Editorial Team Creative Content Director Matt Young Chief Editor Gloria D. Gamat Project Manager Ruchi Mahajan Ranga Writers Olawale Salami Claire Noonan Helin Räägel Designers Winson Chua Edison Tan Photographer Dwayne Foong Published by: Media MICE Pte. Ltd. 6001 Beach Road, #19-06 Golden Mile Tower, Singapore 199589 Tel: +65 8186 7677 Fax: +65 6298 6316 Email: [email protected]www.mediaMICE.com 5 7 8 Highlights Exhibitors have got the ophthalmic field covered: pharma, devices and innovation. Check out the exhibitors’ booth at TWTC... Global experts discuss strategies to eliminate avoidable blindness by 2020. SnapShot! “Looking through the eye” literally means coming up with the most innovative tools and seeing what the eye is really made of. Mar 24 – 27, 2016 • Taipei S H O W DAILY The Official Congress News of APAO 2016 Issue 2 by Helin Räägel The opening ceremony at the 31st Asia-Pacific Academy of Ophthalmology Congress (APAO 2016) began with a spectacular musical performance showcasing local artists who introduced two pieces of their repertoire. The creative mixing of modern interpretation with historical tunes, culture and instruments accentuated the emphasis of the conference – emerging developments in the field of ophthalmology. After the performance, the heads of councils responsible for organizing this annual conference were invited on stage to give an overview of the conference and welcome everyone from near and far to this exciting event and the beautiful city of Taipei. All speakers uniformly emphasized the importance of this meeting in forming deep collaborations between researchers and clinicians to provide better care for patients with eye problems. They also noted the importance of strong collaborations between the different councils – the Asia-Pacific Academy of Ophthalmology (APAO), the International Council of Ophthalmology (ICO) and the European Society of Ophthalmology (SOE), to enforce world-wide support for research to advance this field. The honorable Dr. Chen Chien-jen, the Vice President-elect of Taiwan, as well, pointed out the significance of the APAO Congress, highlighting that this meeting brings together over 5,000 delegates from over 80 different countries, and showcases the research of over 500 outstanding scientists that lead the development of new technologies and techniques in the field of ophthalmology. Yet the success of this conference does not only rely on the dedicated work of top-notch researchers and clinicians; it also requires the involvement of industry partners that would help to make the new techniques and treatments available to everyone, which is why it is a pleasure to see the support of more than 100 companies at this meeting. During the ceremony, 8 distinguished researchers, clinicians, and teachers received a medal for outstanding contributions to the advancement of the field of ophthalmology. Surely, more exciting and novel approaches to treating patients with eye problems will be presented during the upcoming talks throughout this 4-day event. Emerging Developments in Ophthalmology Shine at APAO 2016 Opening Ceremony Treating and slowing the progression of myopia is no longer enough. Prevention is of key importance, according to eye experts.
HighlightsExhibitors have got the ophthalmic field covered: pharma, devices and innovation. Check out the exhibitors’ booth at TWTC...
Global experts discuss strategies to eliminate avoidable blindness by 2020.
SnapShot!
“Looking through the eye” literally means coming up with the most innovative tools and seeing what the eye is really made of.
Mar 24 – 27, 2016 • TaipeiSHOWDAILY
The Official Congress News of APAO 2016
Issue 2
by Helin Räägel
The opening ceremony at the 31st Asia-Pacific Academy of Ophthalmology Congress (APAO 2016) began with a spectacular musical performance showcasing local artists who introduced two pieces of their repertoire. The creative mixing of modern interpretation with historical tunes, culture and instruments accentuated the emphasis of the conference – emerging developments in the field of ophthalmology.
After the performance, the heads of councils responsible for organizing this annual conference were invited on stage to give an overview of the conference and welcome everyone from near and far to this exciting event and the beautiful city of Taipei. All speakers uniformly emphasized the importance of this meeting in forming deep collaborations between researchers and clinicians to provide better care for patients with eye problems. They also noted the importance of strong collaborations between the different councils – the Asia-Pacific Academy of Ophthalmology (APAO), the International Council of Ophthalmology (ICO) and the European Society of Ophthalmology (SOE), to enforce world-wide support for research to advance this field.
