Dr. Lighthizer

                                       THE OCULAR DISEASE UPDATE

Course Topics:

Lumps and Bumps: A Practical Guide to Evaluation and Management
Going Viral – HSV, HZO, EKC
Swollen Optic Nerves: Now What?
Oral Pharmaceuticals in Anterior Segment Disease
DM: New Testing and Treatment for Retinopathy
Laser Procedures for the Management of Glaucoma and More
Uveitis: Systemic and Ocular Approaches to Management
IPL in the Optometric Practice
Optometric Surgical Procedures

Lumps and Bumps: A Practical Guide to Evaluation and Technique Removal

Course Description:

              Optometrists have been able to remove benign eyelid lesions in various states for many years now.  When cutting into the eyelid to remove a benign lesion, it is imperative that one understands the eyelid anatomy.  This interactive presentation will review the anatomy of the eyelids in relation to ophthalmic eyelid surgery.  It was also thoroughly cover all eyelid lesions, from the benign to the malignant.  It will also review, update, and instruct the audience on the how�s and why�s of performing radiofrequency surgery in the optometric practice.

Learning Objectives:

            To become familiar and review the anatomy of the upper lid.

            To become familiar and review the anatomy of the lower lid.

            To become familiar and review the anatomy of the lids in regards to ophthalmic surgery.

            To review the most common benign eyelid lesions and how they affect eyelid anatomy.

            To review the most common malignant eyelid lesions and how they affect eyelid             anatomy.

            To become familiar with how anesthesia affects the eyelids and proper anesthesia          techniques.

To become familiar with the history of Electrosurgery.

            To become familiar with the theory, advantages, indications, and contraindications of     radiofrequency surgery.

            To become familiar with the equipment involved in radiofrequency surgery.

            To become familiar with the various surgical techniques used in radiofrequency surgery.

            To become familiar with the risks/complications of radiofrequency surgery.

            To become familiar with the post-op care of radiofrequency surgery.

 Course Outline:

1.  Anatomy of the upper lid
2. Diagram of the upper lid
3.  Tarsal plate
4.  Levator aponeurosis

                                                          iii.      Muller�s muscle

1.  Orbicularis
2.  Orbital septum
3. Anatomy of the lower lid
4. Diagram of the lower lid
5.  Tarsal plate
6.  Lid retractor muscles

                                                          iii.      Orbicularis

1.  Orbital septum
2. Surgical anatomy of the eyelids
3. Very vascular
4. Very thin
5. Fast turnover
6. Space between the dermis and epidermis accommodates local anesthesia well
7. Benign eyelid lesions
8. Most eyelid lesions are benign
9. Originate in the epidermis and grow outward
10. Squamous papilloma, Seborrheic keratosis, Chalazion, Sebaceous cysts
11. Malignant eyelid lesions
12. Basal cell carcinoma, squamous cell carcinoma, malignant melanoma
13. Benign vs. Malignant (the following are characteristics of malignant lesions)
14.  H � hair � loss of hair bearing structures
15.  A � asymmetrical

                                                          iii.      A � abnormal blood vessels

1.  B � borders irregular
2.  B � bleeding reported
3.  C � multicolored

                                                         vii.      C � change in the size or color of the lesion

                                                       viii.      D � diameter > 5 mm in size

6. Anesthesia and how it affects the eyelid
7. Lidocaine 1% with epi
8. Lidocaine 1% without epi
9.  Dirty or contaminated wounds
10.  Nose, toes, ears
11. History of Electrosurgery
12. Radio Surgery vs. Electrocautery vs. Hyfrecation
13. What is Radio Frequency (RF) surgery?
14. Passage of high frequency radiowaves through soft tissue to cut, coagulate, and/or remove the target tissue
15. Radio-surgical unit consists of:
16.  Active electrode
17. Various electrode tips
18. Bent tip
19. Loop electrode
20. Ball electrode
21.  Antennae (passive electrode)

                                                          iii.      Transformer

9. Advantages of Radiosurgery
10. Cuts and coagulates at the same time
11. Nearly bloodless field
12. Minimal biopsy artifact damage
13. Quick and easy
14. Minimal lateral heat
15.  Lateral heat formula
16. Minimal post-op pain
17. Rapid healing
18. Hazards/Contraindications
19. Excess lateral tissue damage
20. Smoke hazard/unpleasant smells in the office
21. Pacemaker
22. Radiofrequency Surgical devices
23. Introduction and photos of the unit, vacuum, antenna, and foot pedal
24. Different waveforms used
25.  Pure Cut
26.  Cut/Coag

