APAO Beijing - issue 2

In the first glaucoma session ofthe 25th APAO Congress,experts took a closer look atthe relationship betweenstructure and function in the

diagnosis of the disease.Structural evaluation of the

optic disc for the diagnosis of glau-coma includes quantitative andqualitative methods, said Liang Xu,M.D., professor, University ofZurich, Switzerland, of the BeijingInstitute of Ophthalmology.

Quantitative methods, he said,require less experience for the clini-cian, are easier to explain to thepatient, and offer objective results.However, there is a significant over-lap between normal and abnormalresults.

Qualitative methods, on theother hand, offer comprehensiveevaluation and may detect other,

non-glaucomatous conditions of theeye. However, these methodsrequire more experience to use andhave not been standardized.

Dr. Xu described the characteris-tic pattern of rim loss in glaucomausing what he called the ISNT rule.According to the rule, glaucomatousrim loss is characteristically vertical,preferring inferior (I) and superior(S) rim thinning over nasal (N) andtemporal thinning (T). The patternof rim loss is therefore a good wayto differentiate glaucomatouschanges from both normal andnon-glaucomatous pathologicchanges.

Ultimately, said Dr. Xu, follow-up is “most important” in the eval-uation of the optic disc for the diag-nosis of glaucoma. It can be hard todistinguish glaucomatous from non-

Structure vs. function in the diagnosis of glaucoma

Dealing with keratectasia in teens

continued on page 3

by Matt Young EyeWorld Contributing Editor

By Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer

Beyond ophthalmology: Chinese surgeons perform

Even after one day, the25th APAO Congress hasbeen many things tomany different attendees.There’s one thing it hasn’t

been: dull. Theo Seiler, M.D.,Ph.D., proved that Thursday duringhis presentation titled,“Management of post corneal refrac-tive ectasia.”

He started by painting a pictureof how young the LASIK populationhas become worldwide, which posesa unique set of challenges.

“In young people below 18 yearsold, LASIK is starting to becomeconsidered as risky,” Dr. Seiler said.And yet it’s typical in Cairo, Egypt,for example, for a 16-year-old to opt

for LASIK. “You have to have in your mind

that you may oversee a lot of kerate-ctasia,” when operating on ayounger patient population, Dr.Seiler said.

Today, there are many ways todeal with keratectasia successfully,Dr. Seiler said. Corneal collagencrosslinking (CXL) is an option, asare using stromal rings, he said.

“Contact lens wear could work,”he said. “But these patients under-went LASIK because they did notlike or could not tolerate contactlens wear.”

Corneal transplant procedures(such as anterior lamellar keratoplas-

ty) followed by refractive surgeryalso are options, he said. Dr. Seilerbelieves that astigmatism is less thana challenge in these patients thanpreviously.

“In penetrating keratoplasty, wewould have to leave in sutures for1.5 years,” Dr. Seiler said. “Nowthey’re out in a week or so afteranterior lamellar keratoplasty.”

One way or another, keratectasiahas to be dealt with, Dr. Seiler said.

“Once you make a decision thatthere is a progressive central steepisland, it means you have to treatit,” Dr. Seiler said. “Otherwise, it willgo on and show significant progres-sion.”

Dr. Seiler had many good things

to say about CXL, but he also sug-gested it may be the first in a seriesof steps to address optimal refractiveoutcomes after keratectasia.

“Crosslinking helps not only tostabilize, but in 40% of cases theconus really is reduced,” Dr. Seilersaid. In fact, research has shownthat CXL stops keratoconus progres-sion in all cases, he said.

Then again, some patients needmore than CXL.

Dr. Seiler outlined a case inwhich a LASIK patient received a 3.5D correction, although there werewarning signs. The patient devel-oped keratectasia and then under-

Friday, September 17, 2010

5th Anniversary EditionThe News Magazine of APACRS and COS

continued on page 3

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Technology and the e

EyeWorld Asia-Pacific Today / September 17, 2010 3

Structure vs. function - continued from page 1

Dealing with keratectasia - continued from page 1

glaucomatous changes, but newermethods including the use of OCTdevices hold the potential of provid-ing a way to identify not just glau-coma, but other conditions, bothophthalmic and systemic.

