Where all of ophthalmology meets
AAO 2014 October 18–21 Subspecialty Day October 17–18 AAOE Program October 18–21
www.aao.org/2014
FINAL PROGRAM #aao2014
The American Academy of Ophthalmology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
TABLE OF CONTENTS AAO 2014 Highlights...................................................................... ix 2014 Board of Trustees ................................................................. xv 2014 Committe of Secretaries .................................................... xvii The Council................................................................................. xxiii AAO 2014 Overview ...................................................................xxvii Meeting Directory ......................................................................xxxv Shuttle Schedule .......................................................................xxxix
Awards Laureate Recognition Award ..........................................................1 Special Awards ...............................................................................4 Secretariat Award .........................................................................16 Achievement Award Program .......................................................18 International Awards ....................................................................30 Visionary Society, Corporate and Organizational Donors .............31
Courses and Breakfasts Selection Committees ...................................................................33 Programs-by-Day ...........................................................................35 Breakfast With the Experts ...........................................................51 Instruction Course Progam ............................................................58
Skills Transfer Program Skills Transfer Program General Information..............................101 Skills Transfer Course Contributors ............................................102 Skills Transfer Programs-by-Day .................................................103 Skills Transfer Program ...............................................................106
Papers / Posters, Videos Original Papers ............................................................................145 Scientific Posters.........................................................................164 Video Program .............................................................................241
Special Meetings and Events Special Meetings & Events.........................................................249 Learning Lounge ..........................................................................253 Technology Pavilion.....................................................................258 Informational Posters ..................................................................262
AAOE Program / Practice Management AAOE Program.............................................................................265 AAOE Coding Sessions ...............................................................266 AAOE Instruction Courses ...........................................................267 Practice Management Master Classes.......................................280
Exhibition, Indexes Exhibitors.....................................................................................281 Product Index...............................................................................285 Participant Index .........................................................................296 Participant Financial Disclosure Index ........................................307 CME & CE Credit .........................................................................325 Future Meeting Dates & Locations .............................................328
Sessions and Symposia Opening Session .........................................................................121 Academy Café .............................................................................122 Spotlight Sessions & Symposia ..................................................123
P.O. Box 7424, San Francisco, CA 94120-7424 | Tel: 415-561-8500 Fax: 415-561-8533 © 2014 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology.
i
A Little Curious? Come see what’s inside at Booth #2834
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Bacitracin Ophthalmic Ointment USP STERILE
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DESCRIPTION: Each gram of ointment contains 500 units of Bacitracin in a low melting special base containing White Petrolatum and Mineral Oil. CLINICAL PHARMACOLOGY: The antibiotic, Bacitracin, exerts a profound action against many gram-positive pathogens, including the common Streptococci and Staphylococci. It is also destructive for certain gram-negative organisms. It is ineffective against fungi. INDICATIONS AND USAGE: For the treatment of superficial ocular infections involving the conjunctiva and/or cornea caused by Bacitracin susceptible organisms. CONTRAINDICATIONS: This product should not be used in patients with a history of hypersensitivity to Bacitracin. PRECAUTIONS: Bacitracin ophthalmic ointment should not be used in deep-seated ocular infections or in those that are likely to become systemic. The prolonged use of antibiotic containing preparations may result in overgrowth of nonsusceptible organisms particularly fungi. If new infections develop during treatment appropriate antibiotic or chemotherapy should be instituted. ADVERSE REACTIONS: Bacitracin has such a low incidence of allergenicity that for all practical purposes side reactions are practically non-existent. However, if such reaction should occur, therapy should be discontinued. To report SUSPECTED ADVERSE REACTIONS, contact Perrigo at 1-866-634-9120 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. DOSAGE AND ADMINISTRATION: The ointment should be applied directly into the conjunctival sac 1 to 3 times daily. In blepharitis all scales and crusts should be carefully removed and the ointment then spread uniformly over the lid margins. Patients should be instructed to take appropriate measures to avoid gross contamination of the ointment when applying the ointment directly to the infected eye. HOW SUPPLIED: NDC 0574-4022-13 3 - 1 g sterile tamper evident tubes with ophthalmic tip. NDC 0574-4022-35 3.5 g (1/8 oz.) sterile tamper evident tubes with ophthalmic tip. Store at 20°-25°C (68°-77°F) [see USP Controlled Room Temperature].
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AAO 2014
HIGHLIGHTS Join Us at the Opening Session Sunday, Oct. 19, 8:30 - 10 AM North, Hall B Officially launch AAO 2014, in conjunction with the European Society of Ophthalmology (SOE). • Congratulate award winners including the recipient of the 2014 Laureate Award: Jerry A. Shields, MD. • Hear the 2014 Jackson Memorial Lecture, Retinoblastoma: 50 Years of Progress, by Hans E. Grossniklau,s MD, director of the L.F. Montgomery Laboratory and the founding director of the Ocular Oncology and Pathology service of Emory Eye Center. Dr. Grossniklaus is also Professor of Ophthalmology and Pathology, Oculo-Pathology, at the Emory University School of Medicine. • Listen to a distinguished panel discuss: Can We Better Prepare the Residents of 2015 for the Practice of 2020? moderated by Thomas A. Oetting, MD. Panelists include: Nicholas J. Volpe, MD, Tara A. Uhler, MD, Paul Sternberg, Jr., MD and Anthony C. Arnold, MD.
AAO Virtual Meeting The AAO Virtual Meeting allows you to see live-streaming presentations or click on recorded content throughout the meeting. You can also share comments with colleagues. There will be approximately 20 hours of content streamed live. Find details at www.aao.org/virtual-meeting.
Three AAO-SOE Joint Sessions Don’t miss the three AAO-SOE joint “View Across the Pond” symposia examining differences between the United States and Europe in the areas of IOLs, cornea and retina.
A View Across the Pond: Current Cataract and IOL Practices in Europe and the United States SYM04; Sunday, Oct. 19, 2:00 - 3:30 PM North, Hall B
A View Across the Pond: Retina SYM44; Monday, Oct. 20, 8:30 - 10:00 AM Grand Ballroom S100ab
A View Across the Pond: Cornea Enigmas SYM20; Tuesday, Oct. 21, 10:45 AM - 12:15 PM Grand Ballroom S100ab
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
ix
AAO 2014
HIGHLIGHTS Engage Your Mind at Named Lectures Michael F Marmor MD Lecture in Ophthalmology and the Arts
NEW! Jones/Smolin Lecture
SYM09; Sunday, Oct. 19, 12:45 to 1:45PM S406a “Architecture, Ophthalmology and the Seeing of Space” will be given by Mark Foster Gage, a recognized innovator in the fields of architecture and design. In addition to being the principal of Mark Foster Gage Architects (MFGA llc), in New York City, he also holds the positions of Assistant Dean and tenured professor at the Yale School of Architecture, where he has been on the faculty since 2001. His pioneering designs have received numerous awards, been exhibited in museums and featured in the press.
SYM26; Monday, Oct. 20, 10:15 - 11:45 AM Grand Ballroom S100ab “Changing Times in the Diagnosis and Management of Ocular Infectious Diseases,” will be given by Russell N. Van Gelder, MD, PhD, the Boyd K. Bucey Memorial Endowed Chair in Ophthalmology and Professor in the Department of Ophthalmology at the University of Washington. The lecture will take place during the Clinical Pearls in the Diagnosis of Masquerades in Infectious and Inflammatory Disease of the Eye symposium. Combined meeting with the Ocular Microbiology and Immunology Group (OMIG)
The Bruce E. Spivey, MD Lecture in Risk Management and Patient Safety
NEW! Dr. Allan Jensen and Claire Jensen Lecture in Professionalism and Ethics
SPE15; Sunday, Oct. 19, 2:00 - 4:00 PM S406b Come hear Ajit K. Sachdeva, MD, FRSC, FACS, founding director of the Division of Education at the American College of Surgeons, lecture on education and training programs that enhance patient safety and minimize risk of adverse outcomes. The lecture is followed by the OMIC Forum.
SYM33; Monday, Oct. 20, 12:45 - 1:45 PM S406a “Promoting Ethics and Professionalism,” will be given by Gerald B. Hickson, MD, Senior Vice President for Quality, Safety and Risk Prevention, Assistant Vice Chancellor for Health Affairs, and Joseph C. Ross Chair in Medical Education and Administration, at Vanderbilt University Medical Center.
More Interactive Sessions Dynamic experts lead discussions in informal settings throughout AAO 2014:
Learning Lounge
Scientific Poster Tours
Saturday - Tuesday, Oct. 18 - 21 Booth 107 Float among the lounge’s theaters – new topics begin every 15 minutes.
Sunday, Oct. 19 and Monday, Oct. 20, 12:30-1:30 PM The “Meeting Point” near Scientific Posters Online/ Videos on Demand, Booth 65. Explore posters with your peers led by subject matter experts.
Breakfast With the Experts
Ophthalmic Premier League: A Team Video Competition on Managing Cataract Complications
Sunday – Tuesday, Oct. 19 – 21, 7:30 - 8:30 AM South, Hall A Start your day off right with an energetic conversation over breakfast. Separate tickets must be purchased to attend.
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SYM60; Tuesday, Oct. 21, 8:30 - 10:00 AM North Hall B Check out this exciting session where four teams will “compete” for the AAO-OPL trophy, awarded based on audience votes.
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
JOIN US! Understanding JETREA® (ocriplasmin) Intravitreal Injection, 2.5 mg/mL Key Safety Topics An overview of visual function and macular adverse events, and OCT and ERG changes, as presented by leaders in the field. October 18 – 20, 2014 | AAO Booth 1174 | McCormick Place Saturday, Oct 18
Sunday, Oct 19
Monday, Oct 20
11:00 am – 11:30 am Pravin Dugel, MD 1:00 pm – 1:30 pm Baruch Kuppermann, MD 3:00 pm – 3:30 pm Baruch Kuppermann, MD
11:00 am – 11:30 am Jay Duker, MD 1:00 pm – 1:30 pm Jay Duker, MD 3:00 pm – 3:30 pm Carl Regillo, MD
11:00 am – 11:30 am Pravin Dugel, MD 1:00 pm – 1:30 pm Peter Kaiser, MD 3:00 pm – 3:30 pm Peter Kaiser, MD
Pravin Dugel, MD
Jay Duker, MD
Peter Kaiser, MD
Baruch Kuppermann, MD
Carl Regillo, MD
These presentations are not affiliated with the official program of AAO 2014.
Indication JETREA (ocriplasmin) Intravitreal Injection, 2.5 mg/mL, is a proteolytic enzyme indicated for the treatment of symptomatic vitreomacular adhesion (VMA).
Important Safety Information Warnings and Precautions • A decrease of ≥ 3 lines of best-corrected visual acuity (BCVA) was experienced by 5.6% of patients treated with JETREA and 3.2% of patients treated with vehicle in the controlled trials. The majority of these decreases in vision were due to progression of the condition with traction and many required surgical intervention. Patients should be monitored appropriately. •
Intravitreal injections are associated with intraocular inflammation/infection, intraocular hemorrhage and increased intraocular pressure (IOP). Patients should be monitored and instructed to report any symptoms without delay. In the controlled trials, intraocular inflammation occurred in 7.1% of patients injected with JETREA vs 3.7% of patients injected with vehicle. Most of the post-injection intraocular inflammation events were mild and transient. If the contralateral eye requires treatment with JETREA, it is not recommended within 7 days of the initial injection in order to monitor the post-injection course in the injected eye.
•
Potential for lens subluxation.
•
In the controlled trials, the incidence of retinal detachment was 0.9% in the JETREA group and 1.6% in the vehicle group, while the incidence of retinal tear (without detachment) was 1.1% in the JETREA group and 2.7% in the vehicle group. Most of these events occurred during or after vitrectomy in both groups.
•
Dyschromatopsia (generally described as yellowish vision) was reported in 2% of all patients injected with JETREA. In approximately half of these dyschromatopsia cases there were also electroretinographic (ERG) changes reported (a- and b-wave amplitude decrease).
Adverse Reactions • The most commonly reported reactions (≥ 5%) in patients treated with JETREA were vitreous floaters, conjunctival hemorrhage, eye pain, photopsia, blurred vision, macular hole, reduced visual acuity, visual impairment, and retinal edema.
Please see Brief Summary of full Prescribing Information on adjacent page.
©2014 ThromboGenics, Inc. All rights reserved. ThromboGenics, Inc., 101 Wood Avenue South, Suite 610, Iselin, NJ 08830 – USA. JETREA and the JETREA logo and THROMBOGENICS and the THROMBOGENICS logo are trademarks or registered trademarks of ThromboGenics NV. 10/14 OCRVMA0223
BRIEF SUMMARY OF FULL PRESCRIBING INFORMATION Please see the JETREA package insert for full Prescribing Information. ®
5 WARNINGS AND PRECAUTIONS 5.1 Decreased Vision A decrease of ≥ 3 line of best corrected visual acuity (BCVA) was experienced by 5.6% of patients treated with JETREA and 3.2% of patients treated with vehicle in the controlled trials [see Clinical Studies]. The majority of these decreases in vision were due to progression of the condition with traction and many required surgical intervention. Patients should be monitored appropriately [see Dosage and Administration].
5.2 Intravitreal Injection Procedure Associated 1 INDICATIONS AND USAGE JETREA is a proteolytic enzyme indicated for the treatment Effects Intravitreal injections are associated with intraocular of symptomatic vitreomacular adhesion. inflammation / infection, intraocular hemorrhage and increased 2 DOSAGE AND ADMINISTRATION intraocular pressure (IOP). In the controlled trials, intraocular 2.1 General Dosing Information inflammation occurred in 7.1% of patients injected with Must be diluted before use. For single-use ophthalmic JETREA vs. 3.7% of patients injected with vehicle. Most of intravitreal injection only. JETREA must only be the post-injection intraocular inflammation events were administered by a qualified physician. mild and transient. Intraocular hemorrhage occurred in 2.4% vs. 3.7% of patients injected with JETREA vs. vehicle, 2.2 Dosing The recommended dose is 0.125 mg (0.1 mL of the diluted respectively. Increased intraocular pressure occurred in solution) administered by intravitreal injection to the 4.1% vs. 5.3% of patients injected with JETREA vs. vehicle, respectively. affected eye once as a single dose. 5.3 Potential for Lens Subluxation 2.3 Preparation for Administration Remove the vial (2.5 mg/mL corresponding to 0.5 mg One case of lens subluxation was reported in a patient who ocriplasmin) from the freezer and allow to thaw at room received an intravitreal injection of 0.175 mg (1.4 times temperature (within a few minutes). Once completely higher than the recommended dose). Lens subluxation was thawed, remove the protective polypropylene flip-off cap observed in three animal species (monkey, rabbit, minipig) from the vial. The top of the vial should be disinfected with following a single intravitreal injection that achieved an alcohol wipe. Using aseptic technique, add 0.2 mL of vitreous concentrations of ocriplasmin 1.4 times higher 0.9% w/v Sodium Chloride Injection, USP (sterile, than achieved with the recommended treatment dose. preservative-free) into the JETREA vial and gently swirl the Administration of a second intravitreal dose in monkeys, 28 days apart, produced lens subluxation in 100% of the vial until the solutions are mixed. treated eyes [see Nonclinical Toxicology]. Visually inspect the vial for particulate matter. Only a clear, colorless solution without visible particles should be used. 5.4 Retinal Breaks Using aseptic technique, withdraw all of the diluted solution In the controlled trials, the incidence of retinal detachment using a sterile #19 gauge needle (slightly tilt the vial to ease was 0.9% in the JETREA group and 1.6% in the vehicle withdrawal) and discard the needle after withdrawal of group, while the incidence of retinal tear (without the vial contents. Do not use this needle for the intravitreal detachment) was 1.1% in the JETREA group and 2.7% in the vehicle group. Most of these events occurred during injection. or after vitrectomy in both groups. The incidence of retinal Replace the needle with a sterile #30 gauge needle, detachment that occurred pre-vitrectomy was 0.4% in carefully expel the air bubbles and excess drug from the the JETREA group and none in the vehicle group, while syringe and adjust the dose to the 0.1 mL mark on the the incidence of retinal tear (without detachment) that syringe (corresponding to 0.125 mg ocriplasmin). THE occurred pre-vitrectomy was none in the JETREA group and SOLUTION SHOULD BE USED IMMEDIATELY AS IT CONTAINS 0.5% in the vehicle group. NO PRESERVATIVES. Discard the vial and any unused 5.5 Dyschromatopsia portion of the diluted solution after single use. Dyschromatopsia (generally described as yellowish vision) 2.4 Administration and Monitoring was reported in 2% of all patients injected with JETREA. In The intravitreal injection procedure should be carried out approximately half of these dyschromatopsia cases there under controlled aseptic conditions, which include the use were also electroretinographic (ERG) changes reported of sterile gloves, a sterile drape and a sterile eyelid speculum (a- and b-wave amplitude decrease). (or equivalent). Adequate anesthesia and a broad spectrum microbiocide should be administered according to standard 6 ADVERSE REACTIONS The following adverse reactions are described below and medical practice. elsewhere in the labeling: The injection needle should be inserted 3.5 - 4.0 mm posterior to the limbus aiming towards the • Decreased Vision [see Warnings and Precautions] center of the vitreous cavity, avoiding the • Intravitreal Injection Procedure Associated Effects horizontal meridian. The injection volume of [see Warnings and Precautions and Dosage and 0.1 mL is then delivered into the mid-vitreous. Administration] Immediately following the intravitreal injection, patients • Potential for Lens Subluxation [see Warnings should be monitored for elevation in intraocular pressure. and Precautions] Appropriate monitoring may consist of a check for perfusion of the optic nerve head or tonometry. If required, • Retinal Breaks [see Warnings and Precautions and Dosage and Administration] a sterile paracentesis needle should be available. Following intravitreal injection, patients should be instructed to report any symptoms suggestive of endophthalmitis or retinal detachment (e.g., eye pain, redness of the eye, photophobia, blurred or decreased vision) without delay [see Patient Counseling Information].
6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates in one clinical trial of a drug cannot be directly compared with rates in the clinical trials of the same or another drug and may not reflect the Each vial should only be used to provide a single injection rates observed in practice. for the treatment of a single eye. If the contralateral eye Approximately 800 patients have been treated with an requires treatment, a new vial should be used and the intravitreal injection of JETREA. Of these, 465 patients sterile field, syringe, gloves, drapes, eyelid speculum, and received an intravitreal injection of ocriplasmin 0.125 mg injection needles should be changed before JETREA is (187 patients received vehicle) in the 2 vehicle-controlled administered to the other eye, however, treatment with studies (Study 1 and Study 2). JETREA in the other eye is not recommended within 7 days of the initial injection in order to monitor the post-injection The most common adverse reactions (incidence 5% - 20% course including the potential for decreased vision in the listed in descending order of frequency) in the vehiclecontrolled clinical studies were: vitreous floaters, injected eye. conjunctival hemorrhage, eye pain, photopsia, blurred Repeated administration of JETREA in the same eye is not vision, macular hole, reduced visual acuity, visual recommended [see Nonclinical Toxicology]. impairment, and retinal edema. After injection, any unused product must be discarded. Less common adverse reactions observed in the studies at frequency of 2% - < 5% in patients treated with JETREA No special dosage modification is required for any of the aincluded macular edema, increased intraocular pressure, populations that have been studied (e.g. gender, elderly). anterior chamber cell, photophobia, vitreous detachment, ocular discomfort, iritis, cataract, dry eye, metamorphopsia, 3 DOSAGE FORMS AND STRENGTHS conjunctival hyperemia, and retinal degeneration. Single-use glass vial containing JETREA 0.5 mg in 0.2 mL solution for intravitreal injection (2.5 mg/mL). Dyschromatopsia was reported in 2% of patients injected with JETREA, with the majority of cases reported from 4 CONTRAINDICATIONS two uncontrolled clinical studies. In approximately None
half of these dyschromatopsia cases there were also The number of patients with at least 3 lines increase in electroretinographic (ERG) changes reported (a- and visual acuity was numerically higher in the ocriplasmin b-wave amplitude decrease). group compared to vehicle in both trials, however, the number of patients with at least a 3 lines decrease in visual 6.2 Immunogenicity acuity was also higher in the ocriplasmin group in one of the As with all therapeutic proteins, there is potential for studies (Table 1 and Figure 1). immunogenicity. Immunogenicity for this product has not been evaluated. Table 1: Categorical Change from Baseline in BCVA at Month 6, Irrespective of Vitrectomy 8 USE IN SPECIFIC POPULATIONS (Study 1 and Study 2) 8.1 Pregnancy: Teratogenic Effects Pregnancy Category C. Animal reproduction studies Study 1 have not been conducted with ocriplasmin. There are no adequate and well-controlled studies of ocriplasmin in JETREA Vehicle Difference pregnant women. It is not known whether ocriplasmin can cause fetal harm when administered to a pregnant N=219 N=107 (95% CI) woman or can affect reproduction capacity. The systemic ≥ 3 line Improvement in BCVA exposure to ocriplasmin is expected to be low after intravitreal injection of a single 0.125 mg dose. Assuming Month 6 28 (12.8%) 9 (8.4%) 4.4 (-2.5, 11.2) 100% systemic absorption (and a plasma volume of 2700 mL), the estimated plasma concentration is > 3 line Worsening in BCVA 46 ng/mL. JETREA should be given to a pregnant woman Month 6 16 (7.3%) 2 (1.9%) 5.4 (1.1, 9.7) only if clearly needed. 8.3 Nursing Mothers It is not known whether ocriplasmin is excreted in human milk. Because many drugs are excreted in human milk, and because the potential for absorption and harm to infant growth and development exists, caution should be exercised when JETREA is administered to a nursing woman. 8.4 Pediatric Use Safety and effectiveness in pediatric patients have not been established.
Study 2 JETREA
Vehicle
Difference
N=245
N=81
(95% CI)
≥ 3 line Improvement in BCVA Month 6
29 (11.8%)
3 (3.8%)
8.1 (2.3, 13.9)
> 3 line Worsening in BCVA
Month 6 10 (4.1%) 4 (5.0%) -0.9 (-6.3, 4.5) 8.5 Geriatric Use In the clinical studies, 384 and 145 patients were ≥ 65 years and of these 192 and 73 patients were ≥ 75 years in the JETREA and vehicle groups respectively. No significant Figure 1: Percentage of Patients with Gain or differences in efficacy or safety were seen with increasing Loss of ≥ 3 Lines of BCVA at Protocol-Specified Visits age in these studies.
10 OVERDOSAGE The clinical data on the effects of JETREA overdose are limited. One case of accidental overdose of 0.250 mg ocriplasmin (twice the recommended dose) was reported to be associated with inflammation and a decrease in visual acuity. 13 NONCLINICAL TOXICOLOGY 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility No carcinogenicity, mutagenicity or reproductive and developmental toxicity studies were conducted with ocriplasmin. 13.2 Animal Toxicology and/or Pharmacology The ocular toxicity of ocriplasmin after a single intravitreal dose has been evaluated in rabbits, monkeys and minipigs. Ocriplasmin induced an inflammatory response and transient ERG changes in rabbits and monkeys, which tended to resolve over time. Lens subluxation was observed in the 3 species at ocriplasmin concentrations in the vitreous at or above 41 mcg/mL, a concentration 1.4-fold above the intended clinical concentration in the vitreous of 29 mcg/mL. Intraocular hemorrhage was observed in rabbits and monkeys. A second intravitreal administration of ocriplasmin (28 days apart) in monkeys at doses of 75 mcg/eye (41 mcg/mL vitreous) or 125 mcg/eye (68 mcg/mL vitreous) was associated with lens subluxation in all ocriplasmin treated eyes. Sustained increases in IOP occurred in two animals with lens subluxation. Microscopic findings in the eye included vitreous liquefaction, degeneration/disruption of the hyaloideocapsular ligament (with loss of ciliary zonular fibers), lens degeneration, mononuclear cell infiltration of the vitreous, and vacuolation of the retinal inner nuclear cell layer. These doses are 1.4-fold and 2.3-fold the intended clinical concentration in the vitreous of 29 mcg/mL, respectively. 14 CLINICAL STUDIES The efficacy and safety of JETREA was demonstrated in two multicenter, randomized, double masked, vehicle-controlled, 6 month studies in patients with symptomatic vitreomacular adhesion (VMA). A total of 652 patients (JETREA 464, vehicle 188) were randomized in these 2 studies. Randomization was 2:1 (JETREA:vehicle) in Study 1 and 3:1 in Study 2.
15% 10% 5% 0%
-5% -10% -15%
7
14
28
90
180
Days Study 1 JETREA
Study 1 Vehicle
Study 2 JETREA
Study 2 Vehicle
16 HOW SUPPLIED/STORAGE AND HANDLING Each vial of JETREA contains 0.5 mg ocriplasmin in 0.2 mL citric-buffered solution (2.5 mg/mL). JETREA is supplied in a 2 mL glass vial with a latex free rubber stopper. Vials are for single use only. Storage Store frozen at or below -4˚F ( -20˚C). Protect the vials from light by storing in the original package until time of use. 17 PATIENT COUNSELING INFORMATION In the days following JETREA administration, patients are at risk of developing intraocular inflammation/ infection. Advise patients to seek immediate care from an ophthalmologist if the eye becomes red, sensitive to light, painful, or develops a change in vision [see Warnings and Precautions]. Patients may experience temporary visual impairment after receiving an intravitreal injection of JETREA [see Warnings and Precautions]. Advise patients to not drive or operate heavy machinery until this visual impairment has resolved. If visual impairment persists or decreases further, advise patients to seek care from an ophthalmologist.
Manufactured for: ThromboGenics, Inc. 101 Wood Avenue South, 6th Floor Iselin, NJ 08830
U.S. License Number: 1866 ©2013, ThromboGenics, Inc. All rights reserved. Version 1.0 Initial U.S. Approval: 2012 Patients were treated with a single injection of JETREA or ThromboGenics U.S. patents: 7,445,775; 7,547,435; 7,914,783 vehicle. In both of the studies, the proportion of patients and other pending patents. who achieved VMA resolution at Day 28 (i.e., achieved success on the primary endpoint) was significantly higher JETREA and the JETREA logo are trademarks or registered in the ocriplasmin group compared with the vehicle group trademarks of ThromboGenics NV in the United States, European Union, Japan, and other countries. through Month 6. 05/13 OCRVMA0072 PI G
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AAO 2014
BOARD OF TRUSTEES Gregory L Skuta MD Russell N Van Gelder MD PhD David W Parke II MD Paul Sternberg Jr MD George B Bartley MD Cynthia A Bradford MD Louis B Cantor MD Jane C Edmond MD Alaa ElDanasoury MD Paul B Ginsburg MD Mathew W MacCumber MD PhD Frank J Martin MD Christie L Morse MD Thomas A Oetting MD Mildred M G Olivier MD Jonathan B Rubenstein MD John R Stechschulte MD Humphrey J F Taylor Linda M Tsai MD Ann A Warn MD MBA Robert E Wiggins Jr MD MHA Charles M Zacks MD
President President-Elect Executive Vice President/CEO Past President Editor, Ophthalmology Senior Secretary for Advocacy Senior Secretary for Clinical Education Trustee-at-Large International Trustee-at-Large Public Trustee Vice Chair, The Council International Trustee-at-Large Chair, FAAO Advisory Board Trustee-at-Large Trustee-at-Large Secretary for Annual Meeting Trustee-at-Large Public Trustee Trustee-at-Large Chair, The Council Senior Secretary for Ophthalmic Practice Trustee-at-Large
P.O. Box 7424, San Francisco, CA 94120-7424 | Tel: 415-561-8500 Fax: 415-561-8533 © 2014 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology.
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
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SEE YOU IN VIENNA! www.soe2015.org
AAO 2014
COMMITTEE OF SECRETARIES The Committee of Secretaries is directly involved in the development and management of program activities and services. This committee plays an important role in program planning as well as providing recommendations to the board on the relative priority of major programs within the Academy. David W Parke II MD* Richard L Abbott MD George B Bartley MD* Cynthia A Bradford MD* Daniel J Briceland MD Louis B Cantor MD* Anne L Coleman MD PhD Tamara R Fountain MD Robert F Melendez MD MBA Richard P Mills MD MPH Jeffrey A Nerad MD Christopher J Rapuano MD Michael X Repka MD William L Rich III MD Philip R Rizzuto MD Jonathan B Rubenstein MD* Robert E Wiggins Jr MD MHA* George A Williams MD
Chair Secretary for Global Alliances Editor, Ophthalmology Senior Secretary for Advocacy Secretary for State Affairs Senior Secretary for Clinical Education Secretary for Quality of Care Secretary for Member Services Editor-in-Chief, the ONE Network Secretary for Online Education/eLearning Chief Medical Editor, EyeNet Magazine Secretary for Knowledge Base Development Secretary for Ophthalmic Knowledge Academy Medical Director for Governmental Affairs Academy Medical Director of Health Policy Secretary for Communications Secretary for Annual Meeting Senior Secretary for Ophthalmic Practice Secretary for Federal Affairs
*Members of the Board of Trustees
P.O. Box 7424, San Francisco, CA 94120-7424 | Tel: 415-561-8500 Fax: 415-561-8533 © 2014 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology.
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
xvii
International Society of Refractive Surgery A Partner of the American Academy of Ophthalmology
ISRS Chicago Schedule REFRACTIVE SURGERY SUBSPECIALTY DAY 2014: MISSION 20/20 The ISRS Annual Meeting Friday, 17 October | 08:00 to 17:30 Saturday, 18 October | 08:00 to 17:30 Arie Crown Theater Don’t miss the ISRS Award presentation at 10:15 AM on Friday! ISRS Member Lunch Friday, 17 October | 12:30 to 13:30 E354, Lakeside Center ISRS SPECIAL SESSIONS Introduction to Corneal and Lens-Based Refractive Surgery for Residents (SYM02) Sunday, 19 October | 08:00 to 11:00 E450 Best of the Anterior Segment Specialty Meetings 2014 (SYM41) Monday, 20 October | 10:15 to 11:30 S406A Decision Making in Contemporary Refractive Surgery (SYM48) Tuesday, 21 October | 10:15 to 11:45 S406A
ISRS ROUNTABLES* Sunday, 19 October through Tuesday, 21 October 07:30 to 08:30 Hall A ISRS INSTRUCTION COURSES* Surgical Management of Astigmatism in Cataract and Refractive Surgery (198) Sunday, 19 October | 14:00 to 15:00 S103BC Danger Zone: Refractive Surgery Nightmares and Worst-Case Scenarios: A Video-Based Course (314) Monday, 20, October | 09:00 to 11:15 N140 ISRS Laser Refractive Surgery Course (131) Monday, 20 October | 09:00 to 11:15 N138 Laser Refractive Surgery (LAB131A) Monday | 15:30 to 17:30 | N227B Laser Refractive Surgery (LAB131B) Tuesday | 08:00 to 10:00 | N227B A Step-by-Step Primer to Starting LASIK in 2014 (380) Monday, 20 October | 14:00 to 16:15 S103BC Advanced Corneal Topographic Analysis (598) Tuesday, 21 October | 14:00 to 16:15 S104A
For more information on ISRS or to become a member, visit Member Services booth in the Academy Resource Center (Booth 508) or visit www.isrs.org. *onsite fee applies
AAO Final Program
Cover more ground in less time.
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Leaping over 50 times its own length, the rocket frog can accelerate up to twice the speed of gravity.
The Integrated WaveLight® Refractive Suite The fastest refractive platform in the US features: • Unrivaled 500 Hz Excimer Laser ablation times at just 1.4 seconds per diopter* • Precise 200 kHz Femtosecond Laser custom flap creation in 6 seconds* • A 1050 Hz-type Eye Tracker, synchronized at 500 Hz, with 2 millisecond latency time • A broad range of customized, patient-specific treatments available
Ask your Alcon Sales Representative for more information. *Based on typical treatment parameters for myopia. For important safety information about this product, please refer to the adjacent page.
© 2013 Novartis
9/13
ALL13174JAD
WaveLight® FS200 Femtosecond Laser
WaveLight® EX500 Excimer Laser
• taking the medication sumatriptan succinate (Imitrex*); • corneal, lens and/or vitreous opacities including, but not limited to cataract; Important Safety Information about the WaveLight® Excimer Laser Systems This information pertains to all WaveLight® Excimer Laser Systems, including the WaveLight® ALLEGRETTO WAVE®, the ALLEGRETTO WAVE® Eye-Q , and the WaveLight® EX500. Caution: Federal (U.S.) law restricts the WaveLight® Excimer Laser Systems to sale by or on the order of a physician. Only practitioners who are experienced in the medical mangement and surgical treatment of the cornea, who have been trained in laser refractive surgery (including laser calibration and operation) should use a WaveLight® Excimer Laser System. Indications: FDA has approved the WaveLight® Excimer Laser for use in laser-assisted in situ keratomileusis (LASIK) treatments for:
• iris problems including , but not limited to, coloboma and previous iris surgery compromising proper eye tracking; or • taking medications likely to affect wound healing including (but not limited to) antimetabolites. In addition, safety and effectiveness of the WaveLight® Excimer Laser Systems have not been established for: • treatments with an optical zone < 6.0 mm or > 6.5 mm in diameter, or an ablation zone > 9.0 mm in diameter; or • wavefront-guided treatment targets different from emmetropia (plano) in which the wavefront calculated defocus (spherical term) has been adjusted;
• the reduction or elimination of myopia of up to - 12.0 DS and up to 6.0 D of astigmatism at the spectacle plane;
In the WaveLight® Excimer Laser System clinical studies, there were few subjects with cylinder amounts > 4 D and ≤ 6 D. Not all complications, adverse events, and levels of effectiveness may have been determined for this population.
• the reduction or elimination of hyperopia up to + 6.0 DS with and without astigmatic refractive errors up to 5.0 D at the spectacle plane, with a maximum manifest refraction spherical equivalent of + 6.0 D;
Pupil sizes should be evaluated under mesopic illumination conditions. Effects of treatment on vision under poor illumination cannot be predicted prior to surgery.
• the reduction or elimination of naturally occurring mixed astigmatism of up to 6.0 D at the spectacle plane; and
Adverse Events and Complications
• the wavefront-guided reduction or elimination of myopia of up to -7.0 DS and up to 3.0 D of astigmatism at the spectacle plane. In addition, FDA has approved the WaveLight® ALLEGRETTO WAVE® Eye-Q Excimer Laser System, when used with the WaveLight® ALLEGRO Topolyzer® and topography-guided treatment planning software for topographyguided LASIK treatments for the reduction or elimination of up to -9.00 D of myopia, or for the reduction or elimination of myopia with astigmatism, with up to -8.00 D of myopia and up to 3.00 D of astigmatism. The WaveLight® Excimer Laser Systems are only indicated for use in patients who are 18 years of age or older (21 years of age or older for mixed astigmatism) with documentation of a stable manifest refraction defined as ≤ 0.50 D of preoperative spherical equivalent shift over one year prior to surgery, exclusive of changes due to unmasking latent hyperopia. Contraindications: The WaveLight® Excimer Laser Systems are contraindicated for use with patients who: • are pregnant or nursing; • have a diagnosed collagen vascular, autoimmune or immunodeficiency disease; • have been diagnosed keratoconus or if there are any clinical pictures suggestive of keratoconus; or • are taking isotretinoin (Accutane*) and/or amiodarone hydrochloride (Cordarone*). Warnings: The WaveLight® Excimer Laser Systems are not recommended for use with patients who have: • systemic diseases likely to affect wound healing, such as connective tissue disease, insulin dependent diabetes, severe atopic disease or an immunocompromised status; • a history of Herpes simplex or Herpes zoster keratitis; • significant dry eye that is unresponsive to treatment; • severe allergies; or • an unreliable preoperative wavefront examination that precludes wavefront-guided treatment. • a poor quality preoperative topography map that precludes topography-guided LASIK treatment. The wavefront-guided LASIK procedure requires accurate and reliable data from the wavefront examination. Every step of every wavefront measurement that may be used as the basis for a wavefront-guided LASIK procedure must be validated by the user. Inaccurate or unreliable data from the wavefront examination will lead to an inaccurate treatment. Topography-guided LASIK requires preoperative topography maps of sufficient quality to use for planning a topography-guided LASIK treatment. Poor quality topography maps may affect the accuracy of the topography-guided LASIK treatment and may result in poor vision after topography-guided LASIK. Precautions: The safety and effectiveness of the WaveLight® Excimer Laser Systems have not been established for patients with: • progressive myopia, hyperopia, astigmatism and/or mixed astigmatism, ocular disease, previous corneal or intraocular surgery, or trauma in the ablation zone; • corneal abnormalities including, but not limited to, scars, irregular astigmatism and corneal warpage; • residual corneal thickness after ablation of less than 250 microns due to the increased risk for corneal ectasia; • pupil size below 7.0 mm after mydriatics where applied for wavefront-guided ablation planning; • history of glaucoma or ocular hypertension of > 23 mmHg;
Myopia: In the myopia clinical study, 0.2% (2/876) of the eyes had a lost, misplaced, or misaligned flap reported at the 1 month examination. The following complications were reported 6 months after LASIK: 0.9% (7/818) had ghosting or double images in the operative eye; 0.1% (1/818) of the eyes had a corneal epithelial defect. Hyperopia: In the hyperopia clinical study, 0.4% (1/276) of the eyes had a retinal detachment or retinal vascular accident reported at the 3 month examination. The following complications were reported 6 months after LASIK: 0.8% (2/262) of the eyes had a corneal epithelial defect and 0.8% (2/262) had any epithelium in the interface. Mixed Astigmatism: In the mixed astigmatism clinical study, two adverse events were reported. The first event involved a patient who postoperatively was subject to blunt trauma to the treatment eye 6 days after surgery. The patient was found to have an intact globe with no rupture, inflammation or any dislodgement of the flap. UCVA was decreased due to this event. The second event involved the treatment of an incorrect axis of astigmatism. The axis was treated at 60 degrees instead of 160 degrees. The following complications were reported 6 months after LASIK: 1.8% (2/111) of the eyes had ghosting or double images in the operative eye. Wavefront-Guided Myopia: No adverse events occurred during the postoperative period of the wavefront-guided LASIK procedures. In the Control Cohort (traditional LASIK treatment) one subject undergoing traditional LASIK had the axis of astigmatism programmed as 115 degrees instead of the actual 155 degree axis. This led to cylinder in the left eye. The following complications were reported 6 months after wavefrontguided LASIK in the Study Cohort: 1.2% (2/166) of the eyes had a corneal epithelial defect; 1.2% (2/166) had foreign body sensation; and 0.6% (1/166) had pain. No complications were reported in the Control Cohort. Topography-Guided Myopia: There were six adverse events reported in the topography-guided myopia study. Four of the eyes experienced transient or temporary decreases in vision prior to the final 12 month follow-up visit, all of which were resolved by the final follow-up visit. One subject suffered from decreased vision in the treated eye, following blunt force trauma 4 days after surgery. One subject experienced retinal detachment, which was concluded to be unrelated to the surgical procedure. Clinical Data Myopia: The myopia clinical study included 901 eyes treated, of which 813 of 866 eligible eyes were followed for 12 months. Accountability at 3 months was 93.8%, at 6 months was 91.9%, and at 12 months was 93.9%. Of the 782 eyes eligible for the uncorrected visual acuity (UCVA) analysis of effectiveness at the 6-month stability time point, 98.3% were corrected to 20/40 or better, and 87.7% were corrected to 20/20 or better. Subjects who responded to a patient satisfaction questionnaire before and after LASIK reported the following visual symptoms at a “moderate” or “severe” level at least 1% higher at 3 months post-treatment than at baseline: visual fluctuations (28.6% vs. 12.8% at baseline).
Long term risks of LASIK for hyperopia with and without astigmatism have not been studied beyond 12 months. Mixed Astigmatism: The mixed astigmatism clinical study included 162 eyes treated, of which 111 were eligible to be followed for 6 months. Accountability at 1 month was 99.4%, at 3 months was 96.0%, and at 6 months was 100.0%. Of the 142 eyes eligible for the UCVA analysis of effectiveness at the 6-month stability time point, 97.3% achieved acuity of 20/40 or better, and 69.4% achieved acuity of 20/20 or better. Subjects who responded to a patient satisfaction questionnaire before and after LASIK reported the following visual symptoms at a “moderate” or “severe” level at least 1% higher at 3 months post-treatment than at baseline: sensitivity to light (52.9% vs. 43.3% at baseline); visual fluctuations (43.0% vs. 32.1% at baseline); and halos (42.3% vs. 37.0% at baseline). Long term risks of LASIK for mixed astigmatism have not been studied beyond 6 months. Wavefront-Guided Myopia: The wavefront-guided myopia clinical study included 374 eyes treated; 188 with wavefront-guided LASIK (Study Cohort) and 186 with Wavefront Optimized® LASIK (Control Cohort). 166 of the Study Cohort and 166 of the Control Cohort were eligible to be followed at 6 months. In the Study Cohort, accountability at 1 month was 96.8%, at 3 months was 96.8%, and at 6 months was 93.3%. In the Control Cohort, accountability at 1 month was 94.6%, at 3 months was 94.6%, and at 6 months was 92.2%. Of the 166 eyes in the Study Cohort that were eligible for the UCVA analysis of effectiveness at the 6-month stability time point, 99.4% were corrected to 20/40 or better, and 93.4% were corrected to 20/20 or better. Of the 166 eyes in the Control Cohort eligible for the UCVA analysis of effectiveness at the 6-month stability time point, 99.4% were corrected to 20/40 or better, and 92.8% were corrected to 20/20. In the Study Cohort, subjects who responded to a patient satisfaction questionnaire before and after LASIK reported the following visual symptoms at a “moderate” or “severe” level at least 1% higher at 3 months post-treatment than at baseline: light sensitivity (47.8% vs. 37.2% at baseline) and visual fluctuations (20.0% vs. 13.8% at baseline). In the Control Cohort, the following visual symptoms were reported at a “moderate” or “severe” level at least 1% higher at 3 months post-treatment than at baseline: halos (45.4% vs. 36.6% at baseline) and visual fluctuations (21.9% vs. 18.3% at baseline). Long term risks of wavefront-guided LASIK for myopia with and without astigmatism have not been studied beyond 6 months. Topography-Guided Myopia: The topography-guided myopia clinical study included 249 eyes treated, of which 230 eyes were followed for 12 months. Accountability at 3 months was 99.2%, at 6 months was 98.0%, and at 12 months was 92.4%. Of the 247 eyes that were eligible for the UCVA analysis at the 3-month stability time point, 99.2% were corrected to 20/40 or better, and 92.7% were corrected to 20/20 or better. Subjects who responded to a patient satisfaction questionnaire before and after LASIK reported the following visual symptoms as “marked” or “severe” at an incidence greater than 5% at 1 month after surgery: dryness (7% vs. 4% at baseline) and light sensitivity (7% vs. 5% at baseline). Visual symptoms continued to improve with time, and none of the visual symptoms were rated as being “marked” or “severe” with an incidence of at least 5% at 3 months or later after surgery. Long term risks of topography-guided LASIK for myopia with and without astigmatism have not been studied beyond 12 months. Information for Patients: Prior to undergoing LASIK surgery with a WaveLight® Excimer Laser System, prospective patients must receive a copy of the relevant Patient Information Booklet, and must be informed of the alternatives for correcting their vision, including (but not limited to) eyeglasses, contact lenses, photorefractive keratectomy, and other refractive surgeries. Attention: Please refer to a current WaveLight® Excimer Laser System Procedure Manual for a complete listing of the indications, complications, warnings, precautions, and side effects. * Trademarks are property of their respective owners.
Long term risks of LASIK for myopia with and without astigmatism have not been studied beyond 12 months. Hyperopia: The hyperopia clinical study included 290 eyes treated, of which 100 of 290 eligible eyes were followed for 12 months. Accountability at 3 months was 95.2%, at 6 months was 93.9%, and at 12 months was 69.9%. Of the 212 eyes eligible for the UCVA analysis of effectiveness at the 6-month stability time point, 95.3% were corrected to 20/40 or better, and 69.4% were corrected to 20/20 or better. Subjects who responded to a patient satisfaction questionnaire before and after LASIK reported the following visual symptoms as “much worse” at 6 months post-treatment: halos (6.4%); visual fluctuations (6.1%); light sensitivity (4.9%); night driving glare (4.2%); and glare from bright lights (3.0%). © 2014 Novartis 2/14 ALL13174JADUS-PI
LOOK WHO’S DROPPING INTO CHICAGO
VISIT US AT ALLERGAN BOOTH #1408
©2014 Allergan, Inc., Irvine, CA 92612 ® marks owned by Allergan, Inc. www.Combigan.com www.AlphaganP.com APC05FF14 142474
Save the Date! There’s strength in numbers. Lobby on Capitol Hill for ophthalmology’s top legislative issues including advocating for fair Medicare physician payment, reducing regulatory burdens and vision research. Meet face-to-face with your Members of Congress and show the might of our members at this important event. It’s the most effective way to protect the interests of our profession and our patients.
CONGRESSIONAL ADVOCACY DAy April 15 – 16, 2015 Washington, DC “Be an advocate for our patients and our profession! Participate in Congressional Advocacy Day and play a vital role in communicating with our national legislators about issues of importance to ophthalmology during these critical times. Join hundreds of your colleagues and me in Washington, DC in 2015!”
Gregory L. Skuta, MD Academy President
Registration opens in January 2015. Congressional Advocacy Day is open to all Academy members and registration is free. www.aao.org/myf
The Council The Council serves as the advisory body to the Board of Trustees. It was established in accordance with section 7.01 of the Bylaws of the American Academy of Ophthalmology.
Mathew W MacCumber MD PhD – Vice Chair
Councilors representing State Societies Alabama Academy of Ophthalmology Stephen J Kelly MD Alaska Society of Eye Physicians and Surgeons Scott A Limstrom MD Arizona Ophthalmological Society Thomas J McPhee MD Arkansas Ophthalmological Society Justine W Charton MD California Academy of Eye Physicians and Surgeons JoAnn A Giaconi MD Lynn K Gordon MD PhD Asa Dan Morton III MD Frank A Scotti MD Colorado Society of Eye Physicians and Surgeons Alan E Kimura MD MPH Connecticut Society of Eye Physicians Jeffrey R Sandler MD Delaware Academy of Ophthalmology Edward S A Jaoude MD Florida Society of Ophthalmology David B Cano MD Stephen G Schwartz MD MBA Charles B Slonim MD FACS
Kansas Society of Eye Physicians and Surgeons William S Clifford MD Kentucky Academy of Eye Physicians and Surgeons David E Jones MD Louisiana Ophthalmology Association George S Ellis Jr MD FAAO FACS Maine Society of Eye Physicians and Surgeons Cynthia A Self MD Maryland Society of Eye Physicians and Surgeons Sanjay D Goel MD John T Thompson MD Massachusetts Society of Eye Physicians and Surgeons Michael H Goldstein MD Michael J Price MD Michigan Society of Eye Physicians and Surgeons Arezo Amirikia MD Anne M Nachazel MD Minnesota Academy of Ophthalmology Geoffrey G Emerson MD PhD Mississippi Academy of Eye Physicians and Surgeons Curtis D Whittington Jr MD Missouri Society of Eye Physicians and Surgeons P Kumar Rao MD
New York State Ophthalmological Society Gary S Hirshfield MD James A Kinsey MD Martin E Lederman MD Stephen G Spitzer MD North Carolina Society of Eye Physicians and Surgeons J Stuart McCracken MD North Dakota Society of Eye Physicians and Surgeons Lance K Bergstrom MD Ohio Ophthalmological Society Anita Dash-Modi MD Bernard D Perla MD Oklahoma Academy of Ophthalmology Amalia Miranda MD Oregon Academy of Ophthalmology Mary P DeFrank MD Pennsylvania Academy of Ophthalmology James B Dickey MD Joanna M Fisher MD Karl R Olsen MD Puerto Rican Society of Ophthalmology Emilio A Arce-López MD Rhode Island Society of Eye Physicians and Surgeons Robert H Janigian Jr MD South Carolina Society of Ophthalmology Todd D Gwin MD
Montana Academy of Ophthalmology Brian D Sippy MD PhD
South Dakota Academy of Ophthalmology Dustin L Dierks MD
Hawaii Ophthalmological Society George Nardin MD
Nebraska Academy of Eye Physicians and Surgeons David D Ingvoldstad MD
Tennessee Academy of Ophthalmology Ben B Mahan MD
Idaho Society of Ophthalmology Adam C Reynolds MD
Nevada Academy of Ophthalmology Steve M Friedlander MD FACS
Illinois Society of Eye Physicians and Surgeons Sohail J Hasan MD PhD David K Yoo MD
New Hampshire Society of Eye Physicians and Surgeons John J Dagianis MD
Indiana Academy of Ophthalmology Derek T Sprunger MD
New Jersey Academy of Ophthalmology Cecily A Lesko MD FACS John R Stabile MD
Georgia Society of Ophthalmology James Gerard Brooks Jr MD
Iowa Academy of Ophthalmology Brandt M Riley DO
New Mexico Academy of Ophthalmology Kamalesh J Ramaiya MD
The Council
Ann A Warn MD MBA – Chair
Texas Ophthalmological Association John R Fish MD Richard Galen Kemp MD Aaron M Miller MD MBA Utah Ophthalmology Society James G Howard MD Vermont Ophthalmological Society Brian Y Kim MD Virginia Society of Eye Physicians and Surgeons Anthony J Viti MD
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
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The Council
The Council Washington Academy of Eye Physicians and Surgeons Brian E Bowe MD
American Society of Retina Specialists Peter K Kaiser MD Judy E Kim MD
Washington DC Metropolitan Ophthalmological Society Reshma Katira MD
American Uveitis Society Justine R Smith MD
West Virginia Academy of Eye Physicians and Surgeons Mark D Mayle MD Wisconsin Academy of Ophthalmology Deborah W Bernstein MD
Association for Research in Vision and Ophthalmology Emily Y Chew MD Association of University Professors of Ophthalmology Joel S Schuman MD
Wyoming Ophthalmological Society Anne Elizabeth Miller MD
Association of Veterans Affairs Ophthalmologists Mary Gilbert Lawrence MD MPH
Councilors representing Subspecialty and Specialized Interest Societies
Canadian Ophthalmological Society Paul E Rafuse MD PhD
American Academy of Pediatrics, Section on Ophthalmology Gregg T Lueder MD
Contact Lens Association of Ophthalmologists Bennie H Jeng MD
American Association for Pediatric Ophthalmology and Strabismus David A Plager MD
Cornea Society Shahzad I Mian MD Eye Bank Association of America Woodford S Van Meter MD FACS
American Association of Ophthalmic Oncologists and Pathologists George Harocopos MD
Macula Society Michael J Elman MD
American Board of Ophthalmology John E Sutphin MD
National Medical Association, Ophthalmology Section Chasidy D Singleton MD
American College of Surgeons, Advisory Council for Ophthalmic Surgery Vikram D Durairaj MD Sarwat Salim MD American Glaucoma Society Thomas W Samuelson MD American Ophthalmological Society Thomas J Liesegang MD American Osteopathic College of Ophthalmology Kristin E Reidy DO American Society of Cataract and Refractie Surgery David A Goldman MD Thomas M Harvey MD American Society of Ocular Trauma Michael P Grant MD PhD
North American Neuro-Ophthalmology Society Matthew Dean Kay MD Ocular Microbiology and Immunology Group Bradley Dean Fouraker MD Outpatient Ophthalmic Surgery Society Y Ralph Chu MD Pan-American Association of Ophthalmology Stephanie Jones Marioneaux MD Retina Society Jennifer I Lim MD Society of Military Ophthalmologists Jonathan S Collins MD Women in Ophthalmology Laura J King MD MMM
American Society of Ophthalmic Plastic and Reconstructive Surgery Louise A Mawn MD xxiv
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
AAO 2014 Overview Thursday, Oct. 16 Registration
Time
Attendees - onsite
4:00 - 6:00 pm
Attendees - satellite location
2:00 - 6:00 pm
Exhibitors Ticket Sales
AAO 2014 Overview
Event
7:30 am - 6:00 pm 4:00 - 6:00 pm
Friday, Oct. 17 Event
Time
Alumni & Related Group Functions
All Day
Registration
Attendees - onsite
7:00 am - 5:00 pm
Attendees - satellite location
7:00 am - 5:00 pm
Exhibitors
7:00 am - 6:00 pm
Special Meetings & Events
7:30 am - 3:00 pm
Subspecialty Day Meetings
Refractive Surgery
8:00 am - 5:15 pm
Refractive Surgery E-posters
7:00 am - 5:30 pm
Retina
8:00 am - 5:15 pm
Retina Exhibits
9:30 am - 5:30 pm
Ticket Sales
7:00 am - 5:00 pm
Saturday, Oct. 18 Event
Time
AAOE/Practice Management: Introduction to Ophthalmic Coding and ICD-10-CM
8:00 - 11:00 am
AAOE/Practice Management: Coding Camp and Advanced ICD-10-CM
12:30 - 3:30 pm
AAOE/Practice Management Master Classes
8:00 am - 4:30 pm
Academy Café
1:15 - 4:30 pm
Alumni & Related Group Functions
before 8:00 am & after 5:30 pm
Exhibition
9:00 am - 5:00 pm
Learning Lounge
12:00 - 5:00 pm
Registration
Attendees
7:00 am - 5:00 pm
Exhibitors
7:00 am - 5:00 pm
Scientific Posters
9:00 am - 5:00 pm
Scientific Posters Online/Videos on Demand – Booth 65
9:00 am - 5:00 pm
Special Meetings & Events
9:00 am - 4:00 pm
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
xxvii
AAO 2014 Overview AAO 2014 Overview
Saturday, Oct. 18 (cont.) Event
Subspecialty Day Meetings
Time
Cornea
8:00 am - 5:30 pm
Glaucoma
8:00 am - 5:00 pm
Ocular Oncology and Pathology
8:00 am - 5:15 pm
Oculofacial Plastic Surgery
8:00 am - 5:00 pm
Pediatric Ophthalmology
8:00 am - 5:00 pm
Refractive Surgery
8:00 am - 5:30 pm
Refractive Surgery E-posters
7:00 am - 5:00 pm
Retina
8:00 am - 5:30 pm
Uveitus
7:30 am - 5:30 pm
Symposia
2:00 - 5:30 pm
Technology Pavilion
9:30 am - 5:00 pm
Ticket Sales
7:00 am - 5:00 pm
Sunday, Oct. 19 Event
Time
AAO 2014 Opening Session
8:30 - 10:00 am
AAO-SOE Joint Session, A View Across the Pond: Current Cataract and IOL Practices in Europe and the United States
2:00 - 3:30 pm
AAOE/Practice Management Courses
2:00 pm - 5:30 pm
AAOE/Practice Management General Session
10:00 am - 12:00 pm
Academy Business Meeting
10:00 - 10:30 am
Academy Café
10:30 am - 3:45 pm
Alumni & Related Group Functions
before 8:00 am & after 5:30 pm
Breakfast With the Experts
7:30 - 8:30 am
Exhibition
9:00 am - 5:00 pm
Fall Council Meeting
11:30 am - 5:00 pm
Instruction Courses
9:00 am - 5:30 pm
Learning Lounge
10:30 am - 5:00 pm
Orbital Gala
6:00 - 10:00 pm
Original Paper Sessions
10:30 am - 5:30 pm
Registration
Attendees
7:00 am - 5:00 pm
Exhibitors
7:00 am - 5:00 pm
Scientific Posters
7:00 am - 5:00 pm
Scientific Posters Online/Videos on Demand - Booth 65
7:00 am - 5:00 pm
Scientific Posters Online/Videos on Demand - Lakeside Center
8:00 am - 5:00 pm
Scientific Poster Tours
12:30 - 1:30 pm
Skills Transfer Program
8:00 am - 5:30 pm
Special Meetings & Events
6:30 am - 4:00 pm
Symposia and Spotlight Sessions
8:00 am - 5:15 pm
xxviii
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
AAO 2014 Overview Sunday, Oct. 19 (cont.) AAO 2014 Overview
Event
Time
Technology Pavilion
9:30 am - 5:00 pm
Ticket Sales
7:00 am - 5:00 pm
Young Ophthalmologist (YO) Program
10:00 am - 2:00 pm
Monday, Oct. 20 Event
Time
AAO-SOE Joint Session, A View Across the Pond: Retina
8:30 - 10:00 am
AAOE/Practice Management Courses
9:00 am - 5:30 pm
Academy Café
8:30 - 11:45 am
Alumni & Related Group Functions
before 8:30 am & after 5:30 pm
Breakfast With the Experts
7:30 - 8:30 am
Exhibition
9:00 am - 5:00 pm
Instruction Courses
9:00 am - 5:30 pm
Learning Lounge
9:00 am - 5:00 pm
Original Paper Sessions
8:30 am - 5:30 pm
Registration
Attendees
7:00 am - 5:00 pm
Exhibitors
7:00 am - 5:00 pm
Scientific Posters
7:00 am - 5:00 pm
Scientific Posters Online/Videos on Demand - Booth 65
7:00 am - 5:00 pm
Scientific Posters Online/Videos on Demand - Lakeside Center
8:00 am - 5:00 pm
Scientific Poster Tours
12:30 - 1:30 pm
Senior Ophthalmologist (SO) Program
2:30 - 5:00 pm
Skills Transfer Program
7:30 am - 4:30 pm
Special Meetings & Events
12:30 - 5:00 pm
Symposia and Spotlight Sessions
8:15 am - 5:15 pm
Technology Pavilion
9:30 am - 5:00 pm
Ticket Sales
7:00 am - 5:00 pm
Tuesday, Oct. 21 Event
AAO-SOE Joint Session, A View Across the Pond: Cornea Enigmas
Time
10:45 am - 12:15 pm
AAOE/Practice Management Courses
9:00 am - 1:45 pm
Academy Café
10:30 - 11:45 am
Alumni & Related Group Functions
before 8:30 am & after 1:00 pm
Breakfast With the Experts
7:30 - 8:30 am
Exhibition
9:00 am - 1:00 pm
Instruction Courses
9:00 am - 5:30 pm
Learning Lounge
9:00 am - 12:00 pm Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
xxix
AAO 2014 Overview Tuesday, Oct. 21 (cont.) AAO 2014 Overview
Event
Time
Original Paper Sessions
8:30 am - 12:45 pm
Registration
Attendees
7:00 am - 1:00 pm
Exhibitors
7:00 am - 1:00 pm
Scientific Posters
7:00 am - 1:00 pm
Scientific Posters Online/Videos on Demand - Booth 65
7:00 am - 1:00 pm
Scientific Posters Online/Videos on Demand - Lakeside Center
8:00 am - 5:00 pm
Skills Transfer Program
8:00 am - 4:00 pm
Symposia
8:30 am - 12:15 pm
Technology Pavilion
9:30 am - 12:30 pm
Ticket Sales
7:00 am - 1:00 pm
Wednesday, Oct. 22 Event
28° Lo Mejor de la Academia en Español 2014 (The Best of the Academy in Spanish 2014)
xxx
Time
8:00 am - 5:30 pm
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
UNLOCK TREATMENT POSSIBILITIES
10/1/14
SIMBRINZA™ Suspension provided additional 1-3 mm Hg IOP lowering compared to the individual components1 ■ IOP measured at 8 AM, 10 AM, 3 PM, and 5 PM was reduced by 21-35% at Month 32-4 ■ Efficacy proven in two pivotal Phase 3 randomized, multicenter, double-masked, parallel-group, 3-month, 3-arm, contribution-of-elements studies2,3 ■ The most frequently reported adverse reactions (3-7%) in a six month clinical trial were eye irritation, eye allergy, conjunctivitis, blurred vision, dysgeusia (bad taste), conjunctivitis allergic, eye pruritus, and dry mouth5 ■ Only available beta-blocker-free fixed combination2,3 INDICATIONS AND USAGE SIMBRINZA™ (brinzolamide/brimonidine tartrate ophthalmic suspension) 1%/0.2% is a fixed combination indicated in the reduction of elevated intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. Dosage and Administration The recommended dose is one drop of SIMBRINZA™ Suspension in the affected eye(s) three times daily. Shake well before use. SIMBRINZA™ Suspension may be used concomitantly with other topical ophthalmic drug products to lower intraocular pressure. If more than one topical ophthalmic drug is being used, the drugs should be administered at least five (5) minutes apart. IMPORTANT SAFETY INFORMATION Contraindications SIMBRINZA™ Suspension is contraindicated in patients who are hypersensitive to any component of this product and neonates and infants under the age of 2 years. Warnings and Precautions Sulfonamide Hypersensitivity Reactions —Brinzolamide is a sulfonamide, and although administered topically, is absorbed systemically. Sulfonamide attributable adverse reactions may occur. Fatalities have occurred due to severe reactions to sulfonamides. Sensitization may recur when a sulfonamide is readministered irrespective of the route of administration. If signs of serious reactions or hypersensitivity occur, discontinue the use of this preparation. Corneal Endothelium—There is an increased potential for developing corneal edema in patients with low endothelial cell counts. References: 1. SIMBRINZA™ Suspension Package Insert. 2. Katz G, DuBiner H, Samples J, et al. Three-month randomized trial of fixed-combination brinzolamide, 1%, and brimonidine, 0.2% [published online ahead of print April 11, 2013]. JAMA Ophthalmol. doi:10.1001/jamaophthalmol.2013.188. 3. Nguyen QH, McMenemy MG, Realini T, et al. Phase 3 randomized 3-month trial with an ongoing 3-month safety extension of fixed-combination brinzolamide 1%/brimonidine 0.2%. J Ocul Pharmacol Ther. 2013;29(3): 290-297. 4. Data on file, 2013. 5. Whitson JT, Realini T, Nguyen QH, McMenemy MG, Goode SM. Six-month results from a Phase III randomized trial of fixed-combination brinzolamide 1% + brimonidine 0.2% versus brinzolamide or brimonidine monotherapy in glaucoma or ocular hypertension. Clin Ophthalmol. 2013;7:1053-1060.
Severe Hepatic or Renal Impairment (CrCl 2.5 D) may experience spatial distortions. Possible toric IOL related factors may include residual cylindrical error or axis misalignments. Prior to surgery, physicians should provide prospective patients with a copy of the Patient Information Brochure available from Alcon for this product informing them of possible risks and benefits associated with the AcrySof® IQ Toric Cylinder Power IOLs. Studies have shown that color vision discrimination is not adversely affected in individuals with the AcrySof® Natural IOL and normal color vision. The effect on vision of the AcrySof® Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS® or BSS PLUS® Sterile Intraocular Irrigating Solutions. ATTENTION: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions.
© 2014 Novartis 8/14 CRS14007JAD-PI
Selection Committees Each subcommittee has five-ten reviewers who grade the instruction courses and paper/poster abstracts, and three subcommittee members who review the grades and select the courses and abstracts for presentation. The chair of the subcommittee represents the group on the Annual Meeting Program Committee. This peer-review selection process ensures the quality and integrity of Academy educational programs and allows broader input from Academy Members. The Annual Meeting Program Committee monitors the scientific program by reviewing evaluation data, the post-annual meeting survey and reports from independent course/symposium monitors. Volunteer to be a reviewer by visiting Member Services on the Academy’s website and completing the online volunteer form. Volunteer to be a course/symposium monitor by e-mailing the Meetings Division at
[email protected]. Secretary for Annual Meeting Jonathan B Rubenstein MD* Associate Secretary for the Annual Meeting Program Cynthia Mattox MD FACS*
Annual Meeting Program Committee Kathryn A Colby MD PhD* Janet Louise Davis MD* William J Fishkind MD FACS* Don O Kikkawa MD * Jacqueline A Leavitt MD Molly Walsh MD MPH* Sonia H Yoo MD* Terri L Young MD*
Subcommittee for: Cataract Chair: William J Fishkind MD FACS* Subcommittee Members Nicole R Fram MD* Mitchell P Weikert MD* Subcommittee Reviewers George Beiko MD* Gary J Foster MD* Colleen P Halfpenny MD Stephen H Johnson MD Kevin M Miller MD*
Subcommittee for: Cornea, External Disease Chair: Kathryn A Colby MD PhD* Subcommittee Members Bennie H Jeng MD* Shahzad I Mian MD* Subcommittee Reviewers Jessica B Ciralsky MD* Darren G Gregory MD Christina R Prescott MD Vincenzo Sarnicola MD Sonal S Tuli MD
Subcommittee for: Glaucoma Chair: Molly Walsh MD MPH* Subcommittee Members Steven J Gedde MD* Malik Y Kahook MD* Subcommittee Reviewers Husam Ansari MD PhD* Martha Motuz Leen MD* Steven L Mansberger MD MPH* Brian C Samuels MD PhD Thasarat S Vajaranant MD*
Selection Committees
The Annual Meeting Program Committee is responsible for the Academy’s annual meeting Scientific Program, including Breakfast With the Experts, Instruction Courses, Symposia, and Scientific Papers, Posters and Videos.
Subcommittee for: Neuro-Ophthalmology, Computers/ Information Technology, Ethics, General Medical Care, Global Ophthalmology, Electronic Health Records, Medical Education, Ophthalmic History and Vision Rehabilitation Chair: Jacqueline A Leavitt MD Subcommittee Members Sophia Mihe Chung MD* Michael S Lee MD* Subcommittee Reviewers Madhu R Agarwal MD John B Kerrison MD* Howard D Pomeranz MD PhD Kenneth S Shindler MD PhD Prem S Subramanian MD PhD*
Subcommittee for: Ocular Tumors, Pathology and Orbit, Lacrimal Plastic Surgery Chair: Don O Kikkawa MD* Subcommittee Members Julian D Perry MD* Matthew W Wilson MD Subcommittee Reviewers Jonathan W Kim MD Bobby S Korn MD PhD FACS* Jill S Melicher Larson MD Pete Setabutr MD Erin M Shriver MD
Subcommittee for: Pediatric Ophthalmology, Strabismus Chair: Terri L Young MD* Subcommittee Members Hilda Capo MD Martha P Schatz MD Subcommittee Reviewers Arlene V Drack MD* Judith E Gurland MD Anthony Pruett Johnson MD FACS Natalie C Kerr MD Scott R Lambert MD*
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
33
Selection Committees Selection Committees
Subcommittee for: Refractive Surgery and Optics, Refraction Contact Lenses Chair: Sonia H Yoo MD* Subcommittee Members William B Trattler MD* John Allan Vukich MD* Subcommittee Reviewers David A Goldman MD* Daniel F Goodman MD FACS George D Kymionis MD PhD Rajesh K Rajpal MD* Elizabeth Yeu MD*
Subcommittee for: Retina, Vitreous and Intraocular Inflammation, Uveitis Chair: Janet Louise Davis MD* Subcommittee Members Srinivas R Sadda MD* Sharon D Solomon MD Subcommittee Reviewers Ron Afshari Adelman MD MPH J Fernando Arevalo MD* Alay S Banker MD Sharon Fekrat MD* Christina J Flaxel MD Colin A McCannel MD* Andrew A Moshfeghi MD MBA* Dante Pieramici MD* Shlomit Schaal MD PhD* Homayoun Tabandeh MD MS FRCP FRCOphth*
Special Projects Committee The Special Projects Committee is responsible for developing programs and formats that cross subspecialities as well as complement those that are submitted by members or societies. Associate Secretary: Maria M Aaron MD Committee Members Jill S Melicher Larson MD Scott C Oliver MD* Florentino E Palmon MD Douglas J Rhee MD* Nicholas J Volpe MD Tammy L Yanovitch MD
AAOE Program The AAOE Program Committee, with the AAOE Board of Directors, are responsible for selecting the AAOE Program and Practice Management Breakfast With the Experts roundtables. Chair: Sandra Dixon Curd MBA COE COA OCS Board Members Nancy Baker Mary Becka Nan Eversgerd Ravi D Goel MD Elise Levine MA CRC OCS Robert F Melendez MD MBA Bonnie Callahan Parker Rajiv R Rathod MD MBA Andrew Wang COE FACHE MHSA MBA Robert E Wiggins Jr MD MHA* Annual Meeting Program Committee Members Albert Castillo* Tim D Couch Heather Hambrick Dunn COA Traci Fritz COE OCS Barbara Krzeszowski LPN COT Julia Lee JD OCS* Susan M Loen OCS Rosa M Montes COA OCS Paula Vaughn OCS Academy Staff Julia Fennell Sangeeta Fernandes Brandi Garrigus Susan Oslar Melanie Rafaty Michael Rhea* Debra Rosencrance Elizabeth Washburn
European Society of Ophthalmology (SOE) Planning Committee Chair: Stefan Seregard MD Committee Members Jan-Tjeerd H N de Faber MD Thomas F Fenech MBBS
Skills Transfer Advisory Committee The Skills Transfer Advisory Committee is responsible for selecting the Skills Transfer courses and labs. Associate Secretary: Thomas W Samuelson MD* Advisory Committee Susan R Carter MD Jack A Cohen MD FACS William Barry Lee MD* Kevin M Miller MD* Nathan M Radcliffe MD* David D Verdier MD 34
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
Programs-By-Day All rooms are in McCormick Place: North Building (N), South Building (S), Lakeside Center (E), unless otherwise indicated. Courses designated with a plus (+) sign are part of the Academy Plus course pass. Courses designated with a dollar ($) sign are not included in the course pass and must be purchased separately. Sessions and events that are left blank are free. Content from courses and sessions with a diamond ◆ will be captured and available to purchase through AAO Meetings On Demand; courses are not sold individually. Disclaimer: Some content may not be available, or may be audio only, due to extent of recording permission granted by presenter.
MEDED - Medical Education NEURO - Neuro-Ophthalmology NON - General Non-Medical OPTIC - Optics, Refraction, Contact Lenses PATH - Ocular Tumors, Pathology PEDS - Pediatric Ophthalmology, Strabismus PLAST - Orbit, Lacrimal, Plastic Surgery REF - Refractive Surgery RET - Retina, Vitreous VIS - Vision Rehabilitation
Programs-By-Day
Topic Key CAT - Cataract COM - Computers, Information Technology COR - Cornea, External Disease EHR - Elecgtronic Health Records ETH - Ethics GEN - General Medical Care GLA - Glaucoma GO - Global Ophthalmology HIST - Ophthalmic History INTRA - Intraocular Inflammation, Uveitis
PRACTICE MANAGEMENT/AAOE PM-ASC - Ambulatory Surgery Centers PM-BUS - Business Operations & Finance PM-EHR - Electronic Health Records PM-HMR - Human Resources PM-IMT - Information Technology PM-MKT - Marketing & Business Development PM-OPT - Optical Dispensing PM-PROF - Professional Growth PM-REMB - Coding & Reimbursement PM-RISK - Compliance & Risk Management
Type Key AAOEIC - AAOE Instruction Course AAOESP - AAOE Special Meeting ACADCAFE - Academy Café BWE - Breakfast with the Experts
IC - Instruction Course LL - Learning Lounge OP - Original Paper Session OPSESS - Opening Session
PT - Poster Tour SKILLS - Skills Transfer Course SPE - Special Meeting SPOTLIT - Spotlight Session
SUB - Subspecialty Day Meeting SYM - Symposium TP - Technology Pavilion
Friday, Oct. 17 Time
Type
No.
Title
Topic
7:30 AM - 3:00 PM
SPE
SPE01
8:00 AM - 5:23 PM
SUB
Refractive Surgery 2014: Mission 20/20
REF
8:00 AM - 5:38 PM
SUB
Retina 2014: Reaching New Heights
RET
DICOM Working Group 9 - Eye Care
$
◆
Room
Page
Hyatt Regency McCormick Place $ ◆ Arie Crown Theater (E) $ ◆ North, Hall B
250
$
Page
Saturday, Oct. 18 (cont.) Time
Type
7:50 AM - 5:30 PM 8:00 - 11:00 AM 8:00 AM - 12:00 PM 8:00 AM - 5:00 PM
SUB CODE1 AAOESP SUB
8:00 AM - 5:05 PM
SUB
8:00 AM - 5:15 PM
SUB
8:00 AM - 5:21 PM
SUB
8:00 AM - 5:25 PM
SUB
8:00 AM - 5:32 PM 8:00 AM - 5:35 PM
SUB SUB
9:00 - 11:00 AM 9:00 AM - 1:00 PM
SPE AAOESP
No.
SPE03
SPE04 SPE05
Title
Topic
◆
Room
Uveitis 2014: Extinguishing the Great Fire INTRA $ ◆ E450 Introduction to Ophthalmic Coding and ICD-10-CM PM-REMB $ S105 The Profitable Practice: Managing Your Billing Operations PM-BUS $ S502ab Glaucoma 2014: Integrating New Technologies and Approaches GLA $ ◆ Grand Ballroom Into Your Daily Practice S100ab Oculofacial Plastic Surgery 2014: A Global Summit PLAST $ ◆ Grand Ballroom S100c Ocular Oncology and Pathology 2014: Saving Eyes and Saving PATH $ ◆ E350 Lives Refractive Surgery 2014: Mission 20/20 REF $ ◆ Arie Crown Theater (E) Cornea 2014: Restocking the Toolbox: Concepts and Techniques COR $ ◆ E354 for the Toughest Jobs Retina 2014: Reaching New Heights RET $ ◆ North, Hall B Pediatric Ophthalmology 2014: A Magnificent Mile of PEDS $ ◆ Vista Room Innovations S406a Brain Health and Longevity for SOs in the Digital Age GEN N427bc Keeping Your Practice Out of Legal Hot Water: An HR and PM-ASC $ S503ab Compliance Workshop
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
266 280
250 280
35
Programs-By-Day Saturday, Oct. 18 (cont.)
Programs-By-Day
Time
Type
No.
9:30 AM - 5:00 PM 12:00 - 4:00 PM
TP AAOESP
SPE24
12:00 - 5:00 PM 12:30 - 3:30 PM 12:30 - 4:30 PM 1:00 - 4:00 PM
LL CODE2 AAOESP AAOESP SPE
SPE02 SPE06 SPE07
1:15 - 2:30 PM 2:00 - 3:30 PM
ACADCAFE SYM
SYM50 SYM01
2:00 - 5:30 PM
SYM
SYM58
3:15 - 4:30 PM
ACADCAFE
SYM51
Title
Technology Pavilion The Entrepreneurial ASC: Embracing Policy, People, Possibilities and Planning Learning Lounge Coding Camp and Advanced ICD-10-CM Scott Deming’s Emotional Brand Building Workshop The Optical Dispensing Boot Camp Use Blogging & Social Networking to Super Charge Your Website & Internet Marketing Academy Café: IRIS Registry Global Symposium: Low Vision Rehabilitation and New Technologies for the Developing World Conference for Ophthalmic Educators: Improving Teaching Effectiveness Academy Café: Cataract
Topic
$
Room
Page
Booth 165 S505ab
258 280
Booth 107 S105 S501abc S504bc N227a
254 266 280 280 250
S404 S405
122 124
S104ab
124
◆
S404
122
◆
Room
Page
◆
Hall A E450
250 51 124
N226 North Hall B S102d
114 121 125
E352
114
E351 N230 N231 S105bc
110 106 114 111
S103bc N427a S102abc Booth 165 North Hall B S406b N227a S101ab S102d S104a
109 110 106 258 250 265 109 250 118 83
S104b E353c
66 74
E352
106
S106a
115
N427bc
107
◆
PM-ASC
PM-REMB $ PM-PROF $ PM-OPT $ COM EHR GO
◆ ◆
MEDED CAT
Sunday, Oct.19 (cont.) Type
No.
6:30 - 7:30 AM 7:30 - 8:30 AM 8:00 - 11:00 AM
Time
SPE BWE SYM
SPE23 SYM02
8:30 - 10:00 AM 9:00 - 10:00 AM
SKILLS OPSESS SYM
LAB100 SYM61 SYM03
SKILLS
LEC106
SKILLS SKILLS SKILLS SKILLS
LEC107 LAB108 LAB105 LEC101
SKILLS SKILLS SKILLS TP SPE AAOESP SKILLS SPE SKILLS IC
LEC102 LEC103 LEC104 SPE22 SPE09 LAB109 SPE08 LEC111 150
IC IC
166 167
SKILLS
LEC110
SKILLS
LEC112
SKILLS
LEC113
9:00 - 10:30 AM 9:00 - 11:00 AM 9:00 - 11:15 AM
9:30 AM - 5:00 PM 10:00 - 10:30 AM 10:00 AM - 12:00 PM 10:00 AM - 2:00 PM 10:15 - 11:15 AM
10:15 AM - 12:30 PM
36
Title
Topic
$
29th Annual Run for Vision NON $ Breakfast With the Experts $ Introduction to Corneal and Lens-Based Refractive Surgery for REF Residents Orbitofacial Fracture Repair: Plating Workshop PLAST $ Opening Session NON Free and Easy for Low Vision: Help and Resources for the VIS Visually Impaired Periocular Rejuvenation With Fillers and BOTOX With 2-D PLAST + Videos and Video-Assisted Teaching Crosslinking COR + Cataract Femtosecond Laser Surgery CAT $ Neuroimaging in Ophthalmology NEURO $ Computerized Scanning Imaging of the Optic Nerve and Retinal GLA + Nerve Fiber Layer Endothelial Keratoplasty Techniques COR + Anterior Lamellar Keratoplasty: Principles and Practice COR + Management of the Vitreous for the Anterior Segment Surgeon CAT + Technology Pavilion Annual Business Meeting NON AAOE General Session: Powered by Purpose PM-PROF The iPhone and iPad for Ophthalmologists (Basic) COM $ 2014 YO Program - It’s YO World, Jumpstart Your Career! NON + New Techniques for Strabismus Surgery PEDS + Diagnosis and Management of Essential Blepharospasm and PLAST + Hemifacial Spasm Surgical Management of Infectious Keratitis: Make It Simple COR + Selective Laser Trabeculoplasty: Basic Principles and Pearls for GLA + Practice Advanced Refractive Cataract Surgery and Anterior Segment CAT + Reconstruction Cosmetic Botulinum Toxin and Facial Fillers: An Introductory PLAST + Course Phacoemulsification and Advanced Techniques: The Core CAT + Curriculum
◆
◆
◆
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Programs-By-Day Sunday, Oct.19 (cont.) Type
No.
Title
Topic
$
◆
Room
Page
10:15 AM - 12:30 PM
SKILLS SKILLS
LEC114 LEC115
RET PLAST
+ ◆ +
E351 S106b
120 115
IC
151
GLA
+
E353b
74
IC IC IC
152 153 154
COR PLAST PLAST
+ + +
S103d S403a N135
66 84 84
IC IC IC IC IC IC
155 156 157 158 159 160
+ + ◆ + + + +
N427d E451a E353a E451b N140 S103a
89 59 59 91 91 91
IC
161
NEURO
+
S105d
80
IC IC
162 163
RET PLAST
+ +
N138 S403b
92 84
IC
164
RET
+
N139
92
IC
165
Macular OCT: Mastering the Basics Introduction to Aesthetic Facial Surgery by Fractional Lasers, Intense Pulsed Light, Radiofrequency, and Ultrasound Devices Examining the Optic Nerve and Evaluating the Visual Field: The 5 Rs Top 10 Hot Corneal Surgical Tips for 2014 Complete Guide to the Evaluation and Management of Ptosis Management of Orbital Tumors: Case Presentation and Discussion Solving the High Myopia Problem With Phakic IOLs Best of the Best: An Update in Cataract Surgery Cataract Surgery Crisis Management 101 OCT: Interpretation and Clinical Applications Retinoblastoma 2014: They Live and See! State-of-the-Art Techniques and Technologies for Microincision Vitrectomy Surgery to Treat Complex Vitreoretinal Diseases What You Need to Know About Headache: A Pain for the Patient and a Pain for the Doctor Surgery of Retinal Detachment Optimizing Outcomes and Minimizing Complications in Oculofacial Plastic Procedures: A Case-Based Approach Advances in Intraocular Endoscopic Surgery: Anterior and Posterior Segment Techniques White Dots, Spots, and Plaques: Making Sense of the Inflammatory Retinal Lesions: A Case-Based Approach ABC in Effective Ophthalmic Publishing Academy Café: Glaucoma Update on Molecular Analysis in Ophthalmic Disease Treatment for Wet and Dry AMD: Where We Are and Where We Are Going Update 2014: Infectious Keratitis
RET
+
S105a
92
MEDED GLA PATH RET
+
N136 S404 E350 S406a
80 122 126 126
IC 10:30 - 11:45 AM ACADCAFE 10:30 AM - 12:00 PM SYM SYM SYM
SYM07
SPOTLIT
SPO1
10:30 AM - 12:00 PM 10:30 AM - 12:30 PM
OP SKILLS
10:30 AM - 5:00 PM 11:00 AM - 12:00 PM 11:00 AM - 12:30 PM 11:30 AM - 12:30 PM
LL SKILLS SKILLS IC IC IC IC IC IC IC SYM
11:30 AM - 1:00 PM
215 SYM52 SYM05 SYM06
SKILLS
Spotlight on Pediatric Ophthalmology: Front Line and First Steps—Management of Strabismus for the Comprehensive Ophthalmologist OP01 Cataract Original Paper Session LAB106A Periocular Rejuvenation With Fillers and BOTOX on Silicone Head Simulators Learning Lounge LAB107A Crosslinking LAB116 Cataract Femtosecond Laser Surgery 169 Oculoplastic Procedures for the General Ophthalmologist 170 International (Dis)Agreement on Infectious Uveitis 171 Better Surgery Through Chemicals 172 Oculoplastic Office Procedures: Video Clips 173 Peering to the Periphery: Applications of Wide-Angle Retinal Imaging 174 Endothelial Keratoplasty: Descemet-Stripping EK / Descemet Membrane EK / Pre-Descemet EK—A Video-Based Course 175 Useful Things to Do With Your New EHR SYM59 The Food and Drug Administration/National Eye Institute/ Department of Defense LASIK Quality of Life Project LAB104A Management of the Vitreous for the Anterior Segment Surgeon
REF CAT CAT RET RET RET
◆ ◆ ◆
OPTIC
Programs-By-Day
Time
◆ Grand Ballroom 126 S100c ◆ Grand Ballroom 125 S100ab
PEDS CAT PLAST
$
COR CAT PLAST INTRA CAT PLAST RET
$ $ + + + + ◆ +
◆
COR
+
EHR REF
+
CAT
$
◆
S405 N229
146 106
Booth 107 N227b N230 S103bc E353c S105bc S102abc S104a
253 110 106 84 79 59 84 92
N427a
66
S102d E450
72 127
N228
106
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
37
Programs-By-Day Sunday, Oct.19 (cont.) Time
Programs-By-Day
11:30 AM - 5:00 PM
Type
No.
SPE
SPE10
12:00 - 2:00 PM
SKILLS
12:00 - 2:30 PM 12:15 - 1:45 PM
SKILLS SYM SPE
12:30-1:30 PM
PT
12:30 - 2:30 PM 12:45 - 1:45 PM
1:00 - 2:15 PM 1:00 - 3:00 PM 1:30 - 2:00 PM 1:30 - 3:00 PM
2:00 - 3:00 PM
2:00 - 3:15 PM
Fall Council Meeting
LAB101A Computerized Scanning Imaging of the Optic Nerve and Retinal Nerve Fiber Layer LAB117 Surgical Anatomy of the Eyelids: Cadaver Demonstration SYM08 Cataract Surgery: The Cutting Edge SPE11 2015 Medicare Update Scientific Poster Tours
SKILLS LAB103A Anterior Lamellar Keratoplasty: Principles and Practice SYM SYM09 Michael F Marmor MD Lecture in Ophthalmology and the Arts SYM SYM10 EHRs: Improve Quality, Cost-Effectiveness and Your Headaches SPE SPE13 Q&A with FDA ACADCAFE SYM53 Academy Café: Cornea, External Disease SKILLS LAB111A New Techniques for Strabismus Surgery SPE SPE14 OMIC Annual Members Meeting SKILLS LAB112A Cosmetic Botulinum Toxin and Facial Fillers: An Introductory Course SKILLS LAB113A Phacoemulsification and Advanced Techniques AAOEIC 178 Social Media Liability in Your Office AAOEIC 179 Defending the Ophthalmologist in a Medical Malpractice Lawsuit AAOEIC 180 Improving Workflow With EHR AAOEIC 181 Managing Practice Performance AAOEIC 182 Practice Mergers and “Division” or “Care Center” Based “Mega Groups” AAOEIC 183 What Every Administrator (and Optician) Needs to Know About the Retail Selling Process IC 187 Comprehensive Strategy for Unplanned Vitrectomy Technique for the Anterior Segment Surgeon IC 188 Controversies in the Management of Open-Globe Injuries Involving the Posterior Segment IC 196 Pearls for Evaluating Corneal Topography in Patients Scheduled for Cataract Surgery IC 197 Drug-Related Adverse Effects of Clinical Importance to the Ophthalmologist IC 198 Surgical Management of Astigmatism in Cataract and Refractive Surgery IC 200 Electronic Media and Patient Care: Ethical Considerations, Confidentiality, HIPAA, and Encryption IC 201 Optimizing Deep Anterior Lamellar Keratoplasty: The Small Bubble Technique IC 202 Pediatric Eye Emergencies You Don’t Want to Miss! IC 203 All White Dots Are Not the Same! Imaging Techniques in the Diagnosis and Management of Posterior Uveitis IC 207 Surgical Management of Complicated Retinal Detachments AAOEIC 550 ASC Nuts and Bolts of Transitioning ASC Ownership IC 607 Presentation Skills: How to Improve the Effectiveness of Lectures OP OP02 Intraocular Inflammation, Uveitis Original Paper Session SYM SYM12 Grand Rounds: Cases and Experts From Across the Nation SYM
38
Title
SYM47
The Great Debate: Retina
Topic
$
◆
$
PLAST CAT HP
$
Meeting PT COR NON EHR NON COR PEDS NON PLAST
Page
250 Fairmont Chicago, Millennium Park N231 111
GEN GLA
Room
N226 ◆ North Hall B ◆ Grand Ballroom S100c Hall A
164
$
N227b S406a S406b N427d S404 N230 S403b N229
110 127 127 250 122 118 251 115
CAT PM-RISK PM-RISK
$ + +
N228 S504bc S504d
107 272 272
PM-EHR PM-BUS PM-BUS
+ + +
S502ab S504a S505ab
274 267 267
PM-OPT
+
S503ab
277
CAT
+ ◆
E451a
59
RET
+
E352
92
CAT
+ ◆
S102abc
60
GEN
+
N136
74
CAT
+
S103bc
60
ETH
+
N427d
73
COR
+
S105d
66
PEDS INTRA
+ +
S403a S102d
87 79
RET PM-ASC MEDED
+ + +
S103a S501d N427a
93 267 80
INTRA GEN RET
$
115 127 250
◆
◆ $
◆ S405 155 ◆ Grand Ballroom 128 S100ab ◆ E450 128
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Programs-By-Day Sunday, Oct.19 (cont.) Time
2:00 - 3:30 PM
2:00 - 4:15 PM
2:30 - 3:45 PM 2:30 - 5:00 PM 3:00 - 5:00 PM 3:15 - 4:15 PM
3:15 - 5:30 PM
No.
SYM
SYM04
Title
A View Across the Pond: Current Cataract and IOL Practices in Europe and the United States SYM SYM13 Making a Bad Situation Better: Retinoblastoma and the Anophthalmic Socket SYM SYM14 Hot Topics 2014 SYM SYM15 Contemporary Management of Orbital Fractures: An International Perspective SPE SPE15 The Bruce E Spivey MD Lecture in Risk Management and Patient Safety and OMIC Forum SKILLS LEC118 Ab-Interno Approach to Schlemm’s Canal AAOEIC 176 Audits: It’s Not a Matter of If, but When IC 184 Angle Closure and Angle-Closure Glaucoma IC 185 Management of Malpositioned IOLs IC 186 Combined Cataract Surgery With Glaucoma Surgery: Guidelines, Indications, Methods, Techniques, and Postoperative Management IC 189 A Video Symposium of Challenging Cases and the Management of Intraoperative Complications During Cataract Surgery IC 190 Decoding the Uveitis Workup: Why, When, and What to Order IC 191 Ophthalmoscopic Evaluation of the Optic Disc and Retinal Nerve Fiber Layer IC 192 Practical Ocular Oncology for the Comprehensive Ophthalmologist: What You Should Know IC 193 Multifocal and Accommodative IOLs: Face the Challenge IC 194 Practical Considerations for Telemedicine Diabetic Retinopathy Screening IC 195 Complications and Growing Applications in Collagen Crosslinking: Diagnosis, Management, and Prevention IC 199 Advances in Treatment of Severe Ocular Surface Disease: Views From Experts on the Front Lines IC 204 Seeing Is Believing: Spectral Domain OCT and Clinicopathologic Correlation in Macular Diseases IC 205 Descemet Membrane Endothelial Keratoplasty IC 206 Pediatric Corneal Disorders: A Comprehensive Overview ACADCAFE SYM54 Academy Café: Retina SKILLS LAB119 Soft Contact Lens Fitting for the Practicing Ophthalmologist SKILLS LAB114A Macular OCT: Small Group Instruction IC 168 Vision and the Artist AAOEIC 211 Predictive Analytics: The New Face of Quality AAOEIC 212 Fundamentals of Creating an Ophthalmic / Optometric Vision Plan IC 216 How to Handle Pediatric Traumatic Cataract IC 217 Ocular Parasitoses: Diagnosis and Treatment AAOEIC 219 How to Create a Professional Development Program for Your Staff AAOEIC 220 Compliance and Quality of Care IC 543 Case Studies on the Use of Optical Coherence Tomography (OCT) for Diagnosis of Unknown Causes of Visual Loss: Is it the Retina, Anterior Visual Pathway, or Misinterpretation of Normal? SKILLS LEC120 Implantation of Glaucoma Drainage Devices SKILLS LEC121 Diabetes 2014: Course on Diabetic Retinopathy SKILLS LEC122 Microsurgical Suturing Techniques SKILLS LEC123 Endoscopic Forehead and Eyebrow Elevation
Topic
$
◆
Room
Page
CAT
◆
North Hall B
128
PATH
◆ Grand Ballroom 129 S100c ◆ S406a 129 ◆ E350 129
GEN PLAST PM-RISK
S406b
251
GLA PM-REMB GLA CAT GLA
+ + + + +
S103d S501abc S105bc E353b S403b
111 271 75 59 75
CAT
+
E451b
59
INTRA GLA
+ ◆ +
E351 N139
79 75
PATH
+
S105a
82
CAT RET
+ +
E353a N427bc
59 92
COR
+
N140
66
COR
+
S106a
66
RET
+
E353c
93
COR PEDS RET OPTIC RET HIST PM-BUS PM-MKT
+ + $ $ + + +
S106b N138 S404 N227a N231 S105d S502ab S504d
67 87 122 114 120 83 267 276
PEDS + GO + PM-PROF +
N136 S103a S504bc
87 78 278
PM-RISK NEURO
+ +
S503ab E352
273 81
+ + ◆ + +
S101ab S102abc S103bc N427a
112 120 107 115
GLA RET CAT PLAST
◆
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Programs-By-Day
2:00 - 4:00 PM
Type
39
Programs-By-Day Sunday, Oct.19 (cont.) Time
3:15 - 5:30 PM
Type
No.
SKILLS
LEC124
Programs-By-Day
SKILLS AAOEIC AAOEIC AAOEIC IC IC IC IC 3:30 - 5:30 PM
OP SKILLS SKILLS SKILLS SKILLS SYM
3:45 - 5:15 PM
3:45 - 5:20 PM 4:00 - 5:30 PM 4:30 - 5:30 PM
40
SYM
Title
Endothelial Keratoplasty Surgery: Comprehensive Overview and Surgical Pearls LEC125 Phakic IOLs 208 A Practical Guide to Understanding and Negotiating Your First Employment Agreement 209 Surgery Billing Made Easy for All Specialties 210 Human Resources and Your Practice: A Consultant’s Guide to Improved Performance 213 Advanced Techniques With Laser Cataract Surgery 214 Atypical Keratitis 218 Femtosecond Cataract Surgery: Exploring the Limits 326 Pediatric Vitreoretinal Disorders: Current and Future Management OP03 Cornea, External Disease Original Paper Session LAB102A Endothelial Keratoplasty Techniques LAB110A Advanced Refractive Cataract Surgery and Anterior Segment Reconstruction LAB115A Introduction to Aesthetic Facial Surgery by Fractional Lasers, Intense Pulsed Light, Radiofrequency, and Ultrasound Devices LAB126 Workshop in Flap Techniques in Oculoplastic Surgery SYM16 Tumors of the Brain and Orbits: Neuro-Ophthalmic Considerations SYM17 Adult Strabismus: Techniques to Alleviate Visual Discomfort
SYM
SYM18
SYM SPOTLIT
SYM19 SPO2
OP SKILLS SKILLS AAOEIC AAOEIC AAOEIC AAOEIC AAOEIC
OP04 LAB127 LEC128 221 222 223 224 225
IC IC IC
226 227 228
IC IC
229 230
IC
231
IC IC IC IC IC IC IC
232 233 234 235 236 237 238
Structuring a Part-time Practice in the Evolving Medical Environment: How to Make It Work Ocular Drug and Gene Delivery to the Posterior Segment Spotlight on Glaucoma: Medical and Surgical Management for the Comprehensive Ophthalmologist Cataract Original Paper Session Workshop in Techniques of Lacrimal Intubation Endoscopic Transnasal Lacrimal Surgery: Principles and Practice ICD-10-CM: Simplifying the Complex Managing Generation Y Employees Business Strategies for the New Era Identifying and Developing Trainers Better Results from Bad Complications: Risk Management to Avoid Lawsuits and Licence Investigations Pediatric Uveitis: What You Need to Know Pediatric Ocular Tumors Top 10 Essentials of Gonioscopy: 3-D Viewing and Interpretation Intraocular Foreign Body Injuries: An Update Ocular Surface Diseases in Cancer Patients: Update on Clinical Spectrum and Treatment Swollen Disks, Headache, and Vision Loss: A Case-Based Approach to Pseudotumor Cerebri Gonioscopy and Angle Imaging Conjunctival Autografting in Pterygium Surgery, Simplified Toxic Anterior Segment Syndrome Following Cataract Surgery EHR and Meaningful Use for the Small Practice: Is It Worth It? Allergic Eye Disease: An Enigma for Physicians Identifying and Managing Unhappy Patients From Front to Back: Managing Posterior Segment Sequelae of Anterior Segment Surgery
Topic
$
Room
Page
COR
+
S104b
110
REF + PM-PROF +
N427d S504a
119 278
PM-REMB + PM-HMR +
S505ab S501d
271 275
◆
CAT COR CAT RET
+ ◆ + + +
E451a S102d S104a S403a
60 67 60 93
COR COR CAT
◆ $ $
S405 N227b N228
149 109 106
PLAST
$
N230
115
PLAST NEURO
$
GEN
N226 ◆ Grand Ballroom S100ab ◆ Grand Ballroom S100c ◆ S406a
RET GLA
◆ ◆
E450 North Hall B
131 130
◆
PEDS
116 130 131 131
CAT PLAST PLAST PM-REMB PM-HMR PM-BUS PM-HMR PM-RISK
$ + + + + + +
E350 N229 N427bc S406b S502ab S504d S501abc S503ab
147 116 116 271 275 267 275 273
PEDS PATH GLA
+ + +
N140 N139 S105bc
87 82 75
RET COR
+ ◆ +
E351 E353c
93 67
NEURO
+
E352
81
GLA COR CAT EHR COR GEN CAT
+ + + + + + +
S403b S105a E451b E353a S106a S106b N138
75 67 60 73 67 74 60
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Programs-By-Day Sunday, Oct.19 (cont.) Time
4:30 - 5:30 PM
No.
IC IC IC
239 240 241
IC
242
IC
243
AAOEIC
244
Title
Topic
Evaluation and Treatment of Facial Nerve Palsy PLAST Open Sesame: Dealing With the Small Pupil CAT Optimizing the Aesthetic Appearance of the Anophthalmic PLAST Socket Improving Outcomes in Refractive Cataract Surgery With CAT Intraoperative Aberrometry Utilizing Streaming Refractive Data Glued IOL: Scleral Fixation of Posterior Chamber IOL Without CAT Sutures in Absence of Capsular Support Meaningful Use Stage 2, and How to Survive a Meaningful Use PM-EHR Audit
$
Room
Page
+ + +
S105d N136 S103a
84 61 84
+
E353b
61
+
S103d
61
+
S504bc
274
◆
Programs-By-Day
Type
Monday, Oct. 20 (cont.) Time
7:30 - 8:30 AM 7:30 - 9:30 AM 7:30 - 10:00 AM 8:00 - 9:30 AM
Type
No.
8:00 - 10:00 AM
BWE SKILLS SKILLS SKILLS SKILLS SKILLS
LAB122A LAB123A LAB113B LAB118A LAB129
8:00 - 10:30 AM 8:15 AM - 12:15 PM
SKILLS SPOTLIT
LAB121A SPO3
8:30 - 9:30 AM
SYM
SYM24
8:30 - 9:45 AM 8:30 - 10:00 AM
ACADCAFE SYM
SYM55 SYM21
SYM
SYM22
SYM SYM
SYM23 SYM44
SKILLS SYM AAOEIC
LAB130 SYM25 300
AAOEIC AAOEIC AAOEIC IC IC IC IC IC
302 303 305 313 320 321 323 324
IC
325
AAOEIC SKILLS
328 LEC131
SKILLS
LEC132
8:30 - 10:30 AM 8:30 - 11:00 AM 9:00 - 10:00 AM
9:00 - 11:15 AM
Title
Breakfast With the Experts Roundtables Microsurgical Suturing Techniques Endoscopic Forehead and Eyebrow Elevation Phacoemulsification and Advanced Techniques Ab Interno Approach to Schlemm’s Canal Oculoplastic Surgery: Anatomic Foundations, Surgical Techniques, and Enhanced Results Diabetes 2014: Workshop on Diabetic Retinopathy Spotlight on Cataracts: Clinical Decision-making With Cataract Complications Best of NANOS 2014: Featuring Best Papers from the North American Neuro-Ophthalmology Society Academy Café: Uveitis Leveraging Technology and the Educational Team The Affordable Care Act: Present and Future Prospects for Ophthalmology Oculoplastics Oncology Update A View Across the Pond: Retina The iPhone and iPad for Ophthalmologists (Advanced) Global Forum: Global Research Income Division for Group Practices: Structuring Appropriate Physician Compensation Arrangements Three Areas of Succession Planning for Senior Physicians ASC Administration, Operations, and Procedures Health Law From the Patient Perspective Glaucoma Filtration Device Mini-shunt: Friend or Foe? Protecting Your Online Image Scleral Buckling Surgery: A Forgotten Art! Google Hangouts for Free Videoconferencing Managing White Cataracts: Conventional and Femto-Assisted Phacoemulsification Nano-Ophthalmology: State of the Art, Practical Applications and Perspectives Financial Management of Your Practice International Society of Refractive Surgery Laser Refractive Surgery Course Manual Extracapsular Cataract Extraction Surgery: Indications and Techniques
Topic
$
CAT PLAST CAT GLA PLAST
$ $ $ $ $ $
Room
Page
Hall A N227b N229 N228 N230 N226
51 107 116 107 112 116
◆
N231 North Hall B
120 132
NEURO
◆
S405
133
INTRA MEDED
◆ S404 122 ◆ Grand Ballroom 133 S100c ◆ S406a 133
RET CAT
$
HP PLAST RET
◆
134 134
COM GO PM-BUS
◆ E350 ◆ Grand Ballroom S100ab $ N227a S101ab + S501abc
PM-PROF PM-ASC PM-RISK GLA COM RET COM CAT
+ + + + + + + +
S501d S504d S504a S105bc N427a S106a N427d E352
278 267 273 76 65 94 65 61
CAT
+
S103a
61
PM-BUS REF
+ +
S503ab N138
268 119
CAT
+
S102d
108
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
109 134 267
41
Programs-By-Day Monday, Oct. 20 (cont.) Time
9:00 - 11:15 AM
Type
No.
SKILLS AAOESP
LEC133 SPE16
Programs-By-Day
AAOEIC AAOEIC IC IC IC IC IC IC IC IC IC IC IC IC IC IC
9:00 AM - 5:00 PM 9:30 AM - 5:00 PM 10:00 - 11:30 AM 10:15 - 11:15 AM
10:15 - 11:30 AM 10:15 - 11:45 AM
IC LL TP SKILLS SKILLS AAOEIC AAOEIC AAOEIC IC AAOEIC SYM SYM SYM
10:15 AM - 12:30 PM
SKILLS SKILLS AAOEIC IC IC
42
Title
The Surgical Correction of Astigmatism PQRS, Value Based Modifier, Meaningful Use and Sequestration: Bonus and Penalties for 2014 and Beyond 301 Steps for Successful Retina Coding 304 Our Biller Is Leaving! How Do I Handle This Situation and Come Out Ahead? 306 Medical and Surgical Therapy and Diagnosis of Uveitis 307 Systemic Therapeutic Agents and Retinal Toxicity 308 Ocular Surface Disease Management: Moving From Adequate to Expert 309 Review of Clinical Optics 310 Glaucoma Postop Care in the Office: A Video Compendium of Techniques—When and How to Intervene 311 What’s New and Important in Pediatric Ophthalmology and Strabismus for 2014 312 Update on Treatments for Diabetic Retinopathy: Clinically Relevant Results From the Diabetic Retinopathy Clinical Research Network 314 Danger Zone: Refractive Surgery Nightmares and Worst-Case Scenarios: A Video-Based Course 315 Tackling Weak Zonules and Using Capsular Tension Devices 316 Canal-Based Glaucoma Surgery: Canaloplasty vs. Microstent Implantation—Everything You Want to Know 317 Help! A Corneal Ulcer Just Walked In! What Do I Do Next? 318 Diagnosis and Treatment of Polypoidal Choroidal Vasculopathy 319 Spectral Domain OCT Interpretation for the General Ophthalmologist 322 Diagnosis and Management of Ocular Surface Disease due to Systemic Conditions 327 Critical Issues in Management of Ocular Trauma Learning Lounge Technology Pavilion LAB118B Ab Interno Approach to the Schlemm Canal LEC136 Fat Grafting and Volume Restoration 329 Managing Up! 332 Simplifying EHR Security Audits 333 Red 80! Set! Lead! Leadership Lessons From a Football Coach 338 Vitreoretinal Tips for the Comprehensive Ophthalmologist: When to Watch, Treat, or Refer 339 Incorporating the Four Agreements Into Your Practice SYM41 Best of Anterior Segment Specialty Meetings 2014 SYM26 Clinical Pearls in the Diagnosis of Masquerades in Infectious and Inflammatory Disease of the Eye SYM28 New Frontiers of the Vitreoretinal Interface: Where Worlds Collide LEC134 Computerized Perimetry Lecture: Visual Field Testing and Interpretation, Emphasizing Glaucoma LEC135 Schlemm Canal Surgery: From the Outside In 331 Do You Know Your Cornea From Your Retina? Ocular Anatomy and Physiology for Beginners 334 Current Topics in Cornea / External Disease: Highlights of the Basic and Clinical Science Course 8 335 Retinal and Choroidal Manifestations of Selected Systemic Diseases 2014
Topic
$
Room
Page
REF + PM-REMB
N427bc S505ab
119 280
PM-REMB + PM-BUS +
S504bc S502ab
271 268
◆
INTRA RET COR
+ + + ◆
S103d S106b E351
79 93 67
OPTIC GLA
+ +
N140 S104a
83 75
PEDS
+
S403a
87
RET
+ ◆
S102abc
93
REF
+
S105d
89
CAT GLA
+ +
E451b S105a
61 76
COR RET RET
+ + + ◆
N136 S406b E451a
68 94 94
COR
+
S104b
68
GEN
+
GLA PLAST PM-HMR PM-EHR PM-PROF RET
$ + + + + +
N139 Booth 107 Booth 165 N230 S103a S501abc S503ab S504d N427a
74 253 258 112 117 275 274 278 94
PM-PROF + S504a ◆ GEN S406a ◆ Grand Ballroom INTRA S100ab ◆ Grand Ballroom RET S100c GLA + S105bc
275 135 135
112
GLA PM-PROF +
N427d S501d
113 278
136
COR
+
E352
68
RET
+
S106a
94
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Programs-By-Day Monday, Oct. 20 (cont.) Type
No.
Title
Topic
$
10:15 AM - 12:30 PM
IC
336
Lotions, Potions, Botulinum Toxin, and Fillers: Nonlaser Rejuvenation for the Ophthalmologist IOL Implantation in the Absence of Capsular Support Academy Café: Oculoplastics Phakic IOLs Endothelial Keratoplasty Surgery: Comprehensive Overview and Surgical Pearls Adjusting to the Changing Demographic: Valuing the Patient in Determining Options for Treatment Pediatric Ophthalmology, Strabismus Original Paper Session Endoscopic Transnasal Lacrimal Surgery: Principles and Practice Basic Oculoplastic Surgery How to Use Free Technology to Add Interactivity to Face-to-Face Lectures and Presentations Advanced Techniques in Orbital Decompression and Expansion Budgeting for the Ophthalmology Practice Ophthalmology Practice Buy-Ins and Payouts Lean Interactive Workshop for Clinic Process Improvement Battling Information Overload: What Reports Do Owners and Administrators Need? E&M vs. Eye Codes: Who Is the Winner? Strategies for Patient Access in a Consolidating World Asian Blepharoplasty and the Eyelid Crease: Challenges and Solutions: A Video-Complemented Course Evolution’s Witness: How Eyes Evolved Simplifying Treatment of Diabetic Retinopathy for the Comprehensive Ophthalmologist: What You Really Need to Know in 2014 Retinal OCT Interpretation 101 Diplopia After Cataract and Refractive Surgery Contact Lens in Ophthalmology Practice Visual Fields in Neuro-Ophthalmology Refractive Lensectomy: Indications, Lenses, Formulas, Outcomes Update on Intrastromal Corneal Ring Segments Approach to Genetic Eye Diseases for the Comprehensive Ophthalmologist Ocular Surface Disease and Glaucoma Genetics of AMD: Concepts and Controversy Phototherapeutic Keratectomy for the Treatment of Anterior Corneal Pathology An Introduction to Error Disclosure for Ophthalmologists Corneal Edema, Opacification and Ectasia: Diagnostic and Treatment Strategies From the Preferred Practice Pattern Guidelines Third World Cataracts in the First World Setting Meaningful Use Stage 2: Qualifying for Payment Mycotic Keratitis: Novel Strategies Against Emerging Pathogens Hanging a Shingle in the 21st Century: Is a Start-up Solo Practice Possible in 2015? Is It Time to Replace Gonioscopy by Anterior Segment Imaging in the Diagnosis and Management of Angle-Closure Glaucoma? Innovation in Ophthalmology: From Theory to Therapy
PLAST
+
CAT PLAST REF COR
+
IC 337 10:30 - 11:45 AM ACADCAFE SYM56 10:30 AM - 12:00 PM SKILLS LAB125A 10:30 AM - 12:30 PM SKILLS LAB124A 10:45 - 11:45 AM 11:00 AM -12:00 PM 11:00 AM - 1:30 PM 11:30 AM - 12:30 PM
11:30 AM - 1:30 PM 12:15 - 1:45 PM
SYM
SYM29
OP SKILLS SKILLS SKILLS
OP05 LAB128A LAB137 LAB138
SKILLS AAOEIC AAOEIC AAOEIC AAOEIC
LEC139 330 340 341 342
AAOEIC AAOEIC IC
343 344 345
IC IC
346 347
IC IC IC IC IC
348 349 350 351 352
IC IC
353 354
IC IC IC
355 356 357
IC IC
358 359
IC IC IC
360 361 362
AAOEIC
363
SKILLS
LAB140
SYM
SYM30
Room
Page
S403b
85
S103bc S404 N228 N227b
61 122 119 111
◆
E350
136
◆
◆
◆ $ $
GEN PEDS PLAST PLAST MEDED
$ $ $
S405 N229 N226 N227a
157 116 117 109
PLAST PM-BUS PM-BUS PM-BUS PM-BUS
+ + + + +
N138 S504d S504a S502ab S504bc
117 268 268 268 268
S503ab S501abc S104a
271 276 85
+ +
S103d S102abc
83 94
RET PEDS COR NEURO REF
+ + + + ◆ +
E451b N427bc S105a E351 S403a
95 88 68 81 89
COR PEDS
+ + ◆
S105d E451a
68 88
GLA RET REF
+ + +
S104b N427a N136
76 95 90
ETH COR
+ +
S106b S102d
73 68
CAT EHR COR
+ + +
N140 N139 S103a
62 73 69
PM-BUS
+
S505ab
268
GLA
$
N231
113
PM-REMB + PM-MKT + ◆ PLAST + HIST RET
MEDED
Programs-By-Day
Time
◆ Grand Ballroom 136 S100c
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
43
Programs-By-Day Monday, Oct. 20 (cont.) Time
Type
No.
SYM31 SYM32
12:30 - 1:30 PM
SYM SYM PT
Telehealth is in Your Future Beyond Ophthalmology Scientific Poster Tours
12:30 - 1:30 PM
SPE
SPE17
12:30 - 2:30 PM 12:45 - 1:45 PM
SKILLS SPE SPE SYM
LAB120A SPE12 SPE18 SYM33
SYM
SYM34
SYM
SYM35
1:00 - 2:30 PM
SKILLS
LAB132A
1:30 - 2:30 PM
SKILLS
LAB141
1:30 - 3:00 PM 2:00 - 3:00 PM
SKILLS SYM AAOEIC AAOEIC AAOEIC
LAB133A SYM27 364 365 366
AAOEIC
367
AAOEIC AAOEIC AAOEIC IC IC
368 369 370 375 376
IC IC
377 385
IC IC
389 390
IC
391
IC
395
AAOEIC SYM SPOTLIT
396 SYM40 SPO4
SYM
SYM43
OP SYM
OP06 SYM39
Welcome to the Real World: Reality 101 for Residents and Fellows Implantation of Glaucoma Drainage Devices Ergonomics/Musculoskeletal Disorders in Ophthalmologists Visual Impact of Traumatic Brain Injury: Lessons Learned Dr. Allan Jensen and Claire Jensen Lecture in Professionalism and Ethics Why Take the Risk? How to Create an Effective Risk Management Strategy With Patient Education and Informed Consent Documents Management of Retinal Breaks and Idiopathic Macular Holes: Latest Diagnostic and Treatment Strategies from the New Preferred Practice PatternÆ Guidelines Manual Extracapsular Cataract Extraction Surgery: Indications and Techniques An Innovative Approach to Iris Fixation of an IOL Without Capsular Support: Hands-on and Practical The Surgical Correction of Astigmatism Ethics and Professionalism: Why Should I Care? CodeFest Practice Valuations: What’s a Practice Worth Today? Seven Key Differences Between Thriving Practices ... and Average Practices Physician Provider Cooperatives a New Concept in Health Care Delivery The Urge to Merge: When Two or More EHRs Collide Management and Dashboard Reporting for the Retina Practice How to Build and Manage a Dispensary’s Frame Inventory Artificial Iris Implantation Visual Electrophysiology Testing: Principles and Clinical Applications Tips for Cosmetic Eyelid Surgery in Asian Patients Anterior Segment Imaging: A Practical Guide for Ophthalmologists Genetic Testing in Ophthalmology Adult Uveal Tumors: A Systematic Approach for the General Ophthalmologist Ocular Chronic Graft vs. Host Disease: Update and Case Studies for Clinicians Inadequate Capsular Support and IOL Fixation: Techniques From the Vitreoretinal Surgeon’s Toolbox Negotiating Payer Contracts in Today’s Health-care Environment Pediatric Vision Rehabilitation Spotlight on Neuro-Ophthalmology: Things You Don’t Want to Miss Lessons Learned from Recent Clinical Trials on Diabetic Retinopathy Cornea, External Disease Original Paper Session Challenges in Cataract Surgery: Gems to Take Home and Treasure
Programs-By-Day
12:15 - 1:45 PM
2:00 - 3:30 PM
2:00 - 4:00 PM
44
Title
Topic
$
COM HIST Meeting PT GEN GLA GEN GEN ETH
◆
Room
Page
◆
S405 S406b Hall A
137 137 164
S101ab
251
N230 N427bc S102abc S406a
112 251 251 137
S403b
137
E350
138
$ ◆ ◆
GEN RET
◆
CAT
$
N228
108
CAT
$
N227a
108
REF ETH PM-REMB PM-BUS PM-MKT
$ + + +
N227b S406a S505ab S501d S501abc
120 138 271 269 276
PM-BUS
+
S503ab
269
PM-EHR PM-BUS PM-OPT CAT RET
+ + + + +
S504a S504bc S504d N427d N138
274 269 277 62 95
PLAST COR
+ +
N427bc S104a
85 69
GEN PATH
+ +
N136 S106a
74 82
COR
+
S104b
69
CAT
+
E352
62
PM-RISK VIS NEURO
+
RET COR CAT
◆
S502ab ◆ E350 ◆ Grand Ballroom S100ab ◆ Grand Ballroom S100c ◆ S405 ◆ North Hall B
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
273 138 138 139 151 139
Programs-By-Day Monday, Oct. 20 (cont.) Time
2:00 - 4:15 PM
2:30 - 5:00 PM
3:00 - 5:00 PM 3:15 - 4:15 PM
3:15 - 5:30 PM
No.
Title
Topic
$
Room
Page
IC
371
RET
+
IC IC IC IC IC
372 373 374 378 379
IC IC
380 381
IC
382
IC
383
IC IC IC
384 386 387
IC
388
IC OP SKILLS
393 OP07 LAB134A
SKILLS SKILLS SPE SKILLS AAOEIC
LAB139A LAB142 SPE19 LAB135A 397
AAOEIC
398
AAOEIC AAOEIC AAOEIC AAOEIC IC
400 401 402 403 407
IC IC SKILLS SKILLS
408 409 LEC143 LEC144
SKILLS SKILLS AAOEIC
LEC145 LEC146 399
IC IC
404 405
IC
406
AAOEIC
410
Principles of Pediatric Retinal Surgery in Pediatric Retinal Diseases Other Than ROP Conquering Capsule Complications: A Video Primer Periocular Tumors and Techniques of Eyelid Reconstruction Advanced Evidence-Based Management of Diabetic Retinopathy Diagnostic and Therapeutic Dilemmas in Neuro-Ophthalmology Stereo Anatomy of the Orbit, Eyelid, and Lacrimal System: A Surgeon’s Perspective A Step-by-Step Primer to Starting LASIK in 2014 ROP Screening and Treatment: What You Wanted to Know but Were Afraid to Ask (Intermediate/Advanced) Understanding Nystagmus: A Practical Approach for the Clinician The Boston Keratoprosthesis: Case-Based Presentations Highlighting the Essentials for Beginning and Experienced Surgeons The ABCs of AMD for Comprehensive Ophthalmologists Fundamentals of Anterior Segment Reconstruction Managing Angle-Closure Glaucoma With Crystalline Lens Removal and Adjunctive Procedures Posterior Segment Complications of Anterior Segment Surgery: Prevention and Management Surgical Management of Pediatric Glaucoma Glaucoma Original Paper Session Computerized Perimetry Lab: Visual Field Interpretation, Emphasizing Glaucoma Advanced Techniques in Orbital Decompression and Expansion Enucleation and Evisceration: Hands-On Practical Pearls SO Special Program and Reception Schlemm Canal Surgery: From the Outside In American Academy of Ophthalmic Executives Book Club: Professional Growth and Development Employee Discipline for the Smaller Practice: The New Manager, the Seasoned Manager, and the Doctor How Do You Know Your Revenue Cycle Really Is Efficient? Flow and Efficiency With the Femtosecond Laser Space Planning: A Guide to the Effective Ophthalmic Facility How to Survive the Endless Money Pit of EHR Surgical Education: Improving Upon and Going Beyond the Apprentice Model Diagnosis and Management of Corneal Endothelial Diseases Controversies in the Management of Corneal Infections Toric Alignment Imaging and Astigmatism Surgery Glaucoma Laser Therapy: Innovations and Advice From the Experts Glaucoma Filtration Surgery Fundamental Facelifting Techniques Compliance FAQs and NSFAQs (Not So Frequently Asked Questions) How to Evaluate a Patient With Uveitis Mystery Retina 2014: Interactive Discussion of Challenging Cases Code Red: Mastering Phaco Nightmares and Worst-Case Scenarios: A Video-Based Course Retina-Specific Panel Discussion: Ask Your Peers
N139
95
+ + + + ◆ +
E451b S103a S105bc E351 S102d
62 85 95 81 85
REF PEDS
+ +
S103bc N140
90 88
NEURO
+
S105d
81
COR
+
S103d
69
RET CAT GLA
+ ◆ + +
E451a S403a S403b
95 62 76
CAT
+
S105a
62
PEDS GLA GLA
+
S106b S404 N231
88 152 112
PLAST PLAST NON GLA PM-PROF
$ $ $ +
N229 N226 S101ab N230 S504bc
117 117 251 113 278
PM-HMR +
S503ab
275
PM-BUS PM-OPT PM-BUS PM-EHR MEDED
+ + + + +
S501d S504a S505ab S504d N136
269 267 269 274 80
COR COR CAT GLA
+ + + +
S104a N427a N427bc S106a
69 69 108 113
GLA PLAST PM-RISK
+ + +
S104b N427d S502ab
113 118 273
RET
+ +
E352 S406b
79 96
CAT
+ ◆
S102abc
63
+
S501abc
269
CAT PLAST RET NEURO PLAST
PM-BUS
◆
◆ $
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Programs-By-Day
2:00 - 5:30 PM 2:30 - 4:30 PM
Type
45
Programs-By-Day Monday, Oct. 20 (cont.)
Programs-By-Day
Time
46
Type
No.
Title
3:30 - 4:30 PM
SKILLS
LAB147
3:30 - 5:30 PM
SKILLS
3:45 - 5:00 PM
SKILLS SYM
3:45 - 5:00 PM 3:45 - 5:15 PM
SYM OP SYM
SYM36 OP08 SYM37
Best of the Posterior Segment Specialty Meetings 2014 Oculoplastics Original Paper Session Pediatric Orbital Disease
4:30 - 5:30 PM
SYM AAOEIC
SYM38 411
AAOEIC AAOEIC AAOEIC AAOEIC AAOEIC IC
412 413 414 415 416 417
IC
418
IC
419
IC
420
IC IC IC
421 422 423
IC IC IC IC
424 425 426 427
IC
429
IC IC IC IC IC
430 431 432 433 606
Funding Our Future: Making Investments in Ophthalmology Smile… Even If It Kills You: Training for Excellent Customer Service Financial Decision Making in the Eye Care Practice Coding for Ophthalmic Testing Services Managing Your Online Reputation What Happens After an EMR Implementation? How to Hire, Train, and Manage your Staff Complex Endothelial Keratoplasty: Current Strategies to Improve Results and Avoid Complications Intraoperative Floppy Iris Syndrome: Pearls for Management and Prevention Cell Biology, Genetics, and Outflow in Glaucoma in 2014: Impact on Practice Femtolaser: Diagnosis and Management of Intraoperative and Postoperative Complications With the Use of a Femtosecond Laser for LASIK Surgery Normal-Tension Glaucoma: Evaluation and Treatment Basic Browlift: Principles and Techniques Follow the Cornea: Do You Know Where Your Corneal Transplant Tissue Comes From? Diagnosis and Management of Corneal Perforation Cut, Lift and Fill: Three-Way Path to a 3-D Rejuvenation Scleritis: What to Order and How to Treat It! IOL Implantation and Repositioning Techniques for the Vitreoretinal Surgeon Less Than Perfect Outcomes After Uneventful Cataract Surgery: What Are We Missing? Enhancement and Retreatment After Refractive Surgery Refining the Refractive Error After Premium IOLs Diagnosis and Management of Acanthamoeba Keratitis Congenital Ptosis Simplified Resident, Faculty and Program Assessment: Principles & Best Practices
An Innovative Approach to Iris Fixation of an IOL Without Capsular Tension Support LAB110B Advanced Refractive Cataract Surgery and Anterior Segment Reconstruction LAB131A Laser Refractive Surgery SYM11 The Great Debate: Cornea
Topic
$
Room
Page
CAT
$
N227a
108
CAT
$
N228
107
REF COR
$
◆
140 156 141
HP PM-MKT
N227b ◆ Grand Ballroom S100ab ◆ S406a ◆ S405 ◆ Grand Ballroom S100c ◆ E350 + S505ab
PM-BUS PM-REMB PM-MKT PM-EHR PM-HMR COR
+ + + + + +
S501d S504bc S503ab S504d S504a S105d
269 272 277 274 276 70
CAT
+ ◆
E451a
63
GLA
+
S103a
76
REF
+
S103bc
90
GLA PLAST COR
+ + ◆ +
E451b E351 N139
76 85 70
COR PLAST COR RET
+ + + +
S106b S103d S102d N427a
70 85 70 96
CAT
+
S403a
63
REF CAT COR PLAST MEDED
+ + + + +
S105a N136 S403b S104a N140
90 63 70 86 80
RET PLA PEDS
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
119 139
141 277
Programs-By-Day Tuesday, Oct. 21 (cont.) Time
Type
No.
BWE SKILLS
LAB132B
8:00 - 10:00 AM
SKILLS SKILLS SKILLS
LAB136A LAB131B LAB144A
8:30 - 10:00 AM
SYM
SYM42
SYM
SYM45
SYM
SYM60
OP SYM
OP09 SYM46
OP AAOEIC AAOEIC AAOEIC AAOEIC IC IC IC IC IC IC IC IC AAOEIC AAOEIC
OP10 501 503 504 505 506 513 514 517 518 519 522 524 525 526
AAOEIC
530
AAOEIC IC
500 507
IC IC IC
508 509 510
IC
511
IC IC IC
512 515 516
IC IC IC IC LL
520 521 523 605
8:30 - 10:15 AM 8:30 - 10:30 AM 8:30 AM - 12:45 PM 9:00 - 10:00 AM
9:00 - 11:15 AM
9:00 AM - 12:00 PM
Title
Breakfast With the Experts Roundtables Manual Extracapsular Cataract Extraction Surgery: Indications and Techniques Fat Grafting and Volume Restoration Laser Refractive Surgery Glaucoma Laser Therapy: Innovations and Advice From the Experts Focus on Practice Efficiency: How to Deal Effectively with Increasing Patient Volume of the Aging Population The Battle of Glaucoma: How to Diagnose, Assess, and Manage Glaucoma That is Getting Worse Ophthalmic Premier League: A Team Video Competition on Managing Cataract Complications Refractive Surgery Original Paper Session Advanced Treatment of Ocular Surface Inflammatory Diseases Retina, Vitreous Original Paper Session Practice Problems: Practical Solutions Work/Life Balance: Unrealistic Expectation or Achievable Goal? Top 20 Tips for Optimal Billing Is Cloud Computing the Future of EHR? Management of Strabismus in Thyroid Eye Disease Controversies and Advances in Pediatric Oculoplastic Surgery Argon Laser Peripheral Iridoplasty: All You Need to Know Global Trends in Retina: Learning From Each Other Refractive Surgical Complications and Solutions Intraocular Tumor Biopsy: The How, Why, and Why Not? Reading, Dyslexia, and Vision Therapy Keratoconus: The 2014 Protocol Deciphering Financial Reports A Review of Facility Regulatory Requirements for CMS Accreditation X,Y, Boom!: Supercharge Your Management of Employees and Patients Through Awareness of Generational Differences Comprehensive Cataract Coding How to Successfully Accomplish Endothelial Keratoplasty in the Presence of Significant Ocular Comorbidities Low Vision Rehabilitation for Ophthalmologists Emergency Neuro-Ophthalmology: Diagnosis and Management Tubes, Ties, and Videotape: Surgical Video of Baerveldt Glaucoma Implants and Managing Complications Herpes Simplex Keratitis: When Herpes Isn’t a Dendrite, and Vice Versa Advanced Vitreoretinal Surgical Techniques Curbside Consults in Neuro-Ophthalmology A Genetic Approach to Inherited Retinal Dystrophies: Clinical Classification of Common Retinal Dystrophies, Genotyping, and Gene Therapy Complex Corneal Clinics: Logical Solutions Update on Lacrimal Surgery Controversies in Ocular Oncology Evidence-Based Guidelines in the Management of Glaucoma Learning Lounge
Topic
$
Room
Page
CAT
$ $
Hall A N228
51 108
PLAST REF GLA
$ $ $
N229 N227b N230
117 119 113
HP
◆
GLA
◆ Grand Ballroom 141 S100c ◆ S406a 142
CAT
◆
REF COR
◆ S404 ◆ Grand Ballroom S100ab ◆ S405 S504a S504bc S502ab S504d S103bc S103d S105bc N427a S102d N136 S104a S103a S501abc S501d
RET PM-BUS PM-PROF PM-BUS PM-EHR PEDS PLAST GLA GO REF PATH PEDS COR PM-BUS PM-BUS
+ + + + + + + + + + + + + +
North Hall B
142 158 143 160 270 279 270 275 88 86 76 79 90 83 88 71 270 270
PM-HMR +
S505ab
276
PM-REMB + COR +
S503ab S106a
272 70
VIS NEURO GLA
+ + +
S101ab S406b S403a
97 81 76
COR
+
N138
71
E451a N427bc S105d
96 82 96
S403b S106b S104b N139 Booth 107
71 86 83 77 253
RET NEURO RET
+ ◆ + +
COR PLAST PATH GLA
+ + + +
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Programs-By-Day
7:30 - 8:30 AM 8:00 - 9:30 AM
47
Programs-By-Day Tuesday, Oct. 21 (cont.) Time
No.
TP AAOEIC AAOEIC AAOEIC AAOEIC AAOEIC AAOEIC IC IC IC IC IC
502 527 528 529 531 532 535 536 540 541 544
Title
Technology Pavilion Revenue Cycle Reimbursement Strategies Strategic Planning by Fact Making the Most With Modifiers EHR: “Great Expectations” LED) ANCE Divorcing Medicare Commercial Insurance (Cand HIPAA Compliance - Now That There is HITECH Evaluation and Management of Orbital Cellulitis Case-Based Approach to Isolated Eye Pain Myasthenia Gravis or Not? Surgical Simulators: Tool or Toy? OCT in Glaucoma: What’s Real Disease and What’s Red Disease? AAOEIC 545 How ObamaCare Taxes Affect You: New Taxes, Hikes, Breaks, Credits, and Other Changes 10:15 - 11:45 AM SYM SYM48 Decision Making in Contemporary Refractive Surgery 10:15 AM - 12:30 PM SKILLS LEC149 Blepharoplasty SKILLS LEC150 Surgery for Severe Corneal and Ocular Surface Disease IC 533 Learning Phaco Chop: Pearls and Pitfalls IC 534 Managing Your EHR After Implementation IC 537 Corneal Topographic Analysis and Anterior Segment Imaging: Pearls for Your Clinical Practice IC 538 Retinal Pharmacotherapy IC 539 A Video Bouquet of Phaco Complications That Should Never Have Occurred, With Tips on Damage Control and Prevention to Optimize Postoperative Outcome IC 542 Personalized Cataract Surgery: Femtosecond, Advanced Technology IOLs, and New Devices 10:30 - 11:45 AM ACADCAFE SYM57 Academy Café: Cataract 10:30 AM - 12:00 PM SKILLS LAB113C Phacoemulsification and Advanced Techniques Lab 10:30 AM - 12:30 PM SKILLS LAB143A Toric Alignment Imaging and Astigmatism Surgery 10:45 - 11:45 AM SYM SYM49 International Opportunities for Young Ophthalmologists
Programs-By-Day
9:30 AM - 12:30 PM 10:15 - 11:15 AM
Type
48
10:45 AM - 12:15 PM
SYM
SYM20
11:00 AM - 12:30 PM 11:00 AM - 1:00 PM 11:30 AM - 12:30 PM
SKILLS SKILLS AAOEIC AAOEIC AAOEIC AAOEIC AAOEIC
LAB145A LAB146A 546 547 548 549 551
AAOEIC AAOEIC IC IC
552 553 554 555
IC
556
IC
557
IC
558
A View Across the Pond: Cornea Enigmas Glaucoma Filtration Surgery Lab Fundamental Facelifting Techniques Employment Law Basics for the Small Ophthalmology Practice Optical Shops: Sales Strategies for Today’s Economy Ophthalmic Coding Specialist Prep Course Practice Management Perspectives: A Case Study Handling Ancillary Businesses: ASC, Optical, Real Estate, Equipment, and Management Services You’ve Hired a New Employee—Now What? Managing Clinical Trials in Small and Large Practices Meibomian Gland Dysfunction and Chronic Blepharitis 3-D Optic Disc Viewing: Top 10 Pitfalls in Identifying Glaucoma Damage and Progression Diplopia Made Ridiculously Simple: Management of Diplopia for the Comprehensive Ophthalmologist Cliffhanger: Vitrectomy by the Anterior Segment Surgeon for the Broken Posterior Capsule, the Sinking Nucleus, and the Dangling IOL Management of Ocular Chemical Injuries
Topic
PM-BUS PM-MKT PM-REMB PM-EHR PM-BUS PM-RISK PLAST NEURO NEURO CAT GLA
$
◆
+ + + + + + + + ◆ + + +
PM-BUS
+
REF PLAST COR CAT EHR REF
+ + + + +
◆
RET CAT
+ + ◆
CAT
+
CAT CAT CAT GO
$ $
Room
Page
Booth 165 S501d S504bc S505ab S501abc S504a S502ab S105bc E351 S104a S103bc S103d
258 270 277 272 275 269 273 86 82 82 64 77
S504d
270
S406a N140 N427a E451b S102d E352
143 118 111 63 73 90
N136 S102abc
96 63
S105a
64
S404 N228 N227b ◆ Grand Ballroom S100c ◆ Grand Ballroom COR S100ab GLA $ N230 PLAST $ N229 PM-RISK + S501abc PM-OPT + S504d PM-REMB + S504bc PM-PROF + S503ab PM-BUS + S504a ◆
122 107 108 144 144 114 118 273 277 272 279 270
PM-HMR PM-BUS COR GLA
+ + + +
S501d S502ab S406b S105bc
276 271 71 77
PEDS
+
S103bc
89
CAT
+ ◆
E351
64
COR
+
S403b
71
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Programs-By-Day Tuesday, Oct. 21 (cont.) Time
Type
No.
11:30 AM - 12:30 PM
IC IC
559 560
IC IC
12:45 - 1:45 PM
IC SPE AAOEIC IC IC IC IC IC IC IC IC IC IC IC IC
12:45 - 3:00 PM
AAOEIC IC IC
1:00 - 2:30 PM 1:30 - 3:30 PM 2:00 - 3:00 PM 2:00 - 4:00 PM 2:00 - 4:15 PM
IC SKILLS SKILLS IC SKILLS IC IC IC IC
Topic
Vitreoretinal Surgical Rounds, Unleashed! RET What’s Your Next Step? Case Studies in Glaucoma GLA Management 561 Inflammatory Orbital Disorders and Their Differential Diagnoses PLAST 562 Failed Graft: Never Say Die! COR 563 Pediatric Refractive Surgery PEDS 564 Subjective Refraction and Prescribing Glasses 102 OPTIC 565 New Treatments for Retinal Vein Occlusion: Results from Phase RET 3 Clinical Trials 566 Continuous 24-Hour IOP Monitoring: Ready for Prime Time? GLA 567 Preventing Postoperative Endophthalmitis: What We Know, CAT What We Do Not Know, and Where We Should Go From Here 569 Pearls and Pitfalls of OCT in Glaucoma GLA D) SPE20 The Resident Hub User Session ANCELE (CGroup 570 Live Website Analysis: Critique Your Website PM-MKT GLA 572 Medical Therapy for Open-Angle Glaucoma: A Complete Review of the Pharmacodynamics, Pharmacokinetics, and Toxicity of All Potentially Useful Drugs 573 Understanding Ophthalmic Viscosurgical Devices to Optimize CAT Their Use in Cataract Surgery and Complications 575 Presbyopia, the Corneal Approach: State of the Art REF 577 Evaluation and Treatment of Lower Lid Ectropion, Entropion, PLAST and Retraction 578 The Vertical Diplopia Dilemma, Made Simple NEURO 579 Diabetic Vitrectomy RET 580 Achieving Proper Centration and Alignment for Vision CAT Correction in Keratorefractive and Intraocular Surgery 581 Cataract Surgery and Uveitis: Controlling Inflammation, Difficult INTRA Pupils, and Distorted Anatomy 582 Nightmares in Pediatric Cataract Surgery PEDS 583 Intraoperative Biometry for High-fidelity Phaco Surgery CAT COR 584 Descemet Membrane Endothelial Keratoplasty: A Simplified Technique to Shorten the Learning Curve and Avoid Complications 585 Phacoemulsification in Eyes with Coexisting Vitreoretinal CAT Pathologies 586 Reimbursement in 2024 PM-PROF 571 Pterygium: The Outcome Measure Is Now Cosmesis, Not COR Recurrence 574 Update Your Anterior Chamber Angle Skills: How to Best GLA Examine, Grade, and Treat 576 Innovative Uses of Adhesives in Anterior Segment Surgery COR LAB104B Management of the Vitreous for the Anterior Segment Surgeon CAT LAB150A Surgery for Severe Corneal Ocular Surface Disease COR 592 Top 10 Pitfalls, Problem Solving, and Interpretive Strategy for GLA Automated Threshold Perimetry LAB149A Blepharoplasty PLAST 587 EHR: Compliance and Medicolegal Issues EHR 588 Difficult Strabismus Problems: Diagnosis and Management PEDS 2014 589 Management of High-risk ROP in the 21st Century: ThermalRET Destructive vs. Pharmacologic Treatment 590 Advanced IOL Power Calculations for the Cataract and CAT Refractive Surgeon
$
Room
Page
+ +
S104a S105d
96 77
+ + + + +
S103d S403a S103a N427bc N139
86 71 89 83 97
+ +
S106a N138
77 64
+ ◆ + +
E451a N427a S501d S104b
77 251 277 78
+
S106a
64
+ +
S105a S103bc
91 86
+ + +
N427bc S406b S103a
82 97 64
+
E451b
80
+ + +
S106b S105d S102d
89 64 72
S102abc
65
+ +
S504a S403a
271 71
+
E352
78
+ $ $ +
S101ab N228 N227b S105bc
72 106 111 78
$ + +
N229 S103a S105d
118 73 89
+
S106b
97
+ ◆
E351
65
◆
+ ◆
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Programs-By-Day
IC IC IC IC IC
Title
49
Programs-By-Day Tuesday, Oct. 21 (cont.) Time
Programs-By-Day
2:00 - 4:15 PM
3:15 - 5:30 PM
Type
No.
Title
Topic
$
Room
Page
IC
591
GLA
IC
593
CAT
IC IC
594 595
IC
596
IC
597
IC IC
598 599
IC IC IC IC IC
600 601 602 603 604
Complications Following Glaucoma Filtering Surgery: Face Them Boldly, Manage Them Efficiently Cataract Surgery in the Setting of Ocular Comorbidities and High-risk Features for Intraoperative and Postoperative Complications Thyroid Eye Disease How to Interpret Fundus Fluorescein Angiography and Autofluorescence Recent Developments in the Diagnosis and Management of Conjunctival Tumors The Art and Science of Glaucoma Drainage Devices: How to Optimize Your Surgical Results Advanced Corneal Topographic Analysis Improving Success in Filtration Surgery: Intraoperative Surgical Techniques and Postoperative Management of the Failing Filter Should My Visually Impaired Patient Be Driving? Femtosecond Laser for Cornea Surgery: The Actual Options Complex Cataract and IOL Complications Basic Deep Anterior Lamellar Keratoplasty Next-Generation Technologies for the Diagnosis and Treatment of Dry Eye and Meibomian Gland Dysfunction
+
N140
78
+
N427bc
65
+ + ◆
S103bc E451a
87 87
COR
+
S103d
72
GLA
+
S106a
78
REF GLA
+ +
S104a S105a
91 78
VIS REF CAT COR COR
+ + + + +
S104b S102d S403b N427a S101ab
97 91 65 72 72
Topic
$
Room
Page
GEN
$
PLAST RET
◆
Wednesday, Oct. 22 Time
8:00 AM - 5:30 PM
50
Type
No.
SPE
SPE21
Title
28° Lo Mejor de la Academia en Español / 28th Best of the Academy in Spanish
◆
252 Westin Michigan Avenue Chicago
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
BREAKFAST WITH THE EXPERTS Sunday – Tuesday, Oct. 19 - 21 7:30 - 8:30 AM South, Hall A Roundtable discussions are moderated by leading experts in the field. Attendees are encouraged to bring their individual questions and cases for discussion. • Onsite Fee: $40 • Breakfast With the Experts roundtables are not part of the Academy Plus course pass. Separate tickets must be purchased. • Members in Training automatically receive a 50% discount on all roundtables. • Fee includes a buffet breakfast. After breakfast, feel free to use the roundtables area to meet-up with colleagues and network.
Selection Committee Practice Management roundtables were selected by the AAOE Program Committee.The Annual Meeting Program Committee selected all other roundtables. See page 33 for committee details.
P.O. Box 7424, San Francisco, CA 94120-7424 | Tel: 415-561-8500 Fax: 415-561-8533 © 2014 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology.
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
51
Breakfast With the Experts Sunday, Oct. 19
Glaucoma
Cataract Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Cataract and Refractive Surgery (ASCRS)
Roundtable B100
Successfully Incorporate Minimally Invasive Glaucoma Surgery Into Your Practice Moderator: John P Berdahl MD*
Roundtable B110
Managing Cataract in Angle Closure Surgery Moderator: Pratap Challa MD*
Roundtable B111
Judging Glaucomatous Progression Moderator: Gustavo De Moraes MD
Roundtable B112
Roundtable B101
Limbal Relaxing Incisions/Presbyopia IOLs
Breakfast With the Experts
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Glaucoma Society (AGS)
Moderator: R Bruce Wallace MD**
Roundtable B102
Managing Complications of Tube Shunts, Including Tube Failure Moderator: Herbert P Fechter MD
Global Ophthalmology
Femto Cataract Surgery
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Global Education and Outreach Committee
Moderator: Bradley C Black MD**
Roundtable B103
Fuch’s Endothelial Dystrophy: Preoperative Considerations for Cataract Surgery
Roundtable B113
Moderator: Clara C Chan MD*
Moderator: Grace Sun MD
Roundtable B104
Global Ophthalmology: How to Start Volunteering Now!
Intraocular Inflammation, Uveitis
Intraoperative Aberrometry Moderator: Sumit Garg MD*
Roundtable B105
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Uveitis Society (AUS)
Moderator: Kevin M Miller MD*
Roundtable B114
Maximizing Patient Outcomes With Multifocal IOLs
Approach to Patients With Uveitis: Back to Basics
Cornea, External Disease Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Cornea Society
Roundtable B106
Moderator: John J Huang MD*
Roundtable B115
Optimizing Workflow and Outcomes in Uveitis Care Moderator: Paul A Latkany MD
Neuro-Ophthalmology
Boston Keratoprosthesis Moderator: Peter Zloty MD
Roundtable B107
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the North American Neuro- Ophthalmology Society (NANOS)
Moderator: Erich Bryan Groos MD
Roundtable B117
Herpes Simplex Keratitis
Ischemic Optic Neuropathy and Giant Cell Arteritis
Ethics Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Ethics Committee
Roundtable B108
The Ethical Dimensions of Global Ophthalmology Moderator: Hardeep S Dhindsa MD
Roundtable B109
Ethical Relationships Between Physicians and Industry Moderator: Anthony J Aldave MD*
Moderator: Melissa W Ko MD
Roundtable B118
Glaucomatous Versus Nonglaucomatous Visual Loss: A Neuroophthalmic Perspective Moderator: Lanning B Kline MD
Ocular Tumors and Pathology Jointly sponsored by the Academy’s Annual Meeting Program Committee and Women in Ophthalmology (WIO)
Roundtable B119
Clinical Pearls for Management of Eyelid and Conjunctival Tumors Moderator: Bita Esmaeli MD FACS
52
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Breakfast With the Experts Sunday, Oct. 19 (cont.) Orbit, Lacrimal, Plastic Surgery Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Senior Ophthalmologist Committee (SO)
Roundtable B130
Transitions in Practice: Slowing Down and Its Implications Moderator: Paul N Orloff MD
Refractive Surgery
Roundtable B120
Ptosis Repair: How to Achieve the Best Results Moderator: Jeremiah P Tao MD
Roundtable B121
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the International Society of Refractive Surgery (ISRS) Executive Committee
How to Diagnose Brow Ptosis and Browplasty and Techniques to Correct
Roundtable B131
Moderator: John Joseph Martin MD*
Moderator: Damien Gatinel MD*
Eyelid Neoplasms: From Mundane to Malignant Moderator: Hakan Demirci MD
Roundtable B132
Customized Corneal Laser Refractive Surgery in Special Situations Moderator: Raymond Stein MD
Pediatric Ophthalmology, Strabismus
Retina, Vitreous
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS)
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Retina Specialists (ASRS)
Roundtable B124
The Role of Genetic Testing in the Treatment of Patients with AMD
Amblyopia Best Practices: Pearls from the PEDIG Studies Moderator: David K Wallace MD MPH
Practice Management / AAOE Sponsored by the American Academy of Ophthalmic Executives (AAOE)
Ambulatory Surgery Centers
Roundtable B125
ASC Numbers for Nurses Moderator: Albert Castillo*
Business Operations & Finance
Roundtable B133
Moderator: David S Boyer MD*
Roundtable B134
Treatment Algorithms for Refractory Macula Edema From Diabetes and Venous Occlusive Disease Moderator: Judy E Kim MD* Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Macula Society
Roundtable B135
Dietary Supplements and Monitoring Patients at High Risk for Neovascular AMD Moderator: Emily Y Chew MD
Roundtable B126
Jointly sponsored by the Academy’s Annual Meeting Program Committee and The Retina Society
Moderator: Daniel M Bernick JD*
Roundtable B136
Roundtable B127
Moderator: Howard F Fine MD MHS*
Negotiating Your Buy-In: the New Partner Perspective
Partnership Pitfalls: Preparing for the Unexpected
Management of Retinal Vein Occlusions and Macular Edema
Moderator: Robert J Landau JD
Compliance and Risk Management
Roundtable B128
MD/OD Relationships: Business and Compliance Concerns Moderator: Robert A Wade JD
Professional Growth
Breakfast With the Experts
Roundtable B122
Risk Factors for Post-LASIK Ectasia
Vision Rehabilitation Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Vision Rehabilitation Committee
Roundtable B137
The Kickoff: Initiating Low Vision Services in Your Practice Moderator: Joseph L Fontenot MD
Roundtable B129
Savvy Social Security, Medicare, and Retirement Planning for “Baby Boomer” Physicians Moderator: Donna W Howell JD
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
53
Breakfast With the Experts Monday, Oct. 20 Cataract
Roundtable B146
Ethical Research: A “Need-to-Know Basis” for You and Your Patients Moderator: Carla J Siegfried MD*
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Cataract and Refractive Surgery (ASCRS)
Roundtable B138
Cataract Surgery Pearls: Special Techniques That Every Cataract Surgeon Should Know Moderator: Bonnie A Henderson MD*
Roundtable B139
Breakfast With the Experts
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Glaucoma Society (AGS)
Roundtable B147
Conversations Around Ethical Challenges Moderator: George L Spaeth MD FACS*
Complex IOL Calculations Moderator: Mitchell P Weikert MD*
Roundtable B140
Roundtable B148
Reducing Trabeculectomy Complications Moderator: Jody R Piltz-Seymour MD*
Management of the Broken Capsule and Advanced Vitrectomy Technique
Roundtable B149
Moderator: Louis D Skip Nichamin MD*
Moderator: Leon W Herndon JR MD*
Roundtable B141
Improving Operating Room Efficiency Moderator: Gary J Foster MD**
Insights Into Glaucoma and Emerging Corneal Procedures Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Cataract and Refractive Surgery (ASCRS)
Roundtable B150
Roundtable B176
Integrating Microinvasive Glaucoma Surgery Into Clinical Practice
Dysphotopsia
Moderator: Steven D Vold MD*
Moderator: Samuel Masket MD*
Roundtable B151
Roundtable B177
Treatment of Astigmatism in Cataract Surgery Moderator: Jonathan B Rubenstein MD*
Cornea, External Disease Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Cornea Society
Roundtable B142
Deep Anterior Lamellar Keratoplasty Moderator: Vincenzo Sarnicola MD
Roundtable B143
Endothelial Keratoplasty
Techniques to Prevent Scarring with Glaucoma Filtration Surgery Moderator: Steven R Sarkisian MD*
Global Ophthalmology Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Global Education and Outreach Committee
Roundtable B152
How to Develop a Partnership with an Institution in a Developing Country Moderator: David S Friedman MD MPH PhD*
Intraocular Inflammation, Uveitis
Moderator: Natalie A Afshari MD*
Roundtable B181
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Uveitis Society (AUS)
Moderator: Vincent P De Luise MD FACS
Roundtable B153
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the International Society of Refractive Surgery (ISRS) Executive Committee
Moderator: C Stephen Foster MD*
Herpes Simplex Keratitis
Preparing for and Performing Cataract Surgery in Patients with Uveitis
Roundtable B154
Roundtable B144
Corneal Collagen Crosslinking Advances Moderator: Arthur B Cummings MD*
Ethics Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Ethics Committee
Roundtable B145
Digital Media and Ethical Patient Care Moderator: Keith D Carter MD FACS 54
Glaucoma
A Rational Approach to the Use of Laboratory Testing in the Diagnosis of the Uveitides Moderator: Douglas A Jabs MD MBA*
Neuro-Ophthalmology Jointly sponsored by the Academy’s Annual Meeting Program Committee and the North American Neuro- Ophthalmology Society (NANOS)
Roundtable B155
How to Use OCT in Neuro-ophthalmology Moderator: Robert C Sergott MD*
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Breakfast With the Experts Monday, Oct. 20 (cont.) Roundtable B156
Roundtable B165
Assessing Practice Profitability Moderator: Ron Rosenberg PA MPH*
Professional Growth
An Inflamed Orbit: What Should I Do First? and Next? Moderator: Louise A Mawn MD*
Roundtable B157
Neuroimaging for the Comprehensive Ophthalmologist Moderator: Michael S Vaphiades DO*
Ocular Tumors and Pathology
Roundtable B158
Seeking Shelter Under the Hospital Umbrella: From Employment Agreements to Professional Service Agreements Moderator: Lawrence Geller MBA*
Roundtable B167
Neuro-ophthalmology for Fun and Profit Moderator: Thomas C Spoor MD Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Senior Ophthalmologist Committee (SO)
Results and Complications of Ocriplasmin for Vitreomacular Traction and Macular Holes
Roundtable B168
Moderator: Mark W Johnson MD*
Moderator: Harry Zink MD*
Stopping Surgery: When, Why, and What It Means to Your Practice
Orbit, Lacrimal, Plastic Surgery
Refractive Surgery
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the International Society of Refractive Surgery (ISRS) Executive Committee
Roundtable B159
Roundtable B169
New Evaluations of and Treatments for Orbital Inflammations Moderator: Steven M Couch MD
Breakfast With the Experts
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Cataract and Refractive Surgery (ASCRS)
Roundtable B166
Topography-Guided Excimer Treatments Moderator: David Lin MD
Roundtable B160
Management of Congenital Tearing Patient Moderator: Parag D Gandhi MD
Pediatric Ophthalmology, Strabismus Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS)
Roundtable B123 Pediatric Cataract
Moderator: Scott R Lambert MD*
Roundtable B161
Pediatric Glaucoma Moderator: Sharon F Freedman MD
Retina, Vitreous Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Retina Specialists (ASRS)
Roundtable B170
Use of OCT and Autofluorescence Imaging for Diagnosis of Choroidal and Retinal Tumors Moderator: Carol L Shields MD Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Macula Society
Roundtable B171
Current Management of Diabetic Macular Edema Moderator: Susan B Bressler MD*
Roundtable B162
Jointly sponsored by the Academy’s Annual Meeting Program Committee and The Retina Society
Moderator: Sean P Donahue MD PhD*
Roundtable B172
Vision Screening: What’s New in 2014
Practice Management /AAOE Sponsored by the American Academy of Ophthalmic Executives (AAOE)
Business Operations & Finance
Roundtable B163
Ophthalmology Practice Valuation Moderator: Mark E Kropiewnicki JD LLM*
Roundtable B164
Making Practice Mergers Work Moderator: Debra L Phairas
Update on the Mangement of Diabetic Retinopathy and Diabetic Macular Edema Moderator: Tamer H Mahmoud MD*
Roundtable B173
Management of Dry and Wet AMD: 2014 Update Moderator: K Bailey Freund MD* Jointly sponsored by the Academy’s Annual Meeting Program Committee and Women in Ophthalmology (WIO)
Roundtable B174
Update on Screening for Plaquenil Toxicity Susanna S Park MD Ph
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Breakfast With the Experts Monday, Oct. 20 (cont.) Vision Rehabilitation Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Vision Rehabilitation Committee
Roundtable B175
Understanding the Newer Non-trab, Non-tube Glaucoma Surgeries Moderator: Malik Y Kahook MD*
Intraocular Inflammation, Uveitis Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Uveitis Society (AUS)
The Practical Use of Low Vision Referrals in Your Practice: The When, Why, and How of This Critical Tool for Patient Satisfaction
Roundtable B186
Moderator: Kirk H Packo MD*
Moderator: R Christopher Walton MD
Uveitis in the Elderly Patient
Roundtable B187
Tuesday, Oct. 21
Breakfast With the Experts
Roundtable B185
Chronic Anterior Uveitis: What’s the Next Step? Moderator: Wendy M Smith MD
Cataract Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Cataract and Refractive Surgery (ASCRS)
Roundtable B178
Adding Microinvasive Glaucoma Surgery (iStent and Trabectome) to Your Cataract Surgery Moderator: Reay Brown MD*
Neuro-Ophthalmology Jointly sponsored by the Academy’s Annual Meeting Program Committee and the North American Neuro- Ophthalmology Society (NANOS)
Roundtable B116
What To Do With a Patient Who Presents with Anisocoria Moderator: Sophia Mihe Chung MD*
Roundtable B188
Roundtable B179
Psuedophakic Monovision Pearls, Pitfalls, and Contraindications Moderator: Fuxiang Zhang MD Jointly sponsored by the Academy’s Annual Meeting Program Committee and the International Society of Refractive Surgery (ISRS) Executive Committee
Roundtable B180
Femtosecond-Assisted Lens Surgery
CANCELED
Moderator: Jonathan D Solomon MD
Cornea, External Disease Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Cornea Society
Roundtable B182
Idiopathic Intracranial Hypertension for the Comprehensive Ophthalmologist Moderator: Beau Benjamin Bruce MD PHD*
Roundtable B189
Nystagmus in a Child: When to Image Moderator: Paul H Phillips MD
Orbit, Lacrimal, Plastic Surgery Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)
Roundtable B190
Pediatric Considerations in Oculoplastic Surgery Moderator: Cat Burkat MD
Pterygium Surgery
Moderator: Stephen C Kaufman MD PhD*
Ethics Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Ethics Committee
Roundtable B183
Ethical Dilemmas in Emergency Ophthalmic Care Moderator: R V Paul Chan MD
Roundtable B191
Fillers and Neurotoxins for Facial Rejuvenation Moderator: Wendy W Lee MD*
Pediatric Ophthalmology, Strabismus Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS)
Roundtable B192
Glaucoma
Drug Treatment for ROP: Ready for Prime Time? Moderator: Graham E Quinn MD*
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Glaucoma Society (AGS)
Roundtable B184
Management of the Leaking Blebs, Dyesthesia, and Blebitis Moderator: Mark B Sherwood MD*
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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Breakfast With the Experts Tuesday, Oct. 21 (cont.) Practice Management / AAOE Sponsored by the American Academy of Ophthalmic Executives (AAOE)
Ambulatory Surgery Centers
Roundtable B193
The Nuts and Bolts of Transitioning ASC Ownership Moderator: Albert Castillo*
Business Operations & Finance
Breakfast With the Experts
Roundtable B194
Negotiating Your Buy-In Moderator: Mark D Abruzzo JD
Roundtable B195
A Physician’s Guide to Avoiding Embezzlement Moderator: Robert J Wade JD
Professional Growth
Roundtable B196
Employee Physician Contract Review Moderator: Michael D Brown*
Roundtable B197
Mid-Career Planning: It’s Not Too Early to Plan for the Next 20 or 50 Years Moderator: Frank J Weinstock MD
Refractive Surgery Jointly sponsored by the Academy’s Annual Meeting Program Committee and the International Society of Refractive Surgery (ISRS) Executive Committee
Roundtable B198
Innovations in Femtosecond Corneal Refractive Surgery Moderator: Osama I Ibrahim MD PhD*
Retina, Vitreous Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Retina Specialists (ASRS)
Roundtable B199
CANCELED
Choice of Anti-VEGF Treatment for Diabetic Macula Edema Moderator: Jeffrey S Heier MD* Jointly sponsored by the Academy’s Annual Meeting Program Committee and the Macula Society
Roundtable B200
Which Biologic to Use to Treat Neovascular AMD Moderator: Daniel F Martin MD Jointly sponsored by the Academy’s Annual Meeting Program Committee and The Retina Society
Roundtable B201
Imaging of the Retina and Vitreomacular Interface Moderator: Amani Fawzi MD
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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INSTRUCTION COURSE PROGRAM Sunday – Tuesday, Oct. 19 - 21 H
Course received an overall course grade within the top 10% of its subject area based on 2013 attendee evaluation data.
