Day 1 :
Keynote Forum
Ger van Rens
Vrije Universiteit Amsterdam, Netherlands
Keynote: How does visual field loss in patients with glaucoma correlate with loss of mobility and does this affect depressive symptoms?
Time : 09:30-10:00
Biography:
Ger van Rens was appointed as the First Dutch Professor in Ophthalmology in Low Vision Research at the Free University Medical Center Amsterdam in 2001. His research is focused on Epidemiology in Ophthalmology, Glaucoma but predominantly on quality of life and outcome of rehabilitation of visual impairment. He (co)- authored more than 85 publications, guided 11 PhD students and is responsible for the training of residents in Ophthalmology at the Elkerliek Hospital, Netherlands. He has served the board of several national Dutch societies, as an Advisory Member of ICO, as a Member of the ICO Resident Curriculum Group and is a Member of the Task-force Group of the ICD-11 of the WHO. From 2008-2014 he was the Chairmen of the International Society for Low Vision Research and Rehabilitation.
Abstract:
Statement of Problem: Glaucoma is, after cataracts, the second leading cause of blindness worldwide. The chronic aspect and the potential irreversibility of visual impairment caused by glaucoma are factors that contribute to increased psychological
burden in patients. Several studies have reported that the number of glaucoma patients suffering from depressive symptoms is significantly higher compared with controls.
Methodology & Theoretical Orientation: The relationship between visual impairment and depression in glaucoma patients could partially be explained by loss of mobility. Especially, patients with severe visual impairment suffer from loss of balance, greater fear of falling and higher actual fall rates. Furthermore, they experience difficulty in crossing roads, stepping up pavements or ascending curbs or even using public transportation. Loss of mobility may often lead to a decline of participation in recreational activities and even social isolation, especially in the elderly, both of which are risk factors for the onset of depression.
Findings: In a population of 139 glaucoma patients from Dutch and Belgian low vision rehabilitation organizations we found that 35% had subclinical symptoms of depression and 6% had an actual major depressive disorder according to the DSMIV. These percentages are significantly higher than prevalence estimates found in normally sighted peers. Currently, we are investigating the hypothesized mediating role of mobility restrictions on the relation between visual field loss and depressive symptoms in glaucoma patients.
Conclusion & Significance: Depression is highly prevalent in patients with glaucoma which may be explained by the profound mobility restrictions that patients experience.
- Special Session
Location: Kuala Lumpur, Malaysia
Session Introduction
M. Nazrul Islam
Bangladesh Eye Hospital, Bangladesh
Title: Management of Failing Bleb
Time : 10:00-11:00
Biography:
M Nazrul Islam is Professor of Ophthalmology at Bangladesh Eye Hospital. He is the President of Bangladesh Eye Care Society and Immediate Past President of the Bangladesh Glaucoma Society. At present, he is the Chairman of Jessore Community Eye Hospital in Bangladesh, Board Member of the Asia Pacific Glaucoma Society (APGS) and Board Member of Asian Angle Closure Glaucoma Club (AACGC). He is the Chief Editor of the Journal of Bangladesh Glaucoma Society and author of 60 scientific articles published in different journals.
Abstract:
A failed glaucoma filtration bleb is an expected outcome. The body wants to seal off the fistula. Early after surgery the body mounts an aggressive inflammatory reaction which can quickly result in scarring of the bleb. Fibroblast proliferation, synthesis of the extracellular matrix, subconjunctival fibrosis, fibrosis at level of sclera causes sealing of flap and finally external bleb failure. The signs of bleb failure are: local conjunctival hyperemia, vascularization, increased IOP, flat bleb, highly elevated cystic bleb/Tenon’s cyst and small avascular cystic blebs. IOP which does not decrease after massaging risk factors are: Young age, Black race, congenital and juvenile glaucoma, subconjunctival hemorrhage, ICE syndrome, secondary glaucoma following PKP, RD, excessive inflammation, long-term topical glaucoma therapy, traumatic glaucoma, NVG, etc. The options when bleb/trab fails are digital ocular massage, argon laser suture lysis, Release of releasable sutures, loosening of adjustable sutures, medical treatment with bleb needling, revision of trab, repeat trab, GDD, cyclophotocoagulation, etc. The procedures will be
discussed with videos.
- Track 1: Primary Glaucoma
Track 2: Secondary Glaucoma
Session Introduction
Said JamalEddin
Baish General Hospital, Kingdom of Saudi Arabia
Title: Myectomy technique for horizontal squint surgery
Biography:
Said JamalEddin is a Consultant Ophthalmologist currently working in Saudi Arabia, the doctor has finished his MD degree from Cairo Medical University and obtained the Syrian Board in Ophthalmology. His clinical experience goes back to nearly 30 years which started in Syria by introducing many technologies, some of them, as the first ophthalmologist who worked on PHACO, and fluorescein in angiography. He also worked as the Head of the Ophthalmology department in Homs County Hospital (Alwatany), and worked in many private and state owned hospitals. After that, he moved to Libya for two years where he started to develop a new surgical technique for the strabismus and the glaucoma fistula. He is an active member in the Syrian Ophthalmology Society, and published a research paper titled, “The first 70 cases of PHACO in Syria and its complications”, and attended many international conferences, some of them in Egypt, Morocco, India, Lebanon and Riyadh.
Abstract:
Aim: To explain a new surgical technique in squint surgery, and to discuss and compare with old conventional ones. Material & Methods: A retrospective study was done from 2011 until 2015, at Nour Aloyoun Private Hospital, Libya and in Saudi Arabia, at Baish General Hospital, Jazan. Both hospitals approved this study and oral permission was obtained from all the patients who took part in this study. The confidentiality of the patients was preserved for the study. Complete evaluation of the patient medical and psychological history was made, the necessary lab tests were demanded, and CT investigation was performed before and after the surgery to evaluate the adjustment of the muscles. We operated 74 primary strabismus patients (XT-ET and some secondary cases–re-operated) using this new technique. 40 cases were in Libya and the 34 from Saudi Arabia. All patients were evaluated clinically; imagery and follow-up were conducted for up to two years.
Results: Out of the 74 cases, 68 (92%) were successful with high ocular motility after three months. Overcorrection and under correction only appeared in 8% (6) of the cases. No major complications were recorded during and after the surgeries. The results are supported by documents and images.
Conclusion: This myectomy technique is a new revolution in our ophthalmic field because it didn’t interrupt the integrity of the normal ocular motility and it’s simpler, easier, with high successful rate (92%), require less time, without suturing much and more efficient with less complications.
Rajender Singh Chauhan
University of Health Sciences, India
Title: The art and craft of classical trabeculectomy
Biography:
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 Dudley Hospital irmingham 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 presently working as Professor in Regional Institute of Ophthalmology in PGIMS Rohtak.
Abstract:
Sight threatening glaucoma needs meticulous management by medical or surgical modalities. Surgery remains the mainstay of treatment when medical treatment becomes inefficient. The surgery of choice remains the classical trabeculectomy. To have the best outcome of this surgical modality, we should learn the intricacy and modification according to desired outcome and risk factors. Written information should be provided to the patient. It has mainly two approaches-limbal based and fornix based. The basic principal of trabeculectomy is to handle the conjunctiva carefully and minimally. When aggressive filtration is needed, Mitomycin- C is used. Kelly’s punch has been found to be of utmost use. Modification in the form of adjustable /releasable sutures can also be used. Long-term follow up and management of failure are of paramount importance.
Navonil Sau
Vivekananda Mission Asram Netra Niramay Niketan, India
Title: Secondary glaucoma in a rural Indian eye hospital: An overview of dimension, profile and visual presentation
Biography:
Navonil Sau has completed his MS Ophthalmology from Kasturba Medical College, Karnataka, India in 2011 and then completed 2-year long term fellowship in Anterior Segment and IOL Microsurgery from Aravind Eye Hospital, India. Presently, he is working as a Consultant at Vivekananda Mission Asram Netra Niramay Niketan, India. He has 2 national and 1 regional conference presentation.
