academy 2018 san antonio ~ friday times · up to 50%, of contact lens wearers discontinue lens wear...

Optometry and ophthalmology have always been open to imaging systems, according

to the team who presented yesterday at the Cockrell Theater. The mixed discipline group opened the presenta-tion with a brief review of eye care’s passion for developing these tech-nologies. But the early photographers who developed the fi rst images of the human fundus could have never predicted today’s devices and tech-niques that can image layers of the eye’s tissue with such great specifi c-ity. Yesterday afternoon, some of the fi eld’s top minds explained where today’s tech stands and how eye care professional’s can use it to intervene in disease states earlier than ever.

Anterior SegmentAmong the presenters were Hiroshi Ishikawa, MD, a professor of oph-thalmology at New York University’s Langone School of Medicine, who spoke about applications of anterior segment imaging with UBM and OCT devices. He touted the capabili-ties of these machines to provide pre-cise automated analysis, such as angle measurements. “OCT and UBM are not competing technologies,” he explained in diagnoses such as angle closure. “They complement each other.” However, OCT has several variations, such as visible light OCT and OCT-angiography, which make it applicable to a broad range of patients. Dr. Ishikawa analyzed the

many biological structures that these devices can help physicians track.

Adrian Glasser, PhD, also spoke on how data, such as lens thickness, diameter, curvature and volume—all of which can be obtained using UBM

and MRI anterior segment imag-ing—can offer critically important information necessary to aid in ac-commodation restoration procedures. Accommodative biometric changes

REVIEW OF OPTOMETRY • AAO TIMES • NOVEMBER 9, 2018

A C A D E M Y 2 0 1 8 S A N A N T O N I O ~ FR IDAY

WHAT’S INSIDE• Today’s Scientific Program highlights .... 3

• Spotlights on new research presented at Academy 2018 ...................... 3, 4, 6, 12

• Ezell Fellows offer solutions for contact lens discomfort ....................................... 4

• CEE Courses at Academy 2018 .............. 4

• Develop the skills to spot convergence insufficiency ........................................... 6

• Ocular Wellness & Nutrition Society discusses vitamin E ................................ 7

• Exhibitor list and map ............................. 8

• Academy’s 2018 Awards Ceremony and Winners ................................................. 10

• Monroe J. Hirsch symposium ............... 12

• Industry takes center stage at press conference ............................................ 13

• Prescribing tips for neuro-ophthalmic disease ................................................. 14

OD/MD Joint Symposium Reviews Imaging AdvancesDoctors from across disciplines join forces to identify disease.

Research on the advancing area of myopia control has come a long way since the fi eld’s

early understanding of this unique aspect of eye care. Importantly, sci-entifi c understanding of the disease’s mechanism has improved—moving away from a theory of accommoda-tive lag toward one of peripheral refraction—and it is widely under-stood in the fi eld that the disease can be managed, according to speakers in “Myopia Control: From Evidence to Implementation.”

Rethinking the Impossible Mark Bullimore, dean of the Mar-shall B. Ketchum University’s South-ern California College of Optometry, recalled publishing an editorial in 2000 stating that essentially nothing could be done to slow the progres-

sion of myopia in children. Fast forward to his editorial in 2014 titled “Myopia control: the time is now.”

Dr. Bullimore ran through various evidenced-based trials throughout the years evaluating factors contributing to myopia and effective ways to con-trol the disease. Earlier trials showed that executive bifocals exhibited modestly more benefi ts than pro-gressive addition lenses (PALs). The fi ndings provided indirect support for the peripheral defocus theory, know-ing that executive bifocals offer more peripheral plus, Dr. Bullimore said. “If it were accommodation [at play], you would expect to some extent the progressive and the executive to have a similar effect,” he explained.

The Right Tool for the JobAdditional evidence of myopia

control is available, with numerous ways to add plus to the periphery using different devices, he added. One way is to employ orthokeratol-ogy—the fi tting of specially designed GP contact lenses that can be worn overnight—to manage the disease. “With regular contact lenses, noth-ing really happens,” Dr. Bullimore said. “If we fi t kids with rigid lenses, we don’t accrue any benefi t in terms of myopia control. It’s really with

Myopia Control: All About the Peripheral Vision

See OD/MD, 2

See MYOPIA, Page 3

Dr. Bullimore discussed reported fi nd-ings of executive bifocals and progres-sive addition lenses for myopia control in a session yesterday.

Stacey Choi, PhD, of Ohio State, was one of several guest speakers updating the crowd on imaging tech.

Adaptive optics combined with OCT imaging is primed to change monitoring in diseases such as AMD.

Exhibitor listing and hall map, p.8 This year’s Academy Awards ceremony, p.10 T

TIMESIndustry press conference, p. 13

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orthokeratology or corneal reshaping that we have an effect.”

He said the “revolution of Ortho-K” happened in conjunction with three factors: reverse geometry lenses that fi t better, the advent of corneal topography (i.e., computer-assisted videokeratopgraphy) and highly gas permeable materials that permitted overnight wear.

On the BooksAs the growth of Ortho-K lenses in-creased, associated studies on the lens-

es revealed a slowing of axial length growth. One trial he mentioned found a 43% improvement over a two-year period. Turning to soft contact lenses worn during the day, another study evaluating custom lenses from the Brien Holden Vision Institute found a roughly 33% effect in reducing relative peripheral hyperopia over a 12-month period. Other research-ers found a 29% improvement in an “off-the-shelf,” soft, multifocal lens; while investigators in Hong Kong saw a 31% improvement in a custom soft multifocal contact lens; and impres-

sively, trial data reported in 2016 revealed that a distance center bifocal contact lens achieved greater than 70% control over myopia progression and axial elongation.

Dr. Bullimore also mentioned pharmaceutical approaches to myo-pia control. Out of the current op-tions, he said atropine was the most effective option; however, the correct dose was key to seeing benefi ts. He also discussed complications of lens approaches with regard to Acan-thamoeba keratitis.

Finally, he gave compelling reasons

why individuals should care about myopia control: to prevent disability, to improve the patient’s optical envi-ronment for potential future surgery; and to decrease the risk of cataract, retinal detachment, glaucoma and myopic maculopathy.

During the morning session, Earl Smith III, OD, PhD, FAAO, Greeman-Petty professor and dean, College of Optometry, University of Houston, discussed various animal studies helping to explain myopia mechanisms and offering wisdom for management.•

Myopia Control: All About the Peripheral Vision

TODAY’S SCIENTIFIC PROGRAM SCHEDULEToday’s poster sessions:Posters will be displayed from 9am–3pm in Exhibit Hall 3. Odd numbered authors will be present in the morning hours, 10am–12pm, and even numbered authors will be present in the afternoon, 1–3pm.

