3^rd Global Pediatric Ophthalmology Congress March 22-23, 2018 Park Inn by Radisson Hotel, London, UK

Biography:

Ciubotaru Andreea completed her Medical degree at Carol Davila University of Medicine and Pharmacy, Romania in 1998 and; Ophthalmology Residency at Emergency Eye Hospital, Bucharest from 2000–2005. In 2011, she completed her PhD at Ludwig Maximilian University Munich, Germany, with the thesis entitled “The superior oblique posterior tenectomy as therapy for congenital Brown’s syndrome”. Since 2007, she is the Medical Director of Infosan Eye Clinic Bucharest; President of Romanian Society of Pediatric Ophthalmology and Strabismus and Member of Romanian Society of Cataract and Refractive Surgery and Board Member of Romanian Society of Ophthalmic Genetics. She contributes as author in many Romanian and international congresses and also books of ophthalmology. Her preferred topics are strabismus, amblyopia, congenital cataract, and ophthalmic genetics.

Abstract:

Introduction: Patients with strabismus who have undergone previous eye muscle surgery often present a challenge to strabismus surgeons, especially in restrictive strabismus cases like Duane’s retraction syndrome (DRS). Even has been a recognized clinical entity for nearly a century, DRS is sometime mistaken for essential infantile esotropia or abducens paralysis. <br>
Methods: We retrospectively evaluated 15 patients undergoing surgery for esotropia 4 to 22 years ago in other eye clinics. All patients were referred to us for the misalignment in primary position and abnormal head position. After the previous operation, nine patients developed a consecutive exotropia (group 1) and six of them were still esotropic in primary position (group 2). Angle
of strabismus in primary position, head posture, abduction and adduction of the affected eye were measured before and after surgery in our clinic. Photos from childhood were reviewed and the diagnosis for all was DRS. <br>
Results: 12 patients have first heard about DRS. In group 1, the intraoperative findings showed a previous medial rectus recession (in the affected eye) in six cases and a contralateral medial rectus recession (in the normal eye) in three cases. The mean deviation in primary position decreased from 28 prism diopters (PD) exotropia preoperatively to eight PD exotropia postoperatively. In group 2, the intraoperative findings showed in the affected eye a previous medial rectus recession in three cases and lateral rectus resection in three cases. The mean deviation in primary position decreased after reoperation from 25 PD esotropia preoperatively to 10 PD esotropia postoperatively. All patients improved their abnormal head posture after reoperation. <br>
Conclusion: Although the clinical findings and the surgical approach in Duane’s retraction syndrome are very clear, in medical practice from Romania we meet even today misinterpreted forms of DRS requiring reoperation.

Biography:

Abstract:

Introduction: Congenital superior oblique palsy (CSOP) is sometime overlooked by the general ophthalmologist due to the absence of manifest vertical deviation (VD) in primary position (PP), even if it has been a recognized clinical entity for nearly a century.

Methods: We retrospectively evaluated 46 adults undergoing surgery for unilateral CSOP in our clinic (2006-2017). The patients were divided in two groups: Group 1-32 patients with preoperative VD in PP less than 30 prism diopters (PD), in which we performed a graded inferior oblique recession (8 mm, 10 mm or maximal) and group 2-14 patients with preoperative VD in PP greater than 30 PD, in which we performed a maximal inferior oblique recession combined with recession of contralateral inferior rectus muscle. Horizontal and vertical deviations in five positions of gaze and head posture were assessed pre- and postoperatively.

Results: In group 1, VD in PP and in adduction was reduced from median 10 PD and 25 PD to 1 PD and 3PD respectively. In group 2, VD in PP and in adduction was reduced from median 36 PD and 34 PD to 8 PD and 8 PD respectively. All patients improved their abnormal head posture after reoperation. 78% of patients have first heard the diagnosis of CSOP in our clinic; even 92% of them had more than three eye examinations during life.

Conclusion: Although the clinical findings in CSOP are very clear, in medical practice from Romania we meet even today overlooked forms of CSOP, even with massive VD in PP.

Biography:

Abstract:

First described 60 years ago, congenital Brown’s Syndrome ( a disorder of ocular motility manifesting most notably a restriction of active and passive elevation in adduction) is even up to now under debate regarding its etiopathogenesis and surgical methods. This paper reviews the various etiologic theories, from anomalies of the superior oblique tendon and/or the trochlear apparatus to recent hypothesis that congenital Brown’s syndrome might represent a congenital cranial dysinnervation syndrome, caused by a fourth nerve hypoplasia or aplasia with consecutive paradoxical innervation of the superior oblique muscle. Most used surgical treatments for Brown’s syndrome are described and evaluated, with accent on superior oblique posterior tenectomy, a surgical approach used also in Infosan Clinic.

Biography:

Ronni M Lieberman completed her Medical degree at SUNY Downstate in New York, and then Ophthalmology Residency. She completed her two-year fellowship
in Medical and Surgical Retinal Disease at Mt Sinai Medical Center, in New York. She is the Director of Ophthalmology at Queen Hospital Center, both a New York City Health and Hospital Corporation and the Icahn School of Medicine, Mt Sinai Medical Center affiliate. Her main interests include Infectious Retinitis and ROP. She has published papers extensively on a number of topics in retina and vitreous.

Abstract:

The talk will discuss the etiology and staging of retinopathy of prematurity (ROP) and various treatment options. It will then focus on newer algorithms of combination therapies in the face of long term follow up. This will include our experience at the HHC/Mt Sinai using these techniques.

Biography:

Boris I Gramatikov has his areas of expertise which includes “Electronics, optoelectronics, computers, computer modeling, signal/image processing, data analysis, electronic instrumentation design, bio-photonics, ophthalmic optics, and biomedical optics, all applied to the development of diagnostic methods and devices for ophthalmology and vision research”. His team has developed a series of pediatric vision screeners. Along with Dr. Cynthia Toth from Duke University, he is co-PI on a project for combining optical coherence tomography with retinal birefringence scanning, to enable OCT imaging in toddlers and young children. He has over 120 publications, 37 of which in high-impact peer-reviewed journals. He serves as a Reviewer and Editorial Board Member of a number of technical and medical journals.

Abstract:

Optical coherence tomography (OCT) enables volumetric rendering and the generation of fundus images that precisely and register OCT images to fundus features. Yet, there is little data about how a child’s retina develops. This limits
our knowledge of how diseases affect a child’s vision early in life and makes diagnosis of these diseases more difficult. The introduction of OCT to pediatric applications has been impeded by several factors, among them data acquisition and analysis speed, and difficulty in attaining stable fixation of the pediatric patient on a target over a period of time long enough to allow reliable analysis. The system described here integrates three major components: a computer-controlled video player that plays attention attracting movies and directs the subject’s fixation to a central point target; a retinal birefringence scanning subsystem for fast detection of central fixation by detecting the position of the fovea, and; an optical coherence tomography subsystem for acquiring 3D images from the retina (mainly in the foveal region). From a main menu, the operator selects a suitable video to be played by a small monitor in the visual field of the child under programmatic control. The software then starts the birefringence scanning system that scans the area around the fovea using polarized light, and in a double-pass configuration, analyzes the changes of polarization caused by the Henle fibers around the fovea. This allows fast detection of central fixation. The OCT system is instructed by the central software to acquire data if and only if central fixation is detected. This significantly reduces data redundancy and the time needed for analysis of the OCT data, while improving the overall reliability of the system. The idea is applicable to handheld devices.

