Practical Pearls

A Handy Guide to the Best Take-Home Tips in the June 2009 Issue of Ophthalmology MANAGEMENT

A practice can actually benefit from these difficult financial times due to the increased buying power with vendors. Like the automakers, most equipment manufacturers are motivated to move product now………Find it!

DSEK maintains the preoperative shape of the cornea without inducing astigmatism, putting an end to what one surgeon calls "the wildly unpredictable" induced astigmatism of up to 12 D that often accompanies PKP………Find it!

Intraoperative flap thickness measurement via OCT gives the surgeon more confidence in residual stromal bed thickness, for both primary LASIK and enhancement, and can help prevent postop complications………Find it!

Vertical gas breakthrough is the most significant current challenge with femtosecond laser flap creation. While uncommon, it tends to occur when surgeons try to make the flap too thin. To avoid it, do not make the flap thinner than 100-110 μm………Find it!

Endothelial cell loss after DLEK seems to plateau at 5 years at 60% for 9.0 mm incisions and 72% for 5.0 mm incisions. Endothelial cell loss after DSAEK plateaus between 12 to 24 months at 32%, based on data from patients followed for 2 years………Find it!

DMEK requires working with very thin and flimsy tissue that rolls into a scroll. The tissue is difficult to harvest and surgeons often have to deal with tissue lost………Find it!

Ultraviolet technology could be an alternative to infrared violet laser for LASIK flap creation. A study showed its ability to create flaps with a 6 mm diameter and thickness of 100 μm in <2 minutes with low-energy pulses………Find it!

Even with all of DSEK's advantages over PKP, it does not expand the candidate pool for corneal transplants………Find it!

Screening family members of Fuchs' endothelial dystrophy patients is essential, since about 50% of offspring will develop the condition. Doing so often leads to early identification of endothelial changes that might go undiscovered………Find it!

Based on multiple FDA studies, difficulty with night driving in a younger population affects about one-third of that population………Find it!

Because of its high retention rate without complications, one-stage implantation procedure and reports of superior visual outcomes, the Boston KPro has become the artificial cornea of choice………Find it!

This tax year, a practice may expense $250,000 of capital assets as a Section 179 deduction instead of depreciating them off over several years. This is currently a 1-year incentive that may revert to only $25,000 next year………Find it!

Most antimicrobials, except penicillin and polymyxin B, continue to be highly active against MRSA………Find it!

Corneal complications associated with diclofenac might have been due to its vehicle, solubiliser and/or preservative, and not the molecule itself. Therefore, a non-preserved agent might not exert such side effects and could be a more preferable treatment option………Find it!

Even a very small amount of macular thickening (10-20 μm) correlates with a decrease in contrast sensitivity………Find it!

IT implementations that comprise EMR systems have a failure rate of 30% to 50%. So, it is important to have a well-constructed plan in place and to take into account any contingencies that may affect your timetable………Find it!

Ocular manifestations of autoimmune diseases may be mistaken as drug effects in individuals taking NSAIDs while also suffering from autoimmune diseases like rheumatoid arthritis or Sjögren's syndrome………Find it!

A visual field gain of 5% may not seem like much, but for post-stroke or brain injury patients it can be a substantial improvement in their ability to function………Find it!

Total limbal stem cell deficiency is a relatively recently recognized condition in which conjunctivalization and neovascularization of the corneal epithelium causes repeated, persistent surface breakdown. Management usually involves transplantation of stem cells………Find it!

In the presence of early postop bullous keratopathy in a cataract patient, specular microscopy will help predict whether the fellow eye can safely undergo surgery and remain clear……Find it!

With the adjunctive use of steroids to NSAID therapy, excessive suppression of prostaglandins can occur and growth factors can become over-inhibited. This can lead to corneal melts, transforming NSAIDs from a beneficial treatment into a hazardous one………Find it!

DSEK allows functional vision to greatly improve in weeks to months, as opposed to a year or longer with PKP. By avoiding the so-called "open sky" nature of PKP, it also greatly decreases risks of infection, inflammation, retinal detachment and supra-choroidal hemorrhage………Find it!

When a patient presents with complaints of night-vision problems, the first responsibility of the clinician is to determine whether there is an anatomic or physiologic cause for the patient's subjective complaints………Find it!

The typical refractive surgery patient falls below the age of onset of Fuchs dystrophy. Having baseline specular microscopy images will quantify endothelial density and could reveal incipient changes that may dissuade surgeon and patient from pursuing LASIK………Find it!

Given the increasing deployment of wavefront and OCT technologies in ophthalmic practices, these devices may one day be used for objective differentiation between normal and dry eyes in the clinic………Find it!

LASIK has long been known to decrease contrast sensitivity, and, in high myopes, have a negative effect on night vision. Custom wavefront procedures with less tissue removal and a more blended peripheral zone have decreased, but not eliminated, these issues………Find it!

Patients need at least 20/200 vision to be a good candidate for vision restoration therapy, as well as mental alertness and the ability to focus for 30 minutes per session………Find it!

Mechanical microkeratomes for LASIK flap creation had a 0.015% to 0.3% rate for buttonholes while femtosecond laser-created flaps showed a 0.0% rate in one analysis………Find it!

MRSA infections are changing from a primarily hospital-acquired infection to a communityacquired process. Resistance is growing due to a new altered penicillin-binding protein (PBP2a) that has decreased the susceptibility and inhibition of bacteria to methicillin………Find it!