Topics include: • Optometric Education• Health policy / Health Care Delivery• Cornea/ Anterior Segment/ External/ Dry Eye• Optics/Refractive Error/Refractive Surgery• Academy Information Posters• Optics/Refractive Error/Refractive Surgery• Contact Lenses - Gas Permeable• Contact Lenses - Hydrogel• Posterior Segment

Today’s paper sessions:

Category Room Time

P-13: Low Vision and Driving 303 10:15am–12pm

P-14: Amblyopia 304 1:30–2:45pm

P-15: Visual Function 303 2–3:45pm

P-16: Convergence Insufficiency 304 3–4pm

P-17: Glaucoma Treatment: Toward Best Practices 303 4:15–6pm

P-18: Reading and Reading Disorders 304 4:15–6pm

Tomorrow’s paper sessions:

Category Room Time

P-19: Military Relevant Priorities for Vision 303 8–9:30am

P-20: Traumatic Brain Injury 303 9:45–11:15am

Continued from Page 1

Adaptive, light-dependent mechanisms in children may be a pathway through which time outdoors infl uences refractive error development.

During the summer months, children with shorter axial lengths experienced smaller pupils during blue stimulation and larger pupils during red stimula-tion. A potential explanation for this effect is increased summer light expo-sure causing more robust intrinsically photosensitive retinal ganglion cells (ipRGC)-dependent pupil responses.

A recent study evaluated whether the season in which testing occurs affects the relationship between axial length (refractive error) and pupil responses to red and blue stimuli in 50 children between the ages of eight and 17. Pupils tended to become smaller during blue stimulation than dur-ing red stimulation. The difference in these pupil sizes varied signifi cantly by the season in which testing occurred. Although subjects with less myopic refractive error tended to have larger differences in pupil size between blue and red stimulation, this effect did not reach statistical signifi cance in either winter or summer.

Researchers conclude that an adaptive ipRGC-driven dopaminergic path-way may exist where shorter eyes take advantage of greater light exposure to further inhibit the growth of the eye to reduce the risk of the onset of myopic refractive error.

RESEARCH SPOTLIGHT

The above summary was presented at the AAO press conference Wednesday, and the full study was presented in the Myopia Super Session yesterday.

The Association Between Axial Length and Pupil Responses to Blue and Red Stimuli in Children Depends on Season

Marielle Blumenthaler, Andrew T. Hartwick, Donald O. Mutti

Interested in presenting a paper or poster at Academy 2019 Orlando? The Scientifi c Program abstract submission window will be open from May 1 through May 31, 2019. More information will be provided online at www.aaopt.org.



AAO TIMES4

At least 10%, and perhaps up to 50%, of contact lens wearers discontinue lens

wear within three years of their ini-tial fi tting. The most common rea-son cited is lens discomfort. If you want to learn about what causes lens discomfort and how you can help lower the dropout rate, this is the perfect session for you. Learn how to better address this issue and earn two CE hours today at 2pm in Cockrell Theater by attending the Ezell Fellows Lecture “Con-tact Lens Discomfort: More Than (Where the Lens) Meets the Eye” by Maria Markoulli, PhD, MOptom, FAAO, Lakshman Subbaraman, PhD, BSOptom, MSc, FAAO, and Pete Kollbaum, OD, PhD, FAAO.Contact lens discomfort can be cat-egorized into two main etiologies,

one of which is related to the lens itself and the other to the environ-ment. Dr. Markoulli will start the session off with a discussion of factors related to the eye that may contribute to this discomfort. Dr. Subbaraman will then take the fl oor to cover contact lenses and how design and material could cause patients discomfort. Finally, Dr. Kollbaum will cover environmen-tal factors that have the potential to induce patient-reported lens discomfort.

To conclude the session, the trio will talk about new and future research and treatments that aim to give patients the best chance of suc-cess with contact lenses.Every OD interacts with contact lenses in one way another, so we hope to see you later today! •

Ezell Fellows Lecture Takes on Contact Lens Discomfort

TODAY 2–4pm COCKRELL THEATRE

Each year, the Academy showcases some of the best research papers and industry innovations of the year in a fast-paced press conference that man-

ages to pack in 20 presentations. The last talk of the 2018 press conference was reserved for the 2018 AAO Ezell Fellow, Suraj Upadhyaya, OD, AAOF award recipient.

Dr. Upadhyaya concluded the morning by presenting his research on the neural circuits of the oculomotor system in monkeys with strabismus.

About 700,00 children in the United States alone are affected by strabis-mus, which can cause lazy eye, diffi culty reading, eyestrain and headaches. “Although we have known about this disease for more than 70 years, the only defi nite treatment we have is eye muscle surgery,” Dr. Upadhyaya said. “But in most cases, strabismus patients come back to the clinic with reoccurring stra-bismus. It is not only a muscle problem; there must be something else going on. Otherwise, why would patients be coming back?” Dr. Upadhyaya conclud-ed that the brain must be involved and began looking into the superior collicu-lus, a tiny structure deep inside the brain. Using monkey models, he found that the superior colliculus is indeed involved in developmental strabismus—musci-mol inactivation in the area changes the strabismus angle.

2018 EZELL FELLOW

Neural Circuits of the Oculomotor System in Monkey Model of Strabismus

Suraj Upadhyaya

CONTINUING EDUCATION WITH EXAMINATION (CEE) CREDITS AT ACADEMY 2018 SAN ANTONIOThe courses listed below will be presented with an option to take an exam, administered by the University of Houston College of Optometry. All CEE exams are offered by mail or online. All are welcome to attend the courses without taking the exam. Instructions to request the exams are available at the Education Desk.

Friday, November 9

Time Course # Course Title Lecturer(s) Room

8–10am PS-09 How to Improve Outcomes and Help Prevent Blindness Damon Dierker Helmisfair Ballroom C2

10am–12pm GO-09 Pediatrics for the Primary Care Optometrist Marianne Boltz 302

2–4pm NO-12 An Organized Approach to the Patient with Multiple Sclerosis James Fanelli, Leonard Messner, Lorraine Lombardi Stars at Night Ballroom B4

3–5pm OP-07 Pharmaceutical Update 2018 Greg Caldwell, Tracy Offerdahl Stars at Night Ballroom B1

4–6pm GO-11 The Use of Electrodiagnostic Testing (VEP, ERG and EOG) in Clinical Practice Sherry Bass, Kimberly Poirier Helmisfair Ballroom C2

Saturday, November 10

Time Course # Course Title Lecturer(s) Room

8–10am OP-08 Eye Care Update – Part I Ron Melton, Randall Thomas Helmisfair Ballroom C1

9–11am NO-14 An Organized Approach to the Patient with NeuroVascular Disease James Fanelli, Lorraine Lombardi Helmisfair Ballroom C3

10am–12pm OP-09 Eye Care Update – Part II Ron Melton, Randall Thomas Helmisfair Ballroom C1

2–4pm GO-18 Diagnosis and Management of Refractive Error in Infants and Young Children: Current Perspectives Susan Cotter, Tawna Roberts Helmisfair Ballroom C2

3–5pm AS-21 The Herpes Group Joseph Shovlin, Greg Caldwell, Michael DePaolis, Andrew Mick 214


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Only about 5% of your patients have convergence insuffi ciency (CI), Kristine B. Hopkins, OD, MSPH FAAO, told the

optometrists in attendance Thursday morning at her “Managing Symptomatic Convergence Insuffi -ciency” session. This number, however, should not discourage doctors from learning how to identify, manage and treat patients with convergence insuf-fi ciency. And it all starts with obtaining patient history by asking the right questions, especially in cases involving young children.

