The low country of South Carolina, which was once built on a thriving economy based on rice crops, is now mostly resorts. Local residents Drs. Richard Schulze and his son Richard Schulze Jr. aim to maintain the legacy of rice farming which is a nearly lost tradition. The satisfaction is not one of monetary value but of seeing the historical significance of the crop where it once flourished.
On one hand, the pay-for-performance issue has large employers, insurers, and Congress contending that the delivery of substandard medical care by physicians is hurting patient care and costing the health-care system huge sums of money. On the other hand, Congress and insurers are determined to reward physicians for providing high-quality health care and at the same time penalize them for delivering lower-quality health care. Ophthalmologists must participate in the development of standards to ensure good results. Toward that end, physician groups have devised eight ophthalmology-related quality measures, which are detailed here.
Terminating the employment of a worker may be one of the most stressful parts of your job. Here's how to lessen the chances of having to perform this task-and how to minimize the discomfort for you and your employees if you do.
Temporary legislative bandages expired at the end of 2006, so the stage is set for a dramatic increase in the number of individuals who are affected by the alternative minimum tax. Here's how to determine whether you will be one of them.
Take-home message: New discoveries about the signaling pathways regulating cross-linked actin network (CLAN) formation could in the future lead to new therapeutic approaches for steroid-induced glaucoma. CLANs are found in glaucomatous trabecular meshwork cells as well as steroid-treated cell and eye organ cultures, thus the discovery of two distinct signaling pathways is a preliminary step toward targeting of specific proteins associated with steroid-inducedglaucoma.
Researchers have completed a genome scan of 128 families with primary open-angle glaucoma (POAG) and replicated loci on chromosomes 15 and 2. Nearly one-third of the families are of African-American or Ghanaian descent, a group disproportionately affected by POAG.
Transforming growth factor beta (TGF-β2) increases outflow resistance in human anterior segments. Recent analysis has identified several candidate molecules and pathways by which elevated levels of TGF-b2 may trigger changes in outflow resistance.
Achieving high patient satisfaction rates with newer multifocal IOLs requires attention to a variety of details preoperatively, intraoperatively, and postoperatively. R. Bruce Wallace, MD, and Samuel Masket, MD, review important considerations for maximizing outcomes.
Rigorous preoperative evaluation and counseling, meticulous surgery, and thorough postoperative counseling are all critical elements for optimizing outcomes with presbyopia-correcting lenticular surgery. One surgeon shares his four-step approach to excellent functional results and high patient satisfaction.
No substantial differences have been seen in the amount of postoperative flare present on day 1 following cataract surgery using either micro-coaxial phacoemulsification with a torsional handpiece or micropulse phacoemulsification.
A new tool for quantifying visual function after cataract surgery is now available. The Cataract Outcomes Questionnaire is a valid, reliable instrument that can be completed in 3 minutes.
Patients with uveitis who require cataract surgery present challenges to the surgeon at every stage of care. The uveitis must be controlled carefully preoperatively, small pupils are especially problematic during surgery, and inflammation must be controlled postoperatively.
Bilateral frontalis suspension combined with levator transection and transposition appears to be a better technique for treatment of Marcus-Gunn jaw winking synkinesis, suggest results of a large case series reviewed for this rare condition.
Ablation with bipolar wet-field diathermy is effective and safe as a management approach for low-flow vascular lesions, which typically are difficult to treat. Also, it is a less invasive strategy than standard surgery. One surgeon shares his experience.
Supranuclear gaze palsy should be suspected in patients with bilateral and symmetric vertical or horizontal gaze difficulty. Use of specific maneuvers to bypass the supranuclear input to the ocular motor nuclei can help to establish a supranuclear localization to the problem and direct neuroimaging to the supranuclear pathways in the brain and brainstem.
An analysis of results achieved from performing LASIK with a 213-nm solid-state refractive laser (Pulzar Z1, CustomVis) in 10 eyes with high and mixed astigmatism (mean astigmatism, –5.2 D) demonstrate its safety, predictability, and efficacy. Uncorrected visual acuity after a minimum of 8 weeks' follow-up was 20/30 or better in 100% of eyes.
An iris-fixed phakic IOL (Verisyse/Artisan, Advanced Medical Optics) is effective in correcting high myopia, hyperopia, and astigmatism, according to 5-year follow-up data from a prospective study conducted in France.
Customized IOL implantation has become a topic of great interest over the past year. The combined implantation of two different multifocal lenses, an apodized diffractive lens (AcrySof ReSTOR, Alcon Laboratories) and a refractive lens (ReZoom, Advanced Medical Optics), has provided patients with good results in near, intermediate, and distance vision because the two IOLs complement one another. In a survey of patients in whom the diffractive lens had been implanted bilaterally and patients in whom one of each IOL had been implanted, the combination approach received higher marks compared with bilateral diffractive lens implantation.
Several situations are associated with a high risk of failure after donor corneal transplantation. Encouraging results have been seen with a particular keratoprosthesis (Boston KPro, Massachusetts Eye and Ear Infirmary) as an alternative in carefully selected eyes.
Experts discuss strategies for diagnosing intermediate uveitis and pars planitis. This is part one of a two-part series.
Successfully managing progressive post-LASIK corneal ectasia can circumvent the need for keratoplasty. This article describes one technique.
Statin use does not appear to have a significant protective effect against choroidal neovascularization or geographic atrophy in patients with age-related macular degeneration, according to a recent analysis of data collected during the Complications of Age-related Macular Degeneration Prevention Trial.
Vision loss is associated with increasing scores on the simplified severity scale for age-related macular degeneration (AMD) in the Age-Related Eye Disease Study. A correlation also has been found between vision loss and the four fundus lesions associated with advanced AMD. These findings suggest that the fundus lesions could be used as surrogates in prevention studies for development of advanced AMD.
Data analysis from the Complications of Age-related Macular Degeneration Prevention Trial shows that choroidal neovascularization and geographic atrophy share some risk factors but have different influences as well.
Reliable measurement of the distance between a phakic refractive IOL and the crystalline lens is important in detecting direct contact, a risk factor for induced cataract. In a recent study using optical coherence tomography, investigators found that the phakic refractive IOL and anterior lens surface moved forward in all cases during accommodation; mechanical contact was infrequent but was found in all instances in which opacification developed.
Integrating the technology in a private practice is an investment in money and time, but the payoff is worth it, according to one ophthalmologist who recently upgraded his office. Here?s how he did it.
Interim results from a phase III study evaluating an accommodating IOL (Tetraflex [KH-3500], Lenstec) for pseudophakic correction after cataract surgery demonstrate that it provides good near and distance uncorrected visual acuity outcomes along with a favorable safety profile.
A novel investigational compound that removes heavy metals intraocularly following topical administration is being studied for the treatment of cataract, band keratopathy, asteroid hyalosis, and IOL calcifications.
Treatments for dry eye and ocular allergy typically are directed at symptoms. Researchers have begun developing therapeutics to target the causes of dry eye and to prevent the allergic reaction.
Dr. Allingham has been fly-fishing for about 10 years. A friend, also a physician, talked him into trying it, telling him it was very different from "regular" fishing. He can fly-fish locally in North Carolina on the Eno River near home for bluegill and bass, in the Appalachian Mountains, or on the ocean for tarpon.
