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Frequent follow-up visits are necessary to monitor for endothelial cell loss in patients in whom phakic IOLs have been implanted, according to one surgeon who has 5 years of experience with the lens.

Mistaken patient identity during keratorefractive surgery is devastating for the patient and surgeon. A "foolproof" method for avoiding mistaken identity involves obtaining the patient's autorefraction moments before surgery and taping the autorefractor strip to the patient. The patient's individual autorefraction, cylinder axis, and other data stay with the patient at all times, enabling the surgeon to make sure the information on the laser computer matches the information on the strip.

Implantation of two different multifocal IOLs-an apodized diffractive lens (AcrySof ReSTOR, Alcon Laboratories) and a refractive lens (ReZoom, Advanced Medical Optics)-may provide increased ranges of near and intermediate vision for a patient undergoing refractive lens exchange compared with bilateral implantation of the diffractive IOL, according to a study of 20 patients.

Surgeons reviewing their outcomes with an implantable contact lens (Visian Implantable Collamer Lens, STAAR Surgical Co.) reported high-quality visual acuity results and low complication rates over both short-term and long-term follow-up periods.

A study of a subgroup of 11 patients who participated in a multicenter trial found no significant distance changes between the anterior crystalline lens surface of the eye and the posterior surface of iris claw-style phakic IOLs during accommodation. This finding lends further credence to the belief that the IOL and the iris move forward together as a unit during accommodation.

A study using optical coherence tomography (Visante, Carl Zeiss Meditec) found that a single-piece acrylic, hydrophobic phakic IOL (AcrySof phakic IOL, Alcon Laboratories); a single-piece, hydrophilic acrylic IOL (ICare IOL, Corneal); and a newer, trimmed version of the latter (ICare Evolution IOL, Corneal) did not produce anatomic distortion of the iris or the chamber angle. The study compared angle-to-angle distances ≥6 months after lens implantation.

Creating channels using a femtosecond laser (IntraLase FS, IntraLase Corp.) to insert a corneal implant (Intacs, Addition Technology Inc.) has some advantages, but the procedure also has the potential for complications. Both are detailed.

Multifocal and accommodative IOLs can be implanted safely in patients who have undergone prior refractive surgery, and visual results can be good. Frequently, however, enhancements are necessary, and decreased best-corrected visual acuity may be seen more often than with aspheric monofocal IOL insertion, according to the results of a prospective study of 22 eyes in 18 patients.

To address a perceived unmet need for comprehensive refractive surgery training, Sunil Shah, FRCOphth, FRCSEd, FBCLA, and colleagues in England developed an electronically based course for those wanting to develop their knowledge and skills in cataract and refractive surgery.

Torsional phacoemulsification reduces chatter and energy delivered to the eye. It is safer than longitudinal phaco because torsional phaco is associated with a reduced risk of wound burn, less fluid usage, better followability, less turbulence, and less second instrument manipulation.

Management of patients with neovascular age-related macular degeneration has evolved, but clinicians are at a crossroads when considering continuation of treatment. Evidence suggests that monthly treatment and less frequent treatment regimens are better than no treatment. The best treatment regimen remains elusive.

In a phase II study, implantation of the artificial silicon retina microchip (ASR, Optobionics) improved visual acuity in some patients for up to two years. A phase III study is possible if someone interested in continuing these trials purchases the company, now in bankruptcy.

The AWARE Study (Analysis of Safety Outcomes with Anti-VEGF Treatment) is expected to expand retinal specialists' knowledge of the short- and long-term risks of anti-vascular endothelial growth factor treatments for neovascular age-related macular degeneration and diabetic retinopathy. The study may help identify a subset of patients susceptible to adverse events.

Testing of a retinal prosthesis shows that blind subjects who receive the implant have predictable spatial vision and that more electrodes provide higher spatial resolution. Scientists at Second Sight Medical Products have tested a 16-electrode prosthesis for several years and have received approval to conduct tests with a newer, 60-electrode device.

The development of customized component corneal transplantation techniques could enable a single donor cornea to be used to treat multiple patients. The practice could help address tissue shortages and reduce the wait time for surgery in developing countries. A researcher formerly practicing in India talks about the first published report of this strategy.

Initial analyses of data collected in the Canadian Glaucoma Study have identified four variables as powerful independent risk factors for glaucoma progression.

A retrospective cohort study revealed a consistent volume-outcomes relationship for adverse events in cataract surgery. Surgeons performing more than 1,000 procedures a year had the lowest complication rate among four volume classifications. The overall adverse event rate, however, was low as well: less than 1 in 200.

The development of cataract and age-related macular degeneration (AMD) seems to be linked with increased mortality rates in older patients (aged 49 or more years), according to results of the Blue Mountains Eye Study. The finding confirms an association between visual deterioration and mortality found in other studies.

Central corneal thickness (CCT) bears an inverse relationship with the risk of developing glaucoma. The risk of glaucoma progression, however, seems to be independent of CCT. New tonometry technology will allow for more accurate risk stratification of patients.

Findings of a study evaluating in vitro susceptibility of clinical fungal keratitis isolates suggest that use of newer antifungal medications may afford better outcomes in these potentially sight-threatening infections

An ophthalmologist details several questions clinicians must answer when deciding whether to use an excimer laser to perform enhancements after PRK or LASIK, lamellar surgery, incisional surgery, lens surgery, or corneal surgery.

Risk factors for ectasia may exist, but if ophthalmologists carefully screen patients and carefully measure what they're doing, the incidence of this complication of LASIK will be reduced, says one ophthalmologist.

Mitomycin C administered during PRK is safe and effective method to prevent corneal haze and did not cause severe complications over the long term in a recent study that included 59 patients (115 eyes) who were followed for a mean of 65 months postoperatively.

Recent research is yielding interesting information about IOP fluctuation, its role as a glaucoma progression risk factor, and how it is affected by treatment. The findings, expected to have implications for patient management, have focused attention on the ability of treatments to suppress the diurnal IOP curve.

Results so far in a phase II clinical trial indicate that a technique to implant sheets of immature neural retinal cells and retinal pigment epithelium together can improve vision of patients with retinitis pigmentosa or age-related macular degeneration.

All too often, practices look to alternative revenue centers that involve additional risk before looking at the no-risk option of improving current operations to put increased dollars on the bottom line. Read how one retina practice, with assistance from experienced consultants, devised a strategic plan that improved current operations and contributed to a very significant increase in revenue.

A filtering device (Cruise Control, STAAR Surgical Co.) placed between the phacoemulsification handpiece and aspiration tubing increases the stability of the anterior chamber during phaco because it decreases the post-occlusion aspiration flow rate in two venturi systems (Legacy 20000, Alcon Laboratories; Millennium venturi, Bausch & Lomb).

In every phacoemulsification procedure, the critical factors remain the common goals: the care and respect bestowed on the patient and the commitment to obtaining the best possible outcome. There is no place for cynical, business-as-usual attitudes (which are found in some operating rooms) in today's environment of refractive cataract surgery and presbyopia-correcting IOL implants. An expert offers 10 steps to help post-residency ophthalmologists conquer their first solo phacoemulsification procedures.