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Volume
4, Number 1 |
February
2008 |
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FROM
THE DESK OF THE EDITOR
Recently, we at the ORS elected a new president, Dr. Jerry Sherman. While this is an exciting time for the ORS as we welcome a new leader with new ideas and directions, it is also a time to reflect upon what we have done, and give thanks to out founding president, Dr. Bill Jones. Bill have served as the president of the ORS since its e-inception, in May of 2005.
A few years ago, a handful of prominent optometrists came up with the idea of starting the optometric Retina Society. (Unfortunately, I was not one of them, or I would have named it the Optometric Retinal Society. But that is a discussion for another time. ) Their vision was to educate the primary care optometrist in the field of vitreo-retinal disorders and honestly it could not have come at a better time. Since then there have been many notable breakthroughs in the treatment of retinal disease, most significantly the use of anti-VEGF agents in the treatment of macular degeneration.
Now for the first time we can talk about not just slowing down the visual loss in our patients with ARMD, but actually restoring vision in some patients. There have also been great strides in the area of OCTs and other instruments that allow us to view the retina as well as vitreous in never before imagined ways. While I am not quite egotistic enough to feel that we have had any part in the discovery of these devices and treatments, I believe we have been instrumental in educating other optometrists about this information and technology, and how to use it in their practices and how to better serve their patients by prompt referrals to retinal specialists. We have had 4 excellent annual meetings, with about 1000 attendees in total, a testament to the educational desire among optometrists.
Again, many thanks to Bill Jones, our first and founding president. Without him, the ORS would not be where it is today, or have the framework to go where it will in the years ahead. And a personal thanks to Bill for inviting me into the group, and making we feel welcome from day one. You just should have asked me earlier so I could have switched the name....
Steven Ferrucci, O.D., F.A.A.O.
Editor in Chief
NOVEMBER 2007
POLL RESULTS
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PRESIDENT'S MESSAGE
As a student at PCO four decades ago, I viewed a living fundus in a real patient for the first time. I was fascinated with what I saw then and I still am. But knowledge of retinal disorders, diagnostic procedures and treatment modalities have changed remarkably over these 40 years. I distinctly remember Dr. JC, a clinical faculty instructor at PCO, scolding me one day: Sherman, stop wasting so much damn time trying to see the back of the eye; whatever you see, you can’t treat anyway! In contrast,my present students at SUNY are actually requesting more time in the posterior segment course because of all the new material, including numerous treatment strategies, to be mastered. I also recall one of the first ophthalmologists I worked with who concluded after I mentioned that patient X has a hemorrhage in the fundus. He said, “If the patient does not have diabetes and does not have hypertension, then the patient does not have a retinal hemorrhage and just forget it!” Now, my third yearstudents could easily list several dozen retinal disorders associated with hemorrhages.
Remarkably, I am now using diagnostic procedures such as the newest version of the Optos system for panoramic viewing capable of detecting abnormalities that I miss with standard BIO , PHP for early detection of wet macula degeneration, spectral OCTs with remarkable ability to detect and analyze lesions with 6 micron resolution and mf ERGs that can document subtle retinal functional abnormalities even in patients with normal VA and normal fields. Four decades ago, I did not even dream that such diagnostic procedures would ever be available. Similarly, who amongst us would have predicted the miracle anti-VEGF meds that can actually improve vision in wet macular degeneration and, as we are learning, in myriad other retinal disorders?
Over the past decade or two, the vast majority of practicing optometrists have acquired the knowledge, skill and experience in diagnosing and treating external ocular disorders as well as glaucoma. But some optometrists are still are not superb diagnosticians when it comes to retina- but of course, the same can be said about the general ophthalmologist.
Both groups can learn from the many remarkable retinal specialists who are nearly always willing to share their knowledge, experience and recommendations so as to benefit the patient. Some optometrists with a particular interest in the retina have joined the Optometric Retina Society and the members certainly hope that the organization will increase in size, scope and impact upon optometry. Many of us in the ORS believe that the retina is optometry’s next frontier and we hope that you join us in our journey!
Jerry Sherman, O.D.
President
YOU
MAKE THE DIAGNOSIS
Answer appears later in newsletter.
CLINICAL
PEARLS
Retinal Hemorrhages
By Diana Shechtman, O.D., F.A.A.O.
