Article Date: 9/1/2006

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Combating IFIS with Awareness
Patients on Alpha-Blockers Need to Inform Surgeons.

A major new public awareness campaign has been initiated so that cataract surgeons will encounter a "no surprises" environment in operating on patients prone to developing intraoperative floppy iris syndrome (IFIS) during surgery.

The vast majority of IFIS patients are middle-aged and older men who at some time in the past 5 years have taken alpha-blockers such as Flomax (tamsulosin) for prostate enlargement. Women cataract surgery patients who have been prescribed alpha-blockers for lower urinary tract conditions are also at risk for IFIS.

In addition, researchers have recently found that the commonly used over-the-counter product saw palmetto, that many men take to facilitate urine flow, can also lead to IFIS during surgery.

Joining in the public awareness campaign are the American Society of Cataract and Refractive Surgery (ASCRS), the American Academy of Ophthalmology (AAO) and the American Urological Association (AUA). The goal is to encourage patients facing a cataract procedure to tell their surgeons that they have taken an alpha-blocker or saw palmetto. Primary care physicians and urologists are being asked to take an active part in this educational campaign.

"A 160-patient, multi-center study that we recently conducted has shown that when the cataract surgeon knows in advance that IFIS is a possibility, the doctor can take steps that make the surgery as safe as surgery on a patient who does not display the symptoms of IFIS," says David Chang, M.D., who, along with John R. Campbell, M.D., discovered in 2005 that alpha-blockers cause IFIS. "It's important to have this knowledge, as unanticipated IFIS can cause the iris to get stuck in the incision, damaging the iris and capsule."

Surgeons have a variety of ways of dealing with IFIS, including iris hooks, viscoelastics and/or pharmacological products such as atropine and epinephrine.

"These strategies are complementary and surgeons can use one or more of them if they so choose," adds Samuel Masket, M.D., president of ASCRS.

One of the major problems in getting cataract patients to note their use of alpha-blockers has been a reluctance to reveal the fact that they have a prostate problem.

"Though ophthalmologists ask patients about their medications, some patients neglect to mention alpha-blockers because they believe these medications are irrelevant to eye surgery," says Dr. Masket.

Lawrence Ross, M.D., president of the AUA, noted that alpha-blocker users facing cataract surgery should not discontinue the medication as previously thought. In the recent IFIS study, researchers found that stopping the drug in the weeks prior to surgery did not make a difference in the incidence of IFIS.

"For cataract surgeons, having the information on alpha-blocker use in advance is the critical thing," concluded Dr. Masket. "It can make the difference."

STOCK WATCH A LOOK AT THE PERFORMANCE OF OPHTHALMIC COMPANIES
COMPANY	SYMBOL	6/15 CLOSE	52-WEEK LOW	52-WEEK  HIGH	COMPANY	SYMBOL	6/15 CLOSE	52-WEEK LOW	52-WEEK  HIGH
Advanced Medical Optics	EYE	$48.84	32.04	49.29	Johnson & Johnson	JNJ	65.08	56.65	65.38
Alcon	ACL	114.78	77.66	148.70	LCA-Vision	LCAV	42.44	29.76	58.25
Allergan	AGN	114.33	69.01	117.78	Lumenis	LUME	1.40	1.25	2.90
Bausch & Lomb	BOL	46.32	40.75	87.89	Medtronic	MDT	46.20	47.80	59.17
Becton Dickinson	BDX	69.64	49.71	69.74	Merck & Co.	MRK	40.06	25.30	41.78
The Cooper Companies Inc.	COO	47.38	43.99	78.50	Novartis	NVS	57.08	45.36	56.61
Escalon Medical Corporation	ESMC	4.75	4.33	9.29	Occulogix	RHEO	1.86	1.56	12.85
Genentech	DNA	80.18	43.90	100.20	OSI Pharmaceuticals	OSIP	35.93	20.81	50.20
Halozyme Therapeutic	HTI	2.50	1.50	3.50	Pfizer	PFE	27.24	20.27	27.37
Inspire Pharmaceuticals	ISPH	4.74	4.52	16.81	QLT, Inc.	QLTI	7.59	5.97	17.30
IntraLase	ILSE	17.98	12.26	24.38	STAAR Surgical Inc.	STAA	6.70	3.12	9.53
Iridex	IRIX	8.20	3.65	13.40	Synergetics USA	SURG	5.05	1.40	8.00
ISTA Pharmaceuticals	ISTA	5.92	5.26	11.24	TLC Vision	TLCV	5.62	4.23	8.85

