Eyeworld

105 February 2017 EW MEETING REPORTER Capt. Kelly said he never thought that it would be his wife who would nearly lose her life serving her country. He spoke about the day in January 2011 when he received a call to tell him his wife had been shot while attending an event taking questions from her constituents in a grocery store parking lot. After receiving the call, he and his family had to board a flight to Tucson to get to his wife. Capt. Kelly explained that on the way, the television media actually reported that she had died, only to come back and report later that they were wrong and she was in surgery. As she was treated, there were many decisions that had to be made for her care, including brain surgery and choosing how to approach the repair of fractures to her eye sockets. "Before all of this happened to my wife, I was not a big believer in fate," he said. But after his wife went to rehab, Capt. Kelly began to realize how their lives would be changed forever, and he also began to wonder if he had the patience to address the obstacles ahead of them. Although he was scheduled for a shuttle flight, Capt. Kelly called his boss to say that he wouldn't be able to complete the flight that he was scheduled to be on in just a few months. However, after Ms. Giffords was transferred to a recovery facility in Houston, he began to contem- plate the possibility of getting his job back. There was still some concern, he said, because he realized the risk involved with completing his fourth space trip, particularly after his wife had almost lost her life. However, he said "we know that those are the odds and we focus on that risk in almost everything that we do." Risk reduction is central in everything done to operate the space shuttle, and paying attention to minor details is key. Capt. Kelly spoke about the fourth space mis- sion that he ultimately did take and the process of flying in space and landing back at home. Ms. Giffords was able to at- tend the lift off of the mission but couldn't be there for the landing because of a final brain surgery to replace a piece of her skull. Capt. Kelly spoke about the power of the human spirit and how his wife demonstrated this. He said that his wife's spirit was on display after she was shot, particularly when she first went back to Congress to vote on a bill that would raise the debt ceiling. "I could not be more proud of my wife after all she went through to be there that day to do her job," he said. Capt. Kelly and Ms. Giffords also appeared in court at the trial of the man who shot her. "Despite putting a bullet in my wife's head, he has not put a dent in her spirit," Capt. Kelly said. To close his talk, he shared some words from his wife, expressing her appreciation for those in the pro- fession of ophthalmology who gave her one of her eyes back and the message to "be bold, be courageous, and be your best." Oculoplastics Femida Kherani, MD, Vancouver, Canada, highlighted upper eyelid blepharoplasty in her presentation and spoke about anatomy, patient evaluation, surgical techniques, and case examples. According the American Society of Plastic Surgery, statistics from 2015 show that there were 1.7 mil- lion cosmetic surgical procedures, with 203,934 of those being blepha- roplasty. The anatomy to consider for these procedures includes the skin, lid creases, fat pads, and lacrimal gland. A thorough preoperative evaluation is essential to identify patient goals, and expectations are incredibly important, Dr. Kherani said. At this time, she rules out body dysmorphic disorder because surgery will not fulfill these patients' expec- tations. It's also important to rule out malignancy. Dr. Kherani asks patients how they want their eyes to look. This includes factoring in brow position, blepharoptosis, symmetry, and patient expectations. All of these are important in the preop consul- tation, she said. It's also important to know if the patient has a history of corneal surgery, skin cancer, dry eyes, or keloids. If they have low tear production, be cautious, Dr. Kherani said, and discuss artificial tears and lacrimal plugs. You can always say no if a patient comes to you for blepharo- plasty, Dr. Kherani said, stressing her pearls for a balanced blepharoplasty. Preoperative evaluation is critical. Communicate clearly the expecta- tions and limitations of surgery, and remember that the surgery has to reflect the patient's ideals of beauty. Editors' note: Dr. Kherani has financial interests with Allergan (Dublin, Ire- land) and Merz (Frankfurt, Germany). Refractive cataract surgery and the femtosecond laser Jack Holladay, MD, Houston, discussed measuring corneal power, particularly when to use keratome- try, topography, and tomography. In order to have optimal out- comes, there are several things you need, he said. These include accurate biometry, a fourth-generation for- mula, a personalized lens constant, and accurate corneal power. Physicians should not touch or put eye drops in the cornea before they take measurements, Dr. Holladay said, adding that patients shouldn't be staring before taking the measurement. They should blink a few times and open their eye wide. When using keratometry, this works on about 70% of patients be- cause they have regular astigmatism. continued on page 106 View videos from Hawaiian Eye 2017: EWrePlay.org Elizabeth Yeu, MD, shares how to avoid refractive surprises with toric IOLs.

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