Day 2 :
Keynote Forum
Paul Dougherty
Dougherty Laser Vision, USA
Keynote: Topographically-guided laser-in-situ keratomileusis for myopia using a customized aspheric treatment zone
Time : 09:00-09:35
Biography:
Paul Dougherty, MD is an internationally renowned eye surgeon who has helped pioneer many of today’s most popular vision correction techniques. He serves as Medical Director of Los Angeles-based Dougherty Laser Vision and as Assistant Clinical Instructor of Ophthalmology at UCLA’s Jules Stein Eye Institute. He is also one of just 40 surgeons worldwide to serve on the Editorial Board of the Journal of Refractive Surgery – the official peer-reviewed refractive surgery specialty journal published by the American Academy of Ophthalmology (AAO).
Abstract:
Abstract Purpose: To assess the efficacy, predictability, safety and quality-of-life effects of topography- guided laser in situ keratomileusis (LASIK) for the correction of myopia with astigmatism using the EC-5000 CXII excimer laser equipped with a customized aspheric treatment zone algorithm.
Setting: Ophthalmology clinics in the United States and Mexico.
Methods: In a multicenter United States Food and Drug Administration study of topography- guided LASIK, 4 centers enrolled 135 eyes with a spherical manifest refraction error ranging from -0.50 to -7.00 diopters (D) and astigmatism ranging from 0.50 to 4.00 D. All eyes were targeted for emmetropia. Refractive outcomes, higher-order aberrations (HOAs), and contrast sensitivity were analyzed preoperatively and postoperatively. Patient satisfaction was assessed using 2 questionnaires.
Results: Six months postoperatively, the mean manifest refraction spherical equivalent in all eyes was -0.09 ± 0.31 (SD); of the 131 eyes, 116 (88.55%) had an uncorrected visual acuity of 20/20 or better and 122 (93.13%) had an MRSE within +0.50 D. The best spectacle-corrected visual acuity (BSCVA) increased by 2 or more lines in 21 (16.03%) of 131 eyes; no eye lost 2 lines or more of BSCVA. The total ocular HOA increased by 0.04 mm. Patients reported significantly fewer night driving and glare/halo symptoms postoperatively than preoperatively.
Conclusion: Use of a customized aspheric treatment zone in eyes with myopia and astigmatism was safe, effective and predictable and reduced symptoms associated with night driving, glare and halos.
- Special Session on IOL mono-vision: Pearls, pitfalls and contraindications
Session Introduction
Fuxiang Zhang
Henry Ford Health System, Downriver Optimeyes Supervision Center, MI, USA
Title: IOL mono-vision: Pearls, pitfalls and contraindications
Biography:
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, Ann Arbor from 1994-1997. He has been a senior staff member at the Department of Ophthalmology, Henry Ford Health System since 1999, and currently serves as the medical director, Downriver Optimeyes Supervision Center in Taylor, Michigan. Being a natural monovision, Dr. Zhang’s practice has focused on monovision based refractive cataract surgery for the last 20 years. His Ten-Years Review of IOL Monovision data revealed an excellent outcome with near 97% satisfactory rate and about 80% of complete spectacle independence or back up only. He is frequently invited to speak nationally and internationally about IOL monovision. He has been jointly invited by ASCRS and AAO to be in charge of Breakfast with the Expert roundtable seminar about IOL monovision at the American Academy of Ophthalmology in 2014, 2015, and 2016. His clinic research and numerous publications have focused on clinical comparison of multifocal IOL and mono focal pseudophakic monovision, the pros and cons, pearls and pitfalls of IOL monovision, conventional vs. crossed IOL monovision, the preferred anisometropia level, pre-operative tests and evaluation and clinical consults for prospective candidates, potential concerns and contraindications of IOL monovision.
Abstract:
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?
- Track 4: Intraocular Lenses (IOLs)
Session Introduction
Johnny E Moore
University of Ulster, UK
Title: Optimize quality of vision using asymmetric multi-focal IOLs
Biography:
Johnny E Moore completed a Medical degree from Queens University Belfast, trained in Department of Ophthalmology, Belfast before gaining a fellowship in Flinders hospital SA and then a PhD in Ophthalmology from QUB after a year research fellowship in Harvard Medical School, Boston under the tutelage of Professor Tony Adamis and Professor Dimitri Azar. Currently, he is anterior segment lead in the Royal Victoria Hospital Belfast and also Medical Director in Cathedral Eye Clinic. He specializes in cataract, refractive and anterior segment reconstructive surgery. He is actively involved in clinical refractive IOL research with Professor Tara Moore in the development of genetic tools to manage ocular surface pathologies. He is the co-founder of Ulster University online preparatory course for the RC-Ophth Certificate in Cataract and Laser Refractive Surgery. He has published more than 100 scientific papers.