The honorable Dr. Chen Chien-jen, the Vice President-elect of Taiwan, as well, pointed out the significance of the APAO Congress, highlighting that this meeting brings together over 5,000 delegates from over 80 different countries, and showcases the research of over 500 outstanding scientists that lead the development of new technologies and techniques in the field of ophthalmology. Yet
the success of this conference does not only rely on the dedicated work of top-notch researchers and clinicians; it also requires the involvement of industry partners that would help to make the new techniques and treatments available to everyone, which is why it is a pleasure to see the support of more than 100 companies at this meeting.
During the ceremony, 8 distinguished researchers, clinicians, and teachers received a medal for outstanding contributions to the advancement of the field of ophthalmology. Surely, more exciting and novel approaches to treating patients with eye problems will be presented during the upcoming talks throughout this 4-day event.
Emerging Developments in Ophthalmology Shine at APAO 2016 Opening CeremonyTreating and slowing
the progression of myopia is no longer enough. Prevention is of key importance, according to eye experts.
2016SHOWDAILY Mar 24 – 27, 2016 • Taipei Advertorial 3
References:1. Zhang Q, Lee CS, Chao J, et al. Wide-field optical coherence tomography based microangiography for
retinal imaging. Sci Rep. 2016;6:22017.
2. Puliafito CA. OCT angiography: the next era of OCT technology emerges. Ophthalmic Surg Lasers Imaging Retina. 2014;45(5):360.
3. Fang PP, Lindner M, Steinberg JS, et al. Clinical applications of OCT angiography. Ophthalmologe. 2016;113(1):14-22. [Article in German]
4. Fang PP, Harmening WM, Müller PL, et al. Technical principles of OCT angiography. Ophthalmologe. 2016;113(1):6-13. [Article in German]
* Under development, not for sale yet.
Retinal and choroidal vascular involvement is a feature of many posterior segment ocular diseases, with characteristic pathologies such as geographic atrophy, neovascular age-related macular degeneration and diabetic macular edema. These pathological changes in the retinal vasculature are temporally related and vital to optimal monitoring of disease progression.1
Current methods of diagnosis and assessment, such as fluorescein (FA) or indocyanine green (ICG) fluorescence angiography, are fraught with inherent challenges.2 For example, systemic intravenous administration of fluorescein or ICG can lead to systemic adverse events such as nausea and anaphylactic reactions, which may be potentially life threatening. Furthermore, this method is cumbersome and time-consuming for both patient and clinician.3
In this context, recent research and development efforts aimed at producing an innovative, non-invasive method to examine the eye’s vasculature have been a great source of excitement.
How OCT-A works
Optical coherence tomography angiography (OCT-A) is expanding the frontiers of retinal and choroidal vascular imaging.
OCT-A is an application of optical coherence tomography (OCT) that captures minute differences in optical reflectivity within tissues such as the retina. OCT-A works by analyzing both the intensity of the reflected signal and the temporal changes in the reflection caused by particles in motion, such as intravascular erythrocytes. The OCT signal flux, measured by repeatedly recording OCT images (B-scans) at each point on the retina, creates an image contrast between the perfused vessels and the surrounding tissues.4
OCT-A offers some advantages over conventional fluorescence angiography. Notably, OCT-A does not require the use of a contrast agent, so the associated risks of dye injection are eliminated. Therefore, repeated imaging using OCT-A can be performed non-invasively. Furthermore, with OCT-A, it is possible to visualize distinct vascular networks, allowing clinicians to move through the vascular networks of the retina layer by layer, at a resolution which is impossible to achieve by conventional angiographic methods.2 OCT-A is poised to augment,
and in many cases, replace traditional methods of examining the retinal and choroidal vasculature.
At Heidelberg Engineering, OCT-A* is based on the established SPECTRALIS imaging platform. To achieve the scanning speed needed for OCT-A, a new OCT module called OCT2 has been introduced. OCT2 is capable of delivering an improved image quality across the whole depth of field at a considerably higher capture speed of 85,000 Hz. Thus, OCT2 is well suited for advanced applications such as OCT-A.
The SPECTRALIS OCT Angiography Module* produces detailed three-dimensional images of the retinal and choroidal microvasculature in a non-invasive manner.
