News

Philadelphia-The triple corneal procedure should be considered for patients with both visually significant corneal disease and cataract. However, the ultimate visual rehabilitation from combined surgery should be weighed against the increased intraoperative risks and the unpredictability of the refractive error, according to Sadeer B. Hannush, MD.

St. Thomas, U.S. Virgin Islands-When four leading practice management specialists met as a panel recently, the pearls of wisdom they shared encouraged ophthalmologists to be aware of vital aspects of their business, including finances, human resources, and legal issues. The session, titled "Business, Operation, and Legal Pearls," provided physicians and administrators with suggestions on how ophthalmologists can increase efficiency, maximize profit, and avoid pitfalls leading to liability.

San Bernardino, CA-Fixing common billing and documentation errors could mean improvements of up to 35% to your bottom line, according to Donna McCune, CCS-P, COE.

Ophthalmologists know that a very large number of patients in general practice, and in many subspecialty practices, present with eye symptoms that are too dry or too wet. These common situations trigger coding issues that must be understood in order to ensure proper compensation for care of this sizable patient group.

Madison, CT-Common errors related to billing for glaucoma patients may have detrimental effects on the financial success of an ophthalmology practice, said Donna M. McCune CCS-P, COE.

Editor's note: In part one of "Optimize Your Optical" (see Ophthalmology Times, Sept. 15, 2006) optician, dispenser, and educator Laurie Pierce shared five techniques, forged through personal experience, that have enabled her to build patients' confidence while saving time and money. In part two, Pierce offers more of her practical "how-tos."

Sydney, Australia-The first synthetic polymer corneal inlays implanted in humans appear to be biocompatible with corneal tissue and represent a safe, biologically acceptable alternative to other forms of refractive surgery, according to observations made over an 18-month period, said Deborah F. Sweeney, B Optom, PhD.

Alicante, Spain-While one segment of the ophthalmic community sees presbyopic lens exchange for patients with high myopia as a promising, safe technique leading to good improvements in visual acuity, another segment does not, stating that the risk of retinal detachment and other complications related to the surgery are just too high, according to Jorge L. Alio, MD.

Lasers are designed to treat people based on averages in a population. However, an individual or a class of individuals may respond slightly differently to the laser pattern that has been designed by the manufacturer.

Minneapolis, MN-Wavefront-guided enhancements seem to be very effective for correcting residual refractive error after a primary LASIK procedure. The enhancement procedure using the CustomVue Wavefront system (VISX/Advanced Medical Optics) results in significantly better Snellen uncorrected visual acuity (UCVA) than that achieved with conventional enhancements, according to David R. Hardten, MD.

The introduction of the femtosecond laser for flap creation in LASIK gives refractive surgeons an additional treatment option. But beyond the obvious marketing hype of an "all laser" LASIK procedure, are there definite clinical benefits to using this keratome over traditional microkeratomes?

Raleigh, NC-Simplicity is the key word to James Kiley, MD, when he describes the MK-2000 microkeratome (Nidek).

Santiago, Chile-Intracorneal Ferrara rings (Mediphacos) appear to be a useful alternative method to improve corneal shape and best-corrected visual acuity (BCVA) in patients with keratectasia. However, the long-term refractive effects and complications of the rings need further study, according to Marcelo Coria, MD.

London-The structural integrity of the cornea is compromised by refractive surgeries, and the deeper the surgery is the more compromise takes place, according to John Marshall, PhD, FRCOphth(Hon).

Caracas, Venezuela-Implantation of intrastromal corneal ring segments (Intacs, Addition Technology) and penetrating keratoplasty (PKP) result in similar vision improvement when used to treat eyes with a mild grade of keratoconus, but the implantation procedure offers the advantage of faster visual rehabilitation, said Luis A. Rodriguez, MD.

