Approximately 90% of uveal melanomas develop in the choroid, with the remainder arising in the ciliary body or the iris. The treatment of uveal melanoma is aimed at conserving the eye and useful vision, and, if possible, preventing metastatic disease. Enucleation is now reserved for tumors that are large and/or involve the optic disc, having largely been replaced by various forms of radiotherapy (plaque brachytherapy, proton beam or stereotactic radiotherapy) and laser therapy. Whereas iridectomy and iridocyclectomy are widely performed, transscleral exoresection of choroidal tumors is performed only in a few centers because it requires special skills and hypotensive anesthesia. Transretinal endoresection using vitrectomy equipment is easier but controversial because of concerns about tumor seeding. Long-term postoperative surveillance is necessary to identify and treat local tumor recurrence and any other complications, such as radiation-induced morbidity, and to provide counseling to the patient. Factors predicting metastasis include older age, large tumor size, ciliary body involvement, extraocular spread, epithelioid cytomorphology, chromosome 3 loss, chromosome 8q gain, class 2 gene expression profile, loss of BRCA1-associated protein-1 (BAP1), and the presence of inflammation. Prognostication is enhanced by multivariable analysis combining clinical, histologic, and genetic factors, also taking the patient’s age and sex into account. As there is a lack of options for treating metastases, much research is focused on identifying potential therapeutic targets.
Objective: The objective of this study was to assess the intraocular pressure (IOP)-lowering efficacy, tolerability, safety, and usage patterns of prostaglandin analog/prostamide (PGA/P)-containing topical ocular hypotensives in ocular hypertension (OHT) and primary open-angle glaucoma in the Turkish clinical setting.
Invited Program Subspecialty Coordinators and Session Topics
As the longest continuous international medical meeting in the world, the World Ophthalmology Congress® (WOC) is designed to address all subspecialties and related interests in ophthalmology. There are 131 Invited Program Subspecialty Coordinators (representing 36 countries) who are working to organize over 110 scientific program and Subspecialty Day sessions in addition to the inaugural WOC Breakfast Club events.
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Welcome to The Power List 2016 – our second foray into the Top 100 most influential people in the world of ophthalmology.
Though we realize our list can (and should) never be definitive, who can argue that the faces within – both familiar and new – do not beautifully highlight the brilliance and diversity found within the field?
Here, we celebrate 100 reasons to be proud of ophthalmology.
Purpose: To describe the Glaucoma Staging Application (GSA), a new application for automated classification of visual field (VF) severity that can be used in any Humphrey perimeters. We also tested and validated its performance in staging glaucomatous VFs defects and assessed its reproducibility
Glaucoma comprises a group of progressive, neurodegenerative disorders characterized by retinal ganglion cell death and nerve fiber layer atrophy. Several randomized controlled trials have consistently demonstrated the efficacy of intraocular pressure lowering to slow or halt the measurable progression of the disease. Medical therapy, in places where it is easily accessible, is often the primary method to lower intraocular pressure. We review the medical options currently available and possible future options currently in development. The 5 contemporary classes of topical agents in use include prostaglandin analogs, beta blockers, carbonic anhydrase inhibitors, alpha agonists, and cholinergics. In addition, several fixed combination agents are commercially available. Agents from each of these classes have unique mechanisms of action, adverse effects, and other characteristics that impact how they are used in clinical practice. Despite the plethora of medical options available, there are limitations to topical ophthalmic therapy such as the high rate of noncompliance and local and systemic adverse effects. Alternate and sustained drug delivery models, such as injectable agents and punctal plug delivery systems, may in the future alleviate some such concerns and lead to increased efficacy of treatment while minimizing adverse effects.
Purpose: To evaluate the long-term intraocular pressure (IOP)-lowering effect and safety parameters following treatment with two trabecular micro-bypass stents and topical prostaglandin in phakic eyes with open-angle glaucoma (OAG) not controlled on two preoperative medications.
Purpose: To obtain pilot data on posture-induced changes of intraocular pressure (IOP), systemic pressure, and pattern electroretinogram (PERG) predictive of future optic nerve tissue loss glaucoma suspects (GSs).
Methods: Mean peripapillary retinal fiber layer thickness (RNFLT) was measured with optical coherence tomography 2 times/year in 28 GS aged 58+/-8.9 years over 5.0+/-0.73 years. All patients had a baseline PERG, IOP, and brachial blood pressure measurements in the seated and -10 degrees head-down-body-tilt (HDT) position. Outcome measures were seated/HDT PERG amplitude and phase, IOP, mean arterial blood pressure, and estimated ocular perfusion pressure. An additional group of 11 similarly aged controls aged 56.9+/-13 years was tested for comparison.
Results: Although all GS had initial RNFLT in the normal range, 9/28 of them developed significant (P<0.05) loss of mean RNFLT [thinners (T)] over the follow-up period as opposed to 19/28 who did not [nonthinners (NT)]. Significant (P<0.05) differences between similarly aged controls, NT, and T were found in PERG amplitude, PERG phase, mean arterial blood pressure, IOP, and ocular perfusion pressure. A nominal logistic regression using baseline PERG and hemodynamic variables was able to distinguish T from NT with an area under receiving operator characteristic of 0.89 (SE, 0.07).
Conclusions: Baseline PERG, IOP, and systemic blood pressure, together with their changes upon HDT, may have predictive value for future loss of optic nerve tissue in GS. This study supports the rationale for a full-scale clinical trial to identify patients at high risk of development of glaucoma.
Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.
Inder Paul Singh, MD, says the iStent (Glaukos) helps physicians reduce medication burden. He provides details on outcomes and discusses why safety makes this device advantageous for surgeons. Dr. Singh also explains how the iStent has improved the overall efficiency of his cataract surgery cases
We reviewed the current literature on the ability of micro-perimetry to detect non-neovascular age-related macular degeneration (AMD) disease progression. The index test was retinal sensitivity mea-surement assessed by microperimetry and comparators were other func-tional measures (best-corrected and low-luminance visual acuities, and fixation stability) and structural parameters [retinal thickness, choroidal thickness, and area of geographic atrophy (GA) determined by color fun-dus photographs, short-wave or near-infrared fundus autofluorescence].
Glaucoma is currently the second leading cause of blindness throughout the world. The goal of glaucoma treatment is to stop or slow disease progression. Current glaucoma medications achieve this almost exclusively through reduction of intraocular pressure (IOP). Unfortunately, even with appropriate use of currently available medications, many people with glaucoma will still experience vision loss. Intraocular pressure is the only known modifiable risk factor for patients with glaucoma, so improvements in patient outcomes rely on tight IOP control and patient adherence to therapy. In this educational activity, leading clinicians review established and new therapeutic agents for patients with glaucoma, including the recent clinical evidence for their safety and efficacy. In addition, discussion will comprise the recent evidence concerning the effects of low perfusion pressure on glaucoma development and progression
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