Day 1 :
Keynote Forum
Vadrevu K. Raju
West Virginia University, USA
Keynote: Pandemic of diabetes and its health consequences. (Beyond Cataract and Retinopathy)
Time : 10:00-10:45
Biography:
Vadrevu K Raju—MD, FRCS, FACS—is a Clinical Professor of Ophthalmology, West Virginia University, WV, USA and Founder, President of Eye Foundation of America.He received his Medical Degree from Andhra University, India and Residency and Fellowship in UK. He is a Fellow of the Royal College of Surgeons and a Fellow of the American College of Surgeons. He received awards from American Academy of Ophthalmology four times for his teaching, research and international services. His most recent awards include Doctor Nathan Davis International Award of Excellence in Medicine by American Medical Association; Lifetime Achievement Award from WV State Medical Association; the President’s Lifetime Achievement Award from President Barack Obama, Mahatma Gandhi Pravasi Samman Award for Achievement in Medicine, House of Lords, London. He was included in the Leading Physicians of the World by International Association of Ophthalmologists. Medscape placed him among the best
doctors in America.
Abstract:
In 2014, 422 million people had diabetes worldwide, with a global prevalence of 8.5% in adults over 18 years of age. The prevalence is increasing all over the world, but a more rapid rise is occurring in low- and middle-income countries. While incredible advances in medicine have happened over the past 60 years, tertiary care is not the answer to the diabetes pandemic. In 2017, the United States spent nearly $3.5 trillion on healthcare. A treatment-based public health system could have ruinous consequences on the economies
of developing countries, where one vial of insulin may cost the equivalent of a month’s salary. Instead, a balanced, whole population public health approach to diabetes intervention is needed, where public policy, prevention, and tertiary treatment are implemented simultaneously. As a part of that system, ophthalmologists are at the forefront of monitoring and treating diabetes as they are sometimes the first to suspect that a patient is diabetic due to vision changes. This is critical, as the number of young productive patients that will lose their vision because of diabetic complications is predicted to be 10 times greater than the number of older patients affected by cataracts. After a diabetes diagnosis, patients should be counselled regarding beneficial lifestyle modifications, be encouraged to tightly control their glucose levels, and treated promptly and appropriately when diabetic eye complications occur.
Keynote Forum
Ming Ronnier Luo
Zhejiang University, Hangzhou, China
Keynote: Development of comprehensive colour appearance model
Time : 11:15-12:00
Biography:
Ming Ronnier Luo is a Global Expertise Professor at the College of Optical Science and Technology, Zhejiang University (China), a Visiting Professor of Colour Science and Imaging, University of Leeds (UK) and a Chair Professor at the National Taiwan University of Science and Technology, Chinese Taipei. He is also the CIE Vice-President of Publication. He received his PhD in 1986 at the University of Bradford in the field of Colour Science. He has published 600 publications in the areas of colour science, imaging science and LED illumination. He is a Fellow of the Society for Imaging Science and Technology (IS&T), and the Society of Dyers and Colourists (SDC). He has received numerous awards for his research in Colour Science and Technology including the recent AIC 2017 Judd Award.
Abstract:
The International Commission on Illumination (CIE) is responsible to provide standards and procedures for specifying colour and light. It should serve the three main functions of colour science: colour specification, colour difference evaluation and colour appearance prediction. The overall goal of this presentation is to develop a comprehensive colour appearance model (CCAM). For colour specification, CIE 1931 and 1964 systems specify XYZ values for 2o and 10o fields of view, respectively. CIE2006 system has recently been proposed to specify colours for different field sizes and different age of observers. For colour difference evaluation, the CIE proposed two uniform colour spaces, CIELAB and CIELUV in 1976. All colours can be presented to show their relative positions in a 3D space. CIEDE2000 formula was proposed to calculate colour-differences across different industries. In 2006 and 2017, the author proposed CAM02-UCS and Jzazbz UCSs. The latter provides high perceptual uniformity, accurate hue linearity and neutral point convergence, highly desired for HDR and WCG applications. It can be further extended to become a CAM. For predicting colour appearance, the CIE proposed CIECAM02 for the colour management of digital imaging systems. The model is capable of predicting appearance of surface colours under different viewing conditions in terms of lightness, brightness, colourfulness, chroma, saturation and hue composition. Those attributes have recently been extended to include vividness, whiteness and blackness. New models were also developed to predict the appearance of stimulus in isolated field such as CAM15u for unrelated colours. This is particularly useful for light and lighting applications. A list of new colour appearance data will be provided to develop the CCAM. New research instrument based on spectrum tunable multi-channel LED system will be introduced to acquire some of these data.
