Safety & Flexibility: Alcon Intrepid Polymer I/A Tips

Released by Alcon in late 2009, the Alcon Intrepid Polymer I/A tip has brought a sense of increased safety and flexibility into cataract procedures.  Although, not as soft as the Alcon silicone I/A tip, this polycarbonate material still provides the same safety in allowing to polish the capsule and maintaining the integrity of the capsular bag.

In addition to not only providing safety through its design, it is also a “true” single use device that is disposed of after each case thusly reducing potential factors (such as residual, cortical material)  that could attribute to TASS.  The tips come in three configurations, a straight, 20 degree soft curve, and the 35 degree bent tip.  Each of the tip configurations has a .3mm aspiration port and the flange design to allow for proper placement of the sleeve. All of the tips are fully compatible with the threaded Ultraflow handpieces and with all MicroSmooth sleeves.  The Intrepid Polymer I/A tips are unique and quality products to add to any cataract surgeons procedures.

IOL Master 500

What is the fastest and easy way to find the right IOL?  Simply speaking, the IOL Master 500.  The all in one biometer created by Carl Zeiss Meditec (headquartered in Jena, Germany) is the world’s first non contact measuring device that offers the precision measurements surgeons require to give their patients the quality outcomes they deserve.  In 2006, the IOL Master was recognized by ASCRS as a leader in precision biometry.  A 2005 survey conducted by ASCRS showed that 47 percent of cataract surgeons in the United States were using the IOL Master for measuring axial length.  Since 06’, Carl Zeiss Meditec has continued to dominate the area of biometry and the IOL Master 500 is the latest technology leading them into the future.

Using the Zeiss principles of precision, simplicity and outcomes, the IOL Master 500 is again a complete comprehensive workstation designed to aid in the efficiency of a busy clinical atmosphere.  Equipped with a new Twin Technology mode, the IOL Master 500 will allow for multiple axial lengths and keratometry readings to automatically be captured.  The IOL Master 500 has also been integrated to handle any of the aspheric, multi-focal, or toric measurements and their necessary calculations as well.  IOL calculations are simply done and the reports are easily transmitted to the surgeons desired electronic storage locations or can be printed for paper copies.  Equipped with FORUM, Zeiss data management solution, the IOL Master 500 can provide diagnostic data wherever it is needed.  It also integrates with the CALLISTO eye, and electronic medical records as well.

The IOL Master 500 is fundamentally the “Gold Standard” for IOL calculations.  Carl Zeiss Medical has revolutionized the field of ophthalmic biometry and created a diagnostic tool that benefits all of the surgeons that choose to take advantage of this technology.  As IOLs evolve, the IOL Master will continue to provide the quality and reliable data that surgeons expect.  For further detailed online information, please visit www.meditec.zeiss.com/iolmaster and www.iolmaster-online.zeiss.com

R.A.C.E. to Be Safe Prevent OR Fires!

There are a number of potential hazards that surgical staff must be aware of in their daily work environment.  One of the most important is fire.  There are over 100 reported OR fires in a given year with the most common occurring in the patient’s airway, head and face.  The majority of these fires also occurs in oxygen enriched situations and is caused by Electro surgical units and/or lasers.   It is important, as healthcare workers, to be educated in the causes, procedures, and equipment related with fire prevention and safety.

There are three elements that must be present to create a fire.  The “Fire Triangle” consists of a heat source, a fuel source, and the presence of oxygen.  When these elements interact a chemical reaction occurs and fire is created. Common heat sources are Electro surgical units, lasers, and fiber-optic headlights.  Fuel sources include prepping solutions, dressings, surgical drapes, and even patient hair.  Finally, oxygen is supplied by not having adequate ventilation and pockets build creating the “perfect storm”.  In order to extinguish a fire one of these three key elements must be removed from the equation.

The key to fire safety and of course the goal is to prevent.  To avoid potential heat sources be sure to put Electro surgical units in their holsters, always have lasers in stand by modes, and never lay these or fiber-optic headlights on neither the patient nor draping.  Be sure prep solutions have adequate evaporation times, dressings/drapes are always kept away from heat, and patient hair has been removed when necessary.  Finally in order to eliminate the oxygen component of the triangle, be sure drapes are ventilated so that the gas can dissipate efficiently.

