Refractive Management/Intervention 2017-2019
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Summary Benchmarks for Preferred Practice Pattern® Guidelines
SUMMARY BENCHMARKS FOR PREFERRED PRACTICE PATTERN® GUIDELINES TABLE OF CONTENTS Summary Benchmarks for Preferred Practice Pattern Guidelines Introduction . 1 Glaucoma Primary Open-Angle Glaucoma (Initial Evaluation) . 3 Primary Open-Angle Glaucoma (Follow-up Evaluation) . 5 Primary Open-Angle Glaucoma Suspect (Initial and Follow-up Evaluation) . 6 Primary Angle-Closure Disease (Initial Evaluation and Therapy) . 8 Retina Age-Related Macular Degeneration (Initial and Follow-up Evaluation) . 10 Age-Related Macular Degeneration (Management Recommendations) . 11 Diabetic Retinopathy (Initial and Follow-up Evaluation) . 12 Diabetic Retinopathy (Management Recommendations) . 13 Idiopathic Epiretinal Membrane and Vitreomacular Traction (Initial Evaluation and Therapy) . 14 Idiopathic Macular Hole (Initial Evaluation and Therapy) . 15 Posterior Vitreous Detachment, Retinal Breaks, and Lattice Degeneration (Initial and Follow-up Evaluation) . 17 Retinal and Ophthalmic Artery Occlusions (Initial Evaluation and Therapy) . 18 Retinal Vein Occlusions (Initial Evaluation and Therapy) . 19 Cataract/Anterior Segment Cataract (Initial and Follow-up Evaluation) . 20 Cornea/External Disease Bacterial Keratitis (Initial Evaluation) . 22 Bacterial Keratitis (Management Recommendations) . 23 Blepharitis (Initial and Follow-up Evaluation) . 24 Conjunctivitis (Initial Evaluation) . 25 Conjunctivitis (Management Recommendations) . 26 Corneal Ectasia (Initial Evaluation and Follow-up) . 27 Corneal Edema and Opacification (Initial Evaluation) . 28 Corneal Edema -
In Vivo Confocal Microscopy of Toxic Keratopathy
Eye (2017) 31, 140–147 OPEN Official journal of The Royal College of Ophthalmologists www.nature.com/eye CLINICAL STUDY In vivo confocal Y Chen, Q Le, J Hong, L Gong and J Xu microscopy of toxic keratopathy Abstract Purpose To explore the morphological although a wide variety of chemicals and characteristics of toxic keratopathy (TK), systemic medications can also cause TK.1 Cases which clinically presented as superficial of drug-induced TK have been prevalent in punctate keratopathy (SPK), with the ophthalmic clinics for two reasons. On the one application of in vivo laser-scanning confocal hand, most of the topically applied drugs, either microscopy (LSCM), and evaluate its potential prescribed or sold over-the-counter, are capable in the early diagnosis of TK. of causing corneal damage at sufficient Patients and methods This was a cross- concentrations.2 Patients who have glaucoma, sectional study involving 16 patients with viral keratitis, keratoconjunctivitis sicca or other TK and 16 patients with dry eye (DE), ocular surface conditions, generally need demonstrating SPK under slit-lamp multidrug remedies, and these pre-existing observation, and 10 normal eyes were conditions may especially predispose them to enrolled in the study. All participants drug toxicity. The preservative in the eye drops, underwent history interviews, fluorescein mainly benzalkonium chloride (BAC), is another staining, tear film break-up time (BUT) tests, important cause for epithelial lesions. On the Schirmer tests, and in vivo LSCM. other hand, the use of eye drops for a week or Results The area grading of corneal more may cause TK, which can often be confused fluorescein punctate staining was higher in with the worsening of the patient’s initial disease the TK group than the DE group. -
Description of Alternative Approaches to Measure and Place a Value on Hospital Products in Seven Oecd Countries
