UCSF Ophthalmology and Proctor Foundation at “AAO 2019 Annual Meeting”

UCSF Ophthalmology and Proctor Foundation Faculty are attending the American Academy of Ophthalmology “AAO 2019” annual meeting in San Francisco, from Saturday, Oct 12th, 2019 to Tuesday, October 15th, 2019.  Faculty presentations and contributions for the event are listed below.

The Francis I. Proctor Foundation, the Department of Ophthalmology, the Frederick C. Cordes Eye Society, and That Man May See are hosting the annual Alumni Cocktail Reception on Saturday, October 12, from 6 p.m. to 8 p.m. at STEM Kitchen & Garden. Please respond by calling 415.476.4016.

 

AAO 2019 Meeting: UCSF Faculty Presentations and Contributions


Nisha Acharya MD

Letermovir for the Management of Cytomegalovirus-Associated Uveitis

Abstract: Purpose To investigate the use of letermovir 480 mg daily for treatment of cytomegalovirus (CMV)-associated uveitis (AU). Methods Retrospective chart review of patients with CMV-AU on letermovir. Results Six eyes of five patients (mean age: 54 years) were included. Mean follow-up time was 9 months. Four patients had CMV anterior uveitis, and one patient had bilateral CMV retinitis. All were treated initially with valganciclovir (VGC) 900 mg twice daily. Transition to letermovir was due to cytopenias (n = 3), transaminitis (n = 1) and persistent inflammation on VGC (n = 1). At initiation of letermovir, mean visual acuity (VA) was 0.35 logMAR and mean IOP was 14 mmHg. One of six eyes had recurrence of anterior uveitis due to self-discontinuation of letermovir. No adverse events were observed. At last follow-up, no patients had active inflammation. Mean VA was 0.13 logMAR, and mean IOP was 9 mmHg. Conclusion Letermovir may be an alternative treatment for CMV-AU in patients with persistent inflammation or side effects on VGC.

Saturday, 9:00 am- Tuesday 1:00 pm
Session: PO525            Location: EPOSTER & VIDEO TERMINALS

 

Reproducibility of Vitreous Haze Grading: Comparison of Reading Center and Clinician Grades in a Uveitis Clinical Trial

Abstract: Purpose To evaluate the reproducibility of assessing vitreous haze using six-step (NIH) and nine-step (Miami) scales by clinical and reading center grading. Methods Inter-rater agreement study of 1,036 images from 216 consecutive patients enrolled at nine international centers in the First-line Antimetabolites as Steroid-sparing Treatment Uveitis Trial. Results Exact agreement between clinicians was substantial for NIH and Miami scales (k 0.69 and 0.62, respectively). and within 1 (0.96 and 0.92) and within 2 (0.99 and 0.98) levels of agreement were almost perfect. Exact agreement between reading center and clinician grading was low for both scales (0.14 and 0.11). However, within 1 (0.73 and 0.67) and within 2 (0.89 and 0.84) levels of agreement were substantial. Conclusion Reading center grading of vitreous haze can be incorporated into multicenter trials using both ordinal scales to offer a reproducible method of assessing inflammation within one grade. Image quality improvement may enhance correlation with clinical grading.

Saturday  9:00AM – Tuesday  1:00PM
Session: PO533    Location: EPOSTER & VIDEO TERMINALS

 

Vogt-Koyanagi-Harada Outcomes From the First-Line Antimetabolites For Steroid-Sparing Treatment (FAST) Uveitis Trial

Abstract: Purpose A subanalysis of outcomes in Vogt-Koyanagi-Harada (VKH) patients from the FAST Uveitis Trial. Methods Patients were randomized to receive 25-mg weekly oral methotrexate (MTX) or 1.5-g twice daily oral mycophenolate mofetil (MMF), with a standardized prednisone taper, and followed for 6 months. Results Ninety-three patients had a VKH diagnosis; 49 patients were randomized to MTX and 44 to MMF. Treatment success was higher with MTX (80.4%) compared to MMF (64.1%); OR, 2.3; 95% CI, 0.9-6.3; P = .10. MTX was superior in reducing central subfield thickness (P = .004) and resolving serous retinal detachments (P = .02). Acute VKH patients had greater improvement in visual acuity (mean change in logMAR: −0.37; SD, 0.38) than chronic VKH patients (mean change in logMAR: −0.16; SD, 0.27; P = .0004). Conclusions MTX is an affordable antimetabolite that may be more effective than MMF for VKH. Earlier treatment is associated with better visual outcomes.