In the situation a fire does occur, follow the basic R.A.C.E. procedure.  First, Rescue the patient. Next, Activate the facility fire alarm system and alert security.  Third, Confine the fire by compartmentalizing the affected area, and turning off medical gases.  Extinguish using saline solution or ideally fire extinguishing equipment.  It is important that you follow the fundamental principles of using extinguishers by first pulling the pin, aiming towards the base of the fire, squeezing the handle, and sweeping the extinguisher side to side.  Finally, Evacuate using the designated procedures of your facility.

Fire is a dangerous and deadly hazard that surgical staff may encounter at anytime.  It is extremely important to remain educated and up to date on all of the fire policies and procedures of your facility and be aware of all of the elements that may be around you that could potentially complete the “Fire Triangle”.  Through awareness and prevention serious injury and catastrophe can be avoided and both patients and surgical staff will leave your facility safe and happy!

Get a Grip: An Overview of Trends in the World of Medical Gloves.

As the increasing concern over infection control continues to dominate discussion among healthcare professionals; many facilities find themselves looking for answers through stringent policy changes dealing with cleaning and sterilization of instrumentation.  A major component of infection control that is often overlooked is the type of gloves that are being used.   Healthcare facilities need to take the time to examine their glove inventory and determine what types of gloves addresses their particular needs and concerns.

When evaluating gloves, one of the most important factors to consider is barrier protection.  It is essential to have a glove that provides excellent barrier protection against blood borne pathogens and infectious diseases.  An inferior quality glove exposes both healthcare workers and the patients they care for to unnecessary risk of infection.  Natural rubber latex gloves have been shown to have the most effective barrier protection, however due to the increased awareness of latex sensitivity/allergies there are a number of other alternatives (such as synthetics and those with a low level of latex proteins) on the market that address those healthcare workers and patients that may have adverse reactions to latex.

According to data reported by the American Latex Allergy Association, somewhere between 3%-22% of healthcare workers are sensitive to natural rubber latex.  Healthcare workers increase their likelihood for latex sensitivity due to the fact that they are more prone to be exposed routinely to latex proteins in their work environment.  A concerning factor in latex sensitivity/allergy to not only healthcare workers but to patients as well is the use of powdered gloves.  The powder allows for the latex to become airborne and inhaled as well.  Latex sensitivity can result in mild skin irritation to as something as serious as anaphylaxis.

Manufacturers have introduced synthetic materials such as nitrile, neoprene, and polyisoprene into the medical glove marketplace that try to mimic the fit, tactile feel, and protection of the traditional latex glove.  Other manufacturers offer low protein latex alternatives as well.  It is estimated that by the year 2015 the global surgical glove market could exceed $1.38 billion in sales, and is also estimated the powder free alternatives will make up a significant portion of those sales.

Other factors that are important when deciding on a glove are tensile strength, durability, comfort, and ease of donning.   Strength of material must be able to stretch and conform to the hands appropriately.  They must have the durability that corresponds to the tasks the staff or surgeon will be completing, be comfortable to wear, and easy to put on as well.

Gloves are a fundamental component in controlling the spread of pathogens, critical in providing the necessary personal protective equipment for facility staff and surgeons, and key to patient safety.  It is important for any healthcare facility to “get a grip” on the glove needs of their staff, surgeons and patients.

Cataract Outsourcing’s Noteworthy Products for 2009

It is always so interesting to focus on new products each month for our posts.  We as bloggers get the unique opportunity to research products that have very widespread application in the medical arena.  Below is a short list of the noteworthy products of 2009.   I hope you enjoy reading them as much as we enjoyed putting these articles together over 2009.  Be sure to visit these articles in their entirety in the “Featured Products” section.  On behalf of myself and Cataract Outsourcing thank you for your dedicated readership, Happy Holiday, and Best Wishes for 2010!!

ILLUMIN-i System

The ILLUMIN-I  System a significant advancement in Ophthalmic illumination.  The patent-pending ILLUMIN-i module is integrated with a new microscope from Endure Medical and is also available as an upgrade to older optics.

