Benefits & Events

Degenerative myopia affects up to 3% of the world’s population and can lead to progressive, irreversible vision loss. The prevalence of high myopia is increasing across the globe, projected to affect as many as 1 billion people by 2050. High myopia is a combination of refractive error and axial length, and can lead to complications such as chorioretinal atrophy, posterior staphyloma, foveoschisis, lacquer cracks, choroidal neovascularization, retinal tears and detachments. Both genetic and environmental factors are hypothesized to be at play in the development of degenerative myopia, requiring optometrists and ophthalmologists to work closely together for prevention and treatment. Join us for an overview of  novel technologies in myopia prevention and the retinal approaches in treating pathologic myopia

In Colorado Retina Associates October 2021 edition of Virtual Visionaries, CRA's Uveitis Specialist, Dr. Mark Dacey and Colorado Center for Arthritis & Osteoporosis Rheumatologist, Dr. Joseph Lutt will discuss the inter-disciplinary partnership between their sub-specialities.

The eye is an important indicator of rheumatologic disease. Uveitis, i.e. intraocular inflammation, is a sight-threatening condition that begs for collaboration between ophthalmologists and rheumatologists. As these conditions often involve complicated multi-organ systemic disease, close co-management is imperative in the determination of treatment and follow-up needs. Uveitis occurs in approximately 2–5% of patients with inflammatory bowel disease, 6–9% of patients with psoriatic arthritis, 25% of patients with reactive arthritis, and as high as 33% in patients with ankylosing spondylitis, making the joint effort between the two sub-specialties a necessity. Often these systemic diseases go undiagnosed, heightening the risk of serious complications, impaired vision, and blindness when treatment isn’t prompt. Familiarity with and recognition of these uveitic presentations are important in the management of both the systemic and ocular manifestations of the disease. Tips to identify ocular signs and symptoms and diagnostic and management techniques for a variety of systemic inflammatory and autoimmune disorders will be discussed in this review.

Colorado Retina's September edition of Virtual Visionaries features retina expert speakers, Dr. Betty Zhang and Dr. Miriah Teeter for a grand rounds style "retina-round-up", covering a variety of unique and thought-provoking surgical and clinical vitreoretinal cases presented to us by our referring community. This course is a traditional lecture followed by interactive Q&A, providing a comprehensive review of posterior segment disease management, clinical guidelines for referral timing and diagnosis, along with modern patient care techniques for pre and post-surgery. Tune into this interactive, high-energy, posterior segment grand rounds case review.

Colorado Retina Associates (CRA) has spent the last three years making a practice-wide transformation to embrace a model that's Lean. Lean Healthcare is the application of “Lean” ideas implemented within a practice to minimize waste with ongoing process improvement. At CRA, we apply Lean principles curated by all members within our organization, from technicians to administration staff, to continually strive to identify areas of waste in our workflow and eliminate anything that does not add value for our patients.

Our champion Lean physicians, Drs. Alan Kimura and Murtaza Adam, alongside CRA's Lean consultant, Aneesh Suneja of FlowOne will focus their conversation around how to make simple tweaks in your practice to improve patient satisfaction and care outcomes, while reducing overhead costs. They will provide low to no-cost solutions for how to create and deploy fundamental to Lean principles, integrate a Lean culture in staff to advance innovation, and use your practice data to identify the areas within your organization that require improvement in order to be solely patient-focused.

The history of retinal surgery is compiled of stories of interrelated developments of a vast array of techniques and evolution of technique-driven technology. The first operation attempted for treatment of retinal detachment dates back to 1805 where the "surgeon" drained the subretinal fluid by puncturing the sclera with a knife! After some tweaks, retinal detachment surgery became one of the great success stories in the history of medicine.

Retired retina specialist, Dr. Kenneth Hovland, father of Colorado Retina’s Peter Hovland, MD - will take us back in time, reviewing the original concepts of causes of retinal detachments and provide evolutionary principles of successful repair. Dr. Hovland Sr. will cover major improvements in the technical skills and instrumentation in retinal detachment surgery, including the wide suite of ergonomic disposable microsurgical instruments and lasers that lead to the current status of RD repair.

Dr. Brian Joondeph, one of CRA’s “founding fathers” will close us out with coverage of a variety of retinal surgical repair topics; comparing how we did things during his fellowship year in 1989 to now. Dr. Joondeph will focus on ever evolving surgical logistics for AMD treatment, sub macular surgery, macular hole repair, and ERM; exploring means of improved visualization during surgery, digital 3D technology, advances in the surgical setting, anesthesia, and pre and postoperative care of patients that have resulted in better surgical control for the surgeon and rapid visual rehabilitation for the patient.

Take a trip down memory lane to explore how advances in technology and technique have improved the safety, efficiency and outcomes of retinal surgery.

