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Keratoconus Into Focus

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Keratoconus Into Focus SEPTEMBER 2019 # 37 In My View In Practice Profession Sitting Down With Musings of a prospective The amblyopia app making Why the fight for female Stefanie Schmickler: business- glaucoma patient screening accessible to all leadership is far from over minded, patient-focused 12 – 13 32 – 35 46 – 49 50 – 51 Bringing Keratoconus into Focus Sharpening up our response to this underdiagnosed condition 14– 26 NORTH AMERICA www.theophthalmologist.com FOR ROTATIONAL STABILITY, THERE’S NO COMPARISON1,2 1. Lee BS, Chang DF. Comparison of the rotational stability of two toric intraocular lenses in 1273 consecutive eyes. Ophthalmology. 2018;0:1-7. 2. Potvin R, et al. Toric intraoclar lens orientation and residual refractive astigmatism: an analysis. Clin Ophthalmol. 2016;10:1829-1836. Please see Important Product Information on the adjacent page. AcrySof®IQ Toric ASTIGMATISM-CORRECTING IOL © 2018 Novartis 7/18 US-TOR-18-E-1605 105064 US-TOR-18-E-1605 TO.indd 1 1/30/19 4:04 PM ACRYSOF® IQ TORIC IOL IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: The AcrySof® IQ Toric posterior chamber intraocular lenses are Image intended for primary implantation in the capsular bag of the eye for visual correction of aphakia and pre-existing corneal astigmatism secondary to removal of a cataractous lens in of the adult patients with or without presbyopia, who desire improved uncorrected distance vision, reduction of residual refractive cylinder and Month increased spectacle independence for distance vision. WARNING/PRECAUTION: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Toric IOLs should not be implanted if the posterior capsule is ruptured, if the zonules are damaged, or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction; if necessary lens repositioning should occur as early as possible prior to lens encapsulation. All viscoelastics should be removed from both the anterior and posterior sides of the lens; residual viscoelastics may allow the lens to rotate. Optical theory suggests that high astigmatic patients (i.e. > 2.5 D) may experience spatial distortions. Possible toric IOL related factors may include residual cylindrical error or axis misalignments. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and benefits associated with the AcrySof® IQ Toric Cylinder Power IOLs. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® Natural IOL and normal color vision. The effect on vision of the AcrySof® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® or BSS Fool’s Gold ® PLUS Sterile Intraocular Irrigating Solutions. ATTENTION: Reference the Directions for Use This month’s image shows a corneal ulcer specimen under the microscope. labeling for a complete listing of indications, Credit: Channdarith Kith, Resident of Ophthalmology, University of Health Sciences, Cambodia. warnings and precautions. Do you have an image you’d like to see featured in The Ophthalmologist? Contact [email protected] © 2018 Novartis 7/18 US-TOR-18-E-1605 www.theophthalmologist.com 105064 US-TOR-18-E-1605_PI TO.indd 1 2/6/19 12:11 PM Contents 40 In My View 12 Musings of a Prospective Angle Closure Patient Chelvin Sng charts the rise and fall of LPI – the “gold standard” treatment for angle closure disease – and explains why she is looking forward to the 10 bespoke glaucoma management approaches of the future 03 Image of The Month Upfront Feature 08 Corneal Construction 14 Bringing Keratoconus 07 Editorial into Focus CXL Unbound, 09 A New Purpose With prevalence between three by Farhad Hafezi and 100-times higher than once 10 Bitesize Breakthroughs believed, early identification of keratoconus has never been more important. We bring On The Cover together the leading lights SEPTEMBER 2019 # 37 of the field to explain why In My View In Practice Profession Sitting Down With Musings of a prospective The amblyopia app making Why the fight for female Stefanie Schmickler: business- glaucoma patient screening accessible to all leadership is far from over minded, patient-focused 12 – 14 34 – 37 46 – 49 50 – 51 Seeing the world through timely treatment is key to the