                                                          iii.      Coag/Hemostasis

1.  Fulguration
2. Radiofrequency surgery indications
3. Radiofrequency Surgery Procedure Technique
4. Lasso technique
5. Feathering technique
6. Shave flat with the surface of the skin
7. Post-op care
8. Trichiasis procedure technique
9. Radiofrequency Surgery Intro Videos

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Going Viral – HSV, HZO, EKC   Management of Viral Eye Disease

                Viruses are some of the most common microorganisms that affect both the body and the eyes. This interactive presentation will review the etiologies, risk factors, signs, symptoms,
diagnosis, and proper treatment for the ocular and systemic aspects of herpes zoster, herpes simplex and epidemic keratoconjunctivits.

Learning Objectives:

                To become familiar with the risk factors for developing HSV.

                To become familiar with the most common ocular symptoms/signs of HSV.

                To become familiar with the most common ocular treatments for HSV.

                To become familiar with the risk factors for developing HZO.

                To become familiar with the most common ocular symptoms/signs of HZO.

                To become familiar with the most common ocular treatments for HZO.

                To become familiar with the risk factors for developing EKC.

                To become familiar with the most common ocular symptoms/signs of EKC.

                To become familiar with the most common ocular treatments for EKC.

Course Outline:

1. Clinical case of HZO (20 minutes)
2. Herpes Zoster/Shingles (30 minutes)
3. Prevalence
4. Risk Factors
5. Etiology
6. Ocular involvement
7.  Lids
8.  Conj

                                              iii.      Cornea

1. Pseudodendrites
2. Pseudodendrites in HZO vs. Dendrites in HSV
3.  Iritis
4.  Posterior seg involvement
5. Diagnosis
6. Treatment
7.  Oral meds
8. Acyclovir
9. Valcyclovir (Valtrex)
10. Famcyclovir
11.  Topical meds
12. Pred Forte
13. Artificial tears
14. Fresh Kote
15. Topical antivirals
16. Viroptic
17. Zirgan

                                              iii.      Vaccines

1. Zostavax vaccine
2. Who should get it
3. How does it help
4. Herpes Simplex Virus (HSV) (30 minutes)
5. Prevalence
6. Risk Factors
7. Etiology
8. Ocular involvement
9.  Lids
10.  Conj

                                              iii.      Cornea

1. True dendrite
2. Terminal end bulbs
3. Ulceration/opening in the cornea
4. True dendrite in HSV vs. Pseudodendrite in HZO
5.  Iritis
6.  Posterior seg involvement
7. Diagnosis
8. Treatment
9.  Oral meds
10. Acyclovir
11. Valcyclovir (Valtrex)
12. Famcyclovir
13.  Topical meds
14. Topical antivirals
15. Viroptic
16. Zirgan
17. Oral antivirals
18. Acyclovir
19. Valtrex
20. Famcyclovir
21. Other topical meds
22. Steroids in HSV stromal keratitis
23. Adenoviral ocular infections (EKC) (20 minutes)
24. Prevalence
25. Risk Factors
26. Etiology
27. Ocular involvement
28.  Lids
29.  Conj

                                              iii.      Cornea

1. Sub-epithelial infiltrates
2. Diagnosis
3. Treatment
4.  Palliative therapy
5. Artificial tears
6. Cool compresses
7. Good hygiene
8.  Steroids
9. For SEI�s

                                              iii.      Betadine rinse

1.  Zirgan

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Swollen Optic Nerves:  Now What?

Course Description:

Optic nerve head pathology including swelling can range from very benign that only requires monitoring all the way to a life threatening emergency.
This interactive 2-hour lecture in a grand rounds format will review and update the most common causes of ONH swelling, pseudo-swelling and papilledema.

Learning Objectives:

1. To become familiar with the key signs to help differentiate pseudoswelling of the ONH with true swelling of the ONH.
2. To become more familiar and update the signs, symptoms, differential diagnosis and treatment for optic neuritis and MS.
3. To become more familiar and update the signs, symptoms, differential diagnosis and treatment for non-arteritic anterior ischemic optic neuropathy
4. To become more familiar and update the signs, symptoms, differential diagnosis and treatment for arteritic ischemic optic neuropathy
5. To become more familiar and update the signs, symptoms, differential diagnosis and treatment for papilledema/pseudotumor cerebri.
6. To become more familiar and update the signs, symptoms, differential diagnosis and treatment for neuroretinitis.

