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In a symposium, entitled ?Progressive thinking: advances in the diagnosis assessment and management of glaucoma,? a panel of glaucoma specialists provided their expertise on imaging, risk factors that determine glaucoma progression, and understanding angle-closure glaucoma (ACG).

Glaucoma progresses at different rates among patients, and this variability poses a challenge for the ophthalmologist trying to manage the disease. IOP is a well-known risk factor and often is monitored carefully in patients with glaucoma. However, visual field and optic nerve deterioration are direct indicators of progression, and their status also should be considered when developing an initial treatment plan.

Using various types of IOLs in the same patient has been trumpeted as a way to achieve better vision correction than bilaterally implanting the same IOL. Yet, this concept of "mix and match" is not quite that simple, said Rubens Belfort, MD, Vision Institute, Federal University, Sao Paulo, Brazil.

Surface excimer laser and application of topical mitomycin C 0.2% results in increased vision when used to treat refractive errors after penetrating keratoplasty, said Michael Lawless, FRACO, from the Vision Eye Institute, Chatswood, New South Wales, Australia.

Achieving the proper IOL power for patients who have had a refractive procedure such as LASIK, PRK, or RK can be challenging, and taking more measurements leads to greater accuracy, said Jack T. Holladay, MD, MSEE, FACS, Holladay LASIK Institute and Baylor College of Medicine, Houston.

Erythropoietin (EPO), ciliary neurotrophic factor (CNTF), and wolfberry seem to provide neuroprotection of retinal ganglion cells in a rat model of ocular hypertension, according to Kwoh-fai So, PhD, chairman of the Department of Anatomy, University of Hong Kong.

Lamellar sliver: devastating complication of recutting after LASIK

With diabetes cases worldwide expected to double in the first 30 years of the 21st century, telemedicine might be a pathway to ensuring that more patients receive care, and thus, prevent complications from retinopathy, said P. Lloyd Hildebrand, MD, Dean A. McGee Eye Institute, Oklahoma University Health Sciences Center.

Ophthalmologists should assess disease progression in patients with established and suspected glaucoma, should confirm with repeat testing any visual function loss that is seen, should remember that structural measurements have variability, and should consider using structural and functional testing together to detect disease progression, said Robert Weinreb, MD. The distinguished professor of ophthalmology and director, Hamilton Glaucoma Center, University of California in San Diego, LaJolla, CA, concluded a course about detecting progression in glaucoma by highlighting points made in the preceding presentations.

New investigative drugs for age-related macular degeneration (AMD) may complement the vascular endothelial growth factor (VEGF) agents, improve the visual results, and require fewer injections. Various routes of administration are under investigation and combination treatments are likely to provide more favorable results, said Lawrence Singerman, MD, Case University School of Medicine, Cleveland, OH.

The presence of an afferent pupillary defect is the best indicator of visual loss in patients with open-globe injuries, said Michael Grant, MD, PhD, of the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore.

Is there a place for traditional Chinese medicine in modern ophthalmology? Quite possibly, said Dennis Lam, MD, FRCS, Chinese University of Hong Kong. Acupuncture, for example, has been used in China and other Asian countries for thousands of years, and such therapies still may have applications in the world of medicine to this day, he said.

Should the initial treatment in angle-closure glaucoma be laser, lens removal, or trabeculectomy? The answer depends on the patient, said Clement C.Y. Tham, department of ophthalmology and visual sciences, Chinese University of Hong Kong. "There's not a single answer," Dr. Tham said. "Drug therapy and other procedures must be considered, too."

Antioxidants, such as the polyphenols found in green tea, have been championed for their protective value in cancer protection. Their role in eye disease prevention, however, is still unclear. Dorairajan Balasubramanian, director of research, L.V. Prasad Eye Institute, Hyderabad, India, reported on in vitro tests he has performed on cells and polyphenols such as epigallocatechin gallate (ECGC) and catechin, and their protective value against cytotoxic agents.

