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Advances in Ophthalmologyand
Optometry
Editor-in-Chief
Myron Yanoff
Section Editors
Bhavna Chawla
David A. Crandall
Paul B. Freeman
Morris E. Hartstein
Rustum Karanjia
Table of Contents
Coverimage
Title page
Copyright
Editor-in-Chief
Contributors
Preface
In Memoriam
Optometry
Optical Coherence Technology in Glaucoma Diagnosis
Key points
Introduction
Optical coherence tomography retinal nerve fiber layer analysis
in glaucoma diagnosis
10.
Optical coherence tomographyangiography in glaucoma
diagnosis
Clinics care points
An Update on Neurodegenerative Disease for Eye Care Providers
Key points
Introduction: neurodegenerative disease and the eye
Visual and ocular associations of neurodegenerative disease
Visual and ocular side effects of neurodegenerative disease
treatments
Future avenues: neurodegenerative disease, the eye, and the
visual system
Summary: neurodegenerative disease, the eye, and the visual
system
Clinics care points
Neuroanatomical Structures in Extraocular Muscles and Their
Potential Implication in the Management of Strabismus
Key points
Introduction
Structure and function of human extraocular muscles
Sensory receptors in human extraocular muscles
The role of proprioception in oculomotor control
11.
The neural pathwayfor proprioception
The neural substrate for the control of eye movements
Binocular vision anomalies
Current concepts in the diagnosis and management of
strabismus
Nonsurgical management of strabismus
Surgical management of strabismus
Summary and discussion
Summary
Disclosure
Clinics care points
Pediatric
Prenatal Diagnosis of Retinoblastoma
Key points
Introduction
Prenatal diagnosis
Summary
Current Management of Pediatric Glaucoma
Key points
12.
Introduction
Diagnosis
Classification
Diagnostic techniques
Anesthesia
Treatment
Clinics carepoints
Systemic Immunomodulatory Therapy in Pediatric Uveitis
Key points
Introduction
Significance
Clinics care points
Update on Intravitreal Chemotherapy for Retinoblastoma
Key points
Introduction
Challenges of endophytic retinoblastoma
Treatment of intraocular seeding
Safety of intravitreal injections in eyes with retinoblastoma
Classification of seeding
13.
Impact of intravitrealinjections on patient management
Uses of intravitreal chemotherapy other than for vitreous seeds
Dosage
Pharmacokinetics of intravitreal melphalan
Use of intravitreal topotecan
Pharmacokinetics of intravitreal topotecan
Stability of melphalan and topotecan
Future avenues
Summary
Clinics care points
Ophthalmic Pathology & Ocular Oncology
Applications of Plaque Brachytherapy in Posterior Segment Tumors:
A Clinical Review
Key points
Introduction
Historical perspective
Choroidal hemangioma
Retinal capillary hemangioma
Vasoproliferative retinal tumors
Retinoblastoma
14.
Choroidal melanoma
Limitations ofplaque brachytherapy
Future avenues
Clinics care points
Intraocular Tumors—Advances in Ophthalmic Pathology
Key points
Retinoblastoma
Uveal melanoma
Primary vitreoretinal lymphoma
Summary
Clinics care points
Adenoid Cystic Carcinoma of the Lacrimal Gland
Key points
Introduction
Significance (in-depth analysis)
Future avenues
Summary
Clinics care points
Cataract & Refractive Surgery
15.
Micro-Invasive Glaucoma Surgery
Keypoints
Introduction
Significance and current relevance
IStent trabecular micro-bypass stent
Hydrus microstent
Goniotomy-assisted trabeculotomy
Trab360 trabeculotomy
Trabectome
Kahook dual blade
Ab interno canaloplasty
Visco360 and OMNI
XEN gel stent
Preserflo
Summary
Clinics care points
Vitreoretinal Disease
Artificial Intelligence in Retina
Key points
16.
Background and introduction
Overviewof artificial intelligence
Evaluating deep learning algorithms
Diabetic retinopathy
Age-related macular degeneration
Future
Summary
Clinics care points
Retina in the Age of COVID-19
Key points
Background
Introduction
General cleaning and hygiene
Personal protective equipment
Pandemic restrictions
Care in an active pandemic
Care after immediate pandemic restrictions are lifted
Summary
Clinics care points
17.
Diagnostic and TreatmentUpdate on Sickle Cell Retinopathy
Key points
Introduction
Pathophysiology
Epidemiology
Ocular manifestations
Classification system
Diagnosis
Management
Summary
Clinics care points
Glaucoma
Glaucoma Surgery: Which Surgery to Pick for Your Patient?
Key points
Introduction
Significance
Subconjunctival surgery
Cyclodestructive procedures
Schlemm canal–based procedures
18.
