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 160 of 210

Reporting live from the 2014 ASCRS•ASOA Winter Update Fajardo, Puerto Rico E W MEETING REPORTER 158 March 2014 W. Barry Lee, MD, Atlanta, Jonathan B. Rubenstein, MD, Chicago, Larry E. Patterson, MD, C rossville, Tenn., and Roger F. Steinert, MD, Irvine, Calif. The panel addressed a number of topics including astigmatism, dealing with infections, and choosing the correct procedures and lenses for particular patients. Dr. Donnenfeld presented a case of a 63-year-old male patient who w as six years postoperative after having LASIK in both eyes. At that point, the patient developed a cataract. The case had been a very straightforward LASIK case, he said, and the patient wanted visual reha- bilitation. Dr. Steinert said that in this case, whether the patient wanted to f ocus on distance, monovision, or something else, the most important thing is to be very accurate. The other question to ask, Dr. Steinert said, is if you should ever offer this patient a multifocal lens because it may be challenging to use a multifo- cal IOL in a post-LASIK patient. He said when considering the possibil- ity of a multifocal lens, look for patients who are otherwise very happy with their vision and have pristine topography. Ultimately, Dr. Donnenfeld said that the patient did well with a bilateral diffractive mul- tifocal IOL implantation. In order to determine if this was the correct choice, he first looked at the topog- raphy and the ablation profile of the patient. Based on a question from the a udience, the panel discussed whether they would do a PRK or LASIK procedure on a person with a history of herpes simplex. Dr. Rubenstein said that he would consider doing these procedures in this type of patient, but only if the cornea was clear with the ability to get good readings and if there was n o scarring. He said he would start this patient on oral antivirals before treatment and continue for a couple of weeks after treatment. Dr. Donnenfeld noted that he would be more inclined toward using LASIK in this situation and would be certain to check the corneal sensation. Use of the femtosecond laser also came u p in the discussion of limbal relax- ing incisions (LRIs) and femtosecond laser arc incisions. The panel dis- cussed how use of the femtosecond laser may have an advantage over manual incisions for LRIs. LRIs are very technique dependent, Dr. Rubenstein said. You have to correct for different directions and during the course of the LRI, the blade depth and angles need to be correct during the entire incision, he said. When using the femtosecond laser, you can completely control every aspect of the incision, which means there's greater potential for accuracy. Dr. Donnenfeld discussed a patient who had severe complications after a PRK procedure. He posed the ques- tion of whether PRK or LASIK is a safer procedure. Initially, he told the patient that PRK would be safer be- c ause there is less chance of ectasia. However, he noted that LASIK may be safer because it has a reduced risk of infection. Physicians often as- sume PRK is safer when doing refrac- tive surgery, Dr. Donnenfeld said, however the risk of infection is five times higher with PRK. Additionally, with use of the femtosecond laser, t his could help to eliminate some of the complications and difficulties that can arise when doing a micro- keratome LASIK procedure. For a lower volume surgeon who's not comfortable doing LASIK, PRK is the way to go, he said. But LASIK may be a better choice and may offer a better experience for the patient. D r. Donnenfeld discussed using crosslinking in his practice and specifically addressed the potential benefits of using crosslinking with a radial keratotomy (RK). He said that crosslinking can help decrease visual fluctuation and moderate corneal flattening in these cases because visual fluctuation can be a problem with RK. Editors' note: The physicians have no financial interests related to their presentations. About ethics In the "Ethics Interactive" session, John D. Banja, PhD, Atlanta, led a panel discussion on scope of practice and a number of issues related to the topic. Other panel members in- cluded Dr. Donnenfeld, Dr. Lee, and Dr. Rubenstein. Dr. Banja started by outlining scope of practice and parameters for ethical guidelines. Four main points are autonomy, non-maleficence, beneficence, and justice. He highlighted non-malefi- cence and beneficence, which boils down to "do no harm" and doing good. The only factors relevant to scope of practice decision-making are those designed to ensure that all licensed practitioners are capable of providing competent care, he said. Dr. Donnenfeld also highlighted the principle of beneficence, which is "a Sponsored by View it now ... EWrePlay.org David F. Chang, MD, describes advanced OVD techniques for the management of radial tears, zonular dialysis, and posterior capsular rupture. 149-159 MR WU2014_EW March 2014-DL2_Layout 1 3/6/14 4:22 PM Page 158

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