IdentifyDr. Hopkins opened the discussion with one of her own cases to make attendees aware of the signs and symptoms of convergence insuffi ciency that optometrists should be aware of while con-ducting initial evaluations.

At the time he presented, Garen was seven years old. Upon asking whether he was having trouble reading and remembering what he was reading, experiencing diffi culty keeping his place while reading and seeing words move around on the pages he was reading, Dr. Hopkins discov-ered that Garen was juggling diplopia, eyestrain and headaches while reading, all of which are classic signs of convergence insuffi ciency. Dr. Hopkins noted that it is important to rule out other issues, such as dyslexia and poor handwrit-ing, before assuming the problem is vision-re-lated. In this case, it was determined that Garen most certainly had convergence insuffi ciency.

Dr. Hopkins went on to highlight the clinical

profi le of an average convergence insuffi ciency patient. These are patients who have a near exo-tropia/exophoria at least 4Δ greater than distance deviation, an NPC greater than 6cm and conver-gence reserves that are reduced near base out or vergence ranges that are less than 15^base out or fail to meet Sheard’s criteria, she said. She added that convergence insuffi ciency patients also com-monly have accommodative insuffi ciency.

To determine whether a patient qualifi es, Dr. Hopkins suggested conducting numerous tests. For asymptomatic patients, she recommended cover, NPC, MEM and stereo testing. She added that symptomatic patients should go through each of the prior tests in addition to fusional ver-gence reserve, accommodative amplitude, NRA/PRA and vergence and accommodative facility testing.

Manage and Treat A patient is diagnosed with convergence insuf-fi ciency. Now what? Five treatment options exist in Dr. Hopkins’ binocular toolbox: prism, added lenses, vision therapy, surgery and occlusion. Her top choice, and something she offers in her own clinic, is vision therapy. Some children, however, do not do well with or respond well to vision therapy. In this case, Dr. Hopkins resorts to prism. Garen was one of the successful cases. After under-going vision therapy, his convergence and quality of life both improved dramatically.

While home-based treatment is associated with lower rates of compliance and success, the conver-gence insuffi ciency treatment trial concluded that in-offi ce vision therapy is the most successful at 73% and is met with the highest rate of compli-ance. More good news for patients who complete vision therapy with positive results—the success they fi nd is long-term; a study found that 84.4% of treated convergence insuffi ciency patients remained asymptomatic one year after receiving therapy.

Give a Kid Their Childhood Back While CI may not be seen every day, it is impor-tant that ODs give these kids a fi ghting chance. This begins with a thorough evaluation. Perhaps most important is determining whether the patient actually has convergence insuffi ciency, or if it is something else entirely. The process ends with ef-fi cient treatment and monitoring—and hopefully, a happy and healthy patient who is able to fully em-brace being a child without the added hassles. •

Be On the Lookout for Convergence Insuffi ciencyEven though it is less common, optometrists have a duty to their patients to determine who is a candidate and how to help them.

Dr. Hopkins introduces one of her convergence insuffi ciency patients, Garen, who was successful with vision therapy.

AAO TIMES6

Two studies being presented at Academy 2018 raise awareness about sports-related concussion and its visual consequences.

In a study assessing binocular vision symptoms in adolescents with sports-related concussions, researchers found the injuries lead to lower scores on computerized cognitive tests. Adam J. Peiffer of Ohio State University conducted the CogState Brief Battery on individuals with the com-bination and saw that visual symptoms negatively impacted performance on concussion assessment. The presence of these disorders may complicate

neurocognitive assessments of these individuals, he noted.The second study found that poor visual tracking performance in post-

concussion adolescents is correlated with accommodative and vergence defi cits, noted Emily K. Wiecek, OD, PhD, of Boston Children’s Hospital. The study showed quantifi able accommodation and vergence defi cits in over 90% of patients. This knowledge may guide further study into the underlying pathophysiology of visual defi cits post-concussion and may improve man-agement strategies for post-concussion patients, she said.

RESEARCH SPOTLIGHTThe Influence of Binocular Vision Symptoms on Computerized Neurocognitive Testing in Adolescents with Concussion Adam J. Peiffer, James MacDonald, Drew Duerson, G. Lynn Mitchell, Andrew T. Hartwick, Catherine McDaniel

Accommodation and Vergence Deficits Predict Performance on the Developmental Eye Movement Test in Adolescent Post-concussion Patients Emily K. Wiecek, Ankoor Shah, Aparna Raghuram

The above summaries were presented at the AAO press conference Wednesday. Full presentations of both studies will be given tomorrow in this session:

•Traumatic Brain Injury Paper Session, Saturday 9:45–11:15am, Room 303



7AAO TIMES

The fascinating impact of the tocotrienol component of vitamin E was the hot topic

at this year’s Ocular Wellness and Nutrition Society (OWNS) meet-ing, which took place on Wednes-day evening.

Guest lecturer Barrie Tan, PhD, president of American River Nu-trition, has spent the last 30 years researching the component and has successfully found a plant-based form of vitamin E, derived from annatto, that was more po-tent than any other vitamin E on the planet. He talked on the uses and benefi ts of tocotrienol over tocopherol, the other component under the umbrella term of vita-min E, which is the focus of most of the papers on Vitamin E.

In his talk, Dr. Tan made clear that studies show any presence of alpha-tocopherol prevents ab-sorption and interferes with the benefi cial functions of tocotrienol: compromising cholesterol and triglyceride reduction, actuating cancer inhibition, exacerbating stroke injury and preventing adi-pose storage.

Dr. Tan said he was initially interested in studying tocotri-

enol’s effect on metabolism as a nutritional supplement, but its surprising effects on managing chronic diseases made him more curious to see how his product and research on delta-tocotrienol could provide the most benefi ts. Tocotrienol could attenuate an-therosclerotic lesions and reduce the chemotaxis of antheroscle-rosis. Researchers saw improve-ments in non-alcoholic fatty liver disease patients who took 300mg of delta-tocotrienol daily for three months.

Delta- and gamma-tocotrienol have an unambiguous role in cancer control, such as managing pancreatic tumors more effectively as part of a combination with gemcitabine, specifi cally target-ing cancer stem cells and reducing viability of the most severe breast cancer, HER-2, and being ex-tremely potent to induce apopto-sis in breast cancer studies.

