Day 15 :
- Neuro Optometry | Glaucoma | Ocular Diseases | Lenses
Location: Edinburgh
Chair
Carolyn Carman
University of Houston, USA
Session Introduction
Mark Wright
Royal College of Surgeons, Scotland
Title: Quiz on Diagnostics Eye Algorithms
Biography:
Mark Wright perform over 300 small incision phaco-emulsification (modern small incision) cataract surgeries annually with over 99% as a day case. His cataract outcomes
are as follows; over the past three years (1,173 consecutive cases), 96% of patients saw 6/12 or better postoperatively (comparative figure is 91% from the national
cataract audit). Mark’s capsular rupture rate, the most commonly sited measurement of surgical dexterity was 0.6% (1.9% national cataract audit). He co-leads the
oculoplastic (eyelid and socket) service for Lothian. Audit of surgical outcomes forms the backbone of revalidation, He was the inaugural audit secretary for the British
Oculoplastic Surgical Society. He have a keen interest in teaching and has, for the past 10 years, run the undergraduate ophthalmology course at Edinburgh University.
Consultant Ophthalmologist, Lothian University Hospitals NHS Trust, Princess Alexandra Eye Pavilion, Edinburgh Consultant Ophthalmologist, West Lothian NHS Trust,
St John's Hospital, Livingston. Honorary Part-time Senior Lecturer, Edinburgh University.
Abstract:
There are many excellent ophthalmology textbooks which give the novice the appropriate knowledge, however very few
indicate how to apply it. For this reason I have developed along with colleagues a series of diagnostic algorithms (Edinburgh
Diagnostic Algorithms) for the three most commonly encountered scenarios: red eye (s), visual loss and diplopia. I’ve included
two others; anisocoria and epiphora. These diagnostic algorithms allow the inexperienced clinician (in ophthalmological terms) to
start toutilise and build upon their existing knowledge by consulting a framework which represents the thought processes of their
more experienced colleagues. Algorithms are, therefore, simply a user-friendly version of these diagnostic and/or treatment thought
processes. Algorithms are always a compromise between having enough detail to cover the most commonly encountered diagnoses
while remaining simple enough to use. They rely upon the clinician being able to clarify the history and elicit the clinical signs which
act as signposts on the road to diagnostic nirvana.
I’ll present the results of 3 published studies looking at the accuracy of the Edinburgh Diagnostic Algorithms I’m hopeful that during
the course of my talk I’ll convince you of their benefits whilst having a bit of fun!
The accuracy of the Edinburgh Red Eye diagnostic algorithm. H Timlin, L Butler & M Wright Eye (Lond). 2015 May;29(5):619-24.
The accuracy of the Edinburgh Visual Loss diagnostic algorithm. C Goudie, A Khan, C Lowe and M Wright. Eye (Lond). 2015
Nov;29(11):1483-8.
The accuracy of the Edinburgh Diplopia diagnostic algorithm. L Butler, T Yap and M Wright Eye (Lond). 2016 Jun;30(6):812-6
Narrated algorithm talk: https://youtu.be/9MykiR5imtw
Clifford D Brown
Central Alabama Veterans Healthcare System, USA
Title: Observations in a population with diffuse traumatic brain injury
Biography:
Clifford D Brown serves in the Central Alabama Veterans Health Care System as Chief of the Eye Clinics. He was Senior Health Adviser and Senior Analyst/Operations
Chief of National Biosurveillance Integration Center and the U. S. Army Deputy Chief of Eye Services and Behavioral Vision Chief for the Exceptional Family Member
Department and served as a rehabilitative consultant for five school districts in USA.
Abstract:
Much has been said in the past decade concerning traumatic brain injured patients. Although each injury is particularly
unique, certain general observations can be made of neurologically-driven behaviors that seem to be both reasonably
common and associated with this type of sudden, forced movement of the cranial bony structures and the resulting actions
within the cerebral soft tissues. The visual pathways and the globe itself are in a unique position to reveal certain aspects of the
neural damage. Visual field studies, oculocoherence tomography, and dilated fundus examination can be used to demonstrate
vitreous detachments, scotomas, and retinopathy, while other routine testing demonstrates paresis of accommodation,
convergence insufficiency, irregular eye movements, and numerous other degradation of binocular function. As an active
contributor to the general health care team, the eye care specialist should be aware of at least the most common signs, both focal
and global and the associated symptoms. Recent studies have been published that support the contentions of those providers
who work routinely with this particular population. While much research remains to be done, the authors of this paper have
proposals that seem to at least partially suggest possible physical explanations for several of the most commonly encountered
challenges experienced in a significant group of athletes, accident victims and soldiers. This presentation has been developed
based upon clinical experience of the traumatic brain injury (TBI) team in a Veterans Health Administration hospital, a team
of providers that assesses, diagnoses and provides rehabilitation on an outpatient level to patients who have sustained a wide
variety of brain injuries. Principally developed by those who provide this service on a daily basis, the observations are those
of rehabilitative neurological professionals and will provide comment on the mechanism of injury, some diffuse effects on the
structure and function and an attempt to incorporate approaches and applications of techniques used today in restoration of
neuromuscular function in those with traumatic cerebrospinal injury.
Carolyn Carman
University of Houston, USA
Title: Useful clinical pearls for assessing and managing visual impairment in brain injury patients
Biography:
Carolyn Carman is a Clinical Professor and Director of the Center for Sight Enhancement at the University of Houston College of Optometry in Houston, Texas. She is
a graduate of the University of South Florida and of the Southern College of Optometry where she earned her Doctor of Optometry degree. She completed a residency
in ocular pathology and low vision rehabilitation at the VA Medical Center in Kansas City, Missouri. Dr. Carman is a Board Certified Diplomate of the American Board of
Optometry and a Fellow of the American Academy of Optometry. She is a member of the American Optometric Association where she has participated on or chaired
several national committees including the Neuro-Optometric Rehabilitation Committee and Ethics and Values Committee. She was twice appointed by the Texas Governor
to the Texas Optometry Board and served as Chair. Dr. Carman has also been a member of an independent review board reviewing pharmaceutical research studies
and as an investigator in clinical studies. She has lectured extensively, nationally and internationally, on low vision rehabilitation and brain injury and formerly produced a
syndicated radio program geared toward persons with low vision and reading disabilities.
