• Subspecialty Day Meetings: Program Directors’ Picks


    CORNEA SUBSPECIALTY DAY HIGHLIGHTS

    Of Interest Across Subspecialties

    La Nouvelle Orleans AB

    Cataract Surgery Considerations in Abnormal Corneas, presented by Kristin M. Hammersmith, MD (Saturday, 11:24-11:32 a.m.)

    Fight the Blight With Light—Lasers for Blepharitis, presented by Vanitee Y. Bunya, MD (Saturday, 2:35-2:43 p.m.)

    Two presentations during Cornea Subspecialty Day may be of particular interest across subspecialties.

    Patients with corneal abnormalities presenting with cataract can pose a challenge even to experienced anterior segment surgeons. Structural abnormalities of the cornea, such as thinning, scarring, and ectasia, can make cataract surgery complex. Kristin M. Hammersmith, MD, will present accurate lens calculations, management of intraocular complications, and postoperative management in the setting of abnormal corneas.

    Dry eye and blepharitis are challenging for all ophthalmologists. These patients take up considerable chair time, and the situation can be frustrating for both the patient and the physician. There is also increasing evidence that ocular surface disease can affect the outcome of cataract surgery, especially in the setting of multifocal lenses, and can cause considerable dissatisfaction after otherwise pristine surgery. Beyond conservative therapy, lasers can be a useful adjunct for ophthalmologists in treating these ocular conditions. However, the wide variety of lasers and devices available to treat blepharitis can be overwhelming. Vanitee Y. Bunya, MD, will discuss the various current therapies for ocular surface disease and how to select the right one for each patient.

    —Sophie X. Deng, MD, PhD, Vishal Jhanji MD, and Sonal S. Tuli, MD
    Cornea program directors


    Clinical Practices to Reconsider

    La Nouvelle Orleans AB

    Keratoplasty: Layer by Layer, moderated by Vishal Jhanji, MD, FRCOphth (Saturday, 9:08-10:07 a.m.)

    Endothelial keratoplasty has gained rapid popularity among cornea surgeons world-wide and has emerged as the treatment of choice for the management of patients with corneal endothelial dystrophy. This session features three presentations on endothelial keratoplasty. While the focus is on current techniques and outcomes in complex eyes, the talks also feature intriguing newer techniques of endothelial keratoplasty. The concept of customized endothelial keratoplasty will be complemented by discussion of medical treatment for endothelial dysfunction with the use of Rho-kinase inhibitors and cell therapy.   

    —Sophie X. Deng, MD, PhD, Vishal Jhanji MD, and Sonal S. Tuli, MD
    Cornea program directors


    Exciting Developments

    La Nouvelle Orleans AB

    Global Consensus on Limbal Stem Cell Deficiency, presented by Friedrich E. Kruse, MD (Saturday, 1:13-1:21 p.m.)

    Limbal stem cell deficiency (LSCD) is among the most challenging of ocular surface diseases to diagnose, stage, and manage, due in part to its wide spectrum of presentations and subtle clinical signs in the mild stage. LSCD is often accompanied by comorbidities, including dry eye disease, eyelid abnormalities, and ocular surface inflammation. As such, management of LSCD requires a comprehensive approach. The presenter, Friedrich E. Kruse, MD, founded and led the International Limbal Stem Cell Deficiency Working Group to achieve consensus on the classification, diagnosis, staging, and management of LSCD. Dr. Kruse will present the findings and recommendations of the working group, which can serve as general guidelines for cornea specialists and comprehensive ophthalmologists on how to diagnose and manage LSCD.

    —Sophie X. Deng, MD, PhD, Vishal Jhanji MD, and Sonal S. Tuli, MD
    Cornea program directors


    GLAUCOMA SUBSPECIALTY DAY HIGHLIGHTS

    Of Interest Across Subspecialties

    La Nouvelle Orleans AB

    Lens and Glaucoma, moderated by Christine Larsen, MD, and Teresa Chen, MD (Friday, 3:07-3:57 p.m.)

    This session will provide a multispecialty perspective on how glaucoma can be caused by the native crystalline lens, aphakia, an anterior chamber IOL, a posterior chamber IOL, or a displaced lens. In addition to providing a refresher on the myriad ways in which the lens can be associated with glaucoma, this session will focus on best treatment strategies for glaucoma patients with real and artificial lenses of all shapes and sizes. Join us in this session, which will provide a forum for general ophthalmologists, glaucoma specialists, cornea specialists, and retina specialists alike to improve their knowledge about specific topics such as prem-ium and toric lenses for glaucoma patients, solutions for uveitis-glaucoma-hyphema (UGH) syndrome, issues with aphakic glaucoma, narrow angles and phacoemulsification surgery, combined phaco plus glaucoma procedures, and much, much more.

