Genentech. Regneneron. Shire. ZeaVision. Reichert/Ametek HPO IOP. u Issues in measuring IOP
|
|
- Eunice Stone
- 5 years ago
- Views:
Transcription
1 Disclosures MEDICAL MANAGEMENT OF GLAUCOMA California Optometric Association Monterey 2018 Leo Semes, OD, FAAO Commercial Interest Nature of Relevant Financial Relationship Maculogix Honorarium Speaker Science Based Health Honorarium Speaker OptoVue Honorarium Speaker B&L Honorarium Advisor Allergan Honorarium Advisor Genentech Regneneron Shire ZeaVision Reichert/Ametek HPO Honorarium Honorarium Honorarium Honorarium Honorarium Stock options Advisor Speaker Speaker Advisor Speaker Advisor Half of what you learn during your training will be shown to be either dead wrong or out of date within five years of your graduation;... NOBODY can tell which half! And... the most important thing to learn is how to learn on your own. David Sackett, MD IOP u Elevated IOP is the greatest risk factor for developing glaucomatous damage u Lowering IOP is the only means currently of managing glaucoma u Topical drops to lower iop are the prefered initial means to treat glaucoma u Issues in measuring IOP u How is baseline IOP established? u What are the influences on an IOP measurement? u What is the sampling rate of IOP? u The future of IOP monitoring A pinhole view of IOP Our working definition of POAG 5 POAG is a progressive, chronic optic neuropathy in adults in which intraocular pressure (IOP) and other currently unknown factors contribute to damage and in which there is a characteristic acquired atrophy of the optic nerve and loss of retinal ganglion cells and their axons in the presence of an gonioscopically open anterior chamber angle. ala AAO PPP, AOA CPG 1
2 There are some other good reasons There are some other good reasons There are some other good reasons And just last year Issues in treating glaucoma Recent publications regarding IOP-lowering influences 11 How much to lower IOP when Glaucoma or OHT is diagnosed Risk of progression indices 12 Week's Best Articles: Glaucoma One week in October Medical Therapy Cost and side effects issues Adherence issues Optimize and maximize protection to match risk Initial therapy Topical PGA? SLT Advancing topical therapy tcai beta-blocker alpha-agonist fixed-combination (FC) drop Comparison of surgical outcomes between phacocanaloplasty and phacotrabeculectomy at 12 months follow-up: a longitudinal cohort study Journal of GlaucomaOcular surface disease in glaucoma: effect of polypharmacy and preservatives Optometry and Vision SciencePupillary responses to high-irradiance blue light correlate with glaucoma severity OphthalmologyTrabeculectomy vs. EX-PRESS shunt vs. Ahmed valve implant: short-term effects on corneal endothelial cells American Journal of Ophthalmology Meta-analysis of selective laser trabeculoplasty versus topical medication in the treatment of open-angle glaucoma BMC Ophthalmology Full Text Evidence-Based Medicine Risk factors for a severe bleb leak following trabeculectomy: a retrospective case-control study Journal of Glaucoma The macula in pediatric glaucoma: quantifying the inner and outer layers via optical coherence tomography segmentation Journal of AAPOS How glaucoma patient characteristics, self-efficacy and patient-provider communication are associated with eye drop technique International Journal of Pharmacy PracticeAssociation between glaucoma medication usage and dry eye in Taiwan Optometry and Vision Science A survey on the preference of sustained glaucoma drug delivery systems by Singaporean Chinese patients: a comparison between subconjunctival, intracameral, and punctal plug routes Journal of Glaucoma 2
3 Case example Mid -50s WM 13 First seen at UAB Eye Care 4/24/ WM Engineer is referred to UAB Eye Care as a glaucoma suspect. Conditions Hernia Sx, Tinnitus Past Medical History Details Hernia Sx - couple years ago, all okay now. Past Hx of bad rxn to Penicillin Past Hx of Tinnitus Pt. thinks he has Sleep apnea? * *SAS ruled out new Dx = heart murmur (cardiac ultrasound) No medications Glaucoma Negative Cataracts Negative Age-Related Macular Negative Degeneration Eye Injury Retinal Disease Other Disease Blindness Strabismus Amblyopia Diabetes Dry Eye Refractive Other Past / Present Ocular History Negative Lattice Degeneration OU Negative Negative Negative Negative Negative Negative Glasses Full-time H/o transient dipl/intermittent dipl, resolved (spectacle adjustment) Date Diagnosed Drugs Alcohol None None Social History Occupation Engineer (currently unemployed) Hobbies Tobacco Smoking Status Writer, Musician, Woodworker Quit smoking 3 yrs ago, uses Nicotine lozenges Former smoker Family History Glaucoma Negative Cataracts Mother, Father ARMD Negative Eye Injury Negative Retinal Disease Negative Other Disease Negative Blindness Negative Strabismus Sister - DV, wears prism in glasses Amblyopia Negative Diabetes Negative Cancer MGM - skin Heart Disease Negative Hypertension Negative High Cholesterol Negative Kidney Disease Negative Stroke Negative Medications Date Name Strength Form S I 4/21/2014 Advil G 6/9/2010 Ibruprofen 4/24/2014 Zyrtec 10 mg Add'l Sig 3
4 Ophthalmic findings BSCVA 20/20 20/ X X 090 Pupils normally reactive w/o RAPD IOP history (Goldmann) 13/14 (4/24/2014) 16/15 (7/22/2014) Pachymetry: 587u, 586u Anterior segment unremarkable ACA open; AC - D&Q Ophthalmic findings Lens (LOCSIII) : NO 1 / NC2 CS 0 PSC 0 (OD = OS) Optic disc VF OCT What do you expect? Reliable data? (Where s the blind spot?) GHT, PSD, PD significance Good scan quality Note segmentation markers Symmetry Ave RNFL thickness ONH size C/D! Disc margin Note RNFL defects. RNFL profile And, RNFL average sectors are within reference range, But clock hour IT OS, OS show thinning. 4
5 Excellent scan quality What are our next steps? Note the island of GCC thinning IT OD that corresponds to RNFL defect. AND, the raphe respect. And, RNFL average sectors are within reference range. Reviewing the data Good VA (-) family history of glaucoma? SAS / (+) heart murmur // no beta-blocker meds. Normal IOP Apparently clean VF Evidence of ONH / RNFL damage Diagnostic labeling Glaucoma suspect Glaucoma Pre-perimetric glaucoma? Repeated visual field!!! Reliable data? Reliable data? GHT, PSD, PD significance GHT, PSD, PD significance 5
6 Reconciling the data-od Correlating the data-os Management Critical questions Degree of damage Burden of treatment Life span Management Critical questions Degree of damage Burden of treatment Life span Alternatives No treatment at this time Follow, repeating all tests X 6 mo? Other? Most recent visit IOP = 19/20 June 23, 2015 Updated disrupted sleep status diagnosed with SAS and using CPAP device. Reportedly, feeling much better. Does this change our thinking? 6
