RUBBING SILICONE CONTACT LENS MORE EFFECTIVE THAN SOAKING ALONE

Contact Lens and Anterior EyeVolume 32, Issue 2, April 2009, Pages 73-77

"The findings of this study demonstrate that the use of a manual rubbing step is more effective than rinsing or soaking alone in removing pathogenic microbes from silicone hydrogel lenses. Accordingly, it would seem prudent to recommend that contact lens care systems include a rub step as part of the hygiene regimen."

DECREASED RUBBING USING HABIT REVERSAL CAN DECREASE RISK FOR ECTASIA

Contact Lens and Anterior EyeVolume 32, Issue 2, April 2009, Pages 55-63

"Successful habit reversal may slow the rate of ectasia progression. Prophylactic application of the methods described for patients who are at risk for developing keratoconus, or post-laser assisted in situ keratomileusis keratectasia, may show that some forms of keratectasia are preventable."

STERILE KERATITIS RISK FACTORS

OphthalmologyVolume 116, Issue 3, March 2009, Pages 385-392

Compared with planned replacement soft CL, daily disposable lenses significantly reduced the risk of toxic/hypersensitivity, but the most commonly used brand was associated with increased risks of sterile keratitis, mechanical disorders, and a tendency for patients to have lens removal difficulties. Silicone hydrogel CL wear was free from hypoxic complications but associated with an increased risk of sterile keratitis, mechanical disorders, and attendance with any nonulcerative complication when compared with other reusable soft lenses. Significant additional risk factors were identified for sterile keratitis (overnight wear, more days per week of lens wear, poor hand hygiene, smoking, and less contact lens experience).

Conclusions
Neither of the 2 recently introduced CL modalities—daily disposable and silicone hydrogel lenses—reduced the overall risk of acute nonulcerative disorders.

CONTACT LENSES DECREASE FUNCTIONALITY OF MEIBOMIAN GLANDS OVER TIME

OphthalmologyVolume 116, Issue 3, March 2009, Pages 379-384

This study concluded:

Contact lens wear is associated with a decrease in the number of functional
meibomian glands. This decrease is proportional to the duration of CL
wear.

ARTICLE ON POST-CATARACT EYEWEAR REIMBURSEMENT

Review of Ophthalmology

This article reviews the process of getting reimbursed from Medicare for post-surgical glasses.

MELATONIN DECREASES ANXIETY, PAIN, AND IOP DURING CATARACT SURGERY

Melatonin Provides Anxiolysis, Enhances Analgesia, Decreases Intraocular Pressure, and Promotes Better Operating Conditions During Cataract Surgery Under Topical Anesthesia -- Ismail and Mowafi 108 (4): 1146 -- Anesthesia & Analgesia

A 10mg tablet of Melatonin significantly reduced the anxiety scores. Perioperative verbal pain scores were significantly lower in the melatonin group with less intraoperative fentanyl requirement. Melatonin also decreased IOP (mean ± sd) significantly from 17.9 ± 0.9 to 14.2 ± 1.0 mm Hg after premedication

CONCLUSION: We concluded that oral melatonin premedication for patients undergoing cataract surgery under topical anesthesia provided anxiolytic effects, enhanced analgesia, and decreased IOP resulting in good operating conditions.

DIABETIC CYSTOID MACULAR EDEMA

Eye World, 03/18/09

In a study published in the September 2008 issue of Ophthalmology, results indicate that over a two-year span, for most patients, laser photocoagulation is more effective with fewer side effects than steroid treatment. Also, very few doctors are injecting Avastin for diabetic macular edema because you’d almost have to do it monthly and that’s a pretty hard sell.

USING COLOR VISION TESTING TO EVALUATE GLAUCOMA

Journal of Clinical Ophthalmology - Dove Medical Press:

"Quantitative analysis of color vision defects provides the possibility of follow-up and can prove a useful means for detecting early glaucomatous changes in patients with normal visual fields."

