Eyeworld

129 March 2016 EW MEETING REPORTER have cyanoacrylate, an inexpensive alternative can be Kola Loka (known in English as Super Glue), found at local hardware stores, he said. If there is a full-thickness non- self sealing wound, the surgeon must fix it as soon as possible. In 40% of eye injuries, there are corneal foreign bodies, often caused by welding, hammering, or grind- ing. "Sadly, we see a lot of workers who don't even know they should be using protective equipment," Dr. Garcia Arroyo said. Satisfaction in refractive surgery Ronald Krueger, MD, Cleveland, discussed quality of life after refrac- tive surgery, specifically looking at satisfaction in physicians. How good is LASIK? he ques- tioned. Modern day LASIK has 20/20 outcomes in greater than 80% of eyes and satisfaction in 95% of patients, he said. There are around 1 million eyes treated in the U.S. each year with LASIK, and the U.S. military has accepted it for its pilots. However, Dr. Krueger said an inter- esting take is to look at LASIK results among high performing profession- als since physicians and surgeons might have higher demands and be more suspicious. usually uses X-rays but noted that the other more sophisticated equip- ment can be helpful if a surgeon has access to them. Surgeons should consider the medico-legal issues associated with traumatic cataract and should make sure to 1) document a complete case description, 2) fully explain to pa- tients the cause and effect of the in- jury and treatment, 3) note patient compliance to any recommended treatment (this is an area where Dr. Restrepo often finds problems), and 4) document the relationship between the cataract and trauma. Cornea wounds from ocular trauma occur in half of all serious cases, said Santiago Garcia Arroyo, MD, Mexico City. A little more than 40% of these injuries occur at home; 52% are a full thickness laceration. When examining patients with corneal wounds, use external eyelid retractors to better view the eye but avoid putting pressure on the globe. If retractors are not available, Dr. Garcia Arroyo said that a bent paperclip can be used. If necessary, the patient can also receive a pre- servative-free anesthetic during this examination. If there is a large self-sealing wound, Dr. Garcia Arroyo recom- mends use of a bandage contact lens, prophylactic antibiotic, and cyanoacrylate. If a practice does not Corneal biopsy can be per- formed, but it is hard to perform under a slit lamp, Dr. Amescua said. When sending out tissue sam- ples, Dr. Amescua recommended sending half to microbiology and half to pathology to more effectively pinpoint the problem. The most effective treatment Dr. Amescua and colleagues have found for fungal keratitis is natamycin. Surgery is also an option. "Some- times a surgical intervention is better than waiting for a severe case to develop," he said. In the future, photodynamic therapy may play a stronger role in fungal keratitis treatment, but Dr. Amescua has not found it that successful so far. Comprehensive approaches to eyecare to fight global visual impairment There are 3.167 billion people around the world who have vision impairment at various stages, said Silvio Maniotti, MD, World Health Organization, Geneva, Switzerland. The most common causes of blind- ness are refractive errors, cataract, glaucoma, age-related macular degeneration, and diabetic retinop- athy. At the same time, chronic eye disease requires a complex diagnosis, long-term follow up, and sophisti- cated equipment. These factors led clinicians to come together in the session "Comprehensive Eye Care or Disease Specific Approaches" to discuss how to better identify and treat eye dis- ease around the globe. Gullapalli Rao, MD, India, discussed how the LV Prasad Eye Institute uses its clinics to treat cat- aracts. Even though care is provided for free to a large portion of cataract patients, the institute still finds that cataract treatment is effective and provides good cost recovery. One problem that Dr. Rao and colleagues have found is the quality of training for residents; without such training they cannot work effectively within the community, he said. Refractive errors are another common cause of blindness and visual impairment, said Kovin Naidoo, OD, South Africa. By 2050, there will be 5 billion myopes world- wide; this number will become larg- er compared with the current total due to an increase in near work. To better treat refractive errors, clinicians must take into account advocacy, human resource training, sustainable delivery, and research. One mistake to avoid is focus- ing only on the public sector; the private sector and social enterprises/ nonprofits and NGOs play a role in expanding comprehensive eyecare to diagnose and treat refractive errors, Dr. Naidoo said. Assessing and treating anterior segment trauma Better education about eye injuries and the advocacy of protective eye- wear during sports could go a long way in helping to avoid traumatic cataracts in children, said Angela Maria Hernandez, MD, Bogotá, Co- lombia, during the session "Manage- ment of Anterior Segment Injuries." There are 250,000 annual cases of pediatric traumatic cataract, which are a leading cause of monocular childhood blindness, Dr. Hernandez said. The injuries are more common in boys, as they are more likely to engage in eye-risky ac- tivities and sports, such as paintball. Before dilation of these eyes, surgeons should assess the best corrected visual acuity, fixation ref- erence, pupillary reflex, and iris, Dr. Hernandez advised. After dilation, surgeons should view the eye via slit lamp examination and check both the anterior and posterior segments. Dr. Hernandez shared a pearl for optimal IOL selection. "Keep in mind that a myopic shift will happen, so do an undercorrection," she said. Traumatic cataracts in adults are usually caused by blunt trauma, rupture, penetrating trauma, intra- ocular foreign bodies, or perforating trauma, said Carlos Restrepo, MD, Colombia. Common screening tools to better assess the trauma to the eye include X-rays, CT, MRI, optical coherence tomography, and ultra- sound biomicroscopy. Dr. Restrepo View videos from WOC 2016: EWrePlay.org David F. Chang, MD, discusses the use of intracameral antibiotics for endophthalmitis prophylaxis. continued on page 130

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