Dr. Tan said that he was shocked to see that a study found that delta-tocotrienol made a remarkable fi t into the estro-gen receptor protein and inhibit growth of breast cancer cells. “It’s as good as it could ever get,” he

said. “I can’t even imagine a phar-maceutical company giving you things like this.”

Dr. Tan’s annatto tocotrienol supplement helped prevent bone deterioration in males and con-tribute to increased bone building and decreased bone resorption and oxidative stress in post-meno-pausal women with no adverse effects on liver, kidney function and quality of life. Another study saw that tocotrienol could impede cataractogenesis and provide better lens clarity in mice, with a dramatic reduction of infl am-mation and lens aldose reductase and sorbitol. “It’s almost like a reversal of the aging process of the eye,” Dr. Tan said.

The suggested dosages of lipid-soluble tocotrienol supplements are 50mg to 100mg a day as an antioxidant, 200mg to 300mg a day to treat mild chronic condi-tions and 400mg to 600mg a day for advanced chronic conditions.

After the lecture, Stuart Richer, OD, president of the OWNS, asked Dr. Tan if he could possi-bly work to determine the dosage considerations for early macular degeneration before it becomes aggressive in size, given that toco-trienol is a potent anti-angiogenic agent. Dr. Tan responded by sug-gesting cutting the 300mg dose in half. Any higher than that could cause oxidative damage to the back of the eye. •

Nutrition Society Abuzz About TocotrienolResearch on the vitamin E component over the last 10 years shows incredible promise.

Dr. Hopkins introduces one of her convergence insuffi ciency patients, Garen, who was successful with vision therapy.

Stuart Richer Honored at Nutrition SIG

At the conclusion of yesterday’s Nutrition,

Disease Prevention & Wellness SIG meeting, there was a surprise in store for Stuart Richer, OD, PhD, president of the Ocular Wellness & Nutrition Society (OWNS)—he was given a lifetime achievement award by fellow OWNS board mem-ber Dorothy Hitchmoth, OD, who described his contribu-tions as follows:

“Stuart is a brilliant, widely respected visionary who has changed the way we think about taking care of patients. Long before the importance of good nutrition on ocular health and function became mainstream, Stewart focused on this both in his research and practice, and has ulti-mately impacted the lives of thousands of students and colleagues—and, thereby, millions of patients. He has been a career-long mentor to me and many others in this room through his work in the Department of Veterans Affairs, the American Academy of Optometry, the Ocular Wellness & Nutrition Society, this SIG and the Optometric Retina Society. Dr. Richer selfl essly and enthusiastically shares his knowledge with doctors across the country and around the world. Most importantly, he is a passionate patient advocate. I cannot think of an optometrist who has had a bigger impact on our patients.”

Expressing his thanks and appreciation while accepting the unexpected award, Dr. Richer said, “This is why I go to work every day. It’s not about money, and it’s not about anything but taking care of people. Thank you very much.”

SIGNS YOU SHOULD DONATE BLOOD3

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8

REVIEW OF OPTOMETRY • SECO SHOW DAILY • MARCH 2, 2018REVIEW OF OPTOMETRY • AAO TIMES • NOVEMBER 9, 2018

AI Care ............................................................1546AAO Sections & SIGS ....................................1119Acculens .........................................................2131Acuity Pro/VisionScience Software ................1823Akorn Pharmaceuticals.....................................942Alcon Foundation. ............................................927Alcon Laboratories .........................................1331Allergan ..........................................................1342American Academy of Optometry ...................1033American Academy of Optometry Foundation .................................................1027American Academy of Orthokeratology and Myopia Control ...................................1223American Board of Certifi cation in Medical Optometry ......................................744American Board of Opticianry – National Contact Lens Examiners ............846American Board of Optometry ..........................837Armed Forces Optometric Society ..................2247Art Optical Contact Lens .................................1937Association of Schools and Colleges of Optometry ..............................................1555Bausch + Lomb ..............................................1843Beauty and Beyond .........................................1523Bernell ..............................................................948BioTissue ........................................................1518BirdEye .............................................................845Blanchard Contact Lenses ..............................2036BlephEx ..........................................................2143Brien Holden Vision Institute ...........................735Bruder Healthcare Company ..........................1227Bryn Mawr Communications .........................1718CareCredit ......................................................2121Chadwick Optical............................................1933Choroideremia Research Foundation. ............1857Clearlens ..........................................................949Cliara ..............................................................1855Coburn Technologies .....................................1522Collaborative Eyecare .......................................723Compulink Healthcare Solutions ...................1829CooperVision .................................................1635Crystal Practice Management ........................1521Designs for Vision. .........................................1628DGH Technology.............................................2043Digital Health Care Professionals ....................745Digital Heat Corp. .............................................742Diopsys ............................................................946Doctible ............................................................831Elsevier ...........................................................1219Envision University...........................................727Eschenbach Optik ...........................................1634eSight ...............................................................835Essilor Custom Contact Lens Specialists ....... 1954Essilor.............................................................1055Ethis Healthtech ................................................724Euclid Systems Corporation ...........................2055Eye Care and Cure ..........................................1926Eye Designs ......................................................943

Eye Photo Systems. ........................................1321Neurolens .........................................................919Eyeffi cient .......................................................2148Eyevance Pharmaceuticals .............................1020Fashion Optical Displays................................2123Fellows Doing Research SIG ..........................1019Focus Laboratories ...........................................747Optelec ...........................................................1422GlobeChek ........................................................935Good-Lite Company .......................................1418Guardion Health Sciences ..............................1755Haag-Streit USA/Reliance ..............................2127Hadley Institute for the Blind & Visually Impaired .........................................748

Hai Laboratories .............................................2135Health and Social Sector Analysis .................2149Heart of America Eye Care Congress ...............957Heidelberg Engineering ....................................947Heine USA ......................................................1935Hoya Vision Care............................................2249Icare USA ........................................................1524IDOC ...............................................................1018iHireOptometry ...............................................1147iMatrix ............................................................1527ImprimisRx .....................................................1646Independent Optometric Coaching.................1754Indigo Iris Designs ...........................................842Innova Systems ..............................................2142

Integra LifeSciences .......................................1618Invision Magazine ..........................................1048IrisVision ........................................................1544Jeunesse Innovations .....................................1022Johnson & Johnson Vision............................1742Kala Pharmaceutical Medical Affairs ..............1956Kala Pharmaceuticals .....................................1756Keeler Instruments..........................................1322Konan Medical USA .......................................1827LasikPlus ........................................................2246Wolters Kluwer ...............................................1326LKC Technologies ..........................................1254Lombart Instrument ........................................1726LS&S Products...............................................1629

AAO TIMES8

The Academy 2018 San Antonio exhibit hall is the perfect place to experience cutting-edge products and services. Remember, badges are required for admission to the exhibit hall.

