Scientific Program

Conference Series Ltd invites all the participants across the globe to attend World Eye and Vision Congress Dubai, UAE.

Day 2 :

Conference Series Eye 2018 International Conference Keynote Speaker John S Jarstad photo
Biography:

John S Jarstad is an Associate Professor and Director of Cataract & Refractive Surgery at University of Missouri. He is a graduate of Brigham Young University (B.S.), University of Washington Medical School (Seattle WA) and completed an Internship and Residency at the Mayo Clinic in Rochester MN in ophthalmology.
He was a medical student research fellow at the N.I.H. Bethesda MD. Dr. Jarstad is past president of the Washington State Academy of Eye Physicians andSurgeons, a member of the American Society of Cataract and Lasik surgeons, and was elected to the Royal Society of Medicine - United Kingdom in 2006. Dr. Jarstad is the author of one book and more than 90 publications and presentations in the eye surgery literature. He is the inventor of the Jarstad Refractive Cataract Surgery Marker, the fi rst injectable foldable lens inserter (Chiron Passport) and an FDA phase I, II and III clinical investigator for medications and phaco machines used in eye surgery. Along with family members, he has participated in 41 short term medical missions to Egypt, Zimbabwe, Angola, Madagascar and Nigeria Africa, the Philippines, Vietnam, Cambodia, Indonesia and North Korea.

Abstract:

Cornea collagen crosslinking has emerged as a highly successful treatment for keratoconus and post-LASIK ectasia. The use of topical concentrated ribofl avin solution, along with a calibrated ultraviolet light source has been shown to successfully cross-link and stiff en the cornea align storm and arrest and in most cases, reduce the eff ect of corn steepening in several degenerative cornea conditions including keratoconus and post-refractive surgery ectasia. Cornea cross-linking with the Avedro commercial UV light source and concentrated topical ribofl avin solution produced in a standard dose is widely accepted and was FDA approved in the USA in 2016 as a treatment for Keratoconus and post refractive surgery ectasia. Th e high fi nancial treatment cost, along with the high cost of the Avedro machine, has limited ophthalmologist’s and patient’s access to this new eff ective treatment. We report cases at three separate institutions where patients, either on the own or under the suggestion of their ophthalmologist ingested high doses of dietary ribofl avin (Vitamin B2) and were exposed to 15 minutes per day of direct sunlight and noted within 6 months to experience a signifi cant amount of cornea fl attening by both topographic and keratometric measurements. No adverse eff ects were observed or reported in patients taking up to 1500 mg of dietary ribofl avin per day and spending 15 minutes daily outdoors walking briskly facing the sun
without sunglasses. We conclude that high-dose dietary ribofl avin may have a place in the treatment of keratoconus and post-refractive surgery kerectasia as an economical alternative or adjunctive form of treatment. It may be especially useful in paediatric and pregnant patients who are more likely to regress aft er commercial cross-linking therapy.

  • Eye Surgery | Ophthalmology Management | Diagnostic and Imaging Tools in Ophthalmology
Location: Souq
Speaker

Chair

Georges Hatoum

JFK Comprehensive Cancer Institute, USA

Session Introduction

Shlomo Dotan

Hebrew University of Jerusalem, Israel

Title: Neuro-ophthalmic aspects of drug toxicity
Speaker
Biography:

Dr. Shlomo Dotan is working as the director of the Neuro-Ophthalmology Service at the Hebrew University-Hadassah Medical Center in Jerusalem for more than two decades. He is part of the Editorial Board of the esteemed journal - Neuro-Ophthalmology. His major research project in the past was The Optic Neuritis Treatment Trial Study and The International Optic Nerve Trauma Study which were published in The New England Journal of Medicine and several ophthalmological journals. He is currently involved in several scientific projects investigating therapeutic aspects in MS, NMO and NAION. He is member of the Israel Medical Association, Israel Ophthalmological Society, North American Neuro-Ophthalmology Society, and American Academy of Ophthalmology, European Neuro-Ophthalmology Society, and the European Ophthalmological Society. He has been giving lectures worldwide on various ophthalmological and neuro-ophthalmological topics and has published articles in several prestigious medical journals. He has been part of many esteemed conferences held in Europe, including Israel.

 

Abstract:

The toxic optic neuropathies are typically characterized by subacute or chronic, bilateral, symmetrical and painless loss of vision. Treatment is initiated by recognition and drug withdrawal. Historically, methanol (though not a medication), ethambutol and isoniazid were the first to be recognized as neurotoxic. Later, cyclosporine, a widely used immunosuppressant and other chemotherapeutic agents, like; cisplatin, carboplatin and vincristine were recognized as having neurotoxic adverse reactions. Amiodarone-associated optic neuropathy has been widely discussed in the ophthalmic literature less than half a century ago. It is still controversial whether sildenafil and other phosphodiesterase-5 inhibitors prescribed for erectile dysfunction, cause visual loss by triggering ischemic optic neuropathy. Vigabatrin, used around the world as an anti-epileptic drug, was reported to cause irreversible visual field defects in children. Infliximab, an anti-tissue necrosis-alpha monoclonal antibody currently in use for granulomatous diseases, is also known to cause toxic optic neuritis. A long list of reported drugs is associated with increased intracranial pressure, though not confirmed by controlled studies. Vitamin A derivatives, corticosteroids, tetracyclines, fluoroquinolones, gonadal hormones, indomethacin, lithium and tamoxifen are just a small part of this list. Abnormalities of eye movements, including nystagmus and inappropriate vestibulo-ocular reflex are reported at toxic levels of neuroactive drugs like: diazepam, methadone, phenytoin, barbiturates and chloral hydrate. Drug-induced disturbances of neuromuscular transmission, occurring at the pre-or-post synaptic levels, include prominent ptosis and ophthalmoparesis along with variable degrees of extremity muscle weakness resembling true myasthenia gravis.