7 June 23, 2015 Would CH be a useful diagnostic data point? Remember: Risk increases as IOP increases & Risk is compounded with lower CH Source: Corneal Hysteresis in Glaucoma Predictive of Progression in Prospective, Longitudinal Study (DIGS) 41 Percentage per year change in VFI The Effect of IOP on rates of progression was dependent upon Corneal Hysteresis 42 What about complementary techonologies? How would OCT-A influence your management? IOP of 30 is not so bad with a CH of 11. IOP of 20 is very bad with a CH of 6 What about electrodiagnostic testing? Medeiros FA et al. Ophthalmology. 2013;120: Vessel density (OCTA) and VF loss correlation in glaucoma Considerations in management Yarmohammadi A, et al., Relationship between Optical Coherence Tomography Angiography Vessel Density and Severity of Visual Field Loss in Glaucoma.Ophthalmology 2016;123: Does the patient understand the risks and benefits of treatment? What is the risk of vision/sight loss over his lifetime? (25 years?) What is his likelihood of adherence to treatment if offered/accepted? What would be his target IOP? With what would be the initial treatment option? 7
8 45 Another example To treat or not to treat and if so, how? RB 9/24/1938 (AA/F) ONH (5/2006) PACHYMETRY: 642/591) VF Series 1: 2004 (baseline) VF Series 2: 2005 RB 9/24/1938 (AA/F) - IOP Range Frequency Doubling Technology (FDT) Perimetry Results (4/6/05) (OD) (OS) Threshold No flags (OD, OS) PACHYMETRY: 642/591 8
9 (4/6/05) RB 9/24/1938 (AA/F) Retest! (OS) VA 20/20 to 20/20- with mild NS changes BP good PR: 60 Dilemma? or Direction? 4/08 As OHT (IOP range 17-24, 15-21): Risk calculation (1-5% - low) VF Series 3: 2/ (Bad day or progression? Fundus photos 4/5/2006 5/10/2011 Repeat the VF! (5/10/2011) 9
10 Change analysis 5/10/2011 look closely OS OD 5/10/2011 look closely Treat or not? Need more evidence? OCT RNFL MRNFL (GCC) ONH 10
11 5/10/2011 look closely 11
12 Update Choosing an initial treatment strategy 11/11 IOP: 18/13 Switch to Lumigan 0.01% 12/11 IOP: 20/14 Continue L. 0.01% 1/12 IOP: 21/15 Switch to T-Z 2/ 12 IOP unchanged: Switch to Combigan qam 3/12 IOP unchanged: Switch to Azopt tid 5/12 no IOP response = SLT recommendation 6/13 IOP = 17 mm Hg OD, OS. 6/14 IOP 17/15 mm Hg OD, OS 6/15 IOP 14/15 mm Hg OD, OS 70 The trouble with the world is that the stupid are cocksure and the intelligent are full of doubt. ~Bertrand Russell * Realini T, Fechtner R. Ophthalmology (editorial) 2002; 109: * 71 Guidance on initiating therapy - Delphi Panel 72 Which PA is best? It depends! Alasbali T, Smith M, Geffen N, Trope GE, Flanagan JG, Jin Y, Buys. Discrepancy between results and abstract conclusions in industry- vs nonindustry-funded studies comparing topical prostaglandins. Am J Ophthalmol Jan;147(1): Singh K, Lee BL, Wilson MR; Glaucoma Modified RAND-Like Methodology Group. A panel assessment of glaucoma management: modification of existing RAND-like methodology for consensus in ophthalmology. Part II: Results and interpretation. Am J Ophthalmol Mar;145(3): Meta Analyses suggest slight superiority of bimatoprost. (e.g., Aptel F, Cucherat M, Denis P. Efficacy and tolerability of prostaglandin-timolol fixed combinations: a meta-analysis of randomized clinical trials. Eur J Ophthalmol May 19:0. 73 Considerations in the medical management of glaucoma/ OHT Baseline IOP? Target IOP Severity of damage at initial presentation Burden of treatment Ocular surface Side-effects / Systemic issues Cost of medications Likelihood of adherence to regimen* Potential lifespan 74 Adherence... for the long term 12
13 Adherence... for the long term Factors influencing IOP 75 Physiological factors CCT Diurnal variation Arterial (pulse) pressure Posture Blood Flow Exercise Accommodation Axial length / refractive error Corneal dystrophies Situational influences on IOP Extraneous influences on IOP Eye rubbing Necktie Head position Fluid intake Medications Weight lifting Scleral indentation Wind instrument playing Sambala sirsasana Journal of Glaucoma + spontaneous Extraneous influences on IOP And
14 81 An additional confounder surrounding IOP and our sampling 82 An Implantable Intraocular Pressure Transducer QUESTION: How many seconds elapse in the quarterly interval from one visit to the subsequent one for a patient whom you are monitoring for glaucoma progression? ANSWER: about 8,000,000. [8 million] An Implantable Intraocular Pressure Transducer 83 Image credit: um=1&hl=en&sa=n&biw=1101&bih=538&tbm=isch&tbnid=vyr8xy3etzh4cm:&imgrefurl= >/= 3 measurements (each device) Continuous-Intraocular-Pressure-Monitoring/ &docid=WSm-sv0wMjQpnM&imgurl= profiles12/607447/projects/ / f7b82ec1e4716d0a05f e8735d.jpg&w=600&h=400&ei=rdpot_rca9gtgqf1qowoda&zoom=1&iact=hc&vpx=274& vpy=108&dur=84&hovh=183&hovw=275&tx=158&ty=80&sig= &page=2&tbnh=146&tbnw=182& start=9&ndsp=15&ved=1t:429,r:6,s:9,i:109 Example Example 53 yo treated glaucoma patient (PGA qhs + timolol/tcai comb); excellent reproducibility for two overnights blue & yellow. Mansouri K, Medeiros FA, Tafreshi A, Weinreb RN. Continuous 24-Hour Monitoring of Intraocular Pressure Patterns With a Contact Lens Sensor: Safety, Tolerability, and Reproducibility in Patients With Glaucoma. Arch Ophthalmol. 2012; 13: YO Asian female glaucoma suspect (PGA qhs Rx d but may have been noncompliant); good reproducibility pattern for two overnights blue & yellow. Mansouri K, Medeiros FA, Tafreshi A, Weinreb RN. Continuous 24-Hour Monitoring of Intraocular Pressure Patterns With a Contact Lens Sensor: Safety, Tolerability, and Reproducibility in Patients With Glaucoma. Arch Ophthalmol. 2012; 13:
15 Example Sensimed Triggerfish FDA cleared 88 FDA News Release FDA permits marketing of device that senses optimal time to check patient s eye pressure Increased eye pressure is associated with nerve damage common in glaucoma Poor reproducibility in a 20 GS for two overnights with spikes (n.b., pt has poor sleep habits). [app on your iphone] LS For Immediate Release March 4, 2016 Mansouri K, Medeiros FA, Tafreshi A, Weinreb RN. Continuous 24-Hour Monitoring of Intraocular Pressure Patterns With a Contact Lens Sensor: Safety, Tolerability, and Reproducibility in Patients With Glaucoma. Arch Ophthalmol. 2012; 13:1-6. Home tonometry- more frequent data gathering but not continuous. News / FDA Cleared Icare HOME, An Innovative Device Poised To Revolutionize IOP Self-Monitoring Baseline IOP 91 Establishing a baseline IOP with several measurements guards against making the wrong call. For example, a single IOP of 34mmHg might suggest the need for a treatment recommendation and encourage a reduction to 20mmHg (>30%) when that initial measurement may be an aberration. So, baseline IOP is critical to establish. 15
