Eyeworld

16 December 2016 EW ASCRS NEWS talk about off-label information any longer, he said, adding that EyeWorld has made a big difference, filling the gap left by such regulations. Another interesting current EyeWorld activity is data collection for the ASCRS Clinical Survey, Dr. Donnenfeld said. This questionnaire, which garners approximately 1,500 responses a year, helps practitioners put their finger on the pulse of oph- thalmology. The survey is conducted at the ASCRS•ASOA Symposium & Congress, and results are published in a supplement the following fall. Within the pages of EyeWorld, the evolution has been profound. Refractive corneal surgery has been added to both the society and the magazine, Dr. Donnenfeld noted. While EyeWorld had been doing well highlighting cataract and refractive procedures for many years, with the advent of innovative glaucoma procedures such as MIGS, another dimension was added to EyeWorld. "The acceptance that general ophthalmologists should be doing microinvasive glaucoma surgery has added a new aspect to EyeWorld's importance," Dr. Donnenfeld said. Today EyeWorld is covering all of anterior segment surgery. EyeWorld continued from page 13 The fact that EyeWorld doesn't have vested interests in one device or one company has been important over the years. "We provide a fair and balanced educational experi- ence for our readers that they know they can trust," Dr. Donnenfeld said. "If you read EyeWorld thoroughly, I think you'll find yourself to be a better ophthalmologist. This is the best source of education that many ophthalmologists rely upon on a monthly basis." Dr. Donnenfeld credits the editorial staff for bringing this ma- terial to light each month. "I want to thank our editors, starting with Amy Goldenberg and the entire editorial staff," he said. "They're the unsung heroes who do so much work to bring this out every month, and their attention to detail is what makes EyeWorld exceptional." In addition, Dr. Donnenfeld credits the Editorial Board's section editors, in- cluding Clara Chan, MD, in cornea, Rosa Braga-Mele, MD, in cataract, Reay Brown, MD, in glaucoma, and Steven Schallhorn, MD, outgoing refractive editor, for their invaluable contributions in guiding EyeWorld story development. "In addition, in each section, we have five to 10 Editorial Board members who contribute on a regular basis and make this such a special educational experience," he said. In the future, Dr. Donnenfeld envisions EyeWorld evolving more toward digital publishing. "I see EyeWorld moving very rapidly in that area," he said. "We already have a digital version right now, but I think access to stories, video sym- posium through digital media, and more are going to play an increas- ingly important role in EyeWorld's success going forward." He emphasized the fact that EyeWorld is the publication of ASCRS. "ASCRS and EyeWorld go hand-in- hand," he said, adding that as ASCRS continues to grow and prosper, EyeWorld will be right there. "We are the source of innovation for ophthal- mologists. For those of us who are looking to enhance our clinical skills, both ASCRS and EyeWorld are going to be there to fulfill that need for all of us," he said. EW Contact information Donnenfeld: ericdonnenfeld@gmail.com Obstbaum: sobstbaum@northwell.edu View the EyeWorld CME and non-CME supplements at: cmesupplements. eyeworld.org supplements. eyeworld.org Supplement to EyeWorld November 2016 Exploring the next generation of laser vision correction, refractive outcome goals, and practice growth strategies Supported by Abbott Medical Optics Accreditation Statement This activity has been planned and implemented in accordance with the accreditation require- ments and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract and 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: • Describe how next generation diagnostics and ablation profiles will impact patient safety, efficacy, and overall outcomes for the modern refractive practice. Designation Statement The American Society of Cataract and Refractive Surgery designates this enduring materials educational activity for a maximum of 0.75 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 must visit bit.ly/2e4sDHP to review content and down- load 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 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 April 30, 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 Michael Gordon, MD, has received a retainer, ad hoc fees or other consulting income from Alcon Laboratories and Presbia. Colman R. Kraff, MD, has received research funding from Abbott Medical Optics. Edward E. Manche, MD, has an investment in- terest in Calhoun Vision and Seros Medical LLC. He has received research funding from: Abbott Medical Optics, Allergan, Avellino Laboratories, and Ocular Therapeutix. Dr. Manche has received a retainer, ad hoc fees, or other consulting income from Abbott Medical Optics. Karl G. Stonecipher, MD, has an investment interest in Strathspey Crown. He has received a retainer, ad hoc fees, or other consulting income from, and is a member of the speakers bureaus of: Alcon Laboratories, Allergan, Bausch + Lomb, Presbia, Refocus, and Shire. Dr. Stonecipher is a member of the speakers bureaus of Abbott Med- ical Optics