Abstract:
Background/Aim: Vision impairments are often associated with brain injuries and may be combined with other multiple
impairments, but evaluating these patients in order to identify the presence of vision-related problems can be challenging.
Sometimes the deficits are difficult to identify because they are subtle; sometimes they are difficult to assess because the patient
may be non-verbal or unable to respond to conventional testing methods.
Content: This presentation will address clinical pearls and useful approaches for evaluating and managing children or adults
who have suffered vision loss or impairment due to brain injury and may have other impairments complicating the examination
process as well.
Implications: The goal of this presentation is to share the development of useful approaches and techniques gained from over
30 years of experience in the clinical and rehabilitative care of brain injury patients of all ages in both hospital-based and privatepractice
settings.
Chikezie Grand Ihesiulor and Udo A Ubani
University of Manchester, Uinted Kingdom and Abia State University Uturu, Nigeria
Title: Molecular basis of congenital glaucoma
Biography:
Chikezie Grand Ihesiulor was born in Port Harcourt, Nigeria, in 1986. He received the O.D. Doctor of Optometry degree in Optometry from Abia State University, Uturu,
Nigeria, in 2008 and the MSc in Investigative Ophthalmology and Vision Sciences in The University of Manchester, UK in 2013. In 2015, I joined the Department of
Optometry, Abia State University, as a Lecturer. His current research interests include glaucoma, ocular trauma, ocular genetics, preventive optometry, visual psychology
and psychopathology. Dr. Chikezie is a member of the Nigerian Optometric Association (NOA) and the Optometrist and Dispensing Opticians Registration Board of Nigeria.
He is the CEO of Healthy-hope Lifestyle Centre, Nigeria. He was awarded the best clinician by the President, NOA in 2009 and has joined and led several community
health care teams in Nigeria and UK to offer free medical and eye health care services. He is an innovative researcher and is currently pursuing his Ph.D. in Optometry in
The University of Manchester, UK.
Abstract:
Purpose: The purpose of this study was to detect pathogenic mutations in cytochrome P450, family 1, subfamily B, polypeptide
1 (CYP1B1) gene in 19 sporadic primary congenital glaucoma (PCG) cases and to identify patients lacking CYP1B1 mutations.
Secondly, to conduct an in silico analysis of exome sequencing data of variants common to three related pigment dispersion
syndrome (PDS) patients.
Methods: CYP1B1 exon 2 and the coding part of exon 3 of 15 participants were amplified by polymerase chain reaction and
amplicons were sequenced by Sanger sequencing. Sequencing data was analyzed to identify the gene mutations or SNPs. Second,
the exome sequencing data of the PDS patients combined was analyzed in-house by bioinformaticians and further filtered
manually to identify candidate genes for PDS.
Results: Four previously reported PCG-associated CYP1B1 mutations (c.1159G>A; p.E387K, c.230T>C; p.L77P, c.1103G>A;
p.R368H and c.1568G>A; p.R523K) were found in four patients out of the 15 fully ‘sequenced’ patients. Also, 10 previously
reported single nucleotide polymorphisms and two novel noncoding variants were identified. Second, 21 candidate genes were
found after filtering using various databases (OMIM & GeneDistiller). Nine genes (TPCN2, TYR, PAX6, DICER 1, FOXE3, TGIF1,
TCF4, RPGR and CNGB3) may be of more importance since they are associated with ocular diseases.
Conclusion: The relatively low percentage of PCG patients having CYP1B1 mutations (4/15=26.6%) demonstrates that other
known and unknown genes may contribute to PCG pathogenesis. Lack of CYP1B1 gene mutations in some patients stresses the
need to identify other responsible candidates. More analysis may be needed and the genes identified may be screened in future in
other PDS patients to study PDS genetics.
Biography:
Abstract:
Purpose: To compare the clinical outcome of visual acuities and spectacle independency of four different multifocal intraocular lenses (MFIOLs) (ReZoom, Tecnis, Acrysof Restor SN60D3, and Acrysof Restor SN6AD1) based on information reported in the international literature and to investigate a potential follow up treatment.
Methods: Comparative clinical trials that involved bilateral implanting MFIOLs in patients with cataract were extracted from the literature. Clinical outcomes included uncorrected distance visual acuity, binocular distance corrected visual acuity, uncorrected intermediate visual acuity, binocular distance corrected intermediate visual acuity, uncorrected near visual acuity, binocular distance corrected near visual acuity and spectacle independency. All visual acuity declarations were transformed in LogMAR if needed. The statistical results are based on mean visual acuities ±SE.
Results: Six papers were identified describing four MFIOLs (ReZoom, Tecnis, Acrysof Restor SN60D3, and Acrysof Restor SN6AD1). UCDVA was 0.09±0.04, 0.10±0.01, 0.15 ±0.01 and 0.05 ±0.03 LogMAR. The spherical Acrysof Restor SN60D3 had the poorest result. The best result was performed by the Acrysof Restor SN6AD1. BDCVA was 0.06 ±0.01, 0.02 ±0.01, 0.08 ±0.01 and 0.03 ±0.01 LogMAR. UCIVA was 0.10±0.04, 0.22±0.00, 0.22 ±0.00 and 0.16 ±0.01 LogMAR. Tecnis and Acrysof Restor SN60D1 had the worst results, while the best result was performed by the ReZoom. BDCIVA was 0.10±0.04, 0.21±0.00, 0.30 ±0.00 and 0.17±0.02 LogMAR. Even here, the results from Tecnis and Acrysof Restor SN60D3 were inferior compared to the other MFIOLs. The UCNVA in 40 cm was 0.26±0.03, 0.14±0.01, 0.15±0.03 and 0.09±0.04 LogMAR. Best result was performed by the Acrysof Restor SN6AD1; the worst outcome was by ReZoom. BDCNVA in 40 cm was 0.20±0.02, 0.09 ±0.04, 0.13 ±0.04 and 0.05±0.05 LogMAR. The statements from the UCNVA are transmittable. The UCNVA in 33 cm was 0.30±0.00, 0.01±0.01, 0.18 ±0.00 and 0.18±0.00 LogMAR. The difference between the ReZoom and the Tecnis is disproportionate. While the Tecnis has invincible outcome, the performance of the ReZoom is poor in this distant. BDCNVA in 33 cm was 0.31±0.00, 0.12±0.00, 0.15±0.00 and 0.15±0.00 LogMAR. The spectacle independence rate was highest in the Acrysof Restor SN6AD1 group, followed by the Acrysof Restor SN60D3 group. The worst results were in the ReZoom group.
