Author: Healio ophthalmology

Specialist warns against discontinuing steroids after corneal transplantation

HYDERABAD, India — New lamellar techniques have reduced the risk of graft rejection after corneal transplantation, but low-dose steroid therapy should not be discontinued, particularly in patients with African ancestry, pre-existing glaucoma or steroid-induced ocular hypertension, according to a specialist. “A paper published by W. Barry Lee in 2009 reported an average incidence of 10% with DSEK, and a large series published by M.O. Price in the same year estimated a graft rejection probability of 7.6% by 1 year and 12% by 2 years,” Rajesh Fogla, MD, said at the (Read more...)

At 10 years, AREDS formulation still reduces risk of AMD progression

BALTIMORE — Dietary supplements continued to reduce the risk of advanced age-related macular degeneration or neovascular AMD 10 years out, according to a study presented here. At Macula 2013, Emily Y. Chew, MD, elucidated results of the Age-Related Eye Disease Study, a multicenter, randomized clinical trial that included 4,757 patients with varied AMD severity; 3,549 patients participated in the 10-year follow-up examination.

Angle closure involves interplay of multiple anatomical, physiological factors

HYDERABAD, India — New imaging technologies have enabled specialists to determine that an interplay of multiple anatomical and physiological factors are involved in the pathogenesis of angle closure. “We have been able to learn quite a lot on angle closure by using imaging technologies, particularly [ultrasound biomicroscopy] and anterior-segment [optical coherence tomography]. We are studying new risk factors such as iris thickness, smaller anterior chamber width area and volume, and greater lens vault,” Tin Aung, MD, said at the joint meeting of the Asia-Pacific Academy of Ophthalmology and All India (Read more...)

ICG angiography with PDT useful for serous pigment epithelial detachments

WAIKOLOA, Hawaii — Indocyanine green angiography-directed photodynamic therapy provides positive resolution of persistent cases of serous retinal pigment epithelial detachment, a speaker said here.According to Scott W. Cousins, MD, indocyanine green (ICG) angiography with PDT provides approximately 40% resolution of serous retinal pigment epithelial detachment (PED).

Double-K method can improve outcomes in calculating IOL power for post-RK eyes

WAIKOLOA, Hawaii — Using the effective refractive power in a double-K method can improve outcomes when calculating IOL power for post-RK eyes, a surgeon said here.“We do pretty well with post-RK eyes just using the effective refractive power, which is essentially the central corneal power, which is a number you can get from any state-of-the-art topographer,” Mark Packer, MD, FACS, said at Hawaiian Eye 2013.

Ideal IOL power calculations achievable

WAIKOLOA, Hawaii — Manipulation of seven elements can lead, within 5 years, to the perfect IOL calculation, wherein perfection is measured as one-eighth of a diopter of intended outcomes in every patient, according to a speaker here.According to Jack T. Holladay, MD, MSEE, FACS, speaking at Hawaiian Eye 2013, the seven elements that will make ideal IOL power calculations achievable include the formula, biometers, corneal power, new developments in B-scan, improved precision of femtosecond lasers, intraoperative aberrometry and adjustable IOLs.

Surgeon recounts reimbursement dos and don’ts for common femtosecond cataract procedures

WAIKOLOA, Hawaii — The use of femtosecond laser for cataract surgery in the U.S. is changing the way cataracts are managed, a speaker said here. “I definitely don’t think this technology is going away,” Richard S. Davidson, MD, said at Hawaiian Eye 2013, citing the benefits of the laser technology for cataract treatment: more accurate effective lens position, less endothelial cell loss and more precise astigmatism correction.

Very high-frequency collagen cross-linking enhances astigmatic keratotomy

WAIKOLOA, Hawaii — A novel combination of accelerated cross-linking and femtosecond astigmatic keratotomy may significantly enhance the efficacy of the astigmatic keratotomy in a variety of scenarios, a speaker said here. Reporting on behalf of A. John Kanellopoulos, MD, at Hawaiian Eye 2013, presenter Vance M. Thompson, MD, FACS, illustrated the positive effects of the procedure in four situations: after PK, after cataract surgery, as regression enhancement, and in clear cornea incisions. In all cases, accelerated corneal cross-linking enhanced the effect of astigmatic keratotomy, Thompson said.

