Zeiss Updates OCT and HFA Software

Cirrus™ HD-OCT Optic Nerve Head Analysis 
The new Cirrus™ HD-OCT Optic Nerve Head Analysis software provides automated identification of the optic disc and cup boundaries. The analysis is generated using the existing Optic Disc 200 x 200 data cube and a new proprietary ZEISS algorithm. This algorithm is designed to precisely measure the neuro-retinal rim, while accounting for tilted discs, disruptions to the RPE and other challenging pathology. Optic nerve head calculations are presented in a combined report with RNFL thickness data. Key parameters are displayed in table format. In addition, the boundaries of the cup and disc are displayed on the en face image integrated with the RNFL thickness deviation map.

“Doctors always are on the alert for improved ways of managing glaucoma,” said Douglas Anderson, MD, Professor, Douglas R. Anderson, Chair in Ophthalmology at Bascom Palmer Eye Institute, University of Miami. “Recent improvements in OCT imagery of the eye provided such an opportunity, and I was pleased to collaborate with Carl Zeiss Meditec in the development of a new method for quantifying optic nerve damage commonly seen in glaucoma.”

Humphrey Field Analyzer with Guided Progression Analysis (GPA) Software 
The world’s most widely used automated perimeter is now the only perimeter with GPA software that has received clearance from the FDA to specifically assess both change from baseline and the rate of change of visual field loss over time. With GPA, doctors can see at-a-glance whether vision has changed for each individual patient and they can subsequently identify how rapidly visual field loss is progressing. Understanding each patient’s rate of progression helps the doctor to adjust the therapeutic regimen with the goal of preserving vision throughout the patient's expected life.

Humphrey Field Analyzers are used by more eye care providers than any other automated perimeter today, and more than 60 thousand units have been sold since the first models were introduced in 1984. In addition to FDA cleared GPA software for the HFA, GPA software also is FDA-cleared for the Cirrus HD-OCT.

The Five-20 Rule for Dietary Sodium Intake

This article may be helpful for your patients -- and yourself:

Sodium Intake Could Be Managed Using Five-20 Rule.

NBC Nightly News (3/4, story 8, 2:20, Williams) reported in its "Personal Best" series that sodium "has a way of sneaking into the American diet in some of the most unlikely places," in what NBC (Thompson) called "a blizzard of salt." NBC examined how sodium is present in unlikely foods -- such as toasted wheat cereal and tomato juice -- and pointed out "an easier way to keep an eye on your sodium intake. Just remember two numbers, five and twenty. Then look at the label for the daily value or DV percentage." Barbara Schneeman, FDA Nutritional Labeling Director, told NBC, "Five percent or less of the daily value is considered low. Twenty percent or more of the daily value is considered high."

Really? No Glasses after cataract Extraction and IOL?

Long-term study confirms good results, maintenance of accommodation with IOL

BUDAPEST, Hungary — Long-term results of 37 patients followed for nearly 6 years after implantation of the accommodating dual optic Visiogen Synchrony IOL from Abbott Medical Optics showed stability of refraction, with a range of vision for distance, intermediate and near that was maintained throughout the length of the study period.

"The dual optic concept offers the potential for greater and more consistent, long-lasting accommodative amplitude. [Ultrasound biomicroscopy] and iTrace testing gave objective evidence of accommodation movements in the study," Ivan L. Ossma-Gomez, MD, MPH, of Cali, Colombia, said at the winter meeting of the European Society of Cataract and Refractive Surgeons.

All patients achieved 20/25 or 20/20 for distance and intermediate vision, and near vision was 20/25 on average.

Compared with other means of presbyopia correction, such as multifocal IOLs, the quality of vision is better because no optical aberrations are induced, Dr. Ossma-Gomez said. In addition, because of the "no space, no cell" design, the Synchrony lens has the advantage of a low posterior capsule opacification rate. "YAG rate for this cohort was 5.4% over the span of the study period," he noted.

