Best Practices
Step-by-Step: Intratunnel Phacofracture
By Sudhir Singh, MS
Manual small-incision cataract surgery is one of the most popular methods of cataract extraction today, but most commonly practiced techniques require a 7- to 9-mm incision, which induces astigmatism. What if the nucleus could be removed though a sub-6-mm incision at the appropriate site? After some research, Dr. Singh concluded that this strategy would induce approximately the same amount of astigmatism as a 3.2-mm phaco incision. He devised the intratunnel phacofracture technique, in which the lens nucleus is broken in the corneoscleral tunnel instead of the anterior chamber, as with other nucleotomy techniques. This article provides a step-by-step description of his technique.
Visual Rehabilitation After Corneal Collagen Cross-Linking
By Farhad Hafezi, MD, PhD
The main goal of corneal collagen cross-linking is to arrest ectatic progression, but the patient’s biggest concern relates to his or her quality of vision. A number of procedures may be used for the visual rehabilitation of patients after corneal collagen cross-linking, including adaptation of keratoconus contact lenses, implantation of intrastromal corneal ring segments, and topography-guided or corneal wavefront-guided PRK. This article focuses on customized surface ablation for the treatment of keratoconus. The principal idea is to use corneal wavefront data to calculate and apply an ablation profile customized for each patient. The goal is to improve BCVA so that the patient may alternate more easily between glasses and contact lenses.
BUSINESS SENSE
Medical Practice Is Not Business as Usual
By Guy M. Kezirian, MD, MBA
Profits are the lifeblood of every business, and medical practices are businesses. They provide services and receive payments for doing so. They make profits and rely on those profits to survive. (Practices in government-run medical systems also rely on profits, even when some of the revenue comes from government subsidies.) Nevertheless, medical practices are fundamentally different from most other businesses. The former exist to provide a structure that allows committed, highly trained professionals to deliver services to people who need them.
