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  • Contains 1 Component(s)

    Brief history of the Merton C. Flom Leadership Insight Program

    Dr. Merton Flom (1926-2010) was not only an outstanding vision scientist, clinician, and educator, he was also a visionary in optometry with a passion for leadership.  Mert was a past editor of the Academy’s journal, served on the Academy’s Executive Committee for 16 years, and was Academy President 1980-1982.  Recognizing a need in optometry for a leadership culture, Mert founded the Academy’s leadership programs, which have been part of the Annual Meeting since 1994.  With his passing in February 2010, the profession and the Academy lost a giant in optometry.  In memory of him and his inspiration to us all, the Academy is proud to name this program the Merton C. Flom Leadership InSight Program.

  • Contains 3 Component(s)

    This course discusses the diagnosis, classification, and treatment of uveitis. Focus is on the indication and tailoring of the laboratory work-up and co-management with the uveitis specialist. Current treatment options are covered with an emphasis on novel treatments. Several cases from our clinical hospital based practices are discussed.

    This course discusses the diagnosis, classification, and treatment of uveitis. Focus is on the indication and tailoring of the laboratory work-up and co-management with the uveitis specialist. Current treatment options are covered with an emphasis on novel treatments. Several cases from our clinical hospital based practices are discussed.

  • Contains 3 Component(s)

    This course discusses the diagnosis, classification, and treatment of uveitis. Focus is on the indication and tailoring of the laboratory work-up and co-management with the uveitis specialist. Current treatment options are covered with an emphasis on novel treatments. Several cases from our clinical hospital based practices are discussed.

    This course discusses the diagnosis, classification, and treatment of uveitis. Focus is on the indication and tailoring of the laboratory work-up and co-management with the uveitis specialist. Current treatment options are covered with an emphasis on novel treatments. Several cases from our clinical hospital based practices are discussed.

    Megan Hunter, OD, FAAO

    Michelle Marciniak, OD, FAAO

    Dr. Michelle M. Marciniak graduated Magna Cum Laude from Illinois College of Optometry. She completed an ocular disease/low vision residency at West Side VAMC and Hines VA Blind Rehabilitation Center. In the past, she taught at Illinois College of Optometry and worked in private practice. Currently, Dr. Marciniak is an attending and coordinator of externships at Jesse Brown VAMC. She teaches physical diagnosis at ICO. She also works part-time as a private practice ocular disease consultant. She is a Fellow of the American Academy of Optometry and has been active with NBEO, including the Advanced Competency in Medical Optometry committee. 

  • Contains 2 Component(s)

    Differences in philosophy for visual field (VF) testing have been noted. The purpose was to assess whether optometrists dilate their patients prior to threshold VF.

    Purpose: Differences in philosophy for visual field (VF) testing have been noted. The purpose was to assess whether optometrists dilate their patients prior to threshold VF.

    Methods: An electronic survey was sent to: Deans of the Schools/Colleges of Optometry, American Academy of Optometry Comprehensive Care Section members, Illinois College of Optometry faculty, as well as posted on ‘ODs on Facebook’. Those who received the survey link were asked to share it.

    Results: There were 632 who completed the survey. They reported graduating from 22 different Optometry schools/universities (highest ICO 14%) and practicing in 47 states (highest California 12%), DC, Puerto Rico, Canada and 12 other countries . The highest % reported being in practice for 20 yrs. and 22.2% 10-20 yrs. Modes of practice included: private practice (34.7%), education (30.7%), governmental (17.9%), OD/MD (8.6%), commercial (3.2%), other (3.1%) and HMO (1.7%). The highest proportion (49.7%) reported they dilate some time for VF testing while 42.4% reported they do not dilate and 7.9% reported they dilate all patients. For those who dilate patients some or all of the time, reasons included: so dilated fundus evaluation could be performed (69.2%), pupil size (53%), consistent previous VF (42.6%), ocular diagnosis (27.2%), age (12.6%), and consistent with education (9.3%). For those who do not dilate patients, reasons included: unnecessary (65.7%), consistent with education (54.1%), inconvenient to patient (21.3%), and time consuming (13.8%). Most reported their philosophy has not changed (70.1%). However of those whose philosophy has changed, most (65.6%) reported less dilation. The majority (84.8%) reported managing glaucoma. Most (67.4%) order 20.