The management of complicated ocular cases often demands close co-management between anterior and posterior segment treatments. Frequently, cornea and retina surgeons must work closely together to ensure the best outcome for your patients. This course will give you an overview of the newest advancements in anterior segment surgeries, including new technologies and techniques in minimally invasive glaucoma surgery (MIGS), full or partial thickness corneal transplants, and cataract surgery. The program will also detail the common marriage of anterior and posterior segment care in the management of retinal conditions such as epiretinal membranes, lamellar holes, degenerative myopia, and diabetic retinopathy before and after cataract surgery.

It is estimated that more than 200,000 individuals in the United States have an inherited retinal disease (IRD). Historically, there has been little in terms of intervention or ongoing medical care for this population. However, recent advances in targeted gene therapies have elevated the importance of genetic testing and active engagement between providers, patients, and researchers.
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This program aims to prime optometrists and other health care providers on the care of patients with IRDs. We intend to educate about the identification of patients with an IRD, the process and benefits of genetic counseling and testing, recommended follow-up care, and exciting new research opportunities for IRDs. At the end of this hour presentation, we hope to simplify the complex care of this population by providing the tools to identify and refer patients with suspected IRDs.

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Pediatric optometrists, ophthalmologists and retina specialists work together closely to co-manage 0-18 y/o patients to provide optimal comprehensive care. This course will bring you the expertise from each field, covering the common pediatric eye problems seen by optometrists, including how to manage those conditions initially, when to refer, and next-steps to continue assisting with co-management. Clinical evaluation, treatment options, management recommendations, risk factors, diagnostic red flags, and referral tips and timing will be reviewed in depth. Case-based examples of pediatric cataracts, glaucoma, nasolacrimal duct obstruction, esotropia and exotropia, juvenile arthritis, primary iridocyclistis, Staph marginal disease, cystic macular edema, Coats’ disease, Marfan’s disease, Leber congenital amaurosis, traumatic retinal detachments, and a variety of other pediatric eye conditions will be covered.

Retina and glaucoma overlap in terms of etiologies and treatment, the two subspecialties working closely in managing some of the most challenging eyes in ophthalmology. This lecture will review retinal causes of glaucoma, including neovascular and steroid induced glaucoma, and discuss risk factors, diagnostic keys and treatment options. The lecture will be given by both a retina and glaucoma specialist, providing unique perspectives on these overlapping conditions. A review of gonioscopic technique as well as case-based examples will also be included.

Colorado Retina's 2021 Mile High Masters of Retina program looked a bit different than what you've seen from the meeting over the past decade. Due to the pandemic, we took to a virtual platform, shorted the program into a 2.25 hour time block, and condensed the format into one keynote speaker, Dr. Sunil Srivastava, and 8 rapid-fire mini-educational sessions, concluding with either an exciting live debate or interactive panel discussion. Each session was presented live by one of our 13 vitreoretinal specialists, and covered a vision-threatening retina, ocular tumor and/or uveitis disease state. Our physicians and keynote presented both common and complex ocular cases, surgical and clinical treatment options, risk factor reviews and variety of management techniques within retinal care.

New and chronic patients with advanced glaucoma present a host of difficulties for managing providers. Is the patient stable? What testing is helpful? Is the patient at risk for loss of functional vision? Do they need surgery? Is surgery too risky? What other factors besides their intraocular pressure are important to consider? What topics should be discussed with the patient and family?

Dr. Jordan Stanley, glaucoma specialist from Marietta, GA will spend the  first half of the presentation reviewing the management strategies for patients with advanced end stage glaucoma. These patients offer an array of challenges in management because typical diagnostic modalities can be limited or have high variability. They can also be burdened with multiple ocular comorbidities which may make diagnosing the responsible mechanism for visual decline difficult. Advanced glaucoma has natural fluctuations in symptoms making it difficult to distinguish progression from fluctuation for both patient and provider. This virtual activity will review these issues and some tips for managing these complex patients. The second half will address when elevated intraocular pressure and cataract surgery overlap. This will address intraoperative issues that can arise including suprachoroidal hemorrhage and pre-operative glaucoma conditions that benefit from cataract surgery.

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Presenter: Jordan Stanley, MD

Panelists: Zachary Vest, MD + Anjali Sheth, MD + Arvind Neelakantan, MD + Carl Sloan, MD

PART ONE: Prem Subramanian, MD: Diplopia: Recognizing Urgent Cases and Fellow Travelers. Patients often present to an eye care provider with new onset diplopia, and the provider must determine the urgency of obtaining additional investigations including blood tests and neuroimaging. Additionally, further history and examination beyond the typical eye exam may be needed to arrive at a diagnosis. Once a cause is found, treatment may require a multidisciplinary approach both acutely and long-term. An approach to evaluating the patient with diplopia will be presented in a case-based format with emphasis upon both “red flags” that should lead to rapid workup and “green flags” that are typically reassuring signs.

