Showing papers in "Current Opinion in Ophthalmology in 2015"
TL;DR: The diagnosis of primary CNS lymphoma (PCNSL) remains a challenge and is often delayed by several months and treatment options are still debated and the prognosis of PCNSL lymphoma is poor for most patients.
Abstract: Purpose of reviewDespite recent progress, the diagnosis of primary CNS lymphoma (PCNSL) remains a challenge and is often delayed by several months. Treatment options are still debated and the prognosis of PCNSL lymphoma is poor for most patients. This review will describe recent progress and future
220 citations
TL;DR: Ocular demodicosis is a common but overlooked eye disease that manifests a number of morbidities and Cliradex shows promising potential to reduce Demodex counts with additional antibacterial, antifungal, and anti-inflammatory actions.
Abstract: Purpose of reviewTo summarize recent advances on ocular Demodex infestation.Recent findingsDemodex infestation is a potential cause of ocular surface inflammation. The pathogenesis of Demodex in eliciting ocular surface inflammation has been further clarified. Cliradex is currently the treatment of
108 citations
TL;DR: Corneal hysteresis may be more strongly associated with glaucoma presence, risk of progression, and effectiveness of glau coma treatments than central corneal thickness.
Abstract: Purpose of reviewGlaucoma is a leading cause of irreversible blindness worldwide. It is estimated that roughly 60.5 million people had glaucoma in 2010 and that this number is increasing. Many patients continue to lose vision despite apparent disease control according to traditional risk factors. Th
101 citations
TL;DR: Intense pulsed light (IPL) therapy is a relatively new treatment in ophthalmology for patients with evaporative dry eye disease and has promising results, according to patients report subjective improvement in their symptoms.
Abstract: Purpose of reviewEvaporative dry eye disease is one of the most common types of dry eye. It is often the result of chronic meibomian gland dysfunction (MGD) and associated ocular rosacea. Evaporative dry eye and MGD significantly reduce patient's quality of life. Traditional treatments, such as arti
92 citations
TL;DR: The aim of this review was to provide an update on the recent advances in tele-ophthalmology and how it may expand the current concept of eye care delivery for diabetic eye disease.
Abstract: Purpose of reviewEvidence-based practice guidelines and treatments are highly effective in reducing vision loss from diabetic retinopathy. However, less than half of the total number of patients with diabetes mellitus receive recommended annual retinal evaluations, and vision loss due to diabetic re
72 citations
TL;DR: Despite the high prevalence of the LOXL1 variants in the general population, a much lower proportion of the population develops PEX, suggesting that in addition toLOXL1, other genetic, epigenetic and environmental factors may contribute to the development of PEX.
Abstract: Purpose of reviewPseudoexfoliation (PEX) syndrome is a common age-related disorder affecting intraocular and extraocular tissues. This review focuses on recent publications related with the pathogenesis and associations of PEX syndrome with intraocular pressure (IOP), glaucoma and systemic diseases.
70 citations
TL;DR: Defining the mechanisms that underlie glial communication could enable the development of more selective therapeutic targets, with great potential clinical applications.
Abstract: Purpose of reviewThe present review describes new advances in our understanding of the role of glial cells in the pathogenesis of glaucoma. It is becoming clear that retinal glia should not be studied in isolation in glaucoma because glia have dynamic and diverse interactions with a range of differe
68 citations
TL;DR: The potential for the treatment of achromatopsia in humans with gene therapy shows great promise and recent advances in gene therapy in animal models, clinical features in human, and barriers to human translation are described.
Abstract: Purpose of reviewThe purposes of this article are to examine the literature published on achromatopsia and provide a comprehensive review of the clinical disease, genetic characteristics, and potential for therapy. Specifically, this article will describe recent advances in gene therapy in animal mo
68 citations
TL;DR: Blood-derived products, including E-PRP, seem to be a reliable and effective therapeutic approach to enhance epithelial wound healing and promote ocular surface regeneration in different pathological conditions.
Abstract: Purpose of reviewBlood-derived products [autologous serum, eye platelet-rich plasma (E-PRP), plasma rich in growth factors] are successful therapies for ocular surface disorders, which compromise the integrity of the cornea surface and conjunctiva.Recent findingsThe most noteworthy and recent resear
64 citations
TL;DR: Although a curative therapy for blepharitis is unlikely in the near future, several novel treatment options may result in better control of this chronic condition.