E X H I B I T H A L L D E T A I L S

1018

IDOC

1019

20'

30'

FellowsDoing

ResearchSIG

1020

Eyevance

1022

Jeunesse

1027

40'

30'

AmericanAcademy ofOptometryFoundation

1033

40'

30'

AmericanAcademy ofOptometry

1042

30'

Nat

iona

l Vis

ion,

Inc.

1043

20'

40'

NovartisPharmaceuti

cals1048

1054

20'

Tear

Film

Inno

vatio

ns

1055

20'

20'

Essilor ofAmerica

1119

20'

30'

AAOSections &

SIGS

1143

Novabay

1145

West1147ptome

1155

20'

Mac

uHea

lth

1219

Elsevier,

1221

OptiLanes,

1223

American

1227

20'Bru

der

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1235

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1242

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DigitalHeat

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744

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745

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746

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747

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REVIEW OF OPTOMETRY • SECO SHOW DAILY • MARCH 2, 2018REVIEW OF OPTOMETRY • AAO TIMES • NOVEMBER 9, 2018

Lumenis ..........................................................2248Luneau Technology USA ................................2119M&S Technologies .........................................1543MacuHealth ....................................................1155MacuLogix .....................................................1425Marco .............................................................1535Maxivision ......................................................1419MedTech International Group .........................2132Menicon America ...........................................1819MiBo Medical Group ......................................1244Midwestern University – Arizona College of Optometry ..................930Modern Design Architects ..............................1531Moria ..............................................................1644

My Vision Express .........................................1231National Vision ...............................................1042National Board of Examiners in Optometry ..............................................1547Nidek ..............................................................1623Nova Innovations............................................1548Nova Southeastern University ..........................934Novabay Pharmaceuticals ..............................1143Novartis Pharmaceuticals ...............................1043NuSight Medical.............................................1955Ocular Media ..................................................1549Oculus ............................................................1235Ocusoft ...........................................................1318Ocutech ..........................................................1630

OG Wellness ...................................................2235OnSight Wellness .............................................848Ophthalogix ......................................................945OptiLanes .......................................................1221Doctor Multimedia .........................................1519Optometry Times ............................................1421OptoPrep ........................................................1529Optos ..............................................................1835Optovue ............................................................847PDI Check.......................................................2144Pearle Vision–sponsored Re-Charge Lounge ......................................855Pentavision .....................................................2045Plusoptix USA ................................................2244

Practice Director .............................................2237Precision Vision .............................................1542Prestige Brands ..............................................1928Primary Care Optometry News and Healio.com by Slack ...........................1319PRN Nutriceuticals ...........................................923Professional Eye Care Associates of America ....................................................936Quantel Medical .............................................2033Quark Pharmaceuticals...................................1655Quidel Corporation ...........................................932Reichert Technologies ....................................1720Retina-AI .........................................................1256Review of Optometry ......................................1323RightEye ...........................................................843RoyalZ ..............................................................955ScienceBased Health ......................................1545Shire ...............................................................1921Sight Sciences–sponsored Re-Charge Lounge ....................................1455 Solutionreach .................................................1631Sonoma Pharmaceuticals .................................743Spark Therapeutics .........................................1423Sun Ophthalmics ..............................................719SynergEyes. ....................................................2049Tangible Science ............................................2134Tear Film Innovations .....................................1054TelScreen ........................................................2242Topcon Medical Systems ...............................1255TruForm Optics ...............................................1642Try Not To Blink ..............................................1657Umay Care ......................................................2145Valley Contax..................................................1619Virtual Field ....................................................2136Vision Group Holdings.....................................746VSP Global .....................................................1443Visionary Optics .............................................2035Visioneering Technologies. ............................2032VisionWeb ........................................................721Vital Tears .........................................................736Vivid Vision ....................................................1330Vmax Vision. ..................................................1627Volk Optical ....................................................1242VOSH International ...........................................725VRmagic Inc. ..................................................1648Weave .............................................................2034West ................................................................1145Western University of Health Sciences – Center for Innovation ................................734Western University of Health Sciences College of Optometry ...................................833Williams Group ..............................................2243X-Cel Specialty Contacts................................2146Younger Optics ...............................................1626ZeaVision/EyePromise ...................................1622Zeiss ...............................................................1918Zero Gravity Skin ..............................................731Zoomax (USA) Inc. ...........................................729

9AAO TIMES

Stop by to see the latest technologies and services, and talk with company representatives about how their products can make your practice grow. Lunch will be provided in the Exhibit Hall Thursday and Friday.

Wednesday: 4–7pm (Opening Night Welcome Reception)Thursday: 10–11am (Student Focus Hours)Thursday: 11am–6pm (Lunch in the Exhibit Hall)Friday: 10am–3pm (Lunch in the Exhibit Hall)

50'

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1544

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ScienceBas

1546

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1547

National

1548

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1549

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1555

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1618

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ImprimisRx

1648

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1655

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1657

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1855

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VISIONTHEATER

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AAO TIMES10

We look forward to see-ing you at the 2018 Awards and Lectures

Ceremony this morning from 8am to 10am in Room 217CD. Help us celebrate the individu-als who have demonstrated their contributions to the advancement of optometry and vision science! Join us to hear the Charles F. Prentice Lecture and the Glenn A. Fry Lecture (one hour of CE for this two-hour program) and to recognize these outstanding individuals.

Charles F. Prentice Medal and LectureThe Charles F. Pren-tice Medal is the Acad-emy’s top award and lecture at the an-nual meeting, and is presented to an individual who has made a significant contribution to the advancement of knowledge through research in the visual sciences.

Chris A. Johnson, PhD, DSc, FAAO, played a pivotal role in the development of automated perimetry, improving clinical practice and making important clinical trials possible such as the Optic Neuritis Treatment Trial and the Ocular Hyperten-sion Treatment Study.

Glenn A. Fry Award and LectureThe Glenn A. Fry Award and Lecture is sponsored by the

American Academy of Optom-etry Foundation and recognizes a distinguished scientist or clinician for his or her current research contributions.

In addition to studying patient-based epide-miological research related to corneal inflamma-tion and infection, Fiona J. Stapleton, MCOp-tom, PhD, FAAO, also pub-lished a substantial body of animal and in vitro work related to the microbiology and immunology of contact lens-related adverse responses compared to other treatments.

AAO-Essilor Award for Outstanding International Contributions to OptometryThe International Award rec-ognizes an indi-vidual or orga-nization whose direct ef-forts and contri-butions have resulted in unquestionable significant and extraordinary advances in optometry and eye care internationally.

Paul E. Berman, OD, who is receiving the award posthu-mously, was the founder of the Special Olympics Lions Clubs

International Opening Eyes Program and was a chief archi-tect of the overall health plat-form (Healthy Athletes) within the Special Olympics move-ment. He recognized the need for individualized treatment and, through his leadership, created a program for Special Olympic athletes with 20,000 volunteers and countless part-ners providing some 200,000 prescription eyeglasses.