OECD Health Working Papers No. 56 Description of Alternative Approaches to Measure Luca Lorenzoni, and Place a Value Mark Pearson on Hospital Products in Seven OECD Countries https://dx.doi.org/10.1787/5kgdt91bpq24-en Unclassified DELSA/HEA/WD/HWP(2011)2 Organisation de Coopération et de Développement Économiques Organisation for Economic Co-operation and Development 14-Apr-2011 ___________________________________________________________________________________________ _____________ English text only DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS HEALTH COMMITTEE Unclassified DELSA/HEA/WD/HWP(2011)2 Health Working Papers OECD HEALTH WORKING PAPERS NO. 56 DESCRIPTION OF ALTERNATIVE APPROACHES TO MEASURE AND PLACE A VALUE ON HOSPITAL PRODUCTS IN SEVEN OECD COUNTRIES Luca Lorenzoni and Mark Pearson JEL Classification: H51, I12, and I19 English text only JT03300281 Document complet disponible sur OLIS dans son format d'origine Complete document available on OLIS in its original format DELSA/HEA/WD/HWP(2011)2 DIRECTORATE FOR EMPLOYMENT, LABOUR AND SOCIAL AFFAIRS www.oecd.org/els OECD HEALTH WORKING PAPERS http://www.oecd.org/els/health/workingpapers This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language – English or French – with a summary in the other. Comment on the series is welcome, and should be sent to the Directorate for Employment, Labour and Social Affairs, 2, rue André-Pascal, 75775 PARIS CEDEX 16, France. The opinions expressed and arguments employed here are the responsibility of the author(s) and do not necessarily reflect those of the OECD. -
Refractive Surgery Faqs. Refractive Surgery the OD's Role in Refractive
9/18/2013 Refractive Surgery Refractive Surgery FAQs. Help your doctor with refractive surgery patient education Corneal Intraocular Bill Tullo, OD, FAAO, LASIK Phakic IOL Verisys Diplomate Surface Ablation Vice-President of Visian PRK Clinical Services LASEK CLE – Clear Lens Extraction TLC Laser Eye Centers Epi-LASIK Cataract Surgery AK - Femto Toric IOL Multifocal IOL ICRS - Intacs Accommodative IOL Femtosecond Assisted Inlays Kamra The OD’s role in Refractive Surgery Refractive Error Determine the patient’s interest Myopia Make the patient aware of your ability to co-manage surgery Astigmatism Discuss advancements in the field Hyperopia Outline expectations Presbyopia/monovision Presbyopia Enhancements Risks Make a recommendation Manage post-op care and expectations Myopia Myopic Astigmatism FDA Approval Common Use FDA Approval Common Use LASIK: 1D – 14D LASIK: 1D – 8D LASIK: -0.25D – -6D LASIK: -0.25D – -3.50D PRK: 1D – 13D PRK: 1D – 6D PRK: -0.25D – -6D PRK: -0.25D – -3.50D Intacs: 1D- 3D Intacs: 1D- 3D Intacs NONE Intacs: NONE P-IOL: 3D- 20D P-IOL: 8D- 20D P-IOL: NONE P-IOL: NONE CLE/CAT: any CLE/CAT: any CLE/CAT: -0.75D - -3D CLE/CAT: -0.75D - -3D 1 9/18/2013 Hyperopia Hyperopic Astigmatism FDA Approval Common Use FDA Approval Common Use LASIK: 0.25D – 6D LASIK: 0.25D – 4D LASIK: 0.25D – 6D LASIK: 0.25D – 4D PRK: 0.25D – 6D PRK: 0.25D – 4D PRK: 0.25D – 6D PRK: 0.25D – 4D Intacs: NONE Intacs: NONE Intacs: NONE Intacs: NONE P-IOL: NONE P-IOL: NONE P-IOL: NONE P-IOL: -
Short-Term Changes in the Photopic Negative Response Following Intraocular Pressure Lowering in Glaucoma
Glaucoma Short-Term Changes in the Photopic Negative Response Following Intraocular Pressure Lowering in Glaucoma Jessica Tang,1,2 Flora Hui,1 Xavier Hadoux,1 Bernardo Soares,3 Michael Jamieson,3 Peter van Wijngaarden,1–3 Michael Coote,1–3 and Jonathan G. Crowston1,2,4,5 1Glaucoma Research Unit, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia 2Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, Australia 3Royal Victorian Eye and Ear Hospital, Melbourne, Australia 4Centre for Vision Research, Duke-NUS Medical School, Singapore, Singapore 5Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore Correspondence: Jessica Tang, PURPOSE. To evaluate the short-term changes in inner retinal function using the photopic Glaucoma Research Unit, Centre for negative response (PhNR) after intraocular pressure (IOP) reduction in glaucoma. Eye Research Australia, Royal Victorian Eye and Ear Hospital, METHODS. Forty-seven participants with glaucoma who were commencing a new or addi- Level 7, Peter Howson Wing, 32 tional IOP-lowering therapy (treatment group) and 39 participants with stable glau- Gisborne St, East Melbourne, VIC coma (control group) were recruited. IOP, visual field, retinal nerve fiber layer thick- 3002, Australia; ness, and electroretinograms (ERGs) were recorded at baseline and at a follow-up visit [email protected]. (3 ± 2 months). An optimized protocol developed for a portable ERG device was used Received: August 29, 2019 to record the PhNR. The PhNR saturated amplitude (Vmax), Vmax ratio, semi-saturation Accepted: June 16, 2020 constant (K), and slope of the Naka–Rushton function were analyzed. Published: August 7, 2020 RESULTS. -
