Management of Advanced Glaucoma

Nathan M. Radcliffe, MD; Blake Williamson, MD, MPH; and Gary Wörtz, MD

Eyetube

Nathan M. Radcliffe, MD, joins Blake Williamson, MD, MPH, and Gary Wörtz, MD, to share his experiences managing complex patients with advanced-stage glaucoma. He shares a specific case of an 83-year-old man with a cataract and exfoliation glaucoma with an IOP of 56 mm Hg. Dr. Radcliffe walks through how he managed complications he encountered during the combined cataract and glaucoma surgery, including vitreous prolapse and suprachoroidal hemorrhage. The surgeons also discuss how to educate and counsel patients with advanced-stage disease to help them understand realistic surgical outcomes.

Presbyopia-Correcting IOLs Versus Monofocal IOLs

Insights from a multicenter study comparing surgical workload and patient care.

Kendall E. Donaldson, MD, MS; Robert K. Maloney, MD, MA; John F. Doane, MD, FACS; and Robert J. Weinstock, MD

Cataract and Refractive Surgery Today

Cataract surgery has evolved rapidly, transitioning from simple removal of the cloudy lens to the provision of increased spectacle independence. The past decade is full of significant milestones, such as the introduction of femtosecond laser technology in 2011, enhanced astigmatism correction with laser arcuate incisions and toric IOLs, the introduction of extended depth of focus lenses in 2017, and the FDA approval of the Light Adjustable Lens (RxSight) in 2017. These and other developments have expanded surgical options to the benefit of both patients and surgeons and allowed greater customization of the procedure and its outcomes. IOL selection, however, has become increasingly complex. Surgeons must now take the patient’s personality, occupation, hobbies, aspirations, and daily visual requirements into account. The choice of IOL can profoundly affect the recipient’s life. Patient dissatisfaction may necessitate further intervention. For these reasons, considerable time must be devoted to patient education before surgery. Postoperatively, the ocular surface may require refinement, patients may need time for neural adaptation, and additional refractive procedures may be necessary to optimize results. The increasing complexity of IOL selection and an escalation in patients’ expectations led us to evaluate the workload presented by premium cataract surgery.

A Reference Guide for OCT Angiography

An illustrative overview of OCTA findings to help you implement this tool in common clinical scenarios.

Ivy Zhu, MD; Nicole L. Decker, BS; and Amani A. Fawzi, MD

Retina Today

AT A GLANCE OCT angiography (OCTA) has several advantages over traditional imaging techniques, including being noninvasive, depth resolved, and rapid. OCTA can distinguish the various vascular networks without obscuration by leakage, making it helpful for characterizing neovascularization and nonperfusion. OCTA is particularly useful in cases of type 1 neovascularization, where sub-retinal pigment epithelium neovascularization can develop without active exudation. En face OCTA and OCT B-scans are complementary and, together, can provide the clinician with a wealth of knowledge. There are several conditions for which OCTA can provide detailed information that would otherwise be time-consuming or impossible to find with traditional techniques. OCT angiography (OCTA) is a noninvasive imaging technique that uses the principles of motion detection to reveal depth-resolved images of the retinal and choroidal vasculature, down to the capillary level.1 OCTA has several advantages over traditional imaging techniques, including being noninvasive (no dye injection), depth resolved, and rapid. A key benefit of OCTA is its ability to distinguish the various vascular networks without obscuration by leakage, making it very helpful for characterizing retinal neovascularization and nonperfusion with precision beyond dye-based angiography. Here, we detail several clinical scenarios in which OCTA can be a useful diagnostic tool and illustrate key imaging features. In general, absence of flow (nonperfusion) is best appreciated with en face images. The presence of abnormal flow is most accurately detected using a combination of en face imaging assisted by the OCT B-scan with flow overlay to pinpoint abnormal flow related to structural pathological changes.