US OPHTHALMIC REVIEW – VOLUME 4 ISSUE 1 – SPRING 2011

An important change in the field of corneal surgery is the trend toward anterior and posterior lamellar transplants in place of penetrating keratoplasty. Leading the transition are the multiple forms of endothelial keratoplasty for the treatment of Fuchs’ dystrophy and aphakic and pseudophakic bullous keratopathy. This lamellar surgery is much less invasive with a lower […]

Optical coherence tomography (OCT) is a non-contact optical technique that allows imaging and measurement of the retinal nerve fiber layer (RNFL). Since 1991,1 OCT has undergone rapid evolution for use in detection and monitoring of glaucoma and macular diseases. Based on the principle of low-coherence interferometry, OCT measures the intensity of backscattered infrared light. Time-domain […]

Optical coherence tomography (OCT), first developed for ophthalmic imaging in the 1990s,1 has become a ubiquitous and invaluable tool in the retinal clinic. While it will never replace stereoscopic biomicroscopy, it has demonstrated clear advantages. Adjunctive OCT scanning objectively provides the examiner with 2D cross-sections of the retina, while newer machines are able to reconstruct […]

Why Study Glaucoma Genetics? The promise of glaucoma genetic studies is simple: defining genetic risk factors predisposing people toward glaucoma empowers the design of new therapeutic strategies. All current glaucoma medications and surgeries target the same risk factor: intraocular pressure. This strategy is often adequate, but for some patients alternative approaches could be of substantial […]

Glaucoma is a visually debilitating disease that is estimated to affect more than 60.5 million people worldwide, rising to 79.6 million by 2020.1 Most treatment strategies for glaucoma involve lowering intraocular pressure (IOP), some by increasing the outflow of aqueous from the eye. While medical therapy is the first strategy used in treatment, surgical intervention […]

Following my appointment at the Wolfe Eye Clinic in 1980 I quickly learned phacoemulsification from my partners John Graether and Russ Watt in Marshalltown and from Dick Kratz, Tom Mazacco, Mike Colvard, and Bob Sinskey in Los Angeles. Even in those relatively early days, phacoemulsification with the Cavitron Kelman 8000 was an excellent operation; the […]

In patients with corneal astigmatism, a cylindrical defect of about 0.50 diopter (D) to 1.00D may be considered clinically significant, and may influence visual acuity.1 It has been estimated that between 15 and 20% of patients undergoing cataract surgery have at least 1.5D of pre-existing corneal astigmatism.2 Increasing age is correlated with the prevalence and […]

The ‘baby boomers’, those born between 1946 and 1964, are now in their 60s, 50s, and late 40s. Unlike previous generations, baby boomers view the world with a future-forward perspective. According to a report published in January 2010, baby boomers feel younger than they actually are and fully expect that medical breakthroughs will allow them […]

Presbyopia is defined as the inability to focus on near targets, and its correction following cataract surgery remains one of the most significant challenges for ophthalmologists and cataract surgeons.1,2 According to the World Health Organization (WHO), age-related cataracts are responsible for ~48% of world blindness, equating to ~18 million people,3 whereas presbyopia is estimated to […]

According to Research to Prevent Blindness, 20.5 million US citizens have cataract, and two million are visually impaired with glaucoma. Today, we operate on approximately three million cataracts a year, and 10% of these patients have co-existing glaucoma; so, 300,000 times a year, a US surgeon must decide how to treat a patient with co-existent […]

Ocular inflammatory diseases significantly burden patients, family members, healthcare plans, ophthalmic clinics, and workplace productivity due to health-related absenteeism. The cost of prescription medicines for ocular allergy was estimated at over $200 million in the US in 2002, with a projected rise of 25% per year as prescription medicines continue to improve and show benefit […]

Herpes Simplex Keratitis—A Significant Burden and Threat to Human Eyesight Herpes simplex keratitis (HSK), caused by the herpes simplex virus (HSV), is the most common form of viral keratitis and is a common cause of ocular morbidity and blindness.1,2 HSV infection is extremely common in populations worldwide. It is one of the more common severe […]

