Day 1 :
CEO, New Vision Inc. (Taipei)
Time : 9:30
Jui-Teng Lin has completed his PhD in Physics from the University of Rochester in USA. He is currently the Chairman and CEO of New Vision Inc., and the Visiting Professor at HE Medical University in China. He is the Editor in Chief of the Medical Device Diagnosis and Engineer. He has served as a Visiting Professor at National Chao Tung University and an Associate Professor at the University of Central Florida. He holds over 45 patents and is the Inventor of flying spot LASIK procedure. He has published over 55 book chapters and over 150 peer review journal papers including 75 SCI-impacted papers.
This overview presentation consists of a historical review of the 30 years progress of laser vision corrections (1987 to 2016), summary of eye lasers and their applications, recent developments and new trends, the principles and formulas of laser and non-laser vision corrections and UV-light-initiated corneal collagen crosslinking. The first human trial of PRK was conducted by Dr. Trokel in 1987, based upon the IBM patent and the animal study in 1983. FDA approved PRK in 1995. The flying-spot scanning technology was invented by Dr. J.T. Lin in 1992 (US patent) who also introduced the customized procedure in 1996. The waveguide device was commercialized in 1999. FDA approved LASIK in 2002. During 1995-1999, various laser systems/procedures were developed including LTK (using Ho:YAG); DTK (using diode laser), RF and CK designed for hyperopia corrections; slide state lasers (YAG-213 nm for PRK), YAG pico-second-PRK, Mini-Excimer for PRK, etc. Technologies developed in the 2000’s include eye-tracking device, microkeratome, elevation map, topography-guided LASIK, wavefront for customized LASIK, presbyopia treatment using SEB and laser scleral-ablation for presbyopia; accommodative IOL. More recently, femto-second lasers are developed for flat cutting and stroma ablation and cataract. UV-light and Riboflavin activated corneal cross linking (CXL) has been developed for clinical use for various corneal deceases such as corneal keratoconus, corneal keratitis, corneal ectasia, corneal ulcers and thin corneas prior to LASIK vision corrections. Combined technology of CXL-PRK, CXL-intra stroma-femto-laser pocket, CXL-phakic-IOL and CXL-IC-ring.
Ying Li is the Chief Physician and Tutor of Doctoral students at the Department of Ophthalmology in the Chinese Medical Association and the Deputy Head of the Corneal Disease Group. He is the Member of the Asian Dry Eye Institute and Director of Corneal Myopia Laser Surgery Center at the Peking Union Medical College Hospital.
We will present two parts: (A) TransPRK (TPRK) and (B) SMILE clinical outcomes. Part (A) regards to the long term result of TransPRK focusing on its efficacy and safety. This is a retrospective study, 48 patients treating with TPRK and 34 patients with LASEK were followed up for 6 months to 1 year summary. TPRK can correct myopia and astigmatism with high safety and efficacy; comparing to LASEK, TPRK has the advantages of faster epithelium healing and visual recovery, while both achieve great VA. Part (B) presents the study on SMILE clinical outcomes, where a total of 1000 eyes were conducted and 240 eyes having a following up of more than 6 months. The result showed that after surgery, all of the eyes achieved the pre-op best-corrected visual acuity. To evaluate patients’ optical quality following corneal laser refractive surgery, we designed a questionnaire based on National Eye Institute Refractive Error Quality of Life instrument. In SMILE group, patients’ scores were relatively high for these items, indicating rather satisfying surgical outcomes. It can be concluded from the study that the patients’ satisfaction and optical quality were best following SMILE.
Becker College USA
Keynote: Aneurysm mediated release of thrombin into the aqueous humor may be a causative factor of glaucoma
Time : 11:25
Janardan Kumar holds a Ph.D. degree in chemistry under kind supervision of Dr. C. M. Gupta, ex-director, CDRI, Lucknow, India. In the United States, first he received postdoctoral training on motor proteins in the laboratory of Michael P. Sheetz, a lasker award winner, at Duke University Medical Center, North Carolina. He published his work on kinectin, a myocilin like protein, in Science (1995), and an abnormality in myocilin has been predicted to be involved in the pathogenesis of glaucoma.Prior to coming to Becker College, while a research assistant professor at Tufts University, Kumar engineered a new real time perfusion system used for the discovery of drugs to treat glaucoma. Presently, Kumar is chair of the natural sciences department, and is actively engaged in the advancement of course curriculum in microbiology, chemistry, and developing the biotechnology/biology major at Becker College.
