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Focal Point 2019 COLLECTION (7 Module)

Product code : 1564069843

American Academy of Ophthalmology


    Focal Points COLLECTION

    American Academy of Ophthalmology
    -Focal Points 2019 Module: Stem Cell-Based Therapy for Retinal Degenerative Disease

    Over the past several decades, significant advances in stem cell biology have allowed the creation of cell replacement strategies to treat retinal degenerative diseases. Embryonic stem cells and induced pluripotent stem cells have become promising sources of a variety of retinal tissue components.

    Age-related macular degeneration has received attention as a target disease because of the large unmet medical need associated with non-neovascular AMD. While AMD is a multifactorial disease, the dysfunction and ultimate loss of the retinal pigment epithelium is a major milestone in the progression of the disease and is highly correlated with vision loss.

    Based on current clinical trials, it’s clear that stem cell–derived RPE transplantation in the subretinal space is possible and offers a potential therapy for disorders impacting the RPE.

    This Focal Points module lists possible stem cell sources, discusses the surgical approaches used in recent retinal cell–based therapy clinical trials and examines the potential risks of the reviewed therapies.

    By completing this module, you will be able to:

    • List the potential sources of stem cells for use in retinal cell–based therapy.
    • Describe the different formulations of stem cells used in recent clinical trials.
    • Describe the different surgical approaches for delivery of stem cell–based therapy to the posterior pole.
    • Discuss the potential risks of stem cell–based therapies.

    -Focal Points 2019 Module: Current and Emerging Uses of Adjunctive Pharmacologic Agents in Glaucoma Surgery

    Despite decades of research, intraocular pressure reduction remains the sole therapeutic intervention proven to slow glaucoma progression. Trabeculectomy and glaucoma drainage devices aim to reduce IOP by draining aqueous humor to the subconjunctival space. Two newer devices, the XEN Gel Stent (Allergan) and the InnFocus MicroShunt (InnFocus/Santen), also produce de novo subconjunctival outflow pathways.

    The long-term success of any glaucoma filtration operation depends upon maintenance of aqueous humor flow to the subconjunctival space, which can be compromised by postoperative episcleral Tenon fascial fibrosis. Many factors increase the likelihood of excessive fibrosis following glaucoma surgery. It is vital for a surgeon to efficiently recognize these characteristics in order to maximize post-operative success.

    This Focal Points module discusses risk factors that lead to scarring and surgical failure, reviews applications of antifibrotics in glaucoma surgery and evaluates the current roles of these medications. Investigational approaches to the modulation of wound healing in glaucoma surgery are also discussed.

    By completing this module, you will be able to:

    • Recognize common underlying causes of early and late failure of glaucoma filtering surgery.
    • Summarize various application methods of adjunctive antifibrotic agents in traditional glaucoma operations and discuss the advantages and disadvantages of these agents in the intraoperative and early postoperative period.
    • Consider how antifibrotic agents may be applied to novel subconjunctival filtering devices.
    • Evaluate emerging pharmacologic methods for optimizing surgical outcomes.

    -Focal Points 2019 Module: Endothelial Keratoplasty: Current Techniques and Future Directions

    Surgical treatment of corneal endothelial disease has evolved dramatically. Endothelial keratoplasty is now the standard of care for treatment of patients with pure endothelial cell failure.

    To offer this patient population the best visual outcomes, cornea surgeons performing transplant surgery in the U.S. today should develop competence in both Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). It is likely that DMEK will become the standard of care for uncomplicated cases of corneal edema in the near future.

    This Focal Points module reviews recent advances, including new research on DSAEK and DMEK outcomes, progress in eye bank preparation of tissue, as well as future possibilities for transplantation of cultured corneal endothelial cells.