16 Practical Considerations Recent thoughts on baseline IOP 93 Establish the diagnosis Use multiple IOP measurements to determine a baseline IOP Consider charting a diurnal IOP pattern Use all data available (History, medications, vocational and avocational activities, physical findings including stereo photos and digital imaging as well as VF testing.) 94 Asymmetry is damped with MULTIPLE IOP measurements. Predictions of efficacy are impossible but may be more accurate when more data are gathered. King AJ, Uppal S, Rotchford AP, Lakshumanan A, Abedin A, Henry E. Monocular trial of intraocular pressure-lowering medication: a prospective study. Ophthalmology Nov; 118(11): Baseline IOP suggestions measure twice, cut once 95 Study visits 96 Determining Target IOP King AJ, Uppal S, Rotchford AP, Lakshumanan A, Abedin A, Henry E. Monocular trial of intraocular pressure-lowering medication: a prospective study. Ophthalmology Nov;118(11): Target IOP Defined the pressure at which the patient shows stabilization (i.e., no progression) Canadian Perspective Target IOP is a dynamic concept, needing constant reevaluation. What is lacking are established guidelines for determining the target IOP range that can be used in general practice. Damji KF, Behki R, Wang L; Target IOP Workshop participants. Canadian perspectives in glaucoma management: setting target intraocular pressure range. Can J Ophthalmol Apr;38(3):
17 An alternative suggestion ( market IOP ) What it means: With a high risk of vision loss, the emphasis on lowering IOP increases. Alternative target IOP guidance Target IOP needs to be individualized as progression is highly variable and IOP is only partly responsible. If there is a relatively lower risk of vision loss, then there is greater emphasis on guarding against the risks of therapy. Singh K, Shrivastava A. Early aggressive intraocular pressure lowering, target intraocular pressure, and a novel concept for glaucoma care. Surv Ophthalmol ;53 Suppl1:S Once rate of progression has been determined (by a sufficient # of VFs) and treatment advanced accordingly. [e.g, slower progression for NTG but faster for PXG] Rossetti L, Goni F, Denis P, Bengtsson B, Martinez A, Heijl A. Focusing on glaucoma progression and the clinical importance of progression rate measurement: a review. Eye 2010; 24: s1-s7. Hyman L, et al. Natural History of IOP in the EMGT. Arch Ophthalmol. 2010;128(5): What about advancing therapy? 102 What about advancing therapy by adding another medication? Options include Switching to an alternative topical therapy or adding additional topical drops SLT Trabeculectomy Single agent? Consensus guideline suggests tcai A constellation of drops? Using additional dosages is likely to decrease adherence Fixed combination drop? Beta-blocker containing or BB-free? Consider this scenario 103 Ophthalmic Generics The pharmacist calls you and asks, Can I give your patient a generic equivalent of this PGA? Your response would be: A. Sure, they are bioequivalent B. No, they only have the same active ingredient as the original product C. Go ahead, we ll see how it performs D. No, my child is on a NAMEYOURFAVORITEPHARMA scholarship at Vanderbilt 17
18 Ophthalmic generic qualifications ala FDA Ophthalmic generic qualifications ala FDA 105 Generic ophthalmic medications contain the same active ingredients as their brand-name predecessors. 106 Generic ophthalmic medications contain the same active ingredients as their brand-name predecessors. But, is the bioavailability the same? (i.e., what is the other %?) What influences bioavailability? Which would you choose? 107 Excipients Buffers Antioxidants Thickening agents ph Preservatives Tonicity Drop size Bottle composition q=coca+cola&hl=en&tbo=d&source=lnms&tbm=isch&sa=x&ei=hbqvuc LvL5OO9ASlooHQDw&ved=0CAcQ_AUoAA&biw=1126&bih=633#imgrc =ynyqmoo2gbb76m%3a%3bajpa_bsl75wi9m%3bhttp%253a%252f%25 2Fwww.thetimes.co.uk%252Ftto%252Fmultimedia%252Farchive%252F0037 4%252FVIDEO_Cocacola_add_374157a.jpg%3Bhttp%253A%252F%252Fwww.thetimes.co.uk%2 52Ftto%252Fhealth%252Fnews%252Farticle ece%3B1024%3B576 manfoodblog.files.wordpress.com/2011/04/ p jpg&imgrefurl= manfoodblog.wordpress.com/2011/04/08/storebrand-cola-shootout/ &h=1536&w=2048&sz=1343&tbnid=am6yxexn7ck ZrM:&tbnh=90&tbnw=120&zoom=1&usg= c2jltv QyrU4bBmsFWEjTAKSQYm4=&docid=5vjRaELR8N GEkM&hl=en&sa=X&ei=IRUVUfjtBIze8ATUxoDICw &ved=0cdaq9qewaa&dur=0 Issues with generics Approaching the generic substitution issue with patients $/Pharmacy substitution Insurance coverage Medicare part D vs. Private Pay Some patients prefer a branded product When $ is a consideration, discuss the situation Generics may not have equivalent bioavailability, so monitor more closely/frequently Ask patients to bring their bottles to visits Have the dispensing pharmacist understand why what you have prescribed for the patient 18
19 111 Approaching the generic substitution issue with patients Consider options Pharmaceutical manufacturers plans/coupons Other classes of drugs Fewer doses / day, and other offlabel options, etc. 112 Impact of generic latanoprost Impact of the Introduction of Generic Latanoprost on Glaucoma Medication Adherence. Stein, JD, et al. Am J. Ophth.Published Online: February 10, 2015 Conclusions Given that cost can significantly deter adherence, switching patients to generic medications may help improve patients' drug-regimen adherence. A considerable number of patients discontinued glaucoma drug use altogether when generic latanoprost became available. [We] should work with insurers and pharmacists to prevent such discontinuation of use as generic forms of other PGA agents become available. Lipid Family Receptors 115 What about weed? Information is current as of Sept. 14, Lipid Family Receptors Cannabinoids Prostaglandins Prostamides State with legal medical marijuana State with decriminalized marijuana possession laws 114 State with both medical and decriminalization laws AGS position statement AGS position statement Treatment modalities (to lower IOP) Medication Laser Surgery Marijuana as an alternative Frequent dosing SEs Inadequate topical formulations May be neuroprotective Jampel H. American glaucoma society position statement: 11 marijuana and the treatment of glaucoma. J Glaucoma Feb;19(2):75-6. Bottom line: NO scientific evidence for its use to treat glaucoma Jampel H. American glaucoma society position statement: marijuana and the treatment of glaucoma. J Glaucoma Feb;19(2):
20 Perfusion to the ONH 119 Example comparing DOPP and mean OPP 120/80 IOP = 20; DOPP = 60 [ 80-20] Nocturnal hypoperfusion as a glaucoma risk factor What IOP do we measure? diastolic Significant difference between DOPP and MOPP Which to use??? Perfusion to the ONH 120 Example comparing DOPP and mean OPP 120/80 IOP = 20; DOPP = 60 [ 80-20] What IOP do we measure? diastolic Comparing DOPP to MOPP calculation MOPP = 2/3[DBP = 1/3 (SBP-DBP)- IOP 2/3[80 + 1/3 (40)] 20 results in (monkeys) 122 *Recent association between nocturnal BP dips and ODH in NTG over-dippers = progressors Kwon J, Lee J, Choi J, Jeong D, Kook MS. Association Between Nocturnal Blood Pressure Dips and Optic Disc Hemorrhage in Patients With Normal-Tension Glaucoma. Am J Ophthalmol Apr;176: doi: /j.ajo Epub 2017 Jan
