2, Number 1
Here if you are having
problems viewing the newsletter.
This is the fourth edition
of the Optometric Retina Society Electronic Newsletter. We hope that
you have found the previous editions helpful and informative. If it
is your first perusal, welcome to the world of vitreoretinal disorders.
Always feel free to make any comments on the contents and how we can
make it better.
We encourage you to attend the next meeting at the Radisson Hotel in
downtown Boston's theater district. It is a fine hotel in a great area
of Boston with many the theaters and fine restaurants. Come join us
in discovering the new frontiers of retinal vascular diseases and more.
William L. Jones, O.D.
THE DESK OF THE EDITOR
In the November issue of Archives of Ophthalmology,
a severity scale for Age-Related Macular Degeneration is proposed (see
my clinical pearl, below, for details of system). A simplified scale is
also introduced that may be useful clinically to categorize these patients
as well as assign risk of progression to advanced ARMD. I urge everyone
interested in retinal disease and/or macular degeneration to read these
two separate articles. While it remains to be seen if the scale is widely
adopted, it is certainly a move in the right direction to provide a universal
grading system for ARMD that has long been missing.
Also dont forget to attend the ORS Annual Meeting, March 24-26,
2006, in Boston. The details of the meeting, including the conference
schedule and topics, can be viewed at our new and improved website, www.optometricretinasociety.org.
And many thanks to Diana Shechtman for all her hard work to update the
Steven Ferrucci, O.D., F.A.A.O.
Editor in Chief
ANNUAL ORS CONFERENCE
The date of the Third Annual ORS Conference is March 24-26, 2006,
in Historic Boston MA. The theme of this program, Retinal Manifestations
of Vascular and Related Systemic Disease, will focus on vascular
diseases, such as diabetes, and how they affect the retina.
Stay tuned for more information!!
MAKE THE DIAGNOSIS
Answer appears later in newsletter.
Importance of Retinal Vessels
By Joseph Sowka, O.D., F.A.A.O.
Do not ignore the retinal vessels when making diagnoses. Dilated
tortuous retinal vessels are a sign of venous outflow obstruction
and are a hallmark sign of a retinal vein occlusion. Be suspicious
of a diagnosis of central retinal vein occlusion when the retinal
veins are not dilated and tortuous. Dilated non-tortuous retinal
veins are a sign of arterial inflow obstruction and are seen in
ocular ischemic syndrome and blood dyscrasias.
Macular Degeneration Severity Scale
By Steven Ferrucci, O.D., F.A.A.O.
In the November Issue of Archives of Ophthalmology, an Age
Related Macular Degeneration Severity Scale is introduced. The AREDS
Severity Scale is a 9-step sequential scale for photographic grading
that is reported to be easier to use than the original 4-step AREDS
grading system. It scores 3 lesions, drusen area, increased pigment,
and depigmentation, using standardized circles and grids. While
an important research tool, it is perhaps too cumbersome to be used
in the clinical setting.
As such, a 5-step AREDS Simplified Severity Scale is proposed. This
scale scores just the presence of any large drusen or pigmentary
abnormalities in one or both eyes. The presence of 1 or more large
drusen (greater than or equal to 125µm, the typical width of
a retinal vein at the disc margin) and any pigment abnormality is
given a score of 1 in each eye to achieve a total between 0 and
4. Further, if no large drusen are present, intermediate drusen
(greater than or equal to 63µm) in both eyes is given 1 point.
Advanced ARMD in 1 eye at baseline is given a score of 2. This total
score then converts into an approximate 5-year advanced ARMD risk
as follows: no factors, 0.5% risk; a total of 1 factor, 3%
risk: 2 factors, 12% risk; 3 factors, 25% risk and 4 factors,
50% risk. This scale may be more useful clinically, and may
provide convenient risk categories.
The complete articles appear in the November issue of Archives
of Ophthalmology, Arch Ophthalmol. 2005; 123:1484-1498 and 1570-1574.
