Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 15th International Congress on Vision Science and Eye London, UK.

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Day 1 :

Keynote Forum

Samer Hamada

Cornea surgeon, The Eye Clinic London, UK

Keynote: Ocular Surface Reconstruction: Current and Future

Time : 10:00 AM - 11:00 AM

Vision Science and Eye 2017 International Conference Keynote Speaker Samer Hamada photo
Biography:

Samer Hamada, MD, is an ophthalmologist and cornea surgeon performing eye surgeries at his practice, the Eye Clinic London. With nearly two decades' experience, Mr. Hamada is recognised as a leading expert in the field of cataract, refractive lens exchange (RLE) and corneal surgeries, and is frequently asked to lecture at international eye conferences. He has performed thousands of cataract surgeries and RLE surgeries using the latest technological advancements in ophthalmology. Mr. Hamada offers laser cataract surgery with the option of artificial lenses, called intraocular lenses (IOLs), to replace the natural eye lens that has been clouded by a cataract. These IOLs are used for the restoration of near, intermediate and far vision. He is one of the very few eye surgeons who offer trifocal intraocular lens implants. Patients who prefer to be less dependent on glasses or contact lenses, even without a significant amount of clouding due to cataracts, could choose laser or non-laser RLE, both of which are very similar to cataract surgery.

Abstract:

15 years of stem cell research has led to breakthrough in reconstructing the cornea and ocular surface. We are now able to use allogenic or autogenic stem cells for corneal Limbal stem cell deficiency. The latest and most favourable method of reconstructing the ocular surface is the Mouth to Eye Epithelial Transplantation (MEET). It has the advantages of replacing the deficient corneal stem cells as well as creating a microenvironment that would increase the success rate of any future ocular reconstructive procedures. I will present my approach to rehabilitate a damaged ocular surface through various examples and share my experience with MEET both in adults and children

  • Ocular Oncology

Chair

Session 1

Session Introduction

Fawzia Bardag-Gorce

Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, USA

Title: Cultured Autologous Oral Mucosa Epithelial Cell Sheet (CAOMECS) For Corneal Epithelial Regeneration
Biography:

Dr. Bardag-Gorce has been studying ocular surface disease for the last 6 years, and has since published and co‑authored 6 peer-reviewed publications in the field. She began her research on the treatment of limbal stem cell deficiency using cultured autologous oral mucosa epithelial cell sheet (CAOMECS). During these six years, and under her supervision and guidance, her lab has successfully completed pre-clinical studies related to the efficacy and safety of CAOMECS cell-based therapy [see above cited publications]. She is currently directing a new study approved by the Institutional Research Board in which subjects are being recruited for the human oral mucosal epithelial cell sheet characterization. The long-term goal of this study is to regenerate corneal epithelium in patient with severe ocular surface diseases using autologous oral mucosa epithelial cell sheet grafts. 

Abstract:

Statement of the Problem: Corneal limbal stem-cell deficiency (LSCD) caused by ocular trauma or by eye disease leads to impaired corneal epithelial regeneration and conjunctivalization, neovascularization, which often results in significant vision impairment. Patients with bilateral or unilateral LSCD are currently treated with ex vivo cultured allogeneic or autologous transplant of limbal stem cells.  Allogenic grafts requires immunosuppression, and autologous grafts are associated with other risks. 

The purpose of this study is to use a carrier-free cultured autologous oral mucosal epithelial cell sheet (CAOMECS) graft as a therapeutic approach to improve the health and transparency of the corneal epithelium. 

Methodology & Theoretical Orientation: Using a small biopsy from the buccal cheek, epithelial cells were isolated and cultured for two weeks on a temperature responsive surface (CellSeed Inc. Japan). CAOMECS was harvested and grafted onto the cornea of rabbits with experimentally induced LSCD.

 Findings: Both rabbit and human CAOMECS grafts resulted to a multi‑stratified epithelium similar to corneal epithelium with basal cell positive for DeltaNp63 (a marker of progenitor stem cell).  CAOMECS grafts had a healthy extra‑cellular matrix including balanced pro- and anti‑angiogenic factors and upregulated levels of adhesion molecules necessary for the epithelial integrity. CAOMECS grafting onto corneas of rabbits with LSCD successfully re‑epithelized the ocular surface, reduced cornea vascularization and reduced fibrotic tissue re-growth.  We also demonstrated that diseased corneas with LSCD showed little or no staining for adhesion molecules, while CAOMECS-grafted corneas showed normal expression of adhesion molecules and junctional complexes, which is indicative of a non-migratory behavior of cells in CAOMECS. 

