DOCSLIB.ORG

(SUNDROP): Five Years of Screening with Telemedicine

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
(SUNDROP): Five Years of Screening with Telemedicine ■ CLINICAL SCIENCE ■ Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): Five Years of Screening With Telemedicine Natalia Fijalkowski, BA; Luo Luo Zheng, BS; Michael T. Henderson, BA; Sean K. Wang, BS; Matthew B. Wallenstein, MD; Theodore Leng, MD, MS; Darius M. Moshfeghi, MD INTRODUCTION BACKGROUND AND OBJECTIVE: To report the 5-year results of the Stanford University Network for Diag- Retinopathy of prematurity (ROP) is a vision- nosis of Retinopathy of Prematurity (SUNDROP) tele- threatening disease of disordered retinal vasculature medicine initiative. development in premature and low birth weight in- fants.1,2 The underdeveloped retina overcompensates PATIENTS AND METHODS: Infants requiring retinopathy for ischemia at birth by promoting angiogenesis that of prematurity (ROP) screening at six neonatal inten- can damage nearby structures through retinal edema, sive care units from December 1, 2005, to November traction, or detachment.3,4 At United States schools, 30, 2010, were evaluated with remote retinal photogra- ROP accounts for 14% of pediatric blindness.5 The phy by an ROP specialist. Every infant received outpa- World Health Organization (WHO) found ROP to be tient binocular indirect ophthalmoscope examinations the leading cause of avoidable visual impairment in until termination criteria were achieved or until treat- high-income countries and the second leading cause ment. Outcomes were treatment-warranted ROP (TW- in middle-income countries,6 accounting for 15% to ROP, ETROP type 1) and adverse anatomical events. 35% of pediatric blindness in some nations.7-9 Randomized trials and observational studies RESULTS: Five hundred eleven infants (1,022 eyes) were demonstrate that cryotherapy,10,11 laser photocoagu- screened. Fifteen infants had TW-ROP and underwent lation,12-15 and intravitreal bevacizumab16,17 can pre- laser photocoagulation. The TW-ROP cohort had sig- serve vision when administered early in the course nificantly lower birth weight and gestational age (both of disease.14 Armed with vision-saving treatments, P < .001). No patient progressed to adverse anatomical public health efforts have shifted toward screening outcomes and no case of TW-ROP was missed. Tele- and promptly identifying high-risk infants. The land- medicine had 100% sensitivity, 99.8% specificity, mark Early Treatment of Retinopathy of Prematurity 93.8% positive predictive value, and 100% negative (ETROP) trial developed standardized screening time predictive value for detection of TW-ROP. lines based on the natural course of ROP and defined the criteria for initiation of treatment (ETROP type CONCLUSION: Telemedicine demonstrates high di- 1).4,14 In 2013, the American Academy of Pediatrics agnostic accuracy for detection of TW-ROP and can (AAP) and the American Academy of Ophthalmology complement ROP screening. (AAO) released updated ROP screening recommenda- tions stating that every infant with birth weight less [Ophthalmic Surg Lasers Imaging Retina. 2014;45:106-113.] than or equal to 1,500 g, estimated gestational age From the Byers Eye Institute, Horngren Family Vitreoretinal Center, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California (NF, LLZ, MTH, SKW, TL, DMM); and the Lucile Packard Children’s Hospital, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California (MBW). Originally submitted May 21, 2013. Accepted for publication October 23, 2013. Posted online January 20, 2014. Supported by the National Institutes of Health (NIH) Clinical and Translational Science Awards (CTSA) offered through the Stanford Center for Clinical Informatics (CTSA award number UL1 RR025744). Ms. Fijalkowski was supported by the NIH CTSA in Epidemiology and Biostatistics offered through the Stanford School of Medicine Center for Clinical and Translational Research Education (CTSA award number UL1 TR000093). The authors have no financial or proprietary interest in the materials presented herein. Dr. Moshfeghi did not participate in the editorial review of this manuscript. The authors would like to acknowledge Dr. Kristin Sainani, professor of statistics and epidemiology at the Stanford University Health Services and Research Policy Department, for her editorial expertise and assistance with revision as well as inspiring