Herpetic Ocular Disease: A Comprehensive Clinical Approach 

Abstract: Synopsis Herpetic ocular disease caused by herpes simplex virus (HSV), varicella zoster virus (VZV) and cytomegalovirus (CMV) is an important cause of ocular morbidity and a major health problem with remarkable impact on visual outcome. The wide spectrum of herpetic ocular disease may range from anterior segment inflammation, including keratitis, anterior uveitis and scleritis, to the more severe forms of posterior uveitis and retinitis. Recognition of viral retinitis may be challenging for the ophthalmologist, especially in the era of intravitreal corticosteroid therapy. Prompt and specific antiviral treatment is needed [in order] to avoid severe visual loss. In this course, instructors will use interactive discussion sessions to present the most common clinical manifestations of and the diagnostic and therapeutic approaches to different ocular herpetic diseases. Objective At the end of this course, the attendees will be able to develop a stepwise approach to diagnosing and managing herpetic ocular disease caused by HSV, VZV and CMV.

Sunday,  10:15AM – 12:30PM
Session: 211    Location: NORTH 20

One-Year Outcomes of Uveitic Macular Edema in the First-Line Antimetabolites as Steroid-Sparing Treatment (FAST) Uveitis Trial

Abstract: Purpose To compare outcomes of uveitic macular edema (UME) in the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Trial. Methods Patients received methotrexate (MTX) 25 mg weekly or mycophenolate mofetil (MMF) 1.5 g twice daily for 12 months. At the 6-month primary endpoint, treatment failures switched treatments. Results Of 216 patients in the FAST Trial, 42 eyes in the MTX group and 55 eyes in the MMF group had UME. Baseline median logMAR visual acuity (VA) was 0.40 in the MTX group and 0.38 in the MMF group. Baseline median central subfield thickness (CST) was 359 μm in the MTX group and 342 μm in the MMF group. At 12 months, CST was 339 μm in the MTX group and 336 μm in the MMF group (P = .76), and logMAR VA was 0.25 in the MTX group and 0.28 in the MMF group (P = .80). In patients who switched treatment, CST was 319 μm in the MTX group and 326 μm in the MMF group (P = .28), and logMAR VA was 0.27 in the MTX group and 0.25 in the MMF group (P = .26). A 20% decrease in CST was associated with a median 0.5 logMAR VA improvement. Conclusions Treatment with MTX or MMF for UME results in a similar decrease in CST and improvement in VA at 12 months.

Monday,  9:18AM – 9:25AM
Session: PA035 Location: SOUTH 152

ePoster Discussion: Uveitis

Monday,  1:00PM – 1:30PM
Session: PD40    Location: Poster Theater & Lounge: STATION 2


Robert B Bhisitkul MD

Management of the Vitreous for the Anterior Segment Surgeon

Abstract: Synopsis This Skills Transfer course will present management of the vitreous during complicated anterior segment surgery. A variety of vitrectomy techniques will be discussed. Topics will include anterior vitrectomy, pars plana access to the anterior vitreous and effective use of small-gauge instrumentation. Objective This course is designed to enhance participants’ technical skills in handling vitreous during complicated anterior segment surgery.

Monday,  8:00AM – 9:30AM
Session: LAB130A         Location: SOUTH 7

Management of the Vitreous for the Anterior Segment Surgeon

Abstract: Synopsis This Skills Transfer course will present management of the vitreous during complicated anterior segment surgery. A variety of vitrectomy techniques will be discussed. Topics will include anterior vitrectomy, pars plana access to the anterior vitreous and effective use of small-gauge instrumentation. Objective This course is designed to enhance participants’ technical skills in handling vitreous during complicated anterior segment surgery.

Tuesday, 10:30AM – 12:00PM
Session: LAB130B         Location: SOUTH 7


Michele M Bloomer MD

Advanced Refractive Cataract Surgery and Anterior Segment Reconstruction 

Abstract: Synopsis This course is designed for surgeons who want to expand their armamentarium for dealing with difficult cataracts with zonular dehiscence, and dislocated IOLs. Objectives This  course will cover iris suture and scleral fixation techniques for IOLs, in addition to optic capture in cases of compromised capsules, Hoffman pockets for scleral fixation, capsular tension rings including Cionni-modified and Ahmed segments, artificial iris versus primary closure for iris defects, cerclage suture for atonic mydriatic pupils and strategies for dealing with challenging cases. These techniques will be presented in the didactic course, and many will be practiced in the Skills Transfer lab.

Sunday, 3:30PM – 5:30PM
Session: LAB121A         Location: SOUTH 7


Matilda F Chan MD PhD

Step-by-Step Management of Dry Eye Disease

Abstract: Synopsis Dry eye is a very common disease with a wide range of severity, and thus an individualized approach is necessary for treatment of each patient. There are many options available to treat dry eye, and these have been expanded enormously in recent years. Based on its severity, treatment of dry eye may include lubrication, anti-inflammatory therapy, punctal occlusion, tear stimulants, autologous serum drops, prosthetic replacement of the ocular surface ecosystem (PROSE) and transplantation of salivary glands. In addition, treatment of evaporative dry eye in meibomian gland dysfunction (MDG) has lately been expanded to include topical therapy as well as probing. In this course, leading experts in the field will discuss their knowledge of and experience with these different therapeutic measures for dry eye patients. Objective At the conclusion of this course, the attendee will be able to develop a practical algorithm for step-by-step management of dry eye and MGD for each individual patient.

