2013 Co-Management When to Refer Dr. Menard
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This document discusses when to refer patients to a focus eye centre (FEC) after refractive eye surgery. It provides guidelines on referring patients for post-operative findings like diffuse lamellar keratitis, interface debris, or edge defects. It also discusses parameters for referring patients for enhancement procedures if their vision is more than 1 diopter from the target or if visual acuity is worse than 20/40. The document includes several case studies asking whether patients should be referred or not based on their history and exam findings. It provides recommendations to refer patients with cataracts, posterior capsule opacification, or who are unable to adapt to monovision.
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This document discusses pelvic splinting in trauma patients. It notes that pelvic fractures can cause life-threatening bleeding and loss of 6 pints of blood quickly. Existing guidelines recommend using a commercial pelvic splint for prehospital management of suspected pelvic fractures. However, some ambulance services do not have these devices. As a result, clinicians currently improvise with other methods like an upside-down neck brace or wrapping the patient in a sheet, but the effectiveness of these improvised methods is unclear compared to commercial splints. The document questions if appropriate prehospital splinting could minimize catastrophic bleeding from pelvic fractures.
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Berufskolleg für Gestaltung und Technik der Städteregion Aachen, Aachen, Nordrhein-Westfalen
2013 Co-Management Management of complications Dr. Malik
SBK Intralase complications can be divided into three categories: flap, interface, and biomechanical. The most common complication is diffuse lamellar keratitis (DLK), a sterile inflammatory reaction that develops within 48 hours and is treated with topical steroids. Epithelial ingrowth involves the presence of corneal epithelium in the interface and is treated by lifting and scraping the flap. Dry eye is another common complication caused by surgical destruction of nerve endings, but most cases resolve within three months with treatment. Managing complications early and accurately is key to achieving good visual outcomes.
Voice of The Customer (VoC) Presentation - Startup Roadshow
This document discusses how consumer behavior and communication preferences are changing rapidly due to new technologies. It argues that traditional enterprise tactics are not keeping up with these changes and that new brands will emerge to better connect with customers. It provides examples of how communication technologies have evolved over time and asserts that customers now expect interactions to be contextual, mobile, community-oriented, and involve asynchronous communications. The document suggests that enterprises need to design customer experiences from the customer's perspective rather than the enterprise's processes and metrics. It advocates for more authentic and conversational interactions across channels to build personal-emotional connections with customers.
Lars Rosengren - Finding Your True North - Productized15
Product management is inherently complex, as it spans skills across multiple domains and over the past few years, especially digital product development frameworks, job titles etc. have been in constant flux. When dealing with complex problems it sometimes helps to zoom out, to understand what remains constant when the world around us change.
This talk takes a meta view on leading product development and will focus on three ingredients that drive success and failure in most projects. Based on experience from many projects across different disciplines at ustwo, we want to share an approach that balances focus and flexibility to consistently deliver quality products.
03. 2ª reunión padres II 16.17
El resumen describe una reunión de padres del 6o grado en la que se discutieron los siguientes temas: los resultados del primer período, los criterios de promoción, las salidas educativas planificadas como visitas a museos y parques, los detalles del Carnaval escolar incluyendo el desfile y los disfraces, y varios anuncios sobre el uso de blogs, el aula virtual, las normas de apercibimientos, y requisitos para educación física.
Mesencefalo
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Power point
Snapchat fue creada por Evan Spiegel, Bobby Murphy y Reggie Brown, antiguos alumnos de la Universidad de Stanford. La aplicación permite a los usuarios compartir imágenes efímeras de corta duración que se autoborran, con el objetivo de crear una aplicación de fotos que tuviera una duración explícitamente temporal. Ahora Snapchat es una de las aplicaciones de mensajería más populares, que la gente usa para chatear e intercambiar fotos y videos que se eliminan automáticamente después de 24 horas.
Focus Co Management 2016 Edmison
This document summarizes David R. Edmison's 25 years of experience at Focus Eye Centre from 1992 to 2016. It outlines the progression of refractive surgery technologies used at the practice over time, including starting with PRK in 1992, adopting LASIK and Intacs in 2000, and advancing to wavefront guided treatments with CustomVue in 2003 and iDesign in 2013. Patient expectations and outcomes have improved with these technological advances. The integrity and credibility of Focus Eye Centre is maintained through ISO certification, low employee turnover, and use of the most advanced equipment.