SOE
Sponsored by the European Society of Ophthalmology.
NEW New course SA
Designated as self-assessment credit and is pre-approved by the ABO for the Maintenance of Certification (MOC) Part II CME requirements.
P
Eligible for Pain Management credit
EHR
Electronic Health Records
GO
Global Ophthalmology
SO
Endorsed by Senior Ophthalmalogist Committee
YO
Endorsed by Young Ophthalmalogist Committee
Academy Plus Course Pass All Instruction Courses are part of the Academy Plus course pass. Academy Plus offers maximum convenience, with unlimited access to all Academy and AAOE instruction courses. Individual tickets for Academy and AAOE instruction courses are not sold. Note: Due to Fire Marshal regulations, seating capacities are limited. Seating is available on a first-come basis, so please plan accordingly.
Selection Committee The Annual Meeting Program Committee selected all instruction courses in this section. See page 33 for committee details.
P.O. Box 7424, San Francisco, CA 94120-7424 | Tel: 415-561-8500 Fax: 415-561-8533 © 2014 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology.
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Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
Instruction Courses H Management of Malpositioned IOLs
Cataract H YO Best of the Best: An Update in Cataract Surgery Course: 156 Room: E451a Education Level: INT
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
YO Cataract Surgery Crisis Management 101 Course: 157 Room: E353a Education Level: ADV
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Present-day cataract management requires that surgeons not only incorporate newer technologies but also update their skills in managing complications. This course aims to identify complicated situations that every surgeon may encounter during or after cataract surgery and to provide pearls to effectively manage such crises. It will illustrate critical management issues such as posterior capsule rupture, phacoemulsification in challenging ocular environments, and dissatisfied premium IOL patients. Objective: To provide trouble shooting pearls for successful management of different intraoperative and postoperative complications during cataract surgery. The attendees shall learn from the instructors video case demonstration and interactive discussion. Senior Instructor(s): Abhay Raghukant Vasavada MBBS FRCS* Instructor(s): Robert H Osher MD*, Alan S Crandall MD*, Nick Mamalis MD*, Kevin M Miller MD*, Samuel Masket MD*, Gerd U Auffarth MD*
Better Surgery Through Chemicals Course: 171 Room: S105bc Education Level: INT
Sunday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will review the relevant pharmacology and physiology of intracamerally and intravitreally applied agents that include mydriatics, anesthetics, stains, ophthalmic viscosurgical devices, antioxidants, gas, steroids, antibiotics, and anti-VEGF agents. Potential risks of these agents and compounding as well as regulatory issues will be discussed. A panel discussion and questions from the audience will conclude the presentation. Objective: Attendees will learn current options for intraocular administration of intraocular medications and other agents for prophylaxis of intraoperative floppy iris syndrome and endophthalmitis and management of intraocular complications in intraocular surgery. Senior Instructor(s): William G Myers MD* Instructor(s): Minas T Coroneo MD MS*, David B Glasser MD, Steve A Arshinoff MD*, William F Mieler MD*, Charles Leiter*, Hiroyuki Nakashizuka MD, Daniel G Dawson MD, Neal H Shorstein MD*, John Wittpenn Jr MD*, Jeffrey Todd Liegner MD*, Ramon Lorente MD
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: Early and late decentration / dislocation of IOLs represent significant complications of current cataract surgery. This instruction course will consider the etiology, possible prevention, and, primarily, the surgical management of malpositioned IOLs. Objective: To (1) recognize the causes of IOL dislocation / decentration, (2) consider prevention of malpositioned IOLs, and (3) through use of video presentations, demonstrate various surgical techniques for correction of IOL decentration / dislocation. Senior Instructor(s): Samuel Masket MD* Instructor(s): Amar Agarwal MD*, Nicole R Fram MD*, Sadeer B Hannush MD, Thomas A Oetting MD
YO Comprehensive Strategy for Unplanned Vitrectomy Technique for the Anterior Segment Surgeon Course: 187 Room: E451a Education Level: INT
Sunday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: This course will propose a strategy for prevention, early recognition, damage control, and specific plans for action to achieve an optimal outcome in cataract surgery complicated by vitreous presentation. Anterior and pars plana approaches will be detailed with ample video. The panel includes a retina-vitreous subspecialist. Objective: By the conclusion of this course, cataract surgeons of all levels of expertise will be able to describe a strategy for choosing the method and the timing for removal of residual lens material and for undertaking appropriate vitreous management, incision, and choice of IOL to achieve optimal outcomes in cataract surgery involving vitreous presentation. Senior Instructor(s): Lisa B Arbisser MD* Instructor(s): Michael J Howcroft MD*
H A Video Symposium of Challenging Cases and the
Management of Intraoperative Complications During Cataract Surgery Course: 189 Room: E451b Education Level: INT
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will cover a spectrum of difficult cataract cases as well as a potpourri of intraoperative complications. The video content is updated yearly. Objective: This course will expose the surgeon to principles and techniques useful in operating difficult cases and in managing serious intraoperative complications. Senior Instructor(s): Robert H Osher MD*
Multifocal and Accommodative IOLs: Face the Challenge Course: 193 Room: E353a Education Level: ADV
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: We will review the state-of-the-art knowledge on presently available multifocal and accommodative IOLs (MAIs). Their features, indications and contraindications, matching possibilities, and clinical results, pursuing highly satisfactory uncorrected distance, intermediate, and near vision, will be examined. New multifocal IOLs (ie, torics) will be discussed. Objective: Attendees will receive information on how to use MAIs. A structured approach on patient and IOL selection based on accurate matching of IOL features with patient needs will be provided. Discussion will include IOL performance in terms of contrast sensitivity, light distribution and loss, and management of complications and visual complaints, with available solutions. The importance of achieving plano results will be well supported. At the end of this course, the attendee will be able to improve
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
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Instruction Courses
Synopsis: This course will discuss how advances in technology, IOLs, phaco machines, femtolasers, hydrogel bandages, and indications are making cataract surgery extremely similar to refractive surgery. The cataract surgeon must not only provide restoration of vision but also optimal vision quality; the ideal, and increasingly demanded, result of cataract surgery is plano correction. This requires accurate customization of IOL choice, obsessively accurate biometry, adoption of new technologies (microincision and premium IOLs: multifocal, toric, multifocal + toric, aspheric). Objective: This course is designed to provide attendees with key information in applying a refractive surgery approach to exploiting recent technological, surgical, organizational, and patient management advances. Senior Instructor(s): Matteo Piovella MD* Instructor(s): David F Chang MD*, Steven J Dell MD**, Eric D Donnenfeld MD*, Richard L Lindstrom MD**, Roger F Steinert MD*, Steven C Schallhorn MD*, Fabrizio I Camesasca MD, Burkhard Dick MD*
Course: 185 Room: E353b Education Level: ADV
Instruction Courses surgical center organization, choose the best IOLs for each specific patient, and manage possible postop complications. Senior Instructor(s): Matteo Piovella MD* Instructor(s): Jorge L Alio MD PhD*, Claudio Carbonara MD, David F Chang MD*, Jack T Holladay MD MSEE FACS*, Barbara Kusa MD, Richard L Lindstrom MD**, Richard Tipperman MD*
YO Pearls for Evaluating Corneal Topography in Patients
Scheduled for Cataract Surgery Course: 196 Room: S102abc Education Level: INT
Sunday 2:00 - 3:00 PM Target Audience: COMPSUB
Instruction Courses
Synopsis: Patients scheduled for cataract surgery can have surprisingly abnormal corneal topography. This course will be led by a team of topography experts who will help attendees identify and interpret corneal topographies in patients scheduled for cataract surgery, and demonstrate how this information can help them optimize their treatment plans. Both virgin corneas, as well as corneas with previous PRK, LASIK, and radial keratotomy, will be discussed and analyzed by the faculty. Objective: At the conclusion of the course, attendees will be able to analyze and identify normal vs. abnormal corneal topographies in patients scheduled for cataract surgery, and will be able to determine whether patients are eligible for toric or presbyopic IOLs, or for limbal relaxing incisions. Attendees will also be able to determine whether their patients would be eligible for PRK or LASIK following cataract surgery, or would potentially benefit from crosslinking. Senior Instructor(s): William B Trattler MD* Instructor(s): George O Waring MD*, Karolinne M Rocha MD, Renato Ambrosio Jr MD*, Jodi Luchs MD*, Quentin B Allen MD*, David A Goldman MD*
Surgical Management of Astigmatism in Cataract and Refractive Surgery Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the International Society of Refractive Surgery (ISRS)
Course: 198 Room: S103bc Education Level: INT
Sunday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: This course will teach strategies for minimizing surgically induced astigmatism, discuss surgical options for treating astigmatism during cataract and refractive surgery (including wound construction approaches, limbal relaxing incisions, toric IOLs, and corneal refractive surgical techniques), and demonstrate methods to treat postoperative astigmatism occurring after cataract and refractive surgery. Objective: By the conclusion of this course, the participants will be able to (1) identify regular and irregular astigmatism, (2) understand surgical strategies to minimize surgically induced astigmatism and determine treatment strategies for astigmatism, including complex refractive errors and eyes not amenable to surgical treatment, and (3) employ practical strategies for determining patient goals and desires for astigmatism correction. Senior Instructor(s): J Bradley Randleman MD Instructor(s): David T Vroman MD*
Advanced Techniques With Laser Cataract Surgery Course: 213 Room: E451a Education Level: INT
Sunday 3:15 - 5:30 PM Target Audience: COMPSUB
Synopsis: Basic certification in the use of a particular femtosecond laser confers only a degree of facility with the technology. This course will provide a wide range of real-world, experience-driven pearls and tips to enhance efficiency, safety, and efficacy when using the femtosecond laser. Objective: At the conclusion of the course, the surgeon will have a better understanding of optimal patient selection, preoperative preparation, surgical planning,
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surgical execution, and unexpected event management than prior to this educational event. Senior Instructor(s): Mark H Blecher MD* Instructor(s): William W Culbertson MD*, William Wiley MD*, Kathryn Masselam Hatch MD*, Burkhard Dick MD
NEW Femtosecond Cataract Surgery: Exploring the Limits Course: 218 Room: S104a Education Level: INT
Sunday 3:15 - 5:30 PM Target Audience: COMP
Synopsis: This course will show video footage of challenging cases and provide a systematic approach to managing them. The use of the femtosecond laser in advanced cataracts, pediatric cataracts, zonular instability, small pupil, eyes with corneal / media opacity, and for posterior capsulorrhexis will be demonstrated. Objective: Attendees will learn to make laser and technique-related adjustments to facilitate use of the femtosecond laser for challenging cataract surgery situations. Senior Instructor(s): Surendra Basti MBBS* Instructor(s): David M Lubeck MD*, Mitchell P Weikert MD*, Burkhard Dick MD*
NEW Toxic Anterior Segment Syndrome Following Cataract Surgery Course: 234 Room: E451b Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMP
Synopsis: Toxic anterior segment syndrome (TASS) is a sterile postoperative anterior segment inflammation following cataract surgery. Common signs include immediate onset (within 12-48 hours of surgery), blurred vision, diffuse corneal edema, marked anterior segment inflammation, and iris / trabecular meshwork damage. The potential causes include irrigating solutions, medications, problems with instrument cleaning / sterilization, contaminants, and IOL-related problems. Differentiating TASS from infectious endophthalmitis is critical. Treatment requires intense topical corticosteroids with close follow-up. Objective: At the conclusion of this course, the attendee will be able to identify the signs and symptoms, causes, and treatment of TASS, as well as to differentiate this entity from infectious postoperative endophthalmitis. Senior Instructor(s): Nick Mamalis MD* Instructor(s): Randall J Olson MD, Alan S Crandall MD*, Tat-Keong Chan MD FRCS FRCOphth*
NEW From Front to Back: Managing Posterior Segment Sequelae of Anterior Segment Surgery Course: 238 Room: N138 Education Level: BAS
Sunday 4:30 - 5:30 PM Target Audience: COMP
Synopsis: Posterior segment sequelae frequently arise after anterior segment surgeries, including cataract surgery and refractive procedures. Some of these changes include retained lens fragments, endophthalmitis, retinal detachments, cystoid macular edema, progression of diabetic macular edema, and onset of neovascular AMD. Ongoing advances in current surgical techniques, diagnostic modalities, and evidence-based standards of treatment have altered the way these sequelae should be managed. Objective: The objective of this course is to educate the ophthalmology community regarding current strategies of preventing and managing these posterior segment sequelae through case presentations and discussion by an interactive panel of anterior segment and posterior segment surgeons. At the end of the course, attendees will be able to better manage their own posterior segment complications, know when to appropriately refer, and understand fundamental principles of vitreoretinal approaches to these sequelae. Senior Instructor(s): Paul Hahn MD PhD Instructor(s): Christopher S Boehlke MD, Netan Choudhry MD*, Jessica B Ciralsky MD*, Derek W Del Monte MD, Preeya K Gupta MD*, Anton Orlin MD, Lejla Vajzovic MD
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses NEW Open Sesame: Dealing With the Small Pupil Course: 240 Room: N136 Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
NEW Improving Outcomes in Refractive Cataract Surgery With Intraoperative Aberrometry Utilizing Streaming Refractive Data Course: 242 Room: E353b Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: This course will review the impact of intraoperative aberrometry with streaming refractive data on refractive cataract surgery. Faculty will present personal and multicenter study results, cases, and clinical pearls and best practices for the use of this technology in IOL power selection, toric IOL axis selection and positioning, and placement of astigmatic incisions, in both manual and femtosecond laser cataract surgery. Objective: Attendees will learn how to use intraoperative aberrometry with streaming refractive data to improve outcomes in refractive cataract surgery. Senior Instructor(s): Samuel Masket MD* Instructor(s): Nicole R Fram MD*, Tal Raviv MD*, Steven D Vold MD*
NEW Glued IOL: Scleral Fixation of Posterior Chamber IOL Without Sutures in Absence of Capsular Support Course: 243 Room: S103d Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: Management of aphakia in the absence of capsular support remains a challenge for the ophthalmic surgeon. Historical options have included anterior chamber IOLs and iris or scleral suture-fixated IOLs. This course introduces a relatively novel approach for sutureless scleral fixation of a foldable posterior chamber IOL (PC-IOL) by the creation of intrascleral tunnels and the use of fibrin sealant. The procedure may be offered through a small corneal incision, decreasing intraoperative complications and allowing for quicker visual rehabilitation. It compartmentalizes the eye nicely into anterior and posterior segments. Objective: To describe the surgical technique of implanting a foldable PC-IOL in the absence of capsular support with scleral fixation without sutures. Senior Instructor(s): Sadeer B Hannush MD Instructor(s): Amar Agarwal MD*, Iqbal K Ahmed MD*, Thomas A Oetting MD
H Tackling Weak Zonules and Using Capsular Tension Devices Course: 315 Room: E451b Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMP
NEW Managing White Cataracts: Conventional and FemtoAssisted Phacoemulsification Course: 324 Room: E352 Education Level: INT
Monday 9:00 - 10:00 AM Target Audience: COMP
Synopsis: This instruction course aims to teach attendees pitfalls and tips to manage white cataract using conventional and femtosecond-assisted phacoemulsification. Problems associated with white cataract, such as hard, soft, and floating nuclei and hypermature or intumescent-type, will be shown. Complications during capsulorrhexis, nuclear emulsification, irrigation-aspiration, and lens implantation such as zonular dehiscence, rrhexis problems, posterior capsule rent, and nucleus drop will be illustrated. Further challenges during phacoemulsification in white cataract associated with small pupil and subluxated cataract will also be shown. These will be discussed in relation to both the conventional and femtosecond platforms. Objective: At the end of the course, the attendees will be well versed in the challenges faced in managing a white cataract using both the conventional and femtosecond-assisted phacoemulsification techniques. Senior Instructor(s): Jeewan S Titiyal MD Instructor(s): Namrata Sharma MD MBBS, Abhay Raghukant Vasavada MBBS FRCS*, Rajesh Sinha, Tarun Arora
NEW SOE Nano-Ophthalmology: State of the Art, Practical Applications and Perspectives Course: 325 Room: S103a Education Level: INT
Monday 9:00 - 10:00 AM Target Audience: COMPSUB
Synopsis: This course will describe in detail the existing applications of nanotechnology and nano-sized medications in the treatment of glaucoma, dry eye, diabetic macular edema, uveitis, and pre-and post-phaco anti-inflammatory prophylaxis and treatment, as well as novel and even more effective nano-approaches to the treatment of these diseases. Objective: At the conclusion of this course, the attendees will be able to make informed decisions on the use of nano-sized medications or devices in their practices to achieve improved clinical outcomes. Senior Instructor(s): Matteo Piovella MD* Instructor(s): Jorge L Alio MD PhD*, Dimitri Dementiev MD**, Anselm Kampik MD*, John Marshall PhD*, Tatiana Naoumidi MD**
NEW IOL Implantation in the Absence of Capsular Support Course: 337 Room: S103bc Education Level: ADV
Monday 10:15 AM - 12:30 PM Target Audience: COMP
Synopsis: This course will cover various techniques of IOL implantation in the absence of proper capsular support. This includes anterior chamber IOLs, iris claw IOLs, posterior iris claw IOLs, sulcus fixation IOLs, scleral fixation IOLs, Hoffman technique, glued IOLs, etc. The course will go through the details of each and every technique mentioned above.
Synopsis: This course will cover techniques, indications, and pitfalls for the use of capsular tension devices (rings and segments), capsular retractors, and other surgical Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
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Instruction Courses
Synopsis: This course will provide comprehensive instructions on strategies, devices, and techniques to tackle preoperative and intraoperative small pupil in phacoemulsification. Topics will include fluidics, viscomydriasis, iris hooks, pupil expansion rings (Malyugin), and new pupil expansion rings (Bhattacharjee) for Biaxial MICS, 0.9-mm incisions and shallow chambers. Stepwise instructions for each of these devices will be provided. Anticipation, recognition, and management of intraoperative floppy iris syndrome (IFIS) will be specially emphasized. Objective: At the conclusion of this course, the attendee will be able to distinguish the elastic small pupil of IFIS from the nonelastic small pupil due to other causes and also develop a clear strategy to deal with a nondilating or constricting pupil with or without a floppy and prolapsing iris, with judicious use of fluidics, viscoelastics, and devices like iris hooks and rings. Senior Instructor(s): Suven Bhattacharjee MS* Instructor(s): Robert H Osher MD*, David F Chang MD*, Boris Malyugin MD PhD*, Arup Chakrabarti MBBS
techniques in patients with capsular-zonular complex pathology. A strategy for preoperative evaluation and intraoperative clues to unstable or potentially unstable zonules will be presented, and surgical approach and selection of capsular device(s) and techniques for implantation will be discussed. Strategies for avoidance and management of complications will also be presented. Objective: Participants will gain an understanding of the premise of and indications for capsular tension devices, the use of adjunctive devices, specific techniques in implantation, and potential complications. Senior Instructor(s): Iqbal K Ahmed MD* Instructor(s): Robert J Cionni MD*, Alan S Crandall MD*, Samuel Masket MD*, Robert H Osher MD*, Kenneth J Rosenthal MD FACS**
Instruction Courses Objective: Attendees will adapt to different techniques of IOL implantation in the presence of posterior capsular rupture. Senior Instructor(s): Mohan Rajan MD MBBS Instructor(s): Sujatha Mohan MBBS, Amar Agarwal MD*, Richard S Hoffman MD*, Robert H Osher MD*
affect the choice of implant to be used. They will also be able to describe common intraoperative problems and their solutions. Senior Instructor(s): Kevin M Miller MD* Instructor(s): Samuel Masket MD*, Michael E Snyder MD*, Sathish Srinivasan MBBS*
NEW Third World Cataracts in the First World Setting
Fundamentals of Anterior Segment Reconstruction
Course: 360 Room: N140 Education Level: INT
Course: 386 Room: S403a Education Level: INT
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Instruction Courses
Synopsis: Although cataract surgery is the most common surgery performed in the United States, there still exists a large portion of the U.S. population with mature and even hypermature cataracts. This course will provide pearls from panelists experienced at handling the most difficult cases-from the rock-hard nucleus to the white intumescent cataract. A range of experiences will be presented, along with tips on when to attempt phacoemulsification vs. when to perform extracapsular cataract extraction (ECCE), how to convert from phaco to ECCE, IOL management and repositioning, capsular tension rings, and management of complications. Additionally, focus will be placed on postop management of intraoperative complications-including input from a retina faculty member-when faced with loss of capsular support and nuclear fragments slipping toward the retina. Objective: At the end of the course, the attendee will be able to successfully manage patients with mature and hypermature cataracts efficiently and optimize challenging cases where complications occur. Senior Instructor(s): Jennifer M Loh MD Instructor(s): Amar Agarwal MD*, William B Trattler MD*, Geoffrey C Tabin MD, Benjamin J Thomas MD, Andrew M Schimel MD**, Ashvin Agarwal MBBS
H Conquering Capsule Complications: A Video Primer Course: 372 Room: E451b Education Level: INT
Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: Video cases will illustrate a spectrum of techniques for anterior and posterior capsule complications: trypan blue dye, vitreous tap for crowded anterior chamber, torn continuous curvilinear capsulorrhexis (CCC) options, secondary CCC enlargement, flap tear-out rescue technique, posterior CCC, rrhexis capture of the optic, early recognition of posterior chamber rupture, conversion from top/clear corneal incision to extracapsular cataract extraction, posterior polar cataracts, IOL fixation with torn anterior or posterior capsule, capsular tension ring and capsule hooks for weak zonules, small pupil / floppy iris strategies (hooks, Malyugin and other expansion rings, epinephrine, Healon 5), pars plana bimanual anterior vitrectomy (± triamcinolone), and ophthalmic viscosurgical device (OVD) posterior-assisted levitation (PAL) + trap for descending nuclei. Objective: To use video cases to systematically review techniques of preventing, recognizing, and handling complications with either the capsulorrhexis or posterior capsule. Senior Instructor(s): David F Chang MD* Instructor(s): Robert H Osher MD*
Artificial Iris Implantation Course: 375 Room: N427d Education Level: ADV
Monday 2:00 - 3:00 PM Target Audience: SUB
Synopsis: This course will provide an overview of artificial iris devices available from Morcher, Ophtec, and HumanOptics. Indications, device availability in different markets, preoperative planning, implantation tips, and outcomes will be discussed. The effect of ocular comorbidities on the decision-making process will be reviewed. The didactic discussion will be supplemented by surgical video. Devices to be discussed include modified capsule tension rings, iris reconstruction lenses, and foldable silicone wafers. Objective: At the conclusion of the course, attendees will be able to describe the artificial irises available commercially and understand their directions for use. They will know which devices are suitable for capsular bag implantation and which devices are suitable for the sulcus. They will be able to discuss how ocular comorbidities
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Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will consist of didactic lecture, surgical video, and panel discussion highlighting various current topics in anterior segment surgery. Topics will include iris repair, IOL exchange, sutured IOLs, anterior vitrectomy, use of iris and capsule support devices, and complex cataract surgery. Instructive surgical video intertwined with didactic slides will be used as the building blocks for this instructional course. Each case will focus on a common anterior segment situation and a technique or techniques for proper management and/or repair of that scenario. Objective: Attendees will learn several surgical techniques for the repair of the anterior segment and how to apply these techniques in their own clinical practices, thereby improving patient care. Senior Instructor(s): Brandon Ayres MD* Instructor(s): William Barry Lee MD*, George O Waring MD*, Elizabeth Yeu MD*, John P Berdahl MD*, Jeremy Z Kieval MD*
NEW Posterior Segment Complications of Anterior Segment Surgery: Prevention and Management Course: 388 Room: S105a Education Level: INT
Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will include lectures, images, and panel and interactive discussions of risk factors, early recognition, and management of posterior segment complications of anterior segment surgery. A panel of anterior segment and vitreoretinal surgeons will discuss their perspectives. Topics include dislocated lens fragments, dislocated IOL, cystoid macular edema, exacerbation of diabetic macular edema, microscope toxicity, choroidal hemorrhage, and endophthalmitis. Objective: Attendees will be able to recognize risk factors, preventive steps, and issues involved in the management of posterior segment complications of anterior segment surgery. Senior Instructor(s): David S Boyer MD* Instructor(s): Homayoun Tabandeh MD MS FRCP FRCOphth*, Kourous Rezaei MD*, Harry W Flynn MD, John D Hofbauer MD*, Afshin J Khodabakhsh MD*
NEW Inadequate Capsular Support and IOL Fixation: Techniques From the Vitreoretinal Surgeon’s Toolbox Course: 395 Room: E352 Education Level: ADV
Monday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: This course will address surgical strategies for IOL fixation in the absence of capsular support. We will review the techniques, outcomes, and complications of scleral- and iris-sutured IOLs and anterior chamber IOLs. Contemporary methods, including sutureless scleral fixation, transconjunctival scleral pocket fixation, and a microincisional technique for capsular rescue, will be illustrated in detail with surgical video. Objective: Attendees will develop an approach to IOL fixation in the absence of capsular support using new methods, including sutureless scleral fixation, transconjunctival scleral pocket fixation, and microincisional capsular rescue. Evidence-based recommendations will guide attendees in appropriate case selection. Senior Instructor(s): Yannek I Leiderman MD PhD Instructor(s): Jonathan Prenner MD*, Matthew Wheatley MD
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses H Code Red: Mastering Phaco Nightmares and Worst-Case Scenarios: A Video-Based Course
IOLs
Course: 406 Room: S102abc Education Level: INT
Course: 431 Room: N136 Education Level: INT
Monday 3:15 - 5:30 PM Target Audience: COMPSUB
NEW SOE Refining the Refractive Error After Premium Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: This course will first discuss the guidelines for managing refractive errors after premium IOLs, such as avoidance, causes, diagnosis, and timing of management. Second, different methods of improving the refractive errors will be discussed. This includes corneal solutions (femto astigmatic keratotomy, limbal relaxing incision, LASIK, PRK) and intraocular solutions (IOL exchange, redialing, capsule manipulations, etc.). The course will give a plan for each individual case. Objective: At the conclusion of the course, attendees will be able to plan the best procedure of refining the refractive error following premium IOL according to each case. Senior Instructor(s): Mounir A Khalifa MD Instructor(s): David R Hardten MD*, Scott M MacRae MD*, Matteo Piovella MD*
H YO Intraoperative Floppy Iris Syndrome: Pearls for
Synopsis: Phaco chop minimizes ultrasound time and zonular stress. Pearls and strategies for learning this technique will be presented, based upon the instructors’ experience in teaching residents. Using a special projection system, the audience will don stereo glasses to view 3-D high-definition videos that uniquely illustrate the angle and depth of the instrument tips for both horizontal (Nagahara) and vertical (quick chop) methods of chopping. A stepwise game plan for converting to phaco chop will be presented, along with phacodynamics principles for selecting machine parameters and instrumentation. Objective: This course will present both variations of the phaco chop technique, their advantages in complicated cases, the instrumentation, machine parameters, and transition steps involved, and common mistakes. Senior Instructor(s): David F Chang MD* Instructor(s): Randall J Olson MD, Louis D Skip Nichamin MD*, Barry S Seibel MD**
Management and Prevention Course: 418 Room: E451a Education Level: INT
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: Intraoperative floppy iris syndrome (IFIS) continues to challenge cataract surgeons. In this course multiple different surgical methods will be discussed in detail, with the goal of arming surgeons with a range of complimentary strategies. These include intracameral alpha agonists, ophthalmic viscosurgical device strategies, phaco techniques, iris retractors, and pupil expansion devices, including the Malyugin ring. This course will also review what is known about the pharmacologic basis and mechanism of IFIS. Objective: To update anterior segment surgeons on the latest clinical information about benign hyperstatic hypertrophy pharmacology and the preoperative and intraoperative management of IFIS. Senior Instructor(s): David F Chang MD* Instructor(s): Steve A Arshinoff MD*
NEW Less Than Perfect Outcomes After Uneventful
Cataract Surgery: What Are We Missing? Course: 429 Room: S403a Education Level: BAS
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: This course will deal with causes of less than perfect outcomes after uneventful cataract surgery. A definite game plan for dealing with these disgruntled postoperative patients is presented. Topics covered will be a brief overview of the common causes of poor visual outcome after uncomplicated cataract surgery, such as ocular surface disease, keratitis medicamentosa, undetected preoperative astigmatism, problems with multifocal IOL implants, early posterior capsular opacification, dysphotopsia, IOL decentration due to buttonholing, capsular bag decentration, unexpected postoperative ametropia, and subtle macular pathologies. The importance of a thorough evaluation to rule out the entities responsible, as well as preoperative counseling, will be emphasized. Objective: At the end of the course the attendee will become competent in managing their dissatisfied patients who have less than perfect outcomes after uneventful and uncomplicated cataract surgery. Senior Instructor(s): Meena Chakrabarti MBBS Instructor(s): Arup Chakrabarti MBBS, Samuel Masket MD*, Kevin M Miller MD*, Thomas A Oetting MD, Parag A Majmudar MD*, Anthony J Aldave MD*
H YO Learning Phaco Chop: Pearls and Pitfalls Course: 533 Room: E451b Education Level: INT
Tuesday 10:15 AM - 12:30 PM Target Audience: COMPSUB
H A Video Bouquet of Phaco Complications That Should Never Have Occurred, With Tips on Damage Control and Prevention to Optimize Postoperative Outcome Course: 539 Room: S102abc Education Level: BAS
Tuesday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This video course deals with the genesis, management, and prevention of unexpected surgeon- or technique-related complications in phacoemulsification in uncomplicated cataracts. The course will demonstrate complications that may be encountered during all steps of phaco (both uncomplicated and difficult cataracts) and will offer a stepwise strategy to prevent and manage them. Complications and remedial measures demonstrated include wound burns, wound length anomalies, capsulorrhexis extension and retrieval, two-stage rrhexis, use of microrrhexis forceps / scissors in tricky cases, incomplete / difficult hydrodissection, hurdles in phaco chop, misplaced capsular tension ring, inappropriately used iris hook, how to convert to a safer nonphaco technique in problem situations, and more. Objective: At the end of the course, the attendee will have learned how to avoid and successfully manage certain intraoperative phaco complications that can not only mar the postoperative outcome but can also lead to sight-threatening sequelae. Senior Instructor(s): Arup Chakrabarti MBBS Instructor(s): Thomas A Oetting MD, Amar Agarwal MD*, Kevin M Miller MD*, Abhay Raghukant Vasavada MBBS FRCS*, Samuel Masket MD*, Khiun F Tjia MD*, Jeewan S Titiyal MD, Arulmozhi Varman MBBS DO MS
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Instruction Courses
Synopsis: “Code red” signifies danger, and it’s best to be prepared for such cases. Endocapsular rings for subluxated cataracts, prosthetic irides, and pupil expanders are secrets for mastering phaco surgery’s worst-case scenarios. Intraoperative floppy iris syndrome, IOL implantation in eyes with deficient capsules, and glued IOLs will all be explained in this course. Vitreous loss, torn rrhexis management, and other complication management will also be covered. Management of dropped lenses, hard cataracts, posterior capsular ruptures, and the like will all be explained with excellent videos. From basic complications to nightmare situations, all will be covered in this course. Questions from the audience will be discussed so that attendees will be able go back to their practices and manage any situation. Objective: At the conclusion of this course, the attendee will be able to master difficult phaco cases and manage various complications without developing a heart attack. Senior Instructor(s): Amar Agarwal MD* Instructor(s): David F Chang MD*, Robert H Osher MD*, Athiya Agarwal MD, Iqbal K Ahmed MD*, Brian C Little MD*
Instruction Courses NEW SOE Surgical Simulators: Tool or Toy? Course: 541 Room: S103bc Education Level: BAS
Tuesday 10:15 - 11:15 AM Target Audience: COMPSUB
Instruction Courses
Synopsis: Many tools are available to simulate cataract surgery, from traditional wet lab experience to virtual reality computer simulation. Effective surgery simulation is essential for training; however, the time and cost of establishing a surgical simulation program is significant. This course will discuss the spectrum of phacoemulsification simulation tools and their respective strengths and weaknesses. Three distinct examples of surgical training through integration of surgical simulation from the Flaum, Wilmer, and Moran Eye Institutes will be presented. Simulation systems discussed will include the Kitaro wet and dry lab system, the EYESi VR Magic simulator, and the ImmersiveTouch MicroVis simulator. Objective: At the conclusion of this course, the attendee will (1) know the spectrum of surgical simulation tools available, (2) understand the respective strengths and weaknesses of available tools, and (3) know how to implement a systematic, structured, surgical simulation curriculum for training. Senior Instructor(s): Jeff H Pettey MD Instructor(s): Yousuf M Khalifa MD, Shameema Sikder MD*
NEW SOE Personalized Cataract Surgery: Femtosecond, Advanced Technology IOLs, and New Devices Course: 542 Room: S105a Education Level: ADV
Tuesday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Several new technological advancements are progressively transforming cataract surgery into a personalized procedure. Femtosecond laser provides customized incisions and anterior and posterior capsulorrhexis, advanced technology IOLs solve several refractive problems (ie, astigmatism, distance and near vision), and new phaco technology and instruments facilitate complex cases and reduce occurrence of complications. This course will discuss the targets of final plano refraction, reduction of surgical time, and intraoperative and postoperative (ie, better incision sealing) complications. Objective: This course will provide an update on the possibilities of customizing cataract surgery to patient characteristics and needs through the use of new technological advancements. Senior Instructor(s): Matteo Piovella MD* Instructor(s): Jorge L Alio MD PhD*, Steve A Arshinoff MD*, Jack T Holladay MD MSEE FACS*, Barbara Kusa MD, Richard L Lindstrom MD**, Zoltan Nagy MD*, Stephen S Lane MD*
H Cliffhanger: Vitrectomy by the Anterior Segment Surgeon
for the Broken Posterior Capsule, the Sinking Nucleus, and the Dangling IOL Course: 557 Room: E351 Education Level: INT
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Every anterior segment surgeon faces the problem of a broken posterior capsule at some time or another and should know how to perform vitrectomy. One should also know how to manage a dropped nucleus or sinking fragments. In this course, various techniques like the posterior-assisted levitation technique (PAL) and others will be taught, including how to perform bimanual vitrectomy. The dangling IOL and fixation of a posterior chamber IOL in eyes without capsule support using the glued IOL technique will also be taught. The management of these various challenges will be explained through videos. Objective: At the end of the course, the attendee will be able to fix an IOL in eyes without capsules, retrieve sinking lens fragments, and also do a thorough vitrectomy when required. Senior Instructor(s): Amar Agarwal MD* Instructor(s): David F Chang MD*, William F Mieler MD*
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NEW SOE Preventing Postoperative Endophthalmitis: What We Know, What We Do Not Know, and Where We Should Go From Here Course: 567 Room: N138 Education Level: BAS
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Presenting scientific findings from an evidence-based perspective as a foundation, we will consider current clinical practices and outcomes from around the world with an eye toward future research. Objective: (1) To define the proven prophylaxis of postoperative endophthalmitis, (2) To describe the problem of resistance, (3) To describe host and surgical risk factors for endophthalmitis, (4) To describe current standard of care in the United States, (5) To describe current standard of care in the European Union, and (6) To describe current standard of care in Asia. Senior Instructor(s): Andrzej Grzybowski MD* Instructor(s): Mark Packer MD*, George Beiko MD*, Soosan Jacob FRCS
Understanding Ophthalmic Viscosurgical Devices to Optimize Their Use in Cataract Surgery and Complications Course: 573 Room: S106a Education Level: INT
Tuesday 12:45 - 1:45 PM Target Audience: COMP
Synopsis: This course will consist of a slide and video presentation of rheologic properties, classification, and varied utilization techniques for different ophthalmic viscosurgical device (OVD) types. New OVDs, recent discoveries, and principles and techniques to prevent and manage complications and postoperative IOP spikes will be covered. Ample opportunity for discussion will be available. Objective: At the conclusion of this course, attendees will have gained (1) insight into the rheologic properties and surgical behavior of different OVDs and (2) understanding about choice and optimal use of OVDs. This will enhance attendees’ skills in surgery and complication management. Senior Instructor(s): Steve A Arshinoff MD*
Achieving Proper Centration and Alignment for Vision Correction in Keratorefractive and Intraocular Surgery Course: 580 Room: S103a Education Level: INT
Tuesday 12:45 - 1:45 PM Target Audience: COMPSUB
Synopsis: This lecture and video-based course will demonstrate how to center and align keratorefractive and intraocular devices and procedures for vision correction. Pearls on interpreting diagnostic testing, including corneal topography and pupil imaging, will be presented. Techniques for achieving good alignment and centration of diffractive multifocal and toric IOLs, limbal relaxing incisions, and corneal inlaysincluding the importance of angle kappa-will be demonstrated and discussed. Objective: At the conclusion of this course, attendees will be able to apply practical techniques, including the use of common imaging studies, to achieve good centration and alignment in keratorefractive and intraocular surgery. Senior Instructor(s): Daniel H Chang MD* Instructor(s): George O Waring MD*, John P Berdahl MD*
NEW Intraoperative Biometry for High-fidelity Phaco Surgery Course: 583 Room: S105d Education Level: INT
Tuesday 12:45 - 1:45 PM Target Audience: COMPSUB
Synopsis: The course will present the latest advances in intraoperative diagnostics and imaging for phaco cataract surgery, with a focus on intraoperative aberrometry. The faculty will discuss key aspects of the technology and how it can improve surgical outcomes in both standard and challenging cases.
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses Objective: The is to provide a concise and practical primer of intraoperative refractive biometry for the cataract surgeon. Senior Instructor(s): Tsontcho Ianchulev MD* Instructor(s): Kenneth J Hoffer MD FACS*, Mark Packer MD*, David F Chang MD*, Farrell Tyson II MD**, P Dee G Stephenson MD FACS*
NEW Phacoemulsification in Eyes with Coexisting Vitreoretinal Pathologies Course: 585 Room: S102abc Education Level: INT
Tuesday 12:45 - 1:45 PM Target Audience: COMPSUB
H Advanced IOL Power Calculations for the Cataract and Refractive Surgeon Course: 590 Room: E351 Education Level: INT
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: The indications for an IOL implantation following cataract or clear lensectomy have significantly increased. Techniques for determining the proper IOL and power will be presented. Objective: This course will provide clear methods and techniques for determining the proper IOL and power for complicated cases and will familiarize the clinician with indications and limitations of specialty lenses, such as multifocal and toric IOLs. Senior Instructor(s): Jack T Holladay MD MSEE FACS*
H Cataract Surgery in the Setting of Ocular Comorbidities and High-risk Features for Intraoperative and Postoperative Complications Course: 593 Room: N427bc Education Level: ADV
Tuesday 2:00 - 4:15 PM Target Audience: SUB
Synopsis: Ocular comorbidities and high-risk characteristics for intraoperative and postoperative complications occur with surprising regularity in cataract surgery patients. Ocular comorbidities often reduce visual potential. Systemic comorbidities and other characteristics of the eye or patient are often associated with a high risk of intraoperative and postoperative complications. In this course, a faculty of internationally recognized experts in cataract surgery will discuss a variety of common comorbidities and high-risk characteristics, the unique problems they present, and strategies for achieving successful visual and surgical outcomes. Objective: At the conclusion of this course, the attendee will be able to identify a variety of ocular comorbidities and high-risk eye and patient characteristics for surgi-
NEW Complex Cataract and IOL Complications Course: 602 Room: S403b Education Level: INT
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course has two major areas of focus: the first is the complex cataract, and the second is implant complications. The course will be primarily video based, but some didactic lecture will also be presented. Lively discussion between the panelists and attendees will also be encouraged. Topics to be covered include the white and brunescent lens, traumatic cataracts, zonular instability, innovative use of intraoperative aberrometry, and anterior vitrectomy. Implant complications will also be covered, including management of dislocated IOLs, techniques for scleral and iris fixation of implants, and IOL exchange. Objective: At the conclusion of the course attendees will learn both the fundamental concepts and surgical techniques to deal with complex cataracts and implant dysfunction. Attendees should be able to directly apply what is learned to their own clinical practice improving patient care. Senior Instructor(s): Brandon Ayres MD* Instructor(s): Elizabeth Yeu MD*, Jai G Parekh MD MBA, Jessica B Ciralsky MD*, David A Goldman MD*, Nicole R Fram MD*, Preeya K Gupta MD*, Jimmy K Lee MD**, William Wiley MD*
Computers, Information Technology NEW YO Protecting Your Online Image Course: 320 Room: N427a Education Level: INT
Monday 9:00 - 10:00 AM Target Audience: COMPSUB
Synopsis: Currently, physicians are not doing a good job, or in many cases, any job of monitoring their online reviews and reputation. This workshop will help the attendee to understand how online media can help build their practice and reputation, and how to protect against bad reviews or negative comments. Objective: Many doctors and practices have a website, but few are actively managing their online persona and presence. Services like Yelp, Health Grades, Angie’s List, Health Tap, Facebook, Twitter, and many more can either help your practice or hurt it. Participants will be taught how to edit their personas on the websites most commonly used by parents and patients. Strategies for protecting the participant’s online identity will be given. Ethical considerations with regard to self-promotion and advertising will also be addressed. Senior Instructor(s): K David Epley MD Instructor(s): Andrew P Doan MD PhD*
NEW Google Hangouts for Free Videoconferencing Course: 323 Room: N427d Education Level: BAS
Monday 9:00 - 10:00 AM Target Audience: COMPSUB
Synopsis: This course shows how to use Google Hangouts for free videoconferencing. We will go through a step by step power point presentation. Attendees can follow along with their smartphones if they have 4GS or 4GLTE capability or they can use the power point to replicate the same at home with their laptop or mobile device. We will show the audience how to get an gmail account, log onto Google Calendar, create a meeting with videoconference and chat. Objective: At the conclusion of this course, the attendee will be able to set up a videoconference call among satellite offices via a computer or smart phone device. Senior Instructor(s): Gloria Wu MD*
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
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Instruction Courses
Synopsis: This course will deal with all issues pertaining to phacoemulsification (PE) in the presence of posterior segment pathologies. Topics covered: a brief overview of common vitreoretinal pathologies coexisting with cataract (diabetic retinopathy, vitrectomized eyes, high myopia retinal detachment, etc.), how these eyes are different from the routine, intraoperative risks involved, preoperative assessment and surgical planning, intraoperative management of distorted anatomy (small pupil, subluxation, nuclear brunescence, pre-existing posterior capsular rent), combined single-stage phaco vitrectomy, PE in vitrectomized eyes, IOL power calculation in silicone oil filled eyes, IOL options, techniques of silicone oil removal after PE, pars plana vitrectomy for the cataract surgeon, and postoperative management. Objective: At the end of the course, the attendees will become familiar with current strategies in the management of eyes with cataract and coexisting vitreoretinal pathologies. Senior Instructor(s): Arup Chakrabarti MBBS Instructor(s): Kevin M Miller MD*, Abhay Raghukant Vasavada MBBS FRCS*, Warren E Hill MD*, Samuel Masket MD*, Jeewan S Titiyal MD, Meena Chakrabarti MBBS
cal complications at the time of cataract surgery. The attendee will also be able to describe strategies for obtaining optimal outcomes under these conditions. Senior Instructor(s): Kevin M Miller MD* Instructor(s): Arup Chakrabarti MBBS, Michael Colvard MD*, Alan S Crandall MD*, Bonnie A Henderson MD*, Terry Kim MD*, Nick Mamalis MD*, Samuel Masket MD*, Thomas A Oetting MD, Randall J Olson MD, Robert H Osher MD*, Mark Packer MD*, Abhay Raghukant Vasavada MBBS FRCS*
Instruction Courses Cornea, External Disease YO Top 10 Hot Corneal Surgical Tips for 2014 Course: 152 Room: S103d Education Level: INT
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Instruction Courses
Synopsis: An expert panel of experienced corneal surgeons will present their annual survey of the hottest corneal surgical tips for 2014. Each surgical tip has been carefully selected for novelty and maximum potential impact on clinical practice. Annually updated topics include time-saving office techniques (eg, rebubbling, amniotic membrane grafting), refinements of common operations (eg, Descemet-stripping automated endothelial keratoplasty, pterygium), and pearls for cutting-edge surgical procedures (eg, Descemet membrane endothelial keratoplasty, deep anterior lamellar keratoplasty, femtosecond keratoplasty, keratoprosthesis, stem cell grafts). A rapidfire format with expert panel commentary and audience Q&A will promote lively discussion, and annual refreshing of topics and a rotating faculty ensure that material is fresh and of interest to repeat attendees. Objective: Through step-by-step instructions, surgical video, and detailed handouts, the practitioner will gain practical, specific, and immediately applicable knowledge of improved techniques and approaches for common and challenging corneal surgical problems. Senior Instructor(s): David G Hwang MD Instructor(s): Eduardo C Alfonso MD*, Sadeer B Hannush MD, Allan Slomovic MD*, Geoffrey C Tabin MD, Mark A Terry MD*
NEW Surgical Management of Infectious Keratitis: Make It Simple Course: 166 Room: S104b Education Level: ADV
Sunday 10:15 - 11:15 AM Target Audience: SUB
Synopsis: The management of microbial keratitis is challenging. Many cases require surgical treatment for eradication of infection and salvaging the eye. This course will provide an overview of the indications, preoperative planning, surgical techniques, and postoperative management of various surgical procedures, including the recent ones used in the management of active microbial keratitis. Objective: The course is aimed at improving the participants’ understanding of various aspects of surgical management of microbial keratitis so as to achieve preservation of the vision and globe, even under otherwise difficult-to-manage situations. At the conclusion of this course, participants will be able to do manage these conditions with significantly efficient preoperative planning and better postoperative care. Senior Instructor(s): Bhupesh Bagga MD FRCS MBBS Instructor(s): Prashant Garg MD*, Donald Tan MD FRCS FRCOphth*, Namrata Sharma MD MBBS, Vishal Jhanji MBBS
NEW Endothelial Keratoplasty: Descemet-Stripping EK / Descemet Membrane EK / Pre-Descemet EK—A VideoBased Course Course: 174 Room: N427a Education Level: INT
Sunday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Endothelial keratoplasty (EK), including Descemet-stripping EK (DSEK), Descemet membrane EK (DMEK), and the latest, pre-Descemet EK (PDEK), will be taught through videos in this course. The methods by which the graft can be prepared, the injection of the graft into the anterior chamber, and the unrolling of the graft will all be explained through videos. OCT images to explain the postoperative results will also be shown. The technique of endoilluminator-assisted DMEK (E-DMEK), in which an endoilluminator is used to help in identifying the position of the graft, will also be shown. The advantages of PDEK, in that it can be done on any aged donor eye, among others, will be explained. Finally, anterior segment reconstruction including pupilloplasty and glued IOL to help create a barrier for the air to tamponade the graft will also be taught.
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Objective: At the conclusion of this course the attendee will be able to perform endothelial keratoplasty and also master the challenges and complications of the technique. Senior Instructor(s): Amar Agarwal MD* Instructor(s): Soosan Jacob FRCS, Massimo Busin MD*, Yuri F McKee MD*, Anthony J Aldave MD*
Complications and Growing Applications in Collagen Crosslinking: Diagnosis, Management, and Prevention Course: 195 Room: N140 Education Level: ADV
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will present a didactic approach to the clinical experience of complications encountered with several collagen crosslinking (CXL) treatments for indications such as (1) keratoconus and (2) ectasia following refractive surgery. Several surgical treatment modalities utilized in the U.S. clinical trials and internationally will be presented. Long-term clinical results will be presented.(3) Prophylactic CXL in LASIK and PRK (4) CXL in bullous keratopathy, cornea scarring, infectious keratitis, delayed epithelial healing, regression, and endothelial decompensation.Medical and surgical and treatment techniques for the above will be presented and discussed in detail. Objective: The participants will share their vast experience in CXL and the potential complications encountered in managing progressive keratoconus, post-LASIK ectasia, bullous keratopathy, prophylactic CXL in LASIK and PRK and lamellar grafts in order to obtain stabilization and potentially visual rehabilitation. Senior Instructor(s): A John Kanellopoulos MD* Instructor(s): Gregory Pamel MD**, Henry D Perry MD*, R Doyle Stulting MD PhD*, Eric D Donnenfeld MD*, Soosan Jacob FRCS
H Advances in Treatment of Severe Ocular Surface Disease: Views From Experts on the Front Lines Course: 199 Room: S106a Education Level: BAS
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: Exciting new treatment approaches to severe ocular surface diseases (Stevens-Johnson syndrome, graft vs. host disease, chemical injuries, and others) have emerged in the past few years. In this course, leading experts in the field will present their own innovations as well as their perspectives on the latest developments. In Stevens-Johnson syndrome, for example, interventions in the acute disease phase, including topical and systemic medications, specialty contact lenses, and amniotic membrane application, have shown great promise in limiting devastating long-term ocular sequelae. For patients with chronic ocular findings, treatment with mucous membrane grafts, specialty devices such as prosthetic replacement of the ocular surface ecosystem (PROSE), and keratoprostheses constitute potential sightrestoring interventions. Objective: This course is designed to update general and subspecialty ophthalmologists on sophisticated novel treatment approaches to severe ocular surface disease. Senior Instructor(s): Jessica B Ciralsky MD* Instructor(s): C Stephen Foster MD*, Darren G Gregory MD, Deborah S Jacobs MD*, Stella K Kim MD*, Gary J Lelli MD, Virender S Sangwan MBBS, Kimberly C Sippel MD*
NEW Optimizing Deep Anterior Lamellar Keratoplasty: The Small Bubble Technique Course: 201 Room: S105d Education Level: ADV
Sunday 2:00 - 3:00 PM Target Audience: SUB
Synopsis: The advantages of deep anterior lamellar keratoplasty (DALK) for the patient with stromal disease and healthy endothelium are well established. Uptake of this procedure has been poor, due to the high degree of difficulty and the often frequent need to convert cases to penetrating keratoplasty (PK). In this course, the instructors will use video and case presentations to explain several technique modifications that result in improved predictability and success of DALK surgery. In particular, the use of a deep measured trephination and a small-diameter big bubble and
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses reduced-diameter stromal dissection will be explained. Visual outcomes and complications will also be discussed in detail. Objective: At the conclusion of this course, attendees will be able to improve the success rate of their DALK surgery and reduce their rate of conversion to penetrating keratoplasty. Senior Instructor(s): Massimo Busin MD* Instructor(s): Jacqueline E Beltz MBBS, Vincenzo Scorcia MD
NEW Descemet Membrane Endothelial Keratoplasty Course: 205 Room: S106b Education Level: INT
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Atypical Keratitis Course: 214 Room: S102d Education Level: INT
Sunday 3:15 - 5:30 PM Target Audience: COMPSUB
Synopsis: Since many patients with corneal ulcer are managed empirically based on clinical features, it is important to be familiar with not only the classical but also the atypical clinical features. This course will present atypical features of common pathogens as well as clinical features of uncommon pathogens using representative cases. The course will also provide pearls for establishing diagnosis of such atypical cases, including the role of newer diagnostic modalities such as confocal microscopy and molecular methods. Objective: To make participants familiar with atypical keratitis cases and provide pearls for early diagnosis. Senior Instructor(s): Prashant Garg MD* Instructor(s): Yoshitsugu Inoue MD PhD*, Terrence P O’Brien MD**, Elmer Tu MD, Francis S Mah MD*
Ocular Surface Diseases in Cancer Patients: Update on Clinical Spectrum and Treatment Course: 230 Room: E353c Education Level: BAS
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: In this course the clinical spectrum and management of ocular surface diseases due to cancer treatment will be summarized. Update of new cancer treatments and their ocular side effects will be covered. Special surgical considerations in cancer patients will be discussed in an interactive format. Objective: This course is designed to provide an overview and update of ocular surface diseases that result from modern cancer treatments. At the conclusion of the course, the attendees will be able to recognize and treat the spectrum of the ocular surface diseases in cancer patients. Senior Instructor(s): Stella K Kim MD* Instructor(s): Kimberly C Sippel MD*
Course: 233 Room: S105a Education Level: BAS
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: The primary goals of pterygium surgery should ideally be to have a very low recurrence with minimal complications, and to be cosmetically acceptable. This video-assisted course will describe the basics of different conjunctival autografting techniques, which are the gold standard of any pterygium surgery, primary or recurrent. The course will demonstrate the different types of graft fixation: with sutures, with fibrin tissue glue, and finally with autologous blood. It will also describe the complications, amniotic membrane grafting in difficult situations, and adjunctive medical treatments to reduce recurrences. Objective: At the conclusion of this course, the comprehensive ophthalmologist will able to learn (1) the basics of surgical excision of the pterygium with autologous conjunctival graft, (2) various types of graft fixation, and (3) how to deal with the complications of pterygium surgery and tackle the difficult pterygium. Senior Instructor(s): Santanu Mitra MBBS Instructor(s): Anthony J Aldave MD*, Samar K Basak MD DNB MBBS*
NEW Allergic Eye Disease: An Enigma for Physicians Course: 236 Room: S106a Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: Ocular allergy is a common disorder, affecting up to 20% of the population. Allergic eye diseases are important due to their chronic nature and refractory behavior to most therapies. They affect overall quality of life. They are often missed and may mimic other ocular surface pathologies and sometimes infection. This may delay their diagnosis and management. In this course we will present a series of cases depicting common and uncommon manifestations of allergic eye diseases. Topics will include seasonal, perennial, vernal, atopic, and toxic keratoconjunctivitis and their complications and sequelae. A stepwise algorithm approach will describe management for each, including the role of steroidal and nonsteroidal drops, cyclosporine, mast cell stabilizers and antihistamines, topical and oral anti-inflammatory and immunosuppressive drugs, and prevention and management of complications. Objective: Attendees will be able to differentiate various forms of ocular allergies and formulate a logical stepwise treatment plan for them. Senior Instructor(s): Somasheila I Murthy MD Instructor(s): Jatin Naresh Ashar MD, Victor L Perez MD*, Neal P Barney MD*, Anurag Mathur MS
H Ocular Surface Disease Management: Moving From Adequate to Expert Course: 308 Room: E351 Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: Ocular surface disease encompasses several entities, including keratoconjunctivitis sicca and meibomian gland dysfunction, that share a common denominator: an inflamed and desiccated ocular surface. In this course, the pathogenesis, signs and symptoms, and diagnosis of specific ocular surface disease entities will be discussed. Case presentations will be used to help guide discussion of management and treatment options. Objective: This course will help the clinician understand the pathophysiology and management of ocular surface disease. Attendees will (1) improve the diagnostic skills and therapeutic techniques used with keratoconjunctivitis sicca, blepharitis / meibomian gland dysfunction, and atypical conjunctival diseases, (2) understand the pathophysiology of ocular surface disease, (3) increase their knowledge of drugs available to treat ocular surface disease, and (4) have a working differential diagnosis of the irritated and red eye. Senior Instructor(s): Joseph Tauber MD*
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
67
Instruction Courses
Synopsis: This course intends to provide a full description of the Descemet membrane endothelial keratoplasty (DMEK) surgical technique, emphasizing the key steps necessary to make DMEK feasible in various conditions. The course will entail the results and the lessons learned after more than 700 DMEK surgeries with a maximum follow-up of 7 years. Descemet membrane graft harvesting and preparation will be shown, indications and limitations of DMEK will be discussed, the standardized surgical technique will be explained, and additional alternative techniques and surgical considerations for challenging cases will be presented. Objective: At the conclusion of this course, the attendee will be able to recognize the special characteristics of this lamellar keratoplasty technique, appreciate its advantages, and distinguish its limitations. The course intends to offer a stepwise approach to novice DMEK surgeons and useful surgical pearls to the more experienced. Senior Instructor(s): Gerrit RJ Melles MD PhD* Instructor(s): Vasilios S Liarakos MD, Isabel Dapena, Lamis Baydoun MD, Fook Chang Lam MBChB, John Steven Parker MD, Maria Satue MD, Martin Dirisamer MD
NEW Conjunctival Autografting in Pterygium Surgery, Simplified
Instruction Courses H Help! A Corneal Ulcer Just Walked In! What Do I Do Next? Course: 317 Room: N136 Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Instruction Courses
Synopsis: Ophthalmologists invariably encounter corneal ulcers in practice. The knee-jerk response is to treat with fourth-generation fluoroquinolones. However, this may be ineffective and could actually be detrimental in autoimmune or noninfectious keratitis. Features to identify in diagnosing and differentiating between the various types of corneal ulceration (infectious and noninfectious) will be presented in this course. The various established and experimental medical and surgical therapies to treat corneal ulceration will be described, along with an explanation of which therapies may be useful for which types of ulcers. A flow chart for formulating a therapy plan for corneal ulceration will also be presented. Objective: At the conclusion of this course, the attendees will be able to (1) differentiate the various types of corneal ulceration, (2) determine which ulcers need emergent, urgent, or routine therapy, and (3) formulate a logical and stepwise treatment plan and decide when referral to a tertiary center is necessary. Senior Instructor(s): Sonal S Tuli MD
NEW Diagnosis and Management of Ocular Surface Disease due to Systemic Conditions Course: 322 Room: S104b Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: This course will cover the latest developments in the diagnosis and treatment of ocular surface disease caused by systemic disease including Sjogren syndrome (SS), graft vs. host disease (GVHD), and Stevens-Johnson syndrome (SJS). Objective: At the end of this course, attendees will be familiar with systemic causes of ocular surface disease including SS, GVHD, and SJS. An overview of etiopathogenesis, clinical manifestations, and current medical and surgical treatment options for active disease states, as well as various vision rehabilitation options in chronic stages, will be discussed. Senior Instructor(s): Vatinee Y Bunya MD* Instructor(s): Mina Massaro-Giordano MD*, Esen K Akpek MD*, Deborah S Jacobs MD*, Kimberly C Sippel MD*, Frederick B Vivino MD**, Victor L Perez MD*
H SA Current Topics in Cornea / External Disease: Highlights of the Basic and Clinical Science Course 8 Course: 334 Room: E352 Education Level: INT
Monday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course is designed to provide the latest in diagnosis and treatment in the rapidly changing field of cornea and external disease. Objective: At the conclusion of this course, participants should understand the difference between tear insufficiency and evaporative eye disease, as well as the role of the new therapeutic interventions. They should be able to recognize common infectious, neoplastic, and immune-related diseases and prescribe appropriate treatment. They should be able to differentiate the common corneal dystrophies. They should understand the role of collagen crosslinking, Descemet-stripping automated endothelial keratoplasty, Descemet membrane endothelial keratoplasty, deep anterior lamellar keratoplasty, and penetrating keratoplasty for the treatment of corneal disease. Senior Instructor(s): Robert W Weisenthal MD Instructor(s): Stephen E Orlin MD, Kathryn A Colby MD PhD*, Elmer Tu MD, Natalie A Afshari MD*, Denise de Freitas MD, Woodford S Van Meter MD FACS
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Contact Lens in Ophthalmology Practice Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the Contact Lens Association of Ophthalmologists (CLAO)
Course: 350 Room: S105a Education Level: INT
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: In this course, the incentives, scope-of-practice options, and resource requirements for contact lens practice will be presented. Practitioners from various practice settings, including comprehensive solo practice, academic practice, cornea practice, and multispecialty practice, will present their experiences in offering contact lens services to their patients. Both private and institutional practices will be represented. Useful resources will be reviewed. Objective: At the completion of this program, the participant will understand (1) the incentives for offering contact lens as part of comprehensive eye care, (2) options for offering a limited scope or full range of contact lens services, (3) resource requirements for a range of contact lens services and practice models, and (4) availability of resources for reference. Senior Instructor(s): Warren R Fagadau MD* Instructor(s): Deborah S Jacobs MD*, S Lance Forstot MD FACS*, Bruce Koffler MD*, Thomas L Steinemann MD
Update on Intrastromal Corneal Ring Segments Course: 353 Room: S105d Education Level: INT
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Intrastromal corneal ring segments are more than just a solution for low myopia; they can also correct keratoconus, corneal ectasia, and high astigmatism. With the aid of femtosecond lasers, the surgical technique is easier to perform and the use of intracorneal rings is increasing. Nowadays, the principles of its use, the indications, the surgical technique, and the management of complications must be known by all ophthalmologists since it is becoming a frequently used technique for refractive and corneal specialists. Objective: By the conclusion of this course, attendees will be able to learn the principles, when to indicate the technique, and how to diagnose and solve complications in patients with intracorneal rings. Senior Instructor(s): Salvador Garcia-Delpech MD Instructor(s): Paulo Ferrara MD**, Maria T Iradier MD PhD, Rafael I Barraquer Compte MD*, Angel L Cisneros MD**, Patricia Udaondo MD, David Salom MD, Ana Hervas MD, Leonardo Torquetti MD*
NEW Corneal Edema, Opacification and Ectasia: Diagnostic and Treatment Strategies From the Preferred Practice Pattern Guidelines Course: 359 Room: S102d Education Level: INT
Monday 11:30 AM - 12:30 PM Target Audience: COMP
Synopsis: Corneal edema, opacification, and ectasia is the focus of 2 new Preferred Practice Pattern (PPP) guidelines. The authors, PPP Cornea and External Disease panel members, will use the evidence-based recommendations from these PPPs to provide the comprehensive ophthalmologist with a good understanding of how the latest diagnostic equipment and surgical techniques are used to best care for an affected patient. The utility of advanced corneal topography instrumentation and anterior segment OCT will be discussed. The emphasis will be on teaching the comprehensive eye physician the basic indications and techniques and the advantages and disadvantages of Descemet-stripping endothelial keratoplasty, Descemet membrane endothelial keratoplasty, deep anterior lamellar keratoplasty, anterior lamellar surgery, intrastromal ring segment insertion, and collagen crosslinking. Objective: Through didactic lecture and case presentation the attendees will not only understand the terminology, but will leave with management pearls and takehome points that can be implemented in their clinical practices. Senior Instructor(s): Robert S Feder MD Instructor(s): Francis S Mah MD*, Audrey R Talley-Rostov MD*, Steven P Dunn MD
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses NEW Mycotic Keratitis: Novel Strategies Against Emerging Pathogens
NEW Ocular Chronic Graft vs. Host Disease: Update and Case Studies for Clinicians
Course: 362 Room: S103a Education Level: BAS
Course: 391 Room: S104b Education Level: INT
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
H The Boston Keratoprosthesis: Case-Based Presentations
Highlighting the Essentials for Beginning and Experienced Surgeons Course: 383 Room: S103d Education Level: ADV
Monday 2:00 - 4:15 PM Target Audience: SUB
Synopsis: While traditionally considered a procedure of last resort, keratoprosthesis (KPro) implantation is being performed with increasing frequency for an expanding variety of indications, including repeat corneal graft failure and corneal opacification combined with limbal stem cell failure. In this course the indications and contraindications, surgical technique, and postoperative management of the Boston KPro will be presented along with illustrative case presentations. Objective: Attendees will learn to recognize patients in their practices who are good candidates for KPro implantation. Presentation of surgical videos and a detailed discussion of the postoperative management will familiarize attendees with KPro implantation, as well as with avoidance and management of postoperative complications. Senior Instructor(s): Kathryn A Colby MD PhD* Instructor(s): Anthony J Aldave MD*, Esen K Akpek MD*, James Aquavella MD*, James Chodosh MD MPH*, Claes H Dohlman MD PhD*, Sadeer B Hannush MD , Andrea C Cruzat MD
Synopsis: The pathogenesis, presentation, and treatment strategy for ocular chronic graft vs. host disease (cGVHD) will be presented by clinicians with substantial experience treating patients living with this disease. Exemplary cases will be presented for panel and audience polling, review, and questions. Objective: At the completion of this course, the participant will (1) appreciate the presentation of ocular cGVHD, (2) become familiar with stepwise treatment per task force recommendations, (3) understand management of surgical cataract in patients with cGVHD, and (4) learn from the review of exemplary cases, including considerations regarding cataract surgery and innovative approaches to treatment. Senior Instructor(s): Deborah S Jacobs MD* Instructor(s): Stella K Kim MD*, Roni M Shtein MD, Michael C Wu MD
NEW Diagnosis and Management of Corneal Endothelial Diseases Course: 408 Room: S104a Education Level: INT
Monday 3:15 - 4:15 PM Target Audience: COMPSUB
Synopsis: In order to properly diagnose and manage various corneal endothelial diseases, including Fuchs corneal dystrophy and CMV corneal endotheliitis, it is vital to understand disease pathogenesis and the proper selection of surgical treatment. In this course, attendees will learn how to properly diagnosis corneal endothelial diseases and perform current surgical techniques, such as Descemet-stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). This course will also provide a review of endothelial remodeling and the safety of using internationally shipped precut donor corneas for DSAEK, as well as discussion on possible future treatments such as using Rho-associated kinase (ROCK) inhibitors and cell-injection therapy. Objective: At the conclusion of this course, attendees will have a broader understanding of the pathogenesis and clinical management of corneal endothelial diseases, including keys for diagnosis and surgical managements, including DSAEK and DMEK. Senior Instructor(s): Shigeru Kinoshita MD* Instructor(s): Ula Jurkunas MD*, Jodhbir S Mehta MBBS PhD*, Tsutomu Inatomi MD PhD, Friedrich Kruse MD
NEW Controversies in the Management of Corneal Infections
Anterior Segment Imaging: A Practical Guide for Ophthalmologists
Course: 409 Room: N427a Education Level: INT
Course: 385 Room: S104a Education Level: BAS
Synopsis: In recent years there have been several issues that have either provoked controversies or generated new dilemmas regarding various aspects of the management of corneal infections. Some of these controversial issues are empirical vs. microbiology-based management, the use of in vivo corneal imaging in diagnosis, and the use of corticosteroids and lamellar keratoplasty.During this course we will present to the audience the evidence, for and against, involved in these controversial issues. In addition, the audience will also be able to know the opinions of the panel of experts participating in the course. Objective: The course will help participants make an informed decision on various issues presented during the course. Senior Instructor(s): Prashant Garg MD* Instructor(s): Francis S Mah MD*, Donald Tan MD FRCS FRCOphth*, Bennie H Jeng MD*
Monday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: This course will provide a comprehensive review of established and newer anterior segment imaging instruments and their practical clinical uses for evaluation of pathology of the cornea and angle. Instructors will cover anterior segment OCT, ultrasound biomicroscopy, in vivo confocal microscopy, and corneal topography. The course will emphasize a case-based approach to choosing from among the various imaging modalities, what each adds to clinical practice, and how to interpret the images. Objective: This course will provide a practical and comprehensive review of anterior segment imaging techniques for comprehensive ophthalmologists and anterior segment specialists. At the end of the course, attendees will be able to choose the appropriate imaging modality to use for individual patients in the clinical setting. Senior Instructor(s): Roni M Shtein MD Instructor(s): Shahzad I Mian MD*, Sayoko E Moroi MD PhD*, Maria A Woodward MD*
Monday 3:15 - 4:15 PM Target Audience: COMPSUB
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
69
Instruction Courses
Synopsis: Mycotic keratitis is an important cause of corneal blindness. Fungal keratitis is challenging from both a diagnostic and a therapeutic standpoint. Patients with fungal keratitis are often misdiagnosed and incorrectly treated. Furthermore, organisms are often difficult to isolate on microbiological testing. Newer diagnostic modalities, including confocal microscopy, are being used to aid in the earlier detection of mycotic keratitis. The treatments for these infectious disorders are equally challenging, requiring the use of multiple topical and systemic antifungal medications and surgeries. In this course, leading experts will present updates on the medical management of these conditions, including the novel use of liposomal amphotericin B, along with the surgical options and pre- and postoperative considerations. Objective: To update general and subspecialty ophthalmologists on the novel treatment modalities and approaches to mycotic keratitis. Senior Instructor(s): Ana G Alzaga Fernandez MD Instructor(s): Jessica B Ciralsky MD*, Kimberly C Sippel MD*, Priyanka Sood MD, Thomas J Walsh MD**
Monday 2:00 - 3:00 PM Target Audience: COMPSUB
Instruction Courses Complex Endothelial Keratoplasty: Current Strategies to Improve Results and Avoid Complications Course: 417 Room: S105d Education Level: INT
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Instruction Courses
Synopsis: This course will feature a video and slide presentation of the current surgical technique, instrumentation, and complications of Descemet-stripping automated endothelial keratoplasty (DSAEK) in complex situations such as failed penetrating keratoplasty, aphakia, aniridia, filtering tubes, and retained anterior chamber IOL. Easier, faster, and safer DSAEK techniques will be emphasized. Current modifications of EK that avoid complications will be stressed. Various techniques for DSAEK insertion (forceps, Busin glide, “pull through” injectors) will be shown and correlated with their induced endothelial damage. EK combined with vitrectomy, secondary IOL, and cataract surgery will be presented. The course will emphasize an ethical, prospective approach to complex DSAEK surgery and methods on how to avoid common surgical and postoperative pitfalls. Objective: At the conclusion of the course, the attendees will recognize the challenges and solutions of complex DSAEK in special circumstances that produce low complications and excellent vision. Senior Instructor(s): Mark A Terry MD* Instructor(s): Michael D Straiko MD*, Paul M Phillips MD
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: This course will review the epidemiology, diagnosis, and ophthalmic complications of anterior, necrotizing, and posterior scleritis. The wide array of systemic diseases that may be associated with scleritis will be discussed. How to order an efficient and appropriate systemic workup will be emphasized. Treatment algorithms will be presented, with particular attention to medication selection, proper dosing, safety monitoring, and when to switch from one treatment modality to the other. Objective: At the conclusion of this course, the attendee will be able to adequately diagnose and classify patients with scleritis. The attendee will understand how to elicit an appropriate history, undertake an appropriate physical examination, and order a precise systemic workup for these patients. The attendee will also understand the protocols used for different scleritis treatment modalities, such as NSAIDs, corticosteroids, immunomodulators, and antibiotics. Senior Instructor(s): Armando L Oliver MD* Instructor(s): Shree Kumar Kurup MD MB*
NEW Diagnosis and Management of Acanthamoeba Keratitis
Follow the Cornea: Do You Know Where Your Corneal Transplant Tissue Comes From?
Course: 432 Room: S403b Education Level: BAS
Course: 423 Room: N139 Education Level: BAS
Synopsis: This course will review the epidemiology, diagnosis, and management of Acanthamoeba keratitis, including the use of newer diagnostic tools such as confocal microscopy and polymerase chain reaction (PCR) analysis. Objective: At the conclusion of this course, the attendee will be able to (1) recognize the early and late clinical signs of Acanthamoeba keratitis, (2) understand the strengths and limitations of confocal microscopy as a tool to diagnose and follow patients with Acanthamoeba keratitis, (3) understand the various microbiological tests for diagnosing Acanthamoeba keratitis, including culture, smear, and PCR, (4) choose the proper medication regimen for Acanthamoeba keratitis based on susceptibility data, and (5) understand the potential beneficial and detrimental role of topical corticosteroids for Acanthamoeba keratitis. Senior Instructor(s): Jeremy D Keenan MD MPH Instructor(s): Elmer Tu MD, Jeena MARIA Mascarenhas MS, Lalitha Prajna MD, Rajaraman Revathi MD
Monday 4:30 - 5:30 PM Target Audience: SUB
Synopsis: The first steps of corneal transplant surgery take place in the eye bank. Through a combination of brief talks and expert panel discussions, we will inform the corneal surgeon about the process of eye tissue banking. We will (1) follow the path of tissue through recovery to distribution for corneal transplantation, (2) provide the evidence-based standards for surgical tissue selection, (3) discuss trends in eye banking, and (4) inform corneal surgeons on ways to get involved in the process. Objective: At the conclusion of this course, the attendee will understand the intricacies of corneal donation and tissue processing, will know the results of the Cornea Donor Study, will appreciate the complexity of the eye banks’ work, and will know ways to become involved with eye banks. The goal is to educate corneal surgeons in order to promote sustainability, to maintain availability of corneal tissue, and to broaden the surgeon’s knowledge of the vital resource of eye banking. Senior Instructor(s): Roni M Shtein MD Instructor(s): Kristiana D Neff MD*, Maria A Woodward MD*, Bennie H Jeng MD*, Mark J Mannis MD, Marian Sue Macsai-Kaplan MD*, David B Glasser MD, David E Korroch CEBT**, Monty Montoya**, Kevin P Corcoran CAE*
Diagnosis and Management of Corneal Perforation Course: 424 Room: S106b Education Level: INT
Monday 4:30 - 5:30 PM Target Audience: COMP
Synopsis: Corneal perforation is an ophthalmic emergency that requires prompt diagnosis and treatment. Although infectious keratitis is a common cause, other causes such as corneal xerosis and collagen vascular diseases are also important differential diagnoses, especially in cases that do not respond to conventional medical therapy. Based on the size and location of the corneal perforation, various treatment options are applicable that include medical therapy, corneal gluing, amniotic membrane transplantation, and corneal transplantation. Objective: At the end of the course the attendee will have a clear understanding of the concepts of stepwise management of corneal perforation. Senior Instructor(s): Vishal Jhanji MBBS Instructor(s): Rasik B Vajpayee MD, Sujata Das MBBS, Namrata Sharma MD MBBS, Jodhbir S Mehta MBBS PhD*
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NEW Scleritis: What to Order and How to Treat It! Course: 426 Room: S102d Education Level: INT
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
How to Successfully Accomplish Endothelial Keratoplasty in the Presence of Significant Ocular Comorbidities Course: 507 Room: S106a Education Level: INT
Tuesday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: This course will outline successful surgical strategies for accomplishing endothelial keratoplasty (EK) in the presence of comorbidities that make successful completion of surgery more challenging. The instructors will offer pearls for EK in phakic eyes; in the presence of cataract, aphakia, iris coloboma or zonular dehiscence, aniridia, anterior chamber IOLs, iris- or scleral-fixated posterior chamber IOLs; in unicameral eyes; and with failed penetrating or endothelial keratoplasty, trabeculectomy, or tube shunt. Clinical examples will illustrate points where appropriate steps may help avoid unwanted complications. Slides and videos of case studies will be shown, emphasizing dangers and solutions. Objective: This course is designed to enable participants to learn from our experience and avoid complications while shortening their learning curve for EK in the presence of ocular comorbidities. Senior Instructor(s): Sadeer B Hannush MD Instructor(s): Anthony J Aldave MD*, Henry D Perry MD*, George O D Rosenwasser MD
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses H Herpes Simplex Keratitis: When Herpes Isn’t a Dendrite, and Vice Versa Course: 511 Room: N138 Education Level: INT
Tuesday 9:00 - 11:15 AM Target Audience: COMPSUB
NEW Complex Corneal Clinics: Logical Solutions Course: 520 Room: S403b Education Level: ADV
Tuesday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: Complex corneal cases may be treated by various surgical approaches. In this course, options for pellucid marginal degeneration with or without keratoconus, (tectonic patch graft, wedge resection and lamellar dissection, combined tissue excision and corneal tuck, diamond blade-assisted deep anterior lamellar keratoplasty), keratoglobus (two-stage keratoplasty, tuck in keratoplasty, epikeratoplasty), Terrien marginal degeneration (compressive keratoplasty), acute hydrops in ectasias (intracameral air/gas injection and intrastromal fluid drainage), severe chemical injuries (stem cell transplant and large diameter lamellar keratoplasty), peripheral perforations (multilayered, patch and Tenon graft) and partial corneal opacities (optical iridectomy, autorotational keratoplasty) will be discussed in case-based demonstrations by experienced surgeons. Objective: At the end of the course the delegate will be able to master the principles of surgical techniques in difficult corneal situations. Senior Instructor(s): Rasik B Vajpayee MD Instructor(s): Namrata Sharma MD MBBS, Vishal Jhanji MBBS, Jodhbir S Mehta MBBS PhD*, Donald Tan MD FRCS FRCOphth*, Sheraz M Daya MD*, Massimo Busin MD*
NEW Keratoconus: The 2014 Protocol Course: 524 Room: S103a Education Level: INT
Tuesday 9:00 - 10:00 AM Target Audience: COMPSUB
Synopsis: Over the past decade the management of keratoconus (KC) has undergone a sea change. Previously KC management was limited only to rigid gas permeable lenses or penetrating keratoplasty. However, in 2013, the aim of KC management is not just management of ectasia but also to attain a BCVA of 20/20. Our course will discuss a protocol-based approach that would help one customize the therapy based on the severity of the disease. A panel of experts will debate their preferences of therapies such as rigid gas permeable lenses, Rose K and scleral lenses, collagen crosslinking (CXL) (standard and accelerated), Keraflex, intraocular ring segments, combining CXL with PRK/Intacs, toric ICL, and deep anterior lamellar keratoplasty (femtosecond assisted). Discussion of challenging cases, complications of various managements, and wrong decisions will conclude the course. Objective: At the end of the course, attendees will be familiar with the latest protocols and various treatment options for KC in 2014. Senior Instructor(s): Vandana Jain MBBS Instructor(s): Jatin Naresh Ashar MD, Rohit Shetty MD MBBS, Anurag Mathur MS
Course: 554 Room: S406b Education Level: INT
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: The role of meibomian gland dysfunction (MGD) in chronic blepharitis and ocular surface disease is rapidly evolving. MGD is a form of chronic blepharitis and is recognized as a cause of ocular surface disease. Subgroups of MGD will be discussed in this course, along with pathophysiological mechanisms, including the role of bacteria and lipolytic exoenzyme, meibum changes, and tear evaporation. Acute and chronic phase therapy will be presented. The role of topical therapies as well as systemic therapies will be discussed as they relate to both lid and ocular surface abnormalities. Objective: At the conclusion of this course, attendees will be able to diagnose and treat MGD and associated ocular surface disease. Senior Instructor(s): James P McCulley MD FACS FRCOphth*
Management of Ocular Chemical Injuries Course: 558 Room: S403b Education Level: INT
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Acute ocular chemical burn is an emergency and needs immediate management, which includes copious irrigation, topical steroids, autologous and cord serum , amniotic membrane transplantation, and even tissue adhesives and tectonic keratoplasty in severe cases. Regarding chronic chemical burns, this course will present a stepwise approach to the management of ocular surface reconstruction that depends on the laterality and the severity of limbal stem cell deficiency, including the limbal transplantation (direct and cultivated). Visual rehabilitative approaches that include keratoplasty and keratoprosthesis will also be discussed. Objective: At the end of the course, the attendee will be well versed in the acute and emergency management of ocular chemical burns (as should be every ophthalmologist) and will be aware of ocular surface transplantation techniques. This course will give a holistic overview of the management of ocular chemical burns. Senior Instructor(s): Namrata Sharma MD MBBS Instructor(s): Rasik B Vajpayee MD, Vishal Jhanji MBBS, Tushar Agarwal MD
Failed Graft: Never Say Die! Course: 562 Room: S403a Education Level: INT
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course describes selection of appropriate surgical procedure for highrisk failed grafts, such as repeat penetrating keratoplasty (PK), Descemet-stripping endothelial keratoplasty (DSEK), or keratoprosthesis. Even DSEK and deep anterior lamellar keratoplasty (DALK) may fail over time, and repeat surgery may be required. Keratoprosthesis is the answer to multiple failed grafts. Surgical techniques and modifications required for performing DSEK for failed PK, repeat DSEK, repeat DALK, postoperative immunosuppressive regimen, and outcomes of such surgeries will be discussed. A panel discussion on expert consensus on controversial issues regarding Descemet scoring, graft sizing for DSEK for failed PK, and multiple repeat PK / keratoprosthesis will conclude the course. Objective: At the end of this course, attendees will be familiar with the indications and patient selection for regrafts, surgical techniques and modifications, follow-up, and risks of repeat graft (PK, DSEK, DALK, and keratoprosthesis). Senior Instructor(s): Jatin Naresh Ashar MD Instructor(s): Sonia H Yoo MD*, David S Rootman MD*, Anthony J Aldave MD*, Mark A Terry MD*, Pravin Vaddavalli MD
H Pterygium: The Outcome Measure Is Now Cosmesis, Not Recurrence Course: 571 Room: S403a Education Level: BAS
Tuesday 12:45 - 3:00 PM Target Audience: COMP
Synopsis: PERFECT for Pterygium (pterygium extended removal followed by extended conjunctival transplantation) not only results in minimal recurrences (1 recurrence
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
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Instruction Courses
Synopsis: Herpes simplex keratitis (HSK) is the most common cause of corneal blindness in developed nations. Many cases are missed because ophthalmologists are unaware of the nondendritic manifestations of HSK, such as geographic, marginal, necrotizing, endotheliitis, and interstitial keratitis. Features and pathophysiology of the different forms of HSK and clues to their diagnosis will be presented. A logical plan for treatment will be presented, including when and how to use antivirals, steroids, and surgery. Major literature on herpes simplex keratitis will also be briefly discussed. Objective: At the conclusion of this course, attendees will be able to (1) diagnose common as well as unusual forms of HSV keratitis, (2) formulate a logical treatment plan based on their understanding of the pathophysiology of the different manifestations of herpes, and (3) get a general understanding of the newer treatment modalities on the horizon. Senior Instructor(s): Sonal S Tuli MD
Meibomian Gland Dysfunction and Chronic Blepharitis
Instruction Courses in 1000 patients with 99% follow-up of more than 1 year) but also provides an excellent cosmetic result. Objective: Attendees will understand the differences between the PERFECT for Pterygium surgical procedure and routine autoconjunctival surgery for pterygium. They will be prepared to treat pterygium as a significant disease, with “serious surgery” designed to achieve a low recurrence rate and a cosmetic appearance at 1 year, with the site of the pterygium undetectable. Attendees will be able to incorporate into their pterygium surgery any components of PERFECT for Pterygium that they do not already use. They will understand the expected postoperative course and therapy and the complications of this surgery. Above all else, they will learn a new respect for this disease, which has so often been trivialized in the past. Senior Instructor(s): Lawrence W Hirst MD MBBS MPH DO FRACO FRACS* Instructor(s): Ivan R Schwab MD FACS, Linda Rose MD PhD*
Innovative Uses of Adhesives in Anterior Segment Surgery Course: 576 Room: S101ab Education Level: INT
Tuesday 12:45 - 3:00 PM Target Audience: COMPSUB
Instruction Courses
Synopsis: This course will present the use of cyanoacrylate, fibrin-based, and other new adhesives for corneal wounds, cataract surgery, pterygium surgery, LASIK complications, dislocated IOLs, limbal stem cell transplants, and glaucoma surgery. Objective: At the conclusion of this course, the attendee will be able to identify and describe the use of various adhesives for corneal disorders, cataract / corneal procedures, dislocated IOL procedures, LASIK complications, and glaucoma procedures. Senior Instructor(s): Terry Kim MD* Instructor(s): Amar Agarwal MD*, Sadeer B Hannush MD, David R Hardten MD*, Robert J Noecker MD*, Christopher Rapuano MD*, David C Ritterband MD*, Jonathan B Rubenstein MD*
NEW Descemet Membrane Endothelial Keratoplasty: A Simplified Technique to Shorten the Learning Curve and Avoid Complications Course: 584 Room: S102d Education Level: INT
Tuesday 12:45 - 1:45 PM Target Audience: SUB
Synopsis: This course will feature a video and slide presentation of a simplified Descemet membrane endothelial keratoplasty (DMEK) technique that reduces the learning curve. We have found it to be easier, faster, and safer than earlier published techniques. Emphasis will be given to initial case selection, and specific surgical maneuvers that ensure correct orientation and unfolding of DMEK scrolls and that avoid intraoperative mishaps. Important preoperative planning for DMEK combined with cataract surgery as well as in special circumstances such as under failed penetrating keratoplasty and prior refractive surgery will be presented. Postoperative complications and their management will also be presented. Objective: At the conclusion of the course, the attendees will recognize the specific steps of DMEK surgery that produce low complications and excellent vision. Senior Instructor(s): Mark A Terry MD* Instructor(s): Michael D Straiko MD*, Paul M Phillips MD
H Recent Developments in the Diagnosis and Management
of Conjunctival Tumors Course: 596 Room: S103d Education Level: INT
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: Conjunctival tumors have a varied spectrum of clinical presentation. These are often misdiagnosed as simulating conditions, resulting in inappropriate management and tumor recurrence. The aim of this course is to provide a systematic overview of clinical manifestations of conjunctival tumors and to discuss recent concepts in diagnosis, management, and prognosis. Clinical evaluation of a patient with conjunctival tumor and typical and atypical manifestations will be demonstrated with well-documented clinical cases. Systemic associations will be discussed. Advantages of anterior segment imaging techniques will be highlighted. Evidence-based treatment protocols, and indications and outcome of newer treatment modalities such as
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topical chemotherapy and plaque brachytherapy, will be discussed. Standard surgical procedures will be demonstrated with video films. Objective: This course is designed to enable participants to accurately diagnose and appropriately manage common conjunctival tumors. Senior Instructor(s): Santosh G Honavar MD Instructor(s): Carol L Shields MD, Carol L Karp MD, Jerry A Shields MD
NEW SOE Basic Deep Anterior Lamellar Keratoplasty Course: 603 Room: N427a Education Level: INT
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This diagrams- and video-based course will analyze in detail indications for surgery and various deep anterior lamellar keratoplasty (DALK) techniques (hydrodissection, manual dissection, needle big bubble, cannula big bubble, air-visco bubble, and a new opening of bubble technique). The pros and cons of each technique, complications, and penetrating keratoplasty (PK) conversion will also be discussed. Based on 10 years follow-up study data, DALK advantages in terms of functional outcomes, endothelial cell count, and long-term survival will be reported. Objective: At the conclusion of this course, the attendee will be able to move from PK to DALK, acquiring the rupture management and PK conversion techniques. Senior Instructor(s): Vincenzo Sarnicola MD Instructor(s): Edward J Holland MD*, Sadeer B Hannush MD, Rajesh Fogla MD FRCS
H Next-Generation Technologies for the Diagnosis and Treatment of Dry Eye and Meibomian Gland Dysfunction Course: 604 Room: S101ab Education Level: BAS
Tuesday 3:15 - 5:30 PM Target Audience: COMPSUB
Synopsis: While diagnostics and treatments for dry eye are advancing, the majority of practitioners limit their interventions to giving out artificial tears. The panel of experts in this course will engage members of the audience to share their experiences with the presented technologies. The panel will discuss new diagnostic devices such as the InflammaDry Detector, the LipiView Interferometer, and tear osmolarity measurement, as well as the use of existing devices such as high-resolution OCT and topography to evaluate dry eye. Newer, as yet not widely used therapeutic strategies will also be discussed, including LipiFlow, intense pulsed light lasers, and Maskin Meibomian Probes. Finally, emerging therapeutics will be discussed. Objective: Attendees will collaborate with faculty to both summarize and disseminate our growing intuitions about how to approach and successfully treat one of the most common problems we see in the office every day. Senior Instructor(s): Linda Rose MD PhD* Instructor(s): William B Trattler MD*, Parag A Majmudar MD*, Marguerite B McDonald MD*, Penny Asbell MD FACS*, Mina Massaro-Giordano MD*
Electronic Health Records NEW EHR Useful Things to Do With Your New EHR Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the Medical Information Technology Committee
Course: 175 Room: S102d Education Level: INT
Sunday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Now that you have invested all of that time and money into your new EHR system, what can you do to take advantage of it? The real benefits of EHR are only manifest when you can use your data to improve the care you provide and enhance your practice. To help you begin thinking about how your EHR can help you, we will present stories (with data) showing how to make this happen. Examples presented will include creation of a “data mart” to analyze clinical and operational data, leveraging participation in the Intelligent Research in Sight (IRIS) Registry to improve care, development of forms to collect data on postoperative complications in glaucoma surgery, and integration of imaging devices to facilitate care.
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses Objective: At the conclusion of the course, attendees will be able to (1) describe ways in which EHRs can be used to improve patient care and clinic operations and (2) initiate discussions with their IT staff or EHR vendor regarding their own quality of efficiency improvement initiatives. Senior Instructor(s): Michael V Boland MD PhD* Instructor(s): K David Epley MD, Rishi P Singh MD*, Linda L Wedemeyer MD
NEW EHR SO EHR and Meaningful Use for the Small Practice: Is It Worth It? Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the Medical Information Technology Committee
Course: 235 Room: E353a Education Level: BAS
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
EHR EHR: Compliance and Medicolegal Issues Jointly sponsored by the Academy’s Annual Meeting Program Committee and Medical Information Technology Committee and the American Academy of Ophthalmic Executives’ EHR Subcommittee
Course: 587 Room: S103a Education Level: INT
Synopsis: This course will demonstrate how EHRs, while improving the quality of medical records, can also create problems that can trigger serious medicolegal and compliance issues. This course will explore how EHRs can be used wisely or foolishly. Case studies will be presented to illustrate problems created by the use of EHRs. Objective: By the conclusion of this course, attendees will be able to (1) describe some strengths of EHR systems that can improve compliance with chart documentation requirements, (2) describe some “tricks” that could hurt documentation reliability and compliance, (3) identify features in EHRs that pose the greatest threats, and (4) modify EHR utilization to improve documentation reliability and compliance. Senior Instructor(s): David E Silverstone MD Instructor(s): Michele C Lim MD*, Kevin J Corcoran*
NEW EHR Meaningful Use Stage 2: Qualifying for Payment Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the Medical Information Technology Committee
Course: 361 Room: N139 Education Level: BAS
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Health care is one of the last large industries to become computerized. Although EHRs have been around for decades, adoption has only recently begun to increase rapidly. EHRs create potential for improved access to patient data and clinical decision support tools as well as improved efficiency, but many have found the transition difficult. The federal government is promoting an incentive program to propel a large majority of physicians to adopt EHRs. If physicians do not adopt EHRs by 2015, they will face payment penalties from the Centers for Medicare and Medicaid Services. The final rule for Stage 2 of Meaningful Use will take effect in 2014. This course will discuss everything ophthalmologists need to know about this topic. Objective: At the end of this course, attendees will know what is needed to demonstrate Meaningful Use of their EHR system in 2014 by understanding the federal Stage 2 requirements, and what certified EHR technology is required. Senior Instructor(s): Michael F Chiang MD* Instructor(s): Michael V Boland MD PhD*, Julia Lee JD OCS*, Michael X Repka MD MBA*
EHR Managing Your EHR After Implementation Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the Medical Information Technology Committee
Course: 534 Room: S102d Education Level: BAS
Tuesday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Out-of-the-box EHR software doesn’t work well for many physicians. It’s important to alter the EHR itself to make it work for each provider in your group and for the practice as a whole. This timely session will reveal tips and tricks to help your software work for you, whether you are a solo practice, a small group, or part of a large organization. Objective: Here are just a few things to expect from this dynamic session: You will (1) discover tips and tricks for EHR optimization, (2) review lessons learned though EHR implementation, (3) learn ways to customize the software to work for your chart-
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Ethics NEW SO Electronic Media and Patient Care: Ethical
Considerations, Confidentiality, HIPAA, and Encryption Course: 200 Room: N427d Education Level: BAS
Sunday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: This course will define federal privacy mandates and relevant ethical practices: the HIPAA Privacy and Security Rules that protect the privacy of individually identifiable health information. Also featured will be attendees’ responsibilities under federal law, proper use of various mobile devices, encryption strategies, the multiple password conundrum, email authorizations, patient use of social media for communication of health issues, and the relevant ethical issues. Objective: At the conclusion of the course, attendees will be able to define federal privacy mandates and relevant ethical practices by (1) identifying the key components of secure electronic communication and data storage practices and (2) defining the HIPAA Privacy and Security Rules, the HITECH Breach Notification Rule, safeguards needed to ensure the protection of private health information, and the relevant ethical dilemmas involved. Senior Instructor(s): Christie L Morse MD* Instructor(s): Anthony J Aldave MD*, Keith D Carter MD FACS, R V Paul Chan MD, Nadia Martyn JD
NEW SO An Introduction to Error Disclosure for Ophthalmologists Course: 358 Room: S106b Education Level: BAS
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will present an introduction to error disclosure designed for ophthalmologists. The didactic section will discuss current trends toward mandatory error disclosure and summarize the experiences of providers who have adopted a disclosure culture. Attendees will watch video of a sample disclosure conversation and then break into small groups for ophthalmology-based case presentations with role play. After the group members give each other feedback, the instructors will present a summary of best practices in error disclosure. The course will conclude with a question and answer session and assessment of lessons learned from the cases.
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
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Instruction Courses
Synopsis: EHR and Meaningful Use implementation are time consuming and expensive. This course will help the smaller practice decide whether or not it makes sense for the practice to adopt these measures. Objective: EHR systems and Meaningful Use program participation are large hurdles for the small practice, given the time and expense necessary to implement them. This course will address common concerns among practitioners in small practices and debunk myths about adopting an EHR system and complying with Meaningful Use, so attendees can decide whether or not it makes sense for their practices to invest in an EHR and the process of Meaningful Use. Senior Instructor(s): K David Epley MD Instructor(s): Arvind Saini MD MBA
ing style, (4) learn how to deal with unanticipated problems, (5) discover how to maintain rapport with your patients despite the necessary computer use, (6) learn how to stay efficient while complying with Stage 2 of the Meaningful Use requirements. Anyone who has implemented an EHR system, or is in the beginning stages of implementation, should attend this course. Senior Instructor(s): K David Epley MD Instructor(s): Michele C Lim MD*, Michael V Boland MD PhD*
Instruction Courses Objective: At the conclusion of this course, the attendee will be able to(1) explain why error disclosure is relevant to ophthalmology,(2) describe the potential benefits of error disclosure for the patient and physician,(3) conduct a basic error disclosure conversation with a patient. Senior Instructor(s): Bryan S Lee MD JD Instructor(s): Gurunadh A Vemulakonda MD
General Medical Care Drug-Related Adverse Effects of Clinical Importance to the Ophthalmologist Course: 197 Room: N136 Education Level: INT
Sunday 2:00 - 3:00 PM Target Audience: COMP
Instruction Courses
Synopsis: This course will describe adverse ocular reactions from topical ocular and systemic medications, with a focus on recently reported adverse events identified by the National Registry of Drug-Induced Ocular Side Effects (Portland, Oregon) and applying the WHO classification system. Objective: At the conclusion of this course, attendees will be able to recognize drugrelated adverse ocular and systemic side effects when they occur in association with drugs commonly used by clinicians. Only those medications of clinical importance to ophthalmologists will be discussed. Senior Instructor(s): Rick W Fraunfelder MD
NEW Identifying and Managing Unhappy Patients Course: 237 Room: S106b Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: Ophthalmologists report spending an increasing amount of time dealing with “difficult” patients. Some of these patients are unhappy with the outcome of their care, some have substance abuse (drug and alcohol) issues, some may have mental health issues or dementia. At other times, eye surgeons are surprised to learn that former, seemingly satisfied patients have filed a malpractice lawsuit against them. In this course, actual calls to the Risk Management Hotline and closed malpractice cases will be used to identify patients who are unhappy, and to offer ways to improve communication skills for dealing with patients once problems are apparent. Objective: By the end of this course, participants will be able to (1) identify behaviors of patients who may be unhappy with their care, (2) develop approaches that encourage patients to communicate their concerns, and (3) clarify when further communication will not be helpful. Senior Instructor(s): Anne M Menke RN PhD
NEW Critical Issues in Management of Ocular Trauma Course: 327 Room: N139 Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: Using video-assisted, case-based discussion, this course will investigate critical issues in the management of adnexal and globe trauma and will critically review history, evaluation, timing, management principles, complications, prognosis, outcome, and controversies involved. The course will highlight involving patients in management of the injured eyes. Objective: To provide attending ophthalmologists with evidence-based, videoassisted surgical skill transfer in optimal management of complex patients of ophthalmic trauma. Senior Instructor(s): Rupesh Agrawal MBBS DMS FRCS Instructor(s): Ferenc P Kuhn MD PhD, Michael P Grant MD PhD**, Gangadhara J K Sundar MBBS, Rekha R Khandelwal MBBS FRCS
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NEW SO Genetic Testing in Ophthalmology Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the International Society for Genetic Eye Diseases and Retinoblastoma
Course: 389 Room: N136 Education Level: INT
Monday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: Genetic tests have become readily available for confirmation and refinement of the clinical diagnosis of inherited ocular diseases. While ophthalmologists are adept at diagnostic feature recognition, many remain uncertain about the value and process of obtaining and interpreting genetic tests. In this course, the panelists will emphasize the importance of precise clinical diagnosis with the use of ancillary testing modalities and available Web and book resources. The panelists will review categories, definitions, and interpretation of genetic tests and address advantages and difficulties in test interpretation for each. They will review the practical aspects of ordering genetic tests and providing results to the patient / family in the context of formal counseling. Selected cases will be used to illustrate teaching points. Objective: At the conclusion of this course, the attendee will be able to explain the current best-practice methodology for choosing, obtaining, and interpreting genetic tests for inherited eye diseases. Senior Instructor(s): Elias I Traboulsi MD* Instructor(s): Alex V Levin MD, Terri L Young MD*
Glaucoma YO Examining the Optic Nerve and Evaluating the Visual Field: The 5 Rs Course: 151 Room: E353b Education Level: BAS
Sunday 10:15 AM - 12:30 PM Target Audience: COMP
Synopsis: This course will provide a standardized process and technique, using 5 rules, for examination and documentation of the optic disc and retinal nerve fiber layer and for visual field evaluation to identify signs of glaucoma. Objective: At the end of the course, participants will be better able to systematically perform optic nerve examination and interpret visual fields to diagnose glaucoma earlier, correctly stage the disease, and detect glaucoma progression. Senior Instructor(s): Ronald L Gross MD* Instructor(s): Benjamin J Frankfort MD PhD*
NEW Selective Laser Trabeculoplasty: Basic Principles and Pearls for Practice Course: 167 Room: E353c Education Level: INT
Sunday 10:15 - 11:15 AM Target Audience: COMP
Synopsis: Laser trabeculoplasty (LT) is a commonly utilized technique for treating glaucoma. Performing LT is now possible with several different approaches including Argon Laser Trabeculoplasty (ALT), Selective Laser Trabeculoplasty (SLT), Diode Laser Trabeculoplasty (DLT) and others. While LT has been utilized as primary therapy in those newly diagnosed with glaucoma, it is more commonly used in patients who have failed medical therapy or in patients with physical or economic limitations. This session will cover the basics of performing LT with a focus on SLT as a tool for treating various types of glaucoma at various stages of the disease process. The basics of patient consent, laser settings, preoperative drop therapy and postoperative care will all be covered in detail. Case based learning will be used to emphasize key points when appropriate. Objective: At the conclusion of this course, the attendee will be able to explain the current best-practice methodology for performing SLT including patient selection, laser settings and the nuances of preoperative and postoperative care. Senior Instructor(s): Malik Y Kahook MD* Instructor(s): Leonard K Seibold MD*, Jeffrey R SooHoo MD, Mina B Pantcheva MD
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses Angle Closure and Angle-Closure Glaucoma Course: 184 Room: S105bc Education Level: INT
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Combined Cataract Surgery With Glaucoma Surgery: Guidelines, Indications, Methods, Techniques, and Postoperative Management Course: 186 Room: S403b Education Level: ADV
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will provide a comprehensive review of guidelines and indications for combined cataract / glaucoma filtering surgery based on glaucoma severity, IOP control, extent of optic nerve damage, level of visual field loss, and type of glaucoma. Preoperative considerations, from determination of surgical site and antimetabolite use to poorly dilating pupil, shallow anterior chamber, and posterior synechiae, will be discussed. Surgical methods, anesthesia, one- or two-site surgery, and surgical techniques will be explained. Glaucoma filtering surgery methods from conjunctival dissection and wound architecture to antimetabolite use will be stressed. Anticipation, avoidance, and management of surgical and postsurgical complications, and postoperative management of glaucoma will be explained. Objective: At the conclusion of this course, attendees will be able to proceed with combined cataract / glaucoma surgery, determine best surgical method, avoid complications, and manage postoperative glaucoma course. Senior Instructor(s): Leon G Partamian MD* Instructor(s): Eve J Higginbotham MD, Cynthia Mattox MD FACS*, David Lee MD*, Anastasios P Costarides MD PhD*, Thomas W Samuelson MD*, Marlene R Moster MD*
Ophthalmoscopic Evaluation of the Optic Disc and Retinal Nerve Fiber Layer Course: 191 Room: N139 Education Level: INT
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course covers the ophthalmoscopic evaluation of optic disc, cup, neuroretinal rim, parapapillary atrophy, disc hemorrhages, retinal nerve fiber layer, and retinal vessel width. Objective: The course will help participants to (1) understand pseudoglaucomatous macrocupping and pseudonormal minicupping, (2) detect early glaucomatous changes, (3) differentiate glaucoma types by disc morphology, (4) distinguish glaucomatous optic neuropathy from nonglaucomatous optic nerve atrophy, (5) consider ethnic differences in the disc appearance, (6) discuss pathogenic implications of the disc morphology for glaucoma, (7) perform the dynamic optic disc assessment using modified ophthalmodynamometry for estimation of central retinal artery and vein pressure, orbital tissue pressure, and brain pressure, (8) understand the presence of cerebrospinal fluid pressure, and (9) differentiate alpha, beta, gamma, and delta zone of parapapillary atrophy by OCT and histology. Senior Instructor(s): Jost B Jonas MD*
Course: 228 Room: S105bc Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: Participants will wear red-blue glasses to view 3-D PowerPoint projections of stereoscopic gonioscopy and slitlamp images. Identifying traditional gonioscopic anatomy may be confounded by a variety of anterior chamber angle pathologies. The use of different gonioprisms and indispensable gonioscopy techniques (dynamic indentation and termination of the corneal light wedge) will be discussed. Special emphasis will be placed on the evaluation of narrow angles, decision making for laser iridotomy, and laser treatment of the angle and iris. Pathologic variations in overly deep anterior chambers, angle blood vessels, increased trabecular meshwork pigment, peripheral anterior synechiae due to anterior mechanisms with or without membranes and posterior mechanisms with or without pupillary block, and anterior chamber angle clefts will be presented. Objective: While viewing stereoscopic images, the attendee will learn essential gonioscopic anatomy, examination techniques, and categorization with variations in pathology. Senior Instructor(s): Alan H Zalta MD
Gonioscopy and Angle Imaging Course: 232 Room: S403b Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMP
Synopsis: Gonioscopy, like any other skill in that it involves a learning curve. The training here will concentrate on when and how best to hone this skill. This course will educate the comprehensive ophthalmologist on different types of gonioscopy lenses and techniques, correlating the information with imaging studies and the clinical implications of their findings. The different grading systems and methods of documentation will be covered, as well as advice on interpreting state-of-the-art imaging. The course will utilize several high-resolution images of the angle. Objective: At the conclusion of this course, the attendees will be able to incorporate this valuable skill into their practices for the benefit of patients with various angle abnormalities. Senior Instructor(s): Shamira A Perera MBBS Instructor(s): Tin Aung FRCS PhD
Glaucoma Postop Care in the Office: A Video Compendium of Techniques—When and How to Intervene Course: 310 Room: S104a Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: This course will demonstrate strategies and techniques used during the postoperative period of trabeculectomy and glaucoma drainage implant procedures to increase surgical success. Objective: At the conclusion of this course, the attendee will be able to identify causes of surgical failure and early postoperative complications that require intervention. The strategies, timing, and techniques used to deal effectively with postoperative management of trabeculectomy and glaucoma implants will be discussed in detail and demonstrated with the use of slitlamp video footage to allow attendees to utilize these procedures in their own offices. The instructors, who have diverse training backgrounds, will show variations in technique that will allow even the seasoned glaucoma surgeon an opportunity for learning. Senior Instructor(s): Cynthia Mattox MD FACS* Instructor(s): Chandrasekharan Krishnan MD**, Susan S Liang MD**, Alan E Lowinger MD
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
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Instruction Courses
Synopsis: Practically and logically, this course will define and classify these glaucomas, outline their prevalence and incidence, outline methods of assessment, and discuss pathophysiological mechanisms before covering medical, laser, and surgical strategies of prevention and treatment and current approaches to management of the acute angle-closure crisis. Objective: After the course, participants will have a deeper and broader understanding of the burden and current classification of angle closure and angle-closure glaucoma, an awareness of pathophysiological principles underlying choices of new treatment strategies, and a detailed update on how best to prevent and to manage this spectrum of the glaucomas. Senior Instructor(s): Tetsuya Yamamoto MD* Instructor(s): Ivan Goldberg MBBS FRANZCO*, Clement C Y Tham MBBS*, Paul T K Chew MD*, Tin Aung FRCS PhD*, Ki Ho Park MD*, Prin Rojanapongpun MD*, Ning Li Wang MD, Ching Lin Ho FRCS MBBS*
H YO Top 10 Essentials of Gonioscopy: 3-D Viewing and Interpretation
Instruction Courses Glaucoma Filtration Device Mini-shunt: Friend or Foe? Course: 313 Room: S105bc Education Level: INT
Monday 9:00 - 10:00 AM Target Audience: COMPSUB
Synopsis: This course will provide practical tips in the use of Ex-Press shunts, including videos to demonstrate surgery to insert and remove the shunt if necessary. The management pearls for treatment of complications will be highlighted with illustrative cases. Objective: This course will review indications and contraindications for the use of Ex-Press shunts and practical tips for insertion. The course will also discuss prevention of complications and management of these, if they should occur. Senior Instructor(s): Annapurna Singh MD Instructor(s): Richard A Lehrer MD*
Canal-Based Glaucoma Surgery: Canaloplasty vs. Microstent Implantation—Everything You Want to Know Instruction Courses
Course: 316 Room: S105a Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: In this course the anatomy and pathophysiology of the Schlemm canal and its role in glaucoma, ultrasound studies of the canal, canal surgery (canaloplasty and microstent) indications, surgical techniques, outcomes, and management of complications will be discussed using surgical video footage and clinical pictures. Techniques for performing combination cataract and canal surgery and variations in difficult cases will be addressed. Future strategies for improving the surgical outcomes, including in the design and antifibrosis agents, will be discussed. Objective: At the conclusion of this course, the attendee will be able to understand the basic anatomy, pathophysiology, indications, surgical techniques (including combination surgeries), and management of intra- and postoperative complications of canal-based surgeries (canaloplasty and microstent implantation). Senior Instructor(s): Ramesh S Ayyala MD FRCS* Instructor(s): Thomas W Samuelson MD*
NEW Ocular Surface Disease and Glaucoma Course: 355 Room: S104b Education Level: BAS
Monday 11:30 AM - 12:30 PM Target Audience: COMP
Synopsis: Ocular surface disease and glaucoma are common conditions that affect millions of individuals. Often the diagnosis and treatment options for patients with both conditions can be confusing. Objective: This course will present the current modalities of detecting and treating ocular surface disease in individuals with glaucoma. Also, several clinical scenarios will also be presented with audience participation to better illustrate clinical dilemmas. At the conclusion of this course, the attendee will be able to develop strategies for the effective treatment of patients with both glaucoma and ocular surface disease. Senior Instructor(s): Prithvi S Sankar MD Instructor(s): Eydie G Miller MD*, Mina Massaro-Giordano MD*, Vatinee Y Bunya MD*
Managing Angle-Closure Glaucoma With Crystalline Lens Removal and Adjunctive Procedures Course: 387 Room: S403b Education Level: INT
Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: Preoperative diagnostics and ample surgical video will be used to demonstrate a unified approach and specific techniques to safely perform phacoemulsification as a definitive treatment for angle-closure glaucoma. In addition, adjunctive procedures such as goniosynechialysis, endoscoplasty, pars plana vitreous tap, iridozonulo-hyaloidectomy, and pupilloplasty will be demonstrated. Tools such as capsular tension rings, pupillary rings, iris hooks, and microinstrumentation to enhance surgical success will be presented. Objective: This course is designed to provide surgeons with an approach and tools for safely performing phacoemulsification in the management of angle-closure glau76
coma and to introduce adjunctive procedures to further enhance outcomes in these cases. Senior Instructor(s): Devesh K Varma MD* Instructor(s): Iqbal K Ahmed MD*, Garry P Condon MD*, Sebastien Gagne MD**, Arsham Sheybani MD, Diamond Y Tam MD
Cell Biology, Genetics, and Outflow in Glaucoma in 2014: Impact on Practice Course: 419 Room: S103a Education Level: ADV
Monday 4:30 - 5:30 PM Target Audience: SUB
Synopsis: An overview of biology-based theories relevant to clinical glaucoma will be presented. A very brief summary of the discussions at the Trabecular Meshwork Society meeting in December 2013 will be presented, along with other recent scientific advances pertaining to glaucoma. Uniquely, we emphasize the substantial relevance of these findings to diagnosis and therapy. Objective: This course will discuss the pros and cons of future genetic testing. The attendee will understand how specific concepts in cell biology impact clinical care of the glaucoma patient. After the session, many attendees will engage in an ongoing scientific dialog about specific aspects of glaucoma, conducted through email. Handouts will consist of numerous articles disseminated through a large file email service and will serve as a partial basis for these ongoing and sometimes lengthy discussions about the biology of the meshwork and its clinical relevance. Senior Instructor(s): John R Samples MD* Instructor(s): Murray A Johnstone MD*
H Normal-Tension Glaucoma: Evaluation and Treatment Course: 421 Room: E451b Education Level: BAS
Monday 4:30 - 5:30 PM Target Audience: COMP
Synopsis: A neuro-ophthalmologist will review neurologic conditions misdiagnosed as normal-tension glaucoma (NTG) and present the appropriate diagnostic evaluation. A glaucoma specialist will discuss the pathophysiology of NTG and appropriate medical and surgical therapies. Objective: This course will enable participants to identify NTG patients who deserve further neurologic evaluation and to become familiar with the appropriate treatment of patients with glaucoma and normal IOP. Senior Instructor(s): Mark L Moster MD* Instructor(s): Marlene R Moster MD*
Tubes, Ties, and Videotape: Surgical Video of Baerveldt Glaucoma Implants and Managing Complications Course: 510 Room: S403a Education Level: INT
Tuesday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: This course will present clinical photos, patient history, and edited surgical videos of several challenging glaucoma cases and will demonstrate efficient techniques for tube insertion and how to manage postoperative complications. The instructor will demonstrate how to reposition, extend, trim, cover, revise, and tie-off problematic tubes and will discuss how tubes are used in conjunction with surgery for cataracts, corneal failure, and retinal detachment. Objective: At the conclusion of this course, the attendee will be able to formulate an appropriate surgical plan for a glaucoma drainage implant and be better prepared to avoid and manage potential complications. Senior Instructor(s): Herbert P Fechter MD
Argon Laser Peripheral Iridoplasty: All You Need to Know Course: 514 Room: S105bc Education Level: INT
Tuesday 9:00 - 10:00 AM Target Audience: COMPSUB
Synopsis: This course covers all you need to know about argon laser peripheral iridoplasty (ALPI), from indications, contraindications, techniques, pearls, and results to complications and their management. Slitlamp photographs and videos are exten-
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses sively used in the course, the handout, and the course website to illustrate the critical techniques. Objective: At the conclusion of this course, the attendee will be able to safely, effectively, and confidently perform ALPI in the appropriate patients. Senior Instructor(s): Clement C Y Tham MBBS* Instructor(s): Robert Ritch MD FACS*
including the evolution of rim notching, circumlinear vessel baring, laminar dot sign, and vessel course changes. Objective: While viewing stereoscopic optic disc images, physicians will learn to identify (1) glaucomatous disc damage and progression and (2) the most common optic disc anomalies and pathologies that may confound this assessment. Senior Instructor(s): Alan H Zalta MD
Evidence-Based Guidelines in the Management of Glaucoma
What’s Your Next Step? Case Studies in Glaucoma Management
Course: 605 Room: N139 Education Level: INT
Tuesday 9:00 - 11:15 AM Target Audience: COMPSUB
NEW OCT in Glaucoma: What’s Real Disease and What’s Red Disease? Course: 544 Room: S103d Education Level: INT
Tuesday 10:15 - 11:15 AM Target Audience: COMP
Synopsis: Optical Coherence Tomography has become an important tool for diagnosing glaucoma and detecting glaucoma progression. Using a combination of didactic lecturing and case examples, interpretation of OCT for glaucoma diagnosis and progression will be presented, primarily relying on the Cirrus (Zeiss) OCT platform. Examples of glaucoma detection and progression with Spectralis (Heidelberg) and RTVue (Optovue) will also be presented. Case examples of false positives (“red disease”) false negatives (“green disease”) and other diagnostic dilemmas will be reviewed to help the participant sort out what is real vs. artifact in OCT interpretation for glaucoma. Objective: This course will improve the participants ability to diagnose glaucoma and glaucoma progression and avoid diagnostic mistakes. Senior Instructor(s): Donald L Budenz MD MPH*
3-D Optic Disc Viewing: Top 10 Pitfalls in Identifying Glaucoma Damage and Progression Course: 555 Room: S105bc Education Level: INT
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Participants will wear red-blue glasses to view 3-D PowerPoint projections of stereoscopic optic disc images. The most common pitfalls in identifying glaucomatous disc damage (including optic disc anomalies, swelling, and atrophy) will be viewed, discussed, and correlated with visual field loss. Characteristic glaucomatous disc changes will be highlighted, including vertical elongation of cupping and pallor, cup-to-disc asymmetry, focal excavation, nerve fiber layer defects, and splinter hemorrhages. Special emphasis will be placed on simultaneous viewing of serial stereoscopic images that demonstrate progressive glaucomatous disc damage over time,
Tuesday 11:30 AM - 12:30 PM Target Audience: COMP
Synopsis: Both challenging and everyday glaucoma cases will be presented and discussed in a panel format. Visual fields and OCT, among other ancillary tests, will be used to demonstrate the case presentations. Audience participation will be encouraged. Objective: At the conclusion of the course, the participants will have a better understanding of common glaucoma cases with diagnostic or interventional dilemmas. Senior Instructor(s): Prithvi S Sankar MD Instructor(s): Eydie G Miller MD*, Cynthia L Grosskreutz MD PhD*, Sarwat Salim MD*
NEW SOE Continuous 24-Hour IOP Monitoring: Ready for Prime Time? Course: 566 Room: S106a Education Level: BAS
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: IOP, the only modifiable risk factor for glaucoma, is a dynamic parameter. Peak IOPs occurring outside clinic hours remain undetected in many glaucoma patients. Recent availability of telemetric devices for continuous 24-hour IOP monitoring has the potential to improve glaucoma care. Objective: This course will present (1) the nature of 24-hour IOP and its clinical significanceand (2) the role of 24-hour IOP monitoring technologies in clinical practice. At the conclusion of this course, the attendees will understand the complexities of 24-hour IOP patterns and how to integrate current technologies for monitoring IOP into the clinical management of glaucoma patients. Senior Instructor(s): Kaweh Mansouri MD* Instructor(s): Malik Y Kahook MD*, Robert N Weinreb MD, Arthur J Sit MD, Syril Dorairaj MD
NEW Pearls and Pitfalls of OCT in Glaucoma Course: 569 Room: E451a Education Level: INT
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will cover the following topics: (1) description of OCT testing strategies for different machines and how to interpret the results, (2) how to use OCT results for diagnosis and follow-up of glaucoma patients, (3) how to increase compliance with treatment using OCT, (4) frequency of OCT testing, (5) predicting visual field findings from OCT results, (6) how to identify glaucoma masqueraders from OCT results, (7) the rationale behind using macular thickness and ganglion cell complex thickness, (8) pitfalls in results of OCT images, and (9) other nonglaucoma diagnoses made with the help of OCT. Objective: At the end of the course, the attendee will be able to utilize OCT for the diagnosis and follow-up of different stages of glaucoma with confidence. The attendee will be able to identify artifacts and differentiate glaucoma from other masqueraders and other neurological diseases. Senior Instructor(s): Sanjay G Asrani MD* Instructor(s): Masanori Hangai MD*, Michael P Kelly FOPS
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
77
Instruction Courses
Synopsis: Early detection and treatment of glaucoma are of paramount importance to reduce the burden of blindness and its economic impact on society. Two important questions often confront a glaucoma specialist when initiating therapy: Who needs to be treated? And how should a patient be treated? This course will address the evidence-based guidelines for treating glaucoma and review the invaluable information from major clinical trials (Glaucoma Laser Trial, Selective Laser Trabeculoplasty vs. Medical Therapy study, Ocular Hypertension Treatment Study, European Glaucoma Prevention Study, Early Manifest Glaucoma Trial, Collaborative Initial Glaucoma Treatment Study, Advanced Glaucoma Intervention Study, etc.) that have enhanced our understanding of the risk factors and treatment strategies at various stages of the disease. Objective: At the conclusion of the course, the attendee will be knowledgeable about when and how to treat glaucoma patients based on evidence, including many of the major clinical trials that have guided clinical decision making in glaucoma practice. Senior Instructor(s): Sarwat Salim MD* Instructor(s): Malik Y Kahook MD*, Shan C Lin MD*, Raghu Mudumbai MD, Peter Andreas Netland MD PhD**, Joel S Schuman MD*, Quang H Nguyen MD*, Carla J Siegfried MD*
Course: 560 Room: S105d Education Level: BAS
Instruction Courses Medical Therapy for Open-Angle Glaucoma: A Complete Review of the Pharmacodynamics, Pharmacokinetics, and Toxicity of All Potentially Useful Drugs Course: 572 Room: S104b Education Level: ADV
Tuesday 12:45 - 1:45 PM Target Audience: COMPSUB
Synopsis: This course will present the pharmacodynamics, pharmacokinetics, and toxicity of drugs potentially useful for open-angle glaucoma (OAG) treatment, including parasympathomimetics, sympathomimetics, sympatholytics, carbonic anhydrase inhibitors, prostaglandin analogs, osmotics, neuroprotectors, blood flow enhancers, marijuana, Ginkgo biloba, and other alternative therapies. Objective: Participants will be able to treat OAG more effectively by enhancing compliance and risk-benefit ratios. Senior Instructor(s): Allan J Flach MD
H SA Update Your Anterior Chamber Angle Skills: How to
Best Examine, Grade, and Treat Instruction Courses
Course: 574 Room: E352 Education Level: INT
Tuesday 12:45 - 3:00 PM Target Audience: COMP
Synopsis: Studies show we look at the chamber angle in less than half of all initial glaucoma patient visits. Why? This course is about improving your chamber angle organizational skills to overcome chamber angle neglect. It will put everything together for the comprehensive ophthalmologist: how to best look at the angle, distinguish normal from abnormal angles, indent crowded angles, record your findings, and treat the iris and angle with laser therapy. In addition, important landmarks for up-and-coming canal procedures will be emphasized. Objective: At the conclusion of the course, attendees will be able to better view the angle, improve their treatment of the angle, know when to perform and better record their gonioscopic findings, and be updated on the risks and benefits of laser peripheral iridotomy, selective laser trabeculoplasty, argon laser trabeculoplasty, and iridoplasty. Senior Instructor(s): Ronald Leigh Fellman MD OCS* Instructor(s): Ronald L Gross MD*, Silvia D Orengo-Nania MD*, Thomas W Samuelson MD*, Mark B Sherwood MD*, Steven T Simmons MD*, George L Spaeth MD FACS*, Arvind Neelakantan MD*
Complications Following Glaucoma Filtering Surgery: Face Them Boldly, Manage Them Efficiently Course: 591 Room: N140 Education Level: INT
Tuesday 2:00 - 4:15 PM Target Audience: SUB
Synopsis: This course will review the early detection and prevention of and specific management strategy for the common complications that may be associated with glaucoma filtering surgery, such as hyphema, shallow to flat anterior chamber, early or late leaking bleb, encapsulated blebs, hypotony, the “wipeout” phenomenon, blebitis, bleb infection, and endophthalmitis. Objective: At the conclusion of the course, attendees will be able to face complications following glaucoma filtering surgery more boldly and manage them more efficiently. Senior Instructor(s): Anil K Mandal MD Instructor(s): Peter Andreas Netland MD PhD**, Dale K Heuer MD*, Eve J Higginbotham MD, Sriram Sonty MD FACS*
H Top 10 Pitfalls, Problem Solving, and Interpretive Strategy for Automated Threshold Perimetry Course: 592 Room: S105bc Education Level: INT
Tuesday 2:00 - 3:00 PM Target Audience: COMP
Synopsis: This course will present a step-by-step interpretive strategy for automated threshold perimetry. This course will also teach recognition of the most common pitfalls encountered and problem solving to avoid misinterpretation, underdiagnosis, and overdiagnosis. 78
Objective: Participants will learn to (1) systematically interpret central threshold visual fields, (2) recognize common pitfalls, including testing “legally blind” eyes, low reliability message, testing children, normal gray scale display in the presence of early scotomas, isolated peripheral nasal steps, severe visual field loss, limitations of computerized interpretation, SITA variability, and pseudo-scotomas or pseudo-progression due to artifact (miosis, ptosis, lens rim), and (3) problem solve using nonstandard parameters (eg, size V stimulus) or alternate strategies (eg, central 10-degree or peripheral 30/60 degree field). This course was designed to optimize automated perimetry evaluation and monitoring and to eliminate common interpretational errors. Senior Instructor(s): Alan H Zalta MD Instructor(s): John S Cohen MD*
The Art and Science of Glaucoma Drainage Devices: How to Optimize Your Surgical Results Course: 597 Room: S106a Education Level: INT
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: The basic differences among the different glaucoma drainage devices (GDDs)-including design, size, biomaterial, the pathophysiology of the resulting blebs, indications, surgical techniques, outcomes, and management of complications-will be discussed using surgical video footage and clinical pictures. Techniques to perform different surgeries such as Descemet-stripping automated endothelial keratoplasty, penetrating keratoplasty, phaco / posterior chamber IOL, and pupilloplasty in the presence of or combined with GDD will be discussed. Future strategies for improving the surgical outcomes, including in the design and antifibrosis agents, will be discussed. Objective: At the conclusion of this course, the attendee will be able to understand the basic differences among the different GDDs, the pathophysiology of the resulting blebs, the indications, surgical techniques (including combination surgeries), and management of intra- and postoperative complications. Senior Instructor(s): Ramesh S Ayyala MD FRCS* Instructor(s): Steven Gedde MD*
H Improving Success in Filtration Surgery: Intraoperative Surgical Techniques and Postoperative Management of the Failing Filter Course: 599 Room: S105a Education Level: INT
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will describe techniques for successful performance of trabeculectomy and Ex-Press device implantation and will comprehensively review postoperative management of the failing glaucoma operation. Objective: At the end of this course, attendees will understand the available techniques for enhancing glaucoma surgery success and will understand postoperative adjuncts for dealing with failing filtration characterized by either high IOP or low IOP. Senior Instructor(s): Husam Ansari MD PhD* Instructor(s): Bradford J Shingleton MD*
Global Ophthalmology NEW GO Ocular Parasitoses: Diagnosis and Treatment Course: 217 Room: S103a Education Level: INT
Sunday 3:15 - 4:15 PM Target Audience: COMPSUB
Synopsis: Parasitic infections of the eye are a major cause of ocular diseases in many parts of the globe. Lesions in the eye can be due to direct invasion, indirect damage by their toxic products, or the host immune response incited by them. Understanding the natural history of these parasitic diseases, their morphology, and the symptoms and signs produced by them would help in timely diagnosis and prompt intervention, saving vision and sometimes life. From basic anatomy and microbiology to interactive case discussions and surgical videos, this course will give the attendee a comprehensive, practical knowledge as well as presenting the latest trends in the management of various parasitic infections of the eye.
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses Objective: At the conclusion of the course, the attendee will be able to gain ample knowledge in the diagnosis and management of various parasitic infections of the eye. Senior Instructor(s): Tapas Ranjan Padhi MBBS MS Instructor(s): Sujata Das MBBS, Savitri Sharma MD
NEW GO SOE Global Trends in Retina: Learning From
in a fashion that simplifies and optimizes the workup and reduces unnecessary testing. Clinical cases will highlight important features. Objective: Upon completion of this course, participants will be able to (1) selectively order appropriate diagnostic tests based on the clinical presentation of various uveitis entities in a cost-effective fashion and (2) interpret the results of diagnostic tests. Senior Instructor(s): Sarkis H Soukiasian MD Instructor(s): Michael E Zegans MD*, Russell N Van Gelder MD PhD*
Course: 517 Room: N427a Education Level: INT
NEW All White Dots Are Not the Same! Imaging Techniques in the Diagnosis and Management of Posterior Uveitis
Each Other
Tuesday 9:00 - 10:00 AM Target Audience: COMPSUB
Intraocular Inflammation, Uveitis International (Dis)Agreement on Infectious Uveitis Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Uveitis Society (AUS)
Course: 170 Room: E353c Education Level: INT
Sunday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Infectious uveitis is estimated to be responsible for 10%-30% of all uveitis cases. In some parts of the world toxoplasmosis alone is responsible for up to 50% of all posterior uveitis. Infectious uveitis poses unique diagnostic and therapeutic challenges. Uveitis resulting from infections can masquerade as noninfectious uveitis. The diagnosis may require an anterior chamber or vitreous tap. While autoimmune uveitis requires long-term immunosuppressive therapy, most infectious uveitides can be treated with short-term antimicrobial therapy. It is therefore highly desirable to identify possible infectious etiology in idiopathic uveitis. The instructors will present a variety of challenging cases from around the world, with interactive discussion sessions. Objective: At the end of this course, the audience will be able to develop a stepwise approach to diagnosing and managing infectious uveitis entities. Senior Instructor(s): Rubens Belfort Jr MD PhD* Instructor(s): Hatice N Sen MD, Robert B Nussenblatt MD, Narsing A Rao MD, Khalid F Tabbara MD*, Bahram Bodaghi MD PhD, Cristina Muccioli MD, Thomas A Albini MD*, Heloisa Nascimento MD, Wendy M Smith MD
H Decoding the Uveitis Workup: Why, When, and What to Order Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Uveitis Society (AUS)
Course: 190 Room: E351 Education Level: INT
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Uveitis Society (AUS)
Course: 203 Room: S102d Education Level: INT
Sunday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: Advances in imaging technology have resulted in many modalities that allow examination of posterior uveitis in new ways. Fluorescein angiography is often considered the “gold standard” for diagnosis, but indocyanine green with late exposures may provide valuable information when inflammation arises primarily in the choroid. The recent developments of spectral domain OCT (SD-OCT), enhanced depth imaging OCT (EDI-OCT), and fundus autofluorescence (FAF) provide noninvasive methods for examining inflammatory activity in the retina and choroid. Both OCT and FAF can reveal early signs of recurrent disease activity and allow close monitoring of treatment response. In this course the instructors will present a variety of posterior uveitis cases to highlight the role of imaging in diagnosis and management. Objective: The audience will understand how to utilize imaging techniques to diagnose posterior uveitis and monitor for recurrent or progressive inflammation. Senior Instructor(s): Hatice N Sen MD Instructor(s): Wendy M Smith MD, Debra A Goldstein MD*, Amani Fawzi MD, Thomas A Albini MD*, Steven Yeh MD*, Sunil K Srivastava MD*, Emmett T Cunningham Jr MD PhD MPH
Medical and Surgical Therapy and Diagnosis of Uveitis Course: 306 Room: S103d Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: Recent advances have increased our ability to identify a specific etiology for many cases of uveitis. Medical and surgical therapeutic advances have also produced dramatic improvements in our ability to care for patients with uveitis. This course will present our system. Objective: This course will enable participants to recognize, investigate, and treat patients with uveitis. Senior Instructor(s): C Stephen Foster MD* Instructor(s): Albert T Vitale MD, Emil Mitchel Opremcak MD
H SA How to Evaluate a Patient With Uveitis Course: 404 Room: E352 Education Level: INT
Monday 3:15 - 5:30 PM Target Audience: COMPSUB
Synopsis: This course will focus on the step-by-step evaluation of patients with uveitis by using case presentations to illustrate specific uveitis entities. Each course instructor will present interesting cases as unknowns for discussion by the panel of instructors. Course attendees will also be invited to present their own mystery cases by submitting the cases in advance. The rationale for ordering laboratory evaluations / ancillary tests and for the treatment plan will be explained in detail. Objective: Attendees will have ample opportunity to participate in this interactive course and will experience how a uveitis specialist analyzes each patient. Presentations will include both infectious and noninfectious entities in patients with anterior, intermediate, posterior, and pan-uveitis. Special emphasis will be given to the newest
Synopsis: This course will primarily focus on the stepwise, cost-effective uveitis workup utilizing the history and clinical presentation. Uveitis entities will be classified Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
79
Instruction Courses
Synopsis: This course will outline the variations in current global trends in managing vitreoretinal diseases. It will link various vitreoretinal societies from different parts of the world in order to explore the huge potential to learn from their practice trends, specifically where no level 1 evidence exists. The highlights of three comprehensive surveys from three different countries (the United States, the United Kingdom, and India) will be discussed, in addition to expert opinions from six continents. Specific topics will include instrumentation, retinal detachment, macular surgery, perioperative management, AMD, and socioeconomics. Objective: Upon completion of the course, attendees will have gained (1) greater insight into a variety of options for managing a particular vitreoretinal disease, (2) reasons for global variations in practice trends, and (3) the implications for their own practices. This course will provide an opportunity for attendees to compare their own preferences to the global retina practice trends. Senior Instructor(s): Malhar Soni MD MS DNB FRCS Instructor(s): Kirk H Packo MD*, Sundaram Natarajan MD, Ehab N El Rayes MD PHD*, Martin Charles MD*, Virgilio Morales-Canton MD*
Instruction Courses treatment modalities. At the completion of this course, the attendee will be able to formulate a tailored laboratory evaluation for the entities presented. Senior Instructor(s): Careen Yen Lowder MD PhD Instructor(s): Janet Louise Davis MD*, Emilio M Dodds MD, James Philip Dunn Jr MD, Sunil K Srivastava MD*, Debra A Goldstein MD*
design for a clear and organized presentation of content, summarize the communication skills needed for an engaging presentation, and add 3 strategies for increasing interactivity during lectures. Senior Instructor(s): Ana Gabriela Palis MD Instructor(s): Peter A Quiros MD
H Cataract Surgery and Uveitis: Controlling Inflammation, Difficult Pupils, and Distorted Anatomy
Surgical Education: Improving Upon and Going Beyond the Apprentice Model
Course: 581 Room: E451b Education Level: INT
Course: 407 Room: N136 Education Level: BAS
Tuesday 12:45 - 1:45 PM Target Audience: COMP
Instruction Courses
Synopsis: This course will teach the management of difficult and potentially complicated cataract surgery in uveitis using surgical videos (including 3-D videos) highlighting unique uveitic anatomy. The focus will be on preoperative immunosuppression and patient selection, intraoperative management of distorted uveitic anatomy, and postoperative considerations. Both surgical and medical guidelines for the ophthalmologist will be given, with an emphasis on immunosuppression. Objective: At the conclusion of this course, attendees will understand preoperative planning and immunosuppression for cataract surgery in uveitis patients. They will learn intraoperative management of uveitic anatomy via surgical videos and the management of postoperative inflammation. Senior Instructor(s): Michael Saidel MD* Instructor(s): David M Hinkle MD, Donald Stone MD*, Debra A Goldstein MD*
Medical Education NEW SOE ABC in Effective Ophthalmic Publishing Course: 215 Room: N136 Education Level: BAS
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: The fast development of computer technology and the Internet has changed the publishing industry over the last decade. The need for speed and the global availability of publications has become now at least as important as the prestige of a journal. In this workshop we will emphasize the basics of modern scientific publishing, looking more closely at the manuscript traffic within the editorial office and at manuscript selection. In this light we will indicate good author habits that dramatically speed up the publication process. We also take a look at two other major problems, namely, (1) plagiarism and understanding the role of citations and (2) journals’ impact factor on building up one’s scientific career. Objective: (1) To define the basis of a well-written article.(2) To describe how to revise the paper.(3) To describe when the study is worthy of publishing.(4) To describe the role and preparation of case reports.(5) To define the impact factor and its role as a marker for journal ranking.(6) To define the ethical aspects of scientific publishing. Senior Instructor(s): Andrzej Grzybowski MD* Instructor(s): Andrew J Lotery MBCHB*, Jose G Cunha-Vaz MD PhD*, Thomas Kohnen MD*, Thomas J Liesegang MD, Antonia M Joussen MD PhD
Presentation Skills: How to Improve the Effectiveness of Lectures Jointly sponsored by the Academy’s Annual Meeting Program Committee and the International Council of Ophthalmology
Course: 607 Room: N427a Education Level: INT
Sunday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: This course intends to increase participants’ armamentarium for making lectures more engaging, active, and effective. Participants will be able to: 1) consider the need to apply the adult learning principles involved in creating meaningful presentations, 2) organize content logically, and 3) design slides adequately and clearly, and 4) present in an interesting, interactive way. Objective: By the end of the course participants should be able to list the adult learning principles applicable to the creation of presentations, provide a structure to the lecture that allows a logical organization of knowledge. apply principles of slide 80
Monday 3:15 - 4:15 PM Target Audience: COMPSUB
Synopsis: Presenters will cover a wide variety of surgical education techniques, including traditional surgery, wet lab, cognitive computer modeling, and simulation. They will focus on how to improve traditional teaching techniques and how to incorporate new techniques and technologies. The course will include strategies to optimize the use of existing resources and will give attendees a look at modalities to incorporate in the future. Objective: To review and critique existing and new techniques in surgical education. Senior Instructor(s): Andrew J Hendershot MD Instructor(s): Andrew G Lee MD*, Karl C Golnik MD, Thomas A Oetting MD, Bonnie A Henderson MD*
Resident, Faculty and Program Assessment: Principles & Best Practices Jointly sponsored by the Academy’s Annual Meeting Program Committee and the International Council of Ophthalmology
Course: 606 Room: N140 Education Level: BAS
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: Teaching does not equal learning and thus resident’s competence must be assessed in a systematic, valid and reliable manner. Principles of good assessment practices will be discussed. Specific, available assessment tools such as 360 degree evaluation, surgical skill rubric and observed patient encounter will be demonstrated. Effective faculty and program evaluation designed to improve teaching effectiveness will also be discussed. Objective: At the completion of this course, the attendee will be able to 1) list 5 principles of assessment, 2) describe several tools that can be used to teach and assess residents, and 3) outline an approach to effective faculty and program assessment. Senior Instructor(s): Karl C Golnik MD Instructor(s): Ana Gabriela Palis MD, Eduardo P Mayorga MD*
Neuro-Ophthalmology P H What You Need to Know About Headache: A Pain for the Patient and a Pain for the Doctor Jointly sponsored by the Academy’s Annual Meeting Program Committee and the North American Neuro-Ophthalmology Society (NANOS)
Course: 161 Room: S105d Education Level: INT
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Patients are often seen by or referred to the ophthalmologist because of headache or eye pain. These patients present a diagnostic and therapeutic challenge, as many will have no apparent ocular etiology for their pain. The purpose of this course is to present a simplified framework for diagnosis and management of these patients that will both streamline their evaluation and provide guidelines for potentially beneficial therapeutic interventions. This course will use a case-based approach to discuss various headache syndromes with ocular manifestations. Objective: At the conclusion of this course, the attendees will be able to identify the major categories of underlying diagnoses for headache and eye pain, develop a suc-
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses cinct strategy for history and clinical examination to confirm the suspected diagnosis, and develop treatment goals in order to help their patients. Senior Instructor(s): Peter A Quiros MD Instructor(s): Lynn K Gordon MD PhD*
NEW Case Studies on the Use of Optical Coherence Tomography (OCT) for Diagnosis of Unknown Causes of Visual Loss: Is it the Retina, Anterior Visual Pathway, or Misinterpretation of Normal? Course: 543 Room: E352 Education Level: INT
Sunday 3:15 - 4:15 PM Target Audience: COMP
Swollen Disks, Headache, and Vision Loss: A Case-Based Approach to Pseudotumor Cerebri Jointly sponsored by the Academy’s Annual Meeting Program Committee and the North American Neuro-Ophthalmology Society (NANOS)
Course: 231 Room: E352 Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: What do you do when a patient with bilateral disc swelling and headache presents? How do you decide the urgency of evaluation and make the right diagnosis? Using a case-based approach, we will emphasize the workup that this patient needs and will show you how to use technology (CT, MRI/MR venography, spectral domain OCT, visual fields) to help you recognize the warning signs of sight-threatening disease. We will discuss treatment outcomes including venous sinus stenting, and the long-term consequences of pseudotumor cerebri. Objective: At the conclusion of this course, the attendee will be able to recognize features of optic disc swelling that suggest sight-threatening disease and will understand the evaluation and referral process. Attendees will be able to interpret the results of diagnostic imaging techniques and recognize critical findings of venous sinus disease. They will be able to select appropriate medical, surgical, or interventional treatments based on exam and test findings and predict patient outcomes. Senior Instructor(s): Prem S Subramanian MD PhD* Instructor(s): Vivek R Patel MD
H Visual Fields in Neuro-Ophthalmology Jointly sponsored by the Academy’s Annual Meeting Program Committee and the North American Neuro-Ophthalmology Society (NANOS)
Course: 351 Room: E351 Education Level: BAS
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
H Diagnostic and Therapeutic Dilemmas in NeuroOphthalmology Jointly sponsored by the Academy’s Annual Meeting Program Committee and the North American Neuro-Ophthalmology Society (NANOS)
Course: 378 Room: E351 Education Level: ADV
Monday 2:00 - 4:15 PM Target Audience: SUB
Synopsis: In this course, actual diagnostic and therapeutic clinical dilemmas will be presented by a panel of university-based neuro-ophthalmologists, with members of the audience participating in the generation of differential diagnoses and therapeutic strategies. Objective: At the conclusion of the course, the attendee will be able to address difficult problems in the diagnosis and management of neuro-ophthalmic cases. Senior Instructor(s): Nancy J Newman MD Instructor(s): Neil R Miller MD*, Valerie Biousse MD, Andrew G Lee MD*, Steven L Galetta MD
H Understanding Nystagmus: A Practical Approach for the Clinician Course: 382 Room: S105d Education Level: BAS
Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course reviews the clinical features of different types of nystagmus. By using a systematic pathophysiologic approach, clinicians will develop a rational decision-making process in the diagnosis and management of nystagmus. Numerous videos will be presented. Objective: To impart an understanding of nystagmus using a practical approach. At the conclusion of this course, the attendees will be able to identify the salient features of different types of nystagmus, including their etiology and pathophysiology, as well as important diagnostic and treatment issues. This course will aid attendees in improving their clinical management of nystagmus. Senior Instructor(s): Agnes M Wong MD*
H Emergency Neuro-Ophthalmology: Diagnosis and Management Course: 509 Room: S406b Education Level: BAS
Tuesday 9:00 - 11:15 AM Target Audience: COMP
Synopsis: This course will present a case-based review of the emergency management of acute and transient vision loss, optic nerve swelling, pupillary disorders, and ocular motility defects. Objective: To teach participants to identify and manage patients with true neuroophthalmic emergencies, and to review the differential diagnosis and management of acute vision loss, anisocoria, and ophthalmoplegia. Senior Instructor(s): Nicholas J Volpe MD Instructor(s): Mark L Moster MD*
Synopsis: This course will provide an overview of visual fields, with an emphasis on neuro-ophthalmic conditions. The role of visual fields in neuro-ophthalmology will be put in perspective. Guidelines will be suggested for choosing the best field technique. Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
81
Instruction Courses
Synopsis: This will be a case-driven course with audience participation on the use and interpretation of OCT for diagnosing causes of visual loss. Patients with unknown diagnoses will be used as examples to provide a basis for the correct interpretation of OCT results of the optic disc, retinal nerve fiber layer, retinal ganglion cell layer, and outer retina with special reference to the probability plots, quantitative, and qualitative information on OCT reports. The cases will also relate fundus appearance, visual field results and neuro-imaging results to the OCT test. Objective: Attendees will understand how the OCT can be used to differentiate retinopathies from optic neuropathies in patients with unknown causes of visual loss; how to correctly interpret the optic nerve head analysis on OCT, including disc area, rim diameter, and signs of optic nerve edema vs pseudo-papilledema; how to use the retinal ganglion cell layer probability plot to differentiate optic neuropathy from damage to the optic chiasm and optic tract; and become familiar with the pitfalls of misinterpreting OCT scans with special reference to variations in normal and artifacts that can cause a false positive diagnosis or a missed diagnosis. Senior Instructor(s): Randy H Kardon MD PhD* Instructor(s): Fiona E Costello MD*, John C Chen MD*
Some of the newest field techniques will be discussed. Anatomic correlations with visual fields will be comprehensively detailed. Reliability and artifacts in visual fields will be reviewed. Case examples of visual field defects will be presented, with audience participation. Objective: At the end of this course, participants should be able to maximize their use of visual fields as a component of the complete evaluation in assessment of neuro-ophthalmology patients. Senior Instructor(s): Susan M Pepin MD Instructor(s): Jacqueline A Leavitt MD, Steven A Newman MD
Instruction Courses H Curbside Consults in Neuro-Ophthalmology Jointly sponsored by the Academy’s Annual Meeting Program Committee and the North American Neuro-Ophthalmology Society (NANOS)
Course: 515 Room: N427bc Education Level: BAS
Tuesday 9:00 - 11:15 AM Target Audience: COMP
Synopsis: This course will engage the target audience in a participatory and interactive panel-led conversation about common neuro-ophthalmic conditions of interest to general ophthalmologists. Objective: By the conclusion of this course, participants should be able to define specific distinguishing and differentiating symptoms and signs in neuro-ophthalmic disorders; to list specific testing strategies for making an accurate diagnosis in lifethreatening neuro-ophthalmic conditions; and to describe the key clinical, laboratory, diagnostic testing, or radiographic findings for specific neuro-ophthalmic diseases. Senior Instructor(s): Andrew G Lee MD* Instructor(s): Lanning B Kline MD
Instruction Courses
P H Case-Based Approach to Isolated Eye Pain Jointly sponsored by the Academy’s Annual Meeting Program Committee and the North American Neuro-Ophthalmology Society (NANOS)
Course: 536 Room: E351 Education Level: BAS
Tuesday 10:15 - 11:15 AM Target Audience: COMP
Synopsis: Patients with eye pain and a normal ophthalmologic examination often present to the ophthalmologist. In this course, differential diagnosis, pathophysiology, management, and cases of isolated eye pain will be discussed in an interactive fashion. Objective: The attendee will be able to identify common causes of isolated eye pain and summarize current treatment options. Senior Instructor(s): Michael S Lee MD* Instructor(s): Gregory S Kosmorsky DO
NEW Myasthenia Gravis or Not? Course: 540 Room: S104a Education Level: INT
Tuesday 10:15 - 11:15 AM Target Audience: COMPSUB
Synopsis: This course will review the etiology of myasthenia gravis and discuss the appropriate workup, associated diseases, and treatment principles. Case-based examples of diagnostic dilemmas (eg, myasthenia gravis vs. another disease with a similar complaint or exam) will be used to highlight the variable presenting symptoms and exam findings. Objective: Myasthenia gravis can be a challenging disease to diagnose, given the varying manifestations and overlap in presentation with other conditions. This course will allow the attendees to better evaluate and treat patients with myasthenia gravis. At the conclusion of this course, the attendees will be able to (1) discuss the workup for myasthenia gravis, (2) list treatment principles, and (3) discuss disease associations. Senior Instructor(s): Courtney E Francis MD Instructor(s): Peter A Quiros MD
H The Vertical Diplopia Dilemma, Made Simple Course: 578 Room: N427bc Education Level: INT
Tuesday 12:45 - 1:45 PM Target Audience: COMPSUB
Synopsis: In the majority of patients, the etiology of vertical diplopia can be established by careful history taking and clinical examination. In this course, illustrative cases and discussion will identify specific features of common causes of vertical diplopia such as cranial nerve palsy, thyroid orbitopathy, myasthenia gravis, and orbital and head trauma. A systematic approach toward evaluation and critical management pathways will be presented. Objective: At the conclusion of the course, the attendee will be able to diagnose common causes of vertical diplopia. A systematic approach toward management will 82
aid the attendee in ordering appropriate tests, identifying patients requiring emergent management, and making appropriate referrals to specialists. Senior Instructor(s): Madhura A Tamhankar MD Instructor(s): Kenneth S Shindler MD PhD, Nicholas J Volpe MD, Collin M McClelland MD
Ocular Tumors and Pathology Practical Ocular Oncology for the Comprehensive Ophthalmologist: What You Should Know Course: 192 Room: S105a Education Level: INT
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will consist of presentations and discussions of the topics in ophthalmic oncology most important for comprehensive ophthalmologists. These include classic but distinctive fundus lesions, including choroidal melanoma, retinoblastoma, metastatic carcinoma, intraocular lymphoma, and other neoplastic lesions, both benign and malignant. The presenters will emphasize the clinical diagnosis and current management as well as “hot topics” in ocular oncology. Current and future management in cancer and how it can affect the eye will also be discussed (eg, target therapy in systemic cancer has shown ocular side effects). Audience participation will be encouraged with representative cases. Objective: At the end of this course, attendees will be able to identify the most common intraocular tumors as well as to understand current management and how patients can present at a general ophthalmology practice. This course will help comprehensive ophthalmologist to counsel oncology patients. Senior Instructor(s): Miguel A Materin MD Instructor(s): James Augsburger MD, Zelia M Correa MD, Hakan Demirci MD, Dan S Gombos MD*, J William Harbour MD*, Brian P Marr MD, Prithvi Mruthyunjaya MD*, Jose S Pulido MD MS
Pediatric Ocular Tumors Course: 227 Room: N139 Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: This course will cover the important ocular tumors affecting children. An organized presentation will be given on the recognition and management of tumors of the eyelid, conjunctiva, intraocular structures, and orbit. Retinoblastoma management will be summarized. Various cases will be presented, along with discussion of management. Objective: At the conclusion of this course, the attendee should be able to identify the most common ocular tumors of childhood and understand management strategies. Senior Instructor(s): Carol L Shields MD Instructor(s): Jerry A Shields MD
NEW Adult Uveal Tumors: A Systematic Approach for the General Ophthalmologist Course: 390 Room: S106a Education Level: BAS
Monday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: There are many different types of uveal tumor, each of which has a wide variety of clinical features. Several are life threatening or associated with lethal disease. Most tumors can be diagnosed ophthalmoscopically. Imaging is often helpful but can be highly misleading if the results are not interpreted correctly. The scope of biopsy is increasing with advances in surgery and immunohistochemistry. Objective: In this interactive course, a wide variety of cases will be presented to illustrate essential diagnostic features as well as diagnostic pitfalls and clinicopathologic correlations. Senior Instructor(s): Bertil E Damato MD PhD Instructor(s): Arun D Singh MD
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses NEW Intraocular Tumor Biopsy: The How, Why, and Why
Not?
Course: 519 Room: N136 Education Level: INT
Tuesday 9:00 - 10:00 AM Target Audience: COMPSUB
NEW Controversies in Ocular Oncology Course: 523 Room: S104b Education Level: ADV
Tuesday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: There has been a paradigm shift in the management of tumors of the eye and adnexa in the recent past. Newer targeted therapies and multimodal protocols are gradually replacing the conventional gold standard management modalities. Amidst this rapid revolution in evolution, controversies abound. This course aims to compare conventional strategies with emerging modalities using available evidence and create ground for common understanding. Objective: At the end of the course, audience members will be able to categorize their patients with common tumors of the eye and adnexa for conventional management vs. emerging modalities aimed at optimizing life, eye, and vision salvage with minimum treatment-related morbidity. Senior Instructor(s): Fairooz Puthiyapurayil Manjandavida MD Instructor(s): Jerry A Shields MD, Carol L Shields MD, Brenda L Gallie MD*, Bertil E Damato MD PhD, Ralph Eagle MD*, Carol L Karp MD, Santosh G Honavar MD, Arun D Singh MD, Bita Esmaeli MD FACS, Hakan Demirci MD
Ophthalmic History SO YO Vision and the Artist Course: 168 Room: S105d Education Level: BAS
Sunday 3:15 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course fuses ophthalmology and art. We will demonstrate how art teaches ophthalmology - and how ophthalmology enhances the appreciation of art. We will discuss how light, dark, and contrast underlie vision and make representation in art possible. We will also discuss how art may reflect eye disease in the artist and demonstrate the functional effects of failing vision. Art from all ages will be shown, with special attention to the question of eye disease in Rembrandt, Cassatt, Degas, Monet, and O’Keeffe. Simulations of the artists’ own view of their work will illustrate how different disabilities have affected different artists. Objective: Attendees should gain understanding of how visual processes and eye disease affect their patients and gain new appreciation of art. Senior Instructor(s): Michael F Marmor MD* Instructor(s): James G Ravin MD
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Although the journey to spatial vision actually began billions of years ago, the Cambrian explosion (543-490 million years ago) saw the first known eye. The Cambrian was a crucible of evolution and spawned nearly all ocular designs. This was followed by descent over millions of years, providing an unimaginable variety of eyes with at least 10 different models. Some eyes display spectacular creativity, with mirror, scanning, or telephoto optics. From initial photoreception 3.75 billion years ago to early spatial recognition in the first cupped eyespot in Euglena to fully formed camerastyle eyes the size of beach balls in ichthyosaurs, animals have processed light to compete and survive in their respective niches. Vision is evolution’s greatest gift and its greatest triumph. This course will present the story of the evolution of eyes. Objective: To stimulate curiosity about the novelties and the triumphs of the evolution of the eye. Senior Instructor(s): Ivan R Schwab MD FACS
Optics, Refraction, Contact Lenses Review of Clinical Optics Course: 309 Room: N140 Education Level: BAS
Monday 9:00 - 11:15 AM Target Audience: COMP
Synopsis: This review of clinical optics will prepare ophthalmology residents to take the Ophthalmic Knowledge Assessment Program examination and graduates of residency training programs to take the written qualifying examination of the American Board of Ophthalmology. It will also serve as a refresher course for those in practice. The course will be taught in a question-and-answer format, focusing on problem solving. Content and illustrations will be drawn from the American Academy of Ophthalmology’s Basic and Clinical Science Course book on clinical optics. Objective: At the conclusion of the course, participants will be better prepared to answer multiple-choice optics questions on written examinations. Senior Instructor(s): Kevin M Miller MD*
NEW Subjective Refraction and Prescribing Glasses 102 Course: 564 Room: N427bc Education Level: INT
Tuesday 11:30 AM - 12:30 PM Target Audience: COMP
Synopsis: This course will present a discussion of subjective refraction and prescribing glasses, just beyond the basics, to enhance understanding and proficiency. Objective: At the conclusion of this course, the attendee will be able to discuss the role of the conoid of Sturm in the subjective refraction process, describe the order and reason for each step, explain why sphere power needs to be adjusted when refining cylinder power, elucidate the reasons to avoid over-minusing, explain how to determine if cylinder correction is needed, and discuss tips and strategies to manage commonly encountered problems as we work to give the patient an optimal glasses prescription. Senior Instructor(s): Richard J Kolker MD
Orbit, Lacrimal, Plastic Surgery Diagnosis and Management of Essential Blepharospasm and Hemifacial Spasm Course: 150 Room: S104a Education Level: INT
Sunday 10:15 - 11:15 AM Target Audience: COMPSUB
Synopsis: Patients with eyelid and facial spasms frequently present to ophthalmologists. The diagnosis and treatment of essential blepharospasm and hemifacial spasm is straightforward and gratifying. Through lectures, video, and panel discussions, participants will learn to manage these patients confidently.