The ILLUMIN-I creates a homogeneous, brilliant red reflex and tremendous detail perception.  The ILLUMIN-i offers triaxial, collimated illumination and multiple angles of delivery that enhance the optical view for surgeons.  This new technology results in a constant, “glowing” red reflex while maintaining contrast and depth of field.  The surgeon perceives fine details and clarity like never before.  www.enduremed.com

Acrysof IQ Toric IOL-Aspheric Excellence

Intraocular lens (IOL) technology is constantly evolving and striving for better performance and outcomes for both surgeons and most importantly the patients they serve.  One of the advancement in IOLs has been the introduction of the Toric lens.  The Toric IOL is designed to correct astigmatism and was first brought into the US market by Starr Surgical in 1998.  Alcon, Inc followed up in 2005 and received FDA approval for their version, the Acrysof Toric IOL, which quickly became the leading Toric IOL in the market.  In March of 2009, Alcon launched the recently FDA approved Acrysof Toric IQ IOL at the American Society of Cataract and Refractive Surgeons meeting in San Francisco, California.  This Toric IOL is unique. It offers a special aspheric optic which is a new innovation in the world of Toric IOLs.

The Acrysof IQ Toric IOL offers a precise astigmatism correction. The aspheric design component of the lens improves both image quality and contrast sensitivity.  This combination creates patients the best opportunity for distance vision without the assistance of glasses.  It was shown in studies that the Acrysof IQ Toric IOL improved functional vision significantly.  Alcon tested their IOL versus a control lens in low visibility environments (such as night driving).  They showed that the Acrysof IQ Toric IOL performed better in 34 of the 36 conditions that were tested.  Significant advantages were found in the ability of the patients to identify pedestrians and warning signs under conditions conducive to both fog and glare.

The Alcon Acrysof Toric IQ IOL aspheric characteristics brings new dimension to the Toric IOL marketplace.  The innovation of this lens creates high quality outcomes for the surgeons and patients alike.  Its ease of use and the Acrysof Toric IOL Calculator that was created by Alcon makes the IOL a very desirable and easy choice for many surgeons implanting Toric IOLs.  www.alcon.com

Acrysof IOL injector-Crestpoint Management

The new injector, the DK7797-2, is a front loading injector designed to accommodate the Alcon “D” IOL cartridge as well as the “B” and “C”.  It is a smooth, single handed delivery, ergonomically designed to fit any sized hand.  The injector can be pre-loaded.  It also comes completely apart for proper cleaning.  Surgeons contacted Crestpoint and asked for a different injector with a smooth mechanism.  Crestpoint (then Duckworth and Kent USA) took the design to Alcon.  Surgeons truly enjoy the efficient and smooth one handed delivery. www.crestpointmgt.com

I.V. House

For many years, Lisa Vallino, RN, had observed other pediatric nurses, as well as constructed herself, makeshift IV covers to help protect and provide comfort for the patients they were dedicated to care for.  These IV covers were created from plastic specimen cups cut in half and secured to the patient with tape.  In 1991, Lisa Vallino and Betty Rozier (Lisa’s business partner and mother) took a leap of faith, applied for a patent and approached a plastics manufacturer to help develop the concept and their dreams.  From this brave step, a plastic u-shaped domed cup was created and I.V. House was born.

The benefits of this product in the healthcare industry are plentiful.  First and foremost, I.V. House promotes patient safety.  By simply protecting the IV site, patient safety and comfort levels are secured.  I.V. House also extends dwell times and eliminates exposed looping issues. This is not only a safety benefit but it will also save on medical costs by preventing unnecessary IV restarts that may create complications and extend the amount of time the patient spends in the hospital.  I.V. House is a single use device and free of latex and DEHP; another effort to avoid complications and promote patient safety.  The I.V. House also allows hospital staff easy access and the ability to monitor the IV site by having a vented and transparent design.  The design also allows for minimum use of tape and in some models no tape at all.  Some of the I.V. House products have an ergonomic designed UltraDressing that fits the patient more like a glove instead of appearing as an uncomfortable medical device.

