NOV 2013

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

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November 2013 opia," including the condition itself and present and future treatment possibilities. Caroline C.W. Klaver, MD, PhD, Rotterdam, the Netherlands, opened the symposium with a presentation explaining the pathology of myopia in "Why do eyes become myopic?" Donald T.H. Tan, MD, Singapore, offered an overview on "New strategies for the prevention of myopia." Helen Swarbrick, PhD, Sydney, Australia, answered "Does orthokeratology really work?" with research and the response of yes, in some cases, it does work. Dr. Swarbrick said that children are "remarkably quick" at adaptation to wearing the contact lenses used in orthokeratology. Jesper Hjortdal, MD, Aarhus, Denmark, discussed the use of the ReLEx SMILE (Carl Zeiss Meditec, Jena, Germany) as "New laser approaches to myopia correction." "[When we] primarily treat patients with moderate and high myopia, this type of surgery has become our standard treatment for myopia and myopic-astigmatism, and that's because the predictability and the efficacy, at least when we do it, are better than femtosecondLASIK for moderate and high myopia," Dr. Hjortdal said. Rudy Nuijts, MD, Maastricht, the Netherlands, outlined "Phakic IOLs in moderate and high myopia," while Richard Packard, MD, Windsor, U.K., discussed "Clear lens extraction in high myopia." ATOM trials find atropine eye drops reduce myopia progression The Atropine in the Treatment of Myopia Study (ATOM) found that atropine eye drops reduced myopia progression and axial elongation in children in a dose-related way. The study also found a rebound phenomenon with higher doses of the eye drop, Dr. Tan said in his presentation at the "Unraveling the mysteries of myopia" symposium. "We think that atropine eye drops are safe with no serious ad- verse or systemic effects, but in the higher doses, the side effects of pupil dilation, loss of accommodation, and near vision limit practical use," he said. The lower dose of 0.01% atropine "appears to have the best therapeutic index with clinically few, relatively insignificant amounts of pupil dilation, near vision and accommodation loss, and yet [it] appears to be fairly similar in efficacy to higher doses," Dr. Tan said. The trials were conducted at the Singapore Eye Research Institute. Singapore is the "myopia capital of the world," Dr. Tan said, with approximately 80% of teenagers myopic by 18. The ATOM, a 14-year-old study, was a randomized double-masked placebo-controlled clinical trial. It was designed to determine the safety and efficacy of atropine eye drops on myopia progression in children. ATOM1 was conducted from 1999 to 2004 with 400 children, 6 to 12 years old. One eye was administered 1% atropine once at night and the other eye was untreated. There was a second control group with a vehicle in one eye. Photochromic glasses were given to all study subjects. The three-year study had two years of treatment and one year of washout observation without medication. For the first two years, there was a 77% reduction in the mean progression of myopia, Dr. Tan said. No serious adverse effects were found. There were reported cases of allergic conjunctivas and dermatitis. The washout year subsequently showed a "quite significant" rebound phenomenon, Dr. Tan said. "The atropine eyes rapidly tried to become myopic again, although they didn't quite go back," he said. ATOM2 was started at that time, with three lower doses of atropine— 0.5%, 0.1%, 0.01%—to see if the side effects seen in the first trial could be mitigated. The study had the same amount of children and similar methodology, but slightly older patients, slightly higher myopia, and the study was increased to bilateral treatment over five years, with two years on treatment, one washout year, and appropriate concentration for those who progressed for another two years. That study found that retinal sensitivity was reduced in myopic children in this study on lower doses. "There is a dose-related rebound phenomenon inversely related, and the 0.01% had minimal rebound," he said. In the future, Dr. Tan said there are still more questions about the use of atropine. For instance, the optimal age to stop and start atropine still needs to be determined, he said, and there is a possibility that there could still be undiscovered long-term effects. Those questions might be a good basis for an ATOM3 study, he said. Symposium provides comprehensive discussion of clear lens extraction The ESCRS, Asia-Pacific Association of Cataract & Refractive Surgeons EW MEETING REPORTER 65 (APACRS), American Society of Cataract & Refractive Surgery (ASCRS), and Latin American Society of Cataract and Refractive Surgeons (LASCRS) hosted a Combined Symposium, "Clear lens extraction: have we lost our way?" Physicians gave presentations on the topic on behalf of each society. Presenters included co-moderators Graham Barrett, MD, Perth, Australia, from the APACRS, who opened the symposium with a talk about the logic of clear lens extraction, titled "Clear lens extraction for presbyopia: have we gone mad?" and Cesar C. Carriazo, MD, Barranquilla, Columbia, from the LASCRS, who showed a "TIP-CHOP" technique in "Improving techniques and results (TIP-CHOP)." Peter Barry, MD, Dublin, Ireland, who chaired the symposium, asked Steven Schallhorn, MD, former director, Cornea Service & Refractive Surgery, Naval Medical Center, San Diego, who presented on behalf of the ASCRS, what role the surgeon and cataract now plays in the clear lens extraction environ- BSS PLUS® IRRIGATING SOLUTION BRIEF SUMMARY OF PRESCRIBING INFORMATION DESCRIPTION: BSS PLUS®, a sterile intraocular irrigating solution, is used during all intraocular surgical procedures, including those requiring a relatively long intraocular perfusion time (e.g., pars plana vitrectomy, phacoemulsifcation, extracapsular cataract extraction/lens aspiration, anterior segment reconstruction, etc.). The solution does not contain a preservative and should be prepared just prior to use in surgery. INDICATIONS AND USAGE: BSS PLUS® Irrigating Solution is indicated for use as an intraocular irrigating solution during intraocular surgical procedures involving perfusion of the eye. CONTRAINDICATIONS: There are no specifc contraindications to the use of BSS PLUS® Irrigating Solution; however, contraindications for the surgical procedure during which BSS PLUS® Irrigating Solution is to be used should be strictly adhered to. WARNINGS: For IRRIGATION during ophthalmic surgery only. Not for injection or intravenous infusion. Do not use unless product is clear, seal is intact, vacuum is present and container is undamaged. Do not use if product is discolored or contains a precipitate. PRECAUTIONS: DO NOT USE BSS PLUS® IRRIGATING SOLUTION UNTIL PART I IS FULLY RECONSTITUTED WITH PART II. Discard unused contents. BSS PLUS® Irrigating Solution does not contain a preservative; therefore, do not use this container for more than one patient. Do not use additives other than BSS PLUS® Irrigating Solution Concentrate Part II (20 mL) with this product. Tissue damage could result if other drugs are added to product. DISCARD ANY UNUSED PORTION SIX HOURS AFTER PREPARATION. Studies suggest that intraocular irrigating solutions which are iso-osmotic with normal aqueous fuids should be used with caution in diabetic patients undergoing vitrectomy since intraoperative lens changes have been observed. There have been reports of corneal clouding or edema following ocular surgery in which BSS PLUS® Irrigating Solution was used as an irrigating solution. As in all surgical procedures appropriate measures should be taken to minimize trauma to the cornea and other ocular tissues. Geriatric Use: No overall diferences in safety or efectiveness have been observed between elderly and younger patients. ADVERSE REACTIONS: Postoperative infammatory reactions as well as incidents of corneal edema and corneal decompensation have been reported. Their relationship to the use of BSS PLUS® Irrigating Solution has not been established. OVERDOSAGE: The solution has no pharmacological action and thus no potential for overdosage. However, as with any intraocular surgical procedure, the duration of intraocular manipulation should be kept to a minimum. © 2013 Novartis 10/13 BSS13006JAD-PI

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