PART TWO: Salil Shukla, MD: Lamellar Macular Holes. In the OCT era the lamellar macular hole has been observed as a distinct clinical entity, albeit overlapping with vitreomacular interface disorders and degenerative macular disease. The diagnosis of lamellar macular hole is nuanced, with imaging findings often out of proportion to symptoms and concurrent macular diagnoses often present on OCT. Management options are limited as surgical intervention does not reliably improve vision. We will discuss the pathophysiology, presentation, diagnosis, and management of lamellar macular holes with an emphasis on OCT.

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Transforming your practice workplace through Lean implementation leads to higher patient satisfaction through more efficient workflow. Learn first hand from our clinical managers how they directed a thorough examination of Colorado Retina's workflow to pinpoint the inefficiencies, created solutions for those inefficiencies and how we prepared for the transition to a Lean mindset across each of our five Denver Metro clinics and thirteen clinical teams. This presentation will take a in-depth look at our real examples, successes and errors, leading to a successful Lean implementation practice-wide.

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In the November monthly edition of Ophthalmic Surgery Grand Rounds (OSxGR), vitreoretinal specialist, Dr. Adam Martidis, MD will cover pre and post-operative surgical advancements and management of a variety of common retinal procedures. Earlier tools and techniques used in vitreoretinal surgery were revolutionary in their time, but today's options have set the bar higher. Through the presentation of surgical videos, Dr. Martidis will educate on modern surgical tools and techniques that effectively address multiple sight-threatening retinal diseases and conditions. In the hour, surgical repairs of epiretinal membranes, macular holes, vitreous hemorrhages, retinal detachments, retained lens material, and other complex surgical cases such as TRD and PVR will be presented. Dr. Martidis will deep dive into preoperative measures to reduce the risk of postoperative infection and postoperative care with subsequent examination instructions to reduce future complications.

Clinical trials provide essential foundational knowledge regarding dosing, patient selection, safety, and efficacy of novel treatments. In CRA’s October edition of Virtual Visionaries Drs. Eva Kim and Murtaza Adam will first review the overall process that a unapproved drug or device completes before its approval by the Food and Drug Administration. Salient clinical trials addressing anterior segment pathology will then be discussed by Dr. Kim and important research for posterior segment disease will be reviewed by Dr. Adam. We look forward to an enlightening and interactive discussion with our audience and expert panel!

Cataract surgery is the most commonly performed surgical procedure in the US, mainly using an intravenous (IV) sedative. While this practice is ultimately safe and effective, oral sedation for cataract surgery is proving to be a more reasonable alternative.

Specialists Drs. William Richheimer and Robert G. Fante, will provide a review of oral sedation for cataract surgery, breaking down the patient satisfaction rate, benefits to the surgeon and healthcare system in terms of cost and space saving measures, and potential downfalls. A single surgeon case series using oral sedation for cataract surgery will be reviewed, showing while the surgeons preference should still govern anesthesia choice, for many utilizing oral sedation, the method is safe and comfortable for the vast majority of cataract surgery patients.

Stem cell therapy has been a long pursued “Holy Grail” in the field of medicine. Much progress has been made in the past 20 years, but many unknowns remain. The retina is a primary target for stem cell research; it is an immune-privileged site, an examiner can look through the pupil directly onto neuro and vascular tissue for assessment of therapeutic effect, and patients have a second eye which can act as a control. Eye specialists, Dr. Curtis Hagedorn and Dr. Bill Richheimer will explore the unfortunate cases of intravitreal autologous stem cell injections that resulted in multiple PVR detachments in FL, as well as the promise associated with clinical applications of stem cell transplantation/therapy. Past, present, and future stem cell therapy research for retinal disease will be discussed, emphasizing the importance of good stewardship of these powerful tools as desperate patients seek our guidance in this emerging field.

Glaucoma specialists, Zachary Vest, MD and Shamil Patel, MD will address the decision making process for patients with glaucoma who have had prior incisional surgery, and options for obtaining a lower IOP. The talk will explore techniques for revision of trabeculectomy and prior glaucoma tube shunt, as well as address the roll of newer surgical techniques and their success in the setting of prior traditional surgeries. Teaching by means of real surgical videos and slide presentation, along with panel discussions.

