Course

Evaluating The Posterior Segment With New Technologies

Presented by
William L. Jones, O.D., F.A.A.O

Course Information:

Retinal Breaks and Detachment - 2 hours

Peripheral retinal breaks discusses the following entities: atrophic holes, operculated and flap tears, retinal dialyses, and giant tears, and retinal detachments. It is comprehensive lecture that will clearly demonstrate how retinal breaks appear on the fundus camera, BIO, and wide field imaging systems, which allows the attendee to see these entities in many clinical aspects of fundus examination. The wide field images provide a view of the lesions in ways not seen before and this allows for a greater understanding of their appearance and pathophysiology in the eye. Also, "B" scan ultrasonography will be presented to show retinal breaks and detachments in another imaging media. An important aspect of the presentation is the imaging of these lesions using scleral depression will allow the clinician to appreciate the actual application of scleral depression and to demonstrate how it aids in the diagnosis of retinal breaks.

 Learning objectives: 

            1. Gain knowledge of how to diagnose peripheral breaks and detachments using   

            scleral depression.

            2. Learn the significance of retinal breaks and recognize the ones that need immediate referral.

            3. Learn the treatment aspects of breaks.

 
Peripheral Retinal Degenerations - 2 hours

Peripheral retinal degenerations is a presentation of retinal degenerations, some of which may lead to a retinal break/detachment. The some of the retinal degenerations are seen with scleral depression in order to enhance the clinician's diagnostic acumen. There will be images from a wide field imaging system, which will allow for a far greater better understanding of these lesions. Pigmented lesions to be presented are: congenital hypertrophy of the pigment epithelium, pigment clumping secondary to vitreous traction, and tapetochoroidal pigmentary degeneration. Other entities to be discussed are: retinal tuft, meridional retinal folds, chorioretinal atrophy, white-without-pressure, and retinoschisis. The last segment of the lecture will cover the lesions most likely to cause a retinal break/detachment and will include lattice and snail track degeneration.

 Learning objectives:

            1. Gain knowledge of how to diagnose peripheral retinal abnormalities and breaks             using scleral depression of lattice and snail tracking.

            2. Learn the significance of peripheral retinal degenerations and the ones that need closer follow-up.

            3. See images of retinopexy of lattice lesions.

Diagnosis of Anomalies of the Optic Nerve           1hour

Diagnosis of anomalies of the optic nerve head is important in the care of our patients. Even though most of the conditions to be discussed are stable and usually do not cause great harm to the patient's sight; proper management is required in following and counseling these patients. The course will begin with the anatomy of the optic nerve, which will include histological slides. Next developmental anomalies of the optic nerve head will be discussed. The anomalies to be presented are: medullated nerve fibers, Bergmeister's papilla, anomalous disc vessels, cilioretinal vessels, hypoplastic discs, colobomas, optic pits, tilted discs and large physiologic disc cupping. Acquired anomalies to be presented are: intrapapillary drusen, melanocytomas, myopic changes with tilted discs and peripapillary crescents. Many histopathological examples, visual field analysis studies will be presented, and never seen before OCT images.

 Learning objectives: 

            1. Learn how to diagnose congenital and acquired anomalies of the optic nerve.

            2. Gain knowledge of the significance of different anomalies of the and how they affect the visual performance of the patient.

            3. Learn how OCT images many of these anomalies.

 Diabetic Eye Disease - 2 Hours 

The course will cover the etiology of diabetic eye disease, detection, prognosis, and treatment. There will be discussion about the histopathological changes seen in the eye as they relates to tissue hypoxia and neovascularization.  New technologies such as OCT will be presented that will greatly help in understanding. Clinical entities such as capillary "drop-out", IRMA, retinal neovascularization, vitreous hemorrhage, rubeosis iridis, and neovascular glaucoma will be presented. A discussion of how changes in serum glucose causes refractive error shifts will be given. Fluorescein angiography (both regular and wide –field studies) will be discussed. OCT images will reveal retinal changes not easily seen on ophthalmoscopy, e.g. macular edema. The treatment of diabetic eye disease will include photocoagulation, cryotherapy and vitrectomy.