their team to effectively communicate their science through good writing. Address correspondence to Darius M. Moshfeghi, MD, Byers Eye Institute, Horngren Family Vitreoretinal Center, Dept. of Ophthalmology, Stanford Univer- sity School of Medicine, 2452 Watson Court, Room 2277, Palo Alto, CA 94303; 650-644-5561; fax: 650-565-8297; Skype: dmoshfeghi. doi: 10.3928/23258160-20140122-01 106 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina Figure. Images in each eye were external (top left), optic nerve (ON) centered, ON superior, ON inferior (bottom left), ON nasal, and ON temporal. Figure is reproduced with permission from Graefe’s Archive for Clinical and Experimental Ophthalmology. less than or equal to 30 weeks, or an unstable clinical in one location and transmit them to a remote expert course deemed high risk by the attending pediatrician for interpretation. Telemedicine, the use of electronic should be screened with serial eye examinations until technology for remote health care, is promising for the infant meets criteria for terminating screening.18 ROP screening because it may serve as a cost-effective Although screening and treatment are highly effective complement to traditional bedside binocular indirect at preventing ROP related vision loss, thousands of ophthalmoscope (BIO) examination performed by the at-risk infants worldwide remain unscreened because ophthalmologist.21 Among studies comparing tele- of a shortage of ROP specialists.19 medicine with concurrent BIO for detection of treat- The number of neonates requiring screening is ment-warranted ROP, all have found high diagnostic increasing because sophisticated neonatal intensive accuracy.22-28 Most importantly, no infant in any pub- care unit (NICU) technology enables the survival of lished telemedicine study with disease necessitating younger infants worldwide. At the same time, the intervention has been missed. number of physicians willing and able to care for The Stanford University Network for the Diagno- these patients is dwindling. Pediatric ophthalmolo- sis of Retinopathy of Prematurity (SUNDROP) is an gists are already at a shortage in the United States,8 active community initiative that uses telemedicine as and a survey by the AAO projects a 17% decline the sole in-hospital screening technique for high-risk in the current ROP workforce due to legal liability, infants born at six satellite NICUs located through- travel burden, poor reimbursement, and significant out Northern California. The SUNDROP initiative time commitments.20 These shortages are amplified was developed to reduce blindness and poor visual in middle-income countries where there are fewer outcomes from ROP by providing infants in rural practicing pediatric ophthalmologists.19 and county hospitals with quaternary care. The SUN- The ROP screening burden may be alleviated with DROP initiative is the first true implementation of the use of wide-angle digital retinal photography in- telemedicine for ROP screening in the United States. terpreted remotely to complement the work of pediat- All infants meeting AAP/AAO criteria are screened ric ophthalmologists and retina specialists. The ROP with RetCam II images that are sent to the Stanford screening examination relies upon visual analysis of University Byers Eye Institute reading center for re- anatomic structures that can be seen in a photograph. mote interpretation by an ROP specialist, and out- Retinal image devices such as the RetCam II (Clarity comes are confirmed with outpatient ophthalmology Medical Systems, Pleasanton, CA) are now able to follow-up. This report summarizes the 5-year results capture high-resolution digital images from patients of the SUNDROP initiative. March/April 2014 · Vol. 45, No. 2 107 NICUs are located throughout Northern TABLE 1 California and include level I, II, and Comparison of Baseline Characteristics of Infants With III nurseries encompassing community, and Without Treatment-Warranted Retinopathy of private, and county hospitals. Thus, the Prematurity in the SUNDROP Telemedicine Initiative screened infants are a demographically, ethnically, and socioeconomically di- Patient TW-ROP (n = 15), No TW-ROP (n = 496), verse population. This study includes Characteristic Mean ± SD Mean ± SD infants screened from December 1, Gender 2005, to November 30, 2010. The birth Male (%) 66.7 54.9 weight was obtained from the delivery record and further classified into