March 2011




Cataract and the compromised cornea

by Maxine Lipner Senior EyeWorld Contributing Editor


Combined symposium promises a host of different perspectives

Post-RK compromised cornea Source: Mark Packer, M.D.

A brand new course titled Cataract and the Compromised Cornea will make its debut at the 2011 ASCRS Symposium and Congress in San Diego. The session, slated to be held on March 27 from 1 to 2:30 p.m., will bring together cataract and corneal specialists, according to Mark Packer, M.D., clinical associate professor of ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland. Dr. Packer will be moderating the session with Terry Kim, M.D., associate professor of ophthalmology, Duke University School of Medicine, Durham, N.C.

In this course, experts will discuss material ranging from recognition and treatment of dry eye and blepharitis to endothelial disease and dystrophy. Dr. Packer described the new course as rooted in a previous joint session. "It grew out of a session 2 years ago that the cataract and glaucoma committees did on pseudoexfoliation, which was really successful," Dr. Packer said. "Since that was so successful, last year we decided to do a symposium with the retina committee." In that symposium, presenters took four controversial areas and had a couple of people on each committee talk about those areas.

Dual expertise

This year's course will follow a similar format. "We have six different topics and we're going to have one person from each committee give a talk on his or her perspective," Dr. Packer said. For instance, one area will be ocular surface disease. Presenters will discuss dry eye, blepharitis, and cataract surgery in that setting and will delve into how to diagnose and treat the diseases and what to do in the peri-op period. This symposium will offer something that a straightforward cataract or cornea session would not. "We like these combined symposia because everyone gets to learn something," Dr. Packer said. "It's really useful to hear another sub-specialist's perspective on something that you do everyday."

Dr. Packer sees the session as an important one especially for cataract surgeons who are interested in dealing with issues in a proactive way to help improve patient outcomes. He cited endothelial dystrophy, which will be covered here, as a good example of this. Speakers will be looking at a host of questions such as when it is beneficial to get an endothelial cell count or how surgeons should alter their technique when they're doing surgery so that they end up with a clearer cornea. "Another important area that we're covering is the post-refractive surgery cornea," Dr. Packer said. "We'll look at things such as how to do IOL calculations, what differences in technique there are, especially in a patient who has had RK, and what to tell that patientwhat his expectations should be after surgery." Dr. Packer expects that attendees will gain a lot from the panel's experience in dealing with these cases and also obtain the latest information. "I hope they will get up-to-the-minute information about the state-of-the-art techniques and technology because this is an area that is rapidly changing," he said. Practice management will also be part of the agenda. "I hope to touch on some refractive management issues. For example, in someone who has had cataract surgery and who now has a refractive problem, who pays for that enhancement? There are different philosophies on that," he said. "It's helpful to think about those things before you get into that situation and have a policy established that you're comfortable with and that will work for your practice."

Courting controversy

The session will highlight a couple of controversial areas. "One of the things that we will look at is to what degree surgeons can accept corneal issues before deciding that a premium IOL is contraindicated," Dr. Packer said. "For instance, if you have a patient who has Salzmann's nodules with peripheral nodules in the cornea but the central cornea is OK and the patient wants spectacle independencewhat do you do?" Speakers will delve into whether a premium lens such as a multifocal or an accommodative one can be used in such cases and whether treatment such as PTK might be helpful first.

Dr. Packer has had mixed results in such cases. "I think that the most important factor is informed consent so that patients know what they're getting into," he said. "If a patient is willing to take a chance, my experience has been sometimes you win and sometimes you lose."

Ectasia is another area of contention that will be covered. Dr. Packer pointed out that a key treatment elsewhere, corneal crosslinking, is not yet approved in the United States. "What's our take on that?" Dr. Packer asked. "Should we be renegades and go out and buy UV lamps and do our own crosslinking?"

Overall, Dr. Packer sees both cataract and corneal specialists benefiting from the session. "I think the cataract surgeons will get enough information to start expanding their scope of practice and take on some of these more difficult cases," he said. "I think that for cornea specialists who are coming to this, it's a nice update in a broad range of areas of corneal disease. I think they will get something out of it because the presenters are going to be giving state-of-the-art information in all of these different areas."

Editors' note: Dr. Packer has no financial interests related to his comments.

Contact information

Packer: 541-687-2110,

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