Ocular Jeopardy Marc R. Bloomenstein OD, FAAO

Transcription

1 I. Introduction a. Introduction of topics b. Various ocular related topics II. Lipiflow a. Meibomian gland dysfunction i. Define the disease ii. Prevalence iii. Current treatment options 1. Lid scrubs 2. Warm compresses 3. Therapeutic options b. Lipiflow i. LipiFlow, which applies heat and gentle pressure to a patient s eyelid ii. Designed to liquefy and evacuate obstructions in Meibomian glands during a 12-minute in-office procedure. iii. The goal of unblocking the glands is to allow them to resume their natural production of lipids required for a healthy tear film. iv. The clinical study was supported by TearScience and involved nine U.S.-based investigational centers and 139 patients (278 eyes). 1. The average total Meibomian gland score for patients who received a single LipiFlow treatment more than doubled from at the baseline to at 4 weeks. 2. The increase in the average total Meibomian score reflected an improvement in both the quality and quantity of Meibomian glands secreting lipids 3. Two different recognized symptom questionnaires were used in the study: the Standard Patient Evaluation of Eye Dryness (SPEED) and the Ocular Surface Disease Index (OSDI). a. The average total SPEED score for patients who received a single LipiFlow treatment decreased from at the baseline to at 4 weeks, demonstrating a mean reduction in dry eye symptoms. Similarly, the average OSDI score decreased from at baseline to at 4 weeks. c. Management of MGD patients with Lipiflow i. Repeatability ii. Cost III. CXL

2 a. The cornea i. Diagnosis of diseases 1. KCN a. Hydrops b. Munson s c. Apical Scarring d. Vogt Striae e. Abnormal topography f. Thickness abnormalities g. Corneal curvature 2. PMD a. Abnormal topography b. Irregular curvature 3. Forme-Fruste KCN a. Relative thickness b. Irregular curvature c. Inferior steepening 4. Ectasia a. Post-refractive related b. Similar to KCN c. Inferior steepening ii. Biomechanical Properties 1. Ocular Response Analyzer a. Hysteresis i. Low value indicator ii. Predictor of glaucoma b. Corneal compensated pressure 2. What does it mean for the cornea? iii. CXL Procedure 1. CXL is not new a b. Theo Syler 2. Strengthens/Stiffens cornea with UV light and riboflavin % effective 4. Not FDA approved a. Dresden Technique i. Epi-off ii. Riboflavin for 30 minutes iii. UV Light for 30 minutes iv. BCL b. Epi-On Technique i. Riboflavin/UV light ii. No BCL 5. Post-o expectations a. VA improvement b. Thickening of stroma

3 IV. c. Curvature changes iv. Case Studies month Post-op CXL ectasia a. Pre-op/Post-op difference map b. Improved VA 2. LASIK Ectasia a. Progressive vision loss b. Epi-Off 3. Post-RK a. Ecatic cornea b. Pre/Post K s c. Stable RX v. Clinical Studies 1. Hersh Dextran 2. Reid Study 3. Avedro vi. CXL combined 1. Ring Segment 2. PRK 3. Topo-guided vii. Epi-on vs. Epi-off CXL 1. Different philosophies 2. New Standards needed 3. Is there a difference? a. Result b. Meaning? viii. CXL Myths 1. Wait til progresses? 2. Need Epi off? 3. People with KCN over 40 don t progress 4. CXL is temporary 5. CXL is dangerous 6. No CXL is available in the USA ix. Benefits/Applications in Optometry Femtosecond Laser a. Refractive surgery applications i. Flap creation ii. Channels for Intacs iii. Corneal Inlays b. Cataract surgery implications i. AMO ii. Ziemer iii. Carl Zeiss Meditec iv. Technolas v. Alcon 1. Treatment of astigmatism

4 2. Incision a. Paracentesis b. Lens incision 3. Capsularhexis 4. Phaco chop c. Lens Polishing d. Risk and complications associated with Femtosecond laser V. IOL s a. Optical properties of the latest IOL s i. Presbyopic 1. Crystalens AO 2. ReSTOR Tecnis MF ii. Wavefront 1. Tecnis 2. IQ 3. Sofport 4. Akreos iii. Astigmatism 1. STAAR a. Advantages b. Disadvantages 2. Alcon a. Advantages b. Disadvantages b. Understanding the benefits of each lens i. Where do they fit into the OD model? ii. What lens is best for each patient? iii. How much information is necessary? c. Where do ODs fit into the IOL market? i. Aging population ii. Need for OD s d. Pearls for co-managing the new IOLs e. The Future of IOL s f. Lenses only available in Europe g. Lenses in FDA studies VI. Pharmaceutical Options a. Azasite i. Uses and availability b. Alphagan-P i. Uses off-label

5 VII. ii. Refractive options c. Besivance i. Indications for treatment ii. New indications Photos a. Corneal Abrasion i. Treatment modalities ii. New inflammation theories b. OCT of VMT i. Treatment options ii. Patient expectations c. Visante of Intacs i. Discussion of intacs ii. Use in K-conus iii. Pre and Post-operative issues d. Canthanxinin Retinopathy i. Indications and patient presentation