Abstract:
Purpose: To look into the magnitude and pattern of visual profile of patients present with varieties of secondary glaucoma.
Methods: A retrospective hospital based analysis of medical records of patients attending Vivekananda Mission Asram Netra Niramay Niketan, Chaitanyapur, West Bengal, India, over a period of 18 months (Dec 2013 – May 2015) was done in order to know the magnitude and pattern of visual profile of different types of secondary glaucoma walk-in patients.
Results: Out of 224 secondary glaucoma cases, 158 were Open Angle (70.5%) and 66 were Close Angle (29.4%). Secondary glaucoma patients comprised of 0.17% of total out patient, and Secondary Open Angle (SOA) and Secondary Close Angle (SCA) comprised of 1.63% and 0.68% of total glaucoma patients attended the hospital respectively. Male female ratio is 2.8:1 and 2.4:1 in SOA and SCA respectively. We found Psedoexfoliation Glaucoma was the most common cause of SOA and Neovascular Glaucoma was more common SCA glaucoma in our study. Mean presenting visual acuity for SOA was 1.16 logmar and 2.24 logmar for SCA. Mean IOP was 35.9 mm of Hg and 40.7 mm of Hg for SOA and SCA respectively.
Conclusion: In spite of unimpressively lower number of Secondary Glaucoma patients, management strategy of those patients should be prompt and effective considering their presenting vision.
Biography:
Leila Mohan is a leading veteran Ophthalmologist from Kerala specialized in Anterior Segment and Paediatric Ophthalmology. Her special areas of interest are Paediatric Ophthalmology and Oculoplasty. After accomplishing her Medical Graduation (MBBS) and Post Graduation (MS & DO), she worked under Ministry of Health in Saudi Arabia for 6 years. She also worked as Consultant in Baby Memorial Hospital, Calicut and Nirmala Hospital.
Abstract:
Lifestyle diseases which include hypertension, diabetes, arthritis, obesity, insomnia, etc., have been said to be treated or altered by yoga, which is an ancient form of Indian art of living. Today’s stress and lack of physical exercise contributes to many lifestyle diseases. Yoga is a physical, mental and spiritual practice where exercise, breathing and meditation is said to have an influence on reducing high blood-pressure, improving symptoms of heart failure, enhancing cardiac rehabilitation and lowering cardiovascular risk factors. With the awareness of lifestyle diseases and its modifications by exercise, yoga practice has become popular and there is a revival of this among middle aged people. I would like to discuss 4 cases of progressive glaucomatous field loss-two of them with advanced field loss, which had no other risk factors but ardent practice of yoga for more than 10 years as the only ‘risk factor’. One is a male yoga teacher by profession; who, at the early age of 34 years, started developing laucoma and the field changes were progressing at an enormously fast rate. He was being followed up with medication which had to be increased on each visit. The second, a spiritually oriented 45 year old male, who was diagnosed to have glaucoma with intraocular pressures of above 40 mm of Hg, had trabeculectomy and during the postoperative period, was found to be practicing yoga on a regular basis. The third one, a professor in arts, a gentleman who vigorously practiced yoga after retirement-at the age of 55- developed moderate to severe glaucomatous field defects. Intraocular pressure was in the thirties and with maximum medication progression necessitated trabeculectomy. The fourth case was that of a 73 year old doctor, an ardent practitioner of yoga and a spiritual teacher, who had advanced glaucomatous field defects in both eyes with an intraocular pressure in forties without medication who underwent trabeculectomy after a trial of 3 anti-glaucoma medications. Many patients ask us the benefits of exercise or food which may modify glaucoma. Often the answer is negative. But this experience shows that we need to probe into their yogic practices, especially postures in which head goes below the level of the heart as in ‘shirasasana’-standing on the head. All four patients did ‘shirasasana’ for more than10 minutes regularly.
Conclusion: Posture with head below the level of heart for prolonged periods of time can produce deleterious optic neuropathy due to high intra ocular pressures. There are few papers in literature showing the influence of posture on intra-ocular pressure, which need to be studied in more detail.
Enghmingliani Ralte
Civil Hospital Aizawl, India
Title: Treatment of glaucoma with cataract by combined surgery (Phacoemulsification with IOL with Trabeculectomy)
Biography:
Enghmingliani Ralte has completed her MBBS from Lady Hardinge Medical College, New Delhi and MD (Ophthalmology) from Rajendra Prasad Centre for Ophthalmic Sciences (All India Institute for Medical Sciences) New Delhi, India. She has worked in the Government of Mizoram for more than 23 years. At present, she is the Head of the Eye Department in Civil Hospital, Aizawl, Mizoram.
Abstract:
Mizoram is a small state in the North Eastern part of India. Hence, all Ophthalmologists have to practice as general ophthalmologist treating all diseases of the eye. In my practice of over 20 years, I have come across a number of patients having glaucoma associated with cataract. Many of the patients have lens induced glaucoma. In such cases, the best treatment is to do a combined surgery after controlling the IOP. In combined surgery, the trabeculectomy and phacoemulsification incision site may be done at different sites. Usually the trabeculectomy is done at 12 O’clock site and the phacoemulsification is done at the temporal site with the surgeon sifting position or first the trabeculectomy is done at one sitting and then phacoemulsification with IOL implantation is done at a second sitting. In some cases, first phacoemulsification with IOL implantation is done which alone may control the IOP in cases of intumescent cataract. In some cases, phacoemulsification with IOL with trabeculectomy is done at the same site i.e., at 12 O’clock position. This method is the best so far in my experience. First, after making a fornix based conjunctival flap, a partial thickness scleral flap is made. Then, the trabulectomy site is marked with a sharp knife and then phacoemulsification with IOL implantation is done under the scleral flap. This reduces the postoperative astigmatism. After this, the trabeculectomy is done and sutures are passed. When combined surgery is done, two surgeries are incorporated into one surgery. This saves the patient having to undergo two operations at two sittings which are cost effective, time saving and emotionally less traumatic. It also gives the best results.
- Track 3: Causes of Glaucoma
Track 4: Symptoms and Diagnosis of Glaucoma
Track 6: Medication of Glaucoma
Biography:
Philip Kuruvilla completed his MBBS from Christian Medical College, Vellore and his Postgraduation in Ophthalmology from Christian Medical College, Ludhiana. His deep Christian faith and convictions moved him to serve in the North Indian villages of Punjab, Himachal Pradesh and Uttar Pradesh where he performed several thousands of Eye Surgeries in the span of 10 years and gained tremendous expertise in Cataract Surgery, Squint Surgery, Trabeculectomy (Surgery for Glaucoma), Ptosis, and Oculoplastic Surgeries like corrections of conditions like Ptosis (droopy eye), Entropion (inversion of eye lid), Ectropion (eversion of eye lid), Dermatochalasis (excess skin in the upper lid), etc.
