HONG KONG – Sutureless large-incision manual cataract surgery has been shown to be a practical, safe and transfer-rable skill in both urban and rural settings, according to a speaker here.

Dennis SC Lam, MD, FRCOphth, described the tech-nique and results it has produced in an experimental rural eye unit during Cataract and Refractive Surgery Subspecialty Day held prior to the World Ophthalmology Congress.

According to Prof. Lam, sutureless large-incision manual cataract surgery (SLIMCE) can play an important role in bringing safe and affordable surgery to more patients, par-ticularly those in rural settings who would not otherwise be able to afford cataract surgery.

“I think SLIMCE procedures can be performed safely in rural settings, and skill transfer is possible with very short

HONG KONG – At the ICO Presidents’ Dinner here, famed artist Mrs. Chiu Ng Yuet Lau was on hand not only to show her skill and artistry in creating one of her nature paintings, but also to donate a painting for auction to raise money for the Inter-national Council of Ophthal-mology Foundation.

The bid started at US$3,000 but quickly esca-lated from bids by such dig-nitaries as WOC president and organizing secretary, Dennis SC Lam, MD, FRCOphth, Asia-Pacifi c Academy of Ophthalmol-ogy president, Yasuo Tano,

Art auction at Presidents’ Dinner raises money for ICO Foundation

SLIMCE results safe, skills transferrable in rural setting

WOC DAILYA Special Presentation of

Day 1 June 29, 2008

Glaucoma and PhacoCombined procedures shown to be an eff ective option in some cases.

PAGE 3

Surgical ProphylaxisResearcher reports intracameral cefuroxime is a better option to prevent postoperative endophthalmitis.

PAGE 4

Documentary DebutsFilmmaker chronicles experiences with low vision in movie being screened at World Ophthalmology Congress.

PAGE 14

Diagnosing GlaucomaClinician presents 5 simple rules to assist in evaluation of glaucoma suspects.

PAGE 17

Highlights

Featured Activities

11:00 - 12:30Opening CeremonyHall 3

14:00 - 14:30APAO Symposium and AwardsTheatre 2

14:00 - 15:30Phaco Complications: Why? What Now? How?Hall 7A

18:45 – 22:00Gala DinnerGrand Hall

Art auction, continued on page 13

Bruce E. Spivey, MD, (left), artist Mrs. Chiu Ng Yuet Lau, her sonPhilip Chiu, MD, and Dennis SC Lam, MD, FRCOphth, stand with Mrs. Chiu’s painting.

大会特别报道WOC DAILY 将提供

一项特殊服务，在第

6页和第7页用中文报

道“中华眼科学会第

八届大会 (XIII Con-

gress of the Chinese

Ophthalmological So-

ciety)。请在以后几期

中阅读重点关注这些

重要报告的文章。

SLIMCE, continued on page 4

WOC DAILY | Day 1 June 29, 2008 3

HONG KONG – In patients with un-controlled primary angle closure glauco-ma, phacoemulsifi cation alone may be a suffi cient surgical option.

“Phaco alone is a viable initial alter-native in primary angle closure glauco-ma with co-existing cataract,” Clement CY Tham, FRCS, said at Glaucoma Subspecialty Day, held prior to the World Ophthalmology Congress here. “The possible exception is eyes with

very advanced primary angle closure glaucoma.”

Prof. Tham discussed a series of randomized, controlled studies com-prising more than 200 primary angle closure glaucoma cases that he and colleagues conducted in Hong Kong. He presented results of a subset group of 51 patients. In that group, 27 angle closure glaucoma patients underwent phaco, and 24 underwent combined phaco and trabeculectomy, he said. The mean follow-up for the subset group

was 35 months, Prof. Tham said. He and colleagues found that the

combined surgical group had better IOP control than the phaco alone group at 3, 15 and 18 months, and 1.2 fewer drugs. Also, nearly 5% of eyes in the phaco alone group required trabeculec-tomy following lens extraction because of uncontrolled IOP, Prof. Tham said.

However, patients in the combined group had a higher rate of complica-

tions from the fi ltration surgery, Prof. Tham said. He presented pooled anal-ysis of patients in both the subset group and larger study, fi nding multiple com-plications from combined surgery. The fi ltration procedure alone also has more complications, he said.

“Trabeculectomy by itself has a limited role in primary angle closure glaucoma, partly because of the high prevalence for cataract in these cases,” Prof. Tham said.

Because primary angle closure glau-

coma increases with age, a majority of those patients have co-existing cataracts, Prof. Tham said. Studies have shown that removing the cataract deepens the anterior cham-ber and opens the drainage angle wider, he said. Those re-sults appear to show promise that phaco alone could be the best surgical option for primary angle closure patients with co-existing cataract, Prof. Tham said.

Prof. Tham also said these fi ndings do not indicate a replacement for laser peripheral iridotomy as initial treat-ment therapy in primary angle clo-sure patients. Other options should be considered if there is total or near total peripheral anterior synechia. For those patients who do not have total 360° peripheral anterior synechia, iri-dotomy eliminates papillary block and partially opens the close angle safely and effectively, he said.

However, in more advanced cases, especially those with co-existing cata-ract, further surgery might be necessary to signifi cantly reduce IOP, he said.

Cataract surgery for primary angle closure glaucoma could change disease severity

Recognizing the large number of Chi-nese ophthalmologists attending the World Ophthalmology Congress, a special symposium on cataract compli-cations has been or-ganized. David F. Chang, MD, andDennis SC Lam, MD, FRCOphth,will chair the ses-sion “Phaco Com-plications – Why? What now? How?” today from 14:00 to 15:30 in Hall 7A. The session is in-tended for the Chinese audience, but all are welcome to attend. Presentations will be in English with simultaneous

English to Mandarin translation.Dr. Chang and Prof. Lam will pres-

ent video case studies and stop the video when the complications occur,

then a panel of ex-perts will discuss how the complica-tion occurred and how it should be addressed.

