Day 1 :
Keynote: Peripheral Refraction-Yes or No!
Time : 09:35-10:00
Peripheral Refraction-Yes or No!
It is predicted that by the year 2050 half of the world's population (five billion people will be myopic and that nearly one billion will be at a high risk of threatening ocular pathology. The first link between peripheral refraction and myopia, in humans, was found in 1971 by Hoogerheide and his colleagues although this issue was studied even earlier by Earl Smith 3rd using monkeys. Eye care practitioners today must not only think in terms of the short-term effect of treatment but also and more importantly, the long term effect of the treatment. Prescribing spectacles may give an immediate positive result by enabling the child to see well but this will not stop the short sightedness to progress.
Therefore we must treated children who are myopic by trying to retard the progression of the myopia. There are a number of treatments, two of which use contact lenses, either soft contact lenses or rigid gas permeable contact lenses. The treatment when using contact lenses is based on defocus at the periphery of the retina. We call this treatment pattern Myopia Control.
University of Heidelberg
Time : 09:00-09:35
Ingrid Kreissig is currently working as a Professor at the Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Germany. She did Specialization in Posterior Segment of the Eye at St. Gallen, Switzerland (1963-1965), University Eye Clinic Bonn, Germany (1965-1969) and New York Hospital-Cornell Medical Center, New York (1969-1972). She has worked as the Head of Department of Posterior Segment of the Eye at the University Eye Clinic of the Rheinische Friedrich-Wilhelms University at Bonn, Germany (1972-1979) and as Chairman of Department of Ophthalmology III (Retina and Vitreous Surgery) at the Eberhard Karls University Tuebingen, Germany (1979-2000). She has been working as an Adjunct Professor of Clinical Ophthalmology, New York Presbyterian Hospital-Cornell University, New York since 1982, Adjunct Professor of Ophthalmology, University Eye Clinic of Mannheim-Heidelberg, Germany since 2001, Representative for East Europe of EURETINA since 2002 and Professor H.C. of the Ufa Eye Research Institute, Russia since 2011. Her interests include retinal detachment surgery, diabetic retinopathy, age-related macular degeneration (AMD), posterior segment laser surgery, angiography, OCT, Medical Retina, photodynamic therapy (PDT) and application of intravitreal pharmacotherapy for various edematous and neovascular retinal/macular diseases.
The treatment options for a primary retinal detachment will be analysed by starting with Gonin in 1930 up to present in regard to their morbidity, rate of reoperation and long-term visual function. There had been a change from surgery of the entire retinal detachment to a surgery limited to the area of then retinal break and as well a change from an extraocular to an approach for reattaching the retina.
Over the last decades there had been evolved 4 major surgical techniques for repair of a primary retinal detachment being applied in the beginning of the 21st century. All of htese have still one issue in common: To find and close the retinal break which had caused the detachment and which would cause a redetachment, if not sealed off sufficiently.
Conclusion: To find and close sufficiently the break(s) in a primary retinal detachment has accompanied the efforts of retinal detachment surgeons during the past 8 decades which is still the “conditio sine qua non” for long-term reattachment. But, however, today 4 postulates have to be fulfilled for each of the 4 techniques for repair: (1) Retinal reattachment should be achieved with the 1st operation, (2) the procedure should have a minimum of morbidity, (3) it should not harbour secondary complications jeopardizing regained visual acuity and (4) it should be performed on a small budget in local anaesthesia. This is needed, because the budget for ophthalmology of today has to cover as well very expensive and long-term needed treatment modalities for AMD.
