Wills Eye Hospital is a non-profit eye clinic and hospital in Philadelphia, Pennsylvania. It was established in 1832 and is the oldest continually operating eye-care facility in the United States. It is affiliated with the medical school of Thomas Jefferson University.Since 1990, Wills Eye Hospital has consistently been ranked one of the top three ophthalmology hospitals in the United States by U.S. News & World Report and its ophthalmology residency program is considered one of the most competitive residency programs in the world.
PURPOSE:Ten years after the first Global Consensus on Keratoconus and Ectatic Diseases, this updated edition revisits key issues, incorporates advances in new technologies, and integrates the expertise of corneal and refractive surgeons from 12 international societies. This initiative aimed to establish a consensus among global ophthalmology experts, including corneal and refractive specialists from 6 continents, on the definition, diagnosis, staging, clinical management, and surgical treatment of keratoconus and ectatic corneal diseases. METHODS:The Delphi method consisted of 4 rounds of questionnaires, supplemented by a face-to-face meeting. A total of 128 ophthalmologists participated, with 3 main coordinators and 125 keratoconus experts distributed across 7 panels: definition/diagnosis/staging, clinical treatment and noninvasive visual rehabilitation, cross-linking for progression, and invasive visual rehabilitation (including therapeutic approaches, improved corrected distance visual acuity, keratoplasty techniques, and cataract surgery in keratoconus). The consensus threshold was defined as at least two-thirds agreement. RESULTS:A significant consensus was reached on topics such as definitions, diagnostic and progression criteria, and management strategies for keratoconus and other ectatic corneal disorders. A comprehensive approach was outlined, encompassing both nonsurgical and surgical treatments, organized in a group-based approach. In addition, major agreements and disagreements across the 7 subcommittees are outlined in individual tables. CONCLUSIONS:This updated Global Consensus provides revised definitions, expert statements, and recommendations for diagnosing and managing keratoconus and other ectatic corneal diseases. It benefits from broader participation, with more refractive surgeons and greater representation from major ophthalmic societies across 6 continents, capturing a wider range of global clinical perspectives than the prior report.
Objective: To evaluate the impact of training and testing deep learning (DL) models for visual field (VF) forecasting using input-target pairs in which the target is either the measured VF test result, or its smoothed counterpart constructed via linear regression. Design: A retrospective data analysis study evaluating DL models for VF forecasting under multiple training and testing configurations. Subjects and Controls: A total of 1400 subjects (healthy and glaucoma patients) with 19 437 reliable Humphrey VF (24-2 Swedish Interactive Threshold Algorithm) tests collected from longitudinal cohorts at the University of Pittsburgh and New York University. Methods: Three DL-based pointwise VF forecasting methods were trained and tested under 4 different configurations formed by using measured and smoothed VF targets. Smoothed targets were constructed by applying linear regression over triplets of consecutive VF tests. Models were assessed using fivefold cross-validation and mean absolute error (MAE) as the training and testing metric. Main Outcome Measures: Mean absolute error of forecasted VF test results under various training and testing configurations. Results: Models trained and tested on smoothed VF targets consistently achieved lower MAEs compared to those trained and tested on measured VF targets. The performance improvements were most prominent in the 0.5- to 1.5-year forecast range. Furthermore, models trained with smoothed VF targets showed comparable performance when evaluated against measured VF targets. Conclusions: Using smoothed VF targets for training improves forecasting accuracy by guiding DL models to learn long-term trends in the data rather than forcing them to model noise and short-term variabilities, which are prevalent in VF test data. This approach aligns with clinical goals of assessing meaningful functional changes over time and suggested to be considered in future DL-based VF modeling efforts. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
PURPOSE OF REVIEW:This review provides an overview of possible complications of the most commonly performed refractive surgeries: laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), and lens-based refractive surgery. While the vast majority of refractive surgeries are safe with successful outcomes, complications can still occur which requires surgeons to have an in-depth understanding of complication prevention and management. RECENT FINDINGS:Although overall rare, corneal laser refractive procedures and lens-based refractive surgeries are associated with a distinct set of potential complications. The most common complications from LASIK, PRK, and SMILE include flap issues, infectious keratitis, haze, dry eye disease, and corneal ectasia. Implantable collamer lenses (ICLs) come with a possible risk of intraocular pressure elevation and cataract formation. Refractive lens exchange (RLE) introduces younger patients to potential complications typically associated with cataract surgery, such as dysphotopsias, uveitis, and retinal detachment. SUMMARY:The elective nature of refractive surgery may raise expectations of patients for successful outcomes. This timely review provides relevant and detailed guidance to refractive surgeons on best practices to mitigate potential complications, and ultimately maximize patient safety and satisfaction.
