DVOS VETS

Online veterinary ophthalmology consulting service to practicing veterinarians as well online veteri
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06/04/2024

Bilateral enucleation. This is a controversial topic and I have always recommended bilateral enucleations in permanently blind painful eyes non-responsive to treatment. I have summarized a recent publication on this topic. If you are not receiving my summaries and would like to please e-mail me at [email protected]..za

25/03/2024

It has been a very busy month with OP lectures etcetera but I am continuing with my diabetic cataract series. Here is part 4

22/02/2024

Here is part three of the diabetic cataract series. This one is 7 minutes long. I am trying to keep these under 5 minutes but this one proved to be difficult in getting everything in 5 minutes !!. Please like these if you find them helpful.

21/02/2024

As promised part 2 of diabetic cataracts looking at normal glucose metabolism in the lens and the pathophysiology of diabetic cataracts in both dogs and cats.

19/02/2024

Part 1 of 4 of a look at diabetic cataracts. Each video is less than 5 minutes long

17/02/2024

Journal article summary.

I have looked at this very interesting article on the treatment of diabetic cataracts and the difference of doing phaco and not doing phaco on these patients.

The author's conclusion is “Therefore, phacoemulsification may be recommended for this
purpose. Nevertheless, owners should be aware that long-term topical management may be
required even after successful surgery.” I was surprised by some of the findings in this study for example the incidence of complications in surgical vs non surgical treated eyes. I did e mail this to everybody on my article summary e mail list. If you have not received it or would like me to add you please send an e mail to [email protected]

Also watch out for my next diabetic cataracts in 5 minutes presentation coming soon

01/02/2024

This article on intrascleral prosthesis was published in the latest Veterinary Ophthalmology. I am not a great fan of cosmetic surgery in animals but you do get owners that are very reluctant to have their dog’s eye removed. The end result is dogs walking around with very painful chronic glaucomatous eyes. This article describes al the possible complications and success rate. According to this 90 % of patients do not develop any complications there are also some good examples of the final outcome. I did e-mail the summary to all on my journal e-mail list if anybody else would like to receive this let me know [email protected]. I am in the process of seeing if we can get silicone prosthesis manufactured locally at an affordable price.

31/01/2024

This article on bacterial isolates and antibiotic resistance was published in the latest edition of Veterinary ophthalmology. The conclusion of the study was, and I quote.

“This study found Staphylococcus, Streptococcus, and Pseudomonas species as the most common pure isolates in dogs and Staphylococcus and Streptococcus species as the most common pure isolates in cats with corneal stromal ulcerations in a referral population in the Netherlands.

Although the incidence of acquired antibiotic resistance in isolates of dogs and cats did not change significantly over the 8-year time period, the incidence of multi-drug-resistant isolates in dogs increased significantly over time. In addition, the resistance of bacterial isolates to chloramphenicol was more common in dogs that received previous treatment with chloramphenicol. These results underline that prudent antibiotic use is important, both in the first opinion and in referral practice.”

There was no groundbreaking new information in this article however it confirms what I am already advising vets on a regular basis. My first-line antibiotic for simple ulcers as well as prophylactic antibiotic remains a “triple antibiotic” Another option would be second [Ofloaxcin] and third-generation [Levofloxacin] fluoroquinolones.

The use of aminoglycosides and moxifloxacin should be reserved for true melting corneal ulcers.

Feel free to contact me [email protected] or w app +27 833089237 if you want more information.

30/01/2024

Lissamine Green. As requested I have prepared a short 3-minute slide show on the use of lissamine green in veterinary ophthalmology. Please feel free to contact me for more info or to leave a comment. I am also open for any suggestions for topics forfuture very short less than 5 minute presentations

24/01/2024

Here is a short presentation 4 minutes 54 seconds on the use of fluorescein. If you like these very short presentations with tips and tricks let me know and I shall continue uploading them form time to time

22/01/2024

Cyclosporin Episcleral Implant
I have received several requests from vets asking how to implant these. I have prepared a very short 3-minute presentation on this topic.