    Conclusion(s): Practice patterns for VF and reasoning varied among the wide variety of respondents. Further research is needed to provide guidance in this area.

  • Contains 126 Product(s)

    This content package represents several years of education, accessible in 2018 and early 2019.

    This content represents several years of education, accessible in 2018 and early 2019.

  • Contains 2 Component(s)

    Identify differences in vision-related quality of life (VRQoL) for keratoconic (KCN) persons with scleral gas permeable (SGP) correction as compared to corneal gas permeable (CGP) correction. Contact lens comfort and handling were also assessed.

    Purpose: Identify differences in vision-related quality of life (VRQoL) for keratoconic (KCN) persons with scleral gas permeable (SGP) correction as compared to corneal gas permeable (CGP) correction. Contact lens comfort and handling were also assessed.

    Methods: Three geographically diverse locations administered surveys to KCN subjects who habitually wore SGP or CGP lenses in the absence of corneal surgery, other conditions impacting vision, or piggyback lens systems. Severity classification of KCN was based on simulated keratometry using the Collaborative Longitudinal Evaluation of Keratoconus study group’s grading scheme. Outcome measures included the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and questions on lens comfort and handling. Comparisons were assessed using one-tailed Wilcoxon tests.

    Results:  Thirty-five KCN subjects were included in the analysis. There was no significant difference in overall NEI-VFQ-25 scores between SGP and CGP groups (p=0.18). The greatest differences in NEI-VFQ-25 subscale scores between SGP and CGP wearers were found for the dependency upon other persons (p=0.01), general vision (p=0.07) and driving (p=0.07) subscales, with SGP scoring better in all three subscales. No statistically significant differences were found between SGP and CGP for the overall score or the subscale scores when subjects were grouped based on KCN severity (all p > 0.05).  End of the day comfort was significantly better for SGP wearers (p=0.009). Difficulty with lens application and removal was similar between groups (p=0.30).

    Conclusion(s):  KCN persons wearing SGP and CGP have similar VRQoL. The benefits of  superior comfort and vision with SGP lenses may not extend to superior VRQoL in keratoconus. Future cross-over studies may further elucidate differences in VRQoL and help optometrists envisage contact lens options that optimize VRQoL in this important population. 

    Chandra V Mickles, OD, MS, FAAO

    Dr. Mickles is an Associate Professor at Nova Southeastern University College of Optometry. 
    She received her Bachelor of Science degree with honors from the University of Miami and her Doctor of Optometry degree from the State University of New York College of Optometry graduating in the top ten of her 
    class. Her Master of Science in Vision Science and residency training in Cornea and Contact Lenses were completed at the University of Alabama at Birmingham School of Optometry. Additionally, Dr. Mickles completed a two year Veterans Affairs Optometric Research Fellowship at the Birmingham VA Medical Center. 

    Dr. Mickles has lectured and published in the areas of contact lenses and ocular surface disease.

  • Contains 2 Component(s)

    Many optical coherence tomography angiography (OCTA) devices are available, but not all of them provide quantitative measurements of retinal vasculature. Practitioners usually use publicly available image processing software to analyze OCTA images. This study compared vessel density results obtained using ImageJ with those obtained using a software recently launched by a manufacturer.

    Purpose: Many optical coherence tomography angiography (OCTA) devices are available, but not all of them provide quantitative measurements of retinal vasculature. Practitioners usually use publicly available image processing software to analyze OCTA images. This study compared vessel density results obtained using ImageJ with those obtained using a software recently launched by a manufacturer. 

    Methods: A Zeiss Cirrus HD-OCT 5000 (Carl Zeiss Meditec, Dublin, CA) was used to measure the retinal vasculature of 21 eyes from 21 healthy young subjects. A 3x3mm OCTA image was acquired and analyzed using AngioPlex software. The retinal vessel perfusion density in the superficial plexus was provided according to a ETDRS grid. OCTA images were exported using three different settings of brightness (120 from a 255 gray scale, 140/255 and 180/255), followed by a manual calculation of the vessel density by using ImageJ (National Institutes of Health). Images were first converted into a binary format and were then analyzed using an automated thresholding method. Two OCTA images were acquired to study the repeatability for evaluating the vessel density.

