Day 2 :
Time : 09:30
Dr. Fuxiang Zhang, MD, MA, completed his first ophthalmology residency training in China. He came to the USA in 1989 and completed his second ophthalmology residency training at Kellogg Eye Center, University of Michigan from 1994-1997. He has been a senior staff member at the Department of Ophthalmology, Henry Ford Health System since 1999. Dr. Zhang’s practice has focused on refractive cataract surgery and IOL monovision for the last 20 years. He has been frequently invited as an honorable or keynote speaker, and has been invited to be a guest editorial board member by numerous ophthalmology journals. He has been jointly invited by ASCRS and AAO to be in charge of the Breakfast with the Expert round table seminar at the American Academy of Ophthalmology since 2014. His clinical research and numerous publications in prestigious journals have been focused on refractive cataract surgery and IOL monovision.
Cataract surgery is no longer simple vision rehabilitation any more. More and more patients require or even demand postoperative spectacle independence. This presentation will explain the spectrum of modern refractive cataract surgery, including the foundation as well as current popular premium IOLs, advantages and disadvantages of each modality.
Guo-Ying Mu majors in the basic research and clinical treatment for ametropia, cataract and corneal diseases, especially for the treatment of karatoconus and infectious corneal diseases and has more than 20 related SCI papers have been published in international core journals. He has also participated in the editing of 6 monographs.
This review overviews the theoretical basis of corneal collagen crosslinking (CXL) and aims to highlight the advances in this procedure to optimize the efficacy of its clinical applications. It consists of the development history of CXL, physical-chemical changes after CXL, clinical applications of CXL, scleral crosslinking and key elements of CXL. CXL was first introduced in the 1990s and has been adopted as a primary treatment for corneal ectatic disorders such as keratoconus worldwide. By using the combination of Riboflavin and ultraviolet-A (UVA), this method is aimed to increase the corneal biomechanical strength and reduce the requirement for corneal transplantation. Over the past decades, many scientific studies have demonstrated the safety and efficacy of this new minimally-invasive method which has been applied to treat infectious keratitis and bullous keratopathy other than keratoconus. However, more and more laboratory and clinical researches were performed to optimize the effect of this procedure by modifications to the standard treatment protocol, such as methods to remove corneal epithelium, the differences between the CXL procedure with or without epithelium and the way to treat thin corneas less than 400 um. Furthermore, the scleral CXL remains a concern in the future.
Time : 10:55
Prof.B.Shukla has teaching experience at Medical Cololege,Gwalior for 25 years. Susequently he was Director, Regional Institute of Ophthalmology, Bhopoal for 9 years and now as Director of Research at R.J.N. for 9 years. He has been President All India OphthalmologicalSociety& President, Ocular Trauma Society of India. He received Dr. Siva Reddy International Award and important natioinal awards including Dr.Hari Mohan Award, Air Marshal Boparai Award, Community Ophthalmology Award, Dr.A.K.N. Sinha Award and Dr. Mohan Lal Award. He also receiuved Life Time Achievements Award of All India Ophthalmological Society. Dr.Shukla has over 50 publications in various national and international journals.
In physical sciences like physics, chemistry and engineering, it is relatively easy to quantify change. However in medical science it is not always easy and at times we have to make a compromise. An effort has been made to quantify ocular trauma (eye injuries) on the basis of loss of structure and loss of function. The loss of structure is graded in percentage on the basis a formula and the loss of function is mainly calculated from loss of vision in percentage. Loss of structural and functional loss gives total loss. Both should be recorded on a graph paper at weekly interval for moderate injuries and at monthly interval for severe injuries. By joining the upper ends of structural and functional loss an area is formed which is called traumagram. Sq. cm. within this area are counted .Each sq.cm. represents 1 trauma unit. Many types of traumagrams can be expected.
- Seminar: Cataract and Refractive Surgery
Location: Beijing, China
Medical Director Downriver Optimeyes Supervision Center-Taylor, MI, USA
Fuxiang Zhang has completed his first Ophthalmology Residency training in China. He came to the USA in 1989 and completed his second Ophthalmology Residency training at Kellogg Eye Center, University of Michigan from 1994-1997. He has been a Senior Staff Member at the Department of Ophthalmology, Henry Ford Health System since 1999. His has focused on refractive cataract surgery and IOL monovision for the last 20 years. He has been frequently invited as an honorable or keynote speaker and has been invited to be a guest Editorial Board Member by numerous ophthalmology journals. His clinical research and numerous publications in prestigious journals have been focused on refractive cataract surgery and IOL monovision.
