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04.24.2024

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Cataract

Combining Vitreoretinal Surgery With EDOF IOL Implantation

The lens technology’s potential to reduce patients’ trips to the OR and loss of accommodation.

Peter Stalmans, MD, PhD

Cataract and Refractive Surgery Today

Cataract surgery is often thought of as an age-related procedure. In numerous European countries, however, including Belgium, where I practice, many patients receiving a vitrectomy undergo concurrent cataract surgery if they are older than 50 years of age to minimize the number of surgical procedures they will require and maximize their UCVA. IOL selection in this situation is challenging because these individuals are typically active members of the workforce who require crisp intermediate and near visual acuity. My colleagues and I therefore conducted a study to evaluate patient satisfaction when vitrectomy was combined with the implantation of an extended depth of focus (EDOF) IOL (AT LARA, Carl Zeiss Meditec).1 WHY AN EDOF IOL? Traditional multifocal IOLs are designed to provide better near visual acuity and greater spectacle independence than monofocal IOLs.2 Patients who receive multifocal IOLs, however, are more likely to experience glare, halos,2,3 and reduced contrast sensitivity.3 An EDOF lens was selected for our study because it can provide good intermediate visual acuity with fewer unwanted visual effects.4 Participants with more than mild corneal astigmatism received a toric model. Earlier research demonstrated high patient satisfaction with EDOF lenses.5,6 Our study is the first to gauge patient satisfaction with an EDOF IOL implanted following a vitrectomy. The study also explored whether unilateral or bilateral IOL status had an impact on quality of life. METHODOLOGY Patients who underwent a vitrectomy at the University Hospitals Leuven in Belgium from January 2019 to January 2022 were invited to participate in our study. In addition to patients with vision-threatening conditions such as retinal detachment (RD) and epiretinal membrane, the study enrolled a small number of individuals who elected to undergo a vitrectomy to remove floaters. Among patients with an RD, only those with macula-on detachments at the time of the procedure or those with macula-off detachment of less than 24 hours’ duration were included.

Sutureless Scleral Fixation of IOLS

Evaluating real-world outcomes.

Zachary Zavodni, MD

Cataract and Refractive Surgery Today

High Astigmatism and Amblyopia

What are the options for improving the vision of this young patient?

Pavel Stodulka, MD, PhD; Brett Mueller, DO, PhD; Stefanie Schmickler, MD; and Abi Tenen, MBBS(Hons), FRANZCO

Cataract and Refractive Surgery Today

OMDI as an Alternative to Prostaglandin Analogues in Low or Nonresponders

Joseph F. Panarelli, MD; and Neda Shamie, MD

Eyetube

Beyond DEWS II

An overview of the latest advances in dry eye disease management, treatment innovations, and insights into the condition’s pathophysiology since the landmark TFOS DEWS II report.

Quillan M. Austria, MD, and Christopher E. Starr, MD

Cataract and Refractive Surgery Today

The Metaverse in Ophthalmology?

A review of current and upcoming virtual reality simulators for microsurgical training.

Geoffrey Nguyen, MD, and Paul Kang, MD

Cataract and Refractive Surgery Today

04.25.2024

Bausch + Lomb Announces Results of Study Examining its New Daily Nutritional Supplement for Dry Eyes

Eyewire News

04.19.2024

BVI’s Podeye Hydrophobic Monofocal IOL Launched in Japan

Eyewire News

04.15.2024

Ocular Therapeutix Names Pravin U. Dugel, MD, President and CEO

Eyewire News

04.12.2024

Robotic Cataract Surgery Using ForSight Robotics’ Oryom Platform Presented for the First Time at ASCRS

Eyewire News

Refractive

IOL Dislocation After Penetrating Keratoplasty

Surgeons discuss how to proceed after dislocation of the IOL–capsular bag complex is observed in a patient’s better-seeing eye.

Audrey R. Talley Rostov, MD; Ashvin Agarwal, MS; Ehud Assia, MD; and Samuel Masket, MD

Cataract and Refractive Surgery Today

CASE PRESENTATION A 76-year-old patient presents with diplopia and blurry vision in the right eye. This eye underwent penetrating keratoplasty for advanced keratoconus 20 years ago, cataract surgery with the implantation of a toric IOL 4 years ago, and sutured recentration of the IOL 1 year ago. On examination, the patient’s UCVA is 20/200 OD, and their BCVA is -2.50 + 4.00 x 150º = 20/50 OD. The corneal transplant is clear. Superior dislocation of the IOL–capsular bag complex is observed (Figure 1). Residual cortex and anterior tilt of the lens are evident, and iris sutures are present at the 11 and 12 clock positions. Multiple iris transillumination defects are visible. An OCT scan of the macula is normal. Tomography reveals 5.00 D of astigmatism at 140º.