Suprachoroidal
CyPass (Alcon, FortWorth, TX, USA)
Special considerations
Current relevance and future avenues
Summary
Clinics care points
Ocular Blood Flow as It Relates to Race and Disease on Glaucoma
Key points
Introduction
Significance
Summary
Clinical care points
Funding
Neuro-ophthalmology
Glaucoma as a Neurodegenerative Disease: A Clinician Perspective
Key points
Introduction
Is glaucoma a neurodegenerative disease?
Sick eye comes with a sick brain
19.
Common clinical characteristicsbetween glaucoma and
neurodegenerative disease
Overlapping pathophysiology between glaucoma and other
neurodegenerative disease
Glaucoma and cerebrospinal fluid
Looking into the future
Summary
Clinics care points
Neuro-Ophthalmologic Manifestations of Novel Coronavirus
Key points
Introduction
Article body
Relevance
Summary
Clinics care points
Cornea and External Diseases
Advances in Endothelial Keratoplasty Surgery
Key points
Introduction
Significance
20.
Relevance and futureavenues
Summary
Clinics care points
Update in the Management of Keratoconus
Key points
Introduction
Corneal cross-linking
Spectacles and contact lenses
Penetrating keratoplasty
Deep anterior lamellar keratoplasty
Summary
Clinics care points
Update on Refractive Surgery
Key points
Introduction
Significance and in-depth analysis of the topic
Current relevance and future avenues to investigate the topic
Summary
Clinics care points
21.
Oculoplastics
Xanthelasma Palpebrarum: AnOculoplastic Viewpoint of Optimal
Treatment
Key points
Introduction
Significance (in-depth analysis)
Discussion
Nasal bridge
Giant xanthelasmas
Clinics care points
Refractive Error Changes Associated with Eyelid Weight Placement
Key points
Introduction
Significance
Relevance and future avenues
Summary
Clinics care points
Refractive Change after Upper Eyelid Surgery
Key points
22.
Introduction
Preoperative changes
Postoperative changes
Clinicalrelevance
Clinics care points
Canalicular Stenosis Secondary to Chemotherapeutic Agents
Key points
Introduction
Chemotherapeutic agents known to cause canalicular stenosis
Significance of epiphora secondary to canalicular abnormality
Management of canalicular stenosis
Summary
Clinics care points
Uveitis
Optical Coherence Tomography Angiography in White Dot
Syndromes
Key points
Introduction
Overview
23.
Cross-sectional and enface visualizations of the posterior
circulation
Birdshot chorioretinopathy
Multiple evanescent white dot syndrome
Punctate inner choroiditis
Serpiginous choroiditis
Acute posterior multifocal placoid pigment epitheliopathy
Acute zonal occult outer retinopathy
Multifocal choroiditis
Relevance and future avenues
Summary
Clinics care points
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28.
Editor-in-Chief
Myron Yanoff, MD,Chair Emeritus, Department of Ophthalmology,
Drexel University, Adjunct Professor, Department of
Ophthalmology, University of Pennsylvania, Philadelphia,
Pennsylvania
29.
Section Editors
BHAVNA CHAWLA,MD – Ophthalmic Pathology & Ocular
Oncology RP Center for Ophthalmic Sciences, All India Institute of
Medical Sciences, New Delhi, India
DAVID A. CRANDALL, MD – Cataract & Refractive Surgery
Glaucoma Fellowship Director, Henry Ford Health System, Detroit,
Michigan University of Utah, Salt Lake City, Wayne State University,
Salt Lake City, Utah
Paul B. Freeman, OD, FAAO, FCOVD – Optometry Diplomate,
Low Vision, Pi sburgh, Pennsylvania, Clinical Professor, Rosenberg
School of Optometry, University of the Incarnate, Word, San
Antonio, Texas
Morris E. Hartstein, MD, FACS – Oculoplastics Director,
Ophthalmic Plastic and Reconstructive Surgery, Ophthalmology,
Shamir Medical Center, Zerifin, Israel; Tel Aviv University, Sackler
School of Medicine, Tel Aviv, Israel
Rustum Karanjia, MD, PhD, FRCSC, DABO – Neuro-
ophthalmology Department of Ophthalmology, David Geffen School
of Medicine at UCLA, Los Angeles, California; Doheny Eye Institute,
Los Angeles, California, Doheny Eye Institute, Los Angeles,
California, Department of Ophthalmology, University of O awa,
O awa, Ontario, Canada, O awa Hospital Research Institute, The
O awa Hospital, O awa, Ontario, Canada
Ronni M. Lieberman, MD – Vitreoretinal Disease Assistant
Professor of Ophthalmology, Icahn School of Medicine at Mt. Sinai,
Queens Hospital Center, Jamaica, New York
Ann-Marie Lobo, MD – Uveitis Co-Director, Uveitis Service,
Assistant Professor, Department of Ophthalmology and Visual
Sciences, Illinois Eye and Ear Infirmary, University of Illinois at
Chicago, Chicago, Ilinois
STEPHEN ORLIN, MD – Cornea and External DiseasesAssociate
Professor, Scheie Eye Institute, University of Pennsylvania, Perelman
30.
