Day 2 :
University of Granada
Keynote: Glaucoma as a toll for hominid evolution: Constrains of the experimental animal models of glaucoma
Time : 09:00-09:25
Francisco Javier Carreras is a Tenured Professor of Ophthalmology, University of Granada. His research has pivoted around the pathogenesis of the glaucomas. He has contributed in the description and characterization of the Cameral Mucous Gel in humans. He has described a fluid conducting role for the perivascular glial sheat as well as the fenestrations of the basal lamina in the inner limiting membrane. His description of a pathogenetic role of the misdirection of aqueous humor flow is been incrementally delineated by his late contributions. He has developed a computational model of the optic pathways that helps to understand the structural/functional relationship in glaucoma.
Glaucoma continues to be a mysterious disease. High intraocular pressure (IOP), once the landmark of the disease, has been relegated to the humble role of risk factor, in spite of the fact that lowering IOP continues to be the only partially successful treatment. Even with a successfully controlled IOP to statistical standards, many patients still mysteriously progress in the loss of neural tissue. A novel pathogenetic mechanism has been recently suggested as the main agent of the disease. Under this new light, some structural details of the human eye, the result of the peculiar evolutionary development, gain an unexpected role in the presentation of the disease. As results of cladistic analysis, the human eye appears as particularly prone to suffer glaucoma as a consequence of the pursued evolutionary path. That makes glaucoma basically a human (and related hominid) scourge. Exclusive features of the human eye compared to other vertebrates involve both the anterior and posterior segment. Those features that facilitate glaucoma in humans are absent in many of the purported animal models for the disease, convoluting even more, for its inadequacy, the mystery of glaucoma. This suggests the division of the animal models into those that mimic the whole disease and those that only reproduce a pertinent histological feature. Unfortunately most animal models are based in high intraocular pressure which leaves out most cases of low or moderate pressure. For any animal model, it is important that the researcher establishes accurately the constraints of the model, to avoid jumping to conclusions.
Keynote: Aqueous humor fluid dynamics can be better understood by a real time perfusion system at constant pressure
Time : 09:25-09:50
Janardan Kumar is the Professor and Former Chair of Natural Sciences. He has earned MS in biochemistry from University of Allahabad and received PhD in chemistry at CDRI, Lucknow affiliated to Kanpur University in India. Being research Assistant Professor in the department of Cell Biology at Duke University in 1998, he developed his research interest to the field of glaucoma and joined the internationally renowned laboratory of Prof. David L Epstein at Duke Eye Center, Duke University, Durham, NC (USA). His work at Duke Eye Center provided opportunity to file two patents, one for glaucoma therapy and the other for vitrectomy. At TEI biosciences in 2002, he gained a unique experience on stem cell research. His strategies made him capable of inducing differentiation of insulin producing cells from adult human skin fibroblast stem cells using specific signaling complexes, and successful transplantation of these cells into three diabetic nude mice resulted of maintaining the normal glucose level for approximately a month.
For over half a century, glaucoma research has made little progress towards understanding the regulation of aqueous humor outflow resistance and fluid dynamics. Nevertheless, an understanding of the fluid dynamics in the eye, being either pulsatory or continuous as demonstrated in an ex vivo environment, would provide the key information as to the mechanisms of glaucoma. Without this understanding, it is difficult to predict definitively the role of outflow pathway cells in aqueous humor outflow resistance at the molecular level. Several designs of the perfusion systems have been proposed as measurements of the aqueous humor outflow facility in the enucleated eyes either at constant pressure or at constant flow. The major problem of perfusion systems measurement is that the equipment is not available commercially, so the perfusion equipment is self-assembled in laboratories after procuring the parts from different resources. Above all, the Grant perfusion system holds unique features that measure the outflow facility at constant pressure while two pairs of enucleated whole eyes are evaluated, simultaneously. Based on the same principle, the newly engineered real time perfusion system equipped with modern tools and technology using Balance Talk XL program 5.1 (Labtronics Inc., Canada) measures the outflow facility at constant pressure and was presented at ARVO 2006 by J Kumar. Clearly, the perfusion of H-7 in porcine eyes using the newly designed real time perfusion system model demonstrated that the perfusion of Optimedia, the composition similar to aqueous humor is a far superior physiological media than the traditionally used PBS plus glucose for the analysis of outflow facility. Our preliminary data analysis of outflow suggested that the aqueous outflow is discontinuous and exhibits a pulsatory motion. We anticipate that the newly designed real time perfusion system will be a valuable research tool for studies aimed at characterizing fluid dynamics as well as being easy to assemble and commercially available. If so, this will raise awareness for glaucoma research among basic scientists worldwide and contribute to a better understanding of aqueous flow and the mechanism of glaucoma leading to new treatment options.