    —Brian A. Francis, MD, and Kelly W. Muir, MD
    Glaucoma program directors

    Clinical Practices to Reconsider

    La Nouvelle Orleans AB

    Glaucoma in the Digital Age, moderated by Babak Eliassi-Rad, MD, and Ian Conner, MD, PhD (Friday, 1:05-1:55 p.m.)

    This session will present and discuss several tools that are gaining popularity, as they facilitate earlier and more reliable glaucoma diagnosis and treatment. They include home tonometry, which makes it possible to obtain intraocular pressure (IOP) measurements on different days and at different times of day. Currently, ophthalmologists may be obtaining a patient’s visual fields only once a year; however, with virtual reality visual fields, testing can be performed several times a year to identify progression earlier and start or escalate treatment sooner. Because of the pandemic, use of telemedicine has gained popularity, and this type of care can be very beneficial to the glaucoma patient and to the ophthalmologist’s practice. Other topics in this presentation include the use of artificial intelligence in glaucoma management and new visual aid apps that can improve the quality of life for glaucoma patients. We believe that the topics covered in this session will be beneficial for today’s ophthalmologists and will become part of ophthalmology practice in the near future.

    —Brian A. Francis, MD, and Kelly W. Muir, MD
    Glaucoma program directors

    Exciting Developments

    La Nouvelle Orleans AB

    Journal Club/Late Breaking, moderated by Kelly W. Muir, MD, and Ian Conner, MD, PhD (Friday, 1:55-3:07 p.m.)

    Sustained-release glaucoma drug delivery systems have the potential to transform the treatment of glaucoma. We will dive deep into the science and practical use of the bimatoprost implant. A panel of colleagues will take us through a clinical case to the evidence from clinical trials, to the basic science helping us understand the mechanisms of action, and back to the patient for a comprehensive discussion of this exciting development in glaucoma care.

    —Brian A. Francis, MD, and Kelly W. Muir, MD
    Glaucoma program directors

     

    NEURO-OPHTHALMOLOGY SUBSPECIALTY DAY HIGHLIGHTS

    Of Interest Across Subspecialties

    La Nouvelle Orleans C

    Double Vision: I Can’t See Straight! Diplopia, moderated by Madhura Tamhankar, MD, and Jason Peragallo, MD (Friday, 8:02-10:05 a.m.)

    All ophthalmologists encounter patients who have double vision. The differential diagnosis for this symptom ranges from common non–neuro-ophthalmic conditions such as dry eye and cataract that produce monocular diplopia to potentially life-threatening disorders like aneurysmal cranial nerve palsy. Patients describe their visual symptoms in a variety of ways, and the concept and perception of “double vision” varies across ages and even regions of the country and world. The session will engage the audience with several cases in which the initial symptoms alone can lead down several diagnostic and therapeutic pathways. New this year is a focus on common complaints that can cause consternation and confusion about how extensive the diagnostic workup should be and what the best treatment and mitigation strategies are. Our speakers and expert panelists will help the ophthalmologist identify these problems and direct the diagnosis and management in the most efficient and effective way. Come to this session and learn more!

    —Peter A. Quiros, MD, and Prem S. Subramanian, MD, PhD
    Neuro-Ophthalmology program directors

    Clinical Practices to Reconsider

    La Nouvelle Orleans C

    More Than Meets the Eye! Systemic Disease Manifestations, moderated by Chantal Boisvert, MD, and Guy Jirawuthiworavong, MD (Friday, 1:18-3:30 p.m.)

    Neuro-ophthalmologists in particular and ophthalmologists in general are often faced with transient visual complaints that have few or no findings on examination and mixed or incomplete results from diagnostic testing. In this session we focus on characterizing the nature of the vision loss, assessing urgency, and targeting diagnostics, using an evidence-based approach. In addition, we will focus specifically on how to deal with test results that are at odds with the clinical exam and history. Among the questions: Is my patient having a transient ischemic attack? Is this MRI truly normal? The carotids are normal; now what? Join us for the “More Than Meets the Eye!” session at Neuro-Ophthalmology Subspecialty Day, where you will participate in case discussions centered around such dilemmas.