School of Medicine,Philadelphia, Pennsylvania
Joseph M. Ortiz, MD, FRCOphth – Glaucoma Consultant in
Ophthalmology, Sacred Heart Hospital, Allentown,
Pennsylvania; Consultant in Ophthalmology, Abington Memorial
Hospital, Abington, Pennsylvania; Formerly Assistant Professor of
Ophthalmology, Hahnemann University Hospital, Drexel
University School of Medicine, Philadelphia, Pennsylvania
Leonard J. Press, OD, FAAO, FCOVD – Optometry Optometric
Director, The Vision & Learning Center, Fair Lawn, New Jersey;
Adjunct Professor, Southern College of Optometry, Memphis,
Tennessee
Aparna Ramasubramanian, MD – Pediatric Ophthalmology
Director of Retinoblasma and Ocular Oncology, Phoenix Children’s
Hospital, Phoenix, Arizona
32.
Contributors
MARIB AKANDA, MD,Resident, Department of Ophthalmology,
Northwell Health, Great Neck, New York, USA
CESAR ALFARO, MD, The Retina Service, Mount Sinai Hospital,
Manha an, New York, USA
KARL N. BECKER, MD, Uveitis and Medical Retina Fellow, Illinois
Eye and Ear Infirmary, Chicago, Illinois, USA
DEVIN BETSCH, MD, Resident, Department of Ophthalmology
and Visual Sciences, Dalhousie University, QEII Health Sciences
Centre, Halifax, Nova Scotia, Canada
POOJA V. BHAT, MD, Assistant Professor of Ophthalmology, Co-
director of Uveitis Service, Associate Program Director, Director of
Medical Student Education, Illinois Eye and Ear Infirmary,
University of Illinois at Chicago, Chicago, Illinois, USA
JYOTIRMAY BISWAS, MS, FMRF, FNAMS, FAICO, FRCS, Uvea
Department, Medical Research Foundation, Senior Consultant,
Director of Uveitis and Ocular Pathology Department, Sankara
Nethralaya, Chennai, Tamilnadu, India
DANIEL BRISCOE, MD, Ophthalmology Department, HaEmek
Medical Center, Afula, Israel
JAN RICHARD BRUENECH, PhD, Professor, Biomedical Research
Unit, Faculty of Health and Social Sciences, University of South-
Eastern Norway, Campus Kongsberg, Norway
CAT N. BURKAT, MD, FACS, Professor, Oculoplastic, Orbital, and
Facial Cosmetic Surgery, Department of Ophthalmology and Visual
33.
Sciences, University ofWisconsin-Madison School of Medicine and
Public Health, University of Wisconsin-Madison, Madison,
Wisconsin, USA
GREG CALDWELL, OD, FAAO, Optometric Education
Consultants, Lilly, Pennsylvania, USA
JANE W. CHAN, MD, Doheny Eye Institute, Doheny Eye Institute,
Los Angeles, California, USA
NOEL C.Y. CHAN, MBChB, FRCSEd, Department of
Ophthalmology and Visual Sciences, Prince of Wales Hospital &
Alice Ho Miu Ling Nethersole Hospital, Shatin, HKSAR, China;
Department of Ophthalmology and Visual Sciences, The Chinese
University of Hong Kong, HKSAR, China
BHAVNA CHAWLA, MD, Professor of Ophthalmology, Ocular
Oncology Service, RP Center for Ophthalmic Sciences, All India
Institute of Medical Sciences, New Delhi, India
ARIEL CHEN, MD, The Wilmer Eye Institute, Johns Hopkins School
of Medicine, Baltimore, Maryland, USA
KELSEY CHEN, MABS, Medical Student, Midwestern University
Arizona College of Osteopathic Medicine, Glendale, Arizona, USA
DANIEL CHOI, MD, Department of Ophthalmology, Scheie Eye
Institute, University of Pennsylvania, Philadelphia, Pennsylvania,
USA
DAVID A. CRANDALL, MD, Glaucoma and Advanced Anterior
Segment Fellowship Director, Department of Ophthalmology, Henry
Ford Health System, Detroit, Michigan, USA; John Moran Eye
Center, University of Utah, Salt Lake City, Utah, USA
DIPANKAR DAS, MS, Department of Pathology, Uveitis and
Neurophthalmology, Sri Sankaradeva Nethralaya, Guwahati,
34.
