AUG 2013

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

Issue link: https://digital.eyeworld.org/i/153099

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Page 18 of 66

16 EW NEWS & OPINION August 2013 2013 ASCRS•ASOA Symposium & Congress Best Papers of Session Once again, the ASCRS•ASOA Symposium & Congress has provided tremendous scientific advancements to help ophthalmologists deliver state-of-the art care to patients. One of the great challenges of such a big meeting is filtering through all of the great material to find the highest of the high yield. During each paper session, the panelists awarded a Best Paper of Session. From these papers, a "best of the best" was chosen by the EyeWorld Editorial Board to provide concise summaries of some of the best papers. Dr. Reinstein used a mathematical model to help us understand the tensile strength of anterior lamellar stroma versus posterior stroma and the implications of different refractive procedures such as LASIK, PRK, and SMILE. Dr. Durrie showed results of a new ocular shield on improving vision after SBK and PRK. Dr. Gordon presented data on a novel subjective refraction device that uses a point spread function instead of Snellen letters to determine visual acuity. –John Berdahl, MD, Refractive Editorial Board member Mathematical model to compare the relative tensile strength of the cornea after LASIK, PRK, and SMILE Dan Z. Reinstein, MD, Timothy J. Archer, MA(Oxon) Small incision lenticule extraction (SMILE) is a keyhole form of keratomileusis in which a femtosecond laser creates two interfaces that define a refractive lenticule of stromal tissue and therefore leaves anterior lamellae intact. As this is the strongest part of the stroma, it has biomechanical advantages over both PRK and LASIK. We derived a model to calculate the stromal tensile strength after PRK, LASIK and SMILE based on previously published data of depth-dependent stromal tensile strength. The model predicted that the postop tensile strength after SMILE was approximately 10% higher than PRK and 25% higher than LASIK. For example, the postoperative relative total tensile strength would be 60% for an ablation depth of 73 μm in LASIK (ap- proximately –5.75 D), 132 μm in PRK (approximately –10.00 D), and 175 μm in SMILE (approximately –13.50 D), translating to a 7.75 D difference between LASIK and SMILE for a cornea of the same postoperative relative total tensile strength. This model demonstrates that SMILE does not follow the same criteria as LASIK for under the flap residual stromal bed thickness limits and hence can be expected to correct higher levels of myopia within the cornea than is currently possible with LASIK or PRK. Quantifying and improving the speed of visual recovery in first 24 hours after keratorefractive laser surgery Daniel S. Durrie, MD, Stephen Slade, MD, Jason P. Brinton, MD, Michele R. Avila, OD, Erin D. Stahl, MD, Theodore A. Pasquali, MD This is a prospective multicenter study of 199 eyes from 103 myopic (+/– astigmatic) patients that compared the speed of visual recovery after ASA and SBK with and without a four-hour application of the NexisVision Ocular Shield (NexisVision, Menlo Park, Calif.). Long-term binocular UDVA was equivalent among the SBK groups. However, the shielded group attained a faster average monocular visual recovery with a UDVA of 20/25+2 immediately, compared to 20/40+1 in the non-shielded group. Both groups were 20/20 by four hours. Binocularly, vision was also improved in shielded eyes with 74% achieving 20/20 at 30 minutes compared to 23% of non-shielded eyes. With ASA, the difference was dramatic with 100% of shielded eyes achieving 20/40 or better at day one (64% saw 20/20) compared to 42% of non-shielded eyes. Subjectively, shielded patients had an overall greater comfort and a more rapid return to functional vision. Trying continued from page 14 us. How was I going to be able to effectively speak with our representatives if I didn't have a good grasp on the concepts myself? As an ophthalmologist in my third year of practice, my time and energy has been placed into building my practice and taking care of patients. I, like many young ophthalmologists, was somewhat apathetic toward government health issues, feeling there were many other ophthalmologists better informed and suited to "fight the good fight" for our profession and our patients. I took Dr. Parekh's invitation and used it as motivation to make myself a better-informed advocate for my patients and our profession. The greatest benefit of the Fly-In was the education I received on both the current issues facing us and the workings of government. When checking into our conference hotel, all attendees received a folder with summaries of the current issues and the bills addressing them. That evening we had an informational meeting over dinner where Nancy McCann highlighted the current state of the more important issues facing ophthalmology. The dinner meeting was very cordial and relaxed. I got to meet the fellow ophthalmologists I would be spending the next day and a half with. The following morning was filled with talks and question-and-answer sessions with congressmen, senators, and congressional staffers. It was eye opening to see the thought process behind legislation, to get a peek at how legislation is drafted and what it takes to bring it into law. In the afternoon, we broke into groups comprised of the varying specialties of the Alliance, based on the state we were from, and traveled with a staffer/lobbyist to visit with our representatives and congressional staffers. For the first few meetings I took a back seat and watched and learned how the experienced physicians I was with approached the topics and addressed their concerns. After a few meetings, and with some gentle prodding, I was able to take the lead in our discussion. The following morning we had a few more talks and discussions with lawmakers before returning home. The trip was an overall amazing experience. Not only did I become better informed and thereby a better advocate, but I left feeling that I made a difference. Sheri Rowen, MD Mercy Medical Center Baltimore I decided to try something new … government relations. There is a group called the Alliance of Specialty Medicine that I daresay most of you have never heard about. I sure never did. One day I mentioned to Dave Karcher, executive director of ASCRS, that I wanted to give the members of Congress a piece of my mind for all the impedance they were causing our wonderful field of medicine. I was asked to attend the Legislative FlyIn, and I thought, "It is about time I finally got involved and speak my mind!" ASCRS has represented us at the Alliance of Specialty Medicine for the past 10 years and frankly, I never knew anything about this group or what we as ophthalmologists could do instead of just complaining and worrying. This is a wonderful group of physicians and administrators that convene in Washington, D.C. just after the July 4th holiday. The concerns of many specialists are formulated into an agenda, which we learn about, and then can speak about. When I first saw the agenda papers, I was flabbergasted. I had no idea what anyone was talking about and realized that our group had been coming to Washington and representing our interests for years, and I was a newbie who knew nothing. The first night at a sponsored dinner, after originally feeling intimidated and thinking I would not be able to contribute, I realized that our group was there to teach and help us understand the dilemmas facing us today. I started getting the concepts and realized the "fix of the magic bullet" that had been handed to us every year with minimal cuts might not last.

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