A Message from
the Anterior Segment Section
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Anterior Segment Section Newsletter
February 2019
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In This Issue:
- Message from the Chair
- Academy 2018 San Antonio Recap
- Interview with a Diplomate
- Clinical Case Series
- Save the Date
- Mission Statement
- Section Leadership
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Thank you to all for your support and dedication to our Anterior Segment Section! Over the last several years, we continue to grow in our membership, increase in active participation in our section's meetings/events and gain more momentum in our Diplomate process. I'd like to give a shout out to our newest Diplomate, Dr. Mika Moy, who became our 3rd Diplomate in our Section. As we move forward into 2019, I'd like to challenge every one of you to move forward in this process. Currently, we have 9 candidates who are seeking to take the next steps to attain a level of excellence beyond the American Academy of Optometry Fellowship program. You could be our next!!
At our last business meeting, our Section leadership initiated early discussions on what the future direction of our Section will be over the next three years however we can't do this alone. We'd like to know what you want to see our Section become and what needs you have as a member. Feedback is a gift and we welcome yours as we continue this process. Please feel free to reach out to me or any of our officers over the next several months to share your ideas.
Best Regards,
Walt Whitley, OD, FAAO
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Academy 2018 San Antonio Recap
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The Academy's annual meeting in San Antonio, Texas had over 7,948 attendees, making it the largest meeting in Academy history. The Anterior Segment Section was highly productive in conducting:
- The annual business meeting, which allowed for the discussion of innovative plans for the future.
- A Diplomate Preparatory Course to assist in the completion of this process for interested Fellows.
- The symposium, "Biologic Therapy: Applications in Anterior Segment Disease" presented by Casey Hogan, OD, FAAO, Laura Periman, MD, and David Scales, MD, with moderation by our own Walt Whitley, OD, FAAO. This symposium provided vital information for patient care, while making information on immunologic pathways engaging and accessible.
We look forward to bringing you the most knowledgeable lecturers and interesting topics at Academy 2019 Orlando and the 3rd World Congress of Optometry!
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Interview with a Diplomate - Dr. Mika Moy
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Congratulations to you, Dr. Mika Moy, on becoming the newest Diplomate of the Anterior Segment Section of the Academy. What an accomplishment! We'd love to know more about you and how you achieved this remarkable feat.
Can you start by telling us a bit about where you practice?
I am a Clinical Professor at UC Berkeley School of Optometry and work in a multi-disciplinary ambulatory care center. As a result, we see many urgent care referrals from clinicians in the building and co-manage chronic diseases with them as well.
What made you decide to apply to become a Diplomate?
I was a founding member of the Anterior Segment SIG and was the original Diplomate Chair and developed our Diplomate Program. As soon as we graduated two Diplomates in New Orleans (Drs. Bronner and Colatrella), I stepped down as Chair and ran the gauntlet myself!
What is the first step you took to apply to become a Diplomate?
The very first step I took was to pick cases for my case reports. I wanted cases where I had good images and ones that would be interesting and not just 'run-of-the-mill.' I also picked cases that I, myself, wanted to research a bit.
Did you use all case reports or other supporting documents (posters, lectures, etc.) for your application?
I have lectured at the Academy on anterior segment topics and so I was able to use those lectures in lieu of two case reports. All the posters I have done at the Academy have had my previous residents as first author, so I was unable to use those.
All applicants must pass a written and oral examination. Which of these two did you find the most challenging?
The Slide Practical portion was actually fun for me. I knew the first few cases, but then came the case that stumped me. Of course I expected that I wouldn't know all of them. But the ensuing conversation was great as I worked through my differentials. It ended up being fun and I learned a lot from that conversation alone. I also enjoyed the Oral Exam because it was a conversation about my case reports. I was asked to defend some of my clinical choices, but the ensuing conversation also taught me quite a bit about different approaches to the same problem.
What do you feel is the biggest benefit to having Diplomate status?
For me, it's the process and the people. Delving into topics in great detail to generate a case report or a lecture helps me immensely in being a better doctor. Meeting people who share the same area of interest and practice in different settings gives me better perspective from which to teach my interns. That's one of the things I love about our Section--the diversity of optometrists that are active. I also enjoy working with Diplomate candidates and mentoring them through the process.
What piece of advice would you give to a future Diplomate candidate, applying for the Anterior Segment Section?
Do it! Take the plunge! It's hard work, but it is worth it. And, I'd set aside a certain amount of time weekly to work on it. Put it on your calendar and make it a priority. I worked on mine waiting for my kids at their extracurricular activities when that made the most sense. At another time, I came in an hour early to work and used the time before my first patient because that's what worked best for me.