Aneurysm mediated release of thrombin into the aqueous humor may be a causative factor of glaucoma.
Janardan Kumar, Becker College, Worcester, USA.
Glaucoma has been known to be associated with ocular hypertension due to age-related dysfunction of outflow pathway tissues. Based on the geometry of outflow pathway tissues, only the inner wall of Schlemm’s canal (SC) cells in the conventional outflow pathway appeared to be arranged as a monolayer consisting of irregular pores. Several studies suggest the biomechanical properties of the endothelial SC cells to be modulators of endothelial barrier function, outflow resistance, and intraocular pressure (IOP). Our studies of thrombin perfusion in enucleated porcine eyes ex-vivo, procured after thorough investigation of unnoticed impurities, revealed an increased outflow resistance. Of significance, as opposed to the effect of thrombin in other cell types for the endothelial barrier function, treatment of thrombin to the human endothelial SC cells monolayer permeability barrier–function assay exhibited a significant decrease in the permeability of horse-radish peroxidase. Even if there was the di-phosphorylated form of myosin light chain that is located in the peripheral region of the cell, formation of stress fibers and focal adhesions were increased significantly, and that resembles the characteristics for the activation of Rho kinase. Such cellular changes of human SC endothelial cells have been correlated with cellular contraction and/or stiffness, causing increased resistance of the outflow. Since the thrombin can cause increased outflow resistance and is known to be involved in increased extra-cellular matrix (ECM) protein deposition and fibrosis, we speculate that release of thrombin in the aqueous humor followed by an aneurysm may be associated with the etiology of glaucoma. Hence, the clinical diagnosis of an aneurysm in glaucomatous patients and detection of thrombin in glaucomatous aqueous humor would provide a better understanding of glaucoma.
- Sessions: Cornea disorders and Treatment | | Ophthalmology Novel Approaches| Eye and Vision science: An Overview
Location: Beijing, China
New Vision INC, Taiwan
MD, PhD, Taiwan
Capital Medical University, China
Fengju Zhang has completed his PhD in Beijing Tongren Hospital, Capital Medical University in China. He has pursued his Postdoctoral research in St. Erik’s Eye Hospital affiliated to Karolinska Institute in Sweden 1999. He is the Vice President of Chinese Society of Optometry, CMAO and CMDO, Member of Beijing Society of Ophthalmology, Member of APJO and the Academic Leader of the Beijing health system 215 talents project. His research areas include refractive surgery, basic research of myopia and scleral cross-linking surgery.
