CE 2019 abstracts

Sarah MacIver, OD
Derek MacDonald, OD, FAAO

While angle closure glaucoma is not as common as primary open angle glaucoma, it is more likely to result in vision loss and blindness. Additionally, it remains a commonly misdiagnosed type of glaucoma, especially progressive glaucoma that is not responding to medical management. This course will review the scope of angle closure glaucoma and the importance of diagnostic tools such as gonioscopy to promptly diagnose and initiate appropriate treatment. New treatment paradigms, particularly cataract extraction, will be reviewed.

Richard L. Maharaj, OD, FAAO

Over the past 10 years, a paradigm has shifted in the approach to managing DED.  DEWS II has set the stage for DED care and innovation for the next several years and our collective shift in initiating treatment is occurring.  Practitioners are faced with the challenge of assuming an interventional rather than the passive approach of the past in treating MGD.  Learn from our past, and glimpse into the future to challenge everything we thought we knew about DED management.

Faran Vafaie, OD, MSc, BSc

Collaborative care and co-management of patients between optometry and ophthalmology is proving to be of greater utility in today’s climate. The aging population is placing a burdensome demand on our health care system and ophthalmology is becoming increasingly incapable of  meeting these demands alone. Optometry is capable of delivering perioperative care remotely or in shared clinical settings to the benefit of patients, ophthalmologists and optometrists. In order for optometry to play a more specialized role in care and management of these patients, doctors must develop an understanding of diseases that require surgical care. In particular, secondary glaucomas and surgical options indicated in their treatment are areas that optometry can have an impact on.

John G. Flanagan, PhD, DSc, FCOptom, FAAO
Richard L. Maharaj, OD, FAAO
C. L. Prokopich, OD

While many aspects of dry eye disease are being elucidated, the spectrum of disease remains a mystery in many ways.  This course will use a case format to highlight the diagnosis and management of challenging cases of dry eye disease (DED) specifically one of the most challenging form of ocular complaint, that of neuropathic pain.

Zay Khan, BSc, OD, FAAO
Alex Hynes, OD, FAAO

This workshop is designed for the primary care practitioner who wants to review and refine the skill of gonioscopy. The first part of the course reviews the indications for gonioscopy, gonioscopic methods, anterior chamber angle anatomy, normal and abnormal findings, and grading. The second part of the workshop focuses on perfecting the gonioscopy procedure, including tips and tricks as well as an opportunity for hands-on practice.

Sarah MacIver, OD

Participants in the workshop will work through each station. Stations will be set up with OCT software and clinical case examples on the software that the participants will work through to become more familiar with analyzing real life cases in a real-life clinical setting. OCT acquisition will also be practiced to review and overcome common trouble shooting errors. The new technology of OCT-angiography will be reviewed and OCT-A computer software will be available to review clinical cases.

Victor Perez, MD

Graft versus Host Disease (GVHD) is a common complication that occurs in patients that receive a Hematopoietic Stem Cell Transplant (HSCT) for the treatment of lymphomas, blood dyscracias and genetic diseases. This immune mediated reaction can affect the skin, the gastrointestinal track and the eye (ocular GVHD: oGVHD). Approximately, 60% of these patients will develop inflammatory disease of the ocular adnexa that lead to dry eye. In addition to the morbidity that oGVHD brings to these patients, it provides a unique opportunity to understand “inflammatory” mechanisms involved in dry eye and the development of novel target specific therapies for treatment and prevention of this disease, because we know it is going to start after HSCT. Our group has developed a pre-clinical model of oGVHD to dissect tempo and immune mechanisms of oGVDH and used these to study these pathways in patients with oGVHD. In this lecture, we will present how immune responses to minor antigens of transplantation evolve into auto-reactive immune responses against the ocular surface, which lead to the recruitment of donor T cells that orchestrate macrophage infiltration that leads to lacrimal gland damage, decrease goblet cells density, damage of corneal nerve and keratopathy. Moreover, new potential strategies for local delivery to prevent and treat oGVHD will be presented, as we believe these can have an impact in the treatment of dry eye.  

C. L. Prokopich, OD

Dry eye has finally made its way to the surface in terms of our understanding and responsibility to consider all aspects of ocular surface disease in a patients eye care. This talk will investigate the role of glaucoma medications in the symptoms and signs in chronic ocular surface disease and discuss how we can better manage these two chronic and potentially comorbid conditions.

John G. Flanagan, PhD, DSc, FCOptom, FAAO

Intraocular pressure, IOP, is one of the main risk factors for the glaucomas. However more people with ocular hypertension IOP21mmHgdo not have glaucoma, and many people with glaucoma have IOP within normal limits.  The relationship between IOP and systemic blood pressure, BP, will be discussed, with particular relevance to the development of glaucoma. The importance of ocular perfusion pressure OPP and the optic nerve will be discussed. Finally, the relationship between OPP and intra-cranial pressure, ICP, and the clinical importance of the lamina cribrosa pressure differential will be introduced with particular relevance to normal tension glaucoma.

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John G. Flanagan, PhD, DSc, FCOptom, FAAO
Sarah MacIver, OD
Faran Vafaie, OD, MSc, BSc

Detecting glaucomatous optic neuropathy and/or a corresponding characteristic visual field defect are the primary endpoints when making a diagnosis of glaucoma. The diagnosis of POAG is often made presumptively based on consideration of the presence of risk factors including strong family history, elevated IOP, and characteristic optic nerve and/or visual field findings. Only when the subtle signs of progression have been confirmed can glaucoma be definitively diagnosed. This course will include three cases given in a rapid fire rounds format that highlight different presentations of diagnosing glaucoma.

