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EW SHOW DAILY 24 ASCRS Symposia Tuesday, May 10, 2016 by Vanessa Caceres EyeWorld Contributing Writer Findings from military refractive surgery shared at symposium H ydrocodone and oxyco- done similarly controlled pain after photorefractive keratectomy (PRK) in a group of military patients, but patients who used hydrocodone had more pain at each time interval in a study, said Joshua Roe, MD, during Monday's Military Refractive Surgery Symposium. Dr. Roe embarked on the study because even though several oral narcotics are used for pain manage- ment after PRK, there are limited published resources to compare their effectiveness with PRK. All 109 patients in the study had a standardized procedure and kept a pain diary. Patients received either oxycodone or hydrocodone. Twen- ty-five percent of the study patients were female. Overall, 28% of patients did not have to use any narcotic pain med- ications, Dr. Roe said. Ninety-eight percent of the oxycodone group patients used fewer than 10 total narcotic pills on average, compared with 84.5% of the hydrocodone group. Side effects in both groups were similar, although females re- ported more side effects overall. The study indicated that the use of oxycodone and acetaminophen is a preferred treatment for pain associ- ated with PRK, Dr. Roe concluded. Another presentation during the symposium focused on the use of big data to identify trends and complications. Big data are a broad set of data that cannot be processed in a traditional manner, said Elizabeth Hofmeister, MD, San Diego. Big data are used in areas as diverse as traffic, crime, climate, and medicine to track trends and other information. Although using information from a large set of data is useful, some drawbacks include missing data, bias, privacy issues, and the concern that not everyone in the world has access to big data, Dr. Hofmeister said. There is also the pitfall of sam- pling errors, which could lead to misinterpretation. Some researchers in ophthal- mology are starting to use big data, including the EUREQUO from ESCRS in Europe to track femtosec- ond laser-assisted cataract outcomes (www.eurequo.org) and the IRIS registry (www.aao.org/iris-registry), which is tracking endophthalmitis after cataract surgery. The military needs to do a better job of accurately and fully reporting data to take advantage of big data studies, Dr. Hofmeister said. Some other findings reported at the symposium included: • A longer duration of visual rehabilitation may be needed in small incision lenticule extraction (SMILE) patients compared with femtosecond LASIK patients, said Marcus Tan, MD, Singapore. • Keratoconus appears to be a more prevalent problem in the African American and Latino population as well as those with sleep apnea or Down syndrome, said Walter Steigleman III, MD. Ophthalmol- ogists can work with optometrist colleagues to find effective contact lens solutions to assist keratoco- nus patients. EW Editors' note: The physicians have no financial interests related to their comments. by Liz Hillman EyeWorld Staff Writer Predicting IOL power can be like "diving into a murky environment" I t was standing room only for the Monday afternoon "Pearls for Perfect IOL Power Predic- tion" symposium sponsored by the International Intraocular Implant Club. "The importance of this topic is reflected in this large audience that we have," said moderator Graham Barrett, MD, Perth, Australia. Dr. Barrett led the symposium with a scene he thinks all the oph- thalmologists in the room have ex- perienced: "I'm sure you've had the experience of sitting there the night before thinking about what lens to use. It's like diving into a murky environment. You're not quite sure where to go." The audience mur- mured their agreement. Leading an expert panel— Thomas Kohnen, MD, Germany; Stephen Slade, MD, Houston; Roberto Zaldivar, MD, Mendoza, Argentina; Warren Hill, MD, Mesa, Arizona; Douglas Koch, MD, Hous- ton; Thomas Olsen, MD, Aarhus, Denmark; and Eric Donnenfeld, MD, Rockville Centre, New York— Dr. Barrett presented a series of his own cases, asking his colleagues what IOL calculation formula they would use and why, providing pearls for power prediction along the way. The first case Dr. Barrett present- ed was a patient with high myopia (a preop refraction of –24 D, BCVA of 6/60) who had an axial length of Dr. Tan discusses the SMILE procedure. continued on page 26 Dr. Barrett leads a lively panel discussion for a packed room about how to predict the perfect IOL power.

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