and Nidek. He has received research funding from: Alcon Laboratories, Allergan, Baus- ch + Lomb, Presbia, and Refocus, and he has received travel expense reimbursement from: Allergan, Bausch + Lomb, Presbia, and Shire. Staff members: Kristen Covington and Laura Johnson have no ophthalmic-related financial interests. by Karl Stonecipher, MD Accelerating LVC adoption: Successful growth strategies for your refractive practice optimizing our website's search engine performance. Without an optimized website you will lose the millennial quickly. Market Scope respondents rated websites as their most effective marketing tool. 1 Patient education To educate patients, we use a range of tools, including tablets and videos, which drive patients to our website, and encourage them to read the latest research. Surgeons need to counter com- mon misconceptions about LVC. For example, patients may be concerned about post-LASIK dry eye. However, when Price et al. performed a 3-year survey in patients with LASIK vs. contact lenses, LASIK did not signifi- cantly increase dry eye and patients were more satisfied. 6 In the beginning of the process, we explain that presbyopia will even- tually change their vision and that can be corrected when they have cataract surgery, if applicable. We don't discuss this with a 22-year-old, but we start the conversation when patients are 35 to 40 years of age. Patients also need to know an enhancement does not mean the procedure has failed but that we need to fine-tune their results. If this concept is not explained early, it will lead to a long conversation Excellent outcomes also attract new patients. New technology allows us to treat patients who were previously ineligible and provides better outcomes on postoperative day 1. 5 When we achieve 20/15 visual acuity after surgery on the next morning, patients experience a "wow" factor that we reinforce, comparing their previous and cur- rent vision on the eye chart. This visit is also the perfect time to ask patients whether friends or family members might be interested in LVC. However, millennials like fash- ion eyeglass frames, so they may be less interested in LVC, but they do not want to wear glasses for certain activities. Therefore, we explain that they can still wear glasses after LVC but will not need them. Although this seems obvious, sometimes individuals do not register this concept. In fact, websites now sell nonprescription glasses as a fashion accessory. To reach millennials through so- cial media, we have an employee in this age group who mines potential candidates through Facebook and Twitter. If we offer free exams and can encourage the patient to come in for an evaluation, roughly 70% to 75% of candidates choose to have the procedure. We are also Baby boomers interested in LVC have either had the surgery or are beyond the optimal age range. How- ever, patients in my practice who had LASIK from 1995 to 2000 often return early for cataract surgery with premium intraocular lenses because they do not want to wear reading glasses, similar to results reported by Yesilirmak et al. 4 Although millennials may show less interest in LVC and often lack the income for out-of-pocket procedures, I think they offer the most potential in growing our LVC practices. Segmented strategies Market segmentation is a useful tool in reaching potential LVC candi- dates. However, when we target groups through different means, it is important to convey the same messages, or we must segment our marketing dollars toward genera- tion-directed advertising. Word of mouth and physician referrals account for our highest numbers among older patients, so we usually attract millennials by talking to their parents or grand- parents. We also email information about LVC specials to our patients who received the procedure 10 or 15 years ago, advertising LVC as a graduation or holiday gift for their children or grandchildren. Economic and demographic changes are transforming the LVC market F or the first quarter of 2016, Market Scope estimated that laser vision correction (LVC) and non-laser refrac- tive procedures combined showed a 13.7% increase year over year. 1 However, even these positive statistics illustrate that 2015 demon- strated a decline. Moreover, if we recall the peak refractive procedure volume, it is little more than half of what it once was. When Stein et al. gauged interest by examining the Google query rate for "LASIK" from 2007 to 2011, they found it decreased in the United States by 40%. 2 Economic and demographic changes, as well as other factors, have transformed the LASIK mar- ket. The U.S. millennial population (born between 1982 and 2000) now exceeds the baby boomer popula- tion (83.1 million vs. 75.4 million, respectively). 