蕭裕泉醫師眼科筆記

20140420第49次眼科地方醫學會 1.Ortho-K可以讓peripheral retina影像有點在前面，positive SA,可以抑制眼軸增長，瞳孔愈大，度數愈　　深、 抑制近視增長的效果愈好。 2.使用於對散瞳劑atropine無法忍受、近視持續進行、 可以使用。 3.配戴OK矯正度數愈多，產生愈多的spherical aberration 愈多 。 4.Aspherical SCL with positive SA的也可以抑制近視加深 。 5.OK直徑僅量接近角膜邊緣0.5mm。 6.自然的光線，也比較不會近視加深。 7.Scleral CL :像倒一碗水至眼睛上 。 8.Viscoat當成防火牆 。

Toric IOLs Off axis? Fixing a toric IOL that's malpositioned by Vanessa Caceres EyeWorld Contributing Writer Ophthalmic surgeons share pearls, perspectives T here's a starter question to ask if your patient has a toric IOL that is not at the right position postoperatively: Is the patient happy with his/her vision? "If their vision is 20/25 or perhaps even 20/40, I advise leaving it alone. There's no need to reposition their toric lens if they are happy," said Terry Kim, MD, professor of ophthalmology, Duke University Eye Center, Durham, N.C. "Many patients are happy with better, though not perfect, refractive outcomes," said Michael Y. Wong, MD, Princeton Eye Group, Princeton, N.J., and instructor, Rutgers Medical School, New Brunswick, N.J. However, if the patient is unhappy, there are a few choices to consider. First, consider the possible cause of his/her dissatisfaction. "If the patient is not happy, you have to go through a...

Toric IOLs Measurement remains key to best toric IOL outcomes by Rich Daly EyeWorld Contributing Writer " D espite all this planning and preparation, one can still have uncontrollable intangibles and end up with residual, off-axis astigmatism. Just be prepared to handle these eventualities postoperatively …" – Sydney L. Tyson, MD Although many patients can benefit from toric lenses, surgeons have to take special care to ensure their fit and location A dhering to key measurement steps in toric lens implantation can keep both standard and challenging astigmatism patients on track. Although Sydney L. Tyson, MD, an attending surgeon at Wills Eye Hospital , Philadelphia , avoids implanting toric IOLs in eyes with highly irregular corneas for fear of inducing or worsening higher order aberrations, he does not limit toric lenses to patients with regular corneal astigmatism. "In general, I believe that maximizing the treatment ...

Impact of lens design and materials on cataract surgery by George H.H. Beiko, BM, BCh, FRCS(C) outcomes Analyzing the spectrum of light used for scotopic vision shows that blue light provides 35% of scotopic sensitivity. Source: George H.H. Beiko, BM, BCh, FRCS(C) Comparison of transmission of blue light in the natural crystalline lens and different current IOLs18 Source: George H.H. Beiko, BM, BCh, FRCS(C) S ynergy is the value and performance of any elements which, when combined, are greater than the sum of the separate individual parts. Achieving optical synergy in visual outcomes following cataract surgery is accomplished by selecting a high performance lens design produced with proven, high caliber materials. Proper lens selection has been shown to improve spherical aberration correction, chromatic aberration correction, light transmission, material clarity, as well as limit lens epitheli...

The art of advanced technology IOLs Is this IOL centered? Angle kappa and multifocal IOLs by Richard Tipperman, MD Richard Tipperman, MD Almost every clinician has had the experience of seeing a patient with a multifocal IOL where the rings on the optic are "perfectly centered" referable to the pupil and yet the patient is unhappy with his/her visual function; another patient will have a multifocal IOL where the rings are clearly "decentered" in relation to the pupil yet the patient is very pleased. How can this be possible? Is one patient just "high maintenance" while the other is easygoing? A better explanation than "baseline personality" rephrases the question of "Is the IOL centered?" to "Is the IOL centered in reference to what?"         It is likely much more important that the IOL be centered in relation to the patient's true visual axis rather than the geometric center of the pupil. To u...

Using cataract surgery as a treatment for ocular hypertension ________________________________________ by Michelle Dalton EyeWorld Contributing Writer James D. Brandt, M.D. Steven L. Mansberger, M.D.           C ataract surgery can lower IOP in patients with ocular hypertension (OH), according to results from a large cohort study.1 Steven L. Mansberger, M.D., director, Glaucoma Services, Devers Eye Institute, Portland, Ore., and colleagues determined "someone who has early glaucoma or needs only 10-20% IOP lowering should be considered for cataract surgery," he said, but does stress the results are only applicable for those with OH, a point co-author James D. Brandt, M.D., professor of ophthalmology, and director, Glaucoma Service, University of California-Davis, reiterated. "We only evaluated OH. It is dangerous to extrapolate the findings of this study to those with glaucoma. It's a whole different population, es...

30130324 眼科教授醫學會學會 ReSTOR Toric +2.5D Central zoom 0.938mm 較大 Cataract 先做 dominant eye, +2.5D in dominant eye Distant vision excellent Flap thickness 愈薄，愈不會 dry eye. Nerve supply 非只是 3 ， 9 點進入，是從 360 度進入， 所以 hinge 在那個位置，其實沒差！（新觀念） Flap diameter 愈大，愈乾。 逆性散光或斜性散光，要注意非角膜散光比率高，約 10%! 角膜塑型術及近視雷射手術，可減少旁中心離焦， 可以控制近視度數加深。戴眼鏡會有旁中心離焦，近視度數易會加深。 現在有一種鏡片，可以控制近視度數， 眼鏡也要戴好 戴眼鏡如果沒戴好或戴歪 , 戴眼鏡如天天地震 , 也容易加深 近視 300 度以內，除非內隱斜視太強，可以看近不戴眼鏡， 不然建議都戴著，近視比較不會加深。因為看近要調整力較好。 CCC coming full circle Touqui effect, 當角膜前表面後表面的軸度沒有很一致時， 有時會開到 45 度，不是想像中在合力的中間 , 變成怪怪的！ 術前提到 dry eye symptm