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Ophthalmology-Update-Cleveland-Clinic-Pdfdrivecom-1-53221583914735.Pdf CORNEA 2 GLAUCOMA 4 CATARACT 6 PERSPECTIVES 8 COLE EYE INSTITUTE | FALL 2014 Ophthalmology Update Explore beyond the surface. Get practical news on topics that matter to you on our new physician blog. Dear Colleagues There is a remarkable piece of art at the Cleveland Clinic called “Blue Berg” by artist Iñigo Manglano-Ovalle. It is a 30-foot suspended iceberg depicted in hundreds of tiny plastic rods. This issue of Ophthalmology Update reminds me of “Blue Berg.” Here is why. What you hold in your hands is only the tip of the iceberg. There is much more great content below the surface, on Cleveland Clinic’s new specialty blog for medical professionals, Consult QD. Please visit ConsultQD — Ophthalmology for even more great articles and perspectives from the Cole Eye Institute and other thought leaders. So beginning now, you can find additional content for your practice at ConsultQD.org/oph, or simply use your smartphone or tablet to scan the QR codes next to the articles you will find inside this issue. Sincerely, 2008 Daniel F. Martin, MD BlueBerg, Chairman, Cole Eye Institute WELCOME 1 Photo: Barney Taxel Artwork: Iñigo Manglano-Ovalle, Photo: Barney Taxel ® CORNEA Comprehensive Cornea Care, Advancing Tomorrow’s Breakthroughs Cole Eye Institute’s cornea service is among the nation’s top advantages over DSAEK in certain patients. For a decade, our academic and clinical services dedicated to treating diseases of cornea service has offered the Boston Keratoprosthesis for cases of the cornea and anterior segment. Our institute was one of the first corneal blindness where traditional transplantation offers little hope, centers to perform Descemet’s stripping automated endothelial and our commitment to serving these patients will be expanded this keratoplasty (DSAEK), a selective procedure for endothelial fall with the addition of a dedicated ocular surface disease/high-risk diseases such as bullous keratopathy and Fuchs dystrophy that has corneal transplant specialist. revolutionized corneal transplantation through greater safety, faster One of our core missions is advancing science that drives the visual recovery and more favorable refractive outcomes. Since next breakthroughs in therapy. Our team includes leading NIH- 2005, nearly a thousand Cole Eye Institute patients have benefited funded investigators in corneal wound healing, corneal immunology from technical advances in DSAEK pioneered by our surgeons. and infection, and corneal biomechanics and simulation-based Our team provides comprehensive care for corneal disease, therapy. Our corneal surgeons have the world’s most extensive including complex corneal transplantation, advanced dry eye experience in intraoperative OCT-guided surgery and are pioneering treatment, refractive surgery options for patients who are not the use of this exciting technology for enhancing intraoperative candidates for LASIK or PRK, and treatment of vision-threatening visualization and patient outcomes. Access to clinical trials, infections. Our surgeons recently began performing Descemet including a much-anticipated clinical trial of collagen crosslinking membrane endothelial keratoplasty (DMEK), a more selective for keratoconus, is a distinctive feature of our care model. procedure for endothelial dysfunction that may offer visual — William Dupps Jr., MD, PhD | Cole Eye Institute 2 Cleveland Clinic Cole Eye Institute CORNEA : Read more on the web by scanning the QR codes below or visiting ConsultQD.org/Cornea ® Treating Advanced Dry Eye Tips for Managing Herpes Zoster Ophthalmicus Exploring the range of available options Up to half of cases manifest corneal complications Dry eye is a multifactorial disease that causes tear deficiency, Short-term and more serious long-term complications can follow in excess evaporation, or both. Symptoms can be severe or disabling the wake of herpes zoster ophthalmicus (shingles). The cornea discomfort, reduced visual acuity and marked staining on the may be affected in up to half of all cases. Get an overview from cornea and conjunctiva. To read about the best ways to treat dry Dr. Jeffrey Goshe of established and new preventive techniques and eye disease, visit Dr. Peter McGannon’s blog on Consult QD. management approaches for these complications. Read more at: ConsultQD.org/Cornea1 Read more at: ConsultQD.org/Cornea2 Excellent Result in Chronic Corneal Edema Case Visian ICL: An Alternative in Refractive Surgery Precise surgery accomplishes far more than palliation Risks of dormant virus rule out procedures using lasers A surgical procedure to relieve pain in an 85-year-old patient with If your patient is not a candidate for LASIK and PRK, another chronic corneal edema accomplished far more than palliation. option