Comparing Access to Laser Capsulotomy Performed by Optometrists and Ophthalmologists in Oklahoma by Calculated Driving Distance and Time.

PURPOSE: To quantify Medicare beneficiary proximity to his or her yttrium-aluminum-garnet (YAG) laser capsulotomy-providing ophthalmologist and optometrist in Oklahoma by calculating driving distances and times. DESIGN: Cross-sectional cohort study using 2014 Oklahoma Medicare 100% and 5% data sets and Google Maps distance and travel time application programming interfaces. PARTICIPANTS: U.S. fee-for-service Medicare beneficiaries and Oklahoma ophthalmologist and optometrist laser capsulotomy providers. METHODS: The 2014 Medicare Provider Utilization and Payment Limited 100% and 5% datasets from the Centers for Medicare and Medicaid (CMS) were obtained to identify the office street addresses of Oklahoma ophthalmologists and optometrists who submitted claims to Medicare for a YAG laser capsulotomy, and the county addresses of the corresponding Medicare beneficiaries who received the laser capsulotomy. The shortest travel distances and travel times between the beneficiary and the laser provider were calculated by using Google Maps distance and travel time application programming interfaces. MAIN OUTCOME MEASURES: Beneficiary driving distances and times to his or her YAG laser capsulotomy-providing Oklahoma ophthalmologist and optometrist. RESULTS: In 2014, 90 (57%) of 157 Oklahoma ophthalmologists and 65 (13%) of 506 Oklahoma optometrists submitted a total of 7521 and 3751 YAG laser capsulotomy claims to Medicare, respectively. By using the Medicare Limited 5% dataset, there was no difference in driving distance between beneficiaries who received a laser capsulotomy from an ophthalmologist (median, 39 miles; interquartile range [IQR], 13-113 miles) compared with an optometrist (median, 46 miles; IQR, 13-125 miles; P = 0.93) or in driving time to an ophthalmologist (median, 47 minutes; IQR, 19-110 minutes) compared with an optometrist (median, 50 minutes; IQR, 17-117 minutes; P = 0.76). CONCLUSIONS: For Medicare beneficiaries, there was no difference in geographic access to YAG laser capsulotomy whether performed by an Oklahoma ophthalmologist or optometrist as determined by calculated driving distances and times.

Posterior Surface Opacification of a Silicone Intraocular Lens in a Patient with Asteroid Hyalosis

PURPOSE: In the present study, a case of posterior surface opacification of a silicone intraocular lens (IOL) in a patient with asteroid hyalosis (AH) is reported. CASE SUMMARY: 76-year-old male was referred to our clinic with IOL opacification in his left eye. The patient had uneventful cataract surgery 7 years prior with the same silicone IOL implanted in both eyes. Three years after surgery, posterior capsular opacity was observed in his left eye and neodymium:YAG (Nd:YAG) laser capulotomy was performed. After posterior capsulotomy, opacification of the IOL's posterior surface was observed on slit lamp examination. IOL exchange was performed and the explanted IOL was analyzed using a light microscope and a scanning electron microscope with energy dispersive X-ray spectroscopy for elemental analysis of the deposits. The calcification was on the posterior surface of the IOL and composed mainly of calcium and phosphorus, the main components of AH. The right eye showed clear IOL with intact posterior lens capsule. CONCLUSIONS: Surgeons performing cataract surgery should consider the possibility of surface calcification of silicone IOLs in eyes with AH before IOL selection for implantation.

Femtosecond laser-assisted technique for performing bag-in-the-lens intraocular lens implantation.

We describe a technique for femtosecond laser-assisted bag-in-the-lens (BIL) intraocular lens (IOL) implantation. Anterior capsulotomy and lens division into small pieces are performed by the laser. A fluid-filled interface makes it possible to re-dock the laser to the eye for posterior capsulotomy after the eye has been opened for lens aspiration without complications. The integrated optical coherence tomography also visualizes the posterior capsule, allowing a centered central posterior capsulotomy for uncomplicated IOL positioning. In 31 patients, no complications were observed within a 1-month follow-up. Femtosecond laser-assisted cataract surgery facilitated the BIL technique.