DEC 2013

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

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54 EW MEETING REPORTER Reporting live from the 2013 American Academy of Ophthalmology Annual Meeting in New Orleans December 2013 promising, Dr. Vinciguerra said, and results show there has been good BCVA recovery, improved HOA and less pain, among other things, although it is still very early in the results. Editors' note: Dr. Seiler has financial interests with IROC and Alcon. Dr. Vinciguerra has financial interests with Nidek, Oculus, Optikon 2000 SPA, and SCHWIND. Saturday, November 16 Presbyopia treatments abound, but no clear standard Corneal inlays, accommodating IOLs, and multifocal IOLs are all potential treatments for the correction of presbyopia, but none are ideal and ongoing improvements are needed, according to a panel discussion. During Refractive Subspecialty Day, George O. Waring III, MD, served as judge with Daniel S. Durrie, MD, Jack T. Holladay, MD, and Richard L. Lindstrom, MD, serving as jury members; they held court to put presbyopia surgery on trial. There are three corneal inlays under investigation in the U.S.: the KAMRA (AcuFocus, Irvine, Calif.), the Flexivue Microlens (Presbia, Irvine, Calif.) and the Raindrop (ReVision Optics, Irvine, Calif.). "You do need to balance a lensbased procedure with a lens-based solution," Dr. Durrie said. Dr. Holladay, however, believes criticisms surrounding the technology are "unfounded," and Dr. Lindstrom said that the technology can be commercially successful, and these inlays "will become part of our armamentarium." 'Judge' Waring ruled, "Corneal inlays are viable options. You figure out what that means." Patient selection is the key to successful outcomes with the single-optic accommodating IOL, and setting realistic and achievable expectations is mandatory in addition to performing flawless surgery. Presenters and panelists alike lamented the demise of the Synchrony (AMO, Santa Ana, Calif.) dual-optic studies here in the U.S., but a tri-optic lens and sulcus-based IOLs may overcome some of the objections to the single-optic lens. "1 D is not enough to consider these a success," Dr. Durrie said. "I believe the category has potential, but we are not there yet." Dr. Holladay said in-the-bag designs are not likely to work "because of the contraction," but he thinks lenses in the pipeline are "promising." Multifocal lenses are "evolving," said Judge Waring, and Dr. Durrie categorized their success on the surgeon's ability to hit the target refraction. Dr. Holladay said the category should be considered an interim step in the treatment of presbyopia and Dr. Lindstrom called the technology "excellent, but not ideal." Editors' note: All the physicians consult for industry and have financial relationships with the IOL manufacturers. Asymmetric offset ablation combines pupil, corneal vortex info A new ablation profile, asymmetric offset (AO), has the ability to provide a method to combine pupil and corneal vertex information, said Paolo Vinciguerra, MD, Milan. Typically, excimer lasers will feature centration on the pupil center (rim) or on the coaxial light reflex, but this combines the two, he said. "Sphere and cylinder are centered on the corneal vertex and the ablation axis on the visual axis," Dr. Vinciguerra said. Editors' note: Dr. Vincinguerra has financial interests with Schwind eye-tech solutions (Kleinostheim, Germany). CL complications can usually be resolved favorably A retrospective review of 407 eyes implanted with a phakic posterior chamber implantable collamer lens found that although complications can occur, "most can be resolved with favorable visual outcomes," said Alejandro Navas, MD, Mexico City. A total of 14 eyes (3.43%) had complications over the course of the 60 month follow-up: eight had surgical-related complications including endophthalmitis, toxic anterior segment syndrome, accidental anterior capsule rupture; six eyes had complications related to high myopia, including retinal detachment. Editors' note: Dr. Navas has financial interests with STAAR Surgical (Monrovia, Calif.). Clinician: Patients need to know what to expect from glaucoma Patients need information about glaucoma concerning diagnosis, appropriate treatment, realistic and updated prognosis, as well as other factors, George L. Spaeth, MD, Philadelphia, said during Glaucoma Subspecialty Day. "Patients want to know how to prepare for becoming a glaucoma patient," he said in his presentation "AGS Foundation: Unmet Needs in Glaucoma." "What can they reasonably expect? How can they prepare for visual loss? What can they do when they lose vision? For physicians, speaking honestly and in detail about the disease and its ramifications can have positive and negatives aspects with patients, Dr. Spaeth said, as some patients want only good news. "Some patients want to hear the truth, but some patients don't want to hear the truth. But all patients deserve to hear the truth. It's how we present it to them that determines whether they'll be able to accept it, or not accept it," he said. Patients with a reasonable possibility of blindness need to be told as soon as possible, he said. They need information about resources, for what they can do should they start to lose vision. Dr. Spaeth shared his experience of interviewing 14 blind patients—four blind from retinitis pigmentosa and 10 blind from glaucoma—and how he learned that not one patient had been told that there was a reasonable chance that they might go blind. "Not one had been advised what to do if blindness developed," he said. "Not a single one continued on page 56

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