Eyeworld

DEC 2012

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

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December 2012 will be over 65 years old, and by 2030, 79% will be over 65 years old. Over the next 19 years, 10,000 people daily are turning 65, he said. Training for specialists has been capped at 100,000, Dr. Copeland said. ���It���s led to a decrease in specialty training,��� and as a result there are about 5.5 ophthalmologists per 100,000 residents. The only way to remedy the situation is to increase graduate medical school education by at least 30%, and post-graduate training as well. ���In short, we���re in dire need of more specialists,��� Dr. Copeland said. Editors��� note: Drs. Parke and Repka have financial interests with AAO. Drs. Copeland and Repka are practicing ophthalmologists. Tuesday, Nov. 13, 2012 Surgeon���s work looks at TASS risk factors Nick Mamalis, M.D., Salt Lake City, looked specifically at risk factors for toxic anterior segment syndrome (TASS) and found that ���the incidence was actually dropping down.��� He reported his findings during the final day of the joint meeting of the American Academy of Ophthalmology and the Asia-Pacific Academy of Ophthalmology. The lower incidence, Dr. Mamalis said, could relate to some positive trends in instrument cleaning and sterilization. His results were based on comparing recent data to previous reports. His paper was based on a questionnaire on ophthalmic instrument cleaning, products used during cataract surgery, and site visits. The data came from 130 questionnaires and 71 site visits, which revealed 1,570 cases of TASS. Dr. Mamalis said the paper presents an updated analysis of the current state of risk factors for TASS. In 2006, he said, there was a large outbreak of TASS in North America, which led to the initial formation of a task force in 2007 to study the re- action. He noted there is not a particular pattern with geographic area with TASS, an acute post-op inflammatory reaction that most commonly occurs in the 12-48 hours immediately following surgery. He highlighted several positive trends for TASS, including more sites reporting adequate handpiece flushing volumes. He said fewer sites are using renewable cannulas, as well as processing ophthalmic instruments separate from other instruments. In addition, Dr. Mamalis said there was an increased use of distilled/deionized final rinse. Despite many positive trends, he found some negative trends. There was an increased use of enzymatic detergents and ultrasound baths, he noted. Editors��� note: Dr. Mamalis has no financial interests related to his paper. Surgical success similar in glaucoma ���ltration device vs. trabeculectomy At 2 years, similar results for surgical success and mean IOP were found between the EX-PRESS Glaucoma Filtration Device (Alcon, Fort Worth, Texas) and trabeculectomy, a physician reported. ���We did find that intraocular pressure variation was lower during the early post-operative period, vision recovery was more rapid, and post-operative complications were less frequent after EX-PRESS implantation compared with trabeculectomy,��� said Peter A. Netland, M.D., Charlottesville, Va. The randomized, prospective, multicenter, comparative trial looked at the EX-PRESS versus trabeculectomy. A total of 120 eyes were included, with 59 eyes treated with the EX-PRESS and 61 eyes treated with trabeculectomy. Both groups received intraoperative mitomycin-C. Patients were followed post-op for 2 years. Dr. Netland said followup and retention in the study were excellent. Success was defined as IOP less than 18 mm Hg and greater than 5 mm Hg with or without medications and with no additional glaucoma surgery. ���During the visits, there was no statistically significant difference [in mean IOP] during the post-operative period except at the 6-month time point, which probably was not clinically significant,��� Dr. Netland said. There was also no statistically significant difference between the two groups in the mean number of medications used in the post-op period. In addition, visual acuity after implantation of the EX-PRESS device was not statistically significantly different at the 1-month time point, while the trabeculectomy group was not statistically significantly different from baseline at the 3-month time point, Dr. Netland said. The most common post-op complication was shallow anterior chamber and choroidal effusion. Cataract was also a common complication. The complications were slightly higher in the trabeculectomy group, but the difference was not statistically significant when analyzed individually. ���The cumulative complications, however, did show statistically significant difference between the two groups, with the EX-PRESS having the lower overall complication rate as compared with trabeculectomy,��� Dr. Netland said. Editors��� note: Dr. Netland has financial interests with Alcon. Ethnic variations should lead to different treatments, experts say Anatomic risk factors for glaucoma include anterior chamber depth (ACD), anterior chamber width, lens vault, iris thickness, angle/iris changes in response to light changes, and anterior chamber area, among others, said Shan Lin, M.D., EW MEETING REPORTER 59 San Francisco. And the differences in these variables are pronounced between Asians and Caucasian populations, with the former having lower ACDs, corneal arc depth, and chamber width; angle recess area is smaller, and iris thickness and iris area are both thicker in Chinese eyes. ���The bottom line is that Chinese people have a more crowded anterior segment than whites,��� Dr. Lin said. Ethnic differences exist, said Calvin C. Pang, Ph.D., Hong Kong��� Asians are less likely to have primary open-angle glaucoma, but more likely to have angle-closure glaucoma, than whites. Tin Aung, F.R.C.S., Singapore, said that while angle-closure glaucoma is not a homogenous disease, identifying who is at risk is a combination of demographics, biometrics, family history, and novel anatomic risk factors. Additionally, three susceptibility genes have been identified that may lead to a better understanding of the complex disorder. Leon Herndon, M.D., Durham, N.C., reported on the differences between blacks and whites���most notably that POAG is much more prevalent, occurs at an earlier age, is more aggressive, and is more likely to lead to blindness in blacks than whites. Blacks need higher levels of pilocarpine and timolol to achieve the same IOP-lowering effects as whites. Surgical treatment also appears to be more successful in whites than blacks; argon laser trabeculoplasty is more effective in blacks than trabeculectomy, and whites do better after trab than ALT, Dr. Herndon said. ���We may need to think about offering different therapies when medications fail depending upon the patient���s race,��� Dr. Herndon said. Editors��� note: The physicians have no financial interests related to their comments.

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