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The Treatment and Management of Uveitis in Optometric Practice (Credit, 1 Hour, 67693-SD)Contains 3 Component(s)
The Treatment and Management of Uveitis in Optometric PracticeContains 3 Component(s)
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.
IPoster: Dilation or No Dilation for Threshold Visual Field Testing: Optometric Practice PatternsContains 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.
IPoster: Management of Corneo-Scleral Irregularities with Virtually Designed Custom Multi-Meridian Scleral LensesContains 2 Component(s)
Toric haptic scleral lens designs are prescribed more often than in previous years. Recent interest in mapping the sclera and conjunctiva is proving that scleral shape is highly variable, and may explain the difficulty in fitting some patients with scleral lenses. A corneo-scleral topographical system was utilized to evaluate ocular shape of two patients. Custom multi-meridian back surface toric haptic scleral lenses were empirically designed to address the unusual scleral shape, which significantly deviated from a sin2 bitoric curve with a periodicity of 180°.
Introduction: Toric haptic scleral lens designs are prescribed more often than in previous years. Recent interest in mapping the sclera and conjunctiva is proving that scleral shape is highly variable, and may explain the difficulty in fitting some patients with scleral lenses. A corneo-scleral topographical system was utilized to evaluate ocular shape of two patients. Custom multi-meridian back surface toric haptic scleral lenses were empirically designed to address the unusual scleral shape, which significantly deviated from a sin2 bitoric curve with a periodicity of 180°.
Case Reports: Case 1 had central corneal scarring due to recurrent herpes zoster and poor fitting scleral lenses, resulting in inferior decentration. Scleral topography showed a largely flat sclera with the exception of a 120° wide area of depression (~500µ deep) centered at 320°. A custom lens was designed to conform to this inferior depression which was well centered, comfortable, and provided better vision than previously obtained.
Case 2 had advanced keratoconus with corneal ring implants and poor fitting scleral lenses, resulting in a recurrent corneal ulcer overlying bulging edge of the right ring implant, and lens intolerance. Scleral topography showed high scleral/conjunctival toricity, but with the steep axis inferiorly (270°) having a SAG 500µ greater than the steep axis superiorly (70°). A custom lens was designed to conform to this irregular scleral shape which had an optimal fit per OCT and slit lamp evaluation, was comfortable, and provided excellent acuity.
Conclusion/Discussion: The novel topography device and innovative software technology accurately mapped both corneal and scleral irregularities, empirically designed the scleral lenses, and accurately predicted the fit and fluorescein patterns. These virtually fit scleral lenses provided both patients with good comfort and vision they did not experience with previous lens designs.
IPoster: OCT Angiography in Central Retinal Vein OcclusionContains 2 Component(s)
OCT Angiography (OCTA) provides an in-vivo, non-invasive visualization of both the retinal and choroidal vasculature including segmentation of all major vascular layers. OCTA allows for valuable insight into the microvascular circulation of various retinal and choroidal disorders allowing for an in-depth analysis of pathological alterations in specific disease states including retinal vascular occlusion (RVO).
Introduction: OCT Angiography (OCTA) provides an in-vivo, non-invasive visualization of both the retinal and choroidal vasculature including segmentation of all major vascular layers. OCTA allows for valuable insight into the microvascular circulation of various retinal and choroidal disorders allowing for an in-depth analysis of pathological alterations in specific disease states including retinal vascular occlusion (RVO).
Case Report: A 58 y/o diabetic, hypertensive male presented with complaints of decreased vision OS x 2months with light sensitivity and pain. He reported a BS of 225 but was unsure of his HBA1C. BCVA OD was 20/20 and 20/200 OS. Anterior segment exam was unremarkable. Fundoscopy revealed widespread hemorrhaging in the posterior pole, vascular tortuosity and macular edema consistent with CRVO OS. OCTA was performed and identified significant vascular changes to the DCP including widespread ischemia and capillary non-perfusion. A disturbance in macular microcirculation can be visualized on OCTA as an enlarged, asymmetric FAZ with irregularity of the surrounding vascular arcades. These findings provide insight into the causative factor behind the visual impairment associated with CRVO.
Discussion: Fluorescein Angiography (FA) has historically been used in the evaluation of RVO as it has identified abnormalities at the level of the superficial capillary plexus including enlargement of the foveal avascular zone (FAZ). However, FA does not provide segmentation into the individual vascular layers and thus is unable to visualize the deep capillary blood supply. OCTA has allowed for precise visualization of abnormalities at the deep capillary plexus (DCP) in RVO.
Conclusion(s): Depth encoded mapping via OCTA of CRVO patients has allowed for enhanced visualization of the microvascular changes occurring at the level of the DCP. These changes are directly correlated with the level of visual impairment suggesting that these changes are functionally relevant.
IPoster: Ocular Microbial Flora in Contact Lens and Non-Contact Lens Wearers – Are They Symptomatic?Contains 2 Component(s)
To evaluate the microbial profile in Contact Lens (CL) wearers and non- Contact Lens wearers and to compare with symptomatic and asymptomatic contact lens wearers.
Purpose: To evaluate the microbial profile in Contact Lens (CL) wearers and non- Contact Lens wearers and to compare with symptomatic and asymptomatic contact lens wearers.