Topics in the symposium will include capsulor-rhexis complica-

tions, phaco burn, mature nuclear cataract, crowded anterior chamber, posterior capsular rupture, weak zon-ules and small pupils.

David F. Chang Dennis SC Lam

Clement CY Tham

Shopping discount for WOC delegatesPresent your delegate badge or special voucher at the following retail shops to get special discounts.

ELECTRONICS

• Broadway

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JEWELRY

• Chow Tai Fook

CLOTHING

• Dickson

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Special session on cataract complications

Phaco alone is a viable initial alternative in primary angle closure glaucoma with co-existing cataract.— Clement CY Tham, FRCS

WOC DAILY | Day 1 June 29, 20084

HONG KONG – Despite the fact that topical fl uoroquinolones have become standard of care in the United States, intracameral, perioperative antibiotics injections are the best route for pre-vention of postoperative en-dophthalmitis, according to a speaker here.

Peter Barry, FRCS, made his case for why intracameral cefuroxime, and not topi-cal fl uoroquinolones, should be the standard of care for surgical prophylaxis during Cataract and Refractive Sur-gery Subspecialty Day, held prior to the World Ophthalmology Congress.

“There can never be an ideal antibi-otic for prophylaxis. Cefuroxime is the best for now,” Dr. Barry said.

Dr. Barry acknowledged that cefu-roxime is an old drug and is not ef-fective against methicillin-resistant Staphylococcus aureus, Enterococcus and Pseudomonas. Furthermore, it is inex-pensive and, therefore, is not a fea-sible fi nancial option for a company

to produce in the high numbers nec-essary. It is also not approved by the U.S. Food and Drug Administration.

However, “most importantly, it works,” he said.

The effi cacy and safety of cefuroxime have been prov-en with more than 8,000 pa-tients who received the drug in the European Society of Cataract and Refractive Sur-geons (ESCRS) endophthal-mitis study, and in a study of 425,000 Swedish patients conducted by Mats Lund-strom and colleagues.

“Importantly, emerging resistance to fourth-generation fl uoroquinolones would argue against their role in the future,” Dr. Barry said.

He noted that he believes the pop-ularization of latest-generation antibi-otics such as gatifl oxacin and moxi-fl oxacin is too little too late, based on reports of their emerging resistance and on the use of the drugs in animal husbandry.

Dr. Barry said a study evaluating the

effi cacy of topical fl uoroquinolones in a large cohort of patients would be de-sirable to provide an evidence-based standard for surgeons. Yet the prospect of undertaking such a study is “out of the question.”

“You would need an enormous number of patients to prove equiva-lence, the cost would be prohibitive, recruiting patients would be very dif-fi cult, and the study would be superfl u-ous unless … there is something wrong with cefuroxime,” he said.

Dr. Barry also outlined the results of the ESCRS endophthalmitis study, the results of which were released at the society’s 2006 meeting in London. The study, which enrolled some 16,000 pa-tients, found that cefuroxime injection lowers the chances of bacterial con-tamination by a factor of 5.

“This means that the risk rate is re-duced to less than 5 in 10,000 cases,” Dr. Barry said. He noted that the rate of infection, which was criticized in an editorial in Ophthalmology, is consistent with the Swedish study conducted by Dr. Lundstrom and colleagues.

Barry: Intracameral cefuroxime is best option for endophthalmitis prophylaxis

Peter Barry

learning curve even to inexperienced surgeons,” Prof. Lam said.

Prof. Lam discussed prospective study results of 313 patients who un-derwent cataract extraction by two lo-cal surgeons in rural Sanrao, China. Of these, 85.2% had a preoperative visual acuity of 6/60 or worse. The postop-erative uncorrected visual acuity was better than 6/18 in 86.3% of eyes and the postoperative best corrected visual acuity was better than 6/18 in 97.1% of eyes, according to Prof. Lam.

The two surgeons who performed all the cataract extractions were trained to perform SLIMCE independently in 5 months. Since the Sanrao center was opened in December 2004, the same two surgeons have done more than

3,000 cataract surgeries using this tech-nique, averaging around 100 cases per month, Prof. Lam said.

Of the Chinese population, more than 800 million people live in rural villages, he said. The ability to train rural surgeons to perform a technique that is safe and transferrable is essential to providing much needed services to this underserved population.

“But before we do that in the village we need procedures that are simple, safe, effective, easy to learn and easy to trans-fer the skills to local doctors,” he said.

Prof. Lam and colleagues have also studied the endophthalmitis rate among those patients who have under-gone SLIMCE in the rural hospital.

He said there have been three re-ported cases among 3,000 patients since December 2004. The low infec-tion rate can be attributed to the fact that the procedure is done through the

sclera and not clear cornea, and the wound is well-covered by the conjunc-tiva, according to Prof. Lam.

Overall, he said, the results from this experimental model “confi rmed the effectiveness of skill transfer in rural areas with superior outcomes to most studies in rural Asia.”

Dr. Lam invited WOC delegates to attend a live surgical demonstration on Monday, where they will be able to ob-serve the sutureless large-incision tech-nique as well as a small-incision manual cataract extraction technique (see page 3 for more information).