cat- Female (%) 33.3 45.1 egories of extremely low birth weight Estimated gestational 24.8 ± 1.7 29.0 ± 2.8 (less than 1,000 g), very low birth age (weeks)* weight (1,000-1,499 g) and low birth Birth weight (grams)* 678.2 ± 148.5 1,275.0 ± 347.5 weight (1,500-2,500 g) consistent with Multiplicity** WHO classifications. Gender, estimated Single (%) 73.3 84.7 gestational age, and multiplicity data were also obtained from the delivery re- Twin (%) 26.7 14.1 cords at each hospital. Births were clas- Triplet (%) 0.0 1.2 sified as single, twin (including both Number of exams* 10.3 ± 5.8 3.3 ± 2.9 dizygotic and monozygotic), or triplet. Number of images* 144.7 ± 47.5 40.5 ± 44.8 Photography Protocol Adverse outcomes¥ 0 0 NICU nurses were trained to take
Load more

Recommended publications
  • RFT List.Xlsx
    RFT/Posters Last updated: May 7, 2019 RFT/Posters Session 2 Abstract Title Outcomes of Voretigene Neparvovec-rzyl for Leber Congenital Aaron Nagiel Amaurosis in Eleven Patients: The CHLA Experience AAV2/4-RS1 gene therapy in the retinoschisin knockout mouse Brittni Scruggs model of X-linked retinoschisis Fluorescence Lifetime Imaging Ophthalmoscopy (FLIO) in X-linked Alexandria Vitale retinoschisis RFT/Posters Session 3 Rajvardhan Azad Modified Staging System for FEVR Optical Coherence Tomography Measurements of Retinal and Nikisha Kothari Choroidal Thickness In Preterm Infants The Clinical course and progression of incontinentia pigmenti Charles Calvo retinopathy in treated and untreated patients RFT/Posters Session 7 Omar Moinuddin Patient Outcomes in Coats'-like Retinitis Pigmentosa Andrew Tsai Coats like response in Retinitis Pigmentosa Surgical Management of Advanced Coats' Disease - From Lauren Wright Beginning to End Effect of anti-VEGF therapy on persistent vascular leakage and Irina de la Huerta neovascularization in familial exudative vitreoretinopathy Rapid fire presentation A ROP Expert Confidence in Determining Plus Disease in Borderline Agnieshka Baumritter Images Mike Gaynon Prethreshold ROP - VEGF Inhibition Without VEGF Inhibitors Pre-treatment vs. Post-Treatment Optical Coherence Tomographic Robert Gunzenhauser Angiography in children with strabismic and anisometropic amblyopia. Progression from Pre-Plus Disease to Plus Disease in the G-ROP Alomi Parikh Study Practice patterns changes in the treatment of retinopathy
    [Show full text]
  • 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
    [Show full text]
  • HHS Public Access Author Manuscript
    HHS Public Access Author manuscript Author Manuscript Author ManuscriptOphthalmology Author Manuscript. Author Author Manuscript manuscript; available in PMC 2016 December 01. Published in final edited form as: Ophthalmology. 2015 December ; 122(12): 2373–2379. doi:10.1016/j.ophtha.2015.06.013. Ability of bottle cap color to facilitate accurate glaucoma patient- physician communication regarding medication identity Pujan Dave, BA1, Guadalupe Villarreal Jr., MD1, David S. Friedman, MD, PhD1, Malik Y. Kahook, MD2, and Pradeep Y. Ramulu, MD, PhD1 1Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland 2Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado Abstract Objective—To determine the accuracy of patient-physician communication regarding topical ophthalmic medication use based on bottle cap color, particularly amongst individuals who may have acquired color vision deficiency from glaucoma. Design—Cross-sectional, clinical study. Participants—Patients ≥ 18 years old with primary open-angle, primary angle-closure, pseudoexfoliation, or pigment dispersion glaucoma, bilateral visual acuity of 20/400 or better, and no concurrent conditions that may affect color vision. Methods—One hundred patients provided color descriptions of 11 distinct medication bottle caps. Patient-produced color descriptors were then presented to three physicians. Each physician matched each color descriptor to the medication they thought the descriptor was describing. Main Outcome Measures—Frequency of patient-physician agreement, occurring when all three physicians accurately matched the patient-produced color descriptor to the correct medication. Multivariate regression models evaluated whether patient-physician agreement decreased with degree of better-eye visual field (VF) damage, color descriptor heterogeneity, and/or color vision deficiency, as determined by Hardy-Rand-Rittler (HRR) score and the Lanthony D15 testing index (D15 CCI).
