AUG 2013

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

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August 2013 December 2011 May 2013 EW NEWS & OPINION 11 ASCRS update Customer satisfaction survey reveals pros and cons of EHR systems on the market In the journal … by Cindy Sebrell ASCRS•ASOA Director of Marketing and Communications August 2013 Predictors of CXL outcomes Steven A. Greenstein, MD, Peter S. Hersh, MD This study of 104 eyes considered how visual acuity and topography following corneal collagen crosslinking for keratoconus or ectasia might be affected by preoperative patient characteristics. Investigators found that an improvement of two Snellen lines or more was 5.9 times more likely to be seen in eyes with preoperative corrected distance visual acuity of 20/40 or worse. Likewise, there was 5.4 times more likelihood of topographic flattening of 2.0 D or greater occurring after crosslinking in eyes with maximum preoperative Ks of 55.0 D or more. No link between preoperative patient characteristics and either worsening of visual acuity or of corneal topography was found here. Investigators concluded that those most likely to see improvement after crosslinking included patients with higher K values, as well as those with poorer preoperative corrected distance visual acuity. Failure of crosslinking could not be predicted based on preoperative characteristics. Effective corneal CXL in advanced keratoconus Frea Sloot, MD, Nienke Soeters, BOptom, Rikkert van der Valk, MD, Nayyirih G. Tahzib, MD In this retrospective cohort study of progressive keratoconus, investigators evaluated one-year results in a range of cases. Patients with mild to moderate keratoconus, involving a preoperative maximum keratometry of less than 58 D, were placed in group 1. Those with maximum keratometry exceeding this, considered to have advanced keratoconus, were placed in group 2. Overall, investigators found for 48 of the 53 eyes the crosslinking technique halted keratoconus progression. For the mild to moderate patients in group 1 corneal flattening resulted from crosslinking in 42% of eyes and in 74% of the more severe cases in group 2. There were no complications in either of the groups, and failure rates were comparable between the groups. The conclusion reached here was that in mild to moderate cases, as well as in advanced progressive keratoconus, stabilization after crosslinking is attained. However, for those with more advanced disease, the corneal flattening achieved by the technique was greater. The failure of crosslinking was comparable regardless of the patient's keratoconus level. Technique: Tri-soft shell Steve A. Arshinoff, MD, Richard Norman, BSc Since use of a single ophthalmic viscosurgical device (OVD) can't rheologically control the surgical environment as effectively as different combinations of OVDs can, soft shell techniques building on different OVD properties have emerged. The method dubbed simply the "soft shell technique" involves combining lower viscosity dispersive viscoelastics with higher viscosity cohesives. Likewise, the "ultimate soft shell technique" includes use of viscoadaptive OVDs with balanced salt solution. Other modifications have been developed to contend with problems such as floppy iris syndrome, Fuchs' endothelial dystrophy, protruding vitreous, frayed iris strands, and many other issues. The result for some has been the confusion of these numerous soft shell techniques. Investigators in this paper detail the new tri-soft shell technique, a single method that melds the many soft shell varieties into one more intuitive process. Investigators here concluded that like its predecessors, the tri-soft shell technique enables practitioners to better protect endothelial cells and more easily perform complicated surgery than they might with just one OVD alone. E lectronic health record (EHR) systems are expensive and can require significant training and behavior changes. But this new technology can lead to more reliable patient data, improved business operations, reduced costs, and increased revenue. There are countless EHR systems available, and each offers different features, functionality, and support. Having an EHR system that is well suited to one's practice can also make a difference in the ease of reporting meaningful use measures for the EHR Incentive Program. A new customer satisfaction survey of more than 500 members of the American Society of Ophthalmic Administrators (ASOA) reveals firsthand insight into the products by actual users so that ophthalmic administrators shopping for an EHR system can make better-informed decisions. ASOA retained McKinley Advisors, an association consulting firm that specializes in research, to conduct an objective, professional study on EHR customer satisfaction among its members. This comprehensive research study and report looks into the systems currently on the market, their vendors, and the ability of systems to meet meaningful use reporting requirements. The primary goal of the study was to conduct consumer research in a variety of areas related to EHR systems, including: • System and vendor satisfaction • System implementation • System expenses and costs • EHR/Meaningful Use Incentive Program Survey findings are broken out by vendor and system experience (overview, satisfaction, implementation, functionality, and costs) and meaningful use (vendor guarantee, reporting meaningful use, and incentive payments). The results of the survey are available to ASOA and ASCRS members at the discounted price of $99. Nonmembers may purchase the report for $399. The report is available only in electronic format and viewing options are restricted. Call 703788-5777 or email amy@asoa.org for more information. EW Contact information Sebrell: csebrell@ASCRS.org PLAN AHEAD FOR NEXT YEAR YEAR HOUSI NG IS NOW OPE N HOUSING NOW OPEN www.WinterUpdate.org www.WinterUpdate.org 2014 2014 APRIL 25–29 APRIL 25–29 BOSTON www.AS C R S.org www.ASCRS.org

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