LASIK RESULTS 7 YEAR POST-OP

Postoperatively, best corrected visual acuity was obtained at 2 months, 2 years, and at last follow-up, respectively. Spherical equivalent was within 0.50 diopters (roughly 20/25-20/30 vision) in 75% of patients at 2 months, 63% at 2 years, and 42% at 7 to 8 years. Mean spherical equivalent was about -0.50 at 2 years and -1.37 diopters (roughly 20/40ish) at 7-8 years. Patient satisfaction was high—100% of patients would have LASIK again.

LASIK outcomes tend to shift toward undercorrection over time. Postoperative ectasia was not noted 7 to 8 years after LASIK. All patients were satisfied with the postoperative results although emmetropia was not reached. [J Refract Surg. 2009;25:312-318.]

With this information, it may be worth it to overcorrect a patient about -0.50 to -0.75 D originally to accommodate for this shift. However, more studies should confirm these findings.

Optometry and Vision Science - Abstract: Volume 86(3) March 2009 p 251-259 Care Regimen and Lens Material Influence on Silicone Hydrogel Contact Lens Deposition.

Optometry and Vision Science - Abstract: Volume 86(3) March 2009 p 251-259 Care Regimen and Lens Material Influence on Silicone Hydrogel Contact Lens Deposition.:

"Among all lenses tested, Balafilcon A lenses exhibited greatest extracted cholesterol (4.1 to 8.2 μg/lens) and total protein (5.4 to 23.2 μg/lens). AQuify was the most effective solution in reducing extracted deposits, especially extracted protein, from Balafilcon A lenses. AQuify and Opti-Free RepleniSH solutions were most effective in reducing extracted cholesterol from Senofilcon A and Galyfilcon A lenses, respectively. Use of Opti-Free Express solution resulted in more extracted protein from Lotrafilcon B lenses than use of other solutions. Generally, Night & Day, Senofilcon A, and Galyfilcon A lenses accumulated relatively low amount of proteins. on Night & Day lenses accumulated the least amount of cholesterol deposit among all lenses tested regardless of solution used."

ANY NECK PROCEDURE CAN LEAD TO HORNER SYNDROME

Ophthalmic Plastic and Reconstructive Surgery - Abstract: Volume 25(1) January/February 2009 p 16-18 Neck Procedures Resulting in Horner Syndrome.:


"Physicians should be aware that procedures involving the neck, even relatively minor ones, may be a cause of Horner syndrome. In the evaluation of patients with newly diagnosed Horner syndrome, it is important to obtain the history of prior surgeries or procedures involving the neck that may identify a cause of sympathetic denervation and etiology of Horner syndrome."

FABRY DISEASE MAY CAUSE CHRONIC CHEMOSIS

Cornea - Abstract: Volume 28(2) February 2009 p 224-227 Fabry Disease and Chemosis.:

"Although the pathology of chronic chemosis in patients with Fabry's Disease is as yet unknown, we believe that Fabry Disease should be considered in the differential diagnosis of patients presenting with chronic chemosis of unknown etiology."

ACUITY LOSS AFTER AVASTIN INJECTION FOR DIABETIC MACULAR EDEMA

Acute Visual Acuity Loss Following Intravitreal Bevacizumab for Diabetic Macular Edema

This is the case of a woman who suffered foveal ischemia following Avastin injection for diabetic macular edema. EVenthough Avastin has had significant benefits for patients with macular degeneration and diabetic retinopathy, there are risks involved that should be considered.

AMBLYOPIA TREATMENT 1998 VS. 2004

Amblyopia Treatment: 1998 Versus 2004:

"Atropine would have been offered in 2004 as an alternative to patching in 1998, and in five of the seven scenarios the combination of simultaneous atropine and patching would have been prescribed. In six of the seven scenarios, some type of nonspecific near work would now be prescribed as an adjunct treatment."

REVIEW OF PRESBYOPIC INTRAOCULAR LENSES

Review of Ophthalmology

Some of the points from this article:

*A patient with normal sized pupils or vocational requirements that might limit them should have the Rezoom in the first eye (dominant eye). If the patient needs more help for near, then put the ReStor in the second eye (non-dominant eye)

* People with very large or small pupils with vocational requirements should go with the Crystalens HD in the first eye (dominant eye) and a Crystalens for monovision or Restor in the non-dominant eye.
People who are emmetropic or slightly myopic are difficult to make happy.