Early Postoperative Rotational Stability and Its Related Factors of a Single-Piece Acrylic Toric Intraocular Lens
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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. -
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. -
Medical Treatment of Operative Corneal Perforation Caused By
CASE REPORTS AND SMALL CASE SERIES and clinical course of a patient with the stromal bed was thin; in the left Medical Treatment a LASIK-induced corneal perfora- eye, the corneal flap was very edema- of Operative Corneal tion that affected the final visual acu- tous and a space was visible between Perforation Caused ity. We believe that this report on the the corneal flap and the stromal bed treatment and recovery of the cor- (Figure 1, left). The anterior cham- by Laser In Situ neal perforation will be valuable in- ber was very shallow, and aqueous Keratomileusis formation for refractive surgeons. humor was observed to leak onto the ocular surface with blinking (Figure Laser in situ keratomileusis (LASIK) Report of a Case. A 33-year-old man 1, right). A round, 0.25-mm diam- is an effective procedure to treat a was referred to us with a complaint eter perforation site was observed in wide range of myopia.1 The advan- of decreased visual acuity in the left the center of the stromal bed by slit- tages of LASIK over photorefrac- eye after bilateral simultaneous lamp examination. tive keratectomy (PRK) are rapid vi- LASIK performed 3 days previ- We treated the corneal perfo- sual recovery, lower risk of corneal ously at a different facility. A cor- ration by applying a therapeutic soft haze, greater regression of myopia, neal perforation was noticed in the contact lens with topical antibiot- and less postoperative pain.1-3 How- left eye during LASIK laser abla- ics, oral carbonic anhydrase inhibi- ever, LASIK requires more skillful tion in this eye. -
Nd:Y AG LASER CLEARANCE of the ANTERIOR SURFACE of POSTERIOR CHAMBER INTRAOCULAR LENSES
Nd:Y AG LASER CLEARANCE OF THE ANTERIOR SURFACE OF POSTERIOR CHAMBER INTRAOCULAR LENSES S. J. TALKS Northampton SUMMARY CASE REPORTS Purpose: To demonstrate the use of Nd:YAG laser in Case 1. Post-operative Haemorrhage clearing the anterior surface of posterior chamber A 73-year-old Caucasian insulin-dependent diabetic intraocular lenses. man, on aspirin, who had previously had a right Method: Six cases are presented with the following trabeculectomy, had a right extracapsular cataract conditions: haemorrhage, inflammatory deposits, a extraction (ECCE) + pcIOL. At surgery a broad fibrinous papillary membrane, capsulorhexis shrinkage. iridectomy was performed through the original Nd:YAG laser was successful in managing Results: peripheral iridectomy to enable adequate pupil each of these cases. dilation. This was sutured with 10.0 Prolene. No Conclusion: With careful use Nd:YAG laser clearance haemorrhage was noted during surgery but the next of the anterior surface of a posterior chamber day a large blood clot covered the pupil. This did not intraocular lens can be carried out successfully without clear with the use of prednisolone acetate 1 % damaging the lens. (Predforte) and mydriatics. The patient did not wish further surgery. Following cataract surgery the anterior surface of After 3 months the visual acuity was still hand posterior chamber intraocular lenses (pcIOL) can movements and so Nd:YAG laser was used. The sometimes become obscured.1 This may be due to laser was applied to the organised clot at the edge of haemorrhage, inflammatory deposits, the formation the pupil (171 pulses, at 2-3 mJ, Q switched). Most of of a fibrinous pupillary membrane, or the shrinkage the clot cleared leaving a fibrinous membrane. -
Little Capsulorhexis Tear-Out Rescue
J CATARACT REFRACT SURG - VOL 32, SEPTEMBER 2006 Little capsulorhexis tear-out rescue Brian C. Little, FRCOphth, Jennifer H. Smith, MD, Mark Packer, MD Backward traction on the capsule flap forms the basis of a predictable technique for rescuing the capsulorhexis from a radial tear-out. J Cataract Refract Surg 2006; 32:1420–1422 Q 2006 ASCRS and ESCRS The continuous curvilinear capsulorhexis (CCC) has pro- and in the direction of the projected circular path of the fin- vided important advantages for lens removal and intraocu- ished capsulorhexis. In the event of a tear-out, the path of lar lens (IOL) implantation by prompting the development the progressing tear veers peripherally toward the lens of endocapsular phacofragmentation techniques and the equator. To ‘‘rescue’’ the capsulorhexis, the tear must be re- use of advanced IOL technology. Ophthalmologists have directed centrally and back to the desired circumferential benefited from the work of Fercho, who developed contin- path. The first step in rescuing the tear with the Little tech- uous tear capsulotomy (C. Fercho, MD, ‘‘Continuous Cir- nique is to fill the chamber completely with an OVD. The cular Tear Anterior Capsulotomy,’’ presented at the Welsh force applied to the capsule flap is then reversed in direc- Cataract Congress, Houston, Texas, USA, September tion but maintained in the plane of the anterior capsule. 1986), and Gimbel and Neuhann, who popularized the If necessary, a second corneal paracentesis incision is CCC.1–3 made at the position that allows the optimum angle of ap- In constructing the capsulorhexis, it is essential to con- proach for applying traction. -
