2^nd International Conference on Eye and Vision September 26-28, 2016 Orlando, Florida, USA

Biography:

Cesar Gomezperalta is a Senior Consultant Eye Surgeon in the field of Cornea, Cataract and Refractive Surgery at Angeles Lomas Hospital in Mexico City. He specializes in Lamellar Corneal Transplant and Ocular Reconstruction. He is the Founder and Director of Vision-Percepcion heading the Keratoconus and Corneal Transplant Clinic. He is the Chairman of the World Wide Alumni of the Singapore National Eye Centre and was appointed Chairman for the 2013 world meeting of the World Association of Eye Hospitals. He received his Medical Degree from the Anahuac University School of Medicine and then trained in General Surgery & Laparoscopy at the American British Cowdray Hospital. He completed his Ophthalmology residency at the Lopez Mateos Regional Hospital and visited as a fellow the Wolfe Clinic in Iowa, USA. He then spent a few years specializing in Cornea, Cataract and Refractive Surgery at the Singapore National Eye Centre in Singapore, where he also gained experience in Ocular Surface Reconstruction and Artificial Corneas.

Abstract:

Aim: The aim of this study was to evaluate the possibility and effectiveness of reaching 20/20 uncorrected visual acuity after refractive surgery in patients treated with anterior lamellar keratoplasty for keratoconus, as part of their full visual recovery.

Method: This is a retrospective review of 30 patients (22 eyes) treated with automated lamellar keratoplasty for moderate to severe keratoconus. One year after surgery, suture removal was completed and refractive surgery (LASEK) was evaluated for them to depend less on glasses or contact lenses. All surgeries were done by a single surgeon.

Results: After automated lamellar keratoplasty, all 22 eyes restored normal thickness and acceptable curvature improving uncorrected and best corrected visual acuity compare to before surgery. All 30 patients were candidates for refractive surgery LASEK which was performed with no complications. Final uncorrected visual acuity after three months was: 17 eyes (77.2%) 20/20, two eyes (9.9%) 20/25, One eye (4.5%) 20/30 and two eyes (9.09%) 20/40.

Conclusion: Refractive surgery in its variant of LASEK is a very useful and safe procedure to remove post lamellar keratoplasty refractive errors. It is limited to the amount of degree to treat and other procedures such as LASIK or phakic IOL insertions are possibly good alternatives. All patients operated bilaterally were able to develop their normal life activities depending less on glasses and started doing sport activities that previously were impossible.

Biography:

Rodrigo Schwartz Pegado has completed his Post-graduation in Ophthalmology from the University of Pontificia Católica in Rio de Janeiro, Brazil; Master's degree in 2010 from the Universidade Federal Fluminense, Niteroi, Brazil. He is the Director of the Brazilian Institute of Assistance and Research in Ophthalmology and a member of the Brazilian Society of Retina and Vitreous. He has served as the Editorial Board of the Journal of Ophthalmology.

Abstract:

Here, we report the case of a patient who underwent Nd:YAG treatment of macular hemorrhage in Valsalva retinopathy with a persistent ILM unsealed after Nd:YAG membranotomy. The Valsalva maneuver was named after the Italian anatomist Antonio Maria Valsalva (1666-1723), who defined the Valsalva ligaments and anatomy related to the forced exhalation effort against a glottis. The Valsalva retinopathy usually appears as a pre-macular hemorrhage limited, but its exact anatomical location, subMLI or subialoide, is still controversial and difficult to define by ophthalmoscopy. The Valsalva retinopathy occurs in healthy young adults as a result of weight lifting, constipation (Stretching the toilet), vomiting, cough (asthma), sneezing, work, airbag automobile trauma related, vigorous sexual activity, dance vigorous, bungee jumping, comprehensive injury and is also associated with fiber optic gastroenteroscopy. Creating a sudden increase in intra-thoracic and intra-abdominal pressure can cause a rapid increase in venous pressure with spontaneous rupture of capillaries perifoveal retina (Valsalva retinopathy), leading to a sudden and painless loss of vision. The low cost outpatient procedure is relatively safe and results in faster recovery as well as in good visual results in most patients with Valsalva retinopathy. Previous studies have shown that, in patients with acute premacular hemorrhage, the Nd: YAG membranotomy must be performed within the first three weeks to avoid the failure of blood draining into the vitreous. In our case, there was a persistent ILM unsealed after the Nd: YAG membranotomy, as demonstrated by tracking Optical Coherence Tomography (OCT).

Biography:

Sergio Ozán has studied Optician course from University of Buenos Aires, Argentina. He is Specialist in Contact Lenses, Specialist and Manufacturer of Ocular Prosthesis. He is a Scientific Adviser for Ocular Prosthesis in APO (Asociación Profesional de Optómetras in Argentina). He is a Precursor and Creator of multi-perforated orbital implant, JUMAT, and Precursor and Creator of expander orbit osmotic hydrogel filling for microphthalmia. He is the Director of CEPROC, Director of Ocular Prosthesis Division in Perfect Vision, Santiago, Chile.

