Eyeworld

EW MEETING REPORTER 90 February 2011 Advances in the treatment of ocular surgery disease Hawaiian Eye 2011 began early Sun- day, January 16, with a seminar on identifying and treating ocular sur- face disease—a topic especially salient for cataract and refractive surgeons because the condition of the eye can affect surgical outcomes, according to the panel. Eric D. Don- nenfeld, M.D., co-chairman, Cornea, Nassau University Medical Center, East Meadow, N.Y., said symptoms, which may not correlate with clini- cal signs, vary greatly. "The real key for me is visual fluctuation," he said. Dr. Donnenfeld said he prefers lis- samine green/rose bengal conjuncti- val stains to diagnose dry eye because those will pick up early ep- ithelial changes in the cornea and conjunctiva. Osmolarity is now being used as an in-office diagnostic tool as well. "I will not have a pa- tient undergo cataract or refractive surgery until these problems are re- solved," Dr. Donnenfeld said. For a treatment protocol, the disease is broken up into severity levels, rang- ing from mild to severe. The first line of defense, artificial tears, are a palliative therapy and don't stop dis- ease progression. "For any patient who has significant ocular surface disease, we can do better than artifi- cial tears," said Edward J. Holland, M.D., professor of ophthalmology, University of Cincinnati, and direc- tor, Cornea Service, Cincinnati Eye Institute. Topical cyclosporine has dramatically improved practitioners' ability to treat aqueous tear defi- ciency, Dr. Holland said. "We're see- ing studies now that show we're able to slow the progression of the dis- ease, which we've never been able to do before," Dr. Holland said. Corti- costeroids, which ophthalmologists have long been warned to avoid, have value as an adjunct therapy for topical cyclosporine, Dr. Holland said. Punctal occlusion has moved down the treatment paradigm. Low doses of oral doxycycline (50 mg qid or 20 mg bid) can be used for treat- ment, as can autologous serum drops. "I would recommend you re- serve that for severe inflammatory dry eye," Dr. Holland said about the serum drops. Nutritional supple- ments, such as fish and flax seed oil, have also provided a significant breakthrough in treatment. Med- icated scrubs are important to mei- bomian disease patients, although Dr. Holland advised against using baby shampoo on the lids. "Soap is an irritant," he said. "Stop recom- mending baby shampoo to your pa- tients." The business of ophthalmology Alan E. Reider, J.D., M.P.H., focused on changes in healthcare that will affect ophthalmologists. Mr. Reider said new legislation expands the government enforcement capability of fraud and abuse, funding for which was increased over the next 10 years to $350 billion. Enforce- ment under the anti-kickback statute has also been ratcheted up. It's now much easier to prosecute cases under the statute, Mr. Reider said. Simi- larly, the False Claims Act has been expanded, and violators will have to pay a steep penalty, in addition to three times the damages. Mr. Reider said a practice that discovers that it has been overpaid can be accused of submitting a false claim. "If you have a payment that you know to be an overpayment and you sit on it for more than 60 days, that overpay- ment turns into a false claim, subject to a triple damages provision and a penalty between $1,100 and $55,000." Mr. Reider told the audi- ence about the Recovery Audit Con- tractor (RAC) program, which receives contracts from the federal government to find overpayments. "These contractors are outrageously aggressive," Mr. Reider said. Another provision that Mr. Reider calls "truly frightening" allows the Medicare program to suspend payments based on credible evidence of fraud. In the proposed regulation, credible evi- dence could come from anonymous fraud hotline complaints or claims of data mining. Mr. Reider advised practitioners to get an annual cod- ing and billing review, assure con- tractual relationships are proper, and establish a compliance program. Kevin J. Corcoran, C.O.E., C.P.C., F.N.A.O., president, Corcoran Con- sulting Group, San Bernardino, Calif., rounded out the session by giving physicians updates on coding and billing for 2011. A copy of the changes is available on his website, www.corcoranccg.com. Mr. Corcoran started his talk with some good news—there is a 2011 Medicare Physician Fee Schedule, and it is sta- ble for the next year. "The conver- sion factor is flat. You did not fall off a cliff," he said. Mr. Corcoran also discussed bonus programs including PQRS and HIT. "If you're going to make yourself a note, make sure you do e-prescribing," he said. "It's the easiest bonus you will ever get. It re- quires that each eligible provider re- ports 25 times during the year." Editors' note: Mr. Corcoran has financial interests with Corcoran Consulting Group. Dr. Donnenfeld has financial in- terests with Allergan (Irvine, Calif.), Ad- vanced Vision Research (Woburn, Mass.), Bausch & Lomb (Rochester, N.Y.), and Inspire Pharmaceuticals (Durham, N.C.). Dr. Holland has financial interests with Allergan, Bausch & Lomb, and Inspire Pharmaceuticals. Mr. Reider has no fi- nancial interests to report. Hawaiian Eye 2011 continued Monday, January 17, with a focus on advances in cataract and IOL technology and techniques. Reviewing refractive lens exchange Mark Packer, M.D., clinical associ- ate professor, Oregon Health & Sci- ence University, Portland, gave a retrospective review of refractive lens exchange procedures over 3½ years of 128 eyes in his practice. The lenses that were included were 50 ReZoom (Abbott Medical Optics, AMO, Santa Ana, Calif.), 44 Crystal- ens (Bausch & Lomb Surgical, Aliso Viejo, Calif.), two ReSTOR (Alcon, Fort Worth, Texas) as mix-and- match with the ReZoom, and 32 Tecnis Multifocal (AMO), 15 bilateral and two unilateral. RLE safety ratio is safer than eximer laser procedures, Dr. Packer asserted. "No eyes lost two lines or more of best corrected vision," he said. There were 16 en- hancements; 11 eyes had LASIK, four had ReZoom, and seven had Crystalens. Four eyes had PRK and one piggyback Crystalens was in- Reporting live from the 2011 Hawaiian Eye Meeting, Maui, Hawaii by Jena Passut Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team

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