Managing Retinal Detachment After Refractive Surgery
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History of Refractive Surgery
History of Refractive Surgery Refractive surgery corrects common vision problems by reshaping the cornea, the eye’s outermost layer, to bend light rays to focus on the retina, reducing an individual’s dependence on eye glasses or contact lenses.1 LASIK, or laser-assisted in situ keratomileusis, is the most commonly performed refractive surgery to treat myopia, hyperopia and astigmatism.1 The first refractive surgeries were said to be the removal of cataracts – the clouding of the lens in the eye – in ancient Greece.2 1850s The first lensectomy is performed to remove the lens 1996 Clinical trials for LASIK begin and are approved by the of the eye to correct myopia.2 Food & Drug Administration (FDA).3 Late 19th 2 Abott Medical Optics receives FDA approval for the first Century The first surgery to correct astigmatism takes place. 2001 femtosecond laser, the IntraLase® FS Laser.3 The laser is used to create a circular, hinged flap in the cornea, which allows the surgeon access to the tissue affecting the eye’s 1978 Radial Keratotomy is introduced by Svyatoslov Fyodorov shape.1 in the U.S. The procedure involves making a number of incisions in the cornea to change its shape and 2002 The STAR S4 IR® Laser is introduced. The X generation is correct refractive errors, such as myopia, hyperopia used in LASIK procedures today.4 and astigmatism.2,3 1970s Samuel Blum, Rangaswamy Srinivasan and James J. Wynne 2003 The FDA approves the use of wavefront technology,3 invent the excimer laser at the IBM Thomas J. Watson which creates a 3-D map of the eye to measure 1980s Research Center in Yorktown, New York. -
Perioperative Assessment for Refractive Cataract Surgery
642 REVIEW/UPDATE Perioperative assessment for refractive cataract surgery Kendall Donaldson, MD, MS, Luis Fernandez-Vega-Cueto, MD, PhD, Richard Davidson, MD, Deepinder Dhaliwal, MD, Rex Hamilton, MD, Mitchell Jackson, MD, Larry Patterson, MD, Karl Stonecipher, MD, for the ASCRS Refractive–Cataract Surgery Subcommittee As cataract surgery has evolved into lens-based refractive surgery, decisions regarding the power of the IOL to be implanted during cata- expectations for refractive outcomes continue to increase. During ract surgery. However, with all the available technology, it can be diffi- the past decade, advancements in technology have provided new cult to decipher which of the many technologies is necessary or best ways to measure the cornea in preparation for cataract surgery. for patients and for practices. This article reviews currently available The increasing ability to accurately estimate corneal power allows options for topography, tomography, keratometry, and biometry in determination of the most precise intraocular lens (IOL) for each pa- preparation for cataract surgery. In addition, intraoperative aberrom- tient. New equipment measures the anterior and posterior corneal etry and integrated cataract suites are reviewed. surfaces to most accurately estimate corneal power and corneal ab- errations. These measurements help surgeons make the best J Cataract Refract Surg 2018; 44:642–653 Q 2018 ASCRS and ESCRS ver the past 2 decades, we have experienced an only the anterior corneal surface with the use of topo- evolution in cataract surgery from simply the graphic devices; however with discovery of the impact of O removal of the cloudy lens to a refractive proced- posterior corneal astigmatism, we can now achieve higher ure that provides patients with increasingly higher levels degrees of accuracy by taking into account the effect of the of spectacle independence. -
Binocular Vision Disorders Prescribing Guidelines
Prescribing for Preverbal Children Valerie M. Kattouf O.D. FAAO, FCOVD Illinois College of Optometry Associate Professor Prescribing for Preverbal Children Issues to consider: Age Visual Function Refractive Error Norms Amblyogenic Risk Factors Birth History Family History Developmental History Emmetropization A process presumed to be operative in producing a greater frequency of occurrence of emmetropia than would be expected in terms of chance distribution, as may be explained by postulating that a mechanism coordinates the formation and the development of the various components of the human eye which contribute to the total refractive power Emmetropization Passive process = nature and genetics 60% chance of myopia if 2 parents myopic (Ciuffrieda) Active process = mediated by blur and visual system compensates for blur Refractive Error Norms Highest rate of emmetropization – 1st 12-17 months Hyperopia Average refractive error in infants = +2 D > 1.50 diopters hyperopia at 5 years old – often remain hyperopic Refractive Error Norms Myopia 25% of infants are myopic Myopic Newborns (Scharf) @ 7 years 54% still myopic @ 7 years 46% emmetropic @ 7 years no hyperopia Refractive Error Norms Astigmatism Against the rule astigmatism more prevalent switches to with-the-rule with development At 3 1/2 years old astigmatism is at adult levels INFANT REFRACTION NORMS AGE SPHERE CYL 0-1mo -0.90+/-3.17 -2.02+/-1.43 2-3mo -0.47+/-2.28 -2.02+/-1.17 4-6mo -0.00+/-1.31 -2.20+/-1.15 6-9mo +0.50+/-0.99 -2.20+/-1.15 9-12mo +0.60+/-1.30 -1.64+/-0.62 -