Course Outline:

1. ONH Swelling vs. Pseudoswelling � How to differentiate
2. Direct viewing of the ONH
3.  Is there obscuration of blood vessels?
4.  Is there spontaneous venous pulsation (SVP)?

                                                          iii.      Pictures to help show those 2

1. OCT
2.  rNFL thickness
3.  splitting of the retinal layers (V sign)

                                                          iii.      Pictures/OCT�s to help show those 2

1. Symptoms?
2.  HA�s
3.  Transient visual obscurations (TVO�s)

                                                          iii.      Tinnitus

1.  Double Vision
2.  Weight gain
3. B-scan
4.  Drusen on the B-scan
5. Cases that demonstrate swelling vs. pseudoswelling
6. Case #1 � atypical NAION
7. Case presentation
8. NAION
9.  Pathophysiology
10.  Demographics

                                                          iii.      Symptoms

1.  Signs
2.  Differential Diagnosis
3.  Treatment Options
4. Observation
5. Aspirin?
6. BP control
7. Case #2 � AAION
8. Case presentation
9. AAION
10.  Pathophysiology
11.  Demographics

                                                          iii.      Symptoms

1.  Signs
2.  Differential Diagnosis
3.  Treatment Options
4. Steroids
5. Temporal artery biopsy
6. Case #3 � Idiopathic Intracranial Hypertension
7. Case Presentation
8. AKA Pseudotumor cerebri
9.  Pathophysiology
10.  Demographics

                                                          iii.      Symptoms

1.  Signs
2.  Differential Diagnosis
3.  Treatment Options
4. Oral Diamox
5. Shunts

5.  Case #4 � atypical optic neuritis
6. Case presentation
7. Optic Neuritis
8.  Pathophysiology
9.  Demographics

                                                          iii.      Symptoms

1.  Signs
2.  Differential Diagnosis
3.  Treatment Options
4. IV Steroids
5. Monitoring

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Oral Pharmaceuticals in Anterior Segment Disease

This interactive course examines the use of oral pharmaceuticals in the treatment/management of a variety of anterior segment diseases.

Topical areas include HSV keratitis, herpes zoster ophthalmicus, bacterial/allergic conjunctivitis, lid/periocular tissues, uveitis and dry eye disease/Sjogrens.

Learning Objectives:

–          Upon completion of this course the attendee will know the diagnostic criteria for HSV keratitis and the appropriate oral and topical treatments

–          Upon completion of this course the attendee will know diagnostic criteria for herpes zoster ophthalmicus and the appropriate oral and topical treatments

–          Upon completion of this course the attendee will know the diagnostic criteria for lid/periocular tissue disease (e.g. hordeola, preseptal cellulitis) and appropriate oral treatments

–          Upon completion of this course the attendee will know the diagnostic criteria for allergic and bacterial conjunctivitis and appropriate oral and topical treatments

–          Upon completion of this course the attendee will know the diagnostic criteria for blepharitis and meibomian gland dysfunction and appropriate oral and topical treatments

–          Upon completion of this course the attendee will know the diagnostic criteria for dry eye disease and importance of ruling out Sjogrens disease and appropriate oral and topical treatments

–          Upon completion of this course the attendee will know the diagnostic criteria for a patient suffering from a uveitis and the treatment including topical and oral medications.

Outline:

1. Herpes Simplex virus keratitis: (10 minutes)

            – patient case outlining the presenting signs and symptoms

            – etiology of HSV keratitis

            – pathophysiology of HSV keratitis

            – current treatment options (oral and topical) and the �controversy� over oral prophylactic treatment

2. Herpes zoster ophthalmicus: (10 minutes)

            – patient case outlining the presenting signs and symptoms

            – etiology of herpes zoster

            – pathophysiology of herpes zoster

            – current treatment options (oral) for the management of the outbreak and pain management and the �controversy� over the shingles vaccination

3. Hyperacute conjunctivitis: (10 minutes)

            – patient case outlining the presenting signs and symptoms

            – etiology of hyperacute conjunctivitis including chlamydia and gonorrhea

            – pathophysiology of hyperacute conjunctivitis and the underlying conditions

            – current treatment options (oral) for the management of chlamydia and gonorrhea with a review of the importance of obtaining diagnostic testing and reporting