21 *Recent association between nocturnal BP dips and ODH in NTG 125 How should glaucoma be managed comprehensively? First, lower IOP over-dippers = progressors è Kwon J, Lee J, Choi J, Jeong D, Kook MS. Association Between Nocturnal Blood Pressure Dips and Optic Disc Hemorrhage in Patients With Normal-Tension Glaucoma. Am J Ophthalmol Apr;176: doi: /j.ajo Epub 2017 Jan 12. New directions in glaucoma treatment Nov. 2, Yes, treatment Beyond IOP reduction, regulation of blood flow... Systemically (regulating blood pressure and monitoring perfusion pressure) Locally endothelial-cell activity by modulating Nitric Oxide (NO) This is the NEXT BIG THING! n Regulation of aqueous dynamics at the trabecular meshwork by vascular modulation n In addition, the application of NO-donating compounds for the lowering of IOP directly 128 Future options for medical management targeting the site of glaucoma, the TM 129 Future options for medical management targeting the site of glaucoma, the TM Rho-kinase inhibitors (Rhopressa and Roclatan, (netarsudil/latanoprost ophthalmic solution) 0.02%/0.005%, Aerie) Completed 12-month safety evaluation, Rocket (Canada) Completed 3-month efficacy study (USA), Mercury FDA-Approved December 2017 Rho-kinase inhibitors (Rhopressa and Roclatan, (netarsudil/ latanoprost ophthalmic solution) 0.02%/0.005%, Aerie) Completed 12-month safety evaluation, Rocket (Canada) Completed 3-month efficacy study (USA), Mercury FDA-approved December 2017 *MOAs increase fluid outflow through the trabecular meshwork, (1 0 drainage) increase fluid outflow through the uveoscleral pathway, (2 0 drainage) reduce fluid production in the eye, and reduce episcleral venous pressure (EVP). 21
22 130 Other future directions for medical management of glacuoma 131 How should glaucoma be managed comprehensively? Drug delivery (continuous, episodic) Neuroprotection & Neuroregeneration Second, consider increasing perfusion (may be a consequence of lowered IOP) Topical treatments? (betaxolol, brimonidine, brinzolamide, Gingko Biloba) Exercise, weight loss Lower cholesterol, blood sugar levels Treat underlying vascular disorders (HT, SAS, CVD) Etc. Anti-oxidant/Supplement formulation Study design 132 Harris A, Gross J, Moore N, et al. The effects of antioxidants on ocular blood flow in patients with glaucoma. Acta Ophthalmol Aug 3. doi: /aos [Epub ahead of print] patients with confirmed glaucoma on IOPlowering treatment (placebo controlled, X-over) Baseline and post-administration (@ 1 month) measurements IOP OPP Retrobulbar (ultrasound) and retinal capillary (Doppler) blood flow Results SO, what were they given? 134 Increased peak systolic and/or end diastolic velocities among the active group (but not placebo) Reduced vascular resistance in central retinal and short posterior ciliary arteries Increased superior and inferior temporal retinal artery mean blood flow Enhanced retinal capillary density
23 136 SO, what were they given? 137 How should glaucoma be managed comprehensively? Third, reduce oxidative stress (Ca ++ blockade [BUT, not systemic β-blockers], supplements) 138 NON-SELECTIVE Beta-blockers: Significant additional precaution Consider this: Topical β-blockers administered at night to those taking systemic β -blockers may reduce perfusion to the ONH plus β -blocker therapy to reduce IOP is ineffective at night. Is glaucoma AION that happens over a lifetime? OR Is AION glaucoma that happens overnight? Which brings us to... Hayreh SS. Effect of nocturnal blood pressure reduction on retrobulbar hemodynamics in glaucoma. Graefes Arch Clin Exp Ophthalmol. 2002; 240: Remember Adherence and life span are increasingly parts of our management paradigm. Technology is allowing us better diagnostic (earlier) and progression (monitoring) algorithms. A number of options for initial and advancing treatment are available and considerations include systemic and financial factors. Liu C-H, et al. Comparison of the Retinal Microvascular Density Between OAG and naion. IOVS. 2017;58: DOI: /iovs
24 142 Thank you! 24
Is this glaucoma? Leo Semes, OD Michael Chaglasian, OD Danica Marrelli, OD. Optometry s Meeting 2015 Seattle, WA
Is this glaucoma? Leo Semes, OD Michael Chaglasian, OD Danica Marrelli, OD Optometry s Meeting 2015 Seattle, WA Case 1. 54 WM Engineer is referred to UAB Eye Care as a glaucoma suspect. Mild myopic refractive
More information9/13/17 DISCLOSURES LATE 50S WM. Honoraria, Consultant or Advisory Board: IS THIS GLAUCOMA?
DISCLOSURES HEART OF AMERICA 2018 LEO SEMES, OD Honoraria, Consultant or Advisory Board: Alcon, Allergan, B&L, Genentech, Maculogix, OptoVue, Regeneron, Shire, Zeavision IS THIS GLAUCOMA? Stock options:
More informationCollaboration in the care of glaucoma patients and glaucoma suspects. Barry Emara MD FRCS(C) Nico Ristorante November 29, 2012
Collaboration in the care of glaucoma patients and glaucoma suspects Barry Emara MD FRCS(C) Nico Ristorante November 29, 2012 Goals of Collaboration Patient-centred and evidence based approach Timely access
More informationTreatments on the Horizon
Latanoprostene bunod (Vesneo) Treatments on the Horizon Dominick L Opitz, OD, FAAO Associate Professor Illinois College of Optometry Valeant (B+L) Nitrous oxide-donating prostaglandin F2-alpha analogue
More informationPage 1. Robert P. Wooldridge, OD, FAAO
Robert P. Wooldridge, OD, FAAO I have received support from the following companies Alcon, Allergan, Biotissue, Centervue, EyeiC, Oculus, Optovue, Synemed, 46 yo WM referred as glaucoma suspect MH: no
More informationGlaucoma Clinical Update. Barry Emara MD FRCS(C) Giovanni Caboto Club October 3, 2012
Glaucoma Clinical Update Barry Emara MD FRCS(C) Giovanni Caboto Club October 3, 2012 Objectives Understand the different categories of glaucoma Recognize the symptoms and signs of open angle and angle-closure
More information3/31/2019. Role of IOP. Role of IOP. Role of IOP. Role of IOP. Evaluation of glaucoma has changed Why hasn t treatment?
Glaucoma Update ROLE FOR RHOPRESSA Gregory D. Searcy, M.D. 1857: German ophthalmologist Albrecht Van Graefe concluded all glaucomatous optic disc excavation is associated with high IOP based on the only
More informationCourse # Glaucoma Pearls: From OGS to ARVO
Course # 101 DISCLOSURE STATEMENT Consultant-Aerie, Allergan, B + L, Carl Zeiss Meditec, Heidelberg Engineering, Novartis Pharma, Topcon Course Title: Lecturer: Glaucoma Pearls: From OGS to ARVO Murray
More informationIntro to Glaucoma/2006
Intro to Glaucoma/2006 Managing Patients with Glaucoma is Exciting Interesting Challenging But can often be frustrating! Clinical Challenges To identify patients with risk factors for possible glaucoma.