Brien Holden Humanitarian AwardThe Brien Holden Humanitar-ian Award is presented to an individual or organization who has made significant contribu-tions to improve eye care in developing communities.

Akio Kanai, OD is being hon-ored for his tireless and sustained contribu-tions in partnership with the Office of the United Nations High Com-missioner for Refugees. Since 1984, Dr. Kanai has been active in advocating for access to eye care and in providing direct care to over 100,000 refugees in difficult and haz-ardous environments including Thailand, Nepal, Armenia, Azerbaijan, and, most recently, to the displaced Rohingya.

Carel C. Koch Memorial Medal The Carel C. Koch Memorial Medal is awarded to a person who has made outstanding

contributions to the enhance-ment and development of rela-tionships between optometry and other professions.

Kovin S. Naidoo, OD, PhD, FAAO is an internationally celebrated public health leader, Dr. Naidoo is an advocate for the synergy between ophthal-mology and optometry. Exam-

ples include his founding of the Afri-can Vision Research Institute, linking optometry and oph-thalmology from all over

the continent in the pursuit of confronting the challenges of Africa’s eye health issues and the Our Children’s Vision cam-paign, a cooperative project between optometry and oph-thalmology that has reached some 19 million children.

Julius F. Neumueller Award in OpticsThe American Academy of Optometry Foundation’s Julius

F. Neumuel-ler Award in Optics is issued to a student pursuing the Doctor of Optom-etry degree in a school or college

of optometry who submits a first-authored original research paper on one of the following topics: Geometrical Optics, Physical Optics, Ophthalmic

Academy Presents: 2018 Awards Ceremony


ROOM 217CD

Optics, Optics of the Eye.This year the Awards Com-mittee selected two research

articles: “Objec-tive and Subjective Visual Per-formance of Soft Multi-focal Con-tact Lenses of Various Add Powers

and Center Optic Zone Sizes,” by Jacob Andrew Boroff, OD, MS, of The Ohio State

University College of Optometry, and “Lag by Retinoscopy versus Au-torefraction Spherical Equivalent or Horizon-tal Merid-

ian,” by Angeline Nguyen, OD, and Jenna Wayne, OD, of the University of Houston Col-lege of Optometry (pictured in order listed).

Vincent Ellerbrock Clinician Educator AwardThe Vincent Ellerbrock Cli-nician Educator Award is presented to a distinguished clinician who has made out-standing and sustained con-tributions to the Academy’s

Lectures and Workshops program.

Tammy P. Than, MS, OD, FAAO has been selflessly dedicated to

sharing her clinical knowledge with her students, her patients and Academy attendees over the decades, making her most deserving of this award. Not only has she been a highly rat-ed presenter within the Acad-emy’s education program, she was the chair of the Lectures and Workshops Committee from 2006-2010.

Eminent Service AwardThe Eminent Service Award honors those persons who have rendered extraordinary and/or distinguished long-term service to the Academy.

Bernard J. Dolan, OD, MS, FAAO has an outstanding record of service to the Acad-

emy and to numerous inter- and intra-profes-sional or-ganizations such as the Accredita-tion Council on Optomet-ric Educa-

tion, the American Optometric Association, the National Board of Examiners in Op-tometry and as a key liaison with the American Academy of Ophthalmology. He served as chair of the Admittance Com-mittee from 2001-2004 and on the Academy’s Board of Direc-tors, culminating in his presi-dency in 2013 and 2014.

William Feinbloom AwardThe William Feinbloom Award is presented to an individual who has made a distinguished and significant contribution to clinical excellence and the direct clinical advancement of

visual and optometric service and thus the visual enhance-ment of the public.

David B. Elliott, PhD, MCOptom, FAAO has been de-scribed as the quintessential optometric clinician-scientist and

educator. He is the leading authority on the effects of cataract on vision and visual functionality, and also on the effects of vision on postural stability, gait, mobility and falls.

Michael G. Harris Award for Excellence in Optometric EducationPresented by the American Academy of Optometry Foun-dation, the Harris Award rec-ognizes an optometric educator who has demonstrated ongoing

and consistent excellence in the education of optometry stu-dents and/or advancement of optometric education.

Patricia K. Hrynchak, OD, FAAO is an exceptional edu-cator and has advanced opto-metric education locally, within the School of Optom-etry and Vision Science at the University of Wa-terloo; nationally, as an active member of optometric colleges (the Canadian equivalent of State Boards of Optometry); as an active member of the Cana-dian Examiners in Optometry (Canadian equivalent of the NBEO); and internationally through her influential research in optometric education. •

The Garland W. Clay AwardThe Garland W. Clay Award is presented to the authors of the manuscript pub-lished in Optometry and Vision Science that has been most widely cited in world research literature in the preceding five years and has the vote of the Optometry and Vision Science Editorial Board.

The 2018 Clay Award paper is “Mechanisms of TBI and Visual Consequences in Military and Veteran Populations,” and its authors are Gregory L. Goodrich, PhD, FAAO, Heidi M. Flyg, OD, Jennine E. Kirby, OD, Chea-Yo Chang, OD, FAAO, and Gary L. Martinsen, OD, FAAO (pictured clockwise from top left). The article was published in Optometry and Vision Science 2013;90:105-12.

11AAO TIMES


TODAY 8–10AM



AAO TIMES12

T he American Academy of Optometry’s research com-mittee drew attention to

advancements in scientifi c research toward vision restoration in this year’s Monroe J. Hirsch Research Symposium.

Tom Reh, PhD, of the University of Washington, spoke on his work harnessing the power of retinal progenitor cells and stem cells for the repair of retinal and vision restoration. He also discussed his current work to stimulate the re-generation of new retinal neurons from endogenous sources within the retina instead of transplanta-tion.

New CellsCertain diseases, such as macular degeneration, retinitis pigmentosa, diabetic retinopathy and glaucoma, each affect different retinal cells and lead to cell loss. Once lost, there is not human endogenous mechanism to replace the cells. Currently, options include replac-

ing them with a prosthetic device or putting new cells back in. Spe-cifi cally, researchers are developing stem cell therapies, especially for diseases that target the outer retina photoreceptors. There, Dr. Reh and his contemporaries believe, will be an easy target for stem cell replacement.

While many use gene therapy to correct the defect in retinal cells before cell death, complete cell loss eliminates any chances of it as an option. “Once you start los-ing an appreciable number of rod cells, then you need to move to cell therapy,” Dr. Reh said. Instead, he

offers to replace the cells lost and likens his work to making spare parts in a dish. Dr. Reh did note that rods and cones can be made in the dish and have been transplant-ed to animal models.

Regeneration Dr. Reh’s work with squirrel monkeys helped prove that human embryonic stem cells can survive in a primate host, as well as integrate and grow axon-dendritic processes into the retina, with no evidence of rejection or tumor formation.