Diagnostic potential and current limitations
OCT-A is poised to help improve diagnosis and monitoring of eye diseases, specifically in identifying and classifying degenerative changes in the perfusion behavior of the retinal vasculature and monitoring these changes over time.4 It offers new, treatment-relevant information in a wide range of applications. The
use of multimodal imaging enables a more targeted approach needed for individualized treatment.
Despite the enthusiasm, it is important to recognize that the technology does have some limitations. Static or very slow flow phenomena such as capillary leakage and polyps are not well visualized on OCT-A. In such cases, it is not possible to generate sufficient motion contrast. With OCT-A, it is also not possible to differentiate between arteries and veins in the same way as with the inflow of dye in fluorescence angiography. In addition, interpreting the 3D images may pose a challenge as this is still a relatively new technique.
SPECIAL REPORT on OCT Angiography
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OCT Angiography ModuleNon-invasive vascular imagingThe OCT Angiography Module* non-invasively produces detailed three dimensional illustrations of the retinal and choroidal microvasculature.
2016SHOWDAILY Mar 24 – 27, 2016 • Taipei4
by Claire Noonan
Delegates at 31st Asia-Pacific Academy of Ophthalmology Congress (APAO 2016) were addressed by an array of expert speakers about the various types of infectious uveitis and their diagnosis and treatment. Some diseases are more prevalent in certain regions, while others, such as toxoplasmosis, have a worldwide distribution.
Dr. Shishir Narain, FRCOphth, FRCSEd, MS, Fellow Sankara Nethralaya at the Shroff Eye Centre, discussed the diagnostic challenges and controversy of toxoplasmic retinochoroiditis.
Positive serology is very common, but a positive IgG gives no indication of the presence of disease. “However, a negative IgG (measured in undiluted serum) is useful in ruling it out,” said Dr. Narain.
Treatment options include the classic triple therapy, but the use of intravitreal injection of clindamycin is becoming more prevalent. Steroids may have a role, but Dr. Narain cautioned delegates that their use must be judicious. “Depot steroids are contraindicated due to their permissive effect on the infection,” said Dr. Narain.
‘And if your patient is worsening on steroids alone - stop,” he emphasized.
A range of manifestations of intraocular syphilis were described by Professor Ann-Marie Lobo, M.D., from the University of Illinois and the Illinois Eye and Ear Infirmary.
“We think of syphilis as the great masquerader,” she said. “It should always be in our differential if we have a patient with ocular inflammation.”
Syphilis is still a common cause of uveitis and if anything there has been a recent resurgence, in the context of HIV positivity. In any patient with ocular syphilis, HIV testing is imperative, said Professor Lobo, as in some cases ocular syphilis is the first presenting sign of HIV.
Ocular syphilis responds well to intravenous penicillin, with resolution of retinitis and improvement in visual acuity, delegates were told. Decline in titres can be a sign of treatment response, while some other diagnostic tests (e.g. TPPA, can remain positive for life).
Notable cases of infectious endophthalmitis were presented by Professor R.V. Paul Chan, M.D., FACS, of the University of Illinois College of Medicine. These included a cautionary tale of a 60 year old patient with HIV and a history of a Gancyclovir implant. He presented with injection and irritation and was initially treated with topical steroids. He ended up with severe endophthalmitis
requiring vitrectomy. The procedure was dramatic, with the patient’s bucking under anaesthesia accelerating the drainage of pus.
Professor Chan told delegates: “Don’t miss this, and don’t give topical treatment in a case you suspect might be endophthalmitis.”
He advised to treat early and treat aggressively, and that there should be a low threshold for vitrectomy. In one case, where response to treatment was suboptimal, focal vitreal biopsy revealed intraocular candida.
“Fungal endophthalmitis can oftentimes be very tricky to deal with, often because we’re unable to get a positive culture,” said Professor Chan.
He is hopeful that incidence of infectious endophthalmitis might decline. ‘With good presurgical planning and new intraoperative techniques, we’re getting better at preventing this, especially with the use of povidine-iodine,” he said.