Tuesday, 12:45PM – 3:00PM
Session: 675    Location: SOUTH 156


Thuy A Doan, MD, PHD

Letermovir for the Management of Cytomegalovirus-Associated Uveitis

Abstract: Purpose To investigate the use of letermovir 480 mg daily for treatment of cytomegalovirus (CMV)-associated uveitis (AU). Methods Retrospective chart review of patients with CMV-AU on letermovir. Results Six eyes of five patients (mean age: 54 years) were included. Mean follow-up time was 9 months. Four patients had CMV anterior uveitis, and one patient had bilateral CMV retinitis. All were treated initially with valganciclovir (VGC) 900 mg twice daily. Transition to letermovir was due to cytopenias (n = 3), transaminitis (n = 1) and persistent inflammation on VGC (n = 1). At initiation of letermovir, mean visual acuity (VA) was 0.35 logMAR and mean IOP was 14 mmHg. One of six eyes had recurrence of anterior uveitis due to self-discontinuation of letermovir. No adverse events were observed. At last follow-up, no patients had active inflammation. Mean VA was 0.13 logMAR, and mean IOP was 9 mmHg. Conclusion Letermovir may be an alternative treatment for CMV-AU in patients with persistent inflammation or side effects on VGC.

Saturday  9:00AM – Tuesday  1:00PM
Session: PO525            Location: EPOSTER & VIDEO TERMINALS

Vogt-Koyanagi-Harada Outcomes From the First-Line Antimetabolites For Steroid-Sparing Treatment (FAST) Uveitis Trial

Abstract: Purpose A subanalysis of outcomes in Vogt-Koyanagi-Harada (VKH) patients from the FAST Uveitis Trial. Methods Patients were randomized to receive 25-mg weekly oral methotrexate (MTX) or 1.5-g twice daily oral mycophenolate mofetil (MMF), with a standardized prednisone taper, and followed for 6 months. Results Ninety-three patients had a VKH diagnosis; 49 patients were randomized to MTX and 44 to MMF. Treatment success was higher with MTX (80.4%) compared to MMF (64.1%); OR, 2.3; 95% CI, 0.9-6.3; P = .10. MTX was superior in reducing central subfield thickness (P = .004) and resolving serous retinal detachments (P = .02). Acute VKH patients had greater improvement in visual acuity (mean change in logMAR: −0.37; SD, 0.38) than chronic VKH patients (mean change in logMAR: −0.16; SD, 0.27; P = .0004). Conclusions MTX is an affordable antimetabolite that may be more effective than MMF for VKH. Earlier treatment is associated with better visual outcomes.

Saturday  9:00AM – Tuesday  1:00PM
Session: PO534            Location: EPOSTER & VIDEO TERMINALS

One-Year Outcomes of Uveitic Macular Edema in the First-Line Antimetabolites as Steroid-Sparing Treatment (FAST) Uveitis Trial

Abstract: Purpose To compare outcomes of uveitic macular edema (UME) in the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Trial. Methods Patients received methotrexate (MTX) 25 mg weekly or mycophenolate mofetil (MMF) 1.5 g twice daily for 12 months. At the 6-month primary endpoint, treatment failures switched treatments. Results Of 216 patients in the FAST Trial, 42 eyes in the MTX group and 55 eyes in the MMF group had UME. Baseline median logMAR visual acuity (VA) was 0.40 in the MTX group and 0.38 in the MMF group. Baseline median central subfield thickness (CST) was 359 μm in the MTX group and 342 μm in the MMF group. At 12 months, CST was 339 μm in the MTX group and 336 μm in the MMF group (P = .76), and logMAR VA was 0.25 in the MTX group and 0.28 in the MMF group (P = .80). In patients who switched treatment, CST was 319 μm in the MTX group and 326 μm in the MMF group (P = .28), and logMAR VA was 0.27 in the MTX group and 0.25 in the MMF group (P = .26). A 20% decrease in CST was associated with a median 0.5 logMAR VA improvement. Conclusions Treatment with MTX or MMF for UME results in a similar decrease in CST and improvement in VA at 12 months.