More information4/06/2013. Medication Observation POAG. Proportion. Native American 0.1% 0.4%
Clinical Research in Glaucoma: Putting Science into Practice J. James Thimons, O.D., FAAO Chairman, National Glaucoma Society www.nationalglaucomasociety.org Ocular Hypertension Treatment Study (OHTS)
More informationManaging the Patient with POAG
Managing the Patient with POAG Vision Institute Annual Fall Conference Mitchell W. Dul, OD, MS, FAAO mdul@sunyopt.edu Richard J. Madonna, MA, OD, FAAO rmadonna@sunyopt.edu Ocular Hypertension (OHT) Most
More informationEast and North Hertfordshire treatment pathway for primary open angle glaucoma and ocular hypertension in adults
East and North Hertfordshire treatment pathway for primary open angle glaucoma and ocular hypertension in adults Introduction Glaucoma is a group of eye diseases causing optic nerve damage. In most cases
More information7/25/2018 GLAUCOMA: YOU MAKE THE CALL GLAUCOMA: YOU MAKE THE CALL. Please text us your questions! PACHYMETRY
GLAUCOMA: YOU MAKE THE CALL Lori Vollmer, OD Jessica Steen, OD Greg Caldwell, OD Joseph Sowka, OD GLAUCOMA: YOU MAKE THE CALL Please text us your questions! Joe: 954-298-0970 Greg: 814-931-2030 PACHYMETRY
More informationDISCLOSURE: What to do? 2/22/2016
DISCLOSURE: Dr. Joseph Sowka is a member of the Speakers Bureau for Alcon Laboratories, and Carl Zeiss Meditec. He is on the advisory boards for Alcon, Zeiss, and Allergan. He is a consultant for Alcon.
More information53 year old woman attends your practice for routine exam. She has no past medical history or family history of note.
Case 1 Normal Tension Glaucoma 53 year old woman attends your practice for routine exam. She has no past medical history or family history of note. Table 1. Right Eye Left Eye Visual acuity 6/6 6/6 Ishihara
More informationGenerics are Cheaper and Just as Effective
Disclosures Generics are Cheaper and Just as Effective Robert L. Stamper, MD UCSF Department of Ophthalmology No current pharmaceutical industry connections Data & Safety Monitor for Cypass - Chair - Transcend
More informationMEDICAL POLICY SUBJECT: CORNEAL ULTRASOUND PACHYMETRY. POLICY NUMBER: CATEGORY: Technology Assessment
MEDICAL POLICY SUBJECT: CORNEAL ULTRASOUND,, PAGE: 1 OF: 5 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including
More informationThe second most common causes of blindness worldwide. ( after cataract) The commonest cause of irreversible blindness in the world Estimated that 3%
The second most common causes of blindness worldwide. ( after cataract) The commonest cause of irreversible blindness in the world Estimated that 3% of our population age > 40 have glaucoma In the past:
More informationPractical approach to medical management of glaucoma DR. RATHINI LILIAN DAVID
Practical approach to medical management of glaucoma DR. RATHINI LILIAN DAVID Glaucoma is one of the major causes of visual loss worldwide. The philosophy of glaucoma management is to preserve the visual
More informationMicro-Invasive Glaucoma Surgery (Aqueous Stents)
Micro-Invasive Glaucoma Surgery (Aqueous Stents) Policy Number: Original Effective Date: MM.06.029 02/01/2019 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 02/01/2019 Section:
More informationGlaucoma. Glaucoma. Optic Disc Cupping
Glaucoma What is Glaucoma? Bruce James A group of diseases in which damage to the optic nerve occurs as a result of intraocualar pressure being above the physiological norm for that eye Stoke Mandeville
More informationGLAUCOMA SUMMARY BENCHMARKS FOR PREFERRED PRACTICE PATTERN GUIDELINES
SUMMARY BENCHMARKS FOR PREFERRED PRACTICE PATTERN GUIDELINES Introduction These are summary benchmarks for the Academy s Preferred Practice Pattern (PPP) guidelines. The Preferred Practice Pattern series
More informationBuilding a Major Ophthalmic Pharmaceutical Company. Aerie Pharmaceuticals, Inc. Company Overview June 2-3, 2015
Building a Major Ophthalmic Pharmaceutical Company Aerie Pharmaceuticals, Inc. Company Overview June 2-3, 2015 1 Important Information Any discussion of the potential use or expected success of our product
More information10/3/2018. Case: 63 year old white female 6/11/2012 visit. Glaucoma Update for the Primary Care OD CHRISTOPHER WOLFE, OD, FAAO, DIPL ABO
DISCLOSURE STATEMENT Ihave no direct financial or proprietary interest in any companies, products or services mentioned in this presentation. GLAUCOMA UPDATE FOR THE PRIMARY CARE OD Please silence all
More information9/6/2013. Evidence Based Guidance on Glaucoma Laser Trabeculoplasty and Early Surgery. Simon K. Law, MD. Clinical Professor of Health Sciences
Evidence Based Guidance on Glaucoma Laser Trabeculoplasty and Early Surgery Simon K. Law, MD Clinical Professor of Health Sciences 25.5 mmhg 24 mmhg 1 Additional Opinions. First ophthalmologist diagnosed
More informationFinancial Disclosure. Prostaglandin Analogs (PGs) The Glaucoma Grab Bag: Practical Guidelines for Effective Glaucoma Therapy
The Glaucoma Grab Bag: Practical Guidelines for Effective Glaucoma Therapy Danica J. Marrelli, OD, FAAO University of Houston College of Optometry Financial Disclosure I have received I have received speaking
More informationMicro-Invasive Glaucoma Surgery (Aqueous Stents)
Micro-Invasive Glaucoma Surgery (Aqueous Stents) Policy Number: Original Effective Date: MM.06.029 02/01/2019 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 02/01/2019 Section:
More informationPresent relevant clinical findings of four landmark glaucoma trials OHTS, EMGT, CNTGS and CIGTS.
Course title: The Glaucoma Compass Course length: 1 hour +/- 31 slides Corse Description: Even with the technology and available information, glaucoma decision making can still be confusing. How should
More informationPRACTICAL APPROACH TO MEDICAL MANAGEMENT OF GLAUCOMA
PRACTICAL APPROACH TO MEDICAL MANAGEMENT OF GLAUCOMA DR. RAVI THOMAS, DR. RAJUL PARIKH, DR. SHEFALI PARIKH IJO MAY 2008 PRESENTER AT JDOS : DR. RAHUL SHUKLA T.N. SHUKLA EYE HOSPITAL TERMINOLOGY POAG: PRIMARY
More informationIs NTG different from POAG?
Is NTG different from POAG? Sunita Radhakrishnan, M.D Glaucoma Center of San Francisco Glaucoma Research and Education Group Subset of POAG 1 Connective tissue structure within ONH Ganglion cell susceptibility
More informationGlaucoma: NOT just IOP, Think DPP, OMG!
Glaucoma: NOT just IOP, Think DPP, OMG! Bruce E. Onofrey, OD, RPh, FAAO Professor, Univ. Houston Exec. Director Continuing Education Programs I m a clinician, so let s talk patients TWO Patients ( a priest
More informationOCT in the Diagnosis and Follow-up of Glaucoma
OCT in the Diagnosis and Follow-up of Glaucoma Karim A Raafat MD. Professor Of Ophthalmology Cairo University Hmmmm! Do I have Glaucoma or not?! 1 Visual Function 100% - N Gl Structure : - 5000 axon /
More informationCorporate Medical Policy
Corporate Medical Policy Glaucoma, Evaluation by Ophthalmologic Techniques File Name: Origination: Last CAP Review: Next CAP Review: Last Review: glaucoma_evaluation_by_ophthalmologic_techniques 3/2001
More informationGlaucoma Disease Progression Role of Intra Ocular Pressure. Is Good Enough, Low Enough?