Inspired by animals that can regrow their retinas, Dr. Reh inves-tigated Müller glial cells in birds and zebrafi sh. There is no endog-enous regeneration from Müller in any mammalian species. However, Dr. Reh’s team is working on a way around that. “If you make a new neuron in the adult retina of a mouse, will it have all the informa-tion it needs to wire a circuit in an appropriate way,” he asked. It appears that it does. “I think that offers a lot of hope that the mam-malian retina can accept new neu-rons, can wire them into the circuit and can respond to light.”

This is the fi rst evidence for functional regeneration in a mam-mal.

Going Genetic Dr. Byron Lam, MD, of Bascom Palmer, is working on ways of changing the genetic expression to repair damage from retinal dis-eases, He uses genetic tools to alter gene expression in the retina to treat inherited retinal diseases.Inherited retinal disease prevalence is low, but is a signifi cant source of morbidity.

In his discussion, Dr. Lam stated that gene therapy using AAV vec-tor is relatively safe. The ocular therapy RPE65 was FDA approved in late 2017. The near future may see additional gene therapies hit shelves. Gene therapy helps pa-tients improve or maintain vision. Dr. Lam did note that practitioners

should choose the patients care-fully who will best benefi t from therapy. Younger patients would correspond well and show dramat-ic improvement, while the goal for older patients should be to main-tain vision. “It’s time to go ahead and do genetic testing and recog-nize patients with inherited retinal diseases earlier,” he said. •

Hirsch Symposium Considers Vision Restoration Can degenerative retinal diseases be reversed? Yesterday’s session investigated.

can be measured with reasonable accuracy, he said, even with the relatively low resolution of UBM. Dr. Glasser also discussed the capability of eye “schematics” constructed from anterior segment imaging and its abil-ity to provide a predictive model of the patient’s accommodative response.

Retinal ImagingStacey Choi, PhD, of Ohio State University’s College of Optometry, presented on how to combine adap-tive optics, OCT and a scanning laser ophthalmoscope to create a high resolution, three-dimensional image of the retina. These kinds of imaging can show minute changes in age-related macular degeneration subjects, such as the depositing of tiny drusen, that previously evaded doctors’ detection. She also provided several moving images that helped

show the activity of cell bodies and retinal ganglion cells. The moving images could show when these cells are displaced and help guide treat-ment.

GlaucomaDonald Miller, PhD, was also on hand to reprise some of the ground-breaking work he shared earlier this week with the Optometric Glaucoma Society. That research explained the capabilities of imaging devices to penetrate targeted layers of the eye from both a B-Scan and en face angle, revealing cellular damage never before perceivable.

The new technologies and discov-eries regarding structure and func-tion that have been made using them are the future of eye care. With the research being done by these experts, that future is here today.•

OD/MD Joint SymposiumContinued from Page 1

In hopes of improving glaucoma management through the use of

sustained-release drug delivery, two implants containing travoprost (iDose, Glaukos) showed promise through their initial effi cacy and excellent safety profi le in a prospec-tive, randomized trial presented by Mitch Ibach, OD, FAAO. A total of 154 subjects were randomized to two forms of the drug delivery device and evaluated at 12-week post-op visits. All study patients achieved at least 30% IOP reduction. These implants may potentially change the treatment paradigm in glaucoma by addressing the unmet medical need of high rates of patient non-adherence with topical glaucoma regimens.

RESEARCH SPOTLIGHT

The findings above were presented at the AAO press conference Wednesday. Dr. Ibach will give a full presentation of the study today in this session:

• Glaucoma Treatment: Toward Best Practices, 4:15–6pm, Room 303

Interim Results of a Prospective, Randomized Phase II Study Evaluating the Safety and Efficacy of Travoprost Intraocular Implants

Mitchel Ibach, Justin Schweitzer



13AAO TIMES

The annual Academy meeting is known and loved for its superlative clinical education, and Academy 2018 San Antonio is no excep-

tion—but it’s also where a number of innovative products debut! On Wednesday morning, several manufacturers shared the latest offerings out in the market now or planned for the near term.

The Long and the Short of ItWith myopia control becoming more of a priority among eye care practitioners, industry is respond-

ing with increased attention, including ways to slow axial elon-gation during develop-ment. Thomas Aller, OD, of Visioneering Technologies presented

data showing that NaturalVue 1 day multifocal contact lenses lowered refractive error change and decreased axial length change in fast-progressing myopic children. Overall, the children demonstrated a statistically signifi cant average of 1.04D (81%) per year decrease in myopic refractive error change. The study suggests that these lenses could help address under-corrected myopia—the most common cause of visual impairment globally—and contribute to worldwide efforts to prevent the number of myopes from increasing to nearly fi ve billion by 2050.

Low Vision, High TechThe central vision loss that accompanies late-stage AMD is a profound hardship for patients that dev-astates quality of life. Henry Greene, OD, FAAO,

of Ocutech presented the company’s new VES Falcon Autofocus Bioptic Telescope, an autofo-cusing head-mounted device that allows the visually impaired to

restore some central vision. Fast autofocusing allows wearers to comfortably complete their daily routines in a more normal manner, according to Dr. Greene, who says, the device “has the potential to revolutionize many peoples’ lives, improving qual-ity of life, independence and academic and career opportunities.”

Supra HeroFilling a need for intra-ocular pressure control that relies less on medi-cations and avoids fi ltering procedures, Glaukos presented its

next-generation minimally invasive glaucoma sur-gery (MIGS) device, the iStent Inject Trabecular Micro-bypass Stent. The device includes two stents preloaded in an auto-injection mechanism that allows surgeons to inject stents into multiple trabec-ular meshwork locations through a single corneal entry point.

Ban the BowlA new company called Virtual Field announced the launch of a virtual reality platform for visual fi eld exams that does away with the classic, but incon-venient, automated perimetry bowl. The product

that consists of a VR headset, computer and clicker, runs standard 24-2 and suprathresh-old visual fi eld tests, tests both eyes simul-taneously and includes

fi xation and sleep monitoring features that reduce invalid test results. The device comes in handy for ODs who want to provide visual fi eld tests to their patients but don’t want to devote additional space or money to a conventional perimeter.

Eat to WinPRN announced the launch of the fi rst ‘medical food’ in eye care—Nuretin, formulated to reduce the risk and slow the progression of diabetic retinopathy. The product is a purifi ed triglyceride omega-3 that pro-

vides 1200mg of EPA and DHA in a 1:5 ratio. James Thimons, OD, noted that the epidemic of obesity—90 million US adults are prediabet-ic or diabetic—requires

greater attention to controllable risk factors, one of which is abnormal lipid metabolism. The product’s effi cacy in this regard “becomes a signifi cant issue going forward in why Nuretin has a potential for major impact for our patients,” Dr. Thimons said.