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
83
Instruction Courses
Synopsis: The management of intraocular lesions often requires accurate pathologic diagnosis to direct future treatment. Whereas lesions can develop at various sites including the iris, ciliary body, retina, and choroid, the approach and instrumentation needs to address specific anatomic considerations. There are increasing indications for tumor biopsy that utilize new instrumentation and approaches. Objective: Using illustrative case examples and videos, this course will describe the indications, techniques, pitfalls and potential complications of iris biopsy, iridocyclectomy, retino-choroidal biopsy, and choroidal lesion biopsy. A special emphasis will be placed on tissue handling. At the conclusion of the course, the attendee will be able to describe the indications for intraocular biopsy, dictate the instrumentation required for successful biopsy, and understand the anatomic considerations relevant to prevention of vision-threatening complications in retinal and choroidal biopsy. Senior Instructor(s): Prithvi Mruthyunjaya MD* Instructor(s): Tara A McCannel MD*, Miguel A Materin MD, Thomas M Aaberg Jr MD*, Amy C Schefler MD
SO Evolution’s Witness: How Eyes Evolved Course: 346 Room: S103d Education Level: INT
Instruction Courses Objective: This course will familiarize participants with the diagnostic features and current treatment options for blepharospasm, hemifacial spasm, and related facial dystonias. Senior Instructor(s): Richard L Anderson MD FACS* Instructor(s): Michael T Yen MD*
Complete Guide to the Evaluation and Management of Ptosis Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)
Course: 153 Room: S403a Education Level: INT
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Instruction Courses
Synopsis: This course will provide a comprehensive understanding of ptosis syndromes and surgical treatments. Surgical techniques, including Müller muscle resection and levator and frontalis sling surgery, will be presented in detail. Objective: Upon completion of this course, participants will gain a thorough understanding of ptosis syndromes and their evaluation and management. Participants will evaluate, categorize, and surgically plan for the ptosis patient. Senior Instructor(s): Morris E Hartstein MD Instructor(s): Adam G Buchanan MD, Gabriela Espinoza MD, Steven M Couch MD
Management of Orbital Tumors: Case Presentation and Discussion Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)
Course: 154 Room: N135 Education Level: ADV
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will focus on management of orbital tumors through representative cases from the instructors’ orbital practices. Emphasis will be on clinical pictures showing initial presentation, imaging characteristics of orbital lesions, surgical approach, and the role of ancillary treatment options such as radiotherapy and/or systemic chemotherapy. Objective: This course is designed to enable the orbital and oculoplastic specialist to appropriately diagnose orbital tumors and become familiar with the multidisciplinary management of orbital tumors using illustrative cases and the collective experience of the course instructors. Senior Instructor(s): Bita Esmaeli MD FACS Instructor(s): Geoffrey E Rose FRCOphth, Timothy J Sullivan MBBS, Dale R Meyer MD FACS, Jonathan J Dutton MD PhD
Optimizing Outcomes and Minimizing Complications in Oculofacial Plastic Procedures: A Case-Based Approach Course: 163 Room: S403b Education Level: INT
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will present a practical, case-based guide for the evaluation, planning, and surgical management of common oculofacial plastic procedures. The course will feature high-definition surgical videos of selected cases, including blepharoplasty, eyelid and brow ptosis repair, and entropion and ectropion repair. Emphasis will be placed on optimizing surgical outcomes and minimizing and managing complications, using case-based vignettes. Objective: At the conclusion of this course, the attendee will be able to evaluate and manage common outpatient oculofacial plastic procedures in an efficient manner with optimal outcomes. Senior Instructor(s): Bobby S Korn MD PhD FACS* Instructor(s): Don Kikkawa MD*, Karim G Punja MD**, Nattawut Wanumkarng MD, Richard L Scawn MBBS
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YO Oculoplastic Procedures for the General Ophthalmologist Course: 169 Room: S103bc Education Level: BAS
Sunday 11:30 AM - 12:30 PM Target Audience: COMP
Synopsis: This course will describe basic and effective procedures for the treatment of involutional ectropion and entropion, tarsorrhaphy, marginal eyelid lesions, dermatochalasis, and aponeurogenic involutional ptosis. Objective: At the conclusion of this course, the attendee will be able to select and perform the appropriate surgical technique for the treatment of common eyelid problems encountered in a general ophthalmology practice. Senior Instructor(s): Robert C Kersten MD Instructor(s): Francesco P Bernardini MD, Carlo de Conciliis MD, Martin H Devoto MD, Jose R Montes MD*
Oculoplastic Office Procedures: Video Clips Course: 172 Room: S102abc Education Level: INT
Sunday 11:30 AM - 12:30 PM Target Audience: COMP
Synopsis: Detailed instruction with emphasis on pearls of office eyelid and lacrimal surgeries will be presented with the use of video clips. The following procedures will be discussed: incision and drainage of a chalazion, lesion biopsy, lesion excisions, tarsorrhaphy (chemical and surgical), lacrimal probing and irrigation, punctoplasty, punctal cauterization, canaliculotomy, entropion repair, ectropion repair, and upper eyelid blepharoplasty. Objective: Participants will be shown the relevant anatomy and surgical steps in performing office eyelid and lacrimal procedures. Senior Instructor(s): Susan M Tucker MD Instructor(s): Nancy A Tucker MD
NEW Evaluation and Treatment of Facial Nerve Palsy Course: 239 Room: S105d Education Level: BAS
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: Judicious treatment of patients with facial nerve palsy may be sight saving. Urgent situations often necessitate tarsorrhaphy procedures, while less urgent situations address the lower eyelid / mid-face, upper eyelid, and brow. Objective: At the conclusion of the course, the attendee will be able to list the indications and recite the procedures for urgent intervention in facial nerve palsy patients. The attendee will also be able to recite the indications and procedural details for addressing the less urgent lower eyelid / mid-face, upper eyelid, and brow conditions. Senior Instructor(s): Erin Shriver MD Instructor(s): Richard C Allen MD PhD, Alex W Cohen MD
NEW Optimizing the Aesthetic Appearance of the Anophthalmic Socket Course: 241 Room: S103a Education Level: BAS
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: Who gets an evisceration, and who gets an enucleation? How do we choose an implant size and material? To peg, or not to peg? How do we address the ill-fitting prosthesis? How can we work with ocularists to ensure an aesthetically pleasing result? This course will discuss the management of the anophthalmic socket from an aesthetic perspective, with surgical and nonsurgical techniques. At the end of this course, the attendee will be able to assess the anophthalmic patient and formulate a plan to comprehensively address the appearance of the socket. Objective: At the end of the course, participants will be familiar with surgical and nonsurgical issues that arise in the anophthalmic socket, and how to work with ocularists to maximize cosmetic outcomes. Socket expansion and shrinkage techniques
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses will also be discussed, along with ocularistry and techniques to surgically address upper and lower lid malpositions in the anophthalmic socket. Senior Instructor(s): Victor M Elner Ph D MD* Instructor(s): Cesar A Briceno MD, Christine C Nelson MD, Shivani Gupta MD, Hakan Demirci MD, Fatemeh Rajaii MD, Allison N McCoy MD PhD**
sions, safely diagnose every suspicious periocular tumor, and master the most useful techniques for upper and lower eyelid reconstruction. Senior Instructor(s): Jeffrey A Nerad MD Instructor(s): Francesco P Bernardini MD, Martin H Devoto MD, Robert C Kersten MD, Carlo de Conciliis MD
Lotions, Potions, Botulinum Toxin, and Fillers: Nonlaser Rejuvenation for the Ophthalmologist
Tips for Cosmetic Eyelid Surgery in Asian Patients
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)
Course: 336 Room: S403b Education Level: BAS
Monday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Asian Blepharoplasty and the Eyelid Crease: Challenges and Solutions: A Video-Complemented Course Course: 345 Room: S104a Education Level: BAS
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will cover the basic surgical techniques used in creation of an upper eyelid crease in Asians. The fundamental parameters, proper techniques, pitfalls, and complications will be presented. Videos will be used to illustrate the steps. A general handout will be available from each instructor. The senior instructor will present his views on the functional biodynamic of the lid crease, as well as the “Faden” effect and consequences of placement of buried sutures used in some techniques. Objective: At the end of the course, the attendee will have an understanding of anatomy, specific terminology, and issues relating to primary as well as revisional cases and will take away a working knowledge of the steps involved in Asian blepharoplasty, as developed by the instructors. Senior Instructor(s): William Pai-Dei Chen MD Instructor(s): Don Liu MD
Periocular Tumors and Techniques of Eyelid Reconstruction Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)
Course: 373 Room: S103a Education Level: BAS
Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will give an overview of the most common benign and malignant skin lesions that involve the periocular region, will highlight the general features of malignancy, will provide a detailed description of the most common eyelid neoplasms, will describe the different biopsy techniques, and will provide the requisites to reconstruct the upper and lower eyelid under any circumstance. Objective: At the conclusion of this course, the attendee will be able to recognize malignant and benign tumors, differentiate among the various types of malignant le-
Monday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: Asian people have different anatomic characteristics from non-Asian people, and different beauty standards as well. To obtain a satisfactory surgical outcome, it is important to understand the distinct points in anatomy and surgical techniques. This course will present detailed anatomic differences, as well as surgical pearls for cosmetic eyelid surgery, such as double eyelid operation, upper lid blepharoplasty, and epicanthoplasty for Asian patients. Objective: At the conclusion of this course, the attendee will be familiar with different approaches and unique surgical techniques for performing various cosmetic eyelid procedures in Asian patients. Senior Instructor(s): Yoon-Duck Kim MD Instructor(s): Don Kikkawa MD*, Randal Pham MD FACS, Kyung In Woo MD
Stereo Anatomy of the Orbit, Eyelid, and Lacrimal System: A Surgeon’s Perspective Course: 379 Room: S102d Education Level: BAS
Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will provide a comprehensive review of orbital, eyelid, and lacrimal system anatomy using projected stereo images of meticulous cadaveric dissections. Surgical approaches and complications will be emphasized. Objective: This course will reacquaint participants with the anatomy of the orbit / ocular adnexa and increase their confidence when operating in these areas. Senior Instructor(s): Asa Dan Morton III MD Instructor(s): Victor M Elner Ph D MD*, Kimberly Cockerham MD FACS*
H Basic Browlift: Principles and Techniques Course: 422 Room: E351 Education Level: BAS
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: There are many brow elevation techniques, and in general the procedure should be tailored to the specific patient. This course will review the anatomical foundations, evaluation, patient selection, and treatment of brow ptosis. The techniques reviewed will include direct, mid-forehead, pretrichial, coronal, limited incision, chemical, and browpexy. Objective: At the conclusion of the course, the attendee will be able to describe the anatomical foundations of brow ptosis, evaluate the patient with brow ptosis, list the different techniques available for brow elevation, and select which procedure is most appropriate for each particular patient. Senior Instructor(s): Richard C Allen MD PhD Instructor(s): Jill S Melicher Larson MD, Keith D Carter MD FACS
NEW SOE Cut, Lift and Fill: Three-Way Path to a 3-D Rejuvenation Course: 425 Room: S103d Education Level: INT
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: This course focuses on aesthetic rejuvenation of the periocular aesthetic unit combining blepharoplasty (cut), endoscopic lifting (lift), and volume restoration (fill). Three-D and HD videos will be used to demonstrate each technique proposed during the course, including fat grafting, endoscopic lifting, and tissue-sparing blepharoplasty.
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
85
Instruction Courses
Synopsis: Cosmeceuticals, botulinum toxin, chemical peels, and facial fillers are all nonlaser options for minimally invasive facial rejuvenation. This course will review facial skin analysis and minimally invasive therapeutic options available to patients. Assessment, indications, and techniques for use of botulinum toxin, chemical peels, and facial fillers will be discussed. Objective: At the end of this course, attendees will be familiar with skin assessment techniques, cosmeceutical categories, and applications. The indications, techniques, and complications (management and avoidance) for botulinum toxin, facial fillers, and chemical peels will also be reviewed. Patient cases will be reviewed to emphasize the integration of lotions, potions, and injectables to optimize outcomes. Senior Instructor(s): Femida Kherani MD* Instructor(s): Christopher M DeBacker MD, Jill Annette Foster MD FACS*, Scott M Goldstein MD, Wendy W Lee MD*
Course: 377 Room: N427bc Education Level: INT
Instruction Courses Objective: The of the course is to provide the attendees with an alternative rejuvenative approach to the periocular aesthetic unit, based on tissue repositioning and volume restoration, to traditional subtractive eyelid surgery, focusing on proper patient selection for each specific technique and treatment combination. At the conclusion of this course attendees will be able to advance their skills in the field of modern aesthetic practice and be able to recommend the best treatment option for each individual patient. Senior Instructor(s): Francesco P Bernardini MD Instructor(s): Morris E Hartstein MD, Martin H Devoto MD, Jose R Montes MD*
Objective: At the conclusion of the course, the attendees will be able to make an appropriate choice for management of the spectrum of lacrimal disorders and improve their surgical techniques in lacrimal surgery. Senior Instructor(s): Ashok K Grover MBBS Instructor(s): Hunter Yuen MBBCHB MRCSED, Reynaldo M Javate MD**, Kelvin Kam Lung Chong MD, Raoul D Henson MD*, Darmayanti Siswoy MD, Kyung In Woo MD, Mohammad Javed Ali MD, Dongmei Li MD
NEW Congenital Ptosis Simplified
Course: 535 Room: S105bc Education Level: INT
Course: 433 Room: S104a Education Level: BAS
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Instruction Courses
Synopsis: This course will present the approach to a patient with congenital ptosis. Evaluation and nuances in the choice of appropriate surgical management will be discussed. Finer points in the surgical techniques for Muller’s muscle surgery, Fasanella Servat surgery, Levator resection and Sling procedures including fascia lata surgery will be presented by video films. Management of Jaw winking syndrome and Blepharophimosis syndrome will be outlined. Objective: At the conclusion of this course, the attendee will be able to choose the appropriate management for a patient with congenital ptosis and understand the surgical techniques for cases of simple and complicated ptosis. Senior Instructor(s): Ashok K Grover MBBS Instructor(s): Chai-Teck Choo**, Yoon-Duck Kim MD
Controversies and Advances in Pediatric Oculoplastic Surgery Course: 513 Room: S103d Education Level: INT
Tuesday 9:00 - 10:00 AM Target Audience: COMPSUB
Synopsis: In this course a panel of experienced oculoplastic, pediatric, and pediatric oculoplastic surgeons will combine (1) short lectures on controversial topics, presented by pediatric and oculoplastics for differing views and (2) interactive case discussions. Topics include congenital ptosis with poor levator function, timing of surgery, unilateral vs. bilateral repair, technique (frontalis sling, levator / tarsal resection, Müller muscle-conjunctival resection), fascia lata / gortex / silicone sling choices, and whether bilateral surgery and levator extirpation are needed in Marcus-Gunn ptosis. Other topics include congenital nasolacrimal duct obstruction, timing / order of repair, Pediatric Eye Disease Investigator Group updates, balloon dacryoplasty and endoscopic dacryocystorhinostomy advanced techniques, anophthalmia management with dermis fat, static and hydrogel expanders, and periorbital hemangioma treatment. Objective: The attendee should be better equipped to make treatment recommendations that incorporate the expertise of both specialties for these difficult pediatric oculoplastic issues. Senior Instructor(s): Cat Burkat MD Instructor(s): Francesco P Bernardini MD, Martin H Devoto MD, Morris E Hartstein MD, Michael C Struck MD, Angela M Dolmetsch MD
NEW Update on Lacrimal Surgery Course: 521 Room: S106b Education Level: INT
Tuesday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: This course will present the current management practices for a wide spectrum of lacrimal disorders. Choice of procedures will be discussed in the light of currently available evidence and finer points of surgical techniques outlined by videos. The course will discuss congenital nasolacrimal duct obstruction, proximal canalicular obstructions, external and endonasal dacryocystorhinostomy (DCR), transcanalicular recanalization, laser DCR, failed lacrimal surgery, and canalicular trauma.
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Evaluation and Management of Orbital Cellulitis Tuesday 10:15 - 11:15 AM Target Audience: COMPSUB
Synopsis: Orbital cellulitis is a condition that may be associated with vision- and life-threatening complications. Despite numerous medical advances in antimicrobial therapy, radiographic imaging, and surgical technique, the treatment of orbital cellulitis remains challenging. Successful management requires prompt diagnosis, aggressive medical therapy, and in some cases, timely surgical intervention. Through lectures, video, and panel discussions, participants will learn to manage these patients confidently. Objective: This course will familiarize participants with the clinical features, radiographic presentation, and current medical and surgical treatment options for orbital cellulitis. Senior Instructor(s): Michael T Yen MD* Instructor(s): Thomas Edward Johnson MD
Inflammatory Orbital Disorders and Their Differential Diagnoses Course: 561 Room: S103d Education Level: BAS
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will cover the inflammatory orbital disorders and their differential diagnoses. The systemic manifestations of inflammatory disorders, including infections, Graves eye disease, inflammatory pseudotumor and IgG-4 variant, Sjögren disease, sarcoidosis, Wegener granulomatosis, adult xanthogranulomatous disease, and fungal infections, will be discussed. The clinical and imaging characteristics, the differential diagnosis from orbital malignancy, and current management options for orbital inflammations will be reviewed. This will be an interactive course with case presentations and discussions. Objective: The attendee will learn how to evaluate, provide a differential diagnosis for, and manage patients with inflammatory orbital diseases. Senior Instructor(s): Hakan Demirci MD Instructor(s): Victor M Elner Ph D MD*, Christine C Nelson MD, Alon Kahana MD PhD, Raymond Douglas MD PhD*, Terry A Smith**, Cesar A Briceno MD
H Evaluation and Treatment of Lower Lid Ectropion, Entropion, and Retraction Course: 577 Room: S103bc Education Level: BAS
Tuesday 12:45 - 1:45 PM Target Audience: COMPSUB
Synopsis: Lower eyelid malpositions are common and include entropion, ectropion, and retraction. Etiologies of entropion include involutional, cicatricial, and spastic; etiologies of ectropion include involutional, cicatricial, paralytic, and mechanical; and etiologies of retraction include involutional, cicatricial, and paralytic. Surgical management is based upon the underlying etiology. Objective: At the conclusion of the course, the attendee will be able to identify and classify each of the lower lid malpositions by their etiologies. In addition, the participant will be able to develop an appropriate surgical plan for each of the malpositions. Senior Instructor(s): Richard C Allen MD PhD Instructor(s): Erin Shriver MD, Jill S Melicher Larson MD
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses H Thyroid Eye Disease Jointly sponsored by the Academy’s Annual Meeting Program Committee and the International Thyroid Eye Disease Society (ITEDS)
Course: 594 Room: S103bc Education Level: INT
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Pediatric Ophthalmology, Strabismus NEW Pediatric Eye Emergencies You Don’t Want to Miss! Course: 202 Room: S403a Education Level: INT
Sunday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: Pediatric eye emergencies that present to the comprehensive or pediatric ophthalmologist can be vision- or life-threatening for the child. Appropriate and early treatment of such eye conditions is critical in optimizing a successful outcome for the patient. In this course diagnoses with typical clinical presentations such as retinoblastoma, acquired nystagmus, non-accidental trauma, orbital cellulitis, rhabdomyosarcoma, herpes simplex keratitis, neonatal dacryocystitis, infantile glaucoma, and orbital vascular malformation will be presented. Illustrative photographs of clinical findings will be used throughout the presentation. Critical collaborative medical care will be discussed. Audience discussion and questions will be encouraged at the end of the course. Objective: At the conclusion of this course, the audience will be able to diagnose and manage vision- and life-threatening pediatric eye conditions. The attendee will be able to appropriately work up each diagnosis with relevant labs, neuroimaging, and associated tests. Senior Instructor(s): Yasmin Bradfield MD Instructor(s): Laura B Enyedi MD, Megan E Collins MD, Shira L Robbins MD*
NEW Pediatric Corneal Disorders: A Comprehensive Overview Course: 206 Room: N138 Education Level: INT
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: Using didactic presentations and case scenarios, this course will explore various aspects of pediatric corneal disorders. A comprehensive overview of typical and atypical presentations of various corneal pathologies unique to the pediatric age group, such as congenital corneal opacities, anterior segment dysgenesis, congenital corneal anesthesia, corneal infections, ectatic disorders, and allergies will be presented. We will discuss the management protocols for these disorders and various surgical challenges and modifications in techniques to perform pediatric penetrating, rotational and lamellar keratoplasty (Descemet-stripping endothelial keratoplasty / deep anterior lamellar keratoplasty), and keratoprosthesis.
NEW How to Handle Pediatric Traumatic Cataract Course: 216 Room: N136 Education Level: INT
Sunday 3:15 - 4:15 PM Target Audience: COMPSUB
Synopsis: Ocular trauma is an important cause of cataract formation in the pediatric age group. It may or may not be associated with corneal or uveal injury. The course will discuss the various presentation patterns and the levels of involvement of the lens and surrounding tissue. Emphasis will be placed on the need for thorough preoperative assessment and the evaluation parameters. The appropriate IOL designs and power and the modifications needed in the surgical technique will also be highlighted. The adjunctive and additional procedures needed for managing corneal and uveal trauma will also be discussed. The need for parental counseling in order to prevent ocular trauma to the child will be emphasized. Objective: The course aims to provide an insight into the need for a careful assessment as well optimal management of pediatric traumatic cataract. Senior Instructor(s): Rajesh Sinha Instructor(s): Jeewan S Titiyal MD, Namrata Sharma MD MBBS, Tushar Agarwal MD, Tarun Arora
H Pediatric Uveitis: What You Need to Know Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Uveitis Society
Course: 226 Room: N140 Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: This course will cover the challenging issue of pediatric uveitis through case presentation and interactive discussion with the audience. More than 10% of blindness due to uveitic conditions occurs in the pediatric population. Among etiologic entities, juvenile idiopathic arthritis, infectious diseases, and pars planitis remain predominant. Objective: At the conclusion of this course, the attendee will be able to diagnose common intraocular inflammatory conditions in children, evaluate the severity of disease, and propose a tailored workup. Therefore it will be possible to select the best therapeutic strategy in each situation and propose systemic immunosuppressors, when necessary. Senior Instructor(s): Janet Louise Davis MD* Instructor(s): Bahram Bodaghi MD PhD, Debra A Goldstein MD*
What’s New and Important in Pediatric Ophthalmology and Strabismus for 2014 Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the American Association for Pediatric Ophthalmology and Strabismus (AAPOS)
Course: 311 Room: S403a Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: This course will provide a stimulating overview of important publications from a variety of peer-reviewed journals from 20013/2014 in the field of pediatric ophthalmology and strabismus. Objective: At the conclusion of this workshop, attendees will be able to (1) understand the latest research in retinopathy of prematurity prevention and treatment, (2) understand the causes of various forms of strabismus, as elucidated by the most recent research, (3) be aware of the resources available for genetic testing and how to more wisely implement genetic testing into their practices, (4) understand trends in pediatric cataract and refractive surgery and implement this new information into
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
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Instruction Courses
Synopsis: Thyroid eye disease (TED) can be challenging to manage. This course will provide a practical update to help the ophthalmologist care for the patient with TED. The International Thyroid Eye Disease Society (ITEDS) “VISA” standardized evaluation form will be utilized in the discussion of the clinical evaluation and management of this disorder. An overview of favored approaches for surgical management will also be provided. Objective: By the conclusion of this course, participants should understand (1) disease activity, progress, and severity, (2) the ITEDS-VISA classification, (3) the use of the ITEDS-VISA classification for management, (4) management during the active phase, including conservative therapy, medical therapy, radiotherapy, and urgent surgery, and (5) management during the quiescent phase, including conservative therapy and surgical intervention. Senior Instructor(s): Jennifer A Sivak MD Instructor(s): Kenneth V Cahill MD FACS, Peter J Dolman MD, Raymond Douglas MD PhD*, Jonathan J Dutton MD PhD, Victor M Elner Ph D MD*, Steven E Feldon MD*, Michael Kazim MD, Don Kikkawa MD*, Mark J Lucarelli MD FACS, John Nguyen MD, Jimmy M Uddin MD
Objective: By the conclusion of this course, attendees will be familiar with common pediatric corneal pathologies, their typical and atypical features, overlapping features and signs to differentiate one from other, and their medical and surgical management. Senior Instructor(s): Vandana Jain MBBS Instructor(s): Jatin Naresh Ashar MD, Muralidhar Ramappa MBBS, Kanwal K Nischal MBBS*, Kathryn A Colby MD PhD*, Asim Ali MD
Instruction Courses their practices, and (5) understand the latest information on therapeutic treatment options for amblyopia. Senior Instructor(s): Jitka L Zobal-Ratner MD Instructor(s): Darron A Bacal MD*, Arlene V Drack MD*, Patrick J Droste MD, Majida A Gaffar MD**, Ramesh Kekunnaya MBBS MD, Stacy L Pineles MD, Terri L Young MD*, W Walker Motley MD
Diplopia After Cataract and Refractive Surgery Course: 349 Room: N427bc Education Level: INT
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Instruction Courses
Synopsis: Diplopia after cataract or refractive surgery is frustrating for the anterior segment surgeon and can be challenging for the strabismus specialist. We will provide a case-based approach to the evaluation and management of patients with diplopia after cataract or refractive surgery. Case presentations will illustrate how some problems can be avoided prior to anterior segment surgery, and other cases will illustrate how to manage the patient when problems occur. Specific topics to be covered will include monocular vs. binocular diplopia, pre-existing strabismus, need for a specific refractive state, need for a specific fixation pattern, long-standing optical blur, myotoxicity, and technical or optical problems. Audience participation and discussion will be encouraged. Objective: At the completion of this course, the attendee should have a greater understanding of how to avoid diplopia after cataract and refractive surgery, and if diplopia occurs, how to evaluate and manage the patient. Senior Instructor(s): Jonathan M Holmes MD* Instructor(s): Rosanne Superstein MD
Approach to Genetic Eye Diseases for the Comprehensive Ophthalmologist Course: 354 Room: E451a Education Level: BAS
Monday 11:30 AM - 12:30 PM Target Audience: COMP
Synopsis: This course will focus on the comprehensive ophthalmologist’s role in the treatment of genetic eye diseases. It will review the pertinent medical background and the availability of diagnostic testing, and will discuss nondirective counseling. Illustrative cases will be used to highlight important aspects of the management of these patients. Objective: By the end of this course, participants will be able to understand (1) how to approach and evaluate a patient and family with a genetic disorder, (2) the principles of inheritance patterns, (3) where to find reliable information and laboratory diagnostics, including the eyeGENE network on genetic disorders, (4) guidelines on genetic counseling, and (5) complexities of the processes, including medicolegal considerations. Senior Instructor(s): Johnny Tang MD Instructor(s): J Bronwyn Bateman MD, Wadih M Zein MD, Pamela C Sieving MA MS AHIP
H ROP Screening and Treatment: What You Wanted to Know but Were Afraid to Ask (Intermediate/Advanced) Course: 381 Room: N140 Education Level: INT
Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: Retinopathy of prematurity (ROP) can be a difficult and challenging disease to manage. This course is for established screeners / treaters familiar with ROP who want to enhance their proficiency. This course will provide advice on how to effectively screen and treat with an emphasis on clinical pearls designed to improve the approach to this condition. Topics include updated findings of the Early Treatment for ROP study (ETROP), the accurate diagnosis of plus disease, pitfalls in managing aggressive posterior ROP, the impact of oxygen on ROP, the appropriate time to refer for vitreoretinal surgery, medicolegal issues, the role of telemedicine and photodocumentation, and the use of anti-VEGF therapy. This will be followed by a presentation of challenging cases and how they were managed.
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Objective: At the conclusion of this course, the attendee will be better able to recognize children progressing to treatment-requiring ROP and to more effectively deal with the challenges of laser treatment. Senior Instructor(s): Thomas Lee MD* Instructor(s): Michael F Chiang MD*, William V Good MD**, Kenneth W Wright MD*, G Baker Hubbard MD*, R V Paul Chan MD, Anne M Menke RN PhD, Maria Ana Martinez-Castellanos MD, Audina Berrocal MD*
NEW Surgical Management of Pediatric Glaucoma Course: 393 Room: S106b Education Level: INT
Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This two-hour course will give practical knowledge on when and how to perform surgery for childhood glaucoma. A series of clinical cases will be presented to the audience, and there will be a discussion of management between the audience and the panel of experts. Videos of the surgical techniques will be presented, and surgical pearls given by the panel of experts. The format will be interactive, with participation of the audience encouraged in every section. All the surgical techniques performed in pediatric glaucoma will be presented, including angle surgery (goniotomy and trabeculotomy), trabeculectomy, glaucoma drainage devices, and cyclodestructive procedures. Objective: At the conclusion of this course, the attendees will be able to indicate the optimal surgical procedure for different types of childhood glaucoma and will have gained knowledge on how to perform the surgical techniques most frequently used. The attendees will learn surgical pearls to apply on their procedures for childhood glaucoma. Senior Instructor(s): Alana Grajewski MD* Instructor(s): Elena Bitrian MD*, Sharon F Freedman MD, Allen Dale Beck MD*, James D Brandt MD*
Management of Strabismus in Thyroid Eye Disease Course: 506 Room: S103bc Education Level: INT
Tuesday 9:00 - 10:00 AM Target Audience: SUB
Synopsis: Strabismus associated with thyroid eye disease (TED) is one of the more challenging types of ocular misalignments to correct. A variety of techniques have been described using adjustable as well as fixed sutures. This course will review the steps in the preoperative examination of the patient in the office, the gathering of necessary information to determine the muscles to be operated on, and the operative technique used by the instructors. Video clips will be used to partly transfer the necessary skills. A summary of the literature on the topic will also be given. Objective: Upon completion of the course, participants will be able to (1) list the clinical data necessary for management of the patient with TED and strabismus, (2) describe the operative steps involved in the surgical technique used to correct the ocular misalignment, and (3) understand the differences between the different surgical techniques for the correction of strabismus in TED and the pros and cons for each. Senior Instructor(s): Elias I Traboulsi MD* Instructor(s): Paul Joseph Rychwalski MD, Natalie Kerr MD
NEW Reading, Dyslexia, and Vision Therapy Course: 522 Room: S104a Education Level: BAS
Tuesday 9:00 - 10:00 AM Target Audience: COMPSUB
Synopsis: This course will give a comprehensive summary of the latest information on reading, dyslexia, the eye functions necessary to read and how to test for them in the ophthalmic examination, vision training, tinted lenses, and resources available for our patients and their families. The role of the ophthalmologist will be stressed. Objective: The attendees will achieve a full understanding of reading, dyslexia, and the controversies involved. The participants will be better equipped to evaluate these patients and discuss this subject with their patients and families. Senior Instructor(s): Sheryl M Handler MD Instructor(s): Walter M Fierson MD**, A Melinda Rainey MD
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses H YO Diplopia Made Ridiculously Simple: Management of Diplopia for the Comprehensive Ophthalmologist Course: 556 Room: S103bc Education Level: BAS
Tuesday 11:30 AM - 12:30 PM Target Audience: COMP
NEW Pediatric Refractive Surgery Course: 563 Room: S103a Education Level: INT
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will cover many challenging aspects of pediatric refractive surgery, including patient selection, surgical decision making, and postoperative expectations. Experts in the field will also present cases to reinforce the didactic topics. Objective: At the completion of this course, the participant should be able to identify pediatric patients who could benefit from refractive surgery. In addition, the participant should be able to differentiate between the goals and of adult refractive surgery and those of pediatric refractive surgery. Senior Instructor(s): Erin D Stahl MD* Instructor(s): Evelyn A Paysse MD, Amy K Hutchinson MD
Nightmares in Pediatric Cataract Surgery Course: 582 Room: S106b Education Level: INT
Tuesday 12:45 - 1:45 PM Target Audience: COMPSUB
Synopsis: In this video- and case-based presentation, cataract surgery in children with association of anterior segment trauma, anterior segment dysgenesis, microcornea, subluxation, posterior lenticonus, persistent fetal vasculature, coloboma, after keratoplasty (penetrating / endothelial), after glaucoma filtering surgery, uveitis, and extended anterior capsulorrhexis / other intraoperative disasters will be discussed. These cases are prone to develop intraoperative complications. Modifications in standard surgical technique will be discussed. Objective: At the end of this course, the attendee will be able to identify challenging situations that arise in complicated pediatric cataract surgery, including the surgical modifications required and the optimal outcomes of surgery. Senior Instructor(s): Ramesh Kekunnaya MBBS MD Instructor(s): Kanwal K Nischal MBBS*, Muralidhar Ramappa MBBS, Murali Krishnamachary Aasuri
H Difficult Strabismus Problems: Diagnosis and Management 2014 Course: 588 Room: S105d Education Level: ADV
Tuesday 2:00 - 4:15 PM Target Audience: SUB
Synopsis: Case presentations of complex strabismus will form the basis for panel discussion and audience participation in this course on proper diagnosis and management. Diagnostic techniques such as orbital imaging, forced ductions, saccadic velocity, and active force generation testing will be discussed as they apply to specific cases. Reoperations, cranial nerve palsies, trauma, Duane syndrome, Brown syndrome, and thyroid ophthalmopathy are representative topics.
Refractive Surgery Solving the High Myopia Problem With Phakic IOLs Course: 155 Room: N427d Education Level: INT
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will present a review of state-of-the-art knowledge on anterior and posterior chamber phakic IOLs, with information on patient, eye, and IOL selection, surgical techniques, and management of intra and postoperative complications. Special attention will be dedicated to diagnostic instruments for patient selection and follow-up. Objective: Participants will be able to assess phakic IOLs as a valuable tool in refractive surgery. Experience, imaging, and long-term follow-up will provide a safer approach to phakic IOLs. At the conclusion of this course, attendees will be able to understand the phakic IOL’s potential and possible weak points in order to decide whether to add phakic IOL’s advanced technology to their practices. Senior Instructor(s): Dimitri Dementiev MD** Instructor(s): Matteo Piovella MD*, Jorge L Alio MD PhD*, Georges D Baikoff MD*, David R Hardten MD*, Gregory Parkhurst MD*, Luca Gualdi MD
H Danger Zone: Refractive Surgery Nightmares and WorstCase Scenarios: A Video-Based Course Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the International Society of Refractive Surgery (ISRS)
Course: 314 Room: S105d Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: Refractive surgery has its own danger zones. Various refractive surgery techniques, from surface ablation to LASIK and phakic IOLs, can have disasters that have to be handled with care. In this course, collagen crosslinking for ectasia and other conditions will be taught. Viscocannula-assisted reinversion of an implantable contact lens will be shown. Topics like flap complications, decentered ablations, and iatrogenic ectasia will be explained in detail. Attendees will be taught how to manage eyes with previous LASIK flaps and how to address problems with Kerarings and other intrastromal ring segments. Objective: At the conclusion of this course, the attendee will know how to manage refractive surgery catastrophes, perform crosslinking, and treat iatrogenic keratectasia, flap complications, and femtosecond problems. Senior Instructor(s): Amar Agarwal MD* Instructor(s): Ronald R Krueger MD*, Athiya Agarwal MD, Alaa M Eldanasoury MD*, Marguerite B McDonald MD*, Sonia H Yoo MD*, A John Kanellopoulos MD*, Soosan Jacob FRCS, Ashvin Agarwal MBBS, J Bradley Randleman MD
Refractive Lensectomy: Indications, Lenses, Formulas, Outcomes Course: 352 Room: S403a Education Level: ADV
Monday 11:30 AM - 12:30 PM Target Audience: COMP
Synopsis: This course will present different approaches using refractive lensectomy as a refractive surgical procedure to achieve spectacle independence for far and near. The indications, contraindications, IOL calculation and selection (monofocal, multifocal, accommodative), and patient selection criteria for successful outcomes will be shown and discussed in a didactic format. Objective: At the conclusion of this course, the attendee will be able to define the best indications and most frequent contraindications of refractive lens exchange, identify the best IOL calculation method, know how to manage astigmatism, select
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
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Instruction Courses
Synopsis: This course will use diplopia case examples to illustrate important clinical management concerns, including when to consider medical workup, surgery, and nonsurgical methods of alleviating diplopia. This course will demonstrate how presson (Fresnel) prisms, ground-in prisms, and occlusive methods can be used to treat diplopia. Objective: At the conclusion of this course, the attendee will be able to (1) identify diplopic patients who need further evaluation for medical issues, (2) understand which diplopic patients should be managed surgically vs. nonsurgically, (3) clinically evaluate for and appropriately prescribe press-on and ground-in prisms, and (4) understand the indications for occlusive devices (eg, spot patch, occlusive contact lens, and frosted tape) for diplopia. Senior Instructor(s): Laura B Enyedi MD Instructor(s): Michelle J Cabrera MD, Andrew G Lee MD*
Objective: This course is intended to enhance participants’ ability to accurately diagnose and treat complicated strabismus patients. Surgical and nonsurgical options will be elaborated. Senior Instructor(s): Burton J Kushner MD Instructor(s): Edward G Buckley MD, David G Hunter MD PhD*
Instruction Courses the best choice for a multifocal IOL and the best cases for accommodative IOLs, and understand practical tips to achieve a high patient satisfaction rate with refractive lens exchange. Senior Instructor(s): Jorge L Alio MD PhD* Instructor(s): Andrzej Grzybowski MD*, Warren E Hill MD*, Mark Packer MD*, Eric D Donnenfeld MD*
NEW Phototherapeutic Keratectomy for the Treatment of
Anterior Corneal Pathology Course: 357 Room: N136 Education Level: INT
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Instruction Courses
Synopsis: This course will include an updated overview of phototherapeutic keratectomy (PTK) for the treatment of anterior corneal pathology. Objective: At the conclusion of the course, the attendee will be able to (1) identify the preoperative and patient selection criteria for PTK treatment, (2) select the surgical technique to improve PTK outcomes and minimize complications, and (3) recognize the use of mitomycin C in PTK to prevent and treat corneal scarring. Senior Instructor(s): Dimitri T Azar MD* Instructor(s): Damien Gatinel MD*, Sandeep Jain MD*, Rajesh K Rajpal MD*, Christopher Rapuano MD*, Walter J Stark MD*
H A Step-by-Step Primer to Starting LASIK in 2014 Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the International Society of Refractive Surgery (ISRS)
Course: 380 Room: S103bc Education Level: BAS
Monday 2:00 - 4:15 PM Target Audience: SUB
Synopsis: This course will provide an overview of the principles underlying the safe, modern practice of LASIK, as well as pearls of surgical technique to benefit the beginning LASIK surgeon. Technology overview will include wavefront sensing, excimer laser, microkeratome, femtosecond, and modern topographic technologies. Prevention and management of complications will also be covered. Objective: The attendee will acquire a broad understanding of the scientific principles underlying the various technologies involved in the practice of LASIK. The course will provide the foundations for patient selection, surgical planning, and operating technique, as well as an overview of complication avoidance and management. Senior Instructor(s): Dan Z Reinstein MD* Instructor(s): Daniel S Durrie MD*, David R Hardten MD*, Jack T Holladay MD MSEE FACS*, Cory M Lessner MD, Gustavo E Tamayo MD*
H Femtolaser: Diagnosis and Management of
Intraoperative and Postoperative Complications With the Use of a Femtosecond Laser for LASIK Surgery Course: 420 Room: S103bc Education Level: INT
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: We will discuss the surgical complications that occur with femtosecond laser flap creation: data entry errors, centration difficulties, suction loss, interface entry issues, vertical gas breakthrough, and flap tears. Also covered will be the diagnosis and management of postoperative complications: flap slippage, interface inflammation, and how to distinguish these from diffuse lamellar keratitis, interface haze, transient light sensitivity, rainbow glare, etc. This course is recommended for those surgeons who have recently purchased or already use a femtosecond laser. Objective: This course will educate users in the potential risks associated with femtoLASIK flap creation. Senior Instructor(s): Christopher L Blanton MD* Instructor(s): Edward E Manche MD*, Jonathan H Talamo MD*, Ronald R Krueger MD*, Sonia H Yoo MD*
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NEW SOE Enhancement and Retreatment After Refractive
Surgery
Course: 430 Room: S105a Education Level: INT
Monday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: This course will be divided into four main sections: in the first part the authors will present how to diagnose regression and how to make differential diagnosis from ectasia; moreover, the important role of corneal epithelium in regression will be covered. The second part will illustrate the management of myopic, hyperopic, and astigmatic regression. In the third section a new, multistep technique for the management of difficult cases will be presented (sequential custom therapeutic keratectomy or SCTK). In the last section, how and when to retreat a small incision lenticule extraction (SMILE), an all-femto procedure, will be covered. Results and case reports will be presented, as well as how to prepare a shot-file for a regression treatment. Objective: Attendees will learn how to diagnose a regression after refractive surgery and to differentiate from ectasia. Moreover, they will learn how to treat a regression with advanced refractive therapeutic keratectomy. Senior Instructor(s): Paolo Vinciguerra MD* Instructor(s): Jorge L Alio MD PhD*, Jerry Tan MBBS*, Dan Z Reinstein MD*, Leonardo Mastropasqua**, Fabrizio I Camesasca MD
NEW Refractive Surgical Complications and Solutions Course: 518 Room: S102d Education Level: INT
Tuesday 9:00 - 10:00 AM Target Audience: COMPSUB
Synopsis: This course is being offered by the editorial committee of the Basic and Clinical Science Course, volume 13-Refractive Surgery, and will be directed toward the general ophthalmologist who either performs some refractive surgery or cares for patients who have undergone refractive surgery. Material to be covered will include common (and some unusual) complications of refractive surgery and their management. Areas to be included range from preoperative screening issues to the intraoperative and postoperative surgical repair of patients with visual and structural complications resulting from a variety of refractive surgical procedures. Objective: At the conclusion of this course, the attendee will have the intellectual tools be able to recognize, prevent if possible, and manage a variety of complications of refractive surgical procedures. Senior Instructor(s): M Bowes Hamill MD* Instructor(s): J Bradley Randleman MD, Richard S Davidson MD*, Neda Shamie MD*, Gregg J Berdy MD*, Parag A Majmudar MD*, Bradley Dean Fouraker MD*, Renato Ambrosio Jr MD*
SA Corneal Topographic Analysis and Anterior Segment Imaging: Pearls for Your Clinical Practice Course: 537 Room: E352 Education Level: INT
Tuesday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will present a systematic approach to the interpretation of corneal topographies and anterior segment imaging studies using didactic instruction combined with numerous clinical examples. The course will highlight several imaging systems and technologies, including Placido-based topography, single and dual Scheimpflug imaging, OCT, and scanning slit beam imaging. Objective: At the conclusion of this course, the attendee will understand the different technologies used to image the anterior segment, be able to use the different maps and displays available on multiple devices, know the advantages and disadvantages of the most common topographers and imaging devices, and use the study results to manage common clinical situations in corneal, cataract, and refractive surgery. Senior Instructor(s): Mitchell P Weikert MD* Instructor(s): Douglas D Koch MD*, Thomas Kohnen MD*, Cynthia Roberts PhD*, Surendra Basti MBBS*, William J Dupps MD PhD*
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses Presbyopia, the Corneal Approach: State of the Art Course: 575 Room: S105a Education Level: INT
Tuesday 12:45 - 1:45 PM Target Audience: SUB
Synopsis: The course will discuss different corneal methods of correcting presbyopia, including Allegretto custom-Q, Visx presbyLASIK, Amaris PresbyMAX, Mel 80 laser blended vision, corneal inlays, and Femtec Intracor. Presbyopia and its adaptive optics will be demonstrated. Objective: Attendees will be able to design the best corneal treatment profile for each presbyopic patient according to age, error of refraction, and corneal measurements. Senior Instructor(s): Mounir A Khalifa MD Instructor(s): Ronald R Krueger MD*, Gustavo E Tamayo MD*, Jorge L Alio MD PhD*, Dan Z Reinstein MD*
Advanced Corneal Topographic Analysis Course: 598 Room: S104a Education Level: INT
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will discuss advanced topographic analysis in the patient evaluation process for the comprehensive clinician and refractive surgeon, focusing on understanding and recognizing normal and abnormal topographic patterns generated by multiple technologies, including standard Placido imaging, slitbeam-based imaging (Orbscan II), Scheimpflug imaging (Pentacam), and wavefront imaging. Objective: By the conclusion of this course, the participants will be able to (1) identify subtle abnormal topographic patterns that place patients at increased risk for postoperative complications, including ectasia, (2) differentiate truly abnormal preoperative topographies from artifactual images, and (3) effectively utilize topographic imaging techniques to demonstrate corneal pathology before keratorefractive refractive surgery. Senior Instructor(s): J Bradley Randleman MD Instructor(s): William J Dupps MD PhD*
Femtosecond Laser for Cornea Surgery: The Actual Options Course: 601 Room: S102d Education Level: INT
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: The use of femtosecond laser for cornea and refractive surgery has rapidly expanded, to the point that this technology is now the gold standard, state-of-the-art procedure for cornea and refractive treatments. In this course instructors will use video and case presentations to explain the five different femtosecond laser platforms used for most techniques in routine cases such as flap creation, intrastromal ring segment implantation, penetrating, anterior lamellar, and endothelial keratoplasties, and refractive lenticule extraction. The panel members will discuss the benefits and advantages of the different laser platforms. Clinical outcomes and complications will also be discussed in detail. Objective: Attendees will gain information about the similarities and differences among the most popular femtosecond lasers and their use in all the cornea and refractive techniques. Senior Instructor(s): Arturo J Ramirez-Miranda MD* Instructor(s): Jose L Guell MD PhD*, Sheraz M Daya MD*, Jorge L Alio MD PhD*, Arturo S Chayet MD*, Luis Izquierdo Jr MD, Mauricio Velez Fernandez MD, Alejandro Navas MD*, Marco A Cantero MD**, Enrique O Graue Hernandez MD
H OCT: Interpretation and Clinical Applications Course: 158 Room: E451b Education Level: BAS
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Through a series of lectures and case presentations, participants will be presented with a practical guide to reading OCT images. The OCT features of a large variety of posterior pole pathologies will be reviewed, including vitreomacular traction, macular degeneration, macular edema, central serous retinopathy, hydroxychloroquine toxicity, and glaucoma. Instructive cases will be reviewed by the panel, with audience participation. Objective: At the conclusion of the course, the attendee will be able to interpret OCT images for diagnosis and management of patients with posterior pole disorders. Senior Instructor(s): Caroline R Baumal MD* Instructor(s): Michael S Ip MD*, Joel S Schuman MD*, Carmen A Puliafito MD MBA*, Brandon J Lujan MD*, Lejla Vajzovic MD
Retinoblastoma 2014: They Live and See! Course: 159 Room: N140 Education Level: INT
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Recent advances in the diagnosis and management of retinoblastoma have contributed to improved outcome. The new staging and grouping systems are now clinically validated. Modern diagnostic and management strategies such as wide-field imaging, transpupillary thermotherapy, chemoreduction, and intravitreal and periocular chemotherapy are effective in improving eye and vision salvage. Selective intra-arterial chemotherapy is an exciting new development. Minimal manipulation enucleation has been optimized. Adjuvant therapy for histopathologic risk factors identified following enucleation has reduced the risk of systemic metastasis. A multimodal protocol is effective in orbital retinoblastoma. Genetic studies now help in prenatal diagnosis and screening of siblings. This course will highlight the practical aspects in the current standard of care for retinoblastoma. Objective: To enable the participants to incorporate recent advances in the diagnosis and management of retinoblastoma into their practices. Senior Instructor(s): Santosh G Honavar MD Instructor(s): Ralph Eagle MD*, Brenda L Gallie MD*, Ashwin C Mallipatna MBBS, Carol L Shields MD, Jerry A Shields MD, Arun D Singh MD
State-of-the-Art Techniques and Technologies for Microincision Vitrectomy Surgery to Treat Complex Vitreoretinal Diseases Course: 160 Room: S103a Education Level: ADV
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will highlight the current indications and “state-of-theart”surgical techniques and technologies for 27-gauge sutureless vitrectomy to treat a variety of vitreoretinal pathologies, including macular surgery, primary rhegmatogenous retinal detachment, diabetic traction retinal detachment, and massive subretinal hemorrhage. With the video clips demonstration, the course will provide step-by-step instruction on tips for transition to the 27-gauge system. The format will encourage open interaction between the faculty and the audience. Objective: By the end of this course, the attendees will not only be familiar with the current indications and the state of the art in 27-gauge vitrectomy systems, but they will also get a glimpse of future technological advances. Senior Instructor(s): Yusuke Oshima MD* Instructor(s): Maria H Berrocal MD*, Pravin U Dugel MD*, Marco Mura MD, Sundaram Natarajan MD, Shunsuke Osawa MD*, Stanislao Rizzo MD
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
91
Instruction Courses
Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the International Society of Refractive Surgery (ISRS)
Retina, Vitreous
Instruction Courses Surgery of Retinal Detachment Course: 162 Room: N138 Education Level: INT
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Instruction Courses
Synopsis: This course will review the principles involved in managing rhegmatogenous retinal detachment. We will provide a detailed, comprehensive, state-of-the-art approach to techniques of scleral buckling, primary vitrectomy, and pneumatic retinopexy for the management of selected detachments. The principles of buckle placement, the selection of elements, drainage, and the use of gases and other adjutants will be described. Objective: At the conclusion of this course, the attendee will be able to (1) discuss the advantages and disadvantages of scleral buckling, vitrectomy, and pneumatic retinopexy, (2) identify the indications and contraindications and technique of drainage of subretinal fluid, (3) select the appropriate gas for intraocular injections, (4) discuss postoperative management of retinal detachment patients, and (5) recognize alternate techniques for the management of different types of retinal detachments. Senior Instructor(s): Daniel P Joseph MD PhD Instructor(s): Harry W Flynn MD, George A Williams MD*, Edwin Hurlbut Ryan MD*
Advances in Intraocular Endoscopic Surgery: Anterior and Posterior Segment Techniques Course: 164 Room: N139 Education Level: INT
Sunday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will introduce the concept of endoscope-assisted intraocular surgery and will showcase video-based presentations of a wide range of anterior and posterior segment procedures. Pearls for rapid attainment of endoscopic proficiency will be discussed. Anterior segment surgery will include cataract/IOL, trauma, and glaucoma, including goniosynechialysis, cyclodialysis cleft repair, plateau iris treatment, and endoscopic cyclophotocoagulation. Posterior segment surgery will include management of blunt and penetrating trauma, safe sutured IOL removal, sclerotomy site pathology, cyclitic membranes, rhegmatogenous retinal detachment (RD) and traction RD in ROP, familial exudative vitreoretinopathy, and persistent fetal vasculature syndrome. The presenters are experienced anterior and posterior segment surgeons familiar with endoscopy. Objective: To educate anterior and posterior segment surgeons on how intraocular endoscopy can assist them in complex surgical procedures. Senior Instructor(s): S Chien Wong MBBS FRCS* Instructor(s): Brian A Francis MD*, Robert J Noecker MD*, Thomas Lee MD*
NEW White Dots, Spots, and Plaques: Making Sense of the Inflammatory Retinal Lesions: A Case-Based Approach Course: 165 Room: S105a Education Level: INT
Sunday 10:15 AM - 12:30 PM Target Audience: SUB
Synopsis: Differentiating the “white spot syndromes” remains a challenging task for ophthalmologists and subspecialists. Recent advances in retinal imaging have improved our understanding and expanded the spectrum of these entities. Great debate still exists between the retina and the uveitis subspecialties regarding the classification and management of these entities. This course includes instructors from both uveitis and retina subspecialties, which will allow dynamic and interesting discussions about controversies in the field. The instructors will present a variety of cases of these entities, with a focus on an approach that differentiates them in an interactive format. Objective: At the end of this course, attendees will have an in-depth understanding of the nuances of inflammatory spots of the retina, including finer points of differentiating and managing these entities in real life. Senior Instructor(s): Amani Fawzi MD Instructor(s): Janet Louise Davis MD*, K Bailey Freund MD*, Debra A Goldstein MD*, Lee M Jampol MD*
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Peering to the Periphery: Applications of Wide-Angle Retinal Imaging Course: 173 Room: S104a Education Level: INT
Sunday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: Wide-angle retinal imaging platforms have gained increased popularity. Numerous applications have been demonstrated, including disease documentation, diagnosis, and targeted treatment of retinal diseases. Utilizing wide-angle angiography and autofluorescence provides insights into retinal and choroidal conditions such as macular degeneration, diabetic retinopathy, retinal vascular disease, and ocular tumors. Pitfalls with these technologies include artifact registration and false color processing, which may result in inaccurate diagnosis. In this course, cases will be presented to highlight the clinical applications of wide-angle imaging. Objective: After completing this course, the attendee will be able to identify imaging options for retinal peripheral diseases, understand the role of wide-angle angiography in retinal vascular disease, identify critical imaging artifacts, and understand applications of these technologies in pediatric and ocular oncology patients. Senior Instructor(s): Prithvi Mruthyunjaya MD* Instructor(s): Szilard Kiss MD*, Seenu M Hariprasad MD*, R V Paul Chan MD, Michael P Kelly FOPS, Sunil K Srivastava MD*
Controversies in the Management of Open-Globe Injuries Involving the Posterior Segment Course: 188 Room: E352 Education Level: INT
Sunday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: Controversies in the management of open-globe injuries will be presented and thoroughly discussed. An overview of the problem will be provided, followed by a detailed breakdown of the controversies for which controlled clinical data regarding management are incomplete. These areas include the timing of surgery, use of prophylactic antibiotics, placement of prophylactic cryotherapy and/or scleral buckle, management of intraocular foreign bodies, use of silicone oil, concurrent placement of primary IOLs, management of hypotony, and surgery on NLP eyes. Guidelines for treatment will be provided based on clinical data and the experience of the presenters. Several videos will be presented, documenting select procedures and techniques. Objective: This course is designed to provide an update on the clinical management of controversial issues in the setting of open-globe injuries through the use of slide presentations, videos, and interactive panel discussions. A comprehensive handout will be provided. Senior Instructor(s): William F Mieler MD* Instructor(s): Ferenc P Kuhn MD PhD, Robert A Mittra MD
Practical Considerations for Telemedicine Diabetic Retinopathy Screening Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the American Telemedicine Association
Course: 194 Room: N427bc Education Level: INT
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: Evidence-based recommendations for diabetes eye care are highly effective in reducing the risk for vision loss. However, poor compliance with recommendations for retinal examinations to ensure early detection of diabetic retinopathy (DR) remains a major unresolved challenge in ophthalmology. Telemedicine programs based on remote digital retinal imaging have demonstrated the potential to complement current DR surveillance methods and increase the rate of DR assessment. In this course, clinical recommendations, technical requirements for hardware, software, and personnel, and operational considerations will be discussed. Successful business models and financial and reimbursement factors will be presented. Objective: At the conclusion of this course, the attendee will understand the rationale for telemedicine DR assessment and have a framework for implementation of a remote program for evaluation of DR. Senior Instructor(s): Ingrid E Zimmer-Galler MD Instructor(s): Mark B Horton MD, Paolo Antonio S Silva MD
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses NEW Seeing Is Believing: Spectral Domain OCT and Clinicopathologic Correlation in Macular Diseases Course: 204 Room: E353c Education Level: INT
Sunday 2:00 - 4:15 PM Target Audience: COMPSUB
NEW Surgical Management of Complicated Retinal
Detachments
Course: 207 Room: S103a Education Level: INT
Sunday 2:00 - 3:00 PM Target Audience: SUB
Synopsis: This instruction course will discuss the management of complicated retinal detachments such as giant retinal tear, diabetic combined retinal detachments, retinal detachments associated with coloboma, retinal detachments with severe proliferative vitreoretinopathy, and retinal detachments associated with microcornea / microphthalmos. The course will include surgical video presentations, and speakers will share their experience in managing such cases. Objective: At end of the course, attendees will be able to improve surgical planning, predict intraoperative difficulties, and understand the management of such cases. Senior Instructor(s): Jay K Chhablani MD Instructor(s): Alay S Banker MD, Manish Nagpal MD*, Sundaram Natarajan MD, Yusuke Oshima MD*
NEW SOE Pediatric Vitreoretinal Disorders: Current and Future Management Course: 326 Room: S403a Education Level: ADV
Sunday 3:15 - 5:30 PM Target Audience: COMPSUB
Synopsis: This course will focus on advances in the management of a range of hereditary and nonhereditary pediatric vitreoretinal disorders. Management themes will include the emerging role of intraoperative OCT, new surgical insights and techniques including endoscopic vitrectomy, and a glimpse into the future of gene, stem cell, and pharmacologic therapies for hereditary diseases. Disorders that will be discussed will include (1) retinovascular diseases, including ROP, familial exudative vitreoretinopathy, Coats disease, incontinentia pigmenti, and persistent fetal vasculature syndrome, (2) vitreoretinal degeneration (eg, Stickler and X-linked retinoschisis), and (3) childhood-onset retinal dystrophies. Objective: At the conclusion of this course, the attendee will have a better understanding of the advances in the current and potential future management options for a range of challenging hereditary and nonhereditary pediatric vitreoretinal disorders. Senior Instructor(s): S Chien Wong MBBS FRCS* Instructor(s): Cynthia A Toth MD*, Antonio Capone Jr MD*, Thomas Lee MD*, R V Paul Chan MD
Jointly sponsored by the Academy’s Annual Meeting Program Committee and the American Society of Ocular Trauma and the International Society of Ocular Trauma
Course: 229 Room: E351 Education Level: INT
Sunday 4:30 - 5:30 PM Target Audience: COMPSUB
Synopsis: Using intraoperative videotapes, this course will review all aspects of managing patients with intraocular foreign bodies: history, epidemiology, pathophysiology, evaluation, instrumentation, timing, management principles and practice, complications, prognosis and outcome, and controversies. A novel surgical method (prophylactic chorioretinectomy) to prevent the development of proliferative vitreoretinopathy will also be discussed. Objective: To provide ophthalmologists with the necessary information for optimal treatment of patients with intraocular foreign body injuries. Senior Instructor(s): Ferenc P Kuhn MD PhD Instructor(s): Jose Dalma MD
Systemic Therapeutic Agents and Retinal Toxicity Course: 307 Room: S106b Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: This course will provide a thorough review of systemic (and select intravitreal) medications that are capable of causing various patterns of retinal toxicity. Examples of all of these types and patterns of toxicity will be presented, including disruption of the retinal pigment epithelium, retinal vascular occlusion, cystoid macular edema / retinal edema, crystalline deposition, uveitis, miscellaneous , and subjective visual symptoms. The mechanism of action will be discussed. Numerous examples of all conditions will be shown, and time will be allotted for questions and answers. A comprehensive referenced handout will be provided to all attendees. Objective: At the conclusion of the course, the attendee will be able to (1) recognize the various patterns of toxicity induced by a variety of systemic, topical, and intravitreal medications, (2) recognize medications capable of causing subjective visual symptoms, and (3) better understand the clinical setting in which toxicity is most likely to occur. Senior Instructor(s): William F Mieler MD* Instructor(s): George A Williams MD*, David F Williams MD*, Scott R Sneed MD, David Sarraf MD*
H Update on Treatments for Diabetic Retinopathy: Clinically Relevant Results From the Diabetic Retinopathy Clinical Research Network Course: 312 Room: S102abc Education Level: INT
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: This course will present clinically relevant results of recently completed Diabetic Retinopathy Clinical Research Network (DRCRnet) protocols, and through case examples it will demonstrate implementation of these results into clinical practice. Objective: At the conclusion of this course, the attendee will be able to describe the results of recently completed DRCRnet protocols. Specifically, the attendee will learn what role topical NSAIDs can play in the progression of noncentral diabetic macular edema (DME) to center-involved DME. The course will also include a review of the ongoing DRCRnet protocols, including the trial comparing ranibizumab, bevacizumab, and aflibercept for DME and the ranibizumab for proliferative diabetic retinopathy trials. The assessment of wide-field imaging in the management of diabetic retinopathy will also be discussed. Finally, the attendee will be able to apply the DRCRnet results to clinically relevant situations in daily practice. Senior Instructor(s): Carl W Baker MD* Instructor(s): Lee M Jampol MD*, Neil M Bressler MD*, Susan B Bressler MD*, Scott M Friedman MD*, Jennifer K Sun MD**, Andrew N Antoszyk MD*, Raj K Maturi MD*, John A Wells III MD*
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
93
Instruction Courses
Synopsis: Although pathological biopsy has been the gold standard for our understanding of macular diseases for so many decades, the advent and continuing development of spectral domain OCT (SD-OCT) technology has enhanced our understanding of these conditions. Through case presentations and interactive discussions, this course will correlate clinical scenarios through color fundus photography, fluorescein angiography, SD-OCT, and fundus autofluorescence with the histopathology of various macular diseases. This will include degenerative, inherited, inflammatory, vascular, and toxic diseases of the macula. Objective: At the conclusion of the course, the participants will have a better understanding of the normal macula and the conditions that can affect it. They will be able to identify various conditions like macular degenerations and dystrophies, vascular occlusions, diabetic retinopathy, and toxic maculopathies with the help of different testing modalities with correlation of the pathophysiology of that condition. Senior Instructor(s): Sandeep Grover MD Instructor(s): Deepak Paul Edward MD, Vikram S Brar MD, Ralph Eagle MD*
Intraocular Foreign Body Injuries: An Update
Instruction Courses H Diagnosis and Treatment of Polypoidal Choroidal Vasculopathy
H Retinal and Choroidal Manifestations of Selected Systemic Diseases 2014
Course: 318 Room: S406b Education Level: INT
Jointly Sponsored by the Academy’s Annual Meeting Program Committee and the Pan-American Retina and Vitreous Society
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Instruction Courses
Synopsis: Polypoidal choroidal vasculopathy (PCV) is a condition characterized by multiple, recurrent, serosanguineous pigment epithelial detachment and neurosensory retinal detachment due to abnormal choroidal polypoidal, aneurysmal lesions. PCV is particularly prevalent in Asians and occurs in up to 40% of cases presenting as neovascular AMD; it may pose a diagnostic challenge to ophthalmologists. This instruction course aims to provide a comprehensive overview of the diagnosis and treatment of PCV through review of the currently available literature, illustrative case examples, and interactive panel discussion. Objective: By the completion of this course, participants will understand the epidemiology of PCV, the differences between PCV and AMD, the use of various diagnostic tools for PCV, the available treatment options for PCV, and the overall management strategy for PCV. Senior Instructor(s): Timothy Y Lai MBBS* Instructor(s): Fumi Gomi MD PhD*, Gregg T Kokame MD*, Adrian H Koh MD*, Won Ki Lee MD*
H YO Spectral Domain OCT Interpretation for the General Ophthalmologist Course: 319 Room: E451a Education Level: BAS
Monday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: The purpose of this course is to provide general ophthalmologists with basic knowledge for incorporating spectral domain OCT (SD-OCT) into clinical practice. Attendees will be given an overview of scanning protocols on various SD-OCT systems on the market today. Lecturers will present an organized method for analysis of images and identification of pathology in the anterior segment, optic nerve, vitreous, macula, and choroid. The course will have a special focus on use of SD-OCT in patients with glaucoma and/or retinal disease. Objective: At the conclusion of this course, the attendee will be able to select appropriate SD-OCT scanning protocols and analyze pathology in SD-OCTs of the anterior segment, optic nerve, and posterior segment, especially to detect preparametric glaucoma, progression of glaucoma, and the most common retinal pathology. Senior Instructor(s): Purnima S Patel MD Instructor(s): Vikas Chopra MD*, Rajeev Kumar R Pappuru MBBS MD, Srinivas R Sadda MD*, Alexander C Walsh MD*
NEW SOE Scleral Buckling Surgery: A Forgotten Art! Course: 321 Room: S106a Education Level: ADV
Monday 9:00 - 10:00 AM Target Audience: COMPSUB
Synopsis: This course will provide a comprehensive, state-of-the-art approach to techniques of scleral buckling (SB) surgery. A practical and interactive way to achieve successful retinal detachment (RD) repair will be discussed with interesting videos. Specific topics will include principles of buckle placement, selection of elements, segmental vs. circumferential, drainage vs. nondrainage, indications for and techniques of drainage, and use of gases and other adjuvants. Advanced topics will include sutureless buckle, suprachoroidal buckling, macular buckling, management of complications and the ‘goal’ of SB surgery in the 21st century. Audience participation will be encouraged, and a detailed handout will be provided. Objective: Upon completion of the course, the attendee will have gained a greater insight into applying safe, efficient, and minimalist ways of performing SB surgery. The course will provide beginners with a foundation for learning a “forgotten art” and for understanding how to manage complications. Senior Instructor(s): Malhar Soni MD MS DNB FRCS Instructor(s): Ron Afshari Adelman MD MPH, Manish Nagpal MD*, Stanislao Rizzo MD, Carlos Mateo MD*
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Course: 335 Room: S106a Education Level: INT
Monday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will discuss the current state of retinal and choroidal manifestations of selected systemic diseases, including AIDS, gastrointestinal diseases, systemic syndromes with Coats disease, lupus, diffuse unilateral subacute neuroretinitis, lymphoma, metastasis, tuberculosis, and retinal-choroidal toxicity of systemic drugs. Experts from the United States, Asia, and South America will discuss the impact that systemic diseases of the posterior pole of the eye have had worldwide. Topics are rotated every year to cover a wide variety of diseases. Objective: At the conclusion of this course, participants will understand the variety of retinal and choroidal manifestations of selected systemic diseases both inside and outside the United States. Senior Instructor(s): J Fernando Arevalo MD FACS* Instructor(s): Rubens Belfort Jr MD PhD*, Carol L Shields MD, Jerry A Shields MD, William F Mieler MD*, Careen Yen Lowder MD PhD, Lihteh Wu MD*, Francisco J Rodriguez MD*, Alay S Banker MD
NEW YO Vitreoretinal Tips for the Comprehensive Ophthalmologist: When to Watch, Treat, or Refer Course: 338 Room: N427a Education Level: BAS
Monday 10:15 - 11:15 AM Target Audience: COMP
Synopsis: To aid the comprehensive ophthalmologist, ophthalmologist in training, and other ophthalmologists without retina subspecialty training in planning a coherent strategy for managing or coordinating care with vitreoretinal specialists for those patients with posterior segment disorders. The emphasis will be on clinical slides, videos, and discussion between panel members and audience members, with an extensive handout for later reference. Objective: This course will cover the relative indications for when to watch, treat, or refer patients who have vitreoretinal disease and are followed in a comprehensive practice. At the conclusion of the course, the attendees will be able to formulate an effective treatment strategy based on their individual ophthalmological skills and the resources available to them. Senior Instructor(s): Richard M Feist MD Instructor(s): Bradley T Smith MD, Thomas A Oetting MD, John O Mason MD, Martin Lee Thomley MD, Michael A Albert MD
H Simplifying Treatment of Diabetic Retinopathy for the Comprehensive Ophthalmologist: What You Really Need to Know in 2014 Course: 347 Room: S102abc Education Level: INT
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will provide a review of recent publications and clinical trials involving diabetic retinopathy (DR), including the Diabetes Control and Complications Trial, Early Treatment Diabetic Retinopathy Study, Diabetic Retinopathy Study, etc. Indications / techniques of laser, control of systemic disease, anti-VEGF intravitreal injections, and steroid treatment in the management of DR will be discussed. Actual patient cases and management with panel discussion / audience participation will include every DR scenario seen in clinical practice. Objective: To present management and treatment approaches for DR, enabling participants to understand (1) focal and panretinal photocoagulation, (2) anti-VEGF intravitreal injections, and (3) other pharmacotherapy. At the conclusion of this course, attendees will be confident about when and how to use laser based on current 2014 DR literature (DRCRnet articles on laser, ranibizumab, and steroids) and proficient in
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses determining when and how often to implement intravitreal injections as an adjunct to laser. Senior Instructor(s): John O Mason MD Instructor(s): Richard M Feist MD, Michael A Albert MD, Thomas A Finley MD, Jacob Yunker MD**
Advanced Evidence-Based Management of Diabetic Retinopathy
H YO Retinal OCT Interpretation 101
Synopsis: This course assumes knowledge by the attendees of the Diabetic Retinopathy Study, Diabetic Retinopathy Vitrectomy Study, Early Treatment Diabetic Retinopathy Study, Diabetes Control and Complications Trial, and the U.K. Prospective Diabetes Study. From this base, a series of cases encountered by ophthalmologists managing diabetic retinopathy will be presented, discussed by a course instructor with extensive references to the pertinent literature, and then opened for a dialogue with the ophthalmologists enrolled in the course. Therapies covered will include systemic and metabolic interventions, focal / grid and panretinal laser photocoagulation, intravitreal pharmacology, and vitreoretinal surgery. Issues of timing, sequencing, combination therapies, and modifying factors in choice of interventions will be covered. Objective: At the conclusion of this course, the attendee will be able to successfully integrate clinical presentations with evidence-based options for physician intervention, and will recognize the areas of controversy in management. Senior Instructor(s): David J Browning MD PhD* Instructor(s): Keye L Wong MD*, Scott E Pautler MD, Michael W Stewart MD*, David G Telander MD*
Course: 348 Room: E451b Education Level: BAS
Monday 11:30 AM - 12:30 PM Target Audience: COMP
NEW Genetics of AMD: Concepts and Controversy Course: 356 Room: N427a Education Level: BAS
Monday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: In this course a summary of AMD genetics, commercially available genetic AMD tests, and the current state of knowledge regarding the pharmacogenetics of AMD will be reviewed. Objective: At the conclusion of this course, the attendee will be able to appreciate the relevant genetic polymorphisms that play a role in determining AMD risk, be familiar with the currently available genetic AMD tests and the American Academy of Ophthalmology guidelines on AMD genetic testing, and understand the potential relationship of genetic AMD risk factors and response to vitamin supplementation and antivascular endothelial growth factor therapy. Senior Instructor(s): Jaclyn L Kovach MD Instructor(s): Stephen G Schwartz MD MBA*, Milam A Brantley Jr MD
Principles of Pediatric Retinal Surgery in Pediatric Retinal Diseases Other Than ROP Course: 371 Room: N139 Education Level: ADV
Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will present the management of pediatric retinal diseases other than retinopathy of prematurity, which are seen frequently in practices that are focused on pediatric vitreoretinal surgery. Objective: This course will deal with the surgical management of pediatric vitreous hemorrhage, Coats disease, familial exudative vitreoretinopathy, persistent fetal vasculature syndrome, Norrie disease, and congenital retinoschisis. The material will include timing of intervention as well as surgical intervention, utilization of genetic testing, and analysis of angiographic data to aid in the management and prevention of retinal detachment. Also covered will be the management of retinal detachment in these diseases that are often accompanied by an exudative response. The use of pharmacologic therapy as well as surgical techniques will be discussed. In addition, instrumentation and timing of intervention will be emphasized. Senior Instructor(s): Michael T Trese MD* Instructor(s): Philip J Ferrone MD*, Antonio Capone Jr MD*, Kimberly A Drenser MD PhD*
Monday 2:00 - 4:15 PM Target Audience: COMP
H Visual Electrophysiology Testing: Principles and Clinical Applications Course: 376 Room: N138 Education Level: INT
Monday 2:00 - 3:00 PM Target Audience: COMPSUB
Synopsis: Visual electrophysiologic tests are diagnostic tools that are helpful or essential in a variety of retinal and visual disorders. This course, approved by the International Society for Clinical Electrophysiology of Vision (ISCEV), provides a comprehensive overview of clinical electrophysiologic tests with a focus on basic principles (including ISCEV standards) and clinical applications. A variety of clinical cases will be presented to illustrate the appropriateness and utility of visual electrophysiology testing. Objective: At the conclusion of this course, the attendee will understand the basic principles and clinical applications of full-field electroretinogram (ERG), multifocal ERG, electro-oculogram, and pattern visual evoked potential, enabling the attendee to incorporate these tests effectively in clinical practice. Senior Instructor(s): Byron L Lam MD* Instructor(s): Michael F Marmor MD*, Mitchell Brigell PhD*
The ABCs of AMD for Comprehensive Ophthalmologists Course: 384 Room: E451a Education Level: INT
Monday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will present a review of major clinical trials and recent publications involving AMD. The pathogenesis of AMD, the progression of dry AMD to wet AMD, and the indications and techniques of laser, pharmacologic, surgical, and radiologic treatments for AMD, as well as nutritional supplementation recommendations, will be reviewed thoroughly. A panel of experts will present actual patient cases and treatments for discussion. Objective: To present an overview of the risk factors, pathogenesis, and management and treatment approaches for AMD. The indications for various treatment options and the potential complications associated with treatments will be discussed. At the conclusion of this course, attendees will be familiar with the current and future treatment options for managing this disease. Senior Instructor(s): Michael A Albert MD Instructor(s): John O Mason MD, Richard M Feist MD, Martin Lee Thomley MD, Dustin Pomerleau MD
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
95
Instruction Courses
Synopsis: OCT is increasingly being used to diagnose and manage retinal diseases. This is an introductory, basic-level course for those who are not retina specialists and are interested in learning about OCT and interpretation of OCT images of retinal conditions. In this course, we will review the fundamentals of OCT, with emphasis on interpreting and recognizing OCT images obtained from various retinal conditions, through examples, to become more proficient at differentiating normal from pathologic findings. Objective: At the conclusion of this course, the participants will be able to (1) discuss how OCT works, (2) understand potential sources of artifacts, (3) recognize OCT images of normal retina and common retinal diseases, and (4) learn to incorporate OCT into a practice. Senior Instructor(s): Judy E Kim MD* Instructor(s): Jennifer Irene Lim MD*
Course: 374 Room: S105bc Education Level: INT
Instruction Courses H Mystery Retina 2014: Interactive Discussion of Challenging Cases Course: 405 Room: S406b Education Level: ADV
Monday 3:15 - 5:30 PM Target Audience: SUB
Instruction Courses
Synopsis: The instructors will present 20 to 25 diagnostically challenging “mystery retina” cases. The majority of the presentations will include interpretation of color photographs, fluorescein angiograms, and OCT imaging studies. When indicated, indocyanine green angiography, echography, autofluorescence, enhanced depth imaging, infrared images, electrophysiologic studies, microperimetry, CT, MRI, cytology, and/or histopathology will also be shown. The cases will be presented as unknowns, and audience participation will be encouraged. At the completion of the case presentations, the attendees will receive a handout summarizing the cases, complete with pertinent references and images. Objective: At the conclusion of this course, attendees will be better able to assess and evaluate a variety of diagnostically challenging “mystery retina” cases. They should also be able to establish a more complete differential diagnosis and know how to make the best use of ancillary diagnostic tests and formulate a definitive treatment plan. Senior Instructor(s): William F Mieler MD* Instructor(s): Lee M Jampol MD*, Jerry A Shields MD, Richard F Spaide MD*, Lawrence A Yannuzzi MD
NEW IOL Implantation and Repositioning Techniques for the Vitreoretinal Surgeon Course: 427 Room: N427a Education Level: INT
Monday 4:30 - 5:30 PM Target Audience: SUB
Synopsis: This interactive course will explore the latest IOL insertion and repositioning techniques for the vitreoretinal surgeon. Using cases and videos, a panel of anterior segment and retina specialists will discuss specific surgical techniques, instrumentation, choice of IOLs, and potential pitfalls. Objective: At the conclusion of this course, attendees will understand scleralfixated (sutureless and simplified sutured methods), iris-fixated, sulcus, and anterior chamber IOL insertion techniques. Senior Instructor(s): Jason Hsu MD* Instructor(s): Allen C Ho MD*, Omesh P Gupta MD, Sunir J Garg MD*, Brandon Ayres MD*
H Advanced Vitreoretinal Surgical Techniques Course: 512 Room: E451a Education Level: ADV
Tuesday 9:00 - 11:15 AM Target Audience: SUB
Synopsis: This interactive, case-based course will highlight the latest developments in vitreoretinal surgery. The panel will make extensive use of videos to discuss the most advanced approaches to vitreoretinal surgery. Objective: By the end of this course, attendees will be familiar with the latest advances in surgical techniques and instrumentation used to treatment macular diseases, retinal detachment, dislocated IOLs, retained lens material, and diabetic retinopathy. Senior Instructor(s): Sunir J Garg MD* Instructor(s): Julia A Haller MD*, Tarek S Hassan MD*, Allen C Ho MD*, Mark W Johnson MD*, George A Williams MD*, Jason Hsu MD*
NEW A Genetic Approach to Inherited Retinal Dystrophies: Clinical Classification of Common Retinal Dystrophies, Genotyping, and Gene Therapy Course: 516 Room: S105d Education Level: BAS
of international leaders in this field, several of whom are actively involved in gene therapy trials. A version of this course was presented by some of the faculty at the American Society of Retina Specialists meeting this past year in Toronto, and this was very well attended and received. Objective: To (1) provide an overview of common inherited retinal dystrophies, reviewing clinical appearance / prevalence / natural history of these disorders,(2) describe methodologies for characterizing these patients in the clinic (discuss imaging, including OCT and adaptive optics OCT, visual perimetry, electrophysiology), (3) explain the logistics of genotyping patients at Clinical Laboratory Improvement Amendments-certified genetic testing laboratories,4) provide an introduction to gene therapy, explain the use of viral vectors (with a focus on both adeno-associated virus and lentivirus), and (5) discuss previous and current clinical gene therapy trials. Senior Instructor(s): Christine Nichols Kay MD* Instructor(s): Jacque L Duncan MD, Elliott H Sohn MD, Isabelle Audo, Mark E Pennesi MD PhD*, Michel Michaelides MD**, Byron L Lam MD*, Sandeep Grover MD
Retinal Pharmacotherapy Course: 538 Room: N136 Education Level: INT
Tuesday 10:15 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: The management of retinal diseases has changed in recent years, as the focus has moved into pharmacologic treatments. Several currently existing and upcoming drugs are being used to treat various retinal diseases. This course will provide an in-depth knowledge of the drugs in retinal pharmacotherapy. Objective: This course will serve as an overview of how various drugs may work in the retina. The session will present cutting-edge results of clinical trials, such as the Comparison of AMD Treatment Trial (CATT), as well as an overview of the techniques and complications in retinal pharmacotherapy. The most important drugs available in clinical practice, ranibizumab (Lucentis), bevacizumab (Avastin), aflibercept (Eylea), and dexamethasone intravitreal implant (Ozurdex), will be presented in detail. At the conclusion, the attendee will be able to understand the indications, applications, and status of drugs available in retinal pharmacotherapy. Senior Instructor(s): Eduardo B Rodrigues MD* Instructor(s): Andrew P Schachat MD*, Michel Eid Farah MD, Quan Dong Nguyen MD*, Carsten H Meyer MD**, Philip J Rosenfeld MD PhD*, William F Mieler MD*, Fernando M Penha MD**
Vitreoretinal Surgical Rounds, Unleashed! Course: 559 Room: S104a Education Level: ADV
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Synopsis: This course will feature an interactive panel discussion, with debate about different surgical approaches to a wide spectrum of vitreoretinal pathology and management of complications during vitreoretinal surgery and in the postoperative period. Challenging cases will be presented, with drawings, intraoperative photos, and high-definition videos simulating the Saturday morning Duke vitreoretinal surgical rounds. Objective: At the conclusion of this course, the attendee will be able to (1) determine the differences between and proper selection of 20-, 23-, 25-, and 27-gauge vitrectomy instrumentation, (2) identify and manage complications associated with different surgical approaches, (3) differentiate between the available light options with a better selection of diffusion light pipes, lighted picks, and chandeliers, according to the selected approach, and (4) recognize the evolving value of intraoperative OCT in vitreoretinal surgical techniques. Senior Instructor(s): Tamer H Mahmoud MD* Instructor(s): Carl C Awh MD*, Dean Eliott MD*, Sharon Fekrat MD*, Paul Hahn MD PhD, Glenn J Jaffe MD*, Prithvi Mruthyunjaya MD*, Eric A Postel MD*, Cynthia A Toth MD*, Lejla Vajzovic MD, Francisco A Folgar MD, Sumit Sharma MD
Tuesday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: In this course, we will discuss inherited retinal dystrophies and updates in the field of gene therapy, providing both a lecture and Q&A session with a faculty 96
H Top 10% in subject area. NEW New Course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Instruction Courses NEW New Treatments for Retinal Vein Occlusion: Results from Phase 3 Clinical Trials
H How to Interpret Fundus Fluorescein Angiography and Autofluorescence
Course: 565 Room: N139 Education Level: BAS
Course: 595 Room: E451a Education Level: INT
Tuesday 11:30 AM - 12:30 PM Target Audience: COMPSUB
Diabetic Vitrectomy Course: 579 Room: S406b Education Level: ADV
Tuesday 12:45 - 1:45 PM Target Audience: SUB
Synopsis: This course will use video and panel discussions, along with limited didactic lecturing, to review the current indications, techniques, and results of vitrectomy for complications of proliferative diabetic retinopathy and diabetic macular edema. The merit of preoperative and postoperative adjunctive treatments (such as preoperative intravitreous bevacizumab or postoperative tamponade) will also be discussed. Emphasis will be placed on highlighting the advantages of each technique, particularly in situations shown on the video presentations. Objective: At the completion of the course, attendees will be familiar with several intraoperative techniques and maneuvers that can be employed to increase anatomic and visual success. Moreover, attendees will be able to judiciously employ preoperative, intraoperative, and postoperative adjunctive treatments that will benefit the patient. Senior Instructor(s): Petros Carvounis MD FRCSC Instructor(s): Andrew J Barkmeier MD, Jorge A Fortun MD**, Annal D Meleth MD
H Management of High-risk ROP in the 21st Century:
Thermal-Destructive vs. Pharmacologic Treatment Course: 589 Room: S106b Education Level: ADV
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will describe the identification of high-risk ROP eyes and will present the rationale for both thermal and pharmacologic treatment. Objective: By the conclusion of this course, attendees will be better able to (1) identify aggressive posterior ROP, (2) distinguish typical stage 3 ROP from flat stage 3 ROP, (3) understand the rationale for both thermal (laser) and pharmacologic (anti-VEGF) treatment, (4) be familiar with the technique of current thermal laser treatment for posterior retinal disease, specifically dealing with flat neovascularization, and (5) be familiar with the technique of off-label pharmacologic management using available FDA-approved anti-VEGF drugs. Senior Instructor(s): Michael T Trese MD* Instructor(s): Antonio Capone Jr MD*, Kimberly A Drenser MD PhD*, Lois E H Smith MD PhD*
Synopsis: This course will teach how to interpret fundus fluorescein angiography (FA) and fundus autofluorescence (FAF) images. A step-by-step guide will be used, supported by (1) targeted review of the retinochoroidal anatomy, (2) illustrations to acquire a “visual” understanding of fluorescence patterns, and (3) numerous FA and FAF images correlating these patterns with fundus findings. The majority of vascular, degenerative, inflammatory, hereditary, and tumoral chorioretinal pathologies will be reviewed, and the audience will be taught how to recognize these diseases based on the imagery. Objective: The attendee will be empowered with the know-how to recognize and interpret the angiographic and autofluorescent features of the majority of chorioretinal pathologies and to recognize these disease entities based on the angiographic and autofluorescence findings. Senior Instructor(s): Sawsan R Nowilaty MD Instructor(s): Emad Bishara Abboud MD, Hardeep S Dhindsa MD, Albert T Vitale MD
Vision Rehabilitation Low Vision Rehabilitation for Ophthalmologists Course: 508 Room: S101ab Education Level: INT
Tuesday 9:00 - 11:15 AM Target Audience: COMPSUB
Synopsis: Ophthalmologists already have the skills necessary to help low vision patients with vision rehabilitation. This course will offer basic, informative low vision testing tools that will help your low vision patients achieve their visual potential. Objective: After completion of this course, you will know how to use the necessary tools, whether as a resident, comprehensive ophthalmologist, or retinal specialist, to incorporate low vision rehabilitation into your practice. Senior Instructor(s): Robert M Christiansen MD FACS Instructor(s): Paul Homer MD, Gwen K Sterns MD
SO Should My Visually Impaired Patient Be Driving? Course: 600 Room: S104b Education Level: BAS
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Synopsis: This course will cover the current evidence-based information on visual risk factors for motor vehicle collision involvement and impaired driving performance, ethical / legal issues for managing visually impaired patients who want to drive, where ophthalmologists can refer patients for driving assessments, what these services are, case studies presented by specialists, and the increasingly common cases of older drivers who are likely to have medical comorbidities in addition to visual impairment. A nationally recognized expert panel will lead the course. Objective: At the conclusion of this course, participants will be familiar with visual characteristics that elevate crash risk, methods for managing and referring to driving assessment specialists those visually impaired patients who want to drive, the ophthalmologist’s important role in having a dialogue about vision and driving with visually impaired patients, and practical information from case studies that facilitate clinical practice. Senior Instructor(s): Cynthia Owsley MSPH PhD* Instructor(s): David B Carr MD*, Lylas G Mogk MD*, Jennifer Elgin
Electronic Health Records. GO Global Ophthalmology. P Eligible for Pain Management credit. SA Designated as self-assessment credit. SO Endorsed by Senior Ophthalmologist Committee. SOE Sponsored by SOE. YO Endorsed by Young Ophthalmologists committee. * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
EHR
97
Instruction Courses
Synopsis: This course will present results of relevant Phase 3 clinical trials for the treatment of macular edema (ME) due to retinal vein occlusions. Objective: At the conclusion of this course, the attendee will be able to describe the results of relevant Phase 3 clinical trials for the treatment of ME due to retinal vein occlusions. Specifically, the attendee will understand the results of the following Phase 3 trials: Branch Retinal Vein Occlusion Study — focal laser photocoagulation for ME due to branch retinal vein occlusion (BRVO); BRAVO — ranibizumab for ME due to BRVO; CRUISE — ranibizumab for ME due to central retinal vein occlusion (CRVO); COPERNICUS and GALILEO — aflibercept for ME due to CRVO; GENEVA — dexamethasone implant for ME due to BRVO and CRVO; SCORE Study — triamcinolone vs. standard of care for ME due to BRVO and CRVO. Senior Instructor(s): Scott M Friedman MD* Instructor(s): David Brown MD FACS*, Michael A Singer MD*
Tuesday 2:00 - 4:15 PM Target Audience: COMPSUB
Notes
98
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
Notes
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
99
The
largest public service program in
American medicine
has helped more than
1.8 million people since 1985. Visit the Foundation desk at the Academy Resource Center (Booth 508) to: •
Pick up a special 30th anniversary volunteer gift and recognition certificate. •
Enroll as a volunteer! www.eyecareamerica.org
Give MGD a Second Glance normal meibomian gland structure
structural change (duct dilation, gland atrophy and drop out)
structural change (severe gland atrophy and drop out)
Meibomian Gland Dysfunction isn’t always visible. Identify, diagnose and treat MGD without all the dry eye complexity. Visit us at Booth 3153 to learn more about the TearScience® Solution for MGD, featuring LipiView® and LipiFlow®.
tearscience.com
919-459-4880
[email protected]
• O nline & mobile viewing from your iPad, iPhone and Android devices • More than 200 hours of synchronized presentation slides with audio
AAO Meetings on Demand includes: • More than 150 hours of content from AAO 2014 • A AO 2014 Subspecialty Day content presented in the following programs: Cornea 2014:
Restocking the Toolbox: Concepts and Techniques for the Toughest Jobs
Glaucoma 2014:
Integrating New Technologies and Approaches Into Your Daily Practice
Ocular Oncology and Pathology 2014: Saving Eyes and Saving Lives
Oculofacial Plastic Surgery 2014: A Global Summit
Pediatric Ophthalmology 2014: A Magnificent Mile of Innovations
Refractive Surgery 2014: Mission 20/20
Retina 2014:
Reaching New Heights
Uveitis 2014:
Extinguishing the Great Fire
Don’t miss out! Order onsite and save 10% Grand Concourse Lobby (Friday – Tuesday) credit card only Academy Resource Center Booth #508 (Saturday – Tuesday) After the meeting, order online: www.aao.org/ondemand Disclaimer: Some courses may not be available, or may be audio only, due to permissions not granted from the original presenter.
SKILLS TRANSFER PROGRAM Sunday – Tuesday, Oct. 19 - 21 NEW
New course
EQUIP
Participants are required to bring specific equipment to the course
W
Participants are required to sign an infectious disease transmission waiver/release form
YO
Endorsed by Young Ophthalmologist Committee
These hands-on courses offer intensive training in surgical and diagnostic techniques, with direct supervision and a low participant-toinstructor ratio. Attendance is limited to physicians only, except where noted in the course description. (The term physician refers to the definition in the Federal Register: “those individuals licensed to practice medicine and surgery or osteopathy.”) Registrants in Skills Transfer lab courses may be required to bring instruments and/or sign an infectious disease waiver form. Refer to individual course listings for specific requirements. Skills Transfer courses are intended to provide instruction leading to new knowledge and/or skills. The Academy does not certify competence upon completion of Academy courses. Academy courses are not intended to serve as a basis for requesting new or expanded privileges.
Tickets and The Academy Plus Course Pass Skills Transfer Labs are ticketed events - they are not included in the Academy Plus course pass and must be purchased separately. • New! Prerequisite lectures are recommended, NOT required. • Skills Transfer lectures are included in the Academy Plus course pass. • Due to Fire Marshal regulations, seating capacities in courses/lectures are limited. Seating is available on a first-come basis, so please plan accordingly. • Members in Training automatically receive a 50% discount on all Skills Transfer labs, except where noted. • Tickets are non-transferable.
Selection Committee The Skills Transfer Advisory Committee selected all Skills Transfer Courses and Labs.
Associate Secretary
Thomas W Samuelson MD
Advisory Committee Susan R Carter MD Jack A Cohen MD FACS William Barry Lee MD
Kevin M Miller MD Nathan M Radcliffe MD David D Verdier MD
P.O. Box 7424, San Francisco, CA 94120-7424 | Tel: 415-561-8500 Fax: 415-561-8533 © 2014 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology.
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
101
Skills Transfer Course Contributors The Academy gratefully acknowledges the following companies for their generous support of equipment and supplies used during the Skills Transfer Course Program:
Medical Optics
Skills Transfer Course Contributors
We would also like to thank the following companies for their contributions in the Cataract, Refractive Surgery/Cornea, Glaucoma, Retina, and Plastics Skills Transfer Labs:
Durable Equipment / Instruments: Abbott Medical Optics Accurate Surgical & Scientific Instruments Corporation Accutome, Inc. Alcon Laboratories, Inc. Anodyne Surgical Aurora Surgical Bausch + Lomb Black & Black Surgical Buffalo Filter Carl Zeiss Meditec
Crestpoint Management Dutch Ophthalmic, USA Ellman International Inc. Endo Optiks, Inc Epsilon Eye Care Heidelberg Engineering IOP Inc. IRIDEX JEDMED Instrument Company Lensar Inc. Lumenis, Inc.
Lutronic Mastel Inc. Microaire Surgical Instruments MST (MicroSurgical Technology) NeoMedix New World Medical, Inc. Rhein Medical Rumex International Co Sciton, Inc. Stryker Medical Surgistar
Disposables: Beaver-Visitec International, Inc. Ethicon, Inc. FCI Ophthalmics IOP, Inc. STAAR Surgical Company Tissue: Bio-Tissue, Inc. Vision Share Eyebank Network
102
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
Skills Transfer Programs-By-Day All rooms are in McCormick Place: North Building (N), South Building (S), Lakeside Center (E), unless otherwise indicated. The following schedule is organized by day and time. Courses designated with a plus (+) sign are part of the Academy Plus course pass. Labs designated with a dollar ($) sign are not included in the course pass and must be purchased separately. New! Prerequisite lectures are recommended, not required. Topic Key CAT - Cataract COM - Computers, Information Technology COR - Cornea, External Disease GLA - Glaucoma
NEURO - Neuro-Ophthalmology OPTIC - Optics, Refraction, Contact Lenses PEDS - Pediatric Ophthalmology, Strabismus PLAST - Orbit, Lacrimal, Plastic Surgery
REF - Refractive Surgery RET - Retina, Vitreous
Sunday, Oct. 19 (cont.) Time
No.
Topic
$
Room
Page
SKILLS
LAB100
Orbitofacial Fracture Repair: Plating Workshop
Title
PLAST
$
N226
114
9:00 - 10:00 AM
SKILLS
LEC106
PLAST
+
E352
114
COR
+
E351
110
CAT
$
N230
106
NEURO
$
N231
114
SKILLS
LEC107
Periocular Rejuvenation With Fillers and BOTOX With 2-D Videos and Video-Assisted Teaching Crosslinking
9:00 - 10:30 AM
SKILLS
LAB108
Cataract Femtosecond Laser Surgery
9:00 - 11:00 AM
SKILLS
LAB105
Neuroimaging in Ophthalmology
9:00 - 11:15 AM
SKILLS
LEC101
GLA
+
S105bc
111
SKILLS
LEC102
Computerized Scanning Imaging of the Optic Nerve and Retinal Nerve Fiber Layer Endothelial Keratoplasty Techniques
COR
+
S103bc
109
SKILLS
LEC103
Anterior Lamellar Keratoplasty: Principles and Practice
COR
+
N427a
110 106
SKILLS
LEC104
Management of the Vitreous for the Anterior Segment Surgeon
CAT
+
S102abc
10:00 AM - 12:00 PM
SKILLS
LAB109
The iPhone and iPad for Ophthalmologists (Basic)
COM
$
N227a
109
10:15 - 11:15 AM
SKILLS
LEC111
New Techniques for Strabismus Surgery
PEDS
+
S102d
118
10:15 AM - 12:30 PM
SKILLS
LEC110
CAT
+
E352
106
PLAST
+
S106a
115
CAT
+
N427bc
107
SKILLS
LEC112
Advanced Refractive Cataract Surgery and Anterior Segment Reconstruction Cosmetic Botulinum Toxin and Facial Fillers: An Introductory Course
SKILLS
LEC113
Phacoemulsification and Advanced Techniques: The Core Curriculum
SKILLS
LEC114
Macular OCT: Mastering the Basics
SKILLS
LEC115
RET
+
E351
120
PLAST
+
S106b
115
PLAST
$
N229
115
COR
$
N227b
110
CAT
$
N230
106
10:30 AM - 12:30 PM
SKILLS
11:00 AM - 12:00 PM
SKILLS
Introduction to Aesthetic Facial Surgery by Fractional Lasers, Intense Pulsed Light, Radiofrequency, and Ultrasound Devices LAB106A Periocular Rejuvenation With Fillers and BOTOX on Silicone Head Simulators LAB107A Crosslinking
11:00 AM - 12:30 PM
SKILLS
LAB116
11:30 AM - 1:00 PM
SKILLS
LAB104A Management of the Vitreous for the Anterior Segment Surgeon
CAT
$
N228
106
12:00 - 2:00 PM
SKILLS
GLA
$
N231
111
PLAST
$
N226
115
COR
$
N227b
110
Cataract Femtosecond Laser Surgery
12:00 - 2:30 PM
SKILLS
LAB101A Computerized Scanning Imaging of the Optic Nerve and Retinal Nerve Fiber Layer LAB117 Surgical Anatomy of the Eyelids: Cadaver Demonstration
12:30 - 2:30 PM
SKILLS
LAB103A Anterior Lamellar Keratoplasty: Principles and Practice
1:00 - 3:00 PM
SKILLS
LAB111A New Techniques for Strabismus Surgery
PEDS
$
N230
118
1:30 - 3:00 PM
SKILLS
LAB112A Cosmetic Botulinum Toxin and Facial Fillers: An Introductory Course
PLAST
$
N229
115
SKILLS
LAB113A Phacoemulsification and Advanced Techniques
CAT
$
N228
107
2:00 - 4:15 PM
SKILLS
LEC118
Ab-Interno Approach to Schlemm’s Canal
2:30 - 5:00 PM
SKILLS
LAB119
Soft Contact Lens Fitting for the Practicing Ophthalmologist
3:00 - 5:00 PM
SKILLS
LAB114A Macular OCT: Small Group Instruction
GLA
+
S103d
111
OPTIC
$
N227a
114
RET
$
N231
120
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Skills Transfer Programs-By-Day
Type
8:00 - 11:00 AM
103
Skills Transfer Programs-By-Day Sunday, Oct. 19 (cont.) Time
3:15 - 5:30 PM
3:30 - 5:30 PM
Type
No.
SKILLS
LEC120
SKILLS
LEC121
SKILLS
Topic
$
Implantation of Glaucoma Drainage Devices
GLA
Diabetes 2014: Course on Diabetic Retinopathy
RET
LEC122
Microsurgical Suturing Techniques
SKILLS
LEC123
Endoscopic Forehead and Eyebrow Elevation
SKILLS
LEC124
SKILLS
LEC125
Endothelial Keratoplasty Surgery: Comprehensive Overview and Surgical Pearls Phakic IOLs
Room
Page
+
S101ab
112
+
S102abc
120
CAT
+
S103bc
107
PLAST
+
N427a
115
COR
+
S104b
110
REF
+
N427d
119
SKILLS
LAB102A Endothelial Keratoplasty Techniques
COR
$
N227b
109
SKILLS
CAT
$
N228
106
PLAST
$
N230
115
SKILLS
LAB110A Advanced Refractive Cataract Surgery and Anterior Segment Reconstruction LAB115A Introduction to Aesthetic Facial Surgery by Fractional Lasers, Intense Pulsed Light, Radiofrequency, and Ultrasound Devices LAB126 Workshop in Flap Techniques in Oculoplastic Surgery
PLAST
$
N226
116
4:00 - 5:30 PM
SKILLS
LAB127
Workshop in Techniques of Lacrimal Intubation
PLAST
$
N229
116
4:30 - 5:30 PM
SKILLS
LEC128
Endoscopic Transnasal Lacrimal Surgery: Principles and Practice
PLAST
+
N427bc
116
SKILLS
Skills Transfer Programs-By-Day
Title
Monday, Oct. 20 (cont.) Time
Type
No.
Title
Topic
$
Room
Page
8:00 - 10:00 AM
SKILLS SKILLS SKILLS SKILLS SKILLS
LAB122A LAB123A LAB113B LAB118A LAB129
CAT PLAST CAT GLA PLAST
$ $ $ $ $
N227b N229 N228 N230 N226
107 116 107 112 116
8:00 - 10:30 AM 8:30 - 10:30 AM 9:00 - 11:15 AM
SKILLS SKILLS SKILLS
LAB121A LAB130 LEC131
RET COM REF
$ $ +
N231 N227a N138
120 109 119
SKILLS
LEC132
CAT
+
S102d
108
10:00 - 11:30 AM 10:15 - 11:15 AM 10:15 AM - 12:30 PM
SKILLS SKILLS SKILLS SKILLS
LEC133 LAB118B LEC136 LEC134
REF GLA PLAST GLA
+ $ + +
N427bc N230 S103a S105bc
119 112 117 112
10:30 AM - 12:00 PM 10:30 AM - 12:30 PM
SKILLS SKILLS SKILLS
LEC135 LAB125A LAB124A
GLA REF COR
+ $ $
N427d N228 N227b
113 119 111
11:30 AM - 12:30 PM
SKILLS SKILLS SKILLS
LAB128A LAB137 LAB138
PLAST PLAST MEDED
$ $ $
N229 N226 N227a
116 117 109
11:30 AM - 1:30 PM
SKILLS SKILLS
LEC139 LAB140
PLAST GLA
+ $
N138 N231
117 113
12:30 - 2:30 PM 1:00 - 2:30 PM
SKILLS SKILLS
LAB120A LAB132A
GLA CAT
$ $
N230 N228
112 108
1:30 - 2:30 PM
SKILLS
LAB141
Microsurgical Suturing Techniques Endoscopic Forehead and Eyebrow Elevation Phacoemulsification and Advanced Techniques Ab Interno Approach to Schlemm’s Canal Oculoplastic Surgery: Anatomic Foundations, Surgical Techniques, and Enhanced Results Diabetes 2014: Workshop on Diabetic Retinopathy The iPhone and iPad for Ophthalmologists (Advanced) International Society of Refractive Surgery Laser Refractive Surgery Course Manual Extracapsular Cataract Extraction Surgery: Indications and Techniques The Surgical Correction of Astigmatism Ab Interno Approach to the Schlemm Canal Fat Grafting and Volume Restoration Computerized Perimetry Lecture: Visual Field Testing and Interpretation, Emphasizing Glaucoma Schlemm Canal Surgery: From the Outside In Phakic IOLs Endothelial Keratoplasty Surgery: Comprehensive Overview and Surgical Pearls Endoscopic Transnasal Lacrimal Surgery: Principles and Practice Basic Oculoplastic Surgery How to Use Free Technology to Add Interactivity to Face-to-Face Lectures and Presentations Advanced Techniques in Orbital Decompression and Expansion Is It Time to Replace Gonioscopy by Anterior Segment Imaging in the Diagnosis and Management of Angle-Closure Glaucoma? Implantation of Glaucoma Drainage Devices Manual Extracapsular Cataract Extraction Surgery: Indications and Techniques An Innovative Approach to Iris Fixation of an IOL Without Capsular Support: Hands-on and Practical
CAT
$
N227a
108
7:30 - 9:30 AM 7:30 - 10:00 AM 8:00 - 9:30 AM
11:00 AM - 1:30 PM
104
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Skills Transfer Programs-By-Day Monday, Oct. 20 (cont.) Time
Type
1:30 - 3:00 PM 2:30 - 4:30 PM
SKILLS SKILLS
2:30 - 5:00 PM
3:30 - 4:30 PM
SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS
3:30 - 5:30 PM
SKILLS
3:00 - 5:00 PM 3:15 - 5:30 PM
SKILLS
No.
Title
LAB133A The Surgical Correction of Astigmatism LAB134A Computerized Perimetry Lab: Visual Field Interpretation, Emphasizing Glaucoma LAB139A Advanced Techniques in Orbital Decompression and Expansion LAB142 Enucleation and Evisceration: Hands-On Practical Pearls LAB135A Schlemm Canal Surgery: From the Outside In LEC143 Toric Alignment Imaging and Astigmatism Surgery LEC144 Glaucoma Laser Therapy: Innovations and Advice From the Experts LEC145 Glaucoma Filtration Surgery LEC146 Fundamental Facelifting Techniques LAB147 An Innovative Approach to Iris Fixation of an IOL Without Capsular Tension Support LAB110B Advanced Refractive Cataract Surgery and Anterior Segment Reconstruction LAB131A Laser Refractive Surgery
Topic
$
Room
Page
REF GLA
$ $
N227b N231
120 112
PLAST PLAST GLA CAT GLA GLA PLAST CAT
$ $ $ + + + + $
N229 N226 N230 N427bc S106a S104b N427d N227a
117 117 113 108 113 113 118 108
CAT
$
N228
107
REF
$
N227b
119
Topic
$
Room
Page
CAT
$
N228
108
PLAST REF GLA PLAST COR CAT CAT GLA PLAST CAT COR PLAST
$ $ $ + + $ $ $ $ $ $ $
N229 N227b N230 N140 N427a N228 N227b N230 N229 N228 N227b N229
117 119 113 118 111 107 108 114 118 106 111 118
Tuesday, Oct. 21 8:00 - 9:30 AM
8:00 - 10:00 AM 10:15 AM - 12:30 PM 10:30 AM - 12:00 PM 10:30 AM - 12:30 PM 11:00 AM - 12:30 PM 11:00 AM - 1:00 PM 1:00 - 2:30 PM 1:30 - 3:30 PM 2:00 - 4:00 PM
Type
SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS SKILLS
No.
Title
LAB132B Manual Extracapsular Cataract Extraction Surgery: Indications and Techniques LAB136A Fat Grafting and Volume Restoration LAB131B Laser Refractive Surgery LAB144A Glaucoma Laser Therapy: Innovations and Advice From the Experts LEC149 Blepharoplasty LEC150 Surgery for Severe Corneal and Ocular Surface Disease LAB113C Phacoemulsification and Advanced Techniques Lab LAB143A Toric Alignment Imaging and Astigmatism Surgery LAB145A Glaucoma Filtration Surgery Lab LAB146A Fundamental Facelifting Techniques LAB104B Management of the Vitreous for the Anterior Segment Surgeon LAB150A Surgery for Severe Corneal Ocular Surface Disease LAB149A Blepharoplasty
During AAO 2014 visit www.aao.org/mobile to access course handouts and evaluations. After the meeting visit www.aao.org/aao-archives.
Skills Transfer Programs-By-Day
Time
105
Skills Transfer Program Cataract
Management of the Vitreous for the Anterior Segment Surgeon Course Director(s): Natalie A Afshari MD*
Recommended Didactic Sunday, 9:00 - 11:15 AM Target Audience: COMPSUB EduLevel: INT Synopsis: This course will review the anatomy, physiology, and pathophysiology of the vitreous and will present vitrectomy techniques for challenging anterior segment surgery scenarios. Topics will include management of vitreous loss from the anterior and posterior approach, utilizing the vitrector for decompression in challenging cataract cases, and visualizing the vitreous with triamcinolone acetonide (Kenalog). Objective: This course is designed to enhance the anterior segment surgeon’s familiarity with anterior and posterior vitrectomy techniques for challenging anterior segment cases.
Skills Transfer Program
Course: LEC104 Room: S102abc
Instructor(s): Iqbal K Ahmed MD*, Rosa Braga-Mele MD*, Ron Afshari Adelman MD MPH, Keith A Warren MD*, Baseer U Khan MD*, Thomas A Oetting MD
Labs Synopsis: This Skills Transfer course will present management of the vitreous during complicated anterior segment surgery. A variety of vitrectomy techniques will be discussed. Topics will include anterior vitrectomy, pars plana access to the anterior vitreous, and effective use of small-gauge instrumentation. Objective: This course is designed to enhance participants’ technical skills in handling vitreous during complicated anterior segment surgery. Select one of the following Course: LAB104A Sunday, 11:30 AM - 1:00 PM Room: N228 Target Audience: COMPSUB Fee: $255 EduLevel: INT Instructor(s): Ron Afshari Adelman MD MPH, Sherleen Huang Chen MD, Baseer U Khan MD*, Roberto Pineda II MD*, Jack A Cohen MD FACS, Ali R Djalilian MD, Aryan Shayegani MD, Jerzy Nawrocki MD PhD, Francesco Boscia MD*, Shameema Sikder MD*, Robert B Bhisitkul MD*, Thomas A Oetting MD, Shahzad I Mian MD*, Joung Y Kim MD, William Barry Lee MD*
Course: LAB104B Room: N228 Fee: $255
Tuesday, 1:00 - 2:30 PM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Ron Afshari Adelman MD MPH, Bonnie A Henderson MD*, Maria Mendicino Aaron MD, Sherleen Huang Chen MD, Baseer U Khan MD*, Gary S Schwartz MD, Ivan J Suner MD*, Roberto Pineda II MD*, Jack A Cohen MD FACS, Neda Shamie MD*, Ali R Djalilian MD, Aryan Shayegani MD, Jerzy Nawrocki MD PhD, Francesco Boscia MD*, Brad H Feldman MD, Shameema Sikder MD*, Robert B Bhisitkul MD*, Kenneth M Goins MD**, Thomas A Oetting MD NEW
Cataract Femtosecond Laser Surgery
Course Director(s): Robert P Rivera MD*
Synopsis: Femtosecond laser-assisted cataract surgery is performed in the United States with 4 currently approved laser platforms. In this course each platform will be described in detail and demonstrated in a wet lab format. Objective: At the conclusion of this course, the attendee will understand the manner in which modern anterior segment imaging techniques are combined with femtosecond laser applications to successfully perform femtosecond laser-assisted cataract surgery. The 4 major femtosecond lasers utilized for cataract surgical procedures in the United States will be demonstrated, and each attendee will be given direct, hands-on exposure to these via a wet lab with each of the laser platforms. Faculty will consist of surgeons widely experienced in the utilization of each of 106
the femtosecond cataract lasers, and will address the manner in which the lasers perform advanced treatment of corneal astigmatism, the anterior capsulotomy, and nuclear softening and fragmentation. Note: Participants will be sharing equipment.
Course: LAB108 Room: N230 Fee: $255 Course: Course: LAB116 Room: Room: N230 Fee: $255
Select one of the following Sunday, 9:00 - 10:30 AM Target Audience: COMPSUB EduLevel: ADV Sunday, 11:00 AM - 12:30 PM Target Audience: COMPSUB EduLevel: ADV
Instructor(s): Kevin M Miller MD*, Robert J Weinstock MD*, Carlos Buznego MD*
Advanced Refractive Cataract Surgery and Anterior Segment Reconstruction Course Director(s): Brock K Bakewell MD*
Recommended Didactic Sunday, 10:15 AM - 12:30 PM Target Audience: COMP EduLevel: INT Synopsis: This course is designed for surgeons who (1) want to achieve a higher level of emmetropic results by addressing toricity through the use of limbal relaxing incisions, toric IOLs, and bioptics, and (2) want to expand their armamentarium for dealing with difficult cataract cases, dislocated IOLs, and traumatized eyes. Objective: This course will cover iris and scleral suture fixation techniques for IOLs, chopping techniques, capsular tension rings, artificial iris vs. primary closure for iris defects, pars plana vitrectomy, femtosecond cataract surgery on various platforms, and strategies for dealing with challenging cases. These techniques will be presented in the didactic course and many will be practiced in the Skills Transfer lab. Course: LEC110 Room: E352
Instructor(s): William J Fishkind MD FACS*, Samuel Masket MD*, Warren E Hill MD*, Alan S Crandall MD*, Lisa B Arbisser MD*, Garry P Condon MD*, Richard S Hoffman MD*, Louis D “Skip” Nichamin MD*, Mark K Walsh MD, Roger C Furlong MD
Labs Synopsis: This course is designed for surgeons who (1) want to achieve a higher level of emmetropic results, and spectacle independence through the use of bioptics, limbal relaxing incisions, toric, multifocal, and accommodative IOLs and who (2) want to expand their armamentarium for dealing with difficult cataract cases, dislocated IOLs, and traumatized eyes. Objective: This course will cover iris and scleral suture and sutureless fixation techniques for IOLs, chopping techniques, capsular tension rings and stabilization devices, pupil expanders, pupilloplasty and primary closure for iris defects, pars plana vitrectomy, and strategies for dealing with challenging cases. Select one of the following Course: LAB110A Sunday, 3:30 - 5:30 PM Room: N228 Target Audience: COMPSUB Fee: $290 EduLevel: INT Senior Instructor(s): Robert P Liss MD Instructor(s): Brock K Bakewell MD*, Louis D “Skip” Nichamin MD*, Warren E Hill MD*, Bonnie A Henderson MD*, Ayman Naseri MD**, Garry P Condon MD*, James A Bryan III MD, Michael G Orr MD, Richard S Hoffman MD*, Roger C Furlong MD, Michele M Bloomer MD, Steven H Dewey MD*, Jeff S Maltzman MD, Corey A Miller MD, Bruce David Nichols MD, Lynn Polonski MD, Kevin Lee Waltz MD*, Christine S Ament MD, Cynthia S Chiu MD, Sumit Garg MD*, Mark Alan DiPillo MD**, John J DeStafeno MD*
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Skills Transfer Program Course: LAB110B Room: N228 Fee: $290
Monday, 3:30 - 5:30 PM Target Audience: COMPSUB EduLevel: INT
Course: LAB113B Room: N228 Fee: $255
Monday, 8:00 - 9:30 AM Target Audience: COMPSUB EduLevel: INT
Senior Instructor(s): Roger C Furlong MD
Senior Instructor(s): Gerald Roper MD, Anita Nevyas-Wallace MD
Instructor(s): George Beiko MD*, Steven H Dewey MD*, William S Clifford MD*, Kenneth J Rosenthal MD FACS**, Douglas Katsev MD*, Robert A Kaufer MD, Jeff H Pettey MD, Richard S Davidson MD*, James T Banta MD, Brock K Bakewell MD*, Pablo Miguel Arregui MD*, Charles S Ahn MD, Donald Stone MD*, Robert J Weinstock MD*, Susan M MacDonald MD*, Sumit Garg MD*, Robert P Liss MD, Daniel H Chang MD*, Jason J Jones MD*, Tal Raviv MD*, Anthony J Aldave MD*, Jake P Bostrom MD, Balamurali K Ambati MD*, Lindsay Ong-Tone MD*
Instructor(s): David R Hardten MD*, Warren E Hill MD*, Alan N Carlson MD*, Jeffrey Whitman MD OCS*, Bennett Chotiner MD*, Erik A Chotiner MD, Ricardo G Glikin MD, Michael Hater MD, Herbert J Nevyas MD**, Florentino E Palmon MD, Clark L Springs MD**, P Dee G Stephenson MD FACS*, Linda M Tsai MD, James F Freeman MD, Kevin M Miller MD*, Asim R Piracha MD*, Maria Cirone Scott MD*, Cathleen McCabe MD*, Tom Coffman MD**, James A Katz MD*, Dan B Tran MD** Senior Instructor(s): Maria Mendicino Aaron MD
Phacoemulsification and Advanced Techniques: The Core Curriculum Course Director(s): Steven H Dewey MD*
Instructor(s): Anita Nevyas-Wallace MD*, Ricardo G Glikin MD, Nick Mamalis MD*, Helen K Wu MD*, Mark H Blecher MD*, Thomas A Oetting MD
Labs Synopsis: In the past few years, noteworthy new phaco technologies have altered the way surgeons execute and analyze this procedure. In this course, the latest phaco techniques and technologies will be presented. The most topical techniques will be taught, including wound construction, capsulorrhexis, capsular staining, phaco chop techniques, techniques for operating the mature cataract, astigmatism management, capsular tension rings, and pupil expanders and hooks. New machine principles, including micropulse phaco and torsional phaco, will be assessed. Training will be one on one, allowing for customization of the techniques emphasized for each surgeon attendee. Objective: By the conclusion of this course, the surgeon attendee should understand the concepts influencing the latest phaco machine technologies and phaco techniques and attain the skills necessary for undertaking them. Select one of the following Course: LAB113A Sunday, 1:30 - 3:00 PM Room: N228 Target Audience: COMPSUB Fee: $255 EduLevel: INT Senior Instructor(s): Gerald Roper MD, Anita Nevyas-Wallace MD Instructor(s): Boris Malyugin MD PhD*, Randall J Olson MD, Chi-Wah (Rudy) Yung MD, Donald J Doughman MD, Linda M Tsai MD, Steven R Sarkisian MD*, Marc A Michelson MD**, Audrey R Talley-Rostov MD*, Herbert J Ingraham MD, Nan Wang MD PhD, Surendra Basti MBBS*, Frank W Bowden III MD FACS*, Stephen E Orlin MD, Michael Sulewski MD, William Wiley MD*, Robert W Weisenthal MD, Steven D Vold MD*, R Bruce Wallace MD**, Stephen V Scoper MD*, Deepinder K Dhaliwal MD*, Luther Fry MD FACS*, Kristiana D Neff MD*
Tuesday, 10:30 AM - 12:00 PM Target Audience: COMP EduLevel: BAS
Instructor(s): Natalie A Afshari MD*, Ron Afshari Adelman MD MPH, David B Krebs MD, Nina A Goyal MD, Raj K Goyal MD MPH*, Hilary A Beaver MD*, Robert S Bailey MD, Chi-Wah (Rudy) Yung MD, C Diane Song MD, Thomas A Oetting MD, Nan Wang MD PhD, Rahul T Pandit MD, Jill R Wells MD, Joung Y Kim MD, Amy Grossman Coburn MD, Paul B Pruett MD, Maria A Woodward MD*, Clark L Springs MD**, Preston H Blomquist MD, Daniel H Chang MD*, Purnima S Patel MD, Jeremy K Jones MD
Microsurgical Suturing Techniques Course Director(s): Marian Sue Macsai-Kaplan MD*
Recommended Didactic Course: LEC122 Room: S103bc
Sunday, 3:15 - 5:30 PM Target Audience: COMP EduLevel: BAS Synopsis: This course will cover basic microsurgical suturing techniques. In addition, principles, theories, and practical instruction in corneal-scleral laceration and corneal wound repair, management of cataract wound problems, including wound burns, and extension of clear corneal incisions will be offered. Objective: This course offers basic microsurgical suturing training that is applicable in the management of penetrating keratoplasty suturing, corneal lacerations, and cataract wound problems. Instructor(s): Woodford S Van Meter MD FACS
Lab Synopsis: This course will cover basic microsurgical suturing techniques. In addition, principles, theories, and practical instruction in corneal-scleral laceration and corneal wound repair, management of cataract wound problems, including wound burns, and extension of clear corneal incisions will be offered. Objective: This course will offer basic microsurgical suturing training that is applicable in the management of penetrating keratoplasty suturing, corneal lacerations, and cataract wound problems. Course: LAB122A Monday, 7:30 - 9:30 AM Room: N227b Target Audience: COMP Fee: $180 EduLevel: BAS Instructor(s): Marian Sue Macsai-Kaplan MD*, Woodford S Van Meter MD FACS, Andrew J W Huang MD MPH*, Carol L Karp MD, Anthony J Lubniewski MD*, Joel Sugar MD*, Andrea Kara-Jose MD, R Doyle Stulting MD PhD*, Anthony J Johnson MD**, William Barry Lee MD*, Charles S Bouchard MD, David B Glasser MD, Aaleya F Koreishi MD*, Ali R Djalilian MD, Anat Galor MD*, Michael Saidel MD*, Satya Reddy MD, Jennifer Y Li MD, Robert S Feder MD, Denise de Freitas MD, Wen-Hsiang Lee MD PhD*, Jeanine A Baqai MD**, Helen K Wu MD*, Julie H Tsai MD, Paras R Shah MD, Tony N Pira MD, Luciene Sousa MD*
NEW New Course. YO Endorsed by Young Ophthalmologists committee. W Participants are required to sign an infectious disease transmission waiver/release form. EQUIP Participants are required to bring specific equipment to the course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced
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Skills Transfer Program
Recommended Didactic Sunday, 10:15 AM - 12:30 PM Target Audience: COMPSUB EduLevel: INT Synopsis: In this course, a faculty of experienced surgeons will present the latest phaco techniques and technologies that are of interest to ophthalmologists at every level of experience. This comprehensive course will cover the steps of phacoemulsification, including incisions, capsulorrhexis, hydrodissection, and phaco techniques with an emphasis chop. Safe cortex removal and IOL implantation will be demonstrated. Capsular tension rings, pupil expanders, hooks, capsular staining, and related techniques will also be presented. This course will teach the most up-to-date phacoemulsification techniques both to individuals with little or no experience with the method and to those wishing to refine or update their technique or transitioning from other cataract surgery methods. Objective: This course is designed to teach participants the principles and skills necessary to understand and perform state-of-the-art phacoemulsification safely and efficiently. Course: LEC113 Room: N427bc
Course: LAB113C Room: N228 Fee: $255
Skills Transfer Program Manual Extracapsular Cataract Extraction Surgery: Indications and Techniques
An Innovative Approach to Iris Fixation of an IOL Without Capsular Support: Hands-on and Practical
Course Director(s): Jeff H Pettey MD
Course Director(s): Paul R Rosenberg MD FACS
Recommended Didactic Monday, 9:00 - 11:15 AM Target Audience: COMPSUB EduLevel: BAS Synopsis: Although extracapsular cataract extractions by large incision (ECCE) and small incision (SICS), also known as sutureless extracapsular cataract surgery (SECS), are still performed routinely throughout the world, phacoemulsification surgery has become the standard of care in many countries, and therefore ECCE / SICS is no longer being taught. However, understanding how to perform this surgery competently is still crucial when faced with complications during phacoemulsification surgery, or when a SECS approach may be a better choice for the patient. Objective: By the conclusion of this course, the attendee will (1) have learned and be able to practice primary ECCE and SECS surgery, (2) have learned and be able to practice how to convert from a clear corneal phacoemulsification to either a ECCE or a SECS approach, and (3) better understand how to deal with complications of all forms of extracapsular cataract surgery.
Synopsis: This course will present an innovative variation of a McCannel / Siepser small-incision retrievable suture technique for peripheral iris fixation in the absence of capsule support for secondary foldable IOLs and dislocated IOLs. This technique will be demonstrated with video, animation, and hands-on practice with a model. Objective: Surgeons will learn the rationale for iris fixation of a foldable implant and will add this technique to their arsenal of management options for IOL dislocation and aphakia. Their understanding of the practical method of suturing will be cemented by a hands-on approach. Course: LAB141 Monday, 1:30 - 2:30 PM Room: N227a Target Audience: COMP Fee: $60 EduLevel: INT
Instructor(s): Bonnie A Henderson MD*, Geoffrey C Tabin MD, Maria Mendicino Aaron MD
Instructor(s): Elana S Rosenberg MD**
Skills Transfer Program
Course: LEC132 Room: S102d
Labs Synopsis: Although extracapsular cataract extractions by large incision (ECCE) and small incision (SICS) are still performed routinely throughout the world, phacoemulsification surgery has become the standard of care in many countries, and therefore ECCE / SICS is no longer being taught. However, understanding how to perform this surgery competently is still crucial when faced with complications during phacoemulsification surgery or when an ECCE approach may be a better choice for the patient. Objective: By the conclusion of this course, the attendee will (1) have learned and be able to practice primary ECCE and SICS surgery, (2) have learned and be able to practice how to convert from a clear corneal phacoemulsification to either a ECCE or a SICS approach, and (3) better understand how to deal with complications of ECCE surgery. Select one of the following Course: LAB132A Monday, 1:00 - 2:30 PM Room: N228 Target Audience: COMPSUB Fee: $255 EduLevel: BAS Senior Instructor(s): Bonnie A Henderson MD* Instructor(s): Eduardo C Alfonso MD*, Maria Mendicino Aaron MD, Geoffrey C Tabin MD, Preston H Blomquist MD, Abhay Raghukant Vasavada MBBS FRCS*, Francisco J Gutierrez-Carmona MD PhD, Soosan Jacob FRCS, Amar Agarwal MD*, Dianna L Bordewick MD, Neera N Kanjani MBBS, Surendra Basti MBBS*, Samar K Basak MD DNB MBBS*, Arup Chakrabarti MBBS, Nilesh K Kanjani MBBS, Joung Y Kim MD, Zaiba Malik MD, Jaime Tejedor MD
Course: LAB132B Room: N228 Fee: $255
Tuesday, 8:00 - 9:30 AM Target Audience: COMPSUB EduLevel: BAS
Senior Instructor(s): Bonnie A Henderson MD*,
Instructor(s): Elana S Rosenberg MD**
Course: Course: LAB147 Room: Room: N227a Fee: $60
Monday, 3:30 - 4:30 PM Target Audience: COMP EduLevel: INT
Toric Alignment Imaging and Astigmatism Surgery Course Director(s): Louis D “Skip“ Nichamin MD*
Recommended Didactic Course: LEC143 Room: N427bc
Monday, 3:15 - 5:30 PM Target Audience: COMPSUB EduLevel: INT Synopsis: This course will cover management techniques for pre-existing astigmatism, specifically at the time of implant surgery, with focus upon intralimbal relaxing incisions, toric IOLs, and laser (femto / excimer) treatment modalities. Objective: At the conclusion of this course, participants will be able to plan and perform the techniques necessary to control postcataract astigmatism. Instructor(s): Jonathan B Rubenstein MD*
Lab Synopsis: This course will cover management techniques for pre-existing astigmatism, specifically at the time of implant surgery, with focus upon intralimbal relaxing incisions, toric IOLs, and laser (femto / excimer) treatment modalities. Objective: At the conclusion of this course, participants will be able to plan and perform the techniques necessary to control postcataract astigmatism. Course: LAB143A Tuesday, 10:30 AM - 12:30 PM Room: N227b Target Audience: COMPSUB Fee: $220 EduLevel: INT Instructor(s): Brock K Bakewell MD*, Y Ralph Chu MD*, Jonathan Davidorf MD, Steven J Dell MD**, Randy J Epstein MD*, Leslie Grosinger MD, James C Hays MD*, Warren E Hill MD*, Richard S Hoffman MD*, Terry Kim MD*, Nick Mamalis MD*, Kevin M Miller MD*, Parag D Parekh MD MPA**, Gerald Roper MD*, Kenneth J Rosenthal MD FACS**, Alan Victor Spigelman MD, David T Vroman MD*, R Bruce Wallace MD**, Bonnie A Henderson MD*
Instructor(s): Eduardo C Alfonso MD*, Maria Mendicino Aaron MD, Geoffrey C Tabin MD, Preston H Blomquist MD, Francisco J Gutierrez-Carmona MD PhD, Abhay Raghukant Vasavada MBBS FRCS*, Soosan Jacob FRCS, Amar Agarwal MD*, Dianna L Bordewick MD, Neera N Kanjani MBBS, Surendra Basti MBBS*, Samar K Basak MD DNB MBBS*, Nilesh K Kanjani MBBS, Arup Chakrabarti MBBS, Joung Y Kim MD, Zaiba Malik MD, Craig J Chaya MD*, Michael R Feilmeier MD
108
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Skills Transfer Program Computers, Information Technology Computer Courses are open to all registrants. EQUIP YO
(Basic)
The iPhone and iPad for Ophthalmologists
Course Director(s): Vinay A Shah MD*
Note: Each participant is required to bring their iPhone or iPad to the course.
Instructor(s): Ron K Lord MD*, Hemang K Pandya MD, Rohit Krishna MD*, Michael A Cassell MD**, Judith Lee** EQUIP The iPhone and iPad for Ophthalmologists (Advanced)
Course Director(s): Vinay A Shah MD*
Course: LAB130 Monday, 8:30 - 10:30 AM Room: N22a Target Audience: COMPSUB Fee: $80 EduLevel: INT Synopsis: Eighty percent of physicians use smartphones, and this number is expected to rise. The iPhone has covered about 50% of the smartphone market. This course will introduce the user to intermediate to advanced applications of the iPhone and iPad in following areas: (1) office management: calendar, ICD-9, schedules, (2) patient care tools: near vision card, Amsler grid, color plates, optokinetic nystagmus drum, pupil gauge, patient consents, and external, slitlamp, and fundus photos, (3) patient education material: diagrams / videos, (4) physician education / reference material: eye atlas, study guides, pharmacopoeia, and board review material, (5) practice marketing through social media and a Personalized Doctor app, and (6) use of the iPhone for personal use, from making a conference call to using various handy apps. Objective: After the course, attendees will have an advanced understanding of and be able to use the iPhone for patient care, as a reference guide, for their education, and to be more efficient. Note: Each participant is required to bring their iPhone or iPad to the course.
Instructor(s): Ron K Lord MD*, Hemang K Pandya MD, Rohit Krishna MD*, Michael A Cassell MD**, Judith Lee**
How to Use Free Technology to Add Interactivity to Face-to-Face Lectures and Presentations NEW EQUIP
Jointly Sponsored by the Academy’s Skills Transfer Advisory Committee and the nternational Council of Ophthalmology Course Director(s): Eduardo P Mayorga MD*
Note: Each participant is required to bring their smartphone, iPad or laptop to the course.
Instructor(s): Matthew D Gearinger MD, Ana Gabriela Palis MD
Cornea, External Disease
Endothelial Keratoplasty Techniques Course Director(s): Mark A Terry MD*
Recommended Didactic Course: LEC102 Room: S103bc
Sunday, 9:00 - 11:15 AM Target Audience: COMPSUB EduLevel: INT Synopsis: This course will explore the various surgical techniques used for endothelial keratoplasty (EK): Descemet-stripping EK, Descemet-stripping automated EK, and Descemet membrane EK. Emphasis will be placed on basic techniques that minimize complications and maximize donor endothelial survival. Methods of donor tissue preparation, insertion, unfolding, and positioning will be discussed. Benefits and problems with tissue injectors will be presented. Techniques to promote donor tissue adhesion and to avoid primary graft failure will be emphasized. Detailed videos and discussion of EK in complex and combined cases will be presented. Objective: At the conclusion of the course, participants will understand the safest methods of EK to avoid dislocation, primary graft failure, and pupillary block, and how to enhance faster visual rehabilitation. Instructor(s): Kenneth M Goins MD**, George O D Rosenwasser MD
Lab Synopsis: This laboratory course will use pig eyes to allow participants to become generally familiar with the instrumentation and surgical techniques involved with Descemet-stripping endothelial keratoplasty (DSEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK), but not Descemet membrane endothelial keratoplasty (DMEK). Safe methods of donor insertion, unfolding, and positioning will be stressed. Techniques of promoting donor adherence and avoiding primary graft failure will be practiced. Objective: At the conclusion of this course, the participants will understand the complexity and required instrumentation for the most common technique of endothelial keratoplasty. Techniques to avoid complications and preserve donor endothelial cells will be understood. Note: Participants will be sharing equipment.
Course: LAB102A Room: N227b Fee: $220
Sunday, 3:30 - 5:30 PM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Mark A Terry MD*, George O D Rosenwasser MD, Kenneth M Goins MD**, Neda Shamie MD*, Anand K Shah MD, Irving M Raber MD*, Paul M Phillips MD, David D Verdier MD, Mark S Gorovoy MD, Edwin S Chen MD, Thomas John MD**, Ann McColgin MD, Robert L Schultze MD*, Michael D Straiko MD*, Mark Greiner MD, Jeffrey M Goshe MD, Julia C Talajic MD**, Peter B Veldman
NEW New Course. YO Endorsed by Young Ophthalmologists committee. W Participants are required to sign an infectious disease transmission waiver/release form. EQUIP Participants are required to bring specific equipment to the course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced
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Skills Transfer Program
Course: LAB109 Sunday, 10:00 AM - 12:00 PM Room: N227a Target Audience: COMPSUB Fee: $80 EduLevel: BAS Synopsis: Eighty percent of physicians utilize smartphones, and this number is expected to rise. Recently, the iPhone has covered about 50% of the smartphone market. This course will introduce the user to more intermediate applications of the iPhone and iPad in the following areas: (1) office management: calendar, ICD-9, schedules, (2) patient care tools: near vision card, Amsler grid, color plates, optokinetic nystagmus drum, pupil gauge, patient consents, and external, slitlamp, and fundus photos, (3) patient education material: diagrams / videos, (4) physician education / reference material: eye atlas, study guides, pharmacopoeia, and board review material, (5) marketing of one’s practice through social media and a Personalized Doctor app, and (6) use of the iPhone for personal use, from making a conference call to using various handy apps. Objective: After the course, the attendees will understand and be able to use the iPhone for patient care, as a reference guide, for their own education, and to be more efficient.
Course: LAB138 Monday, 11:30 AM - 12:30 PM Room: N227a Target Audience: COMPSUB Fee: $45 EduLevel: BAS Synopsis: This course will cover the principles, strategies, and techniques of lecture interactivity. The audience will actively participate during the entire course using their smartphones, iPads, or laptops in the role of attendees. They will also learn, as presenters, to set up different software (“Socrative”, “Google Drive”) and use them effectively, working together with PowerPoint in the same presentation screen. Objective: At the end of the course, attendees will be able to apply different strategies of interaction, such as polling, multiple choice questions, hot spot questions, brainstorming, and multiple column pro and con discussions, using free audience interactive response software.
Skills Transfer Program MD, Colleen C Grace MD, Jennifer Y Li MD, Rajesh Fogla MD FRCS, Luciene Sousa MD*, Karen L Hoar MD**, Christopher S Sales MD
linking, and obtain hands-on experience with several UV light devices and corneal ring segments.
Anterior Lamellar Keratoplasty: Principles and Practice
Instructor(s): A John Kanellopoulos MD*, Theo Seiler MD PhD, Roy Scott Rubinfeld MD**, Peter S Hersh MD*, William B Trattler MD*, Yaron S Rabinowitz MD Course Director(s): Parag A Majmudar MD*
Course Director(s): Sheraz M Daya MD*, Sadeer B Hannush MD
Recommended Didactic Sunday, 9:00 - 11:15 AM Target Audience: SUB EduLevel: ADV Synopsis: This course will cover current and evolving practice in anterior lamellar keratoplasty. Topics include evolving lamellar techniques, including the “big bubble,” modified Melles, viscodissection, Ferrara, and automated and femtosecond lamellar techniques. A series of didactic lectures will be provided, with technique pearls (and complications), supported by video presentations and handouts. The lecture portion is a prerequisite for the wet lab, where candidates will be guided through many techniques. Objective: The participant should leave the course with an understanding of various options for performing anterior lamellar keratoplasty. The participant will have a thorough understanding of the indications, advantages, and disadvantages of each of these techniques. Additional hands-on training on the use of some of these procedures will be provided in the associated laboratory.
Skills Transfer Program
Course: LEC103 Room: N427a
Instructor(s): Luigi Fontana MD PhD, Shigeto Shimmura MD*, Donald Tan MD FRCS FRCOphth*, Woodford S Van Meter MD FACS
Lab Synopsis: This wet lab course will cover current and evolving practice in anterior lamellar keratoplasty. An international faculty will cover different lamellar dissection techniques, including “big bubble,” viscodissection, modified Melles, and automated and femtosecond lamellar deep anterior lamellar keratoplasty. Avoiding and managing complications will also be discussed. Candidates will be personally guided through these techniques by expert and experienced faculty, and there will be opportunity for in-depth discussion. Objective: At the end of the course, the attendee will have a good understanding of the indications for anterior lamellar keratoplasty, the techniques involved, and how to avoid and manage complications. Course: LAB103A Sunday, 12:30 - 2:30 PM Room: N227b Target Audience: SUB Fee: $220 EduLevel: ADV Instructor(s): Luigi Fontana MD PhD, Shigeto Shimmura MD*, Donald Tan MD FRCS FRCOphth*, Woodford S Van Meter MD FACS, Hamed Mofeez Anwar MD, Brandon Ayres MD*, Federico Badala MD**, Deepinder K Dhaliwal MD*, Dasa Gangadhar MD, Jose Gomes MD*, Samer Hamada MD, Alfonso Iovieno MD, Mayank A Nanavaty MD, Irving M Raber MD*, Konstantinos Samaras MD, Vincenzo Sarnicola MD, Elmer Tu MD NEW
Crosslinking
Course Director(s): Parag A Majmudar MD*
Recommended Didactic Course: LEC107 Room: E351
Sunday, 9:00 - 10:00 AM Target Audience: COMPSUB EduLevel: INT Synopsis: Collagen crosslinking has emerged in the last several years as a frontline therapy in keratoconus and post-LASIK ectasia. This course will explore the history and current uses of crosslinking, including epithelium-off and transepithelial crosslinking and concurrent crosslinking with corneal ring segments, as well as examining future applications, including combined crosslinking with topographyguided excimer laser ablation. Objective: At the conclusion of this course, participants will have a better understanding of patient selection criteria, be able to evaluate the merits of the various treatment strategies, develop a protocol for postoperative management of cross110
Lab Synopsis: Collagen crosslinking has emerged in the last several years as a frontline therapy in keratoconus and post-LASIK ectasia. This course will explore the history and current uses of crosslinking, including epithelium-off, and transepithelial crosslinking, and concurrent crosslinking with corneal ring segments, as well as examining future applications, including combined crosslinking with topographyguided excimer laser ablation. Objective: At the conclusion of this course, participants will have a better understanding of patient selection criteria, be able to evaluate the merits of the various treatment strategies, develop a protocol for postoperative management of crosslinking, and obtain hands-on experience with several UV light devices and corneal ring segments. Note: Participants will be sharing equipment.
Course: LAB107A Room: N227b Fee: $130
Sunday, 11:00 AM - 12:00 PM Target Audience: COMPSUB EduLevel: INT
Instructor(s): A John Kanellopoulos MD*, Theo Seiler MD PhD, Roy Scott Rubinfeld MD**, William B Trattler MD*, Peter S Hersh MD*, Yaron S Rabinowitz MD, Randy J Epstein MD*, Jodi Luchs MD*, Jonathan H Talamo MD*, Kathryn Masselam Hatch MD*, Sandy T Feldman MD**, Arthur B Cummings MD*, Michael Mrochen PhD*, Antonio Leccisotti MD**, Paolo Vinciguerra MD*, Aleksandar Stojanovic MD, R Doyle Stulting MD PhD*, Michael B Raizman MD*, Rajesh K Rajpal MD*, Simon P Holland MD*, Raymond Stein MD
Endothelial Keratoplasty Surgery: Comprehensive Overview and Surgical Pearls Course Director(s): Edward J Holland MD*
Recommended Didactic Course: LEC124 Room: S104b
Sunday, 3:15 - 5:30 PM Target Audience: COMPSUB EduLevel: INT Synopsis: Endothelial keratoplasty (EK) has become the standard of care for the surgical treatment of endothelial diseases of the cornea. This course will utilize international corneal experts to teach a comprehensive overview of a variety of surgical techniques for Descemet-stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK). Participants will learn about indications, surgical techniques, outcomes, and complications of both procedures with specific pearls to enhance success from the experienced EK faculty. Updates in donor tissue insertion for EK will be reviewed, including helpful tips for novice and experienced surgeons for the various steps of DSEK and DMEK techniques. Objective: At the conclusion of the course, the attendee will understand indications, surgical techniques, surgical pearls, and potential complications of DSEK and DMEK. Instructor(s): Francis W Price Jr MD*, Donald Tan MD FRCS FRCOphth*, Massimo Busin MD*, Mark J Mannis MD, David T Vroman MD*, William Barry Lee MD*, Keith A Walter MD*
Lab Synopsis: Endothelial keratoplasty (EK) has become the standard of care for the surgical treatment of endothelial diseases of the cornea. This course will utilize international corneal experts to teach the various steps of Descemet-stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK). Participants will perform various steps of the EK procedure, with individual stations to practice various tissue insertion techniques. Surgical videos of DSEK insertion techniques and surgical pearls will be reviewed during the course
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Skills Transfer Program to enhance performance of various steps. Attendees will receive hands-on experience with all steps of DSEK, including donor tissue preparation steps with DMEK. Objective: At the end of this course, participants will understand all steps of DSEK and have hands-on experience with donor tissue preparation and surgical steps of DSEK and DMEK. Course: LAB124A Monday, 10:30 AM - 12:30 PM Room: N227b Target Audience: COMPSUB Fee: $220 EduLevel: INT
Maria S Cortina MD, Andrea Y Ang MBBS**, Guillermo Amescua MD, Leela V Raju MD, Victor L Perez MD*, Joshua H Hou MD
Glaucoma
Computerized Scanning Imaging of the Optic Nerve and Retinal Nerve Fiber Layer Course Director(s): E Randy Craven MD*
Senior Instructor(s): Clara C Chan MD*, William Barry Lee MD* Instructor(s): Francis W Price Jr MD*, Friedrich E Kruse MD*, Donald Tan MD FRCS FRCOphth*, David B Glasser MD, Massimo Busin MD*, Mark J Mannis MD, David T Vroman MD*, Keith A Walter MD*, David D Verdier MD, Richard S Davidson MD*, Shahzad I Mian MD*, Andrea Y Ang MBBS**, Kristiana D Neff MD*, Heather M Skeens MD**, Mahshad Darvish-Zargar MD, Jennifer Y Li MD, Kenneth C Mathys MD**, Joseph S Tims MD, Florentino E Palmon MD, Michael J Taravella MD**, Vipul C Shah MD, Charles L Thompson MD** W
Surgery for Severe Corneal and Ocular Surface Disease
Course Director(s): Ali R Djalilian MD, Gunther Grabner MD*
Instructor(s): Edward J Holland MD*, Scheffer C G Tseng MD PhD*, James Chodosh MD MPH*, Ahmad Kheirkhah MD, Maria S Cortina MD, Victor L Perez MD*, Darren G Gregory MD
Lab Synopsis: This course is intended for ophthalmologists who plan to expand their surgical skills in the management of severe corneal and ocular surface disease. The topics will include amniotic membrane transplantation, limbal stem cell transplantations, and keratoprosthesis. Objective: At the conclusion of this wet lab course, the attendee will be able to (1) apply the surgical techniques for amniotic membrane transplantation using sutures and/or fibrin glue, (2) perform the various surgical techniques for limbal stem cell transplantation including conjunctival limbal autograft / allograft and keratolimbal allograft, and (3) assemble and surgically implant a Boston type I keratoprosthesis. Attendees with all levels of experience (including no experience) are encouraged to participate and take advantage of the opportunity to work one-on-one with faculty with extensive experience in all of these techniques. Note: Participants are required to sign an infectious disease transmission waiver / release form.
Course: LAB150A Room: N227b Fee: $220
Tuesday, 1:30 - 3:30 PM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Andrew J W Huang MD MPH*, Jose Gomes MD*, Jose J de la Cruz Napoli MD*, Joung Y Kim MD, David D Verdier MD, Daniel H Scorsetti MD, Julie H Tsai MD, Pedram Hamrah MD*, Vadrevu K Raju MD FRCS FACS, Anthony J Lubniewski MD*, Ahmad Kheirkhah MD, Kristiana D Neff MD*, Clara C Chan MD*,
Sunday, 9:00 - 11:15 AM Target Audience: COMPSUB EduLevel: BAS Synopsis: This lecture, required for the hands-on workshop, will deepen the participants’ understanding of OCT in glaucoma, with historical background of older technologies as required to understand the OCT. This is a basic / intermediate course featuring current technologies. Objective: By the conclusion of this course, participants will be able to (1) understand the scientific basis for imaging, (2) understand how scanning imaging may be used in clinical practice, (3) learn how imaging can be applied to the optic nerve head, retinal nerve fiber layer, and macula, with emphasis on glaucoma, (4) understand the relationship between structure and function, and (5) differentiate normal from abnormal scans through appropriate clinical examples. A questionand-answer session will be held at the end of the presentations, during which time questions will be entertained by the faculty. Instructor(s): Neil T Choplin MD, Sanjay G Asrani MD*, Howard Barnebey MD*
Lab Synopsis: This workshop will advance knowledge for participants in the clinical uses of OCT for imaging the optic nerve, the nerve fiber layer, and the ganglion cells of the macula. Historical review of older technologies will be briefly done as needed for understanding OCT content. The main focus of the workshop will be interpretation of representative printouts from clinical examples. Instructors will be available to discuss imaging technologies for interested participants. Objective: By the conclusion of this course, participants will be able to (1) understand image quality control and the indications for repeating images, (2) become familiar with the analysis software, and (3) practice interpretation of representative cases. Course: LAB101A Sunday, 12:00 - 2:00 PM Room: N231 Target Audience: COMPSUB Fee: $100 EduLevel: INT Instructor(s): Howard Barnebey MD*, Arvind Neelakantan MD* W
Ab-Interno Approach to Schlemm’s Canal
Course Director(s): Sameh Mosaed MD*
Recommended Didactic Course: LEC118 Room: S103d
Sunday, 2:00 - 4:15 PM Target Audience: COMPSUB EduLevel: INT Synopsis: Angle-based surgery for glaucoma via an internal approach will be covered in this course. The Trabectome is an instrument used for ab-interno trabecular ablation for the treatment of adult and juvenile open-angle glaucoma. We will review data from an ongoing case series exceeding 2000 eyes, including combined cataract and glaucoma surgery. Trabecular bypass stent (iStent) will also be presented, including data from recent FDA trials comparing combined iStent and cataract surgery with cataract extraction alone at 1 and 3 years postop. Indications, surgical technique, IOP outcomes, and complications of these 2 procedures will be described during a 2-hour didactic course. Other new and evolving ab-interno approaches to Schlemm’s Canal will be considered as well. This will be followed by a hands-on lab session using inverted corneal donor rings for practice.
NEW New Course. YO Endorsed by Young Ophthalmologists committee. W Participants are required to sign an infectious disease transmission waiver/release form. EQUIP Participants are required to bring specific equipment to the course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced
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Skills Transfer Program
Recommended Didactic Tuesday, 10:15 AM - 12:30 PM Target Audience: SUB EduLevel: INT Synopsis: This course is intended for ophthalmologists who plan to expand their surgical skills in the management of severe corneal and ocular surface disease. The topics will include amniotic membrane transplantation, limbal stem cell transplantations, and keratoprosthesis. Objective: At the conclusion of this course, the attendee will be able to (1) describe the indications and apply the surgical techniques for amniotic membrane transplantation, (2) recognize limbal stem cell deficiency and effectively apply the various surgical techniques for limbal stem cell transplantation, (3) recognize and successfully prevent / treat limbal allograft rejection using systemic immunosuppression, and (4) describe the patient selection, surgical techniques, and postoperative management of patients with keratoprosthesis. Course: LEC150 Room: N427a
Recommended Didactic Course: LEC101 Room: S105bc
Skills Transfer Program Objective: At the conclusion of the course, attendees will understand the indications, surgical technique, IOP outcomes, and complications associated with these ab interno trabecular bypass procedures. Instructor(s): Brian A Francis MD*, Nils A Loewen MD*, Nathan M Radcliffe MD*, Steven R Sarkisian MD*
Labs Synopsis: During this lab session, attendees will practice trabecular bypass procedures with a Trabectome console and handpiece, with adjustable power level and foot-pedal control, and a tissue model consisting of an inverted human corneal ring, including the trabecular meshwork. The corneal donor ring will be pin-fixated to a rubber holding device. Practice surgery will be done via an operating microscope, enabling a realistic view of the instrument effects as the Schlemm canal is unroofed by electroablation. Simultaneous video illustrating the gonioscopic view and live surgeries will also be presented. A model of the iStent will be available to gain comfort with the handling of a trabecular microbypass insertion device. Objective: At the course conclusion, the attendees will have had a realistic exposure to the surgical technique and one-on-one discussion of the advantages and disadvantages of these ab interno trabecular bypass procedures.
Skills Transfer Program
Note: Participants are required to sign an infectious disease transmission waiver / release form. Participants will be sharing equipment.
Course: LAB118A Room: N230 Fee: $170
Select one of the following Monday, 8:00 - 9:30 AM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Nathan M Radcliffe MD*, Brian A Francis MD*, Donald S Minckler MD*, Quang H Nguyen MD*, Douglas J Rhee MD*, Paul A Sidoti MD*, George Baerveldt MD*, Arthur J Sit MD*, Michael C Stiles MD*, Steven D Vold MD*, Martha Motuz Leen MD*, Marina A Ramirez MD**, Troy M Tanji MD, Masahiro Maeda MD, John P Berdahl MD*, Ilya M Rozenbaum MD*, Steven R Sarkisian MD*
Course: LAB118B Room: N230 Fee: $170
Monday, 10:00 - 11:30 AM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Nathan M Radcliffe MD*, Brian A Francis MD*, George Baerveldt MD*, Carla J Siegfried MD*, Douglas J Rhee MD*, Martha Motuz Leen MD*, Donald S Minckler MD*, Paul A Sidoti MD*, Quang H Nguyen MD*, Arthur J Sit MD*, Masahiro Maeda MD, John P Berdahl MD*, Ilya M Rozenbaum MD*
Implantation of Glaucoma Drainage Devices Course Director(s): Ronald Leigh Fellman MD OCS*
Recommended Didactic Course: LEC120 Room: S101ab
Sunday, 3:15 - 5:30 PM Target Audience: COMPSUB EduLevel: INT Synopsis: The first part of this course is didactic, covering the indications, pathophysiology, surgical technique, postoperative management, and complications of drainage devices (from anterior chamber tube to extraocular reservoir). The second part is hands-on, with implantation of Molteno, Krupin, Baerveldt, Ahmed, and Schocket devices on porcine eyes. Ex-Press shunt, Trabectome, and canaloplasty will not be covered. Objective: At the conclusion of this course, the attendee will be aware of principles and techniques of glaucoma drainage device implantation. Instructor(s): Richard P Mills MD MPH*, George Baerveldt MD*, Anne Louise Coleman MD PhD*, Frederick M Kapetansky MD, Donald L Budenz MD MPH*, Paul A Sidoti MD*, Angelo P Tanna MD*
part is hands-on, with implantation of Molteno, Krupin, Baerveldt, Ahmed, and Schocket devices on porcine eyes. Ex-Press shunt, Trabectome, and canaloplasty will not be covered. Objective: By the conclusion of this course, attendees will be able to complete a drainage device implantation in a fresh tissue eye. Course: LAB120A Monday, 12:30 - 2:30 PM Room: N230 Target Audience: COMP Fee: $220 EduLevel: INT Instructor(s): Richard P Mills MD MPH*, Paul A Sidoti MD*, Martha Motuz Leen MD*, Alfred M Solish MD*, Keith Barton MD*, Frederick M Kapetansky MD, Howard Barnebey MD*, Eugenio J Maul MD, Margaret Sophia Spencer MD, Marianne E Feitl MD, Simon K Law MD*, Joern B Soltau MD*, Steven Gedde MD*, Sameh Mosaed MD*, JoAnn A Giaconi MD*
Computerized Perimetry: Visual Field Testing and Interpretation, Emphasizing Glaucoma Jointly Sponsored by the Academy’s Skills Transfer Advisory Committee and The American Glaucoma Society Course Director(s): Julia Whiteside-de Vos MD MPH
Recommended Didactic Monday, 10:15 AM - 12:30 PM Target Audience: COMP EduLevel: BAS Synopsis: This lecture reviews computerized perimetry, emphasizing glaucoma and the Humphrey field analyzer. Topics will include the stepwise interpretation of individual visual fields (VFs), the significance of each portion of the VF printout, determining if the VF is reliable and if it is normal or abnormal, tips for obtaining a more reliable VF and for selecting the appropriate test, SITA, SWAP, frequency doubling perimetry, and the analysis of a series of VFs for progression. Numerous, mostly glaucomatous, case examples will be used. Objective: This course will provide participants with the background knowledge necessary to be more comfortable with VF interpretation and to be prepared for the separate laboratory session. Course: LEC134 Room: S105bc
Note: Octopus perimetry will be covered in the lab. This is the lecture portion of a Skills Transfer lab.