Abstract: Purpose of reviewBlepharitis is one of the most common ocular pathologies encountered in the clinical setting. Despite its prevalence, successful treatment is often difficult. The purpose of this review is to provide an update on the medical management of blepharitis.Recent findingsThe available tre
61 citations
TL;DR: Promising, albeit unproven, new therapies and preventive efforts may ameliorate the negative visual outcomes of radiation retinopathy following radiotherapy for malignancies.
Abstract: Purpose of review Radiation retinopathy remains a devastating cause of visual morbidity in patients undergoing radiation for globe, orbit, and head and neck malignancies. This review discusses the recent efforts of several authors to treat radiation retinopathy once it has developed and efforts to prevent its development with early aggressive management. Recent findings Intravitreal anti-vascular endothelial growth factor agents and intravitreal steroid agents have been used to successfully treat radiation-induced macular edema and neovascular events secondary to radiation retinopathy. The visual outcomes, however, have varied. Recent work has been directed towards prevention of radiation retinopathy prior to its development. This has been done with preventive scatter laser and intravitreal bevacizumab therapy. Effective customization of radiation dose to the tumor has also reduced some collateral radiation damage. Preventive vitrectomy and silicone oil placement at the time of plaque brachytherapy may shield normal ocular structures from radiation injury. Summary Radiation retinopathy remains a major source of visual morbidity following radiotherapy for malignancies. Promising, albeit unproven, new therapies and preventive efforts may ameliorate the negative visual outcomes.
TL;DR: Clinicians should recognize that a single IOP measurement is but an often error-prone snapshot of a widely varying physiologic parameter, and IOP data should only be used in the context of the overall clinical picture.
Abstract: Purpose of reviewTonometry is undergoing a long-overdue renaissance. Goldmann applanation tonometry (GAT) is 50-year-old technology. Although GAT is considered a ‘reference standard’, it has many limitations and confounders. This review compares GAT to some of the newer technologies that have recent
TL;DR: Accurate preoperative examinations adjunct with intraoperative use of appropriate pharmacologic and mechanical devices can yield favorable outcomes in cataract surgery with a small pupil.
Abstract: Purpose of reviewPresence of a small pupil is still considered a major challenge for cataract surgeons. Appropriate mydriasis and maintaining it is of paramount importance to prevent potential serious complications. Recently, more interventions and instruments are available for the cataract surgeons
TL;DR: Scleral lenses have become a viable option for severe dry eye syndrome, and have been shown to be efficacious and well tolerated, with most reports citing improved visual acuity and relief of symptoms.
Abstract: Purpose of reviewDry eye syndrome can be difficult to manage in severe or refractory cases. In patients in whom traditional treatments have limited efficacy, alternative treatments may be considered for dry eye syndrome, including scleral lenses. The present review summarizes the evidence regarding
TL;DR: High-resolution imaging modalities have been developed that aid further detection of the microanatomical changes of the optic nerve head and thus may provide a new insight to explain the association between myopia and glaucoma.
Abstract: Purpose of reviewThe aim of the present review was to summarize the evidence implicating the association between myopia and glaucoma, the possible underlying mechanisms for this relation, and the controversies surrounding detection of glaucomatous changes in coexisting myopia.Recent findingsNumerous
TL;DR: It is found that there is still no reliable evidence that treatment of TON with corticosteroids, surgical optic canal decompression or both confers any benefit over observation alone, and yet these interventions incur an additional risk that may not warrant their routine use.
Abstract: Purpose of reviewThe purpose of this study is to discuss current controversies surrounding the proposed treatments for traumatic optic neuropathy (TON) and review recent evidence from the literature relating to these therapeutic options.Recent findingsNo recent randomized controlled trials investiga
TL;DR: Endocapsular support devices allow for cataract surgery success in the setting of zonular instability and provide additional evidence of their benefits in decreasing intraoperative and postoperative complications.
Abstract: Purpose of review To discuss capsular tension devices and recent evidence regarding their use. Recent findings The capsular tension ring, modified capsular tension ring, and capsular tension segment are well established tools for use during phacoemulsification when zonular instability is present. Recent research has provided additional evidence of their benefits in decreasing intraoperative and postoperative complications. Summary Endocapsular support devices allow for cataract surgery success in the setting of zonular instability.
TL;DR: Viscous dispersives may offer equal or increased protection of the corneal endothelium during surgery compared with viscoelastic devices currently in wide use, but further studies are required to support these results.