4. Allergies and allergic conjunctivitis: (10 minutes)

            – etiology of allergies and allergic conjunctivitis

            – pathophysiology including common signs and symptoms and outlining the allergic cascade

            – current treatment options (oral and topical) for the management of systemic allergies and allergic conjunctivitis

5. Periocular infections: (15 minutes)

            – patient case outlining the presenting signs and symptoms of a patient with a preseptal cellulitis, hordeola, dacrocystitis

            – etiology of the various periocular infections

            – pathophysiology of the various periocular infections

            – current treatment options (oral) for the management of the various periocular infections including the use of oral penicillins, cephalosporins, tetracyclines and sulfa�s

6. Blepharitis and meibomian gland dysfunction: (10 minutes)

            – patient case outlining the presenting signs and symptoms of a patient with blepharitis/MGD

            – etiology of blepharitis/MGD

            – pathophysiology of blepharitis/MGD

            – current treatment options (oral and topical) for the management of these conditions including the use of oral doxycycline

7. Uveitis: (20 minutes)

            – patient case outlining the presenting signs and symptoms of a patient undergoing an acute iritis

            – etiology of uveitis

            – pathophysiology of uveitis and the different types of uveitis (anterior, posterior and pan)

            – current treatment options (oral and topical) for the management of uveitis and the importance of lab testing to determine underlying etiology

8. Dry eye syndrome: (15 minutes)

            – patient case outlining the presenting signs and symptoms of a patient with dry eye disease

            – etiology of dry eye disease and particular emphasis on Sjogrens and the new diagnostic criteria for Sjogrens

            – pathophysiology of dry eye disease and Sjogrens

            – current treatment options (oral and topical) for the management of dry eye disease and particular emphasis on differentiating patients with underlying Sjogrens disease, the appropriate lab testing and management options.

9. Recurrent Corneal Erosions (RCE�s)
10. i)      Etiology
11. ii)    Clinical Manifestations

iii)   Treatment Options

(1)  Bandage CL�s

(2)  Muro 128

(3)  FreshKote

(4)  Topical Steroids

(5)  Doxycycline

(6)  No bland artificial tears

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Diabetes:  New Testing and Treatment for Retinopathy

This course will provide an update and thorough understanding of the flash flicker electroretinogram (ffERG), proper indications and protocols, and how to interpret the results.  Diabetic retinopathy has historically been evaluated and followed with structural tests (DFE’s, OCT’s and fundus photos), this lecture will explore functional testing (ERG) and newer OCT testing (OCT-A) that helps in the evaluation of diabetic patients, and will also discuss the newest literature in regards to supplementation of diabetic retinopathy patients.

1. To become familiar with the flash flicker ERG (ffERG) and its role as an objective functional test in diabetic retinopathy
2. To review the role of nutritional supplementation in diabetic retinopathy
3. To review the DIvFUSS study
4. To go through actual cases showing ffERG results and nutritional supplementation effects

 Course Outline:

1)      Diabetes (10 minutes)

1. a)     Statistics
2. b)     Pre-diabetes
3. c)     Rate of complications and diabetic retinopathy

2)      What is Electrodiagnostics? (5 minutes)

1. a)     History of Electrodiagnostics.

3)      Review of Retinal Cell Physiology and the Visual Pathway (5 minutes)

1. a)     Photoreceptors
2. b)     Mid-retinal cells (Amacrine, Bipolar cells)
3. c)     Ganglion cells
4. d)     Nerve Fiber Layer
5. e)     Optic Nerve
6. f)      Optic Chiasm
7. g)     Optic Tract
8. h)     LGN
9. i)       Visual Cortex
10. j)       Model of upstream/downstream flow of visual information

4)      Electroretinogram (ERG) (10 minutes)

1. a)     History & importance
2. b)     Types of ERG�s
3. i)       Full field flash ERG

(1)   Measures the photoreceptors

(2)   A-wave and B-wave

(3)   Have to be dilated

(4)

1. ii)     Pattern ERG

iii)    Focal ERG

1. iv)   Multi-focal ERG
2. v)     Flash-flicker ERG
3. c)     Patient preparation
4. d)     Placement of Electrodes
5. i)       Forehead is the ground electrode
6. ii)     Lower eyelids are the reference and active electrodes
7. e)     Running the test
8. i)       Takes anywhere from 20 seconds to a few minutes to run the tests
9. ii)     Some ERG�s require dark adapation to get a true scotopic response
10. f)      Interpretation
11. i)       Magnitude values
12. ii)     Mag/phase values

