Clinical Diagnosis

Several options are available to cataract surgeons to manage anticipated IFIS. In the multicenter prospective trial, surgeons could use a mechanical restraining device (iris expansion ring or iris retractors) to enlarge the pupil and keep the iris from prolapsing, viscodilation with Healon 5 (Advanced Medical Optics), or pharmacologic intervention with atropine administered three times daily beginning 2 days before surgery.

The American Society of Cataract and Refractive Surgery (ASCRS), the American Academy of Ophthalmology (AAO), and the American Urological Association (AUA) have joined forces to launch a patient and prescriber education campaign about the risk of intraoperative floppy iris syndrome (IFIS) associated with the current or previous use of an alpha-1 blocker and the likelihood of successful surgery if the ophthalmologist is aware of that medication history and is able to employ appropriate surgical strategies.

The American Society of Cataract and Refractive Surgery (ASCRS), American Academy of Ophthalmology, and American Urological Association all encouraged cataract patients to talk about medications, mainly alpha-blockers, used for benign prostatic hyperplasia and certain types of lower urinary tract symptoms before undergoing cataract surgery.

Fort Lauderdale, FL-Significant differences in optic disc topography exist between ethnic groups, according to the results of a study analyzing parameters measured with confocal scanning laser ophthalmoscopy (CSLO) among subjects with European, subcontinent Indian, and African-American ancestries.

San Diego-Imaging instruments can be helpful for detection of glaucomatous damage even before the appearance of visual field loss. Further, the identification of covariates affecting diagnostic performance can help explain differences among the instruments and identify the subjects that will benefit most from different technologies, said Felipe A. Medeiros, MD, PhD, assistant professor of ophthalmology, University of California at San Diego.

Fort Lauderdale, FL-Significant differences in optic disc topography exist between ethnic groups, according to the results of a study analyzing parameters measured with confocal scanning laser ophthalmoscopy (CSLO) among subjects with European, subcontinent Indian, and African-American ancestries.

New York-The Ex-PRESS glaucoma implant (Optonol) is a device that may be coming into its own, at least for some selected patients undergoing glaucoma surgery, Robert D. Fechtner, MD, reported at the Glaucoma 2006 meeting here.

New York-A gold micro-shunt (GMS, SOLX) implant holds promise for reducing complications of trabeculectomy by lowering IOP, said Celso Tello, MD.

Fort Lauderdale, FL-Multifocal visual evoked potentials (mfVEP) and standard automated perimetry (SAP) perform in a similar manner in eyes with high-risk ocular hypertension or early glaucoma, according to a comparison study. However, agreement between the two techniques reached only 80%, suggesting that they detect different defects in some cases, said Brad Fortune, OD, PhD, associate scientist, Discoveries in Sight, Devers Eye Institute, Portland, OR.

An evening CME Symposium and Reception

Salt Lake City-Population studies in Utah and Iceland have identified a gene variant that is associated with an increased risk of a precursor of age-related macular degeneration (AMD), researchers report.

The theoretical benefits of laser iridotomy are that it can relieve reverse pupillary block, alter iris configuration, reduce pigment release, and improve long-term IOP control.

San Francisco-DisCoVisc (Alcon Laboratories) performs better than Healon 5 (Advanced Medical Optics) during cataract surgery in patients who have been taking tamsulosin HCl (Flomax, Boehringer Ingelheim), which is a culprit in the intraoperative floppy iris syndrome (IFIS), according to Satish Modi, MD, FRCS (C).

San Francisco-Questioning patients before cataract surgery about whether they are taking alpha-1 blockers, such as tamsulosin (Flomax, Boehringer Ingelheim), has become increasingly important in light of the observation by David F. Chang, MD, and John R. Campbell, MD, that the drug, which is used to treat the symptoms of benign prostatic hyperplasia, can cause intraoperative floppy iris syndrome (IFIS).

Washington-Sixty-two percent of meno-pausal and perimenopausal women reported dry eye symptoms, yet only 16% of women experiencing dry eye symptoms realized dry eye was a symptom of meno-pause, according to a recent survey sponsored by the Society of Women's Health Research (SWHR). The survey polled 304 women in menopause and perimenopause.

