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  • The Treatment and Management of Uveitis in Optometric Practice (Credit, 1 Hour, 67693-SD)

    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.

  • The Treatment and Management of Uveitis in Optometric Practice

    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. 

  • IPoster: Dilation or No Dilation for Threshold Visual Field Testing: Optometric Practice Patterns

    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.

  • 2018 Academy Online Package

    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.

  • IPoster: OCT Angiography in Central Retinal Vein Occlusion

    Contains 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: Vision-Related Quality of Life in Keratoconus: Scleral versus Corneal Gas Permeable Lens Correction

    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.

  • IPoster: Variability in Retinal Vessel Density Using Manufacturer Software and Publicly Available Image Processing Software in Optical Coherence Tomography Angiography

    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.

  • IPoster: SD-OCT May Help Differentiate Adult-Onset Fovealmacular Vitelliform Dystrophy from Age-Related Macular Degeneration

    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.

  • IPoster: Scleral Lenses in Current Ophthalmic Practice Evaluation: Patient Demographics, Indications and Lens Designs

    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.