- Neuro Optometry | Glaucoma | Ocular Diseases | Lenses
University of Houston, USA
Wright Mark perform over 300 small incision phaco-emulsification (modern small incision) cataract surgeries annually with over 99% as a day case. His cataract outcomes are as follows; over the past three years (1,173 consecutive cases), 96% of patients saw 6/12 or better postoperatively (comparative figure is 91% from the national cataract audit). Mark’s capsular rupture rate, the most commonly sited measurement of surgical dexterity was 0.6% (1.9% national cataract audit). He co-leads the oculoplastic (eyelid and socket) service for Lothian. Audit of surgical outcomes forms the backbone of revalidation, He was the inaugural audit secretary for the British Oculoplastic Surgical Society. He have a keen interest in teaching and has, for the past 10 years, run the undergraduate ophthalmology course at Edinburgh University. Consultant Ophthalmologist, Lothian University Hospitals NHS Trust, Princess Alexandra Eye Pavilion, Edinburgh Consultant Ophthalmologist, West Lothian NHS Trust, St John's Hospital, Livingston. Honorary Part-time Senior Lecturer, Edinburgh University
There are many excellent ophthalmology textbooks which give the novice the appropriate Knowledge, however very few indicate how to apply it. For this reason I have developed along with colleagues a series of diagnostic algorithms(Edinburgh Diagnostic Algorithms) for the three most commonly encountered scenarios: red eye(s), visual loss and diplopia. I’veincluded two others; anisocoria and epiphora. These diagnostic algorithms allow the inexperienced clinician (in ophthalmological terms) to start toutilise and build upon their existing knowledge by consulting a framework which represents the thought processes of their more experienced colleagues. Algorithms are, therefore, simply a user-friendly version of these diagnostic and/or treatment thought processes. Algorithms are always a compromise between having enough detail to cover the most commonly encountered diagnoses while remaining simple enough to use. They rely upon the clinician being able to clarify the history and elicit the clinical signs which act as signposts on the road to diagnostic nirvana.
I’ll present the results of 3 published studies looking at the accuracy of the Edinburgh Diagnostic Algorithms I’m hopeful that during the course of my talk I’ll convince you of their benefits whilst having a bit of fun!
The accuracy of the Edinburgh Red Eye diagnostic algorithm. H Timlin, L Butler & M Wright Eye (Lond). 2015 May;29(5):619-24.
The accuracy of the Edinburgh Visual Loss diagnostic algorithm. C Goudie, A Khan, C Lowe and M Wright. Eye (Lond). 2015 Nov;29(11):1483-8.
The accuracy of the Edinburgh Diplopia diagnostic algorithm. L Butler, T Yap and M Wright Eye (Lond). 2016 Jun;30(6):812-6
Narrated algorithm talk https://youtu.be/9MykiR5imtw
Clifford D Brown serves in the Central Alabama Veterans Health Care System as Chief of the Eye Clinics. He was Senior Health Adviser and Senior Analyst/Operations Chief of National Biosurveillance Integration Center and the U. S. Army Deputy Chief of Eye Services and Behavioral Vision Chief for the Exceptional Family Member Department and served as a rehabilitative consultant for five school districts in USA.
Much has been said in the past decade concerning traumatic brain injured patients. Although each injury is particularly unique, certain general observations can be made of neurologically-driven behaviors that seem to be both reasonably common and associated with this type of sudden, forced movement of the cranial bony structures and the resulting actions within the cerebral soft tissues. The visual pathways and the globe itself are in a unique position to reveal certain aspects of the neural damage. Visual field studies, oculocoherence tomography, and dilated fundus examination can be used to demonstrate vitreous detachments, scotomas, and retinopathy, while other routine testing demonstrates paresis of accommodation, convergence insufficiency, irregular eye movements, and numerous other degradation of binocular function. As an active contributor to the general health care team, the eye care specialist should be aware of at least the most common signs, both focal and global and the associated symptoms. Recent studies have been published that support the contentions of those providers who work routinely with this particular population. While much research remains to be done, the authors of this paper have proposals that seem to at least partially suggest possible physical explanations for several of the most commonly encountered challenges experienced in a significant group of athletes, accident victims and soldiers. This presentation has been developed based upon clinical experience of the traumatic brain injury (TBI) team in a Veterans Health Administration hospital, a team of providers that assesses, diagnoses and provides rehabilitation on an outpatient level to patients who have sustained a wide variety of brain injuries. Principally developed by those who provide this service on a daily basis, the observations are those of rehabilitative neurological professionals and will provide comment on the mechanism of injury, some diffuse effects on the structure and function and an attempt to incorporate approaches and applications of techniques used today in restoration of neuromuscular function in those with traumatic cerebrospinal injury.