Current technological develop-ments make use of the methodsdescribed by Dr. Xu, and threedevices for glaucoma assessmentwere described in the same sessionby Ki Ho Park, M.D., SeoulNational University College ofMedicine, Seoul, Korea

He described digital retinalnerve fiber layer (RNFL) photogra-phy, the confocal scanning laserophthalmoscope, and optical coher-ence tomography (OCT).

Digital RNFL photography, saidDr. Park, is a semi-objective methodthat allows close evaluation of glau-coma, immediate interpretation,and direct adjustment of brightnessand contrast.

The confocal scanning laserophthalmoscope images thin slicesof the optic structures that allow athree-dimensional reconstruction ofthe optic nerve head. The problemwith this device is that it requires areference plane.

Finally, Dr. Park described timedomain OCT, which he said corre-lates with RNFL photography. Thelatest development is the spectraldomain OCT, which examines allfrequencies at once, resulting inhigher resolution acquired in lesstime.

In the functional assessment ofglaucoma ocular blood flow hasbeen implicated in glaucoma devel-opment and progression. MichaelKook, M.D., Department ofOphthalmology, Asia MedicalCenter, The Universityof Ulsan,Seoul Korea, examined the role ofocular blood flow (OBF) and glauco-ma.

Recent studies, he said, providesupporting evidence for such a role,although knowledge of the preciserelationship between OBF and glau-coma pathology hasn’t beenstraightforward.

For instance, earlier studiesimplicated hypertension as a riskfactor for glaucoma. Later studies,however, such as the Barbados EyeStudy, which looked at patients overnine years of follow up, revealedcontrary results: the study implicat-ed lower systemic blood pressurewith a higher incidence ofglaucoma.

Even more recently, expertshave been evaluating the impor-tance of nocturnal hypotension inglaucoma development and progres-sion. Nocturnal hypotension, saidDr. Kook, has a definite negativeprognostic impact on glaucoma.

Nocturnal hypotension perhapscorrelates with optical perfusionpressure (OPP), lower levels ofwhich have been associated with anup to six times greater risk of glau-coma development and progression.Even more important may be thevariations in OPP that occur over 24hours.

Dr. Kook noted the limitationsof the studies whose results have ledexperts to this conclusion.

For one thing, none of the stud-ies have yet been able to determinewhether blood flow changes are pri-mary or secondary in the disease.For another, devices used to meas-ure OBF have their own limitations;specifically, different types of imag-ing devices are needed to assess dif-ferent vascular beds in glaucoma.We still don’t know, he said, whichvascular beds are most relevant.

The development of function-specific perimetry has given clini-cians a new tool for evaluating glau-coma. Lingling Wu, M.D., PekingUnivesity Third Hospital, Beijing,China, described two function-spe-cific perimetry developments: fre-quency-doubling technologyperimetry (FDP) and short wave-

length automated perimetry(SWAP).

Glaucomatous neuropathy, saidDr. Wu, is essentially retinal gan-glion cell death. There are, however,three types: parvocellular, magno-cellular, and bi-stratified cells.

Standard automated perimetry(SAP), she said, is non-specific forthese RGC types. FDP is specific formagnocellular RGCs; SWAP for bi-stratified RGCS

Both FDP and SWAP, she said,detect visual field losses that SAP isunable to detect. However, sheadded, no single technology is supe-rior in all patients.

The same goes for methods usedin the analysis of the data gatheredwith these devices. Chris Johnson,M.D., University of Iowa Hospitaland Clinics, looked at various statis-tical and analytical methods used instudies to detect progression withperimetry.

The problem, he said, is thatsequential perimetry measurementscan sometimes show alternatingimprovement and worsening ofglaucoma. Methods need to bedeveloped to reduce variability,demonstrate larger differencesbetween sequential results, andoverall find better ways to analyzethe data.

For now, he said, all clinicianscan do is use all the methods avail-able and include all the informationpertaining to each case.

went CXL. The patient was stable,but still complaining about theissue. Upon requesting furtherimprovement, the surgeon decidedto insert a stromal ring segment,creating channels for it with thefemtosecond laser. UCVA thenimproved from 0.3 to 0.8. If thepatient wasn’t satisfied, surface abla-tion could have been an additionaloption, but he “decided it was goodenough,” Dr. Seiler said.

So Dr. Seiler considers CXL to bea form of primary management forkeratectasia, specifically to stop pro-gression.