Genetic testing becoming more reliable in gauging AMD risk factors

BALTIMORE — Although refinements are needed, genetic testing for risk assessment in age-related macular degeneration is gaining momentum, a speaker said here.“We’ve made great leaps in the understanding of the genetic basis behind macular degeneration in less than half a decade,” Ivana K. Kim, MD, said at Macula 2013. “Over 25 genes to date have been reported to influence AMD risk. Identification of these major genetic risk factors has elucidated some potential pathways for therapeutic intervention, namely the complement pathway.”

Flapless all-laser procedure outperforms femto-LASIK for high myopia

HYDERABAD, India — A flapless procedure proved more effective than femto-LASIK in the treatment of high myopia and produced fewer dry eye complaints in a series of patients, according to a presenter here.ReLEx small-incision lenticule extraction uses the VisuMax femtosecond laser (Carl Zeiss Meditec) to carve out a lenticule within the cornea in order to correct refractive errors. No excimer ablation is used, and the lenticule is separated and removed through a small incision.

Transepithelial phototherapeutic keratectomy enhances visual outcomes of collagen cross-linking

HYDERABAD, India — Epithelial removal using transepithelial phototherapeutic keratectomy during corneal collagen cross-linking results in better visual and refractive outcomes compared to mechanical epithelial debridement, according to one surgeon.“It is proved that the epithelium at the keratoconus apex is thinner than in the surrounding area. Transepithelial [phototherapeutic keratectomy] allows the excimer laser, set at 50 µm, to ablate the epithelium but also a few microns of stroma at the apex, smoothening the corneal surface before [cross-linking],” Vardhaman Kankaria, MD, said at the joint meeting of the Asia-Pacific Academy of Ophthalmology (Read more...)

Aberration-optimized ablation profile improves vision in pseudophakic patients

HYDERABAD, India — An aberration-optimized LASIK procedure yielded good, stable results in pseudophakic patients implanted with monofocal IOLs, according to one surgeon. “The procedure provides improved uncorrected near and intermediate vision, maintaining distance vision with high levels of patient satisfaction,” Robert Edward Ang, MD, said at the joint meeting of the Asia-Pacific Academy of Ophthalmology and All India Ophthalmological Society.

Written agreements sometimes needed, sometimes not, expert says

WAIKOLOA, Hawaii — Although the questions have been asked and answered and asked again, a speaker here addressed the regulatory and legislative issues that he continues to see. “I can’t remember a time when I shook my head more often than the year 2012,” OSN Regulatory/Legislative Section Editor Alan E. Reider, JD, said in a presentation at the joint opening of Hawaiian Eye 2013 and Retina 2013.

Speaker updates clinicians on Medicare reimbursement, coding

WAIKOLOA, Hawaii — Even though changes are looming, over the past 10 years, there have not been significant changes in reimbursement; however, many CPT codes have had an adjustment in their relative value units, which are the drivers of reimbursements, according to a speaker here. Over the past year, there were some positive changes to the RVUs, as well as some decreases, Donna McCune, vice president of Corcoran Consulting Group, told ophthalmologists gathered at the joint opening of Hawaiian Eye 2013 and Retina 2013.

Speaker advises incremental approach to incorporating frugality into practice

WAIKOLOA, Hawaii — Using the mnemonic ASPEN, one speaker here presented incremental steps that ophthalmologists can take to enhance their practices by adopting frugal innovations.Frugality is necessary to offset the inevitable reckoning that will come with Medicare cutbacks, OSN Practice Management Section Manager John B. Pinto said at the joint opening of Hawaiian Eye 2013 and Retina 2013.