Updates on Corneal Cross‐Linking & Myopia Control
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Differentiate Red Eye Disorders
Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular -
Development of in Vitro Corneal Models: Opportunity for Pharmacological Testing
Review Development of In Vitro Corneal Models: Opportunity for Pharmacological Testing Valentina Citi 1, Eugenia Piragine 1, Simone Brogi 1,* , Sara Ottino 2 and Vincenzo Calderone 1 1 Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy; [email protected] (V.C.); [email protected] (E.P.); [email protected] (V.C.) 2 Farmigea S.p.A., Via G.B. Oliva 6/8, 56121 Pisa, Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-050-2219-613 Received: 24 October 2020; Accepted: 30 October 2020; Published: 2 November 2020 Abstract: The human eye is a specialized organ with a complex anatomy and physiology, because it is characterized by different cell types with specific physiological functions. Given the complexity of the eye, ocular tissues are finely organized and orchestrated. In the last few years, many in vitro models have been developed in order to meet the 3Rs principle (Replacement, Reduction and Refinement) for eye toxicity testing. This procedure is highly necessary to ensure that the risks associated with ophthalmic products meet appropriate safety criteria. In vitro preclinical testing is now a well-established practice of significant importance for evaluating the efficacy and safety of cosmetic, pharmaceutical, and nutraceutical products. Along with in vitro testing, also computational procedures, herein described, for evaluating the pharmacological profile of potential ocular drug candidates including their toxicity, are in rapid expansion. In this review, the ocular cell types and functionality are described, providing an overview about the scientific challenge for the development of three-dimensional (3D) in vitro models. -
Olivia Steinberg ICO Primary Care/Ocular Disease Resident American Academy of Optometry Residents Day Submission
Olivia Steinberg ICO Primary Care/Ocular Disease Resident American Academy of Optometry Residents Day Submission The use of oral doxycycline and vitamin C in the management of acute corneal hydrops: a case comparison Abstract- We compare two patients presenting to clinic with an uncommon complication of keratoconus, acute corneal hydrops. Management of the patients differs. One heals quickly, while the other has a delayed course to resolution. I. Case A a. Demographics: 40 yo AAM b. Case History i. CC: red eye, tearing, decreased VA x 1 day OS ii. POHx: (+) keratoconus OU iii. PMHx: depression, anxiety, asthma iv. Meds: Albuterol, Ziprasidone v. Scleral CL wearer for approximately 6 months OU vi. Denies any pain OS, denies previous occurrence OU, no complaints OD c. Pertinent Findings i. VA cc (CL’s)- 20/25 OD, 20/200 PH 20/60+2 OS ii. Slit Lamp 1. Inferior corneal thinning and Fleisher ring OD, central scarring OD, 2+ diffuse microcystic edema OS, Descemet’s break OS (photos and anterior segment OCT) 2. 2+ diffuse injection OS 3. D&Q A/C OU iii. Intraocular Pressures: deferred OD due to CL, 9mmHg OS (tonopen) iv. Fundus Exam- unremarkable OU II. Case B a. Demographics: 39 yo AAM b. Case History i. CC: painful, red eye, tearing, decreased VA x 1 day OS ii. POHx: unremarkable iii. PMHx: hypertension iv. Meds: unknown HTN medication v. Wears Soflens toric CL’s OU; reports previous doctor had difficulty achieving proper fit OU; denies diagnosis of keratoconus OU vi. Denies any injury OS, denies previous occurrence OU, no complaints OD c. -
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Advances in Health Sciences Research, volume 26 2nd Bakti Tunas Husada-Health Science International Conference (BTH-HSIC 2019) Adherent Leukoma Associated with Measles: A Low Vision Case Report Giselle R. Shi1*, Dr. Maria Cecilia L. Yu1 1Centro Escolar University, *[email protected] Abstract— Objective: To assess if the patient has a and eye disorders that may lead to blindness [3-4]. low vision condition and to give proper management to The higher risks of complications are infants under the patient who has adherent leukoma associated with the age of 1, immune-compromised children and measles. Method: The patient was referred back by an adults especially pregnant woman. The common ophthalmologist to the optometrist for low vision effect of the measles virus to the eyes is the corneal assessment and management. The demographic profile damage which becomes cloudy or hazy. Infected was taken along with case history taking. Subjective children can also have measles keratitis which they examinations were performed like the distance visual acuity test, subjective refraction, binocular vision test, have excessive tearing and excessive sensitivity to visual field test, contrast sensitivity test, near vision test, light. It can also affect the retina, blood vessels and and color vision test. After that, objective examinations optic nerve. Due to scarring or swelling of the retina, like fixation, and retinoscopy was performed. Result patients may loss his or her vision. [4] and discussion: In the subjective refraction, the left eye The layers of the cornea should be transparent had -20.00Dsph with a visual acuity of 20/70-1. Near so that the cornea itself would look transparent as a visual acuity in the right eye was all 8M at 9cm without, whole. -
