Eyeworld

EW FEATURE 50 Glaucoma medical treatment • November 2015 "It's not that you want to disbelieve all patients, but you have to—to a certain extent," he said. Some patients have trouble remembering to take their drops. It's important to try to tie that to a life event, Dr. Feldman said—something they're already doing. It's also im- portant to keep the regimen simple, he said. "The less bottles they have to take, the better, and the less times a day they have to take them, the better." New products and technologies Dr. Boland and his colleagues have carried out randomized trials to determine if people with non-adher- ence issues could be helped by some sort of reminder. Using automated telephone calls or text messages helped improve adherence to medi- cations, he said. He added that it would be interesting to find a way to link elec- tronic health records to medication reminders. "The one thing that's still missing in all of this, however, is ev- idence," Dr. Boland said. "Although it seems logical, we've not yet shown that if you're not adherent, it is more likely that your glaucoma will get worse. It's hard to follow people long enough to show this." Dr. Harbin and his partner, Scott Pastor, MD, developed an app to try to address this problem. With the EyeDrops app, all types of drops are listed so patients can easily create a schedule, and the app will alert them when it's time to take the drops, Dr. Harbin said. The EyeDrops app also helps pa- tients keep track of their pressures. Sometimes if people can see their progress, it helps them become more adherent, he said. The app is help- ful to physicians because it tracks medication use, and the patient can email this information to their doctor. "Over time, this becomes like a mini electronic medical record for glaucoma," he said. There are a number of different types of apps now to address this. "I think ours is the most comprehensive," Dr. Harbin said. "It also helps people with dry eyes." EW Editors' note: Dr. Harbin is the creator of the EyeDrops app. Drs. Boland and Feldman have no financial interests related to the article. Contact information Boland: boland@jhu.edu Feldman: robert.m.feldman@uth.tmc.edu Harbin: tomharbin@harbinbooks.com Non-adherence continued from page 49 Screen on the EyeDrops app that the user sees when it's almost time to take a drop Source: Thomas Harbin, MD View the EyeWorld CME and non-CME supplements at: cmesupplements. eyeworld.org supplements. eyeworld.org Modernizing cataract surgery: Navigating success with toric multifocal IOLs Supplement to EyeWorld September 2015 Supported by an educational grant from Abbott Medical Optics by Francis Mah, MD Success with toric and multifocal IOLs The 2014 ASCRS Clinical Survey demonstrated educational gaps regarding toric and multifocal intraocular lenses T he ASCRS Clinical Survey revealed important information regarding members' use of toric and multifocal intraocular lenses (IOLs). 1 This annual survey is conducted to examine the most compelling and con- troversial issues facing ASCRS members. It included 267 data points from 134 questions on key clinical opinions and practice patterns. It surveyed more than 1,500 unique respon- dents. Toric IOLs After implanting a toric intraocular lens (IOL), 33% of respondents believe 10 degrees of postoperative rotational error or more does not significantly affect visual acuity or quality (Figure 1). When members were asked, "How are you aligning the preoperative axis assessed with your diagnostic tools with your intraop- erative axis where you are placing the toric IOL during surgery?" 37% of respondents are not using any instrumentation to guide their alignment marks. Of these, 6% use anatomic landmarks without preoperative marking, and 31% use ink marking at the slit lamp with- out additional instruments. I found this very surprising. They were correcting astigmatism, however, they were not using any instrumen- tation to guide the alignment of toric IOLs. The survey results demonstrated little consensus on how to manage 1.25 D of astigmatism (Figure 2). Nearly 54% chose toric IOLs. continued on page 3 Figure 1. The 2014 ASCRS Clinical Survey asked, "After implanting a toric IOL, how many degrees of postoperative rotational error is acceptable before visual quality and visual acuity are significantly affected? 33% of respondents believe >10 degrees of error does not significantly affect visual quality/acuity 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Less than 5 5 6 to 9 10 Great than 10 Depends U.S. Non-U.S. Overall Supplement to EyeWorld September 2015 Figure 2. The survey asked, "What is your most common procedure to manage astigmatism in a cataract patient with the following levels of cylinder?" Little consensus on how to manage a 1.25 D patient On axis incision 0.75 D 1.25 D 2 D 3 D 42.1% 12.0% 0.9% 0.5% Manual LRI or AK 13.2% 17.1% 3.5% 1.1% Femtosecond laser LRI or AK 7.9% 8.3% 1.6% 1.1% Toric IOL 5.9% 53.9% 89.7% 91.6% Postop laser vision correction 0.9% 1.6% 2.7% 3.6% Glasses or contact lenses 7.1% 5.3% 1.5% 1.8% No special correction needed 22.9% 1.9% 0.1% 0.2% Little consensus on how to manage a 1.25 D patient Supplement to EyeWorld September 2015 Edward J. Holland, MD The X Factors: Three areas that will improve refractive cataract surgery outcomes Supported by unrestricted educational grants from Alcon Laboratories and Omeros Accreditation Statement This activity has been planned and imple- mented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract & Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medical education for physicians. Educational Objectives