History of Posterior Continuous Curvilinear Capsulorhexis and Optic
HISTORY OF POSTERIOR CONTINUOUS CURVILINEAR BY HOWARD V. GIMBEL, MD, MPH, FRCSC CAPSULORHEXIS AND OPTIC CAPTURE This useful technique is not just for pediatric surgery. econdary cataracts after pedi- I first used this technique in 1987 children in a publication coauthored atric cataract surgery have long to remove a dense posterior capsular with DeBroff in 1994.4 been recognized as an expected plaque and in 1988 to convert a PC In my early experience, the PCCC complication when the posterior tear to a PCCC.2 was done after the IOL was in the bag capsule is left intact. Planned Optic capture in the anterior con- so that, in the event of an unsuccess- Santerior vitrectomy after posterior tinuous curvilinear capsulorhexis was ful PCCC, the IOL would already be capsulectomy or capsulotomy is now described by Neuhann and Neuhann safely in the bag. To keep the vitreous performed routinely with cataract and in a film, “The Rhexis-Fixated Lens,” from coming through the PCCC as it IOL surgery in children. This is because, in 1991.3 With the experience I was being fashioned, a highly cohesive even with the posterior capsule open gained using that technique in adult OVD was placed through the first and the IOL in the bag, lens epithelial cataract surgery, it seemed obvious small tear in the PC. Then more OVD cell migration can proceed through that, after performing a PCCC, the was added as the tear was completed the posterior continuous curvilinear same capture technique could be with forceps. Optic capture was then capsulorhexis (PCCC), behind the IOL, used with the haptics left in the bag performed slowly, one edge at a time, and across the visual axis, making it and the optic captured by the PCCC. -
Tips and Techniques for Cataract Surgery in Glaucoma Patients
Tips and Techniques for Cataract Surgery in Glaucoma Patients Joey Yen-Cheng Hsia, MD Assistant Professor of Ophthalmology Glaucoma Service University of California, San Francisco No Financial Disclosures Introduction • Visually significant cataract often co-exist with glaucoma in the elderly population. • Glaucoma incisional surgery can lead to accelerated cataract formation. • Glaucoma patients are at risk for perioperative complications • Set realistic expectation preoperatively Preoperative Evaluation – Is the cataract or glaucoma causing the decreased vision? – PAP or PAM – Set realistic expectation – Is the IOP at target? – Role of combined surgery? – No. of medications – Anticoagulation – ⍺-1 blocker – Prior incisional surgeries Examination – angle grading, trab ostium - Prior incisional surgery - endothelial dysfunction – shallowing – dilation, prior LPI, iridectomy – PXE, phacodynesis – cupping, pallor, retinal pathology Postoperative IOP Spike • Note the of glaucoma – Foveal involving scotoma – At risk for progression with IOP spike : – Advanced glaucoma, IFIS, No. of gtts, long AXL, PXE • IOP spike occurs after surgery – Same day check up for high risk patients History of Trabeculectomy – Modify incisions accordingly – Avoid suction / fixation ring – High function bleb may lead to chemosis / chamber instability – Age<50, Preop IOP > 10, iris manipulation, postop IOP spike, and short interval time between trabeculectomy and cataract – Longer steroid +/- anti- metabolite Grover-Fellman spatula; Epislon History of Tube Shunt – -
Evaluating the Relation of Refractive Surgery and Glaucoma
Editorial Remedy Open Access Published: 25 Jul, 2017 Evaluating the Relation of Refractive Surgery and Glaucoma Kozobolis V*, Kostantinidis A and Labiris G Department of Ophthalmology, University of Thrace, Greece Editorial Laser-assisted refractive corrections constitute a large part of the ophthalmic surgeries that take place every year. It is estimated that about 4 million refractive procedures were performed in 2014 throughout the world. On the other hand, glaucoma is an optic neuropathy, the incidence of which is increasing steadily over time. Given the frequency of refractive surgeries and the incidence of glaucoma in the general population it becomes necessary for the ophthalmologist to assess the risks of a refractive surgery in a glaucoma patient or a patient at a risk of developing glaucoma in the future. The factors to take into consideration are: the family history of glaucoma, intraocular pressure (IOP), myopia, high vertical cup-to-disc ratio, central corneal thickness, and race, other ophthalmic diseases, hypermetropia, previous antiglaucoma procedure, visual fields and modern imaging modalities. The advantages of these modalities include objective and reproducible measurements that can be compared with future measurements. The disadvantage is that their databases (although constantly enriched) include limited number of people, while "unusual" discs (tilted, high ametropias) are excluded from the databases. Unfortunately many candidates for refractive surgery have optic discs with “unusual” appearance that cannot be meaningfully compared with the “normal” optic discs of the databases. In these cases the digital photographing of the optic disc and the comparison with future photos will give valuable information about the changes of both the optic nerve and retinal nerve fibers. -
