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2013 ASCRS•ASOA San Francisco Daily News Tuesday

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14 EW SHOW DAILY Tuesday, April 23, 2013 ASCRS Symposia Managing pain, inflammation after refractive surgery by Vanessa Caceres EyeWorld Contributing Writer Steven E. Wilson, MD I t's never easy to manage postop pain and inflammation after refractive surgery, but there are some things you can do to help prevent it and alleviate it, said speakers at the Monday afternoon symposium "Problems Postop: Pain and Inflammation in the Refractive Surgery Patient, Incorporating the 2013 Richard L. Lindstrom Lecture." The Contact Lens Association of Ophthalmologists sponsored the symposium. Certain factors make patients more prone to pain, including a younger age, genetic factors, previous chronic pain, level of optimism (or lack thereof), a history of depression, and problems with anxiety, said Audrey R. Talley Rostov, MD, Seattle. Although there is general surgery literature to predict who will develop pain, there is no literature available on this topic that focuses specifically on post-keratorefractive surgery, she said. Anxiety appears to be the biggest factor predicting postop pain, according to the general surgery literature, Dr. Talley Rostov said. Patients who are information seekers—for example, those who scour the internet for information on their medical care—actually seem to experience less postop pain, she added. Some ways to help patients avoid postop pain is to establish a good patient rapport, have someone available to hold the patient's hand during surgery (literally and figuratively), the use of yoga breathing and meditation, and prescribing appropriate pre- and postop medica- tions, including Valium. There are some patients who seem to experience chronic pain after refractive as well as other ocular surgeries, said Todd P. Margolis, MD, San Francisco. Although the symptoms these patients experience may resemble dry eye, they may actually be experiencing neuropathic pain. With these patients, Dr. Margolis encourages listening to the patients (as they often feel their complaints are ignored), reducing ocular manipulation, offering oral agents like tramadol, and providing positive reinforcement when their pain levels decrease. The Richard L. Lindstrom Lecture, given by Steven E. Wilson, MD, Cleveland, focused on LASIK, dry eye, and complex regional pain syndrome. The best approach to manage pain is to be proactive and optimize the ocular surface in the preop period so you can avoid unhappy postop patients, Dr. Wilson advised. Surgeons can optimize by assessing for signs and symptoms of dry eye, using nonpreserved artificial tears, and recommending use of cyclosporine (Restasis, Allergan, Irvine, Calif.) two to four times a day. He also recommends the use of a humidifier in the patient's bedroom set to 40%, steroid use, and punctal plugs as needed to treat dry eye. Dr. Wilson explained that a very small number of patients may have LASIK chronic pain syndrome, which may be confused with dry eye. This is usually diagnosed by exclusion of other possible pain causes, and anticonvulsant medications are the best treatment, he said. Other presenters at the symposium focused on how to manage perioperative pain in surface ablation, acupuncture for dry eye, managing diffuse lamellar keratitis, the role of steroids and cyclosporine and serum tears, insights on wound healing, and managing pain after PRK. EW Editors' note: Dr. Talley-Rostov has financial interests with Allergan (Irvine, Calif.) and Bausch + Lomb (Rochester, N.Y.). Dr. Wilson has financial interests with Allergan. Dr. Margolis has no related financial interests. Exciting new education symposia taking place throughout this year's ASCRS meeting by Brad Fundingsland EyeWorld Educational Development Group O ne of the exciting developments from this year's ASCRS annual meeting is the launch of the EyeWorld Education Development Group, which is focused on the support of the EyeWorld CME and ASCRS-Authorized Education symposia taking place here in San Francisco. This year, eight programs were being supported on many exciting topics facing the ASCRS member on a regular basis. Thousands of members have attended these exciting programs over the past few days. The programs focus on a comprehensive effort to communicate key information around some of the most compelling and controversial topics facing the ASCRS member. Data is obtained from all preregistrants on their opinions and practice patterns prior to the event, which is presented at the beginning of each program. Then important audience response data is obtained throughout the program to determine change in opinions and intended behavior from each attendee during and after the program. After the programs, ASCRS members should expect communications regarding print and electronic content on the topics to continue the dissemination of this important information and extend the dialogue around the topics. The goal is to have these educational programs continue through a longer-term process to help achieve larger scale educational impact. The programs include experts in many different fields, and involve many of the leadership of ASCRS. The faculty includes 46 different physicians, including six Executive Committee/Governing Committee members, and 20 Clinical Committee members. Topics of these year's eight programs include the following: • Reducing residual refractive error in refractive IOL patients • Improving refractive cataract outcomes by reducing post-surgical inflammation • Improving outcomes with toric IOLs • New technologies and techniques for managing corneal and lenticular astigmatism • The latest pearls on excimer and femtosecond laser surgery • Advanced tear film testing: Incorporating into point of care • Mythbusters: The true impact of inflammation on cataract surgery outcomes • The Amazing Race for mitigating the impact of dry eye on refractive cataract outcomes Comprehensive grant support for these programs has been received from many corporations including Abbott Medical Optics (Santa Ana, Calif.), Alcon (Fort Worth, Texas), Bausch + Lomb (Rochester, N.Y.), Allergan (Irvine, Calif.), TearLab (San Diego), TearScience (Morrisville, N.C.), Nicox (Valbonne, France), and PRN (Plymouth Meeting, Pa). Moving forward, the annual ASCRS Clinical Membership survey will help with future topics for the programs by identifying key educational gaps and needs. This survey is currently being conducted at the meeting, and attendees who wish to participate can complete the survey by going to www.eyeworld.org/survey or look out for the various survey takers throughout the convention center. Those interested in attending future EyeWorld CME and ASCRSAuthorized Programs should check www.eyeworld.org/meetings for regular updates. EW

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