Eyeworld

93 February 2016 EW MEETING REPORTER the allotted time. They asked Dr. Weathers to come with them, but he had promised to wait for Rob Hall. After 2:00 p.m., 3:00 p.m., 4:00 p.m., and 5:00 p.m. came and went, he began to realize he had stayed on the mountain too long. After encountering anoth- er guide, Dr. Weathers started to descend with him by being short- roped since he still could not see. They reached a point about 30 to 45 minutes from the camp and believed they were "home free." But as they moved to camp, a huge wind and wall of white began to rise up behind them, trapping a number of climbers in a whiteout. Dr. Weathers and several others stayed behind, while some went back to the camp to get help. They huddled together in an attempt to stay warm. The pain of the cold became nearly unbearable for them. At one point, Dr. Weathers realized he was not so cold anymore but also realized that this was not a good thing. He was left behind when some of the others were rescued and taken to camp, and it was believed that he died from exposure. His wife was called and told that he was dead. But then, Dr. Weathers said an extraordi- nary thing happened. He opened his eyes and saw the lifeless form of his hand in front of him. Dr. Weathers realized he was still somewhere on the mountain and that no one was coming for him. He had to take mat- ters into his own hands to survive, and he struggled back to camp. Despite walking into the camp, it was still uncertain if he would sur- vive to get off the mountain. When his wife was notified that he was in fact still alive, she began making calls, finally reaching the U.S. State Department and finding someone in Nepal who would risk a helicopter rescue. Still, Dr. Weathers knew it was highly unlikely that he would get off the mountain because the helicopter was not designed to fly in that high altitude. After several attempts, the pilot was able to get to where Dr. Weathers could board. "I learned that day that miracles do occur," Dr. Weathers said. Oculoplastics Wendy Lee, MD, Miami, discussed the topic of "Bumps: Diagnosis and Management of Eyelid Lesions." These can come in every different size, color, and shape, she said. It's important to formulate an idea in your mind when you see a lesion of whether it's benign or ma- lignant, Dr. Lee said. Key in deter- mining the specifics of the lesion is taking a patient history. Dr. Lee said to be sure to ask patients how long they have noticed the lesion, if there has been any growth of the lesion, if they have a systemic condition, and to determine if there has been sun exposure. Characteristics of benign lesions include that they are well outlined, there is no loss of lashes, and most of the time, there's normal skin architecture. When she sees a lesion that she thinks is most likely benign, Dr. Lee does an excisional biopsy and sends everything to a patholo- gist. Meanwhile, most malignant le- sions are going to have loss of lashes and loss of normal architecture. There are a number of different approaches to remove skin cancer, including electrodessication and cu- rettage, cryosurgery, photodynamic therapy, laser therapy, radiotherapy, medical therapy, surgical excision and permanent section, surgical ex- cision and frozen section, and Mohs micrographic surgery. Many of these options, however, are destructive procedures not necessarily used on the eyelid, she said. Dr. Lee said that when she sees a malignant lesion, she only takes out a little piece for tissue diagnosis. This allows for a confirmation of the diagnosis and leaves an identifier of where the lesion is for it to be removed completely later on if the diagnosis is confirmed. When man- aging skin cancer, Dr. Lee said the goals are for complete removal, no recurrence, no postoperative compli- cations, and minimal loss or damage to the surrounding tissues. Editors' note: Dr. Lee has financial interests with Allergan (Dublin), Merz Aesthetics (Raleigh, N.C.), and Oph- thalmology Web (San Francisco). Toric alignment There are many methods to measure astigmatism preoperatively, and there are intraoperative tools as well. Mark Packer, MD, Boulder, Colo., focused his presentation on "Toric Alignment for Optimal Astigmatic Correction." "It's very important to line these lenses up correctly," he said. Every degree of misalignment means you have a 3.3% error. Additionally, IOL misalignment has greater impact at higher cylindrical powers, and IOL rotational stability is critical for maintaining alignment, Dr. Packer said. His presentation specifically fo- cused on the Trulign toric (Bausch + Lomb, Bridgewater, N.J.), a posterior chamber presbyopia-correcting IOL with a modified plate haptic lens with hinges across the plates adja- cent to the optic. Dr. Packer discussed the differ- ences between results from pre-mar- ket approval studies and post-ap- proval studies. In the Trulign's FDA pre-market approval study, the patients' corneal astigmatism was greater than or equal to 1.33 D with an on-axis incision and standard- ized SIA of 0.5 D. End results of the FDA study showed that patients had distance vision of 20/25, intermedi- ate vision of 20/20, and near vision of 20/40. There was also an 85% re- duction of cylinder in these patients and very little rotation. Similar results were seen in a "real world" study post-approval. The study Dr. Packer discussed was a View videos from Hawaiian Eye 2016: EWrePlay.org Marjan Farid, MD, discusses approaches for diagnosis and management of dislocated intraocular lenses. continued on page 94

• Cover