ESCLERA is a scleral lens that provides new correction possibilities for irregular corneas like keratoconus. It bears on the sclera without touching the cornea, leaving a 100 micron fluid space. This removes corneal irregularity and optically replaces the front surface of the cornea. Five case studies showed that ESCLERA improved vision and comfort over other options for keratoconus patients, with excellent stability, visual acuity and comfort.
Scleral lens is a large rigid contact lens with a diameter range of 15mm to 25mm. Its resting point is beyond the
corneal borders, and are believed to be among the best vision correction options for irregular corneas. Wearing scleral lens also can postpone or even prevent surgical intervention as well as decrease the risk of corneal scarring.
Scleral lens is a large rigid contact lens with a diameter range of 15mm to 25mm. Its resting point is beyond the
corneal borders, and are believed to be among the best vision correction options for irregular corneas. Wearing scleral lens also can postpone or even prevent surgical intervention as well as decrease the risk of corneal scarring.
Contact Lenses Management in PediatricsKaylie Ling
The post-surgical management of the pediatric aphakic is important. Contact lens is the best optical device in the post-operative aphakia to provide good visual quality.
Eye care that is new to children, and adults. Find what optometrists are doing that is new using the latest technology in vision care. Freedom from glasses and contacts in the daytime. Look and feel great!
It contains Examination Protocol for Contact Lenses along with information about pre-requisites for fitting a Contact Lens. A helpful guide for all Students, Eye Care Practitioners (Optometrist, Ophthalmologist).
Contact Lenses Management in PediatricsKaylie Ling
The post-surgical management of the pediatric aphakic is important. Contact lens is the best optical device in the post-operative aphakia to provide good visual quality.
Eye care that is new to children, and adults. Find what optometrists are doing that is new using the latest technology in vision care. Freedom from glasses and contacts in the daytime. Look and feel great!
It contains Examination Protocol for Contact Lenses along with information about pre-requisites for fitting a Contact Lens. A helpful guide for all Students, Eye Care Practitioners (Optometrist, Ophthalmologist).
IOL implantation in the absence of capsular bagcrisnemato
Manejo de la ectopia lentis y de los implantes secundarios en ausencia de soporte capsular.
Comparativa entre las diferentes opciones quirúrgicas y protocolo de actuación.
Scleral contact lenses , types, uses in various ocular conditions.
An in-depth and unbiased details of these lenses as a therapeutic and also as a drug - delivery system in modern ophthalmology.
A must read for all Ophthalmologists and Optometrists.
Cataract surgery and refractive surgery are now seen as a surgical spectrum
Significant advances in safety, technology, techniques and results
2006 200,000 Cataract operations
2006 50,000 Refractive operations
>10% of >60yo have IOLs
Cataract surgery is very cost effective surgery
This presentation describes all the clinical aspects of keratoconus management
You can watch the illustrated presentation in this link :
https://www.youtube.com/watch?v=pYxwZPGm7e4&list=PLZ_mM13I_TrhWavjTmE9NjW1O5bGxkONO&index=13
Dr. Coşkunseven "Combination of Keraring and Toric phakic implantable collame...Mediphacos
Dr. Dr. Coşkunseven presentation at the Total Keratoconus Solution user meeting organized by Mediphacos:
"Combination of Keraring and Toric phakic implantable collamer lens for keratoconus"
2014 ESCRS, London
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Dr. Smoradkova "Esclera, news for irregular corneas"
1. ESCLERA
Scleral lens - news for irregular corneas
Dr. Adriana Smorádková, Slovakia
ESCRS, London 2014
www.neovizia.sk
2. www.neovizia.sk 2
Clinic NeoVízia
• our clinic specialize in cataract and refractive surgery, glaucoma, retina and
keratoconus
• my specialization is refractive surgery (FemtoLasik, PRK), glaucoma (SLT, LI)
and keratoconus (CXL, implantation Kerarings, Esclera)
Keratoconus
• we started implantation of kerarings in 2011
• we are implanting kerarings with femtosecond laser Visumax since March
2013
• we started application of ESCLERA in March this year
3. ESCLERA – scleral lens
ESCLERA is a scleral lens with semi – scleral design
It performs new possibilities for correction of irregular cornea such as:
• keratoconus, pellucid marginal degeneration
• post implantation intracorneal rings segment
• post penetrating keratoplasties, corneal trauma, LASIK, PRK, Radial
www.neovizia.sk 3
Keratectomy
• dry eye
• Salzmann’s degeneration, Stevens – Johnson’s syndrome
• intolerance of soft contact lenses (myopia, hyperopia, astigmatism)
