bluuebunny/crossref_metadata_2025 huggingface dataset:
Presbyopia-correcting Intraocular Lenses in Cataract Surgery—A Focus on ReSTOR® Intraocular Lenses
Authors: Fisher Bret L ,   Medical Director, Eye Center of North Florida, Panama City
Published: October 2015

Correction for presbyopia in cataract patients is a significant challenge for ophthalmologists and cataract surgeons, however, an increasingly diverse array of intraocular lenses (IOLs) that are capable of providing good quality near vision is available. Currently available synthetic lenses use different technologies to correct for presbyopia. The latest iterations of the AcrySof® ReSTOR® IOLs combine an optic with a central apodized diffractive zone, a peripheral refractive zone, an aspheric anterior to combat corneal aberrations, and an ultraviolet (UV)- and blue-light filtering chromophore. The AcrySof® IQ ReSTOR® IOLs provide excellent near vision restoration with increased spectacle independence and minimal severe side effects. As a result, it may represent a significant advance over other presbyopia-correcting technologies. IOLs such as the AcrySof® IQ ReSTOR® are increasingly replicating the full visual capabilities of the crystalline lens and are an important advancement in the treatment of presbyopia in cataract patients.
Advances in Single-optic Accommodating Intraocular Lenses
Authors: Hovanesian John A ,   Clinical Instructor, University of California, Los Angeles Jules Stein Eye Institute, and Private Practice, Harvard Eye Associates, Laguna Hills, California
Published: October 2015

This article reviews the evolution of single-optic accommodating intraocular lenses (IOLs) from the development of the first commercially available model, the Crystalens AT-45, through to newer models of these presbyopia correcting IOLs, including the Crystalens AO, the Lenstec TetraFlex, the Human Optics 1-CU, and the Tekia Tek-Clear. Current clinical data for all lenses are reviewed, as well as the importance of a thorough pre-operative work-up in order to ensure success with these lenses.
Cataract Surgery in the Glaucoma Patient
Authors: Poley Brooks J , Lindstrom Richard L , Samuelson Thomas W , Schulze Richard R ,   Retired Clinical Associate Professor,   Adjunct Professor Emeritus,   Clinical Associate Professor, Department of Ophthalmology, University of Minnesota,   Schulze Eye Center, Savannah
Published: October 2015

This article describes the changing treatment of co-existent cataract and glaucoma over the past 70 years. Seventy years ago, the cataract was removed using an intracapsular technique. Glaucoma was always controlled with a scleral fistulizing operation before the cataract was removed. In 1975, Charles Kelman introduced phacoemulsification. When clear corneal incisions were introduced for phacoemulsification, glaucoma surgery no longer needed to precede cataract surgery. The combined procedure of phacoemulsification/lens implantation and trabeculectomy became popular 10 years ago. Recently, non-bleb treatments for glaucoma have emerged that eliminate the problems associated with trabeculectomy. These procedures include phaco/intraocular lens (IOL) alone, trabectome, iStent®, and canaloplasty. A major cause of adult glaucoma, the enlarging crystalline lens as it ages, was recognized in 2007. Greater IOP reductions following phaco/IOL alone were discovered at this time. Phaco/IOL may emerge as the preferred treatment of co-existent cataract and glaucoma. Trabectome can be added to phaco/IOL if greater IOP reduction is needed.
Treatment of Lacrimal System Dysfunction—Preventing Basic Mechanisms in the Pathogenesis of Diseases
Authors: Herrick Robert S , Berger Ian B , Goard Allesandria C ,   Director, Herrick Research Foundation,   Founding President, InFocus,   Member, Washington Mental Health Counselors Association
Published: October 2015

In medicine, the discovery of new knowledge has led to paradigm shifts in treatment approaches. A major discovery in the late 20th century was lacrimal system dysfunction (LSD). Lacrimal occlusion therapy (LOT) and surgical procedures to decrease tear film evaporation (rather than therapeutic drops or lubrication therapy) are necessary to obtain long-lasting benefits in patients with LSD. This paper outlines the ramifications of LSD, and discusses the possibility of updating the Delphi Panel recommendation to the National Eye Institute classification for dry eye. A call is made for controlled studies leading to standard testing and treatment protocols in the emerging new surgical specialty of Lacrimology.
Why the Lutein Source in Eye Vitamins Matters
Authors: Alexander Diane E ,   Technical Service Manager, Kemin Health, LC
Published: October 2015

Eye care professionals are increasingly recommending eye vitamins to patients because a growing body of scientific evidence supports the benefits of good nutrition to reduce the risk for certain eye conditions and improve visual function. Eye care professionals expect that the eye vitamins they recommend will benefit the patients they serve. However, in order for ocular supplements to provide eye health benefits, the essential nutrients, including lutein, in eye vitamins should be bioavailable—so that they will be able to be delivered to the beneficial sites of action. Measurement of lutein and zeaxanthin in the macula via macular pigment optical density (MPOD) can help confirm the bioavailabilty of a lutein ingredient and indicate whether patients are getting enough lutein and zeaxanthin through their diet or supplementation regimen.
The Pattern Scanning Laser (PASCAL®) Photocoagulator for Diabetic Retinopathy
Authors: Kiss Szilárd , Miller Joan W ,   Assistant Professor of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital,   Chair, Department of Ophthalmology, Harvard Medical School, and Chief, Ophthalmology, Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital
Published: October 2015