Abstract:
This is a case presentation of a gentleman born in 1950 who came to me in Sep 2006 for refraction. On routine examination, he was found to be slightly hypermetropic (<1 D), with a BCVA of 6/6 N6, IOP of 30.4 mm BE, narrow angles BE and glaucomatous field defects (more in the LE) C/D 0.7 RE and 0.9 in LE. Nd Yag PI was done in BE. Despite treatment with three drops (latanoprost, dorzolamide and timalol), IOP remained around 20 mm Hg. So trabeculectomy was done in RE in July 2008. AC was formed on the first post-op day. But 1 week later, AC was minimally shallow, IOP was 9 mm Hg. Vision was 6/6 with glasses and retina was normal. Without any treatment AC got formed and IOP went up to 20. Releasable suture was removed for 3 months he was fine, then suddenly he presented with dim vision, flat AC and a tension of 26. Responded well with pad and bandage, atropine drops (every 10 mts), acetazolamide tabs and steroid drops. He had repetitions of similar episodes of flat AC and slightly high tension later in the same month (Oct 2008), again in Feb 2009 (episodes followed stoppage of atropine). So he was put on atropine drops at least once in 2 or 3 weeks in the mean time, he was developing a cataract and by March 2012 it was significant enough for it to be operated and cataract extraction with IOLI was done. Since then, he has not had a single episode of high tension in that eye till today even without cycloplegics. In the LE IOP remained in the high teens with 3 drops and he has been too scared to agree for any surgery for that eye. RE is a typical case of Primary Angle Closure Glaucoma (common in India) going on to malignant glaucoma (rare), probably initiated by over filtration after trabeculectomy. This case presentation will be followed by mentioning a few points about malignant glaucoma and treatment modalities.
Zakia Sultana Shahid
Anwer Khan Modern Medical College, Bangladesh
Title: Medical treatment of primary open angle glaucoma: Recent advancement
Biography:
Zakia Sultana Shahid Associate Professor of Anwer Modern Medical College And Hospital, Dhanmondi, Dhaka. She was Former Head of the department of ophthalmology of the same medical college. She is from Chittagong. Studied at Convent, ST. Scholasticas Girls High School and Chittagong Govt College. Graduated from Chittagong Medical college in 1988. She has done her training in ophthalmology in NIOH and obtained Diploma in ophthalmology from NIOH under Dhaka University in 1993. She obtained Master of Surgery in Ophthalmology from NIOH under BSMMU in 2003. Performed her Fellowship in Glaucoma from LV Prashad Eye Institute,Hyderabad ,India in 2005. Her area of interest Cataract ,Glaucoma & Uvea. Along with her many credentials DR. Zakia .S.Shahid has many publications in different journal of both Home
and Abroad. She attended many Conference both Home and Abroad and participated with scientific pappers. She is the Secretary General of Bangladesh Glaucoma Society. Assistant Editor of BGS Journal. Life member of Bangladesh Ophthalmological Society, Founder Life Member of Bangladesh Glaucoma Society, Life Member of Bangladesh Uvea Society, Bangladesh National Society of Blind, Chittagong Maa O Shishu Hospital, Kidney Foundation ctg, Diabetic Assiciation Ctg. She is the President of Soreptimisit International Club Dhanmondi who works for women and girls to improve their lives and status. She achieved ‘ MOTHER TERESSA’ award 2016 for her
contribution in medical science, in Ophthalmology and social work.
Abstract:
Glaucoma is being considered as a second leading cause of blindness in the world and is responsible 12.5% of total blindness. It is a neurodegenerative disease where ganglionic cell become degenerated progressively leading to blindness. Due to lack of proper treatment blindness which occurs is irreversible. Though increased intraocular pressure is the major risk factor to cause damage yet glutamate, nitric oxide, vascular supply can also be considered as other risk factors.
In POAG to maintain the baseline level of IOP to reduce the extent of damage we can do medical, laser or surgical treatment. to with to reduce the mechanical effect over the nerve To reduce IOP, vascular damage, and biochemical effect. Medical therapy is the initial treatment to start. There are different line of treatment. Even we can use single or multiple drug depending on IOP. PG analog, Alpha agonist , beta blocker are most widely used. Along with this newer drug are also being introduced eg Tufluprost .But whatever we use it should be effective, tolerable, and affordable. Future upcoming anti glaucoma drug will not only reduce IOP but also protect trabecular meshwork, improve blood flow to optic nerve head, and slower the progress of damage.
Key word: PG analog, Alpha agonist, IOP, Tufluprost
Disclosure: The authors have no conflicts of interest to declare.
Syed Imtiaz Ali Shah
CMC & SMBB Medical University, Pakistan
Title: Association of pigmentary glaucoma with pigment dispersion syndrome
Biography:
Syed Imtiaz Ali Shah (a nationally and internationally well known scholar/researcher of Pakistan origin) qualified MBBS with Distinction in 1980 from Chandka Medical College/University of Sindh, Pakistan. He passed Fellowship Examination of College of Physicians and Surgeons of Pakistan and was elected as Fellow in Ophthalmology (FCPS) in 1987. He has 40 published research papers and numerous scientific presentations to his credit.
Abstract:
Purpose: To determine the frequency of occurrence of pigmentary Glaucoma in patients with Pigment Dispersion Syndrome (PDS).
Material & Methods: This prospective follow up study was conducted from August 2001 to March 2015 at Ophthalmology Department Chandka Medical College, Larkana, Pakistan. Patients presenting with Krukenberg’s spindle on the endothelial side of cornea and pigmentation of angle of anterior chamber seen on slit lamp examination and gonioscopy were considered as cases of PDS. Patients with presence of secondary pigment dispersion associated with causes like, pseudoexfoliation, iris cyst, nevus, malignant melanoma, intraocular inflammation, intraocular surgery, ocular trauma and irradiation were excluded from the study. Slit lamp examination, Applanation Tonometry, Gonioscopy, Fundoscopy, Automated Perimetry and Refraction was performed on every case. SPSS version 20 was used for data entry and analysis.
Results: 72 cases of Pigment Dispersion Syndrome according to the inclusion criteria were included in the study, amongst them 63 (87.50%) were males and 9 (12.50%) were females. Mean age ± standard deviation of patients was 35.00±6.54 years and age range was 24 to 46 years. 47 (65.28%) patients had an IOP in the range of 10-14 mmHg, 22 (30.56%) patients had an IOP in the range of 15-18 mmHg and 3 (4.17%) patients developed an IOP of greater than 19 mmHg. Fundoscopy showed myopic degeneration in 49 (68.06%) patients and optic disc cupping in 3 (4.17%) patients. 4 (5.56%) patients had refractive error between +1D to +3D, 9 (12.50%) patients had refractive error between -1D to -4D, 21 (29.17%) patients had refractive error between -5 D to -8 D and 38 (52.78%) patients had refractive error between -9 D to -12 D. Our study showed that 1.64% patients having PDS developed glaucoma at 5 years of follow up and 7.32% patients developed glaucoma at 14 years of follow up.
Conclusion: On the basis of this study we conclude that early onset primary open angle glaucoma associated with Pigment Dispersion Syndrome or Juvenile glaucoma associated with PDS might have been mistaken as Pigmentary Glaucoma in Pakistani patients (black population) and a distinct entity in the form of Pigmentary Glaucoma may be non-existent in blacks.
M V Francis
Teresa Eye & Migraine Centre, India
Title: Moon migraines or intermittent angle closure glaucomas
Biography:
M V Francis is a highly experienced Ophthalmologist from Kerala specializing in Neuro Ophthalmology, Headache and Ocular Allergy. He has 24 years of rich expertise in Clinical Research in Neuro-Ophthalmology and Headache. He has accomplished his Medical Graduation (MBBS) & Post Graduation (MS) and has been in practice since 1999. He is currently associated with Teresa Eye Migraine Centre in Aleppey, Kerala.
Abstract:
Objective: To document subacute angle closure glaucomas mimicking moon migraines.
Background: Intermittent angle closure episodes with headache, nausea, vomiting and blurring of vision can mimic migraine with or without auras. The traditional concept among many people in this part of the world is that any recurrent unilateral head pain with nausea and vomiting is migraine and if symptoms manifest after sunset, it is named Moon migraine and early morning onset as Sun migraine. It is also well known that early on in the course of painful eye disorders, including narrow angle glaucoma and uveitis, the eye may be “white” or “quiet” and the disease often misdiagnosed. Subacute angle closure glaucoma is intermittent and difficult to diagnose between attacks without gonioscopy. SACG may present with intermittent headache (with or without eye discomfort) or with amaurosis fugax.