Instructor(s): Todd W Perkins MD*, Julia Whiteside-de Vos MD MPH
Lab Synopsis: This lab will prepare clinicians to interpret computerized visual fields (VFs) and use them more effectively in the diagnosis and management of glaucoma patients. The first 30 minutes of the lab will be devoted to a lecture regarding Octopus perimetry. Subsequently, participants will practice interpreting Humphrey or Octopus unknown VFs under the guidance of an experienced instructor. Examples will include individual VFs and series of VFs for progression evaluation, using event and trend progression analysis methods corresponding to the type of perimeter the participant has chosen for concentration. Objective: This course is designed to enable participants to master the skills necessary for interpreting automated VFs and for using them in the management of glaucoma patients. Course: LAB134A Monday, 2:30 - 4:30 PM Room: N231 Target Audience: COMP Fee: $100 EduLevel: BAS Senior Instructor(s): Todd W Perkins MD* Instructor(s): Anand V Mantravadi MD**, E Randy Craven MD*, Jonathan S Myers MD*, Jeffrey S Schultz MD**, David E Silverstone MD, Martha M Wright MD
Lab Synopsis: The first part of this course is didactic, covering the indications, pathophysiology, surgical technique, postoperative management, and complications of drainage devices (from anterior chamber tube to extraocular reservoir). The second 112
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Skills Transfer Program W
Schlemm Canal Surgery: From the Outside In
Course Director(s): Richard A Lehrer MD*
Recommended Didactic Course: LEC135 Monday, 10:15 AM - 12:30 PM Room: N427d Target Audience: COMPSUB EduLevel: INT Synopsis: Canaloplasty, an ab externo glaucoma procedure, is an alternative approach in glaucoma filtering surgery and has shown results comparable to those of other methods, with a reduction in overall complications. Yet this technique has a learning curve, with its own set of unique challenges. This course will present a systematic, multimedia, video-assisted review of the anatomy, rationale, explanation, and illustration of canaloplasty. Objective: This course will explain (1) the procedure’s method of re-establishing aqueous outflow, (2) the procedure’s advantages, disadvantages, risks, and benefits, and (3) the identification of glaucomas where the procedure would have highest probability of success. Recent clinical results and innovations to enhance the procedure will also be discussed. New this year is added material on ab interno goniotomy using the catheter. Instructor(s): Iqbal K Ahmed MD*, Alan S Crandall MD*, Clive O Peckar MD, Howard Barnebey MD*, John R Kearney MD, Davinder S Grover MD*, Robert Stegmann MD**
Note: Attendees should have experience with nonpenetrating glaucoma surgery. Participants are required to sign an infectious disease transmission waiver / release form.
Course: LAB135A Room: N230 Fee: $220
Monday, 3:00 - 5:00 PM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Iqbal K Ahmed MD*, Alan S Crandall MD*, Clive O Peckar MD, Howard Barnebey MD*, John R Kearney MD, Robert P Liss MD, Davinder S Grover MD*
Is It Time to Replace Gonioscopy by Anterior Segment Imaging in the Diagnosis and Management of AngleClosure Glaucoma? Course Director(s): Syril Dorairaj MD
Course: LAB140 Monday, 11:30 AM - 1:30 PM Room: N231 Target Audience: COMPSUB Fee: $100 EduLevel: BAS Synopsis: Angle-closure glaucomas (ACGs) are a group of disorders characterized by mechanical blockage of the trabecular meshwork by the peripheral iris, resulting from interactions between the structures and hydrodynamics inside the eye. Imaging of the anterior segment is an essential tool aiding the diagnosis and understanding of the mechanism and management of ACG. Various imaging devices are now available, each one representing particular technical advantages / disadvantages over the others. Anterior segment imaging cannot replace the direct visualization of angle structures, but it can overcome some of the limitations of gonioscopy by providing a more objective means of obtaining a qualitative and quantitative evaluation of the angle. These imaging techniques are enlightening clinicians and researchers about the importance of making an early diagnosis, establishing underlying causal mechanisms, and evaluating treatments. Instructor(s): Christopher Kai-shun Leung MD MBChB*, Vishal Jhanji MBBS, Paul F Palmberg MD PhD*, Clement C Y Tham MBBS*, Tin Aung FRCS PhD*
Course Director(s): Lisa S Gamell MD
Recommended Didactic Course: LEC144 Room: S106a
Monday, 3:15 - 5:30 PM Target Audience: COMPSUB EduLevel: INT Synopsis: This course will provide a comprehensive review of laser procedures used to treat glaucoma. Topics discussed will include argon laser trabeculoplasty (ALT), selective laser trabeculoplasty (SLT), micropulse laser trabeculoplasty (MLT), cyclophotocoagulation (both endoscopic and trans-scleral), iridotomy (Nd:YAG, argon, and diode), iridoplasty, and laser suture lysis. Indications, treatment techniques, and postoperative care will be discussed in detail during the didactic portion of the course. During the laboratory section, participants will have the opportunity to perform endoscopic cyclophotocoagulation, trans-scleral cyclophotocoagulation, SLT, ALT, MLT, and iridotomies under the supervision of the course instructors. Objective: At the conclusion of this course, attendees will be able to understand the indications and techniques for the various laser therapies used in the treatment of glaucoma. After the laboratory section, they will have hands-on experience using these modalities on animal eyes. Instructor(s): Robert J Noecker MD*, Joel S Schuman MD*, Jorge A Alvarado MD, Mark A Latina MD*, Malik Y Kahook MD*, Brian E Flowers MD*
Lab Synopsis: This course will provide a comprehensive review of laser procedures used in the treatment of glaucoma. Topics discussed will include argon laser trabeculoplasty (ALT), selective laser trabeculoplasty (SLT), micropulse laser trabeculoplasty (MLT), cyclophotocoagulation (both endoscopic and trans-scleral), iridotomy (Nd:YAG, argon, diode, and krypton), and iridoplasty. Laser enhancement of filtering procedures will be covered as well, including laser suture lysis and bleb revision. During the laboratory section, participants will have the opportunity to perform endoscopic cyclophotocoagulation, trans-scleral cyclophotocoagulation, SLT, ALT, MLT, and iridotomies under the supervision of the course instructors. Objective: At the conclusion of this course, attendees will be able to understand the indications and techniques for the various laser therapies used in the treatment of glaucoma. After the laboratory section, they will have hands-on experience using these modalities on animal eyes. Note: Participants will be sharing equipment.
Course: LAB144A Room: N230 Fee: $220
Tuesday, 8:00 - 10:00 AM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Robert J Noecker MD*, Joel S Schuman MD*, Jorge A Alvarado MD, Mark A Latina MD*, Malik Y Kahook MD*, Brian E Flowers MD*, Martin Uram MD*
Glaucoma Filtration Surgery Course Director(s): Steven L Mansberger MD*
Recommended Didactic Course: LEC145 Room: S104b
Monday, 3:15 - 5:30 PM Target Audience: COMP EduLevel: BAS Synopsis: This course will provide a comprehensive review of the techniques and complications of glaucoma filtration surgery. Glaucoma surgical technique will be stressed in this update of filtration surgery, with a heavy emphasis on surgical video presentations. The course will also discuss novel surgical techniques used in filtration surgery, such as Ex-Press shunts, as compared to conventional surgery. A panel discussion with questions and answers will conclude the session.
NEW New Course. YO Endorsed by Young Ophthalmologists committee. W Participants are required to sign an infectious disease transmission waiver/release form. EQUIP Participants are required to bring specific equipment to the course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced
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Skills Transfer Program
Lab Synopsis: This course will demonstrate and train attendees in the procedure of canaloplasty, an ab externo glaucoma procedure. Attendees will be mentored in the procedure, with microscopic dissection and catheter, and then tension suture placement in the Schlemm canal. Objective: At the conclusion of this course, the attendees should have a good understanding of and hands-on ability to perform this procedure, from the insertion of the microcatheter through placement of the suture invaginating the trabecular meshwork.
Glaucoma Laser Therapy: Innovations and Advice From the Experts
Skills Transfer Program Objective: This course will review surgical anatomy, basic trabeculectomy techniques, antimetabolites (including 5-fluorouracil and mitomycin C), and postoperative management and complications. Instructor(s): George A Cioffi MD*, Jeffrey M Liebmann MD*, F Jane Durcan MD, Robert D Fechtner MD FACS**, George A Cioffi MD*, Celso Tello MD**
Skills Transfer Program
Lab Synopsis: This Skills Transfer course will offer hands-on instruction on glaucoma filtration surgery, specifically for the general ophthalmologist and ophthalmology resident. The lab session will provide experience with the techniques of trabeculectomy. Objective: Using porcine eyes and dissection microscopes (one per student), glaucoma surgical techniques will be performed. The attendees will learn surgical anatomy, scleral flap dissection, fistula creation with and without an Ex-Press shunt, iridectomy, and releasable and standard flap closure techniques. Course: LAB145A Tuesday, 11:00 AM - 12:30 PM Room: N230 Target Audience: COMP Fee: $170 EduLevel: BAS
presentations, videos, and interactive computer simulations to demonstrate and teach SCL fitting skills. The attendee will utilize computer simulation to fit and evaluate multiple SCL fittings. Individual assistance will be available during the computer simulation training. Objective: This course will teach the practitioner (1) recognition of suitable candidates, (2) appropriate SCL selection, (3) soft spherical and toric lens fitting, and (4) patient and practice management. Note: Each participant is required to bring their own PC laptop or MAC computer to the course, and computers must be able to load CDs. Windows XP, Windows Vista, or Windows 7 is required.
Instructor(s): Melvin I Freeman MD FACS*, William T Driebe MD, Zoraida Fiol-Silva MD*, Michael H Goldstein MD*, Jeanine Suchecki MD, Bruce Koffler MD*, Peter R Kastl MD PhD, John S Massare PhD
Orbit, Lacrimal, Plastic Surgery
Orbitofacial Fracture Repair: Plating Workshop
Senior Instructor(s): John C Morrison MD
Course Director(s): Jeremiah P Tao MD
Instructor(s): Young H Kwon MD PhD*, Paul A Sidoti MD*, Steven D Vold MD*, Frank J Mares MD, Jason C Swanner MD**, Mansi Parikh MD, Kevin P Pikey DO**
Course: LAB100 Sunday, 8:00 - 11:00 AM Room: N226 Target Audience: SUB Fee: $165 EduLevel: ADV Synopsis: In this course we introduce the orbitocentric approach to facial fracture repair, including anatomy, principals of rigid internal fixation, and preferred surgical approaches. A series of lectures and a hands-on lab introduce fixation systems and plating concepts. Model skulls, facial plating hardware, and instrumentation will be provided. Objective: At the conclusion of the course, the attendee will understand the benefits of an orbitocentric approach to orbitofacial bone repair. In addition, participants gain practical experience with facial plating and instrumentation.
Neuro-Ophthalmology
Neuroimaging in Ophthalmology Jointly Sponsored By the Academy’s Skills Transfer Advisory Committee and the North American Neuro-Ophthalmology Society (NANOS) Course Director(s): Christopher C Glisson DO*
Course: LAB105 Sunday, 9:00 - 11:00 AM Room: N231 Target Audience: COMPSUB Fee: $100 EduLevel: INT Synopsis: This review of CT and MRI scans of the head and orbit will improve participants’ knowledge of anatomy and imaging analysis using illustrative cases. The course will be supervised by experienced neuro-ophthalmologists and will employ a hands-on format. Through detailed discussion and review of cases and related films, participants will gain knowledge to enhance skills used when ordering and interpreting imaging studies. Objective: Participants will recognize normal structures and pathologic findings on CT and MRI scans, recognize the indications for ordering various types of imaging, and become proficient at reviewing neuroimaging studies. Instructor(s): Michael S Vaphiades DO*, Eric Eggenberger DO*, Eric L Berman MD, Jade Schiffman MD, Larry P Frohman MD*, Jacqueline A Leavitt MD, Michael C Brodsky MD, Nicholas J Volpe MD, Rosa A Tang MD*, Julie Falardeau MD, Roger E Turbin MD*, Fiona E Costello MD*
Optics, Refraction, Contact Lenses EQUIP Soft Contact Lens Fitting for the Practicing Ophthalmologist
Jointly Sponsored By the Academy’s Skills Transfer Advisory Committee and the Contact Lens Association of Ophthalmologists (CLAO) Course Director(s): Peter C Donshik MD*, William H Ehlers MD
Course: LAB119 Sunday, 2:30 - 5:00 PM Room: N227a Target Audience: COMP Fee: $85 EduLevel: BAS Synopsis: To appropriately utilize contact lenses in practice, the Eye M.D. needs to recognize suitable candidates, select the appropriate lens, and know how to fit and evaluate the lens. This course is for Eye M.D.s who want to add or expand soft contact lens (SCL) fitting in their practices. The learning format includes PowerPoint 114
Instructor(s): Hui Bae Harold Lee MD, Peter J Timoney MBBCh, Mithra O Gonzalez MD, Jeffrey M Joseph MD NEW Periocular Rejuvenation With Fillers and 2-D Videos and Video-Assisted Teaching
Course Director(s): Shubhra Goel MD
Recommended Didactic Course: LEC106 Room: E352
Sunday, 9:00 - 10:00 AM Target Audience: COMPSUB EduLevel: BAS Synopsis: This course will provide a of the basics of Botulinum toxin and hyaluronic acid filler injections around the periocular region. The course highlights will include 2-D anatomy videos, clinical case scenarios, and video-assisted teaching to demonstrate and master the planning of various injection techniques. It will also highlight how to manage various complications and surprises using simple modification techniques and use of hyalase / vitrase. There will be interactive case-based discussions and time for audience discussion. Objective: At the conclusion of this course, each attendee will have clear knowledge of periocular anatomy and principles and techniques of periocular rejuvenation using fillers. Instructor(s): Sabrina D Shah-Desai MBBS**, Vinod Gauba MD, Cynthia Boxrud MD FACS**, Nikolaos Trakos MD** Course Director(s): Shubhra Goel MD
Lab Synopsis: This course will provide personalized hands-on instruction in the basic of Botulinum toxin and hyaluronic acid filler injections around the periocular region. The course highlights will include 2-D anatomy videos, clinical cases, video-assisted teaching and specially designed silicone models to practice proper injection
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Skills Transfer Program techniques and learn to manage complications with hyalase / vitrase. There will be interactive case-based discussions and time for audience discussion. Objective: At the conclusion of this course, each attendee will have clear knowledge of periocular anatomy and the principles and techniques of periocular rejuvenation using BOTOX and fillers, with real-time simulated injection practice. Note: Participants are required to bring surgical loupes.
Course: LAB106A Room: N229 Fee: $120
Sunday, 10:30 AM - 12:30 PM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Sabrina D Shah-Desai MBBS**, Vinod Gauba MD, Cynthia Boxrud MD FACS**, Nikolaos Trakos MD**
Cosmetic Botulinum Toxin and Facial Fillers: An Introductory Course EQUIP W
Course Director(s): Kathleen M Duerksen MD
Instructor(s): Michael S McCracken MD, Deborah D Sherman MD*, John Joseph Martin MD*
Lab Synopsis: Taught by experienced instructors, this lab provides hands-on, personalized instruction in the basics of botulinum toxin and facial filler injections utilizing cadaver heads. Objective: At the completion of the lab, the participant will be able to identify the proper sites, doses, and indications for injection of botulinum toxin and facial fillers. The participant will demonstrate proper injection technique with the goal of avoiding technique-related complications. Note: Participants are required to bring surgical loupes. Participants are also required to sign an infectious disease transmission waiver / release form.
Course: LAB112A Room: N229 Fee: $275
Sunday, 1:30 - 3:00 PM Target Audience: COMPSUB EduLevel: BAS
Instructor(s): Michael S McCracken MD, Deborah D Sherman MD*, John Joseph Martin MD*, Christopher M DeBacker MD, Morris E Hartstein MD, Cat Burkat MD, Jose R Montes MD*, Craig Erwin Geist MD, Rona Z Silkiss MD FACS*, Gary Borodic MD**, Charles B Slonim MD, Dawn C Buckingham MD, Dale R Meyer MD FACS, Asa Dan Morton III MD, Ronald W Kristan MD, Jeffrey P Edelstein MD*, Julie A Woodward MD*, Fred S Bodker MD, Kenneth David Steinsapir MD**, Kristin J Tarbet MD**
Introduction to Aesthetic Facial Surgery by Fractional Lasers, Intense Pulsed Light, Radiofrequency, and Ultrasound Devices Course Director(s): Julie A Woodward MD*
Course: LEC115 Room: S106b
Recommended Didactic Sunday, 10:15 AM - 12:30 PM Target Audience: COMP EduLevel: BAS
Instructor(s): Randal Pham MD FACS, Adam J Scheiner MD*, Ioannis P Glavas MD, John Joseph Martin MD*, Wendy W Lee MD*
Lab Synopsis: This lab will present a unique opportunity to compare and contrast a variety of lasers, intense pulsed light, and other energy-based devices in a handson format. Objective: At the completion of this course, participants will (1) understand safe application of rejuvenation technology, (2) learn how to manage complications, and (3) start to choose which devices and procedures to incorporate into their current practices. Note: Participants will be sharing equipment.
Course: LAB115A Room: N230 Fee: $220
Sunday, 3:30 - 5:30 PM Target Audience: COMPSUB EduLevel: BAS
Instructor(s): Julie A Woodward MD*, John Joseph Martin MD*, Randal Pham MD FACS, Adam J Scheiner MD*, Ioannis P Glavas MD, Wendy W Lee MD*, Usha P Reddy MD**, Amina Husain MD**, Kristina M Price MD, Amy M Fowler MD W Surgical Anatomy of the Eyelids: Cadaver Demonstration
Course Director(s): Edward H Bedrossian MD FACS
Course: LAB117 Sunday, 12:00 - 2:30 PM Room: N226 Target Audience: COMPSUB Fee: $140 EduLevel: INT Synopsis: Using slides, video, and cadaver prosections, this course will demonstrate landmarks important in the correction of brow ptosis, blepharoptosis, ectropion, entropion, and retraction. Included will be a precourse quiz and participant interaction. Objective: This course is designed to (1) review eyelid anatomy, (2) show structures in prosected cadavers, and (3) improve surgical technique. Note: Participants are required to sign an infectious disease transmission waiver / release form.
Instructor(s): Edward H Bedrossian MD FACS, Robert C Della Rocca MD**, Bryan Arthurs MD FRCSC EQUIP W
Endoscopic Forehead and Eyebrow Elevation
Course Director(s): Stuart R Seiff MD
Recommended Didactic Course: LEC123 Room: N427a
Sunday, 3:15 - 5:30 PM Target Audience: COMPSUB EduLevel: ADV Synopsis: In this course the aesthetic evaluation of the patient with eyebrow ptosis, the anatomy of the eyebrow and forehead, and a description of the endoscopic brow and forehead elevation procedure will be discussed. A course handbook will be provided, detailing the surgical technique. Objective: This course is designed to provide an understanding of the preoperative patient evaluation, pertinent surgical anatomy, and technique of endoscopic brow and forehead elevation.
NEW New Course. YO Endorsed by Young Ophthalmologists committee. W Participants are required to sign an infectious disease transmission waiver/release form. EQUIP Participants are required to bring specific equipment to the course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced
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Skills Transfer Program
Recommended Didactic Sunday, 10:15 AM - 12:30 PM Target Audience: COMPSUB EduLevel: BAS Synopsis: Principles of aesthetic facial injection of botulinum toxin and facial fillers will be presented in a didactic format. Objective: At the conclusion of this course, the attendee will better understand the salient anatomy, clinical techniques (including complication avoidance), and pharmacological principles pertaining to aesthetic injection of these substances. Course: LEC112 Room: S106a
Synopsis: This course will focus primarily on ablative laser resurfacing (CO2 and erbium), laser incisional blepharoplasty, and intense pulsed light. Preoperative, intraoperative, and postoperative care and management of complications will be covered. There will also be very brief introductions to the latest in nonablative fractional resurfacing, radiofrequency, and microfocused ultrasound. Objective: By the conclusion of this course, attendees will be able to (1) compare and contrast the many different devices on the market, (2) have introductory knowledge of how to incorporate such new technologies into their practices, and (3) recognize and manage complications of these devices.
Skills Transfer Program Senior Instructor(s): Susan R Carter MD
Lab Synopsis: A brief lecture outlining the steps in endoscopic forehead and eyebrow elevation will be followed by step-by-step cadaver dissections for hands-on experience with the equipment and surgical technique. Objective: Participants will obtain a familiarity with the surgical anatomy of the brow and forehead, instrumentation, planes of dissection, and closure techniques in endoscopic forehead and eyebrow elevation. Note: Participants are required to bring surgical loupes. Participants are also required to sign an infectious disease transmission waiver / release form.
Course: LAB123A Room: N229 Fee: $440
Monday, 7:30 - 10:00 AM Target Audience: COMPSUB EduLevel: ADV
Instructor(s): Kimberly Cockerham MD FACS*, Kathleen M Duerksen MD, Jill Annette Foster MD FACS*, Susan R Carter MD, David E Holck MD**, John Bryan Holds MD*, Asa Dan Morton III MD, Eve E Moscato MD, Harmeet S Gill MD, Morris E Hartstein MD, Craig N Czyz DO, Louis Savar MD**, Rona Z Silkiss MD FACS*, David J Russell MD
Skills Transfer Program
Workshop in Flap Techniques in Oculoplastic Surgery Course Director(s): Dawn C Buckingham MD
Course: LAB126 Sunday, 3:30 - 5:30 PM Room: N226 Target Audience: COMPSUB Fee: $120 EduLevel: INT Synopsis: This course will begin with a discussion of various suturing materials and techniques. Basic flap techniques will then be discussed, including advancement, rotation, and bilobe and rhomboid flaps. Additionally, Z-plasty, Y-V plasty, and the management of dog ears will be covered. These techniques are crucial in achieving the best possible cosmetic result in periorbital reconstruction. The majority of the course will be a hands-on practicum, during which participants may perform these procedures under the supervision of experienced course instructors, utilizing pig’s feet. Objective: At the conclusion of this course, the participant will be more familiar with various suturing techniques useful in periorbital wound closure and will have a better understanding of the indications for and techniques utilized in flap reconstruction of periorbital cutaneous defects. Instructor(s): Morris E Hartstein MD, Suzanne K Freitag MD, George O Stasior MD, Junhee Lee MD**, Sang H Hong MD, Cat Burkat MD, Nicholas A Ramey MD, Alice Song MD, Julie A Woodward MD* EQUIP W
Workshop in Techniques of Lacrimal Intubation
Course Director(s): Arthur Perry MD*
Course: LAB127 Sunday, 4:00 - 5:30 PM Room: N229 Target Audience: COMPSUB Fee: $275 EduLevel: INT Synopsis: This course will review indications for silicone intubation and will show different intubation systems and techniques. Participants will spend most of the course time actually performing the intubation procedure on cadavers. Objective: Participants should leave the course feeling confident that they can successfully intubate the lacrimal system and understand both the indications for this procedure and possible complications. Note: Participants are required to bring surgical loupes. Participants are also required to sign an infectious disease transmission waiver / release form.
Instructor(s): Bruce B Becker MD*, Jeffrey P Edelstein MD*, Arthur Perry MD*, Melissa L Meldrum-Aaberg MD, Bert Bowden MD, Karim G Punja MD**, Scott M Goldstein MD, Adam S Hassan MD, Asa Dan Morton III MD
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EQUIP W Endoscopic Transnasal Lacrimal Surgery: Principles and Practice
Course Director(s): Francois Codere MD
Recommended Didactic Course: LEC128 Room: N427bc
Sunday, 4:30 - 5:30 PM Target Audience: COMPSUB EduLevel: INT Synopsis: The transnasal diagnosis and treatment of lacrimal outflow disorders will be presented. Endoscopic nasal anatomy, transnasal dacryocystorhinostomy surgical techniques, endoscopic Jones tubes placement, and endoscopic diagnosis and management of lacrimal disorders will be covered. Objective: At the conclusion of this course, participants will understand transnasal endoscopic diagnosis and treatment of lacrimal outflow disorders. Instructor(s): Bruce M Massaro MD, Jennifer A Sivak MD
Lab Synopsis: This course will present the transnasal diagnosis and treatment of lacrimal outflow disorders. Endoscopic nasal anatomy, transnasal dacryocystorhinostomy surgical techniques, endoscopic placement of Jones tubes, endoscopeassisted intubation, and use of the endoscope for diagnosis and management of lacrimal disorders will be covered. Objective: At the conclusion of this course, participants will understand transnasal endoscopic diagnosis and treatment of lacrimal outflow disorders. Note: Participants are required to bring surgical loupes. Participants are also required to sign an infectious disease transmission waiver / release form.
Course: LAB128A Room: N229 Fee: $440
Monday, 11:00 AM - 1:30 PM Target Audience: COMPSUB EduLevel: ADV
Instructor(s): Francois Codere MD, Bruce M Massaro MD, Jennifer A Sivak MD, Jorge Corona MD**, Steven C Dresner MD, Angela M Dolmetsch MD, James H Merritt MD, John T Harvey MD, Liat Attas-Fox MD, Patrick R Boulos MD
Oculoplastic Surgery: Anatomic Foundations, Surgical Techniques, and Enhanced Results W
Course Director(s): Cat Burkat MD
Course: LAB129 Monday, 8:00 - 10:00 AM Room: N226 Target Audience: COMPSUB Fee: $120 EduLevel: INT Synopsis: Anatomic principles provide the cornerstone of successful oculofacial surgery. This course will cover the anatomic foundations to be considered when performing surgical procedures of the eyebrow, forehead, upper and lower eyelids, midface, and lacrimal system. A series of short lectures will be followed by interactive demonstration and teaching of clinically relevant anatomy on various cadaver prosections. Objective: This course is designed to provide knowledge of anatomic foundations on which participants can build successful oculofacial surgical procedures, and allows close interaction with the instructors. Note: Participants are required to sign an infectious disease transmission waiver / release form.
Instructor(s): Mark J Lucarelli MD FACS, Sang H Hong MD, Don Kikkawa MD*, Bobby S Korn MD PhD FACS*, David B Lyon MD FACS, Marcus M Marcet MD, John J McGetrick MD FACS, Karim G Punja MD**, Nicholas A Ramey MD, Joseph P Shovlin MD**, Leslie A Wei MD, Katherine M Whipple MD**, Gregory J Griepentrog MD, Courtney Y Kauh MD
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Skills Transfer Program EQUIP W
Fat Grafting and Volume Restoration
Course Director(s): David Khoramian Isaacs MD
Recommended Didactic Course: LEC136 Monday, 10:15 - 11:15 AM Room: S103a Target Audience: COMPSUB EduLevel: BAS Synopsis: The purpose of this Recommended Didactic course is to present facial fat grafting as a technique for volume restoration. Indications for surgery, patient selection, alternatives to surgery, surgical techniques and instrumentation, and postoperative details will be reviewed. An interactive case presentation will allow attendees to participate. Objective: At the conclusion of this course, the attendee will be acquainted with facial fat grafting techniques and appropriate patient selection, as well as addressing potential postoperative complications. The course will enable the attendee to formulate a customized approach to a patient’s needs and goals. Instructor(s): Robert M Schwarcz MD**, Brett S Kotlus MD*, Tanuj Nakra MD, Cynthia Boxrud MD FACS**, Robert A Goldberg MD*, Norman Shorr MD**
Note: Participants are required to bring surgical loupes. Participants are also required to sign an infectious disease tansmission waiver / release form.
Course: LAB136A Room: N229 Fee: $275
Tuesday, 8:00 - 9:30 AM Target Audience: COMPSUB EduLevel: BAS
Instructor(s): Robert M Schwarcz MD**, Brett S Kotlus MD*, Catherine Hwang MD, Tanuj Nakra MD, Shu-Hong Chang MD, Robert A Goldberg MD*, Norman Shorr MD** YO
Basic Oculoplastic Surgery
Course Director(s): Eve E Moscato MD
Course: LAB137 Monday, 11:00 AM - 1:30 PM Room: N226 Target Audience: COMP Fee: $225 EduLevel: BAS Synopsis: This course is designed to refresh the ophthalmologist’s basic oculoplastics skills in a laboratory setting (employing porcine specimens), while simultaneously reviewing the fundamentals of ophthalmic plastic and reconstructive surgery knowledge. The basic principles involved in choosing suture materials and types of suture needle for various oculoplastics procedures will be reviewed. Surgical positioning and instrumentation will be touched upon as the course participants perform various surgical techniques employed in ophthalmic plastic and reconstructive surgery, with instructor assistance. Objective: The main of the course is to provide participants with an opportunity to hone surgical skills that are employed in basic oculoplastics procedures such as eyelid lesion removal, eyelid margin lesion resection and reconstruction, eyelid laceration repair, ectropion repair, and blepharoplasty. A very basic introduction to ptosis repair will also be presented. Instructor(s): Christopher I Zoumalan MD, Raymond I Cho MD, Parag D Gandhi MD, Alice Song MD, Julia Song MD, Jennifer Trew Scruggs MD**, Edward Wladis MD*, Harmeet S Gill MD, Keshini C Parbhu MD, Bryan J Winn MD**, Sarit M Patel MD, Amy M Fowler MD, Louis Savar MD**, Ami Ashvin Shah MD, Michael Kangwhi Yoon MD, Lyndon B Lee MD**, Jill S Melicher Larson MD, Elizabeth M Palkovacs MD
Course Director(s): Robert A Goldberg MD*
Recommended Didactic Monday, 11:30 AM - 12:30 PM Target Audience: SUB EduLevel: ADV Synopsis: This course is designed to foster creative thinking in orbital decompression. Staging, planning, and techniques for orbital decompression will be reviewed, including deep lateral, fat removal, transcaruncular, and endoscopic. Surgical versatility and creative decision making will be stressed. Objective: This course is designed to acquaint participants with a variety of techniques for orbital decompression and to enable them to design an individualized approach based on the patient’s needs and goals. Course: LEC139 Room: N138
Instructor(s): Norman Shorr MD**, Catherine Hwang MD, Mehryar Taban MD, Raymond Douglas MD PhD*, Joseph L Lin MD**, Daniel B Rootman MD MSc, Alice Siew Ching Goh MD, Michael Kazim MD, Chee-Chew Yip MBBS FRCS**, Kenneth A Feldman MD**, Jonathan W Kim MD, Raman Malhotra MBChB FRCOphth, Tanuj Nakra MD, Ronald Mancini MD, Shu-Hong Chang MD, Kelvin Kam Lung Chong MD
Lab Synopsis: Through lectures, video presentations, and laboratory dissection, various techniques for orbital decompression will be reviewed, including deep lateral, fat removal, transcaruncular, and endoscopic. Surgical versatility and creative decision making will be stressed. Objective: This course is designed to acquaint participants with a variety of techniques for orbital decompression and to enable them to design an individualized approach based on the patient’s needs and goals. Note: Participants are required to bring surgical loupes and headlamps. Participants are also required to sign an infectious disease transmission waiver / release form.
Course: LAB139A Room: N229 Fee: $440
Monday, 2:30 - 5:00 PM Target Audience: SUB EduLevel: ADV
Instructor(s): Norman Shorr MD**, Catherine Hwang MD, Jonathan W Kim MD, Joseph L Lin MD**, Daniel B Rootman MD MSc, Aline Pimentel MD**, Shu-Hong Chang MD, Kelvin Kam Lung Chong MD, David Khoramian Isaacs MD, Payam Vali Morgan MD**, Jack Rootman MD FRCSC**, Erin B Lessner MD, Shani Golan
Enucleation and Evisceration: Hands-On Practical Pearls Course Director(s): Parag D Gandhi MD
Course: LAB142 Monday, 2:30 - 5:00 PM Room: N226 Target Audience: COMPSUB Fee: $225 EduLevel: INT Synopsis: This skills-oriented course will provide an enriching experience focused on the pearls of enucleation and evisceration surgery with detailed surgical steps, hands-on practical training, and video demonstrations. A variety of ocular implants will be available for attendees to use. Objective: By the conclusion of this course, participants will be able to (1) understand preoperative evaluation and imaging, (2) develop an instrument set and decide ocular implant options before surgery, (3) anticipate anesthesia requirements, (4) understand and perform the steps of enucleation and evisceration surgeries, (5) develop and implement a framework for deciding which procedure to choose and when, (6) gain facility with ocular implants currently available and identify their advantages, (7) understand the controversies of wrapping and pegging implants, and (8) enumerate and apply various strategies for management of early postoperative complications, late complications, and the postenucleation socket syndrome. Instructor(s): Maria Kirzhner MD, Gary J Lelli MD, Marcus M Marcet MD, Eve E Moscato MD, Sarit M Patel MD, Erin Shriver MD, Manoj M Thakker MD, M Reza Vagefi MD
NEW New Course. YO Endorsed by Young Ophthalmologists committee. W Participants are required to sign an infectious disease transmission waiver/release form. EQUIP Participants are required to bring specific equipment to the course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced
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Skills Transfer Program
Lab Synopsis: The purpose of this course is to allow attendees to have a hands-on cadaver learning module in fat grafting. Lectures, video presentations, and laboratory demonstrations on cadavers will teach tumescent anesthesia, fat harvesting, and fat grafting techniques. Objective: At the conclusion of this course, the attendee will be familiar with safe and effective fat grafting techniques and addressing potential postoperative complications. The course will enable the attendee to formulate a customized approach to a patient’s needs and goals.
EQUIP W Advanced Techniques in Orbital Decompression and Expansion
Skills Transfer Program EQUIP W
Fundamental Facelifting Techniques
Jointly Sponsored by the Academy’s Skill Transfer Advisory Committee and the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) Course Director(s): Brett S Kotlus MD*
Recommended Didactic Course: LEC146 Room: N427d
Monday, 3:15 - 5:30 PM Target Audience: COMPSUB EduLevel: INT Synopsis: This basic course will consist of a step-by-step slide and video presentation of a preoperative assessment, surgical facial anatomy, fundamental facelifting techniques, postoperative care, and potential complications. A downloadable course manual will be available to participants. Objective: Participants will acquire the ability to select appropriate patients, develop hands-on familiarity with facial surgical anatomy, perform safe surgical dissection, provide appropriate postoperative care, and integrate facelifting into their aesthetic oculofacial practice.
Skills Transfer Program
Instructor(s): Tanuj Nakra MD, Robert M Schwarcz MD**, Bobby S Korn MD PhD FACS*
Lab Synopsis: Step-by-step cadaver dissection will demonstrate surgical anatomy, safe surgical planes, and fundamental facelifting techniques, including cervicalmental restoration, superficial musculoaponeurotic system and skin management, and skin closure. Objective: Participants will acquire hands-on familiarity with the surgical anatomy and basic facelifting techniques so they will be able to incorporate facelifting procedures into their aesthetic practices. Note: Participants are required to bring surgical loupes. Participants are required to sign an infectious disease transmission waiver / release form.
Course: LAB146A Room: N229 Fee: $360
Tuesday, 11:00 AM - 1:00 PM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Bobby S Korn MD PhD FACS*, Robert M Schwarcz MD**, Tanuj Nakra MD, David E Holck MD**, Stuart R Seiff MD, Allan E Wulc MD FACS*, Kenneth David Steinsapir MD**, Kathleen M Duerksen MD, William R Nunery MD, Jill Annette Foster MD FACS*, Mikel W Lo MD, John D Ng MD*, Asa Dan Morton III MD, Christopher M DeBacker MD, John Joseph Martin MD*, Adam S Hassan MD, Janet M Neigel MD*, Scott M Goldstein MD, Geva E Mannor MD MPH, Dustin M Heringer MD**, David Khoramian Isaacs MD, Robert A Goldberg MD* EQUIP W
Blepharoplasty
Course Director(s): Keith D Carter MD FACS
Recommended Didactic Tuesday, 10:15 AM - 12:30 PM Target Audience: COMPSUB EduLevel: INT Synopsis: This course will cover the latest techniques in upper and lower eyelid blepharoplasty. Basic and advanced surgical techniques, eyelid anatomy, patient selection, preoperative evaluation, and avoidance of complications will be discussed. A course handbook with illustrations outlining the surgical techniques will be provided. Objective: This course will provide participants with the techniques required to perform successful upper and lower eyelid blepharoplasties. Course: LEC149 Room: N140
Objective: Participants will be shown the clinically relevant anatomy as it relates to performing upper and lower eyelid blepharoplasties. Note: Participants are required to bring surgical loupes. Participants are also required to sign an infectious disease transmission waiver / release form.
Course: LAB149A Room: N229 Fee: $360
Tuesday, 2:00 - 4:00 PM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Keith D Carter MD FACS, Mark A Alford MD, Richard C Allen MD PhD, Richard L Anderson MD FACS*, Francesco P Bernardini MD, Carlo de Conciliis MD, Adam G de la Garza MD, Martin H Devoto MD, Jill S Melicher Larson MD, Robert C Kersten MD, Jose R Montes MD*, Jeffrey A Nerad MD, Rachel K Sobel MD, Alice Song MD, Julia Song MD
Pediatric Ophthalmology, Strabismus W
New Techniques for Strabismus Surgery
Course Director(s): Kenneth W Wright MD*
Recommended Didactic Sunday, 10:15 - 11:15 AM Target Audience: COMPSUB EduLevel: INT Synopsis: Over the past several years, important surgical innovations have made strabismus surgery safer and more effective. This course will teach the use of novel strabismus surgical techniques, including grooved hook for suturing the muscle insertion, minimally invasive techniques (rectus central tenotomy and plication), and use of amniotic membrane transplant for restrictive strabismus. Video will be presented to help teach the techniques. Outcome studies of surgical procedures will be presented. Objective: At the conclusion of this course, the attendee will be able to use new strabismus surgical techniques to improve surgical outcomes and reduce complications. Course: LEC111 Room: S102d
Instructor(s): Yi Ning Strube MD, Luke W Deitz MD
Lab Synopsis: This hands-on lab will transfer the surgical skills required for the use of new strabismus techniques. Attendees will actually perform the procedures. Specific techniques will include use of the grooved hook for safe suturing of tight muscles and suturing of muscles during topical anesthesia surgery. Techniques for amniotic membrane transplant useful in the treatment of restrictive strabismus will be taught. Minimally invasive techniques of partial rectus tenotomy and plication will be presented. The minimally invasive procedures have utility for the treatment of small-angle strabismus. Objective: At the conclusion of the course, the attendee will be able to perform new strabismus surgical techniques that will improve patient care and clinical outcomes. Note: Participants are required to sign an infectious disease transmission waiver / release form.
Course: LAB111A Room: N230 Fee: $165
Sunday, 1:00 - 3:00 PM Target Audience: COMPSUB EduLevel: INT
Instructor(s): Yi Ning Strube MD, Lisa S Thompson MD, Luke W Deitz MD, Rebecca S Leenheer MD**
Instructor(s): Mark A Alford MD, Richard C Allen MD PhD, Richard L Anderson MD FACS*, Robert C Kersten MD, Jill S Melicher Larson MD, Jeffrey A Nerad MD
Lab Synopsis: This course is designed to provide hands-on laboratory experience with the techniques used in upper and lower eyelid blepharoplasty. Videos of techniques will be presented, along with personal assistance with cadaver dissection. 118
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Skills Transfer Program Refractive Surgery
Phakic IOLs Course Director(s): Thomas M Harvey MD*
Recommended Didactic Course: LEC125 Room: N427d
Sunday, 3:15 - 5:30 PM Target Audience: COMPSUB EduLevel: INT Synopsis: This course will educate the participant on the use of phakic IOLs in refractive surgery. Topics of discussion will include patient selection and preoperative testing, IOL power calculations, postoperative care, complication management, surgical technique, and managing residual refractive error. Phakic IOLs currently available in the United States will be emphasized. Objective: At the course conclusion, the participant will understand indications for the use of phakic IOLs and key management aspects of phakic IOL candidates. Instructor(s): Sherman W Reeves MD MPH*, David R Hardten MD*, Jack T Holladay MD MSEE FACS*, Scott D Barnes MD**, Paul J Harton Jr MD*, Gregory Parkhurst MD*, Elizabeth A Davis MD*
Instructor(s): David R Hardten MD*, D Rex Hamilton MD*, Scott D Barnes MD**, Thomas M Harvey MD*, Andrew J Velazquez MD**, John P Berdahl MD*, Anthony J Lombardo MD PhD, William Wiley MD*, Sherman W Reeves MD MPH*, Preeya K Gupta MD*, George O Waring MD*, Gregory Pamel MD**, Andrew C Shatz MD**, Asim R Piracha MD*, Michael Vrabec MD, Paul J Dougherty MD*, Lisa Nijm MD**, Paul J Harton Jr MD*, Gregory Parkhurst MD*, Scott M MacRae MD*, Chirag S Shah MD
International Society of Refractive Surgery Laser Refractive Surgery Course Jointly Sponsored by the Academy’s Skills Transfer Advisory Committee and the International Society of Refractive Surgery (ISRS) Course Director(s): Jason E Stahl MD
Recommended Didactic Monday, 9:00 - 11:15 AM Target Audience: COMPSUB EduLevel: BAS Synopsis: This course will start with the basics of how conventional and laser microkeratomes work and what one needs to know before performing LASIK and surface ablation. It will move on to cover tips, step by step, with presentations discussing the newest applications and developments in LASIK and surface ablation. The prevention and treatment of complications will be covered in detail. Objective: This course is designed to give participants the information and skills needed for LASIK and surface ablation, including patient selection, basic principles, postoperative care, and management of complications. Course: LEC131 Room: N138
Synopsis: This wet lab is designed for those interested in learning techniques in laser refractive surgery. Mechanical microkeratomes, femtosecond lasers, excimer lasers, and corneal inlays will be available in the lab, with experienced surgeons on hand to assist with questions and to demonstrate techniques. Objective: Participants will become acquainted with a broad array of both mechanical and laser microkeratomes and how they work with excimer lasers. Note: Participants will be sharing equipment.
Course: LAB131A Room: N227b Fee: $220
Select one of the following Monday, 3:30 - 5:30 PM Target Audience: COMPSUB EduLevel: BAS
Instructor(s): Jason E Stahl MD, Daniel S Durrie MD*, Shachar Tauber MD**, Scott D Barnes MD**, Renato Ambrosio Jr MD*, John A Hovanesian MD*, David A Goldman MD*, Michael Vrabec MD, Erin D Stahl MD*, James C Loden MD*, Allen Boghossian DO, Michael J Collins MD FACS*, Ryan T Smith MD, Lisa Nijm MD**, Erik Letko MD*, Jeremy Z Kieval MD*, Jessica B Ciralsky MD*, Aylin Kilic MD, Jason P Brinton MD
Course: LAB131B Room: N227B Fee: $220
Tuesday, 8:00 - 10:00 AM Target Audience: COMPSUB EduLevel: BAS
Instructor(s): Jason E Stahl MD, David R Hardten MD*, Vance Michael Thompson MD*, Wallace Chamon MD*, Minoru Tomita MD PhD*, Parag A Majmudar MD*, Karolinne M Rocha MD, Sherman W Reeves MD MPH*, Elizabeth Yeu MD*, Duane A Wiggins MD, Raj K Goyal MD MPH*, Paul C Kang MD*, William Wiley MD*, John J DeStafeno MD*, Thomas M Harvey MD*, John P Berdahl MD*, Brandon Ayres MD*, Jodhbir S Mehta MBBS PhD*, Suphi Taneri MD*, Ashvin Agarwal, Mihai Pop MD**, Calvin G Eshbaugh MD**
The Surgical Correction of Astigmatism Course Director(s): Jean-Luc Febbraro MD*, Hamza N Khan MD FACS*
Recommended Didactic Monday, 9:00 - 11:15 AM Target Audience: COMP EduLevel: INT Synopsis: This course will supply participants with the necessary principles, theories, and practical instruction in the various forms of astigmatic keratotomy (PRI, limbal relaxing incisions) and nonincisional astigmatism correction (LASIK, toric IOLs). Objective: Attendees will gain an understanding of techniques used to evaluate and manage astigmatism as a primary procedure and as an adjunct to lens surgery. Course: LEC133 Room: N427bc
Instructor(s): Ronald N Gaster MD FACS*, David H Haight MD, Jack T Holladay MD MSEE FACS*, Douglas D Koch MD*, R Bruce Wallace MD**
Lab Synopsis: This practical wet lab course allows participants hands-on skill development to improve their management of astigmatism, identify appropriate surgical candidates for astigmatism correction, and select the best techniques for each case, either combined with lens surgery or alone. Objective: Participants will learn to mark appropriately for toric IOLs and perform corneal incisions (peripheral corneal relaxing incisions or limbal relaxing incisions), and will learn pearls and common pitfalls of each. The impact of various cataract
Instructor(s): Richard L Lindstrom MD**, Daniel S Durrie MD*, George O Waring IV MD*
NEW New Course. YO Endorsed by Young Ophthalmologists committee. W Participants are required to sign an infectious disease transmission waiver/release form. EQUIP Participants are required to bring specific equipment to the course. Education Level Key: BAS = Basic, INT = Intermediate, ADV = Advanced
119
Skills Transfer Program
Lab Synopsis: Using pig eyes, the participant will have the opportunity to practice the insertion of phakic IOLs. Instructors will be available to assist and answer questions. FDA-approved phakic IOLs will be emphasized and available for implantation. Objective: This wet lab will enable the participant to practice the surgical technique of inserting phakic IOLs. Course: LAB125A Monday, 10:30 AM - 12:00 PM Room: N228 Target Audience: COMPSUB Fee: $255 EduLevel: INT
Labs Course Director(s): George O Waring IV MD*
Skills Transfer Program incisions on astigmatism (surgically induced astigmatism) and laser vision correction will be discussed. Course: LAB133A Monday, 1:30 - 3:00 PM Room: N227b Target Audience: COMPSUB Fee: $170 EduLevel: INT Instructor(s): Ronald N Gaster MD FACS*, Paul Gilwit MD FACS, David H Haight MD, R Bruce Wallace MD**, Baseer U Khan MD*
Retina, Vitreous YO
Macular OCT: Mastering the Basics
Course Director(s): John S Pollack MD*
Recommended Didactic Sunday, 10:15 AM - 12:30 PM Target Audience: COMP EduLevel: BAS Synopsis: This course provides basic instruction on accurate interpretation of OCTs of common macular pathologies, as well as instruction on how to identify and prevent common OCT artifacts. The course also provides a clinically meaningful review of indications and limitations of OCT in the diagnosis and management of common macular diseases such as AMD, diabetic maculopathy, epiretinal membrane, macular holes, vitreomacular traction, central serous retinopathy, vascular occlusions, and postoperative cystoid macular edema. Objective: Upon completion of this course, participants should be able to (1) accurately interpret OCTs of common macular pathologies, (2) describe the indications for and limitations of OCT in the diagnosis and management of macular diseases, and (3) identify, interpret, and correct common OCT artifacts.
Skills Transfer Program
Course: LEC114 Room: E351
Instructor(s): John S Pollack MD*, Anat Loewenstein MD*, Dante Pieramici MD*, Nadia Khalida Waheed MD, Glenn C Yiu MD
thy Study and subsequently reviewing DRCRnet publications that may modify some of those recommendations. Case presentations made to a panel of experts will illustrate the role of OCT and pharmacotherapy relative to laser therapy. Objective: By the conclusion of this course, participants will be able to understand (1) the clinical indications for laser treatment of diabetic retinopathy and (2) the role of pharmacotherapy and OCT in current management of diabetic retinopathy. Instructor(s): Abdhish R Bhavsar MD*, David J Browning MD PhD*, Alexander J Brucker MD*, Emily Y Chew MD, Harry W Flynn MD, Arthur D Fu MD, Justin L Gottlieb MD, Sam Edward Mansour MD* Course Director(s): Keye L Wong MD*
Lab Synopsis: Using case presentations in small groups, the treatment algorithms guiding management of diabetic macular edema, nonproliferative diabetic retinopathy, and proliferative diabetic retinopathy will be reviewed. Panel discussions with an extensive faculty will highlight current treatment controversies in which DRCRnet results may modify Diabetic Retinopathy Study (DRS) and Early Treatment Diabetic Retinopathy Study (ETDRS) recommendations. Objective: By the conclusion of this course, participants will be able to understand the clinical indications for pharmacotherapy and laser treatment of diabetic retinopathy and to know the best treatment techniques based on DRS, ETDRS, and DRCRnet clinical trial results. Course: LAB121A Monday, 8:00 - 10:30 AM Room: N231 Target Audience: COMPSUB Fee: $120 EduLevel: INT Instructor(s): Keye L Wong MD*, Justin L Gottlieb MD, Gary W Abrams MD*, Michael M Altaweel MD*, Neal H Atebara MD, Maria H Berrocal MD*, Robert A Braunstein MD, David J Browning MD PhD*, Alexander J Brucker MD*, Clement K Chan MD*, Suresh R Chandra MD, John H Drouilhet MD FACS*, Michael S Ip MD*, Richard H Johnston MD**, James L Kinyoun MD
Lab Synopsis: This course will provide attendees with a small-group interactive format (5-6 attendees per instructor) for hands-on experience reviewing and evaluating OCTs covering a wide range of common macular diseases, with emphasis on sharpening the OCT interpretation skills of the attendees. Attendees will rotate with all instructors, covering a variety of topics, including but not limited to AMD, vascular occlusions, epiretinal membrane, vitreomacular traction, macular holes, diabetic retinopathy, and postoperative cystoid macular edema. Attendees are invited to bring one challenging case for discussion at the end of the lab, time permitting. Objective: Upon completion of this course, participants should be able to (1) identify the OCT features of normal and abnormal macular anatomy, (2) diagnose common macular pathologies based on specific OCT characteristics, and (3) identify, correct, and prevent common OCT artifacts. Course: LAB114A Sunday, 3:00 - 5:00 PM Room: N231 Target Audience: COMP Fee: $100 EduLevel: BAS Instructor(s): John S Pollack MD*, Jack A Cohen MD FACS, Dafna Goldenberg, Sanford Chen MD FACS*, Justis P Ehlers MD*, Brandon G Busbee MD*
Diabetes 2014: Course on Diabetic Retinopathy Course Director(s): Keye L Wong MD*
Recommended Didactic Course: LEC121 Room: S102abc
Sunday, 3:15 - 5:30 PM Target Audience: COMPSUB EduLevel: INT Synopsis: This course will present a rational approach to the diagnosis and treatment of diabetic retinopathy based on first understanding results and recommendations of the Diabetic Retinopathy Study and Early Treatment Diabetic Retinopa120
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest. Target Audience: COMP = Comprehensive Ophthalmologist, SUB = Subspecialist, COMPSUB = Comprehensive & Subspecialist, ADMIN = Administrators
Cataract Retinal
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ReSure Sealant is indicated for intraoperative management of clear corneal incisions (up to 3.5mm) with a demonstrated wound leak for which a temporary dry surface can be achieved, in order to prevent postoperative fluid egress from such incisions following cataract surgery with intraocular lens (IOL) placement in adults.
Opening Session Opening Session
Sunday, Oct. 19 8:30 – 10:00 AM North, Hall B Join your colleagues to launch AAO 2014, the Academy’s 118th meeting, in conjunction with the European Society of Ophthalmology. Hear from the Academy’s President, Executive Vice-President and CEO, as well as the SOE President. Celebrate the leaders in our profession and hear Hans E. Grossniklaus, MD give this year’s Jackson Memorial Lecture. Listen to a panel of distinguished colleagues discuss how to prepare residents for the future practice of ophthalmology. Time 8:30 AM
Topic Opening Remarks
Speaker Jonathan B Rubenstein MD
8:32 AM
SOE President’s Address
Stefan Seregard MD
8:38 AM
Academy President’s Address
Gregory L Skuta MD
8:44 AM
Academy Awards
8:56 AM
Laureate Award: Jerry A Shields MD
Carol L Shields MD
8:59 AM
Academy’s Executive Vice-President’s Address
David W Parke II MD
9:05 AM
Academy’s President-Elect’s Address
9:10 AM
Can We Better Prepare the Residents of 2015 for the Practice of 2020?
9:30 AM
Introduction of the Jackson Memorial Lecture
Russell N Van Gelder MD PhD Moderator: Thomas A Oetting MD Panelists: Nicholas J Volpe MD, Tara A Uhler MD, Paul Sternberg Jr MD, Anthony C Arnold MD Jonathan B Rubenstein MD
9:32 AM
Jackson Memorial Lecture: Retinoblastoma: 50 Years of Progress
Hans E Grossniklaus MD
9:57 AM
Jackson Memorial Lecture Award Presentation
Thomas J Liesegang MD
9:58 AM
Concluding Remarks
Jonathan B Rubenstein MD
10:00 AM
End of Session
You can experience the Opening Session through the Virtual Meeting: www.aao.org/virtual-meeting. Virtual Moderator: Matthew W Wilson MD
2014 Laureate Award: Jerry A Shields MD
Jackson Memorial Lecture: Hans E Grossniklaus MD
Dr. Shields is director of the Ocular Oncology Service at Wills Eye Hospital and Professor of Ophthalmology at Thomas Jefferson University. For more than 40 years, Dr. Shields has been active caring for patients with tumors of the eyelids, conjunctiva, intraocular structures, and orbit. Through clinical research he has helped pioneer methods of diagnosis and management of these conditions.
Dr. Grossniklaus is director of the L.F. Montgomery Laboratory and the founding director of the Ocular Oncology and Pathology service of Emory Eye Center. He is board certified in both ophthalmology and anatomic pathology. Dr. Grossniklaus is also Professor of Ophthalmology and Pathology, Oculo-Pathology, at the Emory University School of Medicine.
2014 Academy Awards Guests of Honor
Straatsma Award for Excellence in Resident Education
Richard K Parris II MD M Bruce Shields MD Richard Zorab MSc
Laura L Wayman MD
International Blindness Prevention Award
Distinguished Service Award
European Society of Ophthalmology (SOE)
Special Recognition Award Richard P Mills MD
Rubens Belfort Jr MD PhD
Outstanding Advocate Award Cynthia Mattox MD FACS Kenneth D Tuck MD FACS
Outstanding Humanitarian Service Award Donald L Budenz MD MPH Alan S Crandall MD
For a full description of all Academy Awards and award recipients, turn to Tab 1, Awards, page 1. Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
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ACADEMY CAFÉ Saturday - Tuesday, Oct, 18 - 21 Room S404 Engage in the conversation: hear expert panels debate, then use your cell phone, smartphone or laptop to text message the speakers your questions. How to submit a question: Point the browser on your laptop or wireless mobile device to http://ai.acuport.org and log in with your Badge ID and Password or send SMS text to 41411 with the keyword ACafe followed by a space and your question (example: “ACafe Here is my question”).
Free Coffee. Your Questions. Expert Panels. Lively Conversation.
Note: For SMS, standard text messaging fees may apply based on your wireless plan.
Saturday, Oct. 18 SYM50 IRIS Registry
1:15 – 2:30 PM
SYM51 Cataract
3:15 – 4:30 PM
Moderator: William L Rich MD Panel: Michael F Chiang MD*, Cynthia Mattox MD FACS* Moderator: Terry Kim MD* Panel: Quentin B Allen MD*, John P Berdahl MD*, Elizabeth Yeu MD*, Lisa Park MD, Brandon Ayres MD*
Sunday, Oct. 19 SYM52 Glaucoma
10:30 – 11:45 AM
SYM53 Cornea, External Disease
1:00 – 2:15 PM
SYM54 Retina
2:30 – 3:45 PM
Moderator: Thomas W Samuelson MD* Panel: Anjali M Bhorade MD, Reay H Brown MD*, Marlene R Moster MD*, Nathan M Radcliffe MD*, Kuldev Singh MD MPH* Moderator: Edward J Holland MD* Panel: Clara C Chan MD*, Douglas A Katsev MD*, William Barry Lee MD*, Neda Shamie MD* Moderator: Thomas R Friberg MD* Panel: Carl C Awh MD*, Brian B Berger MD*, Alan F Cruess MD*
Monday, Oct. 20 SYM55 Uveitis
SYM56 Oculoplastics
8:30 – 9:45 AM
10:30 – 11:45 AM
Moderator: Justine R Smith MD* Panel: Russell Read MD PhD*, Howard Tessler MD*, Jennifer E Thorne MD PhD*, Daniel V Vasconcelos-Santos MD PhD Moderator: Stuart R Seiff MD Panel: Malena M Amato MD, Suzanne K Freitag MD, Jeffrey A Nerad MD, Bryan S Sires MD PhD
Tuesday, Oct. 21 SYM57 Cataract
10:30 – 11:45 AM
Moderator: Richard S Hoffman MD* Panel: Lisa B Arbisser MD*, George Beiko MD*, Carlos Buznego MD*
P.O. Box 7424, San Francisco, CA 94120-7424 | Tel: 415-561-8500 Fax: 415-561-8533 © 2014 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology.
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Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
SPOTLIGHT SESSIONS AND SYMPOSIA
Saturday - Tuesday, Oct. 18 - 21 Spotlight Sessions and Symposia are free of charge and open to all attendees. SOE Sponsored by the European Society of Ophthalmology SA
Designated as self-assessment credit and is pre-approved by the ABO for the Maintenance of Certification (MOC) Part II CME requirements. EHR Electronic Health Records GO Global Ophthalmology SO Endorsed by Senior Ophthalmologist Committee YO Endorsed by Young Ophthalmologist Committee
Selection Committee The Special Projects Committee developed: the Spotlights on Pediatric Ophthalmology, Glaucoma and Neuro-Ophthalmology; the Great Debates: Retina and Cornea; the Best of Anterior and Posterior Segment Specialty Meetings 2014; Grand Rounds; the Academy Cafés and Hot Topics 2014. The Annual Meeting Program Committee selected all other spotlight sessions and symposia. See page 33 for committee details.
P.O. Box 7424, San Francisco, CA 94120-7424 | Tel: 415-561-8500 Fax: 415-561-8533 © 2014 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology.
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
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Spotlight Sessions & Symposia Saturday, Oct. 18 GO Global Symposium: Low Vision Rehabilitation and New Technologies for the Developing World
Spotlight Sessions & Symposia
Event No: SYM01 Room: S405
2:00 - 3:30 PM
Combined meeting with the Academys Global Education and Outreach Committee Chair(s): Mary Lou Jackson MD*, Brad H Feldman MD This inspiring and forward-looking symposium will address two distinct but critically important aspects of ophthalmology in the developing world: visual rehabilitation for those with low vision and the potential of new technologies to improve eye care. The challenges unique to approaching these problems in the developing world will be discussed by international experts who will share their personal successes and failures. You will hear their perspectives on how we as a global community are developing innovative solutions to some of the largest problems in vision and eye care. Part 1: Low Vision Rehabilitation 2:00 PM Introduction Mary Lou Jackson MD* 2:02 PM Resident Education about Vision Loss and Rehabilitation Mary Lou Jackson MD* 2:08 PM Vision Rehabilitation in Patients with Multiple Disabilities Linda M Lawrence MD 2:16 PM Setting Targets and Measuring Outcomes Karen Wolffe PHD 2:24 PM Integrating Vision Rehabilitation into Comprehensive Eye Care Muhammad M Rabiu MD 2:32 PM Panel Discussion 2:42 PM Break Part 2: New Technologies for the Developing World 2:47 PM Introduction Brad H Feldman MD 2:49 PM WHO initiatives to Improve Access to Appropriate Medical Devices Ivo Kocur MD** 2:57 PM Developing Technologies for Global Eye Care: PEEK 3:05 PM Evaluating Technologies in Global Eye Care: Self-adjustable Glasses Nathan G Congdon MD 3:13 PM Bringing Affordable Technologies and Products to Market Siriam Ravilla Duraisamy* 3:21 PM Panel Discussion 3:30 PM End of Session SOE Conference for Ophthalmic Educators: Improving Teaching Effectiveness
Event No: SYM58 Room: S104ab
2:00 - 5:30 PM
Combined meeting with the International Council of Ophthalmology (ICO) and the European Society of Ophthalmology (SOE) Chair(s): Ana Gabriela Palis MD, Eduardo P Mayorga MD*, Karl C Golnik MD The Conference for Ophthalmic Educators offers expert instruction, interactive workshops, and group discussion for ophthalmic educators. Educators of ophthalmology residents, fellows, medical students, CME, and allied health will learn about the latest tools and practice techniques of modern education. These sessions will help educators at any experience level to improve teaching effective124
ness and provide an opportunity to connect with other educators from around the world. Past conferences have been held in Argentina, South Korea, India, Brazil, Denmark, and Australia. Open to all AAO 2014 registered attendees. For more information: www.icoph.org/ConfEdsChicago2014. 2:00 PM Welcome and Introductions - Goals and Review of the Agenda and Workshops Ana Gabriela Palis MD 2:10 PM Plenary Session I Critical Thinking Eduardo P Mayorga MD* Curriculum Adaptation Ana Gabriela Palis MD Assessment Principles Simon J Keightley MBBS 2:25 PM Workshop Session 1 Helping Residents Develop Critical Thinking Eduardo P Mayorga MD* Curriculum Adaptation Ana Gabriela Palis MD, Peter A Quiros MD Assessment Principles and Tools Simon J Keightley MBBS, Clare C Davey MD**, Nicola Quilter 3:20 PM Large Group Discussion of Workshops 3:35 PM Break 3:55 PM Plenary Session II 3:55 PM Webinars Matthew D Gearinger MD Effective Feedback Andreas Lauer MD* Developing Workshops Karl C Golnik MD 4:10 PM Workshop Session 2 Presenting on the Web: How to Develop Successful Webinars Prashant Garg MD*, Matthew D Gearinger MD Effective Structured Feedback and Resident Remediation Andreas Lauer MD*, Helena Prior Filipe MD Developing Workshops Karl C Golnik MD 5:05 PM Large Group Discussion of Workshops 5:20 PM Wrap-up 5:30 PM Adjourn
Sunday, Oct. 19 YO Introduction to Corneal and Lens-Based Refractive
Surgery for Residents
Event No: SYM02 Room: E450
8:00 - 11:00 AM
Sponsored by the International Society of Refractive Surgery (ISRS) Chair(s): J Bradley Randleman MD, Ronald R Krueger MD* This course will provide an overview of the most relevant topics on corneal and lens-based refractive surgery, including patient evaluation, topographic evaluation, a step-by-step surgical explanation of LASIK and surface ablation procedures, discussion of surgical complication recognition and management, and decision trees for choosing appropriate premium IOL candidates and managing complications unique to these individuals. This will provide a basis upon which
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Spotlight Sessions & Symposia Sunday, Oct. 19 (cont.)
Free and Easy for Low Vision: Help and Resources for the Visually Impaired Event No: SYM03 Room: S102d
9:00 - 10:00 AM
Combined meeting with the Vision Rehabilitation Committee Chair(s): John Shepherd MD, Richard A Harper MD Vision loss adversely affects function and quality of life. It has been demonstrated that vision rehabilitation and “self management” programs improve the function and quality of life for the visually impaired. Fortunately, information and support are available from many organizations—local, national and online. This symposium will inform the ophthalmologist about the ready availability of support, information, resources, and other help, often either free or at low cost, for those with vision loss. Emerging technology such as free apps for smart phones and tablets will be discussed, as well as help from traditional organizations for the blind and visually impaired. After attending this symposium, ophthalmologists will know of currently available resources and organizations that will help their visually impaired patients cope with the problems of vision loss and will be
Spotlight on Pediatric Ophthalmology: Front Line and First Steps — Management of Strabismus for the Comprehensive Ophthalmologist Event No: SPO1 Room: Grand Ballroom S100ab
10:30 AM - 12:00 PM
Chair(s): Laura B Enyedi MD, Michelle J Cabrera MD Virtual Moderator: Erin O Schotthoefer MD This Spotlight symposium will emphasize practical tips that the comprehensive ophthalmologist can use in evaluating and managing strabismus and diplopia in both adults and children. It will follow a case-based format, including panel discussion. Panelists will include pediatric ophthalmologists, strabismus surgeons, and neuro-ophthalmologists. Speakers will highlight clinical pearls for evaluating and managing the following conditions: accommodative esotropia, intermittent exotropia, isolated cranial neuropathies, diplopia in an elderly patient, thyroid eye disease, and sensory strabismus. Participants will gain knowledge in the use of prisms for diplopia management, when to image, and other pearls in systemic workup for diplopia, as well as strategies for examining and managing uncooperative children.
10:30 AM Accommodative Esotropia Tammy L Yanovitch MD 10:40 AM Panel Discussion 10:45 AM Intermittent Exotropia Erin P Herlihy MD 10:55 AM Panel Discussion 11:00 AM Isolated Cranial Neuropathies Mitchell B Strominger MD 11:10 AM Panel Discussion 11:15 AM Elderly Patient With Diplopia Nandini G Gandhi MD** 11:25 AM Panel Discussion 11:30 AM Thyroid Eye Disease Shira L Robbins MD* 11:40 AM Panel Discussion 11:45 AM Sensory Strabismus Erick D Bothun MD 11:55 AM Panel Discussion 12:00 PM End of Session
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Spotlight Sessions & Symposia
these individuals in training may begin to grow their knowledge base and gain comfort in practicing independently after graduation. The course will be an interactive didactic session led by recognized experts and international leaders in the field of refractive surgery, but will be specifically directed at the resident education level, as opposed to many of the courses at AAO directed towards specialists already in practice. This focus should allow the resident to gain the optimal learning experience. Corneal Laser-Based Refractive Surgery Options 8:00 AM Welcome and Opening Remarks J Bradley Randleman MD 8:05 AM Basic LASIK Patient Evaluation Ronald R Krueger MD* 8:30 AM Topographic and Tomography Evaluation J Bradley Randleman MD 8:50 AM Discussion: Patient Screening 9:00 AM Step-by-Step PRK and LASIK Sonia H Yoo MD* 9:20 AM Decision Tree: When PRK and LASIK Marguerite B McDonald MD* 9:30 AM LASIK/PRK Complications and Management David R Hardten MD* 9:50 AM Discussion: Avoiding Complications Lens-Based Refractive Surgery Options 10:00 AM Diagnostic Tools for Achieving Refractive Outcomes George O Waring MD* 10:20 AM Toric, Multifocal, and Accommodating IOLs and Patient Selection Bonnie A Henderson MD* 10:40 AM Video Cases: Techniques and Complications 10:50 AM Discussion: Lens-based Options 10:58 AM Closing Remarks Ronald R Krueger MD* 10:59 AM Closing Remarks J Bradley Randleman MD 11:00 AM End of Session
able to prevent the depression and isolation that all too frequently result from diminished vision. 9:00 AM Introduction John Shepherd MD 9:02 AM Free or Inexpensive Apps for iPhone, iPad and Other Devices Donald Calvin Fletcher MD 9:14 AM Education for the Blind and Visually Impaired: Hadley School for the Blind Online Courses, the Braille Institute, and Others Paul Homer MD 9:24 AM Help from Others: Support Groups—Local, National, and Online Help for the Visually Impaired Joseph L Fontenot MD 9:34 AM Federal and State Programs and Services: Department of Rehabilitation, Vocational Rehabilitation, and Other National Programs Suzanne B Mitchell** 9:44 AM Organizations Offering Services to the Blind and Visually Impaired: Who Are They, and How Do They Help Your Patient? Mary Lou Jackson MD* 9:54 AM Q&A and Panel Discussion 10:00 AM End of Session
Spotlight Sessions & Symposia Sunday, Oct. 19 (cont.)
Update on Molecular Analysis in Ophthalmic Disease
Spotlight Sessions & Symposia
Event No: SYM05 Room: E350
10:30 AM - 12:00 PM
Combined meeting with the American Association of Ophthalmic Oncologists and Pathologists (AAOOP) Chair(s): Debra J Shetlar MD, R Nick Hogan MD PhD Over the past few years, there have been significant advances in our knowledge of the genetics of ocular diseases. Some of these advances are being used to enhance our ability to diagnose and treat these conditions. This symposium will serve to update the audience on molecular advances in ocular disease, with an emphasis on those advances that have translated to diagnostic and therapeutic advances and have had an impact on clinical practice. 10:30 AM Introduction Hans E Grossniklaus MD* 10:32 AM Update on Growth Factors in AMD Joan W Miller MD* 10:40 AM Update on Pathogenesis and Treatment of Diabetic Eye Disease Lloyd P Aiello MD PhD* 10:48 AM Use of Molecular Techniques in the Diagnosis and Treatment of Ocular Infections Patricia Chevez-Barrios MD 10:56 AM Update on Molecular Pathology of Choroidal Melanoma Joan M O’Brien MD 11:04 AM Update on Molecular Pathology of Retinoblastoma Matthew W Wilson MD 11:12 AM Q&A
ZIMMERMAN LECTURE 11:19 AM Introduction of the Zimmerman Lecturer Myron Yanoff MD 11:22 AM Zimmerman Lecture: The Yin and Yang of the Opioid Growth Regulatory System: Focus of Diabetes Joseph W Sassani MD* 11:58 AM Presentation of the Zimmerman Medal Hans E Grossniklaus MD* 12:00 PM End of Session
Treatment for Wet and Dry AMD: Where We Are and Where We Are Going Event No: SYM06 Room: S406a
10:30 AM - 12:00 PM
Combined meeting with American Society of Retina Specialists (ASRS) Chair(s): G Baker Hubbard MD* Virtual Moderator: Jorge A Fortun MD** With the large and growing number of patients affected by AMD, it is becoming increasingly important to balance efficacy of treatment with time and cost burdens on patients and health-care delivery systems. Presently the mainstay for treatment of wet AMD is anti-VEGF therapy. Optimal dosing regimens and the choice of agents in particular circumstances, however, remain uncertain. No proven treatments exist for dry AMD except nutritional supplements and lifestyle strategies that may reduce risk of progression. This symposium will review various strategies for optimizing outcomes for patients with AMD. The latest data on regimens to balance outcomes with treatment burden will be presented. In addition, promising new treatments under investigation for both wet and dry AMD will be reviewed. Case presentations and discussions by a panel of experts will 126
highlight areas of controversy and consensus. Panel members will offer insights into the evolution of AMD treatment in the next several years. 10:30 AM Introduction G Baker Hubbard MD* 10:32 AM AMD: Overview of AMD Risk Factors, Pathogenesis, and Imaging R Theodore Smith MD 10:42 AM Role of Nutritional Supplements and Lifestyle Strategies to Reduce Risk Emily Y Chew MD 10:52 AM Wet AMD Treatment: Risks and Benefits of the 3 Anti-VEGF Medicines Philip J Rosenfeld MD PhD* 11:02 AM Dosing Strategies and Combination Therapy to Optimize Outcomes (PDT, Focal Laser, Submacular Surgery) Jeffrey S Heier MD* 11:12 AM Future Treatments for AMD Timothy W Olsen MD* 11:22 AM Case Presentations and Panel Discussion 11:57 AM Summary and Closing Remarks G Baker Hubbard MD* 12:00 PM End of Session
Update 2014: Infectious Keratitis Event No: SYM07 Room: Grand Ballroom S100c
10:30 AM - 12:00 PM
Combined meeting with the Contact Lens Association of Ophthalmologists (CLAO) Chair(s): Deepinder K Dhaliwal MD*, Deborah S Jacobs MD* This symposium will present current information on the diagnosis and treatment of infectious keratitis. Speakers will present case examples of the various types of infectious keratitis, including bacterial, viral, fungal, and parasitic causes, as well as advances in diagnosis and treatment over the last decade. Therapeutic outcomes of medical treatment, as well as advances in pharmaceutical therapies, will be presented. The symposium concludes with the Whitney G Sampson MD lecture. 10:30 AM Introduction Deepinder K Dhaliwal MD* 10:32 AM Risk Factors for Infection with Contact Lens Wear: Lessons Learned in the Last 10 Years Oliver Douglas Schein MD* 10:40 AM The Role of the FDA in Reducing Cases of Contact Lens-Related Infectious Keratitis Malvina Eydelman MD 10:48 AM The Role of Biofilm Michael E Zegans MD* 10:56 AM Update and Case Studies in the Treatment of Bacterial Keratitis and the Role of Steroids Jennifer R Rose-Nussbaumer MD 11:04 AM Update and Case Studies in the Treatment of Herpes Simplex Virus Keratitis Rookaya Mather MBBCH* 11:12 AM Update and Case Studies in the Treatment of Varicella Zoster Virus Keratitis and the Role of Zostavax Elisabeth J Cohen MD 11:20 AM Update and Case Studies in the Treatment of Fungal Infections Denise de Freitas MD
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Spotlight Sessions & Symposia Sunday, Oct. 19 (cont.) WHITNEY G SAMPSON MD LECTURE
Cataract Surgery: The Cutting Edge Event No: SYM08 Room: North Hall B
11:28 AM Introduction of the Whitney G Sampson MD Lecture Deepinder K Dhaliwal MD* 11:31 AM Whitney G Sampson MD Lecture: Little Things Do Matter: Individual Case Studies and the Complex Role of Risk Factors in Acanthamoeba Keratitis Elmer Tu MD 11:56 AM Award Presentation Deborah S Jacobs MD* 11:58 AM Concluding Remarks Deepinder K Dhaliwal MD*
Chair(s): Robert H Osher MD*
12:00 PM End of Session
Event No: SYM09 Room: S406a
The Food and Drug Administration/National Eye Institute/Department of Defense LASIK Quality of Life Project Event No: SYM59 Room: E450
11:30 AM - 12:30 PM
Panelists: Douglas D Koch MD*, Richard Mackool MD*, Boris Malyugin MD PhD*, Amar Agarwal MD*, Armando Crema MD**, Thomas Kohnen MD*
To stimulate a panel discussion, this symposium will present short videos of novel ideas, techniques, and devices from cataract surgeons around the world. Expect controversy and spirited debate from the expert international panel. Guaranteed to keep you on the edge of your seats!
Michael F Marmor MD Lecture in Ophthalmology and the Arts
12:45 - 1:45 PM
Chair(s): Michael F Marmor MD* In this lecture, Mark Foster Gage will illustrate the often uncelebrated, yet significant links between theories of sight and some of the most dramatic innovations in the history of architecture. 12:45 PM Introduction Michael F Marmor MD* 12:50 PM Architecture, Ophthalmology and the Seeing of Space Mark Foster Gage, Principal, Mark Foster Gage Architects and Assistant Professor, Yale School of Architecture 1:15 PM Discussion 1:45 PM End of Session EHR EHRs: Improve Quality, Cost-Effectiveness and Your Headaches
Event No: SYM10 Room: S406b
12:45 - 1:45 PM
Combined meeting with the Committee on Medical Information Technology (CMIT) Chair(s): Michael F Chiang MD* Ophthalmology is unique in its clinical workflow. Ophthalmologists need systems that can be integrated into a busy workflow, that can provide clinical images and data frequently associated with patient visits, and that can help them meet reporting and information exchange requirements. Payment incentives associated with federal “meaningful use” criteria are accelerating the adoption of EHRs, but it is necessary that these systems actually help ophthalmologists deliver care efficiently. The purpose of this symposium will be to highlight successful EHR implementation stories for audience members. The session will explore the impact of EHR systems on point-of-care clinical decision support, new patient-centric care delivery methods, personalized medicine, data analysis opportunities, integration with imaging and information systems in the office, and ultimately on the bottom line or economics of the practice. 12:45 PM Setting the Stage: What Do We Know about How EHRs Benefit Health Care? Michael F Chiang MD* 12:55 PM How EHRs and Expert Systems Will Change How We Practice James D Brandt MD* 1:05 PM The Positive Impact of EHRs on Cost-Effectiveness (the Bottom Line) Robert E Wiggins MD MHA* 1:15 PM The Positive Impact of EHRs on Data Integration and Accessibility Jeffrey L Marx MD 1:25 PM Panel Discussion and Q&A 1:45 PM End of Session
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Spotlight Sessions & Symposia
Chair(s): Frederick L Ferris MD*, Malvina Eydelman MD The LASIK Quality of Life Collaboration Project (LQOLCP), a government partnership among the Food and Drug Administration (FDA), the Department of Defense (DoD), and the National Eye Institute (NEI), examines patient-reported outcomes (PROs) following LASIK. Initial work showed that previously developed paperbased ophthalmic questionnaires could be administered using the web and yield valid measurements. Following this work, the FDA, DoD, and NEI worked collaboratively with patient input and clinical expertise to develop the Patient Reported Outcomes with LASIK (PROWL) questionnaire, preoperative and postoperative versions. To assess the validity of the questionnaire, we conducted the PROWL-1 study, where U.S. military personnel electing LASIK completed the questionnaire before surgery and at 1, 3, and 6 months after surgery. To determine whether the questionnaire behaved similarly in the general LASIK population, we conducted PROWL-2, a multicenter national clinical study. The LQOLCP datasets contain detailed information on clinical characteristics of the patients, their surgical procedures, and their reported (PROWL questionnaire) and measured clinical outcomes. 11:30 AM Introduction to the LASIK Quality of Life Collaboration Project C P Wilkinson MD* 11:35 AM Overcoming the Study Conduct Challenges: Perspectives from EMMES, the Contract Research Organization Keri Renee Hammel MS* 11:40 AM Web vs. Paper Ophthalmic PRO Assessments Susan Vitale PhD MHS 11:47 AM Development and Validation of the PROWL Questionnaire Ronald Hays PhD* 11:55 AM Findings from the Navy Study: PROWL-1 Elizabeth M Hofmeister MD 12:05 PM Findings from the Multicenter Civilian Study: PROWL-2 Malvina B Eydelman MD 12:15 PM Summary Frederick L Ferris MD* 12:20 PM Question & Answers 12:30 PM End of Session
12:15 - 1:45 PM
Spotlight Sessions & Symposia 2:19 PM
Sunday, Oct. 19 (cont.)
Grand Rounds: Cases and Experts From Across the Nation Event No: SYM12 Room: Grand Ballroom S100ab
2:00 - 3:15 PM
Chair(s): Nicholas J Volpe MD
Spotlight Sessions & Symposia
Panelists: Alfredo A Sadun MD PhD*, Alexander J Bruker MD*, Lee M Jampol MD*, Raymond S Douglas MD PhD* Virtual Moderator: Andreas K Lauer MD* Real residents present real cases from real department grand rounds. Residents chosen from different academic programs will present cases to a panel of experts followed by Q&A and discussion by the panel. 2:00 PM Introduction and Welcome Remarks Nicholas J Volpe MD 2:02 PM I Can’t Close My Eye Craig W See MD** 2:13 PM 49-year-old With Irritation and Inability to Close My Eyes Solly Elmann MD** 2:24 PM 13-year-old Girl With Acute Bilateral Vision Loss Andrew W Stacey MD** 2:35 PM Not This, Nor That Andrew J McClellan MD 2:46 PM 57-year-old With Pain, Proptosis and Ophthalmoplegia Avni V Pate, MD** 2:58 PM Another Case of High Pressure Jiaxi Ding MD 3:10 PM Closing Remarks Nicholas J Volpe MD
The Great Debate: Retina Event No: SYM47 Room: E450
2:00 - 3:15 PM
Chair(s): Peter K Kaiser MD* This symposium will be structured as a lively, old-fashioned debate. Groups of debaters will argue the pros and cons of controversial topics. Speakers will have the opportunity to present prepared statements and then will have a chance to rebut those of their opponents. Audience voting will be used to determine which speakers were most effective in stating their arguments. 2:00 PM Introduction Peter K Kaiser MD* Anti-VEGF Should Be the Initial Treatment for Macular Edema 2:05 PM Introduction of Question and Audience Voting 2:06 PM Pro Neil M Bressler MD* 2:09 PM Con Darius M Moshfeghi MD* 2:12 PM Pro Rebuttal 2:13 PM Con Rebuttal 2:14 PM Audience Voting There is a Safety Difference Between the Anti-VEGF Agents 2:15 PM Introduction of Question and Audience Voting 2:16 PM Pro Robert L Avery MD* 128
Con Jeff S Heier MD* 2:22 PM Pro Rebuttal 2:23 PM Con Rebuttal 2:24 PM Audience Voting There is a Difference in Efficacy Between the Anti-VEGF Agents 2:25 PM Introduction of Question and Audience Voting 2:26 PM Pro Allen C Ho MD* 2:29 PM Con Daniel F Martin MD 2:32 PM Pro Rebuttal 2:33 PM Con Rebuttal 2:34 PM Audience Voting Ocriplasmin is Not Safe to Use in VMT Patients 2:35 PM Introduction of Question and Audience Voting 2:36 PM Pro Mark W Johnson MD* 2:39 PM Con Baruch D Kuppermann MD PhD* 2:42 PM Pro Rebuttal 2:43 PM Con Rebuttal 2:44 PM Audience Voting Wide Field Imaging is a Necessary Imaging Device for Your Office 2:45 PM Introduction of Question and Audience Voting 2:46 PM Pro Szialard Kiss MD* 2:49 PM Con K Bailey Freund MD* 2:52 PM Pro Rebuttal 2:53 PM Con Rebuttal 2:54 PM Audience Voting 2:55 PM Conclusions Peter K Kaiser MD* 3:00 PM End of Session SOE A View Across the Pond: Current Cataract and IOL Practices in Europe and the United States
Event No: SYM04 Room: North Hall B
2:00 - 3:30 PM
Joint Session with the European Society of Ophthalmology (SOE) Chair(s): Bonnie A Henderson MD*, Jan-Tjeerd H N de Faber MD Cataract surgery with an implantation of an intraocular lens is one of the most common ophthalmologic procedures performed in the world. However, the surgical technique, choice of IOLs, and management of the eye differ from country to country. In this symposium, several key differences between surgeries performed in Europe vs in the United States will be highlighted. Top experts will present the viewpoints from their respective continents about management of subluxated lenses, presbyopia correcting IOLs, antibiotic prophylaxis, and governmental approval of new innovations. Don’t miss this Ryder Cup for Ophthalmology! 2:00 PM Introduction Bonnie A Henderson MD* 2:02 PM Scleral Fixated IOLs Roger F Steinert MD*
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Spotlight Sessions & Symposia RUEDEMANN LECTURE
Sunday, Oct. 19 (cont.) 2:10 PM 2:18 PM 2:26 PM 2:34 PM 2:42 PM
2:50 PM 2:58 PM 3:06 PM 3:26 PM 3:30 PM
FDA: Friend or Foe Stephen S Lane MD* Antibiotic Prophylaxis in the United States David F Chang MD* Multifocal IOLs in the United States Robert J Cionni MD* Trifocal IOLs in Europe Rudy Nuijts MD* The Netherlands: Missing the Bag? Artisan the Solution With a Dutch Touch Jan-Tjeerd H N de Faber MD IOLs in Children M Edward Wilson Jr MD Antibiotic Prophylaxis in Europe Peter James Barry MD* Panel Discussion Conclusion Jan-Tjeerd H N de Faber MD End of Session
Making a Bad Situation Better: Retinoblastoma and the Anophthalmic Socket 2:00 - 3:30 PM
Combined meeting with the American Society of Ocularists (ASO) Chair(s): Jonathan W Kim MD, Doss K Tannehill BCO BADO Enucleation remains the most common treatment for children diagnosed with retinoblastoma. There are special considerations when managing the anophthalmic socket of a retinoblastoma patient, such as the young age of the patients, concomitant use of chemotherapy and/or radiation, and increased risk of complications. Ophthalmologists and ocularists will attend this joint symposium to discuss and review the comprehensive care of the anophthalmic socket in a child diagnosed with retinoblastoma. The topics include blepharoptosis in the retinoblastoma patient, socket reconstruction in retinoblastoma patients, psychological implications of enucleation in young children, and options for implant pegging in retinoblastoma patients. 2:00 PM Blepharoptosis in the Retinoblastoma Patient Donnie R Franklin BCO** 2:08 PM Socket Reconstruction in Retinoblastoma Patients James H Merritt MD 2:16 PM Psychological Implications of Enucleation in Young Children William R Trawnik BCO 2:24 PM Tips for Fitting the Pediatric Patient after Enucleation Pascale Scuflaire BCO 2:32 PM Socket Considerations for Patients Undergoing Chemotherapy and/or Radiation Jonathan W Kim MD 2:40 PM Implant Exposure in Retinoblastoma Patients Jonathan W Kim MD 2:48 PM Ideal Implant Choices for Retinoblastoma Patients Jesse L Berry MD 2:56 PM Q&A
3:06 PM
3:26 PM 3:30 PM
Introduction of the Ruedemann Lecture Doss K Tannehill BCO BADO Ruedemann Lecture: Understanding the Dynamics of Managing the Anophthalmic Socket When Things Go Wrong Michael C Webb BCO Presentation of Award Doss K Tannehill BCO BADO End of Session
Hot Topics 2014 Event No: SYM14 Room: S406a
2:00 - 3:30 PM
Chair(s): Maria M Aaron MD Get a quick take on hot topics for the year. Designed for the comprehensive ophthalmologist, the hot topics symposium is a series of 10-minute talks on emerging trends, technologies and therapies across ophthalmology. 2:00 PM Introduction Maria M Aaron MD 2:01 PM Sun Exposure and the Development of Pseudoexfoliation Syndrome Louis R Pasquale MD* 2:11 PM Head Trauma and Neuro-Ophthalmology Laura J Balcer MD MSC** 2:21 PM IgG4 Disease Elizabeth A Bradley MD 2:31 PM SMILE/ReLEx Laser Surgery Dan Z Reinstein MD* 2:41 PM Small Aperture Implants to Achieve Depth of Focus John Allen Vukich MD* 2:51 PM Comparison of CTL and IOL Correction of Monocular Aphakia During Infancy Scott R Lambert MD* 3:01 PM Telemedicine Screening for ROP Graham E Quinn MD* 3:11 PM Aflibercept, Dexamethasone Intravitreous Implant, or Fluocinolone Acetonide Implants Neil M Bressler MD* 3:21 PM Emerging Treatments for Dry AMD Baruch D Kuppermann MD PhD* 3:31 PM End of Session
Contemporary Management of Orbital Fractures: An International Perspective Event No: SYM15 Room: E350
2:00 - 3:30 PM
Combined meeting with the American Society of Ocular Trauma (ASOT) Chair(s): Michael P Grant MD PhD**, Don Kikkawa MD* The evaluation and optimal treatment of patients with orbital fractures continues to inspire great debate. Many of the current treatment paradigms were established prior to modern imaging and still persist today. Absent are clear, agreed upon criteria for treatment and established outcome measures. In this symposium a panel of international experts will present their current practice pattern for treatment of orbital fractures. Advanced technology, such as image-guided surgery, preoperative planning, and STL modeling, will be discussed, and its ap-
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Spotlight Sessions & Symposia
Event No: SYM13 Room: Grand Ballroom S100c
3:04 PM
Spotlight Sessions & Symposia 3:56 PM
Sunday, Oct. 19 (cont.) plication to orbital fractures will be illustrated. After 4-5 brief presentations, a case-based interactive learning session will be the focus of the symposium. 2:00 PM Introduction Michael P Grant MD PhD** 2:02 PM Workflow in the Evaluation and Treatment of Acute Orbital Injuries Nicholas R Mahoney MD 2:10 PM Management of Orbital Foreign Bodies Christopher P Fleming MD** 2:18 PM Diplopia and Extraocular Muscle Dysfunction in Orbital Fractures Kyung In Woo MD 2:26 PM Special Considerations in the Management of Pediatric Orbital Trauma Louise A Mawn MD* 2:34 PM Delayed Reconstruction of Complex Orbital Defect: The Role of Preoperative Planning, Rapid Prototype Modeling, and Navigation Xianqun Fan MD PhD 2:42 PM Case-Based Interactive Learning Session
HELEN KELLER LECTURE 3:02 PM
Spotlight Sessions & Symposia
3:04 PM
3:29 PM 3:30 PM
Introduction of the Helen Keller Lecturer Ferenc P Kuhn MD PhD Helen Keller Lecture: The Concept of the Buttresses of the Orbit in Treatment Paul N Manson MD FACS Presentation of Award End of Session
Tumors of the Brain and Orbits: Neuro-Ophthalmic Considerations Event No: SYM16 Room: Grand Ballroom S100ab
3:30 - 5:30 PM
Combined meeting with the North American Neuro-Ophthalmology Society (NANOS) Chair(s): Timothy J McCulley MD, Mays A El-Dairi MD* Missing malignancy or other neoplasm is one of the most common fears among comprehensive and neuro-ophthalmologists alike. Neoplastic disease can present with any number of elusive signs and symptoms. Balancing the contemporary pressures to control cost and avoid medico-legal repercussions against our primary goal of providing the best care possible for our patients has never been more daunting. This symposium provides an overview of potential neuroophthalmic manifestations of neoplastic disease and discusses recent diagnostic and therapeutic advances in relevant management. Topics will include signs and symptoms (eg, periocular pain, visual field defects, abnormal ocular motility), therapy (eg, glioma and meningioma) and neoplastic mimickers (eg, tumefactive multiple sclerosis). Attendees will be better informed and able to coordinate care among the medical and surgical subspecialties. 3:30 PM Introduction Timothy J McCulley MD 3:32 PM Periocular Pain: When Should I Worry? Fiona E Costello MD* 3:40 PM Optic Nerve Gliomas: Surgery, Radiation, Chemotherapy—or Leave Them Alone? Grant T Liu MD 3:48 PM OCT and an Optic Neuropathy: When Is It Useful? Y Joyce Liao MD PhD 130
4:04 PM 4:12 PM 4:20 PM 4:28 PM
Fooled by the Chiasm: Do Compressive Lesions Always Produce Hemianopia? Jonathan C Horton MD PhD** It’s Not a Tumor: What Is Tumefactive Multiple Sclerosis? Kenneth S Shindler MD PhD Funny Eye Movements in a Child: Could It Be a Tumor? Michael X Repka MD MBA* Cancer-Associated Retinopathy: When and How Do I Test? Byron L Lam MD* Closing Remarks Mays A El-Dairi MD*
WILLIAM F HOYT LECTURE 4:30 PM 4:35 PM
5:00 PM 5:05 PM
Introduction of the William F Hoyt Lecturer Larry P Frohman MD* William F Hoyt Lecture: Optical Imaging of the Optic Nerve—Beyond Documenting RNFL Loss Mark J Kupersmith MD* Presentation of Award End of Session
Spotlight on Glaucoma: Medical and Surgical Management for the Comprehensive Ophthalmologist Event No: SPO2 Room: North Hall B
3:45 - 5:15 PM
Chair(s): Steven Gedde MD*, Douglas J Rhee MD* Glaucoma is a common disease, affecting an estimated 60 million individuals worldwide. Most comprehensive ophthalmologists devote a significant portion of their clinical practice to the care of glaucoma patients. The medical and surgical treatment of glaucoma patients continues to generate questions that are the topic of discussion and debate. In this Spotlight symposium glaucoma experts will provide their perspective on some of these important questions in glaucoma management.
3:45 PM 3:47 PM 3:54 PM
4:01 PM 4:08 PM
4:15 PM
4:22 PM
4:29 PM 4:36 PM 4:43 PM
Introduction Steven Gedde MD* How Should I Set A Target IOP? Philip P Chen MD How Should I Manage a Patient who is Progressing at Low Levels of IOP? Ta Chen Chang MD* When Should I add or Switch a Glaucoma Medication? Peter Andreas Netland MD PhD** Which Glaucoma Medications can be Safely Used During Pregnancy? In childhood? Helen L Kornmann MD Are Any Neuroprotective Agents Currently Available for Treating Glaucoma? Louis R Pasquale MD* What is the Relationship Between Adherence and Glaucoma Progression? Kuldev Singh MD MPH* When Should I Use Selective Laser Trabeculoplasty? Donald L Budenz MD MPH* When Should I Perform a Prophylactic Laser Iridotomy? Douglas J Rhee MD* When Should I Recommend Incisional Glaucoma Surgery? Joseph F Panarelli MD*
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Spotlight Sessions & Symposia Sunday, Oct. 19 (cont.) 4:50 PM 4:57 PM 5:04 PM 5:15 PM
What Is the Role of Microinvasive Glaucoma Surgery? Malik Y Kahook MD* Which is Better—Tube or Trabeculectomy? Dale K Heuer MD* Audience Questions and Discussion End of Session
Adult Strabismus: Techniques to Alleviate Visual Discomfort Event No: SYM17 Room: Grand Ballroom S100c
3:45 - 5:15 PM
Event No: SYM18 Room: S406a
3:45 - 5:15 PM
Combined meeting with the Senior Ophthalmologist (SO) and Women in Ophthalmology (WIO) Committees Chair(s): Harry Zink MD*, Linda M Tsai MD Panelists: Ruth D Williams MD*, Linda M Christmann MD
Times are changing, and practicing ophthalmology less than “full-time” may be desired or needed for a variety of reasons. Our panel of speakers will share their experiences and discuss the challenges, opportunities, and benefits they have experienced in this type of practice. These presentations will help the participants understand the complexities of this model and provide ideas for how to create their own best practice situations. 3:45 PM Introduction Linda M Tsai MD 3:50 PM Demographics and Changing Practice Possibilities Tamara R Fountain MD* 3:57 PM Economics of a Part-time Practice Robert E Wiggins MD MHA* 4:04 PM Work/Family Balance Susan H Forster MD 4:11 PM Slowing Down Approaching Retirement Michael W Brennan MD 4:18 PM Part-time With an Alternate Career Andrew P Doan MD PhD* 4:25 PM Part-time With a Research Career Lynn K Gordon MD PhD* 4:32 PM Panel/Audience Discussion and Questions 5:15 PM End of Session
Ocular Drug and Gene Delivery to the Posterior Segment Event No: SYM19 Room: E450
3:45 - 5:15 PM
Combined meeting with the Association for Research in Vision and Ophthalmology (ARVO) Chair(s): William F Mieler MD* Treatment of numerous retina disorders, including neovascular AMD, diabetic macular edema, and retinal vein occlusion, has become primarily pharmacologic in nature (i.e., anti-VEGF therapy, and corticosteroids). Treatment is oftentimes required on a monthly basis for an extended period of time. While a wide array of new treatments are being investigated, research is also evolving around more effective means of delivering currently available agents to the posterior segment, in terms of being potentially less invasive, and in providing a longer duration of effectiveness. This symposium will review ongoing research in drug delivery, emphasizing new delivery modalities along with the potential limitations of each technique. Finally, gene therapy will be discussed as a potential future solution to the problem of extensive drug therapy. 3:45 PM Introduction William F Mieler MD* 3:47 PM Overview of Challenges in Drug Delivery to the Posterior Segment Henry F Edelhauser PhD** 3:57 PM Topical Drug Delivery Peter A Campochiaro MD*
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
131
Spotlight Sessions & Symposia
Combined meeting with the American Orthoptic Council (AOC) and A merican Association of Certified Orthoptists (AACO) Chair(s): Katherine A Lee MD PhD, Cheryl Lynn McCarus CO COMT Adults with strabismus challenge the skills of the orthoptist and ophthalmologist. Adult strabismus is often acquired, is frequently associated with troublesome diplopia, and can present with concurrent macular or neurologic disease. Successful treatment of adult strabismus can be an extremely rewarding to both patient and practitioner. In this symposium we share the nonsurgical and surgical management of several case presentations, addressing some of the most vexing issues of adult strabismus. Let the orthoptists, pediatric ophthalmologists, and neuro-ophthalmologists in this symposium share their tricks for alleviation of the visual discomfort of adult strabismus. 3:45 PM Introduction Cheryl Lynn McCarus CO COMT 3:48 PM Small Deviations: Vertical, Horizontal, and Combined Steven M Archer MD 3:58 PM Skew Deviations: Utility of the Upright-Supine Test Linda A Colpa CO 4:08 PM Macular Diplopia Sara Shippman CO 4:18 PM Divergence Insufficiency Esotropia: Prism Management Terra Haller CO 4:28 PM Divergence Insufficiency Esotropia: Surgical Treatment Stacy L Pineles MD 4:38 PM Strabismus Associated With Neurodegenerative Disease: Prism Management Rikki Gilligan CO 4:48 PM Strabismus Associated With Neurodegenerative Disease: The NeuroOphthalmologist’s Perspective Michael S Lee MD* 4:58 PM Torsion With Minimal Strabismus Aaron M Miller MD* 5:08 PM Conclusion and Q&A Katherine A Lee MD PhD 5:15 PM End of Session
SO Structuring a Part-time Practice in the Evolving Medical Environment: How to Make It Work
Spotlight Sessions & Symposia 4:07 PM 4:17 PM 4:27 PM 4:37 PM 4:47 PM 4:57 PM 5:00 PM 5:15 PM
Suprachoroidal, Trans-scleral, and Microneedle Drug Delivery Timothy W Olsen MD* Encapsulated Cell Technology Jeffrey L Goldberg MD PhD* Hydrogels and Micro/Nanoparticles Jennifer J Kang-Mieler PhD* Implantable Micropump Drug Delivery Mark S Humayun MD PhD* Gene Delivery to the Retina Stephen Richard Russell MD* Conclusion William F Mieler MD* Q&A End of Session
Spotlight on Cataracts: Clinical Decision-making With Cataract Complications SA
Spotlight Sessions & Symposia
Video Case Studies—”You Make the Call” This case-based video symposium will focus on cataract surgical complications. Twentyone different cataract experts will address prevention and management of complications. Panelists will then comment and recommend management. The audience will weigh in using response pads. The session will conclude with the 10th annual Kelman Lecture.
8:17 AM
8:22 AM 8:27 AM 8:32 AM 8:37 AM 8:42 AM 8:49 AM
8:54 AM 8:59 AM 9:04 AM 9:09 AM 9:17 AM
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9:32 AM 9:39 AM
9:44 AM 9:49 AM 9:54 AM
10:04 AM 10:12 AM
8:15 AM - 12:15 PM
Chair(s): David F Chang MD*, William J Fishkind MD FACS* Virtual Moderator: Mark Packer MD
8:15 AM
9:27 AM
9:59 AM
Monday, Oct. 20
Event No: SPO3 Room: North Hall B
9:22 AM
Introduction David F Chang MD* Case 1: Unhappy Multifocal IOL Patient Panel Jorge L Alio MD PhD*, Eric D Donnenfeld MD* Postop Blur: Is It Astigmatism? Scott M MacRae MD* Postop Blur: Is It the Multifocal Optic? Jack T Holladay MD MSEE FACS* Multifocal IOL Dissatisfaction: When to Exchange? Stephen G Slade MD FACS* Multifocal IOL Exchange: Surgical Pearls Stephen S Lane MD* Audience Response and Panel Discussion Case 2: White Lens Panel Douglas D Koch MD*, Carl C Awh MD* Femtosecond Laser for Complex Cases Kerry D Solomon MD* White Cataract Pearls Brock K Bakewell MD* Anterior Vitrectomy: Limbal or Pars Plana? Abhay Raghukant Vasavada MBBS FRCS* Audience Response and Panel Discussion Case 3: Recurrent Microhyphema Panel Nick Mamalis MD*, Kenneth J Rosenthal MD FACS**
10:17 AM 10:22 AM 10:27 AM 10:34 AM
10:39 AM 10:44 AM 10:49 AM 10:54 AM 11:02 AM 11:07 AM 11:07 AM 11:12 AM 11:17 AM 11:22 AM 11:32 AM
Sulcus IOLs Dos and Don’ts Liliana Werner MD PhD* Suture Fixation of PC IOLs Walter J Stark MD* Audience Response and Panel Discussion Case 4: Misaligned Toric IOL Panel Edward J Holland MD*, Richard L Lindstrom MD** Toric IOL Complications Warren E Hill MD* Correcting Toric IOL Misalignment Roger F Steinert MD* No Capsule Support: Anterior Chamber vs. Posterior Chamber IOL Richard S Hoffman MD* Posterior Capsule Rupture With Premium IOLs Thomas A Oetting MD Audience Response and Panel Discussion Case 5: Diffuse Zonulopathy Panel Boris Malyugin MD PhD*, Robert H Osher MD* Phaco With Zonulopathy Michael E Snyder MD* Fixating the Loose Capsular Bag Robert J Cionni MD* Audience Response and Panel Discussion Case 6: Catarocks and the Crowded Anterior Chamber Panel Rosa Braga-Mele MD*, Alan S Crandall MD* Strategies for Crowded Anterior Chamber Richard Jonathan Mackool Jr MD** Pearls for Endothelial Protection Terry Kim MD* Strategies for the Catarock Juan F Batlle MD* Audience Response and Panel Discussion Case 7: Rapid Cataract Post-vitrectomy Panel David S Boyer MD*, Bonnie A Henderson MD* Rapid Post-vitrectomy Cataract — Why and What Now? David F Williams MD* Phaco With a Compromised Posterior Capsule Samuel Masket MD* IOL Scaffold: Technique and Outcomes Amar Agarwal MD* Audience Response and Panel Discussion Conclusion David F Chang MD*
CHARLES D KELMAN LECTURE 11:35 AM Introduction of Kelman Lecturer William J Fishkind MD FACS* 11:42 AM Charles D Kelman Lecture: Entrepreneurship in Clinical Research Randall J Olson MD 12:15 PM End of Session
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Spotlight Sessions & Symposia STRAATSMA LECTURE
Monday, Oct. 20 (cont.)
Best of NANOS 2014: Featuring Best Papers from the North American Neuro-Ophthalmology Society Event No: SYM24 Room: S405
8:30 - 9:30 AM
Leveraging Technology and the Educational Team Event No: SYM21 Room: Grand Ballroom S100c
8:30 - 10:00 AM
Combined meeting with the Association for University Professors of Ophthalmology (AUPO) Chair(s): Tara A Uhler MD In the Next Accreditation System, training programs are tasked with developing and documenting an effective curriculum and clinical learning environment designed to produce competent physicians prepared to deliver top-notch care both safely and efficiently. The Accreditation Council for Graduate Medical Education (ACGME) is focusing increasingly on safety, quality improvement, use of electronic medical records, and teamwork. Simultaneously, educators must ensure the transfer of increasingly vast amounts of information and technical skills in a short period of time. Educators and institutions need efficient, effective, and inexpensive methods to accomplish this. This is possible if we leverage technology and the skills of all members of the educational health-care system. The topics presented in this section provide concrete examples and encourage participants to leverage their talents. 8:30 AM Welcome, Introduction, and Instructions for Table Selection Tara A Uhler MD 8:35 AM Table One: The Educational Team: Managing Your Coordinator Shahzad I Mian MD*, Tara A Uhler MD Table Two: When and How to Introduce New Technology into Training (Femtosecond Laser) Bhavna P Sheth MD, Thomas A Oetting MD Table Three: Leveraging EMR for Quality Improvement Projects Laura L Wayman MD, R Michael Siatkowski MD* 9:15 AM Summaries
Introduction of Straatsma Lecturer Bartly J Mondino MD 9:22 AM Straatsma Lecture: The Spectrum of Prostaglandin Orbitopathy Laura L Wayman MD 9:42 AM Introduction of the Excellence in Medical Student Education Lecturer Bartly J Mondino MD 9:44 AM Excellence in Medical Student Education Lecture: Educating Referring Doctors of Tomorrow: Why Medical Student Training in Ophthalmology is Critical—Today! Linda S Lippa MD** 10:00 AM End of Session
The Affordable Care Act: Present and Future Prospects for Ophthalmology Event No: SYM22 Room: S406a
8:30 - 10:00 AM
Combined meeting with the American Medical Association Ophthalmology Section Council (AMA) Chair(s): Kevin Thomas Flaherty MD, Ravi D Goel MD, Dawn C Buckingham MD Virtual Moderator: Ruth D Williams MD* The Affordable Care Act (ACA) will continue to impact ophthalmology practices in many ways and at different levels. These include the addition of more patients now covered by insurance, the expansion of Medicaid, new individual insurance mandates, and new insurance exchanges for comparison shopping. The ACA also imposes new regulations on medical practices as business entities, as well as changes in the health insurance environment, with accountable care organizations that may manage a continuum of a patient’s care across different settings. The ACA created the federal center for Medicare and Medicaid Innovation (CMMI), which may result in new payment methodologies such as bundled payments for services. The speakers will provide insight on how ophthalmologists should respond to these changes. 8:30 AM The Accountable Care Act and Ophthalmology Michael X Repka MD MBA* 8:40 AM An Insider’s View of the ACA from a State Perspective Mariannette Miller-Meeks MD** 8:50 AM Balancing Social Media in Light of Newly Expanded Patient Populations Under the ACA Robert F Melendez MD MBA
PARKER HEATH LECTURE 9:00 AM
Introduction of the Parker Heath Lecturer Kevin Thomas Flaherty MD 9:02 AM Parker Health Lecture: Views on Health Care Randal H Paul MD** 9:27 AM Presentation of Parker Heath Award Kevin Thomas Flaherty MD 9:32 AM Q&A 10:00 AM End of Session
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
133
Spotlight Sessions & Symposia
Chair(s): Jacqueline A Leavitt MD 8:30 AM Leber Hereditary Optic Neuropathy G11778A Gene Therapy Clinical Trial: Stability of Clinical Parameters of Carriers in Preparatory Phase Byron L Lam MD* 8:42 AM Small Posterior Fossa Strokes Causing Severe Vertigo: Anatomic Distribution and Clinical Features of the “Lacunar” Acute Vestibular Syndrome Ali S Saber Tehrani MD 8:54 AM In Vivo and In Vitro Imaging of RGC Axonal Transport and Degeneration Following Experimental Anterior Ischemic Optic Neuropathy Y Joyce Liao MD PhD 9:06 AM Orbital Fibroblasts From Thyroid Eye Disease Patients Differ In Proliferative And Adipogenic Responses Depending On Disease Subtype Ajay E Kuriyan MD* 9:18 AM Peripapillary RPE-layer Shape in Idiopathic Intracranial Hypertension: Before and After Treatment Patrick A Sibony MD 9:30 AM End of Session
9:21 AM
Spotlight Sessions & Symposia 8:49 AM
Monday, Oct. 20 (cont.)
Oculoplastics Oncology Update
Spotlight Sessions & Symposia
Event No: SYM23 Room: E350
8:30 - 10:00 AM
Combined meeting with the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) Chair(s): Eric A Steele MD This symposium will provide an update on some of the most feared diagnoses that an ophthalmologist may encounter in clinical practice. A variety of malignant lesions that affect the eyelids, orbit, and lacrimal system will be quickly reviewed by experts in the field, providing an overview of the diagnosis, management, and appropriate referral of these conditions. 8:30 AM Introduction Eric A Steele MD 8:32 AM Sebaceous Carcinoma Bita Esmaeli MD FACS 8:41 AM Extraocular Extension of Choroidal Melanoma Jerry A Shields MD 8:50 AM Conjunctival Melanoma Carol L Shields MD 8:59 AM Orbital Lymphoma Louise A Mawn MD* 9:08 AM Rhabdomyosarcoma Scott M Goldstein MD 9:17 AM Adenoid Carcinoma of the Lacrimal Gland David T Tse MD FACS*
WENDELL L HUGHES LECTURE 9:26 AM
Introduction of the Wendell L Hughes Lecturer James C Fleming MD 9:31 AM Wendell L Hughes Lecture: The Spectrum of Prostaglandin Orbitopathy Philip L Custer MD* 9:58 AM Presentation of Award Eric A Steele MD 10:00 AM End of Session SOE A View Across the Pond: Retina
Event No: SYM44 Room: Grand Ballroom S100ab
8:30 - 10:00 AM
Joint Session with the European Society of Ophthalmology (SOE) Chair(s): Susanne Binder MD*, Jay S Duker MD* Virtual Moderator: Pravin U Dugel MD The symposium will compare and contrast North American and European approaches to the diagnosis and management of a variety of medical and surgical disorders of the retina. 8:30 AM Introduction Jay S Duker MD* 8:32 AM The North American Approach to Silicone Oil Use in Vitrectomy William F Mieler MD* 8:39 AM The European Approach to Silicone Oil Use in Vitrectomy Marta Figueroa MD* 8:46 AM Discussion
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Ocriplasmin for Vitreomacular Traction and Macular Hole: The North American Perspective David R Chow MD* 8:56 AM Ocriplasmin for Vitreomacular Traction and Macular Hole: The European approach Peter W Stalmans MD PhD* 9:03 AM Discussion 9:06 AM Neovascular (Wet) AMD: Which Drug and Which Maintenance Program--The North American Approach Jeffrey S Heier MD* 9:13 AM Neovascular (Wet) AMD: Which Drug and Which Maintenance Program--The European Approach Stephan Michels MD MBA* 9:20 AM Discussion 9:23 AM The Role of Laser in Diabetic Macular Edema in 2014: The North American Approach Charles C Wykoff MD PhD* 9:30 AM The Role of Laser in Diabetic Macular Edema in 2014: The European Approach Francesco M Bandello MD FEBO* 9:37 AM Discussion 9:40 AM New Concepts in Retinal Detachment Surgery: The North American Approach Maria H Berrocal MD* 9:47 AM New Concepts in Retinal Detachment Surgery: The European Approach Christiane I Falkner-Radler MD 9:54 AM Discussion 9:57 AM Conclusion Susanne Binder MD* 10:00 AM End of Session GO Global Forum: Global Research
Event No: SYM25 Room: S101ab
8:30 - 11:00 AM
Combined meeting with the Academy’s Global Education and Outreach Committee Chair(s): Victoria M Sheffield*, Fernando Pena MD* A panel of international experts with wide experience in international clinical, programmatic, and epidemiological research will discuss the current status of global eye research including a presentation by WHO/Geneva, the history of epidemiological studies in public eye health, current studies to address the leading causes and economics of blindness, and the logistical, ethical, and financial considerations of global research. Audience participation in Q&A sessions with the panelists is planned, as well as a generous tea and cookies break for informal interaction. 8:30 AM Welcome Linda M Lawrence MD Panel I: Current Status of Global Research, History of Epidemiological Studies in Public Eye Health, and the Importance of Economic Data in Reducing Blindness Victoria M Sheffield* 8:35 AM An Overview on WHO Key Resources for Internationally Conducted Research and Experiences Ivo Kocur MD**
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Spotlight Sessions & Symposia Monday, Oct. 20 (cont.) 8:45 AM
8:55 AM
9:05 AM
9:25 AM
9:33 AM
9:41 AM 9:49 AM 9:57 AM
10:30 AM 11:00 AM
Best of Anterior Segment Specialty Meetings 2014 Event No: SYM41 Room: S406a
10:15 - 11:30 AM
Chair(s): Tammy L Yanovitch MD, Florentino E Palmon MD This symposium will feature 10 of the best papers from the major anterior segment specialty meetings of 2014. These papers will be in the major anterior segment specialty areas and are selected by the program committees of the respective societies from their annual specialty meetings. 10:15 AM Introduction American Glaucoma Society 10:17 AM Generating an Animal Model of Glaucoma John Fingert MD PhD 10:24 AM IOP Spikes Represent a Significant Portion of Total IOP Energy During Waking Hours J Crawford Downs PhD** American Association for Pediatric Ophthalmology and Strabismus 10:31 AM Binocular iPad Treatment for Amblyopia in Preschool Children Eileen E Birch PhD* American Society of Ophthalmic Plastic and Reconstructive Surgery 10:38 AM Infection Rates Comparing Antibiotic Versus Antibiotic-free Topical Ointments in Blepharoplasty Surgery Mark A Alford MD
10:45 AM The Impact at Five Years of an Ocular Surface Prosthetic Device Joshuan Agranat BS 10:52 AM Diabetes Mellitus Increases Risk of Unsuccessful Graft Preparation in Descemet’s Membrane Endothelial Keratoplasty: A Multicenter Study Mark Greiner MD American Society of Cataract and Refractive Surgery 10:59 AM Role of Percentage of Tissue Altered as Risk Factor for Ectasia After LASIK in Eyes With Normal Preoperative Topography Marcony R Santhiago MD 11:06 AM In-the-Bag IOL Dislocation: Comparison of Presentation Characteristics and Surgical Outcomes in Eyes With and Without CTR Betty Lorente MD** International Society of Refractive Surgery 11:13 AM Advanced Analysis for IOL Power Calculation in Refractive Surgery Karolinne M Rocha MD 11:20 AM Real Time Dynamic Aberrometry Ronald R Krueger MD* 11:27 AM Conclusion 11:30 AM End of Session
Clinical Pearls in the Diagnosis of Masquerades in Infectious and Inflammatory Disease of the Eye Event No: SYM26 Room: Grand Ballroom S100ab
10:15 - 11:45 AM
Combined meeting with the Ocular Microbiology and Immunology Group (OMIG) Chair(s): Bennie H Jeng MD*, Irmgard Behlau MD Management of infectious and inflammatory diseases can be challenging, as even a single diagnosis can have extremely varied presentations. While microbiological and laboratory results can aid in diagnosis, an appropriate suspicion for the various etiologies must be present to drive an appropriate workup. Some more unusual disease entities manifest as other, more common ones do, and thus there is often a delay in diagnosis for these “masquerades”. This symposium will be comprised of leading experts in the field presenting unknown cases that represent some of these masquerades. The attendees will learn methods for developing an appropriate level of suspicion for masquerades, allowing for earlier diagnosis and initiation of treatment. 10:15 AM Introduction Bennie H Jeng MD* 10:16 AM Nongranulomatous Anterior Uveitis Debra A Goldstein MD* 10:25 AM Q&A 10:27 AM Chronic Ocular Surface Inflammation Carol L Karp MD 10:36 AM Q&A 10:38 AM Chronic Panuveitis Arun D Singh MD 10:47 AM Q&A 10:49 AM Peripheral Ulcerative Keratitis Esen K Akpek MD* 10:58 AM Q&A 11:00 AM Posterior Uveitis Lucy H Young MD PhD FACS 11:09 AM Q&A
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Spotlight Sessions & Symposia
10:05 AM 10:25 AM
History of Epidemiological Studies Impacting the Reduction of Blinding Malnutrition, Trachoma, and Onchocerciasis Hugh R Taylor MD FRACS Examples of How Economic Research on Blindness Led to Data That Supported Advocacy That Led to Funding for Specific Prevention of Blindness Programs Kevin Frick PHD** Audience Question & Answer Panel II: Current Studies to Address the Leading Causes of Blindness, and the Logistical, Ethical, And Financial Considerations of Global Research Fernando Pena MD* Using Data and Research for Practice and Advocacy - The Difference Between Clinical and Programmatic Research Fernando Pena MD* Current International Research Supported By the US National Eye Institute Gyan John Prakash PHD Rapid Assessment of Avoidable Blindness Studies Muhammad M Rabiu MD PRECOG Cataract Outcomes Study Nathan G Congdon MD Considerations of Conducting Research in Other Countries David S Friedman MD MPH PhD* Audience Question & Answer Summary Timothy P Page MD* Volunteer Fair End of Session
Cornea Society
Spotlight Sessions & Symposia Monday, Oct. 20 (cont.) 11:11 AM Vitritis and Systemic Disease Prithvi Mruthyunjaya MD* 11:20 AM Q&A
Event No: SYM29 Room: E350
JONES/SMOLIN LECTURE 11:22 AM Introduction of the Jones/Smolin Lecture Bennie H Jeng MD* 11:25 AM Jones/Smolin Lecture: Changing Times in the Diagnosis and Management of Ocular Infectious Diseases Russell N Van Gelder MD PhD* 11:45 AM End of Session
New Frontiers of the Vitreoretinal Interface: Where Worlds Collide
Spotlight Sessions & Symposia
Event No: SYM28 Room: Grand Ballroom S100c
10:15 - 11:45 AM
Combined meeting with the European Latin America Retina Specialist Society (Eurolam) Chair(s): Stanley Chang MD*, Gisbert W Richard MD* Using intraoperative videotapes and case presentations, a panel of internationally recognized experts will demonstrate their approach to various types of diseases involving the vitreoretinal interface, including macular hole, macular pucker, traumatic macular hole, tractional diabetic macular edema, myopic macular hole, and others. Clinical evolution and diagnosis options, as well as different management options, will also be discussed. 10:15 AM New OCT Technology in Vitreoretinal Interface and Digital Biopsy David E Pelayes MD* 10:23 AM New OCT-Based Nomenclature Classification for Diseases of the Vitreoretinal Interface Jay S Duker MD* 10:31 AM Early Vitreomacular Traction: Do We Know the Natural History? Alain Gaudric MD* 10:39 AM The Importance of Internal Limiting Membrane and External Limiting Membrane Federico A Graue-Wiechers MD 10:47 AM Closure of Macular Holes: Lessons Learned from Experimental Retinal Wound Healing Mark S Blumenkranz MD* 10:55 AM Tractional Diabetic Macular Edema Interface Francesco M Bandello MD* 11:03 AM Myopic Hole Interface Borja F Corcostegui MD* 11:11 AM Predictors of Visual Outcome in Vitreomacular Surgery Rene H Cano MD* 11:19 AM Discussion 11:45 AM End of Session
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SO Adjusting to the Changing Demographic: Valuing the Patient in Determining Options for Treatment
10:45 - 11:45 AM
Combined meeting with the Committee on Aging and the Senior Ophthalmologist (SO) Committee Chair(s): Gwen K Sterns MD, Andrew G Lee MD* As the population ages, we are confronted with hard decisions involving the medical and surgical management of our patients. We must help patients and family members make choices that are not always straightforward. How aggressive should our treatments be for the frail elderly patient with macular degeneration or glaucoma? Who should decide? How do we know when an elderly patient is competent to make decisions independently? How do we frame choices between treatment and no treatment in a manner that a cognitively impaired but legally competent patient can understand? When should family or others be involved in these decisions? This symposium will address these questions. 10:45 AM Introduction Gwen K Sterns MD 10:47 AM Customizing Macular Degeneration Care for the Elderly: Does Age Play a Role? Should It? James E Kempton MD** 10:55 AM Macular Degeneration: The Eye Can Handle the Treatment—Can the Patient? Chirag P Shah MD* 11:03 AM Customizing a Glaucoma Treatment Plan in the Elderly Patient: Does the Treatment Improve the Quality of Life for This Patient? M Bruce Shields MD* 11:11 AM Considering Comorbidities When Defining a Glaucoma Treatment Plan: What Defines Success—A Target Pressure or Stable Outcomes in a Satisfied Patient? George A Cioffi MD* 11:19 AM Ethics: How Do We Know if Patients or Their Family Members Understand What We’re Telling Them? Shellie N Williams MD 11:27 AM Panel Discussion 11:43 AM Closing Andrew G Lee MD* 11:45 AM End of Session
Innovation in Ophthalmology: From Theory to Therapy Event No: SYM30 Room: Grand Ballroom S100c
12:15 - 1:45 PM
Chair(s): Emmett T Cunningham Jr MD PhD MPH This course is intended to give clinical ophthalmologists an improved understanding of the factors driving and influencing innovation in ophthalmology. Participants should gain an improved understanding of the innovative process, including how to protect and advance their own innovations. 12:15 PM Welcome Emmett T Cunningham Jr MD PhD MPH 12:19 PM Helpful Tips for Aspiring Entrepreneurs Emmett T Cunningham Jr MD PhD MPH 12:27 PM Funding Innovation Gilbert H Kliman MD** 12:35 PM An Investor’s View on Innovating in the Ophthalmic Sector: Winners, Losers, Lessons Learned William Link PhD*
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Spotlight Sessions & Symposia Monday, Oct. 20 (cont.) 12:43 PM Starting a New Company: How to Pick a Winner Eugene de Juan Jr MD* 12:51 PM The Role of Physician Innovators Daniel M Schwartz MD* 12:59 PM Innovating From Private Practice Richard L Lindstrom MD** 1:07 PM Innovating From Academia Mark S Blumenkranz MD* 1:15 PM Panel Discussion/Q&A 1:45 PM End of Session
Telehealth is in Your Future Event No: SYM31 Room: S405
12:15 - 1:45 PM
Beyond Ophthalmology Event No: SYM32 Room: S406b
12:15 - 1:45 PM
Combined meeting with the Museum of Vision Chair(s): Michael F Marmor MD* The Museum of Vision’s history symposium will look at the lives of ophthalmologists whose passion for medicine is matched or even overshadowed by an interest in another field. “Beyond Ophthalmology” features stories of ophthalmologists who left the profession or pursued activities beyond the profession to achieve notoriety in other disciplines, such as literature, politics, and the arts.
Dr. Allan Jensen and Claire Jensen Lecture in Professionalism and Ethics Event No: SYM33 Room: S406a
12:45 - 1:45 PM
Chair(s): Christie L Morse MD* Failing to address unprofessional behavior may promote similar behavior in other individuals and tarnishes the image of the profession. Addressing unprofessional behavior results in higher levels of personal satisfaction, creates better mentors for younger ophthalmologists, and improves patient safety and risk-management experiences. Attendees will become knowledgeable about issues relating to professionalism and unprofessional behavior, i.e., how to identify and address unprofessional behavior, and what to do about these issues in their own communities. Every physician needs skills for addressing unprofessional / unethical behavior – even if it is as simple as knowing that the Academy’s Ethics Committee is in place to assist. Dr. Gerald B Hickson will be delivering our inaugural Dr. Allan Jensen and Claire Jensen Lecture in Professionalism and Ethics with his presentation, Promoting Ethics and Professionalism. 12:45 PM Promoting Ethics and Professionalism Gerald B Hickson MD 1:15 PM Q&A 1:45 PM End of Session
Why Take the Risk? How to Create an Effective Risk Management Strategy With Patient Education and Informed Consent Documents Event No: SYM34 Room: S403b
12:45 - 1:45 PM
Combined meeting with the Patient Education Committee and the Ophthalmic Mutual Insurance Company (OMIC) Chair(s): Philip R Rizzuto MD FACS Through analysis of specific medicolegal cases and a survey of Ophthalmic Mutual Insurance Company (OMIC) defense counsel, attendees will learn how to minimize their risk against malpractice lawsuits with the effective use of ophthalmic patient education and informed consent tools. 12:45 PM Introductions and Program Overview Philip R Rizzuto MD FACS 12:50 PM A Medicolegal Case Presentation Devin A Harrison MD
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Spotlight Sessions & Symposia
Combined meeting with Women in Ophthalmology (WIO) Chair(s): Kimberly Cockerham MD FACS*, Roberta Gausas MD** The aging population will need additional medical care over the coming decades. Driving to a doctor’s office, checking in, waiting, undergoing examination, and driving home requires access to transportation and time. These human and financial costs do not necessarily improve quality of care for the patient or make financial sense for the doctor. With advances in widely available technology, virtual visits between doctors and their patients have become possible with minimal expense. Webportals, smart phones, video calls, and other forms of communication have opened up new options by which patients and doctors can communicate. Smart phone applications can now remind patients to take their medications, measure blood pressure and other parameters, and record postoperative pictures over time. The goal of this symposium is to provide information to ophthalmologists in a wide range of practice models with the new, fixed (lap or desktop) and mobile options that they can integrate now to improve their efficiency and job satisfaction. 12:15 PM Introduction Kimberly Cockerham MD FACS* 12:20 PM The Evolution of Telehealth in the United States Rosa A Tang MD* 12:35 PM Telehealth and the Department of Veterans Affairs Kimberly Cockerham MD FACS* 12:50 PM Smartphone and Tablet Apps Suzann Pershing MD 1:05 PM International Telehealth: The Orbis Experience Joan Brown BSMT MBA 1:40 PM Conclusion Roberta Gausas MD** 1:20 PM Q&A 1:45 PM End of Session
Speakers including the doctors themselves will discuss how to pursue a dream and how those dreams can change over time. 12:15 PM Welcome Michael F Marmor MD* 12:20 PM Politics: Jose Rizal MD and Other Political Leaders Tracy B Ravin MD 12:35 PM Literature: Sir Arthur Conan Doyle MD and Others James G Ravin MD 12:50 PM Classical Music: Samuel Wong MD and a Conductor’s Life Samuel T Wong MD 1:05 PM Entertainment: Jules Stein MD: The Movies and Beyond Bradley R Straatsma MD 1:20 PM Photography: Howard Schatz MD and His Vision Michael F Marmor MD* 1:35 PM Closing Remarks/Questions Michael F Marmor MD* 1:45 PM End of Session
Spotlight Sessions & Symposia 2:02 PM
Monday, Oct. 20 (cont.) 1:05 PM 1:20 PM 1:35 PM 1:45 PM
Discussion of OMIC Defense Counsel Survey Results and Points Academy and OMIC Resources for Education and Informed Consent Philip R Rizzuto MD FACS Conclusion and Q&A End of Session
Management of Retinal Breaks and Idiopathic Macular Holes: Latest Diagnostic and Treatment Strategies from the New Preferred Practice Pattern® Guidelines
Spotlight Sessions & Symposia
Event No: SYM35 Room: E350
12:45 - 1:45 PM
Combined meeting with the Preferred Practice Patterns Committee (PPPC) Chair(s): Timothy W Olsen MD* Retinal breaks and idiopathic macular holes are the focus of two revised Preferred Practice Pattern guidelines. The authors are the Retina PPP committee members, who will use the evidence-based recommendations from this PPP to provide the comprehensive ophthalmologist with a good understanding of how the latest diagnostic equipment and surgical techniques can provide the best care for a patient with these conditions. The utility of OCT will be discussed. The emphasis will be on teaching the comprehensive eye physician about the basic indications, benefits, and risks of various surgical techniques. Through didactic lecture and case presentation, the goal is to provide the attendees with pearls and take-home points to be used in their clinical practices. A free CD-ROM containing all 20 PPP titles and Summary Benchmarks will be distributed to attendees. 12:45 PM What Is the PPP? Stephen D McLeod MD* 12:48 PM Current Diagnostic Options Jose S Pulido MD MS 12:58 PM How Does the Retina Specialist Manage Retinal Breaks? Ron Afshari Adelman MD MPH 1:13 PM How Does the Retina Specialist Manage Idiopathic Macular Hole? James C Folk MD* 1:28 PM Panel Q&A Timothy W Olsen MD* 1:45 PM End of Session GO SOE
Care?
Ethics and Professionalism: Why Should I
Event No: SYM27 Room: S406a
2:00 - 3:00 PM
Combined meeting with the Academy’s Ethics Committee and the European Society of Ophthalmology (SOE) Chair(s): Christie L Morse MD*, Andrzej Grzybowski MD* Virtual Moderator: Anthony J Aldave MD* In this international symposium, actual ethics case studies will be presented illustrating ethical dilemmas common across international borders such as the learning curve in using new technology, publishing scientific research, the use of IRBs, off-label use of drugs, informed consent and others ethical concerns. Resolution of these dilemmas and the difficulties in creating resolutions where no formal ethics programs exist will be discussed. Potential joint educational endeavors between national societies represented on the symposium panel will be discussed. 2:00 PM Introduction Christie L Morse MD* 138
2:10 PM 2:18 PM 2:26 PM 2:34 PM 3:00 PM
Relationships with Industry Anthony J Aldave MD* Informed Consent Roberto Pineda II MD* Off Label Drugs and Patient Needs Matteo Piovella MD* Learning Curve with New Technology Boris Malyugin MD PhD* Q&A End of Session
Pediatric Vision Rehabilitation Event No: SYM40 Room: E350
2:00 - 3:00 PM
Combined meeting with the Vision Rehabilitation Committee Chair(s): Mary Lou Jackson MD*, Deepthi M Reddy MD This symposium will highlight services available to provide vision rehabilitation for children with vision loss and their families. These services are an essential part of the ocular care of the child with vision loss to ensure healthy development and full participation of the child in educational and community settings. 2:00 PM Introduction Mary Lou Jackson MD* 2:02 PM Pediatric Vision Rehabilitation Interventions: The Preschooler and School Aged Child Gwen K Sterns MD 2:13 PM Vision Rehabilitation Services for Teens and Postsecondary Students Terry L Schwartz MD 2:25 PM Vision Rehabilitation Services for Children: The Perspective of the Vocational Rehabilitation Commission Janet LaBreck 2:38 PM Vision Rehabilitation Services for Children: The Pediatric Ophthalmologist Perspective C Gail Summers MD 2:49 PM Vision Rehabilitation Services for Children; The Parent Perspective Suzanne Kouri 2:59 PM Summary Deepthi M Reddy MD 3:00 PM End of Session
Spotlight on Neuro-Ophthalmology: Things You Don’t Want to Miss Event No: SPO4 Room: Grand Ballroom S100ab
2:00 - 3:30 PM
Chair(s): Nicholas J Volpe MD Virtual Moderator: Michael S Lee MD* This spotlight session for the comprehensive ophthalmologist will both emphasize highstakes diagnoses that must be made and also discuss the perils of overdiagnosis. A case-based series of presentations will provide the state-of-the-art approach to common neuro-ophthalmic signs and symptoms. Examples of topics to be presented include transient monocular vision loss, temporal arteritis, the swollen optic nerve, ptosis, acute vision loss, and the pediatric patient with neuro-ophthalmic findings. A practical approach will be emphasized to ensure “no misses” but also to help the comprehensive ophthalmologist avoid overdiagnosing and overtesting.
2:00 PM 2:13 PM
Introduction Nicholas J Volpe MD Vertical Diplopia: Thirds, Thyroid, and More Dean M Cestari MD
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Spotlight Sessions & Symposia Monday, Oct. 20 (cont.) 2:24 PM 2:35 PM 2:46 PM 2:57 PM
3:08 PM 3:19 PM
The Pediatric Patient: What Not to Miss Grant T Liu MD Temporal Arteritis: What It Does and Doesn’t Do Peter A Quiros MD Ptosis and Double Vision: Who Has Myasthenia Gravis Mark J Kupersmith MD* Not Everything Is the Optic Nerve and Brain: Retinal Disease in Neuro-Ophthalmic Differential Diagnosis Michael S Lee MD* The Patient Probably Does Not Have Optic Neuritis If… Madhura A Tamhankar MD Papilledema? Avoiding the Pseudopapilledema Overcall Alfredo A Sadun MD PhD*
Lessons Learned from Recent Clinical Trials on Diabetic Retinopathy Event No: SYM43 Room: Grand Ballroom S100c
2:00 - 3:30 PM
Combined meeting with the Macula Society Chair(s): Neil M Bressler MD*, Lawrence J Singerman MD* Panelists: Michael J Elman MD*, Lee M Jampol MD*, Michael S Ip MD*, Barbara Ann Blodi MD**
Event No: SYM39 Room: North Hall B
2:00 - 4:00 PM
Combined meeting with the American Society of Cataract and Refractive Surgery (ASCRS) Chair(s): Edward J Holland MD*, Stephen S Lane MD* Panelists: Eric D Donnenfeld MD*, Thomas W Samuelson MD*, Roger F Steinert MD*
The ASCRS Symposium with feature a series of expert speakers to discuss the most significant challenges in cataract surgery. Each talk will be followed by an interactive panel discussion. Topics to be discussed include: Ocular surface disease, astigmatism management, post-refractive calculations, corneal dystrophies, glaucoma, iris abnormalities, dense cataracts, zonular weakness and Retinal pathologies. 2:00 PM Ocular Surface Disease Neda Shamie MD* 2:07 PM Discussion 2:11 PM Astigmatism Management Bonnie A Henderson MD* 2:18 PM Discussion 2:22 PM Dense Cataract Rosa Braga-Mele MD* 2:29 PM Discussion 2:33 PM Post Refractive Douglas D Koch MD* 2:40 PM Discussion 2:44 PM Fuchs’ Dystrophy Terry Kim MD* 2:51 PM Discussion 2:55 PM Glaucoma Richard A Lewis MD* 3:02 PM Discussion 3:06 PM Iris Defects Michael E Snyder MD* 3:13 PM Discussion 3:17 PM Small Pupil Richard S Hoffman MD* 3:24 PM Discussion 3:28 PM Dislocated IOL Robert J Cionni MD* 3:35 PM Discussion 3:39 PM Maculopahthy Stephen Charles MD MBBS 3:46 PM Discussion 3:50 PM Conclusion Edward J Holland MD* 4:00 PM End of Session
The Great Debate: Cornea Event No: SYM11 Room: Grand Ballroom S100ab
3:45 - 5:00 PM
Chair(s): Christopher Rapuano MD* Virtual Moderator: William B Trattler MD*
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
139
Spotlight Sessions & Symposia
The total number of people worldwide with diabetes mellitus is projected to rise to over 350 million by 2030. In the United States, over 20 million people, or 8 percent of the population, have diabetes mellitus, including 4 million Americans age 40 and older who have diabetic retinopathy. This includes almost 1 million with vision-threatening disease, including macular edema or features predicting a high risk of worsening to proliferative diabetic retinopathy. To address the growing burden of this condition on the ophthalmic community, this symposium will address lessons learned from clinical trials evaluating the comparative effectiveness of different anti-VEGF agents for diabetic macular edema from government-sponsored trials, along with new approaches to treating proliferative diabetic retinopathy. 2:00 PM Introduction to the Symposium, Classification and Importance of Diabetic Retinopathy Lawrence J Singerman MD* 2:08 PM Recent Results from Randomized Clinical Trials Evaluating Anti-VEGF Treatments on Management of Diabetic Macular Edema John A Wells III MD* 2:18 PM Current Treatment and Follow-up Strategies for Managing Diabetic Macular Edema Susan B Bressler MD* 2:28 PM Current Approaches to Imaging and Treating Proliferative Diabetic Retinopathy Jennifer K Sun MD** 2:38 PM Potential Impacts of Recent Clinical Trial Results on Preferred Practice Patterns Paul Sternberg Jr MD 2:48 PM Coordinating New Retina Treatments With Primary Care Providers for Diabetes Lloyd P Aiello MD PhD* 2:58 PM Case Studies, Summary, and Future Directions Neil M Bressler MD* 3:30 PM End of Session
Challenges in Cataract Surgery: Gems to Take Home and Treasure
Spotlight Sessions & Symposia
Spotlight Sessions & Symposia
Monday, Oct. 21 (cont.) This symposium will be structured as a lively, old-fashioned debate. Groups of debaters will argue the pros and cons of controversial topics. Speakers will have the opportunity to present prepared statements and then will have a chance to rebut those of their opponents. Audience voting will be used to determine which speakers were most effective in stating their arguments. 3:45 PM Introduction Christopher Rapuano MD* Epithelium-off or Epithelium-on 3:49 PM Introduction of Question and Audience Voting 3:51 PM Epithelium-off Theo Seiler MD PhD 3:56 PM Epithelium-on Rajesh K Rajpal MD* 4:01 PM Epithelium-off Rebuttal 4:02 PM Epithelium-on Rebuttal 4:03 PM Audience Voting Topical Steroid Use Within the First Few Days 4:04 PM Introduction of Question and Audience Voting 4:06 PM Yes Stephen D McLeod MD* 4:11 PM No Sonal S Tuli MD 4:16 PM Yes Rebuttal 4:17 PM No Rebuttal 4:18 PM Audience Voting Separate or Combined Cataract Surgery and EK? 4:19 PM Introduction of Question and Audience Voting 4:21 PM Cataract Surgery First, Then EK Marian Sue Macsai-Kaplan MD* 4:26 PM Combined Cataract Surgery and EK Francis W Price Jr MD* 4:31 PM Separate Rebuttal 4:32 PM Combined Rebuttal 4:33 PM Audience Voting Corneal Transplant for Patient with Advanced Keratoconus, Which Procedure: DALK or PK? 4:34 PM Introduction of Question and Audience Voting 4:36 PM DALK Deepinder K Dhaliwal MD* 4:41 PM PK Yaron S Rabinowitz MD 4:46 PM DALK Rebuttal 4:47 PM PK Rebuttal 4:48 PM Audience Voting 4:49 PM Conclusions 5:00 PM End of Session
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Best of the Posterior Segment Specialty Meetings 2014 Event No: SYM36 Room: S406a
3:45 - 5:00 PM
Chair(s): Nicholas J Volpe MD, Scott C Oliver MD* This symposium will feature best papers focusing on the posterior segment from the major uveitis, neuro-ophthalmology, retina, oculoplastics, and pediatric ophthalmology specialty meetings of 2014. 3:45 PM Introduction American Uveitis Society 3:47 PM
Longitudinal Cohort Study of Birdshot Chorioretinopathy: Highlights From the Analysis of Data at 5 Years of Follow-up Gary N Holland MD* North American Neuro-Ophthalmology Society 3:54 PM
Retinal Ganglion Cell Layer Thinning Within One Month of Presentation for Non-arteritic Anterior Ischemic Optic Neuropathy and Optic Neuritis Mark J Kupersmith MD* Macula Society 4:01 PM
Effect of Aspirin Use on Progression of Age-Related Macular Degeneration Emily Y Chew MD 4:08 PM The Societal Costs Associated With Neovascular Macular Degeneration in the United States Gary C Brown MD* The Retina Society 4:15 PM
Detection Rate of New CNV in Eyes With AMD and Visits Prompted by Home Monitoring Device, Symptoms and Standard Care Susan B Bressler MD* 4:22 PM Intravitreal Ranibizmab for Diabetic Macular Edema With Prompt Versus Deferred Laser Treatment Christina J Flaxel MD American Society of Retina Specialists 4:29 PM
Is A Systemic Effect of Intravitreal Anti-VEGF Agents Observable in the Fellow Eyes of Patients Treated for Diabetic Macular Edema? Robert L Avery MD* 4:36 PM Combined CFH and Age-Related Maculopathy Susceptibility 2 (ARMS 2) Risk Predicts Response to AMD Nutritional Prophylaxis: A New Analysis of AREDS Data Carl C Awh MD* American Society of Plastic and Reconstructive Surgery 4:44 PM
Vismodegib in the Treatment of Periocular and Orbital Basal Cell Carcinoma Hakan Demirci MD American Association for Pediatric Ophthalmology and Strabismus 4:51 PM
4:58 PM 5:00 PM
Comparison of the WINROP and CHOP-ROP Growth Models for the Detection of ROP Irene Shyu** Conclusion End of Session
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Spotlight Sessions & Symposia Monday, Oct. 21 (cont.)
Pediatric Orbital Disease Event No: SYM37 Room: Grand Ballroom S100c
3:45 - 5:15 PM
MARSHALL M PARKS LECTURE 4:43 PM 4:48 PM 5:13 PM 5:15 PM
Introduction of the Marshall M Parks Lecturer Elias I Traboulsi MD* Marshall M Parks Lecture: Craniofacial Malformations James A Katowitz MD Award Presentation Elias I Traboulsi MD* End of Session
Funding Our Future: Making Investments in Ophthalmology Event No: SYM38 Room: E350
3:45 - 5:15 PM
Combined meeting with the National Medical Association (NMA) Chair(s): Leslie S Jones MD**, Chasidy D Singleton MD The future of medicine has become increasingly uncertain due to new government regulations and a sluggish economy, despite an ever-expanding patient population with more demands for excellent service. The field of ophthalmology,
Tuesday, Oct. 21
Focus on Practice Efficiency: How to Deal Effectively with Increasing Patient Volume of the Aging Population Event No: SYM42 Room: Grand Ballroom S100c
8:30 - 10:00 AM
Combined meeting with the Committee on Practice Improvement Chair(s): Joseph Caprioli MD FACS*, Anne Louise Coleman MD PhD* In 2020, the workload for ophthalmology is projected to be 47% greater than in 2001, based on the needs of the aging baby boomer generation. This demographic shift underscores the need to keep up with the growing eye care needs of the country, and to prevent ourselves from being overwhelmed. Ophthalmology can seize the opportunity to solidify its role as the leader of eye care by becoming more efficient and capable of meeting the increased and varied demands of the population. Ophthalmologists may need to consider changes in workflow and to focus on specific areas of competency, delegation of duties, redesign of office space, and use of physician extenders to fill gaps in the delivery of care while maintaining the quality of care. In this symposium, panelists will address the impending demographic trends and present the ophthalmology-led eye care team, a calculator for measuring practice efficiency, and additional tools and resources the Academy has developed to help its members. 8:30 AM Introduction Joseph Caprioli MD FACS*
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
141
Spotlight Sessions & Symposia
Combined meeting with the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) Chair(s): Stephen P Christiansen MD*, Sherwin Isenberg MD* Diagnosing and managing the child with orbital and adnexal disease can be challenging on multiple levels. Congenital malformations, for example, often are hereditary and may require genetic analysis and multidisciplinary care. Growth of the orbit and eye, as well as visual development, demand special consideration and care both in the short and in the long term. The developing brain and facial skeleton require modifications in imaging techniques. These and many more considerations make management of pediatric orbital disease especially challenging and particularly worth our collective attention. In this symposium, experts will discuss advances in diagnosis and in medical and surgical management of pediatric orbital disease. 3:45 PM Welcome and Introduction Stephen P Christiansen MD* 3:47 PM Orbital Vascular Malformations: Classification and Treatment Kenneth V Cahill MD FACS 3:54 PM Mini-symposium: Solid Orbital Tumors - Pathology Ralph Eagle MD* 4:01 PM Clinical Presentation and Treatment William R Katowitz MD 4:08 PM Optic Nerve Gliomas Grant T Liu MD 4:15 PM Mini-Symposium: Expansion of the Small Orbit - Socket Expansion in Congenital Microphthalmos Jill Annette Foster MD FACS* 4:22 PM Orbital Expansion in Congenital Anophthalmos David T Tse MD FACS* 4:29 PM Orbital Cellulitis Rachel K Sobel MD 4:36 PM Congenital Eyelid Malformations Femida Kherani MD*
however, has the opportunity to thrive in the midst of these challenges by making lasting “investments” to maintain productive practices. While some of these “investments” are financial, they are also related to improving the quality of clinical care and patient outcomes by developing efficient practices and improving access to care for our diverse patient population. In addition, we must support the development of our young ophthalmologists as leaders in innovation, research, clinical care, and public policy. Every ophthalmologist has the responsibility to capitalize now on making our profession sustainable and successful through transforming our mindsets to prepare for this exciting future. 3:45 PM Introductions and Welcome Leslie S Jones MD** 3:47 PM Protecting Our Practice: OPHTHPAC and the Surgical Scope Fund Robert A Copeland MD 3:55 PM Managing Our Reputation With the Public Andrew P Doan MD PhD* 4:03 PM Physician Quality Measures: Participation in the IRIS Registration System William L Rich MD 4:11 PM The Time Is Now: Incorporating ICD-10 Without Affecting Patient Flow Patricia Kennedy COMT CPC COE* 4:19 PM Encouraging Our Youth to Pursue Academic Medicine Eydie G Miller MD* 4:27 PM Creating Leaders in Our Young Ophthalmologists Robert F Melendez MD MBA 4:35 PM The Workforce of the Future Ruth D Williams MD* 4:43 PM How the Power of Diversity Creates Better Groups Darrell G Kirch MD 4:51 PM Q&A and Panel Discussion 5:13 PM Closing Remarks Chasidy D Singleton MD 5:15 PM End of Session
Spotlight Sessions & Symposia Tuesday, Oct. 21 (cont.)
8:59 AM
Implications of the Changing Demographics of the United States Paul P Lee MD JD* 8:45 AM Efficiencies of Ophthalmology-Led Eye Care Teams Ruth D Williams MD* 8:55 AM The Practice Efficiency Calculator and How It Can Help Your Practice Joseph Caprioli MD FACS* 9:05 AM Academy Aids and Tools to Enhance Practice Efficiency Robert E Wiggins MD MHA* 9:15 AM How Can the EHR Help Improve Practice Quality and Volume? Michele C Lim MD* 9:25 AM Panel Discussion and Q&A 10:00 AM End of Session
9:01 AM
The Battle of Glaucoma: How to Diagnose, Assess, and Manage Glaucoma That is Getting Worse
9:20 AM
8:35 AM
Spotlight Sessions & Symposia
Event No: SYM45 Room: S406a
8:30 - 10:00 AM
Combined meeting with Prevent Blindness Chair(s): David S Friedman MD MPH PhD*, Steven L Mansberger MD* Virtual Moderator: Savak Teymoorian MD** This symposium will discuss the practical evaluation, detection, and management of patients whose condition is getting worse from glaucoma. The topics include structural evaluation of the optic disc with confocal scanning laser ophthalmoscopy and ocular coherence tomography, visual field testing with evaluation of velocity and location of loss, how to treat when patients are getting worse because of poor adherence to glaucoma therapy, and the best approach for initial surgery on a patient who is getting worse from glaucoma. Two expert speakers will address these topics by advocating for different approaches to the same controversial case of glaucomatous progression, with a rebuttal subsequently. The discussion will be case based and highly clinically relevant for ophthalmologists evaluating and treating glaucoma patients. After each case, attendees will vote for the most convincing management approach. 8:30 AM Introduction and Case #1: Glaucoma Getting Worse By Objective Structural Testing Steven L Mansberger MD* 8:32 AM Case #1: Confocal Scanning Laser Is The Gold Standard Mitra Sehi PHD* 8:37 AM Case #1: Ocular Coherence Tomography Is The Gold Standard Claude F Burgoyne MD* 8:42 AM Rebuttal Mitra Sehi PHD* 8:43 AM Rebuttal Claude F Burgoyne MD* 8:44 AM Case #2: Progression By Visual Field David S Friedman MD MPH PhD* 8:47 AM Case #2: Any Change Is Significant and Needs to Be Addressed Jeffrey M Liebmann MD* 8:52 AM Case #2: Rate of Change Is the Important Aspect Kouros Nouri-Mahdavi MD* 8:57 AM Rebuttal Jeffrey M Liebmann MD* 8:58 AM Rebuttal Kouros Nouri-Mahdavi MD* 142
9:06 AM 9:11 AM 9:12 AM 9:13 AM
9:15 AM
9:25 AM 9:26 AM 9:27 AM
Case #3: Patient Is Getting Worse and Not Taking Drops as Prescribed Steven L Mansberger MD* Case #3: We Should Treat the Adherence Kelly Walton Muir MD* Case #3: Treating Adherence Is a Wasted Effort: It’s Time For Surgery Rohit Varma MD MPH* Rebuttal Kelly Walton Muir MD* Rebuttal Rohit Varma MD MPH* Case #4: Patient Is Worsening on Maximal Medical Therapy: What Next? David S Friedman MD MPH PhD* Case #4: A MIGS Is the Next Best Step Malik Y Kahook MD* Case #4: Forget MIGS: You Should Use Standard Treatments (Trab and Tube) Steven Gedde MD* Rebuttal Malik Y Kahook MD* Rebuttal Steven Gedde MD* Summary of Session David S Friedman MD MPH PhD*
ROBERT N SHAFFER LECTURE 9:30 AM 9:34 AM
9:59 AM
Introduction of Robert N Shaffer Lecturer and Presentation of Plaque Andrew George Iwach MD* Robert N Shaffer Lecture: Global Collaborations: Improving Glaucoma Care Alan L Robin MD* Conclusion David S Friedman MD MPH PhD*
Ophthalmic Premier League: A Team Video Competition on Managing Cataract Complications Event No: SYM60 Room: North Hall B
8:30 - 10:00 AM
Chair(s): Amar Agarwal MD*, Richard L Lindstrom MD** The Ophthalmic premier league (OPL) symposium is similar to the American football league games, but the OPL is connected to ophthalmology. There will be 4 teams with 4 captains. Each team will sport their team jersey. Each team will have a total of 4 members. Each team member will be given 4 minutes to show his/her most challenging cataract/complication cataract case through videos. Each team will be given a total of 18 minutes. There will be a good discussion on each case for the remaining time. The audience will vote for their favorite team. The winning team will be awarded the AAO-OPL trophy. Moderators: Richard L Abbott MD*, Jonathan B Rubenstein MD* Judges: William J Fishkind MD FACS*, Nick Mamalis MD* Match Referee: Ronald R Krueger MD* Team 1: Chicago Choppers Captain: Roger F Steinert MD* Vice Captain: Jorge L Alio MD PhD* Susan M MacDonald MD*, Samuel Masket MD*
Team 2: LA Accommodators Captain: Kevin M Miller MD*
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Spotlight Sessions & Symposia 9:26 AM
Tuesday, Oct. 21 (cont.)
9:35 AM
Vice Captain: Richard S Hoffman MD* Sonia H Yoo MD*, Boris Malyugin MD PhD*
9:44 AM
Team 3: Frisco Flomaxinators Captain: David F Chang MD* Vice Captain: Thomas A Oetting MD
CASTROVIEJO LECTURE 9:57 AM
Athiya Agarwal MD, Thomas Kohnen MD*
Team 4: Vegas Multifocals Captain: Robert H Osher MD* Vice Captain: Abhay Raghukant Vasavada MBBS FRCS* George Beiko MD*, Ehud I Assia MD*
8:30 AM
Advanced Treatment of Ocular Surface Inflammatory Diseases
8:30 - 10:30 AM
Combined meeting with the Cornea Society Chair(s): William Barry Lee MD*, Edward J Holland MD* This symposium will feature a combined effort by the Cornea Society and the German Ophthalmological Society (DOG) to discuss a number of immune-mediated and inflammatory conditions that can severely affect the anterior segment of the eye. The various diagnostic strategies and treatment options for some of the most challenging local and systemic inflammatory conditions of the anterior segment will be reviewed. The symposium will conclude with a lecture from the Castroviejo Lecture awardee for 2014, Professor Mark Mannis MD FACS. 8:30 AM Introduction William Barry Lee MD* 8:32 AM The Itchy Eyes Have It: A Case-Based Approach to Allergic Eye Diseases Penny Asbell MD FACS* 8:41 AM Atypical Causes of Immune-Mediated Conjunctivitis Hans E Grossniklaus MD* 8:50 AM Rosacea and the Ocular Surface: How to Get the Red Out? Gerd Geerling MD PHD* 8:59 AM Cicatricial Ocular Surface Diseases: Advances in Treatment Options Darren G Gregory MD 9:08 AM Graft-versus-Host Disease: Treatment Strategies, from Mild to Severe Disease Claus Cursiefen MD* 9:17 AM Localized Immune-Mediated White Spots of the Cornea Berthold Seitz MD
Introduction of the Castroviejo Lecturer Edward J Holland MD* 9:59 AM Castroviejo Lecture: Points of Light in the History of Cornea Mark J Mannis MD 10:29 AM Conclusion William Barry Lee MD* 10:30 AM End of Session
Decision Making in Contemporary Refractive Surgery Event No: SYM48 Room: S406a
10:15 - 11:45 AM
Combined meeting with the International Society of Refractive Surgery (ISRS) Chair(s): George O Waring MD*, Renato Ambrosio Jr MD* The subspecialty of refractive surgery has evolved significantly in recent years. From topography-guided excimer treatments to laser lens surgery, refractive procedures and platforms are emerging rapidly. Biomechanical treatments are quickly becoming the standard of care for ectatic disorders, and small corneal lenticule extraction may emerge as one of the most versatile treatment paradigms in corneal refractive surgery. Furthermore, lens-based surgery, historically the original refractive surgical procedure, has become a primary focus for the comprehensive refractive surgeon, and the surgical correction of presbyopia is quickly becoming a recognized sub-subspecialty. This symposium was designed to aid the lens- and corneal-based refractive surgeon in decision making in contemporary refractive surgery. 10:15 AM Introduction George O Waring MD* 10:18 AM Corneal or Lens-Based Refractive Surgery George O Waring MD* 10:23 AM Defining Refractive and Therapeutic Procedures Renato Ambrosio Jr MD* 10:28 AM Prevention and Treatment of Infections in Refractive Surgery: What Do We Need to Know? Denise de Freitas MD 10:33 AM Correction of Ametropia on the Cornea: Advanced Excimer Ablation Daniel S Durrie MD* 10:38 AM Correction of Ametropia on the Cornea: Femtosecond Lenticule Extraction Dan Z Reinstein MD* 10:43 AM Crosslinking: Show Me the Evidence: Epithelium Off Theo Seiler MD PhD 10:48 AM Crosslinking: Show Me the Evidence: Epithelium On William B Trattler MD* 10:53 AM Crosslinking: Show Me the Evidence: Iontophoresis Paolo Vinciguerra MD* 10:58 AM Surgical Correction of Presbyopia: Lens Based Jason E Stahl MD 11:03 AM Surgical Correction of Presbyopia: Cornea Excimer Based Gustavo E Tamayo MD* 11:08 AM Surgical Correction of Presbyopia: Corneal Inlay Based Minoru Tomita MD PhD*
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Spotlight Sessions & Symposia
Introduction of OPL Amar Agarwal MD* 8:33 AM Moderator Comments 8:35 AM Judges Comments on the OPL 8:36 AM Match Referee Comments 8:37 AM Team 1: Chicago Choppers 8:55 AM Team 2: LA Accommodators 9:13 AM Team 3: Frisco Flomaxinators 9:31 AM Team 4: Vegas Multifocals 9:49 AM Match Referee Comments 9:50 AM Audience Vote for Best Team and Moderator and Judges Comments 9:55 AM Present OPL-AAO Trophy to the Best Team 10:00 AM End of Session
Event No: SYM46 Room: Grand Ballroom S100ab
Scleritis: Medical Management Strategies for Scleral Disease TBD Stage-Related Therapy for Atopic Ulcerative Keratitis Walter Lisch MD Q&A
Spotlight Sessions & Symposia Tuesday, Oct. 21 (cont.) 11:13 AM Cataract Surgery: Non-Laser Assisted James C Loden MD* 11:18 AM Cataract Surgery: Laser Assisted Burkhard Dick MD*
BARRAQUER LECTURE 11:23 AM Introduction of the Barraquer Lecturer George O Waring MD* 11:26 AM Barraquer Lecture: Predicting and Treating Corneal Ectasia after LASIK R Doyle Stulting MD PhD* 11:41 AM Presentation of the Award George O Waring MD* 11:45 AM End of Session GO YO International Opportunities for Young
Ophthalmologists
Spotlight Sessions & Symposia
Event No: SYM49 Room: Grand Ballroom S100c
10:45 - 11:45 AM
Combined meeting with the Young Ophthalmologist International Subcommittee Chair(s): Grace Sun MD, Brad H Feldman MD Today’s residents and young ophthalmologists (YOs) must become tomorrow’s leaders in the global fight against eye disease. This course will address the challenges of treating eye disease in underserved parts of the world and will identify the organizations working toward this goal and the opportunities available for resident and YO involvement. The course will also examine the unique challenges of incorporating volunteer service into one’s career by sharing the experiences of those who have found ways to balance work abroad with family, clinical practice, and financial concerns at home. There will be ample time for responses to the audience’s questions to the panel. At the conclusion of the course, the attendee will have an understanding of the global burden of eye disease, the organizations and strategies employed to address this burden, the role residents and YOs can play in this work, and the challenges of balancing domestic life with international service. 10:45 AM Introduction Grace Sun MD 10:48 AM Working Abroad During Residency John D Welling MD** 10:56 AM Incorporating International Work Into Your Life Linda M Lawrence MD 11:04 AM Panel Discussion 11:16 AM Bringing World Class Eye Care to Africa John M Cropsey MD 11:24 AM Global Ophthalmology Fellowship Michael R Feilmeier MD 11:32 AM Panel Discussion 11:45 AM End of Session
144
SOE A View Across the Pond: Cornea Enigmas
Event No: SYM20 Room: Grand Ballroom S100ab
10:45 AM - 12:15 PM
Joint Session with the European Society of Ophthalmology (SOE) Chair(s): Friedrich E Kruse MD*, William Barry Lee MD* The symposium will highlight the state of the art treatment of corneal and surface disorders in the United States versus Europe. 10:45 AM Introduction 10:46 AM Diagnosis and Management of Dry Eye Disease: The U.S. Experience Steven I Rosenfeld MD FACS* 10:58 AM Discussion 11:01 AM Diagnosis and Management of Dry Eye Disease: The European Experience Christophe Baudouin MD PhD** 11:13 AM Discussion 11:16 AM Management of Corneal Ectasia: The U.S. Experience Kenneth S Himmel MD 11:28 AM Discussion 11:31 AM Management of Corneal Ectasia: The European Experience Theo Seiler MD PhD 11:43 AM Discussion 11:46 AM Surgical Management of Endothelial Disease: The U.S. Experience William Barry Lee MD* 11:58 AM Discussion 12:01 PM Surgical Management of Endothelial Disease: The European Experience Friedrich E Kruse MD* 12:13 PM Discussion 12:16 PM End of Session
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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ORIGINAL PAPERS Sunday – Tuesday, Oct. 19 – 21 SOE Sponsored by the European Society of Ophthalmology
Unless otherwise noted, a panel discussion will follow each paper presentation. At the end of each session, the panel will select the best paper from that session.