 

Georges Hatoum

JFK Comprehensive Cancer Institute, USA

Title: The radiation treatment of ocular melanoma: Techniques and advances

Time : 11:40-12:05

Speaker
Biography:

Georges Hatoum obtained his medical degree with honors from the Lebanese University, Faculty of Medical Sciences. His residency was completed at the Syracuse Upstate Medical University. He was then appointed as the Chief of Radiation Oncology at the Stratton VA Medical Center, NY. From 2006-2010, Dr. Hatoum worked at the Sylvester Cancer Center of the University of Miami. He carried different appointments including Associate Professor of Clinical Radiation Oncology, co-leader of the head and neck cancer site disease group as well as Associate Director of Radiation Oncology at Jackson Memorial Hospital Dr. Hatoum serves currently as the Medical Director for the JFK Comprehensive Cancer Institute. He is the principal investigator of the NGR oncology clinical trials, and his work has been published in several prominent medical journals. Dr. Hatoum has won several awards, including America’s top Radiation Oncologists, as well as the Osler Institute award of Excellence in teaching.

 

Abstract:

Statement of the Problem: Ocular melanoma is a rare subset of melanoma, yet comprises the majority of ocular malignancies. Management of ocular melanoma consists of either enucleation or glob-preserving therapies including radiation therapy (RT) and surgical resection. There are generally two categories RT for ocular melanoma, radioactive plaque brachytherapy and external beam radiotherapy (EBRT), including charged particle radiation and photon stereotactic radiosurgery (SRS). In this presentation we give an overview of the technical details and clinical efficacies of different RT techniques for ocular melanoma. In an effort to reduce the invasiveness without compromising accuracy, we developed a novel approach of real-time tracking to ocular tumors that can be applied to high-precision RT either with charged particle or photon beams.

 

Methodology & Theoretical Orientation: A novel “pupil tracking” approach uses a derived 2D/3D transformation to relate the pupil’s 2D coordinate captured by a video camera in the image plane with the tumor’s 3D location in the CT space. A motion phantom was development to test the feasibility of this technology with a robotic radiosurgery system.

 

Findings: The results show that the unique 2D/3D transformation algorithm is not only theoretically possible but also consistently reproducible with sub-millimeter accuracy.

Conclusion & Significance: Charged particle RT or SRS can eliminate invasiveness of brachytherapy. Pupil-based tracking can further assure the physical accuracy and achieve optimal clinical outcomes.

 

Speaker
Biography:

Fellow of the Royal college of physicians and surgeons of Glasgow (FRCP – Glasgow). Hold a Doctorate degree in Public Health and Epidemiology, Master degree in Clinical Epidemiology (MSc), Master degree in Public Health (MPH), all from The Netherlands Universities with broad experience driving Research and Development (R&D) strategies and operations.

 

Abstract:

Background: Neonatal and early screening is aimed at the primary prevention of visually impairing disease (e.g. mainly premature infant require a consistent approach to screen them for Retinopathy of prematurity ROP). ROP is one of the few causes of childhood visual disability, which is largely preventable. The screening can as well detect other congenital blinding eye diseases like cataract or Glaucoma that can be treated to prevent permanent visual loss. In addition other diseases that can pick early may include the autosomal recessive inheritance disorders that are the causes for retinal dystrophies such as Retinitis Pigmentosa (RP) and Leber's congenital amaurosis (LCA). 

Method: A qualitative methodology approach is used. An in-depth interview sessions were conducted concentrating on specific topics related to Retinopathy of prematurity (ROP).

Participants: The in-depth sessions consisted of three ophthalmologists working in Dubai, with extensive knowledge about vision programs and services.

Setting: Three sessions were performed during January- June 2017.

Key findings:

1. Retinopathy of prematurity (ROP) is one of the few causes of childhood visual disability which is largely preventable. Many extremely preterm babies will develop some degree of ROP, which usually resolves spontaneously without treatment. A small proportion, develop potentially severe ROP which can be detected through retinal screening. If untreated, it can result in serious vision impairment. Therefore, all babies at risk of sight-threatening ROP should be screened.

2. Among children, Retinopathy of Prematurity (ROP) is potentially blinding eye disorder that primarily affects premature infants. The estimated prevalence is about 10% among premature infants annually develop ROP and about 1–2% that are severe enough to require medical treatment. There is no follow up studies in Dubai to show how many of these each year become blind from ROP.

3. Currently different hospitals used different international guidelines to tackle ROP. However, A local Guideline for the Screening and Treatment of Retinopathy of Prematurity (ROP) is required to set up the standards and criteria when ROP should be screened.

 

Ayman Abd Elhamid Shouman

Institute of Ophthalmology, Cairo-Egypt

Title: FLACS + 27G vitrectomy, perfect combination
Speaker
Biography:

Ayman Abd Elhamid Shouman is a Professor of Ophthalmology in the Research Institute of Ophthalmology in Cairo-Egypt. He has built his experience over 27 years of practice between Egypt, Germany, Saudi Arabia, Sultanate of Oman and United Arab Emirates. He is an expert cataract and vitreoretinal surgeon with expertise in uveitis and ROP management. He has a lot of published articles over a wide range of ophthalmological subjects with a vast experience in teaching and continuous medical education activities through his career. He is a visiting Consultant in the Spanish centre for eyes in Dubai.

 

Abstract:

The emergence of femto laser in the extraction of cataract has revolutionised our mechanisms with better control of the procedure steps and adding to the verstality like addressing astigmatism better with laser assisted LRI. In addition more wide spread use of small gauge 27 and 29 vitrectomy instruments have decrease the traumatic effect of vitrectomy surgery on the eye. By combining the 2 mechanisms in relevant cases increase the benefits and decreased post-operative traumatic inflammatory effect on the eye with better and faster rehabilitation. This presentation is to highlight the procedure, pros and cons and rationale.

 

Speaker
Biography:

Shuliang Jiao received his Ph.D from the department of Biomedical Engineering of Texas A&M University in 2003. He joined the faculty of Bascom Palmer Eye Institute of University of Miami as an assistant professor after graduation. He is currently a professor in the Department of Biomedical Engineering, Florida International University. His research interest is mainly focused on the development of innovative technologies for imaging and treatment of eye diseases. His current research includes the technological development and application of Optical Photoacoustic Microscopy, Optical Coherence Tomography, and Multimodal Functional Imaging for the early diagnosis of age related macular degeneration, diabetic retinopathy, and glaucoma.

 

Abstract:

Lipofuscin, a byproduct of the vision cycle of photoreceptors, is the major source of the fundus auto-fluorescence (FAF) in the Retinal Pigment Epithelium (RPE). Lipofuscin accumulates with aging and in certain pathological disorders and is thus a biomarker for degenerative retinal diseases. Therefore, quantification of lipofuscin is important in the diagnosis, progression monitoring, and treatment evaluation. Lipofuscin quantification is challenging because light is attenuated by the media anterior to the RPE which is subject to inter-individual and intra-individual differences. Further, various illumination power and detection sensitivity of different imaging systems can also affect the readings of the detected FAF.

