3, Number 4
THE DESK OF THE EDITOR
Recently, I attended the American Academy of Optometry meeting in Tampa. As always, there were great lectures on a variety of topics, from practice management to binocular vision to diagnostic imaging. However, what really caught my eye was the number of lectures on retina topics, in particular treatment for macular degeneration, especially the anti-VEGF agents. Prior to the advent of PDT in 2000, or even more so the emergence of Macugen in late 2004/early 2005, none of these lectures would have existed. Instead, we would be talking about low vision, as we would be unable to make any difference in the natural course of these patients' vision loss. Now, with the availability of all these treatments, through early detection and prompt referral to a qualified retinal specialist, hopefully we can make a meaningful change in the vision and hence the lives of our patients. This very education--helping to educate optometrists to better identify retinal problems and seek out appropriate referral--is what the ORS is all about.
Steven Ferrucci, O.D., F.A.A.O.
Editor in Chief
This is the latest edition of the Optometric Retina Society Electronic Newsletter. We hope that you have found the previous editions helpful and informative. Always feel free to make any comments on the contents and how we can make it better.
We encourage you to attend the next ORS meeting in Boston that will be held September 5 - 7, 2008. The Radisson Hotel in the Theatre District will again be the meeting site. This will be our third time in Boston and it has become a great venue for our meeting. It may also be a chance to see a Red Sox game or attend a play. Come join us in discovering the new frontiers of vitreoretinal diseases and more.
William L. Jones, O.D.
MAKE THE DIAGNOSIS
Answer appears later in newsletter.
Practical tips for Interpretation of OCT scans
By Jeffry Gerson, O.D., F.A.A.O.
When looking at an OCT printout, it is important to not only be able to interpret the image for guiding clinical care, but also for educating the patient. Once a patient has been effectively educated, they are more likely to follow through with clinical recommendations. Further, if we can insure that patients understand the findings, we are also insuring that we, the doctor understand the test.
When I discuss an OCT printout with patients, I point out the following 3 points:
1. Uniformity of scan on both sides of the foveal depression. The image should be essentially a mirrored one.
2. General contour of scan. A normal scan will have the foveal depression in the center and be relatively smooth.
3. Central thickness at the foveal depression. I tell patients that we want to see this under 225 microns to signify normal.
If these 3 criteria are met--mirrored image, normal depression, and normal thickness--then it is most likely that there is no significant pathology. If there is pathology, then the conversation is a bit lengthier, but at least I have created a baseline from which to explain any abnormalities.
Counseling patients with dry ARMD
By Steven Ferrucci, O.D., F.A.A.O.
When counseling your patients with dry ARMD, there are several things that they should be advised regarding the progression of their disease. First and foremost, ARDEDS supplementation should be discussed in all eligible patients. Patients who are smokers or with a recent history of smoking should be advised to avoid the beta-carotene, due to its association with increased lung cancer. There are products available that substitute lutein for beta-carotene in these cases. Secondly, patients should be advised that the single biggest modifiable risk factor for macular degeneration is smoking. Smoking has been shown in multiple studies to increase both the incidence and progression of ARMD by as much as 2-5 times. Therefore, smoking should be strongly discouraged. The role of UV protection is somewhat controversial, as the effect of its exposure on the mature eye is somewhat debatable. Nonetheless, I often discuss this with my patients. Lastly, newer studies are alluding to the protective effect of fish, particularly salmon and others with high omega-3 fatty acids, as well as a possible increase risk with higher red meat consumption. Still others studies report increase body mass index with increased rates of ARMD, so obviously overweight patients should be counseled as well.
I have found that most patients appreciate this advice, as most are eager to know what they can do to prevent the effects of this terrible disease. Further, it is important to stay in tune with new research that may help prevent the progression of ARMD, and continue to share this information with our patients.
Examining undilated patients
By Leo Semes, O.D., F.A.A.O.
I have found that when looking at undillated patients at the slit-lamp microscope that finding the fundus is easier if I use 10 magnification (Haag-Street 900). Once I am focused at the plane of the optic disc, I can increase magnification as needed. This also allows the opportunity to increase illumination which offers me a better detail since resolution is dependent on brightness. Although still monocular, this affords a good way to assess the disc, vessels and macula. In a cooperative patient, directing the gaze to different positions allows evaluation beyond the posterior pole.
Sensitivity and Specificity of the Optos Optomap for Detecting Peripheral Retinal Lesions.