Selection Committee The Annual Meeting Program Committee selected all Original Papers. See page 33 for committee details.
P.O. Box 7424, San Francisco, CA 94120-7424 | Tel: 415-561-8500 Fax: 415-561-8533 © 2014 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology.
Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
145
Original Papers Cataract Sunday, Oct. 19 10:30 AM - 12:00 PM Room: S405 Moderator: R Bruce Wallace MD Panel: George Beiko MD, James A Davison MD, Boris Malyugin MD PhD
PA001
10:30 AM
Impact of First Eye vs. Second Eye Cataract Surgery on Quality of Life Presenting Author: Nakul Shekhawat MD Co-Author(s): Michael V Stock MD, Elizabeth F Berzin MD, Mary K Daly MD, David E Vollman MD MBA*, Mary Gilbert Lawrence MD MPH, Amy Chomsky MD Purpose: To compare the impact of first eye with second eye cataract surgery on quality of life (QoL). Methods: 342 patients completed prepost Visual Function Questionnaires for first and second eye surgeries. Postoperative QoL and QoL improvement of first eye surgery were compared to those for second surgery. Results: QoL was higher after second eye surgery than first eye surgery for all subscales and composite score (P < .05 for all). First and second eye surgery showed no significant differences in QoL improvement for general vision, near activity, mental health, role difficulties, dependence, or driving ability subscales and composite score (P > .05 for all). Conclusion: Second eye cataract surgery improves patient’s quality of life beyond first eye surgery alone. For many aspects of vision, second eye surgery is no less beneficial than first eye surgery.
Original Papers
PA002
10:37 AM
SOE Are We Operating Too Many Patients for Cataract? A Critical Analysis of Indications for Cataract Surgery Using Data on 7300 Cataract Extractions
Presenting Author: Mats H Lundstrom MD Co-Author(s): Charlotta Zetterstrom MD**, Ulf Stenevi MD Purpose: To analyze indications for a cataract extraction. Methods: Clinics affiliated with the Swedish Cataract Register participated in outcomes studies during 1 month in 2012 and in 2013. Clinical data and patient-reported visual function were registered. Results: Poor preoperative visual acuity was the indication for the majority of patients. For patients with better preoperative visual acuity, 18% were dissatisfied with their vision and reported visual disabilities. Another 8% reported difficulties performing vision-related daily life activities. Indications like anisometropia or high IOP were stated by the surgeons in 0.4%. For 2.6% of the surgeries, no obvious indication for a cataract extraction was found. Conclusion: In 97.4% a reasonable indication for a cataract was found. The remaining 2.6% will be discussed.
PA003
10:44 AM
Evaluation of Effect of the Amount of Energy on IOP in Nd:YAG Laser Capsulotomy Presenting Author: Harshika Chawla MBBS Co-Author(s): Manav Deep Singh, Vishal Vohra MBBS MS, Mayank Bansal MD Purpose: Although studies suggest that using high energy during Nd:YAG capsulotomy increases the risk of IOP rise, no study has quantified these effects. This study was undertaken to quantify the same. Methods: Nonglaucomatous cases with posterior capsule opacity were recruited. Based on the 146
total energy (mJ) used, cases were grouped into Group A (< 40), Group B (4180), or Group C (> 80). Results: Significant rise of IOP was noted in Groups B and C from 2 hours to 1 week following laser. The rise was greater in Group C than in Group B. Overall, 3.2% of patients in Group A, 17.9% in Group B, and 70% in Group C showed a rise of IOP ≥ 5 mmHg. Conclusion: If energy used during the procedure is ≤ 40 mJ, the procedure can be safely carried out without the need for perioperative antiglaucoma drugs.
10:51 AM Panel discussion of previous papers
PA004
11:01 AM
Evaluation of Sustained-Release Dexamethasone for Safety and Efficacy After Cataract Surgery in a Multicenter Study Presenting Author: Tom R Walters MD* Purpose: To evaluate a 4-week tapered-release dexamethasone punctum plug (OTX-DP) for treatment of ocular inflammation and pain in patients undergoing cataract surgery. Methods: Sixty patients across 4 sites were randomized and administered OTX-DP or placebo vehicle punctum plug (PVPP) immediately following surgery and followed for 30 days. Results: 34.5% of OTX-DP subjects vs 3.4% of PVPP subjects at Day 14 (P = .0027) and 62.1% vs. 13.8% at Day 30 (P = .0002) had an absence of anterior chamber (AC) cells. Significantly more OTX-DP subjects had an absence of pain at Days 1, 4, 8, 11, 14, and 30 (P ≤ .0002). No long-term IOP spikes or adverse events related to OTX-DP were reported. Conclusion: OTX-DP was statistically significantly superior to PVPP for clearing AC cells at Days 14 and 30 and pain at all followup visits.
PA005
11:08 AM
Comparative Effectiveness of Intracameral Antibiotic Agents for Preventing Phacoemulsification-Related Endophthalmitis Presenting Author: Kevin L Winthrop MD** Co-Author(s): Neal H Shorstein MD*, Liyan Liu MHSA Purpose: To compare the effectiveness of intracameral (IC) cefuroxime and moxifloxacin prophylaxis. Methods: Retrospective cohort study of 150,086 Kaiser Permanente members, 118 with confirmed endophthalmitis, from 2005 to 2012. Key variables were validated. The logistic regression analysis adjusted for age, year of surgery, ocular and systemic comorbidity, posterior capsular rupture, and topical antibiotic. Results: Risk on IC cefuroxime was 0.43 per 1000. The odds of endophthalmitis with IC moxifloxacin compared with IC cefuroxime was 1.16 (CI, 0.51-2.65). Conclusion: Cefuroxime and moxifloxacin are effective intracameral agents.
PA006
11:15 AM
Transzonular Steroid/Antibiotic as Cataract Prophylaxis: Retrospective Analysis of 2300 Patients Presenting Author: M Stewart Galloway MD Co-Author(s): Jeffrey Todd Liegner MD* Purpose: To evaluate transzonular injection of combined triamcinolone, moxifloxacin with and without vancomycin to reduce postop inflammation, to serve as prophylaxis against infection, and to reduce use of topical eye drops. Methods: Cataract patients from 2006 to 2013 received TriMoxi and TriMoxiVanc intravitreal injections after IOL implantation, and retrospective outcomes were assessed: CME rates, IOP, rebound inflammation, infection, and floaters. Results: Average age, 71.8; CME rate, 1.99% (low- and high-risk patients, n = 2313); postop IOP, 15 (average POW5 ); rebound inflammation, 3.6% (n = 736); infection, none; floaters, 10.9% (POW5, n = 551). Conclusion: Intravitreal transzonular antibiotic / steroids concurrent with cataract surgery
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Original Papers Sunday, Oct.19
provided significant benefit with minimum risk. Patient acceptance and convenience was high.
3:45 PM to 5:20 PM Room: E350
11:22 AM Panel discussion of previous papers
PA007
11:32 AM
Single-Center Results of Ocular Sealant Evaluation Compared With Suture in Preventing Wound Leaks After Cataract Surgery Presenting Author: Charles D Reilly MD* Co-Author(s): William Flynn MD*, Edward R Rashid MD, Robert A Rice MD Purpose: To evaluate the safety and efficacy of the ReSure Sealant compared to suture at a single site for wound leak prevention in cataract surgery patients. Methods: Forty Seidel positive wounds (spontaneous or provoked with a force gauge) received either sealant (n = 24) or suture (n = 16) following cataract surgery. Wounds were challenged after device application for Seidel. Results: Prior to device application, 65% of wounds leaked spontaneously and 97.5% leaked with ≤ 0.50 ozf. After treatment, no sealant subjects leaked, but 31% of suture subjects leaked when provoked. Sixty-nine percent of suture subjects vs. only 33% of sealant subjects experienced transient ocular adverse events. Conclusion: The ReSure Sealant improved wound resistance to leaks over suture in this case series.
PA008
11:39 AM
Moderator: William J Fishkind MD FACS Panel: Kenneth J Rosenthal MD FACS, R Bruce Wallace MD, Liliana Werner MD PhD
PA025
3:45 PM
Improved Algorithm for IOL Power Calculation in Long or Short Eyes Presenting Author: Eric D Donnenfeld MD* Purpose: To determine the efficacy of a new method of calculating IOL power in long and short eyes using intraoperative aberrometry. Methods: Mean absolute value of the prediction error (MAVPE) was calculated for 119 short and 189 long eyes and compared to MAVPE for 204 short and 227 long eyes after optimization of the power calculation algorithm. Results: Prior to the change, MAVPE was 0.47 D ± 0.36 D in short and 0.40 D ± 0.32 in long eyes, with 84% and 93%, respectively, within 0.75 D of the predicted postop refraction. With the new algorithm, MAVPE was 0.31 D ± 0.26 D in short and 0.27 D ± 0.23 D in long eyes, with 93% and 97% within 0.75 D. Conclusion: A refined intraoperative aberrometry algorithm improves refractive outcomes in eyes with unusual axial lengths.
PA026
3:52 PM
American Society of Cataract and Refractive Surgery / European Society of Cataract and Refractive Surgeons Survey on Foldable IOLs Requiring Explantation or Secondary Intervention: 2013 Update
SOE Laser Arcuate Incisions: One-Year Safety and Effectiveness Data
Presenting Author: Nick Mamalis MD*
Co-Author(s): Michaela Netukova MD
Co-Author(s): Scott Cameron Cole MD MS, Joshua Richard Ford MD, Justin C Kohl MD**
Purpose: To present results of laser astigmatic keratotomy combined with cataract surgery. Methods: Laser arcuate incisions were performed by Victus (Technolas Bausch + Lomb) femtosecond laser on 50 eyes with 1 year follow-up. All patients had corneal astigmatism of 0.5 D -3.0 D. The arc was positioned at a diameter of 8.5 mm, and depth was 80%. Results: Astigmatism decreasing from -1.8 ± 0.7 D preoperatively to -0.5 ± 0.4 D at 3 months. Seventy percent of eyes had manifest cylinder of ≤ 0.50 D, 83% eyes at ≤ 0.75 D, and 94% at ≤ 1.0 D. Mean postoperative objective cylinder was -0.3 ± 0.6 D. Conclusion: Our 1-year data was comparable with the published data on the correction of astigmatism using toric IOLs and better than published data on manual Aks.
11:46 AM Panel discussion of previous papers
PA027
3:59 PM
Residual Astigmatism After IOL Placement Presenting Author: Brent Kramer Co-Author(s): David R Hardten MD*, John P Berdahl MD* Purpose: Analysis of patients with residual astigmatism after toric IOL placement. Methods: Retrospective review of 4572 patients with residual astigmatism after toric IOL placement. Results: Fifty-two percent of patients had IOLs currently > 15° from their intended location, 23% between 5° and 15°, and 25% < 5°. If toric IOLs are rotated to their ideal location, the average residual astigmatism is reduced from 2.05 D to 0.75 D, 1.49 D to 0.96 D, and 1.48 D to 1.21 D respectively. The intended toric IOL placement was with-the-rule in 58% of patients, oblique in 13%, and against-the-rule in 29%. Conclusion: Surgically rotating toric IOLs in patients with residual astigmatism can significantly decrease the amount of astigmatism. Even when the IOL is in the intended location, significant residual astigmatism can be present, and improved by proper rotation
4:06 PM Panel discussion of previous papers * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
147
Original Papers
Purpose: To survey members of the ASCRS/ESCRS regarding explantation of foldable IOLs. Methods: Preoperative data and information on the type and material of IOL requiring explantation were collected. Patients signs and symptoms as well as complications requiring explantation were tabulated. Postoperative results were also assessed. Results: Dislocation / decentration was the most common complication associated with 1-piece and 3-piece acrylic IOLs and 3-piece silicone IOLs. The most common reason for explantation of multifocal IOLs was glare / optical aberrations. Incorrect lens power was the third most common complication. Calcification / opacification of IOLs was also infrequently noted. Conclusion: The most common complications with foldable IOLs were dislocation / decentration, glare / optical aberrations, and incorrect lens power.
Presenting Author: Pavel Stodulka MD PhD*
Original Papers PA028
4:16 PM
Influence of Ophthalmic Viscosurgical Devices on Intraoperative Aberrometry
4:47 PM
Presenting Author: Samuel Masket MD*
Refractive Outcomes in Post-refractive Eyes Undergoing Cataract Surgery With Toric IOL Implantation Guided by Intraoperative Aberrometry
Co-Author(s): Nicole R Fram MD*, Jack T Holladay MD MSEE FACS*
Presenting Author: P Dee G Stephenson MD FACS*
Purpose: To determine whether there is a difference in intraoperative aberrometry IOL power calculation when the anterior chamber is filled with ophthalmic viscosurgical device (OVD) instead of BSS. Methods: Calculated IOL power was compared for 6 groups of 20 eyes, each undergoing aberrometry at measured physiologic IOP when the aphakic eye was filled with BSS and then repeated immediately with 1 of 6 OVDs. Results: Aberrometry-calculated IOL power is insignificantly different between BSS and 3 tested low molecular weight low concentration hyaluronate based OVDs. There were statistically significant differences between OVD and BSS with a chondroitin-hyaluronate combined OVD and higher concentration pure hyaluronate based agents. Conclusion: Some, but not all, OVDs are equivalent to BSS for aphakic lens power calculation.
Purpose: To evaluate outcomes in post-refractive eyes undergoing toric IOL implantation guided by intraoperative aberrometry. Methods: Twenty postrefractive eyes were implanted with toric IOLs with the aid of intraoperative aberrometry (ORA with VerifEye, WaveTec Vision) to refine IOL spherical and cylinder power, and cylinder axis. The ORA prediction error (MAVPE) was compared to the preop lens choice MAVPE. Results: Mean postop manifest astigmatism was 0.25 ± 0.39 D. MAVPE was 0.30 ± 0.23 D with ORA vs. 0.64 ± 0.48 for the calculated preop lens choice (P < .05). The prediction error was ≤ 0.50 D in 80% of eyes, with ORA vs. 60% of eyes with the preop lens choice. Conclusion: Intraoperative aberrometry can improve toric IOL power accuracy in challenging post-refractive eyes.
PA029
Analysis of IOL Calculation Prediction Error in Post-Radial Keratotomy Patients Undergoing Cataract Surgery
4:23 PM
Correlating OCT With Lens Density and Energy Required During Cataract Extraction Presenting Author: Leah Kammerdiener MD Co-Author(s): George N Magrath MD, Lynn Perry MD PHD**, Rupal H Trivedi MBBS MS*, Jan A Kylstra MD
Original Papers
PA031
Purpose: To evaluate the role of preoperative macular OCT signal strength in predicting cataract density. Methods: The OCT signal strength and cataract grade were recorded for patients with otherwise clear media and the effective phacoemulsification (EPT) and cumulative dissipated energy (CDE) were recorded for surgical patients. Results: Twenty-one (15 operated) nuclear sclerotic cataracts and 14 (8 operated) combined cataracts were identified. Nuclear cataract r-squared value was 0.71 and 0.66 when OCT signal strength was compared to nuclear color and opalescence. R-squared values were 0.72 and 0.75 when combined cataracts were compared with EPT and CDE. Conclusion: OCT signal strength has a correlation with nuclear cataract grading and energy required for cataract removal in combined cataracts.
PA030
4:30 PM
Comparison of High Resolution Scheimpflug With OCT Images in Evaluating Anterior Segment Parameters for Femtosecond Cataract Surgery Presenting Author: Harvey S Uy MD* Co-Author(s): Ajay Pillai MD Purpose: To compare the clinical utility of high-resolution Scheimpflug (HRS) with OCT images. Methods: Thirty-seven masked surgeons graded anterior segment images, generated by 4 different laser systems, according to clinical parameters. Results: The mean grading scores of HRS images were higher than those of OCT images with regard to overall image resolution, quality and ability to define lens layers, lens thickness, and nuclear density. One of the OCT-based machines was ranked best for ability to define the posterior capsule. Both modalities were equal with regard to corneal image resolution. Conclusion: FCS laser images differ in image quality and ability to provide information about anterior segment anatomy. Overall, the HRS images were ranked higher than OCT images in majority of evaluated parameters.
4:37 PM Panel discussion of previous papers
148
PA032
4:54 PM
Presenting Author: Stephen F Brint MD* Purpose: To compare refractive outcomes from a new algorithm for intraoperative aberrometry IOL power calculation in post-radial keratotomy (RK) eyes to those of the previous calculation algorithm. Methods: Results were compared from 50 consecutive cases, each with the new algorithm designed for post 4- or 8-incision RK and the previous algorithm for the ORA system. Results: The mean absolute value of prediction error with the old algorithm was 0.54 ± 0.51 D vs. 0.45 ± 0.38 D with the new algorithm. Sixty-eight percent were ±0.5 D, and 48% were ± 0.25 D of the predicted postoperative error with the new algorithm vs. 58% and 40%, respectively, with the old algorithm. Conclusion: A new algorithm designed specifically for post 4- and 8-incision RK improved refractive outcomes better than the previous algorithm.
PA033
5:01 PM
Hoffer H-5 Clinical Results Comparing All Formulas on 6000 Eyes Presenting Author: Kenneth J Hoffer MD FACS* Purpose: To evaluate the new H-5 formula (dependent upon race and gender) with all modern formulas on a very large series of eyes from around the world. Methods: Months of biometric data collection will produce more than 6000 eyes. The eyes will be calculated using the Barrett, Haigis, Hoffer Q, Holladay 1 and 2, and SRK/T formulas and be compared to those with the new Hoffer H-5. Results: This being one of the largest such series performed, the results will compare the MedAE, SD, and range of errors, as well as the % ±0.25, ±0.50 and ±1.00 D prediction. Conclusion: With such a large series, the results will show statistically which formulas are more accurate in predicting IOL power, as well as showing which are more accurate based on AL and corneal power.
PA034
5:08 PM
Diagnostic Intraoperative OCT for the Prediction of Postoperative Lens PositionDuring Femtosecond Refractive Laser-Assisted Cataract Surgery Presenting Author: Joseph J Ma MD* Purpose: To predict postoperative lens position (PLP) from algorithm-derived intraoperative OCT (AD-iOCT) to improve refractive outcomes. Methods: In a retrospective review of 50 eyes, AD-iOCT was compared to theoretical PLP
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Original Papers (T-PLP) calculated from preop biometry and postop measured, manually validated PLP (MV-PLP). Correlation coefficients, t tests, and Bland Altman plots were obtained. Results: Average follow-up: 93 days (SD: 30). Average MVPLP: 5.04 mm (SD: 0.30). Average AD-iOCT derived PLP: 5.00 mm (SD: 0.43), r = 0.59 (P < .01). Average 5 variable preop biometry-based T-PLP: 5.62 (SD: 0.56), r = 0.28 (P = .22). Pachymetry, anterior chamber depth, and lens thickness by AD-iOCT had r = 0.88, r = 0.91 and r = 0.93, respectively, vs. biometry, with P < .01 for all metrics. Conclusion: AD-iOCT data can more accurately predict actual MV-PLP than preop biometry-based T-PLP, which may help improve refractive outcomes.
5:15 PM Panel discussion of previous papers
Cornea, External Disease Sunday, Oct. 19 3:30 - 5:30PM Room: S405 Moderator: Shahzad I Mian MD Panel: Sophie X Deng MD PhD, Anat Galor MD, Vincenzo Sarnicola MD
PA015
3:30 PM Midterm Results of Descemet Membrane Endothelial Keratoplasty: Six-Year Clinical Outcomes SOE
Presenting Author: Fook Chang Lam MBChB Co-Author(s): Maria Satue MD, Lisanne Ham PhD, Gerrit RJ Melles MD PhD*
3:37 PM Panel discussion of previous paper
PA016
3:42 PM
Comparative Study of Long-term Graft Survival Between Full-Thickness and Partial Thickness Corneal Transplants Presenting Author: Anshu Arundhati MD Co-Author(s): Jodhbir S Mehta MBBS PhD*, Stephanie S Lang MS, Donald Tan MD FRCS FRCOphth* Purpose: To compare 5-year graft survival between penetrating keratoplasty (PK), Descemet-stripping automated endothelial keratoplasty (DSAEK), and deep anterior lamellar keratoplasty (DALK) for optical indications. Methods: 1242 primary grafts were analyzed. Kaplan-Meier survival curve was generated to compare graft survival. Results: Pseudophakic bullous keratopathy was the most common diagnosis for PK and DSAEK, and keratoconus was the most common for DALK. The overall graft survival rates for PK, DSAEK, and DALK were 94.3%, 96.7%, and 96.3%, respectively, at 1 year and 70.7%, 77.3%, and 93.1%, respectively, at 5 years. Glaucoma and rejection were significantly lower in the lamellar group. Conclusion: Long-term graft survival is better in DSAEK and DALK than in PK, with lowered risk of rejection and glaucoma.
3:54 PM
Eye Bank-Prepared Preloaded Grafts Can Be Successfully Used for Descemet Stripping Endothelial Keratoplasty Presenting Author: Sotiria Palioura MD Co-Author(s): Kathryn A Colby MD PhD* Purpose: To assess the feasibility of Descemet-stripping endothelial keratoplasty (DSEK) using preloaded donor tissue. Methods: Thirty-five eyes had DSEK with tissue that was precut, trephined, loaded into EndoGlide Ultrathin inserters at the Lions Eye Institute (Tampa, Fla.), and shipped overnight in storage media. Complications and postoperative endothelial cell density (ECD) were reviewed. Results: There was 1 primary graft failure (2.8%), 2 rebubblings (5.7%), and 1 graft rejection (2.8%). Mean preoperative donor ECD was 2859 ± 227 cells/mm2. At 3 months, mean ECD was 2041 ± 505 (cell loss: 28.9% ± 15.6%). At 6 months, mean ECD was 2148 ± 469 (cell loss: 24.5% ±16.6%). Conclusion: Eye bank-prepared preloaded tissue can be successfully used for DSEK without undo surgical complications or endothelial cell loss.
4:01 PM Panel discussion of previous paper
PA018
4:06 PM Descemet Membrane Endothelial Keratoplasty: Early Complications and 6-Month Endothelial Cell Loss in a Comparative Series of Unstamped and Stromal Sided S-Stamped Tissue in 101 Consecutive Cases Presenting Author: Peter B Veldman MD Co-Author(s): Zachary Mayko MS, Michael D Straiko MD*, Mark A Terry MD* Purpose: To compare outcomes in Descemet membrane endothelial keratoplasty (DMEK) cases performed with and without a stromal sided S-stamp to aid tissue orientation. Methods: A series of 101 consecutive cases of DMEK were performed utilizing 32 unstamped and 69 S-stamped grafts. Outcomes compared included rebubble and iatrogenic primary graft failure (iPGF) rates, 6-month endothelial cell loss (ECL), and visual acuity (BSCVA). Results: Rebubbles were performed in 1/32 unstamped vs. 6/69 S-stamped cases (p = .43), and iPGF occurred in 3/32 unstamped vs. 0/69 S-stamped cases (p = .028). Preliminary 6-month ECL was 27% ± 13% (n = 21) in the unstamped, vs. 30% ± 21% (n = 9) in the S-stamped group (p = .67). Conclusion: The introduction of the S-stamp eliminated iPGF in this series without a statistically significant change in rebubble rate or ECL to date, pending BCVA data.
4:13 PM Panel discussion of previous paper
PA019
4:18 PM
SOE Endothelial Cell Changes as an Indicator for Allograft Rejection Following Descemet Membrane Endothelial Keratoplasty
Presenting Author: Maria Satue MD Co-Author(s): Fook Chang Lam MBChB, Claire Monnereau MS, Gerrit RJ Melles MD PhD* Purpose: To report early changes in endothelial cell (EC) morphology as a predictor for allograft rejection after Descemet membrane endothelial keratoplasty (DMEK). Methods: Out of 500 DMEK eyes, 8 developed an allograft rejection. Specular microscopy images were analyzed and compared with 49 asymptomatic DMEK eyes. EC morphology was evaluated by subjective scoring and objective comparison. Results: Subjective scores and EC density differed from control eyes before and after rejection, while hexagonality only differed before rejection. Conclusion: Allograft rejection may not be an acute
3:49 PM Panel discussion of previous paper * The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
149
Original Papers
Purpose: To evaluate the midterm outcomes of Descemet membrane endothelial keratoplasty (DMEK). Methods: In 300 eyes, DMEK was performed for endothelial dysfunction. BCVA and endothelial cell density (ECD) were documented before and up to 6 years after DMEK, as were postoperative complications. Results: At 6 months postoperative, 97% of eyes reached a BCVA of ≥ 20/40, and 79% reached ≥ 20/25, which remained stable for up to 6 years. ECD decreased 35% in the first half-year after surgery, followed by an annual decrease of 9%. Longer term complications were allograft rejection (2%) and late-onset graft failures (0.7%). Conclusion: DMEK provides a fast and often complete visual recovery, with an acceptable ECD remaining stable up to 6 years after surgery. Complications are rare after the first 6 months.
PA017
Original Papers event, but rather a slow-onset immune response, and early, specific changes in EC morphology may “announce” an upcoming allograft rejection.
4:25 PM Panel discussion of previous paper
PA020
4:30 PM
Diagnostic Performance of Descemet Membrane Thickness vs. Central Corneal Thickness in Active Cornea Graft Rejection
5:01 PM Panel discussion of previous paper
Presenting Author: Mohamed F Abou Shousha MD*
PA023
Co-Author(s): Ravi Shah, Sean L Edelstein MBChB, Matthew D Council MD, Rocio Bentivegna, George Harocopos MD, Sonia H Yoo MD*, Victor L Perez MD*
Transepithelial vs. Epithelium-off Corneal Collagen Crosslinking for Progressive Keratoconus
Purpose: To evaluate diagnostic performance of Descemet membrane thickness (DMT) in comparison with central corneal thickness (CCT) in active corneal graft rejection. Methods: Forty-two grafts (27 controls and 15 actively rejecting) were imaged using OCT to measure DMT and CCT. Results: Actively rejecting grafts had significantly thicker CCT and DMT than controls (570 vs. 520 µm, P = .03 and 27 vs. 17 µm, P < .0001). DMT receiver operating characteristic curve showed very high predictive accuracy (area under the curve, or AUC, = 0.97) that was significantly higher (P < .001) than CCT (AUC = 0.65). DMT was 100% sensitive and 89% specific (optimal cutoff = 20 µm), while CCT was 73% sensitive and 59% specific (optimal cutoff = 550 µm). Conclusion: DMT has very high predictive accuracy, sensitivity, and specificity in diagnosing active corneal graft rejection, which are significantly better than CCT.
Co-Author(s): Salman Fawaz Alfayez MBBS
4:37 PM Panel discussion of previous paper
PA021
4:42 PM
Prophylactic Povidone-Iodine Rinses and Topical Amphotericin B Significantly Reduce Postoperative Infections After Boston Type I Keratoprosthesis
Original Papers
thelial defects (14/32), sterile melt (12/32), and microbial keratitis (11/32). There was clinical association between the inability to retain bandage contact lens (BCL) and surface complications. Tarsorrhaphy was the most frequent procedure done. In spite of the complications, the anatomical retention was 43.8% at mean follow-up of 21.8 ± 14.6 months. Conclusion: Ocular surface complications are mainly due to the inability to retain the BCL, but the keratoprosthesis is retained if appropriately managed.
Presenting Author: Jeffrey D Welder MD
5:06 PM
Presenting Author: Mashhoor F Al Fayez MD Purpose: To compare the safety and efficacy of transepithelial corneal crosslinking to that of epithelium-off corneal crosslinking for progressive keratoconus. Methods: In a prospective clinical trial, 70 patients with progressive keratoconus were randomized to undergo corneal crosslinking with intact epithelium (n = 34) or after de-epithelialization (n = 36). The main outcome measure was change in maximum K reading. Results: With a 3-year followup, K-max decreased in the epithelium-off group with a mean of 2.4 D and no patient showed evidence of progression. In the transepithelial group, K-max increased by a mean of 1.1 D and 20 patients (55%) showed progression of keratoconus. Conclusion: In this study, epithelium-off was significantly more effective than transepithelial corneal crosslinking in halting progression of keratoconus (P < .0005).
5:13 PM Panel discussion of previous paper
PA024
5:18 PM
Bowman Layer Implantation to Reduce and Stabilize Advanced Progressive Keratoconus Presenting Author: John Steven Parker MD
Co-Author(s): Michael D Wagoner MD, Anna S Kitzmann MD, Kenneth M Goins MD**, Mark Greiner MD
Co-Author(s): Korine van Dijk OD, Maria Satue MD, Gerrit RJ Melles MD PhD*
Purpose: To compare the incidence of infection in Boston type I keratoprosthesis (Kpro-1) when using vancomycin and fluoroquinolone alone with the incidence when using additional quarterly povidone-iodine fornix rinses or additional topical amphotericin B. Methods: Seventy-nine eyes were reviewed in 3 groups: (1) vancomycin and a fluoroquinolone, (2) additional povidoneiodine, (3) additional povidone-iodine and amphotericin B. Results: The incidence of infection was 0.13/year in Group 1 (12 infections: 4 keratitis, 8 endophthalmitis), 0.09/year in Group 2 (4 infections: 3 keratitis, 1 endophthalmitis), and 0.01/year in Group 3 (1 culture-negative keratitis) (P < .05). Kpro-1 loss occurred in 35.3% of eyes with postoperative infections (P = .0002). Conclusion: Additional quarterly povidone-iodine and amphotericin B significantly reduces postoperative infections in KPro-1.
5:25 PM Panel discussion of previous paper
Purpose: To evaluate the efficacy of Bowman layer (BL) implantation in reducing and stabilizing corneal ectasia in eyes with advanced progressive keratoconus (KC). Methods: Twenty-two eyes of 19 patients with progressive KC, ineligible for UV-crosslinking, underwent midstromal implantation of an isolated BL and were followed for a mean of 21 (±7) months. Results: No complications related to BL implantation were observed. Average maximum corneal power decreased from 72.7 (±6.4) D to 67.2 (±5.2) D (P = .001) 6 months postoperatively and remained stable thereafter (P = .335). Twelve months postoperatively, mean BSCVA had improved significantly (P < .001). Conclusion: BL implantation may be safe and effective in treating ectasia in advanced KC.
4:49 PM Panel discussion of previous paper
PA022
4:54 PM
Ocular Surface Complications after Boston Type I Keratoprosthesis Presenting Author: Shraddha Sureka MBBS MS Co-Author(s): Sayan Basu MBBS**, Virender S Sangwan MBBS Purpose: To describe ocular surface complications after Boston type I keratoprosthesis. Methods: Retrospective case series of 81 procedures. Results: Thirty-two of 81 procedures developed surface complications, including epi150
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Original Papers Monday, Oct. 20
18.2% (median survival: 7 months). Conclusion: PK with SLET is a viable option in extensive stromal scarring or perforation.
2:00 - 3:30 PM Room: S405
2:31 PM Panel discussion of previous paper
Moderator: Bennie H Jeng MD Panel: Darren G Gregory MD, Charles C Lin MD, Jennifer R Rose-Nussbaumer MD
PA040
2:00 PM
Ocular Graft Versus Host Disease: Ten Years’ Experience Presenting Author: Xihui Lin MD Co-Author(s): H Dwight Cavanagh MD PhD FACS* Purpose: To evaluate the presentation, treatment, and course of ocular graft versus host disease (GVHD). Methods: 230 patients with GVHD (2003-2013) were reviewed. Results: Sixty-one patients (26.5%) had ocular involvement. Mean age was 51.1 years and latency of 21.3 months. The most common presentations were keratoconjunctivitis sicca (KCS), cataract, blepharitis, ocular hypertension, and filamentary keratitis. 44.8% of the patients presented with a visual acuity of 20/50 or worse; 45.0% had visual acuity worse than 20/100 at some point during follow-up. KCS was controlled with tears alone in only 6.3% of the patients; the rest required topical cyclosporine (59.4%), steroids (31.3%), autologous serum (34.4%), and/or a bandage contact lens (21.9%). Conclusion: Many patients with GVHD suffered from severe KCS requiring early aggressive therapy.
2:12 PM
Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) for Ocular Graft Versus Host Disease Presenting Author: Hassan Nasir Tausif Co-Author(s): Karen DeLoss OD, Taylor Blachley MS, Shahzad I Mian MD*
SOE Aganirsen Antisense Oligonucleotide Eye Drops Inhibit Keratitis-Induced Corneal Neovascularization and Reduce Need for Transplantation: The I-CAN Study
Presenting Author: Claus Cursiefen MD* Objective To investigate the antiangiogenic effect of aganirsen eye drops on corneal neovascularization. Methods: Multicenter, double-masked, randomized, placebo-controlled Phase 3 study including 69 patients with keratitisrelated progressive corneal neovascularization. Results: Aganirsen significantly reduced the relative corneal neovascularization (P = .014). Conclusion: This first Phase 3 study on a topical inhibitor of corneal angiogenesis showed aganirsen eye drops to significantly inhibit corneal neovascularization and to reduce the need for transplantation in patients with viral keratitis and central neovascularization.
2:43 PM Panel discussion of previous paper
PA044
2:48 PM
Tacrolimus in Vernal Keratoconjunctivitis
2:19 PM Panel discussion of previous paper
2:24 PM
Penetrating Keratoplasty and Simple Limbal Epithelial Transplantation: Clinical Outcomes Presenting Author: Shraddha Sureka MBBS MS Co-Author(s): Sayan Basu MBBS**, Virender S Sangwan MBBS Purpose: To describe outcomes of simple limbal epithelial transplantation (SLET) with penetrating keratoplasty (PK) for limbal stem cell deficiency (LSCD). Methods: Retrospective case series. Results: Of 154 SLET procedures from 2010 to 2013, 8 patients underwent simultaneous PK. Two patients each needed therapeutic PK and repeat SLET. Four of 8 grafts survived, and 5/8 patients had a stable ocular surface at mean follow-up of 11.6 ± 12.0 months (median: 7.9 months). Kaplan-Meier graft survival rate at 6 months was 60 ±
Co-Author(s): Mahmoud O Jaroudi MD, Khalid F Tabbara MD* Purpose: To study topical tacrolimus 0.01% eyedrop effects in patients with vernal keratoconjunctivitis (VKC) not responding to conventional therapy. Methods: We included 32 consecutive patients with VKC. Each patient underwent complete ophthalmologic examination and scrapings for cytology. Patients were placed on tacrolimus 0.01% eyedrops. Results: There were 26 males and 6 females, with an age range of 5-36 years (mean age: 16 years). Twenty six out of 32 patients (81%) had improvements in itching, redness, and discharge. Thirty out of 32 patients (93%) had improvement in ocular surface temperature, keratitis, and limbal infiltrates. Conclusion: Tacrolimus 0.01% eyedrops is effective in severe VKC.
2:55 PM Panel discussion of previous paper
PA045
3:00 PM
The Corneal Ulcer One-Touch Study: A Simplified Microbiological Specimen Collection Method Presenting Author: Kaivon Pakzad-Vaezi MD Co-Author(s): Steve D Levasseur MD, Steven Schendel MD, Richard G Mathias MD, Diane Roscoe MD, Simon P Holland MD* Purpose: To determine if a new, single-sample method can simplify infectious keratitis culturing. Methods: Eighty-one consecutive corneal ulcers received the one-touch ESwab and the traditional multisample method with randomized order. The laboratory was blinded to the two methods. Results: Culture positivity rate for the multisample method and ESwab was 70% and 69%, respectively, with a 75% agreement rate. ESwab sensitivity was 84% (95% CI, 72%-93%), with a specificity of 67% (95% CI, 45%-84%). Positive and negative predictive values were 86% (95% CI, 74%-94%) and 64% (95% CI, 43%-82%), respectively. There was no difference between sampling order. Conclusion: The single-sample ESwab is comparable to the traditional method and is more accessible to community ophthalmologists in the workup of corneal ulcers.
3:07 PM Panel discussion of previous paper
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
151
Original Papers
Purpose: To assess the utility of PROSE as adjunct treatment in patients with ocular graft versus host disease. Methods: Retrospective series measuring degree of symptoms as predicted by the Ocular Surface Disease Index (OSDI) prior to undergoing PROSE treatment was conducted. BCVA was measured at initial consult and compared to BCVA after final fitting. Differences in OSDI and BCVAs were measured for statistical significance (paired t test; a = 0.01; N = 18). Results: 100% (N = 18) of patients with complete follow-up history showed decline in OSDI (P = .003). Mean decline measured at 46.14 (SD = 22.03) (Range: -15.91 to -89.58). BCVA demonstrated mean decrease in logMAR of 0.1721 (p = .001) / 0.1657 (P = .005) O.D./O.S., respectively. Conclusion: Patients who underwent PROSE treatment demonstrated reduction in dry eye symptoms as demonstrated using a standard measurement (OSDI).
PA042
2:36 PM
Presenting Author: Samir S Shoughy MD
2:07 PM Panel discussion of previous paper
PA041
PA043
Original Papers PA046
3:12 PM
SOE Deep Anterior Lamellar Keratoplasty in Acanthamoeba Keratitis
Presenting Author: Caterina Sarnicola Co-Author(s): Vincenzo Sarnicola MD Purpose: To report our experience with deep anterior lamellar keratoplasty (DALK) in Acanthamoeba keratitis (AK). Methods: Two years follow-up cases series report of 12 patients with AK: 9 eyes with controlled infection and 3 eyes with active infection unresponsive to medical treatment (10 days of therapy with chlorexidine gluconate, propamidine isethionate, neomycin sulfate). Results: Nine descemetic DALK and 3 predescemetic DALK were obtained. No Descemet ruptures occurred. Postoperative anti-amoebic therapeutic protocol was prescribed. No episode of rejection or recurrence of the infection was recorded. BSCVA average was 17/20 (range: 14-20/20). Conclusion: DALK is a good procedure for restoring vision in cases with significant corneal scarring. It should also be considered as an early indication for cases with active infection unresponsive to medical therapy.
3:19 PM Panel discussion of previous paper
Glaucoma Monday, Oct. 20 2:00 - 5:30 PM Room: S404 Moderator: Julia Agapov DO Panel: Steven L Mansberger MD MPH, Paul F Palmberg MD PhD, Jody R PiltzSeymour MD
Original Papers
PA047
2:00 PM
Reading Performance in Glaucoma Patients With 20-20 Visual Acuity
the IOP data of 1 eye per case per month from 1116 POAG patients (29,842 eyes) and 1423 NTG patients (27,837 eyes) from January 1997 to December 2012 and then plotted the data. An IOP regression line of POAG and NTG was then made, and each reduction slope (RS) was statistically compared. Results: Yearly POAG and NTG seasonal IOP variation was maintained and gradually decreased over 16 years. The IOP RS was -0.18 mmHg/year in POAG and -0.14 mmHg/year in NTG. Conclusion: In both POAG and NTG, IOP gradually decreased over 16 years with seasonal variation, and its RS was significantly steeper in POAG than in NTG.
2:19 PM Panel discussion of previous paper
PA049
2:24 PM
Influence of Lamina Cribrosa Thickness and Depth on the Rate of Progressive Retinal Nerve Fiber Layer Thinning Presenting Author: Eun Ji Lee MD Co-Author(s): Tae-Woo Kim MD PHD*, Hyunjoong Kim PHD, Seung Hyen Lee MD Purpose: To investigate whether the lamina cribrosa thickness (LCT) and depth (LCD) are associated with a faster rate of progressive retinal nerve fiber layer (RNFL) thinning in open-angle glaucoma (OAG). Methods: Optic nerves of 110 OAG patients were scanned using enhanced depth imaging spectral domain OCT. The LCT and LCD were measured in the B-scan images in each eye. The rate of RNFL thinning was determined by linear regression of serial OCT RNFL thickness measurements against time. Results: Greater RNFL thickness (P = .008), larger LCD (P = .002), and smaller LCT (P = .047) were associated with a faster rate of RNFL thinning both in the univariate and multivariate analysis. Conclusion: Thinner LC and greater LC displacement had a significant influence on the rate of progressive RNFL thinning.
2:31 PM Panel discussion of previous paper
PA050
2:36 PM
Presenting Author: Aron B Guimaraes MD
Lamina Cribrosa Posterior Bowing in Eyes of Primary Open-Angle Glaucoma: Swept Source OCT Study
Co-Author(s): Vital Paulino Costa MD*, Keila M Monteiro de Carvalho MD
Presenting Author: Yong-Woo Kim MD
Purpose: To investigate the influence of visual field defects on the reading performance of patients with primary open-angle glaucoma (POAG). Methods: Data were collected from 35 POAG patients and 35 age-matched controls, all with 20/20 visual acuity. The following parameters were measured during monocular reading using the MNREAD chart: maximum reading speed (MRS), critical print size (CPS), and reading acuity (RA). Results: Mean MRS in the POAG group (125.04 ± 38.36 words per minute) was significantly lower than in the control group (183.95 ± 15.54) (P = .001). MRS correlated significantly with visual field mean deviation (r = 0.954, P = .01) in the POAG group. Conclusion: Glaucoma patients with normal visual acuity show an impairment in reading performance that correlates with the severity of the visual field defect.
Co-Author(s): Jin Wook Jeoung MD*, Ki Ho Park MD*, Dong Myung Kim MD
2:07 PM Panel discussion of previous paper
PA048
2:12 PM
Purpose: Quantitative evaluation of the lamina cribrosa (LC) posterior bowing in primary open-angle glaucoma (POAG) eyes. Methods: Optic discs of 77 POAG eyes and 77 age-matched normal eyes were scanned by swept source OCT. LC vault, defined by the difference between mean LC depth and mean anterior laminar insertion depth, was measured at each horizontal and vertical B-scans (reference plane, Bruch membrane openings). Humphrey visual field (VF) tests were performed. Results: The POAG eyes showed significantly larger horizontal (78.69 ± 43.80 vs. 59.56 ± 63.04, P = .030) and vertical (45.80 ± 45.24 vs. 26.59 ± 38.78, P = .005) LC vault compared to controls. Only vertical LC vault was associated with increased mean deviation of VF (Beta = - 0.020, P = .038). Conclusion: Vertical LC vault was increased in POAG eyes and reflected functional severity.
2:43 PM Panel discussion of previous paper
Evaluation of IOP and Reduction Slope Over a 16-Year Time Course in Japanese Glaucoma Patients Presenting Author: Yoko Ikeda MD Co-Author(s): Kazuhiko Mori MD*, Morio Ueno MD*, Kojiro Imai MD, Kengo Yoshii PHD, Masakazu Nakano PHD Purpose: To evaluate IOP and reduction slope over a 16-year time course based on accumulated primary open-angle glaucoma (POAG) and normaltension glaucoma (NTG) data in our original database. Methods: We selected 152
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Original Papers PA051
2:48 PM
SOE Validation of a Polymorphism Associated With Latanoprost Response in White and Japanese Populations
Presenting Author: Fernando Ussa-Herrera MD* Co-Author(s): Itziar Fernandez, Maria Brion PHD, Angel Carracedo, Ana Sanchez-Jara MD, Lourdes Juan PHD, Soledad Jimenez-Carmona MD, Ramon Juberias MD, Jose Maria Martinez de La Casa MD*, Francisco Blazquez-Arauzo MD MS**, J Carlos Pastor MD PhD Purpose: External validation of a single nucleotide polymorphism (SNP), rs3753380, previously associated with reduced latanoprost response in Japanese (JPN) patients, in a white European (wEU) sample of primary open-angle glaucoma (POAG) patients. Methods: Genotyping (Iplex assay) was performed in 117 POAG patients treated with latanoprost during > 4 weeks. Statistical multiple comparison tests were performed and association evaluation was done with contingency tables analysis and odds ratio (OR) estimation. Results: PTGFR gene SNP rs3753380 increases around 3 times (OR: 3.1938; 95% CI: 9.4696-1.0756) the possibility of a negative latanoprost response in wEU POAG patients. Conclusion: SNP rs3753380 may also determine latanoprost response in wEU POAG patients.
2:55 PM Panel discussion of previous paper
PA052
3:00 PM
A Novel Imaging Device for Monitoring Patient Eye Drop Installation Technique and Compliance at Home and in Clinic Presenting Author: Alexander M Eaton MD* Co-Author(s): Gabriel Gordon PHD*, Adam Sgarlata, Hussein Wafapoor MD*, Robert L Avery MD*
3:07 PM Panel discussion of previous paper
PA053
3:12 PM
Predicting Glaucomatous Visual Field Damage With Fourier Domain OCT in the Advanced Imaging for Glaucoma Study Presenting Author: David Huang MD PhD* Co-Author(s): Xinbo Zhang PHD**, Nils A Loewen MD*, Ou Tan PHD*, Brian A Francis MD*, Rohit Varma MD MPH*, David S Greenfield MD*, Joel S Schuman MD* Purpose: To predict the onset of glaucomatous visual field (VF) damage using Fourier-domain OCT (FD-OCT). Methods: Glaucoma suspect and pre-perimetric glaucoma (GS-PPG) eyes were assessed every 6 months. Disc, retinal nerve fiber layer, and ganglion cell complex (GCC) were mapped by FD-OCT. Conversion to perimetric glaucoma (PG) was confirmed when 3 consecutive VF tests were abnormal. Results: After a mean 52 months of follow-up, 55 of 515 GS-PPG eyes converted to PG. By Cox regression, most OCT variables were
3:19 PM Panel discussion of previous paper
PA054
3:24 PM
Estimated Rates of Retinal Ganglion Cell Loss in Glaucomatous Eyes With and Without Optic Disc Hemorrhages Presenting Author: Carolina P B Gracitelli MD Co-Author(s): Andrew J Tatham MBChB*, Ting Liu MD PHD, Linda Zangwill PhD*, Robert N Weinreb MD*, Felipe A Medeiros MD* Purpose: To evaluate whether disc hemorrhages are associated with faster rates of estimated retinal ganglion cell (RGC) loss in glaucoma. Methods: 222 eyes of 122 patients were followed for 3.74 ± 0.85 years. Serial OCT, standard automated perimetry, and stereophotography were performed. RGC counts were estimated from structural and functional tests using previously described formulas. Results: Nineteen eyes had at least 1 disc hemorrhage during follow-up. A random coefficient model found eyes with disc hemorrhages had faster rates of estimated RGC loss (P = .020). Conclusion: Disc hemorrhages in glaucoma are a risk factor for progression and are associated with faster rates of estimated RGC loss.
3:31 PM Panel discussion of previous paper
PA055
3:36 PM
Functional Measures as Surrogates for Vision-Related Quality of Life in Patients With Glaucoma Presenting Author: Sachin Jain MD Co-Author(s): Vy Nguyen, Jessica Liloong Liu, Krishna Patel, J Jason McAnany MA PHD, Jacob Wilensky MD, Ahmad A Aref MD*, David Scott Hillman MD*, Thasarat S Vajaranant MD* Purpose: To determine which clinical measures best correlate with visionrelated quality of life measures in glaucoma patients. Methods: We recruited 22 patients with primary open-angle glaucoma and visual acuity (VA) ≥ 20/40. VA, Humphrey 24-2 visual fields, contrast sensitivity, and National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) results were analyzed in the eye with better mean deviation. Results: Controlling for age and VA, patients with a higher pattern standard deviation (PSD) reported worse distance vision (r = -0.8, P = .001) and driving (r = -0.8, P = .002), while patients with a lower visual field index (VFI) reported worse distance vision (r = 0.8, P = .003) and color vision (r = 0.8, P = .001). Conclusion: This suggests that PSD and VFI could be used as surrogates for vision-related quality of life.
3:43 PM Panel discussion of previous paper
PA056
3:48 PM
Changes in Glaucoma Procedural Volume Following Reductions in the Medicare Payment Schedules Presenting Author: Dan Gong Co-Author(s): Jun Lin PHD, James C Tsai MD MBA* Purpose: To calculate Medicare payment-procedural volume elasticities for laser trabeculoplasty (CPT 65855), trabeculectomy (CPT 66170 and 66172), aqueous shunt to reservoir (CPT 66180), laser iridotomy (CPT 66761), and scleral reinforcement with graft (CPT 67255). Methods: Fixed-effects regression model using 2005-09 Medicare Part B Carrier data for all 50 states, controlling for national trends in procedural volume, Medicare beneficiary popula-
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
153
Original Papers
Purpose: To develop a compact imaging device to allow physicians to personalize therapeutic regimens based on a better understanding of patient compliance and eye drop technique. Methods: A novel imaging system was used to record video of the drop technique of subjects in the clinic (n = 18) or at home (n = 6) for 1 week. Video assessment by a reading center was compared to patient reporting of how many drops were applied and how many landed in the eye. Results: Reading center assessment of both attempted drops and drops in was significantly different from the prescribed regimen in the clinical (pa = 0.03, pi < 0.001) and at-home arms (pa = 0.03, pi = 0.005). Conclusion: This imaging system is a powerful tool to help physicians tailor therapeutic decisions more accurately for each patient and can help researchers evaluate new drop therapies.
significant risk factors, the best of which was the GCC focal loss volume (FLV, P < .001). Abnormal or borderline GCC FLV increased conversion risk 4-fold at 6 years. Conclusion: FD-OCT may be useful in the prognostic evaluation of glaucoma suspects.
Original Papers tion, number of ophthalmologists, and income per capita. Results: Every 1% decrease in Medicare payment was associated with significant increases in procedural volume for CPT 65855 (+0.78%, P = .009), CPT 66761 (+1.04%, P < .001), and CPT 67255 (+4.19%, P = .005). Conclusion: Reductions in Medicare payment may lead to increased procedural volume for certain glaucoma procedures.
3:55 PM Panel discussion of previous paper Moderator: Shan C Lin MD Panel: Husam Ansari MD PhD, Nathan M Radcliffe MD, Mark B Sherwood MD
PA057
4:05 PM
Cataract Surgery Combined With Trabecular Micro Bypass Stent Implantation in Patients With Open-Angle Glaucoma, 1 Year Follow-up Presenting Author: George Beiko MD*
Original Papers
Purpose: To determine IOP control following combined cataract surgery and trabecular micro bypass stent implantation. Methods: Retrospective analysis of the first 100 patients with medically controlled open-angle glaucoma (OAG), following combined trabecular micro bypass stent implantation and cataract surgery. Results: All patients received 1 stent except for 11, who received 2. The preop IOP was 16.767 ± 3.837 mm Hg; there was a statically significant decrease to 15.310 ± 2.776 mmHg (P = .004) at 6 months; the IOP remained at the same level at 12 months, 15.885 ± 3.307 mm. There was a statistically significant decrease in the number of topical glaucoma meds at 6 and 12 months (P = .000). Conclusion: Trabecular micro bypass stent implantation combined with cataract surgery results in a decrease in topical glaucoma medications.
(PACG). Methods: We retrospectively reviewed 103 subjects with PAC or PACG who underwent cataract surgery. IOL power was calculated with various formulas. The errors according to biometric factors were evaluated. Measurements included 2 novel parameters: relative lens vault (rLV), ratio of LV to anterior vault (AV), and AV, sum of LV and anterior chamber depth. Results: Eyes with PAC or PACG showed significant hyperopic result (P < .05). The Hoffer Q formula had the least prediction error (P = .043). Prediction error was positively correlated with rLV (P < .01). Conclusion: Preoperative rLV can be a key factor predicting unstable refractive outcome in patients with PAC or PACG.
4:36 PM Panel discussion of previous paper
PA060
4:41 PM
Glaucoma-Related Adverse Events After Cataract Removal in Infancy: Outcomes at Age 5 in the Infant Aphakia Treatment Study (IATS) Presenting Author: Sharon F Freedman MD Co-Author(s): Allen Dale Beck MD*, Michael J Lynn MS*, Scott R Lambert MD*
4:12 PM Panel discussion of previous paper
Purpose: To report prevalence of glaucoma (G) and glaucoma suspect (GS) after unilateral cataract surgery (CE) with/without primary (IOL) vs. contact lens (CL). Methods: 114 children were randomized (n = 57 each group). G = IOP > 21 mmHg with IOP-related anatomic changes or glaucoma surgery; GS = IOP > 21 x 2 visits without anatomic changes or glaucoma medication. Results: Prevalence of G vs. G+GS was 20 (18%) vs. 36 (32%), and similar CL vs. IOL groups (P > .05) @ mean 4.8 years post-CE. Younger age at surgery (28-48 vs. > 49 days) and smaller corneal diameter (< 10 mm vs. ≥ 10 mm) conferred higher risk of G+GS (P = .005 and P = .002, resp.). Conclusion: Risk of G+GS rises after cataract removal in infancy, with/without primary IOL. Longer follow-up will better define this complication.
PA058
4:48 PM Panel discussion of previous paper
SOE
PA061
Presenting Author: Magda Rau*
A Randomized Study of a Schlemm Canal Microstent in Combination With Phacoemulsification for IOP Reduction in Open-Angle Glaucoma
4:17 PM Supraciliary Microstent Implantation in Combination With Cataract Surgery in a Single Center: The Cham Experience Co-Author(s): Tsontcho Ianchulev MD* Purpose: To evaluate the ab interno supraciliary implant (CyPass Micro-Stent, Transcend Medical) in patients with open-angle glaucoma undergoing cataract surgery at a single center in Cham, Germany. Methods: The device was implanted after cataract surgery. Adverse events, IOP, and number of IOP-lowering medications were the main outcomes evaluated through the follow-up period. Results: Baseline mean IOP (n = 24) was 22.3 ± 6.6 mmHg, and mean number of IOP-lowering medications was 1.8 ± 1.2. All implants were placed successfully, with no major sight-threatening adverse events. At Month 12 (n = 17), mean IOP was 15.0 ± 3.4 mmHg with mean medication usage reduced to 0.7 ± 1.0. Conclusion: CyPass Micro-Stent implantation with cataract surgery results in minimal complications and reduction of IOP and IOP-lowering medications at 1 year.
4:24 PM Panel discussion of previous paper
PA059
4:29 PM
Factors Affecting Refractive Outcome After Cataract Surgery in Primary Angle-Closure Glaucoma
Presenting Author: Thomas W Samuelson MD* Co-Author(s): Norbert Pfeiffer MD*, Julian Garcia-Feijoo MD PhD**, Hans G Lemij MD**, Jose M Larrosa MD**, Stefano A Gandolfi MD*, Antonio Fea MD, Oliver Schwenn MD** Purpose: To compare the ability of a microstent (Hydrus) to lower IOP in openangle glaucoma (OAG) when combined with phacoemulsification to phacoemulsification alone. Methods: 100 subjects with OAG and cataract were recruited from 7 centers. Prior to surgery subjects were randomized 1:1 into phaco + microstent or phaco only treatment groups. Subjects were followed for 18 months post operatively. Results: At 18 months follow-up, medication use was reduced by 57% (P = 0.015) and a med-free IOP of ≤ 21 mmHg was reached in 80% in the treatment group vs. 48% in the control (P < .05). There were no significant safety events in either group. Conclusion: An intracanalicular microstent reduces IOP and medication use in combination with phacoemulsification.
5:00 PM Panel discussion of previous paper
Presenting Author: Sam Seo MD Co-Author(s): Jin Wook Jeoung MD*, Dong Myung Kim MD, Ki Ho Park MD* Purpose: To evaluate biometric factors associated with IOL power predictions in eyes with primary angle closure (PAC) or primary angle-closure glaucoma 154
4:53 PM
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Original Papers PA062
5:05 PM
One-Year Results of Supraciliary Microstent Implantation in Patients Refractory to Topical Glaucoma Therapy Presenting Author: Quang H Nguyen MD* Co-Author(s): Julian Garcia-Feijoo MD PhD**, Gunther Grabner MD*, Herbert A Reitsamer MD**, Swaantje Grisanti MD*, Salvatore Grisanti* Purpose: To assess the safety and clinical outcomes of supraciliary (SC) microstent implantation as a treatment for open-angle glaucoma (OAG) in patients refractory to topical glaucoma therapy. Methods: Subjects with IOP uncontrolled by topical medications (IOP ≥ 21 mmHg) underwent SC implantation of the CyPass Micro-Stent. Results: There were no adverse events or serious complications. Mean medicated IOP at baseline was 24.5 mmHg (n = 65). Mean IOP at 12 months was 16.8 mmHg, a 32% reduction from baseline. Mean medication use also decreased from 2.2 medications to 1.5 medications. Conclusion: The CyPass Micro-Stent provided safe and sustained IOP reduction in OAG patients refractory to topical medications.
5:12 PM Panel discussion of previous paper
PA063
5:17 PM Intraoperative Injection vs. Sponge-Applied Mitomycin C During Trabeculectomy: One-Year Study Presenting Author: Grace Huang Co-Author(s): Linda Y Huang MD, Albert S Khouri MD*
5:24 PM Panel discussion of previous paper
Intraocular Inflammation, Uveitis Sunday, Oct. 19 2:00 - 3:15 PM Room: S405 Moderator: Khalid F Tabbara MD Panel: Elisabetta Miserocchi MD, Jose S Pulido MD MS
PA009
2:00 PM
2:07 PM Panel discussion of previous paper
PA010
2:12 PM
Diagnostic Findings Identified by Ultrawide-Field Fluorescein Angiography in Uveitis Patients Presenting Author: Sunil K Srivastava MD* Co-Author(s): Kathleen Farhang, Kimberly Marie Baynes COA, Francesco Pichi MD, Justis P Ehlers MD*, Careen Yen Lowder MD PhD Purpose: To identify changes in the retinal periphery identified using ultrawide-field fluorescein angiography (UWF-FA) in uveitis patients. Methods: This is an institutional review board-approved retrospective case series of uveitis patients who had UWF-FA with the Optos 200Tx system. Imaging analysis, including comparisons between simulated 50-degree fundus images and UWF-FA images, was performed. Results: 116 patients with 458 sets of UWF-FA images were reviewed. 71.2% of UWF-FA images yielded information not seen with standard imaging. Findings included peripheral nonperfusion (23.1%), diffuse leakage (70.9%), and multifocal lesions (7.7%). Seventy percent of UWF-FA images impacted medical management. Conclusion: UWF-FA improves the evaluation of the retinal periphery and affects the medical care of uveitis patients.
2:19 PM Panel discussion of previous paper
PA011
2:24 PM
The Use of Anterior Segment Spectral Domain OCT in Evaluation of Patients With Anterior Scleritis Presenting Author: Ashleigh Laurin Levison MD Co-Author(s): Kimberly Marie Baynes COA, Careen Yen Lowder MD PhD, Sunil K Srivastava MD* Purpose: To describe the utility of anterior segment spectral domain OCT (SDOCT) in anterior scleritis. Methods: Institutional review board-approved, prospective, observational case series. Patients underwent slitlamp exam, and scleral inflammation was recorded. Scleral SD-OCT was performed. Results: To date, 23 patients have been enrolled, with a total of 43 separate imaging visits. Of patients with active disease, 95.7% had findings on OCT. The common findings included intrascleral hyporeflective spaces (69.6%), vessels in deep sclera (43.4%), and nodules, some not seen on exam (34.7%). While exam appeared quiet, 2 patients (8.7%) had an OCT suggesting activity. Treatment response corresponded with improvement on OCT (eg, fewer hyporeflective spaces, resolution of deep vessels, changes in thickness). Conclusion: SD-OCT provided objective measures to monitor / grade patients with scleritis.
Characterization of Uveitis in Patients With Multiple Sclerosis
2:31 PM Panel discussion of previous paper
Presenting Author: Wyatt Messenger
SOE Abatacept for Juvenile Idiopathic Arthritis-Related Uveitis
Co-Author(s): Lena Hildebrandt, Friederike Mackensen MD PhD*, Eric B Suhler MD*, James T Rosenbaum MD* Purpose: To characterize uveitis in multiple sclerosis (MS). Methods: Multicenter retrospective review of patients with uveitis and MS. Results: We identified 113 patients (196 eyes) with uveitis and MS. The majority presented with intermediate (80%) and anterior uveitis (15%). Uveitis presented before
PA012
2:36 PM
Presenting Author: Ekaterina V Denisova MD Co-Author(s): Ludmila Katargina Purpose: To evaluate the efficacy and safety of Abatacept (Aba) in the treatment of juvenile idiopathic arthritis (JIA)-related uveitis. Methods: Twenty-six children with active JIA-related uveitis received standard Aba treatment over
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
155
Original Papers
Purpose: To compare outcomes of injection of mitomycin (MMC) against conventional sponge-applied MMC during trabeculectomy. Methods: Patients (N = 60; 30 injection, 30 sponge) were reviewed and postop variables collected up to 1 year. Results: The injection group had overall lower IOP and higher proportions of > 30% IOP reduction at each time point; however, this did not reach significance. The number of postop visits within 3 months and the proportion of eyes needing 5-FU intervention were significantly lower in the injection group (P = .03 and P = .04 respectively). No patients in the injection group needed additional surgical revisions, while 3 patients in the sponge group did. Conclusion: Injection of MMC was as safe and effective as sponge application, with less need for visits within 3 months, 5-FU intervention, and revisions.
or with MS (69%). Mean visual acuity (VA) was fair (20/39). During follow-up, VA improved -0.09 logMAR/year. Compared to controls with intermediate uveitis (n = 16), cases with intermediate uveitis and MS were significantly older (P = .006) and more likely to be female (P = .047), but had no differences in VA (P = .87) or vision loss (P = .56). Conclusion: Uveitis with MS generally presents as intermediate or anterior uveitis. Compared to controls, patients with MS are older and more likely to be female. Visual prognosis is favorable.
Original Papers 3-37 months (mean: 18). All patients received other immunosuppressive drugs; in 8, Aba was the second–fourth biologic. Results: After initiation of Aba, remission of uveitis was achieved in 35%, improvement was achieved in 30% of cases. Efficacy of Aba in patients who received it as the first or as second– fourth biologic was 83% and 25% (P < .05), respectively. No ocular or systemic adverse effects were observed. Intraocular surgery was uncomplicated in all 20 cases. Conclusion: Aba was effective in 65% of children with JIA-related uveitis. Aba is more effective when used as the first biologic.
2:43 PM Panel discussion of previous paper
PA013
2:48 PM
Self-reported Experience With Side Effects From Medications Used to Treat Noninfectious Nonanterior Uveitis Presenting Author: Nisha Acharya MD* Co-Author(s): Suhasini Ramalingam, Michelle L Chernock PHD**, Noah Goodman** Purpose: To characterize the burden associated with treatment in patients with intermediate, posterior, and panuveitis. Methods: 120/141 eligible patients recruited from uveitis and retinal specialty practices completed an online survey. Results: Fifty-one percent of patients have received corticosteroid-sparing immunosuppressants; 28%, corticosteroid injections / implants; 24%, biologics; and 17%, systemic corticosteroids. Systemic corticosteroid side effects were most bothersome, including weight gain/bloating (80%), trouble sleeping (70%), mood swings / irritability (60%), and increased appetite (55%). Fifty percent of patients on immunosuppressants reported fatigue. Fewer side effects were reported with biologics, but there was a high financial burden. Conclusion: Patients experience significant side effects with uveitis medications.
Original Papers
2:55 PM Panel discussion of previous paper
PA014
Monday, Oct. 20 3:45 - 4:20 PM Room: S405 Moderator: Tara A McCannel MD Panel: Hakan Demirci MD, Jeffrey A Nerad MD
PA064
3:45 PM
SOE Eyelid Carcinoma Treated by Interstitial Brachytherapy
Presenting Author: Anna Maria Comoli MD Co-Author(s): Vito Belloli MD, Laura Masini**, Letizia Deantonio MD**, Marco Krengli MD Purpose: To review local control and outcomes in patients with eyelid tumors treated by interstitial 192Ir wires. Methods: Sixty patients (52 basal cell carcinoma and 8 squamous cell carcinoma) were treated with Ir wire implantation: 51 cases had no prior treatment, 4 had received previous surgery with positive or close surgical margins, 5 had local recurrence after surgery. We evaluated toxicity and functional and cosmetic results. Results: Mean followup: 92 months. Local control was obtained in 58/60 patients; functional and cosmetic results were satisfactory in 55/60; late effects higher than grade 2 were observed in 3% of cases. Conclusion: Interstitial brachytherapy for carcinoma of the eyelid can obtain satisfactory results with acceptable late toxicity.
3:52 PM Panel discussion of previous paper
PA065
3:57 PM Gamma Knife Radiosurgery for Uveal Melanoma: Twenty Years of Experience SOE
3:00 PM
Key Outcomes of SAKURA 1: A Phase 3 Study of Intravitreal Sirolimus for Noninfectious PosteriorSegment Uveitis Presenting Author: Quan Dong Nguyen MD* Co-Author(s): Pauline T Merrill MD*, W Lloyd Clark MD*, Alay S Banker MD, Marye Ellen Valentine**, Joel Naor MD**, Afsheen Khwaja MD*, Yang Yang PHD*, Yusuf Ali*, Abu Abraham MD*, Sri Mudumba PhD**, Naveed Shams MD PhD** Purpose: To present key results of SAKURA Study 1. Methods: The SAKURA studies are 2 randomized, double-masked, Phase 3 studies of patients with active noninfectious posterior-segment uveitis (NI-PSU). SAKURA 1 had 347 subjects with baseline vitreous haze (VH) score ≥ 1.5+. Results: At Month 5, primary endpoint (% with VH of 0) favored 440 µg intravitreal sirolimus (44 µg, 10.3%; 440 µg, 22.8%; 880 µg, 16.4%; P = .025, 440 vs. 44 µg). Key secondary endpoints also favored 440 µg: % with VH of 0 or 0.5+ (44 µg, 35.0%; 440 µg, 51.8%; 880 µg, 43.1%; P = .012, 440 vs. 44 µg). Treatment effect of 440 vs. 44 µg was similar across subgroups: age, gender, and race. Safety with 440 µg intravitreal sirolimus was favorable. Conclusion: 440 µg intravitreal sirolimus demonstrated a decrease in VH and was well tolerated in subjects with NI-PSU.
3:07 PM Panel discussion of previous paper
Ocular Tumors and Pathology
Presenting Author: Giulio Modorati MD Co-Author(s): Maura DiNicola MD, Elisabetta Miserocchi MD, Francesco M Bandello MD* Purpose: To evaluate the results of gamma knife radiosurgery (GKR) in treating 141 patients with uveal melanoma. Methods: Records of 141 consecutive patients with uveal melanoma treated with GKR (treatment doses: 50 to 30 Gy at 50% isodose) between 1994 and 2014 were retrospectively reviewed. Results: Mean follow-up was 58.8 months (range: 5.3-209.9). Local tumor control was achieved in 93.6% of patients. Mean ultrasound thickness before and after GKR was 6.56 mm and 3.90 mm, respectively, with mean reduction rate of 40.5% (P < .0001). Eye retention rate was 90.1%. Reasons for enucleation were recurrence in 9 cases, neovascular glaucoma in 3 cases, and phthisis bulbi in 2 cases. Survival rate was 92.2%. Conclusion: GKR can be considered a valid conservative treatment in uveal melanomas.
4:04 PM Panel discussion of previous paper
PA066
4:09 PM
Comprehensive Polymerase Chain Reaction Assay for Detection of Pathogenic DNA in Orbital Lymphoproliferative Disorders Presenting Author: Yoshihiko Usui MD Co-Author(s): Shunichiro Ueda MD**, Hiroki Takahashi DVM, Takeshi Kezuka MD PhD*, Hiroshi Goto MD Purpose: In the present study, we utilized this system to conduct an exhaustive search for DNA of pathogens in orbital lymphoproliferative disorders
156
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Original Papers (OLPD). Methods: Forty-nine patients diagnosed with OLPD of the ocular adnexa were studied. Biopsy specimens were screened for DNA of bacteria, viruses, fungi, and parasites by multiplex polymerase chain reaction. Results: Among 31 cases of mucosa-associated lymphoid tissue lymphoma, HHV-6 DNA was detected in 7 cases, parvovirus B19 DNA in 3 cases, and EBV DNA in 3 cases. Among 18 cases of IgG4-related ocular disease, HHV-6 DNA was detected in 6 cases, HHV-7 DNA in 11 cases, and HHV-8 DNA in 3 cases. Conclusion: Chronic stimulation due to these continuous infections may be involved in the pathogenesis of OLPD.
months. Conclusion: Topical CsA 0.05% showed a satisfactory effect in longstanding prosthetic eye wearers.
4:16 PM Panel discussion of previous paper
Purpose: To document the utility of intraoperative intravenous acetaminophen (IIVA) in orbital surgery. Methods: Postoperative metrics were compared for patients undergoing orbitotomy with (n = 100) or without (n = 100) IIVA. Results: As compared with patients who did not receive IIVA, patients who received IIVA had a statistically significant decrease in the need for postoperative narcotic medications (P < .05) and in the requirement for postoperative antiemetic medications (P < .05). No side effects were related to IIVA. Conclusion: IIVA dramatically reduced the requirement for analgesic and antiemetic medications after orbitotomy. This study documents the first use of IIVA in orbital surgery and indicates that IIVA may be a useful, low-risk, inexpensive adjunct to traditional analgesic regimens for these procedures.
Orbit, Lacrimal, Plastic Surgery Monday, Oct. 20 4:25 - 5:00 PM Room: S405 Moderator: Elizabeth A Bradley MD Panel: Aaron M Fay MD, Michael T Yen MD
PA067
4:25 PM
Are Frozen Section Margin Control and Conjunctival Map Biopsy Mandated in Sebaceous Gland Carcinoma of the Eyelid?
4:44 PM Panel discussion of previous paper
PA069
Intravenous Acetaminophen in Orbital Surgery Presenting Author: Edward Wladis MD* Co-Author(s): Bryant P Carruth MD
4:56 PM Panel discussion of previous paper
Pediatric Ophthalmology, Strabismus Monday, Oct. 20
Presenting Author: Fairooz Puthiyapurayil Manjandavida MD
11:00 AM - 12:00 PM Room: S405
Co-Author(s): Santosh G Honavar MD, Geeta K Vemuganti MD
4:32 PM Panel discussion of previous paper
PA068
4:37 PM
Short-term Effects of Topical Cyclosporine A 0.05% (Restasis) in Long-standing Prosthetic Eye Wearers Presenting Author: Jung-Woo Han MD Co-Author(s): Sun Young Jang MD, Jin S Yoon MD Purpose: Long-standing prosthetic eye wearing induces ocular surface inflammation. We investigated the short-term effects of topical cyclosporin A (CsA) 0.05% in patients with ocular discomfort. Methods: Twenty patients who were unilateral prosthetic eye wearers over a period of 5 years were enrolled. The subjects were instructed to instill topical CsA 0.05% . Measurements were made pretreatment and after 1 and 3 months of treatment. Outcome measures were the ocular symptom score, the lid margin abnormality score, the Schirmer test, and the tear meniscus amount, using Fourier domain OCT. Results: Ocular symptoms were improved after treatment for 1 month in all patients. The Schirmer test results were improved after treatment for 3
Moderator: Terri L Young MD Panel: Audina M Berrocal MD, Hilda Capo MD, Ta Chen Chang MD, Martha P Schatz MD
PA035
11:00 AM
Retinal Fluorescein Angiographic Changes Following Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Treatment-Requiring ROP: A Pilot Study Presenting Author: Andree Henaine-Berra MD Co-Author(s): Gerardo Garcia-Aguirre MD*, Hugo Quiroz-Mercado MD*, Maria Ana Martinez-Castellanos MD Purpose: To describe the retinal vascular morphology in eyes treated with intravitreal bevacizumab (IB) for treatment-requiring ROP. Methods: We included 47 eyes of 26 patients, with stage 3, threshold, or prethreshold ROP. Fundus photographs and fluorescein angiography (FA) were obtained before and after IB treatment. Results: Before treatment, FA showed vascular abnormalities. After IB, FA showed involution of the neovascularization, flattening of the demarcation line, and subsequent growth of vessels to the capillary-free zones. During the following weeks vascular remodeling and vascular loops were seen. Conclusion: Patients showed improvement of their abnormal vascular findings after IB; there was creation of small vessels, establishment of directional flow, and maturation of retinal vessels.
11:07 AM Panel discussion of previous paper
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
157
Original Papers
Purpose: To assess utility of frozen section (FS) margin control and conjunctival map biopsy in the management of eyelid sebaceous gland carcinoma (SGC). Methods: Retrospective interventional study of 107 consecutive cases of SGC that underwent primary surgical excision. Results: Mean age was 56.3 ±12.8 years. Intraoperative FS was used in 83 (76%) and conjunctival map biopsy in 81 (75%). Despite 4-mm clinically clear surgical margins, FS was positive in 16 (19%), necessitating additional excision. Tumor recurrence occurred in 9 of 24 (37.5%), who did not undergo FS vs. 11 of 83 (13%) who did (hazards ratio 5.8, P = .018). Conjunctival map biopsy showed pagetoid invasion in 17 (21%), of whom 16 were clinically suspected. Conclusion: FS margin control is vital in the management of SGC, while conjunctival map biopsy may be reserved for cases with clinical suspicion of pagetoid invasion.
4:49 PM
Original Papers PA036
11:12 AM
Evaluation of an Image-Based Reference Standard for ROP Diagnosis
children for self-assessment, practice improvement, visual outcome studies, and possible re-evaluation of guidelines.
11:43 AM Panel discussion of previous paper
Presenting Author: Michael Ryan MS
PA039
Co-Author(s): Karyn Jonas RN, Audina Berrocal MD*, Kimberly A Drenser MD PhD*, Jason D Horowitz MD*, Thomas Lee MD*, Charles Simmons Jr MD*, Raghu C Murthy MD, Maria Ana Martinez-Castellanos MD, R V Paul Chan MD, Michael F Chiang MD*
Gonioscopy-Assisted Transluminal Trabeculotomy: A Novel Ab Interno Trabeculotomy for the Treatment of Developmental Glaucoma: Technique Report and Preliminary Results
Purpose: To measure diagnostic agreement between image-based exam, ophthalmoscopic exam, and a proposed reference standard. Methods: 714 clinical exams were performed in 289 infants. Retinal images were captured and independently interpreted by 3 readers. Image-based and clinical diagnoses were compared for zone, stage, and category. A new reference standard that combined image-based and clinical diagnoses was also evaluated. Results: Absolute agreement between image-based diagnosis and clinical exam was highest for zone (80%) and lowest for category (68%). Compared to the new reference standard, agreement on category was 90% for the imagebased diagnosis and 81% for the clinical exam. Conclusion: ROP diagnosis is subjective and variable, and may be improved by combining impressions from multiple readers with the clinical exam.
Presenting Author: Davinder S Grover MD* Co-Author(s): Oluwatosin U Smith MD*, Ronald Leigh Fellman MD OCS*, David G Godfrey MD**, Michelle R Butler MD, Ildamaris Mercedes MontesdeOca MD**, William J Feuer MS
IOL Exchange for High Myopia in Pseudophakic Children
Purpose: To introduce gonioscopy-assisted transluminal trabeculotomy (GATT) for the treatment of developmental glaucoma and to report early results. Methods: Retrospective study of 12 eyes of 8 consecutive patients who underwent GATT with > 6 months follow-up. Patients were < 27 years old with trabeculodysgenesis. Results: Twelve eyes of 8 patients (aged 1 to 27 years) underwent GATT with a mean drop in IOP and medications of 13.3 mmHg (range: 1-39) and 1.5 (range: 0-4), respectively. Transient postop hyphema developed in 4 eyes. All eyes were considered a clinical success, with a substantial decrease in IOP and/or glaucoma medications. Conclusion: Early results for GATT demonstrate that it is a safe and effective method for treating developmental glaucoma.
Presenting Author: Courtney L Kraus MD
11:55 AM Panel discussion of previous paper
11:19 AM Panel discussion of previous paper
PA037
11:24 AM
Co-Author(s): Rupal H Trivedi MBBS MS*, M Edward Wilson Jr MD, Brita S Deacon MD
Original Papers
11:48 AM
Purpose: To report preoperative factors and postoperative outcome of children undergoing IOL exchange due to myopic shift. Methods: Chart review of pseudophakic children undergoing IOL exchange for correction of high myopia. Results: Eighteen eyes had IOL exchange, 13 for myopic shift. Nine of 13 had unilateral cataract. Average spherical equivalent before IOL exchange: -9.88; afterwards: -1.48. Average axial length of operative and nonoperative eyes: 24/22.1 mm (P-value < .005). Average eye growth in operative and nonoperative eye: 4.4/3.02 mm (P-value < 0.04). Conclusion: Myopic shifts in refraction may necessitate IOL exchange after infantile cataract surgery with IOL implantation. IOL exchange should be included during initial preoperative informed consent process.
8:30 - 10:15 AM Room: S404 Moderator: Kendall E Donaldson MD Panel: Damien Gatinel MD, Rajesh K Rajpal MD, Karolinne M Rocha MD
PA070
8:30 AM
Corneal Coupling: Its Importance in Incisional and Ablative Procedures Co-Author(s): George Stamatelatos OD*, James Kwan Ong*
11:36 AM
Pediatric Ophthalmologist Glasses Prescribing Patterns Presenting Author: Lindsay Dawson Co-Author(s): Jiayan Huang MS**, Gil Binenbaum MD* Purpose: To describe glasses prescribing patterns among pediatric ophthalmologists and compare them to American Academy of Ophthalmology (Academy) guidelines. Methods: Electronic medical records (EMR) study of 16,011 children refracted by 7 providers. Exclusions: esotropia, cataract, blindness, wearing glasses. Results: Using 19,372 refractions (7421, age 0-3; 6897, 3-8; 5054, 8-18), proportions glasses prescribed were stratified by age, type, and amount of refractive error. Prescribing thresholds decreased with age in all categories. Prescribing matched Academy guidelines in only 15%-50% for age < 1, but in 65%-100% for age 1-3. Conclusion: EMR and IRIS integration will enable large-scale assessment of actual glasses prescribing thresholds in
158
Tuesday, Oct. 21
Presenting Author: Noel A Alpins MD FACS*
11:31 AM Panel discussion of previous paper
PA038
Refractive Surgery
Purpose: To assess the importance of corneal coupling in incisional and ablative procedures. Methods: Retrospective incisional and ablative data are analyzed to demonstrate the applicability of newly defined coupling terms. Results: Compound myopic and hyperopic astigmatism excimer laser treatments (3818 eyes) showed a coupling ratio close to zero, a coupling constant close to 0.5, and a coupling adjustment close to zero. Incisional limbal relaxing incisions (74 eyes) demonstrated a coupling ratio close to 1.0, and a coupling constant close to zero. Conclusion: The revised definitions of coupling ratio and coupling constant can be used with both incisional and ablative surgery. Coupling adjustment can be used to improve surgical outcomes.
8:37 AM Panel discussion of previous paper
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Original Papers PA071
8:42 AM
Prospective Study of Patient Satisfaction With LASIK and Contact Lenses: Two-Year Results
PA074
Presenting Author: Francis W Price Jr MD*
Refractive Outcomes of Topography-Guided Photorefractive Keratectomy With Simultaneous Crosslinking for Keratoconus
Co-Author(s): Marianne O Price PhD*
Presenting Author: David Lin MD
Purpose: To evaluate satisfaction with 2 popular vision correction choices: contact lenses and LASIK. Methods: Subjects 18-60 years old who planned to have LASIK or continue successful contact lens wear were enrolled and surveyed at baseline (before surgery in the LASIK arm) and 1 and 2 years later. Results: Response rates were 69% at 1 year and 64% at 2 years. In the Contacts Group, 1- and 2-year responses were comparable to baseline. In contrast, ease of night driving was significantly improved both 1 and 2 years after LASIK. The rate of dry eye symptoms increased 1 year after LASIK but decreased back to baseline at 2 years. Conclusion: Modern LASIK significantly improves the ease of night driving and temporarily increases the rate of dry eye symptoms.
Co-Author(s): Simon P Holland MD*
8:49 AM Panel discussion of previous paper
PA072
8:54 AM
9:18 AM
Purpose: To evaluate topography-guided photorefractive keratectomy with collagen cross-linking (TG PRK/CXL) for keratoconus. Methods: TG PRK/CXL performed with the Allegretto WaveLight laser and the topography neutralization technique using Dresden protocol safety and efficacy was evaluated at 1 year. Results: 215 eyes met follow-up criteria. Forty-seven percent had UCVA ≥ 20/40. Fifty-five percent improved BCVA: 22% gained ≥ 2 lines; 6% lost ≥ 2 lines. Mean astigmatism decreased 2.52 D. Seven had hyperopic progression; 4 had SE > 1.50 D. Complications included herpetic keratitis, delayed epithelialization, and haze. Conclusion: One-year outcomes of TG PRK/CXL among 215 keratoconus eyes showed satisfactory efficacy and safety, with minimal hyperopic progression.
9:25 AM Panel discussion of previous paper
Contralateral, Randomized Comparison of LASIK With Optimized Prolate Ablation, Wavefront, and TopographyGuided Prolate Ablations
9:30 AM Clinical Outcomes of the Implantable Collamer Lens With Central Port: One Year of Follow-up
Presenting Author: Alaa M Eldanasoury MD*
Presenting Author: Erik L Mertens MD FRACOPHTH*
Co-Author(s): George O Waring III MD FACS*
Purpose: To assess the refractive outcomes at 1-year follow-up on patients who received the implantable collamer lens with central port for the correction of myopic astigmatism. Methods: 165 eyes underwent implantation of a myopic or toric ICL (V4C model, Staar Surgical, Inc.). The design features a central hole that allows a more natural aqueous flow, eliminating the need to perform Nd:YAG iridotomy or peripheral iridectomy. Results: At 1 year the mean spherical equivalent dropped from -5.23 ± 2.80 D (range: -13.75 to 1.25 D) preoperatively to 0.01 ± 0.086 D (range: 0.00 to 0.75 D). 164 eyes (99%) achieved UDVA of 20/20 or better. No case of pupillary block was detected. Conclusion: The results of the present study support the good predictability, efficacy, safety, and stability outcomes of the new implantable collamer lens V4C model.
9:01 AM Panel discussion of previous paper
PA073
SOE
9:37 AM Panel discussion of previous paper
PA076 9:06 AM
SOE Detecting Keratoconus by Combining Topographic and Tomographic Intereye Asymmetry Data
9:42 AM
Comparison of Posterior Chamber and Iris-Fixated Phakic IOLs in 5-Year Outcomes Presenting Author: Akihiro Yasuda MD
Presenting Author: Alain Saad MD*
Co-Author(s): Yoshihiro Kitazawa
Co-Author(s): Emmanuel Guilbert, Damien Gatinel MD* Purpose: To discriminate between normal (N) and keratoconus (KC) corneas by analyzing intereye asymmetry parameters and define a score of similarity that outlines the normal range. Methods: Prospective, nonrandomized study that included 102 N corneas and 64 KC corneas. Topographic and tomographic parameters of the right and left eye were subtracted to determine asymmetry. A discriminant function was constructed in order to separate between the 2 groups. Results: The mean intereye asymmetry differences were statistically significant (P < .001) for all variables except the vertical and horizontal decentration of the thinnest point. The discriminant function reached a sensitivity of 94% and a specificity of 100%. Conclusion: Combining intereye differences may be accurate and useful for the topography-based detection of KC.
Purpose: To evaluate the efficacy and safety of posterior chamber phakic IOLs (eg, ICL) with that of iris-fixated lenses (eg, Artisan). Methods: 1232 eyes with ICLs (mean MRSE: -9.14 D) and 1103 eyes with Artisan lenses (-9.85 D) were compared in terms of outcomes and safety. Results: Mean MRSE of ICL/Artisan eyes were +0.06 D / -0.12 D at 1 month, and -0.35 D / -0.34 D at 5 years. More eyes achieved UCVA of 20/20 or better with the ICL (97.4%) than with the Artisan (88.3%) at 1 month, 92.9% vs. 81.9% at 5 years. BCVA in ICL/Artisan was gained in 56.9%/53.5%, lost in 1.9%/5.9%. During 5 years after 1 month, 21.9% of Artisan and 16.0% of ICL eyes lost more than 10% endothelial cell density. Conclusion: Both lenses showed stable outcomes for 5 years; however, the ICL showed better predictability, UCVA, more gained / less lost BCVA, and less stress to the corneal endothelium.
9:13 AM Panel discussion of previous paper
9:49 AM Panel discussion of previous paper
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
159
Original Papers
Purpose: To compare outcomes of myopic LASIK with those of optimized prolate ablation (OPA), wavefront-guided (WF-OPA), and topography-guided (Topo-OPA) ablation. Methods: Fifty-six patients underwent LASIK, with one eye randomized to receive OPA and the fellow eye to receive WF-OPA or TopoOPA. Results: At 6 months postoperatively, 58% of OPA, 69% of WF-OPA, and 62% of Topo-OPA eyes, respectively, saw -0.10 logMAR or better without correction (P < .05 compared to preoperative, all groups ). Ocular spherical aberration was 0.10 µ 0.09 µ, and 0.13 µ in the OPA, WF-OPA, and Topo-OPA eyes, respectively. Modulation transfer function was similar for all eyes. Patient satisfaction between groups was similar (P > .05, all comparisons). Conclusion: Refractive outcomes, visual quality, and patient satisfaction were similar between groups.
PA075
Original Papers PA077
9:54 AM
Comparison of Depth of Focus and Mesopic Contrast Sensitivity in Small-Aperture Corneal Inlay, Accommodating IOL, and Multifocal IOL Patients Presenting Author: Jay Stuart Pepose MD PhD* Purpose: To compare monocular defocus curves and binocular mesopic contrast sensitivity of a small-aperture intracorneal inlay to those of 3 premium IOLs. Methods: A retrospective comparison of Crystalens AO, AcrySof ReSTOR 3.0, and Tecnis Multifocal to the Kamra inlay. Monocular defocus curves were determined. Binocular mesopic contrast was measured with and without glare at 1.5, 3, 6, and 12 cpd. Results: Crystalens AO (n = 25) and Kamra inlay (n = 327) patients had continuous functional vision of 20/40 or better over 3 D and 4 D, respectively. ReSTOR 3.0 (n = 25) and Tecnis MF (n = 22) IOLs had noncontinuous functional vision over a 4.5 D dioptric range. Conclusion: Patients monocularly implanted with a small-aperture inlay achieved a broader continuous range of vision and better mesopic contrast sensitivity than patients with any of these IOLs.
10:01 AM Panel discussion of previous paper
Retina, Vitreous Tuesday, Oct. 21 8:30 AM - 12:45 PM Room: S405 Moderator: David Sarraf MD Panel: J Fernando Arevalo MD FACS, Neil M Bressler MD, Michael W Stewart MD
Original Papers
PA078
8:30 AM
High-Dose Ranibizumab for Diabetic Macular Edema: Month 24 Outcomes of the READ-3 Study (Ranibizumab for Edema of the Macula in Diabetes, Protocol 3)
8:49 AM Panel discussion of previous paper
PA080
Purpose: To compare 2-mg ranibizumab (RBZ) injections to 0.5-mg RBZ for eyes with center-involving diabetic macular edema (DME) with central subfield (CSF) of 250 microns or greater on time domain OCT (TD-OCT) to determine if high dose was superior. Methods: Eyes were randomized 1:1 to 2-mg RBZ or 0.5-mg RBZ. All eyes received 6 monthly injections. Subjects were followed monthly and received additional injections based on predetermined criteria. Primary outcome was mean change in BCVA at Month 6. Study duration was 24 months. Results: 152 eyes participated. At Month 6 / Month 24 the change in BCVA was +7.0 / +6.77 in the 2-mg group and +9.4 / +11.0 in the 0.5-mg group. Conclusion: At Month 6 both doses appeared equivalent. At Month 24, 0.5 mg was superior (P = .02). High dose showed no improvement over 0.5 mg.
8:37 AM Panel discussion of previous paper
8:42 AM
Open-Label Extension of the RIDE and RISE Trials: Association of Diabetic Macular Edema Patient Characteristics With Treatment Frequency
The Fate of Diabetic Macular Edema Patients With Little or No Initial OCT Response to Ranibizumab in the RISE and RIDE Trials Presenting Author: Dante Pieramici MD* Co-Author(s): Helen Marie Chmiel EdD*, Beiying Ding PHD*, Anne E Fung MD* Purpose: To evaluate BCVA improvement in eyes with ≤ 10% reduction in baseline central foveal thickness (CFT) following 1-6 doses of ranibizumab (RBZ). Methods: Summary statistics and change from baseline BCVA and CFT. Results: In 0.3-mg RBZ arm, ≤ 10% CFT reduction was seen in 23/249 eyes (9%) following 3 doses and in 14/249 eyes (6%) following 6 doses (82/251 [33%] and 56/251 [22%] in sham, correspondingly). The RBZ ≤ 10% CFT reduction eyes had thinner retinas at baseline by ~80 mm compared to eyes with > 10% CFT reduction. At Month 24, BCVA in eyes with ≤ 10% CFT reduction following 1-6 RBZ doses was comparable to the RBZ full study population. Conclusion: Fewer than 10% of RBZ eyes showed ≤ 10% reduction in CFT after 3 injections. Significant BCVA gains were realized despite gradual CFT response.
9:01 AM Panel discussion of previous paper
PA081
9:06 AM Dexamethasone Intravitreal Implant for Treatment of Persistent Diabetic Macular Edema Presenting Author: Soraya Mediero Clemente MD Co-Author(s): Zurnie Del Barrio Lopez De Ipina MD, Jesus Ramon Garcia Martinez**, Paula Larranaga-Fragoso MD, Bruno Casco Silva MD, Felix Armada-Maresca MD Purpose: To evaluate the effectiveness of a single intravitreal injection of Ozurdex over 12 months in patients with chronic diabetic macular edema (CDME). Methods: Retrospective review of the medical records of 52 eyes with CDME refractory to other treatments. Results: Statistically significant improvement was seen in the mean BCVA at Month 1 (P = .0002) and at Month 12 (P = .0261), in the mean thickness central subfield at Month 1 (P < .0001) and at Month 5 (P < .0001), and in the mean thickness average cube at Month 1 (P < .0001), at Month 5 (P < .0001), and at Month 12 (P = .0001) after treatment. Conclusion: The study suggests that dexamethasone implant is a favorable option in patients with CDME refractory to other treatments, producing an improvement that remains over time.
9:13 AM Panel discussion of previous paper
Presenting Author: Charles C Wykoff MD PhD* Co-Author(s): Beiying Ding PHD*, Na Lu PHD*, Ivo Stoilov MD* Purpose: To investigate baseline (BL) characteristics of patients with diabetic macular edema (DME) associated with 0.5-mg ranibizumab (RBZ) treatment frequency during the RIDE/RISE open-label extension (OLE). Methods: Core 160
8:54 AM
SOE
Presenting Author: David S Boyer MD*
PA079
BL RIDE/RISE patient characteristics were analyzed by RBZ p.r.n. injection number per year during the OLE (0, > 0 to ≤ 3, > 3 to ≤ 7 and > 7). Results: Compared to patients receiving > 7 injections/year (n = 88, 18%), patients needing no OLE treatment (n = 121, 24%) had a shorter diabetes duration, shorter time from DME diagnosis, better vision, lower diabetes retinopathy severity scores, and less DME at RIDE/RISE core study BL. Conclusion: Many DME patients in the RIDE/RISE OLE remained stable with no or few injections; in the 24% requiring no injections, RBZ appears to have been initiated earlier in the course of disease.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Original Papers PA082
9:18 AM
Dexamethasone Intravitreal Implant in Previously Treated Patients With Diabetic Macular Edema: Subgroup Analysis of MEAD Presenting Author: Baruch D Kuppermann MD PhD* Co-Author(s): Albert J Augustin MD*, Xiao-Yan Li MD*, Scott M Whitcup MD* Purpose: To evaluate outcomes of dexamethasone intravitreal implant (DEX) treatment in patients with previously treated diabetic macular edema (DME). Methods: Subgroup analysis of MEAD, a 3-year, randomized, Phase 3 study evaluating DEX 0.7 mg and 0.35 mg vs. sham in DME. Results: Within the previously treated subgroup of 757 patients (72.2% of study population), 21.5%, 17.7%, and 11.1% of patients in the DEX 0.7 mg, DEX 0.35 mg, and sham groups, respectively, had ≥ 15-letter BCVA gain from baseline (BL) at study end (P ≤ .036 DEX vs. sham), and mean average central retinal thickness change from BL by OCT was -126, -117, and -39 µm, respectively (P < .001 DEX vs. sham). Conclusion: DEX significantly improved visual and anatomic outcomes in patients with previously treated DME.
9:25 AM Panel discussion of previous paper
PA083
9:30 AM
Two-Year Outcomes of the VISTA/VIVID Trials of Intravitreal Aflibercept Injection in Diabetic Macular Edema Presenting Author: Quan Dong Nguyen MD*
9:37 AM Panel discussion of previous paper
PA084
9:42 AM
Intravitreal Aflibercept Injection in Patients With Prior Therapy for Diabetic Macular Edema: Outcomes From VISTA Presenting Author: David S Boyer MD* Purpose: To assess outcomes after intravitreal aflibercept injection (IAI) or laser in diabetic macular edema (DME) patients with and without prior antivascular endothelial growth factor (VEGF) therapy for diabetic macular edema (DME). Methods: VISTA randomized 872 patients to IAI 2 mg every 4 weeks (2q4), IAI 2 mg every 8 weeks following 5 monthly doses (2q8), and laser. Results: Over 52 weeks, BCVA letter gain with 2q4, 2q8, and laser was 12.5, 10.7, and 0.2 (P < .0001). Of the VISTA patients, 43% had prior anti-VEGF, of which 71%-82% had only bevacizumab. BCVA letter gain with 2q4, 2q8, and laser was +10.7, +10.5, and -1.0 (P < .0001) in patients who had prior anti-VEGF, and +13.8, +10.9, and +1.1 (P < .0001) in patients who had no prior anti-VEGF. The most frequent ocular serious adverse event was vitreous hem-
9:49 AM Panel discussion of previous paper Moderator: Sharon D Solomon MD Panel: Judy E Kim MD, Baruch D Kuppermann MD PhD, Jason S Slakter MD
PA085
9:58 AM
SOE Visual Acuity and Subfoveal Choroidal Thickness: The Beijing Eye Study
Presenting Author: Jost B Jonas MD* Co-Author(s): Du Kuifang** Purpose: To examine the association between BCVA and subfoveal choroidal thickness (SFCT). Methods: In the population-based Beijing Eye Study, participants underwent spectral domain OCT. Results: In multivariate analysis, better BCVA was associated with thicker SFCT (P = .002) in general and a SFCT thicker than 90 µm (P = .001) in particular. If eyes with glaucoma, diabetic retinopathy, late AMD, and myopic retinopathy were excluded, better BCVA was still significantly associated with thicker SFCT (P = .01) and SFCT thicker than 90 µm (P < .001) in multivariate analysis. Conversely, thicker SFCT was associated with better BCVA (P < .001) in multivariate analysis. Conclusion: Better visual acuity is strongly associated with thicker SFCT.
10:05 AM Panel discussion of previous paper
PA086
10:10 AM
No Association of Statin Use and AMD in the Age-Related Eye Disease Study 2 (AREDS2) Presenting Author: Shaza Nizar Al-Holou* Co-Author(s): William R Tucker MBBS, Elvira Agron MS, Traci E Clemons PhD, Emily Y Chew MD, The AREDS2 Research Group Purpose: To evaluate the association of statin use with progression to late AMD. Methods: We assigned propensity scores based on covariates to statin users and nonusers. Age-adjusted Cox regression models were performed on paired propensity-score matched statin users and nonusers in AREDS2. Results: Statin use was not statistically significantly associated with progression to late AMD in participants with baseline bilateral large drusen (hazard ratio [HR]: 0.63; 95% CI, 0.37-1.05) or with baseline unilateral late AMD (HR: 1.22; 95% CI, 0.67-2.20). Conclusion: Statin use was not associated with progression to late AMD.
10:17 AM Panel discussion of previous paper
PA087
10:22 AM
Lack of Association Between Thiazolidinedione Use and Incidence of Diabetic Macular Edema at 4 Years Followup in the ACCORD Eye Study Presenting Author: Craig M Greven MD* Co-Author(s): Emily West Gower PHD, Letitia H Perdue MS, Ronald Peter Danis MD*, Matthew D Davis MD, Emily Y Chew MD, Walter T Ambrosius PhD* Purpose: To report the association between thiazolidinedione (TZD) and incidence of diabetic macular edema (DME) in the ACCORD Eye Study. Methods: Stereoscopic fundus photographs at baseline and Year 4 examinations (n = 2856) were centrally graded and analyzed to examine the longitudinal association of TZD use with DME progression. The analyses were adjusted for age, sex, race, and diabetes duration. Results: DME incidence was 5.2% with and 4.7% without exposure to TZDs (adjusted OR = 1.12; 95% CI, 0.71-1.76, P =
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
161
Original Papers
Purpose: To compare intravitreal aflibercept injection (IAI) with laser for diabetic macular edema (DME). Methods: Patients (n = 872) were randomized to IAI 2 mg every 4 weeks (2q4) or 8 weeks (after 5 monthly doses; 2q8) or laser. Results: Over 52 weeks, BCVA gain with 2q4, 2q8 vs. laser was 12.5, 10.7 vs. 0.2 letters (P < .0001) in VISTA and 10.5, 10.7 vs. 1.2 letters (P < .0001) in VIVID. Most frequent ocular adverse events were conjunctival hemorrhage, eye pain, and vitreous floaters. At Week 100, BCVA was 11.5, 11.1 vs. 0.9 letters (P < .0001) in VISTA. Additional 2-year results will be presented, including diabetic retinopathy severity, where more 2q4, 2q8 vs. laser patients had ≥ 2-step improvement at Week 100 in VISTA (37.0%, 37.1% vs. 15.6%; P < .001). Conclusion: Both IAI regimens significantly improved BCVA in comparison with laser at Week 52 and sustained BCVA gains through Week 100 (VISTA).
orrhage. Conclusion: BCVA gains over laser with both IAI regimens were similar in both patient subgroups.
Original Papers .63). Conclusion: In this longitudinal study of patients with Type II diabetes, there was no increased risk of macular edema associated with TZD use.
10:29 AM Panel discussion of previous paper
PA088
10:34 AM
Ranibizumab in Diabetic Macular Edema: Review of Arterial Thromboembolic Events From Controlled Clinical Trials
11:05 AM Panel discussion of previous paper
PA091
11:10 AM
Intravitreal Aflibercept Injection for Macular Edema Due to Branch Retinal Vein Occlusion: 52-Week Outcomes
Presenting Author: Marco A Zarbin MD PhD FACS*
Presenting Author: David Brown MD FACS*
Co-Author(s): Vladimir Bezlyak**, Philippe Margaron PHD*
Purpose: To compare intravitreal aflibercept injection (IAI) with grid laser for macular edema due to branch retinal vein occlusion (BRVO). Methods: VIBRANT, a Phase 3 trial, randomized eyes with macular edema secondary to BRVO to receive IAI 2 mg every 4 weeks (n = 91) or grid laser (n = 92) from baseline to Week 20. Results: The proportion of eyes that gained ≥ 15 letters from baseline to Week 24 was 53% and 27% (P < .001) in the IAI and laser groups, respectively. The mean improvement in BCVA from baseline to Week 24 was 17.0 and 6.9 letters (P < .0001), respectively. The most common ocular adverse event in IAI eyes was conjunctival hemorrhage (19.8%). The 52-week results will be presented. Conclusion: Monthly IAI provided significantly greater visual benefit at 24 weeks than laser in eyes with macular edema due to BRVO.
Purpose: To review arterial thromboembolic events (ATEs) from diabetic macular edema (DME) studies with up to 36 months ranibizumab exposure. Methods: Retrospective analysis of ATEs from 5 ranibizumab DME studies (> 1250 patients). Results: Relative risks at 12 months (ranibizumab/control, N = 634) for all ATEs, myocardial, and nonmyocardial ATEs were 0.75 (95% CI, 0.32-1.73), 0.70 (0.24-2.07), and 0.98 (0.30-3.19), respectively. At 12 months, 2.9%, 1.7%, and 1.7% of patients had these events per year. By 24 months these values were 3.2%, 0.6%, and 2.8%. There was no increase at 36 months. Conclusion: No pattern suggestive of a causal relationship with ranibizumab was evident for cardiovascular or cerebrovascular events. The favorable systemic safety is consistent with ranibizumabs minimal effect on systemic VEGF levels.
10:41 AM Panel discussion of previous paper
PA089
10:46 AM
Pharmacodynamic Properties of Emixustat Hydrochloride in the Treatment of Geographic Atrophy Presenting Author: Roger L Novack MD PhD*
Original Papers
based on PED thickness, and when analyzed by dose (0.5 mg or 2.0 mg) or by p.r.n. regimen. Conclusion: BL PED eyes had positive VA gains, similar to non-PED, with p.r.n. RBZ regardless of PED size.
Purpose: To evaluate the pharmacodynamic effect of emixustat hydrochloride on rod photoreceptor activity. Methods: Emixustat (2-10 mg) was administered to 54 geographic atrophy subjects for up to 90 days with a 7-14 day follow-up period. Electroretinography (ERG) was performed, and both A- and B-wave amplitudes were measured to assess the effect on photoreceptors and bipolar cells, respectively.Results: A dose-dependent, reversible, and comparable suppression of A- and B-wave activity was observed. Prebleach ERG showed a marked suppression of activity with evening dosing. Conclusion: The linear relationship between A- and B-wave amplitudes with treatment is consistent with the proposed mechanism of action. Suppression of photoreceptor activity during dark adaptation may reduce retinal metabolic stress.
10:53 AM Panel discussion of previous paper
PA090
10:58 AM
Ranibizumab Treatment in Patients With Wet AMD With Pigment Epithelial Detachment: A HARBOR Subgroup Analysis Presenting Author: Nikolas J London MD* Co-Author(s): Helen Marie Chmiel EdD*, Purpose: To evaluate whether the presence / absence of pigment epithelial detachment (PED) at baseline (BL) affects visual acuity (VA) outcomes in eyes with wet AMD given ranibizumab monthly or p.r.n. Methods: Exploratory subgroup analysis of 24-month data from the Phase 3 randomized HARBOR study. Results: At BL, eyes with PED (n = 598; 54.5%) had higher mean BCVA than those without PED (55.7 vs. 51.9 letters, respectively). BCVA gains from BL at Month 24 were comparable in eyes with/without PED after adjusting for BL covariates. In the RBZ 0.5-mg p.r.n. arm, eyes with PED averaged 14 injections vs. 12.5 for no PED. Median Month 24 VA gains were similar across quartiles 162
12:00 AM Panel discussion of previous paper Moderator: Jennifer Irene Lim MD Panel: H Culver Boldt MD, Homayoun Tabandeh MD MS FRCP FRCOphth
PA092
11:26 AM Dual Antagonism of Platelet Derived Growth Factor (Fovista 1.5 mg) and Vascular Endothelial Growth Factor (Lucentis 0.5 mg) Results in Reduced Subretinal Fibrosis and Neovascular Growth SOE
Presenting Author: Usha Chakravarthy MBBS PhD* Co-Author(s): Glenn J Jaffe MD* Purpose: To assess severity of fibrosis in eyes treated with combination Fovista and Lucentis vs. Lucentis alone. Methods: Masked retrospective analysis of fundus images at baseline and 24 weeks in a subset (70 eyes) of a Phase 2B study of which n = 33 (combined); n = 37 (monotherapy) that experienced >0 ETDRS letter loss. Fibrosis was graded on a 0 to 4 categorical scale. Results: At 24 weeks, 27% of eyes (combined) vs. 54% (monotherapy) had ≥ 2 step worsening of fibrosis. In eyes with no fibrosis, 10% (combined) vs. 51% (monotherapy) developed fibrosis. Mean change in fibrosis: 0.97 vs. 2.0 (P = .003). Conclusion: Combined antagonism of VEGF and PDGF was associated with reduced development and progression of fibrosis, and inhibition of neovascular growth may play a role in improved visual outcomes in neovascular AMD.
11:33 AM Panel discussion of previous paper
PA093
11:38 AM
Comparison of Anatomic and Visual Acuity Outcomes in Neovascular AMD Patients Treated With ESBA 1008 and Ranibizumab Presenting Author: Pravin U Dugel MD* Purpose: Efficacy comparison of ESBA 1008 (an antibody fragment) with ranibizumab to treat neovascular AMD. Methods: Prospective, activecontrolled, randomized, double-masked, single-dose ascending, multicenter study. Subjects were randomized to 1 of 5 arms to receive a single intravitreal dose of ESBA 1008 or ranibizumab. Efficacy endpoints included change in cen-
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Original Papers tral subfield thickness (CSFT) at Month 1 (primary) and change in BCVA. Results: 194 subjects were randomized. A dose-related reduction of CSFT was observed for ESBA 1008. At 6 weeks, patients receiving 6 mg of ESBA 1008 gained a mean of 10.4 (±9.2) letters in BCVA, compared to 6.2 (±9.5) letters for ranibizumab. Conclusion: ESBA 1008 exhibited a dose-dependent effect on CSFT reduction and BCVA gain in patients with neovascular AMD.
11:45 AM Panel discussion of previous paper
PA094
11:50 AM
The Prospective Intraoperative and Perioperative Ophthalmic Imaging With Optical Coherence Tomography (PIONEER) Study: Two-Year Vitreoretinal Results Presenting Author: Justis P Ehlers MD* Co-Author(s): Peter K Kaiser MD*, Rishi P Singh MD*, Daniel F Martin MD, Alex Yuan MD, Sunil K Srivastava MD* Purpose: To assess the utility of intraoperative OCT (i-OCT) for vitreoretinal (VR) surgery. Methods: Prospective multisurgeon study examining i-OCT feasibility, safety, and utility during VR surgery with a microscope-mounted OCT system. Surgeon feedback questionnaires were completed on utility. Results: At 24 months, 256 eyes were enrolled in the PIONEER VR surgery arm. The median time required per scan session was 3.4 minutes. No serious adverse events occurred. During membrane peeling, i-OCT informed surgical decision making in 43% of procedures (63/146). Conclusion: i-OCT appears to provide important surgical feedback in a large percentage of vitreoretinal cases while resulting in only minimal delay in surgical time.
11:57 AM Panel discussion of previous paper
PA095
12:02 PM
SOE Indications and Results of a New L-Shaped Macular Buckle to Support a Posterior Staphyloma in High Myopia
Co-Author(s): Ron Afshari Adelman MD MPH Purpose: The efficacy of a macular buckle in treating myopic traction maculopathy (MTM) was studied. Methods: Fifty-two eyes with MTM, macular detachment with macular hole (MHMD), or without macular hole (MD) and macular foveoschisis (MF) were treated with vitrectomy combined with macular buckle or with a macular buckle alone. Results: Combined Group: The retina was attached in 100% and the hole was closed in 32% of MHMD. Buckle Groups: The retina was attached in 100% of MHMD, MD, and MF, with visual improvement. The macular hole was closed in 50% of cases of MHMD. Limited complications included conjunctiva erosion, diplopia, and pain. MRI showed flattening of the posterior staphyloma. Conclusion: Macular buckle alone should be the first treatment of MTM.
12:21 PM Panel discussion of previous paper
PA097
12:26 PM
Clinical Outcomes After Antivascular Endothelial Growth Factor Therapy for Prethreshold ROP: The Results of the International Anti-VEGF for ROP Collaborative Study Group Presenting Author: Jorge I Calzada MD* Co-Author(s): Rocio Diaz MD, Maria Ana Martinez-Castellanos MD, Clio A Harper III MD*, Audina Berrocal MD*, Mehmet Kocak MD, W Lloyd Clark MD*, Caroline R Baumal MD* Purpose: To report the clinical outcomes of anti-VEGF therapy in prethreshold ROP. Methods: Retrospective, interventional, multicenter study. Results: 1207 eyes of 109 infants were included; 98 cases where both eyes were treated Mean gestational age at birth was 26.1 ± 2.7 weeks; mean birth weight was 774 ± 259 grams. Regression of ROP was observed in 93.2% one week following injection. 0.97% of eyes developed a new vitreous hemorrhage, and 0.5% had a retinal detachment following injection. No systemic complications were reported. Eleven infants (10.1%) had recurrence of neovascularization with plus disease. Of these, mean gestational age at birth was 24.6 ± 1.9 weeks for infants with recurrence versus 26.3 ± 2.7 for infants without recurrence (P = .043), and mean birth weight = 608 ± 129 for the infants with recurrence versus 761 ± 217 grams (P = .061). Re-treatment was performed in 24.7% (21.3% laser/ 2.4% injection/1% PPV). Conclusion: Anti-VEGF injections were demonstrated to be an effective treatment for prethreshold ROP.
12:33 PM Panel discussion of previous paper
12:09 PM Panel discussion of previous paper
PA096
12:14 PM
SOE Subretinal Implantation and Functional Results of the Alpha IMS Chip to Restore Vision in 26 Blind Retinitis Pigmentosa Patients
Presenting Author: Helmut Sachs MD* Co-Author(s): Karl-Ulrich Bartz-Schmidt MD**, Caroline K L Chee MBBS*, Veit-Peter Gabel MD**, Florian Gekeler MD*, Timothy L Jackson MBChB*, Robert E MacLaren MBChB**, Janos Nemeth MD, Katarina Stingl MD*, David Wong FRCOPHTH, Walter G Wrobel MD*, Eberhart Zrenner MD* Purpose: Twelve-month visual function and safety data after transchoroidal implantation of a subretinal electronic chip in 26 blind RP patients. Meth* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
163
Original Papers
Presenting Author: Barbara Parolini MD
ods: Transchoroidal subfoveal implantation of a chip with 1500 electrodes. Functional tests with 4 procedures. Monitor-based tests for light perception, localization, movement detection, grating acuity, and Landolt C. Detection, localization, and identification of objects. Reading letters. Visual experiences during daily life. Results: No safety concerns for transchoroidal implantation. Implant mediated light perception in 85% of patients; light localization, 58%; movement detection, 23%; grating acuity, 54%; visual acuity, 18%. Reading letters. Visual experiences during daily life. Conclusion: Improvement of visual function in majority of patients. Transchoroidal surgery is safe. CE mark.
SCIENTIFIC POSTERS Saturday - Tuesday, Oct. 18 - 21 South Hall A There will be two sessions of scientific posters. Session One
Saturday, Oct. 18
9:00 AM – 5:00 PM
Sunday, Oct. 19
7:00 AM – 5:00 PM
Session One Presenters will be at their displays on Sunday, Oct. 19 from 12:30 PM - 2:00 PM.
Session Two
Monday, Oct. 20
7:00 AM – 5:00 PM
Tuesday, Oct. 21
7:00 AM – 1:00 PM
Session Two Presenters will be at their displays on Monday, Oct. 20 from 12:30 PM - 2:00 PM.
Posters designated by a H received the highest grades by the Annual Meeting Program Committee and selected as Best Posters. SOE Sponsored by the European Society of Ophthalmology
Scientific Posters Online Booth 65 and Lakeside Center
View scientific posters at your convenience at the Scientific Posters Online computer terminals in McCormick Place. This service is also available through the Mobile Meeting Guide, www.aao.org/mobile. After Nov. 1, view Scientific Posters online: www.aao.org/aao-archives.
Onsite Poster Tours The “Meeting Point” near Scientific Posters Online/Videos on Demand in Booth 65. Subject
Tour Leaders
Sunday, Oct. 19 – 12:30-1:30 PM Cataract Steve A Arshinoff MD, Stephen H Johnson MD Cornea, External Disease James J Reidy MD Jayne S Weiss MD Glaucoma Robert L Stamper MD Pediatric Ophthalmology, Strabismus Ta Chen Chang MD Terri L Young MD Retina, Vitreous Keith A Warren MD
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Tour Leaders
Monday, Oct. 20 – 12:30-1:30 PM Cataract Mark H Blecher MD Luther Fry MD Cornea, External Disease Penny A Asbell MD FACS Kenneth R Kenyon MD Glaucoma Edward J Rockwood MD, Leonard K Seibold MD Pediatric Ophthalmology, Strabismus Hilda Capo MD Martha P Schatz MD Retina, Vitreous Shlomit Schaal MD PhD Lucia Sobrin MD
P.O. Box 7424, San Francisco, CA 94120-7424 | Tel: 415-561-8500 Fax: 415-561-8533 © 2014 American Academy of Ophthalmology. All rights reserved. No portion may be reproduced without express consent of the American Academy of Ophthalmology.
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Academy staff are available at the Academy Resource Center, Booth 508, to answer any questions you may have.
Scientific Posters Cataract SESSION ONE, SATURDAY & SUNDAY Scientific Poster 1 Residual Astigmatism Discrepancies in FDA Approved Toric IOLs Presenting Author: Fatma Dihowm MD Co-Author(s): David Hjelmstad, Samir Sayegh MD PhD Purpose: To compare residual astigmatism as computed for equivalent lenses for FDAapproved IOLs by 2 manufacturers. Methods: We used the recommended toric IOL calculators by 2 manufacturers and submitted the same spherical power and corneal astigmatism information to generate a recommended toric IOL and its residual astigmatism (RA). RA was compared and graphed for a given amount of astigmatism ranging from 1 to 4 D as a function of increasing spherical IOL power, from 10 to 30. Results: There were consistent discrepancies between manufacturers’ displayed RA. One manufacturer RA was constant throughout the variation range of the IOL power, while the other varied. Conclusion: Calculation paradigms for toric IOLs need to be critically reviewed.
Scientific Poster 2 SOE Presbyopia Correction With Multifocal Toric IOL Implantation Presenting Author: Ewa Mrukwa-Kominek MD PhD* Purpose: To assess presbyopia correction with a toric multifocal IOL in cataract patients with corneal astigmatism (CA). Methods: Fifteen patients (30 eyes) with CA > 1.5 D received the M-Flex T IOL (Rayner). Outcomes included uncorrected distance visual acuity (UDVA), uncorrected near VA (UNVA), refraction, contrast sensitivity, and quality of life (QoL). Results: Mean preop UDVA and corrected distance VA (CDVA) were 0.33 ± 0.11 and 0.61 ± 0.09, respectively. Mean postop UDVA was 0.99, and 85% of eyes achieved UNVA of J2. Mean contrast sensitivity improved in all spatial frequencies. There was no significant difference between preop and postop CA, and no correlation was seen between change in UDVA and QoL. Conclusion: The M-Flex T IOL reduces spectacle dependence.
Scientific Poster 3 Femtosecond Laser OCT-Guided Intrastromal Arcuate Keratotomy to Reduce Corneal Astigmatism During Cataract Surgery Presenting Author: Dilraj Singh Grewal MD Co-Author(s): Surendra Basti MBBS*, Satinder Pal Singh Grewal MD MBBS
Scientific Poster 4 SOE The Clinical Outcomes After Bilateral Implantation of an Apodized Diffractive +2.5 D Multifocal Toric IOL
Presenting Author: Liliana Werner MD PhD* Co-Author(s): Erica Liu MD**, Scott Cameron Cole MD MS, Thomas Kohnen MD*, Fritz H Hengerer MD**, Thomas Kohnen MD*, Nick Mamalis MD* Purpose: To provide complete histopathologic evaluation of explanted IOL capsular bag complexes that spontaneously dislocated in the late postoperative period. Methods: Capsular bags containing an IOL or an IOL and capsular tension ring (CTR) from 28 consecutive explanted specimens were analyzed histopathologically. Additionally, the explanting surgeons submitted a clinical course summary with each specimen. Results: Different IOL materials / designs were represented; 2 specimens contained a CTR. A history of pseudoexfoliation (PEX) was noted in 11 cases. However, PEX material was found in 18 cases histopathologically. Conclusion: PEX may be implicated in a larger proportion of late inthe-bag IOL subluxation / dislocation than previously thought.
Scientific Poster 6 SOE Risk Factors and Treatment Options in Late Postoperative IOL Dislocation Presenting Author: Yaran Koban MD Co-Author(s): Selim Genc MD**, Gorkem Bilgin MD, Halil Huseyin Cagatay Sr** Purpose: To evaluate risk factors and treatment options for IOL dislocation in the late postoperative period. Methods: Retrospective analysis of medical records of 157 patients who had phacoemulsification with IOL implantation and developed IOL dislocation in the late postoperative period was performed. Results: Pseudoexfoliation (PEX) syndrome was found in 74.5% of the eyes. We performed anterior vitrectomy-scleral fixation IOL (70.0%), pars plana vitrectomy (PPV)-scleral fixation IOL (15.9%), IOL reposition (9.6%), PPV-IOL removal (3.2%), and anterior vitrectomy-iris-fixated IOL (1.3%) for treatment. Conclusion: PEX syndrome was the most common predisposing risk factor for late postoperative IOL dislocation. Scleral fixation IOL implantation provides significant increase in postoperative BCVA.
Scientific Poster 7 H Mortality After Cataract Surgery in the U.S. Medicare Population Presenting Author: Victoria L Tseng MD Co-Author(s): Fei Yu PhD, Flora Lum MD, Anne Louise Coleman MD PhD* Purpose: To examine the association between cataract surgery and mortality in patients with cataract. Methods: A 5% random sample of 2011 Medicare files was used to identify cataract patients and their demographics, systemic and ocular comorbidities, and cataract severities. Odds ratios (ORs) of 2-year mortality were calculated for cataract patients with and without surgery, adjusting for all covariates. Results: Of 328,422 cataract patients, 14,616 (4.5%) died within 2 years. Adjusted ORs of cataract surgery on mortality were 0.94 (0.90, 0.99) for all patients, 0.79 (0.74, 0.85) for patients ≥ 80 years old, and 0.85 (0.78, 0.93) for patients with severe cataract. Conclusion: In Medicare cataract patients, cataract surgery is associated with reduced 2-year mortality, especially in patients who are older or with severe cataract.
Scientific Poster 8 The Expression of Micro-34a in Age-Related Cataract and Its Molecular Mechanism of Regulating Apoptosis in Human Lens Epithelial Cells by Targeting Notch2 Presenting Author: Fan Fan
Presenting Author: Yonca A Akova MD*
Co-Author(s): Yi Luo**, Yi Lu MD PhD**, Peng Zhou MD
Co-Author(s): Osman S Arslan MD, Fatma Nilufer Alparslan MD*
Purpose: To investigate the expression changes of miR-34a and the methylation of its promoter in age-related cataract (ARC). Methods: Quantitative real-time polymerase chain reaction was used to evaluate the expression of miR-34a in ARC and transparent lens capsules. Pyrosequencing was performed to detect the DNA methylation in miR-34a promoter. Results: The expression of miR-34a was significantly higher in the cataract group (P < .05), while there was no significant difference in the methylation of miR-34a between the 2 groups (P = .152). After transfection, apoptosis of HLECs increased significantly (P < .05) in the miR-34a overexpressed group. The 3’UTR reporter activities of Notch2 were significantly inhibited in the miR-34a overexpressed group (P = .01), suggesting miR-34a could directly inhibit Notch2. Conclusion: miR-34a is upregulated in ARC patients and induces HLECs apoptosis via targeting Notch2.
Purpose: To assess the outcomes after bilateral implantation of +2.5 D multifocal toric IOL. Methods:Twelve patients with bilateral cataract and corneal astigmatism from 0.75 to 2.5 D had implantation of the AcrySof IQ ReSTOR +2.5 D toric multifocal IOL. Results: At 6 months, the mean spherical equivalent (SE) was 0.12 D ± 0.23, and the mean refractive cylinder decreased from 1.55 ± 0.8 D to 0.42 ± 0.43 D. The mean binocular UCVA was 0.94 ± 0.08 at 4 mt, J4 at 40 cm, J2 at 60 cm. The mean IOL rotation was 0.83 ± 1.7 degrees. Conclusion: Patients had significantly reduced SE and refractive cylinder, excellent visual acuity at far and intermediate distances, acceptable near visual acuity, and minimal IOL rotation.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To determine the efficacy of using the femtosecond cataract laser (FSL) to perform OCT-guided intrastromal astigmatic keratotomy (IAK) to reduce astigmatism during cataract surgery. Methods: The FSL (Catalys, AMO; Calif.) was employed to create single or symmetric IAK (5 µJ energy, 90° side cut angle, 8.5-mm optical zone) at 80% of corneal depth in eyes with > 0.50 D naturally occurring regular corneal astigmatism, assessed using Pentacam topography. Results: In 30 eyes, corneal astigmatism was significantly reduced (P < .0001) from 0.96 ± 0.58 D (range: 0.5 to 3.2 D) to 0.35 ± 0.26 D (range: 0 to 0.8 D) at 1 month following IAK. Average reduction was 0.61 ± 0.51 D (range: 0.1 to 2.4 D). There were no cases of posterior perforation. Conclusion: OCT-guided FSL IAK is an effective way to reduce corneal astigmatism during cataract surgery.
Scientific Poster 5 Pathological Evidence of Pseudoexfoliation in Cases of Inthe-Bag IOL Subluxation / Dislocation
Scientific Posters Scientific Poster 9 SOE Changes in Angle Configuration and Corneal Thickness After Phacoemulsification by Anterior Segment OCT, Ultrasound Biomicroscopy, and Pentacam
Scientific Poster 14 Confocal Microscopic Findings in 1-Year Follow-up of Corneal Inlay Insertion for Presbyopic Correction
Presenting Author: Ahmed Mohamed Ghoneim MD
Co-Author(s): Mauro S Campos MD, Sandra M Beer MD*
Co-Author(s): Tamer E Wasfy MBBS
Purpose: To describe the confocal microscopic images found at 1 year follow-up. Methods: Thirty-one eyes of 31 patients were implanted with Flexivue Microlens for presbyopia correction. Confocal microscopy was performed at 1 year postop. Results: Small, bright, round, hyper-reflective images were observed in all eyes over the inlay area. No signs of active acute inflammation were seen; still, alteration in transparency was observed in all eyes. Well-demarked, sharp-edged images were observed on the surface and in the inlay borders in most cases. Conclusion: The inlay does not to seem to be stable in terms of histological activity and material compatibility over time. Further analysis, such as scanning electronic microscopy and immunohistochemistry, is required to confirm the author’s suspicion of material corrosion.
Purpose: To evaluate results of anterior segment OCT, ultrasound biomicroscopy, (UBM) and Pentacam in evaluating angle changes and corneal thickness and structure compared with contact pachymetry. Methods: In 40 patients undergoing phacoemulsification, anterior segment OCT, Pentacam, and UBM were obtained 1 week before and 1 week and 1 month after phaco to evaluate nasal and temporal angle and to measure corneal thickness. Results: Mean anterior chamber depth increased, from 2.25 mm to 4.06 mm by anterior segment OCT, from 3.02 mm to 4.41 mm by UBM, and from 3.19 mm to 4.45 mm by Pentacam. Also corneal thickness measurements increased 1 week after phaco as measured by all means. Conclusion: Anterior segment OCT, UBM, and Pentacam demonstrated increase of angle width after phaco and also demonstrated increased corneal thickness after phaco, with more or less similar results compared with contact pachymetry.
Scientific Poster 11 Digital Management and Education of Cataract Patients: Analyzing Effects of a Mobile Health Platform Presenting Author: Richard M Awdeh MD Purpose: This multisite clinical study researched the use of a mobile health patient management and education software tool. Methods: Researchers used both qualitative and quantitative research methods to determine the usability and clinical efficacy of the tool in both private practice and academic settings. Results: Patients scored an average of 35% higher on information retention questions as compared to the preimplementation phase of the study. Data also indicated that in the postimplementation phase of the study, patients were more likely to select a premium intraocular lens implant. Conclusion: The tool was clinically effective as a point-of-care intervention in improving patient education, information retention, comfort levels about their upcoming surgery, and adherence to physician after-care instructions.
Scientific Poster 12 Femtosecond Laser Cataract Surgery Using the Alcon LenSx and Abbott Medical Optics (AMO) Catalys Presenting Author: Zaina N Al-Mohtaseb MD
Scientific Posters
Co-Author(s): Seth M Pantanelli MD, Florence A Cabot MD, William J Feuer MS, Daniel Waren MS, Sonia H Yoo MD*, Kendall Donaldson MD Purpose: To evaluate the phaco energy used and endothelial cell loss in patients having manual cataract surgery and femtosecond laser-assisted cataract surgery using 2 different laser platforms. Methods: Mean phaco energy and endothelial cell count were measured in 182 traditional, 56 LenSx, and 33 Catalys cases. Results: There was a significant difference in phacoemulsification energy used between platforms (P = .017, ANOVA). Both LenSx and Catalys were lower than traditional (P < .040), but they were not different from each other (P = .89). The mean endothelial cell loss postoperatively was 15.8% (SD = 38.5%) and not different among the 3 groups (P = .87). Conclusion: The femtosecond laser reduced the mean phaco energy used during lens fragmentation and did not increase endothelial cell damage.
Scientific Poster 13 SOE The Effect of Femtosecond Laser Capsulotomy on the Development of Posterior Capsule Opacification Presenting Author: Zoltan Nagy MD* Co-Author(s): Illes Kovacs MD PhD, Kinga Kránitz MD** Purpose: To evaluate effects of femtolaser and manual capsulotomy on posterior capsule opacification (PCO). Methods: In 40 eyes femtolaser and in 39 eyes manual capsulotomy was performed. PCO was measured with Open-access Systematic Capsule Assessment (OSCA) software, IOL position with Pentacam, 18-26 months postoperatively. Results: Vertical tilt, horizontal and total decentration of IOLs, and PCO were higher in the manual group (P = .03, .04, .03, and .01). After adjusting for axial length and follow-up time, manual capsulorrhexis was a significant predictor of higher PCO in the multivariable regression model (b: 0.33; 95% CI, 0.01 to 0.65; P = .04). Vertical tilt affected PCO after adjusting for axial length and follow-up time (b: 0.07; 95% CI, 0.01 to 0.12; P = .02). Conclusion: Due to better IOL position, femtolaser capsulotomy resulted in slightly decreased PCO scores.
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Presenting Author: Eliane-Mayumi Nakano MD
Scientific Poster 15 Visual Effects of Blue Light Filtration Presenting Author: John P Berdahl MD* Co-Author(s): Billy R Hammond Jr PhD* Purpose: To assess visual performance with the addition of blue light filtration. Methods: Cross-sectional study of 158 pseudophakes with IOL largely transparent to visible light. Photostress recovery time and disability glare threshold were measured with a blue light filter (BLF) and placebo (no blue light filtration). The test eye and order of filter used in the study were randomized. Results: Difference in photostress recovery time (BLF – placebo) was significant (mean difference: -1.37 ± 4.32 seconds, P = .0001), demonstrating faster recovery with BLF. Disability glare threshold was significantly higher with BLF (1.37 ± 0.88 log unit) than with placebo (1.26 ± 0.92, P = .0001). Conclusion: The addition of blue light filter to pseudophakes with no BLF IOL allows significantly faster photostress recovery and greater threshold to disability glare.
Scientific Poster 16 SOE Optical Bench Analysis of Different Optical Designs in IOLs Presenting Author: Florian T A Kretz MD* Co-Author(s): Gerd U Auffarth MD*, Ramin Khoramnia MD*, Tamer Tandogan MD** Purpose: Optical bench analysis of 3 different optic designs. Methods: Optical bench analysis (OptiSpheric IOL, Trioptics) contained modulation transfer function (MTF), autofocus, through focus scan , and effective focal length of 3 IOL models (monofocal, bifocal, and trifocal; Carl Zeiss Meditec) based on the same platform. Five lenses (21 D) per group were analyzed 5 times each. Results: Mean sagittal MTF (100 lp/mm far focus), 0.607 (monofocal), 0.328 (bifocal), and 0.236 (trifocal) showed a statistically significant difference. Conclusion: Monofocal IOLs showed the best image quality and highest MTF values for a far focal point. Near focal point was significantly better for bifocal and trifocal IOLs. Intermediate distance was best for trifocal IOLs.
Scientific Poster 17 SOE Outcomes Obtained With 2 Models of Trifocal IOLs for the Correction of Presbyopia Presenting Author: Ahmed A Abdou MD Phd Co-Author(s): Jorge L Alio MD PhD*, Esperanza Sala OD, Ana Belen Plaza MS** Purpose: To compare visual and optical quality outcomes obtained with 2 models of trifocal lenses. Methods:Two groups of eyes: Group A, 20 eyes implanted with AT LISA tri 839MP, and Group B, 20 eyes implanted with Fine Vision. Main outcomes measures were uncorrected distance (UCVA) and uncorrected near visual acuity (UNVA), defocus curve, and contrast sensitivity. Results: Postoperatively, significant improvement in UDVA and CDVA were found in both groups. Statistically significant differences were not found (P = .337) between groups in UNVA and contrast sensitivity (P ≥ .09) postoperatively. The defocus curves showed significantly better visual acuities in Group A (P < .05). Conclusion: Good results were obtained in both groups at all the distances but were better with AT LISA tri in distance and intermediate.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 18 Evaluating the Visualization and Repeat Placement of Hydrogel Punctum Plugs as a Vehicle for Drug Delivery
Scientific Poster 22 Antimicrobial Activity of Moxifloxacin-Soaked Acrylic IOLs: Hydrophobic SA60 vs. the Hydrophilic Afinity CQ 2015
Presenting Author: Thomas R Elmer MD*
Presenting Author: Deep Parikh MD
Co-Author(s): Michael J Endl MD*, Claus M Fichte MD, William Flynn MD*, Edward R Rashid MD, Robert A Rice MD, Tom R Walters MD*
Co-Author(s): Christopher A Minning MD, Amilia Schrier MD, Edward F Smith MD
Purpose: To assess visualization and replacement of polyethylene glycol hydrogel punctum plugs in healthy volunteers. Methods: Plugs containing fluorescein as a visual aid were evaluated in 60 patients. Plugs were replaced bilaterally every 90 days following insertion. Device presence was monitored via slit lamp and blue light and yellow filter mirror by the investigators and patients, respectively. Results: Preliminary results through Day 330 showed plugs were well tolerated and easily visualized by patients and investigators. Replacement was rated as easy in 94.2% of the cases. There were no serious or unexpected adverse events. Conclusion:The replaceability and detectability of the hydrogel punctum plugs make them a viable means for sustained drug delivery for chronic conditions such as glaucoma.
Purpose: To compare the potential of acrylic IOLs to deliver an intracameral antibiotic. Methods: Twenty hydrophobic acrylic AcrySof SA60 (Alcon) and 20 hydrophilic collamer Afinity CQ2015 (Staar) IOLs were soaked in saline or commercial-strength moxifloxacin (5 mg/ml) for 1 minute. Presoaked lenses were plated on agar with Staphylococcus aureus or Staphylococcus epidermidis overlay. Bacterial kill zones were measured after 24 hours. Results: The mean S aureus kill zone for the SA60 (33.67 ± 3.19 mm) was larger than for the CQ2015 (31.89 ± 2.01 mm) (P = .18). The mean S epidermidis kill zone for the SA60 (38.83 ± 3.52 mm) was likewise larger than for the CQ2015 (37.28 ± 5.78 mm) (P = .50). Conclusion: Presoaked acrylic SA60 lenses have antibiotic properties similar to those of CQ2015 lenses and may be used to deliver antibiotics intracamerally.
Scientific Poster 23 Incremental Effectiveness of Combined Topical and Intracameral Antibiotic Prophylaxis for Preventing Phacoemulsification-Related Endophthalmitis
Presenting Author: Maria Karasawa MD
Presenting Author: Neal H Shorstein MD*
Co-Author(s): , Akira Murakami MD
Co-Author(s): Liyan Liu MHSA
Purpose: To evaluate 2-year postoperative outcomes of Y-fixation technique used for intrascleral haptic fixation of posterior chamber IOL. Methods: Eyes operated with Y-fixation technique from March 2010 to December 2011 were included. All patients were evaluated for preoperative status, postoperative status, and complications. Results: A total of 85 eyes of 70 patients were analyzed. The median follow-up was 26.5 months. IOL decentration was observed in 3 eyes but was corrected without difficulty. There was no decline in corrected visual acuity except 1 eye with a postoperative retinal detachment. Conclusion: Results obtained 2 years after Y-fixation technique showed good visual outcomes with minimal complications.
Purpose: To assess whether topical and intracameral antibiotic (IC) are more effective than either alone. Methods: Retrospective cohort study of 150,086 Kaiser Permanente members, 2005-2012. Ascertainment of endophthalmitis (N =118), prophylaxis, and posterior capsular rupture (PCR) were validated. The logistic regression analysis adjusted for age, year of surgery, ocular and systemic comorbidity, and PCR. Results: Risk on topical agent alone was 1.28 per 1000 (42% of cohort). Compared to topical alone (excluding aminoglycoside), the following odds ratios were observed: 0.40 for IC alone (CI, 0.10-1.7) and 0.55 for topical plus IC (CI, 0.32-0.95). Conclusion:Although sample size was limited, topical antibiotic was not evidenced to increased the effectiveness of IC injection.
Scientific Poster 20 Clinicopathological Correlation of Posterior Capsule Plaques in Postvitrectomized Eyes Presenting Author: Ruchi Mittal MD
Scientific Poster 24 H Refractive Outcomes for Tecnis Multifocal IOL Using Various Lens Power Formulas with Koch Axial Length Correction
Co-Author(s): Srikant Kumar Sahu**, Geet Mayur Shah MS, Sujata Das MBBS
Presenting Author: Arman S Zaman MD
Purpose: Clinicopathologic correlation of posterior capsule (PC) plaques in post-vitrectomized eyes. Methods: Thirty-three post-vitrectomized eyes underwent cataract surgery from July 2011 to June 2013. Results: Seventeen out of 33 patients (51%) had PC plaques, 14/17 (82.3%) were males, and 12/17 patients (70.5%) had rhegmatogenous retinal detachment. Duration between two surgeries varied from 1-35 months; the 0-3, 3-9, and > 9 months groups were called Group A, B, and C, respectively. Thickness and cellularity of plaque was highest in Group B. Group C plaques demonstrated maximum collagen by cytochemical and immunohistochemical techniques. PC rent was seen in 2/5 patients in Group C. Conclusion: PC plaque removal is safe in the early evolving or intermediate cellular to fibrocellular stage.
Co-Author(s): Jamie K Alexander MD, Fei Yu PhD, D Rex Hamilton MD*
Scientific Poster 21 SOE Visual Function Without Corrective Lenses After Cataract Surgery Presenting Author: Hector Fernandez Sr Co-Author(s): Carlos Salvador Fernandez Escamez MD**, Nicolas Toledano Fernandez MD**, Jose Reche-Sainz** Purpose: To study the relationship between refraction after cataract surgery and the use of optical correction in patients over 65 years old. Methods: Retrospective case control study. Forty retired elderly subjects (over 65) were recruited. Patients were asked to complete a validated questionnaire on visual function (VF14). The difference between VF14 with and without glasses (difVF14) was studied. Results: There was a significant correlation between difVF14 and postoperative refraction, with lower values of difVF14 associated with postoperative refraction in the range of -0.50 to -1.00 D (OR 0.479; 95% CI, 0.286-0.804). Conclusion: Patients with postoperative refraction between -0.50 and -1.00 D showed better visual function without optical correction.
Purpose: To determine accuracy of formulas (Holladay I and II, SRK/T, Hoffer Q) in predicting refractive outcomes for cataract surgery using the Tecnic Multifocal IOL (TMF) implant. Methods: Mean absolute errors (MAE) between predicted and actual outcomes were calculated for 101 eyes, stratified by axial length (AL) with Koch correction. Results: Analyzing all eyes, Holladay 1 had the lowest MAE (P < .05). For AL < 22 mm, all formulas were equivalent. For 22 mm < AL < 24.5 mm, Holladay I and SRK/T were equivalent and outperformed other formulas (P < .05). For 24.5 mm < AL < 26 mm, Holladay I and II and Hoffer Q outperformed SRK/T (P < .05). For AL > 26 mm, all formulas were equivalent. Conclusion: Using ALs adjusted according to Koch correction, the Holladay 1 formula provides excellent accuracy across all ALs when implanting the TMF.
Scientific Poster 25 In Vivo Measurement of the Forces of Accommodation With a Zonular Capture Haptics Dynamometer Presenting Author: Paul Beer MD* Co-Author(s): Paul L Kaufman MD*, Mary Ann Croft MS*, Gregg Heatley MD, Jared McDonald**, Alexander Katz Purpose: To measure intraocular forces of disaccommodation in vivo with a zonular capture haptic (ZCH)-based dynamometer. Methods: ZCH dynamometers were implanted in surgically aniridic eyes of rhesus monkeys (Macaca mulatta) and activated. Supramaximal accommodation was induced with 40% carbachol. The loads on the device were determined using a twin device, parallel geometry method. Results: The ZCH dynamometer captured zonular forces successfully. The geometry of the device was carefully recorded in both configurations, and the force load was successfully determined. Conclusion: ZCH technology offered an effective method for in vivo dynamometer load determination. The results obtained with a first-generation ZCH are being refined with a second-generation device.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Posters
Scientific Poster 19 Long-term Postoperative Results of Y-Fixation Technique Used for Intrascleral Posterior Chamber IOL Fixation
Scientific Posters Scientific Poster 26 Analysis of Multifocal IOL Refractive Outcomes With Intraoperative Aberrometry With and Without Streaming Refractive Data
Scientific Poster 30 Improving Efficiency in Ophthalmology Surgery Using LEAN Redesign
Presenting Author: Jason P Brinton MD
Co-Author(s): Jean-Luc Febbraro MD*, Sheila Bissonnette, Carla M Service MHA RN**
Purpose: To compare refractive outcomes after multifocal IOL implantation with intraoperative aberrometry with and without streaming refractive data (ORA with VerifEye and ORA, respectively). Methods: Data from multiple sites were compared, including 1971 cases with standard intraoperative aberrometry and 1267 cases using aberrometry with streaming refractive data. Results: The mean absolute value of prediction error was 0.3 ± 0.27 D for standard aberrometry and 0.28 ± 0.24 D for aberrometry with streaming data (P < .03). The percentage of eyes ≤ 0.5 D was 83% in the standard aberrometry group vs. 85% in the streaming data group. Conclusion: Intraoperative aberrometry with streaming refractive data yielded better refractive results than standard aberrometry.
Scientific Poster 27 The Visual Outcomes and Safety Profile of Scleral-Fixated IOLs Using Gore-Tex Suture Presenting Author: Omesh P Gupta MD Co-Author(s): Ryan G Smith, Brandon Ayres MD*, Marc J Spirn MD, Irving M Raber MD* Purpose: To evaluate the visual outcomes and intraoperative and postoperative complications of Gore-Tex scleral-fixated IOLs. Methods: A retrospective, consecutive series. Results: The study criteria were met by 114 eyes. The mean follow-up was 1.51 years. The mean Snellen visual acuity improved from 20/490 to 20/85 (P < .05). There were 2 cases (1.8%) of ciliary body hemorrhage. Postoperatively, the complications included hypotony (8.8%), hyphema (3.5%), persistent corneal edema (0.8%), vitreous hemorrhage (4.4%), choroidal detachment (0.8%), and epiretinal membrane (0.8%). Endophthalmitis, prolonged inflammation, erosion, or breakage were not observed. Conclusion: Gore-Tex scleral-fixated IOL implantation is a valuable technique in selected cases. The visual outcomes and safety profile are similar to those of other surgical approaches.
Scientific Poster 28 Sutureless Intrascleral Fixation of Posterior Chamber IOL: Simpler Technique and 1-Year Follow-up Presenting Author: Takahiro Kawaji
Scientific Posters
Co-Author(s): Mikiko Fukushima MD PhD, Hidenobu Tanihara MD PhD** Purpose: To report the results of sutureless scleral fixation of posterior chamber IOL using our new, simpler technique. Methods: Forty-three eyes of 42 patients who underwent sutureless intrascleral fixation of IOL for at least 1-year follow-up periods were included in this study. A 25-gauge microvitreoretinal knife was used to create a sclerotomy and a limbus-parallel scleral tunnel in which the haptics were fixed. Results: The median followup was 17 months. The IOLs were fixed and well centered. The postoperative complications included iris capture in 2 eyes, cystoid macular edema in 3 eyes, and no IOL dislocation. Conclusion: Our simpler and safe technique for intrascleral fixation of IOLs may improve the long-term stability without sutures.
Scientific Poster 29 A Novel Device and Technique for Scleral Fixation of an IOL Presenting Author: Michael Erlanger MD Co-Author(s): Jeffrey L Olson MD* Purpose: To describe a novel device and technique to achieve scleral fixation of an IOL. Methods: The device and technique were tested in the laboratory setting. Results: The device, which consists of a double-armed 10-0 prolene needle with a preformed cow hitch with a silicone bolster, is injected with a 25-gauge injector through the pars plana. The IOL haptic is threaded through the preformed cow hitch and the knot is tightened around the haptic. Each of the 2 needles is used to take a scleral bite while externalizing the needles through the sclerotomy, achieving a buried knot and sclerotomy closure. Conclusion:This novel device and technique may simplify the complex process of achieving a secure and sutured scleral-fixated IOL.
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Presenting Author: Hamza N Khan MD FACS*
Purpose: To compare the operational efficiency of cataract surgery after process changes were undertaken to improve patient value and reduce “wastes” using LEAN redesign methods. Methods: We tracked 2 consecutive series of cataract patients (N = 62) through their OR journey with a LEAN redesign of the process. A multidisciplinary team developed recommendations to reduce waste and time through delivery of care. Pre- and postimplementation measures included total duration of stay, OR transit time, and patient satisfaction surveys. Results: Redesign led to a reduction of total patient journey (208 vs. 70 mins; P < .001) and improved satisfaction scores. Mean surgical room transit was unchanged (29 ± 5 min). Conclusion: Use of LEAN redesign to reduce unnecessary steps and time can improve efficiency and satisfaction in the cataract OR.
SESSION TWO, MONDAY AND TUESDAY Scientific Poster 299 SOE Agreement Between Verion and Other Keratometers for Astigmatism Assessment Presenting Author: Juan Gros-Otero Co-Author(s): Jorge Luis Garcia-Perez, Francisco J Hurtado Cena MD**, Gema Bolivar de Miguel MD, Laureano Rementeria PhD Purpose: Accurate assessment of corneal astigmatism plays a significant role in the refractive outcome of cataract surgery. The aim of this study is to compare the new Verion keratometer to other well-known older keratometers. Methods: A retrospective study was performed that includes the first 60 eyes in which Verion was used in our clinic. Keratometric readings were compared to those obtained with IOL Master and Oculyzer or Orbscan. Results: Intraclass correlation coefficient for the steep meridian was 0.958 (P < 0.0005) between Verion and IOL Master, 0.950 (P < 0.0005) between Verion and Oculyzer and 0.910 (P < 0.0005) between Verion and Orbscan. Conclusion: The keratometric measurements showed a very high agreement when measured by Verion and the other keratometers studied.
Scientific Poster 300 Topographic Impact of Femtosecond Laser-Assisted Arcuate Keratotomy Prior to Incision Opening Presenting Author: Sachin Jain MD Co-Author(s): Joshua H Hou MD, Maria S Cortina MD, Jose J de la Cruz Napoli MD* Purpose: To determine the topographic impact of unopened femtosecond laser-assisted arcuate keratotomy (FLAAK). Methods: Retrospective review of patients who underwent FLAAK from October 2012 to February 2014 at a single institution. Patients were excluded if pre- or postoperative topographies were unavailable. Astigmatic calculator and topographic SimK were used to determine arcuate keratomy (AK) position and arc length. Results: In the 23 patients included, average preop astigmatism was 1.4 D (range, 0.3–2.6 D). Anterior and posterior corneal astigmatism decreased by a mean of 0.065 D (standard deviation [SD], 0.68) and 0.030 D (SD, 0.17), respectively. Conclusion: Corneal astigmatism was minimally decreased by unopened FLAAK. Placement of AK wounds at the time of cataract surgery allows for the option of future astigmatism titration while having minimal effect at the time of placement.
Scientific Poster 301 Evaluation of Visual Outcomes Following Artisan Lens Implantation in Complicated Cataract Surgery Presenting Author: Hossein Mohammad Rabie MD** Co-Author(s): Ahmad Shojaei-Baghini MD, Hamid Norouzi**, Kourosh Sheibani Purpose: To determine the visual outcome in eyes undergoing primary aphakic artisan lens implantation due to complicated cataract surgery. Methods: Forty eyes were examined preoperatively and one day, one week, and one, three, and six months following surgery. Patients were followed up for at least six months. Results: At final follow-up, 81.8% of eyes experienced an improvement in best spectacle-corrected visual acuity (BSCVA) compared with that measured preoperatively, 9.1% of eyes matched their preoperative BSCVA and 9.1% of eyes experienced a decline in BSCVA compared with that measured preop-
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters eratively. Conclusion: This study suggests that despite the probable complications after primary artisan aphakia lens implantation, these lenses are beneficial to improve visual outcome in aphakic eyes undergoing complicated surgery.
Scientific Poster 302 Treatment Outcomes for Pseudophakic Negative Dysphotopsia Presenting Author: Jewel L Sandy MD Purpose: To evaluate the benefit of various treatment modalities to address pseudophakic negative dysphotopsia. Methods: Data of patients with pseudophakic negative dysphotopsia treated with either Nd:YAG laser anterior capsulectomy or IOL exchange were reviewed retrospectively. Primary outcome was partial or complete resolution of negative dysphotopsia symptoms six months postoperatively. Results: Fifteen eyes with negative dysphotopsia were treated. Seven of nine eyes treated with Nd:YAG laser anterior capsulectomy and two of six eyes treated with IOL exchange had partial or complete resolution of symptoms by six months. Conclusion: Modification of the anterior capsule-IOL relationship is important for the resolution of negative dysphotopsia symptoms. No one treatment method yielded consistent results, suggesting a multifactorial etiology.
Scientific Poster 303 The Effect of OMS302 on Pupil Diameter in Patients With Diabetes Mellitus During IOL Replacement Presenting Author: Alan S Crandall MD* Co-Author(s): David R Hardten MD*, David Schaaf MD*, Eric D Donnenfeld MD* Purpose: OMS302, a new drug product containing phenylephrine and ketorolac, is added to irrigation fluid during IOL replacement . This analysis evaluated the effect of OMS302 on intraoperative pupil diameter in patients with diabetes mellitus (DM) in a high-risk population. Methods: Patients with DM across three clinical trials were included in the analysis. Pupil diameter was measured every minute during the procedure and analyzed as the mean area under the curve of the change from baseline. Results: In the 184 patients with DM, placebo patients experienced more pupil constriction than OMS302 patients (P < 0.0001). Adverse events were comparable between placebo and OMS302 patients. Conclusion: In these studies, OMS302 improved intraoperative pupil management and was well tolerated in a population with DM, a group prone to intraoperative miosis.
Scientific Poster 304 Lenticular Changes in Congenital Iridolenticular Choroidal Coloboma Presenting Author: Muralidhar Ramappa MBBS Co-Author(s): Ashik Mohamed MBBS, Sunita Chaurasia MD, Virender S Sangwan MBBS, Subhadra Jalali MS
Scientific Poster 306 Practice Eyes for Wet Lab Training in the Use of Iris Hooks, Capsule Support Hooks, and Insertion of Capsular Tension Ring and Pupil Dilating Ring Presenting Author: Satish C Gupta MBBS MS Purpose: To present the method of use of the dummy eyes for wet lab training in the use of iris hooks and capsule hooks and the insertion of a pupil expander and capsular tension ring (CTR). Methods: The dummy eye consists of a flexible transparent cornea fixed in a plastic casing and mounted on a stand for stability. Iris module consists of a flexible iris with a central 3-mm pupil. Capsule module has a capsular bag with a 5-mm capsulorhexis and subluxation in one quadrant. Results: The trainee gets to practice steps needed for insertion of the hooks ó pulling the iris/capsule and locking the stopper in place ó and insertion and placement of the pupil expander and CTR Conclusion: The dummy eyes give a very good opportunity for the beginners to practice the use of iris hooks and capsule hooks and insertion of a pupil expander and CTR in a wet lab setting.
Scientific Poster 307 SOE Comparison of Femtosecond Laser Cataract Surgery With the Manual Procedure in a Contralateral Comparative Study Presenting Author: Gerd U Auffarth MD* Co-Author(s): Ramin Khoramnia MD*, Anna Fitting MS**, Mary Attia MBBCH*, Florian Niklas Auerbach MD, Mike P Holzer MD* Purpose: To compare femtosecond laser cataract surgery with conventional surgery. Methods: In a prospective, contralateral, comparative, randomized, single-center study, capsulotomy and lens fragmentation is performed with the Victus Femtosecond Laser (Bausch & Lomb/Technolas) in one eye of each patient. In the fellow eye, the manual technique is used. Main outcome parameter included effective phacoemulsification time (EPT), absolute phacoemulsification time (APT), and endothelial cell loss. Results: Median EPT was significantly lower in the laser group (1.06 vs. 2.21 seconds). No statistically significant difference between both groups was found in terms of APT (7.70 vs. 13.71 seconds). Lower endothelial cell loss was seen in the laser group. Conclusion: Femtosecond laser cataract surgery reduces EPT significantly, with more precise and centered capsulotomies and less endothelial cell loss.
