Eyeworld

Sponsored by Reporting from the 2016 Combined Ophthalmic Symposium (COS), August 26–28, 2016, Austin, Texas EW MEETING REPORTER 130 September 2016 glabellar lines, perform a "chemical brow lift," and drop the lid in thy- roid eyelid retraction, Dr. Lee said. But she noted that surgeons should be aware of the differences between the three commercially approved products, know the anatomy, and know how to avoid and treat possi- ble complications. Ptosis, for example, is a possible complication of botulinum use, but Dr. Lee said apraclonidine can be used to stimulate muscle contrac- tion. She said the frontalis muscle is one of the most difficult to inject because it is wide and splits in differ- ent places depending on the patient. "To try to get the whole mus- cle is difficult and you can end up with a 'Spock' brow," Dr. Lee said, referencing the Star Trek character and noting that you can prevent this effect or lowering of the brow by staying at or above midline on the forehead and using conservative doses. When it comes to lights and la- ser devices, Dr. Lee said they provide patients with a "good option with other non-surgical things … and are also a great supplement to surgical procedures." They can be used for cosmetic procedures and to treat functional issues as well. Some of the laser uses include correcting acne scars and discol- oration of the skin, resurfacing of eyelids, and reducing the appearance of periocular veins. Different lasers perform different treatments. Pulse light therapy can be used as a rosacea treatment and could soften the meibomian glands with heat to make the meibum softer and more releasable into the tear film. Infrared light can also have a skin-tightening effect and is consid- ered a noninvasive, easy procedure, Dr. Lee said, not even requiring numbing. Editors' note: Dr. Lee has financial interests with Allergan, Galderma (Lausanne, Switzerland), Merz Pharma (Frankfurt, Germany), and Ophthal- mology Web (South San Francisco). then again in 2026 and beyond. It also has the consolidated Merit- Based Incentive Payment System (MIPS) with more flexibility, po- tential for significant bonuses, and lower maximum penalties. There is enhanced technical and financial support for small practices, transi- tional payments for new models, funding for quality measures, and timelier physician access to per- formance data, Ms. McCann said. Physicians do have choices as well, with both MIPS and APMs. Editors' note: Ms. McCann has no finan- cial interests related to her comments. Cosmetic and functional oculoplastics on the rise Wendy Lee, MD, Miami, spoke in two presentations about the use of botulinum toxins, dermal fillers, lasers, light therapy, ultrasound, and more to perform cosmetic and functional procedures. "The reason why this topic is so important is because year after year non-surgical cosmetic enhance- ments way outnumber surgical, and if you break that down, in the non-surgicals, the two most popu- lar by far are botulinum toxins and dermal fillers," Dr. Lee said. "A lot of people are getting into injectables, not just ophthalmologists." Botulinum toxins can be used to erase wrinkles like crow's feet and The specific details have been outlined in a proposed rule, Ms. McCann said, and CMS is expected to issue a final rule in November. She said ASCRS submitted extensive comments on the proposal and re- quested several significant changes, including a delay in the start of the reporting period and a reduction in the thresholds. ASCRS is expecting there could be a number of changes when the final rule is released. The common theme regarding Medicare physician payment, which is bipartisan, is a move toward a system that's based on outcomes, quality, and efficiencies, she said. MACRA was developed in a bipar- tisan process over a several-year period. It permanently eliminates the SGR and implements a new payment system that ties reimburse- ment to performance and offers two payment pathways: a modified fee-for-service model (MIPS) and ad- vanced alternative payments models (APMs). Ms. McCann explained the details of the two pathways and how ophthalmic practices could comply. MACRA offers a number of im- provements over prior law, she said. Under the SGR, physicians were fac- ing negative updates for the foresee- able future. There were overlapping, rigid, and sometimes contradictory reporting and penalty programs. With MACRA, there are modest but positive updates for 5 years and View videos from COS 2016: EWrePlay.org Sumitra Khandelwal, MD, discusses strategies for corneal collagen crosslinking. continued on page 132

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