News

Creating channels using a femtosecond laser (IntraLase FS, IntraLase Corp.) to insert a corneal implant (Intacs, Addition Technology Inc.) has some advantages, but the procedure also has the potential for complications. Both are detailed.

Multifocal and accommodative IOLs can be implanted safely in patients who have undergone prior refractive surgery, and visual results can be good. Frequently, however, enhancements are necessary, and decreased best-corrected visual acuity may be seen more often than with aspheric monofocal IOL insertion, according to the results of a prospective study of 22 eyes in 18 patients.

To address a perceived unmet need for comprehensive refractive surgery training, Sunil Shah, FRCOphth, FRCSEd, FBCLA, and colleagues in England developed an electronically based course for those wanting to develop their knowledge and skills in cataract and refractive surgery.

The growing popularity and long-term use of phakic IOLs inevitably will lead to more explantations, with cataract removal and with or without clear lens removal. An ophthalmologist outlines key steps to success.

Torsional phacoemulsification reduces chatter and energy delivered to the eye. It is safer than longitudinal phaco because torsional phaco is associated with a reduced risk of wound burn, less fluid usage, better followability, less turbulence, and less second instrument manipulation.

Management of patients with neovascular age-related macular degeneration has evolved, but clinicians are at a crossroads when considering continuation of treatment. Evidence suggests that monthly treatment and less frequent treatment regimens are better than no treatment. The best treatment regimen remains elusive.

In a phase II study, implantation of the artificial silicon retina microchip (ASR, Optobionics) improved visual acuity in some patients for up to two years. A phase III study is possible if someone interested in continuing these trials purchases the company, now in bankruptcy.

The AWARE Study (Analysis of Safety Outcomes with Anti-VEGF Treatment) is expected to expand retinal specialists' knowledge of the short- and long-term risks of anti-vascular endothelial growth factor treatments for neovascular age-related macular degeneration and diabetic retinopathy. The study may help identify a subset of patients susceptible to adverse events.

Testing of a retinal prosthesis shows that blind subjects who receive the implant have predictable spatial vision and that more electrodes provide higher spatial resolution. Scientists at Second Sight Medical Products have tested a 16-electrode prosthesis for several years and have received approval to conduct tests with a newer, 60-electrode device.

The development of customized component corneal transplantation techniques could enable a single donor cornea to be used to treat multiple patients. The practice could help address tissue shortages and reduce the wait time for surgery in developing countries. A researcher formerly practicing in India talks about the first published report of this strategy.

Initial analyses of data collected in the Canadian Glaucoma Study have identified four variables as powerful independent risk factors for glaucoma progression.

A retrospective cohort study revealed a consistent volume-outcomes relationship for adverse events in cataract surgery. Surgeons performing more than 1,000 procedures a year had the lowest complication rate among four volume classifications. The overall adverse event rate, however, was low as well: less than 1 in 200.

The development of cataract and age-related macular degeneration (AMD) seems to be linked with increased mortality rates in older patients (aged 49 or more years), according to results of the Blue Mountains Eye Study. The finding confirms an association between visual deterioration and mortality found in other studies.

Central corneal thickness (CCT) bears an inverse relationship with the risk of developing glaucoma. The risk of glaucoma progression, however, seems to be independent of CCT. New tonometry technology will allow for more accurate risk stratification of patients.

Findings of a study evaluating in vitro susceptibility of clinical fungal keratitis isolates suggest that use of newer antifungal medications may afford better outcomes in these potentially sight-threatening infections

An ophthalmologist details several questions clinicians must answer when deciding whether to use an excimer laser to perform enhancements after PRK or LASIK, lamellar surgery, incisional surgery, lens surgery, or corneal surgery.

Risk factors for ectasia may exist, but if ophthalmologists carefully screen patients and carefully measure what they're doing, the incidence of this complication of LASIK will be reduced, says one ophthalmologist.

Mitomycin C administered during PRK is safe and effective method to prevent corneal haze and did not cause severe complications over the long term in a recent study that included 59 patients (115 eyes) who were followed for a mean of 65 months postoperatively.

Recent research is yielding interesting information about IOP fluctuation, its role as a glaucoma progression risk factor, and how it is affected by treatment. The findings, expected to have implications for patient management, have focused attention on the ability of treatments to suppress the diurnal IOP curve.

Results so far in a phase II clinical trial indicate that a technique to implant sheets of immature neural retinal cells and retinal pigment epithelium together can improve vision of patients with retinitis pigmentosa or age-related macular degeneration.

All too often, practices look to alternative revenue centers that involve additional risk before looking at the no-risk option of improving current operations to put increased dollars on the bottom line. Read how one retina practice, with assistance from experienced consultants, devised a strategic plan that improved current operations and contributed to a very significant increase in revenue.

A filtering device (Cruise Control, STAAR Surgical Co.) placed between the phacoemulsification handpiece and aspiration tubing increases the stability of the anterior chamber during phaco because it decreases the post-occlusion aspiration flow rate in two venturi systems (Legacy 20000, Alcon Laboratories; Millennium venturi, Bausch & Lomb).

In every phacoemulsification procedure, the critical factors remain the common goals: the care and respect bestowed on the patient and the commitment to obtaining the best possible outcome. There is no place for cynical, business-as-usual attitudes (which are found in some operating rooms) in today's environment of refractive cataract surgery and presbyopia-correcting IOL implants. An expert offers 10 steps to help post-residency ophthalmologists conquer their first solo phacoemulsification procedures.

Advanced Medical Optics Inc. (AMO) launched three refractive technologies to the European market at the annual meeting of the European Society of Cataract and Refractive Surgeons in Stockholm, Sweden.

Alcon Inc. says it has no immediate plans to conduct the additional clinical study of anecortave acetate depot suspension 15 mg (Retaane) required by the FDA in an approval letter the agency recently sent to the company.

Respondents to a survey of U.S. ophthalmology residency program directors showed only 58% had one or more residents certified in laser refractive surgery in their most recent graduating class. The number of faculty members performing laser refractive surgery, the number of lecture hours on this subject, and the presence of a cornea fellow appeared to influence certification.

Limbal relaxing incisions are making a comeback in an era of high expectations for cataract surgery outcomes and increasingly sophisticated IOLs. The procedure for performing this type of incision is relatively simple and can be performed by experienced surgeons at the slit lamp in the office.

When you plan to appeal an audit, it's important to know that there's a new process in place. Here are the details.

The low country of South Carolina, which was once built on a thriving economy based on rice crops, is now mostly resorts. Local residents Drs. Richard Schulze and his son Richard Schulze Jr. aim to maintain the legacy of rice farming which is a nearly lost tradition. The satisfaction is not one of monetary value but of seeing the historical significance of the crop where it once flourished.

On one hand, the pay-for-performance issue has large employers, insurers, and Congress contending that the delivery of substandard medical care by physicians is hurting patient care and costing the health-care system huge sums of money. On the other hand, Congress and insurers are determined to reward physicians for providing high-quality health care and at the same time penalize them for delivering lower-quality health care. Ophthalmologists must participate in the development of standards to ensure good results. Toward that end, physician groups have devised eight ophthalmology-related quality measures, which are detailed here.