Eyeworld

UPDATE 13 (MIPS) and Advanced Alternative Payment Models (APMs). Since nearly all ophthalmologists will participate in the MIPS program— and all physicians must report through MIPS in the first year of the program—ASCRS focused its efforts on advocating for improvements to the program and was successful in achieving nearly all of the recom- mended changes from the proposed rule. Among the key changes was the "Pick Your Pace" option, which provides flexibility for participation in the first year—in direct response to ASCRS and medical community advocacy. To prepare members to com- ply with this new program, ASCRS developed in-depth training mate- rials; hosted an intensive in-person training session as part of ASOA on Tour; and planned additional oppor- tunities for members to learn how they can best succeed under the new program. Full details of the MACRA program are available at ascrs.org/ macracenter. ASCRS will continue to advocate for additional changes to MACRA in 2017. In addition, it will advocate for legislation supporting key issues in the new Congress. You can stay up to date on the latest legislative developments by reading the Wash- ington Watch Weekly newsletter. Legislative Fly-In: ASCRS participated in the 2016 Alliance of Specialty Medicine Fly-In in Wash- ington, D.C. in July, with 25 ASCRS member ophthalmologists and 15 ASOA practice administrators, repre- senting 22 states and 36 congressio- nal districts, in attendance. Attend- ees met with their senators and representatives on Capitol Hill to outline important issues including MACRA and ask them to take action. The 2016 ASCRS•ASOA group was the largest ever and included five ASCRS residents and fellows who attended via the inaugural ASCRS Young Eye Surgeons (YES) Legislative Fly-In Scholarship Program, de- signed to enhance younger mem- bers' understanding of public policy issues affecting ophthalmology and provide networking opportunities with established ASCRS members, including leadership. Read a full event recap and view photos from the event on the ASCRS website. EW Contact information Monasterio: dmonasterio@ascrs.org In the journal ... Risk of microbial keratitis: Comparative meta-analysis of contact lens wear and post-laser in situ keratomileusis patients Jordan Masters, MD, Mehmet Kocak, PhD, Aaron Waite, MD Investigators in this study compared how those undergoing LASIK fared in terms of microbial keratitis risk versus those wearing contact lenses. After searching the PubMed database for cases occurring from December 2014 to July 2015, a meta-analysis was performed. Investi- gators determined that at 5 years there were about three times as many cases of microbial keratitis in those wearing daily soft contact lenses than those who underwent LASIK. Like- wise, at 1 year, with extended contact lens wear there were three times as many microbial keratitis cases with 12 more cases than for LASIK, while by 5 years there were 81 more cases in these extended wear eyes. Even with LASIK retreatments considered, at an estimated 10% retreatment rate, there was little change in outcomes. Investigators concluded that for both LASIK and contact lens users, occurrence of microbial keratitis is relatively rare, with a similar risk at 1 year for both. However, over time, this risk becomes greater for contact lens wearers, particularly with extended wear lenses, than for LASIK patients. Assessment of a new femtosecond laser-assisted clear corneal incision technique in cataract surgery Sebastiano Serrao, MD, PhD, Daniela Giannini, MEng, Domenico Schiano-Lomoriello, MD, Giuseppe Lombardo, MEng, PhD, Marco Lombardo, MD, PhD In this prospective, randomized case series of 20 eyes, investigators considered how a new femtosecond laser-assisted clear cornea incision method of performing cataract surgery affected corneal topography and higher order wavefront aberrations. Half of the patients underwent the procedure with use of a three-plane femtosecond laser-assisted clear corneal incision, while in the other half, the control group, disposable knives were used to create a manual single-plane angled clear corneal incision. At the 6-month postoperative mark, investigators determined that simulated keratometry values showed a mean change of 0.16 D for those receiving the femtosecond laser clear corneal incision, while for the controls this had changed by a mean of 0.34 D. When corneal higher order aberrations were considered, investigators found that for manual clear corneal incisions these increased significantly over both 3.5 and 6 mm pupils, while in the femtosecond group it was only over the 6 mm pupil that this change increased significantly. Also, with both pupil sizes there were significant differences of induced higher order aberrations between the groups. Investigators conclud- ed that over mesopic pupils, the femtosecond laser-assisted clear corneal incisions did not change simulated Ks and higher order wavefront aberrations significantly. They theorize that this lesser amount of induced changes with the femtosecond approach may be linked to the different geometry used in creating the different clear corneal incisions. Distinguishing between contact lens warpage and ectasia: Usefulness of optical coherence tomography epithelial thickness mapping Julie Schallhorn, MD, Maolong Tang, PhD, Yan Li, PhD, Derek Louie, OD, Winston Chamberlain, MD, David Huang, MD, PhD Can characteristic patterns on corneal topography and optical coherence tomography epithe- lial thickness maps help to distinguish cases of ectasia versus warpage from contact lenses? In this case series, investigators set out to determine this. There was a mix of cases included— 21 keratoconus eyes, six eyes with forme fruste keratoconus, and 15 eyes with warpage from contact lenses. Investigators found that there was coincident topographic steepening with epithelial thinning in cases of keratoconus as well as forme fruste keratoconus. In 90% of eyes with keratoconus they found that the locations of maximum axial power and minimum epithelial thickness agreed. Likewise, in 95% of these cases the maximum mean power and minimum epithelial thickness agreed. Meanwhile, in cases of warpage there was epithelial thickening with coincident topographic steepening, while pachymetry maps were normal. In 93% of eyes with warpage there was agreement in where the maximum epithelial thickness and maximum axial power were located. Likewise, in all eyes with warpage, maximum epithelial thickness and maximum mean power agreed. The conclusion reached here was that to help distinguish between keratoconus and warpage conditions, epithelial thickness and corneal topographic maps can be synergistic methods for determining what is going on in the eye. January 2017 with peers on topics such as cata- ract/refractive, glaucoma, cornea, and business. On an average day, EyeConnect conversations may cov- er IOL calculation questions, specific cataract surgery complications, help with adapting to new technologies, or experience with the latest glauco- ma surgery techniques. To further optimize the use of this interactive forum, ASCRS formed the EyeConnect Commit- tee, which brought new ideas and energy to the initiative, resulting in increased membership involvement on EyeConnect. The forum is now available via mobile app. To down- load it, search for EyeConnect365 in your app store. Post-Refractive IOL Calculator update. In 2016, the Post-Refrac- tive IOL Calculator—available on the homepage of the ASCRS web- site—was updated by the calculator authors Li Wang, MD, PhD, Warren Hill, MD, and Douglas Koch, MD. Membership involvement Membership Committee: In 2016, a Membership Committee, chaired by John Berdahl, MD, was formed to assist with the development of recruitment and retention strategies, and to ensure that ASCRS meets the needs of its diverse and ever-chang- ing membership. ASCRS member- ship includes physicians at every career level, from those currently in residency to seasoned professionals with decades of experience. The Membership Committee represents this diverse breakdown and will play a key role for the future of ASCRS. Council of 100: ASCRS also formed the Council of 100, an ad- visory board that assists the ASCRS Executive Committee and Govern- ing Board with issues of clinical im- portance, membership, and program development. The Council of 100 comprises a diverse cross section of volunteer members who will be con- sulted on a variety of topics to help guide the direction of ASCRS. Active advocacy Focus on MACRA: In 2016, ASCRS and its Government Relations Com- mittee closely monitored and edu- cated membership on the Centers for Medicare and Medicaid Services' (CMS) implementation of the Medi- care Access and CHIP Reauthoriza- tion Act (MACRA). In October, CMS released a final rule on the Merit- Based Incentive Payment System ASCRS continued from page 11

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