Abstract: Purpose of review Cataract surgery is known to lead to some degree of corneal endothelial cell loss (ECL). The purpose of this review is to describe how recent technological advancements such as femtosecond laser-assisted cataract surgery (FLACS) affect corneal endothelium during cataract surgery. Recent findings It has been suggested that FLACS may reduce the amount of required ultrasound energy used in cataract surgery, a factor known to be directly related to ECL. Several recent studies demonstrate either no difference or less ECL with FLACS than with standard phacoemulsification 1-3 months after surgery. However, results at 6 months show comparable ECL between the two techniques. Other recent advancements in surgical technique, such as biaxial microincision surgery, result in similar ECL rates to that of standard phacoemulsification. The use of ultraviolet light in the newly developing light-adjustable intraocular lenses does not increase ECL. Studies show either similar results or less ECL with the use of the newer viscous-dispersives when compared with other viscoelastic devices. Other aspects such as the use of intracameral injections have no adverse effects on corneal endothelium. Summary Newly emerging cataract surgical techniques cause comparable ECL to that of conventional phacoemulsification. Femtosecond laser-assistance may reduce ECL, but likely only in the early postoperative period. Further studies are needed to better elucidate short and long-term effects of FLACS on the corneal endothelium. Viscous dispersives may offer equal or increased protection of the corneal endothelium during surgery compared with viscoelastic devices currently in wide use, but further studies are required to support these results.
TL;DR: The innovative iterations of OCT technology have the potential to further improve the performance of the technology in evaluating ocular structural and functional characteristics and longitudinal changes in glaucoma.
Abstract: Purpose of reviewOptical coherence tomography (OCT) has become the cornerstone technology for clinical ocular imaging in the past few years. The technology is still rapidly evolving with newly developed applications. This manuscript reviews recent innovative OCT applications for glaucoma diagnosis a
TL;DR: Although pars plana intravitreal injection remains the mainstay of therapy for many vitreoretinal diseases, targeted delivery and implantable eluting devices are rapidly demonstrating safety and efficacy.
Abstract: Purpose of reviewEmerging developments and research for drug delivery to the posterior segment offer a promising future for the treatment of vitreoretinal disease. As new technologies enter the market, clinicians should be aware of new indications and ongoing clinical trials.Recent findingsThis revi
TL;DR: A greater understanding of the environmental components associated with XFS may lead to lifestyle preventive strategies to ameliorate disease burden.
Abstract: Purpose of reviewExfoliation syndrome (XFS), the most common cause of secondary open angle glaucoma, is associated with significant ocular morbidity. Recent studies have pointed toward environmental components that may alter the risk of XFS development. This review focuses on the recent studies eluc
TL;DR: Familiarity with reported rates of postoperative choroidal effusions, patient risk factors, and management strategies will aid in reducing the frequency of these complications and in improving patient care.
Abstract: Purpose of review A diverse range of surgical approaches are now used for glaucoma management. This review compares the reported rates of serous choroidal effusion and suprachoroidal hemorrhage after various glaucoma surgical procedures. As these complications can be visually devastating, we summarize the current literature on prevention strategies and management. Recent findings Trabeculectomy remains one of the most effective and widely used glaucoma surgeries, but it is also associated with a significant rate of complications, including serous choroidal effusion and suprachoroidal hemorrhage. Alternative surgical techniques for glaucoma management are increasingly utilized due in part to their lower rate of associated complications. Prevention measures for serous choroidal effusion and suprachoroidal hemorrhage include the recognition of patient risk factors and careful selection of glaucoma surgical technique. Management options include observation, medications, office-based procedures, and surgical interventions directed at maximizing patient outcomes. Summary Familiarity with reported rates of postoperative choroidal effusions, patient risk factors, and management strategies will aid in reducing the frequency of these complications and in improving patient care.
TL;DR: In this article, the authors provide an update of phase 1 and 2 clinical trials in neovascular age-related macular degeneration that are either currently underway or recently completed by the end of 2014.
Abstract: Purpose of reviewThe purpose of this review is to provide an update of phase 1 and 2 clinical trials in neovascular age-related macular degeneration that are either currently underway or recently completed by the end of 2014.Recent findingsThree gene therapy options are currently in early clinical t
TL;DR: This article reviews the current literature on pediatric blepharokeratoconjunctivitis to enhance the understanding on the incidence, clinical course, and treatment options.