Conclusion: All MFIOLs provide a good uncorrected and binocular distance corrected visual acuity. In the intermediate area the ReZoom has the best result. The performance of the Acrysof Restor SN60D3 is poorest for this distance. In the near area, the ReZoom has the worst results in 40 cm and 33 cm. The Tecnis has the best performance in the distance of 33cm. The Acrysof Restor SN6AD1 and the Acrysof Restor SN60D3 have higher spectacle independency rates compared with the other multifocal IOLs. A complete spectacle independency was mostly not reached by any type of MFIOL.
Pamela J Miller
Southern California College of Optometry, USA
Title: Is there still a place for the primary care optometrist?
Biography:
Pamela J Miller has opened her solo practice in Highland, CA, in 1973. She is a Graduate from the Southern California College of Optometry and Loma Linda College of
Law, and a Life Member of the American Optometric Association, a Charter Member of the AOA Contact Lens Section, an American Academy of Optometry Fellow and a
Distinguished Practitioner in the National Academies of Practice. She was the first woman on the California Optometric Association Board of Trustees, the first female OD
on the CA State Board of Optometry and the first OD on the CA Board of Medical Quality Assurance. She has served on numerous boards, was the first President of the
American Optometric Society and CEO of Optometric CE for five years. She lectures extensively, and has written seven books and over 250 articles, while serving as a
Contributing Editor to numerous journals for over 40 years.
Abstract:
As the number of private practices decreases in favor of multi-doctor or multi-disciplinary offices, health maintenance
organization (HMOs), preferred provider organization (PPOs), and chain-store practices, the question of survival of the
private practice or solo practitioner remains a concern to the profession as well as the individual doctor. As insurance companies
and increasing governmental oversight grows, the private practitioner can feel that he or she is obsolete, overwhelmed, or simply
unable to cope with the changing healthcare picture. As the profession grows, with increasing responsibility and ever expanding
scope of licensure, the issue of quality of care, prevention of litigation, meeting or exceeding the patient’s needs, and coordinating
with other practitioners to better care for the patient population continues to grow. Weighing the viable options can be equally
daunting for the experienced practitioner as well as the newly licensed professional. Options may be limited due to financial
constraints, geographic restrictions, practitioner age and experience, and proximity of patients and professional or other healthcare
colleagues and urgent care or emergency services. Before signing the death-knoll of private practice it is essential to weigh
all the options, the benefits and detractors, and reassess the projected future of the private practitioner and this mode of practice.
Sanil Joseph
Aravind Eye Care System, India
Title: Prevalence and risk factors for myopia and hyperopia in an adult population in southern India
Time : 13:55-14:20
Biography:
Sanil Joseph holds an MSc. in Public Health from the London School of Hygiene & Tropical Medicine and a Master’s in Hospital Administration (MHA) from Mahatma
Gandhi University, India. For the last 13 years, he has been working as a Senior Faculty and Health Management Consultant at the Lions Aravind Institute of Community
Ophthalmology, Aravind Eye Care System, Madurai, India. His primary role in the organization is to anchor health services and epidemiological research, and he has
published many scientific papers in reputed international peer reviewed journals. In 2012, he was awarded a Masters Fellowship from the Wellcome Trust UK as a part of
which he successfully completed a Masters in Public Health with specialization is Health Services Research at the London School of Hygiene & Tropical Medicine. His current
areas of research include refractive errors, use of telemedicine in screening of diabetic retinopathy and primary eye care.
Abstract:
Statement of the Problem: Myopia is the most common cause of refractive errors in both children and adults in many countries.
Comparisons of adult myopia prevalence across countries are complicated by variations in the age ranges of populations studied,
definitions of myopia and secular trends in environmental risk factor. The aim of this study was to investigate prevalence and risk
factors for myopia, hyperopia and astigmatism in southern India.
Methodology: Randomly sampled villages were enumerated to identify people aged ≥40 years. Participants were interviewed for
socioeconomic and lifestyle factors and attended a hospital-based ophthalmic examination including visual acuity measurement
and objective and subjective measurement of refractive status. Myopia was defined as spherical equivalent (SE) worse than
-0.75 diopters (D) and hyperopia was defined as SE ≥+1D.
Findings: The age-standardized prevalence of myopia and hyperopia were 35.6% (95% CI: 34.7–36.6) and 17.0% (95% CI: 16.3–
17.8) of those with myopia, 70% had advanced cataract. Of these 79% had presenting visual acuity (VA) <6/18 and after best
correction, 44% of these improved to ≥6/12 and 27% remained with VA <6/18. In multivariable analyses excluding advanced
cataract, increasing nuclear opacity score, current tobacco use and increasing height were associated with higher odds of myopia.
Higher levels of education were associated with increased odds of myopia in younger people and decreased odds in older people.
Increasing time outdoors was associated with myopia only in older people. Increasing age and female gender were associated
with hyperopia and nuclear opacity score, increasing time outdoors, rural residence and current tobacco use with lower odds of
hyperopia.
Conclusions: In contrast to high income settings and in agreement with studies from low income settings, we found a rise in
myopia with increasing age reflecting the high prevalence of advanced cataract. This suggests that older people would benefit more
from cataract removal than spectacle correction.
Thokozile Ingrid Metsing
University of Johannesburg, South Africa
Title: Comparison of the Snellen acuity chart with the spectrum eye care software LogMAR chart amongst children of school going age
Biography:
Thokozile Ingrid Metsing is currently a Lecturer at the University of Johannesburg. This article is part of the research conducted by her towards her DPhil study, entitled:
“Strategies to improve school vision screenings at primary health care level in Johannesburg, South Africa”. She has published six articles with three of them currently
under review from the African Vision and Eye Health and Ophthalmology Clinics and Visual Sciences journals.
