蕭裕泉醫師眼科筆記

by Vanessa Caceres EyeWorld Contributing Editor   Refractive editor's corner of the world In this month's inaugural refractive corner, I'd like to give some food for thought on the topic of astigmatism. Astigmatism is one of the most common conditions a cataract and refractive surgeon deals with. It's more common than dry eye and even more common than blepharitis. In fact, more than 70% of the adult population has more than 0.5 D of pre-existing astigmatism. Interestingly, our incidence of correcting pre-existing astigmatism varies by procedure. With laser vision correction (LASIK, PRK, LASEK), we correct any amount of astigmatism 100% of the time. If it's there, it's addressed. Why? To provide patients the best opportunity to see without being dependent on glasses or contacts lenses. That's the mission of today's refractive surgeon. With cataract surgery, however, there is still a transition of traditional surgeons converting to refractiv

by Matt Young EyeWorld Contributing Editor In a recent study showing the frequency of capsule wrinkling in eyes with PACG, patients underwent laser iridotomy or trabeculectomy (pictured here) before cataract surgery Source: Anand Sudhalkar, M.D.   Capsule wrinkling is common in patients with primary angle-closure glaucoma (PACG); surgeons should exercise extra caution when performing capsulorhexis in these patients. That's according to research published in the September 2010 issue of the Japanese Journal of Ophthalmology. Capsule wrinkling has been a known phenomenon in patients with pseudoexfoliation syndrome, and inadvertent propagation of the capsule tear could occur among such patients. Although less is known about capsule wrinkling and PACG patients, this study found a link. "Capsule wrinkling during cataract surgery was more common in eyes with PACG, especially those with a higher IOP on presentation and iris atrophy," wrote study co-author Yong Yeon Kim,

by Maxine Lipner Senior EyeWorld Contributing Editor   Multiple spots in the placement of the argon laser in the trabecular meshwork. With ALT, practitioners see the burn to the trabecular meshwork, which is a sign the spot has been successfully applied Source: Richard A. Lewis, M.D. The latest on what to expect from varying laser trabeculoplasty options It's often par for the course with open-angle glaucoma patients' use of laser trabeculoplasty. For patients it's a quick, pain-free option that may help to alleviate the need for drops. There's a whole alphabet soup of approaches —ALT (argon laser trabeculoplasty), SLT (selective laser trabeculoplasty), and MLT (micropulse laser trabeculoplasty). But of course not all laser trabeculoplasty is equal, or is it? Here's what EyeWorld found. SLT vs. ALT For some time, practitioners have been weighing how SLT, the relative newcomer, stacks up against the more traditional ALT, which has been around for deca

by Tony Realini, M.D., M.P.H. Rho kinase inhibitors lower IOP by enhancing conventional outflow through the trabecular meshwork Source: National Eye Institute, National Institutes of Health The 1990s were an unprecedented decade for glaucoma therapy. More than 15 years had passed since the advent of topical beta-blockers when suddenly the glaucoma marketplace was inundated by innovation. In the span of just a few years, topical carbonic anhydrase inhibitors, selective alpha adrenergic agonists, and prostaglandin analogues burst onto the scene, forever changing the therapeutic landscape for IOP reduction. Aside from a few formulation changes and a fixed combination of existing drugs, the last 15 years has been another innovation drought for glaucoma drug development. That may be about to change. Several companies are developing molecules in a new class called rho kinase inhibitors. These drugs offer efficacy, safety, and a mechanism of action that could expand our current

by Matt Young EyeWorld Contributing Editor Opinions are varied and so is the evidence, but here's a comprehensive look At the slit lamp, glistenings look devastating. But ophthalmologists have very different views on the clinical impact of these tiny fluid-filled IOL vacuoles. Glistenings occur in many IOL types, although in some more frequently than others. Most patients—even with severe glistenings—never complain of them. And yet some ophthalmologists suggest they do matter, especially for younger, refractive lens exchange patients who may be more prone to develop symptoms over time because the severity of glistenings tends to increase over time. When it comes to the significance of glistenings, the reality is that there are many points and counterpoints. EyeWorld explores several here to give some broad, current perspectives on this issue. Point: Glistenings are here to stay George H.H. Beiko, M.D., assistant clinical professor, ophthalmology, McMaster University, St. C