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Health insurance payers are rating their providers by the efficiency of the care delivered, and are beginning to steer patients to the most cost-effective care providers. However, cost-effectiveness does not always equate to high quality, and there are a number of potential problems inherent in the insurance companies' methodologies that make this a disturbing trend for physicians.

Azithromycin ophthalmic solution 1% (AzaSite, Inspire Pharmaceuticals), a broad-spectrum antibiotic that has the propensity to penetrate into the ocular tissues, rapidly improves anterior blepharitis faster than any other treatments for blepharitis, according to one ophthalmologist.

The electronic database of a large health-maintenance organization was used to identify patients who had a positive temporal artery biopsy indicating a diagnosis of giant cell arteritis (GCA). The calculated incidence of GCA was significantly less than previously reported and is thought to reflect, in part, differences in population demographics between studies.

This article summarizes the recent elucidations on the immunopathogenic process that leads to giant cell arteritis (GCA) and reviews both the well-known and newly recognized clinical subtypes and manifestations of the disease. The role of various noninvasive imaging techniques that are increasingly used to corroborate a clinical diagnosis of GCA as well as traditional and new treatment strategies are discussed.

A retrospective study analyzed outcomes in 18 patients who were treated for idiopathic or post-cataract surgery cystoid macular edema with nepafenac 0.1% (Nevanac, Alcon Laboratories) alone or combined with a corticosteroid. Statistically significant improvements were achieved in mean visual acuity and foveal thickness in both groups.

Difluprednate ophthalmic emulsion 0.05% (Durezol, Sirion Therapeutics) was at least as effective as prednisolone acetate suspension 1% (Pred Forte, Allergan), dosed twice as often, in the treatment of endogenous anterior uveitis. Equivalent effectiveness with less-frequent dosing could improve patient compliance, according to one ophthalmologist.

A prospective, randomized, investigator-masked study was conducted to compare twice-daily and four-times-daily dosing of a corticosteroid after cataract surgery. All patients also received bromfenac 0.09% (Xibrom, Ista Pharmaceuticals). No significant differences in macular thickening or anterior chamber cell and flare were observed between groups.

An active comparator, parallel group study comparing levofloxacin 1.5% and moxifloxacin 0.5% in patients undergoing cataract surgery showed significantly greater aqueous penetration of levofloxacin, measured as area under the curve over a 6-hour interval. Levofloxacin also had a significantly higher Cmax and significantly higher maximum concentration at the end of the dose interval. These findings indicate a possible role for levofloxacin in the prophylaxis of endophthalmitis at the time of cataract surgery.

Besifloxacin (Optura, Bausch & Lomb) was found to be more effective than gatifloxacin and moxifloxacin in reducing the number of methicillin-resistant Staphylococcus aureus organisms in the cornea when applied topically 10 to 18 hours after infection.

A study evaluating eradication of methicillin-resistant Staphylococcus aureus (MRSA) by fluoroquinolones shows that the commercially available preparation of gatifloxacin 0.3% (Zymar, Allergan) has superior bactericidal activity compared with the commercially available preparation of moxifloxacin 0.5% (Vigamox, Alcon). Gatifloxacin was more active than moxifloxacin alone, and its activity was enhanced by the presence of the preservative benzalkonium chloride.

It turns out that, thanks to an extremely insightful article brought to my attention by a loyal Ophthalmology Times reader, we ophthalmologists can enjoy good wine and save money during this outing.

Loteprednol etabonate 0.5%/tobramycin 0.3% ([LE/T]; Zylet, Bausch & Lomb) was found to be superior to dexamethasone 0.1%/tobramycin 0.3% ([DM/T]; Tobradex, Alcon Laboratories) in a comparison study that tested ocular comfort and tolerability in healthy volunteers. LE/T also has shown to be less likely to cause increases in IOP levels compared with DM/T. LE/T may provide some small advantages, possibly resulting from formulation differences and/or the steroid used, the researchers concluded.

Essilor of America Inc. has announced a 3-year extension of Essilor International?s partnership with the Special Olympics Lions Club International Opening Eyes program.

Gary Conrad, PhD, has received a 4-year grant renewal of $1.48 million from the National Eye Institute for the National Institutes of Health (NEI/NIH) to study the cornea. Dr. Conrad is a university distinguished professor at Kansas State University's Division of Biology.

To answer the question of whether quality - specifically, uncorrected vision, astigmatism, visual rehabilitation, and safety - is sacrificed when M-SICS is performed instead of phaco, Sanduk Ruit, MD, Geoffrey Tabin, MD, David F. Chang, MD, and colleagues conducted the first prospective, randomized trial of phaco versus M-SICS in a charity camp population.

