http://www.melbourneeyecentre.com.au/index.htmlHot News!enjoseph@melbourneeyecentre.com.auCopyright 2010 Melbourne Eye Centre2011-10-13T23:50:10+11:00 hourly 1 2000-01-01T12:00+00:00 Mon, 25 Jan 2010 11:57:01 +1100joseph@melbourneeyecentre.com.auNews2011-10-13T23:50:10+11:00http://www.melbourneeyecentre.com.au/page8/files/61efa6b7b4cd7c5ca51f50543b236c53-20.html#unique-entry-id-20http://www.melbourneeyecentre.com.au/page8/files/61efa6b7b4cd7c5ca51f50543b236c53-20.html#unique-entry-id-20
This subject is increasingly being raised in discussion when patients come to see me for cataract surgery.

The committee at the Victoria Parade Surgical Centre where we regularly operate, recently met to discuss the possibility of purchasing one of these devices. To date there are two in operation in NSW only. After the meeting it was decided that we not be acquiring one. The reasons are as foliows. The machine cost more than half a million dollars and the on going maintenance nearly $100,000 per annum. Further the per patient cost is $500. In order for the centre to break even per patient, an additional cost of more than $1500 needs to be imposed on each patient. Now who in their right mind would want to pay this additional sum for their cataract surgery? Particularly since there is no tangible benefit other than to be able to boast that their surgery was done by the state of the art method.

If there was a markedly better outcome or increased safety then maybe, but there isn’t either. Thus at present this type of surgery is nothing more than a marketing gimmick. Now make no mistake, that in the future it will probably be the way to go, but until it becomes significantly cheaper it will not become mainstream.

All that can be said about it is that it is just a “different” way of performing an already excellent operation, not a better way.]]>joseph@melbourneeyecentre.com.auNews2011-10-12T17:55:16+11:00http://www.melbourneeyecentre.com.au/page8/files/e993491d253955f08ec86f9844ab7ffa-19.html#unique-entry-id-19http://www.melbourneeyecentre.com.au/page8/files/e993491d253955f08ec86f9844ab7ffa-19.html#unique-entry-id-19Melbourne Eye Centre will be adopting the new SMI toric alignment technology as part of the surgical workflow.

One of the most difficult aspects of both cataract surgery and refractive surgery, is the accurate alignment of a toric lens.
Furthermore, the position of the surgical wound and or timbal relaxing incisions is critically important and has profound impact on the final. post operative refraction.
This will be made significantly easier with a new eye tracker shortly to be introduced.
The device allows for a scan of the iris to be performed at the time of the consultation which is then “tracked” during surgery and ensures precision placement of surgical wounds and alignment of toric lenses.
Toric lenses in particular are very dependent on alignment as every 10 degrees of misalignment results in loss of 30% of the power of the toric. Thus a 30 degree would mean a complete loss of the toric power.
The link for more information is here]]>joseph@melbourneeyecentre.com.auNews2011-05-31T23:10:52+10:00http://www.melbourneeyecentre.com.au/page8/files/5a41ae9c7b2f71fce9736a8036998a4b-18.html#unique-entry-id-18http://www.melbourneeyecentre.com.au/page8/files/5a41ae9c7b2f71fce9736a8036998a4b-18.html#unique-entry-id-18We are now next door to the Eye and Ear hospital and across the road from St Vincent’s hospital.
MELG is now a walk away
We will be having our grand opening in the next month]]>joseph@melbourneeyecentre.com.auNews2011-02-12T22:56:56+11:00http://www.melbourneeyecentre.com.au/page8/files/e650865eb39d36957590415d39357677-17.html#unique-entry-id-17http://www.melbourneeyecentre.com.au/page8/files/e650865eb39d36957590415d39357677-17.html#unique-entry-id-17This saves the bother of having to come into our office to do so]]>joseph@melbourneeyecentre.com.auNews2010-09-26T16:40:07+10:00http://www.melbourneeyecentre.com.au/page8/files/8835047ea0f6754a618c96ca1d322006-16.html#unique-entry-id-16http://www.melbourneeyecentre.com.au/page8/files/8835047ea0f6754a618c96ca1d322006-16.html#unique-entry-id-16Links are here and here and the flyer is here.]]>joseph@melbourneeyecentre.com.auGlaucoma2010-09-22T23:31:51+10:00http://www.melbourneeyecentre.com.au/page8/files/b82ee9d2b83eceb1713f36d31470e991-15.html#unique-entry-id-15http://www.melbourneeyecentre.com.au/page8/files/b82ee9d2b83eceb1713f36d31470e991-15.html#unique-entry-id-15The important outcomes of this were that it is now understood that SLT is not an all or none phenomenon. That is to say, it was thought that once it had been performed, whatever effect it produced that was it. It was thought that if there was only a less than optimal result, then additional medication was required. It is now known that if there a reasonable pressure lowering effect but not to target pressure then further SLT would produce an additive, further lowering. Further it is also known that the amount of SLT required is less than previously thought at each sitting. It is also apparent that a full 360 of SLT produces a greater pressure lowering effect than say only 180.
Full discussion as well as a round of of interesting presentation from the meeting will shortly follow in a full report.]]>joseph@melbourneeyecentre.com.auCataract2010-08-30T22:34:40+10:00http://www.melbourneeyecentre.com.au/page8/files/9c3d847385b772a28501393a03ad109d-14.html#unique-entry-id-14http://www.melbourneeyecentre.com.au/page8/files/9c3d847385b772a28501393a03ad109d-14.html#unique-entry-id-14
Prior to surgery
A thorough examination of the fundus should be performed to determine if there is any pre-existing disease and if there is then all attempts should be made to stabilise it. This may include liaising with their endocrinologist to optimise blood glucose control, performing a pan retinal photocoagulation if there is proliferative disease or focal laser if there is clinically significant macular oedema. Additionally, it may be necessary to use intravitreal injections of anti VEGF medication or steroids. Any pre-existing neovascularization of the iris or angle should be managed by PRP as it can lead to neovascular glaucoma. Preoperative OCT is useful to determine if there is any preexisting, subclinical oedema as this is likely to get worse.