Biography:

Camelia-Margareta Bogdanici completed her General Medicine at University of Medicine and Pharmacy Grigore T Popa, Romania in 1985. She did her Residency from 1990-1994, in the same hospital in which she is working now. She was an Assistant Professor at University of Medicine and Pharmacy Grigore T Popa, first in Histology department from 1987-1990; in Ophthalmology department from 1991-1999; Lecturer from 1999-2007 and; then an Associate Professor in the same university and hospital. Her lectures are for Romanian and English students in Ophthalmology. She completed Medical Degree (PhD) in 1999. The title of her thesis was “Clinical research for pressure equilibrium at normal, ocular hypertension and glaucoma”. From 2007-2012, she was Medical Director of Hospital Sf. Spiridon Iasi, Romania, and from 2012-2016, she was Deputy in Romanian Parliament, in Health and Family Commission. She is the member of Romanian Board Society, Romanian Society of Ophthalmopediatry and Strabismus, member of Romanian Society of Contact Lenses, member of European Academy of Orthokeratology. She contributes as author in many Romanian and International Congresses, and also of scientific publications and books of ophthalmology.

Abstract:

Amblyopia is an important condition that can affect up to 5% of the general population. Ophthalmologist has many difficulties both in amblyopia diagnosis and treatment. Difficulties of diagnosis can be produced by missing: of children cooperation in examination, of parent’s sincerity in history of the child (or even of treatment done before), of medical, a busy medical program or even missing of amblyopia experience. Difficulties of treatment can be: the moment of diagnosis, small compliance from children or parents or small experience of doctor. It is not possible to state that the impact of amblyopia treatment felt by the child is the same of the adults. The parents can only make a judgment on how they perceive the child is able to see whilst on treatment. Their judgment could be influenced by how important they judge the activity to be. Treatment compliance in amblyopia therapy is influenced by both the child and the parents. Whilst the child may object to the wearing of glasses or a patch on a personal level, a parent’s perspectives can influence the success of such treatment. This may incorporate their own experiences of patching/glasses-wear, or their understanding of the condition and the importance of treatment.
Parental understanding of the condition and belief in the prescribed treatment are key components for good treatment compliance. An argument against using treatment compliance as a measure of quality of life is that a child may consent to wearing the patch but their daily activities and social interactions may still be affected. Currently in Romania there is high interest in preventing amblyopia. For these ophthalmologist tries to inform population doing visual screening for children and by informing through media and press.

Biography:

Abstract:

1. Physiological features of the interconnected functioning of the systems of accommodation, and aqueous humor production and outflow: The regulation systems for accommodation, production and outflow of aqueous humor have one common actuating unit – the ciliary muscle (CM), both in animals and humans. At the same time, the control signals from these systems to the CM can be directly opposite [4,6,8]. For example, to open the trabecular pathway of outflow (TPO), it is necessary to reduce the CM. But at the same time, it is necessary to relax the CM in order to see the approaching danger in the distance. So which command will be executed first? In the eye, there is an overriding priority for executing commands from the accommodation system, since the survival of the species as a whole depends on this. The signals of the control system of aqueous production are in the second place by priority, and the signals from the outflow control system are performed last. It is because that the task of maintaining metabolic processes in the eye is more important than the task of removing the spent aqueous humor [4,6,17]. Such physiological representations are key to understanding the features of the inte rrelated functioning of these three physiological systems of the eye. Most of the animals have only one aqueous outflow pathway – uveoscleral pathway of outflow (USPO), which then passes into the outflow through the sclera. Only in humans and in four species of highly evolved monkeys, during the course of evolution, an additional aqueous outflow pathway was formed through the trabeculae (TPO, trabeculae outflow pathway). This happened because of changes in the habitat, which required to develop the ability of a long visual work at a short distance, and at that moment the USPO is blocked (in the ciliary muscle, the interfiber spaces with the matrix are compressed at that moment). In Table 1 it is shown that TPO is open only when looking near, and USPO is closed at that time. In visual work at medium and long distances, on the contrary, only USPO is open, and TPO is closed. It should be noted that USPO is the main way by which the necessary ingredients are delivered to maintain normal metabolism and reproduction of collagen in the middle and back parts of the sclera. Also, along this basic pathway, prostaglandins are delivered to the sclera, which are normally produced by the intraocular epithelium. The sclera can regulate its permeability with the help of a large number of prostaglandin receptors located in it [1]. That is why the pharmacotherapy of glaucoma with prostaglandins is so effective. The eye does not control the level of IOP directly, since morphologists have not yet detected baroreceptors in it. The level of IOP in the eye is directly determined primarily by the level of rigidity of the sclera [2-4]. A large number of mechanoreceptors have been found in the sclera [1], which allow to control the reciprocal displacement of scleral plates during micro fluctuations of the eye volume. Conclusion: the eye does not control the level of IOP, but constantly monitors its volume with the help of mechanoreceptors, as well as the receptors of prostaglandins [4].

The outflow (slow filtration) of the aqueous humor occurs through the three main eye filters: juxtacanicular tissue, inter-fiber ciliary matrix and scleral matrix. The outflow efficiency is determined by the main functional characteristic of the sclera – its fluctuability (this is a new concept in ophthalmology). Fluctuation is the functional ability of the sclera to "push out" the waste intraocular fluid from the eye with the help of elastic fibers and fibroblasts located in the sclera. Concurrently the volume of the eye decreases. We have learned to reliably measure in vivo the level of fluctuation and rigidity of sclera, as well as the level of IOP in youth and even in elderly patients, using an ORA air analyzer by our own method [2-4].

2. The key links of adaptive myopia (AM) <br>

The development of the most pandemic myopia in the history of mankind shows that until recently there was no workable theory of acquired myopia in the world. The forecast of an increase in the number of myopes to 5 billion people by 2050 (half of the world's population, figure 1) [5] shows that if acquired myopia is a disease, it is transmitted "visually". But the clinical facts show another pattern. AM develops rapidly both in animals and in a healthy person under the age of 45 years. And this apparently is a normal adaptive reaction, which provides the possibility of prolonged strenuous visual work at a short distance. Adaptive myopia is a clear example of the implementation of the energy saving law in anatomical development of biological systems. The length of the optical axis of the eye should be such as to ensure the necessary long-term near visual work with minimal tonus of the ciliary muscle [4,6]. Since children of all animals and humans at an early age are weak hyperops, even the transition to emmetropia or initial myopia can significantly reduce the energy consumption of the eye if necessary to perform long-term near work. Highly developed monkeys, such as gorillas, orangutans and others, are even forced to post a sentry along the perimeter of the troop, because their way of life implies gathering food and looking at it closely.

Biography:

Marina G. Guseva: From 2003 to 2011 Chief doctor-ophthalmologist of 54 urban centers "Nevskaya Optics holding», with 2011 Chief ophthalmologist «Sfera» LTD, with 2012 ophthalmologist in Medical city center "Vodokanal of St. Petersburg". Have 9 international certificates for optometry. Author of 34 publications, co-author of two chapters in the book "Ophthalmocontactology" (St. Petersburg: Military-medical Academy, 2010). Co-author and developer of the modern way of rational optical correction and specialized training manual "Physiological principles of rational optical correction. Practical recommendations. Normal physiology.