Phase II of a clinical study examining a formulation of cyclosporine (Cyclokat, Novagali Pharma) has been completed, and results demonstrate statistically significant improvement with signs and symptoms in patients suffering from moderate-to-severe dry eye syndrome.

The newest version of proprietary software (Guided Progression Analysis, Carl Zeiss Meditec) to measure the functional progression of glaucoma combines event and trend analyses and enables faster, more quantitative evaluation of change in visual field than that permitted by older methods, according to one ophthalmologist. Use of the software requires a particular, newer perimeter (Humphrey Field Analyzer II-i, Carl Zeiss Meditec), and clinical correlation is advised.

Spectral-domain optical coherence tomography (SD-OCT) represents an improvement in imaging compared with time-domain OCT and, therefore, the potential for improved patient care. Proprietary technology (3D OCT 1000, Topcon Medical Systems) is easy to use and has versatile software, according to one ophthalmologist. The choice of any SD-OCT unit, however, must be based on an analysis of an individual practice's needs.

A model under development for in vivo visualization of human lens morphology could have clinical applications in patients at risk for changes in lens transparency. The device, which uses a rotating camera, creates a three-dimensional model of the lens and uses the relationship between contrast sensitivity measurements and lens optical density to evaluate visual function.

Wal-Mart Stores, along with 1-800 Contacts, have a new program that will save customers as much as 12% to 50% on the costs of a yearly supply of contact lenses. Additionally, Wal-Mart is offering frame-and-lens packages for children age 18 or under for as low as $39.

The mini-glaucoma shunt (Ex-Press, Optonol) appears to be an effective procedure compared with standard trabeculectomy, as it shows a higher efficiency with minimal inflammation and lower rates of postoperative hypotony and its sequelae. Although both approaches demonstrate very similar IOP control in the long-term, less postoperative adverse events are seen with implantation of the shunt.

Essilor of America Inc. and Transitions Optical Inc. launched a new progressive sunwear line (Definity Fairway Transitions SolFX lenses) designed to meet the visual demands of golfers who need multifocal prescriptions.

Analyses of optical coherence tomography images from eyes with established diagnoses of optic nerve head drusen or optic disc edema and unaffected controls showed qualitative and quantitative criteria had reasonable sensitivity and specificity for discriminating between the two pathologies.

To celebrate the "Reflection of a woman's soul" campaign, Jee Vice sunglasses are on display in Henri Bendel's Fifth Avenue store window through the end of the month. A Jee Vice Boutique also can be found at the department store.

Genetically engineered mice could immediately use their enhanced color vision to discriminate among colors indistinguishable to all other mice. The authors state "the experiment demonstrates the remarkable plasticity of the mammalian brain."

Elevated IOP accelerates retinal nerve fiber layer (RNFL) loss and increases the risk that glaucoma will progress, according to an observational cohort study of 204 patients recruited from the Diagnostic Innovations in Glaucoma Study.

The upheaval in our current economy is changing the ground rules for skillful handling of personal finances. Some of the time-honored methods for building and maintaining a secure financial future for you and your family need to be modified while today's unpredictable financial crisis runs its course. Here are seven tips from the experts that will help you to come out on top once the financial storm has abated.

Results of a study using a non-contact applanation tonometer (Ocular Response Analyzer, Reichert) to evaluate keratoconic eyes during and after corneal collagen crosslinking demonstrate changes in tonometer measurements that are consistent with changes in corneal thickness, hydration, and regularity.

A 26-year-old African American female presented to the Bascom Palmer Eye Institute emergency room with complaints of progressively decreasing vision in both eyes over the past 2 weeks associated with numbness on the right side of her face and mouth. She also had symptoms of light sensitivity but denied flashes, floaters, or other ocular symptoms. She denied any other recent illnesses, drug usage, exposure to parasites, infections, or risk factors for HIV.

The clinical exam remains the key to ophthalmologists' decision-making related to the diagnosis and determination of progression of glaucoma. "Baseline" technology in ophthalmology practices includes the slit lamp, some lenses, a gonio prism, an automated perimeter, a pachymeter, and optic nerve imaging capability. Other technology, however-such as confocal scanning laser ophthalmoscopy; nerve fiber layer imaging devices capable of scanning laser polarimetry and optical coherence tomography (OCT); and some anterior segment imaging technologies, including ultrasound biomicroscopy and anterior segment OCT-do not yet have absolute sensitivity and specificity and serve as aids to, not replacements for, the ophthalmologist.