A recent “global trends” survey, moderated by Dr. Kourous A. Rezaei, ASRS International Affairs Committee Member and retinal physician at Illinois Retina Associates, has revealed significant discrepancies in practice between retina specialists in the United States and those in other regions. The survey gathered responses from over 1,100 retina physicians from a total of 40 medical societies, including the American Society of Retina Specialists.
The results revealed that retina specialists in the United States take a different approach to managing endophthalmities after intravitreal injection, compared with physicians in nearly every other global region.
“This, I think, is a big discrepancy between the U.S. and Europe,” says Dr. Rezaei in a recent article, “and also almost the rest of the world, where most of them do vitrectomy.”
72% of U.S. respondents said they would handle such cases with a tap and inject strategy. In every other region, less than 50% of respondents gave the same response. In most regions, pars plata vitrectomy is the most commonly used treatment strategy.
This wasn’t the only survey question to illustrate a difference between the US and the rest of the world. Another question asked whether visual acuity improves then stabilizes, or improves before declining in patients on long-term VEGF therapy. A majority of US respondents, 64.1%, said that visual acuity stabilized.
“This is the opposite of what the real-world data indicate,” notes Dr. Rezaei. To view the full survey, click here.Continue reading
Dr. Dante J. Pieramici explores ophthalmologic history and the evolvement of ophthalmologic surgery in his recent Retina Today article entitled, “Managing Severe Open Globe Injuries Through the Years.”
For most of human history, open globe injuries — severe full thickness defects of the eye wall caused by traumatic injury —meant losing the affected eye or its vision. Lacerations, ruptures, perforation, or penetration of the eye made it impossible to restore vision, and surgical techniques put the patients in danger of infection and other severe complications. The prognosis for open globe injury patients prior to the mid-20th century was grim.
Today, advances in modern medicine have supplanted the pigeon blood, leeches, medicinal herbs, and other treatments that were the only recourse for ancient, medieval, and early modern physicians. By the 19th century, enucleation became a favored technique, as pioneered by George Lawson. The early 20th century brought advancements in X-ray imaging and magnetism, improving the ability to remove intraorbital foreign objects — especially those that were ferromagnetic — through a scleral incision.
Dr. Dante J. Pieramici is a retina specialist and partner at California Retina Consultants and Director of the California Retina Research Foundation. His recent article is the first in a series, which will continue to detail the history of open globe injury management. You can read the full article here: http://retinatoday.com/2016/06/managing-severe-open-globe-injuries-through-the-years/.Continue reading
Last month, Dr. Alan Kimura of Colorado Retina Associates attended the Colorado Society of Eye Physicians & Surgeons’ (CSEPS) Day at the Capitol. This event, organized by glaucoma specialist Dr. Leo Seibold of the University of Colorado School of Medicine, is designed to provide an opportunity for optometrists, ophthalmologists, and retina specialists to meet with state legislators at the Capitol.
This advocacy event brings together eye physicians from across the state, including many young physicians with a strong interest in advocacy. Among the attendees were Drs. Cara Capitina and Gabriela Rodriguez-Colon, the 2016 ambassadors for the American Academy of Ophthalmology’s Mid-Year Forum for Advocacy.
During the CSEPS Day at the Capitol, Dr. Kimura and his colleagues met with state legislators, including Colorado state representative Beth McCann. Among the topics discussed were scope of practice for optometry, the Surgical Scope Fund, and how beginning ophthalmologists can get involved in advocacy efforts.
Dr. Kimura is one of two physicians that lectures to ophthalmology residents at the University of Colorado. He focuses on incorporating advocacy topics into his interactions with these young physicians. “I always weave in population health, the patient experience of care, and costs into my retina lectures to them,” he reports. “Residency is the ideal time to speak about advocacy, for once residents are out of training and just starting their practice, it is very challenging to get them to take even a day off of work.”
Events like the CSEPS’s Day at the Capitol provide a prime opportunity for retina specialists and other eye physicians to connect with legislators to advocate for policies that improve the quality and availability of ophthalmologic care for patients. You can find out more about the event here: http://retinacolorado.com/practical-lessons-leadership/.Continue reading
Traditionally, the imaging and examination of macroscopic features has been instrumental in the early detection and treatment of retinal disease. Features such as arterial narrowing, arterial nicking, hemmorhages, and microaneurysms are key signifiers of retinal damage, often secondary to common health conditions such as progressive cardiovascular disease or diabetes mellitus.
