EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
148 EW MEETING REPORTER Reporting live from ASCRS•ASOA Winter Update 2013, Aventura, Fla. March 2013 tional workshop at the meeting. He presented retinal cases in an interactive fashion with the audience, including a patient presenting with exudative macular degeneration and cataract. "[The patient] has friends and his friends have told him that they had cataract surgery, and they got worse. So now he's on the fence, saying, 'OK, I've got this cataract in my eye, but Doctor, is this going to make me any worse?' That's a topic the patient is worried about and certainly something we'd be worried about, too," said Dr. Warren. The Age-Related Eye Disease Study (AREDS) is key in this matter, especially in its odds ratio results, he said. "They saw that the odds ratio, for the development of either neovascular macular degeneration and/ or geographic atrophy, was still in the one range, so the conclusion was there was very little evidence that cataract surgery had a negative effect on the progression of macular degeneration," he said. He said it is vital to tell patients this finding. In addition, some patients will progress after cataract surgery, so knowing the risk factors for developing wet macular degeneration is important. The AREDS determined scales for risk of advancement, he said. "What they found were two things [that were important in helping to predict progression]; large drusen [greater than 250 µ], and any pigment change [in the macula] were particularly predictive in the development of advanced macular degeneration. Those are the two things you are looking for in a patient," Dr. Warren said. Editors' note: Dr. Warren has no financial interests related to this talk. Sunday, February 17 Pearls for happy premium IOL patients Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from ASCRS•ASOA Winter Update 2013. Focusing on five "Cs"—cylinder and residual refractive error, cornea and ocular surface disease, cystoid macular edema, capsular opacities, and centering the pupil on the IOL—are pearls from Eric D. Donnenfeld, M.D., Long Island, N.Y., for surgeons in obtaining happy premium IOL "Rapid F-Eye-R" session panelists educate and entertain attendees. patients. He said these reasons are the most common causes of unhappiness in patients following multifocal IOL implantation and cataract surgery. Ophthalmologists should be aware of these reasons and how they impact surgery, but should not let them deter them from adopting new technology, said Dr. Donnenfeld. "It's the unhappy patient that's the most feared aspect of our practice," he said. "If you look at it, it's a major factor in whether you will adapt a new technology—you're afraid of unhappy patients. If you look at refractive IOL patients in particular, I think that's a case in point." By being aware of the five words/phrases beginning with "C" that Dr. Donnenfeld outlined in his talk, physicians can better evaluate, manage, and improve outcomes for happier patients. "If you go back to your practice and you have a patient who is unhappy following any surgery, particularly cataract surgery, look at the five 'Cs' and make certain that you identify all [of them]. I think you'll end up with a very happy patient, and you'll be happy with the way you managed them as well," he said. He also gave a practice management tip for dealing with premium IOL patients following implantation. He said postoperatively, his staff is aware of patients who are dissatisfied with results and perform topography, refraction and OCT before he sees those patients for a follow-up visit. That way, he can walk into the examine room with the patient, reference his or her chart, and open the conversation by telling the patient what negative symptoms that he or she must be experiencing. He recommended that physicians enter the room "forearmed" and "take these problems head-on." Editors' note: Dr. Donnenfeld has no financial interests related to this talk. Pearl: Individualize glaucoma surgery choice In an update on glaucoma surgery in 2013 and an overview of glaucoma cases and how they are now being treated, Thomas W. Samuelson, M.D., St. Paul, Minn., said that the era of the treatment regime of medications to laser to trabeculectomy to tubes for managing glaucoma is ending. "[Glaucoma] is a great field right now. I love telling residents to go into glaucoma/the anterior segment," said Dr. Samuelson. "We've got so much to offer, and the time has come to individualize glaucoma surgery. What we want to do is match the risk of the procedure we're about to offer to the risk that they have related to their disease— so [for instance], trabeculectomy or EX-PRESS Glaucoma Filtration Device (Alcon) or a canaloplasty, continued on page 150