21/01/2024

Equine ophthalmology 2024
I have eventually finished my online equine ophthalmology course. The course is available online to download. It will be available to purchase as individual modules or as a whole. It is divided into 7 modules. Course material includes a full set of notes [160 pages] and 18 narrated PowerPoints totaling 10.5 hours. It is recommended that the course is started this month and should ideally be completed in a year. Depending on interest I am planning on having 4 online interactive zoom sessions for case discussions during the course of the following 6 months. The course can however be done completely in your own time.
The 7 modules covered are:
1 Clinical Anatomy and Physiology
2 Examination of the eye
3 Corneal disease
4 Ocular neoplasia
5 Equine uveitis and recurrent uveitis
6 Equine glaucoma
7 Equine ophthalmic surgery
7.1 Introduction to ocular surgery
7.2 Eyelid and third eyelid surgery
7.3 Corneal surgery
7.4 Anterior chamber and orbital surgery

For more information on cost, details on conditions covered please e mail me [email protected] or w app +27 833089237

07/01/2024

Online Small animal Ophthalmology course
This course of mine is still available.
Eye conditions are challenging when you’re not that confident at dealing with them. The beauty of ophthalmology is that just about everything we need to see to make a diagnosis is right there in front of our eyes. We just need to know what to look at and how to do it. This online ophthalmology course focusses on Canine & Feline ophthalmology. The modules are subdivided to limit the individual tutorials to plus minus 40 minutes each. PDF course notes will also be supplied. Where applicable short videos will be included. Each module will conclude with a test that can be completed. This is a requirement to be accredited with the South African Veterinary Council. The Canine and Feline Course is accredited with the South African Veterinary Council and a participant will earn 23 CPD points after completion of the course and the online test. For other Veterinary registration bodies, a completion certificate indicating the total time spent on continuing professional development will be issued. Also included is copies of recent articles on new developments as well as suppert for any problematic cases . If you require more information please e mail me [email protected] or w app +27 833089237

After registering a dropbox link will be sent to participants with all the course material that can then be downloaded.

23/12/2023

Chameleons [part 2]
Because accurate focusing requires large retinal images. Image magnification is higher than in any other vertebrate eye scaled to the same size. This is a result of a unique optical design: unlike other vertebrate eyes, the crystalline lens of the chameleon has negative refractive power. In other words, instead of having a biconvex lens, they have a concave lens. This increases retinal image size, allowing more precise focusing. While the lens is negative, the cornea of chameleon eyes is positive, meaning that it is convex as in other animals.

21/12/2023

Melting corneal ulcer[Keratomalacia]
I have received this photo yesterday as an online consultation of a horse with a melting ulcer. This is the best photo of severe melting I have ever seen !! Keratomalacia is causes by excessive amounts of collagenolytic enzymes. These enzymes are normally present in the cornea and play an important role in the normal physiology of the cornea. However excessive amounts can lead to an abnormal breakdown of the corneal stroma as seen in this photo. This is usually the result of a secondary Pseudomonal infection. We are seeing a lot of antibiotic resistance and in these cases cultures are usually indicated, but we need to start treatment ASAP. My antibiotic of choice is Tobramycin. This is combined with serum as anti collagenolytic. In severe cases give serum hourly until the melting stops. I also give systemic Doxycycline as chelating agent again leading to reduced melting.
Ps Thank you Dr Lukacs for the photo.
For more information feel free to contact me: [email protected]

20/12/2023

Journal article summary.
I have not done one for a good month or so. I have looked at a recent publication on Diabetic neuropathy.
Just some interesting results
The corneal nerve fibre length was significantly different with a mean fiber length of 6.742 mm/mm2 in non-diabetic dogs and 3.781 mm/ mm2 in diabetic dogs.
The corneal nerve fiber density was significantly different with a mean (±SD) fiber density of 15.465 fibers/mm2 in nondiabetic dogs and 8.333 (±3.096) fibers/mm2 in diabetic dogs.
The corneal touch threshold (CTT) was significantly different with a mean CTT of 2.808 cm in non-diabetic dogs and 2.058 cm in diabetic dogs

We have been well aware of the decreased corneal sensitivity in diabetic dogs, but this study help explaining this phenomenon. I will continue advocating the use of good quality Tear Substitutes for example high molecular weight hyaluronic acid or chondroitin sulphate in all diabetic dogs.
If you are not already receiving these summaries and would like to please e mail me consult@dvos .co.za to be added to the list.

