Bryan S. Lee

Accuracy and stability of hyperopic treatments.

Purpose of review Treatment of hyperopia presents greater challenges than treatment of myopia for multiple reasons, including the fact that hyperopia tends to progress with age and becomes more symptomatic with the loss of accommodation. Recent findings Despite these issues, surgeons have multiple options to treat hyperopia successfully. Modern laser vision correction has high success rates for most patients and performs acceptably in the presence of high hyperopia or high cylinder. Early studies combining excimer laser treatment with collagen cross-linking (CXL) suggest that this may improve refractive stability. Recent studies have also described femtosecond lenticule extraction and use of a solid-state laser in place of the excimer. In addition to cornea-based treatment, long-term studies of a hyperopic phakic intraocular lens have shown excellent visual outcomes and good safety. Cross-linking is increasingly being applied to the hyperopia that follows radial keratotomy. Summary The established treatments for hyperopia continue to accumulate evidence supporting their safety and efficacy. The next step forward in treatment may arise from combining these treatments with CXL to stabilize the cornea long-term.

Medicolegal pitfalls of cataract surgery

Purpose of review To provide a general overview of medicolegal issues that may arise before, during, and after cataract surgery. Recent findings The Department of Health and Human Services Office of Inspector General has designated ophthalmology as an auditing target, an unusual step to take for an entire specialty. Ongoing False Claims Act litigation may provide greater clarity on billing Medicare for a premium intraocular lens patients return to the operating room and charging for an intervening exam when performing cataract surgery on both eyes. Summary Ophthalmologists should continue to follow basic principles that help decrease medicolegal risk. These include a thorough informed consent discussion before surgery and accurate and contemporaneous documentation. When complications arise, surgeons should handle them in accordance with best practices and refer patients appropriately. Problems can arise from inattentive postoperative care, so ophthalmologists should train staff members on handling of patient calls. Implementing safety protocols for intraocular lens implantation and asking for legal advice when considering certain types of financial arrangements are also prudent. Cataract surgeons also should follow guidelines for billing noncovered services carefully.

Lessons from implementation of an intraocular lens timeout.

techniques. Our marking maneuver is basically the same as the maneuver used to fold the graft, performed right after the folding itself, but in a paracentral zone, which will be highly visible even through a cloudy cornea at almost every moment during the positioning phase; it does not matter whether there is a peripheral opacity such as gerontoxon or a partially rolled graft. The safety of gentian violet has been proven on DSAEK grafts and according to our experience, indirect DMEK graft coloration will not be visible 2 days after the surgery. On the contrary, direct painting of the graft provides a color deposit and could result in a descemetic permanent tattoo.