Estimates of the incidence of allergic conjunctivitis vary, but it is an increasingly common condition that may affect >20% of the general population.1 Annually, at least 40 million Americans experience symptoms related to indoor or outdoor allergies,2 with nearly 25 million adults and children receiving a diagnosis or reporting seasonal allergy (hayfever) in 2009.3 One […]

Corneal endothelial failure is a common cause of corneal transplants. According to the Eye Bank Association of America, transplant tissue distributed for endothelial keratoplasty accounted for 18,221 (43%) of all keratoplasties performed in the US during 2009.1 Fuchs dystrophy, other causes, and post-cataract surgery edema were identified as the leading indications for endothelial replacement surgery. […]

Trachoma is the leading infectious cause of blindness worldwide.1 Trichiasis, the end-stage of trachoma reflecting numerous episodes of infection with Chlamydia trachomatis, carries a high risk for subsequent visual loss due to distortion of the lid architecture and inturned eyelashes abrading the cornea. The World Health Organization (WHO) estimates there are 8.2 million people worldwide […]

Descemet-stripping automated endothelial keratoplasty (DSAEK) has become the procedure of choice to treat corneal endothelial dysfunction. Developed by Melles et al.1 and modified by others,2 DSAEK evolved from posterior lamellar keratoplasty (PLK) and deep lamellar endothelial keratoplasty (DLEK). The host Descemet membrane is removed and a graft consisting of posterior stroma, Descemet membrane, and endothelial […]

In the history of medicine, the discovery of new knowledge has led to paradigm shifts in treatment approaches for diseases, and improvement in overall health. The following are examples: In 1876, Robert Koch identified Bacillus anthraces as the first bacterium to cause infectious disease leading to the identification of multiple infectious diseases such as tuberculosis […]

Carotenoids—Lutein and Zeaxanthin In general, carotenoids are yellow, orange, or red pigments that are soluble in lipids. Mammals utilize carotenoids for a variety of functions but are incapable of synthesizing them. Thus, carotenoids must be obtained solely from the diet. Of the 600 carotenoids found in nature, only dietary lutein and zeaxanthin are deposited in […]

Retinitis pigmentosa (RP) is a group of disorders whose main clinical features include diffuse photoreceptor dysfunction, diminished electroretinogram (ERG), and progressive visual field loss. The disorders affect approximately one in 5000 people worldwide.1 Clinical features often include peripheral retinal pigment epithelial atrophy, ‘bone spicule’ pigment clumping, waxy optic disk pallor and arteriolar attenuation. Patients often […]

Retinopathy is one of the most feared complications of diabetes, severely compromising the quality of life in most affected patients. Diabetic retinopathy is the most common cause of vision impairment in people of working age in the developed world. Over a 20-year period, almost all patients with type 1 diabetes will develop retinopathy with approximately […]

Age-related macular degeneration (ARMD) is a highly prevalent, severely visually disabling disease affecting millions of people worldwide. As its name implies, the disorder affects the macula and therefore central vision, thereby causing significant disability and immeasurable personal impact not only to the patient, but also the family and loved ones caring for those afflicted. There […]

Diabetic macular edema (DME) is, unfortunately, a very common problem affecting millions of diabetes patients worldwide. The Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR) estimated that the prevalence of DME in patients with at least 15 years’ duration of diabetes was 20% in type 1 diabetes mellitus (DM) patients, 25% in type 2 DM patients […]

Uveal melanoma is the most common intraocular primary malignancy. The incidence is reported to be four to seven per million per year in the Caucasian population. Patients usually present around the fifth or sixth decade of life; however, this tumor can rarely occur in young children. The large majority of patients are Caucasian, with this […]

The optic nerve transmits visual information from the retina to the brain. In humans, the optic nerve is composed of approximately 1.2 million axons of retinal ganglion cells (RGCs). RGC axons course through the nerve fiber layer (NFL) to the optic disc, where they merge to form the axonal bundle of the optic nerve. As […]