The sensitivity and specificity of the Optos Optomap Panoramic200 imaging system for the detection of peripheral retinal pathology was assessed. Images of 49 patients with known retinal pathology were evaluated in a masked fashion by retinal specialists and compared to the golden standard dilated fundus examination with scleral indentation. The Optomap showed high specificity and moderate sensitivity for lesions posterior to the equator and low sensitivity for lesions anterior to the equator. Furthermore, lesions missed by the Optomap were generally holes, although small, which required laser treatment after clinical review. For retinal lesions posterior to the equator, sensitivity was 74% (95% confidence interval [95% CI] 61%-87%) overall for all lesions and 76% (95% CI 59%-93%) for lesions requiring treatment. For anterior lesions, sensitivity was 45% (95% CI 28%-62%) overall and 36% (95% CI 14%-58%) for treatable lesions. Specificity was 85% (95% CI 63%-100%). The authors concluded that the Optomap showed high specificity and moderate sensitivity for lesions posterior to the equator and low sensitivity for lesions anterior to the equator.
Isbister, C.M., Maberley, D.A., Mackenzie, P.J., et. al. Retina 2007; 27: 1119-1124.
Medical Consequences of Stopping Anticoagulant Therapy Before Intraocular Surgery or Intravitreal Injections.
The purpose of this editorial was to discuss the clinical choice of either stopping or continuing anticoagulant therapy (Warfarin, Heparin, Plavix, aspirin) before vitrectomy or intravitreal injections due to the rationale that this therapy may predispose patients to intraocular bleeding during or after the procedure. At present, this remains more of a theoretical rather than statistically proven outcome, as there is no literature definitively showing that discontinuation of therapy is necessary. A recent report by Genetech, which noted a slightly increased number of strokes in the SAILOR Study when receiving .5mg dose of Lucentis versus the .3mg dose for AMD, raises concern over the risks and benefits of anticoagulant therapy in these patients. The risk of thromboembolic events in ranibizumab therapy is difficult to elicit given variable ‘as needed’ dosing of anticoagulants and the question of whether warfarin is stopped or not in current practice and trials. It is, at best, exceedingly rare. Also, small incision techniques in vitreoretinal surgery reduce the risk of ocular bleeds. Given the systemic risk of morbidity and mortality of thromboembolic events, anticoagulant therapy should not be discontinued in the perioperative period.
Charles, S., Rosenfeld, P.J., Gayer, S. Retina 2007; 27(7) 813-815.
Current Visual and Anatomic Outcomes of Pneumatic Retinopexy.
This retrospective study reviewed 150 patients with rhegmatogenous retinal detachments to assess both the functional and anatomical outcome after pneumatic retinopexy (PR). Results of this study show that PR may be appropriate in eyes with a wide variety of complicated retinal detachments, with a successful reattachment rate of 76.7% with a single procedure and 98.7% after additional procedures. Male sex may be a risk factor for failed PR, which is thought to be related to noncompliance to post-operative positioning.
Kulkarni, K.M., Roth, D.B., Prenner, J.L. Retina 2007; 27: 1065-1070.
Short-Term Effects of Intravitreal Bevacizumab for Subfoveal Choroidal Neovascularization in Pathologic Myopia.
In this prospective interventional case series, 14 patients with pathologic myopia and subsequent subfoveal choroidal neovascularization (CNV) were treated with 2.5 mg of intravitreal bevacizumab and followed for 3 months. Results showed that intravitreal bevacizumab resulted in a significant decrease in foveal thickness as well as a 3-4 line improvement in visual acuity. Authors feel that these favorable outcomes warrant the need for further studies involving Avastin treatment for CNV due to pathologic myopia.
Hernandez-rojas, M., Quiroz-Mercado, H., Hugo, et al Retina. 27(6):707-712, July/August 2007.
Prophylactic Intraoperative 360° Laser Retinopexy for Prevention of Retinal Detachment.
This retrospective case-control study attempts to evaluate the effectiveness of prophylactic 360[degrees] laser retinopexy for the prevention of retinal detachment following vitrectomy. A case series of 115 patients who underwent vitrectomy with 360 degree laser retinopexy anterior to the equator were compared with a control group of 105 patients who also underwent vitrectomy but had not received laser retinopexy. The group receiving the intraoperative laser retinopexy was found to have a 74% reduction in the rate of postoperative retinal detachment. Authors suggest that this adjunctive treatment should be considered in patients undergoing vitrectomy procedures.
Koh, Hyoung J, Cheng, L., Kosobucki, B. et al Retina. 27(6):744-749, July/August 2007.
