Top News From AAO 2011: Slideshow

The Orange County Convention Center in Orlando, Florida, played host to the American Academy of Ophthalmology (AAO) 2011 Annual Meeting, held October 22 to 25, 2011.

Among this year's highlights:

• Femtosecond laser-assisted cataract surgery is seen as a "major advance"
• MRSA eye infections are on the rise, but treatment is lagging
• Medication compliance in patients with glaucoma varies widely
• Eye-care physicians have more musculoskeletal woes than family physicians
• Cataract surgery helps patients with Alzheimer's disease
• The iPad improves the reading ability of patients with low vision

Femtosecond Laser-Assisted Cataract Surgery a Major Advance

A study provides strong evidence of the increased safety and effectiveness of laser-mediated emulsification of cataracts compared with phacoemulsification. The approach uses femtosecond laser technology, which delivers near-infrared light to create precise subsurface cuts at depths that are greater than those possible using conventional approaches. Stephen Slade, MD, from Slade & Baker Vision Center in Houston, Texas, who was not involved in the study, described this technique as "the single most significant advancement in cataract surgery in the last 40 years."

Novel Eye Insert Improves Diabetic Macular Edema

An intravitreal insert that releases a sustained and controlled amount of the corticosteroid fluocinolone acetonide improved visual acuity for as long as 3 years in a study of patients with diabetic macular edema. This result "is particularly exciting, as it demonstrates that a single insert can provide rapid and sustained improvement in visual acuity for up to 36 months," said David Brown, MD, from Retinal Consultants of Houston, Methodist Hospital, Texas, during his presentation.

New Drug Maintains Visual Acuity in Central Retinal Vein Occlusion at 1 Year

Patients with macular edema caused by central retinal vein occlusion who received injections of VEGF Trap-Eye (Regeneron Pharmaceuticals) on an as-needed basis after receiving the drug once a month for 6 months maintained their initially improved visual acuity, according to 1-year results of the COPERNICUS trial. "This is good information. VEGF Trap-Eye works and appears to have some durability of effect when given on an as-needed basis," said study presenter Julia Haller, MD, ophthalmologist-in-chief at the Wills Eye Institute and professor and chair of the Department of Ophthalmology at Thomas Jefferson University in Philadelphia, Pennsylvania.

New Drug Maintains Mydriasis During Lens Replacement

A novel compound that combines phenylephrine and ketorolac helps keep the pupil dilated during cataract and other lens replacement surgeries, results of a phase 2b study indicate. The anti-inflammatory component of the compound is also associated with decreased postoperative pain, Alan Crandall, MD, from the John A. Moran Eye Center, University of Utah School of Medicine in Salt Lake City, told attendees. The compound, called OMS302, is being developed by the Omerus Corporation and is currently in phase 3 trials.

iPad Improves Reading Ability of Patients With Low Vision

For people with low vision that hampers their enjoyment of life, an iPad might be just the ticket. Kakarla Chalam, MD, PhD, professor of ophthalmology at the University of Florida College of Medicine in Jacksonville, found that using the iPad improved both reading ability and quality of life. The basis of the improvement was beyond the scope of the study, but the ability to alter the screen contrast, to position the tablet to avoid glare, and to seek out a reading spot with optimally comfortable lighting might all have been contributors, Dr. Chalam said.

Survey Shows Boomers' Concern, Lack of Action for Eye Health

A nationwide survey of more than 1000 randomly selected Americans aged 45 to 65 years suggests a high prevalence of knowledge and concern with age-related eye health. However, this concern has not led to eye-healthy nutritional modifications. The survey highlights the need for greater education on lifestyle changes that boomers should be making to safeguard their eye health as they continue to age, said Jeffrey Anshel, OD, principal of Corporate Vision Consulting and president of the Ocular Nutrition Society. A big part of the education responsibility rests with personal physicians, he said.

Intense Protocol With High-Dose Chemotherapy Saves Eyes

In children with advanced retinoblastoma with vitreous seeds, high-dose chemotherapy and periocular carboplatin can yield a "gratifying" outcome, P. M. Fairooz, MD, from the LV Prasad Eye Institute in Hyderabad, India, reported here. In 137 consecutive eyes (101 children; median age, 25 months), vision salvage was achieved in 83% of children, and 77% of them had a regression of the tumor and vitreous seeds. "That is a remarkable result," Dr. Fairooz said. Asked to comment, J. Fernando Arevalo, MD, from the Wilmer Eye Institute, Baltimore, Maryland, said: "This is a very important study because retinoblastoma with vitreous seeds represents one of the most difficult stages of retinoblastoma to treat."

Cataract Surgery Helps Patients With Alzheimer's Disease

Elderly patients with Alzheimer's disease and debilitating cataracts who have cataract surgery improve both their sight and their interaction with others and are less depressed. However, some individuals may experience an increase in agitation right after surgery. That is according to the Life From Vision in Alzheimer's Disease interventional prospective study, reported by Brigitte Girard, MD, from Tenon Hospital, Paris, France. The study showed "dramatic improvement in visual acuity" with cataract surgery without harmful effects on general condition or dementia," she told attendees.

