This document summarizes the results of a survey of 20 surgeons who use conductive keratoplasty (CK) to treat refractive errors. The survey found that surgeons have greater confidence in CK since the introduction of the Lighttouch technique, which provides improved clinical outcomes. Most surgeons use CK primarily to treat presbyopia in patients who are interested in an alternative to reading glasses. On average, surgeons perform over 30 CK procedures per quarter and the procedure is profitable at typical fee and volume levels. CK is also effective at generating additional business in LASIK and future IOL procedures. While opinions vary on CK's long-term role, surgeons believe it remains an essential tool in refractive surgery.
Tien Measuring Situation Awareness Of Surgeons In Laparoscopic TrainingKalle
The study of surgeons’ eye movements is an innovative way of assessing skill and situation awareness, in that a comparison of eye movement strategies between expert surgeons and novices may show differences that can be used in training. Our preliminary study compared eye movements of 4 experts and
4 novices performing a simulated gall bladder removal task on a
dummy patient with an audible heartbeat and simulated vital signs displayed on a secondary monitor. We used a head-mounted Locarna PT-Mini eyetracker to record fixation locations during the operation. The results showed that novices concentrated so hard on the surgical
display that they were hardly able to look at the patient’s vital signs, even when heart rate audibly changed during the procedure. In comparison, experts glanced occasionally at the vitals monitor, thus being able to observe the patient condition.
Narrowband ultraviolet B (NBUVB)
phototherapy is a well-established treatment modality
for psoriasis. We performed a retrospective analysis
of children of East Asian descent with psoriasis
treated with NBUVB phototherapy at the National Skin
Centre, Singapore, over a 5-year period between 2004
and 2008 and found that NBUVB phototherapy is safe
and effective for the treatment of psoriasis in children
of East Asian descent.
McKesson helps improve health care quality and patient safety while reducing health care costs.
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Prospective Evaluation of Intra operative Nucleus 22-channel cochlear implant...IJMER
International Journal of Modern Engineering Research (IJMER) is Peer reviewed, online Journal. It serves as an international archival forum of scholarly research related to engineering and science education.
International Journal of Modern Engineering Research (IJMER) covers all the fields of engineering and science: Electrical Engineering, Mechanical Engineering, Civil Engineering, Chemical Engineering, Computer Engineering, Agricultural Engineering, Aerospace Engineering, Thermodynamics, Structural Engineering, Control Engineering, Robotics, Mechatronics, Fluid Mechanics, Nanotechnology, Simulators, Web-based Learning, Remote Laboratories, Engineering Design Methods, Education Research, Students' Satisfaction and Motivation, Global Projects, and Assessment…. And many more.
An assignment for DH Theory 1 was to create an annotated bibliography for a research topic of our choice. This project was designed to challenge our critical thinking and decision making skills. I chose to research dental lasers and their effectiveness in the removal of oral lesions. It was interesting to compare different literature on this subject, and I had a lot of fun determining what articles were valid based on the evidence provided.
ACC 2011 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1210493.do
The American College of Cardiology (ACC) 2011 Scientific Sessions took place in New Orleans and key trials presented at the sessions include: PARTNER cohort A, PARTNER cohort B cost analysis, RIVAL, STICH, MAGELLAN, OSCAR, EVEREST II, PRECOMBAT, RESOLUTE, PLATINUM, ISAR CABG and EXCELLENT.
DISCOVERING ABNORMAL PATCHES AND TRANSFORMATIONS OF DIABETICS RETINOPATHY IN ...csandit
Diabetic retinopathy (DR) is one of the retinal diseases due to long-term effect of diabetes.Early detection for diabetic retinopathy is crucial since timely treatment can prevent
progressive loss of vision. The most common diagnosis technique of diabetic retinopathy is to screen abnormalities through retinal fundus images by clinicians. However, limited number of well-trained clinicians increase the possibilities of misdiagnosing. In this work, we propose a big-data-driven automatic computer-aided diagnosing (CAD) system for diabetic retinopathy severity regression based on transfer learning, which starts from a deep convolutional neural
network pre-trained on generic images, and adapts it to large-scale DR datasets. From images in the training set, we also automatically segment the abnormal patches with an occlusion test,and model the transformations and deterioration process of DR. Our results can be widely used for fast diagnosis of DR, medical education and public-level healthcare propagation.