- Retina | Glucoma | Cataract | Vision Therapy
Chair
Vadrevu K. Raju
West Virginia University, USA
Session Introduction
Clérin E
Institut de la Vision, France
Title: The development of a therapy for retinitis pigmentosa based on the nucleoredoxin-like 1 gene
Biography:
Clérin E is a Research Engineer and her main expertise is in the fields of Animal Experimentation, Gene Therapy, Tissue Culture, Immunohistochemistry and Biochemistry. He manages the research activities of the team. He developed an automated counting platform at the institute of vision, e-conome to measure cone density over the whole mouse retinal surface4. This system, developed as a part of the translational research projects on RdCVF was used in the majority of the team projects in a total of six publications. Also his main mission is focused currently on this preclinical research project and to assume daily the organization, the follow-up and the feasibility of the totality of the experiment.
Abstract:
Retinitis pigmentosa is an inherited retinal degeneration that processes from the death of rods followed by dysfunction and degeneration of cones. The nucleoredoxin-like 1 (NXNL1) gene encodes for two different proteins: the trophic factor rod-derived cone viability factor (RdCVF) and the long form, the thioredoxin (RdCVFL). RdCVF acts by stimulating aerobic glycolysis to sustain the outer cone segment renewal and RdCVFL protects the cones against hyperoxia. To translate this promising therapy towards the clinic, independently of the causative gene, we have evaluated the therapeutic benefit of delivering both products of the NXNL1 gene by subretinal injection with an AAV vector targeting retinal pigmented epithelial cells and cones in a mouse model of the disease. Unilateral subretinal delivery of AAV-RdCVF/RdCVFL as compared to AAV-GFP and sham were performed in rd10 mice at 15 days post-natal. The visual acuity test was carried out from 30 days to 55 days post-natal. Eye of animals were collected and used for automated counting after the labelling of cones. The quality control of AAV particles was made by transmission electron microscopy. The kinetics of the loss of visual acuity was significantly retarded statistically after injection of AAV-RdCVF-RdCVFL in three independent experiments. The results were validated by the increase of cone density. We have validated the quality of the viral productions by measuring the percentage of full to empty particles using electron microscopy. Poly-unsaturated fatty acids lipids of the external segment of photoreceptors are essential for phototransduction, prone to oxidation. We show a reduced amount of malondialdehyde (MDA), a marker of lipid peroxidation, for animals injected with AAV-RdCVF-RdCVFL demonstrating the additional protective effect of RdCVFL on cones, strengthening the interest to combine RdCVF and RdCVFL. Our results demonstrate that this treatment will likely be successful in preserving central vision in patients suffering from retinitis pigmentosa in the near future.
Maneli Mozaffarieh
Limmat Eye Center & University of Basel, Switzerland
Title: New insights in the pathogenesis of normal tension glaucoma
Biography:
Maneli Mozaffarieh is an Associate Professor and Glaucoma Specialist with particular focus on Microcirculation who completed her specialization with Professor Josef Flammer, former Head of the Department of Ophthalmology at the University of Basel. She currently teaches at the University of Basel and works clinically in Zürich.
Abstract:
Increased intraocular pressure (IOP) is a major risk factor for glaucomatous damage and reducing IOP improves prognosis. Nevertheless, there is little doubt that other risk factors besides IOP such as unstable ocular perfusion are involved. Blood flow is unstable if either the IOP fluctuates at a high level (or blood pressure fluctuates at a low level) or if the autoregulation of blood flow is disturbed. A common cause for a disturbed OBF autoregulation is a primary vascular dysregulation (PVD) also known as the Flammer-syndrome (FS), frequently observed in normal tension glaucoma patients. Patients with FS commonly have increased retinal venous pressures as measured by means of ophthalmodynamometry. An unstable blood flow leads to recurrent mild reperfusion injury (chronic oxidative stress) affecting particularly the mitochondria of the optic nerve head.
