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Toric IOLs currently represent 7% of all cataract surgeries being performed in the U.S. Because corneal astigmatism is corrected close to the nodal point of the eye, patients have generally been pleased with the outcome. However, it is imperative that the IOL be placed in the correct axis to ensure optimal results. We present several pearls in this article that have helped us have success with our toric IOL placements.It is imperative to ensure that the preoperative keratometry values used for IOL calculations are accurate. In addition to the keratometry values obtained with an optical biometer, it is important to validate these values with some form of topography, such as with the Oculus Pentacam, the Zeiss Atlas, the i-Optics Cassini or the Haag-Streit Lenstar T-Cone. This helps ensure that the keratometry values are consistent and that there is no irregular astigmatism. If there is significant irregular astigmatism, a toric IOL will not result in “crisp” postoperative vision.

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“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”– John Quincy Adams

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Microinvasive glaucoma surgery, an alternative to trabeculectomy and tube shunt implantation, is designed to improve aqueous outflow by using stents to direct aqueous humor into the uveoscleral pathway, subconjunctival space or suprachoroidal space.Ab …

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Omidria was recently made commercially available by Omeros Corporation. Omidria is formulated for dilution in standard irrigation solution used during cataract surgery or IOL replacement. This article discusses how Omidria is paid for by Medicare and what implications Medicare’s payment has for physicians.Medicare pays facilities — ASCs and hospital outpatient departments — for Omidria (phenylephrine 1% and ketorolac 0.3% injection) at average sales price plus 6%. This payment is separate from the payment for cataract procedures, which is intended to cover the procedure itself along with any associated drugs or supplies. Because of this additional payment for Omidria, the facility does not have to “eat” the cost within the amount Medicare pays for cataract surgery. The payment formula — average sales price plus 6% — is the same used for injectable drugs furnished in physicians’ offices.

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Adequate visualization of the cataractous lens is essential for safe phacoemulsification and IOL implantation. A compromised lens view due to partial iris coverage, in cases of a pupil smaller than 5 mm, can pose several challenges to the cataract surg…

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Lacrimal drainage plugs improve the signs and symptoms of moderate dry eye and are well tolerated in eyes that do not benefit from topical lubrication, according to 27 level 2 and 3 studies culled from the PubMed and Cochrane Library databases.The report by the American Academy of Ophthalmology, which appeared in Ophthalmology, was generated because of the widespread prevalence of dry eye. “For example, overall dry eye affects about 15% of adults,” lead author Marcus M. Marcet, MD, FACS, a clinical assistant professor of ophthalmology at the University of Hong Kong, said. “And in an ophthalmology clinic, it is often the most common presenting concern for patients.”

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