Eyeworld

EW NEWS & OPINION 15 ASCRS Best papers of session September 2011 Six-month visual and functional outcomes of femtosecond laser intrastromal procedure for presbyopia Claire Hartnett, M.D., Michael O'Keeffe, F.R.C.S. The first trial in Ireland of the fem- tosecond laser intrastromal proce- dure (INTRACOR, Technolas Perfect Vision, St. Louis, Mo.) for the treat- ment of presbyopia was commenced in June 2010. A total of 67 presby- opic patients were included in this trial. The mean pre-op unaided read- ing visual acuity was N18. The mean post-op unaided reading visual acu- ity at 6 weeks was N5 with 91% of patients reporting spectacle inde- pendence for near visual activities. There was minimal loss in distance visual acuity, with 36% of patients noted to experience no drop in dis- tance visual acuity and 53% of pa- tients noted to have a drop of one logMAR line in distance visual acu- ity. The mean myopic shift was –0.66 D spherical equivalence. The results were shown to be stable over the 6-month post-op period. Ninety- one percent of patients reported sat- isfaction with the outcome of the procedure. Practical use of screening method for ectasia-susceptible corneas Damien Gatinel, M.D., Alain Saad, M.D. Answering the question of what technique is superior for early detection of keratectasia-susceptible corneas requires well-designed inves- tigation. These studies must include corneas with known keratectasia sus- ceptibility, and to achieve maximum specificity and sensitivity, they must use discriminant analysis that evalu- ates the method's performance in separating the study groups and so minimizes false negatives and false positives. The fellow "normal" eye of a pa- tient with "unilateral" keratoconus represents the perfect false negative model for discriminant analysis study and should be considered as having forme fruste keratoconus (FFKC). We compared the elevation topography and tomography data obtained with the Orbscan II (Technolas Perfect Vision, St. Louis, Mo.) of both eyes from 40 patients with unilateral keratoconus (KC eyes and FFKC eyes) and 70 normal con- trols selected from eyes that re- mained normal 2 years after LASIK. Both the FFKC and control groups were Placido negative. Comparisons in Orbscan II data between groups showed statistically significant differences between the Placido-negative FFKC eyes and the normal controls in the thinnest point value, eccentricity index (irregularity at 3 and 5 mm), and posterior elevation at the thinnest point. The percentage of variation of the anterior curvature from the thinnest point to the periphery and the percentage of increase in thick- ness from the thinnest point to the periphery were also significantly dif- ferent between the two groups such that the FFKC eyes showed faster flattening and thickening toward the periphery compared with the normal eyes. Discriminant analysis using all of these parameters resulted in an area under the receiver-operat- ing curve of 0.98, sensitivity of 92.5%, and specificity of 92%. A model using fewer of the parameters resulted in significant loss of speci- ficity and sensitivity. These results will be used to de- sign a new software module for the Orbscan II instrument in order to help clinicians to objectively evalu- ate the degree of ectasia susceptibil- ity when screening refractive surgery candidates or keratoconus-suspect corneas. EW components that are weighted and valued, approved by the RUC (which includes primary care and all spe- cialties), and recommended to CMS. CMS then makes the final determi- nation. Cataract surgery in terms of time (currently based on 30 min- utes) and intensity is certainly higher than a primary care visit. In addition, the values for practice ex- pense and malpractice are also higher. Moreover, the fee cataract surgeons receive is a 90-day global fee, it includes all pre- and post-op- erative visits, as well as the surgery itself. Cataract surgery is one of the miracles of modern medicine. It does not simply arrest the loss of vi- sion, it restores vision. And it does so with dramatic effects on quality of life. There is extensive scientific documentation that cataract-related visual problems impair health and daily activity in many ways. Two thousand patients were questioned in one study, and more than 90% responded that they func- tioned better after surgery. Other studies documented that functional daily activity increases, often dra- matically, when vision is restored— cognitive impairment is lessened, risks of falls, fractures, driving acci- dents, and hospitalization decrease after cataract surgery. Again, Mr. Goodman's conclu- sion is wrong. Cataract surgery reim- bursement is set following a rigorous examination and recommendation process. Its value to patients beyond vision … quality of life … reducing cognitive impairment and accidental injury … is well proven. Now, with an increasing senior patient popula- tion, is no time to consider cuts when patient demand will only in- crease." EW ASC staff resources and training at the ASOA Congress T his year ASOA offers a new ambulatory surgery center (ASC) membership category. The benefits include: • ASC EyeMail: This EyeMail discussion eGroup focuses exclusively on is- sues related to ambulatory surgery centers. EyeMail connects you to thousands of ophthalmic practice staff—your colleagues, ophthalmic ex- perts, consultants, and certified ophthalmic executives. ASOA members and ASC members have free access to ASC EyeMail. • Discounts: ASOA training (books and ASC seminars) • ASC "Hot Topics:" FAQs and experts' articles • Administrative Eyecare online (ASC article downloads) and AE eZine • Regulatory updates • Access to ACTIONED: Discounted online courses The ASC membership also includes a reduced rate for the ASC Forum, a 1-day ASOA Congress–Specialty Training program, which covers quality assessment, infection control, and performance improvement. Courses are submitted to be approved by ASORN for AEU continuing edu- cation credits. "We are very excited about the 2012 ASC Forum," said ASC Forum Program Chair Regina Boore, R.N., M.S., CEO of Progressive Surgical So- lutions LLC. "Building upon this year's success and attendee feedback, we have developed a program for the 2012 meeting that includes solid clinical content, industry updates, and professional development for ophthalmic surgery center managers. Industry leaders and subject matter experts will cover a gamut of operations and regulatory issues such as Medicare com- pliance and updates, patient safety, medication management, credentialing and privileging, infection control, and benchmarking. Professional develop- ment sessions focused on collaboration, leadership, human resource man- agement, and finance and accounting will expand your knowledge base and give you solid tools to take back to your facility. Topical issues such as building a retina service and integration of the femtosecond laser into the ASC operation will round out the ASC Forum and keep you on the cutting edge of ophthalmic ASC management. This is a must-attend conference for ASC administrators and nurse managers."

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