News

Since we have been using the femtosecond laser, we have not had to fit a single therapeutic contact lens

Refractive surgery has radically changed the nature of clinical practice, with its success spawning the proliferation of commercial clinics owned and directed by non-medical personnel

The impotence drugs Viagra (sildenafil) and Cialis (tadalafil) may increase the risk of developing non-arteritic anterior ischaemic optic neuropathy (NAION), according to a study published in the February 2006 issue of the British Journal of Ophthalmology.

Challenging phacoemulsification cases can present problems for the cataract surgeon. How a surgeon manages those challenging cases can prevent the case from turning into a nightmare.

New techniques and technology in cataract surgery was the theme of a symposium Wednesday night at the World Ophthalmology Congress. The symposium touched on new phacoemulsification technology, the use of a new ophthalmic viscophthalmic device (OVD), anti-infectives, and the latest intraocular lens technology.

Performing "safe surgery" remains as the sine qua non for using antimetabolites safely and effectively as an adjunct to trabeculectomy. However, there are some strategies that can be incorporated in the surgical technique to reduce the risk of complications resulting from the application of anti-scarring medication, said Richard K. Parrish, II, MD, at the World Ophthalmology Congress.

Exfoliation syndrome (XFS) is a global disease that is important to recognize because of its association with other visual-threatening ocular pathologies, said Alan H. Robin, MD, of the Wilmer Eye Institute at Johns Hopkins University in the United States.

Deep sclerectomy is not the holy grail of glaucoma surgery, but available evidence indicates that it is definitively safer than trabeculectomy and that it can result in long-term success rates matching those of trabeculectomy when performed with proper technique by experienced hands, said Tarek M. Shaarawy, MD, at the World Ophthalmology Congress.

Ophthalmologists are familiar with the use of optical coherence tomography (OCT) for the back of the eye. Now, there also is a role for OCT in anterior segment corneal procedures and complications, reported Ronald Smith, MD, of the United States at the World Ophthalmology Congress on Wednesday.

Early detection of glaucoma is critical. According to the AGIS study, by the time a reproducible visual field defect is detected, 20% to 50% of the retinal nerve fiber layer (RNFL) can be damaged, said Remo Susanna, Jr., MD, at the World Ophthalmology Congress on Wednesday.

Glaucoma implants may fail for a number of reasons, said Felix Gil Carrasco, MD, at the World Congress of Ophthalmology on Wednesday. However, inappropriate patient selection and improper placement of the shunt are probably the most common reasons.

Increasing clinical experience with corneal collagen cross-linking using combined topical riboflavin application and ultraviolet-A (UVA) irradiation indicates this simple, nonsurgical intervention may be an effective treatment for keratoconus and iatrogenic keratectasia. However, its safety may depend on respecting a minimum corneal thickness threshold of 400 microns as a criterion for candidate selection, said Theo Seiler, MD, at the World Ophthalmology Congress.

New technologies and surgical techniques are redefining the refractive surgery arena in ophthalmology. With the progress of customized wavefront-guided LASIK and the use of phakic intraocular lenses (IOLs), today's refractive surgeon can offer a wider range of services to the patient.

Favorable Phase I study results have led to the launch of a Phase I/II trial evaluating the efficacy and safety of AdPEDF (GenVec) treatment of exudative AMD, said Timothy Stout, MD, at the World Ophthalmology Congress.

With the world's population getting older and the rate of blindness increasing in regard to that aging population, cataract surgeons worldwide are facing some clinical challenges in the years ahead, according to Stephen A. Obstbaum, MD, of United States.

Encouraging results have been achieved in a pilot clinical trial of selective epiretinal brachytherapy for exudative age-related macular degeneration (AMD), reported Eugene de Juan, Jr., MD, at the World Ophthalmology Congress.

In the new treatment era for exudative age-related macular degeneration (AMD) heralded by the availability of locally administered anti-VEGF drugs, intravitreal monotherapy with triamcinolone injection may no longer be considered as a current therapy for this neovascular condition, said Jost Jonas, MD, at the World Ophthalmology Congress.

With an aim to further improve efficacy and safety outcomes achieved with anti-VEGF therapy for AMD, ongoing studies with pegaptanib sodium (Macugen, OCI/Eyetech Pharmaceuticals) are evaluating the potential benefits of early treatment initiation and of using an induction/maintenance approach, said Anthony P. Adamis, MD, at the World Ophthalmology Congress.

Interim results from a Phase I study suggest that intravitreal injection of VEGF Trap (Regeneron Pharmaceuticals) is a promising new approach for the treatment of exudative age-related macular degeneration, said Quan Dong Nguyen, MD, at the World Ophthalmology Congress.

There is a wide range of technology available in cataract surgery today and it's easy for ophthalmologists to get excited and carried away by the technology. However, it's the attention to detail; going back to basics about incisions; pre- and post-surgical management; and the proper use of intraocular lenses that also need to be stressed.

Suggesting a change in the way physicians diagnose glaucoma, Robert Weinreb, MD, outlined a new paradigm for diagnosis of the disease in his Glaucoma Society of International Ophthalmology Congress (GCIOC) Day Lecture, presented Monday at the World Ophthalmology Congress. Dr. Weinreb said that the glaucoma field is undergoing a revolution in diagnosis. He said there is a transition from reliance solely on visual fields to the increased use of structural analysis of the optic disk and RNFL. "It's something that was initiated 20 years ago," explained Dr. Weinreb. "Changes are very, very slow in glaucoma, as it does in all medical disciplines. We have reached an infliction point in glaucoma diagnosis where we are about to reap the benefits of this revolution."

The femtosecond laser (IntraLase) holds promise for advancing penetrating keratoplasty (PKP) in the near future, said Denise Fornazari de Oliveira, MD, at the World Congress of Ophthalmology.

Age-related macular degeneration (AMD) is a common cause of vision loss worldwide, particularly in industrialized nations, where it is the main cause of blindness among people of 65 and older, explained Paul Mitchell, MD, at the World Ophthalmology Congress.

The future of penetrating keratoplasty (PKP) may be "a lot more work, but no more money" as Michael Belin, MD, of the United States jokingly described it Monday, but the number of PKP procedures are definitely presenting options for the corneal surgeon.

There is a wide range of technology available in cataract surgery today and it's easy for ophthalmologists to get excited and carried away by the technology. However, it's the attention to detail; going back to basics about incisions; pre- and post-surgical management; and the proper use of intraocular lenses that also need to be stressed.

Establishing the correct diagnosis and modifying therapy appropriately based on response are fundamental in the successful management of bacterial keratitis, said Richard L. Abbott, MD, at the World Congress of Ophthalmology.

Refractive surgeons wishing to achieve successful penetrating keratoplasty need only plan their surgeries more closely.

A target IOP should be set whenever the diagnosis of ocular hypertension or glaucoma is first made, and it should be re-evaluated at each follow-up visit as part of the assessment of the efficacy of treatment for stopping visual field progression and protecting the optic nerve, said Curt Hartleben, MD, at the World Congress of Ophthalmology.

Evidence-based medicine has provided some guidance on the management of herpes simplex virus (HSV) keratitis, but there are still many questions left unanswered, said Thomas J. Liesegang, MD, at the World Congress of Ophthalmology.

Imaging is an essential part of glaucoma management, but while structural damage is frequently apparent before identifiable visual field loss occurs, both functional testing and quantitative imaging should always be performed in eyes with either early or moderate disease, said David F. Garway-Heath, MD.