University of Houston, USA
Carolyn Carman is a Clinical Professor and Director of the Center for Sight Enhancement at the University of Houston College of Optometry in Houston, Texas. She is a graduate of the University of South Florida and of the Southern College of Optometry where she earned her Doctor of Optometry degree. She completed a residency in ocular pathology and low vision rehabilitation at the VA Medical Center in Kansas City, Missouri. Dr. Carman is a Board Certified Diplomate of the American Board of Optometry and a Fellow of the American Academy of Optometry. She is a member of the American Optometric Association where she has participated on or chaired several national committees including the Neuro-Optometric Rehabilitation Committee and Ethics and Values Committee. She was twice appointed by the Texas Governor to the Texas Optometry Board and served as Chair. Dr. Carman has also been a member of an independent review board reviewing pharmaceutical research studies and as an investigator in clinical studies. She has lectured extensively, nationally and internationally, on low vision rehabilitation and brain injury and formerly produced a syndicated radio program geared toward persons with low vision and reading disabilities.
Background/Aim: Vision impairments are often associated with brain injuries and may be combined with other multiple impairments, but evaluating these patients in order to identify the presence of vision-related problems can be challenging. Sometimes the deficits are difficult to identify because they are subtle; sometimes they are difficult to assess because the patient may be non-verbal or unable to respond to conventional testing methods.
Content: This presentation will address clinical pearls and useful approaches for evaluating and managing children or adults who have suffered vision loss or impairment due to brain injury and may have other impairments complicating the examination process as well.
Implications: The goal of this presentation is to share the development of useful approaches and techniques gained from over 30 years of experience in the clinical and rehabilitative care of brain injury patients of all ages in both hospital-based and private-practice settings.
Chikezie Grand Ihesiulor was born in Port Harcourt, Nigeria, in 1986. He received the O.D. Doctor of Optometry degree in Optometry from Abia State University, Uturu, Nigeria, in 2008 and the MSc in Investigative Ophthalmology and Vision Sciences in The University of Manchester, UK in 2013. In 2015, I joined the Department of Optometry, Abia State University, as a Lecturer. His current research interests include glaucoma, ocular trauma, ocular genetics, preventive optometry, visual psychology and psychopathology. Dr. Chikezie is a member of the Nigerian Optometric Association (NOA) and the Optometrist and Dispensing Opticians Registration Board of Nigeria. He is the CEO of Healthy-hope Lifestyle Centre, Nigeria. He was awarded the best clinician by the President, NOA in 2009 and has joined and led several community health care teams in Nigeria and UK to offer free medical and eye health care services. He is an innovative researcher and is currently pursuing his Ph.D. in Optometry in The University of Manchester, UK.
Purpose: The purpose of this study was to detect pathogenic mutations in cytochrome P450, family 1, subfamily B, polypeptide 1 (CYP1B1) gene in 19 sporadic primary congenital glaucoma (PCG) cases and to identify patients lacking CYP1B1 mutations. Secondly, to conduct an in silico analysis of exome sequencing data of variants common to three related pigment dispersion syndrome (PDS) patients.
Methods: CYP1B1 exon 2 and the coding part of exon 3 of 15 participants were amplified by polymerase chain reaction and amplicons were sequenced by Sanger sequencing. Sequencing data was analyzed to identify the gene mutations or SNPs. Second, the exome sequencing data of the PDS patients combined was analyzed in-house by bioinformaticians and further filtered manually to identify candidate genes for PDS
Results: Four previously reported PCG-associated CYP1B1 mutations (c.1159G>A; p.E387K, c.230T>C; p.L77P, c.1103G>A; p.R368H and c.1568G>A; p.R523K) were found in four patients out of the 15 fully ‘sequenced’ patients. Also, 10 previously reported single nucleotide polymorphisms and two novel noncoding variants were identified. Second, 21 candidate genes were found after filtering using various databases (OMIM & GeneDistiller). Nine genes (TPCN2, TYR, PAX6, DICER 1, FOXE3, TGIF1, TCF4, RPGR and CNGB3) may be of more importance since they are associated with ocular diseases.
