Eyeworld

Reporting from the 2017 American Academy of Ophthalmology (AAO) annual meeting, November 11–14, New Orleans EW MEETING REPORTER 88 December 2017 her lecture, Dr. Digre explained how migraine headaches are relevant to ophthalmologists. Dr. Digre discussed how the cor- nea and the dura mater are both in- nervated by the same branch of the trigeminal nerve; the relationship between dry eye and migraines; di- agnosis of visual snow and patients with headaches; and photophobia. According to research, Dr. Digre said patients with migraines are more likely to have dry eye. Dry eye studies and treatment might help modulate migraines, Dr. Digre said. People experiencing visual snow, tiny dots in the visual field for at least 3 months with symptoms inconsistent with typical migraine aura, almost always have a history of migraine or headaches. Patients with visual snow should be reassured that they're not crazy and should be ad- vised to ignore it as best as possible. Dr. Digre described research that shows there is an anatomic pathway that links photophobia and pain, but there can also be an emotional component to this disorder where some patients with photophobia are also more likely to have depres- sion and anxiety. Treatments for photophobia, depending on the cause, include reducing the patient's dark adaptation, tinted lenses that block blue light, treating dry eyes, prescribing anticonvulsants, and partnering with a neurologist. Dr. Martin explained how a "major paradigm shift"—that being intra- vitreal therapy—began 25 years ago with cytomegalovirus (CMV). Intravenous treatment was the most effective at the time but it had a high rate of sepsis and interfered with treating HIV. Eventually, intraocular injection of ganciclovir was tested and proved highly effective. Then the ganciclo- vir implant was developed to release a sustained amount of the drug over time. Dr. Martin said ganciclovir in- jections and the implant played two very important roles in the history of intravitreal pharmacotherapy. It was the first time retina specialists started giving several intravitreal injections each day, and the implant was the first FDA-approved sustained release drug device. Dr. Martin discussed the clinical trial and subsequent studies that compared intravitreal injections of ranibizumab and bevacizumab for the treatment of neovascular AMD, finding that both, in terms of out- comes, were equivalent. From the first intravitreal injec- tions for CMV to the now more than 20 million intravitreal injections performed worldwide for a range of diseases, Dr. Martin wondered if the number of injections will ever de- crease. While he doesn't think that's going to happen in the near future, Dr. Martin said people are working toward creating a drug or device that may significantly reduce the number of these injections. The Opening Session also in- volved a message from AAO Execu- tive Director David Parke, MD, San Francisco, the passing of the gavel from Dr. Bradford to Keith Car- ter, MD, Iowa City, and a keynote address from Seema Verma, admin- istrator, Centers for Medicare and Medicaid Services, Washington, D.C. Editors' note: The presenters have no related financial interests. The eye and migraines The 2017 William F. Hoyt Lecture was delivered by Kathleen Digre, MD, Salt Lake City, in a symposium cosponsored by the North American Neuro-Ophthalmology Society. In Editors' note: Dr. Digre has no financial interests related to her presentation. Teams go head-to-head in Ophthalmic Premier League video symposium The video-based symposium of the Ophthalmic Premier League had four themed teams—the Fantas- tic Four, Cata-Rock Stars, Cataract Kings, and The Ringers—presenting surgical videos to show how they overcame challenges for positive outcomes. Panel judges shared their favorites for best entertainer, best video, and best team, but the audi- ence voted for the ultimate winners. Susan MacDonald, MD, Bos- ton, dressed as Cher as part of the Cata-Rock Stars, won best entertain- er after she sang an "Ode to Endo- thelium" and described the impor- tance of endothelial protection in hard cataract cases. Kevin Miller, MD, Los Angeles, received the vote for best video, in which he showed, what he called, "probably the first artificial iris exchange ever done in the world." Dr. MacDonald, David Chang, MD, Los Altos, California, as Gene Simmons from Kiss, Sumit "Sam" Garg, MD, Irvine, California, as Michael Jackson, and Mitchell Weikert, MD, Houston, as Elvis Pres- ley with the Cata-Rock Stars won best team. View videos from AAO 2017: EWrePlay.org Deepinder Dhaliwal, MD, makes the case for preoperative antibiotic prophylaxis.

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