Dr. Ossma-Gomez has personally implanted a total of 473 Synchrony lenses and has the longest patient follow-up. Worldwide, more than 1,200 lenses have been implanted.

A man ahead of his time

In the early 80's Don Bode, MD an ophthalmologist I worked with in Greenville started using Botox for his HA patients who had muscle tightness and headaches as a result of this.  A couple of Botox injections at the base of the skull on the neck and headaches often disappeared abruptly.

Read on......

Botox may help prevent some types of migraines.

Bloomberg News (2/16, Ostrow) reports, "Allergan Inc.'s Botox [botulinum toxin type A], given in the doses used to reduce facial wrinkles, may stop certain kinds of migraines that patients describe as crushing or 'eye-popping' more than other types," according to research published in the Archives of Dermatology. The company "has filed for approval with the [FDA] to market Botox as a treatment for chronic migraines...said" a spokeswoman for Allergan.

        HealthDay (2/15, Reinberg) reported that the study of 18 patients showed that 13 "saw a reduction in migraine pain," from "almost seven days a month to less than one day a month." Researchers speculated that Botox "may work by blocking pain receptors or reducing inflammation." MedPage Today (2/15, Bankhead) also covered the story.

Clean Hands without all the scrubbing

Plasma hand cleaning from the New York Times article. Interesting!

American Diabetes Association Standards of Medical Care in Diabetes 2010

Complete new standards can be found here.   Eye care standards are attached below:

C. Retinopathy screening and treatment 

Recommendations

General recommendations

• To reduce the risk or slow the progression of retinopathy, optimize glycemic control. (A)
• To reduce the risk or slow the progression of retinopathy, optimize blood pressure control. (A)

Screening

• Adults and children aged 10 years or older with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (B)
• Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist shortly after the diagnosis of diabetes. (B)
• Subsequent examinations for type 1 and type 2 diabetic patients should be repeated annually by an ophthalmologist or optometrist. Less frequent exams (every 2–3 years) may be considered following one or more normal eye exams. Examinations will be required more frequently if retinopathy is progressing. (B)
• High-quality fundus photographs can detect most clinically significant diabetic retinopathy. Interpretation of the images should be performed by a trained eye care provider. While retinal photography may serve as a screening tool for retinopathy, it is not a substitute for a comprehensive eye exam, which should be performed at least initially and at intervals thereafter as recommended by an eye care professional. (E)
• Women with preexisting diabetes who are planning pregnancy or who have become pregnant should have a comprehensive eye examination and be counseled on the risk of development and/or progression of diabetic retinopathy. Eye examination should occur in the first trimester with close follow-up throughout pregnancy and for 1 year postpartum. (B)

Treatment

• Promptly refer patients with any level of macular edema, severe NPDR, or any PDR to an ophthalmologist who is knowledgeable and experienced in the management and treatment of diabetic retinopathy. (A)
• Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with high-risk PDR, clinically significant macular edema, and in some cases of severe NPDR. (A)
• The presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, as this therapy does not increase the risk of retinal hemorrhage. (A)
  
  

Diabetic retinopathy is a highly specific vascular complication of both type 1 and type 2 diabetes, with prevalence strongly related to duration of diabetes. Diabetic retinopathy is the most frequent cause of new cases of blindness among adults aged 20–74 years. Glaucoma, cataracts, and other disorders of the eye occur earlier and more frequently in people with diabetes.

In addition to duration of diabetes, other factors that increase the risk of, or are associated with, retinopathy include chronic hyperglycemia (291), the presence of nephropathy (292), and hypertension (293). Intensive diabetes management with the goal of achieving near normoglycemia has been shown in large prospective randomized studies to prevent and/or delay the onset and progression of diabetic retinopathy (53,57,58). Lowering blood pressure has been shown to decrease the progression of retinopathy (187). Several case series and a controlled prospective study suggest that pregnancy in type 1 diabetic patients may aggravate retinopathy (294,295); laser photocoagulation surgery can minimize this risk (295).