Assam, India
DEEPIKA DHINGRA,MS, DNB, FICO, Advanced Eye Centre,
Postgraduate Institute of Medical Education and Research,
Chandigarh, India
ERIN M. DRAPER, OD, FAAO, A ending Optometrist, Neuro-
Ophthalmic Disease Service, Co-Director, Neuro-Ophthalmic
Disease Residency Program, The Eye Institute, Assistant Professor,
Pennsylvania College of Optometry at Salus University,
Philadelphia, Pennsylvania, USA
PAUL T. FINGER, MD, Director, New York Eye Cancer Center,
New York, New York, USA
PAUL R. FREUND, MD, MSc, FRCSC, Assistant Professor,
Department of Ophthalmology and Visual Sciences, Dalhousie
University, QEII Health Sciences Centre, Halifax, Nova Scotia,
Canada
SAMUEL GELNICK, MD, Resident, Department of
Ophthalmology, Northwell Health, Great Neck, New York, USA
MARK GHASSIBI, MD, Northwell Health Eye Institute, Great
Neck, New York, USA
ROBIN GINSBURG, MD, The Retina Service, Mount Sinai
Hospital, Manha an, New York, USA
SNEHA GIRIDHAR, MD, Shri Bhagwan Mahavir Vitreoretinal
Services, Sankara Nethralaya, Chennai, Tamilnadu, India
LUIS F. GONCALVES, MD, Director of Fetal Imaging, Department
of Radiology, Phoenix Children’s Hospital, Departments of Child
Health and Radiology, University of Arizona College of Medicine,
Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA
35.
GIOVANNA GUIDOBONI, PhD,Departments of Electrical
Engineering and Computer Science, and Mathematics, University of
Missouri, Columbia, Missouri, USA
PAUL HARASYMOWYCZ, MD, Department of Ophthalmology,
University of Montreal, Montreal Glaucoma Institute and Bellevue
Ophthalmology Clinics, Montreal, Canada
ALON HARRIS, MS, PhD, FARVO, Professor of Ophthalmology,
Vice Chair of International Research and Academic Affairs, Director
of the Ophthalmic Vascular Diagnostic and Research Program at
Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai,
New York, New York, USA
IOANA CATALINA IONESCU, MD, PhD, Orbital Center,
Department of Ophthalmology, Amsterdam University Medical
Centers, Amsterdam, the Netherlands
PUNEET JAIN, MD, Consultant, Oculoplasty and Ocular Oncology
Department, Eye-Q Super-Specialty Eye Hospitals, New Delhi, India
RABEA KASSEM, MD, Department of Ophthalmology, University
of Montreal, Montreal, Quebec, Canada
SUSHMITA KAUSHIK, MS, Advanced Eye Centre, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
NUR KHATIB, MD, Orbital Center, Department of Ophthalmology,
Amsterdam University Medical Centers, Amsterdam, the
Netherlands
HAYYAM KIRATLI, MD, Ocular Oncology Service, Professor,
Department of Ophthalmology, Hace epe University School of
Medicine, Ankara, Turkey
IREM KOÇ, MD, Ocular Oncology Service, Department of
Ophthalmology, Hace epe University School of Medicine, Ankara,
36.
Turkey
RONNI LIEBERMAN, MD,Assistant Professor, Department of
Ophthalmology, Mount Sinai Medical Center, Ichan School of
Medicine at Mount Sinai, New York, New York, USA
TIANYU LIU, MD, Scheie Eye Institute, University of Pennsylvania,
Philadelphia, Pennsylvania, USA
SUSAN LUO, BS, Department of Ophthalmology and Visual
Sciences, University of Wisconsin-Madison School of Medicine and
Public Health, Madison, Wisconsin, USA
ILARIA MACCORA, MD, Rheumatology Unit, Meyer Children’s
University Hospital, University of Florence, Florence, Italy
NENITA MAGANTI, MD, Department of Ophthalmology and
Visual Sciences, University of Wisconsin-Madison, Madison,
Wisconsin, USA
ASHLEY KAY MAGLIONE, OD, FAAO, A ending Optometrist,
Neuro-Ophthalmic Disease Service, The Eye Institute, Assistant
Professor, Pennsylvania College of Optometry at Salus University,
Philadelphia, Pennsylvania, USA
KELLY A. MALLOY, OD, FAAO, Diplomate in Neuro-Ophthalmic
Disorders; Chief Optometrist, Neuro-Ophthalmic Disease Service,
Co-Director, Neuro-Ophthalmic Disease Residency Program, The
Eye Institute, Professor, Pennsylvania College of Optometry at Salus
University, Philadelphia, Pennsylvania, USA
ELIZABETH MARUNDE, OD, Neuro-Ophthalmic Disease
Resident, The Eye Institute, Pennsylvania College of Optometry at
Salus University, Philadelphia, Pennsylvania, USA
ARIE Y. NEMET, MD, Department of Ophthalmology, Meir
Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel
37.