- Track 3: Glaucoma: Visual Field Loss
Track 4: Neuro-Ophthalmology
Track 6: Research Trends in Surgical and Medical Ophthalmology
Becker College, USA
Maria Dolores Pinazo Duran
University of Valencia, Spain
Massachusetts General Hospital
Time : 09:50-10:10
Emmanuel Buys obtained his PhD from the Department of Molecular Biology, Gent University and Flanders Institute of Biotechnology. He is currently an assistant professor in Anesthesia at the Massachusetts General Hospital where he studies the role of nitric oxide-cGMP signaling in cardiovascular disease and primary open angle glaucoma. He has co-authored 52 manuscripts since 2006.
Glaucoma is a progressive optic neuropathy characterized by visual field defects that ultimately leads to irreversible blindness. By the year 2020, an estimated 80 million people will have glaucoma, 11 million of which will be bilaterally blind. Primary open-angle glaucoma (POAG) is the most common type of glaucoma. Elevated intraocular pressure (IOP) is currently the only risk factor amenable to treatment. How IOP is regulated and can be modulated remains a topic of active investigation. Available therapies mostly geared towards lowering IOP, offer incomplete protection, highlighting the need for novel therapeutic approaches and drug targets. Impairment of the nitric oxide (NO)-soluble guanylatecyclase (sGC)-cyclic guanosine monophosphate (cGMP) pathway has been associated with POAG and NO-donors are being developed as novel IOP-lowering agents. This presentation will discuss pre-clinical and clinical studies, illustrating the connection between NO-cGMP signaling and POAG. In addition, pilot data will be presented describing the IOP lowering and/or neuroprotective capabilities of available therapeutics known to increase cGMP signaling.
University Eye Hospital ‘Svjetlost’,
Time : 10:10-10:30
Iva Dekaris has completed her PhD from University in Zagreb after Postdoctoral Fellowship at Harvard Medical School, Schepens Eye Research Institute. She is currently a Medical Director at Eye Hospital “Svjetlost”, Professor of Ophthalmology at Universities of Zagreb and Rijeka and Associate-member of the Croatian Academy of Sciences and Arts. She has published 47 papers in CC journals. She works as PI for project “Mechanisms of corneal graft rejection” and has been serving as an Editorial Board Member of 3 and a reviewer for 6 reputed journals. She has an overall experience of over 20,000 surgeries mainly cataract surgery, corneal transplantations, and refractive lens exchange.
Subjects & Methods: Ninety five patients (204 eyes) underwent bilateral trifocal IOL (AT LISA tri 839MP, Zeiss, Germany) implantation after clear lens extraction. Patients were presbyopes; 95 hypermetropes and 7 myopes between 46 and 68 years. Other 20 eyes with hyperopic or myopic astigmatism received trifocal toric IOL (AT LISA tri toric 939 MP, Zeiss, Germany). Uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity at 80 cm (UCIVA), uncorrected near visual acuity (UCNVA), uncorrected distance visual acuity under 10% contrast level, visual disturbances and subjective satisfaction were measured and compared to Bifocal group (AT LISA 809MP; 42 pts, 84 eyes). Follow up was at least 6 months, up to two years. Results: All patients achieved monocular UCDVA better than 0.8, (76.9% eyes 1.0), monocular UCIVA better than 0.63 was achieved in 96.1% patients (37.5% patients 1.0). All patients could read J2 and better; 72.1% of patients could read J1. UCDVA at 10% contrast level was also excellent; 62.5% of patients could read 1.0. Halo and glare were reported in 9.6% and 7.3% of cases, respectively. There was no need for LASIK/PRK enhancement. Spherical equivalent was equal or less than 0.5 D in 97% of trifocal eyes and within the range of +1.00 to -1.00 D of astigmatism in all trifocal toric eyes. Conclusions: Refractive lens exchange with implantation of trifocal or trifocal toric IOL enables good vision at all distances and spectacle independence. It is excellent choice for younger, active presbyopes in need of good intermediate vision.
