Eyeworld

Reporting from the 2016 ASCRS•ASOA Symposium & Congress, May 6–10, 2016 New Orleans Sponsored by EW MEETING REPORTER 84 June 2016 related to various ocular problems. When first seen in the late 1990s, the 20-year-old female was –20 D, and she received an anterior cham- ber IOL. Although surgery was uneventful and the results initially seemed promising, a few months later she developed a retinal detach- ment in both the operated eye and the fellow phakic eye. The patient was treated again, but then she re- turned with a pupil distortion. One year and 4 months after her first surgery, she had an IOL exchange from the anterior chamber IOL to a posterior chamber IOL. The patient was lost to fol- low-up but returned to the clinic for routine care 10 years after she was originally seen. In 2011, she developed an anterior subcapsular cataract; her cataract was removed in 2013. The patient is currently doing well. One lesson from this case is that a phakic IOL is not a perma- nent solution, Dr. Trindade said. "The best visual acuity for her was after cataract surgery," he said. "It's debatable, but maybe refractive lens exchange is a better approach than something temporary." Yet another perspective on challenging cases is that from the laboratory side, as shared by Liliana Werner, MD, Salt Lake City, who shared her lab's investigation of hydrophilic acrylic IOLs that had calcification after DMEK. Some relat- ed findings are also reported in the literature, she added. The IOLs were explanted after poor quality of vi- sion. "There's increasing evidence in the literature of a distinctive pattern of various hydrophilic acrylic IOL designs following procedures using injections of air or gas," Dr. Werner said. The affected eyes/IOLs often had multiple intracameral injec- tions. Further studies are needed to determine the cause of the calcifi- cation; 1 theory Dr. Werner shared is that of metabolic changes in the anterior chamber due to the pres- ence of air or gas. Editors' note: Dr. Rocha has financial interests with Abbott Medical Optics, Alcon, and Allergan. Dr. Werner has Finally, with the clinical practice improvement activities, physicians will work toward a total of 60 points by selecting CPIAs. They will select activities from a list of more than 90 options, with medium level activi- ties worth 10 points and high-level activities worth 20 points. CPIA needs to be performed for at least 90 days during the performance period. "It's important that we get input from all of you when we have to provide input to the federal agen- cies," Ms. McCann said. You need to get off the sidelines and get in the game, she said. Your legislators need to hear from you, she added. Visits, phone calls, and emails made a difference in the development of the SGR repeal and replacement, so you should join physicians and adminis- trators to advocate for our priorities, she said. Editors' note: The speakers have no financial interests related to their comments. How would you handle these cases? Surgeons share cataract, refractive dilemmas Surgeons weighed in on challenging and unusual cases during the "Chal- lenging Cases," symposium spon- sored by the Brazilian Association of Cataract and Refractive Surgery. The session included information on cases with aniridia, calcification of a supplementary IOL after Descemet's membrane endothelial keratoplasty (DMEK), post-LASIK complications, and other topics. A panel of experts weighed in on the cases. One such challenging case was a docking problem during attempt- ed femtosecond LASIK surgery in an obese patient, said Karolinne Rocha, MD, Charleston, South Carolina. Because of the docking problems, an incomplete flap was created. "You don't need to be a hero," said Dr. Rocha, adding that the take-home message is to stop and plan on a surface ablation pro- cedure going forward. Fernando Trindade, MD, Belo Horizonte, Brazil, shared the nearly 20-year saga of a highly myopic patient who had to have 4 surgeries She discussed MACRA compared to prior law. Now, there are modest but positive updates for 5 years, she said. The quality reporting programs are also consolidated with more flexibility, potential for significant bonuses, and lower maximum pen- alties. There's financial support for small practices, Ms. McCann added. With the MIPS program, physicians will receive a composite performance score (from 0–100) based on their performance in 4 categories: quality (making up 50% of the composite score), cost (10% of the composite score), advancing care information, previously called Meaningful Use (25% of the com- posite score), and clinical practice improvement activities (15% of the composite score). This composite score will then be compared to a performance threshold. The most important point is that existing penalties associated with the current programs do end at the end of 2018, Ms. McCann said. Ms. McGlone went into more detail on the 4 components of the MIPS composite score. Under the quality portion of the MIPS pro- gram, physicians will need to report a minimum of 6 measures, with at least 1 cross-cutting measure and an outcome measure, if available. Oth- erwise, the provider would report 1 additional "high quality" measure. The cost aspect includes 2 of the cost measures previously used in the VBPM program: total per capita costs for all attributed beneficiaries and Medicare spending per ben- eficiary. The attribution method is unchanged, and episode-based measures will be used to evaluate resource use. Under the advancing care infor- mation, physicians will submit data for a full calendar year reporting period. This category is comprised of a score for participation and report- ing 6 objectives and their measures. There is also a score for reporting at various levels above the base score (a performance score of up to 80 points in objectives and measures for pa- tient electronic access, coordination of care through patient engagement, and health information exchange).

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