Foundations: The Journey of Neda Squared in Ophthalmology

Neda Shamie, MD; and Neda Nikpoor, MD

Eyetube

Beyond DEWS II

An overview of the latest advances in dry eye disease management, treatment innovations, and insights into the condition’s pathophysiology since the landmark TFOS DEWS II report.

Quillan M. Austria, MD, and Christopher E. Starr, MD

Cataract and Refractive Surgery Today

Effective Preoperative Assessment and Management of the Ocular Surface

Tips for optimizing the ocular surface and therefore surgical success.

Priya M. Mathews, MD, MPH

Cataract and Refractive Surgery Today

Dry Eye Diagnostics for Beginners

It is possible to start simply and expand offerings later.

Kenneth Beckman, MD, FACS

Cataract and Refractive Surgery Today

The Metaverse in Ophthalmology?

A review of current and upcoming virtual reality simulators for microsurgical training.

Geoffrey Nguyen, MD, and Paul Kang, MD

Cataract and Refractive Surgery Today

04.25.2024

Bausch + Lomb Announces Results of Study Examining its New Daily Nutritional Supplement for Dry Eyes

Eyewire News

04.15.2024

Ocular Therapeutix Names Pravin U. Dugel, MD, President and CEO

Eyewire News

04.11.2024

First Patient Enrolled in LYNX-2 Phase 3 Study Evaluating Phentolamine for the Treatment of Decreased VA Under Low Light Conditions Following Keratorefractive Surgery

Eyewire News

04.09.2024

Oasis Medical Introduces SOFT PLUG Extended Duration 180-T Tapered Plug

Eyewire News

Stay Updated

Retina

A Reference Guide for OCT Angiography

An illustrative overview of OCTA findings to help you implement this tool in common clinical scenarios.

Ivy Zhu, MD; Nicole L. Decker, BS; and Amani A. Fawzi, MD

Retina Today

AT A GLANCE OCT angiography (OCTA) has several advantages over traditional imaging techniques, including being noninvasive, depth resolved, and rapid. OCTA can distinguish the various vascular networks without obscuration by leakage, making it helpful for characterizing neovascularization and nonperfusion. OCTA is particularly useful in cases of type 1 neovascularization, where sub-retinal pigment epithelium neovascularization can develop without active exudation. En face OCTA and OCT B-scans are complementary and, together, can provide the clinician with a wealth of knowledge. There are several conditions for which OCTA can provide detailed information that would otherwise be time-consuming or impossible to find with traditional techniques. OCT angiography (OCTA) is a noninvasive imaging technique that uses the principles of motion detection to reveal depth-resolved images of the retinal and choroidal vasculature, down to the capillary level.1 OCTA has several advantages over traditional imaging techniques, including being noninvasive (no dye injection), depth resolved, and rapid. A key benefit of OCTA is its ability to distinguish the various vascular networks without obscuration by leakage, making it very helpful for characterizing retinal neovascularization and nonperfusion with precision beyond dye-based angiography. Here, we detail several clinical scenarios in which OCTA can be a useful diagnostic tool and illustrate key imaging features. In general, absence of flow (nonperfusion) is best appreciated with en face images. The presence of abnormal flow is most accurately detected using a combination of en face imaging assisted by the OCT B-scan with flow overlay to pinpoint abnormal flow related to structural pathological changes.

Capturing Geographic Atrophy with Multimodal Imaging

Noninvasive technologies are redefining how we diagnose and monitor atrophic AMD.

Eric H. Souied, MD; Oudy Semoun, MD; and Vittorio Capuano, MD

Retina Today

Managing Large Macular Holes: ILM Flap vs Peel

The literature continues to identify scenarios in which one technique is more effective than the other.

Kaitlyn Richards, BS, and Ankoor R. Shah, MD

Retina Today

The Importance of Serial OCT Scans in Tractional Retinal Detachment

Ahmed Abdelshafy, MD

Eyetube

Ocular Effects of CAR-T Cell Therapy

Know the risks and potential therapeutic benefits associated with this treatment modality.