Pattern of Corneal Opacity in Ibadan, Nigeria
Annals of African Medicine Vol. 3, No. 4; 2004: 185 – 187 PATTERN OF CORNEAL OPACITY IN IBADAN, NIGERIA A. O. Ashaye and T. S. Oluleye Department of Ophthalmology, University College Hospital, Ibadan, Nigeria Reprint requests to: A. O. Ashaye, Department of Ophthalmology, University College Hospital, Ibadan, Nigeria Abstract Background: The prevalence and causes of corneal blindness vary from one region of the world to another. There is even variation within the developing countries of Africa. Method: A retrospective review of 675 patients with corneal scarring out of the 3,753 new patients corneal scarring in patients attending the eye clinic of the University College Hospital (UCH) Ibadan over a 5year period. Results: Subjects in age groups 0 to 10years and 21 to 30years were mostly affected. Males were more affected with a ratio of 3:1. Most presentations were in the months of January to March and July to September. Almost half (48.99%) of the patients had uniocular blindness and no case of bilateral blindness from corneal opacity was found. The main causes of corneal opacity were trauma (51.1%) and microbial keratitis (26.70%) both of which are avoidable causes of blindness. No case of trachomatous corneal scarring was found in the group studied. Conclusion: Key words: Cornea, opacity, blindness Introduction opacity in the south western part of Nigeria. As a preliminary to community based study to identify the The cornea is exposed to the atmosphere and so often relative importance of known causes of corneal suffers injury, inflammation or infection. Corneal blindness as seen in the south western part of Nigeria, opacity results from a process, which upset its the aetiology of cases seen in hospital was anatomy and physiology. -
World Report on Vision Infographic
World report on vision The Facts Projected number of people estimated to have age related macular degeneration and glaucoma, 2020–2030. 243.4 million 195.6 million Everyone, if they live long enough, will experience at least one eye condition in their lifetime. Age related macular degeneration (any) Cataract surgery US$ 6.9 billion 95.4 million Refractive error 76 million US$ 7.4 billion Glaucoma 2020 2030 US$14.3 billion (is the investment) needed globally to treat existing Eye conditions are projected to unaddressed cases of refractive error and cataract. increase due to a variety of factors, including ageing population, lifestyle and NCDs. At least 2.2 billion people live with a vision impairment In at least 1 billion of these cases, vision impairment low- and middle- high-income regions could have been prevented income regions or has yet to be addressed Unaddressed distance vision impairment in many low- and middle- income regions is 4x higher than in high- income regions. Unaddressed refractive error (123.7 million) Cataract (65.2 million) Glaucoma (6.9 million) Corneal opacities (4.2 million) Diabetic Retinopathy (3 million) Trachoma (2 million) Unaddressed presbyopia (826 million) Eye conditions The problem Some eye conditions do not typically cause vision impairment, but others can. Common eye conditions that do not typically cause vision impairment Eyelid Conjunctivitis Dry eye Eyelid Conjunctivitis Dry eye Availability inflammation Accessibility Cyst or Stye Benign growth SubconjunctivalSubconjunctival in thethe eyeeye haemorrhagehaemorrhage Acceptability Common eye conditions that can cause vision impairment Eye care services are poorly integrated into health systems. The availability, accessibility and acceptability of eye Cataract Corneal opacity GlaucomaGlaucoma care services have an influence on eye conditions and vision impairment. -
Medical Policy Gas Permeable Scleral Contact Lens
Medical Policy Gas Permeable Scleral Contact Lens Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information Policy History Policy Number: 371 BCBSA Reference Number: 9.03.25 Related Policies Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy, #301 Implantation of Intrastromal Corneal Ring Segments, #235 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Medicare HMO BlueSM and Medicare PPO BlueSM Members Rigid gas permeable scleral lens may be considered MEDICALLY NECESSARY for patients who have not responded to topical medications or standard spectacle or contact lens fitting, for the following conditions: Corneal ectatic disorders (e.g., keratoconus, keratoglubus, pellucid marginal degeneration, Terrien’s marginal degeneration, Fuchs’ superficial marginal keratitis, post-surgical ectasia); Corneal scarring and/or vascularization; Irregular corneal astigmatism (e.g., after keratoplasty or other corneal surgery); Ocular surface disease (e.g., severe dry eye, persistent epithelial defects, neurotrophic keratopathy, exposure keratopathy, graft vs. host disease, sequelae of Stevens Johnson syndrome, mucus membrane pemphigoid, post-ocular surface tumor excision, post-glaucoma filtering surgery) with pain and/or decreased visual acuity. Prior Authorization Information Commercial Members: Managed Care (HMO and POS) Prior authorization is NOT required. Commercial Members: PPO, and Indemnity -