Francisco Javier Carreras is a Tenured Professor of Ophthalmology, University of Granada. His research has pivoted around the pathogenesis of the glaucomas. He has contributed the description and characterization of the Cameral Mucous Gel in humans. He has described a fluid conducting role for the perivascular glial sheat as well as the fenestrations of the basal lamina in the inner limiting membrane. His description of a pathogenetic role of the misdirection of aqueous humor flow is been incrementally delineated by his late contributions. He has developed a computational model of the optic pathways that helps to understand the structural/functional relationship in glaucoma.
Is aqueous humor toxicity the missing link in glaucoma? Glaucoma is a prevalent disease characterized by axonal loss related to difficulties in aqueous humor outflow that may manifest as increased intraocular pressure. We have shown in perfusion experiments that the optic nerve with a fluid-conducting paravascular glial sheat is easily permeable. There is increasing evidence that in some regions of the CNS, axons rely on lactate rather that glucose for their nourishment. We have communicated that based on the presence of transport molecules; lactate is the main energy source at the astrocyte-rich pre-laminar level of the optic nerve. Along with them, adherens junctions (AJ) rich in N-cadherin depend of calcium ion to maintain the binding. We study the response of the cultured pre-laminar tissue of the pig to calcium ion withdrawal by transmission electron (TEM) and confocal (CLSM) microscopes to detect changes in the exposed N-Cadherin attachments. There is an increase both in apoptosis and increase in the cleft separation in AJ in the cultured pre-laminar region with aqueous humor-levels of calcium reduction. Phosphorylation of Beta-Catenin shown by immune-labeling and incremented apoptosis as measured by Western Blot of caspases is both induced by calcium reduction. Altogether, this suggests that activation of the signaling system related to AJ triggers a wave of anoikis in astrocytes. Axon loss in glaucoma can be linked to astrocyte detachment provoked by aqueous misdirection through the optic nerve. This mechanism opens new avenues for pathogenetically-oriented treatment of axon loss and corresponding visual field defects in glaucoma.
State University of Campinas
Title: The LEA grating test in assessing detection grating acuity in normal infants less than 4 months of age
Time : 10:50-11:10
Giovana Martini Graduated in Occupational Therapy from Federal University of São Carlos (UFSCar) (2000). Master in Health Program for Children and Adolescents from the State University of Campinas (UNICAMP). Developing activities in clinical practice, research and education with main focus on child development and the interface between health and education for the effectiveness of occupational therapy practices to monitor social and educational inclusion for children with special educational needs. Professor and Supervisor for the Specialization Course in Rehabilitation applied to child neurology (UNICAMP).
Purpose: To assess binocular detection grating acuity using the LEA GRATINGS test to establish age-related norms in healthy infants during their first 3 months of life. Method: In this prospective, longitudinal study of healthy infants with clear red reflex at birth, responses to gratings were measured at 1, 2 and 3 months of age using LEA GRATINGS at a distance of 28 cm. The results were recorded as detection grating acuity values, which were arranged in frequency tables and converted to a one-octave scale for statistical analysis. For the repeated measurements, analysis of variance (ANOVA) was used to compare the detection grating acuity results between different ages. Results: A total of 133 infants were included. The binocular responses to gratings showed development toward higher mean values and spatial frequencies, ranging from 0.55 ±0.70 cycles per degree (cpd), or 1.74 ±0.21 log MAR, in month 1 to 3.11 ±0.54 cpd, or 0.98 ± 0.16 log MAR, in month 3. Repeated ANOVA indicated differences among grating acuity values in the three age groups. Conclusions: The LEA GRATINGS test allowed assessment of detection grating acuity and its development in a cohort of healthy infants during their first three months of life.
University of Valencia
Time : 12:10-12:30
Maria D. Pinazo-Durán received her medical degree and gained PhD at the University of Valencia (Spain), this latter on the subject of developmental neurodevelopment and toxicology of the visual system, mainly the effects of drug and alcohol exposures. She is the foundational member of the Spanish Society of Developmental Biology and from the Spanish Glial Net. She is active member of various professional societies and reviewer of international journals. She is the founder and managing Director of the Ophthalmology Research Unit “Santiago Grisolia” in Valencia. Currently she is General Research Coordinator of the Health Department Valencia- Univ. Hosp. Dr. Peset (Valencia-Spain).
