EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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October 2012 EW NEWS & OPINION 19 mended keeping this to no more than 20 mgs per day. There is some concern that too much lutein and zeaxanthin may have adverse effects on the body, he pointed out. Turmeric supplements may also prove helpful. Given the average Indian diet, Dr. Pratt thinks that it is reasonable to include as much as 2-3 grams of this every day. Dr. Anshel tries to individualize his supplement recommendations, offering nutritional consulting serv- ices in conjunction with a nutrition- ist. He also provides a service that he dubs a "supplement evaluation." "Patients come in with their bag of pills and dump them on the counter and we go through them." Dr. Anshel also offers blood tests. "I highly recommend that doctors do this because the reports come back and it's a slam dunk—it looks like the patient is deficient in this vita- min." He also does a cheek swab for macular risk. "We send it in to be evaluated if we see if they have some drusen forming, or if they have macular degeneration, what's the likelihood of it progressing," Dr. Anshel said. He suggested augment- ing this with macular pigment test- ing. "We test in the office to find out how much macular pigment they actually have, or you could just give [all patients] over 50 years old lutein," he said. "But it's nice to have some numbers that specify it to target their needs." Overall, Dr. Anshel encouraged practitioners to take on the supple- ment challenge. "It seems over- whelming to learn about nutrition because there is a lot out there and it is a whole separate specialty, but it's not beyond our scope of practice to make nutritional recommendations to patients," he concluded. EW Editors' note: Dr. Anshel has no financial interests related to this article. Dr. Pratt has financial interests with MedOp Inc. Contact information Anshel: 760-944-1200, eyexam@cox.net Pratt: 858-457-3010, prattsteveg@aol.com Learn more at AAO booth #3072 Risk for TASS remains D espite some improvements at ophthalmic practices, the risk still remains for toxic anterior segment syndrome (TASS) outbreaks, according to a report in the October issue of the Journal of Cataract & Refractive Surgery. The investigators, led by Zachary Bodnar, M.D., Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, Univer- sity of Utah, Salt Lake City, conducted a retrospective review of 130 surveys from centers that had reported TASS between 2007 and March 2012 as well as 71 site visits to afflicted centers. This encompassed a total of 1,454 TASS cases. Investigators compared the results from 2009 to 2012 to any data from prior to 2009. Education appeared to have improved some cleaning methods. Investigators found a 26% reduction in sites that reported inadequate handpiece flushing volumes. They found a 27% increase in sites that used a deionized/distilled final rinse. There was also a 36% reduction in the use of preserved epinephrine and a 36% reduction in the use of enzymatic detergents at the sites visited. Investigators still found some problematic practices. A 21% increase in the handling of IOLs with gloved hands occurred, and there was a 47% increase in poor instrument maintenance. There was a 34% increase in ultrasound bath use without adequate routine cleaning. Although the total number of TASS outbreaks has declined, the investigators recommended that ophthalmic centers follow guidelines from the TASS Task Force to help avoid further outbreaks. "Careful examination of data provided from surveys and onsite visits of centers reporting cases of TASS showed that problems with the instru- ment cleaning process, especially inadequate flushing of ophthalmic in- struments and handpieces, enzymatic detergents, and [ultrasound] baths, remain the most common factors associated with TASS," the investigators concluded.