Conclusion & Significance: Carrier-free CAOMECS grafting improved the ocular surface in a rabbit model of LSCD.  CAOMECS grafts renewed corneal epithelial cells, including basal cells positive for progenitor stem cells, acted as a barrier to conjunctivalization and neovascularization, and conferred anti-inflammatory as well as anti-fibrotic effects.

Samer Hamada

Cornea surgeon, The Eye Clinic London, UK

Title: Multifocal intraocular lenses: Keys to Success!
Speaker
Biography:

Samer Hamada, MD, is an ophthalmologist and cornea surgeon performing eye surgeries at his practice, the Eye Clinic London. With nearly two decades' experience, Mr. Hamada is recognised as a leading expert in the field of cataract, refractive lens exchange (RLE) and corneal surgeries, and is frequently asked to lecture at international eye conferences. He has performed thousands of cataract surgeries and RLE surgeries using the latest technological advancements in ophthalmology. Mr. Hamada offers laser cataract surgery with the option of artificial lenses, called intraocular lenses (IOLs), to replace the natural eye lens that has been clouded by a cataract. These IOLs are used for the restoration of near, intermediate and far vision. He is one of the very few eye surgeons who offer trifocal intraocular lens implants. Patients who prefer to be less dependent on glasses or contact lenses, even without a significant amount of clouding due to cataracts, could choose laser or non-laser RLE, both of which are very similar to cataract surgery.

Abstract:

Cataract surgery is becoming a refractive surgery. The requirements of our patients are changing and most of our patients are looking for glasses independence after cataract surgery. Refractive lens exchange as well has increased in our practice due to expanding awarness among patients about refractive options past the age of 45. The key elements to success are choosing the most suitable patients, perfect planing, knowledge of available technologies and appreciating the differences so choice to meet patients requirements and life style, surgical techniques, measuring outcomes, and auditing own results.

  • Ophthalmology and Vision Science
Speaker
Biography:

Miguel Rechichi has completed his training in ophthalmology and his PhD from Magna Graecia University and Diploma of Specialist Superior in Ophthalmology from University of Lugano (Switzerland). He’s actually founder of corneal and refractive Surgery service of Eye Center Clinic in Catanzaro, Italy. He was a pioneer of crosslinking clinical application and actually is involved in developing new accelerated cxl protocols and topography guided crosslinking for which he’s invited as opinion leader to several meetings. He has published several papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Corneal collagen cross-linking (CXL) is being used worldwide as a first- line treatment for keratoconus, pellucid marginal degeneration, and post-LASIK ectasia. CXL has been shown to be both safe and effective and nowadays patients as young as 10 routinely undergo this form of treatment when they are first diagnosed with keratoconus. As expected, CXL in the early stages of disease is more successful than in the advanced stages.Treatment may help prevent the corneal thinning and apical scarring typical of advanced keratoconus. After CXL, many patients can resume wearing their contact lenses in a few days or a few weeks. Their vision gradually improves weeks to months after treatment, as the cornea undergoes remodeling. In some cases, improvement continues for many years. Evolution of cxl machines alone was incredible and in the near future topography-guided cxl treatment will be available. More than this several procedures that can be actually combined with CXL, such as topography-guided PRK, intracorneal ring segments, and phakic IOLs. The actual target of cxl research is to evaluate various methods of cross linking to provide better option to patients not only for halting keratoconus but, when possible, to improve corrected and uncorrected visual acuity.

Faisal Fayyad

Senior Vitreo-retinal surgeon, Jordanian Hospital, Jordan

Title: Management of Severe Eye Trauma and Retained Intraocular Foreign Bodies (IOFBs).
Speaker
Biography:

Senior Vitreo-retinal consultant at the Jordanian Hospital in Amman. Fayyad graduated from Rome University (La Sapienza) in 1976, and completed his residency program in ophthalmology at the same university between 1977 and 1981 with honors. He then traveled to Canada and completed a two year fellowship program in clinical Retina, at the department of ophthalmology at Ottawa University. He served at the Jordanian ministry of health hospitals and the King Hussein Medical Center as well as at the Jordan University Hospital.An examiner at the Jordanian Board of Ophthalmology. Fayyad is involved in training ophthalmologists in Vitreo-retinal surgery.

