Global Ophthalmology and Glaucoma Conference October 13-15, 2016 Kuala Lumpur, Malaysia

Prashant S Agnihotri was a Lecturer at Govt Medical College 1980 till 1985. He has worked at the Retina Care Hospital since 1985. He was a Visiting professor and the Head of the Department of Ophthalmology at the Siddhartha Institute of Medical Sciences, Vijayawada, India.

BRVO is a common retinal condition affecting working population and their performance. Its sudden occurrence and protracted course results in unforeseen hardship. Anti-VEGF has revolutionized the management to a large extent. Various studies have proven its efficacy to improve the retinal circulation by clearing the hge early. In our experience over last few years we have been injecting intravitreal soon after diagnosing and ruling out the contraindication for its use. The results shall be presented with serial optical coherence tomography (OCT) and rational for early use shall be discussed.

Kavitha M is a highly qualified and experienced OculoplastyOnco Orbit Aesthetic and Reconstructive Surgeon. After passing various degree courses available in ophthalmology including DO and DNB in ophthalmology in Dec 2005, B M C, she had passed DNB in her first attempt. She joined has Phaco Surgeon at Dahod for 2 years and atVasan has phaco surgeon for another 3 years along with oculoplasty. She worked has phaco trainee at TVPEI, Gujarat for post graduate and others and has trained many under her. She officially joined fellowship in oculoplasty at TVPEI, Gujarat (15 months course), and later continued as consultant in the same institute. A prolific speaker and academician, working in a post graduate institute has experience in all lid surgeries and lacrimal surgeries orbit and onco. Oncology is her passion. Her skills

in aesthetic and reconstructive surgeries speak a ton about her.

Purpose: The purpose of the study is know whether we can get away with membranatomy at NLD junction and avoid probing for nasolacrimal duct obstruction.

 

Methods: A prospective interventional study of patients with congenital nasolacrimal duct obstruction (NLDO), who underwent intervention from June 2012 to June 2015, were included. Firstly, punctal anatomy was noted and sac syringing was performed, if patent, functional epiphora was concluded. If not, inferior turbinate was elevated with periosteal elevator, under the nasal endoscopy guidance, if sac patent, diagnosis of turbinate impaction done. After turbinate elevation, if membrane at NLD junction is seen, membranatomy performed with a sickle knife. If sac patent is seen no probing done. With probe, if observed passing submucosally, it was redirected until the entrance at the NLD junction. If probe not seen at NLD junction, bony obstruction or complex NLD block was diagnosed and endonasal DCR was planned at the same time or later depending on the age of the patient.

 

Results: A total of 150 interventions on 139 children were performed for the study. The mean age at presentation was 36.38 months (SSD - 25.90). Female-Male ratio: 71:68. Bilateral in 11. Right and left eye ratio: 74:76. Out of 150 cases, 124 had membrane (82.6%) and underwent membranatomy. The success rate was defined as disappearance of watering and discharge by the end of 1 year. In our study we achieved a 100% success rate without any complications and false passages. Out of the remaining 26 cases without membrane 1 patient had punctal atresia. 2 patients had canalicular obstruction, in 3 patients the probe passed sub-mucosally and was redirected into NLD. 16 underwent endonasal DCR at the same time. 4 patients were left for a follow-up and explained the possible necessity of doing endonasal DCR in the future.

 

Conclusion: Membrane at valve of hasner the most common cause of obstruction in congenital NLD obstruction and membranatomy alone will suffice to opening with a high success rate. Probing can be avoided in majority of patients.

Tanwir Ahmed Khan has completed his MBBS and DO in Ophthalmology in the year 2004 and 2007, respectively from JNMCH and Institute of Ophthalmology, Aligarh Muslim University, Aligarh. He is the Chief Medical Officer of Akhand Jyoti Eye Hospital, Bihar, India. He has a surgical experience of over 40,000 surgeries. He has organized various CME and scientific seminars in the hospital.

Background: There is no recent evidence on the prevalence of diabetes mellitus and diabetic retinopathy from rural Bihar.