By Matthew Gaston, O.D., F.A.A.O.
Sudden onset of a large floater in an older patient (over age 55)
should have you thinking of a posterior vitreous detachment (PVD).
The best way to search for this is with a 90 or 78 diopter lens.
Upon examination you seldom see a complete ring, but most often
only a partial C-shaped floater. The reason for this is that the
disc attachment tissue frequently fragments upon separation. However,
the absence of even a partial ring does not rule out a PVD. Therefore,
the best way to determine if the posterior vitreous has truly detached
is to focus on the fundus using the biomicroscope with a bright
slit and a 90 or 78 D lens. If you note a clear area as you move
your focus plane slowly back toward the lens before you get to the
posterior hyaloid interface, you have proof that the vitreous has
separated. Contrary to popular belief, advancing age does not guarantee
For a more complete discussion of posterior vitreous detachments,
I recommend: Ang et al, Posterior Vitreous and Management: Current
Concepts and Management, Comprehensive Ophtalmology Update 6: 167-75,
A. Vine, J. Stader, K. Branham, D. Musch,
A. Swaroop. Biomarkers of Cardiovascular Disease as Risk Factors for Age-Related
Macular Degeneration. Ophthalmology, Volume 112, Issue 12;2076-2080.
Reviewed by Mark T. Dunbar, O.D., Bascom Palmer Eye Institute
The purpose of this study was to measure and contrast 2 biomarkers of
cardiovascular disease, C-reactive protein (CRP) and plasma homocysteine,
in individuals with age-related macular degeneration (AMD) and control
individuals without AMD. Seventy-nine affected individuals and 77 unaffected
individuals from the AMD Genetic Study Group had CRP and homocysteine
levels obtained. Mean CRP levels for affected and unaffected individuals
were 3.42 and 2.30 mg/l, respectively (P = 0.03). Mean homocysteine levels
for affected and unaffected individuals were 11.72 and 8.88 micromol/l,
respectively (P<0.0001). In logistic regression models, older age,
higher CRP, and higher homocysteine were risk factors for AMD. There were
no significant differences between cases and controls in terms of gender,
diabetes, hypertension, use of statin drugs, and smoking. The control
group was significantly younger and had a lower rate of vitamin usage
than the affected group. The study concluded that elevated CRP and homocysteine
levels are associated with AMD and implicate the role of chronic inflammation
Macugen Diabetic Retinopathy Study Group, Changes in Retinal Neovascularization
after Pegaptanib (Macugen) Therapy in Diabetic Individuals. Ophthalmology
Vol.113(1) , January 2006;23-28.
Reviewed by James Fabian, O.D., Bascom Palmer Eye Institute
Individuals with retinal neovascularization were retrospectively analyzed
for progression of neovascularization. 16 non-excluded subjects had retinal
neovascularization at baseline. 62% of Macugen treated eyes vs. 0%
sham showed either regression of neovascularization on photography, regression
or absence of fluorescein leakage from neovascularization at 36 weeks.
In 3 of 8 with regression, neovascularization progressed at week 52 after
cessation of Macugen at week 30. These findings suggest a direct effect
of Macugen upon retinal neovascularization in patients with diabetes mellitus.
Further studies will address if treatment would result in sustained regression,
how long treatment would need to continue, and whether the treatment would
be beneficial or improved when employed in combination with scatter PRP.
This study represents possibly the first report to be published documenting
regression of retinal neovascularization as observed on fundus photographs
and angiograms in diabetic retinopathy after selective VEGF165
Paunescu, L.A., Ko, T. H., Duker, J. S., Chan, A., Drexler, W., Schuman,
J. S, Fujimoto, J. G. Idiopathic Juxtafoveal Retinal Telangiectasis, New
Findings by Ultrahigh-Resolution Optical Coherence Tomography. Ophthalmology
Vol.113(1) Jan. 2006;48-57.