Ocular Surface Changes Associated with Ophthalmic Surgery
Journal of Clinical Medicine Review Ocular Surface Changes Associated with Ophthalmic Surgery Lina Mikalauskiene 1, Andrzej Grzybowski 2,3 and Reda Zemaitiene 1,* 1 Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, 44037 Kaunas, Lithuania; [email protected] 2 Department of Ophthalmology, University of Warmia and Mazury, 10719 Olsztyn, Poland; [email protected] 3 Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61553 Poznan, Poland * Correspondence: [email protected] Abstract: Dry eye disease causes ocular discomfort and visual disturbances. Older adults are at a higher risk of developing dry eye disease as well as needing for ophthalmic surgery. Anterior segment surgery may induce or worsen existing dry eye symptoms usually for a short-term period. Despite good visual outcomes, ocular surface dysfunction can significantly affect quality of life and, therefore, lower a patient’s satisfaction with ophthalmic surgery. Preoperative dry eye disease, factors during surgery and postoperative treatment may all contribute to ocular surface dysfunction and its severity. We reviewed relevant articles from 2010 through to 2021 using keywords “cataract surgery”, ”phacoemulsification”, ”refractive surgery”, ”trabeculectomy”, ”vitrectomy” in combina- tion with ”ocular surface dysfunction”, “dry eye disease”, and analyzed studies on dry eye disease pathophysiology and the impact of anterior segment surgery on the ocular surface. Keywords: dry eye disease; ocular surface dysfunction; cataract surgery; phacoemulsification; refractive surgery; trabeculectomy; vitrectomy Citation: Mikalauskiene, L.; Grzybowski, A.; Zemaitiene, R. Ocular Surface Changes Associated with Ophthalmic Surgery. J. Clin. 1. Introduction Med. 2021, 10, 1642. https://doi.org/ 10.3390/jcm10081642 Dry eye disease (DED) is a common condition, which usually causes discomfort, but it can also be an origin of ocular pain and visual disturbances. -
Effects of Depth of Incision on Final Outcome in Radial Keratotomy N
Effects of Depth of Incision on final outcome in Radial Keratotomy N. Raja, M. K. Niazi B-35, PAF Complex, Sector E-9, Islamabad. Abstract Objective: To assess the effect of depth of incision on the final outcome of radial keratotomy for correction of myopia. Methods: Sixty-five eyes with preoperative uncorrected myopia between 2.5-6.0D in subjects with a mean age of 29.2 (+7) years underwent radial keratotomy between Sept 1999--July 2002 in department of Ophthalmology, Military Hospital, Rawalpindi. Based on their preoperative depth of incision the eyes were divided into group-A (twenty-five eyes), with an incision depth of 500-530 µm, and Group-B (forty eyes), with an incision depth of 531- 560 µm. The comparison between the postoperative visual acuity of two groups was made at the end of study after one years` follow up. Results: A total of Sixteen eyes in Group-A (64%) that were within one diopter of emmetropia at first follow-up reverted back to their preoperative myopic state after one year of surgery as compared to only two eyes (5%) in Group-B (p<0.05). Hyperopic shift occurred in two eyes (8%) in Group-A, as compared to four eyes (10%) of Group-B (p >0.05). After one year, refraction showed that only 24% cases of Group-A were within 1 diopter of emmetropia as compared to 85% cases in Group-B. Similarly, 40% cases of Group-A were within 2 diopters of emmetropia as compared to 90% cases of Group-B. Glare and variation of vision in the initial four weeks were the most frequently reported complications in both groups. -
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: -
RCMP GRC 2180E (2017-10) Page 1 of 2 Protected B RM Applicant Vision Examination Report Once Completed Applicant ID