Monday,  9:18AM – 9:25AM
Session: PA035 Location: SOUTH 152


Jacque L Duncan MD 

Retinal Frontiers: Updates in Retinal Gene Therapy

Abstract: Synopsis In this course, we will discuss new treatments for inherited retinal dystrophies, focusing on updates in the fields of retinal gene therapy. A panel of international experts in these fields will provide a didactic introductory lecture, followed by an open panel discussion. Objectives At the conclusion of this course, the attendee will be able to (1) better counsel patients with retinal dystrophies regarding updates in clinical characterization and possible therapies, (2) describe the logistics of ordering and interpreting genetic testing, (3) counsel patients regarding the nuts and bolts of viral vector-mediated retinal gene therapy and categories of gene therapy, (4) deepen their understanding of the surgical implications of these treatment modalities and (5) describe updates in current-day clinical trials in the fields of retinal gene therapy.

Monday,  2:00PM – 4:15PM
Session: 480    Location: SOUTH 156SOIGPASS


John A Gonzales MD

Letermovir for the Management of Cytomegalovirus-Associated Uveitis

Abstract: Purpose To investigate the use of letermovir 480 mg daily for treatment of cytomegalovirus (CMV)-associated uveitis (AU). Methods Retrospective chart review of patients with CMV-AU on letermovir. Results Six eyes of five patients (mean age: 54 years) were included. Mean follow-up time was 9 months. Four patients had CMV anterior uveitis, and one patient had bilateral CMV retinitis. All were treated initially with valganciclovir (VGC) 900 mg twice daily. Transition to letermovir was due to cytopenias (n = 3), transaminitis (n = 1) and persistent inflammation on VGC (n = 1). At initiation of letermovir, mean visual acuity (VA) was 0.35 logMAR and mean IOP was 14 mmHg. One of six eyes had recurrence of anterior uveitis due to self-discontinuation of letermovir. No adverse events were observed. At last follow-up, no patients had active inflammation. Mean VA was 0.13 logMAR, and mean IOP was 9 mmHg. Conclusion Letermovir may be an alternative treatment for CMV-AU in patients with persistent inflammation or side effects on VGC.

Saturday  9:00AM – Tuesday  1:00PM
Session: PO525            Location: EPOSTER & VIDEO TERMINALS

Reproducibility of Vitreous Haze Grading: Comparison of Reading Center and Clinician Grades in a Uveitis Clinical Trial

Abstract: Purpose To evaluate the reproducibility of assessing vitreous haze using six-step (NIH) and nine-step (Miami) scales by clinical and reading center grading. Methods Inter-rater agreement study of 1,036 images from 216 consecutive patients enrolled at nine international centers in the First-line Antimetabolites as Steroid-sparing Treatment Uveitis Trial. Results Exact agreement between clinicians was substantial for NIH and Miami scales (k 0.69 and 0.62, respectively). and within 1 (0.96 and 0.92) and within 2 (0.99 and 0.98) levels of agreement were almost perfect. Exact agreement between reading center and clinician grading was low for both scales (0.14 and 0.11). However, within 1 (0.73 and 0.67) and within 2 (0.89 and 0.84) levels of agreement were substantial. Conclusion Reading center grading of vitreous haze can be incorporated into multicenter trials using both ordinal scales to offer a reproducible method of assessing inflammation within one grade. Image quality improvement may enhance correlation with clinical grading.

Saturday  9:00AM – Tuesday  1:00PM
Session: PO533            Location: EPOSTER & VIDEO TERMINALS

Vogt-Koyanagi-Harada Outcomes From the First-Line Antimetabolites For Steroid-Sparing Treatment (FAST) Uveitis Trial

Abstract: Purpose A subanalysis of outcomes in Vogt-Koyanagi-Harada (VKH) patients from the FAST Uveitis Trial. Methods Patients were randomized to receive 25-mg weekly oral methotrexate (MTX) or 1.5-g twice daily oral mycophenolate mofetil (MMF), with a standardized prednisone taper, and followed for 6 months. Results Ninety-three patients had a VKH diagnosis; 49 patients were randomized to MTX and 44 to MMF. Treatment success was higher with MTX (80.4%) compared to MMF (64.1%); OR, 2.3; 95% CI, 0.9-6.3; P = .10. MTX was superior in reducing central subfield thickness (P = .004) and resolving serous retinal detachments (P = .02). Acute VKH patients had greater improvement in visual acuity (mean change in logMAR: −0.37; SD, 0.38) than chronic VKH patients (mean change in logMAR: −0.16; SD, 0.27; P = .0004). Conclusions MTX is an affordable antimetabolite that may be more effective than MMF for VKH. Earlier treatment is associated with better visual outcomes.

Saturday  9:00AM – Tuesday  1:00PM
Session: PO534            Location: EPOSTER & VIDEO TERMINALS

Diagnose This Live

Abstract: In this highly interactive session, attendees will be divided into three teams that will compete to correctly diagnose new Diagnose This quizzes developed by the Academy’s Online Education Committee specifically for this event. Topics will span the ophthalmic realm, from cataract to uveitis, and a panel will lead discussions around the various diagnostic dilemmas.