Plethora of Etiologies in Infectious Uveitis
Professor R.V. Paul Chan
Dr. Shishir Narain
2016SHOWDAILY Mar 24 – 27, 2016 • Taipei 5
全世界的眼科医生与眼科专家都非常熟
悉 AREDS 的临床试验以及在这些试
验中所测试的药方可以提供给患有黄斑区退
化病变患者们的效益。
到目前为止，中国的医生仍然无法信心十
足地给患者开一个合适的药方。
由澳大利亚制造的 Macutec 每日一次
AREDS-2 配方，已正式在大陆市场上线，
并借由网路销售方式，让大陆消费者直接在
JD.com 购买。
根据 Macutec 的制造商，国际 Stiltec 的
总监史蒂芬·曼说：“是因为该配方的品质
和它能附和 AREDS-2 的各项建议，才让眼
科医生信心十足地给患者开了 Macutec 的
药方。”
f Macutec 有助于干性黄斑病变及维持黄斑健康
ff 单一胶囊含单日所需 AREDS-2 配方剂量
f• 叶黄素 10 毫克f• 玉米黄素 2 毫克f• 维他命 C 500 毫克f• 维他命 E 400IUf• 锌 25 毫克f• 铜 2 毫克
If you’ve been covering the ophthalmology industry like us, you’ll come to the realization that ophthalmologists are the ultimate doctors. Going around the exhibition hall alone, you will see that in ophthalmology, all the components are there: pharmaceutical, devices, technology, innovation, and a whole lot more!
Ophthalmologists may be experts in one of the smallest organs of the body -- the eye -- but it is one of the most critical, not only because it is closest to the brain, but an eye surgeon would need the advanced and delicate modalities of tools to examine and treat it.
That much is evident at each and every exhibitor booth at the 31st Asia-Pacific Academy of Ophthalmology Congress (APAO 2016)...
VisunexLightMedBayer
Heidelberg Engineering with local distributor Hwa-in showcase the company’s SPECTRALIS Module for cataract and glaucoma.
Facets of Ophthalmology Shine at APAO 2016 Exhibition Hall
Join Us
Novel Advances in Pediatric Ophthalmic ImagingCurrent State of Telemedicine and Informatics
Moving Forward - Universal Vision Screening for All Newborns
To learn more about Visunex Medical Systems and our products, please visit us online at visunexmedical.com
The future of brighter vision.
This event is not affiliated with the official program of APAO 2016.
Aside from treating myopia and slowing its progression, prevention is of key importance. “Studying the rate of axial length change can help us predict which children may be about to develop myopia,” said Professor Saw.
Professor Calvin Pang, DPhil, of the Chinese University of Hong Kong Ophthalmic Research Centre, explained that it is important to address myopia because of the potential sight threatening complications that can occur in the prime of life. For example, over 30% of patients with retinal detachment are myopes.
Other possible complications of myopia include maculopathy, glaucoma and optic neuritis.
Risk factors for the development of myopia are only partly genetic, said Professor Pang, and there are more than 30 genes and 60 loci reportedly involved.
The question of nature versus nurture in myopia can be addressed by looking at twin studies, said Professor Mingguan He, M.D., Ph.D., MPH, of the University of Melbourne. As monozygotic twins have 100% concordant genes, any phenotypic difference can be attributed to environmental effects. “If we look at the prevalence of myopia over the last 60 years, it has really increased... There must be some environmental effect,” said Professor He.
Professor He also delivered an address on behalf of Professor Ian Morgan, Ph.D., BSc, of the Australian National University College of Medicine, outlining the effect of education in myopia development; the more education, the higher the rates of myopia. Higher grades also correlate with level of risk. A reason for this can be the amount and intensity of reading and other ‘near work.’
by Claire Noonan
A modifiable factor is the amount of outdoor time a child has each day. There is a dose response relationship, with 2 to 3 hours of outdoor time slowing the onset of myopia. This factor, to a degree, can compensate for parental myopia (heredity) and the performance of large amounts of ‘near work’ inherent in the child’s schooling.
Among the many viable and effective treatment options for myopia are atropine injection, orthokeratology, LASIK, phacoemulsification and intraoccular lens (IOL) implantation.
Dr. Audrey Chia, FRANZCO, Ph.D., from the Singapore National Eye Centre (SNEC), informed delegates about the efficacy and optimal dosage of atropine. There is a dose-related effect, but unfortunately the higher doses have higher rates of rebound myopia when treatment ceases. A lower dose had a better longitudinal effect and safety profile, although the onset of improvement was slower.
