World Ophthalmology Congress 2018

We’re privileged to be presenting several papers and e-posters at the World Ophthalmology Congress 2018 in Barcelona, Spain

Find Out More

No referral needed

We accept almost all insurance including:
VSP • Eyemed • Comp Benefits • Vision Care Direct • 20/20 Advantage • Blue Cross/ Blue Shield of Illinois • Medicare • Cigna • Aetna • United Healthcare • PHCS • Personal Care/ Coventry

IPA Medical Cards Accepted

Don't See Your Insurance?

Just ask ... we probably do!

  • Champaign

    2151 South Neil Street | Champaign, IL | (217) 352-2020

  • Danville

    2 E Main Street, Suite 116A | Danville, IL | (217) 446-2020

  • Terre Haute

    215 E McCalister Drive | Terre Haute, Indiana | (812) 235-2020

  • Chicago

    St. Bernard Hospital, Special Clinics 2nd Floor | 6307 S. Stewart Ave | Chicago, IL | (773) 786-2020

World Ophthalmology Congress 2018

Barcelona, Spain

We're privileged to be presenting several papers at the World Ophthalmology Congress 2018 in Barcelona, Spain

Here are the abstracts of the topics we will be presenting on.  We hope you enjoy finding out more about where the research in our field is going and what we are doing to ensure you are receiving world class care!

Optical Foundations of Twenty First Century IOL Power Calculation Methods

An foundation course taught by Samir Sayegh, MD, PhD on Tue. 19 June 2018

Description

  1. To understand the importance of attaining refractive targets with IOL power selection
  2. To select appropriate targets for each individual eye of each individual patient
  3. To understand the historical development of methods of calculating IOL powers
  4. To understand the sometimes monumnetal errors made in the past when relying on ill-advised methodologies including post LASIK calculations
  5. To appreciate the underlying optics at the foundation of any proper IOL power calculation method
  6. To appreciate the so called "artificial intelligence" methods and appreciate their potential and limitations
  7. To learn the subtleties of selecting toric IOLs and the methodologies that contribute to success
  8. To learn how to select an appropriate environment that can provide excellent results for all patients without committing to a single platform, manufacturer or marketing trend.

Conclusions
We present the optical foundations of IOL power calculation starting with the now classic 1967 Fedorov paper and demonstrate how the two main branches of theoretical and statistical based methods have evolved to this day, sometimes under different names and guises and with multiple "historical accidents" the cost of which was mainly born by the patients. The role of the effective lens position and the methods of predicting it are presented. Toric IOLs and evolving methods to optimize their selection are also presented and a methodology to simultaneously optimize the sphere and toric components of an IOL is described. The course concludes with practical tips and a roadmap for the busy surgeon eager to achieve best refractive results with the broad spectrum of IOL choices now available without necessarily committing to a single platform, manufacturer or marketing trend.

Primary Instructor
Samir Sayegh, MD, PhD

Category
Cataract and Lens Surgery

Spectacle Independence and Postop Glasses Following Monovision Cataract Surgery: A Success Story

An e-Poster presentation by our very own Elizabeth Cotton, BA on Sat, Jun 16, 2018

Description
Recent years have seen the rise of patients' expectations following cataract surgery as well as the rise of "cataract refractive surgery" based in large part on our improved ability to predict refractive outcomes.

To demonstrate the ability to provide excellent visual results for most daily tasks following cataract surgery through the targeting of monovision and the ability to provide postop glasses from day 1 for the more tasking environments such as night time driving in the rain.

Materials / Patients and Methods
A retrospective chart review of 40 patients undergoing sequential bilateral cataract surgery targeted for monovision (~-0.25 and ~-0.75 or slightly more myopic based on professional requirements) through the use of the UniversIOL, a universal IOL calculator. A comparison of targets to final results and to "postop glasses made preop" was performed as well as an evaluation of satisfaction level, residual error and visual acuity with and without the postop glasses.