 

We developed a technology to provide simultaneous VIS-OCT and AF of the retina and a reference standard target at the intermediate retinal imaging plane with a single broadband visible light source. Since both OCT and AF images are generated from the same group of photons the OCT probe light experiences attenuation by the same ocular layers. The technology is able to eliminate the varying pre-RPE attenuation factor in AF imaging using the simultaneously acquired VIS-OCT image. To quantitatively bridge the OCT and AF detection systems thus eliminate the effects of illumination power and detector sensitivity, a standard reference target with known reflectivity and fluorescence efficiency was implemented into the system. Using the standard reference, similar to the one used by Delori AF and reflectance signals are normalized to a known reference value that are independent from the exposure power and detection gain. The system was calibrated and tested in vivo.

 

  • Workshop
Location: Souq
Speaker
Biography:

Shuliang Jiao received his Ph.D from the department of Biomedical Engineering of Texas A&M University in 2003. He joined the faculty of Bascom Palmer Eye Institute of University of Miami as an assistant professor after graduation. He is currently a professor in the Department of Biomedical Engineering, Florida International University. His research interest is mainly focused on the development of innovative technologies for imaging and treatment of eye diseases. His current research includes the technological development and application of Optical Photoacoustic Microscopy, Optical Coherence Tomography, and Multimodal Functional Imaging for the early diagnosis of age related macular degeneration, diabetic retinopathy, and glaucoma.

 

 

Abstract:

 

 

Lipofuscin, a byproduct of the vision cycle of photoreceptors, is the major source of the fundus auto-fluorescence (FAF) in the Retinal Pigment Epithelium (RPE). Lipofuscin accumulates with aging and in certain pathological disorders and is thus a biomarker for degenerative retinal diseases. Therefore, quantification of lipofuscin is important in the diagnosis, progression monitoring, and treatment evaluation. Lipofuscin quantification is challenging because light is attenuated by the media anterior to the RPE which is subject to inter-individual and intra-individual differences. Further, various illumination power and detection sensitivity of different imaging systems can also affect the readings of the detected FAF.

 

We developed a technology to provide simultaneous VIS-OCT and AF of the retina and a reference standard target at the intermediate retinal imaging plane with a single broadband visible light source. Since both OCT and AF images are generated from the same group of photons the OCT probe light experiences attenuation by the same ocular layers. The technology is able to eliminate the varying pre-RPE attenuation factor in AF imaging using the simultaneously acquired VIS-OCT image. To quantitatively bridge the OCT and AF detection systems thus eliminate the effects of illumination power and detector sensitivity, a standard reference target with known reflectivity and fluorescence efficiency was implemented into the system. Using the standard reference, similar to the one used by Delori AF and reflectance signals are normalized to a known reference value that are independent from the exposure power and detection gain. The system was calibrated and tested in vivo.

 

  • Optometry & Contact Lenses | Eye: Developmental Biology | Ocular Inflammation & Immunology
Location: Souq

Chair

Bilal Rawashdeh

Sharif Eye Centers, UAE

Session Introduction

Bilal Rawashdeh

Sharif Eye Centers, UAE

Title: Speciality contact lenses in practice
Biography:

Abstract:

Contact lenses play an Effective role in the treatment plan for critical cases especially in paediatric and refractive unites. In this presentation, short and direct to the point – case studies will be discussed to show (practically) the Importance of specialty contact lenses in practice.

Case studies will include scleral CL fitting, aniridia and albinisim (made to order) CLs. All cases will be in a simple and direct to the point manner, Q & A are more than welcomed.

 

Biography:

Rahat Husain MBBS FRCOphth MD(Res)Senior Consultant Ophthalmologist, Glaucoma Service, Singapore National Eye Centre.

He is Director, Regional/Community Eyecare (SingHealth), Adjunct Associate Professor, Duke-NUS Graduate Medical School, Adjunct Senior Clinician Investigator, Singapore Eye Research Institute, Associate Program Director, SingHealth Residency (Ophthalmology).

 

Abstract:

Problem: The ministry of health in Singapore has recently announced an initiative to change the landscape of healthcare from hospital to community care and from quality care to value driven care. This necessitates a change in the way ophthalmologists and optometrists manage patients.

Methodology: In this presentation I will elaborate on various initiatives we have embarked upon to fulfil the ministry of health’s directives. This includes training of hospital optometrists, engaging community optometrists, virtual clinics, establishing fit-for-purpose eye centres in the community and rationalising the movement of eye patients around the island such that they are seen by the right level of professional, in the right place and at the right time. Similar models of care that have already been established in UK will be described for comparison.

Findings: Models of care that have already been established will be described and data presented on patient outcomes including patient experience, safety and effect on the hospital eye service. Theoretical approaches to collaborations between optometrists and ophthalmologist will be discussed and an interactive question and answer session is anticipated.

Conclusions: I hope to expound some ideas of collaborations between optometrists and ophthalmologists that draw upon the strengths of each such that patient care remains high quality but with greater value.

 

Biography:

Elatta Kamal has clinical MD in Ophthalmology and has sub speciality in cataract surgery, working in Magrabi eye center in Alahsa. He has good experience in medical researches and special interest in cataract and glaucoma. Elatta has long experience as volunteer in many camps for free cataract surgery and trachoma surveuys and surgeries in Sudan and other african countries. . He has built this model after years of experience in research, evaluation, teaching and administration both in hospital and education institutions.

 

Abstract:

Introduction: Glaucoma and Cataract often coexist in the same eye One of the accepted surgical options in patients with severe glaucoma and coexisting cataract is first to control the IOP with trabeculectomy and then extract the cataract several months later , or by cataract surgery alone when trabeculectomy is not indicated Recently, primary lens extraction alone gained more acceptance.

Purpose: To review the current ophthalmic literature regarding the impact of modern cataract surgery on intraocular pressure (IOP)

Materials and Methods: Study design: Hospital based, retrospective study conducted from November 2014 to March 2015.

Study population: Patients who had phaco surgery for cataract with coexisting POAG.

Sample size: 50 patients were selected according to inclusion criteria.

Study area: MAKKAH EYE COMPLEX; specialized ophthalmology Center, well equipped and serves patients from all over Sudan, with sub specialized ophthalmic services. Sample selection obtained from only one clinic twice a week.

