an area that has been dominated by Avastin
(bevacizumab, Genentech, South San Francisco) and Lucentis (ranibizumab, Genentech), considered breakthrough drugs in their own right for AMD patients. Investigators are also honing in on other drugs such as integrin peptide therapy. EyeWorld asked practitioners to offer their insights on these valuable drugs.
The approval of EYLEA is considered a coupe for patients since it can be administered much less frequently than other anti-VEGFs. It has an additional mechanism of action,...

Alternatives to trabeculectomy

Thu, 19 Jan 2012 03:15:19 -0500

An overview of what's available

Post-op photos for a patient with the EX-PRESS in the anterior chamber with superior bleb
Source: Sarwat Salim, M.D.

An example of a canaloplasty
Source: Richard A. Lewis, M.D.

It's no secret that trabeculectomy, the so-called "gold standard" of glaucoma surgery, has been called some pretty nasty things of late by glaucoma surgeons. Everyone, it seems, is desperate for an alternative to the procedure, which was first considered contemporary when Lyndon B. Johnson was in office. It may be the most effective glaucoma surgery for lowering intraocular pressure, but it also comes with the highest risk of complications. So what are the alternatives? And can any usurp trabeculectomy from its battered and beleaguered throne?
EyeWorld spoke to...

Guidelines for glaucoma

Thu, 19 Jan 2012 03:15:19 -0500

Group sets out to clear the muddy waters when it comes to rules, standards

When it comes to glaucoma research, many subspecialists agree that the rules have been anything but clear as to how glaucoma research all over the world is undertaken and reported.
To that end, the World Glaucoma Association (WGA) recently published "Guidelines on Design and Reporting of Glaucoma Surgical Trials" and presented it at the WGA meeting in Paris in June 2011.
The document, surgeons said, was an answer to the huge interest in research on how to improve glaucoma surgery, trabeculectomy, and drainage devices, as well as to determine how new surgical methods might fit into a practitioner's list of options.
"Clinical glaucoma surgical research is currently hindered by, among other things, the lack of uniform guidelines...

Fighting preventable blindness in the Dominican Republic

Thu, 19 Jan 2012 03:15:19 -0500

Dr. Kosoko-Lasaki tackles glaucoma and vitamin A deficiency

Doctors at Creighton University's ILAC medical facility perform surgeries on Dominican villagers from rural areasSource: Creighton University

Dr. Kosoko-Lasaki screens a patient for glaucoma in the D.R.
Source: Creighton University

Dr. Kosoko-Lasaki examines a young girl for VAD, the leading cause of preventable blindness in childrenSource: Creighton University

The ILAC medical facility
Source: Creighton University

For the entirety of her career, Sade Kosoko-Lasaki, M.D., has centered her research around the prevention of blindness. Over the past decade, Dr. Kosoko-Lasaki, professor of ophthalmology surgery and glaucoma specialist, Creighton University, Omaha, Neb., has traveled to the Dominican Republic...

The correction of age-related focus dysfunction (ARFD) with advance technology IOLs: The Latin American Society of Cataract and Refractive Surgeons' experience

Thu, 19 Jan 2012 03:15:19 -0500

Enrique Suárez, M.D.
Docent Medical Centre La Trinidad
Venezuela

Edgardo Carreño, M.D.
Medical Director of Centro Oftalmológico Carreño
Chile

Virgilio Centurion, M.D.
Clinical Director of the IMO – Instituto de Moléstias Oculares
São Paulo, Brazil

William De La Peña, M.D.
Chief executive officer of the Latin
American Society of Cataract and
Refractive Surgeons

The ALACCSA-R Newsletter, the monthly journal of the Latin American Society of Cataract and Refractive Surgeons, invited three Latin American surgeons experienced in IOL presbyopia-correction surgery to share their experiences. William De La Peña, M.D., CEO of ALACCSA-R, coordinated, and Enrique Suárez, M.D. (Venezuela), Edgardo Carreño, M...

Remembering Eric John Arnott, B.M., B.Ch., B.A.O., D.O., F.R.C.S., F.R.C.Ophth.

Thu, 19 Jan 2012 03:15:19 -0500

June 12, 1929 – December 1, 2011

Dr. Arnott and his wife, Veronica

Eric Arnott was a combination of establishment doyen and visionary innovator prepared to challenge accepted medical opinion. He was one of the first ophthalmic surgeons to recognize in the work of Charles Kelman, the inventor of phacoemulsification, a new approach to cataract surgery that heralded the dawn of small-incision surgery. Dr. Kelman had found a method of removing the cataract through an incision of 3.5 mm compared to the 12 mm required for most surgery at the time. This meant that patients no longer had to lay in bed for 2 weeks after their surgery with all movement restricted. In 1971, Dr. Arnott went to the U.S. and attended one of Dr. Kelman's first courses. Upon returning to
England, he raised the money to...

