The Cornea - A Vital Part of Eye Health and Vision

A member on the Board of Regents of the University of California, Dr. William De La Peña is a respected ophthalmologist who guides an eye clinic and provides a full range of surgical care solutions for persistent vision problems. Serving the needs of 350,000 patients in the Los Angeles metropolitan area, Dr. William De La Peña has in-depth knowledge of ophthalmological diseases and corneal issues.

The cornea plays a vital role in the health of the eye, from triggering the reflex that closes the eyelid to focusing the eyes properly on near and far objects. It is composed of a group of proteins and cells with nerve endings that form the eye’s transparent anterior portion. The cornea covers the iris, pupil, and anterior eye chamber, with the transparency offering refractive properties that focus the light in the right direction. When the consistency of this is altered even slightly, vision changes in ways that include blurring.

Common corneal conditions including temporary allergic reactions that result in burning, redness, itching, and mucus discharge. These typically go away with the application of a cold compress, eye drops, or removal of the irritant. Another issue is dry eye, which occurs when the quality and quantity of tears is no longer sufficient to irrigate the eyes. For more serious issues impacting eyesight, a knowledgeable ophthalmologist should be consulted.

The Pan-American Association of Ophthalmology Leadership Coursel

An accomplished ophthalmologist with more than three decades of experience, Dr. William De La Pena serves as the CEO and medical director of the De La Pena Eye Clinic, one of the largest private ophthalmology practices in Los Angeles. Dr. William De La Pena also belongs to the Pan-American Association of Ophthalmology (PAAO).

Dedicate to preventing blindness, the PAAO promotes cultural exchanges and education among ophthalmologists in the Western Hemisphere through its many programs and courses, including its Leadership Course. The PAAO Leadership Course provides skill development and orientation support to future leaders of affiliated ophthalmology organizations. Individuals can only participate in the program if they have been nominated by an affiliated organization and have provided the PAAO with a financial commitment.

All individuals who participate in the PAAO Leadership Course are practicing ophthalmologists, either in a public, private, or academic setting or an independent practice. They must have a clear track record of showing respect to patients, staff, and peers and be a full member of the organization that nominated them. Ideal candidates already belong to the PAAO, have exhibited dedication to their nominating organization, and show great potential for service and development within that organization.

Research Finds MMC Application Time Could Reduce Post-Op Vision Haze

A new study shows that patients who undergo photorefractive keratectomy (PRK) with extended mitomycin c (MMC) may be less likely to experience corneal breakthrough haze after surgery.

The single-center, retrospective study included 3,854 patients and looked at the post-operative incidence and risk factors for corneal breakthrough haze, which can worsen vision. Researchers grouped the eyes by intraoperative time, MMC application time, and pre-operative refraction. In addition, they measured onset time, incidence, and the severity of patients’ corneal haze.

The findings showed that patients with the lowest incidence of haze after surgery had an MMC application time of more than 40 seconds. Eyes were almost twice as likely to develop haze if they had high vs. low-to-moderate myopia and three-and-a-half times more likely with high vs. low astigmatism. Eyes treated for hyperopia vs. myopia were eight times more likely to develop haze.

The study also found that haze was more likely to occur when the epithelium was removed with alcohol as compared with those patients who had trans-epithelial PRK. On average, mild early haze reached peak levels at 69 days and late haze at 115 days.

While other studies have examined the risk factors for developing corneal haze after PRK, the research reinforces findings that patients with hyperopia, high myopia, or astigmatism are more likely to experience breakthrough haze in spite of MMC use. The study shows that longer MMC application could reduce the incidence of haze in these high-risk groups.

How to Observe a Solar Eclipse while Protecting Your Eye Health

A partial solar eclipse is a natural phenomenon that prompts people around the world to turn their eyes to the sky. However, this astronomical event can have adverse effects on your vision and eye health, even causing permanent vision damage or blindness, if you fail to take the proper precautions. 