Methods: 17 patients aged 42 to 74 with recurrent late evening headaches were prospectively evaluated over a period of 19 years. All were diagnosed in the past as late onset migraines or moon migraines. A thorough history of headaches applying ICHD 3 beta migraine with and without aura diagnostic criteria applied to diagnose migraine or probable migraine (duration less than 4 hours). Full ophthalmic work up including gonioscopy done in all.
Results: Eleven fulfilled probable migraine without aura criteria; four with definite migraine without aura and 2 with probable aura migraines. Clinching diagnostic evidence from history was redness/halos/blurring (lasting more than one hour) at the time of headache attacks and absence of past or family history of migraines. Well known angle closure triggers other than dark surroundings were noted in 7 people. Nausea/vomiting were present in most of them but not considered diagnostic as they are common in both the disorders. Intraocular pressure, slit lamp biomicroscopy and gonioscopy findings were confirmative of subacute angle closure attacks in all.
Conclusion: When elderly patients present with history of recurrent unilateral headaches in the late evenings/night time or with a past or self diagnosis of moon migraine and if the pain doesn’t conform to a well defined headache syndrome, a carefully taken ophthalmic history and meticulous eye examination including gonioscopy to be done to rule out intermittent angle closure glaucomas. Subacute angle closure glaucoma (SACG) is difficult to diagnose between attacks without gonioscopy. This study concludes that ophthalmologists must be aware that headaches can be a prominent feature of SACG and that gonioscopy, which is not part of a routine ophthalmology exam, is necessary.
Angshuman Das
Mursidabad Medical College, India
Title: Prostaglandin analogues in glaucoma – The current perspectives
Biography:
Angshuman Das Graduated in Medicine in 1995 from Burdwan Medical College, India. He started his Ophthalmology Residency there in 1996. He got his Diploma in Ophthalmology in 1999. He completed his MS in Ophthalmology in 2005 from the Regional Institute of Ophthalmology, Kolkata. He started his teaching career in 2006, and is now working as Assistant Professor of Ophthalmology in Murshidabad Medical College, India since 2012. He has been an ICO Fellow at Ludwig Maximillian University at Munich, Germany. He passed FRCS Ophthalmology from Glasgow in 2013.
Abstract:
Since inception in 1996, prostaglandin analogues (PGAs) have gained more attentions in recent years as the first line of drug for medical management of glaucoma. They can reduce the intraocular pressure (IOP) more effectively than other topical anti glaucoma medications; have fewer systemic side effects & above all once a daily dosing advantage. Four PGAs are now commercially available in India namely Latanoprost, Bimatoprost, Travoprost & Tafluprost. Studies indicate that the IOP-lowering efficacies of the prostaglandin analogues are comparable, although each has a unique receptor-binding profile. The mechanism of action is same with each drug and the adverse reactions are similar. Here, we discuss the basic pharmacology, clinical uses, indications, contraindications and the advantages over other anti-glaucoma medications. We also discuss some uncommon but important side effects of these drugs, which may be clinically significant. We made a search on Medline and other databases about the recent developments on the PGAs since 2011 and report some interesting findings.
Shoumya Jyoti Datta Mazumder
Vivekananda Mission Asram Netra Niramay Niketan, India
Title: Diabetic Retinopathy: An experiment with behavior change communication program
Biography:
S J Datta Mazumder joined Department of H&FW, Government of Assam, as M&HO in 1998. In 2006, he completed his Diploma in Ophthalmology from SMC, Assam University and joined VMANNN, Chaitanyapur as Medical Officer. He completed Fellowship from Aravind Eye Hospital, Madurai in 2008. In 2010, he became Chief, VR services, VMANNN. In 2012, he took over as Chief Medical Officer of VMA, NNN. He is a Senior Faculty of VMA, IOT. He attended several national and international conferences as delegates, presenter and faculty. He is a Vidyasagar University accredited examiner and paper setter.
Abstract:
Purpose: To look at how the status of awareness, attitude, practice and economy of any given population suffer from diabetic retinopathy (DR) is far more important than only clinical diagnosis and evaluation.
Material & Methods: We selected and covered around 1 million populations (exact figure 1014976) surrounding our base hospital (average distance 26 km). Out of the total population around 0.25 million people (23.6%) projected to be below poverty line. We did a baseline KAP study for diagnosing basic educational status of the population regarding the disease. Considering the recommendations of the study we had designed our awareness activities around the area along with financial support for examination and treatment at base hospital from 2008 to 2011. We then observed the impact of service uptake at the base hospital during the project period and after.
Result: We recognized rise (mean 51.75%) of DR patients at base hospital for evaluation and treatment during 4-year project period as compared to 2007 and fall (mean 17.15%) of DR patient in 2012 to 2015 as compared to project period, still maintaining rise (mean 34.6%) as compared to 2007.
Conclusion: Despite multitude of treatment options, appropriate awareness and square funding is the mainstay of early detection and prevention of moderate to severe vision loss and related morbidity due to DR.
Biography:
Anita Shah completed MBBS in 1986 and DOMS in 1989 from APS University, Rewa, MP and is working in GB Pant Hospital, A&N Islands from 1994. She is managing the clinical and administration works for prevention of blindness in islands. She is trained in Glaucoma from Dr. RP Centre, AIIMS, New Delhi. Apart from Glaucoma, she is trained in Phaco Surgery, Medical Retinal and Eye Banking in Keratoplasty. Her works in preventing blindness in tribal population of Car Nicobar is well appreciated and published in reputed journal and presented in conferences. She is also working to prevent irreversible blindness due to diabetic retinopathy.
Abstract:
Glaucoma is a major cause of blindness in India, which could be greatly reduced by early diagnosis, proper management and lifelong follow up. There as at least 12 million people in India affected with glaucoma and 1.5 million are blind from disease. A study conducted by National Programme for Control of Blindness, Directorate General of Health Services, Govt. of India, during the year 1999–2001, showed prevalence of glaucoma as 5.9% in blind people among 50+ age group. The Union Territory of Andaman and Nicobar Islands comprising 572 Islands, is situated in Bay of Bengal. Out of 572 Islands, only 38 islands are inhabited with the population of 3.79 lakhs comprising mainly people from different parts of India and tribal population. Few islands are tribal restricted islands. The capital city of Andaman and Nicobar Islands is Port Blair which is more than 1000 kms away from mainland India. In A&N islands, no blindness survey of population based study on glaucoma has done till date. According to population prevalence of glaucoma in 50+ group of general population should be approximately 10765, but islands differ is demographic pattern from the rest of the India. 240 glaucoma patients are registered and managed in eye OPD of one District Hospital with single ophthalmologist. Patients are diagnosed after proper investigations like vision recording by Snell’s charts, IOP by NCT and AT, CCT, Vongrafe’s Sign, Goinoscopy, Fundus examination for disevaluation and HFA (Carl Zeiss), OCT (Carl Zeiss) by single ophthalmologist. In the absence of ophthalmologist in different islands, early diagnosis and management of glaucoma is a real challenge. Intensive awareness campaign and training of PMOs helped in preventing blindness due to glaucoma in Islands.