Protected B once completed PIB CMP PPU 070 RM Applicant Vision Examination Report Applicant ID Applicant Information To be completed by the applicant Surname Given Names Date of Birth (yyyy-mm-dd) Street Address City Province Postal Code (A9A 9A9) Date of Exam (yyyy-mm-dd) Visual Examination To be completed by the Ophthalmologist or Optometrist Visual Acuity Any standardized procedures (Landoit Ring, Snellen) may be utilized. No error is allowed per line of symbols. Uncorrected Right Eye (6/ or 20/) Uncorrected Left Eye (6/ or 20/) Corrected Right Eye (6/ or 20/) Corrected Left Eye (6/ or 20/) Corrected by Eyeglasses Contact Lenses RCMP Vision Standards Visual Acuity Corrected vision (with glasses or contacts): Visual acuity must be at least 6/6 (20/20) in one eye and 6/9 (20/30) in the other; and Uncorrected vision (without glasses or contacts): Visual acuity must be at least 6/18 (20/60) in each eye or 6/12 (20/40) in one eye and at least 6/30 (20/100) in the other eye. Meets Standards, both corrected and uncorrected? Yes No Visual Fields RCMP Field of Vision Standards Must be at least 150 degrees continuous along the horizontal meridian and 20 degrees continuous above and below fixation, with both eyes open and examined together. Meets Standards? Yes No Colour-Vision Standardized Ishihara pseudo-isochromatic plates must be utilized. Testing is to be done without the candidate using any colour correcting aids, such as coloured contact lenses. a) Result of standardized Ishihara pseudo-isochromatic plates test Passed Failed. If so, re-test using Farnsworth D-15. -
Modern Laser in Situ Keratomileusis Outcomes
REVIEW/UPDATE Modern laser in situ keratomileusis outcomes Helga P. Sandoval, MD, MSCR, Eric D. Donnenfeld, MD, Thomas Kohnen, MD, PhD, FEBO, Richard L. Lindstrom, MD, Richard Potvin, OD, David M. Tremblay, MD, Kerry D. Solomon, MD Laser in situ keratomileusis (LASIK) articles published between 2008 and 2015 that contain clin- ical outcomes data were reviewed and graded for quality, impression, and potential bias. All 97 relevant articles (representing 67 893 eyes) provided a positive or neutral impression of LASIK. Industry bias was not evident. The aggregate loss of 2 or more lines of corrected distance visual acuity was 0.61% (359/58 653). The overall percentage of eyes with uncorrected distance visual acuity better than 20/40 was 99.5% (59 503/59 825). The spherical equivalent refraction was within G1.0 diopter (D) of the target refraction in 98.6% (59 476/60 329) of eyes, with 90.9% (59 954/65 974) within G0.5 D. In studies reporting patient satisfaction, 1.2% (129/9726) of pa- tients were dissatisfied with LASIK. Aggregate outcomes appear better than those reported in summaries of the safety and effectiveness of earlier laser refractive surgery systems approved by the U.S. Food and Drug Administration. Modern results support the safety, efficacy, and patient satisfaction of the procedure. Financial Disclosure: Proprietary or commercial disclosures are listed after the references. J Cataract Refract Surg 2016; 42:1224–1234 Q 2016 ASCRS and ESCRS Laser in situ keratomileusis (LASIK) is one of the most have been performed globally.1 Laser in situ keratomil- commonly performed elective procedures in the United eusis was introduced by Pallikaris et al.2 in 1990. -
Strabismus, Amblyopia & Leukocoria
Strabismus, Amblyopia & Leukocoria [ Color index: Important | Notes: F1, F2 | Extra ] EDITING FILE Objectives: ➢ Not given. Done by: Jwaher Alharbi, Farrah Mendoza. Revised by: Rawan Aldhuwayhi Resources: Slides + Notes + 434 team. NOTE: F1& F2 doctors are different, the doctor who gave F2 said she is in the exam committee so focus on her notes Amblyopia ● Definition Decrease in visual acuity of one eye without the presence of an organic cause that explains that decrease in visual acuity. He never complaints of anything and his family never noticed any abnormalities ● Incidence The most common cause of visual loss under 20 years of life (2-4% of the general population) ● How? Cortical ignorance of one eye. This will end up having a lazy eye ● binocular vision It is achieved by the use of the two eyes together so that separate and slightly dissimilar images arising in each eye are appreciated as a single image by the process of fusion. It’s importance 1. Stereopsis 2. Larger field If there is no coordination between the two eyes the person will have double vision and confusion so as a compensatory mechanism for double vision the brain will cause suppression. The visual pathway is a plastic system that continues to develop during childhood until around 6-9 years of age. During this time, the wiring between the retina and visual cortex is still developing. Any visual problem during this critical period, such as a refractive error or strabismus can mess up this developmental wiring, resulting in permanent visual loss that can't be fixed by any corrective means when they are older Why fusion may fail ? 1. -
Early Postoperative Rotational Stability and Its Related Factors of a Single-Piece Acrylic Toric Intraocular Lens