Abstract:

Statement of the Problem: Fighting adaptive myopia (AM) will only be effective when truly working theory of myopia is developed and confirmed by clinical trials. The pandemic of myopia confirms the absence of a theory that can explain all known clinical facts and give physiologically approved practical recommendations. And as practice has shown, unfortunately, the incremental retinaldefocus theory (IRDT) is no exception. The hypothesis of this theory not always corresponds to the known clinical facts about the physiology of the eye taking into consideration interconnected operation of accommodation and aqueous humor production and outflow systems [1]. However, in 2001 Russian authors Ivan Koshits (biomechanics) and Olga Svetlova (ophthalmologist) proposed a metabolic theory of adaptive myopia (MTAM), which was based on a profound long-term interdisciplinary analysis of modern clinical facts in such fields like morphology, physiology, biomechanics and accommodative mechanisms of the eye [1]. MTAM not only explains known clinical facts, but also gives an opportunity to develop the theory of Optometry in teachings on «Rational optical correction» and « Visual comfort» [2,3]. To verify practical application of MTAM a long term clinical trials were planned. The results of these studies are presented below. Objectives of the study were following. 1) To compare the effectiveness of traditional use of incomplete optical correction with the rational optical correction method using eyeglasses or contact lenses of modern design. 2) To show benefits of choosing lesser rational correction when the individual visual acuity is more than 1.0. 3) To show the advantages of early AM correction using MTAM hypothesis which implies that adaptive myopia is not a disease, but a natural adaptive reaction to certain visual conditions in humans and animals [5]. 4) To justify the physiological principles of prevention of AM using the rational optical correction method and give practical advices to doctors and optometrists.

Biography:

Obrubov S Anatoly is an Ophthalmologist of City Clinical Hospital named after S.P. Botkin, Ophthalmological Hospital (Moscow, Russia) and he is an Assistant Professor in Department of Ophthalmology of Russian Medical Academy.

Abstract:

The question of the adequacy of the results obtained with the use of isolated scleral specimens to the characteristic of the functioning eye remains relevant. It was believed that lifetime assessment of the biomechanical properties of eye tissues is an almost impossible task due to deformities of various type of eye tissue and the necessity to take into account a large number of parameters characterizing eye functioning. Aim: Aim of this study is to reveal the biomechanical properties of the pre-equatorial area of sclera and to investigate the relationship between the severity of changes in eye fundus and biomechanical characteristics of the sclera in children with axial myopia. Methods: 130 children (260 eyes) aged 12 to 16 are studied. The biomechanical properties of the sclera are measured by a threetrack sensor modification of the acoustic tissue analyzer in 8 areas of the pre-equatorial area of sclera in scanning direction both along equatorial and meridional direction. Acoustic range measurements are 5-6 kHz. Results: With an increase in magnitude of myopia and the anteroposterior size of the eyeball in sclera the tensile stress in the meridian direction increases and the compression stress in the equatorial direction is formed. Periphery eye fundus changes and optical coherence tomography appearance of macular area add to the picture of biomechanical changes in pre-equatorial area of sclera and revealed subtle morphological changes of retina in children with myopia. Conclusion: The increase in tension stress together with the increase in the magnitude of myopia is explained by the morphological immaturity of fibroblasts in children and by the insufficient functioning of mechanism of mechanical stress destruction, which consists in the isolation of proteases for destruction of the adhesive bonds.

Biography:

Nadezhda V Khamnagdaeva is an Assistant of Pathophysiology department of Pirogov Russian National Research Medical University and; Ophthalmologist of Central Clinical Hospital with Policlinic of Department of Presidential affairs.

Abstract:

Statement of the Problem: Myopia in childhood and adolescence is the most common cause of visual impairment. Often myopia is seen separately from the concomitant pathology, despite the fact that these diseases prevalent in myopia. Concomitant chronic pathology in children often associated with undifferentiated connective tissue dysplasia. The purpose of this study is to determine the patterns of the formation of axial myopia in children with poly-morbidity. Methods: Three groups of children aged 11 to 17 years are formed. The main group consisted of 45 children with axial myopia and poly-morbidity. Poly-morbidity included: chronic tonsillitis and bronchial asthma. 38 children had axial myopia without clinical signs of concomitant chronic diseases. 35 children had emmetropia without concomitant chronic diseases. We examined surface phenotype of peripheral blood lymphocytes, the level of retinol and malondialdehyde in the blood. Results: Significant decrease in the number of CD3+, CD4+, CD20+, CD54+, mIgM lymphocytes, an increase malondialdehyde level and decrease retinol level in the blood in children with myopia and poly-morbidity. In children with myopia without concomitant pathology, there is a significant increase in the number of CD20+, CD95+, CD54+ lymphocytes, a decrease retinol level and an increase malondialdehyde level in the blood. Conclusion: The patho-genetically grounded concept of formation of myopia in children with poly-morbidity is formulated. Poly-morbidity enhances the growth of the eye due to the acceleration of scleral remodeling. These processes are mediated by activation of lipid peroxidation and disturbance of the formation of nitric oxide. Immuno-depression increases the frequency of exacerbation of chronic pathology which leads to an increase in the number of pro-inflammatory cytokines, affecting scleral fibroblasts. The decrease in the retinol level, due to its consumption as an antioxidant and oxidation to all trans retinoic acid. All trans- retinoic acid through gene expression increases the proliferation of fibroblasts.

Biography:

Liudmila Stepanova has completed her PhD for studying the biophysical mechanisms of water exchange in the eye. Currently, he works at the Siberian Federal University in the direction of health-saving technologies based on bioluminescent analysis of biological fluids. She conducts joint research with the staff of the Department of Ophthalmology of Medical Universities to study the problems of cataract development and children's myopia in violation of water-exchange processes in the eye.

Abstract:

The purpose of this study was to identify the mechanisms of water-exchange processes in the lens and the vitreous chamber of a rabbit. Fluid transport processes in the lens were studied in vitro by the change in mass when immersed in the washing environments of the lenses, with the addition of an inhibitor of the active transport system Na+,K+-ATPase and without it. The direction of movement of aqueous humor was studied in vivo by the displacement of the fluorescein using biomicroscopy and "stopped diffusion". The removal of aqueous humor from the vitreous chamber was investigated by changing the concentration of the fluorescein in blood plasma taken from the vascular eye veins and the lateral ear veins, with increased or decreased pressure in the vascular system. It is established that water-exchange processes represent the physiological mechanism of "breathing" in the lens at the moments of accommodation "near-in the distance". At a sight "in the distance" pressure in the flattened lens is minimal, therefore "fresh" aqueous humor enters the lens through its anterior capsule. The active ion transport system Na+,K+-ATPase, which is localized in the epithelium of the anterior capsule, promotes the osmotic transport of "fresh" aqueous humor and its further unidirectional diffusion from the anterior capsule to the posterior. Intensive receipt of aqueous humor maximally increases the inside the lens pressure to 6 mm Hg and translates the lens into a accommodation phase "near". Тhe lens is maximally rounded and the greatest inside the lens pressure, which promotes the diffusion of "spent" aqueous humor through the posterior capsule. The movement of aqueous humor in the vitreous chamber takes place in the direction of the retina along the gradient of the oncotic pressure. Excretion of aqueous humor from the eye's posterior part occurs through the eye's vortical veins into the total bloodstream.

