Biography:

Lyne Racette is an Assistant Professor of Ophthalmology at the Eugene and Marilyn Glick Eye Institute at Indiana University’s School of Medicine (Indianapolis, IN), and an Adjunct Professor at Indiana University’s School of Optometry (Bloomington, IN). After receiving her PhD from Carleton University (Ottawa, Canada), she joined the University of California at San Diego (San Diego, CA) where she completed a Postdoctoral Fellowship at the Hamilton Glaucoma Center.

Abstract:

While the presence and rate of glaucoma progression influences treatment decisions, the methods currently available to detect and monitor progression are imprecise and do not allow clinicians to make accurate assessments of the status of their patients. We have developed a dynamic structure-function (DSF) model to detect glaucoma progression, with the long-term goal of improving the detection and monitoring of glaucoma progression using structural and functional data jointly. This DSF model has two descriptors: Centroids and velocity vectors. The centroids represent the current stage of the disease, while the velocity vectors represent the trend of change of the centroids over time. The velocity vectors are in 2-dimensional space and show the direction (vector orientation) and rate (vector length) of change. We have also developed an individualized inferential component for our DSF model that is based on permutation analysis and that allows the model to tease out true progression from variability for each eye. Longitudinal data from patients with ocular hypertension or primary open-angle glaucoma enrolled in the diagnostic innovations in glaucoma study or in the African descent and glaucoma evaluation study were used to assess the prediction accuracy of the model. We used mean sensitivity as a functional measure and rim area as a structural measure. In this paper, we present the details of our DSF model, compare its prediction accuracy to that of ordinary least square linear regression, and assess its agreement with other measures of glaucoma progression.

Biography:

Janardan Kumar, PhD is a Professor of Microbiology and Chemistry at Becker College. He served as a Chair of the Natural Science Department. Prior to joining Becker College, while working as a Research Associate/Assistant Professor at Duke University, he first proposed at the ARVO international conference, Fort Lauderdale, that the Rho-GTPase activation mediated through LPA and thrombin perfusion caused increase outflow resistance in porcine eyes. In 2001 while at Duke University, he filed for intellectual property in the U.S. on RGD-containing peptides as safe therapeutic alternatives for glaucoma therapy. The same molecule has been filed for patent in Japan, with additional international applications to follow.

Abstract:

The emerging evidence on Rho-GTPase studies in the field of glaucoma research has reinforced a growing understanding of the molecular mechanism(s) of aqueous humor outflow resistance and provided new drug targets for glaucoma therapy. Several laboratories, including our research team suggested that the increased outflow facility was as a result of the cellular contractions in outflow pathway cells. Even perfusion of thrombin with impurities in porcine eyes, initially misled us to a conclusion that the Rho-GTPase activation with thrombin leading to cellular contraction might increase the outflow facility. Furthermore, investigation of pure thrombin and Lysophosphatidic Acid (LPA) perfusion in porcine eyes led us to conclude that Rho-GTPase activation, in fact, decreased the outflow facility. A number of studies have focused on to the regulation of outflow, however, very little is known about the regulation of fluid dynamics in the eye and the role of outflow pathway cells for maintaining aqueous humor outflow resistance. The simple reason is that the physiologically compromised fluid dynamics measuring device at constant pressure and the fluid medium for perfusion, similar to the aqueous humor, are not fully developed. Hence, measurement of the fluid dynamics at constant pressure is warranted to determine if aqueous flow is continuous or discontinuous, and could be directly correlated with the function of outflow pathway cells. Moreover, we hypothesize that the measurements of LPA and/or thrombin in the aqueous humor of glaucomatous eyes might provide a rationale to the pathophysiology of glaucoma. We anticipate that this new knowledge will ultimately lead to the development of new therapeutic alternatives in the management of glaucoma.

Biography:

Abstract:

Although smooth pursuit eye movement (SPEM) is a reliable endophenotype of schizophrenia, exact underlying cognitive and neural substrates remain unknown. A simple mechanistic model of SPEM assumes an efficient interaction in integrating sensory input from the medial temporal (MT)/medial superior temporal (MST) brain regions and subsequent motor response through the frontal eye field (FEF). Poor functional connectivity between these two regions could explain impaired motion perception and SPEM maintenance in schizophrenia. In the present study, we combined an eye tracking paradigm with electroencephalography (EEG) recordings to investigate the putative functional connectivity among frontal/posterior brain regions in mediating the modulation of SPEM. Twenty four schizophrenic (SZ) and 22 healthy control (HC) participants performed remembered pursuit tasks with EEG recordings. Behaviorally, HC subjects showed significant improvement in SPEM response on repeated presentations of target compared to SZ subjects. Neurophysiologically HC subjects showed higher frontal/posterior phase synchronization in the beta to low gamma range frequency bands during all target presentations. In addition there was a significant increase in phase synchronization in the beta-2 frequency band in HC subjects during late compared to early target presentation. In contrast, higher frontal/posterior phase synchronization in the beta-2 frequency predicted better performance during late target presentation and lower enduring psychosis in SZ subjects. These data suggest a pathologically perturbed connectivity between frontal and posterior cortical regions during SPEM in SZ. The integrative eye tracking-EEG approach used in this study to dissect the endophenotype may reveal novel targets for studying schizophrenia psychopathology.

Biography:

Abstract:

Biography:

Abstract:

Aim: Bone marrow transplantation is a treatment procedure usually applied for the patients suffering from leukemia. It is observed that some of these patients complain from partial vision loss some months after the operation whereas the routine visual examination of these patients are normal, therefore the aim of present work is to examine the visual pathway of these patients to search for the probable visual pathway degeneration of these patients using visual evoked potential (VEP). Method: 10 patients following bone marrow transplantation were selected randomly. These patients had this operation for at least one year before. Routine ophthalmological examination of these patients was normal or at most they have refractive error problem which could be corrected by suitable spectacles. Visual evoked potential was recorded in these patients. Latency (msec) and amplitude (μV) of VEP, P100 Peak was noted for each patient. Beside these patients10 human being with healthy visual system was selected to compare the result of VEP in patients with healthy group following VEP recording. Result: It is observed that 4 patients had abnormal VEP pattern which was reflected either in latency or amplitude of VEP, P100 Peak. Conclusion: From the result of present work, one can conclude that VEP examination of patients following bone marrow transplantation is necessary prior to operation so that if at all any unexplained visual loss is observed after operation; the medical staff can follow the case for the probable reason for this malfunction.

Biography:

Abstract:

Purpose: Following the introduction of the history of OQAS we will look into how the quality of the tear film severely affect quality of vision. The purpose of this work was to develop a novel optical non-invasive approach to characterize tear film quality. It is based on analysis of the ocular scattering dynamics measured objectively with a double-pass instrument. Methods: The procedure consists in dynamic recording of double-pass (DP) images during unforced tear film break-up. Series of images (every half second) are recorded in the eyes of a group of both healthy and dry-eye patients with a DP-based instrument (OQAS, Visiometrics, Spain). An unstable tear film would produce an elevation of the ocular scattering and in consequence a degraded retinal image. The relative dynamic changes of scatter would be related with modifications in the tear film quality. The dynamics of ocular scattering was evaluated with an Objective Scatter Index (OSI) calculated for each individual DP image. This parameter quantifies the level of scatter and its variations with time will indicate the impact of tear film deterioration. Results: In healthy eyes with good quality tear film, the analysis of the series of DP images showed that normal tear film break-up process involves minor fluctuations in the OSI value (0.5±0.2), whereas an abnormally accelerated tear film break-up tends to increase this value (0.9±0.3). Patients with diagnosed dry eyes showed both an increased average OSI value and higher fluctuations (3±2). The quality of the tear film can be determined and graded by the average value and standard deviation of the scatter parameter. Conclusions: A new robust and objective optical method to quantify the quality and stability of the tear film has been developed. It is based on measuring the induced changes in the scattering that affect the retinal image. This technique may be useful to detect and follow-up tear-film related patient’s complaints.

Biography:

Dr. Dan Samaha, optometrist (O.D.), obtained his Bachelor’s degree in physiology from McGill University before receiving his doctorate in optometry from the Université de Montréal in 2011. He completed in 2012 an ocular health residency at the Institut de l'Oeil des Laurentides (IOL), during which has been participating in the education of optometry student, while working at the retina, glaucoma, emergency and cataract surgery evaluation clinics. Like all his colleagues at the EIL, Dr. Samaha, optometrist, is actively involved in strengthening the bonds of collaboration between optometrists and ophthalmologists in the Laurentians region, particularly at the IOL.