Abstract:
Routine monitoring of preoperative, operative and postoperative data enables one to determine visual outcomes and assess quality of IOL surgery. Recent advancement in multifocal intraocular lens (MIOL) technology provides an increasing variety of choices to the ophthalmic surgeon and parameters to consider. It is well recognized that patients can experience different subjective responses to MIOLs with a small number of patients being dissatisfied with their quality of vision (QOV). Postoperative objective visual assessment is very important but it lacks insight into a patient’s subjective response to the intervention. Utilization of patient reported outcomes (PROs) is therefore essential to improve our understanding. Both standard (Rasch) and non standard methodologies are utilized to develop and analyze PROs in order to gain the greatest information from these valuable tools. Investigating pre or postoperative factors affecting the postoperative QOV enables the surgeon to stratify patients preoperatively with regards to those who would be more likely to complain postoperatively of substandard QOV. Stratification of patients suitable for MIOLs requires full ophthalmological assessment including refraction, unaided and best-corrected visual acuity, keratometry, topography, biometry, slit-lamp examination, Goldmann tonometry, dilated funduscopy and OCT. OPD-Scan, Topcon Aladdin, ARK-10000, Nidek Co., Ltd. and Adobe Photoshop suite are also used to ascertain aspects such as pupil size, angle kappa, pupil shift, capsulorhexis size and centration. Additionally, the position of asymmetric MIOLs is now recognized to represent an important consideration to optimize patients QOV.
Serena X Wang
UT Southwestern Medical Center at Dallas, USA
Title: Contact lenses in aphakic children
Biography:
Serena Wang joined the UT South-western faculty in November 2006, following a successful private practice in Dallas and Plano for the previous two years. She has trained extensively at UT South-western, completing her ophthalmology internship and residency, as well as her pediatric ophthalmology and corneal and external disease fellowships. She also has a strong research background in pediatric ophthalmology, especially in the treatment of pediatric cataracts. She completed a research fellowship at the Storm Eye Institute, Medical University of South Carolina in 1995. Passionate in her care of pediatric ophthalmic patients, she is known for her caring approach. She specializes in the treatment of pediatric eye diseases with a special focus on pediatric cataracts and adult strabismus. She is currently seeing patients at Children’s Medical Center at Legacy and Children’s Medical Center Dallas.
Abstract:
Introduction: Primary intraocular lens (IOL) implantation in very young children undergoing cataract surgery is still controversial. Contact lens (CL) use is the mainstay treatment of aphakia in this age group. Aim of the study: The purpose of our study is to evaluate the safety and tolerance of CL use in aphakic pediatric patients. Methods: We performed a retrospective chart review of 88 patients≤ 2 years old undergoing cataract extraction without IOL implantation performed between 2009 and 2015 at Children’s Medical of Dallas. Results: Eighty-one patients qualified for the study. All had Silsoft CL placed in the postoperative period. Thirty- eight patients (76 eyes) underwent bilateral surgery while 42 patients had unilateral; 52% female and 48% male. The mean age at surgery was 3.54 mos±4.09mos (range 1-24mos). The time between surgeries in bilateral cases was 5.8 days±5.2 days (range 0-28 days). The mean changes in CL were 7.2± 6.5 (range 1-32). In all, 81 patients used 568 CL within the mean follow up period of 19.4 mos±14.5. The reasons for changes in CL were: lost CL (71.6%), change in power (18.3%), deposits (3.7%), and difficulty managing CL (6.3%). The rate of complications was low 0.08% (conjunctivitis, corneal edema, and corneal ulcer). Discussion: We note that the frequency of change in CL is mainly due to loss of contact lenses followed by change in power. The rate of CL related complication is low. Conclusion: Contact lenses are safe to use in aphakic children; however frequent loss of contact lenses is the most common problem, it may affect the effectiveness of the vision rehabilitation.
Paul Dougherty
UCLA’s Jules Stein Eye Institute, USA
Title: Same-Day Bilateral Sequential IOL Surgery (SBSS)
Biography:
Dr. Paul Dougherty, M.D. is an internationally renowned eye surgeon who has helped pioneer many of today’s most popular vision correction techniques. He serves as medical director of Los Angeles-based Dougherty Laser Vision, and as assistant clinical instructor of ophthalmology at UCLA’s Jules Stein Eye Institute. He is also one of just 40 surgeons worldwide to serve on the editorial board of the Journal of Refractive Surgery – the official peer-reviewed refractive surgery specialty journal published by the American Academy of Ophthalmology (AAO).
Abstract:
This presentation is a summary of a chapter on SBSS and In-Office IOL surgery that I published in Refractive Lens Exchange: A Surgical Treatment of Presbyopia edited by Ming X. Wang MD, PhD. In this talk I will discuss acceptance, barriers, risks, benefits and mechanics of performing SBSS. My personal clinical experience as well as a literature review on SBSS was used to create the presentation. Special attention is given to risks of bilateral endophthalmitis and its prevention with intracameral antibiotics, in-office IOL surgery, as well as inclusion and exclusion criteria for SBSS. Data will be presented from a paper reviewing my personal experience with SBSS presented at the American Academy of Ophthalmology in 2012. At the conclusion of the presentation, the audience will be given data as to the safety and effectiveness of SBSS.