Scientific Poster 308 Femtosecond Laser-Assisted Cataract Surgery in the Presence of Corneal Opacity Presenting Author: Safaa Ibrahim Beheiri Co-Author(s): William May MD** Purpose: In Saudi Arabia, corneal opacity is present in one-half of cataract surgery patients. We evaluated the ability of the femtosecond laser to make incisions through opaque corneas. Methods: We developed a scale to grade corneal opacities. The corneal opacity grading scale grades the opacity in terms of the observer’s ability to recognize iris details from one to three. After grading opacity, the default settings of the Alcon LensEx were used in eight consecutive cataract surgery patients with corneal opacity. Results: In all patients with peripheral corneal opacity, the primary incision was successful. Three of these patients had complete opacity. Four cases had central corneal opacity. All had complete capsulorhexis. Conclusion: Even patients with complete corneal opacity may be candidates for femtosecond laser-assisted cataract surgery.
Scientific Poster 305 SOE Opacification of Hydrophilic Acrylic IOLs After Vitreoretinal Surgery Presenting Author: Jose Juan Martinez Toldos MD
Scientific Poster 309 Laser Capsulotomy With the LensAR Laser Is as Effective as Manual Continuous Capsulorrhexis in Supracapsular Cataract Surgery
Co-Author(s): Aida Navarro-Navarro MBBS, Cristian Fernandez MD, Fernando Hernandez-Artola MD, Javier Clavel Laria MD
Presenting Author: William J Lahners MD* Co-Author(s): William L Soscia MD**
Purpose: To describe four cases of secondary optic lens opacification in hydrophilic IOLs after vitreoretinal surgery. Methods: Decreased vision with central optic lens opacification was observed in all cases. Surgical extraction of the IOL was performed with implantation of a new hydrophobic lens. The explanted lens was examined using electron microscopy and spectrometry. Results: In all cases, central optic lens opacification with calcium deposits was confirmed in patients who underwent several surgeries after IOL implantation due to vitreoretinal diseases. Conclusion: We describe a rare complication where hydrophilic lenses can suffer central opacification when the patient is subjected to several complex interventions with a significant inflammatory process.
Purpose: To determine if laser capsulotomy with the LensAR laser is as effective as manual continuous capsulorrhexis in supracapsular surgery. Methods: We performed 1,195 cases of LensAR-assisted laser cataract surgery and 862 cases of matched controls manually. In all cases, the lens was hydrodissected into the iris plane. Results: There was one anterior capsular tear without vitreous loss with LensAR and one anterior capsular tear without vitreous loss with manual. One capsule complication was seen in 1,195 consecutive LensAR capsulotomy cases and one capsule complication in the 862 manual cases (P = 0.320). Conclusion: There was no difference in capsular complications between LensAR and manual techniques. There was no clinically significant difference in the strength of the capsulotomy in LensAR-assisted cataract surgery versus manual.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To evaluate lenticular changes in congenital iridolenticular retinochoroidal coloboma. Methods: Medical records of patients (n = 98; median age, 23 years; approximately 1:1 male to female) with this diagnosis (48% bilateral) seen at a tertiary eye care center in 2011 to 2012 were reviewed retrospectively. Results: Lens showed cataract in 68 eyes (48.9%), one-half (51%) being nuclear sclerosis. A distinct type named “coloboma cataract” (characterized by linear opacity in the region of coloboma) was seen in 29%. Disc and/or macular involvement in 57 eyes (39.3%) did not influence the type or density of cataract (P > 0.05). Conclusion: A distinct description with nomenclature “coloboma cataract” is suggested to be considered in clinical grading of cataract in such conditions associated with early cataractous changes.
Scientific Posters Scientific Poster 311 SOE Accommodation Amplitude and Visual Acuity of the Accommodative IOL, the AkkoLens Lumina
Scientific Poster 315 Cataract Surgery Practice and Endophthalmitis Prophylaxis in Australia
Presenting Author: Jorge L Alio MD PhD*
Presenting Author: Jonathon Q Ng MBBS*
Co-Author(s): Ana Belen Plaza MS**, Alfredo Vega-Estrada MD, Alexander Angelov Angelov MD, Yavor Petrov Angelov MS
Co-Author(s): Max Bulsara**, Nigel Morlet MBBS
Purpose: To compare the accommodation response and visual acuity of the Akkolens Lumina with a monofocal IOL. Methods: Two groups of eyes are differentiated: group A, 18 eyes implanted with the accommodative Akkolens Lumina IOL and Group B, eight eyes implanted with the monofocal Acrysof SA60AT. Main outcomes measures were near visual acuity, defocus curve, contrast sensitivity, and objective accommodation. Results: Postoperatively better uncorrected near visual acuity and distance-corrected near visual acuity were found for group A (P ≤ 0.01). In the defocus curve, significant better visual acuities were observed for group A (P ≤ 0.02). No statistical differences were detected between groups in contrast sensitivity (P ≥ 0.28). Conclusion: The Akkolens Lumina restores the visual function with good near visual acuity due to the accommodation provided.
Scientific Poster 312 Pseudophakic Dysphotopsia
Scientific Poster 316 Analysis of Higher-Order Aberrations After Intrascleral Fixation of Posterior IOLs
Presenting Author: Robert Dale Pilkinton Jr MD
Presenting Author: Kenji Yamamoto MD PhD
Purpose: To evaluate the occurrence of negative and positive dysphotopsia between a larger ovoid monofocal IOL and other monofocal IOLs. Methods: A dysphotopsia questionnaire was given to patients at two to three weeks postop over a two-month period. This standard questionnaire measures the presence and severity of both positive and negative dysphotopsia. Results: The most common lenses implanted were the AMO Z9002, a 6-mm silicone three-piece lens, the Softec HD, a 6-mm hydrophilic acrylic one-piece lens, and the Softec HDO, a 6.5- by 5.75-mm oval hydrophilic acrylic one-piece lens. The incidence of negative dysphotopsia was 30.4%, 25%, and 1.9%. The incidence of halo was 13%, 29%, and 13.4%. The incidence of streaks was 15.9%, 39.5%, and 17.3%. Lastly, the incidence of unwanted images was 1.4%, 12.5%, and 3.8%. Conclusion: Negative dysphotopsia was greatly reduced in the Softec HDO.
Co-Author(s): , Akira Murakami MD, Tetsuro Oshika MD
Scientific Poster 313 Visual and Optical Performance With a Small-Aperture IOL
Scientific Poster 317 H Orthopedic Benefits of Visual Restoration Measured With Cataract and Simulated Patients
Presenting Author: Robert Edward T Ang MD*
Scientific Posters
Purpose: To determine current cataract surgery practice in Australia. Methods: Australian ophthalmologists were surveyed about their cataract surgery practices and methods of chemoprophylaxis. Results: The 407 respondents reported 118,170 cataract operations. Self-reported postoperative endophthalmitis incidence (0.01%) decreased five-fold compared with a 2003 survey. Phacoemulsification was predominant (96%) with femtosecond laser-assisted cataract surgery comprising 3% of operations. Almost 70% of operations were under anesthetic block (43.5% peribulbar, 21.3% subtenons, and 5% retrobulbar), with temporal corneal wounds most popular. Intracameral antibiotic use increased from 5% of surgeons in 2003 to 78%. Conclusion: The reduction in postoperative endophthalmitis may be related to the marked uptake in use of intracameral antibiotics.
Purpose: Previous studies have reported a correlation between intraocular coma-like aberrations and the amount of tilt of IOLs. We compared intraocular coma aberrations after standard cataract surgery (in-the-bag group), intrascleral IOL haptics fixation (intrascleral fixation group), and conventional transscleral suture fixation of the IOL (suture group). Methods: Aberration was measured with a wavefront sensor in 25, 26, and 20 eyes, respectively. Results: Mean aberration was 0.11 ± 0.08, 0.13 ± 0.07, and 0.21 ± 0.11 µm, respectively. Values were significantly larger in the suture group than the other groups (P < 0.01, Scheffe’s F test). Conclusion: Intrascleral haptic fixation technique allows smaller IOL tilt, resulting in better optical outcomes after surgery.
Co-Author(s): Gunther Grabner MD*
Presenting Author: Masahiko Ayaki MD
Purpose: To evaluate visual performance of patients implanted monocularly with a small aperture hydrophobic IOL (HP-SA-IOL). Methods: Prospective, nonrandomized study of cataract patients who were implanted monocularly with a single-piece hydrophobic acrylic IOL with a centrally located opaque annular mask measuring 3.23 mm in total diameter with a 1.36-mm central aperture. Visual acuity was evaluated at six months. Results: At six months, mean binocular uncorrected distance visual acuity (UCDVA) and uncorrected intermediate visual acuity (UCIVA) were 20/20. Mean uncorrected near visual acuity (UCNVA) was 20/25. Additionally, 100%, 82%, and 91% of patients achieved 20/25 or better for UCDVA, UCIVA, and UCNVA, respectively. Conclusion: Early results demonstrate monocular HP-SA-IOL implantation provides a continuous, broad range of vision and excellent acuity across all focal distances.
Co-Author(s): Kazuno Negishi MD, Kazuo Tsubota MD* Purpose: To measure and simulate improvement of mobility after cataract surgery. Methods: The participants included 223 cataract patients (mean age, 74 years) and 197 subjects with normal vision. Four-meter gait speed was measured. Three-dimensional motion analysis with eight-camera capture system was performed for 11 simulated patients with impaired vision to 20/2000, hand motion, or no light perception. Results: Mean gait speed was 0.86 ± 0.18 m/s before surgery, 0.96 ± 0.23 m/s two months after surgery, 0.98 ± 0.24 m/s seven months after surgery, and 0.88 ± 0.23 m/sec for controls. Gait speed increased significantly for seven months after surgery (P < 0.05, t-test). The results of gait speed and one leg standing of simulated patients were closely correlated with vision. Conclusion: Visual restoration may be beneficial to maintain postural control.
Scientific Poster 314 SOE Results of 6 Years’ Experience With Plate TorsionHaptic IOLs
Scientific Poster 318 Transconjunctival Sutureless Needle-Guided Intrascleral IOL Fixation
Presenting Author: Sergey Kuznetsov MD*
Presenting Author: Shin Yamane MD
Co-Author(s): Timur Galeev**, Andrey Zolotarev**
Co-Author(s): Maiko Inoue MD, Akira Arakawa MD, Kazuaki Kadonosono MD
Purpose: Clinical study of six-year results of implantation of plate torsion-haptic IOL (PTHIOL; open-bag device) in patients with age cataract. Methods: PTHIOL by Reper-NN were used in 207 eyes of 175 patients with age cataract during a routine phaco through 2.2-mm incision. PTHIOL position was monitored by ultrasound biomicroscopy (UBM) in follow-up from six months to six years (4.14 ± 1.51 years). Results: Visual acuity was at mean 0.72 ± 0.15. Correct and stable PTHIOL position was proved by UBM. In studied group, the parameters of the capsular bag with implanted PTHIOL did not significantly differ from those of the native lens. Refractive error was less than 1.0 D in 95.65% of all cases. Secondary cataract was observed in five cases (2.42%) of follow-up. Conclusion: The study shows that PTHIOL really can restore eye anatomic parameters and decrease a number of secondary cataracts.
Purpose: To report clinical and experimental outcomes of a new technique for intrascleral fixation of an IOL. Methods: Two angled incisions parallel to the limbus were made by 30-G needles. Haptics of an IOL were externalized with the needles and cauterized. The cauterized haptics were pushed back and fixed into the scleral incisions. Strength of the haptic fixation was evaluated using porcine eyes. Results: Thirty eyes of 30 patients underwent this surgery. The mean IOL tilt was 3.2 degrees. The mean best-corrected visual acuity was improved from 0.38 to 0.70 (P = 0.03). The force to pull out cauterized haptic from porcine sclera was over 0.8 N . Conclusion: This simple technique provides good functional and anatomical outcomes and solid IOL fixation.
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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 319 H Randomized Controlled Trial of the Efficacy of PovidoneIodine in Reducing Bacterial Load Prior to Cataract Surgery when Premedicated With Gel vs. Drops
Scientific Poster 323 Comparison of Predicted Vault on Ultrasound Biomicroscopy and Postoperative Vault on Anterior Segment OCT in Patients with Implantable Collamer Lens
Presenting Author: Joshua C Teichman MD
Presenting Author: Vishal Arora MD
Co-Author(s): Michael Ying Kit Mak, Nina Ahuja MD, Dalia M Eino MD**,Varun Chaudhary MD**
Co-Author(s): Mathew Kurian MD MBBS, Shama Chandrashekhar Shaligram Sr, Rohit Shetty MD MBBS
Purpose: Laboratory studies suggest that the antiseptic effect of povidone-iodine may be inhibited by application of gels to the eye. The purpose of this study is to elucidate if this is seen clinically. Methods: Randomized controlled trial. Patients were randomized to medications in gel versus liquid form. The skin and eye were cleansed with povidoneiodine. The conjunctiva was swabbed and plated. Colony forming units (CFU) were read by masked readers. Results: For this trial, 104 eyes were included. Prerandomization, there were no differences in CFU between the groups (P = 0.3197). Post-povidone-iodine, mean CFU was 0.019 in both groups. Linear regression revealed no significant difference between the groups on blood or chocolate agar (P = 0.989 for both). Conclusion: There were no significant differences in CFU after gel or liquid premedication.
Purpose: To compare predicted vault with ultrasound biomicroscopy (UBM) and postoperative vault on anterior segment optical coherence tomography (ASOCT) in patients with implantable collamer lenses (ICLs). Methods: Preoperative ASOCT and UBM were done for 23 patients who underwent ICL implantation. Predicted vault from UBM was calculated and compared with postoperative vault on ASOCT. Results: Mean age was 25.09 ± 3.46 years, with mean spherical equivalent of -11.73 ± 5.51 D. Preop anterior chamber depth was comparable on UBM and ASOCT (P = 0.86). Postop vault (0.57 ± 0.14 mm) on ASOCT was comparable to predicted vault (0.66 ± 0.21 mm) on UBM (P = 0.06). Two patients needed resizing of ICL on the basis of preop UBM. Conclusion: UBM can be used to predict postop vault in patients undergoing ICL implantation.
Scientific Poster 320 Risk Factors for Phacoemulsification-Related Endophthalmitis, Other Than Prophylaxis
Scientific Poster 324 Macular Edema Following Intravitreal Triamcinolone as an Alternative to Postcataract Anti-inflammatory Drops
Presenting Author: Lisa Herrinton PhD*
Presenting Author: James S Lewis MD*
Co-Author(s): William J Chang MD
Purpose: To investigate postcataract macula thickness when intravitreal triamcinolone is used in lieu of topical steroids and nonsteroidal anti-inflammatory drugs (NSAIDs). Methods: Two hundred consecutive cataract patients were followed with OCT assessment preoperatively and one day, one week, one month, and two months following uncomplicated surgery. Transzonular injection of 0.2 cc of a compounded medication containing triamcinolone acetonide was performed at the end of each case. Macula scans were performed at the intervals described. Results: Macula thickness was not statistically different from those reported in the literature for patients treated with topical steroids and NSAIDS. Conclusion: Transzonular triamcinolone matches topical anti-inflammatory drops in control of OCT-detectible postcataract macular edema.
Purpose: To examine risk factors for endophthalmitis other than prophylactic antibiotic. Methods: Retrospective cohort study of 150,086 Kaiser Permanente members, from 2005 to 2012. Endophthalmitis (118) was confirmed with chart review. Logistic regression analysis evaluated age, year of surgery, comorbidity, and posterior capsular rupture (PCR) after accounting for prophylaxis and surgeon. Results: Risk of endophthalmitis declined 6% with each calendar year (CI, 5%–7%) and increased by a factor of 1.76 (CI, 1.15–2.70) with ocular comorbidity and by a factor of 3.9 (CI, 1.5–9.8) with PCR. Age (OR, 1.0; CI, 0.98–1.03) and systemic comorbidity (OR, 1.02; CI, 0.82–1.13) were not related to endophthalmitis. Conclusion: PCR remains a target for quality improvement.
Scientific Poster 321 SOE Assessing the Imaging Quality of Different Multifocal IOLs With Different Optics Presenting Author: Gerd U Auffarth MD* Co-Author(s): Tamer Tandogan MD**, Ramin Khoramnia MD*, Florian T A Kretz MD*
Scientific Poster 325 Systemic Pharmacokinetics of Phenylephrine / Ketorolac Irrigating Solution During IOL Replacement Procedures Presenting Author: John A Hovanesian MD* Co-Author(s): Mitchell Jackson MD*, Johnny L Gayton MD* Purpose: OMS302, a new combination of phenylephrine (PE) and ketorolac (KE), is added to irrigation fluid used during an IOL replacement procedure (ILR). This study’s purpose was to assess systemic exposure of KE and PE. Methods: In a Phase 3 trial of subjects undergoing ILR, plasma concentrations of PE and KE were measured prior to surgery and at 15, 30, 60, 120, 240, 480, and 1,440 minutes following the start of study drug administration. Results: Twenty-six subjects (14 OMS302) entered this PK study; only one had detectable PE levels, and the highest level preceded OMS302 administration, most likely due to preoperative drops. Ten subjects had detectable levels of KE, the highest of which was lower than the range reported for topical KE drops. Conclusion: OMS302 administration during ILR resulted in minimal to no systemic exposure to PE or KE.
Scientific Poster 322 Visual Results and Patient Satisfaction: Trifocal Diffractive vs. Bifocal Diffractive IOLs
Scientific Poster 326 SOE A Novel Iridoplasty Suture Technique to Repair Iris Defects and Traumatic Mydriasis
Presenting Author: Luis Izquierdo Jr MD Co-Author(s): Maria A Henriquez MD, Mauricio Rodriguez Sr** Purpose: To evaluate visual outcomes after cataract surgery with trifocal diffractive IOL and bifocal diffractive IOL. Methods: A prospective, comparative study included 30 patients with bilateral Tecnis ZBM00 and 30 patients with bilateral FineVision (Physiol) IOL between September 2012 and November 2013. At three months, postoperative near, intermediate, and distance visual acuities, defocus curve, and patient satisfaction were compared. Results: There was no statistically significant difference between the groups in uncorrected distance, intermediate, and near visual acuity (P > 0.05, all). The range of focus in intermediate vision was larger in the trifocal group (P < 0.001, all). Conclusion: Both IOLs showed excellent near and distance visual acuity. The trifocal IOL showed larger range of focus in intermediate vision.
Presenting Author: Levent Veysel Karabas MD Co-Author(s): Ozlem Sahin MD**, Sengul C Ozdek MD* Purpose: To describe a new U-shaped iridoplasty suture technique. Methods: Two 0.9mm corneal incisons were created. An Alcon PC-9 needle was used. One of the suture loops was cut close to its needle insertion. The needle was inserted through the first incision, passed through iris leaflets, and externalized through the other side, and the needle was reinserted, passed through the iris again to create an U-shaped suture, and taken out from the initial incision. Modified Siepser technique was performed to secure the suture, or, alternatively, suture ends were pulled out by a 23-G forceps and tied, and the knot was inserted and secured by using an IOL manipulator. Results: Satisfactory aesthetic and functional results were achieved in all cases. Conclusion: U-shape suture is an easy-to-use, effective, and safe iridoplasty technique.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To assess optical quality for different multifocal IOLs (MIOLs). Methods: Optical bench analysis (OptiSpheric IOL, Trioptics) was performed for Mplus LS-313 MF30, Oculentis; M-Flex 630F, Rayner; AcriLisa 809M, Carl Zeiss Meditech; Restor SN6AD1, Alcon; and Tecnis ZMB00, AMO. Analyzed parameters included MTF , TFS, EFL, Autofocus, and USAF. Results: Distance sagittal MTF values were as follows: M-Flex = 0.119; Mplus = 0.161; Restor = 0.194; AcriLisa = 0.153; and Tecnis = 0.163. Energy loss with a 4-mm apperture was, respectively, 7% (Mplus), 14% (M-Flex), 19% (AcriLisa), 22% (Restore), and 22% (Tecnis). Conclusion: Energy loss was significantly lower in asymmetric, segmental the MIOL compared with the other symmetric refractive or diffractive models.
Scientific Posters Scientific Poster 327 Evaluation of Wound Closure Techniques in Large Clear Corneal Incisions Presenting Author: Rajesh K Rajpal MD* Co-Author(s): John A Hovanesian MD*, John F Doane MD*, Farrell Tyson II MD**, Josef Tamory, Sachin D Rajpal MS Purpose: To evaluate sutures versus an ocular sealant for wound closure in 3.0- to 3.5-mm incisions. Methods: Cataract patients with a demonstrated wound leak were randomized to a 10-0 nylon suture or the ReSure Sealant in a prospective multicenter study. Up to 1-oz force was applied using an ocular force gauge intraoperatively to assess fluid egress pre- and postrandomization. Results: Sixty-four patients were evaluated at nine U.S. clinical sites. Patients randomized to suture (26) experienced a leak rate of 38.5% versus the sealant (38) at 2.6%. Device-related adverse event rates were 26.9% for suture and 0.0% for sealant patients. Conclusion: Incisions may require enlargement during surgery due to type of IOL, etc. The sealant demonstrated more effective wound closure than sutures with fewer adverse events.
Computers, Information Technology
Scientific Posters
SESSION TWO, MONDAY AND TUESDAY
Cornea, External Disease SESSION ONE, SATURDAY & SUNDAY Scientific Poster 31 Confocal Scan Study of Corneal Grafts Following Descemeton vs. Descemet-off Deep Anterior Lamellar Keratoplasty Presenting Author: Hamidreza Hasani MD Co-Author(s): Sepehr Feizi, MohamadAli Zare Mehrjerdi MD**, Roghiyeh Shamsoddinimotlagh MD, Shahin Yazdani MD Purpose: To compare the confocal features of grafts following big-bubble deep anterior lamellar keratoplasty using a donor without Descemet membrane (DM) to those of grafts from a donor with intact DM. Methods: Of 45 keratoconic eyes, 27 received DM-free donor tissue (Group 1), and 18 received donor tissue with an intact DM (Group 2). A group of normal eyes (n = 28, Group 3) served as controls. Confocal scan was used to determine keratocyte density, explore the donor-recipient interface, and evaluate endothelial cell density and morphology. Results: Significantly more severe interface haziness was observed when donor DM was retained (mean interface reflectivity value of 102.7 ± 2 vs. 161.7 ± 3 light reflectance units in Groups 1 and 2, respectively; P < .001). Conclusion: Graft cellular profiles and healing response at the donor-recipient interface can be profoundly affected, depending on DM removal or retention.
Scientific Poster 328 Design and Rapid Prototyping of a Novel 3-D Printed Smartphone Lens Adapter System
Scientific Poster 32 Descemet-on vs. Descemet-off Deep Anterior Lamellar Keratoplasty: Does It Make a Difference?
Presenting Author: David Myung MD*
Presenting Author: Hamidreza Hasani MD
Co-Author(s): Alexandre Jais MS, Lingmin He MD*, Mark S Blumenkranz MD*, Robert T Chang MD*
Co-Author(s): MohamadAli Zare Mehrjerdi MD**, Sepehr Feizi, Roghiyeh Shamsoddinimotlagh MD
Purpose: To develop a modular 3D-printed smartphone lens adapter system for both anterior and posterior segment imaging. Methods: A computer-aided design model of the adapter system was rendered and initially printed at the Stanford Product Realization Laboratory using a Multi-Jet Modeling 3D Printer. Subsequent adapters were printed out of black, laser-sintered polyamide material with higher print quality. Results: The adapter system captured high-quality anterior and posterior segment photographs. Fundus photographs taken with the adapter provided a wider field of view compared to those taken with the Welch Allyn iExaminer. Conclusion: A novel 3D-printed lens adapter system has been developed that enables high quality images of the eye using smartphones and may lower the barrier to mobile teleophthalmology.
Purpose: To determine the effect of retained donor Descemet membranes on visual outcomes, contrast sensitivity (CS), higher-order aberrations (HOA), and central graft thickness after deep anterior lamellar keratoplasty (DALK) using the big-bubble technique. Methods: A donor cornea without DM (Group 1; 48 eyes) or with DM (Group 2; 22 eyes) was sutured to the recipient bed. Results: The postoperative BSCVA was 0.18 logMAR and 0.24 logMAR, respectively(P = .36). The 2 groups had comparable postoperative keratometric astigmatism, spherical equivalent refraction, and HOAs. In terms of CS, however, Group 1 demonstrated better results at a low spatial frequency. Conclusion: DALK performed using the big-bubble technique for keratoconus may give better results in terms of CS if a donor cornea without the DM is transplanted.
Scientific Poster 329 Web-Based Patient Referral System
Scientific Poster 33 SOE Limbal Stem Cell Transplantation in Congenital Aniridia
Presenting Author: Hussein Wafapoor MD* Co-Author(s): Alexander M Eaton MD* Purpose: To develop a Web-based patient referral portal, which would facilitate patient exchange between diferrent offices independent of the electronic health record system used. Methods: Initially, a prototype using HTML and static pages was developed. A Web-based system was created using ASP.NET, CSharp, and SQL servers. A secure Health Insurance Portability and Accountability Act-compliant testing environment with SSL was selected for hosting. Testing of 250 offices was performed for quality assurance (QA). Fictitious incoming and outgoing patients were created and referred. Once QA was completed, seven local ophthalmic/optometric pratices were signed up for live referrals. A warning email system was set up if a failure in scheduling was detected. Results: A total of 520 patients were referred electronically. Conclusion: We have created a Web-based referring system that may facilitate patient referral.
Presenting Author: Osman S Arslan MD Co-Author(s): Yonca A Akova MD*, Olgu Capar MD, Ceyhun Arici Sr MD, Mustafa Unal MD** Purpose: To present our outcomes of conjunctival-limbal allograft transplantation in congenital aniridia (CA) patients. Methods: Twelve eyes of 9 patients (5 male, 4 female) with CA were treated with allogeneic conjunctival-limbal transplantation (7 partial, 5 total). First-degree relatives with HLA-DRB1 compatibility were chosen as donors. Four eyes of 2 first-degree relatives were used as stem cell donors in 360-degree limbal stem cell deficiency cases. Results: Mean follow-up time was 38.7 ± 17.9 months. Age range was between 11 and 29 years. Eight (66.6%) achieved a stable ocular surface. Overall, the mean visual acuity improved from 20/1000 to 20/165. Conclusion: Limbal stem cell transplantation seems to be an effective method to provide sustainable ocular surface, although it needs long-term follow-up and strict medical attention.
Scientific Poster 34 Endothelial Cell Densities in Congenital Hereditary Endothelial Dystrophy Presenting Author: Ali A AlRajhi MD Purpose: To report endothelial cell densities (ECD) in congenital hereditary endothelial dystrophy (CHED). Methods: Fifteen patients (20 eyes) with a mean age of 7 years (range: 1-20), underwent pachymetry prior to surgery, specular microscopy (SM), and scanning electron microscopy (SEM) for corneal buttons of CHED eyes during penetrating keratoplasty. Results: Corneal thickness was 1147 µm (1060-1200) centrally and 1114 µm (987-1080) peripherally. Mean ECD by SM and SEM was 1690 (550-2650) and 1504 (640-2184) cen-
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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters trally and 1336 (550-2050) and 1511 (867-2084) peripherally, respectively. The Descemet membrane was covered by endothelium in 78%-84%. Conclusion: Corneal edema with adequate ECD could be due to dysfunctional endothelium.
was an increase in the apoptotic markers and a concurrent decrease in the proliferation markers in LECs exposed to A-CXL. Conclusion: The higher energy dosage delivered in the A-CXL procedure has a more severe adverse effect on the cultured LECs.
Scientific Poster 35 Intracorneal Scleral Patch-Supported Cyanoacrylate Application for Corneal Perforations Secondary to Rheumatoid Arthritis
Scientific Poster 39 SOE Corneal Collagen Crosslinking With Ionthophoresis Imbibition: Clinical and Morphological Results
Presenting Author: Ashok Sharma MD**
Co-Author(s): Roberta Calienno MD, Niccolo Salgari**, Mario Nubile MD, Leonardo Mastropasqua**
Co-Author(s): Verinder S Nirankari MD
Presenting Author: Manuela Lanzini MD PhD
Purpose: To evaluate results of intracorneal scleral patch (ICSP)-supported cyanoacrylate tissue adhesive (CTA) applications in corneal perforations greater than 3.0 mm secondary to rheumatoid arthritis (RA). Methods:Prospective, nonrandomized series included 14 eyes (age range: 34-72 years) with corneal perforations of 3.5-4.5 mm (mean: 3.9 mm) due to RA treated with ICSP-supported CTA application. Results: All 14 eyes (100%) healed with corneal opacity. No eyes developed infectious keratitis or wound leak requiring penetrating keratoplasty. Conclusion: ICSP-supported CTA application is an effective modality in treating corneal perforations (3.5-4.5 mm) with associated RA.
Purpose: To describe clinical and morphological results of collagen crosslinking (CXL) with iontophoresis. Methods: Thirty-five eyes with progressive keratoconus underwent CXL with iontophoresis imbibition and irradiation at 10 mW. Clinical, morphological, and biomechanical evaluation was performed preoperatively and at 1 hour, 1 day, 1 week, and 1, 3, 6, 9, and 12 months. Results: Stability of UCVA, BCVA, K1/2, and K-max was observed (P = ns). Confocal microscopy showed a superficial and transient epithelial damage. The deformation index improved at 1 month (P = .039) and remained stable. No significant changes were observed in anterior segment OCT. Conclusion: Iontophoresis in CXL is safe and effective to stabilize progressive keratoconus with minimal damage on corneal tissue.
Scientific Poster 36 Antibodies to Salivary Gland Protein 1 Parotid Secretory Protein and Carbonic Anhydrase VI in a Cohort of Patients With “Idiopathic” Xerophthalmia
Scientific Poster 40 Accelerated vs. Conventional Corneal Collagen Crosslinking in Progressive Keratoconus: Does Faster Work Better?
Presenting Author: Sandra L Everett MD Co-Author(s): Sahana Vishwanath MBBS, Lakshmanan Suresh MS, Kishore Malyavantham PhD* Purpose: Sjögren syndrome (SS) is an autoimmune disease presenting with dry eyes. Antibodies to SP1, PSP, and CA VI have recently been described as markers for early SS. Methods: A group of 64 patients were studied. Dry eyes was confirmed by Schirmer testing. Sera were evaluated for ANA, RF, Ro, La, anti-SP1, PSP, and CA VI. Results: Of the 64 patients, 12 expressed only antibodies to Ro and/or La, and 18 patients were Ro and La negative. Of the 18 Ro- and La-negative patients, 13 expressed antibodies to of SP1, PSP, and/or CA VI. Three expressed ANA and/or RF, and 5 did not express any autoantibodies. Conclusion: Many patients with “idiopathic” xerophthalmia have SS and express antibodies to SP1, PSP, and CA VI but not the commonly recognized autoantibodies including ANA, RF, Ro, and La, and this allows for early identification of SS.
Scientific Poster 37 Keratoconus in Children: Long-term Follow-up Presenting Author: Enrique Graue MD
Purpose: To determine visual outcomes and risk factors for progression in patients younger than 18 years old with keratoconus (KC). Methods: Retrospective chart review / case series in a 6-year period. We evaluated as risk factors for progression: age, allergic conjunctivitis, refraction, and KC grade. Results: We included 132 eyes of 79 patients; mean age, 13.6 years; median follow-up, 33.6 months (up to 71 months); 82.1% had allergic conjunctivitis and 40.2% showed progression. Progression was correlated with less than 13 years of age (RR 1.85) and greater severity of disease (RR 1.99). Conclusion: Progression occurred in 40.2% of children with KC; younger age and greater severity were associated with risk of progression.
Scientific Poster 38 Comparative Analysis of the Effect of Conventional and Accelerated Corneal Crosslinking on Ex Vivo Cultured Limbal Epithelial Cells Presenting Author: Harsha Nagaraja MS Co-Author(s): Rohit Shetty MD MBBS, Debashish Das PhD**, Ashwini Ranganath**, Himanshu P Matalia MBBS** Purpose: Accelerated corneal crosslinking (A-CXL) is becoming a treatment of choice for patients with keratoconus. As a procedural safety assessment we have compared the effects of conventional crosslinking (C-CXL) with those of the A-CXL procedure on cultured limbal epithelial cells (LECs). Methods: Cultured LECs were exposed to both C-CXL and A-CXL. The outcome was assayed using molecular biological and biochemical tools for proliferative, apoptotic, and regenerative markers. Results: The results showed that there
Co-Author(s): Mohammad Mehdi Sadoughi MD**, Roghiyeh Shamsoddinimotlagh MD Purpose: To compare outcomes of accelerated with those of conventional corneal crosslinking (CXL) in progressive keratoconus. Methods: Sixty eyes of 30 patients randomly received conventional CXL (3 mW/cm2 for 30 min) in one eye or accelerated CXL (18 mW/ cm2, 5 min) in the fellow eye. Results: Decrease in K-min and K-max were statistically significant in the accelerated CXL group (P = .02) and the conventional CXL group (P = .03). But there was no statistically significant difference in K-max change (P = .11), K-min change (P = .43), uncorrected distance visual acuity (P = .61), or corrected distance visual acuity (P = .52) between the 2 groups. The mean decrease of corneal hysteresis (P = .33), corneal resistance factor (P = .92), central corneal thickness (P = .061), and endothelial cell count (P = .08) was similar in both groups. Conclusion: Refractive and visual outcome, biomechanical and central corneal thickness changes, and endothelial cell loss were comparable in both accelerated and conventional CXL methods.
Scientific Poster 41 Collagen Crosslinking in Infectious Keratitis: Does Light Save the Sight? Presenting Author: Hamidreza Hasani MD Co-Author(s): Mohammad Mehdi Sadoughi MD**, Roghiyeh Shamsoddinimotlagh MD Purpose: To evaluate the effect of collagen crosslinking (CXL) in the management of infectious keratitis. Methods: Forty eyes (22 male and 18 female) with active bacterial, fungal, or Acanthamoebal keratitis after medical (20 eyes) or combined medical plus CXL treatment (20 eyes) were enrolled. Results: The infectious keratitis was associated with bacteria in 26 eyes (65%), with fungus in 9 eyes (22.5%), and with Acanthamoeba in 5 eyes (12.5%). The mean time of re-epithelialization after CXL was 15.41 ± 1.8 days in the CXL group vs. 17.23 ± 1 days in the control group (P = .04). Small infiltrations (≤ 3 mm) healed in 10.24 ± 1 days in the CXL group vs. 15.38 ± 1 days in the control group (P = .03). Conclusion: Compared to conventional medical therapy, combined medical and CXL accelerate corneal epithelialization. The smaller the lesion, the faster the healing time.
Scientific Poster 42 Sleep Position and Obstructive Sleep Apnea in Keratoconus Presenting Author: Natasha V Nayak MD Co-Author(s): Tenley N Bower MD, Leela V Raju MD, Amy Catherine Nau OD, Alex Mammen MD**, Roheena M Kamyar MD**, Deepinder K Dhaliwal MD* Purpose: To characterize sleep position and prevalence of obstructive sleep apnea (OSA) in patients with keratoconus (KCN). Methods: Telephone survey (Berlin questionnaire for OSA, sleep position) and retrospective chart review. Wilcoxon rank-sum test for analysis. Results: Fifty-six KCN patients (39.9 ± 14.1 years old; 66% males) were included. Six (11%) had prior OSA diagnosis; another 13 (23%) were at high risk for OSA. Supine/prone (n =17 [30%]) vs. lateral decubitus (n =39 [60%]) sleepers had lower interocular differences in Scheimpflug parameters: central corneal thickness, pachymetry at thinnest point, astigmatism, max keratometry, corneal toricity (P < .05 for each). Conclusion: Lateral decubitus sleep positions are associated with more asymmetric KCN.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Co-Author(s): Arturo J Ramirez-Miranda MD*, Andrew Olivo Payne, Alejandro Navas MD*, Jazmin Lucero Pedro-Aguilar MD, Aida Jimenez, Enrique O Graue Hernandez MD
Presenting Author: Hamidreza Hasani MD
Scientific Posters Scientific Poster 43 The Incidence of Tomographic Features of Keratoconus in Patients With Sleep Apnea Syndrome: A Prospective Randomized Double Masked Clinical Study
Scientific Poster 47 Pythium Insidiosum Keratitis: A Severe and Under-reported Fungal Infection
Presenting Author: Brent R Mittelstaedt DO
Co-Author(s): Swapna Reddy Motukupally**, Prashant Garg MD*, Praveen Kumar Balne, Varsha M Rathi DO
Co-Author(s): Matthew C Caldwell MD, Laura Rubinate MD, Vasudha A Panday MD, James R Townley MD, Douglas Apsey MS OD Purpose: To determine if a correlation exists between obstructive sleep apnea (OSA) and keratoconus (KCN). Methods: 150 patients undergoing routine sleep studies were evaluated by Pentacam. Eyes with a Belin and Ambrósio total deviation value (D) of 1.6 or greater were categorized as suspicious for KCN; and less than 1.6, as normal. The presence and severity of OSA was determined by the Apnea Hypopnea Index (AHI) and the Respiratory Distress Index (RDI). Results: Mean AHI separated by normal and suspicious keratoconus indices were 9.8 and 23.6 (P = .033). Mean RDI separated by normal and suspicious were 18.3 and 34.5 (P = .034). Conclusion: The presence of Pentacam tomographic features of KCN has a statistically significant positive correlation with the presence of OSA.
Scientific Poster 44 Photorefractive Keratectomy and Corneal Crosslinking in Keratoconus
Purpose: To describe clinicomicrobiological features of patients with Pythium insidiosum keratitis. Methods: Corneal scrapings were examined by microscopy and culture. Zoospore-based identification was confirmed by sequencing of ITS1-5.8S-ITS2 of rRNA gene. Results: Eight patients (7/8, farmers), with clinically fungal keratitis (mean age: 45 ± 6.2 years, M:F = 3:5), were seen between January and March of 2014. Vision was light perception in 5 with corneal infiltrate > 25 mm2 in 7/8. Characteristic features were seen in microscopy (7/8) and culture. Treated with natamycin, all patients worsened and required penetrating keratoplasty. Conclusion: P insidiosum causes severe keratitis that responds poorly to natamycin. Zoospore demonstration helps make a quick and reliable diagnosis.
Scientific Poster 48 Microbial Keratitis in Stevens-Johnson Syndrome: Clinicomicrobiological Profile and Outcome Presenting Author: Bhupesh Bagga MD FRCS MBBS
Presenting Author: Khalid F Tabbara MD*
Co-Author(s): Savitri Sharma MD, Virender S Sangwan MBBS
Co-Author(s): Ashraf Said Mahrous**, Samir S Shoughy MD
Purpose: To study clinicomicrobiological profile and outcome of microbial keratitis in Stevens-Johnson syndrome (SJS). Methods: Retrospective data review. Results: Data of 70 eyes were reviewed. Average time of presentation was 3 weeks from onset. Mean size of ulcer was 3.5 mm. Fifty-five percent of ulcers responded to medical management. Average time of response was 30 days. Six eyes needed tarsorrhaphy. eyes needed tissue adhesive application. Two required therapeutic graft, and 1 got eviscerated. Positive culture was isolated in 45 eyes (64.3%): bacterial, 60%; fungal, 11%; and polymicrobial, 37.8%. All Gram-positive isolates were susceptible to vancomycin and Gram-negative isolates were susceptible to gentamicin and amikacin. Conclusion: Corneal infections in SJS need a systematic approach along with surface protective procedures.
Purpose: To evaluate the safety and efficacy of surface ablation followed by corneal crosslinking (CXL) in patients with keratoconus. Methods: Patients with contact lens intolerance, corneal thickness > 450 µm, keratometry < 56 D, and corneal astigmatism < 6 D were included. Results: Forty-four patients (30 males and 14 females) with mean age of 27 years underwent PRK and CXL on the same day. There was significant improvement in visual acuity and keratometry. Patients had 20/40 or better vision in 91% of the cases. Conclusion: Surface ablation with CXL is a safe and effective procedure in mild keratoconus.
Scientific Poster 45 Conjunctival Microbial Flora in Stevens-Johnson Syndrome Ocular Sequelae Patients at a Tertiary Eye Care Center Presenting Author: Namrata Sharma MD MBBS
Scientific Posters
Presenting Author: Savitri Sharma MD
Scientific Poster 49 SOE Cytoarchitecture of Corneal Epithelium Indicates the Etiology of Infectious Keratitis
Co-Author(s): Renu Venugopal PhD, Sushil Kumari Sangwan PhD**, Geeta Satpathy MD**, Rasik B Vajpayee MD
Presenting Author: Adrian P Smedowski MD
Purpose: To evaluate and compare conjunctival microbial flora in Stevens-Johnson syndrome (SJS) eyes (n =176) with controls (n = 73) prospectively. Method: Conjunctival swabs were collected and cultured for bacteria and antibiotic resistance testing. Results: 104 eyes had positive cultures (59%)in SJS vs. 9 eyes (12.08%) in controls. In SJS eyes, coagulase-negative Staphylococci was the most common (17%), followed by Staphylococcus aureus (10.7%)and Corynebacteriae (19.8%). Analysis of microbial flora between the 2 groups showed a significantly higher rate of positivity in the SJS group (46%) than in the control group (P = .001). Multiple micro-organisms were found in 7 eyes. Sixteen percent of isolates in SJS eyes showed resistance to fluoroquinolones. Conclusion: Conjunctival microbial flora varies widely in SJS eyes, and the pathogenic organism may predispose them for infection.
Purpose: To analyze histological findings of infectious keratitis in corneal epithelium. Methods: In vivo corneal confocal microscopy in 190 infectious keratitis (72 viral, 66 bacterial, 34 fungal, 18 amoebal) was performed. Analysis of inflammatory cell infiltration, superficial nerve plexus and cytology of epithelial cells was compared between groups. Results: Inflammatory cell densities showed no differences between groups; however, there was various ratios of round / dendritic inflammatory cells: respectively, 0.07, 8.0, 1.0, and 1.2 for viral, bacterial, fungal, and amoebal keratitis (P < .05). Differences were observed also in nerve fiber numbers (P < .05) and epithelial layer architecture. Conclusion: In vivo analysis of corneal epithelial histology shows high specificity and sensitivity in infectious keratitis diagnosis.
Scientific Poster 46 H Evaluation of Efficacy of Auro Keratoprosthesis in Endstage Corneal Disease Presenting Author: Namrata Sharma MD MBBS Co-Author(s): Rasik B Vajpayee MD Purpose: To evaluate results of Auro keratoprosthesis (Auro KPro), a low-cost modification of the Boston Keratoprosthesis in end-stage corneal disease, prospectively. Methods: Ten eyes underwent Auro Kpro. Parameters analyzed were BCVA, retention, and complications. Preoperative diagnoses were multiple failed grafts (n = 7), bullous keratopathy (n = 2), and chemical injury (n = 1). Mean BCVA logMAR before surgery was 2.6 (range: 2-3); and after surgery, 1.13 (range: 0.3-3). The most frequent complication was formation of retroprosthetic membrane (RPM) (n = 4), followed by glaucoma (n = 2). One eye underwent therapeutic keratoplasty due to infection. Anatomical retention with ambulatory visual acuity was seen in 9 eyes at 1 year follow-up. Conclusion: The Auro Kpro is a viable low-cost option in end-stage corneal disease in developing countries.
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Co-Author(s): Dorota Tarnawska MD, Edward A Wylegala MD PhD**
Scientific Poster 50 Persistence of Ocular Surface Disease After Resolution of Infectious Keratitis Presenting Author: Rodrigo Thiesen Muller MD Co-Author(s): Bernardo Menelau Cavalcanti MD, Andrea C Cruzat MD**, Arsia Jamali MD, Deborah P Langston MD FACS*, Pedram Hamrah MD* Purpose: To analyze clinical and in vivo confocal microscopy (IVCM) findings in patients with infectious keratitis (IK). Methods: Fifty-four patients with IK were evaluated prospectively during the acute phase, at cessation of antimicrobial therapy, and 1 to 6 months thereafter. Clinical signs, symptoms, and corneal IVCM images were assessed. Results: One to 6 months after resolution of infection, foreign body sensation (6.6%), tearing (6.6%), photophobia (20.0%), and superficial punctate keratitis (52.9%) persisted. Despite regeneration, significantly lower corneal sub-basal nerve density (12.1 ± 6.9 mm/mm2) was shown, as compared to controls (24.1 ± 5.1; P < .0001). Conclusion: Patients with IK demonstrate persistent signs and symptoms after the resolution of IK, which may be related to persistent corneal nerve alterations.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 51 H Late Acute Graft Rejection After Kerato-Limbal Allograft
Scientific Poster 55 Topical Cysteamine Effects in Corneal Cystinosis
Presenting Author: Medi Eslani MD
Presenting Author: Amal I N Alhemidan MBBS
Co-Author(s): Alireza Baradaran-Rafii MD, Asadolah Movahedan, Adam M Moss MD, Edward J Holland MD*, Ali R Djalilian MD
Co-Author(s): Mahmoud O Jaroudi MD, Khalid F Tabbara MD*
Purpose: To report late acute graft rejection (> 3.5 years) after successful kerato-limbal allograft (KLAL). Methods: A retrospective review of 5 patients (2 aniridia, 3 chemical burn) with late KLAL graft rejection who had either been tapered off of the immunosuppression (n = 3) or were receiving inadequate levels (n = 2). Results: The mean time to acute KLAL graft rejection was 52.2 ± 7.4 months. The presenting signs in all cases included graft injection and epithelial rejection line. Despite aggressive treatment, all patients developed sectoral limbal stem cell deficiency. Conclusion: This study provides evidence for the persistence of donor cells up to 5 years after KLAL. It suggests that while immunosuppression can be tapered off successfully in many patients, in some cases long-term therapy may be necessary for graft survival.
Scientific Poster 52 Safety, Efficacy, and Ease of On-site Compounded Autologous Serum in the Treatment of Ocular Surface Disease Presenting Author: Mona Sane MD Co-Author(s): Archana Anil Gupta MBBS, James J Reidy MD** Purpose: To describe on-site compounding of autologous serum (AS) in an office setting and evaluate its safety and efficacy for treatment of chronic ocular surface diseases. Methods: Retrospective review of medical records of patients treated with on-site compounded AS for noninfective nonhealing corneal epithelial defects from 2011 to 2014. Preparation and storage of serum is described. Results: Seventy-five percent of eyes with neurotrophic keratopathy, and all eyes with graft versus host disease and keratoconjunctivitis sicca showed resolution of epithelial defects over an average of 5 months (25 days to 547 days), with no incidence of microbial keratitis. Conclusion: AS prepared in office is safe, effective, and economically favorable in most patients with chronic ocular surface diseases resistant to conventional therapies.
Scientific Poster 53 SOE The Risk Factors for Pterygium: A Field-Wide Metaanalysis Identifies Chaos and Brings Order Presenting Author: Stylianos Serghiou Co-Author(s): YanYu Tan**, Menelaos S Serghiou MD, John Ioannidis MD DSC**, Peter Y Koay FRCS(ED) FRCOPHTH
Scientific Poster 54 SOE Evaluation of Cicatricial Pemphigoid Conjunctiva With OCT Presenting Author: Michele Lanza MD Co-Author(s): Raffaele Ppiscopo PhD, Diego Strianese, Michela Cennamo MD** Purpose: To evaluate conjunctival changes in patients with ocular cicatricial pemphigoid (OCP) using anterior segment OCT. Methods: A complete ophthalmic visit, slitlamp imaging, and OCT scans were performed in 16 eyes of 8 patients affected by OCP (at different stages). OCT and slitlamp data were compared. Results: OCT showed many alterations in OCP conjunctiva impossible to detect only with slit lamp: subepithelial folds (in 81% of eyes), increase of subepithelial optical reflectivity (in 88% of eyes), a membrane identified over the conjunctiva epithelium (in 75% of eyes), and a combination of them (in 31% of eyes). Conclusion: If these results should be confirmed in further studies, OCT could have an important role in early diagnosis and management of patients affected by OCP.
Scientific Poster 56 H Lifitegrast 5.0% vs. Placebo for Dry Eye Disease: Symptom Outcomes From the Phase 3 OPUS-2 Study Presenting Author: Joseph Tauber MD* Co-Author(s): Charles P Semba MD*, Aparna Raychaudhuri PhD* Purpose: Lifitegrast (LIF) 5.0% is a novel LFA-1 antagonist targeting chronic inflammation of dry eye disease (DED). Methods: A randomized, double-masked, placebo-controlled study was conducted comparing LIF (n = 360) with placebo (n = 358) twice daily for 84 days in subjects with DED. Co-1° endpoints: change from baseline in inferior corneal staining (ICSS) and eye dryness score (EDS; visual analogue scale [VAS]). 2° symptom endpoints: eye discomfort (VAS), ocular discomfort. Ocular Surface Disease Index (OSDI) was supporting. Results: LIF did not improve ICSS (P = .6186) or other signs. LIF improved EDS (P < .0001), 2° parameters (nominal P < .001), all OSDI parameters (total score and all subscales; nominal P < .05). No ocular serious adverse events. Conclusion: LIF 5.0% improved symptoms of DED.
Scientific Poster 57 Effectiveness of Additional LipiFlow Treatment for Chronic Meibomian Gland Dysfunction and Evaporative Dry Eye Presenting Author: Parag A Majmudar MD* Co-Author(s): Chad L Betts MD, Jack Volker Greiner DO PhD*, Edward J Holland MD*, John A Hovanesian MD*, Mitchell Jackson MD*, Stephen S Lane MD*, William B Trattler MD* Purpose: To evaluate effectiveness of second LipiFlow treatment for meibomian gland dysfunction (MGD) and evaporative dry eye. Methods: This prospective, multicenter controlled study of 200 patients included 18 who reported declining symptom relief 1 year after initial LipiFlow treatment and had a second treatment. Twelve control patients who received crossover LipiFlow treatment also had a second treatment. Results: Mean improvement in MG function from 1 year after initial treatment to 1 month after second treatment was 13.7 to 17.7 (P = .0005) and in symptoms was 42.9 to 26.9 (P < .0001). Outcomes were similar for crossover patients after second treatment. Conclusion: Additional LipiFlow treatment provides continued benefit for chronic MGD.
Scientific Poster 58 Ocular Surface and Tear Function After Allogeneic Hematopoietic Stem Cell Transplantation Presenting Author: Soonil Choi Co-Author(s): Kyung-Sun Na, Choun-ki Joo MD Purpose: We evaluated the changes of ocular surface and tear function after hematopoietic stem cell transplantation (HSCT) in nonchronic graft versus host disease (GVHD) patients. Methods: In this prospective study, patients without chronic GVHD had undergone tear breakup time (TBUT), Schirmer test, Ocular Surface Disease Index (OSDI) score, tear osmolarity, and corneal / conjunctival staining before and after (1, 2, and 3 months) HSCT. Results: Total of 56 eyes of 28 patients were included. Compared with the baseline, there were significant differences of TBUT, Schirmer score, OSDI score, and ocular staining score after HSCT(all P < .01). Conclusion: Regardless of GVHD status, HSCT aggravated instability of the ocular surface and reduced tear function.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To identify heterogeneous data availability and pterygium risk factors. Methods: Systematic literature search for observational studies on pterygium risk factors and metaanalytic data synthesis. Results: Fifty-one eligible studies with 173,792 participants and 18,715 pterygium cases. Each of 63 risk factors was studied on average 4.3 times (8.4%; standard error [SE], 7.0). Type of statistical analysis significantly altered the effect size (Fχ2 = 24.1; P-value < .0001). Significant risk factors at a = 0.01 were rural residence, low income, high sunlight exposure, and manual/outdoor occupation. No measures of prevention were significantly protective. Conclusion: Field-wide meta-analyses can map data availability and heterogeneity. Sunlight and dust exposure are the most likely direct or indirect causes of pterygium.
Purpose: To study the effects of topical cysteamine 0.5% eyedrops in corneal cystinosis. Methods: Patients with nephropathic cystinosis were included. Each patient underwent examination. Patients with cystine crystals in the cornea were given topical cysteamine 0.5% eyedrops. Symptoms and corneal findings were graded before and after treatment. Results: Thirty-three patients with cystinosis (13 males and 20 females). The age range was 6 months to 19 years, with a mean age of 8 years. Twenty patients (61%) showed improvement in symptoms, and 26 patients (79%) had improvement in corneal deposits. Conclusion: Cysteamine 0.5% eyedrops are safe and effective in cystinosis.
Scientific Posters Scientific Poster 59 Predicting Patient Satisfaction After Thermal Pulsation Treatment for the Management of Meibomian Gland Dysfunction
Scientific Poster 63 Long-term Follow-up in Boston Type 1 Keratoprosthesis Implantation
Presenting Author: Allister G Gibbons MD
Co-Author(s): Anthony J Aldave MD*
Co-Author(s): Tayyeba K Ali MD, Daniel Waren MS, Juan Carlos Murillo MD, Kendra Davis COA**, Samantha P Herretes MD, Carolina Betancurt MD**, Victor L Perez MD*
Purpose: To evaluate long-term outcomes of the Boston type I keratoprosthesis (KPro). Methods: Retrospective, interventional case series of KPros performed by a single surgeon prior to 3/2009. Preoperative characteristics and postoperative outcomes including retention, visual acuity, and complications were determined. Results: Seventy-one KPros were implanted in 61 eyes with a mean follow-up of 43.5 months. 23 KPros were not retained (mean time to removal: 26.3 months) with an annual retention rate between 91% (1 year) and 40% (8 years). In the 84% of eyes that maintain a KPro, current corrected distance visual acuity is ≥ 20/200 in 57% (4% preop) and ≥ preop in 80%. Complications included RPM (56%), PED (41%), and sterile corneal necrosis (21%), but no endophthalmitis. Conclusion: KPro offers significant lasting visual improvement to eyes not eligible for other forms of visual rehabilitation.
Purpose: To evaluate the dry eye parameters with the highest ability to predict patient satisfaction after a thermal pulsation treatment (TPT). Methods: A retrospective review of patients with meibomian gland dysfunction and evaporative dry eye. Patients received a full dry eye workup. Measured outcome was patient subjective improvement. Results: Thirty-four patients had bilateral treatment, with 2 follow-ups involving manual expression of the meibomian glands. Twenty patients (58.8%) reported subjective improvement. A higher corneal staining score was the most significant factor (P = .03) associated with TPT satisfaction. Conclusion: TPT can be effective in treating dry eye symptoms of patients. Our data show that patients with more objective findings of dry eye have a higher chance of satisfaction.
Scientific Poster 60 The Effect of Trabeculectomy on the Ocular Surface
Scientific Poster 64 Therapeutic and Cosmetic Keratopigmentation Using an Intrastromal Streaking Technique Presenting Author: Hamed Mofeez Anwar MD
Presenting Author: Hesam Hashemian MD
Co-Author(s): Alaa M Eldanasoury MD*
Co-Author(s): Mahmoud Jabbarvand Behrooz MD**, Mehdi Khodaparast MD**, Mohammad Riazi Esfahani MD
Purpose: To demonstrate the surgical technique and therapeutic applications of a novel method of keratopigmentation by intrastromal streaking with suture material. Methods: Keratopigmentation was performed on 38 eyes of 38 patients with disorders including corneal leucomata, opacified patch grafts, and traumatic aniridia. Postoperative satisfaction and complications were noted. Results: At 5 years, all except 2 patients were satisfied with their postoperative appearance. Three eyes with traumatic aniridia noted a subjective reduction in glare. Three patients required a tattoo enhancement after 5 years. Conclusion: Keratopigmentation by intrastromal streaking is easy to perform, safe, and effective, yielding good cosmetic and therapeutic results.
Purpose: To analyze the ocular surface changes after trabeculectomy. Methods: Seventytwo glaucoma patients who were candidates for trabeculectomy entered the study. We evaluated 9 subjective and objective measures for dry eye preoperatively and during 1 year postoperatively. We compared dry eye scores during the follow-up period with the preoperative data and normal controls. Results: Preoperatively 5 out 9 parameters were significantly higher than normal controls. After 1 year, 2 out of 9 parameters had significant differences compared to preoperative values, but 3 out of 9 parameters were significantly higher than normal controls. Conclusion: Patients on topical antiglaucoma medication and post-trabeculectomy patients were more likely to have ocular surface deterioration.
Scientific Poster 61 SOE Topical Cyclosporine A Therapy in Children With Ocular Rosacea
Scientific Posters
Presenting Author: Jamie K Alexander MD
Scientific Poster 65 Comparative Evaluation of Harvesting Corneas Through Hospital Cornea Retrieval Program and Voluntary Eye Donation at a Tertiary Eye Care Center Presenting Author: Rasik B Vajpayee MD
Presenting Author: Yonca A Akova MD*
Co-Author(s): Tushar Agarwal MD, Murugesan Vanathi, Namrata Sharma MD MBBS
Co-Author(s): Osman S Arslan MD, Fatma Nilufer Alparslan MD* Purpose: To assess the efficacy of topical cyclosporine A (CsA) therapy in patients with pediatric ocular rosacea (OR) with steroid-dependent corneal inflammation. Methods: Topical CsA 0.05% was given 4 times daily, combined with topical loteprednol therapy for 3 weeks. Results: The study included 10 children (16 eyes) with a mean age of 10 years (range: 5-14 years). The disease was previously resistant to lid hygiene (all patients), oral erythromycin (9), and intermittent topical steroids (all). Inflammation was diminished in all eyes during CsA therapy, with a mean follow-up of 12 ± 7 months. The treatment was stopped in 8 patients after a mean of 11 ± 6 months without recurrences. Conclusion: Long-term topical CsA 0.05% therapy is effective in controlling ocular inflammation in children with OR.
Purpose: To compare donor corneas from a hospital cornea retrieval program (HCRP) and voluntary eye donation (VED), prospectively. Methods: 1014 corneas were retrieved. Demography, death preservation time (DPT), socioeconomic status (SES), lens status, cornea grade, and endothelial counts were analyzed. Results: 81.4% in HCRP were < 65 years, and 79% in VED were > 65 years (P = .0001). DPT was < 6 hours in 48% and > 12 hours in 12% in HCRP vs. 85% and 1%, respectively, in VED (P = .0001). SES was above middle class in 40% and 82% in HCRP and VED (P = .0001). 13.5% were pseudophakic in HCRP vs. 66% in VED (P = .0002). Forty-five percent had cell counts > 2000 in HCRP , compared to 28% in VED (P = .0001). Optical and therapeutic grade eyes were 59.3% and 39.4% in HCRP, respectively, compared to 12.7% and 80.6% in VED (P = .0001). Conclusion: HCRP yields better quality corneas than does a VED program.
Scientific Poster 62 Efficacy of Autologous Serum Tears for Treatment of Severe Corneal Pain in Patients With Corneal Neuropathy: An In Vivo Confocal Microscopic Study
Scientific Poster 66 SOE Corneal Graft Patch to Repair Baerveldt Valve Silicone Tube and Scleral Buckling Extrusions
Presenting Author: Shruti Aggarwal MBBS Co-Author(s): Clara M Colon, Ahmad Kheirkhah MD, Pedram Hamrah MD* Purpose: To evaluate use of autologous serum tears (AST) in treatment of severe corneal pain in patients with corneal neuropathy using in vivo confocal microscopy (IVCM). Methods: Sixteen eyes of 16 patients suffering from severe corneal neuropathy-induced corneal pain and no current ocular surface disease were compared retrospectively to 16 age-matched controls. Changes in pain severity (0-10) and IVCM nerve parameters were evaluated after AST treatment. Results: Pain severity decreased from 9.4 ± 0.2 at baseline to 3.4 ± 0.4 (P = .03) following 3.8 ± 0.5 months of AST. IVCM showed significantly improved nerve density and morphology from baseline, paralleling symptomatic improvement (P = .01). Conclusion: AST-induced nerve regeneration may lead to improvement in patientreported corneal pain, particularly post-refractive surgery pain.
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Presenting Author: Caterina Sarnicola Co-Author(s): Gian Marco Tosi MD, Vincenzo Sarnicola MD Purpose: To evaluate the efficacy of corneal and sclerocorneal graft to cover Baerveldt valve (BV) silicone tube or scleral buckling (SB) extrusions. Methods: Retrospective cases series about 8 patients with BV silicone tube extrusion and 4 patients with SB extrusion. The movable conjunctiva was opened in flaps, and the graft patch was placed on the device. Interrupted suture and fibrin glue were used. Results: Graft patches were all vital at last follow-up (6 months). The conjunctival flaps had progressively covered the whole grafted tissue (7 cases after 3 months and 5 cases after 6 months). No complications were recorded. Conclusion: Corneal and sclerocorneal graft patches seem to be a good option for the treatment of SB and BV silicone tube extrusions. However, a larger number of cases and a longer follow-up are required.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 67 H Rho-Associated Kinase (ROCK) Inhibitors in the Management of Persistent Corneal Graft Edema: Does It Work?
Scientific Poster 71 SOE Repeat Descemet Membrane Endothelial Keratoplasty (DMEK) for Unsuccessful Previous DMEK
Presenting Author: Hamidreza Hasani MD
Co-Author(s): Lamis Baydoun MD, Gerrit RJ Melles MD PhD*
Co-Author(s): Alireza Baradaran-Rafii MD, Roghiyeh Shamsoddinimotlagh MD
Purpose: To describe the feasibility, outcomes, and complications of repeat Descemet membrane endothelial keratoplasty (re-DMEK). Methods: Seventeen eyes received reDMEK for graft detachment and/or endothelial graft failure after initial DMEK. Outcome measures were BCVA, endothelial cell density (ECD), and complications. Results: ReDMEK was uneventful and BCVA improved in all eyes. Donor ECD decreased from 2580 (± 173) cells/mm2 before, to 1390 (± 466) cells/mm2 6 months postoperatively. Complications included graft failure, graft detachment, secondary glaucoma, and cataract. Conclusion: Re-DMEK proved feasible, with acceptable BCVA. Complications may be better anticipated because graft detachment and failure tended to reoccur, suggesting an influence by intrinsic properties of the host eye.
Purpose: To report cases of corneal persistent graft edema that were successfully treated by Rho-associated kinase (ROCK) inhibitors. Methods: Three eyes unresponsive to medical treatment (BCVA ≤ 4/100) underwent subconjunctival Fasudil injection (0.5 mg/1 ml) 2 times with 2 weeks interval time. Results: Corneal clarity recovered and vision improved 4-6 weeks after the second injection. At 3 months, vision improved to 20/160. Average central corneal thickness was 579 ± 10 µm, significantly lower than its pretreatment value (744 ± 9 µm). The average corneal endothelial density in the central cornea increased from 894 ± 64 to 1549.3 ± 98 cells/mm3;. Conclusion: These cases highlight the possibility of the use of subconjunctival ROCK inhibitors as an alternative to regraft surgery for certain forms of persistent corneal graft edema.
Scientific Poster 68 Crystalline Lens Management in a Case of Boston Keratoprosthesis 1, and Its Relationship With Retroprosthetic Membrane Formation Presenting Author: Samar K Basak MD DNB MBBS* Co-Author(s): Soham Basak Purpose: To report the relationship between crystalline lens management during Boston KPro1 implantation and formation of retroprosthetic membrane (RPM). Methods: Retrospective review of charts of 70 consecutive cases of Boston KPro1 surgery. Crystalline lens status and case management were noted. In phakic eyes, a plano 3-piece IOL was placed in some cases. RPM formation in these cases were analyzed separately. Results:Thirty-three eyes were phakic; 14 were aphakic; and 23 were pseudophakic preoperatively. Posterior chamber IOL was implanted in 13 phakic eyes (39.4%). Incidence of RPM was significantly higher in aphakic eyes with capsule than without capsule and then pseudophakia (P < .05). Conclusion: Incidence of RPM is less in pseudophakic eyes, whether present preoperatively or made pseudophakic during surgery.
Presenting Author: Maria Satue MD
Scientific Poster 72 Clinical Outcomes of Repeat Keratoplasty After Failed Therapeutic Keratoplasty Performed for Fungal or Bacterial Keratitis Presenting Author: Shraddha Sureka MBBS MS Co-Author(s): Jagadesh C Reddy MD**, Pravin Vaddavalli MD, Shreyas Ramamurthy MBBS MS Purpose: To analyze outcomes of repeat optical penetrating keratoplasty (PK) or endothelial keratoplasty (EK) after failed therapeutic keratoplasty (TPK). Methods: Retrospective study of patients (112 eyes) who underwent optical PK (67 eyes) or EK (45 eyes) after failed TPK from 2000 to 2012. Results: Improvement in corrected distance visual acuity among both types of grafts was statistically significant(P < .01). Graft transparency at 1 year was significantly better in the PK group than in the EK group (P < .05). Significantly better outcomes were obtained in Aspergillus-infected corneas than in corneas infected with other agents. Cumulative graft survival at 8 years was 50%. Conclusion: Good long-term functional outcomes can be achieved by performing repeat PK or EK in patients after failed TPK.
Scientific Poster 73 Randomized Comparison of loteprednol 0.5% Gel vs. Prednisolone Acetate 1% Solution in the First Year Following Endothelial Keratoplasty
Presenting Author: Samar K Basak MD DNB MBBS*
Presenting Author: Marianne O Price PhD*
Co-Author(s): Ayan Mohanta
Co-Author(s): Francis W Price Jr MD*
Purpose: To evaluate the clinical outcomes of Descemet-stripping endothelial keratoplasty (DSEK) to treat corneal edema in iridocorneal endothelial (ICE) syndrome. Methods: Clinical course of 15 consecutive patients who underwent DSEK for corneal edema in ICE syndrome between 2007 and 2013 was reviewed retrospectively for BCVA, graft clarity, and glaucoma control. Results:Ten patients had glaucoma before DSEK. Cataract surgery was required in 11 eyes; and additional trabeculectomy, in 6 eyes. Grafts remained clear in 9 eyes (60%) with BCVA of ≥ 20/40 in 7 eyes (46.7%) with mean follow-up of 19 months. Poor outcomes after DSEK included uncontrolled glaucoma and late graft failure. Conclusion: Outcomes of DSEK in ICE syndrome are not always favorable because of the continuous nature of the disease.
Purpose: To compare efficacy and side effects of prednisolone 1% to those of a new loteprednol gel formulation following Descemet membrane endothelial keratoplasty (DMEK). Methods:Subjects used prednisolone 4x/day for 1 month, then were randomized to continue it or switch to loteprednol. Dosing was 4x/day for 2 more months, 3x/day for 1 month, 2x/day for 1 month, then 1x daily for 1 year. Results: 232 eyes were enrolled. Rejection episodes were rare (< 1%). The incidence of IOP elevation was significantly lower in the loteprednol arm. Conclusion: Compared with prednisolone 1% ophthalmic solution, loteprednol 0.5% gel had a similarly low rate of rejection episodes and a significantly lower incidence of IOP elevation in the first year after DMEK.
Scientific Poster 70 Femtosecond Laser-Assisted Intrastromal Astigmatic Keratotomy for the Treatment of Astigmatism Following Penetrating Keratoplasty Presenting Author: Season T Yeung MBBS Co-Author(s): Ronan Conlon MD, Joshua C Teichman MD, Salina Teja MD, George Minstioulis FRCSC, W Bruce Jackson MD FRCSC*, Kashif Baig MD MBA* Purpose: To report the outcomes of femtosecond laser-assisted intrastromal astigmatic keratotomy (FISAK) in post-penetrating keratoplasty (PKP) patients. Methods: A prospective, interventional case series of 10 PKP patients with high corneal astigmatism. Results: At the 3-month follow-up, the mean manifest cylinder was reduced significantly, from 5.78 ± 1.43 D preoperatively to 2.25 ± 1.09 D postoperatively (P = .001). Similarly, the mean topographic cylinder was decreased significantly from 5.90 ± 2.37 D to 3.49 ± 0.97 D (P = .01). No serious adverse effects were reported. Conclusion: FISAK is a precise, effective, and safe technique in reducing corneal astigmatism in post-PKP patients.
Scientific Poster 74 Retrospective Single-Center Evaluation of an Ocular Sealant for Wound Closure in Descemet-Stripping Endothelial Keratoplasty Presenting Author: Terry Kim MD* Co-Author(s): Gary L Legault MD Purpose: To evaluate the safety and effectiveness of ReSure Sealant for wound closure in Descemet-stripping endothelial keratoplasty (DSEK) surgery. Methods: Fourteen patients were treated with the sealant during DSEK surgery. Patients enrolled included patients who had DSEK only (n = 5), DSEK with cataract surgery and IOL placement (n = 7), DSEK with anterior vitrectomy (n = 1), and DSEK with lens exchange (n = 1). The main temporal clear corneal wounds were 4.1 mm. Results: 100% of patients maintained a complete air bubble fill after the sealant was placed, and 100% of patients were Seidel negative on postop Day 1. Wound healing was normal, patients were comfortable overall, and no adverse events occurred in relation to the device. Conclusion: The sealant proved safe and effective for wound closure in DSEK surgery.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Posters
Scientific Poster 69 Descemet-Stripping Endothelial Keratoplasty for Corneal Edema in Iridocorneal Endothelial Syndrome
Scientific Posters Scientific Poster 75 Evaluation of Endothelial Cell Changes and Pachymetry of Precut Corneal Tissues Stored in McCarey-Kaufmann Media
Scientific Poster 79 SOE Aloe Vera Gel Facilitates Re-epithelialization of the Cornea in Normal and Diabetic Rats
Presenting Author: Somasheila I Murthy MD
Presenting Author: Tamer E Wasfy MBBS
Co-Author(s): Varsha M Rathi DO, Hemal Vinod Kenia BMBS**, Geeta K Vemuganti MD
Co-Author(s): Ahmed Mohamed Ghoneim MD, Ayman Atiba**
Purpose: To evaluate the safety-efficacy of McCarey-Kaufman medium for precut corneal tissues. Methods: 180 precut corneal tissues obtained with automated microkeratomes 300 and 350 µ targeted cap were evaluated for ultrasound pachymetry, endothelial cell (EC) changes, and immediate post-endothelial keratoplasty (EK) complications. Results: 300µ and 350-µ blades cut tissues thicker by 15.26% and 17.46%, respectively. Precutting caused a 2.17% decrease in ED density (P = .0018), a 2.64% decrease in hexagonal cells (P = .575), and a 5.33% increase in coefficient of variation (P = .001). Post-EK primary graft failure (1.11%) and corneal infiltrate (1.67%) were noted. Conclusion: Storage in McCarey-Kaufman medium was comparable to published literature with Optisol-GS Medium.
Purpose: To investigate the wound healing effect of aloe vera gel (AV) after a corneal alkali injury in normal and diabetic rats. Methods: Twenty-eight Wastar male rats were divided into 4 groups (normal untreated, normal treated, diabetic untreated, and diabetic treated). The corneal alkali-burn injury model was established by contacting eyes with filter paper saturated with 0.01 N NaOH for 45 seconds. Treated groups were treated with AV eye drops 4 times daily for 3 days, and the untreated groups were treated with normal saline. Results: Corneal wound healing was significantly accelerated in the diabetic treated group compared with the diabetic untreated group (P < .005). Conclusion: Corneal alkali injuries heal faster and more completely in AV treated groups than in untreated groups, by means of rapid re-epithelialization and reduced inflammation.
Scientific Poster 76 Descemet Membrane Endothelial Keratoplasty: Enhanced Results With a Standardized Technique
Scientific Poster 80 Trauma in a Large Series of Ehlers-Danlos Syndrome: Characteristics and Outcome
Presenting Author: Michael D Straiko MD*
Presenting Author: Ali A AlRajhi MD
Co-Author(s): Mark A Terry MD*, Peter B Veldman MD, Zachary Mayko MS
Purpose: To report trauma characteristics and outcome in Ehlers Danlos syndrome. Methods: Forty eyes of 23 patients sustained 1 to 3 episodes of trauma at a mean age of 4.6 years (1-12). Results: Trauma occurred twice in 10 and 3 times in 2 eyes, 83% of eyes had corneal laceration following minor trauma, and 65% of cases were bilateral. Trauma resulted in adherent leukoma and glaucoma in 42%, visual loss in 67%, and globe loss in 15% of eyes. Conclusion: Eyes in EDS are easily traumatized and associated with visual and structural poor outcome. Protective measures against trauma and strengthening procedures such as epikeratoplasty are highly recommended.
Purpose: This report improved Descemet membrane endothelial keratoplasty (DMEK) results with a standardized technique using prestripped tissue, SF6 gas, glass injector, and avoiding graft overlap with the host Descemet. Methods: Prospective study of our initial consecutive 101 DMEK surgeries using this standardized technique. Results: Seven cases received an air bubble injection postoperatively (7%). There were 3 primary graft failures (PGF); all were upside-down grafts (3%). The 6-month endothelial cell loss was 30% (n = 31). There were no cases of pupillary block. A technique modification has eliminated upside-down grafts and PGF in our 68 most recent cases. Conclusion: The use of this standardized technique at our institution has resulted in low complication rates and acceptable cell density. Further modifications have improved our results by eliminating our main cause of PGF.
Scientific Poster 77 SOE IOL Opacification After Descemet-Stripping Automated Endothelial Keratoplasty Presenting Author: Peter J Morgan-Warren BMBCH
Scientific Posters
Co-Author(s): Amit K Patel MBBCH Purpose: To report 5 cases of IOL opacification after Descemet-stripping automated endothelial keratoplasty (DSAEK) surgery. Methods: Retrospective case note review of patients identified with IOL opacification after DSAEK. Results: Five patients developed IOL opacification 5 to 80 months after DSAEK. All patients had Fuchs endothelial dystrophy and had received hydrophilic acrylic IOL models previously. Central anterior IOL opacification was noted in all 5 cases. Four cases (80%) required rebubbling due to dislocated graft tissue, and 1 had an early postoperative IOP rise. Conclusion: Intracameral air, elevated IOP, and other factors may be major etiological factors for IOL opacification after DSAEK. We advise avoiding hydrophilic acrylic IOLs in patients who may require future DSAEK.
SESSION TWO, MONDAY AND TUESDAY Scientific Poster 330 SOE Deep Anterior Lamellar Keratoplasty vs. Penetrating Keratoplasty for Keratoconus: A Systematic Review Presenting Author: Christin Henein MBBS Co-Author(s): Mayank A Nanavaty MD Purpose: A systematic review of comparative studies assessing the outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty for keratoconus. Methods: Inclusion criteria were sample size of at least 20 eyes in each arm and follow-up of at least 12 months. Primary outcomes were uncorrected and best-corrected visual acuity. Secondary outcomes were allograft rejection, endothelial density, and complications. Fixed and random effects models were applied to results combined for analysis. Results: DALK had less allograft rejection and more endothelial density (P < 0.05). Secondary outcomes were not significantly different. There was no evidence to suggest heterogeneity of results (P > 0.05). Conclusion: Studies showed no difference in visual acuity. DALK reduces the risk of allograft rejection and has significantly increased endothelial cell density at 12-month follow-up.
Scientific Poster 78 Characteristics of Patients Undergoing Endothelial vs. Penetrating Keratoplasty for Corneal Endothelial Disease, 2009 to 2011
Scientific Poster 331 Deep Anterior Lamellar Keratoplasty in Children With Advanced Keratoconus
Presenting Author: Roni M Shtein MD
Co-Author(s): Ritu Arora MD MBBS, Pooja Jain MBBS MS, Parul Jain MD, Aditi Abhay Manudhane MBBS, Vikas Veerwal MBBS, Vikas Veerwal MBBS
Co-Author(s): Taylor Blachley MS, Maria A Woodward MD*, Shahzad I Mian MD*, Alan Sugar MD, Joshua D Stein MD MS* Purpose: To assess differences in characteristics of patients undergoing endothelial (EK) vs. penetrating keratoplasty (PK) for corneal endothelial disease (CED) from 2009 to 2011. Methods: Retrospective longitudinal cohort study of 83,918 individuals with CED in a U.S. managed care network. Multivariable regression modeling was performed to assess factors that affected odds of undergoing EK vs. PK. Results: 1115 keratoplasties were performed for CED (644 EK; 471 PK). Latinos had a 56% reduced odds of undergoing EK (OR = 0.44, P = .02) compared to whites. Women had a 49% increased odds of undergoing EK (OR = 1.49, P = .01). Conclusion: Further research needs to be done to understand variations in the demographic characteristics of those who undergo EK vs. PK for CED and its impact on outcomes.
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Presenting Author: Jawahar Lal Goyal MD
Purpose: To evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) in children with advanced keratoconus. Methods: Retrospective analysis of 20 eyes of 16 children (11–18 years old) who underwent DALK for advanced keratoconus. The follow-up ranged from one to nine years. Graft clarity, best-corrected visual acuity (BCVA), average keratometry, and complications were evaluated. Results: Eighteen eyes had clear grafts. Mean decimal BCVA changed from 0.12 preoperatively to 0.35. The average keratometric power changed from 64.86 to 45.70 D . The complications noted were graft rejection (1), interface infection (2), and shield ulcers (2). They were managed accordingly, and only one patient needed penetrating keratoplasty. Conclusion: DALK is an excellent therapeutic modality for management of advanced keratoconus in children.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 332 Subconjunctival Injection of Anti-Vascular Endothelial Growth Factor Agents for Treatment of Superior Limbic Keratoconjunctivitis
Scientific Poster 336 Intrastromal Corneal Rings Segments for the Treatment of Keratoconus
Presenting Author: Chi Chiau Wu
Purpose: To report the visual, keratometric, and safety outcomes of intrastromal corneal rings placed in patients with keratoconus. Methods: An observational, retrospective study was conducted. Patients with keratoconus treated with intrastromal rings between 2007 and 2012 with one year of follow-up were included. Visual acuity, keratometry, pachymetry, degree of incision, follow-up, and complications were assessed. Results: A total of 197 eyes were included. Uncorrected and best-corrected visual acuity improved by 0.36 ± 0.47 logMAR (P ≤ 0.001) and 0.16 ± 0.28 logMAR (P ≤ 0.001), respectively. Mean keratometric values decreased by 2.66 ± 3.62 D (P ≤ 0.001). A total of eight patients (4.06%) had complications. Conclusion: Instrastromal corneal ring segments appear to improve visual acuity and corneal topography.
Co-Author(s): Shihkung Huang MD**, Lu Jyun-Wei MD, Chieh-Chih Tsai MD Purpose: To evaluate the efficacy of subconjunctival injection of bevacizumab or aflibercept for treatment of superior limbic keratoconjunctivitis (SLK). Methods: Patients with SLK unresponsive to conventional treatments were included and followed up for six months. Five cases recieved 0.1 cc subconjunctival bevacizumab, and five recieved 0.05 cc subconjunctival aflibercept every one to four months as clinicaly needed. The subjective symptoms and signs, including slit-lamp examination, external eye photography, and fluorescein angiography, were recorded and compared before and after treatment. Results: The fluorescein leakage from abnormal microvasculature was compatible with the severity of symptoms in each eye. Both the symptoms and signs improved after treatments. Conclusion: Anti-VEGF agents are effective treatments for remission of SLK.
Presenting Author: Erick Hernandez-Bogantes MD
Scientific Poster 333 Characteristics of Primary Sjögren Syndrome in Men
Scientific Poster 337 SOE Intraoperative OCT Pachymetric Mapping During Accelerated Pulsed High-Fluence Corneal Collagen Crosslinking With Dextran-Free Riboflavin
Presenting Author: Priya Mathews MD
Presenting Author: Miguel M Rechichi MD
Co-Author(s): Alan N Baer MD, Esen K Akpek MD*
Co-Author(s): Sheraz M Daya MD*, Cosimo Mazzotta MD PhD, Rita Mencucci MD, Michele Lanza MD
Purpose: To report the clinical features of primary Sjögren syndrome (pSS) in men. Methods: Retrospective review of a tertiary care-based, longitudinal cohort. Results: Of the 163 patients with pSS, 14 were men. On presentation, men were a decade older (61 vs. 50 years, p < 0.01) and reported less chronic dry eye (5.9 vs. 10.8 years, p = 0.07) than women. Men were more likely to present with serious ocular complications than women (43% vs. 11%, p = 0.001). Systemic complications were also more common in men (64% vs. 40%, p = 0.08). Furthermore, men were more likely to be seronegative than women (36% of men were negative for Sjögren syndrome A, Sjögren syndrome B, and anti-nuclear antibodies vs. 11% of women, p = 0.01). Conclusion: Although pSS is typically a disease of middle-aged women, clinicians should note that it may be underdiagnosed in men, which may contribute to the differences in disease severity.
Purpose: To assess in vivo intraoperative corneal pachymetric variations by OCT mapping during corneal pulsed accelerated collagen crosslinking (PACXL) treatment with the use of dextran-free riboflavin. Methods: Thirty eyes underwent PACXL. Pachymetric maps within central 5-mm zone were obtained. Central anf thinnest corneal thickness measurements were obtained at baseline, after epithelial removal, after 10-minute riboflavin drop instillation, and after eight minutes of pulsed irradiation at 30 Mw/cm2 and 7.2 J/cm2. Results: There was not a statistically significant decrease after 10 minutes of the corneal soaking phase and after eight minutes of pulsed irradiation. No complications were observed. Conclusion: PACXL is a safe procedure that does not induce a statistically significant corneal shrinking.
Scientific Poster 334 SOE Corneal Intrastromal MyoRing Implantation in Keratoconus Treatment
Scientific Poster 338 Is Inflammation Driving Keratoconus? A Holistic Study of Molecular Pathways
Presenting Author: Ahmed M Saeed MD
Presenting Author: Natasha Kishore Pahuja DOMS MBBS
Co-Author(s): Amr Ibrahim Sharawy, Doaa Mohammad Guda MD
Co-Author(s): Rohit Shetty MD MBBS, Arkasubhra Ghosh MS PhD, Himanshu P Matalia MBBS**, Himabindu Veluri MS**, Bhujang K Shetty MD**
Scientific Poster 335 SOE Influence of Pregnancy on Corneal Biomechanics Presenting Author: David Tabibian MD Co-Author(s): Begona Martinez-de-Tejada MD PhD**, Farhad Hafezi MD PhD* Purpose: There is increasing evidence that hormonal changes during pregnancy alter the biomechanical stability of the human cornea. Methods: Prospective, monocentric clinical study measuring biomechanical changes during and after pregnancy. Examinations included slit-lamp examination, blood samples, and Ocular Response Analyzer (Reichert Technologies) and Pentacam (Oculus) measurements. Results: Results show increases of the following parameters in the third trimester: corneal hysteresis (P = 0.007), cornealcompensated intraocular pressure (IOP; p < 0.001), and Goldmann-corrected IOP (P = 0.008). Conclusion: Changes in estradiol levels may lead to biomechanical adaptations in the cornea during pregnancy, which might explain ectatic decompensation triggered during pregnancy.
Purpose: Biomarkers that may predict outcome and severity of disease in keratoconus are unknown. Therefore, we investigated inflammatory and genetic components in tears and the epithelium. The process was to understand deregulated pathways that may drive the pathophysiology of disease. Methods: Tears and epithelium of 94 patients and 20 controls were analyzed using mass spectroscopy for TNFa, MMP9, lysyl oxidase (LOX), and COL4A1 (collagen), and genetic screening was done in eight families for mutation in the VSX1 gene. Results: Tear cytokine results show high levels of inflammatory markers and low levels of LOX in the epithelium. Genetic screening revealed mutation in the VSX1 gene. Conclusion: This holistic data argues that etiopathogenesis of keratoconus is possibly linked to an inflammatory network. These signals resemble chronic autoimmune disease.
Scientific Poster 339 SOE H Factors Influencing Outcomes of Corneal Collagen Crosslinking in Pediatric Keratoconus Patients Presenting Author: Nurullah Cagil MD Co-Author(s): Ozge I Sarac MD**, Mehtap Caglayan, Emine Kalkan Akcay**, Hasan Basri Cakmak MD Purpose: To assess the preoperative patient characteristics that may predict outcomes of corneal collagen crosslinking (CXL) in pediatric keratoconus (KC). Methods: Thirty-nine eyes with one-year follow-up period following CXL were included. Subgroup analyses and cutoff values included age (≥14 years), uncorrected visual acuity (UCVA; ≥0.8 logMAR), cone location (central, paracentral, and peripheral), Kmax (≥54 D), and thinnest pachymetry (t-CCT , ≥450 µm). Results: Kmax in patients under 14 years of age and/or with paracentral cones showed more progression (age:P = 0.017, OR = 16.5; cone location:P = 0.025, OR = 14.0). UCVA in patients with paracentral cones and/or t-CCT lower than 450 µm was more likely to decrease (cone location:P = 0.012, OR = 7.5; t-CCT:P = 0.04, OR = 20). Conclusion: In pediatric KC, age, cone location, and baseline t-CCT affect the success of CXL.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To evaluate corneal intrastromal MyoRing in keratoconus (KC) management. Methods: A MyoRing was inserted into 22 KC eyes. Data included uncorrected (UCVA) and best-corrected visual acuity (BCVA) and Pentacam imaging. Results: There was statistically significant improvement of UCVA, BCVA, K1, K2, and Km (0.12 ± 0.2, 0.3 ± 0.1, 48.5 ± 3.8, 54.5 ± 4, and 51.3 ± 3.6, respectively), compared with 0.5 ± 0.2, 0.7 ± 0.2, 45.8 ± 3, 42.6 ± 3.2, and 49.1 ± 3.3, respectively, at six postoperative months (P < 0.001). Four cases underwent position adjustment of the implant. Conclusion: The MyoRing could represent an efficient, safe, and modifiable therapeutic option for KC treatment.
Scientific Posters Scientific Poster 340 Complication of Corneal Collagen Crosslinking in Keratoconus in Young Patients With Vernal Keratoconjunctivitis
Scientific Poster 344 Penetrating Keratoplasty in cases of Post-herpetic (HSV) Vascularized Scars: Indications, Surgical Challenges, and Outcomes
Presenting Author: Vikas Veerwal MBBS
Presenting Author: Muralidhar Ramappa MBBS
Co-Author(s): Ritu Arora MD MBBS, Jawahar Lal Goyal MD, Pooja Jain MBBS MS, Trushaa Garg MS**, Parul Jain MD
Co-Author(s): Sunita Chaurasia MD, Ashik Mohamed MBBS
Purpose: To report patterns of sterile corneal infiltrates after corneal collagen crosslinking (CXL) in keratoconus with vernal keratoconjunctivitis (VKC). Methods: Retrospective case series of eight eyes of eight patients (age group, 10–15 years) in a series of 92 patients who underwent CXL for progressive keratoconus. Results: The patients presented 24 to 48 hours after CXL with severe pain and redness. All patients had central corneal edema with pinpoint corneal infiltrates. There was associated moderate to severe VKC in all patients. There was also severe stromal melt with perforation on the fourth day in one of the patients. All except two patients responded to topical steroids. Conclusion: CXL in younger patients with VKC is fraught with the possibility of sterile corneal infiltrates.
Scientific Poster 341 SOE H Unusually Low Prevalence of Keratoconus in a Very Large Series of Patients With Vernal Keratoconjunctivitis Presenting Author: Roberto Caputo MD* Co-Author(s): Rita Mencucci MD, Francesco Versaci MS*, Neri Pucci**, Salvatore DeMasi MHSA, Gioia Danti Sr**, Bennie H Jeng MD*
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Purpose: To evaluate the prevalence of keratoconus (KC) in a large series of patients affected by vernal keratoconjunctivitis (VKC) treated with topical cyclosporine A (CycA). Methods: Three hundred ninety-one patients affected by VKC (mean age, 11.15 ± 3.13 years) and a control group of 301 (mean age, 11.21 ± 2.82 years; range, six to 20 years) were investigated by means of a Scheimpflug camera combined with a corneal topographer. Results: Only three patients out of 391 (0.76%) in the VKC group presented with topographic signs of KC, and corneal indices were similar in both groups (symmetry indices and corneal thickness). Conclusion: The prevalence of topographic KC in this study is lower than the 11% to 22% reported in previous studies. Constant control of symptoms using CycA with less eye rubbing could lead to a lower risk of developing KC.
Purpose: To determine long-term functional success of penetrating keratoplast (PK) in cases of postherpetic corneal scars. Methods: Retrospectively analysed the data of 87 eyes of 84 patients with postherpetic vascularized corneal scars that underwent PK from 2001 to 2013. Results: Median age, 35 years; male:female = 67:17. Active keratitis was noted (19), and healed keratitis (65) underwent therapeutic PK and optical PK, respectively. Mean BCVA improved from 2.32 ± 0.82 preoperatively to 1.08 ± 1.22 at one year postoperatively (P < 0.001). In regards to complications, 34 cases (39%) experienced a herpes simplex virus recurrence, and 29 (33%) had a graft rejection. In 28 cases (32%), the graft eventually failed. Conclusion: PK in postherpetic scars is associated with higher postoperative complications. Surgeons should be aware of the long-term consequences and the need for reintervention.
Scientific Poster 345 Comparison of 10 Commercially Available Contact Lens Solutions in the Complete Kill of Acanthamoeba Cysts Presenting Author: Salwa Abdel-Aziz MD Co-Author(s): Regis P Kowalski MS, Amy Catherine Nau OD Purpose: Acanthamoeba keratitis incidence may be reduced with good hygiene complemented with the use of amoeba cysticidal solutions. Methods: We tested 10 contact lens solutions against five isolates of Acanthamoeba incubated over 24, 48, and 72 hours. The “Standard of Efficacy” was the complete kill of all isolates calculated at each time point. Results: Only one contact lens solution killed all five isolates at 24 hours. Three solutions produced a complete kill at 48 hours, and five solutions produced a complete kill at 72 hours. Overall, 72-hour incubation was most efficacious in killing Acanthamoeba cysts (Chi-square, p = 0.032). Conclusion: Contact lens solutions have varied Acanthamoeba cysticidal actions, which improve with increased incubation time.
Scientific Poster 342 Herpetic Eye Disease and Glaucoma
Scientific Poster 346 Changes in Corneal Sub-basal Nerves in Different Subtypes of Dry Eye Disease
Presenting Author: Charles Daniel Earley
Presenting Author: Ahmad Kheirkhah MD
Co-Author(s): Sarkis H Soukiasian MD
Co-Author(s): Bernardo Menelau Cavalcanti MD, Andrea C Cruzat MD**, Pedram Hamrah MD*
Purpose: To describe the presenting features and long-term consequences of glaucomarelated diagnosis (GRD) in patients with herpetic eye disease (HED). Methods: Ten-year retrospective medical record review of patients with the diagnosis of HED (herpes simplex [HS] and herpes zoster [HZ]) and GRD. Results: Of 1,098 patients with HED, 371 (33.8%) had a GRD (226 with HZ [61%] and 145 [39%] with HS), with 177 (54%) being diagnosed at the time of (35) or after (142) the onset of HED. The average time to reporting a GDR was 2.2 years, with a significant difference between the HZ (1.9 years) versus the HS (2.7 years) groups (P < 0.05). There was no difference in age at diagnosis (69.8 years). Conclusion: GRD is commonly encountered with HED, with the majority of cases reported around two years after onset of HED and with HZ being more common and with earlier onset.
Scientific Poster 343 Clinical Features of Atypical Mycobacterial and Nocardial Keratitis Presenting Author: Mahmoud O Jaroudi MD Co-Author(s): , Khalid F Tabbara MD* Purpose: To report the clinical features and risk factors of atypical mycobacterial and nocardial keratitis. Methods: Seventeen patients were included. All patients underwent complete ophthalmologic examination and corneal scraping for cytology and cultures. Results: There were eight female and nine male patients. Mean age was 39 years. Indolent, round corneal ulcers with ring infiltrates and mild edema were characteristic features. Eight patients (47%) were contact lens users, and nine (53%) were after LASIK. Conclusion: Atypical mycobacteria and nocardia are uncommon exogenous causes of keratitis that are frequently misdiagnosed. Characteristic clinical features and microbiologic evaluation are important for diagnosis. Refractive interventions (LASIK and contact lenses) are main risk factors.
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Purpose: To evaluate changes in corneal subbasal nerve fibers (SNF) in different subtypes of dry eye disease (DED). Methods: This study included 75 eyes with aqueous-deficient dry eye (ADDE), 68 eyes with evaporative dry eye (EDE), and 32 eyes of age-matched controls. Laser in vivo confocal microscopy was used to quantify SNF in central cornea. Results: SNF number and density were significantly lower in ADDE (14.2 ± 8.2 nerves/frame and 17.2 ± 7.6 mm/mm2) and EDE (17.5±9.2 nerves/frame and 19.7±7.4 mm/mm2) than controls (28.4 ± 6.2 nerves/frame and 24.3 ± 3.6 mm/mm2), all P < 0.05. Eyes with ADDE had significantly lower SNF number and density compared with those with EDE (P < 0.05). Conclusion: SNF parameters are significantly lower in ADDE than EDE. This may show the role of corneal nerves in reduced tear production and pathophysiology of DED.
Scientific Poster 347 Effects of Steroid Therapy on Corneal Sub-basal Nerves in Dry Eye Disease Presenting Author: Ahmad Kheirkhah MD Co-Author(s): Thomas Dohlman MD**, Michael Alexander Arnoldner MD, Pedram Hamrah MD* Purpose: To evaluate changes in corneal subbasal nerve fibers (SNF) and immune dendritic cells (DC) after treatment with topical steroids in dry eye disease (DED). Methods: Thirty-four patients with DED were randomized to receive either topical loteprednol (19) or artificial tear (15) twice daily for four weeks. In vivo confocal microscopy was used to quantify corneal SNF and DC before and after treatment. Results: In the loteprednol group, SNF density increased from 18 ± 5 mm/mm2 to 20 ± 5 mm/mm2 after four weeks, and DC density decreased from 139 ± 129 cell/mm2 to 83 ± 99 cell/mm2 (all P < 0.05). In the artificial tear group, SNF and DC densities did not change significantly at four weeks (SNF, 19 ± 6 mm/mm2 and DC, 160 ± 144 cell/mm2) compared with baseline (SNF, 18 ± 5 mm/mm2 and DC, 138 ± 135 cell/mm2; all P > 0.05). Conclusion: Reduced ocular surface inflammation in DED is associated with corneal nerve regeneration.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 348 H Dry Eye Symptoms Align More Closely to Systemic Complaints Than to Tear Parameters
Scientific Poster 352 Demodex Infestation as a Potential Cause of Keratitis
Presenting Author: Anat Galor MD*
Co-Author(s): Lixia Lin MD
Co-Author(s): Nabeel M Shalabi MBBS**, Allison Louise McClellan OD, Elizabeth Roy Felix PhD, William J Feuer MS, Roy Clifford Levitt MD*
Purpose: To report ocular demodicosis in keratitis. Methods: This retrospective study reviewed 20 eyes of 15 patients with refractory keratitis. Results: The patients included eight males and seven females aged 17.8 ± 12.1 years. Demodex mites were detected in all cases, while other pathogen cultures were negative. The corneal changes included peripheral infiltration in 12 eyes, peripheral ulceration in five eyes, and central infiltration in three eyes. In vivo confocal microscope revealed Langerhan cell infiltration. After using tea tree oil lid scrub, all patients showed dramatic resolution of ocular inflammation, while Demodex counts dropped from 4.3 ± 2.5 to 0.4 ± 0.6 (P < 0.001). All corneal signs resolved within two weeks, except for residual stromal scar in four eyes. Conclusion: Demodicosis should be considered as a potential cause of keratitis.
Purpose: To evaluate correlations between dry eye symptoms and systemic complaints versus tear parameters. Methods: Fifty-three patients completed questionnaires on dry eye symptoms, systemic pain, depression, and PTSD and underwent tear measurements. Results: Correlations between dry eye symptoms and all systemic measures were moderate (r = 0.52–0.65, P < 0.05), while correlations between symptoms and all tear parameters were weak (r = -0.09–0.29). Multivariable regression analysis revealed that depression and systemic pain explained approximately 33% of variability in dry eye questionnaire-5 scores. PTSD and antidepressant use explained approximately 48% of variability in ocular surface disease index scores. No tear parameters significantly predicted symptoms. Conclusion: Dry eye symptoms more closely align to systemic complaints than to tear parameters.
Scientific Poster 349 A New, Objective, Automated, Computer-Assisted Method to Quantify Corneal Fluorescein Staining Presenting Author: Francisco Amparo MD* Co-Author(s): Haobing Wang**, Reza Dana MD MSc MPH* Purpose: To describe a new automated method to objectively quantify corneal fluorescein staining (CFS) in slit-lamp photographs. Methods: We developed a system that quantifies CFS as a proportion of the corneal surface and provides the average intensity of the fluorescence, both using a centesimal scale. We clinically assessed CFS in a set of photographs (n = 50) from patients with dry eye disease. Next, we used the computer-assisted system to score the same set of photographs. Results: The automated scores were strongly correlated with the scores from the clinical evaluation for both affected area (R = 0.80, P < 0.001) and fluorescence intensity (R = 0.85, P < 0.001). Conclusion: The new system provides a reliable, continuous, and objective score to evaluate CFS in patients with dry eye.
Scientific Poster 350 SOE Comparing Effects of Plasma Rich in Growth Factors (Endoret) With Those of Autologous Serum Eye Drops on on Ocular Surface Wound Healing Presenting Author: Francisco Muruzabal PhD* Co-Author(s): Jesus Merayo-Lloves MD**, Gorka Orive PhD*, Gorka Orive PhD*
Scientific Poster 351 Classification and Grading of Meibomian Gland Dysfunction: A Novel Approach Presenting Author: Juan Carlos Murillo MD Co-Author(s): Samantha P Herretes MD, Daniel Waren MS, Allister G Gibbons MD, Hilal E Ozturk MD**, Carolina Betancurt MD**, Victor L Perez MD* Purpose: To present a new standardized scale for the assessment of meibomian gland dysfunction (MGD). Methods: Eighty-nine eyes with MGD were included. Lid margin features and meibomian gland morphology were evaluated with both Foulks and Bron (F and B) scoring system and our novel scale by two independent observers. Results: The new evaluation scale is shown to effectively evaluate MGD, correlating with tear osmolarity (P = 0.004), tear breakup time (P < 0.001), Schirmer’s test (P = 0.027), and meibum expression expressibility (P = 0.008). Comparison with the F and B scale denoted a positive correlation (r = 0.53) in the assessment of MGD. Interobserver reproducibility was obtained with a correlation coefficient of 0.71 for our new scale. Conclusion: MGD is evaluated in an effective and practical fashion with this novel evaluating system.
Scientific Poster 353 Meibomian Gland Dysfunction and Dyslipidemia: A Systematic Review Presenting Author: Puneet S Braich MD Co-Author(s): Amarjot Singh Mann, Vikram S Brar MD, Christopher T Leffler MD** Purpose: To perform a systematic review examining the relationship between meibomian gland dysfunction (MGD) and dyslipidemia. Methods: None of the patients had a prior diagnosis of dyslipidemia. A total of 219 patients with MGD were compared to 216 agematched controls from the local populations in three different studies. Results: Dyslipidemia was found in 58% to 67% of patients with MGD versus 6% to 39% of controls (P < 0.01). Mean LDL was 127 ± 6 versus 90 ± 8 (P ≤ 0.01). Logistic regression analysis revealed that patients with MGD were at 8% to 18% higher odds of having dyslipidemia. The prevalence of increased LDL was not statistically significant in one of three studies. Conclusion: Patients with MGD with no history of dyslipidemia may have undetected serum cholesterol abnormalities compared with controls of similar age without MGD.
Scientific Poster 354 OCT in the Diagnosis of Scleritis and Episcleritis Presenting Author: Samir S Shoughy MD Co-Author(s): Mahmoud O Jaroudi MD, Igor Kozak MD, Khalid F Tabbara MD* Purpose: To assess the scleral thickness in scleritis by OCT. Methods: OCT of the sclera was performed on 16 patients with scleritis and 16 control eyes. Results: There were 10 male and six female patients. The mean age was 43 years. Twelve patients had scleritis, and four had episcleritis. The mean scleral thickness was 836 ± 47 µm in patients with scleritis compared with 722 ± 74 µm in normal eyes P = 0.0005. The mean scleral thickness in patients with episcleritis was 766 ± 37 µm (P = 0.293). Conclusion: OCT showed significant increase in scleral thickness in patients with scleritis and no significant increase in episcleritis.
Scientific Poster 355 Outcomes of Cataract Surgery in Patients With Ocular Surface Disease Secondary to Graft Versus Host Disease Presenting Author: Tulio Batista Abud MD Co-Author(s): Ujwala Saboo MD, Francisco Amparo MD*, Reza Dana MD MSc MPH* Purpose: To evaluate the outcomes of phacoemulsification in patients with chronic ocular graft-versus-host disease (oGVHD). Methods: Records of 51 eyes with oGVHD undergoing phacoemulsification were reviewed. Preoperative and postoperative visual acuity and postoperative complications were recorded. Results: The mean preoperative visual acuity was 0.70 ± 0.60 logMAR and improved to 0.16 ± 0.19 at one month (P < 0.001) and 0.13 ± 0.19 at the final visit (P < 0.001). Postoperative complications included corneal epithelial defect (10%), filamentary keratitis (12%), posterior capsular opacification (20%), and cystoid macular edema (6%). Conclusion: Phacoemulsification significantly improves visual acuity and is a safe procedure with complication rates comparable to other reports in patients with ocular GVHD.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To evaluate and compare the biological outcomes of Endoret eye drops versus autologous serum (AS). Methods: AS and Endoret eye drops were obtained from 10 donors. Several growth factors were quantified in each sample. The proliferative and migration potential of Endoret and AS was evaluated on keratocytes and conjunctival fibroblasts. Their capability to prevent and inhibit myofibroblast differentiation was also evaluated. Results: Endoret showed significant (P < 0.05) higher levels of all growth factors. Furthermore, Endoret enhanced significantly (P < 0.05) the proliferation and migration of both cell types and reduced myofibroblast differentiation compared with AS. Conclusion: Endoret may improve the treatment of ocular surface wound healing, minimizing scar formation compared with AS.
Presenting Author: Lingyi Liang MD
Scientific Posters Scientific Poster 356 Symptom and Imaging Assessment of Topical Steroids in Meibomian Gland Dysfunction-Associated Inflammation Presenting Author: Yureeda Qazi MBBS Co-Author(s): Ahmad Kheirkhah MD, Thomas Dohlman MD, Reza Dana MD MSc MPH*, Pedram Hamrah MD* Purpose: To assess changes in symptoms and lid and corneal inflammation in meibomian gland dysfunction (MGD) using in vivo confocal microscopy (IVCM) comparing topical steroid-containing drugs (loteprednol [LE] and loteprednol plus tobramycin [LE/T]) to artificial tears (AT). Methods: A randomized, double-masked clinical trial was conducted with 54 subjects with MGD receiving either AT, LE, or LE/T for four weeks with symptom assessment and lid and corneal immune cell quantification on IVCM pre- and posttreatment. Results: Lid and corneal immune cell densities reduced significantly in both steroid-containing treatment groups (P ≤ 0.04) but not AT (P ≥ 0.4). Symptomatic improvement (11%) approached significance only for LE (P = 0.08). Conclusion: Steroid-containing drugs, but not AT, are effective at reducing lid and corneal immune cell densities in MGD on IVCM.
Scientific Poster 357 New Device for Preparation of Donor Corneal Tissue During Boston Keratoprosthesis (KPro) Surgery Presenting Author: Ronan Conlon MD Co-Author(s): Salina Teja MD, Joshua C Teichman MD, Season T Yeung MBBS, Kashif Baig MD MBA*, Behrooz Azizi MD
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Purpose: To assess centration accuracy and precision of an adapter used in trephination, developed for Boston keratoprosthesis (KPro) donor cornea tissue preparation. Methods: Thirty corneoscleral rims were trephined. Ten donor corneas were prepared by trephining the 8-mm cut followed by the 3-mm cut (Group 1). Ten corneas were prepared by trephining the 3-mm cut followed by the 8-mm cut (Group 2). Ten corneas were prepared by using our adapter, which allows for the cuts to be made almost simultaneously (Group 3). Results: The simultaneous method of trephination revealed a mean decentration of 0.185 mm. Group 1 had a mean decentration of 0.388 mm, and Group 2 had a mean decentration of 0.135 mm. Conclusion: Our study demonstrates that a device that cuts the corneal tissue simultaneously yields more predictable grafts for Boston KPro surgery.
Scientific Poster 360 SOE Effect of Scleral Buckling in Retinal Detachment Surgery on Corneal Biomechanics Using the Ocular Response Analyzer Presenting Author: Mohsen A Abou Shousha MD Purpose: To evaluate effect of scleral buckling on corneal biomechanics. Methods: This study included 21 patients with bilateral high myopia (-6.00 or more) and unilateral rhegmatogenous retinal detachment (RRD). All patients were subjected to cryotherapy for the retinal break(s) with encircling buckle in eyes with RRD. Ocular response analyzer (ORA) was done for both eyes (the operated and the contralateral eye) one month postoperatively. Statistical analysis of different ORA parameters were evaluated using one-way analysis of variance. Results: A statistically significant decrease in corneal hysteresis of the buckled eyes (7.78 ± 1.72) when compared with the nonoperated eyes (9.13 ± 1.90; P = 0.025). Other ORA parameters also differed. Conclusion: Scleral buckling leads to changes in corneal biomechanics.
Scientific Poster 361 Pediatric Therapeutic Penetrating Keratoplasty: Challenges and Outcomes in a Tertiary Care Centre Presenting Author: Meena Lakshmipathy MBBS Co-Author(s): K Lily Therese PhD**, Sudhir R Rachapalle MBBS DO DNB MPH, Lingam Gopal MBBS* Purpose: To study the indications, microbiology, and outcome of therapeutic keratoplasty in children less than 18 years old in a tertiary care center in South India. Methods: This is a retrospective case series of 40 children with a mean age group of 6.8 ± 5.06 years. Underlying predisposing factor was trauma in 55%. Central corneal ulcers (27.5%) was the most common presentation. Positive cultures were noted in 42.5% in corneal buttons. Results: Range of follow-up was six months to four years. Thirty-seven (92.5%) patients completed six months follow-up, and failed graft was noted in 33 patients (82.5%). Postoperative complications were graft infiltrate (7.5%), glaucoma (25%), and persistent epithelial defect (20%). Moreover, 92.5% had vision less than 20/200 at last follow-up. Conclusion: Poor outcome was attributed to late presentation and predisposing trauma.
Scientific Poster 358 Surgical vs. Medical Treatment of Ocular Surface Squamous Neoplasia: A Comparison of Costs
Scientific Poster 362 Vital Dye Staining Evaluation of Internationally Shipped Prestripped Donor Tissue for Descemet Membrane Endothelial Keratoplasty
Presenting Author: Christina S Moon MD
Presenting Author: Akira Kobayashi MD
Co-Author(s): Afshan A Nanji MD, Anat Galor MD*, Carol L Karp MD
Co-Author(s): Hideaki Yokogawa, Noriaki Murata**, Kazuhisa Sugiyama MD PhD
Purpose: To compare financial and time costs of surgery versus interferon (IFN) for ocular surface squamous neoplasia (OSSN). Methods: Retrospective review of 49 patients treated with surgery and 49 treated with IFN. Financial costs were calculated by two methods: hospital billing records and Medicare-allowable charges. Results: Hospital charges were higher in the surgical group compared with the IFN group. Overall cost between the two was comparable using Medicare-allowable charges. The cost to the patient depended on insurance coverage. The IFN group had an average of two more office visits than the surgical group over one year. Conclusion: Treating OSSN with IFN involves compliance and often out-of-pocket expenses. The difference in financial cost between the two treatments is dependent on a patient’s insurance status and coverage.
Purpose: To evaluate endothelial cell damage of internationally shipped prestripped Descemet membrane endothelial keratoplasty (DMEK) donor. Methods: Internationally shipped prestripped DMEK donors (n = 6) and precut Descemet-stripping automated endothelial keratoplasty (DSAEK) donors (n = 7) were stained with trypan blue and quantitatively analyzed. Results: Mean endothelial cell damage of prestripped DMEK donors (0.32%) was higher than that of precut DSAEK donors (0.01%, P = 0.029). Conclusion: Although the endothelial damage of internationally shipped prestripped DMEK donors was higher than precut DSAEK donors, the damage was relatively low.
Scientific Poster 359 SOE Five-Year Follow-up in Patients With Keratopigmentation Presenting Author: Jorge L Alio MD PhD* Co-Author(s): Alejandra Rodriguez MS, Mohamed Elbahrawy MBBCH MS, Ahmed A Abdou MD Phd Purpose: Analysis of the five-year follow-up outcomes of keratopigmentation, both cosmetic therapeutic or functional. Methods: Study of 20 keratopigmentation patients, with an average follow up of 7.15 ± 1.85 years. Surgery was done either by manual intrastromal dissection (17) or superficial pigmentation (3), using black and brown medical-grade chemical pigments. Results: Eighty-five percent of patients expressed satisfaction with their results. Only 10% experienced discomfort. Complications were recorded in three patients. Although pigmentation pattern was excellent in 65% of the patients, repigmentation was required in 50% of cases. Conclusion: At the five-year follow-up, all patients expressed significant cosmetic satisfaction, while maintaining excellent pigmentation stability.
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Scientific Poster 363 SOE Hemi-DMEK (Descemet Membrane Endothelial Keratoplasty) Transplantation: A Novel Method for Increasing the Pool of Endothelial Graft Tissue Presenting Author: Fook Chang Lam MBChB Co-Author(s): Lamis Baydoun MD, Martin Dirisamer MD, Gerrit RJ Melles MD PhD* Purpose: To evaluate the technical feasibility and clinical outcome of using whole-diameter semicircular grafts for Descemet membrane endothelial keratoplasty (hemi-DMEK). Methods: A prospective evaluation of three eyes of three patients with Fuchs endothelial dystrophy. Results: At six months, best-corrected visual acuities were 20/28, 20/40 (amblyopic eye), and 20/17. Central corneal thicknesses decreased from 682 to 707 mm to 489 to 534 mm, and endothelial cell density decreased by 38% to 63%. Conclusion: Hemi-DMEK proved technically feasible and may give visual outcomes similar to routine DMEK. Hemi-DMEK potentially allows the use of a single donor cornea for two endothelial keratoplasty procedures.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 364 Wide-Field Analysis of Corneal Endothelial Remodeling Following Descemet Membrane Endothelial Keratoplasty by Contact Scanning-Slit Specular Microscopy Presenting Author: Hiroko Nakagawa MD Co-Author(s): Tsutomu Inatomi MD PhD, Shigeru Kinoshita MD* Purpose: To investigate corneal endothelial cell (CEC) remodeling after Descemet membrane endothelial keratoplasty (DMEK) by use of wide-field contact specular microscopy. Methods: In five patients, endothelial cell density (ECD) of the DMEK graft at the central and peripheral regions was analyzed (mean follow-up, three months). Results: Throughout the follow-up period, ECD at the central area was higher than that at the graft edge. ECD loss from one to three months postoperatively at the central and peripheral regions was 7% and 16%, respectively. Migration of endothelial cells was detected toward the stripped regions at one month postoperatively. Conclusion: ECD at the center of the DMEK graft is higher than that at the periphery, and CECs migrate from the donor graft to the stripped region of the host.
Scientific Poster 365 Descemet Membrane Endothelial Keratoplasty and Descemet-Stripping Automated Endothelial Keratoplasty Performed on Different Eyes of the Same Patients: A Comparison of Visual Outcome and Endothelial Cell Survival Presenting Author: Mahmood J Showail MD Co-Author(s): Yakov Goldich, David S Rootman MD* Purpose: To compare visual outcome and endothelial cell survival after Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK) in the fellow eye of the same patients. Methods: A chart review was completed for 17 patients who underwent DSAEK in one eye and later DMEK in the contralateral eye. Main outcomes included best-corrected visual acuity (BCVA) and endothelial cell density at six months after surgey. A subjective questionnaire was used to assess patients’ satisfaction. Results: The DMEK group showed better BCVA (P = 0.02) and lower endothelial cell density (P = 0.049) than the DSAEK group at six months. Average level of satisfaction was higher after DMEK (P = 0.002). Conclusion: Our results support the benefits of DMEK and suggest the need for long-term studies for further evaluation.
Scientific Poster 366 Descemet Membrane Endothelial Keratoplasty in Corneas With Prior Refractive Surgery: Visual Results, Topography Changes, and Complications Presenting Author: Mark A Terry MD*
Purpose: Report results and complications of Descemet membrane endothelial keratoplasty (DMEK) in eyes with prior LASIK or radial keratotomy (RK). Methods: Seven LASIK and two RK eyes with edema from Fuchs received DMEK. Best spectacle-corrected vision (BSCVA) and Pentacam astigmatic changes (astig) were measured. Rebubble and graft failure events were recorded. Results: Mean BSCVA improved from preop 20/41 to 20/24 postop (P = 0.026). Topographic astig changed from preop between 0.9 D of astig increase to 3.2 D of astig decrease. Steep axis changes from preop were unpredictable, ranging from only a 1-degree shift to a 64-degree shift . One eye was rebubbled. Conclusion: DMEK improves vision in eyes with prior refractive surgery, but correction of corneal edema may unmask large shifts in corneal topography. Triple procedures and especially toric lenses may be unpredictable in these eyes.
Scientific Poster 367 SOE H Clinical Outcome of the First 500 Consecutive Cases Undergoing Descemet Membrane Endothelial Keratoplasty Presenting Author: Martin Dirisamer MD Co-Author(s): Marina Rodriguez Calvo De Mora MD, Gerrit RJ Melles MD PhD*
Scientific Poster 368 Sulfur Hexafluoride for Descemet Membrane Endothelial Keratoplasty in the Learning Curve: Six-Month Postoperative Endothelial Cell Loss Presenting Author: Matthew Raeker MD Co-Author(s): Jordan J Rixen MD, Anna S Kitzmann MD, Michael D Wagoner MD, Kenneth M Goins MD**, Mark Greiner MD Purpose: To report six-month endothelial cell density (ECD) loss after Descemet membrane endothelial keratoplasy (DMEK) using sulfur hexafluoride (SF6) 20% air-gas tamponade. Methods: A retrospective review was performed on 22 eyes with Fuchs or posterior polymorphous dystrophy that underwent DMEK using SF6 20% by surgeons in their learning curve. ECD prior to graft preparation was obtained using specular microscopy. ECD six months after DMEK was obtained using confocal microscopy. The percentage ECD loss 6 months after DMEK was calculated. Results: Mean ECD prior to graft preparation was 2,684 cells/mm2 (range, 2,123–3,067; standard deviation [SD], 177). Mean ECD six months after DMEK was 1,594 cells/mm2 (range, 713–2,399; SD, 461). Mean percentage ECD loss six months after DMEK was 41% (range, 9–68; SD, 16). Conclusion: The use of SF6 20% in DMEK results in acceptable six-month postoperative endothelial cell loss for surgeons in their learning curve.
Scientific Poster 369 SOE H Endothelial Cell Loss Stabilizes as Early as 2 Years After Descemet-Stripping Automated Endothelial Keratoplasty Presenting Author: Yoav Nahum MD Co-Author(s): Cristina Bovone MD, Benedetta Filipovic-Ricci MD, Massimo Busin MD*, Cataldo Russo MD Purpose: To evaluate the progression of endothelial cell loss after Descemet-stripping automated endothelial keratoplasty (DSAEK) performed by an experienced surgeon. Methods: Student’s t test was used to determine, in 846 eyes, the significance of changes in endothelial cell count obtained six and 12 months after surgery and then yearly for up to five years. Results: The average follow-up time was 21.3 ± 18.6 months. The mean endothelial cell loss at six months was 33.3% and increased significantly only up to two years postoperatively, reaching 39.3%. At later examination times (three, four, and five years), changes were not statistically significant and varied between 2.1% to 2.4% yearly. Conclusion: Endothelial cell density stabilizes as early as two years after DSAEK.
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Co-Author(s): Michael D Straiko MD*, Peter B Veldman MD, Ahmad Mohammad Alshaarawy MD, Zachary Mayko MS
surgeries declined from 10% to 4%. Conclusion: DMEK may consistently give excellent clinical results. Technique standardization contributed to less graft detachments and relatively few secondary interventions required.
SESSION ONE, SATURDAY AND SUNDAY Scientific Poster 81 SOE Optimizing EHRs for Ophthalmology and Big Data Analysis: An Experience Report Presenting Author: Karsten Ulrich Kortuem MD Co-Author(s): Paul Foerster, Thomas C Kreutzer MD*, Anselm Kampik MD* Purpose: To design ophthalmological user interfaces (UIs) in EHR “i.s.h.med”, linking examination devices and thus creating a base for Big Data analysis. Methods: UIs were modified to ophthalmological needs using Advanced Business Application Programming language. Examination devices were linked using HL7 and DICOM standard. For every exam order, the unique EHR Patient ID was used. Results: Several UIs for in- and outpatients were created since 2012 based on clinical needs and workflow to acquire structured data. All clinical data (eg, visual acuity, medication, diagnosis) were saved in a database using the unique EHR Patient ID. In 2013, 27,599 outpatients were documented. Conclusion: A powerful base for clinical documentation as well as for future Big Data use was implemented.
Purpose: Clinical evaluation of Descemet membrane endothelial keratoplasty (DMEK). Methods: In 500 DMEK eyes, clinical outcome was evaluated up to six months postoperatively. Outcome was compared between three groups (I: cases 1–125, II: cases 126–250, and III: cases 251–500). Results: At six months, 80% of eyes reached a best-corrected visual acuity of ≥20/25 and 44% reached ≥20/20 (n = 394). Mean endothelial cell density was 1,600 ±490 cells/mm2 (n = 447) and did not differ between groups. (Partial) graft detachment rate decreased from 24% in group I to 10% in group III. Likewise, secondary
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Posters Scientific Poster 82 Identifying Factors Associated With Increased Pediatric Ophthalmology Visit Times Using EHR Data Presenting Author: Grant D Aaker MD Co-Author(s): Sarah Read-Brown, David S Sanders MD*, Leah Greenhill Reznick MD**, Thomas Yackel MD MPH**, Michael F Chiang MD* Purpose: To identify factors leading to increased patient visit times in a single-practitioner pediatric ophthalmology practice using EHR data. Methods: All patient visits from 1 year were reviewed, and multiple regression was employed comparing the following factors: age, new versus follow-up visit, and diagnosis type, to total visit time from EHR timestamp data. Results: Of 2701 visits, 5 visit types resulted in significantly longer visits (P < .001) with all other variables held constant: new patients (29 minutes longer than follow-up), adult patients (20 minutes longer than infants), adult strabismus, nystagmus, and new patients with cataract were 18, 19, and 34 minutes longer, respectively, than visits without these diagnoses. Conclusion: EHRs can identify factors affecting patient visit times.
Scientific Poster 83 H Postoperative Eye Drop Documentation Omissions With EHRs After Resident Cataract Surgery: An Under-recognized Source of Error Presenting Author: Julie M Kumata MD Co-Author(s): , Jayne Weiss MD* Purpose: To evaluate the accuracy of medication reconciliation (MR) in EHRs after resident-performed cataract surgery. Methods: This is a retrospective EHR review of all patients with resident cataract surgery in 2013 at one hospital. All patients received prednisolone acetate, moxifloxacin, and Tobradex ointment postoperatively. MR was reviewed to determine if drops were accurately charted by the first postoperative visit (POD1). Results: Ninety-eight percent of the 302 patients (296/302) returned for POD1. Thirteen percent had no MR completed, while 87% (258/296) had a completed MR. Of these, 64% (164/258) had a MR that omitted some or all of the drops. Only 36% (94/258) had a correct MR. Conclusion: Despite perceptions that EHRs facilitate accuracy of documentation, our study shows that MR errors and omissions still occur.
General Medical Care
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SESSION ONE, SATURDAY AND SUNDAY Scientific Poster 84 SOE The Choroid and Lamina Cribrosa Is Affected in Patients With Parkinson Disease: Enhanced Depth Imaging OCT Study Presenting Author: Muhsin Eraslan MD Co-Author(s): Sevcan Balci, Eren Çerman, Ozlem Sahin MD**, Devran Suer Purpose: To compare lamina cribrosa(LC) and choroidal thickness using enhanced depth imaging OCT (EDI-OCT) in Parkinson patients (PP) and controls. Methods: Complete ophthalmic examinations and OCT assessments of 28 PP and 26 healthy subjects were done. Severity was evaluated according to United Kingdom Parkinson Disease Society Brain Bank criteria. Results: There were no significant differences between groups regarding age and sex (P = .144, P = .569). The mean LC and choroidal thicknesses were significantly less in PP than control subjects. (P < .001, P < .05, respectively). Results were not correlated with severity of PP. Conclusion: Parkinson disease causes anatomical changes in the LC and choroid. Imaging these changes with OCT may help in diagnosis of early stage PP.
Scientific Poster 85 Ocular Trauma in the Emergency Department, 2006–2011
of 20 and 49, and the most common causes of injury were foreign bodies and falls. Conclusion: Policies aimed at protecting working-age males would likely have the greatest effect on reducing ocular trauma in the United States.
Scientific Poster 86 Ocular Manifestation in Severe Familial Hypercholesterolemia Patients Presenting Author: Alaa Samih Bou Ghannam MD Co-Author(s): Rola N Hamam MD, Jean Magdi Chalhoub BSMT MD, Mohamed Serhan Hamam MD, Robert H Habib PhD Purpose: To study ocular manifestations of patients with severe familial hypercholesterolemia (FHC). Methods: Twenty-eight patients known to have severe FHC and 24 agematched healthy controls were recruited and underwent full eye exam, including fluorescein angiography and OCT. Results: Patients with FHC had significantly higher percentage of early corneal arcus (64% vs. 4%) and xanthelasmas (32% vs. 0%) than the control group. These patients had also a prominent yellow rim around the optic nerve, not found in the control group (35% vs. 0%). Peripheral retinal vascular plaques and occlusions were more common among patients with FHC than among controls (21.4% vs. 0%). Conclusion: Severe FHC can have many ocular manifestations and complications that may require regular eye exam.
SESSION TWO, MONDAY AND TUESDAY Scientific Poster 370 Modified Portable Digital Camera (Pictor Plus) Is as Effective as Traditional Nonmydriatic Fundus Camera for Teleretinal Screening of Diabetic Retinopathy Presenting Author: Shailesh K Gupta MD** Co-Author(s): Sandeep Grover MD, K V Chalam MD PhD Purpose: To compare the efficacy of a modified portable digital camera (MPDC) to nonmydriatic fundus camera (NMFC) in screening of diabetic retinopathy. Methods: One hundred sixteen patients underwent one-field NMFC photography prior to MPDC photography followed by ophthalmoscopy by an ophthalmologist . The main outcome measure was detection of referable diabetic retinopathy (DR). Results: For MPDC, the sensitivity was 98.2%, specificity was 96%, and the technical failure rate was 2.2%. For nonmydriatic photography, the sensitivity was 93.0%, specificity was 89.7%, and the technical failure rate was 11.7%. Conclusion: Portable digital camera-assisted retinal photography is a cheap, effective method of screening for DR and superior to nonmydriatic digital photography.
Scientific Poster 371 H Effects of Relocating an Academic Ophthalmology Program From a Regional Level-1 Trauma Center to an Outpatient Facility Presenting Author: Surbhi Bansal MD Co-Author(s): Jorawer Singh MD, Vincent M Imbrogno MD, Mary Howard, Amandip Singh Cheema, Ausra Selvadurai MD Purpose: To investigate the effect on consult service of moving an inpatient ophthalmology department to an outpatient office. Method: Consults performed at a level 1 trauma center for the three years before and after department relocation were reviewed for patient demographics, diagnoses, and related procedures. Results: Relocation did not affect total surgical or consult volume, but fewer Medicaid patients and more privately insured patients were seen. Consults after the move focused more on acute ophthalmic issues and less on systemic conditions. Twenty-three percent of patients were seen for outpatient follow-up before the move versus 2% after. Conclusion: Closure of an ophthalmology clinic at a county hospital resulted in a greater than 90% decrease in patient follow-up but had little effect on inpatient and emergency department consultations.
Presenting Author: Sterling Haring Co-Author(s): Joseph Kaiser Canner MS, Rohit R Lakhanpal MD*, Eric B Schneider PhD* Purpose: To characterize demographic, causational, and mechanistic attributes of ocular trauma in the United States. Methods: Data on primary and all-diagnosis ocular trauma were collected from the Nationwide Emergency Department Sample and stratified by sex, age, type of injury, external mechanism, and whether ocular trauma was a primary diagnosis. Population-specific rates were calculated. Results: Over a period from 2006 to 2011, a total of 5,541,434 ocular trauma cases presented to emergency departments nationwide. 64.8% of presenting patients were male. Peak incidence rates occurred between the ages
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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Glaucoma SESSION ONE, SATURDAY AND SUNDAY
group. The myopic glaucoma eye group showed significantly higher ALD (P = .018), PTT (P < .001), PTT/line connecting BMO (P < .001), and PTT/ALD (P < .001) than the myopic eye group. Conclusion: LC parameters may be useful to differentiate normal, myopic, and myopic glaucoma eyes.
Scientific Poster 87 H Female Reproductive Factors and Risk of Glaucoma in the United States
Scientific Poster 91 Analysis of the Effect of Lighting Variation on Anterior Chamber Angle Measurements using Spectral Domain OCT
Presenting Author: Noelle Layer Pruzan MD
Presenting Author: Vikas Chopra MD*
Co-Author(s): Mary Qiu MD, Sophia Ying Wang MD, Kuldev Singh MD MPH*, Shan C Lin MD*
Co-Author(s): Kenneth Marion MBA MS,
Purpose: To investigate the relationship between female reproductive factors and glaucoma prevalence. Methods: Cross-sectional study of 2220 women age ≥ 40 years, including 1158 postmenopausal women, from the 2005-2008 National Health and Nutrition Examination Study. Results: In a multivariate analysis adjusted for potential confounders, a significantly greater risk of self-reported glaucoma was found with later age of menarche (OR: 4.92; 95% CI, 1.86-13.00). Among postmenopausal women, glaucoma was not significantly associated with the time between menarche and menopause (OR: 0.98; CI, 0.22-4.33) or with the use of hormone replacement therapy (OR: 0.87; CI, 0.33-2.26). Conclusion: Late menarche is associated with greater risk of glaucoma, adding support to the potentially protective role of sex hormones in glaucoma development.
Scientific Poster 88 SOE Does Early Glaucoma Affect the Central 10 Degrees of Visual Field? Presenting Author: Katia Novak-Laus PhD Co-Author(s): Freja Barisic**, Zoran Vatavuk MD**, Mia Zoric Geber MD*, Renata Ivekovic MD PhD** Purpose: To explore the comparison between the loss in sensitivity measured by standard automated perimetry (SAP) with local retinal ganglion cell + inner plexiform layer (RGC+IPL) thickness measured by spectral domain OCT in the macula of patients with an early stage of glaucoma. Methods: We evaluated the central 10 degrees in the Octopus visual field (VF). In OCT we analyzed RGC+IPL layer thickness. Results: Seventy-one percent of patients had loss of retinal sensitivity in the central 10 degrees VF, and 58% had structural changes; 44% of all patients had structural and functional changes. Conclusion: A 10 degree test pattern in 2/3 of patients showed loss of retinal sensitivity in the central VF. This functional damage more often appeared in the upper hemifield of VF, which corresponds to the lower retina, like a mirror picture.
Presenting Author: Mary Qiu MD Co-Author(s): Noelle Layer Pruzan MD, Ye Elaine Wang MD**, Kuldev Singh MD MPH*, Shan C Lin MD* Purpose: To examine the association between gynecologic surgery and glaucoma. Methods: Cross-sectional study of 2262 women age ≥ 40 years from the 2005-2008 National Health and Nutrition Examination Survey. Results: Self-reported history of hysterectomy and/or bilateral oophorectomy was associated with an increased odds of self-reported glaucoma (OR: 1.6; 95% CI, 1.0-2.6), adjusting for demographics and systemic diseases. Additional adjustment for gynecologic history resulted in an OR increase to 2.1 (CI, 1.2-3.9). Further adjustment for other eye diseases resulted in the OR decreasing to 0.7 (CI, 0.31.9), with diabetic retinopathy diagnosis having the greatest impact. Conclusion: Diabetic retinopathy may augment or confound the association between gynecologic surgery and glaucoma.
Scientific Poster 90 Comparison of the Lamina Cribrosa Parameters in Myopic Eyes and Myopic Glaucoma Eyes Presenting Author: Bo Ram Seol MD Co-Author(s): Jin Wook Jeoung MD*, Ki Ho Park MD*, Dong Myung Kim MD Purpose: To compare the lamina cribrosa (LC) parameters between normal, myopic, and myopic glaucoma eyes. Methods: This study included 35 normal eyes, 24 myopic eyes, and 64 myopic glaucoma eyes. The LC parameters3/4including anterior lamina depth (ALD), prelamina tissue thickness (PTT), ALD/line connecting Bruch membrane opening (BMO), and PTT/line connecting BMO, PTT/ALD3/4were obtained using swept source OCT. Results: The normal eye group showed significantly higher PTT/ALD (P = .006) than the myopic eye
Scientific Poster 92 SOE Mapping the Visual Field to the Macular Ganglion Cell Complex Thickness in Glaucoma Presenting Author: Antonio Ferreras MD PhD* Co-Author(s): Ana Belen Pajarin MD PhD, Pilar Calvo MD PhD*, Beatriz Abadia MD PhD, Michele Figus MD, Blanca Monsalve MD, Michele Iester MD Purpose: To determine the relationship between standard automated perimetry (SAP) and ganglion cell complex (GCC) thickness measured with OCT. Methods: Fifty-six healthy subjects and 52 open-angle glaucoma patients were selected. Factor analysis determined 5 superior and 7 inferior visual field (VF) regions. Pearson correlations were calculated between the GCC thickness and the VF regions. A map relating the GGC to the VF regions was plotted. Results: Mild to moderate correlations were observed between the VF regions and the GCC thicknesses. The strongest correlation was found between temporal inferior GCC and the sector corresponding to the nasal step in the superior hemifield (r = 0.556; P < .001). Conclusion:There was a moderate association between SAP and the GCC thickness.
Scientific Poster 93 SOE Relationship Between the Macular Ganglion Cell Complex and the Retinal Nerve Fiber Layer in Glaucoma Presenting Author: Antonio Ferreras MD PhD* Co-Author(s): Pilar Calvo MD PhD*, Mirian Ara MHSA, Beatriz Abadia MD PhD, Paolo Frezzotti MD**, Paolo Fogagnolo**, Ana Belen Pajarin MD PhD Purpose: To evaluate the relationship between the macular ganglion cell complex (GCC) measured with OCT and the retinal nerve fiber layer evaluated with scanning laser polarimetry (GDx). Methods: Forty-five healthy subjects and 40 open-angle glaucoma subjects were included. Participants were examined with Cirrus OCT (Macular Cube 512x128) and GDx with enhanced corneal compensation. Pearson correlations were calculated between the parameters of both devices. Results: Moderate to strong correlations were observed between the GCC thicknesses and the GDx parameters. The strongest correlation was found between the inferior GCC thickness and the nerve fiber indicator (NFI) of GDx (r = 0.704; P < .001). Conclusion: NFI of GDx showed the strongest correlations with the GCC.
Scientific Poster 94 Vessel Caliber, Not Retinal Oximetry, Is Affected in Glaucoma: A Comparison Between Eyes With Asymmetrical Glaucoma Severity Presenting Author: Clarissa Cheng MBBS Co-Author(s): Charles Ong, Zhu Li Yap MD, Shih Hsiang Andrew Tsai MD, Monisha E Nongpiur MD, Shamira A Perera MBBS Purpose: To compare and correlate retinal vascular oxygenation (RVO2) and vessel caliber (VC) in glaucoma and normal controls. Methods: Prospective cross-sectional study of primary angle-closure glaucoma (PACG), primary open-angle glaucoma (POAG), normaltension glaucoma (NTG), and normal control eyes. RVO2, VC, OCT, and visual field were tested. Results: Forty PACG, 44 POAG, 42 NTG, and 40 normal controls were included. Venular diameter was thinner in all glaucoma groups than in normal controls (P < .01). In eyes with asymmetrical severity, arteriolar diameter was thinner in the worse eye in the
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Poster 89 Association Between Gynecologic Surgery and Glaucoma Prevalence in the United States
Purpose: First study to report the impact of variations in ambient lighting conditions on the reproducibility of newer anterior chamber angle parameters based on the Schwalbe line (SL). Methods: The inferior angles of 50 normal eyes were imaged 20 times (total = 500 assessments) with Zeiss Cirrus SD-OCT at 5 different strictly controlled light levels guided by a light meter and graded independently by 2 experts. Results: Angle parameters are exquisitely sensitive to changes in ambient illumination. Decreasing the light level from 1.0 to 0.0 ft-candles decreased SL-angle opening distance (AOD) and SL-trabecular iris space area (TISA) by 10.7% and 13.7%, respectively. Intra- and intergrader results showed excellent reproducibility at each lighting level (R2 = 0.94-0.98). Conclusion: Strict control of lighting conditions is needed to obtain reproducible anterior chamber measurements.
Scientific Posters PACG group (P = .001). Arteriolar RVO2, venular RVO2, and arteriovenous difference was similar across the groups and between eyes of asymmetrical severity. Conclusion: VC, not RVO2, is reduced in glaucoma and inversely related to severity.
Scientific Poster 95 SOE Comparison of the Results of Heidelberg Retina Tomograph III and Spectral Domain OCT in Large and Small Discs Presenting Author: Belgin Izgi MD Co-Author(s): Serife Bayraktar, Nevbahar Tamcelik MD Purpose: To evaluate the correlation between the optic nerve head parameters obtained by the Heidelberg Retina Tomograph III (HRT III) and the retina nerve fiber layer (RNFL) measurements obtained by spectral domain OCT (SD-OCT) in large and small discs for the diagnosis of glaucoma. Methods:The patients who had large (> 2.55 mm2) and small (< 1.60 mm2) discs were evaluated by HRT III and SD-OCT on the same day. Results: We have evaluated 194 eyes of 133 patients in the large disc group (Group 1) and 115 eyes of 70 patients in the small disc group (Group 2). The mean disc area was 2.9 ± 0.3 mm2 and 1.4 ± 0.13 mm2 in Group 1 and Group 2, respectively. The correlation was poor in all quadrants in Group 1. It was moderate only in the superior quadrant and poor in the other quadrants in Group 2. Conclusion: To avoid the misdiagnosis of glaucoma in large and small discs it is important to obtain the RNFL measurements by SD-OCT after HRT III evaluation.
Scientific Poster 96 Factors Affecting Plastic Lamina Cribrosa Displacement in Glaucoma Patients Presenting Author: Kyoung In Jung Co-Author(s): Younhea Jung MD, Hae-ri Yum MD, Purpose: To investigate factors associated with irreversible components of anterior lamina cribrosa (LC) depth in glaucoma patients. Methods: A total of 141 glaucoma patients and 51 control subjects were enrolled. The depth of the lamina cribrosa (LC) was measured at the optic nerve head using Spectralis OCT. Results: In younger patients (age < 60 years), multivariate analysis revealed that those with a young age, short axial length, and a high follow-up IOP were at increased risk for having a deeper LC (P = .042, .028, .010). In older patients (age > 60 years), young age and a high untreated IOP were significantly associated with a deeper LC (P = .023, .001). Conclusion: Age and axial length as well as IOP were significantly related to LC depth in glaucoma.
Scientific Poster 97 Risk Factors for the Hypertensive Phase Presenting Author: Kyoung In Jung
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Co-Author(s): Younhea Jung MD, Hae-ri Yum MD, Purpose: To investigate risk factors for the development of the hypertensive phase after implantation of the Ahmed glaucoma valve (AGV). Methods: A total of 130 patients who had undergone AGV implantation were included in the study. Patients were divided into hypertensive and nonhypertensive groups. Results: Axial length was significantly longer in the hypertensive group than that in the nonhypertensive group (P = .011). Only axial length was significantly associated with development of the hypertensive phase (P = .009). Axial length was correlated with postoperative IOP postoperatively (P < .05). Axial length was correlated with bleb wall thickness at 1 month postoperatively (P = .021). Conclusion: Eyes with a long axial length were at the greatest risk for developing the hypertensive phase.
Scientific Poster 98 SOE Effect of Topical Prostaglandin Analogues on the IOP Measured Using 3 Different Tonometers
Scientific Poster 99 SOE Intraocular Pressure After Intravitreal Anti-Vascular Endothelial Growth Factor Injections Presenting Author: Vanessa Lemos MD Co-Author(s): Ana Cabugueira MD, Duarte Moreira Amado**, Maria P Reina MD, Teresa Gomes MD Purpose: To determine the effect of intravitreal bevacizumab injections (bIV) on IOP and to identify possible risk factors. Methods: This prospective study included 106 eyes receiving bIV as treatment for macular edema or choroidal neovascularization. IOP was measured immediately before and 5 minutes, 1 hour, and 15 days after injection. Data collected were age, gender, glaucoma, diabetes mellitus, phakic status, medication, subconjunctival reflux, and number of injections. Results: Mean preoperative IOP was 15.31 ± 3.90 mmHg and postoperative IOP at 5 minutes was 27.27 ± 11.87 mmHg; at 1 hour, 17.59 ± 6.24 mmHg; and at 15 days, 16.86 ± 3.86 mmHg. IOP elevation was statistically significant. Conclusion: One-third of the eyes achieved IOPs higher than 30 mmHg. Subconjunctival reflux contributes to a lower mean postoperative IOP. IOP management should be performed.
Scientific Poster 100 SOE Method Agreement in IOP Measurement With the Keeler Tonometer, Ocular Response Analyzer, Dynamic Contour Tonometer, and Goldmann Applanation Tonometer Presenting Author: Taiwo Christopher Makanjuola MD Co-Author(s): Gerassimos Lascaratos, Ahmed Elsheikh PhD, Ahmed Abass, Tuan Ho PhD, David F Garway-Heath MD FRCOphth* Purpose: The aim of this study was to compare the intermethod agreement in IOP measurements made with the Keeler Non-Contact Tonometer, Ocular Response Analyzer (ORA), Pascal Dynamic Contour Tonometry (DCT), and Goldmann applanation tonometer (GAT). Methods: IOP was measured with all 4 devices in the right eye of 89 healthy subjects and in 58 patients with primary open-angle glaucoma and in 1 with ocular hypertension. Results: Mean IOP was 16.2 (3.6) mmHg, 18.7 (3.7) mmHg, 15.4 (4.4) mmHg, 16.6(4.3) mmHg, and 17.4 (4.2) mmHg for GAT, DCT, Keeler, ORA IOPg, and ORA IOPcc, respectively. The mean difference in IOP measurement (in mmHg) was +2.5, -0.8, +0.4, and +1.2 between GAT and DCT, Keeler, ORA IOPg, and ORA IOPcc, respectively, with 95% LoA (in mmHg) of ±4.0, ±4.8, ±4.6, and ±5.5, respectively. Conclusion: The differences in IOP measurements between Keeler and ORA may be due to a calibration difference.
Scientific Poster 101 Comparison of IOP Readings Following Radial Keratotomy Using 3 Tonometry Techniques Presenting Author: Mujtaba A Qazi MD* Co-Author(s): Jay R Patel MD, Jay Stuart Pepose MD PhD* Purpose: To compare IOP and corneal biomechanical metrics following radial keratotomy (RK) using Goldmann (GAT), Ocular Response Analyzer (ORA), and Pascal Dynamic Contour (DCT) Tonometry. Methods: Topography, pachymetry, and ORA corneal biomechanical markers were recorded in RK eyes (n = 14). IOP measurements using 3 tonometry techniques were statistically analyzed. Results: Hysteresis following RK was 8.5 ± 1.8 mmHg. Mean GAT (mean: 17.8 mmHg) and DCT (18.1) IOP were significantly lower (P < .05) than ORA IOPg (20.6) and IOPcc (22.4). Conclusion: IOP measurement in RK presents a unique challenge given normal pachymetry with altered corneal shape and biomechanics. Clinical correlation of IOP with visual field and optic nerve imaging should be utilized to screen and monitor these patients for glaucoma.
Presenting Author: Cristina Sanchez-Barahona MD
Scientific Poster 102 Poor Follow-up and Knowledge Retention Despite Glaucoma Disease Counseling
Co-Author(s): Gema Bolivar de Miguel MD, Consuelo Gutierrez PhD
Presenting Author: Anna Do
Purpose: To evaluate the IOP using the Goldmann applanation tonometer (GAT), Ocular Response Analyzer (ORA), and Corvis ST after treatment with prostaglandin analogues (PGAs) in naive eyes. Methods: Prospective, observational study. GAT IOP, ORA cornea compensated IOP (IOPCC), and Corvis IOP were measured before and after 3 months of topical PGA treatment. Results: Fifty-nine eyes were analyzed. We did not find any statistically significant difference in drug-induced IOP decrease between GAT-IOP and IOPcc. IOP decrease measured by Corvis was significantly different (P = .0001). Conclusion: The IOP decrease induced by PGA treatment is different depending on the tonometer used.
Co-Author(s): Kuldev Singh MD MPH*, Elizabeth Washburn, Bradford William Lee MD MSC
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Purpose: To quantify longitudinal loss to follow-up among newly diagnosed glaucoma patients, and to evaluate learning and retention of glaucoma knowledge through disease counseling. Methods: 399 glaucoma patients completed a 9-point glaucoma knowledge questionnaire before and after glaucoma counseling at diagnosis and follow-up visits over a 12-month period. Results: After 12 months, 86.5% of subjects were lost to follow-up. Counseling improved knowledge of glaucoma temporarily (35.6% increase in glaucoma questionnaire score, P < .0001), but with poor retention 1 month later (14.1% decrease
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters in questionnaire score from prior visit, P < .001). Conclusion: Despite diligent counseling efforts, the majority of newly diagnosed glaucoma patients were lost to follow-up at 12 months and showed poor retention of learned glaucoma knowledge.
Scientific Poster 103 SOE An Open, Nonrandomized Study on the Effect of Preservative-Free Tafluprost on IOP in Patients With Ocular Hypertension or Primary Open-Angle Glaucoma Presenting Author: Anton B Hommer MD* Co-Author(s): Doreen Schmidl MD DOMS, Gerhard Garhofer, Leopold Schmetterer PhD* Purpose: To investigate the effect of an 8-week treatment with preservative-free tafluprost on IOP in patients with primary open-angle glaucoma (POAG) or ocular hypertension (OHT). Methods: Sixteen patients with either POAG or OHT with an uncontrolled IOP ≥ 30 mmHg were included in the study. IOP was measured at 8 a.m. and 6 p.m. on each study day. Results: Eight weeks after treatment start, average IOP had decreased from 35.6 ± 4.5 mmHg to 24.4 ± 4.6 mmHg at 8 a.m. and from 32.9 ± 5.4 mmHg to 21.9 ± 3.9 mmHg at 6 p.m. (P < .01 each). Conclusion: Our data indicate that treatment with preservative-free tafluprost is a safe and potent therapy to lower IOP in patients with POAG and OHT. Further studies are warranted to investigate the effect of preservative-free formulations for longterm treatment.
Scientific Poster 104 Adherence and Persistence of Topical Bimatoprost 0.01% vs. Bimatoprost 0.03% in Prior Latanoprost Users Presenting Author: Gail F Schwartz MD* Co-Author(s): Vaishali Patel**, Pamela Landsman-Blumberg MS PhD*, William Wong MS PHARMD* Purpose: Bimatoprost 0.01% (B01), a new ophthalmic formulation, was hypothesized to improve adherence and persistence compared with the original bimatoprost 0.03% (B03) formulation. Methods: Using pharmacy claims, adherence in 6035 B01 and 2705 B03 patients was measured as proportion of days covered (PDC). Persistence, as proportion of patients on continuous treatment for 12 months, was measured in 7780 B01 and 3454 B03 patients. Results: Adherence to B01 was significantly greater than to B03 (mean PDC: 0.74 vs. 0.68; P < .001). Persistence with B01 (52%) was significantly greater than with B03 (46%), < .001 . Those < 65 and 65+ had similar results. Conclusion: In clinical practice, B01 demonstrated adherence and persistence superior to that of B03 in latanoprostexperienced patients.
Presenting Author: Hector Fernandez Sr Co-Author(s): Nicolas Toledano Fernandez MD**, Carlos Salvador Fernandez Escamez MD**, Esther Corredera MD**, Susana Perucho** Purpose: To assess the effects on the human cornea of ocular hypotensors with benzalkonium chloride (BAK). Methods: Prospective single-blind cohort study of 50 eyes of 50 patients. One group was exposed to BAK and the other group was not. Mean follow-up time was 22 weeks. The change in cell density before and after therapy was measured. The changes in stromal reflectivity and branches of the sub-basal nerve plexus were also measured. Results: A major increase in the density of the layer of basal cells in the epithelium was observed in the group exposed to BAK (P < .05). No significant density differences were detected in the endothelium, the limbal cells, stromal reflectivity, or the sub-basal nerve plexus. Conclusion: Drops without preservatives showed less alteration of the eye surface, using confocal microscopy analysis.
Scientific Poster 106 Trabeculodialysis for Uveitic Glaucoma Presenting Author: Sunita Radhakrishnan MD* Co-Author(s): Dmitry Yarovoy MD, Lian Chen MD, Terri-Diann Pickering MD, Andrew George Iwach MD* Purpose: To describe outcomes of trabeculodialysis in uveitic glaucoma. Methods: Retrospective review. Success defined as ≥ 30% IOP reduction with no further surgery. Results: Ten eyes (7 patients) were included. Mean age was 33.6 ± 23.3 years. Causes of uveitis (juvenile rheumatoid arthritis, herpetic disease, and idiopathic: 80%; 8/10) were quiet be-
Scientific Poster 107 SOE Segmental Dilation of the Schlemm Canal Using an Original Canal Expander in Open-Angle Glaucoma Surgery: One-Year Results Presenting Author: Vinod Kumar MD PhD Co-Author(s): Frolov Mikhail**, Elena Bozhok, Galina Dushina** Purpose: To evaluate effectiveness of segmental dilation of the Schlemm canal (SC) using an original canal expander (CE) in decreasing IOP in patients with open-angle glaucoma (OAG). Methods: Between October 2012 and December 2013, an original CE was implanted ab externo to dilate a segment of SC in 18 eyes (18 patients) with OAG. Efficacy measures were IOP changes, complication rate, and additional medication. Results: At 12 months, complete and partial success was achieved in 60% and 40% of cases; mean IOP decrease was 13.5 mmHg (49.8% decrease from the baseline; P = .000); mean decrease in medication use was 1.5 (62% decrease; P = .000), respectively. Conclusion: Permanent dilation of a segment of SC using an original CE significantly decreases IOP in the long term.
Scientific Poster 108 H Twelve-Month Results After Stand-alone Implantation of CyPass Micro-Stent in Patients With Open-Angle Glaucoma in Bulgaria Presenting Author: Tsontcho Ianchulev MD* Co-Author(s): Bissera Petrova Samsonova MD PhD, Pravoslava Ianchuleva MD PhD* Purpose: To evaluate a supraciliary implant as a stand-alone treatment for patients with open-angle glaucoma unresponsive to topical therapies in a single site in Bulgaria. Methods: The implant was placed ab interno through a corneal incision under gonioscopic visualization as a stand-alone procedure. Outcomes were adverse events, IOP changes, and number of IOP-lowering medications at baseline and 1 year. Results: Eyes (n = 17) were enrolled. There were no major adverse events. Mean (SD) baseline IOP (n = 17) was 24.2 (5.2) mmHg, and medication usage was 2.1 (1.1). At 12 months (n = 15), subjects had a mean IOP of 17.6 (5.4) mmHg, representing a 23% reduction, with mean medication usage of 1.3 (0.9). Conclusion: The CyPass Micro-Stent is a safe and effective stand-alone treatment for open-angle glaucoma patients unresponsive to medications.
Scientific Poster 109 Effect of Trabectome in Patients With Prior Failed Tube Shunt Surgery Presenting Author: Sameh Mosaed MD* Purpose: To evaluate the safety and efficacy of Trabectome after failed tube shunt surgery. Methods: Twenty-four patients with prior failed tube shunt surgery who underwent Trabectome procedures were included in this study. All patients had at least 3 months of follow-up. Outcomes measured included IOP, glaucoma medications, and secondary glaucoma surgeries, if any. Results: IOP was reduced from baseline of 23.0 ± 6.5 mmHg to 16.1 ± 4.9 mmHg (P = .02), while number of medications was reduced from 3.2 ± 1.4 to 2.4 ± 1.5 (P = .34) at 12 months. Three patients required additional glaucoma surgery, with 15 patients reaching 12 months follow-up. Conclusion: The Trabectome was safe and effective in reducing IOP at 1 year follow-up in patients with prior failed tube shunt surgery, but not effective in reducing medication reliance in these patients.
Scientific Poster 110 Trabeculectomy Following Intraocular Bevacizumab for Neovascular Glaucoma: Long-term Outcomes and Prognostic Factors Presenting Author: Tomomi Higashide MD PhD Co-Author(s): Shinji Ohkubo MD PhD*, Kazuhisa Sugiyama MD PhD Purpose: To evaluate long-term outcomes and prognostic factors of trabeculectomy (TLE) following intraocular bevacizumab (IOB) for neovascular glaucoma (NVG). Methods: Retrospective review of consecutive cases (60 eyes of 54 patients). Postoperative follow-up periods were 42.2 ± 23.0 months. Surgical failure was defined as IOP ≥ 21 mmHg, additional medical or surgical treatments to reduce IOP, or loss of light perception. Results:
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Poster 105 SOE Corneal Effects of Ocular Hypotensors That Contain Benzalkonium Chloride: In Vivo Confocal Microscopy Analysis
fore surgery. Mean follow-up was 6.0 ± 5.6 years. Eight eyes (80%) were successful; at last follow-up, IOP reduction was 39%-67% from baseline in these eyes and number of medications was reduced by 1.8 ± 1.6. Two eyes (20%) failed due to further glaucoma surgery. There were no major complications; 1 eye had a 2-stage procedure due to bleeding. Conclusion: Trabeculodialysis was successful in 80% of eyes in this series. Since it is a minimally invasive procedure, it may be considered as first-line surgery in patients with uveitic glaucoma.
Scientific Posters Surgical success rates were 89.0%, 78.5%, and 68.2% at 1, 3, and 5 years, respectively. Multivariate Cox regression analysis showed that vitrectomy before and after TLE were significant independent risk factors (hazard ratio = 8.35, 8.44; P = .015, .006, respectively). Conclusion: The long-term outcome of TLE following IOB for NVG was favorable. Vitrectomy may negatively affect it.
Scientific Poster 115 H Management and Visual Outcome of Hemorrhagic Descemet Detachment in Canaloplasty
Scientific Poster 111 SOE Subconjunctival Bevacizumab Compared With Adjunctive Mitomycin C for Trabeculectomy
Co-Author(s): Ibrahim A Aljadaan MD, Saleh Alobeidan MD
Presenting Author: Nitin Anand MD FRCS* Purpose: To compare medium-term outcomes of primary trabeculectomy with subconjunctival bevacizumab (SCB) to those with intraoperative mitomycin C (MMC) application. Methods: Sixty-seven eyes of 61 patients, with 36 eyes receiving SCB 2.5 mg and 31 eyes in with MMC 0.02% for 2-3 minutes and a mean follow-up of 33 months, were included. Results:The probability of an IOP of < 19, > 5 mmHg with 20% decrease from baseline was 66% and 61% in the first year and 64% and 57% in the second year in the bevacizumab and MMC groups, respectively (P = .8). No differences were noted in complications, avascular blebs, or postoperative medications. Conclusion: No differences were found between IOP outcomes, bleb characteristics, or complications after trabeculectomy was augmented by either SCB or MMC.