Abstract:

Eye trauma including retained IOFBs carries many challenges in the management and prognosis depends on the severity of the initial trauma.Traditional good prognostic factors include; small foreign bodies with anterior location, clear media, no afferent pupillary defect and good vision at presentation. Traditional poor prognostic factors are; globe rupture, large retained IOFBs with posterior location, afferent pupillary defect, media opacity and poor vision at presentation. No light perception (NLP) is not a contra-indication for surgery, unless a combined lesion involving the optic nerve is present. There are possible causes of permanent NLP vision in the injured eye, including total destruction of the eyeball, loss of posterior retina and major optic nerve trauma. There are many possible causes of potentially reversible NLP vision in the injured eye and this includes patients with altered mental status, severe lid edema with inability to open, corneal wound with edema, Hyphema, traumatic cataract, severe vitreous hemorrhage, retinal edema with hemorrhage, retinal detachment, subretinal hemorrhage and suprachoroidal hemorrhage. In the management of eye trauma there is no specific protocol to follow, and the choice of treatment depends on personal experience and experience of others. In perforating eye injuries closure of the posterior wound is often impossible, with the risk of retinal incarceration. Primary surgery includes the closure of the entrance and exit wounds if it is anterior to the equator, with anterior segment reconstruction if needed and limited PPV to remove the vitreous traction between the entrance and exit wounds. Secondary surgery to follow within 100 hours. Chorioretinectomy lowers the PVR rate, prevents retinal folds and improves prognosis. The final goal of our treatment should be to restore the best possible vision and to prevent immediate and late complications.

Douglas Borchman

University of Louisville, School of Medicine, USA

Title: Whales, lifespan, phospholipids and the cause and cure for cataracts
Speaker
Biography:

Dr. Borchman is a Professor of Ophthalmology and Visual Sciences at the University of Louisville.  He is also an adjunct Professor in the Departments of Chemistry, and Physiology and Biophysics.  He earned a Ph.D. in Chemistry from Wayne State University and is the author of over 100 peer reviewed articles. He is/was principal or co-investigator on seven major peer awarded grants totaling over 10 million dollars to study cataract and dry eye.  His 1st and last major NIH grants scored in the top 5% and 2% of the nation, respectively. He has given over 250 scientific presentations around the world.

Abstract:

Our study addresses the question why do rats get cataracts at two years, dogs at eight years and whales do not get catarcts for over 200 years? The cholesterol and phospholipid content of bow head whale lenses were measured using 1H and 31P NMR spectroscopy, respectively. Lens lipid structure was measured using FTIR spectroscopy. Whale lens lipid phase transitions were compared to the lipid phase transitions of rabbit, guinea pig, bovine, camel and human lenses. The major phospholipids of the whale lens were sphingolipids which composed 60 to 100 % of the total phospholipid. The average molar cholesterol/phospholipid ratio for all four samples was similar 10 moles cholesterol per mole phospholipid. There was a linear correlation between the percentage of lens sphingolipid and lens lipid hydrocarbon chain order until about 60 % sphingolipid. The percentage of lens sphingolipid correlated with the lens lipid phase transition temperature.  The expected lifespan of the bowhead whale (200 y) and the percentage of whale lens sphingolipid fit well in the correlation between the percentage of lens sphingolipid and expected lifespan measured for other species. In conclusion, bowhead whale lens membranes have a high sphingolipid content that confers resistance to oxidation, allowing these lenses to stay clear for a relatively longer time than is the case in many other species. If human lenses could be made to have a lipid composition similar to bowhead whales, like the whale, one could hope humans would not develop cataracts for over 200 years.

Speaker
Biography:

Dr. R. Lakshminarayanan obtained his PhD from the Department of Chemistry at the National University of Singapore. He was a recipient of the Singapore Millennium Foundation Postdoctoral Fellow and then obtained further postdoctoral training at the University of Southern California. Since 2009, he has been working as a Principal Investigator II at the Singapore Eye Research Institute. His major interests include antimicrobial polymers and peptides, antimicrobial coatings for medical devices, new crosslinking methods for electrospinning of hydrogel polymers and protein aggregation diseases. He has published more than 80 papers in reputed journals and 3 book chapters. 

Abstract:

In the era of increasing evolution of antimicrobial resistance to antibiotics treatment, there is a perceived need for antiseptics with high biocompatibility index for the management of topical infections. Since the fitness cost for a microbes to modify microbial membranes is higher, agents that target cytoplasmic membranes of prokaryotes are attractive alternatives for combating antimicrobial resistance. Cationic antimicrobial polymers have been shown to elicit rapid bactericidal action by targeting cytoplasmic membrane of the bacteria, but their cytotoxicity for mammalian cells limited their therapeutic potential. In this work, we tested the antimicrobial activity and mammalian cell cytotoxicity of cationic polymers with varying back bones and side chain functional groups. Among the various polymers compared,  polymers with ethylenimine (Polymer1) or isopeptide (Polymer 7) backbones displayed good selectivity for microbial cell membranes over mammalian cell membranes. Both the polymers abrogated the adverse effects of bacteria or bacterial secretomes on cell morphology and cell migration, respectively. Polymer 7 displayed broad-spectrum antimicrobial properties which includes carbapenem-resistant enterobacteriocae, vancomycin-resistant enterococcus, MRSA, multi-drug resistant Pseudomonas aeruginosa and filamentous fungal pathogens. The polymer elicits rapbid bactericidal activity, antibiofilm properties and inhibits fungal hyphae as well. Topical instillation of the polymer (0.3% w/v in PBS) restored the re-epithelialization in a rabbit corneal scratch wound model, indicating good biocompatibility. In a rabbit model of  bacterial keratitis, topical instillation of Polymer 7 decreased the bacterial bioburden, conreal edema and conjuntival redness when compared to topical antibiotics. Together, these results establish excellent safety and efficacy of the polymer for treating topical infections. 

Tsioumas G. Sotiris

Eye surgeon – Oculoplastic, President of Hellenic Society of Aesthetic Medicine and Non Invasive Surgery, Prof of University of Camerino for Aesthetic Medicine, Greece

Title: New treatment with Plasma Exeresis for non- surgical blepharoplasty
Speaker
Biography:

Dr. Tsioumas is a surgeon Opthamologist and graduate of the Medical School of the University of Modena in Italy. He is a master in Aesthetic Medicine , having completed his specialization at the “Agios Savvas” Oncology hospital; , and his areas of specification include toxins , fillers , mesotherapy , peels , threads , tumour removal and painless , bloodless and suture-free blepharoplasty with Plexr. Dr Tsioumas is also a lecturer at the University of Camerino and President of S.A.M.N.A.S (Society Aesthetic Medicine Non Ablative Surgery. Moreover his persistent research and devotion on Aesthetic Medicine made him write his first book “Manual of Aesthetic Medicine “ that was translated in three languages.

Abstract:

The survey aims to highlight new noninvasive techniques on Oculoplastic focusing on the eyelid. Research and test object were 80 patients, age range 40-78 years, who had problems of small, medium and high degree of ptosis and problems from older surgical blepharoplasties. Common factor and 80 cases were surgical avoidance desire, due to cost and fear in the process. The method of solving the mentioned problems was the bloodless blepharoplasty using Plasma Exeresis. For the evaluation of the results through Plasma Exeresis method, set a satisfaction scale of 1 to 5 (1 = not at all satisfied - 5 = completely satisfied). All patients have described the results of treatment as 5 .

  • Vision and Cognition

Session Introduction

Sergio Ozan

CEPROC Centro Prótesis Oculares y Contactología especializada. Mendoza. Argentina

Title: JUMAT Orbit Implant
Speaker
Biography:

Optician, University of Buenos Aires, Argentina. Specialist in Contact Lenses. Specialist and manufacturer of ocular prosthesis. Scientific adviser  for ocular prosthesis in APO (Asociación Profesional de Optómetras in Argentina). Precursor and creator of multiperforated orbital implant, JUMAT. Precursor and creator of expander orbit asmotic hydrogel filling for microophthalmia. Director of CEPROC.  Director of Ocular Prosthesis Division in Perfect Vision, Santiago, Chile. Developer of one-hour customized ocular prosthesis method, unique in Latinamerica. Precursor and creator of the first prosthetic sclera lens

Abstract:

This implant was created considering the good qualities of previous ones and improving their flaws. To start the fabrication I looked for material that was easy to get in the market and with low cost. JUMAT is made with hypoallergenic high-density polymethylmethacrylate. It is made in different sizes, from 10 mm to 22 mm. This is really helpful for the surgeon as he counts with different sizes at the operation theater and can select on site the most suitable one. This is essential for the successful adaptation of the implant.

JUMAT Orbit implant has multiple perforations of different diameters, being the principal one, the one that marks the implant axis and crosses it completely. This perforation has larger diameter in the back area and smaller in the front one. All other perforations connect with the principal one and interconnect among themselves too. This system of perforations is essential to foster an excellent vascularization.  Within ten days of surgery the patient is ready to start with the testing for the adaptation of a prosthethic eye.

As from 2010 to present time, 235 JUMAT implants have been implanted with only two expulsions reported. These cases were studied in detail. It was observed that both cases involved children with retinoblastoma. They were enucleated and were implanted with JUMAT.

These two children were derived  to Children's Garrahan Hospital in Buenos Aires, leading children’s hospital in Argentina. They were under radiotherapy and chemotherapy. These two processes avoided tissue vascularization by necrosia, which determined the expulsion of the implant.

