Eyeworld

EW MEETING REPORTER 58 May 2011 Optimizing the tear film, keeping the cornea clear, and other pre-op surgical pearls Cornea Day 2011 kicked off with a discussion on optimizing the tear film prior to cataract and refractive surgery, led by Elmer Tu, M.D., Uni- versity of Illinois Eye and Ear Infir- mary, Chicago. Although the diagnosis of dry eye syndrome has advanced, there is a high prevalence of dry eye and blepharitis in pa- tients, Dr. Tu said. At the same time, patients have increasingly high ex- pectations of their surgical results. Pre-op lubrication, inflammation treatment, and therapeutics can help patients optimize their tear film, leading to better post-op outcomes, Dr. Tu said. Preservative-free tears can help patients with their dry eye, as can cyclosporine ophthalmic emulsion (Restasis, Allergan, Irvine, Calif.). However, cyclosporine may take several months to make a differ- ence in patients' dry eye, he added. If a patient has blepharitis, warm compresses, massages, tetracy- clines, and macrolides can assist with pre-op treatment. John Sheppard, M.D., professor of ophthalmology, microbiology, and immunology, Eastern Virginia Medical School, Norfolk, addressed surgical steps to help prevent post- cataract dry eye. These include opti- mizing the tear film before surgery, minimizing the surgical incision size and the number of incisions made, managing astigmatism with a toric IOL, and avoiding large limbal relax- ing incisions (LRIs). Surgeons should remain assertive in not doing sur- gery if a patient's signs and symp- toms show he or she may have post-op dry eye problems. Dr. Sheppard also addressed ways to avoid post-refractive dry eye. In addition to optimizing the tear film, surgeons may want to con- sider photorefractive keratectomy (PRK), refractive lens exchange, or ICLs; consider nasal instead of supe- rior hinges, use femtosecond beveled flap edges, and avoid patients who often have dry eye problems, such as high myopes or patients with Sjo- gren's syndrome. Stephen G. Slade, M.D., Hous- ton, addressed the growing expecta- tions of cataract surgery patients and the use of femtosecond laser arcuate incisions to treat astigmatism. Of the 3 million cataract surgery proce- dures in the United States every year, 72% have 0.5 D or more of astigmatism, Dr. Slade said. "I think we need to improve our ability to treat astigmatism. What we cur- rently do with limbal relaxing inci- sions is good but may not get us LASIK-type results," he said, refer- ring to the quick recovery time that patients associate with LASIK. Fem- tosecond arcuate incisions appear thus far to lead to less astigmatism than LRIs, Dr. Slade said. Editors' note: Dr. Sheppard has finan- cial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), Bausch & Lomb (Rochester, N.Y.) and other ophthalmic companies. Dr. Slade has financial interests with Alcon, Abbott Medical Optics (AMO, Santa Ana, Calif.), Bausch & Lomb, and other oph- thalmic companies. Dr. Tu has finan- cial interests with Alcon. Glaucoma Day 2011: Pearls and pitfalls Glaucoma Day 2011 contained an extensive overview of glaucoma strategies and challenges given by a distinguished panel of experts. Led by program chair Thomas W. Samuelson, M.D., clinical associate professor of ophthalmology, Univer- sity of Minnesota, Minneapolis, the panel covered the most important areas of the disease such as imaging technology, surgical techniques, lasers, medication strategies, and in- ternational efforts. John R. Samples, M.D., Col- orado, gave a quick summary of what's in the pipeline for treating glaucoma, speculating that Rho- kinase inhibitors and new prostaglandins are the next likely classes of drugs. Regretfully, no new neuroprotectants are on the immedi- ate horizon, largely due to the ex- pense of proving their efficacy in clinical trials. Steven D. Vold, M.D., Booz- man-Hof Regional Eye Clinic, Ariz., offered attendees insight into his ap- proach to using lasers in glaucoma surgery, listing his initial treatment options as medications; laser tra- beculoplasty using either argon laser, selective laser, or micropulse diode laser techniques; minimally invasive glaucoma surgery; and finally filtra- tion surgery. Barbara A. Smit, M.D., clinical instructor, University of Washington Reporting live from the 2011 ASCRS•ASOA Symposium and Congress, San Diego, Calif. Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team. Siddartha Mukherjee, M.D. (center), pictured here with Nick Mamalis, M.D. (left), and Roger F. Steinert, M.D. (right), delivered this year's Lecture on Science and Medicine

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