Eyeworld

83 June 2016 EW MEETING REPORTER Some of the key issues impacting ophthalmology were highlighted, including the implementation of MACRA (quality payment program), minimizing drastic cuts to retina and glaucoma codes, the 21st Cen- tury Cures Initiative, office-based surgical suite cataract surgery, repeal of IPAB, private contracting/patient shared responsibility, drug com- pounding, cleaning and sterilization guidelines, and proposed health insurer mergers (possible anti-trust issue). Ms. McCann spoke about the details of the newly proposed quali- ty payment program, which includes the Merit-Based Incentive Payment System (MIPS) and advanced alter- native payment models (APMs). Many programs in existence today are more primary care focused, Ms. McCann said. MIPS will probably be "the way to go" in ophthalmol- ogy at this time, she said, because ophthalmology doesn't currently fit nicely in the APM model. MIPS consolidates the current quality reporting programs (PQRS, VBPM, and Meaningful Use) and adds clinical practice improvement activities (CPIAs) into this new pro- gram. MIPS will begin in 2019, based on 2017 performance. an author and biochemist who was approached by the U.S. government to work on a project during the Cold War that would, as Dr. Barrett put it, "encourage innovation." Dr. Asimov declined but this moment, Dr. Barrett said, stimulated him to write an essay on creativity, 1 that suggested creativity was not some- thing that you could encourage in someone. "It's something that comes from inward reflection by people who are sometimes a bit odd and eccentric," Dr. Barrett said. Dr. Barrett said that a sense of curiosity fostered beyond child- hood into adulthood, coupled with inspiration not only from oneself but from mentors and friends, and persistence are the source of creativi- ty and innovation. Editors' note: Dr. Barrett has financial interests with Alcon, Bausch + Lomb, Haag Streit (Koniz, Switzerland), and Microsurgical Technology (Redmond, Washington). Legislative and regulatory update highlights key ophthalmology topics Nancey McCann, director of govern- ment relations, ASCRS, Fairfax, Vir- ginia, and Ashley McGlone, manager of regulatory affairs, ASCRS, spoke at a Legislative and Regulatory Update. "All you need is your iPhone and a felt-tipped marking pen," he said, demonstrating how the app helps determine the axis of corneal limbal marks for ideal IOL align- ment. Dr. Barrett conducted a prospec- tive study to evaluate the error in alignment when marking is done using a slit lamp, a slit lamp with toriCAM, free hand, and free hand with toriCAM. "Even with slit lamp marking, the app improves the accuracy by about 50%, and with free-hand marking it reduces the error … by about 68%," he said. "The bottom line is if you use the app and free- hand marking, it is more accurate than if you use slit lamp alone." His final concern with astig- matism is the prediction of it after cataract surgery. Dr. Barrett has developed many formulas to aid in IOL calculations. With his and many other calculators available as well as technologies to help measure astig- matism and accurately place IOLs, Dr. Barrett said he thinks "astigma- tism prediction with toric IOLs is just about as accurate as spherical power prediction." Bringing his lecture back to the idea of innovation itself, Dr. Barrett pulled out a newspaper clipping that he has carried around for years. It's an article about Isaac Asimov, PhD, "There are many things that have fascinated me in cataract and refractive surgery over the years, but when I think back, the common thread that extends back to the be- ginning when I started ophthalmol- ogy was an interest in astigmatism." Dr. Barrett related the principles of keratometry to "all the wonder- ful instruments that we still have today." "Back when I was a resident, I was intrigued about the prospect of using intraoperative keratome- try, and the devices available then were somewhat complex and time consuming to use, and I thought 'A semi-quantitative device would be something that would be useful,'" he said before showing an image of the first keratometer he built and going on to reveal later iterations all the way to his development of a keratoscopic lens. In addition to measuring astigmatism, Dr. Barrett said also of interest to him is the correction of astigmatism at the time of cataract surgery, particularly the impact of the incision and the issue of toric IOL alignment. Dr. Barrett discussed research involving different incision sizes and said he has found "there is some merit in smaller incisions." When it comes to positioning a toric IOL, Dr. Barrett highlighted his toriCAM app. View videos from ASCRS•ASOA 2016: EWrePlay.org Jennifer Loh, MD, discusses results of her study comparing low add to high add multifocal IOLs. continued on page 84 View videos from ASCRS•ASOA 2016: EWrePlay.org Peter Hersh, MD, reviews the FDA label indications for corneal collagen crosslinking and discusses technique and workflow.

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