Conclusion: The relatively low percentage of PCG patients having CYP1B1 mutations (4/15=26.6%) demonstrates that other known and unknown genes may contribute to PCG pathogenesis. Lack of CYP1B1 gene mutations in some patients stresses the need to identify other responsible candidates. More analysis may be needed and the genes identified may be screened in future in other PDS patients to study PDS genetics.
Augenoptik Doman, Germany
Purpose: To compare the clinical outcome of visual acuities and spectacle independency of four different multifocal intraocular lenses (MFIOLs) (ReZoom, Tecnis, Acrysof Restor SN60D3, and Acrysof Restor SN6AD1) based on information reported in the international literature and to investigate a potential follow up treatment.
Methods: Comparative clinical trials that involved bilateral implanting MFIOLs in patients with cataract were extracted from the literature. Clinical outcomes included uncorrected distance visual acuity, binocular distance corrected visual acuity, uncorrected intermediate visual acuity, binocular distance corrected intermediate visual acuity, uncorrected near visual acuity, binocular distance corrected near visual acuity and spectacle independency. All visual acuity declarations were transformed in LogMAR if needed. The statistical results are based on mean visual acuities ±SE.
Results: Six papers were identified describing four MFIOLs (ReZoom, Tecnis, Acrysof Restor SN60D3, and Acrysof Restor SN6AD1). UCDVA was 0.09±0.04, 0.10±0.01, 0.15 ±0.01 and 0.05 ±0.03 LogMAR. The spherical Acrysof Restor SN60D3 had the poorest result. The best result was performed by the Acrysof Restor SN6AD1. BDCVA was 0.06 ±0.01, 0.02 ±0.01, 0.08 ±0.01 and 0.03 ±0.01 LogMAR. UCIVA was 0.10±0.04, 0.22±0.00, 0.22 ±0.00 and 0.16 ±0.01 LogMAR. Tecnis and Acrysof Restor SN60D1 had the worst results, while the best result was performed by the ReZoom. BDCIVA was 0.10±0.04, 0.21±0.00, 0.30 ±0.00 and 0.17±0.02 LogMAR. Even here, the results from Tecnis and Acrysof Restor SN60D3 were inferior compared to the other MFIOLs. The UCNVA in 40 cm was 0.26±0.03, 0.14±0.01, 0.15±0.03 and 0.09±0.04 LogMAR. Best result was performed by the Acrysof Restor SN6AD1; the worst outcome was by ReZoom. BDCNVA in 40 cm was 0.20±0.02, 0.09 ±0.04, 0.13 ±0.04 and 0.05±0.05 LogMAR. The statements from the UCNVA are transmittable. The UCNVA in 33 cm was 0.30±0.00, 0.01±0.01, 0.18 ±0.00 and 0.18±0.00 LogMAR. The difference between the ReZoom and the Tecnis is disproportionate. While the Tecnis has invincible outcome, the performance of the ReZoom is poor in this distant. BDCNVA in 33 cm was 0.31±0.00, 0.12±0.00, 0.15±0.00 and 0.15±0.00 LogMAR. The spectacle independence rate was highest in the Acrysof Restor SN6AD1 group, followed by the Acrysof Restor SN60D3 group. The worst results were in the ReZoom group.
Conclusion: All MFIOLs provide a good uncorrected and binocular distance corrected visual acuity. In the intermediate area the ReZoom has the best result. The performance of the Acrysof Restor SN60D3 is poorest for this distance. In the near area, the ReZoom has the worst results in 40 cm and 33 cm. The Tecnis has the best performance in the distance of 33cm. The Acrysof Restor SN6AD1 and the Acrysof Restor SN60D3 have higher spectacle independency rates compared with the other multifocal IOLs. A complete spectacle independency was mostly not reached by any type of MFIOL.