I.V. House has an extensive line of products.  They have developed a full range of sizes that will correspond to the individual needs of the patients.  There are also varying degrees of how the domes are padded and are designed for the area of the body where the IV site will be located. The I.V. House also has the specialized UltraDressing configurations to be completely free of the usage of tape.  I.V. House has a product that will fit and protect, no matter the needs of the patient.  www.ivhouse.com

Vision Blue

Although capsular staining had been being performed worldwide for a number years, it wasn’t until late 2004 before DORC International received FDA approval in the United States for their product Vision Blue.  This approval allowed US surgeons to finally have a resource that could help with performing a capsulorhexis in less than ideal conditions.  Before the use of Vision Blue, a surgeon may have experienced the inability to adequately visualize the anterior capsule which can result in an incomplete capsulorhexis.  With Vision Blue, the risk of radial capsule tears and other complications are greatly diminished.

With the introduction of Vision Blue into the US market, surgeons have gotten to enjoy the ability to get a much needed assist when performing procedures in which the anterior capsule is associated with a mature cataract or small pupil.  Capsular staining makes the capsulorhexis an easier and safer task when dealt   with such situations.  Ultimately, Vision Blue allows for a much safer procedure and high quality outcomes for the patient which is a win-win scenario for all involved. www.dorc.nl/

STERIS System 1: FDA Safety Alert!

The FDA has issued an alert to healthcare facilities using the STERIS System 1 (SS1), to discontinue its use after receiving reports of injuries. These injuries included exposure burns by healthcare staff operating the device, as well as its inability to determine if the currently marketed device can support its labeled claims that it effectively sterilizes medical devices.  The FDA strongly encourages healthcare facilities to seek alternative methods to sterilize and disinfect instrumentation.

The STERIS System 1 (SS1) is a liquid chemical system processing device that is designed to provide sterile processing of instrumentation between patient uses.  Examples of such instrumentation includes (but not limited too) endoscopes and bronchoscopes among others.  The STERIS System 1 uses a peracetic acid solution referred to as STERIS 20 Sterilant to destroy microorganisms that would cause infection among patients.

In May of 08’, the FDA issued a warning statement to STERIS due to changes that had been made to the SS1.  Since these changes had not been evaluated by the FDA, it was unknown if the device would continue to safely and effectively perform instrument sterilization. Throughout the rest of 08’, Steris and the FDA negotiated a possible resolution for the situation.  It was decided that STERIS would commit to work with current SS1 customers in order to transition them to an approved alternative.  In January 09’, STERIS issued a letter to the customers detailing the FDA warning and their plan of action to remedy the situation.  According to the FDA, STERIS has not satisfied the requirements of their previous agreement in terms of transitioning users. They have even had reports that STERIS has assured customers there is no need for any changes.  This has prompted the FDA to step in and advise all healthcare facilities to seek alternative sterilization options.  STERIS is yet to issue a voluntary recall on the SS1 units. However, they have agreed to cease any further U.S. sales and only proceed with product and part replacement, as well as, service to existing customers.

The FDA has posted guidelines on its website to offer guidance on how to choose an alternative product.  They suggest that the first step is to determine the degree or reprocessing required.  The FDA has broken these down into three device categories:  critical, semi-critical, and noncritical.  Critical devices (implants, etc.) are those instruments that have direct contact with the bloodstream or other sterile areas of the body.  Semi-critical is described as those devices (endoscopes, etc.) that contact mucous membranes, non intact skin, and those that don’t penetrate the blood barrier.  Finally, noncritical devices (bedpan, etc.) that only come in contact with intact skin.  Once the degree of reprocessing is determined, a facility will have the ability to choose the appropriate alternative.

One can find the FDA notice letter, Q&A, and alternative device information at the following sites:

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm191585.htm

http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm192685.htm

http://www.accessdata.fda.gov/scripts/ cdrh/cfdocs/cfPMN/PMNSimpleSearch.cfm

http://www.accessdata.fda.gov/scripts/ cdrh/cfdocs/cfPMA/pmasimplesearch.cfm.

http://www.fda.gov/MedicalDevices/ DeviceRegulationandGuidance/ ReprocessingofSingle-UseDevices/ UCM133514.

Steris Responds to FDA’s SS1 Warning

ILLUMIN-i System: A Revolution in Ophthalmic Illumination

Recently, Cataract Outsourcing sat down with Rob and Edie Hewlett of Endure Medical, Inc. to find out more about the ILLUMIN-I  System, a significant advancement in Ophthalmic illumination.  Based in Cumming, Georgia, this small company has been in the business of the refurbishment, sales and service of surgical microscopes for over 20 years.  Although the main focus of this interview deals with the Ophthalmic side, Endure Medical is also involved with ENT, neurosurgery, orthopedic, plastics, OB/GYN, and dentistry to just name a few.  They definitely cover a large spectrum of the surgical market and have a comprehensive knowledge of all of those specialties.