One of the main motivations for screening for diabetic retinopathy is the established efficacy of laser photocoagulation surgery in preventing vision loss. Two large trials, the Diabetic Retinopathy Study (DRS) and the Early Treatment Diabetic Retinopathy Study (ETDRS), provide the strongest support for the therapeutic benefits of photocoagulation surgery.

The DRS (296) showed that panretinal photocoagulation surgery reduced the risk of severe vision loss from PDR from 15.9% in untreated eyes to 6.4% in treated eyes. The benefit was greatest among patients whose baseline evaluation revealed high-risk characteristics (chiefly disc neovascularization or vitreous hemorrhage). Given the risks of modest loss of visual acuity and contraction of the visual field from panretinal laser surgery, such therapy is primarily recommended for eyes with PDR approaching or having high-risk characteristics.

The ETDRS (297) established the benefit of focal laser photocoagulation surgery in eyes with macular edema, particularly those with clinically significant macular edema, with reduction of doubling of the visual angle (e.g., 20/50–20/100) from 20% in untreated eyes to 8% in treated eyes. The ETDRS also verified the benefits of panretinal photocoagulation for high-risk PDR, but not for mild or moderate NPDR. In older-onset patients with severe NPDR or less-than-high-risk PDR, the risk of severe vision loss or vitrectomy was reduced 50% by early laser photocoagulation surgery at these stages.

Laser photocoagulation surgery in both trials was beneficial in reducing the risk of further vision loss, but generally not beneficial in reversing already diminished acuity. This preventive effect and the fact that patients with PDR or macular edema may be asymptomatic provide strong support for a screening program to detect diabetic retinopathy.

As retinopathy is estimated to take at least 5 years to develop after the onset of hyperglycemia (298), patients with type 1 diabetes should have an initial dilated and comprehensive eye examination within 5 years after the onset of diabetes. Patients with type 2 diabetes who generally have had years of undiagnosed diabetes (299) and who have a significant risk of prevalent diabetic retinopathy at the time of diabetes diagnosis should have an initial dilated and comprehensive eye examination soon after diagnosis. Examinations should be performed by an ophthalmologist or optometrist who is knowledgeable and experienced in diagnosing the presence of diabetic retinopathy and is aware of its management. Subsequent examinations for type 1 and type 2 diabetic patients are generally repeated annually. Less frequent exams (every 2–3 years) may be cost effective after one or more normal eye exams (300–302), while examinations will be required more frequently if retinopathy is progressing.

Examinations can also be done with retinal photographs (with or without dilation of the pupil) read by experienced experts. In-person exams are still necessary when the photos are unacceptable and for follow-up of abnormalities detected. Photos are not a substitute for a comprehensive eye exam, which should be performed at least initially and at intervals thereafter as recommended by an eye care professional. This technology has great potential in areas where qualified eye care professionals are not available and may also enhance efficiency and reduce costs when the expertise of ophthalmologists can be used for more complex examinations and for therapy (303).

Results of eye examinations should be documented and transmitted to the referring health care professional. For a detailed review of the evidence and further discussion of diabetic retinopathy, see the ADA technical review and position statement on this subject (304,305).

The Next Frontier for Optometry?

First Oklahoma, now maybe W. Virginia. Keep in mind that WVA was the first state in the nation to have a therapeutic drug law.  NC was second.

West Virginia bill broadening optometrists' scope-of-practice advances.

The Charleston Daily Mail (2/11, Gavin) reported that on Wednesday, a West Virginia "Senate Committee on Government Affairs voted unanimously to pass a bill that would broaden the scope of practice for doctors of optometry in the state." The measure "would allow optometrists to start performing certain laser procedures but only when collaborating with an ophthalmologist licensed in West Virginia." It will also allow optometrists to give "injections that do not puncture the eyeball."