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N e w O r l e a n s A c a d e m y o f O p h t h a l m o l o g y

Eye on

the Bayou

New Concepts in Glaucoma,

Cataract and Neuro-Ophthalmology

e d i t e d b y J o n a t h a n D . N u s s d o r f

Kugler Publications, The Hague, The Netherlands

EYE ON THE BAYOU

NEW CONCEPTS IN GLAUCOMA, CATARACT

AND NEURO-OPHTHALMOLOGY

afafasfsafsafds

EYE ON THE BAYOU NEW CONCEPTS IN GLAUCOMA, CATARACT AND NEUROOPHTHALMOLOGY

edited by Jonathan D. Nussdorf

Proceedings of the 54th Annual Symposium of the New Orleans Academy of Ophthalmology, New Orleans, LA, USA, February 18-20, 2005

Kugler Publications/The Hague/The Netherlands

ISBN 10: 90-6299-209-9

ISBN 13: 978-90-6299-209-6

Distributors:

For the USA and Canada: Pathway Book Service

4 White Brook Road

Gilsum, NH 03448 U.S.A.

email: pbs@pathwaybook.com

For all other countries: Kugler Publications P.O. Box 97747

2509 GC The Hague, The Netherlands Telefax (+31.70) 3300254

website: www.kuglerpublications.com

© Copyright 2006 Kugler Publications

All rights reserved. No part of this book may be translated or reproduced in any form by print, photoprint, microfilm, or any other means without prior written permission by the publisher. Kugler Publications is an imprint of SPB Academic Publishing bv, P.O. Box 97747,

2509 GC The Hague, The Netherlands

Table of contents

v

Table of Contents

 

Preface

vii

President’s letter

viii

Contributors

ix

Neuro-Ophthalmology

 

Ten easy mistakes to avoid in your next neuro-ophthalmic patient,

 

Andrew G. Lee

3

Life-threatening diplopia with pupil involvement, Andrew G. Lee

11

Optic neuritis: what’s hot and what’s not…, Andrew G. Lee

19

What to tell your next patient with non-arteritic anterior ischemic optic

 

neuropathy (NAION) … other than “nothing can be done”, Andrew G. Lee

25

MRI and CT: Which is which, why to order, and when, Andrew G. Lee

31

Optical Coherence Tomography (OCT) in neuro-ophthalmology, Andrew G. Lee

 

and Culver Boldt

39

Round Table: The pale nerve, Andrew Lee, Moderator

47

Questions and Answers, Jill Koury, Presiding Physician

53

Glaucoma

 

Risk factors for open-angle glaucoma, Harry A. Quigley

61

Does either sex or ethnicity matter in glaucoma?, Eve J. Higginbotham

65

Low tension glaucoma: A bad concept that just won’t die. So how do you deal

 

with it?, Harry A. Quigley

75

Neuroprotection strategies from the research lab (’cause there aren’t any ready

 

for prime time yet), Harry A. Quigley

79

The myth of the glaucoma continuum, Paul Palmberg

83

Landmark clinical trials in glaucoma: Questions and answers, Kuldev Singh

89

Practical implications of the Collaborative Normal Tension Glaucoma Study,

 

Harry A. Quigley

99

What have we learned from the Ocular Hypertension Treatment Study thus far?,

 

Eve J. Higginbotham

103

Round Table: Critiquing the clinical trials, Eve Higginbotham, Moderator

111

Psychophysics

 

Update on short wavelength automated perimetry (SWAP) and frequency

 

doubling technology (FDT) in glaucoma and neuro-ophthalmologic

 

disorders, Chris A. Johnson

123

Questions and Answers, Jonathan Calkwood, Presiding Physician

135

New developments in perimetry, including SITA, ZEST and TOP,

 

Chris A. Johnson

137

vi

Table of contents

 

 

Evaluation of visual field loss in glaucoma: Progression and classification of

 

perimetric damage, Chris A. Johnson

 

147

Round Table: Detecting and monitoring progression, Harry A. Quigley,

 

Moderator

 

159

Anterior Segment Surgery

 

 

Toxic anterior segment syndrome, James Gills

 

171

Questions and Answers, Barry Leader, Presiding Physician

 

173

Laser trabeculoplasty – background, mechanisms, clinical applications,

 

Robert Noecker

 

177

How to stay out of trouble managing trabeculectomies, Harry A. Quigley

187

Simple strategies to improve the safety of trabeculectomy: The Moorfields

 

Safer Surgery System, Peng T. Khaw, Jonathan Clark and Annegret Dahlmann 195

Round Table: Building a better drainage system – perfecting the

 

 

trabeculectomy, Katherine Loftfield, Moderator

 

207

Questions and Answers, Jill Koury, Presiding Physician

 

215

Questions and Answers, Ramesh Ayyala, Presiding Physician

 

221

Slit lamp procedures in postoperative glaucoma management, Paul Palmberg

225

Round Table: Surgical choices: Trabs, tubes and Betadine, Paul Palmberg,

 

Moderator

 

237

Table of contents

vii

 

 

Preface

The 54th annual symposium of the New Orleans Academy of Ophthalmology was held February 18-20, 2005. This Academy meeting was devoted to current topics pertaining to glaucoma, cataract surgery and neuro-ophthalmology. The meeting consisted of formal lectures, roundtable discussions with questions from the audience and workshop presentations.