Laser Learning Lecture and Lab: YAG Caps, LPI, And
5/9/17 Overview Laser Learning Lecture and Lab: • Why we use lasers YAG caps, LPI, and SLT • YAG capsulotomy • Laser Peripheral Iridotomy (LPI or PI) Aaron McNulty, O.D., F.A.A.O. • Argon Laser Peripheral Iridoplasty (ALPI) Nate Lighthizer, O.D., F.A.A.O. • Argon Laser Trabeculoplasty (ALT) • Selective Laser Trabeculoplasty (SLT) • Other Laser Trabeculoplasty Why do we use lasers? Posterior Capsular Opacification (PCO) • Vision is decreased from PCO following cataract surgery • Lens capsular bag has an anterior and • Narrow angles/angle closure posterior surface • Glaucoma is progressing in a pt on max meds – Anterior surface usually removed w/ capsulorhexis – Something else needs to be done – Surgery not wanted yet • PCO is the formation of a cloudy membrane • Compliance issues on the posterior surface of the capsular bag • Cost issues following ECCE • Convenience issues – AKA: Secondary cataract • Doctor preference PCO YAG Laser • Incidence: • Nd: YAG laser – Most common complication of post ECCE – Neodymium: Yttrium aluminum garnet laser – 10-80% of eyes following cataract surgery – Can form anywhere from a few days to years post surgery • Tissue interaction: Photodisruptive laser – Younger patients higher risk of PCO – High light energy levels cause the tissues to be reduced – IOL’s to plasma, disintegrating the tissue • Silicone > acrylic – A large amount of energy is delivered into very small focal spots in a very brief duration of time • Prevention: • 4 nsec – – Capsulotomy during surgery No thermal reaction/No coagulation when bv’s are hit – Posterior capsular polishing – Pigment independent* 1 5/9/17 YAG Cap Risks, Complications, YAG Cap Pre-op Exam Contraindications • Visual acuity, glare testing, PAM/Heine lambda Contraindications Risks/complications – Vision 20/30 or worse 1. -
Posterior Cornea and Thickness Changes After Scleral Lens Wear in Keratoconus Patients
Contact Lens and Anterior Eye xxx (xxxx) xxx–xxx Contents lists available at ScienceDirect Contact Lens and Anterior Eye journal homepage: www.elsevier.com/locate/clae Posterior cornea and thickness changes after scleral lens wear in keratoconus patients Maria Serramitoa, Carlos Carpena-Torresa, Jesús Carballoa, David Piñerob,c, Michael Lipsond, ⁎ Gonzalo Carracedoa,e, a Department of Optics II (Optometry and Vision), Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain b Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, Spain c Department of Ophthalmology (OFTALMAR), Vithas Medimar International Hospital, Alicante, Spain d Department of Ophthalmology and Visual Science, University of Michigan, Northville, MI, USA e Ocupharm Group Research, Department of Biochemistry and Molecular Biology IV, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain ARTICLE INFO ABSTRACT Keywords: Purpose: To evaluate the changes in the corneal thickness, anterior chamber depth and posterior corneal cur- Scleral lenses vature and aberrations after scleral lens wear in keratoconus patients with and without intrastromal corneal ring Keratoconus segments (ICRS). Corneal curvature Methods: Twenty-six keratoconus subjects (36.95 ± 8.95 years) were evaluated after 8 h of scleral lens wear. Corneal aberrations The subjects were divided into two groups: those with ICRS (ICRS group) and without ICRS (KC group). The Anterior chamber study variables evaluated before and immediately after scleral lens wear included corneal thickness evaluated in Corneal thickness different quadrants, posterior corneal curvature at 2, 4, 6 and 8 mm of corneal diameter, posterior corneal aberrations for 4, 6 and 8 mm of pupil size and anterior chamber depth. -
National Correct Coding Initiative's (Ncci) General