There are a number of safeguards to be aware of when planning to observe an eclipse. First and foremost, ensure that you have the correct tools to protect your eyes during the event. Ordinary sunglasses do not provide adequate protection for viewing the sun. Instead, acquire eclipse glasses or hand-held solar viewers containing solar filters that meet the international standard for solar viewing equipment, ISO 12312-2. 

It is only safe to view an eclipse without protective gear when the moon has completely covered the sun. This is known as the totality phase of the eclipse, and is the only portion of the event that does not pose a risk to your retina. However, depending on your geographic location, you may not experience this phase. 

Before using a solar viewer or pair of eclipse glasses, remember to carefully read all instructions. In addition, never view a solar eclipse through a separate device with a lens, such as a camera or telescope. These devices can allow solar rays to pass through their lenses and damage the human eye, even with the added protection of a solar filter.

Member Benefits at ASCRS

A professional organization with more than 9,000 members across the globe, the American Society of Cataract and Refractive Surgery (ASCRS) has pioneered technological advancements in ophthalmic surgery and developed state-of-the-art education programs for students and clinicians.

ASCRS members enjoy access to a number of educational benefits, including a year-long continuing medical education program. Members can choose from a variety of in-person sessions and online webinars, as well as podcasts from leaders in the field. ASCRS also offers a variety of practice tools and resources, such as a member directory and post-refractive IOL calculator.

In terms of government relations, ASCRS works hard to improve patients’ access to surgery and specialty care. Members are encouraged to take an active role in the advocacy process. For individuals interested in giving back to their communities via volunteer work, ASCRS organizes several humanitarian cataract surgery projects every year.

To learn more about membership benefits at the American Society of Cataract and Refractive Surgery, visit the official website at ascrs.org.

A member of ASCRS, Dr. William De La Peña is the CEO and medical director of De La Peña Eye Clinic in Los Angeles and Orange Counties.

When Should Children Have Their First Eye Exam?

Dr. William De La Peña and the De La Peña Eye Clinic provide optometric, ophthalmological, and optical services for adults and children. One question often asked by new parents is when they should schedule their children’s first eye exam. Many parents are surprised to learn that eye screenings should begin as soon as a child is born in order to detect any problems early and have the best chance of treating them effectively. According to the American Academy of Ophthalmology, exams are recommended at the following ages:

Newborn: A trained health professional, such as an ophthalmologist or family doctor, should conduct a basic examination on the eyes of newborns, including a “red reflex” test, to ensure that the eyes are functioning normally.

6 months to a year: A second screening should be administered between the ages of 6 and 12 months.

Ages 3 to 3 1/2: Around this time, a child should undergo a more comprehensive assessment of their vision and eye alignment. The screening can help to detect problems such as misaligned eyes, refractive errors, and other focusing problems.

School age: A child starting school should have another screening for visual acuity and alignment, particularly as nearsightedness, or myopia, is a common refractive error in this age group. In addition, children of any age should have a screening whenever a vision problem is suspected.

A Look at Normal Vision Development in Seniors

Even adults who have always had good eyesight may begin to notice changes in their vision as they age. Sometimes, however, it can be difficult to tell whether the changes occurring are indicative of an eye disease or are simply the natural result of aging.

To aid in our understanding of what “normal” vision looks like over the age of 60, the American Academy of Ophthalmology (AAO) has put together a helpful online guide describing some of the most common vision changes experienced by older adults. These include the following:

- A longer time needed for eyes to adjust and focus, especially during the transition from a brightly lit area to a dimly lit area and vice versa.

- More difficulty driving at night due to the challenge of adjusting between light and dark.

- More difficulty distinguishing between an image and its background when both feature the same subtle gradations of tone. This development is referred to as a loss of “contrast sensitivity.”

While these changes may be part of normal vision development, seniors should visit their ophthalmologist or eye care professional if they are experiencing any discomfort or the changes are causing problems in daily life. In addition, the AAO recommends that all adults over the age of 65 undergo a complete eye exam at least once every two years.

