Pub Date : 2017-01-01DOI: 10.17925/USOR.2017.10.01.27
P. Tornambe
I n the current costand resource-constrained healthcare environment in the United States, characterized by declining government reimbursement and increased utilization scrutiny by managed care plans, providers are challenged to continue delivering quality care to more patients while also more effectively managing practice economics. Employing technology to improve practice efficiency is one of the most promising solutions to this dilemma. We have demonstrated that the integration of ultra-widefield (UWF) retinal imaging in our practice is cost-effective. It has allowed us to increase the number of patient encounters while simultaneously raising the quality of care, and increasing patient satisfaction.
{"title":"The Impact of Ultra-widefield Retinal Imaging on Practice Efficiency","authors":"P. Tornambe","doi":"10.17925/USOR.2017.10.01.27","DOIUrl":"https://doi.org/10.17925/USOR.2017.10.01.27","url":null,"abstract":"I n the current costand resource-constrained healthcare environment in the United States, characterized by declining government reimbursement and increased utilization scrutiny by managed care plans, providers are challenged to continue delivering quality care to more patients while also more effectively managing practice economics. Employing technology to improve practice efficiency is one of the most promising solutions to this dilemma. We have demonstrated that the integration of ultra-widefield (UWF) retinal imaging in our practice is cost-effective. It has allowed us to increase the number of patient encounters while simultaneously raising the quality of care, and increasing patient satisfaction.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"10 1","pages":"27"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67620575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USOR.2017.10.02.93
J. Mehta
C orneal transplantation has changed rapidly over the last 20 years. In spite of the fact that endothelial keratoplasty has become the most dominant procedure, deep anterior lamellar keratoplasty (DALK), the anterior lamellar procedure, has not become so popular. There are several reasons for this, and this editorial will attempt to give some useful tips, that may not be found in papers or books, in the hope of helping people performing or starting off on their DALK journey.
{"title":"The ABCD of DALK","authors":"J. Mehta","doi":"10.17925/USOR.2017.10.02.93","DOIUrl":"https://doi.org/10.17925/USOR.2017.10.02.93","url":null,"abstract":"C orneal transplantation has changed rapidly over the last 20 years. In spite of the fact that endothelial keratoplasty has become the most dominant procedure, deep anterior lamellar keratoplasty (DALK), the anterior lamellar procedure, has not become so popular. There are several reasons for this, and this editorial will attempt to give some useful tips, that may not be found in papers or books, in the hope of helping people performing or starting off on their DALK journey.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"10 1","pages":"93"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67620392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USOR.2017.10.01.13
M. Farid
Received: February 6, 2017 Published Online: February 23, 2017 Citation: US Ophthalmic Review, 2017;10(1):13–4 Corresponding Author: Marjan Farid, MD, University of California-Irvine, Gavin Herbert Eye Institute, 850 Health Sciences Road, Irvine, CA 9269, US. E: mfarid@uci.edu The role of secondary intraocular lens (IOL) implantation has evolved. Following advances in cataract surgery, surgical aphakia is becoming uncommon, and secondary IOL implantation is now most commonly performed as part of an IOL exchange procedure. A number of techniques and IOLs are available for secondary IOL implantation, and debate persists regarding which methods are best for eyes lacking sufficient capsular support. It is therefore important to consider specific techniques, choice of IOL, sutures, and medication regimens, in order to tailor the approach to the individual patient. In an expert interview, Marjan Farid of Gavin Herbert Eye Institute discusses the optimal use of some of the most widely used techniques.
