Eyeworld

EW MEETING REPORTER 93 and less hyperopic shift. There is also thought to be a lower incidence of rejection with DMEK, he said. Editors' note: Dr. Raber has financial interests with B+L. Dr. Rubenstein has financial interests with Alcon and B+L. The expanding glaucoma armamentarium The session on glaucoma examined topics including detecting glauco- ma progression, anterior chamber visualization, cataract surgery for glaucoma patients, minimally invasive glaucoma surgery (MIGS), tube shunts, and syndromes masquerading as glaucoma. Douglas J. Rhee, MD, Cleve- land, gave a presentation focusing on anterior chamber visualization, mentioning both ultrasound biomi- croscopy (UBM) and OCT as 2 main anterior segment imaging tests. Although anterior segment imaging is important, goniosco- py remains a vital tool. "There is nothing that you can diagnose with an anterior segment imager that you cannot diagnose with gonioscopy," Dr. Rhee said. "Gonioscopy is still the gold standard." Editors' note: Dr. Rhee has financial interests with Alcon, Allergan, and Santen Pharmaceutical (Napa, Calif.). The premium cataract experience In a session focusing on premi- um-level cataract surgery options, Gary J.L. Foster, MD, Fort Collins, Colo., shared pearls for balancing the premium cataract experience with patient goals and expectations. When it comes to choosing the best premium IOL for a patient, "my specific goal is to match the lens that is most likely to fit well in their lifestyle," Dr. Foster said. He matches the visual results his patients hope to achieve with their daily tasks and activities to determine the best IOL for each patient. Jonathan Rubenstein, MD, Chicago, shared pearls for managing patients who are unhappy with their visual results after premium cata- ract surgery. He stressed the need to manage patients' vision expectations in the preoperative period. Elizabeth Yeu, MD, Norfolk, Va., shared pearls for preoperative management of astigmatism. Dr. Yeu stressed that surgeons must accurate- ly assess both anterior and posterior corneal astigmatism, understand the astigmatic effects of corneal incisions, consider the patient's age when setting an astigmatic target, and understand that effective lens position can affect the true toricity of a lens. Charles D. Reilly, MD, San Antonio, shared his reasons for switching from a diamond blade to the femtosecond laser for limbal relaxing incisions and astigmatic keratotomy. Dr. Reilly discussed the advantages and disadvantages of laser incisions, and presented several cases that reaffirmed his belief that the laser provides more "bang for the buck" for astigmatism surgery. Steven C. Schallhorn, MD, San Diego, highlighted the role that astigmatism correction plays in patient satisfaction. "If you want to maximize the number of happy pa- tients you have after a premium IOL procedure, you want to minimize the postop astigmatism," he said. A large study of premium IOL outcomes showed that even a half diopter of astigmatism can impact a patient's satisfaction, he said, so careful astigmatism management is paramount. Editors' note: Dr. Foster has financial interests with Alcon and WaveTec Vision. Dr. Reilly has financial interests with AMO, Alcon, Allergan, and B+L. Dr. Rubenstein has financial interests with Alcon and B+L. Dr. Schallhorn has financial interests with AMO and Allergan. Dr. Yeu has financial interests with B+L. Femtosecond laser-assisted cataract surgery debate continues The final part of the session focused on femtosecond cataract surgery, with Sumitra S. Khandelwal, MD, Houston, offering pearls for short- ening the learning curve associated with switching to the laser. One of the most important things a surgeon can do is pick cases that are straight- forward, she said—choose patients who have large pupils, clear corneas, normal brows, and small palpebral fissures. Douglas D. Koch, MD, Houston, discussed the potential for femtosecond laser surgery to become mainstream, with the deciding factors being the clinical benefits, cost, and efficiency of the procedure. While the clinical benefits are still being researched, the technology will allow for new IOL designs that could better assess effective lens position, Dr. Koch said. Editors' note: Dr. Khandelwal has no related financial interests. Dr. Koch has financial interests with AMO, Alcon, ReVision Optics (Lake Forest, Calif.), and Ziemer. The anterior segment and refractive surgery The "The Kitchen Sink" session highlighted a number of anteri- or segment and refractive surgery topics and was moderated by Sumit "Sam" Garg, MD, Irvine, Calif., and Dr. Yeu. Dr. Yeu's presentation focused on monovision. She highlighted some of the advantages and disad- vantages associated with it. "With regard to monovision, it's an excellent option for presbyopia correction," she said. Advantages include financial savings over pres- byopia-correcting lenses, predictable refractive outcomes, and the fact that an "ideal eye" is not necessarily needed. There are, however, some disadvantages, like stereoacuity, depth of focus, contrast sensitivi- ty, and patient acceptance of such issues as blur, headaches/strain, and glare. When doing monovision, it is also important to gauge the needs of your patient, Dr. Yeu said. Factors like occupation and personality can play a role. For example, mono- vision may be more favorable for someone whose occupation requires constant change in viewing distanc- es. However, it is unfavorable for prolonged distance or near vision. In terms of personality, perseverance is more important than motivation, Dr. Yeu said. Among the factors that are not predictive are gender, pupil size, immediate reaction to monovi- sion, motivation, and self-efficacy. M. Bowes Hamill, MD, Houston, highlighted sutured and dislocated IOLs. He mentioned 3 key questions that a surgeon needs to ask when faced with a dislocated IOL. These questions address how bad the dislocation is, if the lens needs to be replaced, and how to fixate out of the original lens or the replacement lens. Editors' note: Dr. Hamill has no related financial interests. Dr. Yeu has financial interests with B+L. Surgical pearls highlighted in video symposium The video symposium "Toys, Traps, and Tricks" focused on surgical pearls for glaucoma, cataract, and corneal surgeries. Peter T. Chang, MD, Houston, described his tech- nique of injecting mitomycin-C in glaucoma surgery instead of using the traditional sponge application, and highlighted silver nanoparticles as a potential new antimetabolite option in the future. EW Editors' note: Dr. Chang has financial interests with Alcon. Ophthalmic Symposium, San Antonio September 2014

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