For 40 years, laser photocoagulation has been the gold standard for the treatment of diabetic retinopathy (DR). Since receiving Food and Drug Administration (FDA) approval in 2005, the pattern scanning laser (PASCAL®) photocoagulator is emerging as a superior method of such treatment. PASCAL is a 532nm frequency-doubled neodymium-doped yttrium aluminum garnet (Nd:YAG) solid state laser that can be used for pan-retinal, focal, and macular grid photocoagulation in the setting of proliferative and non-proliferative DR. A more precise and predictable pre-determined pattern array may be delivered with more controlled spot spacing and predictable burn characteristics resulting in enhanced uniformity of laser treatment. Multiple spot delivery technique allows physicians to treat in a much shorter time, with less discomfort to the patient and diminished operator fatigue.
Age-related Macular Degeneration—Review and Current Concepts
Authors: Seth Rajeev K , Sigler Eric J , Adelman Ron A ,   Assistant Professor of Ophthalmology, and Director of Retina Service, Department of Ophthalmology, University of Arizona College of Medicine,   Chief Resident,   Associate Professor of Ophthalmology and Director of Retina Center, Department of Ophthalmology and Visual Science, Yale University School of Medicine
Published: October 2015

Age-related macular degeneration (ARMD) continues to be a significant public health concern, given its high prevalence and potential blinding prognosis in the elderly. Several risk factors have been identified in the development of ARMD, including age, race, and family history. The pathogenesis of ARMD continues to be elucidated, and recent research has focused on genetic factors. ARMD presents in either the atrophic or exudative form. Treatment for atrophic disease consists of antioxidants and zinc and close monitoring. Treatment for exudative disease is aimed at targeting choroidal neovascularization. The development of anti-vascular endothelial growth factor (anti-VEGF) agents has revolutionized the treatment of exudative ARMD, providing a more favorable prognosis for previously blinding disease. Considerable amount of research is being carried out on new treatment modalities for both the atrophic and exudative forms of the disease.
Vitreomacular Adhesion in Exudative Age-related Macular Degeneration
Authors: Punjabi Omar S , Kaiser Peter K ,   Vitreoretinal Fellow, Department of Ophthalmology, Cole Eye Institute, Cleveland Clinic,   Professor of Ophthalmology, Cleveland Clinic Lerner College of Medicine
Published: October 2015

There have been several recent studies that support the idea that posterior vitreomacular adhesion (VMA) might be associated with the development and progression of exudative age-related macular degeneration (AMD). Although VMA itself does not cause exudative AMD, retina specialists should consider the presence or absence of VMA when evaluating and treating patients with exudative AMD. This article reviews the recent literature regarding the posterior hyaloid and its relationship to exudative AMD.
Uveal Melanoma—Molecular Basis and Potential Treatment Targets
Authors: Woodman Scott E , Williams Michelle D , Esmaeli Bita ,   Department of Melanoma Medical Oncology,   Department of Pathology,   Section of Ophthalmology, Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center
Published: October 2015

Uveal melanoma is the most common primary intraocular malignancy in adults. Despite significant advances in the treatment of primary uveal melanoma, approximately 40–50 % of patients with large tumors develop metastases, with very poor survival after discovery of metastatic disease, despite therapy. To date there is no effective systemic therapy in the adjuvant or advanced uveal melanoma setting. Recent progress in characterizing the molecular nature of primary uveal melanoma offers the possibility of enhancing prognosis and treatment options. This article aims to highlight what is known about potential specific molecular targets that may be amenable to therapeutic intervention.
Vitreoretinal Complications of Phacoemulsification
Authors: Charles Steve ,   Clinical Professor of Ophthalmology, University of Tennessee and Founder, Charles Retina Institute
Published: October 2015

Many vitreoretinal complications of phacoemulsification (phaco) can be prevented by use of proper technique when managing rupture of the posterior capsule and posterior dislocation of lens material. A better understanding of the causative factors in vitreoretinal complications of phaco leads to rational, effective treatment strategies.
The Role of Ocular Blood Flow in the Pathogenesis of Glaucomatous Damage
Authors: Flammer Josef , Konieczka Katarzyna , Flammer Andreas J ,   Professor, Department of Ophthalmology, University of Basel,   Professor, Department of Ophthalmology, University of Basel,   Research Fellow, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester
Published: October 2015