ORS Fellow
Retinal hemorrhages are not disease entities, they represent
manifestations of ocular or systemic disease. For example,
dot-and-blot hemorrhages are found deep in the intra-retinal layers
and are most often associated with venous stasis disease, like vein
occlusions. Conversely, flame shaped hemorrhages which are arterial
based are more commonly associated with diseases like hypertension.
Classifying the type of hemorrhage based on appearance and retinal
location can aid in determining the underlying pathology and the
appropriate management.
Cotton Wool Spots
By Joe Sowka, O.D., F.A.A.O.
ORS Founding Fellow
Cotton wool spots occur commonly in patient with hypertension.
However, in order for a cotton wool spot to develop, the diastolic
pressure needs to be approximately 105. Thus, cotton wool spots
occurring in controlled hypertensive cases are likely due to
another cause unless the patient has labile hypertension or is
not truly controlled and compliant with medications.
Demarcation lines
By Matt Garston, O.D., F.A.A.O.
ORS Founding Fellow
Demarcation lines are formed by the RPE when some
retinal detachment occurs. The RPE needs to be liberated
in sufficient amounts to form at the edge of the detached
area. Not all detachments liberate enough pigment to form
these lines. A retinoschisis, as it classically only splits
the retina and spares the RPE, does not liberate any RPE
and thus no demarcation line is seen at its border.
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JOURNAL
ABSTRACTS
Improved Vision-Related Function After Ranibizumab Treatment of Neovascular Age-Related Macular Degeneration.
Results of a Randomized Clinical Trial
The purpose of the MARINA study was to examine the effects of Lucentis (Ranibizumab) in patients with neovascular age-related macular degeneration (AMD). This double-masked clinical trial consisted of 716 patients with minimally classic or occult choroidal neovascular membranes with recent disease progression. The 12 month and 24 month follow-up results showed improvements on the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ-25) in patients treated with Lucentis. The sham-injected patients were found to have a progressive decline in vision. Results indicate that treatment with Lucentis in patients with neovascular ARMD can improve patient-reported visual function compared to treatments with sham injections.
Chang, T., Bressler, N., Fine, J. et al. Arch Ophthalmol 2007; 125(11):1460-1469.
Intravitreal Bevacizumab vs Verteporfin Photodynamic Therapy for Neovascular Age-Related Macular Degeneration.
In this randomized prospective clinical trial, 62 patients with predominantly classic choroidal neovascularization secondary to age-related macular degeneration were treated with standard PDT (n = 30) or 2.5 mg intravitreal Avastin (Bevacizumab) injections (n = 32). At the 3 and 6 month follow-ups, the mean central retinal thickness was significantly less in the bevacizumab group compared to those who received PDT. Although the best corrected visual acuity (BCVA) and greatest linear dimension were not significantly different between the 2 groups at the 3 month follow-up, both variables were significantly better in the bevacizumab group at the final 6 month follow-up. Results indicate that intravitreal Avastin is superior to PDT in controlling predominantly classic CNV in age-related macular degeneration.
Bashshur, Z., Schakal, A., Hamam, N. et al. Arch Ophthalmol. 2007; 125:1357-1361.
Changes of Intraocular Pressure after Intravitreal Injection of Bevacizumab (Avastin).
The purpose of this study was to determine the changes and need to monitor intraocular pressure (IOP) following an injection of bevacizumab (Avastin). Seventy patients (122 injections) underwent an intravitreal injection of Avastin for age-related macular degeneration treatment. Twenty-nine eyes were evaluated for baseline IOP changes following multiple injections. The baseline IOP measurements taken prior to injection had a mean IOP of 15 +/- 3.42 mmHg. Postinjection 3 minutes the IOP had risen to a mean 36.27 +/- 5.1 mmHg and decreased to 24.56 +/- 5.9mm Hg at 10 minutes. All eyes were below 30 mmHg at 15 minutes and no significant change between multiple baseline IOP measurements was detected. There was no IOP change after multiple injections. In conclusion, Avastin injections caused a predictable probably volume-related rise in IOP which never occluded the central retinal artery and which all fell to below 30 mmHg within 15 minutes. Evidence from this study is a strong safety profile, which provides guidelines on monitoring IOP post intraocular Avastin injections.
Cheng, L., Falkenstein, I. A., Freeman, W.R. Retina 2007; 27(8): 1055-1047.
Intravitreal Bevacizumab Injections for Treatment of Central Retinal Vein Occlusion: Six-Month Results of a Prospective Trial.
