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

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.