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OSN Las Vegas expands to 3-day meeting format
Leading ophthalmologists shared their experiences with the latest technologies, but also focused on well-known, simple diagnostics.
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LAS VEGAS – The OSN Las Vegas meeting expanded to a 3-day program this year to focus on additional subspecialties.
“We’ve decided to expand a little this year, to include cataract and refractive surgery, and also to still include glaucoma,” said Richard L. Lindstrom, MD, OSN Chief Medical Editor and one of the meeting’s course directors.
Louis B. Cantor, MD, meeting course director, said that the “expanded format adds a great deal to the program.”
Presentations from OSN Las Vegas are highlighted in the remainder of this article. These items appeared first on the OSN SuperSite as daily reports from this meeting. Look to upcoming issues of OSN for expanded coverage of selected items.
IOL Economic Summit
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Clinicians desiring to incorporate presbyopic IOLs into their practices are faced with issues ranging from reimbursement concerns to potential conversion rates, according to speakers here at the IOL Economic Summit.
The summit, held in conjunction with the OSN Las Vegas meeting, brought together experts to discuss the change in billing for presbyopic lenses that took place in May 2005. J. Andy Corley, chairman and chief executive officer of eyeonics, described his efforts to get the Centers for Medicare and Medicaid Services (CMS) to rule in favor of partial reimbursement for presbyopic IOLs.
The CMS ruling clarified that a beneficiary may request insertion of a presbyopia-correcting IOL in place of a conventional IOL following cataract surgery and elect to pay privately for the difference between these amounts. Mr. Corley, along with Rep. Christopher R. Cox, R.-Calif., were instrumental in bringing the issue to CMS’ attention.
“This is another example of what the power of a group of people can do,” said Dr. Lindstrom, who moderated the summit.
AdvaMed, the advocacy association whose member companies produce medical devices, diagnostic products and health information systems, is currently trying to obtain additional reimbursement for procedures performed in ambulatory surgical centers, said Andy Stapars, an official with the association. Mr. Stapars addressed AdvaMed’s role in IOL reimbursement, as well as in ensuring appropriate payment in the hospital outpatient system.
“The ophthalmic sector is well represented at AdvaMed,” Mr. Stapars said.
OSN Cataract Surgery Section Editor William F. Maloney, MD, spoke about ethical issues involved in the use of presbyopic IOLs.
Elizabeth A. Davis, MD, OSN Practice Management Section Member, explained how the CMS ruling has affected her practice.
“In our practice, we will see a growth rate over the next 5 years to a conversion rate of at least 10% to 15%,” she said.
Shareef Mahdavi, a practice consultant, spoke about future practice management considerations in presbyopia correction.
Cataract Surgery
Endophthalmitis prophylactic practices need review
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Image: Archer ME, OSN |
A recent European study found strong evidence for the effectiveness of intracameral antibiotics in endophthalmitis prophylaxis, and physicians should review the results of the study to ensure they are following best practices, said Francis S. Mah, MD.
Dr. Mah discussed results of the study by members of the European Society of Cataract and Refractive Surgeons. The study found that intracameral cefuroxime administered at the time of cataract surgery reduced the risk of developing endophthalmitis after surgery. The published data from the study included results in 13,698 patients.
Dr. Mah said caution is needed before altering one’s prophylactic regimen in cataract surgery. He noted “the potential short- and long-term issues of intracameral antibiotics need to be examined.”
“Who knows if intracameral antibiotics may be associated with such diseases as glaucoma or age-related macular degeneration?” he asked.
Dr. Mah said there are other caveats regarding the use of cefuroxime, including a high rate of antibacterial resistance to the drug. The antibiotic “would not protect against any methicillin-resistant Staphylococcus aureus,” Dr. Mah said. He added that if all U.S. surgeons adopted use of intracameral cefuroxime in cataract surgery, this would result in “about $11 million per year in additional health costs.”
Furthermore, he said, the “potentially devastating” complication of toxic anterior segment syndrome could result from either the mislabeling or miscalculation of the amount of medication to be administered intracamerally.
Dr. Davis also discussed the ESCRS study at the meeting. She said that there was a “tremendous power” in the number of patients enrolled. However, she added that patients in the study had undergone surgery with many variations, as the surgical techniques used were not uniform.
The results of this study were published in the March 2006 issue of the Journal of Cataract and Refractive Surgery.
Refractive Surgery
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Image: Archer ME, OSN |
Transition to femtosecond lasers went smoothly, surgeon reports
The transition to use of a femtosecond laser for LASIK flap-making in one large practice was relatively smooth, according to Dr. Lindstrom.
