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Read PDF Edition PHACO: KNOW YOUR FLUIDICS OPTIONS P. 16 • MEDICARE UPDATES FOR 2017 P. 23 SECRETS FOR MANAGING GLAUCOMA WITH OCT P. 50 • A REVIEW OF PORTABLE RETINAL IMAGING P. 60 Review of Ophthalmology Vol. XXIV, No. 2 • February 2017 • Cataract and Refractive Issue • Toric IOL Alignment • 2017 • Cataract and Refractive Issue Toric No. 2 • February Review of Ophthalmology Vol. XXIV, A NEW DAY DAWNS FOR DRY-EYE THERAPY P. 64 • WILLS EYE RESIDENT CASE STUDY P. 71 JanuaryJanuary 20172017 reviewofophthalmology.comreviewofophthalmology.com CATARACT REFRACTIVE ISSUE Surgeons share their best tips SMILE T SMILE and techniques for helping you ips • Multifocal IOLs in Post-refractive Eyes ips • Multifocal IOLs in Post-refractive improve your outcomes. Toric IOLs: Nailing the Target Meridian P. 26 Tips for a Better SMILE P. 34 Odd Couple: Multifocals in Post-refractive Patients P. 40 001_rp0217_fc.indd 1 1/20/17 12:15 PM 66 EXTENDED RANGE OF VISION MONOFOCAL-LIKE DISTANCE Raise your expectations. Deliver theirs. Now you can give your patients the best of both worlds with the ȴUVWDQGRQO\K\EULGGHVLJQHG PRQRIRFDOPXOWLIRFDOΖ2/ AcrySof®IQ ReSTOR® +2.5 PRESBYOPIA-CORRECTING IOL 6HHDGMDFHQWSDJHIRUΖPSRUWDQW3URGXFWΖQIRUPDWLRQ © 2016 Novartis 10/16 US-RES-16-E-4014 RRP0217_AlconP0217_Alcon AAcrysofcrysof RRestor.inddestor.indd 1 11/9/17/9/17 22:57:57 PPMM IMPORTANT PRODUCT INFORMATION FOR THE ACRYSOF® IQ RESTOR® FAMILY OF IOLs CAUTION: Federal (USA) law restricts this Left your Review device to the sale by or on the order of a physician. INDICATIONS: The AcrySof® IQ ReSTOR® Posterior Chamber Intraocular Lens (IOL) of Ophthalmology is intended for primary implantation for the visual correction of aphakia secondary to removal of a cataractous lens in adult patients with and without presbyopia, who magazine at the offi ce? desire near, intermediate and distance vision with increased spectacle indepen- dence. The lens is intended to be placed in the capsular bag. No problem! WARNINGS/PRECAUTIONS: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Physicians should target emmetropia, and ensure that IOL centra- tion is achieved. Care should be taken to remove viscoelastic from the eye at the close of surgery. Some patients may experience visual dis- turbances and/or discomfort due to multi- focality, especially under dim light condi- tions. As with other multifocal IOLs, visual symptoms may be significant enough that the patient will request explant of the mul- tifocal IOL. Spectacle independence rates vary with all multifocal IOLs; as such, some patients may need glasses when reading small print or looking at small objects. Clinical studies with the AcrySof® ReSTOR® lens indicated that posterior capsule opaci- fication (PCO), when present, developed earlier into clinically significant PCO. Prior to surgery, physicians should provide pro- spective patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and benefits associated with the AcrySof® IQ ReSTOR® IOLs. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® Natural IOL and normal color vision. The effect on vision of the AcrySof® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glauco- ma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile Read Review on the go irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solutions. from any mobile device! ATTENTION: Reference the Direc- tions for Use labeling for a complete listing of indications, warnings and precautions. Go to www.reviewofophthalmology.com and click on the digimag link to get your current issue. © 2016 Novartis 10/16 US-RES-16-E-4014 003_rp0217_houseads.indd 3 1/18/17 4:32 PM REVIEW NEWS Volume XXIV • No. 2 • February 2017 Lucentis Approved for Myopic Choroidal Neovascularization Genentech (South San Francisco, Calif.), ity stabilization guidelines. Group II confi rms my personal experience, and part of Roche (Basel, Switzerland), received Lucentis 0.5 mg injection on the collective experience of retina announced in January that Lucentis day one of the study and as needed specialists, that PDT is vastly inferior (ranibizumab injection) was ap proved thereafter per disease-activity crite- to Lucentis 0.5 mg for the treatment by the Food and Drug Administration ria. Group III received vPDT on day of myopic CNV.” Dr. Wells adds that for the treatment of myopic choroidal one, but were permitted treatment the upswing in ETDRS letters gained neovascularization, a sight-threatening with Lucentis and/or vPDT based by the PDT group once Lucentis was complication of high myopia. MCNV upon disease activity, at investiga- allowed after three months is also im- affects more than 41,000 people in the tors’ discretion, from months three portant in illustrating “that PDT is not United States.1 through 11. Groups I and II showed a good option for myopic CNV if anti- Myopic choroidal neovasculariza- dramatic gains in mean average best- VEGF therapy is available.” tion is a complication of high myopia corrected vision as measured by ET- 1. Willis JR, Vitale S, Morse L et al. The prevalence of (eyes with a refractive error of -6 D or DRS letters at three months (10.5 myopic choroidal neovascularization in the United States. greater, and/or axial length of 26.5 mm and 10.6, respectively), compared to Ophthalmology 2016;123:8:1771-1782. 