Ocular blood flow (OBF) is on average lower in glaucoma patients than in healthy controls. This reduction is more pronounced in normal-tension than in high-tension glaucoma and more distinct in cases with progressing damage as compared to those with stable disease. Besides a secondary component caused by atrophy, there is an important primary component of OBF reduction, which also has a predictive value. The fact that hypoxia-related factors are upregulated in eyes of glaucoma patients indicates oxygen depletion. It is, however, not constant hypoxia, but rather the fluctuation of oxygen supply that leads to tissue damage, likely because of oxidative stress. Low perfusion pressure and disturbed autoregulation are the major causes of insufficient and fluctuating oxygen supply, and both systemic hypotension and disturbed autoregulation are often consequences of the primary vascular dysregulation syndrome. The observed splinter hemorrhages in these patients are a consequence of a local breakdown of the blood–brain or blood–retinal barrier. The often associated vein occlusions can be a consequence of a local vein dysregulation.
Refractive Surgery Outcomes Comparison—All Wavefront-guided Versus a Decision Tree for Selecting Wavefront-guided or Wavefront-optimized
Authors: Stonecipher Karl G , Potvin Richard , Meyer Jay J , Durrie Dan , Stonecipher Kody ,   Director of Refractive Surgery, The Laser Center, Greensboro,   Consultant, Science in Vision, Burleson,   Resident, Department of Ophthalmology, University of North Carolina,   Director, Durrie Vision, Overland Park,   Independent Contractor, The Laser Center, Greensboro
Published: October 2015

The purpose of this article is to compare refractive outcomes based on all wavefront-guided procedures versus a decision tree designed to assist with the selection of wavefront-guided or wavefront-optimized procedures. The setting was the The Laser Center, Greensboro. Twenty subjects were treated with a VISX CustomVue™ wavefront-guided refractive procedure in one eye and a WaveLight Allegretto procedure (wavefront-guided or optimized) in the contralateral eye. A decision tree was used to decide whether a wavefront-guided or wavefront-optimized procedure would be performed with the WaveLight system. The CustomVue eye was chosen at random. Visual acuity and refractive error were recorded pre-operatively and post-operatively. Subjective post-operative data included patient reported eye preference and post-operative glare and halos. The results were that one subject was lost to follow-up, leaving 19 subjects for analysis at three months. Of those subjects with data, 12 received wavefront-optimized treatment while seven subjects received a wavefront-guided treatment with the WaveLight laser. There were no significant differences in uncorrected visual acuity between the VISX and Wavelight groups at the one-day or six-month visits. At three months, 56 % of patients indicated no preference, with the remaining 44 % indicating a preference for the WaveLight-treated eye (p<0.05). The patient reported outcomes showed a similar incidence of post-operative glare and halos reported between the two treatments. Results with the Allegretto Wave Eye-Q laser, using a decision tree to determine whether a wavefront-optimized or a wavefront-guided treatment would be performed, were equivalent to those achieved with the VISX Star S4 wavefront-guided procedure.
Flap Technology Review—The Case for Femtosecond Laser Flaps in Laser In Situ Keratomileusis
Authors: Krueger Ronald R , Potvin Richard ,   Medical Director, Cole Eye Institute, Cleveland Clinic Foundation,   Consultant, Science in Vision
Published: October 2015

Purpose:To review the literature concerning the relative advantages and disadvantages of laser in situ keratomileusis (LASIK) flaps created with mechanical microkeratomes versus femtosecond laser systems.Setting:Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH 44195.Methods:A review of the literature available related to mechanical microkeratomes and femtosecond laser systems was conducted. Operational limitations, complications, complication rates, and clinical outcomes were compared.Results:Data from the peer-reviewed literature showed that intra-operative complication rates were slightly higher with mechanical microkeratomes, and a training effect was evident. Complication rates with femtosecond laser systems have dropped as the laser spot size and/or energy has decreased and shot frequency has increased. Laser-created flaps showed lower variability in flap thickness and greater variety in programmable flap geometry. Spherocylindrical refractive outcomes were generally similar but higher order aberrations were reported as lower with femtosecond laser flap creation.Conclusion:There is now extensive evidence in the literature comparing these technologies. The results support current femtosecond laser technology as superior to mechanical microkeratomes for the creation of LASIK flaps in refractive surgery.
Endoscopic Goniotomy
Authors: Töteberg-Harms Marc , Ciechanowski Peter P , Funk Jens ,   Research Fellow, Massachusetts Eye and Ear Infirmary, Harvard Medical School,   Resident, Department of Ophthalmology, UniversityHospital Zurich,   Resident, Department of Ophthalmology, UniversityHospital Zurich,   Professor, Department of Ophthalmology, UniversityHospital Zurich
Published: October 2015

Usually an elevated drainage resistance is responsible for elevated intraocular pressure (IOP) in glaucoma, while aqueous humor production is still normal. Therefore, currently there are great efforts to develop surgical techniques that enhance the conventional outflow through the trabecular meshwork and Schlemm’s canal and into the episcleral veins. One of these techniques is excimer laser trabeculotomy (ELT). ELT is easy to perform at the end of cataract surgery. The duration of cataract surgery is only prolonged by 2–3 minutes. IOP can be reduced by up to 34.7 %. It is known that the effect of IOP reduction is constant over time, unlike argon or selective laser trabeculoplasty. The procedure is also very safe. If required later, filtering surgery is not compromised because there is no conjunctival touch during ELT and therefore no scarring of the conjunctiva is induced. For a selected cohort of glaucoma patients, this procedure may avoid the need for trabeculectomy.
Descemet’s Stripping Endothelial Keratoplasty—Insertion Techniques for Endothelial Keratoplasty
Authors: Belin Michael W , Hannush Sadeer B ,   Professor of Ophthalmology & Visual Sciences, University of Arizona & Southern Arizona VA Healthcare System, Tucson,   Attending Surgeon, Cornea Service, Wills Eye Institute, Philadelphia
Published: October 2015