In this prospective study, the authors set out to evaluate the effect of intravitreal bevacizumab (Avastin) injections on visual acuity and foveal thickness in central retinal vein occlusion (CRVO). Forty-six patients with macular edema secondary to a CRVO were treated. The duration of symptoms prior to treatment ranged from 1 week to 150 weeks including 30 nonischemic CRVOs (NICRVO) and 16 ischemic (ICRVO> 30 disk diameters of retinal capillary nonperfusion based on fluoroscein angiography). In ICRVO, 14 eyes (88%) had baseline visual acuity of worse than 20/200, and only 2 had visual acuity of 20/200 to 20/50 (12%). In NICRVO, 10 eyes (33%) had visual acuity of worse than 20/200, 19 (63%) had visual acuity of 20/200 to 20/50, and 1 (3%) had visual acuity of better than 20/50. At the 6-month follow-up in ICRVO, 7 eyes (44%) had visual acuity of worse than 20/200, 9 (56%) had visual acuity of 20/200 to 20/50, and none had visual acuity of greater than 20/50. In NICRVO, 3 eyes (10%) had visual acuity of less than 20/200, 14 (47%) had visual acuity of 20/200 to 20/50, and 13 (43%) had visual acuity of better than 20/50. In conclusion, ICRVO was associated with significantly lower visual acuity than NICRVO (P < 0.001). However, visual acuity gain was similar in both groups. Independent of duration of symptoms, CRVO was associated with a similar gain in visual acuity. Furthermore, mean central retinal thickness +/-SD decreased from 535 +/- 148 [mu]m at baseline to 323 +/- 116 [mu]m at the 6-month in both ICRVO and NICRVO. Intravitreal injection of Avastin provides a new viable option for patients with macular edema secondary to CRVO.
Alge, C.S., Haritoglou, C., Hofer, A., (et. al.). Retina 2007; 27 (8): 1004-1012.
The Natural History of Pigment Epithelial Detachment associated with Central Serous Chorioretinopathy.
This retrospective study’s purpose was to determine the visual outcome of retinal pigment epithelial detachment (PED) associated with central serous chorioretinopathy (CSC), to further characterize the natural history of these lesions, and to provide a review of previous reports. 340 consecutive cases of CSC with angiographic evidence of PED were reviewed. Age, sex, use of corticosteroid medications, presenting visual acuity, and final visual acuity were recorded. Lesion characteristics including location, number of lesions, and laterality were recorded. Clinical outcome measures included resolution or persistence of the PED, progression to retinal pigmentary atrophy, or development of choroidal neovascularization. Fluorescein angiograms were obtained if available. Thirty-four (9%) of 319 patients with angiographic evidence of CSC were diagnosed with PED over a mean follow-up of 49 months, most of whom were males (68%). Mean initial visual acuity was 20/32 (range, 20/13 to 20/400). PEDs were commonly unilateral (88%), unifocal (76%), and extrafoveal (82%). Overall mean final visual acuity was 20/25 (range, 20/13 to 20/250) for all patients. Mean visual acuity for the group of patients with subfoveal PED (18%) was 20/50 (range, 20/25 to 20/250). Complete resolution of the PED occurred in 65% of patients, with resultant mean visual acuity of 20/25 (range, 20/13 to 20/250). In this group, localized retinal pigment epithelial atrophy developed in 86%, with mean final visual acuity of 20/25 (range, 20/13 to 20/250). Persistent PED was observed in 35% of patients, resulting in mean visual acuity of 20/25. There were no cases of choroidal neovascularization. In conclusion, CSC with associated retinal PED may be seen and generally has a good visual prognosis. Most PED’s resolve and result in retinal pigment epithelial atrophy.
Ai, E., Goff, M.J., Fu, A.D., (et. al.). Retina 2007; 27(9): 1168-1173.
Anterior Ischemic Optic Neuropathy in Patients Younger than 50 Years.