Ophthalmologists who participate in this activity will: • Distinguish predisposing factors putting patients at higher risk for inflammatory reaction after cataract surgery • Identify the true impact of ocular inflam- mation levels on outcomes in refractive cataract surgery • Identify new agents and acquire strategies to eliminate inflammation and relieve pain by maximizing the penetration of anti- inflammatory agents into target tissues • Assess the clinical impact of various levels of ultrasound energy applied during cataract surgery, and how these differ with complex vs. routine cataract patients • Recognize the amount of reduction in these levels available with laser cataract technol- ogy for specific types of patients Designation Statement The American Society of Cataract & Refractive Surgery designates this enduring materials activity for a maximum of 1.0 AMA PRA Cate- gory 1 Credits. ™ Physicians should claim only credit commensurate with the extent of their participation in the activity. Claiming Credit To claim credit, participants must visit bit.ly/1PhspcC to review content and download the post-activity test and credit claim. All participants must pass the post- activity test with a score of 75% or higher to earn credit. Alternatively, the post-test form included in this supplement may be faxed to the number indicated for credit to be awarded, and a certificate will be mailed within 2 weeks. When viewing online or downloading the material, standard Internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through March 31, 2016. CME credit will not be awarded after that date. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only. ADA/Special Accommodations ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational program who requires special accommodations or services should contact Laura Johnson at ljohnson@ascrs.org or 703-591-2220. Financial Interest Disclosures David M. Goldman, MD, has received a retainer, ad hoc fees or other consulting income from and is a member of the speakers bureau of Alcon Laboratories Inc., Allergan, and Bausch + Lomb. He has received a re- tainer, ad hoc fees or other consulting income and has an investment interest in Modernizing Medicine. Dr. Goldman has an investment interest in Ophthotech. Preeya K. Gupta, MD, has received a retainer, ad hoc fees or other consulting income from BioTissue and TearScience. Edward J. Holland, MD, has received a re- tainer, ad hoc fees or other consulting income from and is a member of the speakers bureau of Alcon Laboratories Inc., Bausch + Lomb, Kala Pharmaceuticals, Mati Therapeutics, PRN, RPS, Senju Pharmaceuticals, TearLab, and TearScience. He has received research funding from Alcon Laboratories Inc., Mati Therapeutics, PRN, and Senju Pharmaceuti- cals. Dr. Holland has received travel expense reimbursement from Alcon Laboratories Inc. and Bausch + Lomb. Mitchell A. Jackson, MD, is a member of the speakers bureau of Allergan, Avellino, Bausch + Lomb, Carl Zeiss Meditec, Diopsys, Doctor's Allergy Formula, Marco Ophthalmics, Nicox, Omeros Corporation, Science Based Health, Sucampo Pharmaceuticals, TearLab, and TearScience. He has an investment interest in Ace Vision Group Inc. Staff members Laura Johnson, Beth Marsh, and Erin Schallhorn have no ophthalmic- related financial interests. by Edward J. Holland, MD Experts take aim at threats to optimal results diagnostic accuracy of ocular sur- gery diseases (OSDs) and treatment efficacy?" 62% agreed or strongly agreed that Schirmer testing reliably increases their diagnostic accuracy. Only 13% use advanced tear film diagnostics at the initial point of care. The Schirmer test is more than a century old, and we believe there are newer, better ways to identify dry eye. In response to a question regarding whether they follow the Dry Eye Workshop (DEWS)/Delphi guidelines for treating dry eye and meibomian gland dysfunction, most respondents didn't know or didn't use evidence-based guidelines (Figure 1). Visual outcomes When members were asked how many degrees of postoperative rotational error is acceptable after implantation of toric intraocular lenses (IOLs) before visual quality and visual acuity are significantly affected, nearly a third responded 10 patterns based on responses from more than 1,500 unique respon- dents. It focused on 267 data points related to the most compelling and controversial issues facing ASCRS members and has guided the ASCRS Program Committee on its educa- tional efforts. Dry eye diagnosis and treatment When members were asked, "How much do you believe the following tests can reliably increase your Our panel of experts will concentrate on the 3 factors that physicians can control to enhance refractive cataract surgery outcomes: dry eye diagnosis and treatment, reducing residual error, and elimi- nating or reducing postop inflam- mation. Respondents to the 2014 ASCRS Clinical Survey reported important information about their practices regarding these issues and a range of others. This extensive survey revealed opinions and practice Experts share insights on dry eye diagnosis and treatment, reducing residual error, and eliminating or reducing inflammation after refractive cataract surgery I n this supplement, we will examine the "X factors"—the extra undefinable elements that may lead to the best possible outcomes for your refractive cataract surgery patients, who have high visual expectations from their procedures. " … There is increased awareness of the significance of inflammation and the role it plays in outcomes regarding vision and pain. "

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