acronyms abound - a talk for ophthalmologists.pptx

There are numerous confusing acronyms associated with all walks of life and this includes ophthalmology. Mr Simcock explains some of the more common and also rare but important acronyms in use today.

1. Ophthalmology acronyms explained Peter Simcock

2. Acronyms abound First know English acronym used with wireless telegram in 1879 POTUS Use when sending letters during WW2 SWALK BURMA Used all the time with social media communications LMFO YOLO FOMO

3. Acronyms in ophthalmology to be discussed ISBCS EDOF SRHM RAP MacTel PDS PCV CSCR

4. ISBCS – Immediate sequential bilateral cataract surgery Who do you think it is for and why? What issues may there be?

5. ISBCS – Immediate sequential bilateral cataract surgery Patient satisfaction with immediate improvement in vision in both eyes Minimum time spent in theatre / at facility BUT Patient fully informed of risks No ocular co-pathology If any problems with first eye, not to proceed with second eye

6. ISBCS – Issues Either topical anaesthesia or GA GA in patients with mild dementia not shown to aggravate their condition Subtle problems that could affect outcome to look out for Anterior segment – PXF and corneal guttae Posterior segment – VMT and mild ERM Endophthalmitis Not such an issue with intracameral Cefuroxime and use of Povidone Iodine prep Refractive surprise ELP

7. Irvine – Gass syndrome What is the incidence of CMO after uncomplicated cataract surgery? What increases the risk?

8. Irvine – Gass syndrome 2% to 3% of operations with up to 5% in some studies Increased risk if diabetic, uveitic , complicated surgery – all obvious Increased risk if VMT or ERM and can be subtle Always do an OCT and fundoscopy prior to surgery

9. Orange ring sign

10. Case presentation Unhappy patient after ISBCS Bilateral CMO No OCT prior to surgery but look at post op OCT scans after resolution of the oedema Bilateral subtle VMT

11. Post cxn increased fluid with erm

12. ELP – Effective lens position Zeiss IOL Master 700 – very accurate AL – Axial length – directly measured ACD – Anterior chamber depth – directly measured LT – Lens thickness – directly measured K’s – Corneal topography – directly measured (less accurate if prior LASIK) ELP – where the IOL ends up after surgery Calculations from formulae Depends on various unknow factors like zonular tension, capsule elasticity Main reason for refractive surprise (provided measurement done correctly) May improve with big data and AI based formulae but not there yet

13. Avoid ISBCS if large refractive error Avoid if high myopia Increased risk of retinal detachment Increased risk of complications during surgery Increased risk of refractive error Avoid if high hypermetropia Technically more demanding surgery Increase risk of refractive error

14. MFL – Multifocal IOL’s Problem with multifocal lenses Most are diffractive design with concentric rings Do patients like Fresnel prisms? Main problem is dysphotopsia’s with multifocal lenses IOL’s go into the eye easily, they do not come out without putting up a fight!

15. Dysphotopsia’s Very common early on after cataract surgery (up to 50%) Most patients neuro-adapt (brain gets used to it) Positive dysphotopsia’s Bright artifacts: streaks, haloes, starbursts Negative dysphotopsia’s Dark artifact: arc shaped dark shadow in temporal visual field (blinkers)

16. EDOF Extended depth of focus lenses Technis Eyhance Lens Still a monofocal lens (higher order polynomial aspheric anterior surface) Allows good distance and intermediate vision Good for driving and seeing the dashboard Good for computer distance Usually still need reading glasses Much reduced dysphotopsia’s compared to diffractive multifocal lenses

17. The Spiral IOL – RayOne Galaxy World first IOL designed by AI Collaboration with Rayner and Logos Bioscience in Brazil Has an optic spiral with continuous variance of the power to focus light at any position on the defocus curve Holy grail of optics? Full range of vision like a trifocal BUT Minimal dysphotopsias – like an enhanced monofocal lens

18. SRHM – subretinal hyper-reflective material An OCT finding of opacity between the neurosensory retina and RPE What are the causes of SHRM?

19. SRHM – subretinal hyper-reflective material Choroidal neovascularization (Type 2 – more about this later) Fibrosis (scarring) Vitelliform material Haemorrhage Drusenoid material

20. SRHM – subretinal hyper-reflective material Most important question to ask – is SRHM due to active neovascular AMD? If so, needs urgent treatment Other causes usually do not need urgent referral How can you tell?

21. SRHM – look at the company it keeps Main sign of activity is leakage and swelling on OCT Sub RPE, SRF and IRF (localized pockets of fluid) BUT also – is there interstitial (diffuse swelling)? Often overlooked but easily seen with the en -face surface map Don’t forget to look for new haemorrhage

22. Do not been fooled by involutional cystic change This is not a sign of active neovascular AMD Likely to be retinal degeneration with underlying scarring or atrophy Retina is thinned NOT thickened May be associated outer retinal tubulations Watch out for liquified vitelliform lesions – involutional change rather than active CNV

23. Involutional cysts & leaking disciform scar

24. Vitilliform type lesions

25. Revision on neovascular AMD Treatment the same for all but some more active than others! Type 1 / Occult sub RPE Most commons Can be low grade and inactive Type 2 / Classic Subretinal Ring of fire SRHM Type 3 / Retinal angiomatous proliferations (RAP) Intraretinal neovascularization first then goes deep and subretinal Small intraretinal haems , can look like a macular BRVO but crosses the midline Often bilateral and difficult to treat

26. Type 1

27. Type 2

28. Type 3

29. Mac Tel – Macular telangiectasia Type 2 It is primarily a neurodegenerative conditions with telangiectasia being a secondary phenomenon OCT findings important ILM drape sign Loss of Ellipsoid zone Retinal thinning Don’t forget to look at the fundus Tiny yellow crystalline deposits on retinal surface Telangectactic vessels temporal to fovea Pigmentary changes

30. Mac Tel – Differential diagnosis Macular BRVO Diabetic maculopathy RAP Resolved VMT

31. Mac Tel type 2

32. PDS - Pachychoroid disease spectrum Diseases that have a thickened choroid CSCR – Central serous chorioretinopathy Subretinal fluid +/- PED Younger population with healthy Bruch’s membrane PCV – Polypoidal choroidal vasculopathy Polyps Branching vascular network Type 1 CNV Haemorrhagic PED’s Peaked “thumbprint” PED on OCT scan Pachychoroid CNV Often poor responders

33. Polypoidal choroidal vasculopathy

34. CSR vs Pachychoroidal CNV

35. What has changed?