Lars H. Andersen, MD; Jaskirat S. Takhar, MD; and Jose J. Echegaray, MD

Retina Today

Successful Management of Vitreous Opacities

Eyetube

04.25.2024

Bausch + Lomb Announces Results of Study Examining its New Daily Nutritional Supplement for Dry Eyes

Eyewire News

04.23.2024

New Ocular Telehealth Program Enables Diabetic Retinopathy Screening

Eyewire News

04.20.2024

Retina Community Mourns the Loss of Ramin Tadayoni, MD, PhD

Eyewire News

04.19.2024

Ocugen Completes Dosing in Phase 1/2 Trial of OCU410 for Geographic Atrophy

Eyewire News

Glaucoma

IOL Selection and Glaucoma

The effects of certain lenses on the disease and patients’ visual outcomes.

Luke Barnard, MD, and Christopher Teng, MD, MBA

Glaucoma Today

The Effect of Blue-Light Filtering Intraocular Lenses on the Development and Progression of Glaucoma Hecht I, Kanclerz P, Achiron A, Elbaz U, Tuuminen R1 Industry support: R.T., Advisory board and honoraria (Alcon, Allergan, Novartis) and clinical trial support (Bayer, Théa) ABSTRACT SUMMARY This retrospective cohort study assessed 11,208 patients’ (11,028 eyes) overall risk of developing glaucoma or requiring a glaucoma procedure after undergoing uneventful cataract surgery with the implantation of a blue light–filtering (BLF) or non-BLF IOL at a Finnish hospital between the years of 2007 and 2018. BLF IOLs (AcrySof model SN60WF, Alcon) were implanted in 5,188 eyes (47%), and non-BLF IOLs (Tecnis models ZA9003 and ZCB00, Johnson & Johnson Vision) were placed in 5,840 eyes (53%). STUDY IN BRIEF A large, retrospective cohort study evaluated patients’ glaucoma-free and glaucoma procedure–free survival rates after undergoing uneventful cataract surgery with the implantation of a blue light–filtering (BLF) or non-BLF IOL. Compared to patients who received a non-BLF lens, those who received a BLF IOL were 22% less likely to develop glaucoma and 38% less likely to require a glaucoma procedure. No significant differences were observed for any outcome, however, among patients who had preexisting glaucoma or were diagnosed with the disease within 12 months of cataract surgery. WHY IT MATTERS The study indicates that oxidative damage may play a role in the development of glaucoma. It also suggests that BLF IOLs may have a protective effect in patients who currently do not have glaucoma but are at increased risk of developing the disease. The main outcomes assessed were glaucoma-free survival and glaucoma procedure–free survival. Patients diagnosed with glaucoma before or within 12 months of cataract surgery were excluded from the primary outcome and analyzed separately for disease progression as a secondary outcome. Glaucoma-free survival rates demonstrated an advantage to the BLF IOL (P = .036).

Sulcus Placement of Glaucoma Drainage Device

Ahmed Samir, MD

Eyetube

The Glaucoma Tension

Arsham Sheybani, MD

Glaucoma Today

OMDI as an Alternative to Prostaglandin Analogues in Low or Nonresponders

Joseph F. Panarelli, MD; and Neda Shamie, MD

Eyetube

Screening and Establishing a Diagnosis With OCT

Closer consideration of nonglaucomatous conditions is warranted.

Sanjay Asrani, MD

Glaucoma Today

Is Glaucoma Policy Short-Sighted?

Redefining innovation to keep an eye on patient access.

Sara Riaz, MSc; Blake Oberfeld, MD; Hani El Helwe, MD; Henisk Falah, BS; and David Solá-Del Valle, MD

Glaucoma Today

04.25.2024

Bausch + Lomb Announces Results of Study Examining its New Daily Nutritional Supplement for Dry Eyes

Eyewire News

04.24.2024

LEP Biomedical Closes Pre-Seed Funding to Advance HyaGuard Platform

Eyewire News

04.15.2024

iHealthScreen Awarded US Patent on Glaucoma Detection Based on AI and Color Fundus Imaging

Eyewire News

04.15.2024

Ocular Therapeutix Names Pravin U. Dugel, MD, President and CEO

Eyewire News

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Optometry

Managing Keratoconus With Scleral Lenses

Advances in technology have driven significant improvements in patient care and outcomes.

