flex - the Royal College of Ophthalmologists

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The Royal College of Ophthalmologists
Annual Congress 2014
Final Programme
& Abstracts
20-22 May 2014
The ICC,
Birmingham
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WEDNESDAY 21ST MAY 2014
THURSDAY 22ND MAY 2014
9.00 – 10.30
8.00 – 9.00 Breakfast Meetings
8.00 – 9.00 Breakfast Meetings
PRESIDENT’S SESSION: WHAT’S NEW IN
OPHTHALMOLOGY?
Harminder Dua
Medically Unexplained Visual Loss (MUVL)
Graham Holder & Michel Michaelides
Simulated Ocular Surgery
John Ferris
Training
Mike Hayward
Grand Rounds: Medical Retina
James Talks
Grand Rounds: Inflammatory Eye Disease
Clive Edelsten
How to Run a Private Practice
Robert Taylor
Grand Rounds: Glaucoma
Cecilia Fenerty
Ophthalmology Out to Tender
Richard Smith
Grand Rounds: Oculoplastics
Cornelius René
NIHR CRN, Ophthalmology Specialty:
focus on working with Industry
Faruque Ghanchi
TUESDAY 20TH MAY 2014
Glaucoma
Robert Weinreb
Neuro-ophthalmology
Nancy Newman
Corneal Surgery
Donald Tan
Oculoplastic Surgery
Jurij Bilyk
10.30 – 11.00 Coffee & Posters
9.00 – 10.00
9.00 – 10.45
11.00 – 12.30
Amblyopia
Mike Clarke
Corneal Infections
Parwez Hossain
Glaucoma Dilemmas that Make Us Sweat!
Rupert Bourne & Peter Shah
Challenges of Managing Chronic
Diseases of the Eye
Declan Flanagan
Mitochondrial Disease & the Eye
Mike Burdon & Patrick Yu Wai Man
Measuring Outcomes in Ophthalmology
Melanie Hingorani & John Sparrow
Endophthalmitis – Prevention & Management
Larry Benjamin
Tropical Disease and the Eye
Richard Bowman
Grand Rounds: FFA
Adnan Tufail, Alan Bird & Srinivas Sadda
Update on Retinal Vascular Disease
Sobha Sivaprasad
Management of Incomitant Strabismus
Tony Vivian
£ Laser Course (8.00 - 11.00)
Samer Elsherbiny, Robin Hamilton & Jim Innes
Paediatric Cataract
Chris Lloyd
* £ Retinal Imaging Course Part I
Paulo Stanga & James Talks
10.00 – 11.00
£ Disc and Retinal Imaging in Glaucoma
Diagnosis and Monitoring Course Part I
Rupert Bourne & Stephen Vernon
12.30 – 1.30 Lunch
1.30 – 3.00
THE DUKE ELDER ORATION 2014
Richard Abbott
Introduction by Nick Astbury
Training the Trainers (9.00 - 12.00)
Melanie Corbett
Update on Macular Oedema
Faruque Ghanchi
11.30 – 1.00
Adnexal Reconstruction and Rehabilitation
David Verity
11.30 – 12.00
Acquired Optic Neuropathies
Nicholas Sarkies
Systemic Disease & the Eye
Elizabeth Graham
The Great Debate
Bill Aylward
Corneal Transplantation
Frank Larkin
12.00 – 1.00
Translational Research
Paul Bishop
How to Run an Emergency Eye Service
Dilani Siriwardena & Richard Andrews
* £ Retinal Imaging Course Part II
Paulo Stanga & James Talks
Uveitis for the rest of us: key knowledge
for the non-specialist
Phil Murray
THE OPTIC UK LECTURE 2014
Neil Miller
Introduction by Mike Burdon
3.00 – 3.30 Tea & Posters
3.30 – 4.30
£ Laser Course (11.30 - 2.30)
Samer Elsherbiny, Robin Hamilton & Jim Innes
Rapid Fire Session
Andrew Dick
1.00 – 2.00 Lunch
2.00 – 3.00
4.30 – 5.30
THE BARRIE JONES LECTURE 2014
Gullapalli Rao
Introduction by Allen Foster
Rapid Fire Session
Ian Rennie
3.00 – 3.30
5.30 – 7.00
Presidential Handover
Drinks Reception
For all delegates and speakers at ICC,
Birmingham
4.00 – 4.30
AGM
4.30 – 5.30
MONDAY 19TH MAY 2014
9.00 – 5.00
Retina Day & Drinks Reception
Winfried Amoaku & Paulo Stanga
THE BOWMAN LECTURE 2014
John Marshall
Introduction by Alan Bird
1.00 - 2.00 Lunch
2.00 – 2.15
Awards Ceremony
2.15 – 4.00
Infectious Disease of Posterior Segment
Sue Lightman
How to Avoid Complications
in Cataract Surgery
Brian Little
Inherited Retina Disease
Andrew Lotery & Andrew Webster
Grand Rounds: Neuro-ophthalmology
Mike Burdon & Gordon Plant
£ Disc and Retinal Imaging in Glaucoma
Diagnosis and Monitoring Course Part II
Rupert Bourne & Stephen Vernon
4.00 Congress Close
5.30 – 6.30
Ophthalmic Trainees Forum
SAS Forum
MONDAY 19TH MAY 2014
WEDNESDAY 21ST MAY 2014
THURSDAY 22ND MAY 2014
9.00 – 5.00
9.00 – 4.30
9.15 – 4.00
Glaucoma Day & Drinks Reception
Peter Shah & Fiona Spencer
Allied Professions Day
Larry Benjamin & Janet Marsden
GP Day
Seema Verma & David Rapley
* For Retinal Imaging Course timings please refer to the listing in the programme
1
Annual Congress Final Programme & Abstracts
Birmingham 2014
CONTENTS
EPONYMOUS LECTURES 2014
General Information
PRESIDENT’S SESSION – Harminder Dua
Corneal Infection – Parwez Hossain
Mitochondrial Disease & the Eye – Mike Burdon & Patrick Yu Wai Man
Tropical Disease and the Eye – Richard Bowman
Management of Incomitant Strabismus – Tony Vivian
COURSE: Retinal Imaging – Paulo Stanga & James Talks
Update on Macular Oedema – Faruque Ghanchi
Adnexal Reconstruction and Rehabilitation – David Verity
Systemic Disease & the Eye – Elizabeth Graham
Translational Research – Paul Bishop
RAPID FIRE SESSION: Tuesday 20th May – Andrew Dick
BARRIE JONES LECTURE: GULLAPALLI RAO
DRINKS RECEPTION in the Exhibition Hall
BREAKFAST MEETING: MUVL – Graham Holder & Michel Michaelides
BREAKFAST MEETING: Training – Mike Hayward
BREAKFAST MEETING: Grand Rounds: Inflammatory Eye Disease – Clive Edelsten
BREAKFAST MEETING: Grand Rounds: Glaucoma – Cecilia Fenerty
BREAKFAST MEETING: Grand Rounds: Oculoplastics – Cornelius René
Amblyopia – Mike Clarke
Glaucoma Dilemmas that Make Us Sweat! – Rupert Bourne & Peter Shah
Measuring Outcomes in Ophthalmology – Melanie Hingorni & Richard Smith
Grand Rounds: FFA – Adnan Tufail
COURSE: Laser Course – Samer Elsherbiny, Robin Hamilton, Jim Innes
DUKE ELDER ORATION: RICHARD ABBOTT
Acquired Optic Neuropathies – Nicholas Sarkies
Corneal Transplantation – Frank Larkin
How to Run an Emergency Eye Service – Dilani Siriwardena & Richard Andrews
Uveitis for the rest of us – Phil Murray
RAPID FIRE SESSION: Wednesday 21st May – Ian Rennie
PRESIDENTIAL HANDOVER
AGM
BOWMAN LECTURE: JOHN MARSHALL
Ophthalmic Trainees Forum
SAS Forum
ALLIED PROFESSIONS DAY
BREAKFAST MEETING: Simulated Ocular Surgery – John Ferris
BREAKFAST MEETING: Grand Rounds: Medical Retina – James Talks
BREAKFAST MEETING: How to Run a Private Practice – Robert Taylor
BREAKFAST MEETING: Ophthalmology Out to Tender – Richard Smith
BREAKFAST MEETING: NIHR, CRN Ophthalmology Speciality – Faruque Ghanchi
Challenges of Managing Chronic Diseases of the Eye – Declan Flanagan
Endophthalmitis – Prevention & Management – Larry Benjamin
Update on Retinal Vascular Disease – Sobha Sivaprasad
Paediatric Cataract – Chris Lloyd
COURSE: Disc & Retinal Imaging in Glaucoma Diagnosis & Monitoring
Training the Trainers – Melanie Corbett
The Great Debate – Bill Aylward
OPTIC UK LECTURE: NEIL MILLER
Awards Ceremony
Infectious Disease of Posterior Segment – Sue Lightman
How to Avoid Complications in Cataract Surgery – Brian Little
Inherited Retina Disease – Andrew Lotery & Andrew Webster
Grand Rounds: Neuro-ophthalmology
GP DAY
Poster Exhibition
DVD Exhibition
Optic UK & Exhibitor Listings
Poster Abstracts
DVD Abstracts
Seminar Calendar 2014
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3
4
4
4
4
5
5
5&7
6
6
7
7
8
8&9
8
10
10
10
10
11
11
11
11
12
11 & 13
12 & 16
12
12
13
13
13
14
14
14 & 17
14
14
15
18
18
18
18
19
19
19
19
20
20 & 22
20
20
21 & 23
21
21
21
21
21
22
24
34
35
38
142
148
Birmingham 2014
EPONYMOUS LECTURERS 2014
BARRIE JONES LECTURE 2014
Dr. Gullapalli Rao
Gullapalli N Rao completed his medical school and ophthalmology residency in
India following which he pursued the subspeciality of cornea. After fellowship
training in Boston and Rochester, he continued in Rochester and was on the
clinical faculty at the University of Rochester until 1986 where he was involved in
clinical care, teaching and research. His research interests included corneal
endothelium, specular microscopy, neurobiology of cornea, contact lenses, corneal
transplantation and Keratoprosthesis.
In 1986 he moved back to India to establish the well-known L V Prasad Eye
Institute for which he was the Founder Chairman and Director.
BOWMAN LECTURE 2014
Professor John Marshall
Professor John Marshall is the Frost Professor of Ophthalmology at the Institute of
Ophthalmology in association with Moorfields Eye Hospital, University College
London and the theme leader for new devices and new technologies NIHR. He is
Emeritus Professor of Ophthalmology at Kings College London, Honorary
Distinguished Professor University of Cardiff, Honorary Professor the City
University and Honorary Professor Glasgow Caledonian University.
His research over the past forty years has ranged over a number of ocular problems
but has concentrated on the inter-relationships between light and ageing and the
environmental mechanisms underlying age-related, diabetic and inherited retinal
disease.
DUKE ELDER ORATION 2014
Professor Richard Abbott
Dr Abbott currently is the Thomas W. Boyden Health Sciences Professor of Clinical
Ophthalmology at the University of California San Francisco and Research Associate at
the Francis I. Proctor Foundation. He is the former Co-Director of Corneal and
Refractive Surgery and was responsible for establishing the refractive surgery clinical
and research program at UCSF.
After completing his Bachelor of Science degree at Tufts University in Boston,
Dr. Abbott earned his medical degree at the George Washington University School of
Medicine in Washington, DC. He performed his residency at the California Pacific
Medical Center in San Francisco and was a Heed and Fight for Sight fellow at the
Bascom Palmer Eye Institute in Miami.
OPTIC UK LECTURE 2014
Professor Neil Miller
Dr. Neil Miller attended Harvard University, where he majored in biochemistry,
graduating Magna cum Laude in 1967. He then matriculated to Johns Hopkins
Medical School. After finishing medical school at in 1971, he took an internship in
medicine at Johns Hopkins, followed by an ophthalmology residency at the Wilmer
Eye Institute and a fellowship in neuro-ophthalmology at the University of California,
San Francisco, with Dr. William F. Hoyt.
Dr. Miller joined the staff of the Wilmer Eye Institute of the Johns Hopkins Hospital
in 1975 and has been a faculty member at Johns Hopkins since then. He is currently
Professor of Ophthalmology, Neurology, and Neurosurgery at the Johns Hopkins
Medical Institutions, and also the Frank B. Walsh Professor of Neuro-Ophthalmology
and head of the Neuro-Ophthalmology and Orbital Units of the Wilmer Institute.
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Birmingham 2014
PROGRAMME - Tuesday 20th May 2014
11.00 – 12.30 HALL 1
CORNEAL INFECTIONS
Mr Parwez Hossain, Consultant Ophthalmologist,
Southampton General Hospital
Dates and venue
The Annual Congress will be held from Tuesday 20th
to Thursday 22nd May 2014 at The ICC, Birmingham
Registration opening hours
Monday 19th May 2014
Tuesday 20th May 2014
Wednesday 21st May 2014
Thursday 22nd May 2014
4.00 p.m.
8.00 a.m.
7.45 a.m.
7.45 a.m.
–
–
–
–
6.30
5.00
5.00
3.00
p.m.
p.m.
p.m.
p.m.
CMV Keratitis - The Great Masquerader
Professor Donald Tan, Medical Director, Singapore
National Eye Centre
Management of Acanthamoeba Keratitis
Professor Vincent Borderie, Ophthalmic Surgeon,
Centre Hospitalier National d'Ophtalmologie, Paris
Security
All delegates must wear their badge at all times. Please assist
the hall stewards by having your badge on display.
Management of Bacterial Keratitis
Miss Fiona Carley, Consultant Ophthalmologist,
Manchester Royal Eye Hospital
Language
The language of Congress is English.
Continuing professional development
One CPD point per hour of educational activity is
awarded at Congress. The total CPD allocation for
the main Congress is 23 points: Tuesday 8 points,
Wednesday 8 points and Thursday 7 points
Exhibition opening hours
Microbiologist’s Perspective
Dr Helmut Schuster, Consultant Microbiologist,
Health Protection Agency, Southampton General
Hospital
Management of Fungal & Viral Keratitis
Mr Parwez Hossain, Consultant Ophthalmologist,
Southampton General Hospital
8.00 a.m. – 7.00 p.m.
8.30 a.m. – 5.30 p.m.
8.30 a.m. – 3.00 p.m.
11.00 – 12.30
HALL 5
MITOCHONDRIAL DISEASE & THE EYE
Mr Mike Burdon, Consultant Ophthalmologist,
University Hospitals Birmingham
& Mr Patrick Yu-Wai-Man, Senior Lecturer and MRC
Clinician Scientist, Newcastle University
Refreshments and lunch
Your fee includes welcome coffee, morning coffee
break, two course lunch and afternoon tea. There will
be a vegetarian option but we are unable to provide
for any other dietary requirements. No refunds will
be given for lunch not taken
11.00 – 11.10
Mitochondrial Genetics and Physiology – What You
Need to Know
Mr Patrick Yu-Wai-Man, Senior Lecturer and MRC
9.00 – 10.30 HALL 1
PRESIDENT’S SESSION: WHAT’S NEW IN
OPHTHALMOLOGY?
The President, Professor Harminder Dua, The Royal
College of Ophthalmologists, London
Glaucoma
Professor Robert Weinreb, Distinguished Professor of
Ophthalmology, University of California, San Diego,
USA
11.10 – 11.30
Mitochondrial Diseases – When to Suspect It
Professor Nancy Newman, Professor of
Ophthalmology & Neurology, Emory University,
Atlanta, USA
Neuro-ophthalmology
Ophthalmology and Neurology, Emory University,
Atlanta, USA
11.30 – 11.50
Mitochondrial Optic Neuropathies
Mr Patrick Yu-Wai-Man, Senior Lecturer and MRC
Corneal Surgery
National Eye Centre
11.50 – 12.10
Chronic Progressive External Ophthalmoplegia
Professor Neil Miller, Frank B Walsh Professor of
Neuro-ophthalmology, John Hopkins Hospital,
Baltimore, USA
Oculoplastic Surgery
Professor Jurij Bilyk, Professor of Ophthalmology,
Thomas Jefferson University Hospital, Philadelphia,
USA
12.10 – 12.30
Retinal Involvement in Mitochondrial Diseases
Professor Anthony Moore, Professor of
Ophthalmology, Moorfields Eye Hospital, London
10.30 - 11.00 COFFEE & POSTERS: Meet the Authors
4
Birmingham 2014
11.00 – 12.30 HALL 9
MANAGEMENT OF INCOMITANT STRABISMUS
Mr Anthony Vivian, Consultant Paediatric
Ophthalmologist, Cambridge University Hospitals
11.00 – 12.30 HALL 11
TROPICAL DISEASE & THE EYE
Mr Richard Bowman, Consultant Ophthalmologist,
The Hospital for Sick Children, Great Ormond Street,
London
11.00 – 11.05
Introduction
11.00 – 11.10
Studying Blindness. There’s an app for that…
Mr Andrew Bastawrous, Clinical Research Fellow in
International Eye Health, ICEH London School of
Hygiene and Tropical Medicine
11.05 – 11.25
Assessment of patients with incomitant deviations
Mr Robert Taylor, Consultant Ophthalmologist, York
Hospital
11.10 – 11.15
Discussion
11.15 – 11.25
Epidemiology and management of glaucoma in sub
Saharan Africa
Dr Fatima Kayari, Consultant Ophthalmologist and
Senior Lecturer, College of Health Sciences,
University of Abuja, Nigeria
11.25 – 11.45
Strabismus following retinal detachment surgery
Mr Jonathan Durnian, Consultant Ophthalmologist,
Royal Liverpool University Hospital
11.45 – 12.05
The Challenges of Duane Syndrome
11.25 – 11.30
Discussion
11.30 – 11.40
Glaucoma – wrong name?
Mr Ian Murdoch, Consultant Ophthalmologist,
Moorfields Eye Hospital, London
12.05 – 12.25
The use of Botulinum toxin in the management of
patients with incomitant deviations
Miss Joanna Hancox, Clinical Fellow, Moorfields Eye
Hospital, London
11.40 -11.45
Discussion
11.00 – 2.00
HALL 6
£ RETINAL IMAGING COURSE PART I
Professor Paulo Stanga, Consultant Ophthalmologist
and Vitreoretinal Surgeon, Manchester Royal Eye
Hospital
& Mr James Talks, Consultant Ophthalmologist,
Royal Victoria Infirmary, Newcastle upon Tyne
11.45 – 11.55
Outcomes of cataract surgery in children in
developing countries
Dr Guy Negretti, Speciality Registrar, Moorfields Eye
Hospital, London
11.55 – 12.00
Discussion
Pre-registered delegates only. Check availability with
our registration staff.
12.00 – 12.10
Neglected Tropical Disease: An Update
Dr Babar Qureshi, Director of Neglected Tropical
Disease, CBM and Chair for the East Mediterranean
Regional Alliance for Trachoma Control
Part One – Lectures & Working Lunch
11.00 – 11.20
Comparison of Fourier Domain ( FD-OCT) and
Swept-Source (SS-OCT) Optical Coherence
Tomography and use of Optos® Wide-Field Fundus
Autofluorescene (WT-FAF) in Vitreoretinal Disorders
Hospital
12.10 – 12.15
Discussion
12.15 – 12.25
VISION 2020 to Universal Eye Care
Professor Allen Foster, Professor of International Eye
Health, London School of Hygiene and Tropical
Medicine, London
11.20 – 11.40
Masterclass in the Combined Benefits of Stereo FFA,
Indocyanine-green Angiography (ICG), Fundus
Autofluorescence and OCT
Mr James Talks, Consultant Ophthalmologist, Royal
Victoria Infirmary, Newcastle upon Tyne
12.25 – 12.30
Discussion
5
Birmingham 2014
11.40 – 12.00
Paediatric Posterior Pole Pathology: Retcam® Fundus
Photography and Fluorescein Angiography and
Ultrasound Biomicroscopy (UBM)
Mr Susmito Biswas, Consultant Ophthalmologist,
1.53 – 2.09
Managing Diabetic Macular Oedema
Professor Baruch Kuppermann, Professor of
Ophthalmology & Biomedical Engineering, University
of California, USA
2.10 – 2.26
Retinal Vein Occlusion and Macular Oedema
Professor Anat Loewenstein, Director Ophthalmology
Department, Tel Aviv University, Israel
12.00 - 12.20
How Should We Image Vitreoretinal Disease in
2014?
Professor Srinivas Sadda, Professor of Ophthalmology,
University of Southern California, USA
2.27 – 2.43
Uveitic Macular Oedema
Professor Miles Stanford, Consultant
Ophthalmologist, St Thomas’s Hospital, London
12.20 – 12.30
Round Table & Questions from the Audience
2.44 – 3.00
Service Set Up for Macular Oedema
Mrs Geeta Menon, Consultant Ophthalmologist,
Frimley Park Hospital, Camberley
12.30 – 12.50 WORKING LUNCH
Buffet lunch served outside the session hall to all
attendees
12.50 – 1.10
Angiographic Imaging of Inflammatory Chorioretinal
Disease
Mr Ian Pearce, Consultant Ophthalmologist, Royal
Liverpool & Broadgreen University Hospital
1.30 – 3.00 HALL 9
ADNEXAL RECONSTRUCTION AND
REHABILITATION
Mr David Verity, Consultant Ophthalmologist,
1.10 – 1.30
OCT Findings in Uveal Disorders in an Egyptian
Population
Professor Magdy Moussa, Professor of
Ophthalmology, Tanta University, Egypt
1.30 – 1.50
Reconstruction of the periocular region after injury
USA
1.30 – 1.50
Functional Tests and Retinal Imaging
Professor Bart Leroy, Consultant Ophthalmologist &
Ophthalmic Geneticist, Ghent University Hospital,
Belgium
1.50 – 2.10
The challenges of lacrimal reconstruction after injury
and surgery
Mr Geoffrey Rose, Consultant Ophthalmologist,
1.50 -2.00
Round Table & Questions from the Audience
2.10 – 2.30
Adnexal surgery in thyroid eye disease – pearls and
pitfalls
12.30 – 1.30 LUNCH & EXHIBITION
1.30 – 3.00
HALL 1
UPDATE ON MACULAR OEDEMA
Mr Faruque Ghanchi, Consultant Ophthalmologist,
Bradford Royal Infirmary
2.30 – 2.50
Socket reconstruction and rehabilitation – how to
succeed
Mr Raman Malhotra, Consultant Ophthalmologist,
Queen Victoria Hospital, East Grinstead
1.30 – 1.34
Introduction
2.50 – 3.00
Questions and Close
1.35 – 1.52
Imaging Macular Oedema
Professor Yit Yang, Consultant Ophthalmologist,
Wolverhampton & Midland Counties Eye Infirmary
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Birmingham 2014
1.30 – 3.00
HALL 5
SYSTEMIC DISEASE & THE EYE
Miss Elizabeth Graham, Consultant Ophthalmologist,
St Thomas’s Hospital, London
2.24 – 2.42
Imaging death and sickness in retina
Professor James Morgan, Consultant Ophthalmologist,
University Hospital of Wales
Hypertension
2.42 – 3.00
Using patient specific stem cells to interrogate and
treat recessive retinal degenerations
Professor Budd Tucker, Assistant Professor,
Ophthalmology and Visual Science, University of
Iowa, USA
1.30 – 1.45
The ocular manifestations of hypertension
1.45 – 2.00
Hypertension and beyond…
Professor Gregory Lip, Professor of Cardiovascular
Medicine, University of Birmingham
2.00 – 3.00
HALL 6
£ RETINAL IMAGING COURSE PART II
Hospital
& Mr James Talks, Consultant Ophthalmologist,
Royal Victoria Infirmary, Newcastle upon Tyne
The Patient in Intensive Care
2.00 -2.15
The neurologists perspective – and what they want
from the eye doctor
Dr Robin Howard, Consultant Neurologist, St Thomas
Hospital and the National Hospital for Neurology and
Neurosurgery
Part Two – Case Discussions & Demonstrations
2.15 – 2.30
What the ophthalmologist can contribute
A series of educational retinal cases will be available
on laptops to be worked through by the delegates
with the session presenters. Delegates will be
allocated in to groups and the presenters will rotate
between the groups to achieve one-to-one
interaction.
Hands-on equipment demonstrations by Optos UK
and Topcon UK
By the end of the symposium the delegates should
have not only increased their knowledge in the
interpretation of the results obtained with the
presented imaging techniques but also be able to
image patients themselves
Rheumatoid Arthritis
2.30 -3.00
Rheumatoid arthritis
Professor James Rosenbaum, Professor of
Ophthalmology, Medicine and Cell Biology, Oregon
Health & Science University, Portland, USA
1.30 – 3.00
HALL 11
TRANSLATIONAL RESEARCH
Professor Paul Bishop, Consultant Ophthalmologist,
Demonstrators:
Professor Paulo Stanga, Consultant Ophthalmologist,
Mr James Talks, Consultant Ophthalmologist, Royal
Mr Susmito Biswas, Consultant Ophthalmologist,
Professor Magdy Moussa, Professor of
Ophthalmology, Tanta University, Egypt
Professor Srinivas Sadda, Professor of Ophthalmology,
University of Southern California, USA
Ms Jane Gray, Manchester
Mr Ben Turley, Topcon UK
Ms Anne-Marie Cairns, Optos UK
1.30 – 1.48
Translation of genetic epidemiology studies in twins
Professor Chris Hammond, Consultant
Ophthalmologist, St. Thomas’ Hospital & King’s
College London
1.48 – 2.06
Macrophage responses in the retina as targets for
therapy
Professor Andrew Dick, Consultant Ophthalmologist,
Bristol Eye Hospital
3.00 – 3.30 TEA & POSTERS: Meet the authors
2.06 – 2.24
UK Biobank eye and vision data – A major new
research resource
Professor Paul Foster, Consultant Ophthalmologist,
7
Birmingham 2014
4.12 – 4.18
Translational bypass therapy using ataluren to treat
nonsense-mediated choroideremia
Mariya Moosajee, Dhani Tracey-White, Clare Futter,
Tony Moore, Andrew Webster, Miguel Seabra
UCL Institute of Ophthalmology
3.30 – 4.30
HALL 1
RAPID FIRE SESSION
Professor Andrew Dick, Consultant Ophthalmologist,
3.30 – 3.36 SOE PRIZE WINNER 2014
Intravitreal Aflibercept for Diabetic Macular Edema:
1 – Year Findings from the VIVID-DME and VISTADME Trials
Edoardo Midena
University of Padova
4.18 – 4.24
Metobolomic Analysis of Serum in Graves’ Disease
and Thyroid-Associated Ophthalmopathy: A
Diagnostic Tool?
Matthew R Edmunds, Kristien Boelaert, Jayne A
Franklyn, S John Curnow, Omar M Durrani, Stephen
P Young
University of Birmingham, UK
3.36 – 3.42
Can we replace Temporal Artery Biopsy (TAB) with
Cranial Duplex Ultrasound (CDUS) in the diagnosis
of Giant Cell Arteritis (GCA)?
Adam Croft, Nicola Thompson, Martin Duddy, Fazal
Khattak, Susan Mollan, Paresh Jobanputra
University Hospital Birmingham
4.24 – 4.30
Results from the Sight Loss and Vision Priority
Setting Partnership
Michele Acton
Fight for Sight
3.42 – 3.48
Ranibizumab treatment of diabetic macular oedema
with bimonthly monitoring after a phase of initial
treatment: 18-month outcomes of the Phase IIIb
multicentre RELIGHT study
Ian Pearce
Multicentre study
4.30 -5.30
HALL 1
THE PROFESSOR BARRIE JONES LECTURE 2014
Professor Gullapalli Rao, Chairman, LV Prasad Eye
Institute, Hyderabad, India
Professor Gullapalli Rao will deliver this year’s
Professor Barrie Jones Lecture. Please see page 9 for
further information.
3.48 – 3.54
OCT Findings in Children with Bardet Biedl
Syndrome
Peter Good, John Ainsworth, Marie Tsaloumas,
Alaistair Denniston, Denise Williams
Birmingham Children’s Hospital
5.30 – 7.00
HALL 3
DRINKS RECEPTION
All delegates and speakers are invited to a free drinks
reception in the Exhibition Hall
3.54 – 4.00
Analysis of the Hedgehog signalling pathway in
periocular morphoeic basal cell carcinoma
John Bladen, Caroline Thaung, Michele Beaconsfield,
Michael Philpott
Centre for Cutaneous Research, Barts and The
London
4.00 – 4.06
The effects of anti-VEGFS on human tenon’s
fibroblast growth in vitro
Nurul Nabila Baharudin, Siti Munirah Mohd Noh, Siti
Hamimah Sheikh Abdul Kader, Zakaria Bannur,
Jonathan Crowston, Sushil Kumar Vasudevan
IMMB, UTIM
4.06 – 4.12
A case for re-defining the intraocular pressure
referral threshold: Findings from the UK Biobank
Michelle Chan, Carlota Grossi Sampedro, Stephen
Vernon, James Morgan, Praveen Patel, Peng Khaw,
Paul Foster
Moorfields Eye Hospital Foundation Trust
8
Birmingham 2014
THE BARRIE JONES LECTURE 2014
Tuesday 20th May 2014 4.30 - 5.30 Hall 1
EYE CARE FOR THE NEGLECTED POPULATIONS: CHALLENGES AND SOLUTIONS
Dr. Gullapalli Rao, Chair, Hyderabad Eye Institute & Founder LV Prasad Eye Institute, Hyderabad, India
Gullapalli N Rao completed his medical school and ophthalmology residency in India following which he
pursued the subspeciality of cornea. After fellowship training in Boston and Rochester, he continued in
Rochester and was on the clinical faculty at the University of Rochester until 1986 where he was involved in
clinical care, teaching and research. His research interests included corneal endothelium, specular
microscopy, neurobiology of cornea, contact lenses, corneal transplantation and Keratoprosthesis.
In 1986 he moved back to India to establish the well-known L V Prasad Eye Institute for which he was the
Founder Chairman and Director. The Institute is considered to be among the top eye institutes in the world
and renowned for its innovative models of eye care delivery from primary to advanced tertiary care levels and
is a WHO Collaborating Centre and one of the three global resource centres for the VISION 2020: The Right to
Sight, the global initiative to eliminate avoidable blindness. It has one of the most comprehensive eye care
services in the world encompassing clinical care, education, research, rehabilitation and product development.
In addition, it has played a pivotal role in global eye care over the past 15 years.
Dr.Rao held many international leadership positions and is on the Boards of many organisations in the field of
eye care as well as in the prevention of blindness activities around the world. His standing in this area is
epitomised by his appointment as Secretary – General of the International Agency for the Prevention of
Blindness (1998 – 2004) and then as Chairman, Board of Trustees, President and CEO (2004 – 2008) (the first
ever to be given all these responsibilities). In this capacity, he has played a key role in initiating, coordinating
and mobilising Vision 2020: The Right to Sight activities, which will improve eye care worldwide and
provided exemplary leadership to this program.
Dr.Rao’s main areas of interest are Corneal Diseases and Eye Banking, Community Eye Health, Health Policy &
Planning, Eye Care Reforms. He developed innovative models of eye care delivery and eye banking systems
in addition to expanding his research interest into corneal infections, public health aspects of ophthalmology
and operations research.
Dr.Rao was on the editorial boards of several journals, Visiting Professor at several universities, delivered many
named lectures all over the world and chaired scientific sessions in many international meetings. He
published over 270 papers and on the Editorial Boards of many journals.
He is married to Pratibha, a politician and a social activist and has a son and a daughter.
Introduction by Professor Allen Foster, Professor of International Eye Health, London School of Hygiene and
Tropical Medicine, London
Vote of thanks from Professor Harminder Dua, President, The Royal College of Ophthalmologists
9
Birmingham 2014
PROGRAMME - Wednesday 21st May 2014
Free welcome coffee, tea and pastries will be served
outside session halls for all delegates attending
breakfast sessions
8.00 – 9.00
HALL 5
GRAND ROUNDS: INFLAMMATORY EYE DISEASE
Mr Clive Edelsten, Consultant Ophthalmologist,
Ipswich Hospital, Suffolk
8.00 – 9.00 HALL 1
MEDICALLY UNEXPLAINED VISUAL LOSS (MUVL)
Professor Graham Holder, Consultant
Electrophysiologist, Moorfields Eye Hospital, London
& Mr Michel Michaelides, Consultant Ophthalmic
Surgeon, Moorfields Eye Hospital, London
DIAGNOSTIC AND MANAGEMENT PROBLEMS IN
OCULAR INFLAMMATION
In this session an eminent panel of experts will
provide a case-based discussion using a series of case
reports on the following themes:
Granulomatous disease mimicking sarcoidosis
Choroidal Vasculiltis
Choice of biologics after failure of standard
immunosuppression
Congenital immunodeficiency and ocular
inflammation
Retinal Vascular Occlusion in Children
8.00 – 8.15
Clinical Approach to the Patient with Unexplained
Visual Loss
Baltimore, USA
8.15 – 8.35
The Role of Electrophysiology in the Evaluation of
the Patient with Unexplained Visual Loss
Professor Graham Holder, Consultant
Electrophysiologist, Moorfields Eye Hospital, London
Panel:
Mr Richard Watts, Consultant Rheumatologist,
Dr Paul Brogan, Consultant Rheumatologist, Great
Ormond Street Hospital, London
Miss Jane Ashworth, Consultant Paediatric
Ophthalmologist, Manchester Royal Eye Hospital
Mr Clive Edelsten, Consultant Ophthalmologist,
8.35 – 8.55
Illustrative Case Presentations
Ophthalmology and Neurology, Emory University,
Atlanta, USA
& Professor Neil Miller, Frank B Walsh Professor of
Baltimore, USA
8.00 – 9.00
HALL 10
GRAND ROUNDS: GLAUCOMA
Miss Cecilia Fenerty, Consultant Ophthalmologist,
8.00 – 9.00
HALL 9
TRAINING
Mr Mike Hayward, Chairman of Training Committee,
DIFFICULT GLAUCOMA MANAGEMENT
CHALLENGES
Each expert will present a challenging case for
discussion with the audience and panel
Series of short presentations followed by time for
delegates to feed back their views on the Shape of
Training
Shape of Training – the review and the politics
Mr Mike Hayward, RCOphth Chairman of Training
Committee
Panel:
Miss Cecilia Fenerty, Consultant Ophthalmologist,
Mr Anthony King, Consultant Ophthalmologist,
University Hospital Nottingham
Mrs Anshoo Choudhary, Consultant Ophthalmologist,
Royal Liverpool & Broadgreen University Hospital
Miss Winifred Nolan, Consultant Ophthalmologist,
Length and Content of Training – the times they are a
changing
Mrs Sally Webber, Consultant Ophthalmologist, Royal
United Hospital, Bath
How the ‘Shape of Training’ could improve the UK
Ophthalmology Curriculum
Mr William Dean, RCOphth Chairman of the
Ophthalmic Trainees Group
10
Birmingham 2014
8.00 – 9.00
HALL 7
GRAND ROUNDS: OCULOPLASTICS
Mr Cornelius René, Consultant Ophthalmologist,
Hinchingbrooke Hospital, Huntington
9.00 – 10.00
HALL 5
GLAUCOMA DILEMMAS THAT MAKE US SWEAT!
Mr Rupert Bourne, Consultant Ophthalmologist,
Hinchingbrooke/Addenbrookes/Moorfields Hospitals
& Professor Peter Shah, Consultant Ophthalmologist,
University Hospitals Birmingham NHS Foundation
Trust
This session will comprise of a series of 5-6 interesting
short cases spanning the breadth of oculoplastic
lacrimal and orbital surgery. Each case will be
presented and discussed by a panel of experts.
Patient with a pale cupped optic disc and borderline
IOPs
& Professor Peter Shah, Consultant Ophthalmologist,
University Hospitals Birmingham NHS Foundation Trust
Panel:
USA
Mr Naresh Joshi, Consultant Ophthalmologist,
Mr Geoffrey Rose, Consultant Ophthalmologist,
Mr Tony Tyers, Consultant Ophthalmologist, Salisbury
District Hospital
Young male with IOPs of 40mmhg in each eye
Mr Imran Masood, Consultant Ophthalmologist,
Birmingham & Midland Eye Centre
& Dr Freda Sii, Senior Glaucoma Fellow, University
Hospitals, Birmingham NHS Foundation Trust
Middle-aged female with bilateral angle closure and
6/5 vision
8.00 – 11.00
HALL 11B
£ LASER COURSE
Mr Samer Elsherbiny, Consultant Ophthalmologist,
& Mr Robin Hamilton, Consultant Ophthalmologist,
& Mr Jim Innes, Consultant Ophthalmologist, Hull
Royal Infirmary
9.00 – 10.00
HALL 9
MEASURING OUTCOMES IN OPHTHALMOLOGY
Mrs Melanie Hingorani, Consultant Ophthalmologist,
Hinchingbrooke Hospital
& Professor John Sparrow, Consultant
Ophthalmologist, Bristol Eye Hospital
9.00 – 9.05
Introduction
Mrs Melanie Hingorani, Consultant Ophthalmologist,
Hinchingbrooke Hospital
The laser course will be a practical introduction to
clinical laser for trainees; attendees will be expected
to have completed the online Laser Course on
EyeSite. There will be a number of stations where
trainees can observe and then carry out laser
treatments in a simulated environment.
9.05 – 9.20
National audits – experience and pitfalls
Professor John Deanfield, Consultant
Cardiologist/Clinical Lead, National Institute for
Cardiovascular Outcomes and Research
9.00 – 10.00
HALL 10
AMBLYOPIA
Mr Mike Clarke, Consultant Ophthalmologist, Royal
9.20 – 9.35
The National Ophthalmology Audit
Professor John Sparrow, Consultant Ophthalmologist,
9.00 – 9.20
Does amblyopia matter in real life?
Mr Nadeem Ali, Consultant Ophthalmologist,
Moorfields Eye Hospital & St George’s Medical
School
9.35 – 9.50
PROMs (patient reported outcome measure) in
paediatric ophthalmology
Professor Jugnoo Rahi, Consultant Ophthalmologist,
Institute for Child Health
9.20 – 9.40
What have we learned about amblyopia treatment
from clinical studies?
Professor Helen Davies, Professor of Orthoptics,
University of Sheffield
9.50 -10.00
Discussion
9.40 -10.00
New approaches to amblyopia treatment
Professor Paul McGraw, Allen Standen Professor of
Visual Neuroscience, School of Psychology,
Nottingham University
11
Birmingham 2014
9.00 – 10.00
HALL 1
GRAND ROUNDS: FFA
Mr Adnan Tufail, Consultant Ophthalmologist,
& Professor Alan Bird, Professor of Medical
Ophthalmology, Moorfields Eye Hospital, London
& Professor Srinivas Sadda, Professor of
Ophthalmology, University of Southern California,
USA
11.50 – 12.00
Questions
12.00 – 12.20
The Management of Optic Neuritis
Revd. Dr Alasdair Coles, Senior Lecturer in Clinical
Neuroimmunology, Consultant Neurologist,
Addenbrookes Hospital, Cambridge
12.20 – 12.30
Questions
9.00 – 9.12
An unusual retinal vascular anomaly
Miss Ambreen Kalhoro, Speciality Registrar, St James’s
University Hospital, Leeds
12.30 – 12.50
Toxic and Nutritional Optic Neuropathies
Dr Gordon Plant, Consultant Neurologist, St
Thomas’s Hospital, London
9.12 – 9.24
Routine macula clinic – a diagnositic challenge…
Mr Ajay Kumar Kotagiri, Research Fellow (Retina),
Sunderland Eye Infirmary, Sunderland
12.50 – 1.00
Questions
9.24 – 9.36
Unusual retinal vascular proliferation: a case study
Miss Farrah Islam, Registrar and Vitreoretina Fellow,
Al-Shifa Trust Eye Hospital, Pakistan
11.30 – 1.00
HALL 10
CORNEAL TRANSPLANTATION
Mr Frank Larkin, Consultant Ophthalmic Surgeon,
9.36 – 9.48
Atypical CSR
Miss Kanchan Bahn, Medical Retina and Uveitis
Fellow, Moorfields Eye Hospital, London
11.30 – 11.50
Long term outcomes of anterior lamella keratoplasty.
Professor Vincent Borderie, Ophthalmic Surgeon,
Centre Hospitalier National d'Ophtalmologie, Paris
9.48 – 10.00
Why do cilioretinal artery and central vein
occlusions co-occur?
Mr Jacob Low-Beer, Speciality registrar, Moorfields
Eye Hospital, London
11.50 – 12.10
Influence of surgeon experience on anterior and
posterior lamellar keratoplasty
Mr Frank Larkin, Consultant Ophthalmic Surgeon,
10.00 – 11.00
HALL 1
Professor Richard Abbott, Thomas W. Boyden
Endowed Chair & Health Sciences Clinical Professor
of Ophthalmology, University of California, USA
12.10 – 12.30
Getting better results in DSEK.
Mr Madhavan Rajan, Consultant Ophthalmologist,
12.30 – 12.50
Graft survival and outcomes betweek PK, ALK and
EK: Show me the evidence!
National Eye Centre
Professor Richard Abbott will deliver this year’s Duke
Elder Oration. Please see page 16 for further
information.
11.00 - 11.30 COFFEE & POSTERS: Meet the Authors
12.50 – 1.00
Discussion
11.30 – 1.00
HALL 1
ACQUIRED OPTIC NEUROPATHIES
Mr Nicholas Sarkies, Consultant Ophthalmologist,
11.30 – 1.00
HALL 9
HOW TO RUN AN EMERGENCY EYE SERVICE
Miss Dilani Siriwardena, Consultant Ophthalmologist,
& Mr Richard Andrews, Consultant Ophthalmologist,
11.30 – 11.50
How to distinguish between Papilloedema and
Pseudopapilloedema
Baltimore, USA
11.30 – 11.35
Welcome & Introduction
Miss Dilani Siriwardena, Consultant Ophthalmologist,
12
Birmingham 2014
11.35 – 11.47
The Development of Emergency Eye Care as a New
Sub-Speciality – It’s History & Future
Ms Seema Verma, Consultant Ophthalmologist,
12.05 – 12.20
Management of uveitic macular oedema
Mr Alastair Denniston, Consultant Ophthalmologist,
Queen Elizabeth Hospital, Birmingham
12.20 – 12.35
Raised intraocular pressure in uveitis
Professor Phillip Murray, Consultant Ophthalmologist,
11.47 – 11.59
The Developing and Establishing Emergency Eye Care
Service
Mr Felipe Dhawahir-Scala, Consultant
Ophthalmologist, Director of Acute Ophthalmic
Services, Manchester Royal Eye Hospital
12.35 – 12.50
When to get help
11.59 – 12.11
Surviving the A&E Crisis
Mr John Buchan, Consultant Ophthalmologist, St
James’ University Hospital, Leeds
12.50 – 1.00
Questions
12.11 – 12.23
Making Eye Casualty a High Quality Training
Environment
Miss Lucy Clarke, Consultant Ophthalmologist, Royal
Victoria Infirmary, Newcastle Eye Centre
11.30 – 2.30
HALL 11B
£ LASER COURSE
Mr Samer Elsherbiny, Consultant Ophthalmologist,
& Mr Robin Hamilton, Consultant Ophthalmologist,
& Mr Jim Innes, Consultant Ophthalmologist, Hull
Royal Infirmary
12.23 – 12.35
Experience of Developing the Nurses’ Role
Professor Janet Marsden, Professor of Ophthalmology
& Emergency Eye Care, Manchester Metropolitan
University
12.35 – 12.55
Corneal Tales from the Crypt – Keys to Avoiding
Corneal Mishaps in Eye Casualty
Professor Christopher Liu, Consultant
Ophthalmologist, Brighton & Sussex University
Hospital
The laser course will be a practical introduction to
clinical laser for trainees; attendees will be expected
to have completed the online Laser Course on
EyeSite. There will be a number of stations where
trainees can observe and then carry out laser
treatments in a simulated environment.
12.55 – 1.00
Final Questions
11.30 – 1.00
HALL 5
UVEITIS FOR THE REST OF US: KEY KNOWLEDGE
FOR THE NON-SPECIALIST
2.00 – 3.00
HALL 1
RAPID FIRE SESSION
Professor Ian Rennie, Consultant Ophthalmologist,
Royal Hallamshire Hospital, Sheffield
2.00 – 2.06
A British Ophthalmic Surveillance Unit (BOSU)
study of severe adverse events associated with the
local anaesthesia (LA) in cataract surgery
Richard M H Lee, John R Thompson, Tom Eke
King’s College Hospital
11.30 – 11.35
Introduction
11.35 – 11.50
Investigating patients with uveitis
2.06 – 2.12
Evaluating the Use of Intravitreal Aflibercept in
Patients with Choroidal Neovascularisation
Secondary to Pathological Myopia (mCNV): The
MYRROR Study
Francesco Bandello
San Raffaele Scientific Institute
11.50 – 12.05
Assessing uveitic macular oedema
Mr Pearse Keane, Specialist Registrar, Moorfields Eye
Hospital, London
13
Birmingham 2014
3.00 – 3.30
HALL 1
PRESIDENTIAL HANDOVER
Professor Harminder Dua completes his term of office
as President of the Royal College of Ophthalmologists
and hands over to Professor Carrie MacEwen
2.12 – 2.18
Cochrane review of 5-fluorouracil in
trabecukectomy: too long overlooked?
Elspeth Green, Richard Wormald
London School of Hygiene & Tropical Medicine
2.18 – 2.24
The impact of congenital profound of severe visual
impairment (VI) on behaviour development and
difficulties in the early years
Michelle O’Reilly, Elena Sakkalou, Hanna Sakki,
Michelle De Haan, Alison Salt, Naomi Dale
UCL Institute of Child Health
3.30 – 4.00 COFFEE & POSTERS: Meet the Authors
4.00 – 4.30 HALL 1
AGM
Join the President and College Officers for the 2014
AGM
2.24 – 2.30
Swept-Source Optical Coherence Tomography
Assessment of Choroidal Thickness in Different
Macular Disorders
Salvador Pastor-Idoate, Maria Gil-Martinez, Stephen
Charles, Susmito Biswas, David Henson, David B
McLeod, Paulo Stanga
MREH/NIHR. Wellcome Trust CRF
4.30 – 5.30
HALL 1
Professor John Marshall, Professor of Ophthalmology,
Institute of Ophthalmology, London
Professor John Marshall will deliver this year’s
Bowman Lecture. Please see page 17 for further
information.
2.30 – 2.36
Redefining wolfram syndrome in molecular era
Patrick Yu-Wai-Man, Grant Guthrie, Kamil S Sitarz,
Angela Pyle, Rita Horvath, Philip G Griffiths, Patrick
F Chinnery
Newcastle Eye Centre, Royal Victoria Infirmary
5.30 – 6.30
HALL 10A
OPHTHALMIC TRAINEES FORUM
A free drinks reception offering the chance for all
ophthalmologists in training to pose questions and
talk to the President and College Officers
2.36 -2.42
Glaucoma prescribing trends in England 2000 to
2012
Alan Connor, Scott Fraser
Royal Victoria Infirmary, Newcastle
5.30 – 6.30
HALL 10B
SAS FORUM
A free drinks reception offering the chance for all staff
and associate grade ophthalmologists to pose
questions and talk to the President and College
Officers
2.42 – 2.48
Is Socioeconomic deprivation independently
associated with increased prevalence of diabetic
retinopathy?
Liying Low, Simon Ogston, Peter Wilson, Alex Yeong,
Ritchie McAlpine, Una O’Colmain, Carrie MacEwen
University of Dundee
2.48 – 2.54
Corneal calcification and phosphate buffers – Do
you need to prescribe phosphate free?
Magdalena Popiela
Singleton Hospital
2.54 – 3.00
Visual impairment and health inequalities: findings
from UK biobank (UKBB)
Phillippa Cumberland, Paul Foster, Peng Tee Khaw,
Christopher Hammond, Pirro Hysi, Yanchun Bao,
Jugnoo Rahi
14
Birmingham 2014
9.00 – 4.30
HALL 11A
Mr Larry Benjamin, Consultant Ophthalmologist,
Stoke Mandeville Hospital, Aylesbury
& Professor Janet Marsden, Professor of
Ophthalmology and Emergency Care, Manchester
Metropolitan University
1.30 – 3.00
CATARACT
9.00 – 10.30
UPDATES ON AMD
Femtosecond laser – the way forward?
Ms Brian Little, Consultant Ophthalmologist,
AP involvement in the cataract pathway
Ms Stephanie Hartley, Clinical Nurse Lead for
Ophthalmology, Stoke Mandeville Hospital,
Aylesbury
Developments in the treatment of AMD
Mr Ian Pearce, Consultant Ophthalmologist, Royal
Liverpool & Broadgreen University Hospital
IOLS today and in the future
A Protocol based approach to treatment decisions
Mr Richard Hancock, Service Manager for
Ophthalmic and General Medical Photography,
University Hospitals Aintree, Liverpool
Biometry hints and tips
Mr David Sculfor, Consultant Optometrist, Stoke
Mandeville Hospital, Aylesbury
The nurse role in the care of patient with wet AMD
Ms Sarah Stanley, Department Manager, Ophthalmic
Nurse, Sunderland Eye Infirmary
& Ms Kim Davies, Ophthalmic Nurse, Sunderland
Eye Infirmary
3.00 – 3.30 Tea in Exhibition Hall
3.30 – 4.30
WORKFORCE PLANNING
Growing your own – making mentoring work in
ophthalmic settings
Ms Mary Shaw, Senior Lecturer, School of Nursing &
Midwifery & Social Work, University of Manchester
AMD – Future Possibilities
Professor Andrew Lotery, Consultant
Ophthalmologist, Southampton General Hospital
10.30 -11.15 COFFEE BREAK IN EXHIBITION HALL
CPD the challenges
Ms Lesley-Ann Baxter, Chair, British and Irish
Orthoptic Society (BIOS)
11.15 – 12.45
OPTIMISING SERVICES FOR PEOPLE WITH
LEARNING DISABILITIES
Workforce planning – challenges for the unit
manager
Ms Rebecca Turner, Clinical Lead for Ophthalmic
Services, Oxford Eye Hospital
Capacity, consent and flexibility – Working with
people with a learning disability
Professor Duncan Mitchel, Professor of Health &
Disability, Manchester Metropolitan University
4.30
Close of Allied Professions Day
Putting it into practice: the challenge of hospital eye
care for people with learning disabilities
Miss Rachel Pilling, Consultant Ophthalmologist,
Stroke and its consequences; lessons for eye care
professionals
Dr Jennifer Stanley, Communications and Awareness
Officer, Stroke Association, Scotland
The Orthoptist’s role in the visual and functional
assessment of children with special educations needs
Ms Annette Dillon, Co-Chair, BIOS Special Education
Needs Special Interest Group
12.45 – 1.30 LUNCH IN EXHIBITION HALL
15
Birmingham 2014
Wednesday 21st May 2014 10.00 – 11.00 Hall 1
IMPROVING QUALITY OF CARE BY REDUCING MEDICAL ERROR:
CREATING A GLOBAL INITIATIVE FOR OPHTHALMOLOGY
Professor Richard Abbott, Thomas W. Boyden Endowed Chair & Health Sciences, Clinical Professor of
Ophthalmology, University of California, USA
Dr Abbott currently is the Thomas W. Boyden Health Sciences Professor of Clinical Ophthalmology at the
University of California San Francisco and Research Associate at the Francis I. Proctor Foundation. He is the
former Co-Director of Corneal and Refractive Surgery and was responsible for establishing the refractive
surgery clinical and research program at UCSF.
After completing his Bachelor of Science degree at Tufts University in Boston, Dr. Abbott earned his medical
degree at the George Washington University School of Medicine in Washington, DC. He performed his
residency at the California Pacific Medical Center in San Francisco and was a Heed and Fight for Sight fellow
at the Bascom Palmer Eye Institute in Miami.
Dr. Abbott has served on the editorial boards of several US ophthalmic journals, as well as currently serving on
the editorial boards of numerous international journals. He lectures and publishes on a variety of topics
focusing primarily on corneal and external diseases of the eye, as well as quality of care, patient safety, clinical
practice guidelines, and medicolegal issues. Dr Abbott currently is the Senior International Advisor for the Asia
Cornea Society Infectious Keratitis Study. He has authored or co-authored 90 publications and 32 book
chapters and has delivered over 700 invited lectures and 27 named lectures. In addition, he served on the
ophthalmic devices advisory panel of the FDA.
Dr. Abbott has received numerous honors, including the U.S. President’s 25 year Volunteer Service Award; the
International Golden Service Award from the Chinese Academy of Ophthalmology; the Jose Rizal Medal for
International Service to the Asia Pacific region from the Asia Pacific Academy of Ophthalmology; the AE
Maumenee Pan American Medal for Distinguished Service to Latin America from the Pan American
Association of Ophthalmology; the Asia Pacific Cornea Foundation Medal from the Asia Pacific Cornea
Society; and the American Academy of Ophthalmology’s Lifetime Achievement Award.
Dr. Abbott is Past President of the American Academy of Ophthalmology (AAO) and the Past President of both
the Pan American Association of Ophthalmology and the Pan American Ophthalmological Foundation. He
currently serves as the Secretary for Global Alliances for the AAO. Dr Abbott is the immediate past Chairman
of the Board of the Ophthalmic Mutual Insurance Company (OMIC) and a former Director of the American
Board of Ophthalmology. He is a past Board Director for the International Council of Ophthalmology and
currently serves as Chairman of the Clinical Practice Guidelines Committee. Dr Abbott is recognized in Who’s
Who in America, Who’s Who in the World, and Best Doctors in America. He has been elected as a member of
both the American Ophthalmological Society and Academia Ophthalmologica Internationalis, an international
body limited to 60 active members committed to global vision research, education, and service. He lives in
Mill Valley, California, with his wife, Cecilia. They have three children and five grandchildren.
Introduction by Mr Nick Astbury, Consultant Ophthalmologist, Norfolk &
Norwich University Hospitals NHS Foundation Trust
16
Birmingham 2014
Wednesday 21st May 2014 4.30 – 5.30 Hall 1
A TALE OF TWO MEMBRANES DURING THE LASER REVOLUTION:
BOWMAN'S AND BRUCH'S
Professor John Marshall, Professor of Ophthalmology, Institute of Ophthalmology, London
Professor John Marshall is the Frost Professor of Ophthalmology at the Institute of Ophthalmology in
association with Moorfields Eye Hospital, University College London and the theme leader for new devices
and new technologies NIHR. He is Emeritus Professor of Ophthalmology at Kings College London, Honorary
Distinguished Professor University of Cardiff, Honorary Professor the City University and Honorary Professor
Glasgow Caledonian University.
His research over the past forty years has ranged over a number of ocular problems but has concentrated on
the inter-relationships between light and ageing and the environmental mechanisms underlying age-related,
diabetic and inherited retinal disease. He has also contributed to the development of lasers for use in
ophthalmic diagnosis and surgery. He invented and patented the revolutionary Excimer laser for the correction
of refractive disorders with in excess of 35 million procedures now having been undertaken worldwide. He
also created the world’s first Diode laser for treating eye problems of diabetes, glaucoma and ageing.
He has delivered 48 named lectures and received 36 honours and awards including the Nettleship Medal of
the Ophthalmological Society of the United Kingdom, the Mackenzie Medal, the Raynor Medal, the Ridley
Medal, the Ashton Medal, the Ida Mann Medal, the Lord Crook Gold Medal of the Worshipful Company of
Spectacle Makers, the Doyne Medal of the Oxford Congress, the Barraquer Medal of the International Society
of Cataract and Refractive Surgery, the Kelman Innovator Award of the American Society for Refractive and
Cataract surgery, and the Lim Medal of the Singapore National Eye Centre. He has been visiting professor at
numerous universities on every continent. In 2012 he received the Junius-Kuhnt award and Medal for his
work on AMD and has been designated the Bowman Lecturer for the Royal College of Ophthalmologists in
2014.
He is a Fellow of the Royal College of Pathologists, a Fellow of the Association for Research in Vision and
Ophthalmology and has been elected a Fellow of the Academy of Medical Sciences and a Fellow of the
Institute of Biology. He is also an Honorary Fellow of the Royal College of Ophthalmologists, an Honorary
Fellow of The College of Optometrists, a Fellow and past Director of the Laser Institute of America, a Fellow of
the Royal Society of Arts and an Honorary Fellow of Cardiff University. He has a Senior Achievement Award
of the American Academy of Ophthalmology and the Euretina Award of the European Society of Retinal
Surgeons. In 2009 he was honoured with a Lifetime Achievement Award by the International Society of
Cataract and Refractive Surgery and the American Academy of Ophthalmologists. He is also a Fellow of
several national ophthalmological societies, as well as being elected to the European Academy of
Ophthalmology. Between 2011-2012 he was the Master of the Worshipful Company of Spectacle Makers. This
year he was awarded the MBE in the 2013 New Year Honours List for services to Ophthalmology and an
honorary Doctor of Science degree from Glasgow Caledonian University.
Introduction by Professor Alan Bird, Professor of Medical Ophthalmology, Moorfields Eye Hospital, London
17
Birmingham 2014
PROGRAMME - Thursday 22nd May 2014
Free welcome coffee, tea and pastries will be served
outside session halls for all delegates attending
breakfast sessions
8.00 – 8.10
Introduction to Private Practice and General
Principles
Hospital
8.00 – 9.00
HALL 10
SIMULATED OCULAR SURGERY
Mr John Ferris, Consultant Ophthalmologist,
Cheltenham General Hospital
8.10 – 8.15
Questions
8.00 – 8.05
Introduction
8.15 – 8.25
How was it for me?
Mr Martin Watson, Consultant Ophthalmologist,
8.05 – 8.20
Cataract Surgery
8.25 – 8.30
Questions
8.30 – 8.40
Partnership working – How we did it
Mr John Lipton, Consultant Ophthalmologist, Royal
Oldham Hospital, Manchester
8.20 – 8.30
Glaucoma Surgery
Professor Andrew McNaught, Consultant
Ophthalmologist, Cheltenham General Hospital
8.40 - 8.45
Questions
8.30 – 8.40
VR Surgery
Mr Richard Haynes, Consultant Ophthalmologist,
8.45 – 8.55
Maximising your potential
Mr Paul Ursell, Consultant Ophthalmologist, Sutton
Hospital, Surrey
8.40 – 8.50
Strabismus Surgery
8.55 – 9.00
Questions
8.50 – 9.00
Questions
8.00 – 9.00
HALL 11
OPHTHALMOLOGY OUT TO TENDER: SECURING
BETTER VALUE FOR PATIENTS - OR SELLING THE
FAMILY SILVER?
Mr Richard Smith, Consultant Ophthalmologist,
Buckinghamshire Healthcare NHS Trust
8.00 – 9.00
HALL 1
GRAND ROUNDS: MEDICAL RETINA
Mr James Talks, Consultant Ophthalmologist,
Newcastle upon Tyne NHS Trust
8.00 – 8.05
Introduction
Mr Richard Smith, Consultant Ophthalmologist,
A series of interesting cases that proved a diagnostic
challenge or cases of more common conditions,
where additional imaging helped improve the
management, will be presented.
8.05 – 8.20
Commissioners Perspective
Ms Alison Wakeford, Lead for Strategy, Planning and
Service Redesign, Central and Southern
Commissioning Support Unit
Speakers:
Dr Will Innes, Consultant Medical Ophthalmologist,
Mrs Vina Manjunath, Consultant Ophthalmologist,
Ms Priyanka Sharma, Medical Retina Fellow,
8.20 – 8.35
Public Health Perspective
Mr Jonathan Howell, Consultant in Public Health,
Specialised Commissioning (West Midlands), NHS
England
8.35 – 8.45
Lay Perspective
Mrs Wendy Pepper & Mr Rodger Pepper, Macular
Society
8.00 – 9.00
HALL 5
HOW TO RUN A PRIVATE PRACTICE
Hospital
8.45 – 9.00
Questions and Discussion
18
Birmingham 2014
8.00 – 9.00
HALL 7
NIHR CRN, OPHTHALMOLOGY SPECIALITY:
FOCUS ON WORKING WITH INDUSTRY
Mr Faruque Ghanchi, Industry Studies Lead,
Ophthalmology Speciality Group
9.55 – 10.15
Treatment clinics for diabetic retinopathy: What is
required to meet demand?