Visit the Exhibit HallSunday 8:00 - 18:45Monday 8:00 - 18:45Tuesday 8:00 - 18:45Wednesday 8:00 - 15:00

continued from page 1

SLIMCE

WOC DAILY | Day 1 June 29, 20086

中华医学会第13届全国眼科学术大会隆重开幕2008年6月28日上午11:00整，中华

医学会第13届全国眼科学术大会在香

港会展中心隆重开幕。会议由中华医

学会眼科学分会秘书长王宁利、王

薇教授主持。眼科学分会主任委员

黎晓新教授致开幕词，香港中文大

学、WOC2008主席林顺潮教授、美

国南加州大学Doheny眼科研究所、

WOC2008学术委员会主席Stephen

J. Ryan、台北眼科学会理事长潘志

勤教授分别在开幕式上致词。大会对

2007-2008年度对中国眼科作出杰出

成绩的人员进行了颁奖，还为眼科学

分会首首批专家会员举行了隆重的颁

发证书仪式。

中华医学会会长钟南山教授给大

会发来了贺信。大约容纳600人的

Theater 1 会议厅座无虚席。

开幕式在热情洋溢的气氛中结

束，正如黎晓新主任委员在开幕词中

所说：本次会议的成功举行，体现了

全球华人眼科界的空前团结，预示着

中国眼科将迎来更为美好的明天。

中华医学会眼科学分会 工作秘书

赵明威 。

(按姓氏汉语拼音排序)

褚仁远、谢立信、吴乐正、李美玉、

杨钧、惠延年、何守志、姚克、郭希

让、张军军、严密、黎晓新、王宁

利、张士元、王文吉、赵家良、赵堪

兴。

葛坚、张承芬、廖菊生、李凤鸣、

罗成仁。

附:中华医学会眼科学分会第一批

专家会员入选条件及程序。

一、入选条件

1、眼科学分会专科会员从事眼科

学工作10年以上，具备主任医师或

相应职称。

2、热心本分会工作，为学科带

头人，并做出重要贡献。作为课题

负责人(PI)承担过国家级科研项目1

项，或作为课题负责人(PI)承担过3

项以上（含3 项）省部级以上科研项

目；以第一作者或通讯作者发表SCI

论文5 篇及以上，并以第一作者或通

讯作者在中华系列杂志发表论文10

篇及以上者。

3、具有较高的学术威望，学风正

派，能履行专家会员的义务。

二、遴选程序

（一）遴选第一批专家会员：两院

院士、国外学术机构院士、现任和曾

任眼科学专科分会主任委员、副主任

委员、中华系列眼科杂志总编、副总

编，本人自愿成为眼科学

分会第一批专家会员者。

（二）除第一批专家

会员外，凡申请成为专

家会员者，本人填写申

请表，三个专家会员推

荐，经专科分会常委会

组织专家会员全体大会

或代表大会考核通过，

眼科学分会常委会审

核，报中华医学会组织

工作委员会批准。

WOC2008主席林顺潮教授致辞。

台北眼科学会理事长潘志勤教授致辞。

中华医学会眼科学分会第一批专家会员名单

眼科学分会首批专家会员。

WOC DAILY | Day 1 June 29, 2008 7

一、中华眼科国际金奖获得者：

1. 日本大阪大学医学院眼科学

系主任，田野保雄(Yasuo Tano)

2. 德国海德堡大学曼海姆医院

眼科教授 Dr. Jost B. Jonas

二、海外华人眼科学及视觉科学

杰出成就奖

美国南加州大学医学院Doheny眼

科研究所、何世坤教授

三、中华眼科杰出成就奖

1 D 北京大学人民眼科中心黎晓

新教授

2 D 天津眼科医院赵堪兴教授

四、中美眼科学会金苹果奖

中国医学科学院北京协和医院眼

科 赵家良教授

五、中美眼科学会金钥匙奖

北京同仁医院同仁眼科中心王宁

利教授

六、中华眼科学会奖

余敏斌、樊映川、王志军、姜节

凯、任百超、张虹、傅少颖。

何伟、王成业、袁长明、郑曰

忠、颜华、李建军、卞春及。

欢迎词尊敬的各位同道，各位朋友和来

宾:

我代表中华医学会眼科学分会衷

心地欢迎各位来到香港，参加由世

界眼科学会、亚太眼科学会、香港

眼科学会和中华医学会眼科学分会

共同举办的这次盛大的眼科会议。

今年的第十三届全国眼科大会充

满了学术亮点。有7名来自海外的华

人同道将在会议上特邀发言；来自

台湾的眼科同道将和我们共同举办

9场两岸论坛；学会的各个专业学

组都精心地准备了反映学科最新进

展的专题发言、热点研讨和富有吸

引力的病例讨论⋯⋯这次学术会议

将检阅过去一年来我们所取得的成

就，同时也预示着我们将迎来更加

美好的明天。

我衷心地感谢大会学术委员会、

各个学组为本次大会所付出的艰辛

劳动，感谢他们为本次大会所作的

精心策划。感谢各位发言人、展板

的制作者为大会的成功举行所做出

的贡献。我还要对给予本次学术会

议以巨大支持的国内外厂商表示衷

心地感谢。这次大会的成功举行是

大家共同努力的结果，体现了华人

眼科界的空前团结。

再次感谢大家！并祝大家在香港

度过愉快的时光。

中华医学会眼科学分会主任委员

中华医学会第十三届全国眼科学

术会议主席

黎晓新教授

黎晓新教授致开幕词。

Welcome Message Distinguished guests, colleagues and friends,

On behalf of the Chinese Ophthalmological Society, let me extend my warmest welcome to each and every one of you at-tending the Congress jointly organized by the International Council of Ophthalmology, the Asia Pacifi c Academy of Ophthal-mology, the Hong Kong Ophthalmological Society and the Chinese Ophthalmological Society.