In addition to these macroscopic signs of retina disease, recent developments in imaging technology have begun to enable clinicians and researchers to examine microscopic features of the retina in increasing resolution and detail. One promising emerging technology for non-invasive imaging of the retinal microvasculature is adaptive optics light scanning ophthalmoscopy (AOSLO). AOSLO uses deformable mirrors to correct for ocular aberrations, allowing for non-invasive imaging of nerve fibers, retinal microvasculature, photoreceptors, retinal pigment epithelium, and lamina cribosa.
One of the key advantages of AOSLO is its non-invasiveness. This makes it highly useful for early screening and detection of retina disease, which allows for earlier intervention and better clinical outcomes. For that reason, continuous improvement of AOSLO technology is of great value for retina specialists.
In a recently published review of the clinical literature in the International Journal of Retina and Vitreous, the current state of AOSLO for microvascular retinal imaging is assessed in detail. Key clinical applications include diagnosis of diabetic retinopathy, retinal vein occlusion, and sickle cell disease. The ability to image the retina in increasingly high resolution has opened up new possibilities for identifying clinical biomarkers, enabling early detection of retinal disease, and improving clinical outcomes through earlier intervention.
Diabetic retinopathy, which can remain asymptomatic for years before visual abnormalities develop, has traditionally been diagnosed by detecting microangiopathy. However, histologic studies have demonstrated characteristics such as pericyte loss and basement membrane thickening. The currently available imaging modalities are not capable of detecting these histological changes, and to date, they have essentially been considered subclinical.
New developments in AOLSO have begun to facilitate the imaging of these structures. Studies using AOSLO have already been able to image these subclinical changes in vivo. This allows for the measurement of structural changes in aging healthy patients and those in the early stages of diabetic retinopathy, representing clinical biomarkers that could enable much earlier diagnosis and treatment.
The resolution of which AOSLO is capable is unprecedented, allowing physicians to image the vascular network down to the capillary level. This technology holds promising potential for enabling early detection of retina disease biomarkers, as not only is it non-invasive, but it allows for the imaging of microscopic signs of early retina pathology.
For more information on recent developments in adaptive optics light scanning ophthalmoscopy, you can read the full review here: Human retinal microvascular imaging using adaptive optics scanning light ophthalmoscopy.Continue reading
In May 2016, Dr. Joseph M. Coney, a retina specialist at Retina Associates of Cleveland, embarked on the first of many upcoming humanitarian mission trips to Port au Prince, Haiti. Dr. Coney, who serves as president of both the Cleveland Ophthalmological Society and the Ophthalmology Section of the National Medical Association, has agreed to a multi-year commitment to help train qualified local Haitian ophthalmologists in retina surgery techniques, addressing a previous lack of retina specialists in the country. Through Dr. Coney’s work, Haitian patients will be able to have access to retina surgeries that were previously unavailable in the region, helping restore eyesight in patients with retinal disease and vision impairment.
Training Haiti’s First Retina Surgeons
In the developing nation of Haiti, access to medical care is often quite limited. Currently, there are no retina surgeons in Haiti. Dr. Coney’s mission aims to change that. This humanitarian project is made possible by both SEE International and the Alcon Foundation. SEE International works with volunteer ophthalmic surgeons like Dr. Coney to provide medical, surgical, and educational services in developing countries, and donated surgical equipment to help make Dr. Coney’s work possible.
The goal of Dr. Coney’s humanitarian mission to Haiti is to train qualified local ophthalmologists in retina surgery, introducing new tools and techniques to restore sight in patients with retina disease. Thousands of Haitians suffer from common diseases of the retina, such as age-related macular degeneration. In the past, a lack of trained retina surgeons and necessary equipment has left these patients with debilitating visual impairments.
A Brighter Future for Haitian Retina Patients
Over the next few years, Dr. Coney will continue to make periodic mission trips to Haiti to provide retina surgery training. The undertaking will allow local ophthalmologists to provide sight-restoring surgeries that were previously completely unavailable, helping restore eyesight in patients whose retinal vision impairments were previously untreated.
“All you have to do to be successful in medicine is to do what is best for your patients.” Dr. Paul E. Tornambe received this advice from his father, a primary care physician, and it has been a lifelong influence on his career.
Dr. Tornambe, a retina specialist at Retina Consultants San Diego, has spent much of his life pioneering new surgical techniques and medical technologies to advance retinal medicine and improve patient outcomes. From surgical instruments like the Tornambe torpedo light, to his influential work with pneumatic retinopexy, Dr. Tornambe has made considerable contributions to retinal medicine. Foremost among these has been his work with macular hole surgery without face-down positioning.