Abstract:

In this study, a 51 year-old-patient with double corneal transplant in right eye was studied. First corneal transplant was done in 1999 and she never got vision. Second corneal transplant was done in 2010. After a year, there was considerable deformation in the corneal tissue and the cornea became totally leukomatous, deformed and irregular and the eyeball descended to lower eyelid (keratoglobe). I met the patient with ophthalmologist diagnosis of eyeball evisceration. The patient was in deep depression. Due to the irregular and deformed cornea, neither an ocular prosthesis nor soft prosthetic lens could be adapted. So I tried with a scleral lens. In the first test, the general condition of her irregular cornea improved considerably, permitting a good tear film flow between the cornea and the lens. I checked again her cornea and there was neither vision nor light reflection. I consulted the director of scleral lenses for perfect vision in Chile and suggested using a double flap over the lens. Thus, the landing in the sclera was improved and was not ejected. I adapted a scleral lens X-cel Atlantis, base curve 7.50, diameter 17.5 double flap. I put a soft lens painted with black pupil and then a second scleral lens with the same parameters, with perfect adhesion. The patient felt very comfortable, with improved quality of life, could insert herself at work again and now her life has completely changed for the better.

Biography:

Luiz Formentin has completed his graduation in Medicine from the University Lusíada Foundation (1983) and obtained the title of specialist by the Brazilian Council of Ophthalmology in 1994. Currently, he is working as an Ophthalmologist at Eye Clinic (Santos -SP), Ophthalmologist/Director of the Therapy Center and Diagnostic Ophthalmological (Santos -SP), Ophthalmology Service Head of the Holy Hospital Amaro (Guaruja -SP), Assistant at contact lens industry and refraction of the Institute of Vision/UNIFESP, President of the ethics committee of the Hospital Santo Amaro (Guaruja -SP) and former Chairman of the Ophthalmology department of APM Santos.

Abstract:

The fitting of RGP contact lenses provides a gain in visual acuity of the patient that presents irregularities in the cornea, but these irregularities such as a fingerprint are different for each individual, so standard box cannot solve all cases. The purpose of the presentation is to show some changes from the test lens results for the patient. For example, setting the refractive index for back surface toric lenses or adjust the specific weight for centralization and other issues.

Biography:

Hudson Nakamura is a Medical Specialist in Ophthalmology and specialized in Retina and Vitreous. He completed his study from School of Medicine at the Federal University of Goiás – UFG and Residency from the Base Hospital of the Federal District - Brasília - DF. Presently, member of American Academy of Ophthalmology, Brazilian Council of Ophthalmology, Canadian Society of Ophthalmology and also the member of most prestigious society ARVO - The Association for Research in Vision and Ophthalmology United States. He is working as a Professor in Department of Retina and Vitreous Course of Medical Residency in Ophthalmology at the Bank of Goias Eye Foundation. He also works as Specialist in vitreoretinal disease Fellowship - University of Toronto Canada, Specialist in Ophthalmology - University of Toronto Canada, Specialist in vitreoretinal disease Fellowship - Brazilian Center for Eye Surgery.

Abstract:

Vitreoretinal surgery has far advanced since the last decades, coming to a modern area of both vitrectomy and viewing systems, as well as with better approaches from the retinal surgeon, with the use of smaller gauge instruments, making the procedure easier to perform, thus contributing to a better follow up and recovery from the surgery. Though repairing techniques have changed, scleral buckling techniques are still popular since Charles Schepens’ techniques in the early 1950s. Combined approaches are still largely employed, increasing the likelihood of attaching the retina, such as pars plana vitrectomy and scleral buckling procedures, with laser or cryotherapy, the last one mentioned less used due to disadvantages involving retinal pigment epithelium spreading and proliferative vitreoretinopathy, but not counter indicated though. Even though the cost and equipment involving vitrectomies are higher than those of scleral buckling alone, the anatomical results are proved to be faster with both approaches rather than with just one. Scleral buckling techniques, even though used in a lesser extent, still have the indication especially in the phakic patient. For the pseudophakic or aphakic patient, some buckle techniques or modified and combined buckle and vitrectomy techniques are used, such as using a band together with vitrectomy to help increase the likelihood the retina will attach during and after the procedure is made. Vitreoretinal surgery used to take too long before the development of wide angle vitrectomy viewing systems. Before it, prisms lenses had to be rotated for the aim of viewing the far periphery, and the contact lens often times had to be held with a ring on the cornea. With the advent of 23 gauge vitrectomy, 25 and 27 came afterwards and are far more used nowadays, and benefits are linked to better success rates. Intraoperative Optical Coherence Tomography assisted vitrectomies, despite expensive, are helping treat macular diseases as well as other vitreoretinopathies, giving a simultaneous visualization of the procedure of the actual surgical record comparing with the topographical cut making it more accurate to approach the retina and expecting better outcomes. Magnifying lenses and inverting image systems are applied in the management of manage macular diseases such as macular holes, epiretinal membranes and others such as proliferative vitreoretinopathy. The use of gas or silicon oils increased overtime, as well as fluorocarbon liquids, playing a very important role not only in repairing retinal detachments, but also helping the surgeon control better hard and demanding cases. Conclusions: We conclude that such a combined approach to primary pseudophakic and aphakic retinal detachments offers significant benefits to scleral buckling alone. We believe that the improved success rate is a function of vitrectomy contributing to both an improved peripheral visibility, resulting in fewer missed peripheral breaks, and a lower likelihood of proliferative vitreoretinopathy. We recommend this combined surgical approach for all primary pseudophakic and aphakic retinal detachments. We conclude that such a combined approach to primary pseudophakic and aphakic retinal detachments offers significant benefits to scleral buckling alone. We believe that the improved success rate is a function of vitrectomy contributing to both an improved peripheral visibility, resulting in fewer missed peripheral breaks, and a lower likelihood of proliferative vitreoretinopathy. We recommend this combined surgical approach for all primary pseudophakic and aphakic retinal detachments. Also, smaller gauge vitrectomies and wide angle vitrectomy viewing systems help manage tough cases with less time and better outcome, making it feasible and more cost effective in today’s vitreoretinal surgery techniques.