- Track 7: Retina Disorders during Glaucoma
Track 9: Surgical Techniques in Glaucoma
Track 12: Glaucoma Management
Session Introduction
Sheena Balakrishnan
Burjeel Hospital, UAE
Title: Selection and counselling of patients for Lasik
Biography:
Sheena Balakrishnan has completed her Diploma in Ophthalmology from Madras Medical College and Diplomate of National Board from The Eye Research Foundation, Chennai. She then completed her Fellowship from the International Council of Ophthalmology. She has undergone Medical Retina training and training in Anterior Segment Surgeries mainly focusing Cataract Surgeries and Refractive Surgeries. She has worked with the World Diabetic Foundation in screening and managing diabetic retinopathy patients over 2 years. She has performed retinal laser photocoagulation, intravitreal injections, photodynamic therapy and managed retinal diseases. She is vastly experienced in performing cataract surgeries including small incision cataract surgeries and phacoemulsification surgeries. She has performed more than 3500 LASIK, LASEK, PRK, Wave front guided treatment. She has published and presented various papers at national and international conferences. She was invited faculty for Medical management of age related macular degeneration in APAO Conference in Bali in 2009. She is one of the few Surgeons in India who is experienced in large volumes Implantable Collamer Lens (ICL) technique.
Abstract:
The most important aspect in the success of Lasik surgery is the proper selection of cases. It is important to understand that Lasik being a cosmetic procedure, the pre-operative evaluation of the Lasik patient in terms of history taking, detailed anterior segment evaluation including dry eye work up, correct selection on the basis of topography and aberrometry is very significant in deciding the selection of procedure and outcomes of the Lasik. The role of pupil size diameter, occupation and visual demand of the patient also plays a significant role in the outcomes of Lasik. After the entire evaluation is completed, the most important thing is giving proper counseling to the patients for e.g., denying Lasik with large pupil size in people who work in radiology and other professions of dim light is essential. Discussion of the detailed realistic outcomes of the Lasik patients in relation to the day to day activities in counseling has better satisfaction rate post Lasik. In this presentation, I would like to share my compilation of significant points to be covered in the counseling and evaluation of the patients.
Enrique Suareze
King Khaled Eye Specialists Hospital, Saudi Arabia
Title: The utility of the verus ring in performing safe and efficient capsulorhexis in eyes with corneal scarring
Biography:
Enrique Suarez graduated as Medical Doctor from Universidad de Los Andes. He has obtained Internship and Ophthalmology Residency at Military Hospital (Caracas, Venezuela) and Cornea, External Diseases and Anterior Segment Fellowship with Dr. Herbert Kaufman at Louisiana State University, USA. He is the Head of Cornea Division at Military Hospital, Director of Cataract and Refractive Surgery & Clinic Ophthalmology Service at Centro Medico Docente La Trinidad Private Foundation (Caracas, Venezuela) for 20 years. Currently, he is the Senior Academic Consultant at King Khaled Eye Specialists Hospital (Riyadh, Saudi Arabia). He has over 40 publications to his credit and presented 450 lectures in international meetings. He also serves as the Board of Directors of International Ophthalmological Societies and Editorial Board Member of Ophthalmological Journals.
Abstract:
Purpose: The Verus ring is a silicone ring-shaped intraocular device that can be injected onto the anterior lens capsule that can assist with sizing and centration of the capsulorhexis. Capsulorhexis during cataract surgery in patients with corneal scars can be challenging. In this study, we determine the safety and efficacy of the Verus ring during anterior capsulorhexis.
Methods: Eyes with mild to moderate corneal scars undergoing cataract surgery (n=18) were subjected to implantation of the Verus ring during capsulorhexis by a single surgeon. Outcome measures included complications during the capsulorhexis procedure and time taken to complete the capsulorhexis and surgeon feedback. Historical and surgeon controls (n=18) for capsulorhexis in patients with clear cornea were used as a comparative group.
Results: There were no complications related to the insertion and removal of the device. Anterior capsular extensions were not observed in any of the cases with corneal scarring. The capsulorhexis was well centered in all the eyes. Surgeon feedback indicated that the insertion of the device did not require steep learning curve other than careful following the instructions as noted in the instruction video and was of the opinion that it greatly enhanced safety and efficiency during the capsulorhexis process.
Conclusion: The Verus ring appears to be a useful device in performing safe and efficient capsulorhexis in patients with corneal scars undergoing cataract surgery.
Amit Solanki
Centre for Sight Eye Hospital, India
Title: Interactive session on glaucoma cases: Real case scenario
Biography:
Amit Solanki has been in ophthalmic field for more than 12 years. He has done his Undergraduate & Post-graduate Training from the reputed B J Medical College, Ahmedabad (Gujarat). During two years of Senior Residency tenure at renowned Aravind Eye Hospital, Tamil Nadu, he was awarded the Diplomat of National Board in Ophthalmology (DNB) by the National Board of Examinations. He also completed Special Training in Glaucoma at Aravind Eye Hospital, Coimbatore. He has presented his work at national & state conferences and received many awards. He has also delivered many lectures (more than 55) at various conferences being a guest faculty.
Abstract:
Glaucoma is a leading cause for irreversible blindness in the world. It is estimated that currently nearly 70 million people are affected by glaucoma worldwide. Treatment for glaucoma is widely available and blindness from glaucoma can be prevented if the disease is detected early and treatment is given on time. However, the main challenge in glaucoma facing our country is that nearly 90% of glaucoma in the community is undetected. There is also a need for improving training for ophthalmologists for diagnosis of glaucoma, as there is poor diagnostic rate for those who undergo a routine ophthalmic evaluation. Still there are many missed out cases of glaucoma and also over diagnosed cases of either normal or glaucoma suspects or ocular hypertension or miss diagnosis of open or closed angles. When a patient is evaluated in the outpatient department, it is crucial for the eye surgeon to evaluate the optic disc to detect early changes, to view the anterior chamber to identify open or closed angles. Once there is a suspicion of glaucoma, standard automated perimetry should be performed and repeated in case a visual field defect is seen. This is an interactive session where I have put the real cases photographs (clinical & investigations) and it will be discussed with panelists about glaucoma diagnosis and management. Finally the take home message for each case will be given to audience.
Ashraful Huq Ridoy
Bangladesh Eye Hospital, Bangladesh
Title: Effect of trabeculectomy on retinal nerve fiber layer and macular thickness by optical coherence tomography
Biography:
Ashraful Huq Ridoy is now working as Junior Consultant at Bangladesh Eye Hospital Ltd. He has completed basic Medical degree MBBS in 2007 and accomplished FCPS (Fellow of College of Physicians and Surgeons, Bangladesh) in Ophthalmology in 2015; as well as he had 4 years Professional Training on Ophthalmology. He has completed Fellowship in Cataract Surgery. His working fields of interests are cataract, glaucoma and refractive surgery. He is the Life Member of Ophthalmological Society of Bangladesh and Executive Director of Bangladesh Eye Donation Society & Eye Bank.
Abstract:
Purpose: To assess the change in thickness of retinal nerve fiber layer and macula, after trabeculectomy, by using optical coherence tomography. Materials & Methods: A total of 25 patients with primary open angle glaucoma undergoing trabeculectomy were selected. Average and quadrant RNFL thickness, macular thicknesses were measured by OCT within a month before surgery and 1 and 3 months postoperatively. Main outcome measures were changes in average and quadrant RNFL, macular thickness with respect to post-operative intraocular pressure change. Results: Average and quadrant RNFL thickness increases post-operatively after reduction of IOP from 28.12±7.92 mmHg (mean±SD) to 11.40±2.71 mmHg at 1 month and 11.68±2.61 mmHg (P=<0.0001) at 3 months. A significant increase was observed in superior (18.33±5.55 μm, P=0.0085) and inferior (16.04±6.54 μm, P=0.0178) RNFL thickness at 3 months post-operatively. Average (10.89±5.55 μm, P=0.0555), nasal (13.12±8.16 μm, P=0.1146) and temporal (1.64±3.17 μm, P=0.6069) RNFL thickness increase were not statistically significant (P=>0.05). Macular thickness increases from 229.82±9.99 μm pre-peratively to 243.88±8.89 μm at 1 month and 233.52±7.95 μm at 3 months (P=0.1547) post-operatively, both were not significant. Conclusion: A significant increase in superior and inferior RNFL thickness was observed due to reduction of IOP after trabeculectomy
Biography:
Khalid Qadha has 14 years of experience as an Ophthalmic Technician in the field of Ophthalmics at King Khaled Eye Specialist Hospital. He has 2 years of experience at Cleveland Clinic Abu Dhabi and has 9 years of experience as an Ophthalmic Ultra-sonographer with wide experience in Ophthalmic Pathology.