Mr Peter Scanlon, Consultant Ophthalmologist,
8.00 – 8.05
Welcome
Mr Faruque Ghanchi, Industry Studies Lead,
10.15 – 10.30
Establishing and running a comprehensive glaucoma
service
Mr Anthony King, Consultant Ophthalmologist,
University Hospital Nottingham
8.05 – 8.15
Ophthalmology Speciality Group – Supporting the
delivery of eye & vision research
Professor Usha Chakravarthy, Chair of
10.15 – 10.30
Solutions to meeting the demand in a glaucoma
clinic
Mr Ian Cunliffe, Consultant Ophthalmologist,
Birmingham Heartlands Hospital
8.15 – 8.25
Clinical Research Network: Focus on working with
industry
Ms Jayne Shippin, Industry Operations Manager,
CCRN
9.00 – 10.45
HALL 5
ENDOPHTHALMITIS – PREVENTION &
MANAGEMENT
8.25 – 8.35
Delivering on the ground: The Researcher’s view
9.00 – 9.05
Introduction
Stoke Mandeville, Aylesbury
8.35 – 8.45
Experience of working with the Network – an
Industry view
Mr James Warburton, Novartis Pharmaceuticals
& Ms Helen Townsend, Novartis Pharmaceuticals
9.05 – 9.30
Epidemiology and Clusters
Mr John Sparrow, Consultant Ophthalmologist, Bristol
Eye Hospital
8.45 – 9.00
Open discussion
Ms Sarah Cooper, Speciality Groups Operations
Manager CCRN
9.30 – 9.55
The Perfect Prevention
Mr Alex Foss, Consultant Ophthalmologist, University
Hospital Nottingham
9.55 – 10.20
The Ideal Treatment
Mr Bill Aylward, Consultant Ophthalmologist,
9.00 – 10.45
HALL 11
CHALLENGES OF MANAGING CHRONIC DISEASES
OF THE EYE
Mr Declan Flanagan, Medical Director, Moorfields
Eye Hospital, London
10.20 – 10.45
Questions
9.00 – 9.05
Introduction
9.00 – 10.45
HALL 1
UPDATE ON RETINAL VASCULAR DISEASE
Miss Sobha Sivaprasad, Consultant Ophthalmologist,
Moorfields Hospital and King’s College London
9.05 – 9.20
Ophthalmic epidemiology – The scale of the problem
Miss Parul Desai, Consultant Ophthalmologist,
This session will focus on the diagnostic and
management dilemma of challenging retinal vascular
diseases in the current era of new diagnostic
modalities and therapeutic options.
9.20 – 9.45
The role of the nurse practitioners in delivering
intravitreal Therapy
Mr Peter Simcock, Consultant Ophthalmologist, Royal
Devon and Exeter Hospital
The session will be a panel discussion of cases by 4
panellists:
Mr Philip Hykin, Consultant Ophthalmologist,
9.45 – 9.55
Mobile glaucoma clinics
Mr Peter Simcock, Consultant Ophthalmologist, Royal
Devon and Exeter Hospital
19
Birmingham 2014
9.35 – 10.05
GDx Scanning Laser Polarimetry: Glaucoma
diagnosis and monitoring
Moorfields Hospital and King’s College London
Professor Yit Yang, Consultant Ophthalmologist,
Wolverhampton & Midland Counties Eye Infirmary
10.05 – 10.35
OCT of the Optic Disc and Nerve Fibre Layer:
Glaucoma diagnosis and monitoring
Mr Nick Strouthidis, Consultant Ophthalmologist,
9.00 – 10.45
HALL 7
PAEDIATRIC CATARACT
Professor Chris Lloyd, Consultant Paediatric
10.35 – 10.45
Questions and Answers
9.00 – 9.10
Introduction
Professor Chris Lloyd, Consultant Paediatric
9.00 – 12.00
HALL 9
TRAINING THE TRAINERS – SUPERVISION OF
TRAINING IN PRACTICE
Miss Melanie Corbett, Chair of RCOphth Training the
Trainers Sub-Committee, Chair of RCOphth College
Tutors Sub-Committee
9.10 – 9.40
Modern genomics in paediatric cataract – new
diagnostic protocols
Professor Graeme Black, Consultant Clinical
Geneticist, St Mary’s Hospital, Manchester
Pre-registered delegates only. Registration for this
session closed on 2nd May 2014
9.40 – 10.10
Secondary IOLs in the management of paediatric
aphakia
Professor Jan Tjeerd Dr Faber, Consultant Paediatric
Ophthalmologist, The Rotterdam Eye Hospital,
University of Rotterdam, The Netherlands
RCOphth Training the Trainers Faculty:
Miss Rajni Jain
Miss Sarah Maling
Mr Mike Nelson
Miss Fiona Spencer
Mr Geoffrey Woodruff
10.10 – 10.45
Surgical Videos – “ Challenging cases, tips and
tricks”
Miss Jane Ashworth, Consultant Paediatric
& Mr Manoj Parulekar, Consultant Paediatric
Ophthalmologist, Birmingham Children’s Hospital
& Professor Chris Lloyd, Consultant Paediatric
This course will help Clinical and Educational
Supervisors develop skills to make their conversations
with trainees more valuable for learning. It will cover
many aspects of the GMC standards required for the
appraisal of trainers.
10.45 – 11.30 COFFEE & POSTERS: Meet the Authors
9.00 – 10.45 HALL 6
£ DISC AND RETINAL IMAGING IN GLAUCOMA
DIAGNOSIS AND MONITORING COURSE PART I
& Professor Stephen Vernon, Consultant
Ophthalmologist, University Hospital Nottingham
11.30 – 12.00
HALL 1
THE GREAT DEBATE
Mr Bill Aylward, Consultant Ophthalmologist,
FOR
Mr Brian Little, Consultant Ophthalmologist,
“Modern Cataract Surgery has become Unnecessarily
Sophisticated”
9.00 – 9.05
Introduction to retinal and optic nerve imaging
AGAINST
9.05 – 9.35
HRT Scanning: Glaucoma diagnosis and monitoring
Professor Stephen Vernon, Consultant
20
Birmingham 2014
12.00 – 1.00 HALL 1
THE OPTIC UK LECTURE 2014
Baltimore, USA
3.15 – 3.35
The First Half
3.35 – 3.55
The Second Half
Mr Richard Packard, Consultant Ophthalmologist,
Kind Edward VII Hospital, Windsor
Professor Neil Miller will deliver this year’s Optic UK
Lecture. Please see page 23 for further information.
3.55 – 4.00
Conclusions
2.00 – 2.15 HALL 1
AWARDS CEREMONY
Chaired by Professor Harminder Dua, President, The
Royal College of Ophthalmologists
2.15 – 4.00
HALL 7
INHERITED RETINA DISEASE
Professor Andrew Lotery, Consultant Ophthalmologist,
Southampton Eye Unit
& Professor Andrew Webster, Professor of
Ophthalmology, University College London
2.15 – 4.00
HALL 11
INFECTIOUS DISEASE OF POSTERIOR SEGMENT
Professor Sue Lightman, Consultant Ophthalmologist,
2.15 – 2.40
The Utility of iPSC technology in inherited retinal
disease
Professor Budd Tucker, Assistant Professor,
Ophthalmology and Visual Science, University of
Iowa, USA
Overview of the changing face of infectious disease
in the UK
Professor William Lynn, Professor of Medicine,
University of Buckingham
Tuberculosis today and in the eye
Professor Sue Lightman, Consultant Ophthalmologist,
2.40 – 3.05
Insights into the causes of age-related macular
degeneration
Professor Andrew Lotery, Consultant Ophthalmologist,
Southampton Eye Unit
What’s new with toxoplasmosis that we need to
know?
Professor Marc de Smet, Professor of Ophthalmology,
Clinique de Monthcoisi, Lausanne, Switzerland
3.05 – 3.30
Syndromic retinal disease
Dr Eva Lenassi, Consultant Ophthalmologist,
University Medical Centre, Ljubljana, Slovenia
Syphilis today and the eye
Miss Sarah-Lucie Watson, Consultant
Ophthalmologist, Royal Berkshire Hospital, Reading
3.30 – 3.55
Update on diagnostic testing in the clinic
Professor Andrew Webster, Professor of
Ophthalmology, University College London
2.15 – 4.00
HALL 5
HOW TO AVOID COMPLICATIONS IN CATARACT
SURGERY
Mr Brian Little, Consultant Ophthalmologist,
Moorfield Eye Hospital, London
2.15 – 4.00
HALL 1
GRAND ROUNDS: NEURO-OPHTHALMOLOGY
& Dr Gordon Plant, Consultant Neurologist, St
Thomas’ Hospital, London
2.15 – 2.35
Use Your Head
Mr Paul Sullivan, Consultant Ophthalmologist,
This is an interactive session of case presentations
and discussion with the faculty:
2.35 – 2.55
Pick the Winners
Mr Paul Ursell, Consultant Ophthalmologist, Sutton
Hospital
Miss Margaret Dayan, Consultant Ophthalmologist,
Royal Victoria Infirmary
Dr Stephen Madill, Consultant Ophthalmologist,
Princess Alexandra Eye Pavilion
Miss Brinda Muthusamy, Consultant Paediatric
Neuro-Ophthalmologist, Bristol Eye Hospital
Dr Ghislaine Traber-Hoffman, Neuro-Ophthalmology
Fellow, Moorfields Eye Hospital, London
Dr Sui Wong, Consultant Neurologist, Moorfields Eye
Hospital, London
2.55 – 3.15
Hit the Target
Mr Milind Pande, Director & Consultant
Ophthalmologist, Vision Surgery & Research Centre,
Hull
21
Birmingham 2014
2.15 – 4.00 HALL 6
£ DISC AND RETINAL IMAGING IN GLAUCOMA
DIAGNOSIS AND MONITORING COURSE PART II
By the end of the symposium the delegates should
not only have increased their knowledge in the
interpretation of the results obtained with the
presented imaging techniques but also have had the
opportunity to improve their scanning skills.
Additionally the symposium will provide guidance on
which devices to use and when, when to repeat
imaging, and how to organise one’s glaucoma
imaging service which may involve nonophthalmologist personnel.
PART TWO – CASE DISCUSSIONS &
DEMONSTRATIONS
4.00
CONGRESS CLOSE
A series of educational cases involving glaucoma
suspects and cases will be worked through in an
interactive manner led by the chairmen with input
from the session presenters. There will be the
opportunity during the day to get hands on
experience with some of the imaging modalities.
GP DAY - Thursday 22nd May 2014
9.15 - 4.00
HALL 10
GP DAY
Ms Seema Verma, The Royal College of
Ophthalmologists
& Dr David Rapley, The Royal College of General
Practitioners
11.55 – 12.20
Diabetes and the eye
9.15 – 9.20
Welcome and Introduction
12.20 – 12.45
Age related macular degeneration when to refer?
Newcastle Eye Centre
9.20 – 9.45
Examination of the eye in General Practice: key
points
Gloucester Royal Infirmary
12.45 – 1.45 Lunch in Exhibition Hall
1.45 – 2.10
Common eye lid problems
Mr Richard Harrad, Consultant Ophthalmologist,
9.45 – 10.10
The acute red eye
Ms Seema Verma, Consultant Ophthalmologist,
Moorfields Eye Hospital London
2.10 – 2.55
COMMISSIONING IN OPHTHALMOLOGY
10.10 – 10.35
Common eye problems in children
The Ophthalmologist’s Perspective
Mr Richard Smith, Consultant Ophthalmologist, Stoke
Mandeville Hospital, Aylesbury
10.35 – 11.00
The tear film: How to manage dry eyes and watery
eyes
Mr Geoff Rose, Consultant Ophthalmologist,
The GP’s Perspective
Dr Waqaar Shah, The Royal College of General
Practitioners
2.55 – 4.00
Case discussion and question & answer session
11.00 – 11.30 Coffee break in Exhibition Hall
11.30 – 11.55
Acute visual loss
Miss Susan Mollan, Consultant Ophthalmologist,
22
Birmingham 2014
OPTIC UK LECTURE 2013
Thursday 22nd May 2014 12.00 – 1.00 Hall 1
CURRENT CONCEPTS IN THE DIAGNOSIS, PATHOGENESIS AND MANAGEMENT OF
NONARTERITIC ANTERIOR ISCHAEMIC OPTIC NEUROPATHY
Professor Neil Miller, Professor of Neuro-ophthalmology, The Wilmer Eye Institute,
The John Hopkins School of Medicine, Baltimore, USA
Dr. Neil Miller attended Harvard University, where he majored in biochemistry, graduating Magna cum Laude in
1967. He then matriculated to Johns Hopkins Medical School. After finishing medical school at in 1971, he took an
internship in medicine at Johns Hopkins, followed by an ophthalmology residency at the Wilmer Eye Institute and a
fellowship in neuro-ophthalmology at the University of California, San Francisco, with Dr. William F. Hoyt.
Dr. Miller joined the staff of the Wilmer Eye Institute of the Johns Hopkins Hospital in 1975 and has been a faculty
member at Johns Hopkins since then. He is currently Professor of Ophthalmology, Neurology, and Neurosurgery at
the Johns Hopkins Medical Institutions, and also the Frank B. Walsh Professor of Neuro-Ophthalmology and head of
the Neuro-Ophthalmology and Orbital Units of the Wilmer Institute. Other departmental duties include Chair of the
Wilmer Resident Selection. He is also Chair of the Associate Professor Reappointment Review Committee for the
Johns Hopkins Medical Institutions. Dr. Miller was president of the North American Neuro-Ophthalmology Society
from 2000 to 2002 and Chairman of the Executive Board from 2002 to 2004. He has been past president of the
International Neuro-Ophthalmology Society on three occasions: in 1982, 1992, and 2008. He is also an emeritus
member of the International Orbital Society. In 2009, he was given a lifetime achievement award by the American
Academy of Ophthalmology (AAO).
Dr. Miller is a member of the editorial boards of the Journal of Neuro-Ophthalmology and Neuro-Ophthalmology. He
has served as a reviewer for numerous journals, including the American Journal of Ophthalmology, Archives of
Ophthalmology, British Journal of Ophthalmology, Lancet, Neurology, JAMA, Journal of Neurosurgery, and the New
England Journal of Medicine. He has authored or co-authored over 470 articles, 89 chapters, and 11 books, one of
which was the 4th edition of Walsh and Hoyt's Clinical Neuro-Ophthalmology. With Dr. Nancy Newman of Emory
University, he edited the 5th edition of this textbook, and the two of them also wrote an abbreviated version of the
textbook—Walsh and Hoyt’s Clinical Neuro-Ophthalmology: The Essentials”—for medical students and residents. The
6th edition of the full textbook, again edited by Drs. Miller and Newman with the assistance of two of their colleagues,
Valérie Biousse at Emory University and John Kerrison formerly at Wilmer, was published in December, 2004, and the
second edition of “The Essentials” was published in 2008. A third edition of “The Essentials,” to be written with two of
his colleagues at Wilmer, Prem Subramanian and Vivek Patel, is scheduled to be published in 2014. Dr. Miller also has
co-authored with Michael Burdon of the UK and Anthony Payne in Australia “The Neuro-Ophthalmology Survival
Guide” published in 2007 and designed for medical students, residents, and general ophthalmologists.
Dr. Miller has spoken at numerous meetings around the world and has given 51 named lectures throughout the
world, including the Jackson Memorial Lecture at the 2001 meeting of the American Academy of Ophthalmology,
the Hoyt lecture at the 2005 meeting of the AAO, the Doyne Lecture at the Oxford Congress in the UK in 2006, the
Francis Heed Adler lecture at the University of Pennsylvania in 2009, the Plenary Lecture at the 25th Anniversary
Meeting of the Singapore National Eye Centre in 2011, the F. Bruce Fralick Lecture at the University of Michigan in
2012, and the Morris B. Bender, MD Lecture at Mt Sinai Medical Center in 2013. Many of Dr. Miller’s previous
Fellows and residents hold faculty positions at major institutions throughout the United States and around the world.
Introduction by Mr Mike Burdon, Consultant Ophthalmologist, University Hospitals Birmingham
23
Birmingham 2014
POSTERS: Rapid Fire
All posters will be displayed from 10.00 a.m. on Tuesday 20th May to Thursday 22nd May at 2.00 p.m.
RAPID FIRE
10. Evaluating the Use of Intravitreal Aflibercept in
Patients with Choroidal Neovascularisation
Secondary to Pathological Myopia (mCNV): The
MYRROR Study
Francesco Bandello
1. SOE PRIZE WINNER 2014
Intravitreal Aflibercept for Diabetic Macular Edema:
1 – Year Findings from the VIVID-DME and VISTADME Trials
Edoardo Midena
2. Ranibizumab treatment of diabetic macular
oedema with bimonthly monitoring after a phase of
initial treatment: 18-month outcomes of the Phase
IIIb multicentre RELIGHT study
Ian Pearce
Mulitcenter study
11. Is socioeconomic deprivation independently
associated with increased prevalence of diabetic
retinopathy?
Liying Low, Simon Ogston, Peter Wilson, Alex Yeong,
Ritchie McAlpine, Una O’Colmain, Carrie MacEwen
3. Translational bypass therapy using ataluren to
treat nonsense-mediated choroideremia
Mariya Moosajee, Dhani Tracey-White, Clare Futter,
Tony Moore, Andrew Webster, Miguel Seabra
12. Swept-Source Optical Coherence Tomography
Assessment of Choroidal Thickness in Different
Macular Disorders
Salvador Pastor-Idoate, Maria Gil-Martinez, Stephen
Charles, Susmito Biswas, David Henson, David B
McLeod, Paulo Stanga
MREH/NIHR. Wellcome Trust CRF
4. Metabolomic Analysis of Serum in Graves’
Disease and Thyroid-Associated Ophthalmopathy: A
Diagnostic Tool?
Matthew R Edmunds, Kristien Boelaert, Jayne A
Franklyn, S John Curnow, Omar M Durrani, Stephen
P Young
University of Birmingham
13. Visual Impairment and health inequalities:
findings from UK Biobank (UKBB)
Phillippa Cumberland, Paul Foster, Peng Tee Khaw,
Christopher Hammond, Pirro Hysi, Yanchun Bao,
Jugnoo Rahi
5. The effects of anti-VEGFS on human tenon’s
fibroblast growth in vitro
Nurul Nabila Baharudin, Siti Munirah Mohd Noh, Siti
Hamimah Sheikh Abdul Kader, Zakaria Bannur,
Jonathan Crowston, Sushil Kumar Vasudevan
IMMB, UITM
14. A British Ophthalmic Surveillance Unit (BOSU)
study of severe adverse events associated with local
anaesthesia (LA) in cataract surgery
6. A case for re-defining the intraocular pressure
referral threshold: Findings from the UK Biobank
Michelle Chan, Carlota Grossi Sampedro, Stephen
Vernon, James Morgan, Praveen Patel, Peng Khaw,
Paul Foster
15. Cochrane review of 5-fluorouracil in
trabeculectomy: too long overlooked?
16. The impact of congenital profound or severe
visual impairment (VI) on behaviour development
and difficulties in the early years
Michelle O’Reilly, Elena Sakkalou, Hanna Sakki,
Michelle de Haan, Alison Salt, Naomi Dale
7. Can we replace Temporal Artery Biopsy (TAB)
with Cranial Duplex Ultrasound (CDUS) in the
diagnosis or Giant Cell Arteritis (GCA)?
Adam Croft, Nicola Thompson, Martin Duddy, Fazal
Khattak, Susan Mollan, Paresh Jobanputra
17. Redefining wolfram syndrome in the molecular
era
Patrick Yu-Wai-Man, Grant Guthrie, Kamil S Sitarz,
Angela Pyle, Rita Horvath, Philip G Griffiths, Patrick
F Chinnery
8. OCT Findings in Children with Bardet Biedl
Syndrome
Peter Good, John Ainsworth, Marie Tsaloumas,
Alaistair Denniston, Denise Williams
Birmingham Childrens Hospital
18. Glaucoma prescribing trends in England 2000 –
2012
9. Analysis of the Hedgehog signalling pathway in
periocular morphoeic basal cell carcinoma.
John Bladen, Caroline Thaung, Michele Beaconsfield,
Michael Philpott
Centre for Cutaneous Research, Barts and The
London
19. Corneal Calcification and phosphate buffers –
Do you need to prescribe phosphate free?
Magdalena Popiela, Nicholas Hawksworth
Singleton Hospital
24
Birmingham 2014
POSTERS: Audit & Clinical Governance
AUDIT & CLINICAL GOVERNANCE
20. One year experience with ‘Nurse Injectors’ in a
busy Macular service
Deepali Varma, K Stoddart
Sunderland Eye Infirmary
Sivaprasad
31. Predictors of Failure of Primary Surgery for
Congential Nasolacrimal Duct Obstruction
Mahmoud Nassar, Gordon Lau, Ayad Shafiq, Michael
Clarke
Newcastle Eye Centre, Royal Victoria Eye Infirmary,
Newcastle
21. Engaging children in feedback: Use of an
animated toolkit for recording feedback of patient
experiences from children and young people in
ophthalmology services
Robbie Walker, Yvette Annan, Mally Scrutton, Tim
Withers, Jo Hancox
Moorfields Eye Hospital
32. Substainability in ophthalmic practice: are we
hitting the triple bottom line?
J Somner, N Stone, Z Sipkova, A Koukoulli, G
Lascaratos, G Jóhannesson, A Das, O Bowes, H
Jewsbury, RL Perrott-Reynolds, DS Morris, R Bourne,
A Cassels-Brown, V Cross
Vision and Eye Research Unit, Anglia Ruskin
Univeristy
22. Use of lumbar punctures in the investigation of
ocular syphillis
Ian Reekie, Yavische Reddy
Univeristy of Kwazulu Natal
23. Safety in nurse-led corneal collagen crosslinking
Melanie Mason, Dan Gore, Bruce Allan
33. The carriage of steroid treatment card for
uveitic patients
Simerdip Kaur, Moloy Dey, Adam Mapani, Francis
Chiu, Narciss Okhravi
24. WOScOTT, The West of Scotland Optometrist
Teach And Treat Clinic: Shaping the future of
Community Ophthalmology in Scotland
Kaleena Michael, Maria Elena Gregory, Manish
Gupta, Janet Pooley, Donald Cameron
NHS Greater Glasgow and Clyde
34. Stream-lining a busy macular service: Reducing
the burden of ‘inactive’ wet age-related macular
degeneration patients.
Bushra Mushtaq, Abhijit Mohite, Huzaifa MAlick
Sandwell General Hospital, Birmingham
25. Acute infective conjunctivitis – to swab or not
to swab?
Siegfried Wagner, Ian C Bowler, Stella J Hornby
Oxford University Hospitals NHS Trust
35. Is there correlation between pain during
intravitreal injection and the site of injection?
Jan Sniatecki, Mohan Varikkara, Zachariah Koshy
University Hospital Ayr, NHS Ayrshire and Arran
26. Demographics, referral patterns and
management of patients accessing the Welsh Eye
Care Service
Colm McAlinden, Helen Corson, Peter Garwood
Public Health Wales
36. Efficacy of an educational intervention to
improve adherence to NICE recommended follow up
intervals for Glaucoma
Michael James Gilhooley, R Karun, R Vemala, P
Abeysiri
Queen’s Hospital, Romford
27. Initial experience with barely visable and
sunthreshold yellow wavelength Pascal® laser with
and without Endpoint Management® in diabetic
patients
Maria Gil-Martinez, Salvador Pastor-Idoate, Yvonne
D’souza, Sajjad Mahmood, Stephen Charles, David
Henson, Paulo Stanga
MREH, NIHR/Wellcome Trust CRF
37. 5 year audit of endophthalmitis following
intravitreal injections within antibiotic prophylaxis.
Roopa Vemala, Alastair Porteuos, Judith Field, Niaz
Islam
Queen’s Hospital Romford
38. Situational Analysis of Quality Improvement
Processes in Cataract Surgery in Madagascar
Rini Vyas, Hery Andriamanjato, Lea Raobela, Alice
Harisoa, Johnathan Buchan, Andrew Cassels-Brown
Leeds Teaching Hospital Trust
28. Natural history of patients receiving Lucentis
for WET AMD: A 3-year prospective study
Ruth Peiwan Chen, Pankaj Puri
Royal Derby Hospital, Derby
29. The Impact of Rationing Cataract Surgery in
Gloucestershire
Miranda Buckle, Robert Johnston, Nicholas Price,
John Ferris, John Sparrow, Graham Mennie
Gloucestershire Hospitals NHS Foundation Trust
39. Ozurdex Outcomes in Retinal Vein Occlusion
with Macular Oedema
Valerie Juniat, Eleni Tsolakou, Nishal Patel
Kent and Canterbury Hospital
40. Implications of multiple intravitreal injections
for subsequent cataract surgery
Jack Gromley, Mark Costen
Hull & East Yorkshire Eye Hospital
30. Initial experience of neovascular AMD
unresponsive to ranibizumab treated with aflibercept
Noa Fernandez Ledo, George Kiousis, Raeba
Mathew, Helena Vrizidou, Sheena Koshy, Sobha
25
2014 Final Programme p1-37.qxd:2012 FP&A post RG 2 #C6694E.qxd
20/6/14
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Birmingham 2014
POSTERS: Audit & Clinical Governance
AUDIT & CLINICAL GOVERNANCE
41. Cardiopulmonary resuscitation and the standalone ophthalmic unit.
Priscilla Mathewson, Samer El-Sherbiny
Birmingham Midland Eye Centre
53. Proliferative diabetic retinopathy referrals from
Diabtic Retinopathy Screening Service Wales
(DRSSW): Role of fast track referral system
Shantanu Gudsoorkar, Phillipa Knowles, Sarah Hale
University of Wales, Cardiff
42. Missed pathology or disease progression?
Follow up of patients with acute ‘flashes and/or
floaters’
Shreya Haldar, Melanie Chak
Royal Berkshire Hospital
54. Visual Impairment in acute medical admissions:
streamlining ophthalmic referral
Frederick R Burgess, Elizabeth D Hawkes, Owen D
Ingram, James E Neffendorf
Royal Bolton Hospital
43. Distorted Pathways: Trials and tribulations in
Delivering Lucentis Service in Diabetic Macula
Oedema (DMO) in a Large Foundation Trust
Aaron Thye Wang Ng, Khazina Waraich, Jiang Li,
Rangarajan Prabhu, David Kinshuck, Ramesh Sivaraj
Heart of England NHS Foundation Trust
55. Are we meeting the British Rheumatology
Society (BRS) Guidelines for Temporal Artery Biopsy?
Sophie Hickling, Susan Mollan
56. Our 10 years’ experience in treating periocular
spasm with botulinum toxin
Aneesa Rahim, Jessica Montford, Joyce Burns,
Raghavan Sampath
Leicester Royal Infirmary
44. Unilateral vs Immediate Sequential Bilateral
Cataract Surgery. A Comparison of Inpatient Fall Rates
Alasdair Kennedy, Tom Pampiglione, Pankaj Puri,
Adil Jaulim
Derby Royal Hospital
57. The provision of an objective visual acuity by
General Practitioners during eye casualty referrals:
why is it lacking and how do we improve it?
Osama Giasin, Elizabeth Goodchild, Ruth Jones,
Eulee Seow, Damien Chia Ming Yeo
Royal Glamorgan Hospital
45. Refractive outcomes of cataract extraction in
patients having undergone previous refractive
surgery: Which formula is best?
Chris Matthews, Alan Connor
James Cook University Hospital
46. Adherence to angle closure guidelines.
Yun Wong, Scott Fraser
58. Time from cataract surgery to Nd:YAG
capsulotomy at University Hospitals Birmingham
(UHB) NHS Foundation Trust
Hannah Shereef, Haider Ibrahim, Mike Burdon
University Hospitals Birmingham NHS Foundation
Trust
47. Early experiences with dexamethasone
intravitreal implant ( Ozurdex) for retinal vein
occlusion: an audit and service evaluation
Weijen Tan, Kerolos Bassilious, Dharmalingam
Kumudhan, Winfried Amoaku
Queen’s Medical Centre, Nottingham
59. Health Informatics in Ophthalmology – The
Past, Present and Future
Abison Logeswaran, Thuwaraga Logeswaran, Yu Jeat
Chong, Yogesan Kanagasingam
Imperial and City University
48. One Stop Temporal Artery Biopsy Service
Karim El-Assal, Sachin Salvi, Judith West, Jennifer
Tan, Irene Pepper, Zanna Currie
Sheffield Teaching Hospital
60. Review of Glaucoma Domiciliary Service at
Devon.
Usama Faridi, Naeem Gurmani, Jim Faverty, Michael
Smith, Daniel Byles
Royal Devon and Exeter Hospital
49. An audit to evaluate the efficacy of Selective
Laser Trabeculoplasty (SLT) as adjunctive therapy for
Primary Open-Angle Glaucoma patients at a district
general hospital.
Rahul Dwivedi, Janine Brazier, Jose Gonzalez-Martin
Southport & Ormskirk Hospital NHS Trust
61. Public knowledge of common eye disease
Priyanka Mandal, Anuj Vakharia, Oluwatoyin Oyede,
Philip I Murray
Birmingham and Midland Eye Centre
50. Audit of Eye Casualty neuro-ophthalmology
referral system at Bristol Eye Hospital
Martin Bennett,
62. Appropriateness of referrals into an optometrist
led rapid access wet age related macular
degeneration clinic.
Deborah Bott, Narendra Dhingra
Mid Yorkshire NHS Trust
51. Can general A&E doctors manage common eye
emergencies?
Michael Benjamin, Oluwatoyin Oyede, Philip I
Murray
52. Validity of listing for cataract surgery by
hospital-based optometrists.
Pallavi Tyagi, Simon Hewick
Raigmore Hospital, Inverness.
63. An evaluation of the usage of Medisoft
Electronic Patient Record system in Birmingham and
Midland Eye Centre
Lauren Atkins, Sarah Burgin, George Moussa
Birmingham and Midland Eye Centre, City Hospital
26
POSTERS:
Birmingham 2014
Cataract & Refractive Surgery / Cornea & External Eye Disease
CATARACT & REFRACTIVE SURGERY
CORNEA & EXTERNAL EYE DISEASE
64. The Development of a Virtual Reality Training
Programme for Ophthalmology: Repeatability and
Reproducibility
Korina Theodoraki, George M Saleh, Stewart Gillan,
Paul Sullivan, Fiona O’Sullivan, Bardul Hussain
75. Systemic immunosuppression in patients with
refractive chronic allergic eye diseases
Muhammad Ahad, Kieren Darcy, Phillip Jaycock,
Stuart Cook, Derek Tole
76. Acanthamoeba Keratitis: Experience at Bristol
Eye Hospital 2003-2012
Haned Jasim, Derek Tole, Stuart Cook
65. Patient Reported Outcome Measuring Tools in
Cataract Surgery – Clinical Comparison in a Teriary
Hospital
Simon Fung, Peter Holm, Melanie Hingorani, Joanne
Hancox
77. Hypertonic Ointment vs lubricants and bandage
contact lenses for recurrent corneal erosion
syndrome (RCES)
Sally Blackmore-Wright, Radwan Al Mousa
University Hospital Coventry and Warwickshire
66. Experience with Femtosecond Laser Cataract
Surgery: A prospective review
Edward Ridyard, Ritesh Gupta, Raymond Stein
Bochner Eye Institute, Toronto
78. Day-before vs same-day Eye Bank provided
precut tissue for DSAEK. A prospective single blinded
randomised study of outcomes in a UK tertiary
referral centre
Evripidis Sykakis, Panagiotis Georgoudis, Fook Chang
Lam, Saj Khan, Samer Hamadam Damien Lake
Corneoplastic Unit and Eye Bank, Queen Victoria
Hospital
67. Effect of Speed of Intravitreal Antibiotic
Administration on the Outcome of Post-operative
Endophthalmitis
Anna Gao, Anjali Gupta, Salman Mirza
68. Is second-eye cataract surgery in the NHS cost
effective? Systematic reviews and economic
evaluation
Geoff Frampton, Petra Harris, Keith Cooper, Andrew
Lotery, Jonathan Shepherd
Southampton Health Technology Assessments Centre
(SHTAC)
79. Corneal collagen cross-linking (C3R) with a
mechanical disruption of epithelium technique for
paediatric keratoconus
Fook Chang Lam, Nashila Hirji, Robert Petrarca,
Panagiotis Georgoudis, Damien Lake, Samer Hamada
Queen Victoria Hospital
69. Artificial Iris Implants for Aniridia: Does Near
Infra-Red Light Transmission Risk Retinal Phototoxicity?
Imran Yusuf, Tim H M Fung, Stuart N Peirson, C K
Patel
Nuffield Laboratory of Ophthalmology, Oxford
Univeristy
80. Cellulose spears to dry donor corneal tissue in
the preparation of Ultrathin endolthelial
Keratoplasty: correlation between duration of drying
and residual corneal thickness
Aravind Reddy, Vikas Shankar
Aberdeen Royal Infirmary
70. Rotational stability of a hydrophilic toric lens
implant over 2 years
Ashokkumar Vyas
Scarborough Hospital
81. Service Evaluation of Paediatric Cross-linking
for keratoconus at Moorfields Eye Hospital
Alastair Porteous, Tom Flynn, Stephen Tuft
71. Is Optical Biometry sufficient to estimate Toric
IOL parameters to correct co-existing corneal
astigmatism during cataract surgery?
Constance Jong, Vikas Shankar, Aravind Reddy
82. Ultrathin (UT) DSAEK: a novel Non-double-pass
technique
Vikas Shankar, Paul Chua, Avarind Reddy
83. Five novel mutations in the CHRDL1 gene
associated with X-linked Megalocornea
Halah Ali, Alice E Davidson, Sek-Shir Cheong, Jens M
Hertz, Jonathan B Ruddle, Stephen J Tuft, Alison J
Hardcastle
Institute of Ophthalmology & Moorfields Eye Hospital
72. Toric lenses in pathological corneal astigmatism
Sarah Chaney, David Frazer
Royal Victoria Hospital
73. Spectacle Independence and Vision-Related
Quality of Life in Cataract Surgery Patients Following
Implantation of the ReSTOR® Multifocal Intraocular
Lens
Sunil Shah, Christopher Brittain
84. Deep Anterior Lamellar Keratoplasty (DALK)
versus Penetrating keratoplasty (PK) for keratoconus:
a systematic review
Christin Henein, Mayank Nanavaty
Sussex Eye Hospital
85. Safe use and care of contact lenses by young adults
Evgenia Kanonidou, Vasileios Konidaris, Christina
Kanonidou, Leonidas Papazisis
Department of Ophthalmology, General Hospital of
Veria, GR
74. Rapid corneal cross-linking (CXL) for
progressive ectasia
Dan Gore, Nick Kopsachilis, Bruce Allan, External
Disease Service Consultants
27
Birmingham 2014
POSTERS: Glaucoma
GLAUCOMA
86. Clinical features of fast and slow progressors in
the glaucoma service: Analysis of The Portsmouth
Visual Fields database.
Sameer Trikha, Hannaa Bobat, Clive Osmond,
James Kirwan
Queen Alexandra Hospital Portsmouth
99. Analysis of glaucoma referral and discharge
pathways in Scotland and the need for new SIGN
glaucoma referral guidelines
Andreas Syrogiannis, Donald Montgomery, Jennifer
Burr, Roshini Sanders
NHS FIFE
87. Supramid Management after Baerveldt Tube
Implantation – an Audit
Jayesh Khistria, Pavi Agrawal, Gus Gazzard
100. Glaucoma treatment compliance at a UK
General Practice
Meena Arunakirinathan, Mital Shah, Chrystal Dooley,
Asifa Shaikh
88. Normal tension glaucoma or hyperlipidemia
related angiopathy
Souhad Lawand, Heba Eyadat
Al-Sharq Hospital
101. Managing Capacity in the Ophthalmology
Department – Options review
Anju Kadyan, Anna Gao, Shampa Gupta
Shrewsbury and Telford Hospital NHS Trust
89. Laser suture stretch for post trabeculectomy
bleb management
Rohit Saxena, Marta Hovan, Stephen Vernon
Nottingham University Hospital
102. A comparative study of glaucoma drainage
implant (GDI) surgery in children and adults at a
tertiary referral centre
Achilleas Mandalos, Michael Lai, Velota Sung
90. Virtual Glaucoma Clinics: Patient Acceptability
And Quality of Patient Education Compared to
Standard Clinics.
Jennifer Court, Michael Austin
Singleton and Neath Port Talbot Hospitals
103. Patient orientated outcomes for selective laser
trabeculoplasty.
Marina Hopes, Chrysostomos Dimitriou, Nuwan
Niyadurupola, David Broadway, Tom Eke
Norfolk and Norwich University Hospital
91. The interobserver reliability of Van Herick
measurement.
Ahmed Javed, Mark Batterbury, Stephen Kaye
Royal Liverpool Hospital
104. Ghrelin and Hepcidin Prohormone Levels in
Patients with Primary Open-Angle Glaucoma
Asaad Ghanem
Masnoura Ophthalmic Center
92. Phacoemulsification with endocyclodiode laser
to aid glaucoma management
Line Langsaeter, Pieter Gouws, Ali Hassan
East Sussex Hospital Trust
105. Outcomes of glaucoma referrals from diabetic
retinopathy screening service
Robert Cann, Pavi Agrawal, Gus Gazzard
Moorfields South, St.George’s Hospital
93. Developing predictive model and potential
biomarkers for primary open-angle glaucoma using
metabolomics approach
Zakaria Bannur, Lay Kek Teh, Mohd Zaki Salleh, MI
Ismail, Jonathan Crowston, Sushil Vasudevan
Universiti Teknologi MARA UiTm
106. Current prescribing trends in a tertiary
glaucoma unit.
Stephenie Tiew, Manon Owen, Anshoo Choudhary
RLUH
94. Absence of OPTN E50K mutation in primary
open angle glaucoma and ocular hypertension
Soo Park, Yalda Jamshidi, Lik Thai Lim, Daniela
Vaideanu, Scott Fraser, Jane Sowden
107. Treating Glaucoma: The NOT-so-NICE
Guidance
Daniel Ackland, Neruban Kumaran, Rashid Zia
Williams Harvey Hospital, East Kent
108. Patient Satisfaction with Peninsula Optometry
Community Glaucoma Scheme
Sarah Levy, Adam Booth
Royal Eye Infirmary, Plymouth
95. Squeezing Generic Latanoprost: Are they the
same?
Umama Mulla, Kelvin Wong, Elizabeth Tanner, David
Young, Alan Rotchford
Gartnavel General Hospital
109. Brinzolamide 1.0%/Timolo 0.5% versus
Dorzolamide 2.0%/Timolol 0.5% in the treatment of
open angle glaucoma or ocular hypertension:
Prospective randomized patient preference study
Sheng Lim, Laura Braithwaite
St Thomas’s Hospital
96. Macular Thickness Changes in Glaucoma using
Spectralis Ocular Coherence Tomography
Tulsi Changulani, Neeta Ray-Chaudhuri
Newcastle upon tyne-RVI
97. Glaucoma Patients’ Education Scheme
Mital Shah, Deborah Dow, Jane Diggory, Asifa Shaikh
110. Transscleral Diode Laser
Cyclophotocoagulation with patients with
moderately good vision.
Sharmin Ria, Alaa Attawan, Kais Khalid
Scunthorpe General Hospital
98. Improving information-sharing for glaucoma
patients who move to another area.
Mykolas Pajaujis, Inderraj Hanspal, David Broadway,
Nuwan Niyadurupola, Tom Eke
Norfolk and Norwich Univeristy Hospital
28
Birmingham 2014
POSTERS: Glaucoma / Medical Retina
GLAUCOMA
MEDICAL RETINA
111. Prostaglandin associated periorbitopathy- case
study, pathophysiology and clinical implications
Hiten Sheth, Alison Matthews
Amersham Hospital
121. Progression of retinal atropy in Stargardt’s
Macular Dystrophy estimated from spectral-domain
optical coherence tomography measurements of
macular volume
Rupert Wolfgang Strauss, Beatriz Munoz, Emily
Fletcher, Yulia Wolfson, Milena Bittencourt, Hendrik
P N Scholl
Wilmer Eye Institute, John Hopkins University
112. Pre-natal Diagnosis of Rieger’s Syndrome Based
on Symptoms in Pregnancy
John-Sebastian Barry, Joseph Abbott
Russell’s Hall Hospital, Dudley
122. The cost effectiveness of aflibercept compared
to ranibizumab in the management of wet agerelated macular degeneration (wAMD)
Jennifer Priaulx, Jacqueline Napier, Gabriela Vega,
Matthew Rafford
Bayer
113. No small enemy
Miriam Lara De La Rosa
Mexican Institute of Social Security
MEDICAL RETINA
123. A systematic review on the use of
Photodynamic Therapy to treat Central serous
Chorioretinopathy.
Ore-oluwa C Erikitola, Roxanne Nwanobi-Crosby,
Sobha Sivaprasad
114. Emotional and Physical Impact of Wet AgeRelated Macular Degeneration (wAMD) on Patient
and Caregivers
Steve Winyard
Royal National Institute of Blind People
124. Visual Outcome in Patients with Uveitis
Ahmed Samy, Sue Lightman Oren Tomkins-Netzer,
Lazha Talat, Asaf Bar, Simon Taylor, Albert Lula
Moorfields Eye Hospital, Royal Surrey County
Hospital NHS
115. The use of OCT in Retinal Screening: Results
from the Improving Screening for Macular Oedema
(ISMO) Study
Roly Megaw, Shyamanga Booroah, Keith Goatman,
Graham Scotland, Gordon Prescott, Peter Sharp,
John Olson
University of Aberdeen
125. Real-world outcomes with intra-vitreal
afilbercept as initial therapy for neovascular AMD
Michael Kaye, Carlo Suter, Helen Davenport, Faruque
Ghanchi, Martin Mckibbin
116. Multi-centre, prospective, observational, cohort
study to assess the cost-effectiveness of English,
Scottish and a hybrid grading schemes for diabetic
macular oedema screening: improving screening for
macular oedema (ISMO) study
Shyamango Borooah, Rolf Megaw, Keith Goatman,
Graham Scotland, Gordon Prescott, Peter Sharp,
John Olson
126. Mean visual gain atrophic retinas after five
years of Ranibizumab ‘prn’ treatment in a
neovascular Age-related Macular Degeneration
(nvAMD) service.
Archana Airody, Divya Venugopal, Nicola Topping,
Richard Hanson, Gavin Walters, Richard Gale
York Teaching Hospitals NHS Foundation Trust
117. AURA Study: Real-World Ultilization of AntiVEGF Therapy for Neovascular (Wet) Age-Related
Macular Degeneration (wAMD) in the UK
Philip Hykin, Sobha Sivaprasad, Usha Chakravarthy,
Andrew Lotery, Martin Mckibbin
127. Ocular side effect of mitogen-activated protein
kinase (MEK) inhibtors.
Robert M J Purbrick, Wasir Saka, Denis C Talbot,
Susan M Downes
Oxford Eye Hospital
118. Fluoresence gradient analysis of fluorescein
angiograms
Nigel Davies
Chelsea and Westminster Hospital
128. 6-weekly bevacizumab versus 4-weekly
ranibizumab as required treatment for neovascular
age-related macular degeneration: a 2-year outcome.
Patrick Chiam, Nicholas Hickley, Venkat Kotamarthi
Leighton Hospital, Crewe
119. A study of aged GK rats: is tau the missing link
between diabetes and Alzhiemer’s Disease?
Timothy Wong, Marianne Phllips, Shereen Nizari,
M Francesca Cordeiro
Institute of Ophthalmology, UCL
129. Aflibercept (Eylea) for Treatment Resistant
Neovascular Age-Related Macular Degeneration
(nAMD): Early UK Outcomes
Tejal Magan, Aman Kirmani, Zine Elhousseini,
Matthew Robertson, Samantha Mann
St Thomas’ Hospital, London
120. Long-term visual acuity outcome in patients
with diabetic macular oedema treated with
fluocinolone acetonide
Yit Yang, Niro Narendran, Clare Bailey,
Andrew Lotery
Wolverhampton Eye Infirmary
130. Central serous chorioretinopathy and pigment
epithelial detachments associated with a novel MEK
inhibitor.
Nashila Hirji, Laura Maubon, Vasiliki Michalerea,
Udai Banerji, Paul Ursell
Sutton Hospital
29
POSTERS: Medical Retina / Neuro-Ophthalmology / Ocular Motility
Birmingham 2014
MEDICAL RETINA
NEURO-OPHTHALMOLOGY
131. Pattern scan laser for proliferative diabetic
retinopathy: outcome at 1-2 year follow up
Alexander Baneke, Felicity Allen, Todd Williamson,
Moin Mohamed, Samantha Mann
St Thomas’ Hospital
141. A national epidemiological study of chronic
progressive external ophthalmoplegia – molecular
genetic features and neurological burden
Anna Clements, Victoria Nesbitt, Robert W Taylor,
Douglass M Turnbull, Robert Mcfarland,
Patrick Yu-Wai-Man
Wellcome Trust Centre for Mitchondrial Research,
Newcastle
132. Surveillance Clinic for Screen Positive
Maculopathy Patients
Miranda Buckle, Liam Price, Steve Chave,
Kerry Price, Stephen Adlington, Peter H Scanlon
142. Diabetic retinopathy is associated with
oxidative stress and migration of gene expression of
antioxidant enzymes
Mohamed Fathelbab, Moaz Mojaddidi,
Mann AL-Barry, Hesham El-Beshbishy
Taibah Univeristy
133. To investigate the impact of diabetic
retinopathy of varying severity on sleep.
Rupal Morjaria, Iona Alexandrew, Obaid Kousha,
Victor Chong, Katharina Wulff, Russell Foster,
Susan Downes
Oxford Univeristy Hospitals NHS Trust
143. Vascular morphology in patients with optic
nerve head drusen and optic disc oedema
Anastasia Pilat, Frank Proudlock, Mark Lawden,
Irene Gottlob
University of Leicester
134. Glycated albumin induces IL-8 and MCP-1
modulation by minocycline in cultured retinal
pigment epithelial cells
Joanna DaCosta, Sobha Sivaprasad, Selim Cellek
Cranfield Univeristy
144. Comparison of electroretinographical responses
in albinism, idiopathic infantile nystagmus and
healthy controls
Zhanhan Tu, Christopher Degg, Viral Sheth,
Irene Gottlob, Frank Proudlock
135. A systematic review and meta-analysis
comparing intravitreal ranibizumab with
bevacizumab for the treatment of choroidal
neovascularization secondary to pathologic myopia.
Mohamed Loutfi, Muhammad Siddiqui,
Abdulbaset Dhedhi, Ahmed Kamal
Univeristy of Liverpool
145. Comparative Analysis of the Mollon-Reffin
Minimal Colour Vision Test in the visually normal
and acquired ocular disease
Hetan Ajwani, Carmel P Noonan, Fiona J Rowe
University of Liverpool
136. Inter-injector pain scores for intravitreal
injections for wet age-realted macular degeneration
(AMD): a comparison of Visual Analogue Scale (VAS)
and Verbal Reporting Scale (VRS)
Divya Venugopal, Samalie Kakaire, Atlaf Waraich,
Richard Gale, Richard Hanson
York Disctrict Hospital
146. Expert Opinion in the Clinical Investigation of
Acquired Isolated Horner Syndrome in the United
Kingdom
Jasvir Virdee, Susan Mollan, Michael Burdon
137. Attitudes towards prenatal diagnostic testing for
inherited retinal diseases
Khuram Ahmed, Mushtaq Ahmed, Barbara Potrata,
Hilary Grant, Thomas Willis, Martin Mckibbin
Leeds Teaching Hospital NHS Trust
147. Cerebral migration of intraocular silicone oil: A
clinical and radiological
George Kalantzis, Kevin Falzon, Chin Ong ,
Dan Warren, Bernard Chang
St James University Hospital, Leeds
138. Serpiginous-like choroiditis: as a maker for
tuberculosis in a non-endemic area
Weh Loong Gan, Nicholas Jones
OCULAR MOTILITY
148. Unilateral lateral rectus resection: a simple
solution to age-related distance esotropia
Sohraab Yadav, Jane Young, Claire Voas-Clarke,
Ian Marsh, Jon Durnian
139. Intravitreal Triamcinolone for refractory
macular oedema following failed anti-VEGF
treatment : One year results
Peck- Lin Lip, Hema Kolli, Arijit Mitram Samer
Elsherbiny, Panagiota Stavrou, Bichitra Das,
Bushra Mushtaq
The Birmingham & Midland Eye Centre
149. A Modified Model for Strabismus Surgery
Simulation
Bharat Markandey, John-Sebastian Barry
Russell’s Hall Hospital, The Dudley Group NHS Trust
150. Modified Hang-back single Muscle Medical
Rectus Recession for Paediatric Estopia
Alastair Hardisty, Tin Chan, Claire Duckworth
Sheffield Chrildren’s Hospital
NEURO-OPHTHALMOLOGY
140. Retinal Ganglion cell neuroprotection and axon
regeneration after optic nerve crush induced by
siRNA mediated knock-down of RTP801, a negative
regulator of mTOR signalling
Peter Morgan-Warren, Jenna O’Neill, Martin Berry,
Elena Feinstein, Robert Scott, Ann Logan
151. Medical rectus pulley posterior fixation suture
for acquired estropia with high AC/A ratio.
Rajnish Sekhri, Pouya Alagaband, James Innes,
Usman Mahmood
Hull and East Yorkshire Eye Hospital
30
POSTERS: Orbit & Oculoplastics / Miscellaneous
Birmingham 2014
ORBIT & OCULOPLASTICS
MISCELLANEOUS
152. Orbital Cellulitis in Scotland; epidemiology,
aetiology, treatment and outcome: Scottish
Ophthalmic Surveillance Unit Study
Claire Murphy, Helen Murgatroyd, Caroline
MacEwen, Iain Liveringstone, Barny Foot
Ninewells Hospital Dundee
163. Ophthalmic Involvement in Midfacial trauma:
Our experience in Glasgow
Sonali Tarafdar, Iain Livingstone, Mamun Rahman,
Clifford Weir
Tennent Institute of Ophthalmology
164. Current Utilisation of electronic medical
records in ophthalmic research
Victoria Nowak, Zahra Kadom, Patricia Svrckova, K Y
Ronald Kam
Imperial College London
153. Guidance to locate sutures lost during
ophthalmic surgery.
Damien C M Yeo, Tafadzwa Young-Zvandasara,
Garry Shuttleworth
Singleton Hospital, Swansea
165. Ethnicity and education in myopia: the UK
Biobank (UKBB) study
Yanchan Bao, Phillippa Cumberland, Paul Foster,
Peng Tee Khaw, Christopher Hammond, Pirro Hysi,
Jugnoo Rahi
154. Delayed Skin Graft after Debridement for
Surgical Treatment of Periorbital Necrotising Fasciitis
Mark Sigona, Michael Mckenna, Partha Chakraborty
County Durham and Darlington NHS Foundation
Trust
155. Slit Lamp Dermatoscopy
James Mchugh, Juliana Helou, Chris Mclean
The Royal Surrey County Hospital Guildford
166. Comparison of two prognostic models for
penetrating eye injuries in district general hospitals
Luke Nicholson, Damien Yeo, Rupinder Chana, Ruth
Jones, Julia Escardo-Paton, Osama, Giasin, Elizabeth
Goodchild
Royal Gwent Hospital, Newport
MISCELLANEOUS
156. Choroidal biopsy in the management of
patients with choroidal metastasis
Heinrich Heimann, Lazaros Konstantinidis, Sarah
Coupland, Bertil Damato
167. UK and US contrasted: A qualitative study of
post-graduate training and clinical governance in
ophthalmology using ethnological techniques
Monica Michelotti, Andrew Davies, Jennifer Weizer,
Declan Flanagan, Shahzad Mian, Paul Lee, Simon
Kelly
Univeristy of Michigan, Moorfields, Royal Bolton
Hospital
157. Anxiety, depression and somatisation in
attendees at ophthalmic A&E
Adnaan Haq, Radon Reynolds, Zakariya Jarar
168. Smartphone Tele-Ophthalmology
Ryan Davies, Hugh Jewsbury, Kadaba Rajkumar
Princess of Wales Hospital, Bridgend
158. Photodynamic therapy as initial treatment for
small choroidal melanomas
Fidan Jmor, Bertil Damato, Heinrich Heimann
Ocular Oncology Centre, Royal Liverpool University
Hospital
169. Changing trends in Consultant Appointments
Romeela Rana-Rahman, Alan Connor, Hamed Anwar
Royal Victoria Infirmary, Newcastle Upon-Tyne
159. Ocular surface squamous neoplasia: Anaylasis
of 78 cases from a UK ocular oncology centre
Anu Maudgil, Trushar Patel, Paul A Rundle, Ian G
Rennie, Hardeep Singh Mudhar
170. The microbiology of Endophthalmitis: A Four
Year Review
Sheema Khan, Rosina Zakri, Srinivasulu Reddy,
Nishal Patel
East Kent Hospitals University NHS Foundation Trust
160. Treatment-seeking Behaviour for Ocular
Morbidity (OM) in South-West Cameroon
Emma Gees, Gillian Dalgetty, Laura Senyonjo
University of Leeds
171. A Training Device for YAG Laser Capsulotomy
May Fang, Chris Mclean
The Royal Surrey County Hospital NHS Trust
172. Episcleral Tattooing - An Emerging Body
Modification Trend
James Brodie, Husam El Galhud
161. Association between Depression and Diatetic
Retinopathy in sub-Saharan Africa
Kirsty Hall, Eugene Sobngwi, Linda Penn
Newcastle University
173. Ultraviolet (UV) blocking capability of basic
spectacle lenses (CR-39)
Rongxuan Lim, Fiammetta Fedele, Parul Patel, Susana
Morley
St Thomas’ Hospital
162. The Potential for Using Tablet Computers in
Clinical Vision Testing; a method for calibrating and
validating devices.
Fadi Ghazala, Humza Tahir, Ian Murray, Neil Parry,
Tariq Aslam
31
Birmingham 2014
POSTERS: Paediatric Ophthalmology
PAEDIATRIC OPHTHALMOLOGY
174. Severe retinopathy of prematurity (ROP) in 23
weeks gestation babies between 2000-2013 in
Newcastle
David Cottrell, Ayad Shafiq, Alan Fenton
186. A prospective long-term study of the
ophthalmic natural history of paediatric
craniopharyngioma
Evangelos Drimtzias, Kevin Falzon, Irfan Jeeva, Ian
Simmons
St James’s Univeristy Hospital, Leeds, UK
175. The effect of blood transfusion on fetal
haemoglobin concentration in very preterm infants
and its association with retinopathy of prematurity
Christopher Stucthfield, Anoo Jain, David Odd, Cathy
Williams, Richard Markham
Bristol NICU and Bristol Hospital
187. Retinopathy of Prematurity in Northern Ireland
from 2006-2011
Eibhlin McLoone, Sarah Chamney, Rebecca Rollins,
Emma McCall. Adele Marshall, Stan Craig
176. The importance of globe size in
pharmacological treatment of retinopathy of
prematurity
Ayad Shafiq, David Cottrell, Alan Connor
188. Rationalising the use of Bacterial Conjunctival
Swabs in Alder Hey Children’s NHS Foundation Trust
– Review of a Seven Year Period (2006-2013)
Neeru Vallabh, Fiona Hardiman, Theresa S Cole,
Richard J Drew, William Newman
Alder Hey Hospital
177. Objective visual and radiological response of
recurrent childhood optic pathway gilmoas to
bevacizumab
Ian Simmons, Kevin Flazon, Evangelos Drimtzias
189. Incidence and Management of Non Accidental
injury in south Yorkshire Ophthalmology units.
Mohammed Zayed, Nadeem Ahmad, Alaa Attawan,
Jessy Choi
Royal Hallamshire Hospital
178. Becacizumab v Diode Laser in Stage 3+
Posterior Retinopathy of Prematurity (ROP)
Sarah Moran, Michael O’Keefe, Bernadette Lanigan
Childrens Univeristy Hospital Dublin
190. Study of Optical Perimetric Testing in Children
(OPTIC) – Normative visual field values in children
aged 5-15 years.
Dipesh Patel, Bronwen Walters, Phillippa
Cumberland, Isabelle Russell-Eggitt, Jugnoo Rahi, On
behalf of the OPTIC study group
179. Evaluation of ROPBox; a secure software tool
for Remote screening of Retinopathy of Prematurity
(ROP)
Zahir Mirza, Stephanie West, Lucy Barker, Himanshu
Patel, Gillians Adams
191. Unintentional Injuries in Visually Impaired
Children
Jocelyn Cherry, Julie Mytton, Amanda Hall, Cathy
Williams
University of Bristol
180. Development of infantile nystagmus
Maria Theodorou, Richard Clement, David Taylor,
Anthony Moore
Institute of Child Health
192. The extended role of the Orthopist; increasing
the access to Ophthalmology for Paediatric
Oncology patients
Danielle Guy, Olwyn Nelson, Janice Hoole, Ian
Simmons
Leeds Teaching Hospitals NHS Trust
181. Congenital Glaucoma in Wagner Syndrome
High Jewsbury, Andrew Fry, Patrick Watts, Veronique
Nas, James Morgan
University Hospital of Wales, Cardiff
182. Management of Congenital Nasolacrimal Duct
Obstruction: 15 years experience In the UK
Lana Fu, Susmito Biswas, Ian C Lloyd, Anne E Cook,
Jane L Ashworth
193. Rapid onset of severe ocular injury after
exposure to a button battery.
Yasir Khan, Sundus Maqsood, S Marpuri, V Geh, G S
Bhermi
Southend Univesity Hospital
183. Systemic Ciclosporin in the Management of
Severe Vernal Keratoconjuncitivitis in Children.
Rosalind Stewart, Arvind Chanda, Gavin Cleary,
Harish Nayak
Alder Hey Children’s Hospital
194. Sight-threatening ocular manifestations of JXG
in childhood
David Burton, Evangelos Drimtzias, Kavin Falzon,
Irfan Jeeva, Ian Simmons
St James’s University Hospital, Leeds, UK
184. Proposed algorithms for reducing un-necessary
ROP screening.
Shah Karim, Himanshu Patel, Helen Lock, Ajay
Sinha, Steve Kempley, M Ashwin Reddy
Barts and The London NHS Trust
185. Retinal Vessel architecture in retinoblastoma
patients pre and post treatment
Karen Wong, Aswin Reddy, Mandeep Sagoo, Clare
Wilson
Royal London Hospital
195. Head Posture and Head Movements in Infantile
Nystagmus
Vijay Patel, Irene Gottlob, Frank Proudlock
University of Leicester Ophthalmology Dept.
32
POSTERS: Uveitis / Vitreo-Retinal Diseases & Surgery
Birmingham 2014
UVEITIS
VITREO-RETINAL DISEASES & SURGERY
196. The Dublin Uveitis Evaluation Tool (DUET) – an
algorithm for earlier diagnosis of
spondyloarthropathies by ophthalmologists in acute
anterior uveitis.
Michael O’Rourke, Muhammad Haroon, Pathma
Ramasamy, Oliver FitzGerald, Conor Murphy
Royal Victoria Eye and Ear Hospital, Dublin
205. Anatomical and visual outcomes of posterior
segment ocular trauma requiring vitreo-retinal
surgery
Koushik Basu, Yog Raj Sharma, Raj Vardhan Azad,
Parijat Chandra, Koushik Tripathy
Dr. Rajendra Prasad Centre For ophthalmic Services,
India
197. Use of aqueous humour PCR for diagnosis of
atypical ocular toxoplasmosis
Andre Grixti, Edward Guy, Nicholas Alexander V
Beare, Ian Andrew Pearce
206. Development of the surgical procedure for cell
transplantation treatment for age related macular
degeneration (AMD)
Christopher Jump
198. Pegylated interferon a2b reduces corticosteroid
requirements in patients with Bechet’s syndrome
with upregulation of circulating regulatory T cells
Sue Lightman, Oren Tomkins, Virginia Calder, Catey
Bunce, Hilary Longhurst, Dorian Haskard, Miles
Stanford
207. Comparison of efficacy and safety outcomes
between EU and US petients in MIVI6/7 studies on
ocriplasmin for vitreomacular traction
Zachariah Koshy, on behalf of MIVI Trust study Group
Multiple
199.
Long Term Outcome of Repeat Ozurdex
Implantations in Non-Infectious Uveitis
Oren Tomkins-Netzer, Simon Taylor, Asaf Bar, Albert
Lula, Satish Yaganti, Lazha Talat, Sue Lightman
200. Visual outcome and treatment strategies among
patients with ischaemic retinal vasculitis
Lazha Talat, Oren Tomkins-Netzer, Simon Taylor, Sue
Lightman
Moorfields Eye Hospital/UCL Institute of
Ophthalmology
VITREO-RETINAL DISEASES & SURGERY
201. Ocriplasmin for Pharmacologic Resolution of
Vitreomacular Adhesion: Meta-analysis of anatomical
and functional
Andrew Lotery, Benedicte Lescrauwaet, Kerry Gairy
University of Southampton
202. Recovery of visual symptoms following
ocriplasmin therapy – further evidence from MIVI
trials for ocriplasmin in vitreomacular traction
Niro Narendran, Yit Yang, on behalf of the MIVITRUST Study Group
International Multi-Site Studies
203. Visual function improvements with resolution
of vitreomacular adhension in patients receiving
ocriplasmin
Tim Jackson, ON behalf of the MIVI-TUST Study
Group
International multi-center study
204. Measuring Metamorphopsia in Macular Disease
Gerry McGowan, Tsveta Ivanova, David Yorston,
Niall Strang, Velitchko Manahailov
33
Birmingham 2014
DVD EXHIBITION
1. Video of goniotomy, with tips for the assistant that
allow better surgical access, and an optimal surgical
arc.
