Seen & Heard

Glaucoma Today

AGS Annual Meeting Highlights Catch video updates from the 2024 AGS Annual Meeting, featuring April Maa, MD (left), on implementing telehealth; Sahar Bedrood, MD, PhD (middle), on optimizing refractive outcomes in phaco-MIGS patients; and Cara Capitena-Young, MD (right), on managing an accidentally cut tube during insertion. View these videos and more AGS coverage on Eyetube. Helping Patients With Low Vision Administer Eye Drops On Clinical Minute, host Neda Shamie, MD, invites Robert M. Kinast, MD, to discuss a repeated-measures case series that evaluated the administration of eye drops by patients with low vision and tested whether a nose-pivoted drop delivery device could improve their success. Ahmed Glaucoma Valve to Mitigate Post-Injection IOP Elevation On Glaucoma Case Files, Joseph F. Panarelli, MD; Manjool Shah, MD; and Arsham Sheybani, MD, recap a case of a patient with pseudoexfoliative glaucoma who was receiving anti-VEGF injections to treat wet age-related macular degeneration. Dr. Panarelli describes his rationale for Ahmed Glaucoma Valve (New World Medical) implantation. He notes that anti-VEGF injections could have caused IOP elevations and acute damage to the optic nerve. The surgeons also discuss the pros and cons of alternative surgical interventions.

Don’t “Lump” All Lid Lesions Together

Be thorough in creating your differential diagnosis.

Jacob Lang, OD, FAAO

Modern Optometry

The term chalazion is of Greek origin, meaning hailstone, small lump, or pimple.1 In eye care, a chalazion (Figure) is a chronic cyst of lipogranulomatous material possibly caused by the obstruction of a sebaceous gland of the eyelid (ie, meibomian gland or gland of Zeis).1 Risk factors of chalazia include blepharitis, dry eye disease, eyelid dermatitis, rosacea, and conjunctivitis.1 Figure. Chalazion of the upper lid in a patient with concomitant rosacea. For such a common ocular pathology, it’s surprising we still don’t completely understand the pathophysiology of chalazia. Does a bacterial component alter the lipid composition of meibomian secretions and trigger an inflammatory response? What activates the lipogranulomatous inflammation that causes chalazia? As more attention is focused on the ocular surface and meibomian glands, researchers may find answers to these and other questions about lid lumps. A VARIETY OF LUMPS Not all lid lumps are chalazia. Clinicians must also be on the watch for neoplasms, such as sebaceous, basal, or squamous cell carcinoma, which should be included in the differential diagnosis of chalazia, especially when lesions are recurrent in the same location or have atypical features.1 Infectious etiologies, including herpes simplex virus, varicella zoster virus, molluscum contagiosum, leishmaniasis, sarcoidosis, and tuberculosis, can also mimic chalazia.1 Of note, eye care clinicians observed an increased incidence of chalazia during the COVID-19 pandemic, and some hypothesized that this uptick could be related to mask wear. Silkiss et al reported on this observation, alluding to a multifactorial nature of chalazion development.2 The proposed factors include exacerbation of dry eye disease, meibomian oil hardening, poor lid hygiene, and airflow direction changes leading to oral microbiota contacting the eyelids.2 MANAGEMENT There is little statistically significant evidence supporting the effectiveness of many common treatments for chalazia, especially comparative efficacy, at this time.1 Possible chalazion treatment options include hot compresses and other thermal treatments (eg, Systane iLux MGD Treatment System [Alcon], TearCare System [Sight Sciences], TearScience LipiFlow Thermal Pulsation System [Johnson & Johnson Vision]), topical antibiotics and/or steroids, oral antibiotics and/or steroids, probiotics, intralesional injection of corticosteroids or 5-fluorouracil, incision and curettage, tea tree oil wipes, and light therapy (ie, intense pulsed light or low-level light therapy).

How Digital Health Helps Differentiate Your Optometric Practice

Understand what digital health is and learn how it can distinguish your clinic now and in the future.

Timothy Earley, OD

Modern Optometry

Some optometrists struggle to differentiate their practices from those of their colleagues, and some patients assume that all optometric practices are similar. These patients don’t realize that so many of us have special interests in different areas, such as managing the effects of age-related macular degeneration (AMD), comanaging patients with glaucoma, or treating ocular surface disease. Those of us in medically oriented optometry must therefore distinguish ourselves from nonspecialty eye care. But major capital investments can be daunting, and even if investments were an option, it may be difficult to discern which routes will yield the highest return. This is where expansion of digital health presents a solution to optometrists, as doctors can differentiate their clinic, increase the quality of care offered to patients, avoid steep start-up costs, and create new revenue streams. Before we dive into which specific platforms may be useful to clinicians seeking to expand their digital health offerings, we will first review what digital health is and why it may be attractive to those seeking to grow their clinic’s reach. WHAT IS DIGITAL HEALTH? Digital health is not the mere use of digital tools in a clinical setting. Rather, it is a framework for conceptualizing and executing a practice plan that leverages emerging technologies to provide patients with convenient, high-quality care, thereby empowering a clinician to deliver care irrespective of their physical proximity to the patient. In short, properly implemented digital health increases the quality of patient care without requiring more clinician hours.