Conclusions
All patients had very high satisfaction scores without glasses for a majority of tasks and valued the additional usefulness of postop glasses in special circumstances. Most patients were within -0.25 diopters of target and all were within -0.5 diopters. Patients achieved 20/20 uncorrected vision and J1-J2 uncorrected and 20/20 and J1+ with postop glasses correction, when viewing binocularly.

Monovision remains an excellent choice for addressing the visual needs of all patients undergoing bilateral sequential cataract surgery. The addition of postop glasses, evaluated preop and made available on day 1 following cataract surgery, is an excellent adjunct for operating in the more visually tasking environments these patients may occasionally encounter.

Author
Elizabeth Cotton, BA

Co-Author(s)
Ahmad Al-Heeti, MD
Samir Sayegh, MD, PhD

A Case of Silent Temporal Arteritis (GCA) with a Normal ESR and CRP

Presented by our own Ahmad Al-Heeti, MD during the Neuro-Ophthalmology E-Poster Session on Sat. 16 June 2018

Description
GCA is a blinding and potentially fatal condition that needs to be on the radar for patients at risk. High suspicion and clinical acumen are needed and negative lab results may not be considered definitive proof of absence of the condition.

To present a case of fulminant giant cell arteritis with normal inflammatory lab values, adding to the rare but growing cases of a rapidly blinding disease for which our patients at risk need to be very carefully monitored.

Materials / Patients and Methods
We present a case of a 73 yrs old male who presented to his PCP and optometrist with gradual onset of decreased vision Right eye (OD). He described it as blurry vision with a purple shadow with crazy designs and some sharp flashing. He did not complain of pain, headache, scalp tenderness or jaw claudication. Superior lateral quadrant visual field loss OD was noticed. CBC, LFT, CMP and MRI were within normal. He continued to experience vision decrease OD when referred to our clinic more than a week later. Ophthalmic exam, visual field test, fluorescein angiography were performed at our clinic.

Conclusions
On examination BCVA was LP OD and 20/60 Left eye (OS). There was a right relative afferent pupil defect. Anterior segment exam was unremarkable. IOP 15 OD and 20 mmHg OS. Optic disc edema OD noticed on fundus exam. 24-2 visual field showed generalized depression OD and scattered scotomota OS. Fundus fluorescein angiography showed delayed choroidal perfusion OD. ESR was 13mm/h and CRP less than 0.4 mg/dL. The patient underwent bilateral temporal artery biopsy, confirming a diagnosis of bilateral GCA.

There are very few reported cases of temporal arteritis with normal ESR and CRP and this case contributes to this important literature.

Author
Ahmad Al-Heeti, MD

Co-Author
Samir Sayegh, MD, PhD

Category
Neuro-Ophthalmology

A Novel Test for the Improvement of Visual Assessment in Children

Presented by Samir Sayegh, MD, PhD as an e-poster on Sun. 17 June 2018

Background:
Testing the visual acuity of infants and children is of utmost importance and remains a challenge.

Purpose:
To present a novel method, the Finger Pointing Test, to improve the ability to reliably determine the visual acuity of infants and children.

Materials / Patients and Methods
The test utilizes EyeWare software developed by Dr. Samir Sayegh and others. One software feature is the use of standard fonts and symbols available and scalable with no need for lengthy and extended periods of development and maintenance. A finger pointing up, down, left and right is one such symbol. The child is encouraged to mimic what she or he sees with or without verbalizing the words up, down, left or right. Its use was validated and evaluated in children aged 1 to 5 years old in a retrospective analysis, as well as a prospective analysis on older children and adults.

Results:
The test proved to be reproducible and correlates well with more standard tests. It offers the possibility of testing very young children who fail to cooperate when administered other tests that depend on knowledge of letters or verbal communication.

Conclusion:
The Finger Pointing Test is a valuable addition to the armamentarium of pediatric vision assessment and has been rapidly developed and effectively implemented in a clinical environment.