Carlota Saldanha
University of Lisbon, Portugal
Title: Erythrocyte nitric oxide in glaucoma patients
Biography:
Carlota Saldanha is the Professor of Biochemistry and Head of Unit of Institute of Molecular Medicine João Lobo Antunes, Faculty of Medicine, University of Lisbon. She is a Member of the European Society for Clinical Hemorheology and Microcirculation (ESCHM); Coordinating Committee and Editorial Board of the Clinical Hemorheology and Microcirculation; Strategic Group of the European Society for Microcirculation; President of Sociedade Portuguesa de Hemorreologia e Microcirculação and Collaborator of CEMAT–Center for Computational and Stochastic Mathematics of FCT. She has done basic and clinical research on Biochemistry: membrane properties, cell function, enzymology, metabolism, signal transduction. Her research interests include applied hemorheology and microcirculation, inflammation, erythrocyte signal transduction mechanism, fibrinogen binding, nitric oxide metabolism and signal transduction.
Abstract:
Erythrocyte or red blood cells (RBCs) are influents in the blood flow velocity and hemorheology. RBCs also participate in hemostasis systems and in body tissues oxygenation through the vessel endothelium. Endothelial cells and lymphocytes are able to synthesize acetylcholine (ACh) which is to release plasma. Depending on the endothelium integrity degree, the circulating ACh induce vasodilation or vasoconstriction according to the amount of nitric oxide (NO) synthesized and is released into smooth muscle cells (SMC) or to plasma. The NO released is scavenged by erythrocytes and blood cell free hemoglobin. NO enter into RBCs through its membrane protein band 3 and binds to oxyhemoglobin generating S-nitrosohemoglobin (SNO-Hb) and to glutathione originating nitrosoglutathione (GSNO). The NO efflux from erythrocyte is under dependence of mechanical or chemical stimuli bound to membrane receptors. Those affect the NO reservoir molecules inside erythrocyte in dependence of protein phosphorylation degree and redox thiol status. Timolol maleate is a compound used in treatment of patients with open angle glaucoma (OAG).Timolol is a weak inhibitor or erythrocyte membrane acetylcholinesterase (AChE) which behaves as an enzyme and a receptor of ACh. The erythrocytes obtained from blood samples of OAG patients’ present higher AChE enzyme activity and high NO efflux than those obtained from healthy persons. When blood samples taken from OAG patients were incubated in the presence of Ach, no changes in NO efflux in GSNO were verified. At variance, in presence of timolol, instead of ACh, both NO efflux levels and GSNO concentration increase. These data evidences show that the erythrocyte membrane of OAG patients have different molecular properties than healthy subjects which corroborate the increasing tendency of RBCs to aggregate as observed in previous studies. The NO efflux signal transduction pathway associated to AChE-ACh (Figure) and AChE-timolol will be described at the conference.
Fawzia Bardag-Gorce
Los Angeles Biomedical Research Institute at Harbor—UCLA Medical Center, Torrance, CA, USA
Title: Expression of ALDH in cultured autologous oral mucosal epithelial cell sheet (CAOMECS) grafts for ocular surface reconstruction
Biography:
Fawzia Bardag-Gorce has been studying Ocular Surface Disease for the last six years, and has since published and co‑authored six peer-reviewed publications in the field. She began her research on the treatment of limbal stem cell deficiency using cultured autologous oral mucosa epithelial cell sheet (CAOMECS). During these six years, and under her supervision and guidance, her lab has successfully completed pre-clinical studies related to the efficacy and safety of CAOMECS cell-based therapy. She is currently directing a new study approved by the Institutional Research Board in which subjects are being recruited for the human oral mucosal epithelial cell sheet characterization. The long-term goal of this study is to regenerate corneal epithelium in patient with severe ocular surface diseases using autologous oral mucosa epithelial cell sheet grafts.
Abstract:
Statement of the Problem: The transplantation of allogenic limbal epithelium in the form of a keratolimbal allograft from cadaveric tissue is one of the current treatments for patients suffering from injury to the ocular surface. However, transplantation of donor corneal tissue is dependent on the available supply, and the shortage of donor eyes is a well-known continuing problem worldwide. The use of allogeneic limbal grafts is not regarded as standard treatment; it requires systemic immunosuppression and has a poor rate of success. Recently, we have used a cultured non-limbal autologous cell type (Cultured autologous oral mucosa epithelial cell sheet or CAOMECS) to treat ocular surface disease (limbal stem cell deficiency or LSCD).