Aviv University, TelAviv, Israel
ENNY OYENIRAN, MD, Department of Ophthalmology, Scheie
Eye Institute, University of Pennsylvania, Philadelphia,
Pennsylvania, USA
SURINDER S. PANDAV, MS, Advanced Eye Centre, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
CHINTAN A. PATHAK, MD, Department of Ophthalmology and
Visual Sciences, University of Wisconsin-Madison, Madison,
Wisconsin, USA
LIRON PE’ER, MD, Department of Ophthalmology, Meir Medical
Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv
University, Tel Aviv, Israel
ATHIMALAIPET V. RAMANAN, FRCP, Professor, Department of
Paediatric Rheumatology, Bristol Royal Hospital for Children,
Translational Health Sciences, University of Bristol, Bristol, United
Kingdom
APARNA RAMASUBRAMANIAN, MD, Department of
Ophthalmology, Phoenix Children’s Hospital, Department of
Radiology, Creighton University, Phoenix, Arizona, USA
ANGELINE C. RIVKIN, BS, Medical Student, University of Illinois
College of Medicine, Chicago, Illinois, USA
PEEROOZ SAEED, MD, PhD, Orbital Center, Department of
Ophthalmology, Amsterdam University Medical Centers,
Amsterdam, the Netherlands
ETHAN S. SEN, MD, PhD, Department of Paediatric
Rheumatology, Great North Children’s Hospital, Faculty of Medical
Sciences, Newcastle University, Newcastle on Tyne, United
Kingdom
38.
BRIAN M. SHAFER,MD, Vance Thompson Vision, Sioux Falls,
South Dakota, USA
BRENT SIESKY, PhD, Icahn School of Medicine at Mount Sinai,
New York, New York, USA
ETHAN K. SOBOL, MD, The Retina Service, Mount Sinai Hospital,
Manha an, New York, USA
JOSEPH SOWKA, OD, FAAO, Diplomate, Center for Sight,
Sarasota, Florida, USA
JESSICA STEEN, OD, FAAO, Assistant Professor, Nova
Southeastern University College of Optometry, Fort Lauderdale,
Florida, USA
MICHAEL E. SULEWSKI Jr, MD, The Wilmer Eye Institute, Johns
Hopkins School of Medicine, Baltimore, Maryland, USA
ZUJAJA TAUQEER, MD, DPhil, Department of Ophthalmology,
Scheie Eye Institute, University of Pennsylvania, Philadelphia,
Pennsylvania, USA
VANCE THOMPSON, MD, Director of Refractive Surgery, Vance
Thompson Vision, Sioux Falls, South Dakota, USA
MINH TRINH, MD, Northwell Health Eye Institute, Great Neck,
New York, USA
JAMES C. TSAI, MD, Icahn School of Medicine at Mount Sinai,
New York, New York, USA
ALICE C. VERTICCHIO VERCELLIN, MD, PhD, Icahn School of
Medicine at Mount Sinai, New York, New York, USA
MYRON YANOFF, MD, Chair Emeritus, Department of
Ophthalmology, Drexel University, Adjunct Professor, Department
39.
of Ophthalmology, Universityof Pennsylvania, Philadelphia,
Pennsylvania, USA
CANDICE YOUSIF, MD, Glaucoma Fellow, Department of
Ophthalmology, Henry Ford Health System, Detroit, Michigan, USA
TINA ZENG, OD, Neuro-Ophthalmic Disease Resident, The Eye
Institute, Pennsylvania College of Optometry at Salus University,
Philadelphia, Pennsylvania, USA
In Volume 6of Advances in Ophthalmology and Optometry, we again
have asked experts in each of the pertinent fields to sift through the
current literature to give us insights on the latest developments, such
as: Optical Coherence Technology in Glaucoma Diagnosis; Prenatal
Diagnosis of Retinoblastoma; Systemic Immunomodulatory Therapy
in Pediatric Uveitis; Update on Intravitreal Chemotherapy for
Retinoblastoma; Microinvasive Glaucoma Surgery; Artificial
Intelligence in Retina; Artificial Intelligence in Neuroophthalmology
Review; Retina in the Age of COVID-19; Neuroophthalmologic
Manifestations of Novel Coronavirus; Advances in Endothelial
Keratoplasty Surgery; Adenoid Cystic Carcinoma of the Lacrimal
Gland; Refractive Error Changes Associated with Eyelid Weight
Placement; Optical Coherence Tomography Angiography in White
Dot Syndromes; and much more.
We continue to explore the new ideas, new treatments, and new
ways of doing things to give us a fresh frame of reference to sort
through the crush of data and to make sense in a real way of how to
proceed.
Myron Yanoff, MD
1915 Foulkeways
Gwynedd, PA 19436, USA
E-mail address: myanoff4@gmail.com
44.
In Memoriam
David A.Crandall, MD
Glaucoma Fellowship Director, Henry Ford Health System, Detroit, Michigan
University of Utah, Salt Lake City, Utah
Wayne State University, Salt Lake City, Utah
45.
In Memory ofDr Alan Crandall
We were extremely saddened to hear about the passing of Dr Alan
Crandall, renown ophthalmologist and internationally known
humanitarian, this past October. Dr Crandall was a founding
46.
member of Advancesin Ophthalmology and Optometry and has served
as our Cataracts Section Editor for the last five consecutive issues of
publication. Dr Crandall’s boundless expertise and commitment to
the publication have, without a doubt, helped us grow the series into
a true and trusted resource for our readers, clinicians around the
world. We wanted to acknowledge his passing with some words of
tribute from our Editor-in-Chief, Dr Myron Yanoff, as well as from
Dr Crandall’s son, Dr David A. Crandall.