This overview presentation consists of the research of biomechanical effects and safety of scleral collagen cross-linking (CXL) by Riboflavin/ultraviolet A on human and rabbit eyes, the research of biomechanical effects and safety of scleral collagen cross-linking (CXL) by Riboflavin/blue-light on human and rabbit eyes and the research of biological parameters of scleral collagen cross-linking (CXL) by Riboflavin/ultraviolet A on rhesus eyes. Collagen cross-linking in our research was performed with topical Riboflavin solution (0.1%) followed by irradiation with ultraviolet A (370 nm, 3 mW/cm2) for 30 min on equatorial parts of human, rabbit and rhesus sclera and with topical Riboflavin solution (0.5%) followed by irradiation with blue light (460 nm; 14.6, 19.5, 22.5, 26, 32.5 and 40.6 mW/cm2) for 20 min on equatorial parts of human and rabbit sclera. Stress-strain measurements of scleral strips were performed with a biomaterial tester to evaluate the biomechanical effects. Dark-adapted ERG was repeatedly applied on bilateral eyes of rabbit and rhesus and optical coherence tomography (OCT) examination was performed on bilateral eyes of rhesus to evaluate the safety of CXL in vivo. Histological analysis, terminal deoxynucleotidyl transferase dUTP nick-end labeling, the measurement of outer nuclear layer thickness and transmission of electron microscopy were performed on human and rabbit eyes to evaluate the safety of CXL in vitro. The mechanical and biochemical stability of human and rabbit scleral tissues was statistically increased after the scleral CXL by ultraviolet A and blue-light (P<0.05). The dark-adapted ERG amplitudes were statistically reduced to 1 week, 1 month and 3 months postoperatively by ultraviolet A and blue-light on rabbit eyes (P<0.05), however there was no statistically changes in dark-adapted ERG amplitudes (1 month postoperatively) and thickness of retina and choroid (3 months postoperatively) by ultraviolet A on rhesus eyes (P>0.05). Compared with the control eyes, apoptotic cells and ultrastructural changes can be found in the retinal layers of scleral cross-linked eyes of rabbits in vitro. The results above indicate that biomechanical strength of sclera may be enhanced by CXL with Riboflavin/ultraviolet A and blue-light. However, the safety evaluation is not certainty enough for the postoperative visual function of rabbit and rhesus eyes. Further study should be performed to set up a long-term safe protocol of scleral CXL for clinical prevention from progressive myopia.
Chaokai Chang has graduated from Medical School of Kao-Hsiun University (1990) and has completed his PhD from South Carolina University (2011). His current positions include Chairman and CEO of Taiwan Nobel Medical Institute, President of Taiwan Cataract and Refractive Surgery Society and Taiwan Micro Invasive Aesthetic Society; Board Member of ROC Medical Laser Society, ROC Ophthalmology Society and International Medical Health Care Promotional Society. He is the Assistant Professor of Yuan -Pei University and has over 27 years of experience in cornea, refractive and cataracts surgery.
Purpose: To investigate if presbyopic induce accommodative spasm can be a factor in causing or aggravating dry eye disease. Teaching hospital clinical observational study combines with National Health Insurance database (population data base), 14 years of retrograde data statistical analysis.
Methods: 26193 presbyopic cases and 122959 age-matched control subjects were recruited using the National Health Insurance database. Kaplen-Meier Survival analysis method where use to calculate the hazard rates of these patients becoming dry eye. Using Stratified Cox Proportional Hazard model, confounding factors such as DM, allergic eye, post-surgery status were adjusted and the hazard rate ratio where obtained. 25 patients from dry eye clinic were recruited into the observational study. Dry eye disease was established by traditional methods. Hyperopic/presbyopic corrective glasses were prescribed and patients were follow-up with OSDI (ocular surface disease index) and other dry eye indexes.
Results: The Kaplen-Meier survival curve shows a significant difference between those cases who had presbyopia and those that do not have presbyopia diagnosis. After adjusting for confounding factors with Cox model, the hazard ratio was calculated to be 2.61, showing a significant increase of risk for those that have presbyopia to acquire dry eye disease. In the clinical observational study, full hyperopic corrections and near corrections of glasses were given to the 25 cases, the OSDI shows improvements of symptom signs as soon as 1 week time.
Conclusions: We have statistically proved that the risk of having dry eye disease is much higher if the patient had presbyopic refractive errors. Clinically follow-up of dry eye patients with aggressive treatment of this refractive error such as use of full corrective glasses show an improvement of OSDI. We therefore proposed that presbyopic refractive error can aggravate dry eye disease.
National University of Pharmacy, Ukraine
Abraham Nai had completed his degree and is pursuing his masters from the National University of Pharmacy. He has participated in a research work on tattoos and their side effects on cells of the human body. Currently he is working with Professor Filiptsopva Olga Volodymyrivna on tissue culture.
