Author: Healio ophthalmology

Simple surgical steps give femtosecond laser accuracy to conventional cataract surgery

WAIKOLOA, Hawaii — To improve accuracy of conventional cataract surgery, mark the limbal relaxing incision with the patient upright, mark the capsulotomy, and be compulsive about cleaning up epithelial cells, a speaker said here.In a presentation at Hawaiian Eye 2013, John A. Hovanesian, MD, FACS, presented data on optimizing cataract surgery outcomes to achieve similar accuracy as obtained by femtosecond lasers.

Severity of glaucoma key to choosing surgical approach

WAIKOLOA, Hawaii — Choosing a surgical option for the patient with both glaucoma and cataract depends on the type and severity of glaucoma, according to a presenter here.Options are cataract surgery alone, a combined phacoemulsification and glaucoma procedure, or a two-stage surgery, with either the glaucoma procedure first and then the cataract extraction later or the cataract extraction first and the glaucoma procedure, if necessary, later.

Cataract surgery not linked to progression of AMD

WAIKOLOA, Hawaii — Cataract surgery does not appear to increase a patient’s risk of reactivation and/or progression of pre-existing wet age-related macular degeneration, a speaker said here.Citing multiple studies, Jay S. Duker, MD, OSN Retina/Vitreous Board Member, said at Retina 2013 that cataract surgery in patients with previously treated wet AMD does not appear to result in negative alterations in visual acuity or retinal thickness.

Modifiable risk factors may be key to reducing pterygium rate in India

HYDERABAD, India — Focusing on modifiable risk factors, namely ultraviolet light exposure, may help health care providers reduce the incidence of pterygium in India, according to a corneal specialist. Pterygium is a common condition in India, and there is concern that it may be on the increase due to global warming and ozone layer depletion, Radhika Tandon, MD, said at the joint meeting of the Asia-Pacific Academy of Ophthalmology and All India Ophthalmological Society.

Adaptive optics retinal imaging available but limited by high cost

HYDERABAD, India — By combining adaptive optics with the latest techniques in optical coherence tomography, scientists will open the door to visualization of the cellular details of the retina, altering how retinal diseases are diagnosed and managed, according to one speaker here.“In the new era of pharmacologic, molecular and genetics therapies, [adaptive optics] OCT instruments could represent a giant step forward,” SriniVas R. Sadda, MD, said at the joint meeting of the Asia-Pacific Academy of Ophthalmology and All India Ophthalmological Society.

Lower-concentration prostaglandin analogue may reduce adverse effects

HYDERABAD, India — A 0.01% concentration of bimatoprost showed comparable efficacy and significantly improved tolerability compared to the standard 0.03% formulation.“Prostaglandin analogues are first-line therapy for glaucoma, as they have shown the best efficacy in reducing IOP with a single daily administration. However, side effects such as hyperemia and itchy sensation are common complaints,” Barun K. Nayak, MD, said in an industry-sponsored symposium at the joint meeting of the Asia-Pacific Academy of Ophthalmology and All India Ophthalmological Society.

Early detection, treatment key to management of choroidal melanoma, nevus

BALTIMORE — Early detection and treatment and close long-term surveillance are critical for the management of choroidal nevus and melanoma, two experts told colleagues here.“Prior to about 1970, enucleation was done for almost any lesion, regardless of its size, that was suspected to be possible melanoma,” Jerry A. Shields, MD, said at Macula 2013. “That’s undisputed. It was believed that that saved lives.”

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.