Eyeworld

DEC 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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December 2012 of the great innovations in ophthalmology have originated in private practice.��� Innovation involves more than defining the problems and unmet needs in the preservation, restoration, and enhancement of vision. ���Just doing research is not the same as innovating,��� he said. Some of Dr. Lindstrom���s insights: The innovative technology needs to resolve an unmet, poorly met, or partially met need; there needs to be an adequate market size for the innovation; the innovator needs to understand the types of regulatory hurdles that may be present; the innovators themselves need to have an exit strategy; innovators need to find a ���quality partner��� to invest with; and innovators should expect to have erroneously estimated the amount of capital required. ���It���s like when you remodel your house,��� Dr. Lindstrom said. ���It will take longer than you thought and be more expensive than you thought.��� Finally, Dr. Lindstrom said, the good news is that ophthalmology has generated some of the leading innovations in history and the venture capitalists are willing to invest���albeit carefully���in viable ophthalmic ideas. He encouraged individuals and ophthalmic societies to ���take an active role in defending our ability to educate colleagues and support innovation��� for the benefit of patients worldwide. Editors��� note: Dr. Schwartz has no financial interests related to his comments. Dr. Lindstrom consults for industry. Surgeons argue over necessity of culture and susceptibility testing In a point-counterpoint session on ocular infectious diseases, David Hwang, M.D., San Francisco, and Edward Holland, M.D., Cincinnati, presented differing opinions on whether or not the diagnosis and treatment of ocular infections should be guided by culture and susceptibility. Dr. Hwang argued that cultures facilitate evidence-based diagnosis and treatment. However, the need for cultures depends on the disease severity, he added. Culturing limits unnecessary and incorrect treatment and ���improves patient safety by reducing rare but serious diagnostic and therapeutic errors,��� Dr. Hwang said. He admitted that ���culture is not always going to be the gold standard��� but that it should certainly be performed in severe cases. ���It���s evidence versus hope,��� he said. Meanwhile, Dr. Holland said culture and susceptibility testing is unnecessary in most cases. He said that there is evidence that empiric treatment is efficacious. ���Culture media storage is not practical and adds cost,��� he said. Dr. Holland said he did not want to recommend never culturing a cornea, as some cases including trauma, post-LASIK infections, and severe infections, among other things, could call for culturing, but he stuck to his view that it is unnecessary the majority of the time. ���Culture and susceptibility testing rarely change our management of these infections and therefore are not necessary,��� Dr. Holland said. Grabner narrows Barraquer Lecture to ���ve major discussion topics This year���s Barraquer lecturer, Gunther Grabner, M.D., Salzburg, Austria, gave a heartfelt talk looking back on 30 years of refractive surgery, as well as predicting what he sees for the future. Dr. Grabner focused his discussion on five main points, including the future of astigmatic incisional procedures, the potential revival of corneal onlay techniques, anterior chamber solutions, presbyopia corrections and assessment, and presbyopia inlay surgery. He started his presentation by noting that there have been times of enthusiasm mixed with others like disillusion, straightforward failures, success, and unfinished business. Dr. Grabner first said that he believes astigmatic incisional procedures will come back ���because I���m sure that femtosecond laser-assisted cataract surgery is here to stay,��� he said. He predicted that in the next few years there would be tracking of the axis and the ability to find individual corneal elasticity. However, he said this would require really focusing on the individual corneal elasticity and working on femtosecond laser parameters for different platforms. He said he expects to see a revival of corneal onlay techniques and that the anterior chamber can be addressed with caution. Dr. Grabner said presbyopia is often referred to as the last frontier of refractive surgery. He said he thinks ���we have finally arrived at a very good result��� with corneal inlay surgery, which is effective and safe, is minimally invasive, and provides minimal loss of distance visual acuity. He called it an excellent option for presbyopia patients. Editors��� note: Dr. Grabner has financial interests with Abbott Medical Optics, AcuFocus, and Polytech. Monday, Nov. 12, 2012 Look for existing ocular pathologies in premium IOL patients Identifying pre-existing ocular pathologies and other factors could assist in premium IOL patient selection, a physician said. ���Not recognizing pre-existing ocular pathology is a common mistake in premium IOL patient selection,��� said Edward J. Holland, M.D., Cincinnati. Dr. Holland spoke at the ���Spotlight on Cataracts: Clinical Decision-making With Cataract Complications��� session. He said pre-existing corneal pathologies to look for include corneal degradations, corneal dystrophies, and corneal astigmatism. In addition, ophthalmologists should be aware of any macular disease, such as age-related macular degeneration, diabetic retinopathy, and epiretinal membrane or other maculopathies. EW MEETING REPORTER 57 Another ocular pathology to be aware of is advanced glaucoma. Additional types include postrefractive surgery patients with poor refractive outcomes. Dr. Holland said the following should be avoided: previous high myopes, oblate ablations, small ablation zones, and decentered ablations. When selecting premium IOL patients, ophthalmologists should also be aware of adverse patient characteristics, Dr. Holland said. Patients with unrealistic expectations could be problematic post-surgery. Those include people with an expectation for near vision or who are intolerant of IOL side effects. ���A patient that raises concerns with your staff is another example,��� he said. Patients��� daily tasks should also be considered. Those with occupational requirements such as a night driver or those with near working distance needs might not be the best premium IOL candidates. Poor patient counseling and communication could lead to issues with premium IOL patients, so Dr. Holland recommended carefully documenting what patients were told during the office visit and warning them about all concerns related to the surgery, such as potential visual disturbances and the possible need for another procedure. ���Undersell and overdeliver,��� Dr. Holland said. Editors��� note: Dr. Holland has no financial interests related to his comments. Financial considerations important in femtosecond laser-assisted cataract technology The total cost of owning a femtosecond laser for cataract surgery could be upward of $610,000 to $869,000, while essentially providing physicians with a new marketing tool, a physician said at the ���Femto Forum: Cataract, Cornea, Refractive and Beyond��� symposium, a combined meeting with the American Society of Cataract & Refractive Surgery. ���You���ve heard a lot in this symposium about femtosecond lasers,���

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