Laureen C. Rowland joins ASOA as executive director

Thu, 19 Jan 2012 03:15:19 -0500

Laureen C. Rowland joined the American Society of Ophthalmic Administrators (ASOA) as executive director in early December.
"Ms. Rowland has an impressive record in association management for medical societies and trade associations, and we look forward to her contributions in sustaining and expanding the value of ASOA to its members," said Lisa Gangi, C.O.E., ASOA president.
In terms of immediate goals, Ms. Rowland emphasized the need to sustain and expand membership by providing greater value to members. "It's very important to make sure that our value is communicated to members on an ongoing basis," Ms. Rowland said. "Moreover, we shall continue to innovate and offer new products and services to members to help them navigate the uncertainties they face as the economy and regulatory environment continues to change."
Her most recent position was with GAMA International, an international insurance/financial services trade association...

In The Journal Of Cataract & Refractive Surgery January 2012

Thu, 19 Jan 2012 03:15:19 -0500

Patient understanding of informed consent
Anita N. Shukla, M.D., Mary K. Daly, M.D., Paul Legutko, Ph.D.
Investigators in this study considered whether patients understood the risks and benefits of cataract treatment options better when receiving this information in verbal, written, or videotaped format. Using a randomized protocol, investigators slated cataract patients into one of four arms of the informed consent process. Those in group 1 received their information verbally. Patients in group 2 likewise were verbally told the risks as they would be conventionally and also given a brochure at the second-grade reading level. Those in group 3 likewise were verbally told the risks conventionally plus given a brochure written at an eighth-grade reading level. Patients slated for group 4 were shown a patient education DVD in addition to conventional verbal warnings. All patients were then given a questionnaire. Investigators found that those in group 2 scored...

Two-month tax-extenders package that prevents 27.4% reduction in Medicare physician payments signed into law

Thu, 19 Jan 2012 03:15:19 -0500

President Obama signed a 2-month bill into law in December that extends the payroll tax cut, unemployment benefits, and prevents the 27.4% cut in Medicare physician payments for 60 days. The House and Senate unanimously passed the bill (H.R. 3765) earlier.
As part of the deal, the House and Senate agreed to appoint a conference committee to begin negotiations in January on a longer-term extension.
As a result of the 2-month reprieve, the 27.4% reduction to the Conversion Factor (CF) did not go into effect on January 1, 2012, and the Geographic Practice Cost Index (GPCI) floor will not be changed for 60 days. However, the remainder of the 2012 Medicare Physician Fee Schedule, including the Relative Value Units (RVUs), went into effect as scheduled on January 1, 2012. As the Centers for Medicare & Medicaid Services (CMS) implements the 2012 changes to the fee schedule, the...

Anterior segment grand rounds Reversal of misfortune

Thu, 19 Jan 2012 03:15:19 -0500

Figure 1

Figure 2

Figure 3

Figure 4

Figure 5

Figure 6

Figure 7

Figure 8

Figure 9

Figure 10

I saw the patient soon after his eye started "acting up" again. His vision was CF in the involved OS. IOP was 16 OD and 38 OS and the cornea had
microcystic edema in the involved eye. A microhyphema was present and although the view was compromised I could see that the anterior chamber was very deep with the iris appearing bowed back with peripheral transillumination defects. Figure 1 is a slit lamp view of the eye at presentation. Note the hazy view through the cornea and the peripheral transillumination defects in the iris from 3:30 to 5:30.
Figure 2 is a gonioscopy...

Pars plana vitrectomy for the anterior segment surgeon

Thu, 19 Jan 2012 03:15:19 -0500

Dr. Arbisser, adjunct clinical associate professor, John A. Moran Eye Center, University of Utah, Salt Lake City, discusses the settings and strategies involved for optimal outcomes

In complicated cataract cases involving vitreous, our primary goal is to avoid intra-op and post-op retinal traction. Sequelae of tears and detachment are the primary reasons for poor outcomes. Our secondary goal is to leave a clean anterior segment and a stable intraocular lens while avoiding collateral capsule, iris, and corneal damage.
Early capsule breach recognition helps limit complications progressing from ruptured posterior capsule with intact hyaloid to vitreous prolapse to extraocular vitreous loss. Retained lens material may further complicate matters. Satisfactory resolution and prognosis requires an individualized approach that, if appropriately handled, can maintain excellent chances for an optimal outcome even if a second surgery should occur for retained...