Reviewed by James Fabian, O.D., Bascom Palmer Eye Institute
Ultrahigh-resolution OCT improves visualization of the retinal pathology
associated with IJT and allows identification of new features associated
19 eyes with IJT were imaged with UHR OCT and StratusOCT in a retrospective,
observational, interventional case series. Results identified the following
features of IJT: a lack of correlation between thickening on OCT and leakage
on FA, loss and disruption of the photoreceptor layer, cystlike structures
in the foveola and within internal retinal layers such as the INL or GCL,
a unique ILM draping across the foveola related to an underlying loss
of OPL, intraretinal neovascularization near the fovea, and central intraretinal
deposits and plaques. In 63% of cases, the presence of abnormal vessels
and a discontinuity of the photoreceptor layer correlated with visual
Ozdenir H, Karacorlu S, & Karacorlu M. Optical Coherence Tomography
Findings in Central Retinal Artery Occlusion. Retina 2006; 26(1);110-112.
Reviewed by Noemi Zubizarreta, O.D., Bascom Palmer Eye Institute
Central retinal artery occlusion (CRAO) is a potentially devastating visual
disorder that is usually caused by obstruction of the central retinal
artery (CRA) by an atheroma or emboli. Once a CRAO occurs, the retina
becomes milky white in appearance secondary to intracellular swelling
of the nerve fiber layer. This is especially prominent in the posterior
pole, where the density of ganglion cells and nerve fibers are greatest.
This report was aimed at describing optical coherence tomography (OCT)
findings in a case of a 65 year old male with a CRAO The study found diffuse
thickening of the retina in the perifoveal area. Increased reflectivity
was noted in the inner retinal layers. Decreased reflectivity was noted
from the RPE and photoreceptors secondary to a shadowing effect from the
overlying edematous retinal layers.
Moon S, Kim J, Spaide RF. Optic Pit Maculopathy
without Inner Retinal Schisis Cavity. Retina 2006; 26(1): 113-116.
Reviewed by Noemi Zubizarreta, O.D., Bascom Palmer Eye Institute
Optic pits are congenital anomalies of the optic nerve that can be associated
with serous macular detachment in anywhere from 25-75% of cases. Although
the source of submacular fluid remains unclear, it is thought that the
fluid originates from the vitreous or the cerebrospinal fluid circulation
surrounding the nerve. Lincoff et al had proposed that an optic pit leads
to the formation of a schisis cavity in the retina with fluid secondarily
accumulating and leading to an outer layer detachment in the macular region.
This study reports two cases of optic pit maculopathy without schisis
cavity formation. Instead of a schisis cavity, there was a neurosensory
detachment of the macula in both cases. The study proposes that fluid
may enter the outer retinal stroma and subretinal space concurrently or
sequentially following a pressure gradient. This would explain the submacular
neurosensory detachment without the formation of a schisis cavity between
the inner and outer retinal layers first.
Repka, M.X., Tung, B., Good, W., Shapiro, M., Capone, A., Baker, J.D.,
Barr, C.C., Phelps, D.L., and van Heuven, W.A.J. Outcome of eyes developing
retinal detachment during the early treatment for retinopathy of prematurity
study (ETROP). Arch Ophthalmol. 2006;124:24-30.
Reviewed by Shao Huang O.D., Bascom Palmer Eye Institute
Premature infants weighing less than 1251 grams (approximately 2.75 pounds)
who developed ROP were enrolled in the ETROP. Infants with symmetric,
high-risk, pre-threshold ROP had one eye randomized to early treatment
and the fellow eye to conventional treatment. Infants with asymmetric
disease had the eye with high-risk, pre-threshold ROP randomized to early
treatment or conventional treatment. Retinal detachments were treated
with either vitrectomy, scleral buckle or in combination.
Four hundred and one patients were enrolled, and 89 eyes of 63 patients
developed retinal detachments. The detachments were classified as stage
4A in 30 eyes, stage 4B in 14 eyes, stage 5 in 16 eyes, and not classified
in 18 eyes. Results from the nine-month corrected age follow-up were most
favorable in infants with stage 4A disease who underwent scleral buckle.