The 13th Congress of the Chinese Ophthalmological Society is of special signifi cance in that seven clinicians from mainland China will speak as specially invited guests, our Taiwan counterparts will join with us in launching nine cross-strait symposia, and the eleven subspecialty panels have prepared specialized lectures that introduce the latest developments of their respective fi elds and encourage discussion on hotly debated issues and interesting cases. The academic meeting will review the achievements we have made over the past year and outline a bright future for ophthalmology.

I sincerely thank all members of the academic committees and panels of the congress for their hard work in organizing this meeting. My thanks also go to the speakers and makers of on-the-spot exhibits for their excellent work. I would also like to ex-tend my heartfelt gratitude to all the domestic and foreign companies that have rendered signifi cant assistance. The success of the meeting results from the joint efforts of all involved, which displays the unprecedented unity among Chinese ophthalmologists.

Again thank you and I wish you a happy stay in Hong Kong.Professor Xiaoxin Li

President of Chinese Ophthalmological SocietyPresident of the 13th Congress of Chinese Ophthalmological Society

中华医学会眼科学分会2008年度各种奖项获得者名单

赵堪兴教授获中华眼科学会杰出成就奖。

WOC DAILY | Day 1 June 29, 20088

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HONG KONG – Due to precipitate development that may effectively block up to 94.9% of ceftazidime absorption when mixed with balanced salt solu-tion, one researcher recommends the exploration of the use of newer antibi-otics in combination with vancomycin for the treatment of endophthalmitis.

In a presentation here, Mamie Hui, FRCpath, of the department of micro-biology at the Chinese University of Hong Kong, said that a checkerboard analysis found ceftazidime concentra-tion fell to 94.9% by 48 hours when mixed with balanced salt solution with or without vancomycin.

Researchers theorized that precipi-tate formation blocked the absorption of ceftazidime. Dr. Hui performed an equilibrium dialysis study to test this theory. The tests used an equilibrium

dialyzer, a simple cylindrical instru-ment comprised of two chambers separated by a semi-permeable mem-brane fi lled with donor vitreous and

incubated at 37° C. Ceftazidime and vitreous were added to one chamber and aliquots were taken at regular in-tervals from the other chamber.

“Ceftazidime concentration fell to an extremely low level at 48 hours,” Dr. Hui said. “Such a level may not be suf-fi cient for organisms with high ceftazi-dime MIC levels, such as Pseudomonas, Acinetobacter, Citrobacter, Enterobacter.”

Dr. Hui carried out the same analysis with other gram negative affecting agents. Both ciprofl oxacin and Amikacin were found to have a much higher concentra-tion at 48 hours (greater than 30%).

Dr. Hui said that while intracameral use of such agents is not commonly practiced, they should be considered in light of this research.

“Loss of antibiotic concentrations is a concern with ceftazidime,” she said. “As many newer compounds are coming onto the market, they should be assessed for their potential effi cacy in the treatment of endophthalmitis,” she said.

Precipitate development impedes endophthalmitis treatment eff ectiveness

As many newer compounds are coming onto the market, they should be assessed for their potential effi cacy in the treatment of endophthalmitis.— Mamie Hui, FRCpath

Special Edition, No. 1 • 2008

CONTENT SPONSORED BY AN EDUCATIONAL GRANT FROM AMO

Tear Film Key to Refractive Surgical SuccessKERRY D. SOLOMON, MD

I n thinking about all the factors that go into a successful outcome in an-terior segment surgery, we must con-

sider the quality of the tear film. Many of our refractive and cataract surgery patients have dry eye to start with--and surgery is likely to make that condition worse, at least temporarily.

I advocate an aggressive, proactive ap-proach to treating dry eye symptoms both before and after surgery, using high quality artifi cial tears, along with topical cyclospo-rine and steroids as needed.

Recently, we’ve seen a major break-through with a new tear product, Blink In-tensive Tears (Advanced Medical Optics). The unique viscoelastic properties of this tear help it adhere to the corneal surface so that it reduces symptoms for a longer duration. Optical tear-fi lm interferometry studies have shown that the mean reten-

tion time after just one instillation of Blink Intensive Tears is longer than 31 minutes, and in some cases, the tear fi lm maintains its thick-ness for greater than 60 minutes.

But in addition to the long duration of effect, what really distinguishes Blink In-tensive Tears are its superb optical quali-ties. It behaves like a gel, but without the blurriness. In fact, patients using Blink Intensive Tears report improved quality of vision over time (Fig 1) and signifi cant im-provement in comfort after using the drops for a few weeks.

In a refractive surgical population, there are defi nite advantages to treating dry eye be-fore surgery. A healthy tear fi lm is going to

High Quality of Vision with Blink Intensive TearsERIC D. DONNENFELD, MD, FACS

W hen treating dry eye syndrome, it is important to start with a high-quality tear that can pro-

vide symptomatic relief, either on its own or as an adjunct to prescription therapies such as topical cyclosporine.

Blink Intensive Tears from Advanced Medical Optics (AMO) is a new tear that mimics the natural mucin found in human tears. The active ingredient is polyethylene glycol 400 (PEG-400), but it also has visco-

elastic properties that make it quite unique.

The company conducted a double-masked pilot study to evaluate subjective comfort and vision quality with Blink Intensive Tears. Sub-jects were randomized to either Blink In-tensive Tears or Systane (Alcon), with 12

[Donnenfeld continued on page ii]

[Solomon continued on page iii]

S p o t l i g h t o n :

The Ocular Surface

翻译见内文

Kerry D. Solomon

Eric D. Donnenfeld

REFRACTIVE SURGERY QUARTERLY

REFRACTIVE SURGERY QUARTERLY is presented as a professional service of AMO, Inc. The opinions expressed here are those of the authors and do not necessarily refl ect the views of the editors, publisher or sponsor.