Dr. Edmision - November 14th
This document discusses corneal crosslinking, a procedure proposed in 2000 by Dr. Theo Seiler to strengthen the cornea. It involves applying riboflavin drops to the cornea, then exposing it to UVA light, which causes photopolymerization of corneal fibers. This increases the rigidity of collagen and resistance to deformation by creating new covalent bonds between collagen fibers. The procedure is used to treat keratoconus and keratectasia following LASIK to stabilize the cornea. It may also help treat resistant bacterial ulcers and reduce edema and hyperopia. Potential disadvantages include lack of long-term data and minimal improvement in vision, with risks of infiltrates, scarring and endothelial damage in rare cases
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Focus Co Management Session - Dr. Menard April 2015
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2013 Co-Management Management of complications Dr. Malik
2013 Co-Management Management of complications Dr. Malik
Voice of The Customer (VoC) Presentation - Startup Roadshow
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Treating Patients with Radial Kewratotomy.pptx
People who have had radial keratotomy in the past notice that they may have to get back to wearing glasses. Routine techniques do not work in such patients in this presentation which was initially delivered to eye surgeons from across the world we discuss options with focus on presbyopic implants to restore better vision without glasses.
Ppt ramji pandey
This document outlines pre- and post-surgery protocols for refractive surgery cases. It discusses evaluating patients for stability and medical history, performing exams of visual acuity, keratometry, eye pressure and retina. LASIK criteria include determining stability after contact lens removal. Post-LASIK follow up includes vision checks and flap/inflammation monitoring for 1 year. Medication protocols involve pre- and post-op antibiotics and steroids. Risks include dryness, glare and halos.
Panel of challenging cases
This document summarizes a panel discussion on challenging cases in corneal refractive surgery. The panel discusses various complex cases involving thin corneas, high corrections, posterior corneal elevation, corneal opacities and dystrophies. For these types of cases, the panel discusses techniques like topography-guided PRK combined with corneal collagen cross-linking and evaluating factors like patient age and corneal biomechanics when determining treatment options. The document also provides examples of case studies presented to the panel and the specific considerations and approaches recommended for each case.
OFTATALKS TWO: Autologous transplant of RPE and choroid - B. Parolini
This document summarizes 13 years of experience with autologous transplantation of RPE and choroid to treat exudative macular diseases. Key points include:
- The surgery aims to save a healthy fovea by removing damaged RPE and transplanting healthy RPE/choroid. Good candidates have an intact external limiting membrane on OCT.
- Of 230 eyes followed for up to 11 years, 40% gained 15+ letters and 42% had stable vision. Complications occurred in 10-15% of cases, mostly retinal detachment or CME.
- Imaging shows the transplanted patch revascularizes and resembles surrounding tissue over time. OCTA correlates perfusion with function.
- While
Dr. Pietrini presentation at the Mediphacos User Meeting 2013
Topography-guided customized PRK combined with simultaneous CXL in patients previously implanted ICRS for progressive keratoconus
Advantages of the latest technology in lens surgery_Meister_7_8_14
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This document discusses various biometry techniques and considerations for accurate intraocular lens (IOL) power calculation in complex cases. It describes tools and methods for measuring ocular parameters in conditions like mature cataracts, posterior staphylomas, and post-refractive surgery eyes. Formulas for calculating IOL power for different IOL types and surgical procedures are presented. Intraoperative techniques like retinoscopy and aberrometry are also covered to optimize refractive outcomes.
REFRACTIVE SURGERY.pptx
This document discusses the various techniques used in refractive surgeries to correct vision, including steps for evaluating patients and determining suitability. It describes the history and evolution of refractive surgeries. The main techniques covered are corneal-based procedures like LASIK, PRK, and SMILE as well as lenticular procedures using phakic intraocular lenses. For LASIK specifically, it outlines the surgical technique and potential complications. Contraindications for refractive surgeries are also stated.
Anterior Segment Company Showcase - Encore Vision
Anterior Segment Company Showcase - Encore Vision at OIS@AAO 2016.
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Powered by:
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Current Trends in Refractive Surgery - Lecture given at Harvard by Emil Chynn...
Dr. Chynn graduated from Harvard's ophthalmology program, which is probably the most famous in the world.
As the only member of his graduating class to specialize in Refractive Surgery, and now an recognized authority, Dr. Chynn is frequently invited back to Harvard to give updates on the State of the Art in Refractive Surgery.
This slide show presentation was given to 100 eye surgeons who flew in from across the country to learn the latest advances in glaucoma, retina, cataract surgery--and laser vision correction (from Dr. Chynn).
The title of his talk reflects the movement in the US and worldwide from leading surgeons that is called "Back to the Surface." This means that surgeons are moving away from LASIK and IntraLase, to avoid flap complications and the # 1 problem causing lawsuits (iatrogenic keratoconus, or KC), and back to the surface.
For some doctors, this means going back to the original procedure, PRK, which has a lot of pain, delayed healing, and scarring.
For Dr. Chynn, this means performing an Advanced Surface Ablation, which is either a LASEK or epiLASEK. These are more advanced than PRK because they do not hurt, healing and recovery is quick, and there is no haze or scarring.