Attachment of the macula was noted in sixty percent of eyes status post
scleral buckle, compared to 30% in eyes after vitrectomy with or without
scleral buckle, and 2% in observed eyes. Only 13 or 79 eyes (17%)
had favorable visual acuity outcome with 6 eyes having normal visual acuity.
Among treatment groups, favorable visual outcomes were observed in 8%
of observed eyes, 40% in those with scleral buckle, and 14% in
eyes after vitrectomy with or without scleral buckle. Nine of these 13
eyes had stage 4A detachments before surgery. Surgical results of stage
5 detachments were either no light perception, light perception or bare
detection of low vision card.
The study suggested general poor prognosis for retinal detachments secondary
to ROP. Vitreoretinal surgery maintained macular attachment in 16 of 48
eyes. Some eyes with stage 4A detachment maintained normal acuity after
McGwin, G., Madijarrad, K., Hall T.A., Xie, A., Owsley, C., 3-hydroxy-3-methylglutaryl
conenzyme A reductase inhibitors and the presence of age-related macular
degeneration in the cardiovascular health study. Arch Ophthalmol.
Reviewed by Shao Huang, O.D., Bascom Palmer Eye Institute
This case study from four U.S. communities evaluated the association between
use of statins and AMD prevalence. AMD was defined according to the Wisconsin
age-related maculopathy grading system. Three hundred and ninety cases
of AMD were reported from a total of 2,755 subjects. Three hundred and
sixty cases were judged to be early, while 30 cases showed late AMD disease.
Patients who developed AMD were more likely to be older and Caucasian,
but less likely to be diabetic and have lower LDL. Equal proportion of
cases and controls used either cholesterol-lowering medication or statins.
In fact, after controlling for confounding variables of age, sex, and
race, there was a modest trend toward risk of AMD in statin users.
The study found no association between the use of statins or other cholesterol-lowering
medication to reduced risk of AMD.
Bottoni, F., Massacesi, A., Cigada, M., Viola, F., Musicco, I., and
Straurenghi, G. Treatment of retinal angiomatous proliferation (RAP) in
age-related macular degeneration. Arch Ophthalmol. 2005;123:1644-1650.
Reviewed by Shao Huang, O.D., Bascom Palmer Eye Institute
Eighty-one patients, 54 years or older, with AMD and presenting with a
RAP lesion confirmed by ICG were treated in one of 5 arms. Treatments
included: 1) LASER photocoagulation 2) occlusion of feeder vessels by
LASER 3) grid LASER 4) photodynamic therapy 5) TTT. RAP lesions were also
divided into stage 1) intraretinal neovascularization 2) neovascular extending
into subretinal space 3) communication with choroidal neovascularization.
One hundred and four RAP lesions were identified from 99 eyes. Only stage
one lesions, which were mostly extrafoveal, responded well to photocoagulation
requiring only 1 treatment in 17 months. Mean visual acuity in stage one
lesion was loss of 2.5 lines, loss of 5 lines in stage 2, and loss of
3.3 lines in stage 3. Within each stage, no benefit was found between
the five different treatment arms.
The study concluded that morbidity from RAP lesion could be reduced by
early detection and prompt photocoagulation.
Imaging Polarimetry in Central Serous Chorioretinopathy. Miura MD,
Masahiro, Elsner PhD, Ann, Weber MD, Anke. American Journal of Ophthalmology
Reviewed by Paul Collins, O.D., Bascom Palmer Eye Institute
Central Serous Chorioretinopathy (CSR) is a common disorder that typically
affects middle-aged adults, predominantly male, and is characterized by
serous retinal detachment with leakage at the level of RPE. The serous
detachment resolves spontaneously in most cases. However, the resolution
of the serous detachment is delayed in some, and these patients may develop
permanent visual loss. For such cases, laser photocoagulation at the leakage
point may be recommended if the leakage points are outside the fovea.