REFRACTIVE SURGERY QUARTERLY

is published by SLACK Incorporated, 6900 Grove Road, Thorofare, NJ 08086-9447. For more information, contact Norma Hanna, managing editor: Telephone: 856-848-1000; FAX: 856-848-6091;E-mail: nhanna@slackinc.com

Copyright © 2007, SLACK Incorporated. All rights reserved. No part of this publication may be reproduced without written permission.

CHIEF MEDICAL EDITOR

Kerry D. Solomon, MDCharleston, SC

EDITORIAL ADVISORY BOARD

Kerry K. Assil, MDSanta Monica, CA

Hiroko Bissen-Miyajima, MDTokyo, Japan

Y. Ralph Chu, MDEdina, MN

Eric D. Donnenfeld, MDRockville Center, NY

Jonathan M. Frantz, MDFort Myers, FL

Jose L. Güell, MDBarcelona, Spain

David R. Hardten, MDMinneapolis, MN

Michael C. Knorz, MDMannheim, Germany

Colman R. Kraff, MDChicago, IL

Michael Lawless, MDChatswood, Australia

Richard L. Lindstrom, MDMinneapolis, MN

Terrence P. O’Brien, MDBaltimore, MD

in each group.There was no difference between the two

groups in retention time, ocular comfort, tear fi lm break-up time (TBUT), or meniscus height. However, subjects in the Blink Intensive Tears group had an improvement in quality of vision of 0.33 ± 2.2 points, compared to a decrease in qual-ity of -2.05 ± 2.5 in the Systane group.

Additionally, subjects in the Blink Intensive Tears group reported signifi cantly less blur on instillation (Fig 1) and were more than twice as likely (90% vs. 42%) to say that the tear had no effect on their quality of vision immediately after instillation. This is very important because blurred vision is a major reason that patients dislike using artifi cial tears.

In my practice, we have also studied how Blink Intensive Tears compares to Systane. In a double-masked study, 110 dry-eye patients, (age 19 to 78) were randomized to either Blink Intensive Tears or Systane. Patients were instructed to use the drops four times a day for 30 days and were examined on days 7, 14, 21, and 30.

Patients using Blink Intensive Tears had signifi -

cantly less blur (P =.046) and better comfort on instillation (P = .017) than the group using Sys-tane. End-of-day vision quality was comparable between the two groups. Effi cacy, as determined by corneal/conjunctival staining and TBUT anal-ysis, was also comparable.

Thirty-six percent of the Blink Intensive Tears group preferred the new drop to their previous ar-tifi cial tear, while only 12% preferred Systane over

the products they had previously used. More than twice as many in the Blink Intensive Tears group said they had superior vision with the new tear regimen (Fig 2).

Blink Intensive Tears smoothes out and nor-malizes the tear fi lm, making it a better refract-ing surface. The tear lasts a long time--longer than 30 minutes in some cases--without the short-term negative effect on the quality of vi-sion that one might expect. For this reason I consider Blink Intensive Tears to be the fi rst truly refractive tear.

Dr. Donnenfeld is a clinical professor of ophthalmology at New

York University Medical Center and is a trustee of Dartmouth Med-

ical School. Contact him at (516) 766-2519 or eddoph@aol.com.

泪膜是屈光手术成功的关键

Blink Intensive Tears(特效保湿润眼液)是理想术前和术后使用的人工泪液。

一滴Blink Intensive Tears可保持于眼内长达60分�。

Blink Intensive Tears 具有凝胶的特性，�不会导致�力模糊。

健康的泪膜可提升术前角膜地形图和波前检查的结果，令屈光检查更精确，并可加快术后视力的恢复。

手术后，干眼症的主要症状是视力不稳定。

[Donnenfeld, continued from page i]

Figure 1: Compared to Systane, blink Intensive Tears has signifi -cantly less blur upon installation (p=0.046).

Figure 2: Fluorescein staining in the interpebral fi ssure in a patient with dry eye after LASIK.

SPECIAL EDITION, NO. 1 • 2008: THE OCULAR SURFACE iii

produce better preoperative topography and wavefront exams, a tighter refrac-tion, and speed up visual recovery after surgery. This ensures crisper, more com-fortable vision on the fi rst post-operative day, boosting the “wow factor” and word-of-mouth referrals.

It is not unusual for us to delay elec-tive surgery for one to two months in order to have time to improve the health of the ocular surface. Blink In-tensive Tears is ideal for cataract and refractive patients as they prepare for surgery because they do not need to use it constantly or suffer from reduced quality of vision.

The need for tears and other thera-pies continues after surgery. We know that LASIK induces a neurotrophic condition; Li and colleagues recently reported in Cornea that well over half the patients undergoing cataract sur-gery experienced signifi cant postopera-tive dry eye, as well.

These patients probably will not complain about “dryness.” In fact, they are much more likely to experience dry-ness-related fl uctuations in vision. We can avoid the perception that the sur-gery was not successful, increase patient satisfaction, and avoid enhancements simply by maintaining the patient on a high quality tear, such as Blink Inten-sive Tears, 4-6 times daily, along with twice-daily cyclosporine therapy, for several weeks after surgery.

Dr. Solomon is a Professor of Ophthalmology at Storm

Eye Institute, Medical Director of Magill Laser Center,

and Director of Magill Research Center, all at the Medi-

cal University of South Carolina. Contact him at (843)

792-8854 or solomonk@musc.edu.

