Eyeworld

N AUGUST 2019 | EYEWORLD | 23 Contact information Asbell: penny.asbell@gmail.com "It's good for all clinicians to understand that resistance is part of the picture when we're treating ocular infections, whether it's conjuncti- vitis, corneal ulcer, or, hopefully rarely, endoph- thalmitis. With that, we can be more thoughtful and intelligent in how we pick antibiotics," Dr. Asbell said. Vancomycin, Dr. Asbell said, continues to work well against many resistant staph organ- isms. However, it's not FDA approved nor is it commercially available (it has to be compound- ed). Besifloxacin, which is commercially avail- able for topical ocular use, also seems to do well at killing 90% of isolates at a low concentration. Fluoroquinolones, which are commonly used, have high rates of resistance to staphylococcal organisms. "Some of the topical antibiotics we com- monly use are described as 'broad spectrum'; however, broad spectrum does not equate to being 100% effective. They may not work, and if they don't work, that's when we should be thinking about resistance," she said. "Our real go-to for serious gram-positive infections still appears to be vancomycin." The ongoing ARMOR study includes 15 sites in the U.S. These sites are invited to submit up to a maximum number of ocular isolates per collection year that are then sent to a central laboratory that conducts standardized antibiotic resistance analysis on all isolates collected each year. References 1. Thomas RK, et al. Antibiotic re- sistance among ocular pathogens: current trends from the ARMOR surveillance study (2009–2016). Clin Optom. 2019;11:15–26. 2. Asbell PA, Sanfilippo CM. Antibiotic resistance trends among ocular pathogens in the US – Cumulative results from the Antibiotic Resistance Monitor- ing in Ocular Microorganisms (ARMOR) surveillance study. US Ophthalmic Rev. 2017;10:35–8. 3. Asbell PA, et al. Antibiotic re- sistance among ocular pathogens in the United States: Five-year results from the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveil- lance study. JAMA Ophthalmol. 2015;133:1445–54. Financial interests Asbell: None continued from page 22 said. "They will not only have the objective skill, but they will have the confidence that they have mastered the skill, and that's very important." Dr. Smith said they are still gaining understanding about metrics that can be re- corded by the system. "With comput- er-based simulation, you can measure parameters that you would not be able to measure in the real world, for exam- ple, the depth of the suture when passing a nee- dle," Dr. Smith said. "What we still don't know is what is important to measure and which measurements correlate with user proficiency or competency. But that's the most exciting piece: helping learners understand what they are doing right and specifically where they need to focus on improving." Dr. Smith envisioned a hospital system using simulators to assess skills for internal credentialing. If you could show that surgeons who perform well on a standardized simulated task have better performance in real life, for example a lower complication rate or decreased operating time, that could translate to improved surgical quality as well as cost savings, he sug- gested. Compared to other simulation systems, Drs. Sassani and Smith said theirs does not employ haptic feedback in the instruments, which they consider a bene- fit. Eliminating bulky haptic hardware, Dr. Sassani said, allows for more realistic placement and move- ment of the surgeon's hands, and it's less expensive, making it accessi- ble to a wider range of institutions. Drs. Sassani and Smith also don't think haptic feedback is the most important factor for effective micro- surgery training. "The forces experienced by a surgeon during microsuturing are minuscule. It's more about training and conditioning hand-eye coor- dination," Dr. Smith said. While Drs. Sassani and Smith chose mi- crosurgical suturing in the setting of a corneal laceration as the first simulation task for their system, they think it will have utility in other specialties beyond ophthalmology. "Virtually any place where microsurgery is required, this simulator can assist in teaching or evaluating surgical skills," Dr. Sassani said. continued from page 21 "They will not only have the objective skill but they will have the confidence that they have mastered the skill, and that's very important." —Joseph Sassani, MD

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