He and his colleagues at Minnesota Eye Consultants “were pleased to find no incidence of epithelial defects, epithelial ingrowth, microstriae or haze” after they began using the IntraLase FS 15 kHz laser, Dr. Lindstrom said.
“We were skeptical at first. Our results were not that great at first, but then we used it more, and were pleased with the new data,” Dr. Lindstrom said. He added that a reduction in pulse energy as the laser’s speed increased to 30 kHz and then 60 kHz has appeared to reduce inflammation.
“Our surgeons love it, and it’s also fun to use,” he said.
Advances in laser technology
Advances in laser technology are helping more and more surgeons give their patients 20/20 vision, said Daniel S. Durrie, MD, OSN Refractive Surgery Section Editor.
He said that both wavefront-guided and topography-guided lasers have helped more patients achieve improved vision.
He also said that better nomogram development is important in achieving better results. “If you don’t measure it, you can’t improve it,” Dr. Durrie said.
He said using the IntraLase femtosecond laser has given his patients better results than traditional LASIK.
In one small study, he said, patients who had LASIK with the IntraLase had “better vision at 1 week, 1 month, 3 months and 6 months” than patients who had undergone traditional LASIK.
‘Excellent visual results’ with epi-LASIK
“Excellent visual results” can be achieved using epi-LASIK, according to William B. Trattler, MD.
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“Some of the advantages for these patients [are] that epi-LASIK can be used in patients with thin corneas, who have dry eye or in patients who have had previous flap complications,” Dr. Trattler said.
He added that the epithelial layer can be removed rapidly with epi-LASIK, and there is rapid visual recovery compared with patients who have had PRK.
Surface ablation is less likely to induce ectasia in “at-risk corneas,” although it can still occur, according to Dr. Trattler. He said he defines “at-risk corneas” as those that had undergone previous refractive surgery or were thin at the outset.
Additionally, he said surface ablation can be used to enhance visual recovery in patients who have had LASIK.
Glaucoma
Gonioscopy crucial for diagnostics, surgeon says
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Image: Archer ME, OSN |
Gonioscopy is crucial in diagnosing angle-closure glaucoma, according to one physician.
“Every adult ophthalmic patient should have gonioscopy performed and intermittently reassessed,” Jody Piltz-Seymour, MD, said. “Befriend your goniolens, carry it in your pocket, and use it on every patient. Remember — it’s a simple mirror.”
Dr. Piltz-Seymour said that chronic angle-closure glaucoma can mimic primary open-angle glaucoma unless careful gonioscopy is performed.
“Without gonioscopy, patients with sub-acute and chronic angle-closure glaucoma will be misdiagnosed,” Dr. Piltz-Seymour said.
She advised ophthalmologists to perform gonioscopy in light to identify landmarks, and then to recheck in dim illumination, both with and without compression.
“Beware of the non-pigmented angle,” she said.
She stressed that the biggest mishap in performing gonioscopy “is the failure to perform gonioscopy.”
FDT matrix perimetry is ‘step forward’ in glaucoma diagnosis
Frequency doubling technology (FDT) is an “excellent screening tool for a glaucoma suspect,” according to one speaker.
“This matrix perimetry is a step forward in screening patients for ocular hypertension,” Steven T. Simmons, MD, said. He said that FDT is a valuable tool for following patients with early glaucoma and helps in tracking the progression of the disease.
FDT has shown an “improved ability to detect the progression” of glaucoma, he said. It can also help ophthalmologists identify patients who are more likely to develop significant defects, he said.
Risk calculators help identify potential glaucoma patients, clinician says
Ophthalmologists should consider risk calculators to be “invaluable tools” for incorporating complex results into clinical practice, according to one physician.
“Glaucoma risk calculators help us find those who are at high risk for glaucoma,” said Steven L. Mansberger, MD, MPH.
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Image: Archer ME, OSN |
Dr. Mansberger said that not only do risk calculators help determine the probability of glaucoma, they can also help the physician make important treatment decisions. In a survey conducted to help establish the need for risk calculators, he said respondents “estimated a wide range of probabilities in the same ocular hypertensive patients. So we may be under- or over-treating ocular hypertensive patients. Risk calculators provide a tool to help us to incorporate complex results into clinical practice.”
Dr. Mansberger said one risk calculator he uses can be accessed at www.discoveriesinsight.org.
New risk factors for glaucoma
Physicians should be aware of the newest risk factors for glaucoma, said one specialist.
“Always ask about family history,” said John R. Samples, MD.
He said there are “nine autosomal dominant genes that cause open-angle glaucoma, so you need to ask for family history.”
Dr. Samples added that patients with thin corneas should be checked.
Additionally, he said to watch for diurnal fluctuation in IOP.
“We should all be doing more diurnal curves in the office,” he said.