Future of Posterior Therapeutics

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Leading ophthalmologists join us to discusses the hottest topics in the posterior segment treatment landscape.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Postoperative Intolerance of Monovision

Surgeons are asked to address a case in two parts.

Brandon D. Ayres, MD; Kara Jones, MD; Clara C. Chan, MD, FRCSC, FACS; Jennifer Loh, MD; and Gregory S.H. Ogawa, MD

Cataract and Refractive Surgery Today

KEY TAKEAWAYS Surgeons consider how to manage a patient’s intolerance of monovision 2 years after bilateral cataract surgery Interventions considered include a refractive enhancement and an IOL exchange The panelists weigh how to proceed when the patient’s visual acuity decreases to no light perception following an IOL exchange CASE PRESENTATION A 63-year-old woman is referred by her ophthalmologist for evaluation for an IOL exchange. Two years ago, the patient underwent bilateral cataract surgery with a Light Adjustable Lens (LAL; RxSight) and a monovision strategy; the right eye was targeted for distance vision and the left eye for near vision. She has been experiencing headache and nausea because her eyes are not working together properly. On examination, the patient’s UCVA is 20/20 OD and 20/20-1 OS. The manifest refraction is -0.50 +1.00 x 019º OD and -0.75 +0.25 x 008º OS. Pupillary motility is full, and no relative afferent pupillary defect (RAPD) is evident. A slit-lamp examination shows a well-positioned LAL and an open posterior capsule in each eye. A posterior examination of each eye is normal. How would you approach the patient’s intolerance of monovision? Biometry is provided in Figure 1 to assist with decision-making.

PBM for AMD: Mechanisms, Evidence, and Clinical Integration

Photobiomodulation shows promise, but long-term data are needed.

Luis Acabá-Berrocal, MD, and Anton Orlin, MD

Retina Today

KEY TAKEAWAYS Photobiomodulation (PBM) has been applied across many medical fields, including dermatology, neurology, and dentistry, where it has been shown to improve tissue repair, reduce neuropathic pain, and enhance bone remodeling. Ideal candidates for PBM include patients with intermediate dry AMD who are motivated to pursue a noninvasive treatment option. Patients typically undergo an initial series of nine treatment sessions over 3 to 5 weeks, followed by maintenance treatments every 4 to 6 months based on clinical response and patient preference. While PBM may improve visual function and slow disease progression, it is not curative. Outcomes may vary, and treatment benefits are generally more pronounced in earlier stages of disease. The prevalence of AMD is projected to increase from approximately 200 million to more than 300 million individuals worldwide as global life expectancy rises.1,2 Accordingly, the development of therapies that can prevent, slow, or treat AMD has become critical (Figure). The treatment landscape for AMD has evolved substantially, from AREDS supplementation to anti-VEGF therapies and complement inhibitors, and, most recently, photobiomodulation (PBM). Currently, PBM offers a noninvasive therapeutic option for patients with dry AMD. Figure. Patients such as this 68-year-old woman who has intermediate AMD, with the OCT of the left eye demonstrating drusen, may benefit from early treatment.

Current State of Drug Delivery in Glaucoma Care

Iqbal Ike K. Ahmed, MD, FRCSC; Arsham Sheybani, MD; and Arkadiy Yadgarov, MD

Eyetube

Arkadiy Yadgarov, MD, joins Arsham Sheybani, MD, and Iqbal Ike K. Ahmed, MD, FRCSC, to discuss the current state of drug delivery technology for glaucoma treatment. He outlines how drug delivery platforms help physicians improve predictability and repeatability of treatment outcomes, removing the medication burden from patients. Dr. Yadgarov also comments on factors of access and cost for drug delivery platforms and shares insights into what’s coming next in the pipeline.

