Over the past year, many innovations have affected the way we care for patients. In some areas of medicine, it is normal to continue with the same treatments for various conditions year after year. In the ophthalmic space, however, it is quite normal to make changes in the way we care for patients on a monthly basis.
REFRACTIVE, CATARACT SURGERY TRENDS
One key trend that I believe will affect the way we care for patients is in the area of corneal collagen crosslinking (CXL). The traditional Dresden technique continues to be an effective modality for addressing progressive keratoconus and post-LASIK ectasia, but newer research has proposed several adjustments to the technique that improve the patient experience and maintain similar results. One method adopted by many crosslinking experts has been to increase the power of ultraviolet-A (UV-A) light and shorten the actual time of light administration. Reducing the UV-A treatment time from 30 to 10 minutes or, in some cases, 3 minutes has been reported to improve the patient experience. Another major trend is switching to a less invasive CXL technique. Some early research questioned the effectiveness of epithelium-on CXL, but I believe that preserving the epithelium can result in reduced risk and also produce a similar outcome to the proven Dresden technique.
Without question, the biggest alteration in how we care for patients is in the cataract surgery space. Femtosecond laser platforms designed for cataract surgery have the potential to automate this procedure, making it more consistent, reducing complications, and improving visual outcomes. Patients appear to have a strong interest in this technology.
In glaucoma treatment, availability of the iStent (Glaukos Corp.) is the biggest update for patient care this year. This technology appears to be especially helpful for intraocular pressure control in combination with cataract surgery and can help reduce the need for glaucoma medications, aiding in patient compliance and helping to promote a healthy ocular surface.
OCULAR SURFACE TREATMENTS
In the United States, another new technology increasing in popularity addresses one of the most common conditions that we see—blepharitis. The LipiFlow Thermal Pulsation System (TearScience) is a 12-minute automated procedure that induces mechanical expression of meibomian gland secretions. For patients with inspissated meibomian glands, this technology can jump-start the glands by expressing out the stagnant oils, allowing the glands to return to more normal function.
A further development that has changed the way we treat the ocular surface is our improved understanding of dry eye disease (DED). Because we now know that DED is a common preoperative condition prior to cataract surgery that is under-diagnosed, we now evaluate all patients presenting for cataract surgery for preoperative dry eye. If it is present, they are treated prior to surgery until their condition improves. Common interventions include topical steroids, punctal plugs, topical cyclosporine, and oral omega-3 fatty acid supplements.
Treating patients for preexisitng DED is crucial because dry eye can reduce the accuracy of keratometry measurements, affecting our ability to identify and properly correct astigmatism. Lastly, DED can also reduce the quality of vision following cataract surgery, which is problematic due to the high expectations of patients.
ADOPTION OF EHRs
One of the biggest challenges facing practices is the adoption of electronic health records (EHRs). Some eye care professionals report successful and beneficial implementation of EHRs; however, most report a long learning curve and a significant increase in the time required to fill out patient charts. We have recently experienced this painful learning curve in my practice.
Improvements in software will undoubtedly improve the experience of physicians over the next few years, but there is no question that, as they are now, EHR systems have a long way to go. My advice to surgeons who are considering a switch to EHR is to spend half a day with a colleague who uses a similar system effectively, getting a sense for how it affects work flow and what additional costs are required to integrate the technology into practice.
CONCLUSION
Like previous years, 2012 has been full of positive changes for ophthalmic patient care. Without question, the innovations that have led to improved patient experiences and visual results are impressive, but this is a continuing process, and I bet the future will be even brighter.
William B. Trattler, MD, is the Director of Cornea at the Center for Excellence in Eye Care, Miami. Dr. Trattler states that he is a consultant to CXLUSA, LensAR, and TearScience. He may be reached at tel: +1 305 598 2020; e-mail: wtrattler@gmail.com.