Aim: The purpose of this study is to focus on the expression of aldehyde dehydrogenases (ALDH1A1 and ALDH3A1) in CAOMECS. These enzymes reduce the levels of acetaldehyde, a highly reactive chemical that causes alterations in proteins and DNA. ALDH also protects against UV induced-oxidative damage and plays an important role in reducing ocular diseases associated with photophobia.
Methodology & Theoretical Orientation: To create LSCD, rabbits underwent surgical limbectomy. Rabbit oral mucosal epithelial cells were isolated and cultured to produce CAOMECS grafts. Microarray analysis profiling gene expression was used to detect gene expression of ALDH in cultured oral mucosal epithelial cells. Immunofluorescent staining and western blot analysis were used to examine ALDH protein levels in healthy and LSCD-diseased rabbit corneal epithelial cells.
Findings: Immunofluorescent staining showed that ALDH1A1 was highly expressed in healthy corneal epithelial cells. Staining of corneal epithelial cells in rabbits with LSCD showed greatly reduced expression. Western blot analysis confirmed the decrease of ALDH1A1 in LSCD-diseased corneal epithelial cells. Microarray analysis showed significant gene expression of exclusively ALDH1A1 in rabbit CAOMECS. Other investigators have shown that rabbit do not express ALDH3A1 in corneal tissue. Our data showed similar pattern in CAOMECS. The up regulated gene expression of ALDH1A1 suggests CAOMECS may have cytoprotective characteristics against ultraviolet radiation as well as oxidative damage.
Conclusion & Significance: These findings support the hypothesis that CAOMECS may protect against photophobia by grafting cells that contain ALDH, which may improve corneal epithelium cell function and corneal transparency.
André Pellizzer Marcondes
Leedsay Medical Products, Monte AprazÃvel, Brazil
Title: Evaluation of a new combined ophthalmic viscosurgical device in patients undergoing cataract surgery
Biography:
André Pellizzer Marcondes is a Pharmacist with specialization in Biochemistry. He works as Director of pharmaceutical companies with more than 30 years of experience in the sector. All your efforts and actions are directed towards the evolution, research and development of pharmaceutical products and processes, more focused on ophthalmology. He is passionate about technology and innovation and with a futuristic vision, in mid-2009 he decided to abandon the traditional work platforms definitively and began to work exclusively with his own system of organization, with the purpose of developing innovative processes and products, aiming for global reach.
Abstract:
Statement of the Problem: Ophthalmic viscosurgical devices (OVDs) are viscoelastic solutions used in cataract surgery to create and maintain space in the anterior chamber of the eye during phacoemulsification and implantation of the intraocular lens (IOL). They can be classified into two general categories: cohesive and dispersive. Cohesive OVDs maintain the anterior chamber during the capsulorhexis and IOL implantation and dispersive OVDs protect corneal endothelium during the phacoemulsification. In general, it is necessary to use a dye prior to filling the anterior chamber with OVDs. The most used dye in cataract surgery is the Trypan Blue. Because they are separate substances, it is mandatory to perform two different surgical steps during the phacoemulsification. Combined OVDs are a recent innovation and they allow the execution of two surgical steps simultaneously. The purpose of this study is to evaluate the use of a new combined viscoelastic agent in patients undergoing phacoemulsification.
Methodology & Theoretical Orientation: A longitudinal and prospective study of 20 eyes of consecutive patients with cataract was conducted at the Hilton Rocha Foundation, Brazil. All patients underwent a complete ophthalmologic examination before the phacoemulsification. During the perioperative period, a combined solution containing the viscosurgical HPMC 2% with 0.0012% trypan blue was used to fill the anterior chamber and stain the anterior lens capsule simultaneously. The efficacy of capsule staining was analyzed.
Findings: Capsulorhexis was performed in all eyes without any difficulty. Filling of the anterior chamber and visualization of the anterior lens capsule were possible because of the HPMC and trypan blue, respectively. In the postoperative period there were no cases of toxicity or persistent corneal edema.
Conclusion & Significance: The combined solution containing the viscosurgical HPMC 2% with 0.0012% trypan blue has the ability to fill spaces and blush the capsule simultaneously, resulting in greater safety, greater speed, simplicity and convenience in cataract surgery.