    By completing this module, you will be able to:

    • Discuss advances in endothelial keratoplasty (EK) in recent years.
    • Summarize advances in eye bank preparation of tissue that allows surgeons to adopt the latest iterations of EK.
    • Identify appropriate indications for Descemet stripping automated endothelial keratoplasty and Descemet membrane endothelial keratoplasty.
    • Describe the potential of Descemet stripping only, rho kinase inhibitor use, and transplantation of cultured corneal endothelial cells
    -Focal Points 2019 Module: Gene Therapy for Posterior Segment Disease

    The field of gene therapy has hurtled to the forefront of medical research in recent years. Advancements in genetic sequencing, gene delivery technologies and proof-of-principle work in cell culture and animal disease models have resulted in human gene therapy trials across a wide range of genetic diseases.

    While many medical disciplines are conducting ongoing investigations, ophthalmology, in particular the field of inherited retinal diseases, leads the way with the first published phase III clinical trial and United States Food and Drug Administration (US FDA)–approved gene therapy.

    This Focal Points module summarizes ongoing gene therapy trials for ocular diseases in the US and reviews the unique advantages of intraocular gene therapy. The role of genetic testing and the importance of a multidisciplinary team, including the threshold for referring to an ophthalmic geneticist, is also discussed.

    Complete this module to: 

    • Learn five unique advantages of the posterior segment as a target for gene therapy.
    • Gain strategies to discuss recent advancements in gene therapy and the implications for patients with inherited ocular diseases.
    • Efficiently identify patients with posterior segment disease who would benefit from genetic testing. 
    • Deepen your understanding of the process to refer patients to an ophthalmic geneticist as part of a multidisciplinary plan.

    -Focal Points 2019 Module: Advances in Astigmatism Surgery
    Astigmatism is costly, prevalent and unstable over time. Refractive error, which includes astigmatism, results in billions of dollars being spent annually on treatment in the United States. Astigmatism can be surgically corrected. Sight-restoring procedures, such as cataract surgery, are known to improve quality of life, longevity and reduce long-term healthcare costs.

    This Focal Points module discusses the findings of three recent studies (Coskunseven et al, 2017; Savini et al, 2017; Tanito et al, 2017) that have influenced the field of surgical astigmatism management.

    Complete this module to:

    • Discuss the natural history, prevalence and societal burden of astigmatism.
    • Enumerate the methods by which refractive error can be managed in conjunction with cataract surgery.
    • Evaluate current research aimed at predicting and minimizing postsurgical refractive error.
    • Identify emerging combined methods of treating irregular astigmatic conditions, such as keratoconus.
    • Recognize that astigmatism can be induced surgically during management of other ocular diseases, such as glaucoma.

    -Focal Points 2019 Module: Diagnosis and Management of Anterior Uveitis
    Among working-age adults in developed nations, uveitis is the fourth leading cause of blindness. Anterior uveitis is a challenging disease entity involving inflammation of the anterior structures of the uvea, including the iris and ciliary body.

    To avoid possible permanent vision loss from structural damage, the intraocular inflammation must be controlled promptly, and any associated disorder should be identified and treated.

    This Focal Points module reviews the common causes of anterior uveitis and the steps to creating an effective treatment plan. How recent research is shaping future treatment strategies for anterior uveitis is also discussed.

    Complete this module to:

    • Summarize techniques for the identification and grading of anterior uveitis.
    • Specify when to perform diagnostic evaluation of patients with anterior uveitis.
    • Recognize common and emerging causes of anterior uveitis.
    • Enumerate areas of research in uveitis and their potential future applications.
    • Discuss how to formulate an appropriate management plan for anterior uveitis.

    -Focal Points 2019 Module: Pain in the “Normal” Eye

    There are several conditions that cause eye pain but might not elicit abnormal findings in a standard ocular workup. When a patient presents with eye pain, it is important to obtain a thorough history and consider whether subtle findings could be clues to the etiology—or whether the source of the pain is extraocular.

    This Focal Points module reviews recent research findings regarding ocular pain in the normal-appearing eye and applies these results to patient care.

    Complete this module to:

    • Recognize subtle abnormalities on examination and some common causes of ocular pain
    • Discuss the newer pain pathways and how they relate to the other pathways
    • Recognize the diagnosis and treatment of giant cell arteritis, corneal neuropathy, supraorbital and occipital neuralgia, and migraine
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