Purpose: To utilize the tear film as biological source of micro RNAs (miRNAs) in order to analyze its profile in relation to primary open angle glaucoma (POAG). Material and methods: A total of 30 participants (POAG patients (GG; n=15) and matched healthy controls (CG; n=15) were interviewed, ophthalmologically examined and extracted their reflex tears atraumatically from the inferior meniscus (20-30 microL) with a Pasteur micropipette that were stored at -80º until processing. The mercury TM RNA isolation kit (Exiqon, Denmark) was used for RNA extraction. The SPSS 15.0 program was used for statistical analysis by integrating all variables. Results: Mean age of the participants was 70 + 2 years in the GG vs 68 + 2 years in the CG. We extracted RNA from the pooled tear film samples and its quality was evaluated using Agilent Bioanalyzer 2100. Then, pure RNA (< 200 nucleotides) was utilized to generate a sequencing library for small RNAs. It was obtained significantly higher purified RNA in tears from the GG as compared to the CG [11 + 1 ng/mL vs 8 + 2 ng/mL of pure RNA respectively (p<0.001)]. By next generation sequencing it has been detected a high variety of matured miRNAs with a differential expression profile in tears from both groups of participants. Conclusions: Tear film sampling is a non-invasive, relatively simple and efficient process for glaucoma research. The miRNAs obtained from tears can be used for quantitative and qualitative assays to improve knowledge on the molecular basis of POAG. The possibility remain that specific miRNAs can be used as biomarkers for better monitoring the diagnosis and therapy of the glaucomatous patients.
Specialised Private Practice
Title: Dynamics of compliance in glaucoma progression: A cross-sectional study comparing IOP and CCT devices followed by a longitudinal IOP and cup-to-disc ratio analysis
Time : 12:30-12:50
Stanka Uzunova has completed her graduate training in Medicine in 1991 at the Medical University of Plovdiv and in Ophthalmology at Medical Academy, Sofia. She specialises in glaucoma and has her own private practice. She has published more than 18 papers in reputed journals and in 2009 established the first Glaucoma School for patients in Bulgaria. She supports initiatives for the early detection of glaucoma and organises free annual screening events. Professional interests also include AMD, the application of stem cells in ophthalmology, clinical trials and research.
An observational study by a single investigator was conducted to evaluate the glaucoma progression during adequate therapy and excellent patient compliance. A quantitative analysis was conducted to establish the accuracy and correlation between two widely-used ultrasound and non-contact CCT devices. A qualitative analysis was performed to determine the fluctuations of IOP and glaucoma excavation over a period of 25 weeks. A two-tailed t-test and Pearson’s correlation were performed for statistical analysis. All participants were clinically proved to have POAG. 70 eyes from 35 patients, 7 men and 28 women (age range 51-85, mean age 65,9) were examined. Each had their CCT measured using Ocuscan RxP Ophthalmic Ultrasound System and IOP using Goldman Applanation Tonometer (GAT), and then compared to IOP and CCT measured with Nidek NT-530P Combination Non-contact Tonometer, Non-contact Pachimeter. Baseline: IOP and cup-to-disc ratio. Follow-up: IOP using GAT (after 12 and 25 weeks) and cup-to-disc ratio (after 25 weeks).
Shenzhen Eye Hospital
Time : 13:50-14:10
Hongwei Deng is the assistant professor of department of pediatric ophthalmology and vice chairman of medical services department of the Shenzhen ophthalmological hospital, China. She has completed her graduation from Henan Medical University in 1995 and M.D in 1999. Hongwei Deng has done her PhD from Jinan University, department of ophthalmology in 2002. She also served as the observer in Krieger Children’s Eye Center at the Wilmer Institute, USA and Children's Hospital of Boston, Harvard University. She was awarded industry research and development award on the Chinese National Invention Patent: 200410027122 for her research on porous carbon - polyvinyl alcohol hydrogel artificial cornea. She has published several papers in reputed journal and has been serving as an editorial board member of reputed journals.