Components I. Why do we choose IOL Monovision? II. What tests do we have to do prior to the decision-making? III. What information should we cover during the office consult when a patient is interested in IOL Monovision? IV. What is the preferred level of planned anisometropia? V. Does crossed Monovision work? VI. What are the potential contraindications? VII. What are the key factors in order to achieve success? VIII. Who should be your first few pseudophakic Monovision patients?
- Sessions: Glaucoma: Visual Field Loss | Surgical Ophthalmology and diagnostic tools | Optometry and Vision Science | Orthokeratology and Ocular Oncology
Location: Beijing, China
Director of Research & Training, India
Becker College, Worcester, USA
Wenzhou Medical University, China
Shihao Chen is the Director of Refractive Surgery Center of Affiliated Eye Hospital of Wenzhou Medical University. He is also the Adjunct Clinical Professor of Pacific University since 2009. He is the Committee Member of Laser Medicine of Zhejiang Medical Society and Refractive Surgery Group of Chinese Non-Public Ophthalmology Society, ESCRS, ASCRS, IACLE and COS. He is also the Editorial Member of Chinese Version of SCI Journals Cornea and Optometry and Vision Science. He has published dozens of SCI articles, including F1000 faculty recommended article. His honors include National Education Ministry Achievements award and several provincial scientific and technical progress awards.
Purpose: To evaluate the outcomes of corneal collagen crosslinking for management of progressive corneal ectasia after refractive surgery.
Methods: Collagen crosslinking was performed in 15 eyes of 13 patients with post-LASIK keratectasia. Crosslinking was performed either with LASIK flap lift (n=8; A-CXL, 365 nm, 30 mW/cm2 irradiance, 3 minutes) or with epithelium-on, flap-on (n=7; T-CXL, 365 nm, 3 mW/cm2 irradiance, 30 minutes) technique. The main outcome measures included change in logMAR uncorrected distance visual acuity, corneal thickness and Scheimpflug based corneal keratometry at the end of 12 months.
Results: The uncorrected distance visual acuity improved after A-CXL (1.05±0.45 vs. 0.92±0.31; p=0.394) and T-CXL (1.02±0.48 vs. 0.76±0.51; p=0.087). A significant flattening of maximum keratometry (Kmax) was noted after T-CXL (59.4±9.2 vs. 56.0±9.7; p=0.020) whereas the mean Kmax continued to increase after A-CXL (57.7±7.4 vs. 58.8±8.2; p=0.099). The central and thinnest pachymetry and posterior corneal elevation remained stable after A-CXL and T-CXL at the end of one year. There was no significant endothelial cell loss after A-CXL or T-CXL. Significant intergroup differences were noted in Kmax values at the end of one year (p=0.0180).
Conclusions: In our study collagen crosslinking in post-LASIK keratectasia resulted in mild improvement in visual acuity. Corneal flattening was noted after transepithelial crosslinking without LASIK flap lift. No adverse effects of crosslinking were noted in any of the cases.
Jui-Teng Lin has completed his PhD in Physics from University of Rochester, USA in 1981. He is currently the Chairman and CEO of New Vision Inc., Taiwan and Visiting Professor at HE Medical University, China. 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 (US patents, 1992, 2000) 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 new concept using an effective axial length and ocular components ratios (L/R1, L/R1) to define the refractive states. Wavefront technology for customized laser in situ keratomileusis (LASIK) is gaining popularity. The standard LASIK procedure that requires only preoperative measurements of the cornea, particularly its front surface curvature and patient refractive error is not sufficient for customized procedures. The whole eye system consists of at least seven optical components: The front and back surface; radius of curvature of the cornea (rl, r2) and of the lens (Rl, R2); cornea and lens thickness (tl, t); anterior chamber depth (S) and globe axial length (L). Most published works about measuring optical components, however, are limited to the analysis of mean values. Measurements by Hosny and colleagues were also limited to the refractive states of L/rl and L/S, but no data were shown for lens curvature or thickness. Given the ratio of r2/rl (about 0.85) and R2/R1 (about 0.7), we able to reduce the seven ocular components to only two refractive states, Cl and C2, given by C1+0.51C2=4.33 - mD/1336, with m=0.003L. For a wide range of values of r2/rl=0.8-0.9, R2/R1=0.6-0.8, rl=6.5-8.5 mm, Rl=9.5-13 mm and L=23 mm, we calculated Cl=2.9-3.4, C2=1.8-2.4, ml=0.067-0.071 and m2=0.134-0.138. Using the referenced parameter set of (f1, f2, So, T, L*)=(31, 60, 3.3, 4.0, 24 mm), an ocular system deviating from this referenced-set, its emmetropic state is governed by an effective axial length L*=22.5+0.36(43.1-D1)+0.3(22.3-D2)+0.5(So-3.3)+0.35(T-4.0), where D1 and D2 are the corneal and lens power. Therefore, myopia is developed as a result of mismatching of above parameters, such that L*>L0 (22.5 mm).