Secondary managementincludes contacts, stromal inlaysand lamellar keratoplasty thatincludes customized surface abla-tion. Remember, after a keratectasiapatient undergoes lamellar kerato-plasty, they have sufficient tissuethen to undergo an additional

refractive procedure like surfaceablation.

Still, Dr. Seiler said, the best wayto manage keratectasia is to preventit in the first place.

Surgeons really must be carefulto examine corneal topographybefore a procedure like LASIK, Dr.Seiler said.

In a series of 16 cases of patientsthat underwent CXL because theyhad LASIK that resulted in keratecta-sia, Dr. Seiler said 13 had undiag-nosed keratoconus. That means theLASIK surgeon missed this red flag,he said. Pregnancy was an additionalfactor in two of these CXL cases.

In an exclusive interview withEyeWorld immediately following hispresentation, Dr. Seiler added that intoday’s world, the refractive surgeonis not often a through-and-throughcorneal surgeon.

“That is a pity,” Dr. Seiler said.

“They are not well educated regard-ing the cornea and remodeling ofthe cornea.”

Yet during the last eight years,there has been a paradigm shift incorneal surgery to give it muchmore of a refractive twist, Dr. Seilersaid.

From CXL to ring segments toanterior lamellar keratoplasty, sur-geons have many options toimprove keratectasia and leavepatients with optimal vision, hesaid.

“Crosslinking is the basis to geta stable situation,” Dr. Seiler said. “Ifyou perform cuts in a diseasedcornea, results are very unpre-dictable.”

But if you perform CXL first,and then start to remodel thecornea, things are much more opti-mistic.

“We can stop it [keratectasia],”

Dr. Seiler said. “And we can remodelit [the cornea],” Dr. Seiler said.

There are some risks associatedwith CXL, Dr. Seiler said.

“It’s a surgery so you do havesome risks,” Dr. Seiler said. “Therisks outweigh the benefits by far.And you will end up in a transplantsituation if you don’t do anything.”

Speaking on a related topic, Dr.Seiler also mentioned that hebelieves a lot of keratoconus iscaused by eye rubbing, which can bepassed down from generation togeneration.

“The father rubbed so the sonrubs,” Dr. Seiler said.

Therefore, he said, if someonepresents with keratoconus, you canhelp them avoid eye rubbing by giv-ing them fluorometholone for aperiod of time.

“You can make the eye calmenough for the kid to stop rubbing,”Dr. Seiler said.

Optic nerve cupping with peripapillary

atrophySource: William Trattler, M.D.


4 EyeWorld Asia-Pacific Today / September 17, 2010

Restaurants in Beijingooze style and class,even more so thanManhattan or down-town Las Vegas. Dining

out is not always cheap, but withgood reason; service in Beijing isknown to be prompt, attentive, andobservant. Beijing may be famousfor its Peking Duck and editableoddities such as fried pigs trottersand duck tongue, but the city hasconsiderably expanded its worldcuisine offerings in recent years. Justbecause they’ve built it doesn’tmean you should come, however.Below is a list of restaurants by cui-sine that are known to be safe betsfor an excellent meal.

French

Maison BouludLocation: 23 Qianmen Dong Dajie,

Dongcheng DistrictPhone: (10) 6559-9200Hours: Monday through Friday,

Lunch: 11:30 AM to 2 PM; Monday through Sunday, Dinner: 6 PM to 10 PM; Saturday and Sunday (Brunch), 11 AM to 4 PM

Website: www.chienmen23.comPrice: $$$$

Located in the former AmericanEmbassy building, Maison Boulud isa French/American-inspired restau-rant from the genius of New YorkCity-based Michelin-starred chefDaniel Boulud. In addition to therestaurant, Maison Boulud featuresan exquisite bar and lounge decorat-ed in wood and leather, colored bydeep mahogany hues and accentedwith Asian décor. The menu boastsa superb wine list; seafood and raw

bar selections such as lobster, oys-ters, and shrimp; and a rotating pre-fix menu.

Parfum French RestaurantLocation: 3/F, Bldg 19, China Central Place,

89 Jianguo Lu, Chaoyang DistrictPhone: (10) 6530-5799Hours: Monday through Sunday,

11 AM to 11 PMPrice: $$$

Parfum is designed for thosewanting a full four-course Frenchmeal, as the portion sizes are smallbut the food is savory and well-pre-sented. The décor is all white andsuper stylish and the waitstaff has areputation of speaking excellentEnglish.

