DEC 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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December 2012 View this video at www.EWrePlay.org/ AAO2012 Stephen S. Lane, M.D., Associated Eye Care, Stillwater, Minn., discusses the different uses for femtosecond laser during cataract surgery, which he says help achieve better results for patients. A.R.C. Laser Corporation, Abbott Medical Optics, AcuFocus, and other ophthalmic companies. Targeting diagnosis and treatment for worldwide blindness from glaucoma Zeroing in on gonioscopy An estimated 80 million people worldwide will be blind from glaucoma by 2020, according to Mildred Marie Gerard Olivier, M.D., Chicago. Glaucoma specialists need to collaborate internationally to help fight the spread of blindness caused by glaucoma, said Dr. Olivier, who delivered the American Glaucoma Society Subspecialty Day Lecture. Cost factors, manpower shortages, and lack of infrastructure are all challenges when identifying glaucoma patients around the world. There appear to be better outreach efforts to fight against cataracts worldwide, Dr. Olivier said. One possible way to target glaucoma patients globally is via screening when they are seen for cataracts, she said. Better training for specialists, continuing education, advocacy, and research should also be part of the plan to target and treat glaucoma patients worldwide, Dr. Olivier explained. Glaucoma specialists made the case for gonioscopy at AAO���s Glaucoma Day, held in conjunction with the American Glaucoma Society. An informal poll of audience members found that many did not use gonioscopy because they did not feel they were trained enough in how to perform it. However, gonioscopy helps surgeons identify angle-closure patients, said Paul J. Foster, M.D., London. Plus, new surgical techniques that require visualization of certain angle structures make the skill of gonioscopy even more crucial, said Douglas J. Rhee, M.D., Boston. Both Drs. Foster and Rhee said the website www.gonioscopy. org, created by specialists at the University of Iowa, is an important resource to help train surgeons in the art and science of gonioscopy. Editors��� note: Drs. Foster and Rhee have financial interests with Alcon, Allergan, and other ophthalmic companies. Editors��� note: Dr. Olivier has no financial interests related to her comments. To shunt or not to shunt? AAO���s Glaucoma Day included a pro-con perspective on the use of the EX-PRESS Glaucoma Filtration Device (Alcon). Marlene R. Moster, M.D., Philadelphia, said the EX-PRESS helps deliver a consistent surgical approach. Surgeons can perform a nasal or temporal placement with the possibility of lowering the IOP without the use of a large glaucoma drainage device. It can also be used in patients who have had a previous failed trabeculectomy or vitrectomy. ���It���s imperative that we have options to move away from trabeculectomies,��� she said. However, Robert M. Feldman, M.D., Houston, said that the shunt cannot necessarily outperform the results of a well-constructed trabeculectomy. Other related presenters addressed angle surgery, the benefits of trabeculectomy, and the benefits of using cataract surgery as a treatment rather than a combined procedure in appropriate patients. Editors��� note: Drs. Feldman and Moster have financial interests with Alcon, Allergan, Merck, and other ophthalmic companies. AMD treatment approaching ���next frontier��� The future treatment of age-related macular degeneration (AMD) will most likely rely on the interconnection of pathogenic mechanisms, according to Joan W. Miller, M.D., Boston. Dr. Miller spoke about the current outlook, progress, and future of AMD treatment in the Jackson Memorial Lecture at the Opening Session of Refractive Subspecialty Day, preceding the joint meeting of the American Academy of Ophthalmology and Asia-Pacific Academy of Ophthalmology. ���I think we should be proud of the dramatic changes that we���ve made in the care of patients with AMD from our clinical practice of 10 years ago,��� said Dr. Miller. ���Our current pharmacologic therapy is able to delay and limit progression, and even in some cases lead to vision improvement.��� She said the field of research into the disease is approaching the ���next frontier.��� So far, the pathways, EW MEETING REPORTER 55 lipid and lipoprotein transport and metabolism, inflammation and immunity, extracellular matrix and cellular adhesion, angiogenesis and cellular stress and toxicity have been identified. ���Ultimately, we will be able to complete the puzzle and elucidate the inner connections of pathogenic mechanisms and design breakthrough interventions,��� she said. ���It���s an exciting time to study AMD and one that offers great hope for our patients.��� Editors��� note: Dr. Miller has financial interests with Alcon, Novartis Pharmaceuticals, and QLT Phototherapeutics. Approaching ocular trauma systematically best method A group of physicians from around the world discussed various methods of treating ocular trauma during a symposium on the topic at AAO/ APAO in Chicago. Any time someone reports to the emergency room with potentially life-threatening injuries, ophthalmologists need to ensure the ocular surface is properly irrigated and educate emergency room personnel not to place bandages directly on the eye, said Preston Blomquist, M.D., Dallas. Most open globe injuries will occur in the limbus, peripapillary regions, or at the sites of previous surgery, he said. When it comes to foreign bodies, the speed of entrance into the eye is ���directly proportional to the severity of the injury,��� said Mauricio Velez Fernandez, M.D., Medellin, Colombia. Foreign bodies lodge in the anterior chamber about 10% of the time, but in the retina/ choroid almost 52% of the time, he said. Malvin D. Anders, M.D., Los Angeles, works at a county hospital where causes of trauma range from gunshot wounds to self-enucleation. ���We see about 30 cases of trauma a year,��� he said, adding the main goal is to maintain the anatomic integrity of the eye. During repair surgery, ���avoid the visual axis and use appropriate tension,���

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