Eyeworld

Dr. Stiverson's presentation was about the experience and results of 2 Kaiser doctors in Colorado. "I believe this is the largest series of immediately sequential bilateral cataract surgery reported in the United States," he said. "We are able to generate statistically mean- ingful numbers in a relatively short period of time." The focus of his presentation was on complications, with endophthalmitis and TASS both being statistical worries. "At the time of my presenta- tion, Colorado Kaiser had not had endophthalmitis in 25,000 cases or TASS in 40,000 cases," he said. "Those numbers are now 30,000 and 45,000, respectively." Dr. Stiverson said it is thought that this "exceptionally low infec- tion and inflammation rate" is due to the use of intracameral antibiot- ics, trusted vendors, and the increas- ing use of disposable products. "In determining whether a patient is a good candidate for im- mediately sequential surgery, I think corneal surface problems, epiretinal membranes, diabetic macular ede- ma, and advanced glaucoma require the most consideration," he said. Dr. Stiverson also discussed the surprise that so many people want bilateral surgery, even when present- ed with worse case scenarios. With the exception of a few comorbidities or patient acceptance, there is no reason to not operate on both eyes on the same day, he said. Know- ing the behavior of the first eye is invaluable in performing surgery on the second eye. "Without question, I am a more competent, safer surgeon when I can immediately address a second eye when the first eye was not as easy as expected," Dr. Stiverson said. "I think this has profound implications for how we should train residents (same day bilateral surgery whenever possible), but that is a controversial conversation for another day." EW Editors' note: Drs. Arshinoff and Stiverson have no financial interests related to this article. Contact information Arshinoff: ifix2is@gmail.com Stiverson: richard.stiverson@kp.org among the 3 choices, Dr. Arshinoff said, which suggests that most surgeons lack the experience with ISBCS and a desirable reimburse- ment system. Dr. Arshinoff performs bilateral surgery and said he is not worried about the issues posed in the question. "I think the paradigm is slowly changing as cataract surgery be- comes progressively safer and more accurate," he said. Dr. Stiverson feels that the con- cerns about performing bilateral cat- aract surgery may be disingenuous. "The majority of respondents indicated they are worried about bilateral endophthalmitis or bilateral TASS," he said. "And yet, the ASCRS surveys on frequency of endophthal- mitis and TASS continue to decline." These are now rare, and he thinks the responses were a reaction to the hesitation felt by surgeons over the money aspect of bilateral surgery. "Over the years, I have had innumerable patients who would have truly benefited from same day bilateral surgery," he said. "Transpor- tation, infirmity, terminal diseases, anxiety, and finances are all appro- priate reasons to consider bilateral surgery." However, Dr. Stiverson said the major reason he chose separate sur- geries was financial penalties. "I think that financial penalties are the main reason that same day bilateral surgery lags in the United States," he said. If these penalties were taken away, Dr. Stiverson thinks that 50% of surgeries would be bilateral within 5 years. "I perform same day bilater- al surgery because it benefits the patient, it benefits me surgically, it benefits the Kaiser [Permanente] healthcare delivery system, which I whole-heartedly believe in, and it benefits the United States taxpay- er-funded Medicare system," Dr. Stiverson said. "I think the fact that only 1 in 5 respondents are worried about bilateral endophthalmitis re- flects an understanding and appreci- ation of the evidence." Presentation Dr. Arshinoff stressed that "[ISBCS] is safe and effective, and the issues are mostly lack of experience with the procedure." Dell* Toric Axis Markers 8-12119: Dell Fixed Toric Lens Marker With Rotating Bezel Used When Patient Is In Supine Position 8-12120: Dell Swivel Toric Lens Marker With Rotating Bezel Used When Patient Is In Upright Position BABC 1269 Rev.D Precise Alignment For Correct Toric Axis Placement, From Upright Through The Supine Position. 8-12119: R o t a t i n g I n n e r Bezel Automatically Orients Marks For The Placement Of A Toric IOL In The Correct Meridian. While The Patient Is Upright, An Orientation Mark Is Placed Vertically On The Conjunctiva. In Surgery The Rotating Inner Bezel Is Set To The Desired Meridian. While The Instrument Is Positioned So That The Vertical Conjunctival Mark Is Aligned With The 90 Degree Position On The Outer Bezel Of The Marker. The Marking Blades On The Undersurface Of The Instrument Will Automatically Place A Mark In The Correct Meridian When The Cornea Is Indented. 8-12120: Weighted So That Correct Horizontal Orientation Is Assured. Rotating Inner Bezel Automatically Orients Blades For Corneal Marks For The Placement Of A Toric IOL In The Correct Meridian. Designed For Use With The Patient Upright Immediately Prior To Surgery, The Inner Bezel Is Rotated To The Desired Meridian, And The Cornea Is Indented. The Marking Blades On The Undersurface Of The Instrument Will Automatically Place Marks In The Correct Meridian. www.RheinMedical.com 3360 Scherer Drive, Suite B. St.Petersburg, Florida 800-637-4346 • Tel: 727-209-2244 • Fax: 7273418123 Email: Info@RheinMedical.com • Website: www.RheinMedical.com *Developed In Coordination With Steven J. 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