Saturday,  1:00PM – 2:00PM
Session: SYM06            Location: SOUTH 202-203

How to Recognize and Treat Infectious Uveitis

Abstract: Synopsis This course will focus on how to recognize infectious uveitis, especially those entities that require immediate diagnosis and treatment to avoid vision loss. Because pattern recognition is vital in the initial diagnosis of infectious uveitis, each instructor will present illustrative cases to include the history, signs and symptoms of each entity. Objectives Attendees will have the opportunity to actively participate in this course by helping the instructor describe the imaging studies, thus learning to recognize the pattern. A broad range of infections will be presented. At the end of this course, attendees will be able to recognize and differentiate between the various necrotizing retinitis syndromes that can lead to vision loss, including herpes simplex, varicella zoster, cytomegalovirus and toxoplasmosis, based on the patient’s history and clinical presentation. The attendees will also know how to approach immediate treatment in each case and when to refer a patient to a subspecialist.

Sunday,  3:15PM – 5:30PM
Session: 271    Location: SOUTH 311

One-Year Outcomes of Uveitic Macular Edema in the First-Line Antimetabolites as Steroid-Sparing Treatment (FAST) Uveitis Trial

Abstract: Purpose To compare outcomes of uveitic macular edema (UME) in the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Trial. Methods Patients received methotrexate (MTX) 25 mg weekly or mycophenolate mofetil (MMF) 1.5 g twice daily for 12 months. At the 6-month primary endpoint, treatment failures switched treatments. Results Of 216 patients in the FAST Trial, 42 eyes in the MTX group and 55 eyes in the MMF group had UME. Baseline median logMAR visual acuity (VA) was 0.40 in the MTX group and 0.38 in the MMF group. Baseline median central subfield thickness (CST) was 359 μm in the MTX group and 342 μm in the MMF group. At 12 months, CST was 339 μm in the MTX group and 336 μm in the MMF group (P = .76), and logMAR VA was 0.25 in the MTX group and 0.28 in the MMF group (P = .80). In patients who switched treatment, CST was 319 μm in the MTX group and 326 μm in the MMF group (P = .28), and logMAR VA was 0.27 in the MTX group and 0.25 in the MMF group (P = .26). A 20% decrease in CST was associated with a median 0.5 logMAR VA improvement. Conclusions Treatment with MTX or MMF for UME results in a similar decrease in CST and improvement in VA at 12 months.

Monday,  9:18AM – 9:25AM
Session: PA035 Location: SOUTH 152


Ying Han, MD PhD

CO2 Laser-Assisted Deep Sclerectomy Surgery in the Treatment of OAG in Chinese Patients

Abstract: Purpose To evaluate the efficacy and safety of CO2-laser assisted sclerectomy surgery (CLASS) with 5-fluorouracil (5-FU) for open-angle glaucoma in the Chinese population. Methods This was a retrospective, uncontrolled, interventional case series. All patients from 2016 to 2017 who received CLASS were recruited in this study. Results Forty-two eyes of 31 patients were recruited for this study. The average preoperative IOP was 31.3 ± 7.6 mmHg. During the entire 12-month follow-up period, the mean percentage of IOP reduction from baseline was 48% (P < .01). Significant visual acuity deterioration was not evident. Peripheral iris synechia, iris incarceration and shallow anterior chamber were the major postoperative complications. Conclusion The CLASS procedure with 5-FU is a simple procedure with excellent safety and efficacy for reducing IOP and the number of IOP-lowering medications with a mean follow-up of 12 months.

Saturday  9:00AM – Tuesday  1:00PM
Session: PO224            Location: EPOSTER & VIDEO TERMINALS


David G Hwang MD FACS

Top 10 Hot Corneal Surgical Tips for 2020

Abstract: Synopsis An expert panel of corneal surgeons presents its annual survey of the hottest corneal surgical tips. Each tip has been carefully selected for novelty and maximum impact on clinical practice. Annually updated topics include time-saving office techniques (e.g., office rebubbling), refinements of common operations (e.g., Descemet membrane endothelial keratoplasty [EK] in complex eyes, Yamane technique) and details of novel, cutting-edge surgical procedures (Descemetorrhexis without EK [DWEK], sutureless keratoplasty, simple limbal epithelial transplantation [SLET], and photodynamic therapy [PDT] for infectious keratitis). A rapid-fire format with expert panel commentary and audience Q&A will promote lively discussion, and annual refreshing of topics and rotating faculty ensures value to repeat attendees. Objective Through step-by-step instructions, video and detailed handouts, the attendee will gain practical, specific and immediately applicable knowledge of new techniques and approaches for common and challenging corneal surgical problems.

