Eyeworld

129 September 2016 EW MEETING REPORTER much as some of the other problems because these are a common cause of vision loss," she said. Retinal vein occlusions are the second most common cause of vision loss from retinal vascular disease after diabetic retinopathy. This problem is caused by blockage of venous circulation, which leads to leakage and hem- orrhage accompanied by ischemia. Retinal vein occlusions are classified by where the occlusion is located and can be central, branch, or hemi. They are further divided by ischemic or non-ischemic. Most are unilateral, although some are bilateral. Risk factors for RVOs include age, smoking, glaucoma, hyperten- sion, and hypercoagulability, Dr. Weng said; age and hypertension are the biggest risk factors. Patients typ- ically present with painless blurry vision or central scotoma, which can be rapid or progressive onset. "In general, RVOs are not an emergency," Dr. Weng said. But phy- sicians should check blood pressure, ask the patient about smoking, and recommend follow-up with a prima- ry care provider within 2 weeks. She also said to consider obtaining an OCT and fluorescein angiography. If you decide to refer to a retina spe- cialist, do so in 1 week, she added. There are some cases when physicians might want to consider a further work-up, Dr. Weng said, like when the patient is younger than 50 years old, in bilateral cases, and when systemic disease is suspected. RVOs can cause vision loss, relat- ing to neovascularization, ischemia, and macular edema. In the case of macular edema, Dr. Weng said to initiate treatment immediately. There are several management options for retinal vein occlusions, Dr. Weng said. There are medical approaches as well as ophthalmic approaches, which include intravit- real anti-VEGFs, intravitreal steroids, and laser photocoagulation. Follow-up is important in these cases, Dr. Weng said, because those with RVO could be at a risk of devel- oping another one at a later time. Retinal vein occlusions are a common cause of visual disability, most often via cystoid macular ede- ma, Dr. Weng said. There are a num- ber of treatment options available for RVO-related CME or neovascular- ization, she said. Additionally, visual prognosis correlates with the degree of ischemia. Editors' note: Dr. Weng has financial interests with Allergan. Premium cataract surgery: simplifying patient choices, finding benefits in new technologies With the increasing number of refractive technologies that can be used during cataract surgery, the options, Shamik Bafna, MD, Cleveland, said during a session that focused on premium cataract sur- gery, can leave patients with "anal- ysis paralysis." As such, he said that his practice has simplified surgical choices for patients and modified how they explain technologies. Instead of going through all of the technologies and refractive op- tions with the patient, for example, Dr. Bafna said it is at the discretion of the surgeon to recommend what he or she thinks will achieve the best outcome. "Patients are not interested in whether we put in a toric lens or perform limbal relaxing incisions. The patient just wants good vision," he said. Dr. Bafna presented several anal- ogies that he uses to explain tech- nology to patients. Not correcting astigmatism would be like viewing an image in "standard definition," while correcting astigmatism is more like "high definition." Intraoperative aberrometry he explains as being like GPS, and the femtosecond laser, he tells his patients, softens the lens like a cookie that is dunked in milk. "Ultimately, what we have found in our practice is that [these techniques have] helped to increase our upgrade conversion percentage and ultimately have helped improve our bottom line from that stand- point," Dr. Bafna said. Robert Cionni, MD, Salt Lake City, spoke about the benefits of in- traoperative aberrometry, presenting data that suggests it is more likely to result in outcomes within 0.5 D of the refractive target compared to conventional preoperative methods. "Today I will not do a toric lens or presbyopia-correcting lens with- out ORA [Alcon]," he said. Dr. Cionni admitted there is a learning curve to using ORA, and he provided several pearls for getting an accurate reading. Some of those include using a speculum that lifts the lids off the globe and measuring IOP with a tonometer, looking for pressure between 20–30 mm Hg. Douglas Koch, MD, Houston, chimed in, saying that while he likes ORA, he does the majority of his to- ric and multifocal lenses without the technology with excellent results. "That's because we measure carefully preoperatively. I've used ORA and it has saved me, and I've also seen [where] it would have taken me completely down the wrong road by 10 to 15 degrees. It's a mixed bag," Dr. Koch said. Editors' note: Dr. Bafna has financial interests with Abbott Medical Optics, Alcon, CXL USA (Bethesda, Mary- land), Ocular Therapeutix (Bedford, Massachusetts), and Presbia (Dublin). Dr. Koch has financial interests with Allergan, Genentech (San Francisco), and Regeneron (Tarrytown, New York). Dr. Cionni has financial interests with Alcon. Legislative and regulatory update A legislative and regulatory update was given by Nancey McCann, ASCRS•ASOA director of government relations, and she highlighted the Medicare Access and CHIP Reautho- rization Act (MACRA), which will become effective January 1, 2019. View videos from COS 2016: EWrePlay.org Kendall Donaldson, MD, discusses how to manage positive and negative dysphotopsias in cataract surgery. continued on page 130

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