EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/146899
July 2013 Ophthalmologist continued from page 61 Important Safety Information – TECNIS® Multifocal IOL Caution: Federal law restricts this device to sale by or on the order of a physician. Indications: TECNIS® Multifocal intraocular lenses are indicated for primary implantation for the visual correction of aphakia in adult patients with and without presbyopia in whom a cataractous lens has been removed by phacoemulsification and who desire near, intermediate and distance vision with increased spectacle independence. The intraocular lenses are intended to be placed in the capsular bag. Warnings: Physicians considering lens implantation under any of the conditions described in the Directions for Use labeling should weigh the potential risk/benefit ratio prior to implanting a lens. Some visual effects associated with multifocal IOLs may be expected because of the superposition of focused and unfocused images. These may include a perception of halos/glare around lights under nighttime conditions. It is expected that, in a small percentage of patients, the observation of such phenomena will be annoying and may be perceived as a hindrance, particularly in low-illumination conditions. On rare occasions, these visual effects may be significant enough that the patient will request removal of the multifocal IOL. Under low-contrast conditions, contrast sensitivity is reduced with a multifocal lens compared with a monofocal lens. Therefore, patients with multifocal lenses should exercise caution when driving at night or in poor-visibility conditions. Patients with a predicted postoperative astigmatism >1.0D may not be suitable candidates for multifocal IOL implantation since they may not fully benefit from a multifocal IOL in terms of potential spectacle independence. Precautions: The central one millimeter area of the lens creates a far image focus; therefore, patients with abnormally small pupils (~1 mm) should achieve, at a minimum, the prescribed distance vision under photopic conditions; however, because this multifocal design has not been tested in patients with abnormally small pupils, it is unclear whether such patients will derive any near vision benefit. Autorefractors may not provide optimal postoperative refraction of multifocal patients; manual refraction is strongly recommended. In contact lens wearers, surgeons should establish corneal stability without contact lenses prior to determining IOL power. Care should be taken when performing wavefront measurements, as two different wavefronts are produced (one will be in focus (either far or near) and the other will be out of focus); therefore, incorrect interpretation of the wavefront measurements is possible. The long-term effects of intraocular lens implantation have not been determined; therefore, implant patients should be monitored postoperatively on a regular basis. Secondary glaucoma has been reported occasionally in patients with controlled glaucoma who received lens implants. The intraocular pressure of implant patients with glaucoma should be carefully monitored postoperatively. Do not resterilize or autoclave. Use only sterile irrigating solutions such as balanced salt solution or sterile normal saline. Do not store in direct sunlight or at temperatures over 45°C. Emmetropia should be targeted, as this lens is designed for optimum visual performance when emmetropia is achieved. Care should be taken to achieve centration. Adverse events: The most frequently reported adverse event that occurred during the clinical trial of the TECNIS® Multifocal lens was macular edema, which occurred at a rate of 2.6%. Other reported reactions, occurring in 0.3% –1.2% of patients, were hypopyon, endophthalmitis and secondary surgical intervention (including biometry error, retinal repair, iris prolapse/wound repair, trabeculectomy, lens repositioning and patient dissatisfaction). Attention: Reference the Directions for Use for a complete listing of indications, warnings and precautions. 2011.12.14-CT4390 books to epic-style movies like ÒLawrence of ArabiaÓ and ÒThe English Patient.Ó ÒTheyÕre all written in the vein of historical action,Ó he said. Reviews of his books on Amazon comment on Dr. WilsonÕs sophisticated writing and compelling storylines, noting that the tomes would make good motion picturesÑa possibility thatÕs been discussed with ÒWinter in Kandahar,Ó Dr. Wilson said. The story behind the stories So how did a clinician-researcher get involved with writing epic novels? Dr. Wilson has always had an interest in writing. Around the time he was in college and living in Los Angeles, he wrote song lyrics that were used by some smaller bands in the area. While at the University of Texas Southwestern Medical Center in Dallas in 1994, he decided to write a murder mystery, but it was never published. Of course, heÕs done a good deal of medical and science writing as well. It was around the time of 9/11 that he decided to work on ÒWinter in Kandahar.Ó While traveling in Europe for work, at the time of the terrorist attack, he used writing to fill up the down time. It took about a year to finish the book, after which he shopped around for an agent and distributor. He eventually connected with a book distributor that went on to publish the three books heÕs written so far. After ÒWinter in KandaharÓ was published, Dr. Wilson was asked in 2003 to come on the Fox News morning show ÒFox & Friends.Ó Instead of listing him at the bottom of the screen as an author, they inadvertently listed him as an Al Qaeda expert. ÒThis is when 9/11 was still a hot topic. I spent some time after that trying to hide my address from public records,Ó he said. HeÕs since appeared on the morning news program two more times. Of course, Dr. Wilson is writing about topics that arenÕt exactly in his backyard. HeÕs traveled a good deal to the Middle East and Central Asia, so that helps provide a sense of place for his novels. His books also take an inordinate amount of research to get the historical facts and current events right. Intensive researchÑbe it on cell biology, corneal growth factors and receptors, or Middle Eastern politicsÑis a similarity that Dr. Wilson has found between medicine and his writing work. He still does a good deal of his writing when traveling, although the writing process takes some time at home as well. ÒThere are times when my wife says she loses me for a month, especially when IÕm finishing a book,Ó he said. When he completes a book, he works with a team of three editors who help polish what heÕs written. Ophthalmologists are known for their perfectionism, and that quality has carried over into Dr. WilsonÕs writing. He was reading ÒWinter in KandaharÓ to his children recently and began to question how he structured certain sentences and information. So he updated the book and has a second edition available as an e-book. When the book reaches its sixth printing, the updated edition will be published, he explained. Dr. Wilson is currently working on a fourth novel called ÒEscape from Benghazi,Ó centered on the revolution in Libya. U.S. Ambassador Christopher Stevens was already a major character in the novel when the consulate attacks in Benghazi occurred in September, killing Ambassador Stevens. Dr. Wilson has decided to dedicate the book to him. As his clinical work has been so demanding recently, Dr. Wilson predicts it may take another year before he finishes his fourth book. However, getting some distance from what heÕs written is not always a bad thing, he believes. ÒWhen you put something down for a while, you sometimes get great ideas you hadnÕt thought of before,Ó he said. EW Contact information Wilson: 216-444-5887, WILSONS4@ccf.org