IN THE NEWS

■ Topcon acquires Anka. Topcon Medical Systems, Inc., a leader in ophthalmic instrumentation, has acquired Anka Systems, Inc., which provides networking and software solutions that facilitate digital imaging.

"Anka Systems brings to Topcon advanced Web-based software solutions that dramatically improve workflow for the eyecare professional," said Paul Iwasaki, president of Topcon Medical Systems. "Anka's EyeRoute integrates information from various ophthalmologic instruments into a single, secure, digital environment allowing the eyecare professional instant access to patients' tests in a single document."

"While EyeRoute has been very successful, Topcon brings Anka the additional resources needed to continue our growth and further develop our expanded range of new products, " said Ken Lee, president of Anka Systems.

■ Medicare physician fees. CMS has proposed a cut of 5.1% across-the-board in payments for physician services provided by doctors under Medicare. The cut will take effect on Jan. 1, 2007, unless Congress takes action to roll it back. In recent years, Congress has rolled back proposed cuts in physicians' fees on two occasions.

CMS said the cut was required because spending on doctors' services was increasing faster than expected and faster than the annual goals set by a statutory formula.

■ WaveLight wavefront-guided approval. The FDA has approved WaveLight's wavefront-guided procedure, a LASIK treatment approach that combines the Allegro Analyzer with the 200-hertz Allegretto Wave excimer laser. WaveLight now offers U.S. physicians the choice of wavefront-optimized and wavefront-guided LASIK treatment options, both of which demonstrated similar outcomes in clinical studies.

The wavefront-guided LASIK procedure was approved for the reduction or elimination of up to -7 D of spherical equivalent myopia or myopia with astigmatism, with up to -7 D of spherical component and up to 3 D of astigmatic component at the spectacle plane. The procedure may be performed on patients 18 years of age or older and on patients with documentation of a stable manifest refraction defined as equal to 0.50 D of preoperative spherical equivalent shift over 1 year prior to surgery. The surgeon also can adjust the spherical correction performed by +/- 3 D.

■ Allergan grant program. Allergan, Inc. has created the Allergan Horizon Grant Program, through which the company plans to contribute $1 million over 2 years.

The new program will provide awards to academic medical institutions to support fellows seeking to develop careers in academic medicine. The awards will fund fellowship programs conducting clinical research in the diagnosis or pharmacological treatment of glaucoma and corneal and retinal diseases.

Grant applications should be submitted by the department chair, division chief or fellowship director of the academic institution and must be received by Allergan Medical Affairs, 2525 Dupont Drive, Irvine, CA 92612, no later than Sept. 30, 2006.

■ Video journal available. The Video Journal of Cataract and Refractive Surgery, which highlights new trends, techniques and technologies in both cataract and refractive surgery in a video format, is produced quarterly by Robert Osher, M.D., professor of ophthalmology at the University of Cincinnati. The Video Journal is available on CD, DVD or VHS. For more information, call Glenda Jockers at 513-984-4676, ext. 3239, or e-mail gfjockers@cincinnatieye.com.

■ FedEx supports ORBIS. FedEx Corp. announced it plans to donate $5.5 million over the next 5 years to ORBIS International, a nonprofit organization dedicated to the prevention of blindness worldwide. This pledge represents the largest contribution commitment FedEx has made to ORBIS since joining forces more than 20 years ago to save sight.

■ ROP treatment crisis. A study commissioned by the American Academy of Ophthalmology finds that only half of pediatric and retina specialists currently treat retinopathy of prematurity (ROP) and that one-fifth of these physicians plan to stop taking these infants as patients.