Considering material, cost of material, availability of various implant dimensions, surgeon possibility of choosing exact measure during operation, JUMAT implant proves to be the best option.

  • Visual Impairment

Session Introduction

Petar Markov

Cardiff University, UK

Title: Hitting the Bullseye: Computer Models for Treating Vision Disorders
Speaker
Biography:

Petar Markov is currently doing his PhD at Cardiff University as part of a joined project between the Schools of Optometry and Vision Sciences, Biosciences and Engineering. Previously an Erasmus student, he completed his Master’s thesis at the Institute of Genetics and Molecular and Cellular Biology (IGBMC) in Strasbourg, France. Having a background in Molecular biology and Biophysics, respectively his Bachelor's and Master's degrees from Sofia University benefits his investigation of the role of ocular fibroblasts in determining tissue biomechanics in healthy and diseased eyes. Petar is also a member of the Cardiff Institute of Tissue Engineering and Repair (CITER), which coincides with his interests in further studying ocular diseases and developing new treatments.

Abstract:

Statement of the Problem: Over 300 million people worldwide are affected by vision impairment. Thus, extensive research efforts are being directed towards developing new and improved treatments. The sclera (white of the eye) is vital for healthy vision because it maintains the eye’s structural stability and shape, properties which are compromised in prevalent conditions such as myopia and glaucoma. To better comprehend the disease mechanisms we aim to create biomechanical computer models of the eye that incorporate physiological data on both the scleral cell cytoskeletal and extracellular matrix (ECM) components. Specifically, we targeted the scleral region bordering the optic nerve, a key region in glaucoma and myopia development.

Methodology & Theoretical Orientation: Because body physiology slows down with time we required specimens from closely-matched young adult age. This is particularly problematic when dealing with human tissues. Therefore, we compared several mammal species to find a suitable human analogue. Wide-angle X-ray scattering (WAXS) was used to map the scleral collagen orientation and distribution, while multi-photon microscopy provided clarity on the depth profile. The geometry of the eyeball was acquired from video motion capture imaging of specimens that were inflated under simulated eye pressure. Planned experiments include studies of fibroblast cytoskeletal reorganisation under simulated eye pressure (mimicking glaucoma).

Findings: After comparing 11 mammal species our results revealed that the peripapillary sclera of the bovine has a tissue structure closely resembling that of humans, including the important annular structure around the optic nerve, which is vital for its mechanical support. Furthermore, we have optimized protocols for bovine fibroblasts, which will be used to study their pressure-controlled mechanotransduction pathways.

Conclusion & Significance: ECM and cytoskeletal structural information will be used along with geometric data to create integrated models of the eye for driving future scleral-targeted treatments for glaucoma and myopia.

Kristin Smedley

President & Co-Founder, Curing Retinal Blindness Foundation (CRB1 LCA/RP Patient Organization), USA

Title: The Bridge From Diagnosis To Potential Treatment: The Crucial Role Clinicians Play in Success For Blind Individuals
Speaker
Biography:

Kristin Smedley, from Bucks County, Pennsylvania, is an award winning non-profit leader, TEDx speaker, and author - but she never planned on any of that. Kristin did plan to be a really great third grade teacher, however her personal path to greatness took an unexpected turn when two of her three children were diagnosed as blind. She had to learn the tools of blindness and build a team of experts that would help her navigate this path that she had not been trained for. Kristin’s two blind sons are now thriving as gifted high school and middle school students, elected student council officials, baseball championship winners, International Braille competition finalists, and social butterflies.

In 2011 Kristin founded the Curing Retinal Blindness Foundation (www.crb1.org), the only patient organization in the world for her sons’ blindness, CRB1 LCA/RP. Kristin has led the CRBF to raise over $1 Million, introduced the first ever legislation in the United States in Braille, and has moved rare eye diseases from rarely talked about to being discussed in key circles worldwide. In 2017 Kristin published her first book, Thriving Blind: Stories of Success Without Sight.
Kristin enjoys speaking about her journey and pointing out where she can find the fun in fundamentally challenging situations life delivers. Kristin’s inspirational and humorous style leaves audiences of all sizes wanting to hear more.

Abstract:

Overview:
This dynamic session will provide concrete examples of how connecting blind individuals to resources creates a bridge from diagnosis to potential treatment, thereby enabling the individual to lead a successful life without sight.