3 Karl Stonecipher, MD continued on page 69 EyeWorld September 2016 Supported by Alcon Laboratories Inc., Allergan Inc., Shire Pharmaceuticals, TearLab, and TearScience This monograph is part of a year-long curriculum focused on treatment of ocular surface disease and management. Accreditation Statement This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continu- ing Medical Education through the joint providership of the American Society of Cataract and Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medi- cal education for physicians. Educational Objectives Ophthalmologists who participate in this activity will: • Identify the true impact of a dysfunc- tional ocular surface on cataract and refractive outcomes, identify the conse- quences that accompany an unstable tear film, and discuss the presentation of symptomatic vs. asymptomatic OSD Designation Statement The American Society of Cataract and Refractive Surgery 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 must visit bit.ly/2bfDuPS 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. Alterna- tively, the post-test form included in this monograph may be faxed to the number indicated for credit to be awarded, and a certificate will be mailed within two weeks. When viewing online or down- loading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through March 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 FDA or have been ap- proved 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 partici- pant 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 Marjan Farid, MD, has received a retainer, ad hoc fees or other consulting income from Abbott Medical Optics, Allergan, RPS, Shire, and TearScience. Edward Holland, MD, has received a retainer, ad hoc fees or other consulting income from: Alcon, Bausch + Lomb, Kala Pharmaceuticals, Mati Thera- peutics, PRN, RPS, Senju, Shire, Tear Science, 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. Steven Schallhorn, MD, has received a retainer, ad hoc fees, or other consulting income from Abbott Medical Optics, AcuFocus, Carl Zeiss Meditec, and Ivantis. Elizabeth Yeu, MD, has an investment interest in: Modernizing Medicine, RPS, and Strathspey Crown. She has received a retainer, ad hoc fees, or other consult- ing income from, and is a member of the speakers bureau of: Abbott Medical Optics, Alcon Laboratories, Allergan, Bio-Tissue, i-Optics, Ocular Therapeutix, Shire, TearLab, and Valeant. She has received a retainer, ad hoc fees, or other consulting income from: Alphaeon, GlassessOff, RPS, and TearScience. She is a member of the speakers bureau of Omeros. Staff members: Kristen Covington, Laura Johnson, and Erin Schallhorn have no ophthalmic-related financial interests. 365 Curriculum Ocular surface disease (OSD) The ocular surface: The first refractive interface of the eye continued on page 3 by Steven Schallhorn, MD Refractive patient satisfaction: Expectations for postoperative vision but this percentage declined with increasing cylinder. The condition of the ocular surface critically impacts visual outcomes from refractive and cataract surgery. To achieve results that meet patients' high expecta- tions, surgeons need to evaluate the ocular surface and treat OSD before performing preoperative measurements. In the PHACO study, Trattler et al. found that nearly 77% of patients evaluated for cataract surgery demonstrated fluores- cein corneal staining, with 50% having central corneal staining. 1 However, dry eye had been diag- nosed in only 22.1%. In a multicenter clinical trial, Epitropoulos et al. found that average K readings and anterior corneal astigmatism varied more in patients with increased tear osmolarity, resulting in significant Express centers in the U.K., patients completed question- naires one month after surgery (Schallhorn SC, data presented at 2014 AAO annual meeting). A manifest refraction close to plano was closely associated with 20/20 uncorrected visual acuity. As ex- pected, the greater the refractive error, the less likely the patient's uncorrected distance vision would be 20/20. Likewise, increasing postoperative cylinder reduced the likelihood of 20/20 vision. Consequently, patients with increased residual refractive error after surgery were less likely to be satisfied with their outcomes. Nearly 71% of patients with no residual error were very satisfied with their results compared with 66.3% with 1.00 D MSE and 51.9% with 1.50 D MSE. Further- more, 73.2% of those with no residual cylinder and 66.9% with 1.0 D cylinder were very satisfied, Ocular surface disease may be an overlooked barrier P atients have high visual expectations of laser vision correction and re- fractive cataract surgery. Although surgical and technologic refinements contin- ue to advance our capabilities, surgeons need to address ocular surface disease (OSD) to deliver the results patients expect. Postoperative satisfaction Residual refractive error is a major driver of patient dissatisfaction because of its impact on visual acuity and quality of vision. In a study of more than 4,970 eyes (2,585 patients) un- dergoing refractive lens exchange with multifocal IOLs at Optical Practice pearl: Untreated ocular surface disease (OSD) associated with refractive surgery can lead to worse refractive outcomes, im- paired vision, and reduced patient satisfaction. Properly diagnosing and managing OSD, before surgery or if it develops after surgery, is critical to providing the best care and meeting patient expectations. –Steven Schallhorn, MD EyeWorld September 2016 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 The news magazine of the American Society of Cataract & Refractive Surgery digital.eyeworld.org Supplement to EyeWorld Daily News, Sunday, May 8, 2016

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