    [Show full text]
  • Onchocerciasis
    11 ONCHOCERCIASIS ADRIAN HOPKINS AND BOAKYE A. BOATIN 11.1 INTRODUCTION the infection is actually much reduced and elimination of transmission in some areas has been achieved. Differences Onchocerciasis (or river blindness) is a parasitic disease in the vectors in different regions of Africa, and differences in cause by the filarial worm, Onchocerca volvulus. Man is the the parasite between its savannah and forest forms led to only known animal reservoir. The vector is a small black fly different presentations of the disease in different areas. of the Simulium species. The black fly breeds in well- It is probable that the disease in the Americas was brought oxygenated water and is therefore mostly associated with across from Africa by infected people during the slave trade rivers where there is fast-flowing water, broken up by catar- and found different Simulium flies, but ones still able to acts or vegetation. All populations are exposed if they live transmit the disease (3). Around 500,000 people were at risk near the breeding sites and the clinical signs of the disease in the Americas in 13 different foci, although the disease has are related to the amount of exposure and the length of time recently been eliminated from some of these foci, and there is the population is exposed. In areas of high prevalence first an ambitious target of eliminating the transmission of the signs are in the skin, with chronic itching leading to infection disease in the Americas by 2012. and chronic skin changes. Blindness begins slowly with Host factors may also play a major role in the severe skin increasingly impaired vision often leading to total loss of form of the disease called Sowda, which is found mostly in vision in young adults, in their early thirties, when they northern Sudan and in Yemen.
    [Show full text]
  • Acquired Colour Vision Defects in Glaucoma—Their Detection and Clinical Significance
    1396 Br J Ophthalmol 1999;83:1396–1402 Br J Ophthalmol: first published as 10.1136/bjo.83.12.1396 on 1 December 1999. Downloaded from PERSPECTIVE Acquired colour vision defects in glaucoma—their detection and clinical significance Mireia Pacheco-Cutillas, Arash Sahraie, David F Edgar Colour vision defects associated with ocular disease have The aims of this paper are: been reported since the 17th century. Köllner1 in 1912 + to provide a review of the modern literature on acquired wrote an acute description of the progressive nature of col- colour vision in POAG our vision loss secondary to ocular disease, dividing defects + to diVerentiate the characteristics of congenital and into “blue-yellow” and “progressive red-green blindness”.2 acquired defects, in order to understand the type of This classification has become known as Köllner’s rule, colour vision defect associated with glaucomatous although it is often imprecisely stated as “patients with damage retinal disease develop blue-yellow discrimination loss, + to compare classic clinical and modern methodologies whereas optic nerve disease causes red-green discrimina- (including modern computerised techniques) for tion loss”. Exceptions to Köllner’s rule34 include some assessing visual function mediated through chromatic optic nerve diseases, notably glaucoma, which are prima- mechanisms rily associated with blue-yellow defects, and also some reti- + to assess the eVects of acquired colour vision defects on nal disorders such as central cone degeneration which may quality of life in patients with POAG. result in red-green defects. Indeed, in some cases, there might be a non-specific chromatic loss. Comparing congenital and acquired colour vision Colour vision defects in glaucoma have been described defects since 18835 and although many early investigations Congenital colour vision deficiencies result from inherited indicated that red-green defects accompanied glaucoma- cone photopigment abnormalities.