I have deep appreciation for those who serve as mentors to us and participated in this meeting, they help to elevate the level of care we provide to our patients. Their active participation made this meeting worthwhile. I would like to acknowledge our sponsors for providing unrestricted financial support, which helped to defer the expense of this medical education meeting and subsequent publication. Sincere thanks go to those who participated on the Program Committee and special acknowledgement is given to Dr. Scott Lanoux, President of the New Orleans Academy of Ophthalmology and Amber Howell, Executive Director for their hard work in organizing this symposium.

Jonathan D. Nussdorf, MD

Program Chairman

Ochsner Clinic Foundation

New Orleans, Louisiana, USA

I make progress by having people around me who are smarter than I am and listening to them. And I assume that everyone is smarter

about something than I am.

Henry J. Kaiser

viii

Table of contents

 

 

President’s letter

On behalf of the Board of Directors of the New Orleans Academy of Ophthalmology, I would like to congratulate and give my sincerest thanks to the program committee and program chair for the success of the 54th Annual Symposium, February 18-20, 2005. Each year I continue to marvel at the quality of the faculty and the program, and this year was no exception. The end result of such excellence culminates with this volume of NOAO Transactions. The editor, Dr Jonathan Nussdorf, has put together an outstanding text derived from the various lectures, roundtables and question and answer sessions that will serve as an important reference in ophthalmologic literature for the benefit of the ophthalmologic community for years to come.

I would also like to draw attention to the Eye, Ear, Nose and Throat Foundation, without whose generous support neither the transactions nor the symposium would be possible. The Foundation was created in 1981 to support The Eye, Ear, Nose and Throat Hospital, which was founded in 1889 for the purpose of providing medical care to the indigent population of New Orleans. Their mission is to provide funding for medical research and education for ophthalmology and otolaryngology as well as direct patient care.

As president of the NOAO, I have been extremely fortunate to have such a dedicated board of directors and staff. Their energy and passion towards providing quality ophthalmic education to the region cannot be understated. Our Executive Director, Amber W. Howell, has been an integral part of this organization and of the success of the Symposium for the past four years, and I commend her for her dedication and drive.

Finally, I would like to thank Kugler Publications for their editorial expertise over the many years. However, the true success of this symposium and the subsequent transactions would not have been possible without the enthusiastic and continuing support of the ophthalmologists of New Orleans and the Gulf Coast who are members of the Academy. To them, I give my appreciation.

Scott D. Lanoux, MD

President, New Orleans Academy of Ophthalmology

Contributors

ix

 

 

CONTRIBUTORS

JAMES P. GILLS, M.D.

Clinical Professor of Ophthalmology

University of South Florida

Tarpon Springs, FL, U.S.A.

EVE J. HIGGINBOTHAM, M.D.

Dean and Senior Vice President for Academic Affairs

Morehouse School of Medicine

Atlanta, GA, U.S.A.

CHRIS A. JOHNSON, Ph.D.

Director of Diagnostic Research and Senior Scientist

Discoveries in Sight, Devers Eye Institute

Portland, OR, U.S.A.

PENG T. KHAW, M.D., PH.D., FRCS, FRCOphth

Professor of Glaucoma and Ocular Healing

Moorfields Eye Hospital and Institute of Ophthalmology

London, England

x

Contributors

 

 

ANDREW G. LEE, M.D.

Professor of Ophthalmology, Neurology, and Neurosurgery

University of Iowa

Iowa City, IA, U.S.A.

ROBERT J. NOECKER, M.D.

Vice Chair Clinical Affairs, Associate Professor of

Ophthalmology

University of Pittsburgh School of Medicine

Pittsburgh, PA, U.S.A.

PAUL PALMBERG, M.D., Ph.D

Professor of Ophthalmology

Bascom Palmer Eye Institute

University of Miami School of Medicine

Miami, FL, U.S.A.

HARRY A. QUIGLEY, M.D.

A. Edward Maumenee Professor

Wilmer Eye Institute, Johns Hopkins University

Baltimore, MD, U.S.A.

Contributors

xi

 

 

KULDEV SINGH, M.D.

Professor of Ophthalmology

Stanford University School of Medicine

Stanford, CA, U.S.A.

RICHARD J. MACKOOL, M.D. - Guest Speaker

Director, The Mackool Eye Institute

Senior Attending Surgeon, New York Eye & Ear Infirmary

Astoria, NY, U.S.A.

MARC F. LIEBERMAN, M.D. - Guest Panelist

Physician, Glaucoma Consultants of the Bay Area

San Franscisco, CA, U.S.A.

xii

Contributors