Tien Measuring Situation Awareness Of Surgeons In Laparoscopic TrainingKalle
The study of surgeons’ eye movements is an innovative way of assessing skill and situation awareness, in that a comparison of eye movement strategies between expert surgeons and novices may show differences that can be used in training. Our preliminary study compared eye movements of 4 experts and
4 novices performing a simulated gall bladder removal task on a
dummy patient with an audible heartbeat and simulated vital signs displayed on a secondary monitor. We used a head-mounted Locarna PT-Mini eyetracker to record fixation locations during the operation. The results showed that novices concentrated so hard on the surgical
display that they were hardly able to look at the patient’s vital signs, even when heart rate audibly changed during the procedure. In comparison, experts glanced occasionally at the vitals monitor, thus being able to observe the patient condition.
Narrowband ultraviolet B (NBUVB)
phototherapy is a well-established treatment modality
for psoriasis. We performed a retrospective analysis
of children of East Asian descent with psoriasis
treated with NBUVB phototherapy at the National Skin
Centre, Singapore, over a 5-year period between 2004
and 2008 and found that NBUVB phototherapy is safe
and effective for the treatment of psoriasis in children
of East Asian descent.
McKesson helps improve health care quality and patient safety while reducing health care costs.
Task Actions
Task Not Started ( 00:00:00 )
*
*
*
*
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Prospective Evaluation of Intra operative Nucleus 22-channel cochlear implant...IJMER
International Journal of Modern Engineering Research (IJMER) is Peer reviewed, online Journal. It serves as an international archival forum of scholarly research related to engineering and science education.
International Journal of Modern Engineering Research (IJMER) covers all the fields of engineering and science: Electrical Engineering, Mechanical Engineering, Civil Engineering, Chemical Engineering, Computer Engineering, Agricultural Engineering, Aerospace Engineering, Thermodynamics, Structural Engineering, Control Engineering, Robotics, Mechatronics, Fluid Mechanics, Nanotechnology, Simulators, Web-based Learning, Remote Laboratories, Engineering Design Methods, Education Research, Students' Satisfaction and Motivation, Global Projects, and Assessment…. And many more.
An assignment for DH Theory 1 was to create an annotated bibliography for a research topic of our choice. This project was designed to challenge our critical thinking and decision making skills. I chose to research dental lasers and their effectiveness in the removal of oral lesions. It was interesting to compare different literature on this subject, and I had a lot of fun determining what articles were valid based on the evidence provided.
ACC 2011 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1210493.do
The American College of Cardiology (ACC) 2011 Scientific Sessions took place in New Orleans and key trials presented at the sessions include: PARTNER cohort A, PARTNER cohort B cost analysis, RIVAL, STICH, MAGELLAN, OSCAR, EVEREST II, PRECOMBAT, RESOLUTE, PLATINUM, ISAR CABG and EXCELLENT.
DISCOVERING ABNORMAL PATCHES AND TRANSFORMATIONS OF DIABETICS RETINOPATHY IN ...csandit
Diabetic retinopathy (DR) is one of the retinal diseases due to long-term effect of diabetes.Early detection for diabetic retinopathy is crucial since timely treatment can prevent
progressive loss of vision. The most common diagnosis technique of diabetic retinopathy is to screen abnormalities through retinal fundus images by clinicians. However, limited number of well-trained clinicians increase the possibilities of misdiagnosing. In this work, we propose a big-data-driven automatic computer-aided diagnosing (CAD) system for diabetic retinopathy severity regression based on transfer learning, which starts from a deep convolutional neural
network pre-trained on generic images, and adapts it to large-scale DR datasets. From images in the training set, we also automatically segment the abnormal patches with an occlusion test,and model the transformations and deterioration process of DR. Our results can be widely used for fast diagnosis of DR, medical education and public-level healthcare propagation.