(1)   How to interpret the Mag/phase plot graph

(2)   Tight responses packed into the lower right quadrant are normal on the fixed luminance ffERG

iii)    Artifacts and gaze tracker � how to track reliability

1. g)     When to refer for ERG�s

5)      Patient cases and examples of when to refer. (20 minutes)

1. a)     Diabetic Retinopathy
2. i)       Longstanding diabetic with mild NPDR with abnormal ERG�s started on nutritional supplementation (5 minutes
3. ii)     New diagnosed diabetic with abnormal ERG�s (5 minutes)

iii)    Longstanding diabetic with no retinopathy with very normal robust ERGs where nutritional supplementation is not needed (5 minutes)

1. iv)   Longstanding diabetic with mild NPDR with borderline ERG�s where nutritional supplementation improved them to normal ERG�s. (5 minutes)

6)      Supplementation in Diabetic Retinopathy (10 minutes)

1. a)     DIVFUSS study
2. b)     Indications/When to consider supplementation
3. c)     Contraindications
4. d)     List of ingrediants and how they help vascularure

 

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Laser Procedures for the Management of Glaucoma and More

Course Description:

            The use of laser energy to treat various anterior segment conditions, including posterior capsular opacification (PCO), angle closure glaucoma, and
open angle glaucoma, has been used by optometric physicians in certain states for over a decade now.
This interactive presentation will review and update these ophthalmic laser procedures.

Learning Objectives:

            Why, and for what ocular conditions, are ophthalmic lasers indicated?

            To become familiar with the indications, contraindications, treatment protocols, complications, and follow-up with YAG laser capsulotomies.

            To become familiar with the indications, contraindications, treatment protocols, complications, and follow-up with peripheral iridotomies (PI).

            To become familiar with the indications, contraindications, treatment protocols, complications, and follow-up with argon laser peripheral iridoplasties (ALPI).

            To become familiar with the indications, contraindications, treatment protocols, complications, and follow-up with argon laser trabeculoplasty (ALT).

            To become familiar with the indications, contraindications, treatment protocols, complications, and follow-up with selective laser trabeculoplasty (SLT).

Course Outline:

1. Why do we use lasers?
2. Decreased Vision
3. Narrow angles/Angle Closure
4. POAG progression on max meds
5. Compliance issues
6. Cost issues
7. Convenience issues
8. Doctor preference
9. YAG Laser Capsulotomy
10. PCO
11.  Incidence
12.  Prevention

                                                          iii.      Laser settings

1.  Laser tissue interaction
2. YAG laser
3.  Characteristics of the YAG laser
4. Pre-op exam components
5. Contraindications & Risks/Complications
6.  IOP spike
7.  Inflammation

                                                          iii.      Retinal detachment

1.  Permanent vision loss
2. YAG Cap procedure
3.  Technique
4.  Patient tips

                                                          iii.      Laser lens selection

1.  Patient videos
2. YAG Cap post-op care
3.  Pred Forte QID X 1 week
4.  Patient education
5. YAG cap reimbursement and global period
6. Peripheral Iridotomy (PI)
7. Anatomically narrow angles/Angle closure
8.  Common causes
9. Pupillary block
10. Plateua iris
11. Phacomorphic glaucoma
12. Malignant glaucoma
13. PI indications
14.  Primary angle closure
15.  Plateau iris syndrome/configuration

                                                          iii.      Secondary pupillary block

1.  Pigmentary glaucoma
2.  Prophylaxis � most common indication
3. PI alternatives
4.  Surgical Iridectomy
5. Pre-op exam components
6.  Gonio
7. Contraindications & Risks/Complications
8.  IOP spike
9.  Inflammation

                                                          iii.      Non-perforation

1.  Permanent vision loss
2. PI procedure
3.  Pre-op drops
4. Alphagan
5. Pilocarpine
6.  Laser options (Argon vs. YAG laser)