Biography:

Rolando Toyos is the Medical Director and Founder of Toyos Clinic. He completed his Bachelor’s and Master’s degrees from The University of California, Berkeley and Stanford University. Prior to Medical School, he was National High School Teacher of the Year. He completed his Medical degree at the University of Illinois where he was Class President and a James Scholar. He completed his Ophthalmology Residency at North-western University and Chicago Children’s Hospital before starting Toyos Clinic. He has published several books and research articles, lecturing internationally on scientific topics such as his invention Intense Pulse Light for Dry Eye.

Abstract:

Aim: Aim of this study is to determine the clinical benefits of intense-pulsed-light therapy for the treatment of dry-eye disease due to meibomian gland dysfunction.

Method: A retrospective non-comparative interventional case series was conducted on 91 patients presenting with severe dry eye syndrome (eligibility tear breakup time less than 10 seconds or patient referral). Treatment included intense-pulsed-light therapy and gland expression at a single outpatient clinic over a 30-month study period beginning from May 2009. Pre/post tear breakup time data were available for a subset of 78 patients. For all patients, a specially-developed technique for the treatment of dry eye syndrome was applied as a series of monthly treatments until adequate improvement in dry eye syndrome symptoms by physician-judgment or patient-discontinuation.

Results: Primary outcomes included change in tear breakup time by oculus non-invasive or by standard invasive using fluorescein methods, self-reported patient satisfaction, and adverse events. Physician-judged improvement in dry-eye tear breakup time were found for 68 of 78 (87%) patients with seven treatment visits and four maintenance visits on average (medians). 93% of patients reported post-treatment satisfaction with dry eye syndrome symptoms. Adverse events, most typically redness or swelling, were found for 13% of patients. No serious adverse events were found.

Conclusions: While preliminary, study results of intense-pulsed-light therapy treatment for dry eye syndrome due to meibomian gland dysfunction are promising. A multi-site clinical trial with a larger sample, treatment comparison groups and randomized controlled trials is currently underway.

Biography:

Dr. Ly T. Nguyen is a board-certified ophthalmologist that specializes in cataract, oculoplastic surgeries, and facial rejuvenation procedures. She is an internationally recognized doctor, author, and speaker. As a board certified physician by the American board of ophthalmology,

Dr. Nguyen has published numerous journal articles. Her accolades and awards also include being a recipient of the Hawaii Medical Association Alliance Endowment Award for community service and academic achievement. In addition, she was awarded the prestigious JABSOM Pacific/Asian Scholarship for academic achievement and commitment to serving the Pacific/Asian region. During her ophthalmology residency, she was awarded the Resident Research Award for excellence in ophthalmic research at the University of Colorado.

Dr. Nguyen has hospital privileges at Florida Hospitals, St. Cloud Regional Medical Center, and Orlando Regional Medical Center. She is part of the trauma team at Osceola Regional Medical Center in Kissimmee, Florida.  She currently operates at St. Cloud Regional Medical Center and Kissimmee Surgery Center. Dr. Nguyen is a volunteer faculty member at the University Of Central Florida College Of Medicine in Lake Nona. Her professional affiliations include the American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Florida Society of Ophthalmology, Osceola Council on Aging, The Association of Women Surgeons, and St. Cloud Chamber of Commerce. She has served on the board of The Vietnamese Association of Physicians, Dentists, and Pharmacists of Florida and St. Cloud Regional Medical Center Physician Leadership Group.

Abstract:

We report a patient with lattice corneal dystrophy Type I with preoperative BCVA CF @ 4 feet OS with dense posterior sub capsular cataract left eye. Patient had phacoemulsification cataract surgery with intraocular lens implant and at one-month post-operative exam had BCVA 20/30.  To our knowledge, this is the first reported successful case of cataract surgery in patient with lattice corneal dystrophy without complications such as corneal melt as reported in a case report of a patient with Lattice Corneal Dystrophy type II.

Lattice corneal dystrophy is a non-inflammatory, autosomal non-dominant, bilateral condition that involves morphologic changes in the corneal stroma.  Visual impairments associated with stromal corneal dystrophies vary widely and are determined by the amount of deposits accumulated in the cornea.  Haziness is a result of the irregular corneal surface that induces blurry vision to the patient.  Recurrent erosions, corneal melt, and prolonged healing area some of the potential risk in patient with lattice corneal dystrophy after cataract surgery.