Results: There were 50 patients, 29 Males and 21 females (Fig 1), underwent uneventful phacoemulsification surgery, 26 right eyes and 24 left eyes, 22 % were diabetic. The mean preoperative IOP was 21.3 mmHg 4.8 SD, mean 1 week postoperative IOP 20.4 mmHg 4.3 SD (P – value 0.08), one month 20.1 mmHg 3.7 SD (P – value 0.04), and two months 19.6 mmHg (P – value 0.01) The mean IOP reduction was 0.8 to 1.7 mmHg (P = 0.00). The mean number of preoperative ant glaucoma topical medications 2.1 drugs 0.7 SD, one week postoperative 1.6 drugs 0.9 SD (P-value 0.008), one month 1.58 drugs 0.78 SD (P-value 0.003), two months 1.44 drugs 0.7 SD (P-value 0.000)

Conclusion: In conclusion phaco induces significant intraocular pressure reduction in the short postoperative period in glaucomatous patients. Phaco can be performed with intent of achieving better IOP control. Glaucomatous patients may get benefit from phaco by decreasing the amount of topical anti glaucoma medications.

 

Biography:

Abstract:

  • Special Session
Location: Souq

Session Introduction

Shlomo Dotan

Hadassah-Hebrew University Medical Center, Israel

Title: Neuro-ophthalmic aspects of drug toxicity
Speaker
Biography:

Shlomo Dotan is working as the director of the Neuro-Ophthalmology Service at the Hebrew University-Hadassah Medical Center in Jerusalem for more than two decades. He is part of the Editorial Board of the esteemed journal - Neuro-Ophthalmology. His major research project in the past was The Optic Neuritis Treatment Trial Study and The International Optic Nerve Trauma Study which were published in The New England Journal of Medicine and several ophthalmological journals. He is currently involved in several scientific projects investigating therapeutic aspects in MS, NMO and NAION. He is member of the Israel Medical Association, Israel Ophthalmological Society, North American Neuro-Ophthalmology Society, and American Academy of Ophthalmology, European Neuro-Ophthalmology Society, and the European Ophthalmological Society. He has been giving lectures worldwide on various ophthalmological and neuro-ophthalmological topics and has published articles in several prestigious medical journals. He has been part of many esteemed conferences held in Europe, including Israel.

 

Abstract:

The toxic optic neuropathies are typically characterized by subacute or chronic, bilateral, symmetrical and painless loss of vision. Treatment is initiated by recognition and drug withdrawal. Historically, methanol (though not a medication), ethambutol and isoniazid were the first to be recognized as neurotoxic. Later, cyclosporine, a widely used immunosuppressant and other chemotherapeutic agents, like; cisplatin, carboplatin and vincristine were recognized as having neurotoxic adverse reactions. Amiodarone-associated optic neuropathy has been widely discussed in the ophthalmic literature less than half a century ago. It is still controversial whether sildenafil and other phosphodiesterase-5 inhibitors prescribed for erectile dysfunction, cause visual loss by triggering ischemic optic neuropathy. Vigabatrin, used around the world as an anti-epileptic drug, was reported to cause irreversible visual field defects in children. Infliximab, an anti-tissue necrosis-alpha monoclonal antibody currently in use for granulomatous diseases, is also known to cause toxic optic neuritis. A long list of reported drugs is associated with increased intracranial pressure, though not confirmed by controlled studies. Vitamin A derivatives, corticosteroids, tetracyclines, fluoroquinolones, gonadal hormones, indomethacin, lithium and tamoxifen are just a small part of this list. Abnormalities of eye movements, including nystagmus and inappropriate vestibulo-ocular reflex are reported at toxic levels of neuroactive drugs like: diazepam, methadone, phenytoin, barbiturates and chloral hydrate. Drug-induced disturbances of neuromuscular transmission, occurring at the pre-or-post synaptic levels, include prominent ptosis and ophthalmoparesis along with variable degrees of extremity muscle weakness resembling true myasthenia gravis.

 

Speaker
Biography:

Background: Since LASIK was introduced about three decades ago, an estimated 28 million LASIK surgeries have been performed worldwide, and more than 500,000 of those surgeries were performed in Israel. Many of the patients who had refractive surgery 20 years ago have now reached the age of cataract surgery, and seek to continue their spectacle independence. However, patients who have had refractive surgery frequently experience increased optical aberrations, with the cornea itself often becoming multifocal in nature.  Placing a multifocal intraocular lens (MFIOL) IOL behind a multifocal cornea may run the risk of a reduction in visual quality.

Methods: This is a retrospective compression case series of the cataract surgeries implanted with a MFIOL. Data was abstracted on uncorrected and best corrected visual acuity (UCVA, BCVA). A comparison was made between naïve and post-refractive surgery eyes.

Results: We identified 1200 consecutive cataract surgeries: 800 were naïve eyes (group 1) and 400 had previous refractive surgery (group 2). All cataract surgeries were Femtosecond laser-assisted (Lensx or Victus) and performed by a single surgeon. All MFIOLs were manufactured by Fine Vision (Physiol). The formula used was the “Levinger Formula”, which is a modification of the SRKT formula. At 1 month postoperatively, the UCVA was 0.18 (log MAR) in group 1 and 0.23 in group 2 (p=0.1). At that time, there was a negative effect of age in both groups (r= 0.14 p= 0.04). Near UCVA was 2.01 in group 1 and 3.71 in group 2 (p<0.001). BCVA was 0.09 and 0.12 in group 1 and 2 respectively (p=0.06).

Conclusion: Implantation of a MFIOL in cataract surgery in eyes with previous refractive surgery is a viable option - achieving good distance UCVA, with the understanding that there is a slight limitation of near UCVA.

 

Abstract:

Shmuel Levinger, is a Member in Professional SOCIETIES Academy of Ophthalmology (AAO) American, International Council Representative of Israel-for the American Academy of Ophthalmology, the Eye M.D. Association (ASCRS). American European Congress of ophthalmology (AECOS), Israel Society of Ophthalmology, Israel Society of Laser Surgery. 2000-present- General Manager of Enaim Medical Center, Jerusalem, Israel.