                                                          iii.      Selection of PI location

1. Superior under upper lid
2. Located in a crypt
3. 11:00 or 1:00
4.  Laser lens selection
5.  Goals
6. Patent PI 0.5-1.0 mm in size
7. Deepening of the AC
8. IOP control
9. PI post-op care
10.  Pred Forte QID X 1 week
11.  Patient education
12. Reimbursement/Global period
13. Argon Laser Peripheral Iridoplasty (ALPI)
14. Plateau iris syndrome
15.  Definition, etiology, incidence, treatment
16. Pre-op exam components
17.  Gonio
18. Contraindications & Risks/Complications
19.  IOP spike
20.  Inflammation
21. ALPI procedure
22.  Laser energy settings
23.  Burn location
24. ALPI post-op care
25.  Pred Forte QID X 1 week
26.  Patient education
27. Laser Trabeculoplasty
28. Why it�s done
29. Glaucoma laser trial
30. Laser Trabeculoplasty Indications
31.  POAG
32.  NTG

                                                          iii.      Pigmentary glaucoma

1.  Pseudoexfoliative glaucoma
2.  Summary of predictors
3. Types of Trabeculoplasties
4.  Argon Laser Trabeculoplasty (ALT)
5.  Selective Laser Trabeculoplasty (SLT)
6. Argon Laser Trabeculoplasty (ALT)
7. Laser Trabeculoplasty
8.  Indications, Contraindications
9. ALT mechanism of action
10. Pre-op exam components
11.  Gonio
12.  IOP
13. Contraindications & Risks/Complications
14.  IOP spike
15.  Inflammation
16. ALT procedure
17.  Pre-op drops
18.  Laser settings

                                                          iii.      Procedure tips

1. ALT post-op care
2.  Pred Forte QID X 1 week
3.  Patient education
4. Outcomes/Effectiveness of ALT & SLT
5. Selective Laser Trabeculoplasty (SLT)
6. SLT mechanism of action
7.  Thermalysis (Thermal Relaxation Time)
8. Pre-op exam components
9. Contraindications & Risks/Complications
10.  Narrow angles, Neovascular glaucoma, Inflammatory glaucoma
11.  IOP spike

                                                          iii.      Inflammation

1. SLT procedure
2.  Pre-op drops
3.  Laser settings

                                                          iii.      Lens selection

1.  Procedure tips
2.  Comparison to ALT
3. SLT post-op care
4.  Post-op drops (NSAID only if needed)
5. Outcomes/Effectiveness of ALT & SLT
6. Reimbursement/Global period for ALT & SLT

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Uveitis:  Systemic and Ocular Approaches to Management

Uveitis is an ocular condition with numerous etiologies and management options.  The multiple systemic conditions that are associated with uveitis require the
optometrist to be familiar with not only the ocular management, but with systemic approaches as well.  This interactive presentation will review the most common
etiologies of uveitis, signs, symptoms, and systemic work-ups/management with uveitis.

Learning Objectives:

                What is uveitis?

                To become familiar with the most common causes/etiologies of uveitis.

                To become familiar with the various classifications of uveitis.

                To become familiar with the signs & symptoms of uveitis.

                To become  familiar with the numerous systemic diseases and lab tests/workups needed for     those systemic  diseases associated with uveitis.

                To become familiar with the appropriate treatment regimens and follow-ups for uveitis                management.

Course Outline:

1. Definition of Uveitis
2. Etiology of Uveitis
3. Trauma
4. Autoimmune
5. Infections
6. Signs & Symptoms of Uveitis
7. Anterior uveitis S/S
8. Intermediate/Posterior uveitis S/S
9. Acute uveitis S/S
10. Chronic uveitis S/S
11. Common signs of Uveitis
12.  Cells & flare
13.  KP�s

                                                          iii.      Iris Nodules

1.  Band Keratopathy
2.  Cataracts
3.  Glaucoma
4. Classification/Diagnosis/Systemic Associations
5. Acute, unilateral, non-granulomatous anterior uveitis
6.  Idiopathic
7.  HLA-B27 associated uveitis
8. Ankylosing Spondylitis
9. Reactive Arthritis
10. Psoriatic Arthritis
11. Inflammatory Bowel Disease

                                                          iii.      Herpetic

1. Chronic, bilateral, non-granulomatous anterior uveitis
2.  Juvenile Idiopathic Arthritis
3.  Fuch�s Heterochromic Iridocyclitis
4. Chronic, bilateral, granulomatous anterior uveitis
5.  Sarcoid
6.  Syphilis

                                                          iii.      TB

5. Lab Testing
6. Treatment
7. Cycloplegics
8. Topical Corticosteroids
9. Follow-up

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Intense Pulsed Light (IPL) Therapy in the Optometric Practice

Intense Pulsed Light Therapy is a longstanding treatment in the dermatologic work for many skin conditions.  Accidentally it was discovered to have
ocular benefits as well.  Over the past 2-3 years, it has become an emerging treatment for numerous ocular conditions including dry eye, meibomian gland
dysfunction, ocular rosacea, chalazion, among other conditions.  This interactive one hour lecture will review and update IPL therapy in the optometric practice.