18/12/2023

This is an article I found very interesting and would like to share the following.

The conclusion of this article is that dogs treated with ophthalmic NSAIDs developed GI bleeding at a frequency comparable to dogs receiving systemic NSAIDs or systemic glucocorticoids alone, suggesting that dogs receiving ophthalmic NSAIDs may be at increased risk of GI bleeding.

I have personally never prescribed gastro protectants when dispensing topical NASAID,s but have in most cases when prescribing systemic NSAID’s / corticosteroids. In the light of this article prescribing a gastroprotectant like a PPI when prescribing topical NSAIDS is definitely justified. This is especially the case ketorolac is prescribed as severe GI bleeding was only documented in ketorolac-treated dogs in this study

18/12/2023

I apologize for my long absence not posting anything !! Today I would like to share this stunning ultrasound I have received as an online consultation of a dog with bilateral hyphemia. Note the following changes on the image: hyphemia, cataracts, retinal detachment and possible intra ocular neoplasm.

30/10/2023

I will be attending the 2023 FAVA congress in Borneo this week. I am presenting series of lectures on Feline ophthalmology as well as corneal ulceration in dogs. I am still available for online consultation the report may take slightly longer but I will do everything possible to ensure you receive it within 24 hours.

24/10/2023

Corneal foreign body. I would like to share this stunning photo of a corneal foreign body I have received as an online consultation. This is a common problem in dogs, especially hunting / retrieving dogs. These little grass seeds get stuck on the corneal epithelium and then work their way into the stroma eventually leading to w deep stromal ulcer. I find they are difficult to remove by debriding them but very easy to remove by flushing them out. I use a 22 G Jelco cannula connected to 10 ml syringe and then flush with moderate force. They will dislodge very easily in 99 % of cases. This procedure can be done in un sedated patient just with topical anesthesia

30/09/2023

Neuroprotective therapy.
Some of the information I found interesting in the article I summarized were that 85% respondents [Veterinary Ophthalmologists] had prescribed presumed neuroprotective therapy for at least one of the four conditions in the past five years: 69% for glaucoma, 31% for SARDS, 70% for PRA, and 30% for RD.
The calcium channel blocker amlodipine besylate was the second most used treatment in this survey overall, and the most common presumed neuroprotectant used in canine glaucoma patients.

In my opinion Amlodipine should be concidered as an additional treatment in our primary glaucoma patients. The reason for using calcium channel blockers is to inhibit excessive calcium influx from the extracellular space in order to prevent or reverse increased intracellular calcium concentration and calcium-dependent apoptotic cell death. In addition to its potential neuroprotective effect, amlodipine also has the demonstrated benefit of increasing ocular blood flow in dogs.

Another product I will be looking into is Memantine. Memantine is the third most common neuroprotectant used for canine glaucoma. Memantine is an N-aspartate (NMDA) receptor antagonist that inhibits the toxic effect of excessive glutamate and aspartate in the extracellular space. I will keep you posted on any new information I get.

Please feel free to contact me [email protected] if you would like more information or share your opinion.

30/09/2023

Article summary

I have not done a article summary for some time now. I am busy looking at some nutraceutical products currently used for conditions lie retinal degeneration and KCS. There was a rescent article in Veterinary ophthalmology looking at neuroprotective therapies prescribed by veterinary ophthalmologists for canine degenerative retinal and optic nerve diseases. I shall be sumerizing this. If you are not already receiving my summaries please e mail [email protected]. I will also keep you posted here about any new developments.

