AAO Annual Meeting, New Orleans 2013 - patient access to current thinking

[littlemermaid]

American Academy of Ophthalmology Annual Meeting 2013, New Orleans http://www.aao.org/meetings/annual_meeting/ If anyone non-medical from patient advocacy or patient support has managed to access this, please post up! Mostly what I'm getting on Twitter #AAO13 or #AAO2013 is pictures of cupcakes from med reps and docs whooping it up in restaurants, lol.

However, the ePortal is up for Video and Posters http://aao.apprisor.org/acuWelcome.cfm. You can follow your own interests, but there are some specific to ocular surface disorder management with dry eye eg Meibomian Gland Dysfunction in Aqueous-Deficient Dry Eyes With Sjögren Syndrome, Shizuka Koh. This one shows that air pollution damages people's eyes Environmental factors and dry eye syndrome

Many important new findings on keratoconus management and crosslinking, including the epi-on and epi-off debate http://video.healio.com/video/Cornea...;Ophthalmology.

Here's a link to ongoing news coverage on Healio Ophthalmology http://www.healio.com/ophthalmology/...-news-coverage, and the videos are starting to appear.

I understand why patient groups are excluded just now but why can't we have video presentations and debate streamed, as we can from Universities. This is the future. This presentation and discussion would have been so valuable for us 'Dr Reza Dana - dry eye management'. Plenty of useful information we can't access in Cornea and Paediatric Subspecialty Days.

Big thank you to the docs who are Tweeting sensibly for us from the sessions, lol

[littlemermaid]

November 16, 2013. NEW ORLEANS. Dr Reza Dana, dry eye management, Ocular Surgery News reporting AAO 2013 http://www.healio.com/ophthalmology/...e-corneal-melt

Graft rejection detected early in a low-risk patient may be reversible in 75% of cases, Reza Dana, MD, said at Cornea Subspecialty Day preceding the American Academy of Ophthalmology meeting.

“Our current approach in patients at high risk of rejection (three or more quadrants of neovascularization) is we prophylax intraoperatively with subconjunctival and intravenous steroid, then 3 to 6 weeks of prednisone,” Dana said. “If they do reject, they go on oral cyclosporine.

However, “No consensus has been established yet,” he added.

“With dry eye disease, the approach is to enhance lubrication, support the epithelium, treat lid disease and control inflammation,” Dana said.

The surface wetness can be increased with tear supplements and tear preservation, and sometimes oral secretagogues are used, he said.

“Treat concurrent lid disease with oral tetracycline or macrolides along with lid hygiene and hot compresses,” Dana said.

Some practitioners are using the LipiFlow by TearScience and performing meibomian gland probing.

“Some have responded, some have not,” he said.

Mucolytic therapy can be used for filamentary keratitis, as can diluted 20% autologous serum tears four to six times daily.
“Do not use NSAIDs in dry eyes,” he added.

Topical immunomodulatory treatments are also useful, Dana said.

“Restasis (cyclosporine ophthalmic emulsion 0.05%, Allergan) is extremely safe, but there is a distinct minority who has burning,” he said. “Many have to be on the drug for 4 months or longer.”

Dana noted that he rules out a family history of glaucoma before starting a dry eye patient on corticosteroids, and he only uses them to control flares.

Lifitegrast, a T-cell agonist, is being studied for treatment of dry eye.

“Corneal melt is the rapidly progressive thinning of the stromal matrix, with or without epithelial defect,” Dana explained. “Rule out underlying disease, such as infection. Do cultures at baseline and then from time to time to gauge response to therapy.”

In patients with Sjögren’s syndrome or rheumatoid arthritis, the fellow eye must be ruled out.

He recommended suppressing collagen breakdown with the use of oral tetracyclines.

“We also use medroxyprogesterone 1%, autologous serum tears and high-dose oral ascorbate,” Dana said.

“Minimize the use of preservative-containing medications,” he added. “These are very problematic. I often see patients come in with epithelial defect, and they’re on one or two preserved antibiotics.”

Therapeutic bandage contact lenses, scleral contact lenses and amniotic membranes can also be used.

[hankm9]

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[NotADryEye]

I think it is a travesty that there is no direct patient, advocacy, and support representation in these meetings, particularly from patients like ourselves, the difficult cases.

[littlemermaid]

I've attended some doc/patient consultation, charity, and local health service meetings now. I would recommend making an effort to find and attend meetings rather than expecting someone else to do it, although I am lucky to be well enough. Emotions run high so it's essential to stay sensible and practical and find solutions together. We are the 'difficult to manage' cases, especially with systemic causes of eye problems.

Welcome home, Hankm! Have you read or watched our Ben Goldacre's work? He influences policy now.