In this retrospective analysis of 727 patients with AION, 23% were younger than the typical affected age group of 55+, and 93% of these were Caucasian. Women had their first onset of AION significantly younger than men. Associated risk factors for younger patients included at least one concurrent or preexisting cardiovascular risk factor in 74%, including hypertension, diabetes, hypercholesterolemia, obesity, and cigarette use. Anemia was the only statistically significant association in bilaterality. 82% of young AION patients had “discs at risk” as defined as small, crowded, or drusenoid, and 26% of these were found independent of systemic risks. The study also indicated possible higher risk of fellow eye involvement than older AION patients, but better visual outcomes, with 73% with VA better than 20/64 and only 18% less than 20/200. Although AION typically occurs in the elderly, this study reveals 23% in those aged less than 50, highlighting its higher occurrence than one may predict.
Preechawat, Pisit, Bruce, Beau B. et al. Am J Ophthalmol December 2007; 144(6): 953-960.
The Predictive Value of Patient and Eye Characteristics on the Course of Subclinical Diabetic Macular Edema.
A retrospective case series of 153 patients with subclinical DME were followed for a median of 14 months to determine if OCT analysis and clinical observation could predict progression to the treatment-indicative classification of "clinically significant" as defined by the Early Treatment Diabetic Retinopathy Study (ETDRS). Subclinical DME is defined as that edema found clinically but does not meet CSME criterion, as well as, edema not detected clinically but detected on OCT. Thus, determination of factors predictable of reaching treatable levels and the frequency of following these subclinical patients is of interest. In this series, many eyes spontaneously improved from subclinical levels before reaching those of clinically significant. Follow-up of four to six months was effective in detecting clinical progression, usually slowly, in 31.4%, and OCT was not predictive of this process.
Browning, David J, Fraser, Christina M. Am J Ophthalmol January 2008; 145(1):159-154.
Prevalence and Associations of Asymptomatic Retinal Emboli in Latinos: The Los Angeles Latino Eye Study (LALES).
A population based study of 5,959 participants, aged 40+, was conducted to determine independent risk factors associated with asymptomatic retinol emboli in this demographic. Previous studies such as the Blue Mountains Eye Study and Beaver Dam Eye Study associated hypertension, smoking, vascular disease, age and diabetes with asymptomatic retinal emboli in non-Hispanic whites. LALES found a prevalence of 0.4% and indicated smoking > five pack years and history of coronary artery disease and/or myocardial infarction, and higher systolic blood pressure to be statistically significant associations in the Latino cohort. The lower prevalence in this cohort compared to BMES and BDES was associated with higher smoking use in the earlier groups. With the Latino cohort as America’s fastest growing population, it is vital to advise those patients found with asymptomatic retinal emboli to see a primary care physiciant and advise smoking cessation when applicable.
Hoki, Susan, Varma, Rohit, et al. Am J Ophthalmol January 2008; 145(1):143-148.
Peripapillary Changes Detected by Optical Coherence Tomography in Eyes with High Myopia.
127 eyes with high (>=-8.00 D) myopia were evaluated using Optical Coherence Tomography to investigate the morphologic alterations around the optic disc in highly myopic eyes. In addition, 46 emmetropic eyes and 40 eyes with low myopia were examined as controls. Peripapillary detachment in eyes with pathologic myopia (PDPM) was detected in 11% of highly myopic eyes and was more likely associated with a visual field defect than eyes without a PDPM. Microfolds in the retinal vessels were detected at the conus edge along with retinoschisis, and occasionally a foveoschisis were found in the highly myopic eyes. None of these changes (PDPM, microfolds, and retinoschisis) were detected in controls. These changes might be related to the visually disabling complications, such as visual field loss and myopic foveoschisis, seen in highly myopic eyes.
Noriaki S. MD, Kyoko Ohno-Matsui MD, Akinobu N. MD, et.al. Ophthalmology 2007;114:2070-2076.
Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment a Prospective Randomized Multicenter Clinical Study.
A prospective randomized clinical trial separated into phakic or aphakic/pseudophakic eyes was done to compare scleral buckling surgery (SB) and primary pars plana vitrectomy (PPV) in rhegmatogenous retinal detachments of medium complexity. The results looked at were; change in best-corrected visual acuity (BCVA), primary and final anatomical success, proliferative vitreoretinopathy, cataract progression, and number of reoperations. The study shows a benefit of SB in phakic eyes with respect to BCVA improvement with cataract progression being greater in the PPV group. In the pseudophakic group, the primary anatomical success rate was significantly better in the PPV group 72% vs. 53% in the SB group, and the mean number of retina-affecting secondary surgeries was lower in the PPV group. Redetachment rates were about equal in the phakic trial and were higher for scleral buckels in the pseudophakic trial. No difference in BCVA was demonstrated in the pseudophakic trial.