For almost 2 years, I have pioneered a change in phaco needleconfiguration to improve the safety of cataract surgery. The DeweyRadius Tip, manufactured by Microsurgical Technologies (MST,Redmond, WA) is a standard phaco needle with a simpleexception-no sharp edges. This rounded design can be appliedto any phaco needle of standard gauge, bevel, or bend.

Baltimore?A trial program that provided support and advice to older nursing home residents with poor vision improved their access to cataract surgery substantially. But the debilitated condition of many of those residents led to hesitation about surgery not only from physicians looking after the older people but also from their guardians, according to ophthalmologists at the Johns Hopkins University's Wilmer Eye Institute, Baltimore.

It might be wise to counsel patients regarding the possible but likely low risk of NAION, especially for individuals with a higher risk for NAION.

Proper management of cataract cases involving intraoperative floppy iris syndrome (IFIS) should keep surgeons from experiencing complications associated with the problem, reported Alan Crandall, MD, at the World Ophthalmology Congress on Thursday.

Early detection of glaucoma is critical. According to the AGIS study, by the time a reproducible visual field defect is detected, 20% to 50% of the retinal nerve fiber layer (RNFL) can be damaged, said Remo Susanna, Jr., MD, at the World Ophthalmology Congress on Wednesday.

Interim results from a Phase I study suggest that intravitreal injection of VEGF Trap (Regeneron Pharmaceuticals) is a promising new approach for the treatment of exudative age-related macular degeneration, said Quan Dong Nguyen, MD, at the World Ophthalmology Congress.

Cincinnati—Tamsulosin HCl (Flomax, Boehringer Ingelheim), an alpha-1 blocker used to treat benign prostatic hyperplasia, has been implicated in the development of floppy iris syndrome during cataract surgery, according to Robert H. Osher, MD. Healon 5 (AMO) is his viscoadaptive agent (OVD) of choice to manage this challenging iris behavior during cataract surgery.

Chicago—Insertion of the Perfect Pupil Injectable (PPI, Milvella Pty. Ltd.) is an effective method for protecting the iris and maintaining a large pupil during cataract surgery in eyes predisposed to intraoperative floppy iris syndrome (IFIS), according to the results of an interventional case series reported at the annual meeting of the American Academy of Ophthalmology.

Cincinnati—Tamsulosin HCl (Flomax, Boehringer Ingelheim), an alpha-1 blocker used to treat benign prostatic hyperplasia, has been implicated in the development of floppy iris syndrome during cataract surgery, according to Robert H. Osher, MD. Healon 5 (AMO) is his viscoadaptive agent (OVD) of choice to manage this challenging iris behavior during cataract surgery.

Industrial robots—computer-controlled machines that lift, place, move, or perform specific tasks—have been performing repetitive and even dangerous jobs for several decades. Examples of such machines are found in automobile production lines, spraying paints, transporting assemblies between workstations, and welding frames and bodies with great speed, accuracy, and repeatability.

Cincinnati—Robert H. Osher, MD, professor of ophthalmology at the University of Cincinnati and medical director emeritus of the Cincinnati Eye Institute, is celebrating 20 years of the Video Journal of Cataract and Refractive Surgery with two issues in 2006.

In case you have been so busy with your practice and other obligations that you missed it, two medical miracles (my opinion) have recently been reported. Each is only partially relevant to the practice of ophthalmology, but it seems to me that these are worth awareness.

Chicago—The Heidelberg Retina Tomograph II (HRT II, Heidelberg Engineering GmbH), the most widely available generation of this technology, creates a two-dimensional picture of a three-dimensional structure, such as the optic nerve, by acquiring images in a manner similar to that of computed tomography. Jeffrey D. Henderer, MD, explained the basics of this technology and its relevance to glaucoma at the American Academy of Ophthalmology annual meeting.

Chicago—This past October, the FDA issued a labeling change for the drug tamsulosin HCl (Flomax, Boehringer Ingelheim) warning of the possibility of intraoperative floppy iris syndrome (IFIS), stating "The patient's ophthalmologist should be prepared for possible modifications to their surgical technique."

Paradise, CA—Fashion Optical Displays has named Ed Muehlberger vice president of sales and development. In the new position, Muehlberger will coordinate the company's domestic and international sales, its design staff, and its plans for corporate expansion.