Abstract:
UBM is almost universally defined as an optical science, the human eye is by nature light-sensitive; UBM permit complete imaging of deep ocular structures. UBM is perfect for glaucoma screening, determining lens and cornea pathologies and more. This presentation will help to show what UBM can change in clinical practice when to request it and when to request anterior segment OCT.
Prashant S Agnihotri
Retina Care Hospital, India
Title: Internal limiting membrane and Its role in vitreomacular surgery
Biography:
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.
Abstract:
Internal limiting membrane removal has become a standard of care for various retinal surgeries specially, vitreomacular traction. Various methods and rational for this intricate important step shall be hallmark of this presentation.
Enrique Suareze
King Khaled Eye Specialists Hospital, Saudi Arabia
Title: Femtosecond cataract surgery. Avoiding Complications
Biography:
Enrique Suarez was graduated as Medical Doctor from Universidad de Los Andes. He has obtained Internship and Ophthalmology Residency at Military Hospital (Caracas,Venezuela) and Cornea, External Diseases and Anterior Segment Fellowship with Dr. Herbert Kaufman at Louisiana State University, USA. He is the Head of Cornea Division at Military Hospital, Director of Cataract and Refractive Surgery & Clinic Ophthalmology Service at Centro Medico Docente La Trinidad Private Foundation (Caracas, Venezuela) for 20 years. Currently, he is the Senior Academic Consultant at King Khaled Eye Specialists Hospital (Riyadh, Saudi Arabia). He has over 40 publications to his credit and presented 450 lectures in international meetings. He also serves as the Board of Directors of International Ophthalmological Societies and Editorial Board Member of Ophthalmological Journals.
Abstract:
As more surgeons explore the possibility of femtosecond laser cataract surgery (in which the incision, capsulotomy and nucleus fragmentation are accomplished by the laser), the focus on the details of the surgery’s advantages and pitfalls has become more intense. And as with any surgery, one of the most important details is potential complications. Pearls to perform the different surgical steps of this technique will be presented from the pupil dilatation, incision, capsulorhexis, hydro dissection and phacoemulsification of the lens with practical tips to avoid complications as the posterior capsule blown and vitreous lens drop.
- Symposium
Biography:
Mita Joshi is a leading Ophthalmologist at Indore. She finished her MBBS and DOMS from Surat, Gujarat in 2000. Further to enhance her career, she went to
Agrawal Eye Hospital, Chennai and did her DNB in Opthalmology followed by FERC and FICO [Fellowship of International Council of Ophthalmology] where she was awarded as international scholar. She had a keen interest in cornea so she did a prestigious fellowship of cornea at RIOGOH, Chennai. Later she finished FRCS [UK] and became one of the very few FRCS at Indore. After acquiring adequate experience, she moved to Apollo Rajshree Hospital and simultaneously became Asst. Professor at SAIMS College and Mohak Hospitals due to her keen interest in teaching.
Abstract:
Intraocular pressure (IOP) measurement is an important investigation which forms a part of routine checkup in ophthalmology. Instruments of IOP measurement range from the Schiotz tonometer to ocular response analyzers which include corneal hysteresis in their pressure calculations. Goldmann applanation tonometry remains the gold standard for intraocular pressure measurement. This technique though is not without its pitfalls but with this short educational presentation, we will attempt to demonstrate the same and try to make this test a part of every ophthalmologist’s routine.
Biography:
Ashok Kumar M has completed his MBBS in 1994 from Sri Ramachandra Medical College, Chennai, Tamil Nadu Dr. MGR Medical University. He obtained Diploma in Ophthalmology (2001 – 2003) from Regional Institute of Ophthalmology, Madras Medical College, Chennai and a Diploma from National Board New Delhi during 2003 – 2007. He is a Fellow of International Council of Ophthalmology and fellow of Royal College of Physicians and Surgeons (Glasgow) 2007. He has presented his work at Navkar I Care, India & state conferences and received many awards. He has also delivered many lectures various conferences being a guest faculty.
Abstract:
Gonioscopy or study of the angle of the anterior chamber forms an important part of glaucoma diagnosis and management. This presentation aims to put forward the salient features of gonioscopy and methods of performing the same. The angle of the anterior chamber does not allow direct visualization due to total internal reflection. Use of a gonioscope allows us to overcome this and visualize the angle. Different types of gonioscopes are in use to aid in diagnosis and management. Those can be classified as direct and indirect. Direct goniolenses are: Koeppe and Swan Jacob; and indirect goniolenses are Goldmann and Zeiss. It has both diagnostic and surgical uses. The angle has been graded according to the structure visible on gonioscopy and help to manage glaucoma. There are various methods of grading angle width. Identification of angle structures like: Schwalbe’s line, trabecular, Schlemm’s canal, sclera spur and ciliary body are important. Indentation gonioscopy is very important aspect by which potential angle closure glaucoma patients can be identified. Recording the various findings and use of imaging camera devices are now available. Thus, gonioscopy is an important tool in management of diagnosis and management of glaucoma.
Biography:
Pratik Mahajan obtained MS in Ophthalmology and MBBS in Ophthalmology. He is a known Retina Surgeon with 11 years of experience working as a Chief Vitreoretinal Consultant and Surgeon at Shri Swaminarayan Gurukul Eye Institute, Rajkot. He pursued his long term Vitreoretinal Fellowship from the same institute at Rajkot, Gujarat. He underwent a clinical and research fellowship at Dr. Nagpal’s Retina Foundation, Ahmedabad. Under the able guidance of Dr. P N Nagpal, he learned and mastered the skills of the Retinal Detachment surgeries. He completed a fellowship in Retinopathy of Prematurity at L V Prasad Eye Institute, Hyderabad and got wide exposure to pediatric vitreoretinal diseases and surgeries under Dr. Subhadra Jalali. He was honored Master’s in Surgery (MS) in Ophthalmology by the reputed Saurashtra University, Rajkot, and pursued the training at the recognised Pandit Dindayal Upadhyay Medical College, Rajkot. He did his MBBS from Mahatma Gandhi Memorial Medical College, Indore and pursued clinical internship from Maharaja Yashwantrao Hospital, Indore. Presently, he is associated with Retina Speciality Hospital. Earlier, he was at Vasan Eye Care Hospital Indore.
Abstract:
Primary open-angle glaucoma is a progressive optic neuropathy involving loss of retinal ganglion cells and their axons at the level of the optic nerve head. This change manifests as thinning and excavation of the neural tissues and nerve fiber layer. The structural appearance of the optic nerve head is paramount to both glaucoma diagnosis and to the detection of progression. Hence, careful and systematic clinical examination of the optic nerve remains a cornerstone of glaucoma management. This presentation highlights various conditions which can co-exist and makes the diagnosis and assessment of glaucomatous optic disc difficult. There is a large degree of variability in the size of the normal optic nerve. Focal defects in neuro-retinal rim may be present and may indicate glaucoma, even in the presence of a “normal” cup to disc ratio. Myopic nerves are difficult to interpret, due to optic nerve tilt that makes evaluation of the temporal region, as well as the superior and inferior poles, difficult. Peripapillary atrophy can make determination of the optic disc margin difficult and can be misinterpreted as neuroretinal rim. Congenital colobomas of the optic nerve head are easy to diagnose because of their typical appearance. Optic nerve
pit and conus of the disc can sometimes cause diagnostic difficulties. Pallor disproportionate to cupping, normal intraocular pressure or unusual history of onset, progression and age should arouse suspicion of a neurological cause for the disc changes. Blurring of the disc margin can be due to papilledema, AION, papillitis or optic nerve head drusen.