Heinrich H. MD, Karl Ulrich Bartz-Schmidt MD, Norbert Bornfeld MD, et.al. Ophthalmology, 2007;114:2142-2154.
Is It Worth Reoperating on Macular Holes.
A retrospective case series to evaluate the visual outcome after a second surgical attempt to close idiopathic full-thickness macular holes (FTMH) in patients who underwent unsuccessful primary surgery and in patients with reopened FTMHs. Out of 532 patients who underwent surgery for FTMH in St. Paul’s Eye Unit, Liverpool, United Kingdom, between March, 1995, and March, 2005; 51 had unclosed FTMHs and 21 patients had reopened FTMHs after initially successful surgery. These patients underwent a second surgical attempt to close the macular hole. It was found that reoperating on reopened FTMH resulted in 100% anatomic closure and significant improvement in vision. In contrast, reoperating on patients with initially unsuccessful surgery resulted in a lower anatomic closure rate and relatively poor final vision even if their macular holes were closed successfully.
Xavier Valldeperas MD, FEBO and David Wong FRCS, FRCOphth
Ophthalmology, 2008;115:158-163
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ANSWER
TO "YOU MAKE THE DIAGNOSIS"
This lesion represents Coats' disease. Coast disease, first described by George Coats in 1908, is a unilateral, idiopathic retinal vascular abnormality. It is characterized by telangiectatic retinal vascular abnormalities with lipid exudation. Clinically it appears as retinal edema, with intra- and sub-retinal exudation. The severity can vary, from asymptomatic patches of telangiectatic vessels to total exudative retinal detachment.
Coats' disease is idiopathic, and often asymptomatic, with as many as one quarter of cases discovered in asymptomatic patients on routine exam. It is typically diagnosed before age 20, with the peak incidence around 10 years old. It occurs predominately in males (85%) and is almost always unilateral. Infants with Coats ' disease may present with strabismus, leukocoria, or a red and painful eye from neovascular glaucoma.
The diagnosis of Coats' is typically made on funduscopic appearance alone. Fluorescein angiography may be helpful however in detecting retinal vascular abnormalities, with characteristic "light bulb" aneurysmal dilation apparent, with or without capillary non-perfusion.
The prognosis for Coats' is somewhat guarded. Laser photocoagulation or cryoretinopexy to the abnormal blood vessels is advised, to prevent further exudation and exudative detachment. If a retinal detachment occurs, scleral buckling procedures are recommended. Without treatment, many cases progress to exudative retinal detachment, secondary cataract, rubeosis iridis, uveitis, secondary glaucoma and eventually phthis bulbi.
The asymptomatic nature of Coats' disease highlights the importance of routine dilation, even in younger patients.
Steven Ferrucci, O.D., F.A.A.O.
ORS Fellow
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OPTOMETRIC RETINA SOCIETY ANNUAL MEETING
The Optometric Retina Society is back in Boston in 2008 and we hope you can join us September 5, 6 and 7 for our annual meeting. This year's program features Contemporary Topics in Retina will offer 16 hours of quality education by leading experts in the area of retina and retinal disease. As is the tradition of the ORS, we have placed emphasis on excellence in education and we are offering an array of courses that will challenge the each attendee. The 3 day program will provide updated information on current trends in retina, and will address new technology, emerging concepts in diagnosis, and novel treatment strategies. The program offers many exciting educational opportunities and September is a great time to visit Boston.
Anthony Cavallerano, O.D., F.A.A.O.
ORS Founding Fellow and Education Chair
IN THE
NEWS
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Genentech, AAO, ASRS reach agreement on physician access to bevacizumab
Genentech, the American Academy of Ophthalmology and the American Society of Retina Specialists have agreed on a protocol that will allow bevacizumab to continue being supplied to physicians after the company ceases directly supplying the drug to compounding pharmacies, the company and the organizations announced.
Physicians will be able to obtain Avastin (bevacizumab) for their patients by purchasing the drug directly from an authorized wholesale distributor. The distributor can then ship the drug to the destination of the physician's choice, including hospital pharmacies, compounding pharmacies and the physician's office, according to a press release.
The AAO and the ASRS recognize that implementation of the new process for physician access to bevacizumab may vary, depending on individual state laws. Both organizations recommend that physicians consult with legal advisers before pursuing this option, the AAO said.
