Eyeworld

Reporting from the 2015 AAO annual meeting, November 14–17, Las Vegas Sponsored by EW MEETING REPORTER 80 December 2015 Additionally, the degree of spherical equivalent was not associated with increased risk of haze among the study group patients. Dr. Rosenblatt acknowledged that a longer follow- up may be needed to identify late haze onset and to confirm the stabil- ity of the refractive results. Editors' note: Dr. Rosenblatt has no related financial interests. Hyperopic LASIK treatment fades long term An unusual long-term examination of patients receiving LASIK for hy- peropia found the effect faded over time, but patients remained happy with their vision. Thirty-three eyes of 19 hyperopic patients treated with LASIK had their mean SEQ in- crease from 0.35 D at 1 year postop to 1.61 D at nearly 17 years postop among those receiving less than 3 D of correction, and increase from 0.22 D to 1.87 D among those with more than 3.5 D of correction. Changes in the first 5 years were higher, while changes in subsequent years reflect- ed the expected age-related hyper- opic shift. Stable K values suggested physiological lenticular changes, said Reena Mahendra Dave, MD, London. "The older age patients, essentially, had less of a hyperopic shift, but we feel that's probably because they had lenticular myopic changes to counteract that," Dr. Dave said. Regardless, at the 17-year follow-up, 82% of patients were hap- py and 75% recommended LASIK. Editors' note: Dr. Dave has no related financial interests. Barraquer Lecture This year's Barraquer Lecture was given by Eric Donnenfeld, MD, Rockville Centre, N.Y., highlighting the LASIK procedure. LASIK has fallen into decline in the last several years, Dr. Donnenfeld said. The aim of his lecture was to explore the myths and realities of the LASIK procedure using an evidenced-based approach and to evaluate upcoming advancements. Dr. Donnenfeld highlighted 6 major myths that people associate with LASIK. The first is that phy- sicians would not have LASIK on their own eyes. The second is that the long-term effects of LASIK are not known. The third is that contact lenses are safer than LASIK. The fourth myth is that LASIK signifi- cantly increases the risk of a patient having glare and halo. The fifth myth is that the safety and efficacy of LASIK has not improved over time. The last myth is that dry eye is extremely common following LASIK. Dr. Donnenfeld responded to the myths at the end of his lecture. In terms of physicians not wanting to have LASIK themselves, he said that he knows a large number of physicians who have had LASIK. As far as not knowing the long-term effects of LASIK, Dr. Donnenfeld said that the procedure has a 20-year track record, and long- term studies have shown refractive stability and safety. Contact lenses are not necessar- ily safer than LASIK, as daily wear and extended wear contact lenses are likely less safe than LASIK if worn over a 30-year period. Dr. Donnenfeld said that when con- sidering the misconceptions about glare and halo, modern LASIK actu- ally improves on these. The fifth myth that Dr. Donnenfeld addressed, the safety and efficacy of LASIK, he said is the "greatest fallacy." LASIK is the safest procedure with the greatest patient satisfaction of any surgery performed in the world today, he said. The safety and efficacy have improved markedly over the last 20 years, and will continue to improve with new technology advances. Fi- nally, he said that although dry eye is common after LASIK for the first 3 months, it resolves after 6 months. Editors' note: Dr. Donnenfeld has no related financial interests. Diagnosis and management of ocular infectious diseases During the "Controversies in Ocular Infections" symposium, Todd Margolis, MD, PhD, St. Louis, gave the Jones/Smolin Lecture on "Changing Times in the Diagnosis and Management of Ocular Infectious Diseases." In his lecture, Dr. Margolis covered a number of infectious diseases and important points about each. Chronic and recurrent ocular zoster has been talked about for years, but still a lot of ophthalmol- ogists don't realize it exists, he said. The incidence and prevalence of this are unknown. "The key here is these are infectious processes," he said, adding that it's important to keep in mind "more antivirals and less corticosteroids." Dr. Margolis said that in zoster sine herpete, it's important to note that you can get the eye disease without any skin eruption at all. For varicella zoster virus and temporal arteritis, he said that zoster may be a causative agent, but the only way to find out is to do further studies. Dr. Margolis discussed the herpes zoster vaccine, which he said has been around for awhile, but somehow word hasn't gotten out that everyone who is eligible should be vaccinated. The vaccine reduces the incidence of zoster by 51%, but after 10 years, vaccine efficacy drops to 21%. There is a new vaccine, and results of the phase 3 study were recently reported. Where the current vaccine is not as effective in older patients, this one seems to be, but it is not currently FDA approved. Cytomegalovirus (CMV) iritis is a very real issue, but unfortunate- ly, it's often misdiagnosed. From 2007–2015, Dr. Margolis saw 15 patients with what he believes to be CMV iritis in the U.S. He found that valganciclovir was very effective in treating these patients while topi- cal ganciclovir was not particularly effective. "Perhaps the most important unresolved question in infectious disease is what accounts for the high level of clinical variability between individuals in a population infected with the same microbe," Dr. Margolis said. There's been an incredible revolution in genomics and understanding of the human genome, which could help answer some questions, he said. Editors' note: Dr. Margolis has no related financial interests.

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