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Pacific University College of Optometry Coeur D’Alene Continuing Education April 24 & 25, 2015 Coeur D’Alene Resort, Idaho COPE EVENT #108901

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Pacific University College of Optometry Coeur D’Alene Continuing Education April 24 & 25, 2015 Coeur D’Alene Resort, Idaho COPE EVENT #108901 Pacific University College of Optometry Coeur d’Alene Continuing Education April 24 & 25, 2015 Coeur d’Alene Resort, Idaho COPE EVENT #108901 Date Speaker Title COPE Certification Neuroimaging 101 (1 hr) Friday, Denise Goodwin, 37787 Pages 2-9 4/24/2015 OD 1:00pm – 2:00pm NO 1 hour Therapeutic AMD Update (1 hr) Len V. Koh, PhD, 44205 pages 10-19 OD 2:00 pm – 3:00 pm SD 1 hour Therapeutic Shedding Light on Fundus Lorne Yudcovitch, Autofluorescence (1 hr) 42772 OD, MS Pages 20-22 3:00 pm – 4:00 pm PS 1 hour Therapeutic Primary Eye Care for Len V. Koh, PhD, 44209 Diabetes (1 hr) pages 23-33 OD 4:00 pm – 5:00 pm SD 1 hour Therapeutic Ebola and Other Rare Viruses: What Every Optometrist Lorne Yudcovitch, 44472 Should Know (1 hr) OD, MS Pages 34-36 SD 5:00 pm – 6:00 pm 1 hour Therapeutic Therapeutic Hours: PS, PH, AS, SD, PD TOTAL HOURS ATTENDED: Name License # Mailing Address City/ST/ZIP Pacific University College of Optometry 2043 College Way Forest Grove, Oregon 97116 503- 352- 2202 Pacific University College of Optometry Coeur d’Alene Continuing Education April 24 & 25, 2015 Coeur d’Alene Resort, Idaho COPE EVENT #108901 Fundamentals of Gonioscopy Saturday Denise Goodwin, 44623 (1 hr) Pages 37-45 4/25/2015 OD 8:00 am – 9:00 am GL 1 hour Therapeutic Adverse Drug Reactions Pertinent to 44210 Len Koh, PhD, OD Eyecare (1 hr) Pages 46-58 9:00 am – 10:00 am PH 1 hour Therapeutic Keegan Bench, OD Kolten Kuntz, OD Clinical Cases from Spokane VA 44660 Medical Center Pages 59-61 Brandon McFadden, 10:00 am – 11:00 am OD PS 1 hour Clinical Applications of Denise Goodwin, Electrophysiology (1 hr) 44624 OD Pages 62-70 11:00 am – 12:00 pm NO 1 hour Therapeutic Put a Lid on It: Sutureless Lorne Yudcovitch, Eyelid Procedures (1 hr) 44473 OD, MS Pages 71-74 12:00 pm – 1:00 pm SP 1 hour Therapeutic Therapeutic Hours: PS, PH, AS, SD, PD TOTAL HOURS ATTENDED: Name License # Mailing Address City/ST/ZIP Pacific University College of Optometry 2043 College Way Forest Grove, Oregon 97116 503- 352- 2202 Coeur D’Alene CE Faculty 2015 Denise Goodwin, OD, FAAO ([email protected]) Dr Goodwin is a graduate of Pacific University College of Optometry where she is currently a tenured Professor of Optometry. She is the coordinator of the Neuro- ophthalmic Disease Service and is editor of “Eye on Pacific” a newsletter featuring the College of Optometry referral services and unusual clinical cases. At Pacific University she teaches clinical procedures, ocular disease and ophthalmic imaging. Dr. Goodwin has also maintained a private practice for the past 15 years. Her online course, “Fundamentals of Gonioscopy” is one of the most popular courses on our website. Len Koh, PhD, OD ([email protected]) Dr. Koh holds a doctorate in pharmacology and earned his optometry degree from New England College of Optometry. He completed a residency in primary eye care from Salus University Pennsylvania College of Optometry. Dr. Koh holds the rank of Associate Professor of Optometry