Jason E. Compton, OD, FAAO

Modern Optometry

Scleral lenses have become a cornerstone in the management of keratoconus. They now offer a new approach to a condition that has been traditionally challenging to correct with other optical solutions. These lenses, characterized by their large diameter that vaults over the cornea and rests on the sclera to create a smooth optical surface that effectively mitigates corneal irregularities, have experienced significant evolution in both design and application to enhance the visual acuity of patients with keratoconus.1 Studies have demonstrated that scleral lenses provide patients a markedly improved mean logMAR visual acuity compared with traditional glasses and rigid gas permeable lenses.2 This advancement has not only broadened the scope of visual rehabilitation for patients with keratoconus, but has also paved the way for more practitioners to get involved in their care. ADVANCES IN SCLERAL LENS TECHNOLOGY Over the past decade, scleral lens technology has undergone transformative improvements in design, material, manufacturing technology, and fit, which has significantly affected the treatment of keratoconus. These advances are not just incremental; they represent a paradigm shift in how scleral lenses are used to enhance patient outcomes. Design Recent innovations in scleral lens design have been driven by a deeper understanding of the optical and physiological challenges of managing keratoconus. For instance, the introduction of customizable front-surface eccentricity and toricity directly addresses the unique higher-order aberrations seen in keratoconus.3,4 Other design advances involve better alignment with the ocular shape, including sector-specific and purely custom zones. Practitioners can now accommodate the most extreme variations in landing zones, improving comfort and stability without compromising corneal integrity.5 Material The evolution of scleral lens materials from PMMA to silicone hydrogel represents a leap forward for corneal health. Hyper Dk materials mark another significant advance, offering unparalleled oxygen permeability to promote corneal health in our patients with keratoconus, reduce the risk of corneal edema, and support extended wear times without compromising comfort or vision.6,7 Manufacturing The adoption of computer-assisted design and manufacturing technologies has ushered in a new era of precision in scleral lens production. These technologies allow the fabrication of lenses that are custom-molded to the wearer’s unique ocular surface topography, offering an unprecedented level of fit customization.

Talking About Practice

Marc R. Bloomenstein, OD, FAAO

Eyetube

The State of Optometry’s Financial Health

Five takeaways from the largest income survey conducted in optometry.

Aaron Neufeld, OD

Modern Optometry

The Importance of Increasing OD-to-OD Referrals

And some tips on how to do so.

Jason Besecker, OD, MS

Modern Optometry

Realize the Power of Comanagement

Build community with your local providers to ensure your patients receive the best possible care.

Jeff Banas, OD

Modern Optometry

A Place for House Calls in Optometry

Consider delivering eye care where it’s needed most.

Damaris Raymondi, OD, FAAO

Modern Optometry

04.25.2024

World Council of Optometry and CooperVision Partner on Myopia Management Navigator Educational Resource

Eyewire News

04.23.2024

DigitalOptometrics Surpasses 2 Million Remote Eye Exams

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04.10.2024

Orbis Partners and Heidelberg Engineering Partner to Train Eye Care Professionals Around the World

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04.09.2024

Oasis Medical Introduces SOFT PLUG Extended Duration 180-T Tapered Plug

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Business

Determining When to Use Modifiers -58 and -78

Both are used in association with the original surgery, but ultimately serve different purposes.

Joy Woodke, COE, OCS, OCSR

Retina Today

When retina procedures are performed during the global period of a surgery, an appropriate modifier must be appended to the CPT code for reimbursement. When an unrelated procedure is performed postoperatively in the fellow eye, for example, modifier -79 is used. However, when the surgery is related to the original procedure, either modifier -58 or -78 should be considered. DEFINITIONS When considering which modifier is appropriate for a related procedure, clinicians should carefully review the definitions of modifiers -58 and -78. Modifier -58 is defined as a staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period and has three definitions for use: 1. Planned or anticipated (staged) 2. More extensive than the original procedure 3. Therapy following a surgical procedure Modifier -78 is used for a related but unanticipated return to the OR or office procedure room by the same physician or other qualified health care professional during the postoperative period of the initial procedure. Reporting modifier -58 will initiate a new global period for the CPT code reported. Modifier -78, on the other hand, does not prompt a new postoperative period, and the original global period remains.

Shielding Your Wealth From Potential Liability

The basics of a solid asset protection plan.

