Day 1 :
Keynote Forum
Sultana Khanum
WHO consultant Dhaka, Bangladesh
Keynote: Nutrition solution of displaced children: Bangladesh Rohingya case study
Biography:
Sultana Khanum, a pediatricians is working as consultant for Global Health Solution focusing on women and children in remote and fragile countries in South Asia and she also works as a Freelance International Public Health consultant worldwide, currently involve with Global Scaling up Nutrition (SUN) movement. Dr Khanum received her Doctoral degree or PhD on pediatric clinical nutrition: cost effective approach of management of severe malnutrition from London School of Hygiene and Tropical Medicine (LSHTM), University of London and also obtained Master’s degree on Community Health in Developing Countries from LSHTM, University of London. Dr Khanum has more than 4 decades of working experience in health and development worldwide as reflected in her carrier. She was Director for Health System Development in WHO SEAR Region and prior to that she worked at the Department of Nutrition for Health and Development at the WHO HQ in Geneva as coordinator and as Advisor for Nutrition and Food Safety in South East Asia Region of World Health Organization (WHO). Dr Khanum also worked as Medical Director Save the Children UK, Bangladesh. She has authored several publications in various journals including Lancet, American Journal of Clinical Nutrition, European journal of clinical nutrition etc. her publications reflect her research interests in health and nutrition of children right from conception of their mothers. She is a peer reviewer of nutrition related books and publications including WHO documents. Dr Khanum is serving as a steering group member of Global Civil Society Network for Scaling up Nutrition (SUN), A Global country lead movement and member of Global CSO on ICN2 ( 2nd International Conference of Nutrition). She is a fellow of Royal Society of Medicine, member of Royal Society of Tropical Medicine and Hygiene and also a member of society for international development. She chaired and spoke in many international conferences. Dr. Khanum was awarded Woodruff Medal by LSHTM, University of London for excellence in public health nutrition.
Abstract:
The World Bank Estimates that around 2 billion people live in countries affected by fragility, conflict and violence. Currently around 36 countries or territories as being in fragile situation, Crisis takes many shapes and forms such as: deteriorating governance, prolonged political crisis, post conflict transition and reform processes, natural disasters and climate change to name some, As a result there is a mass population movement either within a country or internally displaced,(estimated at 40 million) or as refugees in bordering countries estimated as 25.4 million people, almost half of which are children.
Since August 2017, 670,000 Rohingya population –mostly women and children have fled to Bangladesh from Myanmar. They are living in refugee camps. Overcrowding, poor water sanitation, monsoon rain and limited food supply putting them in serious health and malnutritional risks. Bangladesh Government, WHO and humanitarian health partners have saved thousands of lives, prevented and curtailed deadly disease outbreaks among children who are mostly unimmunized .
A multi-stakeholder partners conducted two nutrition surveys – October-Nov 2017 and May-June 2018. Data were collected on household, demography, anthropometry, mortality, morbidity, infant and young child feeding practices, nutrition programming and food assistance. The objective was to assess the nutrition status of the Rohingya women and children-aged 6-59m living in camps. Assessment monitored the crisis evolving nutrition situation through comparison with the emergency Nutrition Assessment round 1 in October-Nov 2017.
The findings indicate the prevalence of Global acute malnutrition among children aged 6-59 months using weight-for-height (WHZ) has decreased significantly in Makeshift Settlements, from 19.3% in Round 1 to 12.0% in Round 2, and remains below the WHO Emergency Threshold (15%) in Nayapara camp, from 14.3% in Round 1 to 13.6% in Round 2. Further, the mortality rates are below the WHO emergency threshold of 1/10,000 persons/day in both sites. Chronic malnutrition (stunting) among children aged 6-59 months has declined but remains at or near the WHO critical threshold (40%) in both sites. The overall prevalence of anaemia among children 6-59 months has decreased significantly to below thresholds indicating a severe public health problem. However, the survey shows that over half of all infants and young children aged 6-23 months are anaemic.
While the two-week prevalence of diarrhoea and acute respiratory infections among children 6-59 months of age have decreased in both sites, the disease burden remains a concern given the crowded camp environment. Household level support with food assistance by ration card or e-voucher was found to be nearly universal in both sites. The proportion of children 6-59 months of age receiving fortified foods has quadrupled in the Makeshift Settlements (but still remains below 50%) and it tripled in Nayapara Registered Camp. Meanwhile, half of infants under 6 months are not receiving the protective benefits of exclusive breastfeeding in the Makeshift Settlements and the proportion of children 6-23 months achieving minimum acceptable diet remains low.