Detecting a macular hole or photoreceptor detachment is critical for obtaining good surgical results in patients with myopic foveoschisis. Patients with the foveal detachment type seem to benefit the most from vitrectomy. Spectral-domain optical coherence tomography (SD-OCT) and fundus autofluorescence (FAF) are valuable for managing these patients, said Yasushi Ikuno, MD, Osaka University Medical School, Osaka, Japan.

Glaucoma has long been defined as a disease characterized by elevated IOP. That definition, however, is changing to define the disease as an optic neuropathy characterized by a specific pattern of optic nerve head and visual field damage. That's the word from Theodore Krupin, MD, department of ophthalmology, Sorrel Rosin Eye Center, Northwestern University, Chicago.

Prophylactic intracameral cefuroxime injections prevent development of endophthalmitis after cataract surgery, according to Peter Barry, MD, FRCS, from Royal Victoria Eye and Ear Hospital, Dublin, Ireland. He reported the results of the European Society of Cataract and Refractive Surgeons Endophthalmitis Study.

Small-molecule drugs are being developed for topical application via the transconjunctival/transscleral route. The topical drugs that are under development have shown good posterior segment penetrance, safety, and efficacy in animal models. Clinical studies are now under way.

Although leaking filtering blebs often can be managed with conservative measures, surgery to stop the leak is indicated in some cases. A surgical approach may be indicated especially in certain high-risk eyes, such as those with a history of bleb-related infection. Several surgical techniques may be used to control a leaking bleb effectively.

Customized hyperopia treatment with the Technolas 217z Zyoptix wavefront excimer laser system (Bausch & Lomb) has excellent predictability, with 69% of patients within 0.5 D of the intended correction.

Centering the corneal ablation profile over the corneal vertex when treating hyperopia using an excimer laser platform (Schwind Esiris, Schwind eye-tech-solutions) results in better visual outcomes compared with ablations that were centered over the pupil centroid.

From the sixth postoperative month, the corneal power tended to decrease continuously with respect to preoperative data.

A prospective, randomized, contralateral eye study including an extensive list of outcome measures is under way comparing sub-Bowman's keratomileusis performed with two different femtosecond lasers (IntraLase FS60, Advanced Medical Optics; Femto LDV, Ziemer). Early data show that both lasers create good-quality, planar thin flaps, and their use is associated with excellent vision and safety outcomes.

Equivalent keratometer readings (EKRs) from a novel rotating Scheimpflug camera system (Pentacam, Oculus Inc.), calculated by version 1.16r04 software, are still inaccurate for eyes with a history of LASIK, PRK, or RK. The EKR measures steeper than true corneal power.

A study was conducted in rabbit eyes to compare flap adhesion strength of LASIK flaps created with different techniques and technology. The results indicate that significantly greater force is needed to dehisce flaps created with a 150-kHz femtosecond laser (IntraLase, Advanced Medical Optics) versus a mechanical microkeratome. Femtosecond laser-created flaps with a 150° side-cut design adhere more strongly relative to those with a 70° side-cut design.

Using a simple nomogram can substantially improve flap centration with a proprietary femtosecond laser. When considering the question of how big the LASIK flap should be, a large flap is good because ablation performed on the epithelium induces aberrations. A small flap, however, also is good because corneal strength is impaired less and less dry eye may be induced by the procedure, although the latter is still uncertain.

Patients who have suspected keratoconus based on topography may be candidates for LASIK based on a study that showed refractive stability 1 year after LASIK in patients where keratoconus was excluded preoperatively using epithelial thickness mapping obtained with a VHF ultrasound eye scanner (Artemis 1, ArcScan).

Many ophthalmologists are familiar with Eyemaginations' 3D-Eye in-office educational tools. Now, a home version is available that lets you extend your patient education reach beyond the walls of your office and into your patients' homes.