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Ocular Rosacea
Alexandra Literski, OD
Optometric Resident at Associated Eye Care
A 42-year-old Caucasian female presents to the office with the complaint of ocular discomfort with lid involvement. She typically manages these symptoms with warm compresses, artificial tears, and an omega- 3 fatty acid supplement before seeking medical consultation and intervention for flare-ups. She noticed worsening vision in her left eye more than her right approximately one week ago and noted that the skin around her lids and cheeks seems more irritated and red lately.
At the initial visit, the patient's entering vision with her habitual correction was 20/50+ OD, 20/100 OS, and pinhole showed improvement to 20/25 OD, 20/40 OS. All other entrance testing was normal. Slit lamp exam revealed the following: severe meibomian gland dysfunction with invasive telangiectatic blood vessels throughout the patient's lid margins. Diffuse conjunctiva injection, worse in the inferior quadrant and notably worse in the left eye. Neovascularization of the inferior cornea in both eyes with one large vessel extending 5.5mm upward towards central cornea (Fig 1). An area of corneal thinning of approximately 40% was also noted in the patient's left eye (Fig 2). Other corneal findings included raised epithelial rigid and punctate epithelial erosions in the lower 1/3 of both eyes with associated haze. All other ocular structure findings appeared within normal limits.
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Fig. 1: Cornea Neovascularization
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Clinical findings appeared consistent for poorly controlled ocular rosacea with secondary keratoconjunctivitis. Other conditions considered were infectious and neurotropic keratitis. Due to reduced pain level experienced by the patient, corneal sensitivity was checked at the follow-up visit. It was discovered that the patient did have a notable decrease in sensation between right and left eye, but no difference when comparing superior and inferior cornea. The patient had long standing history of ocular surface disease with recurrent flare-ups, which would induce chronic inflammation leading to the reduced, and asymmetric corneal sensitivity. Therapeutic interventions began with the initiation of oral doxycycline 200mg daily to prevent further stromal loss and reduce ocular inflammation. Ofloxacin was also started prophylactically in the left eye only; no culturing was done due to low suspicious of infectious etiology. After ruling out infectious cause, the patient was started on Durezol 2x a day right eye and 6x a day left eye as well as triamcinolone cream 0.1%, 3x a day to eyelids OU. The patient was educated to keep both eyes well lubricated even if dry eye symptoms were not present, due to decreased corneal sensation. The patient was started on preservative free tears, nighttime lubricating ointment, and was educated on blinking exercises. With improvement in eyelids and her ocular surface, appropriate steroid tapering was initiated at follow-up appointments. Full resolution of all active neovascular vessels took just over 2 months. BCVA noted at that visit was 20/30 OD and 20/25 OS. Long-term therapy will include PF AT, nighttime lubricating ointment, punctal plugs, daily low dose doxycycline, high dose omega-3 supplement, and appropriate lid hygiene and moisturizing. Patient has also scheduled a consult for Intense Pulsed Light therapy, as a more advanced treatment option.
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Newsletter Information
We are looking for members to submit cases, as well as anterior segment photos and clinical pearls that can be included in our newsletter. Please forward them to Dr. Tracy Doll, Newsletter Editor, at
eyedoll@pacificu.edu
for inclusion in future newsletters.
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Mission Statement
The mission of the Anterior Segment Section is to promote collaboration between researchers and clinicians with an interest in anterior segment disorders of the eye. Our role is to promote excellence in the care of patients with anterior segment conditions through professional education and by advancing clinical research. Our intent is to identify new questions for research as well as disseminate knowledge, not only to the Fellows of the Section, but to the entire Academy and profession of optometry.
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Anterior Segment Section Leadership
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Chair
Walter Whitley, OD, FAAO
Vice Chair
Scott Hauswirth, OD, FAAO
Secretary
Grace Brown, OD, FAAO
Treasurer
Vin Dang, OD, FAAO
Immediate Past Chair
Jeffrey Varanelli, OD, FAAO
Chair Elect
Anne Mika Moy, OD, FAAO
Diplomate, Anterior Segment
Program Chair
Scott Han, OD, FAAO
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Program Chair Elect
Jacob Lang, OD, FAAO
Diplomate Development Chair
Aaron Bronner, OD, FAAO
Diplomate, Anterior Segment
Diplomate Case Reports
Marta Fabrykowski, BA, OD, FAAO
Diplomate Written Exam Chair
Chris Wilmer, OD, FAAO
FDR SIG Liaison
Harry Green, OD, PhD, FAAO
Communications Chair
Tracy Doll, OD, FAAO
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