Glaucoma Disease Progression Role of Intra Ocular Pressure Is Good Enough, Low Enough? Glaucoma Diseases Progression Key Considerations Good number of patients may be diagnosed only after some damage the
More informationMacular Ganglion Cell Complex Measurement Using Spectral Domain Optical Coherence Tomography in Glaucoma
Med. J. Cairo Univ., Vol. 83, No. 2, September: 67-72, 2015 www.medicaljournalofcairouniversity.net Macular Ganglion Cell Complex Measurement Using Spectral Domain Optical Coherence Tomography in Glaucoma
More information1/25/2019 OCT & OCTA RETINAL IMAGING: HOW TO PREVENT RAGING GLAUCOMA! THE ORIGINAL RAGING GLAUCOMA OCT RETINAL IMAGING OPTIC NERVE HEAD EXAMINATION
OCT & OCTA RETINAL IMAGING: HOW TO PREVENT RAGING GLAUCOMA! Craig Thomas, O.D. 3900 West Wheatland Road Dallas, Texas 75237 972-780-7199 thpckc@yahoo.com THE ORIGINAL RAGING GLAUCOMA 47-year-old Black
More informationEarly Detection Of Glaucoma Clinical Clues. Points To Live By. Glaucoma Risk Factors 10/3/2014
Early Detection Of Glaucoma Clinical Clues Eric E. Schmidt, O.D. Omni Eye Specialists Wilmington, NC schmidtyvision@msn.com Points To Live By 25% of G pxs NEVER have IOP >21mm 50% of G pxs have trough
More information5/12/2014. Lynn E. Lawrence, CPOT, ABOC, COA
Lynn E. Lawrence, CPOT, ABOC, COA Glaucoma is an optic neuropathy characterized by a loss of ganglion cells and their axons, in the RNFL. The loss of retinal ganglion cells in glaucoma is irreversible
More informationClinical Research in Glaucoma
Clinical Research in Glaucoma J. James Thimons, O.D., FAAO Chairman, National Glaucoma Society www.nationalglaucomasociety.org Ocular Hypertension Treatment Study (OHTS) Primary Goals Evaluate the safety
More informationKeeping Up with the Chaglasian s: Pearls for Glaucoma Cases
Keeping Up with the Chaglasian s: Pearls for Glaucoma Cases Disclosure Michael Chaglasian has the following disclosures: 1. Advisory Board: Allergan, Alcon, B+L, Carl Zeiss, 2. Research Support: Topcon
More informationGoals. Glaucoma PARA PEARL TO DO. Vision Loss with Glaucoma
Glaucoma Janet R. Fett, OD Drs. Kincaid, Fett and Tharp So Sioux City, NE eyewear21@hotmail.com Goals Understand Glaucoma Disease process Understand how your data (objective and subjective) assists in
More informationAdvances in OCT Murray Fingeret, OD
Disclosures Advances in OCT Murray Fingeret, OD Consultant Alcon, Allergan, Bausch & Lomb, Carl Zeiss Meditec, Diopsys, Heidelberg Engineering, Reichert, Topcon Currently Approved OCT Devices OCT Devices
More informationKEY MESSAGES. Details of the evidence supporting these recommendations can be found in the above CPG, available on the following websites:
QUICK REFERENCE FOR HEALTHCARE PROVIDERS KEY MESSAGES 1. Glaucoma is a chronic eye disease that damages the optic nerve, & can result in serious vision loss and irreversible blindness. 2. Glaucoma diagnosis
More informationGlaucoma Evaluation. OCT Pearls for Glaucoma. OCT: Retinal Nerve Fiber Layer. Financial Disclosures. OCT: Macula. Case Example
OCT Pearls for Glaucoma using OCT of the macula for glaucoma Glaucoma Evaluation Right eye Visual Acuity 20/25 20/25 IOP 13 13 Central corneal 530 530 thickness Anterior exam Normal with PCIOL Normal with
More informationDivakar Gupta Glaucoma Fellow, Duke Eye Center 5/14/16
Divakar Gupta Glaucoma Fellow, Duke Eye Center 5/14/16 Pathophysiology of glaucoma Consider risk factors of glaucoma Understand the side effects of glaucoma medications Diagnostic testing Leading cause
More informationThe Role of the RNFL in the Diagnosis of Glaucoma
Chapter 1. The Role of the RNFL in the Diagnosis of Glaucoma Introduction Glaucoma is an optic neuropathy characterized by a loss of of retinal ganglion cells and their axons, the Retinal Nerve Fiber Layer
More informationVI.2.2 Summary of treatment benefits
EU-Risk Management Plan for Bimatoprost V01 aetiology), both OAG and ACG can be secondary conditions. Secondary glaucoma refers to any case in which another disorder (e.g. injury, inflammation, vascular
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Pachymetry Page 1 of 8 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Pachymetry Professional Institutional Original Effective Date: March 11, 2004 Original Effective
More information21st Century Visual Field Testing
Supplement to Supported by an educational grant from Carl Zeiss Meditec, Inc. Winter 2011 21st Century Visual Field Testing the Evolution Continues 21st Century Visual Field Testing 21st Century Visual
More informationTargeting Intraocular Pressure in Glaucoma: a Teaching Case Report 1
Targeting Intraocular Pressure in Glaucoma: a Teaching Case Report 1 By: Andrew Kemp, OD, Marcus Gonzales, OD, FAAO, Joe DeLoach, OD, FAAO, and Zanna Kruoch, OD FAAO Background Glaucoma is a range of conditions
More informationOcular Hypotensive Efficacy of Netarsudil Ophthalmic Solution 0.02% Over a 24-Hour Period: A Pilot Study
Ocular Hypotensive Efficacy of Netarsudil Ophthalmic Solution 0.02% Over a 24-Hour Period: A Pilot Study James H. Peace, M.D. 1, Casey K. Kopczynski, Ph.D. 2, and Theresa Heah, M.D. 2 1 Inglewood, CA 2
More informationA Review Of Risk Factors. Early Detection Of Glaucoma Clinical Clues. A risk factor analysis is critical. Points To Live By
A Review Of Risk Factors Early Detection Of Glaucoma Clinical Clues Eric E. Schmidt, O.D. Omni Eye Specialists Wilmington, NC schmidtyvision@msn.com FINDACAR Family history IOP Nearsightedness Diabetes/Vascular
More informationNoel de Jesus Atienza, MD, MSc and Joseph Anthony Tumbocon, MD
Original Article Philippine Journal of OPHTHALMOLOGY Diagnostic Accuracy of the Optical Coherence Tomography in Assessing Glaucoma Among Filipinos. Part 1: Categorical Outcomes Based on a Normative Database
More informationDr. Harvey Richman, OD, FAAO, FCOVD Diplomate American Board of Optometry Executive Committee AOA Third Party Center Founder Ask the AOA Coding
Dr. Harvey Richman, OD, FAAO, FCOVD Diplomate American Board of Optometry Executive Committee AOA Third Party Center Founder Ask the AOA Coding Experts 92000 Codes Special Ophthalmological Services Describe
