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    <recommendedItem id="20090101_19_3488"
                     title="AAO: Dual Optic Lens Shines (CME/CE)"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAO/tb/16732?impressionId=1265772209412"
                     
      &lt;p&gt;SAN FRANCISCO  --  A novel, &quot;dual optic&quot; accommodating intraocular lens improved intermediate distance vision and contrast sensitivity under low light conditions compared with some multifocal lenses, researchers said.&lt;/p&gt;
&lt;p&gt;The findings, reported in two studies from the same research group here at the American Academy of Ophthalmology meeting, suggest that the new generation of lens will hold functional advantages for patients undergoing cataract surgery.&lt;/p&gt;
&lt;p&gt;&quot;In the past, we only looked at visual acuity,&quot; said presenter Andrea Galvis, MD, of the Fundaci&amp;#243;n Valle del Lili in Cali, Colombia. &quot;Patients are asking for more.&quot;&lt;/p&gt;
&lt;p&gt;First generation monofocal lenses were often used to create &quot;bifocal&quot; vision, with the lens in one eye set for distance vision and the other set for near objects, noted Barry S. Seibel, MD, of the University of California Los Angeles, who spoke at a press conference here.&lt;/p&gt;
&lt;p&gt;To overcome the poor depth perception this created, the next generation of multifocal lenses allowed both eyes simultaneously to focus on far or near objects for &quot;more natural vision with depth perception,&quot; he said.&lt;/p&gt;
&lt;p&gt;Galvis&apos; group compared three of these &quot;premium&quot; intraocular lenses with an experimental lens (Synchrony) designed with a dual optic to theoretically provide a more accommodative amplitude.&lt;/p&gt;
&lt;p&gt;The study included patients given the same lens in both eyes during different &quot;eras&quot; of lens implantation. For a functional, real life performance test of contrast sensitivity, patients were given a reading speed test under low-light conditions. The low lighting speeds were: &lt;ul&gt; &lt;li&gt;164.3 words per minute in the 34 patients with Tecnis Multifocal lenses&lt;/li&gt; &lt;li&gt; 159.6 words per minute in the 29 patients with Synchrony lenses&lt;/li&gt; &lt;li&gt;86.9 words per minute in the 30 patients with ReZoom lenses&lt;/li&gt; &lt;li&gt;75.2 words per minute in the 27 patients with ReSTOR lenses&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The difference was significant for Tecnis and Synchrony compared with ReZoom and ReSTOR at &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001. Seibel noted that Tecnis is considered to have theoretically the best reading vision at more light levels than other multifocal designs.&lt;/p&gt;
&lt;p&gt;Synchrony had the highest contrast sensitivity of all the lenses.&lt;/p&gt;
&lt;p&gt;The second study, presented by Ivan L. Ossma-Gomez, MD, also of the Fundaci&amp;#243;n Valle del Lili, was a randomized, multicenter, prospective, double-masked clinical trial comparing Synchrony to ReSTOR implanted in both eyes for 44 and 48 patients, respectively.&lt;/p&gt;
&lt;p&gt;Intermediate vision in the range of 60 to 200 cm  --  a typical distance from a computer screen  --  was significantly better with Synchron. That might not be a surprise, Seibel said, given that ReSTOR is known to be weaker at intermediate vision.&lt;/p&gt;
&lt;p&gt;Again, contrast sensitivity was higher &quot;at all frequencies in all lighting conditions&quot; with the dual optic design (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.01).&lt;/p&gt;
&lt;p&gt;&quot;Contrast sensitivity is similar to monofocals,&quot; Galvis said. &quot;That&apos;s the goal.&quot;&lt;/p&gt;
&lt;p&gt;Ossma-Gomez noted that glare and halos can be problematic for some patients with the new lens, as with older designs.&lt;/p&gt;
&lt;p&gt;Seibel added that the Synchrony lens requires a larger incision to implant than other designs, but that dual implantation is typical in clinical practice for &quot;premium&quot; intraocular lenses, about 90% to 95% in his experience.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Ossma-Gomez reported consulting and being a clinical investigator for Visiogen, maker of the Synchrony lens, and receiving lecture fees from Alcon.&lt;/p&gt;&lt;p&gt;Galvis also reported conflicts of interest with Visiogen, including grant and travel support.&lt;/p&gt;&lt;p&gt;Seibel reported conflicts of interests with Seibel Instruments from Rhein Medical and Storz, Phacodynamics, SLACK, and consulting for Optimedica and Eyemaginations.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_182"
                     title="Kids with Bionic Ears Have Trouble Controlling Their Voices (CME/CE)"
                     score="-0.006"
                     href="http://www.medpagetoday.com/Surgery/Otolaryngology/tb/18018?impressionId=1265772209412"
                     