KinexCONNECT improves patient experience and therapy compliance during recovery from total knee replacement Focus groups conducted by Kinex Medical Company and HealthFactors. Authored by: Mike Buckholdt, BA, MPT, and Ram Rajagopalan, MS, MBA
Presentation from OIS@ASCRS 2016
Mark Packer, MD, Chief Medical Officer
Video Presentation:
https://www.youtube.com/watch?v=CWwqmEDJOhM&index=20&list=PL1dmdBNnPTZJBhQxPOp0vdNg3s3wtN2yw
Background: Nowadays, ICRS are a step in the treatment of keratoconus. The purpose of this study was to evaluate the refractive effect and the tomographic and biomechanical parameters in keratoconus patients implanted with Ferrara ICRS, and their stability after 18 months.
Variability of Corneal Deformation Response in Normal, Keratoconic, and Post-...asclepiuspdfs
Purpose: The purpose of the study was to determine the repeatability of corneal biomechanical properties obtained with Corvis-ST in normal, keratoconic, and post-LASIK eyes and compare the results between groups. Material and Methods: A total of 30 eyes of 15 subjects in each of the normal, keratoconus, and post-LASIK groups underwent Corvis-ST measurements. The intra-observer intraclass correlation coefficient (ICC) and precision were calculated to evaluate the repeatability of measurements for each group. One-way ANOVA and post hoc test were used for comparison of precision between groups.
Head-to-Head Comparative Study of Two Optical Biometric Devices in Modern Cat...SM2 Strategic
Today's cataract surgeon has adopted non-contact optical
biometry as the standard of care in performing IOL calculations.
While modern formulae incorporate multiple variables as part
of their calculations, Axial Length and Keratometry readings
continue to be the inputs that are most influential in determining
IOL power. Some of the newer generation formulas such as
Holladay 2 and Olsen now incorporate more elements to help
increase accuracy.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. TODAY’S PRACTICE
CK: Worth a
Second Look?
Conductive keratoplasty and its role as a primary and a rescue procedure.
BY SHAREEF MAHDAVI
This is the second in a series of articles with the additional goal of understanding patients’
that highlights results from market stud- motivation and management with this procedure. We
ies on topics of interest to refractive sur- also collected data on the practices’ recent refractive
geons. These studies comprise original procedural volume and pricing to understand where
research conducted by SM2 Consulting of CK fits economically within them. Finally, we conduct-
Pleasanton, California. ed additional interviews with three corneal specialists
Refractive surgery has evolved beyond to discuss emerging therapeutic uses of CK (see the
the era when it was defined by a single procedure such sidebar, Refractive Rescue).
as RK and then LASIK. Today, there are laser and non-
laser corneal treatments and the first of many IOLs for C L I N I C A L O U TCO M E S A N D U S E S
lenticular treatments. Conductive keratoplasty is one Without question, the Lighttouch technique is allow-
procedure in the refractive arsenal that has struggled to ing CK to produce better results today than it was a
find its best fit in the ophthalmic practice. Among year or more ago. Eighteen of 20 surgeons had experi-
refractive surgeons, opinions seem to vary widely regard- ence with both the new and original techniques and
ing the procedure’s utility and whether or not invest- could draw direct comparisons between the two treat-
ment in it makes sense. In mid-2004, the manufacturer ment methods. Lighttouch offers the surgeon the abili-
of the Viewpoint CK device, Refractec, Inc. (Irvine, CA), ty to treat with fewer spots in a single ring placed far-
launched a refinement to its CK technique called ther outside the optical zone. The technique achieves a
Lighttouch, which involved using less forceful compres- greater refractive effect and nearly eliminates the in-
sion with the radio-frequency delivery tip. As a product duced cylinder observed postoperatively with the con-
upgrade, Lighttouch was expected to offer a significant ventional CK method. These improved results have led
improvement in outcomes and patient satisfaction. to a much higher degree of surgeon confidence in the
Refractec, Inc., asked SM2 Consulting to independ- procedure. As Figure 1 shows, confidence on a 10-point
ently interview a group of surgeons from its user base
to better understand current attitudes toward the CK
procedure—especially Lighttouch—and its ongoing
role in refractive surgery.
