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A few months into my residency, a patient and her husband came to see me in clinic. The history revealed they had already sought the opinions of two internationally acknowledged giants in the field of retinal disease, one of whom was a department chairman. The answers they received on those visits had differed somewhat, so they were now coming to get the tie-breaking third opinion. “Thank goodness they have no idea I am just a first-year resident,” I thought to myself.

Hyperosmolarity emerges as key mechanism in TFOS DEWS II pathophysiology report

J. Daniel Nelson, MD, chair of The Tear Film and Ocular Surface Society Dry Eye Workshop II, highlights a new scheme for patient classification.

Many new diagnostic tools are available for dry eye and ocular surface disease (OSD). Treatments for dry eye and OSD have mixed results, however, said Bennie H. Jeng, MD.

Recently, there has been a greater interest in metrics focused upon the impact of dry eye disease on everyday activities such as reading, driving, or use of various visual display devices. These efforts provide a “real-life” assessment of how dry eye disease impacts vision-related activities.

Patients use artificial tears for different reasons and diverse conditions. While available products supplement tear production and provide relief, few distinctions between drops have been clearly established. Recent studies show that direct comparison of a new product to an older, established one and use of “real-world” metrics can be most useful to prescribers.

A thorough investigation of ocular surface health and initiation of any necessary treatment is the first step toward successful cataract surgery.

The first portable, external neurostimulator to be approved in eye care stimulates endogenous tear production without physical irritation. The device can dramatically reduce symptoms and may enable patients to stop use of some or all tear substitutes or medications, noted John Sheppard, MD, MMSc.

Comorbidity of glaucoma poses some increased risks for cataract surgery, but even when there are intraoperative complications during the lens removal procedure, it is almost always possible to still add micro-invasive glaucoma surgery (MIGS), said Reay H. Brown, MD.

Surface ablation performed with mitomycin-C (MMC) seems to be a safe and effective technique for treating residual refractive error after myopic SMILE, said Martin Dirisamer, MD.

Intravitreal ranibizumab (Lucentis, Genentech) appears to be effective for treatment of severe retinopathy of prematurity (ROP) and associated with less persistent suppression of systemic VEGF compared with bevacizumab (Avastin, Genentech), according to research reported by Shunji Kusaka, MD.

Results of a 1-year randomized controlled trial investigating treatment for diabetic macular edema (DME) show that intravitreal ziv-aflibercept (Zaltrap, Sanofi Genzyme) 1.25 or 2.5 mg is safe, according to Masoud Soheilian, MD.

An analysis of data collected in the Intelligent Research in Sight (IRIS) Registry suggests that in the real-world setting, newly diagnosed diabetic macular edema (DME) is being vastly undertreated. Not only are the majority of these patients not receiving active intervention, but those who are started on anti-vascular endothelial growth factor (VEGF) therapy seem to be getting a suboptimal number of injections, said Jeffrey R. Willis, MD, PhD.

Results from two pivotal multicenter trials demonstrate that an intranasal tear neurostimulator (TrueTear, Allergan) safely and effectively increases endogenous tear production in patients with dry eye disease (DED), said Edward Holland, MD.

Punctal plug-based delivery systems for sustained delivery of glaucoma medications represent new and versatile technology that is under development. The hope is it can help with the problem of patient compliance when managing mild-moderate glaucoma, said Marlene Moster, MD.

Results from 1 year of follow-up in a multicenter clinical trial show that an add-on (Scharioth Macula Lens [SML], Medicontour) increases near vision without affecting distance vision in pseudophakic patients with age-related macular degeneration (AMD).

Cornea surgeons encountering a patient with failed penetrating keratoplasty (PK) will wonder if they should repeat the PK. Although there are some exceptions to the rule, according to Donald T.H. Tan, MD, the answer is “no.”

An observational cohort study, published in JAMA Ophthalmology, used Medicare Part D data to assess the number of opioid prescriptions written by ophthalmologists in the United States.

As the number of LASIK procedures being performed continues to fall worldwide, correction of presbyopia is receiving increasing attention as being the final frontier and “holy grail” for refractive surgery, said Wayne Crewe-Brown, MD, at Refractive Surgery 2017.

Removal of the crystalline lens was developed as a procedure to treat the media opacity, but advances in surgical techniques and in pseudophakic IOL technology have increased the functional use of lens-based refractive surgery, said William F. Wiley, MD.

Encountering complications is inevitable for anyone who performs LASIK, and when the complication occurs intraoperatively, surgeons are often faced with the need to make a decision quickly, said Priyanka Sood, MD.

The 2017 meeting of the American Academy of Ophthalmology will convene in New Orleans from Nov. 11 to 14. Go to www.aao.org/annual meeting for the latest updates

After a seven-year hiatus, Ophthalmology Times resumed its Best Programs Survey this fall. While a few new names popped up on the list, Bascom Palmer Eye Institute at the University of Miami Miller School of Medicine, Miami, remained at the top of the Best Overall Program category, followed again by the Wilmer Eye Institute at the Johns Hopkins University School of Medicine, Baltimore.Number three in the overall list has a new name with Dean McGee Eye Institute at the University of Oklahoma, Oklahoma City-the first time that institute has appeared in the top category since the survey’s inception 20 years ago.

The foundations for success in using fillers during oculofacial surgery include understanding the characteristics of these products, which influences outcomes, and learning techniques to avoid and treat complications.

Now with mosquito season past in most parts of North America, it seems we can be confident the predicted spread will not come to pass-at least in this year.

Adopting new technologies across multiple practices using a single ambulatory surgery center can be challenging. A systematic approach leverages technology champions, employs consistent communications, and provides administrative support to secure reimbursement.