Osama Mohiey El Deen Al-Nahrawy
Suez Canal University, Egypt
Title: Measuring and quantifying the complications and lean of laser vision correction techniques
Biography:
Osama Mohiey El Deen Mohamed Al-Nahrawy, Presently working as a Professor of Ophthalmology, Faculty of Medicine, Suez Canal University and its hospital, Ismailia, Egypt. He is the CEO of Al-Nahrawy Eye and lasik Centers, Sharer founder of Private eye centers in Cairo:Al Hayat Eye center, 17 Mekka Street, Dokki, Giza, Cairo & Egyptian Eye Academy, 17 Beirut Street, Heliopolis, Cairo.
Abstract:
Introduction: Laser vision correction techniques include: Laser assisted in situ keratomelieusis (LASIK), Femtosecond laser-assisted LASIK and photo refractive Keratectomy (PRK). Such techniques have different complications, many of them are reported in literature. Those complications are not measured, not quantified and not analysed to know the most and the less serious, to know the root causes and use this in the management plans. Also, it is noticed that no lean analyses and assessment of waste steps inherent in such techniques.
Methods: Review articles and randomised controlled trials are being searched. Reported complications are summarised and analysed. For each technique, number of complications and their severity scores will be calculated. For each complication, further search about its root causes is done and reported. Safety and risk definitions are redefined or reconsidered. Technical steps, equipments, consumables and materials used and time consumed in these techniques are being analysed.
Findings: 22 types of complications related to the LASIK technique , 17 types of complications related to femto-LASIK and 3 types of complications related to PRK were found. Most complications related to the first two techniques were related to flap-lifting. Free caps, button holes, striae, epithelial downgrowths and post lasik ectasia were the most sever types of complications (scores 3-5). Steps of techniques were as follow: LASIK: 8 steps. PRK: 3 steps. Femtolasik: 7 steps.
Conclusion: Photorefractive keratectomy (PRK) is proved to be the least complications, the safest and the best lean technique. In the second order comes the femtolasik, being the second safe but the lowest lean. Conventional microkeratome LASIK is the most risky techniques but has an intermediate lean level.
Mikhail A Ostrovsky
Institute of Biochemical Physics—Russian Academy of Sciences, Russia
Title: Study of lipofuscin granules and melanosomes from human retinal pigment epithelium Mikhail A Ostrovsky
Biography:
Mikhail Ostrovsky is a Physiologist known for his work in Vision and Biology. He is a full member (Academician) of Russian Academy of Sciences, a Professor of Lomonosov Moscow State University and President of the Pavlov Physiological Society of Russia. He has published books on the Molecular Mechanisms of Visual Reception (2002), Spectral Correction of Vision (2005), Actual Tendency of Brain Investigation (2010), Molecular Physiology and Pathology of the Eye Lens (2013) and 200 scientific papers. Over the past two decades, he has been actively studying the lipofuscin granules. Together with co-authors, he found that lipofuscin granules are generators of free radicals under the action of visible light (1993). Recently, together with co-authors he described “changes in spectral properties and composition of lipofuscin fluorophores from human retinal pigment epithelium with pathology” (2015).
Abstract:
Lipofuscin granules (LGs) accumulate in the retinal pigment epithelium (RPE) cells with age, particularly in patients with hereditary diseases. Photosensitization of LGs with blue light can generate reactive oxygen species. Defined differences in fluorescence properties between chloroform extracts obtained from cadaver eyes with and without signs of pathology hold promise for the future improvement of fundus autofluorescence imaging. There is a significant age-related decrease for melanosomes in the RPE cell due to its biodegradation. Oxidants, such as hydrogen peroxide or superoxide radicals, easily lead to melanin destruction. For example, superoxide radicals lead simultaneously both to decrease the amount of melanosomes and concentration of paramagnetic centers of the melanin. We suggest that the age-related loss of melanosomes in the RPE cell is due to melanin destruction in the complex melanolipofuscin granules; superoxide radicals light-induced by LGs cause the destruction. The accumulation of LGs as source of free radicals along with autofluorescence and loss of melanosomes as screening and antioxidant pigment in the RPE cells with age can lead to photo-oxidative stress which is related to the progression of serious eye pathologies. The lecture reviews the recent advances in knowledge of the RPE lipofuscin granules and melanosomes.