Even as a resident, Alan stood out as being a very special
person. So special that at the end of his residency, I asked him
to stay on staff. He accepted. Whatever he did, he did it well
with a sparkle in his eyes. Whether patient care, surgical
prowess, or my tennis partner, he was a joy to be with. After a
few years on staff, we decided that it was time to perform
intraocular lens implantation at the Scheie Eye Institute (only
intracapsular cataract extraction was done by the full-time
staff). We operated together and taught ourselves first to do
extracapsular surgery and then entered into the world of lens
implants (all under an air bubble, as Healon had not yet been
invented). Alan was a brilliant surgeon, a gifted clinician, and a
personality that made one wish to work with him. One of my
saddest days was when Alan decided that it would be best for
his family for him to leave and go back to where he grew up in
Salt Lake City.
We remained fast friends until the end. In fact, a year before he
left us, he removed my cataracts (I would have no other
cataract surgeon anywhere do the surgery), of course, with
perfect results. Each year at the American Academy of
Ophthalmology meeting, we would have dinner together the
night before the meeting started. I cherished our friendship. I
also marveled at his other endeavors. He trained hundreds of
surgeons around the world and performed countless free
surgeries to restore sight in Utah, on the Navajo Nation, and in
more than 20 countries, including Ghana, Nepal, and South
Sudan. Among many awards, he received the AAO
47.
Humanitarian Award, theAmerican Society of Cataract and
Refractive Surgery (ASCRS) Humanitarian Award, and the
inaugural ASCRS Foundation Chang Humanitarian Award.
Alan has left a legacy that few other ophthalmologists even
come close to. He left this world a be er place than he found it.
He certainly is missed, but his teaching and training live on. He
still lives on in my mind, and always will.
Myron Yanoff, MD
Chair Emeritus
Department of Ophthalmology
Drexel University
Adjunct Professor
Department of Ophthalmology
University of Pennsylvania
Philadelphia, Pennsylvania
E-mail address: myanoff4@gmail.com
Like most children growing up, I did not have a strong sense of
my father’s day-to-day life. I knew that he worked long hours. I
knew that he often went in on weekends to see patients. I knew
that he often brought home charts for dictations, slides to
review, and surgical videos. He would have the videos playing
while we worked out in the evening (my siblings and I all knew
the steps of cataract surgery before we had finished high
school). As I got older, I came to appreciate that he did this
because he loved what he was doing.
Dad always wanted everyone around him to be happy. For
myself and my siblings, he wanted us to find something we
enjoyed doing, something that we would want to do every day,
and then strive to be the best at it that we could. He never made
any effort to push me into ophthalmology, or even medicine,
except by the example he provided. The joy he had in his work
helped me decide my path. I’m so thankful this gave me the
opportunity to work with him at meetings and on outreach
surgical trips.
He always encouraged me to push myself surgically, always
saying, “oh yeah, you have the skills to do that,” when I would
48.
y g yy
discuss tough cases or new techniques with him. In him, I had
the ultimate phone support for these hard cases and hard
decisions. I knew he would answer any time I called with
questions. Many know that this was not a special benefit I had
by being family. He would do that for anyone who called him
at any time.
He cast an enormous shadow in ophthalmology, one that I long
ago accepted I would never get out of, but I can continue to do
what he wanted, which is to try to make the world around me
be er and to be the best I can be. The world (and my personal
world) is poorer for his loss, but rich in the legacy he has left
for us.
Optical Coherence Technologyin
Glaucoma Diagnosis
Joseph Sowka, ODa,∗, Jessica Steen, ODb
and Greg Caldwell, ODc a
Center for
Sight, 1236 Jacaranda Boulevard, Venice, FL 34292, USA b
Nova Southeastern University
College of Optometry, 3200 South University Drive, Fort Lauderdale, FL 33328,
USA c
Optometric Education Consultants, 225 Terrace Drive, Lilly, PA 15938, USA
∗ Corresponding author.
email address: jwsowka@gmail.com
Keywords
Optical coherence tomography; Optical coherence tomography
angiography; Glaucoma; Optic disc; Ganglion cell layer; Retinal nerve fiber
layer; Parapapillary vasculature
52.
Key points
• Opticalcoherence tomography is a common technology in
ophthalmologic and optometric practice.
• Optical coherence tomography can objectively image the
peripapillary retinal nerve fiber layer, ganglion cell and inner
plexiform layers, and the peripapillary retinal vasculature.
• Abnormalities in the peripapillary retinal nerve fiber layer, macular
region, and peripapillary vasculature have been shown to occur in
glaucoma.
• Optical coherence tomography provides an objective, quantifiable
assessment of ocular structure that can be used to assist and
enhance glaucoma diagnosis.
53.