Gordon Lau, Ayad Shafiq
10. Needling revision of serverely scarred blebs:
Description of the technique
Rory Nicholson, Charalambos Tossounis, Hannaa
Bobat, James Kirwan
Queen Alexandra Hospital, Ophthalmology
Department
2. TREACHER COLLINS WINNER 2014
Trabeculecomy Bleb Dysaesthesia – Review of how
to prevent & how to treat
Dan Lindfield, Saurabh Goyal
St Thomas’, London
11. A ‘No-speculum’ Technique for Intravitreal
Injections
Shwan Kadare, Huw Oliphant, Tony Leong
Worthing Hospital, West Sussex NHS Trust
12. Removing a dropped IOL and implanting an
ARTISAN aphakic lens: The float and suck technique
Charalambos Tossounis, Rary Nicholson, Richard
Newsom
Queen Alexandra Hospital, Ophthalmology
Department
3. ‘When it just won’t fit’! Transcameral pull-through
suture to enable watertight anterior chamber tube
entry
Avi Kulkarni, Dan Linfield
Kings College Hospital, London
4. IOL haptic exchange through small incision
Daniel Dragnev
Hywel Dda Health Board
13. Ultrathin (UT) DSAEK: a novell Non-double pass
technique
Paul Chua, Vikas Shankar, Aravind Reddy
5. Iris clip Secondary IOL implantation technique –
comparison of needle Vs Vacuum assisted
enclavation
Hidayat Ullah Bhutto, Siddhartha Goel
Diana Princess of Wales Hospital, Grimsby
14. Subjugation of black nucleus by intramural
phacoemulsification – a simplified technique
Mrinal Rana, Ranjeet Kishore Rana, Kunal Rana,
Nidhi Mittal
6. Macular hole eruption during pars plana
vitrectomy
Paul Rainsbury, Emily Gosse, Jonathan Lochhead
St Mary’s Hospital, Isle of Wight
15. Descemet’s stripping endothelial keratoplasty
using needle push on Fichman Glide
Robert Nadler, Rebecca Davie, Henry Perry, Tom
Butler, Allon Barsam
Luton & Dunstable University Hospital
7. Capsule supported phacoemulsification in a case
of subluxed cataract
Siddharth Goel, Hidayat Ullah Bhutto
Diana Princess of Wales Hospital, Grimsby
8. Transconjuntival scleral flap overscrew for
hypotony following trabeculectomy with mitomycin
C – a novel technique
Pavi Agrawal, Dilani Siriwardena
9. A Novel Technique in Predicting Efficacy of Lateral
Tarsal Strip
Huw Oliphant, Ali Hassan, Paul Baddeley
34
Birmingham 2014
OPTIC UK & EXHIBITION
Bayer HealthCare
STAND N
Bayer HealthCare is committed to the global
community of patients with ophthalmic disorders.
Please come and visit the Bayer Healthcare stand to
find out more about our Ophthalmology portfolio.
OPTIC UK
Annual Congress Commercial Exhibition
The UK’s largest ophthalmic exhibition will be open
throughout the Congress. The exhibition is organised
by Optic UK as part of their continuing support to the
ophthalmic profession.
Bausch & Lomb
STAND A
Bausch + Lomb is one of the best known and most
respected healthcare brands in the world. Visit our
stand to see the latest developments on the Stellaris
PC platform
Exhibition opening hours:
8.00 a.m. to 7.00 p.m.
the Exhibition will be open during the drinks
reception
8.00 a.m. to 5.30 p.m.
8.00 a.m. to 3.00 p.m.
Beaver-Visitec International Inc
STAND Z
Beaver-Visitec International offers a broad range of
high-quality precise products for ophthalmic and
speciality microsurgical procedures: Beaver® Knives
and Blades; Visitec® Cannulae, Instruments and
Accessories; Merocel®, Keracel® and Weck-Cel®
Fluid Control Products; Wet-Field® and Eraser®
Electrosurgical Devices; OcuSeal® Liquid Ocular
Bandage; MultiVisc™, Visc™ and Aqueo Premium™
Surgical Solutions CustomEyes® Procedure Packs.
The Optic UK Lecture 2014
The sixth Optic UK Lecture will take place on
Thursday 22nd May 2014. We are delighted that the
eminent and world-renowned speaker Professor Neil
Miller will be delivering this year’s lecture. Please see
page 23 for more details on Professor Miller.
BiB Ophthalmic Instruments
EXHIBITING COMPANIES
Blink Medical
STAND V
Blink Medical are attending the RCO for the first time
this year and are proud to be showing their range of
high quality disposable instruments and customised
packs for cataract, VR, Oculoplastic and IVT
procedures.
Alcon Eyecare UK Ltd
STAND X & H/I
We would be delighted to welcome you to our stands
X or H/I which feature both new and world leading
products in the pharmaceutical and surgical markets.
Alimera Sciences
STAND D & 12
Alimera Science’s ILUVIEN® (fluocinolone acetonide
190µg, intravitreal implant) is indicated for the
treatment of vision impairment associated with
chronic diabetic macular oedema (DMO), considered
insufficiently responsive to available therapies.
ILUVIEN received NICE guidance TA301, December
2013.
Allergan Ltd.
STAND C
Altacor
STAND 7
STAND 35
Butterflies Healthcare
STAND 37
Carl Zeiss Ltd
STAND K
ZEISS offer the complete solution for the diagnosis,
treatment and management of Cataract, Refractive,
Retina and Glaucoma patients. ZEISS will be
showcasing an extensive product range including the
new Cataract Suite Markerless, CIRRUS OCT Family
and FORUM® data management.
Carleton
STAND E
Lasers from Iridex, fundus cameras, OCT from Canon,
operating microscopes, slit lamp workstations, patient
chairs from Takagi Seiko, quality hand held
instruments & indirects from Heine and revolutionary
single use lenses from Sensor Medical
Altomed Ltd
STAND G
As well as displaying new products such as the
Sterimedix ‘2.2’ Coaxial Handpieces, MST Iris Hooks,
and the new Wide Angle Viewing System from Insight
USA, Altomed have dedicated a large portion of their
stand this year to seating and tables, where you can
bring your refreshments and relax in comfort with
your colleagues.
D.O.R.C. Limited
STAND 26
EVA® Phaco/Vitrectomy System·
CryoStar®.LEDstar.Ultra Speed Transformer.20-23-2527GTransconjunctival System Disposables
Forceps & Scissors.Backflush Instruments. Vitrectomy
Lenses. Glaucolight Liquids:.
VisionBlue®,MembraneBlue-Dual®, LM-Blue®.
EFTIAR® / SIL-1000/5000
Amo United Kingdom Limited
STAND P
We offer market leading technologies for myopia,
hyperopia, astigmatism, presbyopia, cataract,
spherical aberration and corneal health with proven
educational and support programmes that help eye
care professionals master refractive technologies and
grow their practices.
Eye News
STAND 14
Launched in 1994, Eye News will be 21 next issue.
Look out from contributions from all of our previous
editors.
Pick up a complimentary copy of the April/May issue
from Stand 14
35
Birmingham 2014
EXHIBITION
Litechnica
STAND J
Visit stand J, where we will be exhibiting our latest
range of laser systems and bespoke video solutions.
With over 37 years in the industry, Litechnica are
renowned for the highest level of service and
aftercare.
Grafton Optical
STAND 19
On show will be the new ‘Avanti’ OCT from
Optovue. 70,000 Scan Rate producing superb HD
Images.The new Grafton Combo 1000 Chair/Stand
Unit allows easy wheelchair access. Plus Reichert,
CSO, DGH, Optronics and Visionix products
Haag-Streit GB Ltd
STAND B
Visit Haag-Streit UK on Stand B to see our
comprehensive ophthalmic portfolio, including the;
LENSTAR biometer, MAIA microperimeter, Octopus
perimeter and the latest in slit lamp imaging.
MacuVision Europe Ltd
STAND 31
MacuVision, the makers of MacuShield, specialise in
products specifically for macular health. MacuVision
are the UK’s leading eyecare supplement
manufacturer. MacuVision supports world class
research and are proud to “Trust the Science”.
Heidelberg Engineering
STAND R
Heidelberg will present Glaucoma Premium Edition
for SPECTRALIS, which provides objective analysis of
ONL, RNFL and Posterior Pole Asymmetry. The
minimum rim width is used to enhance clinical disc
examination
Instinctive Ltd
Mainline Instruments Ltd
STAND 1
Mainline Instruments will be exhibiting the reliable
and accurate icare tonometer range as well as a
selection of Tomey instrumentation such as
topographers and A-scans. As key distributors of
Keeler, a full range of equipment will be on display.
STAND 16
John Weiss and Son Ltd.
STAND 32/33
We will be presenting the Weiss surgical instrument
range and featuring the latest DSAEK advances with
the Tan EndoGlide and CamFlow, Keraring products
for Keratoconus, together with the MedOne products
for VR surgery.
Malosa Medical
STAND F
Malosa Medical are the Specialists in Single-Use. Our
innovative range of single-use instruments and
procedure packs for every ophthalmic procedure are
your guarantee of precision and safety, every time.
Keeler Ltd.
STAND T
Keeler will be delighted to launch at the Royal
College of Ophthalmologists it’s new range of
Symphony K and Q Series Slit Lamps. In addition,
we shall also be showing our new D-Kat Tonometer
and our leading range of Indirect Ophthalmoscopes.
Volk Lenses will also be available to purchase on the
stand.
Kestrel Ophthalmics
Medisoft Limited
STAND 8
Visit our stand to see how exciting new developments
to Medisoft’s ophthalmology clinical system will help
you increase capacity and improve service quality
M.I.S.S Ophthalmics Ltd.
STAND 11
Specialising in Vitreoretinal and Cataract Surgery,
Distributing for Synergetics Inc, MidLabs Inc,
Alchimia srl, Kirwan Surgical Inc, Surgistar Inc, Eagle
Labs Inc.
STAND O
Kowa Optimed
STAND 15
Kowa Optimed will exhibit the WX3d Retinal
camera, providing Gold Standard glaucoma
screening; the new AP7000 perimeter, providing
automated static and kinetic perimetry; and the
NDESP approved Non-myd7 retinal camera.
Moorfields Pharmaceuticals
STAND L
Moorfields Pharmaceuticals is the manufacturing arm
of the world famous Moorfields Eye Hospital NHS
Foundation Trust.
Leica Microsystems
STAND 18
Leica Microsystems focus is to partner and support
micro-surgeons and their care of patients with the
highest quality, most innovative surgical microscope
technology available. Visit stand No. 18 or
www.leica-microsystems.com.
We produce the widest range of ophthalmic specials
in the U.K. and have a growing range of licensed
products.
Lenstec
STAND 23/24
Lenstec; a manufacturer and supplier of intraocular
lenses has a solid reputation in innovation and lens
accuracy, with over 20 years’ experience in the
industry. Premium refractive and standard monofocal
lenses, viscoelastic products and disposable knives
complete the portfolio of surgical solutions from
Lenstec.
Nature Publishing
STAND 43
Novartis Pharmaceuticals Ltd
STAND W
Novartis is one of the world's leading pharmaceutical
companies and works to discover, develop and
deliver new and innovative products to treat patients,
ease suffering and enhance quality of life.
36
Birmingham 2014
EXHIBITION
OpenEyes
STAND 36
OpenEyes is an Electronic Patient Records (EPR)
system for Ophthalmology. It has been developed 'by
clinicians for clinicians' using open source software,
giving a significantly lower cost of ownership by
negating licence fees. OpenEyes promotes safety and
efficiency by collating all ophthalmological and
clinical data into a single, intuitive interface which
includes the inbuilt fast, descriptive drawing tool,
'EyeDraw'. OpenEyes integrates easily with existing
systems and can be deployed in a range of settings,
from small ophthalmic units to specialist hospitals in
the UK and abroad. OpenEyes is governed by the
OpenEyes Foundation, a not-for-profit charity.
Spectrum Thea
STAND S & 40
Spectrum Thea Pharmaceuticals will be focusing on
Innovative Preservative-Free Glaucoma products
(Monopost® and Tiopex®) and Surgical
Pharmaceuticals (Aprokam® and Mydriasert®) and
launching the UK’s most economical preservative-free
dexamethasone eye drops – Dexafree®.’
Oraya Therapeutics Inc
STAND 41/42
Oraya Therapy™ Stereotactic X-ray treatment for wet
AMD has been shown to reduce the number of antiVEGF injections required to treat wet AMD while
improving or maintaining vision. Intended as a onetime treatment, it is a non-invasive, simple outpatient
procedure.
TearLab Corporation
STAND 44
The TearLab Osmolarity System is the first objective
and quantitative test for diagnosing and managing
Dry Eye patients. It produces fast and accurate results
in seconds using only 50 nanoliters (nL) of tears.
Stat One Services
STAND 3
Enjoy the latest VRmagic EYEsi Simulators, try the
ground-breaking LKC handheld Diabetic Retinopathy
Screener and see the latest Oculus BIOM
innovations.
TearScience
STAND 17
TearScience® has pioneered devices that provide
significant clinical improvement in treating
Meibomian Gland Dysfunction (MGD). The
TearScience® Dry Eye Solution, which includes the
LipiView®and LipiFlow® devices, provides eye care
professionals with a complete dry eye clinical and
business franchise.
Rayner Intraocular Lenses Ltd
STAND U
Rayner is a manufacturer of intraocular lenses and
proprietary injection devices for use in cataract
surgery. Rayner is also the exclusive distributor of all
Geuder products in England, Scotland and Wales.
Scope Ophthalmics
STAND 30
STAND 38
Second Sight Medical Products
STAND 34
Argus II Retinal Prosthesis System, intended to
provide electrical stimulation of the retina to elicit
visual perception in blind subjects with severe to
profound Retinal Pigmentosa.
Topcon GB Ltd.
STAND M
Topcon’s wide product portfolio of optometric and
ophthalmic equipment is used and trusted in
practices, clinics and hospitals across the UK. Our
leading edge instruments are supported by a
knowledgeable sales team and an experienced
technical support department.
Sigmacon UK Ltd.
STAND Y
Sigmacon are an independent company with a
comprehensive range of ophthalmic lasers for
glaucoma, retina and anterior chamber - including
YAG, YAG SLT, 532nm green multispot and 577nm
yellow micropulse/multisport lasers
Vision Matrix
STAND 2
FineVision /FineVision Toric Trifocal, Bi-FlexMY
Bifocal, Micro-Incision Toric Acrylic Lenses, PreLoaded Hydrophobic And Hydrophilic Acrylic
Lenses, Healaflow Glaucoma Implant, JetRing PreLoaded Tension Rings, Viscoelastics.
Spectrum
STAND Q
Spectrum located at Stand Q will be displaying
innovative products for surgical, diagnostic and
refractive specialities. Including the iStent, the latest
in pre-loaded small incision intraocular lens
technology from HOYA, Ophthalmic Blades and
instruments, Phacoemulsification and Vitrectomy
systems. Spectrum the UK distributor for Nidek and
Oculus diagnostic systems into ophthalmology will
have some of this range along with the RetCam,
Quantel Ultrasound, ECP and the latest Merge image
management solutions.
Wisepress
STAND WP
Europe’s leading conference bookseller, has a
complete range of books and journals which can be
purchased at the stand or posted worldwide. Please
also visit our online medical bookshop.
37
Birmingham 2014
ABSTRACTS: Rapid Fire
1.
SOE PRIZE WINNER 2014
Intravitreal Aflibercept for Diabetic Macular Edema: 1-Year Findings from the VIVID-DME and VISTA-DME
Trials
Edoardo Midena
Introduction: Diabetic macular edema (DME) is a major cause of vision loss in patients with diabetic
retinopathy.
Purpose: To evaluate the efficacy and safety of intravitreal aflibercept (IVT-AFL) compared with macular laser
photocoagulation in patients with DME.
Method: Two randomised, multicentre, double-masked trials in patients with clinically significant DME with
central involvement. Patients were randomised 1:1:1 to IVT-AFL 2 mg every 4 weeks (2q4) plus sham laser,
IVT-AFL 2 mg every 8 weeks (2q8) (after 5 initial monthly doses) plus sham laser, or laser photocoagulation
plus sham IVT treatment. The primary endpoint was the mean change in best-corrected visual acuity (BCVA) at
Week 52.
Results: 865 patients (VIVID-DME [n=404]; VISTA-DME [n=461]) were randomized and received study
medication. Both doses of IVT-AFL were statistically superior to laser treatment for the mean change in BCVA
at Week 52 with improvements ranging between 10.5–12.5 letters (vs 0.2–1.2 letters for laser; P<0.0001). The
2q8 regimen demonstrated similar efficacy to 2q4 with fewer injections required. Significantly more patients
demonstrated a ≥2-step improvement in the diabetic retinopathy severity score with IVT-AFL (both 2q4 and
2q8) vs laser. Overall, IVT-AFL was generally well tolerated with no differences (vs laser) in the overall
incidence of adverse events (AEs)/serious AEs.
Conclusion: IVT-AFL was shown to be an effective and well-tolerated treatment for DME, with significant
effects on visual and anatomic outcomes. Use of a 2q8 regimen appears to decrease the injection-related
burden on patients, caregivers, physicians, and overall healthcare systems.
2.
Ranibizumab treatment of diabetic macular oedema with bimonthly monitoring after a phase of initial
treatment: 18-month outcomes of the Phase IIIb multicentre RELIGHT study
Ian Pearce,
It was a multicenter study
Introduction: Ranibizumab 0.5 mg is licensed for visual impairment due to diabetic macular oedema (VIDMO) using a pro-re-nata dosing regimen addressing individual patient needs with reduced treatment burden;
however, it requires monthly monitoring and retreatment primarily based on visual acuity (VA).
Purpose: RELIGHT investigates the impact of bimonthly follow-up and individualised retreatment, after a
monthly follow-up for 6 months (M) on maintaining improvements in best-corrected visual acuity (BCVA).
Method: RELIGHT was an 18M, prospective, open-label, multicentre, single-arm, Phase IIIb, UK study. Patients
received three initial monthly ranibizumab injections (Day0-M2), followed by individualised VA- and optical
coherence tomography (OCT)-guided retreatment with monthly (M3-M5), and subsequent bi-monthly followup (M6-M18). Key outcome measures: mean change in BCVA from baseline-M12 (primary), mean change in
BCVA and central retinal thickness (CRT) from baseline-M18, safety over 18M.
Results: 99 (90.8%) of 109 enrolled patients completed the study, with a mean duration of DMO of 40 months
(compared with 20 months in RESTORE). Mean change in BCVA improved from +4.9 letters (M12) to +6.5
letters (M18) with a mean of 6.8 and 8.5 injections respectively. CRT decreased from −127μm (M12) to
−150μm (M18). No new safety findings were reported.
Conclusion: Initial VA gains were maintained with a bimonthly monitoring regimen over 12 months, offering a
lower intensity regimen as a strategy for the longer term management of some patients with VI-DMO.
3.
Translational bypass therapy using ataluren to treat nonsense-mediated choroideremia
Mariya Moosajee, Dhani Tracey-White, Clare Futter , Tony Moore, Andrew Webster, Miguel Seabra
Introduction: Choroideremia (incidence 1:50,000) is an X-linked recessive disorder characterised by a
progressive chorioretinal dystrophy. Ataluren is a small molecule drug, which suppresses disease-causing
nonsense mutations and partially restores functional protein. Over one-third of choroideremia patients harbour
nonsense mutations in the CHM gene, hence translational bypass therapy may be a viable treatment option.
The choroideremia zebrafish (chm-/-) is the only animal model with a nonsense mutation in the chm gene and
displays similar ocular phenotype to patients.
38
Birmingham 2014
Purpose: To identify an effective treatment for choroideremia.
Method: Mutant chm-/- embryos were treated with 10 μM ataluren from 10 hours post-fertilization. The chm
mutation causes embryonic lethality (mean survival 4.8 ± 1.0 days); survival was determined following
ataluren treatment (n=63). Retinal ultrastructure was examined using electron microscopy at day 6 and 10.
Levels of oxidative stress and apoptosis in the retina were measured using dihydroethidium staining and
TUNEL assays, respectively. Functional rep1 protein was detected by Western blot analysis and in vitro
prenylation assays.
Results: Ataluren-treated chm-/- embryos lived 2.0 fold longer (mean survival 10.1 ± 1.6 days); p<0.0001.
There was significant rescue of retinal degeneration at day 6 and 10, with reduced levels of apoptotic cell
death and oxidative stress in treated chm-/- embryos. Western blot detected rep1 protein in treated chm-/samples with active prenylation function.
Conclusion: This study provides ‘proof-of-concept’ for using ataluren as translational bypass therapy for treating
nonsense-mediated choroideremia and may be applicable to other inherited eye disorders with a similar
genetic aetiology.
4.
Metabolomic Analysis of Serum in Graves’ Disease and Thyroid-Associated Ophthalmopathy: A
Diagnostic Tool?
Matthew R Edmunds, Kristien Boelaert, Jayne A Franklyn , S John Curnow, Omar M Durrani, Stephen P Young
Introduction: Although 30-50% of those with Graves’ Disease (GD) develop Thyroid-Associated
Ophthalmopathy (TAO) it is not yet possible to predict which will be affected, nor which will be in the 3-5%
developing sight-threatening manifestations. It is known that distinct pathologies result in specific metabolic
derangements. Metabolomics, the analysis of metabolite profiles in tissues or biofluids, has been shown to
have the potential to derive a “metabolic fingerprint” with biomarker potential for a range of conditions (e.g.
diabetes mellitus, rheumatoid arthritis, multiple sclerosis).
Purpose: To assess metabolomic profiling as a novel means of differentiating a large cohort of GD, TAO and
healthy control (HC) subjects, while also investigating underlying pathological processes.
Method: Nuclear magnetic resonance spectra of the serum of 110 TAO (20 clinically active, 90 quiescent), 67
GD and 78 age- and sex-matched HC were acquired. Thyroid autoantibody status and PTPN22 GD
susceptibility genotype were established. Data were subject to principal component analysis (PCA) and partial
least squares discriminant analysis (PLS-DA). Correlation between metabolite profiles, GD and TAO diagnostic
criteria, PTPN22 genotype and thyroid autoantibody status were assessed.
Results: Metabolomic analysis of serum was able to segregate TAO subjects from those with GD and HC. It
was also possible to discriminate those with active and inactive TAO as well as severe and mild TAO. There
was also good segregation of subjects by thyroid autoantibody status and PTPN22 genotype.
Conclusion: Metabolomics offers the possibility of discriminating GD and TAO patients of different activity and
severity and may represent a useful diagnostic, prognostic and monitoring tool in these conditions.
5.
The effects of anti-VEGFS on human tenon’s fibroblast growth in vitro
Nurul Nabila Baharudin, Siti Munirah Mohd Noh, Siti Hamimah Sheikh Abdul Kader, Jonathan Crowston,
Zakaria Bannur, Sushil Kumar Vasudevan
IMMB,UITM
Introduction: Anti-VEGF agents have received recent interest because they could be potentially used as antifibrotic agents in concurrent with trabeculectomy surgery. Recent preliminary cohort studies have pointed that
there is some improvement of the bleb morphology following trabeculectomy with ranibizumab and
bevacizumab. The effects of these humanized monoclonal antibodies on human Tenon’s fibroblasts (HTF) as
well as the effector cells of post trabeculectomy scar formation however, are not known.
Purpose: This study was conducted to determine the effectiveness of ranibizumab and bevacizumab on HTF.
Method: The effects of ranibizumab and bevacizumab on HTF proliferation and cell viability were determined
by using MTT-based assay (3-(4, 5-dimethylthiazone-2-yl)-2, 5-diphenyl tetrazolium). Ranibizumab and
bevacizumab at concentrations ranging from 0.01 to 0.5 mg/mL and 0.25 to 12.5 mg/mL respectively were
administered for 24, 48, and 72 hours in serum and serum free conditions. Supernatants from the treated and
untreated control cultures were also assessed for fibrosis-related protein using ELISA.
Results: Ranibizumab and bevacizumab at 0.5 mg/mL and 12.5 mg/mL concentrations induced significant cell
death after 48-hours under serum-free culture condition. No significant increases in the caspase 3 were seen in
39
Birmingham 2014
those cultures treated with ranibizumab. However, its level was significantly elevated in bevacizumab treated
group compared to the control monolayers.
Conclusion: Ranibizumab and bevacizumab at 0.5mg/mL and 12.5mg/ml induces significant reduction in
cultured HTF and this occurred in a dose-dependent manner. A significant impact on caspase 3 level was
observed only with bevacizumab treatment but not by ranibizumab. Further studies are underway to determine
the mechanism of cell death.
6.
A case for re-defining the intraocular pressure referral threshold: Findings from the UK Biobank
Michelle Chan , Carlota Grossi Sampedro, Stephen Vernon , James Morgan , Praveen Patel , Peng Khaw, Paul
Foster
Introduction: UK optometrists were advised to refer anyone with intraocular pressure (IOP) >21mmHg to
exclude glaucoma, even without additional risk factors. This sharply increased hospital referrals without
improving the diagnostic yield. The value of 21mmHg (two standard deviations above the population’s mean
IOP) was derived from a 1960s population survey using Goldmann applanation tonometry, but most
optometrists base their referrals on non-contact tonometry, which raises the question whether >21mmHg is
relevant to current referral practice. The UK Biobank is the largest ophthalmic cohort study in the UK, and
presents a unique opportunity to examine the IOP distribution in a UK population.
Purpose: To describe the age-specific IOP distribution by non-contact tonometry in the UK Biobank cohort,
and to estimate the impact of varying the IOP threshold on referable numbers.
Method: A single IOP measurement was taken on each eye using the Ocular Response Analyser, a non-contact
tonometer (NCT). Goldmann-correlated IOP (IOPg) in the left eye was used in all analyses.
Results: IOPg data were available for 65,026 participants (mean age 57.4 years, range 40.0-72.0 years; 54.3%
women). Mean IOPg was 15.7mmHg (SD 4.0mmHg, 95% CI 15.6-15.7mmHg). The age-specific mean
IOP+2SD for men varies between 23.3-24.7mmHg, for women it varies between 22.2-24.1mmHg. Raising the
referral threshold to >24mmHg would reduce the number of referable subjects by 68.1%.
Conclusion: The study population’s mean IOP+2SD measured with an NCT was higher than the conventional
Goldmann referral threshold of 21mmHg. This makes a strong case for increasing the non-contact IOP referral
threshold in patients without additional glaucoma risk factors.
7.
Can we replace Temporal Artery Biopsy (TAB) with Cranial Duplex Ultrasound (CDUS) in the diagnosis
of Giant Cell Arteritis (GCA)?
Adam Croft, Nicola Thompson, Martin Duddy , Fazal Khattak, Susan Mollan, Paresh Jobanputra
Introduction: TAB is currently considered the ‘gold standard’ diagnostic test for GCA.
Purpose: The aim of this study was to evaluate the diagnostic utility of CDUS in patients with suspected GCA.
Method: All patients undergoing CDUS between Jan 2005 and July 2011 were identified. American College of
Rheumatology (ACR) criteria for GCA were used to classify patients. CDUS reports were independently
classified. The relationship between the ACR criteria alone or in combination with CDUS and a final clinical
diagnosis of GCA (made after a minimum of 3-month follow-up) was analysed.
Results: 87 patients were included. 36 patients had a confirmed clinical diagnosis. When compared to clinical
diagnosis at 3 months, the sensitivity of CDUS was 81%, specificity 98%, positive likelihood ratio (PLR) 41 ,
negative likelihood ratio (NLR) 0.2, positive predictive value (PPV) of 97% and negative predictive value (NPV)
of 88%. In contrast, when compared to clinical diagnosis at 3 months TAB had a sensitivity of 53%, specificity
100%, PLR 2.3, NLR 0.2, PPV 100%, NPV 47%.
Conclusion: CDUS had a greater sensitivity than TAB and a comparable specificity to diagnose GCA. CDUS
was the strongest predictor for a diagnosis of GCA at 3 months, whereas ACR criteria when used alone were
insufficiently specific. In contrast, the high positive and negative predictive value of CDUS over TAB indicates
that TAB may be unnecessary particularly where clinical suspicion of GCA is high or quite low.
8.
OCT Findings in Children with Bardet Biedl Syndrome
Peter Good, John Ainsworth, Marie Tsaloumas , Alaistair Denniston, Denise Williams
Birmingham Childrens Hospital
Introduction: Bardet Biedl syndrome (BBS) is one of the Ciliopathies with multi organ involvement, but with
retinal dystrophy being the most common abnormality. Retinal dystrophy is most commonly diagnosed by
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Electroretinography (ERG), but in children with BBS the ERG is not always abnormal. Ocular Coherence
tomography (OCT) may provide a more reliable indicator of early retinal dystrophy in BBS patients
Purpose: This study compares the OCT in BBS patients with normal individuals and those with Retinitis
Pigmentosa (RP), in order to identify whether the OCT in BBS shows some specific abnormalities which may
aid early diagnosis
Method: Fifty children (aged 3-16 years)with Genetically proven BBS underwent ERG and OCT examination.
The ERGs were performed under ISCEV stimulus conditions using lid electrodes. OCT were performed using a
Spectralis Spectral Domain OCT system. Two control groups of age and sex matched children (20 in each
group)were studied; one being normal controls, and the other having Genetically proven RP. Statistical analysis
was by Analysis of Variance.
Results: In the children with BBS 42(84%) showed reductions in the ERG b wave with a mean scotopic b wave
amplitude of 23.6 uV (sd 0.35)compared to 64.3 uV (sd 0.58)amongst the normal controls, and 18.5 uV(sd
0.32)in the group with RP. OCT findings included thinning of the outer nuclear layer (ONL) in 22 children
(28%), and fragmentation of the cones and central rods in 48 children(96%). Amongst those with RP 18 (90%)
showed thinning of the ONL and none showed fragmentation of the cones.
Conclusion: This study shows that OCT abnormalities are a more sensitive indicator of early retinal dystrophy
in children with BBS than the ERG, and that fragmentation of the cones is specific to BBS and not seen in RP.
9.
Analysis of the Hedgehog signalling pathway in periocular morphoeic basal cell carcinoma.
John Bladen, Caroline Thaung, Michele Beaconsfield , Michael Philpott
Centre for Cutaneous Research, Barts and The London
Introduction: The vast majority of eyelid tumours are basal cell carcinomas (BCC). Morphoeic BCC (mBCC) is
a particularly aggressive subtype, which invades local tissue and adjacent structures in an uncompromising
manner. The Hedgehog (Hh) signalling pathway, primarily mediated by Glioblastoma (GLI) transcription factors
are associated with development of BCC, usually through mutational inactivation of the Patched-1 (PTCH1)
gene. Despite the association of Hh and BCC, analysis of eyelid BCC have not been investigated at a
molecular level.
Purpose: Understand the signalling pathways that result in the development and aggressive nature of mBCC.
Method: Periocular morphoeic and nodular BCC tissue was obtained from the Moorfields Biobank; mBCC
(n=15) samples were compared to nodular BCC (n=10) and control tissue (testes, n=4). Expression of PTCH1,
smoothened (SMO), GLI1 and GLI2 were assessed in histological sections using immunohistochemistry and
immunofluorescence techniques. Semi-quantification was carried out comparing subtypes and control tissue
using Image J.
Results: Upregulation of the Hh signalling pathway was seen in mBCC compared to nodular and control
tissue. Interestingly, the stroma of the morphoeic subtype demonstrated higher intensity of SMO expression.
Conclusion: The Hh signalling pathway is significantly more upregulated in periocular mBCC compared to
nodular BCC. The magnitude of hedgehog signalling activity may define skin tumour phenotype. Activation of
the Hh pathway by adjacent ‘normal’ tissue in mBCC may play a role in its aggressive nature.
10. Evaluating the Use of Intravitreal Aflibercept in Patients with Choroidal Neovascularisation Secondary
to Pathological Myopia (mCNV): The MYRROR Study
Francesco Bandello
Introduction: Choroidal neovascularisation (CNV) is a frequent cause of central vision loss in patients with
pathological myopia.
Purpose: To evaluate use of intravitreal aflibercept (IVT-AFL) in patients with mCNV.
Method: MYRROR was a Phase 3, multicentre, randomised, double-masked, sham-controlled study. Patients
received 1 injection of IVT-AFL 2 mg/sham at baseline, followed by monthly assessments until Week 24.
Additional injections were allowed if disease persisted or reoccurred. The primary endpoint was the mean
change in best-corrected visual acuity at Week 24. From Week 24–48 patients receiving sham switched to IVTAFL 2 mg PRN.
Results: 122 patients were randomised to IVT-AFL (n=91) or sham (n=31). Baseline demographics were similar.
At Week 24, patients in the IVT-AFL and sham groups gained 12.1 and lost 2 letters, respectively (P<0.0001).
By Week 48, patients in the IVT-AFL and ‘sham/IVT-AFL’ groups gained 13.5 and 3.9 letters, respectively.
Patients in the IVT-AFL group received 2 injections (median) in week 0-8. The median number of injections in
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quarter 2–4 was 0. Patients in the ‘sham/IVT-AFL’ group received 3 (median) active injections between Week
24–44. More patients had ≥1 treatment-emergent adverse event (TEAE) at Week 48 with IVT-AFL vs sham/IVTAFL (70.3% vs 58.1%); however, the incidence of ocular TEAEs was similar (37.4% vs 38.7) and the majority
were mild. No deaths were reported.
Conclusion: In patients with mCNV, IVT-AFL was well tolerated and associated with clinically meaningful
improvements in visual outcomes. Despite few injections, improvements were maintained from Week 24–48
suggesting that short-term treatment may benefit many patients with mCNV.
11. Is socioeconomic deprivation independently associated with increased prevalence of diabetic
retinopathy?
Liying Low, Simon Ogston, Peter Wilson , Alex Yeong, Ritchie McAlpine, Una O'Colmain, Carrie MacEwen
Introduction: This is the first eye health equity profile conducted in East of Scotland to identify inequalities in
eye health care.
Purpose: To explore the association between socioeconomic deprivation and prevalence of diabetic
retinopathy (DR) in type1 and 2 Diabetes Mellitus(DM) patients in East of Scotland.
Method: We collected data on diabetic retinopathy screening from Scottish diabetes electronic record between
January2011-December2012.
Using the residential postcode, we obtained the overall Scottish Index of Multiple Deprivation(SIMD) score for
each patient.
We used multiple logistic regression to analyse the relationship between overall SIMD score and prevalence of
DR, adjusting for variables: age, gender, HbA1c, cholesterol levels & duration of disease.
Results: In patients with type 1 DM(n=1861), 88.2% attended their annual DR screening. Increased prevalence
of DR in type 1 DM was independently associated with higher overall SIMD score(OR 1.01, 95% CI 1.001.02,p=0.008), male gender(OR 1.32,p=0.015), higher HbA1c value(OR 1.35,p<0.001), higher cholesterol
levels(OR 1.174,p=0.03), younger age(OR 1.17,p=0.03), and longer duration of disease(OR 3.17,p<0.001).
93.5% of type 2 DM patients (n=18197) attended their annual DR screening. The prevalence of DR was not
independently associated with overall SIMD score(OR 0.998, 95% CI 0.995-1.000,p=0.074), but was strongly
associated with longer duration of disease(OR 1.99,p<0.001), higher HbA1c value(OR 1.22,p<0.001), lower
cholesterol levels(OR 0.93, p=0.001) and male gender(OR 1.19,p<0.001).
Conclusion: Socioeconomic deprivation is independently associated with increased prevalence of diabetic
retinopathy in type1DM patients. This highlights the need for targeted interventions to address inequalities in
eye healthcare.
12. Swept-Source Optical Coherence Tomography Assessment of Choroidal Thickness in Different Macular
Disorders
Salvador Pastor-Idoate, Maria Gil-Martinez , Stephen Charles , Susmito Biswas, David Henson , David B
McLeod , Paulo Stanga
MREH/ NIHR.Wellcome Trust CRF
Introduction: Swept-Source Optical Coherence Tomography (SS-OCT) allows the in-vivo characterization of
the Bursa Premacularis (BPM) and the Space of Martegiani (SM), as well as choroidal imaging.
Purpose: SS-OCT assessment of choroidal thickness (CT) and determination of the prevalence of the BPM and
SM in healthy eyes and eyes with various macular disorders.
Method: Retrospective, comparative and non-interventional study. 96 consecutive patients underwent
1,050nm SS-OCT (DRI-OCT1 Atlantis®, Topcon Corp, Japan). Macular CT was determined by measuring the
distance between the RPE and the choroid/sclera junction at three sites along a 500μm line centred on the
fovea of 48 healthy eyes and 95 eyes with macular disorders. Patients were categorised into four groups. The
prevalence of the BPM and SM was assessed.
Results: Mean age was 48±22 years for HE versus 59±20 years for the group with macular disorders (MDG)
(p<0.05). Mean CT was 253±95µ m for HE versus 205±105µ m for the MDG (p=000.9 CI 95% [11.9983.58]). Sub-group analysis showed significant differences in Age Macular Degeneration (AMD), High Myopia
(HM), Vitreomacular Adhesion (VMA) and/or Epiretinal Membrane (ERM) and Central Serous Retinopathy (CSR)
groups. BPM was present in 64.6% of HE versus 32.6% of MDG (p<0.05). SM was present in 52.1% of HP
versus 66.3% of MDG.
Conclusion: SS- OCT allows measurement of CT in different macular pathologies and assessment of the
cortical vitreous and prevalence of the BPM and SM. A thin choroid may be associated with AMD and High
Myopia and a thick one with CSR.
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13. Visual impairment and health inequalities: findings from UK Biobank (UKBB)
Phillippa Cumberland, Paul Foster, Peng Tee Khaw , Christopher Hammond, Pirro Hysi, Yanchun Bao,
Jugnoo Rahi
Introduction: UKBB is a major new resource for the study of eye health and disease.
Purpose: We investigated socio-economic factors associated with risk of visual impairment (VI) and with use of
optical correction.
Method: 109,097 participants had habitual (usual optical correction) acuity measured using the UKBB
computerised system based on LogMAR and were categorised: bilateral/unilateral normal vision (LogMAR 0.2
or better), near normal ( ≥0.2 to ≤0.3), socially-significant VI (SSVI) (>0.3 to <0.5) and low vision (0.5 or
worse). Socio-economic information included ethnicity, educational qualifications and employment status.
Multinomial multivariable analysis was undertaken. To demonstrate the strength of associations, adjusted risk
ratios (RR) for SSVI group are reported.
Results: The proportion with normal bilateral vision decreased by age group: 85% (21,274) in 40-49 years,
77% (26,783) in 50-59 years, and 72% (35,218) 60-70 years. Risk of all cause VI across the acuity spectrum
was consistently associated with increasing age, RR 1.07 [95% confidence interval 1.06, 1.073], being female,
RR 1.11 [1.05, 1.17], having no educational qualifications, RR 1.49 [1.32, 1.66], a higher deprivation score,
RR 1.07 [1.05, 1.08], being unable to work/unemployed, RR 1.58 [1.42, 1.77], and with any/all Black and
Minority Ethnic (BME) groups e,g, Asian, RR 1.87 [1.75, 2.01].
Conclusion: All-cause visual impairment across the spectrum is associated independently with lower socioeconomic, employment and education status, and with BME status in patterns that are not explained by risk of
underlying eye disease. This provides evidence for the inclusion of ophthalmic disorders/visual health in key
UK initiatives tackling Health Inequalities.
14. A British Ophthalmic Surveillance Unit (BOSU) study of severe adverse events associated with local
anaesthesia (LA) in cataract surgery
King's College Hospital
Introduction: To estimate current usage and the incidence of severe adverse events associated with LA for
cataract surgery
Purpose: (i) to estimate current usage of LA for cataract surgery, (ii) to estimate the incidence of severe adverse
events associated with each LA technique, (iii) to compare with our 2002-03 study, which had identical
methodology.
Method: A prospective, observational study. The British Ophthalmological Surveillance Unit (BOSU) sends a
monthly mailing to all senior UK ophthalmologists; for 13 months in 2012-3, BOSU asked for reports of
‘‘potentially sight-threatening or life-threatening complications of LA for cataract surgery’’. Reporting
ophthalmologists were sent a questionnaire. Current LA practice was assessed by another questionnaire, sent to
all on the BOSU mailing list.
Results: Cataract surgery comprised 3.4% general anaesthesia, 92.5% LA without sedation and 4.1% LA with
sedation. Of the estimated 325 000 LA’s, 8.7.% were peribulbar, 1.3% retrobulbar, 50.3% sub-Tenon’s, 0.9%
sub-conjunctival, 13.8% topical and 24.2% topical-intracameral LA. There were 20 reports of complications,
with 11 completed questionnaires received at the time of submission. There were 5 reports of globe perforation
(all peribulbar) and 3 reports of ‘‘Potentially life-threatening’’ complications. Because of likely under-reporting,
further complications probably occurred during the survey period.
Conclusion: This large survey found a lower reported rate of serious complications that may be due, in part, to
improved safety awareness, and a move away from sharp-needle techniques in recent years.
15. Cochrane review of 5-fluorouracil in trabeculectomy: too long overlooked?
Introduction: 1 in 50 people over 40y suffer chronic open angle glaucoma. Many undergo trabeculectomy
surgery with antimetabolite application used to prevent subsequent conjunctival scarring onto the sclera. This
study reviewed the use of one antimetabolite; 5-fluorouracil.
Purpose: To assess the effects of peroperative application and postoperative injections of 5-FU in eyes
undergoing trabeculectomy on risk of surgical failure and intraocular pressure (IOP) at one year.
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Method: We searched, amongst others, CENTRAL, Ovid MEDLINE, and EMBASE for randomised controlled
trials prior to 25 July 2013. We used standard methodological procedures expected by The Cochrane
Collaboration to extract data. Data were summarised using risk ratio (RR), and mean difference (MD), as
appropriate. Population subgroups were analysed separately (high risk of failure and primary trabeculectomy).
Results: In the primary trabeculectomy subgroup risk of failure was significantly reduced by peroperative and
postoperative 5-FU compared to placebo (RR 0.21, 95% confidence interval (CI) 0.06 – 0.68; and 0.67, CI
0.51 – 0.88). IOP was reduced by peroperative 5-FU (MD -1.04, CI -1.6 – -0.43) and postoperative 5-FU (MD
-4.67, CI -6.60 – -2.73). The greater reduction in IOP in postoperative 5-FU eyes compared to peroperative 5FU was statistically significant.
The greatest benefit was in the high-risk population subgroup with postoperative 5-FU (surgical failure RR
0.44, CI 0.29 – 0.68; IOP MD -16.30, CI -18.63 – -13.97).
Conclusion: The small but statistically significant reduction in surgical failures and IOP at one year in the
primary trabeculectomy and high-risk groups must be weighed against the increased risk of complications and
patient preference.
16. The impact of congenital profound or severe visual impairment (VI) on behaviour development and
difficulties in the early years
Michelle O'Reilly, Elena Sakkalou, Hanna Sakki , Michelle de Haan, Alison Salt, Naomi Dale
Introduction: Congenital visual impairment (VI) is associated with later autism and behaviour difficulties (Parr
et al., 2010) but the early impact on behaviour development and difficulties has not been systematically
studied.
Purpose: This study sets out to investigate early behaviour problems in the context of profound or severe
congenital VI and forms part of the first national UK longitudinal study of 100 VI infants (Optimum VI project).
Method: 30 children (mean age 2.2 ± 0.3 yrs) with ‘simple’ congenital disorders of the peripheral visual system
(globe, retina, anterior optic nerve) – 9 profound VI (light perception at best), 21 severe VI (basic levels of
‘form’ vision on standard Near Detection Vision Scale – NDVS, Sonksen 1983). Parent-rated behaviour was
assessed on the Achenbach Child Behavior Checklist (CBCL, Achenbach 2001) and non-parametric analyses
were conducted.
Results: The PVI group had significantly higher behavioural problems in Internalizing (anxious/depressed and
withdrawn behaviour, p=0.04), Emotionally Reactive (e.g. ‘disturbed by change’, p=0.04) and Pervasive
Developmental (e.g. ‘afraid to try new things’, p=0.04) compared to the SVI group. A significant negative
correlation was observed between NDVS scores and CBCL Internalizing problem T scores, r=-0.36, p=0.047,
with lower vision level scores associated with higher internalizing behaviour problems.
Conclusion: As early as two years VI children are at significant risk of ‘internalizing’ and ASD-like pervasive
behaviour problems, highlighting the early behavioural vulnerability of this population and the possible
protective role on behavioural development of developing some ‘form’ vision by the second year.
17. Redefining wolfram syndrome in the molecular era
Patrick Yu-Wai-Man, Grant Guthrie, Kamil S Sitarz , Angela Pyle, Rita Horvath, Philip G Griffiths, Patrick F
Chinnery
Introduction: Wolfram syndrome is a progressive neurodegenerative disorder that was historically defined by a
cluster of common clinical manifestations: diabetes insipidus, diabetes mellitus, optic atrophy and deafness
(DIDMOAD). Although genetically heterogeneous, the majority of affected patients harbour pathogenic
mutations within the WFS1 gene (4p16.1) inherited as an autosomal-recessive trait.
Purpose: To define the clinical and molecular features of Wolfram syndrome.
Method: This study included twenty probands with suspected inherited optic atrophy in whom previous
molecular investigations had failed to identify pathogenic mitochondrial DNA mutations, and mutations within
the OPA1 and OPA3 genes. The entire WFS1 coding region was sequenced using genomic DNA samples
extracted from peripheral blood leukocytes.
Results: Pathogenic WFS1 mutations were identified in five probands. Three probands harboured compound
heterozygous autosomal-recessive WFS1 mutations. In two probands, single heterozygous autosomal-dominant
WFS1 mutations were found. A wide clinical spectrum of varying disease severity was observed: (i) optic
atrophy and early-onset sensorineural deafness (n = 2), (ii) optic atrophy and late-onset diabetes mellitus
(n =1), and (iii) a progressive neurodegenerative phenotype (n = 2), with only one patient fulfilling the
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DIDMOAD criteria. Based on our epidemiological data, the minimum prevalence of this disorder is estimated
at 1 in 440,000 in the North of England.
Conclusion: The greater availability of WFS1 testing has expanded the clinical phenotypes associated with
Wolfram syndrome. Interestingly, WFS1 mutations can exhibit an autosomal-dominant mode of inheritance.
Genetic screening should therefore be considered in suspected cases of inherited optic atrophy, especially if
associated with sensorineural deafness or diabetes mellitus.
18. Glaucoma prescribing trends in England 2000 to 2012
Introduction: In 2009 NICE published guidance on the treatment of ocular hypertension and glaucoma. The
introduction of NICE guidelines has not been without controversy, with unintended changes in the referral
behavior of community optometrists. It is as yet unclear whether these additional referrals have resulted in an
increase in glaucoma detection or treatment.
Purpose: The aim of this study is to describe the impact NICE guidance has had on glaucoma prescribing and
to describe recent glaucoma prescribing trends.
Method: When community pharmacies dispense medication they seek reimbursement from the NHS Business
Authority who collate and publish this data. We extracted and analysed all data relating to glaucoma
medicines from Prescribing Cost Analysis reports produced by NHS Business Authority for the years 2000 to
2012.
Results: The number of prescriptions dispensed has increased by 67% from 4.76 million in 2000 to 7.96
million in 2012 Over the same time period drug costs have increased by 88% from £55.2 million to £103.7
million. Prescriptions for prostaglandin analogs has increased four fold whilst there has been a three fold
decrease in the use of beta blockers. The introduction of generic latanoprost in 2012 has more than halved the
cost associated with this medication.
NICE guidance has had no effect on the total number of prescriptions or the classes of medications prescribed.
Conclusion: The introduction of the NICE guidelines has not changed glaucoma prescribing practice, though it
is not clear whether this represents non-adherence to the guidelines or whether the guidelines embodied preexisting practice.
19. Corneal calcification and phosphate buffers - Do you need to prescribe phosphate free?
Magdalena Popiela, Nicholas Hawksworth
Singleton Hospital
Introduction: Both superficial band kerotopathy and deeper calcareous calcification have been linked to the
presence of phosphate buffers in topical ophthalmic medicines. The European Medicines Agency (EMA) has
concluded that patients with ocular surface disease are at greatest risk. This potential side effect should be
highlighted to both prescribers and patients.
Purpose: To review the excipients of commonly prescribed ophthalmic medicines in order to prepare a list of
phosphate buffered drugs, and also to investigate where to find this information.
Method: We reviewed 77 commonly used ophthalmic drops and ointments looking for the information about
their buffering agents. We reviewed information written on drugs’ boxes, bottles, patients’ leaflets, and in
electronic Medicines Compendium (eMC), which contains up to date details of all medicines licenced for use
in the UK. The British National Formulary (BNF) was also reviewed.
Results: We found 20 phosphate-buffered, 14 non-buffered and 43 ophthalmic drugs containing buffers other
than phosphate based. Most displayed the list of their excipients on their boxes and in patient’s leaflets. This
information was also available on the eMC but not in the BNF. Despite the EMA recommendation none of the
phosphate buffered medicines mention corneal calcification as a potential side effect.
Conclusion: We present an easy reference list of phosphate buffered ophthalmic drugs to be used in caution
especially in patients with compromised ocular surface. We found electronic Medicines Compendium to be a
reliable and easily accessible source of information about drugs’ components. We suggest that this information
should also be included in the BNF.
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ABSTRACTS: Audit & Clinical Governance
20. One year experience with ‘Nurse Injectors’ in a busy Macular service
Deepali Varma, K Davies , K Stoddart
Introduction: Specialist nurses administering ‘intravitreal’ therapy (IVT) under consultant supervision is now
supported by the Royal College of Ophthalmologists’ and the Macular Disease Society. Several units across the
UK have introduced this post to meet the increasing demand for IVT.
Purpose: To audit the IVT procedures performed by specialist macular nurses over a 12 month period at a busy
eye unit.
Method: Data including diagnosis, visual outcomes, complications and patient experience was collected
prospectively in consecutive patients suffering from wet Age related Macular Degeneration (AMD) and
Diabetic Macular Edema (DME) undergoing IVT.
Results: A total of 2945 intravitreal Ranibizumab (Lucentis™) injections were performed by four specialist
macular nurses between 1st October 2012 and 30th September 2013 for wet AMD (n= 2898) and DME (n=
47). Besides optimal visual and anatomic outcomes, patient surveys showed high levels of patient satisfaction.
Significant complications included corneal abrasion (n= 5), raised intraocular pressure (n= 1) and mild vitreous
haemorrhage (n=1). No cases of retinal detachment, cataract or endophthalmitis were seen.
Conclusion: Our 12 month experience demonstrates that IVT performed by trained nurses did not pose a
higher risk of complications compared to those performed by ophthalmologists despite the differing indications
for IVT.
Patient choice, consultant judgment and clearly defined protocols are key factors for optimal outcomes
following introduction of nurse injectors. This service innovation has transformed our macular service and
improved clinical outcomes through timely treatment.
21. Engaging children in feedback: Use of an animated toolkit for recording feedback of patient
experiences from children and young people in ophthalmology services
Robbie Walker, Yvette Annan, Mally Scrutton, Tim Withers, Jo Hancox
Moorfields eye hospital
Introduction: Patient reported experience measures (PREMs) are important in the assessment and planning of
healthcare services. When asked, children are keen to be involved in decisions about their care. We report the
use of an animated toolkit to engage young people in feedback.
Purpose: To demonstrate the effective use of an interactive, animated computer program specifically designed
for children and young people to collect feedback in paediatric ophthalmology services.
Method: Patient feedback was gathered using specially commissioned, age appropriate, animated
questionnaires on a hand held tablet computer devices in Ophthalmology clinics and a surgical day care ward
by trained play specialists.
Results: 287 young people and 157 children completed the questionnaire. The majority of were happy with
their care. Areas for improvement included clarity over who each member of the team was and information
about the effect of the eye drops. 86% of children would recommend their friends attended the eye clinic if
they had an eye problem.
Conclusion: This age appropriate, interactive, animated tool based on an appealing medium such as a tablet
computer provides an excellent opportunity to engage children and collect feedback, thereby involving them
in their care. Feedback can be used to improve childrens’ experience in clinics and directly involve them in
their clinical care, as well as to shape and improve services of the future, guiding healthcare planning and
resource allocation.
22. Use of lumbar punctures in the investigation of ocular syphilis
Ian Reekie, Yavische Reddy
University of KwaZulu Natal
Introduction: Ocular syphilis is rare in the developed world, but is a common presentation to ophthalmology
departments in South Africa. A lumbar puncture is usually advocated to exclude progression to neurosyphilis,
but these are often omitted due to lack of consensus on the need for their use.
Purpose: To determine the proportion of ocular syphilis patients who are investigated by lumbar puncture and
to ascertain the proportion of lumbar puncture results that are suggestive of neurosyphilis in this patient
population.
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Method: Admissions for ocular syphilis at Addington Regional hospital and St Aiden’s mission hospital in
Durban, South Africa in a 20 month period were audited. These patients’ records were retrieved and their
diagnosis by serological tests confirmed. If a lumbar puncture had been performed the results of tests requested
on the CSF were examined for abnormalities suggesting neurosyphilis.
Results: 31 of 68 patients (45.6%) with confirmed ocular syphilis were investigated by lumbar puncture. Of
these, 8 (25.8%) had CSF findings suggestive of neurosyphilis (positive CSF VDRL or FTA and/or lymphocytic
pleocytosis, high protein and low glucose) and so should be under the care of infectious diseases physicians.
Conclusion: Many of this series of patients with ocular syphilis were found to have CSF findings suggesting
neurosyphilis. This suggests that lumbar punctures should be performed on all patients presenting with ocular
syphilis. In this series, only 45.6% of patients with ocular syphilis were investigated by lumbar puncture,
meaning that a significant number of possible neurosyphilis cases may have been missed, and the patients not
properly followed up.
23. Safety in nurse-led corneal collagen cross-linking
Melanie Mason, Dan Gore, Bruce Allan
Introduction: Corneal cross-linking (CXL) is the only treatment proven to halt disease progression in
keratoconus. In our hospital we have trained nurses to perform CXL.
Purpose: The aim of this study was to demonstrate that a nurse-led CXL service is as safe as that performed by
an ophthalmologist.
Method: Design: Prospective audit
Eyes with evidence of recent disease progression underwent epithelium-off rapid CXL (irradiance 4mW/cm2)
by either a post-CCT ophthalmologist or a senior nurse. The nurse underwent both didactic and practical
instruction in taking informed consent, corneal tomography interpretation, epithelial debridement, ultraviolet
(UV) light delivery, applied pharmacology and one-week slit-lamp biomicroscopy follow-up with bandage
contact lens removal. Training followed a strict competency-based approach over several months. The nurse
was signed off as a competent solo practitioner after 20 supervised CXL cases. The primary safety standards at
one week following treatment were no episodes of infective keratitis or UV-related corneal decompensation.
Results: CXL was performed on a total of 210 eyes, of which 49 (23%) were performed by the nurse. No
episodes of infective keratitis or corneal decompensation occurred in either group. One transient peripheral
sterile corneal infiltrate occurred in both the nurse-treated and ophthalmologist-treated groups. One severe
sterile corneal melt and 1 recurrent corneal erosion occurred in patients treated by an ophthalmologist.
Appropriate ultraviolet-light power settings and riboflavin application timings were correctly delivered in all
cases in both groups.
Conclusion: Nurse-led CXL is as safe as that performed by ophthalmologists.
24. WOScOTT. The West of Scotland Optometrist Teach And Treat Clinic: Shaping the future of Community
Ophthalmology in Scotland
Kaleena Michael, Maria Elena Gregory, Manish Gupta , Janet Pooley, Donald Cameron
NHS Greater Glasgow and Clyde
Introduction: The new Scottish General Ophthalmic Services contract encouraged the shift of a proportion of
ophthalmic care from hospitals into the community. NHS Education for Scotland (NES) developed the Teach
and Treat Model to allow Optometrists to gain clinical experience by treating hospital patients under
Consultant supervision.
Purpose: This audit seeks to establish whether this Service Innovation provides measureable benefits to
community Optometrists.
Method: Prospective Audit of clinical outcomes of the first year
Patient Satisfaction questionnaire
Optometrists on-line questionnaire at completion of training.
Results: 78 Optometrists treated 1298 patients in 12 months under the supervision of 2 Consultant
Ophthalmologists . Case mix included adnexae (31.2%), anterior segment (29.8%), posterior segment (22.1%)
and glaucoma (3.9%). 40% of patients had procedures/investigations in clinic, 42.1% treated and discharged
at first visit, 16.6% listed for surgery, 6.8% referred to other sub-specialties. All patients felt they were treated
politely, their privacy and dignity was maintained, and their condition clearly explained. All optometrist
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reported improved knowledge and diagnostic ability, with 80% reported increased confidence and 40%
reported reduced referral to hospital.
Conclusion: This training programme provides experiential learning for optometrists, increases their confidence
in managing a variety of non-sight threatening eye conditions in the community while recognising and
referring more complex conditions appropriately to the hospital Ophthalmologist. This may lead to better
streamlining of referrals to secondary care thus reducing the increasing pressures on the Hospital Eye Service.
25. Acute infective conjunctivitis – to swab or not to swab?
Siegfried Wagner, Ian C Bowler, Stella J Hornby
Introduction: Conjunctival swabs are frequently employed in infective conjunctivitis yet their impact on
patient management has not been explored.
Purpose: To evaluate the clinical utility of conjunctival swabs in the management of infective conjunctivitis.
Method: The microbiology database was retrospectively analysed for all patients presenting to the Eye
Casualty, between January 2011 and July 2013, where conjunctival swabs were taken. Microorganisms were
detected by culture for bacteria and polymerase chain reaction (PCR) for chlamydia and viruses.
Results: In total, 302 swabs were sent from 109 patients – 138 bacterial, 103 viral and 61 chlamydial.
22/138 (16%) of bacterial swabs were culture positive. The most frequent organisms were Staphylococcus
aureus (33%) and Streptococcus pneumoniae (33%). One case of Neisseria gonorrohoeae was accordingly
treated. All bacteria grown were sensitive to chloramphenicol.
58/103 (64%) of viral swabs were positive, the majority yielding Adenovirus (88%) and Herpes simplex (9%).
44 patients were offered follow-up; 6 did not attend. 20% of results were documented in the medical record.
Laboratory and follow-up costs alone approximated £6,500 for those, who had viral swabs sent.
9/61 (15%) chlamydial swabs were positive, with 4 occurring in neonates. All were documented in the
medical record. In one of the 9 cases was the diagnosis not suspected before testing.
Conclusion: The management of patients with infective conjunctivitis incurred significant laboratory costs and
unnecessary appointments. Bacterial culture did not reveal evidence of emerging resistance to
chloramphenicol. Conjunctival swabs have limited clinical utility, except in neonates and suspected
gonococcal/chlamydial conjunctivitis.
26. Demographics, referral patterns and management of patients accessing the Welsh Eye Care Service
Colm McAlinden, Helen Corson, Peter Garwood
Public Health Wales
Introduction: The Primary Eyecare Acute Referral Service (PEARS) and the Wales Eye Health Examination
(WEHE) are enhanced optometry services for patients residing in Wales, enabling the examination of a patient
presenting with an acute eye problem (PEARS) or those at higher risk of eye disease (WEHE).
Purpose: The purpose of the study is to assess the demographics of patients accessing this service, referral
patterns and clinical management.
Method: Information from 2302 patients accessing the service was prospectively collected. The following
information was obtained: type of examination, age, gender, self-referral or GP-referral and clinical
management.
Results: There were 1791 (77.8%) PEARS examinations and 511 (22.2%) WEHE. There were 1379 (59.9%)
females (mean age:58.61±19.75) and 923 (40.1%) males (mean age:56.11±20.42). The majority of patients
were self-referrals compared to GP-referrals (1793 [77.9%] versus 509 [22.1%] respectively). Sub-analysis
indicated similar numbers of self-referrals compared to GP-referrals for the WEHE only (297 [58.1%] versus
214 [41.9%] respectively) but significantly greater numbers of self-referrals for the PEARS examinations only
(1496 [83.5%] versus 295 [16.5%] respectively). For management, 75% of patients were monitored by their
optometrist/OMP, 17% required referral to the HES and 8% required referral to their GP.
Conclusion: Significantly higher numbers of females are accessing the service. The majority of patients selfreferred with 75% of patients being managed in the community by their optometrist/OMP, and 17% being
referred to the HES. These findings have important implications for public health campaigns both for targeting
specific groups, increasing awareness among GPs and demonstrating service cost effectiveness and efficacy.
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27. Initial experience with barely visible and subthreshold yellow wavelength Pascal® laser with and
without Endpoint Management® in diabetic patients
Maria Gil-Martinez, Salvador Pastor-Idoate, Yvonne D'Souza , Sajjad Mahmood, Stephen Charles, David
Henson, Paulo Stanga
MREH. NIHR/Wellcome Trust CRF
Introduction: The Pascal® photocoagulator is a semi automated system that delivers single or pattern-array of
multiple burns in a predetermined sequence and is now available with either 532nm Green or 577nm Yellow
(YW-PL) wavelength laser sources.
Purpose: To report on laser treatment parameters of barely visible YW-PL (with and without Endpoint
Management® (EpM®)) in patients with Proliferative Diabetic Retinopathy (PDR) and /or Diabetic Macular
Oedema (DMO)
Method: Retrospective observational case series of 38 procedures of barely visible laser. Patients categorised in
three treatment groups: 1- Single-session Panretinal Photocoagulation (PRP) 2-Focal or modified macular grid
3- Single-session PRP and macular grid
Results: A total of 38 procedures were performed using YW-PL in 30 patients; 21 (70%) males and 9 (30%)
females. The mean age was 59.81±11.53 (27.3-73.
