MAR 2014

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

Issue link: https://digital.eyeworld.org/i/276058

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Page 151 of 210

Reporting live from the 2014 ASCRS•ASOA Winter Update Fajardo, Puerto Rico Sponsored by E W MEETING REPORTER 1 49 Friday, Feb. 14 A SCRS•ASOA Winter Update 2014 in Puerto Rico opened Friday with a panel of experts discussing challeng- ing cases and complications man- agement during a morning video symposium. Brock K. Bakewell, MD, Tucson, Ariz., shared the case of a 7 2-year-old patient who was hit in the left cheek with a golf ball in 2001. At the time, her traumatic cataract with five clock hours of zonular dehiscence and traumatic mydriasis to 9 mm was repaired with slow-motion phaco with placement of a CTR and a three-piece PCIOL and two Morcher 50 D artificial iris d evices. In December of last year, she presented with a dramatic change in visual acuity. "An exam showed almost complete dislocation of the IOL and artificial iris," Dr. Bakewell said. The case illustrates that a late dislocation of a PCIOL/ artificial iris can occur because of progressive zonulopathy, even with a CTR in place. "In this case, I had no choice but to suture (the CTR)," Dr. Bakewell said, adding that a suture fixation of the CTR using a Hoffman pocket works well. "If there is more than four hours of zonular dehiscence, the CTR needs to be sutured," Dr. Bakewell advised. "Make sure to suture them in 2–2.5 mm posterior to the limbus." Otherwise, Dr. Bakewell continued, the device may crowd the anterior chamber and cause angle-closure glaucoma. In cases of zonular dehis- cence, "I like doing a two-handed CTR insertion. I use a Lester hook in the non-dominant hand and inject with a Geuder injector. It's a lot easier on the bag." EditorsÕ note: Dr. Bakewell has no financial interests related to his presentation. SGR close to repeal ASCRS Government Relations Director Nancey K. McCann gave an u pdate on the future of healthcare reform, and she had big news for attendees—repealing and replacing SGR legislation is closer now than ever before. "We believe that we're very close on this," Ms. McCann said about one of ASCRS' top priori- ties. In the past, the House and Senate have enacted short-term " patches" to fix Medicare's SGR. Most recently, the 24% pay cut was averted until March 31. "Temporary fixes have exacerbated the problem," Ms. McCann said. "The cut goes deeper, and it costs more money." Now, Republicans and Democrats are coming together to support legislation that will repeal and re- place the SGR—a move that would prevent a 24% reduction on April 1, provide for a five-year period of sta- bility with positive updates of 0.5%, and preserve fee-for-service as a con- tinued viable option. Three biparti- san bills from the three committees of jurisdiction were passed out of their respective committees. "We opposed any bills that had a 10-year f reeze and a budget neutral value- based payment system. We stood firm on that," Ms. McCann said. As a result, the three bills were merged into one bill and introduced in the House and Senate as the SGR Repeal and Medicare Provider Payment Modernization Act. The bill repeals the SGR immediately and provides f or five years of a positive update of 0.5%. In addition, the bill consoli- dates three existing quality programs (PQRS, EHR/meaningful use, and value-based payment modifier), eliminates the current penalties associated with them and creates the Merit-Based Incentive Payment System (MIPS). The new system re- wards providers who meet perform- ance thresholds and penalizes those who do not, according to Ms. McCann. The bill also provides a 5% bonus to providers who receive a significant portion of their revenue from an Advanced Payment Model, Reporting live from ASCRS•ASOA Winter Update 2014 in Fajardo, Puerto Rico March 2014 continued on page 150 149-159 MR WU2014_EW March 2014-DL2_Layout 1 3/6/14 4:20 PM Page 149

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