A New Approach to Macular Hole Surgery
Among his important contributions has been pioneering macular hole surgery without the typical face-down posture. In the 1990s, Dr. Tornambe and two colleagues published a groundbreaking paper in Retina, titled “Macular hole surgery without face-down positioning: a pilot study.” In this study, the first of its kind, Dr. Tornambe and his colleagues questioned whether postoperative face-down positioning was really necessary. Although face-down positioning was considered to be important for successful macular hole closure, this had never been conclusively proven.
In the Retina study, Dr. Tornambe and his coauthors examined a total of 33 eyes in 31 patients aged 65-79. None of the patients in the study were positioned face-down. Over a follow-up period ranging from 6 to 40 months, with 73% of the patients observed for over a year, the success rate after one surgery was 79%. After additional vitrectomy surgery, the success rate rose to 85%.
The results of the pilot study illustrated that successful macular hole closure was, in fact, possible without the usual face-down positioning, which can be a significant inconvenience for patients with pseudophakic and phakic eyes.
Today, 26 years later, Dr. Tornambe continues to advocate for macular hole surgery without face-down positioning, especially for patients over 50, who nearly always require cataract surgery within a few months to a few years of a vitrectomy. Today, retina surgeons around the world have adopted Dr. Tornambe’s approach, foregoing unnecessary face-down posturing in the majority of older patients.Continue reading
In the May 2016 issue of Ophthalmology Management, Dr. Logan Brooks and Dr. Andrew D. Hsia of Southern Vitreoretinal Associates have co-authored an article: “Retina issues could undo even the best preparations.”
In the article, Dr. Brooks and Dr. Hsia emphasize the importance of a thorough exam of the posterior segment prior to cataract surgery, including the performance of an OCT to detect subtle signs such as vitreomacular traction or macular thinning due to ischemia. In patients whose mature cataracts interfere with a clear view of the retina, ultrasound should be performed. Up to 20% of patients with mature cataracts also have posterior segment abnormalities, especially those under 50 years of age, those with diabetes and those with a history of trauma.
In the past, patients referred to a retina specialist with an unsatisfactory outcome after cataract surgery have frequently been found to have a macular hole or macular degeneration, contributing to their unmet expectations for vision improvement. Addressing retinal conditions prior to cataract surgery can improve outcomes for these patients, preventing an unsatisfactory degree of visual improvement after the surgery.
You can read the full article here or find it below.Continue reading
On June 11, 2016, Retina Associates of Cleveland will team up with The Retinal Vascular Foundation to host a Retinal Informational Seminar. The seminar, which is free and open to the public, will center around the latest developments in retina research and treatments, along with low vision solutions.
At the seminar, physicians from Retina Associates of Cleveland will offer question and answer sessions for from both patients and physicians. Three retina specialists from Retina Associates of Cleveland will also present four talks on current developments in retina diseases and treatments.
About the Seminar
Interested in attending? Early registration is encouraged due to limited seating.
When: 8:00 AM to 12:00 PM, Saturday June 11, 2016.
Where: Corporated College East, 4400 Richmond Road, Warrensville, OH 44128
Three accomplished retina physicians from Retina Associates of Cleveland will be presenting talks at the Retina Information Seminar, along with Deborah Kogler, LDO, a low vision expert at the Macula Vision Research Foundation.
Dr. Lawrence J. Singerman – “Macular Degeneration”
Dr. Lawrence Singerman will be presenting a talk about macular degeneration at the upcoming seminar. Trained at the Wilmer Eye Institute at Johns Hopkins, Dr. Singerman has contributed significantly over the course of his career to macular degeneration research and clinical trials, along with research into other retinal diseases. Over the years, he has acted as a principal researcher in over 100 multicenter clinical trials, many of which have led to the FDA approval of new drugs for macular degeneration, diabetic retinopathy, and other diseases of the retina.
Dr. Joseph M. Coney – “Diabetic Retinopathy”
Dr. Joseph Coney is an accomplished physician and researcher, with a career-long focus on diabetic retinopathy. A Harvard alumnus, Dr. Coney completed his fellowship in diabetic retinopathy at the Joslin Diabetes Clinic of Harvard Medical School in Boston. An accomplished clinical researcher, Dr. Coney has been an investigator in over 65 research studies for treatments of diabetic retinopathy, along with other retina conditions. Recently, his accomplishments have been recognized in Cleveland Magazine, where he was listed among America’s Top Doctors for 2015-2016.