    [Show full text]
  • Immune Defense at the Ocular Surface
    Eye (2003) 17, 949–956 & 2003 Nature Publishing Group All rights reserved 0950-222X/03 $25.00 www.nature.com/eye Immune defense at EK Akpek and JD Gottsch CAMBRIDGE OPHTHALMOLOGICAL SYMPOSIUM the ocular surface Abstract vertebrates. Improved visual acuity would have increased the fitness of these animals and would The ocular surface is constantly exposed to a have outweighed the disadvantage of having wide array of microorganisms. The ability of local immune cells and blood vessels at a the outer ocular system to recognize pathogens distance where a time delay in addressing a as foreign and eliminate them is critical to central corneal infection could lead to blindness. retain corneal transparency, hence The first vertebrates were jawless fish that preservation of sight. Therefore, a were believed to have evolved some 470 million combination of mechanical, anatomical, and years ago.1 These creatures had frontal eyes and immunological defense mechanisms has inhabited the shorelines of ancient oceans. With evolved to protect the outer eye. These host better vision, these creatures were likely more defense mechanisms are classified as either a active and predatory. This advantage along with native, nonspecific defense or a specifically the later development of jaws enabled bony fish acquired immunological defense requiring to flourish and establish other habitats. One previous exposure to an antigen and the such habitat was shallow waters where lunged development of specific immunity. Sight- fish made the transition to land several hundred threatening immunopathology with thousand years later.2 To become established in autologous cell damage also can take place this terrestrial environment, the new vertebrates after these reactions.
    [Show full text]
  • Ocular Hypertension-A Long-Term Follow-Up of Treated and Untreated Patients
    Br J Ophthalmol: first published as 10.1136/bjo.61.11.668 on 1 November 1977. Downloaded from British Jouirnal of Ophthalmology, 1977, 61, 668-674 Ocular hypertension-a long-term follow-up of treated and untreated patients ROBERT DAVID, DESIREE G. LIVINGSTON, AND MAURICE H. LUNTZ From the Department of Ophthalmology, University of the Witwatersrand and Johannesburg Teaching Hospitals, Johannesbuirg, South Africa SUMMARY Sixty-one patients with ocular hypertension (1 17 eyes) were followed up for I to 11 years (average 40 7 months). Ten patients (12 eyes) developed visual field defects and optic disc lesions of glaucomatous type ( 10 2 %). Their average age was lower than the average of the sample, and the defect appeared between 1 and 5 years (average 41 3 months). The risk of developing glaucoma was related to the level of the intraocular pressure. Of the 75 eyes with pressures between 21 and 25 mmHg only 2 developed glaucoma, of the 25 cases with pressures of 26 to 30 only 3, but 7 of the 17 eyes with pressures of 31 mmHg or more did so. Prophylactic cryosurgery was carried out where indicated by the presence of lattice retinal degeneration or holes before starting miotic therapy. Fifty eyes were given antiglaucoma therapy and compared with 67 eyes not treated. Treatment did not prevent the development of glaucoma and did not seem to influence the course of the ocular hypertension. The response to treatment was also valueless in predicting future glaucoma. Two untreated patients with high pressures developed central vein occlusion. As no harmful effect of treatment could be detected in the 50 treated eyes, elderly patients (more than 70 years) with copyright.
    [Show full text]
  • Treatment of Interface Keratitis with Oral Corticosteroids
    Treatment of interface keratitis with oral corticosteroids Scott M. MacRae, MD, Larry F. Rich, MD, Damien C. Macaluso, MD ABSTRACT Purpose: To describe the results of treating interface keratitis using a combination of intensive topical and oral corticosteroids. Setting: Casey Eye Institute, Portland, Oregon, USA. Methods: Thirteen eyes treated for grade 2 to 3 interface keratitis using an oral cortico- steroid (prednisone 60 to 80 mg) as well as an hourly topical corticosteroid were retrospectively reviewed. The best corrected visual acuity (BCVA) was used as an objective guide of whether to treat with intense topical and oral corticosteroids, flap irrigation, or both. Predisposing factors such as intraoperative epithelial defects or a history of severe allergies or atopy were also looked for. Results: All 13 eyes responded favorably to the combination of intensive topical and oral corticosteroids and had a BCVA of 20/20 after the keratitis resolved. In 6 eyes (46%), the patients had a history of severe seasonal allergies. One day postoperatively, 3 eyes (23%) had an epithelial defect and 2 eyes (15%), lint particles or debris embedded in the interface. With oral corticosteroid use, 3 patients (23%) noted mild stomach irritation and 2 (15%) noted nervousness. All 5 side effects resolved without sequelae. No patient developed a serious side effect. Conclusion: A short, intense course of an oral corticosteroid was an effective treatment in patients with grade 2 or higher interface keratitis when combined with a topical corti- costeroid administered hourly. The BCVA is a helpful objective measure of the severity of interface keratitis and can be used to guide the clinician in the therapeutic strategy.