Objective: To investigate effects of bilberry anthocyanin on form-deprivation myopia in guinea pigs and its mechanism. Method: A total of 30 3-week old healthy guinea pigs were randomly assigned to groups A, B and C with ten (10) in each group. The guinea pigs in group A were given bilberry anthocyanin and in group B were given medication after their eyes had been covered for 14 days. In group C were given normal saline. At Days 1, 14 and 28, diopter and length of optic axis were measured. At Day 28, MMP-2 mRNA and Collagen I mRNA were test by quantitative PCR (Q-PCR). MMP-2 and Collagen I proteins were observed by Western blot. Results: After covering for 14 days, optic axis was elongated and diopter progressed toward myopia in the covered eyes of the non-dosing group (group C). No significant change was observed for optic axis or diopter in dosing group (group A). At Day 28, non-medicated group (group C) showed further elongated optic axis in the covered eyes while the diopter further progressed toward myopia and thus a stable myopia model was established. In dosing groups (groups A and B), covered eyes showed reduced expression of MMP-2 and less severe myopia as compared to the covered eyes in group C. Conclusion: By inhibiting MMP-2 protein expression and preventing Collagen I degradation, orally administered bilberry anthocyanin enhances sclera structure and thereby inhibits the formation of form-deprivation myopia in guinea pigs. Orally administered bilberry anthocyanin has preventive effect against form-deprivation myopia in guinea pigs.
Time : 15:40-16:00
Armando Sandoval Vaca is an Ophthalmologist with institutional and private practice in Quito, Ecuador. He is a Medical Doctor from the Universidad Central del Ecuador, Residency in Ophthalmology and fellowship in Vitreo-Retina at the Universidad de Chile, Observerships in Vitreo Retina atthe Jules Stein Eye and Cleveland Clinic, USA, Clinique Sourdille Nantes, France and Hospital de la Luz, México DF. He is the International Member of the ASRS and received Honor Award and Senior Honor Award of the ASRS. He is the Retina Panelist of the Best of the Academy for Spanish speaking Ophthalmologists during consecutive 21 years at the AAO. He is also Faculty Professor of Retina and Neuro Ophthalmology at the Post-Graduate Medical School, Universidad Central, Quito, Ecuador.
Background: The separation of the ora serrata may affect any quadrant. Traumatic dialysis is usually in the superotemporal quadrant and spontaneous dialysis in the inferotemporal. ITD is approximately 10% of all the RRD. The clinical features of ITD are: Demarcation lines, retinal cysts, yellow white vitreous opacities, bilateral, juvenile and slow progression. Purpose: To determine the incidence of ITD in the Ecuadorian Andes. Is there an enviromental or genetic reason? This question has no answer. Material & Methods: This is a retrospective non randomized revision of 2 series of patients operated by the author with scleral buckling. First: 17 years, 150 eyes in 131 patients. Second: 5 years, 32 eyes in 29 patients. Exclusion criteria: PVR more than C-1, trauma, GRT or RD in myopic patients with macular hole. Results: In the first group, ITD is the most common type of RRD with 51 eyes, (34%). Considering the number of patients, the most common is the idiopathic with 50 patients (38%) while ITD has 24.4%. In the second group, 11 eyes were ITD (34%) and of the total of patients, 8 were ITD (27.6%) Conclusions: ITD is the most common RRD, is bilateral in 59% of group 1 and 37% of group 2, most common in young males from 15 to 35 years and in autochthonous, native inhabitants. ITD is a benign RRD with slow progression and self limited in some cases. Discussion: Is there a genetic factor? Is there a congenital anomaly of the ora serrata?
Universidad de Guayaquil
Time : 16:15-16:35
Daniel Valverde presently working as a Faculty of Medical Sciences at University of Guayaquil. Being Specialist in Retina Medicinal – Ocular Nutrition - Low Vision – Pediatric Vision - Public Health - Community Development Projects in Public Health
More than 99 percent of the diseases have a direct relationship with the imbalance of his immune system in visual and ocular health the same relationship holds the patients who are treated in our clinic everyday are generally seen from the perspectives of treatment of the signs and symptoms is the consequence but not from the perspectives of the cause and the prevention for more than five years we have handled the concept of transfer factors prevention strengthened in the treatment of our patients and we have obtained fully satisfactory results not only in the overall health of the patient but also in visual and ocular health. We apply this auxiliary treatment in patients with different pathologies both general impact at eye level as well as eye diseases in the treatment center. Immune city of Guayaquil and the city of Quevedo, Ecuador reports obtained are highly satisfactory was improved eye health, pressure control intraocular associating the use of enhanced transfer factors and medication prescribed by the treating ophthalmologist as well as visual acuity of patients.
Cairo University School of Medicine
Title: A comparative study between transplantation of conjunctival limbal autograft with mitomycin C and aminotic membrane transplantation with mitomycin C in re-current pterygium
Time : 16:35-16:55
Mohammed Othman has completed his PhD from Cairo University and Post-Doctoral studies from Bascom Palmers Eye institute, Miami School of Medicine, Florida, USA. He supervised more than 35 master degree thesis and 7 PhD thesis. He has published more than 12 papers in reputed journals.