Traditional Chinese

Red Capital Club Location: 66 Dongsi Jiutiao,

Dongcheng District Phone: (10) 8401-6152Hours: Monday through Sunday,

6 PM to 11 PMWebsite: www.redcapitalclub.com.cn Price: $$$

Patrons will feel like they aredining with the Emperor at the RedCapital Club, and that’s exactlywhat this establishment is going for.Set in a regal old country homethat’s decorated to capture a 1950sChina with communist parapherna-lia from Madame Mao’s red-flaglimo to Zhou Enlai’s radios, RedCapital serves imperial fare in atruly unique setting. Patrons canalso choose to eat outside in theelaborate courtyard. Reservationsare highly encouraged.

Beijing Dadong Kaoya DianLocation: Tuanjie Hu Beikou 3,

Chaoyang DistrictPhone: (10) 6582-2892Hours: Monday through Sunday,

11 AM to 10 PMPrice: $$

If you’d rather skip the historylesson but still want traditionalChinese cuisine, look no furtherthan Beijing Dadong Kaoya Dian.The restaurant is especially knownfor its roast duck, which comes ineither whole or half portions andincludes a side of creative condi-ments such as garlic, green onion,and radish. Every meal comes witha free fruit plate and dessert.Another bonus: Dadong Kaoya Dianhas a nonsmoking room; a rarity inBeijing. Reservations are highlyencouraged.

Italian

Danieli’s Location: St. Regis Hotel, 21 Jianguomenwai

Dajie, Chaoyang District Phone: (10) 6460-6688 ext 2440 Hours: Monday through Sunday,

11:30 AM to 9:30 PMWebsite: www.stregis.com/beijingPrice: $$$

If pasta is more your thing,head on over to Danieli at the St.Regis Hotel where the linguine ishomemade by Executive ChefDaniel Kuser. The setting is elegantand demure and an excellent choicefor business meetings thanks to itshighly attentive waitstaff. Themenu is constantly changing but beprepared for traditional Italian pastadishes such as ravioli, gnocchi, andrisotto. Don’t forget to save roomfor dessert and coffee.

Assaggi Location: Sanlitun Bei Xiao Jie 1,

Chaoyang DistrictPhone: (10) 8454-4508Hours: Monday through Sunday,

11 AM to 11 PMPrice: $$

Assaggi spans two floors and isfamous for its patio and outdoor ter-race and bright and cheerful atmos-phere, thanks to its tree-lined roofgarden. The décor is minimalist,with stark white furniture and neu-tral tones used throughout. Assaggiserves moderately priced Italianfood, including prefix menus and ala carte items.

Mediterranean

SureñoLocation: The Opposite House hotel, 11

Sanlitun Road, Chaoyang DistrictPhone: (10) 6410-5240Hours: Monday through Friday and Sunday

12 PM to 10:30 PM; Saturday 6 PM to 10:30 PM

Website: www.surenorestaurant.comPrice: $$

Located in the boutique hotelThe Opposite House, Sureño is asuper trendy restaurant that catersto a young, urban, artsy crowd. Thedécor is sleek and modern, withdark leather sofas featuring patent-leather covered accent pillows andSwedish-style chairs pepperedthroughout. Sureño offers a widerange of southern Mediterraneancuisines and New World wines. Onthe menu you’ll find tapas styletuna tartar and foie gras, as well aswood-fired pizza and rack of lamb.Reservations are encouraged.

Bon Appétit in Beijingby Faith Hayden EyeWorld Staff Writer



Avoiding 20/20 unhappy patientsby Matt Young EyeWorld Contributing Editor

There are unhappy patients– even ones with “good”results - and that’sunavoidable, but it’simportant to still seek

their satisfaction. That’s according to Michael

Lawless, FRANZCO, Vision EyeInstitute, Sydney, Australia, whopresented on “The 20/20 unhappypatient after LASIK” at the 25thAPAO Congress on Thursday.

“Make sure they are 20/20,” Dr.Lawless said. Examine residualrefractive error, the tear film, thepotential for irregular astigmatism,higher-order aberrations, and lensand macula pathology.