Monday, 2:00PM – 4:15PM
Session: 485    Location: WEST 2005


Jeremy D Keenan MD MPH

Vogt-Koyanagi-Harada Outcomes From the First-Line Antimetabolites For Steroid-Sparing Treatment (FAST) Uveitis Trial

Abstract: Purpose A subanalysis of outcomes in Vogt-Koyanagi-Harada (VKH) patients from the FAST Uveitis Trial. Methods Patients were randomized to receive 25-mg weekly oral methotrexate (MTX) or 1.5-g twice daily oral mycophenolate mofetil (MMF), with a standardized prednisone taper, and followed for 6 months. Results Ninety-three patients had a VKH diagnosis; 49 patients were randomized to MTX and 44 to MMF. Treatment success was higher with MTX (80.4%) compared to MMF (64.1%); OR, 2.3; 95% CI, 0.9-6.3; P = .10. MTX was superior in reducing central subfield thickness (P = .004) and resolving serous retinal detachments (P = .02). Acute VKH patients had greater improvement in visual acuity (mean change in logMAR: −0.37; SD, 0.38) than chronic VKH patients (mean change in logMAR: −0.16; SD, 0.27; P = .0004). Conclusions MTX is an affordable antimetabolite that may be more effective than MMF for VKH. Earlier treatment is associated with better visual outcomes.

Saturday  9:00AM – Tuesday  1:00PM
Session: PO534            Location: EPOSTER & VIDEO TERMINALS

One-Year Outcomes of Uveitic Macular Edema in the First-Line Antimetabolites as Steroid-Sparing Treatment (FAST) Uveitis Trial

Abstract: Purpose To compare outcomes of uveitic macular edema (UME) in the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Trial. Methods Patients received methotrexate (MTX) 25 mg weekly or mycophenolate mofetil (MMF) 1.5 g twice daily for 12 months. At the 6-month primary endpoint, treatment failures switched treatments. Results Of 216 patients in the FAST Trial, 42 eyes in the MTX group and 55 eyes in the MMF group had UME. Baseline median logMAR visual acuity (VA) was 0.40 in the MTX group and 0.38 in the MMF group. Baseline median central subfield thickness (CST) was 359 μm in the MTX group and 342 μm in the MMF group. At 12 months, CST was 339 μm in the MTX group and 336 μm in the MMF group (P = .76), and logMAR VA was 0.25 in the MTX group and 0.28 in the MMF group (P = .80). In patients who switched treatment, CST was 319 μm in the MTX group and 326 μm in the MMF group (P = .28), and logMAR VA was 0.27 in the MTX group and 0.25 in the MMF group (P = .26). A 20% decrease in CST was associated with a median 0.5 logMAR VA improvement. Conclusions Treatment with MTX or MMF for UME results in a similar decrease in CST and improvement in VA at 12 months.

Monday,  9:18AM – 9:25AM
Session: PA035 Location: SOUTH 152

Diagnosis and Management of Acanthamoeba Keratitis 

Abstract: Synopsis This course reviews the epidemiology, diagnosis and management of Acanthamoeba keratitis, including the newer diagnostic tools such as confocal microscopy and PCR, and newer treatments such as miltefosine. Objective At the conclusion of this course, the attendee will be able to (1) recognize the early and late clinical signs of Acanthamoeba keratitis, (2) understand the strengths and limitations of confocal microscopy as a tool to diagnose and follow patients with Acanthamoeba keratitis, (3) understand the various microbiological tests for diagnosing Acanthamoeba keratitis, including culture, smear and PCR, (4) choose the proper medication regimen for Acanthamoeba keratitis based on susceptibility data and (5) understand the potential beneficial and detrimental role of topical corticosteroids for Acanthamoeba keratitis.

Tuesday,  11:30AM – 12:30PM
Session: 664    Location: WEST 2005PASS


Robert C Kersten MD

Blepharoplasty

Abstract:Synopsis This course will cover the latest techniques in upper and lower eyelid blepharoplasty. Basic and advanced surgical techniques, eyelid anatomy, patient selection, preoperative evaluation and avoidance of complications will be discussed. A course handbook with illustrations outlining the surgical techniques will be provided. Objective This course will provide participants with the techniques required to perform successful upper and lower eyelid blepharoplasties.

Sunday,  9:00AM – 11:15AM
Session: LEC115    Location: WEST 2003

When Does the Patient Need Surgery for Orbital Fracture?

Abstract: Visit the Learning Lounge to participate in informal, small group facilitated discussions led by experts in the field. New topics begin every 30 minutes. Float among the discussions and interact with colleagues.