Glaucoma has been one of the world's greatest challenges in medicine. Glaucoma is a group of eye related diseases which causes damage to the optic nerve and in the long run affecting vision or causing vision loss. Open angle glaucoma is damage to the optic nerve, usually caused by high intraocular pressure. Open angle glaucoma falls under the types of glaucoma. There are typically no early warning signs or painful symptoms of open angle glaucoma. It develops slowly and sometimes without noticeable sight loss for many years. Open angle glaucoma is the most common form of eye diseases. It is known to cover about 90% of eye related diseases in respect to glaucoma. The risk of being affected is high with African, American or Latino. People with diabetes and cardiovascular diseases stand a high risk too. The drainage angle formed by the cornea and iris remains open, but the trabecular mesh work is partially blocked. This causes pressure in the eye to gradually increase. This pressure gradually damages the optic nerve. Main aim is to create awareness or enlighten people about open angle glaucoma. It is recommended that individuals or persons before age 40 should check for Open Angle Glaucoma (OAG) every two to four years, age 40 to 54 every one to three years, 55 to 64 every one to two years and after age 65 every six to twelve months, even though in cases of high risk, it is recommended much more frequently. With this analysis, we can deduce that risk of OAG increase with age. A regular program of moderate exercise will benefit your overall health and studies have shown that moderate exercise such as walking or jogging three or more times every week can have an intraocular pressure lowering effect. Spinach and other green leafy vegetables or supplements rich in antioxidants can also help with OAG due to presence of vitamins C, E, A and zinc which is good for protecting vision. Treatment of OAG may differ from on patient to the other in Selective Laser Trabeculoplasty (SLT), Drainage Implant Surgery and Nonpenetrating Surgery in severe cases.
Photon Medical Technology Co., China
Sheng-Chieh Huang has completed his MS in Microbiology and Immunology form National Yang-Ming University (2003-2005) and his PhD from Institute of Life Sciences, National Defense Medical Center in Taiwan (2007-2014). He has then completed his Postdoctoral Fellowships from the Institute of Molecular Biology, Academia Sinica, Taiwan (2014-2015). He is currently the Manager at Photon Medical Technology (Xiamen) Co. His expertise includes molecular biology and immunology research.
We will present the CXL protocols in various applications including keratoconus, ectasia and CXL-combined with refractive surgery. Factors influencing the efficacy of CXL include UV light irradiation time, intensity and dose, Riboflavin (RF) instillation time preop and during CXL, RF compound formulations and concentration and available oxygen in the stroma. The most commonly used RF compounds include: TE, M, H and L types which have been used in various applications. Defining T1 and T2 as the preop and during CXL RF instillation time, the protocol based on a UV intensity 18 mW/cm2 are listed as: (1) TE type for epi-on: 0.1% RF solution (without Dextran) for epi-on procedure of corneal ectasia and keratitis. T1 is 10-15 minutes and T2 is 5 minutes. (2) M and H type for epi-off: 0.1% RF solution (with Dextran) for epi-off procedure of corneal ectasia and keratitis. T1 is 15-20 minutes and T2 is 5 minutes. (3) H type: Hypotonic Riboflavin solution for thinner corneal swelling, instillation for 10 minutes until thickness reaches safe range. (4) L type: 0.25% RF solution for use with refractory procedures. T1 is 1.5-4 minutes and T2 is 2 minutes. (5) 0.1% specialized Riboflavin in combination with iontophoresis device for epi-on procedure of corneal ectasia and keratitis. T1 is reduced to 5 minutes and T2 is 5 minutes. To improve the CXL efficacy, the conventional Dresden protocol is revised as follows: For the case of UV intensity 18 mW/cm2. For corneal ectasia and keratitis: Pause UV light-on for 2 minutes, then light-off for 1 minute (after 1 drop of RF), turn on the UV again for 1 minute, then instill 1 drop of RF with light-off for 1 minute, light-on for 2 minutes to complete the process.
