Clinical Diagnosis

San Francisco-Questioning patients before cataract surgery about whether they are taking alpha-1 blockers, such as tamsulosin (Flomax, Boehringer Ingelheim), has become increasingly important in light of the observation by David F. Chang, MD, and John R. Campbell, MD, that the drug, which is used to treat the symptoms of benign prostatic hyperplasia, can cause intraoperative floppy iris syndrome (IFIS).

Washington-Sixty-two percent of meno-pausal and perimenopausal women reported dry eye symptoms, yet only 16% of women experiencing dry eye symptoms realized dry eye was a symptom of meno-pause, according to a recent survey sponsored by the Society of Women's Health Research (SWHR). The survey polled 304 women in menopause and perimenopause.

For almost 2 years, I have pioneered a change in phaco needleconfiguration to improve the safety of cataract surgery. The DeweyRadius Tip, manufactured by Microsurgical Technologies (MST,Redmond, WA) is a standard phaco needle with a simpleexception-no sharp edges. This rounded design can be appliedto any phaco needle of standard gauge, bevel, or bend.

Baltimore?A trial program that provided support and advice to older nursing home residents with poor vision improved their access to cataract surgery substantially. But the debilitated condition of many of those residents led to hesitation about surgery not only from physicians looking after the older people but also from their guardians, according to ophthalmologists at the Johns Hopkins University's Wilmer Eye Institute, Baltimore.

It might be wise to counsel patients regarding the possible but likely low risk of NAION, especially for individuals with a higher risk for NAION.

Proper management of cataract cases involving intraoperative floppy iris syndrome (IFIS) should keep surgeons from experiencing complications associated with the problem, reported Alan Crandall, MD, at the World Ophthalmology Congress on Thursday.

Early detection of glaucoma is critical. According to the AGIS study, by the time a reproducible visual field defect is detected, 20% to 50% of the retinal nerve fiber layer (RNFL) can be damaged, said Remo Susanna, Jr., MD, at the World Ophthalmology Congress on Wednesday.

Interim results from a Phase I study suggest that intravitreal injection of VEGF Trap (Regeneron Pharmaceuticals) is a promising new approach for the treatment of exudative age-related macular degeneration, said Quan Dong Nguyen, MD, at the World Ophthalmology Congress.

Cincinnati—Tamsulosin HCl (Flomax, Boehringer Ingelheim), an alpha-1 blocker used to treat benign prostatic hyperplasia, has been implicated in the development of floppy iris syndrome during cataract surgery, according to Robert H. Osher, MD. Healon 5 (AMO) is his viscoadaptive agent (OVD) of choice to manage this challenging iris behavior during cataract surgery.

Chicago—Insertion of the Perfect Pupil Injectable (PPI, Milvella Pty. Ltd.) is an effective method for protecting the iris and maintaining a large pupil during cataract surgery in eyes predisposed to intraoperative floppy iris syndrome (IFIS), according to the results of an interventional case series reported at the annual meeting of the American Academy of Ophthalmology.

Cincinnati—Tamsulosin HCl (Flomax, Boehringer Ingelheim), an alpha-1 blocker used to treat benign prostatic hyperplasia, has been implicated in the development of floppy iris syndrome during cataract surgery, according to Robert H. Osher, MD. Healon 5 (AMO) is his viscoadaptive agent (OVD) of choice to manage this challenging iris behavior during cataract surgery.

Industrial robots—computer-controlled machines that lift, place, move, or perform specific tasks—have been performing repetitive and even dangerous jobs for several decades. Examples of such machines are found in automobile production lines, spraying paints, transporting assemblies between workstations, and welding frames and bodies with great speed, accuracy, and repeatability.

Cincinnati—Robert H. Osher, MD, professor of ophthalmology at the University of Cincinnati and medical director emeritus of the Cincinnati Eye Institute, is celebrating 20 years of the Video Journal of Cataract and Refractive Surgery with two issues in 2006.

In case you have been so busy with your practice and other obligations that you missed it, two medical miracles (my opinion) have recently been reported. Each is only partially relevant to the practice of ophthalmology, but it seems to me that these are worth awareness.

Chicago—The Heidelberg Retina Tomograph II (HRT II, Heidelberg Engineering GmbH), the most widely available generation of this technology, creates a two-dimensional picture of a three-dimensional structure, such as the optic nerve, by acquiring images in a manner similar to that of computed tomography. Jeffrey D. Henderer, MD, explained the basics of this technology and its relevance to glaucoma at the American Academy of Ophthalmology annual meeting.

Chicago—This past October, the FDA issued a labeling change for the drug tamsulosin HCl (Flomax, Boehringer Ingelheim) warning of the possibility of intraoperative floppy iris syndrome (IFIS), stating "The patient's ophthalmologist should be prepared for possible modifications to their surgical technique."

Paradise, CA—Fashion Optical Displays has named Ed Muehlberger vice president of sales and development. In the new position, Muehlberger will coordinate the company's domestic and international sales, its design staff, and its plans for corporate expansion.

La Jolla, CA—Many optic disc measurements obtained using confocal scanning laser ophthalmoscopy (CSLO) can help predict the development of primary open-angle glaucoma (POAG) in patients with ocular hypertension, according to the recently published results of an ancillary study to the National Eye Institute (NEI)-sponsored Ocular Hypertension Treatment Study (OHTS).

La Jolla, CA—Many optic disc measurements obtained using confocal scanning laser ophthalmoscopy (CSLO) can help predict the development of primary open-angle glaucoma (POAG) in patients with ocular hypertension, according to the recently published results of an ancillary study to the National Eye Institute (NEI)-sponsored Ocular Hypertension Treatment Study (OHTS).

Dossenheim, Germany—The Heidelberg Retina Tomograph (HRT) can help predict the development of glaucoma in eyes that appear otherwise normal, by standard clinical exam, according to one published study.

Siena, Italy—Corneal collagen cross-linking—induced by topical treatment with riboflavin and exposure to ultraviolet A light—appears to be a safe and effective, minimally invasive procedure both to reduce disease pro- gression and improve upon the cornea's optical properties in eyes with early keratoconus, said Aldo Caporossi, MD.

Intraoperative floppy iris syndrome (IFIS) can result in a high complication rate when unanticipated, but with a simple preoperative medication history, cataract surgeons can now predict when this problem may occur, said David F. Chang, MD, in the ?Spotlight on Cataract Surgery 2005? session held during the annual meeting of the American Academy of Ophthalmology.

That cryotherapy was to be useful in ophthalmology was first shown by Frederich Schoeler (1844-1918) in a German paper, in which he described application of cold carbonic acid crystals to the sclera of rabbits and showed that a lesion of the retina could be produced.

Editor's Note: Howard Pomeranz, MD, describes a possible association of sildenafil and non-arteritic anterior ischemic optic neuropathy (NAION). There are several compelling parts of the argument, including temporal relationship of symptoms to drug delivery, a suggestive rechallenge history, a biologically plausible mechanism of effect, and analogy from other cases.

When and how do you use laboratory testing in patients with suspected toxoplasmic retinochoroiditis? What patients require no testing? When and how do you use testing of intraocular fluids? What approach should be taken in routine clinical practice?