 Learning objectives:           

1. Learn to use new technologies such as OCT and Kinetic Field Testing to diagnose the many forms of DR.

            2. Concentrate on gaining knowledge on detecting background, ischemic, and proliferative diabetic retinopathy.

            3. Observe examples of fluorescein angiography regular, including wide-field FA.

 Ocular Trauma of the Posterior - 2 Hours

 The course will cover various traumatic insults to the posterior segment, including diagnosis and treatment. The lecture starts with the lens and ends with the bony orbit. The topics include: dislocation and cataracts of the lens, vitreous prolapse in the AC, vitreous hemorrhage, commotio retinae, retinal tears, choroidal ruptures, optic atrophy, avulsion of the optic nerve and retinitis scolopteria, Lastly, there will be a discussion of fractures of the orbital walls and will include: blow-out Fx of the orbital floor, ethmoid wall Fx, and tripod facial Fx. Video of moving subluxated, luxated lens, and iridophacodonesis will be shown. 

Learning objectives:           

            1. To be exposed to the many forms of trauma to the posterior segment.

            2. To become aware of the significance of trauma and the affect on visual acuity.

            3. To be able to see actual movement of dislocated lenses and iridodonesis.

New Technologies to Detect Retinal/Choroidal Disease – 2 hours  

The course will discuss new technologies to detect retinal and choroidal diseases. Technologies to be discussed are: scanning laser ophthalmoscope (SLO), optical coherence tomography, preferential hyperacuity perimetry (PHP), kinetic field test (KFT), and scanning laser ophthalmoscope microperimeter. Emphasis will be placed on the use of SLO, OCT, and PHP. Topics to be covered are: macular holes, retinal tears, retinal detachment, congenital and acquired pigment epithelial hypertrophy and hyperplasia, retinoschisis, choroidal nevus and melanoma, diabetic retinopathy, macular edema, dry and wet AMD, and more.

 Learning objectives

1.      Learn about how the scanning laser ophthalmoscopes can be used in daily practice.

2.      Learn how ocular coherent tomography and kinetic field testing can be used to detect retinal diseases.

3.      Learn how the PHP is able to detect choroidal neovascular membranes.

How Ocular Coherence Tomography (OCT) Greatly Enhances Diagnosis of Glaucoma, Retina, and Optic Nerve Head Problems – 2 hours

The discussion begins with a description of how that Stratus 3 captures tomographic images of the optic disc and retina.  Next, a description of the parameters of used by the Stratus to determine the likelihood of glaucoma and this is followed by many examples of glaucoma suspects and glaucoma proven cases. The lecture will continue with numerous retinal lesions to show how they can be diagnosed with OCT. Proven cases of lesions not visible with the human eye are detected with OCT. lastly, there will be images of optic disc conditions (not glaucomatous) that can be seen with OCT.

Learning objectives:

            1. How does the Stratus 3 works.

            2. Learn how to diagnose glaucoma with OCT.

            3. Learn how to diagnose retina and optic nerve head lesions with OCT.

Vitreo-macular, -retina, and –disc traction. What every eye doctor should know.  2 hours 

The course will discuss vitreo-macular, vitreo-retinal, and vitreo-disc traction. There will be an extensive discussion on the pathophysiology of a PVD and will include partial and total PVDs. OCT allows for a view of the vitreous and retina never seen clinically before. There is vitreous traction on the macula, retina, and disc long before and long after a PVD. The type and extent of this traction is just now being understood. Complications to be discussed are: macular disruption, epiretinal membrane formation, macular hole, macular edema, and serous tractional detachment. The vitreous traction will be examined by ocular coherence tomography and ultrasonography. A discussion of the proper method of following an acute PVD will be provided. Vitrectomy will be briefly covered.

Learning objectives:

            1. Understand how ocular coherence tomography works.

            2. Learn how to diagnose unseen vitreous traction with OCT.

            3. Learn how vitreous traction produces retinal disease with OCT.
 

 Age-related Macular Degeneration. New Technologies to Detect it and New Treatments  
- 1 hour

 Age-related macular degeneration will be discussed both in the “dry” and “wet” forms. The underlying pathophysiology will be presented along with thoughts about the theories of how this condition occurs. OCT, Preferential Hyperacuity Perimetry (PHP), Kinetic Field Test (KFT), and Fluorescein angiographic studies will be presented to show how to better diagnose this condition. Histopathology slides will be shown and point out how they compare to OCT imagery. Known long-term and short term risk factors will be covered. Discussion concerning the proper methods on following these patients will be provided. Lastly, the numerous treatment modalities will be considered including: intravitreal and periocular steroid and steroid-like medications, intravitreal anti VEGF drugs, transpupillary thermal treatment, macular translocation surgery, and lastly ocular vitamin treatment.

 Learning objectives:

            1. The clinician will gain further comprehension of the pathophysiology of AMD

2. The clinician will understand when referral for laser and drug treatment is necessary.

            3. How one uses new technologies to detect these conditions will be understood.

16 COPE approved continuing education credits
Dr. Travel, LLC is an approved COPE provider