CO: Rob and Edie, please tell us a little about Endure Medical, your position with the company, how long you have been at that position, and how long you have been involved in the ophthalmic industry.

RH & EH: Endure is family owned and operated and we’ve been in business over 20 years.  We provide both new and refurbished microscopes for all specialties.  Our company is ISO 9001:2000; 13485:2003 certified, registered with the FDA and has CE approval on our new products.  All of our equipment comes with a 2 year warranty.   While developing our new ophthalmic scope, the Reflex, we began experimenting with different illumination systems.  After many ideas and prototypes, we finally discovered the technology used in the ILLUMIN-i….tested with several local surgeons….made a few alterations and filed the patent.

CO: What is the ILLUMIN-i system?

RH & EH: The patent-pending ILLUMIN-i module is integrated with our new microscope and is also available as an upgrade to older optics.  The ILLUMIN-I creates a homogeneous, brilliant red reflex and tremendous detail perception.  The ILLUMIN-i offers triaxial, collimated illumination and multiple angles of delivery that enhance the optical view for surgeons.  This new technology results in a constant, “glowing” red reflex while maintaining contrast and depth of field.  The surgeon perceives fine details and clarity like never before.

CO: How does the ILLUMIN-i system benefit surgeons?

RH: Provides an incredible view without having to replace your entire microscope.

EH: They can upgrade their current optical system and save lots of money over a brand new scope.

CO: What type of surgeon feedback (both positive and negative) have you had with those using the ILLUMIN-i system?

RH: By far, the feedback is positive.  The ILLUMIN-i is a cost-effective option to other new microscopes.  The optical view is comparable (if not better), but the price is much less.  For rural hospitals and ASC’s, our system is the perfect fit.  The surgeon gets the view he needs and the facility saves the money they need…especially in today’s economy.

EH: Optically, our system is just as good as or better than any other microscope on the market.  This is based on feedback from many of the top surgeons across the country.  We’ve kept our floorstand simpler with a small profile.  Some hospitals and surgeons prefer the larger floorstands with electromagnetic brakes and we don’t offer this feature.  Our design goals were to provide modern electronics for the footpedal and optics while keeping the floorstand simple.  This gives the surgeons the features they need/want and keeps the price under control!

CO: If you could only make one statement in regards to selling the ILLUMIN-i system to a skeptical surgeon what would that be?

RH: We will bring it to your facility, be in surgery and let you see for yourself.

EH: Take a look at our video of several surgeons using the ILLUMIN-i and then let us bring it to your facility and be in surgery…you don’t buy it unless you like it.

CO: Endure offers a variety of products and services, please tell our readers about all you have to offer your customers.

RH: While the ILLUMIN-i is specific to Ophthalmology, our company provides microscope systems and accessories for every specialty and budget.

EH: Along with our microscopes systems, we offer various new video systems (single, 3-chip and HD), replacement parts (new and refurbished), repair services and disposables.

CO: For those readers who are interested in the ILLUMIN-i or any other of your products and services, how can they find out more and get in contact with you?

RH: Our direct number is 800-736-3873 / 770-888-3755

EH: Our website is:  www.enduremed.com, my email is:  edie@enduremed.com ; rob@enduremed.com

Cataract Outsourcing would like to thank Rob and Edie Hewlett and the staff at Endure Medical, Inc. for meeting with us and providing information in regards to the ILLUMIN-I system.

AAO Live

10/24:  Touched down in beautiful San Francisco around 12pm.  The sun was bright, and the temperatures in the high 60’s.  Great way to start a busy couple of days.  Hit the show around 2:30pm, shuttle was on time and swift, registration and bag pick up hassle free.  Abbott Medical Optics was the “bag/materials” sponsor this year.  As I approached the exhibit hall, one could see that the attendance was very good.  Many attendees visiting booths, meeting old friends and networking as always.  My goal for day one was to visit booths that are in the business of single use instruments.  It is an early start on probably an important movement in Ophthalmology.  May people are looking at this alternative as a way to supply additional instrument sets, save on repair costs, and help avoid the dreaded TASS cases.  I looked at the comprehensive BD Health line, the limited selection but excellent quality of the Moria line, and also briefly visited the Sterimedix and Stephens Instruments booths.  All companies had different things to offer, it’s just a matter of surgeon preferences and of course price point when dealing in the Outsourcing industry.