Cxl Co-Management and Clinical Pearls
CXL CO-MANAGEMENT AND SPONSORED BY CLINICAL PEARLS Avedro gathered leading refractive surgeons and eye care professionals for a roundtable discussion during the 2018 annual meeting of the American Society of Cataract and Refractive Surgery in Washington, DC. The discussion centered around the co-management of keratoconus patients with your optometric network, as well as corneal cross-linking (CXL) clinical pearls. IMPORTANCE OF EARLY DIAGNOSIS I examine the patient’s history thoroughly. I ask about last year’s eye- BRANDON D. AYRES, MD AND TREATMENT n Surgeon on the Cornea Richard L. Lindstrom, MD: Now that glass prescription and how fast the Service, Wills Eye Hospital, we have an FDA-approved treatment for patient’s vision is changing. If a patient Philadelphia patients with progressive keratoconus, has had to change eyeglasses four times n Financial disclosure: it is crucial that we educate diagnosing in one year, for example, the keratoco- Consultant (Avedro) providers on the importance of early nus is clearly progressing. diagnosis and treatment to give patients I also use sensitive diagnostics, such as the best chance for a good outcome. tomography and topography, to exam- ine the posterior cornea. I look at the Kathryn M. Hatch, MD: I completely pachymetry and the posterior float maps, KATHRYN M. HATCH, MD agree. Another key component of early which may show early signs of progres- n Director, Refractive Surgery Service, Massachusetts detection is having proper screening sion or corneal ectasia following refractive Eye and Ear; Site Director, tools and more widespread use of such surgery. Anything that I believe shows Massachusetts Eye and Ear, tools. -
Toxic Keratopathy Following the Use of Alcohol-Containing Antiseptics in Nonocular Surgery
Research Brief Report Toxic Keratopathy Following the Use of Alcohol-Containing Antiseptics in Nonocular Surgery Hsin-Yu Liu, MD; Po-Ting Yeh, MD; Kuan-Ting Kuo, MD; Jen-Yu Huang, MD; Chang-Ping Lin, MD; Yu-Chih Hou, MD IMPORTANCE Corneal abrasion is the most common ocular complication associated with nonocular surgery, but toxic keratopathy is rare. OBSERVATION Three patients developed severe toxic keratopathy after orofacial surgery on the left side with general anesthesia. All patients underwent surgery in the right lateral tilt position with ocular protection but reported irritation and redness in their right eyes after the operation. Alcohol-containing antiseptic solutions were used for presurgical preparation. Ophthalmic examination showed decreased visual acuity ranging from 20/100 to 20/400, corneal edema and opacity, anterior chamber reaction, or stromal neovascularization in the patients’ right eyes. Confocal microscopy showed moderate to severe loss of corneal endothelial cells in all patients. Despite prompt treatment with topical corticosteroids, these Author Affiliations: Department of Ophthalmology, National Taiwan 3 patients eventually required cataract surgery, endothelial keratoplasty, or penetrating University Hospital, College of keratoplasty, respectively. After the operation, the patients’ visual acuity improved to 20/30 Medicine, National Taiwan University, or 20/40. Data analysis was conducted from December 6, 2010, to June 15, 2015. Taipei, Taiwan (Liu, Yeh, Huang, Lin, Hou); Department of Pathology, National Taiwan University Hospital, CONCLUSIONS AND RELEVANCE Alcohol-containing antiseptic solutions may cause severe College of Medicine, National Taiwan toxic keratopathy; this possibility should be considered in orofacial surgery management. University, Taipei, Taiwan (Kuo). Using alcohol-free antiseptic solutions in the periocular region and taking measures to protect Corresponding Author: Yu-Chih the dependent eye in the lateral tilt position may reduce the risk of severe corneal injury. -
The Combined Effect of Low-Dose Atropine with Orthokeratology in Pediatric Myopia Control