More informationGlaucoma: Diagnostic Modalities
Glaucoma: Diagnostic Modalities - Dr. Barun Kumar Nayak, Dr. Sarika Ramugade Glaucoma is a leading cause of blindness in the world, especially in older people. Early detection and treatment by ophthalmologist
More informationLong Term Efficacy of Repeat Treatment with SLT: Seven Years Follow up
Long Term Efficacy of Repeat Treatment with SLT: Seven Years Follow up Lawrence F. Jindra, MD Columbia University Winthrop University Hospital Disclosure Speaker has independently conducted and financed
More informationGlaucoma is the most frequent
Refined glaucoma referral practice offers prospect of improved capacity and expanded role for primary eye care professionals BY ROD MCNEIL Glaucoma is the most frequent cause of irreversible blindness
More informationUniversity Hospital Basel. Optical Coherence Tomography Emerging Role in the Assessment of MS PD Dr. Konstantin Gugleta
University Hospital Basel Optical Coherence Tomography Emerging Role in the Assessment of MS PD Dr. Konstantin Gugleta 15th State of the Art SMSS, Lucerne January 2013 Retinal Nerve Fiber Layer 1.200.000
More informationChronicity. Narrow Minded. Course Outline. Acute angle closure. Subacute angle closure. Classification of Angle Closure 5/19/2014
Chronicity Narrow Minded The management of narrow angles in the optometric practice Acute Subacute Chronic Aaron McNulty, OD, FAAO Course Outline Classification of Angle Closure Evaluation of narrow angles
More informationRoclatan TM Mercury 2 Phase 3 Topline Results
Roclatan TM Mercury 2 Phase 3 Topline Results 1 Important Information Any discussion of the potential use or expected success of our product candidates is subject to our product candidates being approved
More informationAerie Pharmaceuticals, Inc. Additional Rhopressa Rocket 1 Analyses and Path Forward
Aerie Pharmaceuticals, Inc. Additional Rhopressa Rocket 1 Analyses and Path Forward May 7, 2015 1 Important Information Any discussion of the potential use or expected success of our product candidates
More informationUPDATES IN GLAUCOMA MANAGEMENT CASCADE
UPDATES IN GLAUCOMA MANAGEMENT CASCADE TAREK M. EID, MD PROFESSOR OF OPHTHALMOLOGY, TANTA UNIVERSITY GLAUCOMA MANAGEMENT CASCADE I.LEARN CLINICAL SKILLS AND TOOLS FOR DIAGNOSIS I.CATEGORIZE THE STATUS
More informationThe Common Clinical Competency Framework for Non-medical Ophthalmic Healthcare Professionals in Secondary Care
The Common Clinical Competency Framework for Non-medical Ophthalmic Healthcare Professionals in Secondary Care Glaucoma November 2016 Association of Health Professions in Ophthalmology General basic competences
More informationSOUTH-EAST EUROPEAN JOURNAL of OPHTHALMOLOGY 2015; 1 (1) 34 40
Review article SOUTH-EAST EUROPEAN JOURNAL of OPHTHALMOLOGY 2015; 1 (1) 34 40 Retinal nerve fiber layer versus peripapillary capillary density assessment A powerful tool for detecting optic nerve head
More informationIl contributo dell'angio-oct: valutazione integrata della componente nervosa e vascolare della malattia glaucomatosa
SIMPOSIO G.O.A.L. - LE NUOVE FRONTIERE DIAGNOSTICHE E LE LINEE DI INDIRIZZO AMBULATORIALI DEL GLAUCOMA Coordinatore e moderatore: D. Mazzacane Presidente: L. Rossetti Il contributo dell'angio-oct: valutazione
More informationGlaucoma For The Everyday Optometrist
A Review Of Risk Factors Glaucoma For The Everyday Optometrist Eric E. Schmidt, O.D., F.A.A.O. Omni Eye Specialists Wilmington, NC schmidtyvision@msn.com FINDACAR Family history IOP Nearsightedness Diabetes/Vascular
More informationFinancial Disclosure. Visual Field Interpretation RELIABILITY VISUAL FIELD INTERPRETATION IN GLAUCOMA METHODS OF DATA PRESENTATION
VISUAL FIELD INTERPRETATION IN GLAUCOMA Danica J. Marrelli, OD, FAAO University of Houston College of Optometry Financial Disclosure I have received speaking and/or consulting fees from: Aerie Pharmaceutical
More information1/31/2018. Course Objectives. Diagnostic Testing. Optic Nerve Damage ANATOMY AND PHYSIOLOGY OF A GLAUCOMA WORK-UP/TONOMETRY TECHNICIAN: -SDP
ANATOMY AND PHYSIOLOGY OF A GLAUCOMA WORK-UP/TONOMETRY KNOW THE DISEASE PROCESS TECHNICIAN: EXPLAIN PROCESS OF EXAMINATION Presenters: Dana McMahan, COA Nicole Smith, COA Engage with patient s, help alleviate
More informationContents Optic Nerve: The Glaucomatous Optic Nerve Optic Nerve: Clinical Examination Optic Nerve: Heidelberg Retinal Tomography
Contents 1 Optic Nerve: The Glaucomatous Optic Nerve................... 1 1.1 Why Is the Optic Nerve Important in the Diagnosis and Management of Glaucoma?............................ 1 References.................................................
More informationInnovations in Glaucoma Drug Delivery What the Future Holds. Justin Schweitzer, OD, FAAO Vance Thompson Vision Sioux Falls, South Dakota
Innovations in Glaucoma Drug Delivery What the Future Holds Justin Schweitzer, OD, FAAO Vance Thompson Vision Sioux Falls, South Dakota Allergan Glaukos Bausch and Lomb Bio- Tissue Alcon TearScience Reichert
More informationDr Taha Abdel Monein Labib Professor of Eye Surgery Cairo University.
Dr Taha Abdel Monein Labib Professor of Eye Surgery Cairo University. Although the clinical picture of glaucoma is well described, the exact mechanism leading to this specific type of damage to the optic
More information11/30/2009. Glaukosis: ancient greek term meaning sparkling or shining appearance of pupil
Normal Ocular Anatomy Glaucoma Dr Sunil Deokule, MD Asst. Prof and Glaucoma Specialist University of Kentucky Definition Glaukosis: ancient greek term meaning sparkling or shining appearance of pupil Optic
More informationWGA. The Global Glaucoma Network
The Global Glaucoma Network Fort Lauderdale April 30, 2005 Indications for Surgery 1. The decision for surgery should consider the risk/benefit ratio. Note: Although a lower IOP is generally considered
More informationThis policy is applicable to Commercial Products only. For BlueCHiP for Medicare, see related policy section.