Abstract:
Most vision screening protocols worldwide rely on the measurement of visual acuities (VAs) to detect visual anomalies
amongst children of school-going age. This is despite the fundamental design flaws in the Snellen chart. However, there
appears to be a growing demand for the usage of modern technology in the eyecare profession. The aim of this prospective
and quantitative study was to evaluate the equivalence of a standard Snellen chart compared to the Spectrum Eyecare Software
LogMAR chart in evaluating VAs amongst children of school going age. Normative data was collected from three randomly
selected schools in Johannesburg (South Africa) on the non-clinical population of 209 children of school-going age mean
10.13±2.45 years. Monocular and binocular VAs was measured using the Snellen chart at six meters and the spectrum computer
software program at three meters. The statistical significant differences (p<0.05) were determined using ANOVA for distance
binocular and monocular VAs using the Snellen chart and the Spectrum Eyecare Software. The performance of the Spectrum
Software LogMAR was found to be one line better than that of the Snellen chart. However, the Snellen chart still remains the
simple, easily accessible and inexpensive method to be used for vision screening amongst children of school-going age compared
to the Spectrum Eyecare Software.
Julia Pulliam and Angelina F. Bonner
St.Louis Healthcare System, USA and VA Illiana Health Care System, USA
Title: Challenges Beyond the Phoropter: Part I Neuro-Eye Symposium
Biography:
Julia Pulliam attended Indiana University College of Optometry and graduated with Doctor of Optometry degree. Dr. Julia is staff Optometrists at the St. Louis VA Medical
Centre. Julia is an active member of the Armed Forces Optometric Society (AFOS), the American Optometric Society (AOA), the American Academy of Optometry
(AAO), and the St. Louis Optometric Society (SLOS). At St. Louis VA, she served as both Optometry Residency and Externship Coordinator in addition to Contact Lens
Coordinator. Currently, she is serving as the Acting Chief of Optometry.
Angelina Bonner earned her Bachelor of Science from Bradley University and her Doctor of Optometry degree from Indiana University. As a doctoral candidate, Dr. Bonner
performed contact lens research and presented on developing a method to assess on eye contact lens wettability at the 2009 Academy of Optometry meeting. During her
residency at the St. Louis Veterans Affairs Medical Center(VAMC), she specialized in ocular disease, specialty contact lenses, and primary care. Dr. Bonner has presented
on several complex ocular disease cases both locally and nationally during her career. Following residency, Dr. Bonner’s passion for serving veterans led her to the Dallas
VAMC where she managed complex ocular disease, traumatic brain injury cases, and specialty contact lens care. Dr. Bonner currently enjoys working as the Director of
Specialty Contact Lenses, staff optometrist, and attending at the VA Iliana Healthcare System in Danville, IL. In addition to educating students and residents with didactic
activities and clinical training, Dr. Bonner holds adjunct faculty positions at several universities. In fall 2017, she earned the distinguished title of Fellow of the American
Academy of Optometry. Dr. Bonner is currently licensed in Texas, Illinois, and Missouri.
Abstract:
“The eye exam does not stop there.” Eye care practitioners have the privilege and ability to diagnose a variety of neurologic
conditions based on ocular findings. By the utilization of imaging and laboratory tests, we can extend our reach beyond the
phoropter to aid in the diagnosis and management of our patients’ ocular and systemic health. We have the duty and ability to initiate
and coordinate appropriate care in a timely manner for our patients. By actively participating and interacting with other specialists,
we establish our vital role in the health care system. We will present a variety of clinical cases that demonstrate the importance of
utilizing serological testing and imaging to establish a proper diagnosis and treatment plan.
Silvia Gamboa Saavedra
Centro de OftalmologÃa Bonafonte, Spain
Title: Prevalence estimates for myopia in children and young people in 2013–2017
Biography:
Silvia Gamboa Saavedra got her graduate degree from B.A. University, Medical School, Argentina in 1994 and she got her Master and Specialist in Ophthalmology
at Argentine Council Board of Ophthalmology and Health Ministry. She completed an Ophthalmology residency at Juan A Fernández Hospital, B.A., Argentina and
a fellowship in Pediatric Ophthalmology and Strabismus at R Gutierrez Hospital, B.A., Argentina. She was consultant in Pediatric Ophthalmology and Strabismus in
Argentina for 10 years till 2005 when she flew to Barcelona, Spain, where she lives with her husband. She is an active assistant and she has lectured at national and
international optometry and ophthalmological congresses for more than 20 years.
Abstract:
Objective: To compare prevalence estimates for myopia in children and young people in 2013–2017.
Methods: Retrospective study of the ophthalmology history of children (6–9 years old) and young people (10–15 years old) from
2013 to 2017 was conducted in Barcelona. All of them were with diagnosis of myopia and presenting visual acuity ≥0.5 and ≤0.4,
respectively.
Results: The estimated prevalence of myopia in children aged 6–9 years old and young people 10–15 years old was higher in the
last five years in both groups. In last five years, prevalence estimates were higher for children, 17% vs. 33% (p <0.001) and for
young people 30% vs. 47% (p<0.001) and for all levels of myopia severity: <2D 12% to 18% (p<0.001), >/= 2D -<6D 12% to 25%
(p<0.001) and >/= 6D 1-6% (p<0.001).
Conclusions: Using similar methods, the prevalence of myopia in children and young people in Barcelona, appears to be higher
in last 5 years. What are the reasons for the increase in prevalence of myopia? What are we doing to try to slow down the progress
of myopia? Reducing the age of onset of myopia is of great concern. Ophthalmologists and optometrist have to go on looking for
options to reduce the risk of myopia and to educate children and young people for reducing computer vision syndrome.
- Neuro Optometry | Glaucoma | Ocular Diseases | Lenses
Location: Edinburgh
Chair
Nicholas Gidosh
Michigan College Of Optometry, USA
Session Introduction
Julia Pulliam and Angelina F. Bonner
St.Louis Healthcare System, USA and VA Illiana Health Care System, USA
Title: Challenges beyond the phoropter: Part II retina/OCT symposium
Biography:
Julia Pulliam attended Indiana University College of Optometry and graduated with Doctor of Optometry degree. Dr. Julia is staff Optometrists at the St. Louis VA Medical
Centre. Julia is an active member of the Armed Forces Optometric Society (AFOS), the American Optometric Society (AOA), the American Academy of Optometry
(AAO), and the St. Louis Optometric Society (SLOS). At St. Louis VA, she served as both Optometry Residency and Externship Coordinator in addition to Contact Lens
Coordinator. Currently, she is serving as the Acting Chief of Optometry.
