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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.

Recent reports from expert panels emphasize the complexity of dry eye disease, reflecting advances in understanding of this disease in the past decade. Along with this new grasp of the condition's complexity, diagnostic and treatment approaches must evolve as well. New tools and methods for diagnosis and treatment have been developed and have entered clinical practice, while others are in the pipeline or still primarily used in research settings.

Anti-vascular endothelial growth factor (VEGF) therapy has swept through ophthalmology over the past several years, dramatically changing clinicians? approach to the treatment of neovascular age-related macular degeneration (AMD). Although this form of therapy has been shown to be effective in several clinical trials, much remains to be learned about its clinical application.

In today's podcast, Carol L. Shields, MD, shares tips for diagnosing and managing pigmented conjunctival lesions, and Glenn J. Jaffe, MD, describes how spectral-domain optical coherence tomography could affect clinical care and clinical trials. Also, Hans E. Grossniklaus, MD, details worrisome features of iris tumors, and Sue J. Vicchrilli, COT, OCS, relays reasons that ophthalmologists should stay up to date on coding matters.

The consequences of uncontrolled glaucoma progression can be severe. Technology companies have risen to the challenge with sophisticated diagnostic devices, but it falls to the average clinician to make the best use of these tools in monitoring patients' disease status over the years.

The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, was honored for excellence in the area of Best Research in Ophthalmology Times? 2008 Best Programs Awards.

Gene therapy has resulted in functional vision for patients with Leber's congenital amaurosis (LCA), said Albert Maguire, MD, of the University of Pennsylvania, Bryn Mawr. That research is the result of a 13-year effort by Dr. Maguire and colleagues.

Although 40% of eye examinations are performed by ophthalmologists, dispensing ophthalmology practices are not retaining customers, said Arthur De Gennaro, president of Arthur De Gennaro & Associates LLC, Lexington, SC, an ophthalmic practice management firm that specializes in optical dispensary issues.

Results of the 2008 International Society of Refractive Surgery/American Academy of Ophthalmology (ISRS/AAO) survey show trends detected in prior years are continuing, including a demonstration of surgeon confidence in the safety, efficacy, and value of modern laser vision correction procedures.

Enrollment has been completed in a series of phase III studies investigating voclosporin (Lumeniq, Lux Biosciences) as a steroid-sparing agent for the treatment of noninfectious uveitis, according to Quan Dong Nguyen, MD, assistant professor of ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.

The 1990s brought a decade of advances in the medical therapy of glaucoma. That decade saw the introduction of a new carbonic anhydrase inhibitor, dorzolamide (Trusopt, Merck); the first prostaglandin, latanoprost (Xalatan, Pfizer); the first alpha-2 agonist, brimonidine (Alphagan, Allergan); and the first fixed-combination carbonic anhydrase inhibitor/beta-blocker, dorzolamide and timolol (Cosopt, Merck).

In a series of presentations, speakers at an educational program outlined the benefits of technologies for premium cataract surgery including a microincision platform (Stellaris Vision Enhancement System), an accommodating IOL (the Crystalens HD), and an advanced optics aspheric lens (Akreos), all from Bausch & Lomb. The evening program, held at the Georgia Aquarium, also featured two live cataract surgery cases performed in Beverly Hills, CA, by Uday Devgan, MD.

In this podcast, John F. Doane, MD, FACS, discusses addressing presbyopia with accommodating IOLs, and Scott W. Cousins, MD, talks about the role of injury and inflammation in the pathogenesis of dry age-related macular degeneration (AMD). Also Scott M. MacRae, MD, relays the current limitations of laser vision correction, and Paul Sternberg Jr., MD, speaks about new approaches to the treatment of dry AMD.

Skillful physician-patient communication is paramount to successful prevention and management of dissatisfied LASIK patients, said Jennifer Morse, MD, assistant clinical professor of psychiatry, University of California San Diego.

Studies with a night-driving simulator (NDS) found that changes in night-driving performance were associated strongly with the type of treatment used to perform LASIK, and that wavefront-guided procedures were correlated with better performance. The study involved 59 patients (98 eyes) who were tested preoperatively and 6 months postoperatively with the NDS, set to simulate nighttime driving on a rural road at 55 miles per hour, with and without glare.

Planning is underway for a large national prospective study to evaluate postLASIK quality-of-life outcomes in a clinical setting, said Malvina B. Eydelman, MD, director, division of ophthalmic and ear, nose, and throat devices, Center for Devices and Radiological Health (CDRH)/FDA, Rockville, MD.

Refractive surgeons need to remember that the tear film is the most important refracting surface of the eye, and if it is abandoned, surgical outcomes will suffer, said Eric D. Donnenfeld, MD, clinical professor of ophthalmology, New York University.

Scientific evidence does not support the hypothesis that thinner preoperative central corneas are an independent risk factor for postLASIK ectasia, said William B. Trattler, MD, director of cornea at the Center for Excellence in Eye Care, Miami. Eyes with a thin cornea (less than 500 µm) and normal topography are at no greater risk than those with thicker corneas of developing postoperative ectasia and may be biomechanically strong and similar to thicker corneas in their behavior, Dr. Trattler added.

Refractive surgeons may consider the diagnosis of LASIK chronic pain syndrome in postLASIK patients complaining of moderate to severe eye pain in the absence of dry eye or any other identifiable cause, said Steven E. Wilson, MD.

The 2008 annual meeting of the American Academy of Ophthalmology (AAO) is featuring several new and forthcoming patient education, clinical education, and practice management products produced by the AAO to meet the educational and practice needs of its members. During the meeting, these products are available at the academy's resource center and online.

Thirteen ophthalmologists were presented with the American Academy of Ophthalmology (AAO) Lifetime Achievement Honor Awards for their contributions to the academy and the ophthalmology profession.