Fuxiang Zhang
Henry Ford Health System, Downriver Optimeyes Supervision Center, MI, USA
Title: Crossed vs. conventional pseudophakic mono-vision: Patient satisfaction, visual function and spectacle independence comparison
Biography:
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, Ann Arbor from 1994-1997. He has been a senior staff member at the Department of Ophthalmology, Henry Ford Health System since 1999, and currently serves as the medical director, Downriver Optimeyes Supervision Center in Taylor, Michigan. Being a natural monovision, Dr. Zhang’s practice has focused on monovision based refractive cataract surgery for the last 20 years. His Ten-Years Review of IOL Monovision data revealed an excellent outcome with near 97% satisfactory rate and about 80% of complete spectacle independence or back up only. He is frequently invited to speak nationally and internationally about IOL monovision. He has been jointly invited by ASCRS and AAO to be in charge of Breakfast with the Expert roundtable seminar about IOL monovision at the American Academy of Ophthalmology in 2014, 2015, and 2016. His clinic research and numerous publications have focused on clinical comparison of multifocal IOL and mono focal pseudophakic monovision, the pros and cons, pearls and pitfalls of IOL monovision, conventional vs. crossed IOL monovision, the preferred anisometropia level, pre-operative tests and evaluation and clinical consults for prospective candidates, potential concerns and contraindications of IOL monovision.
Abstract:
Introduction & Background: Crossed pseudophakic mono-vision appears to work as well as conventional pseudophakic mono-vision in terms of patient satisfaction, visual function and spectacle independence as long as anisometropia at mild 1.0 to 1.25 D level and potential contraindications were avoided. Crossed pseudophakic mono-vision has not been studied much in literature. Purpose: To compare crossed vs. conventional pseudophakic mono-vision. Methods: 7,311 cataract surgery records from 6/1999 to 12/2013 were reviewed. 40 crossed monovision were identified and 30 of them were enrolled. Thirty control conventional monovision cases were matched with very detailed items. Results: No significant difference was identified for eye-hand, eye-foot coordination, sport related depth perception between the two groups. No significant difference was identified for 6 of 8 spectacle independence measures but nighttime driving and intermediate distance were more favorable in the crossed monovision group. Patient satisfaction was also better in crossed group (p=0.028) Conclusion: Crossed IOL monovision appears to work as well as conventional IOL monovision with mild anisometropia at 1.0 to 1.25 D level. This study has been published at Journal of Cataract & Refractive Surgery, September 2015;41:1845-1854.
R K Bansal
Associate Professor, Department of Ophthalmology, GMCH-32, Chandigarh, India
Title: Comparative evaluation of 3 different toric intraocular lenses for efficacy and rotational stability: A prospective study
Biography:
Dr. RK Bansal is a Consultant ophthalmologist and Incharge of Pediatric Ophthalmology Service Dept. of Ophthalmology, Government medical college and Hospital, Chandigarh, India. He does have articles publication with his name in various field of ophthalmology. He completed his MBBS from Government Medical College, Faridkot, India. He has a surgical experience of Phacoemulsification and Intra-ocular lens Implantation, Laser Applications and Oculo-Plastic Surgery. He is a recipient of many awards and grants for his valuable contributions and discoveries in major area of research.
Abstract:
Introduction: This prospective study was done to study the rotational stability and efficacy of 3 different toric IOLs to correct corneal astigmatism during phacoemulsification. Materials & Methods: Patients having astigmatism from 1-5 dioptres (D) were enrolled for toric IOL implantation. Toric IOL power was calculated as per toric calculator available online. Calculated power was implanted with axis of the toric IOL as calculated. Residual refractive error and IOL axis was assessed at 1, 4 weeks and 3 months. Results: A total of 52 patients were included in the study. Twenty two patients were implanted with AMO toric IOL, 20 with Alcon toric IOL and 15 with Zeiss toric IOL. Preoperative cylinder ranges from 1-5D in all the three groups. Toric IOL was within 5 degree of its axis in 19 patients in AMO group, 19 in Alcon group and all 15 in Zeiss group. Average refractive cylinder was 0.37D, 42D and 0.31D respectively (p>0.05). Conclusions: Zeiss toric IOL showed better stability among three toric IOLs.
Iva Dekaris
University Eye Hospital ‘Svjetlost’, Croatia
Title: Refractive lens exchange with implantation of premium intraocular lenses
Biography:
Iva Dekaris is a Professor of Ophthalmology at Universities of Zagreb and Rijeka (Croatia), and Associate-member of the Department of Medical Sciences of the Croatian Academy of Sciences and Arts. She works as Medical Director at University Eye Hospital “Svjetlost†in Zagreb. Dr. Dekaris completed Postdoctoral Research Fellowship at Harvard Medical School and the Schepens Eye Research Institute in Boston. She was twice awarded with the highest Croatian State Reward for Achievements in Science (1999 and 2013). She is an immediate past president of the European Eye Bank Association (2010-2013).The areas of her expertise are corneal transplantation, cataract and refractive surgery. She has an overall experience of over 20,000 surgeries mainly PHACO, corneal transplantations, refractive lens exchange, phakic IOLs, amniotic membrane and stem-cell transplantations. She published 48 papers in CC Journals (citations: 393 Scopus), presented numerous invited talks all over the world, and co-authored 4 books.