Surgical technique
Surgical planning should include the use of acrylic, monofocal lenses. Siilcone should be avoided in case retinal surgery with vitrectomy is required at a later date. Silicone can be used in patients who have very stable disease and are unlikely to progress.
Multifocal IOL should be avoided if there is any history of macular oedema or likelihood of developing it in the future as it can seriously degrade vision. Monofocal or toric lenses are preferred in these patients

Surgical technique needs to be gentler than normal, with the use of less phaco energy and with less fluid infusion during the surgery. Avoiding stretching or contact with the iris is important to minimise release of inflammatory mediators.
Often the pupil dilates poorly making surgery more challenging. In these patients it may be necessary to use intracameral phenylephrine, iris hooks or Malyugin ring.
In some patients who are at risk of developing progressive disease, intravitreal triamcinalone or or anti VEGF medication is given intravitreal at the end of the case.

Postoperative

In eyes with significant retinopathy, cataract surgery may lead to progression. In those with no or minimal retinopathy, cataract surgery is less likely to do so. For this reason it is often beneficial to perform surgery earlier.
Topical steroids are given but in addition, topical non steroidal medication are used to minimise post operative inflammation. Macular thickness can be evaluated at serial postoperative visits using the OCT.
Diabetics need to make every effort to control their blood sugar in the immediate post operative period to minimise progressive disease.
Posterior capsular opacification and persistent inflammation is more common in theses patients.

In summary, cataract surgery in diabetic patients is more challenging and should be performed by more experienced surgeons.

]]>joseph@melbourneeyecentre.com.auNews2010-08-18T22:44:29+10:00http://www.melbourneeyecentre.com.au/page8/files/3d3a920ba044af3854981454a2eccdf5-13.html#unique-entry-id-13http://www.melbourneeyecentre.com.au/page8/files/3d3a920ba044af3854981454a2eccdf5-13.html#unique-entry-id-13joseph@melbourneeyecentre.com.auNews2010-08-18T22:42:19+10:00http://www.melbourneeyecentre.com.au/page8/files/c3aeb5966c8042c6044468b10d2775de-12.html#unique-entry-id-12http://www.melbourneeyecentre.com.au/page8/files/c3aeb5966c8042c6044468b10d2775de-12.html#unique-entry-id-12Twitter. I expect that there will be plenty of new happenings in the areas of both cataract and refractive surgery]]>joseph@melbourneeyecentre.com.auGlaucoma2010-06-06T21:36:26+10:00http://www.melbourneeyecentre.com.au/page8/files/1ba8cdd9559a05a1401991a08209801e-11.html#unique-entry-id-11http://www.melbourneeyecentre.com.au/page8/files/1ba8cdd9559a05a1401991a08209801e-11.html#unique-entry-id-11Australian College of Optometry National Conference 2010.
I will be presenting the topic “Secondary glaucomas: Facts I wish I had known earlier"
It will be a the Radisson Hotel on Flagstaff Gardens , on Saturday 16 October at 2.45 pm