Despite the observed reductions in malnutrition and anaemia, the results indicate an ongoing health and nutrition emergency among Rohingya children in Cox’s Bazar. Current programming to treat and prevent acute malnutrition, as well as efforts to increase dietary diversity through e-voucher programs providing nutritious foods, and support for optimal breastfeeding practices are far from adequate and call to intensify to save the stateless child population .
Keynote Forum
Fatimah Mohammed Ali Yousef
King Abdulaziz University, Saudi Arabia
Keynote: The effects of green coffee extract supplementation on body weight, lipid profile and adipocytokines in healthy overweight adults in Saudi Arabia
Biography:
Fatimah Mohammed Ali Yousef is an Associated Professor in Nutritional Science with major fields of research interest in dietary, behavioral and lifestyle changes to improve health outcomes, physical performance and long-term maintenance. She has extensive background in nutritional sciences education, counseling and research, dietary assessment and analysis, public speaking, customer service. She has specialized expertise in laboratory work, human research and in body composition methodology and public health and dietary supplements/fortification.
Abstract:
Abnormal excess of fat accumulation in adipose tissue is considered as overweight with Body Mass Index (BMI) from 25 to 29.9 Kg/m2, which cues adversely affect. Overweight is a risk factor for many diseases such as some cancers including (endometria, breast, liver and colon), type II diabetes mellitus, hypertension, cardiovascular diseases, fatty liver disease, sleep apnea, and osteoarthritis. Overweight is considering a global world problem as estimated by world health organization (WHO). According WHO, in 2016 more than 1.9 billion of adults (40% of women and 39% of men) were overweight. In Arabian Gulf such as Qatar, Kuwait and Saudi Arabia there were high rates of overweight and obesity among adult (75-88% women, 70-85% men). Additionally, Saudi Arabia has one of the highest overweight prevalence rates among them. A clinical-based study in AL Khobar showed prevalence overweight and obesity among female aged 18-74 years was 65.4%. Similar result has been reported from Jeddah and Riyadh. Study conducted in south-western of Saudi Arabia at female university students, showed that the overweight and obesity among students was 23.8%. However, other study done in Jeddah and Qassim University in Saudi Arabia the prevalence of overweight was 29.8% and 21.8% in male students, respectively. Because of increasing the prevalence of overweight among adults in Saudi Arabia, there is an urgent need to work on reducing weight. So, our study aimed to investigate the effect of green coffee extract supplementation on body weight, lipid profile and adipocytokines among healthy overweight adults in Saudi Arabia for 22 weeks.
Keynote Forum
Yevhenia Shvets
Children’s treatment center “Nebolejkaâ€, Ukraine
Keynote: Innovative non-surgical method in complex strabismus treatment using new Prismatic Strabismus Compensators (PSC)
Biography:
Abstract:
Statement of the Problem: Although there are only two main approaches in complex strabismus treatment that exist today – surgical treatment and botulinum toxin injections, the search for alternative techniques of strabismus treatment remains relevant.
The purpose of the workshop is to provide recommendations on the appropriateness of Prismatic Strabismus Compensators (PSC) and specific rules of their use in complex strabismus treatment. Current Practice: Although most deficiencies of Fresnel lenses related to visual acuity reduction (foggy glasses) have been overcome by new PSC which have greater range of prismatic power, they remain undervalued by strabismologists and not widely used in practice. The main reason is in prejudice of practicing strabismologists against non – surgical methods of strabismus treatment. The appearance of glasses with PSC, furthermore, is often not suitable for patients and parents. Best Practice: At an early stage of strabismus treatment in patients under 5 y.o an attempt of non - surgical treatment using PSC can and should be made, as this method is less traumatic and able to compensate most of the motor and sensor dysfunctions causing strabismus in childhood, i. e. eliminating the cause of disorder using inartificial method. Expected outcomes: The abilities of PSC’s in forming stable binocular vision will be presented. The correct usage of PSC for patients under 5 years old in most cases leads to successful non-surgical outcome.
For cases, when the surgery involvement is inevitable, the usage of PSC can eliminate the complications of strabismus (“jump symptom“, suppression scotoma etc.) and prepare for 1-stage surgical treatment.
Summary: Non- surgical treatment methods have many advantages, furthermore, the use of PSC is able to eliminate even the most complicated types of strabismus. Incorporating PSC in treatment processes often hampered by practicing strabismologists mistrust.
Keynote Forum
Yevhenia Shvets
Children’s treatment center “Nebolejkaâ€, Ukraine
Keynote: Innovative non-surgical method in complex strabismus treatment using new Prismatic Strabismus Compensators (PSC)
Biography:
Abstract:
Statement of the Problem: Although there are only two main approaches in complex strabismus treatment that exist today – surgical treatment and botulinum toxin injections, the search for alternative techniques of strabismus treatment remains relevant.