25/08/2023

Lens subluxation in a horse.
I received this photo yesterday as an online consultation. Very good photo of a lens subluxation in a horse. Unlike dogs and cats where lens luxations are common, we do not see them often in equines. Gold standard treatment for lens luxations is intracapular lentectomy. Unfortunately, this procedure has a lot of possible complications in equines. My recommendations is usually aimed at preventing secondary glaucoma. Start the patient on Dorzolomide eyedrops and when the lens luxated posteriorly start prostaglandin analogues [Latanoprost / bimatoprost] to control IOP and induce miosis to keep the lens posterior to the pupil.
Please feel free to contact me [email protected].

20/08/2023

Journal article summary. I apologize for being absent for a while. Just being very busy with some other work. I frequently get asked regarding glaucoma medications especially differences between carbonic anhydrase inhibitors. I shall be looking at some article in this context. As always If you would like to receive those e mail me [email protected]. I will also post very short summary here. Also I am still available for online consultations. Please submit cases either by e mail or w app 0833089237.

09/07/2023

Hypertensive retinopathy in a cat. Often these cats present with acute onset blindness. Clinical signs include retinal hemorrhage hyphema as well as exudative retinal detachment. The photo shows clear signs of a retinal detachment.

09/07/2023

Journal summary. I will be e mailing a summary of an article looking at hypertensive retinopathy in cats later today. Retinal changes and secondary blindness is one of the most common manifestations of hypertension in cats and cats are often first diagnosed with hypertension due to the ocular lesions. If not on my e mail list please e mail [email protected].

18/06/2023

I am busy preparing for the FHV webinar I will be presenting soon. I am very excited about some products Vetscripts are starting to compound to assist in treating FHV. This include a Cidofovir in high molecular weight hyaluronic acid eyedrop, palatable famciclovir paste and oral paste with antiviral effects containing Curcumin, Lysine, Beta glucan and Resveratrol.

18/06/2023

Article summary. In the next article we are going back to qualitative tearfilm deficiency and will be looking at a recent article summarizing the diagnostic tests available for tear film deficiency. I will e m ail this summary in the course of this week. If you have any topics in mind that you would ;like me to cover let me know. To receive these please e mail [email protected]

05/06/2023

Calciferous corneal degeneration [CCD]. I am busy preparing an article for Vet 360 June edition. So were looking for good photos. One the the referral I have received from my online consulting service. Not the classic crystalline white appearance with secondary stromal ulcer in this patient. Also note eyelid neoplasia present

05/06/2023

Feline Herpes Virus (FHV-1) is a common respiratory and ocular pathogen of domestic cats, leading to a spectrum of disease in this species. Clinical signs compatible withFHV-1 infection in cats include non-specific upper respiratory disease and keratoconjunctivitis, due to the pathogen's requirement for replication within epithelial tissues, such as those lining the upper respiratory tract, conjunctiva, and the cornea. Corneal disease include dendritic ulcers geographic ulcers, stromal keratitis and KCS

FHV-1 is ubiquitous among the domestic feline population, with up to 97% of cats seropositive for the virus, and 11%–30.1% of cats with active respiratory signs testing positive for FHV-1 via virus isolation, immunofluorescence assay, or PCR testing.

FHV-1 establishes latency within the trigeminal ganglion in 80% of acutely infected cats, leading to recrudescence of clinical signs and subsequent active shedding in 45% of latently infected cats.

In my next article summary we are looking at some of the treatment options. Please let me know if you would like to receive this if you are not already on the list. [email protected]

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Videos

It has been a very busy month with OP lectures etcetera but I am continuing with my diabetic cataract series. Here is part 4

As promised part 2 of diabetic cataracts looking at normal glucose metabolism in the lens and the pathophysiology of diabetic cataracts in both dogs and cats.

Part 1 of 4 of a look at diabetic cataracts. Each video is less than 5 minutes long

Cyclosporin Episcleral Implant I have received several requests from vets asking how to implant these. I have prepared a very short 3-minute presentation on this topic.