Biography:

Abstract:

A modern person spends most of the day in an artificial light environment. The massive introduction of LED lighting and LED backlighting of information display devices exacerbated the problems of light-biological safety, and increased the risk of developing eye disease in the early stages of child development. This reduces the professional potential of an adult and safety of work, especially in transport. Eye diseases occur and develop during his training (work activity), which occurs in a light environment formed by artificial light sources general lighting and backlighting of display devices. Hygienists, studying the spectrum of light and the effect of its photon flux on the eyes and human health, have established that the spectrum of sunlight with hygienically safe color temperature causes an adequate response of human organs and systems. A biologically adequate spectrum of radiation is a collection of photon fluxes that forms a response matrix that ensures the harmonious functioning of the functional elements (cells) of the visual analyzer and the human hormonal system. Biologically adequate light environment is a light environment created by semiconductor sources of white light with a biologically adequate spectrum to minimize the risks of damage to human health at all stages of its life. We conducted a comparative analysis of the spectra of LED and sunlight. All modern artificial light sources are characterized by an increased radiation dose of blue light in the 450-460 nm regions, which exceeds the dose of blue in sunlight at the same color temperature and illumination level, and a dip in the blue-turquoise 480 nm area. The dip in the field of blue-turquoise light of 480 nm in the spectrum of LED light leads to an increase in the diameter of the pupil of the eye more than in sunlight. The analysis of the features of the spectrum of LED light and their negative impact on the incidence of eye and human health made it possible to formulate the theoretical basis for the development of a new generation of semiconductor white light sources to create a healthy light environment. During the implementation of the work development of industrial technology for the production of energy efficient LED white light sources with a biologically adequate spectrum of radiation, ELTAN specialists synthesized a spectrum of white light with no emission in the region of 460 nm and dips in the region of 480 nm, which corresponds to a continuous spectrum of sunlight with a hygienically safe light temperature. The wide introduction of semiconductor white light sources with a biologically adequate spectrum of radiation to illuminate educational and medical institutions and illuminate the displays of information display devices will create a healthy light environment for children and adults, which meets the new requirements of green technologies in construction.

Biography:

Anna S Andryukhina completed her Graduation from Russian National Research University of N.I. Pirogov in 2016. She is an Ophthalmologist, Doctor-intern of MONIKI of M F Vladimirsky.

Abstract:

The work is dedicated to research of the distinctive sight abilities of people of a young age, depending on the illumination source spectral composition. The researches were performed with two groups of young people: school children aged between 12 and 14 and students aged between 20 and 24. Visual acuity of the school children amounted to 1.0 and no more; visual acuity in the students’ group was not less than 2.0. The distinctive ability was assessed using error number in distinction of Landolt’s rings on the Golovin- Sivtsev’s tables. Efficiency of a standard incandescent lamp of Tc=2500 K, of a warm white light-emitting diode lamp of Tc=2500 K and of a cold white light-emitting diode lamp of Tc=6500 K were compared at the same illuminance of 450±3 lx. It was found that for school children, when using a cold white light-emitting diode lamp, error number during distinction of Landolt’s rings (table lines 7–9) was 1.5–2 times higher than when using warm white light sources. And the warm white light emitting diode lamp showed slightly better test values than the incandescent lamp. Error number in the student group was minimal. It was random in character and did not depend on the spectrum of the lamp used. It is supposed that the obtained results were caused by the fact that warm white light emitting diode lamps have the narrowest spectral band in the yellow-orange interval. Thus, they form a clearer image on the retina with minimum chromatic aberrations of an eye. The obtained data suggest that it may be better to use warm white illumination sources in school classrooms.

Biography:

Ivan N. Koshits, mechanical engineer, a member of the St. Petersburg  Sechenov Society of physiologists, biochemists, pharmacologists. Author of 59 scientific works in biomechanics, normal and pathological physiology of the eye and its elements, 2 monographs (2016). Organizer and co-head of the first scientific conferences in Russia on the Biomechanics of the eye in 1998-2011. Co-author and developer of the theory of functions of fibrous sheath eyes, the theory of open angle glaucoma and metabolic adaptation theory of acquired myopia. As well as the co-author of dynamic diagnostic methods to determine the in vivo new physiological and biomechanical characteristics of the eye. General Director of Petercom-Network / Management Systems Consulting Grope Cl. Corp.

Abstract:

Theory: Morpho-physiological characteristics of macula for forming shaped binocular vision

1. Morphology and physiology of the macula.
Cones in the Fovea are susceptible to three colors: blue spectrum (440-480 nm), green (510-550 nm) and red (620-770 nm). The foveola (2.2 mm diameter) consists from only red and green cones. Dark blue cones are found inside the rings located around the foveola, with an outside diameter of approximately 4.5 mm (stereo-angle of 180o). The density of blue cones within this ring has the highest concentration [1]. This ring apparently plays a leading role in the physiological mechanism of aiming the eye for the highest accuracy of the image (fig. 1).

This morphofunctional structure of the macula allows you to reliably "aim" for the area of space even in low-light conditions when the coming light mostly consists from the most powerful violet-blue part of the spectrum. Chart of optical center organization in retina presented in Fig. 2 will help you to better understand the Organization of the incoming optical signal with the functioning of the accommodation system.

Biography:

Svetlana V Alekseenko is an expert in Binocular Vision. Originally a Biophysicist, till 1992 she investigated the directional and orientation selectivity of visual cortical neurons in the cat at University of Vilnius, where she completed her PhD degree. Then she moved to Pavlov Institute of Physiology in St. Petersburg and switched to morphological studies of the neu-ronal connections which are providing the binocular vision in cats. On the basis of neuroana-tomical data, she has built the map of threedimensional visual space representation in the primary cortex, which allows the understanding of absolute disparity coding in this area. She became Habilitated Scientist in 2004. Her further research was studying the postnatal plastici-ty of neuronal connections especially during the development of disbinocular and deprivation amblyopia.

Abstract:

Statement of the Problem: One of the important tasks performed by a binocular system is reconstruction of 3-D visual space from two 2-D retinal images. This task is performed by the analysis of abso-lute and relative disparity of retinal images by binocular neurons in the visual cortex. It is known that abnormal binocular expe-rience during early childhood may produce amblyopia reducing visual acuity and ste-reovision, changing visuo-motor behaviour due to impaired formation of neuronal connections. The dynamics of these pro-cesses is not well understood yet. The purpose of our study was to investigate devel-opment of impairments in crossed and uncrossed pathways originating from each retina in feline experimental models of deprivation and dis-binocular amblyopia. Method: Using histochemical staining for cytochrome oxidase–a mitochondrial enzyme involved in energy production – the functional activity in eye-specific layers of lateral geniculate nucleus (LGN) of both hemispheres was estimated in unilaterally convergent strabismic kittens (SK) and monocularly deprived kittens (MDK) at ages of one to five months. Results: We found alterations of LGN layers activity in the projection of the en-tire visual field in MDK, but only in the projection of central 10-15 degrees in SK. In both experimental groups a relative de-crease of activity in layers innervated by uncrossed pathways from impaired eye was observed earlier than in layers inner-vated by crossed pathways from the same eye. Moreover, these changes were found in MDK at the age of two months while in SK they were found at the age of three months. Conclusion: The observed differences in development of deprivation and dis-binocular amblyopia strongly suggest the different mechanisms implicated in them. We speculate that intense stimulation of nasal visual hemi-field of the impaired eye in pre-surgical period of corrections might be useful to delay the impairments in un-crossed pathway.

