Eyeworld

EW ASCRS PREVIEW 33 and will delve into how to diagnose and treat the diseases and what to do in the peri-op period. This sym- posium will offer something that a straightforward cataract or cornea session would not. "We like these combined symposia because every- one gets to learn something," Dr. Packer said. "It's really useful to hear another sub-specialist's perspective on something that you do every- day." Dr. Packer sees the session as an important one especially for cataract surgeons who are interested in deal- ing with issues in a proactive way to help improve patient outcomes. He cited endothelial dystrophy, which will be covered here, as a good ex- ample of this. Speakers will be look- ing at a host of questions such as when it is beneficial to get an en- dothelial cell count or how surgeons should alter their technique when they're doing surgery so that they end up with a clearer cornea. "Another important area that we're covering is the post-refractive surgery cornea," Dr. Packer said. "We'll look at things such as how to do IOL calculations, what differ- ences in technique there are, espe- cially in a patient who has had RK, and what to tell that patient—what his expectations should be after sur- gery." Dr. Packer expects that atten- dees will gain a lot from the panel's experience in dealing with these cases and also obtain the latest infor- mation. "I hope they will get up-to- the-minute information about the state-of-the-art techniques and tech- nology because this is an area that is rapidly changing," he said. Practice management will also be part of the agenda. "I hope to touch on some refractive manage- ment issues. For example, in some- one who has had cataract surgery and who now has a refractive prob- lem, who pays for that enhance- ment? There are different philosophies on that," he said. "It's helpful to think about those things before you get into that situation and have a policy established that you're comfortable with and that will work for your practice." Courting controversy The session will highlight a couple of controversial areas. "One of the things that we will look at is to what degree surgeons can accept corneal issues before deciding that a pre- mium IOL is contraindicated," Dr. Packer said. "For instance, if you have a patient who has Salzmann's nodules with peripheral nodules in the cornea but the central cornea is OK and the patient wants spectacle independence—what do you do?" Speakers will delve into whether a premium lens such as a multifocal or an accommodative one can be used in such cases and whether treatment such as PTK might be helpful first. Dr. Packer has had mixed results in such cases. "I think that the most important factor is informed con- sent so that patients know what they're getting into," he said. "If a patient is willing to take a chance, my experience has been sometimes you win and sometimes you lose." Ectasia is another area of con- tention that will be covered. Dr. Packer pointed out that a key treat- ment elsewhere, corneal crosslink- ing, is not yet approved in the United States. "What's our take on that?" Dr. Packer asked. "Should we be renegades and go out and buy UV lamps and do our own crosslink- ing?" Overall, Dr. Packer sees both cataract and corneal specialists bene- fiting from the session. "I think the cataract surgeons will get enough in- formation to start expanding their scope of practice and take on some of these more difficult cases," he said. "I think that for cornea special- ists who are coming to this, it's a nice update in a broad range of areas of corneal disease. I think they will get something out of it because the presenters are going to be giving state-of-the-art information in all of these different areas." EW Editors' note: Dr. Packer has no finan- cial interests related to his comments. Contact information Packer: 541-687-2110, mpacker@finemd.com D U R I N G P R O B I N G A F T E R P R O B I N G D U R I N G G P R O B I N D U R I N G R P R O B I N A F T E

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