1. To review dry eye and MGD and the most common causes of both.
2. To provide a background of knowledge on IPL therapy and how it works.
3. To provide the indications and contraindications to IPL therapy, and thoroughly discuss where it falls in the optometrists treatment armamentarium for dry eye, MGD and rosacea.
4. To provide and review the treatment protocols for IPL therapy.
5. To provide and review the possible adverse events for IPL therapy.
6. To review all of the above through actual patient cases

Course Outline:

1. Etiologies of Dry Eye Syndrome
2. Evaporative
3.  Incomplete blink
4. Technology use
5. iPads, iPhones, computers, etc
6.  Lagophthalmos

                                                          iii.      MGD

1. Aqueous Deficient
2.  Sjogren�s syndrome
3. Inflammatory
4. CL related
5. Hormone related
6. Symptoms of Dry Eye Syndrome
7. Burning
8. Irritation
9. Grittiness
10. Evening dryness
11. Morning dryness
12. Blurred vision
13. Signs of Dry Eye Syndrome
14. Lid margin disease
15.  Blepharitis
16. Staphylococcal blepharitis
17. Seborrheic blepharitis
18. Demodex blepharitis
19.  Posterior blepharitis/meibomianitis
20. Frothy/foamy tears
21. Telangiectatic vessels
22. Capped glands
23. Scarred eyelid margins
24. SPK
25. Corneal staining
26. Conj staining
27. Reduced TBUT
28. Decreased Shirmer
29. Elevated Tear Osmolarity
30. Increased MMP-9 levels
31. Other etiologies of dry eye symptoms
32. Conjunctivochalasis
33. Asthenopia
34. IPL Therapy
35. Mechanism of Action
36.  Eliminates telangiectatic vessels which can leak inflammatory products contributing to dry eye
37.  Warming effect of meibomian glands which can help clear stagnant glands.

                                                          iii.      Killing of demodex which can help facilitate improvement of ocular symptoms

1. Indications
2.  Dry eye disease related to inflammation and telangiectasias
3.  MGD

                                                          iii.      Demodex blepharitis

1.  Ocular Roseacea
2.  Hordeolums
3.  Chalazion
4. Contraindications
5.  Darkly pigmented individuals
6.  Recent sunburn.

                                                          iii.      Unprotected sun exposure or solarium use 4 weeks prior to treatment.

1.  Pregnancy.
2.  History of seizures.
3.  Severe dermatitis or eczema (within the treatment area)

                                                         vii.      Active infections.

                                                       viii.      Roaccutane use in the last 6 months.

1. Treatment Protocol
2.  Eye protection is put on the patient
3.  Eye protection is worn by all people in the room

                                                          iii.      Clear ultrasound gel is applied copiously to the treatment areas

1.  Tragus to tragus treatment, 2 passes
2. Typically about 15 pulses applied in one pass from tragus to tragus
3.  In severe dry eye or MGD or chalazion/hordeolum may treat direction on the lids
4.  Clean off the ultrasound gel and remove eye shields
5. Potential Adverse Events
6.  Redness
7.  Swelling

                                                          iii.      Minor bruising

1.  Itching
2.  Peeling
3.  Scabbing

                                                         vii.      Lightening of the skin

                                                       viii.      Eyelash/hair loss

1. Follow-up
2.  A full IPL treatment includes 4 sessions, 3-6 weeks apart. Three to four weeks between sessions is best but if not possible this interval may be extended to up to 6 weeks. After each session, a date for the next session will be set up.

 ——————————-

Optometric Surgical Procedures

Optometric Surgical Procedures for Every Optometrist

Optometric Surgical Procedures, including lump and bump removal, chalazion treatment, punctal occlusion, suture correction for entropion, and various anterior segment

laser procedures, among others, are essential procedures for optometrists to be familiar with. Furthermore, optometrists in many states are now performing these
procedures on a routine basis. This interactive presentation will review and update these optometric surgical procedures including indications, contraindications,
risks, complications, treatment protocols, and pre- and post-op management.

To become familiar and review the anatomy of the lids in regards to ophthalmic surgery.

            To review the most common benign eyelid lesions and how they affect eyelid anatomy.

