Practical Pearls

A Handy Guide to the Best Take-Home Tips in the June 2011 Issue of Ophthalmology Management

Off-label use of saliva-increasing drugs like pilocarpine and cevimeline can potentially alleviate dry eye in Sjögren's patients, but the significant side effects generally negate the relief……Find it!

As 2011 is the first year of EHR meaningful use bonuses, practices are only required to attest to having met the requirements. Attestation means you are collecting the data in some fashion, even if you are only doing it manually, as on a spreadsheet. For 2012, practices will need to actually collect and submit the data to CMS ……Find it!

If a pseudophakic patient has chronic postop inflammation, hyphema, increased IOP and/or vitreous hemorrhage, consider a diagnosis of IOL displacement. Though a slit-lamp exam may be inconclusive, ultrasound biomicroscopy can reveal the position of the misplaced haptics and help make the diagnosis ……Find it!

Differences in tear film turnover, osmolarity, protein content, pH, fornix volume, underlying conjunctival vascularity and lacrimal drainage can affect the amount of antibiotic that reaches the conjunctivo-corneal surface ……Find it!

Solar hybrid air conditioning systems can save you up to 66% of your HVAC electric bill ……Find it!

One in six patients presenting for cataract surgery may have undiagnosed dry eye. Abnormal topography can be a tip-off to the presence of a tear film disorder that must be managed prior to surgery. As topography improves, the patient commonly reports improved vision on dry eye therapy alone, even in the presence of cataracts ……Find it!

Dry eye can cause irregular astigmatism in cat a ract patients and, if left untreated, toric IOL patients could have suboptimal postop results due to a shifted axis of corneal astigmatism ……Find it!

Preservatives used in certain antibiotics have been shown to increase epithelial permeability and transscleral drug delivery ……Find it!

Topical azithromycin BID can reduce signs and symptoms of ocular rosacea in moderate-to-severe blepharitis in just six days—faster than systemic doxycycline or artificial tears ……Find it!

The third-party insurer cost/utility ratio for the utility of topical cyclosporine compares well with the commonly accepted standards of being “very cost-effective” when <$50,000/QALY ……Find it!

Presbyopia-correcting IOLs are notoriously sensitive to refractive error. Treating dry eye before IOL implantation stabilizes vision and can decrease the need for enhancement procedures ……Find it!

An unstable tear film related to aqueous-deficient dry eye can be a signal that a patient has Sjögren's syndrome ……Find it!

A new dry eye therapy called SAR 1118 is a small-molecule LFA-1 antagonist that inhibits T-cell mediated chronic inflammation. In a phase 2 study, patients significantly improved on the Ocular Surface Disease Index and the visual-related function sub-scale (improved ability to drive at night, read, use a computer) ……Find it!

Using ultrasound biomicroscopy to determine posterior chamber depth in patients with negative dysphotopsia can alert the clinician of the need to improve with coverage of the anterior capsule via secondary piggyback IOL and reverse optic capture rather than collapse of the posterior chamber alone, as previously hypothesized ……Find it!

Many certified EHR systems will have a means to upload the report files to CMS, either directly or using report-generating software, while other practices may use a third-party solution such as registries, the same ones that were helping them report PQRI ……Find it!

Before implanting a multifocal IOL, evaluate the tear film, magnitude of astigmatism and the condition of the retina. Patients getting any sort of premium IOL may require a special work-up that includes IOL power calculation, corneal topography, wavefront analysis, and OCT of the macula and posterior pole ……Find it!

Because preoperative screening of contrast sensitivity is not predictive of comorbidity, the cataract surgeon may only learn of a pathology such as AMD or glaucoma after implanting the multifocal IOL ……Find it!

Instructional podcasts, which ophthalmology residents can replay at their convenience, can be a more effective learning tool than classroom instruction in some instances ……Find it!

Treating preoperative dry eye in a cataract patient teaches the patient that they have dry eye disease and that artificial tear treatment is a useful therapy. This virtually eliminates the common perception among patients that cataract surgery caused their dry eye disease ……Find it!

Concerns over whether generic latanoprost will have equal therapeutic value to branded Xalatan are allayed somewhat by a 185-patient study in which generic latanoprost, in use for more than a year, has demonstrated equivalence ……Find it!

Antibiotic compounds with a molecular weight under 500 will diffuse through biologic membranes, but larger compounds like Polymixin and bacitracin may be impeded by their size ……Find it!

The decreased contrast sensitivity that comes with multifocal IOLs may not be a serious problem for most patients, who are far more likely to complain about haloes ……Find it!

Medically necessary “diagnostic tests” are outside Medicare's global cataract surgery package. A final refraction following cataract surgery is not bundled with the global surgery package and not covered by virtue of the Medicare law ……Find it!

A positive antinuclear antibody test may indicate nearly a 14 times greater likelihood of developing Sjögren's syndrome. Also telling: aqueous-deficient dry eye symptoms are significantly worse in Sjögren's syndrome patients than in non-Sjögren's patients ……Find it!