Presenters: Zachary Vest, MD + Shamil Patel, MD
Panelists: Dean Carlson, MD + Oluwatosin Smith, MD

Endocrinologist, Dr. Kelsi Deaver will kick off this hour long CE/CME course with all things you need to know about diabetic management, including how to appropriately ask patients about A1C’s, current treatment and monitoring options of diabetes, and new advances within the field of endocrinology. Dr. Miriah Teeter will then dive into diabetic retinopathy, the leading cause of vision loss and one of the most common problems that we treat for patients in clinic at Colorado Retina. The presentation will focus on the underlying pathophysiology of diabetic retinopathy and directly correlate this with targeted treatments for retinal complications. Advancements in clinical imaging has contributed to improved, individualized management. Appropriate monitoring, imaging, and referral to retinal specialists for treatment improve visual outcomes and quality of life for our diabetic patients.

In this one hour presentation, Murtaza “Moo” Adam will discuss the bizarre world that lies beyond the “looking glass” of the ophthalmic operating microscope. In a world that is both backwards and bizarre, the vitreous cavity presents unique and foreboding challenges for even the most experienced surgeons. With a panel of expert ophthalmologists by his side, Dr. Adam will explore surgical dilemmas relating to complex intraocular lens cases, combined diabetic tractional/rhegmatogenous detachments, and suprachoroidal hemorrhages. With this inaugural presentation of the Ophthalmic Surgery Grand Rounds, we look forward to an exciting evening exploring what lies beyond the 128 diopter “looking glass” with you!

Over the course of an hour, we will dive into the many manifestations of ocular tumors, starting with orbital tumors. Orbital tumors are one of most commonly initially missed ophthalmic diseases seen in clinical practice by Oculoplastic Surgeons. Oculoplastic Surgeon, Dr. Chris Thiagarajah will perform a review of orbital tumors, what to look for, how to diagnose, and key findings. Ocular Oncologist, Dr. Peter Hovland, will then spend the last half of the course presenting an overview of intraocular tumors, exploring eye cancer diagnosis based on patient history and examination, and diagnostic imaging (widefield photography and angiography, ultrasonography, and optical coherence tomography (OCT). By seeking early detection of orbital and intraocular tumors, optometrists and ophthalmologists assist in providing better treatments with lower morbidity and mortality.

PRESENTERS: Peter Hovland, MD, PhD - Ocular Oncologist/Vitreoretinal Specialist at Colorado Retina Associates & Christopher Thiagarajah, MD, FACS - Oculoplastic Surgeon at Park Avenue Oculoplastics

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Uveitis, a general, yet highly complex term for a group of inflammatory diseases with no one size-fits all description, responsible for between 10-15 percent of all cases of blindness in the US. Caused by inflammatory responses, uveitis is not just limited to the uvea, having the potential to wreak havoc throughout the eye and in other parts of the body.

Colorado Retina's uveitis gurus, Dr. Mark Dacey and Dr. Ashleigh Levison, over the course of an hour will explore a variety of uveitis manifestations, underlying systemic diseases, presentation patterns and symptoms, the lengthy road to proper diagnosis, current treatment options, and the vision-threatening implications these diseases can have for patients. Dr. Dacey and Dr. Levison will also cover a few of their most peculiar cases that are not to be missed.

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Colorado Retina & Mile High Eye Institute teamed up to review Optical Coherence Tomography (OCT), an emerging technology for performing high-resolution cross-sectional optical imaging.

Dr. Zak Vest, of MHEI and Dr. Brian Joondeph, of CRA, will provide a brief review of OCT technology, covering the technical aspects of OCT and potential issues that arise while interpreting data. We will dive into OCT output, how to correctly read OCT data findings, signal strength for reliability, and provide education of how to efficiently utilize OCT technology for treatment guidance of glaucoma and diseases of the retina, including AMD and diabetic retinopathy. We will also cover the anatomic measuring capabilities of the current devices in service as well as an overview of their normative database.

PRESENTERS
Murtaza Adam, MD, Peter Hovland, MD, PhD

Dr. Adam reviewed the many inherited, toxic, and idiopathic maculopathies that can mimic age-related macular degeneration (AMD) in the clinic.

Dr. Hovland wrapped up with content on surgical approaches for retinal detachments. He reviewed the types of retinal detachments there are, issues related to intraocular pressure, and special management of patients with retinal detachments who live at altitude.

PRESENTER
Murtaza Adam, MD

Protocols have changed significantly during the COVID-19 pandemic. Which of those procedures are here to stay and which will disappear as the pandemic subsides? NRR host John Kitchens, MD, invites Murtaza “Moo” Adam, MD; David R.P. Almeida, MD, PhD, MBA; and Christina Weng, MD, MBA, to discuss which changes implemented in 2020 will be permanent fixtures in retina practice. Watch the whole discussion back now! 

PRESENTERS
Murtaza Adam, MD & Salil Shukla, MD

Review of common and uncommon peripheral retinal findings found on routine funduscopic imaging and exams, including vitreous base pathology, vascular disease, neoplasms, degenerative disease, and variations of normal anatomy. Differential diagnoses, associated findings, and recommendations for management will be covered.