Update 1. Red Eye. Adenovirus Numbers 3/4/14. For Your Eyes Only 2014 Ophthalmology Update. TKorn, MD, FACS San Diego, California

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1 For Your Eyes Only 2014 Ophthalmology Update TKorn, MD, FACS San Diego, California Update 1 Red Eye Adenovirus Numbers Adults touch their face in an hour 1-5 weeks - Adenovirus infectivity period in humans 1 month - adenovirus survival duration on nonporous surfaces surfaces 1. J Occup Environ Hyg Jun;5(6): Cornea, 2006: 25: Ophthalmology 1993; 100:

2 Adenovirus Conjunctivitis Outbreaks Hospitals Medical offices College dorm rooms Military barracks Schools Swimming pools 1 Everett SL, et al. Cornea. 1995;14: Martin M, et al. N Engl J Med. 2003;348: Crum NF, et al. Clin Infect Dis. 2004;39: Buck JM, et al. Pediatr Infect Dis J. 2006;25: Lateral Flow Immunoassay Adenovirus Detector For Tear Fluid n FDA (2006) n 10 minute ELISA test detects 51 serotypes of adenovirus n CLIA waived & CPT code n American Academy of Ophthalmology Panel suggests cost savings if used routinely Adenovirus Detector CC-IFA Sens. 93% 85% Spec. 98% 95% PCR as referee standard CC-IFA = cell culture / immunofluorescence JAMA Ophthalmol Jan;131(1): doi: /2013.jamaophthalmol.513. Adenovirus Conjunctivitis Management Identify & isolate Return to society when negative Refer severe cases 2

3 Adenovirus Related Immune Keratitis Corneal scarring Conjunctival scarring Topical steroid dependency Update 2 Eye Imaging Technologies Mobile Digital Imaging Teleophthalmology Instantaneous diagnostics Education Documentation Communication Eye (Lond) Mar;23(3): doi: /eye Epub 2008 Feb 15. 3

4 Update 3 Are Contact Lenses Safe? Corneal Ulcers Corneal Ulcer Defined Corneal epithelial defect and Underlying white opacity Risk Factors: Sleeping in soft contact lens increases relative risk of infection times Etiology: Pseudomonas aeruginosa 1- Schein OD, et al. N Engl J Med 1989; 321: Schein OD, et al. Arch Ophthalmol 1994; 112: Cheng KH, et al. Lancet 1999; 354: Alfonso E, et al. Am J Ophthalmol 1986; 101: Corneal Ulcers - Contact Lenses Pearls Recognize & refer No sleeping / swimming FDA approved daily disposable lenses Replace lenses regularly Eye exams 1 - American Academy of Ophthalmology Cornea and External Disease Panel. Preferred practice pattern: bacterial keratitis, American Academy of Ophthalmology Updated Contact Lens Care Guidelines,

5 Update 4 Alpha Blockers & Cataracts Tamsulosin Induced Floppy Iris Syndrome poor pupil dilation floppy, prolapsing iris interferes with removal of cataract Alpha Blocker / Floppy Iris Syndrome Prevention Eye exam - cataracts Consider alternative drugs Friedman AH. JAMA.2009; 301: AAO Practice Guideline Recomendations

6 Update 5 Age-related Macular Degeneration Age-Related Macular Degeneration (AMD) Risk Factors genetics aging hypertension obesity atherosclerosis cigarette smoking UV exposure 1- Hyman L, Schachat AP, He Q, et al. Arch Ophthalmol. 2000; 117: Smith W, Mitchell P, Leeder SR, et al. Arch Ophthalmol. 1998; 116: Seddon JM, Ajani UA, Sperduto RD, et al. JAMA. 1994; 272: Age-Related Macular Degeneration (AMD) Central Blindness Dry AMD 90% Slow deterioration Wet AMD - 10% Severe, rapid vision loss 6