[Solomon, continued from page i]

Blink Intensive Tears 可提高视觉质量

全新推出的Blink Intensive Tears (AMO)除具有活性成份PEG-400，它还有独特的粘弹性。

Blink Intensive Tears于眼内的保持时间及对眼部的舒适度和功效与Systane润眼液相当。

不过，Blink Intensive Tears滴眼后，患者报告的视力模糊显著少于Systane润眼液。

36%使用Blink Intensive Tears的患者认为新的人工泪液较他们以前使用的人工泪液优胜，仅有12%的患者认为Systane润眼液较他们以前使用的人工泪液为佳。超过两倍的人说使用Blink Intensive Tears获得了更好的视力。

Blink Intensive Tears 是唯一可真正改善屈光质量的人工泪液。

Figure 1: At day 30, 22.4% of patients reported “defi nite improvement” in visual quality compared to 7.1% at day 7.

Figure 2: Between day 7 and 21, patients experienced a signifi cant improvement in comfort.

WOC DAILY | Day 1 June 29, 2008 13

24th Congress of the Asia-Pacifi c Academy of OphthalmologyMay 16-19, 2009 • The Westin Resort • Nusa Dua, Bali

Mark your calendars for one of the most prestigious ophthalmology meetings of 2009, the 24th Congress of the Asia-Pacifi c Academy of Ophthalmology, to be held May 16-19 in Bali, Indonesia.

World-renowned experts from the Asia-Pacifi c region will be present to discuss the latest topics and challenges within the fi eld of ophthalmology.

Don’t miss the opportunity to visit beautiful Bali for a unique educational experience.

For more information, please visit apao2009bali.org.

Save the Date

08-1705

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MD, Alcon chairman, president and CEO Cary Rayment and many oth-ers in attendance but eventually was won with a winning bid of US$11,000 by Ms. Nellie Fong. Ms. Fong is the founder of the Hong Kong Lifeline Express Foundation. She is also the Chairman of PricewaterhouseCoopers China Operations.

The money raised by the charity goes to establish scholarships in areas most in need around the world and to further educational goals within oph-thalmology, according to ICO Founda-tion president Bradley R. Straatsma, MD, JD.

“The auction this evening is a very exciting event because it will help serve eye care worldwide by training people, providing for education and assisting the advance of our profes-sion,” Dr. Straatsma said. “The funds generated due to the generosity of this

evening will support people who will be trained to take skills and knowledge from developed countries back to the communities in which they work and live. These scholarships are a very im-portant part of creating quality care in communities around the world.”

Dr. Straatsma praised Prof. Lam for organizing the event for the ICO and said Prof. Lam, “organized this in his innovative and enthusiastic man-ner that has brought about major im-provements in eye care throughout China, the community of Hong Kong and all of Asia.”

Prof. Lam stressed the importance of supporting the ICO Foundation.

“The foundation’s role in creating scholarships for those who have the desire and initiative but lack funding to gain an education in eye care in those places most in need of ophthalmolo-gists is a very important part of solving blindness and low vision rates around the world,” Prof. Lam said.

Mrs. Chiu has a direct connection to ophthalmology through her son

Philip, who is an associate professor of ophthalmology at the Chinese Uni-versity of Hong Kong, and who was on hand to discuss her artistic style with her while she created a gladiola painting in front of the audience. He described her painting as a new kind of art that comes from the south part of China fusing a more modern and open mix of color combined with traditional Chinese brushstrokes.

continued from page 1

Art auction

Balder P. Gloor, MD, (left), and Yasuo Tano, MD, enjoy the beauty of the rooftop deck of the Peak Galleria prior to the dinner.

WOC DAILY | Day 1 June 29, 200814

HONG KONG – When Joseph Lovett encounters people with low vision on the street, he asks if he can help them navigate busy city intersec-tions. Recently, he has also been asking them another question — if they will tell him their personal stories about being blind.

Mr. Lovett has a personal reason for his inquiries: He has pseudoexfoliation

glaucoma and has lost some sight in his left eye. He also has a professional reason. Mr. Lovett, a fi lmmaker and producer based in New York City, has been fi lming a documentary called Going Blind about people living with advanced visual loss.

“The stories I got were fascinating, utterly fascinating,” he said in an inter-view with OCULAR SURGERY NEWS.“I decided this would be a great fi lm. It’s like a whole secret world to share with people.”

The work-in-progress fi lm, which will debut at the World Ophthalmolo-gy Congress here, shows true stories of people with diabetic retinopathy, age-related macular degeneration, retinitis pigmentosa, albinism and glaucoma, Mr. Lovett said.

In addition to the personal stories of blindness, the documentary is also looking at the latest clinical research in these areas. Mr. Lovett said he hopes to elicit the attention of clinicians at the WOC who might want to take part in the fi lm. The project is also seeking ad-ditional funding, he said.

“When you’re dealing with some-thing that is this important and you’ve got something to show, I think it’s good to let people know what you’re doing, and let the experts come in on it,” Mr. Lovett said. “This is a project

that’s public, and you want the best heads around it.”

He and associate producer Logan Schmid will attend several 15 minute screenings of Going Blind at the WOC, highlighting what they have fi lmed thus far.

Mr. Lovett has made medical documentaries in the past, including the HBO-broadcast Cancer: Evolution to Revolution, which won a Peabody Award. Going Blind will mark his own

journey with ophthalmic care, which began in his 20s with high IOP levels. Since then, he has had reduction in the vision in his left eye. Mr. Lovett said his glaucoma is now medically con-trolled, but he still worries about com-plications and progression.

By sharing his own story and those of others, he said he hopes to show the perspective of patients who are living with visual loss and the necessity of visual rehabilitation services. He said he also hopes to show the public the necessity of visual screenings.

“I think the irony of the fi lmmaker losing vision is that it surprises peo-ple,” he said. “A lot of people say, ‘Oh, that’s so particularly awful for you, you’re such a visual person,’ but then you say, ‘Well, everybody needs their vision – the fi le clerk, the sani-tation worker.’ Everybody wants to have their vision, and an awful lot of accommodations have to be made if you don’t have it.”