Biography:

Rolando Toyos is the Medical Director and Founder of Toyos Clinic. He completed his Bachelor’s and Master’s degrees from The University of California, Berkeley and Stanford University. Prior to Medical School, he was National High School Teacher of the Year. He completed his Medical degree at the University of Illinois where he was Class President and a James Scholar. He completed his Ophthalmology Residency at North-western University and Chicago Children’s Hospital before starting Toyos Clinic. He has published several books and research articles, lecturing internationally on scientific topics such as his invention Intense Pulse Light for Dry Eye.

Abstract:

Over the last few years, more companies are spending more research dollars in developing new medications for dry eye disease (DED). We have completed and have several on going studies on different drops specifically designed for DED. Recently a medication, lifitegrast was approved. Lifitegrast is an anti-inflammatory drop that inhibits the binding of LFA-1 to ICAM-1 down-regulating the inflammation mediated by T lymphocytes. It is the only medication FDA approved for the signs and symptoms of DED. We will present FDA and our current research of this novel drop. We will also cover our work with platelet rich plasma eye drops, optimel, and oculocin. All work will include OSDI data, TBUT, and effects on lid margin disease.

Biography:

Daniel Valverde Solis, O.D. Optometrist Faculty of Medical Sciences University of Guayaquil, Fellow in ion Superior Publica Interamerican University of Puerto Rico , Continuing education in Optometry Clinic and Pediatric, The New England College of Optometry Boston, USA, Diploma in Higher Education, Higher Education Specialist, Master in Management in Higher Education Unit Graduate Research and Development University of Guayaquil, PHD Candidate in Atlantic International University Higher Education Honolulu - USA , CEO FALECO Latin American Faculty of Education for Eye Care, CEO Premium Team.

Abstract:

It is the only defense weapon that the human body's immune system has. Over 90% of illnesses appear when this becomes unbalanced, and even if not compensated on time, treatments for restoring health becomes longer and not the desired short term results, with high risk of recurrent clinical pictures. This gift of nature is received by each of those who have reached a pregnancy to term, and fed maternal colostrum and full breastfeeding because it is the only way of passing from mother to son and so complete mature system immature immune with which we are born, if pregnancy is not terminated, the mother does not produce maternal colostrum containing transfer factors that help to strengthen and complete the child's immune system. If a mother does not give breastfeeding to her newborn child and the baby is powered by formula, the newborn does not receive transfer factors included in maternal colostrum and certainly his immune system is not strengthened, being unprotected. Children, who have not completed the maturation of their immune system, suffer from many disorders ranging from constant colds, irritability, recurrent allergic processes, hyperactivity, slow to heal pathological processes and quickly falling in recurring pictures, turning to a vicious circle. A regular event in pediatric patients is the alteration of the ocular optical system, which can be associated or not to the alteration of the neuromuscular system, and if we have a hyperactive patient with disorder of the physiological system and if also suffering from ametropia, hyperopic undoubtedly that the symptoms presented by the patient is aggravated. Taking into consideration of this perspective, certainly we have to consider in our history orientation to seek information about the mode of delivery and initial feeding of the pediatric patient, as it would give us valuable information about the comprehensive patient health.

Biography:

Pradip Kumar Mohanta is a renowned and respected Ophthalmologist in Ranaghat, Nadia (West Bengal) and an experienced Eye Surgeon. He is proficient in all types of eye surgeries, especially phaco and vitreo-retina. He completed his MS in Ophthalmology from the Post-graduate Institute of Medical Education and Research (PGIMER) in Chandigarh. He later did a Fellowship in Vitreo Retina from Sankara Nethralaya in Chennai.

Abstract:

Many eye surgeons are extremely competent in Phacoemulsification. Many others are competent in trabeculectomy and many are not competent in both the surgeries. But to manage a patient having cataract plus open angle glaucoma simultaneously, an eye surgeon needs to develop the skill of combined surgery i.e. phacoemulsification plus trabeculectomy in the same surgical setting. In this video based presentation, combined surgery will be demonstrated with emphasis on releasable sutures to control IOP postoperatively.

Biography:

Luiz Formentin has completed his graduation in Medicine from the University Lusíada Foundation (1983) and obtained the title of specialist by the Brazilian Council of Ophthalmology in 1994. Currently, he is working as an Ophthalmologist at Eye Clinic (Santos -SP), Ophthalmologist/Director of the Therapy Center and Diagnostic Ophthalmological (Santos -SP), Ophthalmology Service Head of the Holy Hospital Amaro (Guaruja -SP), Assistant at contact lens industry and refraction of the Institute of Vision/UNIFESP, President of the ethics committee of the Hospital Santo Amaro (Guaruja -SP) and former Chairman of the Ophthalmology department of APM Santos.

Abstract:

The fitting of RGP contact lenses provides a gain in visual acuity of the patient that presents irregularities in the cornea, but these irregularities, such as a fingerprint, are different for each individual, so that the standard trial sets cannot cover all cases. The purpose of the presentation is to show how changes on the test lenses can bring results for the patient.