Angelina Bonner earned her Bachelor of Science from Bradley University and her Doctor of Optometry degree from Indiana University. As a doctoral candidate, Dr. Bonner
performed contact lens research and presented on developing a method to assess on eye contact lens wettability at the 2009 Academy of Optometry meeting. During her
residency at the St. Louis Veterans Affairs Medical Center(VAMC), she specialized in ocular disease, specialty contact lenses, and primary care. Dr. Bonner has presented
on several complex ocular disease cases both locally and nationally during her career. Following residency, Dr. Bonner’s passion for serving veterans led her to the Dallas
VAMC where she managed complex ocular disease, traumatic brain injury cases, and specialty contact lens care. Dr. Bonner currently enjoys working as the Director of
Specialty Contact Lenses, staff optometrist, and attending at the VA Iliana Healthcare System in Danville, IL. In addition to educating students and residents with didactic
activities and clinical training, Dr. Bonner holds adjunct faculty positions at several universities. In fall 2017, she earned the distinguished title of Fellow of the American
Academy of Optometry. Dr. Bonner is currently licensed in Texas, Illinois, and Missouri.
Abstract:
The eye exam does not stop there. Eyecare practitioners have the privilege and ability to diagnose a variety of retinal conditions
using the Ocular Coherence Tomography (OCT). With the OCT, we can extend our reach beyond the phoropter to aid in
the diagnosis and management of our patients’ ocular and or systemic health. We will present a variety of clinical cases that
demonstrate the importance of the OCT in order to accurately diagnose and subsequently manage and coordinate the care of our
patients.
Joseph Hallak and Jeffrey Becker
State University Of New York, USA and Pennsylvania State University, USA
Title: Neuro-optometric rehabilitation of Mild Traumatic Brain Injury (mTBI)
Biography:
Joseph Hallak is an Optometrist. He was a Founder and Chairman of a continuing education study group and Director of the Contact Lens and Low Vision Clinics.
Hallak is an adjunct Assistant Clinical Professor, the State University of New York, College of Optometry and Adjunct Clinical supervisory faculty, the New England
College of Optometry and Salus University. He is a contributing editor to Primary Care Optometry News. He is a member of certain Optometry societies.
Jeffrey Becker is a graduate of the Pennsylvania State University and graduated from The Illinois College of Optometry. He has been a practicing Optometrist in
Northeastern Pennsylvania for over 34 years, with a specialty practice in Rehabilitative Optometry. Becker is an adjunct faculty member at Misericordia University,
Dallas. He examined and treated over 3000 head injury, stroke, and neurologically impaired patients ranging in ages from birth to senior citizens. Becker recently
accepted an appointment by Governor Wolfe to be a board member on the State board of Optometry in 2017.
Abstract:
MTBI is by definition a complex pathophysiological process affecting the brain, induced by biomechanical forces. It is an
injury to the brain resulting in three categories of symptoms: physical/somatic, e.g. headache, vision, GI disturbance;
cognitive, e.g. attention, memory and; psychiatric, e.g. mood swing, personality changes. Most of these symptoms should get
better within 2–3 weeks of total rest (sometimes more) barring any second impact syndrome. A concussion lasting less than
30 minutes with a Glasgow coma scale (GCS 13–15) is considered mTBI. It can result in temporary or permanent neurological
symptoms. Neuro-imaging tests such as CT scan or MRI may or may not show evidence of any damage. High school football
accounts for 47% of all reported sports concussions, followed by ice hockey and soccer. An mTBI accounted 82% of the 340,000
cases of blast injuries in the US military between 2000 and 2015. Highlights of clinical vision and perception examination
and rehabilitation of the mTBI patients include the following: thorough history, correction of small errors, out of instrument
subjective examination, contrast sensitivity and glare assessment, monocular, bi-ocular and binocular accommodative facility,
vergenses, saccades and fusional ranges. Treating patients with equipment that offers visual, vestibular and proprioceptive
abilities will provide the best outcome. Devices and methods tapping multisensory system and featuring feedback with
proprioceptive and balance capability are essential for office and home. That is because the main goals of rehabilitation
are endurance, integration and internalization of learned skills for lasting long term benefits and avoiding regression after
therapy. Keep in mind the three phases of neuro-optometric rehabilitation: visual stabilization: postural/peripheral awareness,
monocular skills; binocular vision integration: oculomotor/accommodative, convergence, stereopsis, localization–static and
dynamic; visual automaticity: multisensory integration.
Nicholas Gidosh
Lehigh Valley Eye Care Associates, USA
Title: Toric orthokeratology contact lenses for patients with corneal elevation differences
Biography:
Nicholas Gidosh is an Optometrist at Lehigh Valley Eye Care Associates in Allentown Pennsylvania. He has received his Doctor of Optometry Degree from
the Pennsylvania College of Optometry at Salus University, where he is currently doing his part time as a Clinical Instructor. He has also completed a Cornea/
Contact Lens Residency at the Michigan College of Optometry at Ferris State, and is a Fellow of the American Academy of Optometry. He has served as a Clinical
Investigator for studies involving hybrid, scleral, multifocal, and orthokeratology lenses. He has also presented lectures and posters at several conferences.
Abstract:
Orthokeratology is a well-established process by which the corneal surface is reshaped in order to correct refractive
ametropia through the use of specific contact lens designs. Orthokeratology lenses are reverse geometry lenses specially
designed to have very low clearance over the pupil. These designs are comprised of different zones to either provide treatment
or stabilize the lens and can be organized into two broad categories: corneal refractive therapy (CRT, Paragon vision sciences,
Inc.) or vision shaping treatment (VST, Bausch + Lomb). This lecture will review fundamentals in orthokeratology as well
as troubleshooting common problems faced in practice. The presentation will then discuss more advanced design options
available to apply ortho-k fitting to more patients by focusing on toric designs as well as describing other ways of customizing
a fit. This will be done through discussion of elevation data obtained through a corneal topographer including how to measure
the values and apply it when designing an orthokeratology lens. Topographical data is critical in understanding the shape of a
patient’s corneal surface and thereby designing an appropriately fitting contact lens. Topographical maps will be discussed and
analyzed to explain how to troubleshoot different problems and guide custom lens design.