The purpose of the workshop is to provide recommendations on the appropriateness of Prismatic Strabismus Compensators (PSC) and specific rules of their use in complex strabismus treatment. Current Practice: Although most deficiencies of Fresnel lenses related to visual acuity reduction (foggy glasses) have been overcome by new PSC which have greater range of prismatic power, they remain undervalued by strabismologists and not widely used in practice. The main reason is in prejudice of practicing strabismologists against non – surgical methods of strabismus treatment. The appearance of glasses with PSC, furthermore, is often not suitable for patients and parents. Best Practice: At an early stage of strabismus treatment in patients under 5 y.o an attempt of non - surgical treatment using PSC can and should be made, as this method is less traumatic and able to compensate most of the motor and sensor dysfunctions causing strabismus in childhood, i. e. eliminating the cause of disorder using inartificial method. Expected outcomes: The abilities of PSC’s in forming stable binocular vision will be presented. The correct usage of PSC for patients under 5 years old in most cases leads to successful non-surgical outcome.
For cases, when the surgery involvement is inevitable, the usage of PSC can eliminate the complications of strabismus (“jump symptom“, suppression scotoma etc.) and prepare for 1-stage surgical treatment.
Summary: Non- surgical treatment methods have many advantages, furthermore, the use of PSC is able to eliminate even the most complicated types of strabismus. Incorporating PSC in treatment processes often hampered by practicing strabismologists mistrust.
- Pediatric Ophthalmology
Location: Cassia 1+2
Session Introduction
Verlyn Yang
Gold Coast University Hospital, Australia
Title: Utilising Optos fundus photography in paediatric patients
Biography:
Verlyn Yang is a junior doctor in Ophthalmology practicing in a tertiary hospital in Queensland, Australia. Multiple tertiary sub-specialty services are provided in the center. Verlyn is actively pursuing a career in Outreach Ophthalmology.
Abstract:
Purpose and Aim: There has been an increasing trend towards utilising ultra-wide field, non-contact fundus photography systems like the Optos P200DTx, especially in paediatric patients. As a challenging opulation, this requires the use of techniques such as modification of the equipment, development of specific holds and positioning of the child. We describe the specific techniques utilised to take fundus photos on the Optos P200DTx for paediatric patient groups, 0-1 years, 1-3 years and and above 3 years old.
Methods: A systematic literature review of techniques used to image paediatric a patient on the Optos P200DTx was conducted, case reports studied, and expert opinions consulted. For primary data collection, parents were consented for clinical digital images and video recordings to be taken of their child undergoing Optos imaging in a tertiary hospital Ophthalmology clinic. The subsequent media was analysed and compared with the current literature, to develop specific techniques for each age group, 0-1 years, 1-3 years and & above 3 years old.
Results: Photos displaying the specific techniques were illustrated, accompanied by step-by-step descriptions of the methodology. The ‘Flying Baby’ position, ‘Back-to-face’ position and kneeling/seated position were employed for each respective age group.
Conclusion: These results support the use of the Optos P200DTx for fundus photography in paediatric patients of all ages, provided, tailored techniques are utilised.
Jiang Lin
Aier Eye Hospital, China
Title: Diagnoses and surgical outcomes of acute acquired comitant esotropia associated with myopia
Biography:
Jiang Lin is a Chief physician. He is a member of the standing committee of visual health care branch of Sichuan preventive medical association; A senior member of IAOA; Deputy director of Aier eye hospital in Sichuan province. He has over thirty years of clinical experience. He is an expert in strabismus surgery, treatment of refraction, especially for children and Orthokeratology
Abstract:
Purpose: To investigate the diagnoses and surgical outcomes of acute acquired comitant esotropia (ACCE) with similar symptoms who were associated with myopia.
Methods: The data of the 84 cases, who received treatments for esotropia in the Aier eye hospital between February 2014 and February 2019, were collected. The age of them was 12～18 years, and 44 patients were male. Preoperatively, patients complained diplopia. All they were homonymous diplopia and no difference in different diagnostic eye positions; Eye movements were normal; Prism test was +15～+45 prism diopters(PD); The angle of deviation at distance was more than 10PD greater than that at near; Cycloplegic refraction was -1.00～-5.00D. No one had neurological diseases. After six months of follow-up, we did the medial rectus (MR) weaken procedure with lateral rectus (LR) strengthen procedure.
Results: Diplopia disappeared, and eye positions turned to normal postoperatively. Meanwhile no regressions appeared during six-month reviews.