{"title":"Pearls for Secondary Intraocular Lens Implantation","authors":"M. Farid","doi":"10.17925/USOR.2017.10.01.13","DOIUrl":"https://doi.org/10.17925/USOR.2017.10.01.13","url":null,"abstract":"Received: February 6, 2017 Published Online: February 23, 2017 Citation: US Ophthalmic Review, 2017;10(1):13–4 Corresponding Author: Marjan Farid, MD, University of California-Irvine, Gavin Herbert Eye Institute, 850 Health Sciences Road, Irvine, CA 9269, US. E: mfarid@uci.edu The role of secondary intraocular lens (IOL) implantation has evolved. Following advances in cataract surgery, surgical aphakia is becoming uncommon, and secondary IOL implantation is now most commonly performed as part of an IOL exchange procedure. A number of techniques and IOLs are available for secondary IOL implantation, and debate persists regarding which methods are best for eyes lacking sufficient capsular support. It is therefore important to consider specific techniques, choice of IOL, sutures, and medication regimens, in order to tailor the approach to the individual patient. In an expert interview, Marjan Farid of Gavin Herbert Eye Institute discusses the optimal use of some of the most widely used techniques.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"10 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67620456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USOR.2017.10.01.35
P. Asbell, C. Sanfilippo
A ntibiotic resistance among ocular pathogens is a public health concern. The multicenter, prospective Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study is an ongoing surveillance study designed to report on antibiotic resistance rates and trends among Staphylococcus aureus, coagulase-negative staphylococci (CoNS; includes Staphylococcus epidermidis), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae isolates from ocular infections. Results for more than 4,000 isolates collected from 2009 –2015, representing 7 years of ARMOR, were recently presented. More than a third of S. aureus and almost half of all CoNS isolates were found to be resistant to methicillin. Staphylococcal isolates also showed high levels of multidrug resistance (resistance to ≥3 antibacterial drug classes) with 76.4% and 73.7% of methicillin-resistant S. aureus (MRSA) and methicillin-resistant CoNS (MRCoNS) isolates, respectively, demonstrating multidrug resistance. Resistance among S. pneumoniae was notable for azithromycin (36.8%) and for penicillin (34.0%), whereas P. aeruginosa and H. influenzae were generally susceptible to the antibiotic classes tested. Longitudinal analyses demonstrated a small decrease in methicillin resistance among S. aureus over the 7-year study period, which may be a result of improved antibiotic stewardship. Continued surveillance of antibiotic resistance among ocular pathogens is warranted.
{"title":"Antibiotic Resistance Trends Among Ocular Pathogens in the US—Cumulative Results from the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) Surveillance Study","authors":"P. Asbell, C. Sanfilippo","doi":"10.17925/USOR.2017.10.01.35","DOIUrl":"https://doi.org/10.17925/USOR.2017.10.01.35","url":null,"abstract":"A ntibiotic resistance among ocular pathogens is a public health concern. The multicenter, prospective Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) study is an ongoing surveillance study designed to report on antibiotic resistance rates and trends among Staphylococcus aureus, coagulase-negative staphylococci (CoNS; includes Staphylococcus epidermidis), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae isolates from ocular infections. Results for more than 4,000 isolates collected from 2009 –2015, representing 7 years of ARMOR, were recently presented. More than a third of S. aureus and almost half of all CoNS isolates were found to be resistant to methicillin. Staphylococcal isolates also showed high levels of multidrug resistance (resistance to ≥3 antibacterial drug classes) with 76.4% and 73.7% of methicillin-resistant S. aureus (MRSA) and methicillin-resistant CoNS (MRCoNS) isolates, respectively, demonstrating multidrug resistance. Resistance among S. pneumoniae was notable for azithromycin (36.8%) and for penicillin (34.0%), whereas P. aeruginosa and H. influenzae were generally susceptible to the antibiotic classes tested. Longitudinal analyses demonstrated a small decrease in methicillin resistance among S. aureus over the 7-year study period, which may be a result of improved antibiotic stewardship. Continued surveillance of antibiotic resistance among ocular pathogens is warranted.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"10 1","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67620619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USOR.2017.10.02.95
D. Chang
A djustable intraocular lenses (IOLs) are uniquely poised to disrupt the refractive IOL arena for both cataract and refractive lens exchange patients. This is because they will not only improve refractive outcomes, but will dramatically enhance the patient experience as well. Patients will be able to postpone confusing decisions about refractive targets and objectives until they can preview them postoperatively. The unique benefit of being able to customize and “choose” their pseudophakic vision after the surgery will be understandable, desirable, and easily explained to family and friends.