Method:

For example, when setting the refractive index for back surface toric lenses adjust the specific weight and change the asphericity.

Conclusion:

It is possible to achieve a good fitting with hard work and some concepts. Use specific gravity and refraction index to go up or go down the contact lenses, use refraction index near to the tear index to minimize induced astigmatism and more or less asphericity to adjust the lens on the cornea.

Biography:

Lawrence D Lampert is a developmental/behavioral Optometrist with a private office in Boca Raton, Florida. He is among only 350 in the world that has completed a fellowship in Developmental Vision.  In addition to general eye care, he works with children and adults that have visually related learning problems, develops sports vision programs for professional and amateur athletes and is on the medical staff of Pine Crest Rehab Hospital where he does Neuro Optometric Rehabilitation.

Abstract:

Vision care presently concerns itself with visual acuity, ocular health, and systemic health.  Visual Skills Training goes beyond that to include the use of vision as sense gathering information, directing action and the training of those skills. This talk will go over the rationale for and advances in visual skills training for learning, sports performance, TBI, and risk management in the areas of falls prevention, driving safety and law enforcement.

Biography:

Maria Soledad Romero is an Ophthalmologist focusing on Anterior Segment Surgery. She completed her Residency in Ophthalmology at LSU/Ochsner and then joined the Wilmer Eye Institute at Johns Hopkins University where she was an Assistant Professor in the Comprehensive Ophthalmology Service

Abstract:

Presbyopia is an aging process of the crystalline lens, and cliliary muslcle that limits the ability of achieving adequate near sightedness. Prevalence studies report that it is more common in females and in developed communities. Presbyopia has a high impact on quality of life as well as increasing concomitant financial costs. The purpose of this review is to examine and help the audience to better understand the current trends in presbyopia therapy. A detailed review of the FDA approved and off-label therapies was performed. Studies performed overseas were also a part of this review. The different modality therapies involved in this review involves standard glasses, contact lens corrections, topical instillation of eye drops as well as surgical approaches such as refractive surgery, refractive surgery combined with intraocular implants, intraocular surgery, and corneal inlays and onlays. A discusion will also be held regarding better customized treatment for those patients with underlying ocular pathology.

Biography:

Melissa Morrison Toyos is a Summa Cum Laude graduate of Louisiana State University who is a board-certified Ophthalmologist.  She joins Toyos Clinic from one of the largest practices in the country, Discover Vision Centers in Kansas City, where she was a partner. She specializes in cataract surgery, glaucoma, and cosmetic procedures of the face. She has extensive experience in the use of lasers, fillers, botox, latisse, and lid surgery to achieve facial rejuvenation.  She is the pioneer of the Mixto Laser Lift, a laser procedure that has won the International Non-Surgical Enhancement Award for the last three years.

Abstract:

Fractional continuous wave MIXTO CO2 laser resurfacing can be used in super pulse mode for incisional lid surgery including blepharoplasty with less swelling, faster healing and better hemostasis compared with blepharoplasty using Colorado tip. In this study, the author examined the efficacy and safety of incisional MIXTO fractional CO2 laser in super pulse mode in the upper lid. Standard lid measurements were performed including marginal reflex distance, palpebral fissure, and upper lid crease pre-operatively and at six weeks by the surgeon. All patients underwent MIXTO CO2 laser blepharoplasty with MIXTO Slim Evolution 2. We evaluated results at six weeks after laser treatment and found that on average after MIXTO blepharoplasty, MRD increased from baseline 0.5 mm to 2.0 mm, palpebral fissures increased from 5.2 to 6.7 mm, and upper lid crease was relatively stable going from 5.5 to 5.3 as compared to before treatment. Side effects were mild; patients reported lid swelling, mild erythema and tenderness that resolved within 10 days. This data demonstrates the safety and efficacy of non-invasive fractional CO2 laser in the treatment of mild and moderate upper eyelid dermatochalasis.

Biography:

Elise Kramer Rouimi is a residency-trained Optometrist who specializes in ocular health and disease, ocular surface disease and regular and specialty contact lens fitting. Her Doctorate degree was awarded in Optometry from the Université de Montréal in 2012 where she received a grant from the Scholarship Program of the Québec Ministry of Education for short-term university studies outside of Québec and receipt of this scholarship award is based on academic performance. In the summer of her second year, she participated in a humanitarian mission in Laayoune, Morocco where she helped hundreds of impoverished people by giving them free eye examinations and glasses corresponding as closely as possible to their prescription.

Abstract:

Aim: This case report aims to explore the use of scleral lenses for the treatment of ocular and visual complications in an adult patient presenting with post-LASIK (Laser-Assisted in situ Keratomileusis) ectasia in both eyes with cross-linking in the right eye and Intrastromal Corneal Ring Segments (ICRS; Intacs, Addition Technology, Fremont, California) in the left eye.

Methods: Following a comprehensive eye exam and specific testing for contact lens fitting, scleral lenses were fitted with success in both eyes and dispensed. Due to progressive fibrosis and neovascularization of the inferior ICRS in the left eye, the inferior ICRS was removed and scleral lenses were refit with success.

Results: Prescribed scleral lenses helped the patient achieve optimal visual correction (20/20) as well as ocular protection of the cornea.