Eye (2020) 34:474–479 https://doi.org/10.1038/s41433-019-0521-0 ARTICLE Early Postoperative Rotational stability and its related factors of a single-piece acrylic toric intraocular lens 1,2 3 4 5 1 1 1 Shuyi Li ● Xi Li ● Suhong He ● Qianyin Zheng ● Xiang Chen ● Xingdi Wu ● Wen Xu Received: 30 November 2018 / Accepted: 18 June 2019 / Published online: 12 July 2019 © The Author(s) 2019. This article is published with open access Abstract Purpose In the present study, we aimed to evaluate the early postoperative rotational stability of TECNIS toric intraocular lens (IOL) and analyse its correlation with preoperative and intraoperative parameters. Methods A total of 102 eyes from 87 cataract patients who underwent implantation of TECNIS toric IOL during July 2016 to November 2017 were enrolled in this retrospective study. Preoperative parameters including corneal astigmatism, axial length (AL), lens thickness (LT), anterior chamber depth (ACD) and sulcus-to-sulcus (STS), were determined. The area of capsulorhexis was measured with Rhinoceros 5.0 software. The follow-up examinations including the residual astigmatism (RAS) and postoperative toric IOL axis, were performed at 1 month and 3 months after surgery. − − 1234567890();,: 1234567890();,: Results RAS was 0.84 ± 0.88 D at 1 month and 0.81 ± 0.89 D at 3 months after surgery. The rotation of toric IOL at 3 months was 4.83 ± 3.65°. The Pearson’s r of ACD, horizontal and vertical STS, and toric IOL target axis was 0.011, 0.039, 0.045 and 0.082. The toric IOL rotation was positively correlated with the area of capsulorhexis (r = 0.522, P = 0.0003), LT (r = 0.288, P = 0.003) and AL (r = 0.259, P = 0.009). -
Ophthalmology Abbreviations Alphabetical
COMMON OPHTHALMOLOGY ABBREVIATIONS Listed as one of America’s Illinois Eye and Ear Infi rmary Best Hospitals for Ophthalmology UIC Department of Ophthalmology & Visual Sciences by U.S.News & World Report Commonly Used Ophthalmology Abbreviations Alphabetical A POCKET GUIDE FOR RESIDENTS Compiled by: Bryan Kim, MD COMMON OPHTHALMOLOGY ABBREVIATIONS A/C or AC anterior chamber Anterior chamber Dilators (red top); A1% atropine 1% education The Department of Ophthalmology accepts six residents Drops/Meds to its program each year, making it one of nation’s largest programs. We are anterior cortical changes/ ACC Lens: Diagnoses/findings also one of the most competitive with well over 600 applicants annually, of cataract whom 84 are granted interviews. Our selection standards are among the Glaucoma: Diagnoses/ highest. Our incoming residents graduated from prestigious medical schools ACG angle closure glaucoma including Brown, Northwestern, MIT, Cornell, University of Michigan, and findings University of Southern California. GPA’s are typically 4.0 and board scores anterior chamber intraocular ACIOL Lens are rarely lower than the 95th percentile. Most applicants have research lens experience. In recent years our residents have gone on to prestigious fellowships at UC Davis, University of Chicago, Northwestern, University amount of plus reading of Iowa, Oregon Health Sciences University, Bascom Palmer, Duke, UCSF, Add power (for bifocal/progres- Refraction Emory, Wilmer Eye Institute, and UCLA. Our tradition of excellence in sives) ophthalmologic education is reflected in the leadership positions held by anterior ischemic optic Nerve/Neuro: Diagno- AION our alumni, who serve as chairs of ophthalmology departments, the dean neuropathy ses/findings of a leading medical school, and the director of the National Eye Institute. -
Managing a Patient with Post-Radial Keratotomy and Sjogren's Syndrome with Scleral Contact Lenses
Managing a patient with Post-Radial Keratotomy and Sjogren's Syndrome with Scleral Contact Lenses Case Report 1 Candidate #123 Abstract: Surgeons used radial keratotomy (RK) in the past as an attempt to flatten the corneal shape and reduce refractive myopia in a patient. In the present day, many post-RK patients suffer from poor, fluctuating vision due to an irregular corneal shape induced from this procedure. Rigid gas permeable lenses, such as scleral lenses, are an excellent solution to improve and stabilize vision. Scleral lenses help recreate an optimal refractive surface to enhance vision for the patient. Patients with specific dry eye symptoms can receive a therapeutic benefit from scleral lens use as the lens acts as a protective barrier for corneal hydration. This is a case report on a patient suffering from both ocular and systemic conditions resulting in decreased vision and discomfort from severe dry eye. She has been successfully fit with scleral lenses to improve signs and symptoms. Key Words: Radial keratotomy (RK), dry eye, Sjogren's syndrome, scleral lens 2300 East Campbell Avenue, Unit 316 Phoenix, AZ 85016 [email protected] (480) 815-4135 1 Introduction: Patients may present to their eye care provider with multiple conditions impacting 2 both their ocular and systemic health. Ocular comorbidities frequently lead to visual impairment 3 and decreased quality of life. To suitably manage these coinciding ailments, it is essential to 4 obtain an early and proper diagnosis. [1] In some instances, similar approaches can help alleviate 5 patient symptoms in managing these comorbidities. 6 7 The goal of refractive surgery is to eliminate the dependency on glasses and contact lenses.