{"title":"Adjustable IOLs—Disrupting the Refractive IOL Industry","authors":"D. Chang","doi":"10.17925/USOR.2017.10.02.95","DOIUrl":"https://doi.org/10.17925/USOR.2017.10.02.95","url":null,"abstract":"A djustable intraocular lenses (IOLs) are uniquely poised to disrupt the refractive IOL arena for both cataract and refractive lens exchange patients. This is because they will not only improve refractive outcomes, but will dramatically enhance the patient experience as well. Patients will be able to postpone confusing decisions about refractive targets and objectives until they can preview them postoperatively. The unique benefit of being able to customize and “choose” their pseudophakic vision after the surgery will be understandable, desirable, and easily explained to family and friends.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"10 1","pages":"95"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67620398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USOR.2017.10.01.23
David M. Brown
T he incidence of diabetes in the US population has increased more than fourfold over the last several decades and a high proportion of these patients manifest diabetic eye disease, including diabetic retinopathy (DR) and diabetic macular edema (DME). Ultra-widefield (UWF) retinal imaging has emerged as a valuable tool in the evolving standard of care for DR, providing essential visualization of ischemia and related pathology across the retina, particularly in the periphery, where these signs may appear earliest but may not be detected by conventional fundus photography. Multimodal UWF imaging has helped correlate changes in the periphery with DR progression, providing important guidance for treatment planning and facilitating improved understanding of the underlying mechanisms of disease. Rapid capture, immediate retrieval and efficient sharing of UWF retinal images support a wide spectrum of care settings—including teleophthalmology programs—and facilitate patient education.
{"title":"Advancing the Detection and Management of Diabetic Retinopathy with Ultra-widefield Retinal Imaging","authors":"David M. Brown","doi":"10.17925/USOR.2017.10.01.23","DOIUrl":"https://doi.org/10.17925/USOR.2017.10.01.23","url":null,"abstract":"T he incidence of diabetes in the US population has increased more than fourfold over the last several decades and a high proportion of these patients manifest diabetic eye disease, including diabetic retinopathy (DR) and diabetic macular edema (DME). Ultra-widefield (UWF) retinal imaging has emerged as a valuable tool in the evolving standard of care for DR, providing essential visualization of ischemia and related pathology across the retina, particularly in the periphery, where these signs may appear earliest but may not be detected by conventional fundus photography. Multimodal UWF imaging has helped correlate changes in the periphery with DR progression, providing important guidance for treatment planning and facilitating improved understanding of the underlying mechanisms of disease. Rapid capture, immediate retrieval and efficient sharing of UWF retinal images support a wide spectrum of care settings—including teleophthalmology programs—and facilitate patient education.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"10 1","pages":"23"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67620566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USOR.2017.10.01.64
Kirti Singh, Ankush Mutreja, M. Bhattacharyya, S. Dangda
P urpose: To study the aetiology, epidemiological profile of patients presenting with ocular trauma and compare visual outcomes of early versus late presentatiod. Design: Prospective observational study performed over fifteen month interval. Methods: Patients' epidemiological characteristics were evaluated along with cause of trauma, place of injury, time lag post injury, and postoperative management. Injuries were classified by Birmingham Eye Trauma Terminology (BETT). Final visual and anatomical outcome after providing tailored surgical management was evaluated. All patients had a minimum follow up of 6 months. Statistical Analysis: All the data collected was analysed using SPSS version 17.0 software. Results: One hundred and three cases of incident ocular injury were included in the study. Open globe: closed globe injuries were 78:22% respectively with intraocular foreign body present in 9% of cases. Actively working adults younger than 25 years of age were the commonest age group affected (64%). The commonest place of injury was at home (32%) followed by workplace environment (29%). Good outcome (vision of > 6/60 Snellen) could be achieved in 50% cases, of which 53% had purely anterior segment injury and 20% concomitant retinal injury. Good outcome had a direct correlation with early presentation in 57% and poor outcome with late presentation seen in 64% cases. Conclusion: Serious ocular trauma frequently occurs at home with the younger population maximum at risk. Good visual acuity is associated with early intervention and purely anterior segment injuries.
