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Tools for home use have been developed for IOP measurement and visual field testing, according to Ying Han, MD, PhD, associate professor of ophthalmology, co-director of the glaucoma service, and director of the glaucoma fellowship program at the University of California San Francisco. De Moraes et al. conducted a study (JAMA Ophthalmology 2018) in 445 patients and found that the contact lens sensor recordings may have a better association with visual field progression than Goldman mean IOP measured multiple times during office hours. According to Dr. Han, it showed good correlation with the Humphrey Visual Field testing ,and about 80% repeatability in a 2017 study in the American Journal of Ophthalmology by Johnson et al, who evaluated the app's performance in Nepal.

Pediatric Primary goal to make outcomes measures more useful for physicians Providing patient-centered care is one component of improving the quality of health care, and this becomes more challenging in pediatric ophthalmology since both the child's and parents' perspectives on the eye condition and how it affects their lives have to be considered. Dr. Holmes and Eileen E. Birch, PhD, of the Retina Foundation of the Southwest in Dallas, led the teams that developed the questionnaire, designed to help clinicians gather patient-reported outcome measures (PROMs) on health-related quality of life and functional vision in childhood eye conditions. The investigators have grant funding from the National Institutes of Health for this study. r TAKE-HOME -I i Researchers hope questionnaire will lead to a world where patient-reported outcome measures are commonly used in pediatric eye care, not just for research but also in clinical practice.

Cataract Capsulorhexis-guided lens confirms intended axis during surgery, decreases astigmatism ABOUT HALF OF the population 60 years of age and over exhibits more than 1.0 D of corneal astigmatism,1-2 and one of the challenges surgeons face in treating pre-existing astigmatism is ensuring precise alignment of the toric IOL. RETROSPECTIVE ANALYSIS In a recent retrospective analysis of 54 eyes in which laser iris-registered femtosecond laser-assisted anterior capsular marks (IntelliAxis Refractive Capsulorhexis, LENSAR) were used to guide alignment of the Trulign toric IOL (Bausch + Lomb) and ORA (Optiwave Refractive Analysis, Alcon) to confirm intended axis during cataract surgery, astigmatism decreased significantly postoperatively (p<0.001), said Dr. Stephenson, who performed the procedures. Iris registration, based on high-definition preoperative infrared images obtained with numerous corneal diagnostic instruments in the clinic, allows precise correlation of corneal topographic and total corneal astigmatic data with laser treatment, opening the way for accurate correction of astigmatism.

Similar to the personality and actions this character displayed in the original trilogy, she recommends: * Being friendly, adaptable, and action-oriented * Planning ahead * Building a squad or team with shared goals * Recognizing challenges * Using various resources available to you to help establish your practice Dr. Nijm suggested that a solo practitioner would ideally have an amicable personality, which would allow them to easily talk with patients and maintain good relationships with staff members. Often, there is a lag time between opening a practice and receiving steady reimbursements. [...]a major consideration is obtaining the necessary funding ahead of time to purchase equipment, hire staff, and float a functioning practice for anywhere from three to six months. 'STRIKE BACK' AGAINST CHALLENGES Then, just as the cinematic \"rogue hero\" Han Solo was constantly doing battle with Darth Vader and other villains, solo practitioners will confront their own particular challenges: insurance companies and Medicare, billing and coding-not something physicians should simply leave to their staff, Dr. Nijm emphasized-as well as government compliance requirements and human resources.

Goals include providing accessible, convenient, and efficient care; using improved imaging and diagnostic modalities (portable fundus cameras, smartphone cameras, tablet- or virtual reality-based visual field testing, and spectral-domain optical coherence tomography); increasing rates of diagnosed and treated glaucoma; and allowing glaucoma specialists to focus on advanced disease and surgical work. Walmart Vision Centers were chosen as partners for the EQUALITY program because in the rural areas of Alabama, where the project is based, Walmart stores are often the largest, or only, retail centers and therefore provide a convenient central point of access for the target population, Dr. Rhodes explained. Since the screenings are conducted at a regularly staffed clinic, patients know that they can readily return for follow-up visits, while the optometrists can bill for their services, making the project more sustainable. Based on a review of teleglaucoma programs, the keys to success that Dr. Rhodes has identified include targeting high-risk populations; choosing imaging modalities based on budget, convenience, and portability; engaging community partners to spread awareness and increase attendance; and utilizing patient navigators, social workers, and technology to increase follow-up adherence rates.