Aim: To compare the efficacy and the complications of Conjunctival Limbal Autograft (CLAU) with mitomycin C 0.02% and Amniotic Membrane Transplantation (AMT) with mitomycin C 0.02% for treatment of re-current pterigum. Methods: 80 eyes of 60 patients with recurrent pterigum were divided into two groups , Group A, included 40 eyes underwent pterigum excision and MMC with CLAU, Group B, included 40 eyes underwent pterigum excision and MMC with AMT. Recurrence was defined as fibrovascular tissue extension of more than one mm onto the cornea in the area of previously excised pterigum after period of follow up from 6-9 months. Recurrence was compared in each group by using ӽ2 test. Results : No major post-operative complications occurred during 6-9 months of follow-up. In CLAU group (A), only 5 eyes of recurrence occur (12.5%) after 7 months of follow up. Recurrence occur in 12 eyes (30%) in AMT group (B) after 6 months (P value=0.043, ӽ2 test). Conclusion : CLAU with MMC is more effective than AMT with MMC for treatment of recurrent pterygium.
American University of Beirut
Time : 16:55-17:15
Rola Hamam is an Assistant Professor of Ophthalmology at the American University of Beirut. She is the director of the residency training program and the medical retina fellowship training program. She received her BS degree in biology from the American University of Beirut in 1998 and her MD in 2002. She completed her residency in Ophthalmology at the same institution then had fellowship training at Harvard University in Boston at the Beetham Eye Institute, the Massachusetts Eye and Ear Infirmary, and the Massachusetts Eye Research and Surgery Institution with Doctor C Stephen Foster until 2008. She returned to her home country and joined her Alma matter in 2009 to start the first uveitis specialty referral clinic in the country at the American University of Beirut. Doctor Hamam is a member of several national and international societies. She has organized and lectured on ocular immunology and uveitis in many national and international conferences and scientific meetings. She is involved in multiple research projects on ocular inflammatory and infectious disease and she continues to contribute scientific publications in the field.
Purpose: To review the epidemiology, risk factors and pathophysiology of uveitic macular edema and discuss advances in diagnosis and treatment Methods: Review of the literature and presentation of case series of the use of topical bromfenac for the treatment of uveitic macular edema, also discussion of the effect of intravitreal adalimumab on uveitic macular edema. Results: Advanced age and chronic edema are among the poor prognostic factors. 11 patients (14 eyes) treated with bromfenac 0.09% daily. Median CRT improved from 427 to 257 (p=0.002). 8/10 eyes had resolution of SRF. 6/11 eyes had resolution of CME. Median logMar improved from 0.39 to 0.17 (p=0.3) and 6/14 eyes gained more than 2 lines. 1.5 mg adalimumab injected intravitreally every month for active non infectious uveitis. 5/8 eyes had resolution of macular edema. Median time to resolution was 6 weeks (range: 2-26). Median CRT improved from 317 mm to 277 mm at 6 months (p=0.021).
Malla Reddy Medical College for Women
Title: Grievance in teaching: Article (226) high court & article (32) supreme court- Indian penal code applicable to all specialties
Time : 17:15-18:00
Katta S V has completed his MB, BS, DO from S V University and Fellow of Retina Foundation under beloved Dr Nagpal. He worked for 9 years under Ministry of Health, Algeria. He is Senior Resident in Ophthalmology in Malla Reddy Institute of Medical Sciences, India. He presented the grievance in general body AIOS 2015.
AIOS is second largest society in the world registered under society Act in the constitution of India. Are we justified in learning and also teaching knowingly non-precise/incorrect medical terms to younger generation without even mentioning misnomers and in turn making them habituated? Under article 226 (high court) & 32 (Supreme Court) in the Constitution of India-Grievance; our solution is to change or to teach misnomer along with the word. For the past 10 years, the same concept was being projected to the world as ‘Questionable medical terms in Ophthalmology’. As some of our AIOS governing council (2013-14) defended as lack of law and not authorized to opine on, retired judge was being consulted and the title is changed with law details as ‘Grievance in literature Ophthalmology-our solutions’. Retrospective study of ophthalmic literature shows for the last more than hundred years, imprecise medical terms like ‘retinoscopy’, ‘syringing’, ‘retinal detachment’, ‘intracapsular cataract’ has been in existence. Phaco emulsification came approximately 28 years ago, 10 years ago small incision cataract surgery and 5 years ago computer vision syndrome. These less precise terms are being added to the medical literature during our own generation. No attempt has been made in the past even with appeal to restore precision and greater accuracy to the terminology in current use. Perhaps none took cognizance of the problem or the need for such correction was not taken seriously. It is unethical that evidence based medical terms are being refused to get published in all scientific journals. Even with appeal, knowingly publishing incorrect medical terms in scientific journals and passing on to innocent younger generation is grievance. At present evidence based science is kept on the desk of chairman, ethics committee and international council of ophthalmology for consideration after relooking. Law is applied to all sciences. Ophthalmology is the starter of the procedure.