Injection of Triamcinolone Acetonide into the Posterior Sub-Tenon Capsule for Treatment of Diabetic Macular Edema.
This prospective study was performed to assess the effectiveness sub-Tenon injections of triamcinolone acetonide (TA) for treatment of diabetic macular edema (DME). Nine patients with bilateral DME were treated with injections of 20mg of TA into the posterior sub-Tenon capsule of only one eye. Central macular thickness was compared between the treated and non-treated eye. Results showed a significant improvement in macular thickness of the eyes treated with TA. Therefore, authors suggest that TA injected into the posterior sub–Tenon capsule should be considered as a possible treatment in patients with DME.
Toda, J., Fukushima, H., Kato, S. Retina. 27(6):764-769, July/August 2007.
Reopening of Previously Closed Macular Holes After Cataract Extraction.
Two hundred eleven eyes were retrospectively studied to evaluate reopening of macular holes after cataract surgery that followed successful closure of the hole at least 3 months after vitrectomy. Four groups were assembled based on those with prior cataract surgery, vitrectomy and subsequent cataract surgery, vitrectomy only, and combined procedures. The study showed that those patients in Group 2 had a four-fold increased risk of macular hole reopening and clinically apparent CME was significantly associated with a seven-fold increased risk of reopening. An inflammatory, fibrinolytic mechanism has been implicated in the degradation of the glial attachment. Because cataract formation is a known sequela of vitrectomy surgery, one must be vigilant of the risk of reopening in the postoperative period, especially in those having subsequent cataract removal after vitrectomy.
Bhatnagar, R., Kaiser, P., Smith, S et al. Am J Ophthalmol 2007; 144(2): 252-259.
Selective Photodynamic Therapy for Neovascular Age-Related Macular Degeneration with Polyploidal Choroidal Neovascularization.
The purpose of this study was to evaluate the efficacy of Indocyanine Green (ICG) angiography-guided photodynamic therapy (PDT) used in conjunction with Verteporfin to treat Polyploidal Choroidal Vasculopathy (PCV). After one year of treatment, 15 of the 30 treated eyes improved to >= 3 lines and 9 eyes remained stable. Therefore, the authors of this study found that stabilization or visual improvement can be achieved in most eyes (80%) with PCV via ICG angiography-guided PDT.
Eandi, C.M., Freund, B.K., Ober, M.D., et al. Retina 2007; 27: 825-831.
Intravitreal Bevacizumab injections for treatment of Central Retinal Vein Occlusion.
The authors of this study set out to evaluate the effect of intravitreal Bevacizumab (Avastin) injections on visual acuity and retinal thickness in 46 patients with a Central Retinal Vein Occlusion (CRVO). At 6 months post-treatment, the mean visual acuity was enhanced from 20/250 to 20/80 and mean central retinal thickness decreased from 535 +/- 148 [mu]m at baseline to 323 +/- 116 [mu]m. The researchers in this study concluded that intravitreal Bevacizumab treatment is a viable option for macular edema secondary to CRVO.
Alge, CS., Armin H., Haritoglou, C., et al. Retina 2007; 27: 1004-1012.
Incidence of New Tumor Formation in Patients with Hereditary Retinoblastoma Treated with Primary Systemic Chemotherapy: Is There a Preventive Effect?
This retrospective study looked at fifty-eight consecutive patients with hereditary retinoblastoma treated with primary systemic chemotherapy for new tumor formation. The study found new tumors continue to form in patients with hereditary retinoblastoma despite treatment with primary systemic chemotherapy. Younger patients and those with a positive family history are more likely to have new tumors formed. However, chemotherapy may impact small previously undetected lesions by slowing their growth and facilitating later focal consolidation.
Matthew W.W., Barrett G.H., Catherine A.B., et al. Ophthalmology 2007;114:2077-2082.
Adverse Events after Intravitreal Triamcinolone in Patients with and without Uveitis.
A Retrospective observational case series evaluated two hundred twenty-two eyes of 173 patients for the rates of adverse ocular events after intravitreal triamcinolone acetonide (IVTA) injection in patients with and without uveitis. The study found uveitis patients were significantly younger, more likely to be female, and more likely to have had prior posterior sub-Tenon’s capsule steroid injection and/or glaucoma therapy than their nonuveitis counterparts. Intraocular pressure elevation and PSC progression occurred with greater frequency in uveitis patients receiving IVTA. Patients with uveitis treated with IVTA should be counseled about these risks and monitored closely.