PAOF Scholarship Programs for Latin American Ophthalmologists

Established to support the activities of the Pan-American Association of Ophthalmology, the Pan-American Ophthalmological Foundation (PAOF) aims to prevent blindness through ongoing educational and cultural exchanges among ophthalmologists throughout the Americas. In order to accomplish its mission, the nonprofit offers a variety of fellowships, scholarships, and observerships to eligible ophthalmologists and ophthalmology students from Latin America. Dr. William De La Peña is a former chairman of the PAOF.

Increasing the supply of highly trained ophthalmologists in Latin America in order to improve both the quality and accessibility of eye care in the region has been a longtime focus of PAOF. Its scholarship programs provide an important way to connect promising candidates with valuable education and training opportunities.

Scholarships available through PAOF include the Gillingham Pan-American Fellowship, a $10,000 fellowship offered to Latin American candidates who are no more than three years out of their ophthalmological residency program and who have been accepted into an accredited training institution or program in either Canada or the United States; and the Latin American/PAAO Pediatric Ophthalmology Fellowship, which supports one eligible Latin American ophthalmologist through a one-year pediatric ophthalmology and clinical research fellowship at the University of Texas Southwestern Medical Center and its pediatric affiliate, the Children’s Medical Center. Interested candidates can find out more about PAOF’s scholarship and fellowship opportunities at www.paao.org.

Highlights from UC’s 2016 Report on Sustainable Practices

Covering 10 campuses and five medical centers, the University of California’s sustainability program is a robust, comprehensive initiative designed to implement, maintain, and promote a broad scope of sustainable actions and efforts. As a key part of the program, an annual report is presented to the UC Board of Regents every January, detailing the previous year’s progress towards meeting key goals.

Some of the most important highlights from the 2016 Annual Report on Sustainable Practices include:

- Carbon neutrality. Two UC campuses, UC Santa Barbara and UCLA, have already met and exceeded the goal, originally set for 2020, of lowering greenhouse gas emissions to 1990 levels. To help other campuses achieve the further goal of complete carbon neutrality by 2025, a Strategic Planning Framework was designed and developed this past year by the UC Office of the President.

- Energy efficiency. In 2016, 45 UC projects became registered participants in the Energy Efficiency Partnership program. These projects not only earned $4.4 million in incentives, but they also helped the University reduce its utility and energy costs by $550,000.

- Food sustainability. In the 2015-16 academic year, more than 20 percent of UC’s food purchases came from sustainable products and producers. Furthermore, at seven out of UC’s 10 campuses, at least one food service facility was certified as a green business.

- Waste. An impressive 69 percent of UC’s waste was diverted from California landfills during the 2015-16 academic year. In a typical year, UC sends 26 percent less waste to landfills than other comparable universities (an average of 198 pounds per person).

Long-Term Antiviral Treatment Increases Corneal Transplant Success

In the largest case study so far looking at the outcome of pediatric corneal transplants, results show that children who undergo the procedure for herpes simplex virus (HSV) keratitis need long-term antiviral treatment.

Corneal transplants can prove difficult, with half of children who undergo the surgery experiencing a recurrence of HSV 13 to 15 months afterward. Children also face a high rate of failure/rejection for corneal transplants, along with a challenging recovery. 

The case study, however, shows that when recurrences of HSV and its related issues are managed, corneal transplants can result in vision benefits for children. The case study looked at nine children ages three to 17 who had undergone a corneal transplant and then developed interstitial keratitis as a result of a scar on their central visual axis. Patients received oral acyclovir for half a year before surgery and then had a post-op prophylactic course for as long as 33 months. Most patients showed improved best corrected visual acuity (BCVA), which emphasizes the importance of long-term antiviral prophylaxis in reducing HSV recurrence and increasing the probability of the surgery’s success.