Eyeworld

9 EW NEWS & OPINION T he American Society of Cataract & Refractive Surgery (ASCRS) announced that Natalie A. Afshari, MD, FACS, would be the new chair of the ASCRS U.S. Food and Drug Administration (FDA) Committee. The accomplished clinician, surgeon, and research scientist's role will be to provide oversight and feedback on ASCRS regulatory activities involving drugs and medical devices. Prior to her new role with ASCRS' FDA Committee, Dr. Afshari served as ASCRS' representative on the Council of the American Acad- emy of Ophthalmology (AAO) and as chief judge for ASCRS' scientific posters. Her government relations experience includes consultation with the FDA on matters of safety and efficacy of various ophthalmic treatments, as well as a National Institutes of Health (NIH) grant support to study Fuchs' endothelial corneal dystrophy. Dr. Ashfari was also elected to the cornea program and awards committees of the Association for Research in Vision and Ophthalmology (ARVO). A recognized expert in corneal transplantation and refractive surgery, Dr. Afshari specializes in cataract surgery, endothelial keratoplasty, and collagen crosslink- ing for keratoconus. With regard to laser refractive surgery, Dr. Afshari specializes in LASIK, LASEK/advanced surface ablation, photorefractive keratectomy, and phototherapeutic keratectomy. Dr. Afshari's numerous hon- ors have included the prestigious Research to Prevent Blindness (RPB) Award; the Heed Foundation Ophthalmic Award; the Teacher of the Year Award at Duke University Eye Center; the inaugural Top Ten Women in Medicine Award from Triangle Medical News; the AAO Achievement Award; and the AAO Secretariat Award. She has been named by her peers as one of the "Best Doctors in America" (in each listing over the past decade). In addition to many speaking engagements, Dr. Afshari has published extensively in both medical journals and textbooks. She is the co-editor of a two-volume cornea book "Principles and Practice of Cornea"; on the editorial board of Investigative Ophthalmology & Visual Science; and a cataract surgery editor for Current Opinion in Ophthalmology. Dr. Afshari has served on the editorial board of EyeNet magazine, a journal published by the AAO. Dr. Afshari completed a 2-year fellowship in cornea and refractive surgery at Harvard University. She received her medical degree from Stanford University and her residency training at Harvard University, Massachusetts Eye and Ear Infirmary. EW Contact information Elliot: aelliott@ascrs.org In the journal . . . 18-year follow-up of excimer laser PRK Zaid Shalchi, MB BS, BSc, David P.S. O'Brart, MD, FRCS, FRCOphth, Robert J. McDonald, BSc, BMed, MPH, FRANZCO, Parul Patel, MRCOptom, Timothy J. Archer, MA, John Marshall, PhD In this prospective case series, the aim was to consider PRK's long-term efficacy. Preop, the 46 patients included had a mean spherical equivalent refractive error of –4.86 D, and patients underwent a mean correction of –4.43 D. Investigators found that there was a mean change in spherical equivalent of –0.31 D in the postoperative period between 1 and 18 years. For those younger than age 40 at the time of correction there was a mean change in spherical equivalent of –0.54 D during this period. Meanwhile, for those over age 40 there was a change of just –0.05 D. For women, the mean change was –0.40 D versus –0.08 D for men. During this same period, there was a significant improvement in corrected distance visual acuity. At the 18-year mark, haze scores diminished and corneas were clear. Investigators concluded that during the 18-year period, for those younger than age 40 and in women there was a significant increase in the myopic spherical equivalent. Predictability also decreased. However, over time, corneal transparency and corrected distance visual acuity improved. Investigators noted that there were no long-term complications, and they found the procedure to be safe. Femtosecond laser versus conventional phacoemulsification Robin G. Abell, MB BS, Erica Darian-Smith, Jeffrey B. Kan, MB BS, Penelope L. Allen, PhD, Shaun Y.P. Ewe, MB BS, Brendan J. Vote, FRANZCO The investigators in this prospective case series compared safety and complication rates of femtosecond laser-assisted cataract surgery with conventional phacoemulsification. Investigators found that for eyes treated with the femtosecond cataract approach (the study group), vacuum/docking attempts, treatment and vacuum time, and surface recognition adjustments all improved significantly during the course of the study. They determined that in 1.84% of eyes in the study group there were anterior capsule tears versus 0.22% in the conventional phacoemulsification group. Also, in study group cases there were anterior capsulotomy tags in 1.62% of eyes, and there was a significantly higher incidence of intraoperative corneal haze and occurrence of miosis. However, in this group effective phacoemulsification time was significantly lower. The conclusion reached was that there was an overall low occurrence of significant intraoperative complications likely to impact visual outcomes or patient satisfaction. They noted that posterior capsule complications were equal to that of conventional phacoemulsification but that anterior capsule tears remained a concern. Incidence of postoperative endophthalmitis over 20 years Martin M. Nentwich, MD, Christopher N. Ta, MD, Thomas C. Kreutzer, MD, Bing Li, MD, Fabian Schwarzbach, MD, Yazmin M. Yactayo-Miranda, MD, Anselm Kampik, MD, Herminia Miño de Kaspar, PhD This retrospective chart review at a single institution considered how changes in preop prophylaxis affected incidence of postoperative endophthalmitis over a 20-year period from 1990 to 2009. Overall, there was a 0.113% postoperative endophthalmitis rate, with coagulase-negative Staphylococcus determined to be the most commonly isolated organism. In the initial period from 1990 to 1992 no preoperative prophylaxis was used, and this rate was 0.2915. Meanwhile, during period 2, from 1993 to 1998, patients were preoperatively treated using topical medication, with 1 drop of povidone-iodine 10% applied periorbitally and 1 drop of 1.0% povidone-iodine placed directly onto the conjunctiva. With this regimen the endophthalmitis rate dropped to 0.170%. By period 3, from 1999 to 2009, practitioners began also incorporating irrigation of the conjunctiva with 10 mL of povidone-iodine 1.0%, together with the regimen used in period 2. In this period there was just a 0.125% rate of endophthalmitis. The conclusion reached was that at this institution over a 20-year period there was a decrease in the rate of postoperative endophthalmitis. Investigators believe that ample use of povidone-iodine was an important factor here, although they note that multiple factors may have been at play. January 2015 ASCRS names UC San Diego professor as FDA Committee chair by Abbie B. Elliott ASCRS•ASOA Communications Manager Natalie Afshari, MD, FACS January 2015 ASCRS update

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