Biography:

V I Serdiuchenko is a Doctor of Medical Science, Professor and, Chief of Laboratory of Disturbance of Binocular Vision at Filatov Institute of Eye Diseases and Tissue Therapy of National Academy of Medical Science of Ukraine. In 1985, with co-author I Viazovsky, the new device for investigation of accommodation in different meridians of the eye was proposed. With help of this device the possibility of irregular accommodation was demonstrated. In 1995, she has completed Doctoral dissertation entitled “New dynamic methods of investigation of visual functions in children with anomalies of refraction and disturbance of binocular vision”. She has authored 200 scientific works, two monographs (in 2014, 2015). Main direction of her scientific activities include: diagnostic and treatment of complicated forms of strabismus; creation of devices for treatment of accommodative disturbances and; studying of visual functions in children living in radioactively contaminated regions. She is member of European and International Associations.

Abstract:

Background & Aim: Prisms in patients with strabismus are used for: dimension of deviation angle; its compensation; conservative treatment of strabismus (provocation of diplopia, development of fusional reserves etc.). The data about efficiency of prismatic correction for compensation of deviation in patients with strabismus are contraries. Aim of this study is to estimate the efficacy of prismatic correction in children with strabismus. Materials & Methods: 63 children with concomitant convergent squint, 5-16 y/o, with deviation 10-25 pr. dptr, were observed. Methods used were viso, refracto-, deviometry, investigation of binocular functions, ophthalmoscopy. Visual acuity in 45 patients was 1.0, in 18-0.5-0.9. 2-3-divisible investigation during 1 hour was performed on prism tolerance test (for exclusion of phenomenon of secondary increase of deviation). Results: Orthophoria and binocular vision (BV) were noted in all children in spectacles after prism selection. Every 2-3 months the control of visual acuity, state of eyes and binocular functions was performed. Long-term follow up observations were conducted during 5-28 months. Normal BV in prismatic spectacles saved in 45 children (71.4%). Asymmetrical BV in spectacles developed in 6 (9.5%), that affirmed about late appearance of phenomenon of secondary increase of deviation. Power of prisms was diminished on 4-8 pr. dptr with preservation of BV in 25 children. Complete abolition of prisms was possible only in three children (4.8%). 20 children with normal BV in prisms were operated; after surgery BV was noted (BV without prisms or with weak prisms). Conclusion: Prisms are so useful for making a prismatic orthophoria and development of binocular vision in free space. It is necessary to follow-up the patients and to control the eye position, state of BV

Biography:

Olga Svetlova, Med.Sc.D., professor of Department Ophthalmology of North-Western State Medical University named after I.I. Mechnikov. Author of 211 scientific works, 2 monographs (2016). More than 25 years, conducts research on Biomechanics and physiology of the eye at the intersection of academic disciplines. The co-author generalized classification of executive mechanisms of  accommodation and proposals for development of the theory of accommodation of lens by Helmholtz, including the joint work of the front mini-lens and posterior mini-lens in the capsule of the lens to create a sharp image. Co-author and developer of the theory of functions of fibrous sheath eyes, the theory of open angle glaucoma and metabolic adaptation theory of acquired myopia. As well as the co-author of new dynamic diagnostic methods to determine the in vivo new physiological and biomechanical characteristics of the eye

Abstract:

Theory- Actuating mechanisms of accommodation and development of the theory of accommodation by Helmholtz

1. Development Helmholtz theory of accommodation:

Basic Helmholtz of lens accommodation theory (HLAT) has stood the test of time [1]. However, the truth of accommodation was disclosed only in part, and on the basis of HLAT could not be attributed to a number of physiological and clinical facts. In particular, HLAT cannot explain facts partial ability to accommodation in the eyes with the artyphacia and aphacia. In addition, actuators in HLAT were not fully developed. Traditional views on the functioning of the single lens mechanism of accommodation on HLAT violate the laws of mechanics. It is believed that when you look "completely near" zonula fiber relaxed, but then in the eye do not have structures that hold the lens in position (fig. 1).

However, Helmholtz considered that when looking "totally near" the Zonula fiber did not relax but only weaken [8]. I.e. in all phases of accommodation the Zonula fiber is tight, and when vision nears the minimum, while vision distance maximum [9]. Our research has made it possible to develop basic HLAT, which for now is consistent with the laws of mechanics in all phases of accommodation [7-11]. Also we have been able to find many other additional mechanisms of accommodation [12].

Biography:

Serdiuchenko Vira is a Doctor of Medical Science, Professor and, Chief of Laboratory of  Disturbance of Binocular Vision at Filatov Institute of Eye Diseases and Tissue Therapy of National Academy of Medical Science of Ukraine. In 1985, with co-author I Viazovsky, the new device for investigation of accommodation in different meridians of the eye was proposed. With help of this device the possibility of irregular accommodation was demonstrated. In 1995, she has completed Doctoral dissertation entitled “New dynamic methods of investigation of visual functions in children with anomalies of refraction and disturbance of binocular vision”. She has authored 200 scientific works, two monographs (in 2014, 2015). Main direction of her scientific activities include: diagnostic and treatment of complicated forms of strabismus; creation of devices for treatment of accommodative disturbances and; studying of visual functions in children living in radioactively contaminated regions. She is member of European and
International Associations.

Abstract:

A device for studying the volume of absolute accommodation (VAA) of the eye is known - the two-point diaphragm of Scheiner
(1619), based on the principle of monocular diplopia, that allows to study this index quite accurately. However, it has some drawbacks: reduced illumination of the pupil; narrow field of view; if one of the holes is not projected onto the pupil, then the phenomenon of monocular diplopia is not caused. The aim of the work was to make a device that would eliminate the existing shortcomings of the Scheiner diaphragm. The modified device is a disk with a diameter of 38 mm from an opaque material, in the center of which there is a depression with the bottom. The bottom is a lattice with parallel slots and bridges of the same width. Advantages of this device in comparison with the diaphragm of Scheiner are the following: the illumination of the pupil increases; the field of view is widened to 80-90 degrees; when the lattice is shifted, its function does not disappear, because in the projection of the pupil there are 2 or 3 slots, which allows provoking the phenomenon of monocular diplopia. The test-object is a thin line on a light background. Using this device, VAA was studied in preschool and schoolchildren. It is shown that from 3 to 7 years the VAA increases (from 7.4±0.1 dptr to 10.3±0.06 dptr), and then (to 15 years) gradually decreases (to 7.3±0.05 dptr). The installation of slots and test-object in this or that meridian allowed proving the possibility of irregular accommodation of the eye. The modified device is an accurate and convenient device for investigating VAA.