Genentech announced in October that it would cease to distribute bevacizumab to compounding pharmacies as of Nov. 30. The cessation date was then postponed to Jan. 1.
Physicians often prescribe bevacizumab off-label for treating age-related macular degeneration, although Lucentis (ranibizumab, Genentech) is specifically indicated and approved for the disease.
"Genentech continues to believe Lucentis is the most appropriate treatment for patients with wet age-related macular degeneration because it was specifically designed, formally studied, approved by the U.S. Food and Drug Administration and manufactured for intraocular delivery for the treatment of wet AMD," Genentech said in its release.
Genentech will continue to work with the AAO and the ASRS on ways to facilitate patient access and physician reimbursement for ranibizumab, the company said.
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Rapid rise in the use of intravitreal injections reported
Intravitreal injections increased exponentially in 2006, becoming the fastest growing procedure in ophthalmology, according to Kevin J. Corcoran, COE, CPC, FNAO.
Mr. Corcoran presented CMS data from 2006 showing intravitreal injections ranked third among ophthalmic procedures. He said it underwent "exponential growth" over the course of 5 years, making it the fastest growing procedure in all of Medicare.
Cataract surgery with IOL implantation still ranked No. 1 with YAG capsulotomy coming in second, but intravitreal injections grew by 111% in 1 year, outpacing all other procedures, he said. Most of the other procedures that increased were lacrimal procedures, he said. Complex cataract surgery also increased 25%, he said.
The CMS data showed that, in 2006, there were more than 500,000 procedures performed in the United States through Medicare. Out of every 100 eye exams performed there were 2.4 intravitreal injections administered, he showed.
Conversely, photodynamic therapy, laser choroid and focal laser decreased by 61%, 30% and 9%, respectively
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Triple therapy reduces treatment burden for wet AMD in anti-VEGF nonresponders
A three-part treatment protocol involving injections of triamcinolone and bevacizumab followed by short-duration photodynamic therapy stabilized vision and reduced the re-treatment burden in patients with neovascular age-related macular degeneration who did not respond to initial anti-VEGF therapy, a retrospective study found.
Allan Franklin, MD, and colleagues in Pensacola, Fla., reviewed outcomes for 27 patients treated with the triple therapy. They presented their results in a poster at the American Society of Retina Specialists annual meeting.
The treatment protocol involved combined injections of triamcinolone acetonide and Avastin (bevacizumab, Genentech). Surgeons then performed short-duration PDT with Visudyne (verteporfin, Novartis/OLT) within 2 weeks after the injections, according to the study.
At 1 year follow-up, investigators found that approximately 40% of patients required one re-treatment with a combination intravitreal injection, and 11% required two to three combination injections or repeated triple therapy. Additionally, 11% of patients required three or more re-treatments and were considered refractory to triple therapy, the authors reported.
Overall, patients showed a stabilization in vision during the first 12 months of follow-up. Among 14 patients followed for longer than 1 year, three patients gained at least three lines of vision, three patients lost three lines or more and vision remained stabilized in eight patients, according to the study. At 12 months follow-up, central foveal thickness had significantly decreased by an average of 70 µm to 75 µm (P < .05), the authors noted.
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Vitrectomy with intravitreal drug injection may improve long-term AMD treatment, study suggests
Performing a core pars plana vitrectomy significantly increases intraocular oxygen distribution, which may improve the long-term effectiveness of pharmacologic treatments for choroidal neovascularization secondary to age-related macular degeneration by reducing VEGF production, according to a study by researchers in Germany.
Frank H.J. Koch, MD, and colleagues performed a prospective study evaluating outcomes from a combined treatment approach involving core pars plana vitrectomy and the injection of an intravitreal steroid and Avastin (bevacizumab, Genentech). They presented their results in a poster at the American Society of Retina Specialists annual meeting.
Patients with predominantly classic lesions were treated with Visudyne (verteporfin, Novartis/QLT) photodynamic therapy followed by core pars plana vitrectomy performed 24 hours later with intravitreal injection of dexamethasone and bevacizumab. Patients with predominantly occult lesions received a core pars plana vitrectomy and injection of intravitreal Kenalog (triamcinolone, Bristol-Meyers Squibb) and bevacizumab.
