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EW MEETING REPORTER 56 December 2011 Jonathan H. Talamo, M.D., Boston, talked about the conver- gence of business and ethics with the new technology and asked whether surgeons, as advocates for patients, should lobby government agencies and third-party payers to allow a self-pay option for patients who desire the use of the femtosec- ond laser. "I would say probably not at this time," Dr. Talamo said. "The data and safety efficacy advances aren't there yet. I think they're com- ing. Coverage, if it happens, will likely not include overhead costs (of the technology) versus if there were a self-pay scenario." During the question/answer portion, Gary J. Foster, M.D., Fort Collins, Colo., without giving spe- cific numbers, shared that his prac- tice is currently charging patients what they think it costs them to per- form the surgery on patients. "If the value starts to be demon- strated in studies, we would feel con- fident raising that price," Dr. Foster said. Stephen G. Slade, M.D., who is in a solo referral-based private prac- tice, has used the LenSx Laser for cataract surgery on close to 500 pa- tients in Houston during the 2 years he has had it. "If this were a stock, I'd say it's at an all-time high," he said. Editors' note: The ASCRS & EyeWorld Town Hall was supported by educa- tional grants from Alcon, Bausch + Lomb, and Abbott Medical Optics (AMO, Santa Ana, Calif.). OptiMedica also offered its financial support as a patron-level sponsor. Dr. Foster has fi- nancial interests with Alcon. Dr. Link has no financial interests related to his comments. Ms. McCann has no finan- cial interests related to her comments. Dr. Slade has financial interests with Alcon and AMO. Dr. Talamo has fi- nancial interests with Alcon, Bausch + Lomb, and OptiMedica. Dr. Uy has financial interests with Alcon and LensAR. October 25, 2011 Pursuing the Next Level of Outcomes in Customized Laser Refractive and Cataract Surgery Modern-day, high-technology LASIK does not cause long-term dry eye in patients with no dry eye history, said Daniel S. Durrie, M.D., Kansas City, Kan., after conducting a single- center, prospective, randomized study. The study also found no dif- ference in subjective or objective re- sults between 8.0 mm and 9.0 mm flap sizes. "We had excellent visual acuity results," said Dr. Durrie. "The data showed that the halo, glare, and night vision problems were not worse overall. That temporary halo and glare is probably due to the tem- porary dryness. We do have a tem- porary dryness that goes away with the modern laser." Louis E. Probst, M.D., Chelsea, Mich., compared operative and im- mediate post-op results between the FS60 CustomVue (Abbott Medical Optics, AMO, Santa Ana, Calif.) and the iFS CustomVue (AMO), stating he estimates that flaps are "50% eas- ier to lift" with the iFS. "The iFS is much better in the OBL department. Patients are more comfortable after, they have less flap edema and faster visual recovery," he said. He also described oval flap cre- ation with the iFS, stating that he thinks "everyone will be doing oval flaps in the next couple of years." "The ovality ensures surgeons have perfect flap alignment without using any alignment marks. This en- sures they're not getting any rota- tion and will reduce the incidence of striae. It's a better surgical technique and in my mind will give better re- sults." Editors' note: This program was supported by an educational grant from AMO. Kelman Lecture After a dynamic case-based video session where surgeons shared some of their groan-inducing cataract sur- gery complications, R. Bruce Wallace, M.D., Alexandria, Wis., introduced David F. Chang, M.D., Los Altos, Calif., who gave the 2011 Charles D. Kelman Lecture. Dr. Chang kept with the compli- cations theme and presented his "most technically challenging and emotionally frightening case"—a 61-year-old author with a severe case of scleritis. "Her doctor had managed her secondary glaucoma with a tra- beculectomy 20 years earlier in her right eye, but the left eye went blind following phaco complications, sec- ondary glaucoma, and optic atro- phy," Dr. Chang said. "Now her good eye had a rock- hard cataract and was 20/200," he said. "She's one-eyed, living alone. I'm worried about the scleritis be- coming activated. I'm worried about the bleb failing. I'm worried about a wound burn, how I might close the incision with such a thin cornea, and about corneal decompensation with a rock-hard nucleus." His biggest concern, however, was that he didn't know what he would do if there was a complica- tion, which there was. "Here's the worst part," Dr. Chang said. "I cannot incise the an- terior capsule because there is pha- codonesis. The zonules are totally loose, and the lens is just bopping away from me as though the needle was dull." The patient ended up J3, but be- cause the lens was placed in the sul- cus and she had a large eye, it tended to subluxate. "Her pupil was small enough that she tolerated it," Dr. Chang said. Sadly, 9 years post-op, at 20/60 vision, the patient fell and ruptured her globe. Despite heroic efforts to save her eye, she only recovered enough vision to count fingers. "I was heartbroken to learn a year later that she had committed suicide," Dr. Chang said. "This is a very poignant and tragic reminder of the tremendous risk and the tremendous burden and the stress that we and our patients take on when we operate on the only eye of a patient." EW Reporting live from the 2011 American Academy of Ophthalmology meeting in Orlando, Florida Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2011 AAO meeting, Orlando, Fla.

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