“Are they contributing to poorquality of vision?” Dr. Lawless said.These are good questions to ask, hesaid.

“By far, the biggest driver ofunhappiness is residual refractiveerror,” Dr. Lawless said. This may berelatively trivial to the surgeon, butit isn’t to the patient, he said. It’salso the major cause of patientunhappiness, he said.

If a patient has residual astigma-tism, for instance, fix it – for free,he said.

If they are unhappy with mono-vision, further follow-up is warrant-ed, he said.

“Some people even after monthsdon’t deal with monovision proper-ly,” Dr. Lawless said. “Sort it outwith further contact lens trials.Work out what is their happy pointand put them there. Don’t makethem live with a result that theywanted to achieve, did achieve, butit was the wrong result for them.”

Diagnosing and fixing dry eyeissues also is important, Dr. Lawlesssaid.

Consider whether they havenight halos, Dr. Lawless said.

“Deal with the pupil issue,” hesaid. Consider whether thesepatients may need a topographic-based retreatment, he said.

When things “get ugly,” get asecond opinion for the patient, andoffer to pay for that opinion, hesaid.

Part of dealing with potentiallyunhappy patients is recognizingwho they are from the get-go, Dr.Lawless said.

“Patients with higher scores ondepression and negativity scales hada 3-times greater likelihood of beingless satisfied with their quality ofvision one month after LASIK,” Dr.Lawless said.

Although it’s difficult to deter-mine which patients may bedepressed, it requires a discussion.

Remember, “chair time” with apatient prior to surgery is preferableto chair time after surgery, he said.

Dr. Lawless also suggested thatthe informed consent paperworkshould do more than provide a sur-geon with legal protection. It helpsto provide a framework for discus-sion with a patient preoperatively,he said.

Although a surgeon’s view ofLASIK may be that it is a streamlinedprocess of consultation/clinicalexam, procedure, and follow-up, it’smuch more than that to a patient,he said.

“From the patient’s view, this isa powerful emotional experience fullof hope and anxiety,” Dr. Lawlesssaid. “Patients value communica-tion.”

Although surgeons may imparttechnical expertise to their refractivesurgery candidates, they may not beaware of both the verbal and non-verbal communication mannersthey use with patients, he said.

“You have to listen more thantalk,” Dr. Lawless advised. “Considera patient’s nonverbal behavior. Thisis time well spent.”

What’s the single worst thingyou can say to a 20/20 unhappypatient? “You should be happy withthe result,” Dr. Lawless said.

“We say that because we feeldefensive,” Dr. Lawless said. “Hopeis precious. Give them futureoptions.”

In fact, there are more optionsthan ever for refractive surgery can-didates.

Dr. Lawless cited recent researchby Karl G. Stonecipher, M.D.,which is a two-part study on myopiaand hyperopia topography-guidedLASIK.

The study found that 73.9% ofpatients had a cumulative gain inone or more lines of BSCVA.

This is important because manypatients – if asked – will say thattheir BSCVA is not perfect withglasses or contact lens wear preoper-atively.

Yet Dr. Stonecipher found thatBSCVA can be improved remarkably,Dr. Lawless said, to the delight ofpatients.

The study also found aftertopography-guided LASIK decreasesin light sensitivity, fluctuation ofvision, glare and halos.

“Quality of vision was better ona whole line of parameters that cor-relate with unhappiness,” Dr.Lawless said.

Dr. Lawless is excited to see thisas part of a drive toward makingLASIK as good as “phaco quality.”

Meanwhile, Srinivas K. Rao,M.D., senior consultant, ApolloHospitals, Chennai, India, com-

mented on the “Role of advancedsurface ablation,” on Thursday.

Similar to Dr. Lawless’s presenta-tion, Dr. Rao’s presentation outlinedthe many options that refractivepatients have available to them foroptimal results.

Types of surgery discussedincluded LASIK, LASEK, PRK, Epi-LASIK, advanced surface ablation,and others.

He suggested that the use ofalcohol and also mitomycin C(MMC) during surface ablation canlead to good results.

He recommended, for example,using absolute alcohol in a 20%dilution to achieve good results,although there is some technicalcomplexity involved in the proce-dure.

He also said using a solution of0.02% MMC for 30 to 120 secondshelps promote good outcomes with-out haze or scarring.

In cases of haze or previoushaze, Dr. Lawless opts for threeminutes of MMC.