For more information:Joseph Lovett is president of Lovett Productions.

He can be reached at 17 Van Dam St., Ground Floor,

New York, NY 10013; 212-242-8999; fax: 212-242-

7347; e-mail: info@lovettproductions.com.

WOC DAILY Editorial Board Editor Clement CY Tham, MD

Glaucoma

Associate Editor Philip TH Lam, FRCS, FRCOphth Cataract

Editorial Advisors Dennis SC Lam, MD, FRCOphth Bruce E. Spivey, MD Yasuo Tano, MD

Members Srinivas Rao, MD, FRCS Corneal & External Eye Diseases

Arthur Cheng, MD Refractive Surgery

Benson Cheung, MD, FRCS Retina

OCULAR SURGERY NEWS

Chief Operating Offi cer John C. Carter

Vice President, Publishing Operations Joan-Marie Stiglich, ELS

Director, Custom Publishing Group Chris Rosenberg

Managing Editor Bryan Bechtel

Writers Katrina Altersitz Erin Boyle David Mullin Lauren Wolkoff

Creative Director Linda Baker

Operations Manager Cheryl McKeown

Information Technology Chas White

WOC DAILY is published during WOC 2008 as a service for all who attend.

©2008 SLACK Incorporated

Published bySLACK Incorporated

6900 Grove Road, Thorofare, NJ 08086Phone: 856-848-1000

WOC DAILYA Special Presentation of

WOWW C20000 8HONG KONG

Documentary shows personal, clinical sides of blindnessFilmmaker is screening part of a documentary about people living with low vision at the World Ophthalmology Congress.

Selections of the documentary Going Blind will be screened at the WOC:

Video Screening Theatre, Room 605, Hong Kong Exhibition and Convention Center

Sunday, June 29, 18:10

Tuesday, July 1, 8:10

Wednesday, July 2, 14:00

To watch a clip from the fi lm, go to www.goingblindmovie.com.

I think the irony of the fi lmmaker losing vision is that it surprises people. … Everybody wants to have their vision, and an awfullot of accommodations have to be made if you don’t have it.— Joseph Lovett

WOC DAILY | Day 1 June 29, 2008 15

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HONG KONG – An additional classi-fi cation type is necessary to better treat age-related macular degeneration pa-tients and further clarify the differences in lesions, one surgeon said here.

“Does lesion composition matter in the VEGF age? I believe it does,” James Klancnik, MD, said during the Retina Subspecialty Day held prior to the World Ophthalmology Congress.

Dr. Klancnik said the current Gass Classifi cations of Type 1 and Type 2 le-sions do not cover all lesions seen by daily practitioners and, therefore, he proposed a third classifi cation.

Type 3 lesions, he said, would be characterized by intraretinal neovascu-larization, retinal angiomatous prolifer-ation with distinct clinical angiography of cystoid macular edema and retinal anastomoses.

Spectral domain optical coherence tomography allows today’s surgeon to better visualize this new classifi cation, he explained, showing that early moni-toring revealed the retinal pigment epi-thelium (RPE) detachment appeared after the formation of retinal choroidal anastomosis.

“One of the nice things about this clas-sifi cation feature is it helps to remove the confusing natures of describing the neo-vascularization solely based on fl uorescein angiography,” he said. “Describing it in terms of its location – sub-RPE state, sub-retinally or intraretinally – I think is quite helpful. It also allows the description of mixed lesions.”

Dr. Klancnik explained that these more detailed classifi cations also allow for the retina specialist to better estimate the course of anti-VEGF treatment and

the visual results. Type 1 lesions may require more fre-

quent injections, but will produce better visual results, despite RPE detachments that do not fl atten, as the retina is not damaged. Type 2 lesions will require less frequent injections, but produce poorer visual results due to early damage, mak-ing early treatment critical. Type 3 lesions will require less frequent injections with a quick fl attening of the RPE detachment if caught early, but still poorer visual results will occur because vessels have invaded the retina.

“A revised anatomic classifi cation might help reduce confusion associated with fl uorescein based grading and may help guide treatment. Type 3 neovascu-larization is unique in that there is intra-retinal proliferation and retinal choroidal anastomosis,” Dr. Klancnik said.

Additional classifi cation type needed for CNV to reduce confusion, aid treatment

WOC DAILY | Day 1 June 29, 200816

HONG KONG – The International Council of Ophthalmology president called for cooperation from educators in a mission to improve medical edu-cation from the point of student selec-tion for medical school to continuing medical education among their peers.Bruce E. Spivey, MD, addressed a full crowd of ophthalmic educators during the fi rst World Ophthalmic Educational Colloquium during the World Ophthalmology Congress here.

“New education expectations are not less time, not less costly and not less demanding. They’re more,” Dr. Spivey said.

He said they needed to help their colleagues see the value in taking the time to select students who combine the scientifi c and humanist characteristics.

Once chosen, Dr. Spivey said medi-cal students are in an ever-changing technological world. This can some-times perpetuate the traditional view of pedagogical education in which the student is not fully involved in his or her education, he said.

“We continue to teach our students as if they are not adult learners,” Dr. Spivey said. More adult education wirh mutual respect between teacher and student is necessary, he said.

This mentality should be maintained through residencies and fellowships where the student can move toward

setting his or her goals and create a portfolio to refl ect personal achieve-ments.

Dr. Spivey advocated for more developed cur-ricula for fellowships. Here, he said, students should begin to learn their core competencies with credentialing.

He explained that the other aspect educa-tors must take into con-sideration is that each student will not absorb their education in the same manner.

