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Visual hallucinations caused by Charles Bonnet Syndrome (CBS) are not infrequent in older individuals with decreased visual function. While individuals who experience these hallucinations, which are usually generic people, animals, patterns, or scenes, understand that what they are seeing is not real and often are not disturbed by the images, they are worried about the reaction of their families, friends, and physicians.

When faced with a postcataract surgery refractive surprise, implanting a secondary piggyback IOL can be a successful option with careful attention to selecting appropriate candidates, IOL model, and power calculation technique, said Warren E. Hill, MD, a private practitioner, Mesa, AZ.

The difficulty of accurate IOL power calculation in postLASIK eyes is an issue being faced increasingly by cataract surgeons. Jack T. Holladay, MD, clinical professor of ophthalmology, Baylor College of Medicine, Houston, offered several tips for achieving better refractive outcomes in this growing population of eyes.

If the posterior capsule breaks during cataract surgery and vitreous presents to the anterior chamber, patients are best served by anterior vitrectomy using a pars plana technique, said Louis "Skip" Nichamin, MD, medical director, Laurel Eye Clinic, Brookville, PA.

Instead of combined surgery, cataract extraction alone by phacoemulsification through a clear corneal incision with posterior chamber IOL implantation may be the most appropriate procedure for patients with controlled or modestly uncontrolled glaucoma as well as for patients with ocular hypertension or glaucoma suspects, said Richard L. Lindstrom, MD, in his delivery of the Kelman Lecture during the Spotlight on Cataract Surgery session of the annual meeting of the American Academy of Ophthalmology.

A new how-to guide for dispensary issues, entitled "The Dispensing Ophthalmologist," outlines what ophthalmologists and administrators need to know to operate a profitable dispensary. The book is written by Arthur De Gennaro, president of Arthur De Gennaro & Associates LLC, Lexington, SC, an ophthalmic practice management firm that specializes in optical dispensary issues.

The launch of a specialized dietary supplement (DiaVis, ScienceBased Health) to support the visual and overall health of those with diabetes was announced at the American Academy of Ophthalmology meeting.

Dry eye disease and cataract and refractive surgery are intertwined closely. Pre-existing dry eye can affect surgical outcomes and, in severe cases, is a contraindication for surgery, whereas surgery causes trauma to the ocular surface and may lead to signs and symptoms of dry eye. To break this cycle, a two-pronged approach of treating dry eye before surgery and taking steps to prevent its development postoperatively is advisable.

At the American Academy of Ophthalmic Executives (AAOE) meeting, Derek A. Preece, MBA, from the BSM Consulting Group, Orem, UT, talked about the importance of understanding exactly what benchmarks are and how to use them effectively during his presentation, "Using benchmarks to improve your practice."

A novel drug delivery device using a punctal plug to provide pressure-lowering medication to patients with glaucoma could improve compliance and reduce the amount of medication required to maintain pressure control, said Richard A. Lewis, MD, a cataract surgeon and glaucoma specialist based in Sacramento, California.

Anti-vascular endothelial growth factors (VEGF) drugs may have a role in the treatment of diabetic maculopathy, according to Robert Avery, MD, of Santa Barbara, CA.

Ptosis is a sign of a number of diseases, most of which are benign. Julie Falardeau, MD, of the Casey Eye Institute, Portland, OR, described how ophthalmologists can avoid overlooking myasthenia gravis, which can be associated with serious morbidity and mortality.

The Early Treatment Diabetic Retinopathy Study (EDTRS) laser is still the standard of care of diabetic maculopathy. There is enthusiastic support for the potential of pharmaceutical therapy, using anti-vascular endothelial growth factor agents, however, the laser remains the gold standard, said Francesco Bandello, MD, of the University of Udine, Udine, Italy.

Optical coherence tomography (OCT) is valuable in managing diabetic macular edema (DME), more so than fluorescein angiography, in which the degree of leakage is not correlated with visual acuity and outcomes, according to Peter Kaiser, MD. In addition, angiography does not show vitreoretinal abnormalities that may require a different treatment.

A new incentive is being offered under Medicare for physicians who choose to prescribe electronically, or e-prescribe. At the American Academy of Ophthalmic Executives (AAOE) meeting, a panel of academy representatives and members presented, "Introduction to e-prescribing: Improving the safety and efficiency of medication management."