Anat Galor, Ron Margolis, Oswaldo M.F. Brasil, et al. Ophthalmology 2007;114:1912-1918.
Findings in Fluorescein Angiography and Optical Coherence Tomography after Intravitreal Bevacizumab in Type 2 Idiopathic Macular Telangiectasia.
A retrospective case series of seven eyes in 6 patients were studied to report the short-term effects of intravitreal bevacizumab in patients with type 2 idiopathic macular telangiectasia (IMT). Patients received 2 doses of intravitreal bevacizumab (1.5 mg) at 4-week intervals, while assessments of OCT retinal thickness, angiographic characteristics, and VA were performed at baseline and at 4 and 8 weeks after the initial treatment. Short-term results indicate that inhibition of vascular endothelial growth factor by intravitreal bevacizumab is associated with a decrease in retinal thickness and a reduction in angiographic leakage in type 2 IMT. Furthermore, intravitreal bevacizumab may improve VA in affected patients.
Peter Charbel I., Frank G.H., and Hendrik P.N.S., Ophthalmology 2007;114:1736-1742.
Ketoconazole in the Treatment of Chronic Idiopathic Central Serous Chorioretinopathy.
Exogenous steroids administration has long been implicated in CSC. Endogenous corticosteroids, secreted by the cortex of the adrenal glands are also culpable in the pathogenesis of the disease in the setting of stress, pregnancy and Cushing’s disease. Ketoconazole, an anti-fungal agent, is an endogenous corticosteroid antagonist and its use extends beyond mycology. 600mg per day for 4 wks of Ketoconazole was used in 5 patients with chronic CSC for its glucocorticoid receptor antagonism and adrenal biosynthesis inhibition. Evaluation was done at baseline, 4 wks and 8 wks. The results showed that visual acuity remained stable throughout the course of the evaluations at 20/40 and at 8 wks, medial lesion height and medial linear dimension of the lesion decreased. Although the results are inconclusive, it appears that the drug persists after discontinuation of therapy since anatomical results were evident at 8 wks. Further investigation into duration and dosage of Ketoconazole in CSC may reveal therapeutic potential.
Meyerle, C, Freund, K.B., Bhatnagar P et al. Retina 2007; 27; 943-946.
Plaque Radiotherapy for Choroidal Melanoma Encircling the Optic Disc (Circumpapillary Choroidal Melanoma)
Thirty-seven patients with circumpapillary choroidal melanoma were retrospectively studied to report the outcomes including treatment complication, long-term visual acuity, enucleation, tumor recurrence, metastasis, and death. Only those tumors 1mm of the optic disc and surrounded the disc 12 clock hours were included and these tumors comprise less than 10% of posterior uveal melanomas and were excluded in the Collaborative Ocular Melanoma Study. The article states that custom-designed notched (housing the optic nerve) plaque radiotherapy with I125 adequately controlled the tumor in 89%. Long-term visual loss, defined as 20/200 or less, was found in 13 eyes (62%). Tumor recurrence was in 14% and enucleation was necessary in 7 (25%). Metastasis developed in 1 (4%) and no deaths were reported. In eyes that otherwise would be enucleated, precise plaque placement radiotherapy with or without adjunctive transpupillary thermotherapy can preserve the eye involved but secondary complications such as radiation retinopathy, maculopathy, papillopathy, cataract, neovascular glaucoma, vitreous heme, or arterial occlusion may ultimately result in visual loss.
M. Sangoo, Shields, C, Mashayekhi, A et al. Arch Ophthalmology 2007; 125(9), 1202-9.
TO "YOU MAKE THE DIAGNOSIS"
These fundus photos represent a case of adult onset foveomacular vitelliform dystrophy (AFVD). In 1974 Gass described various configurations of macular pigment deposits arranged in a variety of patterns, known today as 'pattern dystrophies of the RPE.' Among these is adult-onset foveomacular vitelliform dystrophy. Unlike congenital dystrophies, pattern dystrophies have an adult-onset manifestation with peak incidence of symptoms occurs in the 4th-5th decade of life. Pattern dystrophies are slow to progress with most patients retaining relatively good visual acuity. Due to the fact that these patients manifest macular changes later in life, they're often mistaken for other retinal conditions, such as AMD.
Patients with AFVD may present with history of metamorphopsia and mild to moderate decreased in visual acuity. The characteristic retinal sign includes bilateral yellow "yolk-like" subretinal lesions. Diagnosis is typically made based on clinical evaluation. However auxiliary tests such as FA and OCT may aid in the diagnosis and can help monitor the condition.