Abstract:
Introduction: “Premium" intraocular lenses have advanced features beyond those found in basic mono-focal intraocular lenses (IOLs). Multifocal IOLs (m-IOLs), for example, are presbyopia-correcting lenses enabling almost spectacle-free life after conventional cataract surgery, or in case of refractive lens exchange (RLE). Currently, there is a whole spectrum of mIOLs on the market out of which bifocal IOLs correct only distance and near vision, while trifocal and extended range of vision IOLs provide also good intermediate vision. With invention of toric mIOLs, full visual correction may be obtained even in patients with pre-existing astigmatism. Our results with the implantation of different types of premium IOLs are presented. Subjects & Methods: In a period 2005-2015, at our Hospital over 3000 eyes had RLE with m-IOL implantation (Restor +4, Restor +3, Tecnis ZM900&ZMA00&ZMB00, Re-Zoom, Acry-Lisa & ATLISA 809MP, Tecnis Symfony and Trifocal ED). In last two years mostly trifocal and Symphony lenses were used, with the results presented in this study. Trifocal IOL: Ninety five patients (204 eyes) underwent bilateral trifocal IOL implantation (ATLISA tri839MP, Zeiss, Germany) after RLE. Patients were presbyopes; 95 hypermetropes and 7 myopes, aged 46 to 68 years. Twenty 20 eyes with hyperopic or myopic astigmatism received trifocal toric IOL (ATLISA tri-toric 939MP, Zeiss, Germany). Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm, uncorrected near visual acuity (UNVA), uncorrected distance visual acuity under 10% contrast level, visual disturbances and subjective satisfaction were measured and compared to Bifocal group (AT LISA 809MP; 42 patients, 84 eyes). Follow up was at least 6 months, up to three years. Symfony IOL: Forty six patients (92 eyes) were followed after RLE with bilateral implantation of the Tecnis Symfony IOL. Emmetropia was targeted in dominant eye, and mild myopia of up to -0.50 D in non-dominant eye. UDVA, UIVA at 66 cm, UNVA, spectacle independence, patient satisfaction and visual disturbances were measured. Follow up was at least 3 months. Results: Trifocal IOL: All patients achieved monocular UDVA better than 0.1 log-MAR, (76.9% of eyes 0.0 log-MAR). Monocular UIVA better than 0.2 log-MAR was achieved in 96.1% of patients. All patients could read J2 and better; 72.1% of patients could read J1. UDVA at 10% contrast level was 0.0 log-MAR in 62.5% of patients. Halo and glare were reported in 9.6% and 7.3% of cases, respectively. 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. Symfony IOL: Binocular UDVA of 0.02 log-MAR or better was achieved in 95% of patients. Mean binocular UIVA at 66 cm was 0.01 log-MAR and UNVA at patient’s preferred distance was 0.01 log-MAR (J1-J2). Night driving visual disturbances was reported in 6 out of 46 patients (13%), only 2% of patients reported halos. Conclusions: Refractive lens exchange with implantation of trifocal or Symfony IOL enables good vision at all distances and almost completes spectacle independence. It is an excellent choice for younger, active presbyopes in need of good intermediate vision. Meticulous preoperative counseling is of outmost importance to choose proper mIOL for each patient.
Biography:
Sajjad Ahmad is a consultant ophthalmologist with an interest in cornea, cataract and external eye disease. He is based in St Paul’s Eye Unit at the Royal Liverpool University Hospital (UK) and the Department of Eye and Vision Science at the University of Liverpool. He has a particular clinical interest in ocular surface and anterior segment reconstruction. His laboratory research is translational in nature and relates to corneal stem cells.
Abstract:
As an ophthalmologist with an interest in anterior segment reconstruction, I often get referred patients with no capsular support for sulcus or capsular bag intraocular lens insertion. Some of these patients also have no or little iris for iris clipped lenses. Scleral suturing of intraocular lenses is often an effective means of managing such patients, often with corneal grafting at the same time. In this presentation, I will describe the methods for scleral suturing and potential pitfalls and complications.
Peirong Lu
The First Affiliated Hospital of Soochow University, China
Title: Secondary multifocal intraocular lens implantation in patient with white cataract
Biography:
Peirong Lu received his PhD degree from Kanazawa University at 2004. He did his Post-doctoral training at Soochow University. Currently, he is the Professor and Director of Department of Ophthalmology, the First Affiliated Hospital of Soochow University. His research focuses on ocular neovascularization and cataract and is well funded. He has published more than 20 papers including Invest Ophthalmol & Vis Sci, Journal of Immunology, Cornea, and Molecular Vision and American Journal of Pathology.