- Instruction course
Location: Valencia, Spain
University Hospital Coventry & Warwickshire
Time : 14-10-15:40
Atul Bansal is a consultant ophthalmic surgeon with special interest in modern glaucoma and cataract surgery based at University Hospital Coventry & Warwickshire(UHCW). He has extensively including specialist training in Oxford region, advanced specialist training from Birmingham and a clinical and surgical fellowship from Manchester Eye Hospital. He was awarded Birmingham Eye Foundation Roper-Hall Prize Medal in 2004. He specializes in advanced surgical techniques for glaucoma including modern Trabeculectomy, glaucoma drainage implant (Tube surgery), minimally invasive glaucoma surgery (iStent), and lasers and also in complex cataract surgery. He is an author of 15 indexed peer reviewed publications, an MD thesis and chapters in a book on cataract surgery in difficult situations. He has regularly presented at international and national meetings. He has chaired instruction course on glaucoma management and has been an invited speaker and faculty. He has been principal investigator for multicenter clinical trials. Mr. Bansal lead for Quality assurance for postgraduate training for School of Ophthalmology, West Midlands, UK and lead for post graduate medical education and College Tutor for Royal College of Ophthalmologist for UHCW. He is the departmental lead for Clinical Governance, and clinical audit and cataract service for his department.
Surgical Glaucoma management has evolved considerably in recent times. The safety and efficacy of augmented trabeculectomy has increased significantly due to optimisation of the techniques but it still remains a surgery with potential risks, potential of failure over time and more so in certain conditions. Although augmented glaucoma filtration surgery remains the gold standard surgical treatment for most of the patients with uncontrolled glaucoma, there has been a significant increase in the array of options available. Glaucoma drainage device surgery has become safer with refinement of the techniques and is being used more widely and in some conditions they may be used as primary surgical treatment. Modern angle surgery including has provided minimally invasive options in specific situations and MIGS (Minimally invasive glaucoma surgery) have proved to be useful in avoiding the need of more invasive glaucoma filtration surgery. There is increasing use of trabeculoplasty with increased popularity of selective laser trabeculoplasty (SLT) and the refinement of technique of diode laser cycloablation has improved its safety and expanded its indications. Non penetrating surgery may provide an alternative and safer solution in certain situations. There are strong proponents of different types of treatments but each treatment modality has its own risks and benefits and one modality does not fit all uncontrolled glaucoma patients. The optimum treatment depends on number of factors. Disease factors include the type of glaucoma, stages of the disease, level of intraocular pressure (IOP) and the desired target pressure and previously used treatments. Patient factors including age and expected life span, occupation, patients expectation from treatment and their ability and compliance for the necessary post operative management and their ability to afford the treatment or series of treatments. Associated factors like ocular surface disease and atopy influence the outcome of certain modalities more than the other while presence of coexisting conditions like cataract may influence the first choice of treatment by allowing a less invasive treatment. Phacoemulsification and goniosynechialysis in a patient with recent attack of angle closure may be a very useful option before considering trabeculectomy or phacoemulsification and iStent in patient with symptomatic cataract and moderate glaucoma and moderately raised IOP may help avoid or delay need of glaucoma filtration surgery. Whereas at the same time coexistence of a cataract may make the choice difficult in conditions like uncontrolled IOP and advanced cataract in the only eye where prioritisation of one over the other may be sometimes difficult and combination surgery may carry a higher risk and a lower success rate. Trabeculectomy would be the treatment of choice when a large reduction on intraocular pressure is required in an advanced glaucoma case or when an ultra low target pressure is required. A glaucoma drainage device may be the best option in a case of iridocorneal endothelial syndrome and uncontrolled glaucoma or case of repeated failures of trabeculectomy.