Although the retinal findings associated with AFVD may progress over time, the lesions typically fade, leaving irregular RPE depigmentation and/or central pigment spots formation. Associated choroidal neovascular membranes (CNVMs) are rare. Due to the relatively mild progression and good prognosis, AFVD patients are generally monitored with home Amsler grid testing and regular dilated fundus examinations.
Diana L. Shechtman, O.D., F.A.A.O.
Genentech postpones discontinuation of bevacizumab sales to compounding pharmacies
Genentech has postponed the date on which it will stop supplying bevacizumab to compounding pharmacies to Jan. 1, 2008, according to an open letter posted on the company's Web site. The discontinuation had initially been scheduled for Nov. 30.
"We made this change so that affected physicians will have sufficient time to develop and implement transition plans to assure that patient care is not adversely affected," the Genentech letter said.
The company made the decision to postpone discontinuing Avastin (bevacizumab) sales to compounding pharmacies after Genentech senior executives met with leaders from the American Academy of Ophthalmology (AAO) and American Society of Retina Specialists (ASRS).
In addition to the postponement, Genentech agreed that it would reinstate supplying bevacizumab to compounding pharmacies if the U.S. Food and Drug Administration gives it the legal and regulatory authorization.
Genentech originally announced its decision to cease selling bevacizumab to compounding pharmacies in a letter to physicians made public on Oct. 11. Private physicians, as well as organizations including the AAO and ASRS, immediately expressed concerns over how the decision could affect patient care.
"The decision we communicated was not made lightly," the latest letter said. "In fact, it was guided by our company's strong commitment to take actions that are scientifically and clinically sound and in the best long-term interest of patients, while at the same time adhering to government regulations and remaining mindful of the retinal community's views."
FDA requires additional clinical study before approval of Alcon AMD treatment
Alcon has received an approvable letter from the U.S. Food and Drug Administration for Retaane, its anecortave acetate treatment for wet age-related macular degeneration. However, the FDA will require an additional clinical trial before it grants final approval, according to an Alcon press release.
Alcon has no immediate plans to conduct a new study due to the difficulty of recruiting patients in light of other treatments currently available for wet AMD, the release said.
However, the company continues to believe that Retaane (15 mg anecortave acetate suspension) could play a role in the treatment of wet AMD. Alcon plans to continue supporting the Anecortave Acetate Risk-Reduction Trial, which is studying the ability of Retaane to reduce the risk of the progression from the dry form of AMD to the wet form. This trial, which is fully enrolled with more than 2,500 patients, is expected to be completed within 3 years, according to the release.
In addition, Alcon is conducting clinical studies of anecortave acetate, the active ingredient in Retaane, for the treatment of glaucoma. Retaane suspension remains commercially available in several countries outside of the United States.
Cataract surgery improves quality of life in AMD patients with cataract
Performing cataract surgery in patients with early age-related macular degeneration and visually significant cataract can produce significant improvements in both vision and quality of life, a study published in the August issue of Optometry and Vision Science by Australian researchers shows.
Ecosse L. Lamoureux, PhD, and colleagues at the Centre for Eye Research Australia, University of Melbourne, used the impact of vision impairment (IVI) questionnaire to investigate how cataract surgery affected the quality of life of patients with early AMD. The study included 56 patients who averaged 78.5 years of age and had an average preoperative visual acuity of 6/15, according to the study.
In addition to early AMD, all patients had visually significant cataract and were being considered for cataract surgery in one eye, the study authors noted.
Investigators randomly assigned 29 patients to undergo early surgery and 27 patients to undergo standard surgery, which has a 6-month waiting time, the authors reported.
At follow-up, the researchers found significant interaction effects for the overall IVI score as well as for the subscales evaluating emotional well-being, mobility and independence, and reading and accessing information, according to the study.
Surgery improved visual acuity in patients with peripapillary CNV
Patients with extensive peripapillary choroidal neovascularization secondary to age-related macular degeneration may benefit from surgery involving the removal of the neovascular complex, according to a small study published in the August issue of British Journal of Ophthalmology by researchers in Germany.
Sabine Aisenbrey, MD, and colleagues at the University of Tuebingen evaluated the functional and physical effects of subretinal surgery performed on eight consecutive patients.
In all cases, surgeons performed pars plana vitrectomy and extracted the choroidal neovascular lesion through a small retinotomy at the lesion's edge. In addition to the vitrectomy, two patients also underwent cataract extraction and IOL implantation, the authors noted.