Localization of this leakage point has traditionally been done with fluorescein
angiography. This report evaluates the potentiality of other non-invasive
techniques for localizing such a point within the retinas pigment
epithelial layer. It was determined that by using a polarimetry device
such as a GDx-N, a confocal scanning laser ophthalmoscope to take images
saved as 256 x 256 pixels with 8 bits of grayscale, this could be done.
Intensities of the computed polarimetry images varied and were too dark
for subjective evaluation. A Photoshop product was used to adjust the
grayscale for better visualization. Within Photoshop, intensities from
maximum to minimum were converted to a grayscale that ranged from 0 to
250 units. What was found was that in the depolarized light images and
in a non-invasive way, the leakage areas could be clearly visualized as
bright areas in all eyes tested, thus potentially negating the need for
CSR fluorescein in the near future.
Smoking, Alcohol Intake, Estrogen Use, and ARMD in Latinos: The Los
Angeles Latino Eye Study. Fraser-Bell MBBS MHA, Samantha, WU MS, Joanne,
Klein MD MPH, Ronald. American Journal of Ophthalmology, December
Reviewed by Paul Collins, O.D., Bascom Palmer Eye Institute
Previous epidemiologic studies have identified several behavioral or lifestyle
characteristics that may be associated with AMD. Smoking has been the
most consistent of these factors. There have been conflicting reports
that a history of alcohol consumption or a history of estrogen exposure
may also be associated with AMD. This data was derived mostly from studies
of white populations. In this study, LALES, there was cross-sectional
association between a history of smoking (2X greater risk for 5+ pack
years), heavy drinking (>105g/week)*, or beer drinking with AMD. There
was a protective effect of wine drinking and use or history of using oral
contraceptive pills with early AMD lesions. This data emphasizes similar
relationships that are found in Non-Hispanic white individuals and suggest
that common mechanisms exist for the presence of various AMD lesions among
persons of different ethnicities.
*One serving of alcoholic beverage is as follows: 12oz beer = 12.96g,
4oz wine = 11.48g, 1.5oz liquor = 14g ~ Heavy drinking was defined
as consumption of any day of at least 5 standard drinks. Beer drinking
increased odds of developing soft indistinct drusen.
TO "YOU MAKE THE DIAGNOSIS"
This patient in has multifocal choroiditis. Multifocal choroiditis
is a disorder occurring primarily in middle-aged females. Its
presentation is typically bilateral without any racial predilection.
Etiology of this condition is unknown but there are associations
with Epstein-Barr virus, sarcoidosis, syphilis, toxoplasmosis,
Patients typically present with a decrease in visual acuity in
one or both eyes. Ocular findings include chorioretinal lesions
with an overlying vitritis. These lesions range in size from 50
- 350um and number from several to several hundred aligned in
streaks or linear clusters. Fresh lesions appear yellow to gray
in color, while older lesions appear atrophic and punched-out.
While the vitritis occurs in all patients, only 50% of patients
will have an anterior uveitis. The anterior cellular reaction
may range from 1+ to 3+ and the amount of keratic precipitates
may range from non-granulomatous to granulomatous.
Other findings include peripapillary atrophy, mild disc edema/enlarged
blind spot, macular or peripapillary choroidal neovascular membranes,
cystoid macular edema, and subretinal fibrosis.
Additional tests would include Amsler grid, fluorescein angiography
and/or indocyanine green angiography if any choroidal neovascular
membrane is suspected or cystoid macular edema is present and
Differential diagnosis includes presumed ocular histoplasmosis
syndrome (POHS), birdshot choroidopathy, acute posterior multifocal
placoid pigment epitheliopathy (APMPPE), serpiginous choroiditis,
multiple evanescent white dot syndrome (MEWDS), diffuse unilateral
subacute neuroretinitis (DUSN), sarcoidosis, Vogt-Koyanagi-Harada
syndrome, sympathetic uveitis, punctate outer retinal toxoplasmosis,
punctate inner choroidopathy (PIC) and myopic degeneration.
