meeting round-up
Highlighting ASCRS Lectures
Complied by the Ophthalmology Management Staff

This year's ASCRS meeting held in San Francisco offered numerous lectures unveiling researchers' latest findings. Subjects such as multifocals, surface ablation, minimizing IOP fluctuation, and visual acuity measurements were all subjects of discussion and debate at the meeting.

The following topics are a few that were awarded "Best Paper of Session:"

►Long-Lasting Therapy for Glaucoma Caused by Intravitreal Triamcinolone Acetonide: Anterior Juxtascleral Depot of Anecortave Acetate. It has been established that intravitreal triamcinolone (IVT) injections create a risk of increased IOP. Based on evidence that anecortave acetate (AA) minimizes steroid-related IOP elevations in rabbits and humans, Alan L. Robin, M.D., and his co-authors gave a single inferior sub-Tenon's injection of 24 mg AA to 4 eyes of 3 patients with glaucoma due to IVT injections, 3.75±0.96. Participants were on an average of 3 to 5 glaucoma medications. Participants pre-treatment IOP was 41.3±10.8 mmHg. As a result, the IOP decreased 47.6%± 6% lasting 6 months, and avoided glaucoma surgery in 75% of the eyes, without adverse events. Although one eye had a 45% decrease in IOP, filtration surgery was needed. The authors concluded a Sub-Tenon's AA injection may be a novel valuable adjunct in minimizing the risk of IOP elevations associated with intravitreal triamcinolone.

►New and Functional Near-Vision Assessment Test. David T. Vroman, M.D., and colleagues reported how current vision acuity charts do not measure distance or near functional vision well for patients with presbyopic IOLs. He and colleagues developed the newspaper (NP) reading test, which was to assess patient's functional vision while doing a common activity, reading the newspaper. With the help of one local newspaper, the researchers were able to come up with a 100-word test using a font similar to a newspaper and using 8 font sizes.

Dr. Vroman concludes that today's functional vision tests are not adequate for determining what the best technologies are for correcting near vision. He says reading acuity and speed-reading tests might be helpful guides for evaluating IOLs utilized for treating presbyopia. 

►Intracorneal Lens to Treat Presbyopia. Arturo S. Chayet, M.D., presented data on the implantation of the 1.5 mm PresbyLens corneal inlay concurrent with LASIK for hyperopic presbyopia. Eight patients received LASIK targeted for plano in both eyes, with the PresbyLens placed into the non-dominant eye. In the patients' eyes which had LASIK performed only, these eyes had a mean pre-op MRSE of -3.14 D, and their fellow eyes, which had the PresbyLens implanted and LASIK performed had a mean preop MRSE of -3.29 D.

As expected with patients with presbyopia, treating their myopia with the excimer decreased their UCNVA in the LASIK-only eye, but expectations were that patients would maintain or increase the UCNVA in the eye that had LASIK performed and the PresbyLens implanted. However, Dr. Chayet reported these patients' eyes improved in near and had a greater improvement in intermediate vision than the patients who had only LASIK performed in their eye.

►Correlation of Visual Acuity with Corneal Thickness and Donor Contour After Descemet's Stripping with Endothelial Keratoplasty. To identify factors significantly associated with visual acuity 6 months post-DSEK, Francis W. Price Jr. M.D., and Marianne O. Price, Ph.D., performed a retrospective multivariate analysis on 270 eyes.

The factor most significantly correlated with postoperative visual outcomes was presence of preoperative retinal or amblyopia problems in the treated eye (P<.0001). Younger age was also highly correlated with better postoperative visual acuity, even after excluding eyes with pre-existing retinal or amblyopia problems (P=.001). Anterior stromal scarring may also degrade postoperative visual acuity, as suggested by the degree of light-
scattering observed with confocal microscopy. Surprisingly, total corneal thickness was not correlated with postop visual acuity (P=.75).

Dr. Price says that his research shows younger patients have better visual outcomes after DSEK. "Whereas patients used to postpone PK as long as possible, DSEK has shifted the risk-benefit ratio so that now earlier treatment is preferable," he says.