EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/357599
9 EW NEWS & OPINION P ast ASCRS President Alan S. Crandall, MD, has been named the 2014 recipient of the American Academy of Ophthalmology's (AAO) Outstanding Humanitarian Service Award. Dr. Crandall is the John A. Moran Presidential Professor of Ophthalmology & Visual Sciences, Val A. and Edith D. Green Presidential Endowed Chair, senior vice chair, director of glaucoma and cataract, and co-director of the Division of International Ophthalmology at the John A. Moran Eye Center, University of Utah. The honor is awarded to AAO members who have demonstrated a pattern of humanitarian service in the United States or abroad. It recognizes "Academy members for contributions to charitable activities, care of the indigent, and community service performed above and beyond the typical duties of an ophthalmologist." "Dr. Crandall has placed himself in harm's way countless times while delivering care in war zones and unstable nations," said Eric Donnenfeld, MD, who nominated Dr. Crandall. "I can think of no other individual more deserving. Alan represents the best of what ophthalmology offers the world, and the lives of thousands in Africa, Latin America, Asia, and the United States are better for his dedication and consistent willingness to help." Dr. Crandall will receive his award in October at the AAO's annual meeting in Chicago. In his nomination letter, Dr. Donnenfeld highlighted Dr. Crandall's work in establishing a teaching hospital in Ghana and his humanitarian work with the ASCRS Foundation in Ethiopia. Dr. Crandall's teaching visits to the ASCRS Foundation's Robert Sinskey Eye Institute have been a key part of preparing the physi- cians and staff to handle more than 15,000 patients annually. "You see the gratitude on peo- ple's faces, which reminds you every day of the profound difference the Foundation is making in their lives," said Dr. Crandall of the experience. "Sometimes we forget that blind- ness and other visual impairment in countries like Ethiopia have far greater economic and social con- sequences than they do in more developed countries." Coupled with his efforts in Ghana and Ethiopia, Dr. Crandall has been actively involved with Geoffrey Tabin, MD, and the Moran Eye Center's international outreach program. Through this program, they created an education- al exchange between the Tilganga Eye Center in Nepal and the Moran Eye Center. In addition to the Outstanding Humanitarian Service Award, Dr. Crandall has received numerous accolades. These include AAO's Senior Honor Award, the Health Care Heroes Award for Excellence in Health Care—Community Outreach, Rotary International's Vocational Excellence Award for Humanitarian Service, the Dr. Clark Lowe Rich Distinguished Surgeon and Mentor award, and being named one of the 50 most prominent opinion leaders by Cataract and Refractive Surgery Today. "What I think is important about Alan is that he has not only done a tremendous amount of work internationally performing cataract surgeries, he is involved in teaching others in the developing world and creating mechanisms to show other In the journal . . . Microincision glaucoma surgery: cataract surgery in glaucoma patients Reay H. Brown, MD, Le Zhong, BS, Mary G. Lynch, MD Investigators considered how lens-based surgery can affect glaucoma. For patients with glaucoma, cataract surgery can lower IOP. In particular, for those with angle closure glaucoma, there is substantial evidence that cataract surgery can not only lower IOP but also effectively tamp down on future acute attacks and occurrences of IOP spikes, they reported. Some evidence from randomized controlled trials shows that procedures such as laser iridot- omy or phacotrabeculectomy may not fare as well as cataract surgery in these angle closure cases, investigators noted. Spurred by such evidence, a randomized controlled trial has been launched to determine whether uncontrolled IOP cases may be effectively handled with clear lens extraction. However, investigators observed that for open angle glaucoma, there is more contention around use of cataract surgery to lower pressure. While open angle glaucoma pa- tients, who were stratified by IOP, showed a notable pressure reduction, these findings were called into question for methodological weakness. Nevertheless, up to 8.5 mm Hg pressure reduction was seen, investigators said. They added that combining microinvasive glaucoma procedures with cataract surgery was another option for lens-based glaucoma surgery. Review/update: segmental and distal aqueous outflow Swarup S. Swaminathan, Dong-Jin Oh, Min Hyung Kang, Douglas J. Rhee, MD Ocular hypertension, resulting from impaired aqueous humor outflow through the trabecular meshwork, is a well-known risk factor for primary open angle glaucoma. In this update, in- vestigators noted that the main contributors to aqueous outflow resistance have been tagged as the trabecular meshwork's juxtacanalicular region and the inner wall of Schlemm's canal. Also shown to affect outflow is trabecular meshwork cell shape, as well as the meshwork's extracellular matrix. The idea of segmental flow in which only certain segments of the trabecular meshwork can achieve outflow has been shown by several groups, they noted. This has been described not only in humans but also in the eyes of primates, bovines, and mice. Investigators explained that the theory here is that there are discrete pores within Schlemm's canal that the aqueous outflow depends upon. Meshwork bypass procedures, however, have been unable to equal the degree of IOP reduction observed with trabeculectomy, despite the fact that this appears to be the major source of resistance. This likely stems from the influence that the flow through Schlemm's canal and collector channels have on outflow. Investigators concluded that such distal structures may be more important to preserving aqueous outflow than previously thought, with several studies indicating that outflow occurs preferentially near such sites. Corneal inlay for presbyopia Caroline Baily, MD, Thomas Kohnen, MD, PhD, FEBO, Michael O'Keefe, MD, FRCS In this case series, investigators reported on how presbyopic patients fared with the Icolens corneal inlay at the 12-month postoperative mark. Those included in the study were emmetropic and had the inlay implanted in the nondominant eye through a corneal pocket created by the femtosecond laser. Investigators reported that with the inlay, mean uncorrected near visual acuity, which ranged from N18 to N24 preoperatively, improved to a mean of N8 postoperatively. They found that 17% of patients attained uncorrected postoperative near vision of N5 or better, while all, at minimum, reached the N16 mark. In the treated eye, there was a mean loss of 1.67 lines of uncorrected distances visual acuity. However, there was a mean binocular gain in distance acuity of 0.48 lines, with 42% of patients postoperatively gaining more than 1 line. Meanwhile, for corrected distance acuity investigators found that there was a mean loss of 1.78 lines postoperatively, with no significant change in endothelial cell count or corneal topography postoperatively. When it came to satisfaction, 90% of patients reported that they were happy or rather happy with the procedure. However, 11 implants were removed due to minimal uncorrected near visual improvement. But there were no significant adverse events. Investigators concluded that for emmetropic patients, presbyopia could be effectively corrected with the Icolens inlay. August 2014 Alan Crandall, MD, receives Outstanding Humanitarian Service Award by Abbie B. Elliott ASCRS•ASOA Communications Manager Alan S. Crandall, MD continued on page 10 August 2014 ASCRS update