Biography:

Abstract:

Background: Astigmatism is one of the most frequent refractive abnormalities in children and offers 34.5-39% among all forms of refractive abnormalities. Adaptation of visual system to astigmatism is provided with two mechanisms-irregular accommodations
in main meridians and regular fluctuations of optic setting, thank to different focal lines that connect with retina. The main method of correction of astigmatism is usage of ocular correction (glasses). The investigation of adaptation to astigmatism by irregular accommodation in different meridians of astigmatic eye is an actual and interesting problem in pediatric ophthalmology. Aim: To investigate accommodative disorders in different forms of with-the-rule astigmatism, to increase the effectiveness of treatment refractive amblyopia in children by using the modificated original method of treatment accommodative disorders by its training in the weak meridian. Methods: Visual acuity for far and for near, proxymetria in main meridians, common indexes of accommodation, keratometria, refractometria and ophthalmoscopia. Results: 183 children (358 eyes) from 5 to 14 years old with different forms of with-the-rule astigmatism (mixed astigmatism, simple hyperopic astigmatism, simple myopic astigmatism) were investigated. The degree of astigmatism: 0.75-5.0 D. The presence of irregular accommodation in main meridians of the eye in the majority cases of the investigated forms of astigmatism was shown. Different
forms of meridional accommodation were determined by comparing the quantity of difference of nearest point of clear vision in diopters in main meridians with the degree of astigmatism. The role of irregular accommodation upon non-corrected and corrected visual acuity for far and for near was investigated. The treatment of accommodative disorders by using the original proposed methodic was conducted. We proposed the original methodic of training accommodative ability in weak meridian by using changing of positive and negative cylindrical lenses in order to increase non-corrected and corrected visual acuity for far and for near in children with astigmatism. The significant efficiency of modificated original methodic by training the accommodative ability in weak meridian was shown in all investigated forms of astigmatism. Conclusion: The presence of irregular accommodation in the majority cases of investigated forms of astigmatism in children was
shown. Different forms of meridional accommodation were determined. The influence of meridional accommodation upon visual acuity was shown. The use of proposed method of accommodative training in weak meridian is effective in all forms of with-the-rule astigmatism.

Biography:

Didar S Anwar has completed Pediatrics and Strabismus Fellowship training at Wilmer Eye Institute-Johns Hopkins Hospital. He is now Director of Neega Eye Center in Erbil, Iraq. He was speakers at many national and international ophthalmology meetings. He has also many peer-reviewed publications in international
journals.

Abstract:

Aim: To report the outcome of the first 10 cases of 360 degree prolene suture trabeculotomy at Neega Eye Center.
Methods: Ten eyes underwent 360 degrees prolene suture trabeculotomy by one surgeon (DA). Mean age was six months. Mean postoperative follow-up was one year. Preoperative mean intra-ocular pressure was 35 mm Hg.  Tonopen Avia was used to measure the intraocular pressure. Surgical Technique: Conjunctival peritomy is  performed. The sclera is then cauterized. Four by four millimeter flap is fashioned. Then another two by two millimeter flap is also performed. Schlemm’s canal is reached and 5-0 prolene suture is inserted and pushed 360 degree until the prolene suture come out from the other end. The prolene suture is then pulled to open the trabecular meshwork 360 degree and this way decrease the outflow resistance and decrease the intraocular pressure. Results: Postoperative mean intraocular pressure was 18 mm Hg. The corneal edema cleared in all eyes. Three eyes underwent further surgery because target intraocular pressure was not achieved. Hyphema was observed in all ten eyes but cleared eventually at one week postoperative visit. Conclusions: 360 degree prolene suture trabeculotomy seems to be effective technique for congenital glaucoma surgery.

Biography:

Yizhi Liu’s research focuses on ocular stem cells’ self-renewal, differentiation and senescence, and the role of extracellular matrix and engineered biomaterials that surround both normal and degenerated cells in cornea, lens and retina. Dr. Liu has published or co-authored more than 80 peer reviewed manuscripts in top journals including Nature, New England Journal of Medicine, Science, BMJ and PNAS. He is recognized as one of the pioneer ophthalmologists in China who perform phacoemulsification and intraocular lens implantation. He has carried out approximately 200, 000 surgical operations for cataract patients. He is serving as the Co-Editorin- Chief of Molecular Vision, Associate Editor-in-Chief of Current Molecular Medicine. He has received grants from the National Basic Research Program of China, the Chinese Ministry of Health Key Clinical Program, the Chinese National Natural Science Foundation and the Natural Science Foundation’s Key Program in Guangdong.

Abstract:

The repair and regeneration of tissues using endogenous stem cells represents an ultimate goal in regenerative medicine. However, tissue or organ regeneration using endogenous stem cells in human has not been demonstrated. Currently, the only treatment for cataracts, the leading cause of blindness worldwide, is to extract the cataractous lens and implant an artificial intraocular lens. This procedure poses significant risks of complications for young patients. Here we isolate lens epithelial stem/ progenitor cells (LECs) in mammals and show that Pax6 and Bmi-1 are required for LEC renewal. We designed a surgical method of cataract removal that preserves endogenous LECs and achieved functional lens regeneration in rabbits and macaques, as well as in human infants with cataract. Compared with the traditional procedure, we move the anterior capsulorhexis from the center to the periphery, reducing the diameter to 1-1.5mm, preserving the capsule, sub-capsular cells, and the physiological barrier between the anterior and the posterior segment. For infants and young children, this procedure reduces post-operative inflammation and the incidence of postoperative complications such as iris adhesion and secondary ocular hypertension while protecting the local milieu required for lens regeneration. Our approach conceptually differs from current practice, as it maximally preserves endogenous LECs and their natural environment, and regenerates lenses with visual function. Our findings demonstrate a novel treatment strategy for cataract and provide a new paradigm for tissue regeneration using endogenous stem cells.

Biography:

Federico Iacono has been working in Ophthalmic department of Santobono Hospital of Naples; his main interest has always been the strabismus surgery, its strategies and techniques. During his hospital career, he has performed many strabismus operations, has worked with the most expert Italian surgeons of strabismus and every year he has attended national and international congresses to keep up to date with new surgical techniques.

Abstract:

Aim: To report the outcomes in a patient who underwent surgical corrections of bilateral MR paralysis. Methods: This was a case report. Preoperative and postoperative follow-up of a patient with bilateral MR paralysis were assessed. Surgery was performed in the Pediatric Hospital of Naples, Ophthalmic department. Results: Patient M M was born with 2.3 kg at term, with growth retardation in the first year of life, affected by arthrogryposis. At the first ophthalmic examination in our center, at the age of 3 year old, she showed complete bilateral adduction restriction and limitation of elevation (LE greater than RE) with large angle exotropia and head rotated right-side or left-side according to fixation, RE dominants. Refraction performed by instillation by ciclo-pentolato three times, showed hyperopia w.n.l. Any pathologies in anterior chamber and fundus were excluded. Follow-up was performed during time with complete orthoptic evaluation. Preoperatively VA was 6/10 in both eyes. Krimsky test showed an exodeviation, with an angle greater than 85 PD. M M underwent surgery at age 4. In both eyes the following surgical approach was performed: LR 10 mm. recession + MR 6.5 mm. resection with insertion forwarded at 1 mm. from limbus. Postoperatively, one year after surgery, adduction deficit was still present, bilateral down-shoot was reported, with abduction limitation. Cover test showed: at distance an angle of 15 PD with 4 PD L/R hypertropia (RE fixating) and 10 PD with 4 PD R/L hypertropia (LE fixating); at near an angle of 20 PD with 10 PD L/R hypertropia (RE fixating) and 15 PD with 8 PD R/L hypertropia (LE fixating). Conclusion: Overall the surgical procedure performed has shown an improvement of preoperative clinical deviation, nevertheless a Jensen technique may be another option, as first surgery, in such cases. A video is available to show the case before and after surgery treatment.

Biography:

Hanife Tuba Akcam has completed her MD at Kırıkkale University and  Residency at Gazi University School of Medicine. She is an Assistant Professor at Duzce University Medical School. She has published various papers in reputed journals. Also, she has a lot of project about pediatric eye disorders.