Group
Number
of eyes
Mean number
of spots (Range)
Power mW
(SD)
Duration
msec
Spot Size
Âμ ("on air")
1-Single-session PRP
21
1845(196-2861)
364(74)
20
200
2-Focal or Modified Grid
11
255(77-533)
183(55)
10
100
2141 (888-2805)
370(67)
20
200
186(60-698)
150(36)
10
100
3-Single-session
PRP with
PRP
Macular Grid
Macular Grid
6
Burns could be partially visualized with fundus biomicroscopy and were later confirmed with fundus
autofluorescence. There were no peri-treatment laser-associated adverse effects or ocular complications
associated with the PRP or macular YW-PL array treatments.
Conclusion: Pascal® laser using 577nm wavelength with and without EpM® was found to be safe.
28. Natural history of patients receiving Lucentis for WET AMD: A 3-year prospective study
Ruth Peiwen Chen, Pankaj Puri
Royal Derby Hospital, Derby
Introduction: To establish the natural history and follow-up characteristics of patients attending a one-stop
intravitreal injection service for management of WET macular degeneration
Purpose: To estimate the incremental demand on the service
Method: 146 eyes treated at a one-stop intravitreal injection service were followed up for a period of over
three years or up to point of discharge. Data on their visual acuity were collected at presentation, 12 months,
24 months, 36 months or at discharge.
The reasons for premature withdrawal from treatment and the number of patients who returned to the service
with either a recurrence or involvement of the other eye were recorded.
Results: 146 eyes were recruited into the study. The mean visual acuity at presentation was 53 letters (95% CI:
50.67 – 55.38) with a median of 54 and a range of 21 to 85.
Of the 146 eyes, 138 were followed up at 12 months, 116 at 24 months and 79 at 36 months.
The main reasons for the withdrawal of patients were stabilisation of visual acuity (17 eyes), and death in 17
patients (21 eyes).
30 patients had second eye involvement in 3 years and 4 patients returned to the service after discharge due to
recurrence.
Conclusion: This audit gives valuable data demonstrating that 94.8% of patients were still attending the service
after one year, 78.4% after two, and 54.3% after three years of treatment. These figures help estimate the
demand for an effective workforce management.
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29. The Impact of Rationing Cataract Surgery in Gloucestershire
Miranda Buckle, Robert Johnston, Nicholas Price , John Ferris, John Sparrow, Graham Mennie
Introduction: In June 2010 the “Gloucestershire Cataract Assessment Questionnaire” (GCAQ) was introduced
after discussion between commissioners, community optometrists, and the hospital eye service. The aim was to
standardise referral practice, achieve a consistent threshold for surgery, and reduce cataract surgery volume to
save money.
Purpose: Here we audit the impact of the GCAQ on National Health Service cataract surgery volume and
patient visual acuity (VA) in Gloucestershire.
Method: Community optometrists applied the GCAQ prior to referral, and ophthalmologists when making
listing decisions. Data items extracted from an electronic medical record system include: best measure VA in
each eye pre-operatively and date of surgery.
Results: Mean annual cataract surgery volume had been approximately stable at 4100 cases per annum
between 2007-2010. After GCAQ implementation this dropped by 21% in year one, but only by 6.5% from
baseline in year two. Between 2007-2010 on average 57% of eyes had pre-operative VA worse than 6/12, but
after GCAQ implementation this increased by 8% in year one, and by 7.4% in year two. Between 2007-2010
on average 22% of patients had pre-operative visual acuity impairment (VA in better-seeing eye worse than
6/12). No change was noticed one year after GCAQ implementation, but in year two there was a 16%
increase in this cohort.
Conclusion: These data suggest that attempts to ration cataract surgery do not reduce permanently the volume
of surgery and may have had an adverse impact on patients’ quality of life. Development of a national
standard threshold for cataract surgery is needed to ensure patients are treated equitably.
30. Initial experience of neovascular AMD unresponsive to ranibizumab treated with aflibercept
Noa Fernandez Ledo, George Kiousis, Raeba Mathew , Helena Vrizidou, Sheena Koshy, Sobha Sivaprasad
King's College Hospital
Introduction: With the introduction of intravitreal aflibercept as a new NICE approved treatment for wet age
related macular degeneration (AMD) based on VIEW studies, there is increasing usage of this agent in patients
already being treated with ranibizumab . The aim of this study was to assess the anatomical outcomes of
patients switched to aflibercept irrespective of previous responsiveness to ranibizumab.
Purpose: Study the outcome of patients with wet AMD who have been treated with repeated intravitreal
injections of ranibizumab, and were switched to aflibercept.
Method: Retrospective study on OCT outcomes of patients switched to aflibercept after initial ranibizumab
therapy. The electronic medical records and the OCT scans were reviewed for the study period. Both
qualitative and quantitative evaluation of morphological changes at the macula were done to better understand
differences in the drying effect of these two agents.
Results: Records of 44 patients with a mean age group of 78 ± 9 years were reviewed. Prior to the switch, the
median visual acuity of the cohort was 53 (20-79) EDTRS. The average number of ranibizumab injections
given was 19 ± 10. The initial experience of changing from a ranibizumab PRN dosing regimen to aflibercept
treat and extend resulted in patients being treated with various injection regimes. Five months after initial
aflibercept injection and following an average of 3.84±0.83 injections, the central retinal thickness improved
by 71±83 microns from 375±102 to 300±91 (p<0.0001). The proportion of patients with intraretinal and
subretinal fluid improved from baseline, 61% vs 41% and 64% vs 32% respectively. In patients with pigment
epithelial detachment (PED), its height decreased by 37±97 (p=0.0016) microns.
Conclusion: Despite different dosing regimens of aflibercept used, the drying effect of the drug on the macular
fluid is significant in patients that are offered a choice to switch from ranibizumab to aflibercept
31. Predictors of Failure of Primary Surgery for Congenital Nasolacrimal Duct Obstruction
Mahmoud Nassar, Gordon Lau, Ayad Shafiq , Michael Clarke
Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle
Introduction: Congenital Naso-Lacrimal Duct (NLD) obstruction is the commonest cause of epiphora from
birth. Most cases resolve spontaneously, however, a few require surgical interference. We are investigating
success rates of surgery and possible risk factors for surgical failure.
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Purpose: To assess the success rate of primary surgery for Congenital NLD Obstruction and to investigate risk
factors of failure of primary surgery to cause resolution of symptoms.
Method: A retrospective case series of children undergoing primary surgery for Congenital NLD Obstruction.
Children included were under 10 years with persistent epiphora and/or discharge from birth not responding to
massage. Only primary procedures were included; and children with craniofacial or ocular abnormalities were
excluded. Collected data included age at first probing in months, gender, laterality and results of first probing
(failure based on need for repeat surgery).
Results: We identified 104 eyes of 77 patients between January 2011 and December 2012. 13 patients were
excluded (5 craniofacial abnormalities, 5 first surgery before January 2011, 2 over 10 years old and 1 ocular
abnormality) and 85 eyes of 64 patients were included. Age at first probing was 9 – 111 months (mean 29.65 +
19.52 SD), 33 (51.6%) were females and 31 were males. 43 (50.6%) patients had unilateral surgery and 21
had bilateral, there were 44 (51.8%) right sided surgery and 41 left sided. 66 (77.6%) eyes had single surgery
(60 probing and 6 intubation) and 19 required repeat surgery. There was no significant difference (p> 0.5) in
Gender, Laterality or Age at first surgery between the single and repeat surgery groups.
Conclusion: Primary surgery for Congenital NLD Obstruction has a 77.6 % success rate. Gender, Laterality and
Age at first probing were not risk factors for further surgery.
32. Sustainability in ophthalmic practice: are we hitting the triple bottom line?
J Somner, N Stone, Z Sipkova, A Koukoulli, G Lascaratos, G Jóhannesson, A Das, O Bowes, H Jewsbury, RL
Perrott-Reynolds, DS Morris, R Bourne, A Cassels-Brown, V Cross
Vision and Eye Research Unit, Anglia Ruskin University
Introduction: Sustainability is a priority in healthcare planning and physicians have a duty to advocate for the
cost effective and just distribution of finite resources.
Purpose: To assess whether abstracts accepted by the Royal College of Ophthalmologists for its Annual
Congresses between 2008 and 2013 feature examples of sustainable practice.
Method: The study included 1496 abstracts. Two raters independently assessed and classified each abstract.
Inter-rater reliability was assessed with the Kappa test. A third, independent rater arbitrated any disagreements.
Results: There was fair agreement between the raters (Kappa 0.374). Twenty six percent of abstracts related to
sustainable eye care. Fifty six percent of these were designed to save doctors’ time, money or reduce
complications and further management. Twenty one percent involved informatics, technology or staff
interventions that streamlined care pathways. Twelve percent related to primary and secondary preventive
measures, 11% promoted improved self-care and less than 1% focused on interventions that were specifically
designed to reduce the environmental impact of care. Between 16 and 38% of abstracts related to
sustainability each year. Sustainability topics featured in all sub-specialty sections, most commonly in the audit
and clinical governance section. Over 1000 authors and 150 organisations were involved in work on
sustainability.
Conclusion: Sustainable eye care interventions are commonly described but are not officially recognised or
flagged for attendees at meetings. Greater recognition and promotion of sustainable eye care might facilitate
research and dissemination of ideas that could increase social, ecological and economic capital.
33. The carriage of steroid treatment cards for uveitic patients
Simerdip Kaur, Moloy Dey, Adam Mapani , Francis Chiu, Narciss Okhravi
Introduction: The British National Formulary suggests that all patients on oral steroids for greater than 3 weeks
must be issued with and carry an updated steroid card. At present, there are no studies in the literature
defining current practice in the use of steroid cards in uveitic patients.
Purpose: To assess the proportion of uveitic patients on steroids who carry an up to date steroid card and are
aware of its significance. Also to assess the role of different healthcare professionals involved in its use.
Method: We prospectively collected responses in the form of a questionnaire from 77 patients who were on
oral steroids for at least 3 weeks at the time of their clinic appointment
Results: 99% patients owned a steroid card but 70% admitted that this was up to date. 74% of them carried it
to their appointment whilst however 79% knew the importance of doing both. 92% of patients were asked
about their steroid card by a hospital pharmacist. However, only 4% of both hospital doctors and nurses ever
enquired if the patient had a steroid card.
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Conclusion: Majority of patients on oral steroids are being issued with steroid cards. However doctors and
nurses need to be more proactive and involved in educating patients on the importance of possessing a steroid
card.
We have implemented training for nurses, pharmacists and doctors highlighting these results and have
developed an electronic poster making patients aware of the cards.
34. Stream-lining a busy macular service: Reducing the burden of 'inactive' wet age-related macular
degeneration patients.
Bushra Mushtaq, Abhijit Mohite, Huzaifa Malick
Sandwell General Hospital, Birmingham
Introduction: The need for close follow-up of patients treated with intravitreal Ranibizumab for wet age-related
macular degeneration (AMD) as per guidance from NICE has substantially increased clinical workload and put
a great stress on resources. Unfortunately however, there is no clear guidance about discharge policy in treated
patients once they are deemed 'inactive' (remaining intervention free for a period of one year or more).
Purpose: Previous audits found a delay in follow-up appointments for patients within our macular service. Our
aim with this study was therefore to identify patients treated in our macular service at Sandwell and West
Birmingham NHS Trust who were deemed to be 'inactive', so as to potentially reduce the burden on the
service and improve clinic flow.
Method: We undertook a retrospective review of patient records of all 1700 patients since the inception of
intravitreal Ranibizumab at our Trust, who were still under follow-up in our medical retina clinics. For patients
deemed inactive, we recorded reasons for continued follow-up.
Results: A total of 445 patients were identified as inactive, of which 136 (31%) could have been discharged
altogether. Of the remaining 309 patients, 112 had documented ocular co-morbidity requiring other subspecialty follow up. We therefore identified 56% (248/445) of inactive patients who could be followed up in
other ophthalmic services or discharged to optometrists.
Of the remainder, 47 had developed active wet AMD in the contralateral eye and 150 were patients with
“only eyes”, thus requiring closer ongoing monitoring.
Conclusion: A more careful use of follow-up appointments in a busy AMD service should allow for active
patients to be followed up sooner as per national guidelines. Giving clear instructions on how to contact the
medical retina service if they noticed sudden deterioration in either eye is paramount, since 10% (47/445) of
our inactive patients developed wet AMD in their second eye.
35. Is there a correlation between pain during intravitreal injection and the site of injection?
Jan Sniatecki, Mohan Varikkara, Zachariah Koshy
University Hospital Ayr, NHS Ayrshire and Arran
Introduction: Intravitreal injection has become one of the most common performed procedures in
Ophthalmology. Most of them deliver anti-VEGF agents, where multiple injections are required. Pain
accompanying the injection can have an influence on patient's compliance. There is scarse data investigating
pain and location of the injection.
Purpose: To evaluate whether different locations of intravitreal injection have an influence on patient reported
pain.
Method: The prospective study included 67 patients who received routine ranibizumab or aflibercept
intravitreal injection. Patients were randomized into four groups according to the different eye quadrant site of
injection. Shortly after the injection, patients were asked to rate their pain by the use of Visual Analog Scale
(VAS). Topical anaesthesia was standardized and the same injection technique applied in every group. Other
factors considered in this study included age, sex, indication for injection, grade of injector and diabetes
mellitus.
Results: The main indication for intravitreal injection was Age-Related Macular Degeneration 89%. Diabetic
retinopathy accounted for 13%, central / branch retinal vein occlusion 4%, inflammatory disease 1%. The
average pain score was 20,97; standard deviation 18,99. The minimum recorded pain score was 0, the
maximum 60. Mean pain scores for the following eye quadrant site of injections were: supero-temporal 23,82;
infero-temporal 20,43; supero-nasal 21,90; infero-nasal 21.29. There was no significant difference between the
four groups (p=0,896). No correlation between diabetes nor surgeon grade and the pain has been noted.
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Conclusion: This series does not show any correlation between pain and site of injection. Moreover, there is
no significant difference in pain between different surgeon grades who performed the procedure.
36. Efficacy of an educational intervention to improve adherence to NICE recommended follow up
intervals for Glaucoma.
Michael James Gilhooley, R Karim, R Vemala, P Abeysiri
Queen's Hospital, Romford
Introduction: NICE has reviewed the evidence to determine the appropriate interval between assessments of
glaucoma patients. The RCOphth suggests delayed appointments should be rescheduled within 15% of the
intended interval.
Purpose: 1. Quantify adherence to NICE guidelines on glaucoma follow up intervals.
2. Quantify delays from hospital & patient rescheduling.
3. Assess long-term efficacy of an educational intervention.
Method: Best practice
The intervals suggested in NICE Guideline 85 for OHT and COAG.
Current practice
Ascertained by a prospective audit of consecutive clinic patients recording:-Requested interval
-Actual interval
-Source of delay
-Diagnosis
-IOP control
-Evidence of progression
Intervention
A dedicated teaching session on the guidelines, emphasising follow up periods.
Re-audit
Identical methodology, repeated one year later.
Results: Initial Practice Re-audit
n= 119 83
Not Seen within recommended time:- 32% 32%
Pt cancelled 9% 15%
Hospital cancelled 23% 17%
Cancelled twice by hospital 3% 2%
Mean delay (months) 0.61 1.93
Mean interval 5.09 5.83
As percentage 12% 33%
Number of patients by diagnosis and proportion progressing were similar in both samples. In the re-audit,
fewer patients were outside of their ideal IOP and fewer had treatment changed.
Conclusion: 1. A third of patients had their appointments delayed beyond recommendations, however, length
of delays were small.
2. The source of the delay moved from hospital towards patients.
3. An educational intervention provided a modest improvement in compliance, which was negated by
increased patient cancellations: the next cycle should assess an intervention to reduce these.
37. 5 year audit of endophthalmitis following intravitreal injections without antibiotic prophylaxis
Roopa Vemala, Alastair Porteuos, Judith Field , Niaz Islam
Queens Hospital, Romford
Introduction: Topical antibiotics are used frequently in clinical practice in association with intravitreal
injections, although level 1 evidence for this practice does not exist,most ophthalmologists use prophylaxis to
protect them from litigation in a unlikely case of infection. The Royal College of Ophthalmologists guidelines
2009 recommended use of post injection topical antibiotics.The incidence of endophthalmitis is<0.1% in
Novartis wAMD safety outcome,0.02% in14,320 injections by Fintak et al and 0.049%in the meta analysis of
105,000 injections. However Bhavsar and N Bressler suggested that low rates of endopthalmitis can be
achieved using a protocol that includes topical povidine iodine, sterile lid speculum,topical anaesthetic but not
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requiring topical antibiotics. Bhavsar also reported a low rate endophthalmitis (0.007%) in 15,000 intravitreal
injections in absence of prophylaxis, stating povidine iodine is sufficient and no study has shown that any
medication reduces the risk of endophthalmitis post operatively.
Purpose: To evaluate the necessity of antibiotic prophylaxis for intravitreal injection in wAMD.
Method: Audit of incidence of endophthalmitis following intravitreal injections at Queens Hospital, BHR trust
between 2008 and 2013. We used a clean room, topical povidine Iodine, sterile set(gloves and speculum)and
appropriate asepsis. No antibiotics were given post injection.
Results: We had a total number of 6957 injections in 870 eyes of 749 patients.10 doctors administering
injections with an experience ranging 20 to 551 injections. The incidence of endopthalmitis was
0.04%(3cases),which is within the documented Novartis safety data.
Conclusion: We found no added risk to endophthalmitis when antibiotics were not given as prophylaxis post
intravitreal injection. Topical Povidone Iodine during the injection might suffice as prophylaxis
38. Situational Analysis of Quality Improvement Processes in Cataract Surgery in Madagascar
Rini Vyas, Hery Andriamanjato, Lea Raobela , Alice Harisoa, Johnathan Buchan, Andrew Cassels-Brown
Leeds Teaching Hospitals Trust
Introduction: The World Health Organisation / International Agency for the Prevention of Blindness initiative
‘Vision 2020’ focuses on increasing the quantity of cataract surgery globally. However, little attention has been
paid to the quality of the surgery provided and visual outcomes. The implementation of Quality Improvement
Processes (QIP) for cataract surgery is a priority to achieve the agreed target of elimination of cataract
blindness.
Purpose: A situational analysis questionnaire was conducted in Madagascar to determine current cataract
surgery QIP, with the aim of informing future changes towards a quality culture.
Method: A questionnaire was designed to evaluate general quality; surgical quality; personal development;
patient and community. It was pre-tested and administered in Madagascar to ophthalmologists representing
different units, experiences and seniority, via feedback sessions and email.
Results: Thirteen ophthalmologists completed the questionnaire. Ten respondents stated their department
carried out some QIP, commonly cataract surgery auditing. All ophthalmologists were able to compare their
results against previous years, but only three were aware of their hospital’s results and international standards.
Five stated their hospital evaluates personal development. Eleven thought patient satisfaction should be
monitored but only three reported collecting patient feedback.
Conclusion: Basic QIP in Madagascar have been highlighted, particularly surgical audits. More awareness on
available benchmarks may help to standardise results across centres and encourage quality improvement.
Formal systems for personal development appraisals and handling patient complaints would further support a
quality culture. This study has identified areas where long-term QIP can be implemented, in partnership with
local ophthalmologists, to improve cataract surgery outcomes in Madagascar.
39. Ozurdex Outcomes in Retinal Vein Occlusion with Macular Oedema
Valerie Juniat, Eleni Tsolakou, Nishal Patel
Kent and Canterbury Hospital
Introduction: Ozurdex is a biodegradeable intravitreal steroid implant that is currently NICE approved for
treatment of patients with MO due to RVO.
Purpose: This retrospective audit aimed to evaluate the visual outcomes, anatomical outcomes, and
complications in patients treated with Ozurdex for MO secondary to RVO.
Method: Data was collected using Medisoft and Topcon OCT imaging. Data was analysed using Microsoft
Excel and statistical analysis was carried out using Medcalc software.
Results: 182 Ozurdex implants were carried out over 15 months between 2012 and 2013. 115 procedures
were included in the audit. 6% were lost to follow up. The average time interval between pre-treatment
baseline visual acuity (VA) and post-treatment final VA was 6 months (range 2 to 19 months). Mean difference
in VA post-treatment was -0.08 (Logmar). OCT analysis showed average central retinal thickness (CRT)
reduction of 159µ m post-treatment. Complications included cataract formation (4.4%) and raised intraocular
pressure >35mmHg (4.3%). 3.4% patients converted into ischaemic vein occlusion.
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Conclusion: This audit demonstrated that Ozurdex implantations achieved anatomical improvement in patients
with MO secondary to RVO that did not correlate with visual improvement. It also highlighted a lack of
rigorous measures for reviewing patients post treatment. The audit recommends a dedicated retinal vein
occlusion service to ensure patients are reviewed in clinic at appropriate time intervals to achieve better
outcomes. Alternative treatment modalities such as laser treatment and anti-VEGF injections should be
available for patients who do not achieve visual improvement with Ozurdex, and vice versa.
40. Implications of multiple intravitreal injections for subsequent cataract surgery
Jack Gormley, Mark Costen,
Hull & East Yorkshire Eye Hospital
Introduction: The use of intravitreal therapy for conditions affecting the posterior segment continues to grow,
with many patients in the original wet AMD cohort having in excess of 40 injections of anti-VEGF therapy per
eye. Anecdotally, patients who have had multiple intravitreal injections are often noted to have more dense
cataracts, with potentially more challenging surgery at the time of phacoemulsification.
Purpose: To ascertain whether cataract surgery following multiple intravitreal injections was associated with a
greater number of surgical difficulties and / or complications during subsequent cataract surgery
Method: We identified 29 patients retrospectively from the hospital wet AMD database who had received in
excess of 5 intravitreal anti-VEGF injections and who had also undergone subsequent cataract surgery.
Operative details were taken from the operation note, and details including phaco power used, intraoperative
complications, use of capsular tension ring and surgeon's comments, were recorded.
Results: 29 patients (74-93y) were identified, who had received between 5 and 29 intravitreal injections of
anti-VEGF therapy, and who had also had cataract surgery performed by a senior surgeon. 6 patients (20.7%)
had intraoperative difficulties reported. 3 patients had unstable capsular bags requiring capsular tension ring
insertion. 4 patients were noted to have extremely dense cataracts peroperatively, one of whom developed
corneal decompensation postoperatively. 1 patient had a dropped nucleus.
Conclusion: Although limited in scope, this small retrospective study suggests that cataract surgery in patients
undergoing multiple intravitreal injections may be more problematic than 'normal'. This raises important
considerations in terms of taking informed consent for these patients, appropriate case-mix stratification, timing
of surgery, and ensuring the skill level of the surgeon is appropriate for the case in question. Further
prospective study into this area is planned.
41. Cardiopulmonary resuscitation and the stand-alone ophthalmic unit
Priscilla Mathewson, Samer El-Sherbiny
Birmingham Midland Eye Centre
Introduction: A safe protocol for patients who become acutely unwell or sustain cardiopulmonary arrest whilst
in a stand-alone ophthalmic unit is essential and requires detailed risk assessment.
Purpose: To establish the frequency of emergency medical and cardiopulmonary arrest calls at our institution
over a 10-year period and to survey practice in similar stand-alone ophthalmic units.
Method: Switchboard records were searched for all ‘2222’ and ‘999’ calls from our institution between June
2003 and June 2013. Seventeen months of consecutive ‘2222’ call audio-records were analysed. An online
survey was conducted for the six stand-alone ophthalmic units in the United Kingdom to establish their
frequency of medical emergency calls, and management protocols.
Results: ‘2222’ calling was introduced to our institution in June 2005. There were an average of 2.3 ‘2222’
calls and 1.5 ‘999’ calls per month between June 2005 and June 2013. Only 9% of ‘2222’ calls and 7% of
‘999’ calls were made out of hours.
Four out of the six units surveyed dial ‘2222’ to access the Emergency Medical Response Team (EMRT) of an
affiliated general hospital. The remaining two units have an eye hospital based EMRT with a resident doctor on
site at night.
Conclusion: Cardiopulmonary arrest is an infrequent event in our unit with the majority of emergency medical
calls being made between 08:00 and 20:00. More information is required regarding predisposing factors and
patient outcomes across multiple centers before a safe protocol can be devised for emergency medical
assistance in a stand-alone ophthalmic unit.
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42. Missed pathology or disease progression? Follow up of patients with acute ‘flashes and/or floaters’
Shreya Haldar, Melanie Chak
Royal Berkshire Hospital
Introduction: Posterior vitreous detachment (PVD) occurs in 75% of patients aged over 65 years and represents
a significant proportion of eye emergencies (1). The natural history of patients presenting with acute photopsia
and floaters is unknown. Furthermore it is not certain if these patients require follow up to detect disease
progression or missed pathology.
Purpose: To determine if patients presenting with acute symptoms of flashes and floaters (within 10 days)
require routine follow up 10 to 14 days post presentation.
Method: All patients presenting with flashes and floaters to eye casualty during August – September 2012 were
reviewed. Patient notes were cross-referenced with Argon laser room and theatre records.
Results: 200 patients presented with flashes and/or floaters. Of these, 110 complete patient notes were
reviewed.
63/110 patients were followed up within two weeks after presentation. 3 patients (4.76%) were diagnosed with
sight threatening pathology at follow up (1 retinal tear, 2 retinal detachments).
Conclusion: A significant proportion of patients that presented with flashes and floaters were seen to have
further pathology on follow up that required intervention. The management of these patients represent a
typical eye casualty service and as such would suggest that patients presenting with acute retinal symptoms
should be routinely followed up.
43. Distorted Pathways: Trials and tribulations in Delivering Lucentis Service in Diabetic Macula Oedema
(DMO) in a Large Foundation Trust
Aaron Thye Wang Ng, Khazina Waraich, Jiang Li, Rangarajan Prabhu, David Kinshuck, Ramesh Sivaraj
Heart of England NHS Foundation Trust
Introduction: Anti-VEGF (Lucentis) is NICE approved for the treatment of visual impairment in DMO.
Increasing demands and limited resources pose challenges in delivering timely treatment. Our trust, serving a
population of 1.2 million, has recently initiated our Lucentis service for DMO. We report our results with
barriers in our service delivery.
Purpose: To monitor and compare visual acuity (VA) and OCT outcomes in patients awaiting and following
anti-VEGF treatment with landmark trials, identify obstacles and apply changes to the service delivery.
Method: Prospective collection of patient demographics, VA, OCT findings, DMO duration, diabetic control
and listing-to-treatment time. Patients with poor quality OCT are excluded.
Results: We report interim results from our prospective audit. Of November 2013, 340 eyes of 272 DMO
patients were listed for anti-VEGF. Patients were prioritised based on clinical urgency. To date, 80 eyes needing
treatment have been audited. 40 eyes were treated with Lucentis and 40 eyes awaiting treatment. Mean listingto-treatment time is 141 days (94-205). Follow-up data revealed treated eyes had a mean VA improvement and
retinal thinning of 1 line (Snellen) and 114 microns respectively. Eyes awaiting treatment had a mean VA
reduction and retinal thickening of 2 lines (Snellen) and 100 microns respectively. Barriers include reduced
capacity and treatment space.
Conclusion: Our audit provides insight into real world logistical issues in administering Lucentis in DMO
patients at one of the largest foundation trusts in the UK. Such problems need to be identified and tackled to
mirror the success of anti-VEGF treatment in DMO as reported in landmark trials.
44. Unilateral vs Immediate Sequential Bilateral Cataract Surgery: A Comparison of Inpatient Fall Rates
Alasdair Kennedy, Tom Pampiglione, Pankaj Puri, Adil Jaulim
Derby Royal Hospital
Introduction: Evidence suggests fall rates drop following unilateral cataract surgery.
In a prospective study, 31 out of 84 patients reported falls preoperatively and 6 continued to fall
postoperatively.(1) Furthermore, a RCT demonstrated a 34% reduction in falls.(2)
In 2007, Chesterfield Royal Hospital (CRH) started providing an immediate sequential bilateral cataract (ISBC)
surgery service. One advantage is that ISBC eliminates the period between two separate operations for patients
with large refractive errors.
Interestingly, the concept that ISBC may further reduce falls has not been explored.
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Purpose: The aim of this audit is to compare inpatient fall rates between unilateral surgery in Derby Royal
Hospital (DRH) and ISBC surgery in CRH.
Method: The time period was from 2007 to date.
All data was pooled using PAS.
At CRH, there were 17 ISBC patients. This data was cross matched against 6917 inpatient falls recorded in
patient safety databases.
In DRH, 2805 unilateral cases were cross matched against 3587 inpatient falls.
Results: 2 patients fell as inpatients in the CRH group, both prior to their cataract operations. Similarly, in the
DRH group, 2 fell preoperatively. No patients fell postoperatively in either group.
Conclusion: Postoperative inpatient fall rates did not differ between the two patient groups.
However, the ISBC group was not large enough for these findings to be significant. Another caveat was that
only inpatient falls were examined thus not excluding a discrepancy in the community.
A prospective study demonstrating that ISBC surgery reduces falls would support its cost effectiveness and is
recommended.
45. Refractive outcomes of cataract extraction in patients having undergone previous refractive surgery:
Which formula is best?
Chris Matthews , Alan Connor
James Cook University Hospital
Introduction: Selection of an appropriate intraocular lens involves measurement of axial length and corneal
curvature. Formulae based both on optical principals and postoperative refractive outcomes are in use.
Refractive surgery changes the shape of the cornea and may render the use of these formulae inaccurate.
Purpose: To assess the refractive outcome of patients undergoing phacoemulsificaiton who had previous
refractive surgery and which method of lens calculation was most likely to result in a refractive outcome
within 1D of intended outcome (RCOphth audit standard >85%)
Method: A retrospective case note review of all patients attending our cataract surgery service who had a
history of refractive surgery.
Results: 52 eyes were included in our study of which 79% were within 1.0D of aim.
Types of refractive surgery included; LASIK (40 eyes), LASEK (2 eyes), RK (6 eyes) and PRK (4 eyes).
The formula used in 38 eyes was, HAIGIS-L. In this group 81.6% were within 1 D of aim.
The ASCRS online calculator was used in 11 eyes. 63.6% were within 1D of aim.
SRK-T was used in 3 eyes, all were within 1D of aim. The numbers are too small to make comparisons.
Conclusion: Refractive surgery makes it difficult to predict post cataract extraction refractive outcomes. Within
this selected group of patients we did not meet the RCOphth audit standards. Our data suggests that Haigis-L
results is a more accurate prediction of refractive outcome compared to the ASCRS online calculator.
46. Adherence to angle closure guidelines
Yun Wong, Scott Fraser
Introduction: This audit focuses on the adherence to the acute angle closure glaucoma (ACAG) protocol
produced in October 2012 by the glaucoma unit at Sunderland Eye Infirmary. The audit also included
registrar's opinions of why they deviated from this protocol.
Purpose: The purpose of the audit was not to evaluate the guidelines themselves but to see how closely
departmental protocols are adhered to and the possible reasons for deviations.
Method: 20 consecutive cases of ACAG were identified and the relevant information was collected
retrospectively using a 12 question proforma. Additionally an anonymous online questionnaire was circulated
to all registrars who had worked in the unit.
Results: 20 patient's notes were analysed. Only one patient had been managed completely according to the
angle closure protocol. The most common cause for non adherence was addition of further medication or the
patient not being discharged home on the correct treatment. The results highlighted that both iopidine and
timolol were commonly added to treatment despite not being part of the guidelines. Even though 100%
adherence to the guidelines was poor, on average 70% of the guidance was followed.
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The SpR questionnaire revealed that 40% of registrars felt that they had adhered to the angle closure guidelines
whilst a further 30% felt it was necessary to stray from them due to specific patient related reasons.
Conclusion: Complete adherence to the angle closure protocol at Sunderland Eye infirmary was low. The most
common failure being the addition of further medication. The questionnaire revealed that even though
adherence was poor, most registrars believed that they had followed the guidelines. The study highlighted that
the SpRs need to be made more aware of the existence of the protocol. We are therefore adding educational
sessions into the internal teaching programme to increase awareness and will re-audit in a years time.
47. Early experiences with dexamethasone intravitreal implant (Ozurdex) for retinal vein occlusion: an
audit and service evaluation
Weijen Tan, Kerolos Bassilious, Dharmalingam Kumudhan , Winfried Amoaku
Queen's Medical Centre, Nottingham
Introduction: Ozurdex is licensed for the treatment of macular oedema following retinal vein occlusion (RVO).
There is limited information on the effect of this new treatment in clinical practice.
Purpose: To assess visual acuity (VA), central retinal thickness (CRT), complications in our patients and
adherence of Ozurdex re-treatment with RCOphth guidelines (2010).
Method: Hospital records were retrospectively searched for patients who received Ozurdex between 1/1/2012
and 1/6/2013. VA, CRT, intraocular pressure (IOP) and complications were obtained from paper and electronic
records. 57 eyes were included, 37 branch RVO (BRVO) and 20 central RVO (CRVO). Data was analysed
using Microsoft Excel.
Results: LogMAR improvement >0.2 was observed in 7/21 (33.3%) BRVO eyes and 3/9 (33.3%) CRVO eyes at
3 months. CRT reduction >200μm was observed in 13/19 (68.4%) BRVO eyes and 3/8 (37.5%) CRVO eyes at
3 months. Among BRVO eyes without re-treatment, mean LogMAR improvement was 0.105 (n=21) at 3
months and 0.023 (n=12) at 6 months. Mean CRT reduced by 205μm (n=19) at 3 months and 18μm (n=10) at
6 months.
All 61 Ozurdex re-treatments had VA and CRT which complied with RCOphth recommended criteria. 8/61
(13.1%) eyes were re-treated before the recommended interval of 4 months.
18/57 (31.6%) eyes had IOP>22mmHg after Ozurdex treatment.
Conclusion: Ozurdex is effective in reducing macular oedema secondary to RVO. Optimum time for retreatment is variable, requiring close follow-up. Short term complications were mainly limited to raised IOP.
48. One Stop Temporal Artery Biopsy Service
Karim El-Assal, Sachin Salvi, Judith West , Jennifer Tan, Irene Pepper, Zanna Currie
Sheffield Teaching Hospital
Introduction: Giant cell arteritis (GCA) is a chronic vasculitis of large and medium vessels with an Incidence of
2.2/10000 patient-years in the UK. Visual loss occurs in up to one-fifth of patients. Temporal Artery Biopsy
(TAB) is the gold standard for diagnosis but delays/negative biopsies can occur due to inadequate service
provision.
A one stop TAB service was hence established by the Ophthalmology department in Sheffield from June 2010.
Patients can be booked directly for TAB by clinicians from all specialities by means of a customised referral
form.
Purpose: To assess the effectiveness of the service in respect to waiting times, complications, length of biopsy
specimen, histopathological results and further management based on the biopsy result.
Method: A retrospective case note review of patients referred to the TAB service from June 2010 till end of
September 2012 was done. 96 patients were identified.
Results: 88.5%(85/96) of patients had TAB within two weeks of referral.
1%(1/96) had non-arterial biopsy.
84%(81/96) of specimens were equal to or longer than 1 cm in length.
27%(26/96) were positive biopsies.
No major intra or post-operative complications were documented.
Treatment was altered in 19%(18/96) based on the result.
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Conclusion: The service has streamlined the pathway for patients suspected with GCA from Ophthalmology
and other specialities while reducing the wait time. The incidence of complications and non-arterial biopsies
was low. The length of biopsy specimen was identified to be suboptimal in 16% of cases which needs
improvement to reduce the possibility of false negative results.
49. An audit to evaluate the efficacy of Selective Laser Trabeculoplasty (SLT) as adjunctive therapy for
Primary Open-Angle Glaucoma patients at a district general hospital
Rahul Dwivedi, Janine Brazier , Jose Gonzalez-Martin
Southport & Ormskirk Hospital NHS Trust
Introduction: Selective Laser Trabeculoplasty (SLT), although used infrequently, offers an alternative and
adjunctive treatment option to pharmacological agents in managing Primary Open Angle Glaucoma (POAG).
Purpose: This audit evaluates the efficacy of SLT in lowering intraocular pressure (IOP) in POAG patients on
pharmacological treatment at a district general hospital.
Method: A retrospective audit of patients undergoing SLT over a seven-month period between 25/9/2012 to
27/4/2013 was performed. Data collected assessed patient demographics, pseudophakia status, IOP-lowering
medication used pre-and post-SLT, number of SLT applications, IOP pre-and post-SLT and any further surgical
intervention.
Results: Total of 50 eyes from 50 patients (male=19, female=31). Mean age=74 years. Thirty-seven patients
(74%) were phakic. Twelve different IOP-lowering drops were used by patients pre-SLT (0 drops=10%, 1
drop=12%, 2 drops=40%, 3 drops=38%). Thirty-one patients (62%) continued on same number of drops postSLT, 10% stopped one drop and 6% added one drop. Mean number of SLT applications=102 applications per
eye. Mean IOP pre-SLT=27mmHg (SD=5.2). Mean IOP post-SLT=23mmHg (SD=6.1). Thirty-seven patients
(74%) had an overall reduction in IOP at follow-up compared to their pre-SLT IOP. Five patients (10%) had a
trabeculectomy operation on the eye treated with SLT.
Conclusion: SLT demonstrates an IOP reduction in the majority of our patients, achieving a mean IOP
reduction of 4mmHg, whilst allowing 10% of patients to decrease the number of their IOP-lowering
medications. Although 10% of our patients eventually required surgical intervention, SLT provides an effective
option at countering raised IOP that has not responded adequately to pharmacological treatment.
50. Audit of Eye Casualty neuro-ophthalmology referral system at Bristol Eye Hospital
Martin Bennett
Introduction: BEH sits in the county of Avon with a population catchment area of approximately 1 million. It
sees approximately 25,000 Eye Casualty attendances annually, of which they are approximately 18 neurology
cases per week.
Prior to 2011, these cases once assessed in casualty were not seen in dedicated neuro-ophthalmology clinics,
as there was not enough capacity at the time.
Two audits were conducted which have subsequently changed our practice. The first in 2011, which helped to
quantify the number of cases seen and the need for dedicated neuro-ophthalmology clinics at BEH, as patients
were followed-up in a combination of motility clinics in-house and others referred to Frenchay neurology
hospital.
Purpose: To quantify the number of neuro-ophthalmology cases seen in casualty.
Determine the number of urgent out-patient slots required in neuro-ophthalmology and motility clinics for
casualty referrals.
Method: Two prospective 4-week audits completed in 2011 and 2013.
Data collected from casualty notes for the following:
Number of patients seen
Provisional diagnosis
Investigations
Urgency of follow-up required
Results: 18 patients were seen in the 2011 Audit. It highlighted the need for 5 – 6 urgent neuro-ophthalmology
outpatient weekly slots to accommodate casualty referrals. As a result dedicated neuro-ophthalmology clinics
have since been created.
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Conclusion: The 2011 audit was pivotal in identifying a need for urgent neuro-ophthalmology outpatient
appointments for casualty referrals. The implemented recommendations have effectively addressed the
problem.
The 2013 re-audit confirms the appointments are being optimally utilized. As it comes to completion, absolute
numbers will be adjusted accordingly.
51. Can general A&E doctors manage common eye emergencies?
Michael Benjamin, Oluwatoyin Oyede, Philip I Murray
Introduction: Eye casualties in the general A&E department constitute 6% of the overall workload, with 69%
of them treated without further consultation of eye specialists. Also 21% of UK Medical Schools do not have
compulsory attachments in Ophthalmology that may have implications in the management of eye casualties.
Purpose: We wished to study whether general A&E doctors can manage common eye emergencies.
Method: A questionnaire was distributed to doctors working in general A&E departments in 6 Trusts and
included questions on:
•Grade of doctor
•Adequacy of undergraduate Ophthalmology teaching
•Perceived competence in using ophthalmological equipment
•Confidence in formulating a differential diagnosis and management plan for common eye emergencies
Results: There were 65 responses from 12 Foundation, 19 CT1-ST2, 12 ST3-6+, 13 SAS doctors and 9
Consultants. 37/65 (57%) doctors thought their undergraduate ophthalmology teaching was inadequate. Only
19/65 (29%) felt competent or highly competent in using a direct ophthalmoscope and 21/65 (32%) in using a
slit-lamp. The number (%) of doctors who were confident or very confident in formulating a differential
diagnosis and management plan for: the red eye was 26/65 (40%), acute loss of vision 22/65 (34%), ocular
trauma 21/65 (32%) and chemical injury 28/65 (43%).
Conclusion: Many doctors working in general A&E departments do not feel they are competent in using
ophthalmological equipment or confident in managing common eye emergencies. 4/12 (33%) of Foundation
doctors believed they were not competent in performing ophthalmoscopy and this skill is an F1 competency in
the Foundation Programme curriculum. This highlights the importance of adequate undergraduate
Ophthalmology teaching.
52. Validity of listing for cataract surgery by hospital-based optometrists
Pallavi Tyagi, Simon Hewick
Raigmore Hospital, Inverness
Introduction: A model of integrated management of patients by optometrists and ophthalmologists is assessed
Purpose: To assess the validity of listing for cataract surgery by hospital-based optometrists.
Method: Prospective cohort of patients listed by hospital-based optometrists was examined by 2
ophthalmologists on the day of surgery
Results: 63 patients (36- 1st eyes, 27- 2nd eyes) examined.
Out of 36 patients, 30 (83%) had no risk factors for surgery, 4 (11%) had risk factors like Fuch’s endothelial
dystrophy, glaucoma, poor dilator and trauma respectively which were correctly identified and 2 (6%) had risk
factors like pseudoexfoliation and corneal guttattae which were missed by hospital optometrist. Overall risk
factor identification validity was 94% (34/36) with a specificity of 100% and sensitivity of 66.7%.
Listing for 2nd eyes was based on post-op cataract surgery form with priority outcome (PO) for fellow eye after
first eye cataract surgery. Of the 27 patients, 2nd eyes with PO-1/2 were 48%, PO-3 were 7%, PO-4 were 15%
and re-referrals were 19%. PO-1/2 were listed for anisometropia/poor VA in fellow eye and mean gap between
2 eye surgeries was 13 weeks. PO-3 listed for poor VA and mean gap was 5 months. PO-4 listed for patient
preference and mean gap was 20 weeks. Re-referrals were made poor VA over time and mean gap was 6
years.
Conclusion: For first eyes, the identification of risk factors by optometrists needs to be strengthened. Post-op
cataract surgery form with priority outcome for community optometrists is successful in prioritising timing for
surgery for fellow eye.
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53. Proliferative diabetic retinopathy referrals from Diabetic Retinopathy Screening Service Wales
(DRSSW): Role of fast track referral system
Shantanu Gudsoorkar, Phillipa Knowles , Sarah Hale
University Hospital Of Wales , Cardiff
Introduction: The fast track referral system was introduced in Cardiff and Vale Local Health Board to improve
our performance and meet the National Screening Committee (NSC) criteria for referrals of possible
proliferative diabetic retinopathy from DRSSW.
Purpose: The previous audits of R3 referrals from DRSSW showed that only 12% (2007) and 18% (2009) of
these referrals were seen in the diabetic retinopathy clinics within 2 weeks in comparison to a minimum of
60% as per NSC criteria.
A robust fast track referral system was introduced to improve these figures and prevent the delay in treating this
vision threatening problem. This retrospective audit was done to confirm that the changes implemented were
effective meeting the standards.
Method: A retrospective audit with the data of all patients referred with possible proliferative diabetic
retinopathy obtained from DRSSW referral database. Further information regarding date and mode of referral,
date of clinic appointment, diagnosis , date of laser treatment if necessary were obtained from the clinical
portal of Cardiff and Vale Local Health Board.
Results: 76.3% patients were offered appointments within 2 weeks and 84.2% within 4 weeks meeting the
NSC criteria of 60% < 2weeks and 80% <4 weeks.
The standards for timescales for Screening to laser (82.4% <6 weeks) and listing to laser (94%< 2 weeks) were
also met.
Conclusion: Implementation of a robust fast track referral system was effective in meeting the NSC criteria and
successfully closing the audit loop.
54. Visual impairment in acute medical admissions: streamlining ophthalmic referral
Frederick R Burgess, Elizabeth D Hawkes, Owen D Ingram, James E Neffendorf
Royal Bolton Hospital
Introduction: Visual loss carries increased morbidity in the elderly population and is frequently overlooked by
medical physicians. Despite often having reversible disease, many patients are not referred to ophthalmologists
since vision is not measured.
Purpose: To assess whether those admitted to hospital with general medical problems have impaired vision
(worse than 6/18 Snellen) and if it is measured.
Method: We retrospectively examined case notes of 50 consecutive acute admissions to the medical
admissions unit (MAU) in a 48 hour period in the over 55 age group to see if VA had been measured. We
subsequently tested best corrected visual acuity (BCVA) of 30 patients aged over-55 in the MAU. Presenting
complaint, diabetic status, falls history, whether they had previously seen an ophthalmologist and when they
last visited an optician was also noted.
Results: 0% (0/50) of patients had VA measured by the admitting medical team. 10% (3/30) of patients had
BCVA below 6/18 in their better eye, 2 of whom had never seen an ophthalmologist previously. 23% (7/30) of
patients had BCVA of worse than 6/12 in both eyes.
Conclusion: 10% of admissions had substantially impaired BCVA and 23% had VA below DVLA driving
standard. We recommend visual acuity is routinely assessed in all medically admitted patients. A proforma is
suggested as a care pathway for physicians to follow regarding urgency of ophthalmic referral. This will
streamline ophthalmic referrals to those most in need without overburdening the service.
55. Are we meeting the British Rheumatology Society (BRS) Guidelines for Temporal Artery Biopsy?
Sophie Hickling, Susan Mollan
Introduction: The BSR guidelines for Giant Cell Arteritis (GCA) include guidance for TAB length (between 12cm). The literature finds rates of positive TAB to be between 15% to 29%, depending on the type of practice
that is surveyed.
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Purpose: An evaluation of a Temporal Artery Biopsy (TAB) Service to improve local practice, and compare the
rate of positive TABs to the literature.
Method: Prospectively collected surgical database of all undergoing a TAB from October 2012 - October
2013. Demographics, inflammatory markers, corticosteroid treatment, ischaemic complications,
histopathological diagnosis, length of specimen and TAB complications were recorded.
Results: Thirty cases were included, 3 males and 27 females with a mean age of 70 years (Range 59-92 years).
One case had bilateral TAB. Rheumatology were the largest users of the service, followed by Ophthalmology
and General Practice. The mean TAB specimen length was 13.9. 20% were positive, a further 13.3% negative
biopsies were treated as clinically GCA. There was no significant difference in length between the positive
(13.8±6.1mm) and negative (14.0±5.4mm) biopsies (student t-test p<0.01). No surgical complications were
seen.
Conclusion: This service meets the standard set. Good practice points include intraoperative measurement of
specimen (to allow for histopathological fixation loss) and a patient information leaflet.
56. Our 10 years’experience in treating periocular spasm with botulinum toxin
Aneesa Rahim, Jessica Montford, Joyce Burns , Raghavan Sampath
Leicester Royal Infirmary
Introduction: Blepharospasm is a bilateral, progressive, involuntary contraction of orbicularis and facial
muscle.Occurs in 1 in 20,000 population.Cause functional blindness.Misdiagnosed as dry eye syndrome as it
presents as photophobia,excessive blinking,dryness or uncontrolled closure of eyelids
Purpose: Is to analyse the effectiveness of botulinum toxin injection in treating periocular spasm.
Method: It’s a 10 year retrospective case notes review of 168 patients who received botulinum toxin injection
for the periocular spasm are evaluated according to gender, ocular complaints, treatment outcome and
complications.
Results: One hundred and sixty eight patients received botulinium toxin injection for the particular spasm of
which 84(50 %)had essential blepharospasm,38(27%)had hemifacial spasm,41(24%) had facial palsy with
aberrant reinnervation including iatrogenic causes,4(2%)apraxia of the lid and 1(0.5%)other causes.The age
group ranged from 28 to 90 years with the mean age of 62 years.57%(95) of females and 43%(73)of males
received toxin.All patients underwent through ophthalmic examination to exclude ocular surface diseases.The
patients with hemifacial spasm were investigated with MRI brain to rule out vascular loop and cerebropontine
angle lesions prior to injection.Dose varied between 2.5U to 5U.The majority of patients received injection to
2 lids 57% (96) followed by 4 lids 33%(56)and 7%(12) lacrimal gland;however 2.3%(4)declined
treatment.Muscle spasm reduced significantly within 2 days of the first injection and effect lasted for 10 to 12
weeks.96% of patients had regular injections every 3 months.Complications related to the treatment included
transient ptosis 1% (2), diplopia 0.5% (1) and watering 0.5% (1).Only one patient needed surgical correction
for the toxin induced ptosis.6%(10)of patients were non responsive to botulinum toxin underwent orbicularis
stripping (8) and frontalis brow suspension (2).
Conclusion: Treatment with botulinum toxin A was effective in periocular spasm, with very low complication
rates.
57. The provision of an objective visual acuity by General Practitioners during eye casualty referrals: why
is it lacking and how do we improve it?
Osama Giasin, Elizabeth Goodchild, Ruth Jones, Eulee Seow, Damien Chia Ming Yeo
Royal Glamorgan Hospital
Introduction: An objective visual acuity is a necessary part of the clinical examination for any ophthalmic
emergency. Knowing the acuity allows for a quick diagnosis as well as ensuring a safe triage. However, GPs do
not always provide a VA. This limits the assessment of the triaging clinician and can slow the clinic down.
Purpose: 1) Find out what are the most common reasons for not providing a VA.
2) Once we know why, we will address the issues by providing an educational leaflet to the GPs.
3) Recollect data to see if this particular technique has worked.
Method: Prospective data collection of 30 consecutive telephone referrals(GPs only) followed by an
intervention sent out in the post and further data collection of 28 consecutive telephone referrals.
Results: During the first period, 40% of the GPs did not provide a VA. The top 3 reasons for not providing a
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visual acuity were the absence of a Snellen chart(31%), lack of a visual problem(17%), and the patient being
too young(9%).
After our intervention, 46% of the GPs did not provide a VA. The top 3 reasons remained the same.
Conclusion: An objective visual acuity is often not provided during a general practitioner’s referral to eye
casualty. The lack of a Snellen chart appears to be the chief reason. However, even when specifically
providing tips to overcome this, the rate did not improve.
58. Time from cataract surgery to Nd:YAG capsulotomy at University Hospitals Birmingham (UHB) NHS
Foundation Trust
Hannah Shereef, Haider Ibrahim, Mike Burdon
University Hospitals Birmingham NHS Foundation Trust
Introduction: Nd:YAG capsulotomy is a laser procedure used to treat posterior capsular opacification (PCO),
the commonest long-term complication following cataract surgery. Royal College of Ophthalmologists
guidelines state that the procedure is indicated for visual symptoms which can be attributed to evidence of
PCO on slit-lamp examination.
Purpose: To perform a service evaluation of the use of Nd:YAG capsulotomy at UHB NHS Foundation Trust.
Method: For each eye, we collected data on the length of time from cataract surgery to Nd:YAG procedure,
and whether patients were discharged following cataract surgery with no routine follow-up, or in regular
follow-up in ophthalmology for other conditions.
Results: Data for 95 (89%) of 107 consecutive eyes which had Nd:YAG capsulotomy over a 4 month period
were available for analysis.
The mean time from cataract surgery to Nd:YAG capsulotomy was 1142 days (3 years, 1.5 months). 46% of
Nd:YAG capsulotomy procedures were performed after the second year from cataract surgery. For patients
followed up after cataract surgery, the mean time from cataract surgery to Nd:YAG capsulotomy was 870 days
(2 years, 5 months), compared to 1575 days (4 years, 4 months) for patients with no routine follow up
(p=0.003).
Conclusion: Our findings suggest that the 2 year follow-up time often quoted in studies comparing PCO rates
with different intraocular lens designs is inadequate and only picks up a half of patients who will go onto
develop PCO.
59. Health Informatics in Ophthalmology - The Past, Present and Future
Abison Logeswaran, Thuwaraga Logeswaran, Yu Jeat Chong, Yogesan Kanagasingam
Imperial and City University
Introduction: Health Informatics (HI), specifically electronic patient records (EPR’s) are an increasingly
important aspect of modern medicine.
They provide a number of distinct advantages over paper based medicine: 1)Increased accessibility to medical
records in various geographical locations 2) Provide a temporal and spatial link within different episodes of
care 3) The possibility of decision support systems to increase efficiency.
Purpose: To assess the specific requirements, current use and potential areas of expansion within
Ophthalmology HI and EPR’s
Method: A literature review was conducted using key terms: 1) Ophthalmology 2) Electronic Patient/Health
Records 3) Open Standards 4) HL7 5) DICOM
Results: 1) The rate of EPR/HI uptake within Ophthalmology lags behind that of other medical specialties
2) There are four main requirements of Ophthalmology that potentially underlie poor uptake of EPR’s in
Ophthalmology
• Medical and surgical specialty
• Ophthalmology is heavily dependent on the documentation and analyze of visual data
• Traditional parameters such as vital signs are different from normal medical disciplines
• Ophthalmology tends to use specific diagnostic tools that are not routinely used in other disciplines
3) Examples of HI use in Ophthalmology
• DRSCREEN
• OpenEyes
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Conclusion: There is evidence that HI and EPR’s are increasingly being used in ophthalmology and have the
potential to assist in screening programs. However, at this present time widespread use of such system does not
exist. There needs to be greater analysis of end user needs and increased use of open standards to enable data
sharing and increased uptake of such systems.
60. Review of Glaucoma Domiciliary Service at Devon
Usama Faridi, Naeem Gurmani, Jim Faverty , Michael Smith, Daniel Byles
Royal Devon and Exeter Hospital
Introduction: Glaucoma domiciliary service (GDS) is a Optician-led service with a central coordinator and is
supervised by Consultant Ophthalmologists at Royal Devon and Exeter Hospital. The glaucoma patients who
are unable to attend normal follow-up clinics due to significant physical and mental disabilities are offered
GDS at their residence.
Purpose: This study investigated the effectiveness of Glaucoma Domiciliary Service in Devon through an audit
using locally produce protocols.
Method: The cases were identified from the records of visiting optometrists. The medical record of 91 patients
were analysed in detail for this audit, as clinical records of 14 patients were not available. The protocols were
produced by using NICE guidelines by Glaucoma Consultants and optometrists. The protocols included the
referral criteria, plans for the follow-up appointments, and the examination protocol during each home visit.
Results: One hundred and five home-bound patients were benefitted with from GDS from January 2010 to
February 2012. Patients with different forms and severity of glaucoma were seen. The main reasons for referral
were patients with Alzheimer’s disease, mobility problems and frail elderly patients.
The GDS protocols were followed in majority (98%) of cases. Adequate actions were taken in all patients
where intra-ocular pressures were not within the target level and the follow-up appointments were according
to the protocols.
Conclusion: This study shows that GDS is safe and effective in managing glaucoma patients who are otherwise
unable to attend hospital due to various reasons. We recommend the continuation of the service in Devon.
61. Public knowledge of common eye disease
Priyanka Mandal, Anuj Vakharia, Oluwatoyin Oyede , Philip I Murray
Introduction: Cataract, glaucoma and age-related macular degeneration (AMD) are common eye disorders. It
is vital that the public is aware of these conditions, as there are now effective treatments than can restore or
prevent sight loss.
Purpose: To study the public knowledge of common eye disease.
Method: A questionnaire based on cataract, glaucoma and AMD was trialled on 100 members of the general
public. Questions included: the part of the eye affected, being able to locate it on a diagram, symptoms,
treatment and if it was a ‘blinding’ condition.
Results: There were 58M, 42F; 71% aged 20-49 yrs, 29% 50 yrs and older. 65% had heard of cataract, only
24% knew it affected the lens, 82% could not locate it on the diagram but 38% thought surgery was the
treatment. 48% had heard of glaucoma, 93% did not know the optic nerve was affected, 97% could not locate
it on the diagram and 81% had no idea how it was treated. 82% had not heard of AMD, 95% did not know
the retina was affected, 99% could not locate it on the diagram and 91% had no idea how it was treated.
48%, 69% and 92% did not think cataract, glaucoma and AMD, respectively were ‘blinding’ conditions.
Conclusion: There was a lack of knowledge regarding common eye conditions, and that included people of an
age when these conditions occur. Although some had heard of them, they did not understand them. It is
imperative we increase public awareness to prevent sight loss
62. Appropriateness of referrals into an optometrist led rapid access wet age related macular degeneration
clinic
Deborah Bott, Narendra Dhingra
Mid Yorkshire NHS Trust
Introduction: Wet age related macular degeneration (AMD) is an ocular emergency. Patients suspected with
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ABSTRACTS:
Audit & Clinical Governance / Cataract & Refractive Surgery
Birmingham 2014
this condition should be assessed and treated within 2 weeks. In February 2013, an optometrist led service for
all patients referred with this condition was established at our hospital.
Purpose: To look at the appropriateness and origin of referrals into the optometrist led rapid access wet AMD
clinic.
Method: Retrospective review of suspected new wet AMD referrals into the optometrist clinic was carried out.
The data was collected and analyzed using Microsoft Excel package.
Results: 41 patients were seen in this clinic between February and July 2013. 61% of referrals were received
from community optometrists, 34% from diabetic retinal screening services (DRSS) and 5% from general
practitioners (GP). The mean time from referral to clinic was 6.6 days. All patients referred from community
optometrists or GP were seen within 2 weeks. Referrals from DRSS took up to 25 days to be seen. Nearly half
(47%) of patients were discharged at initial visit and did not require any further investigations (50% of these
referrals originated from DRSS, 44% from community optometrists and 6% from GPs). From those deemed
appropriate, 90% required fluorescein angiography, of which 75% were diagnosed with wet AMD.
Conclusion: Referral from community optometrist or GP is the quickest. Almost half of the referrals from
optometrists and DRSS were inappropriate and required no further investigations.
63. An evaluation of the usage of Medisoft Electronic Patient Record system in Birmingham and Midland
Eye Centre
Lauren Atkins, Sarah Burgin, George Moussa
Birmingham and Midland Eye Centre, City Hospital
Introduction: Across the NHS, electronic patient record (EPR) systems are replacing paper documentation,
enabling improved availability and quality of patient information and more efficient auditing. However, in
order for this to be achieved, EPR systems must be used correctly. Medisoft EPR system has been utilised at
Birmingham and Midland Eye Centre (BMEC) Emergency Department since February 2013.
Purpose: This audit assesses completeness of Medisoft clinical documentation at BMEC Emergency
Department.
Method: Data were collected retrospectively from Medisoft records of BMEC emergency department
attendances during August and September 2013, following referral from a GP or optometrist.
Results: Medisoft records of 200 attendances were reviewed. Diagnosis information was entered in the correct
section in 67% of cases, and medication was entered in the correct section in 85% of cases. Correct recording
of both diagnosis and medication was present in 58% of records. In 6% of cases, no diagnosis information was
documented. Referral letters were scanned and linked in for 6% of patients.
Conclusion: At BMEC emergency department, Medisoft is not being used fully. Although in most cases,
diagnosis and medication information was recorded, improvements in training and utilisation are needed to
ensure this information is recorded correctly. Instances of no diagnosis information must be eliminated, and all
referral letters must be scanned. As EPR systems are adopted nationwide, other eye units may encounter
similar problems; this issue requires monitoring as it pertains to accurate note keeping and therefore clinical
governance.
CATARACT & REFRACTIVE SURGERY
64. The Development of a Virtual Reality Training Programme for Ophthalmology: Repeatability and
Reproducibility
Korina Theodoraki, George M Saleh, Stewart Gillan, Paul Sullivan, Fiona O'Sullivan, Badrul Hussain
Introduction: In ophthalmology, evidence has emerged for a wider spread of performance in early stage of
training. What we don’t know is how an individual with minimal experience scores when undertaking the
same task on several occasions (variability and reproducibility).
Purpose: To evaluate the variability of performance among novice ophthalmic trainees in a range of repeated
tasks using the Eyesi virtual reality (VR) simulator.
Method: Eighteen subjects undertook three attempts of five cataract specific and generic 3-dimensional tasks:
continuous curvilinear capsulorhexis, cracking and chopping, cataract navigation, bimanual cataract training,
anti-tremor. Scores for each attempt were out of a maximum of 100 points. A non-parametric test was used to
analyze the data where a P value of <0.05 was considered statistically significant.
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ABSTRACTS: Cataract & Refractive Surgery
Results: Highly significant differences were found between the scores achieved in the first attempt and that
during the second (P < 0.0001) and third (P < 0.0001) but not between the second and third attempt (P =
0.65). There was no significant variability in the overall score between the users (P=0.1104) or in the difference
between their highest and lowest score (P=0.3878). Highly significant differences between tasks was shown
both in the overall score (P=0.0001) and in the difference between highest and lowest score (P=0.003).
Conclusion: This study, which is the first to quantify reproducibility of performance in entry level trainees using
a VR tool, demonstrated significant intra-novice variability. The cohort of subjects performed equally overall in
the range of tasks (no inter-novice variability) but each showed that performance varies significantly with the
complexity of the task when using this high fidelity instrument.