and serves as the Clinic Director of Pacific EyeClinic Hillsboro. His research interests include Ocular Therapeutics, Biochemical and Molecular Basis of Ocular Disease. Lorne Yudcovitch, OD, MS ([email protected]) Dr. Yudcovitch hails from Alberta, Canada, and earned his optometry degree from Pacific University, where he is a full professor and Chief of the Medical Eye/Ocular Disease Service. He is an engaging instructor and has been honored by his students as Didactic Instructor of the Year for three consecutive years. He is also a well-regarded national and international speaker in advanced ocular imaging, diabetes and glaucoma management, and eye disease pharmacological treatment. Spokane Veterans Administration Medical Center – OPTOMETRY RESIDENTS Keegan Bench, OD Dr. Bench earned a Bachelor of Science in Biology from Utah State University, and completed his Doctor of Optometry at Midwestern University Arizona College of Optometry. He is completing his residency in geriatric care and ocular disease. Brandon McFadden, OD Dr. McFadden earned his undergraduate degree in Exercise Physiology from the University of Utah and his Doctor of Optometry from The Ohio State University College of Optometry. His residency training is in Ocular Disease and Cornea & Contact Lenses. Kolten Kuntz, OD Originally from Helena, Montana, Dr. Kuntz earned his undergraduate degree from Eastern Washington University and his Doctor of Optometry from Midwestern University Arizona College of Optometry. He is completing his Ocular Disease residency. Coeur d’Alene CE Course Administrator; Jeanne Oliver ([email protected]) 1 of 74 4/9/2015 Why? Improve communication Neuroimaging 101 Direct studies for the Optometrist Understand reports Understand limitations Denise Goodwin, OD, FAAO Double check reports Coordinator, Neuro-ophthalmic Disease Clinic Pacific University College of Optometry [email protected] What to Order? What to Order? What to Order? MRI CT MRI CT – Brain – Brain – ABC’S – Brain – Brain – ABC’S – Orbits – Orbits • Acute blood – Orbits – Orbits • Acute blood • Bone – Fat suppression – Chest • Bone – Fat suppression – Chest • Calcification – With gadolinium – With contrast – With gadolinium – With contrast • Calcification • Sinuses • Sinuses 2 of 74 1 4/9/2015 What to Order? What to Order? MRI CT MRI CT – Brain $1471 – Brain $653 – Brain $1471 – Brain $653 – Orbits $2134 – Orbits – Orbits $2134 – Orbits – Fat suppression – Chest – Fat suppression – Chest – With gadolinium $5/mL – With contrast – With gadolinium $5/mL – With contrast Diagnosis? 3 of 74 2 4/9/2015 What to Order? MRI CT – Brain – Brain – Orbits – Orbits – Fat suppression – Chest – With gadolinium – With contrast T2 T1 T2 T1 No Contrast Contrast 4 of 74 3 4/9/2015 Diagnosis? Image by Tracy Doll, OD What to Order? MRI CT – Brain – Brain – Orbits – Orbits – Fat suppression – Chest – With gadolinium – With contrast 5 of 74 4 4/9/2015 Diagnosis? 6 of 74 5 4/9/2015 Diagnosis? Images by Ami Halvorson, OD Diagnosis? 