Investigators found that patients with predominantly classic lesions had a significant improvement in vision of 1.1 lines at 3.2 months mean follow-up, 1.9 lines at 8.7 months and 1.6 lines at 13.6 months (P < .01), according to the study.These patients also had a mean reduction in macular thickness of 211 µm (P < .01), the authors noted.
In patients with predominantly occult lesions, the gain in visual acuity averaged 0.9 lines at 3.2 months, 1.3 lines at 8.7 months and 1.2 lines at 13.6 months (P < .01), with a mean decrease in macular thickness of 195 µm (P < .01), according to the study.
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Diclofenac better than fluorometholone for preventing postop CME in pseudophakic eyes
Topical diclofenac appears to be more effective than fluorometholone for preventing the reduction in choroidal blood flow, disruption of the blood-aqueous barrier and development of cystoid macular edema that can occur in pseudophakic eyes during the early postoperative period, according to a study published in the December issue of Investigative Ophthalmology & Visual Science by researchers in Japan.
Investigators found that patients who received fluorometholone had significantly reduced choroidal blood volume at 2 weeks follow-up (P = .022) and significantly reduced choroidal blood flow at 1 week (P = .003) and 2 weeks (P = .000) weeks after surgery.
Fluorometholone-treated patients also showed significantly more anterior flare at 1 week (P = .001) and 2 weeks (P = .025) follow-up, according to the study.
At 5 weeks follow-up, both choroidal blood volume and flow returned to normal in the fluorometholone-treated group and were similar to patients who received diclofenac, the authors noted.
However, the incidence of fluorescein angiographic CME trended to be higher (P = .08) at 2 weeks and was significantly higher (P = .001) at 5 weeks after surgery in eyes with fluorometholone than with diclofenac, they said.
The study is published in the December issue of Investigative Ophthalmology & Visual Science.
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Studies show bevacizumab improves vision in CRVO patients
Intravitreal injections of bevacizumab appear effective for improving vision and central retinal thickness in eyes with macular edema secondary to central retinal vein occlusion, according to findings from two separate studies.
In the first study, Siegfried G. Priglinger, MD, and colleagues in Munich prospectively evaluated the effects of repeated intravitreal injections of 1.25 mg of Avastin (bevacizumab, Genentech) in 46 patients with central retinal vein occlusion (CRVO).
At 6 months mean follow-up, investigators found that visual acuity had improved from an average of 20/250 at baseline to 20/80 (P < .001), with an average gain of 13.9 ETDRS letters. Also, central retinal thickness had decreased from an average of 535 µm at baseline to 323 µm, the authors reported.
Patients with ischemic CRVO had a significantly lower visual acuity compared with patients with nonischemic CRVO (P < .001). However, both patient groups had similar gains in visual acuity, and the improvement in vision was independent of symptom duration, according to the study.
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Combined radiation, anti-VEGF therapy shows efficacy in wet AMD patients
A new beta radiation epiretinal therapy, in combination with bevacizumab injections, improved visual acuity in patients with wet age-related macular degeneration, a study here at the American Academy of Ophthalmology Annual Meeting showed.
Jeffrey S. Heier, MD, presented 1-year results of an ongoing multicenter study evaluating the efficacy and safety of NeoVista's beta radiation epiretinal therapy for wet AMD when used in combination with Avastin (bevacizumab, Genentech).
Twenty-seven patients with either predominantly classic, minimally classic or occult with no classic choroidal neovascularization received a single-treatment dose of 24-Gy beta radiation through vitrectomy and two injections of bevacizumab. One injection was administered at the time of radiation and the second was administered 1 month later.
Patients averaged 72 years of age and were treated between June 2006 and April 2007.
Visual acuity at baseline averaged 41 ETDRS letters. At 12 months follow-up, patients had improved by 13.1 letters. Additionally, 96% of patients lost less than 15 letters.
Overall, 15% of patients required additional bevacizumab injections, and 12% experienced adverse events, which included retinal tear, retinal detachment, subretinal hemorrhage and vitreous hemorrhage.
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MEET
THE FELLOWS
In each issue, a Fellow of the Optometric Retinal Society will be highlighted. In this issue, Dr. Lori Vollmer will be highlighted.