 

  • Incidence of diabetes mellitus (DM) is increasing worldwide
Location: Souq

Session Introduction

Ayman Abd Elhamid Shouman

Institute of Ophthalmology, Cairo-Egypt

Title: Incidence of diabetes mellitus (DM) is increasing worldwide

Time : 16:20-16:50

Speaker
Biography:

Ayman Abd Elhamid Shouman is a Professor of Ophthalmology in the Research Institute of Ophthalmology in Cairo-Egypt. He has built his experience over 27 years of practice between Egypt, Germany, Saudi Arabia, Sultanate of Oman and United Arab Emirates. He is an expert cataract and vitreoretinal surgeon with expertise in uveitis and ROP management. He has a lot of published articles over a wide range of ophthalmological subjects with a vast experience in teaching and continuous medical education activities through his career. He is a visiting Consultant in the Spanish centre for eyes in Dubai.

 

Abstract:

The duration of diabetes and glycaemic control is collective risk factors for severity and progression of diabetic retinopathy. Diabetic macular edema (DME) emerges as one of the leading causes of blindness. The incidence of diabetes and its retinal complications is increasing in a rapid pace especially in the gulf region. The treatment of DME has evolved from focal and grid laser photocoagulation as the gold standard of therapy for DME, as stated in the Early Treatment of Diabetic Retinopathy Study (ETDRS), yet, the evolvement of new modalities specially the intravitreal injection changed the paradigm of treatment of DME. New therapies has developed with proven efficacy like vascular endothelial growth factor inhibitors (VEGF) agents like Bevacizumab and Ranibizumab, VEGF and placental growth factor inhibitor like Aflibercept, Corticosteroid materials like Triamcinolone Acetonide, Dexamethasone and Fluocinolone Acetonide. A high volume of studies to support such modalities have been conducted including RISE and RIDE, RESOLVE , DRCR, RRESTORE, RETAIN, RELIGHT, VIVID, VISTA, CHAMPLAIN, ETC…. A review of the different results of these trials with different case reviews with the different modalities of treatment is to be presented and discussed.

 

  • Photorefractive ablation of the cornea with cross-linking effect
Location: Souq

Session Introduction

Igor Komilovskiy

Pirogov National Medical-Surgical Center, Russia

Title: Photorefractive Ablation Of The Cornea With Cross-linking Effect
Speaker
Biography:

Igor Kornilovskiy is professor of the Department of Ophthalmology of Institute of Postgraduate Medical Education; consultant and laser refractive surgery of the Center of Ophthalmology of Pirogov National Medical-Surgical Center; Doctor of Medical Sciences, Professor, Academician of the Laser Academy of Sciences of Russia.In1974, Dr I.M. Kornilovsky had graduated from the Faculty of Medicine of Krasnoyarsk State Medical University, then, completed the one-year internship training in ophthalmology at the same university. While working as a healthcare practitioner specializing as an ophthalmologist, in 1979 he had defended the M.D. thesis on the topic: “Experimental and clinical development of the test and method to evaluate the functional state of blood vessels in the eye”, and was awarded the M.D. degree. In 1981, Dr I.M. Kornilovsky had moved to Moscow where he worked for many years at the Federal IRTC “Eye Microsurgery” complex named after S.N. Fedorov. In1995, while working at the IRTC, he had defended the doctorate thesis on the topic: “Eximer-laser for treating corneal pathology” and was awarded the degree of doctor of medical sciences. In 1997 Dr I.M. Kornilovsky was elected the acting member (academician) of the Russian laser academy of sciences. The scientific interests of Professor Igor Kornilovskiy cover a wide range of research related to new technologies of laser refractive surgery of the cornea with photo protection and cross-linking; refractogenesis; accommodation; etiology and pathogenesis of myopia; aberrations of the eye optical system; restorative correction of vision based on spectacle, contact, laser and surgical correction; laser therapeutic and optic-reconstructive surgery on different pathology of the cornea. Igor Kornilovskiy is the author of 350 scientific papers on different issues of ophthalmology, over 35 inventions, patents and innovation proposals.

 

Abstract:

Purpose: To evaluate the effect of a cross-linking under photorefractive ablation of the cornea saturated with riboflavin

Methods: Several studies on corneal collagen cross-linking (CXL) and secondary radiation induced by excimer laser ablation were reviewed. TransPRK, LASIK and FemtoLASIK were performed on 402 eyes with myopia and myopic astigmatism. Photorefractive ablation was performed after corneal stroma saturation with 0.25% isotonic riboflavin.  Follow-up varied from 1 month to 4 years. The effects of CXL were assessed by spectral-domain OCT and corneal densitometry

Results: CXL induced by photorefractive ablation with riboflavin is realized through the series of consecutive reactions of riboflavin activation. Activation of riboflavin with the secondary radiation induced by corneal ablation is considered as a trigger. Broad spectrum of the secondary radiation covers all four peaks of maximum riboflavin absorption at 223, 268, 374, and 445 nm. Cross-linking effect amplifies due to the secondary interaction of riboflavin with peroxyl radicals of the oxidative stress and aseptic inflammation in the stroma in response to photorefractive keratectomy. Corneal densitometry and anterior segment OCT demonstrate that CXL increases optical density of the residual stroma and enhances the absorption of external UV photons. This improves or compensates impaired mechanical and photo protective functions of the ablated cornea. Thin membrane-like Structure on the ablation surface as well as higher optical density of the corneal stroma adjacent to the ablation zone are revealed after TransPRK with riboflavin. In addition to the higher optical density of the corneal stroma, demarcation line of various intensity (which resolves later) is revealed after LASIK and FemtoLASIK.

Conclusions: The effect of crosslinking in photorefractive ablation with riboflavin was realized through the formation of a membrane-like structure on the ablation surface and was accompanied by an increase in the optical density in the layers of the stroma adjacent to the ablation zone

Key words: cross-linking, secondary excimer laser radiation, photorefractive ablation, riboflavin.

 

  • Diagnostic and Imaging Tools in Ophthalmology | Biomaterials in Ophthalmology | Cataract and Refractive Surgery | Ocular Pharmacology
Location: Souq
Speaker

Chair

David Israeli

ENAIM Medical and Refractive Centres, Israel,

Session Introduction

David Israeli

ENAIM Medical and Refractive Centres, Israel

Title: Use of artificial iris implant and devices in patients with aniridia
Speaker
Biography:

Dr. David Israeli is a Head of the corneal disease and corneal transplantation unit at Carmel hospital, Haifa, Israel. Director of cornea and refractive surgery at Enaim medical center, Haifa and northern region, Israel. Co-founder of Maayan medical centre, Haifa, Israel. Doctor at general surgery department. Dushanbe, USSR.

