Articles

A study published in the January issue of Antimicrobial Agents & Chemotherapy, has found that the high proportion of corneal infections linked to contact lens solutions are fuelled and made resistant to treatment by the formation of a highly resistant structure of microbial cells held together with a glue-like matrix material, called biofilms.

Telemedicine benefits

Using a telemedicine system to assist ophthalmologists in developing countries with the diagnosis and management of various ophthalmic conditions can be successful.

In eyes that have undergone corneal refractive surgery, non-Goldmann measurements of intraocular pressure (IOP) and continued examination of the optic nerve is essential as changes of the corneal shape can lead to falsely low IOP values.

Systematic screening for diabetic retinopathy (DR) has been identified as a cost-effective use of health service resources,1-4 with national screening programmes based on digital photography being implemented across Europe. In Scotland, images are captured at local screening centres and sent electronically to one of nine regional grading centres, where they are manually graded using a three-level system (Figure 1).

Modern intraocular lenses (IOLs) transmit only a part of the spectrum, just like natural lenses, but the transmission of the natural lens changes with age. With increasing age, the lens becomes far less transparent in the violet/blue part of the visible spectrum. Can the transmission of an IOL, therefore, be compared to that of the natural lens at a certain age? In other words, can we assign a virtual age to an IOL? The answer is yes and such an age is far easier to interpret than the complicated transmission curves provided by industry.

Sreening for early ectatic disease is essential in the evaluation of the refractive surgical candidate. There have, however, been many cases of severe post-LASIK ectasia without evidence of preoperative risk factors. Improving preoperative screening with better detection of subtle corneal topographic abnormalities may therefore help eliminate these rare but devastating cases.

Refractive surgery has come a long way since the first lamellar refractive surgeries were performed decades ago. Through continuous fine-tuning and evolution, LASIK has become today's dominant refractive procedure. However, as with all medical procedures, there is always room for improvement.

Events that have taken place in the market of contact lens hygiene and care products over the last two years give the impression that the hygiene scene is again in crisis. A crisis which is perhaps comparable with the "chlorhexidine shock" of almost three decades ago, which raised the question "is there a completely effective, safe and trouble-free way of caring for contact lenses?"

Cataract surgeons agree that proper incision construction is paramount for achieving good postoperative stability that will reduce the risk for endophthalmitis. The safety of the clear cornea incision technique versus use of other incision types remains controversial, however.

As a modern ophthalmic surgeon, I feel a reading test for clinical practice must be highly standardized, accurate, easy and quick to perform, whilst also offering the opportunity to perform research.

New developments in diagnostic technology should enable better screening and follow-up of refractive surgery patients, said Dan Z. Reinstein, MD, delivering a keynote address during the refractive surgery subspecialty day preceding the annual meeting of the American Academy of Ophthalmology in November 2007.

The clinical assessment of an anterior chamber inflammatory reaction may be difficult to determine in eyes where corneal clarity is reduced by corneal oedema. Slit lamp examination is currently the gold standard method to assess inflammation1-3 but in conditions such as poor corneal clarity, the clinician routinely encounters difficulties.

Glaucoma gene identified

Researchers from the University of Iowa, USA have discovered that a gene and related signaling pathway play a role in the development of glaucoma.

A travoprost - travoprost/timolol (T-TT) treatment sequence is more effective at preventing the need for a third-line treatment than a latanoprost - latanoprost/timolol (L-LT) treatment sequence.

The Pulsair EasyEye non-contact tonometer (Keeler) can be considered an accurate and reliable method of measuring intraocular pressure (IOP) in the normotensive population but it cannot be used interchangeably with the Goldmann tonometer.

The side effects and complications associated with intravitreal bevacizumab (Avastin) are minimal and can be prevented, in most cases, by careful injection and good patient selection.

The da Vinci Surgical System (Intuitive Surgical) provides adequate dexterity for performing delicate intraocular manipulation, however, the kinematics of the robotic arms is insufficient for standard intraocular surgery.

The anti-inflammatory nepafenac 0.1% is more comfortable and at least as efficacious as ketorolac 0.5% in the prevention and treatment of postoperative ocular pain and inflammation.

With regards to maintaining corneal biomechanics, sub-Bowman's keratomileusis (SBK) and advanced surface ablation (ASA) are improvements over conventional LASIK.