Southern California College of Optometry, USA
Pamela J Miller has opened her solo practice in Highland, CA, in 1973. She is a Graduate from the Southern California College of Optometry and Loma Linda College of Law, and a Life Member of the American Optometric Association, a Charter Member of the AOA Contact Lens Section, an American Academy of Optometry Fellow and a Distinguished Practitioner in the National Academies of Practice. She was the first woman on the California Optometric Association Board of Trustees, the first female OD on the CA State Board of Optometry and the first OD on the CA Board of Medical Quality Assurance. She has served on numerous boards, was the first President of the American Optometric Society and CEO of Optometric CE for five years. She lectures extensively, and has written seven books and over 250 articles, while serving as a Contributing Editor to numerous journals for over 40 years.
As the number of private practices decreases in favor of multi-doctor or multi-disciplinary offices, health maintenance organization (HMOs), preferred provider organization (PPOs), and chain-store practices, the question of survival of the private practice or solo practitioner remains a concern to the profession as well as the individual doctor. As insurance companies and increasing governmental oversight grows, the private practitioner can feel that he or she is obsolete, overwhelmed, or simply unable to cope with the changing healthcare picture. As the profession grows, with increasing responsibility and ever expanding scope of licensure, the issue of quality of care, prevention of litigation, meeting or exceeding the patient’s needs, and coordinating with other practitioners to better care for the patient population continues to grow. Weighing the viable options can be equally daunting for the experienced practitioner as well as the newly licensed professional. Options may be limited due to financial constraints, geographic restrictions, practitioner age and experience, and proximity of patients and professional or other health-care colleagues and urgent care or emergency services. Before signing the death-knoll of private practice it is essential to weigh all the options, the benefits and detractors, and reassess the projected future of the private practitioner and this mode of practice.
Mahatma Gandhi University, India
Title: Prevalence and Risk Factors for Myopia and Hyperopia in an Adult Population in Southern India
Time : 13:55-14:20
Sanil Joseph holds an MSc in Public Health from the London School of Hygiene & Tropical Medicine and a Master’s in Hospital Administration (MHA) from Mahatma Gandhi University, India. For the last 13 years, he has been working as a Senior Faculty and Health Management Consultant at the Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, Madurai, India. His primary role in the organization is to anchor health services and epidemiological research, and he has published many scientific papers in reputed international peer reviewed journals. In 2012, he was awarded a Masters Fellowship from the Wellcome Trust UK as a part of which he successfully completed a Masters in Public Health with specialization is Health Services Research at the London School of Hygiene & Tropical Medicine. His current areas of research include refractive errors, use of telemedicine in screening of diabetic retinopathy and primary eye care.
Statement of the Problem: Myopia is the most common cause of refractive errors in both children and adults in many countries. Comparisons of adult myopia prevalence across countries are complicated by variations in the age ranges of populations studied, definitions of myopia and secular trends in environmental risk factor. The aim of this study was to investigate prevalence and risk factors for myopia, hyperopia and astigmatism in southern India.
Methodology: Randomly sampled villages were enumerated to identify people aged ≥40 years. Participants were interviewed for socioeconomic and lifestyle factors and attended a hospital-based ophthalmic examination including visual acuity measurement and objective and subjective measurement of refractive status. Myopia was defined as spherical equivalent (SE) worse than -0.75 diopters (D) and hyperopia was defined as SE ≥+1D.
Findings: The age-standardized prevalence of myopia and hyperopia were 35.6% (95% CI: 34.7–36.6) and 17.0% (95% CI: 16.3–17.8). Of those with myopia, 70% had advanced cataract. Of these 79% had presenting visual acuity (VA) <6/18 and after best correction, 44% of these improved to ≥6/12 and 27% remained with VA <6/18. In multivariable analyses excluding advanced cataract, increasing nuclear opacity score, current tobacco use and increasing height were associated with higher odds of myopia. Higher levels of education were associated with increased odds of myopia in younger people and decreased odds in older people. Increasing time outdoors was associated with myopia only in older people. Increasing age and female gender were associated with hyperopia and nuclear opacity score, increasing time outdoors, rural residence and current tobacco use with lower odds of hyperopia.