Biography:
Amit Solanki has been in ophthalmic field for more than 12 years. He has done his Undergraduate & Post-graduate Training from the reputed B J Medical College, Ahmedabad (Gujarat). During two years of Senior Residency tenure at renowned Aravind Eye Hospital, Tamil Nadu, he was awarded the Diplomat of National Board in Ophthalmology (DNB) by the National Board of Examinations. He also completed Special Training in Glaucoma at Aravind Eye Hospital, Coimbatore. He has presented his work at national & state conferences and received many awards. He has also delivered many lectures (more than 55) at various conferences being a guest faculty.
Abstract:
Glaucoma is the 2nd most common cause of blindness worldwide. It is the most common irreversible cause of vision loss. Definition of glaucoma has changed over a period of time. In 1960, glaucoma is a condition characterized by raised IOP, optic nerve head changes and visual field defects. In 1980, it is an optic neuropathy characterized by ONH changes, visual fields with IOP as a risk factor. In 2004, glaucoma is recognized and defined by changes in the optic nerve head and RNFL as a result of a characteristic acquired loss of retinal ganglion cells. Diagnostic tools such as Anterior segment evaluation, Gonioscopy,
Ophthalmoscopic examination, IOP, Stereoscopic ONH photograph, NFL photography, Fields, Imaging techniques are used. There are various disadvantages of each technique. C/D ratio is not reliable (tremendous variability in the size of normal disc), Photography has relatively high inter-observer and intra-observer variability: Subjective psychophysical test; Automated perimetry. It demands high degree of performance by patient. VF damage was a relatively late phenomenon, and has 30- 45% death rate of RGC to produce a demonstrable field defect. It is not sufficient to diagnose “Pre perimetric glaucoma”. So a technology that assesses the health, structure and thickness of RNFL is clearly the most appropriate choice to diagnose and follow glaucoma. In this presentation, I will be discussing the principle, techniques, interpretation, advantages and disadvantages of each imaging technique and also will compare each of them.
- Track 13: Eye-Sight and Vision: An Overview
Track 16: Cornea and Corneal desease
Session Introduction
Ajit Kumar Poddar
Akhand Jyoti Eye Hospitals, India
Title: Prevalence, causes of avoidable blindness, visual impairment and cataract surgical services in rural Bihar, India
Biography:
Ajit Kumar Poddar has completed his MBBS and MS in Ophthalmology in the year 1995 and 2002, respectively from Patna University, India. He is a Medical Director of Akhand Jyoti Eye Hospital, Bihar, India, which is the largest eye hospital in Eastern India with community eye care being its core strength. He has presented his papers at various state and national level conferences and has a surgical experience of over 100,000 surgeries. He has organized various CME and scientific seminars under his leadership.
Abstract:
Background: There is no recent evidence on the prevalence of blindness and visual impairment (VI) from rural Bihar.
Aim: To estimate the prevalence and causes of blindness and cataract surgical services in rural Bihar.
Subjects: Individuals aged ≥ 50 years were considered for this study.
Materials & Methods: We conducted a house-hold survey from January to March 2016 in randomly chosen Siwan district by using validated rapid assessment of avoidable blindness (RAAB) methodology.
Results: We enumerated 3476 and examined 3189 individuals (92% response rate). The overall prevalence of blindness, severe visual impairment (VI) and moderate VI was found to be 2.2% (95%CI: 1.6-2.8), 3.4% and 18.3%, respectively. Untreated cataract was the leading cause in all three categories including blindness (73%), severe VI (93%) and moderate VI (79%). Refractive error (71%) was the main cause in mild VI category. Cataract surgical coverage for the district was 78.1%, 79.4% for males and 77% for females. 30.6% eyes had borderline to poor outcome.
Conclusion: Untreated cataract continues to remain a major cause of avoidable blindness including both moderate and severe VI. This suggests a huge backlog of cataract cases among the marginalized populations of Bihar. In spite of good coverage, cataract surgical complications are also significant, that means quality needs to be improved. Focused community outreach services targeting the rural regions are required to address the problem.
Rajesh Babu T J
Dr Rajesh Hospitals, India
Title: Laser vision correction beyond LASIK-“RELEX SMILEâ€
Biography:
Dr.Rajesh completed his under graduation from India and post graduation from university of London. Presently as director of Dr.Rajesh Hospitals, Bangalore and Medical Director of Dr.agarwal’s eye hospital with Dr.Rajesh eye hospital Bangalore. Dr.Rajesh is one among top eye surgeons who perform SMILE procedure in India.
Abstract:
From past 2 to 3 decades widely spoken refractive treatment option across the world is LASIK; after invention of newer possibilities by Femto seond laser applications I present to you all laser flap less laser vision correction beyond LASIK “Relex Smile”
RELEX SMILE (Small incision lenticule extraction) is flapless corneal refractive surgery only femtosecond laser used to complete the refractive surgery on intact cornea, potentially reducing surgical time and side effects. SMILE could potentially replace the current, widely practiced LASIK. The three main steps involved in Relex smile are first docking then Lenticule creation on intact cornea and last extraction of lenticule through a small access incision. Docing procedure performed after application of topical anesthesia, standard sterile draping, and insertion of the speculum, the patient’s eye will be centered and docked with the curved interface cone before application of suction fixation. Then Femto second laser will then be activated for photo-dissection in the following sequence: first the posterior surface of the refractive lenticule (spiral in), Then the lenticule border is created. The anterior surface of the refractive lenticule (spiral out) is then formed which extended beyond the posterior lenticule diameter by 1 mm to form the anterior cap Followed by an access rim cut of 4mm. I use the following FS laser parameters: 120 μm flap thickness, 7.0 mm cap diameter, 6.0 mm optical zone of lenticule, 170 nj of power with side cut angles at 90°. A superior access cut of 4mm. After the suction is released by manually the refractive lenticule is separated from the stromal bed then lenticule is then grasped with non-toothed serrated forceps through the small incision and extraction completed. Post operatively medication given for a period of 4 weeks and lubrication eye drops given for a period of 12 weeks.
- Young Research Forum
Session Introduction
Kareem B. Elessawy
Cairo university, Egypt
Title: Comparative study between conventional external dacryo-cystorhinostomy and transconjunctival dacryocysto-rhinostomy for management of primary acquired naso-lacrimal duct obstruction
Biography:
Kareem B Elessawy has completed his Master’s degree in 2012 from Cairo University and MD degree from Cairo University School of Medicine in 2015. He is Assistant Lecturer in Ophthalmology Department, and he is promoted for Lecturer degree soon.
Abstract:
Purpose: To study the efficacy of scarless dacryocystorhinostomy through inferomedial transconjunctival approach in comparison to traditional external dacryocystorhinostomy.
Setting: Tertiary ophthalmic referral centre, Cairo, Egypt.
Design: Prospective randomized comparative interventional case series
Method: It included 40 eyes suffering from nasolacrimal duct obstruction that needed DCR. Patients were randomly divided into two groups. Group A included 20 eyes who underwent conventional DCR surgery via skin incision while group B included 20 eyes who underwent transconjunctival DCR.