Journal of Clinical Medicine Review The Combined Effect of Low-dose Atropine with Orthokeratology in Pediatric Myopia Control: Review of the Current Treatment Status for Myopia José-María Sánchez-González 1,2,* , Concepción De-Hita-Cantalejo 1, María-José Baustita-Llamas 1, María Carmen Sánchez-González 1 and Raúl Capote-Puente 1 1 Department of Physics of Condensed Matter, Optics Area, University of Seville, 41012 Seville, Spain; [email protected] (C.D.-H.-C.); [email protected] (M.-J.B.-L.); [email protected] (M.C.S.-G.); [email protected] (R.C.-P.) 2 Department of Ophthalmology & Optometry, Tecnolaser Clinic Vision, 41018 Seville, Spain * Correspondence: [email protected] Received: 25 May 2020; Accepted: 23 July 2020; Published: 24 July 2020 Abstract: Pediatric myopia has become a major international public health concern. The prevalence of myopia has undergone a significant increase worldwide. The purpose of this review of the current literature was to evaluate the peer-reviewed scientific literature on the efficacy and safety of low-dose atropine treatment combined with overnight orthokeratology for myopia control. A search was conducted in Pubmed and Web of Science with the following search strategy: (atropine OR low-dose atropine OR 0.01% atropine) AND (orthokeratology OR ortho-k) AND (myopia control OR myopia progression). All included studies improved myopia control by the synergistic effect of orthokeratology with low-dose atropine, compared with orthokeratology treatment alone. All studies included a short or medium follow-up period; therefore longer-term studies are necessary to validate these results. Keywords: atropine; orthokeratology; myopia control; refractive errors; peripheral refraction; myopia progression 1. -
The Definition and Classification of Dry Eye Disease
DEWS Definition and Classification The Definition and Classification of Dry Eye Disease: Report of the Definition and Classification Subcommittee of the International Dry E y e W ork Shop (2 0 0 7 ) ABSTRACT The aim of the DEWS Definition and Classifica- I. INTRODUCTION tion Subcommittee was to provide a contemporary definition he Definition and Classification Subcommittee of dry eye disease, supported within a comprehensive clas- reviewed previous definitions and classification sification framework. A new definition of dry eye was devel- T schemes for dry eye, as well as the current clinical oped to reflect current understanding of the disease, and the and basic science literature that has increased and clarified committee recommended a three-part classification system. knowledge of the factors that characteriz e and contribute to The first part is etiopathogenic and illustrates the multiple dry eye. Based on its findings, the Subcommittee presents causes of dry eye. The second is mechanistic and shows how herein an updated definition of dry eye and classifications each cause of dry eye may act through a common pathway. based on etiology, mechanisms, and severity of disease. It is stressed that any form of dry eye can interact with and exacerbate other forms of dry eye, as part of a vicious circle. II. GOALS OF THE DEFINITION AND Finally, a scheme is presented, based on the severity of the CLASSIFICATION SUBCOMMITTEE dry eye disease, which is expected to provide a rational basis The goals of the DEWS Definition and Classification for therapy. These guidelines are not intended to override the Subcommittee were to develop a contemporary definition of clinical assessment and judgment of an expert clinician in dry eye disease and to develop a three-part classification of individual cases, but they should prove helpful in the conduct dry eye, based on etiology, mechanisms, and disease stage. -
One-Year Clinical Outcomes of a Corneal Inlay for Presbyopia
CLINICAL SCIENCE One-Year Clinical Outcomes of a Corneal Inlay for Presbyopia Sandra M. C. Beer, MD, Rodrigo Santos, MD, Eliane M. Nakano, MD, Flavio Hirai, MD, Enrico J. Nitschke, Claudia Francesconi, MD, and Mauro Campos, MD phthalmologists have used a wide variety of procedures Purpose: To report the results of a 1-year follow-up analysis of the Oto correct for refractive errors. Corneal laser surgery safety and efficacy of the Flexivue Microlens corneal inlay. with multifocal patterns or monovision approaches have been Methods: The Flexivue Microlens corneal inlay was implanted in developed including laser-assisted in situ keratomileusis (LASIK),1,2 presbyLASIK,3 photorefractive keratectomy,4 the nondominant eye of patients with emmetropic presbyopia 5 2 laser epithelial keratomileusis thin-flap femto-LASIK, and (a spherical equivalent of 0.5 to 1.00 diopter) after the creation 6 7,8 of a 300-mm deep stromal pocket, using a femtosecond laser. The sub-Bowman keratomileusis. Conductive keratoplasty, patients were followed up according to a clinical protocol involving clear lens extraction, cataract surgery using multifocal, pseudoaccommodative intraocular lenses, or monovision refraction, anterior segment imaging analysis (Oculyzer), and optical 9–11 quality analysis (OPD-Scan). monofocal intraocular lenses have also been used to treat presbyopia. Results: Thirty-one patients were enrolled in this ongoing study. The necessity of a minimally invasive, removable, The mean age was 50.7 years (range 45–60 yrs), and 70% of the and safe surgical technique with a flat learning curve for patients were female. The mean uncorrected near visual acuity patients aged 45 to 60 years has led to the development of improved to Jaeger 1 in 87.1% of the eyes treated with the inlays.