Month: August 2014

Femtosecond astigmatic keratotomy before LASIK can be beneficial

Early in my years as a refractive surgeon performing incisional corneal refractive surgery, I learned that I could achieve the maximal effect of corneal incisions when they were made at 90° to the corneal plane. With the advent of femtosecond laser technology, surgeons now have the ability to create precise incisions anywhere from 30° to 150° relative to the corneal plane. This has allowed for a new means of titrating the effect because angulated femtosecond laser incisions are greater in length, provide an increased corneal healing interface and thus have (Read more...)

Survey shows doctors predominantly lead ACOs

Accountable Care Organizations are largely led by physicians or physician and hospital partnerships, according to data published in Health Affairs. “The broad reach of physician leadership in ACOs has important implications for the future of health care reform,” researcher Carrie H. Colla, PhD, assistant professor of the Dartmouth Institute for Health Policy & Clinical Practice, Geisel Medical School, said in a press release. “A central role for physicians in the leadership of ACOs is likely to have a powerful influence on how both physicians and patients view the ACO model.”

Woman reports acute painless vision loss in left eye

A 64-year-old woman was seen at the ophthalmology clinic with a 1-day history of decreasing vision in her left eye. She reported that throughout the preceding 24 hours, she noted increasingly blurred vision in her left eye at both distance and near. She described the blurred vision as looking through a “veil.” She denied pain, diplopia, photophobia, flashing lights or floaters. She denied constitutional symptoms including headache, weakness, dizziness, weight loss, fevers, jaw claudication, scalp pain, myalgias, arthralgias or rashes.The patient denied having an ocular history and reported that her (Read more...)

Is the premium surgeon still the captain of the ship?

With the mounting pressures of state and federal guidelines and the added burdens of local hospital and ambulatory surgery center bureaucracy, the question remains: Are premium surgeons still in charge in the OR setting?The decisions on whether to use trypan blue to stain the anterior capsule, to use capsular tension rings/hooks in pseudoexfoliation cases or to open the extra viscoelastic tube to avoid endothelial trauma are all examples in play when trying to achieve the best outcome for our patients, but administrative pressures to keep costs down and be compliant (Read more...)

Challenging cases may necessitate placement of IOL in ciliary sulcus

For routine cataract cases, we like to insert our new IOL into the same place as the original human crystalline lens — into the capsular bag. In most eyes, the capsular bag provides a secure positioning of the IOL with good long-term stability. But in some cases with a compromise of the posterior capsule or weakness of the zonules, placement of an IOL in the ciliary sulcus is preferred.The ciliary sulcus, as the name implies, is a small space between the posterior surface of the iris base and the anterior (Read more...)