David B. Mandell, JD, MBA

Modern Optometry

The Good Life

Selina R. McGee, OD, FAAO; Justin Schweitzer, OD, FAAO; and Walter O. Whitley, OD, MBA, FAAO

Modern Optometry

Comparing AI-Generated Answers to Patients’ Eye Care Questions With Ophthalmologists’ Responses

Robert T. Chang, MD; and Neda Shamie, MD

Eyetube

5 Steps to Building Financial Security

Planning for the future can feel overwhelming. Here’s how to make it simpler.

Christopher Lopez, OD

Modern Optometry

Why You Should Hire an Associate OD

Welcoming another eye care practitioner to your practice can accelerate practice growth and expand your range of services offered.

Christopher Lopez, OD

Modern Optometry

04.24.2024

LEP Biomedical Closes Pre-Seed Funding to Advance HyaGuard Platform

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04.16.2024

Regeneron Backs $500 Million Venture Capital Fund for Biotechnology Innovation

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04.16.2024

EyeSouth Partners Affiliates With Community Eye Care Specialists in New York

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04.15.2024

Ocular Therapeutix Names Pravin U. Dugel, MD, President and CEO

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Executive Updates

Johnson & Johnson Vision

Zeiss

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World Council of Optometry and CooperVision Partner on Myopia Management Navigator Educational Resource

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LEP Biomedical Closes Pre-Seed Funding to Advance HyaGuard Platform

Stocks

Cataract

Combining Vitreoretinal Surgery With EDOF IOL Implantation

Sutureless Scleral Fixation of IOLS

High Astigmatism and Amblyopia

OMDI as an Alternative to Prostaglandin Analogues in Low or Nonresponders

Beyond DEWS II

The Metaverse in Ophthalmology?

04.25.2024

Bausch + Lomb Announces Results of Study Examining its New Daily Nutritional Supplement for Dry Eyes

04.19.2024

BVI’s Podeye Hydrophobic Monofocal IOL Launched in Japan

04.15.2024

Ocular Therapeutix Names Pravin U. Dugel, MD, President and CEO

04.12.2024

Robotic Cataract Surgery Using ForSight Robotics’ Oryom Platform Presented for the First Time at ASCRS

Refractive

IOL Dislocation After Penetrating Keratoplasty

Foundations: The Journey of Neda Squared in Ophthalmology

Beyond DEWS II

Effective Preoperative Assessment and Management of the Ocular Surface

Dry Eye Diagnostics for Beginners

The Metaverse in Ophthalmology?

04.25.2024

Bausch + Lomb Announces Results of Study Examining its New Daily Nutritional Supplement for Dry Eyes

04.15.2024

Ocular Therapeutix Names Pravin U. Dugel, MD, President and CEO

04.11.2024

First Patient Enrolled in LYNX-2 Phase 3 Study Evaluating Phentolamine for the Treatment of Decreased VA Under Low Light Conditions Following Keratorefractive Surgery

04.09.2024

Oasis Medical Introduces SOFT PLUG Extended Duration 180-T Tapered Plug

Stay Updated

Follow Eyewire News

Retina

A Reference Guide for OCT Angiography

Capturing Geographic Atrophy with Multimodal Imaging

Managing Large Macular Holes: ILM Flap vs Peel

The Importance of Serial OCT Scans in Tractional Retinal Detachment

Ocular Effects of CAR-T Cell Therapy

Successful Management of Vitreous Opacities

04.25.2024

Bausch + Lomb Announces Results of Study Examining its New Daily Nutritional Supplement for Dry Eyes

04.23.2024

New Ocular Telehealth Program Enables Diabetic Retinopathy Screening

04.20.2024

Retina Community Mourns the Loss of Ramin Tadayoni, MD, PhD

04.19.2024

Ocugen Completes Dosing in Phase 1/2 Trial of OCU410 for Geographic Atrophy

Glaucoma

IOL Selection and Glaucoma

Sulcus Placement of Glaucoma Drainage Device

The Glaucoma Tension

OMDI as an Alternative to Prostaglandin Analogues in Low or Nonresponders

Screening and Establishing a Diagnosis With OCT

Is Glaucoma Policy Short-Sighted?

04.25.2024

Bausch + Lomb Announces Results of Study Examining its New Daily Nutritional Supplement for Dry Eyes

04.24.2024

LEP Biomedical Closes Pre-Seed Funding to Advance HyaGuard Platform

04.15.2024

iHealthScreen Awarded US Patent on Glaucoma Detection Based on AI and Color Fundus Imaging

04.15.2024

Ocular Therapeutix Names Pravin U. Dugel, MD, President and CEO

Featured Podcasts

Ophthalmology off the Grid