Treatment occurs on several levels, and is geared toward managing
the ensuing inflammation. Systemic corticosteroids are used to
reduce vitritis, edema and macular detachment during the active
stages. Topical corticosteroid may also be needed to control and
mitigate the anterior segment inflammation. Further, periocular
corticosteroid injections to reduce anterior segment uveitis,
vitritis, macular detachment, and edema may be warranted. Lastly,
laser photocoagulation may be necessary to treat any associated
choroidal neovascular membranes (CNVM). Ironically, laser photocoagulation
of CNVM may cause an increase in choroidal inflammation, which
in turn may initiate the growth of new CNVM.
Andrew Gurwood, OD, FAAO
ORS Founding Fellow
In a second phase
3 trial, 95% of patients taking Lucentis (ranibizumab, Novartis/Genentech)
for the treatment of wet age-related macular degeneration either
maintained or improved vision for 1 year, according to the drugs
developers. The ANCHOR (Anti-VEGF Antibody for the Treatment of
Predominantly Classic Choroidal Neovascularization in AMD) study
is a phase 3, randomized, multi-center, double-masked, active-treatment
controlled trial comparing two doses of Lucentis to photodynamic
therapy in patients with predominantly classic wet AMD.
One-year results of the 2-year study show that 94% of patients
treated with 0.3 mg and 96% of patients treated with Lucentis
0.5 mg maintained vision or improved vision. In comparison, 64%
of those treated with Visudyne (verteporfin for injection, Novartis/QLT)
in the trial maintained or improved vision at 1 year. Study data
will continue to be analyzed through a second year, according
to a press release from Novartis.
macular degeneration was found to be common in a study in a U.S.
Hispanic population, but the prevalence of late AMD in that population
was lower than estimates for white people in the United States.
This finding from Proyecto VER (Vision and Eye Research), a population-based
study of blindness and visual impairment in Hispanic people in
Arizona, is published in the November issue of Archives of
Ophthalmology. The overall prevalence of late AMD was 0.5%.
The prevalence of late AMD was associated with age; 0.1% of
participants in the 50- to 59-year age range had late AMD, increasing
to 4.3% in those aged 80 years and older. Early AMD was also
strongly associated with age. Twenty percent of patients in the
50- to 59-year age range had early AMD, and 54% of those aged
80 years and older.
verteporfin photodynamic therapy at 2-month intervals did not
show a significant benefit at 1 year compared with re-treatment
every 3 months in patients with age-related macular degeneration,
a study published in the December issue of Ophthalmology
Stephan Michels, MD, and colleagues conducted the prospective,
randomized, multi-center clinical study, including 203 patients
with predominantly classic choroidal neovascularization (CNV)
secondary to AMD, to determine the value of early re-treatment
with verteporfin PDT.
Baseline mean visual acuity was 20/100 -1 for both groups. Mean
visual acuity was better in the early re-treatment group at all
follow-up points, but the difference did not reach statistical
significance. The re-treatment group trended toward better outcomes,
with 61% losing less than three lines of vision at 12 months
compared with 51.7% of the standard re-treatment group.
Juxtafoveal or subfoveal
idiopathic choroidal neovascularization responds significantly
better to combined photodynamic therapy and systemic steroid treatment
than to PDT alone, according to a study by Alfonso Giovannini,
MD, of Ancona University, Italy. In addition, steroids alone should
be used in specific forms of extrafoveal lesion.
In a group of 20 patients with juxtafoveal or subfoveal lesions,
the results of PDT alone and PDT plus systemic steroid treatment
were compared. The mean age of patients was 29 years, ranging
from 10 to 44 years. The median follow-up was 23 months.