4. www.neovizia.sk 4
Characteristic
• material is fluoro-silikon akrylat copolymer
• it has excellent optical properties, good stability
and oxygen permeability
• surface is plasma treated which makes lens wetter and cleaner
• surface is resistant to protein deposition
• the lens is bearing on the sclera without touching cornea
• between the cornea and the lens is a 100 microns
space, filled with saline fluid
5. Mechanism of action
• liquid between cornea and ESCLERA
removes corneal irregularity
• Esclera optically replaced the front surface
www.neovizia.sk 5
of the cornea
• operates on the principle of optical substitutions
6. Why is ESCLERA comfortable ?
• it has excellent stability on irregular
cornea
• lens is large and always in center
• it reduced movement
• it has excellent visual acuity
• exceptional comfort compared with
hard corneal lenses
www.neovizia.sk 6
7. www.neovizia.sk 7
History
Makro lens, Esclera 1 – 6
Esclera 7
This ESLERA is seventh generation of scleral
lenses with new material, new surface modified
by plasma, new sizes and curvature.
8. Size and models
• each lens has a customized design
• we have a trial set which consists 20 basic models with different sizes and
www.neovizia.sk 8
corneal curvatures
• when we are choosing the right model we are
looking for lateral bowing curvature and
corneal diameter WTW - white to white
• the models have different....
diameter 16.0, 16.5, 17.5, 18.2 mm
diopter − 20 .... + 20 D
curvature 6.49 mm .... 8.44 mm
9. Trial set – 20 lens
www.neovizia.sk 9
Moderate cone
(A,B)
Instruction
Advanced cone
(C,D)
Post surgical
Sunken
Post surgical
Bulging
Keratoconus Post LASIK, PRK, RK, PMD
Group A Group A Group B Group A
7,50 / 16,0 / 4,47 7,03 / 16,0 / 4,64 7,85 / 16,5 / 4,75 6,49 / 16,0 / 4,89
Group C Group C Group D Group D
7,85 / 17,5 / 5,20 6,89 / 17,5 / 5,64 7,85 / 17,5 / 5,20 6,89 / 17,5 / 5,64
Specification of lens
10. Choosing the right model
• patient open eye lids
• we look from side and check corneal elevation
• than check white to white
• we are choosing predictive model from the trial set
• put saline solution + fluorescein into the lens
• apply the lens with face down
• and control it under the slit lamp
www.neovizia.sk 10
11. www.neovizia.sk 11
Ideal fit
Has 4 simple steps
• Size – ESCLERA must be 2 mm larger than the limbus
• Vault – is without touching
• SAG - Saggital Depth Value is 100 microns space
• Edge – without pressure vessels and
without movement
12. Trouble Shooting
too large SAG 250 um –
steep fit
www.neovizia.sk 12
central bearing 2 mm-flat
fit
flat lens, central bearing,
bubbles, edge lift
Rules:
1. central bearing 1 mm -
increase SAG about 0,1 mm
2. Vault more than 100 um -
decrease SAG... 50
um=0,1mm
peripheral bearing
13. Choosing the next model
• if it was an incorrect model, we must remove the lens
• than try another model
• again control under the slit lamp
• if it is correct model....
• patient has it inserted in the eye for 30 minutes
• we are doing manifest refraction - final lens power
• write all information to the order form
• patient’s lens is manufactured and delivered
• ESLERA is produced in 4 weeks
www.neovizia.sk 13
14. www.neovizia.sk 14
Lens care
• we must teach the patient how to use Esclera
• lens wear during day approximate 8 - 10 hours
• patients need cleaning solution, saline solution for rinse and application
and GP (gas permeable) lens solution for conditioning in the box
• highlight possible complications associated with Esclera, which are such as
other types of contact lenses
Esclera can last up 2 years if good care is taken
16. www.neovizia.sk 16
Case 1
man, 33 years , keratoconus on both eyes
• myopia gravis, wearing glasses from 6 y. (o.dx: -7,25, -2,0/ 91, o.sin: -6,0, -0,5/85)
• we implanted keraring to the left eye and we proposed penetrating keratoplasties or to try