With malpractice settlements in the multimillion dollar range, this study shows an increasing number of physicians are shying away from the field over the past decade, a trend consistent with that of other high-risk medical specialties. The Academy and the American Medical Association will share the survey results with Congress to illustrate the urgency of medical malpractice reform.

GIVING BACK:The Browns: 25 Volunteer Missions
This Husband-and-Wife Team Keeps Their Bags Packed.
By Leslie Goldberg, Assistant Editor

For Robert Brown, M.D., of Clemson, S.C., the notion of donating his skills to those in need began with his residency at the Mayo Clinic in 1976.

At the time, the Mayo Clinic had in place a program in which a finishing resident could choose to volunteer for 3 months in Kaduna, Nigeria. This opportunity came about because of the Biafran war —a civil war in which a great number of people were killed, starved to death or gravely injured. The Guinness Brewery established an eye clinic in Kaduna called the Guinness Eye Clinic. Dr. Brown chose to volunteer there from January through March of 1976.

A young Chinese boy, happy after bilateral cataract surgery.

"The clinic had only one ophthalmologist, and I chose to hone my skills there before starting my own practice. I guess this might sound selfish," explains Dr. Brown. "But while I was there, I was much more impacted by the needs of the people. I was actually helping those that could not have gotten help had I not gone on this mission."

During his 21 years of running a successful practice in the United States, Dr. Brown always had in the back of his mind that there was another ophthalmology practice just down the street from him and another down the street from that one. He realized that while the loss of his one practice might be inconvenient, it would not be devastating, while in Nigeria it would be.

In 1996 he and his wife Susan, a dietician by vocation, decided they would wrap up their practice in Clemson, which his associate was willing to take over. They chose to take an early retirement and began taking 2- to 3-week trips (maximum of 5 weeks on any trip) beginning in 1998. To date, they have completed 25 missions, including six to Ghana, six to Haiti, two to Zambia, two to Nigeria, one to Rwanda, one to Cambodia, two to Vietnam, two to China, one to India, one to Guatemala and one to Nicaragua.

The Browns' local Presbyterian church established a support committee to help the Browns get started. This allowed them to form a tax-exempt entity that could receive donations and supplies.

"Our purpose is to go to places that are unserved," says Dr. Brown. "We want to go to the rural areas or the peripheral clinics where no ophthalmology is provided. By seeking out these more remote places, we encounter poorer people and by not charging them, remove some of the roadblocks that keep them from receiving the proper eye care."

Dr. Brown explains that, to provide that care, many roles need to be filled by only a few people. "Once we got into the field, my wife became administrator, scrub tech and preparer of rooms for surgery. We can set up a clinic and safe operating room with what's in our suitcases." The Browns have learned over time what to take with them so that they do not have to depend on what may or may not be available. A team of three to four people will usually travel with them.

The greatest number of problems they encounter and treat are mature cataracts, pterygiums and eyelid problems, such as those caused by trachoma. These conditions require surgery, so creating conditions amenable to surgery is the real reason for the Browns' success. Dr. Brown says nothing can compare to the first postop morning when a blind person sees again. In addition, they see a lot of glaucoma, which, Dr. Brown says, is very difficult to treat in these locations. "In general, follow-up is the problem for these short-term mission trips," says Dr. Brown. "We try to train a local person who has medical abilities and we leave a written list of instructions to help with any complications. Thank goodness, almost none ever have problems."

Dr. Brown, who is 63, and his wife now donate around 8 weeks a year to these missions and spend the remainder of the year enjoying their retirement. However, much time at home is required in preparation for each trip.

The Browns would like to encourage others who may have an interest in reaching out to the truly desperate and unserved. They can be contacted at either 864-654-6625 or at robrown@bellsouth.net. They can attest to the principle that blessings come much more to the giver than to the receiver. Their "second career" is their most rewarding and memorable.

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Ophthamology Management, Issue: September 2006