    —Peter A. Quiros, MD, and Prem S. Subramanian, MD, PhD
    Neuro-Ophthalmology program directors


    Exciting Developments

    La Nouvelle Orleans C

    Is This Nerve Okay? Optic Nerve Disease, moderated by Anne Abel, MD, and John Chen, MD, PhD (Friday, 10:05-11:52 a.m.)

    This session will review optic nerve diseases that are common yet often difficult to diagnose, as well as new and emerging diagnostics and therapeutics. Patients with optic nerve disease have, until recently, had little in the way of pharmacologic therapy other than corticosteroids for treatment of their disease. New treatments, new drugs, and revised treatment regimens for existing drugs are now available and will increase our treatment armamentarium. In this session, speakers and panelists will discuss difficult-to-differentiate cases of primary optic nerve disease and the new imaging modalities and techniques that can help clinicians discern them. Come to this session and get up to date on how to image and treat optic nerve disease.

    —Peter A. Quiros, MD, and Prem S. Subramanian, MD, PhD
    Neuro-Ophthalmology program directors

    OCULOFACIAL PLASTIC SURGERY SUBSPECIALTY DAY HIGHLIGHTS

    Of Interest Across Subspecialties

    Room 243

    Trending, moderated by Cat Burkat, MD, FACS (Saturday, 3:12-4:07 p.m.)

    This session on trending topics is not to be missed by comprehensive ophthalmologists, cornea specialists, or oculofacial plastic surgeons. Michael Yen, MD, will begin the session with the orbital approach to managing the neurotrophic cornea, and then Alon Kahana, MD, PhD, will discuss how best to introduce corneal neurotization to your practice by “Breaking the Barriers” to start performing these procedures. Elizabeth Bradley, MD, will discuss management of facial nerve palsy, specifically the lower eyelid aspects. Finally, Mark Lucarelli, MD, will discuss the treatment of synkinesis with toxins.

    —Catherine J. Hwang, MD, and Thomas E. Johnson, MD
    Oculofacial Plastic Surgery program directors

    Clinical Practices to Reconsider

    Room 243

    Face Forward—Practice Perfect, moderated by Catherine J. Hwang, MD, FACS (Saturday, 8:05-9:05 a.m.)

    We all strive to improve our practices each day. This session focuses on a variety of topics that will help oculofacial plastic surgeons as well as comprehensive oph-thalmologists expand their practices. Topics include building a social media presence, by Andrea Tooley, MD; adding skin care to your practice, by Tanuj Nakra, MD; and practical lasers for your practice, by Julie Woodward, MD. Finally, the topic of physician extenders in your practice will also be discussed by all panelists.

    —Catherine J. Hwang, MD, and Thomas E. Johnson, MD
    Oculofacial Plastic Surgery program directors


    Exciting Developments

    Room 243

    What’s New in Orbital and Adnexal Cancers, presented by Bita Esmaeli, MD, FACS (Saturday, 1:55-2:07 p.m.)

    We will receive an update by Bita Esmaeli, MD, professor of ophthalmology at the University of Texas MD Anderson Cancer Center, on new treatments for orbital and adnexal cancers. This talk is essential for understanding the current biologics, chemotherapeutics, and therapies being used for eyelid and orbital cancers.

    —Catherine J. Hwang, MD, and Thomas E. Johnson, MD
    Oculofacial Plastic Surgery program directors

    PEDIATRIC OPHTHALMOLOGY SUBSPECIALTY DAY HIGHLIGHTS

    Of Interest Across Subspecialties

    Room 243

    Childhood Glaucoma—New Approaches to an Enduring Foe, moderated by Deborah K. VanderVeen, MD (Friday, 1:15-2:15 p.m.)

    Medical and surgical management of childhood glaucoma has evolved rapidly during recent years, but dissemination of these advances in pediatric glaucoma care has been slower. If you see children in your practice, this session will be of interest because it reviews state-of-the-art management of childhood glaucoma.

    Faculty of the Pediatric Ophthalmology Subspecialty Day program will discuss key topics in this area. The session will include talks on interpretation of OCT for management of childhood glaucoma, microinvasive glaucoma surgery, and consideration of various types of angle surgery, including goniotomy, circumferential Schlemm canal surgery, trabeculectomy, and glaucoma drainage devices in the treatment of childhood glaucoma.