Sunday,  10:30AM – 11:30AM
Session: LL10    Location: LEARNING LOUNGE 1

Blepharoplasty

Abstract: Synopsis This course is designed to provide hands-on laboratory experience with the techniques used in upper and lower eyelid blepharoplasty. Videos of techniques will be presented, and instructors will provide personal assistance with cadaver dissection. Objective Participants will be shown the clinically relevant anatomy as it relates to performing upper and lower eyelid blepharoplasties. Note: Participants should bring surgical loupes. Participants are required to sign an infectious disease transmission waiver / release form.

Monday,  11:00AM – 1:00PM
Session: LAB115A    Location: SOUTH 8

Oculoplastic Procedures for the General Ophthalmologist

Abstract: Synopsis This course will describe basic and effective procedures for the treatment of involutional ectropion and entropion, tarsorraphy, marginal eyelid lesions, dermatochalasis and aponeurogenic involutional ptosis. Objective: At the conclusion of this course, the attendee will be able to select and perform the appropriate surgical technique for the treatment of common eyelid problems encountered in a general ophthalmology practice.

Tuesday,  11:30AM – 12:30PM
Session: 657    Location: SOUTH 308


Stephen D McLeod, MD

Section III: It’s Time For an Update in Refractive Surgery

12:03               Update on Emerging Accommodating IOLs in Early Development
12:22               LUNCH and ISRS Member Lunch

Friday,  11:00AM – 1:47PM
Session: REF07    Location: ESPLANADE BALLROOM


Anthony T Moore, BMBCH

Incorporating New Technology Into My Practice: When, How and Why? A Perspective From Global Leaders

Abstract: Cosponsored by Academia Ophthalmologica Internationalis (AOI)

4:06                 Wide-Field Retinal Imaging in Pediatric Ophthalmology Practice

Sunday,  3:45PM – 5:15PM
Session: SYM26    Location: WEST 2002RECORD


Sriranjani P Padmanabhan, MD

Manual Small Incision Cataract Surgery

Abstract: Synopsis Manual small-incision cataract surgery (SICS) plays a vital role in the fight to eradicate global cataract blindness. Its low cost, high efficiency and quality outcomes make this surgery a must for working in the developing world. Additionally, the superior outcomes compared to traditional extracapsular cataract extraction (ECCE) are invaluable to any surgeon faced with challenging cataract cases better suited to a manual extraction or conversion, and this skill set is a valuable addition to any phaco surgeon’s toolbox. Objectives By the conclusion of this interactive video-based course framed by expert panel discussion, the attendee will have (1) learned the instrumentation and techniques to practice SICS surgery, (2) learned the indications and technique for converting phacoemulsification to a SICS approach and (3) developed skills in dealing with complications and troubleshooting during SICS surgery.

Sunday,  11:30AM – 1:00PM
Session: LAB110A    Location: SOUTH 7

Manual Small Incision Cataract Surgery

Abstract: Synopsis Although phacoemulsification surgery is considered the standard of care for cataract extraction, manual small-incision cataract surgery (SICS) is non-inferior and often the procedure of choice. The low cost, high efficiency and quality outcomes make this surgery a must for working in the developing world. Additionally, the superior outcomes compared to traditional extracapsular cataract extraction (ECCE) are invaluable to any surgeon faced with cases better suited to a manual extraction or conversion. Objectives By the conclusion of this course, the attendee will (1) have learned and be able to practice key steps in SICS surgery, (2) have learned and be able to practice how to convert from a clear corneal phacoemulsification to a SICS approach and (3) be better able to deal with and troubleshoot complications that may arise during SICS surgery. Note: Attendance in the Manual SICS: Indications and Techniques lecture course is highly recommended for lab participation.

Monday,  10:30AM – 12:00PM
Session: LAB110B    Location: SOUTH 7


Julie M Schallhorn, MD

No Capsule, No Problem: Intrascleral Haptic Fixation of IOLs

Abstract: Synopsis This lab will provide attendees the opportunity to learn intrascleral haptic fixation of three-piece IOLs. One-on-one wet lab instruction from experienced surgeons will be emphasized. Techniques covered will include the glued IOL technique (Agarwal) and the double-needle flanged-haptic technique (Yamane). Instructors will share their surgical pearls for the successful adoption of these techniques. Please note that this course is primarily intended for experienced surgeons who are interested in learning scleral fixation of IOLs. Pars plana vitrectomy will not be taught during this course. The first 30 minutes of this course will be a didactic portion covering surgical steps, and the remaining two hours will be spent in supervised wet lab practice. Both model eyes and animal eyes will be used. Objective At the conclusion of this course, the attendee will be able to perform intrascleral haptic fixation of three-piece IOLs using the glued IOL technique and the double-needle flanged-haptic technique.