Attendance is only for registered participants only.]]>joseph@melbourneeyecentre.com.auGlaucoma2010-05-30T23:49:56+10:00http://www.melbourneeyecentre.com.au/page8/files/6139d1049f84ded2ea8f9f7603f330d6-10.html#unique-entry-id-10http://www.melbourneeyecentre.com.au/page8/files/6139d1049f84ded2ea8f9f7603f330d6-10.html#unique-entry-id-10spectralis OCT. This will be operational hopefully mid June. The spectralis OCT is THE market leader in OCT boasting the highest resolution of all the currently available OCT’s.
This will greatly enhance our ability to detect and follow glaucoma.
It will also of course enable us to detect retinal pathology such as macular degeneration, cystoid macular oedema, macular holes and other pathologies.]]>joseph@melbourneeyecentre.com.auNewsletters2010-03-21T23:00:46+11:00http://www.melbourneeyecentre.com.au/page8/files/3e1e463fddf1de624884dd4c249c737f-9.html#unique-entry-id-9http://www.melbourneeyecentre.com.au/page8/files/3e1e463fddf1de624884dd4c249c737f-9.html#unique-entry-id-9here for download from the downloads page]]>joseph@melbourneeyecentre.com.auCataract2010-03-21T15:58:53+11:00http://www.melbourneeyecentre.com.au/page8/files/3b862bf869ad382cf0f6f310c681b8c7-8.html#unique-entry-id-8http://www.melbourneeyecentre.com.au/page8/files/3b862bf869ad382cf0f6f310c681b8c7-8.html#unique-entry-id-8
My ow view, which is shared by others, is the best approach is to reduce the amount of SIA by the use of small corneal wounds and controlling any astigmatism by either the use of toric lenses or by Limbal Relaxing Incisions (LRI’S).
For a number of years I have been performing 2.4mm wounds which in my hands still induce 0.25-0.5 diopters of SIA. Most recently I have moved to 2.2mm as new blades have become available. The rate limiting step at present is the size required to implant an Acrysoft lens. At present these are my preferred lenses as they have the lowest posterior capsular opacification (PCO) rates and the best toric platform to date. Baush and Lomb do make a lens that can be implanted through a 1.8 mm wound, but these lenses have much higher PCO rates.
It remains to be seen what effect, reducing my wound size has on SIA. Another benefit of going to a smaller wound is of course a lower risk of wound leak and a lower risk of endophthalmitis.]]>joseph@melbourneeyecentre.com.auNews2010-03-06T14:09:10+11:00http://www.melbourneeyecentre.com.au/page8/files/7a24d0a9f340ec7ea839060a1ddd0579-7.html#unique-entry-id-7http://www.melbourneeyecentre.com.au/page8/files/7a24d0a9f340ec7ea839060a1ddd0579-7.html#unique-entry-id-7I will be giving a talk on photography and my experiences.
This is as a consequence of my patients seeing my photographic exhibition in my waiting area.
I trained in photography and have a Diploma of Illustrative Photography from Photography studies college prior to my medical training.
Attendance is open to the general public]]>joseph@melbourneeyecentre.com.auGlaucoma2010-03-06T13:53:20+11:00http://www.melbourneeyecentre.com.au/page8/files/3e8e32a40608c14bc51d31834cc6a129-6.html#unique-entry-id-6http://www.melbourneeyecentre.com.au/page8/files/3e8e32a40608c14bc51d31834cc6a129-6.html#unique-entry-id-6It will be in the Fritz Loewe building at the University of Melbourne from 10.00am to 1.00pm.
The seminar is on the surgical management of glaucoma. It will include discussion on laser treatment as well as surgical options such as trabeculectomy and valve implantation
Attendance is restricted to those optometrists enrolled]]>joseph@melbourneeyecentre.com.auLasik2010-03-03T22:52:13+11:00http://www.melbourneeyecentre.com.au/page8/files/5aa461bf7cfdfece3eb70c2867810dd2-5.html#unique-entry-id-5http://www.melbourneeyecentre.com.au/page8/files/5aa461bf7cfdfece3eb70c2867810dd2-5.html#unique-entry-id-5There is emerging evidence that in most cases it is actually an exacerbation of pre-existing dry eye rather than being actually caused by the surgery.
There is no doubt however that the inevitable severing of corneal nerves that occurs during the procedure is a major contributor to this problem. As such it is less common with INTRALSE than in cases where a free corneal flap is created. It is also considerably less common with PRK.