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Derek MacDonald, OD, FAAO
John G. Flanagan,  PhD, DSc, FCOptom, FAAO
C. L. Prokopich, OD

This course will include three cases given in a rapid fire rounds format that highlight different presentations of diagnosing glaucoma. Each section will include a case and associated important management considerations for primary open angle glaucoma. The focus will be around technologies role in staging disease and monitoring for progression as well as establishing and reaching target pressures. Contemporary management options such as new therapeutics and  laser/surgical options will be included.

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Vishakha Thakrar, OD

This course will describe the properties and indications of scleral lenses and amniotic membranes in severe ocular surface disease.  It will also describe scleral lens fitting and complications, and amniotic membrane application on these patients.

Arthur Bookman, MD FRCPC

Objectives of this lecture

1. Learn how to diagnose Sjogren’s Syndrome
2. Understand the place of the minor salivary gland biopsy in diagnosis
3. Understand the impact of Sjogren’s Syndrome
4. Review the multisystemic features of the disease
5. Review some local and systemic management tools, including role of Rituximab

Derek MacDonald, OD, FAAO

Optical coherence tomography (OCT) is arguably the biggest advancement in eye care in the last several decades. It has revolutionized the care of patients with retinal and neuro-ophthalmic disorders, including glaucoma. This course will review the use of OCT in the diagnosis and management of glaucoma, emphasize the analysis of retinal nerve fibre layer and macular retinal ganglion cell scans, and include practical tips for integrating this valuable technology into primary optometric practice.

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Emily Chew, MD

Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries, including United States and Canada.  History of the development of treatment for AMD will be briefly reviewed and the focus of the lecture will be on the development of the nutritional supplements and the epidemiologic studies of the association of nutrition with AMD.  The genetic aspects of AMD will also provide a background for discussion of potential pathways involved in the pathogenesis of AMD.  There will be special attention paid to the use of genetic testing in AMD.  Newer techniques such as artificial intelligence/deep learning is recognized as a potential game changer in how we deliver our care and how we may screen for diseases such as AMD.  This will be applied to AMD management in the future.

Victor Perez, MD

Corneal blindness is a very frustrating condition as in most instances the vital structures of the posterior segment are intact and patients cannot see because a clear cornea “cannot be maintained.”. Among the most common causes of corneal opacification, limbal stem cell deficiency and immunological rejection of corneal transplants are the main culprits of this condition. Even though limbal stem cells and corneal transplants are being used to treat rehabilitate the ocular surface of these patients, many procedures succumb to either poor long-term survival of somatic stem cells transplant or immunological rejection of these high risk corneal transplants. Our group has been working in the development of ex vivo cell therapies that could be used to rehabilitate structures of the ocular surface and immune mechanism involved in the rejection reactions against corneal transplants.  In the 2019 Woodruff Distinguished lecture these will be presented and novel algorithm approach to the treatment of corneal blindness will be discussed.    

Dennis Ruskin, OD, FAAO

This lecture is a review of the evidence-based science examining the environmental and genetic factors contributing to exudative macular degeneration. Our nutrient status changes as we age causing nutrient deficiencies that may increase our risk to exudative AMD. The macronutrients and micronutrients intake affects our metabolic pathways causing increasing risk to AMD. Chronic cardiovascular and metabolic diseases can be prevented or reduced with modification of diet. The Mediterranean diet has been shown to reduce cardiovascular and metabolic diseases. Recently, the Eye Risk Consortium study showed adherence to the Mediterranean diet was associated with a 41% reduced risk. Nutrient rich foods and reducing unhealthy foods contributes to the prevention of AMD. Gut microbiota also plays an important role to minimize AMD by influencing pathological angiogenesis in obesity driven exudative choroidal neovascularization. A systematic review of significant long-term studies of diet and food intake to reduce AMD identifies that: high dietary glycemic index, carotenoid intake, sausage consumption, calcium intake, EPA/DHA, and fish consumption reduces the progression to exudative AMD. The scientific contributions of AREDS researchers including recent papers showing evidence that the response to treatment using AREDS in cases of Exudative AMD is largely determined by genetics. A review of how the selection of clinical endpoint can directly impact actual outcomes will be discussed.

Patricia Hrynchak, OD, FAAO

This course presents the pearls learned from the landmark studies in glaucoma: the Ocular Hypertension Treatment study, the Early Manifest Glaucoma trial, the Advanced Glaucoma Intervention Study, the Collaborative Initial Glaucoma Treatment Study, and the Collaborative Normal Tension Glaucoma Study. These studies are reviewed with a perspective on interpretation of the results with a lens of evidence-based practice. 

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Lyndon Jones, PhD, DSc, FCAHS, FCOptom, FAAO

Dry eye disease (DED) is the most common condition that primary eye care providers encounter in daily practice. In 2017, members of the Tear Film and Ocular Surface society (TFOS) published an updated series of consensus papers regarding the fundamental aspects of DED.  The major aims of the Dry Eye Workshop #2 (TFOS DEWS II) were to:

1. Update the definition, classification and diagnosis of DED.
2. Critically assess the etiology, mechanism, distribution and impact of this disorder.
3. Address its management and therapy.

In this presentation, I will review the top 10 “tips” from TFOS DEWS II that are valuable to a clinician to help them diagnose and manage patients with DED, using contemporary methods.

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Sarah MacIver, OD

Glaucoma is one of the world’s leading causes of irreversible blindness and yet there was no new class of medication for over 20 years since the prostaglandins. In 2018 a new glaucoma medication molecule was finally introduced and for the first time targeting the trabecular meshwork, the primary site of aqueous outflow reduction. This course will review current trends in glaucoma management including new formulations of old molecules and also introduce the new medication classes.