Eyeworld

EW MEETING REPORTER 55 VIEW 1 was composed of 1,217 patients in North America, while VIEW 2 was made up of 1,240 pa- tients in Europe, Asia, South Amer- ica, and Australia. In the VIEW 1 study, 96% of pa- tients who received 0.5 mg monthly of VEGF Trap-Eye, 95% of patients who received 2 mg of the drug monthly, and 95% of patients who received 2 mg every 2 months were able to maintain their vision. In the VIEW 2 study, 96% of pa- tients who received 0.5 mg of VEGF Trap-Eye monthly and 96% of pa- tients who received VEGF Trap-Eye 2 mg every 2 months where able to maintain their vision. Editors' note: Dr. Heier has no financial interests related to his comments. Loosen restrictions on donor tissue, speaker says A greater restriction on donor age and endothelial cell density would decrease availability and increase the cost of transplant tissue, said Kevin Ross, M.P.H. A 2-year retrospective analysis of 10,310 donor corneas (from 9,365 donors) evaluated the impact of endothelial cell density and donor age restrictions, presum- ing a $2,000 processing fee was in place. "According to the Cornea Donor Study guidelines, 100% of the tissue would be available with a 70- year-old donor and 2,000 cells," he said. But if surgeons demanded 2,300 cells, only 87.5% of the avail- able tissue would be available (at a cost of $2,285); at 2,800 cells only 36.9% of the donor tissue would be available, and the "break even" point would be $5,427, Mr. Ross said. If donor age is restricted to 65 years, available tissue declines to 74.4% of current levels; restrict the age to 60 and available donor tissue drops to 56.4% of current levels. Editors' note: Mr. Ross is president and CEO of Midwest Eye-Banks. October 23, 2011 Evolving keratoplasty techniques For better Descemet's stripping en- dothelial keratoplasty, surgeons should carefully select patients and donors, select the type of insertion technique they will use, and con- sider converting to Descemet's mem- brane endothelial keratoplasty or ultrathin DSAEK, said Friedrich E. Kruse, M.D., Erlangen, Germany. Other related presentations focused on the transition from penetrating keratoplasty to deep anterior lamel- lar keratoplasty. Glaucoma Subspecialty Day How to talk to patients Conveying hope and optimism when talking to patients is one of the most challenging aspects of glaucoma care, said Reay H. Brown, M.D., Atlanta. Glaucoma visits are usually fear-based; patients are scared they're going blind. "But the doctor is fearful, too," Dr. Brown said. "We fear we may not be doing enough to prevent [blindness]." Doctors should never say to a patient, "Nothing is working," or "I give up." Emphasize clinical success. Most treatments are effective, most patients do well, and physicians never run out of therapies to try. Don't get hung up on specific target pressures; it sets everyone involved up for failure. "Nothing frightens a patient more than a doctor who's afraid. Hope is powerful. Treating high pressure is not enough; our words are a critical part of therapy," he said. Will cutting cure? Wondering if the chance to operate in a glaucomatous eye may be its salvation, Dale K. Heuer, M.D., Milwaukee, Wis., said an under ap- preciation for potential risks and complications of medical therapies could be the rationale for surgery. "Glaucoma surgery's 'holy grail' may be predictable intraocular pres- sure reduction" with a subsequent reduction in medication use, said Dr. Heuer. Ideally, glaucoma surgery should be able to offer complete preservation of pre-op visual func- tion without long-term complica- tions. October 24, 2011 Future therapies for corneal endothelial disease Three types of therapies are in devel- opment to treat corneal endothelial disease, said Shigeru Kinoshita, M.D., Kyoto, Japan: cultivated corneal endothelial cell sheet trans- plantation, cultivated corneal en- dothelial cell injection therapy, and eye drops. Dr. Kinoshita and fellow investigators have used cell sheet transplantations in primates with advanced corneal endothelial dys- function; the transplantations were moderately successful. Cell injection therapy along with a Rho-kinase (ROCK) inhibitor in a group of rabbits and monkeys led to better endothelial cell adhe- sion, high cell density, and normal- looking morphology. The use of eye drops, which Dr. Kinoshita described as still "a dream," involves the use of ROCK inhibitor eye drops. Experi- mental use of drops in rabbits and monkeys led to the regeneration of a corneal endothelial monolayer and high endothelial cell density. Examining limbal stem cell deficiency Corneal limbal stem cell deficiency is more common than previously thought, but it is also easy to con- fuse with other conditions. For ex- ample, punctuate epitheliopathy, corneal vascularization, acne rosacea, and fibrosis all may resem- ble limbal stem cell deficiency, said Mark Mannis, M.D., Sacramento, Calif. Clinicians must consider the historical setting, whether the con- dition is unilateral or bilateral, the presence of significant inflamma- tion, and associated lid or skin dis- ease to make a proper diagnosis, he said. Town Hall Meeting on Laser- Assisted Cataract Surgery Experts in femtosecond laser-assisted cataract surgery participated in a forum to continue the dialogue about the new technology. Currently, the LenSx Laser (Alcon, Fort Worth, Texas) is being used in the U.S. for anterior capsulo- tomy and lens fragmentation. The LensAR Laser System (Winter Park, Fla.) was approved this year by the FDA for anterior capsulotomy and lens fragmentation. The Bausch + Lomb/Technolas laser (Rochester, N.Y./St. Louis) and OptiMedica Catalys (Santa Clara, Calif.) are not yet available in the U.S. William J. Link, Ph.D., Newport Beach, Calif., said that when a new technology is introduced, "there's al- ways this beautiful, awkward, dis- ruptive time where we try to sort it out and debate, and then it will be refined with data and experience." Dr. Link said he believes that in the future, cataract surgery will be dramatically different because of the advent of the femtosecond platform. "For that to happen, it has to work economically," he said. "It has to be good for the patient, it has to be good for the practice, and it has to be good for the company. We don't have those answers quite yet." In a rapid-fire session on techni- cal experience and outcomes, Harvey Uy, M.D., Makati, Philip- pines, who has been using the LensAR system for 2 years, said he has demonstrated that the use of the laser for lens fragmentation means less phacoemulsification energy will be needed during removal of the cataract. "As we gain more experience with this technology and as the technology gets upgraded, we're finding that it's easier to remove the anterior capsules," Dr. Uy said. In a panel on the ethics and business of the procedure, ASCRS Director of Government Relations Nancey K. McCann said that the coverage and payment parameters for medically necessary cataract sur- gery are well defined by the U.S. government. The covered procedure encom- passes cataract steps including, "making an opening in the eye to permit entrance of the surgical in- struments, capsulorhexis of the an- terior capsule, and fragmentation of the lens nucleus," Ms. McCann said, adding that this includes insertion of the IOL. "You cannot bill the pa- tient extra for anything that is part of the covered service." continued on page 56 December 2011

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