Abstract:
White cataract occupies certain proportion in cataract patients in developing country. Most of the white cataracts have to give up the refractive IOL implantation because of the limited accuracy of the axis length and IOL power measurement. However, the white cataract patients also have the right to choice refractive IOL and obtain satisfied uncorrected distance and near visual acuity and spectacle independence after cataract surgery if we can detect the axis length precisely. To evaluate the outcomes of secondary multifocal intraocular lens (IOL) implantation in white cataract eyes, white cataract patients accepted secondary multifocal IOL implantation between June 2014 and January 2015 were retrospective reviewed. Ocular biometric parameters, surgical and visual outcomes were analyzed. Compared to conventional primary IOLs implantation, for the optimal white cataract patient, the white cataract were firstly extracted, following the optical biometry being precisely measured and also it is easy to identify whether the patient has adequate visual function, then the multifocal intraocular lens was secondary implanted. A total of five appropriate white cataract patients were enrolled in the secondary multifocal IOL implantation and were retrospective reviewed. The novel management strategy of secondary multifocal IOLs implantation were successful and without obvious adverse events. All the patients were achieved satisfied near and distance visual acuity and spectacle freedom. The outcomes suggest our novel management strategy is a safe and effective option for white cataract undergoing cataract surgery.
Fayyaz Musa
Cathedral and Huddersfield NHS Foundation Trust, UK
Title: Safety and efficacy of the Zeiss trifocal and trifocal toric IOL
Biography:
Fayyaz Musa is a consultant Ophthalmologist at Calderdale & Huddersfield NHS Foundation Trust. He is a fellow of the Royal College of Ophthalmologists, Member of the American Academy of Ophthalmology, North of England Ophthalmological Society, European Society of Cataract and Refractive Surgeons and a member of the United Kingdom and Ireland Society of Cataract and Refractive Surgeons. His specialties are cataract surgery, corneal and external eye disease, glaucoma treatment and refractive surgery.
Abstract:
Aim: To evaluate the safety and efficacy of the Zeiss trifocal and trifocal Toric IOL. Method: Retrospective evaluation including UCNVA, UCIVA, UCDVA and degree of spectacle independence following bilateral/unilateral implantation. Results: More 95% of patients were spectacle independent for commonly performed tasks. Conclusion: Selective implantation of the Zeiss trifocal and trifocal Toric IOL results in a high degree of patient satisfaction
Naren Shetty
Narayana Nethralaya Foundation, India
Title: Screening corneal epithelial gene expression patterns for predicting post-PRK (Photorefractive keratectomy) corneal haze
Biography:
Naren Shetty is currently the Head of the Department of Cataract and Refractive Lens Services and the Vice Chairman of Narayana Nethralaya, Bangalore. He completed his basic medical education at S.D.M.M.C.H, Dharwad, Residency from Ramaiah Medical College and Hospital, Bangalore and MS Ophthalmology at R.R.M.C.H, Bangalore. He has undertaken cataract and refractive training at Narayana Nethralaya, Bangalore. He has worked under cataract and refractive surgeons of Moran eye Center, USA and S.N.E.C, Singapore. He is an experienced cataract and refractive surgeon with special skills in LASIK, SMILE, phakic IOL and premium IOL implants. He has presented papers in national and international conferences. He has won the Best Postgraduate Scientific Paper in the state conference KOS (Karnataka Ophthalmic Society). He has won the Travel Grand Award in the international conference ARVO (The Association for Research in Vision and Ophthalmology) 2015 for paper presentation.
Abstract:
Purpose: Post surgical corneal haze has been previously studied, but pre-surgical predisposing factors towards corneal haze remains unknown. This study aims at analyzing gene expression in corneal epithelium collected during primary surgery of patients who developed corneal haze following PRK by microarray analysis and validating them by real-time PCR. Methods: Corneal epithelium was collected intra-operative in patients undergoing PRK. Epithelium of 4 eyes of 2 patients who developed haze postoperatively and that of 6 eyes of 3 age matched control patients who did not develop haze were analyzed. Mean age of cases and controls was 26 and 28 years respectively. Mean spherical equivalent of cases and controls was -3.37D &- 2.38D respectively. Gene expression microarrays were performed for the mRNA samples followed by bioinformatics analysis of underlying molecular pathways. Validation of deregulated genes was performed using quantitative real-time PCR for inflammatory markers, corneal structure genes, fibrosis associated genes and regulators of signaling cascade. Results: Bio-informatic analysis revealed 1100 up regulated and 1700 down regulated genes in the post PRK haze group. Patients who developed haze demonstrated up-regulation of ECM (extracellular matrix) regulatory pathways (collagen, Laminin, ITGA1, etc), inflammatory cytokines (IL11, IL6, etc) and oxidative stress (PREX1 etc). Wnt signaling pathway (JUN, SOX17, etc) responsible for cellular proliferation and CXC motif containing chemokines (CXCL10, CXCL1, etc) were found to be down-regulated on microarray analysis. Indian Hedgehog (IHH) signaling independent of Wnt and PI3 kinases may have a role in corneal haze. Validation of the microarray results by real-time PCR analysis showed that inflammatory cytokines like IL6 and TNFα were up-regulated. Regulators of signaling cascades EGFR and Wnt3a were reduced in haze patients. The mechanism of action of these factors is being investigated. Conclusions: Our study identifies some novel corneal biomarkers that may help in screening patients prone to develop corneal haze prior to surgery. This would help in better surgical planning and in the future, targeting and preventing the process of corneal haze.