M E T H O D O LO G Y
My staff and I developed a set of research objectives,
a discussion guide, and data-collection processes, and
we conducted research interviews from a sample of 20
practices currently using the CK with Lighttouch tech-
nique. The practices represented a wide distribution by
geography and practice type. Most of the surgeons we
interviewed had been using the CK device for several
years (mean = 2.6 years), with a range that included a
relatively new user (3 months) and two of the original Figure 1. Surgeons’ rating of their confidence in the CK pro-
clinical investigators (7 years’ experience each). Questions cedure was heavily weighted toward the high end of the 10-
focused on users’ current clinical experience with CK, point scale. No surgeon placed his confidence below a 7.
SEPTEMBER 2005 I CATARACT & REFRACTIVE SURGERY TODAY I 97
2. TODAY’S PRACTICE
REGISTER TODAY!
The Evolution
of NearVision CK
Seminar Series for Surgeons Figure 2. This graph shows the percentage of practices using
CK by indication. Multiple responses were allowed.
CME Breakfast Symposium
scale received an average score of 8.6, with no surgeon
rating his confidence in the procedure below a 7. Many
SUNDAY, OCTOBER 16, 2005 surgeons remarked that this sentiment is much higher
7:00-8:30 AM than what they would have expressed if asked this
question a year ago.
All 20 surgeons said that their primary use for the pro-
PENINSULA HOTEL cedure is with plano presbyopes, whereas only 30% of
them indicated using it with mild hyperopes (Figure 2).
CHICAGO, ILLINOIS
This is a dramatic shift between the procedure’s first
indication (for hyperopia) and the more recent approval
INVITED FACULTY for presbyopic treatment. Additional uses included
Daniel S. Durrie, MD LASIK refinement (55%) and IOL refinement (25%).
Overland Park, Kansas
RETURN ON
Jack T. Holladay, MD I N V E S TM E N T — TO DAY
Houston, Texas We analyzed the return on investment to under-
stand whether Refractec’s Viewpoint CK device could
Shareef Mahdavi indeed pay for itself in a typical practice. Surgeons pro-
Pleasanton, California vided data on procedural volume and pricing for the
first quarter of 2005. As Figure 3 shows, the largest sub-
group of surgeons performed between 20 and 49 CK
TO R EGI ST ER
procedures during the quarter. The average number of
• Online: www.CRSToday.com/refractec eyes treated with CK by all the surgeons was 32, and
• Fax: 484-581-1818 the median number of eyes treated with CK was 18.6
during the quarter. The more conservative average is
• Phone: 484-581-1827 preferable given the wide range of procedural volumes
• E-mail: aargenbright@bmctoday.com (0 to 120 eyes treated). We found no correlation
between CK and LASIK volumes. The highest- and low-
The Dulaney Foundation is accredited by the Accreditation Council for est-volume CK surgeons interviewed were also the
Continuing Medical Education to sponsor continuing education for physicians. highest-volume LASIK surgeons in this sample. Impor-
tantly, surgeons also indicated that their CK volumes
The Dulaney Foundation designates this continuing medical education activity are increasing rapidly due to their improved results
for a maximum of 1 category 1 credit toward the AMA Physician’s Recognition
Award. Each physician should only claim those hours of credit that he/she
with the Lighttouch technique.
actually spent in the educational activity. The average collected fee per CK treatment was
$1,637 (range: $1,250 to $2,000), and treatments were
typically unilateral. Using these figures, treating two
eyes or more per month justifies the cost of the
Jointly sponsored by The Dulaney Foundation and Cataract
& Refractive Surgery Today. Supported by an unrestricted
educational grant from Refractec.