Dr. Shawn Lewis – “Other Retinal Diseases”
Dr. Shawn Lewis will be presenting a talk that covers a range of retinal diseases, including retinal detachment, age-related macular degeneration, and other conditions. Dr. Lewis is an accomplished retina specialist, and completed his vitreoretinal surgery fellowship at the University of Chicago.
Reserve Your Seat Today
If you’re interested in attending the Retina Information Seminar, you can RSVP by calling 1-216-831-5704.
Dr. Mark Dacey of Colorado Retina Associates has published a paper in the April 2016 edition of The American Journal of Ophthalmology. The paper, a retrospective observational case series, is entitled “Dexamethasone Intravitreal Implant in the Treatment of Uveitic Macular Edema in the Peri-operative Cataract Setting: A Case Series.”
Dr. Dacey is a nationally renowned ocular immunology and uveitis specialist, as well as an active researcher who regularly contributes to the clinical literature. Over the course of his medical career, he has published numerous articles about ocular inflammatory diseases and treatments.
Clinical Findings: DEX Implants for Uveitic Macular Edema
In Dr. Dacey’s most recent paper, he his two coauthors evaluated the efficacy of the Ozurdex dexamethasone intravitreal implant in patients with uveitic macular edema in the perioperative setting of cataract surgery.
In the study, they examined a set of patients who underwent phacoemulsification within four months of receiving a DEX 0.7 mg implant. Ocular coherence tomography was used to measure change in central macular thickness as a measure of outcome.
Dr. Dacey and his coauthors found that the dexamethasone intravitreal implant prevented the worsening or recurrence of macular edema in the uveitis patients who underwent the procedure up to 4 weeks prior to phacoemulsification surgery.
You can read the abstract of the study below. The full text of the article from The American Journal of Ophthalmology is available here for subscribers.Continue reading
The study “evaluated the occurrence, management and clinical significance of increases in intraocular pressure in individuals with diabetic macular edema treated with dexamethasone intravitreal implant.”
Dr. Maturi is a nationally known retinal physician that performs surgeries and laser therapies at Midwest Eye Institute. Dr. Maturi is actively involved in vitreoretinal research and has been published in numerous respected ophthalmology and retina journals throughout his career. He teaches and assists physicians worldwide as a consultant at ORBIS as well as physicians in training at Indiana University.
Read the study by Raj K. Maturi M.D. in Review of Ophthalmology or find the full-text below:
IOP in DME Subjects Treated With DEX Implant: Three-year Study
Investigators evaluated the occurrence, management and clinical significance of increases in intraocular pressure in individuals with diabetic macular edema treated with dexamethasone intravitreal implant, as part of a randomized, multicenter, three-year Phase III study.
Those (n=1,048) with diabetic macular edema were randomized to 0.7-mg DEX implant; 0.35-mg DEX implant; or sham procedure with retreatment allowed at ≥six-month intervals (seven injections maximum).
Investigators observed ≥10-mmHg IOP increases from baseline in: 27.7 percent of the 0.7-mg DEX implant group; 24.8 percent of the 0.35-mg DEX implant group; and 3.7 percent of the sham group. Frequency did not increase with repeat injections. IOP-lowering medication was used by 41.5 percent of 0.7-mg DEX implant subjects; 37.6 percent of 0.35-mg DEX implant subjects; and 9.1 percent of sham subjects. Only one individual (0.3 percent) in each DEX implant group had filtering surgery to manage a steroid-induced IOP increase. Among 0.7-mg-treated DEX implant subjects, 21.9 percent (21 of 96) of those with a ≥10-mmHg IOP increase, and 22.4 percent (57 of 255) without a ≥10-mmHg IOP increase achieved ≥15-letter best-corrected visual acuity gain. Mean average change in central retinal thickness from baseline was -127 µm in those with a ≥10-mmHg IOP increase; and -106 µm without a ≥10-mmHg IOP increase.
Investigators found DEX implant demonstrated clear treatment benefits despite IOP increases. Sequential implants had no cumulative effect on IOP.
SOURCE: Maturi, Raj K. MD; Pollack, Ayala MD; Uy, Harvey S. Intraocular pressure in patients with diabetic macular edema treated with dexamethasone intravitreal implant in the 3-year mead study. Retina. 2016;Feb 11 [Epub ahead of print].Continue reading