Author
Samir Sayegh, MD, PhD, FACS

Co-Author(s)
Ahmad Al-Heeti, MD
Sandra Perez, OD

Presenting Author
Samir Sayegh, MD, PhD

Category
Pediatric Ophthalmology and Strabismus

Torque and Tell: The Sayegh-Gabra Formula for Uncovering the Underlying Methods of Toric IOL Calculation

Presented by Samir Sayegh, MD, PhD as an e-poster on  Mon. 18 June 2018

Description
Toric IOLs (tIOL) have expanded our ability to successfully perform refractive cataract surgery with sometimes stunning results. However, there has been some significant confusion as to the best methods of computing the best tIOL. Some manufacturers have "changed" their online toric calculator in an attempt to improve results without making such changes transparent to the user. We provide a tool that contributes to the discovery of the underlying algorithms used by arbitrary tIOL calculators.

Materials / Patients and Method
The "vector addition" and residual cylinder methods for astigmatic elements combination were reviewed. The use of constant and variable toricity rations methods were analyzed in the context of the "vector addition" methods. An inversion method was developed to compute the toricity ratio.

Conclusions

A simple formula, the Sayegh-Gabra formula was derived that determine the toricity ratio used for an arbitrary calculation of a tIOL by an arbitrary tIOL calculator, regardless of manufacturer. The different manufacturers calculators were classified as constant or variable toricity ratio calculators and the specific toricity ratios were determined.

The Sayegh-Gabra formula is a simple yet powerful tool to determine the underlying methods of tIOL power calculation and thus help select the most appropriate tIOL, improving refractive cataract surgery outcomes.

Author
Samir Sayegh, MD, PhD

Co-Author
Lauren Gabra, BSc

Category
Cataract and Lens Surgery

Advancing Optimal IOL Selection: from Conventional to UniversIOL

A paper presented Tue. 19 June 2018 by our own Ahmad Al-Heeti, MD

Description
The environment facing the cataract surgeons and options available to the patients have rapidly evolved in recent years. Better refractive outcomes are expected, the repertoire of multifocal and toric intraocular lenses (IOL) has expanded and spherical and toric IOL power calculators specific to manufacturers have proliferated. Issues with the computational methods and algorithms used by these calculators remain. We present an integrated methodology represented by the universal IOL calculator UniversIOL, addresses most of these issues, yielding both accurate and user-friendly outcomes by combining spherical power and toric calculations in one optimized approach and one interface and offering multiple computational algorithms allowing the surgeon to individualize the approach to each patient and each eye operated.

Materials / Patients and Methods
Over 50 cases performed in 2017 by one surgeon were retrospectively analyzed with one eye per patient. Patients with any retinal pathologies were excluded from this study.  Refractive targets were set at -0.25, -0.75, or -1.25. with cases representing short hyperopic, long myopic, flat or steep corneas, with or without significant astigmatism. The complexty and accuracy of traditional methods and manufacturer calculators was compared to ones obtained by UniversIOL and its features highlighted. 

Conclusions:
From the methods of computations examined, the majority of calculation environments were found to be stand-alone sphere or toric; implementing only one portion of a computation in a necessarily sequential algorithm that places the burden of additional computations on the surgeon. Fixed toricity ratio methods were still broadly used despite a growing awareness of their limitations. Flexibility for re-computation and comparison was limited with few exceptions. There was significant variability in user experience and quality/functionality of the graphic user interface, including on the generation of a specific, clear, and easy to use surgical plan. UniversIOL addressed and resolved the majority of these limitations and provided an integrated environment to compute and analyze IOL powers for complex cataract cases. All patients came within 0.50 diopters of their refractive target.

While choices for IOLs and toric IOLs are growing rapidly, with an increasing range of options for patients with cataracts seeking spectacle independence, calculation environments continue to lag. UniversIOL, an extended computational tool, represents a significant improvement and has demonstrated its ability to produce optimal outcomes for both routine and complex cataract cases.

Author
Ahmad Al-Heeti, MD

Co-Author(s)
Elizabeth Cotton, BA
Samir Sayegh, MD, PhD

Category
Cataract and Lens Surgery