Alejandra Mendivelso Suárez
Universidad de la Salle, Colombia
Title: Ocular burning-smartphone and symptoms in university students
Biography:
Alejandra Mendivelso Suárez is a assistant professor at El Bosque University Bogotá and KOL for Coopervision in Colombia. Alejandra did her education in
magister vision sciences at University of La Salle. She is also an optometrist at University of La Salle. Alejandra relevant course work includes El Bosque University
- course in scientific writing and evaluation in research; University of Oklahoma - Designing courses for significant learning, etc.
Abstract:
Communication is one of the primary needs of young people, since technological evolution has generated the creation
of devices such as smart mobile phones in order to entertain, communicate, and generate access to different sources of
information. Most university students have a smart mobile device that they use in all their daily activities. The overuse of
these smartphones can produce general and ocular symptoms. During 2017, we studied 204 university students in Bogotá -
Colombia to evaluate symptoms by use of smartphone.
Aditi Chinmay Deshpande
Bharati Vidyapeeth Deemed University, India
Title: Amblyopia And Its Management With Vision Therapy Program
Time : 12:40-13:05
Biography:
Aditi Chinmay Deshpande MOptom., FAAO, FIACLE—is working as an Assistant Professor at Bharati Vidyapeeth Deemed University, School of Optometry, Pune, India. She specializes in Binocular Vision and Orthoptics predominantly, and practices Low Vision at private eye hospital in Pune. She has presented paper at the American Academy of Optometry (AAO) in 2012 and has facilitated workshops on Binocular Vision in popular national and international optometry conferences.
Abstract:
Statement of the Problem: Amblyopia is a developmental disorder resulting from anomalous binocular visual input early in life in the absence of visible ocular or visual pathway disease caused by an uncorrected refractive error, strabismus or form and light sense deprivation. Those with amblyopia may suffer from poor visual acuity, poor special acuity, and low sensitivity to contrast, impaired stereoacuity and abnormal binocular summation. In children, undetected and untreated amblyopia may preclude children’s visual development and impair productive participation in society.
Purpose: To assess the course of amblyopia treated with vision therapy exercises in children.
Method: A total of 50 subjects ageing from 3–11 years were enrolled in this hospital based study. All the subjects had undergone preliminary eye examination to rule out various types of amblyopia. The visual acuity measured with Snellen’s Visual Acuity chart and stereo-acuity measured with TNO test were compared, for the amblyopic subjects before and after giving vision therapy exercises along with patching at three months, six months and nine months of follow-ups, respectively using statistical analysis.
Results: Of the 50 subjects examined, 15 were having strabismic amblyopia and 35, refractive amblyopia. The mean visual acuity of strabismic amblyopic subjects was 0.38 before treatment and was found to be clinically significant after treatment (0.54), but showed no statistically significant difference. Similarly, clinically significant difference was found between mean visual acuity of uniocular and binocular refractive amblyopic subjects compared before and after treatment. There was statistically significant difference found between stereoacuity measured before treatment and after treatment in subjects with refractive (p=0.001) and strabismic (p=<0.001) type of amblyopia.
Conclusion: This study proved that vision therapy exercises were effective treatment therapy in subjects with refractive and strabismic amblyopia which showed significant improvement in visual acuity and stereoacuity.
Recent Publications
- Chinmay Deshpande, Dipti Amod Gogate and Aditi Deshpande (2017) The functional impact of amblyopia on visual skills in children. Delhi Journal of Ophthalmology 28(2):26–31.
Evan J. Kaufman
University of Virginia, USA
Title: Ocular graft-versus-host disease and treatment with scleral contact lenses
Biography:
Evan J Kaufman got his undergraduate degree from Southern Illinois University. He then went on to earn his doctorate at the Indiana School of Optometry. After
graduation, he continued his education and completed a residency in ocular disease at the University of Kentucky. He is an adjunct clinical instructor at the New
England College of Optometry. He is expertise in Blepharitis, Conjunctivitis (Pink Eye), Farsightedness (Hyperopia), Glaucoma, Nearsightedness, Astigmatism,
Eyelid Swelling, Eye Care.
Abstract:
Over the past several decades, hematopoietic stem cell transplantation (HCT) has become the routine treatment for a
number of hematological disorders (e.g., leukemia, lymphoma), as well as treatment for some autoimmune diseases and
inherited metabolic disorders. One possible complication after stem cell transplantation is graft versus-host disease (GVHD),
an inflammatory condition that can affect many different organs, including the eyes. Ocular manifestations of GVHD are
common and can significantly decrease quality of life. Without a basic understanding of ocular GVHD, the condition can
be challenging to diagnose and adequately treat. This lecture summarizes the basics of HCT and ocular GVHD, and gives an
example case of ocular GVHD treated with scleral lenses.
Jason Chin
Andover Eye Associates, USA
Title: Ophthalmic clinical trials: a global perspective and how to incorporate them into your practice
Biography:
Jason Chin is a graduate of McGill University and he received his Optometry Degree from the New England College of Optometry in 2004, where he also completed his Cornea and Contact Lens Residency in 2005 and was awarded the American Optometric Foundation's "Dr. George Mertz Contact Lens Residency Award". He primarily sees patients in a private practice setting but is also a Clinical Investigator for Ora, Inc. and an Investigator/Consultant for national clinical trials on contact lenses for various contact lens companies around the US. His main area of interest and expertise are in Specialty Contact Lenses and Clinical Research. He is a Fellow of the American Academy of Optometry in the Cornea and Contact Lens Section, and is Board Certified and a Diplomat of the American Board of Optometry.
Abstract:
Clinical trials are an important entity for the advancement of medicine. At any given time, anywhere around the globe, a clinical trial is occurring and new advancements are being made. As optometrist and providers of eye care, we should be involved in this to further help the advancement of our field and specialty. This talk will give a global perspective and give some overview of the different clinical trials occurring around the world in the field of optometry and ophthalmology. An overview will be discussed on what the particular focuses are for various regions of the world; whether it be pharmaceutically based, disease detection, disease prevention, disease treatment or disease elimination and how the research may impact our field. Many of these issues are ones that we encounter and deal with, every day in our practice. This talk will also discuss some of the benefits of incorporating clinical trials into your practice and briefly review things to consider when incorporating them into your practice.