Sunday,  8:00AM – 10:30AM
Session: LAB107    Location: SOUTH 7

Advanced Endothelial Keratoplasty (DSEK/DMEK): Overview and Surgical Pearls

Abstract: Synopsis In this course, corneal experts will share pearls about performing the steps of Descemet-stripping endothelial keratoplasty (DSEK) and Descemet membrane endothelial keratoplasty (DMEK), emphasizing tips on how to transition to DMEK. Tips will be presented for complex cases (anterior chamber IOL, tube/trab, post-penetrating keratoplasty, post-pars plana vitrectomy, aphakic eyes) and complication management for DSEK and DMEK. An update on Descemet-stripping automated endothelial keratoplasty (DSAEK), ultrathin and nano-thin DSAEK, and DMEK and hybrid-DMEK will also be presented. A realistic DMEK practice model will be shown. Surgical videos of both DMEK and DSEK will be shown to emphasize key learning points. Objectives At the end of this course, participants will be up to date on everything related to posterior endothelial keratoplasty, will have learned how to perform the surgical steps of DSEK and DMEK, and will be fully prepared for the accompanying hands-on wet lab component course with individual instruction.

Monday,  3:30PM – 5:30PM
Session: LAB137A    Location: SOUTH 4


Gerami D Seitzman MD

Metagenomic Deep Sequencing for the Diagnosis of Cornea and External Disease Infections

Abstract: Purpose To compare the performance of metagenomic deep sequencing (MDS) to present standard microbiologic testing for the diagnosis of infections of the cornea, sclera and conjunctiva. Methods Retrospective clinical case-series. Results All organisms identified by culture or polymerase chain reaction were also detected by MDS. MDS was able to identify parasitic, fungal, bacterial and viral infections. The mean time from disease onset to gold standard diagnosis was 37 days (0 to 125 days, n = 9). When atypical organisms were the cause of the infection (fungal or parasitic), the length of time to diagnosis further increased to 62 days (25 to 125 days, n = 5). Conclusion For the diagnosis of corneal, scleral and conjunctival infections, this proof-concept case series demonstrates that MDS can replicate the identification of causative organisms as determined by current gold standard microbiologic testing. Especially with atypical infections, MDS has potential to be more efficient and economical.

Saturday  9:00AM – Tuesday  1:00PM
Session: PO113    Location: EPOSTER & VIDEO TERMINALS

Poster Theater: Cornea, External Disease

Abstract: Poster Theater and Lounge, South, Exhibition Level
Attend moderated poster discussions by your mentors and colleagues.

Monday,  8:30AM – 9:30AM
Session: PT06    Location: SOUTH EXHIBITION LEVEL

Diagnosis and Management of Acanthamoeba Keratitis

Abstract: Synopsis This course reviews the epidemiology, diagnosis and management of Acanthamoeba keratitis, including the newer diagnostic tools such as confocal microscopy and PCR, and newer treatments such as miltefosine. Objective At the conclusion of this course, the attendee will be able to (1) recognize the early and late clinical signs of Acanthamoeba keratitis, (2) understand the strengths and limitations of confocal microscopy as a tool to diagnose and follow patients with Acanthamoeba keratitis, (3) understand the various microbiological tests for diagnosing Acanthamoeba keratitis, including culture, smear and PCR, (4) choose the proper medication regimen for Acanthamoeba keratitis based on susceptibility data and (5) understand the potential beneficial and detrimental role of topical corticosteroids for Acanthamoeba keratitis.

Tuesday,  11:30AM – 12:30PM
Session: 664    Location: WEST 2005


Jay M Stewart MD

Scientific Insights From Big Data From the RPB/AAO Awards for IRIS Registry Research

Abstract: Cosponsored by the IRIS Registry Executive Committee. Broad participation across ophthalmology has enabled the IRIS Registry to become the largest specialty clinical data registry in the world. Beyond quality reporting, IRIS Registry is enabling groundbreaking research in the field of ophthalmology. The IRIS Registry is the basis for real-world studies on practice patterns, factors affecting clinical outcomes, complications and possible risk factors for disease development. The value of the IRIS Registry lies not only within its ability to support Academy members in meeting the increased demands of quality reporting but also in driving true improvements in quality and patient outcomes and enhancing clinical knowledge and advancing scientific discoveries. An important driver for these discoveries is the Research to Prevent Blindness (RPB)/American Academy of Ophthalmology Award for IRIS Registry Research. In this symposium, the four awardees will discuss their studies.

2:25                 Effect of Metformin Use on Incidence and Progression of AMD

Monday,  2:00PM – 3:00PM
Session: SYM44    Location: WEST 2002


M Reza Vagefi MD

Section III: Changing Paradigms in the Treatment of Orbital Disease

Oculoplastics, Orbit

11:50               Treatment of Orbital Blowout Fractures: Rethinking Dogma
M Reza Vagefi MD

Saturday,  11:00AM – 1:25PM
Session: OCU04    Location: WEST 2002