A study in a rat model found retinal ganglion cell loss and retinal thinning following excitotoxic damage. This finding has led researchers to speculate that axonal damage and excitotoxicity are related, and that the connection may be through the Wallerian degeneration gene. Future research into this pathway could lead to new forms of treatment for glaucoma and other neurologic diseases.
Surgical outcomes were compared in a retrospective study of 76 eyes with a miniature glaucoma shunt (Ex-PRESS, Optonol) implanted and 77 eyes that underwent standard trabeculectomy. The two procedures were associated with similar IOP-lowering efficacy, but the shunt procedure had a benefit for reducing the risk of hypotony.
Considerable progress has been made in recent years in the understanding of the epidemiology of dry eye disease. Here, two doctors discuss some of the studies that have helped ophthalmologists understand the prevalence, burden, and risk factors of dry eye disease. They also highlight how improved diagnosis will have a significant effect on the quality of life of patients with dry eye.
A retrospective study of eyes undergoing wavefront-guided PRK, LASIK with a mechanical microkeratome, or LASIK with a femtosecond laser shows that biomechanical changes are affected by flap creation technique and ablation depth.
Is bilateral implantation of an IOL better than contralateral "mixing and matching" of lenses? In one cross-study comparison, postoperative visual outcomes were examined to compare the effectiveness of bilateral implantation of an apodized diffractive IOL versus contralateral implantation of one apodized diffractive IOL and one refractive zonal progressive IOL.
Advanced surface ablation with mitomycin C is more effective than LASIK for treating ametropic after corneal transplantation, according to results of one study.
A retrospective study evaluated complications and associated outcomes in eyes that underwent LASIK with femtosecond laser flap creation at a university-based refractive surgery center. A direct or indirect complication due to flap creation occurred in 44 (0.92%) of 4,772 eyes; there was no loss of best spectacle corrected visual acuity in any of the 44 eyes.
A Talbot-Moiré wavefront aberrometer developed for use during cataract surgery is being investigated for its potential to enhance the accuracy of astigmatic correction with limbal relaxing incisions, toric IOL alignment, and IOL power selection.
Accumulating experience with corneal collagen crosslinking indicate it is a safe and effective treatment for arresting progression of keratoconus. However, further studies are needed to better characterize its indications and contraindications.
Review of a small series of eyes shows surface ablation procedures do not eliminate the risk of postoperative ectasia in eyes with forme fruste keratoconus, even in eyes without other ectasia risk factors.
An excimer laser platform features technology for automated cyclotorsional compensation. A study comparing outcomes of patients undergoing LASIK for myopic astigmatism treated with and without the system demonstrates that its use increases the predictability of astigmatism correction.
A retrospective study including 800 eyes compared outcomes using the Zyoptix XP (Bausch & Lomb) to create 120 μ flaps and the Hansatome (Bausch & Lomb) to create 160 μ flaps. Safety was excellent overall, the 120 μ flaps created with the Zyoptix had better thickness predictability and were associated with faster re-epithelialization and less discomfort.
A retrospective analysis has found favorably low enhancement rates using a wavefront-optimized excimer laser platform (WaveLight Allegretto Wave, Alcon).
According to a prospective study, epi-LASIK seems to have two advantages compared with PRK performed with a mechanical microkeratome: faster visual recovery and less postoperative pain.
The hardware and software used in refractive surgery has undergone a steady evolution that has resulted in more precise refractive outcomes.
Results of retrospective studies comparing haze after PRK in eyes treated with 0.002% mitomycin C (MMC) versus no MMC and in eyes treated with 0.002% MMC versus 0.02% MMC suggest an approach for using MMC in clinical practice.
Outcomes of wavefront-guided LASIK performed using a proprietary excimer laser (STAR S4 IR, Advanced Medical Optics) are superior to those achieved when the laser is used for conventional LASIK, and the benefits associated with the wavefront-guided procedure appear to persist even when the iris registration function cannot be used.
New guarded knives (Sharpoint, Angiotech) retain their sharpness far longer than other disposable blades, and this durability translates into the ability to perform more procedures with the same instrument and to make cleaner, faster-healing incisions, according to one ophthalmologist.
Cataract surgical techniques and IOLs have both been evolving for many years. The advances have been-and continue to be-tremendous, but each new advance also has the potential to give birth to new complications. The need to suture clear corneal incisions to prevent potentially blinding complications during subsequent surgery, and the dislocation of one-piece IOLs and capsular tension rings, are examples of complications of which practitioners need to be aware.
In a fluidics test of three phacoemulsification machines, differences were found in vacuum, flow, and postocclusion surge-and these differences were found not only between the three machines but also between the machines' own settings and what they were actually delivering. Other important findings: there is a significant amount of unoccluded vacuum at the tip, and the parameters for what constitutes a safe postocclusion surge can be dramatically different among eyes.
Optical coherence tomography performed preoperatively can predict the surgical success rates and the visual acuity outcomes in patients with myopic macular holes.
Laser photocoagulation seems to be associated with stable rates of visual acuity up to 2 years after treatment for diabetic retinopathy.
Lens-sparing vitrectomy for IV retinopathy of prematurity provides a good anatomic success rate and achieve good visual acuity success rates. Forty-two weeks postmenstrual age seems to be the ideal time for surgery.
In the current era of presbyopia-correcting IOLs, toric IOLs, and aspheric IOL technology, the practice milieu is changing.
Low rates of ocular and nonocular adverse events were found in patients receiving either 0.3 mg or 0.5 mg of ranibizumab (Lucentis, Genentech) for neovascular age-related macular degeneration. Final 1-year results from the safety study of over 2,300 patients showed that rates of adverse events were similar to those found in other large studies of ranibizumab.
A recent study evaluating the efficacy of an investigational dexamethasone delivery system (Posurdex, Allergan) for the intravitreal treatment of uveitis in rabbits demonstrated that it significantly reduced intraocular inflammation.
Pre-meeting subspecialty day activities will offer updates on the latest advances that can be applied immediately to the ophthalmic practice. Here some sessions taking place on both Friday and Saturday.
The annual meeting of the American Academy of Ophthalmology in Atlanta Nov. 8 to 11 will be held in conjunction with the European Society of Ophthalmology. Keynote speaker Michael T. Osterholm, PhD, MPH, will discuss the effects of infectious diseases on health care. The joint meeting will be packed with scientific presentations, instructional courses, breakfast with the experts, practice management courses, and symposia, plus an opportunity to see what is new from industry in the exhibit hall.
Changing demographics in the United States will require ophthalmology practices to adopt strategies to deliver care to large numbers of diabetic and elderly patients. Possible steps could include more effective use of support staff and increasingly efficient practice patterns.
U.S. documentary film director Joseph Lovett he has been progressively losing his vision since glaucoma was diagnosed in him 20 years ago. He is making a film, "Going Blind," to document the effects that blindness has on people's lives and to relay his own experience with the condition.
