Eyeworld

43 July 2016 "because the soldiers don't pay for the surgery." "This [surgery] is enhancing the soldier's ability to do his or her job," Dr. Barnes said. This is a unique prospect, where physicians can take a healthy soldier and help him or her to do better by using medical technology, he added. It's very satisfying to see these soldiers and hear them say that they have returned home because they were able to see while in the field or while involved in some danger- ous conflict, Dr. Barnes said. His work in the Army has continued for 25 years and he feels that every day he can make a difference in someone's life. EW Editors' note: Dr. Barnes does teaching and physician certification for Abbott Medical Optics and STAAR Surgical (Monrovia, California). Contact information Barnes: scott.d.barnes.mil@mail.mil Since 2000, the estimates are some- where between 500,000 and 600,000 surgeries among all 3 forces. In general, the Air Force does about 9,000–10,000 a year, he said, estimating that the Navy might have around 13,000–15,000 a year. The Army saw a large drop around 5 years ago, Dr. Barnes added, from 23,000–24,000 procedures a year to 16,000–18,000. Part of this can be attributed to downsizing in the military, he said, because there is not as much recent involvement in the Middle East. These numbers will go up and down when there are more active people and more conflicts going on, he said. Dr. Barnes added that he has seen a similar pattern nationwide where it seems like there's less of a drive to have these procedures. Just like in the general population, there are those in the military who are very aggressive about getting treatment, those who are more hesitant, and those who don't mind wearing glasses. "We do know that the decrease is not just the economy or money related," Dr. Barnes added, well-controlled and interesting study on patient-reported LASIK outcomes, Dr. Barnes said, and a large arm of that was done at the Navy Hospital in San Diego. Meanwhile, the Air Force is conducting specific research on the implantable collamer lens at the Air Force/Army Center in San Antonio, he said. There are always many individ- uals setting up studies, Dr. Barnes said. One recent study he highlight- ed was done at Fort Belvoir in Vir- ginia, which looked at night vision testing for firing weapons. Another focused on identifying various tar- gets after laser surgery. It's one thing to be able to see a stop sign from far away because you know the shape, but soldiers need to identify many different signs, people, and potential improvised explosive devices (IEDs), he said. The study simulated soldiers driving in different conditions while attempting to identify specific types of targets. Surgery volumes The number of surgeries each year fluctuates a bit, Dr. Barnes said. EW REFRACTIVE " LASIK is such a predominant player in the refractive surgery world. But in the military setting, the majority of work that we have done is with surface ablation. " –Colonel Scott Barnes, MD View the EyeWorld CME and non-CME supplements at: cmesupplements. eyeworld.org supplements. eyeworld.org The impact of refractive error on outcomes and patient satisfaction: Data-driven pathways to target outcomes and reduce refractive surprises Presbyopia 365 Curriculum continued on page 2 Supported by Abbott Medical Optics Inc., Alcon Laboratories Inc., and AcuFocus This monograph is part of a year-long curriculum focused on treatment of presbyopia and management. Accreditation Statement This activity has been planned and implement- ed in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract & Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accred- ited by the ACCME to provide continuing medical education for physicians. Educational Objectives Ophthalmologists who participate in this activity will: • Implement a lower threshold for acceptable pseudophakic refractive errors in presbyopia- corrected patients • Identify steps to mitigate refractive surprises and other key variables to increase postopera- tive success Designation Statement The American Society of Cataract & Refractive Surgery designates this enduring materials educational activity for a maximum of 1.0 AMA PRA Category 1 Credits. ™ Physicians should only claim credit commensurate with the extent of their participation in the activity. Claiming Credit To claim credit, participants may visit bit.ly/28QBtJM to review content and download the post-activity test and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. Alternatively, the post-test form included in this monograph may be faxed to the number indicat- ed for credit to be awarded, and a certificate will be mailed within 2 weeks. When viewing online or downloading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through December 31, 2016. CME credit will not be awarded after that date. