This book provides a practical guide to the most recent advances in the diagnostic management of corneal ectasia. Clear, concise chapters address new standardized nomograms of treatment of early progressive ectasia, new epithelium on future crosslinking with and without oxygen supplement, customized protocols, laser assisted corneal regularization protocols and the new femtolaser assisted lamellar corneal transplant. Clinicians and surgeons seeking a go-to guide on the topic of corneal ectasia will find this book to be an essential resource for the latest developments and predicted future trends in the field.
This book presents new technologies which are available now for the rehabilitation of visual acuity in patients suffering from keratoconusand for arresting the progression of this frustrating disease. All these current treatment options in differing combinations aim to improve the quality of life of the patients and although successful, they are causing confusion for the ophthalmologists; what procedure to do and when? How to perform? Which combination of treatments to choose? Controversies in the Management of Keratoconusprovidesthe widely used treatment options for keratoconus including collagen corneal cross –linking (CXL) covering all the available techniques, intrastromal corneal ring segments (ICRS) , phakic intra-ocular lenses (IOLs), photorefractive keratectomy (PRK) combined or not with CXL penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty ( DALK). Each treatment is addressed by more than one author with different points of view in order to present the various approaches, the logic behind them and the most relevant clinical data available.A chapter by the editor tries to put some light on how to navigate among these controversies. This book will be of interest to trainees as well as the specialized ophthalmologists.
Written by an international team of ophthalmic practitioners, this authoritative book is a vital resource not only for ophthalmic professionals, but for any healthcare professional who cares for patients with eye problems. In the ten years since the first edition was published, practice has moved on, as has the evidence for practice. This second edition draws on the passion and goodwill of the original team of authors, complemented by other colleagues, to fully revise and update the text in line with new findings, new practice and new and exciting treatments. The book is broadly divided into three sections. The first section considers the structure and function of the eye, as well as the basic principles of ophthalmology and eye examination. The second section considers patient care in diverse settings, as well as work-related issues and patient education. It also includes two entirely new chapters on eye banking and global eye health. The third section takes a systematic approach to patient care, working from the front to the back of the eye, discussing some of the common disorders affecting each structure (such as the lens or cornea) or group of structures (such as the eyelids or lacrimal drainage system). The book concludes with a very useful glossary of ophthalmic terms. Some aspects of practice discussed in the text are, of necessity, UK based, but these are clearly indicated and, wherever possible, principles (rather than specifics) are addressed and readers are directed to local policies and interpretations. The first edition of this book became a core text for ophthalmic nursing, in particular, and for the education of ophthalmic nurses across the world. This new edition will provide a comprehensive, up-to-date, evidence-based resource for all ophthalmic healthcare professionals. Contents include: • Physiology of vision • Optics • Pharmacology • Examination of the eye • Visual impairment • Patient education • Work and the eye • Care of the adult ophthalmic patient in an inpatient setting • The care of the child undergoing ophthalmic treatment • Developments in day care surgery for ophthalmic patients • Ophthalmic theatre nursing • The care of patients presenting with acute problems • Eye banking • Global eye health • The eyelids and lacrimal drainage system • The conjunctiva • The cornea • The sclera • The lens • The uveal tract • The angle and aqueous • The retina and vitreous • The orbit and extraocular muscles • Visual and pupillary pathways and neuro-ophthalmology • The eye and systemic disease
While lecturing in recent months at a number of prominent institutions, I asked some of the residents and fellows whether and how they might benefit from a book on corneal biomechanics. The typical response was the look of a deer caught in the headlights as they tried to intuit the “appropriate” answer, but had little understanding or insight as to why this would be an important and useful knowledge base for them now, or in the future. I then posed the question differently. “Would a book that explained corneal biomechanical principles and testing devices and their application in detecting eyes at risk for developing keratoconus and post-LASIK ectasia, understanding the biomechanical impact of specific types of keratorefractive surgery and riboflavin UV-A corneal collagen cross-linking, and the impact of corneal biomechanics on the fidelity of intraocular pressure measurement and risk for glaucoma progression be of interest?” Framed in this context, the answer I got was a resounding, “Yes!” Therein lies a fundamental disconnect that highlights both the opportunity and need to educate all ophthalmologists about this nascent field. This comprehensive book is strengthened by the breadth of contributions from leading experts around the world and provides an important resource for ophthalmologists at all levels of training and experience. It gives a panoramic snapshot of our understanding of corneal biomechanics today, bridging the gap between theoretical principles, testing devices that are commercially available and in development as well as current and potential future