Background:
A diagnosis of blindness is devastating. Whether it is an adult that finds out they are losing their sight or a parent finding out their baby has no sight, it is a traumatic experience. Typically, clinicians say nothing more than “I’m sorry” to the patients and their caregivers. Parents’ dreams for their child are destroyed and they feel hopeless, which usually causes them to completely alter the way in which they parent that blind child. Adults that lose their sight often end up unemployed and depressed. In fact, 70% of blind adults are unemployed. Although the impact of blindness is affecting more and more people, most sighted people have no idea of what blind individuals are capable of and therefore a stigma of sadness and pity is misappropriated to the blind community. This stigma creates a vicious cycle of low expectations, under achievement and dependence for blind individuals.

Changing The Blindness/Visual Impairment Diagnosis Delivery:
Kristin Smedley is raising two sons that are blind due to CRB1 LCA/RP. In the seventeen years she has been a parent of blind children she has connected with many successful blind adults to guide her in raising her expectations of her boys and getting all the resources they need to level the educational and social playing field of their peers. She connected with other families raising CRB1 LCA/RP children to share resources. Smedley leads the Curing Retinal Blindness Foundation, the only patient organization in the world for CRB1 LCA/RP. The CRBF is a leader in the rare eye disease community. The CRBF has created a resource toolkit for clinicians, educators, and caregivers to change the way a blindness/visual impairment diagnosis is delivered such that patients are empowered to lead a full life.

Results:
Due to consistent exposure to blind role models and proper resources as well as maintaining high expectations for a full life, Smedley’s two blind sons have achieved success much greater than many blind children their age: baseball and swimming championships, elected student council executives, International Braille competition awards, gifted programs in regular public schools and more. In addition, the CRBF has forged collaboration in the rare eye disease community where multiple organizations are combining resources to affect many more patients, clinicians, researchers and caregivers for a positive impact worldwide.

  • Diabetic Retinopathy

Session Introduction

Rashidul Haque

Emory University School of Medicine, Atlanta, USA

Title: MicroRNA and the ocular Renin-Angiotensin System
Speaker
Biography:

He has more than 20 years of experience in molecular biology research. His research interest includes retinal circadian biology as well as ocular microRNA. He is interested in characterizing microRNA molecules and investigating their role in the expression of genes related to ocular diseases like age-related macular degeneration, diabetic retinopathy, and retinal vascular diseases. He is a member of the Association for Research in Vision and Ophthalmology.

Abstract:

Angiotensin (Ang) II is the most physiologically active component of RAS that mediates its effect through two G-protein coupled receptors, Ang II type 1 or type 2 (AT1R and AT2R), having different functional properties and signal transduction mechanisms. Most of the known cardiovascular effects of Ang II are mediated by AT1R. Prorenin has long been considered as an inactive precursor of renin, without any biological function of its own. However, prorenin binding to a receptor called (pro)renin receptor (PRR) has recently been reported to exert biological effects in the neuronal retina and retinal pigment epithelium (RPE). All the components of the RAS including PRR are expressed in RPE, retinal endothelial cells, and other ocular cell types. It is also known now that Prorenin is highly elevated in ocular fluid of diabetic patients with proliferative retinopathy, which all suggest that Prorenin and the system RAS are very important in the eye. Using RNA interference tools, we have shown that both the receptors are implicated in hyperglycemia-induced increase of vascular endothelial growth factor (VEGF), VEGFR2, and transforming growth factor beta (TGFβ1). In order to block the effect of Ang II through AT1R and AT2R, in our experiments we inhibited angiotensin converting enzyme (ACE) by perindopril, where Ang II formation is blocked. We have shown that the increased prorenin synthesis due to hyperglycemia has been attributed to the activation of PRR and VEGF by a mechanism involving NADPH oxidase activity, miRNA-21, HIF1-α and NF-κB. Furthermore, we have demonstrated that the downstream targets of miR-21 are three important genes Smad7, an inhibitor of TGF-β1-induced VEGF expression, Pten, a negative regulator of PI3 kinase/Akt signaling pathway, and Spry1, a negative regulator of ERK signaling pathway. The PRR-mediated induction of VEGF under hyperglycemic conditions occurs via Rac1 signaling by regulating miR-21 expression. Our studies suggest that hyperglycemica-induced PRR signaling may play a role in the VEGF-induced angiogenesis that may lead to proliferative diabetic retinopathy, wet AMD and other vascular complications in the eye.