3. Viewpoint CK device, and all but one of the surgeons
interviewed met this criterion. REGISTER TODAY!
S P I L LOV E R E F F E C T
Although not directly measured, surgeons also indi-
cated that CK is effective at building their LASIK proce- Embracing New Monofocal
dural volume. Sixteen of the 20 surgeons interviewed
conduct external marketing for their services and, on IOL Technologies: Pearls and
average, 22% of their budgets is devoted to CK. This
boost in overall volume makes sense, as news stories Clinical Outcomes
and advertising about any visual-performance treat-
ment are likely to generate interest in all refractive pro-
cedures. Anecdotally, surgeons noted that inquiries Seminar Series for Surgeons
about CK often lead to LASIK procedures, and vice
versa. CME Breakfast Symposium
FUTURE BUSINESS
One surprise finding in this survey was the essential MONDAY, OCTOBER 17, 2005
role that CK played as part of a strategy to secure future 7:00-8:30 AM
IOL business. For surgeons with a long-term view of
growing their refractive businesses, offering CK provides LE MERIDIEN
a means of establishing a relationship with patients who CHICAGO, ILLINOIS
would otherwise not seek surgical treatment for another
10 to 15 years. By leveraging the less invasive (and less EDUCAT I O NAL OBJECTIVE
expensive) aspects of this procedure relative to a refrac-
To elevate the surgeon's understanding of the benefits of
tive IOL, CK allows the surgeon to form a bond with
patients and begin a dialog that will continue years later. new aspheric-optic IOLs and the clinical pearls and pit-
The surgeons in this study also reported that many falls to look for with these new-technology IOLs.
patients who are attracted to CK (1) have never been
under the care of an eye doctor, (2) have been told INVITED FACULTY
that there was nothing that could be done for their Warren E. Hill, MD
presbyopia (and sent to the drugstore for some inex- Mesa, Arizona
pensive reading glasses), or (3) are too fearful to con-
sider LASIK, much less an IOL implant. Thus, CK Jim Schwiegerling, PhD
becomes an entry point for these patients by which to Tucson, Arizona
ease into eye care services. Kerry D. Solomon, MD
Encino, California
TO R EGI ST ER
• Online: www.CRSToday.com/alcon
• Fax: 484-581-1818
• Phone: 484-581-1827
• E-mail: aargenbright@bmctoday.com
The Dulaney Foundation is accredited by the Accreditation Council for
Continuing Medical Education to sponsor continuing education for physicians.
The Dulaney Foundation designates this continuing medical education activity
for a maximum of 1 category 1 credit toward the AMA Physician’s Recognition
Award. Each physician should only claim those hours of credit that he/she
actually spent in the educational activity.
Figure 3. This graph shows the number of CK eyes treated in
the first quarter of 2005.
Jointly sponsored by The Dulaney Foundation and Cataract
& Refractive Surgery Today. Supported by an unrestricted
educational grant from Alcon.
