Eyeworld

81 December 2015 EW MEETING REPORTER (Sarasota, Fla.), TearScience, and TearLab (San Diego). Surgeon language sets patient expectations Patients' subjective perception of their postop results frequently stem from what their expectations were to begin with, said Richard Tipperman, MD, Bala Cynwyd, Pa. Setting a so-called reference point "is critical to managing the outcomes postop," Dr. Tipperman said. "If you exceed the expectations that you set with reference points then patients are going to be happy." Most sur- geons use the wrong reference point when it comes to advanced tech- nology IOLs. "Most people begin with what they can give the patient with an advanced technology IOL, and that is a setup for failure," Dr. Tipperman said. Instead, he sug- gested educating patients about what they will get from monofocal cataract surgery and then what the difference will be if they choose an advanced technology lens. "It's a very simple concept but it changes things 180 degrees for most offices," Dr. Tipperman said. EW Editors' note: Dr. Tipperman has financial interests with Alcon. Editors' note: Dr. Ahmed has financial interests with Abbott Medical Optics, Alcon, and Allergan. Patient characteristics key with multifocal lenses Surgeons looking to take on a growing refractive IOL practice need a more standardized approach to matching patients to presbyopia-cor- recting lenses, said Elizabeth Yeu, MD, Norfolk, Va. In her practice, that included the use of a "cataract counselor," who speaks with and evaluates patients. Key results that are provided to the surgeons include the patient's profession, hobbies, and what type of reader he or she is. Additionally, height is a "huge consideration," which has taken on increased importance because of the various add powers. The conversa- tions allow understanding of the patient's personality. "Not all type A professions are created equally," Dr. Yeu said. "Someone who is a family attorney is going to be very different from a corporate lawyer or a mal- practice lawyer." Editors' note: Dr. Yeu has financial interests with Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, Bio-Tissue (Doral, Fla.), RPS New calculation method could boost IOL power accuracy A new way to select the right IOL for patients and improve patient safety, reduce refractive surprises, and boost physician confidence may soon make its way online, said Warren Hill, MD, Mesa, Ariz. Dr. Hill spoke about the new IOL calculation method during the Charles D. Kelman Lecture, "IOL Power Selection: Think Different." Dr. Hill called IOL power se- lection "the elephant in the room" during cataract surgery, as even with trusted calculation methods, there is room for error. "Nobody is getting this right all the time," he said. Although surgeons are becoming more aware of the importance of effective lens position for accurate calculations, he said that it cannot always be correlated with preop measurements, so it remains a limit- ing factor. Dr. Hill, already a pioneer of IOL power calculations, began to inves- tigate other innovative methods. This led him to radial basis function, a mathematical approach used in other industries to measure oil reser- voirs, calibrate engines, conduct fa- cial recognition, and make financial predictions. Radial basis function is based on recognizing patterns, han- dling multiple factors, and working with nonlinear relationships. As part of the investigation within cataract surgery, an IOL cal- culator that uses radial basis func- tion was retrospectively evaluated by 13 surgeons in 8 countries. Its use led to a weighted mean accuracy of 95%, which was an improvement on the current mean accuracy of 78% from a variety of IOL calculations, Dr. Hill said. Work is underway to make a radial basis function calculation available online and have it be part of the LENSTAR equipment (Haag-Streit, Koniz, Switzerland), Dr. Hill said. Dr. Hill's talk was part of the "Spotlight on Cataract Complica- tions," which featured a variety of video-based cataract case discus- sions. Editors' note: Dr. Hill has financial interests with Alcon, Haag-Streit, and other ophthalmic companies. Bacterial keratitis requires thorough treatment, patient compliance The size of a corneal ulcer from bacterial keratitis will determine the appropriate treatment, said Francis S. Mah, MD, San Diego, during the "Spotlight on Ocular Infection." For one that is 2 mm or smaller, topical fluoroquinolones and/or fortified antibiotics should be used. If the ulcer is larger than 2 mm, doing a culture and staining, in addition to the use of fluoroquinolones and fortified antibiotics, is appropriate. Patients play a key role in improv- ing the keratitis. "Compliance [with medication] is the most important factor," he said. There are emerging treatments for bacterial keratitis that are not yet approved for topical use. Although Dr. Mah said the jury is still out regarding the use of cor- neal collagen crosslinking to treat bacterial keratitis, emerging research seems to indicate it could become an appropriate treatment. Editors' note: Dr. Mah has financial interests with Abbott Medical Optics, Alcon, and Allergan. Certain risks tied to bleb- related infections after glaucoma surgery The incidence of bleb-related infections after glaucoma surgery have decreased thanks to improved techniques, said Ike K. Ahmed, MD, Toronto. The incidence is currently 0.5% to 1.5%. Risk factors for bleb-related infection include a bleb leak, chronic antibiotic use, mitomycin C and 5-fluorouracil use, and other factors. There is no randomized study regarding the treatment of bleb-related infections, Dr. Ahmed said. Prevention at this point includes education and a focus on reducing risk factors. Although the risk for infection following mi- croinvasive glaucoma surgery is still unclear, Dr. Ahmed said it will likely be similar to infection rates after phacoemulsification.

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