Joobin Khadamy
Iran University of Medical Sciences, Iran
Title: Visual, keratometric and corneal biomechanical changes after intacs SK implantation for moderate to severe keratoconus
Biography:
Joobin Khadamy has completed his MD from Tehran University of Medical Science. He has finished his ophthalmology specialty. He is ophthalmologist researcher at Eye research Center, Rassoul Akram Hospital, Iran University of Medical Sciences. He has published 4 papers in reputed journals and has been serving as a reviewer for well known journals.
Abstract:
Aim: Current study is designed to report visual outcomes and corneal biomechanical changes after Intacs SK implantation in keratoconic eyes. Methods: In a prospective interventional case-series comprised 32 keratoconic eyes of 25 patients (mean age: 24 years) with a clear central cornea and contact lens intolerance. Intacs SK was implanted using a Technolas femto-second laser platform. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, manifest refraction spherical equivalent (MRSE), keratometry, central corneal thickness (CCT), corneal hysteresis (CH) and corneal resistance factor (CRF) were measured preoperatively and at 1, 3 and 6 months post-operatively. Results: The mean UDVA improved from 0.81±0.3 logMAR preoperatively to 0.53±0.2 logMAR at 6 months (P<.001). At 6 months, MRSE was better significantly only in eyes with moderate KCN (mean change=+2.61±0.54 diopter [D]; P<.001). A significant improvement in sphere (mean change= +1.92±0.37 D; P<.001) and mean keratometry reading (mean change= -3.34±0.47; P<.001) was observed. Mean CCT increased from 446.1±38μm preoperatively to 462.2±50μm at 6 months (P<.001). CRF decreased from 6.5±1.6 mmHg to 5.9±1.1 mmHg at 6 months (P=.02). CDVA, cylinder and CH did not change significantly (P=.48, .203 and .55 respectively). 19 eyes (60%) gained ≥2 lines of UDVA while 5 eyes (16%) lost ≥2 lines of UDVA. Conclusion: Generally, visual, refractive and keratometric indices improved remarkably in a parallel fashion. CRF was inversely correlated with CCT. Fluctuations in corneal hydration might explain trends of changes in biomechanical parameters and CCT during the early postoperative months.
Shiming Wang
Aier Eye Hospital Group, China
Title: The changes of posterior corneal curvature measured by Sirius topography in post Femto second LASIK patients
Biography:
Shiming Wang has completed his MD at the age of 26 years from Wenzhou Medical University. Dr Wang is work in Aier Eye Hospital Group. He is an specialist in Cataract & Refraction, and has completed more than 5000 cases of surgery. He has published more than 10 papers in reputed journals. He has been invited to speak at the International Conference on several times as invited experts.
Abstract:
Purpose: To investigated changes of posterior corneal curvature (ΔK) in post Femto-second LASIK patients using Sirius topography, and to analyze its relationship with ablation percentage, ablantion depth, residual bed thickness and equivalent power. Setting: Ningbo Aier Guangming Eye Hospital and a private practice, Ningbo, China. Methods: Seventy-three post Femto-second LASIK patients (146 eyes; aged19~41 years, mean 23.7±5.1 years; equivalent power , -9.00~-3.00 D, mean-5.21±1.07D) were recruited in this study. The posterior corneal curvature was measured by Sirius topography pre-operatively and at one month post-surgery. The correlation between ΔK and ablation percentage, ablantion depth, residual bed thickness and equivalent power were analyzed. Results: The posterior corneal curvature increased from (-5.89±0.74D) pre-operatively to (-7.01± 0.81D) at 1 month post-surgery. The ΔK was positively correlated with ablation percentage (r=0.213, P<0.05）and ablantion depth (r=0.197, P<0.05). The ΔK was negatively correlated with equivalent power (r=-0.246, P<0.05) and residual bed thickness (r=-0.329, P<0.05. Conclusions: The ΔK is related to ablation percentage, ablantion depth, equivalent power and residual bed thickness. Financial Disclosure: None of the authors has financial interest concerning this study.
- Track 9: Refractive Surgery
Track 14: Ophthalmology Community
Track 15: Ophthalmology Practise
Session Introduction
Michael O’Keefe
Mater Private Hospital, Republic of Ireland
Title: Phakic intra-ocular lenses in refractive surgery
Biography:
Michael O’Keefe is a Consultant Ophthalmic Surgeon at the Children’s University Hospital and the Mater Misercordiae Hospital Dublin. He is the Newman Clinical Professor of Pediatric Ophthalmology at University College Dublin. His special interests include congenital cataract, ROP and Refractive Surgery. He is a book and chapter editor and has published over one hundred and fifty peer review papers. He was awarded the Claud Worth Medal for his contribution to Pediatric Ophthalmology in 2004 by the British Child Health Foundation. In 2008 he was awarded the Eustace Medal for his research and contribution to Ophthalmology.