Jason Chin
Andover Eye Associates, USA
Title: Ophthalmic clinical trials: A global perspective and how to incorporate them into your practice
Biography:
Jason Chin is a graduate of McGill University and he received his Optometry Degree from the New England College of Optometry in 2004, where he also completed
his Cornea and Contact Lens Residency in 2005 and was awarded the American Optometric Foundation's "Dr. George Mertz Contact Lens Residency Award". He
primarily sees patients in a private practice setting but is also a Clinical Investigator for Ora, Inc. and an Investigator/Consultant for national clinical trials on contact
lenses for various contact lens companies around the US. His main area of interest and expertise are in Specialty Contact Lenses and Clinical Research. He is a
Fellow of the American Academy of Optometry in the Cornea and Contact Lens Section, and is Board Certified and a Diplomat of the American Board of Optometry.
Abstract:
Clinical trials are an important entity for the advancement of medicine. At any given time, anywhere around the globe, a
clinical trial is occurring and new advancements are being made. As optometrist and providers of eye care, we should be
involved in this to further help the advancement of our field and specialty. This talk will give a global perspective and give some
overview of the different clinical trials occurring around the world in the field of optometry and ophthalmology. An overview
will be discussed on what the particular focuses are for various regions of the world; whether it be pharmaceutically based,
disease detection, disease prevention, disease treatment or disease elimination and how the research may impact our field.
Many of these issues are ones that we encounter and deal with, every day in our practice. This talk will also discuss some of the
benefits of incorporating clinical trials into your practice and briefly review things to consider when incorporating them into
your practice.
Saleha Al-atawi
Cardiff University, UK
Title: Internal lens structure changes during simulated accommodation
Biography:
Saleha Al-atawi is a PhD student in Cardiff University. I have Master Degree of optometry from NSW University at Australia 2012 and my Bachelor Degree in
optometry from king Saud University, Riyadh, Saudi Arabia 2007. My current research focus on understanding the eye lens structure under accommodation
mechanism, Also, main interesting areas are eye health care, eye lens structure and cataract disease.
Abstract:
Aim: Since the internal structural changes that occur during the lens accommodation process are not fully understood, in this
study we aimed to analyze lens fibre widths during simulated accommodation.
Methods: Porcine eyes (n=11) were dissected and attached to a lens stretcher. 3D image stacks (between 120 μm to 240/270
μm depth) of the anterior and posterior surfaces of five lenses, while immersed in artificial aqueous humour solution, were
acquired using confocal microscopy in the un-stretched configuration and then the stretched configuration. Three lenses
remained in the un-stretched configuration and three lenses were subjected to stretching. All six lenses were fixed with 4%
paraformaldehyde, snap frozen and then serially cut into cryosections of 25 μm in thickness. 1 mm interval sections were
incubated in PBS- wheat germ agglutinin-Hoechst 33342 solution. Lens fibre widths were measured following acquisition of
fluorescent images of each lens at different depths.
Result: From the confocal images, there was a significant difference between unstretched and stretched configurations in
both anterior (mean lens fibre width: 5.1±0.589 μm versus 5.625±0.345 μm, p<0.0001) and posterior surfaces (5.55±0.16 μm
versus 5.67±0.25 μm, p<0.0001). In fluorescent images, lens fibre widths were unchanged between unstretched and stretched
configurations at depths of 1 mm (mean lens fibre width: 5.7±0.29 μm, versus 5.7±0.52 μm, p=0.411), and at 5 mm (7.7±1.89
μm, versus 7.9±2.14 μm, p=0.2309 and at 6 mm (6±1.08 μm, versus 5.97±0.89 μm, p=0.814). An increase in mean lens fibre
widths was observed in stretched lenses at depths 2 mm (mean lens fibre width: 6.9±1.76 μm, versus 7.9±1.9 μm, p<0.0001),
and at 3 mm (8.9±2.42 μm, versus 8.98±2.326 μm, p=0.0002), lastly at 4 mm (8.45±2.8 μm versus 9.1±2.2 μm, p=0.033). A
decrease in cortical lens fibre widths occurred (mean lens fibre width: 6.67±1.37 μm versus 5.65±0.29 μm, p<0.0001) at 7 mm.
Conclusion: Controversy exists as to whether nuclear lens fibres are altered during accommodation. This study shows that lens
fibre width alters at some depths, but not in others during accommodation.
David Richards
USF Eye Institute, USA
Title: Importance of initial and serial gonioscopy in the management on narrow-angle glaucoma
Biography:
David W Richards is an Associate Professor of Ophthalmology (Retired), University of South Florida, Tampa, and holds a Diploma from American Board of Ophthalmology, Fellow in Glaucoma, Bascom Palmer Eye Institute, Miami. He has 30 years’ of experience as a Clinical and Surgical Glaucoma Specialist. He has a particular interest in the dissemination of useful clinical information to the optometry community. He has lectured for several years at the Inter American University of Puerto Rico, School of Optometry in Bayamon.
Abstract:
Statement of the Problem: There is a common misconception among ophthalmologists and optometrists that a patent laser peripheral iridotomy (LPI) is a permanent cure for narrow angle glaucoma.
Discussion: In fact, the AC angle can progress to complete synechial closure and uncontrolled intraocular pressure despite a patent LPI. The most common risk factors for this process are: Hyperopia, phacomorphic lens changes and plateau iris syndrome. Diagnosis and treatment consist of: serial gonioscopy; OCT of the AC angle; laser iridoplasty, and in some cases, lens extraction even in eyes with little or no lens opacification. Examples of clinical cases will be discussed.
Recent Publications
Chen B H, Drucker M D, Louis K M and Richards DW (2016) Progression of normal-tension glaucoma after
- ventriculoperiotoneal shunt to decrease cerebrospinal fluid pressure. J Glaucoma. 25 (1): e50-e52.
- Lovelace RVE and Richards DW (2013) On the dispersion measure of high-redshift synchrotron sources. Monthly Notices of the Royal Astronomical Society. 433 (3): 2275-2277.
- Potcoava MC, Kay CN, Kim MK and Richards DW (2009) In vitro imaging of ophthalmic tissue by digital interference holography. Journal of Modern Optics. 57 (2): 115-123.