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only. ADA/Special Accommodations ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational program who requires special accommodations or services should contact Laura Johnson at ljohnson@ascrs. org or 703-591-2220. Financial Interest Disclosures Steven Dell, MD, has an investment interest in and has received a retainer, ad hoc fees, or other consulting income from: Presbyopia Therapies and Tracey Technologies. He has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Advanced Tear Di- agnostics, Bausch + Lomb, Lumenis, and Optical Express. Douglas Koch, MD, has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Alcon Laboratories Inc., Clarity Medical System, Ivantis Inc., Perfect Lens LLC, PowerVision Inc., and ReVision Optics Inc. He has received research funding from: i-Optics, TrueVision Systems Inc., and Ziemer Inc. Richard Tipperman, MD, has no ophthalmic- related financial interests. John Vukich, MD, has received a retainer, ad hoc fees, or other consulting income and is a member of the speakers bureau of AcuFocus Inc. Elizabeth Yeu, MD, has an investment interest in Modernizing Medicine and Strathspey Crown LLC. She has an investment interest in and has received a retainer, ad hoc fees, or other con- sulting income from RPS. Dr. Yeu has received a retainer, ad hoc fees, or other consulting income from and is a member of the speakers bureau of: Abbott Medical Optics, Alcon Laboratories Inc., Allergan, Bio-Tissue Inc., Ocular Therapeutix Inc., Shire, TearLab, and Valeant. She has received a retainer, ad hoc fees, or other consulting income from Alphaeon, GlassesOff, and TearScience. Dr. Yeu is a member of the speakers bureau of Omeros Corporation. Staff members: Laura Johnson has no oph- thalmic-related financial interests. Jan Beiting has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, AcuFocus, Allegro Ophthalmics, Imprimis Phar- maceuticals, Johnson & Johnson Vision Care, and STAAR. satisfaction drops off dramatically (Figure 2). This mirrors what we have seen in previous studies of patient satisfaction with multifo- cal IOLs as well. Surgical monovision Monovision results in a loss of binocularity, depth perception, and image summation and may not be tolerated by some patients. Although –2.0 D is the practical Targeting inlay outcomes It is recommended, for example, that the small aperture corneal inlay be implanted monocularly in an eye with –0.75 D myopia (and a plano fellow eye). This re- fractive target can provide a depth of focus of up to 2.75 D and near visual acuity of J1 or better. A plano to hyperopic refraction in an eye implanted with this style of inlay will result in poorer near and distance vision (Figure 1). As visual acuity—and especial- ly near acuity—decline, patient power. This concept now has expanded to include pseudopha- kic loss of near vision with implantation of distance-correct- ed monofocal intraocular lenses (IOLs). To effectively take presbyopia correction to new levels, we need to examine how we can use the latest technology to correct a pa- tient's refractive error and restore uncorrected vision at all ranges. The options for correcting presbyopia include progressive or bifocal spectacles; multifocal contact lenses; monovision with contact lenses, LASIK, or IOLs; cor- neal inlays; and presbyopia- cor- recting IOLs. Specific visual needs and preferences, ocular anatomy, concomitant disease, and other factors must be taken into con- sideration in determining which approach is best suited for a given patient. When pursuing any surgical solution to presbyopia, refractive targeting must be precise. The ideal refractive target may be a slightly myopic or hyperopic one, rather than plano. Advances in technology and techniques are making new refractive outcomes possible T raditionally, ophthalmol- ogists have considered presbyopia to be an age-related alteration in the ability of the hu- man lens to change its refractive by John Vukich, MD Today's options and opportunities: What is the "new bar" for presbyopia correction? John Vukich, MD " Satisfaction drops significantly if patients have more than 0.5 D of error in either direction. " –John Vukich, MD EyeWorld July 2016 The news magazine of the American Society of Cataract & Refractive Surgery digital.eyeworld.org Supplement to EyeWorld Daily News, Sunday, May 8, 2016 Advanced therapeutic and surgical options to eliminate post-cataract surgery inflammation and pain Supplement to EyeWorld July 2016 continued on page 2 Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Edu- cation through the joint providership of the American Society of Cataract & Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medical education for physicians. Educational Objectives Ophthalmologists who participate in this activity will: • Distinguish predisposing factors putting patients at higher risk for an inflammatory reaction after cataract surgery, including key uveitis, retina, and corneal issues • Identify the true impact of ocular inflammation levels on outcomes in refractive cataract surgery: variability in visual acuity and quality results; delayed visual recovery that reduces the postop- erative "wow" factor; pain and discomfort that reduce patient satisfaction • Develop personal protocol for acceptable levels of inflammation for post-cataract surgery, as guided by ASCRS leadership • Identify new agents and acquire strategies to eliminate inflammation and relieve pain by maximizing the penetration of anti-inflammatory agents into target tissues, including: dosing lev- els, interventional timing, concomitant therapies and duration to address ocular inflammation; key vehicle parameters including viscosity and other key considerations in selecting the appropriate formulation; and patient adherence to regimen • Assess the clinical impact of various levels of ultrasound energy applied during cataract surgery, and how these differ with complex vs. routine cataract patients, and recognize the amount of reduction in these levels available Designation Statement The American Society of Cataract & Refractive Sur- gery designates this enduring materials educational activity for a maximum of 1.0 AMA PRA Category 1 Credits. ™ Physicians should claim only credit commensurate with the extent of their participation in the activity. Claiming Credit To claim credit, participants may visit bit.ly/28N3jDJ to review content and download the post-activity test and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. Alternatively, the post-test form included in this supplement may be faxed to the number indicated for credit to be awarded, and a certificate will be mailed within 2 weeks. When viewing online or downloading the material, standard Internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through January 31, 2017. CME credit will not be awarded after that date. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only. ADA/Special Accommodations ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational program who requires special accommodations or services should contact Laura Johnson at ljohnson@ascrs.org or 703-591- 2220. Financial Interest Disclosures Eric Donnenfeld, MD, has an investment interest in and has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Acu- Focus, Alcon Laboratories, Allergan, AqueSys, Bausch + Lomb, Beaver Visitec International, CRST, Glaukos, Icon Bioscience, Kala Pharmaceuticals, Katena, Mati Pharmaceuticals, Merck Sharp & Dohme, Mimetogen, NovaBay Pharmaceuticals, Novaliq, OcuHub, Odyssey, Omeros, Pfizer, PRN, RPS, Shire, and Straths. Edward Holland, MD, has received a retainer, ad hoc fees, or other consulting income from: Alcon, Bausch + Lomb, Kala Pharmaceuticals, Mati Therapeutics, PRN, RPS, Senju, Shire, TearScience, and TearLab. He is a member of the speakers bureau of: Alcon, Bausch + Lomb, Kala, Mati, RPS, Senju, and TearLab. Dr. Holland has received research funding from Alcon, Mati, PRN, and Senju, and has received travel expense reimbursement from Alcon and Bausch + Lomb. Terry Kim, MD, has received a retainer, ad hoc fees, or other consulting income from and has an invest- ment interest in Ocular Therapeutix and Omeros. He has received a retainer, ad hoc fees or other consult- ing income from and is a member of the speakers bureau of Alcon and Bausch + Lomb. Dr. Kim has received a retainer, ad hoc fees, or other consulting income from: Acucela, Acuity Advisors, Allergan, CoDa Therapeutics, Foresight Biotherapeutics, Kala, NovaBay, Ocular Systems Inc., Oculeve, PowerVision, Presbyopia Therapies, Shire, Stealth BioTherapeutics, TearLab, and TearScience. Richard Lindstrom, MD, has received a retainer, ad hoc fees, or other consulting income and has an investment interest in: 3D Vision Systems, Abbott Medical Optics, AcuFocus, BioSyntrx, Broad- Spot, Bruder, Calhoun Vision, Clarity Ophthalmics, Clear Sight, EBV Partners, EGG Factory Ventures, Encore Vision, Equinox, Evision Photography, Eyemaginations, Glaukos, High Performance Optics, LENSAR, LifeGuard Health, Minnesota Eye Consultants, NovaBay, NuLens, Ocular Optics, Ocular Therapeutix, Omega Eye Health, Photo EyeWear, Revi- talVision, Schroder Life Science Venture, Sightpath, TearLab, Tracey Technologies, Transcend Medical, and TrueVision. He has an investment interest in: Confluence Acquisition Partners, CXL Ophthalmics, Evision Medical Laser, Foresight Venture Fund #3, FzioMed, Healthcare Transaction Services, Heaven Fund, OnPoint, Rainwater Healthcare, Refractec, and Viradax. Dr. Lindstrom has received a retainer, ad hoc fees, or other consulting income from: Advanced Refractive Technologies, Alcon, Elenza, ForSight Labs, NASA-Vision for Mars Program, Nicox, OSN, Oculeve, Omeros, Versant, and Vision Solution Technologies. He earns a royalty or derives other financial gain from, has received a retainer, ad hoc fees, or other consulting income from, and has an investment inter- est in Bausch + Lomb, and earns a royalty or derives other financial gains from and has an investment interest in Quest. Francis Mah, MD, has received a retainer, ad hoc fees, or other consulting income from, is a member of the speakers bureau of, and has received research funding and travel reimbursement from: Abbott Medical Optics, Alcon, Allergan, Bausch + Lomb, and Shire. He has received a retainer, ad hoc fees, or other consulting income from: CoDa Therapeutics, ForSight Labs, NovaBay Pharmaceuticals, Ocular Therapeutix, and TearLab. Dr. Mah has received research funding from Ocular Therapeutix. Staff members: Laura Johnson has no ophthalmic- related financial interests. Beth Marsh has received a retainer, ad hoc fees, or other consulting income from Akorn and Shire. The survey demonstrat- ed that more than half (52%) of respondents who prescribe NSAIDs for the average cataract patient discontinue them 4 patterns. The survey collected responses from 2,047 unique respondents, based on 485 data points centered on the most compelling and controversial issues facing ophthalmologists. T o ensure successful outcomes from cat- aract surgery, it is critically important to recognize the influence of ocular inflammation on sur- gical results. In this supplement, we will examine the impact of inflam- mation as well as therapeutic strategies to help you achieve the excellent visual outcomes your patients expect from cata- ract surgery. Survey results Results from the 2015 ASCRS Clinical Survey provided key insights regarding members' clinical opinions and practice ASCRS Clinical Survey demonstrates members' clinical practices by Richard Lindstrom, MD Achieving excellent visual outcomes from cataract surgery " Although other medical fields largely use generic medications, ophthalmologists still prescribe numerous branded drugs. " –Richard Lindstrom, MD Richard Lindstrom, MD Supported by Alcon Laboratories, Bausch + Lomb, Imprimis Pharmaceuticals, Ocular Therapeutix, and Omeros Corporation The news magazine of the American Society of Cataract & Refractive Surgery digital.eyeworld.org Supplement to EyeWorld Daily News, Monday, May 9, 2016 Innovative IOL technologies for the cataract surgeon

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