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In this podcast, John F. Doane, MD, FACS, discusses addressing presbyopia with accommodating IOLs, and Scott W. Cousins, MD, talks about the role of injury and inflammation in the pathogenesis of dry age-related macular degeneration (AMD). Also Scott M. MacRae, MD, relays the current limitations of laser vision correction, and Paul Sternberg Jr., MD, speaks about new approaches to the treatment of dry AMD.

Skillful physician-patient communication is paramount to successful prevention and management of dissatisfied LASIK patients, said Jennifer Morse, MD, assistant clinical professor of psychiatry, University of California San Diego.

Studies with a night-driving simulator (NDS) found that changes in night-driving performance were associated strongly with the type of treatment used to perform LASIK, and that wavefront-guided procedures were correlated with better performance. The study involved 59 patients (98 eyes) who were tested preoperatively and 6 months postoperatively with the NDS, set to simulate nighttime driving on a rural road at 55 miles per hour, with and without glare.

Planning is underway for a large national prospective study to evaluate postLASIK quality-of-life outcomes in a clinical setting, said Malvina B. Eydelman, MD, director, division of ophthalmic and ear, nose, and throat devices, Center for Devices and Radiological Health (CDRH)/FDA, Rockville, MD.

Refractive surgeons need to remember that the tear film is the most important refracting surface of the eye, and if it is abandoned, surgical outcomes will suffer, said Eric D. Donnenfeld, MD, clinical professor of ophthalmology, New York University.

Scientific evidence does not support the hypothesis that thinner preoperative central corneas are an independent risk factor for postLASIK ectasia, said William B. Trattler, MD, director of cornea at the Center for Excellence in Eye Care, Miami. Eyes with a thin cornea (less than 500 µm) and normal topography are at no greater risk than those with thicker corneas of developing postoperative ectasia and may be biomechanically strong and similar to thicker corneas in their behavior, Dr. Trattler added.

Refractive surgeons may consider the diagnosis of LASIK chronic pain syndrome in postLASIK patients complaining of moderate to severe eye pain in the absence of dry eye or any other identifiable cause, said Steven E. Wilson, MD.

The 2008 annual meeting of the American Academy of Ophthalmology (AAO) is featuring several new and forthcoming patient education, clinical education, and practice management products produced by the AAO to meet the educational and practice needs of its members. During the meeting, these products are available at the academy's resource center and online.

Thirteen ophthalmologists were presented with the American Academy of Ophthalmology (AAO) Lifetime Achievement Honor Awards for their contributions to the academy and the ophthalmology profession.

A cyclic 13-amino acid peptide (POT-4, Potentia Pharmaceuticals Inc.) is the first complement-binding therapy tested in humans with wet age-related macular degeneration (AMD). Philip Rosenfeld, MD, PhD, of the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, presented results from the phase I Clinical Trial Assessment of Safety for POT-4 (ASaP) that indicate the drug appears to be safe and well tolerated and released slowly from a deposit in the vitreous cavity.

An antioxidant eye drop (OT-551, Othera) is being investigated to treat geographic atrophy in dry age-related macular degeneration (AMD), said Paul Sternberg, MD, from the Vanderbilt Eye Institute, Vanderbilt University School of Medicine, Nashville, TN.

A pepidomimetic inhibitor of the receptor for C5aR (JPE1375) blocks the mechanism that draws inflammatory cells into the disease process of age-related macular degeneration (AMD). When blocked, the numbers of neutrophils and macrophages decrease substantially, and in turn, choroidal neovascularization (CNV) also decreases, according to Anthony Adamis, MD, Department of Ophthalmology & Visual Sciences, University of Illinois.

Twenty-five-gauge sutureless vitrectomy has been increasing in popularity. In conjunction with this surge, however, is the observation that the procedure is associated with increased postoperative complications such as hypotony, choroidal detachment, and an increased incidence of endophthalmitis. Richard Kaiser, MD, from the Retina Service of Wills Eye Institute, Philadelphia, focused on endophthalmitis and noted that the 25-gauge procedure has a risk of infection that is 12.4 times greater than the 20-gauge procedure.

Alcon Inc. has executed a new agreement and broadened an existing agreement with two different companies to expand its products under development.

A proprietary purified human neural stem cell product (HuCNS-SC, StemCells), when transplanted into a well-established animal model, may protect the retina from progressive degeneration, according to researchers.

The multi-component IOL (PrecisionLens) is a novel, foldable implant technology consisting of three optical elements (two exchangeable) that was created to produce an emmetropic result reliably in all patients who undergo cataract surgery or refractive lens exchange.

Arriving at the proper IOL power is difficult to achieve in patients who have undergone prior cornea-altering refractive procedures such as LASIK, PRK, or RK.

The American Academy of Ophthalmology (AAO) has announced the participants for its 2009 Leadership Development Program (LDP).

Postoperative anterior optical coherence tomography may provide a more accurate measurement of LASIK flap thickness than intraoperative subtraction pachymetry.

The state-of-the-art material and design of a novel one-piece IOL can offer refractive stability and predictability, according to Daniel A. Black, MBBS, FRACO, FRACS. This newer IOL rivals other more established IOLs and may soon become the gold-standard treatment in cataract procedures, he said.

Two lenses may be better than one. In a prospective trial of 30 eyes, a dual-accommodating IOL, with a high-diopter anterior optic and a minus-power posterior optic, provided good distance visual acuity, depth of focus, and a good safety profile.

Prophylactic intracameral cefuroxime injections prevent the development of endophthalmitis after cataract surgery, according to results of the European Society of Cataract and Refractive Surgeons Endophthalmitis Study. The finding remains controversial in the United States, where cefuroxime has not been approved by the FDA and the standard of care to prevent endophthalmitis after cataract surgery is the administration of preoperative, perioperative, and postoperative topical fluoroquinolone drops.

A cataract surgeon who first identified intraoperative floppy iris syndrome (IFIS) and its association with tamsulosin describes several approaches to managing the surgical complication. The approach a surgeon uses will depend on the severity of IFIS, he says.

Ophthalmic practice administrators know that keeping physicians happy is crucial to the practice's overall success. And the best way to do that is by making sure their incomes are continually growing.

Depending on your location, your specialty, and the size of your practice, insurers may actually want to keep you happy, especially if you threaten to walk away from a bad deal. If nothing else, negotiations may reveal that lowball reimbursement for a particular code is nothing more than an inadvertent mistake that most insurers are willing to correct.

Physician groups are adopting tougher collection tactics, largely in response to tough times. What compounds their problem of skimpy third-party reimbursements and rising overhead is having to depend on patients for a bigger portion of their revenue stream-a result of the rising number of uninsured and the growth of high-deductible health plans.

Losing even one patient to another local practice is one too many. To achieve and maintain an edge in the LASIK market, you've got to stay on top of your competitors with research and analysis, and regularly evaluate where you fit in terms of image and consumer perception.

Organized medicine's "victory" resulted in postponing harsh reductions in payments to physicians for Centers for Medicare and Medicaid Services.

Safety and efficacy outcomes from a five-year study indicate that intravitreal triamcinolone can be an appropriate treatment in selected patients with advanced diabetic macular edema. Beneficial effects persisted throughout the study period, and no unexpected adverse events were seen.

In an evaluation of the anatomic changes of CNV lesions, patients treated with ranibizumab (Lucentis, Genentech) in the PIER study had smaller changes than patients who had received sham injections.