DEC 2013

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

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56 EW MEETING REPORTER Reporting live from the 2013 American Academy of Ophthalmology Annual Meeting in New Orleans December 2013 had been referred to a comprehensive low vision service." In one exchange with a patient, when Dr. Spaeth asked if the patient had a low vision specialist, the patient had not only never heard of the term, the patient thought he had said "blue vision" specialist. "They don't even know what low vision is," he said. The AGS Foundation has developed a committee to address unmet patient needs such as this one and hopes to explore the topic further if possible, Dr. Spaeth said. Pearls for phacotrab include consider it in advanced cases Combined phacoemulsification and trabeculectomy still has a role in glaucoma surgery, a physician said, offering his pearls for the combined procedure. In the presentation "Combined Phacoemulsification and Filtration Surgery: Does it Still Have a Role? Top 3 Surgical Pearls," Ronald Leigh Fellman, MD, Dallas, Texas, said that his talk might have been retitled "Is phaco-trabeculectomy dead?" because the program at "The Future is Now! #Glaucoma2013 Subspecialty Day" had minimal scheduled discussion or presentations about trabeculectomy. "I'm here to tell you that it's still alive, and it still has a role … but mainly thanks to the many benefits of small incision cataract surgery—that really revolutionized our combined procedures," Dr. Fellman said. Combined phaco-trabeculectomy had been the "go-to" procedure for uncontrolled glaucoma with cataract for many years, but with the advent of new minimally invasive glaucoma surgical procedures, less filtration surgery is now being performed, he said. Dr. Fellman listed his pearls for combined phaco-trabeculectomy first as, until more is known about the collector channel capacity, the combined procedure might be the best option in advanced glaucoma cases. "If you have a patient with really bad glaucoma and maybe their collectors aren't in great shape, you can certainly consider phaco-trabeculectomy," Dr. Fellman said. His other pearls were: • Determine if the disc can withstand a postoperative IOP spike. • Titrate flow in the operating room to blunt IOP spike. •Achieve improved long-term bleb morphology by incorporating Tenon's into the wound closure. Editors' note: None of the doctors have financial interests related to their presentations. Medical treatment of corneal diseases The first session of Cornea Subspecialty Day focused on medical treatment of corneal diseases. Bennie Jeng, MD, Baltimore, Md., discussed compounded therapies. His presentation looked at the history and current use of compounded therapies and whether they are worth the headache that they often cause. He said the history of compounded medication goes all the way back to the beginning of medicine, and they have continued to be used over time. Compounded medications can allow physicians the ability to use different doses and strengths of medications in different situations as they see fit, Dr. Jeng said. Several issues with these medications are the inconvenience for both the patient and the provider and the price. "It's expensive," Dr. Jeng said. "Many times insurance doesn't cover this." There is also the risk for contamination within compounding facilities, which can cause additional problems and headaches. Despite the potential for complications, Dr. Jeng said he believes that these medications are worth the hassle because they make it possible to use medications that are otherwise unavailable. at risk for zoster. Dr. Cohen noted that the risk for herpes zoster will start to significantly increase at age 40 and will rise again sharply after age 50. Dr. Cohen said she does not believe it to be an epidemic because it occurs sporadically and is not highly contagious. Additionally, there is a vaccine that can help reduce the overall burden of the disease. But there are also a number of barriers for the vaccine, including a high cost, reimbursement issues, and the production. Editors' note: Dr. Cohen has financial interests with Merck & Co. Keratoprosthesis: Past, present, and future Claes Dohlman, MD, Boston, gave a keynote lecture discussing keratoprosthesis. He discussed the progress that has been made with the Boston K-Pro (also called the DohlmanDoane, developed at Massachusetts Eye and Ear Infirmary, Boston) over the years. "To manage such a device with long-term safety has been extremely difficult," he said. The past was terrible, he said, with many issues and complications. In the present, there are some benefits of the device, and he said the future seems very promising. The primary complications have traditionally been tissue melt, infection, glaucoma, and inflammation, Dr. Dohlman said. "Fortunately, the two first issues have been brought under reasonable control," he said. But the two others still require work, particularly glaucoma. Editors' note: Dr. Dohlman has financial interests with the Massachusetts Eye and Ear Infirmary. Editors' note: Dr. Jeng has no financial interests related to this topic. Sunday, November 17 Infections "The Great Debate: Glaucoma" In a session devoted entirely to infections, Elisabeth Cohen, MD, New York, discussed herpes zoster. She stressed the large percentage of people born in the U.S. age 40 and above who have had chicken pox whether they know it or not and are "The Great Debate: Glaucoma" session featured debates on topics relating to the specialty, with participants arguing the pros and cons of a number of issues. In one debate, Anne Coleman, MD, Los Angeles, argued that IOP variability is a risk continued on page 58

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