Practical Pearls

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

Two retrospective studies that compared outcomes between anterior lamellar keratoplasty and penetrating keratoplasty show ALK gaining ground as an alternative to PK ………Find it!

By reducing rejections, enhanced claims management has decreased one practice's receivables aging and accelerated cash flow. Their A/R is better than the national average now, with payments frequently arriving in less than 2 weeks ………Find it!

In small pupils, a large capsulorhexis allows nucleus to be tilted out of the bag and into an upright position where it acts as its own mechanical pupil dilator. It also ensures easier removal of epinuclear and cortical material and avoids excessive aspirator movement ………Find it!

When a dislocated IOL falls onto the surface of the retina, it may be difficult to extract. Using active suction with a vitrector or infusing with perfluorocarbons may be helpful in removing the IOL ………Find it!

Preop NSAID use in IFIS patients can potentiate better dilation and iris stability during cataract surgery. Schedule such patients toward the end of the operating schedule to allow the patient more time to dilate and the surgeon more time to prepare and work ………Find it!

Top cataract surgeons agree that all of the presbyopia-correcting lenses have been improved since they were approved by CMS for patient-shared billing in 2005 ………Find it!

In cataract patients with borderline endothelial dysfunction (i.e., guttae but no edema or visual fluctuation) give the cornea, and our techniques to protect the endothelium during surgery, the benefit of the doubt. Should the need arise, performing an endothelial transplant will be far easier once the eye is pseudophakic ………Find it!

When comanaging cataract patients with an optometrist, don't collect the full charge from the patient and then reimburse the O.D., as this may be construed as a kickback. The O.D. should bill the patient separately ………Find it!

Photoscreening via analysis of red reflex allows early detection of sight-threatening conditions in children. Use code 99174 rather than the other vision screening codes (92002-92014, 99172, and 99173) ………Find it!

Training makes your staff more confident and productive. The ideal amount of training is 1 hour for every 80-hour pay period ………Find it!

Bevacizumab is safe and effective for treatment of persistent macular edema secondary to branch or central retinal vein occlusion, research shows, but its benefits are short term and recurrence rates are …high……Find it!

The Malyugin Ring has been earning praise as one of the best ways to combat Intraoperative Floppy-Iris Syndrome ………Find it!

Allowing O.D.s to handle IOL selection and education makes sense because optics and refraction are their core strengths of an optometrist's training and expertise, plus the O.D. has likely known the patient for years and is able to assess their needs with greater perspective ………Find it!

Approximately 5% of cataract-surgery patients who experience a dislocation in an IOL will also develop a retinal detachment ………Find it!

Having an exhaustive online repository of information about payer policies, transmission and formatting requirements, rejection and error messages, and other claim errors can allow for swift correction and resubmission of rejected claims. ………Find it!

A newer 7.0 mm Malyugin Ring offers many advantages to surgeons who use the "phaco flip" technique and also to those who prefer IOLs with 6.5 mm optics ………Find it!

Design refinements to Crystalens and a greater database to help refine A-constants allow for power accuracy that approaches that of the ReSTOR D3 IOL ………Find it!

A medical career is not without its difficulties. Among numerous other challenges is enduring the incomparable length of the training process. Few college students are aware of the time commitment required when they first set out to become a physician ………Find it!

Using intraoperative wavefront aberrometry during cataract surgery can reduce astigmatism below a half a diopter on almost all cases and give patients better uncorrected visual acuity on the first postoperative day ………Find it!

An article in the April 2009 Ophthalmology found that, while pseudoexfoliation was the primary cause of IOL dislocation, prior vitreoretinal surgery was the second most common cause among "in-the-bag" disclocations ………Find it!

Anterior vitrectomy is preferable to posterior vitrectomy in cases where a poster-chamber IOL has dislocated, because anterior vitrectomy runs a lower risk of vitreous prolapse into the anterior chamber ………Find it!

In survival mode, the staff is encouraged out of fear and driven by adrenaline. While this mode can be quite productive in the short term to fix a specific problem, it does not function well over longer periods of time, as physical and mental exhaustion settles in ………Find it!

In an FDA-monitored clinical trial, 88% of Tecnis Multifocal patients reported never wearing glasses 4 to 6 months after surgery ………Find it!

Researchers comparing intermediate vision of the AcrySof ReSTOR +3 Multifocal with that of the original ReSTOR +4 found that intermediate acuities were better than observed in the ReSTOR +4 FDA study and that the percentage of patients with 20/40 or better VA at intermediate distances was higher as well ………Find it!

The Light Adjustable Lens contains photosensitive silicone molecules that enable precise and noninvasive postoperative adjustment of refractive power using ultraviolet light, the manufacturer says ………Find it!

Despite measurable improvements in premium IOLs, surgeons agree that a lens with 4 D of accommodation is still a wish for the future. One investigational lens that may come closer to that goal is the Synchrony from Visiogen ………Find it!