NATIONAL CORRECT CODING INITIATIVE’S (NCCI) GENERAL CORRESPONDENCE LANGUAGE AND SECTION-SPECIFIC EXAMPLES (FOR NCCI PROCEDURE TO PROCEDURE (PTP) EDITS AND MEDICALLY UNLIKELY EDITS (MUE)) EFFECTIVE: April 1, 2017* *INCLUDES 2017 HCPCS/CPT CODES Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2016 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. TABLE OF CONTENTS Section Page Introduction 5 General Correspondence Language for NCCI PTP Edits and Medically Unlikely Edits (MUEs) Standard preparation/monitoring services for anesthesia 8 HCPCS/CPT procedure code definition 8 CPT Manual or CMS manual coding instruction 8 Mutually exclusive procedures 9 Sequential procedure 9 CPT “Separate procedure” definition 9 More extensive procedure 9 Gender-specific procedures 10 Standards of medical/surgical practice 10 Anesthesia service included in surgical procedure 10 Laboratory panel 10 Deleted/modified edits for NCCI 11 Misuse of column two code with column one code 11 Medically Unlikely Edits (MUE) (Units of Service) 11 Deleted/modified edits -
Laser Procedures for the Management of Glaucoma and More Handout
4/25/17 Overview Laser Procedures for the Management • Why we use lasers of Glaucoma and More • YAG capsulotomy Nate Lighthizer, O.D., F.A.A.O. • Laser Peripheral Iridotomy (LPI or PI) Assistant Professor, NSUOCO • Argon Laser Peripheral Iridoplasty (ALPI) Assistant Dean, Clinical Care Services • Argon Laser Trabeculoplasty (ALT) Director of CE Chief of Specialty Care Clinics • Selective Laser Trabeculoplasty (SLT) Chief of Electrodiagnostics Clinic • Other Laser Trabeculoplasty [email protected] Why do we use lasers? Posterior Capsular Opacification (PCO) • Vision is decreased from PCO following cataract surgery • Lens capsular bag has an anterior and • Narrow angles/angle closure posterior surface • Glaucoma is progressing in a pt on max meds – Anterior surface usually removed w/ capsulorhexis – Something else needs to be done – Surgery not wanted yet • PCO is the formation of a cloudy membrane • Compliance issues on the posterior surface of the capsular bag • Cost issues following ECCE • Convenience issues – AKA: Secondary cataract • Doctor preference PCO YAG Laser • Incidence: • Nd: YAG laser – Most common complication of post ECCE – Neodymium: Yttrium aluminum garnet laser – 10-80% of eyes following cataract surgery – Can form anywhere from a few days to years post surgery • Tissue interaction: Photodisruptive laser – Younger patients higher risk of PCO – High light energy levels cause the tissues to be reduced – IOL’s to plasma, disintegrating the tissue • Silicone > acrylic – A large amount of energy is delivered into very small focal spots in a very brief duration of time • Prevention: • 4 nsec – – Capsulotomy during surgery No thermal reaction/No coagulation when bv’s are hit – Posterior capsular polishing – Pigment independent* 1 4/25/17 YAG Cap Risks, Complications, YAG Cap Pre-op Exam Contraindications • Visual acuity, glare testing, PAM/Heine lambda Contraindications Risks/complications – Vision 20/30 or worse 1. -
Retinal Pigment Epithelial Tear Resembling Retinal Tear
Correspondence 333 References 5University of Washington/Fred Hutchinson 1 Dean WH, Banda L, Kambewa ES, Sherwin JC. Increased Cancer Research Center, Seattle, WA, USA intraocular pressure on the first post-operative day 6Department of Ophthalmology and Visual following sutureless extracapsular cataract surgery in Sciences, The University of Texas Medical Branch, Africa. Eye 2012; 26: 332. Galveston, TX, USA 2 Kim JY, Jo MW, Brauner SC, Ferrufino-Ponce Z, Ali R, 7Ophthalmic Consultants of Boston, Harvard Cremers SL et al. Increased intraocular pressure on the first Medical School, Boston, MA, USA postoperative day following resident-performed cataract E-mail: [email protected] surgery. Eye (Lond) 2011; 25: 929–936. Eye (2012) 26, 332–333; doi:10.1038/eye.2011.274; JY Kim1,2,3, M-W Jo4, SC Brauner3, Z Ferrufino-Ponce5, published online 11 November 2011 R Ali6, SL Cremers3 and BA Henderson7 1Department of Ophthalmology, University of Sir, Ulsan College of Medicine, Asan Medical Center, Retinal pigment epithelial tear resembling retinal Seoul, Republic of Korea tear 2Research Institute for Biomacromolecules, University of Ulsan College of Medicine, Case report Asan Medical Center, Seoul, Republic of Korea A 74-year-old Caucasian female with history of advanced 3Massachusetts Eye and Ear Infirmary, Harvard age-related macular degeneration presented with Medical School, Boston, MA, USA decreased vision in the right eye. The patient was 4Department of Preventive Medicine, University of treated with two ranibizumab injections for choroidal Ulsan College of Medicine, Seoul, Republic of Korea neovascularization 5 months prior without Figure 1 (a) SD-OCT showing RPE defect with overlying intact retina. -