Conclusions: In contrast to high income settings and in agreement with studies from low income settings, we found a rise in myopia with increasing age reflecting the high prevalence of advanced cataract. This suggests that older people would benefit more from cataract removal than spectacle correction.
University of Johannesburg, South Africa
Thokozile Ingrid Metsing is currently a Lecturer at the University of Johannesburg. This article is part of the research conducted by her towards her DPhil study, entitled: “Strategies to improve school vision screenings at primary health care level in Johannesburg, South Africa”. She has published six articles with three of them currently under review from the African Vision and Eye Health and Ophthalmology Clinics and Visual Sciences journals.
Most vision screening protocols worldwide rely on the measurement of visual acuities (VAs) to detect visual anomalies amongst children of school-going age. This is despite the fundamental design flaws in the Snellen chart. However, there appears to be a growing demand for the usage of modern technology in the eyecare profession. The aim of this prospective and quantitative study was to evaluate the equivalence of a standard Snellen chart compared to the Spectrum Eyecare Software LogMAR chart in evaluating VAs amongst children of school going age. Normative data was collected from three randomly selected schools in Johannesburg (South Africa) on the non-clinical population of 209 children of school-going age mean 10.13±2.45 years. Monocular and binocular VAs was measured using the Snellen chart at six meters and the spectrum computer software program at three meters. The statistical significant differences (p<0.05) were determined using ANOVA for distance binocular and monocular VAs using the Snellen chart and the Spectrum Eyecare Software. The performance of the Spectrum Software LogMAR was found to be one line better than that of the Snellen chart. However, the Snellen chart still remains the simple, easily accessible and inexpensive method to be used for vision screening amongst children of school-going age compared to the Spectrum Eyecare Software.
St.Louis Healthcare System, USA and VA Illiana Health Care System, USA
Julie Pulliam attended Indiana University College of Optometry and graduated with Doctor of Optometry degree. Dr. Julie is staff Optometrists at the St. Louis VA Medical Centre. Julie is an active member of the Armed Forces Optometric Society (AFOS), the American Optometric Society (AOA), the American Academy of Optometry (AAO), and the St. Louis Optometric Society (SLOS). At St. Louis VA, she served as both Optometry Residency and Externship Coordinator in addition to Contact Lens Coordinator. Currently, she is serving as the Acting Chief of Optometry.
Angelina Bonner earned her Bachelor of Science from Bradley University and her Doctor of Optometry degree from Indiana University. As a doctoral candidate, Dr. Bonner performed contact lens research and presented on developing a method to assess on eye contact lens wettability at the 2009 Academy of Optometry meeting. During her residency at the St. Louis Veterans Affairs Medical Center (VAMC), she specialized in ocular disease, specialty contact lenses, and primary care. Dr. Bonner has presented on several complex ocular disease cases both locally and nationally during her career. Following residency, Dr. Bonner’s passion for serving veterans led her to the Dallas VAMC where she managed complex ocular disease, traumatic brain injury cases, and specialty contact lens care. Dr. Bonner currently enjoys working as the Director of Specialty Contact Lenses, staff optometrist, and attending at the VA Iliana Healthcare System in Danville, IL. In addition to educating students and residents with didactic activities and clinical training, Dr. Bonner holds adjunct faculty positions at several universities. In fall 2017, she earned the distinguished title of Fellow of the American Academy of Optometry. Dr. Bonner is currently licensed in Texas, Illinois, and Missouri.
“The eye exam does not stop there.” Eye care practitioners have the privilege and ability to diagnose a variety of neurologic conditions based on ocular findings. By the utilization of imaging and laboratory tests, we can extend our reach beyond the phoropter to aid in the diagnosis and management of our patients’ ocular and systemic health. We have the duty and ability to initiate and coordinate appropriate care in a timely manner for our patients. By actively participating and interacting with other specialists, we establish our vital role in the health care system. We will present a variety of clinical cases that demonstrate the importance of utilizing serological testing and imaging to establish a proper diagnosis and treatment plan.