The Ocular Response Analyzer (ORA) (Reichert Ophthalmic Instruments, Buffalo, NY) allows direct measurement of corneal biomechanical properties. Since its introduction, many studies have sought to elucidate the clinical applications of corneal hysteresis (CH) and corneal resistance factor (CRF). More recently, detailed corneal deformation signal waveform analysis (WA) has potentially expanded the diagnostic capabilities of the ORA. In this review, the role of CH, CRF, and WA are examined in keratoconus (KC) and iatrogenic ectasia (IE). The PubMed database was searched electronically for peer-reviewed literature in July 2012 and August 2012 without date restrictions. The search strategy included medical subject heading (MeSH) and natural language terms to retrieve references on corneal biomechanics, CH, CRF, corneal deformation signal WA, IE, and KC. The evidence suggests that while CH and CRF are poor screening tools when used alone, increased sensitivity and specificity of KC and IE screening result when these parameters are combined with tomography and topography. Recent advances in WA are promising, but little is currently understood about its biomechanical and clinical relevance. Future studies should seek to refine the screening protocols for KC and IE as well as define the clinical applicability of WA parameters.
Although little is understood about the etiology, pathophysiology, epidemiology, and genetics of PMD, new treatments are improving visual outcomes and reducing complications. Corneal collagen cross-linking is especially exciting because it halts disease progression. Combined treatments and improved screening could eliminate the need for surgical management in most cases of PMD.
PurposeTo evaluate the current United States Food and Drug Administration (FDA) recommendations regarding laser in situ keratomileusis (LASIK) surgery in patients with collagen vascular diseases (CVD) and assess whether these patients make appropriate candidates for laser vision correction, and offer treatment recommendations based on identified clinical data.MethodsA literature search was conducted using PubMed, Medline, and Ovid to identify all existing studies of LASIK in patients with collagen vascular diseases. The search was conducted without date limitations. Keywords used for the search included MeSH terms: laser in situ keratomileusis, LASIK, refractive surgery, ocular surgery, and cataract surgery connected by “and” with the following MeSH and natural-language terms: collagen vascular disease, rheumatic disease, systemic disease, rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, seronegative spondyloarthropathy, HLA B27, ankylosing spondylitis, reactive arthritis, psoriatic arthritis. The abstracts for all studies meeting initial search criteria were reviewed; relevant studies were included. No prospective studies were found; however, four retrospective case studies were identified that examined LASIK surgery in patients with CVD. Several case reports were also identified in similar fashion.ResultsThe FDA considers CVD a relative contraindication to LASIK surgery, due largely to the ocular complications associated with disease in the CVD spectrum. However, recent studies of LASIK in patients with CVD indicate LASIK may be safe for patients with very well-controlled systemic disease, minimal ocular manifestations, and no clinical signs or history of dry-eye symptoms.ConclusionLASIK surgery may be safe in patients with rheumatoid arthritis or systemic lupus erythematosus and the seronegative spondyloarthropathies if stringent preoperative criteria are met. Evidence suggests patients with Sjögren’s syndrome are not suitable candidates for LASIK.
Background The phenomenon of internet dependence has changed the way the rising generation seeks information. This mentality has caused medical students to turn to online resources as they seek information about potential residency training programs. Residency program web presence (PWP) is increasingly important, and may even impact recruitment efforts. Improvement of PWP could enhance programs' recruitment of ideal candidates. Objectives The purpose of this study is to assess how ophthalmology residency PWP is impacting the residency recruitment process by understanding how it influences applicants' application and rank list choices as well as to identify the contributing factors. Methods Applicants applying for ophthalmology residency training at Penn State University during the 2015–2016 and 2016–2017 application cycles were surveyed using Research Electronic Data Capture (REDCap). Surveys sought applicants' perspectives with respect to their experiences with PWP and how those experiences shaped their application and rank list decisions. Results Of 860 applicants, 214 (24.9%) responded, accounting for 17.4% (214/1,228) of all ophthalmology residency applicants during the respective cycles; 72.4% of respondents expressed PWP does impact where they apply, how they form their rank list, or both; 93.4% said websites are an important resource during the application process; 47.2% conveyed interest in programs utilizing social media tools; and 76.5% of respondents felt websites gave sufficient information less than 50% of the time. Conclusion Ophthalmology PWP does impact resident recruitment. By enhancing program websites and adding social media tools, programs can improve recruitment efforts.
This observational case report describes the development of bilateral Mooren-like ulcers in a patient with anesthetic keratopathy. A 42-year-old man with a recent history of minor eye trauma and pain self-treated with tetracaine eye drops presented with complaints of acutely worsening vision and severe pain bilaterally. His visual acuity at presentation was limited to hand motion. Slit-lamp examination revealed bilateral epithelial defects at the center of the cornea, and an area of stromal infiltration and thinning with an undermining leading edge resembling a Mooren’s ulcer in both eyes. Corneal haze and hypopyon were visible. Anesthetic use was halted immediately and the patient was started on prednisolone and mycophenolate mofetil (Cellcept®), after which visual acuity gradually improved and pain decreased. Despite improvement of symptoms, residual epithelial defects remained, and the patient was ultimately treated with keratoplasty for recovery of vision. We suggest that anesthetic keratopathy should be included in the differential diagnosis for any patient presenting with ring-shaped stromal infiltrates or nonhealing epithelial defects.
Objective The aim of this study is to investigate the prevalence of post-interview communication (PIC) during the ophthalmology residency match process and its impact on program directors' (PD's) ranking of applicants. Design Prospective cross-sectional survey. Methods An anonymous, online survey was emailed to the PD of each ophthalmology residency program accredited by the Accreditation Council for Graduate Medical Education. Results Fifty-four percent (63/116) of PDs completed the survey. Eighty-five percent (54/63) of PDs received PIC from applicants or applicants' faculty mentors during the 2018 to 2019 application cycle; 62% (39/63) received PIC regarding >25% of applicants interviewed. Although 41% (26/63) of PDs reported they would likely rank an applicant higher due to PIC endorsement from a faculty mentor known to the PD, only 3% (2/63) believed that applicants who did not have a faculty mentor conduct PIC on their behalf were disadvantaged. Fourteen percent (9/63) of PDs reported they would likely rank an applicant higher due to PIC endorsement from a faculty mentor unknown to the PD, and 3% (2/63) reported they would likely rank an applicant higher as a result of PIC from the applicant. Conclusion There is a high prevalence of PIC during the ophthalmology residency match process. The potential impact of PIC on PDs' ranking of applicants varies according to whether the PIC is from a faculty member known to the PD, a faculty member unknown to the PD, or the applicant. This may disadvantage applicants without faculty mentors known to PDs.
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