Tomey
Its serial photography feature allows for a sequence of 15 shots, with the most accurate photo displayed onscreen. Its seven fixation points provide for wide photographing even on an irregular corneal surface, while simultaneously measuring corneal thickness. Should automatic photographing prove difficult, the device permits manual photography using the power joystick. The EM 3000 opts out of the conventional xenon lamp as it requires costly maintenance and instead implements the use of a long-life LED light source.
The EM 3000 can also be utilized daily to monitor and detect abnormal variation in cellular size (polymegathism) and shape (pleomorphism) to ensure early diagnosis of endothelial disease. For information call 1 (888) 449-4045 or visit tomeyusa.com.
Ocusoft Partnership Adds to Alodox Convenience Kit
CyNAcon/Ocusoft is now including Tranquileyes Moist Heat Therapy Goggles and Thermoeyes Reusable Heat Packs from Eye Eco, in its prescription-only, low-dose doxycycline Alodox Convenience Kit for adjunctive eyelid therapy and hygiene. The kit contains Alodox (doxycycline hyclate 20 mg), Ocusoft Lid Scrub Plus Extra Strength Pre-Moistened Pads, Ocusoft Lid Scrub Original Foaming Eyelid Cleanser and the complimentary goggles and heat packs.
When used with warm water, Tranquileyes Moist Heat Therapy Goggles create heat to help stimulate tear production providing soothing relief from dry eyes. Increased humidity helps prevent the evaporation of natural and artificial tears, bathing the cornea in moisture, relieving dry, tired and scratchy eyes. Moist heat treatment is further enhanced using the Thermoeyes reusable heat packs which provide an additional heat source to prolong the benefits of the Tranquileyes Moist Heat Therapy Goggles. Thermoeyes heat packs are used by snapping the stainless steel disc inside to instantly generate heat that lasts approximately 30 minutes. Thermoeyes heat packs are reusable by boiling in water for several minutes and are ready to reuse after they cool.
The Alodox Convenience Kit contains low-dose doxycycline, which reports confirm is prescribed partly because it is a potent collagenase inhibitor. The use of sub-antimicrobial dose (low-dose) doxycycline hyclate has been shown to be beneficial in the enzyme modulation treatment of inflammatory disease. At such low levels (<50 mg), doxycycline reduces inflammation while maintaining maximum plasma drug concentrations below the anti-microbial threshold resulting in fewer side effects, the company says. For information, call 1 (800) 233-5469.
Pearls from the Deep
Salzmann's and Cataract/ Refractive Surgery
Salzmann's nodular degeneration is a rare, non-inflammatory, slowly progressive, degenerative condition that affects the surface of the cornea. Characteristic findings are blue/white, elevated nodules that are more commonly seen superiorly and peripherally. SND is typically seen in chronic keratitis of multiple etiologies, most often keratitis sicca, and has a female preponderance. SND can create a large refractive shift and can lead to decreased BCVA. A hyperopic and astigmatic shift is common, and it can be quite significant. I have seen over 6 D of hyperopic and astigmatic corrections with treatment. To achieve optimum results, it is best to treat SND before rather than after surgery—especially with advanced surface ablation. If SND is not treated before surgery, it can lead to refractive surprises with IOL implantation due to poor keratometry readings and significant under- or overcorrections with ASA since one is unable to accurately adjust for the refractive effect of the SND. Loose epithelium is also associated with SND and this can lead to corneal abrasions with LASIK and IOL implantation.
The easiest technique, and the one I have been using for several years, is to peel off the nodules with either a spatula or 0.12 forceps and then smooth the surface with a diamond burr. I also apply mitomycin C for about 12 seconds, thoroughly irrigate with BSS, and then apply a bandage contact lens. I also check for any loose epithelium to treat this to prevent corneal erosions. Once the cornea and refraction are stable, usually six to eight weeks later, one can perform the measurements again and proceed with the IOL or surface ablation. One should avoid LASIK in these patients, as they tend to have more risk for dry eye.