Visual acuity after PDT alone was improved in only one patient,
was stable in five and decreased in four cases. Lesion size was
stable in four patients, reduced in two and increased in four
cases, according to the study. In the group that was treated with
a combination of PDT and systemic steroids, visual acuity was
stable in five cases, improved in four cases and decreased in
only one case. The CNV lesion size increased in one patient, while
it was stable in four cases and reduced in five cases, according
to the study.
is affected by genetics, a recent study in twins suggests. The
differences in macular thickness between older, healthy identical
and nonidentical twins "suggest an inherited basis of macular
thickness," according to the study published in the January
issue of Investigative Ophthalmology & Visual Science.
Matthew D. Chamberlain and colleagues at the Centre for Eye Research
Australia performed a classic twin study to compare the correlation
of macular thickness between monozygotic and dizygotic twins.
They analyzed data from 109 white twin pairs who ranged in age
from 50 to 80 years old and had no evidence of ocular disease.
The correlation of retinal thickness was significantly greater
between the identical twins than the fraternal twins in all macular
regions. After adjusting for significant covariates and model
fitting, there was a final heritability estimate of 85% in
the foveal region, 81% in the inner macular region and 81%
in the outer macular region, the authors said. They also found
a significant negative correlation between outer macular thickness
and axial length.
Two drugs for the
treatment of type 2 diabetes have been reported to be associated
with rare instances of macular edema, according to a letter from
GlaxoSmithKline to physicians issued late last week. GlaxoSmithKline
markets the drugs Avandia and Avandamet, both containing rosiglitazone,
for the treatment of type 2 diabetes.
According to a Reuters news report, a Glaxo spokeswoman said the
incidence of macular edema associated with these drugs was "extremely
rare, affecting fewer than one in 10,000 patients" taking
the drugs. To date, more than 6 million patients worldwide have
taken either Avandia or Avandamet, according to the letter Glaxo
sent to health care providers discussing the side effects.
"In the majority of these cases, the patients also reported
concurrent peripheral edema," the letter said. "In some
cases, the macular edema resolved or improved following discontinuation
of therapy and in one case, macular edema resolved after dose
In each issue, a Fellow
of the Optometric Retinal Society will be highlighted. In this issue,
Dr. Rex Ballinger, Secretary and one of the Founding Fellows
of the Optometric Retinal Society will be highlighted.
Following graduation from the Pennsylvania college of Optometry, Dr.
Ballinger completed a residency at the Veterans Administration Medical
Center in Baltimore, Maryland. Upon completion of his residency, Dr.
Ballinger then stayed at the VA in Baltimore.
Dr. Ballinger is a frequent publisher and lecturer both nationally and
internationally on ocular disease with an interest in retina. Dr. Ballinger
was a clinical investigator with the National Institutes of Health,
National Eye Institute (NIH/NEI) Age-related Eye Disease Study (AREDS).
He is currently involved in the NIH/ NEI Action to Control Cardiovascular
Risks in Diabetes (ACCORD) study. He also serves on the National Board
of Examiners in Optometry Clinical Skills Committee and Part III Examination
Council. He also serves as a journal reviewer for several optometric
journals. In addition, Dr. Ballinger has also been or is currently involved
in research in Low Vision and Glaucoma. He is currently Secretary the
Optometric Retinal Society, as well as one of the Founding Fellows.
Dr. Ballinger resides in Baltimore, Maryland.
BECOME AN ORS MEMBER?
By Rex Ballinger, O.D., F.A.A.O.
Chair, Membership Committee
Membership in the Society can provide several benefits. You may
receive discounts at annual meetings. Youll receive regular
newsletters on new and exciting updates on retinal disease diagnosis
and management as well as other newsy items of interest. And youll
be associated with a body of knowledge and resources which can
help you in many other ways. So consider membership in the Society.
It will be worth your while in your quest for better understanding
of the retina.
If your interests extend beyond the general, if you want to become
part of the dynamic team involved in the Society to share your
interest and enthusiasm with your colleagues, consider becoming
a Fellow member. Details and applications can be found at www.optometricretinasociety.org
- ICaps L&Z and AREDS for Ocular Health
Lutein & Zeaxanthin Eye Vitamin and Mineral Supplement is formulated
for people at risk of age-related eye conditions. This formula contains
all the high-potency antioxidants and zinc important to eye health,
plus the added benefit of lutein and zeaxanthin, the primary carotenoids
found in the retina and lens of the eye.
