EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/78708
June 2012 EW MEETING REPORTER 67 & Congress stripping endothelial keratoplasty versus Descemet's membrane en- dothelial keratoplasty. In the latter discussions, Ed- ward J. Holland, M.D., Cincinnati, cited several advantages for ocular surface transplant, including its use in severe conjunctival disease. "It's not a matter of which technique is better," he said, "but which is best indicated for the patient." Dr. Hol- land's preference is to perform ocu- lar surface transplantation first and then move to a keratoprosthesis if necessary. Anthony Aldave, M.D., Los Angeles, countered, saying the Boston keratoprosthesis "provides superior visual outcomes" to allogeneic keratolimbal transplanta- tion and avoids immunosuppression issues. Docs talk dry eye With dry eyes and ocular surface disorders being top complaints from patients, the rush is on for a diagnostic test that will definitively diagnose the disease. At one of the afternoon sessions at Cornea Day, four clinicians de- bated what they felt would be the primary diagnostic test for dry eye in the next 5 years. Presenters were tasked with looking beyond clinical presentations such as Schirmer's test, tear breakup times, or conjunctival/ corneal staining to biomechanical markers to diagnose ocular surface dysfunctions. Richard S. Davidson, M.D., Aurora, Colo., said the LipiView Ocular Surface Interferometer (TearScience, Morrisville, N.C.) allows for close monitoring of the lipid levels in tear film over time and can be combined with the LipiFlow treatment system for meibomian gland dysfunction. "After a 20-second measurement time, it is able to quantify the lipid level of tear film," Dr. Davidson said. Reza Dana, M.D., Boston, argued that the osmolarity test Roger F. Steinert, M.D. (left), and Richard L. Lindstrom, M.D. (right), induct Jack T. Holladay, M.D. (center), into the ASCRS Hall of Fame Source: Convention Photo by Jeff Orlando would reign in this arena. Osmolarity testing with the TearLab Osmolarity System (TearLab Corp., San Diego) is currently available to test for subclinical dry eye. "Tear osmolarity correlates strongly and tightly with disease severity in dry eye disease, especially in mild to moderate disease," he said. Stephen C. Kaufman, M.D., Minneapolis, touted the metallopro- teinase 9 (MMP-9) inflammatory marker, a new objective test by Rapid Pathogen Screening Inc. (Sarasota, Fla.) that detects MMP-9 in tears. MMP-9 is a non-specific inflammatory mediator that is ex- pressed by stressed epithelial cells. It has been correlated to be present in dry eye disease when inflammation is present and has a specificity of 92% and a sensitivity of 87%. Results take about 10 minutes. Victor L. Perez, M.D., Miami, talked about what he dubbed "epithelial irregularity factor" (EIF), a novel qualitative and quantitative criterion to diagnose dry eye that essentially is mapping the epithelial thickness using optical coherence tomography. In another exciting afternoon session, sets of doctors faced off to debate hot issues in ophthalmology with a twist—they were asked to take the opposite stance they normally would hold. In one debate, Jayne S. Weiss, M.D., Detroit, argued that the epithelium in advanced surface ablation should be preserved and not discarded, while Perry S. Binder, M.D., San Diego, disagreed. "Alcohol is toxic to the epithe- lium," Dr. Binder said. "Concentra- tion and exposure time increase toxicity." Mechanical disruption to the epithelial basement membrane damages basal cells, and surgeons get better results with the epithe- lium removed and discarded, Dr. Binder concluded. The audience, which voted on each case, took Dr. Binder's side, and Marian S. Macsai, M.D., Glenview, Ill., good-humoredly presented him with a "Cornea Day Oscar," as she did with others who won their debates. Editors' note: Dr. Dana has financial interests with Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), and Bausch + Lomb (Rochester, N.Y.). Dr. Davidson has financial interests with Alcon. Drs. Binder, Kaufman, Macsai, and Perez have no financial interests related to this article. Saturday, April 21 ASCRS Opening General Session honors several With more than 7,000 attendees at this year's ASCRS•ASOA Symposium & Congress, outgoing president Edward J. Holland, M.D., Cincin- nati, said, "We simply do not have enough ophthalmologists to meet the growing needs of 30 million people who will develop cataracts in the next 7 years." The goal is to move more non-surgical eyecare to optometrists to encourage efficiency. Dr. Holland said ASCRS has created an optometry membership category, but enrollment will be limited to those optometrists "employed by board-certified ophthalmologists." Incoming president David F. Chang, M.D., San Francisco, said he was "deeply honored" to be the incoming president and cited three core values he hopes his presidency will embrace and foster: teaching others, performing charity work, and promoting professional ethics. He spoke about the Global Site Alliance (funded by ASCRS), which matches volunteer ophthalmologists with philanthropic organizations that need eyecare services. Louis Braille and Jack T. Holladay, M.D., Houston, were inducted into the ASCRS Hall of Fame. Dr. Holladay received a stand- ing ovation and was visibly moved by the honor. "In my wildest dreams, I never thought I'd be up here receiving an honor like this," he said, especially after having been comatose for 8 days post-aorta surgery 2 years ago. Binkhorst Lecturer Randall J. Olson, M.D., Salt Lake City, spoke about what makes patients unhappy. In a study that he presented in greater detail later during the confer- ence, he said, "Dysphotopsia is the strongest and only factor that corre- lates with patient satisfaction." What can improve patient satisfac- tion outcomes in the future is the continued on page 68