Methods: Contact lens wearers with minimum of one year of soft CL wear and controls with no history of any CL wear were included. Subjects went through preliminary examination followed by a comprehensive battery of clinical tests. At the end of all these test comfort rating using visual analogue scale of vision, comfort, dryness and redness were documented. Conjunctival swab, contact lens sample and lens case sample were collected for microbial assessment.
Results: A total of 24 contact lens wearers and 24 non contact lens wearers were included in the study. There was no growth of organism in conjunctival swab between CL and non-CL wearers, except for 2 subjects in each category with increased number of non pathogenic organism (Staphylococcus epidermidis). A positive growth of non-pathogenic organisms was observed in contact lens of 9 subjects. Pathogenic organisms were predominantly isolated from lens case (11/24 samples) than in CL (8/24 samples). The subjective comfort rating of dryness and the clinical findings of papillary roughness and meibomitis were higher in symptomatic than asymptomatic CL wearers which was found to be statistically significant (p < 0.05). Surprisingly only 5 samples from symptomatic and 9 samples from asymptomatic CL wearers were identified with pathogenic organisms. Pathogenic organisms namely Pseudomonas species and non pathogenic organism Staphylococcus epidermidis were identified in both symptomatic and asymptomatic group. Significant positive correlation (r=0.61, p=0.001) was found between years of lens wear and comfort with lenses and between hours of contact lens wear and with a positive growth of organisms in CL(r=0.44, p=0.02).
Conclusion(s): Both pathogenic and non pathogenic microorganisms were isolated in contact lens and lens case samples of a daily wear soft contact lens users. Both symptomatic and asymptomatic subjects showed presence of pathogenic organisms though only few subjects presented with positive clinical signs.
Rajeswari Mahadevan, PhD, FAAO
Dr. Rajeswari Mahadevan is the head of contact lens clinic at the Medical Research Foundation, Sankara Nethralaya, India. She is also an associate Professor at the Elite school of optometry and SN academy. She has been recently elected as the Asia pacific regional president for IACLE executive board.
She obtained her B.S.Optometry degree, the M.Phil degree in optometry specializing in the subject of contact lens and completed PhD from Elite School Of Optometry, Birla Institute of Technology and Science.
She has presented several scientific presentations in international and national conferences and has 20 peer reviewed publications. She has mentored 10 post graduate students since the year 1999. She is a mentor for 7 post graduate students currently. She has recently authored a book on “Trouble shooting and problem solving in contact lens practice.” She has authored a chapter on “Role of contact lens in different environment” in a book published on occupational optometry. She is the principal investigator for different clinical trials on contact lens at the Vision and Medical Research Foundation.
IPoster: Ocular Surface Imaging to Assess Tear Film Dynamics Associated with Contact Lens WearContains 2 Component(s)
To evaluate the use of ocular surface imaging on pre-corneal tear film (PCTF) and pre-lens tear film (PLTF) dynamics associated with contact lens wear. To quantify changes in the PLTF on contact lens surfaces differing in material composition. To assess possible visual effects of PLTF changes during the course of a 6 hour period using high and low contrast visual acuity.
Purpose: To evaluate the use of ocular surface imaging on pre-corneal tear film (PCTF) and pre-lens tear film (PLTF) dynamics associated with contact lens wear. To quantify changes in the PLTF on contact lens surfaces differing in material composition. To assess possible visual effects of PLTF changes during the course of a 6 hour period using high and low contrast visual acuity.
Methods: 5 clinically normal subjects were fit into 2 contact lens designs, delefilcon A and etafilcon A. Lipid layer thickness measurements of the PCTF were acquired using the Stroboscopic Video Color Microscope prior to lens insertion. The PLTF was assessed 15 minutes after lens insertion, and after 6 hours of lens wear. High and low contrast logMAR acuities were measured at each time interval. Average lipid layer thickness and logMAR acuity were averaged between the right and left eye and compared using paired t-tests.
Results: A trend towards decreased lipid layer thickness was found after 6 hours of contact lens wear when compared to the baseline PCTF, -6.2 ± 7.7 nm (p = 0.14) in delefilcon A and -9.6 ± 13.8 nm (p = 0.19) in etafilcon A. From 15 minutes to 6 hours of contact lens wear, there was an average decrease in lipid layer thickness of -3.0 ± 7.9 nm (p = 0.44) in delefilcon A and -9.2 ± 14.8 nm (p = 0.24) in etafilcon A. After 6 hours in delefilcon A, there was no significant change in high (p = 0.24) or low contrast (p = 0.11) logMAR acuity. After 6 hours in etafilcon A, there was no difference in high contrast acuity (p=0.41), but a significant decrease in low contrast acuity, 0.10 ± 0.6 logMAR (p = 0.02).
Conclusion(s): Ocular surface imaging is useful in assessing tear film dynamics associated with contact lens wear, where quantifiable changes in lipid layer thickness can be identified over the course of a wearing cycle. Low contrast acuity may be a more sensitive marker than high contrast acuity for vision changes associated with PLTF dynamics.
IPoster: Predicting End-of-Day Clearance and Effect of Solution Viscosity in Scleral Lens Wear Over TimeContains 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
IPoster: Scleral Lenses in Current Ophthalmic Practice Evaluation: Patient Demographics, Indications and Lens DesignsContains 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.