Chinese PLA General Hospital, China
Dr. Liqiang Wang is the vice director of the Department of Ophthalmology at the Chinese People Liberty Army (PLA) General Hospital. As a specialist in cornea and refractive surgery, she possesses expertise in laser vision correction surgery, femtosecond assisted keratoplasty surgery, complex cataract surgery, and artificial cornea surgery. In addition to being one of the highest volume corneal and refractive surgeons at Chinese PLA Hospital, she teaches residents and fellows about corneal, cataract, and refractive surgery as well as the clinical management and diagnosis of corneal and refractive conditions. She also is an experienced Boston KPro surgeon.
Purpose: To evaluate the safety and efficacy of corneal collagen crosslinking (CXL) for the treatment of corneal ectasia after laser refractive surgery.
Design: Retrospective review of post-LASIK ectasia patients referred to and treated at Chinese PLA General Hospital.
Method: 12 patients (16 eyes; mean age, 39.7±12.6 years) underwent epithelium-off CXL with follow-up ranging from 12-32 months. Best spectacle-corrected visual acuity (BSCVA), simulated keratometry and corneal topography indices were measured with a rotating Scheimpflug camera (Pentacam, Oculus). Comparisons between baseline measurements and postoperative outcomes were performed using paired t test analysis.
Results: At last follow-up, 15 of 16 eyes showed no keratometric deterioration. Central corneal thickness was not significantly altered. No major postoperative complications were observed.
Conclusions: Corneal collagen crosslinking was effective at stabilizing the progression of ectasia after refractive surgery.
JinHai Huang, MD is the vice director of the National Engineering Research Center of Ophthalmology & Optometry, group leader of the Evaluation and Application Research of New Ophthalmology & Optometry Instruments Group. He sits in the editor board of the PLOS ONE and are reviewers for leading ophthalmology journals. He has published more than 110 research papers in leading domestic and international journals including the New England Journal of Medicine, Lancet, Journal of the American Medicine.
Accurate obtainment of parameters of the eyeball is crucial in both clinic and research. Main parameters include central corneal thickness, anterior chamber depth, axial length, keratometry, lens thickness, white to white, pupil diameter and so on. For example, central corneal thickness is critical laser in situ keratomileusis and glaucoma diagnosis, intraocular lens calculation. The topography was an essential method to evaluate the cornea shape and cornea disease just like keratoconus. Ultrasound was the main method to acquire most of those parameters for years and it was thought as a golden standard. The first optical biometer, the IOLMaster basing on partial coherence interferometry was introduced in 1999. The optical method had shown excellent repeatability and reproducibility in clinic and the accuracy had been confirmed in many studies. Since 2009, several optical biometers are available including the Lenstar, the Aladdin, the AL-Scan, the OA-1000, the Galilei G and the Pentacam AXL. The Lenstar which is based on optical low-coherence reflectometry is another widely used optical biometer comparable to the IOLMaster. Placido’s disk is a widely used technique to provide topography but it is unable to show the posterior surface of cornea. The Orbscan corneal topography system which is an optical-based, slit scanning instrument is the first one which can measures three-space points on the anterior and posterior corneal surfaces. However, it was gradually replaced by the Pentacam using Scheimpflug principle which showed higher repeatability, reproducibility and agreement with Placido. After that, Sirius which combines Placido and Scheimpflug shows its reliability in some studies. More recently, the OA-2000, the IOLMaster 700, the Argos which mainly based on swept-source optical coherence tomography are introduced for dense cataract.
Jing Hong is the Deputy Director of the Department of Ophthalmology at the Peking University Third Hospital, China. She is the Committee Member of Chinese Ophthalmological Society Corneal Disease Group and also the Member of Editorial Board of Chinese Journal of Ophthalmology and many other magazines. She has been mainly engaged in corneal and ocular surface disease clinical research. She has published more than 100 articles.