7 of 74 6 4/9/2015 Diagnosis? http://emedicine.medscape.com 8 of 74 7 4/9/2015 Summary Is neuroimaging necessary? Localize the lesion Provide appropriate clinical information What is the most appropriate sequence? Should contrast should be given? Review you own neuroimaging Helpful Resources Neuroimaging in Ophthalmology. Edited by Michael Johnson, Bruno Policani, Andrew Lee, and Wendy Smoker. Imaging of Orbital and Visual Pathway Pathology. Editor WS Muller-Forell MedPix: http://rad.usuhs.edu/medpix 9 of 74 8 12/31/2014 Age‐related macular degeneration Len V Koh Koh PUCO 1 Introduction • Leading cause of irreversible blindness • More than 8 million Americans Koh PUCO 2 Normal Fundus • Macula, 6 mm • Fovea, 0.8 mm • RPE • Bruch’s Koh PUCO 3 10 of 74 1 12/31/2014 Pathophysiology of Age‐Related Macular Degeneration • Drusen • small (<63 μmin diameter) • medium (63 to 124 μm) • large (>124 μm) • Chronic aberrant inflammation Koh PUCO 4 Koh PUCO 5 Features of AMD Koh PUCO 6 11 of 74 2 12/31/2014 • Large druse • 125um • Width of an average large vein • Intermediate druse • 63um‐125um Koh PUCO 7 5‐year prognosis Koh PUCO 8 Progression scoring Koh PUCO 9 12 of 74 3 12/31/2014 Risk Factors for Advanced Stages of AMD Koh PUCO 10 Neovascular AMD Koh PUCO 11 Degenerating photoreceptors may become arranged in a circular or ovoid fashion during a process known as outer retinal tubulation. Koh PUCO 12 13 of 74 4 12/31/2014 • The mean VA of eyes with ORT at week 104 was worse than the mean VA of eyes without ORT. Koh PUCO 13 Intravitreal Injection Koh PUCO 14 Koh PUCO 15 14 of 74 5 12/31/2014 Fundus appearances Koh PUCO 16 Invest Ophthalmol Vis Sci. 2005; 46:3309–3314 Koh PUCO 17 Autofluorescence patterns Koh PUCO 18 15 of 74 6 12/31/2014 mfERG as functional test mfERG responses from a normal subject Koh PUCO 19 • Antioxidants • Anti‐Inflammatory Agent • AREDS • Eculizumab • Visual Cycle Inhibitors • Sirolimus (rapamycin) • fenretinide (100 and 300 mg daily, • Glatiramer acetate (Copaxone) orally) • Neuroprotective Therapy • Isotretinoin or 13‐ cis ‐retinoic acid (Accutane) • Ciliary neurotrophic factor (CNTF) • Emixustat • Stem Cell Therapy • Stem cell‐derived RPE and photoreceptors Koh PUCO 20 AMD Categories Koh PUCO 21 16 of 74 7 12/31/2014 AREDS Formulations • an approximate cost of $200 per annum • Vit C: kidney stones • Vit #: fatigue, thyroid, stroke • Β‐carotene: lung cancer • Zn: anemia, stomach upset Koh PUCO 22 Koh PUCO 23 Dietary products with AREDS nutrients Koh PUCO 24 17 of 74 8 12/31/2014 • Although primary analysis of the AREDS2 data did not reveal a clear benefit of daily supplementation with lutein/zeaxanthin and/or omega‐3 LCPUFAs (DHA/ EPA) on AMD progression • secondary exploratory analyses did suggest that lutein/zeaxanthin were helpful in reducing this risk. Koh PUCO 25 • The majority of top‐selling ocular nutritional supplements did not contain the identical ingredient dosages of the AREDS or AREDS2 formula • had product description claims that lacked level 1 evidence Koh PUCO 26 Candidate genes Koh PUCO 27 18 of 74 9 12/31/2014 Invest Ophthalmol Vis Sci. 2014;55:6167–6174. • Direct‐to‐consumer personal genome tests are not suitable for clinical application as yet. Koh PUCO 28 • RPE death is due to a deficiency in the enzyme DICER1, which leads to accumulation of toxic Alu RNA • Alu RNA causes RPE death by activating an immune platform called the NLRP3 inflammasome • Alu RNA induces RPE death by activating the enzyme Caspase‐8 downstream of inflammasome activation Koh PUCO 29 Information for patients Koh PUCO 30 19 of 74 10 Shedding Light on Fundus Autofluorescence Lorne Yudcovitch, O.D., M.S., F.A.A.O.
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