1 2. Adatia FA, Luong M, Munro M, Tufail A. The other CNVM: A or more) in which the eye progres- Group III (2.2 letters gained). Mean review of myopic choroidal neovascularization treatment in the sively lengthens from front to back BCVA gains from baseline to month age of anti-vascular endothelial growth factor agents. Survey of Ophthalmol, 2015;60:3:204-15. and degenerates, and neovasculariza- 12 were 13.8 letters for Group I: 14.4 3. RADIANCE: A randomized controlled study of ranibizumab tion develops. The condition is most for Group II; and, 9.3 for Group III, in patients with choroidal neovascularization secondary to prevalent in people ages 45 to 64.1 who were able to get Lucentis injec- pathologic myopia. Ophthalmology 2014:121;3;682–692. Until this approval for mCNV, the tions after three months. The results FDA-approved standard of care for show that treatment with Lucentis on mCNV has been verteporfi n photody- either schedule I or II resulted in ReSTOR Toric namic therapy, although anti-VEGF dramatic early gains, and gains injections were previously used off in BCVA continued throughout MF: New label and recommended as fi rst-line the study period. Group I patients treatments.2 Lucentis inhibits choroi- received a median of four injections Options And dal neovascularization by binding to over 12 months; Groups II and and interfering with the vascular en- III underwent a median of Challenges dothelial growth factor VEGF-A, the two. There were no ad- As Alcon begins its protein implicated in the formation of verse safety events. scheduled fi rst-quarter incompetent blood vessels. “I think that having an rollout of the new Re- The fi ndings of the RADIANCE FDA approval for Lu- STOR +3 D Multifocal study form the basis of Genentech’s centis benefi ts patients Toric intraocular lens, approval.3 This Phase III, 12-month, and supports reimburse- which was approved in randomized, active-controlled study ment from payers, as late December of 2016, sur- enrolled mCNV patients from 76 it is clearly superior to geons are understandably inter- centers worldwide. They were ran- the other FDA-approved ested in giving their patients a new domized into three treatment groups: treatment, PDT,” says John alternative for vision correction Group I received Lucentis 0.5 mg A. Wells, III, MD, of the Pal- post-cataract, but say it’s best to injection on day one, month one and metto Retina Center in West Co- thereafter as needed per visual acu- lumbia, S.C. “The RADIANCE study (Continued on page 8) 4 | Review of Ophthalmology | February 2017 004_rp0217_news.indd 4 1/20/17 4:20 PM ® E DITORIAL STAFF Editor in Chief Walter C. Bethke (610) 492-1024 [email protected] Dell* Toric Axis Markers Precise Alignment For Correct Toric Axis Placement, From Upright Through The Supine Position. Senior Editor Christopher Kent (814) 861-5559 [email protected] Senior Associate Editor Kristine Brennan (610) 492-1008 [email protected] 8-12119: Dell Fixed Toric Lens Marker With Rotating Bezel Used When Patient Is In Supine Position Associate Editor Liam Jordan (610) 492-1025 [email protected] Chief Medical Editor Mark H. Blecher, MD Art Director Dell Swivel Toric Lens Marker 8-12120: Jared Araujo With Rotating Bezel Used When Patient Is In Upright Position (610) 492-1032 [email protected] 8-12119: Rotating Inner Bezel Automatically Orients Marks For The Placement Of A Toric Senior Graphic Designer IOL In The Correct Meridian. While The Patient Matt Egger Is Upright, An Orientation Mark Is Placed Vertically On The Conjunctiva. In Surgery The Rotating Inner (610) 492-1029 Bezel Is Set To The Desired Meridian. While The Instrument Is Positioned [email protected] So That The Vertical Conjunctival Mark Is Aligned With The 90 Degree Position On The Outer Bezel Of The Marker. The Marking Blades On The Undersurface Of The Instrument Will Automatically Place A Mark In The Correct Meridian When International coordinator, Japan The Cornea Is Indented. Mitz Kaminuma [email protected] 8-12120: Weighted So That Correct Horizontal Orientation Is Assured.
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