Abstract:
Phakic intra ocular lenses are increasingly used in Refractive surgery particularly in patients with more than -8 dioptres of myopia. They give excellent quality vision and are reversible. Long-term issues such as endothelial cell count and cataract are cited as areas of concern. However, there is increasing long term data available as to their safety and effectiveness. Newer designs have become available which improve their quality. Phakic IOL’s offers an alternative to Laser Refractive Surgery in patients with high myopia. We discuss our long term findings with Artisan, Artiflex and Collamer implants.
Brandon Rodriguez
St. Luke’s Cataract & Laser Institute, USA
Title: Utilization of amniotic membrane grafting for the optimization of the ocular surface prior to refractive cataract surgery
Biography:
Brandon Rodriguez, MD, is a board certified, fellowship trained cornea surgeon, specializing in advanced refractive cataract surgery and dry eye techniques. His surgical experience and cutting-edge treatments for dry eye syndrome have resulted in him serving on numerous medical advisory board and speaker bureaus for pharmaceutical companies. He is published and a frequent speaker at meetings on cataract surgery and advanced treatment options for dry eye syndrome. During this time, he has also been graced with numerous awards including Who’s Who among Healthcare Professionals & Executives in America, the Mellinger Medical Award and the Hy Berman Memorial Award in Ophthalmology
Abstract:
The single largest generation and most affluent demographic in America, the “Baby Boomers” (Americans born between 1946 to 1964), will age into the need for refractive cataract surgery at a patient volume never experienced before. These are the same patients that have numerous ocular co-morbidities, such as dry eye syndrome. These demanding patients will want immediate gratification, not only visually, but symptomatically. Amniotic membrane grafts (AMG) have shown in a non-comparative study that up to 95% of individuals have complete resolution of their dry eye surface related changes within 5-7 days vs. almost 300 days on medical treatment alone. More recently, the same group, in a multi-center study has shown a change in the axis of astigmatism, after treatment with AMG, of up to 20 degrees. Post-operatively that would translate into a 60% reduction in the power of the intraocular lens and a significantly unhappy patient. The purpose of this discussion is to show data supporting the use of AMG for the optimization of the ocular surface for the demanding refractive cataract surgery and dry eye patient.
Brandon Rodriguez
St. Luke’s Cataract & Laser Institute, USA
Title: Utilization of amniotic membrane grafting for the optimization of the ocular surface prior to refractive cataract surgery
Biography:
Brandon Rodriguez, MD, is a board certified, fellowship trained cornea surgeon, specializing in advanced refractive cataract surgery and dry eye techniques. His surgical experience and cutting-edge treatments for dry eye syndrome have resulted in him serving on numerous medical advisory board and speaker bureaus for pharmaceutical companies. He is published and a frequent speaker at meetings on cataract surgery and advanced treatment options for dry eye syndrome. During this time, he has also been graced with numerous awards including Who’s Who among Healthcare Professionals & Executives in America, the Mellinger Medical Award and the Hy Berman Memorial Award in Ophthalmology.
Abstract:
The single largest generation and most affluent demographic in America, the “Baby Boomers†(Americans born between 1946 to 1964), will age into the need for refractive cataract surgery at a patient volume never experienced before. These are the same patients that have numerous ocular co-morbidities, such as dry eye syndrome. These demanding patients will want immediate gratification, not only visually, but symptomatically. Amniotic membrane grafts (AMG) have shown in a non-comparative study that up to 95% of individuals have complete resolution of their dry eye surface related changes within 5-7 days vs. almost 300 days on medical treatment alone. More recently, the same group, in a multi-center study has shown a change in the axis of astigmatism, after treatment with AMG, of up to 20 degrees. Post-operatively that would translate into a 60% reduction in the power of the intraocular lens and a significantly unhappy patient. The purpose of this discussion is to show data supporting the use of AMG for the optimization of the ocular surface for the demanding refractive cataract surgery and dry eye patient.
Christine de Weger
Donders Institute-Radboud University Nijmegen, the Netherlands
Title: Bifocals in Down: A study on the effect of bifocals in children with Down syndrome
Biography:
Christine de Weger is orthoptist and clinical epidemiologist. After many years of orthoptics in different hospitals and contributions to quality policy she completed her Master in Clinical Epidemiology in 2008. In 2010 she published on the subject of “Termination of Amblyopia Treatment” and was co-author of the “Dutch Update of the Multidisciplinary Clinical Practice Guideline for Children with Down syndrome” (2011). Since 2009 she has been working at Bartiméus, an institute for the visually impaired and since 2014 also as a researcher at Donders Institute of the Radboud University Nijmegen, The Netherlands.
