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Insight January 2015

Record Attendance for Academy Case Study: Vision Correction for Bedtime Reader Meeting in Denver By Susan Hoki, MD Seattle’s record attendance of 6,003 In Case: Healthy, active and easy-going 76-year-old female referred for in 2013 didn’t hold very long! The consultation. Multifocal contact lens wearer for over 10 years. She removes final tally for Denver was 6,323. lenses at bedtime to read for an hour. She strongly desires reduced spectacle The American Academy of Optometry dependence after . is trending positive for many reasons, including a respected and Cycloplegic manifest correction (no recent changes): energizing platform for new OD: -3.00 + 0.50 x 150 ► 20/25 (glare to 20/40) knowledge — from evidence-based  OS: -2.50 + 0.50 x 015 ► 20/40 (glare to 20/70) CE courses to pioneering clinical Exam: and vision-related research that Mild nuclear and cortical cataract in right and left eye with 2+ posterior can complement your practice. subcapsular cataract in left eye. Mild dry eyes. Planned cataract surgery in the Yes, clinicians can garner new ideas left eye first. and practice-enhancing education This is a potentially difficult case as the patient has been happy with contact from results of clinical studies and lenses and enjoys uncorrected myopia “for reading a good book” at the end of apply this new knowledge to the day. The main options recommended were monovision versus Vision patient care. Correction (VC) with multifocal lens implant. Since the patient tried monovision Join me at next year’s meeting in without success in the past, she chose Vision Correction with a multifocal lens New Orleans, October 7-10, 2015. implant left eye (with a similar implant a few months later in the right eye). Come explore, learn, share and Post-operatively, distance without correction: Near (40 cm) without correction: become a better provider. OD 20/20 (plano) OD 20/25 As a further commitment to your OS 20/25+ (plano -0.75* x 165 ► 20/25) OS 20/25 profession and patient care, you may want to consider becoming a *Residual sphere or cyl > 0.5D can lead to dissatisfaction, and may require PRK touch-up, included in VC program Fellow of the Academy. Please send Generally, patient qualities ideal for Vision Correction with multifocal lens me an email ([email protected]) implant include (in order of importance): or visit the Academy website at aaopt.org for information on ▪ easy-going personality ▪ no significant night driving fellowship. ▪ healthy eye without macular ▪ success with multifocal contact corneal disease lenses ▪ motivation for reduced spectacle independence

Potential concerns preoperatively were dry eyes and visible blur with relatively mild . However, patient was treated for dry eyes. She was explicitly cautioned regarding risks for glare and visual disturbances sometimes requiring lens explantation/removal. After the information was presented, she still wanted Vision Correction with multifocal lens implants. Brett Bence, OD, at 2014 Annual American Academy of Optometry meeting in Denver. Continued on page 2 A New Case Study: Vision Correction, continued from page 1 Case Pearl: Clear the vision with cataract removal, but deliver at least the same Physician or better vision quality with less spectacle dependence than preoperatively. In this case, Vision Correction with multifocal lens implants was necessary to give Joins NWES Please help us welcome the patient what she had prior to surgery, resulting in a very happy patient. our newest physician to Our would be glad to talk with you further about Vision Correction. For Northwest Eye more information, reach us at 800-826-4631, or [email protected]. Surgeons.

Ingrid Carlson, MD SPECIALTY: Pediatric and NWES Nurse Delivered Eye Care at Free Clinic Adult Strabismus LOCATIONS: Mount Vernon, Bellingham Donica Byers, a Reserve Corps member and one of Northwest Eye Dr. Carlson joined NWES after practicing Surgeons’ lead RNs in Seattle, participated in Colorado for several years. in the Remote Area Medical Event, a free ”There is something delightful in knowing clinic held at Key Arena in October. that a child’s school work has improved The four-day clinic served 3,400 patients because of aligned eyes, or knowing a over four days, and provided a range of grandmother can live independently services to underserved and vulnerable because eye muscle surgery has populations in the region: medical care, eliminated her troublesome double mental health, social services, rapid STD vision,” Dr. Carlson said. screening, mammograms, , Away from the office, Dr. Carlson enjoys acupuncture, chiropractic, diabetic foot care, scuba diving, pottery and wilderness wound care and more. hiking. Beginning at 5 a.m. each day, Donica DR. CARLSON’S EDUCATION AND volunteered in preliminary triage and vision TRAINING INCLUDES: and dental sterile processing. Her husband Donica sterilizes instruments during the ▪ Indiana University School of , four-day event for people in need. helped make in the mobile vision Indianapolis, IN; MD lab, producing approximately 250 unique pairs of prescription glasses each day. ▪ Indiana University School of Medicine, Indianapolis; Ophthalmology Residency Sixty dental chairs occupied the arena floor where dentists and hygienists performed extractions, ▪ University of Colorado, Denver; fillings and dental cleanings. Optometric physicians Pediatric Ophthalmology & Adult performed vision exams, after which patients could Strabismus Fellowship choose frames and walk away with new glasses a Dr. Carlson’s arrival will coincide nicely few hours later. with the opening of our additional clinic “I am lucky to have the skills and resources to be space in Bellingham, which is on track able to give back to the community,” says Donica. for completion in February. We will “I hope to participate in more events like this one continue to see patients in our current in the future.” suite while the additional space is under construction. This expansion and the addition of a new specialist will help Teams were happy to provide a range further the services we provide to you, of health services at the Remote Area Medical Event in October. your patients and to the community. Annual Winery Event: Pours and Presentations

