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EW MEETING REPORTER 116 February 2015 Reporting from Hawaiian Eye 2015, Maui, Hawaii January 17–23 would use Ks that were consistent. However, the end result was a myo- pic surprise, and Dr. Yoo said if she had used the one outlier, it would have been closer. Eric Donnenfeld, MD, New York, one of the panelists, said this could have been a perfect case for the use of intraoperative aberrom- etry, which could have potentially helped to anticipate and avoid the myopic surprise. Because the surgery was already done and the patient was myopic, he suggested that an IOL exchange might be the next step, which is the course of treatment that Dr. Yoo took for her patient. Editors' note: Dr. Yoo has financial interests with Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, and Carl Zeiss Meditec. Dr. Donnenfeld has financial interests with Abbott Medical Optics, Alcon, Bausch + Lomb, and Carl Zeiss Meditec. Social determinants of health have impact Eve Higginbotham, MD, Philadel- phia, discussed what every oph- thalmologist should know about the social determinants of health. Potential social determinants in- clude access to healthcare, poverty, education, work, leisure, and living conditions. She used the case of a patient she treated to explain this topic. Her patient was a 70-year-old retired female public school teacher who presented with advanced glau- coma. Dr. Higginbotham said she was struggling to find a treatment to help the patient preserve her vision because the visual field over the last 3 years was concerning. Dr. Higginbotham realized that deciding on a course of treatment required knowing about the pa- tient's life beyond her eye exam. Physical environment is important, as is behavior, biology, and social en- vironment. A question that should be asked when treating patients is, "How can we address health dispar- ities?" Answering this could require a step back from the case to look at the patient in a holistic way. Dr. Higginbotham highlighted data from studies in the U.S. that stress how diverse the country is, with a number of different populations that have varying life expectancies. The U.S. is one of the richest coun- tries in the world, but there is also a disparity of income across the coun- try, which has a major influence on health and access to treatment. Disparities in health are determined from a number of factors. Genetics may account for only 20% to 25% of variation, she said, and different physical and social environments in the U.S. may account for 20% to 25% of the variation in outcomes in morbidity and mortality. Visu- al impairment particularly has a serious functional impact on elderly patients. It is one of the 4 most significant contributors to the loss of independence among older pa- tients, she said, and can contribute to driving accidents and falls. This particular patient did not understand the importance of eye drops, had missed drops, lived alone, relied on public transportation, and was not aware that medica- tion could be ordered by mail. Dr. Higginbotham said she engaged the patient's daughter to help with her mother's condition. The patient was prescribed affordable medication sent by mail to make it easier. Dr. Higginbotham said it is im- portant to understand that the social determinants of health matter and can make a difference in the quality of care that is delivered. "Think and act beyond the technical consider- ations of care," she said. Personal- izing treatment based on both the ocular and non-ocular needs of the patient is key. Editors' note: Dr. Higginbotham has no related financial interests. How to approach patients with family history of glaucoma Janey Wiggs, MD, PhD, Boston, spoke to attendees about how to approach patients who have a family history of glaucoma. "First of all, about 50% of glaucoma cases have family members with glauco- ma," she said. Patients with primary affected family members have more severe disease, are more likely to become blind, and are more likely to benefit from genetic testing for mu- tations in glaucoma genes. But she had a note of caution about testing: "With today's collection of glau- coma genes, not every patient bene- fits from genetic testing," Dr. Wiggs said. She recommended clinicians pay attention to age of diagnosis of patients and their family members. For those diagnosed before the age of 50, with early onset disease, the mutation causes the disease, and gene-based therapies are emerging. But for those diagnosed after age 50, with late onset disease, the disease View it now: Hawaiian Eye 2015 ... EWrePlay.org Kevin Miller, MD, talks about the state of the Calhoun Vision Light Adjustable Lens.

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