The ABCs of AMDMaculogix, maker of the AdaptDx device for AMD

assessment, presented its new publication, “Practical Perspectives on the Diagnosis and Management of AMD,” a practical guide that the company says will sim-

plify adoption of updated standards of care. Seven leading educators and private practice clinicians collaborated to compile a broadly comprehensive

review of the disease to aid practitioners in identifi -cation and care. According to Amanda K. Lee, OD, director of professional relations, “This compilation will lead to changes in the way we all care for our patients who are at risk for AMD.”

A Spark of HopeInherited retinal disorders (IRDs) all but doom patients to a lifetime of visual compromise, so last year’s news of an effective gene therapy (Luxturna) was celebrated far and wide. Parag Meswani of Spark

Therapeutics unveiled Eye Want 2 Know, the company’s new digital resource dedicated to raising awareness of the need for genetic testing for affected patients.

Through genetic testing, those living with an IRD may obtain diagnostic clarity and pursue resources and community support specifi c to their condition.

Those Awesome AussiesJudith Stern, global manager of education at the Brien Holden Vision Institute, detailed the institu-

tion’s comprehensive myopia education program, which helps eye care practitioners identify candidates at risk and empower them with the skills to bet-

ter manage progressive myopia for their patients. The three-course program—the second of which, “Complex Cases” will soon launch—is based on the latest advances in research.

Around the BendOphthalmic lenses are the oldest product category in eye care, and many would agree that their break-throughs have dwindled in recent decades. That’s why the folks are EyeBrain Medical are so excited about their product, Neurolens, the fi rst prescrip-

tion lens that adds a contoured prism that bends light rays in a unique way to address a condition called tri-geminal dysphoria. The goal is to relieve

the headaches, neck/shoulder pain and eyestrain that adults complain of when using digital devices, reading or doing detail work. Gradually increasing the prism from distance to near provides smooth eye alignment at all distances, Neurolens presi-dent Davis Corley explained. •

Industry Rises to the OccasionInnovation is alive and well, as manufacturers fi nd new ways to help doctors serve their patients.


AAO TIMES14


Prescribing for Neuro-Ophthalmic DiseaseThese diagnoses and treatments aren’t brain surgery, but they’re close.

A 58-year-old woman was driving to work when she started to see spots. Suddenly, her vision

just shut down. Having driven the route numerous times, she knew just where she could pull over. She was lucky. Her vision returned quickly, but the epi-sode left a pain in one side of her head. She showed up at her optometrist’s offi ce the next day. Would you be prepared to deal with such a patient? You should be. This case was among the several presented by neuro-ophthalmic specialist Kelly Malloy, OD, FAAO, at Thursday’s presentation “Neuro-Ophthalmic Disease and Related Medica-tions.” If it affects a patient’s vision, they’re likely to appear in your chair. That’s enough reason to bone up on neurological issues that can intersect with the visual pathway. Dr. Malloy spoke on the differential diagnoses, lab testing and co-man-agement protocols and medical treatments along with Tracy Offerdahl, PharmD, BPharm. The pair reviewed a range of presentations including herpes zoster, lyme’s disease, giant cell arteritis (GCA), multiple sclerosis, rheumatoid arthritis.

Giant Cell ArteritisThe patient in the above example was tossed from offi ce to offi ce, but was eventually diagnosed with a condition she had already twice tested nega-tive for. Her disease required co-management with a rheumatologist and she was treated with the steroid Prednisone and Actemra (tocilizumab, Genetech). The presenters also discussed the use of specialized pro-resolving mediators such as some fi sh oils. These supplements may help decrease infl ammation, improve cognitive function and even provide some cardiac protection. Dr. Offerdahl warns, though, that some patients may experience considerably uncomfortable refl ux (or, “the fi sh burps” as she called it).

Herpes ZosterThe patients that end up in Dr. Malloy’s chair seem to have frequently been previously misdiag-nosed and shuffl ed from offi ce to offi ce. Such was the case for a 56-year-old woman struggling with sudden migraines—an issue she hadn’t experienced before—with excessive tearing and congestion. She was offered Flonase and Amoxicillin for what her primary care physician believed was a sinus infection, but when she developed an oozing scab, her eye care team was able to accurately diagnose her with shingles. This left her open to a number of ophthalmic presentations, including cranial nerve palsies III, IV and VI, which can appear two to four weeks after the initial rash. Her manage-ment plan included lab testing, (such as CBC, platelet count, ESR, CRP, Lyme titer, ANA, RPR, FTAABS, ANA, ACE, BUN and creatinine) as well as an MRI exam and the use of oral anti-virals.

Lyme’s diseaseThis illness is stealthy and, according to the presenters, is often fi rst noticed when the patient experiences visual presentations—particularly, diplopia. Its cause is the bacterium Borrelia burgdor-feri which is transmitted to humans through tick bites and, although these bites often leave a tell-tale red bullseye on the skin, 20% to 30% never develop this rash. The ticks themselves are about as small as a stray pen mark, but the prevalence of the disease they spread is enormous.

In fact, Dr. Offerdahl mentioned data devel-oped from a study on Pennsylvania horses and other livestock that dwell outside. They found the bacteria in 100% of the animals studied. In humans, it can lead to debilitating condi-tions such as heart palpitations, infl ammation of the brain and spinal cord and even problems with short-term memory. These patients can be treated with doxycycline—the best tolerated of the tetrcyclines, which is now indicated for the treatment of Lyme in children as young as eight years—or Amoxicillin and Cefuroxime Axetil. These patients need to be followed even after they’re disease free as some have devel-oped adverse affects sometimes referred to as “post-treatment Lyme Disease syndrome.” They may need to undergo a course of Ceftriaxone, although controversy surrounds this long-term antibiotic treatment. •

Drs. Offerdahl (left) and Malloy presented a number of cases on systemic, neurological conditions and how they impact the eye.

ABO: Go for the GoldBoard certifi cation assessments now shorter, focused and more fl exible.The American Board of Optometry (ABO) announced a new Continuous Assessment Program (CAP) that will replace the 10-year recertifi cation exam in 2019. Seeking to make board certifi cation more meaningful, convenient, fl exible and less costly for Diplomates, the ABO now provides 25-question assessments taken three times per year for a total of nine assessments over a three-year cycle. Erich Hinel, OD, presented the new process Wednesday morning at the Academy press conference.

The CAP will help Diplomates maintain their board certifi cation without the stress and expense of a high-stakes exam every 10 years, yet still be confi dent that they are keeping up with advancements in the profession while maintaining their commitment to continuous learning and excellent patient care. During each three-year cycle, Diplomates will be evaluated on the completion of the following requirements: (1) 100 Hours of CE, (2) 2 Self Assessment Modules (SAMs), (3) one Quality Improvement Initiative (QII), (4) and passing 7 of nine continuous assessments.

The assessments will emphasize on clinically relevant content and new clinical guidelines. They will cover a specifi c topic area, with emphasis on reinforced clinical knowledge, new research, new practice guidelines. The ABO states that there is no additional cost for CAP; instead, a cost savings of over $1,000+ may be realized by not taking the recertifi cation exam.


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