    [Show full text]
  • Frequency and Risk Factors of Symptomatic Dry Eye Disease at Tertiary Care Eye Hospital, Karachi
    Biostatistics and Biometrics Open Access Journal ISSN: 2573-2633 Research Article Biostat Biometrics Open Acc J Faisal’s Issue - January 2018 Copyright © All rights are reserved by Muhammad Faisal Fahim DOI: 10.19080/BBOAJ.2018.04.555639 Frequency and Risk Factors of Symptomatic Dry Eye Disease at Tertiary Care Eye Hospital, Karachi Shaheerah Gul1, Adil Salim Jafri1, Muhammad Faisal Fahim2* 1Department of Ophthalmology, Al-Ibrahim Eye Hospital, Pakistan 2Department of Research & Development, Al-Ibrahim Eye Hospital, Pakistan Submission: November 27, 2017; Published: January 19, 2018 *Corresponding author: Muhammad Faisal Fahim, M.Sc (Statistics), Statistician, Research & Development Department, Al-Ibrahim Eye Hospital, Isra postgraduate Institute of Ophthalmology, Karachi, Pakistan, Tel: ; Email: Abstract Objective: To determine frequency and risk factors of symptomatic dry eye disease at tertiary care eye hospital, Karachi. Material & Methods: This was a descriptive cross sectional study carried out at Al-Ibrahim Eye Hospital, Isra postgraduate Institute of Oph- thalmology, Karachi from March to October 2016. Non-Probability purposive sampling technique was used for data collection. Inclusion criteria give consent. Symptoms of dry eye were assessed using Tear breakup test (TBUT) test. SPSS version 20.0 was used to analyze data. were patients aged ≥ 21 years and on the basis of dry eye symptoms. Exclusion criteria were other systemic eye disease and those who did not Results: A total of 100 patients 65 female and 35 male were diagnosed with dry eye syndrome. The age group of 21-30 years having the high- est frequency of 34 patients, whereas after the 50 years of age the frequency of patients decreases to 21.
    [Show full text]
  • The Eyes Have It! Update on Common Conditions Affecting the Eye
    Pharmacy Tech Topics™ VOLUME 22 NO. 2 | APRIL 2017 The Eyes Have It! Update on Common Conditions Affecting the Eye AUTHORS: Steven R. Abel, BS Pharm, PharmD, FASHP Kirk Evoy, PharmD, BCACP, BC-ADM, TTS PEER REVIEWERS: Sami Labib, RPh Rita Edwards, CPhT EDITOR: Patricia M. Wegner, BS Pharm, PharmD, FASHP DESIGN EDITOR: Leann Nelson Pharmacy Tech Topics™ (USPS No. 014-766) is published quarterly for $50 per year by the Illinois Council of Health-System Pharmacists, 4055 N. Perryville Road, Loves Park, IL 61111-8653. Phone 815-227-9292. Periodicals Postage Paid at Rockford, IL and additional mailing offices. POSTMASTER: Send address changes to: Pharmacy Tech Topics™, c/o ICHP, 4055 N. Perryville Road, Loves Park, IL 61111-8653 COPYRIGHT ©2017 by the Illinois Council of Health-System Pharmacists unless otherwise noted. All rights reserved. Pharmacy Tech Topics™ is a trademark of the Illinois Council of Health-System Pharmacists. This module is accredited for 2.5 contact hours of continuing pharmacy education and is recognized by the Pharmacy Technician Certification Board (PTCB). Cover image property of ©2017 Adobe Stock. LEARNING OBJECTIVES Upon completion of this module, the subscriber will be able to: 1. Identify the parts of the eye and the function of each part. 2. Summarize various eye disorders including ocular hypertension, glaucoma, infections, dry eyes, conjunctivitis, age-related macular degeneration, macular edema following retinal vein occlusion, and diabetic macular edema. 3. Discuss brand/generic substitutions, possible side effects, and proper administration of ophthalmic medications. 4. Describe the roles of various ophthalmic agents including those used to treat the following conditions: ocular hypertension, glaucoma, infections, dry eyes, conjunctivitis, age-related macular degeneration, macular edema following retinal vein occlusion, and diabetic macular edema.