Abstract:

Cataract which means clouding in eye lens may result in a wide variety of visual outcomes from blurry vision to blindness. Moreover, if cataract has congenital roots, it may turn out to be a huge power affecting the course of whole life in patients as visual development will be deeply affected. Therefore, it is important whether timely and appropriate treatment is performed. Congenital cataract occur about 3 in 10000 live births. Besides, cataracts coupled with genetic abnormalities are much rarer. In this presentation, we aimed to draw attention to syndromic cataracts by reporting a rare instance of congenital cataract with Hallermann-Streiff syndrome (HSS). One-month-old full-term female infant has been referred to our clinic since the cataract etiology cannot be determined. Examination showed bilateral congenital cataract, microphthalmia and microcornea. Patient’s medical history was normal except parents were relatives. We didn’t find any abnormalities that can shed light on etiology of cataract in the systemic investigation including TORCH panel. When we re-evaluate the patient in detail, we noticed bird-like face, dental abnormalities, hypotrichosis, skin atrophy and short stature. In the light of these findings, the patient was diagnosed with HSS. HSS diagnosis was confirmed by chromosome analysis which showed gene defect in sixth chromosome (6q21-q23.2). Bilateral limbal lensectomy was performed for the cataract treatment. In conclusion, HSS is a rare condition that possesses a typical facial appearance. True diagnosis of congenital cataracts with unclear etiology must be made by thoroughly evaluating the cases and recording any atypical phenotypic finding.

Biography:

Abstract:

Aim: To assess the clinical outcomes in children, having cataract surgery with posterior capsulorhexis and intraocular lens (IOL) implantation using two techniques: standard surgical steps, in-the-bag IOL with anterior vitrectomy and optic capture of IOL and eliminate the need for vitrectomy. Methods: The study included 43 children (54 eyes) between two and six years old. Patients were randomized in two groups. Group 1 (phaco-aspiration was accompanied by posterior capsulorhexis followed by an anterior vitrectomy and in-the-bag IOL implantation). Group 2 (phaco-aspiration was accompanied by posterior capsulorhexis and optic capture 3-piece IOL implantation without anterior vitrectomy). Intraoperative complications were documented. All patients had at least 21 months of follow-up (mean 42±13 months [range 21 to 59 months]).
Results: In Group 1 (20 children (32 eyes) 2 eyes developed visual axis obscuration (VAO). Significant VAO was detected three months postoperatively and pars plana membranectomy was performed 4-6 months postoperatively. In Group 2 (23 children (22 eyes) the IOL could not be captured in five eyes (22.7%), no complications occurred in these eyes. Conclusion: This study found the incidence of complications was comparable between two methods of congenital cataract surgery. Optic capture of IOL is an alternative to the standard approach for pediatric cataract surgery and it eliminates anterior
vitrectomy as a routine step during surgery.

Biography:

Abstract:

Monitoring the outcomes of surgical interventions to correct strabismus was found to be limited in literature. The first step to improve quality of care given to patients is imperative to have a full discussion with patients/family about outcomes, long term and short term, of surgery. Reasons identified for the limited monitoring of outcomes where the different etiology of strabismus, age groups variability, and wide variations of outcome measures definitions. In this review we did a retrospective audit, using a modified goal determined audit tool suggested by Ehrenberg et.al in 2014. The audit was done at King Fahad Medical City, a tertiary care center for pediatrics and neuro-science in Saudi Arabia. Outcomes of surgeries done over a five year period, with minimum follow up of six months, and up to three years post-surgery. The risk factors for poor surgical outcomes were identified using a Pareto chart, a process used most frequently used in quality studies to identify causes of failure. Quality improvement processes like the goal determined outcome tool, and the Pareto chart are simple to use and helpful for monitoring outcomes in a variable etiology surgical outcomes.

Biography:

Abstract:

Aim: Anteriorization procedure of the inferior oblique muscle in its hyperfunction. Materials & Methods: 18 patients admitted to the Department of Vision Protection of children of the National Centre of Ophthalmology named after acad. Zarifa Aliyeva with the diagnosis of inferior oblique muscle hyperfunction were under observation. For investigation of refraction, we used the method of sciascopy and autorefractometry at the height of cycloplegia (pediatric autorefractometer “Plusoptix A-09”, auto-refractometer “Tomey”). Result & Discussion: In postoperative in all patients, the functions of the inferior oblique muscle was rehabilitated. There were no any negative results after the surgery. This changes the inferior oblique from an elevator to more of a depressor.

Biography:

Teuta Haveri completed her MD diploma in 1999 and Specialization Diploma in Ophthalmology in 2006 from Faculty of Medicine University of Tirana. She is currently working as Ophthalmologist Surgeon at Eye Clinic, American Hospital of Tirana, Albania.

Abstract:

Statement of the Problem: Keratoconus is a degenerative disease of the cornea, starting generally at 14-25 years old, and causing progressive thinning of the cornea, leading to a conical shape and causing distortion of vision. Extreme advancement of the keratoconus can cause corneal perforation. At the last 20 years the incidence and prevalence of keratoconus has increased and also the number of keratoconus in children has increased. Lately, the number of patients in pediatric age, presenting high values of astigmatismus (4 and 5 diopters) has considerably increased. It is also not rare to examine children with evidenced progressive keratoconus. Trying to understand if the latest are only sporadic cases or is a real change in cornea profile between generations that could predict a keratokonic future generation; we collect data from patient of different ages and make a comparison statistical study. Methodology & Theoretical Orientation: A total number of 701 eyes are examined, patient that undergone three dimensional corneal topography (Oculus Pentacam HR). Parameters recorded were: Corneal pachymetry: central and thinnest point, main perpendicular corneal radius (K1/K2) and maximal value Kmax, corneal astigmatismus and values of posterior face of the cornea. Patients are divided in three main groups: 1st group 1 (<14 years old) 215 eyes/2nd group 2 (14-40 years) 397 eyes/3rd group 3(>40 years) 81 eyes. Findings: Corneal thickness 2nd group presents the lowest values (524.24±45.57) than 1st (545±45.57) and 3rd (549.42±43.89). The difference is statistically significant between the 1st and 2nd age group (p≤0.001) and between 1st and 3rd (p=0.02). Central corneal thickness is higher in 1st age group (549.42±43.89) than 2nd (524.24±51.48), difference statistically significant (p≤0.001). 3rd group measurements (533.87±69.49) are lower than 1st, a difference significant (p=0.06). The difference in measurements between the 2nd and the 3rd group (p=0.63). Corneal radius K1: The patient younger than 14 year old presents lowest values (49.64±51.45 D) than 3rd (51.75±51.19) and 2nd group (56.67±71.94. Corneal radius K2: 1st group has lower values (45.04±3.49), than 3rd (49.07±42.06) and 2nd group (50.23±49.60), however differences between the groups are not statistically significant (p=0.71; p=0.28). Furthermore the second age group records just slightly higher values than the third group, difference that is not statistically significant (p=0.960). Maximal radius Kmax is higher in 2nd group (51.56±49.74) compared 1st and 3rd, that have similar measurements (46.03±4.69; 46.65±5.20), however, there are not statistically significant (p=0.19; p=0.52). Corneal astigmatismus is higher in the patients under 14 years old (2.60±4.54) compared with 3rd (0.47±3.38) and 2nd (0.95±2.44), differences that are statistically significant (p=0.003; p≤0.001). The maximal value of cornea’s posterior face is lower in the young patients (under 14 years old) (59.10±179.92) than in 3rd group (99.34±211.61), and the 2nd (186.93±253.70). Conclusion & Significance: Keratoconus early signs are high values in corneal radius and posterior face of the cornea, accompanied with lower values of corneal thickness and also high and asymmetric astigmatisms. In this statistical study, we found that 1st group of patients (up to 14 years old) present high values of corneal astigmatisms but, low values of corneal radius and posterior face of the cornea and high values of corneal thickness. So there is an increasing in corneal astigmatisms but not predicting a future keratokonic generation.