Descemet’s stripping endothelial keratoplasty has emerged as the treatment of choice for primary and secondary endothelial failure. One of the most crucial portions of the procedure is introducing the donor lenticule into the anterior chamber. Numerous techniques and instruments have been developed in an attempt to simplify the incision and reduce endothelial cell loss.
Ganciclovir in the Treatment of Ophthalmic Viral Infections – Case Reports
Authors: Affeldt John , Gadaria-Rathod Neha , Fernandez Karen B , Asbell Penny A ,   Assistant Clinical Professor, University of Southern California, California, US,   Associate Professor, Loma Linda University School of Medicine, California, US,   Associate Researcher,   Cornea Fellow,   Professor of Ophthalmology and Director of Cornea and Refractive Services, Department of Ophthalmology, Mount Sinai School of Medicine, New York, US
Published: October 2015

Adenovirus is likely the most common cause of eye infections but remains a challenge for ophthalmologists to diagnose as well as treat. While ganciclovir gel is approved for the topical treatment of eye infections arising due to herpes simplex virus, it is not licensed for use against adenoviral conjunctivitis. This antiviral agent selectively targets infected cells and disrupts viral DNA replication. A small study and previous anecdotal reports had illustrated the potential of ganciclovir in improving symptoms and transmissibility of adenoviral eye infections. The present article describes a series of case studies where ganciclovir was used off label in the management of the morbidity caused by adenovirus. The observations are promising and suggest that ganciclovir can be used successfully in this patient population. However, large-scale randomised trials are needed to confirm these findings.
A Minimally Invasive Device for the Monitoring of 24-hour Intraocular Pressure Patterns
Authors: Mansouri Kaweh , Goedkoop René , Weinreb Robert N ,   Consultant, Glaucoma Section, Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland,   Chief Medical Officer, Sensimed AG, Lausanne, Switzerland,   Professor and Chairman, Hamilton Glaucoma Center, University of California, San Diego, US
Published: October 2015

Intraocular pressure (IOP) is the only modifiable risk factor for glaucoma, and lowering of IOP remains the mainstay of glaucoma treatment. IOP is a dynamic biologic parameter, nevertheless, current glaucoma management usually relies on single IOP measurements during clinic hours. However, a majority of glaucoma patients have their high, including their highest, IOP levels outside clinic hours. These undetected IOPs may explain why certain patients have progressive disease despite treatment. The interest in continuous 24-hour IOP monitoring started over half a century ago, but only recent technologic advances have provided clinicians with a practical device for continuous IOP monitoring. In this article, we discuss innovative approaches with permanent and temporary devices for 24-hour IOP monitoring, such as a contact lens sensor. Despite being in their infancy, these devices may soon enable clinicians to use 24-hour IOP data to improve glaucoma management and reduce the glaucoma-related burden of disease.
Glaucoma Diagnosis and Monitoring Using Advanced Imaging Technologies
Authors: Sehi Mitra , DO Shawn M Iverson ,   Research Assistant Professor of Ophthalmology,   Glaucoma Research Fellow, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, USA
Published: October 2015

Advanced ocular imaging technologies facilitate objective and reproducible quantification of change in glaucoma but at the same time, impose new challenges on scientists and clinicians for separating true structural change from imaging noise. This review examines time-domain and spectral-domain optical coherence tomography, confocal scanning laser ophthalmoscopy and scanning laser polarimetry technologies and discusses the diagnostic accuracy and the ability of each technique for evaluation of glaucomatous progression. A broad review of the current literature reveals that objective assessment of retinal nerve fiber layer, ganglion cell complex and optic nerve head topography may improve glaucoma monitoring when used as a complementary tool in conjunction with the clinical judgment of an expert.
Descemet Membrane Endothelial Keratoplasty—A Review
Authors: Parker Jack , Parker John S , Melles Gerrit RJ ,   Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands,   Melles Cornea Clinic Rotterdam, The Netherlands,   UAB Callahan Eye Hospital, Birmingham, Alabama,   UAB Callahan Eye Hospital, Birmingham, Alabama,   Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands,   Melles Cornea Clinic Rotterdam, The Netherlands,   Amnitrans EyeBank Rotterdam, The Netherlands
Published: October 2015

Descemet membrane endothelial keratoplasty (DMEK) is the most recent step forward in the evolution of endothelial keratoplasty toward thinner grafts and more natural, anatomic corneal restoration. Offering unprecedented visual results and requiring no special or expensive equipment, DMEK has the potential to become the first line treatment for corneal endothelial disorders. The surgery’s perceived shortcomings (primarily technical difficulty) have mostly been addressed by new ‘no-touch’ procedures for both graft preparation and graft unfolding in the recipient eye. And as a result, DMEK has been gaining traction with ophthalmologists the world over. Now, in its most recent formulation, DMEK is ready for the typical corneal surgeon, in any clinical setting, and at low cost.
Symptoms and Signs of Anterior Uveitis
Authors: Guney Esra , Tugal-Tutkun Ilknur ,   Department of Ophthalmology, Umraniye Training and Research Hospital, Istanbul,   Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul
Published: October 2015

