SEP 2013

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

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September 2013 December 2011 May 2013 EW NEWS & OPINION 11 ASCRS update ASCRS news and events by Allene Bryant ASCRS•ASOA Media Communications Specialist In the journal … September 2013 Femtosecond versus manual cataract surgery Kasu Prasad Reddy, MRCOphth (UK), Jochen Kandulla, PhD, Gerd U. Auffarth, MD How does the safety and efficacy of cataract surgery with femtosecond laser-assisted lens fragmentation and anterior capsulotomy compare with manual cataract surgery? That's what investigators in this prospective open-label, randomized, controlled trial set out to determine. In the study, the 56 eyes that underwent the femtosecond-assisted cataract procedure had a mean effective phacoemulsification time that was significantly lower at 5.2 seconds versus 7.7 seconds for the 63 eyes done with the manual procedure. Likewise, for those in the laser group, mean phaco energy needed was significantly less at just 13.8% versus a mean of 20.3% for those receiving traditional phacoemulsification alone. Investigators also determined that the accuracy and precision of the capsulotomies were significantly greater for those in the laser-assisted group. In terms of safety, on day one no adverse events were seen in either group, and these were deemed equivalent. Investigators concluded that with the laserassisted approach, capsulotomies tended to be more precise and reproducible while mean phacoemulsification energy needed for lens fragmentation was lower. They also determined that the safety of both approaches was equivalent. IOL power calculation methods after myopic laser refractive surgery Ruibo Yang, MD, Annie Yeh, OD, Michael R. George, MD, Maria Rahman, BS, Helen Boerman, OD, Ming Wang, MD Investigators in this case series compared how post-myopic excimer laser surgery patients fared with different lens power calculation formulas when dealing with cases without the benefit of prior refractive surgery data. For the study, investigators back-calculated optimum IOL power using the patient's implanted IOL power and stable post-cataract surgery refraction. When they compared eight different power calculation methods, they found that the most accurate was the Holladay 2 FlatK method, with the Holladay 2 partial coherence interferometry (PCI)-K coming in second, followed by the ASCRS-Min, Wang-Koch-Maloney, ASCRS-Average, Shammas No-History, Haigis-L, and ASCRS-Max. Statistically significant differences were found between some of the methods. Results with the Holladay 2 FlatK were significantly better than with the next best formula, the Holladay 2 PCI-K. Likewise, there were significant differences between the Wang-Koch-Maloney and the ASCRS-Average and also the Haigis-L and the ASCRS-Max. Investigators determined that in cases where there is no prior myopic laser surgery data, the Holladay 2 FlatK method was deemed most accurate followed by the Holladay 2 PCI-K. The ASCRS-Min method was found to be the next most accurate and suggested for use in cases in which practitioners do not have access to the Holladay IOL Consultant Program. Review/update: European IPOE prophylaxis practice patterns Anders Behndig, MD, Beatrice Cochener, MD, José Luis Güell, MD, Laurent Kodjikian, MD, Rita Mencucci, MD, Rudy M.M.A. Nuijts, MD, Uwe Pleyer, MD, Paul Rosen, FRCS, Jacek P. Szaflik, MD, Marie-José Tassignon, MD In this overview of cataract surgery endophthalmitis prophylaxis practice patterns, investigators used national registers and published surveys to determine current steps taken in nine European countries to avoid the condition. They reported on each country's rates of infectious postoperative endophthalmitis (IPOE), non-antibiotic prophylactic approaches used, as well as topical and intracameral antibiotic regimens. Investigators also considered what adherence to the European Society of Cataract & Refractive Surgeons (ESCRS) 2007 guidelines was like. They determined that country-to-country infectious postoperative endophthalmitis rates varied significantly. Use of povidone-iodine and postoperative antibiotics were common. However, there was wide variation between and within countries when it came to topical antibiotic use pre- and perioperatively. Likewise, despite the fact that ESCRS guidelines for intracameral cefuroxime had been published five years earlier, there appeared to be no unanimity for usage here. Hindrances to this included legal issues, continued disagreement in some countries about the reasoning for intracameral cefuroxime use, and lack of commercial availability of this until recently. W ith a membership comprised of expert ophthalmologists, many active both as educators and with busy clinical practices, ASCRS is always bustling. Whether hard at work developing multifaceted educational programs to offer members, gearing up for the next annual meeting, or through its continuing humanitarian efforts in developing countries, ASCRS strives to contribute to the professional development of ophthalmologists while improving vision worldwide. If you've fallen behind on what's happening lately, here's a roundup of the most recent ASCRS news and events. Grant winner's research to make cornea transplant surgery more widely available engaged in research that could potentially make cornea transplantation surgery safer, more affordable, and more available to patients suffering from corneal disease. Dr. Hemmati's approach would automate the even placement of sutures in cornea transplant surgery. Working with a mechanical engineering group at the Massachusetts Institute of Technology, Dr. Hemmati says the project is currently in the prototype stage. "We are using the generous grant from the ASCRS Foundation to build and test our early prototype. Within two years, we hope to have a final prototype ready for testing in humans," Dr. Hemmati said. Learn more about Dr. Hemmati's research and its potentially significant impact in developing world countries at www.ASCRSFoundation.org. ASCRS Foundation 2012 grant winner, Houman Hemmati, MD, is continued on page 12 Bias continued from page 8 generating positive data, the temptation to be less than truthful or "objective" can be tremendous. Consequently, we shouldn't be surprised when we hear about occasional scandals where researchers have withheld contrary or worrisome findings, reported only positive results, failed to recognize others scientists' findings that contradicted their own, used unreliable experimental methods, or simply falsified their data. To the extent that individuals have a stake in a body of data or a clinical outcome, they will have feelings about them and those feelings might well corrupt their objectivity. Neuroscience research has consistently shown that human beings cannot dissociate their feelings from their evaluations. In fact, that is the evolutionary role of feelings: They inform our assessment and evaluation of X so that if I can control your feelings about X, I have an upper hand in controlling your judgment about X as well. Just Google all the articles on pharmaceutical companies employing cheerleaders as drug representatives and you get the idea. Because, like Dr. Steinert, I believe that bias is ineradicable in clinical decision making, I am re- signed to the search for clinical truth being slow, tedious, expensive, and frustrating. And yet, even though Consultant X may be conflicted up to his eyeballs, it might turn out that his findings hold up to the clinical scrutiny of his peers. That's the way clinical science marches on: through replicability. If a consultant ascends the podium and knowingly offers his audience a false but glowing report about a drug or intervention that does not pan out when the audience members try it back home, that presenter has done the field an enormous disservice: He has wasted their time, possibly their income, and worst of all, has imperiled patients. But if he believes his findings will withstand that kind of peer-reviewed confirmation, then we have reason for hope. What we need to do is what people like Dr. Steinert who oversee CME events have been doing all along: manage the biases and conflicts of interest of presenters as best we can and hope that integrity wins out when the search for truth collides with the reality of selfinterest. EW Contact information Banja: jbanja@emory.edu Steinert: roger@drsteinert.com

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