“We assume that be-cause we teach every-one the same way that they learn the same way, but they don’t,” he said. This theory applies to continuing medical education where learning also varies between the gen-erations of practicing physicians.

“With CME, it’s not a one size fi ts all,” he said.

Dr. Spivey said those developing CME programs must continue the

move toward more adult learning, but must also incorporate a greater level of involvement, less “seat time” and more evaluation.

“You folks are the key to creating bet-ter education and better patient care,” Dr. Spivey said to his peers.

Simultaneous Interpretation

As a service to attendees, scien-tifi c sessions from Convention Halls A & B, Theater 1 and Halls 7A and 7B will feature simultaneous interpretation with PowerPoint translation into Mandarin. In ad-dition, simultaneous interpreta-tion will be available for Sponsor Symposia from Convention Halls A & B, Theaters 1 and 2 and Halls 7A and 7B.

ICO approves Abu Dhabi for WOC 2012HONG KONG – The International Council for Ophthalmology has ap-proved Abu Dhabi in the United Arab Emirates as host city for the 2012 World Ophthalmology Congress to be orga-nized by the Middle Eastern-African Council of Ophthalmology, according to MEACO offi cials.

“This is the fi rst time in 150 years that the World Ophthalmology Con-gress will be held in a Middle East-ern city,” Abdulaziz Al-Rajhi, MD,MEACO president said here.

The decision to hold the meeting in Abu Dhabi was offi cially approved in the ICO council meeting on Friday, according to MEACO offi cials. While dates have not been set, MEACO’s di-

rector of international affairs and con-ventions, Rasha K. Alshubaian, said it will most likely take place in Febru-ary or March 2012.

She said MEACO will organize the meeting with the cooperation of the government of the United Arab Emirates.

“MEACO received this honor in recognition of its excellent track re-cord in organizing high quality inter-national congresses over the past years, with proven organizational capacity,” a press release from the organization said. “MEACO will strive to fulfi ll the trust entrusted in it by the ICO and the in-ternational ophthalmic community, to make this a truly historic meeting.”

ICO president calls on colleagues to facilitate improvement in education from medical school to CME

Mark OM Tso, MD, DSc, lead coordinator for the World Ophthalmic Educational Colloquium, addressed a group of educators and challenged them to improve ophthal-mic education. “Now we know we have to teach the art of ophthalmology,” Dr. Tso said. “We must … teach the souls of our trainees so that they can achieve a new level of eye care through competency, clinical judgment, surgical innovation and medical ethics.”

WOC DAILY | Day 1 June 29, 2008 17

Professional Congress Organizer:(PCO )Porstmann Kongresse GmbHpco@woc2010.de

Venue:ICC Berlin

www.woc2010.dewww.dog.org

WOC® Organizing Committee:

Congress PresidentProf. Dr. med. Gerhard K. Lang

Congress General SecretaryProf. Dr. med. Anselm Kampik

Congress TreasurerProf. Dr. med. Jochen Kammann

Scientific Programme DirectorProf. Dr. med. Gabriele E. Lang

DOG Managing DirectorDr. Philip Gass

WOC® 2010ICO (Sponsor)DOG (Host)AAD (Co-Host)

WOC® 2010 See you

World Ophthalmology Congress5-9 June 2010 Berlin, Germany

XXXII International Congress of Ophthalmology (ICO)108th DOG Congress (German Society of Ophthalmology)AAD Congress 2010 (German Academy of Ophthalmology)

in conjunction withFEOph (Federation of European Ophthalmology)SOE (European Society of Ophthalmology)AAO (American Academy of Ophthalmology)DOC (German Ocular Surgeons)

Five guidelines could assist in diagnosis of nerve damage in glaucoma suspectsHONG KONG – Clinical evaluation can be effective in the diagnosis of a glaucoma suspect with the assistance of fi ve rules that address each area of the optic nerve and retinal nerve fi ber layer that can be affected by the dis-ease, a physician said here.

Examining the neuroretinal rim at the scleral ring and cup border, para-papillary atrophy, retinal nerve fi ber layer (RNFL), lamina cribrosa and op-tic disc for hemorrhage are fi ve ways that physicians can more accurately di-agnose glaucoma, Remo Susanna Jr., MD, said at Glaucoma Subspecialty Day, held prior to the World Ophthal-mology Congress.

“These fi ve rules are simple,” Dr. Susanna said. “You can easily make the diagnosis of suspicion of glaucoma.”

He and colleagues devised the rules

as a way of accurately assessing the optic disc and RNFL. He said IOP is still an important risk factor to be measured, but other aspects of diagno-sis should also be examined, because IOP is not the disease itself. By looking directly at the optic nerve and RNFL, physicians can detect and assess direct glaucomatous damage, he said.

He showed images that demonstrat-ed problems with each rule, including localized RNFL abnormality or loss.

Clinical evaluation is not always ef-fective at diagnosing optic nerve dam-age, Dr. Susanna said. However, by knowing what to look out for in the optic nerve and RNFL, physicians will be at a signifi cant advantage in making an accurate diagnosis, he said.

Identifying the rim by looking at the scleral ring and cup border is es-

pecially important in assessing optic disc damage, Dr. Susanna said. The normal disc follows the “ISNT Rule,” he said, which states the “Inferior rim is thicker than the Superior rim that is thicker than the Nasal rim that is thick-er than the Temporal rim.” By compar-ing those aspects of the disc, physicians can detect any changes, subtle or se-vere, that could indicate glaucomatous damage, he said.

Optic nerve damage can be found by disc photos, binocular indirect slit lamp examination and direct ophthalmos-copy, Dr. Susanna said. While he said that digital images can help physicians to determine damage to the optic nerve, he cautioned them not to rely only on images obtained by technical means.

“Results of digital images may be misleading,” he said.

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