Take-home points from the Hawaiian Eye meeting

One of my favorite meetings of the year is the Hawaiian Eye meeting, and not just because of the opportunity to enjoy the beautiful islands. With the format of the meeting, it is easy to understand key take-home points and immediately incorporate them into my own practice.
Here are some of my highlights:

• The cataract session led by David Chang and Roger Steinert was excellent as usual, and many speakers presented about toric IOLs. For preoperative evaluation, make sure that the patient has regular, symmetric and stable astigmatism. If there are lesions that are inducing keratometric astigmatism, such as epithelial basement membrane dystrophy or pterygium formation, these must be treated before cataract surgery and even before doing IOL calculations. Placement of the toric IOL must be precise, and there are now systems that allow tracking of eye rotation by limbal vessels. Even better are systems that allow intraoperative aberrometry to assist in optimal alignment.
• I had the pleasure of participating in David Chang's challenging case symposium, which focused on decentered IOLs and IOL exchange. These were very tricky cases that had panel members giving a wide spectrum of suggestions for surgery. For any IOL that is displaced posteriorly into the vitreous cavity, it may be wiser to have a vitreoretinal colleague remove the IOL, leave the eye aphakic, and then refer the patient back to the cataract surgeon for a secondary IOL implantation. And while sutured or even glued posterior chamber IOLs look pretty in the eye and provide good results, it was pointed out that a properly placed anterior chamber IOL has the same visual results according to a number of published studies as well as the expertise of the panel.
• Tom Samuelson presented sage advice about trabeculectomies and stated that in many of his patients he prefers other, more predictable glaucoma procedures, such as the new implants, due to an apparently safer risk profile. Kuldev Singh asked a great question, "Is cataract surgery really a glaucoma surgery?" and then presented both sides of the coin. With these newer glaucoma procedures and the benefit, even if temporary, of cataract surgery, I think we will see more general ophthalmologists being involved in the surgical care of glaucoma.
• In addition to the concurrent retina-specific meeting, there was a session about posterior segment disease for anterior segment surgeons. Carmen Puliafito presented a very novel way of quantifying macular drusen volumetrically with OCT scanning. This may allow an objective way of measuring and then tracking changes in macular degeneration.
• And finally, I learned something the hard way: If you decide to follow your kids down the giant 60-foot water slide, be sure to hold your nose when you hit the pool - otherwise you'll end up getting a high-pressure sinus cleansing.