Eyeworld

UPDATE 15 internist because graduates can match right away, and "they will be rich." OB/GYN is also popular be- cause the Ethiopian government and World Health Organization provide resources and subsidies. Ophthalmology, by comparison, is not well supported or well paid because eyecare is not currently a government priority. The young doctors wait a long time to match in an ophthalmology residency, having to serve between 2 and 6 years as a general practitioner. Residency is 4 years long. After residency, the doctors serve again somewhere in the region assigned by their medical school, with only a few managing to stay at their residency program as an attending. They can do a fellowship during their years of post-residency service, but still must pay back 4 to 8 years total education before being able to go into private practice. Currently there are "sandwich fellowships" set up by the ASCRS Foundation's partner, Himalayan Cataract Project, and supported by private charitable donations. These fellowships allow doctors to train in several other countries before return- ing to Ethiopia. But there is progress being made for in-country training. ASCRS member Scott Lawrence, MD, is starting a glaucoma fellowship at St. Paul's hospital in Ethiopia, and other Ethiopian training programs are planning to follow suit. With your kind donations, the ASCRS Foundation launched the Ethiopian Residency Education Initiative a few years ago. Because of you, the quality of ophthalmologist training is rapidly improving under this program and others working in tandem. The number of residents is increasing each year. Your continued support will help pay for residency directors, the doctors teaching res- idents at Sinskey Eye Institute, and fellowship training. Together with our Ethiopian colleagues, we can help tackle the cataract blindness and countless other eye conditions plaguing the country. We can help Dr. Abera and Dr. Fedoku become superb ophthalmologists, make a difference in their country, and make their parents proud. EW Contact information Erny: berny@ascrs.org Zundel: nzundel@ascrs.org Dr. Fedoku is a third-year resident in Ethiopia. Source (all): Barbara Erny, MD In the journal Long-term effectiveness and safety of trabecular micro-bypass stent implantation with cataract surgery in patients with glaucoma or ocular hypertension: 5-year outcomes Tobias Neuhann, MD, Dana Hornbeak, MD, Raphael Neuhann, MD, Jane Ellen Giamporcaro, MS How does implantation of a trabecular micro-bypass stent in conjunction with cataract surgery affect eyes with ocular hypertension or open angle glaucoma? In a recent prospective consecutive case series, investigators reported on 26 eyes of patients with open angle glaucoma who had completed 5 years of follow up in this ongoing investigation. Investigators determined that there was a 38% de- crease in mean IOP to 14.7 mm Hg among those who had not previously under- gone trabeculectomy and/or glaucoma laser procedures. Medication usage, which was at 2 preoperatively, dropped by 75% to a mean of 0.5. Just 4% of patients required 3 to 4 medications versus 28% preoperatively. Investigators found that while 5% required no medications preoperatively, this rose to 69% postoperative- ly. They determined that postoperatively mean medication number was 0.5 or lower at all visits and mean IOP was 16 mm Hg or lower. Investigators concluded that with implantation at the time of cataract surgery of a trabecular micro-by- pass stent in eyes with ocular hypertension or open angle glaucoma, safe and lasting medication and IOP reductions were attained through the 5-year mark. Parameters affecting anterior capsulotomy tear strength and distension Sheraz Daya, MD, Soon-Phaik Chee, FRCOphth, Seng-Ei Ti, FRCS(Ed), Richard Packard, MD, David Mordaunt PhD In two separate randomized cadaver eye preclinical studies, investigators examined the effects on tear threshold of the diameter of the anterior capsulo- tomy and continuity of the capsulotomy. Included were 40 cadaver eyes from 20 donors in which continuous curvilinear capsulorhexis was performed. Eyes were divided into two groups. In Study A investigators compared continuous to discontinuous capsulotomies. In Study B they compared a 5.0 mm continuous capsulotomy diameter or less to one that was 5.2 mm or more. Investigators found that in Study A for both anterior tear threshold load and distension the continuous capsulotomies were superior. In Study B, investigators determined that in 80% of the cases, a capsulotomy with a 5.2 mm diameter or greater was less likely to tear than if this was 5 mm or less. Investigators concluded that when it came to anterior tears, continuous circular capsulotomies were more resistant than their discontinuous counterparts. For this kind of anterior tear, capsuloto- mies with larger diameters were more resistant than the smaller ones. Refractive outcomes of phacoemulsification after pars plana vitrectomy using traditional and new IOL calculation formulas Thomas Lamson, BS, Jane Song, MD, Azin Abazari, MD, Sarah Weissbart, MD With this retrospective review, investigators considered how eyes that had previ- ously undergone vitrectomy fared in terms of refraction after undergoing cataract surgery. They examined how well this population did with formulas for calculat- ing IOL powers. For the study, investigators considered all patients who under- went phacoemulsification at Stony Brook University Hospital from 2013 to 2017 who had previously undergone pars plana vitrectomy in the same eye. Investiga- tors found that with the Holladay 1 formula the mean prediction error was 0.30, with the WKA-H1 was –0.09, with the Holladay 2 was 0.23, with the SRK/T was 0.25, with the WKA-SRK/T was 0.04, with the Barrett was 0.30, with the Hill-RBF was 0.33, and with the Ladas was 0.45. They reported that the Holladay 2 with 60.42% of predictions within 0.5 D of postoperative outcome had the most eyes in this range. Investigators determined that with the exception of the WKA-H and WKA-SRK/T, there were statistically significant differences between refrac- tive outcomes that were predicted and those that occurred. All of the formulas also had low repeatability. Investigators reached the conclusion that for patients who have had vitrectomized eyes and who underwent cataract surgery, refractive outcomes tended toward being more hyperopic and were more variable than out- comes attained in other populations. This is something that such patients should be advised about, the investigators concluded. EW March 2019

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