Bringing Keratoconus into Focus Expert views on how to tackle the corneal disorder that is a lot more common than previously thought 16– 27 keratoconic eyes prevention of vision loss NORTH AMERICA www.theophthalmologist.com ISSUE 37 - SEPTEMBER 2019 Editor - Aleksandra Jones [email protected] Deputy Editor - Phoebe Harkin [email protected] Content Director - Rich Whitworth [email protected] Publishing Director - Neil Hanley [email protected] Business Development Executive, Americas- Ross Terrone [email protected] Associate Publisher - Sam Blacklock [email protected] Business Development Executive- Paul Longley [email protected] Head of Design - Marc Bird [email protected] Designer - Hannah Ennis [email protected] Designer - Charlotte Brittain [email protected] 32 Digital Team Lead - David Roberts [email protected] Digital Producer Web/Email - Peter Bartley [email protected] Digital Producer Web/App - Abygail Bradley [email protected] In Practice Audience Insight Manager & Data Protection Officer- 50 Tracey Nicholls [email protected] 30 Just Asking Traff ic & Audience Database Coordinator - Hayley Atiz [email protected] The Advanced Glaucoma Project Manager - Webinars - Lindsey Vickers Technologies Forum audience [email protected] put questions to our expert panel, Traffic Manager - Jody Fryett [email protected] tackling everything from drug Traffic Assistant - Dan Marr delivery to artificial intelligence [email protected] Events Manager - Alice Daniels-Wright [email protected] 32 Tackling the Event Coordinator - Jessica Lines Global Vision Crisis [email protected] Of the nine million people Marketing Manager - Katy Pearson [email protected] living in Mumbai’s slums, Social Media Manager - Joey Relton only 48 percent have access [email protected] to healthcare facilities. Darcy Marketing Executive - Sarah Botha [email protected] Wendel presents the app Profession Financial Controller - Phil Dale making vision screening [email protected] accessible to all 46 Female Leadership – is it in Accounts Assistant - Kerri Benson [email protected] Good Health? Senior Vice President (North America) - Fedra Pavlou Louisa Wickham explains why [email protected] we need diversity in ophthalmic Chief Executive Officer - Andy Davies [email protected] NextGen leadership – be it gender, Chief Operating Officer - Tracey Peers ethnicity or disability – in [email protected] 40 Pouring Oil on order to deliver the level of care Change of address/General enquiries [email protected] Troubled Retinas patients deserve The Ophthalmologist, Texere Publishing, 175 Varick St, New York, NY 10014. Silicone oil tamponades can +44 (0) 1565 745 200 inhibit scar tissue formation [email protected] Distribution in patients with a high risk of The Ophthalmologist North America (ISSN 2398-9270) is published monthly by Texere retinal scarring after retinal Sitting Down With... Publishing, 175 Varick St, New York, NY 10014. Single copy sales $15 (plus postage, cost available on detachment. But how much request [email protected]) more effective would these 50 Stefanie Schmickler, CEO of Non-qualified annual subscription cost is available on request Reprints & Permissions – [email protected] products be if they also Augen Zentrum Nordwest in The opinions presented within this publication are those of the authors and do not reflect the opinions of The Ophthalmologist or its publishers, Texere Publishing. delivered antifibrotics? Germany and Deputy Editor of Authors are required to disclose any relevant financial arrangements, which are presented at the end of each article, where relevant. Victoria Kearns investigates GMS Ophthalmology Cases © 2019 Texere Publishing Limited. All rights reserved. Reproduction in whole or in parts is prohibited. www.theophthalmologist.com A TissueTech Company Find Your Wow Moment at www.YourWowMoment.com CXL Unbound Editorial What drives progress in medicine? Identifying and meeting unmet needs ometimes, the sheer scale of an unmet need can surprise you. For many years, keratoconus was thought of as a rare disease: in 1986, a paper reported that 1 in 2,000 people Sin Olmstead County, Minnesota, had keratoconus. And that figure stuck for at least
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