Anterior uveitis is an inflammation of the uveal tract that involves the iris, anterior part of ciliary body or both. It can be classified as acute or chronic anterior uveitis, according to its clinical course, granulomatous or non-granulomatous anterior uveitis, according to its clinical appearence or infectious or non-infectious anterior uveitis, according to its etiology. It is the commonest form of uveitis and less sight-threatening than posterior segment inflammation, however in some cases it can lead to serious complications such as cataract, glaucoma, and cystoid macular edema. Nevertheless these complications can be prevented if anterior uveitis diagnosed and treated on time. Recognition of ocular findings and diagnostic clues in anterior uveitis is essential in order to identify specific ocular and systemic conditions.
Aflibercept as a Treatment for Age-related Macular Degeneration
Authors: Stewart Michael W ,   Associate Professor and Chairman, Department of Ophthalmology, Mayo Clinic, Florida, US
Published: October 2015

Vascular endothelial growth factor (VEGF) plays a central role in the development of several chorioretinal vascular disorders including exudative age-related macular degeneration (AMD). Detailed understanding of VEGF biochemistry has led to the development of four drugs which specifically inhibit its actions. Bevacizumab and ranibizumab have been the dominant ophthalmic anti-VEGF drugs for seven years and their regular use has significantly decreased vision loss. In late 2011, aflibercept, a high-affinity, fusion protein that acts as a soluble VEGF receptor, was approved for the treatment of exudative AMD. Phase three trials showed that monthly and bimonthly aflibercept maintained vision in 95 % of patients, improved average visual acuity by +8.3 to +9.4 letters, and thinned the macula comparably to monthly ranibizumab. Since its approval, aflibercept has been shown to decrease retinal edema and subretinal fluid, and flatten retinal pigment epithelial detachments in eyes that have responded incompletely to frequent ranibizumab and bevacizumab injections. Aflibercept’s longer duration of action coupled with its comparable unit price (versus ranibizumab) promise to decrease the total cost of treatment.
Optic Nerve Sheath Fenestration—Indications and Techniques
Authors: Mukherjee Nisha , El-Dairi Mays A , Bhatti M Tariq ,   Department of Ophthalmology,   Department of Ophthalmology,   Associate Professor, Neuro-Ophthalmology and Orbital Disease, Department of Ophthalmology and Neurology, Duke University Eye Center, Duke University Medical Center, Durham, US
Published: October 2015

The optic nerve is a white matter tract of the brain and its sheath is composed of pia mater, arachnoid mater, and dura mater. The subarachnoid space (SAS) of the optic nerve sheath, which contains cerebrospinal fluid, is contiguous with the SAS of the brain. Elevated intracranial pressure is transmitted to the optic nerve head through the SAS resulting in papilledema. Optic nerve sheath fenestration (ONSF) can be an effective surgical technique to preserve vision in patients with progressive optic neuropathy due to papilledema caused by idiopathic intracranial hypertension (IIH); however, a dreaded complication of ONSF is visual loss. This article will discuss the rationale, indications, and complications of ONSF. A variety of surgical techniques can be employed to perform an ONSF. In particular, the medial transconjuctival approach will be highlighted.
Repair of Primary Noncomplex Rhegmatagenous Retinal Detachment
Authors: Schneider Eric W , Johnson Mark W ,   Vitreoretinal Fellow, Department of Ophthalmology, Duke University, North Carolina, US,   Professor of Ophthalmology, Department of Ophthalmology and Visual Sciences, University of Michigan; WK Kellogg Eye Center, Ann Arbor, Michigan, US
Published: October 2015

With the development of pars plana vitrectomy in the 1970s and pneumatic retinopexy in the 1980s, the primacy of scleral buckling for repair of rhegmatogenous retinal detachment (RRD) came under challenge. While a degree of consensus exists for certain forms of complex RRD, there remains little agreement concerning the optimal treatment of primary noncomplex RRD. This debate is further muddied by application of adjuvant procedures to supplement the primary surgical approach. This article aims to present the current evidence regarding repair of primary noncomplex RRD. A brief summary of primary surgical approaches—pneumatic retinopexy, scleral buckling, and pars plana vitrectomy—will be presented along with a short discussion on potential adjuvant procedures. The remainder of the article focuses on reported outcomes for the different treatment modalities for primary noncomplex RRD.
Treatment of Macular Edema following Branch Retinal Vein Occlusion
Authors: Sophie Raafay , Campochiaro Peter A ,   Post-doctoral Fellow,   Eccles Professor of Ophthalmology and Neuroscience, Departments of Ophthalmology and Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland, US
Published: October 2015