    Results: Using AngioPlex software, the median perfusion density at a 3mm ETDRS circle was 0.373 (IQR 0.034). No significant difference was observed between the two measurements, 0.376 (0.013) (Wilcoxon signed rank test: p = 0.60). The vessel density obtained using ImageJ depended on the brightness setting applied when exporting the images. The densities were 0.380 (0.042), 0.346 (0.030) and 0.299 +/- 0.040 at brightness settings of 120/255, 140/255, and 180/255, respectively. Only images obtained in the 120/255 setting had vessel density similar to those obtained using AngioPlex (Wilcoxon signed rank test: p = 0.06). The vessel density was significantly lower at other brightness settings. AngioPlex software also provided repeatable results for the perimeter and circularity of the foveal avascular zone (FAZ). Significant variation was observed between the two measurements for the FAZ area (mean difference 0.006mm², 95% CI 0.001 to 0.011mm²; paired t-test, t = 2.65, p = 0.015).

    Conclusion(s): When built-in software is not provided, practitioners may use publicly available image processing software to analyze the vessel density obtained from OCTA. For repeatability or follow-up studies, the same setting should be used when exporting OCTA images. Practitioners should be cautious when comparing the results obtained using publicly available image processing software.

    Andrew KC Lam, PhD, FAAO

    Dr. Andrew Lam graduated from the then Hong Kong Polytechnic with a Professional Diploma in Optometry. After working in a private optometric practice for two years, he returned to the then Hong Kong Polytechnic working as a Research Assistant and later obtained his Masters and PhD degrees from the Department of Optometry, University of Bradford, in the UK. He is now the Programme Leader of the Bachelor of Science in Optometry Programme at the School of Optometry, PolyU. He was a recipient of the Department's Teaching Excellence Award in 2002 and also 2008.  Dr. Lam is a Fellow of the American Academy of Optometry. He is Chairperson of the Preliminary Investigation Committee and the Registration Committee of the Optometrists Board of Hong Kong. He has also served as Chairperson in various Committees of the Optometrists Board of Hong Kong, including Education Committee and Examination Committee. He was Treasurer of the Hong Kong Society of Professional Optometrists from 1993 to 1998.  Dr. Lam’s research interests include the study of cornea, ocular blood flow and intraocular pressure. He has published in many scientific journals, including Ophthalmic and Physiological Optics, Optometry and Vision Science, and Clinical and Experimental Optometry. He teaches Ocular Pathology and Ocular Pharmacology for the BSc (Hons) in Optometry at PolyU.  Away from the university and Optometry, Dr. Lam has had a long-standing interest in travelling and photography.

  • Contains 2 Component(s)

    Adult-onset fovealmacular vitelliform dystrophy (AOFVD) is a retinal dystrophy, characterized by bilateral foveal, yellow, round elevated subretinal lesions. These lesions mimic drusen and are often misdiagnosed as age-related macular degeneration (AMD). SD-OCT may be a useful technique to assist in distinguishing these two conditions.

    Introduction: Adult-onset fovealmacular vitelliform dystrophy (AOFVD) is a retinal dystrophy, characterized by bilateral foveal, yellow, round elevated subretinal lesions. These lesions mimic drusen and are often misdiagnosed as age-related macular degeneration (AMD). SD-OCT may be a useful technique to assist in distinguishing these two conditions.

    Case Report: Patient 1, an 85yo WM, complained of blurry vision OU. BCVA were 20/30 OD and 20/40 OS. Dilated eye exam revealed mild RPE changes OD, and a large elevated yellow lesion OS. SD-OCT revealed a small lesion between the inner/outer segment (IS/OS) interface and the RPE band OD, and a large vitelliform-like lesion OS consistent with AOFVD. Patient 2, a 72yo WM, reported blurry vision OS at distance. BCVA were 20/30 OD and 20/60 OS. Dilated eye exam revealed several small drusen OS>OD, and a large elevated lesion OS. SD-OCT confirmed small drusen OU, and a large pigment epithelial detachment (PED) with mild sub-retinal fluid OS, consistent with wet AMD.