Introduction
Glaucoma is amultifactorial disease consisting of characteristic damage to
the optic disc, retinal nerve fiber layer (RNFL), and visual field,
additionally involving numerous risk factors including race, age, family
history, and intraocular pressure at levels incompatible with ocular health
of the individual [1,2]. Glaucoma diagnosis has traditionally been
accomplished through patient risk factors assessment, optic disc clinical
and photographic analysis, as well as automated threshold perimetric
testing. There exist limitations with this traditional approach, though.
Many risk factors are currently unknown, and those that are known may
be improperly assessed and their impact is not universally agreed upon.
Clinical optic disc assessment is a challenging learned technique not
possessed equally among all clinicians, and there exists no normative
database for comparison. Threshold perimetry has an inherent limitation
in that it is a subjective psychophysical test that depends on patient
interaction and responses and the learned skills of the perimetrist. As an
adjunct to clinical examination, spectral domain optical coherence
tomography (SD-OCT) technology is increasingly being integrated into
glaucoma evaluation to provide a more objective method of assessment
that may lead to more accurate and earlier diagnosis [3].
54.
Optical coherence tomographyretinal
nerve fiber layer analysis in glaucoma
diagnosis
Optical coherence tomography is an imaging technique based on
interferometry, comparing the coherence between near-infrared light
reflected off the retina and light reflected off a reference mirror. The
returning light is compared with the reference light and allows computer
reconstruction of the underlying tissue with quantitative measurements
that can be subsequently compared with a validated, normative database
[3].
Peripapillary RNFL analysis is the SD-OCT parameter most commonly
used for glaucoma diagnosis, drawing from measurements of retinal
ganglion cells (RGC) throughout the retina [4]. An inherent limitation of
this parameter is the high degree of physiologic variability between
individuals and the subsequent difficulty in universally applying a
normative database [4]. Macular thickness and ganglion cell complex
assessment is also used to overcome this limitation because there is less
anatomic variability of RGCs in this area and pathologic defects are more
easily differentiated from anatomic variants. In addition, OCT
angiography also has been investigated as another objective measure
because peripapillary loss of retinal capillaries is being recognized as an
early change in glaucoma [5].
There are several clinically available SD-OCT devices that can measure
RGC tissue and assess this information in a variety of parameters that are
subsequently measured against individual proprietary normative
databases. Most devices will assess anatomic quadrants of superior retina,
inferior retina, nasal retina, and temporal retina (in some form) as well as
look at overall average RNFL thickness. There may also be subgroup
assessment of individual clock hours or more defined anatomic areas such
as inferior temporal or superior temporal. The parameters assessed are
reflections of the branded technology and vary by device (any
informational inclusion or exclusion of branded technology throughout
this article neither implies superiority nor inferiority of any device.)
In a pooled meta-analysis, Kansal and associates [2] noted that
information for average, superior, and inferior RNFL parameters were
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ITALIAN
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PITMAN'S SHORTHAND
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INSTRUCTION BOOKS
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TMAN'S SHORTHAND TEACHER. An elementary work suited for
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TMAN'S SHORTHAND PRIMERS. In three Books: Elementary,
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TMAN'S SHORTHAND READING LESSONS. Nos. 1, 2 and 3 3d.
YS TO "PITMAN'S SHORTHAND READING LESSONS." Nos, 1,
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TMAN'S SHORTHAND COPY BOOKS. Nos. 1, 2, 3, and 4. An
entirely new series covering the theory of the system. Foolscap
4to (8-3/4 in. by 6-1/2 in.) 6d.
TMAN'S SHORTHAND DRILL EXERCISES. Oblong 8d.
MPEND OF PITMAN'S SHORTHAND. 2d.
TMAN'S SHORTHAND INSTRUCTOR. Complete Instruction in the
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RADUATED TESTS IN PITMAN'S SHORTHAND. Illustrating all
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OGRESSIVE STUDIES IN PITMAN'S SHORTHAND. 1/-
LKS WITH SHORTHAND STUDENTS. By James Hynes 1/-
ATS ABOUT PITMAN'S SHORTHAND. By George Bletcher 1/-
CTURETTES ON PITMAN'S SHORTHAND. By J. Hynes 1/-
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Iron and Steel Trades, Civil Engineering, Naval and Military,
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EDICAL REPORTING IN PITMAN'S SHORTHAND. By H.
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3/-
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Outlines, and Abbreviations.In crown 8vo, cloth
ORTHAND CLERK'S GUIDE. By Vincent E. Collinge, A.C.I.S. In
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UDENT'S PRACTICE BOOK. In cr. 8vo, 241 pp. 2/-
RADUATED DICTATION BOOKS. (New Series) I and II. 6d.
RADUATED COMMERCIAL LETTERS FOR DICTATION. 8-1/4
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PORTING PRACTICE. In crown 8vo, cloth 2/6
OGRESSIVE DICTATOR. Third Edition. In crown 8vo, cloth 2/6
ORTHAND CANDIDATE'S DICTATION EXERCISES. In crown
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EED TESTS AND GUIDE TO RAPID WRITING IN
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VE MINUTE SPEED TESTS. With Introduction on Acquisition of
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MULATIVE SPELLER AND SHORTHAND VOCABULARY. By
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CKET DICTATION BOOKS, Nos. 1, 2, 3, and 4. 2-7/8 in. by 3-
3/4 in. 2d.