Branch retinal vein occlusion (BRVO) is a relatively prevalent cause of reduced vision primarily due to macular edema. Vascular endothelial growth factor (VEGF) is the major stimulator of excessive vascular leakage and also contributes to retinal hemorrhages and progressive retinal nonperfusion (RNP). Progressive RNP results in worsening of retinal ischemia further increasing levels of VEGF, resulting in a positive feedback loop for disease worsening over time. Aggressive early treatment with a specific antagonist of VEGF causes rapid improvement in edema and visual acuity, speeds resolution of hemorrhages, and stabilizes or improves RNP. Therefore, first-line treatment of acute BRVOs is monthly injections of an anti-VEGF agent for at least 6 months. After that, a period of monthly follow up with anti-VEGF treatment, only if there is recurrent edema, can be used to gauge persistent disease activity and the need for grid laser photocoagulation to diffuse leakage in the macula outside the foveal avascular zone. Following grid laser, another period of monthly follow up with anti-VEGF treatment only if there is recurrent edema provides a measure of persistent disease activity, and if frequent injections are still needed to control edema, the benefits and risks for switching to dexamethasone implants should be discussed with the patient.
Topical Therapy for Ocular Surface Squamous Neoplasia
Authors: Bitner Derek , Stone Donald U ,   Resident Physician, Department of Ophthalmology, University of Oklahoma, Oklahoma, US,   Clinical Associate Professor, Department of Ophthalmology, University of Oklahoma, and Dean McGee Eye Institute, Oklahoma, US
Published: October 2015

Ocular surface squamous neoplasia, or OSSN, is a clinical spectrum often encountered in ophthalmic practice. The incidence varies depending on the population being studied, but is more common among less pigmented males with increased occupational ultraviolet (UV) exposure as well as among those living in closer proximity to the equator. The incidence increases with age; in younger patients, the presence of OSSN is often associated with another underlying disorder, such as the genetic defect in xeroderma pigmentosum, or immunosuppression as is seen in patients infected with HIV. The challenges of complete surgical excision in patients with extensive tumors, in addition to the high recurrence rates in some series, led to a search for nonsurgical treatment modalities. In addition to avoiding surgery, topical agents may offer the additional benefit of treating clinically unapparent disease. Due to the theoretic advantages of topical chemotherapy, multiple agents have been used in both the primary and adjuvant treatment of OSSN. Mitomycin, interferon alpha-2b, and 5-fluorouracil have all been utilized with success; mitomycin may invoke a greater risk for limbal stem cell failure, and interferon is well tolerated and effective but more expensive. Future developments in imaging and chemotherapeutics will likely continue to alter the treatment paradigm for ocular surface tumors.
Topical Corticosteroids and Antihistamines—Mast Cell Stabilizers for the Treatment of Allergic Conjunctivitis
Authors: Gong Lan , Blaiss Michael S ,   EYE and ENT Hospital of Fudan University, Shanghai, China,   University of Tennessee Health Science Center, Memphis, Tennessee, US
Published: October 2015

The most common ocular manifestation of allergy, allergic conjunctivitis (AC), is the result of a hypersensitivity response occurring after exposure of the ocular surface to airborne antigens. Treatment options for AC comprise antihistamines, mast cell stabilizers, dual-acting mast cell stabilizer-antihistamines, corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), and combinations thereof. Despite clinical evidence to support the use of antihistamines, such as levocabastine, antihistamines are unable to mitigate all symptoms of AC because histamine is not the only mediator released during the allergic inflammatory response and has no direct effect on inflammatory cells involved in clinical symptoms. Dual-acting mast cell stabilizer-antihistamines, such as bepotastine, alcafatidine, epinastine, ketotifen, and olopatadine, have a broader effect than antihistamines alone. Corticosteroids inhibit the entire inflammatory cascade and therefore offer the most complete option for AC, although their use has been limited due to concerns about increased intraocular pressure (IOP) and the potential for cataract formation with extended use. Loteprednol etabonate (LE) has a decreased effect on IOP and cannot form Schiff base intermediates with lens protein, which is considered a first step in cataractogenesis. The efficacy and safety of LE in the treatment of seasonal AC (SAC) has been demonstrated in clinical trials.
Cataract Surgery and the LenSx® Femtosecond Laser System
Authors: Potvin Richard , Makari Sarah ,   President,   Research Associate, Science in Vision, Burleson, Texas, US
Published: October 2015

The use of femtosecond laser systems in cataract surgery has been stated to be arguably the single biggest change to the procedure since phacoemulsification. The combination of a controllable high-frequency laser with increasingly advanced ocular imaging technology provides for a surgical precision that is difficult or impossible to duplicate manually. As a new technology, much clinical research is underway to identify best practices, and quantify the benefits of femtosecond cataract surgery. The main measures of interest are improvements in surgical precision, reduced complication rates and lower variability in clinical outcomes compared with manual procedures. The lower variability in outcomes would translate to a higher percentage of patients achieving their desired refractive target after surgery. This article provides an overview of the LenSx® femtosecond laser system, some of the ways in which it is being utilized in cataract surgery, and related surgical/ clinical results recently reported in the peer-reviewed literature.
New Developments in the Lenticule Extraction Procedure
Authors: Hjortdal Jesper , Ivarsen Anders ,   Clinical Professor,   Assistant Professor, Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
Published: October 2015