Keep Autoimmune Rheumatic Disease On Your DED Radar

Cecelia Koetting, OD, FAAO, Dipl ABO; Sierra Tisdelle, OD, FAAO; Alison Mercer, OD; Jen Kirby

Eyetube

Podcast host Cecelia Koetting, OD, FAAO, Dipl ABO, talks with Sierra Tisdelle, OD, FAAO, and Alison Mercer, OD, about their upcoming article, "Autoimmune Rheumatic Disease." Specifically, the pair discusses the tips, tricks, and tests to keep in mind when you may be dealing with an autoimmune rheumatic disease, as well as the related treatments and therapies. Dr. Koetting wraps up the episode by introducing Modern Optometry’s new Editor-in-Chief Jen Kirby, who answers questions about what readers can expect from Modern Optometry moving forward.

Zeiss Launches App to Improve Workflow

Eyetube

Zeiss releases a software app that aims to address longstanding challenges in ophthalmic care; Oertli launches its new surgical platform, the OS 4 Up, in Europe; and Harrow introduces direct-to-prescriber cash-pay kits for ophthalmic branded medications. Learn more about your ad choices. Visit megaphone.fm/adchoices

The State of Glaucoma Care

My perspectives on present and future management.

Brian M. Shafer, MD

Glaucoma Today

The pathophysiology of glaucoma has been associated with upregulation of pathological cell cascades that can lead to apoptosis of retinal ganglion cells (RGCs). When RGCs undergo programmed cell death, their axons, which comprise the retinal nerve fiber layer (RNFL), ultimately degenerate. This leads to the RNFL thinning that is observed on OCT and typically characteristic of glaucomatous progression. The exact pathway that links IOP to RGC apoptosis is unknown, but I believe it involves dysregulated axoplasmic flow that causes an accumulation of toxins and lack of nutrient flow. Axoplasm flows anterogradely from the ganglion cell to the axon (nerve fiber), across the lamina cribrosa, and into the retrobulbar optic nerve; it ultimately synapses in the lateral geniculate nucleus. Axoplasm flows retrogradely in the opposite direction. Elevated IOP seems to disrupt the translaminar pressure difference (difference between IOP and intracranial pressure across the lamina cribrosa). The flow of fluid inside of the eye begins with aqueous humor production and transudation through the ciliary processes. Fluid then flows from behind the iris into the anterior chamber, egresses through the trabecular meshwork (TM) into Schlemm canal, and moves out through the collector channels and into the episcleral venous plexus. From there, fluid enters the normal venous drainage system from the face (cavernous sinus into jugular vein).

Extending Treatment Efficacy in Wet AMD

Lejla Vajzovic, MD; Robert L. Avery, MD; Carl D. Regillo, MD; and Durga S. Borkar, MD, MMCi

Eyetube

Podcast moderator Lejla Vajzovic, MD, sits down with Robert L. Avery, MD; Carl D. Regillo, MD; and Durga S. Borkar, MD, MMCi, to explore how new therapies hold promise for extending treatment efficacy in patients with wet AMD. They touch on various drug delivery platforms, gene therapy, tyrosine kinase inhibitors, and the challenges of drug development and approval. 

How Ophthalmology Strategics are Rewriting the Playbook

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Ophthalmic executives discuss strategies to scale and grow in today’s economic and regulatory environments.  Learn more about your ad choices. Visit megaphone.fm/adchoices

How to Succeed in Ophthalmology Residency

Pavlina Kemp, MD; Samuel Tadros, MD; Blake K. Williamson, MD, MPH; and Gary Wörtz, MD

Eyetube

Blake Williamson, MD, MPH, and Gary Wörtz, MD, return for a new season of Ophthalmology off the Grid! This season, the hosts dive into the basics of training and education at the most prestigious programs in ophthalmology across the United States. In this episode, they invite Pavlina Kemp, MD, residency program director at the University of Iowa Department of Ophthalmology and Visual Sciences, and Samuel Tadros, MD, a PGY-4 ophthalmology resident, to share a state of the union on ophthalmology residency. They discuss what it takes to stand out during the application and interviewing process and find success in the field.