APR 2013

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

Issue link: https://digital.eyeworld.org/i/119916

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April 2013 Quantitative continued from page 32 tools help us accomplish that," he said. There's a war and there are thousands of battles every day in the clinics of America trying to stop progression and the condition that can lead to blinding corneal ulceration and significant deterioration and quality of life." Just because these tests don't all correlate with each other does not mean clinicians should only use one or the other, Dr. Lemp said. "These tests all measure a different aspect of the disease that comes into play at different stages of development for different people," he said. Overall, taking the clinical guess work out of the equation in favor of objective testing is welcome, Dr. Starr said. "We shouldn't shun any of these new diagnostics," he said. "In fact, we should embrace them and incorporate them into our daily practice." EW OCT and microscopy References www.AcrySofReSTOR.com CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof® IQ ReSTOR® Posterior Chamber Intraocular Lens (IOL) is intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who desire near, intermediate and distance vision with increased spectacle independence. The lens is intended to be placed in the capsular bag. WARNING/PRECAUTION: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia, and ensure that IOL centration is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery. Some patients may experience visual disturbances and/or discomfort due to multifocality, especially under dim light conditions. Clinical studies with the AcrySof® ReSTOR® lens indicated that posterior capsule opacification (PCO), when present, developed earlier into clinically significant PCO. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and benefits associated with the AcrySof® IQ ReSTOR® IOLs. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® Natural IOL and normal color vision. The effect on vision of the AcrySof® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solutions. ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions. © 2013 Novartis 1/13 RES12192JAD The Keratograph combines keratometric and corneal topography measurement with high resolution of the cornea. Source: Oculus "The InflammaDry test is nice because you take samples from the palpebral conjunctiva and within minutes you have a readout not unlike a pregnancy test—two lines and there's excessive inflammation on the surface, one line there's not," Dr. Sheppard said. "This device has potential—in my practice it will be a synergistic or adjunctive test to run in addition to osmolarity and will help guide my treatment plan," Dr. Starr said. Dr. Lemp believes the test has value, but perhaps more as a means to determine if a patient will respond to an anti-inflammatory. "It's not very sensitive for mildto-moderate disease, but is valuable for moderate-to-severe disease," he said. Lipid layers The LipiView Ocular Surface Interferometer (TearScience, Morrisville, N.C.) helps physicians assess a patient's tear film; the second part of the system, the LipiFlow Thermal Pulsation System, treats the primary cause of evaporative dry eye—obstructed meibomian glands. "If the tear layer is too thin or the tear component is abnormal, then the associated treatment can be used to express the glands," Dr. McDonald said. "It offers very valuable information; it's a bit pricey but it is rapidly becoming a popular tool." The system is invaluable for clinicians because it can precisely determine the health, thickness, and stability of the tear film and lipid layer, Dr. Starr said. "Targeting our treatments toward the underlying problem, whether it be aqueous deficiency or evaporative dry eye, obviously makes a lot of sense, and all of these Although the concept of using optical coherence topography (OCT) to evaluate the tear film is not a new one (Dr. McDonald presented on the idea in 2002), high-res OCT "actually shows a fair amount" of promise for imaging and measuring tear film thickness, she said. For one, OCT is not invasive, is exceedingly accurate, and can document tear film changes, Dr. McDonald said. "Because it doesn't require contact with the ocular surface, it may be less affected by reflux tearing that the traditional tests have," she said. The Keratograph (Oculus, Wetzlar, Germany) combines keratometric and corneal topography measurements, and "now comes with robust dry eye screening software," Dr. McDonald said, including a noninvasive measurement of tear breakup time and tear meniscus height. She added confocal microscopy is also promising as a dry eye diagnostic. Final thoughts There is no "giant leap forward" in dry eye diagnostics that is going to occur, Dr. Sheppard said. "It will be a gradual improvement over time. 1. Lemp MA, Bron AJ, Baudouin C, Benitez del Castillo JM, et al. Tear osmolarity in the diagnosis and management of dry eye disease. Am J Ophthalmol 2011;111:792-798. 2. American Academy of Ophthalmology. Preferred practice pattern: Dry eye syndrome. 2011. Editors' note: Dr. Lemp has financial interests with Novagali (Evry, France), Merck (Whitehouse Station, N.J.), TearLab, TearScience, and a number of private equity firms. Dr. McDonald has financial interests with Oculus, RPS, and TearLab. Dr. Sheppard has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), Bausch + Lomb (Rochester, N.Y.), LacriSciences, RPS, and TearLab. Dr. Starr has financial interests with Alcon, Allergan, Bausch + Lomb, Merck, RPS, and TearLab. Contact information Lemp: 202-255-6842, malemp@lempdc.com McDonald: 516-593-7709, margueritemcdonaldmd@aol.com Sheppard: 757-622-2200, docshep@hotmail.com Starr: 646-962-3370, cestarr@med.cornell.edu Find us on social media Are you a fan of EyeWorld? Like us on Facebook at facebook.com/EyeWorldMagazine

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