Conclusion: Post-LASIK ectasia is a common finding among contact lens specialists today. When ICRS surgery is involved, the fitting of contact lenses may become more challenging. Scleral lenses offer a unique way of addressing many issues raised in this case report including corneal neovascularization and ectasia. This lens modality may be considered for any other case involving irregular corneal curvature following surgery resulting in reduced visual acuity.

Biography:

Melissa Morrison Toyos is a Summa Cum Laude graduate of Louisiana State University who is a board-certified Ophthalmologist.  She joins Toyos Clinic from one of the largest practices in the country, Discover Vision Centers in Kansas City, where she was a partner. She specializes in cataract surgery, glaucoma, and cosmetic procedures of the face. She has extensive experience in the use of lasers, fillers, botox, latisse, and lid surgery to achieve facial rejuvenation. She is the pioneer of the Mixto Laser Lift, a laser procedure that has won the International Non-Surgical Enhancement Award for the last three years.

Abstract:

Aim: This project was undertaken to assess the clinical value of using a new trans-scleral cyclophotocoagulation device in patients with mild to severe glaucoma including those who have unsuccessfully undergone other procedures. This is a one year update of earlier reported data.

Method: This is a single site review of 26 eyes of 20 patients; four eyes were classified as mild glaucoma, five as moderate and 18 as severe or end stage glaucoma. Two eye of one patient were lost to follow up all eyes but three had previously undergone phacoemulsification and SLT or MLT. Four eyes had previously undergone trabeculectomy.

Results: Patients undergoing the procedure had an average IOP of 25.6 and were on an average of three IOP lowering meds. After the procedure, patients were started on difluprednate hourly for the first day then tapered over three weeks. Average IOP drop at POD 1 was 20% and 34% at POD 7 (using an average 1.3 IOP lowering meds). At POD 14, average IOP from baseline was 8% using one IOP lowering medication. At one month, IOP was down by 20% and average number of IOP reducing medications was 1.2. At 6-12 months, the average IOP lowering was 30% compared with baseline IOP on and average of 1.8 medications. There were no serious adverse events.

Conclusion: Patients with glaucoma of varying severities are able to safely undergo trans-scleral cyclophotocoagulation. On average, IOPs were reduced by 30% over one year time and number of IOP lowering medications was reduced by 60%. Further study is required to determine ideal treatment guidelines.

Biography:

Arun C Gulani, MD, MS, is an internationally recognized, board-certified Ophthalmologist and the Founder of the Gulani Vision Institute, a state-of-the-art LASIK and cataract eye surgery facility serving the needs of patients from Northeast Florida and throughout the world. As a renowned vision correction expert, he specializes in both cataract and laser vision correction surgeries. He has been listed in Forbes magazine as one of the "Top Ten Laser Eye Surgeons" in the entire country. He is widely regarded as a "Doctor's Doctor." Over the course of his career, he has been honored with awards from the American Society of Cataract and Refractive Surgery, the Business Journal, Becton Dickinson, Bausch & Lomb and many other organizations. He is regularly invited to teach eye surgeons at major conferences and specialized forums around the world. His prominent standing in the field of eye surgery is well balanced by his impeccable bedside manner and gentle touch, which continue to attract vision correction patients from around the world.

Abstract:

Aim: To assess the benefits of the ReSure Sealant in cataract patients who have previously undergone post-radial keratotomy (RK) surgery.

Methods: Seven patients (nine eyes) of average age 66 years were examined at a single site following coaxial phacoemulsification clear corneal cataract surgery in patients with previous RK surgery ranging from 8 to 20 cuts. A median of 2.8 mm biplane incisions were used across the population. Following toric lens implantation, the sealant was painted over the incision, and allowed to polymerize for 30 seconds. Patients were evaluated at one day and one month for wound healing and adverse events.

Results: At post-operative day one, IOP presented at a mean 15 mm Hg. Mean UVA for five eyes was recorded at 20/60-(two eyes with maculopathy excluded). No fluid egress was noted and all wounds were stable. At one month, mean UVA stabilized at 20/30 with mean spherical equivalent improvement of 73%. No adverse events were noted and patients were comfortable overall with a comfort survey of 10/10.

Conclusion: Fragility of the cornea in post-RK patients may lead to excess edema, perforations, hyperopic shifts, or against-the-rule astigmatism. Although sutures have previously been utilized in these patients to stabilize the wound post-operatively, they can induce additional adverse events. The sealant proved safe and effective for wound closure in post-RK patients.

Biography:

Viral Kansara is Investigator and Head of Ocular Pharmacology and Drug Delivery Laboratory in the Ophthalmology department at Novartis Institutes for Biomedical Research, Inc. He has over 10 years of combined industry and academia experience and expertise in the field of “Ocular drug discovery, delivery and drug development”. At Novartis, his lab focuses on “The discovery and development of novel treatment therapies” for blinding diseases such as macular degeneration, diabetic retinopathy and glaucoma.