- Ayyala RS, Zurakowski D, Monshizadeh R, Hong C-H, Richards D, Layden WE, Hutchinson BT and Bellows AR (2002) Comparison of double-plate Molteno and Ahmed glaucoma valve in patients with advanced uncontrolled glaucoma. Ophthalmic Surgery Lasers and Imaging Retina. 33 (2): 94-101.
Julia Pulliam and Angelina F. Bonner
St.Louis Healthcare System, USA and VA Illiana Health Care System, USA
Title: Challenges beyond the phoropter: Part III anterior segment
Biography:
Julia Pulliam attended Indiana University College of Optometry and graduated with Doctor of Optometry degree. Dr. Julia is staff Optometrists at the St. Louis VA Medical
Centre. Julia is an active member of the Armed Forces Optometric Society (AFOS), the American Optometric Society (AOA), the American Academy of Optometry
(AAO), and the St. Louis Optometric Society (SLOS). At St. Louis VA, she served as both Optometry Residency and Externship Coordinator in addition to Contact Lens
Coordinator. Currently, she is serving as the Acting Chief of Optometry.
Angelina Bonner earned her Bachelor of Science from Bradley University and her Doctor of Optometry degree from Indiana University. As a doctoral candidate, Dr. Bonner
performed contact lens research and presented on developing a method to assess on eye contact lens wettability at the 2009 Academy of Optometry meeting. During her
residency at the St. Louis Veterans Affairs Medical Center(VAMC), she specialized in ocular disease, specialty contact lenses, and primary care. Dr. Bonner has presented
on several complex ocular disease cases both locally and nationally during her career. Following residency, Dr. Bonner’s passion for serving veterans led her to the Dallas
VAMC where she managed complex ocular disease, traumatic brain injury cases, and specialty contact lens care. Dr. Bonner currently enjoys working as the Director of
Specialty Contact Lenses, staff optometrist, and attending at the VA Iliana Healthcare System in Danville, IL. In addition to educating students and residents with didactic
activities and clinical training, Dr. Bonner holds adjunct faculty positions at several universities. In fall 2017, she earned the distinguished title of Fellow of the American
Academy of Optometry. Dr. Bonner is currently licensed in Texas, Illinois, and Missouri.
Abstract:
The eye exam does not stop there. Eyecare practitioners have the privilege and ability to diagnose a variety of retinal conditions
using the Ocular Coherence Tomography (OCT). With the OCT, we can extend our reach beyond the phoropter to aid in
the diagnosis and management of our patients’ ocular and or systemic health. We will present a variety of clinical cases that
demonstrate the importance of the OCT in order to accurately diagnose and subsequently manage and coordinate the care of our
patients.
John A Patterson
St. Vincent’s School for Sensory Impairment, UK
Title: Social capital, human capital and flight paths to opportunity and employment for visually impaired
Biography:
Originally an engineer, John retrained as a primary teacher serving in Liverpool inner city schools and across public private and voluntary sectors within EU Objective
One programmes as community and education consultant leading to a Senior Lecturer role as Head of Physical Education on teacher education programmes at
Liverpool Hope University. His MSC and PhD surround social capital, social enterprise, volunteerism and curriculum design. He is currently Principal at St. Vincent’s,
a residential non-maintained School for VI in West Derby Liverpool rated as outstanding by The Office for Standards in Education. His research and focus remains
with securing outcomes for VI young people.
Abstract:
Statement of the Problem: High unemployment amongst visually impaired (VI) young people remains a global concern; as
does the connected impact on health and wellbeing attached to the lack of opportunity and meaningful engagement. This
study documents how linking schools, universities, and businesses to mobilize resources and support for career choice for
VI students (Patterson and Loomis 2016) in Liverpool, England has developed and is progressing with measurable outcomes
attached to friendship group generation and employment opportunities on a local, national and international platform.
Driven through participation in sport and the raising of self esteem, we connect Science Technology Engineering and Maths
(STEM) and research development and innovation surrounding the making and sharing of VI access technologies with the
international VI community through the physical SIGHTBOX medium (www.sightbox.org.uk) Connecting with community ,
VI engagement in sport and making reference to the United Nations Sustainable Development Goals (SDG’S) throughout, we
present our outcomes focussed formula for the research community consideration in seeking to connect more closely medicine
with education through teaching and learning i.e. social/human capital + reverse inclusion + service learning + creativity =
outcomes.
Shroug M. Aldaham
Ministry of Education, Saudi Arabia
Title: Mesopic pupillary state in type 2 diabetics without retinopathy: A review
Biography:
Shroug M. Aldaham has graduated from Complutense University of Madrid (UCM), Spain with a PhD degree in Optics, Optometry and Vision (with distinction). She
has a BSc (Hons) in Optometry from King Saud University (KSU), Riyadh, Saudi Arabia, and a Master of Science in Vision Science from the University of Waterloo,
Ontario, Canada. She has joined the Optometry department at KSU as a demonstrator (an academic position that prepares for professorship) before joining the
Master program in Canada. After her masters she returned to Riyadh and later joined the PhD program at UCM. Both of her Masters and PhD studies were Saudi
government-funded research grants. She has a research experience in pediatric vision screening and visual function testing in diabetics and has published in
international optometric and vision research meetings. Her research interests are pediatric and diabetic visual function.
Abstract:
Background: It is known that the pupil diameter decreases under high illumination levels and increases under low illumination
levels. Several reports showed changes in mesopic pupillary function in patients with diabetic retinopathy. There is little
information however about mesopic pupillary changes in diabetics without retinopathy.
Purpose: To review pupillary size changes under mesopic luminance conditions in type 2 diabetics without retinopathy.
Methods: A literature search was conducted on pupillary size changes in diabetics without retinopathy. The search criteria
considered the type of diabetes, luminance conditions under which the pupil diameter was measured, and the instrument used.
Results: There was a general consensus that diabetics show smaller pupil diameters compared to normal healthy subjects.
The testing method and luminance conditions varied across studies. Pupil diameter changes were affected by the retinopathy
progression. Little information was reported for mesopic pupillary changes in diabetics without retinopathy. Some studies
specified the type of diabetes while others did not.
Conclusions: Care should be taken when comparing pupil diameter changes between studies related to the luminance level
and type of instrument used. In this presentation, mesopic visual function data for type 2 diabetics without retinopathy will be
presented, aiming to show its independency from pupil diameter.