65. Patient Reported Outcome Measuring Tools in Cataract Surgery – Clinical Comparison in a Tertiary
Hospital.
Simon Fung, Peter Holm, Melanie Hingorani, Joanne Hancox
Introduction: Patient Reported Outcome Measures (PROMs) collects information on the effectiveness of care
delivered to NHS patients as perceived by the patients themselves. Although there is a push to extend PROMs
across the National Health Service, there is currently a lack of guidance for patients undergoing cataract
surgeries. It is also unclear if the generic health questionnaire recommended was suitable for cataract patients.
Purpose: This study assesses the performance of different questionnaires to determine their appropriateness for
cataract patients in the UK.
Method: Patients awaiting cataract surgery at Moorfields Eye Hospital were recruited for the study. A study
pack of four questionnaires, including Catquest-9SF, EQ-5D-5L, NEI-SES and VF-8R were given to patients to
complete during pre-assessment appointment, 2 weeks post-surgery and 3 months post-surgery. Data were
Rasch-analyzed when possible to allow direct comparison of the performance of the questionnaires.
Results: Fifty-five patients were recruited to date, with 25 patients completed 3 months follow-up. All
questionnaires shows correlate with visual improvement. The change in Catquest-9SF, EQ-5D-5L, NEI-SES and
VF-8R at 2 weeks post-surgery were 147.37% (p=0.01), 3.89% (p=0.79), 0.48% (p=0.91) and 12.44% (p=0.23)
respectively. These change at 3 months were 105.65% (p<0.01), 4.13% (p=0.37), 45.65% (p=0.09) and
41.37% (p=0.18), respectively.
Conclusion: Collecting patient reported outcome in cataract surgery is feasible and should be introduced into
daily clinical practice. Improvements in visual function could be detected as early as 2 weeks post-surgery by
Catquest-9SF, while socioemotional changes may be a delayed effect of cataract surgery.
66. Experience With Femtosecond Laser Cataract Surgery: A prospective review
Edward Ridyard, Ritesh Gupta, Raymond Stein
Bochner Eye Institute, Toronto
Introduction: Cataract surgery is the most frequently performed surgical procedure in the world, with an
estimated 15 million procedures per year. Femtosecond cataract surgery is considered to be one of the most
significant advances in cataract surgery in the last 50 years.
Purpose: The purpose of this study is to analyse the experience and outcomes of femtosecond laser surgery.
Method: A prospective review was performed on 250 consecutive patients who underwent femtosecond laser
cataract surgery.
Results: Phacoemulsification was required in 50 (20%) cases whereas 200 (80%) cases had complete
elimination of phacoemulsification energy. Intraoperative complications included incomplete capsulotomy
(n=1, 0.4%) and no cases of posterior capsule rupture were identified. Postoperative complications included
subconjunctival haemorrhage (n=243, 97%), 3 weeks post-surgery iritis (n=3, 1.2%), 2+ transient corneal
edema (n=3, 1.2%) and cystoid macular edema (n=2, 0.8%). No cases of endophthalmitis, subluxated
intraocular lens or wound leak were identified. In terms of refractive outcomes, a sphero equivalent of -0.37D
(SD = ) was measured for the first 50 cases at three months.
Conclusion: Femtosecond laser cataract surgery is associated with a high rate of patient satisfaction and
relatively easy learning curve. It provides a perfect capsulotomy in nearly 100% of cases and helps eliminate
phacoemulsification in 80% of cases. It was associated with no posterior capsule rupture or endophthalmitis
and allowed for quick return of best corrected visual acuity. However, it is associated with an expensive
capital investment, significant ongoing costs and requires more time per patient.
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67. Effect of Speed of Intravitreal Antibiotic Administration on the Outcome of Post-operative
Endophthalmitis
Anna Gao, Anjali Gupta, Salman Mirza
Introduction: Prompt administration of intravitreal antibiotics is thought to be paramount in the treatment of
postoperative endophthalmitis.
Purpose: To compare the door-to-needle time, visual outcome, culture positive rates and the safety aspect
between patients who received their intravitreal antibiotics in the casualty treatment room and those who
received it in the operating theatre, at the Birmingham and Midland Eye Centre.
Method: All patients who were treated for post-cataract endophthlmitis between May 2007 and April 2013,
were included. Patient demographics, past ocular history, details of cataract surgery, door-to-needle time,
causative organisms and antibiotic sensitivity data, treatment, visual outcome and complications were
collected.
Results: A total of 44 patients were included, 19 had their intravitreal antibiotics in Eye Casualty and 25 in the
operating theatre. Mean time from surgery to presentation was 10 days (range 2-29 days) in the casualty group
and 28 days (range 3-183 days) in the theatre group. The door-to-needle time was significantly less in the
casualty group (mean=161 min., range 77-127 min) compared to the theatre group (mean=308 min, range
137-633 min). Culture negative rate was higher in the casualty group (42%) compared to the theatre group
(28%). Final visual outcome was similar in both groups. 5% of patients in the casualty group went on to have
vitrectomies whereas 20% of the theatre group had further surgical intervention.
Conclusion: Patients were managed much more promptly if treatment was initiated in the casualty setting. The
door-to-needle time does significantly affect the final visual outcome. The treatment of infective
endophthalmitis appears to be safe and prompt when carried out in the casualty treatment room compared to
sampling in the theatre.
68. Is second-eye cataract surgery in the NHS cost effective? Systematic reviews and economic evaluation
Geoff Frampton, Petra Harris, Keith Cooper, Andrew Lotery, Jonathan Shepherd
Southampton Health Technology Assessments Centre (SHTAC)
Introduction: First-eye surgery can improve vision and quality of life. However, it is unclear whether cataract
surgery on the second eye provides enough incremental benefit to be considered clinically and cost effective.
Purpose: To determine the clinical effectiveness and cost effectiveness of second-eye cataract surgery
compared to surgery in one eye alone.
Method: Systematic reviews of clinical effectiveness, cost effectiveness and health-related quality of life
(HRQoL) were conducted and an economic model developed to estimate the cost-effectiveness of second-eye
surgery.
Results: Three randomised controlled trials (RCTs) of clinical effectiveness, three studies of cost-effectiveness
and 10 studies of HRQoL were included in the systematic reviews and where possible used to inform the
economic analysis. Heterogeneity of studies precluded meta-analyses. Improvements in binocular visual acuity
and contrast sensitivity were small and unlikely of clinical significance, but stereopsis was improved to a
clinically meaningful extent following second-eye surgery. In the model, second-eye surgery generated 0.68
incremental quality-adjusted life years (QALY) with an incremental cost-effectiveness ratio (ICER) of £1,964 per
QALY gained. Sensitivity and scenario analyses gave a worst-case ICER of £6,432 per QALY gained.
Conclusion: Second-eye cataract surgery is cost-effective based on the best available data. However, no
relevant RCTs have been conducted recently and the patient-reported outcomes (PROs) employed have several
limitations. A well-conducted RCT that reflects the current population case mix and enables estimation of costeffectiveness would be appropriate. Clarification is needed on the selection and interpretation of PROs in
cataract surgery
69. Artificial Iris Implants for Aniridia: Does Near Infra-Red Light Transmission Risk Retinal Phototoxicity?
Imran Yusuf, Tim H M Fung, Stuart N Peirson, C K Patel
Nuffield Laboratory of Ophthalmology, Oxford University
Introduction: Artificial iris implants for aniridia and oculocutaneous albinism aim to restore iridocosmesis and
the light occlusive properties of the absent or deficient anatomical iris. The native human iris serves a critical
function in protecting the posterior segment from retinal hazard light (400-1400nm). Artificial iris implants
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must replicate this photoprotection across the retinal hazard range. The light occlusive properties of clinically
available artificial iris implants are unknown.
Purpose: This study aimed to evaluate light transmission through clinically used artificial iris implants.
Method: Spectral transmission was recorded across five Morcher BDI (67B/67F/67G/67L/68/94A) and two Dr
Schmidt Artificial Iris implants using a broad-spectrum light source and spectroradiometer. Near-infrared (NIR)
light as a percentage of total retinal incident light was calculated in daylight, incandescent and fluorescent
light environments to simulate retinal exposure through each aniridia implant.
Results: All Morcher iris implants demonstrated high levels of NIR transmission across the black iris interface,
accounting for up to 82% of total retinal incident light in incandescent environments. Dr Schmidt’s Artificial
Iris demonstrated total occlusion of all wavelengths of light.
Conclusion: Morcher BDI iris implants transmit high-levels of near infra-red light (700-1400nm) within the
retinal hazard range, risking long-term retinal photochemical toxicity across the life of the implant. Dr
Schmidt’s Artificial Iris implants produce physiological light occlusion and may offer improved safety and
efficacy. This study may impact on pre-operative aniridia implant selection in eligible patients with traumatic
and congenital aniridia and oculocutaneous albinism.
70. Rotational stability of a hydrophilic toric lens implant over 2 years
Ashokkumar Vyas
Scarborough Hospital
Introduction: To establish long term rotational stability of a toric lens and continued patient satisfaction
Purpose: To analyse the rotational stability of hydrophilic Rayner T-flex IOL over 2 years post-surgery using
serial digital photographs and software
Method: In a prospective study over 2 years, 12 eyes with keratometric cylinder of ≥ 2.5D underwent routine
phacoemulsification with in-the bag implantation of hydrophilic Rayner T-flex IOL. This lens has anti-vaulting
haptics designed for rotational stability. Slit-lamp digital photographs were taken after maximal pupillary
dilatation at 1 week, 6 months and 2 years post-operatively and analysed with Adobe Acrobat Professional
software. Unaided acuities were recorded and patients were asked to rate the visual outcome as highly
satisfied, satisfied or not satisfied.
Results: Eyes were grouped based on the extent of IOL rotation (≤ 5 degrees, 5-10 degrees and > 10 degrees).
At 2 years, all 12 eyes showed IOL rotation of < 5 degrees post-surgery. Unaided acuity was 20/40 or better in
11 out of 12 eyes. All but one patient were highly satisfied with the outcome of the surgery
Conclusion: Rayner T-flex Toric IOL showed excellent rotational stability at 2 years post-surgery. It also
provided excellent post-operative unaided visual acuity with a high patient satisfaction rate.
71. Is Optical Biometry sufficient to estimate Toric IOL parameters to correct co-existing corneal
astigmatism during cataract surgery?
Constance Jong, Vikas Shankar, Aravind Reddy
Introduction: Toric Intraocular lenses (IOL) are increasingly used to correct higher degrees of co-existing
corneal astigmatism during cataract surgery
Purpose: To compare corneal curvature parameters assessed by Optical Biometry (IOL Master) and Corneal
Topography in the estimation of Toric IOL.
Method: Optical biometry (IOL Master) and corneal topography (TOPCON) was performed on all patients
undergoing cataract surgery with toric IOL implantation. All patients had more than 2.50 Dioptres of corneal
astigmatism. Corneal curvature parameters (K1, K2) from IOL master biometry was compared with topographic
curvature in the flat and steep meridians for each patient
Results: Forty seven eyes of forty seven consecutive patients underwent toric IOL implantation. The mean
corneal astigmatism was 3.56 dioptres (range 2.26-5.22) with IOL Master and 3.29 dioptres (range 2.46-4.82)
with topography. The mean difference in magnitude of corneal astigmatism between IOL master and
Topography was 0.45 dioptres (range 0-2.59D)
Twenty eyes (42.5%) had a difference of more than 0.5 dioptre and six eyes (12.7%) had a difference of more
than 1 dioptre in the magnitude of corneal astigmatism between IOL master and topography. In eight eyes
(17%), the steep meridian of astigmatism assessed by IOL master was different from topographic steep
meridian by more than 10 degrees
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ABSTRACTS:
Cataract & Refractive Surgery / Cornea & External Eye Disease Annual Congress Final Programme & Abstracts
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Conclusion: Correlation between corneal curvature data assessed by IOL master and Corneal topography may
be necessary in estimating toric IOL parameters especially in eyes with higher degree of corneal astigmatism
72. Toric lenses in pathological corneal astigmatism
Sarah Chaney, David Frazer
Introduction: The use of Toric intraocular lenses (IOL) for the correction of astigmatism at the time of cataract
surgery has increased in recent years. Toric IOLs can also be used to correct pathological corneal astigmatism.
Purpose: Our aim was to review the results of the use of Toric IOLs in complex corneal cases at the Royal
Victoria Hospital, Belfast.
Method: A retrospective case note review of all cases of Troic IOL insertion over a 5 year period (2008-2013)
in complex corneal cases.
Results: Fourteen patients had a Toric IOL placed in 1 eye. Ten of the patients were female and 4 were male.
The average age was 53± 13 years. The under lying pathology was keratoconus in 9 patients, herpetic corneal
scaring in 4 patients and Fuchs Endothelial dystrophy in 1 patient. Six eyes had a previous penetrating
keratoplasty and 3 a previous deep anterior lamellar graft. Only 2 of the eyes had a pre-op uncorrected visual
acuity of 6/18 or better. The average pre-op corneal cylinder was 4.14 Dioptres ± 3.43 D (Range 2.57- 9.27
D). Post-op 8 eyes achieved an uncorrected visual acuity equal to or better than 6/18. The average post op
cylinder was 1.77D ±1.20D (Range plano-4.00D). One eye required an IOL exchange and 1 eye developed
glaucoma which required a trabeculectomy and an additional sulciflex lens insertion
Conclusion: Toric intraocular lenses are useful in the correction of astigmatism in patients with pathological
corneal astigmatism
73. Spectacle Independence and Vision-Related Quality of Life in Cataract Surgery Patients Following
Implantation of the ReSTOR® Multifocal Intraocular Lens
Sunil Shah, Christopher Brittain
Introduction: Patients who undergo phacoemulsification with monofocal IOL implantation may remain
dependent on spectacle correction at least for near vision. Multifocal IOLs are designed to optimise visual
acuity across varying focal points, thus reducing spectacle dependence.
Purpose: This study compared spectacle independence and vision related quality of life (QoL) in patients
implanted with the ReSTOR® multifocal intraocular lens (IOL) against those with a monofocal IOL.
Method: This 6 month, randomised, multicentre, controlled, double masked, parallel group study compared
patients who underwent bilateral phacoemulsification followed by bilateral implantation of either ReSTOR®
multifocal (n=108) or hydrophobic monofocal IOLs (n=100). The primary endpoint was achievement of VA of
≤0.1 logMAR at both near and distance.
Results: Patients had a mean age of 70.4 years. At 6 months, the proportion of patients with a postoperative
BCVA of ≤0.1 logMAR at near and distance was significantly higher in those who received the ReSTOR®
multifocal IOLs compared to the monofocal IOLs (45.7% versus 2.1%, p<0.0001). Vision related QoL with the
ReSTOR® multifocal was comparable to that in monofocal IOLs, except for a significant improvement in
dependence on correction (p<0.0001). Spectacle cost showed a significant difference (p<0.0001) favouring the
ReSTOR® multifocal IOL.
Conclusion: Compared to monofocal, the ReSTOR® multifocal IOLs resulted in greater spectacle
independence. This was reflected in patient reported quality of life. Additionally, analyses suggest a long-term
cost benefit of the ReSTOR® multifocal IOL when taking into account spectacle costs.
74. Rapid corneal cross-linking (CXL) for progressive ectasia
Dan Gore, Nick Kopsachilis , Bruce Allan , External Disease Service Consultants
Introduction: Rapid treatment protocols for CXL based on shorter ultraviolet light exposure times and higher
irradiances are emerging.
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ABSTRACTS: Cornea & External Eye Disease
Purpose: To report safety and efficacy outcomes at 6-months following rapid CXL.
Method: Design: Prospective audit.
Serial tomography and refractions were used to confirm pre-operative ectasia progression, defined by: >1.5
dioptre (D) increase in Kmax or K2; 0.5D increase in posterior K2; >1D increase in refractive astigmatism; >1
line loss of corrected distance visual acuity (CDVA), > 13μm decrease in pachymetry. Patients with a minimum
pachymetry <375 μm were excluded. Continuous UVA exposure at 30mW/cm2 for 4 minutes was used in all
eyes. Audit standards were 90% efficacy and <3% losing >2lines of visual acuity.
Results: Rapid CXL was performed on 33 eyes (30 keratoconus, 3 post-LASIK, age range 17-43). At 6-months,
28 (85%) eyes had either stabilised or improved, while 5 (15%) showed signs of continued progression. No
significant differences between mean pre- and post-operative keratometric indices were observed: Kmax
58.93D vs. 58.64D (P=0.47), anterior K2 50.45D vs. 50.63D (P=0.2) and posterior K2 -7.93D vs. -7.84D
(P=0.96). Mean spherical equivalent remained unchanged (-2.54D vs. -2.88 D, p=0.87) as did mean refractive
astigmatism (4.92 D vs. 4.86D, p=0.91). 2 (6%) eyes lost more than 2 lines of CDVA. One peripheral sterile
infiltrate developed which rapidly responded to intensive topical steroids. No infective complications
occurred.
Conclusion: While safe and effective in the majority of patients, audit standards were not achieved at 6-months
follow-up.
75. Systemic immunosuppression in patients with refractive chronic allergic eye diseases
Muhammad Ahad, Kieren Darcy, Phillip Jaycock , Stuart Cook, Derek Tole
Introduction: Vernal (VKC) and atopic keratoconjunctivitis (AKC) are sight-threatening inflammatory diseases of
conjunctiva and cornea. Severe cases may be refractory to topical conventional therapy and need systemic
therapy to prevent blindness.
Purpose: The aim of this study was to analyse the efficacy of systemic immunosuppressive agents in patients
with refractory allergic eye diseases.
Method: Non comparative, retrospective case series of 33 patients with AKC or VKC, where topical therapy,
like steroids, cyclosporine and tacrolimus had failed to control the disease.
28 consecutive patients with AKC and 5 patients with VKC were analysed in this study. Information regarding
duration, activity of disease, complications, visual acuity, therapeutic strategies, side effects and clinical
outcome were analysed
Results: In all patients systemic prednisolone was used to induce remission. On the last day of visit, disease
was under control in 97% (32/33) of the cases. Following systemic immunosuppressive therapy was used:
Tacrolimus in 30 patients, mycophenolate in 12 patients, Intravenous immunoglobulins in five patients and
cyclosporine, methotrexate and azathioprine in four patients each. 17 patients had keratoconus, eight
developed herpetic eye disease, six developed shield ulcers and five patients developed infective keratitis. 12
patients underwent corneal transplant for visual rehabilitation. At final visit (41/66) 62% of the eyes had visual
acuity of 6/12 or better
Conclusion: Systemic immunosuppression is a safe and effective treatment in patients with severe chronic
allergic eye disease, which is refractory to conventional treatment. These patients however need careful
monitoring, and the long-term benefits need to be assessed as part of a clinical trial
76. Acanthamoeba Keratitis: Experience at Bristol Eye Hospital 2003-2012
Haneen Jasim, Derek Tole, Stuart Cook
Introduction: Acanthamoeba keratitis (AK) has been seen more frequently at the Bristol Eye Hospital (BEH) in
recent years. We aimed to quantify the number of cases and analyze their clinical progress with a casenote
review.
Purpose: To establish the number of cases of AK at the BEH in 2003-2012, what risk factors they were exposed
to, how they were managed and their clinical outcomes.
Method: Cases were identified through pharmacy records, patients’ notes were reviewed for the following
information:
1) Date of first presentation
2) Clinical picture
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3)
4)
5)
6)
Risk factors
Basis of diagnosis(cultures/clinical picture)
Treatment, duration and side effects
Clinical outcomes
Results: 32 patients were treated for AK in 2003-2012
6 patients were treated in 2003- 2007.
26 patients have been treated for AK in 2008-2012
93% were contact lens wearers.
71.8% of the cases were culture positive (scrape/ biopsy/ contact lens).
50% cases fully resolved with medical management.
37.5% patients required surgical treatment.
75% were initially misdiagnosed, with 25% diagnosed >6 weeks after initial presentation.
Patients with a late diagnosis were more likely to require surgical management
Conclusion: There has been an increase in cases of AK at the BEH. Some of these patients have suffered
devastating consequences and further research is needed to see if this is a widespread trend and to identify risk
factors for the condition. Our group will undertake a survey through the British Ophthalmic Surveillance Unit
to gain this information on a national basis.
77. Hypertonic ointment vs lubricants and bandage contact lenses for recurrent corneal erosion syndrome
(RCES)
Sally Blackmore-Wright, Radwan Al Mousa
University Hospital Coventry and Warwickshire
Introduction: RCES is associated with abnormal adhesion complexes between corneal epithelial basement
membrane and underlying stroma. Epithelial oedema induced by hypotonicity of tears during sleep further
weakens adhesion complexes, increasing the risk of epithelial cell avulsion on awakening. Hypertonic
ointments instilled before bedtime, in addition to having a lubricating effect, creates an osmotic gradient to
counteract the epithelial oedema induced during eyelid closure.
Purpose: To evaluate the effectiveness of sodium chloride 5% ointment used before bedtime for 6 months in
reducing the frequency of acute RCES episodes compared to lubricants and BCL treatment.
Method: Retrospective observational cross-over study in which RCES patients (n=52) who were initially treated
with lubricants or BCL had treatment modified to sodium chloride 5% ointment. The number of acute painful
episodes per year was compared before, during, and after treatment.
Results: The mean number of episodes per year significantly reduced from 10.92 (SD 16.64, range 0.57-73.0)
before treatment, to 0.692 (SD 1.77, range 0.0-8.0) during treatment. Wilcoxon signed rank test indicates this
change is significant (Z = -6.59, p =0). Following treatment, the mean number of episodes per year remained
significantly reduced at 1.33 (SD 2.80, range 0.0 – 10.9). Again, Wilcoxon signed rank test indicates this
change is significant (Z= -4.32, p=0).
Conclusion: A 6 month course of sodium chloride 5% ointment is more effective than lubricants or BCL in
reducing the reoccurrence of painful episodes of RCES.
78. Day-before vs same-day Eye Bank provided precut tissue for DSAEK. A prospective single blinded
randomised study of outcomes in a UK tertiary referral centre
Evripidis Sykakis, Panagiotis Georgoudis, Fook Chang Lam , Saj Khan, Samer Hamada, Damian Lake
Corneoplastic Unit and Eye Bank, Queen Victoria Hospital
Introduction: Donor cornea preparation for DSAEK can be performed by the surgeon intraoperatively or prior
to surgery by the eye bank. Standardization of precutting donor tissue by the eye bank has been shown to
increase safety of DSAEK surgery by reducing risk of tissue-related complications and increasing surgeon’s
efficiency.
Purpose: As tissue preparation on the day may delay the start time of surgery, we wished to study whether
preparation of the graft tissue the previous day would affect surgical outcomes.
Method: DSAEK grafts of 24 consecutive patients were randomised by the Eye Bank team into either group
1(prepared on the day) or group 2 (prepared the day before) without the knowledge of the surgical team. The
outcomes analysed were dislocation rate, pre and post op best corrected visual acuity (BCVA) and Endothelial
cell loss.
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Results: Each group comprised of 12 patients.
For group 1, the average follow-up was 8.61±1.80months(range 5-11 months). The average preoperative
LogMAR BCVA was 1.01±0.81(range 0.26 - 3.00) and postoperative was 0.34±0.16(range 0.20 0.70)(p=0.009).
For group 2, the average follow-up was 8.7±2.31months(range 5-13 months). The average preoperative
LogMAR BCVA was 0.98±0.54(range 0.60 - 2.00) and postoperative was 0.25±0.13(range 0.1 0.50)(p=0.003).
Comparison of the two groups showed no clinically or statistically significant difference in terms of final BCVA
and endothelial cell loss.
Conclusion: The use of precut tissue offers a number of advantages such as safety, time saving, convenience
and consistency in the quality of the cut while surgical outcomes and final clinical results are the same.
79. Corneal collagen cross-linking (C3R) with a mechanical disruption of epithelium technique for
paediatric keratoconus
Fook Chang Lam, Nashila Hirji, Robert Petrarca , Panagiotis Georgoudis, Damian Lake, Samer Hamada
Queen Victoria Hospital
Introduction: Diagnosis of keratoconus in childhood is a negative prognostic factor for progression and
younger patients are at risk for faster progression of disease.
Purpose: To assess the safety and efficacy of corneal collagen cross-linking in the treatment of progressive
paediatric keratoconus using a technique where the corneal epithelium is physically disrupted but not
removed.
Method: A retrospective analysis of the visual, refractive and topographic outcomes of 25 consecutive
paediatric patients with progressive keratoconus treated with C3R in a tertiary referral centre in the UK.
Results: Mean age 15.9 (range: 13-18) years. 2 patients were lost to follow-up. At 12 months, proportion of
patients gaining ≥2 lines in BCVA was 57%, while 7.14% lost 2 or more lines of BCVA mainly related to
progression of keratoconus. 50% gained ≥2 lines in UCVA. Median difference in BCVA was an improvement
of 1 line logMAR (mean: 1 line gain, SD: 2.2 lines logMAR). Median difference in UCVA was an improvement
of 1 line logMAR (Mean: 0, SD 3.7 lines logMAR). KMax regressed by ≥1D in 23.53%, remained stable in
41.18%, and progressed by ≥ 1D in 23.53%. Median difference in KMax was +0.5D (mean +1.3D, SD: 3.3D).
No patients developed sterile keratitis or microbial keratitis.
Conclusion: Corneal collagen cross-linking after the mechanical disruption of corneal epithelium provides a
safe and effective way of stabilising progressive keratoconus in children, which can otherwise progress
aggressively.
80. Cellulose spears to dry donor corneal tissue in the preparation of Ultrathin endothelial Keratoplasty:
correlation between duration of drying and residual corneal thickness
Aravind Reddy, Vikas Shankar
Introduction: Ultrathin(UT) corneal endothelial transplants offer excellent visual outcomes without the
complexities of donor tissue preparation, insertion and post-operative graft dislocation associated with
Descemet Membrane Endothelial Keratoplasty(DMEK). Double pass technique to prepare UT grafts requires a
bank of microkeratome heads of various cut-depths. Drying the cornea with cellulose sponge prior to using the
microkeratome allows an easy and cost effective method to prepare UT transplants
Purpose: Determine degree of corneal thinning in relation to duration of drying using cellulose spears prior to
using microkeratome
Method: Donor corneal tissue suitable for endothelial keratoplasty was mounted on an artificial anterior
chamber and epithelium removed with cellulose spears. Central corneal pachymetry (Palm Scan AP2000 with
DSAEK Package) was performed at baseline and at 30, 60, 90, 120, 180, 240 and 300 seconds during the
drying process. The drying process was performed using cellulose spears for 5 minutes.
Results: Four donor corneas underwent drying with cellulose spears prior to the use of microkeratome. The
mean baseline central pachymetry was 630μ (range 575 to 670μ). The mean central pachymetry at 30, 60,
120, 180, 240, 300 seconds of drying was 607, 580, 560, 539, 532, 525 μ respectively. The percentage
thinning of cornea with the drying at 3 minutes in each of the four corneas were 93.1%, 86.79%, 82.17% and
82.89%. (Mean 86.25%).
72
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TARGETING THE MEDIATORS OF INFLAMMATION1
IL-6
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Delivering efficacy in the clinical setting2-5
These images are for illustrative purposes only and do not represent inflammatory mediator
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OZURDEX® (Dexamethasone 700 micrograms intravitreal implant in
applicator)
Abbreviated Prescribing Information
Presentation: Intravitreal implant in applicator. One implant contains
700 micrograms of dexamethasone. Disposable injection device, containing a
rod-shaped implant which is not visible. The implant is approximately 0.46 mm in
diameter and 6 mm in length. Indications: Treatment of adult patients with
macular oedema following either Branch Retinal Vein Occlusion (BRVO) or Central
Retinal Vein Occlusion (CRVO). Treatment of adult patients with inflammation of
the posterior segment of the eye presenting as non-infectious uveitis. Dosage and
Administration: Please refer to the Summary of Product Characteristics before
prescribing for full information. OZURDEX must be administered by a qualified
ophthalmologist experienced in intravitreal injections. The recommended dose is
one OZURDEX implant to be administered intravitreally to the affected eye.
Administration to both eyes concurrently is not recommended. Repeat doses should
be considered when a patient experiences a response to treatment followed
subsequently by a loss in visual acuity and in the physician’s opinion may benefit
from retreatment without being exposed to significant risk. Patients who experience
and retain improved vision should not be retreated. Patients who experience a
deterioration in vision, which is not slowed by OZURDEX, should not be retreated.
There is only very limited information on repeat dosing intervals less than 6 months.
There is currently no experience of repeat administrations in posterior segment
non-infectious uveitis or beyond 2 implants in Retinal Vein Occlusion. Patients
should be monitored following the injection to permit early treatment if an infection
or increased intraocular pressure occurs. Single-use intravitreal implant in applicator
for intravitreal use only. The intravitreal injection procedure should be carried out
under controlled aseptic conditions which include the use of sterile gloves, a sterile
drape, and a sterile eyelid speculum (or equivalent). The patient should be instructed
to self-administer broad spectrum antimicrobial drops daily for 3 days before and
after each injection. Before the injection, the periocular skin, eyelid and ocular
surface should be disinfected and adequate local anaesthesia should be administered.
Remove the foil pouch from the carton and examine for damage. In a sterile field,
open the foil pouch and gently place the applicator on a sterile tray. Carefully remove
the cap from the applicator. Once the foil pouch is opened the applicator should be
used immediately. Hold the applicator in one hand and pull the safety tab straight
off the applicator. Do not twist or flex the tab. With the bevel of the needle up away
from the sclera, advance the needle about 1 mm into the sclera then redirect toward
the centre of the eye into the vitreous cavity until the silicone sleeve is against the
conjunctiva. Slowly press the actuator button until an audible click is noted. Before
withdrawing the applicator from the eye, make sure that the actuator button is
fully pressed and has locked flush with the applicator surface. Remove the needle
in the same direction as used to enter the vitreous. Immediately after injecting
OZURDEX, use indirect ophthalmoscopy in the quadrant of injection to confirm
successful implantation. Visualisation is possible in the large majority of cases. In
cases in which the implant cannot be visualised, take a sterile cotton bud and lightly
depress over the injection site to bring the implant into view. Following the
intravitreal injection patients should continue to be treated with a broad spectrum
antimicrobial. Contraindications: Hypersensitivity to the active substance or to
any of the excipients. Active or suspected ocular or periocular infection including
most viral diseases of the cornea and conjunctiva, including active epithelial herpes
simplex keratitis (dendritic keratitis), vaccinia, varicella, mycobacterial infections,
and fungal diseases. Advanced glaucoma which cannot be adequately controlled
by medicinal products alone. Aphakic eyes with rupture of the posterior lens capsule.
Eyes with Anterior Chamber Intraocular Lens (ACIOL) and rupture of the posterior
lens capsule. Warnings/Precautions: Intravitreous injections, including OZURDEX
can be associated with endophthalmitis, intraocular inflammation, increased
intraocular pressure and retinal detachment. Proper aseptic injection techniques
must always be used. Patients should be monitored following the injection to permit
early treatment if an infection or increased intraocular pressure occurs. Monitoring
may consist of a check for perfusion of the optic nerve head immediately after the
injection, tonometry within 30 minutes following the injection, and biomicroscopy
between two and seven days following the injection. Patients must be instructed
to report any symptoms suggestive of endophthalmitis or any of the above mentioned
events without delay. All patients with posterior capsule tear, e.g. those with a
posterior lens, and/or those who have an iris defect (e.g. due to iridectomy) with
or without a history of vitrectomy, are at risk of implant migration into the anterior
chamber. Other than those patients contraindicated where OZURDEX should not
be used, OZURDEX should be used with caution and only following a careful risk
benefit assessment. These patients should be closely monitored for any signs of
implant migration. Corticosteroids should be used cautiously in patients with a
history of ocular herpes simplex and not be used in active ocular herpes simplex. The
safety and efficacy of OZURDEX administered to both eyes concurrently have not
been studied and is not recommended. OZURDEX is not recommended in patients
with macular oedema secondary to RVO with significant retinal ischemia. OZURDEX
should be used with caution in patients taking anti-coagulant or anti-platelet
medicinal products. Interactions: No interaction studies have been performed.
Systemic absorption is minimal and no interactions are anticipated. Pregnancy:
There are no adequate data from the use of intravitreally administered
dexamethasone in pregnant women. OZURDEX is not recommended during
References: 1. Nehme A & Edelman J. Invest Ophthalmol Vis Sci. 2008;49(5):2030-2038. 2. Pommier S & Meyer F. Realites Ophthlamologuiques 2012; 195.
3. Augustin A. et al. Poster presented at EVER 2012, October 10-13; Nice, France. 4. Querques L. et al. Ophthalmol. 2013;229:21-25. 5. Rostron E. et al.
Poster presented at North of England Ophthalmological Society (NEOS) Summer Meeting 2013, June 12; Chester, UK.
Date of Preparation: March 2014 UK/0062/2014
pregnancy unless the potential benefit justifies the potential risk to the foetus.
Lactation: Dexamethasone is excreted in breast milk. No effects on the child are
anticipated due to the route of administration and the resulting systemic levels.
However OZURDEX is not recommended during breast feeding unless clearly
necessary. Driving/Use of Machines: Patients may experience temporarily reduced
vision after receiving OZURDEX by intravitreal injection. They should not drive or
use machines until this has resolved. Adverse Effects: RVO In clinical trials the
most frequently reported adverse events were increased intraocular pressure (IOP)
(24.0%) and conjunctival haemorrhage (14.7%). Increased IOP with OZURDEX
peaked at day 60 and returned to baseline levels by day 180. Elevations of IOP either
did not require treatment or were managed with the temporary use of topical
IOP-lowering medicinal products. The following adverse events were reported:
Very common (≥1/10): IOP increased, conjunctival haemorrhage* Common (≥1/100
to <1/10): Ocular hypertension, vitreous detachment, cataract, subcapsular cataract,
vitreous haemorrhage*, visual disturbance, vitreous opacities* (including vitreous
floaters), eye pain*, photopsia*, conjunctival oedema*, anterior chamber cell*,
conjunctival hyperaemia*, headache Uncommon (≥1/1,000 to <1/100): Retinal
tear*, anterior chamber flare* Headache. Uveitis In clinical trials the most frequently
reported adverse events in the study eye were conjunctival haemorrhage (30.3%),
increased IOP (25.0%) and cataract (11.8%). The following adverse events were
reported: Very common: Increased IOP, cataract, conjunctival haemorrhage*
Common: Retinal detachment, Myodesopsia, vitreous opacities, blepharitis, sclera
hyperaemia*, visual impairment, abnormal sensation in the eye*, eyelid pruritis,
migraine. (*Adverse reactions considered to be related to the intravitreous injection
procedure rather than the dexamethasone implant). Please refer to Summary of
Product Characteristics for full information on side effects. Basic NHS Price: £870
(ex VAT) per pack containing 1 implant. Marketing Authorisation number:
EU/1/10/638/001 Marketing Authorisation Holder: Allergan Pharmaceuticals
Ireland, Castlebar Road, Westport, Co. Mayo, Ireland. Legal Category: POM.
Date of Preparation: May 2013.
Adverse events should be reported.
Reporting forms and information can be found
at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to
Allergan Ltd. [email protected]
or 01628 494026.
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Conclusion: Three minutes of drying of donor corneas with cellulose spears provides significant thinning of
donor cornea.
81. Service Evaluation of Paediatric Cross-linking for Keratoconus at Moorfields Eye Hospital
Alastair Porteous, Tom Flynn, Stephen Tuft
Moorfields
Introduction: Corneal collagen cross-linking is offered to both adults and children with keratoconus who fulfil
defined clinical criteria of disease progression. Adults have the treatment under topical anaesthetic but
children have either topical, with sedation if necessary, or general anaesthesia determined on a case-by-case
basis. Recent studies in paediatric patients have been performed exclusively under local anaesthetic but have
included no data on the patient experience.
Purpose: To evaluate patient feedback of paediatric patients who have undergone cross-linking at Moorfields in
order to guide changes in the service and improve the patient experience.
Method: A telephone-based questionnaire was conducted asking the following: How likely are you to
recommend our service to friends and family if they needed similar care or treatment (scale of one to five)
Were you happy with the facilities during your stay? Did the clinical staff provide you with adequate
information regarding the procedure? If you had the procedure again would you have topical or general
anaesthetic?
Results: Nine of the thirteen male paediatric patients were contacted. The mean Friends and Family score was
1.56. All patients were happy with the facilities and information provided. Two patients had local, three had
local and sedation and four had general anaesthetic. All thirteen patients would choose to have the same
anaesthetic if they were to have the procedure repeated.
Conclusion: All patients were satisfied with their treatment experience. Although general anaesthesia was
offered, cross-linking can be well tolerated under local anaesthetic in paediatric patients.
82. Ultrathin (UT) DSAEK: a novel Non-double-pass technique
Vikas Shankar, Paul Chua, Aravind Reddy
Introduction: Ultrathin(UT) DSAEK achieves visual outcomes comparable to those of Descemet’s Membrane
Endothelial Keratoplasty (DMEK) but without the higher rates of complications associated with DMEK. A novel
non-double-pass technique offers a simple, cost effective method of preparing an UT graft
Purpose: To report the visual outcome, graft thickness, re-bubbling rate and graft failure with non-double-pass
UT DSAEK
Method: This is a retrospective case-note review of patients undergoing UT DSAEK at Aberdeen Royal
Infirmary. A non-double-pass technique of preparing UT graft tissue is described elsewhere (video submission).
Post-operative corneal endothelial graft thickness was measured with Corneal Optical Coherence Tomography
(OCT)
Results: Thirty-five patients had DSAEK over a two-year period for Fuch’s endothelial dystrophy. 20 patients
had combined phacoemulsification and IOL along with DSAEK. Mean pre-operative visual acuity was 6/36. 5
patients (14%) needed re-bubbling post-operatively for partial graft detachment. 58.33% patients had 6/12 or
better vision at 3 months post-op and 81.81 % had 6/12 or better at 6 months post-op. Mean post op
endothelial graft thickness as measured on OCT was 93.22 microns (range 41 to 174) at 3 months,
93.3microns (range 41 to 174) at 6 months and 93.38 (range 34 to 200) at 9months post-op. Graft failure was
noted in 2 patients during the learning curve (primary endothelial failure) and needed re-graft
Conclusion: Ultrathin corneal endothelial transplants prepared by a non-double-pass technique provide
excellent and rapid visual rehabilitation. Complications and failure rates are comparable to those prepared by
the double-pass technique
83. Five novel mutations in the CHRDL1 gene associated with X-linked Megalocornea
Halah Ali, Alice E Davidson , Sek-Shir Cheong , Jens M Hertz, Jonathan B Ruddle, Stephen J Tuft, Alison J
Hardcastle
Institute of Ophthalmology & Moorfields Eye Hospital
Introduction: X-linked Megalocornea is an inherited congenital disorder characterised by non-progressive
bilateral enlargement of the corneas.
81
Birmingham 2014
Purpose: We aim to test for novel mutations in the chordin-like 1 gene (CHRDL1) in six males who were
phenotypically diagnosed with X-linked megalocornea.
Method: Genomic DNA was isolated using standard methods in six males, two of whom were related. All 12
exons of CHRDL1 were amplified using PCR and screened for mutations with bi-directional Sanger
sequencing. The extent of deletions encompassing CHRDL1 were refined by targeted proximal and distal PCRs
amplifying the CHRDL1 flanking genes RGAG1 and PAK3. Fifty-three controls and the Exome Variant Server
were used to exclude non-pathogenic polymorphisms. Subjects were phenotyped by consultant
Ophthalmologists by performing ophthalmic examinations, pedigree assessment and optical coherence
tomography.
Results: Five novel X-linked CHRDL1 mutations have been identified: c.240T>A (p.Cys80X); c.871G>A
(p.Cys291Tyr);c.1247_1247-1delGG ; whole CHRDL1 gene deletion (neighbouring genes PAK3 and RGAG1
not deleted); c.297C>A (p.Cys99X). The same mutation was found in two members of the same family.
Conclusion: A variety of novel mutation types (nonsense, missense, frameshift and gene deletion) in CHRDL1
were identified as the cause of X-linked Megalocornea. All mutations published to date have allelic
heterogeneity. The missesnse mutation identified is located within a highly conserved cysteine-rich protein
domain, known to be important for Bone Morphogenic Protein signalling. Genetic screening in male children
with ‘large eyes’ should be offered to distinguish between primary congenital glaucoma and megalocornea as
prognoses are very different.
84. Deep Anterior Lamellar Keratoplasty (DALK) versus Penetrating Keratoplasty (PK) for keratoconus: a
systematic review
Christin Henein, Mayank Nanavaty
Sussex Eye Hospital
Introduction: Evidence supporting similar outcomes between DALK and PK for the treatment of keratoconus is
questionable because the number of randomised trials is sparse and underpowered to detect any meaningful
difference. Furthermore, more recent randomised studies and the evolving techniques and expertise in the
DALK procedure may bear weight to overall findings.
Purpose: The aim was to perform a systematic view of randomised and non-randomised comparative studies
assessing the outcomes of DALK and PK for keratoconus.
Method: A systematic review of English abstracts using MEDLINE (1950-2013),Embase (1980-2013) and
ClinicalTrials.gov database. Inclusion criteria were sample size of at least 20 eyes in each arm and a follow-up
of at least 12 months. Primary outcomes were uncorrected (UCVA) and best-corrected visual acuity (BCVA).
Secondary outcomes were allograft rejection, failure, endothelial density and complications. Fixed and random
effects models were applied to results combined for analysis using Microsoft excel.
Results: Three randomized and 7 non-randomised studies were included. There was no significant difference
in UCVA or BCVA (P>0.05). DALK had significantly less allograft rejection and more endothelial density
compared to PK(p<0.05). Other secondary outcome measures were not significantly different. There was no
evidence to suggest heterogeneity of study results (p>0 .05).
Conclusion: Both randomised and non-randomised studies showed no difference in visual acuity between
DALK and PK. DALK reduces the risk of allograft rejection and has significantly increased endothelial cell
density at 12 months follow-up.
85. Safe use and care of contact lenses by young adults
Evgenia Kanonidou, Vasileios Konidaris, Christina Kanonidou , Leonidas Papazisis
Department of Ophthalmology, General Hospital of Veria, GR
Introduction: The use of contact lenses for visual, therapeutic or cosmetic reasons has increased over the last
few years and is higher among young people.
Purpose: To evaluate the compliance in safe handling, care and maintenance among contact lens wearers.
Method: 173 contact lens wearers (85male), aged 19-24 years old participated in the study. 91% wore them to
correct ammetropia and 9% for cosmetic reasons for a mean duration of 3 years. All used monthly disposable
hydrophilic contact lenses. The study was performed using anonymous self-administered questionnaire.
Results: 49% washed their hands before lens insertion and 67% after lens removal. 23% followed the rub and
rinse technique after the contact lens removal. 82% wore the lenses longer than recommended and 93% were
not compliant with the recommended replacement schedule. Only 13% of them followed the rub and rinse
82
ABSTRACTS: Cornea & External Eye Disease / Glaucoma
Birmingham 2014
technique for the cleaning of contact lens case and 25% replaced the storage case after a period of three
months. All of them were using a multipurpose solution for cleaning, disinfecting and storing. All reported
occasional use of saline solution or tap water to clean, disinfect and store their lenses. The findings were not
significantly different among males and females and were not correlated with the year of contact lens wearing.
Conclusion: It was interesting to observe the poor hand hygiene as well as the inadequate cleaning and
disinfection patterns of lenses and storage cases followed by the participants. Health professionals should
therefore spend more time in educating their patients.
GLAUCOMA
86. Clinical features of fast and slow progressors in the glaucoma service: Analysis of The Portsmouth
Visual Fields database
Sameer Trikha, Hannaa Bobat, Clive Osmond , James Kirwan
Queen Alexandra Hospital Portsmouth
Introduction: Increasing pressures within glaucoma services necessitate an improved understanding of
progression, ensuring management is stratified according to need.
Purpose: To determine clinical characteristics of patients stratified according to visual field progression.
Method: We extracted Humphrey VFs from our database drawn from normal clinical practice. VF series from
4177 eyes from 2208 patients who had >5 VFs were obtained. A retrospective pilot study analysing 187
patients with POAG/NTG only was performed. Fast progressors (FP) were deemed to progress >2.0dB per year
and slow (SP) between >-0.3 and <1.0dB/year. Mean presenting MD, MD change and clinical features
(systemic/ocular co-morbidities) were analysed.
Results: The mean rate of progression for the whole cohort of patients was -0.26dB/year, over a median of
seven years. 187 patients – 57 slow progressors (SP), 60 medium progressors (MP) and 70 fast progressors were
identified. Initial MD was -7.25dB in FP vs. -4.17 dB in SP. Average slope was -0.67 dB/yr (SP), -1.23 dB/yr
(MP) and -3.67 dB/yr (FP). Mean change in MD over 5 VFs in FP was -13.03 dB vs. -2.75dB in SP(p < 0.001).
Mean age at diagnosis was 68.5 yrs FP vs 61.3 yrs SP (p = 0.001). Multivariate regression revealed later age at
diagnosis associated with more negative average slope (p =0.002), and more negative slope was also
associated with hypertension, IHD (p = 0.009) and subsequent development of cognitive impairment (p =
0.001). Mean IOP reduction following treatment was 25.1% in SP vs. 21.6% in FP (p = 0.035). At the time of
review, mortality rate was higher in 34.3%(FP) compared to 7.0%(SP).
Conclusion: Fast progressors were associated with later age at presentation, worse initial MD and increased
prevalence of hypertension, ischaemic heart disease and subsequent cognitive impairment compared to slow
progressors. Initial findings warrant close scrutiny of systemic risk factors and necessitate further investigation.
87. Supramid Management after Baerveldt Tube Implantation - an Audit
Jayesh Khistria, Pavi Agrawal, Gus Gazzard
Introduction: Non-valved aqueous shunt implants often require luminal occlusion to prevent hypotony in the
early postoperative period. This can be achieved through external ligation or use of an intraluminal supramid
suture. The 3-0 nylon supramid suture acts as an aqueous flow restrictor until such time when the intraocular
pressure rises above threshold and the suture can be removed.
Purpose: Our aim was to compare clinical outcomes in postoperative tube-shunt surgery patients that had
undergone supramid removal vs. non-removal.
Method: This was a retrospective case series of 41 eyes of 36 patients.
Results: The mean age was 60.9 ± 14.8 years. The spectrum of glaucoma phenotypes was similar between the
two groups. Of the 41 eyes 78% (32/41) underwent either partial or complete supramid removal and 22%
(9/41) required no supramid removal. The mean preoperative IOP in the supramid removal group was 27.9
mmHg on a mean of 3.1 glaucoma medications. The non supramid removal group had a mean IOP of 26.3
mmHg on a mean of 2.6 glaucoma medications. At 6 months in the supramid removal group mean IOP was
14.3mmHg (1.4 glaucoma medications) in comparison to the non-removal group where mean IOP was
15.4mmHg (0.4 glaucoma medications).
Conclusion: Tube shunt surgery can result in 40-45% reduction in IOP at 6 months. IOPs were equally well
controlled between the two groups and interestingly the “supramid in situ” group had lower number of
medications.
83
Birmingham 2014
ABSTRACTS: Glaucoma
88. Normal tension glaucoma or hyperlipidemia related angiopathy
Souhad Lawand, Heba Eyadat
Al-Sharq Hospital
Introduction: Automated perimetry has become the mainstream for assessment of functional glaucomatous loss
and progressive damage.
It is also standard to think that absolute scotomas are irreversibly non functional areas related to the damage
incurred to the optic RNFL by increased IOP even if the IOP readings show normal values eg. normal tension
glaucoma.
Purpose: 1.to investigate the similarity of visual field defects that occur during suspected normal tension
glaucoma and retinal angiopathy induced by hyperlipidemia
2.To consider visual field analysis and its findings a new marker in determining the effectiveness of
hyperlipidemia control and/or treatment.
Method: 10 patients with hyperlipidemia underwent visual field examination using the 30-2 supra threshold on
the oculus twinfield and in almost all cases, enlargement of blind spots were detected. Another visual field test
was conducted after prescribed treatment for hyperlipidemia and data was compared.
Results: 9 out of 10 patients showed disappearance of some or all absolute scotomas after the 1st month of the
prescribed recommendations.
Conclusion: 1.This research suggests that hyperlipidemia can cause visual field defects similar to those seen at
the onset of glaucoma.
2.The reversibility of absolute scotomas in automated perimetry makes it a less subjective method in
monitoring glaucomatous changes.
3.Automated perimetry can be used to determine the effectiveness of hyperlipidemia treatment and control.
89. Laser suture stretch for post trabeculectomy bleb management
Rohit Saxena, Marta Hovan, Stephen Vernon
Nottingham University Hospital
Introduction: Trabeculectomy aims to promote a filtering conjunctival bleb formation with a loose scleral flap
to allow aqueous outflow, but tight enough to prevent hypotony and flat anterior chamber. This balance is
critical to the success of the operation.
Purpose: To describe the performance and safety of a new technique of laser suture stretch (LSS) for managing
a tight scleral flap following trabeculectomy.
Method: Medical records of a consecutive series of 42 laser suture stretch procedures performed between
Oct’2009 and Dec’2012 at our hospital were reviewed. There were 21 male and 20 female patients (mean age
69.8 years). Mean follow up was for 12.9 months. The mean interval between trabeculectomy and laser suture
stretch was 12 days.
Outcome measures included IOP levels immediately following LSS, at three months and at last review,
hypotony, bleb leak, and further surgery rates.
Results: Mean pre-stretch IOP was 25.2 (Range 12-38) mmHg, reducing to a mean of 12.7mmHg (range 4-20)
immediately after the procedure. None of the patients had any significant shallowing of the anterior chamber
or any demonstrable bleb leak. The mean IOP at 3 months was 10.5mmHg (Range 2-29) & 12.3mmHg at last
review. None of the patients required further surgery in the follow up period.
Conclusion: LSS achieves loosening of scleral flap sutures in a controlled, graded manner and is a safe
alternative to laser suture lysis and adjustable sutures.
90. Virtual Glaucoma Clinics: Patient Acceptability And Quality of Patient Education Compared To
Standard Clinics
Jennifer Court, Michael Austin
Singleton and Neath Port Talbot Hospitals
Introduction: Virtual glaucoma clinics allow rapid, reliable patient assessment but are patients satisfied with
the service and is patient education adequate to maintain compliance?
Purpose: To compare experiences and understanding of patients reviewed via the virtual clinic versus the
standard clinic.
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Method: 100 patient satisfaction questionnaires (PSQs) were given to consecutive patients attending glaucoma
clinics in October 2013. All 135 patients reviewed via the virtual clinic from April 2013 until August 2013
were sent postal PSQs in September 2013. Data was obtained for demographics, understanding of glaucoma,
their condition, satisfaction with their experience, and quality of information. Responses were analysed in
conjunction with the clinical records.
Results: 75% of clinic patients and 63% of virtual clinic patients responded to the PSQ.
The mean satisfaction score was over 4.3/5 in all areas surveyed.
Virtual clinic patients' understanding of their condition was very good, with 95% correctly identifying their
diagnosis as glaucoma, 83% as ocular hypertension and 78% as suspects. There was no evidence to support
inferior knowledge or self perceived understanding compared to standard clinic patients. Follow up patients
knew more about glaucoma than new patients.
Over 95% of patients found our information leaflet useful. 1/3 of patients sought additional information but
less than 20% used the internet for this.
Conclusion: A substantial proportion of glaucoma pathway patients may be seen by non-medical staff
supervised by glaucoma specialists via virtual clinics. Patients are accepting of this format, reporting high
levels of satisfaction and non-inferior knowledge to those seen in standard clinics.
91. The interobserver reliability of the Van Herick measurement
Ahmed Javed, Mark Batterbury, Stephen Kaye
Introduction: The Van Herick method is a quick and simple method to estimate peripheral anterior chamber
depth and predict the risk of angle closure glaucoma. However, as a subjective test, it may not be reproducible
between observers.
Purpose: To determine the reproducibility of Van Herick grading between observers; to determine if some
grades are more reproducible than others; to study the concordance between the temporal and nasal scores.
Method: The temporal and nasal Van Herick scores of a single eye were measured in 18 patients by 15
observers. Results were analysed by assigning an eye to a Van Herick grade based on the median interobserver
score and then calculating the average standard deviation and percentage consistency for each grade.
Results: Grades 1 and 4 had a high average percentage consistency (80%, 84.6%) and a low average standard
deviation (0.45, 0.26). Grades 2 and 3 had low average percentage consistencies (57.5%,50%) and high mean
standard deviations (0.71, 0.89). The temporal and nasal scores showed good agreement (κ=0.61 p<0.001)
Conclusion: The Van Herick angle grading system has good interobserver reproducibility for grades 1 and 4
but not for grades 2 and 3 so cannot be relied on for predicting the risk of angle closure glaucoma. Temporal
and nasal scores are in good agreement, so that if the nasal angle cannot be measured, the temporal angle can
be used as an approximation.
92. Phacoemulsification with endocyclodiode laser to aid glaucoma management
Line Langsaeter, Pieter Gouws, Ali Hassan
East Sussex Hospital Trust
Introduction: Many glaucoma patients are reliant on several drops. Any intervention that reduces drop
dependency benefits patients and health system alike. The fairly new procedure of endocyclophotogoagulation
of the ciliary body during phacoemulsification has been shown to lower the intraocular pressure (IOP). A
recent literature search returned 4 relevant papers that site IOP reduction of 6mm Hg, equivalent to 1 drop.
Purpose: This study aims to establish the outcome of glaucoma patients who had combined
phacoemulsification and endoscopic cyclodiode laser (phaco-ECP).
Method: All patients who underwent combined phaco-ECP by one experienced surgeon at East Sussex
Healthcare Trust between 1/9/2009 and 16/9/2013 were included in a retrospective audit. Previous
interventions were not excluded and all glaucoma subtypes were included in the study.
Results: The number of eyes included in the study was 284. The mean age was 78.7, with a female:male ratio
of 1.95. The subtype distribution was: 76% primary open angle glaucoma, 8% pseudoexfoliation, 7% ocular
hypertension, 6% normal tension glaucoma and 3% (trauma, chronic angle closure, Sturge Weber and
neovascular CRVO). The mean IOP pre-procedure was 16.7mmHg and at 6 months post-up 13.8mmHg,
resulting in a reduction of 18%. The mean number of drops used pre-op was 2.27 and one year post-op 0.83
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resulting in a decrease of 70%. Follow-up varied between 2 months and 16+ months.
Conclusion: The use of endocyclophotocoagulation during photocoagulation may be an addition in long term
glaucoma management and may reduce dependency glaucoma drops.
93. Developing predictive model and potential biomarkers for primary open-angle glaucoma using
metabolomics approach
Zakaria Bannur, Lay Kek Teh, Mohd Zaki Salleh, MI Ismail, Jonathan Crowston, Sushil Vasudevan
Universiti Teknologi MARA UiTm
Introduction: Biomarkers are objectively measurable biological characteristics that can be used to diagnose,
monitor or predict diseases. As ‘‘omics’’ technologies have emerged, the possibility of both measuring and
using multiple biomarkers simultaneously to predict diseases has captured the imagination of many clinicians
and scientists. Indeed, the molecular basis of primary open-angle glaucoma (POAG) is not fully understood.
Purpose: Thus, this study aims to establish a predictive model to differentiate POAG patients from healthy
volunteers using metabolomics approaches.
Method: Serum samples of sixteen POAG patients and healthy volunteers were analysed by Liquid
chromatography/Quadruple time-of-flight mass spectrometry system (Q-TOF LC/MS). Statistical analysis
included principal component analysis (PCA), clustering tests and partial least squares analysis. A predictive
model was developed and validated by Mass Profiler Professional and ROCCET softwares. The performance of
the model was evaluated by measuring the area under the ROC curves, error rates, and permutation tests.
Results: The model discriminates each group in separate clustering. An overall predictive accuracy of 96.7%
was obtained by this model. Ten features predictive model was the best with highest sensitivity and specificity
and with less variation in cross validation (AUC =0.999, CI 0.991-1). The model testing resulted in predictive
accuracy around 0.95 (AUC= 0.985 95% CI: 0.944-1), and empirical p-value at 1000 times permutation test
p< 0.002.
Conclusion: The predictive model would be widely applicable in clinical use after further training and
validation. This generates new hypothesis for designing medicine, substantial improvements in patient care
and clinical outcomes.
94. Absence of OPTN E50K mutation in primary open angle glaucoma and ocular hypertension
Soo Park, Yalda Jamshidi, Lik Thai Lim , Daniela Vaideanu, Scott Fraser, Jane Sowden
Introduction: Primary open-angle glaucoma (POAG) is a common but complex disease with a strong genetic
component. Notably, few genes have been robustly associated with POAG.
Purpose: This study aims to ascertain the contribution of OPTN E50K mutation to unrelated POAG and ocular
hypertension (OHT) in white British subjects.
Method: Two Independent cohorts comprised of 329 cases affected with either OHT (n= 57) or POAG (n=272)
and 276 matched controls of white British descent were recruited in this study. The prevalence of E50K
mutation was examined using TaqMan® SNP genotyping assays.
Results: The E50K mutation was not present among OHT subjects (a major risk factor for POAG) and POAG
individuals, as well as among the controls.
Conclusion: This study confirms the absence of E50K mutation among unrelated POAG/OHT individuals from
the North-East of England.
95. Squeezing Generic Latanoprost: Are they the same?
Umaima Mulla, Kelvin Wong, Elizabeth Tanner , David Young, Alan Rotchford
Gartnavel General Hospital
Introduction: Generic Latanoprost is the most widely prescribed topical anti-glaucoma treatment. 3.5 million
bottles were dispensed in England in 2011. Patients may receive different bottle types every month depending
on pharmacy supplier. Some patients may find the use of different bottles difficult.
Purpose: To assess the force required to expel one drop of Latanoprost from different generic bottles.
Method: Three bottles of seven preparations of generic Latanoprost (Pfizer, Actavis, Beacon, Sandoz, Teva,
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Tubilux, and Zentiva) were tested. A 1kN load cell was positioned horizontally with an aluminium semi
cylindrical loading head attached, connected to a Zwick-Roell 250 mechanical testing unit. The bottle was
inverted and force applied to expel 10 individual drops from each bottle measured . Maximum load applied
(Newtons) during the delivery of each drop was analysed using Zwick-Roell software.
Results: The mean force required was: Actavis 11.50N, Beacon 33.94N, Sandoz 15.99N, Teva 17.81N, Tubilux
19.29N, Xalatan 22.61N, Zentiva 18.82N. There is a statistical significance in force required between xalatan
drop bottles and other manufacturers (p<0.001).
Conclusion: The bottle requiring least force was Actavis (11.50N) and most was Beacon (33.94N). Normal grip
force is 17.8-160N. Force required for some generic preparations was higher than the lower range of normal,
suggesting that patients with weak grip force may have difficulty with expression of drops from these bottles.
Bottles with lower force requirements may run out quickly due to over expression. Ophthalmologists should
consider difficulties patients may have with differing bottle types of generic Latanoprost and prescribe
accordingly.
96. Macular Thickness Changes in Glaucoma using Spectralis Ocular Coherence Tomography
Tulsi Changulani, Neeta Ray-Chaudhuri
Newcastle upon tyne-RVI
Introduction: Posterior Pole Asymmetry Analysis combines mapping of the posterior pole retinal thickness with
asymmetry analysis between eyes (bilateral asymmetry) and between hemispheres of each eye
Purpose: To compare macular thickness and retinal nerve fibre layer thickness (RNFL) in normal and
glaucomatous eyes using spectralis optical coherence tomography
Method: We performed Spectralis macular and peripapillary RNFL thickness,complete ocular examination in
36 normal and 44 glaucoma patients (Male 42, female 38).
Exclusion criteria were best-corrected visual acuity less than 20/40; diseases other than glaucoma , unreliable
perimetry.
Main Outcome measures were Mean total and hemifield Macular and RNFL thickness measurements.
Reports were saved as
1.Asymmetry Analysis Single Exam Report OU
2.Spectralis RNFL
Results: Eighty eyes of 80 patients (36 normal and 44 glaucomatous) were enrolled. All eyes with glaucoma
had associated visual field loss (mean +/- SD Mean defect,-5.6 +/- 6.0 dB).Mean Macular thickness was
significantly associated with visual field mean defect, pattern standard deviation and mean RNFL thickness. In
glaucomatous eyes with visual field loss localised to 1 hemifield mean +/- SD macular thickness in the
hemifield associated with field defect(269 +/- 16 micro m) was significantly less than the unaffected hemifield
(282 +/- 19 micro m).Mean RNFL thickness in the affected hemifield (72 +/- 17 micro m) was significantly
thinner than in the unaffected hemifield (91 +/- 14 micro m)
Conclusion: Macular thickness changes are well correlated with changes in visual function and RNFL structure
in glaucoma and is a good indicator of retinal ganglion cell loss.