 

Abstract:

Total or partial Aniridia often occurs as a result of penetrating ocular trauma. This condition may cause symptoms including glare, light sensitivity, reduced vision, and asymmetric appearance was Morcher iris reconstruction lens and Human optics in our presentation treatment options artificial iris implant.

We present the surgical management and clinical course of 2 patients with traumatic total Aniridia and 1 patient with partial Aniridia. No patient exhibited complications in the postoperative course conclusions. In patients with total and partial Aniridia the artificial iris implants allows functionally and aesthetically satisfactory reconstruction of the anterior segment.

 

Shlomo Dotan

Hadassah-Hebrew University Medical Center, Israel

Title: Neuro-ophthalmologic diagnoses you do not want to miss
Speaker
Biography:

Shlomo Dotan is working as the director of the Neuro-Ophthalmology Service at the Hebrew University-Hadassah Medical Center in Jerusalem for more than two decades. He is part of the Editorial Board of the esteemed journal - Neuro-Ophthalmology. His major research project in the past was The Optic Neuritis Treatment Trial Study and The International Optic Nerve Trauma Study which were published in The New England Journal of Medicine and several ophthalmological journals. He is currently involved in several scientific projects investigating therapeutic aspects in MS, NMO and NAION. He is member of the Israel Medical Association, Israel Ophthalmological Society, North American Neuro-Ophthalmology Society, American Academy of Ophthalmology, European Neuro-Ophthalmology Society, and the European Ophthalmological Society. He has been giving lectures worldwide on various ophthalmological and neuro-ophthalmological topics and has published articles in several prestigious medical journals. He has been part of many esteemed conferences held in Europe, including Israel

Abstract:

The presentation will elaborate on five neuro-ophthalmologic disorders, part of a much longer list, which can potentially cause death or blindness if not diagnosed and treated correctly: (i) Aneurysmal third nerve palsy- the aneurysm is not the most common compressive lesion causing third nerve palsy, but it has the highest mortality if untreated; (ii) Giant Cell Arteritis- is an idiopathic inflammatory vasculitis affecting small to medium size arteries, which can cause blindness, but also cerebral infarction and cardiac ischemia; (iii) Myasthenia Gravis- is an autoimmune disease of the neuromuscular junction, which has both an ocular and generalized form. Myasthenic crisis is a neurologic emergency, which could cause paralysis of the muscles of breathing; (iv) Pituitary apoplexy results from hemorrhagic infarction of the pituitary gland, and causes acute endocrine and neurologic symptoms and; (v) Pseudotumor cerebri or idiopathic intracranial hypertension is a condition of unknown cause that produces elevated intracranial pressure and papilledema primarily in young obese females, and in about 25% of cases might cause visual dysfunction.

 

Ayman Abd Elhamid Shouman

Institute of Ophthalmology, Cairo-Egypt

Title: Cataract extraction in diabetic patient
Speaker
Biography:

Ayman Abd Elhamid Shouman is a Professor of Ophthalmology in the Research Institute of Ophthalmology in Cairo-Egypt. He has built his experience over 27 years of practice between Egypt, Germany, Saudi Arabia, Sultanate of Oman and United Arab Emirates. He is an expert cataract and vitreoretinal surgeon with expertise in uveitis and ROP management. He has a lot of published articles over a wide range of ophthalmological subjects with a vast experience in teaching and continuous medical education activities through his career. He is a visiting Consultant in the Spanish centre for eyes in Dubai.

 

Abstract:

The diabetic patient has increased incidence of cataract affection. He has a lot of factors that we have to consider before doing him cataract extraction procedure like evaluation of eye surface abnormalities, astigmatism, general condition and most notable his diabetic retinopathy staging and how to manage before proceeding with the cataract removal. This is a review of the different factors to consider and how to manage them accordingly.

 

Speaker
Biography:

Sandra Fiorentini is a consultant ophthalmologist with over 15 years of experience as ophthalmic surgeon. She started the ophthalmology residence in Brazil and completed it in Portugal where she became an European board certified consultant. She continued her education doing 2 fellowships: in Corneal and external eye diseases and refractive surgery and she also completed a PhD in anterior segment. Due to her international career working in Dublin -Ireland in Royal Victoria Eye and Ear Hospital, in the private clinic specialized in refractive surgeries called OPTILASE Eye Clinic and also in 2 different hospitals in London- UK for the latest  years, Dr Fiorentini is currently registered in 5 countries (UK, Ireland, Brazil, Portugal and UAE) and member of a range of professional bodies:

·       Irish College of Ophthalmology

·       European Society of Cataract and Refractive Surgeons

·       Brazilian Council of Ophthalmology

·       American Society of Cataract and Refractive Surgery

At this moment, Dr Fiorentini is working as an ophthalmologist specialist at Moorfields Eye Hospital Dubai.

 

Abstract:

The tear film can be considered the first refractive layer of the eye; however, its importance has been not receiving the proper attention, especially before cataract and refractive surgeries. The accuracy of regular pre surgical investigations like keratometry and aberrometry can be hugely affected by the quality of the tear film. In addition, dry eye and other corneal and conjunctival problems can easily compromise the final refractive result even after a prestine uncomplicated surgery. In this presentation, I’ll bring evidence based data to convince the importance of the ocular surface proper assessment and management timely, including diagnosis tools and updated treatment of ocular surface most common diseases.

 

  • Internuclear Ophthalmoplegia | Ophthalmology Management | Ophthalmic Genetics | Cornea and anterior segment | Cataract and Refractive Surgery
Location: Souq
Speaker

Chair

Igor Komilovskiy

Pirogov National Medical-Surgical Center, Russia

Session Introduction

Ronit Levinger

ENAIM Medical and Refractive Centres, Israel

Title: Building and Marketing successful Refractive centres
Biography:

Abstract:

Enaim Medical Refractive centre is an international model for excellence, Innovation and leadership in the field of Refractive, Cataract and corneal surgery, unique combination of experienced and responsible ophthalmic privet practice, with academic achievements, has created successful business development. The financial results keep growing, the budget of marketing is devaluating and that enable ENAIM to grow and extend its involvement in collateral medical businesses.

The purpose of this lecture is to present our vision: “who is the wise man – the one who sees the future”.