      Although children who are deaf may be able to hear when fitted with cochlear implants in both ears, they have a more difficult time controlling their voices than kids with normal hearing, a single-center study showed.&lt;br&gt;
&lt;br&gt;Children with bilateral implants had deficits in controlling both the pitch and loudness of their voices when making a sustained &quot;ahh&quot; sound (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both), according to Karen Gordon, PhD, of the Hospital for Sick Children in Toronto, and colleagues.&lt;br&gt;
&lt;br&gt;Pitch control, however, improved significantly the longer the implants were used (&lt;em&gt;P&lt;/em&gt;=0.03), the researchers reported in the January issue of &lt;em&gt;Archives of Otolaryngology  --  Head &amp;amp; Neck Surgery.&lt;/em&gt;&lt;br&gt;
&lt;br&gt;&quot;The more experience one has with hearing, the better able to produce voice they have,&quot; Gordon said in an interview.&lt;br&gt;
&lt;br&gt;The number of children who receive cochlear implants for deafness has been increasing steadily over the past two decades, and it is now common, she said.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;The implants directly stimulate the auditory nerve to compensate for a nonfunctioning cochlea, regardless of the reason for the deafness.&lt;/p&gt;
&lt;p&gt;At the Hospital for Sick Children, a multidisciplinary team  --  including an audiologist, otolaryngologist, social worker, speech language pathologist, and auditory verbal therapist  --  assesses each child&apos;s suitability for the implants.&lt;/p&gt;
&lt;p&gt;&quot;We really look at the child, their candidacy from a hearing point of view, their expectations for what the implant can do for them, whether they&apos;re up for the surgery, and whether they&apos;re up for the therapy that&apos;s involved afterward,&quot; Gordon said.&lt;/p&gt;
&lt;p&gt;Although children with cochlear implants are able to hear, it&apos;s unclear exactly what their perception of sound is, she said. All must go through therapy lasting about two years to be able to interpret what they&apos;re hearing.&lt;/p&gt;
&lt;p&gt;However, the voicing of children with the implants compared with that of kids with normal hearing has not been extensively studied.&lt;/p&gt;
&lt;p&gt;So Gordon and her colleagues evaluated how 27 children with bilateral implants  --  ages 3 to 15  --  were able to control their voices, finding poorer control of long-term frequency perturbation (pitch) and long-term amplitude perturbation (loudness) compared with those with normal hearing.&lt;/p&gt;
&lt;p&gt;&quot;Despite the incredible opportunities that cochlear implants provide for auditory and linguistic development, abnormalities in acoustic voice outcomes persist,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;However, through a four-month follow-up, pitch control  --  but not loudness control  --  improved significantly with increased implant use.&lt;/p&gt;
&lt;p&gt;&quot;This result underlines the importance of early recognition and treatment of children with hearing loss to provide auditory experience as soon as possible,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;However, the use of cochlear implants is not free of complications, according to another study in the same issue of the journal by Natalie Loundon, MD, of the H&amp;#244;pital d&apos;Enfants Armand-Trousseau in Paris, and colleagues.&lt;/p&gt;
&lt;p&gt;Among 434 children younger than 16 who received the devices, 9.9% had complications, nearly two-thirds of which occurred more than eight days after implantation (mean 2.2 years).&lt;/p&gt;
&lt;p&gt;Major complications included severe cutaneous infections or hematoma, magnet displacement, meningitis, cholesteatoma, cerebrospinal fluid leak, and electrode misplacement.&lt;/p&gt;
&lt;p&gt;Minor complications included vertigo, soft-tissue infection, persistent otitis media, and facial nerve palsy.&lt;/p&gt;
&lt;p&gt;A large minority of those with complications (30.2%) required reimplantation.&lt;/p&gt;
&lt;p&gt;Trauma to the mastoid area and inner ear malformations were risk factors for delayed major complications and early minor complications, respectively (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both).&lt;/p&gt;
&lt;p&gt;Age at implantation was not associated with complication risk.&lt;/p&gt;
&lt;p&gt;&quot;The finding of complications several years after surgery highlights the need for long-term medical follow-up in this population and the importance of repeatedly providing information to the patients and their family,&quot; Loundon and colleagues wrote.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;None of the authors of either of the studies made any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_2_668"
                     title="AAO: Vision Threat from Pediatric Uveitis Persists Over Time"
                     score="-0.007"
                     href="