Abstract:

Objective: To propose a novel non-invasive method for screening patients at risk of angle closure and thus the need for laser peripheral iridotomy using anterior segment OCT imaging. Methods: Horizontal scans of the nasal and temporal anterior chamber angles in glaucoma suspect patients were performed at 870 nm wavelength Fourier-domain OCT (Spectralis-Heidelberg). Schwalbe’s line (S) was identified on the images and using the integrated caliper tool, a line was drawn to the nearest point of the iris (S-I). A glaucoma specialist carried out gonioscopy and irido-corneal angles were graded according to a Shaffer grade. Anterior chamber depths as well as irido-corneal angle measurements were also carried out using Pentacam imaging. Spearman  analysis was performed to assess the correlation between S-I and Shaffer grades as well as between the different Pentacam measurements and Shaffer grades. Furthermore Tukey-Kramer HSD analysis was also carried out to evaluate the statistical differences between the means of S-I and each of the Pentacam measurements for each Shaffer grade. Results: Thirty-four images from forty enrolled subjects were available for analysis. Schwalbe’s line was identifiable in 94% of the total images. Correlation coefficients between S-I measurements and Shaffer grades were 0.81 and 0.77 for nasal and temporal quadrants respectively. The correlation was much lower with Pentacam-measured anterior chamber depth and irido-corneal angle (r=0.55 and 0.37 respectively). The means of S-I for gonioscopically occludable angles were statistically different than the means for gonioscopically wide-open angles. On the other hand the same statistical difference could not be achieved when comparing the means for Pentacam-measured anterior chamber depth and irido-corneal angle with gonioscopic Shaffer grade. The diagnostic cutoff value of S-I for occludable angles was established at 300 µm. Conclusion: The measurement of S-I using anterior segment OCT imaging strongly correlates with gonioscopy and may be a suitable non-invasive alternative for evaluating the risk for angle closure.

Biography:

Abstract:

Objetivo: Mostrar los resultados de la profilaxis de endoftalmitis postquirugica tras cirugía de catarata con cefuroxima intraestromal y evaluar la presencia del medicamento en el estroma corneal mediante OCT de segmento anterior. Metodo:Se realizo un estudio retrospectivo con 400 ojos intervenidos de catarata de Marzo 2013 a Febrero de 2015. Todos los pacientes fueron intervenidos con facoemulsificacion. Todos los casos recibieron una inyeccion intraestromal de cefuroxima 0,1ml (1mg), se le realizo un OCT de segmento anterior evaluando la deturgescencia corneal a las 24, 48 y 72 horas del postoperatorio. Resultados:La incidencia de EPQ fue de 0% (0 casos).EL OCT demostro un decrecimiento progresivo del espesor corneal. No se detecto ningún signo clínico de toxicidad ocular. Conclusiones: La profilaxis de endoftalmitis postquirurgica con Cefuroxima intraestromal es muy eficaz para reducir la incidencia de endoftalmitis postoperatoria, mediante el OCT muestra la presencia del medicamento descreciente en el postoperatorio.

Biography:

Kiran Turaka did MD in Ophthalmology at All India Institute of Medical Sciences (AIIMS) New Delhi. Later, she did fellowship in Ocular Oncology from Wills Eye Institute in Philadelphia under the renowned ocular oncologists Dr. Shields. She pursued a medical retina fellowship at Associated Retina Consultants Ltd in Phoenix AZ and clinical Pediatric Ophthalmology fellowship at UPMC. She co-authored more than 35 articles in both peer reviewed and non-peer reviewed medical journals. She presented the research work at both national and international meetings

Abstract:

Purpose: Primary intraocular lymphoma is a rare eye malignancy accounting for <1% of all non-Hodgkin’s lymphoma (NHL). Secondary intraocular lymphoma is associated with central nervous system (CNS) NHL and is associated with poor visual and clinical outcomes. The purpose of the study is to repot the clinical, ocular image study findings in patients (pts) with vitreoretinal lymphoma (VRL) and outcomes of treatment with intravitreal chemotherapy. Methods: A retrospective chart review of pts presenting to retina clinic with non-responsive uveitis and vitritis between Jan 2007 to Feb 2012 was performed. Data recorded included demographics, systemic lymphoma status & treatment, ocular symptoms & clinical findings, optical coherence tomography (OCT), fluorescein angiography (FA) & immunocytological findings, treatment methods (intravitreal methotrexate 300 micrograms/0.05 ml, 1000 mcg of rituximab in 0.1 cc) and response. Ocular and systemic lymphoma outcomes at last follow-up visit were noted. Results: Three Caucasian pts (1 female and 2 male) with bilateral vitritis (6 eyes) and CNS- NHL were identified. Mean age of pts was 64.7 years (range 53-80). Visual acuity was better than 20/40 in 4 eyes and ≤ 20/200 in 2 eyes at presentation. Iritis and uveitis were seen in 2 (33.3%) eyes and vitritis in all 6 eyes (100%). Yellowish-white subretinal infiltrates in peripapillary & macular region were present in 4 eyes (66.7%). Mean central foveal thickness on OCT was 270 (range 215-371) μm. Cystoid macular edema was present in 3 eyes (50%), subretinal fluid in 2 (33.3%) & RPE irregularities in 4 (66.7%) eyes. Most common FA findings were macular edema in 3 eyes and perivascular leakage in 1 eye. Immunocytological analysis revealed elevated levels of IL-6 (26.7 pg/ml), IL-10 (12783.5 pg/ml) and IgH gene rearrangement suggestive of lymphoma. All 6 eyes were treated with intravitreal methotrexate (mean 9.7, range 2-15). Mean duration between first intravitreal methotrexate injections to the treatment response was 3.7 weeks (range 3-7). Two pts developed keratitis secondary to methotrexate toxicity. Of which one was treated with intravitreal rituximab (2 injections in right eye and 4 in left eye) for persistent vitritis. First pt developed keratitis after 6 months of six methotrexate injections (monthly) and second patient developed after 5 weeks of seven injections (biweekly & weekly). None of the pts developed rituximab related side effects. Mean duration of follow-up was 15 months (range 4-33). At last follow-up, VRL was persistent in 4 eyes and resolved in 2 eyes. Systemic disease was in remission in 2 pts. Visual acuity was better than 20/40 in 5 eyes and ≤ 20/200 in 1 eye. One patient CNS-NHL died 6 months after treatment of VRL due to CNS relapse. He was treated with 15 intravitreal injections of methotrexate for VRL and also was treated with systemic chemotherapy and radiotherapy for CNS-NHL. Conclusions: Intravitreal methotrexate and rituximab were effective in controlling the VRL with less local side effects. Primary CNS-NHL is associated with poor survival among these pts though VRL is well controlled with localized chemotherapy.

Biography:

Sherief R Janmohamed has completed his PhD (Infantile Hemangioma Pathogenesis, Evaluation, and Therapy) after graduating in Medicine, Clinical Epidemiology (including courses at Harvard University, Boston, MA, USA), and Health Sciences (specialization Public Health) from the Erasmus University Rotterdam, the Netherlands. Currently he works at the Department of Dermatology of the University Hospital Brussels, Belgium, and is involved in international studies and a Cochrane review. In his short academic career he has already published more than 20 papers including articles in reputed Dermatology journals. He is also author of several book chapters and often speaks at international congresses and has been awarded for his research.

Abstract:

Background: Infantile hemangioma (IH) is the most frequently occurring tumor in childhood. The pathogenesis remains elusive. Currently, alarming IHs are treated with oral propranolol, a β-blocker. Before 2008, oral corticosteroids were used but these showed more side effects. We have evaluated the use of intra-lesional corticosteroids in alarming peri-ocular IHs, and topical timolol (another β-blocker) in non-alarming peri-ocular IHs. Method: Thirty-four patients with alarming peri-ocular IHs were included. Intra-lesional treatment was standardized according to a prospective protocol. There were no complications at all after therapy. A second intra-lesional injection was necessary in five patients. At follow-up, 6 and 12 months after injection, 94% and 91% of the patients, respectively, had regression of the IH. Astigmatism, activity-score and global assessments all had improved after therapy. Twenty patients with small mostly superficial peri-ocular IH were included and treated with timolol 0.5% ophthalmic solution 3-4 times daily. The treatment was effective in all superficial IHs after 1-4 months. A quick direct inhibitory effect on the growth of the IH followed by slower regression was observed. The children had to be treated during the whole proliferative phase. Deep IHs showed no response. Conclusions: Intra-lesional therapy with corticosteroids is very safe in the treatment of alarming peri-ocular IHs. It remains a good and safe alternative when propranolol is not possible. Topical timolol 0.5% ophthalmic solution is safe and effective in small, non-alarming peri-ocular IHs. We recommend that small superficial peri-ocular IHs should be treated in an early proliferative phase.

Biography:

Presently Saeed Al Wadni is an assistant professor in Department of Ophthalmology from King Saud University and Consultant Ophthalmologist of Pathology Unit.