Most patient can expect dry eyes and in some cases this can last up to 6 months.
If dry eye is detected at the initial assessment, it should be treated with intensive use of topical lubricants as well as topical FML four times per day for several weeks prior to the surgery. Similarly this should also be instituted post procedure more some months. In the USA, topical cyclosporine is available but alas not us here in OZ land.

read full story]]>joseph@melbourneeyecentre.com.auNews2010-03-03T22:50:48+11:00http://www.melbourneeyecentre.com.au/page8/files/096228f8ca2feb584ae3fe287574e182-4.html#unique-entry-id-4http://www.melbourneeyecentre.com.au/page8/files/096228f8ca2feb584ae3fe287574e182-4.html#unique-entry-id-4joseph@melbourneeyecentre.com.auCataract2010-02-18T21:58:57+11:00http://www.melbourneeyecentre.com.au/page8/files/1b962caa6efb6a4115f7d0fb0999ad1e-3.html#unique-entry-id-3http://www.melbourneeyecentre.com.au/page8/files/1b962caa6efb6a4115f7d0fb0999ad1e-3.html#unique-entry-id-3The most common technique used for anaesthesia during cataract surgery or clear lens exchange is a peribulbar or retrobulbar injection. This is very effective but carries risks. These risks include globe perforation, accidental injection of an extraocular muscle which can result in diplopia (double vision) and of course the fear that patients have of an injection in the eye. A newer method is the use of topical (anaesthetic drops) instead. This is a more challenging method for the surgeon as the eye is mobile (unlike injections in which there is total eye immobility). It is also more challenging for patients because they are more aware of touch and the speculum which is used to hold the lids open. Despite this however patients seem to overall prefer this method. We are presently running a trial in which half our patients receive topical and the other half get the standard injections. To date the vast majority prefer topical. Once this trial is completed, we plan to publish our results.]]>joseph@melbourneeyecentre.com.auNews2010-02-07T18:12:45+11:00http://www.melbourneeyecentre.com.au/page8/files/564c86c1955b5be227c2674799c43d88-2.html#unique-entry-id-2http://www.melbourneeyecentre.com.au/page8/files/564c86c1955b5be227c2674799c43d88-2.html#unique-entry-id-2I will be conducting a grand rounds in which I will present interesting cases in cataract, refractive surgery and glaucoma.

I will be discussing the new Crystalens HD and my experiences with it. I will also be discussing the soon to be available Calhoun lens which promises to be exciting.
Hope to see you all there.
]]>joseph@melbourneeyecentre.com.auNews2010-02-01T00:04:02+11:00http://www.melbourneeyecentre.com.au/page8/files/2d8a3b443db8292031506465406d37c7-1.html#unique-entry-id-1http://www.melbourneeyecentre.com.au/page8/files/2d8a3b443db8292031506465406d37c7-1.html#unique-entry-id-1Instead it has reduced it by only 12% and will not index the amount to inflation for at least the next few years.
At least patients cataract surgery will only have a small out of pokect cost.
See link to articles here, here, here, here and here.
Also here is the AMA press release.]]>joseph@melbourneeyecentre.com.auNews2010-01-26T13:07:20+11:00http://www.melbourneeyecentre.com.au/page8/files/bca0dbcd4bf8c97b2e5aa88e3048f17b-0.html#unique-entry-id-0http://www.melbourneeyecentre.com.au/page8/files/bca0dbcd4bf8c97b2e5aa88e3048f17b-0.html#unique-entry-id-0Over time I will add updates regarding goings on in our practice, such as new procedures or educational events.
Also, as new technologies or techniques come to light, I will write about them here.

as were are early adopter, techno-junkies, you can rest assure that if some new happens, you’ll read about it here.

jsl ]]>