    Conclusion(s): AOFVD and AMD have similar clinical features making differentiation challenging. SD-OCT may distinguish subtle differences between these conditions. The early yellow subretinal deposits in AOFVD on OCT have been localized between the IS/OS interface and the RPE band. In contrast, AMD drusen have been described as irregularities generally within the level of the RPE on OCT. AOFVD progression presents as a large vitelliform lesion, similar to PED in AMD. It has been suggested that vitelliform lesions in AOFVD may maintain photoreceptor integrity and visual function longer than AMD, because the contact between the apical RPE and IS/OS is preserved. PED lesions in AMD exhibit RPE elevation and gradual IS/OS loss. Since both conditions may develop choroidal neovascularization leading to significant vision loss, SD-OCT is useful in differentiating between AOFVD and AMD, and identifying the need for further treatment.

  • Contains 2 Component(s)

    This multi-center study reports demographics of scleral lens wearers and scleral lens prescription patterns as reported in an online survey.

    Purpose: This multi-center study reports demographics of scleral lens wearers and scleral lens prescription patterns as reported in an online survey.

    Methods: An online survey was conducted from December 13, 2016 to March 31, 2017. Scleral Lens Education Society members were invited to participate via e-mail, links to the survey were posted on the Scleral Lens Fitters Facebook page and were included in two monthly online newsletters. Fitters were asked to provide information about their most recently evaluated established scleral lens patient (history of ≥ 6 months of lens wear). We describe demographics of scleral lens wearers, indications for wear, and lens designs prescribed.  

    Results: We received 376 responses.  Mean patient age (n=339) was 44 ± 14 years (range 9-86 years). Male gender was reported in 62% of patients (n=352). Primary indications for scleral lens wear (n=312) were corneal irregularity (84%), ocular surface disease (7%) and correction of refractive error (5%). Median lens diameter was 16 mm (range 10-23 mm) for both right (n=207) and left (n=212) eyes. Single vision lenses were prescribed for 97% of right eyes (n=207) and 98% of left eyes (n=211).  Right lenses (n=201) incorporated spherical (69%), toric (28%) and wavefront-corrected (3%) optics.  Left lenses (n=207) incorporated spherical (70%), toric (28%) or wavefront-corrected (2%) optics.  Right lenses (n=201) featured spherical (61%), toric (28%), quadrant-specific (8%) or impression-based (3%) haptics.  Left lenses (n=207) featured spherical (63%), toric (27%), quadrant-specific (7%) or impression-based (2%) haptics.

    Conclusion(s): Scleral lenses are most commonly prescribed for management of corneal irregularity. Median lens diameter prescribed is 16 mm. Most scleral lenses feature single vision optical correction, and a majority of lenses prescribed feature spherical optical power and haptic designs.

  • Contains 2 Component(s)

    This study aims to evaluate the settling of a scleral lens and if this process is influenced by the nature of the fluid layer.

    Purpose: This study aims to evaluate the settling of a scleral lens and if this process is influenced by the nature of the fluid layer.

    Methods: A prospective, non-randomized control study was performed using an 18 mm scleral lens. They were fitted with a central clearance of 400 um at insertion. One eye was randomly assigned to be fitted with a non-preserved gel solution of carboxymethylcellulose, while the other was inserted with non-preserved saline. Measurements of clearance in 3 locations were taken (OCT) at baseline, every 30 min up to 1h30 post insertion and every 2 h thereafter up to 6h00 of wear. A two-way repeated measure analysis of variance (liquids × times) was used to test central, nasal and temporal fluid thickness.

    Results: Following 6 h of wear, the 18 mm lens had a mean central settling of 70.0 ± 9.8 μm, 36.7 ± 9.8 μm of which occurred within the first 30 min of wear. There was no significant difference between lenses filled with non-preserved saline to those with non-preserved gel. However, a paired comparison concluded to a significant difference between mean nasal settling (41.4 μm) and temporal settling (20.4 μm).

    Conclusion(s): With respect to the lens studied, current results suggest that practitioners can evaluate the lens 30 min post insertion and can estimate the amount of fluid that will remain after lens stabilization by doubling the value obtained initially. The use of non-preserved saline or non-preserved more viscous solution to fill the lens does not influence its settling.

    Claudine Courey, OD, MSc, FAAO