For example, Dr. Chynn performs over 1,000 LASEKs and epiLASEKs per year--he performed his last PRK in 1999.
Obviously, he moved away from PRK to LASIK, then to IntraLase, and now back to the safer LASEK and epiLASEK procedures.
View the following slide show to find out more, and call us with your questions--better yet, come in and meet with our MDs!
The basics of retinal oct ophso.net
The document provides an overview of retinal optical coherence tomography (OCT). It discusses how OCT works using light to provide non-invasive, high resolution imaging of ocular structures. Examples of anterior segment, optic nerve, and retinal OCT scans are shown. Interpretation of macular OCT scans and quantitative thickness maps are described. Indications for retinal OCT include examining retinal layers, monitoring progression of diseases like age-related macular degeneration and diabetic macular edema, aiding treatment planning, and monitoring response to therapy. Case studies demonstrate how OCT enhanced diagnosis and treatment decisions for vitreoretinal interface disorders, retinal vascular diseases, and other retinal entities compared to other imaging tests.
Erika Eskina ASCRS 2015: One-Year Outcome of Presbyopia Correction in Myopic ...
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This document summarizes the one-year outcomes of presbyopia correction using monovision surface ablation (PresbyMAX μ-Monovision PRK) in 44 eyes of 22 myopic and hyperopic patients. Key results include: 1) Myopic patients achieved refractive stability between 1-3 months, with good distance and near vision, while hyperopic patients showed stability at 6 months; 2) Visual and refractive outcomes met or exceeded targets in both groups; 3) Safety was high with no loss of more than one line of vision; 4) Outcomes support PresbyMAX as an effective treatment for presbyopia.Final clinical outcomes of laser refractive surgery
This document summarizes an optometrist conference that reviewed laser refractive surgery procedures. It discussed that LASIK can currently treat up to 11 diopters of myopic astigmatism and 4.5-5 diopters of hyperopic astigmatism. It is important to perform thorough preoperative evaluations including corneal topography and pachymetry. Results from the local eye center showed that 76% achieved 6/6 or better unaided vision after LASIK and PRK procedures. Complications were low, with only 2 eyes requiring enhancement procedures.
Visual acuity and patient satisfaction results with a new trifocal diffractiv...
The document summarizes a study evaluating visual acuity and patient satisfaction results with a new trifocal diffractive intraocular lens (IOL). 32 patients underwent bilateral implantation of the AT LISA 839MP IOL. At 8-12 weeks post-op, patients had good unaided distance, intermediate, and near vision. A survey found greatly improved unaided vision and high satisfaction, though some reported increased glare and halos. The IOL provided good intermediate vision without compromising other distances. Results demonstrated the IOL's effectiveness in reducing spectacle dependence.
Mr. Dan Gore presentation at the Mediphacos User Meeting 2013
This document summarizes a new clinical pathway for treating keratoconus that begins with inserting intracorneal ring segments (ICRS) for gross shape correction if best corrected distance visual acuity (CDVA) is less than 20/20 and coma is greater than 3μm. Next, collagen cross-linking (CXL) is performed for shape stabilization. Patients with good CDVA then undergo fine shape correction with photorefractive keratectomy (PRK) at least two years post-CXL, while those with poor CDVA receive a phakic intraocular lens for refractive correction. The document then evaluates outcomes for 17 keratoconus patients who underwent ICRS implantation using a femtosecond laser,
BRVO Etiopatho, Management with studies
This document provides a literature review and overview of current trends in the management of branch retinal vein occlusion (BRVO). It summarizes the pathogenesis, risk factors, clinical findings, investigations, and treatment options for BRVO. Regarding treatment, it discusses the results of major studies evaluating laser photocoagulation, intravitreal steroids like triamcinolone, and dexamethasone implants. It also reviews studies on the use of anti-VEGF agents like bevacizumab for treating macular edema associated with BRVO. The goal of treatment is to prevent vision loss from complications of BRVO such as macular edema, macular ischemia, and neovascularization.
How To Make a Cataract Surgery Perfect - Posterior Segment Perspective
When your cloudy natural lens is removed and replaced with a clear artificial lens is called Cataract Surgery.
Subjective Refraction-1
This document provides instructions for performing subjective refraction using both distance and near vision tests. It discusses evaluating visual acuity with current prescriptions, estimating spherical and astigmatic errors, determining best sphere and refining the prescription. Tables are included showing relationships between visual acuity, refractive error and calculating residual sphere. Procedures for spherical correction using letter charts and duochrome tests are outlined. LogMAR and Snellen visual acuity charts are also described.