Others also have reporting usinga brushstroke of 0.01% MMC withsuccess, he said.

MMC also allows for surgeonsto treat beyond 6 D, which wouldnot be possible with surface abla-tion otherwise, he said. Efficacy andpredictability for these higherdiopter patients is excellent afteruse of MMC, he said.

Surgeons have a different view of LASIK than patients, who feel more emotionally impacted by the procedureSource: Michael Lawless, FRANZCO


6 EyeWorld Asia-Pacific Today / September 17, 2010

It is a constant struggle for cli-nicians to keep track of theever-growing volume of infor-mation in the medical sci-ences. Each succeeding gener-

ation of clinician has exponentiallymore information to assimilate thanany previous generation.

This has resulted in an increasedfocus on evidence-based medicine;to this end, randomized controlledtrials (RCTs) serve a dual purpose:RCTs are constantly being conduct-ed to provide the information thatforms the basis for practice, whilealso providing clinicians with a rela-tively convenient way to access thatinformation.

Paul Palmberg, M.D., BascomPalmer Eye Institute, began by relat-ing an experience he had as an oph-thalmology fellow. Prior to graduat-ing, Dr. Palmberg wanted to be sure

he was ready for practice as a glau-coma specialist. Towards the end ofhis fellowship, he decided to reviewthe hospital records of his profes-sors’ patients.

After studying all the cases, Dr.Palmberg came to the conclusionthat advanced cases of glaucoma didbetter over longer periods withgreater, more consistent IOP reduc-tions.

If he had looked at the litera-ture, he said, he would have savedhimself a lot of effort: he wouldhave found that Paul Chandler hadpublished similar conclusions asearly as 1960.

At the time, said Dr. Palmberg,Dr. Chandler’s views weren’t verypopular, but over time, the sciencehas come to back up his conclu-sions.

In particular, Dr. Palmberg citedevidence from three RCTs: EMGT,CIGTS, and AGIS.

The EMGT study, he said, foundthat more than 80% of untreatedglaucoma cases worsened, and thatIOP reductions of less than 35% ofbaseline constituted sub-optimaltreatment, unable to prevent glau-coma progression. Meanwhile, bothCIGTS and AGIS found no net pro-gression in visual function defectswith IOP reductions of at least 35%of baseline.

AGIS further found that consis-tently maintaining IOP below 14mm Hg produced better outcomes.Treatment that allowed IOP to fluc-tuate to levels above 14 mm Hg—even if on average the IOPremained below this level—was sub-optimal, allowing net progressionof visual field defects.

RCTs, said Dr. Palmberg, haveother practical uses. In the clinic, hesaid, he can use relevant RCTs toeducate his patients and give them aclearer idea of the steps in the man-agement of their condition.

With his lecture on Thursday,Dr. Palmberg kicked off “Glaucomarandomized controlled trials - howhave they changed my practice?,” aglaucoma symposium that was akind of ode to the RCT. At the sym-posium, experts described in detailhow they have refined and continueto refine their practices according tothe evidence RCTs provide.

In some cases, RCTs provideanswers to very specific questions.Discussing cases of normal tensionglaucoma (NTG), for instance,Kyung Rim Sung, M.D., AsanMedical Center, Seoul, Korea,sought RCTs to answer the follow-

How to stop worrying and love the RCTby Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer

The 25th APAO Congress kicked off yesterday...



ing questions, each one relevant toher clinical decision making in spe-cific cases: What is the natural his-tory of NTG? Is IOP a primary riskfactor? Is IOP reduction effective inpreventing glaucoma developmentand progression? What can be donebesides IOP reduction?

RCTs, she said, have providedthe following answers: NTG pro-gresses without treatment, and RCTshave shown the progression rate ofuntreated cases; IOP reduction iseffective in stopping developmentand progression of glaucoma; NTGand other types of glaucoma havevariable clinical courses, and RCTshave shown some of the risk factorsthat affect these courses; andprostaglandin analogs, beta-blockersand other agents are effective forlowering IOP.

There is, however, still quite abit of information that RCTs aren’tyet able to provide, said Dr. Sung.For instance, although RCTs havelooked into alternative agents suchas ginkgo biloba, she said that IOPlowering remains the main mode ofaction for the medical treatment ofglaucoma.

