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Patients with uveitis who require cataract surgery present challenges to the surgeon at every stage of care. The uveitis must be controlled carefully preoperatively, small pupils are especially problematic during surgery, and inflammation must be controlled postoperatively.

Supranuclear gaze palsy should be suspected in patients with bilateral and symmetric vertical or horizontal gaze difficulty. Use of specific maneuvers to bypass the supranuclear input to the ocular motor nuclei can help to establish a supranuclear localization to the problem and direct neuroimaging to the supranuclear pathways in the brain and brainstem.

An analysis of results achieved from performing LASIK with a 213-nm solid-state refractive laser (Pulzar Z1, CustomVis) in 10 eyes with high and mixed astigmatism (mean astigmatism, –5.2 D) demonstrate its safety, predictability, and efficacy. Uncorrected visual acuity after a minimum of 8 weeks' follow-up was 20/30 or better in 100% of eyes.

An iris-fixed phakic IOL (Verisyse/Artisan, Advanced Medical Optics) is effective in correcting high myopia, hyperopia, and astigmatism, according to 5-year follow-up data from a prospective study conducted in France.

Customized IOL implantation has become a topic of great interest over the past year. The combined implantation of two different multifocal lenses, an apodized diffractive lens (AcrySof ReSTOR, Alcon Laboratories) and a refractive lens (ReZoom, Advanced Medical Optics), has provided patients with good results in near, intermediate, and distance vision because the two IOLs complement one another. In a survey of patients in whom the diffractive lens had been implanted bilaterally and patients in whom one of each IOL had been implanted, the combination approach received higher marks compared with bilateral diffractive lens implantation.

Several situations are associated with a high risk of failure after donor corneal transplantation. Encouraging results have been seen with a particular keratoprosthesis (Boston KPro, Massachusetts Eye and Ear Infirmary) as an alternative in carefully selected eyes.

Statin use does not appear to have a significant protective effect against choroidal neovascularization or geographic atrophy in patients with age-related macular degeneration, according to a recent analysis of data collected during the Complications of Age-related Macular Degeneration Prevention Trial.

Vision loss is associated with increasing scores on the simplified severity scale for age-related macular degeneration (AMD) in the Age-Related Eye Disease Study. A correlation also has been found between vision loss and the four fundus lesions associated with advanced AMD. These findings suggest that the fundus lesions could be used as surrogates in prevention studies for development of advanced AMD.

Data analysis from the Complications of Age-related Macular Degeneration Prevention Trial shows that choroidal neovascularization and geographic atrophy share some risk factors but have different influences as well.

Reliable measurement of the distance between a phakic refractive IOL and the crystalline lens is important in detecting direct contact, a risk factor for induced cataract. In a recent study using optical coherence tomography, investigators found that the phakic refractive IOL and anterior lens surface moved forward in all cases during accommodation; mechanical contact was infrequent but was found in all instances in which opacification developed.

Integrating the technology in a private practice is an investment in money and time, but the payoff is worth it, according to one ophthalmologist who recently upgraded his office. Here?s how he did it.

Interim results from a phase III study evaluating an accommodating IOL (Tetraflex [KH-3500], Lenstec) for pseudophakic correction after cataract surgery demonstrate that it provides good near and distance uncorrected visual acuity outcomes along with a favorable safety profile.

A novel investigational compound that removes heavy metals intraocularly following topical administration is being studied for the treatment of cataract, band keratopathy, asteroid hyalosis, and IOL calcifications.

The lure of fly-fishing

Dr. Allingham has been fly-fishing for about 10 years. A friend, also a physician, talked him into trying it, telling him it was very different from "regular" fishing. He can fly-fish locally in North Carolina on the Eno River near home for bluegill and bass, in the Appalachian Mountains, or on the ocean for tarpon.

There are three types of employees: climbers, quitters, and some who camp at mediocrity. Practice administrators who get to know their employees and what makes them tick will contribute to the success of the practice. It may be a matter of uncovering his or her true talents and finding the right place for that person within the practice.

No poaching allowed

Dianna Graves comments on her experience formally and informally training ophthalmic technicians. The task is often times difficult and good candidates are hard to find. Technicians however, serve an important service in a practice allowing physicians to carry out their jobs more efficiently.

Although medication use is common in ophthalmology offices there is still confusion on how to report these services. Describing it's service correctly can save practices money.

The bar for refractive and vision outcomes has been raised in patients in whom multifocal IOLs have been implanted. Laser vision correction, therefore, has become an important enhancement tool. Multifocal IOL patients should be managed the same as laser vision refractive surgery patients, but additional issues should be considered.

When the performance of four different aspheric IOLs in scotopic light conditions was evaluated using a computer model, the results favored one three-piece lens (Tecnis, Advanced Medical Optics) for providing the best compromise between spherical and chromatic aberrations and depth of focus.

The potent corticosteroid difluprednate is being developed as an emulsion for topical use. Phase III clinical trials of the treatment of postoperative inflammation have been completed and a phase III study of anterior uveitis treatment is under way. Positive efficacy and safety results were achieved in phase III clinical trials in Japan.