Medication Compliance in Patients With Glaucoma Varies

A look back at data for nearly 18,000 patients with glaucoma in California shows that 20% are not compliant with their medication. Jason Jones, PhD, from Southern California Kaiser Permanente Medical Group in Baldwin Park, presented the data here. Brian Flowers, MD, from Ophthalmology Associates in Fort Worth, Texas, who sat in on the presentation, said: "This is a very nice study of a very vexing issue. It boils down to the fact that many patients don't take all their medications. Just like flossing, medication adherence goes up just before and after a visit to the doctor."

Simulator Improves Resident Training for Cataract Surgery

Research shows that practicing cataract surgery on a surgical simulator instead of on a live human being can make learning the procedure easier for the resident, and ultimately safer for the patient. "The simulator is a way to get the resident ready to start operating on human eyes. They can learn the steps, they can learn the microsurgical techniques, before actually operating on patients," research presenter Scott W. Yeates, MD, from Case Western Reserve University School of Medicine, Cleveland, Ohio, told attendees. The simulator that was used in the study was the EYESi, manufactured by VR Magic.

More Time Outdoors Reduces Nearsightedness

Spending a greater amount of time outdoors may decrease nearsightedness, a study found. The findings stem from a systematic review of the literature and a meta-analysis of data involving more than 10,000 participants. Study presenter Anthony Khawaja, MBBS, from the University of Cambridge, United Kingdom, said: "Increasing children's outdoor time could be a simple and cost-effective measure with important benefits for their vision and general health."

Eye Docs Have More Aches and Pains Than Family Docs

Eye care physicians are more apt to suffer neck, hand, wrist, and lower back pain than family medicine physicians, according to a case-control study presented by Anna S. Kitzmann, MD, from the University of Iowa, Iowa City. "Bending over, working in awkward positions for a long time, grasping small instruments, being in a static position, bending and twisting — these are all things that contribute to musculoskeletal disorders," she noted. The equipment ophthalmologists and optometrists use "has never really been ergonomically updated," she said. The industry should "take note and start to improve the design of their equipment," Dr. Kitzmann said.

MRSA Eye Infections on the Rise, Treatment Lagging

Findings from one of the largest known studies analyzing ophthalmic methicillin-resistant Staphylococcus aureus (MRSA) infections indicate that the number of these infections has continued to increase, but the extent of the problem has not generally been recognized. The majority of the cases are community-acquired MRSA, and most manifest as conjunctivitis, reported Jordon Piluek, MD, from Stanford University in Palo Alto, California. Richard Allen, MD, PhD, from the University of Iowa Health Center, Iowa City, said the results "confirm what many of us are seeing day in and day out."

Simple Test Detects Occult Eye Injury After Combat Blast

Specular microscopy helps detect occult ocular injury in veterans exposed to combat blast and might prove useful as a baseline screening test before the deployment of military personnel, Glenn Cockerham, MD, from the Veterans Administration Health Care System and Stanford University, Palo Alto, California, told attendees. He has found that many combat veterans with blast exposure have occult closed-globe injuries. "Cell density below 2000 cells/mm², as measured by specular microscopy, should alert clinicians to the possibility of such injuries in these veterans and prompt a thorough ocular examination," he said.

Video Games Help to Correct Amblyopia in Older Kids

A regimen that adds playing video games and the drug citicoline to standard treatment can improve visual acuity and binocular function in 10- to 18-year-old children with amblyopia, reported Somen Ghosh, MD, an ophthalmologic surgeon from Kolkata, Bengal, India. In the study of 100 children, visual acuity improved by 52% with standard treatment, 56% with antioxidant therapy, 64% with video game therapy, and 72% with video game plus citicoline therapy.

IOP Not Affected by Phacoemulsification in Patients With Diabetes

Phacoemulsification does not affect intraocular pressure (IOP) in patients with diabetes, unlike in their nondiabetic counterparts and in contrast to findings from previous studies, a retrospective study shows. Lisa Park, MD, and colleagues from New York University Langone Medical Center say that if these findings are confirmed, they might indicate that cataract surgery in some patients with diabetes does not carry the benefit of lowered IOP, which could herald longer-term eye problems beyond cataract resolution.

Postoperative Endophthalmitis Traced to Contaminated Trypan Blue

A large outbreak of postoperative endophthalmitis caused by multidrug-resistant Pseudomonas aeruginosa after phacoemulsification was traced to contaminated trypan blue solutions. The outbreak was described in a poster by Huan Pham, MD, from Kaiser Permanente in Modesto, California. "This is a fairly novel result. Only 1 case has been reported in the literature," Dr. Pham noted. "Contamination of compounded medications should be considered when investigating outbreaks of postoperative endophthalmitis," the researchers advise in their abstract.

Photo Credits

Slides 1, 2, 5, 8, 9, 10, 11, 13, 18, and 20 by Roberto Gonzalez

Slide 6 by Fran Lowry

Slide 7 by Darbe Rotach

Slides 3, 4, 14, 15, 16, and 19 by WikiMedia Commons

Slide 17 by Getty/Thinkstock