Phacoemulsification after radial keratotomy

Thu, 19 Jan 2012 03:15:19 -0500

Figure 1. The left-hand clear corneal 1.2-1.4 trapezoidal incision is placed between two RK incisions

Figure 2. The right-hand incision is placed between RK incisions in this 16-cut cornea

Figure 3. Utilizing the 20-gauge Tsuneoka front-end irrigating chopper in the left hand and a 30-degree bevel 20-gauge straight phaco needle in the right hand, a pie-shaped segment is mobilized with high vacuum (270 mm Hg) and zero ultrasound power

Figure 4. The slit beam retroillumination
feature of the operating microscope (Carl Zeiss Meditec) highlights a posterior subcapsular plaque while the front-end irrigation stream from the chopper puts the posterior capsule on stretch and facilitates polishing with the silicone-coated 0.3 mm aspiration tip

Figure 5. The 2.7 mm temporal incision for IOL insertion...

Sitting down with Clayton Christensen

Thu, 19 Jan 2012 03:15:19 -0500

World-renowned innovator and author discusses the FDA and disruptive
innovation

Dr. Chang: As a patient, you have undergone both retinal detachment and cataract surgery. How did these personal experiences impact your understanding and appreciation of medical device innovation in ophthalmology?

Dr. Christensen: One of the things is wow, would I love to meet the first person to cut into another person's eye. The technology is absolutely extraordinary. Outcomes that were unthinkable 30 years ago are commoditized today so that many more people have access to great care. The medical device innovation is the "Intel inside" of every procedure.

Dr. Chang: Compared to Europe, gaining FDA approval for a medical device takes much longer and is far more expensive. The risk for venture capital investment due to...

OWL leadership promises more programs, networking

Thu, 19 Jan 2012 03:15:19 -0500

Increasing the number of educational programs, symposia, and online programs as well as having more women present at various ophthalmology meetings are but two of the goals Jan Beiting, principal of Wordsmith Consulting (Cary, N.C.), has for the Ophthalmic Women Leaders (OWL, www.owlsite.org) in the next year. Ms. Beiting, the group's current president, is also one of its cofounders.
"When we first started OWL 8 years ago, there was a tremendous amount of excitement about the concept. We had about 150 people at that first event; the response then indicated there was a need for OWL," she said.
In those 8 years, Ms. Beiting said she's been most impressed with OWL's ability to interest women in all stages of their careers and from all aspects of ophthalmology, from marketing to research and bench scientists, to clinicians and industry.
"We have everyone from CEOs to those just starting in their career,...

Sell your practice to an insurance company? Why not!

Thu, 19 Jan 2012 03:15:19 -0500

We all understand the traditional ways to sell your practice:
• Hospital sale
• Company buy-out
• Partnership buy-in buy-out
These are the normal analytics for a sale. Now I'm talking about selling your practice to an insurance company—a carrier.
All of us have been reading about the buying of practices (all practices, not just primary care) by United Healthcare, Anthem Blue Cross Blue Shield, Cigna, etc. United's Optum health services unit includes 2,300 physicians in a range of specialties. Optum Chief Executive Larry Renfro said his company "shares Monarch HealthCare's commitment to bringing patients, physicians, hospitals, and healthcare payers closer together in the mission to increase the quality and affordability of care." They are pursuing these buy-outs aggressively. I have interviewed and met with all the above. Let's look at some of the advantages...

A new deal for a new day

Thu, 19 Jan 2012 03:15:19 -0500

President Franklin Delano Roosevelt offered Americans a New Deal in 1933. The New Deal was a series of economic programs that responded to what we know as the Great Depression. Consumers were very uncertain about the economy, and many expressed the emotional response of fear when asked about their futures.
Flash forward 79 years. Pundits offer as many opinions about economic recovery as there are channels on your cable television. Historians say that the stimulus packages passed while Roosevelt was president focused on what they call the "3 Rs": Relief, Recovery, and Reform.
These same "3 Rs" can become your practice's roadmap to 2012 being your best year ever.

1. Relief
You, your employees, and your patients want relief from managed care. Wait! Really? What you are looking for is the profitable patient. This patient, statically speaking, comes with insurance and perhaps a vision plan. Wouldn't it be a relief if the...

Is LASIK an option for older patients?

Thu, 19 Jan 2012 03:15:19 -0500

Surgeons debate LASIK advantages, discuss other possible approaches

A Thornton-Fine fixation ring with a guide going down the middle that the surgeon rests his
diamond blade up against so that his incision is perfectly radial Source: Mastel

Image shows two incisions in the cornea from the 5- to 8-mm optical zones. One
incision is at about the 10 o'clock position, and the other is at about the 2 o'clock position. This demonstrates an alternative technique to use for residual refractive errors
Source: Mastel

It's no secret that LASIK is typically associated with younger patients. However, is LASIK a viable option for patients over the age of 60?
"In our current society, a lot of patients in their 60s are 'young' 60s," said Louis E. Probst, M.D., national medical director,...