ESLERA to the right eye. He wanted to try ESCLERA
eye UCVA BCVA AR CCT CCT -
thinnest
K1 K2 K max
OD 0,01 0,2 -21,5,-2,0/171 418 381 53,0 59,0 66,5
OS 0,05 0,6 -9,5,-4,25/78 474 439 49,0 52,5 60,8
penetrating
keratoplasties or
ESCLERA
Keraring
Transplantation Keraring
17. Case 1 - conclusion
Method: OD: ESCLERA ( fitting 2/2014, wear from 5/2014)
OS: implantation of keraring (surgery 1/2014)
before after
eye UCVA BCVA AR BCVA MR
0D 0,01 0,2 -21,5,-2,0/171 ESCLERA 0,9
OS 0,05 0,6 -9,5,-4,25/78 Keraring 0,7 -5,0
the patient is satisfied
www.neovizia.sk 17
18. www.neovizia.sk 18
Case 2
man, 38 years old, keratoconus on both eye, doctor – cardiologist, keratoconus both eyes
• myopia gravis, wearing glasses from 4 y. (o.dx: -3,0, o.sin: -4,0)
• we implanted kerarings to both eyes, after surgery the vision improved significantly
eye UCVA BCVA AR CCT K1 K2 K max AL
OD 0,5 0,9 -5,0,-9,75/26 469 46,5 53,75 61,1 24,38
OS 0,05 0,3 -13,5,-10,0/178 474 53,25 59,0 65,7 24,59
Keraring
Keraring ESLERA
19. Case 2 - conclusion
Method: OD: implantation of keraring (1/2014)
OS : implantation of keraring (7/2013)...ESCLERA (fitting 2/2014, wear from 6/2014)
• but the left eye had low vision, so we decided to try ESCLERA
before after
eye UCVA BCVA AR method BCVA MR/AR
OD 0,5 0,9 -5,0,-9,75/26 Keraring 1,0 -3,0
OS 0,05 0,3 -13,5,-10,0/178 Keraring 0,5 -10,0-1,25/152 ESCLERA 1,0
the patient is satisfied
www.neovizia.sk 19
20. www.neovizia.sk 20
Case 3
woman, 47 years, keratoconus on both eye
• right eye with myopia gravis, ambylopia, fundus myopicus, cataract scutelaris, strabizmus,
• left eye with myopia medii
• she is wearing hard corneal lens on the left eye (now she has problem with tolerance)
• wearing glasses from 20 y. (o.dx: -3,5, o.sin: -3,0,-1,0/156)
eye UCVA BCVA AR CCT K1 K2 K max AL
OD 0,01 0,05 -16,25,-5,75/70 484 46,25 49,75 51,4 29,91
OS 0,1 1,0 -4,5,-3,75/156 458 48,5 51,25 55,5 23,7
ESCLERA
ESCLERA
21. Case 3 - conclusion
Method: OD: ESCLERA (fitting 5/2014)
OS: ESCLERA (fitting 5/2014)
We proposed to try ESCLERA to both eyes.
UCVA BCVA AR BCVA
before after
OD 0,01 0,05 -16,25,-5,75/70 ESCLERA 0,05
OS 0,1 1,0 -4,5,-1,0/149 ESCLERA 1,0
the patient is satisfied
www.neovizia.sk 21
22. www.neovizia.sk 22
Case 4
man, 35 years, keratoconus on both eye, wearing glasses from 11 y. (o.dx: -6,75, -2,5/48, o.sin: -8,0,-3,5/105)
• he had implantation of myoring combined with CXL to the left eye at another clinic in 2013
• after surgery was his vision still very low, with halo and glare effect
He wanted keraring to the right eye, but he was afraid of surgery and finally he decided to try ESCLERA.
eye UCVA BCVA AR CCT K1 K2 K max AL
OD 0,05 0,8 -12,75,-4,75/38 447 48,75 51,25 51,4 26,10
OS - myoring 0,1 0,4 -8,0,-6,25/1 370 45,5 46,75 55,5 26,48
ESCLERA
ESCLERA
23. Case 4 - conclusion
Method: OD: ESCLERA (fitting 6/2014)
OS: ESCLERA (fitting 6/2014)
UCVA BCVA AR BCVA
before after
OD 0,05 0,8 -12,75,-4,75/38 ESCLERA 0,9
OS 0,1 0,3 -8,0,-6,25/1 ESCLERA 0,3
He ordered ESCLERA to both eyes.
www.neovizia.sk 23
24. www.neovizia.sk 24
Case 5
man, 46 years, keratokonus on left eye, he doesn’t have glasses
• we proposed implantation of kerarings to the left eye. After surgery the vision was 0.5, so we decided to try
ESCLERA
Keraring ESCLERA
eye UCVA BCVA AR CCT K1 K2 Kmax
OD 0,9 1,0 +1,0,-0,5/63 571 44,25 45,00 45,5
OS 0,16 0,4 -3,75, -12,5/96 537 48,75 57,25 58,7
Kerarings 10/2013
SI5 160/300 - sup.
SI5 90/250 - infer
UCVA post keraring 0,5 AR -3,5, -3,0/84
25. Case 5 - conclusion
Method: OS: ESCLERA (fitting 7/2014)
UCVA AR BCVA
post implantation keraring after
OS 0,5 -3,5, -3,0/84 ESCLERA 0,8
He ordered ESCLERA to the left eye.
www.neovizia.sk 25
26. Final conclusion
• has excellent stability
• excellent visual acuity
• it is comfortable to wear
And this is a new type of correction for patients
with keratoconus and irregular cornea.
www.neovizia.sk 26