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EW MEETING REPORTER June 2014 59 Mr. Forchette looks back on the encounter as a "pivotal experience" that shaped the direction his career would take, motivating him to pursue business and become a CEO. Mr. Forchette dedicated the award to his passionate colleagues at OptiMedica. "It's not just a company that people enter to work in every day," he says. "It's a spirit of passionate people driven to deliver break- through technologies. And those people came into work every day to deliver their best, and they did it over and over again. This award really is their award." O.U.S. vs. U.S. Panelists from around the world commented on clinical studies, including Donald T.H. Tan, FRCS, Singapore, Michael Mrochen, PhD, Switzerland, Roberto Zaldivar, MD, Argentina, Matteo Piovella, MD, Italy, Malvina B. Eydelman, MD, director of the Division of Oph- thalmic and Ear, Nose and Throat Devices, Office of Device Evaluation, Center for Devices and Radiological Health, FDA, and Aron Shapiro, the vice president of Ora (Andover, Mass). The session was moderated by Gilbert Kliman, MD, Menlo Park, Calif. Dr. Eydelman gave a presenta- tion about O.U.S. (outside U.S.) vs. U.S. clinical trials in ophthalmic innovation. Recent trends are that initial clinical testing of some novel devices has moved to non-U.S. sites, and some devices are being developed exclusively for non-U.S. markets. These trends can have conse- quences, including concerns regard- ing applicability of study findings to the U.S. population and a delay in availability of some beneficial medical devices for U.S. patients. "We're committed to improving U.S. patients' access to new devices," Dr. Eydelman said. Cornea Day topics range from nomograms to glaucoma The 2014 Cornea Day program featured presentations on topics ranging from advances in cataract surgery for the corneal surgeon, to the benefits of using viscosurgical devices and staining materials for better visualization. With 50% of all patients pre- senting for cataract surgery having "at least 0.75 D of astigmatism," choosing how to correct that astig- matism is becoming more of an issue, said Kendall Donaldson, MD, Miami. Studies have shown that for astigmatism levels of 2.25 D or higher, toric IOLs are preferred, but at lower levels there's not much statistical difference in outcomes between toric and limbal relaxing incisions (LRIs). "We know from the Nichamin nomograms that we need to treat with-the-rule astigmatism differently from against-the-rule," she said. Although there are no published nomograms when using the fem- tosecond laser, "if you're using the Donnenfeld or Nichamin nomo- grams, subtract about 33% from your manual nomograms," she said. Some tips for success when using the femtosecond laser: patient selection, managing patient expecta- tions, and "select and personalize your nomogram with continual outcome analysis." The etiology of dry eye is "not perfectly clear," and the neurotoxic- ity of the excimer laser results in a cyclical process of "inflammatory dessication of the ocular surface," said Elizabeth Yeu, MD, Norfolk, Va. Several factors increase the risk of dry eye complications/complaints in the postop LASIK patient, includ- ing low Schirmer's scores, preop contact lens wear, and ocular allergies, among others. "An older age and female gen- der may confer a greater risk," she said. Race may also play a role, as chronic dry eye after 6 months is seen more frequently in Asian eyes than in Caucasian eyes, she added. Postop dry eye will peak between 1 week and 3 months after LASIK, and will be "considerably worse" if preop dry eye exists, she said. She suggests tear film break-up time be more than 8 seconds and preop dry eye be mild before considering LASIK in these eyes. In general, she suggested treat- ing preop dry eye medically first, then procedurally, which may in- clude thermal pulsation or chalasis cauterization. Douglas D. Koch, MD, Hous- ton, Texas, stressed to attendees that "if you measure only the anterior cornea," there will be over- and undercorrection, depending on which IOL is chosen and whether astigmatism is with-the-rule (WTR) or against-the-rule (ATR). If the ATR is on the front cornea, it will be steeper horizontally and will not create much of a change on the back surface, but a WTR astigmatism (steeper on the posterior surface) can result in as much as 0.9 D difference. "I try to leave patients with 0.4 D of WTR astigmatism. That gives them good uncorrected vision for many years," he said, adding the importance of accounting for the impact of effective IOL toricity of IOL power and anterior chamber depth. Two nomograms to use are the Holladay II and the Abbott Medical Optics toric IOL calculator. "Don't forget to factor in surgi- cally induced astigmatism," he said. The "holy grail" for perfecting nomograms would be the ability to measure the posterior corneal with either Scheimpflug or optical coher- ence tomography, he said. Surgeons are well aware that IOP spikes occur during phaco, often exceeding 60 mmHg, but advanced phaco machines will address these fluctuations. Malik Y. Kahook, MD, Aurora, Colo., said that few publica- tions currently address IOP changes related to femtosecond cataract surgery. "The literature suggests a modest rise in IOP during suction and treatment," he said. Editors' note: Dr. Donaldson has no related financial interests. Dr. Koch has financial interests with Abbott Medical Optics and Alcon. Dr. Yeu has financial interests with companies including Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, and TearLab. Glaucoma Day celebrates 10th anniversary, tackles glaucoma's hot issues The 2014 Glaucoma Day celebrated its 10th anniversary in Boston with Reay Brown, MD, Atlanta, sharing how the meeting's attendance has nearly doubled since its inception. Glaucoma Day in 2005 had 245 attendees vs. 550 attendees last year, he said. In 2005, more of the meet- ing was devoted to medical therapy while in recent years, two-thirds of the sessions have focused on surgical approaches. Other highlights regarding the growth of Glaucoma Day in general and within ASCRS include the regu- lar inclusion of a video complica- tions session and a cornea/cataract crossover talk, said Dr. Brown. Three continued on page 60 58-65 MR-ASCRS_EW June 2014-Dl2_Layout 1 6/3/14 12:43 PM Page 59

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