For the last 20 years controlled excimer laser ablation of corneal tissue, either directly from the corneal stromal surface or from the corneal interior after creation of a superficial corneal flap, has become widely used to correct myopia, hyperopia, and astigmatism. Recently, an intrastromal refractive procedure whereby a tissue lenticule is cut free in the corneal stroma by a femtosecond laser and removed through a small peripheral incision has been introduced. The procedure avoids creation of a corneal flap and the potential associated risks while avoiding the slow visual recovery of surface ablation procedures. The all-femtosecond-based flap-free intracorneal refractive procedure has been documented to be a predictable, efficient, and safe procedure for correction of myopia and astigmatism. Technologic developments related to further improved cutting quality, hyperopic, and individualized treatments are desirable.
Flow Dynamics of the EX-PRESS® Glaucoma Filtration Device
Authors: Samuelson Thomas W , Stamper Robert , Gallardo Mark ,   Attending Surgeon, Glaucoma and Anterior Segment Surgery, Minnesota Eye Consultants, University of Minnesota, Minneapolis, US,   Fortisure Distinguished Professor of Clinical Ophthalmology, University of California, San Francisco, US,   Adjunct Clinical Professor, University of Texas Health Science Center, San Antonio, US
Published: October 2015

Trabeculectomy has been the gold standard of glaucoma surgery for over 40 years, but the technique is imprecise and is associated with complications. Glaucoma filtration implants offer an alternative to trabeculectomy. The EX-PRESS® device is a miniature implant of which the standardized ostium allows a potentially more reproducible outflow by creating a constant diameter channel for fluid to drain out of the anterior chamber into the subconjunctival space. In clinical studies, the EX-PRESS device has demonstrated similar efficacy to trabeculectomy in terms of reduction of intraocular pressure, but with a lower incidence of hypotony and choroidal effusions, a result of its standardized ostium. Glaucoma patients require fewer postoperative interventions and less glaucoma medication after EX-PRESS device compared with trabeculectomy, and have faster visual recovery to their preoperative baseline compared with trabeculectomy.
Lasers in Open Angle Glaucoma
Authors: Cheng Jason , Buys Yvonne M ,   Associate Consultant, Department of Ophthalmology and Visual Science, Alexandra Health, Khoo Teck Puat Hospital, Singapore,   Professor, Co-Director, Glaucoma Unit, Department of Ophthalmology and Vision Sciences, University Health Network, University of Toronto, Toronto, Canada
Published: October 2015

Lasers have been used in open angle glaucoma for more than 40 years and have grown in importance in recent years. This article reviews the latest research and trends in the use of lasers in the management of open angle glaucoma.
Comparison of Diabetic Macular Edema Treatment Patterns and Outcomes by European and US Retina-treating Ophthalmologists
Authors: John Eric G , Harris James F ,   Senior Vice President, SciMedica Group, Conshohocken, Pennsylvania, US,   Executive Director, Marketing, Alimera Sciences, Alpharetta, Georgia, US
Published: October 2015

AIM:To uncover and evaluate diabetic macular edema (DME) patient treatment patterns in the US and the largest EU countries.METHODS:Quantitative analyses of self-report data from retina-treating ophthalmologists via 30-minute Internet-based surveys. Data were collected across the US (one study) and EU (two studies— EU-1 and EU-2) between November 2011 and January 2013. Visual outcomes and rates of treatment success or failure were evaluated.RESULTS:Respondents were surveyed across the US (n=71) and EU (EU-1: n=180; EU-2: n=106). Nearly one-third of treated patients (US 38.6 %; EU-1 37.8 %; EU-2 30.7 %) reached a plateau in vision improvement. Geographical comparison showed no significant difference in responses between the US and the EU (EU-1, EU-2) (p>0.05).CONCLUSIONS:These data help to quantify the size of the chronic DME patient population in the US and EU, which is not achieving an acceptable functional outcome with current therapy. The paper provides solid empirical evidence regarding similarities in DME patient treatment and outcomes in the US and EU. The global and reproducible similarities in terms of physicians’ perceptions of the threshold of DME treatment burden and the visual outcomes when treatment benefit is limited are compelling. This is especially interesting within the present context where information regarding the effect of current treatments is limited. Diabetes is growing around the world at epidemic proportions, and these data provide insight into the impact DME may have on healthcare systems.
Dry Eye and Clinical Disease of Tear Film, Diagnosis and Management
Authors: Achtsidis Vasilis , Kozanidou Eleftheria , Bournas Panos , Tentolouris Nicholas , Theodossiadis Panos G ,   Consultant Ophthalmologist,   Consultant Ophthalmologist, Department of Ophthalmology, Worthing Hospital, West Sussex, UK,   Senior SpR in Internal Medicine,   Consultant Ophthalmologist and Clinical Lead, Department of Ophthalmology, “St Panteleimon” General Hospital of Nikaia, Piraeus, Greece,   Associate Professor in Internal Medicine and Clinical Lead, 1st Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece,   Associate Professor in Ophthalmology and Clinical Lead, 2nd Department of Ophthalmology, “Attikon” University Hospital, University of Athens, Greece
Published: October 2015