    [Show full text]
  • Microbial Keratitis After Corneal Collagen Crosslinking
    CASE REPORT Microbial keratitis after corneal collagen crosslinking Juan J. Pe´rez-Santonja, MD, Alberto Artola, MD, Jaime Javaloy, MD, Jorge L. Alio´, MD, PhD, Jose´L. Abad, PhD Several infiltrates appeared in the upper midperipheral cornea of a 29-year-old woman who had had uneventful corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A light (UVA) for the treatment of keratoconus in the right eye. Staphylococcus epidermidis keratitis was con- firmed by microbiological studies, which guided treatment with topical fortified antibiotic agents. Before CXL, the best spectacle-corrected visual acuity (BSCVA) in the right eye was 20/25, the manifest refraction was À0.25 À0.25 Â 125, and the anterior segment was normal under biomi- croscopy. Five months after the procedure, the BSCVA was 20/22, the manifest refraction was C1.00 À2.50 Â 40, and slitlamp examination revealed a mild residual haze in the upper midper- ipheral cornea. Collagen crosslinking with riboflavin–UVA is a minimally invasive method but tra- ditionally requires epithelial removal, which could be a predisposing factor to bacterial keratitis. J Cataract Refract Surg 2009; 35:1138–1140 Q 2009 ASCRS and ESCRS Keratoconus is a noninflammatory ectasia of the cor- light (UVA) has been developed.3 This technique in- nea that is usually bilateral. The condition typically creases the corneal rigidity of treated corneas, and pre- starts at puberty, progressing in approximately 20% liminary clinical studies have shown improvement of cases to the extent that keratoplasty is necessary.1 and stabilization of keratectasia with few, if any, com- Hard contact lenses and corneal grafting have been plications in patients with keratoconus.4,5 the major treatment modalities for keratoconus, We report a case of microbial keratitis that devel- although some patients can now benefit from intracor- oped after CXL with riboflavin and UVA for the treat- neal ring segment implantation.1,2 None of these tech- ment of keratoconus.
    [Show full text]
  • Subconjunctival Bevacizumab Injection for Corneal Neovascularization in Interstitial Keratitis
    perim Ex en l & ta a l ic O p in l h Journal of Clinical & Experimental t C h f a o l m l a o Thakur et al., J Clin Exp Ophthalmol 2019, 10:2 n l o r g u y o Ophthalmology J DOI: 10.4172/2155-9570.1000797 ISSN: 2155-9570 Case Report Open Access Subconjunctival Bevacizumab Injection for Corneal Neovascularization in Interstitial Keratitis Anchal Thakur, Amit Gupta* and Sabia Handa Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India *Corresponding author: Amit Gupta, Department of Ophthalmology, Advanced Eye Centre, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, India, Tel: 0172 274 7585; E-mail: [email protected] Received date: January 31, 2019; Accepted date: March 19, 2019; Published date: March 26, 2019 Copyright: ©2019 Thakur A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract We describe the use of subconjunctival Bevacizuamb as an adjunct in the treatment of viral interstitial keratitis in a 17-year-old boy. He presented with a 3 months history of gradually progressive diminution of vision. The presenting visual acuity was 20/120 in the right eye and counting fingers close to face in the left eye. Examination revealed bilateral disc shaped stromal edema with leash of blood vessels entering the superior quadrant of the cornea. Subconjunctival injection of 0.1 mL (2.5 mg) of commercially available Bevacizumab (100 mg/4 mL; Avastin) was given under topical anesthesia along with initiation of topical steroids in the form of Betamethasone 0.1%.
    [Show full text]