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.
There are three types of employees: climbers, quitters, and some who camp at mediocrity. Practice administrators who get to know their employees and what makes them tick will contribute to the success of the practice. It may be a matter of uncovering his or her true talents and finding the right place for that person within the practice.
Dianna Graves comments on her experience formally and informally training ophthalmic technicians. The task is often times difficult and good candidates are hard to find. Technicians however, serve an important service in a practice allowing physicians to carry out their jobs more efficiently.
Safeguard Your Sight is a Web-based refractive surgery database for keeping track of the patient's preoperative, operative, and postoperative cornea measurements.
Although medication use is common in ophthalmology offices there is still confusion on how to report these services. Describing it's service correctly can save practices money.
Newly identified factors that increase the risk of development of persistent esotropic amblyopia are delay in referral and anisometropia in children with infantile or accommodative esotropia.
The bar for refractive and vision outcomes has been raised in patients in whom multifocal IOLs have been implanted. Laser vision correction, therefore, has become an important enhancement tool. Multifocal IOL patients should be managed the same as laser vision refractive surgery patients, but additional issues should be considered.
When the performance of four different aspheric IOLs in scotopic light conditions was evaluated using a computer model, the results favored one three-piece lens (Tecnis, Advanced Medical Optics) for providing the best compromise between spherical and chromatic aberrations and depth of focus.
The therapeutic regimen chosen by a clinician can have a major effect on surgical success, practice, and patient well-being. Here are the attributes you should look for.
An ophthalmic formulation of the popular antibiotic azithromycin is now on the market for the treatment of bacterial conjunctivitis.
The potent corticosteroid difluprednate is being developed as an emulsion for topical use. Phase III clinical trials of the treatment of postoperative inflammation have been completed and a phase III study of anterior uveitis treatment is under way. Positive efficacy and safety results were achieved in phase III clinical trials in Japan.
A prospective, randomized, contralateral eye-controlled study demonstrated that eyes treated with nepafenac 0.1% (Nevanac, Alcon Laboratories) for 4 to 5 days after PRK had significantly greater haze than eyes treated with ketorolac tromethamine 0.4% (Acular LS, Allergan). The study findings and similar experience of other surgeons raise questions about the safety of nepafenac use after surface ablation procedures.
Topical ophthalmic nonsteroidal anti-inflammatory drugs vary considerably in characteristics such as the number of days and the number of drops needed to reach the therapeutic endpoint. Although all are effective, doctors should learn to compare the NSAIDs based on their potency and penetration to make the best decisions for their patients.
Results of testing in an animal model demonstrated that topical moxifloxacin 0.5% ophthalmic solution (Vigamox, Alcon Laboratories) provided effective prophylaxis against endophthalmitis following an intravitreal injection.
Nepafenac (Nevanac, Alcon Laboratories) administered three times daily after bilateral PRK, facilitated corneal healing that was comparable to ketorolac (Acular LS, Allergan) in a recently reported prospective, randomized, and double-masked study. In addition, pain relief occurred earlier in patients randomly assigned to receive nepafenac compared with patients who received ketorolac or bromfenac (Xibrom, ISTA Pharmaceuticals).
Appropriate management of malignant lesions of the conjunctiva requires detailed knowledge of the appearance and nature of the lesions. Here's how to recognize and treat the most common malignant lesions seen by ophthalmologists.
Keratoconus appears to be a "two-hit" phenomenon, a genetic predisposition propelled by external factors to result in damage to the cornea.
No difference exists regarding the prevalence of amblyopia and strabismus in a population of Hispanic and African-American preschool children, and the prevalence of the two pathologies increases with age, according to findings of the Multi-Ethnic Pediatric Eye Disease Study.
Descemet's stripping endothelial keratoplasty (DSEK) has changed the landscape in cornea surgery. Compared with those who have undergone penetrating keratoplasty, DSEK patients have an easier time postoperatively with rapid visual recovery. DSEK also affects decision-making about cataract extraction, and data appear to indicate that in most cases cataracts should be removed before DSEK or as a combined procedure.
Many patients whose open-angle glaucoma is treated with phacoemulsification plus endoscopic cyclophotocoagulation (ECP) are able to stop taking topical medications shortly after cataract surgery.
In a pooled dataset, the fixed combination of 0.2% brimonidine/0.5% timolol (Combigan, Allergan) showed greater reductions in IOP and a better tolerability profile than another combination agent, 2.0% dorzolamide/0.5% timolol (Cosopt, Merck). The twin advantages of greater pressure lowering and greater tolerability could help guide clinicians in choosing which therapy to choose when the initial treatment has not resulted in adequate improvement.
A retrospective analysis was performed of 54 eyes undergoing pars plana insertion of a glaucoma drainage implant (GDI) with simultaneous penetrating keratoplasty or that had an existing corneal graft. During a mean follow-up of 3 years, IOP control and graft survival rates were considered to be at least as high as rates in eyes with anterior chamber GDI placement and corneal grafts.
Application of the fixed combination 2% dorzolamide hydrochloride/0.5% timolol maleate ophthalmic solution (Cosopt, Merck, Sharp & Dohme) resulted in a significant decrease in IOP 6 and 8 weeks after the onset of therapy in patients with ocular hypertension or primary open-angle glaucoma whose IOP had not been controlled by 0.5% timolol alone. The daytime and nighttime IOP values also were significantly reduced at the same time points compared with baseline.
Thorough patient education about anticipated side effects and benefits of treatment can improve patient acceptance of therapy and potentially increase adherence, concluded researchers who studied the effects of counseling intervention in patients treated with a prostaglandin analogue.
Selective laser trabeculoplasty seems to exert a systemic effect that results in the lowering of IOP in the untreated fellow eyes of patients with open-angle glaucoma.
A proprietary miniature glaucoma device (Ex-PRESS, Optonol Ltd.) implanted under a partial-thickness scleral flap achieved significant decreases in IOP in patients with glaucoma.
Three devices for conducting structural analysis of glaucomatous eyes have pros and cons.
An anti-glaucomatous medication formulated with a less toxic preservation causes less ocular surface toxicity, according to one cornea specialist. The development of travoprost ophthalmic solution 0.004% (Travatan Z, Alcon Laboratories), a prostaglandin analogue preserved with a new ionic-buffered preservative system (sofZia, Alcon Laboratories), seems to be the direction in which pharmaceutical companies will be moving in the future to eliminate harmful side effects caused by chronic application of anti-glaucoma medications.
Results of a prospective, randomized, investigator-masked trial comparing brimonidine 0.15% with oxidative preservative (Purite) (Alphagan P, Allergan) and dorzolamide 2% (Trusopt, Merck) as adjuncts to latanoprost 0.005% (Xalatan, Pfizer) show the addition of either agent results in further IOP reduction, but the IOP-lowering effect was greater in the brimonidine/oxidative preservative group.
A novel route of administration of anecortave acetate suspension (Retaane, Alcon Laboratories) by anterior juxtascleral depot in the sub-Tenon's space may represent a new paradigm in glaucoma treatment.
