Eyeworld

79 June 2016 EW MEETING REPORTER and it was evaluated on a second population. Meanwhile, some of the shortcomings are the percentages of false positive and false negative rates, its subjective classification of topographies, it does not consider thickness profiles, it does not utilize all diagnostic technologies, and it does not perform as well in recently published clinical studies. The sensitivity of the risk score system over time falls, he noted. So why does the risk score system seem to be failing today? The incidence of FFKC has been falling in ectatic eyes in published case reports. The residual stromal bed is going up. The mean preoperative corneal thickness is going up as well. These reflect implementation of the risk score system even if not done consciously or formally, Dr. Stulting said. "The ERSS appears to be failing because it's working," Dr. Stulting said. "Physicians avoid surgery on patients with previously publicized risk factors, so new analyses will not identify risk factors that cur- rently prevent patients from being treated," he said. Future screening methodologies must recognize all risk factors, Dr. Stulting added. Comprehensive ectasia screen- ing should include early cases in future analyses. It should also utilize don't want competent, they want virtuoso. … Most of us are coasting. Here's the problem with coasting: It only happens downhill." Binkhorst Lecture highlights ectasia Doyle Stulting, MD, Atlanta, pre- sented this year's Binkhorst Lecture on "Predicting and Treating Corneal Ectasia." In 1998, Theo Seiler, MD, Zurich, Switzerland, published the first case of corneal ectasia after LASIK, Dr. Stulting said, and he postulated that forme fruste kera- toconus (FFKC) was a risk factor. Meanwhile from 1996 to 2001, Dr. Stulting said 17 cases of ectasia presented to the Emory Contact Lens Service. They found 10 eyes of 7 patients with adequate data for analysis of risk factors. Preoperative refraction, preoperative pachyme- try, residual stromal bed, and forme fruste keratoconus were significant risk factors, with FFKC seemingly the strongest predictor. Further study indicated that age could be another risk factor. Dr. Stulting developed an ectasia risk score system (ERSS) that "placed patients at low, medium, and high risk for corneal ectasia." Advan- tages of the ERSS, Dr. Stulting said, are that it measures multiple risk factors simultaneously, it utilizes commonly measured parameters, them, and help them navigate through change affecting ophthal- mic practice—change that is only expected to continue. "We are sailing into uncharted waters as we travel down the path of MACRA [the Medicare Access and CHIP Reauthorization Act of 2015], MIPS [Merit-Based Incen- tive Payment System], and declin- ing reimbursement," said Daniel Chambers, MBA, COE, Dallas. Mr. Chambers is the incoming president of ASOA. "ASOA stands ready to lead our members through the tsunami of legislative and regulatory [chang- es]. Now more than ever practice administrators need to support one another, and ASOA is here to sup- port you." Then keynote speaker Mike Rayburn, CSP, took to the stage, plugged in his guitar, and spent the next hour entertaining the crowd with his often hilarious musical tal- ent, mixing musical metaphors with tools attendees can use to create change versus manage it. Mr. Rayburn provided 3 tools for attendees to help them do just that. The first was to ask the question "what if" in a positive way—and ac- tually entertain the ideas that could come from that question instead of dismissing them. The second tool was to "write music you can't play," which in non-musical terms he explained as setting goals that don't exist, goals that might be that "in a perfect world" scenario. "What is it that's nuts but you're going to do it anyway?" he said. Once you have that goal, Mr. Rayburn said you need to commit to it in your heart, write it down, and start taking steps to reach it. The third tool Mr. Rayburn offered is to become a virtuoso or at least make the choice to go down the road leading to virtuoso, which in non-musical terms means resolv- ing to be the best in your field. "Most adults will never make this choice," he said, noting that the opposite of a virtuoso is not failure but competence. "The people who come into your offices, the people whose lives you make better, they will change the way physicians communicate with each other. Some of these initiatives include the newly launched ASCRS 365 App, the online Center for Learning, and free online CME activities. "We're working hard to find new ways for you to get involved with ASCRS and provide more value to your member- ship," Dr. Solomon said. Advocacy is another way physi- cians can get involved, Dr. Solomon continued. ASCRS has been at the forefront of some key legislative and regulatory accomplishments. "We have been effective, but we must remain vigilant," he said. "This is such a critical time in health care." For the first time, ASCRS is sponsor- ing and sending 5 ophthalmology residents to this year's Alliance of Specialty Medicine Legislative Fly-In. "There are a lot of opportunities to get engaged and involved, and more are coming," Dr. Solomon said. He pledged to work hard to get members more involved. Editors' note: The speakers have no financial interests related to their comments. ASOA 30th anniversary celebration kicks off at its Opening General Session In 1986, gas was 89 cents, a first- class stamp cost 22 cents, and IBM revealed the laptop computer. It was also, as Laureen Rowland, ASOA executive director, said to round out this list, the year ASOA founder Lucy Santiago met ASCRS Executive Director David Karcher. That year and this chance meeting lead to the formation of ASOA. ASOA's Opening General Ses- sion kicked off the celebration of this important milestone: its 30th anniversary. When ASOA was first established, it garnered about 300 members within a month. Three decades later, the organization now has more than 2,800 members, sev- eral hundred of whom have received credentials under ASOA's Certified Ophthalmic Executive (COE) pro- gram, which started in 1999. Over the years, ASOA has been there to support members, educate View videos from ASCRS•ASOA 2016: EWrePlay.org Amar Agarwal, MD, introduces a new trocar AC maintainer. He reports fewer leaks and easy insertion. continued on page 80

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