EED TRAINING IN PITMAN'S SHORTHAND. By T. F. Marriner 6d.
QUISITION OF SPEED IN SHORTHAND. By E. A. Cope. In
ordinary print. In crown 8vo 9d.
ROWN'S SHORT-CUTS IN SHORTHAND. By George Brown,
F.I.P.S. In crown 8vo 1/-
E STENOGRAPHIC EXPERT. By W. B. Bottome and W. F. Smart. In
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ORTHAND COMMERCIAL LETTER-WRITER. Advanced Style
6d.
FICE WORK IN SHORTHAND. Specimens of Legal and other
Professional Work commonly dictated to Shorthand clerks, in the
Advanced Style 6d.
77.
1/3; Key
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2/-;Cloth
1/6; Cloth
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No. 1, 6d. No. II
MMERCIAL CORRESPONDENCE IN SHORTHAND. In crown
8vo, cloth 3/6
SINESS CORRESPONDENCE IN SHORTHAND. In the
Advanced Style. 10d.
ADE CORRESPONDENCE IN SHORTHAND. In the Advanced
Style. 8d.
SCELLANEOUS CORRESPONDENCE IN PITMAN'S
SHORTHAND. First, Second, Third, and Fourth Series. Advanced
Style, with Keys in ordinary print. Each in crown 8vo, oblong 1/3
SHORTHAND READING BOOKS
In the Elementary Style.
SOP'S FABLES 6d.
SY READINGS. With Key 8d.
ARNER'S SHORTHAND READER. Illustrated 8d.
IRRING TALES 8d.
RILS OF THE BUSH AND OTHER STORIES 8d.
In the Intermediate Style.
TMAN'S PHONOGRAPHIC READER, No. 1. With Key 6d.
ULLIVER'S VOYAGE TO LILLIPUT. By Jonathan Swift. With Key. 2/-
BMARINE X7 AND OTHER STORIES. Illustrated 1/3
E VICAR OF WAKEFIELD. By Oliver Goldsmith. Illustrated. 2/6
LES AND SKETCHES. By Washington Irving. With Key. 2/-
LES OF ADVENTURE. By various Authors 1/-
E RUNAWAY AIRSHIP AND OTHER STORIES. 1/3
E SILVER SHIP OF MEXICO. An abridgment of J. H. Ingraham's
Story 2/-
LECT READINGS 8d.
E BOOK OF PSALMS. Bible Authorised Version. Cloth gilt, red
edges 3/6
78.
Each
1/3; Cloth
Cloth
Cloth
Each, cloth
1/-;Cloth, 1/6; Key
The Set
MMERCIAL READERS IN SHORTHAND. (1) Commercial
Institutions, 8d. (2) Commodities. (3) Leaders of Commerce. (4)
Gateways of British Commerce. 6d.
In the Advanced Style.
ONOGRAPHIC READER II. With Key 6d.
CHRISTMAS CAROL. By Charles Dickens. 1/9
LES FROM DICKENS 2/6
E SIGN OF FOUR. By Sir A. Conan Doyle 2/-
E RETURN OF SHERLOCK HOLMES. Vols. I, II and III 2/-
ROUND THE WORLD IN EIGHTY DAYS. By Jules Verne 2/-
LF-CULTURE. By J. S. Blackie. 2/6
LECTIONS FROM AMERICAN AUTHORS. With Key 1/3
E LEGEND OF SLEEPY HOLLOW. By Washington Irving. With Key 8d.
P VAN WINKLE. By Washington Irving. With Key 6d.
COURSE IN BUSINESS TRAINING. By G. K. Bucknall, A.C.I.S.
(Shorthand Edition), 288 pp. 3/-
SHORTHAND TEACHERS' BOOKS
TMAN'S SHORTHAND TEACHER'S HANDBOOK. In crown 8vo,
cloth 1/6
OTES OF LESSONS ON PITMAN'S SHORTHAND. Size 8 in. by 3-
3/4 in., cloth 2/6
EPARATION FOR A SHORTHAND TEACHER'S EXAMINATION.
Size 8 in. by 3-3/4 in., cloth 1/6
COMMENTARY ON PITMAN'S SHORTHAND. By J. W. Taylor. In
foolscap 8vo, cloth gilt, 448 pp. 5/-
E METHODS OF TEACHING SHORTHAND. By E. J. McNamara,
M.A. In crown 8vo, cloth 2/6
ART OF THE PHONOGRAPHIC ALPHABET. 22 in. by 35 in. 2d.
ARTS ON PITMAN'S SHORTHAND. Twenty large Charts (22 in.
by 35 in.) 7/6
79.
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