Scientific Poster 112 SOE Cataract Extraction After Nonpenetrating Filtering Surgery Presenting Author: Nitin Anand MD FRCS* Purpose: To report the incidence of cataract extraction (CE) after deep sclerectomy (DS) and its effect on IOP control. Methods: 241 eyes of 241 patients with consecutive DS and follow-up of 85.4 ± 30.6 months. Results: The probability of avoiding cataract surgery was 97.5%, 83%, and 74.2% at 1, 3, and 5 years after DS. There was a significant association of age with cataract surgery (HR 1.06, P < .0001) and needle revision prior to cataract (HR 1.9, P = .02). Mean follow-up after CE was 47.6 ± 28.3 months. The mean IOP before CE was 11.6 ± 4.5 mmHg and increased significantly at all measured time intervals up to 3 years after cataract surgery by 1-2 mmHg, with no change in the number of glaucoma medications. Conclusion: The probability of CE after DS is low and gradually increases with time and age. IOP increases after CE.
Scientific Poster 113 Long-term Outcome of Ahmed Glaucoma Valve Implantation for Refractory Glaucoma in a Tertiary Hospital in Brazil Presenting Author: Ricardo Y Abe MD
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Co-Author(s): Jose Paulo Cabral Vasconcellos MD**, Vital Paulino Costa MD*
Presenting Author: Faisal Almobarak MD Purpose: To report the management and visual outcome of hemorrhagic Descemet detachment (HDD) in canaloplasty. Methods: Noncomparative case series. Results: Four eyes of 65 (6.15%) developed HDD. The first case was observed for 2 weeks and then intracameral SF6 15% injection was given. The patient developed dense corneal stain that resolved slowly over 24 months. The vision dropped from 20/40 to 20/80. Two cases underwent immediate and 1 day after canaloplasty surgical evacuation and regained vision (20/30 and 20/100) and corneal transparency. The last case had Yag membranotomy 2 weeks later and regained vision (20/60) and corneal transparency. Conclusion: HDD is a rare but serious complication of canaloplasty. Early recognition and management are important to prevent visual impairment.
Scientific Poster 116 Second Glaucoma Drainage Device vs. Combined Phacoemulsification After Primary Tube Shunt Failure Presenting Author: Yohko Murakami MD Co-Author(s): Laurie Dustin MS**, James Chee Hian Tan MD*, Vikas Chopra MD*, Brian A Francis MD* Purpose: To evaluate the efficacy in controlling IOP with second glaucoma drainage device (GDD2) implantation vs. phacoemulsification cataract extraction with GDD2 (phaco-GDD2) in the treatment of glaucoma with a prior aqueous shunt. Methods: A retrospective chart review was conducted. Treatment success was defined as 5 ≤ IOP ≤ 21 mmHg and 20% reduction from baseline. Main outcome measures were reduction in IOP and antiglaucoma medications. Results: A total of 82 patients matched on preoperative IOP were analyzed. GDD2 lowered IOP by 34.3% and phaco-GDD2 by 36.4% at 3 years. GDD2 reduced antiglaucoma medications by 1.5 at 1 year. Phaco-GDD2 reduced medications by 2.0 at 1 year and 1.0 at 2 years. Conclusion: Both GDD2 and phaco-GDD2 are effective as a second surgery. Phaco-GDD2 achieved successful IOP control with fewer medications than GDD2 at 2 years.
Scientific Poster 117 Combined Trabectome and Cataract Surgery vs. Combined Trabeculectomy and Cataract Surgery in Open-Angle Glaucoma Presenting Author: Sahar Bedrood MD Co-Author(s): Brian A Francis MD*
Purpose: To evaluate survival of Ahmed glaucoma valve and risk factors associated with failure. Methods: Retrospective study with 80 eyes of 77 patients. Failure was defined as additional glaucoma surgery, loss of light perception, or IOP greater than 18 mmHg and less than 5 mmHg. Results: The patients had a mean age of 57.16 years (± 18.73) and mean follow-up time of 35.25 months (± 20.05). Using Kaplan-Meier survival analyses, the cumulative probability of success was 80% in 1 year, 64.4% in 3 years, and 50.4% in 5 years. Cox proportional hazards model indicated that failure was associated with previous glaucoma surgery (P = .02) and African-American descendance (P = .002). Conclusion: African-American descendance and previous glaucoma surgery were associated with increased risk of failure.
Purpose: To compare the IOP-lowering effect of Trabectome combined with phacoemulsification cataract extraction (Trabectome+PCE) and trabeculectomy combined with PCE (trabeculectomy+PCE). Methods: Eighty-nine eyes were in the Trabectome+PCE group and 23 eyes were in the trabeculectomy+PCE group with at least 1 year follow-up. The main outcomes were IOP, complications, and glaucoma medications. Results: IOP was reduced from 22.1 ± 5.5 mmHg (n =89) to 15.4 + 3.1 mmHg (P < 0.01) in Trabectome+PCE cases, and 23.0 ± 10.7 mmHg (n = 23) to 11.0 ± ;5.7 mmHg at 1 year (P < 0.01) in the trabeculectomy+PCE cases. Four cases (4%) required additional glaucoma surgery in the Trabectome+PCE group and 3 cases (13%) in the trabeculectomy+PCE group. Conclusion: Trabectome+PCE may be another option for patients. However, patients requiring low target IOP may still benefit from trabeculectomy+PCE.
Scientific Poster 114 H Effectiveness of Retrobulbar Chlorpromazine Injection in Controlling Ocular Pain in Patients With Glaucoma
Scientific Poster 118 Anterior Chamber Biometrics and IOP Dynamics Following Cataract Extraction in Glaucoma Patients
Presenting Author: Davinder S Grover MD*
Presenting Author: Ferhina S Ali MD
Co-Author(s): Stephen M Hypes DO, Ronald Leigh Fellman MD OCS*, Ildamaris Mercedes MontesdeOca MD**, Harry A Quigley MD*, Pradeep Y Ramulu MD PhD*
Co-Author(s): Sasan Moghimi MD, Diego Tebaldi de Queiroz Barbosa MD, Guofu Huang MD**, Shan C Lin MD*
Purpose: To determine the effectiveness of retrobulbar chlorpromazine injection (RBCI) in reducing ocular pain. Methods: The charts of glaucomatous eyes undergoing RBCI between 2011 and 2012 were reviewed. Survival analyses were performed to assess ocular pain. Results: 109 patients received RBCI with 94% simultaneous diode laser cyclophotocoagulation. Fifty-seven percent of eyes had neovascular, 13% had primary open-angle, and 8% had traumatic glaucoma. Kaplan-Meier analyses of 1 injection resolved pain in 89%, 86%, and 81% of patients at 6, 12, and 24 months. With persistent pain, a second injection was successful in 71% of eyes. Conclusion: RBCI is an effective procedure for painful eyes with glaucoma and should be considered as an alternative to enucleation.
Purpose: To determine the association of anterior chamber biometrics with IOP lowering after cataract surgery in primary open-angle glaucoma (POAG) patients. Methods: Preand postoperatively, angle opening distance 500 µm anterior to the scleral spur (AOD500), the trabecular–iris space area 500 µm from the scleral spur (TISA500), and iris curvature were obtained by anterior segment OCT (n = 34). Results: The mean AOD500 increased significantly by 0.180 mm and the mean TISA500 increased with marginal significance by 0.054 mm3. The mean IOP decreased significantly by -2.5 mmHg (P < .01), which correlated by marginal significance with the increase in the AOD500 (r = 0.30, P = .05) and with the change in iris curvature (r = 0.032, P = .05). Conclusion: The reduction in IOP was associated with the increase in the angle opening and the change in iris curvature.
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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 119 A Retrospective Survey of Childhood Glaucoma Prevalence According to Childhood Glaucoma Research Network Classification
Scientific Poster 123 Clinical Utility of Short-Duration Transient Visual Evoked Potential Pathologic Indicators in Chronic Glaucoma
Presenting Author: Ambika Hoguet MD
Co-Author(s): Richard Trevino OD, Sylvia L Groth MD, Joseph J Allen, Kimberly A Thoe COA
Co-Author(s): Alana Grajewski MD*, Elizabeth A Hodapp MD, Mark A Werner MD**, Ta Chen Chang MD* Purpose: To evaluate the Childhood Glaucoma Research Network (CGRN) classification system and describe the prevalence of each subtype according to this classification. Methods: The medical records of 125 consecutive childhood glaucoma and glaucoma suspect patients over a 6-month period were retrospectively reviewed. The initial diagnosis and new diagnosis according to CGRN classification were recorded. Results: All patients fit 1 of the 7 categories of the new classification. Seventy-three percent of diagnoses were changed upon reclassification. The most common diagnosis was Glaucoma Suspect (38%, P < .05), followed by Primary Congenital Glaucoma (18%) and Glaucoma Associated With Acquired Conditions (18%). Conclusion:The CGRN classification provides a useful method of classifying childhood glaucoma.
Scientific Poster 120 SOE Early Clinical Features of Pseudoexfoliation Syndrome Presenting Author: Atilla Bayer MD Co-Author(s): Sirel Gur Gungor MD, Ahmet Akman MD Purpose: To determine the early signs of pseudoexfoliation (PX) in fellow eyes of cases with unilateral PX. Methods: Fellow eyes of 34 cases with unilateral PX were evaluated by slit lamp and gonioscopy. Findings associated with PX were recorded. Results were compared with the findings of 25 age-matched healthy eyes. Results: Mean age was 65.8 ± 3.4 years. Thirty-two eyes (94%) had pigmentation in the inferior angle located on or anterior to the Schwalbe line (P < .05). Other findings were pigmentation of trabecular meshwork in the inferior angle (71%), loss of peripupillary ruff (43%), and pigment dispersion following pupil dilation (43%) (P < .05). Conclusion: Pigmentation in the inferior angle seems to be the earliest finding associated with PX. This finding must be considered in cases with ocular hypertension for proper management.
Presenting Author: William Eric Sponsel MD*
Purpose: To assess rates of abnormal amplitude and latency findings in adults with chronic glaucoma using Diopsys Nova-LX P100 / N-75-referenced high contrast (Hc) and low contrast (Lc) stimuli. Methods: 143 eyes of 88 adults with chronic glaucoma staged as mild (HVF 30-2 MD > -6 dB), moderate (< -6 > -12 dB), or severe (< -12 dB) with Nova-LX were assessed, with paired t tests of Hc vs. Lc deficits. Results: Age (68.1 ± 13.2) was consistent across staged subgroups (71 mild, 25 moderate, 47 severe). Amplitudes were normal in > 85% of eyes and nondiscriminatory. Conversely, Lc and Hc latency both showed strong associations with perimetric staging, but Hc latency deficits were far more common (% abnormal [mild / moderate / severe / ] Lc: 8.1:13.3:38.2; Hc: 22.5:43.1:53.9; P = .0002). Conclusion: Latency increased with glaucoma severity, with Hc twice as common as Lc defects.
SESSION TWO, MONDAY AND TUESDAY Scientific Poster 372 Exfoliation Syndrome and Human T-Lymphotropic Virus Type 1 Presenting Author: Mineo Ozaki MD Co-Author(s): Saya Ishii MD, Mitsugu Shimmyo MD, Robert Ritch MD FACS* Purpose: The onset of exfoliation syndrome (XFS) may be influenced by virus infection.The epidemiological distribution of human T-lymphotropic virus type 1 (HTLV-1) carriers seems to correlate with the distribution of XFS in Japan. Our aim was to compare the prevalence of HTLV-1 carriers between XFS and non-XFS patients. Methods: We studied 165 XFS patients and 160 controls. Blood samples were analyzed by chemiluminescent immunoassay. Results: HTLV-1 was positive in 21 cases (12.7%) in the XFS group and in 17 cases (10.6%) in the control. Conclusion: There was no statistically significant difference in the prevalence of HTLV-1 carriers between the two groups (P = 0.5554).
Scientific Poster 121 Comparison of Anterior Chamber Parameters in Patients With Plateau Iris Configuration and Pupillary Block Using Anterior Segment OCT
Scientific Poster 373 Juvenile Open-Angle Glaucoma: Clinical and Genetic Characterization in Mexican Patients
Presenting Author: Sasan Moghimi MD
Purpose: To describe the clinical features in patients with juvenile glaucoma and perform genetic mutation Pro137Leu and Q368X study in a Mexican population. Methods: Complete ophthalmic examination and study in search of the mutation Pro137Leu and Q368X. Results: Of a total of 22 patients with juvenile glaucoma, 63.63% of patients had a history of hereditary familial primary open-angle glaucoma and juvenile glaucoma. A change was found, never before reported in three patients from the same family I432T. The PolyPhen analysis suggests that this change is probably damaging, with a score of 0.998. Conclusion: A Mexican group of 22 patients with juvenile glaucoma was studied, and a new mutation was found in the myocilin gene for the Mexican population.
Co-Author(s): Yingjie Li Jr**, Diego Tebaldi de Queiroz Barbosa MD, Mingguang He MD PhD, Shan C Lin MD*
Scientific Poster 122 Natural History of Visual Field Loss in Myopic Eyes Presenting Author: Paul M Tesser MD PhD* Co-Author(s): Jeremy Andrew Beatty OD Purpose: To investigate the natural history of visual field loss in eyes with myopia and myopic discs. Methods: Observational cohort study evaluating 55 patients with myopic discs who were referred with a previous diagnosis of primary open-angle glaucoma or normaltension glaucoma and established visual field loss in the context of myopia. Patients were followed for ≥ 5 years with serial achromatic perimetry. Patients demonstrating an IOP > 24 mmHg were excluded. Results: The decrease in mean deviation (MD) was ≤ -0.5 dB/yr for 76% of patients this cohort. In 54% of patients no net decrease in MD was observed. No patient demonstrated a change in MD of > -1.5 dB/yr. The change in pattern standard deviation was < 1.0 dB/yr for 96% of patients. Conclusion: The majority of patients with myopic discs demonstrated no progression of visual field loss.
Scientific Poster 374 SOE Correlation Between Posterior Pole Asymmetry Analysis and Peripapillary Retinal Nerve Fiber Layer in Early Primary Open-Angle Glaucoma Presenting Author: Ana Cabugueira MD Co-Author(s): Vanessa Lemos MD, Luís Pinto, Teresa Gomes MD, Rita Maria Flores*, Maria P Reina MD Purpose: To investigate the diagnostic ability of spectral-domain OCT posterior pole asymmetry analysis (PPAA) in early primary open-angle glaucoma (POAG). Methods: Peripapillary retinal nerve fiber layer (RNFL) and PPAA were acquired in 48 eyes of early POAG and in 39 eyes with ocular hypertension. Results: Total, superior, and inferior macular thickness was lower in the POAG group (P < 0.01). In POAG subjects, we observed a moderate positive correlation between superior temporal RNFL and macular thickness of a selected region of the superior hemisphere (R = 0.403; P < 0.01) and a strong positive correlation between inferior temporal RNFL and a selected region of the inferior hemisphere (R = 0.612; P < 0.001). Conclusion: Used with RNFL measurements, PPAA may be useful for early detection of POAG. The inferior macular hemisphere may be more vulnerable to early glaucomatous damage.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To quantitatively analyze the anterior chamber parameters in patients with pupillary block (PB) and plateau iris configuration (PIC) using anterior segment OCT (AS-OCT). Methods: Nonglaucomatous subjects were consecutively recruited and divided into 3 groups of open angles (121 eyes), PB (60 eyes), and PIC (31 eyes) based on gonioscopic and ultrasound biomicroscopy findings. AS-OCT parameters were obtained and compared. Results: There was no significant difference in angle parameters, anterior segment parameters (anterior chamber depth and area), iris thickness, iris curvature, or lens vault between PB and PIC groups. PIC eyes had borderline greater iris thickness than the PB group eyes (P = .05). Conclusion: AS-OCT parameters are not significantly different between PB and PIC eyes.
Presenting Author: Janet M Galicia Del Castillo MD
Scientific Posters Scientific Poster 375 Reduction Rates of Macular Ganglion Cell Complex Thickness in Preperimetric Glaucoma and Normal Eyes
Scientific Poster 379 Changes in the Prelamina and Lamina Cribrosa of Contralateral Eyes in Unilateral Glaucoma Patients
Presenting Author: Daisuke Shiba MD
Presenting Author: Dai Woo Kim MD
Co-Author(s): Takeshi Ono, Naoki Ozeki**, Kenya Yuki MD PhD, Kazuo Tsubota MD*
Co-Author(s): Jin Wook Jeoung MD*, Young Kook Kim MD, Ki Ho Park MD*, Dong Myung Kim MD
Purpose: To compare the changes of the macular ganglion cell complex thickness (GCCT) measured by spectral-domain OCT (SD-OCT) between preperimetric glaucoma (PPG) eyes and normal eyes. Methods: We retrospectively enrolled 27 PPG and 30 normal eyes with five or more times of macular SD-OCT examination as routine clinical practice. We compared the velocities of mean GCCT within 10 degrees from the fovea between PPG eyes and normal eyes by unpaired t-test. Results: The mean ages of PPG eyes and normal eyes were 51.6 ± 11.0 and 54.9 ± 13.3, respectively. The velocities of GCCT were –0.77 ± 0.70 µm/ year in PPG eyes and 0.00 ± 0.43 µm/year in control eyes (P < 0.001). Conclusion: GCCT reduction rate in PPG eyes was higher than that in normal eyes.
Scientific Poster 376 SOE Noninvasive Intracranial Pressure Measurement Method in Open-Angle Glaucoma Presenting Author: Lina Siaudvytyte MD Co-Author(s): Ingrida Januleviciene MD PhD*, Laimonas Bartusis, Alon Harris PhD* Purpose: To present a noninvasive absolute intracranial pressure (ICP) measurement method using a two-depth transcranial Doppler (TCD) device in open-angle glaucoma patients. Methods: We used a novel TCD device (Vittamed 205) to measure ICP in 60 normaltension glaucoma (NTG) and 60 high-tension glaucoma (HTG) patients. Results: Patients with NTG had lower ICP compared with HTG (P > 0.05). ICP was positively correlated with neuroretinal rim area in NTG (P < 0.05). Conclusion: The TCD device is the only available noninvasive ICP measurement method that does not need an individual patient-specific calibration. Further studies are needed to evaluate ICP’s role in the progression and management of glaucoma.
Scientific Poster 377 Baseline Structural Risk Factors for Functional Progression in the Advance Imaging for Glaucoma Study Clinical Trial Presenting Author: Mitra Sehi PhD*
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Co-Author(s): Xinbo Zhang PhD**, Ou Tan PhD*, Rohit Varma MD MPH*, David S Greenfield MD*, Joel S Schuman MD*, Brian A Francis MD*, David Huang MD PhD* Purpose: To identify baseline structural predictors for the development of glaucomatous visual field (VF) progression. Methods: Two hundred seventy-seven glaucomatous eyes underwent Fourier-domain OCT and VF biannually. Event-based progression was defined as significant deterioration of at least three locations on three pattern deviation plots. Trendbased progression was defined as significant loss of VF index . Multivariate Cox models were constructed. Results: Forty-eight eyes reached event-based and 64 eyes reached trend-based progression. The most significant predictors of progression were baseline ganglion cell complex focal loss volume (GCC FLV; HR = 1.08 per 1% higher; P < 0.001) and central corneal thickness (HR = 1.07 per 10 µm thinnerl; P = 0.01). Conclusion: Greater GCC FLV and a thinner cornea are risk factors for VF progression.
Scientific Poster 378 SOE Screening of Glaucoma Using Spectral Domain OCT in an Elderly Population: The ALIENOR Study Presenting Author: Cedric Schweitzer MD Co-Author(s): Olivier Rahimian**, Florence E Malet MD, Melanie Le Goff PhD, MarieBenedicte Rougier MD**, Marie-Noelle Delyfer MD PhD**, Jean-Francois Dartigues PhD**, Pascale Barberger-Gateau PhD*, Jean-Francois Korobelnik MD*, Cecile Delcourt PhD* Purpose: To screen glaucoma patients in an elderly population. Methods: Populationbased study involving 535 patients aged 75 years or older. Retinal nerve fiber layer (RNFL) thickness was measured using spectral-domain OCT (SD-OCT), and glaucoma diagnosis was made using retinophotography of the optic nerve head and International Society for Epidemiologic and Geographical Ophthalmology criteria. Results: RNFL thickness was significantly lower in the glaucoma group (65.4 ± 14.4 m ) than in the control group (88.2 ± 13.0 m; P < 0.001). Area under the receiving operating curve was higher for the global RNFL thickness (0.886), followed by the inferotemporal (0.867) and the superotemporal RNFL sector (0.857). Conclusion: SD-OCT may be a useful, fast, and noncontact tool to screen glaucoma in an elderly population.
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Purpose: To investigate the changes of the prelamina (PL) and lamina cribrosa (LC) of contralateral nonglaucomatous eyes in unilateral glaucoma patients. Methods: Optic discs of 52 glaucomatous eyes (Group 1), 52 contralateral nonglaucomatous eyes (Group 2), and 46 eyes of healthy control subjects (Group 3) were scanned by swept-source OCT. The LC parameters were measured and compared. Results: In Group 1, anterior PL surface depth (APLD) and LC depth (LCD) were deeper (P = 0.001 and P = 0.029, respectively), and PL thickness (PLT) was thinner (P < 0.001) than in Group 3. In Group 2, APLD and LCD showed no differences compared with Group 3; however, PLT was significantly thinner (P = 0.009). Conclusion: In the fellow eyes of unilateral glaucoma patients, PLT was decreased compared with that of healthy control eyes.
Scientific Poster 380 Three-dimensional Swept Source OCT Accurately Measures Optic Cup Volume in Primary Open-Angle Glaucoma Presenting Author: K V Chalam MD PhD Co-Author(s): Shailesh K Gupta MD**, Kumar Sambhav MBBS MD, Sandeep Grover MD Purpose: To measure optic nerve cup in primary open-angle glaucoma (POAG) using 3D swept-source OCT (SS-OCT). Methods: In this prospective, observational case series, SSOCT scans of the optic nerve head (12- by 9-mm area; 100,000 B-scans; interval, 100 µm ) were obtained in 66 POAG eyes and compared with 66 age-matched controls. Bruch’s membrane opening and anterior LC boundary were automatically delineated. The point with maximum LC depth and prelaminar neural thickness were averaged. Results: Optic cup volume in POAG measured 0.414 ± 0.281 (range, 0.022–1.5) cu mm and is significantly larger (P < 0.01) compared with controls with mean of 0.076 ± 0.005 (range, 0.01–0.23). Conclusion: SS-OCT objectively and accurately measured cup volume in POAG and is a useful tool in longitudinal monitoring of disease.
Scientific Poster 381 Effect of Myopia and Optic Disc Size on Ganglion Cell Inner Plexiform Layer and Retinal Nerve Fiber Layer Profiles Presenting Author: Sam Seo MD Co-Author(s): Jin Wook Jeoung MD*, Ki Ho Park MD*, Dong Myung Kim MD Purpose: To evaluate the effect of myopia and optic disc size on the ganglion cell inner plexiform layer (GCIPL) and retinal nerve fiber layer (RNFL) profiles. Methods: This study enrolled 168 eyes of 168 young healthy subjects. All individuals underwent imaging with the Cirrus OCT. RNFL and GCIPL thickness profiles were determined according to the disc area and spherical equivalent (SE). Results: Average and nontemporal RNFL thickness decreased as the SE decreased and disc area increased (all, P ≤ 0.001). The overall GCIPL thickness parameters were correlated positively with SE (all, P ≤ 0.005). Temporal GCIPL shows increasing tendency as disc area increased. Conclusion: Myopia and optic disc size affected the RNFL and GCIPL thickness profiles. GCIPL thickness decreased consistently depending on the degree of myopia.
Scientific Poster 382 Peripheral Lamina Cribrosa Depth in Primary Open-Angle Glaucoma: A Swept-Source OCT Study of the Lamina Cribrosa Presenting Author: Yong-Woo Kim MD Co-Author(s): Jin Wook Jeoung MD*, Dong Myung Kim MD, Ki Ho Park MD* Purpose: To investigate anterior laminar insertion depth (ALID) in primary open-angle glaucoma (POAG) eyes. Methods: The optic discs of 90 POAG eyes and 90 age-matched normal eyes were scanned by swept-source OCT. ALID, defined by vertical distance between anterior laminar insertion and the reference plane connecting Bruch’s membrane openings, was measured at each horizontal and vertical scans and compared between the groups. Results: The horizontal (382.60 ± 155.26 µm vs. 339.53 ± 111.61 µm; P = 0.034) and vertical ALID (429.93 ± 158.95 µm vs. 357.05 ± 115.57 µm; P = 0.001) was significantly larger in POAG eyes than normal eyes. Vertical-horizontal ALID difference was significantly larger in POAG eyes (P = 0.001). Conclusion: POAG eyes showed increased ALID and increased vertical-horizontal ALID difference compared with normal eyes.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 383 SOE Corneal Biomechanical Parameters in Different Types of Glaucoma
Scientific Poster 387 Caffeinated Energy Drink and IOP in a Young Population
Presenting Author: Goktug Seymenoglu MD
Co-Author(s): Sang Soo Kim MD
Co-Author(s): Esin Fatma Baser MD
Purpose: We examined the effect of caffeinated energy drinks on IOP of healthy young people. Methods: Forty healthy young volunteers consumed two types of drinks, each taken after four weeks of washout period. IOP and blood pressure (BP) were measured at 0, 30, 60, 90, and 120 minutes and 12 and 24 hours after the ingestion of the drink. Results: Ingested caffeinated energy drinks increase IOP, and the difference between both groups was statistically significant at 30, 60, 90, and 120 minutes (P < 0.05). There was also a corresponding increase in BP of the experimental group, and it was clinically significant at 30 and 60 minutes after consumption. Conclusion: Consumption of caffeinated energy drinks, which are popular among young people, induces increase of IOP and BP for a short duration of time.
Purpose: To compare the corneal biomechanical parameters in different types of glaucoma. Methods: Data from 400 patients were recorded. Corneal biomechanical properties and central corneal thickness (CCT) were compared between different glaucoma groups. Results: The mean corneal resistance factor of normal-tension glaucoma (NTG; 8.5) and pseudoexfoliative glaucoma (PXG; 8.7) groups were significantly lower than those of the primary open-angle glaucoma (POAG; 10.6) group (P = 0.001). The mean corneal hysteresis of NTG (7.9) and PXG (8.4) groups were significantly lower than those of POAG (9.6), primary angle-closure glaucoma (9.8), and ocular hypertension (10.8) groups (P = 0.001). The mean CCT of NTG (554) and PXG (533) groups were significantly thinner than those of all other glaucoma groups (P = 0.001). Corneal-compensated IOP measurements of NTG and PXG groups were significantly lower than all other glaucoma groups (P = 0.001). Conclusion: Corneal biomechanical parameters vary between different glaucoma types.
Scientific Poster 384 Change in Corneal Hysteresis and Optic Nerve Head Topography After IOP Reduction in Adult Glaucoma Patients Presenting Author: Surinder Singh Pandav MBBS MS Co-Author(s): Alka Khera PhD, Savleen Kaur MBBS, Sushmita Kaushik, Srishti Raj Sr**, Jagat Ram MBBS Purpose: To study any correlation in the change in corneal hysteresis (CH) and the lamina compliance after surgical reduction of IOP. Methods: Forty-eight adult patients underwent measurement of CH by the Ocular Response Analyzer and optic disc imaging on the Heidelberg Retina Tomograph preoperatively and at one week, one month, and three months posttrabeculectomy. Results: At three months, the CH decreased from a preoperative value of 8.96 ± 1.92 to 6.52 ± 2.89 (P = 0.00) and showed no correlation to the lamina compliance (r = 0.26) Conclusion: Changes in corneal biomechanical properties are independent of change in the lamina position in glaucoma patients.
Scientific Poster 385 The Effect of Repeat Selective Laser Trabeculoplasty on IOP Control Presenting Author: Georges M Durr MD Co-Author(s): Paul J Harasymowycz MD*
Scientific Poster 386 SOE Trans-scleral Diode Laser Cyclophotocoagulation for the Management of Refractory Glaucoma Following Intravitreal Triamcinolone Acetonide Presenting Author: Mohamed El-Bradey MD
Scientific Poster 388 Introducing Generic Latanoprost to the Marketplace: The Impact on Glaucoma Medication Adherence Rates Presenting Author: Joshua D Stein MD MS* Co-Author(s): Nidhi Talwar MS, Rajesh Balkrishnan** Purpose: To determine whether enrollees with open-angle glaucoma (OAG) who switched from brand name to generic prostaglandin analogues (PGAs) exhibited a difference in medication adherence compared with those who remained on brand name products. Methods: We calculated the mean PGA adherence rates during the 18 months prior to generic latanoprost availability (September 2009–February 2011) and the mean adherence rates during the subsequent 18 months after generic latanoprost became available (July 2011– December 2012) for 8,427 patients with OAG. Results: Patients who remained on brand name PGAs after generics became available had 39% increased odds of experiencing a 25% worsening of adherence (OR = 1.39; CI, 1.04–1.86). Conclusion: Adherence can be significantly improved by switching from brand name to generic PGAs.
Scientific Poster 389 SOE Temperament and Character Personality Traits of Glaucoma Patients Presenting Author: Sema Oruc Dundar MD Co-Author(s): Gokhan Evren Evlicoglu Sr MD**, Suzan Guvenyilmaz III, Tolga Kocaturk MD, Alper Yazici MD, Ali Osman Saatci MD** Purpose: To characterize the temperament and character personality profile of glaucoma patients. Methods: All participants were given theTemperament and Character Inventory (TCI). The TCI measures four domains of temperament (novelty seeking [NS], harm avoidance [HA], reward dependence, and persistence [PS]) and three domains of character (self-directedness [SD], cooperativeness, and self-transcendence [ST]). Results: Patients have lower scores compared with controls for the NS, PS, and ST dimensions (P < 0.0001). Patients achieved higher scores for the HA dimensions than controls (P < 0.0001). The SD scores were higher in the patients than controls (P = 0.008). Conclusion: Glaucoma patients had different personality profiles than healthy individuals. This may affect treatment compliance and is important for coping with maladaptive patient attitudes.
Scientific Poster 390 The Novel Topical Ocular Insert (Helios) for Sustained Delivery of Bimatoprost in Glaucoma and Ocular Hypertension Presenting Author: Ivan Goldberg MBBS FRANZCO*
Co-Author(s): Tarek Ragaey MD**
Co-Author(s): Guna Laganovska MD, Kristine Baumane, Juris Vanags, Stuart L Graham MBBS MS PhD*, Yair Alster*, Anne Rubin MBA*, Eugene de Juan Jr MD*
Purpose: To evaluate the efficacy and safety of transscleral diode laser cyclophotocoagulation (TDLC) in the management of refractory glaucoma complicating intravitreal triamcinolone acetonide (TAAC). Methods: This study included 21 eyes of 21 patients that developed refractory glaucoma following intravitreal TAAC (IOP ≥35 mmHg despite maximum medical treatment). Low energy level of TDLC was used, and the patients were followed up for at least one year. Results: The mean pretreatment IOP was 42.67 ± 5.61 mmHg, which reduced significantly (P = 0.0001) to 16.28 ± 5.82 mmHg after one year. The mean number of medications per eye dropped significantly from 3.52 ± 0.51 to 0.95 ± 1.24 (P = 0.0001). Only three eyes (14.3%) failed to respond to repeated TDLC. Conclusion: TDLC is a safe and effective treatment modality for refractory glaucoma following intravitreal TAAC.
Purpose: To assess the safety and effectiveness of the topical ForSight VISION5 Helios Insert to lower IOP. Methods: In two Phase 1 trials, eye drops were replaced by placebo ocular inserts during a washout of four weeks. Then, the effects of 4.2-mg bimatoprost inserts were monitored up to six months. Results: Of 43 subjects, 36 (71 eyes) received active inserts. Mean ± standard deviation IOP fell from 25.1 ± 2.8 mmHg post washout to 18.4 ± 4.4 mmHG (n = 66 eyes) at three months (D = -6.7 ± 3.4 mmHg; last observation carried forward if second medication added). Efficacy decreased after four months. Insert awareness/discomfort, increased mucus, and hyperemia were the most common observations. Conclusion: Bimatoprost inserts controlled IOP through three months with satisfactory safety. An insert designed to control IOP for six months is also under study.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Posters
Purpose: To evaluate the effect of repeat selective laser trabeculoplasty (SLT) on IOP. Methods: This study was conducted on 46 eyes with primary open-angle glaucoma (31), normotensive glaucoma (10), or secondary glaucoma (5). We measured the IOP at baseline before the first (SLT1) and second (SLT2) 360-degree SLT and at one, six, and 15 months. Results: Baseline IOP prior to SLT1 was 19.0 ± 3.7 mmHg, which dropped to 16.0 ± 3.7 mmHg, 16.9 ± 3.8 mmHg, and 17.2 ± 3.3 mmHg at one, six, and 15 months (P < 0.01). For SLT2, baseline IOP was 18.0 ± 4.5 mmHg, which dropped to 15.1 ± 3.8 mmHg, 15.1 ± 4.3 mmHg, and 16.0 ± 3.6 mmHg at one, six, and 15 months (P < 0.01). Conclusion: Repeat SLT diminishes IOP similarly to the first SLT, with a slightly more important response initially that seems to diminish similarly to the primary SLT with time.
Presenting Author: Seung Hwan Jo MD
Scientific Posters Scientific Poster 391 SOE Supraciliary Device Implantation With Phacoemulsification: One-Year Single-Center Experience in Warsaw, Poland Presenting Author: Marek Rekas MD* Co-Author(s): Izabela Nowak-Gospodarowicz, Mariusz Kosatka**, Tsontcho Ianchulev MD* Purpose: To evaluate the CyPass Micro-Stent, an ab interno supraciliary device, in patients with glaucoma undergoing cataract surgery. Methods: Patients were enrolled at the Military Institute of Medicine in Warsaw, Poland. The device was implanted following cataract surgery through the same corneal incision. Adverse events, IOP changes, and number of medications at one year were the main outcomes. Results: At baseline (n = 20), subjects had a mean IOP of 16.1 ± 3.3 mmHg, with 80% of patients taking at least two medications. There were no major adverse events. At one year, mean IOP reduced to 14.1 ± 3.1 mmHg, with 82% of subjects taking no medications. Conclusion: CyPass implantation with cataract surgery has an excellent safety profile and can reduce IOP and IOP-lowering medication usage at one year postoperatively.
Scientific Poster 392 Phaco-iStent in the Management of Patients With Cataract and Open-Angle Glaucoma Using the Modified Edmonton Surgical Technique Presenting Author: Michael W Dorey MD** Co-Author(s): Sourabh Arora MD, Christopher J Rudnisky MD*, Khaliq Kurji MD, Simrenjeet Sandhu** Purpose: To study the efficacy and safety of Phaco-iStent in patients with cataract and open-angle glaucoma (OAG) using a modified surgical technique. Methods: Patients underwent combined phacoemulsification and implantation of two iStents using the Edmonton technique. Results: One hundred forty-one eyes of 91 patients were included. The sixmonth IOP reduction among all cases was 4.82 mmHg (P < 0.01). Number of medications was reduced by 0.16 at six months (P = 0.45). For eyes with a preop IOP of at least 21 mmHg (n = 41), there was a reduction of 9.71 mmHg (P < 0.001). One patient had frank hyphema, and 12 (8.5%) had an IOP spike greater than 25 mmHg. Conclusion: Phaco-iStent using the modified Edmonton technique appears to be highly safe and efficacious in patients with cataract and OAG, especially those with higher baseline IOP.
Scientific Posters
Scientific Poster 393 Conjunctival Sparing Surgery in Overfiltration Hypotony: Transconjunctival Sutures of the Scleral Flap for Hypotony Maculopathy After Trabeculectomy
there was no significant difference in IOP at each time point between the two groups. The success rate of TR and LTDS at two years were 51.8% and 54.6%, respectively (P = 0.51). Conclusion: TR and LTDS were equally effective in lowering IOP in patients with POAG and EXG.
Scientific Poster 395 SOE Subconjunctival Bevacizumab to Augment Trabeculectomy with Mitomycin-C in Management of Failed Glaucoma Surgery Presenting Author: Ahmed M Saeed MD Co-Author(s): Tarek Tawfik Aboulnasr V** Purpose: To evaluate the efficacy and safety of trabeculectomy with intraoperative mitomycin C (MMC) plus subconjunctival bevacizumab injection compared with the effect of trabeculectomy with only adjunctive MMC. Methods: Twenty-eight eyes with failed scarred bleb were divided into two equal groups. The main outcome results included cumulative probability of surgical success, IOP values, and number of antiglaucoma drugs needed. Results: The achieved cumulative probability of complete success was 0.769 at 24 months. It achieved lower mean IOP with less antiglaucoma drugs at all visits (P > 0.05). No significant adverse effects were reported. Conclusion: Trabeculectomy with adjunctive MMC and bevacizumab could present an efficient and safe treatment strategy for failed trabeculectomy.
Scientific Poster 396 SOE Modified Trabeculectomy With Extended Subscleral Tunnel: Could It Be a Secure Way to Successful Glaucoma Surgery? Presenting Author: Ahmed M Saeed MD Co-Author(s): Sameh Mahmoud Saleh** Purpose: To evaluate safety and efficacy of an extended subscleral tunnel (ESST) in IOP control. Methods: Fifty-four glaucomatous eyes were divided into two groups. The main outcome results included surgical success, IOP values, number of needed antiglaucoma drugs, and size of aqueous drainage route (ADR). Results: The modified technique group achieved a cumulative probability of success of 0.96 at 24 months, lower mean IOP values with less antiglaucoma drugs at all postoperative visits, larger size of ADR (P > 0.05), and less postoperative complications and additional interventions (P = 0.029). Conclusion: Modified trabeculectomy with ESST could present an efficient and safe technique for a favorable long-term outcome of glaucoma surgery.
Presenting Author: Noureen J Khan MD
Scientific Poster 397 Safety and Efficacy of Combined TrabeculotomyTrabeculectomy With Intraoperative Mitomycin C for Developmental Glaucoma
Co-Author(s): Cyrus Golshani MD, Sameer Ahmad MD
Presenting Author: Vera A Essuman MBCHB*
Purpose: To assess transconjunctival resuturing of the scleral flap as a means of surgical intervention for hypotony maculopathy after glaucoma filtering surgery. Methods: Retrospective case series of transconjunctival resuturing in 11 eyes with hypotony maculopathy after trabeculectomy. Results: Mean preoperative IOP of 11 eyes was 2 mmHG, and mean final IOP was 12 mmHG (P < 0.05). Postoperative day 1 IOP spikes were noted (mean IOP, 22 mmHg). Preoperative visual acuity (VA) ranged from hand movements to 20/200. Final mean VA was 20/60, ranging from 20/25 to counting fingers (P < 0.05). VA improved after surgery from a mean of 20/200 to a final vision of 20/60. Conclusion: Transconjunctival scleral flap resuturing is a simple, repeatable, and minimally invasive procedure that can improve hypotony with quicker postoperative recovery compared with tradition bleb revision. Repeat sutures may be necessary.
Co-Author(s): Tom Akuetteh Ndanu**, Imelda-Odille Dziffa-Bella Ofori-Adjei MBCHB*, Samuel Owusu Asiedu OD, Christine Ntim-Amponsah MBCHB**
Scientific Poster 394 Clinical Results of Trabectome vs. Trabeculotomy Combined With Deep Sclerectomy for Open-Angle Glaucoma Presenting Author: Takanori Mizoguchi MD Co-Author(s): Tomoki Sato MD, Nobuchika Ogino MD PhD Purpose: To compare the effect of Trabectome (TR) with trabeculotomy combined with deep sclerectomy without using mitomycin C (LTDS) for primary open-angle glaucoma (POAG) and exfoliation glaucoma (EXG). Methods: We retrospectively reviewed 82 eyes (POAG, 43; EXG, 39) for the TR group and 66 eyes (POAG, 38; EXG, 28) for the LTDS group. Data were analyzed by using Kaplan-Meier survival analysis with an IOP endpoint of at least 20 mmHg and no more than 20% IOP reduction from baseline. Results: IOPs after surgery were significantly lower than baseline IOP in both groups (P < 0.000). However,
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Purpose: To compare safety and efficacy of combined trabeculotomy-trabeculectomy (CTT) with intraoperative mitomycin C (MMC; 0.4 and 0.2 mg/mL) for developmental glaucoma. Methods: Randomized controlled trial of children younger than 16 years of age enrolled from 2009 to 2013. Results: Fifty-seven eyes of 34 patients were analyzed: 37 controls and 20 in treatment groups. Overall success was 84.2%. Probability of success was reduced from 84% at six months to zero at 48 months. Significant differences found in pre- and postoperative IOPs ( P < 0.001). No significant differences found between groups regarding surgical success, pre-and postop visual acuities, bleb characteristics, and complications ( P > 0.05). Twenty-one eyes (36.8%) had well-functioning blebs. Conclusion: MMC added no advantage to the surgical success.
Scientific Poster 398 Visco-Trab Operation: A Dual Filtration Pathway for Management of Advanced Glaucoma Presenting Author: Tarek M Eid MD Purpose: To study efficacy and safety of visco-trab operation for management of advanced uncontrolled glaucoma. Methods: Visco-trab (a merge between viscocanalostomy and trabeculectomy operations) was used in 170 eyes. Mean follow-up was 37.3 ± 11.3 months. Results: Postoperative IOP, glaucoma drops, and visual field mean deviation were 11.6 ± 5.0, 0.7 ± 1.2, and 15.2 ± 5.7, compared with 23.1 ± 9.2, 3.1 ± 1.1, and 17.8 ± 6.8, preoperatively. Early postoperative course was unremarkable, with no devastating complications or visual loss. Moreover, 83.6% of eyes achieved a target IOP of 14 mmHg. Old age (P = 0.01),
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters previous surgery (P < 0.001), high preoperative IOP (P = 0.004), pseudophakia (P = 0.002), and needling (P = 0.001) were associated with failure. Conclusion: Visco-trab operation is safe and effective in achieving a low target pressure for advanced glaucoma.
number of antiglaucoma drugs in PEG eyes was 3.6 ± 0.85 1 versus 3.45 ± 1.28 in POAG eyes (P = 0.603). The complication rate was comparable (P = 1.000). Conclusion: ExPress is as effective in PEG as in POAG.
Scientific Poster 399 SOE Survival of Central Visual Acuity in Patients With Advanced Glaucoma Undergoing Trabeculectomy With Mitomycin C
Scientific Poster 403 SOE The Outcomes of Ex-Press Glaucoma Filtration Device in Secondary Glaucomas
Presenting Author: Dimitrios Tsoukanas MD
Co-Author(s): Shimon Rumelt MD MPA
Co-Author(s): Georgia Kosti**, Konstantina Platari MD, Theodoros Filippopoulos MD*
Purpose: To evaluate the ExPress glaucoma filtration device in eyes with secondary glaucomas. Methods: Forty-two consecutive eyes (n = 37) with secondary glaucomas. Results: The IOP decreased by 20.7 ± 7.4 mmHG (mean ± standard deviation) in all the secondary glaucomas, except in neovascular glaucoma (NVG) and iridocorneal endothelial dystrophy (ICE; 56 ± 10.4 mmHg, P = 0.007), at a follow-up of six to 40 months (mean, 12.2). Failure was encountered only in NVG and in ICE (P = 0.048) because of recurrent uveal tissue blockage. Conclusion: ExPress is efficient in secondary glaucomas, except for NVG and ICE.
Purpose:To determine the survival of visual acuity (VA) in advanced glaucoma patients undergoing surgery. Methods: Retrospective consecutive case series of 28 eyes with mean deviation 20 years) with RB. Results: The mean age at presentation was 27 years (range: 22-37). There were 3 males and 3 females. The mean duration of symptoms was 9 months (range: 1-25). All cases had sporadic unilateral RB. Based on International Retinoblastoma Staging System, 4 cases were classified as stage I (intraocular), and 2 as stage IIIA (orbital). Intraocular RB was treated by enucleation (n = 5). Multimodal treatment was performed in the 2 cases with orbital RB. Systemic metastasis and death due to metastasis occurred in 1 case. Conclusion: RB in adults is rare. It usually presents as an advanced disease necessitating multimodal approach.
Scientific Poster 154 SOE Swept-Source OCT Imaging of Choroidal Tumors Presenting Author: Jose M Caminal MD PhD Co-Author(s): Jaume Catala MD*, Alejandro Filloy MD, Agnieszka Dyrda MD, Ignacio Flores-Moreno MD PhD, Estefania Cobos MD, Marcos J Rubio Caso MD* Purpose: To describe the swept-source OCT (SS-OCT) features of a series of choroidal tumors and correlate them with clinical findings. Methods: A group of 50 tumors from 50 eyes corresponding to 45 patients with choroidal tumors underwent fundus photography, ultrasound and fundus autofluorescence imaging, and SS-OCT. Results: We included 22 nevi, 7 melanocytic lesions at risk, 6 choroidal melanomas, and 5 hemangiomas. SS-OCT allowed an accurate measurement of all tumors. Choroidal nevi displayed a compact and regular structure with preserved choriocapillaris. Choroidal melanomas showed an irregular inner structure. Choroidal hemangiomas have a regular sponge-like pattern different from melanomas and nevi. Conclusion: SS-OCT may play a role in differential diagnosis, follow-up, and monitorization of the choroidal tumors of the posterior pole.
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Scientific Poster 155 Iris Metastasis From Systemic Cancer in 103 Patients Presenting Author: Carol L Shields MD Co-Author(s): Swathi Kaliki MD, Gordon Crabtree, Ani Peshtani, Spenser Joel Morton, Ronan Akshay Anand, Jerry A Shields MD Purpose: To describe features of iris metastasis. Methods: Analysis of 103 patients. Results: The primary tumor was located in the breast (33%), lung (27%), skin (12%), kidney (7%), esophagus (3%), prostate (2%), endometrium (2%), urinary bladder (2%), and others (12%). The tumor was located at the iris root (52%), midzone (34%), or pupillary margin (15%), with mean diameter of 6 mm, multifocality (21%), and secondary glaucoma (37%). Ocular treatment included plaque / external radiotherapy (64%), systemic chemotherapy (22%), iridectomy (5%), or enucleation (4%). Conclusion: Iris metastases arise from breast or lung carcinomas in 60% of cases and are mostly controlled with chemotherapy or radiotherapy.
Scientific Poster 156 Comparison of Impression Cytology and Pathology in 72 Consecutive Conjunctival Tumors Presenting Author: Maria Cristina Gabela Co-Author(s): , Maria Teresa Daza**, Pedro F Salazar MD Purpose: To estimate sensitivity and specificity of impression cytology for suspicious conjunctival neoplasia. Methods: We included 72 patients with clinically suspicious ocular surface neoplasia. All cases underwent impression cytology, complete resection and histopathology study. Results: Sensitivity for cytology was 84.8% (CI, 68.1%-94.9%), and specificity 40.7% (CI, 20.4%-61.1%). Bayesian methods showed that sensitivity of cytology is near 65%, with 0.95 probability to be between 63% and 76%. Conclusion: Impression cytology is sensitive but has a low specificity. Using Bayesian analysis and combining clinical and cytologic diagnosis, a better specificity can be obtained. Impression cytology may be helpful in clinical practice for a more accurate diagnosis of ocular surface squamous neoplasias.
SESSION TWO: MONDAY AND TUESDAY Scientific Poster 442 SOE Incidence and Indications for Pars Plana Vitrectomy Following the Treatment of Posterior Uveal Melanomas in Scotland, United Kingdom Presenting Author: Henry Smith MD Co-Author(s): Seen Chia, Harold M Hammer MBChB**, Ewan G Kemp MD Purpose: To analyze indications and outcomes from vitrectomy following globe-sparing treatment of uveal melanoma in the Scottish Ocular Oncology Service. Methods: Review 715 cases from 1993 to 2008. Results: Of 445 eyes treated with Ru-106 plaque brachytherapy, 43 treated with local resection, and 227 treated with proton beam therapy (PBT), 17 (2.4%) required vitrectomy ó 10 for vitreal hemorrhage (VH), eight for retinal detachment (RD), and one combined VH/RD. Mean interval from tumor treatment vitrectomy was 2.2 years. RD followed 9.3% of local resection, 0.2% of plaques, and 0.9% of PBT. VH followed 7.0% of local resection and 1.6% of plaques. Conclusion: Most early vitrectomies (less than six months) were for RD following local resection (P = 0.011), and most late vitrectomies (more than six months) were for VH following plaques (P = 0.007). Rates of late RD following Ru-106 plaques were low.
Scientific Poster 443 H Ocular Toxicity, Systemic Toxicity, and Safety of Intravitreal Melphalan Injections for Retinoblastoma Presenting Author: Jasmine H Francis MD Co-Author(s): Scott Brodie MD PhD, Brian P Marr MD, Yves Pierre Gobin MD**, Ira Dunkel MD, David Abramson MD FACS Purpose: To evaluate the toxicity and safety of intravitreal melphalan. Methods: Twentynine eyes received 173 weekly intravitreal melphalan injections (a median of six times). Electroretinogram (ERG) recordings and complete blood counts were obtained. One hundred fifty-nine ocular surface and 108 needle-washing samples were cytopathologically evaluated. Results: Linear regression: For every additional injection, the ERG amplitude decreased by 4.6 µV (P = 0.0008). Upon treatment completion, there was no significant change in ERG (P = 0.63). There were no grade ≥2 hematologic events nor malignant cells in the ocular/ needle-washing samples. Conclusion: Despite no systemic toxicity, weekly melphalan injections can result in a decreased ERG response, suggesting retinal toxicity. The procedure appears safe, with no malignant cells recovered in the ocular/needle washings.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 444 Blood Flow Velocity in Monocular Retinoblastoma Presenting Author: Maria Teresa B Bonanomi MD
Scientific Poster 448 Renal Cell Carcinoma Metastasis to the Eye and Ocular Adnexa in 27 Patients
Co-Author(s): Osmar Cassio Saito, Patricia Picciarelli MD, Roberta Chizzotti Bonanomi FEBO**
Presenting Author: Sanket U Shah MD
Purpose: To compare velocity in central artery (vCRA )and vein (vCRV) between normal and tumor eyes, correlate them with tumor diameter and volume (TUvol), and evaluate influence on flow of clinical and high-risk features, including invasion of optic nerve (ONi), prelaminar (PreONi), postlaminar, surgical margin, anterior uvea, choroid, sclera, and extrascleral space. Methods: Enucleated retinoblastoma, magnetic resonance imaging, and ultrasonography with color Doppler 16 MHz assessing vCRA, vCRV, resistive index in central artery, pulse index (PI) in central vein, and HE pathology. Results: Eighteen cases. In terms of significant findings, vCRA and vCRV were higher in tumor eyes than in normal eyes (P < 0.001 for both). A larger TUvol is associated with a higher vCRA (P = 0.03). Boys had lower PI than girls (P = 0.02). Lower PI is related to ONi and PreONi (P = 0.008 for both). Conclusion: Retinoblastoma eyes have faster flow. Lower PI is related to ONi.
Purpose: To describe features and management of ocular metastases from renal cell carcinoma (RCC). Methods: Retrospective study. Results: RCC diagnosis preceded metastasis in 95% by 41 months. Of 56 tumors, most were unilateral (89%) and in males (81%). Involvement was intraocular (75% choroidal, 5% ciliochoroidal, 4% iridociliochoroidal, and 4% iris) or extraocular (7% orbit and 5% eyelid). Uveal metastases were orange, 4-mm thick, and echodense. Brachytherapy (25%), teletherapy (22%), intravitreal anti-VEGF (19%), or systemic chemotherapy (16%) achieved tumor control in 56%. Final visual acuity was 60 D. Methods: Twenty-four cases of extreme ectasia were fitted with various CLs. CL fit, visual acuity (VA), comfort, and chair time in 10 keratoconus (KCN), six pellucid marginal degeneration, four post-LASIK, and four post-radial keratotomy (RK) cases were analyzed. Results: VA improved to mean 0.9 in all. H CL, Rose K XL, and E CL fitted equally well in KCN. Peripheral design modification was done in post-LASIK and RK in Rose K XL, thus needing multiple trials. Reverse geometry S CL and E CL required minimal design modification. Comfort was maximum with E CL and H CL. Subjective visual improvement was maximum with H CL. Conclusion: CLs are a good option in extreme ectasia and can avoid need for keratoplasty.
Scientific Poster 162 SOE Significantly Aberrated Ocular Condition: Elevated Higher-Order Aberrations in Patients With Visual Symptoms in Native Eyes
Scientific Poster 452 Contact Lenses in Patients With Boston Keratoprosthesis Type 1 Implants: Do They Play a Role in Surface Inflammation?
Presenting Author: Jens Buehren MD
Presenting Author: Sarmad H Jassim MBChB
Co-Author(s): Oliver Klaus Klaproth*, Thomas Kohnen MD*
Co-Author(s): Joshua H Hou MD, Ellen Shorter OD, Maria S Cortina MD
Purpose: To compare higher-order aberrations (HOA) of eyes with visual complaints such as monocular diplopia to those of a young, normal population. Method: Total, corneal, and internal aberrations from 44 native symptomatic eyes (30 patients; mean age: 48 ± 11 a ) and 50 asymptomatic control eyes (50 subjects; mean age: 27 ± 4 a) were compared. Results: Symptomatic eyes exhibited significantly higher total coma (0.502 ± 0.291 vs. 0.287 ± 0.122 µm, P < .001), spherical aberration (0.301 vs. 0.184 µm, P < .001) and residual HOA RMS (0.497 ± 0.329 vs. 0.088 ± 0.074 µm, P < .001); also internal HOAs were elevated significantly. Conclusion:Patients who complained about visual symptoms had significantly elevated HOA and a lower retinal image quality compared to a control group.
Purpose: To investigate the inflammatory role of biofilm found on contact lenses (CLs) of patients with Boston type 1 (KPro). Methods: CLs (Kontour, Air Optix, or Hybrid) were collected from 10 KPro patients and processed for immunofluorescence (IF) or electron microscopy (EM) for the detection of biofilm components. IF for neutrophil elastase (NE) and cathelicidin (Cath) was performed. 4’,6-diamidino-2-phenylindole was used to identify nuclei. Results: Two of two CL analyzed by EM showed bacteria growing in biofilm structures. Eight of eight CLs revealed some degree of cellular components. IF showed the presence of neutrophils with neutrophil extracellular traps stained with NE and Cath. Conclusion: Biofilm formation on the surface of CLs in patients with KPro may induce sustained surface inflammatory activity that could contribute to complications and corneal melt.
SESSION TWO: MONDAY AND TUESDAY Scientific Poster 449 SOE Vision Improvement in Pilots With Presbyopia Following Perceptual Learning Presenting Author: Anna Sterkin PhD* Co-Author(s): Oren Yehezkel PhD*, Maria Lev MS**, Ravid Doron**, Yuval Levy MD MHA**, Liora Levian II MHA**, Russell Pokroy MD**, Barak Gordon MD MHA, Uri Polat PhD*, Tova Ma-Naim MD Purpose: Israeli Air Force pilots continue flying combat missions after the onset age of presbyopia. Optical corrections limit their flying capabilities. Here, we aimed to improve pilots’ near visual acuity (VA) using our proven, effective perceptual learning method. Methods: Forty presbyopic pilots were trained (GlassesOff mobile app, Gabor stimuli, three per week, 15-minute sessions, two to four months). Results: Despite their advantage of 0.26 logMAR (P = 0.001) in VA for brief presentations (120 or 60 ms) compared with 152 agematched controls, pilots improved after training (P = 0.01), most of them reaching the level
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Orbit, Lacrimal, Plastic Surgery SESSION ONE, SATURDAY AND SUNDAY Scientific Poster 163 Should We Perform Levator Resection in Congenital Ptosis Patients With Poor Levator Function? Presenting Author: Adit Gupta Jr MBBS Co-Author(s): Akshay Gopinathan Nair MD, Swathi Kaliki MD, Milind N Naik MBBS, Mohammad J Ali MBBS MS, Tarjani V Dave MBBS** Purpose: To report the outcome of levator resection in patients with severe congenital ptosis. Methods: Single-surgeon, retrospective, interventional case series. Records of patients with severe congenital ptosis (levator palpebrae superioris [LPS] action < 5 mm) were reviewed. Outcome of the correction was evaluated by objective grading by 2 surgeons us-
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters ing photographs. Results: Twenty-five patients with a mean age of 16.92 years and mean follow-up duration of 7.2 months. The mean LPS action was 3.84 mm. Functional success was noted in 21 eyes. Objective grading of the correction reported 11 cases with perfect symmetry, 10 with mild-moderate undercorrection, and 4 with no benefit. Complications were noted in 7, which included exposure keratopathy in 4, microbial keratitis in 1, and contour abnormality in 3. Conclusion: Levator resection is a good alternative in severe congenital ptosis.
Scientific Poster 164 Endonasal Endoscopy-Assisted Lacrimal System Intubation Presenting Author: Jia-xu Hong MD Co-Author(s): Jian-jiang Xu MD** Purpose: To investigate the usefulness and safety of endonasal endoscopy (EES) in aiding the intubation for lacrimal duct obstruction. Methods: The surgery was performed in 378 eyes of 346 patients. Patients decided to receive or not receive the help of EES for the intubation. Intraoperative complication, surgery time, and patients’ pain scores were assessed. Results: With EES, the intubation was performed successfully in all 206 patients (221 eyes). However, the success rate was only 93% (146/157 eyes) without EES. The nasal mucosal bleeding rate and the pain scores were higher without the EES. The EES group took less surgery time. Conclusion: EES proved to be easy to perform, time saving, less invasive, and better tolerated for lacrimal system intubation.
Scientific Poster 165 The Effectiveness of Topical Steroid Instillation in Patients With Recently Developed Nasolacrimal Drainage Stenosis Presenting Author: YongDae Kim Co-Author(s): Namju Kim MD, Ho Kyung Choung MD**, Sang In Khwarg MD
and 95.8%. There was a significant difference in operation duration; C was shortest, then A, then B. There was no difference in success rate. Conclusion: The double encirclage technique has many advantages, such as saving time, ease of communication, keeping canaliculus widely, resistance to avulsion force, and lower possibility of narrowing after tube removal.
Scientific Poster 168 Plasma Surface Modification of Porous Polyethylene Implants in Orbital Reconstruction Presenting Author: Seong-Won Yang MD PhD Co-Author(s): Saemi Park MD Purpose: To investigate the preosteoblast adhesion and osseointegration on hydrophobic porous polyethylene (PE). Methods: Surface modified PE was prepared by oxygen or nitrogen plasma. After plasma treatment, adhesion and differentiation of MC3T3-E1 cells were evaluated using a MTT assay and alkaline phosphatase (ALP) activity, respectively. A total of 6 white rabbits’ orbital (medial, inferior, and maxilla) bones were exposed. After that, the pretreated implant was inserted. Micro-CT and immunostaining were performed before exposure and at 4 and 8 weeks. Results: In vivo, plasma-treated samples demonstrated a better bone formation than the control. Conclusion: Plasma-treated porous PE can be used as a useful material for orbital fracture.
Scientific Poster 169 Periocular Changes Associated With Topical Bimatoprost in the Rabbit Presenting Author: Tiffany L Kent MD Co-Author(s): Philip L Custer MD*
Purpose: To evaluate the effectiveness of steroid eye drops in patients with recently developed nasolacrimal drainage stenosis. Methods: The medical records of 108 eyes of 56 patients who recently (within 3 months) developed epiphora and received topical steroid eye drops were reviewed. Changes in epiphora were assessed, and tear meniscus heights and fluorescein dye disappearance tests were evaluated at 1, 3, and 6 months. Results: Epiphora had improved in 45 patients (42.0%) at 1 month and in 55 patients (51.0 %) at 3 months after treatment, and mean time to symptom improvement was 3.8 ± 1.9 weeks. Fifty-six eyes (51.9 %) of 108 eyes had improved at last follow-up visit. Conclusion: Instillation of topical steroids should be considered in patients who got recent-onset epiphora.
Purpose: To determine the anatomic effects of topical prostaglandin analogs on the eyelids of New Zealand white rabbits. Methods: Animals were divided among 3 groups: untreated controls, 0.03% bimatoprost (PGA), and artificial tears (AT). Eyelid measurements were obtained at baseline and after 3 months of treatment. Results: Measurements from controls, Ats-treated lids, and PGA-treated lids, respectively, were as follows: (1) canthuscanthus: 21.5 ± 0.58, 20.25 ± 1.26, and 19.0 ± 0.87; (2) lower lid distraction: 8.125 ± 0.63, 8.75 ± 0.5, and 6.11 ± 0.60; (3) upper lid distraction: 11.25 ± 0.5, 10.0 ± 0.82, and 7.78 ± 1.20. Conclusion: Daily topical PG drops resulted in horizontal shortening of the eyelids and acquired blepharophimosis in rabbits. This finding is similar to what is observed in human patients.
Scientific Poster 166 Crawford Tube Dislocation Following Endoscopic Dacryocystorhinostomy: A Retrospective Comparison of 3 Securing Techniques
Scientific Poster 170 Slitlamp Laser for Removal of Small Eyelid Nonmelanoma Skin Cancers
Presenting Author: Mazeyar Saboori MD
Co-Author(s): Victoria Michelle Rice
Purpose: To compare the rate of Crawford tube prolapse in patients who underwent endoscopic dacryocystorhinostomy (DCR) using 3 different techniques for securing the tubes in the nose. Methods: Retrospective review of patients who underwent primary endoscopic DCR. All patients underwent surgery by 1 of 3 surgeons who used a similar technique except for their method for securing the Crawford tubes: (1) tying a knot and securing to the lateral wall with 6-0 vicryl, (2) using a red rubber catheter at the end of the tube, or (3) tying the tubes in a square knot. Results: Dislocation rates for the 3 groups were as follows: (1) 7% (n = 57), (2) 11.5% (n = 61), (3) 17.8% (n = 45) P = .243. Conclusion: While there was a higher rate of tube prolapse in Group 3 than in the other groups, this difference was not statistically significant.
Scientific Poster 167 Comparing the New Bicanalicular Double Silicone Encirclage and Thick Bicanalicular Mono Silicone Encirclage in Canalicular Laceration Presenting Author: Seong-Won Yang MD PhD Co-Author(s): Saemi Park MD Purpose: To compare the double silicone encirclage with the thick mono silicone encirclage in canalicular laceration. Methods: Forty-eight patients were reviewed. Twelve were treated with a mono silicone encirclage (A, diameter = 0.6 mm), 12 with a thick mono silicone encirclage (B, diameter = 0.9 mm), and 24 with a double encirclage (C, diameter = 0.6 mm). The outcome was analyzed according to the operation methods, types of tube, and number of suture knots. Results: The success rates of A, B, and C were 91.6%, 91.6%,
Purpose: To determine the success of an office-based slitlamp 532-nm diode laser for removal of small eyelid margin nonmelanoma skin cancers that are typically removed in an outpatient setting. Methods: Twenty-five malignant eyelid lesions along the lid margin or lash line underwent biopsy and slitlamp laser ablation over a 6-year period. Results: There was a success rate of 88% (22 of 25 lesions) with a follow-up period ranging from 12 to 71 months (median: 31 months). The 3 recurrences were detected at 9, 12, and 44 months following initial treatment. Conclusion: The slitlamp diode laser is a cost-effective method for removal of small eyelid nonmelanoma skin cancers. The nearly 90% success rate supports further research into this minimally invasive and less expensive office-based treatment.
Scientific Poster 171 Hemifacial Spasms: Epidemiological Aspects and Management Outcome Over a Decade Presenting Author: Ankita Nema MBBS MS Co-Author(s): Aditi Pujari, Swathi Kaliki MD, Mohammad J Ali MBBS MS, Milind N Naik MBBS, Akshay Gopinathan Nair MD Purpose: To describe the epidemiologic profile and management outcomes of hemifacial spasm (HFS). Methods: Clinicoepidemiologic profile and management outcomes with botulinum toxin injection of patients diagnosed with HFS and treated at the Department of Ophthalmic Plastic Surgery, LV Prasad Eye Institute, Hyderabad, India, between 2003 and 2013 were reviewed. Results: Among the 198 patients studied, mean age at presentation was 49.7 years. 482 injections with average dose of 18.5U were given, with the effect lasting for 4.6 months with a follow-up of 17.6 months. Side-effects noted were lagophthalmos and ptosis. Conclusion: HFS patients usually present in the fifth decade. With an average dose of 18U, control was observed for 4.6 months.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Co-Author(s): Ryan T Scruggs MD, Evan H Black MD, Geoffrey J Gladstone MD**, Francesca D Nesi MD, Frank A Nesi MD**
Presenting Author: Charles D Rice MD
Scientific Posters Scientific Poster 172 Sutureless Blepharoptosis Repair Presenting Author: Christian Swinney
Scientific Poster 176 SOE Occurrence and Severity of Upper Eyelid Skin Contracture in Facial Paralysis
Co-Author(s): Ming Chen MD, Douglas P Dworak MD, Thomas D Patrianakos DO
Presenting Author: Kimia Ziahosseini MD
Purpose: To describe the efficacy and safety of the sutureless Fasanella-Servat operation. Methods: A sutureless variation of the Fasanella-Servat operation was performed by a single surgeon at a single surgical location. Results: Of the 61 eyes included in this study, good lid position was obtained in 58 eyes (95.1%). The remaining 3 eyes showed improvement of lid position but not to the desired extent. No major complications were observed. Conclusion: The sutureless Fasanella-Servat procedure can be used to effectively treat mild blepharoptosis. The extended follow-up of this study supports this procedure’s longterm efficacy. The lack of complications suggests that this operation is a safer alternative to the traditional Fasanella-Servat operation.
Co-Author(s): Vanessa Venables**, Charles Nduka**, Raman Malhotra MBChB FRCOphth
Scientific Poster 173 Dynamic Analysis of Müller’s Muscle Response to Phenylephrine Presenting Author: Sathyadeepak Ramesh MD Co-Author(s): Ronald Mancini MD Purpose: To characterize the in vivo response of the Müller’s muscle to phenylephrine regarding time response and diurnal variation. Methods: A nonrandomized trial of healthy adults (n = 20, 40 eyes) measured for response of margin reflex distance-1 (MRD-1) to topical phenylephrine in the morning (6-9 a.m.) and evening (6-9 p.m.). Mean MRD-1 was plotted over time, and morning and evening MRD-1 were compared with paired t test. Results: Ninety percent of subjects had maximal response to phenylephrine within 1 minute. There was no difference between morning and evening response. Conclusion: Maximal response to phenylephrine occurs within 1 minute of instillation; there was no diurnal variation with the phenylephrine test.
Scientific Poster 174 Methicillin-Resistant Staphylococcus Aureus Infection as a Cause of Chronic Socket Discharge and Orbital Implant Exposure Presenting Author: Imtiaz Chaudhry MD PhD
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Co-Author(s): Yonca O Arat MD**, Ayman Al-Ayoubi MD**, Milton Boniuk MD** Purpose: To report methicillin-resistant Staphylococcus Aureus (MRSA) infection as the cause of anophthalmic socket complications. Methods: A noncomparative, interventional, retrospective case series of 40 patients with MRSA-caused socket infection studied over a 4.5-year period for their complications. Results: Among the 40 patients (25 male; average age: 45.4 years), all had chronic discharge from their sockets, and despite therapy, 27 showed evidence of orbital implant exposures or extrusions. Presence of MRSA was confirmed by culture results. All patients required treatment with antibiotics, and 25 required surgical intervention in the form of implant removal, exchange, or dermis fat graft. Conclusion: MRSA infection should be considered in patients with chronic discharge and exposed / extruded orbital implants.
Scientific Poster 175 Eyelid Complications due to Trachoma in Patients Presenting to a Tertiary Care Center Presenting Author: Imtiaz Chaudhry MD PhD Co-Author(s): Waleed A Al Rashed MBBS**, Osama ALSheikh, Yonca O Arat MD**, Ayman Al-Ayoubi MD**, Farrukh A Shamsi PhD, Milton Boniuk MD** Purpose: To report eyelid complications due to trachoma in patients presenting to a tertiary care center (TCC). Methods: A retrospective clinical study of eyelid complications due to trachoma was conducted in patients presenting to an eye clinic of a TCC over a 2-year period to document types of abnormalities. Results: There were 156 patients (108 females) with average age of 64.3 years (range: 11 to 95 years), all had clinical evidence of old trachomatous scarring. Evidence of entropion / trichiasis was found in 82 patients (52.6%), eyelid retraction in 24 patients (15.4%), and eyelid ptosis in 7 patients (4.5%). Eyelid complications of trachoma were more severe in female patients who presented at early age than in male patients. Conclusion: Eyelid complications are common in patients with trachoma presenting to an eye clinic of a TCC.
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Purpose: To quantify upper eyelid skin contracture in patients with facial paralysis (FP). Methods: We developed a standardized technique to measure the distance between the upper eyelid margin and the lower border of brow (LMBD). We prospectively compared the LMBD on both sides in patients with unilateral FP and without previous eyelid surgery. Results: Thirty-six patients (mean age: 50.3) with a mean FP duration of 65 months were identified. Sixty-four percent showed shorter LMBD compared to the normal side. The mean LMBD on the paralytic side was significantly smaller than on the contralateral side; 30.4 mm (95% CI, 29.2-31.8) vs. 32.6 mm (95% CI, 31.2-34.0), P = .02. Five patients showed contracture of 5 mm or more. Conclusion: This is the first study that quantifies shortening of LMBD in FP. This reinforces the principle of avoiding skin excision in FP.
Scientific Poster 177 SOE Combined Nasolabial and Glabellar Flaps for Reconstruction of Large Medial Canthal Defects: Ten Years’ Experience Presenting Author: Joyce N Mbekeani MBBS Co-Author(s): Frederic Chiambaretta MD**, Selwa A F Al-Hazzaa MD FRCS, Hachemi Nezzar MD Purpose: To report the results of combined nasolabial and glabellar flaps for reconstruction of large medial canthal defects following excision of basal and squamous cell carcinoma. Methods: Retrospective, observational study of 416 patients over 10 years. Moh’s micrographic surgery and nasolabial and glabella flaps were rotated to defects greater than 2 cm. Flaps were anchored to canthal ligaments. Success was defined as no necrosis, functional and cosmetic canthal position, and no recurrence. Results: Mean follow-up was 23 months. The first month, 30% experienced flap edema; 10%, ecchymosis; 3.5%, recurrence. Flap necrosis, ectropion, or lagophthalmos have not been observed, and canthal positions are anatomically stable. Conclusion: Combined glabella-nasolabial V-Y flap technique results in good lid position, function, and cosmesis.
Scientific Poster 178 Surgical Outcomes of Deep Superior Sulcus Augmentation Using Acellular Human Dermal Matrix in Asian Anophthalmic or Phthisis Socket Presenting Author: Won Kyung Cho MD PhD Co-Author(s): Hae-ri Yum MD, Won-Mo Lee MD** Purpose: To evaluate surgical outcomes of deep superior sulcus (DSS) using acellular dermal matrix in Asian patients with anophthalmos. Methods: We retrospectively reviewed medical records and focused on 3 aspects: the possibility of wearing contact prosthesis, correction degree, and complications. The correction degree was classified as excellent (removal of sunken sulcus shadow), fair (shadow remained), or fail (no effect). Results: Ten eyes of 10 Korean patients could wear contact prosthesis. Correction degree was excellent in 8 patients and fair in 2. Three of 10 showed complications: entropion, multiple creases, and spontaneous wound dehiscence followed by inflammation. Conclusion: The overall surgical outcomes were favorable, showing an excellent degree of correction of DSS and low surgical complication rates.
Scientific Poster 179 Radiological Assessment of the Variation of the Angle of the Orbital Strut Between Right and Left Orbits Using CT Scans Presenting Author: Raghuraj S Hegde MBBS Co-Author(s): Gangadhara J K Sundar MBBS Purpose: To describe and compare the angle of the orbital strut (AOS) between right and left orbits using CT scans. Methods: Retrospective review of 50 consecutive CT scan orbits (max. 3-mm cuts) with intact bilateral orbits measuring angle between orbital floor and medial wall. AIOS were measured at 3 standard locations: (1) Rim–Rim AOS (RAOS), (2) 9 mm behind the RAOS; Middle AOS (MAOS), (3) 18 mm behind the RAOS; Posterior AOS (PAOS). Statistical analysis (unpaired t test) was done taking race into account. Results: 100 orbits (50 patients) were studied. Analysis showed significant symmetry of AOS at all the above locations irrespective of race (P > .05). Average AOS: East Asians: 127.6°; South Asians: 126.7°; and whites: 127.3°. Conclusion: Variations of AOS between the right and left orbits are small, indicating real-world applications in repair of orbital fractures.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 180 Serum IgG4 Level as a Prognostic Factor for Ocular IgG4Related Disease Presenting Author: Wei-Kuang Yu Co-Author(s): Chieh-Chih Tsai MD Purpose: To investigate factors associated with response to systemic steroid in patients with ocular IgG4-related disease (IgG4-RD). Methods: We suspected a relationship of clinical factors to steroid treatment response and retrospectively reviewed 10 pathologically confirmed ocular IgG4-RD patients who underwent steroid treatment to analyze possible factors associated with outcome. Results: Patients with lower serum IgG4 and IgG4-toIgG ratio at diagnosis were associated with poor response to systemic steroid (P = .037). Conclusion: Results suggest that lower serum IgG4 level at diagnosis may be a factor for poor response to steroid treatment in ocular IgG4-RD.
Scientific Poster 181 Treatment of Lower Eyelid Retraction With Silicon Sheet Presenting Author: Wei-Kuang Yu Co-Author(s): Chieh-Chih Tsai MD Purpose: To report a new technique for correction of lower eyelid retraction using silicon sheet as a posterior lamellar spacer graft. Methods: Seven Graves ophthalmopathy patients with symptomatic lower eyelid retraction were treated with surgical correction using silicon sheet (Perthese) as a spacer graft. Results: Mean improvement in margin reflex distance-2 was 2.0 ± 0.4 mm. After a mean follow-up of 9 months, all achieved satisfactory functional and cosmetic outcome. They had improvement of ocular symptoms, with a decreased dependence on topical lubricants. Conclusion: Silicon sheet can offer an alternate graft for eyelid reconstruction.
Scientific Poster 182 SOE H Prevalence of Ocular Hypertension and Glaucoma in Graves Orbitopathy Presenting Author: Susanne Pitz MD* Co-Author(s): Esther M Hoffmann MD**, Norbert Pfeiffer MD* Purpose: Graves orbitopathy (GO) is postulated to increase IOP via increased orbital pressure / pressure of extraocular muscles on the eyeball, and reduced venous outflow. However, studies investigating the prevalence of glaucoma in Graves orbitopathy yield conflicting results. Methods: 294 GO patients and 61 healthy subjects underwent IOP measurement, white-on-white perimetry, funduscopy, and imaging of the optic nerve head. Results: Seven of 217 (3.2%) GO patients were identified to suffer from glaucoma, and 37/217 (17.1%) from ocular hypertension (OHT). Conclusion: Prevalences of glaucoma and OHT in GO are higher than previously reported, and higher than known for the average European/white population.
Presenting Author: Hamidreza Hasani MD Co-Author(s): Roghiyeh Shamsoddinimotlagh MD Purpose: To describe children with post-traumatic subperiosteal orbital hematoma. Methods: A retrospective analysis of 5 cases plus literature review was performed. Results: A total of 28 cases (82% boys) with a mean age of 10 (4-17) years; 27 patients (96%) had a history of blunt trauma. Eighty-nine percent were unilaterally involved. Mean time interval between trauma and presentation was 10 days. Visual acuity was decreased in 63% of patients, of which 30% had a compressive traumatic optic neuropathy. Seventeen percent had a nondisplaced orbital roof fracture. Treatment options were surgical evacuation in 13 patients (46%), needle aspiration in 6 patients (21%), and observation in 8 children (28%). Conclusion: Pediatric post-traumatic orbital subperiosteal hematoma typically occurs in the superior orbital wall after blunt trauma. Traumatic optic neuropathy is uncommon. Surgical drainage is a safe option.
SESSION TWO: MONDAY AND TUESDAY Scientific Poster 453 SOE Management of Dysfunctional Epiphora: Comparing the Surgical Outcome of Bicanalicular Silicone Intubation, Transcanalicular Diode Laser-
Presenting Author: Can Ozturker MD Co-Author(s): Pelin Kaynak Hekimhan MD, Gamze Ozturk Karabulut**, Korhan Fazil, Serpil Akar MD, Ahmet Demirok MD, Omer Faruk Yilmaz MD** Purpose: Comparing the outcomes of bicanalicular intubation (BI), transcanalicular diode laser-assisted dacryocystorhinostomy (TDL-DCR), and external dacryocystorhinostomy (ExtDCR) as the first choice of treatment of dysfunctional epiphora. Methods: Postsurgical success rates of the three groups were compared retrospectively. Results: Data of 76 eyes of 72 patients in demographically similar groups were analyzed. Functional success rates were 62.5% in BI, 66.7% in TDL-DSR, and 82.1% in Ext-DSR groups at 12.9, 18.8, and 18.4 months, respectively (P = 0.035 and P = 0.045). Conclusion: The Ext-DCR group yielded a higher success rate compared with BI and TDL-DCR groups for the treatment of dysfunctional epiphora. BI may be the first choice of treatment as a minimally invasive procedure that eliminated the need for DCR in 62.5% of the cases.
Scientific Poster 454 A Novel, Stepwise Diagnostic Protocol for the Differentiation Between Malignant and Benign Lacrimal Gland Tumors Presenting Author: Jiang Qian MD Purpose: To assess the ability of magnetic resonance imaging in differentiating benign from malignant lacrimal gland tumors. Methods: Eighteen malignant and 24 benign masses were recruited. Apparent diffusion coefficient (ADC) obtained from diffusion-weighted imaging and time intensity curve (TIC) type obtained from DCE were compared in the two groups. ADC threshold for differentiation was determined. The dignostic performances of TIC and of ADC and TIC in concert were compared. Results: ADC threshold for discriminating pleomorphic adenomas from carcinomas was 1.097 x 10-3 mm2/s. After referring to ADC, the diagnostic sensitivity (77.78%–100%) and accuracy (88.1%–92.86%) were enhanced significantly (P = 0.0313). Conclusion: The type A with ADC less than 1.097 x 10-3 mm2/s and type C were regarded as malignant, while type A with ADC greater than that and type D were regarded as benign.
Scientific Poster 455 Randomized Controlled Trials in Endoscopic Dacryocystorhinostomy: A Systematic Review Presenting Author: Marcus M Marcet MD Co-Author(s): Andrew Kin Ting Kuk BSB MBBS MRCS, Paul O Phelps MD, Ebby Elahi MD FACS, Dinesh Selva MBBS Purpose: To systematically review all randomized controlled trials (RCTs) for endoscopic dacryocystorhinostomy (e-DCR). Methods: PubMed database Boolean search on April 7, 2014, without age, date, or language limits of endonasal OR endoscopic AND dacryocystorhinostomy, which yielded 767 studies. Of 25 RCTs, seven were excluded (five, unrelated topic; one, no abstract; and one, duplicate study). Eighteen articles met inclusion criteria and were analyzed. Results: The 18 RCTs reported on antimetabolite use (6), stents (4), lasers (3), and other techniques (5). Conclusion: Antimetabolites reduce scarring but do not improve outcomes, except possibly in revision e-DCR. Use of silicone stents is not associated with improved outcomes and may lower surgical success. There is limited evidence laser is beneficial.
Scientific Poster 456 Management of Failed External, Transcanalicular Laser, and Endonasal Dacryocystorhinostomy Presenting Author: Sabita Katoch MBBS MD Purpose: To evaluate outcomes after repeat dacryocystorhinostomy (DCR) following failed lacrimal surgery. Methods: Repeat external DCR done in 131 cases (Group A) and repeat transcanalicular diode laser (TCL) DCR done in 42 cases (Group B). Follow-up ranged from four to 36 months. Results: In Group A, success rates were 64.6% (primary surgery external), 86.2% (primary TCL), and 100% (primary endonasal). In Group B, success rate was 70.73%. Repeat external DCR had prolonged surgical time and many minor complications. Conclusion: TCL DCR may be a good alternative to the external approach in failed external DCR. The external route is as good as the primary surgery post TCL and endonasal DCR, as these approaches interfere least with the anatomy.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Poster 183 Posttraumatic Orbital Subperiosteal Hematoma in Children
Assisted Dacryocystorhinostomy, and External Dacryocystorhinostomy
Scientific Posters Scientific Poster 457 Extreme Eyelid Lymphedema Associated With Rosacea (Morbihan Disease): Case Series, Literature Review, and Therapeutic Considerations
Scientific Poster 461 Changes in Spontaneous Blinks After Blepharoptosis Repair and Blepharoplasty
Presenting Author: Bryant P Carruth MD Co-Author(s): Dale R Meyer MD FACS, Edward Wladis MD*, Elizabeth A Bradley MD, Rami N Al-Rohil MBBS, David Michael Jones**, George B Bartley MD
Co-Author(s): Takayuki Hattori MD**, Norihiko Yokoi MD PhD**, Yukito Yamanaka, Hideki Fukuoka, Noriko Koizumi MD**, Kazutaka Suzuki*, Haruyoshi Toyoda PhD*, Shigeru Kinoshita MD*
Purpose: To describe Morbihan disease, an infrequently reported and poorly understood entity consisting of solid midfacial and eyelid lymphedema and rosacea. Methods: Chart review, pathologic and immunohistochemical analysis, and literature review. Results: Histopathologic examination of five cases revealed pleomorphic perivascular/lymphatic inflammation with lymphangiectasis, suggesting elements of both rosacea and localized lymphedema. Therapeutic interventions included antiinflammatory therapy, surgical debulking, and corticosteroid injection. Conclusion: Extreme eyelid edema associated with characteristic skin changes and histopathologic findings represents Morbihan disease, which is rare and difficult to treat. Multiple modalities have been employed, and future therapeutic considerations may include targeted biologic agents.
Purpose: To assess spontaneous blinks post blepharoptosis repair and blepharoplasty (BLEPH). Methods : Eighty-two eyelids of 50 blepharoptosis cases (mean age, 63.8 years) underwent blepharoptosis repair, and 18 eyelids of 10 dermatochalasis cases (mean age, 71.5 years) underwent BLEPH. Spontaneous blinks were measured prior to surgery and 1.5, three, and six months after surgery by an intelligent vision system camera prototype. Results: Mean blepharoptosis group blink up-phase maximum velocity (mm/sec), up/downphase depth, and down-phase duration were statistically greater at all follow-up points, yet in the BLEPH group, only the mean down-phase blink duration was significantly greater. Conclusion: Spontaneous blinks are longer and faster after blepharoptosis repair, yet only slightly change after BLEPH.
Scientific Poster 458 Comparison of Orbital Anatomy in Korean and White Subjects by Computed Tomography
Scientific Poster 462 The Effect of Upper Lid Blepharoplasty on Visual Quality in Patients With Lash Ptosis and Dermatochalasis
Presenting Author: Hee Bae Ahn MD PhD
Presenting Author: An Seounghyun
Co-Author(s): HyunChul Jeong, Jongsoo Kim MD
Co-Author(s): Jongsoo Kim MD, Hee Bae Ahn MD PhD
Purpose: To analyze and compare the anatomy of orbits in Korean and Caucasian subjects using computed tomographic measurements. Methods: A retrospective analysis of 44 CT scans of subjects (22 Korean and 20 Caucasian) with no appreciable orbital disease was performed by two observers. Ten length and three angle measurements of the orbit were obtained. Results: Anterior medial interorbital length was 24.05 mm in Korean subjects and 21.85 mm in Caucasian subjects. Anterior vertical orbital length was 34.19 mm in Korean subjects and 34.99 mm in Caucasian subjects. Interorbital angle was 47.7° in Korean subjects and 45.9° in Caucasian subjects. Significant differences were found in those measurements mentioned above. Conclusion: Compared with Caucasian subjects, the Korean orbit shows narrower orbital opening and longer interorbital distance.
Purpose: To assess the effect of upper lid blepharoplasty surgery on visual quality. Methods: Seventy-three eyes of 39 patients underwent upper lid blepharoplasty surgery. Preand postoperative contrast sensitivity, visual acuity, vertical palpebral fissure, and degree of lash ptosis were measured. Results: The mean log contrast sensitivity in photopic (P = 0.017) and mesopic conditions (P = 0.009) was improved after surgery and statistically significant. The degree of lash ptosis also decreased after blepharoplasty (P < 0.001). Conclusion: In our study, significant contrast sensitivity increase was found after surgery. These results suggest that upper lid blepharoplasty can be helpful to improve visual quality.
Scientific Poster 459 Imaging Analysis of Pleomorphic Adenoma of Lacrimal Gland Presenting Author: Hyun Jin Shin MD
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Co-Author(s): Kyung In Woo MD, Yoon-Duck Kim MD Purpose: To analyze the imaging characteristics of primary lacrimal gland pleomorphic adenoma (LGPA). Methods: We reviewed computed tomography and magnetic resonance imaging findings of 41 patients who were histologically diagnosed with primary LGPA. Results: Most LGPAs showed typical radiologic findings with well-defined margins. Calcification (9.8%), orbital roof defect (9.8%), hemorrhage (4.9%), and bone invasion (2.4%), which are characteristic findings in malignant lacrimal gland tumors, were also observed in primary LGPA. Conclusion: Even if malignancy is suspected based on the radiologic findings, lacrimal fossa tumors with well-defined margin should be removed intact without prior biopsy to reduce the risk of recurrence and malignant transformation.
Presenting Author: Akihide Watanabe MD
Scientific Poster 463 The Role of Prophylactic Antibiotics in Preventing Infection and Sling Exposure in Patients Undergoing Frontalis Sling Presenting Author: Justin J Kuiper Co-Author(s): Meredith S Baker MD, Richard C Allen MD PhD, Keith D Carter MD FACS, Jeffrey A Nerad MD, Erin Shriver MD Purpose: To evaluate the role of prophylactic intravenous and postoperative oral antibiotics in preventing infection and exposure in patients undergoing frontalis sling procedures. Methods: Retrospective review of frontalis sling procedure patients from January 1987 to January 2014. Results: There were 23 cases of infection or exposure in 104 patients. Infections, exposures, and total complications (percentage rate), respectively, for each of the antibiotics categories were: IV and oral (n = 29), two, one, and three (10.3%); IV only (n = 7), zero, one, and one (14.2%); oral only (n = 15), zero, two, and two (13.3%); and none (n = 53), seven, 10, and 17 (32.0%). Sling materials were: silicone (n = 72), fascia lata (n = 17), and Supramid (n = 15). Conclusion: Prophylactic antibiotics significantly reduced the postoperative complication rate in frontalis sling patients (P = 0.023).
Scientific Poster 460 H Epidemiology, Clinical Features, and Treatment Outcomes of Orbital Inflammatory Disease: A 10-Year Review
Scientific Poster 464 Müller’s Muscle and Conjunctival Resection With or Without Tarsectomy for the Treatment of Severe Ptosis
Presenting Author: Stephanie M Young
Co-Author(s): Juliana de Filippi Sartori MD, Vinay Aakalu md**, Allen M Putterman MD, Pete Setabutr MD
Co-Author(s): Anita S Y Chan MD**, Sunny Shen MD, Lay Leng Seah MBBS**, Stephanie S Lang MS, Audrey Looi MD FRCS(ED) Purpose: To analyze the clinical profile and treatment outcomes of orbital inflammatory disease in our local population. Methods: A 10-year (2001–2011) retrospective review of patients with biopsy-proven orbital inflammatory disease at a tertiary referral center in Singapore. Results: Our study was comprised of 70 patients, of which one-half (n = 35) had nonspecific inflammation of the orbit. Patients with lacrimal gland disease responded better to treatment (P = 0.002), whereas the vasculitic group had poorer response (P = 0.013). Subtypes with the highest recurrences were the myositic (75%) and vasculitic (75%) groups. Conclusion: Our study of biopsy-proven orbital inflammatory disease in an Asian population allows us to better understand the clinical response of various histological subtypes.
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Presenting Author: Rakesh M Patel MD*
Purpose: Müller’s muscle and conjunctival resection (MMCR) has classically been described to treat mild to moderate ptosis. We hypothesize it is an effective modality for treatment of severe ptosis. Methods: We performed a retrospective chart review identifying all patients with severe involutional ptosis (margin reflex distance 1 [MRD-1] of 0 mm or less) from January 2008 to December 2012 who had a MMCR. Results: One hundred forty-one eyelids of 91 patients were defined as severely ptotic. Average preoperative MRD-1 was -1.08 mm, and postoperative MRD-1 was 2.73 mm. We found that 80.2% achieved symmetry on initial surgery, defined as the difference in MRD-1 being 1 mm or less. Conclusion: MMCR with or without tarsectomy is an effective procedure in the management of severe involutional ptosis.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 465 H Drill Hole Canthopexy: Our Technique and Experience Presenting Author: Andrea N Kossler MD* Co-Author(s): Erin Shriver MD, David T Tse MD FACS* Purpose: To describe a technique aimed at correcting lateral canthal tendon disinsertion with drill hole augmentation, review our experience, and determine which patients would benefit from drill hole canthopexy. Methods: A retrospective, interventional case series of all patients who underwent drill hole canthopexy between 2006 and 2011. Results: Fifty-three drill hole canthopexy (DHC) procedures were performed on 42 patients. Risk factors for failure with conventional treatments include previous lateral canthal surgery, anophthalmic sockets, and paralytic ectropion. All DHC cases showed an improvement in eyelid position; however, two cases (3.77%) needed additional surgery. Conclusion: DHC is effective and simple to perform and should be considered in patients with previous lateral canthal surgery, anophthalmic sockets, or paralytic ectropion.
Scientific Poster 466 Lateral Canthal Tendon Disinsertion: The Clinical Clues and Anatomic Rationale for Surgical Repair Presenting Author: Erin Shriver MD Co-Author(s): Andrea N Kossler MD*, David T Tse MD FACS* Purpose: To provide a diagnostic algorithm for lateral canthal tendon disinsertion (LCTD) and rationale for superficial lateral canthopexy (SLC). Methods: Retrospective, interventional case series. A thumb test identified LCTD patients who underwent SLC. Results: Sixty-four eyelids (48 patients) met criteria and underwent SLC. LCTD features included medial lateral canthal tendon displacement, incomplete blink, temporal eyelid imbrication, pseudoretraction, and lagophthalmos. We found that 76.5% had resolution of signs and symptoms postoperatively with 19 months median follow-up. Ninety-two percent did not require further canthal surgery. Conclusion: LCTD is a seldom-recognized anatomic defect, identified with a thumb test, that alters eyelid blink mechanics and lacrimal pump function. SLC restores lateral canthal anatomy, thereby improving eyelid function and ocular symptoms.
Scientific Poster 467 H Rapid and Cost-effective Orbital Prosthesis Fabrication via Automated Noncontact Facial Topography Mapping and 3-D Printing Presenting Author: Landon Grace PhD Co-Author(s): Mauro Fittipaldi, David T Tse MD FACS*
Pediatric Ophthalmology, Strabismus SESSION ONE, SATURDAY AND SUNDAY Scientific Poster 184 Cost-effectiveness of School-Based Eye Examinations in Preschoolers Who Fail Vision Screening Presenting Author: Eugene Lowry MD Co-Author(s): Alejandra G de Alba-Campomanes MD* Purpose: Cost-effective analysis of community vs. preschool-based eye exams after screening. Methods:The same 37 preschools were screened over 4 years, first with charts and community referral then with autorefraction and eye-mobile follow-up. With this data, we model an auto-refraction screening program with community or eye-mobile follow-up. Cases met AAPOS 2013 refractive errors or abnormal cover-uncover. Results: Community follow-up rate was 59% at a cost of $802 per case compared with 55% in preschool-based follow-up at a cost of $675 per case. Community referral was dominant in cost-effective
Scientific Poster 185 SOE Fixation Patterns Evaluation in Anisometropic Children Without Manifest Strabismus Presenting Author: Joao Nuno Bicho Beato MD Co-Author(s): Joao Breda MD, Carla Sofia Ferreira MD, Augusto Magalhaes MD, Renato Santos-Silva MD, Jorge F R Breda MD**, Fernando M Falcao-Reis MD PhD** Purpose: To study fixation changes through microperimetry in a population of anisometropic children and compare these with a control group. Methods: We studied 32 eyes of 16 controls and 38 eyes of 19 anisometropic patients. Inclusion criteria were anisometropia > ±2 D (spherical equivalent) and presence of amblyopia at the beginning of follow-up. Results: There was a statistical difference between the anisometropic patients’ eyes regarding BCVA (P < .001), sensitivity (P = .046), and fixation malpositioning (P = .036). A significant correlation was found between the patients’ “worst” eyes and control eyes regarding fixation stability and position (P = .007 and P = .048, respectively). Conclusion: Anisometropic children have altered fixation patterns between both eyes and in comparison with controls.
Scientific Poster 186 Predictors of Postoperative Visual Acuity After Bilateral Cataract Surgery in Children Presenting Author: Rupal H Trivedi MBBS MS* Co-Author(s): M Edward Wilson Jr MD, Viswanathan Ramakrishnan PhD** Purpose: To identify predictors of long-term visual acuity (VA) after bilateral cataract surgery in children. Methods: A multivariate model was constructed to predict the odds of worse logMAR postoperative VA based on perioperative variables. Results: N = 157 (314 eyes). Age at surgery: median = 3.9 years. Target refraction: median 1 D (IQR: 0.1-3.3). Follow-up: median = 6.4 years. Age at final VA: median = 11.1 years (range: 5-32). For univariate analysis, age at surgery (P = .048), nystagmus (< .001), strabismus (.03), IOL (.04), and interocular axial length difference (< .001) were found to be significant. In multivariate analysis, however, only nystagmus was found to be significant (P < .001). Conclusion: The presence of preoperative nystagmus was the most important predictor of poor VA after bilateral cataract surgery in children.
Scientific Poster 187 H Cost of IOL vs. Contact Lens Treatment After Unilateral Congenital Cataract Surgery in the Infant Aphakia Treatment Study: Retrospective Analysis at Age 5 Years Presenting Author: Stacey J Kruger MD Co-Author(s): Lindreth G DuBois CO, Edmund Becker MA PhD, M Edward Wilson Jr MD, Scott R Lambert MD* Purpose: To analyze differences in the cost of treating infants randomized to primary IOL implantation vs. contact lens (CL) after unilateral cataract extraction (CE) in the Infant Aphakia Treatment Study (IATS). Methods: Retrospective cost analysis of a prospective, randomized clinical trial based on Georgia Medicaid reimbursement as well as costs of supplies, adjusted for inflation. Results: The cost of treatment for 5 years of the IATS for an infant in the IOL arm was $35,293 vs. $33,452 for a patient in the CL arm. The total cost of supplies was $2,669 in the IOL group vs. $6128 in the CL group. Conclusion: CE coupled with primary IOL is about 5% more expensive than aphakia and CL correction. Patient costs are more than double with aphakia and CL vs. IOL.
Scientific Poster 188 Genetic Analysis of True Leber Congenital Amaurosis With (and Without) Neurodevelopmental Delay Presenting Author: Arif O Khan MD Co-Author(s): Saleh A Al-Mesfer MD**, Shahira I Al-Turkmani MD, Hanno Jörn Bolz MD Purpose: Leber congenital amaurosis (LCA) is severe nonsyndromic infantile retinal dystrophy. Neurodevelopmental delay has been described in up to 20% of cases in older studies; however, more recent genetic studies have not replicated this association, raising the possibility that older studies included syndromic retinal dystrophy cases. We investigate this possibility. Methods: Retrospective review (2012-2014) of children diagnosed with LCA, all of whom underwent genetic analysis (candidate gene screening). Results: Eighteen of 19 (22/23 children) families (all consanguineous or endogamous) harbored homozygous
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Posters
Purpose: To propose a novel, low-cost technique for orbital prosthesis development. Methods: A noncontact facial topography mapping technique was used to build a digital representation of facial anatomy including the orbital defect. Results: A custom prosthesis seamlessly integrated with surrounding facial structure was fabricated using 3D printing. Exterior surface details were based on a mirrored version of the contralateral periorbital region and the posterior prosthesis contour based on orbital defect geometry. This technique was applied to the orbital defect of an exenteration patient with excellent cosmetic match and prosthesis fit. Conclusion: The method is capable of fabricating quality prostheses without an ocularist and providing a patient from remote parts of the world an affordable solution to the facial disfigurement associated with orbital exenteration.
analysis. Preschool-based follow-up may become cost-effective at a follow-up rate of 76% or if costs were reduced by 50%. Conclusion: Referral to community is likely more costeffective than preschool-based follow-up.
Scientific Posters mutations in RPGRIP1 (11), GUCY2D (5), and RPE65 (2). Five of /23 children (22%) had delay, and they harbored homozygous mutations in RPGRIP1 (2) or GUCY2D (3). Conclusion: Neurodevelopmental delay is a recurrent feature of true LCA.
Scientific Poster 189 The Use of Irradiated Corneal Patch Grafts in Pediatric Glaucoma Drainage Implants Presenting Author: Kaitlyn M Wallace MD Co-Author(s): Eun Sara Huh MD, Ahmad A Aref MD*, Thasarat S Vajaranant MD*, Jacob Wilensky MD, Javaneh Abbasian MD Purpose: To describe the novel use of irradiated cornea for scleral reinforcement in glaucoma drainage implant (GDI) devices in children. Methods: Retrospective case series of patients under age 18 who underwent GDI surgery with irradiated cornea as scleral reinforcement. Results: Twenty-five procedures on 23 eyes met the inclusion criteria. Mean follow-up was 9 months (range: 1-782 days). Baerveldt glaucoma implants were used in 5 cases, and Ahmed glaucoma valves were used in 20 cases. One tube (4%) extruded at postoperative Month 3.5. There was no known transmission of infectious agents and no cases of endophthalmitis. Conclusion:This is the first report describing the use of corneal patch grafts in children. Irradiated cornea improves cosmesis and enhances visualization of the underlying tube. Risk of tube exposure was found to be low.
Scientific Poster 190 SOE Spectral Domain OCT Findings in Pediatric Tilted Disc Syndrome Presenting Author: Paolo Nucci MD* Co-Author(s): Francesco Pichi MD, Antonio P Ciardella MD, Kyoko Ohno-Matsui MD* Purpose: To report a novel OCT finding in children affected by tilted disc syndrome (TDS) and to correlate it with early visual field defects. Methods: Pediatric patients with a diagnosis of TDS were examined with spectral domain OCT (SD-OCT) and standard automated perimetry 24-2. Results: Seventy eyes of 35 patients (mean age: 13.1 years, range: 8-17 years) were enrolled. The OCT images of the optic discs showed a protrusion of the upper edge of the Bruch membrane and choroid at the nasal edge of the optic disc in 81.4% of the eyes. The retinal nerve fiber tissue appeared to be herniated into this protrusion and bent superiorly in 57 eyes. This severe bending corresponded to early visual field anomalies in 97.7% of the eyes. Conclusion: SD-OCT provides important evidence on how TDS affects the optic nerve from early childhood.
Scientific Poster 191 iExaminer: A Portable and Inexpensive Option for Fundus Photography and Videography in the Pediatric Population
Scientific Posters
Presenting Author: Jiaxi Ding MD Co-Author(s): Matthew S Pihlblad MD Purpose: Fundus photography is invaluable for documenting and tracking pathology as well as educational visualization. Standard fundus cameras are not feasible for inpatients and those unable to position, such as children. We will test the iExaminer, which combines PanOptic ophthalmoscopy and iPhone technology, as a viable alternative for photography and videography. Methods: We utilized the iExaminer to image pediatric patients in the clinic and hospital. Results: We imaged a diverse range of retinal and optic nerve findings: ROP plus-disease, retinal coloboma, morning glory disc, optic nerve hypoplasia, pallor, cupping, drusen, hemorrhages, and others. Conclusion: The iExaminer is an inexpensive, portable, and effective tool for imaging posterior pole pathology with telemedicine potential.
Scientific Poster 192 SOE Pediatric Visual Impairment in Northern Ireland: 1984–2011 Presenting Author: Sarah Chamney MBBCh Co-Author(s): Premadeva Satkurunathan MBBS MS, Eibhlin M Mc Loone MBBCh** Purpose: The aim of this study was to establish the most common causes of pediatric visual impairment in Northern Ireland. Methods: Data were collected from the “Certificate of Visual Imapirment” of every child registered partially sighted or blind in Northern Ireland over a 28-year period. Results: 227 children were registered as partially sighted, and 353 were registered as blind. The mean age at registration was 7.4 years (± 4.6 years). The most common causes for registration were coloboma, cerebral visual impairment, and optic atrophy. Sixty-one percent of cases were neither preventable nor treatable. The prevalence of visual impairment in those under 16 years was 0.52/1000. Conclusion: This study gives new insights into the causes of pediatric visual impairment in Northern Ireland.
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Scientific Poster 193 Diamond Knife-Assisted Deep Anterior Lamellar Keratoplasty for the Treatment of Mucopolysaccharidoses 1H (Hurler Syndrome) in Children Presenting Author: Michelle R Boyce MD Co-Author(s): John E Sutphin MD*, Erin D Stahl MD* Purpose: To describe diamond knife-assisted deep anterior lamellar keratoplasty (DiaDALK) for the treatment of mucopolysaccharidoses 1H (MPS 1H). Methods: A case series reviewing surgical techniques and outcomes of Dia-DALK in MPS 1H. Results: Four eyes in 3 patients, ages 8-18, underwent Dia-DALK for treatment of corneal clouding and visual acuity of 20/200 or worse. All patients showed improvement in corneal clarity and visual acuity ranging from 20/60 to 20/125 during follow-up of 1-8 months. One patient had improved visual acuity of the untreated eye. Conclusion: Dia-DALK therapy is useful for the treatment of corneal complications of MPS 1H in children.
Scientific Poster 194 Cycloplegic Autorefraction: Does It Have a Role in Children? Presenting Author: Sujata Guha MBBS Co-Author(s): Tarun Sharma MBBS, Preeti Megundappa Hurakadli Sr** Purpose: To determine the accuracy of autorefraction vs. traditional retinoscopy under cycloplegic conditions. Methods: 294 children (mean age: 8.2 years) were enrolled. Clinically significant difference was defined as > 0.5 D difference in sphere or cylinder or > 20° in axis. Patients were categorized in to 3 groups: 1: myopia and myopic astigmatism; 2: hyperopia and hyperopic astigmatism; 3: mixed astigmatism. Results: Clinically significant differences were noted in 13.2% of eyes in Group 1, 15.1% of eyes in Group 2, and 20.9% of eyes in Group 3. These differences were greater in those with age < 6 years: 25% vs. 9.1%. Conclusion: Cycloplegic autorefraction can be used reliably in children > 6 years of age; in others it should be corroborated with retinoscopy.
Scientific Poster 195 SOE The Utility of Early IGF-1 and Clinical Parameters to Predict the Development of Severe ROP in a Diverse Population Presenting Author: Maddy A Reddy MBBCH* Co-Author(s): Himanshu Patel FRCS MBBS MS, Shah Karim**, Catey Bunce MBBS PhD, Steve Kempley MA MBBCHIR MD, Ajay Kumar Sinha MBBS MD Purpose: To validate risk factors and identify a threshold level for serum insulin-like growth factor 1 (IGF-1) in the development of severe ROP in an ethnically diverse population. Methods: Data were collected prospectively. Risk factors included IGF-1 at 31, 32, and 33 weeks, gestational age (GA), birth weight (BWT), absolute weight gain (AWG), and maternal ethnicity (ME). Outcomes were minimal ROP (stages 0 or 1) and severe ROP (stages 2 and worse). Results: Thirty-six patients (14 minimal, 22 severe) were collected. Significant differences between the groups were found in GA, BWT, AWG, ME, and IGF-1 at 32 and 33 weeks. Minimal IGF-1 rise existed for Black babies. No threshold level of IGF-1 could distinguish between the ROP outcomes. Conclusion: About a third of patients could safely be excluded from screening.
Scientific Poster 196 Large Spot Laser for the Treatment of ROP Presenting Author: Parijat Chandra MD Co-Author(s): Priti Bhoutekar MBBS MD**, Raj V Azad MD FRCS(ED)**, Yog Raj Sharma MD MBBS, Anil Babanrao Gangwe MBBS MD** Purpose: To compare large spot laser with standard spot laser for treatment of ROP. Methods: Eighty eyes of 40 premature babies with bilateral type 1 ROP were randomized to treatment with standard spot laser in one eye and large spot laser in other eye. Results: All babies had 100% regression. Total treatment duration was significantly reduced in the large spot laser group in zone I (P = .005) and zone II (P = .0006) ROP. Total laser duration was 32% and 63.4% less in zone I and zone II, respectively. High Premature Infant Pain Profile scores indicated moderate to severe pain during laser in both groups. Mean induced myopia was comparable. Conclusion: Large spot laser can be a better alternative for treatment of ROP in terms of faster procedure, shorter total duration of pain, and similar regression profile.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 197 H Regression Patterns Following Primary Anti-Vascular Endothelial Growth Factor Therapy Without Laser for Aggressive Posterior Retinopathy of Prematurity Presenting Author: Alay S Banker MD Purpose: To evaluate efficacy of intravitreal bevacizumab (IB) without laser in aggressive posterior ROP (APROP). Methods: Prospective study of APROP eyes receiving IB as primary therapy. Primary outcome was regression of ROP, and secondary outcomes were degree of vascularization and recurrences. Results: In 37/40 eyes (92.5%), ROP regressed and had continued vascularization (Responders). Three eyes (7.5%) had minimal regression and received laser (Resistors). Twenty-two of 37 responder eyes (59.5%) vascularized up to 1 DD of ora (Vascularized). Fifteen of 37 (40.5%) had persistent avascularity (Nondevelopers), of which 4 (10%) developed recurrence after 14.5 weeks. Conclusion: IB is effective in treating APROP, alleviates the need to ablate Zone 1 retina, and preserves the macula. The majority of eyes developed full vascularization; only a few had persistent avascularity and recurrences.
Scientific Poster 198 Role of Strabismus Surgery in the Treatment of Adult-Onset Esotropia Presenting Author: Sara Grace MD Co-Author(s): Kara M Cavuoto MD, Wei Shi MS**, Hilda Capo MD Purpose:To describe the characteristics, surgical management, and outcomes of adultonset esotropia. Methods: Retrospective chart review of 250 patients with strabismus surgery for adult-onset (≥ 18 years) esotropia in the past 15 years at a large academic center. Results:The most common etiologies were cranial nerve VI palsy (32%), thyroid eye disease (18%), and divergence insufficiency (DI) (15%). Diplopia was present in over 90%. All patients had various strabismus surgeries, with adjustable sutures in approximately 80% of cases. Diplopia resolved in three-fourths, and 13% required reoperation within a year postoperatively. DI patients had the lowest reoperation rate at 8%. Conclusion: Multiple surgical options, in conjunction with adjustable sutures, yield good results with low reoperation rates in adult-onset esotropia.
Scientific Poster 199 Botulinum Toxin-Augmented Surgery Compared to Conventional Surgery in the Treatment of Large-Angle Infantile Esotropia Presenting Author: Michael J Wan MD Co-Author(s): Melanie A Kazlas MD, Carolyn S Wu MD, David G Hunter MD PhD*, Jason S Mantagos MD, Ankoor S Shah MD*
Scientific Poster 200 Incidence and Natural History of Traumatic Cataract After Hyphema in the Pediatric Population Presenting Author: Ankoor S Shah MD* Purpose: To understand the sequelae of traumatic cataract after blunt trauma that causes hyphema. Methods: Retrospective, cohort study of patients at a single tertiary-care pediatric hospital. Results: Seventeen of 128 (13%) developed cataract a median of 14 days (range: 2-113) after injury. Median follow-up was 29 months (range: 5-97). Median visual acuity was 20/245 initially and 20/25 at final visit (P = .0001). Seven patients required surgery at a median of 54 days (range: 20-698). Conclusion: Traumatic cataract after hyphema from blunt ocular trauma is common, presents within 2 weeks, requires surgery in ~40% of cases, and can be associated with good visual outcomes.
Scientific Poster 468 The Safety of Difluprednate Ophthalmic Emulsion for Treatment of Inflammation After Cataract Surgery in 0-3 Year-Olds Presenting Author: M Edward Wilson Jr MD Co-Author(s): Pam Kaur** Purpose: To evaluate the safety of difluprednate ophthalmic emulsion after pediatric cataract surgery. Methods: Patients up to three years of age were randomized to receive difluprednate 0.05% (39) or prednisolone acetate 1% (40), one drop four times daily in the operated eye for 14 days followed by a two-week tapering period. Safety parameters were assessed at all postoperative visits. Results: The proportion of patients with treatmentrelated adverse events (TRAEs) in the difluprednate and prednisolone group were 7.7% and 5%, respectively, with the most common TRAEs being increased IOP (5.1% vs. 2.5%), corneal edema (2.6% vs. 0%), and ocular hypertension (0% vs. 2.5%). Conclusion: In patients up to three years of age, the safety profile of difluprednate 0.05% is similar to that of prednisolone acetate 1%.
Scientific Poster 469 Pharmacokinetic and Safety Study of Travoprost 0.004% Ophthalmic Solution in Pediatric Glaucoma Patients Presenting Author: Erin D Stahl MD* Purpose: To assess steady-state plasma pharmacokinetics (PK) and safety of travoprost 0.004% in pediatric subjects. Methods: Travoprost was administered QD for seven days to patients aged two months to 5 years; P = 0.01, mean age ). High-quality images (grades 4/5) were obtained in 178 eyes (86%), and images of clinical value (grade ≥2) were obtained in 207 (99.5%). Image quality interobserver agreement was 0.896. Conclusion: Nonmydriatic imaging may supplement standard clinical examination of a pediatric diabetic population.
Scientific Poster 474 SOE ROP Hybrid Form: Fluorescein Angiographic Findings
Scientific Poster 477 Is the Childhood Obesity Epidemic Affecting the Prevalence and Patient Characteristics of Pediatric Idiopathic Intracranial Hypertension? Presenting Author: Rebecca A Shields MD Co-Author(s): Roberto Warman MD, Kara M Cavuoto MD Purpose: Our multicenter study investigates the characteristics of pediatric idiopathic intracranial hypertension (IIH). Methods: A retrospective chart review identified children (four to 17 years of age) diagnosed with IIH. Results: Fifty-four patients were divided into Group 1 (four to eight years), Group 2 (nine to 12 years), and Group 3 (13 to 17 years). The overall average age was 11.5 years, differing significantly between males and females (9.7 vs. 13.3 years, P = 0.001). Females comprised 48% of Group 2 versus 86% of Group 3. The body mass index (BMI) differed between males and females in Group 3 (23.6 vs. 33.5). Conclusion: Postpubescent females have similar clinical presentations to adults, whereas males are younger, with lower BMI.
Scientific Poster 478 Serial Fundus Photography and Fluorescein Angiography After Off-label Intravitreal Bevacizumab Treatment for ROP: The Importance of Angiography in Off-label BevacizumabTreated Eyes Presenting Author: Luxme Hariharan MD Co-Author(s): Aleksandra V Rachitskaya MD, Ditte J Hess CRA FOPS**, Catherin Negron, Audina Berrocal MD*
Purpose: To analyze and describe a new form of retinopathy of prematurity (ROP) called Hybrid Form and its features. We try to use such information for indication for laser treatment. Methods: Retrospective review of fundus angiographic images from 2007 to 2013 of all newborns sent to our regional referential center for ROP screening in Turin, Italy. Results: We included 12 patients (24 eyes) among 200 babies. Conclusion: Fluorescein angiography is a useful tool to diagnose and treat hybrid forms.
Purpose: To demonstrate the importance of fluorescein angiography (FA) in the management of retinopathy of prematurity (ROP) after an intravitreal bevacizumab treatment. Methods: This is an institutional review board-approved retrospective, consecutive case series of 38 eyes of 19 infants with ROP from 2006 to 2013. Eleven patients were treated solely with intravitreal bevacizumab, while eight received additional laser. Clinical exam, RetCam fundus photography, and fluorescein angiography were performed prior to and post treatment. Results: Regression and progression of ROP was difficult to assess solely by digital fundus photographs and clinical exam. FA showed changes in vasculature more clearly. Conclusion: Fluorescein angiograms are critical in demonstrating the details in the vasculature needed to follow bevacizumab-treated eyes.
Scientific Poster 475 Measurement of Corneal Thickness and IOP in Preterm Babies
Scientific Poster 479 SOE Optos-Guided Targeted Retinal Laser Photocoagulation in Premature Infants With ROP
Presenting Author: Sandeep Grover MD
Presenting Author: Timothy Fung MBCHB
Co-Author(s): Shamim A Haji MBBS, Wassia A Khaja MD, K V Chalam MD PhD, Merrill L Stass-Isern MD
Co-Author(s): Chetan K Patel MD**
Presenting Author: Mario Ravot MD
Scientific Posters
nese school children (n = 98) who were examined annually for four years. Refractions and axial length were determined by an optical biometer (IOL Master, Carl Zeiss) and wavefront analyzer (KR-9000PW, Topcon). Results: The mean refraction/axial length at years 1, 2, 3, and 4 were -0.54 D/23.09 ± 0.81 mm, -0.57 D/23.27 ± 0.85 mm, -0.77 D/23.46 ± 0.4mm , and -1.12 D/23.64 ± 0.99 mm, respectively. Long axial length during the first year was found to be the primary risk factor for the progression of myopia (P < 0.01). Conclusion: Measurement of axial length should be included in the yearly medical examinations of elementary school children.
Purpose: To study the central corneal thickness (CCT) and IOP in preterm babies. Methods: During retinopathy of prematurity screening rounds at the neonatology intensive care unit, the IOP was measured using the Tono-Pen tonometer, and CCT was measured with a pachymeter. Results: Fifty eyes of 34 infants were measured. The mean gestational age at birth was 28.1 weeks (standard deviation [SD], 2.3 weeks) and at the time of measurements was 33.4 weeks (SD, 2.0 weeks). The mean IOP measured 31 mmHg (SD, 10.7 mmHg), and the mean corneal thickness was 647 µm (SD, 69.7 µm). Conclusion: Compared with the adult population, both the CCT and IOP measurements were higher in preterm infants.
Purpose: To evaluate the clinical effects of targeted retinal laser photocoagulation (TRLP) in threshold retinopathy of prematurity (ROP). Methods: A retrospective review of six premature infants (12 eyes) with threshold ROP who had laser photocoagulation to zones of retinal ischemia and capillary nonperfusion guided by noncontact ultra-widefield fluorescein angiography (Optos). Main outcome measures, determined by repeat Optos ultra-widefield fluorescein angiography, were regression of neovascularization and decrease in vascular dilatation and tortuosity. Results: Following TRLP, there was regression of neovascularization and improvement in vascular dilatation and tortuosity in all eyes. Conclusion: Optosguided TRLP demonstrated a favorable outcome in premature infants with threshold ROP.
Scientific Poster 476 The Relationship Between the Progression of Myopia and the Growth of Axial Length in Elementary School Children Presenting Author: Yoshinori Nakai Co-Author(s): Osamu Hieda MD, Shigeru Kinoshita MD* Purpose: To investigate the relationship between myopia progression and axial length growth in Japanese school children. Methods: This study involved eight-year-old Japa-
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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 480 SOE Extreme Prematurity and Its Impact on Visual Development Presenting Author: Carla Sofia Ferreira MD Co-Author(s): Jorge F R Breda MD**, Augusto Magalhaes MD, Renato Santos-Silva MD, Angela Maria Carneiro MD PhD*, Amandio A Rocha de Sousa MD, Fernando M Falcao-Reis MD PhD** Purpose: To assess the overall impact of prematurity on visual development. Methods: Forty children were included, born .05). Flap displacement occurred in 5 eyes in the 100-micron group and in 3 eyes in the 120-micron group (P > .05). Conclusion: LASIK outcomes were comparable between 100- and 120-micron flaps 1 week postoperatively.
Scientific Poster 208 Intraoperative Flap Complications in LASIK Surgery Performed by Ophthalmology Residents in Training Presenting Author: Arturo J Ramirez-Miranda MD* Co-Author(s): Lorena Romero-Diaz-de-Leon MD**, Juan Carlos Serna MD, Alejandro Navas MD*, Enrique O Graue Hernandez MD Purpose: To determine the incidence of flap-related complications in LASIK surgery performed by in-training ophthalmology residents and the risk factors involved in those complications. Methods: We analyzed 273 flap sections from 145 patients during one year, performed by 25 residents using a microkeratome. Results: There were 19 flap-related complications out of the 273 flap sections involved (6.95%). The most common complication was an incomplete flap section (n = 10; 3.66%). No significant differences in right or left eye, flat or steep keratometries, pachymetries, white-to-white diameter, or spherical equivalent between complicated and uncomplicated cases were seen. Conclusion: Flaprelated complications are frequent in resident-performed LASIK. They should be considered as part of the informed consent in training hospitals.
Scientific Poster 209 Predictability of Postoperative Day 1 Wavefront Aberrometry Refraction to Postoperative Year 1 Aberrometry and Subjective Manifest Refraction Presenting Author: Charles Q Yu MD Co-Author(s): Edward E Manche MD* Purpose: To determine if wavefront refractions 1 day after LASIK are predictive of objective and subjective refractions at 1 year. Methods: Ninety-four eyes underwent LASIK. Wavefront refractions were recorded on postoperative Day 1 and Year 1. Subjective manifest refractions were collected at Year 1. Results: The mean Day 1 wavefront spherical equivalent was +0.22 D. The mean Year 1 wavefront refraction was -0.08 D. The mean Year 1 manifest refraction was -0.20 D. There was a correlation of R = 0.66 (P < .0001) when comparing wavefront refraction at Day 1 and Year 1. There was a correlation of R = 0.53 (P < .0001) when comparing wavefront refraction at Day 1 with subjective refraction at Year 1. Conclusion: Postoperative Day 1 wavefront aberrometry refractions correlate well with objective and subjective refractions at 1 year.
Scientific Poster 206 SOE Prospective Visual Outcomes in LASIK Myopic Patients With WaveLight EX500 Excimer Laser and FS200 Femtosecond Laser
Scientific Poster 210 Role of Percentage of Tissue Altered as a Risk Factor for Ectasia after LASIK
Presenting Author: Arthur B Cummings MD*
Co-Author(s): David Smadja MD*, Beatriz De Abreu Fiuza Gomes, Glauco H Reggiani Mello MD, Mario Luiz R Monteiro MD**, Steven E Wilson MD*, J Bradley Randleman MD
Purpose: To assess the visual outcomes of patients who had myopic LASIK with the WaveLight Refractive Suite: BCVA preop vs. UCVA postop at 1 month. Methods: 194 eyes were treated at 4 sites (2 United States / 2 European Union); interim analysis at 1 month postop. Preop mean manifest spherical equivalent (MRSE) was -3.79 (SD ± 2.09), with mean cylinder -0.28 (SD ± 0.84). Results: 166/194 treated eyes at 1 month had mean MRSE of
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Presenting Author: Marcony R Santhiago MD
Purpose: To investigate the association of percentage of tissue altered (PTA) with ectasia after LASIK. Methods: PTA is obtained from (flap thickness + ablation depth) / preoperative
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters corneal thickness. We suspected a relationship between PTA ≥ 40 and post-LASIK ectasia in eyes with normal preoperative topography and retrospectively reviewed 30 cases to test this hypothesis. We selected a control group of 174 eyes with uncomplicated LASIK and 3 years of postoperative follow-up. Results: Prevalence of PTA ≥ 40 was significantly higher in the ectasia group (97%) than in controls (11%; P < .0001). Stepwise logistic regression revealed the PTA ≥ 40 as a significant factor (P < .0001) with a high odds ratio (223). Conclusion: PTA ≥ 40 may be a factor in susceptibility to ectasia and may permit identification of ectasia risk.
Scientific Poster 214 SOE Femtosecond-Assisted Myopic LASIK: Long-term Comparison of LASIK Combined With Prophylactic HighFluence Crosslinking to Stand-alone LASIK
Scientific Poster 211 SOE Comparison of Femtosecond Small-Incision Lenticule Extraction (SMILE) and Wavefront-Optimized LASIK for the Correction of Myopia and Myopic Astigmatism
Purpose: To evaluate the refractive and keratometric stability of myopic LASIK with prophylactic high-fluence crosslinking (LASIK-Xtra). Methods: LASIK-Xtra, Group A, 65 eyes; standard LASIK, Group B, 75 eyes. MRSE, visual acuity, and keratometry were investigated 3, 6, and 12 months postoperatively. Results: In Group A MRSE was -0.25 D from -6.75 D. Flat K was 37.67 D from 43.92, and steep K was 38.37 D from 45.15 D. In Group B MRSE was -0.27 D from -5.33 D. Flat K was 38.02 D from 43.15, and steep K was 38.66 D from 44.03 D. Refractive predictability was 0.975 in Group A and 0.968 in Group B. Conclusion: LASIK-Xtra offers improved refractive and keratometric stability in comparison to the stand-alone. The procedure is safe and opens up a new potential for LASIK application in myopic corrections.
Presenting Author: Moataz Mohamed Sabry MD Co-Author(s): Osama I Ibrahim MD PhD*, Purpose: To compare femtosecond small-incision lenticule extraction (SMILE) with wavefront-optimized femtoLASIK in patients with myopic astigmatism up to -6.00 D sphere and 3.00 D cylinder. Methods: Forty eyes were divided into 2 groups: in Group A, SMILE was performed using the VisuMax 500, and in Group B, wavefront-optimized femtoLASIK using the Allegretto excimer laser. The WASCA analyzer was used to measure ocular wavefront. Results: Preoperative mean spherical equivalent refraction was -4.25 ± 1.19 D and - 4.15 ± 1.21 D in Groups A and B, respectively. Three months postoperatively, 18 eyes in Group A and 17 eyes in Group B had uncorrected distance visual acuity of 20/20. Higher-order aberrations increased in both groups. Conclusion: The 2 techniques achieved similar refractive outcomes. Higher-order aberrations and contrast sensitivity changes were the same in both groups.
Scientific Poster 212 SOE Comparison of Visual Outcomes After Correcting Myopia Using the Variable Spot Scanning Refractive Procedure vs. the Wavefront Optimized Procedure Presenting Author: Mounir A Khalifa MD Co-Author(s): Ehab Farouk Mossallam**
Scientific Poster 213 SOE Scanning Electron Microscopy of Lenticules at Variable Corneal Thickness in Small-Incision Lenticule Extraction (SMILE) cases Presenting Author: Ihab M Osman MD Co-Author(s): Osama I Ibrahim MD PhD* Purpose: To evaluate lenticule surfaces using electron microscopy in deeper corneal layers and compare them to the superficial ones. Methods: Forty eyes underwent SMILE refractive procedure using femtosecond laser by VisuMax (Zeiss Meditech). Two groups were used, one with lenticules at 100 µm and the other at 160 µm. Lenticules were immediately processed (fixed, dehydrated, dried, and mounted with gold coating). A JSM-5300 scanning electron microscope was used for observations. Results: Deeper lenticules had more irregular surfaces and were more difficult to dissect. Comparing the central and peripheral thickness of lenticules to the intended thickness was significantly more accurate in the superficial group. Conclusion: Energy settings still needs further adjustment to be able to create deeper predictable lenticules in SMILE cases.
Co-Author(s): George Asimellis PhD
Scientific Poster 215 SOE Refractive Corneal Correction With TopographyAssisted Customized High-Fluence Crosslinking (PiXL) Presenting Author: A John Kanellopoulos MD* Co-Author(s): Ioanna Kontari MD, George Asimellis PhD Purpose: Investigation of customizable high-fluence transepithelial crosslinking (PiXL) to achieve predictable myopic, astigmatic, and hyperopic refractive changes. Methods: One-year evaluation of 20 cases (10 myopic eyes, 5 hyperopic, and 5 astigmatic) for PiXL refractive error change and cornea clarity, keratometry, topography, OCT tomography, and endothelial cell count (ECC). Results: Mean values achieved: -1.8 D in the myopic group, +0.12 D in the hyperopic group, and -1.3 D in the astigmatic group; there was a 0.3 D regression in Month 1. No change in ECC or corneal clarity. Conclusion: This novel application of PiXL appears to offer predictable and stable myopic, astigmatic, and hyperopic effect. Minimal postoperative morbidity and immediate visual rehabilitation were noted.
Scientific Poster 216 SOE Combined Femtosecond Laser-Assisted Myopic Refractive Lens Extraction With Customized Very HighFluence Collagen Crosslinking: A Novel Procedure Presenting Author: A John Kanellopoulos MD* Co-Author(s): George Asimellis PhD Purpose: To evaluate feasibility of a novel technique combining femtosecond laser in refractive lens extraction and collagen crosslinking (cCXL). Methods: Femtosecond laserassisted myopic refractive lens extraction was pioneered with the WaveLight FS200 laser. The 50-µm lenticule was extracted through a novel 3.5-mm canal. cCXL was applied in the pocket created. Scheimpflug and anterior segment OCT were employed for imaging perioperatively. Results: All 10 cases were feasible ex vivo. Corneal thickness and topographic differences were consistent with achieved myopic change. Interlamellar CXL effect was verified by corneal OCT imaging. Conclusion: This study demonstrated feasibility and expands FSME with another platform. Additional combination with cCXL introduces a novel technique.
Scientific Poster 217 Evaluation of an OCT-Based Keratoconus Risk Scoring System Presenting Author: Edwin W Nunnery III MD Co-Author(s): J Bradley Randleman MD Purpose: To investigate the validity of an OCT-based risk scoring system for keratoconus risk stratification in patients with normal and suspicious Placido-based topographic patterns. Methods: Fourier-domain OCT acquired corneal pachymetric maps. Variables included minimum, minimum-median, superior-inferior, superonasal-inferotemporal, and the vertical location of the thinnest cornea. Summation of variables yielded a composite keratoconus risk score. Low risk was defined as 0 to 3, and high risk as 4 or higher. Results: Ninety-eight normal eyes were evaluated; 78% were classified as low risk, and 22% as high risk. 100 suspicious eyes were evaluated; 70% were classified as low risk, and 30% as high risk. Conclusion: An OCT-based pachymetric keratoconus risk scoring system correctly classifies most normal eyes but not suspicious eyes.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To compare variable spot scanning (VSS) with wavefront-optimized (WFO) ablations for the correction of myopia. Methods: Two groups, each with 50 eyes of myopia. Both had LASIK using the M2 microkeratome. The VSS group had VSS refractive ablation using the Star S4IR, and the WFO group had WFO ablation using the Allegretto Eye-Q. Visual outcome was evaluated preoperatively and 3 months postoperatively including contrast sensitivity and higher-order aberrations. Results: Mean pre- and postoperative spherical equivalent (SE) in the VSS group: 3.8 and -0.14; in the WFO group: -4.03 and -0.15, with no significant difference. After 3 months, there was no significant difference in UCVA, BCVA, or SE. Mean induced +ve spherical aberration (SA): 0.041 µm (P = .00) in VSS and 0.195 µm (P = .00) in WFO, with significant difference between the 2 groups (P = .000). Conclusion: VSS and WFO ablations are equally effective, safe, predictable, and stable in treating myopia. Both ablations induced minimal +ve SA, which was significantly higher with WFO.
Presenting Author: A John Kanellopoulos MD*
Scientific Posters Scientific Poster 218 SOE Femtosecond Laser Lenticular Extraction Outcomes in Correction of Myopia Compared to Sixth-Generation Excimer Laser
Scientific Poster 222 Phakic IOL Sizing Using Manual Caliper and Videoimaging Modalities
Presenting Author: Ahmed A Abdou MD PhD
Co-Author(s): Jay R Patel MD, Jay Stuart Pepose MD PhD*
Co-Author(s): Jorge L Alio MD PhD*, Mohamed Elbahrawy MBBCH MS
Purpose: To compare predictability of white-to-white (w-w) or sulcus measurements for horizontal sizing of posterior chamber phakic (Visian ICL) IOLs. Methods: Postoperative ICL vault and angle dimensions were retrospectively used to predict resizing of ICL (rICL) diameters, which were then statistically compared to values predicted by manual caliper and imaging (Orbscan, IOLMaster, Visante) techniques. Results: There was no statistical difference between caliper w-w (mean 11.9 mm) and Visante sulcus readings (12.0, P > .07). Correspondingly, planned ICL size differed significantly from rICL for Orbscan or IOLMaster w-w (P < .02), but not for caliper and Visante measurements (P > .2). Conclusion: Anterior segment imaging did not offer a significant advantage over manual caliper white-to-white measurements for ICL sizing.
Purpose: Femtosecond lenticular extraction (FLEx) / small-incision lenticule extraction (SMILE) efficiency and safety profile assessment. Methods: Comparative retrospective series of cases including 128 eyes, divided into 4 groups of 16 eyes according to gender, each of which was matched to an identical LASIK case. Results: FLEx showed a slight BCVA decrease; SMILE showed a slight increase, evident in females; 0.093 ± 0.1 (P = .083), -0.025 ± 0.1 (P = .014), on logMAR. Females had more residual error, highest with FLEx, -0.21 D (±2.16). Horizontal coma changes were most significant in males: SMILE, P = .06); FLEx, P = .026, with no significant changes in vertical coma in any group. Conclusion: FLEx/SMILE techniques had satisfyingly stable refractive outcomes.
Scientific Poster 219 SOE Presbyopia Reversal: Accommodation Research Using Femtosecond Lasers Presenting Author: Sunil Shah MD*
Scientific Posters
Purpose: To determine effect of in vivo femtosecond lenticular treatments on accommodative amplitude. Methods: Prospective evaluation of 80 patients undergoing cataract surgery and 20 undergoing clear lens extraction treated with a range of treatment algorithms. Follow-up visits at Weeks 1 and 2 and Month 1. Results: At 1 week, 33.3% showed an improvement in objective accommodation. Fifty-three percent of subjects showed an improvement in subjective accommodation. best distance-corrected near visual acuity (BDCNVA) improved in 37.3% of patients at Week 1, improving to 40.8% at Month 1. Maximum improvement at Month 1 was 1.5 D and 2.3 D for objective and subjective accommodation, respectively. Mean improvement in best corrected distance visual acuity was an increase from baseline of 31 letters at Month 1. Conclusion: In-the-lens treatment can improve objective and subjective accommodation and DCNVA in many patients.
Presenting Author: Mujtaba A Qazi MD*
Scientific Poster 223 Ten-Year Follow-up of Patients With Keratoconus Who Received a Staar Toric Phakic Lens Implant Presenting Author: Juan F Batlle MD* Purpose: Retrospective study of the long-term safety and efficacy of the Staar Toric Phakic Lens in patients with keratoconus. Methods: Seventy-two patients who were diagnosed with keratoconus have been followed for at least 3 years, and 12 have reached the 10-year mark. The implant was studied for refractive and rotational stability, and the patients were studied for progression of their cone. Results: The average spherical equivalent was -12.0 D, and the average cylinder was 3.5 D. The lens remained within 5 degrees of the predicted axis in 90% of the cases, and the position remained unchanged. Conclusion: This study demonstrates that the Staar Toric ICL is safe and effective in the treatment of keratoconus. The toric ICL remained stable without axis rotation and refractive changes over this period of follow-up.
Scientific Poster 220 SOE Clinical Results and Rotation Stability of Toric IOLs
Scientific Poster 224 Treating Emmetropic Presbyopes With a Small Aperture Inlay: Three-Year Results
Presenting Author: Rita Matos
Presenting Author: John Allan Vukich MD*
Co-Author(s): Joana Pires MD, Mariana S Cardoso MD**, Sergio G Monteiro MD**, Manuel S Mariano MD**
Purpose: To evaluate the safety and efficacy of a small-aperture corneal inlay for the treatment of presbyopia. Methods: Prospective, nonrandomized clinical trial of 154 emmetropic presbyopes implanted in the nondominant eye with a small-aperture inlay for the correction of presbyopia. Inclusion criteria were uncorrected near visual acuity (UCNVA) of worse than 20/40 and better than 20/100 and a best corrected distance VA ≥ 20/20 in both eyes, with a SE between +0.50 D and -0.75 D. VA, refractive stability, and satisfaction were evaluated. Results: Mean UCNVA improved from J8 at preop to J2 at 3 years postop. Mean uncorrected distance VA was virtually unchanged. Ninety-two percent of patients were 20/25 or better at 3 years postop; 96% were within ±1.00 D of intended target. Conclusion: Near VA improves with implantation of a small aperture inlay, while good distance vision is retained over the long term.
Purpose: To compare the clinical results and rotation stability of 3 toric IOLs. Methods: A total of 60 eyes with corneal astigmatism ranging from 1.03 to 4.13 D underwent phacoemulsification with toric IOL implantation; 20 eyes were implanted with an Alcon AcrySof Toric IOL, 20 eyes with an Abbott Tecnis Toric IOL, and 20 eyes received a Bausch+Lomb enVista Toric IOL. Patients were observed at 1 day and 1, 3, and 6 months postoperatively. Results: At final follow-up, 91.6% of the eyes showed an UCVA of 20/25 or greater; average overall rotation was 3.78 ± 2.26° with a range of rotation between 0-8°. Conclusion: All IOLs showed good rotational stability, with no significant differences being found between the 3 IOLs.
Scientific Poster 221 Confocal Observation of Corneal Reinnervation After SmallIncision Lenticule Extraction: Two-Year Results Presenting Author: Meiyan Li MBCB Co-Author(s): Xingtao Zhou MD PhD Purpose: To evaluate corneal reinnervation and the corresponding corneal sensitivity after small incision lenticule extraction (SMILE). Methods: In this prospective, observational study, 10 patients (20 eyes) who received SMILE surgery to correct myopia were included. The corneal sub-basal nerve fibers were evaluated by confocal microscopy prior to surgery and 2 years after surgery. Corneal sensation was tested with Cochet-Bonnet esthesiometry. A correlation analysis was performed between sub-basal nerve density and corneal sensation. Results: There was no statistical difference in sub-basal nerve density (P > .05) or corneal sensation (P > .05) relative to the corresponding preoperative values. Conclusion: The corneal sub-basal nerve density after SMILE can recover to preoperative levels by postoperative 2 years.
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Scientific Poster 225 Lens-Based Accommodation Restoration Using a Femtosecond Laser Presenting Author: Harvey S Uy MD* Co-Author(s): Sunil Shah MD*, Ajay Pillai MD, Ronald R Krueger MD* Purpose: To determine the efficacy and safety of accommodation restoration (AR) using a femtosecond laser (FS). Methods: Interventional case series of 20 presbyopic eyes that underwent FS applied to the crystalline lens. Main outcome measures: proportion of eyes with distance-corrected near visual acuity (DCNVA) > 20/40 at 40 cm, binocular viewing distance (BVD) after 1 month. Results: Among emmetropes, the proportion of eyes with DCNVA > 20/40 at pre- and post-treatment was 0% and 100%, while among nonemmetropic eyes it was 7.9 % and 38.5%, respectively. Among emmetropes, the mean BVD (SD) at pre- and post-treatment was 50.25 cm and 46.3 cm while among nonemmetropic eyes, 45.8 cm (11.0) and 37.2 cm (9.2), respectively. Conclusion:These results suggest that lens-based FS is a promising and safe method for AR.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 226 PRK vs. LASEK vs. Epi-LASIK: A Comparison of Corneal Haze and Visual Recovery in Myopic Patients
Scientific Poster 488 Clinical Outcomes of Topography-Guided Photorefractive Keratectomy With Crosslinking for Ectasia After LASIK
Presenting Author: James R Townley MD
Presenting Author: David Lin MD
Co-Author(s): Gary L Legault MD, Courtney Hintz MD, Matthew C Caldwell MD, Vasudha A Panday MD
Co-Author(s): Simon P Holland MD*
Purpose: To compare clinical outcomes of visual acuity (VA) and corneal haze following PRK, LASEK, and epi-LASIK. Methods: A retrospective institutional review board-approved study assessed advanced surface ablation (ASA)/ PRK performed at the War Fighter Refractive Surgery Center at Lackland, Texas, from January 2002 to 2011. The study compared postoperative UCVA, BCVA, BCVA at 5% contrast, and corneal haze. Results: 2240 eyes PRK, 347 eyes LASEK, and 125 eyes epi-LASIK. No statistical difference was found in haze, UCVA, BCVA, or BCVA; 5% among PRK, LASEK, and epi-LASIK at 6 months. Patient age was associated with haze at 3 months (P < .001) but not at 6 months. Conclusion: There was no significant difference in clinical outcomes between PRK, LASEK, and epi-LASIK.
Scientific Poster 227 SOE The Influence of New Technologies on the Quality of Vision in Patients After Refractive Surgery Presenting Author: Ewa Mrukwa-Kominek MD PhD*
Purpose: To evaluate simultaneous topography-guided photorefractive keratectomy with collagen crosslinking (TG PRK/CXL) for ectasia after LASIK. Methods: Fifty-five eyes with post-LASIK ectasia treated by Allegretto Wavelight (AW) laser with TG PRK/CXL. Clinical outcomes were evaluated. Results: Thirty-one of 55 eyes treated by AW laser with sixmonth follow-up. Fifty-nine percent had uncorrected visual acuity ≥20/40. Fifty-two percent gained at least two lines of best-corrected visual acuity, with none losing two or more lines. Mean reduction in astigmatism was 2.65 D. All but three patients symptomatically improved. Complications included delayed epithelialization beyond one week in two patients and visually symptomatic haze in one. Conclusion: Early results with TNT TG PRK/CXL show promise as an effective and safe treatment for post-LASIK ectasia.
Scientific Poster 489 Vector Analysis of Compound Myopic Astigmatism Comparing Wavefront-Guided and Wavefront-Optimized Excimer LASIK
Co-Author(s): Aanna Orlicka-Mosiej, Monika Sarnat
Presenting Author: Brian C Toy MD
Purpose: To assess the influence of new technologies on tear film stability, corneal epithelium condition, and optical aberrations in patients after PRK. Methods: Twenty eyes, cationic nanoemulsion, and 20 eyes, preservative-free artificial tears used 4 times daily after PRK. Changes in UCVA, BCVA, spherical equivalent (SEq), keratometric values, optical aberrations, fluorescein tear breakup time, and subjective symptoms. Results: No differences in UCVA, BCVA, SEq, or keratometric values. Changes observed in corneal aberration. We observed significant differences in tear film stability in Group I, 6 weeks after PRK (P < .05). Epitheliopathy and dryness were not observed in Group I, while 4 eyes in Group II. Patients’ subjective symptoms changed significantly in Group I (P < .05). Conclusion: Cationic nanoemulsion after PRK is efficient in tear film stability and improvement of subjective satisfaction.
Purpose: To compare astigmatic outcomes in eyes undergoing wavefront-guided (WFG) and wavefront-optimized (WFO) LASIK. Methods: Sixty-six eyes of 33 patients underwent LASIK for myopia. One eye underwent WFG LASIK, and the fellow eye underwent WFO LASIK. Eyes were stratified for subgroup analysis based on preop astigmatism, 0.25 to 1 D, 1.25 to 2.25 D, and 2.5 to 3.5 D. Results: Vector analyses for the WFG and WFO groups were, respectively, surgically induced astigmatism (0.9 ± 0.7 D vs. 1 ± 0.9 D, P = 0.71), error magnitude (0.2 ± 0.2 D vs. 0.2 ± 0.3 D, P = 0.3), correction index (1 ± 0.4 vs. 1.1 ± 0.3, P = 0.2), success index (0.3 ± 0.6 vs. 0.3 ± 0.4, P = 0.91), and flattening index (1 ± 0.8 vs. 1.1 ± 0.9, P = 0.8). Conclusion: There were no significant differences between eyes undergoing WFG LASIK and WFO LASIK using Alpins vector analysis of astigmatism.
SESSION TWO: MONDAY AND TUESDAY Scientific Poster 486 H Transparent Corneal Hydrogel Inlay in Emmetropic Presbyopes: Clinical Trial Update Presenting Author: Gregory Parkhurst MD* Co-Author(s): Roger F Steinert MD*
Co-Author(s): Edward E Manche MD*
Scientific Poster 490 Agreement of Aberrometry With Manifest Refraction Before and After LASIK: Prospective Comparison of HartmannShack and Tscherning Devices Presenting Author: Christopher S Sales MD Co-Author(s): Edward E Manche MD* Purpose: To assess agreement of manifest refraction (MR) with Hartmann-Shack and Tscherning aberrometry. Methods: Measurements were obtained in 100 eyes of 50 subjects preoperatively and 12 months after myopic LASIK with the WaveScan and the WaveLight. Correlation with MR was assessed with intraclass correlation coefficients (ICCs; 1 = perfect agreement, 0 = disagreement). Results: Preoperative agreement was excellent between the MR and both aberrometers (ICC, WaveScan: sphere = 0.97, cylinder = .95; WaveLight: sphere = 0.98, cylinder = 0.92) but poor to fair after LASIK (ICC, WaveScan: sphere = 0.4, cylinder = 0.1; WaveLight: sphere = 0.2, cylinder = 0.02). Conclusion: Variable effects of LASIK on Hartmann-Shack (WaveScan) and Tscherning (WaveLight) devices may affect the accuracy of spherocylinder measurements.
Scientific Poster 487 SOE Screening for Ectasia Risk Using Corneal Indices and High-Order Aberrations: Creation and Validation of an Artificial Intelligence Scoring System
Scientific Poster 491 A Prospective Comparison of Wavefront-Guided LASIK and Wavefront-Guided PRK Following Prior Keratorefractive Surgery
Presenting Author: Damien Gatinel MD*
Presenting Author: Jennifer S Kung MD
Co-Author(s): Alain Saad MD*
Co-Author(s): Edward E Manche MD*
Purpose: Evaluate the accuracy of a new objective method for the detection of ectasia susceptibility. Methods: Three hundred consecutive Placido topographies were retrospectively classified as “normal” or “at risk for LASIK” by a refractive surgeon and then by an objective automated system. The concordance between the objective and the subjective classification was assessed by receiver operating characteristic curve Results: The sensitivity and specificity of the scoring system were 88% and 89%, respectively. Only 20 cases were wrongly classified. Conclusion: The combination of high-order aberrations can create an accurate artificial intelligence for the detection of corneas at risk for refractive surgery.
Purpose: To prospectively evaluate retreatment with LASIK versus photorefractive keratectomy (PRK) after prior keratorefractive surgery. Methods: Twenty-six eyes of 22 participants (mean age, 39.6 years; 77% female) initially treated with LASIK or PRK were retreated with wavefront-guided LASIK (38%) or PRK (62%) using the AMO VISX S4 CustomVue IR excimer laser. Uncorrected distance visual acuity (UDVA) and manifest refraction were measured at one, three, six, and 12 months. Results: Mean UDVA was better in LASIK versus PRK retreatment eyes at postop month 1 (0.08 < 0.04 D ; P = 0.04) but was equivalent in both groups at three, six, or 12 months. The percentage of eyes with spherical equivalent within ±0.5 D of plano was equal between the two groups at all time points. Conclusion: Wavefront-guided LASIK or PRK following prior refractive surgery achieves similar efficacy and predictability.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To evaluate visual outcomes and satisfaction in emmetropic presbyopes unilaterally implanted with a transparent hydrogel corneal inlay in the U.S. Federal Drug Administration’s Investigational Device Exemption study. Methods: Visual acuities were collected at various distances and time points. Visual symptoms and patient satisfaction were evaluated with a National Eye Institute-Refractive Error Quality of Life questionnaire. Results: Binocularly at 12 m , 93% of patients were 20/25 (0.8) or better at all distances. Ninety-four percent of patients reported absent or mild visual symptoms (glare and halos) at 12 m. Patient satisfaction was high at 94%. Conclusion: Raindrop inlay provided patients with good binocular acuity, low visual symptoms, and high patient satisfaction.
Scientific Posters Scientific Poster 492 SOE Long term Epithelial Ingrowth Presenting Author: Melania Cigales MD Co-Author(s): Jairo Hoyos-Chacon MD, Jairo E Hoyos MD Purpose: We present a myopic patient with a history of LASIK 10 years ago. Methods: The patient arrived to our clinic complaining of a loss of vision and foreign body sensation for over a year due to epithelial ingrowth. Uncorrected visual acuity (UCVA) was 20/30, and best-corrected visual acuity was 20/20 with a refraction of +1–2 x 120°. Topography showed irregular astigmatism of 4 D. Results: We treated this by lifting the flap and scraping the epithelium on the bed and in the stromal face of the flap. To avoid a recurrence, we scraped the epithelium on the bed until the corneal limbus, and in this way, the re-epithelialization occurs from both the flap border and the limbus, coinciding halfway and far from the border of the flap. Conclusion: One month later, UCVA was 20/20, and topography was regular. Today, two years later, there has been no recurrence.
Scientific Poster 493 SOE FemtoLASIK to Correct Low Myopia vs. High Myopia Presenting Author: Miguel A Teus MD* Co-Author(s): Pilar Drake MD, Montserrat Garcia-Gonzalez MD, Esther ArranzMarquez MD PhD Purpose: To compare the refractive results of FemtoLASIK performed to correct low myopia (up to -5.75 D) versus high myopia (higher than –6 D). Methods: Retrospective study. Visual and refractive outcomes were evaluated at one day, one week, and one and three months postoperatively. Results: We included 1,177 eyes (900 in the low myopia group vs. 277 in the high myopia group). At three months, 89.8% of the eyes with low myopia versus 73.6% with high myopia (P < 0.01) were within ±0.5 D. Conclusion: FemtoLASIK to correct myopia is an effective and safe procedure. The accuracy obtained in low myopia is slightly, but significantly, better than in high myopia.
Scientific Poster 494 H Patient-Reported Quality of Vision After Refractive Surgery Presenting Author: Osamu Hieda MD
Scientific Posters
Co-Author(s): Shigeru Kinoshita MD* Purpose: To evaluate the short- and long-term efficacy of refractive surgery via a patient reported quality-of-vision (QOV) questionnaire. Methods: This study involved 1,400 patients who underwent refractive surgery at the Baptist Eye Clinic in Kyoto, Japan. The patients were asked to respond to the Refractive Status and Vision Profile questionnaire prior to surgery and at six months (n = 1,100) and 5.5 years (n = 230) postoperatively. Results: The mean preoperative total QOV score was 35.13, yet that score significantly improved six months after surgery (P < 0.01) and remained the same throughout the 5.5-year postoperative period. Conclusion: After refractive surgery, the patients reported short-term improvement of their QOV, which continued throughout the 5.5-year follow-up period.
Scientific Poster 495 SOE Femtosecond-Assisted LASIK With or Without Intraoperative Mitomycin C to Correct Hyperopia Presenting Author: Pilar Drake MD Co-Author(s): Miguel A Teus MD*, Montserrat Garcia-Gonzalez MD, Javier Paz Moreno-Arrones MD** Purpose: To compare the refractive results of Intralase laser using mitomycin C (MMC) in hyperopic patients versus no MMC. Methods: One hundred fifty-two consecutive patients were divided in two groups: applying MMC (0.02% for five seconds) and without MMC. We evaluated the uncorrected visual acuity (UCVA) at one day, one week, and one and three months after surgery and the refractive error. Results: There was no significant difference in UCVA between groups at any visit, except at three months, when UCVA was better in the MMC group (P = 0.03) . The residual sphere at the three-month postop was significantly lower in the MMC group (P = 0.007), and more eyes with MMC were within ±0.50 D than in the non-MMC group (P = 0.006). Conclusion: MMC hyperopic eyes showed less regression three months after surgery and had better UCVA and a smaller residual sphere. The use of MMC seemed to have a better predictability.
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Scientific Poster 496 SOE Evaluation of the Aberrometric Outcomes After LASIK Surgery Using iDesign System for Treatment Planning in Myopic Eyes Presenting Author: Aylin Kilic MD Purpose: To evaluate outcomes of wavefront-guided LASIK surgery using iDesign. Methods: Fifty-eight eyes with spherical -2.71 ± 2.23 D and cylinderic –1.26 ± 1.10 D were enrolled. High-order aberration (HOA) root mean square (RMS) and spherical aberration were measured for a 5-mm (32 eyes) and 6-mm (26 eyes) pupil size. Results: All eyes had a spherical refraction between ±0.50 D. Postoperatively, in 97% of the eyes, the uncorrected visual acuity (UCVA) was 1.0 or better (Snellen acuity chart), and 65% achieved an UCVA of 1.2 or better. There was insignificant change in the HOA RMS and spherical abberation (P > 0.05) for 5-mm and 6-mm pupil diameters after three months . Conclusion: Use of the iDesign system to calculate the ablation profile was found effective, safe, and predictable. There was insignificant induction of HOA and spherical aberrations.
Scientific Poster 497 Intra-user, Intrasubject Reliability of a New, Advanced Aberrometer for Normal Refractive Surgery Candidates Presenting Author: Gaurav Prakash MBBS Co-Author(s): Dhruv Srivastava OD, Vishal Jhanji MBBS Purpose: To evaluate intrauser repeatability of a new aberrometer. Methods: In this cross-section study, 110 right eyes were assessed on a new aberrometer (iDesign, AMO). Three readings were taken by a single user five minutes apart. Corneal and wavefront measurements were analyzed. Results: All parameters were similar between three measurements (ANOVA, P < 0.001). Outcomes were (in terms of overall mean ± standard deviation and intraclass correlation coefficient), sphere (–3.7 ± 2.9 D, 0.99), cylinder (–0.99 ± 1.0 D, 0.99), white to white (12.05 ± 0.35 mm, 0.96), scotopic pupil (6.5 ± 0.91 mm, 0.97), topographic K1 (42.4 ± 1.5 D, 0.96) and K2 (43.5 ± 1.6 D, 0.96), high-order abberation (0.36 ± 0.15 µm, 0.91), coma (0.18 ± 0.09 µm, 0.93), spherical aberration (0.03 ± 0.1 µm, 0.97), and trefoil (0.14 ± 0.07 µm, 0.89). Conclusion: The new aberrometer has repeatable measurements for anatomical parameters and ocular wavefront.
Scientific Poster 498 Tissue Glue for the Treatment of Recalcitrant Epithelial Ingrowth Presenting Author: Edward E Manche MD* Co-Author(s): Jennifer S Kung MD Purpose: To evaluate the efficacy of fibrin tissue glue for the treatment of epithelial ingrowth under LASIK flaps and buttonholes. Methods: A retrospective chart review was conducted to evaluate outcomes of eyes treated with fibrin glue after removal of epithelial ingrowth in LASIK flaps and buttonholes. Results: Eight eyes of eight patients were identified. Three had paracentral buttonhole defects, three had prior multiple ingrowth removal procedures, and one had epithelial ingrowth after a traumatic flap dislocation. All were treated with a flap lift and scraping of the ingrowth with fibrin tissue glue applied to the flap edges. No eyes have experienced significant recurrence of the epithelial ingrowth at last follow-up. Conclusion: Fibrin glue can be a useful adjunct for the treatment of epithelial ingrowth under LASIK flaps and buttonholes.