- Young Research Forum
King Saud University
Title: Evaluation of calibration errors of goldmann tonometers in university affiliated hospitals in Riyadh, KSA
Time : 18:00-18:15
Noor Al Anazi is 5th year Medical Student (final year) at King Saud University. Graduation date from college of medicine was 7th of May 2015. She will start her internship in July 2015. She is a Member in Ophthalmology Interest Group at King Saud University.
Intraocular Pressure (IOP) is the fluid pressure inside the eye; it is a fundamental parameter in conditions of ocular health. Despite the development of other modes of IOP measurement, the Goldmann tonometer (GT) remains the gold standard in the clinical environment. GT need calibration process periodically. These machines may give false readings if left un-calibrated for long time which may lead to deterioration of ocular health. This study was conducted to estimate the calibration errors of GT in different ophthalmology departments and to clarify the importance of keeping these machines calibrated and maintained. The study aims to raise awareness among health care practitioners. This Observational cross sectional study based on estimating the calibration errors in two major hospitals, King Abdulaziz Medical City and King Abdulaziz University Hospital in different ophthalmology clinics and departments using a special device called Calibration Error Weight Bar at three different levels (0, 20 and 60) mmhg and readings is recorded. Calibration errors were classed to <=0.5, 1 and >=1.5 mmhg; the machines with error readings above 0.5 needs to be calibrated. A total of 30 machines were evaluated in regular clinics, emergency department, wards and screening clinics. A small number of machines used in clinics had error more than 0.5, the other machines in emergency, wards and screening clinics had error less than 0.5. This study suggests GT in the clinics are prone to error, so a more rigorous maintenance program for calibration need to be considered. We recommend conducting a similar study at tertiary Ophthalmology centers.
Dr. Agarwal’s Eye Hospital
Time : 18:15-18:30
Rohit Sanjay Laul has completed his MBBS and MS Ophthalmology from Maharashtra University of Health Sciences, Nashik, India in 2008 and 2013 respectively. Then he joined as long term Vitreoretina fellow at Dr Agarwal’s Retina Foundation, Chennai, India (A Retina care unit of Dr. Agarwal’s Eye Hospital, Chennai) under one of the world’s finest Ophthalmic Surgeon and also Chairman cum Managing Director of Dr Agarwal’s Group of Eye Hospitals Ltd., Prof. Amar Agarwal, where he underwent rigorous training in medical and surgical management of vitreoretinal diseases. He passed optics & refraction, basic sciences and clinical sciences examinations conducted by International Council of Ophthalmology UK. He has presented several posters in state conferences and has publications to his name in the International Journal of Medical Research. He is now working under Dr. Atif Ali Mir, Senior Vitreoretinal Surgeon & Director Retina services of all Dr. Agarwal’s Eye Hospitals in the golden quadrilateral of Tamil Nadu. The area of his interest is management of advanced diabetic eye diseases, macular diseases and age related macular degeneration.
Purpose: To find out the effectiveness of vitrectomy with intraoperative bevacizumab injection in pseudophakic patients with proliferative diabetic retinopathy. Material & Method: A total of 45 pseudophakic eyes of 45 patients with proliferative diabetic retinopathy underwent standard 23G Pars Plana with intraoperative bevacizumab injection and were followed up for 6 months. Patients age ranged from 46-83years of which 30(66.66%) were males and 15(33.34%) were females. After detailed history taking, they underwent assessment of visual acuity, slit lamp biomicroscopy, fundus examination using 78D lens, indirect ophthalmoscope with 20D lens & B-scan. Standard 23 G pars plana vitrectomy with intraoperative bevacizumab injection was performed in all the cases. Follow up examination was done on next day, at 15 days, 3 months and 6 months following the surgery. The visual acuity, recurrence of hemorrhage and need for another vitrectomy were analysed. Results: The visual acuity improved in 34 eyes (75.55%), after vitrectomy with intraoperative bevacizumab injection. The mean postoperative visual acuity was significantly better than mean preoperative visual acuity. Recurrence of hemorrhage was noted in 4 eyes (8.88%) out of which only 1 eye (2.22%) required another vitrectomy for clearance of hemorrhage. Conclusion: These results demonstrates that vitrectomy with intraoperative bevacizumab injection is an effective procedure in, treating proliferative diabetic retinopathy in pseudophakic patients , reducing the recurrence of hemorrhage and need for another vitrectomy.