 

Aim: To determine the prevalence of diabetes mellitus (DM) and DR in rural population of Bihar aged >50 years. Materials & Methods: We conducted a population-based study using validated rapid assessment of avoidable blindness (RAAB-6) in 57 clusters in Siwan district, Bihar, India from January to March 2016. The Scottish grading system was used to grade the diabetic retinopathy.

 

Results: Among examined 3189 individuals (92% response rate) 134 persons reported with known diabetic history and 67 were newly diagnosed with RBS >200 mg/dl. Overall prevalence of known and newly diagnosed diabetes was 6.3% (95% CI, 5.4%-7.2%) persons. Prevalence of any retinopathy, maculopathy and sight threatening DR was 15%, 12.4% and 6%, respectively.

 

Conclusion: Study shows the lack of awareness and underutilization of eye care services by the diabetic community at present, suggesting a focused community programs to reduce visual impairment caused due to diabetic retinopathy.

Chandni Chakraborty has completed MBBS and MS (passed in 2005). She is trained in Pediatric Ophthalmology & Adult Strabismus at Aravind Eye Hospital, Madurai, India, and is a Senior Consultant in Pediatric Ophthalmology and Strabismus. She is incharge of VMA Institute of Ophthalmic Training conducting 18 clinical and 7 non clinical courses for Ophthalmologists and MLOP since 2010. She has 7 years of experience in Pediatric Ophthalmology and attended several national & 3 international conferences (namely AAPOS SNEC Joint Meeting 2013, Singapore AAPOS – JAPO - JASA Joint Meeting in Kyoto, 2014 and the 12th Meeting of the ISA, Kyoto, 2014). She also attended Eyexcel (2012 and 2015), a workshop on Ophthalmic Training as participant and faculty respectively.

In the present day rapidly growing ophthalmic science, the need for skilled ophthalmic personnel is increasing exponentially which in turn is proportionately causing an increasing demand for ophthalmic training for Ophthalmologists as well as MLOP that is mid level ophthalmic technicians specially optometrists, management and other non clinical staffs. This instruction course deals with the scientific and systematic approach to Ophthalmic training programme starting from need assessment, curriculum development, evaluation, administration, marketing and sustainability. This speech is meant to help those who are planning to start their own training centre for ophthalmology, and also to help those who already have their own training Institute and want to improve or expand their activities.

Rajender Singh Chauhan completed his MS in Ophthalmology in 1990 from Medical College Rohtak. He joined PGI of Medical Sciences, Rohtak in 1993 and continued as Consultant till date. He has undergone training in LVPEI Hyderabad, Dr. R P Centre, AIIMS, New Delhi and Dudlay Hospital Birmingham, UK. He had been actively involved in teaching in PGIMS Rohtak and Oman Medical College. He is Postgraduate teacher since 1998 and guided many MS student and DNB students. He has attended many international and national conferences and had chaired many sessions and conducted instruction courses in SICS. He has plenty of publications and presentations to his credit. He is presentably working as Professor in Regional Institute of Ophthalmology in PGIMS Rohtak.

Tonometry is the method of measuring intraocular pressure. Tonometry can be performed with or without anesthesia in sitting or lying down position. The technique of recording IOP can vary from digital palpation of globe to use of complex pressure recording devices. These devices are based on applanation, (Goldmann, Perkins, pneumatic, air pufftonometry, tonopen), indentation (Schiotz, Electronic indentation tonometers), or dynamic contour tonometry (not dependent on corneal thickness). Goldman applanation tonometer is the “gold standard” that measures the force required to flatten (applanate) the constant area of cornea with a sensor. The airpuff noncontact tonometer, which generally requires no anesthetic drop, is widely used in for screening. Schiotz tonometer measures the depth of corneal indentation by a small plunger carrying a known weight but varies with rigidity. Patient self-testing devices are in their infancy. Glaucoma is now considered optic neuropathy, but it does not undermi ne the importance IOP recording, as IOP remains the only significantly modifiable risk factor in the treatment of glaucoma at present. In the workshop, practical tips of accurate use of applanation tonometer will be demonstrated.

Sumit Sachdeva is Associate Professor working in the Regional Institute of Ophthalmology PGIMS, Rohtak, Haryana India. He has keen interest in Glaucoma Diagnosis & Management and is a faculty of Glaucoma unit in the same institute. He has contributed many chapters and articles in national and international journals and books.