Dr. Lori Vollmer earned her undergraduate degree from the University of South Florida in 1990. Following graduation, she worked as a certified ophthalmic technician for eight years until pursuing a career in optometry in 1998. She graduated with honors from Nova Southeastern University College if Optometry in 2002. She completed a residency in ocular disease at the Aran Eye Associates in Miami, Florida. Dr. Vollmer is currently an Assistant Professor of Optometry and Director of Residency Programs at Nova Southeastern University. Her professional interests lie in primary care and ocular disease. She is an attending optometric physician at The Eye Institute in the primary care and electrodiagnostic clinics. She performs course lectures on congenital fundus dystrophies, clinical gerontology and electrophysiology. Her lecturing interests involve anterior and posterior segment disease with emphasis on medical and surgical management. Dr. Vollmer is a fellow in the American Academy of Optometry, a Fellow in the Optometric Retina Society, a member of the American Optometric Association, and a trustee in the Broward County Optometric Association.
WHY
BECOME AN ORS MEMBER?
By Rex Ballinger, OD, FAAO
Chair, Membership Committee
Membership in the Society can provide several benefits. You may
receive discounts at annual meetings. You’ll receive regular
newsletters on new and exciting updates on retinal disease diagnosis
and management as well as other newsy items of interest. And you’ll
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 |
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- ICaps® MV for Eye and Body Health
Alcon's ICaps
MV (Multivitamin) gives patients an optimal combination of vitamins and nutrients for complete eye and body health. This product is the first AREDS-based formulation to also contain 23 essential ingredients for the body, including 10 mg of lutein and zeaxanthin. The product is formulated without beta-carotene, which is preferred for patients who smoke.
For more information, go to www.Icapsvitamins.com
 OFFICEMATE
- Retinal Examination and Documentation
Retinal examination and documentation couldn’t 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 ExamWRITER’s seamless instrument
interface.
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
at www.officemate.net.
 Optos Releases V2® Vantage Operating Software
Optos recently introduced the latest version of its proprietary operating software - V2® Vantage - which is available with all new device installations and to Optos Partners as part of the Optos Partnership model. This upgrade represents the next step in Optos' commitment to continuous improvement of the optomap® Retinal Exam and optomap® plus Medical Retinal Exam for both the practitioner and patient. These improvements reflect Optos' ongoing commitment to helping their Partners deliver efficient and enhanced care to patients.
The V2® Vantage clinical enhancements include: ResMax™ High Resolution Enhancement for the Central Pole; Targeted Ophthalmoscopy which simulates the view of a BIO exam; added image artifact counting; enhanced retinal drawing tools; and the capability to more easily export optomap® Images.
Patient education is enhanced with Optos' exciting new 3D Wrap™ Patient Orientation Tool, an expanded Image Library, added customized "quick print" patient take-away as well as trial access to Eyemaginations educational 3D animations. Partners also benefit from improved practice performance reporting, more procedure and diagnostic codes and other usability enhancements.
The introduction of V2® Vantage delivers on the Optos Partnership model to keep the technology relevant and on the leading edge of retinal imaging.
For more information, visit www.optos.com.
Current Optos Partners may download the V2® Vantage software at www.optos.com/v2Vantage.
 Volk 3rd Generation Diagnostic Lenses --
Digital Series
What Are Digital Series Lenses?
Our goal to improve the industry leading designs of the Classics and Super Series lenses led is to refine our design techniques and work with superior grade glass, enabling us to further optimize our advanced double aspheric designs. The 'Super Series' family evolved into the 'Digital Series'.
 Why Digital Series?
As these lenses were developed, we found the enhanced double aspheric design coupled with gains in the quality of our A/R coating provided a noticeable reduction in glare and reflections. We realized that this helped improve slit lamp photography imaging. Is photography their sole purpose? Absolutely not -- the Digital Series family of lenses provide the finest views for all examinations and imaging, enabling discernment of details previously unattainable at the slit lamp.
In The Family:
BIO: Digital ClearField and Digital ClearMag
Slit Lamp: Digital Wide Field®, Digital High Mag® and Digital 1.0x
Call Volk for a 30 day risk free trial of this superb new lens.
Call us: 800-345-8655 (toll free) or 440-942-6161, fax 440-942-2257.
Email: Volk@Volk.com or visit www.volk.com
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Editor
in Chief
Steven Ferrucci, OD, FAAO
Co-Editor
Mark T. Dunbar, OD, FAAO
|
Journal
Reviewers
Sarah Kirkpatrick, OD
Brad Masuga, OD
Ashley Muhlada, OD
J. Suzanne Parker, OD
Art/Production Director
Joe Morris
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