10 Ferrara Ring for ectasia after refractive surgery
This study evaluated the outcomes of implanting intrastromal corneal ring segments (ICRS) in 25 eyes of 20 patients with corneal ectasia after refractive surgery. Post-operatively, uncorrected distance visual acuity significantly improved from 20/185 to 20/66 on average and corrected distance visual acuity significantly improved from 20/125 to 20/40 on average. Keratometry and corneal asphericity values also significantly improved. The study found that ICRS implantation can effectively treat corneal ectasia after refractive surgery by improving vision and corneal shape.
Subjective refraction
The document describes the procedures for performing subjective refraction to determine a patient's distance and near visual prescription. It involves first establishing the patient's best corrected and uncorrected visual acuity. The examiner then determines the patient's best vision sphere and estimates their astigmatism before refining the prescription with trial lenses to account for cylinder power and axis. Verification steps like binocular balance and range of clear vision are also mentioned. Near addition is calculated based on the patient's near point of focus and amplitude of accommodation. The document provides guidance on techniques, tools, and considerations for optimizing subjective refraction outcomes.
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2013 Co-Management When to Refer Dr. Menard
- 1. When to Refer Claude Ménard, MD Focus Eye Centre David R. Edmison, MD John Cheung, MD November 21, 2013
- 2. FEC Post-op Referrals • When should you refer to FEC? – – – – – Post-op findings Retx parameters Monovision Cataracts, IOL PCO Other • Happy to see any patient. November 21, 2013
- 3. Post-operative findings • • • DLK TLS Debris – – – - seen early and managed at FEC - manage with PF or refer - monitor Fibre Fine particles Mucoid • Epi-ingrowth - monitor, refer if progressive or decrease in BCVA • Edge defects • Striae - monitor, refer if progressive - monitor, refer if decrease in BCVA November 21, 2013
- 4. Retx Parameters • +/- 1.00 D from target Rx or 20/40 UCVA for near or distance. • Within anatomical limits – K’s 50-36D & >400 μm cornea for SBK after PRK • Enhancement considerations – Age, visual requirements, myopic vs hyperopic regression, cataracts. • Motivation and expectations November 21, 2013
- 5. Other Considerations • Monovision – unable to adapt to Mv, consider reversal and wear readers. • Cataracts or IOL PCO – can refer to favorite Cat Sx for treatment. • Other reasons November 21, 2013
- 6. Mv - Case Study • • • • • 54 y.o. male: WGA SBK OU Nov 2012 Target -1.50 Mv OD cc: blurry at PC dist., great reading UCVA: 20/100-2 / 20/20-1 / near J1+ Rx: OD -2.25 20/20 OS -0.25+0.50x90 20/20 Should we retx OD for -1.50 or counsel and stay with current Rx status? November 21, 2013
- 7. Case Study • • • • 34 y.o. female: WGA SBK OU 2008 cc: Poor distance vision UCVA: 20/50 / 20/40 Rx: OD -1.00 20/20 OS -1.00+0.25x20 20/20 • OD dominant Should we retx OD and leave OS for near? November 21, 2013
- 8. Case Study • • • • 44 y.o. female: WGA PRK OU 2008 (Mv OS) cc: Poor near vision UCVA: 20/20 / 20/25 / near J2Rx: OD -0.50+1.00x93 20/20 OS -1.00+0.75x91 20/20 Should we leave with current Rx or consider retx OS for near with WGA SBK if reasonable pachymetry? November 21, 2013
- 9. Case Study • • • • 50 y.o. female: WGA PRK OU 2006 (Mv OS) cc: readers prn UCVA: 20/30- / 20/30+ / near J2 Rx: OD -1.00+0.50x85 20/20 OS -0.75+0.25x110 20/20 Should we leave with current Rx or consider retx OS for near with WGA SBK if reasonable pachymetry? November 21, 2013
- 10. Epi ingr - Case Study • 27 y.o. female: WGA SBK OU 2011 • • • cc: none UCVA: 20/20-1, 20/20 Rx: OD -0.25 20/20 OS Plano 20/20 Slit lamp exam reveals peripheral epithelial ingrowth. Do we try and remove ingrowth? November 21, 2013
- 11. Cataract - Case Study • • • • 62 y.o. female: WGA SBK OU 2008 (Mv OD) cc: Decrease dist acuity OS. UCVA: 20/80, 20/50-1 Rx: OD -2.00+0.25x180 20/25-1 OS -1.25 20/30 1-2+ NS observed (OS>OD). Refer for cataract Sx. November 21, 2013
- 12. IOL PCO - Case Study • • • • 53 y.o. male: CLE OU 2010 (Mv OS) cc: Decrease dist acuity OD. UCVA: 20/40, 20/200-1 Rx: OD -0.50 20/30-1 OS -2.75+0.50x90 20/25 1-2+ PCO observed (OD>OS). Refer for YAG Caps November 21, 2013
- 13. Thank You for your Attention. Questions? November 21, 2013