Abstract:

The field of sustained ocular drug delivey has seen remarkable innovations in the last decade. Many ocular blinding diseases require a chronic, in some cases lifelong treatment, and hence an unmet medical need for sustained ocular delivery technologies is becoming more evident. Recent advancements in novel drug delivery technologies have opened a new avenue in the field of sustained ophthalmic products. An integrative ocular drug delivery approach involvolving discovery scientists, pharmacologists, polymer chemists, clinicans, toxicologists and regulatory agenices is a paramount to the success of the sustained ocular delivery system. This talk will focus on key barriers and factors affecting ocular drug delivery, and strategies to overcome these barriers. Various routes of ocular drug administration and challenges associated with current strategies will be discussed in details. Key pharmacokinetic princiles and pharmacological considerations for developing successful sustained ocular delivery products will be presented. Recent advancements and future opportunities and a few success stories in the field of sustained drug delivery to the eye will also be discussed.

Biography:

Cesar Gomezperalta is a Senior Consultant Eye Surgeon in the field of Cornea, Cataract and Refractive Surgery at Angeles Lomas Hospital in Mexico City. He specializes in Lamellar Corneal Transplant and Ocular Reconstruction. He is the Founder and Director of Vision-Percepcion heading the Keratoconus and Corneal Transplant Clinic. He is the Chairman of the World Wide Alumni of the Singapore National Eye Centre and was appointed Chairman for the 2013 world meeting of the World Association of Eye Hospitals. He received his Medical Degree from the Anahuac University School of Medicine and then trained in General Surgery & Laparoscopy at the American British Cowdray Hospital. He completed his Ophthalmology residency at the Lopez Mateos Regional Hospital and visited as a fellow the Wolfe Clinic in Iowa, USA. He then spent a few years specializing in Cornea, Cataract and Refractive Surgery at the Singapore National Eye Centre in Singapore, where he also gained experience in Ocular Surface Reconstruction and Artificial Corneas.

Abstract:

Corneal transplantation has been around for many years.

Understanding of the corneal anatomy and physiology through decades of worldwide research has given the steps to an enormous evolution in techniques and technology which has made corneal microsurgery more precise and reproducible. From rudimentary trephines and instruments to microqueratomes and now day’s femtosecond lasers. Even more, the possibility of a full visual recovery combing corneal, anterior segment and refractive surgery is an everyday possibility.

Here we discuss the combination of current technology, techniques and knowledge for optimal corneal transplantation and ocular reconstruction.

Biography:

Hudson Nakamura is a Medical Specialist in Ophthalmology and specialized in Retina and Vitreous. He has completed his School of Medicine at the Federal University of Goiás – UFG and residency from the Base Hospital of the Federal District - Brasília - DF. Presently, he is the member of American Academy of Ophthalmology, Brazilian Council of Ophthalmology, Canadian Society of Ophthalmology and also the member of most prestigious society ARVO - The Association for Research in Vision and Ophthalmology United States. Currently, he is working as a Professor in Department of Retina and Vitreous Course of Medical Residency in Ophthalmology at the Bank of Goias Eye Foundation and is also working as Specialist in Vitreoretinal Disease Fellowship - University of Toronto Canada, Specialist in Ophthalmology - University of Toronto Canada, Specialist in Vitreoretinal Disease Fellowship - Brazilian Center for Eye Surgery.

Abstract:

Age related macular degeneration is a common cause of blindness, evident with many clinical distinct signs, such as sub retinal neovascular membrane (SRNM) causing metamorphosis and visual acuity loss; there are several treatment options, to reduce its devastating visual effects. The treatment of SRNM in the past was solely relied upon laser photocoagulation of the membrane, reducing the risks of visual loss when treated without much delay. On the other hand, if the membrane treated was located in the foveal area, the outcome was bad despite treatment, because most of the times the photoreceptors and other retina cells were damaged in the macular area. Laser used to be applied in the macula, and despite the reason was to halt the process of membrane evolution, the patient lost visual acuity immediately after the foveal laser, but MPS (Macular Photocoagulation Study) studies realized that within a couple of years the contrast sensitivity got better rather if the lesion was not treated. Of course nowadays we do not laser the fovea. Other recent studies that come on the way until today show how the involvement of pharmacology and the numerous labs may contribute to the success of the treatment. Treatments such as PDT (Photodynamic Therapy) with the use of verteporfin (visudyne), which was used together with the PDT treatment protocol for stimulating the action of the drug through this non thermal laser pathway acted shrinking the size and inhibiting the spreading and growth of the membrane; another option applied was TTT (Trans pupillary Thermotherapy), with non-thermal laser, played a role towards the treatment of the membrane; last but not least on the list was surgical treatment was attempted, with the use of special cannulas underneath the retina to actually remove the sub retinal membranes; macular translocation, withdrawing the membrane area from the macular center, rotating good retina do override the retinal pigment epithelium, but bad results and outcomes contributed to the discontinuation of these procedures. Clinical research on pharmacology and the ARMD pathogenesis came up with the targeted cause of these lesions that is VEGF (vascular endothelial growth factor), responsible for the membrane formation and the process of angiogenesis. Development of pharmacological treatment for the membrane came to the most evolving drugs used in ophthalmology today, ranging from pegaptanib sodium (Macugen), FDA approved, to the off label bevacizumab (Avastin), largely employed. Ranibizumab (Lucentis) is largely also used for the treatment of the disease, and Aflibercept (Eyelid) was approved for several diseases, many drugs also included in protocols for diseases different from ARMD. Corticosteroids were far more developed these days for the treatment of ARMD, to mention triamcinolone acetate, Ozurdex (dexametasone implant), and Illuvien (fluocinolone acetone) these last two mentioned drugs being delivered as intravitreal implant different from the others mentioned, delivered as injections. Other drugs are in the way of development. Several studies concerning the use of intraocular anti-VEGF (anti-vascular endothelial growth factor) drugs proved to show great results and membrane shrinking to the point of complete resolution. Usually many of those studies show that after one year duration treatment, and some protocols advise monthly injections, the treatment could be performed as necessary, with larger intervals between sessions. Other drugs are still under investigation and development, but we already have had good results with the approved worldwide medication for the moment.

