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 152 of 210

Reporting live from the 2014 ASCRS•ASOA Winter Update Fajardo, Puerto Rico E W MEETING REPORTER 150 prohibits the use of quality perform- ance measures as "standards of care" in medical malpractice claims, and r equires all EHRs to be interoperable by 2017. "Most importantly, this bill eliminates penalties," Ms. McCann said. "All physicians can get a posi- tive update if they reach the thresh- old." The biggest obstacle at this point is getting the two sides to agree on appropriate offsets to pay for the legislation, Ms. McCann a dded. In addition to the SGR, Ms. McCann identified ASCRS' other top priorities: advocating for Medicare private contracting; repealing the Independent Payment Advisory Board (IPAB); working for the elimi- nation of the cataract outcomes measure for ASC quality reporting; resolving ACO exclusivity; and f ighting for continued access to compounded drugs. She asked that ASCRS members get involved. "Con- tact your members of congress. We make it really easy for you on our website," Ms. McCann said. "(Legis- lators) have to hear from physicians. I cannot emphasize that enough." Editors' note: Ms. McCann has no financial interests related to her presentation. Interactive cornea The "Interactive Cornea" session highlighted a number of issues with presentations on five different top- ics, followed by an interactive dis- cussion where the panel addressed specific cases and discussed their approach, concerns, pearls, and t reatment options in these cases. The session was moderated by W. Barry Lee, MD, Atlanta, and pan- elists included Vincent P. de Luise, MD, New Haven, Conn., Jonathan B. Rubenstein, MD, Chicago, and Roger F. Steinert, MD, Irvine, Calif. Dr. Lee presented on both corneal considerations in cataract s urgery and contact lens complica- tions. Some cornea considerations that are important to note before cataract surgery include dry eye disease/blepharitis, anterior corneal dystrophies, corneal degenerations like Salzmann's or pterygium, corneal ectatic disorders/astigma- tism, posterior corneal dystrophies a nd IOL selection in corneal disease, he said. Dr. Rubenstein touched on the topic of HSV keratitis for the com- prehensive ophthalmologist, giving an overview of the herpes simplex virus. He went over clinical infec- tion, the ocular manifestations of HSV that could be seen, when the virus becomes latent and localizes, and possibilities for recurrence. Dr. de Luise presented on scleri- tis and episcleritis, highlighting the differences between the two and possible treatments. Dr. Steinert discussed cataract surgery in high astigmatism, specifi- cally looking at toric IOLs for the correction of high amounts of astigmatism after penetrating keratoplasty. He said the main question he wanted to answer was w hat are the issues with the toric IOL when you have enough astigma- tism that it's not easily correctable with spectacles from a patient satis- faction point of view? Dr. Steinert presented a retrospective review he worked on with 21 eyes of 16 patients with astigmatism of greater than 2.5 D after a zig-zag incision F LEK PKP. He looked at the status of the patients post full suture removal because the sutures themselves often cause astigmatism that will not be there when they are removed. The patients were treated using a toric intraocular lens, the AcrySof IQ Toric IOL (Alcon, Fort Worth, Texas). The mean follow-up was a little o ver a year. The outcome measures showed uncorrected distance visual acuity (UDVA), spectacle corrected distance visual acuity (CDVA), and postoperative manifest refraction astigmatism compared to the preoperative topographic astigma- tism. He said that toric IOLs after femtosecond penetrating keratoplasty do improve the uncor- rected and best corrected acuities. There are, however, some optical concerns for toric IOLs, including limited upper range of correction. "One [concern] is that we currently in the United States are limited at four diopters," Dr. Steinert said. This type of treatment does not correct for higher order aberrations or irreg- ular astigmatism. He said he uses corneal topography, and fortunately with the femtosecond incision, it's more likely that there will be less higher order aberration and more regular astigmatism, even when there is high astigmatism. "I think toric IOLs are a wonderful new therapeutic alternative to get visual function restored in these patients once the sutures are out and they have regular astigmatism," Dr. Steinert said. Editors' note: The physicians have no financial interests related to their presentations. M arch 2014 Sponsored by View it now ... EWrePlay.org W. Barry Lee, MD, explains how to recognize signs of contact lens-associated limbal stem cell deficiency and how to treat this serious complication. 149-159 MR WU2014_EW March 2014-DL2_Layout 1 3/6/14 4:21 PM Page 150

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