Optic Nerve Head evaluation is integral part of Glaucoma diagnosis and management. The evaluation of ONH involves estimating the size of the disc, looking at the neuroretinal rim, looking for peripapillary changes, evaluating the retinal nerve fiber layer as seen on ophthalmoscopy and also recording or drawing the image of the disc for future reference. This evaluation not only requires proper knowledge but also a keen eye to detect subtle changes which if missed can be devastating for the patients. In this workshop, we will be dealing in basics of optic nerve head evaluation with the help of illustrations and pictures. We will go through the proper protocol and the steps required for proper disc evaluation. We will teach how to correlate the disc changes with field defects on perimetry. We will also deal with the tools and equipment required for such evaluation. After this course the student should be able to observe the optic disc in a more objective manner so as to detect the finer changes at an early stage.

Rajender Singh Chauhan completed his MS in Ophthalmology in 1990 from Medical College Rohtak. He joined PGI of Medical Sciences, Rohtak in 1993 and continued as Consultant till date. He has undergone training in LVPEI Hyderabad, Dr. R P Centre, AIIMS, New Delhi and Dudlay Hospital Birmingham, UK. He had been actively involved in teaching in PGIMS Rohtak and Oman Medical College. He is Postgraduate teacher since 1998 and guided many MS student and DNB students. He has attended many international and national conferences and had chaired many sessions and conducted instruction courses in SICS. He has plenty of publications and presentations to his credit. He is presentably working as Professor in Regional Institute of Ophthalmology in PGIMS Rohtak.

Current Gold standard in visual field testing is automated perimetry. Automated perimetry is helpful in detecting visual field defects in many neurological conditions and is an indispensable tool in glaucoma diagnosis. Although it has been around for quite some time now and with the advent of OCT, HRT and GDx the focus has shifted to preperimetric Glaucoma, but its value as a diagnostic tool in detection and progression of Glaucoma cannot be underrated. There are two types of perimeters worldwide Humphry and Octopus. Out of this Humphry perimeter is by far the most commonly used, hence here in this course we will be dealing with interpretation of a Humphry field analyzer printout. We will deal with the various aspects of visual field analysis like proper way of conducting the exam, common pitfalls and also the about fallacies in reading the printout. At the end of this course, the student will be able to have a basic understanding about automated perimetry and will be able to make interpretations regarding diagnosis and progression of glaucoma.

Sumit Sachdeva is Associate Professor working in the Regional Institute of Ophthalmology PGIMS, Rohtak, Haryana India. He has keen interest in Glaucoma Diagnosis & Management and is a faculty of Glaucoma unit in the same institute. He has contributed many chapters and articles in national and international journals and books.

Optical coherence tomography is fast becoming an indispensable tool for aiding not only in diagnosis of glaucoma but also in tracking its progression. It is now known that structural damage of Retinal Nerve fiber layer (RNFL) precedes the functional damage which becomes evident on testing the visual fields. Approximately 40% of axonal loss has to occur

before any detectable change occurs in visual function. The recognition of RNFL loss in patients with normal visual fields has led to the concept of “Pre-perimetric” glaucoma, signifying early glaucomatous damage not evident on standard automated perimetry. It has been suggested that RNFL loss even precedes the disc changes which ultimately are reflected in field defects on perimetry. OCT is one such modality and is based on the principle of Low coherence interferometry. It is a non-invasive imaging technology which uses light to create high resolution (<10 μ), cross-sectional images in an acquisition time of around 1.2 seconds. OCT scans for detecting glaucoma includes scanning three regions in retina:

 

• The Peripapillary Retinal Nerve Fiber Layer (RNFL)

• The Ganglion cell complex in macular region

• The optic nerve head

 

Combined data from above scans is then interpreted by the system and compared with the data of age matched individuals thus giving us information about the abnormal thinning of RNFL. In this workshop, we will stress on the working of machine and interpretation of OCT data by the beginners. The reading of OCT printout will be demonstrated and also common pitfalls and fallacies in the system will be highlighted.