Biography:

Richard Michael Faris is pursuing his Master of Science in Organizational Development. The curriculum at Regis University compliments his work in disruptive technologies and application of telemedicine. He is the President of Global∑os Inc. an international consulting service.

Abstract:

Innovation and technology have major impacts on ophthalmology with future implications, particularly 3D printing. The advancements in 3D printing are transforming ophthalmology approach to business. Boroujerdi (2014) states “3D printing offers the potential for high degrees of customization, reduced costs for complex designs, and lower overhead costs for short-run parts and products”. Understanding impacts require putting 3D printing into a contextual evaluation and understanding what 3D printing is and how it works. 3D impacts on healthcare put future influences into perspective for ophthalmology. Understanding 3D influences requires comprehension of breakthrough and disruptive technology and the potential for creative destruction. Furthermore, current uses include 3D printable contact lenses, surgical planning, patient education, and retinal imaging adapter that the FDA approved in 2013. Looking towards the future of 3D printing includes a cure for blindness, visual implants, and a functional human eye implant. Potential impacts of 3D require overcoming major challenges. Understanding the challenges and the potential for a pioneering approach to the issues can points to the speed of future development.

Biography:

Mike Cohen served three major corporations in senior management as a professional service executive with international leadership in retail optical, corporate-affiliated eye care and managed vision care following private practice and ophthalmology administration. After retirement, he has utilized his experience, strong business and marketing orientation to develop MLC Medical, LLC; an incubator designed to innovate ophthalmic devices and understand the ever-changing needs and concerns of eye care professionals.

Abstract:

Intraocular pressure (IOP) is only one of many diagnostic test used to determine if a patient has one of the glaucomas. However, controlling IOP is the only successful outcome- no matter what tool is in the ophthalmic plumber’s kit. As far back as the October 2003 issue of eye world, in an article titled, “Wanted: Reliable home tonometer,” the author, Rich Daly wrote, “A take-home tonometer that could reliably measure diurnal IOP fluctuations is the missing link in attempts to control glaucoma progression.” That was over a decade ago, and today we do not have one do-it-yourself instrument that could easily be used by the patient at home to measure their own pressures. In the future, some younger OD residents may ask: “I hear that there was a time when glaucoma diagnosis and treatment relied exclusively on IOP measurements once every three months, if not just yearly…is that true?” The honest response will be, “Yes, very few if any of us did serial tonometry”. The truth is that we measure IOP infrequently, usually once every time a patient visits the office. If the IOP measurement is within an acceptable range, it will be evaluated once again after several months or, in many cases, only after years. We record the time and date, because we test at any time during the day, according to the patients’ convenience and the time of follow-up visit. Even though we know that this is what usually happens today, there is wide-ranging evidence that IOP fluctuates considerably during the 24-hour diurnal variation period, may be rather different in the prone rather than sitting position, higher in the early morning hours and subject to at least three different three types of IOP fluctuations: ultrashort-term that happen in minutes; short term that occur over hours to a few days and; long term. Unquestionably, due to the variations in IOP and from evidence emerging from studies, this isn’t sufficient. In most cases, we can only guess what the real IOP of the individual patient may be.

Biography:

Maneli Mozaffarieh is a Glaucoma Specialist who completed her specialization with Prof. Josef Flammer, former Head of the Department of Ophthalmology at the University of Basel. She currently teaches at the University of Basel and works clinically at the Augenglattzentrum in Zurich.

Abstract:

The pathogenesis of retinal vein occlusions remains to be solved. Mechanical compression of the vessel wall or thrombotic occlusion of the vessel lumen sometimes, combined with rheological disorders are often assumed mechanisms. Accordingly, the therapy also either relies on mechanical decompression, lysis of thrombi or improvement of the rheology. Yet the pathophysiological concepts described in the literature so far covers some aspects of the disease, they do not sufficiently explain all the phenomena. A number of observations as for example, the occurrence of RVO in younger patients without any signs of atherosclerosis, spontaneous reversibility particularly in young patients, occlusion despite anti coagulation or thrombocytopenia and finally the positive effect of anti-VEGF therapy are not explained by the present pathogenetic concept. As a new concept, we previously proposed a local venous constriction induced by vasoactive molecules diffusing from neighboring diseased arteries and/or from neighboring (hypoxic) tissues.