Vitreoretinal Surgery for Macular Hole After Laser Assisted in Situ
1423 Br J Ophthalmol: first published as 10.1136/bjo.2005.074542 on 18 October 2005. Downloaded from SCIENTIFIC REPORT Vitreoretinal surgery for macular hole after laser assisted in situ keratomileusis for the correction of myopia J F Arevalo, F J Rodriguez, J L Rosales-Meneses, A Dessouki, C K Chan, R A Mittra, J M Ruiz- Moreno ............................................................................................................................... Br J Ophthalmol 2005;89:1423–1426. doi: 10.1136/bjo.2005.074542 macular hole between March 1996 and March 2003 at seven Ams: To describe the characteristics and surgical outcomes institutions in Venezuela, Colombia, Spain, and the United of full thickness macular hole surgery after laser assisted in States. Preoperative examination including a thorough situ keratomileusis (LASIK) for the correction of myopia. dilated funduscopy with indirect ophthalmoscopy, and slit Methods: 13 patients (14 eyes) who developed a macular lamp biomicroscopy was performed by a retina specialist and/ hole after bilateral LASIK for the correction of myopia or a refractive surgeon. Patients were female in 60.7% of participated in the study. cases, and underwent surgical correction of myopia ranging Results: Macular hole formed 1–83 months after LASIK from 20.75 to 229.00 dioptres (D) (mean 26.19 D). Patients (mean 13 months). 11 out of 13 (84.6%) patients were were followed for a mean of 65 months after LASIK (range female. Mean age was 45.5 years old (25–65). All eyes 6–84 months). Patients who underwent vitreoretinal surgery were myopic (range 20.50 to 219.75 dioptres (D); mean to repair the macular hole were included in the study 28.4 D). -
Collecting Empirical Physician Time Data
H EA LTH POLI CY CEN TER RESEARCH REPORT Collecting Empirical Physician Time Dat a Piloting an Approach for Validating Work Relative Value Units St ephen Zuckerman, PhD Kat ie Merrell, BA Robert Berenson, MD Susan Mitchell, RHIA URBAN INSTITUTE ACTUARIAL RESEARCH URBAN INSTITUTE RTI INTERNATIONAL CORPORATION (FORM ERLY SOCIAL & SCIENTIFIC SYSTEM S, I N C.) Divvy Upadhyay, MD, MPH Rebecca Lewis, MPH URBAN INSTITUTE RTI INTERNATIONAL December 2016 ABOUT THE URBAN INSTITUTE The nonprofit Urban Institute is dedicat ed to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Copyright © December 2016. Urban Institute. Permission is granted for reproduction of this file, with attribution to the Urban Institute. Cover image by Tim M eko. Contents Acknowledgments v Execut ive Summary vi Background 1 Collecting Empirical Service Time Dat a 3 Analytic Approach and Methods 6 Preparing t he Empirical Time Data for Analysis 6 Empirical Measure of Intraservice Physician Time 6 Clinical Expert Review Met hods 10 Physician Int erviews 13 Result s 15 Empirical Time Analysis 15 Empirical Time Estimates for Selected Services 15 Implications for Physician Work Values 21 Clinical Expert Review Results 29 Representativeness of Vignettes 29 Accuracy of Service Descriptions 30 Intraservice Time Estimates 34 Limitat ions: Challenges of Empirical Time Data Collection 36 Summary 38 Recommendations for Further Data Collection 39 Appendix A. -
Sub-Bowman's Keratomileusis
REFRACTIVE SURGERY FEATURE STORY Sub-Bowman’s Keratomileusis A case for a new “K” in refractive surgery. BY STEPHEN G. SLADE, MD he superiority of surface or lamellar excimer laser face ablation with the quicker visual recovery and rela- surgery is a long-running debate in ophthalmol- tively pain-free experience of LASIK. ogy. In general, although different studies find LASIK and PRK to be similar in longer-term fol- CLINICAL RESULTS Tlow-up, patients achieve better results with LASIK Our study of 50 patients (100 eyes) was conducted at two through the 1- to 6-month postoperative period. As a sites (Houston and Overland Park) in the spring of 2006. One result, LASIK is the procedure of choice for many ophthal- eye of each patient underwent a femtosecond-laser–assisted mologists. It is a better operation than PRK in terms of LASIK procedure (with an intended flap thickness of 100 µm), safety and efficacy, according to a Cochrane methodology and the fellow eye underwent a PRK procedure. Because it meta-analysis,1 although most of the literature cited in was a contralateral study, the two groups were almost evenly this study dates to before 2001. More recently, surface matched in terms of preoperative mean refractive error. The ablation has generated renewed interest, because sur- femtosecond laser group had an average refractive error of geons perceive it as a safer procedure in terms of ectasia. -3.64 D (range, -2.00 to -5.75 D; SD = 0.97), and the mean What if there is a better technique, a hybrid of the two manifest cylindrical refraction was -0.63 D (range, 0 to procedures that combines the faster recovery and greater -3.00 D).