10/25:  The day got off to an early start.  Woke up, threw on the running shoes and headed to AT&T Park to participate in the Annual Run for Vision 5K sponsored by Bausch and Lomb.  The event benefits the Eye Bank Association of America, a very worthy group to support.  Over 200 people participated in the event which is excellent since it starts at 6:30am in order to accomadate the rest of the AAO events scheduled for the day.  The course began at the Home of the San Francisco Giants, along the China Basin and McCovey Cove, through the USCF campus and by the shores of the San Francisco Bay.  It was a very well organized event and I would encourage all runners attending the show to make an effort to participate in the future.  On a personal note, I finished 64^th overall with a time of 23:19.  My racing philosophy is a very simple one, if more people finish behind me than in front, I have had a successful run.  No matter what though, anyone who puts out the effort to lace up the sneakers and hit the road running be it for health, competition, or supporting a worthy organization is a positive!

The rest of day has been full of meetings and networking.  In fact, I have had little time to blog or walk the floor looking at all of the exhibits.  I’m sure that I am the norm and not the exception at shows like these.  I will offer a few words of wisdom for those attending any of these Ophthalmic shows.  First, do your homework.  Prior to coming to the event, look through your pre show materials determine what your interests are.  Search out the information on those interests.  If it is symposiums or classes be sure to pre-register and enter the times of those events into your planners.  If you are looking into new equipment, products, or HIT technology research the vendors that deal in those items.  Look up on the floor plan on where the locations of those vendors booths are and plan your day in which you can hit them in the most efficient manner.  It will save time, and it will save some wear and tear on your feet too!  Finally, all though we are all here for business and to broaden our knowledge base, schedule in some “down time” to see all the sights of the host city.  These events are always in cities with a lot of history and a lot of things to do, take advantage, relax and have a little fun.  It will make the show a little more exciting and give your brain and body a little rest which is a good thing.

Tomorrow, is a couple of quick meetings and back to the airport.   Overall the show has been personally successful and from the foot traffic I have seen over the last couple of days and the information I have received from the vendors I spoke with it has been successful for them as well.  For now, best of luck to all the AAO attendees this year, and please visit Cataractoutsourcing.com often for up to date happenings in the industry.

Toxic Anterior Segment Syndrome and How to Help Avoid an Outbreak in Your Facility

Toxic Anterior Segment Syndrome, commonly known as TASS, is a concerning and feared occurrence when a patient is diagnosed following an uneventful cataract surgery.  Surgeons and the facilities they perform cases in are required to scrutinize procedures and protocols in order to try to solve the originating source of this inflammation.  This is often a trying and sometimes impossible task to take on.  However trying the task, it is extremely important to investigate possible sources.

Toxic Anterior Segment Syndrome is an acute inflammation that occurs postoperatively.  It occurs when a noninfectious substance enters the anterior chamber of the eye and inflicts toxic damage to intraocular tissue.  It is often confused with endophthalmitis, but is actually quite different.  TASS has a very rapid onset, usually within 12-24 hours following surgery, while endophthalmitis often takes 2-7 days to show.  The TASS patient rarely experiences pain and shows limbus to limbus edema, while those diagnosed with endophthalmitis often experience severe pain and edema only at the site of the trauma.  Endophthalmitis patients also have shown to have vitreal inflammation, lid swelling, and reactive pupil.  Those afflicted with TASS rarely experience vitritis, have a non-reactive or fixed pupil, and usually don’t have any swelling in the lids.  The other symptom that may help distinguish between the two is intraocular pressure.  TASS patients often experience a rapid change in pressure while those with endophthalmitis rarely experience a change in IOP.

Treatment for TASS is a regimen of topical steroids and constant monitoring/assessment of the associated edema and elevated intraocular pressure.  Normally, if caught early and correctly diagnosed, steroid treatments will drastically improve the patient’s condition.  However, if medical treatment is unresponsive it may require surgical procedures including IOL exchange (if suspected to be source), corneal transplant (if cornea becomes seriously compromised), and sometimes a valve procedure if the IOP can’t be controlled properly.