clinical applications. While there has been a long-held appreciation that all types of keratorefractive surgery have an impact and interdependence on corneal biomechanics and wound healing, the initial finite element analyses that were applied to understand radial keratotomy were limited by incorrect assumptions that the cornea was a linear, elastic, homogenous, isotropic material.1 With the advent of excimer laser vision correction, critical observations indicated that Munnerlyn’s theoretic ablation profiles did not account for either lower or higher order (e.g. spherical aberration) refractive outcomes,2 suggesting that there were important components missing from the equation—e.g., corneal biomechanics and wound healing. In a seminal editorial, Roberts3 pointed out that the cornea is not a piece of plastic, but rather a material with viscoelastic qualities. Since that time, much has been learned about spatial and depth- related patterns of collagen orientation and interweaving, as well as the biomechanical response to different keratorefractive surgeries that sever tension-bearing lamellae, as the cornea responds to and redistributes stress induced by IOP, hydration, eye rubbing, blinking and extraocular muscle forces.3-6 The first reports of post-LASIK ectasia7 highlighted the need to identify a biomechanical signature of early keratoconus as well as corneas at high risk of developing ectasia irrespective of their current topography or tomography. The introduction of two instruments into clinical use—the Ocular Response Analyzer (ORA) and the Corneal Visualization Scheimpflug Technology (Corvis ST)—that allow measurement of various biomechanical metrics further catapulted the field. The availability of these instruments in routine clinical settings allowed the systematic study of the effect of age, collagen disorders, collagen cross-linking, corneal rings, flaps of various depths, contour, sidecut angulation, pockets, and flockets, just to name of few. Future application of biomechanics to the sclera may improve our understanding of the development and prevention of myopia, as well as scleral surgeries and treatments under development for presbyopia. It was appreciated by Goldmann and Schmidt that corneal thickness and curvature would influence the measurement of applanation tonometry. The recent ability to measure some corneal biomechanical metrics have led to IOP measurement that may be more immune both to their influence and the impact of central corneal thickness (CCT). Certain chapters in this book explain how a thin cornea could be stiffer than a thick one and that stiffness is also impacted by IOP, thereby precluding simplistic attempts to adjust IOP measurements using nomograms based upon CCT alone. Also highlighted is how corneal hysteresis, the ability of the cornea to absorb and dissipate energy during the bidirectional applanation response to a linear Gaussian air puff, appears to be an independent risk factor for glaucoma progression and rate of progression.9,10 This comprehensive book starts out with a section devoted to outlining basic biomechanical principles and theories, teaching us the language of what Dupps11 has referred to as “mechanospeak”, thus providing a context and common vocabulary to better comprehend the following chapters. By first defining basic concepts such as stress-strain relationships and creep, this theoretical basis is later applied to explain the pathogenesis of corneal diseases, e.g., explaining how a focal abnormality in corneal biomechanical properties precipitates a cycle of decompensation and localized thinning and steepening, clinically expressed as ectasia progression. These early chapters further detail biomechanical differences between in-vivo and ex-vivo testing, between human and animal corneas and sclera, and between methods of testing. The second section provides a thorough description of two FDA-approved devices to measure corneal biomechanics in the clinic (i.e., the ORA and the Corvis ST), as well as an overview of potential future technologies, including OCT with air puff stimulus, ocular pulse elastography, and Brilloiun microscopy. The third and final section of the book is a thorough treatise on how to interpret the metrics derived from the waveform provided by available clinical devices; their adjunct use in ectasia risk screening; the comparative biomechanical impact of various keratorefractive surgeries and corneal procedures such as PRK, LASIK, SMILE, and corneal collagen cross-linking; the impact of corneal biomechanics on IOP measurement; and potential biomechanical markers of enhanced susceptibility to glaucoma progression. This compendium of our current knowledge of corneal biomechanics, its measurement and application, provides a strong foundation to more fully understand advances in keratorefractive and corneal surgery, diseases, and treatments, all of which are interdependent on and influence inherent corneal biomechanical properties and behavior. Both the robust aspects and limitations of our current understanding are presented, including the challenge of creating accurate and predictive finite element models that incorporate the impact of IOP, corneal thickness, geometry, and scleral properties on corneal biomechanics. This book provides a key allowing clinical ophthalmologists and researchers to grasp the basics and nuances of this exciting field and to shape it as it evolves in the future.
"DSEK: What You Need to Know About Endothelial Keratoplasty provides a comprehensive background of EK, where it is today, and where it is headed in the future. Francis W. Price, MD. who was the first to complete DSEK in the United States, along with Marianne Price, PhD, have designed this text to offer a special emphasis on how to perform surgeries along with preventing and managing complications. In addition, a diverse group of contributing authors provides a wide array of insights and tips for better patient outcomes."--BOOK JACKET.