97. Glaucoma Patients’ Education Scheme
Mital Shah, Deborah Dow , Jane Diggory , Asifa Shaikh
Introduction: Noncompliance with glaucoma medications is common. Lack of information about glaucoma is
a causative factor. Educational interventions improve compliance. Clinicians have time constraints to deliver
effective educational interventions. Trained volunteers offer an alternative opportunity to educate patients,
which may help improve compliance.
Purpose: To assess patients’ experience and acceptability of volunteers used to provide information about
glaucoma.
Method: Clinicians referred patients attending glaucoma clinics at one trust to volunteers for education about
glaucoma, surgical or laser interventions and eye drop technique. Patients were subsequently contacted by
telephone to complete a satisfaction survey with five responses ranging from strongly disagree to strongly
agree.
Results: 68 patients were referred to the volunteers over a 7 months’ period. 27 (40%) were contacted by
telephone. All were happy with their experience of the volunteer service with 23 patients (57.5%) strongly
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agreeing that they were comfortable talking to a volunteer, 18 (45%) strongly agreeing that the volunteer was
able to answer their questions and explain the condition properly and 22 (55%) strongly agreeing that speaking
with the volunteer was a positive experience. 17 (42.5%) strongly agreed that they had better knowledge and
understanding about glaucoma and 22 (55%) strongly agreed that they understood the importance regular
therapy. Of the 17 patients surveyed about eye drop technique, 14 (82.4%) strongly agreed they were more
confident with their technique.
Conclusion: Patients were comfortable and accepting of the volunteer scheme and reported better
understanding of glaucoma. Using volunteers to educate patients helps clinicians and improves compliance.
98. Improving information-sharing for glaucoma patients who move to another area
Mykolas Pajaujis, Inderraj Hanspal, David Broadway , Nuwan Niyadurupola, Tom Eke
Introduction: When a glaucoma patient moves home, it is useful for their new ophthalmologists to have
background clinical information. The importance of information-sharing is stressed in the 2009 NICE
Guideline CG85 (Glaucoma).
Purpose: We looked at quality of data-sharing, for glaucoma patients who had moved to our area.
Method: We retrospectively audited data-requests for glaucoma patients who had moved to our area since
2009. Results allowed us to develop an improved system, which was then audited
Results: In the first audit cycle, we identified 18 patients for whom we had requested background information.
Of letters sent, the mean response time was 124 (range: 8 – 938) days and only limited information was
received. We then developed a “New standard letter” which was addressed to a named consultant where
possible, and specifically asked for information on IOP, disc, field, medication problems, and ‘any other
relevant information’. Audit of the first 22 “New letters” showed a response rate of 22/22 (100%), mean
response time 47 (range: 4 – 216) days. Completeness of data received was: IOP 16/18 (89%) old, 22/22
(100%) new; discs 7/18 (39%) old, 11/22 (50%) new; fields 7/18 (39%) old, 19/22 (86%) new; medication
problems 8/18 (44%) old, 16/22 (73%) new. Receipt of background data resulted in a change of management
in 11/40 patients (27%).
Conclusion: Our “New standard letter” system gave quicker response times and more complete data. It is
important to share information on glaucoma patients who move to another clinical team.
99. Analysis of glaucoma referral and discharge pathways in Scotland and the need for new SIGN
glaucoma referral guidelines
Andreas Syrogiannis, Donald Montgomery, Jennifer Burr , Roshini Sanders
NHS FIFE
Introduction: Glaucoma accounts for 20% of Scottish NHS new ophthalmic referrals.
Purpose: The study aimed to collect national information for the SIGN group in order to provide guidance for
referral recommendations
Method: Survey of 16 consultant glaucomatologists in Scotland
Results: Approximately10,000 new glaucoma referrals are generated annually in Scotland. 84% are from
community optometrists . 33% of them are vetted by a consultant glaucomatologist.
The information provided by optometrists is characterised as inadequate in 25% and by far the most common
information missing is visual field testing .
80% of all patients are seen in a consultant led clinic, and they are followed up at the same clinic .Only one
unit has a formal shared care community facility. An estimate of 33% are diagnosed with glaucoma with a
false positive rate of 30 – 40%.
Finally, 60% of stable patients are discharged in the community with simple generic advice and annual
optometrist review.
Conclusion: SIGN guidelines are set to mandate referral information and the Scottish Eyecare Integration
Project with community electronic link will mandate digital images of the optic disc. Low risk patients will be
identified for community follow up in accordance with the Scottish General Ophthalmic Service Contract.
Other recommendations include patient held data and discharge to a named community professional.
A national SIGN model will hopefully achieve conformity and equality in care across Scotland and identify
sight threatening disease early.
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100. Glaucoma treatment compliance at a UK General Practice
Meena Arunakirinathan, Mital Shah , Chrystal Dooley, Asifa Shaikh
Introduction: Noncompliance with glaucoma medications is common. The ophthalmologist’s ability to
accurately determine patient compliance within short clinic visits is suboptimal. General practitioners in the
UK are uniquely positioned to identify patients with compliance issues as they provide repeat prescriptions for
medications.
Purpose: To identify patient compliance with glaucoma therapy from prescriptions issued and factors
identifiable from computerised patient records.
Method: Identification of patients diagnosed with glaucoma, ocular hypertension or glaucoma suspect and/or
prescribed topical glaucoma medications registered at a practice with 13,422 patients. Compliance was
defined as mean difference in the actual number of prescriptions collected annually compared to twelve
prescriptions required annually over the duration of treatment.
Results: 278 patients were identified of which 139 (50%) were male. Mean age was 72 years (range: 22–100).
206 patients (74%) were prescribed glaucoma treatment. Compliance varied significantly between age groups
(p=0.0057). Patients aged 50-59 collected 3.2 fewer prescriptions per year and those aged 90-99 collected 1.3
more prescriptions per year than the twelve required. Compliance was better with prostaglandin analogues
compared to other medication groups but there was no statistically significant difference (p=0.0638); equally
there was no difference when comparing diagnoses, co-morbidities or number of drops being taken.
Conclusion: Glaucoma treatment compliance improves with increasing age. Older patients require more
prescriptions and may experience drop wastage. Younger patients should be targeted with educational
interventions to improve their understanding of glaucoma. Older patients may benefit from drop technique
review. GPs are well placed to provide such interventions.
101. Managing Capacity in the Ophthalmology Department – Options review
Anju Kadyan, Anna Gao, Shampa Gupta
Shrewsbury and Telford Hospital NHS Trust
Introduction: Ophthalmology services are currently facing huge capacity issues and delayed review
appointments raise concerns on patient safety.
Purpose: To evaluate overflow capacity in general ophthalmology clinics in a district general hospital (DGH)
and review options to manage demand efficiently.
Method: Prospective data from consecutive local Consultant clinics at a DGH (April-July 2013) and
independent outsourced clinics commissioned subsequently (August-September 2013) to manage pending
reviews was evaluated for diagnosis and outcomes.
Results: A total of 144 patients data were collected from the Consultant clinics. The main diagnosis was
glaucoma (n=117, 81.3%). 31 (21.5%) patients were deemed by the Consultant to have a different diagnosis
from the previous doctor. Clinic review was felt not to be necessary in 17 (11.8%) patients based on the
previous clinic entries. 34 patients (23.6%) were discharged, 94 (65.3%) had follow ups in general clinics, 10
(6.9%) in subspecialty clinics, 6 (4.2%) were listed for surgery or laser. Data for 129 patients from the
Outsourced clinics was provided and 121 (93.8%) had glaucoma. 10 (7.8%) were discharged, 115 (89.1%)
reviews arranged for general clinics, 2 (1.6%) were referred for cataract surgery and 2 (1.6%) to subspecialty
clinics.
Conclusion: An overwhelming majority of the patients in general clinics with delayed reviews had diagnosis of
glaucoma. Consultant clinics led to three times as many discharges probably related to appropriate diagnosis
and decision making skills. Majority of patients had stable glaucoma and could be managed more efficiently in
Consultant-led Nurse/Optometry clinics by the Glaucoma service.
102. A comparative study of glaucoma drainage implant (GDI) surgery in children and adults at a tertiary
referral centre
Achilleas Mandalos, Michael Lai, Velota Sung
Introduction: Given the differences in the prevalent types of glaucoma in children and adults and the technical
challenges of GDI implantation in paediatric eyes, it would be interesting to explore whether GDI surgery has
similar outcomes and pitfalls in children compared to adults.
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Purpose: To compare the postoperative outcomes and complications of GDI surgery in paediatric (<18 years
old) versus older patients.
Method: Retrospective, comparative study including all patients who underwent Baervedlt or Molteno implant
surgery by a single surgeon. Success criteria included postoperative intraocular pressure (IOP) between 6 and
22 mmHg and a 20% reduction from baseline.
Results: Fifty two children (69 eyes) and 130 adults (145 eyes) were followed up for a mean of 45.7 months
and 32.6 months, respectively. Mean IOP and number of medications were significantly reduced
postoperatively in both groups. Overall success rate was statistically similar in children (66.7%) and adults
(71.7%) at the last clinic visit. However, adults failed earlier than children. Hypotony was the most common
complication in both groups in the first 6 months postoperatively. Later, bleb encapsulation was more frequent
in children, while corneal decompensation occurred more frequently in adults. Children also had a higher rate
of infectious endophthalmitis and required tube repositioning more frequently than adults.
Conclusion: GDI surgery presents different postoperative challenges in children and adults. It is important that
the surgeon remains vigilant for complications throughout the postoperative period, especially for signs of
endophthalmitis or bleb encapsulation in paediatric patients. On the other hand, adults may be more prone to
early corneal decompensation.
103. Patient oriented outcomes for selective laser trabeculoplasty
Marina Hopes, Chrysostomos Dimitriou, Nuwan Niyadurupola, David Broadway, Tom Eke
Introduction: Selective laser trabeculoplasty (SLT) was introduced in the Norfolk and Norwich University
Hospital glaucoma service in late 2009.
Purpose: To assess effectiveness of SLT in terms that are directly relevant to patients.
Method: Retrospective case-notes audit. The stated 'goal' of SLT was categorised. We looked at intraocular
pressure (IOP) and whether the 'goal' of treatment had been achieved, at 1 year and at 2.5 years after SLT.
Results: Notes for 52 consecutive patients (81 eyes) were analysed. Prior to SLT, mean (±SD) IOP was 19.5
(±4.2) mmHg on 1.3 (±1.2) anti-glaucoma agents. At 12 months, mean IOP was 16.3 (±4.1) mmHg using 1
(±1.2) agent; at 2.5 years mean IOP was 15.6 (±2.9) mmHg, using 1 (±1.2) agent. There were no
complications. Goal-based outcomes were:
(1) To avoid starting IOP-lowering medication: 8/10 patients (80%) success at 1 year, 4/10 patients (40%)
success at 2.5 years.
(2) To stop or reduce IOP-lowering medications: 9/15 patients (60%) success at 1 year, 8/15 patients (53%)
(3) To avoid adding IOP-lowering medication: 18/20 patients (90%) success at 1 year, 15/20 patients (75%)
(4) To avoid IOP-lowering procedure (cyclodiode laser or surgery): 2/7 patients (29%) success at 1 year, 1/7
patients (14%) success at 2.5 years.
Conclusion: SLT can give a clinically useful reduction of IOP. Overall, the patient-oriented ‘goal’ was achieved
in 71% and 54% of patients at 1year and 2.5 years respectively. Best success rate was when the goal was to
avoid starting or adding IOP-lowering medication.
104. Ghrelin and Hepcidin Prohormone Levels in Patients with Primary Open-Angle Glaucoma
Asaad Ghanem
Masnoura Ophthalmic Center
Introduction: Glaucoma, which is characterized by retinal ganglion cell (RGC) apoptosis, is the prominent
cause of blindness. RGC apoptosis may be the result of increased intraocular pressure, neurotoxicity and
apoptosis, extracellular matrix (ECM) changes, oxidative stress, and hypoxia due to ocular and systemic
vascular dys-regulation
Purpose: To assess the levels of ghrelin and hepcidin prohormone (Hep) in aqueous humor and plasma of
human eyes with primary open-angle glaucoma (POAG) and to correlate their concentrations with the severity
of glaucoma.
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Method: Fifty patients with POAG and thirty five patients with senile cataract (control group) were enrolled in
the study prospectively. Aqueous humor samples were obtained by paracentesis from glaucoma and cataract
patients who were undergoing elective surgery. Aqueous humor and corresponding plasma samples were
analyzed for ghrelin and Hep concentrations by radioimmunoassay diagnostic kits and enzyme-linked
immunosorbent assay respectively
Results: Ghrelin and Hep levels were significantly lower in aqueous humor of POAG patients with respect to
the comparative group of cataract patients (P<0.001). No significant difference in the levels of ghrelin and Hep
in plasma of POAG and cataract patients. A positive correlation was found between ghrelin and Hep in
aqueous humor of POAG patients (P<0.001). No significant correlation was found between either ghrelin and
Hep levels and the severity of visual field loss
Conclusion: Lower levels of aqueous humor ghrelin and Hep may be associated with POAG. In addition,
ghrelin and Hep may be useful protein derivatives levels in aqueous humor of POAG patients as a
consequence of glaucomatous damage
105. Outcomes of glaucoma referrals from a diabetic retinopathy screening service
Robert Cann, Pavi Agrawal , Gus Gazzard
Moorfields South, St. George's Hospital
Introduction: Approximately 2% of the population have glaucoma, 50% undiagnosed (Beaver Dam and Blue
Mountains Eye Studies). Diabetic retinopathy screening service (DRSS) disc photos can identify suspected
glaucoma.
Purpose: To determine the outcomes of glaucoma referrals made from the St. George’s DRSS to Moorfields
South, including direct referrals and those made after recommendation of a glaucoma consultant.
Method: Of 16,222 patients screened by the St. George’s DRSS during 2011-12 electronic records identified
235 patients graded as suspected glaucoma. Patients were graded by the DRSS alone or following disc photo
review by a glaucoma consultant. Of these, paper records identified 87 suspected glaucoma referrals, 54 to
Moorfields South. Patients already under a glaucoma clinic or without available notes were excluded. Medical
notes of 43 patients were reviewed to determine glaucoma clinic attendance, initial diagnosis and
discharge/follow-up plans.
Results: 1) 88% (n=38) of Moorfields South referrals attended glaucoma clinic
2) 71% (n=27) of attendees diagnosed with ?glaucoma/POAG/NPG
3) 79% (n=30) of attendees offered follow-up
4) 58% (n=11) of referrals after glaucoma consultant review vs 84% (n=16) of direct referrals diagnosed with
?glaucoma/POAG/NPG
Conclusion: This reflects a relatively effective single modality means to identify and refer suspected glaucoma.
1.4% of all screened patients had suspected glaucoma signs and 0.28% of all screened patients were newly
diagnosed as ?glaucoma/POAG/NPG.
The direct referral route had a better diagnostic PPV, likely reflecting more borderline cases being sent to the
glaucoma consultant and more obvious cases being referred directly.
106. Current prescribing trends in a tertiary glaucoma unit
Stephenie Tiew, Manon Owen, Anshoo Choudhary
RLUH
Introduction: In recent years, numerous new glaucoma topical therapies have emerged commercially
including the increase in selection of preservative-free drops. Generic competition will increase with more
drug patents expiring.
Purpose: This cross-sectional study aims to assess current practice in dedicated glaucoma clinics in a tertiary
eye unit in England including trends in prescribing, control of intraocular pressure and side effects relating to
therapy (either branded or generic).
Method: The study was conducted from May to July 2013. Data was collected prospectively from 100
consecutive patients attending glaucoma clinics. Standard proformas were filled by clinicians during clinic
consultations and via corroboration with medical notes.
Results: 66 patients were controlled on monotherapy for a mean duration of 3.31 years (95% CI, 0.86 to 6.2),
with 30% of patients on dual therapy and 5% of patients on triple therapy. Follow-up time ranged from 1
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month to 30 years (mean: 7.2 years). The first choice drug-class prescribed by clinicians was prostaglandin
analogues (63%) Interestingly, 10 patients were switched between the prostaglandin analogues sub-groups with
improved efficacy and tolerability (p<0.05). We found that topical carbonic anhydrase inhibitors have
overtaken beta- blockers or beta-blocker combination drops as preferred 2nd line therapy and adjunctive
therapy (21.7 %). 7 patients were on preservative-free drops. Only 2 patients reported a problem with generic
drops.
Conclusion: Practice patterns are similar to the current evidence base and guidelines. Further studies may
provide further information on switching within drug-class and differences between branded and generic
drops.
107. Treating Glaucoma: The Not-so-NICE Guidance
Daniel Ackland, Neruban Kumaran, Rashid Zia
William Harvey Hospital, East Kent
Introduction: The National Institute for Health and Care Excellence (NICE) offers treatment guidance protocols
for patients with ocular hypertension or suspected chronic open angle closure which are widely followed in
the UK. Treatment of Goldmann applanation tonometer (GAT) derived intra-ocular pressure (IOP) is advised
until a certain age depending on central corneal thickness (CCT).
Purpose: Does the guidance disregard differences between the individual patients being treated and the
inaccuracy of the measured IOP?
Method: NICE guidance shortcomings were addressed individually with reference to published evidence.
Results: Life expectancy is assumed based on population averages. General health and social priorities of the
individual are not considered. Other factors overlooked by NICE when recommending target IOPs include
levels of glaucoma damage, and rate of glaucoma progression. CCT is the only corneal property taken into
account, despite engineering models suggesting that material properties of the cornea (i.e. Tensile Modulus,
inherent stiffness and viscoelastic properties) likely dwarf CCTs effect on GAT measurements. There are also
multiple other artefacts that will affect GAT measurements in the clinic, not limited to: diurnal variation,
corneal curvation, corneal hydration, Valsalva manoeuvres and external pressure. There are potential areas of
research to consider, such as the use of dynamic contour tonometry in patients with out-of-range corneal
thickness to potentially reduce mistreatment.
Conclusion: Whilst guidelines fail to cater for each and every patient in a population, the clinician must
exercise their right to deviate, using their own judgement if this is likely to benefit the individual patient.
108. Patient Satisfaction with Peninsula Optometry Community Glaucoma Scheme
Sarah Levy, Adam Booth
Royal Eye Infirmary, Plymouth
Introduction: Glaucoma patients make up a large proportion of the ophthalmic department's outpatient work
load of any Hospital Eye Service (HES). There are a large number of shared care glaucoma schemes throughout
the UK. There has however been very little published data as to whether patients like being cared for in shared
care schemes.
The aim of this study was to evaluate patients' satisfaction with our optometrist run, community based shared
care scheme.
Purpose: We conducted an audit of patient satisfaction with their community care using a self-completion
questionnaire.
Method: 120 patients were randomly identified and sent a self completion, anonymous, questionnaire. Patients
were asked for details of age, gender and nine questions in relation to patient satisfaction with the community
service. Patients were also asked to compare their community optometry care to the HES where all patients are
initially seen.
Results: 80 patients responded giving a 68% response rate. Overall 57.1% (47.5-66.25%) patient's were 'very
satisfied' with the nine aspects of their care in the community and 90.4% responded they were 'satisfied' or
'very satisfied' with their care.
When asked to compare their care in the community to hospital care 35 (43.8%) reported that their care was
'better' in the community, 34 (42.5%) the 'same' and 3 (3.8%) 'not as good'.
Conclusion: With growing demands for new patients to be assessed and treated it is likely that community
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optometry schemes are utilised more in the future. Our audit shows that the patients receiving community
optometry care in the Peninsula Optometry Community Glaucoma Scheme are pleased with the service they
receive.
109. Brinzolamide 1.0%/Timolol 0.5% versus Dorzolamide 2.0%/Timolol 0.5% in the treatment of openangle glaucoma or ocular hypertension: Prospective randomized patient preference study
Sheng Lim, Laura Braithwaite
St Thomas' Hospital
Introduction: When considering adherence to topical ocular medications, side effect profile, ease of instillation
and comfort are important. Dorzolamide 2.0%/timolol 0.5% (DTFC; Cosopt®) has lower pH than brinzolamide
1.0%/timolol 0.5% (BTFC; Azarga®) which may result in a variation in ocular comfort level.
Purpose: This study compares patient preference with respect to ocular comfort, as well as a measure of ocular
discomfort, between these two medications.
Method: This was a multi-center, multi-national, single-masked, crossover study design. Patients (n= 108) were
randomised 1:1 to self-administer (except for Day 7 am dose) one drop of BTFC or DTFC in both eyes BID for
7 days. Following a 48-hour washout period, on day 9 patients crossed-over to opposite treatment (selfadministered except for Day 15 am dose). After each treatment period, patients completed an ocular
discomfort scale (0 no discomfort and 9 substantial discomfort). At the end of the study, patients completed a
preference rating question.
Results: Patient demographics were comparable at baseline. More patients (59.3%, 64/108) preferred BTFC to
DTFC Mean ocular discomfort score was less with BTFC compared to DTFC (2.6 versus 3.7, P=0.0002).
Conclusion: Patient preference and ocular discomfort levels for BTFC were better than that of DTFC in patients
with either open-angle glaucoma or ocular hypertension.
110. Transscleral Diode Laser Cyclophotocoagulation with patients with moderately good vision.
Sharmin Ria, Alaa Attawan, Kais Khalid
Scunthorpe General Hospital
Introduction: Assessing the use of transscleral diode laser cyclophotocoagulation (TS-CPC), in patients with
refractory glaucoma and good vision.
Cyclodestruction, by laser cyclophotocoagulation, of the ciliary epithelium improves the intra-ocular pressure
(IOP) for refractory glaucoma.
TS-CPC has been established as a safe treatment method for patients with poor vision. This loop closure
focuses on patients with good vision as its use is less well documented.
Purpose: Evaluating whether use of TS-CPC on refractive glaucoma patients with increased IOP and good
vision, had a positive post-operative outcome with regards to; intra-ocular pressure and number of medication.
Method: 25 retrospective case notes over an 18 month period reviewed from a single unit who had TS-CPC.
Data collected on pre- and postoperative visual acuity (V/A), intra-ocular pressure (IOP), cup-to-disc ratio
(C.D) and number of medications administered. Median average for pre-operative visual acuity was 6/6. Postoperative follow-up data collected after 1, 3, 6, 12 and 18 months.
Results: Of 25 eyes, there was 12.01 mmHg IOP reduction post-operatively; greatest reduction 25.6 mmHg;
the least 1.00 mmHg.
44% (11/25) of eyes had reduction in post-operative medications; 2 eyes decreased by 3 medications; 3 by 2
medications; 6 by 1 medication.
40% (10/25) eyes had complications; 2 cases of inflammation, 4 cases of distorted pupil and 6 cases with
other complications.
Conclusion: This study supports that TS-CPC have a positive role in the management of select patients with
uncontrolled IOP with good pre-operative vision.
111. Prostaglandin associated periorbitopathy-case study,pathophysiology and clinical implications
Hiten Sheth, Alison Matthews
Amersham Hospital
Introduction: Prostaglandin associated periorbitopathy (PAP) refers to changes that may occur in the periorbital
soft tissue of patients using topical prostaglandin analogue glaucoma drops (PGAs).
93
Birmingham 2014
ABSTRACTS: Glaucoma
The phenomenon appears little reported or discussed. Due to the subtlety of the changes the true incidence is
unknown although changes are most noticeable in monocularly treated patients. These include, upper lid
ptosis,deepening of the superior sulcus, mild enophthalmos,increased scleral show and involution of
dermatochalasis-all secondary to orbital fat atrophy. The changes are often reversible and can be seen on MRI
imaging.
Purpose: To raise awareness of this phenomenon amongst ophthalmic professionals potentially initiating
treatment with PGAs as the cosmetic changes may be distressing to the patient if not anticipated.
Method: Case report and associated literature review. a 71 year old male Glaucoma suspect commenced on G
Bimataprost 0.1mg/mL nocte to one eye only. Several clinical photographs (with written consent of the patient)
illustrate the impressive physical changes to eyelid and facial appearance
Results: within 3 months of commencing treatment, the patient,family and friends noticed a marked change in
the appearance of the treated eye with relative deepening of the superior sulcus and resolution of eyelid bags
and dermatochalasis.
Conclusion: PAP seems to be relatively under-observed and under-reported and may cause distress to patients
if not discussed beforehend alongside the better known side effects of PGAs. Increasing awareness will allow
clinicians to better establish the true frequency and spectrum of this intriguing periorbital fat atrophy
phenomenon.
112. Pre-natal Diagnosis of Rieger's Syndrome Based on Symptoms in Pregnancy
John-Sebastian Barry, Joseph Abbott
Russell's Hall Hospital, Dudley
Introduction: Axenfeld-Rieger syndrome is a rare autosomal dominant disorder associated with anterior
segment dysgenesis, glaucoma, tooth and other abnormalities (including of the umbilical cord).
Purpose: To report the observation made by an affected mother with two affected children in the lineage, that
pregnant ladies may be aware that their unborn child will be affected by the disorder without the need for
medical testing/investigation.
Method: Report the symptoms described in the history from the prenatal period (and from childbirth) and
describe the associated findings on ophthalmic examination.
Results: There is evidence that mothers in this lineage may be able to detect whether their pregnancies are
affected based on pre-natal symptomatology (of foetal movements).
Conclusion: Further corroboration is required to assess the sensitivity and specificity of this interesting
observation. The fact that members of the lineage have noted differences in symptoms during pregnancy
between affected and non-affected pregnancies is unique in the experience of the authors in ophthalmic
disorders. The difference in symptoms is postulated to be due to restricted intra-uterine movements resulting
from abnormally short umbilical cords in affected pregnancies. Maternal suspicion was apparently further
confirmed at birth based on abnormalities of the umbilical cord (in particular rupture of a short cord during
childbirth) prior to formal ophthalmic examination of the baby being carried out. In this lineage at least, one
might postulate that intra-uterine ultrasonography could help give objective evidence to determine the risk that
a pregnancy was affected by Rieger’s Syndrome.
113. No small enemy
Miriam Lara De La Rosa
Mexican Institute of Social Security
Introduction: The depth and volume of the anterior chamber decrease steadily throughout life due to the
continuous thickening of the lens with age.
When the dilation pupil remains for a long time the intraocular pressure in the posterior chamber will be
higher than the IOP in the anterior chamber. The trabecular meshwork thereby becomes blocked by the iris.
This leads to a sudden and extreme rise in IOP called glaucoma attack.
Purpose: Case report
Method: July 12, 2013 Female 72 years old, she has pterygium both eyes.
VA OD 0.1 Log MAR 1 OS 0.04 Log MAR 1,4
AS OD nasal pterygium with corneal invasion 5.6 x 4.0mm, anterior chamber van Hering 3. AS OS nasal
pterygium with corneal invasion 6.0 x 7.0mm.
94
Birmingham 2014
ABSTRACTS: Glaucoma / Medical Retina
IOP OD 12mmHg IOP OI 13mmHg
Pterygium removal surgery with conjunctival autograft of the left eye on September 3th, 2013. Five days after
surgery, the patient presented red eye, blurred vision, severe ptosis and pupil dilation of the left eye and an
extreme headache.
VA OD 0.5 Log MAR 1.3 OI 0.02 LogMAR 1.7
IOP OD 12mmHg OS 40mmHg
Patient was medicated with intravenous and topical hypotensors, an iridectomy was carried out on September
22nd, 2013 due to a continuing elevated IOP.
Last review on October 21st, 2103 VA OD 0.05 Log MAR 1.3, OS 0.04 Log MAR 1.4. IOP OD 12mmHg OS
11mmHg
Results: Glaucoma attack for block pupillary
Conclusion: No small enemy, we must not forget that the retrobulbar block produces pupillary dilation that
can lead to pupillary block in people with narrow anterior chamber.
MEDICAL RETINA
114. Emotional and Physical Impact of Wet Age-Related Macular Degeneration (wAMD) on Patients and
Caregivers
Steve Winyard
Royal National Institute of Blind People
Introduction: wAMD is a leading cause of vision loss in older people in the Western world. The impact of
wAMD on patients and caregivers is not well understood
Purpose: To evaluate the physical and emotional impact of wAMD on patients and caregivers.
Method: Patients, and caregivers of patients diagnosed with wAMD, who currently or previously had received
intravitreal injections to treat their wAMD were surveyed. The survey was conducted in 9 countries, including
the UK.
Results: 910 patients and 890 caregivers (103 and 107, respectively, from the UK) were surveyed. About half
of patients had wAMD in 1 eye (global:55%/UK:51%) and most had been receiving injections for >1 year
(global:64%/UK:59%). Patients reported a range of disease consequences, including difficulty reading
(global:61%/UK:39%) and inability to drive (global:39%/UK:35%). Many patients felt fearful
(global:45%/UK:29%), sad (global:40%/UK:31%), and frustrated (global:37%/UK:36%). Most caregivers were a
child or grandchild of the patient. While some (global:31%/UK:24%) felt that caregiving had a negative impact
on their life; others (global:35%/UK:40%) believed the experience of being a caregiver had a positive impact.
Similar to patients, some caregivers experienced sadness (global:35%/UK:41%), fear (global:28%/UK:31%,)
and frustration (global:27%/UK:38%); however, nearly half (global:48%/UK:51%) felt useful.
Conclusion: wAMD has a significant negative impact on the lives of most patients. Patients suffer from fear of
permanent loss of vision, frustration, and sadness. Although some caregivers feel that wAMD has had a
negative impact on their life, a similar proportion believe it has had a positive impact, leading many of them to
feel useful.
115. The use of OCT in Retinal Screening : Results from the Improving Screening for Macular Oedema
(ISMO) Study
Roly Megaw, Shyamanga Booroah, Keith Goatman , Graham Scotland, Gordon Prescott, Peter Sharp, John
Olson
Introduction: The prevalence of diabetes is increasing and ocular complications will increase pressure on
clinical services. The UK has several schemes for diabetic macular oedema (DMO) screening.
Purpose: We assessed the cost effectiveness of OCT within retinal screening programmes in addition to
photographic surrogate markers.
Method: This prospective, observational cohort study recruited patients from Aberdeen, Birmingham, Dundee,
Edinburgh, Fife, Liverpool and Oxford. Patients with exudates within 2 disc diameters (DDs) or dot/blot
haemorrhages within 1 DD were included. Visual acuity, retinal photography and OCT was undertaken.
95
ABSTRACTS: Medical Retina
Birmingham 2014
Images were annotated, graded and analysed. Results were weighted to correct for sampling bias. Cost
effectiveness was assessed using a Markov microsimulation model.
Results: 3170 patients were included. Exudates within 1DD were the greatest predictor of DMO. 243 patients
(7.7%) had DMO on OCT. Addition of OCT to English and Scottish screening systems resulted in cost savings
without reducing health benefits. Deterministic sensitivity analysis suggests £58 saving per patient in England,
and £47 in Scotland, when suspected DMO is monitored with 6-monthly photography plus OCT.
Conclusion: Economic modelling suggests utilising OCT within retinal screening programmes, in addition to
photographic surrogate markers, is cost-effective without reducing health benefits.
116. Multi-centre, prospective, observational, cohort study to assess the cost-effectiveness of English,
Scottish and a hybrid grading schemes for diabetic macular oedema screening: improving screening for
macular oedema (ISMO) study
Shyamanga Borooah, Roly Megaw, Keith Goatman , Graham Scotland, Gordon Prescott, Peter Sharp,
John Olson
Introduction: Currently the grading of diabetic retinopathy in England and Scotland is relatively standardised
but there is a divergence in diabetic macular oedema (DMO) screening criteria. As the prevalence of DMO
rises it places an increasing financial burden on the national health service (NHS) highlighting the need to
move to the most cost-effective model.
Purpose: We compared the English, Scottish and a hybrid scheme with features of both to assess which was
the most cost-effective.
Method: 3170 patients who had photographic features of DMO in at least one eye were enrolled from 7 NHS
regions. OCT was used as the gold standard for DMO diagnosis. The mean costs, years free of moderate visual
loss and quality adjusted life years (QALYs) were compared between the different schemes. A Markov
microsimulation model was developed to assess the cost-effectiveness of the schemes for triggering referral
using data from this sample cohort.
Results: The sensitivity and specificity for DMO were 72.6% and 66.8% for English, 59.5% and 79% for the
Scottish and 73.3% and 70.9% for the hybrid schemes respectively. Following modelling more sensitive
schemes resulted in only minimal increases in QALYs from preservation of moderate visual acuity, but led to
increased costs from referral. Overall the Scottish scheme was found to be most cost-effective.
Conclusion: Modifications to current screening criteria improve the cost-effectiveness of screening for DMO in
the NHS.
117. AURA Study: Real-World Utilization of Anti-VEGF Therapy for Neovascular (Wet) Age-Related Macular
Degeneration (wAMD) in the UK
Philip Hykin, Sobha Sivaprasad, Usha Chakravarthy , Andrew Lotery, Martin McKibbin
Introduction: In clinical trials, monthly ranibizumab improves visual outcomes in patients with wAMD. In
real-life, this regimen is often unachievable, which may impact visual outcome.
Purpose: Evaluate real-world utilisation and visual outcomes of anti-VEGF therapy for wAMD in the UK.
Method: Retrospective, international (Canada, France, Germany, Ireland, Italy, Netherlands, UK, Venezuela)
study. Consecutive wAMD patients (anti-VEGF-naïve) who started treatment with ranibizumab between 1
January and 31 August, 2009 were included. Data were collected until end of treatment or 31 August, 2011.
Outcomes included change in visual acuity (VA) and resource utilisation.
Results: 410 patients from the UK were included in the effectiveness analysis set; follow-up was documented
for 396 in the first year and 350 in the second year. Mean baseline VA score was 55 letters. Most (63%)
patients received their first treatment within 28 days of diagnosis. Mean number of injections in Year 1 and 2
was 5.8 and 3.2, respectively. Mean number of VA tests (reflecting monitoring) in Year 1 and 2 was 10.0 and
7.8, respectively. Mean change in VA from baseline at Year 1 and 2 was +6.0 and +4.1 letters, respectively.
This compared favourably with results from all countries combined (mean VA gain; +2.4 and +0.6 letters,
respectively). Injections and VA tests were less frequent in all countries combined (Year 1/Year 2; injections:
5.0/2.2, VA tests: 6.0/3.8).
Conclusion: In the UK, patients were monitored more frequently and received more anti-VEGF injections,
resulting in better visual outcomes in clinical practice than those in countries with less frequent monitoring
and treatment.
96
Active Fluidics™
Automatically optimises chamber stability
by allowing surgeons to customise and
control IOP throughout the procedure.
Balanced Energy™
Cataract emulsification using Ozil
Intelligent Phaco and the new INTREPID
Balanced Tip design.
Applied Integration™
Designed to work seamlessly with other
Alcon technologies for an integrated
cataract procedure experience.
THE
BIMATOPROST
FAMILY
PRODUCTS TO MEET
YOUR PATIENTS’ NEEDS
UD
Preservative Free Single Dose
UD
UD
UD
UD
NEW
Preservative-free
monotherapy
Monotherapy
Preservative-free
fixed combination
Fixed combination
Bimatoprost
0.3mg/ml, eye
drops, solution,
in single-dose
container
Bimatoprost
ophthalmic
solution 0.01%
(0.1mg/ml)
0.3mg/ml + 5mg/
ml eye drops,
solution, in singledose container
bimatoprost/timolol
Bimatoprost/
timolol ophthalmic
solution 0.03%/0.5%
(0.3mg/ml/5mg/ml)
TOUGH
Prescribing information can be found overleaf
but gentle
LUMIGAN® (Bimatoprost Ophthalmic Solution) 0.01%
Presentation: Eye drop solution, one ml contains 0.1mg bimatoprost
Indications: Reduction of elevated intraocular pressure (IOP) in chronic openangle glaucoma and ocular hypertension in adults (as monotherapy or as
adjunctive therapy to beta-blockers). Dosage and Administration: Please
refer to the Summary of Product Characteristics before prescribing. Recommended
dose is one drop in the affected eye(s) once daily, administered in the evening.
More frequent administration may lessen the IOP lowering effect. If more than
one topical ophthalmic medicinal product is being used, each should be
administered at least 5 minutes apart. Not recommended in children or
adolescents (under the age of 18). Use with caution in renal or moderate to
severe hepatic impairment. Contraindications: Hypersensitivity to bimatoprost
or any of the excipients. Patients who have had a suspected previous adverse
reaction to benzalkonium chloride that has led to discontinuation. Warnings/
Precautions: Prior to treatment patients should be informed of the possibility
of eyelash growth, darkening of the eyelid skin, increased iris pigmentation
and the potential for hair growth in areas where Lumigan repeatedly comes
into contact with the skin surface. Some of these changes may be permanent
and may lead to differences in appearance between the eyes when only one
eye is treated. The change in iris pigmentation is likely to be permanent, occurs
LUMIGAN® (Bimatoprost Ophthalmic Solution) 0.03%
Presentation: Eye drop solution, one ml contains 0.3mg bimatoprost.
Indications: Reduction of elevated intraocular pressure (IOP) in chronic openangle glaucoma and ocular hypertension in adults (as monotherapy or as
adjunctive therapy to beta-blockers) in either Multi Dose bottles or Unit Dose
vials. Dosage and Administration: Please refer to the Summary of Product
Characteristics before prescribing. Recommended dose is one drop in the affected
eye(s) once daily, administered in the evening. More frequent administration
may lessen the IOP lowering effect. If more than one topical ophthalmic medicinal
product is being used, each should be administered at least 5 minutes apart.
Not recommended in children or adolescents (under the age of 18). Use with
caution in renal or moderate to severe hepatic impairment. Contraindications:
Hypersensitivity to bimatoprost or any of the excipients. Warnings/Precautions:
Prior to treatment patients should be informed of the possibility of eyelash
growth, darkening of the eyelid skin, increased iris pigmentation and the
potential for hair growth in areas where Lumigan repeatedly comes into contact
with the skin surface. Some of these changes may be permanent and may lead
to differences in appearance between the eyes when only one eye is treated.
The change in iris pigmentation is likely to be permanent, occurs slowly and
may not be noticeable for several months or years. At 12 months, the incidence
was 1.5% and did not increase following 3 years treatment. Periorbital tissue
pigmentation has been reported to be reversible in some patients. The multidose
GANFORT® (bimatoprost 0.03% / timolol 0.5%)
Presentation: Eye drop solution, one ml contains 0.3mg bimatoprost and 5mg
timolol (as maleate). Indications: Reduction of intraocular pressure (IOP) in adult
patients with open-angle glaucoma or ocular hypertension who are insufficiently
responsive to topical beta-blockers or prostaglandin analogues in either multi-dose
bottles or single-dose containers. Dosage and Administration: Please refer to
the Summary of Product Characteristics before prescribing. Recommended dose
is one drop in the affected eye(s) once daily, administered either in the morning
or in the evening. It should be administered at the same time each day. If more
than one topical ophthalmic medicinal product is to be used, each should be
instilled at least 5 minutes apart. Not recommended in children or adolescents
(under the age of 18). Use with caution in renal or hepatic impairment.
Contraindications: Hypersensitivity to active substances or to any of the excipients.
Reactive airway disease including bronchial asthma or a history of bronchial asthma,
severe chronic obstructive pulmonary disease. Sinus bradycardia, sick sinus
syndrome, sino-atrial block, second or third degree atrioventricular block not
controlled with pace-maker, overt cardiac failure, cardiogenic shock. Warnings/
Precautions: Ganfort may be absorbed systemically. Systemic absorption can be
reduced by using nasolacrimal occlusion, or closing the eyelids for 2 minutes.
Following topical ophthalmic administration, the same types of cardiovascular,
pulmonary and other adverse reactions as seen with systemic beta-blockers may
occur, although at a lower incidence. Cardiac failure should be adequately controlled
before beginning therapy. Patients with cardiovascular diseases (e.g. coronary
heart disease, Prinzmetal’s angina and cardiac failure) and receiving hypotension
therapy with beta-blockers should be critically assessed and therapy with other
active ingredients should be considered. Patients with cardiovascular diseases
should be watched for signs of deterioration and of adverse reactions. Use with
caution in patients with first degree heart block and in patients with severe
peripheral circulatory disturbance/disorders (i.e. severe forms of Raynaud’s disease
or Raynaud’s syndrome). Respiratory reactions, including death due to bronchospasm
in patients with asthma have been reported following administration of some
ophthalmic beta-blockers. Use with caution in patients with mild/moderate COPD.
Beta-adrenergic blocking agents should be administered with caution in patients
subject to spontaneous hypoglycaemia or to patients with labile diabetes as
beta-blockers may mask the signs and symptoms of acute hypoglycaemia. Betablockers may mask the signs of hyperthyroidism. Ophthalmic beta-blockers may
induce dryness of eyes, therefore use with caution in corneal diseases. Closely
slowly and may not be noticeable for several months or years. At 12 months
there was one report of iris hyperpigmentation (incidence of 0.5%). Periorbital
tissue pigmentation has been reported to be reversible in some patients. Contains
the preservative benzalkonium chloride (0.2mg/ml) which may cause eye
irritation and may be absorbed by and discolour soft contact lenses. Lenses
should be removed before Lumigan instillation and may be reinserted 15 minutes
after administration. Use with caution in dry eye patients, those where cornea
may be compromised and in patients taking multiple BAK-containing drops.
Monitoring required with prolonged use in such patients. Use with caution in
patients with COPD, asthma or compromised respiratory function: those
predisposed to low heart rate or low blood pressure or prior history of significant
ocular viral infections or uveitis/iritis. Lumigan has not been studied in patients
with heart block more severe than first degree or in uncontrolled congestive
heart failure; inflammatory ocular conditions, neovascular, inflammatory,
angle-closure glaucoma, congenital glaucoma or narrow-angle glaucoma.
Cystoid macular oedema has been uncommonly reported (≥1/1000 to <1/100)
with Lumigan 0.03% therefore Lumigan 0.01% should be used with caution in
patients with known risk factors for macular oedema (e.g. aphakic patients,
pseudophakic patients with a torn posterior lens capsule). It has been shown
that the more frequent exposure of the eye to more than one dose of bimatoprost
daily may decrease the IOP-lowering effect. There have been reports of bacterial
keratitis associated with the use of multiple dose containers of topical ophthalmic
products, particularly in patients with a concurrent ocular disease. Patients with
a disruption of the ocular epithelial surface are at greater risk of developing
bacterial keratitis. Interactions: There is a potential for the IOP-lowering effect
of prostaglandin analogues (e.g. LUMIGAN) to be reduced in patients with
glaucoma or ocular hypertension when used with other prostaglandin analogues.
Pregnancy: Do not use unless clearly necessary. Lactation: Decision should
be made taking into account the benefit of breast-feeding to child and Lumigan
therapy to woman. Adverse Effects: In a 12-month clinical study, approximately
38% of patients experienced adverse reactions, the most frequently reported
of which was conjunctival hyperaemia (mostly trace-mild) which occurred in
29% patients. Approximately 4% patients discontinued due to any adverse
event in the 12-month study. The following undesirable effects were reported:
Very Common (≥1/10) conjunctival hyperaemia; Common (≥1/100 to <1/10):
punctate keratitis, eye irritation, eye pruritus, growth of eyelashes, eye pain,
eyelid erythema, eyelid pruritus, skin hyperpigmentation, hypertrichosis ,
instillation site irritation. Please refer to Summary of Product Characteristics
for full information on side effects. Basic NHS Price: £12.43 per 3ml bottle.
£37.29 for 3x3ml bottle. Marketing Authorisation Number: EU/1/02/205/003004. Marketing Authorisation Holder: Allergan Pharmaceuticals Ireland,
Castlebar Road, Westport, Co. Mayo, Ireland. Legal Category: POM Date of
Preparation: October 2013
formulation contains the preservative benzalkonium chloride which may cause
eye irritation and may be absorbed by and discolour soft contact lenses. Lenses
should be removed before Lumigan instillation and may be reinserted 15 minutes
after administration. Monitoring required with frequent or prolonged use in
dry eye patients or where the cornea is compromised. Use with caution in
patients with COPD, asthma or compromised respiratory function; those
predisposed to low heart rate or low blood pressure or prior history of significant
ocular viral infections or uveitis/iritis. Lumigan has not been studied in patients
with heart block more severe than first degree or in uncontrolled congestive
heart failure, inflammatory ocular conditions, neovascular, inflammatory,
angle-closure glaucoma, congenital glaucoma or narrow-angle glaucoma.
Cystoid macular oedema has been uncommonly reported (≥1/1000 to <1/100)
and Lumigan should be used with caution in patients with known risk factors
for macular oedema (e.g. aphakic patients, pseudophakic patients with a torn
posterior lens capsule). It has been shown that the more frequent exposure of
the eye to more than one dose of bimatoprost daily may decrease the IOPlowering effect. There have been reports of bacterial keratitis associated with
the use of multiple dose containers of topical ophthalmic products, particularly
in patients with a concurrent ocular disease. Patients with a disruption of the
ocular epithelial surface are at greater risk of developing bacterial keratitis.
Interactions: There is a potential for the IOP-lowering effect of prostaglandin
analogues (e.g. LUMIGAN) to be reduced in patients with glaucoma or ocular
hypertension when used with other prostaglandin analogues. Pregnancy: Do
not use unless clearly necessary. Lactation: Decision should be made taking
into account the benefit of breast-feeding to child and Lumigan therapy to
woman. Adverse Effects: In clinical trials the most frequently reported adverse
events (>1/10) were growth of eyelashes (up to 45% in first year with new
reports decreasing to 7% at 2 years and 2% at three years), conjunctival
hyperaemia (mostly trace to mild - up to 44% in first year decreasing to 13%
at 2 years and 12% at 3 years), and ocular pruritus (up to 14% in first year
decreasing to 3% at 2 years and 0% at 3 years). Less than 9% of patients
discontinued due to any adverse event in the first year with additional
discontinuations being 3% at both 2 and 3 years. The following undesirable
effects were reported: Very Common (≥1/10): conjunctival hyperaemia, ocular
pruritus (common with Unit Dose formulation), growth of eyelashes (common
with Unit Dose formulation); Common (≥1/100 to <1/10): superficial punctate
keratitis, corneal erosion, ocular burning, ocular irritation, allergic conjunctivitis,
blepharitis, worsening of visual acuity, asthenopia, conjunctival oedema, foreign
body sensation, ocular dryness, eye pain, photophobia, tearing, eye discharge,
visual disturbance/blurred vision, increased iris pigmentation, eyelash darkening,
eyelid erythema, eyelid pruritus, pigmentation of periocular skin, headache,
hypertension, liver function test abnormal. Please refer to Summary of Product
Characteristics for full information on side effects. Basic NHS Price: £10.30
per 3ml bottle. £30.90 for 3x3ml bottle. £13.75 for 30 Unit Dose vials. Marketing
Authorisation Number: EU/1/02/205/001-002; 006. Marketing
Authorisation Holder: Allergan Pharmaceuticals Ireland, Castlebar Road,
Westport, Co. Mayo, Ireland. Legal Category: POM. Date of Preparation:
October 2013
monitor IOP in patients concomitantly receiving systemic beta-blockers. The use
of 2 topical beta-blocking agents is not recommended. While taking beta-blockers,
patients with a history of atopy or a history of severe anaphylactic reaction to a
variety of allergens may be more reactive to repeated challenge with such allergens
and unresponsive to the usual dose of adrenaline used to treat anaphylactic
reactions. Choroidal detachment has been reported with administration of timolol
after filtration procedures. Anaesthesiologist should be informed when the patient
is receiving timolol. Before treatment is initiated, patients should be informed of
the possibility of eyelash growth, darkening of the eyelid or periocular skin and
increased brown iris pigmentation since these have been observed during treatment
with bimatoprost and Ganfort. Increased iris pigmentation is likely to be permanent,
and may lead to differences in appearance between the eyes if only one eye is
treated. After discontinuation of Ganfort, pigmentation of iris may be permanent.
After 12 months treatment with Ganfort (multi-dose), the incidence of iris
pigmentation was 0.2%. After 12 months treatment with bimatoprost eye drops
alone, the incidence was 1.5% and did not increase following 3 years treatment.
The pigmentation change is due to increased melanin content in the melanocytes
rather than to an increase in the number of melanocytes. The long term effects of
increased iridial pigmentation are not known. Macular oedema, including cystoid
macular oedema has been reported with Ganfort (multi-dose). Therefore, Ganfort
should be used with caution in aphakic patients, in pseudophakic patients with a
torn posterior lens capsule, or in patients with known risk factors for macular
oedema (e.g. intraocular surgery, retinal vein occlusions, ocular inflammatory
disease and diabetic retinopathy). Ganfort should be used with caution in patients
with active intraocular inflammation (e.g. uveitis) because the inflammation may
be exacerbated. There is a potential for hair growth to occur in areas where Ganfort
solution comes repeatedly in contact with the skin surface. Thus, it is important
to apply Ganfort as instructed and avoid it running onto the cheek or other skin
areas. The multi-dose formulation of Ganfort, contains the preservative
benzalkonium chloride, which may cause eye irritation and may be absorbed by
and discolour soft contact lenses. Lenses should be removed before Ganfort multidose instillation and may be reinserted 15 minutes after administration.
Benzalkonium chloride has been reported to cause punctate keratopathy and/or
toxic ulcerative keratopathy, therefore monitoring is required with frequent or
prolonged use of Ganfort multi-dose in dry eye patients or where the cornea is
compromised. In studies of bimatoprost 0.3 mg/ml in patients with glaucoma or
ocular hypertension, it has been shown that more frequent exposure of the eye
to more than 1 dose of bimatoprost daily may decrease the IOP-lowering effect.
Patients using Ganfort with other prostaglandin analogs should be monitored for
changes to their intraocular pressure. Interactions: Potential for additive effects
resulting in hypotension, and/or marked bradycardia when ophthalmic beta-blocker
solution is administered concomitantly with oral calcium channel blockers,
guanethidine, or beta-adrenergic blocking agents, parasympathomimetics, antiarrhythmics and digitalis glycosides. Beta-blockers may increase the hypoglycaemic
effect of antidiabetic medicinal products. Potential systemic beta-blockade (e.g.
decrease heart rate, depression) has been reported during combined treatment
with CYP2D6 inhibitors. Mydriasis resulting from concomitant use of ophthalmic
beta-blockers and adrenaline has occasionally been reported. Pregnancy: There
are no adequate data from the use of Ganfort in pregnant women. Do not use
during pregnancy unless clearly necessary. Ganfort should not be used by breastfeeding women. Adverse Effects: No adverse drug reactions (ADRs) specific for
Ganfort have been observed in clinical studies. The ADRs have been limited to
those earlier reported for bimatoprost and timolol and the majority were ocular,
mild in severity and none were serious. Based on 12-month clinical data, the most
commonly reported ADR was conjunctival hyperaemia (mostly trace to mild and
thought to be of a non-inflammatory nature) in approximately 26% and 21% of
patients and led to discontinuation in 1.5% and 1.4% of patients for Ganfort
multi-dose and Ganfort single-dose respectively. The following ADRs have been
reported with Ganfort multi-dose. Very common (≥1/10): conjunctival hyperaemia.
Common (≥1/100 to <1/10): headache, dizziness, superficial punctuate keratitis,
corneal erosion, burning sensation, eye pruritus, stinging sensation in the eye,
foreign body sensation, eye dryness, eyelid erythema, eye pain, photophobia, eye
discharge, visual disturbance, eyelid pruritus, visual acuity worsened, blepharitis,
eyelid oedema, eye irritation, epiphora, growth of eyelashes, rhinitis, blepharal
pigmentation, hirsutism, periocular skin hyperpigmentation. The following ADRs
were reported during clinical trials with Ganfort single-dose. Very common (≥1/10):
conjunctival hyperaemia. Common (≥1/100 to <1/10): punctuate keratitis, eye
irritation, conjunctival irritation, eye pruritus, eye pain, foreign body sensation,
dry eye, lacrimination increased, erythema of eyelid, photophobia, growth of
eyelashes, headache, skin hyperpigmentation. Additional adverse events that have
been seen with one of the components and may potentially occur also with Ganfort.
Please refer to the Summary of Product Characteristics for full information on side
effects. Basic NHS Price: £13.95 per 3ml bottle. £37.59 for 3x3ml bottle. £17.50
for 30 single-dose vials. Marketing Authorisation Number: EU/1/06/340/001005. Marketing Authorisation Holder: Allergan Pharmaceuticals Ireland,
Castlebar Road, Westport, Co. Mayo, Ireland. Legal Category: POM. Date of
Preparation: July 2013
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to Allergan Ltd. [email protected] or 01628 494026.
UK/0241/2014 Date of Preparation: February 2014
M.I.S.S Ophthalmics
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118. Fluorescence gradient analysis of fluorescein angiograms
Nigel Davies
Chelsea and Westminster Hospital
Introduction: This study investigates the use of image analysis software to automatically delineate abnormal
rate of change in fluorescence in fluorescein angiograms.
Purpose: To assess software written to analyse the rate of change of fluorescence in angiograms. This may
allow clinicians a more objective method for examining the results of an angiographic study rather than
current subjective methods.
Method: Software was written using MATLAB (Mathworks Inc). Image registration to align angiographic frames
was performed. Fluorescence gradients (in fluorescence units/sec) were calculated at each pixel for dye entry
(first) phase and recirculation (second) phase. Finally a gradient classifier identified areas of hyper and hypo
fluorescence. Positive gradients in the second phase were used to identify hyperfluorescent pixels and the
lowest quartile gradients in both first and second phases identified hypofluorescent pixels.
Results: 50 angiograms were analysed from patients with diabetes, AMD and vein occlusion. 2 failed the
registration process. First phase gradients ranged from 0.3 units/sec (SD 3.9) to 13.2 units/sec (SD 9.8) and
second phase from -0.4 units/sec (SD 0.9) to +0.4 units/sec (SD 1.2). Hyperfluorescence ranged from 0% to
23% in the registered angiogram area. Areas of hypofluorescence ranged from 0% to 12%.
Conclusion: The software was able to identify areas of abnormality in each angiogram. Areas of quantified
abnormality can be colour-coded and overlaid onto an angiographic frame and/or the aligned colour fundus
photograph. Data relating to gradients at individual pixels can be displayed, leading to a more standardised
analysis of rates of fluorescence.
119. A study of aged GK rats: is tau the missing link between diabetes and Alzheimer’s Disease?
Timothy Wong, Marianne Phillips, Shereen Nizari , M Francesca Cordeiro
Institute of Ophthalmology, UCL
Introduction: Research has shown that diabetes and Alzheimer’s disease (AD) share similar pathophysiology.
The hallmarks of AD include neurofibrillary tangles (NFTs), which consist of abnormal tau and neurofilaments
(NFs), which tend to be hyperphosphorylated.
Purpose: Goto Kakizaki (GK) rats are spontaneously diabetic and are considered a model for T2DM in
humans. As the brain and retina share a common embryological origin, AD pathology that occurred in the
brains of AD transgenic mice also occurred in the retina. We investigate tau pathology and
neurofilamentopathy in the retinas of aged GK rats, as measures of AD pathology.
Method: The eyes from 23 3-, 12- and 18-month old GK rats and age-matched controls were obtained and
embedded in paraffin blocks. Sections from these blocks were stained with antibodies for tau,
hyperphosphorylated tau (p-tau) and NF-heavy (NFH). Immunohistochemistry images were visualized and
obtained. These images were graded for distribution and fluorescence of the antibodies by three independent
observers without knowledge of diabetic or control status.
Results: There seemed to be an age-dependent increase of p-tau and NFH in the diabetic retina, but not the
control retina. Increased levels of p-tau and NFH were found in the diabetic retina as compared to the control
retina. No change of colocalization of p-tau and NFH was found in the control or diabetic retina over time.
Conclusion: There is increased neurodegeneration in the diabetic retina over time and as compared to the
control retina. This seems to be the first study that demonstrated AD pathology in the retinas of aged diabetic
GK rats.
120. Long-term visual acuity outcome in patients with diabetic macular oedema treated with fluocinolone
acetonide
Yit Yang, Niro Narendran, Clare Bailey, Andrew Lotery
Wolverhampton Eye Infirmary
Introduction: Iluvien® (intraocular fluocinolone acetonide [FAc] implant) is recommended by NICE for chronic
diabetic macular oedema (DMO) which has been insufficiently responsive to available therapies but only in
pseudophakic patients.
Purpose: Evaluate visual benefit in phakic patients who underwent cataract extraction during the 3-year FAME
trials (NCT00344968).
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Method: Mean BCVA improvement at 12 months post-cataract surgery was determined for all phakic patients
who required cataract extraction during the FAME studies. BCVA improvement was compared between shamand 0.2 μg/day FAc-treated patients, including pre-specified subgroups with chronic and non-chronic DMO.
Due to the post-hoc nature, statistical hypothesis testing was not performed.
Results: Median cataract formation time (Kaplan-Meier estimates) was 811 days for sham-injected and 435
days for 0.2 μg/day FAc-treated patients. Median cataract extraction time (Kaplan-Meier estimate) was 550
days for 0.2 μg/day FAc-treated patients (could not estimate for sham-injected patients). At 12 months postcataract-surgery, BCVA improvement in sham-injected patients was +13.9 letters in the chronic DMO subgroup
and +19.7 in the non-chronic DMO subgroup. BCVA improvement at 12 months post-cataract-surgery in 0.2
µg/day FAc-treated patients was +23.7 letters in the chronic DMO subgroup and +23.2 letters in the nonchronic DMO subgroup.
Conclusion: Phakic patients treated with 0.2 µg/day FAc who required cataract surgery during the FAME trial
period, experienced substantial visual improvement following cataract surgery irrespective of their status in
terms of chronicity of DMO.
121. Progression of retinal atrophy in Stargardt’s Macular Dystrophy estimated from spectral-domain optical
coherence tomography measurements of macular volume
Rupert Wolfgang Strauss, Beatriz Munoz, Emily Fletcher , Yulia Wolfson, Millena Bittencourt,
Hendrik P N Scholl
Wilmer Eye Institute, Johns Hopkins University
Introduction: Stargardt Macular Dystrophy (STGD) is the most common juvenile macular degeneration.
Several treatment approaches are in early (pre-)clinical studies and may require efficacy measures in the future.
Purpose: To estimate disease progression based on analysis of macular volume measured by spectral-domain
optical coherence tomography (sd-OCT) in patients affected by Stargardt Macular Dystrophy (STGD).
Method: 58 eyes of 29 STGD patients were included. Numbers and types of algorithm failures were recorded
and manually corrected. In a subgroup of 36 eyes of 18 patients with at least two examinations over time, total
macular volume (TMV) and volumes of all nine ETDRS subfields were obtained. Random effects models were
used to estimate the rate of change per year for the population, and empirical Bayes slopes were used to
estimate yearly decline in total macular volume for individual eyes.
Results: 6958 single B-scans from 190 macular scans were analyzed. 2360 (33.9%) showed algorithm failures.
Mean observation period for follow-up data was 15 months (range 3 to 40). The mean (± sd) TMV was 6.321 ±
1.000 mm3 at baseline and rate of decline was -0.118 mm3 per year (p=0.003). The median (interquartile
range) change in TMV using the empirical Bayes estimates for the individual eyes was -0.103 (-0.145, -0.059)
mm3 per year.
Conclusion: Sd-OCT measurements allow to monitor the decline in retinal volume in STGD and may serve as
outcome measures for clinical trials.
122. The cost effectiveness of aflibercept compared to ranibizumab in the management of wet age-related
macular degeneration (wAMD)
Jennifer Priaulx, Jacqueline Napier , Gabriela Vega , Matthew Radford
Bayer
Introduction: The National Institute for Health and Care Excellence in July 2013 recommended aflibercept as
an option in TA294 for patients with wAMD. Cost and effectiveness are both important considerations when
allocating scarce health care resources.
Purpose: To estimate the long-term costs and outcomes of aflibercept compared to ranibizumab in wAMD.
Method: An economic model was developed to consider visual acuity in both eyes and extrapolate costs and
benefits of treatment beyond the time frame of clinical trials. Patients considered were those included in the
VIEW studies. An indirect comparison of data from aflibercept and ranibizumab trials informed efficacy.
Frequency of injections and monitoring were assumed in line with the UK marketing authorisations. Utilities at
different levels of visual acuity were collected in aflibercept trials using the EQ5D instrument. Costs to the
NHS and personal social services were estimated at 2012 prices. The primary outcome was cost per Quality
Adjusted Life Year (QALY) gained.
Results: The model predicted that aflibercept reduced costs per patient per year by £3,588 at NHS list prices
whilst generating a similar number of QALYs. In a scenario where treatment of the second eye was also
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considered, aflibercept remained less costly than ranibizumab with comparable outcomes. Results were
sensitive to drug costs, frequency of administration and monitoring.
Conclusion: This economic evaluation found that aflibercept was associated with lower costs than
ranibizumab and produced similar outcomes for the treatment of wAMD in the UK
123. A systematic review on the use of Photodynamic Therapy to treat Central serous Chorioretinopathy
Ore-oluwa C Erikitola, Roxanne Nwanobi-Crosby, Sobha Sivaprasad
Introduction: Central serous chorioretinopathy (CSCR) is an idiopathic disorder characterized by detachment
of the neurosensory retina due to serous fluid accumulation between the photoreceptor outer segments and the
retinal pigment epithelium. There are currently no set guidelines or protocols on its treatment.
Purpose: This study was undertaken to assess the current literature on the use of photodynamic therapy (PDT)
in the treatment of CSCR and assess PDT’s efficacy in treating this condition.