Conclusion: These patients had similar symptoms (e.g. normal eye movements, diplopia especially at distant, etc.). According to these they were diagnosed as ACCE [1]. Besides, they had other same features like low to moderate myopia and wearing glasses all the time. Therefore, ACCE associated with myopia could be a better diagnosis. The onset of this disease related to near-work directly leads to convergence excess and divergence insufficiency. Apparently, visual training is not a preferred treatment of divergence insufficiency, and surgery for this kind of esotropia would be better. Compared with other doctors, we rarely use the MR weaken procedure only. Our surgeries mainly strengthen LR with slight weakening MR. We just strengthen LR with people less than 15PD at near. By this way, patients with Preoperative diplopia, normal binocular visual function, get pretty surgical outcomes.
Vinita Gupta
All India Institute of Medical Sciences, India
Title: CHOOSING AN IOL FOR A CHILD – It’s not a child’s play!!
Biography:
Vinita Gupta is working as an additional Professor in Department of Ophthalmology at All India Institute of Medical Sciences, Rishikesh, India. She also have published many article in reputed journals.
Abstract:
Although dramatic advances have occurred in the field of paediatric cataract surgery over the last decade, calculating and selecting an optimum intraocular lens for the small eye of a growing child is a unique challenge. The need to implant a fixed power lens into the eye that is still growing makes it difficult to choose an optimum IOL power that best suits the child’s eye. The younger the child, the more difficult it is.
What are the issues we encounter? Just as a child’s body grows after birth through adolescence, so does the child’s eye from infancy till adult life. Moreover, as regards the amount of myopic shift, just as some children grow faster than others, some eyes grow faster than others. And there are no factors that clearly indicate which eye will grow faster than others. So there is large variability in myopic shift and difficulty in predicting future (target) refraction for any given child.
Then comes the issue of measuring axial length and keratometry measurement in children, can be as difficult as unattainable in the office setting – most children need an EUA. Then the question – which IOL formula is to be used for children? Since these are short eyes, all the formulas are slightly inaccurate.
Then comes the influence of genetic behaviour of the refractive error in the parents, which can again not be predicted with accuracy. It has been noted that if both parents are myopic, 30-40% of children become myopic whereas if only one of the parents is myopic, 20-25% of children will become myopic. If none of the parents is myopic, then 10% of children become myopic, so it depends upon genetic influence, and it is therefore unpredictable.
The undercorrection guidelines and power calculation methods therefore vary according to the age of the child and there has been changing trends towards implanting IOL in even infants. Also methods for piggyback IOLs and secondary IOLs implantation have evolved, but with their own merits and demerits.
In summary, choosing an IOL for paediatric patients is not a child’s play, and the surgeon has several considerations to keep in mind in order to give optimal vision children with pediatric cataracts.
Aisling McGlacken-Byrne
Lions Eye Institute, WA
Title: See-saw nystagmus caused by an optic nerve glioma: case report
Biography:
Aisling McGlacken-Byrne is currently a Senior House Officer in her first year as an Ophthalmology Surgical Trainee in Sligo University Hospital. She has special interests thats include rural and remote medicine and health inequity. Her previous employment was a resident with the Lions Outback Vision Van, part of the Lions Eye Institute. The Lions Outback Vision Van is a mobile eye health clinic launched in 2016 which travels around Western Australia providing specialist eye health services to remote communities
Abstract:
Gliomas are the most common paediatric tumours of the central nervous system, exhibiting a broad range of clinical behaviours depending on origin, size and pathological subgroup. Knowledge of current and evolving advances in molecular characterization of this tumour is needed to ensure effective management. A 2-year-old boy presented with nystagmus since 10 months of age. Parents described initially left eye moving horizontally then right eye moving horizontally, then both with a vertical component. Poor vision was reported, with running into objects and difficulty recognizing people far away. He was otherwise well, normal term vaginal delivery and reaching developmental milestones. On examination the boy had high frequency, small amplitude see-saw nystagmus. It had no null point and no change with convergence or fixation. He had no anomalous head position and a normal red reflex with clear corneas. Dilated exam under general anaesthetic revealed left subtle nerve pallor and atrophy. Magnetic resonance imaging revealed a large optic nerve glioma originating from the optic nerve chiasm, spreading anteriorly and posteriorly. Our case documents see-saw nystagmus in a patient with likely bi-temporal hemianopia due to a large tumour but without mesencephalic compression or CSF dissemination. Because preschool children rarely complain about poor vision, by the time symptoms manifests, the disorders of vision have already progressed. Early diagnosis is paramount in diagnosing these often silently enlarging optic pathway gliomas.