Nilufer Koyluoglu

Liv Hospital Adnan Saygun St Canan st no 5 Ulus - Beşiktaş, Turkey

Title: WHAT & WHEN WOULD YOU KNOW?
Speaker
Biography:

She graduated from Istanbul University, Istanbul School of Medicine in 1997. She was completed her residency in Ophthamology, Istanbul Universtiy, Cerrahpasa School of Medicine, Department of Ophthalmology in 2002. She has worked in Turkish Diabetes Hospital since 2002. She has held the position of Medical Retina Specialist and deputiy Chief Physician in Dünyagöz Hospital between 2005-2016. She coordinated the first bionic eye operational procedures in Turkey; incorporating the Frankfurt World Eye Hospital in Germany as scientific committe initiative and a board member of Dünyagöz Foundation. She initiated the projects Dunyadiyabet and Athletic Eye Health in order to contribute to ‘Retina Awareness’ as a clinical scientist to prevent the loss of resources that would be used for keeping patients healthy. She aims that the eye would be a symbol organ/logo for the preventive medicine globally, starting from athletes. She is the consultant ophthalmologist for the Association of Turkish Family Medicine and the Turkish Family Medicine Federation and active member of AAO, Euroretina, ARVO, Board member of Turkish Medicine Academy, Turkish Society of Pharmacogenomic and Personalized Medicine, Turkish Diabetes Association and Turkish Association of Ophthalmology. She works with the international program of the Orbis, married with two children.

Abstract:

INTRODUCTION

Over 382 million people in the World have diabetes, 46% of globally diabetes population is undiagnosed. Up to 50% of diabetes is detected with a clinical complication. Diabetic population will increase 54% while the number of ophthalmologists will increase by 2%. Will present activities address the magnitude of the issues that are coming up? This massive problem requires a high level solution. The average lag between onset and diagnosis of type 2 diabetes is 7 years. If diabetes cannot be prevented, the best way to ensure better patient outcomes is to detect early and manage continuously. Fortunately technological developments can make a significant difference in perception.

Advanced glycation end products (AGEs) are proteins that become glycated as a result of exposure to sugars. AGEs affect nearly every type of cell and molecule in the body. In the blood stream glucose sticks to the haemoglobin to make a 'glycosylated haemoglobin' molecule, called haemoglobin A1C (HbA1c) which is most recognised one among the large molecular family of AGEs. HbA1c is measured primarily to identify the three-month average plasma glucose concentration. The HbA1C test is currently one of the best ways to check diabetes is under control.

In a similar way fructosamine testing, typically reflect albumin glycation that is rarely used in clinical practice, because albumin has a half-life of approximately 20 days, the plasma fructosamine concentration reflects relatively recent (1-2 week) changes in blood glucose.

Although most proteins in living system turn over with sufficient rapidity to avoid signficant accumuation of AGEs, published evidence shows that with the appearance of glucose in the blood, glucose also appears in the aqueous humor of the eye and is subsequently transported within the crystalline lens. These glucose molecules are still “sticky,” with the same affinity for protein, including collagen within the lens. The non-enzymatic, chemical bonding between glucose and lens proteins forms irreversible glyco-protein aggregates. AGEs accumuate in these proteins over a persons lifetime.

Lens autoluorescence may have a clinical utility is suggested by its physiological basis, which is the accumulation of AGEs, a heterogenous family of yellow-brown and fluorescent proteins that have been modified by glycation.

MATHERIAL AND METHOD

Studies of the autoflurescence of the human crytalline lens have established that lens autofluorescence intensity increases with the age of the subject and that lens autofluorescence is further increased in patients with diabetes mellitus. Thus lens autofluorescence as a noninvasive measure of AGE accumulation, can be regarded as a measure of cumulative tissue damage due to elevated sugar in plasma and interstitial fluids. The clinical application of lens autofluorescence with a scanning confocal lens fluorescence biomicroscope enables the clinican to measure lens autofluorescence in routine examinations. Patients with lens fluorescence significantly higher then expected for their ages may have accelereted accumulation of AGEs and increased risk for the pathologies associated with diabetes and AGEs. AGEs throughout the body, including lenticular AGE’s, are higher in people with diabetes and pre-diabetes than the rest of the population. An interesting characteristic of AGE’s is that they will fluoresce when exposed to light, and the amount of fluorescence can be detected by an optical sensor. The transparency of the ocular media (cornea, aqueous and lens) provides a unique opportunity to shine an excitatory light source on fluorescent AGEs within the human lens and correlate that fluorescence with the degree of AGE deposition. The only technology available in the U.S. cleared by the U.S. Food and Drug Administration (FDA) for the non-invasive measurement of lens autofluorescence is the CLEARPATH DS-120™, manufactured by Freedom Meditech, Inc. (San Diego, CA). 