Medical Coverage Policy Ophthalmologic Techniques that Evaluate the Posterior Segment for Glaucoma EFFECTIVE DATE: 01 01 2017 POLICY LAST UPDATED: 09 18 2018 OVERVIEW Several techniques have been developed
More informationGlaucoma is a heterogeneous
Old and New Drug Classes Expanding To Include Glaucoma Treatments Troy Kish, PharmD, BCPS Glaucoma is a heterogeneous disease characterized by the development of increased intraocular pressure (IOP) that
More informationTHE CHRONIC GLAUCOMAS
THE CHRONIC GLAUCOMAS WHAT IS GLAUCOMA? People with glaucoma have lost some of their field of all round vision. It is often the edge or periphery that is lost. That is why the condition can be missed until
More informationNeovascular Glaucoma Associated with Cilioretinal Artery Occlusion Combined with Perfused Central Retinal Vein Occlusion
Neovascular Glaucoma Associated with Cilioretinal Artery Occlusion Combined with Perfused Central Retinal Vein Occlusion Man-Seong Seo,* Jae-Moon Woo* and Jeong-Jin Seo *Department of Ophthalmology, Chonnam
More information24-hour Intraocular Pressure and Ocular Perfusion Pressure in Glaucoma
SURVEY OF OPHTHALMOLOGY VOLUME 58 NUMBER 1 JANUARY FEBRUARY 2013 MAJOR REVIEW 24-hour Intraocular Pressure and Ocular Perfusion Pressure in Glaucoma Luciano Quaranta, MD, PhD, 1 Andreas Katsanos, MD, PhD,
More informationIOP measurements: 8.00 am (trough drug levels) and am (peak drug levels)(2 hours post dose)
This overview of 2% eye drops was presented by Dr. Ravin N. Das, at Hotel Satya Ashoka, on 19-6-2004 in place of Dr. H. S. Ray due to unforseen circumstances. This dinner meeting was sponsored by Cipla
More informationEvolution of the Definition of Primary Open-Angle Glaucoma
OCULAR BLOOD FLOW IN GLAUCOMA MANAGEMENT AHMED HOSSAM ABDALLA PROFESSOR AND HEAD OF OPHTHALMOLOGY DEPARTEMENT ALEXANDRIA UNIVERSITY Evolution of the Definition of Primary Open-Angle Glaucoma Former definition
More informationAmerican Board of Optometry Board Certification Examination DETAILED OUTLINE
American Board of Optometry Board Certification Examination DETAILED OUTLINE General Practice (160 items) The core of the examination is based in the following ten areas of general practice. 1. Ametropia/Ophthalmic
More informationCHAPTER 13 CLINICAL CASES INTRODUCTION
2 CHAPTER 3 CLINICAL CASES INTRODUCTION The previous chapters of this book have systematically presented various aspects of visual field testing and is now put into a clinical context. In this chapter,
More informationCHARTING THE NEW COURSE FOR MIGS
CHARTING THE NEW COURSE FOR MIGS SEE WHAT S ON THE HORIZON CyPass Micro-Stent the next wave in micro-invasive glaucoma surgery. MICRO-INVASIVE GLAUCOMA SURGERY (MIGS) OFFERS A REVOLUTIONARY APPROACH TO
More informationBuilding a Major Ophthalmic Pharmaceutical Company. Aerie Pharmaceuticals, Inc. July 13, 2016
Building a Major Ophthalmic Pharmaceutical Company Aerie Pharmaceuticals, Inc. July 13, 2016 1 Important Information Any discussion of the potential use or expected success of our product candidates is
More informationLandmark Glaucoma Studies
Landmark Glaucoma Studies: How They Affect Our Management Strategies Today Disclosures None By: Alex Kabiri, O.D. & Devin Singh, O.D. Course Goals 1. Review series of glaucoma studies that: Evaluate when
More informationClinical Discussions in Glaucoma
Clinical Discussions in Glaucoma Joseph W. Sowka, OD, FAAO, Diplomate Professor of Optometry Nova Southeastern University, College of Optometry 3200 South University Drive Fort Lauderdale, Florida 33328
More informationCorporate Medical Policy
Corporate Medical Policy Optical Coherence Tomography (OCT) Anterior Segment of the Eye File Name: Origination: Last CAP Review: Next CAP Review: Last Review: optical_coherence_tomography_(oct)_anterior_segment_of_the_eye
More informationTHE CHRONIC GLAUCOMAS
THE CHRONIC GLAUCOMAS WHAT IS GLAUCOMA People with glaucoma have lost some of their field of all round vision. It is often the edge or periphery that is lost. That is why the condition can be missed until
More informationManagement of Angle Closure Glaucoma Hospital Authority Convention 18 May 2015
Management of Angle Closure Glaucoma Hospital Authority Convention 18 May 2015 Jimmy Lai Clinical Professor Department of Ophthalmology The University of Hong Kong 1 Primary Angle Closure Glaucoma PACG
More informationGlaucoma Diagnosis. Definition of Glaucoma. Diagnosing Glaucoma. Vision Institute Annual Fall Conference
Glaucoma Diagnosis Vision Institute Annual Fall Conference Mitchell W. Dul, OD, MS, FAAO mdul@sunyopt.edu Richard J. Madonna, MA, OD, FAAO rmadonna@sunyopt.edu Definition of Glaucoma Glaucoma can be regarded
More information(Eye)Drop It Like It s Hot New & Exciting Advancements in Glaucoma
Disclosures (Eye)Drop It Like It s Hot New & Exciting Advancements in Glaucoma I have no financial ties or relationships to any of the companies or products mentioned in this lecture. Although if one wants
More informationElectrodiagnostics Alphabet Soup
Nathan Lighthizer, O.D., F.A.A.O Assistant Professor, NSUOCO Chief of Specialty Care Clinics Chief of Electrodiagnostics Clinic What is electrodiagnostics testing? Visual Pathway Basic Understanding VEP
More informationHOW TO MAKE THE MOST OF A NEW OCT. with Kelly Kerksick, OD
HOW TO MAKE THE MOST OF A NEW OCT with Kelly Kerksick, OD 3 How to Make the Most of a New OCT Kelly Kerksick, OD, graduated from Southern College of Optometry and immediately started her own private practice
More informationMark Dunbar: Disclosure
Important Things to Understand About OCT Mark T. Dunbar, O.D., F.A.A.O. Bascom Palmer Eye Institute University of Miami, School of Medicine Mark Dunbar: Disclosure Optometry Advisory Board for: Allergan
More information5/18/2014. Fundamentals of Gonioscopy Workshop Aaron McNulty, OD, FAAO Walt Whitley, OD, MBA, FAAO
1 Fundamentals of Gonioscopy Workshop Aaron McNulty, OD, FAAO Walt Whitley, OD, MBA, FAAO 2 3 4 5 6 Optometry s Meeting 2014 The Most Valuable Glaucoma Tool Glaucoma Diagnosis Gonioscopy Central corneal
More informationBehandlungsstrategien beim Offenwinkelglaukom. F. Bochmann, Augenklinik LUKS
Behandlungsstrategien beim Offenwinkelglaukom F. Bochmann, Augenklinik LUKS What is strategy? what is our goal? where are we? how can we achieve our goal? Mission Statement The goal of glaucoma management
More information@HUHEYE in Haiti 2018
@HUHEYE in Haiti 2018 Eye Evaluation and Common Eye Diseases Leslie S. Jones, MD Associate Professor and Interim Chair Residency Program Director Glaucoma Services Director Department of Ophthalmology
More informationEfficacy of latanoprost in management of chronic angle closure glaucoma. Kumar S 1, Malik A 2 Singh M 3, Sood S 4. Abstract
Original article Efficacy of latanoprost in management of chronic angle closure glaucoma Kumar S 1, Malik A 2 Singh M 3, Sood S 4 1 Associate Professor, 2 Assistant Professor, 4 Professor, Department of
More informationIOP in Perspective. IOP in Perspective
IOP in Perspective Commercial Interest Disclosures Nature of Relevant Financial Relationship (Why are we so hung up on IOP?) Leo Semes, OD, FAAO Maculogix Honorarium Speaker Science Based Health Honorarium
More informationUnderstanding Angle Closure
Case Understanding Angle Closure Dominick L. Opitz, OD, FAAO Associate Professor Illinois College of Optometry 56 year old Caucasian Male Primary Eye Exam BCVA: 20/25 OD with+1.25 DS 20/25 OS with +1.75
More information