Eyeworld

FEB 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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100 EW MEETING REPORTER February 2012 Meeting Reporter continued from page 99 Reporting live from the 2012 Hawaiian Eye meeting gineering, Oregon Health & Science University, Portland. Dr. Huang and his colleagues developed a way to use OCT to measure blood flow, and a study he presented showed a significant cor- relation between decreased retinal blood flow and visual field defects. This is independent of other indica- tors in measuring the progression of glaucoma, he said. A double concen- tric circular scan around the optic nerve head provides cylindrical cross-sections of all the major blood vessels in two diameters, Dr. Huang explained. This scan, combined with other OCT anatomical information, al- lowed the clinicians to compute blood flow in each vessel. Re- searchers then developed a semi-au- tomated angiography algorithm to measure the total blood flow. Newer OCT technology gives even more de- tailed information, Dr. Huang said. "We found something really remark- able and that's that the visual field mean deviation was highly corre- lated with total retinal blood flow," Dr. Huang concluded. Expert: 'You have time' to treat pre-perimetric glaucoma Clinicians should be wary of unnec- essarily treating pre-perimetric glau- coma patients with IOP-lowering therapy and instead focus on identi- fying people with active disease, said Kuldev A. Singh, M.D., director, glaucoma service, Stanford Univer- sity School of Medicine, Stanford, Calif.With an aging population will come an exponential increase in the number of people with glaucoma, the surgeon said. Dr. Singh pointed to a huge, Watch videos from Hawaiian Eye on your smartphone or iPad using your QR code reader. (Scanner available for free at your app store.) Or view the video at http://www.eyenewstv.com/hawaiimr Editors' note: This Meeting Reporter contains original reporting by the EyeWorld news team from the 2012 Hawaiian Eye meeting, Maui. landmark population-based survey that found that 50-75% of people with glaucoma are unaware they have the disease. "Twenty-five to 50% are aware they have it, and it's a bold stretch to say that half of those are under care, getting treat- ment, and actually using their treat- ment," he said. Pre-perimetric glaucoma patients aren't going blind at rapid rates from it, Dr. Singh added. "You have time. Most pa- tients with primary open-angle glau- coma are not sitting on a cliff waiting to go blind if they're sitting there with a normal visual field," Dr. Singh said, adding that treatment sometimes may make the patient symptomatic. Since glaucoma progression is generally slow, physicians should stress regular follow-up visits with pre-perimetric glaucoma patients. "If you see patients regularly, they do better," he said. "People live with glaucoma, die with glaucoma, and never know they have glaucoma or have symptoms of glaucoma. But you still need to find all those peo- ple because a subset of those people are destined for bad outcomes." Dr. Singh concluded, "Find the people who have glaucoma and treat them, instead of diagnosing the ones who don't." Friday, January 20 Surgeon sees value in amniotic membrane use Using an amniotic membrane graft with a two-part tissue adhesive is a highly effective way to correct corneal defects, said a surgeon who spoke at the 2012 Hawaiian Eye meeting in Maui."The value of am- niotic membrane is both its anti-in- flammatory and antifibrotic effects, which are essential for healing wounds of the cornea and limbus when we're doing pterygium surgery and other common procedures such as conjunctival chalasis," said John A. Hovanesian, M.D., Jules Stein Eye Institute, David Geffen School of Medicine, University of Califor- nia, Los Angeles.Currently, there are three commercially available amni- otic membranes—a cryopreserved version from Bio-Tissue Inc. (Miami, Fla.) and two freeze-dried options from IOP Ophthalmics (Costa Mesa, Calif.). A graft of any version of amni- otic membrane to the ocular surface offers the most painless and rapid healing of any of the grafting tech- niques, Dr. Hovanesian said. "I like this procedure," he said. "With this, as opposed to cautery or pinch-and- snip techniques, I've had the very best adherence of the new ocular surface and the lowest rate of recur- rence." Dr. Hovanesian uses tissue adhe- sive that is a mix of fibrinogen and thrombin to simplify the amni- otic graft process. "There's no need for sutures or other fixation," he said. "It's certainly easy to use with the various teaching tools on web- sites." Dr. Hovanesian uses two tech- niques to perform a pterygium. In the first, he uses just an amniotic membrane graft and applies 0.025% mitomycin from 1-3 minutes on the conjunctiva to reduce recurrence. "Cosmetic appearance is beauti- ful 1 week post-op, and they tend to stay that way nicely," Dr. Hovane- sian said, adding that the procedure has about a 5% recurrence rate in his hands.The second technique con- sists of an autograft from the pa- tient's conjunctiva and subsequent amniotic membrane addition. "The amniotic membrane is used as a bar- rier around the autograft. This is a

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