Rethinking management of HZO, future role for antivirals ACUTE HIGH-DOSE ANTIVIRAL treatment is recommended for herpes zoster ophthalmicus (HZO), but an initiative is under way to evaluate a new treatment protocol for HZO utilizing a lower dose of medication administered over a longer period, according to Elisabeth J. Cohen, MD, professor of ophthalmology, New York University School of Medicine, New York. Secondary objectives include evaluating whether the effect of treatment on the key endpoint persists for six months; testing the theory that suppressive valacyclovir treatment reduces the incidence, severity, and duration of postherpetic neuralgia compared to placebo at 12 and 18 months; the development of disease manifestations of HZO, including primary endpoint diagnoses, neurotrophic keratopathy, scleritis, and glaucoma. \"ZEDS is an opportunity to do a randomized clinical trial to develop evidence-based recommendations regarding the role of suppressive antiviral treatment in the management of HZO,\" Dr. Cohen said, adding physicians can refer HZO patients or contact the team if they are interested in becoming a study investigator. ? take-home * The Zoster Eye Disease Study is focusing on knowledge of the infectious pathogenesis of complications of herpes zoster and HZO is relatively new, and that suppressive antiviral treatment offers significant benefits in reducing recurrent HSV eye disease.

Roger A. Dailey, MD, FACS, professor and Lester T. Jones Endowed Chair of Oculofacial Plastic Surgery, Casey Eye Institute, Oregon Health and Sciences University, Portland, said that external DCR has been viewed as the gold standard for a long time. When an obstruction is severe and the canaliculi cannot be reconstructed, conjunctivodacryocystorhinostomy (CDCR) is performed, and a Pyrex tube known as the Jones tube comes into play to connect the surface of the eye directly to the nasal cavity. GETTING RESULTS With the strategy of replacing tubes with those having a large collar size as needed, Dr. Dailey has achieved 100% anatomic success, a 97% symptomatic patient cure rate, and a loss or migration rate of about 3%.

Just as with visual fields, an important step is following a reliability checklist: make sure that the signal strength is good and that there is no tracking error; measure the slope of the retinal nerve fiber layer (RNFL) thickness over time to see if there is any unusual pattern of tissue loss; search for artifacts due to pathology; and determine if the RNFL loss matches the macular loss. RNFL PROFILE CHANGES The parameters for structural change include focal loss in the RNFL profile and the average thickness in the superotemporal or inferotemporal sectors. Co-existing uveitis and glaucoma requires extra vigilance in interpreting OCT scans, Dr. Asrani noted. \"Because the RNFL is swollen, it appears thicker than it actually is, giving you a false sense of reassurance that the glaucoma is not bad,\" he concluded.

Researchers target form of conjunctivitis MUCH HAS BEEN learned about epidemic keratoconjunctivitis (EKC) since it was first described in 1889, yet aspects of the viral pathogenesis of adenovirus keratitis have remained an enigma, according to James Chodosh, MD, MPH, the David Glendenning Cogan Professor of Ophthalmology in the field of cornea and external disease, Massachusetts Eye and Ear, Harvard Medical School. Dr. Chodosh referred to the work of the late Prof. Barrie Jones of Moorfields Eye Hospital, who postulated that the adenovirus grows in the epithelial cells alone, and in killing them, liberates antigens, which soak into the underlying stroma to become fixed in the surface of fiber and cell membranes. PATHOGENESIS MODEL He described a proposed pathogenesis model for adenoviral keratitis: * Infection of the ocular surface epithelium * Interaction between the viral capsid and molecular pattern receptors on corneal cells * Intracellular signaling * Chemokine expression * Binding of chemokine protein to epithelial basement membrane * Migration of limbal leukocytes to chemokine reservoirs at corneal epithelial basement membrane, forming infiltrates within corneal subepithelial stroma Based on this model, Dr. Chodosh would rewrite Jones' statement to say: \"I postulate that the virus grows on the surface, initiating the expression of chemo-attractants which soak into the stroma to become fixed in the underlying basement membrane.