4. TODAY’S PRACTICE
A P P E A L I N G TO C K
REFRACTIVE RESCUE: CK’S ROLE AS A THERAPEUTIC DEVICE
C A N D I DAT E S
Corneal specialists David Hardten, MD, of Minneapolis, Minnesota; Peter Hersh, MD, The patient who wants CK is
of Hackensack, New Jersey; and Marc Michelson, MD, of Birmingham, Alabama, shared not likely to be found in the
their perspectives on the therapeutic uses of conductive keratoplasty (CK; Refractec, waiting room of a typical oph-
Inc., Irvine, CA) and its emergence as an essential tool for the corneal surgeon. thalmologist’s practice. Rather,
Dr. Michelson acquired his Nearvision CK device (Refractec, Inc.) just after the he fits somewhere between the
FDA approved it for refractive procedures. He quickly realized that it could be an typical LASIK patient (younger,
ideal tool for managing corneal astigmatism. With the ability to change the cornea’s myopic, has not enjoyed un-
shape within 0.6 seconds, he began correcting irregular astigmatism of all causes, aided vision for years) and the
including trauma, the cataract wound, and previous refractive surgery “gone bad.” typical IOL patient (older, has
Dr. Hersh concurred. He has been using CK heavily with post-LASIK patients who other age-related health issues).
are still unhappy after multiple enhancements. “All corneal surgeons need this as an Many patients who choose CK
adjunctive tool,” commented Dr. Hersh. “Not having CK available is like not having have never had a relationship
the ability to put in a compression suture.” with an eye care professional
All three specialists said they appreciate the “instantaneous fix” radio-frequency and only now need visual help.
energy creates when applied to the cornea. Therapeutic CK offers an immediate Blessed with good distance
visual improvement and fast recovery with no discomfort. “This is truly appreciated vision all their lives, they reach
by patients, many of whom are desperate for even a slight improvement in acuity or their late 40s to find themselves
image quality,” remarked Dr. Hardten. increasingly frustrated and even
The Nearvision device’s handheld probe allows more precise, localized use on the angry at their inability to per-
cornea relative to an excimer laser, said Dr. Hardten. Although not as titratable as the form near and intermediate
excimer laser, the CK procedure has the benefit of simply contracting or molding visual tasks. Such frustration can
corneal tissue, which is of high value when tissue is at a premium. This level of versatili- be classified in the context of
ty has enabled Dr. Hardten to use the procedure after penetrating keratoplasty, after the physical and emotional toll
RK, and in keratoconic patients who are not appropriate candidates for other forms of getting older. In addition,
of refractive surgery. many feel that there is nothing
The physicians agreed that corneal topography helps them plan and reconcile
aesthetically redeeming about
therapeutic CK cases. Additionally, the intraoperative assessment of keratometry
wearing reading glasses. The CK
and a reflected ring light or placido disc provides guidance in placing the treatment
candidate comes in saying, “I
spots. Dr. Hersh noted, “The surgeon should define an endpoint to the procedure in
look and feel old.” The surgeons
the preoperative plan.”
in this study reported that their
ART VERSUS SCIENCE average CK patient was 48 to 52
All three surgeons commented that therapeutic CK procedures demand a high de- years of age, which can be
gree of artistry. “CK requires far more thought and technique than LASIK,” said Dr. Hersh. among the most active and
Dr. Michelson likened the approach to “fighting fire with fire”: to treat astigmatism with financially productive years of a
CK, one has to create an opposite effect of equal strength. Yet, the outcomes their CK person’s life.
patients are achieving make the extra time worthwhile. The three reported that the Similar to research conducted
procedure allows them to resolve a lot of patients’ visual complaints. about patients’ motivation for
Surgical goals with the procedure are more conservative than those of a primary sur- undergoing LASIK, our study
gery, including the recovery of BCVA, the removal of ghost images, and the ability to showed that the CK patient
again wear contact lenses. CK involves the selective application of low-level energy spots wants to reduce his dependency
at 8 to 9mm from the visual axis, a safety profile that carries virtually no downside. on reading glasses and improve
his visual performance. In the
GAINING EXPERIENCE context of presbyopia, perform-
Dr. Michelson is now analyzing the results from 250 therapeutic CK cases with 2 years ance means being able to read
of follow-up in preparation for publication. Dr. Hersh will present data from 150 eyes at cell phones, price tags, menus,
this year’s AAO meeting in Chicago. Dr. Michelson summed up what is on the hori- and newspapers without read-
zon: “Therapeutic CK is an undiscovered and invaluable tool that most surgeons ing glasses. CK’s minimal inva-
don’t know about yet. We are just scratching the surface of this tool and how much siveness, affordability, and abili-
it can help us help our patients.” ty to restore vision to a quality
previously enjoyed resonate
100 I CATARACT & REFRACTIVE SURGERY TODAY I SEPTEMBER 2005
5. TODAY’S PRACTICE
predictability with less risk than an intraocular implant.