Abstract:
Near vision is reduced in most children with Down Syndrome (DS). This is an additional barrier achieving their maximum potential in development. DS is one of the most common genetic anomalies, occurring in about 14.6 in 10000 live births in the Netherlands in 2007. In the last two decades many researches has been performed to study the differences in ocular findings between children with and without DS. Some previous smaller studies by J.M. Woodhouse et al (Cardiff UK 2001-2009) and K Nanda Kumar and S.J. Leat (Toronto Canada 2009-2010) showed that bifocal correction could be a tailor-made treatment for children with DS. Therefore we started a study in children with DS in the Netherlands. Bifocals are rarely prescribed. Usually children with DS receive single vision glasses for distance. By means of our multicentre randomized controlled trail (RCT) we aim to establish whom to prescribe bifocals and to identify possible prognostic determinants (at start, baseline measurement before therapy with bifocals) for improvement of visual acuity at near. A multicentre randomized controlled trail (RCT) in 15 participating locations in the Netherlands. In order to be able to show differences between the effect of usual care and the new intervention, the bifocals, we included 110 children, 2-18 years old, with DS and accommodation deficit, who had not worn bifocals before. Bifocals were prescribed for children (n=55) in the intervention group and single vision glasses for distance were prescribed in the control group (n=55). We study the effect of these two interventions on visual acuity at near and at distance, on accommodation and occurrence of strabismus and task readiness (monitoring executive functions). Inclusion time started June 2015 and was completed March 2016. Baseline measurements such as refractive errors, near visual acuity, distance visual acuity and accommodation deficit will be presented.
A K Chandrakar
Pt. JN Medical College, India
Title: Evaluation of learning curve of ophthalmology residents when performing cataract surgery at tertiary care centre
Biography:
A K Chandraker completed his Graduation in medicine in 1979 and Post-graduation in Ophthalmology in 1983. He has completed fellowship in oculoplasty and strabismology from Sitapur Eye Institute in 1983. He has completed another fellowship in Phacoemulsification from LVPEI, Hyderabad in 1996 and medical retina fellowship from AIIMS, Delhi in 2002. He has teaching experience of more then 25 years and being a Professor, he has guided about 50 theses, 45 desertions, more then 300 papers and 15 research projects. His area of interest is Cataract, Oculoplasty and squint, Medical retina, diabeticretinopathy & paediatric ocular diseases.
Abstract:
Aim & Objectives: The aim of this study is to analyze the complications and problems faced during learning curve of ophthalmology residents when performing cataract surgery. Material & Methods: Hospital based-Prospective study was done at tertiary care centre and it includes all Residents. The duration of study period is 22 months. In this study, there are four proforma, Proforma- 1 is related to bio-data, history taking and general & local examination of the patient, proforma- 2 is related to Surgical Competency Assessment of Extra-capsular Cataract Extraction (ICO-OSCAR:ECCE, scoring system) which is filled by evaluator at the end of surgery, proforma- 3 is related to problem faced during cataract surgery and proforma- 4 is related to complications of cataract surgery. Results: In this study total 173 cases of cataract surgery done by 14 Residents included. Cataract surgery done by Residents were observed and score was given by evaluator according to ICOOSCAR:ECCE scoring and learning curve was prepared. Our study shows that only 4 residents encountered posterior capsule tear and vitreous loss in beginning surgeries and improved later. The common problem and complications faced by all residents were more in number in initial 50% cases, which was reduced in next 50% cases. Conclusion: It can be concluded that during residency the residents must have more exposure of surgery for their training so that they confidently perform individual surgery after completion of residency. At last for best residency training a customised and closely monitored program for residents is required.
Biography:
Norah Ahmed Musallama is a fifth year medical student of a five-year program at King Saud University (KSU) School of Medicine, Riyadh, Saudi Arabia. She’s a member in Ophthalmology Interest Group at KSU.
Abstract:
Purpose: To evaluate the changes of intraocular pressure (IOP) in non-glaucomatous eyes following phaco-emulsification among patient groups with different axial lengths (AL). Method: Within a retrospective study design, medical records of cataract patients operated on between 2000 and 2010 at the Department of Ophthalmology, King Abdul-Aziz University Hospital (KAUH), Riyadh, Saudi Arabia were reviewed. Cases were identified as having an ocular AL >24 mm, <22mm and a normal group of AL range; 22-24 mm. The relationship between IOP changes and AL was evaluated for all patients fulfilling the inclusion criteria. Results: Among the reviewers at KAUH, 507 eyes of 229 cataract patients were included in our study. The mean age was 61.8±10.5. Males slightly exceeded females with similar OD to OS ratio. Of all study group the average IOP baseline was 14.5 mmHg, which significantly decreased to 13.8 mmHg following phaco-emulsification (p<0.001). Moreover, a significant reduction was noticed among normal AL group (22-24 mm), the IOP reduced from preoperative value of 14.4 to 13.6, (p=0.001). Furthermore, eyes with longer AL >24 mm showed a significant reduction (p=0.003). However, among the shorter AL group (<22 mm), postoperative IOP was significantly raised from preoperative value of 13.7 to 14.4, (p=0.230). Univariate analysis, high preoperative IOP >21mmHg (p=0.006) and long AL (p=0.021) were significantly associated with higher IOP reduction. Conclusion: The reduction in IOP following phaco-emulsification positively correlates to higher preoperative IOP. The axial length was significantly associated with postoperative IOP changes, where normal and longer AL groups showed a major reduction in postoperative IOP. However, the study found that shorter AL group had a significant raise in postoperative IOP.