AREDS Eye Vitamin and Mineral Supplement formula matches the combination
of vitamins and minerals established by the AREDS trial as effective
in delaying the progression of AMD.
For more information, go to www.icapsvitamins.com
- Retinal Examination and Documentation
Retinal examination and documentation couldnt be easier and more
complete using ExamWRITER electronic health record. Finally, retinal
documentation, including specialized retinal imaging procedures such
as the Optomap Retinal Exam, and Visual Field testing like the Zeiss
Meditec HFA II i are both captured, stored and reviewed from within
the electronic patient chart via ExamWRITERs seamless instrument
Designed exclusively as an eyecare medical program by eyecare professionals,
ExamWRITER integrates with OfficeMate software and enables doctors and
staff to fully document patients charts with effortless speed
by utilizing standardized controls and customizable templates that follow
the SOAP protocol.
ExamWRITER electronic health records brings a new level of efficiency
and accuracy into your practice by giving you the ability to create,
edit, store, and access complete and comprehensive patient exam records.
For additional information contact us at 800.269.3666 or visit our website
- Multi-Center Study Concludes Optomap and BIO When Used in Tandem Provides
Improved Detection of Retinal Disorders
The results of an Optos sponsored study conducted at the University
of Houston, UC, Berkeley and Pennsylvania College of Optometry were
presented at the 2005 Association for Research in Vision and Ophthalmology
Both Standard (subject looking straight ahead) and Steered (subject
looking 15 degrees eccentrically at 12, 3, 6 and 9 oclock positions)
Optomap Retinal Exams compare favorably with the BIO in detecting clinically
important abnormalities posterior to the equator. Both Optomap Standard
and BIO examination of the entire retina failed to detect a small but
significant percentage of findings compared to the referee gold standard
(when discrepancies between exams were noted, a referee examiner, performed
BIO and re-evaluated the Optomap Images). Given that the types of findings
missed were different between techniques, it is suggested that the combination
of Optomap with BIO provides improved detection of retinal abnormalities.
For more information, go to www.optos.com.
Gonio Lenses Facilitate Diagnosis and Treatment
Volk G Series 4 mirror Gonio lenses deliver the brightest, crispest
and clearest images attainable of anterior chamber structures. We continue
to provide leading edge lens technology:
All glass design provides imaging of the highest clarity
No fluid (nf) design
eliminates the need for viscous interface solutions facilitating
Large or small
hand held ring
2-in-1 handle for a straight or 45° angled handle design
Goniolaser lens with an optional flanged design provides a stable platform during laser treatment or diagnosis
Call Volk for a 30 day risk-free trial : 800
345 8655 (toll free), 440 942 6161 or visit us online at www.Volk.com.
- A Breakthrough in Early Detection of Wet AMD
The PreView PHP is a new perimeter used to detect recent-onset neovascular
(wet) AMD, and differentiate it from the intermediate (dry)
stage of the disease, often before signs or symptoms are noticed by
the patient or the doctor. Validated in multi-center clinical studies,
this new technology will allow earlier detection of the advanced, blinding
form of AMD, allowing treatment before the patient has suffered irreversible
For more information, go to www.meditec.zeiss.com.
Steven Ferrucci, OD, FAAO
Mark T. Dunbar, OD, FAAO
Paul Collins, OD
James Fabian, OD
Jeffrey S. Huang, OD
Noemi Zubizarreta, OD
paid, promotional message was sent to you by Jobson Professional
Publications Group. The content does not necessarily reflect the
views, or imply endorsement, of the Group's editors or publisher.
If you do not want to receive this type of information in the future,
simply reply to this message with the words "Unsubscribe Mailings"
in the subject header. Jobson Professional Publications never releases
its e-mail list.