Dry eye disease (DED) is a clinically significant multifactorial disorder of the ocular surface and tear film as it results in ocular discomfort and visual impairment and predisposes the cornea to infections. It is important for the quality of life and tends to be a chronic disease. It is also common, as the prevalence is estimated between 5 % to 30 % and this increases with age. Therefore, it is recognized as a growing public health problem that requires correct diagnosis and appropriate treatment. There are two main categories of DED: the deficiency of tear production (hyposecretive), which includes Sjögren’s syndrome, idiopathic or secondary to connective tissue diseases (e.g. rheumatoid arthritis), and non-Sjögren’s syndrome (e.g. age-related); and the tear evaporation category, where tears evaporate from the ocular surface too rapidly due to intrinsic causes (e.g. meibomian gland disease or eyelid aperture disorders) or extrinsic causes (e.g. vitamin A deficiency, contact lenses wear, ocular allergies). Management of the disease aims to enhance the corneal healing and reduce patient’s discomfort. This is based on improving the balance of tear production and evaporation by increasing the tear film volume (lubrication drops) and improving quality of tear film (ex omega-3 supplements, lid hygiene, tetracyclines), reducing the tear film evaporation (paraffin ointments, therapeutic contact lenses), reducing tear’s drainage (punctal plugs, cautery), and finally by settling down the ocular surface inflammation (steroids, cyclosporine, autologous serous), as appropriate. In this article we will review the clinical presentation, differential diagnosis, and treatment options for DED.
Cost-effectiveness in the Treatment of Glaucoma
Authors: Chan Poemen P , Li Emmy Y , Tham Clement C ,   Associate Consultant, Hong Kong Eye Hospital and Honorary Clinical Assistant Professor, Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, The People’s Republic of China,   Associate Consultant, Hong Kong Eye Hospital and Honorary Clinical Assistant Professor, Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, The People’s Republic of China,   Honorary Chief-of-Service, Hong Kong Eye Hospital and S.H. Ho Professor, Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, The People’s Republic of China
Published: October 2015

The cost-effectiveness of treating different types of glaucoma and ‘pre-glaucoma status’—namely ocular hypertension, primary angle closure suspect, and primary angle closure—were investigated by numerous studies. Overtreatment could lead to undesirable opportunity cost and unnecessary exposure to adverse effects for the patients; under-treating moderate to advance glaucoma could lead to preventable blindness. Despite being a leading cause of blindness, the need for a comprehensive glaucoma screening program and early intervention of pre-glaucoma status is questionable. Numerous reports have investigated the cost-effectiveness of treating ocular hypertension, primary open angle glaucoma, and normal tension glaucoma. The cost-effectiveness of different treatment modalities and their application at different stages of glaucoma were also discussed. To date, there is no cost-effectiveness analysis for the treatment of primary angle closure glaucoma. Some early reports also suggested that prophylactic treatment for primary angle closure and primary angle closure suspect might not be the most effective modalities.
The Dynamics of Aqueous Humor Outflow—A Major Review
Authors: Shoeb Ahmad Syed , Abdul Ghani Shuaibah , Singh Daljit , Wah Lott Pooi ,   Specialist Ophthalmologist,   Consultant Ophthalmologist,   Consultant, Dr Daljit Singh Eye Hospital, Amritsar, India,   Resident, Department of Ophthalmology, Queen Elizabeth Hospital, Kota Kinabalu, Malaysia
Published: October 2015

Aqueous humor outflow occurs through the conventional and unconventional pathway. With aging, the latter becomes less active so that the conventional pathway remains the primary mechanism of aqueous humor outflow. An abnormality of this pathway contributes significantly to disordered aqueous humor dynamics and consequent rise in intraocular pressure seen in primary open angle glaucoma and ocular hypertension. Recently, the ocular lymphatics have been implicated in aqueous humor outflow. Additionally, the trabecular meshwork is now understood to be a complex organization of structures, which are controlled by various biomechanical and biochemical mechanisms. Among others, these include the actinomyosin cytoskeletal system, extracellular matrix, intracellular signaling responses mediated by protein kinase C, Rho/Rho kinase, and other biologic factors. This review shall describe the various pathophysiologic mechanisms involved in aqueous humor dynamics.
Current Medical and Surgical Management of Retained Lens Fragments After Cataract Extraction
Authors: Schaal Shlomit , Nesmith Brooke LW , Ihnen Mark A , Al-Latayfeh Motasem ,   Director of Retina, Director of Fellowship Programme in Vitreoretinal Diseases and Surgery, and Associate Professor,   Chief Resident,   Resident, Department of Ophthalmology and Visual Sciences, University of Louisville School of Medicine, Kentucky, US,   Retina Specialist, Department of Ophthalmology, Faculty of Medicine, Hashemite University, Amman, Jordan
Published: October 2015

Purpose:To review current literature understanding and modern clinical guidelines, and to provide contemporary management recommendations regarding the medical and surgical management of retained lens fragments (RLF) after cataract surgery.Methods:Literature review for articles published in the PubMed database between 1948 and 2014 with the following keywords: retained lens fragments, retained lens material, dropped nuclear fragments, dislocated lens.Results:RLF is a complication of cataract surgery, with incidence reported between 0.18 % and 1.1 %, which can result in severe inflammatory reaction, leading to significant vision-threatening complications, including cystoid macular edema, glaucoma, uveitis, and corneal edema. Management of RLF can be either medical or surgical, depending upon the severity of inflammation and symptoms. Proper timing of either medical or surgical management is crucial in preventing visual loss.Conclusion:RLF is a well-known complication of modern cataract surgery that should be managed promptly medically or surgically. Close cooperation between the anterior segment and posterior segment surgeon is crucial for optimal results.