There have been a variety of suspected causes for TASS. Some of the most common offenders were recently identified in an article entitled “Toxic Anterior Segment Syndrome Common Offenders” found in the August 2009 edition of Outpatient Surgery Magazine.  A TASS task force determined the most common factor that contributes to Toxic Anterior Segment Syndrome is insufficient flushing of phaco and I/A handpieces.  The task force recommends that all handpieces are to be flushed with no less than 120cc of sterile or distilled water.  This will insure that all debris and viscoelastic has been removed and not been dried inside of the handpieces.  Enzymatic cleaners and ultrasound baths were also noted as potential offenders.  If properly flushed and cleaned, there is not a need for enzymatic cleaners that contain toxins that may not be denatured in the sterilization process.  Ultrasonic cleaners can also lead to bacterial growth in the water that may be accumulated over time and remain on the instruments even after sterilization as well.  Inappropriately mixed antibiotics have also shown to be a contributing source as well as preservatives including BAK (benzalkonium chloride), the most common preservative used in conjunction with ophthalmic solutions and medications.  Reuse of single use items such as blades, tips, sleeves, and cannulas have also been shown to accumulate debris and result in toxin build up as well.

Toxic Anterior Segment Syndrome is a potentially serious issue for patients, surgeons and facility staff.  It is extremely important to stay educated on possible causes and evaluate your procedures and protocols accordingly to make every effort to avoid any potential risks.  TASS may not be completely preventable due to such a wide variety of factors, but it can be easily controlled and kept to a minimum with a proactive approach and intense investigation when a case does occur.

Innovation in IOL Injection-Duckworth and Kent Acrysof IOL Injectors

Cataract Outsourcing recently conducted an interview with Dot Smith, the Director of Customer Service for Crestpoint Management Ltd.  Crestpoint Management Ltd. was previously known as Duckworth and Kent USA Ltd.  They are known for their premium lines of instrumentation for not only ophthalmology, but a number of other fields as well.  Crestpoint Management Ltd. prides themselves in service, customer satisfaction, and quality products.

CO:  Dot, please tell us about your position with Crestpoint Management and how long you’ve been employed with them.

DS:  I have served the last 15 years as the Director of Customer Service.  Over the years I have developed a broad knowledge base of Ophthalmology.  I handle a lot of customer work and personally follow up with each of them.  It is equally important to me, that my staff also follows up with all of their customers as well.  Crestpoint is known for our excellent customer service and dedication to those customers.

CO:  Tell us about your new Acrysof IOL injector.

DS:  Our new injector, the DK7797-2, is a front loading injector designed to accommodate the Alcon “D” IOL cartridge as well as the “B” and “C”.  It is a smooth, single handed delivery, ergonomically designed to fit any sized hand.  The injector can be pre-loaded.  It also comes completely apart for proper cleaning.

CO:  Was Alcon involved in the design and development of these Injectors?

DS:  Surgeons contacted us and asked for a different injector with a smooth mechanism.  Crestpoint (then Duckworth and Kent USA) took the design to Alcon.

CO:  What are some of the positive response you have gotten from surgeons that have used these Injectors?  Have there been any negative or critical responses?  If so, what were they?

DS:  The positive responses we have gotten have been great.  Surgeons truly enjoy the efficient and smooth one handed delivery.  We have not experienced any negative feedback in terms of the injector.

CO:  If you had to make one statement telling a surgeon why he/she should use this injector what would it be?

DS: It works better than any other injector currently on the market!!

CO:  Crestpoint Management will be attending the 2009 AAO meeting in San Francisco.  What other new or exciting products will you have on display?  Where can our readers stop to see you if they are out and about at AAO?

DS:  The items that we are most excited to have available to our customers are the Osher Changeable tips for forceps/scissors, Toric Axis & Reference Markers, Injector for the AMO Technis IOL, and Capsulorhexis forceps for Microincision.  Please stop by and see us at Booth #917.

We would like to thank Dot Smith and Crestpoint Management Ltd. for sharing their products and time with us.  Please visit their website, www.crestpointmgt.com, or stop by and see them at the AAO 2009 in San Francisco.

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