Biography:

Nagendra Prasad is an experienced Ophthalmologist based in Patna, where he practices at Buddha Eye and Lasik Laser Centre, which is a centre of excellence for phaco, retina, glaucoma and diabetic eye care. His areas of specialization include Cataract (MICS), LASIK, Glaucoma and treatment of retinal disorders. He is currently Secretary of the Patna Ophthalmic Club, and also a life member of several regional and national ophthalmological associations. He has done his MBBS and MD in Ophthalmology, and also completed fellowship in vitreo-retinal surgery. After completing his MBBS and subsequent Residency training, he worked as Medical Officer in State health services from February 1991 to June 1992, after which he pursued his MD in Ophthalmology from All India Institute of Medical Sciences (AIIMS), New Delhi. He was then Senior Resident in Department of Ophthalmology at the Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, from September 1995 to August 1998. He then moved into the area of training at the same institute for over eight years, first as Assistant Professor, and subsequently as Associate Professor and Officer-in-Charge, up to December 2006.

Abstract:

Background: Amblyopia is one of the most common disorders of decreased vision in children, the approximate prevalence is 2-4% and one third of it is due to anisometropia. If not treated in time lead to permanent subnormal vision throughout life, it is totally preventable disease. The recommended treatment is full correction of refractive error after cycloplegia with spectacles and occlusion therapy. Classical method of occlusion therapy is complete full time patching with eye pad, but sometimes it has fewer acceptances to stick to the treatment for both parents and child owing to odd looks. Another form of occlusion is partial occlusion for few hours a day has been tried with varying results. Aim: In this prospective randomised trial, full time complete occlusion when child awake on spectacles have been done and result was analysed. Method: 40 child of anisometropic amblyopia between the ages of 3 to 10 years has been enrolled into study and divided into two groups; group A-20 patients with complete occlusion with eye patch and group B-20 patients with spectacle patching. Inclusion criteria age was 3-10 years, anisohypermetropia within 3-9 diopters with amblyopia and first time attending the clinic. Exclusion criteria-age beyond 3-9 years, previously treated amblyopia occlusion has been given in the ratio of 1:7 i.e. the better eye has been occluded for seven days and amblyopic eye for one that monthly follow up has been done for six months. Result: It has been analysed at the end of six months. All patients showed some improvement at the end of three months and few patients are still under occlusion. Final result will be analysed after two months.

Biography:

Norma Helen Medina has her expertise in Public Health Ophthalmology and Epidemiology of eye diseases. She coordinated activities to assess the ocular health practices, within the neonatal units of the State of São Paulo. She and her team trained more than 800 pediatricians to perform red reflex examination and prevention of blindness in children. Implemented the trachoma control program in São Paulo state and give advisory services to the States and Ministry of Health of Brazil, and Portuguese speaking countries. She collaborated in the elaboration of school eye health manuals and training materials. Her division is responsible to train health personnel to perform primary eye care, prevention of eye disabilities in leprosy and trachoma elimination.

Abstract:

In State of São Paulo, Brazil the prevalence trachoma in the last school survey was 3.8%. The World Health Organization (WHO) has set the global elimination of trachoma, aiming a prevalence of trachomatous inflammation-follicular (TF) in children aged 1–9 years of < 5%, by 2020. Two strategies are used to verify the elimination: a trachoma census, in the municipalities with <2.000 children 1 and 9 years of age, and household survey using a random sample targeting the poorest census tracks, with the mean per capita income below ¼ of the Brazilian minimum wage, in the larger cities. Trachoma cases diagnosed are notified, treated and re-examined twice, in six-month intervals. The interim results of the progress towards elimination is: trachoma censuses were conducted in 68 municipalities, and prevalence survey conducted in Itapevi and Francisco Morato, municipalities of São Paulo metropolitan area, with a population of 223,408 and 168,234 respectively. In these a two stage cluster sample frame was used to select a sample of 2,400 children in each; the ocular examination with a 2.5X glass, according to WHO criteria. Among children 1 and 9 years of age, trachoma prevalence was 1.5% (79/5393). In the 1 to 9 age group, the prevalence was 1.2% among boys, and 1.7% among girls (χ2=1.73; p=0.19). The prevalence was in Francisco Morato (1.3%) and in Itapevi (1.0%). In trachoma censuses the examined children were 42,276 and a prevalence of TF (475-1.1%). The São Paulo state trachoma elimination plan is being implemented; currently three surveys are being conducted, with the objective to assess the extension and distribution of trachoma, in order to implement the control activities for the elimination as a public health problem. After the elimination, epidemiological surveillance for TF prevalence should be conducted in high risk communities.

Biography:

Fernando O Avellis is a Pediatric Ophthalmologist, focused his expertise in finding new measurable parameters useful in order to improve screening, early diagnosis and rehabilitation of childhood visual performance alterations. Particular emphasis is placed on new digital technologies, in particular those designed to achieve applications in low vision. One of fields of his research activity regards the identification of anatomical macular aspects typical of eyes affected by visual impairment at optic coherence tomography with the intent of using for future development of rehabilitation tools. He tries to create these models along with more than 10 years of experience spent in research, evaluation, teaching and administration in Pediatric Ophthalmology Service of University Hospital of Parma, Italy.

Abstract:

Statement of the Problem: Finding new parameters could be important for earlier diagnosis and follow-up of amblyopia, a visual condition that actually seems to have not much objectively measurable prognostic factors. There's a relationship between fixation eccentricity and visual acuity (VA). In recent studies amblyopic eyes compared to normal shown an increase in central choroidal thicknesses measured by optical coherence tomography (OCT). We evaluated through OCT how foveal choroidal thicknesses (CT) correlates with strabismic amblyopia. Methodology: 15 patients (mean age 5.4±1.9) including seven cases with strabismic amblyopia and eight controls with nonstrabismic amblyopia were recruited. Amblyopic eye CT was measured in nine points of the foveal region within a fixed topographic map: in center-fovea (CF) and in four cardinal points respectively at 1.5 mm and at 3 mm from CF. Thicknesses in topographic map was matched within two groups and maximum CT was reported. Three eccentricity patterns based on the distance from CF and maximum CT site were identified: first was in CF, second at 1.5 mm and third at 3 mm from CF. To each amblyopic eye a specific eccentricity pattern was attributed and compared between two groups. Subsequently, affected group eccentricity patterns were matched with the strabismic deviation degree. Finally, amblyopic eyes VA were correlated with the corresponding central CT for both groups. No statistically significant difference between groups was found in 9 CT topographic points. Instead maximum CT eccentricity differed statistically between two groups (p<0.05). No correlation between degree of eccentricity and strabismic deviation was found. Furthermore, there was a weak negative correlation between center-foveal CT and depth of amblyopia as VA in controls. Conclusions: These results suggest correlations between CT and amblyopia degree and probably between eccentricity of maximum foveal CT and VA. Our data encourage looking into analyzed parameters as possible prognostic indicators for antiamblyopic rehabilitation.