Jonathan Ettler, MD, of the Duke Eye Center, Duke University, Durham, NC, won first-place honors in the sixth annual Ophthalmology Times Resident Writer's Award program, it was announced Sunday evening in a dinner presentation at the Westin Peachtree Plaza. The program was sponsored through an unrestricted educational grant from Advanced Medical Optics (AMO).

Anti-VEGF therapy has met with widespread acceptance in the ophthalmic community, and a recent poll of retinal specialists suggest it is being used off-label, as well as formally studied in clinical trials, for conditions other than age-related macular degeneration, including proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME). Anti-VEGF therapy, however, has yet to be studied in a randomized controlled clinical trial of diabetic retinopathy, according to Francesco Boscia, MD, professor, Department of Ophthalmology and Otolaryngology, Bari, Italy.

Results from a study evaluating the first photochromic IOL (Aurium, Medennium) indicate that it provides stable and effective pseudophakic correction and outperforms a yellow IOL under mesopic conditions, said David Mendez Noble, MD, Mexicali, Mexico.

Ranibizumab (Lucentis, Genentech) has revolutionized the treatment of age-related macular degeneration, but the impressive results from clinical trials lead to new questions. Is long-term suppression of vascular endothelial growth factor (VEGF) in the eye safe? Do other members of the VEGF gene family contribute to retinal vascular diseases? Are other cytokines or growth factors involved in disease pathogenesis? Are there safe and effective delivery methods other than monthly injections?

Intravitreal bevacizumab (Avastin, Genentech) shows promise as an alternative treatment modality for eyes with refractory pseudophakic cystoid macular edema (CME), according to results from an interventional, retrospective, multicenter study conducted by the Pan-American Collaborative Retina Study Group.

Implantation of a toric IOL appears to be a safe and effective method for correcting spherical error and astigmatism in eyes with cataract and a history of penetrating keratoplasty, said Renée D. Solomon, MD.

Throughout his address at the opening session of the American Academy of Ophthalmology (AAO) annual meeting Sunday morning, President David W. Parke II, MD, quoted Martin Luther King Jr. because of the relevancy his words still have on the challenges faced today, nearly half a century later, in the ophthalmic profession and as a nation in transition. Having read several speeches "by one of Atlanta's most illustrious citizens," Dr. Parke said that he found one of Dr. King's statements particularly compelling: "Where do we go from here?"

President-elect Michael W. Brennan, MD, stressed commitment in his address during the opening session at the annual meeting of the American Academy of Ophthalmology (AAO) Sunday morning.

IOL repositioning with suturing techniques and IOL exchange for the management of a dislocated IOL are associated with similar improvement in visual acuity. The two approaches, however, are distinguished by their different complication profiles, said Joshua C. Teichman, MD, Toronto, Ontario.

The specialty of ophthalmology is "in the cross hairs of the demographic transition and the demand for services and the cost of care in the United States" occurring as the aging of the large baby boomer population necessitates increased amounts of clinical care. By rising to the challenge, however, the profession can serve as an example to other specialties, said Harvey V. Fineberg, MD, PhD, in his keynote address during the opening session of the American Academy of Ophthalmology/European Society of Ophthalmology joint meeting.

Long-term treatment of glaucoma is needed in many cases to prevent progression of the disease to vision loss. Paradoxically, the treatments that can be extremely effective at lowering IOP also can have a harmful side effect that causes additional eye problems. Dysfunctional tear syndrome and ocular surface disease (OSD) are common in patients with glaucoma, due to the extended use of topical medications containing a preservative that can harm the ocular surface. Aging also is associated with a higher rate of dry eye, so the demographics of patients with glaucoma also influence their risk of developing ocular surface disease.

The Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, was honored for excellence in three areas of ophthalmic achievement in Ophthalmology Times' 2008 Best Programs Awards.

A phase I trial of rapamycin (Sirolimus, Wyeth) indicated that the drug is safe and has biologic activity against diabetic macular edema (DME), according to Mark Blumenkranz, MD.

A study of two femtosecond lasers (IntraLase FS60, Advanced Medical Optics; Zeimer LDV, Ziemer Ophthalmic Systems) found that both lasers produced very similar results at all time points examined after LASIK, according to Dan Durrie, MD.

Bevacizumab (Avastin, Genentech) provided a visual acuity (VA) improvement that lasted 36 weeks following one intravitreal injection in patients with diabetic macular edema (DME), said Gholam A. Peyman, MD, of the Vitreoretinal Service, Department of Ophthalmology, University of Arizona School, Tucson.