LASIK is the most frequently performed elective surgical procedure in the world, and one where patients are usually very happy with the outcome,
Fighting the
The world is seeing an epidemic of myopia, with rates as high as 80% to 90% in young adults. The Asian region is particularly affected and rates are higher in urban areas, Professor Seang-Mei Saw Ph.D., MPH, MBBS, Singapore Eye Research Institute (SERI), told delegates at the 31st Asia-Pacific Academy of Ophthalmology Congress (APAO 2016). The age of onset can be predictive of severity, with children who are myopic already on entering the education system at risk of developing high myopia by the time they are 11 years old.
‘Myopia Boom’
Professor Ronald Krueger, M.D., MSE, of the Cole Eye Institute in Cleveland, Ohio, told APAO 2016 delegates. Because it is so frequently performed, industry has been very involved, meaning the procedure has developed and improved over recent years. Two of the more recent changes are femtosecond laser flap creation, and customised ablation profiles. Custom treating the patient’s outer surface irregularities is satisfying, said Professor Krueger. “We get beautiful large zones of great clarity,” he said.
Session chair Renyuan Chu, M.D., from the Eye and ENT Hospital, Fudan University in Shanghai, China, noted that patient acceptability of potential outcomes should be taken into account when deciding on treatment. For some patients, finishing with presbyopia is unacceptable, as they are accustomed to living in a myopic world; for example, viewing their smartphone up close. “They may complain bitterly that they can’t see near stuff anymore,” he said.
Professor Calvin Pang, DPhil
Panel of experts discuss important issues related to myopia
Dr. Audrey Chia, FRANZCO, Ph.D.
2016SHOWDAILY Mar 24 – 27, 2016 • Taipei8
In a plenary session on the latest advances in ophthalmology and visual sciences, he explained that the projected incidence of blindness based on current figures is 90 million people are going to be blind by 2020.
“We should be able to reduce this to 25,000,” he said, “by treating the conditions we know how to treat.”
The Wold Health Organization (WHO) has taken note of the prevalence of avoidable visual impairment and has implemented an action plan aiming to reduce it by 25%.
by Claire Noonan
Causes of blindness vary with age, but it is apparent that some causes are becoming more prevalent. For example, rates of diabetes-related eye conditions are increasing. There is also a global increase in glaucoma, especially in the Western Pacific region.
There is a clear need for public eye care, but there are only around 205,000 ophthalmologists in the world. As well as training more specialists, we need to take a targeted approach, emphasized Professor Taylor. “We need to work smarter and better, and to work in
eye care teams,” he said. This entails integration of eye care into the primary health care system and also developing world standards of ophthalmology training.
The ICO is taking the lead in enabling the delivery of specialist eye care on a global scale, with its functions including the development of clinical guidelines and provision of worldwide examinations. It also runs a fellowship program for new specialists.
Cont. on Page 12 >>
Global Strategies and Developments Aim toImprove Vision Worldwide
The goal of the International Agency to Prevent Blindness is to eliminate avoidable blindness by the year 2020, Professor Hugh Taylor, A.C., M.D. and President of the International Council of Ophthalmology (ICO) told delegates during the first plenary session of the 31st Asia-Pacific Academy of Ophthalmology Congress (APAO 2016).
ultraviolet light. Enhanced protocols include accelerated CXL, pulsed CXL, and trans-epithelial CXL. All of these are still fairly uncharacterized in large patient cohorts, making it hard to draw conclusions whether they are indeed more efficient than the standard Dresden protocol. However, Dr. McGhee was especially optimistic about the trans-epithelial CXL, where drugs like EDTA are used beforehand to loosen up the tight cell-cell contacts in the epithelium to allow more riboflavin to enter the tissue before crosslinking. He brought out that despite some reports showing similar outcomes to the standard protocol, there are studies showing better results with fewer complications.
Numerous others speakers included Professor Tien Yin Wong, Ph.D., MPH, FRCS(Ed), FRANZCO, FAFPHM of Singapore National Eye Centre (SNEC) and Dr. Ronald Krueger from Cleveland, Ohio, who have highlighted the importance of using customized topographical screenings of the patients’ eyes prior to surgery to decrease complications of surgery. Dr. Krueger described a method to obtain a biomechanical model of the eye that would help screen out the potentially risky eyes that have deviations from a normal eye curvature, and are thus at risk of forming early-stage keratoconus. He emphasized that despite the absence of enough metrics to
Professor Masayo Takahashi, M.D., Ph.D., for example, showed how induced pluripotent stem (iPS) cells from patient’s own skin grafts can safely be used to generate new retinal pigment epithelium (RPE) cells that can then be transplanted into the eye of the patient. The most important aspect for this study was to prove safety, and show that even though this procedure requires the use of iPS cells, they do not form tumors after transplantation.