RESULTS

The CLEARPATH DS-120™ accurately measures a person’s lenticular fluorescence and reports if the result is at normal, high, or low limits versus age-adjusted normative data. Thus, since the glycation process in the lens has been reported to be irreversible, one can think of lens autofluorescence as a tool to obtain information about a person’s glucose excursions over a lifetime. Over 60 peer-reviewed published studies have shown a significant correlation between higher than average age-dependent lens autofluorescence, associated degenerative changes in the lens, and the presence of AGE’s, which are considered a hallmark of uncontrolled glucose. Patients with measurements above the 95% prediction interval should be referred by the clinician to primary care for a follow-on glycemic control evaluation. For patient’s whose measurements fall between the 80% and 95% prediction intervals, the clinician may decide to perform a clearpath evaluation annually to monitor if a patient’s fluorescence ratio moves up to the 95% prediction interval. Patients with an autofluorescence measure below the 80% prediction interval are suggested for a clearpath evaluation again in three years time. By placing a patients’s lens autofluorescence measure the clinician can identify patients with lens fluorescence that is higher than expected as red or orange line. Patients with measurements above the 95% prediction interval should be referred by the clinician to primary care for follow on glycemic control evalution. Above the red line means that is highly likely they will receive a differential diagnosis of prediabetes or diabetes. Orange colour code means the patient has higher than expected AGE accumulation again. It is likey they have had poor glucose control over their lifetime. Green line means the patient is likely within normal range and has had less than expected AGE accumulation, if the subject has diabetes, it is possible their glucose levels have been under good control such as diabetic patients with normal HbA1c. It is also possible the patient has latent autoimmune diabetes in adults or other metabolic issues such as pancreatitis, infections, and certain drugs maybe in green due short duration of out of control glucose. On the other side, lens autofluorescence measurement can identify patients with lens fluorescence lower than expected as under the green line. Thus fluorescein ratio provides information on the mobility of the person, the calories they get / the calories burned and
it should be investigated by further studies whether it will be an athletic performance indicator such as an athlete's pulse.

CONCLUSION

The clinical data indicated that the fluorescence ratio could provide better discrimination between individuals with and without diabetes than fluorescence intensity. This new parameter expresses metabolic control as longterm for patients with or without diabetes. Whereupon the crystalline lens has a new dimension which is providing information other than its own function related to visual function and cataract, as HbA1c that provides information other than haemoglobin’s own function If we think of fasting blood sugar and postprandial blood sugar as photograph, HbA1c as fragman, fluorescein ratio can be considered as whole film of life until cataract operation and it should be considered as a metabolic credit note of the person. Noninvasive measurements of lens autofluorescence may have clinical utility for general health beyond the diabetes and its complication.

  • Visual Neuroscience
Speaker
Biography:

Dr Haisheng Zhao has his expertise in optic nerve injury and regeneration, neuroprotection on retinal ganglion cells. He has published 6 peer-reviewed journal articles in this aspect. He also has his research interests on maculopathy and age-related macular degeneration, and he has published 2 peer-reviewed journal articles in this aspect. Based on15 years of research accumulation, he has given 13 international seminar and conference presentations. His conference contribution “Expression of Thy1 in rat retinal ganglion cell cultures is regulated by LEDGFp52”and “A comparison of None-staining of the internal limiting membrane vitrectomy outcomes for high myopic patients with macular hole (MH) and control patients with idiopathic MH” represent his recent research results both in basic and clinic interests. These two results will provide some new looks on RGCs neuroprotection and MH surgery skills.

Abstract:

Statement of the Problem:  To evaluate None-staining of the internal limiting membrane vitrectomy outcomes for high myopic patients with macular hole (MH) and to compare these outcomes with those of control patients with idiopathic MH.

Methodology & Theoretical Orientation:  The study was designed as a retrospective chart review. We performed a retrospective chart review of consecutive cases that underwent None-staining of the internal limiting membrane vitrectomy for MH from 2016.1 through 2017.2. 36 eyes of 36 patients were selected to participate in this study. They were divided into 2 groups: 9 study eyes with high myopic MH and 27 control eyes with idiopathic MH. The main outcomes were preoperative, postoperative best-corrected visual acuity (BCVA), MH closure rates, and abnormal IOP complications in both groups.

Findings: There was a closure rate of 88% in the study group and 85% in the control groups, and no cases of reopening were reported during the follow-up visits. After surgery, there were significant improvement of mean BCVA in the study group(88%)and in the control group (85%). The aplitude of postoperative BCVA in the study group was significantly higher than that in the control group. Abnormal IOP complications taken place in the study group was 33%,while in the control group was 11%. Conclusion & Significance: None-staining of the internal limiting membrane vitrectomy results in satisfactory anatomical and visual acuity improvement in patients with high myopic MH and in patients with idiopathic MHs. However,abnormal IOP complications taken place in the high myopic MH group was higer than that in the idiopathic MHs group. Therefore,pay much more attention to control and regulate IOP in the duration and post of surgery.