When and How to Incorporate Steroids for Persistent Diabetic Macular Edema: A Discussion of Real-World Treatment Optimization Strategies.

In the United States, diabetic macular edema (DME) is the leading cause of vision loss among people with diabetic retinopathy. Despite the availability of different therapies for DME, up to half of patients with DME show some persistent edema after anti-vascular endothelial growth factor (VEGF) treatment alone, leaving these patients at high risk for vision loss. However, dosing in a similar fashion to that of pivotal anti-VEGF trials is difficult because of real-life challenges faced in clinical practice. This is particularly true for DME, in that the frequency and burden of anti-VEGF injections are a major challenge to patient care. Research evaluating anti-VEGF therapies has shaped the treatment paradigms for patients with DME, and similar benefits have also been noted in clinical trials evaluating the use of intravitreal steroids. Treatment with a long-term intravitreal corticosteroid, which requires fewer injections than treatment with most short-acting therapies, has been found to reduce inflammation and improve vision in a percentage of patients. This roundtable discussion, which took place during the 2018 annual meeting of the Vit-Buckle Society, reviews the current treatment paradigms for DME and evaluates how to customize and optimize treatment strategies geared toward individualized patient care. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:S5-S15.].

Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagnosis and treatment.

Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition.

Presbyopia-correcting intraocular lenses.

PURPOSE OF REVIEW: Multifocal and accommodating intraocular lenses (IOLs) were introduced 2 decades ago and have gone through several iterations. This technology has allowed ophthalmologists to provide their cataract surgery patients with a broader range of visual function. The purpose of this article is to discuss the currently available presbyopia-correcting IOLs, the role of patient selection, and future technologies. RECENT FINDINGS: Newer versions of both the multifocal and accommodating IOLs offer better vision at distance, intermediate, and near than their predecessors. The procedure remains attractive for patients with cataracts or those who are too hyperopic for corneal surgery. However, following successful implantation of the latest generation of lenses, some patients are still not completely satisfied with their visual results. Additional procedures, such as yttrium aluminum garnet (YAG) capsulotomies or reduction of astigmatism and refractive error or both, may be required to increase patient satisfaction. SUMMARY: Experience has shown us that the majority of patients who present with cataracts are potential candidates for multifocal or accommodating IOLs. Familiarity with accommodative and multifocal lenses, in conjunction with careful patient selection, maximizes surgical success in this challenging group of surgical patients.