    —Gena Heidary, MD, PhD, and David K. Wallace, MD, MPH
    Pediatric Ophthalmology program directors


    Clinical Practices to Reconsider

    Room 243

    Reimagining Clinical Practice, moderated by Gil Binenbaum, MD, and David G. Morrison, MD (Friday, 9:35-11:05 a.m.)

    Pediatric ophthalmologists and comprehensive ophthalmologists have seen a tremendous upheaval in clinical practice due to the COVID-19 pandemic. Clinicians have sought to become resourceful in conducting eye examinations remotely, utilizing current technology to provide continued access to care, and maintaining practice solvency during this difficult time.

    Faculty of the Pediatric Ophthalmology Subspecialty Day program will share their expertise and insight on home vision apps, solutions for accessing clinical care, and consideration of billing guidelines. Practicing ophthalmologists will complete the session with tools for reenvisioning and advancing clinical practice.

    —Gena Heidary, MD, PhD, and David K. Wallace, MD, MPH
    Pediatric Ophthalmology program directors

    Exciting Developments

    Room 243

    Looking to the Future—How Clinical Studies Will Impact My Practice, moderated by Sergul Erzurum, MD, and David Wallace, MD (Friday, 2:15-3:45 p.m.)

    Michael F. Chiang, MD, the new director of the National Eye Institute (NEI), will provide an exciting introduction to this session. Dr. Chiang will help to frame the discussion of evidence-based research and goals for the NEI within the context of pediatric ophthalmology.

    Faculty of the Pediatric Ophthalmology Subspecialty Day program will expand on this to discuss key clinical studies and their importance in clinical practice. Topics will include intermittent exotropia, atropine therapy for myopia, treatment of retinopathy of prematurity, and management of optic neuritis.

    —Gena Heidary, MD, PhD, and David K. Wallace, MD, MPH
    Pediatric Ophthalmology program directors

    REFRACTIVE SURGERY SUBSPECIALTY DAY HIGHLIGHTS

    Of Interest Across Subspecialties

    New Orleans Theater AB

    “Tis the Times” Plague, presented by Ronald D. Gerste, MD (Friday, 8:23-8:33 a.m.) 

    The general public’s perception of med-icine and medical progress is shaped by diseases and the quest to cure them. Diseases that have both fascinated and frightened people for generations include infections, cancer, heart disease, diabetes, and neurodegenerative ailments like Lou Gehrig’s disease.

    However, there is a dysfunction of a major organ that afflicts not just millions, or even hundreds of millions, but billions of people—in fact, the majority of human beings. Refractive errors are a major burden on the daily lives of individuals, as well as on national economies, around the world. The number of people who are blind or have severe vision loss due to uncorrected refractive error does not create headlines, but it surpasses all other eye diseases. As gigantic as this challenge is, so are the chances for ophthalmology and ophthalmic surgery, now and even more in the future, to become a positively life-altering presence for people all around the world.

    —Burkhard Dick, MD, and Deepinder K. Dhaliwal, MD
    Refractive Surgery program directors


    Clinical Practices to Reconsider

    New Orleans Theater AB

    Building on New Interest in Refractive Surgery and How to Keep the Momentum Going, presented by Michael C. Knorz, MD (Friday, 8:35-8:45 a.m.)

    It is always inspiring to hear from a true pioneer. Michael C. Knorz, MD, has been that—both as a surgeon, who in 1993 introduced LASIK in Germany, and as a patient, becoming one of the first refractive surgeons to undergo a corneal procedure himself. With extensive experience in both corneal and lens-based procedures, Dr. Knorz will present an overview of current and future techniques that will enable the refractive surgeon to offer customized solutions for almost any patient’s visual needs. Long-established interventions continue to be modernized; for example, photorefractive keratectomy may be performed through a transepithelial approach, and femto-LASIK is now used to create near-perfect flaps and correct for cyclotorsion and pupil offset. Phakic IOLs and refractive lens exchange are offering new opportunities for patients with high ametropia who, in the past, might have been reluctant to undergo these relatively more invasive procedures. As Dr. Knorz will convincingly explain: There is considerable momentum in refractive surgery—it is up to every practice to utilize and foster it!

    —Burkhard Dick, MD, and Deepinder K. Dhaliwal, MD
    Refractive Surgery program directors

    Exciting Developments

    New Orleans Theater AB

    Laser-Generated Aperture to Extend Depth of Focus, presented by Omid Kermani, MD (Friday, 5:06-5:12 p.m.)

