Eyeworld CME Supplements

EW MAR 2015 - Supported by an unrestricted educational grant from Alcon

This is a supplement to EyeWorld Magazine that doctors can take a test after reading and receive CME credits for.

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by Bonnie An Henderson, MD The true impact of inflammation Accreditation Statement This activity has been planned and implemented in accordance with the Essential Areas and pol- icies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract & Refractive Surgery (ASCRS) and EyeWorld. ASCRS is accredited by the ACCME to provide continuing medical education for physicians. Educational Objectives Ophthalmologists who participate in this course will: • Distinguish predisposing factors putting patients at higher risk for inflammatory reaction after cataract surgery, including re- view of key uveitis, retina, and corneal issues; • Identify the true impact of ocular inflamma- tion levels on outcomes in refractive cataract surgery: (a) variability in visual acuity and quality results, (b) delayed visual recovery that reduces the postoperative "wow" factor, and (c) pain and discomfort that reduce patient satisfaction; • Acquire strategies to eliminate inflammation and relieve pain by maximizing the penetra- tion of anti-inflammatory agents into target issues; • Develop key adjustments to perioperative therapeutic strategies for preventing inflammation specific to those with predis- posing factors and in routine cases without predisposing factors; and • Assess the clinical impact of various levels of ultrasound energy applied during cataract surgery and the amount of reduction in these levels available with laser cataract technology for specific types of patients. Designation Statement The American Society of Cataract & Refractive Surgery designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credits.™ Physicians should claim only credit commensu- rate with the extent of their participation in the activity. Claiming Credit To claim credit, participants must visit bit.ly/1E5Dhsp to review content and download the post-activity test and credit claim. All participants must pass the post-activity test with a score of 75% or higher to earn credit. Alternatively, the post-test form included in this supplement may be faxed to the number indicat- ed for credit to be awarded, and a certificate will be mailed within 2 weeks. When viewing online or downloading the material, standard Internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through October 31, 2015. CME credit will not be awarded after that date. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses only. ADA/Special Accommodations ASCRS and EyeWorld fully comply with the legal requirements of the Americans with Disabilities Act (ADA) and the rules and regulations thereof. Any participant in this educational program who requires special accommodations or services should contact Laura Johnson at ljohnson@ ascrs.org or 703-591-2220. Financial Interest Disclosures Bonnie An Henderson, MD, has received a retainer, ad hoc fees, or other consulting income and travel expense reimbursement from Alcon Laboratories and Bausch + Lomb. Dr. Henderson has received research funding from Bausch + Lomb. David A. Goldman, MD, has received a retainer, ad hoc fees, or other consulting income from: Alcon Laboratories, Allergan, Bausch + Lomb, Compare Networks Inc., Modernizing Medicine, and SARcode Bioscience. He is a member of the speakers bureau of: Alcon Laboratories, Allergan, and Bausch + Lomb. Dr. Goldman has received research funding from Bausch + Lomb. He is a part-time employee of and has an investment in- terest in Modernizing Medicine. Dr. Goldman has an investment interest in SARcode Bioscience. Stephen V. Scoper, MD, has received a retainer, ad hoc fees, or other consulting income from Alcon Laboratories. Elizabeth Yeu, MD, has received a retainer, ad hoc fees, or other consulting income from: Abbott Medical Optics, Alcon Laboratories, Allergan, Bausch + Lomb, BioTissue, Nicox, Rapid Patho- gen Screening, TearLab Corp, and TearScience. She is a member of the speakers bureau of Abbott Medical Optics and has an investment interest in Rapid Pathogen Screening. Staff coordinators Jan Beiting, Brad Fundingsland, and Laura Johnson have no ophthalmic-related financial interests to disclose. Femtosecond laser and pharmaceutical strategies for eliminating post-surgical inflammation in refractive cataract surgery Supplement to EyeWorld April 2015 Supported by an unrestricted educational grant from Alcon dissatisfied with her vision and still complained about itchy FBS. Eventually her edema resolved, but during those 2 months, I had a very unsatisfied patient. Most patients with corneal edema do not have pre-existing conditions; the placebo arm of a postop steroid trial noted meaningful corneal edema can be seen throughout the first postop month (dropping from 0.6 at day 3–4 to 0.3 at day 28). 1 See Figure 1. In fact, the incidence of post-cataract cystoid macular edema (CME) is 1–2%, but there is a higher incidence of angiograph- ic CME. 2 There is a significant impact on both the short- and long-term visual acuity, on cost of care, and on patient satisfaction for a patient who has developed CME postoperatively. See Figure 2 for an example of an eye that developed CME 30 years after extracapsular cataract extraction. P ostoperative pain and inflammation is not un- usual after cataract sur- gery, and U.S. surgeons typically expect greater than 1+ cell and flare during the first postop week. 1 In general, about half of U.S. surgeons be- lieve visual recovery and patient comfort/satisfaction are signifi- cantly impacted by 1+ cell/flare. Of course, inflammation is associated with cystoid macular edema, and U.S. surgeons tend to use steroids and nonsteroidals more than non-U.S. surgeons. 1 But how does that translate in the real world settings? Take an example of a hyperope with narrow angles and a short axial length, with a history of laser peripheral iridotomy bilaterally. On postop day 1 after uneventful cataract surgery, the patient was dissatisfied with her outcome. She complained about foreign body sensation (FBS), and uncorrected vision was 20/200. By week 1, vision had improved to 20/80, but she was (understandably) still Figure 1. Mean corneal edema scores when no anti-inflammatory therapy has been prescribed continued on page 3 Bonnie An Henderson, MD

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