At 26 months mean follow-up, the researchers found that best corrected visual acuity had improved in six of the eight patients and had stabilized in one patient. The one remaining patient had a deterioration in BCVA, according to the study.
Additionally, CNV reoccurred in one patient 2 years after surgery and one other patient experienced a retinal detachment 5 years postoperatively.
Overall, mean BCVA improved from 20/63 preoperatively to 20/40 at final follow-up, according to the study.
Prior retinal vein occlusion associated with increased risk of pseudophakic CME
Patients with a history of retinal vein occlusion, epiretinal membrane or prostaglandin use may have an increased risk of pseudophakic cystoid macular edema, according to a study by Massachusetts researchers. However, prophylactically treating high-risk patients using nonsteroidal anti-inflammatory drugs postoperatively decreases the edema incidence to that of normal-risk patients, the authors noted.
Bonnie A. Henderson, MD, and colleagues investigated the incidence and risk factors of cystoid macular edema (CME) after cataract surgery in 1,659 patients treated between 2001 and 2006. They published their results in the September issue of Journal of Cataract and Refractive Surgery.
The researchers found that a history of retinal vein occlusion was predictive of the development of CME postoperatively (P < .001). Overall, 39 of the 1,659 patients (2.35%) developed postop CME, the author reported.
After excluding patients with diabetes, CME occurred in 29 of the remaining 1,357 non-diabetic patients (2.14%). Among these patients, a history of retinal vein occlusion (P < .001), epiretinal membrane (P < .03) or preoperative use of prostaglandins (P < .04) was associated with the development of CME after surgery, according to the study.
Study finds higher than expected response rate from pegaptanib against CNV
Using pegaptanib as a primary treatment for choroidal neovascularization secondary to age-related macular degeneration may result in better visual outcomes than those reported in previous clinical trials of the drug, a retrospective study published in the September issue of Retina suggests. Among eyes that had received no prior AMD treatment, 90% had an improvement or stabilization of vision, the study authors reported.
Polly A. Quiram, MD, PhD, and colleagues reviewed outcomes for 90 newly diagnosed exudative AMD patients treated with Macugen (pegaptanib sodium, OSI Eyetech Pharmaceuticals) for previously untreated choroidal neovascular membranes. Of these patients, 72 (80%) had occult lesions, 12 (13%) had minimally classic lesions and six (7%) had predominantly classic lesions. Additionally, 45 lesions (50%) were four disc areas or less in size and 45 (50%) were more than four disc areas in size, according to the study.
Patients received pegaptanib injections at 6-week intervals. Investigators performed fluorescein angiography and optical coherence tomography imaging after every third injection.
Overall, 90% of patients had responded to pegaptanib treatment at 9.1 months mean follow-up. Specifically, 18 patients (20%) gained three or more lines of vision, and vision stabilized in 63 patients (70%), which the authors defined as the prevention of a loss of three lines of vision, according to the study.
Patients who gained three or more lines of vision received an average of 3.5 injections, the authors noted.
Nine patients (10%) lost three or more lines of vision, and one patient developed endophthalmitis, they added.
In each issue, a Fellow of the Optometric Retinal Society will be highlighted. In this issue, Dr. Jeff Gerson will be highlighted.
Jeffry Gerson, O.D., F.A.A.O. is in private practice in Shawnee, Kansas and practices part time at Omni Eye Center of Kansas City, an optometric referral center. Before entering into his current private practice, he spent several years in a retina referral office where he only saw patients with retinal diseases.
Dr. Gerson is a member of the American Optometric Association (AOA) and a fellow of the American Academy of Optometry (AAO) and the Optometric Retinal Society (ORS). He currently serves as the educational chair for the Kansas Optometric Association. He has participated in several large NEI clinical trials, and has authored numerous articles in optometric publications. He lectures frequently on the national level on retinal and systemic disease.
He lives in Leawood, Kansas with his wife Karen, and their three and a half year old son, Gilli.
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. 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 MV for Eye and Body Health
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. With 10 mg of lutein and zeaxanthin, ICaps
MV may help reduce the risk of the progression of age-related macular
degeneration. The product is formulated without beta-carotene, which
is preferred for patients who smoke.
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
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Designed exclusively as an eyecare medical program by eyecare professionals,
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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.
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Steven Ferrucci, OD, FAAO
Mark T. Dunbar, OD, FAAO
Sarah Kirkpatrick, OD
Brad Masuga, OD
Ashley Muhlada, OD
J. Suzanne Parker, OD
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