Nowadays, Endothelial Keratoplasty (EK) has become the mainstay of treatment for corneal endothelium disorders. Smaller incision, thinner graft and faster vision recovery are the trends for EK. DMEK, more consistency with corneal anatomy is preferred by more doctors worldwide. However, corneal endothelium dysfunction in China has its own unique features. We overviewed our DMEK patients from 2007-2016 with total number 1142. Most of them are combined surgeries. There are 4 features which are as follow: First feature: Shallow anterior chamber (AC), peripheral iris bulge and narrow angle, thick lens. Second feature: Severe corneal edema with opacity. Causes for this bad situation are delay of seeking treatment, lack of donor cornea, mean waiting time for donor cornea is 6 months. One of the characteristic in China is, almost every case is the end stage when patient agree to do the operation. Most of their vision acuity is figure counting, which makes the surgery more challenging because the cornea is too swollen to see the cataract clearly. Third feature: More complicated combined surgery, simple EK 35.71%, combined surgery 64.29%. Fourth feature: Disorganized ocular structure for those seriously trauma, sometimes, PKP is performed combined with silicone oil tamponade to ensure the retina reattached well, however it may result in endothelium dysfunction. Peripheral anterior synechiae (PAS) easily occurs with thick corneal endothelium graft in Asian eye. So it can be concluded that DMEK is not suitable for majority complicated cases in China, since the cases are very complicated. Most cases are complicated with shallow AC, severe corneal opacity and difficult intraocular status. So combined surgeries are required. Ultra-DSEK is currently adapted to our need in Chinese patients with the features mentioned above. Ultra-DSEK is the most suitable EK procedure in China.
Tianjin Medical University Eye Hospital, China
Mei-nan He had completed her degree from Tianjin Medical University Eye Hospital, China. She is doing her research work under Prof. RH Wei.
Laser in situ keratomileusis (LASIK) is the most common way of corneal refractive surgery and corneal expansion is the most common complication after LASIK, while the incidence rate arrived 0.04%-0.060%. For the patients who were suspicious of keratoconus, we can give them cornea cross linking combined with LASIK, which can provide a more safe and effective treatment. Studies show that cornea cross linking combined with LASIK (LASIK-Xtra) can re-strengthen the cornea and increase stability in visual outcomes and increase accuracy of refractive correction. Besides, high myopic LASIK combined with prophylactic higher-fluence CXL intervention seems to induce less postoperative epithelial increase in high myopic cases; this may be an indication of enhanced cornea stability and may reduce the incidence of future myopic regression and the potential for ectasia. We will present our protocol of LASIK-Xtra and review some published clinical data.
Catholic University of Korea, South Korea
Choun-ki Joo is the Professor of Department of Ophthalmology, College of Medicine at Catholic University of Korea. He serves as a Member of the Scientific Advisory Board at EyeGene, Inc., and a Member of Medical Scientific Advisory Board at LinCor Biosciences, Pte. Ltd.
Introduction & Aim: The third-generation formulas require the information of the anterior corneal power (K) or the anterior corneal radius of curvature (R) as measured by keratometry and of the axial length (AL) as measured by biometry. This study aims to evaluate the repeatability of the SS-OCT measurements (Argos, Movu, Inc.) and to compare the AL, anterior chamber depth (ACD) and K measurements with the results obtained with the PCI (IOLMaster, Ziess, Germany).
Methods: The retrospective, cross-sectional study was done between September 2016 and October 2016. In 65 patients with planned cataract surgery, the following were measured using both methods; visual acuity, auto-refraction, manifest-refraction, keratometry (D), AL (mm) and ACD (mm). Each measurement was measured three times; the comparison between the two groups and between 3 measurements in one individual was done.
Results: The mean difference between the two groups was 0.06±0.009 mm in AL (p=0.539), 0.14±0.019 D in Keratometry (p=0.134) and 0.20±0.021 mm in ACD (p=0.121). There was no significant difference between the two groups. The intraclass correlation coefficient of SS-OCT was 1.000 in AL, 0.999 in keratometry and 0.996 in ACD, respectively.
Conclusions: The measurements of SS-OCT ocular biometer (Argos, Movu, Inc.) were not significantly different from those of the PCI device (IOLMaster). Measurements with the SS-OCT biometer were repeatable.