The challenge of treating hyperopia

Thu, 19 Jan 2012 03:15:19 -0500

Although options exist, they are not nearly as numerous as treatments for myopia

Hyperopes present a unique set of challenges for refractive surgeons—most excimer lasers "do a great job with hyperopia with or without astigmatism, as long as you're not steepening the cornea more than about +3.00 diopters, and that last part is a bit laser-specific," said Daniel S. Durrie, M.D., professor of ophthalmology, University of Kansas Medical Center, and president, Durrie Vision, Overland Park, Kan.
The typical hyperope who wants laser vision corrective surgery is "in his early 50s and is presbyopic,"said Richard L. Lindstrom, M.D., adjunct professor emeritus, ophthalmology department, University of Minnesota, Minneapolis, and founder, Minnesota Eye Consultants, Minneapolis. Compared with the typical myope, who is about 35 years old, "the management of the two are very different," Dr. Lindstrom said. "The hyperopes typically have...

Practice makes perfect: But how in the wet lab?

Thu, 19 Jan 2012 03:15:19 -0500

Joel Reisman, M.D.
Assistant professor of ophthalmology and
director of Resident Wet Lab
Tufts University School of Medicine, Boston

My goals for residents in the wet lab are:
1) Learn the basic steps in
phacoemulsification;
2) Learn how to use an operating microscope;
3) Know the parameters and settings of the phaco machine; and
4) Become familiar with the names and uses of instruments.
We then give residents the unique skills to coordinate all the different aspects of phaco surgery—left foot microscope pedal, right foot phaco pedal, sideport hand, phaco hand, and phaco sounds—all into a smooth dance. This multitasking is the key to good eye surgery.
I teach using positive reinforcement, praising each small step in the learning process.
When demonstrating the use of the operating microscope, I recommend residents...

Small-aperture corneal inlay for the correction of presbyopia: 3-year follow-up

Thu, 19 Jan 2012 03:15:19 -0500

Orang Seyeddain, M.D., Melchior Hohensinn, M.D., Wolfgang Riha, M.D., Gerhard Nix, M.D., Theresa Rückl, M.D., Günther Grabner, M.D., Alois K. Dexl, M.D., M.Sc.

J Cataract Refract Surg (January) 2012; 38:35–45

Purpose: To report the 3-year post-op safety and efficacy outcomes of the AcuFocus corneal inlay
Setting: University Eye Clinic, Paracelsus Medical University, Salzburg, Austria
Design: Prospective, non-randomized, non-comparative cohort study
Methods: The corneal inlay was implanted in the non-dominant eye of naturally emmetropic presbyopic patients. Refraction, uncorrected near (UNVA), intermediate (UIVA), and distance (UDVA) visual acuities; corrected distance visual acuity (CDVA); contrast sensitivity; visual fields; subjective patient satisfaction and symptoms; and operative and post-operative adverse events and complications were evaluated.
Results:...

Review of "Small-aperture corneal inlay for the correction of presbyopia: 3-year follow-up"

Thu, 19 Jan 2012 03:15:19 -0500

This month I asked the University of Utah residents to review this interesting study on 3-year results of refractive corneal inlays from the January issue of the Journal of Cataract and Refractive Surgery. —David F. Chang, M.D., chief medical editor

Figure 1

Despite the introduction of various surgical modalities in cataract and refractive surgery, the safe and effective correction of presbyopia remains an elusive goal. Current approaches include surgical reshaping of the cornea or replacement of the crystalline lens. Either modality may attempt to achieve good uncorrected distance and near acuity through "monovision" or "blended vision," or alternatively through induction of multifocality of each eye individually. Lens platforms offer the additional possibility of movement of optical elements or...

Looking back

Thu, 19 Jan 2012 03:15:19 -0500

This month, we invite anterior segment surgeons to direct their attention posteriorly toward the retina. In the five articles that comprise our cover focus on retina co-morbidities, we call on 14 different vitreoretinal specialists to help us with practical dilemmas that cataract surgeons face every week. What is the best way to test visual potential in cataract patients with maculopathy? Does cataract surgery increase the risk of developing or reactivating wet ARMD? How should we time anti-VEGF treatments in patients with macular degeneration or diabetic macular edema undergoing phaco? How could multifocal IOLs affect treating these conditions in the future? Does lattice degeneration need to be treated prior to cataract surgery? Is routine CME prophylaxis with topical NSAIDs necessary? These are just some of the questions that we pose to our panel of retina experts in this series of complementary articles, and you'll be impressed with how much some of their answers differ from...