This year marked Northwest Eye Surgeons’ 14th Annual We were pleased to Optometric Medicine Review and Surgical Update at the invite outside guest Chateau Ste. Michelle Winery in Woodinville. speakers, Jeremy Kampp, MD and Over two separate nights, 375 guests enjoyed a night of Sarah Patton, PA-C, camaraderie, fine cuisine and cogent continuing who offered great education. Any guest will assure you, the staff of insight on of the ocular adnexa and Mohs Chateau Ste. Michelle host with the utmost style and surgery. partner with us to create one of the best local continuing education events of the year! This event symbolizes Northwest Eye Surgeons’ ongoing commitment to offer quality education programming to Following some festive wine tours and tasting, four our referring community. We were pleased to offer a hours of continuing education were offered by Drs. record total 28 hours of continuing education across Britta Hansen, Audrey Talley Rostov, Susan Hoki and our six Puget Sound area offices in 2014! We hope you Paul Griggs. Dr. Aaron Kuzin led an engaging and your office colleagues will plan to join us for panel discussion on challenging case conundrums. programs already being organized for 2015 and offer Members of the panel included Drs. Bruce Cameron more suggestions for the type of CE that you find to be and Brett Bence along with our newest glaucoma the most beneficial. specialists, Drs. Meng Lu and Sara Huh.

Practice Update Paradigm Shift: 10-2 for Glaucoma Management? For years, we have held a general opinion that early ▪ Structure/function comparison: 10-2 is a faster and loss in glaucoma is peripheral, including easier test than 24-2, and a promising parallel with nasal step, relative arcuate scotomas and peripheral macular thickness testing from imaging devices. constriction. And, we recall that central “tunnel vision” ▪ Curcio et.al. (J Neuro 1990) demonstrated that the was the unfortunate consequence of long-term macula contains about 50% of all retinal ganglion glaucoma. Well, that paradigm looks to be changing. cells (RGCs), and the central 8 degrees 1/3 of all At the annual meeting of our American Academy of RGCs. Optometry, Michael Sullivan-Mee* provided an excellent ▪ 10-2 relates to the high concentration of these update on his and other’s research on macular foveal ganglion cells which can be lost early with thickness with glaucomatous central VF loss. Here are a glaucoma. few key considerations concerning 10-2 visual fields: ▪ Traynis et.al. (JAMA Ophthal 2014) noted that early ▪ 10-2 tests every 2 degrees vs. 6 degrees for 24-2; glaucomatous defects in central 10 degrees of often better for central VF loss detection, visual field correlate with the more vulnerable progression. inferior paracentral macular region, with ▪ Therefore, the 10-2 (10 degree field) has roughly 64 corresponding superior VF loss near fixation. test points versus 24-2, which theoretically has only ▪ Recent studies purport that central visual field loss 4 test points in the central 10 degrees and moves can be a common early marker of incipient up to 16 test points in the central 12 degrees. glaucoma, often only noted when 10-2 visual fields are used. Continued on back 10330 Meridian Ave. N. Suite 370 Seattle, WA 98133

CONTINUING EDUCATION Paradigm Shift, continued from page 3 ▪There may be a parallel between early blue-yellow color vision weakness in glaucoma JANUARY 26 | MONDAY Glaucoma Update (as noted in Short Wavelength Automated Perimetry—SWAP) and damage to the Dr. Lu central ganglion cells. Renton Dinner 6 p.m. Sampling of central 10 degrees is only accomplished with the inner 4 points on 24-2 VF Program 6:30 p.m. (A&B). Example of 10-2 VF showing central loss (C) FEBRUARY 3 | TUESDAY Glaucoma Update A) B) C) Drs. Lu & Huh Seattle Dinner 6 p.m.

Program 6:30 p.m.

FEBRUARY 10 | TUESDAY VC Candidate Selection for ODs & Post-op Pearls So, where does this lead us as clinicians? When can 10-2 be advantageous? Drs. Hansen and Wright ▪ If you suspect early VF loss without any perimetric loss on 24-2 Mount Vernon Dinner 6 p.m. ▪ If you see global or vertical quadrant reduction of RNFL on OCT or comparable optical Program 6:30 p.m. scanning device Watch for more details about these upcoming events: ▪ For normal tension glaucoma suspects MARCH 2015 ▪ Observed Drance/disc margin hemorrhage Open House/Peds Overview CE in Bellingham with Ingrid Carlson, MD ▪ We are hopeful that ultimately we will develop statistical measures for glaucoma progression analysis software for 10-2 fields, an area yet to be established. NWES to host King County Optometric Society Meeting As always, if you have any questions that we may help answer, please feel free to contact APRIL 2015 any of our doctors. ICD-10 Training put on by Corcoran Brett G. Bence, OD, FAAO Multi-Disciplinary Medical Symposium DIRECTOR OF OPTOMETRY on Oncology—April 29, 2015

Please send us your ideas for future *Michael Sullivan-Mee OD, FAAO works at the Albuquerque VA Medical Center, Albuquerque, New continuing education programs. Reach us Mexico, and has a Diplomate in Glaucoma, American Academy of Optometry. at 800-826-4631, or [email protected].