Eyeworld

73 EW RETINA July 2015 Contact information Wall: Michael-wall@uiowa.edu be the result of the diet kicking in, Dr. Wall said, adding that a statisti- cal model showed that the effect of acetazolamide was independent of weight loss. "We learned there are 2 effects. There is the placebo plus diet effect that starts out with no improvement until about the second month and then is gradual after that," Dr. Wall said. "Then there is the improve- ment, which occurs mostly in the first month, from acetazolamide." The effects are thought to be com- plementary. Investigators also found there was a marked improvement in optic nerve swelling particularly for those taking acetazolamide. This decreased by –1.31 units in the acetazolamide group versus just –0.61 for those on placebo. "The quality of life measure was highly improved in the acetazol- amide group, even though acet- azolamide does have side effects," Dr. Wall said. While the drug can make patients' fingers tingle and soft drinks taste metallic, in addition to drowsiness in some cases, these effects were marginalized by the improvements that the patient had, he reported. "Lastly, spinal fluid pressure decreased in both groups, but went down about twice as much in the acetazolamide plus diet group," Dr. Wall said. Out of the 165 subjects, there were just 7 treatment failures, 6 of which were in the placebo group, he said, adding that risk factors for treatment failure included the presence of high grade papillede- ma and lower ETDRS visual acuity measures at baseline. As a result of the study, there is now an evidence base for treat- ing patients with mild idiopathic intracranial hypertension. "I think what we have now is a protocol that works for people with mild visual loss," he said, adding that this is a combination of a modest amount of weight loss coupled with acet- azolamide treatment. "We say lose a pound a week for 6 to 12 weeks depending on how much you need, aiming for 6% weight loss." Most people can lose 6% and maintain this when their vision is at stake, he said. While those with mild idiopath- ic intracranial hypertension can now be readily treated, it's a different story for those with more extensive disease. "We don't know how best to treat people right now with moder- ate-to-severe visual loss," Dr. Wall said. Going forward, he plans to study this population as well. EW Editors' note: Dr. Wall has no financial interests related to this article. The power of one The Ziemer FEMTO LDV Z Models are FDA cleared and CE marked and available for immediate delivery. For some countries, availability may be restricted due to local regulatory requirements; please contact Ziemer for details. The creation of a corneal pocket is part of a presbyopia intervention. Availability of related corneal inlays and implants according to policy of the individual manufacturers and regulatory status in the individual countries. Cataract procedures with the FEMTO LDV Z2, Z4 and Z6 models are not cleared in the United States and in all other countries. An upgrade possibility for these devices is planned once cataract options are available and cleared by the responsible regulatory bodies. THE ONE FEMTO PLATFORM for cornea, presbyopia and cataract. Presenting the unparalleled Ziemer FEMTO LDV Z Models – a technical revolution in ocular surgery. No laser is more precise, more powerful or more progressive when it comes to meeting all your procedural needs in a single platform. With Ziemer's FEMTO LDV Z Models, now you can operate with a modular femtosecond system that is easy to configure, designed to grow with your practice – cornea and presbyopia today, cataract tomorrow. www.ziemergroup.com

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