Day 1 :
Cornea surgeon, The Eye Clinic London, UK
Time : 10:00 AM - 11:00 AM
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.
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
- Ophthalmolgy and Vision Science | Vision and Cognition
Jordanian Hospital, Jordan
University of Louisville, USA
Douglas Borchman is a Professor of Ophthalmology and Visual Sciences at University of Louisville. He is also an adjunct Professor in Department of Chemistry, and Physiology and Biophysics. He completed his PhD in Chemistry at Wayne State University and is the author of over 100 peer reviewed articles. He was a Principal or Co-investigator of 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
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.
Jordanian Hospital, Jordan
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.
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.
Singapore Eye Research Institute, Singapore
Rajamani Lakshminarayanan completed his PhD in Department of Chemistry at National University of Singapore. He was a recipient of the Singapore Millennium Foundation, Post-doctoral Fellow and then obtained further Post-doctoral training at University of Southern California. Since 2009, he has been working as a Principal Investigator II at 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 three book chapters.
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 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 include carbapenem-resistant Enterobacteriaceae, vancomycin-resistant enterococcus, MRSA, multi-drug resistant Pseudomonas aeruginosa and filamentous fungal pathogens. The polymer elicits rapid bactericidal activity, anti-biofilm 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 bio-burden, corneal edema and conjunctival redness when compared to topical antibiotics. Together, these results establish excellent safety and efficacy of the polymer for treating topical infections.
- Vision and Cognition | Low Vision | Visual Impairement | Diabetic Retinopathy
Centro Polispecialistico Mediterraneo, Italy
Los Angeles Biomedical Research Institute, USA
Fawzia Bardag-Gorce has been studying ocular surface disease for the last six years, and has published and co‑authored six peer-reviewed publications in this 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. 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.
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 require 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 up-regulated 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.
Centro Polispecialistico Mediterraneo, Italy
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.
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.
Haisheng Zhao has his expertise in “Optic nerve injury and regeneration, neuroprotection on retinal ganglion cells”. He has published six peer-reviewed journal articles. He also has his research interests on Maculopathy and age-related macular degeneration. Based on15 years of research accumulation, he has given 13 international seminar and conference presentations.
Statement of the Problem: Aim of this study is 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 to 2017.2. 36 eyes of 36 patients were selected to participate in this study. They were divided into two groups: Nine 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 improvements of mean BCVA in the study group (88%) and in the control group (85%). The amplitude 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 higher than that in the idiopathic MHs group. Therefore, pay much more attention to control and regulate IOP in the duration and post of surgery.
Institute of Neurobiology, Bulgaria
Nadejda Bocheva is an Associate Professor at Institute of Neurobiology, Bulgarian Academy of Sciences. Her research interests include “Human visual information processing, spatial vision, motion perception, visual recovery of 3D shape and ageing”. She has more than 40 publications in scientific journals. She has received a Fogarty International Collaborative Award in 2002. She is member of American Psychological Association and of the Sofia section of the Bulgarian Physiological Society.
Statement of the Problem: The optic flow pattern occurring during the observer’s motion through the environment is a powerful cue for the direction of self-motion (heading). Most of the existing theories on visual heading determination considered only the contribution of the instantaneous flow field. The aim of the present study is to evaluate the relative contribution of spatial and temporal information integration in heading estimation.
Methodology & Theoretical Orientation: Four different conditions simulated the observer’s motion towards a wall with stationary eyes and head. In the static condition a single snapshot of an instantaneous flow field was presented and the heading direction was specified by the orientation of paired dot elements. In the flicker condition, a random sequence of snapshots with paired dots was presented. In the motion condition the heading direction was specified by the trajectory of the moving dots, while in the combined condition it was specified both by the trajectory of motion and the orientation of paired dots. In all conditions except the static one the lifetimes of the dots was limited to 100 ms and on every frame one-third of the dots were randomly re-positioned. In all conditions, 30% of the dots had random direction and/or orientation. The observers had to determine whether the heading direction was shifted away from straight ahead.
Findings: The heading direction was estimated with highest sensitivity in the combined condition. The improvement in this condition could not be predicted by an optimal combination of the information in the static and motion displays, but is well described by the combination of the information in the flicker and motion displays.
Conclusion & Significance: The results imply that temporal information integration plays a significant role in heading perception and that the determination of self-motion direction is not based solely on the instantaneous optic flow.
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.
Keratoconus is an aggressive and progressive disease in younger patients. There is very little known about keratoconus in children. In my presentation, I will show how keratoconus is a childhood disease. I will go through diagnosis, monitoring, and treatment options. I will discuss in details our results in keratoconus in children where we have cross linked more than 60 children with progressive keratoconus. Large proportions of these children are younger than 12 years. I will discuss in details interesting corneal topography findings, methods of diagnosing the disease in small children and epithelial-off off versus epithelial-off on crosslinking in children. Special precautions are essential in treating children which will be highlighted as well.
Liv Hospital International, Turkey
She graduated from Istanbul University, Istanbul School of Medicine in 1997. She has completed her residency in 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 Deputy Chief Physician in Dünyagöz Hospital between 2005-2016. She coordinated the initiation of the long-term partnership of Orbis which is a branch of the World Health Organisation and Dünyagöz Hospital Group. She is the ophthalmology consultant of telemedicine systems of GSM operators in Turkey. She coordinated the bionic eye treatment initiation (Argus II Retinal Implant) in Turkey, also incorporating the Frankfurt World Eye Hospital in Germany as a scientific committee and board member of Dünyagöz Foundation and Turkish Medical Academy. 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 has been invited contribute to the Turkish Olympic Committee and is working with the Turkish Paralympic Committee. She aims that the eye would be a symbol for the preventive
medicine globally, starting from athletes.
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. Advanced glycation end products (AGEs) are proteins that become glycated as a result of exposure to sugars. The HbA1C test is currently one of the best ways to check diabetes is under control. 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.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).
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. 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.
The clinical data indicated that the fluorescence ratio could provide better discrimination between individuals with and without diabetes than fluorescence intensity.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.