Method: Randomised controlled trials (RCTs) and case series that met the Strengthening the Reporting of
Observational Studies in Epidemiology (STROBE) criteria were identified from the current literature for
analysis. Data concerning treatment with PDT, mean duration of CSCR symptoms, dosing regimens (which
includes: treatment dose of vertoporfin, treatment time, fluence, spot size), number of treatment session,
response to treatment, mean follow up duration and complications from the treatment of CSCR were extracted
and compiled into a database.
Results: Since the introduction of PDT for the treatment of CSCR in 2003, there have been 2 RCTs that have
assessed the efficacy of PDT in treating CSCR (includes both acute and chronic). Both RCTs compared the use
of PDT with other treatments. 26 studies that met the STROBE criteria with similar outcomes to the RCT were
also identified. In both RCTs by Chan el al and Bae et al, there was a mean improvement in BCVA post PDT
treatment at 3 months (p=0.015 and p= 0.075 respectively). In the STROBE group also, although the studies
were not heterogenous, there was a statistically significant improvement in visual acuity at 3 months in all
studies. This effect was maintained at 6 months in studies with longer follow-up.
Conclusion: There is sufficient scientific and statistical evidence to advocate the use of PDT in the treatment of
chronic CSCR. This is clearly reflected in our systematic review.
124. Visual Outcome in Patients with Uveitis
Ahmed Samy, Sue Lightman, Oren Tomkins-Netzer , Lazha Talat, Asaf Bar, Simon Taylor, Albert Lula
Moorfields Eye Hospital, Royal Surrey County Hospital NHS
Introduction: Uveitis, although comparatively rare when compared with other eye problems for example
diabetic retinopathy and age related macular degeneration, remains a significant cause of visual handicap in
the UK
Purpose: To evaluate the long term clinical and functional outcome, treatment strategies, causes of vision loss
and burden of disease among patients with uveitis.
Method: Cross-sectional study conducted on 1077 Patients diagnosed with uveitis attending the uveitis clinic
at between the years 2011-2013.
Results: 1799 eyes of 1077 patients were included in this study, with an average follow-up of 7.97±0.17yrs
(range 1 month to 54 years, 8159 patient years, 14226 eye years). Average BCVA remained stable throughout
follow-up from 0.34±0.04 LogMAR at baseline to 0.33±0.02 LogMAR at 10 years (p=0.23), and continued to
remain stable also among patients with a follow-up of over 10 years who had a final BCVA of 0.35±0.03
LogMAR. Vision loss was noted in 19.2% of eyes with an incidence for VL of 0.01 per eye year or 0.02 per
patient year and for SVL 0.01 per eye year or 0.02 per patient year. Chronic cystoid macular oedema was the
most common cause of VL (3.55%) and macular scarring the most common cause for irreversible SVL (4%).
525 patients (48.7%) received oral prednisolone, 320 (29.7%) requiring a dose of over 40mg a day and 130
(12.1%) also required one or more second line agents. Patients were reviewed on average 33.7±0.7 times or
5.9±0.46 times a year.
Conclusion: Long term functional outcome among uveitis patients is good with BCVA remaining stable over 10
years of follow-up. In cases when vision loss occurs it is mainly related to retinal changes. The burden of
disease is similar regardless the severity of disease or the risk of vision loss
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125. Real-world outcomes with intra-vitreal aflibercept as initial therapy for neovascular AMD
Michael Kaye, Carlo Suter, Helen Devonport , Faruque Ghanchi, Martin McKibbin
Introduction: Collection of real-world outcome data is important to determine if clinical trial outcomes are
achievable in the NHS
Purpose: To report the functional and anatomical outcomes following intra-vitreal aflibercept therapy for
neovascular AMD (nAMD) in two UK centres
Method: Treatment naïve, nAMD patients were treated with intra-vitreal aflibercept, with a loading phase of 3
monthly injections followed by two-monthly injections for the first year. Outcomes include change in mean
ETDRS letter score, 1mm central retinal thickness (CRT) measured by spectral domain OCT and the absence of
intra- or sub-retinal fluid at the month 4 visit, before the start of the maintenance phase. Patients with other
significant ocular pathology or prior vitrectomy in the study eye were excluded.
Results: For the 195 patients, mean age was 82 years and 86 were male. Mean ETDRS letter score at baseline
was 51 letters and mean CRT was 412µ m. Before the third injection in the loading phase (month 2), mean
ETDRS letter score increased by 7 letters and CRT decreased by 131µ m from baseline. Before the first
injection in the maintenance phase (month 4), mean ETDRS letter score change from baseline was +5 letters
and the CRT reduction was 104µ m but only 29% of OCT images were “dry”.
Conclusion: Although the number of patients with follow-up into the maintenance phase of treatment is small,
these data suggest that good functional and anatomical gains are achievable with intra-vitreal aflibercept in a
real-world setting.
126. Mean visual gain and atrophic retinas after five years of Ranibizumab ‘prn’ treatment in a neovascular
Age-related Macular Degeneration (nvAMD) service.
Archana Airody, Divya Venugopal, Nicola Topping , Richard Hanson, Gavin Walters, Richard Gale
York teaching Hospitals NHS Foundation Trust
Introduction: The SEVEN UP analysis shows one third had poor visual outcome following on from clinical
trials. A four-year study showed a mean 2.7 ETDRS letters decline in visual acuity in a clinical setting.
Purpose: To demonstrate outcomes in patients treated with intravitreal ranibizumab for neovascular Agerelated Macular Degeneration for five years in a clinical setting.
Method: Retrospective review of patients completing five years of nvAMD clinic attendance prior to August
2013. Treatment was using a ‘tight prn’ regimen.
Results: 68 eyes with a mean age 83.39 (range 66-92) completed five years. 48.52% were angiographically
occult with 83.82% >1DD. The mean visual acuity was 42.44 ETDRS letters (SD +/- 13.60) at baseline,
55.22(SD +/- 14.22) at 6 months and 53.36(SD +/- 17.24) at 60 months. 29.14% gained >/=15 letters. Mean
baseline CRT was 328.39(SD +/- 80.17) microns, 274.4(SD +/- 49.57) at 6 months and 230.23(SD +/- 48.47) at
60 months. 66.17% showed OCT activity at 60 months. The total mean number of injections per person was
24.0 over 60 months with 5.9(+/-1.98) in year 1 and 6.6(+/-4.4) in year 5.
Conclusion: Patients completing 5 years sustained a mean visual improvement, a third gaining 15 letters or
more with 5 injections per year. Long term treatment was required with persistent activity in the majority. OCT
thickness progressively thinned below that of healthy individuals.
127. Ocular side effects of mitogen-activated protein kinase (MEK) inhibitors
Robert M J Purbrick, Wasir Saka, Denis C Talbot , Susan M Downes
Oxford Eye Hospital
Introduction: MEK inhibitors are small molecular weight agents under investigation for treatment of advanced
cancer. Our unit assists in monitoring patients in MEK inhibitor trials and we have documented ocular side
effects associated with these drugs.
Purpose: To describe the ocular side effects of MEK inhibitors seen in a local study population.
Method: A retrospective case series of 16 patients referred as part of safety monitoring for trials evaluating a
number of MEK inhibitors.
Results: Of the 16 patients in this series, eight (50%) experienced probable ocular toxicity: four cases of
bilateral central serous chorioretinopathy (CSC); two patients developed significantly raised intraocular
pressure (IOP); one central retinal vein occlusion (CRVO); and one case of anterior uveitis with hypopyon. All
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four CSC cases resolved following cessation of the study drug; both patients with raised IOP required topical
treatment acutely but had no further problems after withdrawal of MEK inhibitor; the CRVO patient requires
ongoing treatment with intravitreal bevacizumab for macular oedema; the case of anterior uveitis settled with
topical steroid treatment and withdrawal of the study drug.
Conclusion: Animal models demonstrate that MEK inhibition induces oxidative stress, inflammation and bloodretinal barrier/RPE damage. Cases of MEK inhibitor-induced retinopathy have been reported previously, but our
series is unique in that we have reliable baseline information demonstrating a temporal relationship between
MEK inhibition and ocular side effects. The release of matrix metalloproteinases is directly influenced by MEK
and inhibition of this pathway could raise IOP due to reduced uveoscleral outflow.
128. 6-weekly bevacizumab versus 4-weekly ranibizumab as required treatment for neovascular age-related
macular degeneration: a 2-year outcome
Patrick Chiam, Nicholas Hickley, Venkat Kotamarthi
Leighton Hospital, Crewe
Introduction: The 4-weekly bevacizumab on an as-required-basis has been shown to have equivalent effect as
ranibizumab on the same regime for the treatment of neovascular age-related macular degeneration however
the 6-weekly regime has not been investigated.
Purpose: To compare the visual and central macular thickness (CMT) outcomes of 6-weekly bevacizumab and
4-weekly ranibizumab treatment on an as-required-basis for neovascular age-related macular degeneration
over 24-month.
Method: Retrospective analysis of consecutive patients who were treated with bevacizumab or ranibizumab
and fitted the study criteria. Patients were followed-up 6-weekly in the bevacizumab and 4-weekly in the
ranibizumab groups. All patients received 3-loading injections followed by as-required-basis treatment.
Samples of 102 for bevacizumab and 101 ranibizumab were obtained to provide a study power of 80% to
detect non-inferiority limit of 5 letters (significance 2.5%, one-tailed). Normality test for distribution and
intention-to-treat analysis were performed. Main outcomes measured were mean change in visual acuity
(unpaired t-test), CMT and number of injections (Mann-Whitney test for latter two).
Results: At 12-month, the mean letter gained with bevacizumab was 7.6 and ranibizumab 10.7 (p=0.06). The
95% confidence interval (CI) for bevacizumab minus ranibizumab was -6.8 to 0.6. At 24-month, the
improvements were 7.0 and 9.2 letters (p=0.31). The 95% CI was -6.3 to 2.3. The mean number of
bevacizumab injections after 12-month was 6.6 and ranibizumab 5.9 (p<0.001). At 24-month, there were 11.9
and 10.3 (p<0.001). At 12-month, the CMT improvement were 139μm for bevacizumab and 150μm
ranibizumab (p=0.33); at 24-month 146μm and 160 μm (p=0.43).
Conclusion: The comparison between the two treatment regimes in terms of visual acuity at 12- and 24-month
was inconclusive. There was no difference between the CMT changes. The number of bevacizumab injection
required in 2 years was one fewer than ranibizumab.
129. Aflibercept (Eylea) for Treatment Resistant Neovascular Age-Related Macular Degeneration (nAMD):
Early UK Outcomes
Tejal Magan, Aman Kirmani, Zine Elhousseini , Matthew Robertson, Samantha Mann
St Thomas' Hospital, London
Introduction: Aflibercept was approved by NICE for NHS use in July 2013. Our local commissioners
authorised earlier use in April 2013.
Purpose: To report anatomical and functional outcomes of Aflibercept in eyes with nAMD showing suboptimal response with prior Ranibizumab therapy. This was defined as persisting disease activity on OCT (sub/ intra-retinal fluid or new haemorrhage), despite a full ‘loading phase’ of three injections and a further three
consecutive injections administered on each subsequent visit.
Method: Prospective data collection in all patients switched to Aflibercept. The main outcome measures after
three Aflibercept injections were central foveal thickness (CFT), the maximal height and width of retinal
pigment epithelial detachments (PED) and visual acuity; other outcomes included the number of previous
injections and the proportion of eyes regarded as inactive.
Results: 83 eyes of 79 patients had their therapy switched to Aflibercept, all had their outcomes assessed 6-8
weeks after the third injection. The mean CFT reduced from 388μm to 319μm, mean PED height reduced from
294μm to 218μm, PED width changed minimally from 2074μm to 1910μm and VA showed a slight gain from
69 ETDRS letters to 73 letters. The mean number of prior injections was 11.1, whilst 29% had no signs of
activity after 3 injections.
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Conclusion: Switching to Aflibercept resulted in improved macular anatomy, but only modest functional gains
were noted, these probably reflect the chronicity of disease in these individuals.
130. Central serous chorioretinopathy and pigment epithelial detachments associated with a novel MEK
inhibitor
Nashila Hirji, Laura Maubon , Vasiliki Michalarea , Udai Banerji, Paul Ursell
Sutton Hospital
Introduction: There are rare reports of central serous chorioretinopathy (CSCR) and pigment epithelial
detachments (PEDs) occurring following treatment with MEK inhibitors. However, the literature in this field is
sparse.
Purpose: In our study, we aimed to demonstrate the extent and frequency of ophthalmic signs and symptoms
in patients commenced on a novel MEK inhibitor.
Method: We retrospectively analysed the case notes of 15 patients commenced on a new MEK inhibitor,
administered orally as monotherapy for the treatment of advanced tumours. The development of ocular
symptoms and signs whilst they were on treatment was evaluated, and the time to resolution was noted.
Results: Of the 15 patients, 5 developed PEDs and 3 developed CSCR. These were associated with minimal
change in Snellen visual acuity, although patients tended to report positive visual phenomena. Symptoms and
signs developed within a month of commencing treatment in 6 of these patients (within 1 week in 4 cases). In
most cases, symptoms resolved spontaneously between 1 to 4 months after onset.
Conclusion: Our results demonstrate that PEDs and CSCR appear to be relatively frequent side effects of MEK
inhibitors. It would therefore be prudent to emphasize the likelihood of possible visual disturbances to patients
on these drugs, and organise for them to have a baseline ophthalmic assessment prior to commencing
treatment, followed by regular ophthalmic examinations thereafter whilst on treatment.
131. Pattern scan laser for proliferative diabetic retinopathy: outcome at 1-2 year follow up
Alexander Baneke, Felicity Allen, Todd Williamson , Moin Mohamed, Samantha Mann
St Thomas' Hospital
Introduction: Pattern scan (PASCAL) laser has replaced argon green laser as the standard treatment for newly
diagnosed proliferative diabetic retinopathy. However, recent research has suggested that it may be less
effective at maintaining lasting regression of retinal neovascularisation. The Early Treatment of Diabetic
Retinopathy Study group (EDTRS) guidelines were designed for the older, argon green laser, but these
guidelines are still being used for the PASCAL.
Purpose: We aimed to assess PASCAL laser effectiveness at reducing progression of diabetic retinopathy.
Method: A retrospective database search was carried out on 31 patients (49 eyes) from St Thomas’ Hospital
who had been referred with R3 grade diabetic retinopathy between October 2011 and November 2012. Laser
spot number and spot size were recorded for the first 1-3 sessions within the initial 3 months of treatment.
Progression was recorded at 6, 12 and 24 months post first treatment.
Results: At 6, 12 and 24 months post initial treatment, further progression of diabetic retinopathy occurred in
25/49 (51%), 33/49 (67%) and 23/28 (82%) of eyes. There was a difference between the chance of progression
at 12 months in patients who had a total retinal burn area of < 3x10*8µ m2 and those who had an area >
3x10*8µ m2, but this was not significant (92%, 72%, p = 0.07).
Conclusion: Chance of progression of proliferative diabetic retinopathy with PASCAL laser may be higher than
with the older argon green laser. EDTRS guidelines should be updated for the PASCAL laser.
132. Surveillance Clinic for Screen Positive Maculopathy Patients
Miranda Buckle, Liam Price, Steve Chave, Kerry Price, Stephen Adlington, Peter H Scanlon
Introduction: The NHS Diabetic Eye Screening programme introduced surveillance clinics as part of the 2012
& 2013 Service Specifications that NHS England will use to commission services but this did not include
Optical Coherence Tomography (OCT).
Purpose: To investigate the effectiveness and outcomes of surveillance clinics with OCT in Gloucestershire.
Method: Surveillance clinics with OCT were introduced in Gloucestershire on 1st February 2012 and results
for the preceding 2 years and the first 18 months were recorded prospectively.
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Results: Gloucestershire Diabetic Eye Screening Programme (GDESP) screened 21,632 and 21,344 people with
diabetes in the 2 years prior to 1st February 2012, and 21,854 and 13,291 in the following 18 months. In the
first 2 years, 606 and 553 people with R1M1 were referred directly to the Hospital Eye Service (HES) and in
the following 18 months, 96 and 23 patients were referred directly to the HES and 389 and 186 referred to the
surveillance clinics. Of the 575 referred to the surveillance clinics, only 115 (20%) were referred to the HES,
98 (17%) were returned to annual screening, 17 (3%) did not attend and 339 (59%) were followed up in the
surveillance clinics. No patient given routine follow ups or discharged from surveillance presented
symptomatically to the HES and receive treatment.
Conclusion: The introduction of surveillance clinics resulted in a reduction in unnecessary referrals to the
ophthalmology department with no deleterious effect on patient outcomes.
133. To investigate the impact of diabetic retinopathy of varying severity on sleep
Rupal Morjaria, Iona Alexander, Obaid Kousha , Victor Chong, Katharina Wulff, Russell Foster, Susan Downes
Introduction: Circadian misalignment, defined as a mismatch between the sleep-wake cycle and the timing of
the circadian system, can occur either because of inadequate exposure to the light-dark cycle, or reduction in
light transmission resulting from ophthalmic diseases.
Purpose: We investigate the impact of diabetic retinopathy on sleep in patients with varying severity of
retinopathy.
Method: Patients attending diabetic retinopathy clinics with no significant ocular co-morbidities completed the
self-rated Pittsburgh Sleep Quality Index (PSQI) to assess subjective sleep quality. The PSQI measures seven
sleep variables (scale of 0 to 3) providing a global sum of 0 to 21. A PSQI score ≥6 indicating poor sleep.
Using ETDRS grading, patients were allocated to 3 groups depending on severity of retinopathy: no/mild 1035, moderate 35-53, severe >61. Statistical analysis was performed using SPSS.
Results: 327 patients participated, (57 excluded due to ineligibility/incomplete data). 270 completed
questionnaires were analysed. The mean PSQI score (mild =5.10, moderate =5.18, severe =5.45 p >0.05)
across the three diabetic retinopathy severity groups did not reveal a statistically significant difference.
Conclusion: Retinal ganglion cells have been reported to be affected by diabetes. Melanopsin- retinal ganglion
cells (mpRGCs) are integral to the entrainment of 24 hour circadian cycle with rods and cones also involved.
Our study showed that no significant differences in the PSQI were identified even with increasing stages of
diabetic retinopathy. Presumably therefore there are enough functioning melanopsin cells and or rods and
cones for entrainment to be unaffected.
134. Glycated albumin induced IL-8 and MCP-1 modulation by minocycline in cultured retinal pigment
epithelial cells
Joanna DaCosta, Sobha Sivaprasad, Selim Cellek
Cranfield University
Introduction: Age related macular degeneration (AMD) is the leading cause of blindness in people over the
age of 50 in the Western world. The pathogenesis of AMD is complex and evidence suggests chronic low
grade inflammatory processes may eventually culminate in visual loss. In AMD drusen formation occurs and
glycated albumin (GA) represents a component of drusen. Minocycline is a semi synthetic tetracycline
derivative with improved penetration through the blood brain barrier. Apart from well recognised antimicrobial
effects it also has potent anti-inflammatory and immunomodulatory effects.
Purpose: To investigate glycated human serum albumin induced MCP-1 and IL-8 modulation by minocycline
in retinal pigment epithelial cell culture
Method: ARPE-19 cells were cultured in Dulbecco’s modified media supplemented with 10% foetal calf
serum. Once cellular confluence was reached media was substituted to serum free media for 16 hours and
cells were exposed to varying concentrations of GA and minocycline.
After exposure cell culture media was collected and stored at -80°C for MCP-1 and IL-8 enzyme linked
immunosorbant assay (ELISA). ELISA was conducted with negative and positive controls. Standards and
samples were analysed in duplicate.
Interplate and intraplate reproducibility tests were performed
Results: The effects of minocycline on ARPE-19 cell viability and growth identified a potential narrow
therapeutic window for effectiveness. Minocycline at <5μM effectively abrogated glycated albumin induced
MCP-1 and IL-8 production from ARPE-19 cells in culture (p<0.05)
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Conclusion: Minocycline may have a potential therapeutic role in the treatment of inflammatory changes in
choroidal neovascularisation secondary to age related macular degeneration.
135. A systematic review and meta-analysis comparing intravitreal ranibizumab with bevacizumab for the
treatment of choroidal neovascularization secondary to pathologic myopia
Mohamed Loutfi, Muhammad Siddiqui, Abdulbaset Dhedhi , Ahmed Kamal
Introduction: Intravitreal injections of ranibizumab (IVR) and bevacizumab (IVB) have both been used as
treatments for myopic choroidal neovascularisation.
Purpose: A meta-analysis of published literature comparing IVR with IVB for the treatment of myopic choroidal
neovascularization.
Method: Electronic databases were searched from January 1950 to March 2013.
Results: 3 studies reported on 117 patients. The mean number of lines improvement after IVR appeared better
compared with IVB [fixed effects model: SMD=0.46,95%CI(0.09,0.83),z=2.44,p=0.01]. The number of patients
who had a greater than 3 line improvement was similar between groups [fixed effects model:
RR=0.95,95%CI(0.67,1.32),z=0.33,p=0.74]. At follow up there was no difference in number of those who had
an absence of leakage [fixed effects model: RR=1.04,95%CI(0.93,1.16),z=0.64,p=0.52]. There was no
statistical significance between the two groups in relation to the number of injections [random effects model:
SMD=-0.25,95%CI(-1.12,0.61),z=0.57,p=0.57].
Conclusion: Early evidence suggests that intravitreal injections of ranibizumab are comparable to intravitreal
injections of bevacizumab in the treatment of myopic choroidal neovascularization. Both treatments result in a
statistically significant increase in visual acuity with high numbers of patients maintaining stable vision.
Moreover, reduction of leakage in the retinal layers following treatment is ubiquitous; reported rates of ocular
and systemic complications emphasize that the treatment is very safe. Further studies are still needed to
strengthen results.
136. Inter-injector pain scores for intravitreal injections for wet age-related macular degeneration (AMD): a
comparison of Visual Analogue Scale (VAS) and Verbal Reporting Scale (VRS)
Divya Venugopal, Samalie Kakaire, Altaf Waraich , Richard Gale, Richard Hanson
York District Hospital
Introduction: Intravitreal injections are performed by a variety of health care professionals in NHS clinics.
Patients’ experience of pain is an important aspect of quality of care and compliance with longterm follow up.
Anecdotal evidence from patients suggest that a “favoured injector” may emerge from within the departmental
team placing strain on a service which seeks to deliver individualised care wherever possible.
Purpose: To study intravitreal injection pain scores using 2 different methods of reporting pain.
Method: Pain scores after 176 intravitreal injections were recorded for 169 patients receiving intravitreal
injections from a team of five injectors. Patients were asked to rate pain using 2 different methods - VAS and
VRS - each scored between 0 and 10, 15 minutes after injection . Pain scores for the entire group and across
the five injectors were compared. Correlation coefficient between VRS and VAS was calculated.
Results: The group mean of 3.1± 2.7 is comparable with published series and sets a benchmark for future
audit. All injectors had some pain scores > 7. No significant difference in pain score was observed among the
five injectors (ANOVA:F=0.913 ;P= 0.458). Correlation between VRS and VAS is good (r= 0.912).
Conclusion: Pain associated with intravitreal injections is generally mild and is independent of injector in this
series. VRS correlates well with VAS and is more easily applied in a setting where patients are visually
impaired.
137. Attitudes towards prenatal diagnostic testing for inherited retinal diseases
Khuram Ahmed, Mushtaq Ahmed, Barbara Potrata , Hilary Grant, Thomas Willis, Martin McKibbin
Introduction: With increasing access to genetic testing, individuals with inherited retinal disease (IRD) may
have an option to access prenatal diagnosis (PND). Prior research has identified that less than 50% are in
favour of PND for IRD.
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Purpose: To explore the factors that influence peoples’ decision-making in relation to PND.
Method: Semi-structured interviews were conducted with 50 adults with IRD, transcribed verbatim and
analysed using thematic analysis. Interviewees were selected from a larger sample of 200 research participants
in order to provide a diversity of backgrounds, knowledge and support for genetic testing.
Results: Potential benefits from PND included: more information to help prepare and plan the future care of
children, earlier access to novel treatments and the option to proceed to termination of pregnancy for severe,
early onset disease. Negative aspects included: moral objection to termination of pregnancy, the risk
associated with the procedure, concerns about accuracy of PND and personal experience of a good quality of
life. Although many interviewees wouldn't access PND personally, they could see that it may be an option for
others, but only in specific circumstances and not offered routinely.
Conclusion: Adults with IRD have mixed views on PND. Disease severity, the impact on quality of life and the
risk to future generations were important considerations. Many participants believed that it should be available
but would not access it themselves. The range of attitudes suggests that adults with IRD need genetic
counselling before they can make an informed choice about PND.
138. Serpiginous-like choroiditis: as a marker for tuberculosis in a non-endemic area
Weh Loong Gan, Nicholas Jones
Introduction: Tuberculosis is increasingly recognised as a cause intraocular inflammation. In the UK, the
current incidence is low at 14.4 per 100,000 populations, but this has risen from 11.6 in 2001. The variable
presentations and treatment outcomes of TB-associated uveitis in patients attending the Manchester Uveitis
Clinic (MUC) have been reported. However, we have recently experienced a striking increase in the number of
patients presenting with atypical multifocal outer retinal and inner choroidal inflammation associated with TB;
this phenomenon has been described as ‘serpiginous-like choroiditis’ (SLC) and is now increasingly recognised
as a marker for TB.
Purpose: To describe the increasing incidence of multifocal outer retinal and inner choroidal inflammation, as
a marker for intraocular tuberculosis in the United Kingdom, an non-endemic area.
Method: Retrospective case series.
Results: Fourteen patients presented with serpiginous-like choroiditis (SLC) over 10 years (7 within the last 2
years). Seven of 14 patients showed evidence of exposure to tuberculosis and received anti-tuberculosis
treatment. Seventeen of 23 eyes showed stable or improved visual acuity. All with decreased acuity had direct
macular involvement at presentation.
Conclusion: Multifocal outer retinal and inner choroidal inflammation is a marker for intraocular tuberculosis
of increasing importance, even in a non-endemic area. Originally described as 'serpiginous-like choroiditis',
the lesions are multifocal, irregular in shape, very numerous, widespread, often asymmetrical and
demonstrating both active and resolved lesions simultaneously. Active lesions show contiguous extension. We
recommend that every patient with SLC should undergo testing for previous exposure to tuberculosis, and
undergo anti-tuberculosis treatment if lesions are progressive and sight-threatening.
139. Intravitreal Triamcinolone for refractory macular oedema following failed anti-VEGF treatment: One
year results
Peck-Lin Lip, Hema Kolli, Arijit Mitra , Samer Elsherbiny, Panagiota Stavrou, Bichitra Das, Bushra Mushtaq
The Birmingham & Midland Eye Centre
Introduction: Intravitreal or periorbital steroid injections have been used for many years to treat macular
oedema(CMO) which is non-amenable for laser treatment. Its popularity has lessened with the introduction of
anti-VEGF injections.
Purpose: To evaluate the anatomical and visual outcomes following Intravitreal Triamcinolone injections(IVT)
in treating CMO refractory to other therapies.
Method: Retrospective analysis of patients with CMO treated with IVT(4mg/0.1ml) repeated 4 monthly when
indicated. Outcome measures were Snellen vision(Va) and OCT measured central retinal thickness(CRT) at preinjection(baseline), at 4-weeks post-first injection(R1) and at one year’s follow-up.
Results: We studied 29 eyes in 19 patients (15 males; mean age 60.7, SD14.7, range 29-80): 25 eyes(86%)
were diabetic CMO, 3 eyes(10%) were retinal vein occlusion and one was post-operative CMO, all failed to
respond to Bevacizumab and laser therapies.
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Average number of Bevacizumab applied pre-IVT was 5.3(mode 3, range 2-9) before it was concluded poor
response. Baseline median CRT was 539µ m[IQR 414-706], which was reduced to 287µ m[264-379] (paired
Wilcoxon, p<0.001) at R1 and, to 348µ m[251-483](p=0.001) at 1 year. All eyes showed total resolution of
CMO after each IVT. ‘Stable/improved’ Va at R1 and one year was 69% and 72%, respectively; whilst 22% Va
improved by 3 lines at both. Adverse effects: 45% developed ocular hypertension and 10% developed
cataracts.
Conclusion: Intravitreal Triamcinolone has a role as an effective treatment for macular oedema poorly
responsive to other therapies. It remains a secondary treatment choice due to its adverse effects.
NEURO-OPHTHALMOLOGY
140. Retinal ganglion cell neuroprotection and axon regeneration after optic nerve crush induced by siRNA
mediated knock-down of RTP801, a negative regulator of mTOR signalling
Peter Morgan-Warren, Jenna O'Neill, Martin Berry , Elena Feinstein, Robert Scott, Ann Logan
University of Birmingham
Introduction: Traumatic optic nerve (ON) injury results in retinal ganglion cell (RGC) apoptosis and a failure to
regenerate axons. There are currently no treatments available to promote functional repair of axotomised RGC.
The serine/threonine kinase, mammalian Target of Rapamycin (mTOR), is involved in numerous cellular
signalling pathways associated with cell survival and growth, and is implicated as a key determinant of
neuronal survival and axon regeneration after ON injury. RTP801 is a negative regulator of mTOR signalling,
activated in response to cellular stress.
Purpose: To investigate the effects of knock-down of RTP801 with a targeted small-interfering RNA (siRNA) on
RGC survival and axonal regeneration in an ON injury model in vivo.
Method: Adult male rats (n=5) underwent bilateral ON crush and received intravitreal injections of siRTP801
(20μg/10μl) in the right eye and control siRNA (siEGFP,20μg/10μl) in the left on days 0, 8 and 16 after injury.
Surviving RGC and regenerating axons were quantified at day 24 with immunohistochemistry of retinal and
ON sections for Brn3a and GAP43, respectively.
Results: Intravitreal siRTP801 promoted significant RGC survival compared to control siRNA after ON crush
(16.9±0.6 vs 9.2±0.6 RGC/250μm linear retinal sample, p<0.001), and increased the number of GAP43+
regenerating axons in the distal ON at 400μm (87.1±21.1 vs 44.9±23.0, p=0.024), 800μm (68.9±11.1 vs
28.6±15.8, p=0.015) and 1200μm (55.8±11.5 vs 15.4±9.9,p=0.02) beyond the crush site.
Conclusion: Knock-down of RTP801, a negative regulator of mTOR signalling, promotes RGC survival and
axon regeneration after ON crush, and is a potential novel translatable neuroprotective and axogenic treatment
for traumatic ON injury.
141. A national epidemiological study of chronic progressive external ophthalmoplegia – molecular genetic
features and neurological burden
Anna Clements, Victoria Nesbitt, Robert W Taylor , Douglass M Turnbull, Robert McFarland,
Patrick Yu-Wai-Man
Wellcome Trust Centre for Mitochondrial Research, Newcastle
Introduction: Chronic progressive external ophthalmoplegia (CPEO) is a classical manifestation of
mitochondrial disease that is characterised by slowly progressive ptosis and ophthalmoplegia. CPEO can occur
either in isolation or as part of a more severe multisystemic “CPEO plus” phenotype.
Purpose: (i) To establish the prevalence of CPEO in the North of England; (ii) To define the spectrum of
molecular genetic defects observed in this group of patients; and (iii) To describe the ocular and extra-ocular
clinical features associated with CPEO.
Method: Patients were recruited from the Mitochondrial Disease Patient Cohort Study Database funded by the
MRC. The medical records of patients with suspected CPEO were retrospectively reviewed.
Results: Out of a total of 631 patients currently on the database, 255 patients (40.4%) were confirmed to have
CPEO. The minimum prevalence of CPEO in the North of England was estimated at 3.39 per 100,000
inhabitants, about 1 in 30,000. The most commonly identified genetic defect was a pathogenic mitochondrial
DNA (mtDNA) point mutation (n=80, 31.4%), followed by a single mtDNA deletion (n=72, 28.2%), and a
nuclear point mutation (n=70, 27.5%). Neurological symptoms were common in our CPEO patient cohort
(n=221, 86.7%). The degree of ptosis and ophthalmoplegia was found to be more severe among patients
harbouring single mtDNA deletions.
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Conclusion: CPEO causes significant visual impairment and it is invariably associated with the development of
other neurological features. The management of this group of patients therefore requires a multidisciplinary
team approach to minimise long-term morbidity.
142. Diabetic retinopathy is associated with oxidative stress and mitigation of gene expression of
antioxidant enzymes
Mohamed Fathelbab, Moaz Mojaddidi , Maan AL-Barry, Hesham El-Beshbishy
Taibah University
Introduction: Type 2 diabetes is a metabolic disease associated with serious complications, including diabetic
retinopathy (DR).
Purpose: The aim was to investigate biochemical parameters and the oxidative stress associated with the type
2 DR patients and to study gene expression of superoxide dismutase (SOD), catalase (CAT), and glutathione
peroxidase (GPx) among patients with DR [DR(+)] compared with a control nondiabetic group.
Method: 67 DR patients were diabetic for more than 10 years. 22 patients were DR(+),and 45 were DR(-).
Their age range from 14 years to 80 years old having diabetes from 2 and 45 years.
Results: BMI was 31.43 ± 5.94 and 32.33 ± 6.54, systolic blood pressure was 117.15 ± 18.16 mmHg and
126.15 ± 20.26 mmHg, diastolic blood pressure was 81.11 ± 10.55 mmHg and 82.77 ± 10.85 mmHg, HbA1c
was 7.2 ± 1.1 and 8.19 ± 1.95, serum total cholesterol was 6.61 ± 1.11 and 4.11 ± 0.31, serum triglycerides
were 3.52 ± 0.89 and 3.42 ± 0.79, serum low-density lipoprotein (LDL) was 2.12 ± 0.10 and 2.42 ± 0.15,
high-density lipoprotein (HDL) was 2.66 ± 0.30 and 2.55 ± 0.21, SOD was 3.12 ± 0.87 and 1.53 ± 0.14, GPx
was 11.14 ± 2.21 and 8.2 ± 1.84, CAT was 26.43 ± 3.34 and 9.60 ± 2.14, for DR(-) and DR(+) patients,
respectively. SOD, GPx and CAT polymerase chain reaction (PCR) products of the DR(+) patients revealed the
diminished expression of CAT gene followed by GPx and SOD genes. All were significant compared with the
normal controls, P < 0.05. Linear regression analysis revealed a strong significant positive correlation between
the retinopathy grade and the diastolic blood pressure, diabetes duration, hemoglobin A1c (HA1c)%, and
fasting blood glucose (P < 0.001). A marginally significant positive correlation between the retinopathy grade
and LDL-cholesterol and a significant negative correlation with total cholesterol was observed
Conclusion: Poor glycemic control and alteration in mRNA gene expression of antioxidant enzymes are
strongly associated with development of DR
143. Vascular morphology in patients with optic nerve head drusen and optic disc oedema
Anastasia Pilat, Frank Proudlock, Mark Lawden , Irene Gottlob
Introduction: In optic nerve head drusen (ONHD) retinal vascular abnormalities including abnormal
branching, vessel trifurcations, increased capillarity and large shunt vessels have been described. In contrast
the main findings in optic disc oedema (ODE) were retinal hemorrhages and venous dilatation.
Purpose: We aimed to analyze quantitatively peripapillary retinal vessel morphology in ONHD and ODE.
Method: Colour optic disc (OD) photographs of 25 ONHD, 22 ODE patients and 25 healthy participants were
analyzed using computer-based fundus analysis (ARIA software, Peter Bankhead between two rings (diameters
4.2 and 8.4 mm) centered on the OD. OCT was used for calibration.
Results: Patients with ONHD showed larger diameters of arteries without branching (p=0.05), arteries after
primary/before secondary branching (p=0.04) and secondary venous branching started closer to the OD
(p=0.03) compared to healthy controls. ODE patients had reduced number of small peripapillary veins and
larger number of veins without branching as compared to ONHD and controls (p=0.02). Anomalous branching
with arterial and venous trifurcation presented in the ODE and ONHD groups with higher prevalence in ODE
patients for venous trifurcations as compared to ONHD and controls (p=0.02).
Conclusion: Quantitative analyses revealed different changes than described previously with larger arteries in
ONHD and increased size of the small veins in ODE. Venous trifurcations were more common in ODE. In
ONHD changes may be attributed to anomalous vessel development or compensatory vascular changes due to
retinal hypoxia while the increased size of small peripapillary veins and venous trifurcations in ODE may help
decreasing venous pressure and prevent retinal damage.
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144. Comparison of electroretinographical responses in albinism, idiopathic infantile nystagmus and healthy
controls
Zhanhan Tu, Christopher Degg, Viral Sheth , Irene Gottlob, Frank Proudlock
Introduction: Previous studies describe children with albinism showing significantly better ERG results
compared to controls, while idiopathic infantile nystagmus (IIN) had normal ERGs using small sample sizes
and skin electrodes.
Purpose: To compare ERG results between a large sample of adults with albinism, IIN and controls. To
investigate the correlation between ERGs with visual fields (VF) and retinal structure measured using optical
coherence tomography (OCT).
Method: Sixty-seven albinism, 43 IIN and 24 controls were recruited. Dilated Ganzfeld flash ERG testing was
performed using DTL™ corneal electrodes. The thicknesses of retinal layers in the foveal area were obtained
using OCT and Humphrey VF test was used.
Results: The IIN group demonstrated significantly smaller photopic a- and b-wave amplitudes compared to
controls (P<0.001, P<0.01, respectively). The IIN group also showed significantly longer photopic b-wave
latencies compared to the albinism group (P<0.01). However, the IIN group has shorter b-wave latencies
compared to albinism group under scotopic conditions with standard flash. The thicknesses of macular, inner
plexiform and inner segment layer were correlated with b-wave amplitude, a-wave latency and b-wave
latency, respectively under photopic condition. The VF was strongly correlated with scotopic b-wave latency
with dim flash.
Conclusion: Our findings of reduced photopic a- and b-wave amplitudes and longer b-wave latencies in IIN
may indicate a subclinical reduction of retinal function in IIN which has not been previously detected.
Interestingly, participants with albinism did not show the same changes despite having nystagmus possibly
because hypopigmented retinae can cause increased ERG responses.
145. Comparative Analysis of the Mollon-Reffin Minimal Colour Vision Test in the visually normal and
acquired ocular disease
Hetan Ajwani, Carmel P Noonan, Fiona J Rowe
Introduction: Currently a variety of different colour vision tests exist in clinical practice each with its own
merits and limitations. The Ishihara test is commonly used to test for congenital deficiencies, which cause redgreen deficits. However acquired deficiency is also common in any ocular pathology affecting the optic nerve.
Purpose: The aim of our study was to compare the Mollon-Reffin Minimal Test (MRMT) against the Ishihara
and City colour vision tests. The comparison would provide information about the diagnostic accuracy of the
MRMT.
Method: All three tests were performed within the same clinic visit, with a small rest between each test. The
main parameters of interest were correlation levels between tests for defect detection, severity grading and
defect type classification. We assessed the time taken to complete testing and evaluated the patients
experience of the tests.
Results: We assessed 100 patients and 54 control subjects, with re-testing in the latter group to evaluate testretest reliability. We found a reasonable level of agreement between the MRMT and the other tests once
considering possible confounders for defect detection, severity grading and defect type classification in the
patient group. There was a strong level of agreement in the control group which suggests a high specificity
relative to the other tests. The time taken to perform the MRMT is clinically acceptable in comparison to the
City Test.
Conclusion: Patients experiences of the MRMT were positive, and they preferred it to the other tests. We
recommend that the MRMT be used to detect colour vision defects, or monitor deficiency, in patients with
significant visual field defects.
146. Expert Opinion in the Clinical Investigation of Acquired Isolated Horner Syndrome in the United
Kingdom
Jasvir Virdee, Susan Mollan, Michael Burdon
Introduction: Currently there is no robust evidence on imaging required for acquired isolated Horner
Syndrome (HS), additionally there is a low yield from tests employed.
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Birmingham 2014
Purpose: A consensus statement would enable a multi-centre prospective study on the directed use of
investigations and provide standardised agreement which clinicians may use.
Method: An online survey tool was used to collect responses from members of the British Isles NeuroOphthalmology Club (BINOC). Ten multiple choice questions were used, which covered 3 HS scenarios.
Results: Responses were obtained from 27 out of 45 members contacted (3 opted out). 18 NeuroOphthalmologists and 6 Neurologists took part. 83% routinely used topical medications to confirmation HS;
the majority used apraclonidine 1%. 17% used drops for lesion localisation. Despite using drops, 67% had a
predetermined algorithm for imaging. The consensus for non-traumatic cases is chest X-ray (58%), MRI head
(79%) and MRI neck (67%). In traumatic cases, a combination of MRI/MRA head (63%) and MRI/MRA neck
(67%) was favoured. In the third case involving a diabetic hypertensive, MRI thorax (29%), MRI head (71%),
MRI neck (50%) and MRA neck (25%) were chosen. Follow up was favoured at 3 months if neuro-imaging
was normal.
Conclusion: This survey contains the preferred investigations for adult isolated HS. Almost all use of drops to
diagnose HS, but few use drops to localise the HS. Interestingly, CT scanning/angiography was not preferred
for any scenario. Choice of imaging was directed by the clinical history.
147. Cerebral migration of intraocular silicone oil: A clinical and radiological
George Kalantzis, Kevin Falzon, Chin Ong , Dan Warren, Bernard Chang
Introduction: Silicone oil (SO) is commonly used following complicated retinal detachment (RD) surgery.
Neurological complications of SO endotamponade are rare.
Purpose: To report a case of cerebral migration of intraocular SO mimicking an oribital mass with posterior
cerebral migration.
Method: Observational case report. A 74-year-old lady presented with a six-month history of chronic
headaches and photophobia. She had a history of high myopia with multiple left RD surgery and SO
endotamponade 20 years previously. Ophthalmological examination showed a phthisic left eye with a
superonasal soft epibulbar mass. Neurological examination was unremarkable. Differential diagnosis included
lymphoma, metastases or choroidal melanoma. Computed tomography showed a left globe mass with
posterior extension along the optic nerve with intracranial foci. Conjunctival and carancular biopsy showed
reactive lymphoid infiltration with no evidence of lymphoma. Magnetic resonance imaging findings were
consistent with migration of intravitreal SO along the ipsilateral optic nerve with subsequent extension to the
chiasm and subarachnoid space.
Results: The possibility of the SO causing chemical meningitis was raised. However, the patient's headaches
improved without treatment and it was decided not to pursue any further diagnostic work up.
Conclusion: Cerebral migration of intraocular SO may present with headaches due to possible chemical
meningitis and may be misdiagnosed as an orbital mass with extra-orbital spread or intracranial metastasis.
OCULAR MOTILITY
148. Unilateral lateral rectus resection: a simple solution to age-related distance esotropia
Sohraab Yadav, Jane Young, Claire Voas-Clarke , Ian Marsh, Jon Durnian
Introduction: Acquired concomitant esotropia occurring in adults (age-related distance esotropia) is a relatively
common condition seen in strabismus clinics. This condition may be managed conservatively or surgically
using a variety of different techniques.
Purpose: We report a case series of patients who underwent single muscle lateral rectus resection to correct
their esotropia.
Method: Fourty-nine randomly selected patients undergoing unilateral lateral rectus resections within the past
three years were identified. Of these, 19 patients with symptomatic distance esotropia without an underlying
cause were included and followed up until discharge from the clinic. Near and distance prism dioptre
measurements pre- and post-operatively were compared.
Results: The average age of the patients was 80.2 years (range 68 to 90 years). 10 females and 9 males made
up the cohort. Mean lateral rectus resection was 4.9mm (SD 1.3) with non-adjustable sutures. Diplopia
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resolved in all cases following surgery. Median distance esotropia measurements in primary gaze were reduced
from 16.0 prism dioptres pre-operatively to 0 prism dioptres post-operatively (p<0.005) at final follow-up. Near
esotropia also resolved in all cases when present.
Conclusion: Age-related distance esotropia can be effectively managed with unilateral lateral rectus resection
alone and this surgical procedure offers a simple solution in a potentially difficult patient group.
149. A Modified Model for Strabismus Surgery Simulation
Bharat Markandey, John-Sebastian Barry
Russell's Hall Hospital, The Dudley Group NHS Trust
Introduction: Surgical simulation can be costly but is increasingly seen as crucial for improving patient safety.
Despite the relatively low cost of models for strabismus surgery compared to other forms of ophthalmic surgery
(e.g. computer-based models for cataract and VR surgery) keeping costs to a minimum without compromising
quality of training is crucial in the current financial climate.
Extremely successful strabismus surgery workshops run at International Meetings reportedly gained excellent
feedback from trainees. Different forms of strabismus surgery simulation workshop using cadaveric heads,
animal model eyes, artificial eyes and artificial heads have been described. We wished to provide elements of
this training locally.
Purpose: To describe a novel inexpensive head model developed to ‘house’ artificial eyes to enhance the
experience of trainees at minimal cost. This was a modified commercially available mannequin with total costs
for materials for a single artificial head for this purpose being very modest (£5 approximately).
Method: A local artificial eye workshop was run to assess the effectiveness of the model. Artificial eyes were
obtained from the leading national source. An inexpensive modification of a commercially available
mannequin head was used to keep costs to a minimum.
Results: Feedback from 6 trainees from pilot workshops demonstrated an excellent learning experience.
Conclusion: This model could be adapted and used by strabismus trainers and trainees without the need for
expensive start-up equipment. This model does not replace the need for purpose-designed high-quality models
and workshops which will further enhance simulation training
150. Modified Hang-back Single Muscle Medial Rectus Recession for Paediatric Esotropia
Alastair Hardisty, Tin Chan , Claire Duckworth
Sheffield Children's Hospital
Introduction: Unilateral medial rectus (UMR) recession has been previously described as safe and predictable
for correction of esodeviations of less than 35 prism diopters (PD) using a free hangback technique. We
present our outcome data for UMR recession using a modified hangback technique in a paediatric population.
Purpose: To evaluate acceptability of modified hang-back UMR in a paediatric population
Method: We performed a review of UMR surgery performed between August 2011 and August 2012 by a
single surgeon. Our primary outcome measure was predictability of esotropia angle correction. Patient
acceptability of single muscle surgery was compared with age-matched controls undergoing two-muscle
surgery using a visual analogue pain scale. Operative time was compared between the two groups.
Results: 9 consecutive patients were identified. All patients had a pre-operative deviation of 25-30PD (Mode:
25). All underwent 5.5mm medial rectus recession to correct 20PD. At the 2-month postoperative reviews all 9
patients had a residual esotropia of less than 8PD (Mean 5.5 Range 4-8). Mean correction was 19PD (Range
17-22). No adduction deficit was found.
Single muscle surgery was associated with less post-operative pain on day 1 post surgery vs 2-muscle surgery mean 4.6 vs 7.2 (0=no pain 10=worst pain imaginable). Mean operative time was 18 minutes for single
muscle vs 35 minutes for 2-muscle surgery.
Conclusion: Surgical predictability of our modified hangback technique is in line with the previously described
free hang-back technique. Children find this surgery more comfortable and surgical time is reduced compared
with 2-muscle surgery. UMR recession surgery is a quick, simple and less painful procedure and should be
considered as a primary approach in the treatment of small to moderate angle esotropia
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Birmingham 2014
151. Medial rectus pulley posterior fixation suture for acquired esotropia with high AC/A ratio.
Rajnish Sekhri, Pouya Alagaband, James Innes, Usman Mahmood
Hull and East Yorkshire Eye Hospital
Introduction: Posterior fixation (Faden Procedure)suture has traditionally been used to reduce the force of
rectus muscles in their direction of action. We have alternatively suggested suturing the rectus to its pulley as a
safer option.
Purpose: Suturing the medial rectus muscle (MR) to its pulley 10 mm from its insertion should eliminate pulley
retraction thereby reducing MR action in adduction. It also eliminates risk of globe perforation.
Method: Patients with acquired esotropia (ET), high AC/A ratio and ET 10 prism diopters more for near than
distance were included. 12 children fulfilled the criteria from 2010 to 2013. They had unilateral/ bilateral
medial rectus pulley suture along with/without MR recession, depending on the ET for distance. Follow up was
at least 3 months. A reduction in half of near esotropia was considered a success.
Results: 6 children achieved the desired results with a mean reduction of near ET by 67.79%. 2 of these cases
needed more than one procedure. 6 other children did not achieve desired results.
Conclusion: Posterior fixation pulley suture is effective in half the cases with high AC/A ratio. A large sample
can only show whether it is an alternative to Faden procedure.
ORBIT & OCULOPLASTICS
152. Orbital Cellulitis in Scotland; epidemiology, aetiology, treatment and outcome: Scottish Ophthalmic
Surveillance Unit Study
Claire Murphy, Helen Murgatroyd, Caroline MacEwen , Iain Livingstone, Barny Foot
Ninewells Hospital Dundee
Introduction: Orbital cellulitis is a potentially blinding and life threatening condition. There is little published
data regarding the incidence of orbital cellulitis, the current literature consisting mainly of case reports and a
number of single centre retrospective case series.
Purpose: This prospective study aimed (i) to establish the incidence of orbital cellulitis in Scotland over a 12
month period in children vs adults and (ii) to identify the differences in aetiology, treatment and outcomes
between children and adults.
Method: Cases were identified prospectively through the Scottish Ophthalmic Surveillance Unit. Reporting
consultants completed an incident and follow up questionnaire after 3 months.
Results: There were 20 cases of orbital cellulitis; 15 children and 5 adults. The incidence in the paediatric and
adult groups was 1.6/100,000 and 0.1/100,000 respectively. Sinus disease and upper respiratory tract infection
was the most common predisposing factor in children. Trauma and immunosuppression were more common
amongst adults. Streptococcus and Haemophillus Influenzae were the most commonly isolated pathogens.
All patients were treated with intravenous antibiotics. Seventy percent of cases had orbital or subperiosteal
abscesses. All abscesses in children were drained; one abscess in an adult was managed non-surgically. Two
patients had a poor outcome; one child had intracranial spread of abscess and one adult required an
evisceration.
Conclusion: We have described the largest series of orbital cellulitis from the United Kingdom and the current
incidence and morbidity of orbital cellulitis in Scotland. We will discuss our results in context of the literature.
153. Guidance to locate sutures lost during ophthalmic surgery.
Damien CM Yeo, Tafadzwa Young-Zvandasara, Garry Shuttleworth
Singleton Hospital, Swansea
Introduction: Sutures may fall or "ping" out of needle holders when grasped incorrectly. Finding lost sutures +/needles often presents considerable difficulties in the ophthalmic operating environment due to their size and
colour. Lost sutures waste time and constitutes a health hazard.
Purpose: This study aims to give a guide as to the maximum distance that such sutures may travel.
Method: Sutures of differing lengths were “pinged" from a needle holder under constant conditions in an
operating theatre and their distance of travel measured. 6 different commonly used sutures (5.0 Prolene
W8721, 5.0 Vicryl W9953, 6.0 Vicryl W9952, 6.0 Vicryl W9760, 6.0 Prolene W8807 and 5.0 Silk W468) at 3
different lengths were studied over 5 repetitions.
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ABSTRACTS: Orbit & Oculoplastics
Results: For 6cm sutures the mean distance travelled ranged from 43.4cm (SD:8.02, 95%CI:36.37-50.43) for
6.0 Prolene W8807 to 147.2cm (SD:24.84,95%CI:125.42-168.98) for 5.0 Silk W468. For full length sutures
the mean distance travelled ranged from 26.3cm (SD:4.70,95%CI:22.18-30.42) for 6.0 Prolene W8807 to
60.1cm (SD:27.84,95%CI:35.70-84.50) for 6.0 Vicryl W9552. 5.0 Vicryl W9553 sutures travelled a shorter
distance than identically needled 6.0 Vicryl W9552. With only one minor exception did the suture with the
shortest length not travel furthest.
Conclusion: Distances travelled by sutures appeared to relate to both length and gauge. Monofilament Prolene
travelled shorter distances than similar gauged filament sutures. The radius of the search for monofilament
Prolene sutures should be ~75cm, but should be doubled for short filament sutures.
154. Delayed Skin Graft after Debridement for Surgical Treatment of Periorbital Necrotising Fasciitis
Mark Sigona, Michael Mckenna, Partha Chakraborty
County Durham and Darlington NHS Foundation Trust
Introduction: Necrotising fasciitis is a potentially fatal soft tissue infection that spreads rapidly through
superficial tissue planes. We present a series of five patients presenting to a District General Hospital with
clinically evident necrotising fasciitis of the periorbital region.
Purpose: Is delaying skin graft after debridement for periorbital necrotising fasciitis more beneficial than early
skin graft or allowing healing by secondary intention alone?
Method: Retrospective casenote review.
Results: Patients were aged between 56 and 76. Two had bilateral periorbital involvement. Two were
secondary to insect bites, one of whom also had sinus disease demonstrated on CT scan. One was secondary
to herpes zoster ophthalmicus; one had concomitant tonsillitis and one had no obvious cause. Three of the
patients were febrile, with temperatures ranging from 37.7 to 39.5 degrees C. All were admitted and treated
with IV antibiotics. All patients required debridement of periorbital tissue, three requiring secondary
debridement procedures.
One patient had skin graft procedures bilaterally six days after debridement. She later developed upper lid
contractures with ectropion and exposure, and required a repeat skin graft four months later. In one patient,
healing by secondary intention was allowed and she subsequently developed bilateral upper lid ectropion
requiring skin grafts four months after debridement. The remaining patients all had planned autografts five to
eight weeks after debridement with donor tissue from contralateral lids or neck. All patients with delayed skin
graft made an excellent recovery.
Conclusion: This case series highlights the benefit of late surgical repair once patients have completely
recovered from the initial infection and initial debridement. Early skin Graft, or healing by secondary intention
alone, was shown to be associated with contractures leading to ectropion and exposure requiring further
surgery.
155. Slit Lamp Dermatoscopy
James McHugh, Juliana Helou, Chris McLean
The Royal Surrey County Hospital Guildford
Introduction: Dermatoscopy is commonly used to identify a wide variety of skin lesions. A new technique of
slit lamp dermatoscopy is described, which is suitable for periocular and ocular lesions.
Purpose: The technique of slit lamp dermatoscopy aids in differentiating benign lesions from malignant ones
using equipment that is readily available in ophthalmology departments.
Method: A variety of diagnostic contact lenses were used to assess both periocular and ocular surface lesions
by viewing through a Haag Streit 900 slitlamp. Viscotear gel was used to eliminate surface reflections and the
results were recorded with a Nikon Coolpix 4500 camera with slitlamp adaptor.
Results: The images from several lesions are illustrated utilising a Goldman 901 contact lens and a four mirror
gonio lens. The identifying features for each lesion are described.
Conclusion: Slit lamp dermatoscopy offers additional information about periocular and ocular lesions that can
aid in diagnosis and management. The equipment used is readily available in ophthalmology departments. The
advantages of the different types of contact lenses are discussed with illustrations of the lesions.
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ABSTRACTS: Miscellaneous
MISCELLANEOUS
156. Choroidal biopsy in the management of patients with choroidal metastasis
Heinrich Heimann, Lazaros Konstantinidis, Sarah Coupland, Bertil Damato
Introduction: Choroidal metastasis are the most common intraocular malignancy. In a significant number of
cases, no underlying primary tumour is known at diagnosis.
Purpose: To evaluate the potential of choroidal biopsies in identifying unknown primary tumours.
Method: Retrospective review of patients with choroidal metastasis treated at the Liverpool Ocular Oncology
Unit between 2007-2012. Ninety-six patients (109 eyes) were identified.
Results: The median time interval between diagnosis of the primary cancer and the choroidal metastasis was
24 months (range, 0-288). Thirty-nine patients underwent ocular biopsy, confirming the diagnosis in all
patients. The biopsy indicated the site of origin in 24 out of the 27 without a known primary tumour. In 7 of
these 27 cases, previous systemic investigations had failed to identify the primary tumour. Seventy-three
patients received external beam irradiation, 2 patients received photodynamic therapy, and 2 patients had Ru106 plaque radiotherapy. The visual acuity was stable or improved in 75.5% of the cases.
Conclusion: Immediate biopsy provides a quick diagnosis that may expedite treatment and improve any
opportunities for conserving vision while facilitating the general oncologic management of these patients.
157. Anxiety, depression and somatisation in attendees at ophthalmic A&E
Adnaan Haq , Radon Reynolds, Zakariya Jarar
Introduction: The reasons patients attend emergency medical services are complex, involving psychological,
social and logistical factors, besides clinical issues. Psychiatric factors have been studied in patient
presentations in GP and general A&E settings, but not in ophthalmic A&E.
Purpose: To evaluate depression, anxiety and somatisation in patients attending an inner-city ophthalmic A&E.
To compare different ophthalmic diagnoses with regard to these.
Method: Three validated psychiatric tools were administered to patients: the Patient Health Questionnaire-8
(PHQ-8) for depression, the Generalised Anxiety Disorder (GAD-7) for anxiety and the PHQ-15 for
somatisation. Patient demographics, co-morbidities and ophthalmic diagnoses were documented.
Results: Of 527 patients approached, 503 completed questionnaires (95.4% response rate). Scores (mean+/SD) for the whole group were: depression (PHQ-8): 3.52+/-1.50; anxiety (GAD-7) 3.19+/-1.51; somatisation
(PHQ-15) 4.46+/-1.12. Significant differences between ophthalmic diagnostic classes were found for
depression (1-way ANOVA, P<0.002), with neuro-ophthalmic patients having the highest scores (mean 7.92)
and corneal patients the lowest (mean 2.59). A similar profile of differences across ophthalmic classes was
found for somatisation (1-way ANOVA, P<0.01). However, no statistically significant differences between
diagnostic classes were found for anxiety.
Conclusion: To our knowledge, this is the first study to use validated psychiatric tools to assess depression,
anxiety and somatisation in ophthalmic A&E. Response rates were excellent. Significant differences in
depressive symptoms and somatisation exist between different ophthalmic diagnoses. Anxiety is
understandably raised in some patients, but appears constant between different diagnoses. Ophthalmologists
may employ simple, validated psychiatric tools to obtain a fuller picture of the reasons behind a patient’s
presentation.
158. Photodynamic therapy as initial treatment for small choroidal melanomas
Fidan Jmor, Bertil Damato , Heinrich Heimann
Ocular Oncology Centre, Royal Liverpool University Hospital
Introduction: Verteporfin photodynamic therapy (PDT) can destroy malignant cells through cytotoxicity and
ischaemia induction. It has potentially less vision-threatening side-effects than conventional radiotherapy for
small choroidal melanomas at the posterior pole.
Purpose: To assess PDT as primary management for small choroidal melanomas at the posterior pole.
Method: Retrospective review of patients with small choroidal melanomas treated with PDT at the Ocular
Oncology Centre in Liverpool. Patient and tumour characteristics, PDT session details, visual acuity, B-scan
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ultrasonography measurements and colour fundus photographs at each follow-up were analysed.
Results: Between 2001 and 2012, 22 eyes (from 22 patients) with small choroidal melanomas were treated
with PDT. Patients were aged 62 years (mean; range 40-80 years) with 15 male and 7 female. Eight tumours
were amelanotic, while 14 were melanotic. Nine melanomas (40.9%) showed complete regression in size on
B-scan and colour photographs, five (22.7%) showed partial regression, five remained unchanged in
dimension and two showed definite recurrence for which alternative standard treatment was offered. Baseline
best corrected visual acuity (BCVA) was 0.2 logMAR (mean; range 0.0 to 0.6) compared to a post-PDT BCVA
of 0.5 logMAR (mean; range -0.2 to 1.7) over a follow-up of 36.2 months (mean; range 6 – 124 months).
Conclusion: PDT can induce tumour regression in a significant proportion of small posteriorly located
choroidal melanomas, in which other standard treatments would be associated with a high risk of significant
visual loss. Major drawbacks compared to standard treatment modalities are the necessity of more detailed
follow-up and higher rates of recurrence or incomplete regression.
159. Ocular surface squamous neoplasia: Analysis of 78 cases from a UK ocular oncology centre
Anu Maudgil, Trushar Patel, Paul A Rundle , Ian G Rennie, Hardeep Singh Mudhar
Introduction: Ocular surface squamous neoplasia is a spectrum of disease, on which few large series have
been published, in particular none from the UK.
Purpose: The purpose of this study is to describe experience of this condition from a UK national ocular
oncology centre, including statistical analysis to elucidate factors significant in recurrence.
Method: Retrospective review of case notes, clinical photographs and histopathology reports of all new
histopathologically confirmed cases of conjunctival intraepithelial neoplasia (grades I-III) and invasive
squamous cell carcinoma of the conjunctiva between May 1994- April 2010. 78 cases were included. Data
was analysed using Kaplan Meier analysis with Cox's proportion hazard regression and Mantel-Cox log rank
test.
Results: 10 of 78 cases (12.8%) recurred during the follow up time (mean 37 months). One-year recurrence
rate was 10.9%, and the 5-year recurrence rate was 18.5% using Kaplan-Meier analysis, with a mean time to
recurrence of 9.5 months. Significant factors in recurrence were tumour size and first treatment given. Grade of
OSSN, including presence of invasive disease and positive biopsy margins were not found to be statistically
significant in recurrence.
