Eyeworld

EW MEETING REPORTER June 2014 63 The session was moderated by Edward J. Holland, MD, Cincinnati, and panelists included Eric D. Donnenfeld, MD, Rockville Centre, N.Y., Bonnie An Henderson, MD, Boston, and Thomas W. Samuelson, MD, Minneapolis. Specialists gave their comments on the state of the art in their sub- specialty and shared predictions for the future. Donald T.H. Tan, FRCS, Singapore, discussed cornea surgery; Thomas Kohnen, MD, Germany, addressed presbyopia correction; Reay H. Brown, MD, Atlanta, spoke about glaucoma surgery; Roger F. Steinert, MD, Irvine, Calif., talked about refractive surgery; David F. Chang, MD, Los Altos, Calif., ad- dressed cataract surgery; and Kent Stiverson, MD, Denver, spoke about an alternative model for eyecare. There is a paradigm shift in the way that corneal transplantation can be performed, according to Dr. Tan. He mentioned a number of proce- dures: penetrating keratoplasty (PK), endothelial keratoplasty (EK), Descemet's stripping endothelial keratoplasty (DSEK), and deep ante- rior lamellar keratoplasty (DALK). Recent studies of PK have looked at donor age, but it was found that it has minimal effect on graft survival. What's most surpris- ing was the substantial endothelial cell loss after PK. DALK is being studied and a number of articles have found it to be better than PK, but the major problem with DALK is the learning curve, Dr. Tan said. The field of corneal transplanta- tion is rapidly evolving with the revolution of selective lamellar keratoplasty, Dr. Tan concluded. This looks to be the future of corneal transplantation, but PK will always be needed, he said. Dr. Brown took attendees back to a time when "eye drops ruled glaucoma." There were a number of problems with eye drops because compliance is terrible and there is a recurring expense, as well as a number of side effects. He questioned whether glau- coma should be treated as a surgical disease, noting that this can't be the case with trabeculectomy and tubes because of the complications associ- ated with these procedures. There could be changes coming in the next few years, though, and Dr. Brown said there are new indica- tions for glaucoma surgery. There are also a number of MIGS devices that are being introduced and seeking approval, and new combinations of devices will start to be seen. Currently MIGS is only indi- cated for combination with cataract surgery for mild to moderate cases, but Dr. Brown believes that soon it will have standalone indications that can be used for advanced cases of glaucoma. Dr. Steinert said there has been a major decline in the U.S. market for refractive surgery. Despite this decline, Dr. Steinert said many surgeons believe that there will be growth. Various factors can influence the demand for laser vision correc- tion. In the near term, technology, the economy, consumer perceptions, price/value, and national issues are going to play a role, while in the intermediate term, demographics, psychographics and purchase behavior, right of passage culture, and alternatives to laser vision correction will be major factors. The future market is more promising than current patterns, and it could start to look like the past, Dr. Steinert said. Editors' note: Dr. Steinert has financial interests with Abbott Medical Optics and ReVision Optics. Dr. Tan has financial interests with Alcon, Bausch + Lomb, Carl Zeiss Meditec, Moria, Network Medical, and Santen. Dr. Brown has financial interests with Glaukos, Ivantis, Rhein Medical, and Transcend Medical. 'Hot Off the Press' ends ASCRS 2014 The final session of the 2014 annual meeting was "Hot Off the Press," which featured a panel discussion on the best papers of ASCRS 2014. David F. Chang, MD, Los Altos, Calif., moderated the session, and panelists were Eric D. Donnenfeld, MD, Rockville Centre, N.Y., Graham Barrett, FRANZCO, Perth, Australia, Reay Brown, MD, Atlanta, Clara Chan, MD, Toronto, and Bonnie An Henderson, MD, Boston. Speakers in the session were Boris Malyugin, MD, PhD, Moscow, John P. Berdahl, MD, Sioux Falls, S.D., Susan MacDonald, MD, Burlington, Mass., Bennie Jeng, MD, Baltimore, and Husam Ansari, MD, PhD, Boston, and they pre- sented on papers from a number of subspecialties. Dr. Berdahl presented on refrac- tive topics. The first paper discussed the role of the percentage of tissue altered (PTA) as a risk factor for post LASIK ectasia in an eye with normal preoperative topography. When comparing this to other potential risk factors, the PTA was found to be considerably higher than other risk factors. What was found in the paper was high PTA was the most prevalent identifiable risk factor in ectasia eyes with nor- mal preoperative topography. PTA greater than or equal to 40% was a more robust indicator of risk than all other variables in this patient population, the paper concluded. Dr. Berdahl also highlighted a paper titled "Military Target Identifi- cation After Wavefront-Guided (WFG) and Wavefront-Optimized (WFO) Photorefractive Keratectomy (PRK)." The purpose of this study was to determine the effect of WFG and WFO PRK on military task per- formance through psychophysical testing. It aimed to determine how quickly people could identify what type of military object was coming at them, Dr. Berdahl said, and the results show that no one lost any lines of vision. The majority of pa- tients were able to see targets better after having this type of treatment, he said. Some conclusions of this paper were that a significantly greater number of eyes achieved refractive stability within the first 6 months after WFO PRK compared to WFG PRK, and refractive outcomes follow- ing WFG and WFO PRK are other- wise excellent and comparable. Additionally, the paper concluded that wavefront refractive surgery appears to improve military task performance. Dr. Ansari presented on glaucoma paper topics, the first of which focused on patients undergoing cataract surgery with two iStents (Glaukos) compared to those undergoing cataract surgery with the Trabectome (NeoMedix). Both the iStent and Trabectome offer sustained and significant reduction in IOP and medications used over a one-year period when combined with cataract surgery, and both have "excellent safety profiles," according to the paper. Additional reduction in IOP and medication use is seen in combined cataract surgery and double iStent implantation as compared to com- bined cataract and Trabectome, the paper concluded. EW Editors' note: Dr. Ansari has financial interests with Ivantis. Dr. Berdahl has financial interests with Glaukos. Dr. Berdahl presents at the "Hot Off the Press" symposium. 58-65 MR-ASCRS_EW June 2014-Dl2_Layout 1 6/3/14 12:44 PM Page 63

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