Central South University, China
Shaowei Li has worked in ophthalmology since 1989. He has pursued his Post-doctoral training in Corneal Diseases at Louisiana State University Eye Center under Professor Herbert E. Kaufman. With over 20 years of experience in ophthalmology, he specializes in corneal diseases, cataract, refractive surgery and anterior segment diseases. Prior to joining Aier Ophthalmology, he has worked at Shandong Eye Institute as a Vice Director and Professor for more than 16 years. In 2006, he is the first Doctor who performed femtosecond laser assisted corneal transplantation in China. He is also the Council Member of the Cataract Subspecialty Group of the 8th Chinese Ophthalmology and the 8th Chinese Ophthalmology Society. He is currently the Deputy Director of the Academic Committee of Aier Eye Hospital Group, Chairmen of Aier Eye Bank, Chairmen of Corneal Diseases Group of Aier Eye Hospital Group. He has published more than 90 papers in various Chinese and international medical journals, co-authored 4 books on ophthalmology, undertaken medical researches on 21 national provincial and ministerial-level topics and won 11 awards.
We will report several unique cases of using free anterior capsule as an endothelial cells protector during femtosecond laser assisted cataract surgeries. Three cases of cataract patients with very low endothelial cell density were chosen to accept this procedure. These cases have a very potential to receive endothelial transplantation after cataract surgery, the situation was informed to them and consents were signed. Femtosecond laser assisted cataract surgeries were conducted, after femtosecond laser treatment by LenSx, the freed anterior capsule was lifted by viscoelastic agent and was attached to patient’s corneal endothelial layer firmly. Then the phacoemulsification was performed as routine procedure. After IOL implantation, the anterior capsule was removed by gentle irrigation and aspiration by I/A tip. No corneal edema and other complications were observed in all cases. The unique method may have potential benefit to cataract patients.
Tianjin Medical University Eye Hospital, China
Rui-hua Wei has completed her graduation in 1998 with basic Medical degree from the Tianjin Medical University and registered as a Medical Practitioner in Tianjin Medical University Eye Hospital. She has achieved her Master of Clinical Science degree in Ophthalmology Department at National University of Singapore in 2005. She has completed her PhD in Ophthalmology from Tianjin Medical University in 2011. She has completed General Ophthalmology and Refractive Surgery Fellowship at Singapore National Eye Centre (2001-2005) and Cornea Fellowship from the University of Southern California (2009-2010). She has specialized in management of corneal and external eye diseases, dry eye, refractive surgeries and contact lenses. She is also interested in myopia control and management of high myopia related macular disease and complicated cataract.
Myopia has the highest incidence in the eye diseases and presents a trend of rapid growth. In China, 78.4% in children who are older than 15 years of age are myopic. While the degree of myopia is deeper, the risk of retinal detachment, retinal neovascularization, cataracts and glaucoma also increased significantly. These complications can cause severe visual loss and irreversible visual impairment. In myopic eye, the structure of sclera was changed, the dry weight of sclera was reduced, the collagen arrangement was disordered, the diameter of the sclera was reduced and the anti-tension ability of sclera was poor. Fortunately, some recent studies have shown that the scleral collagen cross-linking can covalently bind the sclera collagen to enhance the anti-traction ability of sclera, thereby to prevent further extension of axial length. In 2003, Wollensak first reported the safety and effectiveness of using Riboflavin-UVA induced cross-linking to treat progressing keratoconus. Its effect on slowing axial elongation was first documented in 2004. Subsequently, a series of studies was set to test its safety and efficiency in vitro and rabbit sclera. Our research adopts the method of making form deprivation myopia in guinea pigs model and through the Riboflavin-UVA induced collagen cross-linking in the posterior sclera and found that Riboflavin-UVA collagen cross-linking could slow down the experimental myopia in guinea pigs via enhancing the mechanical properties of the sclera and make no obviously damage in the structure of retina and RPE cells.
Jui-Teng Lin has completed his PhD in Physics from the University of Rochester in USA. He is currently the Chairman and CEO of New Vision Inc., and Visiting Professor at HE Medical University in China. He has served as a Visiting Professor at National Chao Tung University and was the Associate Professor at the University of Central Florida. He holds over 45 patents and is the Inventor of flying spot LASIK procedure. He has published over 55 book chapters and over 150 peer review journal papers including 75 SCI-impacted papers.