Scientific Poster 499 H A Prospective Evaluation of Eyes Undergoing PRK Using a Novel Silicone Corneal Shield for Pain Mitigation Presenting Author: Edward E Manche MD* Co-Author(s): Christopher S Sales MD Purpose: To prospectively evaluate the safety, efficacy, and predictability of photorefractive keratectomy (PRK) in eyes using the Nexis Vision silicone corneal shield. Methods: Forty-five eyes were fitted with the Nexis corneal shield for three days after undergoing wavefront-guided myopic PRK. The corneal shield was designed to minimize postop pain and speed visual recovery. Results: Six months after PRK, the mean preoperative uncorrected distance visual acuity (UDVA) improved from 1.3 to -0.1 logMAR (P = 0.000), 78% of eyes achieved UDVA of 20/20 or better, 13% of eyes lost one line of corrected distance visual acuity (CDVA), and no eye lost two lines of CDVA. Conclusion: Preliminary results suggest that the novel corneal shield provides safe and effective refractive outcomes.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 500 SOE Effect of Intraoperative Mitomycin C on Postoperative Pain after Laser-Assisted Subepithelial Keratomileusis (LASEK)
Scientific Poster 504 SOE Stromal Surface Topography-Guided Ablation as a Repair Tool for Irregular Stromal Surface
Presenting Author: Gustavo A Fernandez-Baca MD
Co-Author(s): Marine Gobbe PhD**, Timothy J Archer MS, Gerhard Youssefi PhD**, Hugo F Sutton MD
Co-Author(s): Jaime Garrido Linares MD, Cristina Perez Casaseca** Purpose: To evaluate the analgesic effect of intraoperative mitomycin C (MMC) 0.02% in postoperative laser-assisted subepithelial keratomileusis (LASEK) patients. Methods: This retrospective study included 106 patients who underwent bilateral LASEK. We compared 73 LASEK cases that received MMC 0.02% intraoperatively for 10 seconds (MMC group) with 33 LASEK cases not receiving MMC (no MMC group). Patients were asked to rate their experience of pain two days after surgery, and we compared both groups. Results: Mean patient age was similar in both groups (P = 0.055). Preoperative spherical equivalent refraction was higher in the MMC group (P = 0.021). The level of pain reported by patients in the MMC group was 1.51 (standard deviation [SD], 0.7) and 2.45 (SD, 0.9) in the no MMC group (P = 0.000). Conclusion: MMC 0.02%, used to prevent corneal haze, also reduces pain in patients after LASEK surgery.
Scientific Poster 501 H Infectious Keratitis After Photorefractive Keratectomy in 31,563 Procedures Presenting Author: Mahmoud Jabbarvand Behrooz MD** Co-Author(s): Hesam Hashemian MD, Mehdi Khodaparast MD**, Narges Hassanpoor MD, Mohammad Riazi Esfahani MD Purpose: To review the recorded data of infectious keratitis cases after photorefractive keratectomy (PRK) during an eight-year period. Methods: The medical records of postPRK patients (62,312 eyes) were searched for cases of infectious keratitis. Results: Infectious keratitis was diagnosed in 92 eyes of 79 patients. Most of the cases diagnosed were between the second and tenth day (87%). Cultures were positive in 56 of the 92 eyes. The most frequent organism was Staphylococcus (27 cases). The final visual acuity was 20/20 or better in 54 eyes. Conclusion: Infectious keratitis is a rare but potentially visionthreatening complication of PRK. Visual outcome is good after treatment in most cases.
Scientific Poster 502 SOE Small-Incision Lenticule Extraction Induces Significantly Less Spherical Aberration With Less Tensile Strength Change Compared to Wavefront Optimized LASIK Presenting Author: Dan Z Reinstein MD* Co-Author(s): Timothy J Archer MS, Marine Gobbe PhD**
Scientific Poster 503 SOE Bilateral Surgical Flap Amputation for the Treatment of Bilateral Central Flap Necrosis After LASIK Presenting Author: Montserrat Garcia-Gonzalez MD Co-Author(s): Pilar Drake MD, Juan Gros-Otero, Esther Ciancas MD Purpose: To report a case of bilateral central flap necrosis syndrome (CFNS) after LASIK treated with a surgical flap amputation. Methods: Bilateral CFNS was diagnosed after uneventful FemtoLASIK. One month postop, uncorrected visual acuity (UCVA) was 0.05 with a hyperopic shift of +3.25 D (best spectacle-corrected visual acuity [BSCVA] was 0.2 in both eyes). Both flaps were surgically amputated, and mitomycin C 0.02% was applied for one minute over the stromal bed. Results: One day postop, UCVA was 0.7 in both eyes. At three months, the residual refraction was +3.00 D in both eyes, and the BSCVA was 1.0. Conclusion: Surgical flap amputation is a valid option for the treatment of CFNS, at least for the more severe cases.
Purpose: To present the first report of stromal surface topography-guided ablation for repair after a short nasal LASIK flap and ablation. Methods: To account for epithelial masking of the stromal irregularity, the ablation profile was calculated using the stromal surface height obtained by subtracting Artemis VHF digital ultrasound epithelial thickness from Orbscan II corneal front surface elevation. Results: One month after treatment, the epithelial thickness irregularity was reduced by 54%. Axial power asymmetry was reduced by 4 D. Anterior elevation map showed reduced asymmetry. The patient reported significant improvement in night vision. Conclusion: Stromal surface topography-guided ablation was effective in reducing stromal surface irregularity and improving visual quality.
Scientific Poster 505 SOE IOP Changes Following Lengthy Topical Corticosteroid Use in Normal vs. Keratoconic Nonglaucoma Patients Presenting Author: Emerson M Cruz MD Co-Author(s): Robert Edward T Ang MD*, A John Kanellopoulos MD*, George Asimellis PhD Purpose: To investigate steroid-related IOP spikes following topical corticosteroid use for over a month in normal versus keratoconic (KCN) patients. Methods: Four hundred sixtyone normal and KCN eyes were treated with topical dexamethasone 0.1% following corneal laser refractive and/or collagen crosslinking for over six weeks and were evaluated for IOP changes. Results: Six percent of normal eyes had IOP rise over 25 mmHg compared with the statistically significant (P < 0.001) 21% of KCN cases. All cases returned to normal IOP within three months (follow-up, one to five years). Conclusion: This study demonstrates a potentially significant predisposition for KCN eyes to develop steroid-induced glaucoma.
Scientific Poster 506 SOE Phototherapeutic Keratectomy for Groenouw Corneal Dystrophy: Five-Year Results Presenting Author: Fabrizio I Camesasca MD Co-Author(s): Paolo Vinciguerra MD*, Silvia Trazza MD, Riccardo Vinciguerra MD* Purpose: Groenouw type 1 (granular) and 2 (macular) corneal stromal dystrophies (CSDs) cause progressive visual acuity decrease and recurrent erosions. We present long-term follow-up of phototherapeutic keratectomy (PTK )for Groenouw CSD. Methods: Twentynine eyes with Groenouw (type 1, 44.8%; type 2, 55.2%) hindering visual acuity underwent PTK. Results: Preoperative best spectacle-corrected visual acuity (BSCVA) was 0.26 ± 0.24 with +1.06 ± 2.12 D sphere and -1.95 ± 0.37 D cylinder . Mean pupillary K was 45.16 ± 4.38 D. Five years after PTK, BSCVA was 0.65 ± 0.12 with +1.50 ± 1.90 D sphere and -1.71 ± 0.90 D cylinder. Mean pupillary K was 42.72 ± 2.51 D. No patients reported recurrence of corneal erosions. Conclusion: Five years after PTK, eyes with Groenouw types 1 and 2 showed BSCVA improvement, stability of refraction, and no recurrent erosion.
Scientific Poster 507 Clinical Outcomes of Transepithelial Photorefractive Keratectomy in the Correction of Astigmatism: A Follow-up Study Presenting Author: Soheil Adib Moghaddam MD Co-Author(s): Fatemeh Adili-aghdam**, Saeed Soleymanjahi Purpose: To evaluate trans-photorefractive keratectomy (PRK) using a Schwind Amaris 500 laser in astigmatism. Methods: In this prospective study, 95 eyes were enrolled and followed up till 12 months. Results: Preoperative mean uncorrected distance visual acuity (UDVA) logMAR of 0.68 ± 0.41 improved to -0.08 ± 0.09 (P < 0.0005). Moreover, 91.5% of eyes reached UDVA of 20/20 or better. The mean spherical equivalent of eyes was reduced greatly from -3.66 ± 1.54 D to -0.02 ± 0.17 D (P < 0.0005). Mean reduction in astigmatism was 91% (1.39–0.12 D). We also found that 96.7% and 100% of eyes were within ±0.5 D and ±1 D of target refraction, respectively. These percentages were 90.3% and 100% for cylindrical refraction. Only one eye lost more than two lines of preoperative corrected distance visual acuity, and 95.3% of eyes had preserved it or gained one line or more. Conclusion: Trans-PRK is an effective, predictable, and safe method for treatment of astigmatism.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To analyze spherical aberration (SA) induction by small-incision lenticule extraction (SMILE) and LASIK correlated to postop tensile strength (PTS). Methods: SMILE eyes using a spherical profile (6- to 7-mm optical zone) were matched for sphere, cylinder, and pachymetry to LASIK eyes using an aspheric profile (6-mm optical zone). Corneal SA change and PTS were plotted against spherical equivalent . Results: SA induction was 64% lower in the SMILE group (0.11 vs. 0.31 µm), and PTS was 28% greater in the SMILE group (73% vs. 57%), despite 32% more tissue removal (107 and 81 µm) from use of larger optical zones (6.7 and 6.1 mm). Conclusion: SA induction was lower for spherical SMILE than aspheric LASIK for same tissue removal. By preserving stronger anterior stroma, SMILE optical zones can be increased to improve SA control while still leaving higher PTS.
Presenting Author: Dan Z Reinstein MD*
Scientific Posters Scientific Poster 508 SOE AcrySof Cachet Angle-Supported Phakic IOL: Safety, Stability, and Visual Outcomes Presenting Author: Joana Pires MD
Scientific Poster 512 Novel Ocular Fixation Device Improves Implant Positioning and Leads to Improved Results in Scleral Implant Surgery for Presbyopia
Co-Author(s): Mariana S Cardoso MD**, Rita Matos, Manuel S Mariano MD**
Presenting Author: Barrie D Soloway MD*
Purpose: To assess the safety, stability, and visual outcomes of implantation of an anglesupported phakic IOL (pIOL). Methods: Seventy-nine eyes underwent implantation of the Acrysoft Cachet pIOL. Rotational stability, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), IOP, and endothelial cell density (ECD) were the main outcomes recorded at one, six, and 12 months postoperatively. Results: Seventy-nine eyes of 43 patients, ranging in age from 21 to 51 years old, were evaluated. At final follow-up, the mean UDVA was ≥0.8 in 93.7% of the eyes, the CDVA was ≥1.0 in 87.3%, and the overall mean ECD loss was 0.44% ± 1.16% (P > 0.05) . Conclusion: The Acrysoft Cachet pIOL seems to be predictable, effective, and safe, providing satisfactory refractive correction in patients with moderate to high myopia.
Purpose: To discuss novel advancements in the device, surgical instrumentation, and technique used in the clinical trial for presbyopia. Methods: An evolution of the device, instrumentation, and technique has occurred. Changes to a two-piece locking implant and the Oculock Incisional System have standardized the procedure. Results: Three hundred thirty subjects (645 eyes) have received the two-piece locking implant. No slipping has been noted, and efficacy continues to improve (95% 20/40 or better by 24 months). Conclusion: A greater number of patients treated by a wider variety of surgeons meet or exceed the primary outcome efficacy of distance-corrected near visual acuity of 20/40 or better.
Scientific Poster 509 SOE Five-Year Assessment of Endothelial Cell Density and Cell Morphology With an Investigational Angle-Supported Phakic Lens Presenting Author: Thomas Kohnen MD* Purpose: To sssess corneal endothelium changes of an angle-supported phakic lens for the correction of moderate to high myopia. Methods: Five hundred fifteen study eyes (n = 360 patients) in a prospective, multicenter clinical trial. Corneal images with the Konan Noncon Robo specular microscope. Assessments at five years included endothelial cell density (ECD), percentage hexagonality (% hex), and coefficient of variation (CV). Results: Mean central comparison of preop versus five years, respectively: ECD was 2,856.5 (standard deviation [SD] ± 299.2; n = 515) and 2,620.4 (SD ± 343.7; n = 409), % hex was 57.5 (SD ± 6.3; n = 512) and 58.0 (SD ± 6.0; n = 417), and CV was 33.4% (SD ± 4.5%; n = 512) and 31.3% (SD ± 3.6%; n = 417). Conclusion: Five-year outcomes showed minimal changes in corneal ECD and stable cell morphology compared with preop. Six-month follow-up is recommended to monitor possible changes in ECD loss.
Scientific Poster 510 SOE Visual Results After Femtosecond Laser-Assisted Phacoemulsification and Implantation of a Trifocal IOL
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Presenting Author: Thomas Kohnen MD* Purpose: To evaluate outcomes after femtosecond laser-assisted phacoemulsification and implantation of a trifocal IOL. Methods: Thirty patients were enrolled after bilateral femtosecond laser-assisted (LenSx, Alcon) phacoemulsification with implantation of a trifocal IOL (AT Lisa Zeiss). Assessment three months postop included uncorrected and corrected visual acuity (VA) at 4 m, 0.8 m, and 0.4 m and a questionnaire. Results: Postop sean spherical equivalent was 0.34 ± 0.00 D. Uncorrected binocular VA was -0.1 ± 0.1 logMAR at 4 m and 0.0 ± 0.1 logMAR at 0.8 and 0.4 m. Eighty-four percent of patients do not use additional optical aids. Sixteen percent occasionally use additional near correction. Conclusion: The trifocal IOL showed good VA at far, intermediate, and near distance and a high rate of spectacle independence.
Scientific Poster 511 SOE Visual Performance and Subjective Experience of Patients Implanted With a new Bi-aspheric, Segmented, Multifocal IOL: The SBL-3 Presenting Author: Sunil Shah MD* Purpose: To assess visual performance of a new biaspheric, segmented multifocal (MIOL), the SBL-3. Methods: Patients were monocularly (n = 7) or binocularly (n = 10) implanted. Three months later, assessment was made of manifest refraction, uncorrected (UCDVA) and best-corrected distance visual acuity, uncorrected (UCNVA) and best-corrected near visual acuity (BCNVA), defocus curves, contrast sensitivity (CS), and halometry. Results: Mean residual manifest refraction was +0.06 ± 0.45 D. Mean UCDVA was +0.07 ± 0.14 logMAR. Mean UCNVA was J3, and BCNVA was J2. Mean CS was 1.66 ± 0.13 log units. Halometry showed a glare profile of less than one degree of light scatter. Conclusion: The SBL-3 MIOL provides a good visual outcome at distance and near with minimal dysphotopsia.
Scientific Poster 513 Visual Outcomes of Pseudophakes When Implanted With a Transparent Hydrogel Corneal Inlay to Treat Presbyopia Presenting Author: Jeffrey Whitman MD OCS* Co-Author(s): Dan B Tran MD**, Arturo S Chayet MD*, Enrique Barragan MD*, Hai Yen Tran MD** Purpose: To assess visual function in pseudophakes treated with a hydrogel corneal inlay (Raindrop) to improve near and intermediate vision. Methods: Uncorrected and distance corrected visual acuities will be reported based on standard measurement methods, while patient satisfaction, visual function, and any visual symptoms will be assessed using a questionnaire. Results: At three months , 35 patients were examined, and on average, subjects achieved binocularly 0.1 uncorrected near visual acuity, 0.1 uncorrected intermediate visual acuity, and 0.0 uncorrected distance visual acuity logMAR. Eighty-five percent of subjects were satisfied or very satisfied with this procedure. Conclusion: In this cohort of pseudophakic patients implanted with monofocal IOLs, the transparent inlay provided functional binocular vision at all distances.
Scientific Poster 514 SOE Femtosecond Laser-Assisted Intracorneal Ring Segment Implantation, Corneal Collagen Crosslinking, and Topography-Guided PRK in Combined Keratoconus Treatment Presenting Author: Alexander V Doga MD PhD** Co-Author(s): Ekaterina Branchevskaya Purpose: To evaluate the efficacy of topography-guided photorefractive keratectomy (PRK) and intracorneal ring segments (ICRSs) implantation and corneal collagen crosslinking (CXL) in keratoconus management. Methods: Consecutive patients received femto-assisted ICRS implantation followed by a sequential CXL procedure. T-guided PRK was performed 12 months after CXL. Outcome measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), topography, Scheimpflug tomography, contrast sensitivity, and ocular aberrations (PSF , Strehl ratio). Results: Study included 36 eyes of 22 patients. Preop UDVA and CDVA (logMAR) were 1.24 ± 0.13 and 0.64 ± 0.16 and improved at last follow-up 12 months after PRK to 0.44 ± 0.23 and 0.21 ± 0.12. No patients lost lines of CDVA. Conclusion: Combined keratoconus treatment was effective for improving visual functions in select patients.
Retina, Vitreous SESSION ONE, SATURDAY AND SUNDAY Scientific Poster 228 SOE Effect of Intraocular Silicone Oil on Subfoveal Choroidal Thickness Presenting Author: Gunhal Satirtav MD** Co-Author(s): Enver Mirza**, Hurkan Kerimoglu MD, Refik Oltulu MD**, Pinar Topcu Yilmaz MD, Mehmet Okka MD Purpose: To detect any potential effect of intraocular silicone oil (SiO) endotamponade on subfoveal choroidal thickness (SFCT). Methods: Seventeen eyes with retinal detachment were operated with pars plana vitrectomy (PPV) and 1000 cst SiO endotamponade injection. SFCT was measured with enhanced depth imaging with OCT, 1 month and 3 months after PPV and 1 month after SiO removal. Contralateral eyes served as controls. Results: Mean
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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters SFCT was 300.43 ± 74.90 µm at post-PPV first month, 285.21 ± 86.92 µm at post-PPV third month, and 253.15 ± 61.01 µm after SiO removal. The difference between each measurement was found to be statistically insignificant (P > .01). Conclusion: Results suggest that intraocular 1000 cst SiO endotamponade does not seem to exert any effect on SFCT.
Scientific Poster 229 Central Serous Chorioretinopathy Misdiagnosed as Ocular Inflammatory Disease Presenting Author: Salim Ben Yahia MD* Co-Author(s): Rim Korbaa Kahloun MD, Mbarek Samah MD**, Bechir Jelliti MD, Moncef Khairallah MD Purpose: To determine the proportion of central serous chorioretinopathy (CSCR) cases misdiagnosed as ocular inflammatory condition (OIC). Methods: The charts of 120 patients with a definitive diagnosis of CSCR were reviewed. Results: CSCR had been initially misdiagnosed as OIC in 17 patients (14.2%). Referring diagnoses included Vogt-Koyanagi-Harada disease (N = 5), multifocal choroiditis (N = 2), serpiginous choroiditis (N = 1), Birdshot chorioretinopathy (N = 1), Behçet uveitis (N = 2), toxoplasmic retinochoroiditis (N = 1), tubulointerstitial nephritis and uveitis syndrome-associated uveitis (N = 1), idiopathic panuveitis (N = 2), and optic neuritis (N = 2). Fifteen patients (88.2%) had received systemic corticosteroids before referral. Conclusion: It is not uncommon for CSCR to be misdiagnosed as OIC. This usually leads to inappropriate management with potentially harmful corticosteroid therapy.
Scientific Poster 230 Gene Variants Associated With ROP Presenting Author: Mary Elizabeth Hartnett MD FACS* Co-Author(s): Margaret M DeAngelis PhD* Purpose: To determine genetic variants associated with severe ROP in extremely low birth weight U.S. infants. Methods: Whole genome amplified DNA from blood spots was genotyped for 145 candidate gene single nucleotide polymorphisms (SNPs) in preterm infants phenotyped for ROP. Results: Ventilation days and seizures were associated with severe ROP. After controlling for significant factors and multiple comparisons, SNPs in BDNF (rs7934165, rs2049046; P < 3.1x10-5) were associated with severe ROP in discovery (n = 817 infants). After meta-analysis with 543 different infant blood samples, rs7934165 increased in associated significance with severe ROP (P = 2.9 x10-7). Conclusion: Variants in BDNF encoding brain-derived neurotrophic factor were associated with severe ROP.
Scientific Poster 231 Reassessment of Scleral Depression in the Clinical Setting Presenting Author: Shripaad Y Shukla MD Co-Author(s): Nikhil N Batra MD, Ravi D Patel MD, Shaun Ittiara MD*, Seenu M Hariprasad MD*
Scientific Poster 233 Speculum vs. Bimanual Lid Retraction During Intravitreal Injection: Prospective Comparison of Patient Experiences Presenting Author: Ehsan Rahimy MD Co-Author(s): Allen Chiang MD, Marc J Spirn MD, Sunir J Garg MD*, Jason Hsu MD*, Richard S Kaiser MD*, Mitchell S Fineman MD* Purpose: Effective lid retraction, a critical step during intravitreal injection, has been associated with patient discomfort. Methods: Thirty-one patients with bilateral retinal disease requiring intravitreal anti-VEGF therapy were randomized to either bimanual retraction or a bladed metal speculum in the first eye followed by the opposite method in the fellow eye. Level of discomfort was assessed with a visual analog 0-10 pain scale. Results: Twenty-six patients (83.9%) preferred bimanual retraction vs. 0 (0.0%) for a speculum, while 5 (16.1%) had no preference. Mean pain score was 2.50 (0-7) with a speculum vs. 0.63 (0-5) with bimanual retraction (P = .0005). Conclusion: A majority of patients preferred bimanual retraction over a speculum based on discomfort level.
Scientific Poster 234 Fundus Autofluorescence in Retinal Angiomatous Proliferation Presenting Author: Masaaki Saito MD Co-Author(s): Kanako Itagaki**, Mariko Kano**, Tetsuju Sekiryu MD Purpose: To evaluate the characteristics of fundus autofluorescence in retinal angiomatous proliferation (RAP). Methods: We retrospectively studied the fundus characteristics of 42 patients (mean age: 81.4 years) of 56 eyes with naïve RAP. Short-wavelength and near-infrared autofluorescence (SW-AF and IR-AF) were performed. Results: Abnormalities corresponding to the RAP lesions on indocyanine green angiography were seen in 23 eyes with SW-AF and 50 eyes with IR-AF (P < .001). Of 42 patients, 13 eyes developed RAP during the follow-up period. All 13 eyes showed hypoautofluorescence by IR-AF before onset of RAP. Conclusion: Abnormalities on SW-AF and IR-AF may be related to the dysfunction of the photoreceptor-retinal pigment epithelium complex. Hypoautofluorescence on IR-AF may indicate the presence or the onset of RAP lesions.
Scientific Poster 235 Subfoveal Choroidal Thickness After Intravitreal Aflibercept for Neovascular AMD: Twelve-Month Results Presenting Author: Hideki Koizumi MD Co-Author(s): Akiko Yamamoto MD, Masaaki Saito MD, Ichiro Maruko MD, Tetsuju Sekiryu MD, Annabelle A Okada MD*, Tomohiro Iida MD* Purpose: To investigate subfoveal choroidal thickness (SCT) after intravitreal aflibercept injections (IAIs) in eyes with neovascular AMD. Methods: SCT was measured in 42 eyes with neovascular AMD before and after 3 monthly IAIs, followed by injections every 2 months for a 12-month period. Results: The mean SCT decreased significantly, from 264 µm at baseline to 230 µm at 3 months (change ratio compared with baseline, 87.1%), and to 217 µm (81.8%) at 12 months (P < .0001 for both), independent of AMD subtype. Conclusion: Subfoveal choroidal thickness decreased with aflibercept therapy in eyes with neovascular AMD.
Scientific Poster 232 H Clinical, Functional, and Imaging Characteristics of Cancer-Associated Retinopathy and Optic Neuropathy
Scientific Poster 236 Association Between Reticular Pseudodrusen and Choroidal Thickness in Early AMD
Presenting Author: Rebecca S Epstein MD
Presenting Author: Celine Saade
Co-Author(s): Eric Sollenberger BBA, Alessandro Iannaccone MD
Co-Author(s): Hao Cheng MD PhD**, Nicole Pumariega MS, Rachel M Cymerman, R Theodore Smith MD
Purpose: To characterize patients with cancer-associated retinopathy (CAR) and/or cancerassociated optic neuropathy (CAON). Methods: We report 13 cases, 45-76 years old, with visual loss and a diagnosis of cancer consistent with CAR and/or CAON. Results: Photophobia (87%) and nyctalopia (73%) were most common at onset. Acuity ranged from 20/20 to count fingers. Cone electroretinograms were always abnormal in CAR. Changes at or around the disc, delayed visual evoked potentials, and perimetry changes consistent with optic nerve involvement were always seen. Compared to 45 primary autoimmune cases, patients > 50 years old and with < 3 autoantibodies (AAbs) were 13.5-fold (χ2: 24.4, P < .001) and 5.4-fold (χ2: 6.8, P = .009) more likely to have CAR/CAON, respectively. Conclu-
Purpose: To study the association between reticular pseudodrusen (RPD) and choroidal thickness (CTh) in early AMD. Methods: Thirty-three eyes (26 subjects) with early AMD/ no RPD and 18 eyes (16 subjects) with early AMD/RPD underwent enhanced depth imaging OCT. Temporal, foveal and nasal CTh were measured. Results: CTh was significantly reduced in the RPD group vs. the non-RPD group in the nasal and foveal areas (116.9 ± 7.1 vs. 134.3 ± 8.8, P = .002; 155.2 ± 3.4 vs. 172.4 ± 4.2, P < .001) but not in the temporal area (171.6 ± 6.6 vs. 171 ± 7.2, P = .83). Conclusion: RPD eyes have a thinner choroid in the studied areas than non-RPD eyes, except in the temporal area, the known area of predilection for RPD; this relative temporal thickness may be due to fibrotic changes.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To examine the use and utility of scleral depression in today’s retina practice. Methods: Prospective comparative trial of 100 eyes of 50 new patients (25 with symptoms, 25 without) with the findings of a single examiner using a 28 D lens compared to findings in the same eye after 360-degree scleral depression. Patients rated the level of pain associated with each exam on a 0-10 scale. Retina specialists (128) were anonymously surveyed regarding their use of scleral depression. Results: No additional pathology was detected by the use of scleral depression (0%, P < .001). Patients reported more pain with scleral depression (4.68 vs. 1.84, P < .001). Survey revealed that use of scleral depression is symptom driven. Conclusion: Exam with scleral depression provided little benefit over exam without depression, while increasing pain.
sion: Besides pure CAON, optic neuropathy is seen also in CAR. Cone dysfunction prevails in CAR. Patients > 50 years old and with < 3 AAbs are far more likely to have a cancerassociated etiology.
Scientific Posters Scientific Poster 237 Serum Auto-Antibody (AAb) Studies in Patients With AMD Identify the Apoptosis Inhibitor of Macrophage / CD5 Molecule-Like Protein as a Novel Human Retinal Protein and an AAb Target in AMD Presenting Author: Alessandro Iannaccone MD Co-Author(s): David New PhD, Francesco Giorgianni MBA PhD**, Nataliya I Lenchik MD, Albert Alhatem MD MS, Sarka Beranova-Giorgianni PhD, Ivan Cullen Gerling PhD, Marko Radic PhD* Purpose: To characterize the serum autoantibody (AAb) profile in AMD and to show evidence for a novel retinal protein as one of the targets recognized by circulating AAbs in AMD. Methods: Sera from 131 AMD and 245 controls, all ≥ 70 years old, were screened for AAbs against human macular tissue antigens. A subset underwent immunoprecipitation, 2D gel electrophoresis, mass spectrometry, and ELISA. Tissue antigen expression was confirmed by immunohistochemistry. Results: Autoreactivity in AMD is more frequent (P = .02x10-8) and more intense than in controls. AIM/CD5L is a novel 38-kDa retinal protein with 2.5-fold higher reactivity in AMD (P = .000007) expressed throughout the human retina. AMD sera stain retinal sections consistently with its expression pattern Conclusion: Autoreactivity is frequent, and AIM/CD5L is a novel retinal protein and autoantigen in AMD.
Scientific Poster 238 SOE Visual and Anatomical Outcomes of Intravitreal Aflibercept for Chronic Refractory AMD
Scientific Poster 241 Intraocular Inflammation and Pain Following Intravitreal Injection of Ranibizumab or Aflibercept: The PLANET Study Presenting Author: Arshad M Khanani MD* Purpose: To evaluate intraocular inflammation and pain following ranibizumab (RBZ) or aflibercept (AFL) injection for wet AMD. Methods: Patients given open-label RBZ 0.5 mg (n = 35) or AFL 2.0 mg (n = 53) were followed up 24-48 hours (Visit 1) and 5-7 days following injection (Visit 2) for pain, anterior chamber inflammation (ACI), and vitreous inflammation (VI). Evaluator was blinded to treatment allocation. Results: One RBZ (2.9%) and 10 AFL eyes (18.9%) had mild ACI (score = 0.5) at Visit 1 (P = .04), which resolved by Visit 2 in all but 1 AFL eye. Moderate to severe pain (≥ 4 on 0-10 scale) immediately following injection was greater in patients switching from RBZ to AFL (31.9%) than in those switching from AFL to RBZ (11.8%; P = .04). Conclusion: AFL-treated eyes may be more likely to have post-injection inflammation.
Scientific Poster 242 H Evolution of Reticular Pseudodrusen in Eyes With AMD
Presenting Author: Manju Chandran Jr MRCOPHTH
Presenting Author: Celine Saade
Co-Author(s): Geeta Menon MD*
Co-Author(s): Camellia Nabati MS, Marcela Marsiglia MD PhD, Sucharita Boddu**, Ana Rita Santos MS, Rufino Silva MD MSC*, Jose G Cunha-Vaz MD PhD*, R Theodore Smith MD
Purpose: To assess the efficacy of aflibercept in eyes refractory to ranibizumab in AMD. Methods: Retrospective review of patients who had more than 10 injections of ranibizumab and had persistent fluid on OCT. Visual acuity (VA), central macular thickness (CMT), macular volume (MV), and OCT features were analyzed. Treatment involved 3 monthly doses of 2-mg aflibercept followed by 8 weekly dosing. Results: 119 eyes were included. There was significant improvement in CMT and MV (P < .0001). OCT assessment showed anatomic normalization in 27% of eyes, improvement in 55%, no change in 8% eyes, and deterioration in 15% of eyes. Twenty-one percent gained 1 line of vision, while 58% maintained vision and 22% lost 1 line. Conclusion: Converting patients with AMD to aflibercept results in stabilized vision and improved anatomic outcomes.
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to measure CT and microperimetry to assess Se. Eight patients had bilateral GA (16 eyes) (B-GA group), 11 patients had GA in one eye and CNV in the fellow eye (11 eyes) (FE-CNV group). Results: CT was significantly thicker in the B-GA group at baseline and during follow-up. CT significantly decreased only in the FE-CNV group (P = .0276), whereas Se significantly decreased only in the B-GA group (P = .0405). Conclusion: Se and CT show different changes in GA, probably reflecting different GA phenotypes. These results should be taken into consideration when planning clinical trials to treat GA.
Scientific Poster 239 H Treatment Extension and Visual Outcomes of AntiVascular Endothelial Growth Factor Therapy With Ranibizumab or Aflibercept for 100 Patients With Neovascular AMD Presenting Author: Michelle V Carle MD Co-Author(s): Thomas Gerald Chu MD PhD**, Homayoun Tabandeh MD MS FRCP FRCOphth*, Firas M Rahhal MD*, Roger L Novack MD PhD*, Richard H Roe MD*, Pouya N Dayani MD*, David S Liao MD, Alexander C Walsh MD*, David S Boyer MD* Purpose: To evaluate maximal treat-and-extend (T&E), BCVA, and anatomic outcomes in neovascular AMD (nvAMD) treated with IV ranibizumab (IVR) or aflibercept (IVA). Methods: Retrospective case series of nvAMD on therapy with IVR or IVA. BCVA, number of treatments, duration of drug-free phase, OCT characteristics. Results: 100 patients, 50 with each IV drug. Mean drug-free interval: IVR, 8.8 (SD 2.8); IVA, 7.5 (SD 2.8) weeks. Average number injections: 7.6. Failed to reach a drug-free phase: IVR, 10; IVA, 13. Improved or stabilized BCVA: over 85% of IVR and IVA. BCVA improved ≥ 2 lines: IVR, 17 (34%); IVA, 24 (48%). BCVA stabilized: IVR, 29 (58%); IVA, 14 (28%). Vision loss of ≥ 2 lines: IVR, 4 (8%); IVA, 7 (14%). Conclusion: T&E with IVR and IVA resulted in improvement or stabilization in over 85%. Both groups had similar T&E (8.8 and 7.5 weeks).
Scientific Poster 240 SOE Different Phenotypes of Progressing Geographic Atrophy Presenting Author: Elisabetta Pilotto MD Co-Author(s): Francesca Guidolin MD, Enrica Convento PhD, Francesco Giuseppe Stefanon MD, Raffaele Parrozzani MD, Edoardo Midena MD Purpose: To analyze choroidal thickness (CT) and retinal sensitivity (Se) changes in patients with geographic atrophy (GA). Methods: Nineteen consecutive patients with GA at least in 1 eye were studied every 6 months by means of enhanced depth imaging OCT
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Purpose: To quantitatively analyze reticular pseudodrusen (RPD) evolution in eyes with AMD. Methods: Fifty-two patients with AMD and unilateral CNV were included. The nonCNV eye was prospectively analyzed for the development of CNV and for the presence and extent of RPD at baseline and 2-year follow-up using indocyanine green angiography, short wavelength autofluorescence (AF), and near infrared reflectance (NIR) imaging. Results: In eyes that developed CNV compared to eyes that did not, RPD were less prevalent on AF (12% vs. 50%, P = .013) and covered smaller areas on NIR (9.69% of total image area vs. 22.72%, P = .027) and AF (4.31% vs. 14.78%, P = .011). Conclusion: RPD are dynamic structures demonstrating spatiotemporal changes with a tendency to fade when CNV develops.
Scientific Poster 243 Systematic Review of Safety Across the Phase 2 and 3 Clinical Trials of Intravitreal Aflibercept Injection Presenting Author: Peter K Kaiser MD* Purpose: Systematic review of selected ocular / systemic adverse events (AEs) from intravitreal aflibercept injection (IAI) trials for neovascular AMD, macular edema due to central / branch retinal vein occlusion (CRVO/BRVO), and diabetic macular edema (DME). Methods: Number of events and person-years at risk (PYR) from patients across 9 Phase 2/3 trials were analyzed. Results: Over 4000 patients contributed > 5400 PYRs. Event rates were low and similar between controls and IAIs. Intraocular inflammation, hypertension, and adjudicated Antiplatelet Trialists’ Collaboration rates were 2.5 and 2.3; 14.5 and 12.7; and 1.9 and 1.9 per 100 PYR for controls vs. IAI. Conclusion: Overall, Phase 2/3 trials data demonstrate rates of selected ocular / systemic AEs were low, similar to controls, and this suggests that IAI was generally well tolerated.
Scientific Poster 244 Endophthalmitis Is More Common After Intravitreal Injection of Ranibizumab and Aflibercept Than Bevacizumab Presenting Author: Christopher D Riemann MD* Co-Author(s): Martin F Wilkes MD, Robert A Sisk MD, Daniel Matthew Miller MD PhD*, Robert E Foster MD, Michael R Petersen MD Purpose: We investigated endophthalmitis rates after injection of bevacizumab (IVA), ranibizumab (IVL), aflibercept (IVE), and triamcinolone (IVT) at our institution. Methods: A retrospective analysis was performed on all patients who received intravitreal injections by 6 surgeons from January 2002 to July 2013 at the Cincinnati Eye Institute. Results: 71,988 injections were performed: 49,756 IVA, 11,480 IVL, 7774 IVT, 2590 IVE, and 388 pegaptanib. Fifty-five eyes received vitreous tap and inject for endophthalmitis (14 IVA, 13
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters IVL, 25 IVT, 3 IVE), and 15 of these were culture positive (5 IVA, 7 IVL, 3 IVT). Conclusion: At the Cincinnati Eye Institute, intravitreal injection of bevacizumab has a much lower rate of endophthalmitis than intravitreal injection of any other drug.
Scientific Poster 245 H Vitreomacular Interface after Anti-Vascular Endothelial Growth Factor Intravitreal Injections in AMD Presenting Author: Frederico Braga Pereira MD Co-Author(s): Carlos Veloso, Tereza Kanadani, Marcio B Nehemy MD* Purpose: To evaluate the prevalence of posterior vitreous detachment (PVD) induced by intravitreal injection of anti-VEGF agents. Methods: Vitreomacular interface of 68 eyes with neovascular AMD and presence of vitreomacular adhesion (VMA) were evaluated by spectral domain OCT before and after intravitreal injection of anti-VEGF. Results: The mean number of intravitreal injections was 7.9 (53.5% were ranibizumab injections, 32.0% were bevacizumab, and 14.5% were aflibercept injections). Four eyes (5.8%) developed PVD following intravitreal drug injection (2 eyes after the first injection, 1 eye after the second, and 1 eye after the sixth). Sixty-four eyes remained with VMA. Conclusion: Intravitreal injection of anti-VEGF agents rarely induces PVD.
Scientific Poster 246 Retinal Pigment Epithelial Elevation Size/Intraretinal Fluid Effect on Visual Acuity in VIEW 1 and 2 Presenting Author: Jason S Slakter MD*
Scientific Poster 249 Baseline BCVA–Low Luminance Visual Acuity Gap Predicts Treatment Response in Patients With Wet AMD Presenting Author: Ronald Eric P Frenkel MD* Co-Author(s): Howard Shapiro PhD*, Ivo Stoilov MD* Purpose: This HARBOR study subanalysis explored the effect of baseline (BL) low luminance visual acuity (LLVA) on mean BCVA gain in patients with wet AMD treated with ranibizumab (n = 1097). Methods: LLVA was measured using a 2.0-log-unit neutral density filter while reading a normally illuminated ETDRS chart. LLVA and BCVA were assessed at BL and over 24 months of treatment. Results:The magnitude of the difference (gap) between BCVA and LLVA at BL was negatively correlated with BCVA gain at Month 24 (P < .0001). Patients with a BCVA-LLVA gap ≤ 17 letters at BL gained 13.4 letters in BCVA at Month 24, while those with a ≥ 33-letter gap gained only 2.4 letters in BCVA at Month 24. Conclusion:The BCVA-LLVA gap was prognostic for treatment response, with a wider gap predicting lower BCVA gains over 24 months of treatment.
Scientific Poster 250 SOE The Role of Posterior Vitreous Detachment and Vitreomacular Adhesion in Patients With AMD Presenting Author: Cezmi Akkin MD Co-Author(s): Orhan Ilim, Serhad Nalcaci**, Zafer Oztas MD, Filiz Afrashi MD*, Jale Mentes MD*
Purpose: To determine baseline (BL) effect of retinal pigment epithelium elevation (RPEE) size and (intraretinal fluid) IRF status on visual acuity in VIEW 1 and 2 studies in neovascular AMD (NV-AMD) patients. Methods: Pooled analysis of 1593 patients treated with 2-mg intravitreal aflibercept injection (IAI) or 0.5-mg ranibizumab with known BL RPEE size (sum of width and height) and IRF status was done. Six groups were determined based on BL RPEE size (0, < median, > median) and IRF status (absent / present). Differences in methods for determining RPEE size and IRF within each study were accounted for. Results: Mean BCVA change from BL to Week 52 decreased as RPEE size increased and was 13.6, 11.2, and 7.6 letters in eyes without BL IRF, and 8.7, 8.8 and 6.5 letters in eyes with BL IRF. Conclusion: Week 52 visual acuity outcomes were worse with larger RPEE and presence of IRF at BL.
Purpose: To evaluate the state of the posterior vitreous in exudative AMD, nonexudative AMD, and controls. Methods: Spectral OCT and B-scan ultrasonography were performed in exudative AMD (86 eyes), nonexudative AMD (44 eyes), and controls (46 eyes). Results: Total posterior vitreous detachment (PVD) incidence was 37.2% in exudative AMD, 50.0% in nonexudative AMD, and 28.2% in control eyes. Incomplete PVD incidence was 50.0% in exudative AMD, 29.5% in nonexudative AMD, and 28.2% in control eyes. Vitreomacular adhesion (VMA) was present in 33.7%, 18.1%, and 10.8% of exudative AMD, nonexudative AMD, and control eyes, respectively. Conclusion: Since incomplete PVD and VMA rates were higher in the exudative form of AMD, tractional forces through the posterior vitreous face may play a role in AMD pathogenesis.
Scientific Poster 247 SOE Treatment Outcomes in Patients Switched From Ranibizumab to Aflibercept for Resistant Exudative AMD in Aberdeen, Scotland
Scientific Poster 251 Single-Session Pattern Scan Laser (Pascal) Panretinal Photocoagulation in Proliferative Diabetic Retinopathy: A Randomized Study
Presenting Author: Lai-Yeung Ngai MBBS PhD* Co-Author(s): Kay Por Yip, Chee Peng Cheng, Kurt Spiteri Cornish, Cynthia Santiago FRCS*
Scientific Poster 248 Incidence of CNV in Asymptomatic Fellow Eyes of Patients with Neovascular AMD Presenting Author: Abdhish R Bhavsar MD* Purpose: To determine the incidence of asymptomatic CNV in fellow eyes of patients with neovascular AMD. Methods: Consecutive patients with neovascular AMD who were seen by the same surgeon between April 18, 2011, and August 31, 2013, who had asymptomatic CNV in the fellow eye were noted. Results: Fifty-six patients developed CNV in their asymptomatic fellow eye out of 803 patients with exudative AMD over the 16-month study timeframe. The incidence of CNV in asymptomatic fellow eyes of patients with neovascular AMD was 7%. Conclusion: The incidence of asymptomatic CNV in fellow eyes warrants bilateral complete retinal examination of all patients with neovascular AMD during each visit, even if they are presenting “only” for an injection in the eye that originally developed CNV.
Co-Author(s): Janice Jing Chee Cheung MBBS**, Lap Ki Ng, Rita Gangwani**, Derek K Yu MBBS, Kenneth K W Li MBCHB Purpose: To assess the safety and efficacy of single-session panretinal photocoagulation (PRP) using pattern scan laser in proliferative diabetic retinopathy (PDR). Methods: Twentyfour treatment-naive PDR patients were randomized to 1700 or 2500 shots PRP in a single session. Central foveal thickness (CFT) was measured before and 1 week after laser by OCT. Regression of PDR was judged using fundus photos and fluorescein angiograms taken before and 3 months after laser. Results: Between the 2 groups, there was no significant difference in the change of CFT or final visual acuity at 6 months. Neovascularization regression rate at 3 months was higher in the 2500-shot group than in the 1700-shot group (33.3% vs. 9.1%). Conclusion: Single-session PRP, with up to 2500 shots, using pattern scan laser, is safe in PDR, but more aggressive treatment is required to achieve a higher regression rate.
Scientific Poster 252 Contrast Sensitivity Outcome After Panretinal Photocoagulation and Macular Lasers in Diabetic Retinopathy Presenting Author: Nilesh A Kakade MBBS Co-Author(s): Sheetal D Dharmadhikari MBBS** Purpose: To determine the changes in contrast sensitivity after panretinal photocoagulation (PRP) and macular lasers done for diabetic retinopathy. Methods: Contrast sensitivity was measured with a Peli-Robson contrast sensitivity chart before and after PRP and macular lasers done in patients with diabetic retinopathy. Contrast sensitivity was measured at 1 week, 6 weeks, and 6 months after the procedure. Results: Thirty-five eyes underwent PRP, and 32 eyes underwent macular lasers. At the end of 6 months contrast sensitivity decreased in 65.71% of cases of PRP (P = .002), whereas after macular lasers 56.25% of
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To report functional and anatomical outcomes following switch from ranibizumab to aflibercept in patients with active exudative AMD. Methods: Patients whose treatment was changed from ranibizumab to aflibercept from July 2013 to December 2013 were included. Visual and anatomic outcomes were analyzed at 4 months after 3 monthly loading doses of 2-mg aflibercept. Results: 163 eyes were switched to aflibercept. The number of prior ranibizumab injections ranged from 3-39. Thirty-five percent of patients showed a better visual outcome (≥ 5 ETDRS letter improvement, n = 133), and 84% had an improved OCT appearance following 3 injections(n = 126). Conclusion: Aflibercept is of therapeutic benefit in a subgroup of patients with persistent exudative AMD following multiple injections with ranibizumab.
Presenting Author: Chung-yee Chung FRCS(ED) MBBS MRSCED(OPHTH)
Scientific Posters cases maintained contrast sensitivity to prelaser levels and 43.75% of cases improved(P = .125). Conclusion: PRP causes a decrease in contrast sensitivity, whereas it was either maintained to prelaser levels or improved after macular lasers.
with decreased IRL intensity (R = 0.5; P < .001; N = 91). Increased RT was correlated with decreased IRL intensity (R = -0.4; P < .001; N = 91). Conclusion: ISe intensity and RT were significantly correlated with IRL intensity in DR subjects.
Scientific Poster 253 Comparing Technical Failure Rates in Diabetic Retinopathy Screening Between RETeval, a Novel ERG Device, and Dilated Fundus Photography
Scientific Poster 257 SOE Diabetic Retinopathy Screening: Is It Effective?
Presenting Author: April Y Maa MD
Purpose: To evaluate the effectiveness of diabetic retinopathy screening (DRS) service in a defined population. Methods: Retrospective comparative analysis of 4-year DRS data (2010- 2014). Results: Our region has a population of 320,000. Five percent to 6% of the population are diabetic and eligible for DRS during this period. An increase of 5%-6 % in the number of diabetics had been noted over the preceding 12 months. The referable retinopathy was reduced from 5.6% in 2010/11 to 2.93% in 2013/14, with reduced need for vitrectomy. Conclusion: DRS service in our region is effective in early detection and intervention for diabetic retinopathy and thereby reduces preventable blindness. Education of diabetic patients and providers has helped tremendously.
Co-Author(s): Ensa Pillow MD, William J Feuer MS, Quentin Davis PhD*, Rachel Caywood, Joel Chasan MD, Stephen Fransen MD* Purpose: Screening reduces visual impairment from diabetic retinopathy. Better methods are necessary as current ways have high failure rates. This study compared the failure rate between fundus photos and RETeval. Methods: 408 patients with varying retinopathy levels (ETDRS scores of 10-53+) were recruited. RETeval was performed followed by mydriatic 7-field ETDRS stereo fundus photography. Results: The RETeval device failed (no results generated) 0.7% (3/408 patients), whereas photography failed (ungradeable images) 14.7% (60/408 patients)3/4a highly statistically significant difference (P < .001, exact McNemar test). Conclusion: Results suggest the RETeval device has promise as a new screening tool because of low failure rates.
Scientific Poster 254 Real-World Outcomes in Diabetic Macular Edema Treated with Anti-Vascular Endothelial Growth Factors: An Analysis of EMR Data From a Large Integrated U.S. Health System Presenting Author: Szilard Kiss MD* Co-Author(s): Arghavan Almony MD, Herbert J Ingraham MD, Steven J Marks MD**, Ashley Cole MS*, Hitesh Chandwani MBBS MS*, Nancy M Holekamp MD*
Scientific Posters
Purpose: To examine vision outcomes in diabetic macular edema (DME) patients managed with intravitreal anti-VEGFs in clinical practice. Methods: Electronic medical records analysis of 94 anti-VEGF treated eyes from January 2007 to May 2013 with baseline BCVA of 20/40-20/320. Results: At 12 months, mean number of anti-VEGF injections was 2.6; mean BCVA change was 3.7 letters; the number of eyes gaining ≥ 3 lines was 21 (22.3%), while 10 eyes (10.6%) lost ≥ 3 lines, by LOCF. Conclusion: This study links less frequent injections to less visual acuity gain in clinical practice than reported in randomized clinical trials like RISE/RIDE. Further research should assess potential factors that may result in underutilization of anti-VEGF injections for DME patients.
Scientific Poster 255 Intravitreal Aflibercept Injection in Diabetic Macular Edema by Baseline Demographics and Systemic Disease Characteristics Presenting Author: Rishi P Singh MD* Purpose: To compare intravitreal aflibercept injection (IAI) with laser in diabetic macular edema (DME) patients by race and baseline hemoglobin A1c (BL HbA1c) levels (≤ 8% vs. > 8%). Methods: VISTA/VIVID randomized 872 patients to IAI 2 mg every 4 weeks (2q4) or 8 weeks (after 5 monthly doses; 2q8) or laser. Results: Of patients, 82% were White, 6% were Black, and 10% were Asian. Over 52 weeks, BCVA letter gain with 2q4, 2q8 vs. laser was +11.9, +10.7 vs. +0.6 (P < .0001) in Whites, +10.8, +9.8 vs. +2.9 (P ≤ .0206) in Blacks, and +8.8, +10.6 vs. -0.4 (P < .0001) in Asians. At baseline, 65% and 35% of patients had HbA1c ≤ 8% and > 8%. BCVA letter gain in patients with BL HbA1c≤ 8% was +12.3, +10.9 vs. +1.1 (P < .0001), and in patients with BL HbA1c> 8% was +10.4, +10.3 vs. -0.3 (P < .0001). Conclusion:BCVA gains with 2q4 and 2q8 were significantly greater than laser and similar in the subgroups studied.
Scientific Poster 256 Enface Imaging of Inner Retinal and Inner Segment Ellipsoid Layer Integrity in Diabetic Retinopathy Presenting Author: Andrew W Francis MD Co-Author(s): Justin Wanek MS, Jennifer Irene Lim MD*, Mahnaz Shahidi PhD** Purpose: To relate photoreceptor inner segment ellipsoid layer (ISeL) intensity, inner retinal layer (IRL) intensity, and retinal thickness (RT) in diabetic retinopathy (DR) subjects by spectral domain OCT (SD-OCT) enface imaging. Methods: SD-OCT volume imaging and image processing were performed in 12 DR and 12 control subjects. Regions of reduced intensity on ISeL enface image were identified, and indices of IRL and ISeL intensities and RT were compared to data in control subjects. Results: Ranges of IRL and ISeL intensity indices were 0.19-1.57 and 0.30-0.85, respectively. Reduced ISeL intensity was correlated
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Presenting Author: Balakrishna Vineeth Kumar MBBS* Co-Author(s): Gianluca Carifi MBBS, Farrukh Ali FRCS
Scientific Poster 258 SOE MAPKAPK3, the Causal Gene of West Indies Crinkled Retinal Pigment Epitheliopathy Presenting Author: Albert P Jean-Charles MD Co-Author(s): Salomon Y Cohen MD*, Harold R Merle MD, Alain Gaudric MD*, Christian Hamel, Isabelle A Meunier MD Purpose: To identify the causal gene of Martinique crinkled retinal pigment epithelium (RPE) dystrophy. Methods: Whole exome sequencing was performed in 1 nonaffected and 4 affected patients (3 generations). Results: Three genes of chromosome 3 were in line with familial segregation. ELP6 and USP4 variations were not retained considering frequency or predicted benignity. MAPKAPK3 with a variation predicted to be damaging, not noted in human databases, is expressed in RPE. The mutant protein has an abnormal localization in the cytoplasm in transfected HEK cells. Retina of MAPKAPK3 knockout mice disclosed thickening and disorganization of Bruch membrane. Conclusion: MAPKAPK3, actor of p38 MAPK pathway, is the causal gene of this dystrophy, characterized by an autosomal dominant transmission and a striking crinkled pattern of the RPE.
Scientific Poster 259 Familial Pediatric Cone-Rod Dystrophy From Recessive RPGRIP1 Mutations Presenting Author: Arif O Khan MD Co-Author(s): Carsten Bergmann MD**, Hanno Jörn Bolz MD Purpose: Recessive RPGRIP1 mutations cause severe Leber congenital amaurosis. Although an alternate phenotype, cone-rod dystrophy, was reported in one study of Pakistani families, this has not been since replicated. We document RPGRIP1-related cone-rod dystrophy in an affected Saudi Arabian family. Methods: Retrospective case series. Results: A brother and sister born of first-cousin parents had nystagmus, poor vision, and photophobia noted soon after birth; serial electroretinography over a 4-year period confirmed conerod dystrophy. Candidate gene testing revealed underlying homozygous RPGRIP1 mutations (c.3565C>T; p.Arg1189*; NM_020366.3) Conclusion: Recessive RPGRIP1 mutations can cause pediatric cone-rod dystrophy rather than severe Leber congenital amaurosis.
Scientific Poster 260 H Global Reported Endophthalmitis Risk Following Intravitreal Injection of Anti-Vascular Endothelial Growth Factor Presenting Author: Douglas K Sigford MD Co-Author(s): Shivani Reddy MD, Christine Mollineaux MD**, Shlomit Schaal MD* Purpose: To compare the risk of endophthalmitis with bevacizumab vs. ranibizumab. Methods: A total of 535 articles on intravitreal use of bevacizumab and/or ranibizumab were analyzed for total injections, endophthalmitis cases, and perioperative techniques. Results: The overall risk of endophthalmitis was 0.058% with bevacizumab and 0.029% with ranibizumab (P = .01). There was a significantly higher culture-negative risk with bevacizumab (0.036% vs. 0.015%, P < .01). Culture-positive risks were not statistically different. The use of postoperative antibiotics significantly increased the risk of culture-positive endophthalmitis. Conclusion: The risk of reported postinjection endophthalmitis was higher with bevacizumab than ranibizumab, although the risk of culture-positive disease was not statistically different.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 261 Ultrawide-Field Fundus Abnormalities in Various Uveitic Disorders
Scientific Poster 265 SOE Dexamethasone Intravitreal Implant for Treatment of Persistent Macular Edema in Irvine-Gass Syndrome
Presenting Author: Min Sagong MD
Presenting Author: Zurnie Del Barrio Lopez De Ipina MD
Co-Author(s): Hossein Nazari Khanamiri**, Narsing A Rao MD, Srinivas R Sadda MD*
Co-Author(s): Soraya Mediero Clemente MD, Pino Cidad MD, Felix Armada-Maresca MD
Purpose: To evaluate peripheral fundus autofluorescence (FAF) and color photographic findings in various uveitic disorders. Methods: Eyes of 82 intermediate / posterior uveitis with ultrawide-field FAF and pseudocolor images were graded for the presence, location, extent, and type of peripheral FAF abnormalities. Results: Peripheral abnormalities were observed in 73.2% of FAF images, whereas clinical abnormalities were evident on 75.6% of pseudocolor images. Although there was significant overlap in the pseudocolor and FAF findings, discordance was noted in 25.6% of cases. There was no significant difference or trend in localization of the peripheral abnormalities. Conclusion: Wide-field pseudocolor and FAF images appear to provide complementary information regarding peripheral abnormalities in uveitis.
Purpose: To evaluate the effectiveness of a single intravitreal injection of Ozurdex over 12 months in patients with chronic cystoid macular edema (CCME) due to Irvine-Gass syndrome. Methods: Retrospective review of the medical records of 12 eyes with CCME refractory to other treatments. Results: Statistically significant improvement was seen in the mean BCVA at Month 1 (P = .0042), at Month 5 (P = .0103), and at Month 12 (P = .0015), in the mean central subfield thickness at Month 1 (P < .0001), at Month 5 (P = .0008), and at Month 12 (P = .0083), and in the mean thickness average cube at Month 1 (P = .003) and at Month 5 (P = .0178) after treatment. Conclusion: The study suggests that dexamethasone implant is a favorable treatment option to improve visual acuity and reduce CCME.
Scientific Poster 262 Intravitreal Aflibercept for Presumed Ocular Histoplasmosis Syndrome-Related CNV: Six-Month Results From the HANDLE Study
Scientific Poster 266 Real-World Assessment of Efficacy and Safety of ≥1 Dexamethasone Intravitreal Implant(s) (0.7 mg) in Patients With Macular Edema
Presenting Author: Brian W Toussaint MD
Presenting Author: Wai-Ching Lam MD*
Co-Author(s): Daniel Matthew Miller MD PhD*, Dennis M Marcus MD*, John W Kitchens MD*, Harinderjit Singh MD*
Co-Author(s): Amin Kherani MD, John C Chen MD*, Darryl Baptiste*
Purpose: To evaluate the response of presumed ocular histoplasmosis syndrome (POHS)related CNV to aflibercept. Methods: Eyes were randomized to 2 regimens: monthly aflibercept for 3 months then mandatory aflibercept every 2 months for 12 months (SG) or 1 aflibercept at randomization with monthly p.r.n. dosing for 12 months (PRN). Results:Ten eyes had 6-month follow-up. At baseline, mean visual acuity was 70 letters (20/40) and average OCT central subfield thickness (CST) was 388 µm. SG and PRN groups received on average 4.2 and 3.6 injections, respectively, by the 6-month visit. At 6-month follow-up, mean visual acuity of the SG group was 86.4 letters (20/18). Average visual acuity of the PRN group at 6 months was 78.6 letters (20/26). At 6 months, mean OCT CST of SG was 356.4 µ. Average 6-month OCT CST of the PRN group was 248.8 µ. Conclusion: There was favorable acuity and anatomic response to aflibercept.
Scientific Poster 263 Intraocular Inflammation Following Aflibercept (Eylea) Injection Presenting Author: Howard F Fine MD MHS* Co-Author(s): Daniel B Roth MD*, Sumit P Shah MD**, Matthew Wheatley MD
Scientific Poster 264 Medical Management of Live Subretinal Cysticercosis With Exudative Retinal Detachment Presenting Author: Kaushick Biswas MBBS Co-Author(s): Wondwossen T Kabtimer MD** Purpose: To evaluate the efficacy of combined oral albendazole and prednisolone therapy in cases of live subretinal cysticercosis presenting with exudative retinal detachment (RD) and vitritis. Methods: Three patients who presented with live subretinal cysticercosis and exudative RD with vitritis were treated with oral albendazole 400 mg twice daily for 3 weeks and 1 week after starting albendazole oral prednisolone 1 mg/kg body weight were started for 3 weeks. Results: Exudative RD and vitritis subsided in all 3 patients with improvement of visual acuity. Conclusion: Medical management with oral albendazole and prednisolone is effective and an alternative to complicated surgical procedures in cases of live subretinal cysticercosis.
Scientific Poster 267 Analyses of Dome-Shaped Macula in a Large Population of Patients With Pathologic Myopia Presenting Author: I-Chia Liang MD Co-Author(s): Noriaki Shimada MD, Natsuko Nahako MD, Kosei Shinohara MD, Kyoko Ohno-Matsui MD* Purpose: To analyze the fundus and OCT features of dome-shaped macula in a large series of highly myopic patients. Methods: Retrospective review. Results: 225 eyes of 160 patients were divided into bidirectional, horizontally oriented, and vertically oriented dome. LogMAR BCVA was inversely correlated with dome height (r = -0.245, P < .01). In the horizontally oriented group, serous retinal detachment, macular pigmentation, and a newly described horizontal line were significantly more frequently found in eyes with dome height over 200 µm. Conclusion: Some fundus features may suggest the existence of high dome, which may relate to more complications and lead to worse vision.
Scientific Poster 268 SOE Dome-Shaped Macula in Patients With Pathological Myopia Presenting Author: Edward Millan Valbuena MD Co-Author(s): Daniel Lorenzo Parra MD, Netan Choudhry MD*, Luis Arias MD* Purpose: To describe the clinical features of dome-shaped macula (DSM) due to pathological myopia. Methods: Retrospective cases series of 16 patients with DSM (followup range: 12-40 months). Results: DSM was bilateral in 12 patients and unilateral in 4. The mean initial visual acuity was 20/50; at the last visit, it was 20/60. In all affected eyes, spectral-domain OCT exhibited a serous retinal detachment (SRD) and a convexity of the retinal-choroidal complex in the macula. Seven patients were treated with intravitreal ranibizumab, 4 with photodynamic therapy, and 5 were observed only. SRD remained unchanged in all patients, and none of the subgroups showed statistically significant differences in the final visual acuity. Conclusion: We could not determine any effective treatment for SRD in DSM.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To report the characteristics and frequency of intraocular inflammation following intravitreal aflibercept injection. Methods: Retrospective case series of consecutive patients. Results: There were 28 cases of intraocular inflammation following a total of 5905 aflibercept injections among 1660 patients. The mean baseline acuity was 20/57, which decreased to 20/179 at diagnosis (P < .0001) but recovered to 20/59 at Month 1, 20/57 at Month 3, and 20/52 at Month 6 (P = NS). Vitreous culture and injection of antibiotics were performed in 8 cases; all were culture negative. The remainder received only topical corticosteroids. Conclusion: The frequency of inflammation following aflibercept was 0.47% per injection. Visual acuity and inflammation returned to baseline within 1 month in most cases with topical corticosteroids.
Purpose: Assessment of real-world efficacy and safety of ≥ 1 dexamethasone intravitreal implant(s) (0.7 mg) in patients with macular edema (DME). Methods: Retrospective chart review of 101 patients (120 study eyes including DME, n = 34; retinal vein occlusion, n = 30; and uveitis, n = 23), treated with ≥ 1 implants and followed 2-26 weeks after last implant. Results: Mean peak changes in Snellen equivalent lines, central retinal thickness, and IOP from baseline was +1.4 (± 0.3) lines, -183.4 (± 17.9) µm, and 0.0 (± 0.5) mmHg. Glaucoma and cataract surgery occurred in 2.5% and 28.3%. Conclusion: DEX implant(s) alone or in combination with other treatments is safe and effective for improving vision and CRT.
Scientific Posters Scientific Poster 269 H Comparison of Intravitreal Gas (C3F8) Injection vs. Intravitreal Ocriplasmin for Vitreomacular Traction Presenting Author: Nathan C Steinle MD* Co-Author(s): Dilsher S Dhoot MD*, Alessandro A Castellarin MD*, Dante Pieramici MD*, Robert F See MD, Carlos Quezada Ruiz MD, Melvin D Rabena MD*, Stephen S Couvillion MD**, Ma’an A Nasir MD, Robert L Avery MD* Purpose: To evaluate the efficacy and safety of C3F8 for vitreomacular traction (VMT) vs. intravitreal ocriplasmin (IVO). Methods: Consecutive VMT patients treated with IVO or C3F8 injection were retrospectively reviewed. VMT release rates, visual acuity (VA), and outer retinal band (ORB) changes on spectral domain OCT were compared. Results: Thirtyeight cases were included. Release rate was 48% (11/23) with IVO and 73% (11/15) with C3F8, P = .22. Three of 4 C3F8 patients without release showed a reduction in retinal traction and edema. Four of 5 patients with past failed IVO released with C3F8. VA improved slightly in both groups. ORB changes were noted in 10/23 with IVO and 0/15 with C3F8, P < .01. Conclusion: C3F8 is an inexpensive treatment option for VMT, even after failed IVO. No ORB changes with C3F8 implies that its presence after IVO may be due to enzymatic effect rather than release of VMT alone.
Scientific Poster 270 Characterization of Epiretinal Membrane Features Associated With Lamellar Macular Holes Presenting Author: Ashleigh Laurin Levison MD Co-Author(s): Yuji Ito MD, Peter K Kaiser MD*, Rishi P Singh MD*, Sunil K Srivastava MD*, Justis P Ehlers MD* Purpose: To characterize and compare the OCT features of lamellar macular holes and pseudoholes. Methods: Institutional review board-approved, retrospective review of eyes with lamellar macular holes (LMH) and ERM with pseudoholes. Qualitative and quantitative OCT analysis was performed. Results: Eighty-two eyes (53 LMH and 29 pseudoholes) were included. A preretinal prominent hyporeflective band (eg, between internal limiting membrane and ERM) was present in 27 eyes (50.9%) with LMH compared to 2 (6.9%) with pseudohole (P < .001). The hyporeflective band ranged from 16 to 118 microns. Conclusion: Compared to pseudoholes, LMH is characterized by the presence of a preretinal hyporeflective band. Further research is needed to better characterize the pathophysiologic nature of this band.
Scientific Poster 271 SOE Novel Aqueous Cytokines in Diabetic Macular Edema and Neovascular AMD
Scientific Posters
Presenting Author: Marten Brelen BMBCH FRCOPHTH PhD Co-Author(s): Shaheeda Mohamed MBBS MRCSEd MRCOphth, Carmen Chan, Fiona O Luk MBChB*, Terri Pui Pui YIP**, Chi Wai Tsang MBCHB, Yolanda Yip**, Chi-Pui Pang PhD**, Timothy Y Lai MBBS* Purpose: To assess the levels of 9 cytokines in the aqueous of diabetic macular edema (DME) and neovascular AMD. Methods: The aqueous from 15 eyes with DME and 25 eyes with AMD were sampled. The cytokines VEGF, Ang2, bFGF, HGF, PDGF, IL8, TNF-alpha, TIMP1, and TIMP2 were analyzed using multiplex ELISA and correlated with BCVA and central macular thickness (CMT). Results: In DME, a greater CMT was correlated with higher bFGF (P = .034) and a worse BCVA was correlated with higher IL8 (P = .044) and HGF (P = .022). In AMD, both greater CMT and worse BCVA were correlated with higher levels of Ang2 (P < .001 and P = .028, respectively). Conclusion: Elevated levels of bFGF, Il8, and Ang2 may have important roles in the pathogenesis of DME and AMD.
Scientific Poster 272 H Retinal Alterations After Intravitreal Injection of Ocriplasmin for Symptomatic Vitreomacular Adhesion Presenting Author: Yuji Itoh MD Co-Author(s): Peter K Kaiser MD*, Rishi P Singh MD*, Sunil K Srivastava MD*, Justis P Ehlers MD* Purpose: To evaluate the retinal architecture following ocriplasmin injection for symptomatic vitreomacular adhesion (sVMA). Methods: Quantitative spectral domain OCT analysis of retinal layer changes were assessed in 19 eyes following ocriplasmin treatment. Results: Outer retinal thickness was significantly reduced at 1 week after ocriplasmin injection (P < .001) and recovered by 3 months. The distance between ellipsoid zone and retinal pigment epithelium was also reduced at 1 week (P < .0001), 1 month (P < .0001), and 3 months (P < .001) after injection. Subretinal fluid (SRF) accumulation and ellipsoid zone
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loss was found in 10 of 19 eyes (52.6%). Conclusion: Transient outer retinal thickness change and SRF accumulation after intravitreal ocriplasmin injection appears to be a common finding.
Scientific Poster 273 Pediatric Choroidal Neovascular Membranes in the AntiVascular Endothelial Growth Factor Era Presenting Author: Cindy S Hwang MD Co-Author(s): Steven Yeh MD*, G Baker Hubbard MD* Purpose: To review clinical characteristics and outcomes of pediatric patients with choroidal neovascular membrane (CNV) since the advent of intravitreal anti-VEGF therapy. Methods: A retrospective chart review of patients under the age of 18 years between January 2004 and February 2014 with a diagnosis of CNV was conducted. Results: Of 19 eyes, 53% were treated with intravitreal bevacizumab and 47% were observed. In both groups, there was no statistically significant difference between presenting and final visual acuity (P = .9 and .8 in observation and treatment groups). Causes of CNV included uveitis (10), tumors (4), retinal dystrophies (2), disc drusen (1), and idiopathic (1). Conclusion: In this small retrospective study, treatment with intravitreal bevacizumab was well tolerated and led to maintenance of visual acuity.
Scientific Poster 274 To Study the Effect of Intravitreal Bevacizumab in Nonresolving Vitreous Hemorrhage in Eales Disease Presenting Author: Pooja Jain MBBS MS Co-Author(s): Meenakshi Thakar**, Usha K Raina MD, Basudeb Ghosh** Purpose: To compare pars plana vitrectomy (PPV) with intravitreal bevacizumab-assisted treatment in Eales disease. Methods: Group I (14) received IVB. At 4 weeks, resolution of vitreous hemorrhage (VH) was noted. If the VH resolved, laser was done; otherwise PPV with endolaser (EL) was done. Group II (15) underwent PPV with EL. BCVA, intraoperative ooze, and need of hemostatic measures were evaluated. Results: In Group I, VH resolved in 6 patients. Intraoperative ooze and need of hemostatic measures were noted in 1 patient in Group I and in 5 patients in Group II. In Group I, a significant change in BCVA at 2 and 4 weeks following laser (P = .027) and following PPV (P = .011) was noted. In Group II, there was a significant change in BCVA at 2 and 4 weeks (P = .001). Conclusion: The use of IVB results in resolution of VH and assists surgery.
Scientific Poster 275 Ocriplasmin for Vitreomacular Adhesion (VMA) in the Clinical Setting: Rates of VMA Release and Visual Outcomes Presenting Author: Claudia G Hooten MD Co-Author(s): Amy C Schefler MD, David Brown MD FACS*, Tien Pei Wong MD* Purpose: To evaluate visual outcomes of symptomatic vitreomacular adhesion (VMA) after intravitreal injection of ocriplasmin. Methods: Consecutive case series of all patients treated with ocriplasmin immediately after the FDA approval at a multisite retina practice. Results: Twenty-two of a total of 47 patients demonstrated resolution of VMA by OCT. The majority of patients with hyaloid release had stable or improved visual acuity with a mean of 1 line gained. Twelve patients developed a loss of the inner segment/outer segment junction. Conclusion: This large series describes the use of ocriplasmin in a clinical setting since the MIVI-TRUST trial. We observed a 46.8% rate of anatomic resolution of VMA. Almost 40% of patients required vitrectomy. While temporary in most, the incidence of photoreceptor disruption was evident in 25% of patients.
Scientific Poster 276 Infrared Reflectance and Spectral Domain OCT Findings Following Pneumatic Retinopexy Presenting Author: Steven M Cohen MD Purpose: To describe the infrared reflectance (IR) and spectral domain OCT (SD-OCT) findings in eyes with retinal detachment repaired by pneumatic retinopexy. Methods: A retrospective chart review was done of 10 consecutive patients. Results: IR showed 0-1000 (average: 285) 200-micron hyporeflective spots in the dependent, inferior area, where the retina had been detached. The SD-OCT showed the lesions were small subretinal fluid pockets 10-500 microns high. The subretinal deposits were documented from 25 to 259 days following retinal detachment repair (average: 126 days). Conclusion: IR shows multifocal hyporeflective spots in eyes following retinal detachment repair with pneumatic retinopexy. The SD-OCT shows that these spots represent small pockets of subretinal fluid.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 277 SOE En Face Swept Source OCT Features of Macular Area in Retinal Detachment Patients Presenting Author: Marcos J Rubio Caso MD*
Scientific Poster 281 Noninvasive Retinal Angiography (OCTA) of AMD and Diabetic Retinopathy Using Ultrahigh Speed, Swept Source OCT
Co-Author(s): Ignacio Flores-Moreno MD PhD, Estefania Cobos MD, Luis Arias MD*
Presenting Author: Mehreen Adhi MD
Purpose: To characterize en face anomalies of macular area in eyes operated on for retinal detachment and relate these to visual acuity. Methods: Swept source OCT (SS-OCT) images were obtained from 17 eyes using 2 patterns: high-definition scan (HD Scan) through the foveal area and 3-D 9x12-mm macular raster scan (3D Scan) using a Topcon DRI OCT-1 Atlantis (Topcon Corp.; Japan). Segmentation of the retinal pigment epithelium generated a reference surface, and images from 6 layers were extracted for analysis. Results: Concordance between observers (kappa 1.0 to 0.638). For HD scans: Inner retinal cysts (P = .032) and inner segment / outer segment (IS/OS) anomalies (P = .003) were associated with visual acuity. For 3D scans: IS/OS anomalies (P = .048) were associated with visual acuity. Conclusion: En face SS-OCT can effectively detect these macular anomalies.
Co-Author(s): Nadia Khalida Waheed MD, WooJhon Choi MS, Eric Michael Moult, Chen David Lu MS, Benjamin Potsaid PhD*, Zhao Wang PhD**, Tarek Alasil MD, Caroline R Baumal MD*, Andre J Witkin MD, Jay S Duker MD*, James Fujimoto PhD*
Scientific Poster 278 Characteristics and Outcomes of Sequential Rhegmatogenous Retinal Detachments Presenting Author: Harpreet S Walia MD Co-Author(s): Gaurav K Shah MD*, Kevin J Blinder MD* Purpose: To evaluate features and outcomes of patients with subsequent rhegmatogenous retinal detachment (RRD). Methods: Retrospective review of patients with sequential RRD repair in each eye over 5 years. Results: Eighty-eight eyes were included. The initial eye was symptomatic of an average of 21.11 days and the subsequent eye for 3.95 days. 22.7% of initial eyes had prior treatment; 36.36% of subsequent eyes did. 47.7% of initial eyes were macula-off; 18.2% of subsequent eyes were. Ten initial eyes presented with proliferative retinopathy (PVR). Twenty-five percent of initial eyes redetached, while 6.81% of subsequent eyes did. Conclusion: Initial eyes had worse initial visual acuity, longer duration of symptoms, macula-off status, and concurrent PVR. More initial eyes redetached. Initial eye had worse final visual acuity. Subsequent eyes developed RRD despite retinopexy.
Scientific Poster 279 OCT Angiography in Diabetic Retinopathy Presenting Author: Thomas Hwang MD Co-Author(s): Yali Jia PhD*, Steven T Bailey MD, Andreas Lauer MD*, Christina J Flaxel MD, David J Wilson MD*, David Huang MD PhD*
Scientific Poster 280 SOE Comparison of Smartphone-Based Ophthalmoscopy With Dilated Ophthalmic Examination to Detect Ocular Pathologic Features Presenting Author: Andrea Russo MD Co-Author(s): Francesco Morescalchi Sr FICO**, Ciro Costagliola MD, Mario R Romano MD PhD*, Iari-Gabriel Marino PhD*, Francesco Semeraro Sr MD Purpose: To evaluate the ability of smartphone-based imaging to detect ocular pathologic features compared to dilated ophthalmic examination by retinal specialist ophthalmologists. Methods: 160 outpatients underwent dilated examination and smartphone ophthalmoscopy. The smartphone was equipped with a compact add-on that filtered and delivered the smartphone’s LED light coaxially to the camera, allowing a clear and convenient view of the retina. Results: K-values for all lesions (k ≥ 0.66) demonstrated substantial agreement between smartphone-based imaging and clinical examination. Conclusion: Smartphone ophthalmoscopy showed considerable agreement with clinical examination in the detection of ocular diseases, suggesting a potential role in screening environments for smartphone-based imaging.
Scientific Poster 282 SOE H Comparison of Smartphone-Based Ophthalmoscopy With Dilated Ophthalmic Examination for Diabetic and Nondiabetic Eye Disease Presenting Author: Andrea Russo MD Co-Author(s): Francesco Morescalchi Sr FICO**, Ciro Costagliola MD, Mario R Romano MD PhD*, Iari-Gabriel Marino PhD*, Francesco Semeraro Sr MD Purpose: To evaluate the ability of smartphone-based imaging to grade diabetic retinopathy (DR) compared to dilated ophthalmic examination by retinal specialist ophthalmologists. Methods: A subset of 120 diabetic patients underwent dilated examination and smartphone ophthalmoscopy. The smartphone was equipped with a compact add-on that filtered and delivered the smartphone’s LED light coaxially to the camera, allowing a clear and convenient view of the retina. Results: There was exact agreement in 213 eyes (88.8%) and agreement within 1 step in 237 (98.8%). Weighted kappa was 0.80 ± 0.04. Conclusion: Smartphone ophthalmoscopy showed near-perfect agreement with dilated ophthalmic examination in the detection of DR.
Scientific Poster 283 SOE Characterization of Central Serous Chorioretinopathy Spectrum by Multi-wavelength Retinal Imaging Presenting Author: Roberto Gallego-Pinazo MD* Co-Author(s): Rosa Dolz Marco MD*, Sergio Pagliarini MD**, Mariano Cozzi, Maria Andreu-Fenoll NP**, Diamar Pardo PhD**, Pablo D Hernandez Martinez MD Purpose: To study the multi-wavelength retinal imaging (MWL) characteristics in cases of central serous chorioretinopathy (CSC) and its clinical spectrum. Methods: The macular area of consecutive patients with CSC, pachychoroid pigment epitheliopathy (PPE), and neovasculopathy (PNV) was simultaneously scanned with MWL, autofluorescence (AF), and OCT. Results: Leaking points appeared whitish on MWL and hypoautofluorescent on FA; outer retinal atrophic areas appeared blue-green on MWL and hyperautofluorescent on FA; drusen-like deposits appeared red on MWL and hyperautofluorescent on FA. Conclusion: MWL imaging may distinguish the different types of retinal changes in cases of CSC, PPE, and PNV. The potential clinical value of these findings warrants further investigations.
Scientific Poster 284 Vitreomacular Adhesion Progression Traits During Normal Aging of Human Eyes Presenting Author: Agustina Cecilia Palacio MD Co-Author(s): Akash Gupta, Puja Jadav, Brooke L W Nesmith MD, Shlomit Schaal MD*, Lahav Lipson Purpose: To characterize the normal progression of vitreomacular adhesion (VMA) through 8 decades of life. Methods: Spectral domain OCT (Heidelberg Spectralis) was used to measure and delineate the area of VMA in 324 normal eyes of asymptomatic patients aged 20-97 years. Results: Patients were grouped by decade (3rd to 10th). As a proportion of total macular area, VMA declined with age (93 ± 1%, 76 ± 2%, 60 ± 3%, 49 ± 2%, 49 ± 2%, 25 ± 2%, 3 ± 1%, 2 ± 1%). VMA area continuously and significantly decreased (26 ± 2 mm2, 21 ± 7 mm2, 17 ± 8 mm2, 14 ± 7 mm2, 14 ± 5 mm2, 7 ± 7 mm2, 0.9 ± 2 mm2, 0.8 ± 2
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Posters
Purpose: To demonstrate OCT angiography findings of diabetic retinopathy. Methods: Ten patients with proliferative and nonproliferative diabetic retinopathy were imaged with fluorescein angiography and compared to OCT angiography using split-spectrum amplitude decorrelation angiography algorithm (SSADA). Results: En face and 3-D OCT angiography show areas of retinal neovascularization, capillary dilation, and nonperfusion in eyes with diabetic retinopathy. These areas correlate well with fluorescein angiography. Conclusion: OCT angiography demonstrates clinically relevant features of diabetic retinopathy and shows promise as a noninvasive alternative to fluorescein angiography in the management of diabetic retinopathy.
Purpose: We investigated microvascular changes using a prototype 400-kHz long wavelength swept source OCT (SS-OCT) and noninvasive retinal angiography (OCTA) in eyes with macular pathology. Methods: Volumetric scans of 15 patients with drusen, 4 patients with geographic atrophy (GA), and 32 diabetics with and without diabetic retinopathy (DR) using an ultrahigh-speed SS-OCT prototype to perform OCTA and generate en face images at different depths. Results: Choriocapillaris drop-out was seen underlying some drusen and beyond the margins of GA. Enlargement of the foveal avascular zone and patchy loss of choroidal vasculature was seen in eyes with DR and in a subset of diabetic eyes with no DR. Conclusion: The ability to comprehensively image changes in 3-D structural and vascular features, especially the choriocapillaris, promises to be an important tool for assessing early disease and progression.
Scientific Posters mm2) and became significantly more irregular with increasing decades of life. Differences in gender, race, and refraction were insignificant. Conclusion: VMA progresses throughout life in healthy eyes. VMA progression traits in normal aging are characterized herein.
Scientific Poster 285 Retinal Angiography Without Contrast Media: SplitSpectrum Amplitude Decorrelation Algorithm-Based OCTAngiography Presenting Author: Ching-Jygh Chen MD* Co-Author(s): Albert L Lin MD, Matthew James Olson Purpose: To evaluate the retinal vascular imaging potential of a novel, noninvasive splitspectrum amplitude decorrelation algorithm (SSADA)-based OCT-angiography. Methods: Prospective nonrandomized comparative study of retinal images obtained by standard fluorescein angiography and SSADA OCT-angiography. Results: Quality images were obtained by this OCT-angiography in 78% of 151 eyes. OCT-angiography identified vascular changes in major retinal vascular diseases and localized choroidal neovascular membrane in AMD. Conclusion: SSADA OCT-angiography can produce retinal vascular images without contract media. The en face scan capability allows it to image the vascular changes at different tissue depths. However, it is more difficult to obtain high-quality images, and the image size is limited.
Scientific Poster 286 H En Face Imaging of the Choroid in Polypoidal Choroidal Vasculopathy Using Swept-Source OCT Presenting Author: Tarek Alasil MD Co-Author(s): Daniela Ferrara MD PhD, Mehreen I Adhi MBBS, Erika M Brewer MD, Martin F Kraus MS**, Caroline R Baumal MD*, James Fujimoto PhD*, Jay S Duker MD*, Nadia Khalida Waheed MD Purpose: To define morphological features of polypoidal choroidal vasculopathy (PCV) using swept source OCT (SS-OCT). Methods: Patients with PCV were scanned with a prototype 1050-nm SS-OCT. Results: Six eyes from 4 patients with unilateral PCV were enrolled. En face imaging demonstrated pigment epithelial detachments (PEDs). Irregularities in the outline of the PED were identified as small adjacent PEDs and correlated with the polypoidal lesions seen on indocyanine green angiography in all PCV eyes. The feeder vessels were visualized in 3 out of 4 PCV eyes. En face SS-OCT demonstrated abnormal dilated choroidal vessels in 4 out of 4 PCV eyes, and in the 2 enrolled contralateral eyes. Conclusion: En face SS-OCT provides an in vivo tool to visualize the choroidal vascular features in PCV.
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Scientific Poster 287 Paravascular Inner Retinal Defects Associated With the Deviation of Major Retinal Vessels Presenting Author: Yuki Muraoka MD Co-Author(s): Masayuki Hata MD**, Abdallah A Ellabban, Akitaka Tsujikawa MD PhD*, Kenji Yamashiro MD PhD, Sotaro Ooto MD*, Hideo Nakanishi, Nagahisa Yoshimura MD PhD* Purpose: To investigate the clinical characteristics of paravascular inner retinal defect (PIRD) and its effect on retinal function. Methods: We examined 34 eyes with PIRD by using OCT and Goldmann perimetry (GP). Results: Most PIRDs were detected along the major retinal vessels in highly myopic eyes. These vessels appeared to be deviated by the axial length elongation. However, PIRDs had formed along the major retinal vessels deviated by the traction of the epiretinal membrane (ERM) in 3 eyes with normal axial length. The visual field defects caused by the PIRDs were revealed by GP. Conclusion: Deviated major retinal vessels due to axial length elongation or ERM may result in PIRDs, which could cause the corresponding visual field defects.
Scientific Poster 288 SOE Ocular Injuries Related With Empty Bullets During Military Training: A 10-Year Review Presenting Author: Soner Guven Co-Author(s): Ali H Durukan MD, Cuneyt Erdurman MD Purpose: To raise awareness of potential significant ocular damage secondary to empty bullets while shooting training. Methods: We reviewed the cases of empty bullet injuries from 2004 to 2014. Patients demographics, visual acuity (baseline and final), ocular trauma scores, and surgical approaches have been recorded. Results: Fifteen eyes of 15 patients with an average age of 21.3 years were included. None had ocular protection at the time of ocular injury. Nine eyes (60%) of the patients had closed-globe and 6 (40%) had open-globe
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injury. The baseline and final visual acuities were 20/200 or better in 26.6% and 80% of patients, respectively. The most common ocular findings were hyphema (60%) and vitreous hemorrhage (53%). Conclusion: Ocular injuries related to empty bullets are unpredictable. This is the first report about this topic.
Scientific Poster 289 SOE Ocular Injury Characteristics and Surgical Outcomes in Terrorist Warfare Presenting Author: Gungor Sobaci MD Purpose: To describe ocular injury characteristics and surgical outcomes in terrorist warfare. Methods: Retrospective review of injuries by terrorist attack and complete data for Ocular Trauma Classification System for the last 10 years. Results: 112 patients (130 eyes) averaging 23 years had open-globe in 80% and closed-globe in 20%. Intraocular foreign body, in 76.9%, was the most common (type C), as was grade 4, in 55.3%. All in closed globe and 67.3% in open globe had Zone III injury; 6 eyes (4.61%) had endophthalmitis. All had no protective eyewear. Improvised explosive devices and mines caused 49.1% and 39.2% of the injuries, enucleation in 23%; VRS in 87%. PVR, comprising 55% and resulting in anatomical and/or functional failure (< VA 5/200) in 57.7% eyes, was the most common and dreadful complication. Conclusion: Devastating visual outcomes are common in terrorist warfare. Protective eyewear should be a must.
Scientific Poster 290 Comparative Study of Initial Ozurdex vs. Avastin in the Treatment of Macular Edema following Central Retinal Vein Occlusion Presenting Author: Vincent A Deramo MD* Purpose: To compare visual outcomes in eyes with macular edema following central retinal vein occlusion after initial treatment with Ozurdex dexamethasone implant (DEX) or bevacizumab (BEV). Methods: Prospective, randomized, 6-month trial comparing initial treatment with DEX 0.7 mg (Group I, n = 14 eyes) or BEV 1.25 mg (Group II, n = 13 eyes). At each monthly visit, eyes with macular edema were treated with BEV 1.25 mg in a p.r.n. fashion. Results: Visual acuity improved 11.1 letters in Group I and 16.1 letters in Group II (P = .35). OCT macular thickness decreased 350 µm in Group I and 382 µm in Group II (P = .75). On average, eyes in Group I received 2.6 injections and eyes in Group II received 5.1 injections (P = .002). Conclusion: Eyes initially treated with DEX received significantly fewer injections in a 6-month period. Vision and OCT findings were similar.
Scientific Poster 291 SOE Temporal Inverted Flap Technique for Macular Hole Closure: A Comparative Study Presenting Author: Jerzy Nawrocki MD PhD Co-Author(s): Karolina Dulczewska-Cichecka**, Zofia Michalewska MD Purpose: Comparative study: Classic internal limiting membrane (ILM) flap technique (Group A) vs. temporal inverted flap technique (Group B) for macular hole. Methods: Fortythree eyes with stage IV macular hole were randomized in Group A and 44 in Group B. In Group B, ILM between the fovea and optic disc was not peeled. Results: 100% closure rate. In Group B retina nerve fiber layer (RNFL) defects were less frequent and a “U-shape contour” was achieved faster. Conclusion: The temporal inverted ILM flap technique seems to be equally as effective as the original method, with less damage to the RNFL. It allows us to achieve good anatomical and functional results.
Scientific Poster 292 Vitrectomy and Scleral Shortening in Patients With Macular Hole Retinal Detachment or Myopic Traction Maculopathy Presenting Author: Yoshimasa Ando MD Purpose: The purpose of this study was to assess anatomical and functional outcomes after vitrectomy with scleral shortening in patients with high myopia. Methods: Fourteen patients with high myopia, who had progressive visual impairment due to macular hole retinal detachment (MHRD) or traction maculopathy were studied. Myopic macular schisis or shape of posterior staphyloma were confirmed with OCT. Pars plana vitrectomy with scleral shortening was performed in all eyes of 14 patients. Results: The macular detachment resolved completely in all eyes of MHRD (6 eyes) or traction macular detachment (8 eyes). The curvature of the posterior staphyloma became less steep after the operation according to OCT findings. Conclusion: Scleral shortening may be effective for changing the shape of posterior staphyloma.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 293 Scleral Imbrication Combined With Pars Plana Vitrectomy for Myopic Schisis
Scientific Poster 297 SOE Perfusion Pressure During Pars Plana Vitrectomy
Presenting Author: Takayuki Baba MD
Purpose: To calculate mean ocular perfusion pressure (MOPP) during pars plana vitrectomy (PPV) in order to assess if it drops below safe values during surgery. Methods: Real-time IOP and noninvasive blood pressure (NBP) were continuously monitored throughout surgery and compared to baseline in 18 consecutive patients undergoing PPV for a variety of reasons. Results: Average IOP increased and NBP decreased during surgery, compared to baseline. MOPP decreased an average 37.1% compared to baseline. Sixteen of 18 patients had a significant intraoperative MOPP decrease; 15/18 spent more than 20% and 5/18 more than 50% of the entire surgery below 30 mmHg MOPP. Conclusion: MOPP may drop well below safe values during surgery for a lengthy time. This could explain visual field defects after uncomplicated surgery.
Co-Author(s): Sumiyoshi Tanaka MD PhD, Shuichi Yamamoto MD Purpose: To report the efficacy of scleral imbrication combined with pars plana vitrectomy (PPV) for myopic schisis (MS). Methods: Thirteen cases with MS have been treated by scleral imbrication combined with PPV. We retrospectively reviewed BCVA and resolution of MS determined by spectral domain OCT (SD-OCT). Results: BCVA improved from 0.57 ± 0.39 to 0.41 ± 0.37 logMAR units (P = .011) with a follow-up of 6.7 months. Significant resolution of MS was observed by SD-OCT in 92% of cases. No adverse event, including macular hole formation and chorioretinal atrophy, was observed in the postoperative period. Conclusion: Scleral imbrication combined with PPV appears to be effective to treat MS.
Scientific Poster 294 Cystoid Macular Edema After Cataract Surgery in Eyes With Previous Vitrectomy for Epiretinal Membrane Removal Presenting Author: Tanuj Banker MD Co-Author(s): Michael M Lai MD PhD, James M Osher MD
Presenting Author: Tommaso Rossi MD
SESSION TWO, MONDAY AND TUESDAY Scientific Poster 515 A Retrospective Analysis of the Correlation Between Central Serous Chorioretinopathy and Obstructive Sleep Apnea
Purpose: To determine the incidence of cystoid macular edema (CME) after cataract extraction / posterior chamber IOL (CE/PC-IOL) in eyes that have previously undergone pars plana vitrectomy (PPV) with epiretinal membrane peel (MP) with and without internal limiting membrane (ILM) peeling. Methods: A review of 81 cases of ERM removal and subsequent CE/PC-IOL. All PPVs were done using 23-/25-gauge systems. CME was documented by exam, spectral domain OCT, and fluorescein angiography. Results: The mean visual acuity was 20/60 pre-MP, 20/80 pre-CE/PC-IOL, and 20/30 (post-CE/PC-IOL (P < .01). The mean central macular thickness (CMT) was 396.30 µ pre-MP, decreasing to 334.1 µ post-MP (P < .01), and to 341.41 µ post-CE/PC-IOL (P < .02). Post-CE/PC-IOL, 21.0% of eyes had CME. The rate of CME with ILM peeling was 31.2%, vs. 7.7% without (P < .02). Conclusion: CME develops frequently after CE/PC-IOL in eyes with previous MP. Peeling of the ILM may be associated with higher rates of CME.
Presenting Author: Christopher Joel Rodriguez MD
Scientific Poster 295 Cystoid Macular Edema After Cataract Surgery in Eyes With Previous Macular Hole Surgery
Scientific Poster 516 Application of Transpupillary Thermotherapy in the Treatment of Central Serous Chorioretinopathy
Presenting Author: Tanuj Banker MD
Presenting Author: Durgesh Kumar MBBS
Co-Author(s): James M Osher MD, Michael M Lai MD PhD
Co-Author(s): Pankhuri Johari MBBS**
Purpose: To determine the incidence of cystoid macular edema (CME) after cataract extraction / posterior chamber IOL (CE/PC-IOL) in eyes that have undergone macular hole (MH) surgery with 23-/25-gauge pars plana vitrectomy (PPV). Methods: A review of eyes (N = 75) that underwent MH surgery and subsequent CE/PC-IOL. Exam, spectral domain OCT, and fluorescein angiography documented CME. The primary outcome measure was the incidence of CME post-CE/PC-IOL. Results: The mean visual acuity was 20/100 preMH surgery, 20/80 prior to CE/PC-IOL, and improving to 20/40 post-CE/PC-IOL (P = .005, P < .001). Post-CE/PC-IOL, 9.5% of eyes had CME. Neither internal limiting membrane (ILM) peeling nor time between MH repair and CE/PC-IOL were significantly related to CME (P = .64, P = .75). Conclusion: Occurrence of CME was not associated with ILM peeling during MH surgery, or the interval between MH surgery and CE/PC-IOL.
Purpose: To evaluate the role of transpupillary thermotherapy (TTT) in treating leaks of central serous chorioretinopathy (CSCR). Methods: Sixty-three eyes with CSCR of three to 18 weeks duration, with fall in visual acuity (VA) of two to five lines on Snellen chart, were investigated with fundus fluorescein angiography and OCT . All single (64%) or multiple leaks (subfoveal/extrafoveal) were treated with titrated TTT power of 110 to 200 mW (10- to 30-mW subthreshold, i.e., power to produce mild blanching) and spots size of 0.6 or 1.0 mm for 90 seconds. Results: At one week follow-up, submacular fluid (SMF) was reduced by 75% to 83% with VA gain of two to four lines on Snellen chart in >75% of eyes. Overall success rate was 92.2%. Earliest complete SMF reabsorption was seen on tenth post-TTT day and latest in the eighth week in the chronic case. Both subfoveal/extrafoveal leaks closed successfully. Conclusion: TTT is a fast, safe, and effective modality in all forms of CSCR.
Scientific Poster 296 Vitrectomy, Perfluorocarbon, and External Subretinal Drainage for Eyes With Advanced Coats Disease With Total Retinal Detachment
Scientific Poster 517 SOE H A New Surgical Technique to Treat Hypotony
Presenting Author: Shunji Kusaka MD*
Co-Author(s): Gaye Kilic, Ali H Durukan MD, Ali H Durukan MD
Purpose: To determine the efficacy of vitrectomy for severe Coats disease with total retinal detachment (RD). Methods: The medical records of 10 eyes of 10 patients with Coats disease (stage 3B, 9 eyes; stage 4, 1 eye) that had undergone surgery for total RD were reviewed. All patients were boys, with a mean age of 5.9 years. Results: Vitrectomy and injection of perfluorocarbon liquid (PFCL), followed by external drainage of subretinal fluid (SRF), were performed on all eyes. The retinas were successfully reattached in 8 eyes, with a mean follow-up of 18.9 months. In the other 2 eyes, the retinas remained detached due to reproliferations. Conclusion: These results indicate that vitrectomy, use of PFCL, and external SRF drainage are effective in reattaching the retina in eyes with advanced Coats disease.
Purpose: To elucidate an association between central serous chorioretinopathy (CSCR) and obstructive sleep apnea (OSA). Methods: This is a retrospective study using the Department of Defense’s health informatics division database to determine the yearly incidence of CSCR, the prevalence of OSA, and then the prevalence of OSA in CSCR compared with the general population of active-duty/retired Air Force and/or beneficiaries from 2009 to 2013. Results: A total of 924 patients were diagnosed with CSCR. Of those, 20.5% also had a diagnosis of OSA at the end of the study period compared with only 7.8% of the total population (1,369,407). Conclusion: This higher prevalence of OSA in the CSCR population likely represents an association between these two conditions.
Presenting Author: Gokhan Gurelik MD* Purpose: To assess the effect of a new surgical method, implantation of a capsular tension ring to the iridocorneal angle, for the treatment of severe hypotony. Methods: Nine eyes of nine patients were included in the study. All eyes had severe ocular hypotony (IOP, 9 for eyes without PVD. Conclusion: In patients with SRF or PVD at baseline, treatment frequency may be reduced with similar BCVA outcomes, while patients without SRF/PVD may require continuous monthly treatment.
Scientific Poster 533 Ranibizumab 1 mg as Rescue Therapy for Patients Failing Traditional Therapy for the Treatment of Neovascular AMD Presenting Author: Vaidehi S Dedania MD Co-Author(s): Pawan Bhatnagar MD**, Devang Laxmikant Bhoiwala, Naomi S Falk MD**, Paul Beer MD* Purpose: To evaluate the efficacy of high-dose ranibizumab (RZB) for the treatment of neovascular AMD in patients with persistent fluid on traditional therapy (bevacizumab 1.25 mg or RZB 0.5 mg). Methods: Retrospective review of best-corrected visual acuity (BCVA) and central foveal thickness (CFT) outcomes of 38 eyes with intractable disease switched to RZB 1 mg. Results: After switching from monthly traditional dose therapy to monthly RZB 1 mg, the mean baseline BCVA improved from 20/89 to 20/75 at one year (P = 0.16). The mean baseline CFT of 323 µm decreased to 281 µm at one year of follow-up (P = 0.03).
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Purpose: To compare the dynamic change of aqueous concentrations of VEGF receptors betweeen ranibizumab and aflibercept in patients with wet AMD. Methods: Aqueous humors were collected at the time of three monthly injections of anti-VEGF drugs (15 ranibizumab, 16 aflibercept). Aqueous concentrations of VEGF and soluble VEGF receptors (sVEGFRs) in each sample were analyzed by enzyme-linked immunosorbent assay. Results: Aqueous VEGF was dramatically reduced by both drugs. While aqueous sVEGFRs were gradually decreased in ranibizumab-treated eyes, they increased in aflibercept-treated ones. Conclusion: Although both ranibizumab and aflibercept suppressed an intraocular VEGF activity in AMD, the dynamic changes of intraocular sVEGFRs were dependent upon the action mechanisim of anti-VEGF drugs.
Purpose: To determine pharmacokinetics of aflibercept (AFB) and VEGF-A in aqueous humor. Methods: We included seven nonvitrectomized patients with wet AMD, who received an intravitreal injection (IVI) of 2 mg AFB for the first time. Samples were obtained prior to IVI for six months (three times monthly, then every two months). Thus, of each patient, five samples were analyzed with a self-developed ELISA for AFB. Results: In all cases, wet AMD was inactive after IVI. Initial mean concentration of AFB was 300.47 ± 46.97 µg/mL and remained stable with 0.87 ± 0.43 µg/mL, with small individual deviations. Initial mean level of VEGF-A was 190.71 ± 26.92 pg/mL. It significantly decreased after the first IVI to 93.71 ± 26.92 pg/mL (P < 0.05) and remained stable. Conclusion: Levels of AFB and VEGFA remained stable after every month and every second month IVI.
Scientific Posters Conclusion: RZB 1 mg led to a statistically significant improvement in CFT with a trend towards improvement in BCVA and may be considered as rescue therapy for the treatment of neovascular AMD in patients failing traditional therapy.
Scientific Poster 534 Long-term Follow-up of Intravitreal Aflibercept Injection for Neovascular AMD Presenting Author: W Lloyd Clark MD* Purpose: To assess long-term safety of intravitreal aflibercept injection (IAI) in neovascular AMD in an open-label extension study of VIEW1. Methods: In VIEW1, patients (n = 1,217) received 0.5 mg ranibizumab every four weeks, 2 mg IAI every four weeks, 0.5 mg IAI every four weeks, or 2 mg IAI every eight weeks after three monthly doses from weeks zero to 48, followed by mandatory quarterly dosing from weeks 52 to 96. After VIEW1, patients received at least quarterly dosing of 2 mg IAI. Results: Patients in the extension study (n = 323) received a mean of 12.9 injections over a mean of 116.9 weeks. Best-corrected visual acuity (BCVA) letter gain from the VIEW1 baseline was 10.2 and 6.8 at weeks 96 and 208. The most common serious ocular adverse event was endophthalmitis (0.9%). Conclusion: BCVA gains with anti-VEGF therapy in VIEW1 were largely maintained with IAI 2 mg in the extension study. IAI showed no new safety signals.
Scientific Poster 535 Intravitreal Bevacizumab (Avastin) for Choroidal Neovascularization Secondary to AMD: Five-Year Results of a Collaborative Retina Study Group Presenting Author: J Fernando Arevalo MD FACS* Co-Author(s): Andrçs Francisco Lasave MD, Lihteh Wu MD*, Maria H Berrocal MD*, Manuel Diaz Llopis MD PhD**, Roberto Gallego-Pinazo MD*, Martin A Serrano MD, Cristian Carpentier Giglio MD**, Arturo A Alezzandrini MD**, Veronica Gabriela Fortuna MD**, Mauricio Maia MD*, Sergio Rojas*, Silvio M Lujan MD
Scientific Posters
Purpose: To report long-term results of intravitreal bevacizumab (IVB; 1.25 mg) for choroidal neovascularization (CNV) secondary to AMD. Methods: Retrospective, multicenter, interventional case series of 247 patients (292 eyes). Results: Patients were followed up for 60 months. Mean number of IVB injections per eye was 10.9 ± 6.4 (range, one to 46). At five years, best-corrected visual acuity decreased from 20/150 (logMAR, 0.9 ± 0.6) to 20/250 (logMAR, 1.1 ± 0.7; P ≤ 0.0001 ). Mean central macular thickness (CMT) decreased from 343.1 ± 122.3 µm at baseline to 314.7 ± 128.8 µm (P = 0.009). Complications included uveitis in six eyes (2.1%) and endophthalmitis in two eyes (0.7%). Conclusion: IVB treatment seems to provide significant decrease of CMT in CNV in AMD at five years. However, no functional improvement was seen in 80.3% of eyes.
Scientific Poster 536 Intravitreal Bevacizumab (Avastin) for Diabetic Macular Edema: Five-Year Results of a Multicenter Collaborative Retina Study Group Presenting Author: J Fernando Arevalo MD FACS* Co-Author(s): Andrçs Francisco Lasave MD, Lihteh Wu MD*, Michel Eid Farah MD, Manuel Diaz Llopis MD PhD**, Roberto Gallego-Pinazo MD*, Arturo A Alezzandrini MD**, Veronica Gabriela Fortuna MD**, Hugo Quiroz-Mercado MD*, Guillermo Salcedo-Villanueva MD, Raul Velez Montoya MD**, Mauricio Maia MD*, Sergio Rojas*, Martin A Serrano MD Purpose: To report long-term results of intravitreal bevacizumab (IVB; 1.25 mg) for diffuse diabetic macular edema (DDME). Methods: Retrospective, multicenter, interventional, comparative case series of 201 patients (296 eyes). Results: All patients were followed up for 60 months. The mean number of injections per eye was 8.4 ± 7.1 (range, one to 47). At five years, best-corrected visual acuity (BCVA) remained stable at 20/100 (logMAR, 0.7 ± 0.5; P = 0.387). Mean central macular thickness (CMT) decreased significantly from 403.5 ± 142.2 µm at baseline to 313.7 ± 117.7 µm (P ≤ 0.0001 ) at the end of follow-up. No safety concerns were noted. Conclusion: IVB treatment seems to provide stability (43.6%) but no improvement (71%) in BCVA and reduction in CMT for DDME at five years of follow-up.
Scientific Poster 537 SOE Multispot Lasers: What Constitutes an Effective Panretinal Photocoagulation? Presenting Author: Felicity Allen MBCHB Co-Author(s): Alex Baneke MBBS*, Tom H Williamson md*, Samantha S Mann MBBS* Purpose: To assess the effectiveness of the multispot pattern scan laser (PASCAL) in treating proliferative diabetic retinopathy (PDR). Methods: We performed a retrospective study of 56 patients (80 eyes) with PDR. The area of the treated retina was correlated with PDR progression and compared with ETDRS guidelines of a ≥236 mm2 treatment area. Results: At 12 months, 65% of eyes had progression of PDR. The mean burn area in this group was 310 mm2, compared with 536 mm2 in eyes that did not progress (P = 0.0091). Seventy percent of eyes with burn area >800 mm2 did not progress. Conclusion: Progression of PDR occurs with PASCAL panretinal photocoagulation despite using the ETDRS burn area. We recommend a burn area of 310 to 800 mm2 to reduce the risk of progression and potential visual loss from PDR.
Scientific Poster 538 The Effects of Bariatric Surgery and Intensive Medical Therapy on Diabetic Retinopathy: Two-Year Data Presenting Author: Adiel G Smith MD Co-Author(s): Rumneek Bedi BA, Stacy Alan Brethauer MD*, John P Kirwan, Richard E Gans MD**, Deepak L Bhatt MD*, Rishi P Singh MD* Purpose: Glycemic control (GC) improves immediately after bariatric surgery in type 2 diabetes mellitus (T2DM) patients. However, rapid change in GC may cause progression of diabetic retinopathy (DR). This study examines the effect of bariatric surgery on DR. Methods: One hundred fifty patients with T2DM had gastric bypass, sleeve gastrectomy, or intensive medical therapy. Fundoscopic exams were performed at baseline and year 2. Results: At two years, there was no statistically significant difference in DR among (P > 0.5) or within (P > 0.99) the cohorts. There was a difference in mean change in A1c values between the medical therapy (-1.1) and surgical (-2.8, -2.7) groups (P < 0.001). Conclusion: Despite improved GC and A1c, T2DM patients undergoing bariatric surgery or intensive medical therapy may not be free from DR.
Scientific Poster 539 SOE Untargeted Metabolic Screen Identifies Purine Metabolite With Potential Protective Effects in Diabetic Retinopathy Presenting Author: Liliana Paris MD Co-Author(s): Edith Aguilar MD, Tim U Krohne MD*, Martin Friedlander MD, Yoshihiko Usui MD Purpose: To identify circulating factors that may help further understand why some type 1 and type 2 diabetic patients with long-term disease do not develop late-stage retinal complications. Methods: A retrospective analysis was performed on blood serum samples collected from well-characterized type 1 and type 2 diabetic patients with at least 20 years of disease duration and different diabetic retinopathy stages, using a metabolomics mass spectrometry-based approach. Results: Inosine, a purine metabolite, was significantly upregulated in 33% of the type 1 and type 2 diabetic patients who did not develop proliferative diabetic retinopathy (PDR) despite long-term diabetes. Conclusion: Inosine can be a protective factor towards PDR development in a subset of diabetic patients and may hold great potential as a therapeutic agent in diabetic retinopathy.
Scientific Poster 540 H Fluocinolone Acetonide for Diabetic Macular Edema: A Single-Center 5-Year Follow-up Study Presenting Author: Ramandeep Singh MBBS** Co-Author(s): Mangat R Dogra MBBS, Vishali Gupta MBBS**, Abiraj Kumar Sr MS**, Amod K Gupta MBBS Purpose: To evaluate the efficacy of a fluocinolone acetonide (FA) insert at five years. Methods: Subjects participating in the Fluocinolone Acetonide for Macular Edema trial were evaluated prospectively for two more years. Outcome measures included change in best-corrected visual acuity (BCVA), foveal thickness, and IOP. Results: Of 36 patients enrolled, 30 (83.3%) completed five-year follow-up, including nine in sham, 10 in low dose, and 11 in high dose. At five-year follow-up, 16 of 21 (76%) patients in two FA insert groups
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* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters versus four of nine (44%) in the sham group improved by ≥15 BCVA letters. None had an increase in IOP during the last two years. Conclusion: Both low-dose and high-dose FA inserts continued to be effective at five years.
Scientific Poster 541 SOE Diabetic Retinopathy: The Influence of Antiangiogenic Therapy in Choroidal Thickness Presenting Author: Rufino Silva MD MSC* Co-Author(s): Ines Carvalho Lains MD, Joao P Figueira MD* Purpose: To analyze the effect of anti-VEGF in the choroidal thickness (CT) of diabetic retinopathy (DR) patients. Methods: Cross-sectional study. Twenty-five DR patients (50 eyes), two groups: nonproliferative DR (NPDR) and dDME in both eyes, submitted to macular laser in both eyes and anti-VEGF injection only in one eye (n = 11), and proliferative DR (PDR) in both eyes, treated with panretinal photocoagulation in both eyes and anti-VEGF injection only in one eye (n = 14). Results: Eyes treated with anti-VEGF showed a reduction in central CT (CCT; P = 0.002) and subfoveal CT (P = 0.004) versus fellow eyes treated with laser . The PDR group revealed similar results (CCT, P = 0.02; subfoveal CT, P = 0.03). In NPDR plus diabetic macular edema group, CCT was also significantly thinner in eyes treated with anti-VEGF (P = 0.04). Conclusion: Diabetic eyes treated with anti-VEGF have reduced CT.
Scientific Poster 542 Four-Year Incidence and Progression of Diabetic Retinopathy in India Presenting Author: Tarun Sharma MBBS Co-Author(s): Vaitheeswaran Kuloyhungan**, Swakshyar Saumya Pal**, Rajiv Raman MBBS** Purpose: To determine the four-year incidence and progression of diabetic retinopathy (DR) in type 2 diabetes. Methods: Between 2003 and 2006, a cohort of 5,999 was enumerated for estimating prevalence; subsequently eligible ones were re-evaluated for incidence and progression. Results: The cumulative four-year incidence of any DR was 7.93% and, of two-step progression, 1.67%. Multivariate models identified risk factors related to incidence, including 10-year increment of duration of diabetes (OR, 1.78) and anemia (OR, 1.85), and factors related to progression, including duration (OR, 2.08), hemoglobin bA1c (OR, 1.18), total cholesterol (OR, 2.08), insulin use (OR, 4.15), and microalbuminuria (OR, 1.11) . Conclusion: A low incidence and much lower progression was observed.
Scientific Poster 543 TIE2 Pathway in Diabetic Macular Edema: A Phase 1b/2a Open-Label, Multiple-Ascending Dose Cohort Study to Assess the Safety, Tolerability, and Pilot Efficacy of Repeat Subcutaneous Doses of AKB-9778 Co-Author(s): , Peter A Campochiaro MD* Purpose: To evaluate the safety and efficacy of 28-day BID subcutaneous dosing of AKB9778 in patients with diabetic macular edema (DME). Methods: Twenty-four patients with central retinal subfield thickness of >325 µm and ETDRS acuity of 50 µm, and 13 of 18 patients gained five or more letters of visual acuity. Conclusion: Subcutaneous dosing of AKB-9778 is safe and well tolerated. Reduction of DME and corresponding increase of visual acuity were observed. The results suggest that TIE2 activation may be effective in the treatment of DME.
Scientific Poster 544 SOE Multimodal Imaging Using Quantitative Autofluorescence in Achromatopsia: A Case Series Presenting Author: Alexandre Jacques Matet MD Co-Author(s): Susanne Kohl PhD, Saddek Mohand Said MD**, Michel Paques*, Jose A Sahel MD*, Isabelle Audo Purpose: To correlate quantitative autofluorescence in blue (qBAF) and near infrared (qIRAF) with spectral-domain OCT in achromatopsia (ACHM). Methods: Patients underwent genetic, clinical, and imaging (Heidelberg Retina Angiograph 2/Spectralis) evaluation. qBAF and qIRAF charts were generated by pixel averaging along concentric semicircles with an ImageJ plug-in. Results: Of 12 ACHM patients, six had mutations in CNGA3 and six in
Scientific Poster 545 H The Natural History and Genetic Variability of Choroideremia Presenting Author: Paul R Freund MD Co-Author(s): Ian M MacDonald MD* Purpose: To describe the natural history of choroideremia (CHM) in a quantified and clinically relevant format. Methods: A retrospective review of 128 males with confirmed molecular diagnoses of CHM. Results: Males with missense mutations in the CHM gene do not have a different natural history compared with males with loss-of-function mutations. Visual acuity is stable until 40 years of age (P = 0.71) but decreases by 0.05 logMAR units/ year above the age of 40 (P = 0.001). Visual fields decrease at a rate of 0.9 horizontal degrees/year above the age of 20 (P = 0.006). Visual fields demonstrate higher intereye correlations than visual acuity (r = 0.95 and 0.76, respectively). Conclusion: This natural history data will guide the selection and monitoring of participants in CHM gene therapy trials.
Scientific Poster 546 SOE Treatment With Repeat Dexamethasone Implants Results in Long-term Disease Control in Eyes With Noninfectious Uveitis Presenting Author: Oren Tomkins-Netzer MD Co-Author(s): Susan L Lightman MBBS, Asaf Bar MD, Lazha Talat, Lavnish Joshi, Ahmed Samy FRCS Purpose: To describe the long-term outcome of eyes with uveitis following repeated treatment with dexamethasone (Ozurdex ) implants. Methods: A retrospective review of 38 eyes of 27 adult patients. Results: Average follow-up was 17.3 ± 1.8months, with 24 eyes (63.1%) receiving multiple implantations. Following treatment, the average best-corrected visual acuity improved from 0.47 ± 0.05 logMAR to 0.27 ± 0.07 logMAR (P < 0.001), and central retinal thickness decreased by 263 ± 44.22 um (P = 0.003). The median duration of theraputic effect was six months (range, two to 42months), with a similar response achieved after each repeat implantation. Conclusion: The accumulated effect of repeat Ozurdex implantations improves retinal thickness, ocular inflammation, and vision.
Scientific Poster 547 Optic Nerve/Retinal Ganglion Cell Involvement in Autoimmune Retinopathies Resulting in Autoimmune Neuroretinopathy Presenting Author: Alessandro Iannaccone MD Co-Author(s): Eric Sollenberger BBA, Rebecca S Epstein MD, Aleksandr Birg MD, Purpose: To present evidence for frequent optic nerve/retinal ganglion cell (ON/RGC) involvement in autoimmune retinopathy (AIR) patients (n = 57) confirmed via autoantibody testing and immunohistochemistry. Methods: Fundus exams, retinal and disc spectral-domain OCT (SD-OCT), and pattern reversal visual-evoked potentials (PVEPs) were analyzed. Results: Papillary/juxtapapillary changes, disc elevation/hyperemia, temporal atrophy, or cupping were seen in 53 of 57 patients, and PVEP delays were seen in 50 of 57 patients, even with 20/20 acuity. Retinal nerve fiber layer (RNFL) changes were common on disc OCT. Manual segmentation of macular SD-OCT on a subset of patients (n = 22) showed that macular RNFL was thicker in AIR patients than in healthy patients (P = 0.0186). Conclusion: AIR patients commonly have ON/RGC involvement, hence they actually have AINR . ON/RGC imaging and functional studies impact diagnosis, treatment, and follow-up and should be obtained in AIR.
Scientific Poster 548 Endophthalmitis Rates After Intravitreal Anti-Vascular Endothelial Growth Factor Injections for Various Retinal Diseases Presenting Author: Jason Hsu MD* Co-Author(s): Nadim Rayess MD, Ehsan Rahimy MD, Chirag P Shah MD*, Jeremy D Wolfe MD*, Eric Chen MD*, Francis C DeCroos MD, Sunir J Garg MD* Purpose: To compare endophthalmitis rates after intravitreal anti-VEGF therapy for diabetic eye disease (DED), wet AMD (wAMD), and retinal vein occlusion (RVO). Methods:
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Presenting Author: Victor H Gonzalez MD*
CNGB3, with three new variants. Two groups were identified: A, perifoveolar hyper-qBAF ring with continuous or granular ellipsoid line on OCT (n = 4), and B, central hypo-qIRAF with hyporeflective foveal cavity on OCT (n = 5) . Mean age was higher in Group B (36 vs. 18 years; P = 0.02). Conclusion: qBAF and qIRAF clearly correlate with OCT changes and may serve as clinical endpoints in forthcoming gene therapy trials.
Scientific Posters Certain populations may have a higher infection risk due to immune dysfunction. We retrospectively reviewed 499,025 intravitreal anti-VEGF injections given from Jan. 1, 2009 to July 1, 2013. Results: Endophthalmitis occurred in 159 of 411,823 injections for wAMD (1/2590), 16 of 40,708 for DED (1/2544), and eight of 46,494 for RVO (1/5812). Endophthalmitis rates for RVO were significantly lower than that for DED (P = 0.0497) and wAMD (P = 0.0219). Conclusion: RVO had the lowest rate of endophthalmitis, possibly due to immune dysfunction in diabetics and waning immunity in the older wAMD population.
Scientific Poster 549 Intravitreal Aflibercept for Diabetic Macular Edema Refractory to Bevacizumab and/or Ranibizumab Presenting Author: Brian P Lehpamer MD Co-Author(s): Jaafar F El Annan MD, Petros Carvounis MD FRCSC, Robert E Coffee MD Purpose: To investigate the efficacy of aflibercept for diabetic macular edema (DME) unresponsive to bevacizumab and/or ranibizumab. Methods: Retrospective review of 33 patients (42 eyes) switched to aflibercept for refractory DME. Mean best-corrected visual acuity (BCVA) and mean Spectralis OCT central subfield thickness (CSFT) were analyzed. Results: Forty-two eyes with baseline BCVA of 20/46 and CSFT of 445 µm received an average of 5.5 bevacizumab and/or ranibizumab injections. BCVA and CSFT were stable at 20/45 (P = 0.67) and 420 (P = 0.24), respectively. After switching to aflibercept, BCVA improved to 20/37 (P = 0.0005) and CSFT to 349 (P = 0.0007), with an average of 3.3 injections. Conclusion: DME unresponsive to other agents may show favorable response to aflibercept.
Scientific Poster 550 SOE Efficiency and Safety of the Dexamethasone Implant Ozurdex in Irvine-Gass Syndrome Presenting Author: David Bellocq MD
Scientific Posters
Co-Author(s): Laurent Kodjikian MD PhD*, Philippe Denis MD**
decrease in $/QALY was seen for longer durations of HCQ use. Conclusion: Testing beyond the Academy’s guidelines for HCQ retinopathy substantially decreases the cost eficacy of annual screening.
Scientific Poster 553 Factors Associated With Spontaneous Release of Vitreomacular Traction Presenting Author: David Almeida MD PhD MBA* Co-Author(s): Eric Chin MD, Karim J Rahim PhD, James C Folk MD*, Stephen Richard Russell MD* Purpose: To analyze the factors that may predict the release of vitreomacular traction (VMT) and vitreomacular adhesion. Methods: Retrospective case-control study of 61 patients with VMT imaged by OCT over at least three months. Release of VMT (R-VMT) was defined by resolution of patients’ symptoms or traction by OCT without surgical intervention or ocriplasmin injection. Results: Of 61 patients, 21 (35%) developed R-VMT and 40 (65%) did not. Isolated inner retinal distortion without outer retinal involvement was associated with R-VMR (P = 0.01). Vitreous injections were also associated with R-VMR (P = 0.02). Conclusion: Eyes with VMT and isolated inner retinal distortion and those receiving vitreous injections are more likely to develop VMT release without the need for additional treatment.
Scientific Poster 554 Expanded spectral domain OCT Findings to Assist in Early Detection of Hydroxychloroquine Retinopathy and Progression Following Drug Cessation Presenting Author: David R Lally MD Co-Author(s): Elias Reichel MD*, Andre J Witkin MD, Caroline R Baumal MD*, Adam H Rogers MD*, Chirag P Shah MD*, Jeffrey S Heier MD*, Jay S Duker MD*
Purpose: To evaluate the efficiency and safety of an implant of dexamethasone, Ozurdex, in the treatment of Irvine-Gass syndrome. Methods: This is a interventional pilot trial including non-naive patients. An assessment of visual acuity in ETDRS letters and an OCT spectral domain were made at the baseline visit and then on a monthly basis. The main objective was to assess changes in visual acuity and macular thickness at M2 and M4 after a first injection of Ozurdex. Results: Fifty patients were included. The initial mean visual acuity was 55.7 letters . A gain of 15.6 letters was obtained at M2 and a gain of 7.4 letters at M4. The mean macular thickness decreased to 238 µm at M2 and 148 µm at M4. Conclusion: Dexamethasone intravitreal implant seems to be effective in the treatment of Irvine-Gass syndrome.
Purpose: To report large series of eyes with hydroxychloroquine (HCQ) retinopathy after HCQ cessation and present new spectral-domain OCT (SD-OCT) findings to enable earlier diagnosis. Methods: Retrospective case review of eyes with HCQ retinpathy followed after drug cessation. Cohort was divided into three groups (Early, Moderate, and Severe) based on SD-OCT appearance at diagnosis. Thickness measurements of all nine ETDRS subfields were recorded. Changes in morphological appearance of SD-OCT appearance were analyzed. Results: Forty-six eyes were included. Eighty-two percent of Early eyes had reduced reflectivity of parafoveal EZ , broadening of parafoveal Henle’s fiber layer reflectivity, or loss of interdigitation zone. Progression of toxicity was detected in 66%. Conclusion: SD-OCT shows signs of HCQ toxicity before disruption of parafoveal EZ. SD-OCT shows progression after drug cessation is common.
Scientific Poster 551 Clinical Characteristics of Bilateral vs. Unilateral Central Serous Chorioretinopathy
Scientific Poster 555 The Healing Process of Myopic CNV After Anti-Vascular Endothelial Growth Factor Therapy
Presenting Author: Umesh Chandra Behera MS Co-Author(s): Rohit Ramesh Modi, Siddharth Shekhar DOMS**, Taraprasad Das MD** Purpose: To compare clinical characteristics of unilateral (u-CSCR) versus bilateral central serous choroidoretinopathy (b-CSCR). Methods: Retrospective analysis of 251 u-CSCRs and 112 b-CSCRs. Results: Between u-CSCR and b-CSCR, age at presentation was 40.98 and 45.129 years (P < 0.0001), duration of symptoms was 370 and 791 days (P = 0.0002), presenting vision (logMAR) was 0.364 and 0.509 (P = 0.008), and retinal pigment epithelium atrophy was in 44 and 98 eyes (P < 0.0001), respectively. On follow-up, u-CSCR gained eight letters and b-CSCR lost five letters (P = 0.0203). There were more males with b-CSCR. Conclusion: b-CSCR occurs in older age males, with poorer presenting and final vision.
Scientific Poster 552 A Cost Analysis of Screening for Hydroxychloroquine Retinopathy Presenting Author: Andrew J McClellan MD Co-Author(s): William E Smiddy MD Purpose:To evaluate the cost utility of screening for hydroxychloroquine (HCQ) retinopathy employing current recommendations. Methods: Cost of diagnostic tests and office visits in hospital and office settings were calculated using Medicare fee schedules. Lines of vision lost, average age, and incidence per five-year period of HCQ use were abstracted from published studies to caluclate the cost per quality-adjusted life-year ($/QALY). Results: $/QALY ranged from 57,000 to 255,000, representing up to a 2-fold increase from previous visual field-only regimens. Each additional test increased the cost as follows: OCT, 30%; fundus autofluorescence, 50%; and multifocal electroretinography, 100%. A slight
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Presenting Author: Kaori Sayanagi MD Co-Author(s): Yasushi Ikuno MD, Masahiro Akiba PhD* Purpose: The hyperreflective line (HRL) on the surface of choroidal neovascularization (CNV) on OCT image is thought as a CNV encapsulation by retinal pigment epithelium, which may indicate the stabilization of myopic CNV (mCNV). We observed the extension of HRL and investigated the healing process of mCNV after anti-VEGF therapy. Methods: The length of HRL on the surface of CNV was measured in 10 eyes with mCNV using sweptsource OCT preoperatviely and one week and one month after anti-VEGF therapy. The factors associated with the length of HRL and the extension speed of HRL were explored. Results: The length of HRL indicating the CNV encapsulation increased over time significantly (P < 0.05). The choroidal thickness was significantly correlated with the length of HRL and the extension speed of HRL (P < 0.05). Conclusion: The choroidal thickness is critical for stabilizing mCNV.
Scientific Poster 556 Stellate Nonhereditary Idiopathic Foveomacular Retinoschisis Presenting Author: Michael D Ober MD* Co-Author(s): K Bailey Freund MD*, Manthan R Shah MD**, Shareef B Ahmed MD**, Tamer H Mahmoud MD*, Thomas M Aaberg Jr MD*, David N Zacks MD PhD*, Hua
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Gao MD PhD, Sri Krishna Mukkamala MD, Uday Ravindra Desai MD, Kirk H Packo MD*, Lawrence A Yannuzzi MD Purpose: To describe a new disorder, stellate nonhereditary idiopathic foveomacular retinoschisis (SNIFR). Methods: This retrospective case series analyzed history, multimodal imaging, and genetic testing. Patients with family history, RS1 mutation, myopic degeneration, epiretinal membrane, vitreoretinal traction, optic pit, or advanced glaucomatous optic nerve were excluded. Results: Twenty-two eyes from 16 female and one male patient were reviewed from five institutions. Initial visual acuity was ≥20/50 in all eyes (mean, 20/27). Follow-up ranged from six months to over five years. Conclusion: In this largest known series of patients with SNIFR, all patients demonstrated splitting of the outer plexiform layer, with relatively preserved visual acuity (≥20/40) except in one case that developed subfoveal fluid.
Scientific Poster 557 SOE Approach of Subretinal and Suprachoroidal Space: Experimental Study Presenting Author: Alfredo Insausti Garcia MD Purpose: To describe a device and an experimental surgical technique for repeated application of therapies in the subretinal and suprachoroidal spaces. Methods: Experimental study in 25 ex vivo pig eyes. Procedure: subconjunctival device implantation; radial sclerotomy, 4 mm; viscodissection; lighted fiber optic dissection; and microcatheter implantation. Prototype device: rigid base; methacrylate-cellulose; and diameter, 5 mm. Microcatheter: polyimide, 36 G. Results: Procedure performed successfully in 18 (72%) out of 25 operated eyes. Major complications included difficulty to localize and guide the lighted optic fiber, choroidal perforations, retinal perforations, and detachments. Conclusion: Feasible device and reproducible surgical technique may allow repeated application of intraocular therapies in subretinal and suprachoroidal spaces.
Scientific Poster 558 Intravitreal Vascular Endothelial Growth Factor Levels in Proliferative Sickle Cell Retinopathy Strongly Correlate With the Extent of Capillary Nonperfusion Noted on WideAngle Angiography Presenting Author: Shailesh K Gupta MD** Co-Author(s): K V Chalam MD PhD
Scientific Poster 559 Paraproteinemic Maculopathy Presenting Author: Ahmad M Mansour MD* Co-Author(s): J Fernando Arevalo MD FACS*, Josep Badal Lafulla MD, Ramana S Moorthy MD, Gaurav K Shah MD*, Hernando Zegarra MD, Jose S Pulido MD MS, Alaa Samih Bou Ghannam MD, Luis Amselem MD, Alejandro Lavaque MD, Antonio M Casella MD, Baseer U Ahmad MD**, Joshua G Paschall MD, Antonio Caimi MD**, Giovanni Staurenghi MD* Purpose: To ascertain the course and therapy of paraproteinemic maculopathy (PM). Methods: Case series with the following outcome measures: best-corrected visual acuity (VA), area of PM, and rheology. Results: Thirty-three cases were followed for seven months: diabetes (7); mean immunoglobulin (Ig) of 6,497 mg/dL; viscosity of 5.5 cP ; logMar VA initlal (final), 0.55 (0.45) in right eye and 0.38 (0.50) left eye; plasmapheresis (18), chemotherapy (30), and intravitreal bevacizumab/triamcilonone (8). PM resolved in 17 cases (when Ig normalized with medical therapy) and was unchanged or worsened in 14 cases. PM manifested at lower Ig in diabetics, with positive correlation between PM area and serum viscosity. Intravitreal therapies failed. Conclusion: Decreasing blood Ig is the primary therapy in PM. Coexisting diabetes facilitates leakage of Ig at lower levels than for nondiabetics.
Presenting Author: Ahmad M Mansour MD* Co-Author(s): Rola N Hamam MD, Joanna S Saade MD, Fadi Camille Maalouf MD**, Mahmoud O Jaroudi MD Purpose: Scleral windows and sclerotomies often fail due to episcleral scarring in nanophthalmic uveal effusion (NUE). A new surgical technique is presented. Methods: Sclera was dissected till bluish reflex appeared, and anterior 90% of sclera was excised from muscle insertion to vortex vein 300 degrees sparing superior temporal quadrant. Results: Seven patients (11 eyes) were treated, having mean values for age (25 years), hyperopia (14 D), axial length (15.2 mm), initial visual acuity of 20/200 improving to 20/100 (P = 0.05) at 12 months follow-up. NUE resolved as soon as one day after surgery by OCT, with resolution of fluorescein leakage, while nondraining techniques require several weeks for subretinal fluid resolution. Conclusion: This extreme sclera thinning technique rectifies basic defect of megasclera by transforming pomelo into orange.
Scientific Poster 561 Intravitreal Injection of Bevacizumab in Retinal Detachments at High Risk for Proliferative Vitreoretinopathy: A Randomized Pilot Clinical Trial Presenting Author: Masoud Soheilian MD Co-Author(s): Adib Tousi MD, Alireza Ramezani MD Purpose: To evaluate the effect of intravitreal bevacizumab (IVB) on proliferative vitreoretinopathy (PVR) development. Methods: In this pilot randomized trial, eyes with primary rhegmatogenous retinal detachment (RRD) that were high risk for PVR C formation and underwent encircling band plus pars plana vitrectomy were randomized into two groups. Eleven received IVB at the end of the procedure, and 12 eyes received no drug. Results: Anatomical success was 72.7% and 50.0% in the IVB and control groups, respectively (P = 0.40), at month 3. Conclusion: This pilot study suggests a possible efficacy of IVB in the prevention of PVR formation in high-risk RRD.
Scientific Poster 562 Vitrectomy-Scleral Buckle vs. Vitrectomy Alone for Retinal Detachment at High Risk for Proliferative Vitreoretinopathy Presenting Author: Philip P Storey MD Co-Author(s): Rayan A Alshareef MD**, Nikolas J London MD*, Benjamin Leiby PhD, Francis C DeCroos MD, Richard S Kaiser MD* Purpose: To compare pars plana vitrectomy (PPV) alone and PPV with scleral buckle (SB) in patients with rhegmatogenous retinal detachment (RRD) at high risk for proliferative vitreoretinopathy (PVR). Methods: Six hundred seventy-eight patients with RRD from April 1, 2010 to Aug. 1 2012 were reviewed. High-risk characteristics for PVR were considered RRD in more than quadrants, retinal tears greater than one clock hour, preoperative PVR, or vitreous hemorrhage. Results: Sixty-five patients were identified as high risk for PVR. Thirty-six patients received PPV-SB and 29 patients received PPV alone with 63.1% overall single-surgery anatomical success. PPV-SB was associated with a significantly higher success rate compared with PPV alone (odds ratio, 3.24; 95% CI, 1.12–9.17; P = 0.029). Conclusion: For patients at high risk for PVR, PPV-SB may have superior success compared with PPV alone.
Scientific Poster 563 SOE Treatment Patterns for Patients Starting Anti-Vascular Endothelial Growth Factor Therapy for Retinal Vein Occlusion in U.S. Clinical Practice Presenting Author: Andrew J Lotery MBCHB* Co-Author(s): Stephane Regnier PhD* Purpose: To assess real-world usage of anti-VEGF in patients with central (CRVO) or branch retinal vein occlusion (BRVO). Methods: Analysis of IMS Health’s claims database to calculate frequency of ophthalmologist visits and injections in U.S. patients commencing anti-VEGF and not switching therapy. Results: In year 1 of ranibizumab therapy, the mean (standard deviation) number of injections was 4.3 (2.9) for CRVO (n = 1,130) and 4.0 (2.8) for BRVO (n = 1,394). The mean number of ophthalmologist visits was 7.8 (3.7) for CRVO and 7.7 (3.8) for BRVO. We also found that 15.4% of CRVO and 13.4% of BRVO patients had at least eight injections. For CRVO, aflibercept injection frequency was similar to that of ranibizumab. Conclusion: In U.S. clinical practice, patients with retinal vein occlusion receive substantially fewer ranibizumab injections in the first year than participants in clinical trials.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Posters
Purpose: To report the correlation between intravitreal VEGF levels in prolferative sickle cell retinopathy (PSR) and compare them to the degree of capillary nonperfusion (CNP) noted on wide-angle angiogram (WFA). Methods: In this retrospective study, in patients with SPR (28), WFA was performed and the ratio of CNP was estimated. The cohort consisted of PSR that required vitrectomy SPR (28). VEGF levels obtarined during surgery were measured with Luminex assay. Results: VEGF levels ranged from 448 to 1,456. Degree of CNP ranged from 44% to 89% and correlated strongly (r = 0.69) with VEGF Levels. Conclusion: Degree of capillary nonperfusion noted on WFA is a good predictor of intravitreal VEGF levels and may help in modulating anti-VEGF therapy in proliferative sickle cell retinopathy.
Scientific Poster 560 Nanophthalmic Uveal Effusion Managed With Maximal Subtotal Scleral Excision: Pomelo Scleral Peel Technique
Scientific Posters Scientific Poster 564 Patterns of Fundus Autofluorescence Defects in Exudative AMD Subtypes
Scientific Poster 568 SOE Appearance on Adaptive Optics of Foveal Sparing in Geographic Atrophy Secondary to AMD
Presenting Author: Ahmet Ozkok MD
Presenting Author: Giuseppe Querques MD
Co-Author(s): Douglas K Sigford MD, Tongalp H Tezel MD
Co-Author(s): Anouk Georges, Capuano Vittorio**, Rocio Blanco-Garavito MD*, Eric H Souied MD PhD*
Purpose: To test whether exudative AMD subtypes can be differentiated from their fundus autofluorescence (FAF) patterns. Methods: Macular and peripheral FAF patterns of 52 patients with three different exudative AMD (exAMD) subtypes were compared in a masked fashion. Results: All clinical subtypes had nondistinctive macular FAF patterns; however, peripapillary FAF defects were common in polypoidal choroidal vasculopathy (PCV; 88.2%) compared with RAP (12.5%) and non-RAP non-PCV (21.1%) cases (P < 0.0001). Conclusion: Presence of peripapillary FAF defects in exAMD should suggest PCV as the the cause of choroidal neovascularization.
Scientific Poster 565 SOE Choroidal Thickness in Multisystemic Autoimmune Diseases Under Hydroxychloroquine Treatment Without Ophthalmologic Manifestations Presenting Author: Joao Nuno Bicho Beato MD
Scientific Posters
Co-Author(s): Carla Sofia Ferreira MD, Manuel Falcao MD, Angela Maria Carneiro MD PhD*, Fernando M Falcao-Reis MD PhD**
Purpose: To describe the appearance on adaptive optics (AO) of foveal sparing (FS) in geographic atrophy (GA) secondary to AMD. Methods: AO images were overlaid with near-infrared autofluorescence (NIA). Results: In five eyes of four patients (all female; mean age, 74.2 ± 11.9 years), by direct comparison with adjacent regions of GA, FS areas appeared as well-demarcated areas of reduced reflectivity with less hyporeflective clumps. AO revealed cone photoreceptors as hyperreflective dots over the background reflectivity. Microperimetry demonstrated residual function in areas of FS detected by NIA. Conclusion: AO allows appreciating differences in reflectivity between regions of GA and FS. Preservation of functional cone photoreceptors was demonstrated in areas of FS detected by NIA.
Scientific Poster 569 SOE The Natural History of Lamellar Macular Holes: A Spectral Domain OCT Study Presenting Author: Goktug Seymenoglu MD Co-Author(s): Esin Fatma Baser MD
Purpose: To evaluate choroidal thickness in individuals with multisystemic autoimmune diseases. Methods: One hundred fifty eyes of 75 patients were included, with autoimmune disease treated with hydroxychloroquine. Choroidal thickness was measured in the center of the fovea and along a horizontal section, using enhanced depth-imaging spectral-domain OCT. Results were compared with a control sample. Results: Lupus patients had a thicker choroid in all measures (P < 0,001). Below the fovea, the choroid was thinner in rheumatoid arthritis and other autoimmune diseases than controls (P = 0.043). Results were adjusted for age (P < 0.001), spherical equivalent (P < 0.001), and beginning of therapy (P = 0.032). Cumulative dose had no influence. Conclusion: Autoimmune diseases may possibly present in the choroid, with differences between diseases.
Purpose: To study the evolution of lamellar macular holes (LMHs) using spectral-domain OCT (SD-OCT). Methods: Thirty-one consecutive patients (15 males and 16 females; mean age, 63.9 ± 2.15 years; mean follow-up, 21.95 months) diagnosed with a LMH were examined. LMHs were quantitatively and qualitatively characterized by SD-OCT in terms of base and apex diameter and residual foveal thickness. Results: The mean best-corrected visual acuity (logMAR), residual foveal thickness, and apex and base diameters at baseline and at the final visit were 0.45 ± 0.18 versus 0.42 ± 0.11, 184.25 ± 31.25 µm versus 182 ± 22.36 µm, 589 ± 82.20 versus 615 ± 93.25 µm, and 828 ± 76.14 versus 842 ± 80.65 µm, respectively (P > 0.05 for all). Conclusion: Most lamellar macular holes do not progress anatomically and do not contribute to a significant decrease in visual acuity during the follow-up period.
Scientific Poster 566 Smartphone Photography in ROP Screening: One NICU Experience From a Community-Based Hospital
Scientific Poster 570 Intraoperative OCT During Vitreoretinal Surgery for Dense Vitreous Hemorrhage in the PIONEER Study
Presenting Author: Fatima Ahmed MD
Presenting Author: Joseph F Griffith MD*
Co-Author(s): Anupa Mandava MD**, Cono M Grasso MD, Ajey Jain**, Julia P Shulman MD*
Co-Author(s): Sunil K Srivastava MD*, Jamie L Reese RN**, Justis P Ehlers MD*
Purpose: To present our initial experience with fundus photography using a smartphone and ophthalmic lenses in neonates. Methods: Fundus images were captured with a smartphone and indirect lens. The phone flash provided a coaxial light source for a fundus image. Results: We were successful in capturing images in neonates with retinopathy of prematurity (ROP). There was a learning curve associated with this technique. It seems inferior to traditional fundus photography in capturing peripheral findings in ROP at adequate magnification. Conclusion: This technique can be successfully used for photodocumentation, parent education, and resident training.
Scientific Poster 567 Retinal Invasion by Uveal Melanoma With Tumoral-Retinal Anastomoses and Angiomatous Proliferations Presenting Author: Gene W Chen MD Co-Author(s): Jose S Pulido MD MS, Anthony B Daniels MD, Carol L Shields MD Purpose: To describe multimodal imaging of retinoinvasive uveal melanoma with angiomatous/anastomotic changes on fluorescein angiography (FA)/indocyanine green angiography (ICG). Importantly, invasion may confer poorer prognosis with radiation therapy. Methods: Case series of 70 tumors with imaging was reviewed. Results: Tumors showed encroachment/loss of retina in a “dome-on-dome” configuration on OCT in 17% of patients (35.5% medium). Mean size on ultrasound was greater with invasion compared with without invasion (thickness, 5.1 vs. 2.2 mm, P > 0.0001; base, 13.3 vs. 8.5 mm, P 0.0004 ). Of 12 patients with OCT invasion, all had evidence of tumoral-retinal anastomoses and angiomatous proliferations (TRAAP) on FA/ICG. Conclusion: OCT may help detect tumoral invasion, which seems to be accompanied by a vasogenic sequence we propose TRAAP because of a resemblance to RAP .
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Purpose: To evaluate intraoperative OCT (iOCT) during vitrectomy surgery (pars plana vitrectomy [PPV]) for dense vitreous hemorrhage (VH). Methods: Eyes were identified within the PIONEER study, a prospective multisurgeon iOCT study, that underwent PPV for VH, precluding a preoperative OCT, within 60 days of study enrollment. iOCT images were analyzed for retinal abnormalities that might impact intra- or perioperative management. Results: Nineteen eyes were identified. iOCT revealed epiretinal membranes (14), macular edema (10), vitreomacular traction (4), macular holes (2), and retinal detachment (1). Six eyes had iOCT following membrane peeling to confirm completeness of peel. Conclusion: iOCT during PPV for VH may provide surgeons with clinically relevant information that may impact management and outcomes.
Scientific Poster 571 Swept Source OCT is Superior to Spectralis in Accuracy as Well as Reproducibility of Choroid Thickness and Volume Measurements Presenting Author: K V Chalam MD PhD Co-Author(s): Sandeep Grover MD Purpose: To compare coefficient of reproducibility (COR) of choroid measurements between swept-source OCT (SS-OCT) images and Spectralis spectral-domain OCT. Methods: A prospective observational study of persons (N = 46) with normal macula (CSF thickness, 0.05) and between eyes containing different types of gases (P > 0.05) at all stations of ascent. Conclusion: This direct correlation between increasing altitude and IOP rise can guide us in the postoperative management of patients undergoing ascending car travel.
Scientific Poster 586 Direct Intraocular Pressure Measurements During Vitrectomy with Minimal Incision Valve Surgery Presenting Author: Kazuhito Yoneda Co-Author(s): Shigeru Kinoshita MD* Purpose: To directly measure dynamic IOP during vitrectomy with minimal incision valve surgery (MIVS). Methods: Dynamic IOP of 44 cases was tested via pars plana trocar with a sensor to directly measure IOP during 25- and 27-G MIVS vitrectomy. Disposable pressure transducers were placed in the vitreous cavity to directly determine IOP. Results: IOP varied from 0 to 80 mmHg during surgery. During high-flow infusion cannula, mean 25- and 27-G IOP were 17.0 and 20.6 mmHg, respectively (P < 0.01). During normal-infusion cannula, mean 25- and 27-G IOP were 6.3 and 7.8 mmHg, respectively (P < 0.01). Within the same-size incision, high-flow infusion maintained IOP (P < 0.01 for both 25 and 27 G). Conclusion: IOP was higher during 27 than 25 G. High-flow infusion cannula maintained IOP during various MIVS vitrectomy steps.
Presenting Author: Homayoun Tabandeh MD MS FRCP FRCOphth*
Scientific Poster 587 Bimanual Internal Limiting Membrane Peeling in Repair of Rhegmatogenous Retinal Detachment With a High Risk of Proliferative Vitreoretinopathy
Co-Author(s): Nikolas J London MD*, David S Boyer MD*
Presenting Author: Lala Akhundova MD
Purpose: To evaluate outcomes of small-gauge pars plana vitrectomy (PPV) without routine scleral depressed shaving of vitreous base for treatment of retinal detachment (RD). Methods: Retrospective, consecutive case series including all cases of RD who underwent PPV. Small-gauge PPV (25 or 23 G) and wide-angle vitrectomy viewing systems were used in all cases. Results: Two hundred twenty-five eyes (86 pseudophakic, 48 high myopia, 10 giant retinal tear, and three funnel RD). Retina was reattached with one procedure in 212 eyes (94%). Final reattachment was 99% (222 eyes). Conclusion: In the era of wide-angle viewing systems, small-incision PPV without routine scleral depressed shaving of vitreous base is associated with good outcomes.
Co-Author(s): Elmar Kasimov MD PhD**, Mushfig Karimov**
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Purpose:To analyze the effect of internal limiting membrane (ILM) peeling in patients undergoing vitrectomy for the treatment of rhegmatogenous retinal detachment with a highrisk proliferative vitreoretinopathy (PVR). Methods: Thirty-eight eyes of 38 patients were included in the study. All eyes underwent vitrectomy with ILM peeling with silicone oil/ gas tamponade for retinal detachment with a high-risk PVR. The follow-up was at least three months. Results: Single-surgery anatomic success was achieved in 86.8%, and final reattachment was achieved in 97.4% of patients. There was no subsequent development of epiretinal membranes after ILM peeling. Conclusion: ILM peeling in conjunction with vitrectomy is an effective technique, with a high anatomic success rate in the challenging scenario of high-risk PVR-related retinal detachments.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
Scientific Posters Scientific Poster 588 SOE Inverted Internal Limiting Membrane Flap Technique vs. Standard Internal Limiting Membrane Flap Technique for Large Macular Holes
Scientific Poster 592 To Evaluate the Effect of Vitreous Surgery on Corneal Endothelium
Presenting Author: Ligia M Figueiredo MD Co-Author(s): Ligia M Ribeiro MD, Miguel Afonso Almeida Pinto Bilhoto
Co-Author(s): Brijesh Takkar**, Amit Jain MBBS MS**, Kumar Vivek Sr, Raj V Azad MD FRCS(ED)**
Purpose: To compare the functional and anatomic outcomes of a standard internal limiting membrane (ILM) flap technique with a modified inverted ILM flap technique for large macular holes. Methods: Retrospective, nonrandomized, comparative study. Twenty eyes with macular holes larger than 400 µm were included. In Group 1, 13 eyes underwent ILM peeling. In Group 2, seven eyes underwent the inverted flap technique. Results: Best-corrected visual acuity three months after surgery improved from 0.067 to 0.223 decimal equivalent (DE) in Group 1 and from 0.084 to 0.286 DE in Group 2 (P < 0.05). Macular hole closure was observed in 54% of patients in Group 1 and 100% of patients in Group 2. A flat-open hole was observed in 38.5% of patients in Group 1 (P < 0.05). Conclusion: The inverted ILM flap technique seems to be an effective surgical treatment for large macular holes.
Purpose: To evaluate the effect of vitreous surgery on corneal endothelium. Methods: One hundred thirteen eyes undergoing pars plana vitrectomy for variable indications were included prospectively. Specular count was noted preoperatively and on postoperative day 1, 30, 90, and 180. Percentage and rate of endothelial loss were measured. Results: We found that 7.6% of endothelial cells were lost at postoperative day 1. This rate had decreased to 2.5% in the first 30 days, 1.5% between day 30 and 90 and 1.4% between day 90 and 180. Significant difference in endothelial loss was noted on day 1 between phakic, pseudophakic, and aphakic eyes at 7.2%, 6.4%, and 11.4%, respectively. Conclusion: Precautions should be taken in aphakics and patients requiring anterior segment manipulation. Endophthalmodonesis in aphakic vitrectomized eyes may be a serious concern.
Scientific Poster 589 Macular Hole Surgery Sans Gas Tamponade Presenting Author: Meena Chakrabarti MBBS
Scientific Poster 593 Brilliant Blue Staining Using Whole Blood vs. Conventional Brilliant Blue Staining in Macular Hole Surgery
Co-Author(s): Arup Chakrabarti MBBS
Presenting Author: Supriya Batta MS
Purpose: To study whether gas tamponade was necessary to improve anatomic and functional outcomes in macular hole surgery (MHS). Methods: Retrospective analysis of 100 patients who underwent MHS with internal limiting membrane (ILM) peeling and with intraoperative gas tamponade (50 eyes) and without gas tamponade (50 eyes) . A comparative analysis of hole closure rate, vision, and complications in both groups was performed. Results: Hole closure rate was 92% (400 µm) in both groups. Complications such as retinal tears (5%), retinal detachment (2%), retinal pigment epithelium degeneration (16%), and epiretinal membrane (5%) were similar in both groups. A higher incidence of cataract (40% vs. 8%) was seen in Group 1. Final vision recovery of >6/60 (60%) was achieved in both groups. Conclusion: The anatomic and functional outcomes in MHS are similar, irrespective of whether intraoperative gas tamponade was used or not.
Co-Author(s): Neha Goel MBBS**, Nalini Saxena MBBS, Richa Pyare MBBS**, Usha K Raina MD, Meenakshi Thakar**, Basudeb Ghosh**
Scientific Poster 590 Structural and Visual Outcomes After Epimacular Membrane Surgery With Internal Limiting Membrane Peeling
Scientific Poster 594 Tomographic Features of the Fovea After FoveolaNonpeeling Macular Hole Surgery
Presenting Author: Meena Chakrabarti MBBS
Purpose: To study the tomographic features after foveolar internal limiting membrane (ILM) nonpeeling surgery in stage 2 macular hole. Methods: The patients were divided into two groups (14 eyes in each group) by the extent of peeling: preservation in Group 1 and total peeling in Group 2. Results: There was more improvement of logMAR best-corrected visual acuity in Group 1 than in Group 2. Regain of inner segment/outer segment line in all eyes in Group 1 (100%) and in seven eyes in Group 2 (50%). Recovered external limiting membrane lines were found in all eyes in Group 1 (100%) and in eight eyes in Group 2 (57%). Group 1 eyes restored umbo reflex and smooth and symmetric foveolar contour without postoperative inner retinal dimpling. Conclusion: Nonpeeling of the foveolar ILM restored better foveolar microstructures and achieved more visual acuity improvement.
Co-Author(s): Arup Chakrabarti MBBS
Scientific Poster 591 SOE Geometry, Penetration Force and Cutting Profile of Different 23-Gauge Trocars Systems for Pars Plana Vitrectomy Presenting Author: Carsten H Meyer III MD Co-Author(s): Zengping Liu MD**, Sandeep Saxena MBBS MS, Hakan Kaymak MD**, Eduardo B Rodrigues MD* Purpose: To examine 11 23-G trocar systems (spear, back, lancet bevel, and spatula bevel). Methods: Normative geometrical data were analyzed (ISO 7864 and ISO 9626). A penetrometer measured the piercing, cutting, and sliding and plotted a load displacement diagram. Results: The mean outer diameter was 0.630 ± 0.009 mm, the point length was 3.11 ± 0.4 mm, the bevel length was 1.46 ± 0.2 mm, the primary angle was 10.75 ± 0.4°, and the secondary angle was 65.9 ± 42.56°. The piercing forces of back and spear were 0.087 ± 0.028 Newton (N), and the lancet was 0.41 N (0.35–0.47), but the spatula was 1.6 N (1.59–1.73) . The back bevel induced a triangular shape, the spear a linear, the lancet a straight, and the spatula accurate incisions. Conclusion: Lancet and back systems show less penetration force than the spatula systems.
Purpose: To compare the outcome of sequential intraoperative use of autologous heparinized whole blood (WB) followed by brilliant blue (BB) versus conventional BB staining for internal limiting membrane (ILM) peeling in macular hole surgery. Methods: This randomized, controlled trial included 30 patients in each group. Clinical examination and spectral-domain OCT were done at three, six, and 16 weeks and six months postoperatively. Results: Group A (BB staining using WB) had a higher mean best-corrected visual acuity at all postoperative visits (P < 0.001, 0.001, 0.004, and 0.04, respectively) compared with Group B (conventional BB staining). Conclusion: Use of WB prior to staining ILM with BB improves functional outcome of surgery.
Presenting Author: Tzyy-Chang Ho MD
Scientific Poster 595 Anatomical and Visual Outcomes of Vitreoretinal Surgery in Pediatric Retinal Detachments Presenting Author: Yog Raj Sharma MD MBBS Co-Author(s): Abdul Shameer MBBS, Raj V Azad MD FRCS(ED)**, Pradeep Venkatesh**, Parijat Chandra MD, Koushik Tripathy MD MBBS Purpose: To study outcomes of vitreoretinal surgery (VRSx) in pediatric retinal detachments (RDs). Methods: Prospective case series. Three hundred twenty-two eyes of 308 children (≤14 years of age) undergoing VRSx with silicone oil injection (23 or 25 G) were studied, excluding retinopathy of prematurity cases. Results: Mean age was 10.7 ± 2.6 years. Two hundred nineteen patients (71.1%) were boys. Forty-six patients (14.9%) had bilateral RD. The most common cause was trauma in 135 eyes (41.9%). One hundred eighty-six eyes (57.7%) had proliferative vitreoretinopathy. At six months, 287 eyes (89.1%) achieved retinal reattachment. Visual acuity was ≥20/200 in six eyes preoperatively and in 96 eyes at six months (P < 0.001) of the 307 eyes in which visual acuity could be measured. Conclusion: The anatomical outcomes of pediatric VRSx are good; however, visual recovery remains modest.
* The presenter has a financial interest. ** The presenter has not submitted financial interest disclosure information as of press date. No asterisk indicates that the presenter has no financial interest.
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Scientific Posters
Purpose: To study the long-term visual outcome and macular structural changes in 130 consecutive patients who have undergone epimacular membrane surgery with internal limiting membrane peeling. Methods: Retrospective review of the visual outcome and OCT changes at one, three, six, and 12 months postoperatively. Results: Visual acuity improvement at six months (>6/9) decreased by two lines (90% of eyes experience a change in axis of ≤5° between two consecutive visits approximately three months apart. 1. TECNIS Toric 1-Piece IOL [package insert]. Santa Ana, Calif: Abbott Medical Optics Inc. 2. Novis C. Astigmatism and toric intraocular lenses. Curr Opin Ophthalmol. 2000; 11:47-50. TECNIS is a trademark owned by or licensed to Abbott Laboratories, its subsidiaries, or affiliates. ©2014 Abbott Medical Optics Inc. www.AbbottMedicalOptics.com 2013.01.31-CT6316
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