Admittedly, however, they lacked enough data to evalu-
ate whether or not a multifocal ablation or an inlay
would be efficacious in real-world clinical practice. Only
time will tell. Furthermore, although these surgeons
expected advances beyond CK, it was still an important
tool in their refractive practice today.
In spite of differing opinions about the future, all 20
surgeons interviewed believed that CK was an essential
surgical tool and would purchase the system again if
given the choice today.
SU M M ARY
This survey yielded several key findings that should
prove helpful to surgeons who are considering adopting
the technology as well as to current CK users who wish
to increase their use of and success with it.
• Not unlike other eye care technologies such as
phacoemulsification or corneal excimer laser ablation,
CK has undergone refinements that have improved its
Figure 4. Surgeons in the survey had varied predictions for outcomes.
where they saw CK in the next 3 to 5 years. • The ideal CK patient is different from other oph-
thalmic patients. The former requires time to become
deeply with this mature, conservative age group that educated about and interested in CK. This was also true
has had good vision for 50 years. of laser vision correction in its early days.
• Surgeons need to approach CK differently than
CK’S ROLE IN THE FUTURE LASIK. Patients’ expectations for CK and the manage-
Refractive surgery is a field rapidly advancing, with ment of those expectations are indeed different from
many developments geared toward alleviating presby- those of LASIK patients.
opia. Some promising innovations include accommo- • The low acquisition cost of the Viewpoint CK
dating, multifocal, and phakic IOLs; corneal inlays and device makes it easily justifiable; its break-even proce-
onlays; and presbyopic (multifocal) LASIK. Even with dural volumes are a fraction of what is required with
these potentially more advanced developments on the LASIK. Further, CK has an additive effect on existing
horizon, 80% of surgeons interviewed (16 of 20) be- LASIK procedural volume and can be used as a tool for
lieved that CK would still be important during the next future growth of the practice with advanced IOLs.
3 to 5 years (Figure 4). This majority was impressed • Despite more advanced technology on the horizon,
with CK’s safety profile and what it offers to patients CK is destined to have a role within the ophthalmic
who are averse to risk. Half of this majority (eight indi- practice due to its strong safety profile relative to exist-
viduals) believed CK would grow into a big player in ing and emerging technologies designed for the presby-
the refractive field. They viewed its widespread market opic population.
adoption as only a matter of time, considering the • Therapeutic uses for CK are just beginning to
growing awareness and acceptance of the procedure emerge, with several key, large studies currently under-
among both surgeons and patients. The other half of way. Leading corneal specialists view CK as a tool that
this majority saw CK as remaining an important niche allows them to rescue less-than-desirable outcomes
player, much as it is today, with its role limited to a step from other refractive procedures or ocular trauma. ■
before the full refractive correction offered by LASIK
for pre-presbyopes and by an IOL for presbyopes, with Shareef Mahdavi draws on 20 years of medical device
and without a cataractous lens. marketing experience to help companies and providers
The remaining 20% of surgeons interviewed (four of become more effective and creative in their marketing and
20) felt that CK would become obsolete once presby- sales efforts. Mr. Mahdavi welcomes comments at (925)
opic LASIK or a corneal inlay became available. They 425-9963 or shareef@sm2consulting.com. Archives of his
hoped that a different solution would provide better monthly column may be found at www.crstoday.com.
SEPTEMBER 2005 I CATARACT & REFRACTIVE SURGERY TODAY I 101