We will present a new analytic Z* formula for corneal cross linking (CXL). CXL safety the criteria for the validity of Bunsen-
Roscoe law (BRL) for accelerated CXL and its comparison to the new nonlinear law will be discussed. New formulas for
CXL efficacy for both type-I and type-II will be presented. The minimum corneal thickness given by a Z*-formula, Z*=(1/A’)
ln(E*/Ed), where a steady state effective absorption constant given by A’=2.3[mε2G(z)C0+Q], where Ed is the endothelial cell’s
cytotoxic damage energy threshold (Ed). CXL efficacy (for type-I) is given by Ceff=1-exp(-S) with S being the rate function.
The Bunsen-Roscoe law (BRL) is based on the Beer-Lambert law for UV light intensity without RF depletion, such that S=akE,
which is a linear function of the dose E=(tI). In comparison, using a time-dependent generalized Beer-Lambert law, we obtain
S=√(4kCo/aIo) exp(A'z) [1-exp(-0.5aE] which is a nonlinear function of E and has a steady-state proportional to √(Co/aIo)
exp(A'z). Our nonlinear law predicts that high UV intensity requires longer exposure time than what is calculated based on
BRL. In addition, for the same dose, higher intensity depletes the RF faster and reaches a lower steady-state efficacy than that
of lower intensity, consistent with the recent clinical data. The CXL efficacy (for type-II) is given by Ceff=1-exp(-S) with S is the
time integral of the singlet oxygen concentration, given by S(z,t)=(k7/k4)b1 V(z,t)[1-b2 V(z,t)] , where V(z,t)=ln (1+Bt), with
B=apqI(z)X0., where X0 is the initial oxygen concentration, p and q are the type-I and type-II quantum yield, respectively. The
S formula provides the role of oxygen in type-II efficacy.
Photon Medical Technology Co., China
Sheng-Chieh Huang has completed his MS in Microbiology and Immunology from National Yang-Ming University (2003-2005) and his PhD from the Institute of Life Sciences, National Defense Medical Center in Taiwan (2007-2014). He has then completed Postdoctoral Fellowships (2014-2015) from the Institute of Molecular Biology, Academia Sinica in Taiwan (2014-2015). His is currently a Manager at Photon Medical Technology (Xiamen) Co. His expertise includes molecular biology and immunology research.
We will present summary of clinical outcomes of corneal crosslinking using CCL-vario device. CXL is widely accepted as an effective strategy for stopping progression of keratoconus and ectasia after refractive surgery. CXL using Dresden protocol with 30 minutes Riboflavin instillation and 3 mW/cm2 irradiation has been proved safe and effective. In recent years, accelerated CXL was developed with higher irradiation intensity (9-30 mW/cm2) can theoretically shorten surgery time (4-10 minutes) and reduce discomfort of patients. However, it still needs more clinical evidences to evaluate the safety and effectiveness of accelerated CXL. Here we used MEDLINE to identify all CXL studies on keratoconic or ectasic eyes [n>6, follow-up >3 months, using CCL-365 various system (3-18 mW/cm2)] and compared the clinical data of traditional and accelerated CXL. In 3 mW group: 3 studies and 120 eyes were included, for visual acuity (logMAR UDVA, CDVA) and Kmax, at latest follow-up 100% studies reported improvement. In 9 mW group: 4 studies and 99 eyes were included, for visual acuity and Kmax, at latest follow-up, 50% vs. 100% studies reported improvement. In 18 mW group: 10 studies and 456 eyes were included, for visual acuity and Kmax, at latest follow-up, 40% vs. 70% studies reported improvement. On the other hand, stromal edema, haze were reported in all 3 groups within first 3 months and disappeared at latest follow-up. There is no severe complication including keratitis, prolonged haze or scarring was reported. These clinical results showed accelerated CXL also can stop corneal ectasia without significant complication although corneal stiffening effect was not compared in 3 groups. In conclusion, accelerated CXL (9-18 mW/cm2) may achieve similar efficacy of traditional CXL without significant safety problems.