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A microincisional lens (Akreos MI60, Bausch & Lomb) can be implanted through a 1.8-mm incision. Although not yet available in the United States, excellent results have been achieved with the IOL internationally. Surgeons can use it after biaxial or coaxial microincisional phacoemulsification with an integrated phaco platform (Stellaris Vision Enhancement System, Bausch & Lomb) to provide patients with the benefits of less invasive surgery.

Results of a study evaluating contrast sensitivity in patients with a multifocal IOL (ReZoom, Advanced Medical Optics) implanted corroborate anecdotal reports that this zonal refractive implant provides excellent quality of vision under photopic conditions.

Aspheric IOLs represent a major move forward in IOL design. In this study of 40 patients, visual acuity achieved with the aspheric lens was equal to or better than that achieved with the spherical lens, and patient satisfaction was significantly higher with the aspheric lens on several visual disturbance ratings.

Results from a series of 100 eyes with an accommodating IOL (crystalens, Bausch and Lomb) implanted shows that meticulous anterior capsule lens epithelial cell removal using a combination of ultrasonic irrigation-aspiration with free-flow fluidics and capsule polishers is associated with stable anterior capsulotomy diameters, stable refraction, and excellent vision outcomes.

In a 1-year follow-up study, 119 patients in whom a toric IOL (AcrySof Toric, Alcon Laboratories) had been implanted had excellent results, including minimal residual refractive cylinder. The lens, which is available in three toricities, provides very accurate results for several different patient populations.

Spherocylindrical corrections were performed in six patients implanted with a photosensitive IOL (Light-Adjustable IOL, Calhoun Vision) after cataract surgery. Mean cylinder was –0.50 D postadjustment, and uncorrected visual acuity improved in all patients to 20/25 or better.

Implanting specialty IOLs in patients with glaucoma requires special attention because of changes in vision that result from anti-glaucomatous medications.

Many features that are specific to glaucoma patients raise concerns about whether they are appropriate candidates for multifocal IOLs. In the absence of extensive clinical data to guide decision-making, the benefits and compromises must be considered carefully in each patient.

IOL effects on contrast sensitivity are a major consideration for selecting implants in patients with glaucoma who are undergoing cataract surgery. On this basis, an aspheric IOL is preferred except in the rare patient with a history of hyperopic LASIK, whereas presbyopia-correcting IOLs are best avoided.

Increasing the funding for the National Eye Institute is one of the goals of non-profit advocacy coalition National Alliance for Eye and Vision Research and its education affiliate, the Alliance for Eye and Vision Research. The organizations, however, do not expect the budget for fiscal year 2009 to be finalized until February, after the presidential election.

Ongoing analysis of data from the Early Manifest Glaucoma Trial (EMGT) has shown that positive cardiovascular history and thinner central corneal thickness increase the risk of progression, but only in patients with higher baseline IOP. Low blood pressure emerged as a risk factor in normal-tension glaucoma.

Buffalo Grove, IL-Akorn Inc. has received FDA approval of its abbreviated new drug applications for 0.1% diclofenac sodium ophthalmic solution and 0.3% ofloxacin ophthalmic solution USP.

Management of thyroid eye diseases should be individualized to the severity of signs and symptoms of each patient and based as well on whether the disease is in an active or quiescent phase. Some corrective procedures should be postponed for months or years until the disease no longer is active.

Novartis plans to acquire a majority share of Alcon for $39 billion in a two-part deal. First, Novartis and Nestle have reached an agreement under which Nestle will sell 74 million of its shares of Alcon to Novartis for about $11 billion. Then, Novartis has an exclusive option to purchase the remaining 52% share from Nestl? for $28 billion between Jan. 1, 2010, and July 31, 2011.

A retrospective study of eyes with a spherical IOL implanted found the lens haptics maintained a stable position in most eyes, but significant rotation was observed in a small proportion. This information is important to consider when implanting toric IOLs where orientation and rotation can affect vision outcomes.

Posterior keratocyte densities were significantly lower in ectatic eyes than in normal eyes following both histopathologic and confocal microscopic analysis in a recent small study. If further studies verify that finding, serial confocal measurements of density could be used to monitor progression of post-LASIK ectasia.

LASIK and PRK are both safe and, over the long term, produce similar visual outcomes. A preference for one or the other can be based on both scientific evidence and personal opinions, and it is a complex decision that does not necessarily have a right or wrong answer. Physicians should fully inform patients of the pros and cons of both and respect the decision, suggested participants in a point-counterpoint debate.

The Verteporfin Intravitreal Triamcinolone Acetonide Study (VERITAS) of intravitreal triamcinolone acetonide (Kenalog, Bristol-Myers Squibb) or pegaptanib (Macugen, Pfizer) in combination with photodynamic therapy (PDT) with verteporfin (Visudyne, Novartis Pharmaceuticals) was underpowered to reach definitive conclusions about the therapies.

Cyclosporine 0.05% ophthalmic emulsion (Restasis, Allergan) is beneficial for treating patients with dry eye because it increases goblet cell density and production of transforming growth factor ?2, an immunoregulatory factor, compared with artificial tear formulations, which do not.

A hydroxypropyl cellulose ophthalmic insert (Lacrisert, Aton Pharma) is a preservative-free product recommended for once-daily insertion in the inferior cul-de-sac. Its convenience, efficacy, and safety make it a valuable option for the management of dry eye disease.

When initiating treatment with topical cyclosporine ophthalmic emulsion 0.05% (Restasis, Allergan), adjunctive use of loteprednol etabonate ophthalmic suspension 0.5% (Lotemax, Bausch & Lomb) hastens and increases relief of dry eye signs and symptoms and reduces cyclosporine-associated burning and stinging without adding safety concerns, according to the results of a multicenter, randomized, controlled, masked trial comparing the combination regimen with cyclosporine plus artificial tears.

Multiple studies evaluating the effects of treatment with Systane Lubricant Eye Drops (Alcon Laboratories) on corneal staining in patients with dry eye disease demonstrate this novel artificial tear has benefits for improving ocular surface health.

Carboxymethylcellulose 0.5% with compatible solutes (CMC-solutes) (Optive, Allergan), a new artificial tear formulation, when used with topical cyclosporine 0.05% (Restasis, Allergan) in patients with ocular surface disease, improved the objective signs and subjective symptoms of the disease when compared with the patients' previously used artificial tears.

A new lubricating eye drop (blink Tears, Advanced Medical Optics) with the active ingredient polyethylene glycol is designed to provide a balance between viscosity and retention without sacrificing a patient's visual quality. It can help optimize the ocular surface before and after refractive surgery, aiding postoperative visual outcomes and patient satisfaction.