 

Speaker
Biography:

Edna Joyce Santos is an accomplished and dedicated ophthalmologist for the past 28 years. She has pioneered the establishment of the Southern Tagalog Society of Ophthalmology and served as President from 1996 to 1998. She was also the Past President of the Philippine Medical Women’s Association, Lucena-Quezon Chapter for four years. She had shown remarkable competence and professionalism as Head of the Department of Ophthalmology in different hospitals in her country and in the United Arab Emirates. She has been in the UAE for the past 18 years and presently she is the Head of the Department of Ophthalmology in International Medical Center in Ras Al Khaimah. She was the first one to do research on the Prevalence of Diabetic Retinopathy in the UAE together with Dr. Fatima Al Maskeri and Dr. Mohammed Saddiq of the Faculty of Medicine, Health and Sciences. She is also a published author, and her books are available in Amazon, entitled “Are You Crazy?” and she co-authored a book with Jack Canfield of Chicken Soup for the Soul entitled “Success Mastery”. She will soon publish two more books entitled “Dearly Beloved” and the biography of world famous life coach, Wolfgang Christoph, entitled “Sohni, The Human Will Against The Force of Destiny”. She is a member of the National Association of Expert Writers and Speakers in the United States. She holds several positions, namely, Lead Corporate Activist for YGB Hybrid Cryptocurrency, Official Mandate for the UAE, Middle East and Africa for Wefsech Ocean Nexus Solutions which deals with aquaculture farming based in Malaysia and the Netherlands, Board Advisor of the Board of Directors of Laurel Resources, LLC based in Atlanta, Georgia, USA, Consultant for Eneq, ELV and Engrid Digital Solutions based in Dubai, UAE, Member of the Board of Directors of Sheema Africa Safaris, Ltd. based in Kampala, Uganda, and Official Mandate for UAE, Middle East, Africa and Asia for Saccadio Suites based in Trondheim, Norway. She is also International Reviewer for articles and researches in ophthalmology for the Journal of Ocular Therapeutics and Pharmacology as well as other international ophthalmic journals.

 

Abstract:

Statement of the Problem:  A lot of  countries around the world are still underserved by ophthalmologists. The expense of setting up an ophthalmology clinic is so high that majority of the population do not have access to ophthalmic services and investigations. In fact, instead of expanding. most medical centers prefer to forego opening satellite clinics that could have increased practice efficiency and revenue.

The purpose of this study is to show that there is a new online platform, called Saccadio Suites, that bridges the gap between the lack of ophthalmologists in distant locations and the availability of management systems that not only provide access to affordable ophthalmic tests and investigations but also could connect more patients to the clinic than ever before.

Methodology & Theoretical Orientation:  In order to give a clear picture of a patient’s eye condition, a powerful blend of structural and functional devices were used such as the Saccadio Web and Saccadio Haploscope, collectively known as the Saccadio Suites.

Discussion will center on the different devices in the Saccadio Web (structural tests) and the Saccadio Haploscope (functional tests). Each device will be briefly described and an overview given.

Conclusion: The Saccadio Suites help in the prevention of blindness by bridging the gap between the lack of ophthalmologists and ophthalmic services in remote areas. It increased the clinic’s efficiency by making very fast, accurate and comprehensive eye examination. The remote teleophthalmologist gets the report online, makes an immediate interpretation and decides on the treatment.

Recommendations: Most of the ophthalmic devices in the market today provide only structural tests but not the functional tests included in the Saccadio Haploscope.  It is, therefore, highly recommended that clinics and medical centers avail of Saccadio Suites which are integrated with artificial intelligence that can be automated to facilitate diagnosis and management of eye diseases.

 

Speaker
Biography:

Fellow of the Royal college of physicians and surgeons of Glasgow (FRCP – Glasgow). Hold a Doctorate degree in Public Health and Epidemiology, Master degree in Clinical Epidemiology (MSc), Master degree in Public Health (MPH), all from The Netherlands Universities with broad experience driving Research and Development (R&D) strategies and operations.

 

Abstract:

Background: The prevalence of sight loss increases with age, and the Dubai population is ageing. In addition there is a growing incidence in key underlying causes of sight loss such as obesity and diabetes. This means, that without action, the number of people with sight problems in the Dubai is likely to increase dramatically over the next 25 years.

Purpose: The purpose of the eye health needs assessment is:

  • To build a picture of current eye health services, i.e. a baseline.
  • To gather information in order to plan and change services for the betterment of eye health.

 

Method: In order to carry out eye health assessment we applied qualitative (focus groups with 20 ophthalmology experts) and quantitative methodology (Analyzing hospital, population health related surveys. Prevalence or incidence estimates based on research from national and international documents. It is intended to help stakeholders discuss the scale of the issue locally.

 

Key findings:

  1. A number of studies have shown that that rate of reported cataracts is around 2% on average. If these estimated prevalence rates (2%) are applied to the population of Dubai(without  adjustment), there may have been 47,716 people with cataract across Dubai in 2015 of which: 33,145 would be males and 14,571 females.
  2. It was estimated around 9,144 residents in Dubai aged 40 years or more in 2015 had glaucoma (of which 8,149 were OAG and 995 were ACG).
  3. It was estimated there would be approximately 12,128 (95%confidence interval 9,639-15,001) Adults aged 18+ years in 2015 suffering from diabetic retinopathy at some stage.
  4. Age-related macular degeneration (AMD) seem to be a rare condition in Dubai and patients and AMD are not often seen at private health care sectors, as it is most common among the older white population.

 

Biography:

Nadav Levinger is ophthalmology resident in his second year of training at the Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. From the beginning of the residency his major fields of research were medical retina, cataract and refractive surgery.  He is hoping to bring a comprehensive look to the field of ophthalmology. Among others, Dr. N. Levinger teaches the medical and nursing students of the Hebrew University.

 

Abstract:

Purpose: To evaluate for association among socio-economic status (SES), baseline visual acuity, clinical parameters, and treatment outcome in neovascular age-related macular degeneration (nvAMD).

 

Methods: Retrospective single center cohort study. Patients' residential addresses were extracted from medical records. SES was determined for each patient based on the 2008 Israeli census, and classified into four different groups. Clinical and demographic parameters were extracted from patient charts. The relationship between the SES cluster and clinical parameters was then evaluated.