Abstract: Purpose of reviewThis article reviews the current literature on pediatric blepharokeratoconjunctivitis (BKC) to enhance the understanding on the incidence, clinical course, and treatment options.Recent findingsPediatric BKC is a disorder with a wide spectrum of clinical manifestations. Therapies tar
TL;DR: Good outcomes in terms of long-term IOP control have been found following lens extraction for PACG, and lens extraction should be considered in patients withPACG, especially with hyperopia, or a thick and anteriorly vaulted lens.
Abstract: Purpose of reviewLens extraction for primary angle-closure glaucoma (PACG) is a subject of increased interest recently, with advocates promoting its benefits of anatomical opening of the angle, intraocular pressure (IOP) reduction and improved vision. The present review seeks to evaluate recent avai
TL;DR: Phacoemulsification of uncomplicated cataracts with intraocular lens implantation can be performed safely in high-risk patients, taking both anticoagulants and antiplatelet drugs when topical anesthesia is administered and cataract surgery is performed through a clear corneal incision by a skilled surgeon.
Abstract: Purpose of review The objective of this review is to evaluate the result of cataract surgery in patients continuing antiplatelet and/or anticoagulant treatment. Recent findings The number of elderly patients using anticoagulant and antiplatelet treatment in prevention of venous thromboembolism has significantly increased in recent years. It was believed for many years that those patients might be at higher risk for complications during ocular surgery. Thus, different strategies were proposed to prevent these complications, including discontinuation of anticoagulants, dose reduction, or low-molecular-weight heparin replacement. We performed a PubMed search over a period of 7 years (2007-2013) about possible intraoperative and postoperative complications in patients receiving anticoagulant and/or antiplatelet therapy at the time of cataract surgery. No significant increase in intraoperative or postoperative complications has been identified. Summary Phacoemulsification of uncomplicated cataracts with intraocular lens implantation can be performed safely in high-risk patients, taking both anticoagulants and antiplatelet drugs when topical anesthesia is administered and cataract surgery is performed through a clear corneal incision by a skilled surgeon.
TL;DR: SMILE is a promising new surgery for refractive error correction and Prospective and retrospective studies have shown that results of SMILE are similar to FS-LASIK, with advances in femtosecond laser technology.
Abstract: Purpose of reviewSmall-incision lenticule extraction (SMILE) is a novel technique devised to correct refractive errors. SMILE circumvents excimer laser photoablation of cornea, as the stromal lenticule cut by femtosecond laser is removed manually. Smaller incisions and preservation of anterior corne
TL;DR: VKH disease is an autoimmune, multisystem inflammatory disorder, the cause of which is still incompletely understood, and continued research may elucidate the causes and triggers of immune dysregulation in this disease, and in doing so, identify novel therapeutic targets.
Abstract: Purpose of reviewThe purpose of this article is to review the current literature on Vogt−Koyanagi−Harada (VKH) disease, including current treatment options and new research directions.Recent findingsRecent publications on VKH disease show an increased focus on the immunogenetics and immune pathways
TL;DR: A review of the available published peer-reviewed results of the novel vectored thermal pulsation therapy for patients with MGD is investigated in this article, which revealed a significant increase in meibomian gland function (∼3×) and symptom improvement post a single 12-min treatment.
Abstract: Purpose of review Meibomian gland dysfunction (MGD) is understood to be a highly prevalent, chronic progressive disease and the leading cause of dry eye. All available published peer-reviewed results of the novel vectored thermal pulsation therapy for patients with MGD are investigated. Recent findings The PubMed and meeting abstract search revealed a total of 31 peer-reviewed reports on vectored thermal pulsation therapy at the time of the search (eight manuscripts and 23 meeting abstracts). All manuscripts evidence a significant increase in meibomian gland function (∼3×) and symptom improvement post a single 12-min treatment. Additional reported objective measures such as osmolarity, tear break-up time, or lipid layer thickness also increased as a result of the therapy; however, not all findings were statistically significant. The randomized controlled studies evidence sustained gland function and symptom relief lasting out to 12 months. The uncontrolled case series evidence significantly longer duration of effect. Summary A single 12 minute vectored thermal pulsation treatment allows for reducing dry eye symptoms, improving meibomian gland function and other correlates of the ocular surface health.
TL;DR: On the basis of recently published data, contrast-enhanced MRI is recommended for all patients presenting with acute, isolated ocular motor mononeuropathies irrespective of age.
Abstract: Purpose of reviewThis article will discuss the management of isolated, acute cranial nerve 3,4 and 6 palsies with special focus on the role of neuroimaging in older adults based on recently published data.Recent findingsAcute cranial nerve palsies affecting the third, fourth or sixth cranial nerves