As a degenerative disorder of the eye, keratoconus can cause substantial distortion of vision, with multiple images, streaking, and sensitivity to light all reported by patients. Keratoconus: Recent Advances in Diagnosis and Treatment updates ophthalmologists about the innovations that have occurred within the last decade, discussing the diagnostic imaging techniques that have been developed for keratoconus diagnosis, understanding of how examination techniques are related to the evolution of keratoconus, and how to indicate the different therapeutic tools that have been created for keratoconus over the last several years. Additionally, fundamentals for new diagnostic elements, based on the mathematical, physical and biomechanical data are analyzed in depth for a better understanding of the essential diagnostic steps for the clinician to guide patients towards the most adequate therapeutic tool in the case. Modern keratoplasty techniques, assisted by femtosecond lasers or other devices, are also covered and these techniques, along with the emerging conservative treatments, have added to more precise control of the evolution of the disease.
This book provides comprehensive coverage of corneal collagen cross-linking (CXL), a major management modality for keratoconus and ectatic corneal disorders. All aspects are covered, including refractive and non-refractive surgery indications, models of application, safety, efficacy, performance, outcome measures, evidence of CXL, complications, contraindications, use in children, and controversies. The discussion reflects the considerable progress that has been made in understanding of the modality since its development in the late 1990s. Detailed attention is paid to new concepts, changing surgical techniques and indications, the latest evidence-based science and research, and the future of CXL. Guidance is also provided on the use of CXL in combination with other modalities, such as LASIK, PRK, intracorneal ring implantation and others. The text is accompanied by numerous high-quality color illustrations. Corneal Collagen Cross Linking will provide the reader with a sound grasp of the technique and its use and will hopefully also serve as a stimulus to further research and advances.
The field of cornea has seen tremendous advances over the last 40 years—this uniquely comprehensive book will discuss the history of these advances, current best practices in important diseases of the cornea and ocular surface, and examine future directions in diagnosis and management. Written by leading experts, many of whom trained under Claes Henrik Dohlman, MD, PhD, whose influence and many invaluable contributions have defined and shaped the field of cornea, each chapter will reflect the state of the art in the various aspects of cornea. Foundations of Corneal Disease: Past, Present, and Future contains six different sections, opening with an introduction which delves into the evolution of subspecialty training in cornea, and provides a historical perspective of our understanding of ocular surface disease. Section Two addresses perspectives on important corneal and external diseases including infectious keratitis, dry eye, and herpes simplex. Section Three and Section Four address surgery and surgical alternatives, and frontiers in corneal research. Section Six closes this book with a discussion of special topics: imaging the cornea, corneal blindness, eye banking, and clinical trials in dry eye, and explores future directions in this fast-paced field. Foundations of Corneal Disease: Past, Present, and Future contains is an ideal guide for corneal specialists, ophthalmology residents and fellows planning to enter cornea, corneal scientists, and to those in ophthalmology and visual science interested in a comprehensive resource on cornea and the history of this field.
This illustrated guide is written by international opinion leaders with extensive experience in the practice of refractive surgery. It is the first book devoted to refractive complications (with practical hints and case reports on outcomes) to provide ophthalmic surgeons with the most adequate solutions for the most frequent problems. All complications are described and lavishly illustrated. The book provides ophthalmic surgeons with the most adequate solutions for the most frequent problems they face in their daily practice.
Refractive Surgery: An Interactive Case-Based Approach presents all of the necessary refractive surgery material to make an informed decision regarding diagnosis and management plans. Rather than utilizing the standard organization of most books, where major points are first introduced and then explained through a series of writings and references, this book relies on the clinical decision-making process involved with treating refractive surgery patients. Refractive Surgery: An Interactive Case-Based Approach by Dr. J. Bradley Randleman builds upon foundational initial chapters through the case presentations and focused case discussions, encompassing the major topics in refractive surgery today. For each case, the critical question is simply, “what data in this chart is the most critical to consider when evaluating this patient for surgery?” Refractive Surgery: An Interactive Case-Based Approach is unique in its format. Specifically, the book facilitates active learning by forcing the reader to think through a series of questions surrounding each patient scenario. This active learning not only facilitates better recall of the information presented but also mimics the actual physician-to-patient clinical experience, making this book more relevant than other routine refractive surgery books. Bonus! This dynamic learning tool is also supplemented by interactive online video material to further the learning experience. Enhance the clinical decision-making process by watching the videos and then answering a series of questions that lead to the conclusion of each scenario. By challenging the reader to perform the thinking and decision making up-front, and then providing some guidance on the most salient concepts for each case scenario presented along with resources to gain a deeper understanding of the most complex concepts, Refractive Surgery: An Interactive Case-Based Approach engages more in the learning process and thereby allowing to absorb and retain significantly more information to apply to patient care and the education of others. Ophthalmologists, residents, fellows, resident and fellowship educators, who want to update their refractive surgery knowledge base will appreciate the unique format and style of Refractive Surgery: An Interactive Case-Based Approach.