7 Wet AMD Sudden, rapid vision loss Vascular Endothelial Growth Factor (VEGF) Bleeding - photoreceptor damage Optical Coherence Tomography (OCT) Infrared light interference Ultrasound like HD image 3-10 micrometer resolution Regatieri et al. Ophthalmic Surg Lasers Imaging 2011 July Wet AMD Treatment Anti-VEGF Injections recombinant monoclonal antibodies for Anti-VEGF (2006) fusion proteins bind VEGF (2011) 7

8 CATT Findings for Wet AMD Ranibizumab vs. Bevacizumab Both medications have similar efficacy Monthly and PRN dosing are equivalent for either medication Low risk of adverse systemic events for both Ranibizumab and Bevacizumab for Neovascular Age-Related Macular Degeneration. The CATT Research Group. N Engl J Med Apr 28. PubMed PMID: Age Related Eye Disease Study (AREDS Report 18) Probability of Developing Advanced Macular Degeneration in One Eye Arch Ophthalmol November; 123(11): AREDS Vitamin Formulation for Wet AMD Prevention* Vitamin C 500 mg (753% RDA) Vitamin E 400 IU (1333% RDA) Zinc 80 mg (464% RDA) Copper 2 mg (80% RDA) Vitamin A (Beta-Carotene)15 mg (573% RDA) Lung cancer risk in ex-smokers Carotenemia Age-Related Eye Disease Study Research Group. Arch Ophthalmol. 2001; 119: * only in high risk patients 8

AREDS 2 for Wet AMD Prevention Results No benefit Omega 3 acids Omitting beta-carotene in AREDS formulation no loss of protective benefit for macular degeneration if lutein & zeaxanthine are

9 AREDS 2 for Wet AMD Prevention Results No benefit Omega 3 acids Omitting beta-carotene in AREDS formulation no loss of protective benefit for macular degeneration if lutein & zeaxanthine are substituted Ophthalmology Nov;119(11): doi: /j.ophtha Epub 2012 Jul 26. Amsler Grid PCP Pearl Self-monitoring for wet AMD Sensitive for early detection Each eye tested separately Acute distortion = urgent referral Macular Degeneration Pearls for Patients Avoid smoking Exercise Healthy diet (green veggies & fish) Annual dilated retina exam > 60 yrs AREDS2 vitamin for high risk pts 9

10 Update 6 Eye Safety Eye Trauma Number of eye injuries per year 65,000 work 40,000 sports Industrial ANSI safety goggles Polycarbonate sports wear Peate WF. Work-related eye injuries and illnesses. Am Fam Physician. 2007;75: Rodriguez JO et al. Am Fam Physician. 2003;67(7): Bauza et al. Eur J Ophthalmol Mar-Apr;23(2): doi: /ejo Eye Injuries Pearls Encourage eye safety wear Work School Sports & Crafts Home 10

11 Laser Classifications Class 3A Hazardous if laser beam momentarily viewed directly unaided Laser pointers 5mW is legal limit of laser pointers Laser Pointer Human Eye Exposure Prospective Study Class 3A laser pointers 1-5 mw 3 eyes to be enucleated for melanoma exposed to laser for 1, 5, and 15 minutes at different locations No ocular damage Arch Ophthalmol Dec;118(12): Carry-out Pearls Adenovirus Digital eye imaging tech Contact lens Alpha blockers Macular degeneration Eye protection / safety 11

Update 1. Red Eye. Adenovirus Numbers 7/29/14. Adenovirus Conjunctivitis Outbreaks. Adenovirus Conjunctivitis Management

Update 1. Red Eye. Adenovirus Numbers 7/29/14. Adenovirus Conjunctivitis Outbreaks. Adenovirus Conjunctivitis Management For Your Eyes Only 2014 Ophthalmology Update Update 1 Red Eye TKorn, MD, FACS San Diego, California Adenovirus Numbers Adenovirus Conjunctivitis Outbreaks 15.7 - Adults touch their face in an hour 1-5