may be just right for correcting his or her vision. If there’s It also eliminated corneal neovascularization, and restored been no cataract surgery, the Visian ICL (implantable collamer epithelium and epithelial function, corneal clarity and visual lens) can correct a wide range of myopia with up to 2.5 diopters acuity. Learn more from Dr. Scott Wagenberg’s blog on of astigmatism. To find out more, check out Dr. Michael Gressel’s Consult QD. blog on Consult QD. Read more at: ConsultQD.org/Cornea3 Read more at: ConsultQD.org/Cornea4 CORNEA 3 GLAUCOMA Expanding to meet growing volume, new surgical offerings We continue to see tremendous growth and opportunity for One of our greatest strengths is our ability to put together glaucoma care at Cleveland Clinic’s Cole Eye Institute. In response, multidisciplinary teams to provide the most effective care to our we now have four full-time glaucoma specialists seeing patients at glaucoma patients with complex disease states, such as bleb-related our locations throughout Northeast Ohio. Last year alone, 17,949 endophthalmitis, steroid-induced glaucoma, glaucoma related to patients were seen across Cole Eye Institute for a primary diagnosis genetic syndromes and severe ocular surface disease. Just a few of glaucoma and 316 outpatient laser procedures for glaucoma examples of our multidisciplinary surgical collaboration here at were performed. Cole Eye Institute include simultaneous tube implant and PPV To accommodate this patient volume, there have been (together with retina specialists), comanagement of complex uveitic expansions and renovations at our regional locations. For example, glaucoma (together with uvetis staff), simultaneous postoperative electronic medical records and images from our 12 Cirrus HD-OCT management of glaucoma and amblyopia (together with pediatric machines and 12 visual field machines are immediately available at ophthalmology), and transscleral cyclophotocoagulation in any of our offices to allow easy coordination and continuance of care. preparation for a keratoprosthesis (together with cornea service). Cole Eye Institute remains a leader in providing high-quality We are proud of the success we have had, and plan to build on that surgical glaucoma care. Although trabeculectomies and tube shunts success for 2014. remain our most commonly performed procedures, we are offering — Jonathan Eisengart, MD | Cole Eye Institute newer procedures such as iStent®, canaloplasty and endoscopic cyclophotocoagulation, with iStent® implants increasing significantly in 2014. 4 Cleveland Clinic Cole Eye Institute GLAUCOMA : Read more on the web by scanning the QR codes below or visiting ConsultQD.org/Glaucoma Traditional vs. Minimally Invasive Glaucoma Surgery Challenges of Treating Childhood Glaucoma Conventional care is still the gold standard procedure Stakes are high; fast, effective action is essential Traditional glaucoma surgery is being challenged by the advent “The stakes are high in childhood glaucoma — sight or blindness of innovative techniques and new implants. However, minimally — and early diagnosis and treatment are imperative,” says Elias invasive glaucoma surgeries (MIGS) lack a body of literature on Traboulsi, MD, ophthalmologist at Cleveland Clinic’s Cole Eye their efficacy and long-term outcomes. To find out more, see Institute. To find out how he deals with the different types of Dr. Edward Rockwood’s Consult QD blog. childhood glaucoma, read his blog on Consult QD. Read more at: ConsultQD.org/Glaucoma1 Read more at: ConsultQD.org/Glaucoma2 Case Study: Treating Primary Open-Angle Glaucoma Case Studies: Cataract Surgery for Narrow-Angle Glaucoma Handling complications after Ahmed tube placement Faster, lower-risk procedure also can lower IOP The Ahmed™ valve can effectively reduce intraocular pressure. Glaucoma has been successfully treated with cataract surgery. However, valve function on Ahmed tube shunts is not necessarily Although it’s not right for everyone, it can be performed much guaranteed. Dr. Stella Paparizos’ case study on Consult QD on faster, with much lower risk, and a quicker recovery time treatment for open-angle glaucoma includes a discussion of the compared with traditional glaucoma surgery. To find out how best ways to proceed when valve failure is suspected. Dr. Jonathan Eisengart uses cataract surgery to treat glaucoma, read his blog on Consult QD. Read more at: ConsultQD.org/Glaucoma3 Read more at: ConsultQD.org/Glaucoma4 GLAUCOMA 5 CATARACT Innovating and refining surgical techniques for optimal outcomes Cataract surgery is among the world’s most commonly performed We have also taken a leadership role in providing surgical surgical procedures. It’s also one of the most positive and rapidly training to residents. A surgery lab — with four fully equipped
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