The use of nonsteroidal anti-inflammatory drugs (NSAIDs) before and after cataract surgery significantly lowers the incidence of cystoid macular edema (CME) and provides patients with better quality of vision. The results of three studies presented at the annual meeting of the American Society of Cataract and Refractive Surgery, San Francisco, bore out that finding.

New York-It is essential for clinicians who treat glaucoma to recognize all the fundamental characteristics of the glaucomatous nerve, David S. Greenfield, MD, said at the Glaucoma 2006 meeting here.

Winter Haven, FL-Combination therapy using bevacizumab (Avastin, Genentech) as a "booster shot" in conjunction with pegaptanib sodium (Macugen, OSI/Eyetech/Pfizer) to treat exudative age-related macular degeneration (AMD) appears to work very well in both the short term and the long term, according to Michael Tolentino, MD.

Results from a case study comparing inter-eye central corneal thickness (CCT) in patients with asymmetric glaucoma show a positive association between more advanced glaucomatous cupping and a thinner central cornea, according to Shawn J. Khan, MD, FRCSC.

Durham, NC-A fluocinolone acetonide sustained drug delivery system (Retisert, Bausch & Lomb) implanted in patients with chronic macular edema associated with retinal venous occlusive disease reduced the edema and improved visual acuity in a significant portion of the eyes of 19 patients enrolled in the first 12 months of a 3-year study.

Madison, WI-The visual and morphology measurements used as endpoints in a clinical trial have both advantages and disadvantages that must be balanced by their value in achieving the goals of the study, according to Ronald Danis, MD.

Charleston, SC-Pediatric cataract surgery with IOL implantation and primary posterior capsulectomy plus vitrectomy is associated with a satisfactory outcome, especially in children operated on after their first birthday, said Rupal H. Trivedi, MD, MSCR.

Wilkes Barre, PA-Bilateral implantation of the apodized diffractive IOL (AcrySof ReSTOR, Alcon Laboratories) appears to result in a high rate of complaints about intermediate vision that can be completely mitigated by implanting the ReSTOR IOL in one eye and the second-generation refractive multifocal IOL (ReZoom, Advanced Medical Optics) contralaterally, according to a study by Frank A. Bucci Jr., MD, a private practitioner in Wilkes-Barre, PA.

Afyon, Turkey-A highly flexible posterior chamber Collamer lens may be problematic for some cataract surgery patients and require an exchange due to progressive hyperopia, explained Faruk Ozturk, MD.

Salt Lake City-Implantation of a hydrophilic acrylic IOL (C-flex, Rayner) presoaked in a solution containing a fourth-generation fluoroquinolone resulted in anterior aqueous humor concentrations of antibiotic that were significantly higher and more persistent than what was achieved with a topical drop administration protocol, according to the results of a preclinical study undertaken by Guy Kleinmann, MD, and colleagues at the John A. Moran Eye Center, University of Utah Health Science Center, Salt Lake City.

Previously, ophthalmic viscosurgical devices (OVDs) could be divided into two camps: dispersive OVDs and cohesive OVDs. Both have pros and cons. Cohesive OVDs create and maintain space, they don't trap air bubbles against the endothelium, and they are easy to remove at the end of the surgery. However, they don't coat tissues well.

Santiago, Chile-Analysis of the characteristics of capsular tension devices in eyes with lens subluxation indicates that in the medium term following cataract surgery, these devices seem to maintain stability in the eye and the correct anatomic positioning, according to Juan J. Mura, MD.

Baltimore-Cataract surgery in eyes with posterior polar cataracts presents a special challenge, but safety may be optimized with a customized approach that recognizes that not all posterior polar cataracts are alike and employs techniques for minimizing the risk of posterior capsule rupture, said Robert S. Weinberg, MD.

Salt Lake City-Failure to recognize late opacification of the MemoryLens IOL (CIBA Vision) as a cause for vision problems can have potentially negative consequences, including unnecessary surgery and complications secondary to those procedures, said Jonathan G. Haymore, MD.

IOL preference could be related to the degree of dysphotopsia, a better depth of field, or other factors.