{"title":"Epidemiology and Implications of Ocular Trauma Admitted to a Tertiary Care Hospital in North India","authors":"Kirti Singh, Ankush Mutreja, M. Bhattacharyya, S. Dangda","doi":"10.17925/USOR.2017.10.01.64","DOIUrl":"https://doi.org/10.17925/USOR.2017.10.01.64","url":null,"abstract":"P urpose: To study the aetiology, epidemiological profile of patients presenting with ocular trauma and compare visual outcomes of early versus late presentatiod. Design: Prospective observational study performed over fifteen month interval. Methods: Patients' epidemiological characteristics were evaluated along with cause of trauma, place of injury, time lag post injury, and postoperative management. Injuries were classified by Birmingham Eye Trauma Terminology (BETT). Final visual and anatomical outcome after providing tailored surgical management was evaluated. All patients had a minimum follow up of 6 months. Statistical Analysis: All the data collected was analysed using SPSS version 17.0 software. Results: One hundred and three cases of incident ocular injury were included in the study. Open globe: closed globe injuries were 78:22% respectively with intraocular foreign body present in 9% of cases. Actively working adults younger than 25 years of age were the commonest age group affected (64%). The commonest place of injury was at home (32%) followed by workplace environment (29%). Good outcome (vision of > 6/60 Snellen) could be achieved in 50% cases, of which 53% had purely anterior segment injury and 20% concomitant retinal injury. Good outcome had a direct correlation with early presentation in 57% and poor outcome with late presentation seen in 64% cases. Conclusion: Serious ocular trauma frequently occurs at home with the younger population maximum at risk. Good visual acuity is associated with early intervention and purely anterior segment injuries.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"10 1","pages":"64"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67620232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USOR.2017.10.02.99
M. Packer
M anagement of astigmatism at the time of cataract or refractive lens surgery has evolved to include arcuate keratotomy and toric intraocular lens (IOL) implantation. Integration of preoperative corneal diagnostic instrumentation via Streamline digital wireless connectivity to the LENSARTM femtosecond laser (LENSAR Inc., Orlando, FL, US) now allows improved precision and accuracy of arcuate incision and toric IOL alignment, eliminating a significant source of error in astigmatism correction. Use of a pre-programmed, surgeondefined nomogram for arcuate incision construction, based on transmitted data from preoperative corneal analysis, permits further efficiency and reduction of transcription error. Toric IOL alignment is currently facilitated with IntelliAxisTM (LENSAR Inc., Orlando, FL, US) corneal marks. Management of astigmatism at the time of cataract surgery provides the refractive benefit of reduced dependence on glasses and sets the stage for correction of presbyopia
{"title":"Management of Astigmatism with the LENSAR Laser System with Streamline","authors":"M. Packer","doi":"10.17925/USOR.2017.10.02.99","DOIUrl":"https://doi.org/10.17925/USOR.2017.10.02.99","url":null,"abstract":"M anagement of astigmatism at the time of cataract or refractive lens surgery has evolved to include arcuate keratotomy and toric intraocular lens (IOL) implantation. Integration of preoperative corneal diagnostic instrumentation via Streamline digital wireless connectivity to the LENSARTM femtosecond laser (LENSAR Inc., Orlando, FL, US) now allows improved precision and accuracy of arcuate incision and toric IOL alignment, eliminating a significant source of error in astigmatism correction. Use of a pre-programmed, surgeondefined nomogram for arcuate incision construction, based on transmitted data from preoperative corneal analysis, permits further efficiency and reduction of transcription error. Toric IOL alignment is currently facilitated with IntelliAxisTM (LENSAR Inc., Orlando, FL, US) corneal marks. Management of astigmatism at the time of cataract surgery provides the refractive benefit of reduced dependence on glasses and sets the stage for correction of presbyopia","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"10 1","pages":"99"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67620648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-01DOI: 10.17925/USOR.2017.10.01.52
Shawn M. Iverson, W. Clark
{"title":"Update on the Management of Diabetic Macular Edema","authors":"Shawn M. Iverson, W. Clark","doi":"10.17925/USOR.2017.10.01.52","DOIUrl":"https://doi.org/10.17925/USOR.2017.10.01.52","url":null,"abstract":"","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"10 1","pages":"52"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67620187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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