PCON Editorial Board members speak at AAO meeting

Topics will include retina, pharmaceuticals and grand rounds case reports.

Primary Care Optometry News will sponsor three 2-hour continuing education courses during Academy 2011 Boston, the annual meeting of the American Academy of Optometry, featuring four members of the PCON Editorial Board.

Evidence-based retinal care

Anthony A. Cavallerano

Anthony A. Cavallerano, OD, FAAO, PCON Editorial Board member and director of the Store and Forward Boston Training System at the VA Boston Health Care System, and Jerry Cavallerano, OD, on staff at Beetham Eye Institute, Joslin Diabetes Center, Boston, will present research results that drive clinical decisions for treating age-related macular degeneration and diabetic retinopathy.

These presenters will review the methodology and results behind well-known clinical trials, including the Age-Related Eye Disease Study 2, MPS (Macular Photocoagulation Study), TAP (Treatment of AMD with Photodynamic

Jerry Cavallerano

Therapy), MARINA (Minimally Classic/Occult Trial of the Anti-VEGF Antibody RhuFab V2 in the Treatment of Neovascular AMD), ANCHOR (Anti-VEGF Antibody for the Treatment of Predominantly Classic Choroidal Neovascularization in AMD) and VIP (Verteporfin in Photodynamic Therapy) study.

The Diabetic Retinopathy Clinical Research Network, a National Eye Institute-funded diabetes eye research collaborative established in 2002, has 18 trials in various stages of progress. Trials still recruiting patients include An Evaluation of Intravitreal Ranibizumab for Vitreous Hemorrhage Due to Proliferative Diabetic Retinopathy, Effect of Diabetes Education during Retinal Ophthalmology Visits on Diabetes Control and Phase 2 Evaluation of Topical NSAIDS in Eyes with Non-Central Involved DME (diabetic macular edema).

“Evidence-Based Retinal Care” will be held Oct. 12, 10 a.m. to 12 p.m., in the John B. Hynes Veterans Memorial Convention Center, Room 313.

Pharmaceutical update

Bruce E. Onofrey

PCON Editorial Board member and University of Houston College of Optometry professor Bruce E. Onofrey, OD, RPh, FAAO, FOGS, will present a comprehensive discussion of the most up-to-date pharmaceutical management of a range of ocular disorders from dry eye to glaucoma.

The keys to managing dry eye are quantifying the symptoms, finding the cause, staging the disease and selecting the proper therapy, according to Dr. Onofrey. Today’s therapies include mucomimetic drops and bandage contact lenses, omega-3s, anti-inflammatories, punctal occlusion and Evoxac (cevimeline HCl, Daiichi), which is used for treating Sjögren’s patients.

Dr. Onofrey says Zirgan (ganciclovir ophthalmic gel 0.15%, Bausch + Lomb) is “the new way to treat herpes simplex.”

The drug is absorbed rapidly, he says. The initial dosage is five times daily. Zirgan exhibits selective toxicity; therefore, the toxicity associated with trifluoridine, commonly seen after 21 days of treatment, does not occur with Zirgan.

For those suffering from post-herpes zoster trigeminal neuralgia, he recommends Neurontin (gabapentin, Pfizer) for pain.

Dr. Onofrey says a number of advancements have been made in the field of allergy: a better understanding of immune mechanisms, multi-tasking drugs, safer and more effective therapy, and an opportunity for better patient counseling.

Optometrists must know that they cannot cure patients with allergy, according to Dr. Onofrey. Stage the disease, choose a treatment appropriate for the level and be aggressive when necessary. It is important to determine if you are treating a histamine or an inflammatory response, he notes.

In inflammatory allergic disorders, such as vernal and atopic keratoconjunctivitis, Restasis (cyclosporine A, Allergan) may have a role. It has the ability to reduce the use of topical steroid due to its T-cell modulating properties.

“Pharmaceutical Update” will be held Oct. 13, 3:30 p.m. to 5:30 p.m., in Ballroom C of the convention center.

Rapid fire rounds

Ron Melton

Ron Melton, OD, FAAO, and Randall K. Thomas, OD, MPH, FAAO, both PCON Editorial Board members and private practitioners from North Carolina, will share an array of case presentations covering anterior segment, retina, neuro, glaucoma and pharmacology.

Topamax (topimarate, RW Johnson) is indicated for the treatment of seizure disorders but is primarily used off-label for migraine headache, weight loss, depression and bipolar disorder. Optometrists must be aware of patients who take this agent and watch for acute, bilateral, simultaneous angle-closure glaucoma, Drs. Melton and Thomas say. Onset usually occurs within the first 2 weeks of therapy and presents initially as blurred vision. If an angle-closure event is seen, treat it medically and telephone the prescribing physician to stop the medicine or reduce the dosage. IOP should return to normal within 2 to 3 days.

Randall K. Thomas

Keratopathy resulting from Fabry’s disease, an X-linked recessive disorder, looks similar to hydroxychloroquine and amiodarone keratopathy, according to the presenters. Visual acuity is usually not affected. No ocular therapy is needed, but a systemic therapy, Fabrazyme (agalsidase beta, Genzyme) is now available for Fabry’s disease.

Amiodarone is prescribed for life-threatening arrhythmias, but it accumulates in high concentrations in tissue, the presenters said. Corneal subepithelial microdeposits can be seen in a verticillate pattern. Papillopathy is possible, but uncommon. The papillopathy may be confused with non-arteritic anterior ischemic optic neuropathy, they say.

“Rapid Fire Rounds” will be held Oct. 15, 8 a.m. to 10 a.m., in Room 206 of the convention center.

For more information on these courses or to register, go to www.PCONSuperSite.com/AAO. – by Nancy Hemphill, ELS

• Disclosures: Drs. Anthony and Jerry Cavallerano and Dr. Onofrey have no relevant financial disclosures. Drs. Melton and Thomas are paid consultants to Baush + Lomb.