Abstract:

Purpose: Extra nodal Rosai-Dorfman disease is a rare benign condition recently reported to sometimes show features of IgG4-related disease. Ophthalmic manifestations are seen in 11% of cases including orbit (most common), eyelid, nasolacrimal system, conjunctiva and uvea. The purpose of this study was to describe the corneal-limbal manifestation of the entity and to investigate whether numerous IgG4-positive plasma cells are associated with the disease at this site. Methods: We report two cases of extra nodal RDD presented as isolated limbal masses in young patients. Histopathological, immunohistochemical and pyro sequencing analysis of the lesions were performed in the surgical pathology and molecular laboratories at the Johns Hopkins Hospital using standard techniques. This is an interventional retrospective small case series. Results: We report two cases in young patients presented as pink, elevated, triangular limbal lesions associated with neovascularization. No systemic involvement was present in both cases. Patients underwent excisional biopsy of the lesions for histopathological examination as well as immunohistochemistry, molecular and genetic studies. On microscopic examination both cases were characterized by an atypical histiocytic infiltrate present in the substantia propria with chronic inflammation including histiocytes with engulfed lymphocytes (emperipolesis). Immunohistochemistry was performed and the atypical histiocytes were found to be CD68 positive, S-100 positive and IgG was also positive. CD1a and IgG4 were negative. Although there is association described between extra nodal RDD and IgG4 plasma cell expression, we do not found such in our two limbal lesion cases. Point mutations (V600E) in the BRAF oncogene were absent. Conclusions: Rosai–Dorfmann disease should be considered in the differential diagnosis of limbal mass lesions. Involvement at this site was not associated with BRAF mutation or IgG4 abnormalities in the cases examined.

Biography:

Didar S. Anwar MD, has completed his fellowship in cornea and refractiver surgery at the Univeristy of Texas Southwestern. He is now the only corneal specialt in Erbil, Iraq. The first eye doctor to start cornea transplant surgery overthere. He is now on faculty in the Ophthalmology department of the Hawler Medical University. He is publised more than 10 peer-reviwed papers.

Abstract:

The purpose of this talk is to describe a new technique for corneal stromal dissection in Deep Anterior Lamellar Keratoplasty (DALK) after a failed big bubble attempt. The technique utilizes blunt lamellar dissection with blunt-tipped corneal miniscissors. Traditionally, a crescent blade is used for this dissection, which can be difficult for surgeons to master and is associated with a high risk of perforation. Other techniques of blunt dissection, such as the Melles technique, cannot proceed after a failed big bubble due to emphesyma in the stroma that prevents visualization of the spatula. In contrast, our blunt scissors lamellar dissection technique takes advantage of the emphysema and microdetachments of Descemet’s membrane created during big bubble attempt. In conclusion, this technique provides DALK surgeons with an easier, more reliable technique that can proceed after failure of a big bubble, thereby significantly increasing the success rate of DALK. A case series study is needed to evaluate the short and long term visual and clinical outcome of this technique.

Biography:

Objective: To determine efficacy of full time occlusion therapy in visual improvement of severe amblyopia patients and its relation with patient’s age. Methods: 82 patients with unilateral, severe amblyopia were selected at the Kabul NOOR Eye Hospital. These trials of consecutive cases were kept under this study from March 2012 to December 2014. We have divided the patients in to three age categories, First Category 4-7 years, Second Category 8-15 years, Third Category 16-32 years. In the first category 12 patients, second Category 37 patients and third Category 33 patients were included. A complete eye examination was conducted in several departments to exclude any organic diseases. Patients with refractive errors were prescribed spectacles for 2 months and then full time occlusion therapy was started. The patients were encouraged for near visual activities at least 5 hours per 24 hours. Each patient was followed up until the best vision recovery obtained 6/6 snellen chart. After that best visual acuity achieved the occlusion therapy period was decreased step by step and finally stopped. Each patient was observed separately and followed up for a period of one year. Results: We achieved 99% success in first category, 98.2% in the second category and 97.7% in the third category patients. Conclusion: Without observing the age of patients, visual improvement achieved in severe amblyopic patients with full time occlusion therapy.

Abstract:

Bashir Ahmad Mehraban has completed his Graduation from Kabul Medical University from 2003- 2009 and then he joined specialty program in Kabul NOOR Eye Hospital - Ministry of Public Health of Afghanistan during 2010-2014. Presently, he is the National/International Relations In-charge of Afghanistan Eye Doctors Society. He is the Member of European Society of Cataract & Refractive Surgeons since 2013 and the Member of American Academy of Ophthalmology since January 2015. He has attended many international conferences including World Ophthalmology Congress in Japan.