    Although the optical principle of the small aperture as a means to increase depth of focus has been known for more than 400 years, it has recently been introduced in refractive surgery with varying degrees of success and patient satisfaction. Small-aperture IOLs such as the IC-8 and the Xtrafocus have shown excellent visual results; a remarkable tolerance for astigmatism; and a significant reduction (compared with multifocal and extended depth of focus IOLs) of halos, glare, and shadows. Concerns about restricted night vision due to the small aperture have now been laid to rest: After an adaptation period of a few weeks, the retina “learns” to compensate.

    If this principle is as good as we now think it is, wouldn’t it be great to convert an already implanted IOL into a small-aperture lens? As Omid Kermani, MD, will explain, we can. Femto-Masking, currently under development by a number of European companies, offers an elegant method for creating small apertures in the majority of common IOL materials. Femto-Masking can be performed according to the patient’s needs and thus offers an individualized—and truly exciting—new option in refractive lens and cataract surgery.

    —Burkhard Dick, MD, and Deepinder K. Dhaliwal, MD
    Refractive Surgery program directors

    RETINA SUBSPECIALTY DAY HIGHLIGHTS

    Of Interest Across Subspecialties

    The Great Hall

    Developing a Pancoronavirus Vaccine, presented by Lbachir BenMohamed, PhD (Friday, 9:12-9:18 a.m.)

    Genetic variants of SARS-CoV-2 have been emerging and circulating widely around the world throughout the COVID-19 pandemic. Given the concern over variants that demonstrate greater transmissibility, cause more serious disease, or show greater resistance to currently available vaccines, there is enormous interest in developing vaccines that can target all SARS-CoV-2 variants as well as other coronaviruses, such as those that cause the common cold. Lbachir BenMohamed, PhD, a herpes virologist, will discuss the efforts by his laboratory and other scientists to develop effective pancoronavirus vaccines, which would be of enormous public health importance across the globe. This fascinating highlight presentation will be of interest to physicians of all specialties and subspecialities.

    —Mark W. Johnson, MD, and Srinivas R. Sadda, MD
    Retina program directors

    Clinical Practices to Reconsider

    The Great Hall

    Management of Vision-Obscuring Vitreous Hemorrhage Associated With PVD: Observe or Operate? presented by Gaurav Shah, MD (Friday, 8:21-8:27 a.m.)

    Panretinal Photocoagulation: A Rational Guide for Its Use, presented by David N. Zacks, MD, PhD (Saturday, 11:54 a.m.-12:00 p.m.)

    Historically, patients with posterior vitreous detachment (PVD) complicated by vision-obscuring vitreous hemorrhage were managed with cautious observation while awaiting spontaneous clearing of the hemorrhage. Gaurav Shah, MD, will discuss the risks and merits of observation versus prompt vitrectomy to clear the hemorrhage, identify retinal breaks, and reduce the otherwise high incidence of retinal detachment in this setting. This information will help ophthalmologists and their patients to make the most prudent choice in this critical situation. 

    Since the DRCR Retina Network Protocol S clinical trial found similar outcomes for anti-VEGF therapy compared with panretinal photocoagulation (PRP) in the management of proliferative diabetic retinopathy (PDR), the use of anti-VEGF therapy for this indication has increased. David N. Zacks, MD, PhD, will highlight the relative risks and benefits of anti-VEGF injections versus PRP for PDR, emphasizing the durability of PRP in this vulnerable population and proposing a rational guide for its use in the anti-VEGF era.

    —Mark W. Johnson, MD, and Srinivas R. Sadda, MD
    Retina program directors

    Exciting Developments

    The Great Hall

    Faricimab in Neovascular Age-Related Macular Degeneration: 1-Year Efficacy, Safety, and Durability in the Phase 3 TENAYA and LUCERNE Trials, presented by Carl D. Regillo, MD (Saturday, 9:44-9:50 a.m.)

    Newly released results from two phase 3 clinical trials of an investigational bispecific antibody, faricimab, demonstrate the potential of this new agent to reduce treatment burden in patients with neovascular age-related macular degeneration (AMD) by allowing extended dosing intervals. Carl D. Regillo, MD, will present the one-year efficacy, safety, and durability results of the phase 3 trials comparing faricimab with aflibercept in patients with neovascular AMD. If approved by the FDA, faricimab, which targets two distinct pathways (via angiopoietin-2 and VEGF-A), would represent the first new class of therapeutic agents for neovascular AMD in 15 years.

    —Mark W. Johnson, MD, and Srinivas R. Sadda, MD
    Retina program directors