Zhao Xiquan
Xi'an Jiaotong University, China
Title: Surgery treatment of rhegmatogenous retinal detachments in adult retinopathy of prematurity
Biography:
Zhao Xiquan is working as Shaanxi Ophthalmic Medical Center, Xi’an No. 4 Hospital, Affiliated Guangren Hospital, School of Medicine, Xi'an Jiaotong University, Xi’an, China
Abstract:
Purpose: To report a treatment of rhegmatogenous retinal detachments in adult with retinopathy of prematurity.
Methods: We present a case of rhegmatogenous retinal detachments in a 21-year-old female with retinopathy of prematurity. The patient had history of premature birth and treatment of ROP. After a full ophthalmic examination, scleral buckling was taken to treat the rhegmatogenous retinal detachments.
Results: The fundus examination showed retinal folds in both eyes, and the retinal vessels were pulled straight, the retina of the left eye was removed from 1 to 8 o'clock, and the peripheral hole was at 5 o’clock. The silicone tape was pressed from the 4 to 6 o'clock pad at the anterior equatorial hole. Intraoperative combined retinal drainage. Postoperative follow-up observation of subretinal fluid absorption, and the retinal are flat.
Conclusion: In patients with a history of premature birth, features of fundus examinations do not correlate with the occurrence of a retinal detachment. Repair of detachment in such a patient is more likely to require multiple procedures. Physicians should consider widespread relief of vitreoretinal traction for detachment in any patient with a history of premature birth.
Jiwen Yang
Aier Eye Hospital Group, China
Title: Clinical observation of surgical outcomes of patients with Bielschowsky type acute acquired concomitant esotropia
Biography:
Jiwen Yang got a master's degree of Strabismus and Pediatric ophthalmology in 2005, then obtained PhD of Optometry from China Medical University in 2008. She engages in clinical work and scientific research, especially in diagnosis and treatment of strabismus, amblyopia and refractive error. She has completed tens of thousands strabismus correction surgery, including horizontal, vertical and rotating strabismus correction, and has fitted with Ortho-K lense and RGP for tens of thousands patients with myopia or astigmatism. She is the master tutor of Central South University, had completed mang provincial projects, received two items of Shenyang new technology awards, two projects sponsored by Health Development Planning Commission of Hunan province participated in formulating professional criteria of diagnosis and treatment criteria of strabismus of national third-level hospital, making many times of presentation in domestic and foreign academic conferences doing academic communication to the United States, Japan and so on.
Abstract:
Purpose: To review and analyze surgical outcomes of patients with Bielschowsky type acute acquired concomitant esotropia (AACE).
Methods: Retrospective study. We enrolled 9 esotropia and diplopia patients with myopia who performed strabismus surgery in Shenyang Aier Eye Hospital between June 2018 and March 2019, including 4 males, 5 females. The mean age of the patients was 22.67±5.41 (range, 16-30) years. They underwent monocular Medial Rectus Recession and Lateral Rectus Resection (6 cases), monocular Lateral Rectus Resection (3 cases).
Results: 1.The mean time of esotropia and diplopia onset: 22±15.59 (range, 6-48) months. 2. Incentives and treatment history: Excessive near working (2 cases), acupuncture treatment (3 cases), others with no treatment.3.The mean refractive errors in the right and left eyes were -4.05±1.34 (range,-2.25~-6.50) and -3.52±0.98 (range,-2.00~-5.25) diopters (D), respectively. 4. The mean AC/A value: 2.04±1.10 (range,0.67~4).5.Esodeviations: Average preoperative esodeviations at near and distance were 22.67±12.41(range,14~48) and 29.11±9.27(range,18~46) PD, average postoperative esodeviations at near and distance were 0 and 0.44±1.33(range,0~4)PD. There were significant statistically difference between preoperative and postoperative esodeviations both at near (T=5.48，P＜0.01) and distance (T=8.65，P＜0.0 1), respectively.6.The mean Medial Rectus Recession 2.44±1.94 (range,0-5) mm, 3 cases had dominant diplopia at distance, so they underwent monocular Lateral Rectus Resection, the mean Lateral Rectus Resection 4. 89±0.78 (range,4-6) mm.7.Diplopia: 9 patients all had diplopia preoperatively, all disappeared postoperatively. 8. Stereopsis: 5 patients had no stereopsis before surgery, 3 cases regained stereopsis after surgery.
Conclusions: In case of patients with Bielschowsky type AACE, surgery is the main treatment, patients achieved successful surgical alignment and the diplopia vanished as well. For patients with myopia, they should control the near work moderately.