VEW 2024: Modern tonometers, swollen optic nerves, injections, and more

At Vision Expo West in Las Vegas, Nevada, Nathan Lighthizer, OD, FAAO, is presenting a variety of talks to further education for optometrists. Topics include a new technology showcase, an injections workshop, swollen optic nerves, and modern tonometers. Attendees can expect to learn a lot about new technology in eye care and how to build out their armamentarium of diagnostic tech in their offices.

Vision Expo West is an annual meeting put on by The Vision Council in Las Vegas, Nevada. This year's conference is held September 18-21, 2024.

Video transcript

Emily Kaiser Maharjan:
Hi everyone. I'm here with Dr Nate Lighthizer, who is here to tell us more about his Vision Expo West presentations. Thanks for taking the time to be here. Dr Lighthizer.

Nathan Lighthizer, OD, FAAO:
Very glad to be here. Thank you.

Kaiser Maharjan:
Of course. So first, what can you tell me about the new technology that's being featured in the West Coast Case Challenge? Do you have, like, a favorite innovation that will be highlighted? What's going on there?

Lighthizer:
Yeah, it's all about imaging diagnostics, you know, the different things that we use. There's going to be 6 or 8 of us speakers that are going to present a case, and it has to be focusing on imaging or diagnostics of some sort. It could be dry eye, it could be retina, it could be glaucoma. The instrumentation could be OCT, OCT angiography, you know, our new headset visual fields, ERG, the Rabin Cone Contrast, so it doesn't really matter. But we're each going to present a case, our favorite case, where imaging played a role, diagnostic test played a role in that case, and then the audience is going to decide which case was their favorite. They're going to vote. So it's a little friendly competition, but talking ocular disease, front of the eye, back of the eye, with a lot of new technology focused on imaging.

Kaiser Maharjan:
Yeah, so you're also running an injections workshop. Can you tell me more about what's going to be covered in that?

Lighthizer:
Yeah, the injections workshop, we're going to be focusing on a variety of different injections that optometrists are doing in the 15 to 20 states where we do injections. It will be intradermal injections of lidocaine into the eyelid to numb up eyelid lesions, lumps and bumps. That's the main injection that we do would be an intradermal or subcutaneous injection. So we'll focus on indications, contraindications, procedural techniques; you know, how do you do this? Potential complications, [etc.] But [it's] hands-on, where I'm going to bring syringes and needles, and it's a hands-on workshop to to get their hands dirty, and this in terms of the injections workshop. So we'll do that. Subconjunctival, if anybody wants to dive into subconjunctival injections, intramuscular injections, you know, [indicates shoulder] things like that, or even an IV injection. So different injections, but the most common is, how do you do injections in the eyelid to numb up lesions for lump and bump removal?

Kaiser Maharjan:
Fantastic. And do you think the optometrists who maybe practice in a state where they are not able to perform injections, do you think they could still get value out of this workshop?

Lighthizer:
I think they could get a lot of value out of this. Because even if you don't practice in a state that does this, you are now, by going to this, you're more on the cutting edge. You're learning of, hey, what we can do, what we're doing in other states, it may open your eyes of going, "Hey, we should be doing this in our state." And let's get motivated, let's get driven, and let's change our laws in our state so optometrists can do this because we're more than capable of doing these procedures.

Kaiser Maharjan:
Absolutely. And you have yet another talk, "Swollen optic nerves: Now what?" Can you tell me more about some of the topics that you're covering in this session?

Lighthizer:
Yeah, swollen optic nerves is an interesting one because there's just so many different roads that you can go down in terms of diagnosis. When you look at a patient's got a swollen optic nerve, it could be as something as benign as optic nerve head drusen, it could be something as significant as a malignant brain tumor, and a lot of things in between. So our day gets more complicated when we see that patient that's got an elevated optic nerve. Is it swollen? Is it not swollen? And if it's swollen, is it infection? Is it inflammation? Is it cancerous? There's just, there's a lot of diagnostic things that are involved when you see a swollen optic nerve; one eye, both eyes, etc. So we're going to cover some of the more common causes of swollen optic nerves, like non-arteritic ischemic optic neuropathies, papilledema, giant cell arteritis, getting into optic neuritis as well. So some of the more common, but also some of the more rare.

Kaiser Maharjan:
Fantastic. And lastly, you also have a talk on modern tonometers. Can you tell me more about some of the tonometers that you'll be talking about and why it's important for optometrists to be up on the modern versions of these?

Lighthizer:
Yeah. So you know, tonometry, measuring intraocular pressure, is so very important. And Goldmann Applanation Tonometry, GAT, G-A-T, is the standard. It's what most of us use when we're measuring pressures in glaucoma patients. Well, it's been around for a long time. It's been around for like 40-50+ years, and it does a good job. But there's some limitations with Goldmann Applanation Tonometry. Corneal properties play a role in that, and they influence the readings. Are there other ways that we can do that? We'll cover Goldmann. We'll look at the new CATS tonometer. We will look at rebound tonometry, whether it's iCare or the new Tono-Vera from Reichert. We'll just look at different ways that--what's the literature say? What's clinical experience say on is there more that we can do than the standard, let's always do Goldmann? The answer is yes.

Kaiser Maharjan:
Fantastic. And have you run into clinical situations where it's been helpful to have all of these tools in your tool belt?

Lighthizer:
It is, you know, even something like corneal hysteresis. You know, you do something called the ORA, the ocular response analyzer, that gives you a puff tonometry, but it gives you readings of IOP, corneal compensated. It gives you IOP Goldmann equivalent. [It] gives you corneal hysteresis, which we'll talk about in this case, has value. And there's times where patients can't get behind a slit lamp and they can't have Goldmann, and maybe rebound tonometry with an iCare or a Tona-Vera may be a better application. So there are times where Goldmann just isn't practical for a particular patient.

Kaiser Maharjan:
Absolutely. So do you have anything else that you want to mention that we haven't touched on?

Lighthizer:
Just looking forward to Vision Expo West in Vegas. Hope to see a lot of you there. We'll have a good time, a little education, and have some fun at Vision Expo.

Kaiser Maharjan:
Absolutely. Well, thank you so much for taking the time to talk to me about your Vision Expo presentations, Dr Lightizer. It's always a joy to hear from you, whether it's about injections, optic nerves, tonometry; you're always a source of wisdom. So thank you so much.

Lighthizer:
You bet. My pleasure.