Results: Tear meniscus height decreased in both groups after the surgery with more reduction in group A. Patient satisfaction improved in both groups after the surgery with more improvement in group A. In group A, total success was obtained in 19 cases while one case showed partial success. No failures were reported. On the other hand, group B had 17 cases with total success, 2 cases with partial success, and failure in only one case. No major intra-operative complications were encountered in external DCR group. However, complications were reported in 50 % of cases in transconjunctival approach.
Conclusion: External DCR remains the most successful surgery in the management of complete nasolacrimal duct obstruction. While, the trans-conjuntival approach may be considered as a new tool that can be used in specific patients as skin diseases, tendency
for keloid formation or patient preference with comparable results to external DCR. Also, it can be converted into external approach when needed.
Putri Pamulani
Universitas Padjadjaran, Indonesia
Title: Pathogenesis of mutant myocilin-related primary open angle glaucoma
Biography:
Putri Pamulani is a Medical Student from Universitas Padjadjaran. Talk about ideas, interested in medical science and interpersonal skill, as well as social and cultural activity, guitar and amateur art and ceramic, opened to new things and dream to explore the earth!
Abstract:
Glaucoma affected about 66.8 million people worldwide. Primary open angle glaucoma (POAG) contributed to 70% cases of glaucoma. Of different genetic type discoveries in glaucoma, MYOC gene mutation has been considered as a single POAG-causing gene. This mutation caused production of mutant myocilin protein which was rarely observed in people without glaucoma. An exact pathogenesis of how mutant myocilin induced POAG is important for further intervention and treatment, meanwhile it remains unknown. This literature review is aimed to describe the pathogenesis of POAG related to mutant myocilin. Reviewed literatures revealed that turnover of mutant myocilin involved autophagy pathway, rather than ubiquitin-proteasome and lysosomal pathways which was involved in turnover of non-mutant Myocilin. Grp94 was found as a product of unfolded protein response to mutant myocilin. Grp94 bound mutant myocilin and directed its degradation to endoplasmic reticulum-associated degradation (ERAD). ERAD pathway degraded mutant myocilin inefficiently, which resulted in accumulation of mutant myocilin. The accumulation of mutant myocilin in trabecular meshwork (TM) cells led to ER stress-induced cell death. TM cell death interfered the outflow of aqueous humour therefore increased intra-ocular pressure. Another research revealed that mutant myocilin is consistently causing stress-induced cell death by increasing sensitivity towards oxidative stress. Knowledge of the mutant myocilin involvement in POAG can help further investigation strategies for myocilin-related glaucoma. In summary, the binding between Grp94 and mutant myocilin induced the death of TM cell and led to the development of POAG.
- Posters
Session Introduction
Hamoud Al-Shahrani
Prince Sultan Military Medical City, Saudi Arabia
Title: Genetic association of catechol-O-methyltransferase val(158)met polymorphism in Saudi primary glaucoma patients
Biography:
Hamoud Al-Shahrani completed his M.B., Ch, B from Alexandria University, Alexandria, Egypt. He is Ex- Director of Prince Sultan Military Medical City, Saudi Arabia. Earlier he was Director of Academic Affairs & Training Riyadh Military Hospital. He has published several papers in reputed journals. He is associated with several ongoing projects on genetic basis of dermatological diseases in Saudis.
Abstract:
Primary glaucoma (PG) refers to a diverse group of ocular disorders that are characterized by retinal neurodegeneration, visual field defects and blindness. The etiology of PG is attributed to multifactorial mechanisms. Increasing evidence indicates that oxidative stress (OS) plays a major role in ocular pathologies. Several molecules are able to regulate interaocular pressure (IOP). Adrenergic, cholinergic, serotonergic, and dopaminergic systems are all involved. Catechol-O-methyl transferase (COMT) may be a candidate gene for PG that encodes an enzyme involved in the metabolic inactivation of dopamine. We examined a possible association between the COMT Val158Met polymorphism and PG. Saudi subjects including 210 unrelated PG patients and 177 matched controls were analyzed for allele and genotype distribution of COMT Val158Met polymorphism. We found significant differences in allele and genotype frequencies between patients and controls. The frequencies of Met(158) allele (A) and genotype Val(158)Met (GA) were significantly higher in patients compared to those in controls. On the other hand, the frequencies of Val(158) allele (G) and genotype Val(158)Val (GG) were significantly higher in controls than those in patients. We found a significant association of the COMT Val158Met polymorphism with PG. Upon stratification of our results into POAG and PACG, the distribution of frequencies genotypes followed similar pattern in PAOG and PACG. These results provide evidence for a role of COMT Val158Met polymorphism in the etiopathology of PG (PAOG and PACG) in Saudi population. It appears that the association of COMT Val158Met polymorphism with PG is not mediated by gender.
Poundra Adhisatya Pratama
Universitas Padjadjaran, Indonesia
Title: Pathogenesis of mutant myocilin-related primary open angle glaucoma
Biography:
Poundra Adhisatya Pratama is Medical Doctor graduated from Universitas Padjadjaran, Indonesia. He is now working at Majalengka District Hospital, West Java. He has a passion in medical research, especially ophthalmology. Currently he is running his Private Primary Health Care in Bandung, Indonesia and is a Founder of Global Health Alliance, a community that focused on strengthening the role of primary health care in Indonesia.
Abstract:
Glaucoma affected about 66.8 million people worldwide. Primary open angle glaucoma (POAG) contributed to 70% cases of glaucoma. Of different genetic type discoveries in glaucoma, MYOC gene mutation has been considered as a single POAG-causing gene. This mutation caused production of mutant myocilin protein which was rarely observed in people without glaucoma. An exact pathogenesis of how mutant myocilin induced POAG is important for further intervention and treatment, meanwhile it remains unknown. This literature review is aimed to describe the pathogenesis of POAG related to mutant myocilin. Reviewed literatures revealed that turnover of mutant myocilin involved autophagy pathway, rather than ubiquitin-proteasome and lysosomal pathways which was involved in turnover of non-mutant Myocilin. Grp94 was found as a product of unfolded protein response to mutant myocilin. Grp94 bound mutant myocilin and directed its degradation to endoplasmic reticulum-associated degradation (ERAD). ERAD pathway degraded mutant myocilin inefficiently, which resulted in accumulation of mutant myocilin.The accumulation of mutant myocilin in trabecular meshwork (TM) cells led to ER stress-induced cell death. TM cell death interfered the outflow of aqueous humour therefore increased intra-ocular pressure. Another research revealed that mutant myocilin is consistently causing stress-induced cell death by increasing sensitivity towards oxidative stress. Knowledge of the mutant myocilin involvement in POAG can help further investigation strategies for myocilin-related glaucoma. In summary, the binding between Grp94 and mutant myocilin induced the death of TM cell and led to the development of POAG.
- Track 17: Retina and Retinal Disorders and Ophthalmic education
Session Introduction
Prashant S Agnihotri
Retina Care Hospital, India
Title: Branch retinal vein occlusion: New paradigm
Biography:
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.
Abstract:
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 Manivasagan
Dr. Thakorbhai V Patel Eye Institute, India
Title: Nasolacrimal duct obstruction: Can we get away with membranatomy at the NLD junction and avoid probing
Biography:
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.
Abstract:
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
Akhand Jyoti Eye Hospitals, India
Title: Prevalence of diabetes mellitus and diabetic retinopathy in rural Bihar, India
Biography:
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.
Abstract:
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
Vivekananda Mission Asram Netra Niramay Niketan, India
Title: Practical tips for running a successful ophthalmic training institute
Biography:
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.
Abstract:
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.
- Workshop
Biography:
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.
Abstract:
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.
Biography:
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.
Abstract:
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
University of Health Sciences, India
Title: Interpretation of automated perimetry
Biography:
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.
Abstract:
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.
Biography:
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.
Abstract:
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.