Moreover, due to the use of patient’s own cells for the treatment, there is no need for immunosuppression. However, the surgical procedure itself is complicated, and there are not enough patients who have undergone this treatment to derive definite conclusions about the efficacy of this treatment. Prof. Takahashi’s team is currently working on a mouse model for retinitis pigmentosa to acquire more data for the support of this treatment, and they are preparing to include a monkey model in the near future. In three years, they hope to start clinical trials.
Professor Charles McGhee, Ph.D., DSc, FRCS, FRANZCO, FRCOphth, underscored the advancements in collagen crosslinking (CXL), and discussed three new techniques that could potentially enhance its effects. During CXL, the patient receives a riboflavin solution in the eyes, which is then crosslinked using
generate a solid platform for this type of analysis, the topography-guided ablation profiles have thus far created the best LASIK outcomes for the patients. He also mentioned the development of a new small incision lenticular extraction (SMILE) procedure, where small incisions are made to the cornea, instead of cutting almost the entire structure off for the surgery. This provides an avenue for better preservation of the biomechanical properties of the cornea, as fewer corneal nerves are cut during the process. Moreover, the arrival of new femtosecond lasers that have hit the market will revolutionize the LASIK surgery, as they make finer cuts than the ones used at the moment.
On the other hand, Dr. Wong focused his talk on the problems of diabetes-induced ocular problems, such as diabetic retinopathy (DR). He pointed out that as diabetes is a global epidemic, more and more patients will be affected by this disease. However, he also noted that since diabetes is a systemic disease, it also requires a systemic treatment, meaning one should not only focus on the effects diabetes has on the eyes, and treating these symptoms. He called out for a refocusing of available resources into understanding the underlying processes of this disease, in order to discover the most cost-effective (systemic) treatment for it.
The second plenary session on the first day of the 31st Asia-Pacific Academy of Ophthalmology Congress (APAO 2016) offered talks from six researchers who gave an overview of numerous promising novel developments in ophthalmology.
Professor Charles McGhee, Ph.D., DSc, FRCS, FRANZCO, FRCOphth
Dr. Ronald Krueger, M.D.
Professor Masayo Takahashi, M.D., Ph.D.
Dr. Ronald Krueger, M.D.
2016SHOWDAILY Mar 24 – 27, 2016 • Taipei12
>> Page 8 cont.
Meanwhile, myopia is one of the types of visual impairment that is increasing in incidence. Professor Mingguan He, M.D., Ph.D., M.P.H., of the University of Melbourne, explained that is not only important to explore ways to treat myopia, but also to work on prevention and the delaying of its progression.
Orthokeratology can reduce the progression by delaying the rate of change in axial length, but the most promising preventative measure, with randomised controlled trial evidence to support it, is the promotion of increased time spent outdoors. “Even an additional 40 minutes outdoors each day can reduce the incidence of myopia from 39% to 30%,” said Professor He.
The other side of refractive error was explored by Professor Jorge Alio, M.D., Ph.D. of the VISSUM Instituto Oftalmologico de Alicante, who discussed treatment of presbyopia. To counteract the loss of accommodation, treatment aims to enable pseudoaccommodation.
Laser surgery, intracorneal implants, intraocular lenses (including multifocals) plus pharmacological developments (e.g. InnoVision Drops) are leading to clear improvements in near vision.
Advances in diagnostics and treatments are often dependent on the sensitivity of imaging systems. Professor Christopher Leung, M.D., MbChB, of the Chinese University of Hong Kong, told
delegates about the CASIA SS2000 system, which features a faster scanning speed and increased depth. This enables better visualisation of the anterior chamber angle in glaucoma patients. Imaging modalities that track changes in the angle and track the rate of thinning in the retinal neurofibrillary layer can identify patients whose glaucoma is more rapidly progressing.
Panel of experts discuss strategies in eliminating blindness worldwide