Bjophthalmol-2020-318090 1..2
At a glance Br J Ophthalmol: first published as 10.1136/bjophthalmol-2020-318090 on 26 October 2020. Downloaded from Highlights from this issue doi:10.1136/bjophthalmol-2020-318090 Keith Barton , James Chodosh , Jost B Jonas , Editors in chief Glaucoma in the Northern Ireland Cohort The effect of partial posterior vitreous Comparison of OCT angiography in for the Longitudinal Study of Ageing detachment on spectral-domain optical children with a history of intravitreal (NICOLA): cohort profile, prevalence, coherence tomography retinal nerve fibre injection of ranibizumab vs laser awareness and associations (seepage1492) layer thickness measurements photocoagulation for retinopathy of The crude prevalence of glaucoma in (seepage1524) prematurity (see page 1556) Northern Ireland of 2.83% (95% CI Among glaucoma suspects, eyes with par- In this cross-sectional study, we found that 2.31%, 3.46%) is comparable to other tial posterior vitreous detachments, com- the central foveal vessel length density and European population-based studies. pared to eyes without, were associated perfusion density, the foveal avascular Approximately two thirds of people with with greater average, superior, and inferior zone area and central foveal thicknesses glaucoma were undiagnosed. Associations retinal nerve fibre layer thickness of children who had undergone different with glaucoma were consistent with cur- measurements. treatments, might vary. rent understanding of the disease. Three-year follow-up of choroidal Comparison of central visual sensitivity Selective -
A Review of Selective Laser Trabeculoplasty: Recent Findings and Current Perspectives
Ophthalmol Ther DOI 10.1007/s40123-017-0082-x REVIEW A Review of Selective Laser Trabeculoplasty: Recent Findings and Current Perspectives Yujia Zhou . Ahmad A. Aref Received: January 17, 2017 Ó The Author(s) 2017. This article is published with open access at Springerlink.com ABSTRACT explored, revealing that minor modifications may lead to a more favorable or safer clinical Selective laser trabeculoplasty (SLT) has been outcome. The utilization of postoperative widely used in the clinical management of medications remains controversial based on the glaucoma, both as primary and adjunctive current evidence. A short-term IOP increase treatment. As new evidence continues to arise, may complicate SLT and can also persist in we review the current literature in terms of certain cases such as in exfoliation glaucoma. indications and efficacy, surgical technique, The efficacy and safety of repeat SLT are shown postoperative care, repeatability, and compli- in multiple studies, and the timing of repeat cations of this therapy. SLT has been shown to procedures may affect the success rate. be effective in various glaucomas, including primary open-angle glaucoma (POAG), nor- mal-tension glaucoma (NTG), steroid-induced Keywords: Glaucoma; Intraocular pressure; glaucoma, pseudoexfoliation glaucoma (PXFG), Laser; Selective laser trabeculoplasty and primary angle-closure glaucoma (PACG), as well as other glaucoma subtypes. Relatively high preoperative intraocular pressure (IOP) INTRODUCTION may predict surgical success, while other parameters that have been studied do not seem Intraocular pressure (IOP) reduction is the to affect the outcome. Different techniques for mainstay of therapy for glaucomatous optic performing the procedure have recently been neuropathy. Selective laser trabeculoplasty (SLT) has been widely employed for this pur- Enhanced content To view enhanced content for this pose over the past several years as both a pri- article go to http://www.medengine.com/Redeem/ mary and adjunctive treatment [1].