Perhaps most importantly, Dr.Sung pointed out that RCTs onAsian populations are rare, creatinga significant gap in medical knowl-edge.

Taking things a step further, HoChing-Lin, M.D., SingaporeNational Eye Centre, and JimmyLai, M.D., Eye Institute, TheUniversity of Hong Kong, presentedspecific examples illustrating theeffect RCTs have had on theirrespective clinical practices.

Drs. Ho and Lai each began bypresenting their original preferredtreatment algorithms for particularcases. Dr. Ho talked about how sheused to treat acute primary angleclosure (APAC), and Dr. Lai dis-cussed his approach to chronicangle closure glaucoma (CACG).

After sifting the literature forrelevant information, Drs. Ho andLai used the new information torefine their treatment algorithms.

As with Dr. Sung, neither doctorfound everything they would haveliked to find in the literature. Forthe treatment of APAC, Dr. Ho rec-ommended some future directionsfor clinical trials. She recommendedlooking into neuroprotection inAPAC, understanding the optimaltiming of lens extraction in cases ofAPAC with cataract, and delving

into the role of goniosynechialysisin these cases.

At the beginning of his lecture,Dr. Palmberg described the “per-fect” RCT. Such an RCT, he said,should address important clinicalquestions, have an adequate samplesize and duration, and should provethat what doctors are doing is bene-ficial to their patients. However, nomatter how technically perfect anRCT may be, it can’t be expected toanswer all the questions that arisein the clinic.

So, as Dr. Lai said of his ownpractice at the end of his lecture, allthat clinicians can do is continue torefine their approach to treatingpatients as more RCTs becomeavailable.

...with lots of energy, education and entertainment


Saturday, September 18

Maximizing CataractTechnologies for Today'sSurgeon Room: 309A (Level 3)

12:45 – 13:00 PM Registration and Reception13:00 – 14:00 PM Program

Moderators Han Bor FAM, MD and Ke YAO, MD, PhD

Faculty Y. Ralph CHU, MDMartin A. MAINSTER, MD, PhD, FRCOphth.George H. BEIKO, BM, BCh, FRCSC

B E I J I N G C H I N A 2 0 1 0

China National Convention Center

��

Sunday, September 19

Refractive Surgery - DrivingSuperior Patient OutcomesFunction Hall B (Level 1)

12:45 – 13:00 PM Registration and Reception13:00 – 14:00 PM Program

Moderators Michael C. KNORZ, MD and John CHANG, MD

Faculty Zheng WANG, MD, PhDTong SUN, MD, PhDMarguerite B. McDONALD, MD, FACS

AAggeennddaa13:00 Welcome Note – Han Bor FAM, MD

and Ke YAO, MD, PhD 13:05 Spherical Aberration and Decentration

of IOLs in the Market – Y. Ralph CHU, MD

13:15 Visual Function After Implantation of Aspheric Diffractive Multifocal IOLs – Ke YAO, MD, PhD

13:25 IOL Materials and the Many Myths of Blue-Blocking– Martin A. MAINSTER, MD, PhD, FRCOphth.

13:35 Optical Synergy: Tecnis Acrylic 1 Piece IOLs – George H. BEIKO, BM, BCh, FRCSC

13:45 Signature: Dual Pump and Ellips When You Should Use It – Han Bor FAM, MD

13:55 Questions and Answers – Panel Discussion

14:00 Closing

AAggeennddaa13:00 Welcome Note – Michael C. KNORZ, MD

and John CHANG, MD13:05 Comparison of Biomechanical Influences of

Corneal Flaps Created Using Intralase and Hansatome – Zheng WANG, MD, PhD

13:15 Advancement in Femtosecond Lasers– John CHANG, MD

13:25 Bridging It All Together: Presbyopic Treatment – Michael C. KNORZ, MD

13:35 Wavefront-Guided Treatment For Superior Patient Outcomes – Tong SUN, MD, PhD

13:45 Patient Satisfaction and Outcomes with iLasik – Marguerite B. McDONALD, MD, FACS

13:55 Questions and Answers – Panel Discussion

14:00 Closing

�� '"�� (�$&�%�!�"&��#)�� APAO Beijing 2010 Daily_Friday_0428 EWDaily_01-21 ASCRS NEWS_11x15-dl.qxd 9/16/10 6:04 AM Page 8

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