            To review the most common malignant eyelid lesions and how they affect eyelid anatomy.

            To become familiar with how anesthesia affects the eyelids and proper anesthesia techniques.

To become familiar with the history of Electrosurgery.

            To become familiar with the theory, advantages, indications, and contraindications of radiofrequency surgery.

            To become familiar with the equipment involved in radiofrequency surgery.

            To become familiar with the various surgical techniques used in radiofrequency surgery.

            To become familiar with the indications, contraindications, treatment protocols, complications, and follow-up with YAG laser capsulotomies.

            To become familiar with the indications, contraindications, treatment protocols, complications, and follow-up with peripheral iridotomies (PI).

            To become familiar with the indications, contraindications, treatment protocols, complications, and follow-up with selective laser trabeculoplasty (SLT).

Course Outline:

1. Ocular Eyelid Anatomy Review
2. Important to know and understand the anatomy in regards to surgical procedures
3. Lump and bump review
4. Benign eyelid lesions
5.  Most eyelid lesions are benign
6.  Originate in the epidermis and grow outward

                                                          iii.      Squamous papilloma, Seborrheic keratosis, Chalazion, Sebaceous cysts

1. Malignant eyelid lesions
2.  Basal cell carcinoma, squamous cell carcinoma, malignant melanoma
3.  Benign vs. Malignant (the following are characteristics of malignant lesions)
4. H � hair � loss of hair bearing structures
5. A � asymmetrical
6. A � abnormal blood vessels
7. B � borders irregular
8. B � bleeding reported
9. C � multicolored
10. C � change in the size or color of the lesion
11. D � diameter > 5 mm in size
12. What is Radio Frequency (RF) surgery?
13. Passage of high frequency radiowaves through soft tissue to cut, coagulate, and/or remove the target tissue
14. Advantages of Radiosurgery
15.  Cuts and coagulates at the same time
16.  Nearly bloodless field

                                                          iii.      Minimal biopsy artifact damage

1.  Quick and easy
2.  Minimal lateral heat
3.  Minimal post-op pain

                                                         vii.      Rapid healing

1. Hazards/Contraindications
2.  Excess lateral tissue damage
3.  Smoke hazard/unpleasant smells in the office

                                                          iii.      Pacemaker

1. Radiofrequency surgery indications
2. Optometric Surgical Procedures – Benign lesion removal
3. Indications
4. Contraindications
5. Risks
6. Benefits
7. Alternative procedures
8. Potential complications
9. Procedures Techniques
10. Pre- and post-op management
11. Videos of actual procedures performed by optometrists
12. Optometric Surgical Procedures � Permanent punctal occlusion
13. Indications
14. Contraindications
15. Risks
16. Benefits
17. Alternative procedures
18. Potential complications
19. Procedures Techniques
20. Pre- and post-op management
21. Videos of actual procedures performed by optometrists
22. Optometric Surgical Procedures � Chalazion Management
23. Indications
24. Contraindications
25. Risks
26. Benefits
27. Alternative procedures
28. Potential complications
29. Procedures Techniques
30. Pre- and post-op management
31. Videos of actual procedures performed by optometrists
32. Optometric Surgical Procedures � Entropion repair with lid everting sutures
33. Indications
34. Contraindications
35. Risks
36. Benefits
37. Alternative procedures
38. Potential complications
39. Procedures Techniques
40. Pre- and post-op management
41. Videos of actual procedures performed by optometrists
42. Optometric Surgical procedures � Radiofrequency trichiasis ablation
43. Indications
44. Contraindications
45. Risks
46. Benefits
47. Alternative procedures
48. Potential complications
49. Procedures Techniques
50. Pre- and post-op management
51. Videos of actual procedures performed by optometrists
52. YAG Laser Capsulotomy
53. Indications
54. Contraindications
55. Risks
56. Benefits
57. Alternative procedures
58. Potential complications
59. Procedures Techniques
60. Pre- and post-op management
61. Laser Peripheral Iridotomy (PI)
62. Indications
63. Contraindications
64. Risks
65. Benefits
66. Alternative procedures
67. Potential complications
68. Procedures Techniques
69. Pre- and post-op management
70. Selective Laser Trabeculoplasty (SLT)
71. Indications
72. Contraindications
73. Risks
74. Benefits
75. Alternative procedures
76. Potential complications
77. Procedures Techniques
78. Pre- and post-op management

      Course Page