 

Results: A weak correlation was found between baseline visual acuity (VA) of the first eye diagnosed with nvAMD and SES (R=-0.13, p=0.049; n=233). No correlation was found between the SES and baseline VA of the second eye (R=-0.05, p=0.95). SES was not associated with the number of anti-VEGF injections of the first (p=0.943) or second eye (p=0.704). No association was found between the SES and the VA outcome of the first or second eye after 1 year of therapy (p=0.421, p=0.900 respectively). Central subfield thickness (CST) at presentation as measured by OCT was associated with SES ( r= -0.31 p= 0.001).

Conclusion:  The lack of association between SES and visual outcome in nvAMD suggests that there are no Social disparities in ophthalmologic care in our study population

 

 

  • Video Presentation
Location: Souq

Session Introduction

John S Jarstad

University of Missouri School of Medicine, USA

Title: Unusual cataract cases
Speaker
Biography:

Jarstad is an Associate Professor and Director of Cataract & Refractive Surgery at University of Missouri.  He is a graduate of Brigham Young University (B.S.), University of Washington Medical School (Seattle WA) and completed an Internship and Residency at the Mayo Clinic in Rochester MN in ophthalmology.  He was a medical student research fellow at the N.I.H. Bethesda MD.   Dr. Jarstad is past president of the Washington State Academy of Eye Physicians and Surgeons, a member of the American Society of Cataract and Lasik surgeons, and was elected to the Royal Society of Medicine - United Kingdom in 2006.  Dr. Jarstad is the author of one book and more than 90 publications and presentations in the eye surgery literature. He is the inventor of the Jarstad Refractive Cataract Surgery Marker, the first injectable foldable lens inserter (Chiron Passport) and an FDA phase I, II and III clinical investigator for medications and phaco machines used in eye surgery.  Along with family members, he has participated in 41 short term medical missions to Egypt, Zimbabwe, Angola, Madagascar and Nigeria Africa, the Philippines, Vietnam, Cambodia, Indonesia and North Korea.

 

Abstract:

The surgical management  of Phacodonesis, Duplication of the anterior lens capsule, small eyelid fissures, removal of an unusual foreign body to avoid causing a traumatic cataract and “emergency” cataract surgery in a monocular law student with chronic uveitis and microphthalmos using edited surgical videos.

1.  The Forgetful Patient with pseudophacodonesis and a surprise!

2.  The Second Opinion on a colleague’s cataract procedure that was “unsuccessful.”

3.  The “almost” Femtofailure

4.  A “thorny” issue

5. The law school student “emergency”

 

  • Visual out come and patient satisfaction following unilateral refractive lens exchange with a multifocal intraocular lens in emmetropic presbyopic patients
Location: Souq
Speaker
Biography:

Abstract:

ABSTRACT

PURPOSE:  To assess efficacy, safety, and patients satisfaction after unilateral Presby-lasik procedure, compared to multifocal IOl (fine vision), in presbyopic emmetropic patients.

SETTING: Enaim Refractive Medical Centers, Israel.

DESIGN: Retrospective case-series.

METHODS:

26 patients underwent unilateral Phacoemulsification with Femto-laser assisted cataract surgery (FLACS) and refractive lens exchange (RLE), followed by an implantation of a trifocal diffractive intra ocular lens (IOL) (FineVision Micro F). The surgery  was performed on the non-dominant eyes of presbyopic emmetropic patients.

35 patients underwent laser Presby-Lasik procedures in the non-dominant eye, using the Supracore algorithm, Technolas.

 After 6 months of follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA). Secondary outcomes included spherical equivalent (SE), refraction, defocus curves, contrast sensitivity, patient questionnaire and presence of visual side effects.

RESULTS: In both groups no sight lost >1 line for corrected distance and near VA.

Overall uncorrected distance and near visual acuity were better in MF IOL group.

Patients satisfaction was higher in the MFIOL, 88%, compared to 63% in the Presby-Lasik group.

CONCLUTIONS: Presbyopic lens exchange with implantation of MFIOL in the non-dominant eye of emmetropic patients is the preferred procedure in age group>48.

 

  • Anti-VEGF treatment in neovascular Age-Related Macular Degeneration (AMD)
Location: Souq

Session Introduction

Doukas Dardabounis

University Hospital of Alexandroupolis, Greece

Title: Anti-VEGF treatment in neovascular Age-Related Macular Degeneration (AMD)
Speaker
Biography:

Doukas Dardampounis was born in Alexandropoulos, Greece, 1-2-1965. Degree in Medicine (Aristotelian University of Thessaloniki) in 1988. Specialty in Ophthalmology in 1998. Consultant of Ophthalmology in University Hospital of Alexandropoulos, Thrace since 2001. Head of Medical Retina Unit of the Ophthalmology Department, Democritus University of Thrace,  University Hospital of Alexandropoulos, since 2003. President of the Ophthalmological Society of Thrace, Eastern Macedonia & North Aegean Islands, Greece since December 2017.

 

Abstract:

Purpose: Evaluation of 10 years results in visual acuity (VA) and central macular thickness (CMT) in patients with neovascular age-related macular degeneration (AMD) in ‘real life’ practice.

Material and methods: This is a retrospective study including   417 patients treated with intravitreal anti-Vegf injections the last 10 years that the specific treatment was introduced as first line treatment for wet AMD.VA and CMT were recorded using SLO-OCT prior to initiation of therapy and at the last follow-up visit of each patient as long as the total number of injections applied.The treatment protocol was PRN with monthly patients’ examination.

Results: The follow-up period was up to 10 years. Visual acuity at the last follow-up was improved in 157 (38%), remained stable in 126(30%) and worsened in 134 (32%). The mean change in CMT was approximately 178±41μ. The total number of injections was 2689. We had 1 case of endophthalmitis responded very well in treatment with no other major side effects or other complications (local or systemic) after the injections.

Conclusion: Intravitreal anti-Vegf injections seem to be, as indicated by ‘real life’ practice data, an effective and safe therapy for the treatment of wet AMD, contributing mostly in preservation of patient’s VA.

 

  • Poster Presentations
Location: Souq
Speaker

Chair

Doukas Dardabounis

University Hospital of Alexandroupolis, Greece

Session Introduction

Han-Chih Cheng

Taipei Tzu Chi Hospital, Taiwan

Title: Risk factors of myopia – A questionnaire survey
Biography:

Abstract:

Biography:

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Biography:

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Biography:

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