Conclusion: Ocular surface squamous neoplasia in an uncommon disease in the UK population. However,
when managed appropriately in a specialist centre, it is associated with good outcomes, even in recurrence
situations.
160. Treatment-seeking Behaviour for Ocular Morbidity (OM) in South-West Cameroon
Emma Gees, Gillian Dalgetty, Laura Senyonjo
University of Leeds
Introduction: OM is high in Cameroon, with a prevalence of 18.9%1 and only 38.9% of individuals seeking
care for their condition. There is a need to investigate why so few people seek care and how this can be
improved. Previous research has shown that treatment-seeking behaviour is complex and so requires
qualitative research.
Purpose: To investigate treatment-seeking behaviour for OM, including barriers and motivating factors to
seeking eye-care in Fako District, South-West Region, Cameroon.
Method: Data collection was in the form of semi-structured interviews from eighteen individuals with OM,
nine who had sought treatment and nine who had not, using purposive sampling. Analysis was conducted
using thematic analysis.
Results: There were many factors that acted as barriers to seeking eye-care: the most predominant were
finance and distance. Motivating factors for seeking treatment included fear of sight loss and impact upon life.
Peers and the church were seen to have an influence on treatment-seeking behaviour. Lack of awareness about
treatment costs, eye-care and OM was widespread.
The findings from this study are similar to findings from other research. However, no study has discussed
unawareness of treatment costs or specifically the impact of religious beliefs. Validity of results was increased
by triangulation with the Sightsavers survey.
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Conclusion: There is a need to increase the amount of OM treated at community level, thus reducing indirect
costs. Awareness could be increased through peer education and church-led campaigns. Furthermore, schemes
to support individuals with the financial costs of eye-care are needed.
161. Association between Depression and Diabetic Retinopathy in sub-Saharan Africa
Kirsty Hall, Eugene Sobngwi, Linda Penn
Newcastle University
Introduction: The incidence of Diabetic Retinopathy is increasing and set to impact many of the world’s
diabetic population of whom 75% reside in Low and Middle Income Countries (LMIC).
The relationship between depression and DR has been established in high-income countries but evidence from
LMIC is scarce.
Purpose: This research aimed to determine association between depression and DR in a sub-Saharan African
diabetic population.
Method: Analysis of cross-sectional data from the ‘Improving access to HbA1c measurements in sub-Saharan
Africa’ study was used. Primary data were collected from six diabetic care facilities in Yaoundé, Cameroon.
Participants were aged ≥18 years with at least a six month history of Diabetes Mellitus (DM). The presence of
DR was established through ophthalmoscopy and angiography using the Early Treatment Diabetic Retinopathy
Study (ETDRS) classification. Depression was assessed using the Centre for Epidemiological Studies Depression
scale (CES-D). A CES-D score ≥16 was used to identify clinically significant depression. Categorical data were
analysed using the EPI-INFO 7 and Minitab 16 statistical packages.
Results: Data were available for 158 participants. Depression was detected in 60% of the population studied.
The prevalence of DR was 27.2% (23.4% non-proliferative, 2.5% pre-proliferative and 3.2% proliferative). A
longer duration of DM (P<0.01), poor glycaemic control (P<0.01) and insulin use (P=0.02) were associated
with DR but we found no association between depression and the DR.
Conclusion: The high level of depression identified in this study suggests a need for increased detection of
depressive symptoms in individuals with DR.
162. The Potential for Using Tablet Computers in Clinical Vision Testing; a method for calibrating and
validating devices
Fadi Ghazala, Humza Tahir, Ian Murray, Neil Parry, Tariq Aslam
Introduction: Advancing technology and the development of LCD screens have made computers more
portable, accessible and functional. With respect to vision testing, this technology has the potential to
significantly improve medical care. There are many applications on the market designed to test vision using
tablet computers, however as of now these tests have not been validated and cannot be used clinically.
Purpose: To this end we have investigated the physical characteristics of 3 tablet computers, the iPad3, Nexus
7, and Nexus 10.
Method: Using a photospectrometer, the characteristics of the RGB gamma functions for the devices were
measured, allowing us to compute the possible colour range and grey-scale contrasts the devices can display.
We compare the available contrasts for each screen against two common clinical tests, the Pelli-Robson
contrast test chart and the Vistech grating test chart. We also measured the consistency of the luminance at
various locations on the screens with different viewing angles as well as the stability of the display when
switching the devices on and off.
Results: While all three devices have limited contrasts available compared to the test charts, they have a large
enough range to allow for vision testing. The screens displayed luminance variability at the edges but,
crucially, contrast remained stable. Screen luminance stability was achieved after as little as 15 minutes of
warm-up time for all devices.
Conclusion: The work highlights the potential for tablet computers to produce reliable grey-scale and colour
vision tests for use in clinics and demonstrates a method for calibrating such devices.
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163. Ophthlmic involvement in Midfacial trauma: Our experience in Glasgow
Sonali Tarafdar, Iain Livingstone, Mamun Rahman, Clifford Weir
Introduction: There is a recognized association between midfacial trauma and ocular/ periocular injury. The
incidence varies widely from 2.7% to 90.6% in reported series. Ophthalmic sequelae of these injuries can be
anything from mild to severe requiring immediate intervention. It remains a challenge for the emergency
physician to make time appropriate referral to ophthalmologist.
Purpose: To evaluate the extent of ophthalmic involvement in patients presenting with mid facial trauma in
Glasgow.
Method: All patients who attended the maxillo-facial department of Southern General Hospital in Glasgow and
Tennent Institute of Ophthalmology with mid facial trauma over 3 year period from Jan-2007 to Jan-2010 were
included. Information collated prospectively from case notes, radiology report and clinical portal on a set
protocol. Data was analyzed using descriptive statistics.
Ocular injuries were categorized into mild, moderate , and severe based on previous publications.
Results: 106 out of 142 patients were analyzed due to limited data on rest. Median age of this cohort was 28
years with a male predilection. 61% of total injuries had mild ophthalmic involvement and 11% had severe
trauma. Vast majority was caused by assault followed by accident, sports injury and RTA in reducing order of
frequency. Visual acuity of 6/12 or less was significantly associated with severe injury (P=0.007). Blow out
fracture was associated with injuries of all grades.
Conclusion: Ocular injuries occur more frequently in patients with orbital blow out fracture. Ophthalmic
consultation is essential in patients with blow out fracture, diplopia and reduced visual acuity at presentation.
164. Current utilisation of electronic medical records in ophthalmic research
Victoria Nowak, Zahra Kadom, Patricia Svrckova, K Y Ronald Kam
Imperial College London
Introduction: Electronic medical records (EMR) systems are increasingly being implemented in ophthalmic
units globally. While their usefulness in clinical practice and administration has been evaluated, their current
use in ophthalmic research remains unexplored.
Purpose: To investigate the current extent of EMR utilisation in ophthalmological research and identify barriers
to their use.
Method: To guarantee an international cross-section of researchers, we examined the Methods sections of 220
papers, choosing the 20 latest retrospective clinical studies from the top 11 clinical ophthalmic journals ranked
by Impact Factor (ISI Web of Knowledge), to record how many used EMR. Where use of EMR was not obvious,
the corresponding author was sent a standard e-mail asking whether the source of data was mostly/entirely
EMR, paper records or approximately equal.
Results: Of 127 papers for which a definite source of data could be established, 61 (48%) used EMR as their
main source, 46 (36%) used mostly paper notes and 20 (16%) studies used a combination. In 93 out of 220
papers (42%) the source of data could not be established despite attempted e-mail verification (61% response
rate from teams). Examples of factors discouraging EMR use included records pre-dating EMR implementation
and incompletely entered data.
Conclusion: This is the first study investigating the practical use of electronic records in current ophthalmology
research. We have identified barriers that are relevant to those who wish to use these systems for research
without having to revert to paper notes.
165. Ethnicity and education in myopia: the UK Biobank (UKBB) study
Yanchun Bao, Phillippa Cumberland, Paul Foster , Peng Tee Khaw, Christopher Hammond, Pirro Hysi,
Jugnoo Rahi
Introduction: UKBB, the world’s biggest contemporary resource for the study of health and disease, recruited
more than half million people aged 40-69 years.
Purpose: To investigate associations between myopia and educational attainment (as proxy for education
duration) and ethnicity.
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Method: Spherical equivalent (SE) was used to categorise refractive error: emmetropia (SE -0.99D to +0.99D),
mild myopia (SE -1.0D to -2.99D), moderate myopia (SE -3.0D to -5.99D) and high myopia (SE -6.0D or more
extreme) for 110,295 subjects whose refraction was measured by Tomey RC 5000 autorefkeratometer
(excluding those who had refractive/cataract surgery or retinal detachment). Odds Ratios (OR) were estimated,
using bivariate logistic regression to allow for paired data, with adjustment for age, sex, and other sociodemographic factors.
Results: All myopia was associated with higher educational attainment in White, Asian and Chinese subjects
but not those of Black ethnicity: highest education level vs. no qualifications, OR 2.6 [95% confidence interval
2.5, 2.7], OR 2.1 [1.1, 3.8], OR 5.2 [1.1, 24] and OR 1.5 [0.8, 2.8] respectively. The strength of association
between educational achievement and myopia increased with severity of myopia. Notably across all ethnic
minority groups including Chinese, those without qualifications did not have an increased risk of myopia
compared to White subjects, indeed South Asians had a reduced risk OR 0.6 [0.5, 0.8].
Conclusion: The nature and size of UKBB affords unique opportunities to examine the complex relationship
between ethnicity and educational attainment in myopia and our early findings suggest that genetic
predisposition (represented by ethnicity) can be modified by educational exposure.
166. Comparison of two prognostic models for penetrating eye injuries in district general hospitals
Luke Nicholson, Damien Yeo, Rupinder Chana , Ruth Jones, Julia Escardo-Paton, Osama Giasin,
Elizabeth Goodchild
Royal Gwent Hospital, Newport
Introduction: Several prognostic models have been developed to help ophthalmologist predict the likely
outcome following penetrating eye injuries. However, these models were created using data from large tertiary
centers.
Purpose: We wish to assess the sensitivity and specificity of the Classification and Regression Tree (CART)
model (Schmidt et al) and the Ocular Trauma Score (Kuhn et al) in a District General Hospital setting.
Method: Theatre records were used to identify patients who had surgery for penetrating eye injuries from 1st
October 2007 to 30th September 2012.
A retrospective prognostic prediction was calculated using the CART model and the Ocular trauma score
model for no vision(NPL) vs vision (PL or better) and for minimal to severe visual loss (>3/60) vs profound
visual loss (<3/60). This was then compared with the final visual outcome. Sensitivity and specificity of each
model were calculated.
Results: 22 patients had sufficient documentation of all the criteria required to formulate a prognosis and
therefore included.
Using the CART model, sensitivity and specificity for vision (PL or better) vs no vision (NPL) was 100%.
Positive predictive value (PPV) was 100% and Negative predictive value (NPV), 100%. As for predicting
minimal-severe visual loss (>3/60) vs profound visual loss (<3/60), sensitivity was 87.5%, specificity 83.3%,
PPV 93.3%, and NPV 71.4%.
Using the OTS model, sensitivity for vision vs no vision was 42.1% and specificity, 100%. PPV calculated to
be 100% and NPV was found to be 21.4%. As for minimal-severe visual loss vs profound visual loss,
sensitivity and specificity were 43.8% and 83.3% respectively. PPV was 87.5% and NPV was 35.7%.
Conclusion: The CART model appears to have a higher predictive accuracy in our cohort of patients. We
recommend the use of the CART model in a district general hospital setting when dealing with a penetrating
eye injury.
167. UK and US contrasted: A qualitative study of post-graduate training and clinical governance in
ophthalmology using ethnological techniques
Monica Michelotti, Andrew Davies, Jennifer Weizer , Declan Flanagan, Shahzad Mian, Paul Lee, Simon Kelly
University of Michigan, Moorfields, Royal Bolton Hospital
Introduction: International collaboration promotes information sharing and supports innovation. Providing
insight into differences in clinical care and medical education can benefit all parties involved.
Purpose: To compare hospital practice patterns and specialist training in ophthalmology in the UK with that in
the US.
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Method: A US ophthalmology trainee (second year resident) visited a variety of ophthalmology departments in
the UK for five weeks to compare higher surgical training, education, and clinical governance. Supervisors of
ophthalmic training in the UK and US were interviewed.
Results: Differences were directly observed and confirmed with Delphi techniques in the utilization of allied
health care staff and the supervision of trainees in the UK compared to the US. Clinical duty hours are more
restricted in the UK given EU Working Time Directives, but current UK training is prolonged (7 years with 1
year fellowship) compared to US training (3 years with optional 1 or 2 year fellowship). The differences in
surgical training in the two countries are outlined. UK trainees perform more cataract surgeries and start earlier
in their training, but have less surgical experience in other subspecialties. NHS funding limits efficiency in
some areas while billing and defensive medicine impacts training and patient care in the US.
Conclusion: International collaboration in medicine is an invaluable experience and this nested study into
practices in ophthalmology training and clinical governance in the UK and US provides unparalled insight.
168. Smartphone Tele-Ophthalmology
Ryan Davies, Hugh Jewsbury, Kadaba Rajkumar
Princess of Wales Hospital, Bridgend
Introduction: Smartphone technology is ever advancing and Ophthalmology as a specialty is prime placed to
utilise this. 'Smartphone tele-medicine' is widely used in other specialties such as dermatology with good
effect. We aimed to determine whether this tool could be suitable for Junior Trainess to discuss complicated
Ophthalmology patients with senior colleagues.
Purpose: Assess the use of the ‘Facetime’ application on Smartphones, as a method of discussing
ophthalmology patients with anterior segment pathology.
Method: A group of patients with various anterior segment eye pathologies were enrolled from eye casualty /
clinic patients at Princess of Wales Hospital, Bridgend. Fully informed written consent was obtained from all
patients for the video consultation, recordings and photographs taken. The iphone 5 and slit lamp adaptor
were used along with an attachable lighting system for illumination. A Facetime consultation was then
performed between the Doctor present in clinic and a consultant not present, who was blinded to the
pathology.
Results: There proved to be an excellent correlation in diagnoses between the doctor present in clinic and the
Consultant on the video conversation. It was possible to identify and assess lid lesions, corneal foreign bodies,
loose sutures, iris trauma, cataracts and immediate post-operative reviews such as bleb appearance following
trabeculectomy.
Conclusion: This has the potential to become a very useful and readily accessible tool in the modern world of
ophthalmology, where the use of smartphones and Tablets are commonplace. It has applications in out of
hours advice for junior ophthalmologists, leading to prompt diagnosis and effective treatment. It can be
applied to inter-hospital referrals, as well as in the ‘Primary care / Optometry’ to secondary care referral
process.
169. Changing Trends in Consultant Appointments
Romeela Rana-Rahman, Alan Connor, Hamed Anwar
Royal Victoria Infirmary, Newcastle Upon-Tyne
Introduction: In October of this year, “The Shape of Training” a major review of postgraduate education was
published. Recommendations were that the future needs of patients should be met by less specialist doctors
and more generalist doctors.
Amongst various recommendations they made they suggested:
Shortening training
The removal of all subspecialty training from training programmes
More service delivery in the community
Purpose: We wanted to examine the changing trends in consultant appointments and explore if there is
currently a need for generalists or community ophthalmologists.
Method: We performed a retrospective analysis from January 2008 to November 2013 of all substantive
consultant ophthalmology posts advertised in BMJ Careers. The number of posts in the 2013 group were pro
rated for analysis.
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Results: During the 5 years analysed there were only 25.5 (5.1%) posts advertised for general ophthalmologists
and 22.5 (4.5%) posts advertised for community ophthalmologists.
All the remaining 504 (90.4 %) advertisements expressed a requirement for a subspecialty interest or skills.
Over the period studied, medical retina posts had increased from 27.5 in 2008-09 to 70 in 2012-13.
Glaucoma posts increased from 12.5 in 2008-09 to 33 in 2012-13.
Conclusion: This analysis shows that the majority of consultant delivered ophthalmology care is delivered by
consultants who have a subspecialist interest. Furthermore there is no demand for general ophthalmologists,
contradicting the recommendations of the shape of training report.
However, the increase in number of medical retina and glaucoma posts demonstrates that consultant
appointments reflect recent advancements in medical science (anti-VEGFs) and (NICE) national guidance.
170. The microbiology of Endophthalmitis: A Four Year Review
Sheema Khan, Rosina Zakri, Srinivasulu Reddy , Nishal Patel
East Kent Hospitals University NHS Foundation Trust
Introduction: Endophthalmitis is a rare, devastating intra-ocular infection caused by endogenous or exogenous
mechanisms. Exogenous endophthalmitis is most often post surgical, particularly post cataract surgery.
Purpose: The aim of this study is to investigate the causes and microbiology of endophthalmitis in East Kent,
United Kingdom over a four year period.
Method: A retrospective single centre observational study. Intravitreal aspirates over a four year period
identified from local microbiology database, used to obtain patient demographic information and electronic
patient notes accessed revealing cases clinically diagnosed with endophthalmitis. All patients identified were
included in the study.
Results: Vitreal aspirates performed in 49 patients. Fifty-seven vitreal aspirates performed and 20 aqueous taps.
Males represented 47% and females 53%. Average age 69 years. Eighteen vitreal aspirates culture positive and
clinically 16 (89%) patients with endophthalmitis. One aqueous tap was culture positive (5%) and clinically
positive for endophthalmitis (vitreal aspirate negative). Bacterial growth present in all culture positive cases and
1 was fungal PCR positive. Majority due to gram positive organisms 13 (81%) and gram negative responsible
for 3 (19%) cases. A total of 42 vitreal aspirates were culture negative, 73% of which were clinically positive
for endophthalmitis.
Conclusion: Significant levels of culture negative, clinically positive endophthalmitis cases highlighting
importance of clinical management rather than microbiology findings alone. Need for further investigation into
protocol for accurate sampling, lab techniques for culturing and post-operative care. We advise performing
aqueous and vitreous aspirates in all patients clinically suspected of endophthalmitis and advise further
investigation into sources of gram negative infection.
171. A Training Device For YAG Laser Capsulotomy
May Fong, Chris McLean
The Royal Surrey County Hospital NHS Trust
Introduction: A device is described to aid junior doctors in gaining expertise in YAG laser capsulotomy in a
safe controlled simmulation.
Purpose: It is advantageous to train junior doctors on surgical simmulators as the first part of their training to
improve patient safety.
Method: The eye simmulator consists of a used bandage contact lens bottle. The bottle is attached with tape to
the head rest of the slitlamp, with the top end of the bottle pointing towards the operator. The metal cap
represents the iris and the silicone stopper represets the cornea and anterior capsule. The trainee is asked to
focus the helium-neon aiming beam onto the 'capsule' and to disrupt the capsule surface. Accuracy of the
shots is determined by a chaged in the reflectivity of the silicone 'capsule'.
Results: This training device has been very helpful in the acquisition of the skills necessary for safe YAG laser
capsulotomy.
Conclusion: This cheap and readily available device can help in the training of junior doctors in performing
YAG laser capsulotomy.
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172. Episcleral Tattooing - An Emerging Body Modification Trend
James Brodie, Husam El Galhud
Maidstone Hospital
Introduction: In 2007 an article was published describing the first forays into the practice of episcleral
tattooing. Currently only a handful of people worldwide have undergone this procedure, whereby a needle is
used to inject dye under the bulbar conjunctiva. To date there have been no previous reports of the risks and
complications of this emerging practice in the medical literature.
Purpose: We present a case involving a complication that arose in one of the few people in Britain to have
undergone episcleral tattooing for cosmetic purposes.
Method: A 43-year-old man presented to the eye casualty clinic with red, lumpy conjunctivae bilaterally,
having undergone episcleral tattooing 7 weeks previously. On examination there were 3 distinct areas of
conjunctival swelling in each eye, representing a total of 6 injection sites. No other gross abnormalities were
identified. The clinical picture remained unchanged one month on.
Results: Episcleral tattooing is carried out by individuals with no medical training. The short-term
complications reported so far include: headaches, severe photophobia, persistent foreign body sensation, and
migration of ink staining. More serious short-term risks such as infection, globe penetration, and peri-ocular
haemorrhage could occur. For now we can only speculate as to the long-term consequences, but these may
include carcinogenic change or granulomatous inflammation.
Conclusion: We feel that the potential risks of the procedure should be communicated more widely to those
body modification practitioners undertaking it. This practice could result in more serious presentations to acute
eye services in the future.
173. Ultraviolet (UV) blocking capability of basic spectacle lenses (CR-39)
Rongxuan Lim, Fiammetta Fedele, Parul Patel , Susana Morley
St Thomas' Hospital
Introduction: Patients with Xeroderma Pigmentosum (XP) cannot effectively repair UV-induced DNA damage
and need rigorous solar ophthalmic protection. This usually consists of over-the-counter sunglasses; however,
many patients find wearing these in the winter months socially unacceptable, thus limiting compliance.
Furthermore, such glasses are not available on the NHS.
Purpose: We investigate the UV-blocking capability of basic transparent CR-39 lenses used in NHS
prescription glasses and their potential use as an alternative means of UV protection in XP patients.
Method: Eight untinted CR-39 lenses (Pentax Standard 1.5 UltraTough; range -6.00DS to +5.00DS) and one
CR-39 UV400 (-3.00DS) were obtained from the manufacturer.
An Abet 2000 solar simulator (Abet Technologies, Inc. Connecticut) was used to simulate solar radiation. The
spectrum of light transmitted through the lenses was collected using a Bentham DMC150 monochromator
(Bentham Instruments, Berkshire). The lens transmission was derived by comparing the spectrum to that of the
unfiltered monochromator light.
Results: All tested lenses blocked 100% of UVB (290-320 nm) and variable levels of UVA (320-380nm). All
myopic prescription lenses showed similar UV transmission spectrums, blocking 100% of wavelengths under
344nm. Hypermetropic prescription lenses had greater UV blocking capability that increased with greater
hypermetropic spherical power. The +1.00DS and +5.00DS lenses blocked 100% of wavelengths under
349nm and 362nm respectively. The UV400 coated lens blocked 100% of wavelengths under 371nm.
Conclusion: Standard refractive NHS CR-39 lenses offer XP patients significant UV protection and could be
worn continuously in a socially acceptable way, thus improving compliance.
PAEDIATRIC OPHTHALMOLOGY
174. Severe retinopathy of prematurity (ROP) in 23 week gestation babies between 2000-2013 in Newcastle
David Cottrell, Ayad Shafiq, Alan Fenton
Introduction: We analysed data for the most at risk group of babies over a 13 year interval in a large neonatal
unit in the North of England. This retrospective data analysis provides useful data on incidence of ROP as well
as results of treatment for this group of babies
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ABSTRACTS: Paediatric Ophthalmology
Purpose: We set out to ascertain the percentage of 23 weekers needing treatment for ROP, the severity and
type of the ROP, and the outcomes of treatment. We compared this to published data on this fragile age group.
Method: This was a retrospective consecutive case series analysis
Results: Over the 13 year period 72 babies were born, with 36 (50%) surviving into the screening period. Data
existed for 35 babies. Of these 24 (69%) were treated for threshold ROP with 11 (31%) needing no treatment.
18 were treated with laser, whilst 6 received avastin injection. All were bilateral. 14 were treated between 3234 weeks gestational age. 13 babies had zone 1 disease. Resolution occurred in all cases.
Conclusion: This is the largest consecutive case series of 23 weekers reported to date. The incidence of babies
requiring treatment is higher than in other series. Zone 1 ROP has a 30 to 56% retinal detachment rate after
treatment in other publications. In our case series, there were no retinal detachments. We reflect on the
possible reasons for this as well as the role of avastin in the current management of posterior ROP.
175. The effect of blood transfusion on fetal haemoglobin concentration in very preterm infants and its
association with retinopathy of prematurity
Christopher Stutchfield, Anoo Jain, David Odd , Cathy Williams, Richard Markham
Bristol NICU and Bristol Eye Hospital
Introduction: Increasing numbers of blood transfusions and higher oxygen saturations have both been
associated with increased risk of retinopathy of prematurity (ROP). Blood transfusion (with adult haemoglobin
[HbA]) reduces infants’ fetal haemoglobin (HbF) concentration and as HbA has a lower affinity for oxygen than
HbF, leads to increased oxygen availability.
Purpose: We hypothesise that as the HbF:HbA ratio decreases with blood transfusion, more oxygen is made
available to the retina, contributing to ROP development. We aimed to identify if there is an association
between %HbF concentration and ROP.
Method: Inborn infants born <32 weeks gestation or <1501g were enrolled. HbF: HbA ratios were calculated
using high pressure liquid chromatography. Clinical data were obtained from case notes. Student t tests and
logistic regression were performed to quantify the relationship between initial and mean HbF and ROP.
Results: 31 infants were recruited (mean gestation 27.8w; mean birthweight 1026g): 16 did not develop ROP
(64%), 9 developed ROP (36%) and 6 died before screening. Those with ROP had similar initial %HbF (85.7%
vs.91.8%,p=0.229) but lower mean %HbF whilst inpatients (49.9% vs.92.7%,p<0.001) than those without
ROP. Odds ratios (OR,95% CI) for developing ROP, adjusted for birthweight, gestation and transfusion volume,
were 1.11(0.95-1.31) for initial %HbF and 0.90(0.82-0.99) for mean %HbF.
Conclusion: These data suggest that higher %HbF concentrations may be protective against ROP development.
Further studies are needed to confirm whether this is a causal and potentially modifiable association.
176. The importance of globe size in pharmacological treatment of retinopathy of prematurity
Ayad Shafiq, David Cottrell, Alan Connor
Introduction: Avastin treatment of threshold ROP may have systemic side-effects due to drug diffusion into the
systemic circulation following intravitreal injection . The current dose of avastin may create a higher than
necessary concentration of drug in the smaller eyes possibly predisposing those babies to greatest systemic
absorption? We set out to determine the axial length as a proxy measurement for globe size in a case series of
babies treated.
Purpose: We set out to determine the variation of axial length in this group. We estimated the variation in
vitreous concentration between the smallest to largest eyes.
Method: This was a consecutive case series. 8 babies (16 eyes) were treated in a 2 year period. Data was
analysed retrospectively, calculating average axial length and range.
Results: The mean length was 16.18mm (range 15.3 to 17.5). Mean gestational age was 23.7 weeks (range
23.56 to 24.28). Mean age at treatment was 35.1 weeks (range 34.14 to 37.86). 15/16 eyes resolved with
single injection.
Conclusion: The smallest eye was 15.3mm. The largest 17.5mm. Assuming that the change in vitreous volume
with a change in axial length depends on the cubic power, the concentration in the vitreous of avastin is 1.5
times greater in the smallest compared to the largest eye. If systemic absorption of avastin depends on
concentration across the blood-retinal barrier,this finding should stimulate a search for optimal minimal dosing
of avastin, particularly in the absence of research on systemic side-effects.
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177. Objective visual and radiological response of recurrent childhood optic pathway gliomas to
bevacizumab
Ian Simmons, Kevin Falzon, Evangelos Drimtzias
Introduction: Chemotherapy has taken on a prominent role in the treatment of paediatric optic pathway
gliomas (OPGs). While slow-growing and biologically benign tumours, they possess increased vasculature, and
thus are an attractive indication for anti-angiogenic therapy. Bevacizumab-based therapy has been shown to be
successful at inducing rapid objective responses in multiply recurrent OPGs. There have been no previous
reports of quantifiable visual field improvement in chiasmal OPGs in the literature.
Purpose: To review the indications and outcomes, both clinical and radiological, of two children with
recurrent, progressive OPGs refractory to standard chemotherapy, treated with bevacizumab.
Method: Interventional case series.
Results: Neither patient had neurofibromatosis type 1. Both presented with progressive visual loss due to
chiasmal OPGs, having failed at least two prior treatment regimens. Patient 1 had an objective improvement in
both visual acuity (VA) and visual fields (VF). VA improved after 8 weeks of therapy, whilst VF improvement
was demonstrable 5 months after starting treatment. No progression was recorded 7 months after completion
of treatment. Patient 2, who is still on treatment, had stable VA with significant improvement of VF 4 months
following treatment. Radiological tumour enhancement resolution and marginal volume reduction was
observed after 2 months of treatment in both patients. Treatment-related toxicity was mild with recurrent
epistaxis in patient 1 and mild proteinuria in patient 2.
Conclusion: Bevacizumab-based therapy is successful at inducing objective visual and radiological responses
in OPGs. It appears to be safe in children and was relatively well tolerated.
178. Bevacizumab v Diode Laser in Stage 3+ Posterior Retinopathy of Prematurity (ROP)
Sarah Moran, Michael O'Keefe, Bernadette Lanigan
Childrens University Hospital Dublin
Introduction: We investigated outcomes following bevacizumab injection in Stage 3+ posterior ROP.
Purpose: To establish whether bevacizumab is an effective treatment for Stage 3+ ROP compared to the gold
standard of diode laser, and to observe occurrence of any adverse ocular or systemic events associated with
bevacizumab injection.
Method: We conducted a prospective case-control study in 14 premature infants with gestation 24-26 weeks
and birth weight 500-1000 grams. We compared conventional laser therapy in one eye to intravitreal
bevacizumab in the fellow eye in stage 3 plus disease in Zone 1 and posterior Zone 2 of the retina. Primary
outcomes of regression and recurrence were recorded, as well as secondary outcomes of visual function,
systemic health and development and adverse effects at one and two year follow-up.
Results: We achieved regression of ROP using intravitreal bevacizumab (1.25mg in 0.1ml). There was
recurrence of ROP in 3 bevacizumab treated eyes (21.43%) at a mean age of 51 weeks post menstrual age
(PMA) and in 1 laser treated eye (7.14%) at 37 weeks PMA. These were successfully treated with laser or
repeat injection of bevacizumab
Conclusion: Bevacizumab is as effective as laser for Stage 3+ posterior ROP. Recurrence is likely to occur at a
later stage in bevacizumab treated eyes, therefore these eyes require longer term follow up. At two year followup we encountered no ocular or systemic adverse effects
179. Evaluation of ROPBox; a secure software tool for Remote screening of Retinopathy of Prematurity
(ROP)
Zahir Mirza, Stephanie West, Lucy Barker , Himanshu Patel, Gillian Adams
Introduction: Retinopathy of Prematurity requires frequent screening of infants in neonatal intensive care units
to enable timely treatment and prevention of blindness. A paucity of trained screeners means it can be difficult
for units to provide a continuous service throughout the year. Current remote screening systems either are nonspecific to ROP or require images and patient data to be transferred via a USB stick which is not
recommended by information governance guidelines. ROPBox works with existing RetcamsTM to enable
automatic secure HIPAA compliant transfer of images to www.ROPBox.net , a ROP specific EPR system. This
provides protected data backup and allows remote screening of images by trained ophthalmologists.
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Purpose: This study will assess the reliability of ROPBox for remote ROP screening.
Method: Retrospective clinical notes review was performed on all infants screened for ROP during 2012.
Images taken using RetcamTM during routine screening by a trained nurse were uploaded to ROPBox.net.
Masked to the clinical outcome; images were graded remotely by a consultant paediatric ophthalmologist.
Results were compared against the onsite clinical examination results.
Results: 117 infants (mean gestation age =28 weeks (range 23-34), birth weight =1004g (range 465-2150)
underwent 360 screenings. Correlation between clinical exam and ropbox for detecting ROP had a sensitivity
of 73.2% and a specificity of 95.8%. Identification of infants requiring treatment (5%) had a sensitivity of 67%
and a specificity of 100%.
Conclusion: ROPBox is a useful tool to provide secure data compliant remote screening of infants with
retinopathy of prematurity.
180. Development of infantile nystagmus
Maria Theodorou, Richard Clement, David Taylor, Anthony Moore
Institute of Child Health
Introduction: Infantile nystagmus is an involuntary horizontal oscillation of the eyes which usually develops
within the first 6 months after birth. Eye movement recording is challenging in young children as cooperation
is required.
Purpose: To obtain quantitative measurements of the development of infantile nystagmus in children.
Method: Eye movements were recorded using an infrared limbal tracker. The oscillations in short duration eye
movement recordings were identified by the method of close returns and the characteristics of the saccadic
main sequence were used to calibrate the oscillations. These techniques were applied to 9 subjects who were
all tested on more than one occasion up to the age of 4 years.
Results: The range of waveforms could be described by a sum of asymmetric pendular and pseudocycloid
components. The amplitude of the nystagmus decreased from upto 1.5 years and then increased again. The
foveation associated with the nystagmus increased up to 1.5 years and then remained approximately constant.
The average visual acuity of the subjects increased steadily.
Conclusion: These findings imply that waveform changes are only associated with improved visual acuity up
to 1.5-2 years of age.
181. Congenital Glaucoma in Wagner Syndrome
Hugh Jewsbury, Andrew Fry, Patrick Watts, Veronique Nas, James Morgan
University Hospital of Wales, Cardiff
Introduction: Wagner Syndrome (WS) is an autosomal dominant vitreoretinopathy caused by mutations in the
VCAN gene.
Purpose: To describe three members of a British family diagnosed with the autosomal dominant
vitreoretinopathy, Wagner syndrome, that developed congenital glaucoma. All three have a novel spicing
mutation in VCAN, the gene responsible for Wagner syndrome. VCAN encodes Versican an extracellular
matrix proteoglycan that has been found in the ciliary body and trabecular meshwork in addition to the
vitreous and retina.
Method: Case series and literature review
Results: Each family member developed glaucoma by 3 months of age requiring multiple surgical interventions
and now has significant visual loss secondary to glaucomatous optic neuropathy. In addition the siblings have
each experienced recurrent anterior uveitis.
Conclusion: Congenital glaucoma is a rare complication of WS. Clinicians caring for WS families need to be
aware of this feature and consider screening infants at risk, particularly when close relatives are affected.
Conversely, clinicians caring for patients with ‘primary congenital glaucoma’ should consider the possibility of
an autosomal dominant VCAN mutation, causing WS, as an underlying aetiology.
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182. Management of Congenital Nasolacrimal Duct Obstruction: 15 years experience in the UK
Lana Fu, Susmito Biswas, Ian C Lloyd, Anne E Cook, Jane L Ashworth
Introduction: Congenital nasolacrimal duct obstruction (CNLDO) occurs commonly in newborns, with the
majority spontaneously resolving by 12 months of age. There is widespread variation in the management of
congenital nasolacrimal duct obstruction in the UK.
Purpose: This study aims to describe management and outcomes of CNLDO in a UK tertiary hospital over a 15
year period.
Method: A retrospective review of 259 case notes was undertaken, comprising consecutive patients presenting
to general paediatric clinic from 1997 to 2012 with a diagnosis of CNLDO. Data included age at presentation
and first probing, past ocular history, dye test and lacrimal massage advice, probing outcomes, and further
management.
Results: Symptoms spontaneously resolved in 77.5% of patients by the age of 12 months, decreasing to 33.6%
after the age of 12 months. Overall success rate following first probing was 70.7%, with highest success rate in
patients aged between 19 and 24 months (78.9%). Stent placement was eventually made in 50% of cases who
failed primary probing. Second probing was successful in 57.1%, with stent placement successful in 78.6%.
Conclusion: Surgical intervention in congenital nasolacrimal duct obstruction can be deferred until 18 months
of age. Primary probing was less successful in patients older than 3 years. Stent placement was more
successful than repeat probing, and should be recommended following failure of a primary probe.
183. Systemic Ciclosporin in the Management of Severe Vernal Keratoconjunctivitis in Children.
Rosalind Stewart, Arvind Chandna, Gavin Cleary, Harish Nayak
Alder Hey Children's Hospital
Introduction: Vernal Keratoconjunctivitis (VKC) is a chronic inflammatory disorder, typically of young males.
In severe cases it causes significant burning, itching and discharge; with corneal vascularisation, shield ulcers
and visual loss. Such cases are often challenging to manage with conventional therapies.
Purpose: To describe the successful use of systemic ciclosporin in the management of refractory VKC in
children.
Method: A prospective observational study of 5 children with severe refractory VKC, who were commenced
on systemic ciclosporin. Baseline and outcome data was collected on symptoms, visual acuity and clinical
findings; and ciclosporin serum levels and side effects.
Results: 5 boys (aged 6.25-13.75, mean 10.5 years) were commenced on systemic ciclosporin at 1.25-4mg/kg
od in divided doses. Ciclosporin was well tolerated in 4 cases. Treatment was discontinued in 1 case due to
deranged liver function tests. Of the 4 cases; 2 cases achieved complete resolution within 3 months; 1 case
achieved complete resolution at 6 months following a recurrent exacerbation (burning and cobblestone
papillae) which prompted increased dosing; 1 case remained to have persistent but reduced activity
(cobblestone papillae and corneal epitheliopathy) with frequent exacerbations in the first 12 months but
completely resolved thereafter. Serum ciclosporin levels were 18-82μg/l, significantly below the therapeutic
range for post-transplant immunosuppression.
Conclusion: Systemic ciclosporin offers a novel, effective and usually well tolerated treatment for severe
refractory VKC in children. It should be considered as an adjuvant therapy in such cases.
184. Proposed algorithms for reducing un-necessary ROP screening
Shah Karim, Himanshu Patel, Helen Lock , Ajay Sinha, Steve Kempley, M Ashwin Reddy
Barts and The London NHS Trust
Introduction: The role of biomarker IGF-1 and other perinatal risk factors in the development of Retinopathy of
Prematurity in East London.
Purpose: To identify prenatal and longitudinal postnatal risk factors including IGF-1 level associated with
progression of severe ROP for neonates born <32 weeks &/or birth weight <1500gm, who required regular
screening. To determine whether unnecessary screening could-be avoided in infants who are not at risk of
developing severe ROP.
Method: Data were collected from a prospective longitudinal study from all at risk infants as per standard
protocol.
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Risk factors included (i) Gestational Age (GA), (ii) Birth Weight (BW), (iii) Absolute Weight Gain in 6
weeks(AWG), (iv) Serum IGF-1 level at 31(IGF1),32(IGF2) and 33(IGF3) weeks.
Patients were categorised into (1) Low Risk ROP (Stage 0 and 1) (2) High Risk ROP (Stage 2 or worse). All
babies were screened using RetCam every week or alternate week depending on stages of ROP at The Royal
London Hospital.
Results: 36 premature babies were included in this prospective study. 15 patients developed Low Risk ROP,
and 21 patients progressed to High Risk ROP (of which 4 patients required laser therapy). There were
significant association (negative-correlation) of High Risk ROP with GA, BW, IGF2, IGF3 and absolute weight
gain in 6 weeks, but not with IGF1 at 31 weeks. High risk babies had following features: GA (25.4±1.5 wks),
BW (731.6±184grams), AWG (478.5±218.9 grams), IGF2 (12.1±6.6), IGF3 (15.2±9.3) [Mean+/-SD].
Conclusion: There were significant differences in GA, BW, AWG, IGF (at 32 and 33 weeks) between neonates
with severe ROP (Stage 2 and Worse) and those with no or minimal ROP (Stage 0 or 1). Considering all risk
factors above, 15 babies out of 36 (40%), could be excluded from regular ROP screening which will reduce
enormous clinician’s workloads as well as neonatal systemic stress encountered with RetCam and/or BIO
examination.
185. Retinal vessel architecture in retinoblastoma patients pre and post treatment
Karen Wong, Ashwin Reddy, Mandeep Sagoo, Clare Wilson
Royal London Hospital
Introduction: Retinoblastoma is the most common childhood malignant intraocular tumour. Previous
observational studies have shown that active retinoblastoma exhibits engorged and tortuous retinal vessels
which subsequently settle with regression of disease.
With recent development of computer software, it is possible to quantify the vessel parameters objectively with
speed.
Purpose: This study aimed to quantify the vessel parameters including width and tortuosity in patients with
retinoblastoma before and after treatment.
Method: 20 RetCam images from 10 children diagnosed with retinoblastoma at Royal London Hospital were
analysed. The sentinel vessel width and tortuosity values were analyzed with semi-automated software CAIAR
(Computer Aided Image Analysis of Retina) at the time of diagnosis and after effective treatment. Data were
analyzed with two tailed paired-t test.
Results: The mean width of sentinel vessel pre-treatment is 2.59 and post-treatment is 1.60 (p= 0.001; SD=
1.07); the mean tortuosity value of sentinel vessel pre-treatment is 2.55 and post treatment is 1.19 (p=0.011;
SD= 2.02). The sentinel vessel width and tortuosity value were significantly less after effective treatment.
Conclusion: Prompt treatment is paramount to saving the eye and preventing death from metastasis in
retinoblastoma. Retinal vessel width and tortuousity decreases with disease regression. Following further study,
the quantification of retinal vessel architecture may be of use as a valuable screening tool, predictor of disease
progression and assessment of treatment response in retinoblastoma patients.
186. A prospective long-term study of the ophthalmic natural history of paediatric craniopharyngioma
Evangelos Drimtzias, Kevin Falzon, Irfan Jeeva , Ian Simmons
St James`s University Hospital, Leeds, UK
Introduction: Craniopharyngiomas are benign epithelial tumours arising from remnants of the Rathke`s pouch.
Their natural history, with regard to their effects on the visual system, has not, to date, been investigated
prospectively.
Purpose: To present our experience over an 8 year period of monitoring of visual function in children with
craniopharyngioma.
Method: Visual data, of multiple modality, of all paediatric patients younger than 16 at presentation was
prospectively collected between 2004 and 2012.
Results: Twenty patients were surveyed. Severe visual loss and papilledema at the time of diagnosis were more
common in children under the age of 6. Visual signs, tumour calcification and optic disc atrophy at
presentation are predictors of poor visual outcome with the first two applying only in children younger than 6.
In contrast with previous reports, preoperative visual field (VF) defects and type of surgery were not
documented as prognostic indicators of poor postoperative visual acuity (VA) and VF. Among patients
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undergoing radiotherapy, better visual outcomes were recorded in children aged > 6. Contrary to previous
reports calcification at diagnosis, adjunctive radiotherapy, type of surgery and preoperative visual field defects
were not prognostic indicators of tumour recurrence.
Conclusion: This is the first prospective long-term study of the visual natural history of craniopharyngiomas to
our knowledge. Local recurrence is common in craniopharyngioma. Magnetic resonance imaging is
considered to be the recommended means of follow up in patients with craniopharyngioma. However VA and
VF are useful tools in monitoring for recurrence.
187. Retinopathy of Prematurity in Northern Ireland from 2006-2011
Eibhlin McLoone, Sarah Chamney, Rebecca Rollins , Emma McCall, Adele Marshall, Stan Craig
Introduction: Retinopathy of prematurity (ROP) is one of the leading causes of preventable childhood
blindness. Screening uses considerable resources and is invasive for premature infants.
Purpose: To establish the incidence of ROP and to identify baseline characteristics, demographic information
and co-morbidities associated with its development.
Method: Clinical information on all infants born at less than 32 weeks or 1500g were retrospectively entered
on to the Neonatal Intensive Care Outcomes Research and Evaluation (NICORE) database. The infants were
classified based on those who developed no ROP, any ROP and severe ROP which required treatment.
Results: The number of live births in this 6 year period was 148,852. The number of infants born at less than
32 weeks or 1500g in the same time period was 1866. Of those at risk, 316 developed any ROP. Ninety- two
developed severe ROP requiring treatment. The incidence of the development of any ROP was 2 per 1000 live
births. Using multinomial logistical regression the main risk factors for the development of any ROP were
gestational age in weeks (p=0.000), small for gestational age (p=0.017), maternal smoking (p=0.040) and total
number of days of oxygen therapy at > 21% (p=0.010).
Conclusion: With this data we are currently building a statistical model which will allow us to better assess the
risk of the development of ROP, enabling us to modify our screening protocol accordingly and better inform
parents of the risk to their child.
188. Rationalising the use of Bacterial Conjunctival Swabs in Alder Hey Children’s NHS Foundation Trust
- Review of a Seven Year Period (2006-2013)
Neeru Vallabh, Fiona Hardiman, Theresa S Cole , Richard J Drew, William Newman
Alder Hey Hospital
Introduction: The use of routine bacterial conjunctival swabs (BCS) is common and possibly represents an
unnecessary demand on the microbiology department. Could the use of BCS be rationalised without effecting
clinical care?
Purpose: To review the impact of a new testing regime for BCS which was introduced in September 2012.
Method: Results of all BCS were retrieved using the Laboratory Information System for the pre-intervention
(January 2006-September 2012) and post-intervention (October 2012-October 2013) periods. The intervention
was that in September 2012, BCS from departments other than ophthalmology could only be processed if
discussed with Microbiology/ Infectious Diseases clinicians.
Results: 3169 BCS were taken between January 2006 and October 2012. 58.0% from wards and admission
units, 2.6% from the ophthalmology clinic and 30.6% from A+E.
42.7% were positive for Haemophilus spp, 20.1% for Staphylococcus aureus, 14.0% for Streptococcus
pneumoniae., 11.3% for Moraxella spp. and 3.6% for Pseudomonas spp.
Post-intervention only 35 swabs have been taken, which represents a drop of 93% from the number of swabs
expected from the previous seven years’ experience (current average 2.69 swabs per month vs. previous
average 2006-2012 of 39.12 swabs per month). 8 of these 35 swabs were from Ophthalmology.
Conclusion: The results show that there were a large number of BCS being acquired from patients throughout
the hospital, particularly from wards and the A&E department. Review of the use of BCS within hospitals is
beneficial, and has led to a 93% reduction in the number of eye swabs being sent for testing, with an annual
saving of £5,207.
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189. Incidence and Management of Non Accidental Injury in South Yorkshire Ophthalmology units
Mohammed Zayed, Nadeem Ahmad, Alaa Attawan , Jessy Choi
Royal Hallamshire Hospital
Introduction: The population of South Yorkshire area is 1.34 million inhabitants and Non Accidental Injuries
(NAI) remains a challenging clinical scenario requiring a multidisciplinary approach.
Purpose: We aim to review NAI recorded in South Yorkshire and assess our referral system efficacy in line with
the Royal College of Ophthalmologists guidelines.
Method: A retrospective study included NAI children up to 4 years old recorded between August 2011 and
August 2012 obtained from the Child protection team and Sheffield Children’s Hospital accident and
emergency database. 306 children were included
Results: Of 306 patients, 67 children were referred to ophthalmology (21.8%). 41 cases (61.19%) were seen by
a consultant; 23 (34.3%) were seen by a Senior Specialty trainee. 3 (4.4%) were seen by junior trainee and
seen by a consultant at a later date except of one child failed to attend and was discharged to local hospital.
62 patients (92.5%) were seen within 24 hours; 2 after 2 days, 2 after 3 days and 1 was referred after 5 days
for lack of suspicion.
12 children had positive findings (17.9%) aged between 3 and 26 months. 7 had retinal hemorrhages in both
eyes, and 1 had a retinal hemorrhage in one eye. 4 children had sub-conjunctival hemorrhages.
All patients were followed up for a mean of 7.25 months.
Conclusion: NAI cases referred were reviewed promptly and with strong involvement of senior
ophthalmologists in line with the Royal College's recommendation.
190. Study of Optimal Perimetric Testing In Children (OPTIC) – Normative visual field values in children
aged 5-15 years
Dipesh Patel, Bronwen Walters, Phillippa Cumberland , Isabelle Russell-Eggitt, Jugnoo Rahi, On behalf of the
OPTIC study group
Introduction: The evidence base for perimetry in children is incomplete. We are conducting a programme of
research to address feasibility, reliability, repeatability and characterise normative values of visual fields in
children.
Purpose: Here we describe normative values for kinetic and static perimetry in children without visual field
defects (‘controls’) using Goldmann and Humphrey perimeters and report changes in visual field (VF) area and
sensitivity with age.
Method: To date 145 children aged 5 to 15 years and without ocular pathology that could cause a visual field
defect, have undergone kinetic perimetry (Goldmann) and static automated perimetry, SAP (Humphrey SITA
24-2 FAST) using standardised protocols. Linear regression was used to investigate associations between VF
area and age.
Results: VF area (Goldmann) increased with age for isopters III4e, I4e and I2e. Per year, the area of the III4e
isopter increased by 193.04deg2 (95%CI: 113.68-272.41), I4e increased by 174.87deg2 (88.57-261.17) and
I2e by 148.24deg2 (89.58-206.90).
Piecewise regression of mean deviation (MD) in SAP demonstrated an increase in MD with age up to 12 years
(0.28dB/year, 95%CI: 0.089-0.47), remaining stable thereafter (mean MD = -0.53, 95%CI: -0.96-(-0.10)).
Conclusion: There is a small, linear increase in VF area with age resulting in, for example, a 14.5% greater VF
area for isopter III4e at 15 years compared to 5 years. Sensitivity with SAP also increases with age, plateauing
at 12 years. Interpretation of perimetry should account for developmental changes in visual fields in children.
191. Unintentional Injuries in Visually Impaired Children
Jocelyn Cherry, Julie Mytton, Amanda Hall , Cathy Williams
University of Bristol
Introduction: Unintentional injury(UI) is a leading cause of death in under-15s and a major cause of less
severe injury requiring hospital treatment. Children with visual impairment(VI) are at increased risk of harm
due to the cumulative effects of incomplete development and sensory impairment. Few relevant data exist to
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support this or to aid parents/teachers devising preventative strategies.
Purpose: To identify and summarise the available data on the prevalence, mechanisms, risk factors and
outcomes of UI in children with VI.
Method: A systematic review of four databases was undertaken in 2013. A highly sensitive search strategy was
developed. Inclusion criteria were children under the age of 18y with VI (author defined) and UI.
Results: 22,439 articles were identified and 652 abstracts reviewed, yielding 12 papers meeting inclusion
criteria. 2/3 were published pre-1990. Meta-analysis was not possible due to significant heterogeneity and risks
associated with synthesis of observational data. VI children were reported with road traffic incidents,
poisoning, prosthesis asphyxiation and trauma secondary to contact lens or glasses.
Conclusion: There is limited published evidence on injuries in children with VI. That identified was mostly
published pre-1990. Analysis of risk factors for injury is required to support the development of advice for
parents and professionals.
192. The extended role of the Orthoptist; increasing the access to Ophthalmology for Paediatric Oncology
patients
Danielle Guy, Olwyn Nelson, Janice Hoole, Ian Simmons
Introduction: Trusts across the country are under financial constraints to provide high quality patient-led care
with decreasing facilities and staff. The following report details the use of Orthoptists to deliver ophthalmic
support to a regional paediatric oncology centre.
Purpose: To demonstrate the potential effectiveness of utilising Orthoptic services within a multi-disciplinary
paediatric oncology service.
Method: A senior Orthoptist with experience of ophthalmology, ocular motility and oncology support was
placed within the Paediatric Oncology Department for one session per week to assess patients with
opportunity to liaise via email / telephone with the Ophthalmologist when necessary.
Results: 174 patients were seen within the Oncology Department for visual field or acuity monitoring,
orthoptic examination and diplopia relief. 46 (26%) of these were new referrals seen for the first time. 90% of
patients were able to be managed by the Orthoptist alone without the immediate aid of the Ophthalmologist.
Further ophthalmological examination was needed for less than 10% of patients; this included fundoscopy
opinion, listing for strabismus surgery and prescription of ophthalmic medication. 3 patients required referral to
hospital optometry service. A number of other queries such as sticky eye, glasses wear, watery eye etc were
able to be discussed promptly with the Oncologist / patient and appropriate appointments arranged. An
estimated 150 joint paediatric ophthalmological / orthoptic clinic appointments were saved over the year.
Conclusion: The use of Orthoptists as part of a paediatric oncology multi-disciplinary team saves medical staff
time, paediatric clinic appointments, as well as unnecessary travel and long waits for a vulnerable patient
group.
193. Rapid onset of severe ocular injury after exposure to a button battery
Yasir Khan, Sundus Maqsood, S Marpuri, V Geh, G S Bhermi
Southend University Hospital
Introduction: Button batteries are commonly used in many household electronic items and are a potential
health hazard, especially in children. Therefore health professional and general public should be aware of
potential danger of button batteries and packaging should carry an appropriate warning sign.
Purpose: To report an unusual clinical presentation of button battery induced ocular injury.
Method: Two year old girl presented with painful red eye secondary to a metallic foreign body.
On examination, upper eye lid was swollen, erythematous with corneal and conjunctival abrasion. A shiny
button battery lodged in the supero-nasal conjunctival fornix was noted. On removal of FB under GA
surrounding conjunctiva and sclera appeared pigmented and necrotic .The battery's positive end was normal,
whereas the negative end was corroded. The pH of affected ocular tissue and 9. The eye was irrigated and the
pH neutralised and tissue injury was treated with topical antibiotics and steroids.
Two weeks later, there was residual conjunctival fibrosis overlying an area of scleral necrosis, with mild
symblepharon formation. Vision was normal in both eyes.
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Results: Button battery induce liquefaction necrosis by
1) Generation of an electric current that hydrolyses tissue fluid and produces hydroxide ions at battery's
negative pole,
2) Leakage of battery's alkaline contents,
3) Physical pressure on adjacent tissue.
Button-battery-induced ocular burn may be severe and requires prompt treatment to avoid complications.
Ocular injury from button batteries is uncommon. In our case, the battery was intact and found in an unusual
site with a rapid onset of injury.
Conclusion: Current labelling guidelines on button batteries packaging need to be amended, we recommend
that this should be changed to 0- 6 years, and advice to carefully dispose of used batteries is emphasised.
Button battery impaction in eye is a medical emergency and it should be removed as quickly as possible as
delay could result serious complications.
194. Sight-threatening ocular manifestations of JXG in childhood
David Burton, Evangelos Drimtzias, Kevin Falzon , Irfan Jeeva, Ian Simmons
St James`s University Hospital, Leeds,UK
Introduction: JXG is a benign histiocytic lesion encountered primarily in infancy and childhood although
adolescent and adult forms do exist. Ocular involvement is the most common extracutaneous manifestation.
Purpose: To report the unusual clinical presentation of JXG in 2 paediatric cases.
Method: A 7-month old boy diagnosed by biopsy with multi site Langerhans Cell Histiocytosis (LCH)
developed extensive retro-bulbar orbital disease causing compressive optic neuropathy.
A 3-year old boy with JXG skin lesions confirmed by biopsy presented with bilateral tractional funnel-shaped
retinal detachment which was managed with scleral buckling.
Results: The LCH in the first case was treated with chemotherapy initially. A CT scan revealed bilateral optic
disc masses which following biopsy were diagnosed as JXG. Further chemotherapy failed to achieve tumor
control as visual acuities continue to deteriorate.
One year following vitreoretinal surgery in the second case new iris masses were seen in both the eyes with
subsequent fibrous contracture in the anterior chamber causing distortion of the iris. Tumors were treated with
bilateral subconjunctival triamcinolone injections.
No perception of light was the visual outcome in both cases.
Conclusion: JXG in the first case developed during the time of chemotherapy and was therefore resistant to
treatment. Differentiation caused by the chemotherapy agents resulted in lineage transformation. Both cases
confirm that the diagnosis of JXG should be considered as a differential diagnosis of unusual intraocular
manifestations in children with recognized cutaneous JXG.
195. Head Posture and Head Movements in Infantile Nystagmus
Vijay Patel, Irene Gottlob, Frank Proudlock
University of Leicester Ophthalmology Dept.
Introduction: The mechanisms behind Infantile Nystagmus (IN) null regions and their relationship to
anomalous head postures is unclear.
Purpose: Our aims are to investigate the relationship between head postures and null regions two
dimensionally and to investigate the nature of head movements in IN.
Method: 18 IN patients and 15 controls were recruited. Null regions were mapped in IN patients in the
horizontal and vertical plane using the EyeLink II binocular pupil tracker to measure the intensity of their
nystagmus. Patients also carried out a number of visual tasks, during which head posture and movements were
measured using the InertiaCube head movement measuring device and Eyelink 1000 head tracker. Eye
movements were also recorded using the EyeLink 1000 monocular pupil tracker. Controls only carried out
head posture and head movement experiments at 1.2m and 0.6m.
Results: Nystagmus characteristics in IN patients were shown to dramatically change in the vertical and
horizontal planes. The individual characteristics of null regions varied between patients. Head postures were
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found to correlate to accessing the null region, particularly in tasks of high visual demand. Furthermore IN
patients were found to make significantly more functional head movements than controls.
Conclusion: The two dimensional null region acquisition protocol enables a more comprehensive analysis of
null regions than traditional methods. Whether null regions are accessed using anomalous head postures is
dependent on a number of factors.
UVEITIS
196. The Dublin Uveitis Evaluation Tool (DUET) – an algorithm for earlier diagnosis of
spondyloarthropathies by ophthalmologists in acute anterior uveitis
Michael O'Rourke, Muhammad Haroon, Pathma Ramasamy , Oliver FitzGerald, Conor Murphy
Royal Victoria Eye and Ear Hospital, Dublin
Introduction: Early diagnosis in SpA is crucial as morbidity is related to duration of the disease. Acute anterior
uveitis (AAU) is the first manifestation of SpA in 20%. An acutely painful red eye will prompt a patient to seek
medical attention more readily than lower back pain of insidious onset.
Purpose: This study establishes the incidence of previously undiagnosed SpA in patients presenting with AAU.
Using the most significant clinical factors, a referral algorithm to the rheumatologist was generated with the
aim of earlier diagnosis and treatment.
Method: 104 consecutive patients with non-infectious AAU were recruited prospectively. Other causes of AAU
and a known history of SpA were excluded. These patients were subsequently examined by a rheumatologist
for the presence or absence of SpA.
Results: A new diagnosis of SpA was made in 38%. The referral algorithm advises that patients with AAU and
back pain of onset under 45 years of age with duration greater than 3 months should have HLA-B27 checked.
If positive they should be referred to rheumatology. In addition, any patient with AAU and a personal history of
psoriasis, even in the absence of back pain should also be referred. This algorithm has sensitivity of 95% and
specificity of 98% and was subsequently validated in a second cohort of 80 patients.
Conclusion: Close collaboration between ophthalmologists and rheumatologists utilizing our algorithm will
result in earlier treatment intervention to improve disease outcome in SpA.
197. Use of aqueous humour PCR for diagnosis of atypical ocular toxoplasmosis
Andre Grixti, Edward Guy, Nicholas Alexander V Beare, Ian Andrew Pearce
Introduction: Ocular toxoplasmosis is a major cause of posterior uveitis worldwide. Diagnosis is usually based
on ophthalmological examination. However, diagnosis and treatment can be delayed in patients with atypical
lesions. Furthermore, specific antibodies suggestive of recent infection are not always detected. In such cases,
rapid identification of the causative agent requires aqueous humour polymerase chain reaction (PCR).
Purpose: To determine the diagnostic value of aqueous humour PCR for detection of atypical toxoplasmic
uveitis.
Method: Retrospective, non-comparative case series of patients having aqueous PCR for Toxoplasma gondii as
an investigation for posterior uveitis in St Paul’s Eye Unit, Liverpool (UK). Serum levels of anti-Toxoplasma
gondii specific IgM and IgG were determined by ELISA technique. Aqueous humour obtained by anterior
chamber paracentesis in clinic underwent PCR for T. gondii DNA at Toxoplasma Reference Laboratory
Swansea (Wales, UK).
Results: From November 2009 to December 2012, 5 patients with chorioretinitis of uncertain cause had
aqueous sampling for toxoplasmosis. Three patients had multifocal chorioretinitis, and two had diffuse retinitis.
Two subjects were immunosuppressed (liver transplant recipient; Waldenstroms macroglobulinaemia).
All patients were seropositive for T. gondii. Aqueous PCR detected toxoplasmic DNA in 3 patients including
both immunosuppressed, confirming diagnosis of toxoplasmosis despite atypical clinical presentations. Two of
these subjects were IgM negative. Both patients with negative aqueous PCR were diagnosed with toxoplasma
choroiretinitis due to positive anti-Toxoplasma IgM serology and clinical findings (pigmented chorioretinal
scar).
Conclusion: Aqueous humour PCR testing for toxoplasmosis should be performed as a diagnostic tool where
atypical toxoplasmosis is a possibility, particularly in the immunosuppressed.
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ABSTRACTS: Uveitis
198. Pegylated Interferon α2b reduces corticosteroid requirement in patients with Behcet’s syndrome with
upregulation of circulating regulatory T cells
Sue Lightman, Oren Tomkins, Virginia Calder, Catey Bunce, Hilary Longhurst, Dorian Haskard, Miles Stanford
Moorfields Eye Hospital and Institute of Ophthalmology
Introduction: BS often requires treatment with immunosuppressive agents and corticosteroids. INF α2a and 2b
are reported in small case series to be effective in BS. The mechanism is unknown but regulatory T cells (Tregs)
are induced in other diseases which respond to IFN.
Purpose: To determine if IFN reduces the requirement for systemic medication at 1 and 3 years in BS.
Method: A randomised clinical trial adding 26 weeks of subcutaneous pegIFN α2b/ week to standard
treatment in half and follow for 3 years. Tregs in peripheral blood measured over the first year at one site.
Results: At 1 year the mean dose prednisolone was 6.74±5.78 mg/day in pegIFN α2b group and 10.53±9.28
mg/day in non-IFN group (p=1.00). However in patients (69.4% in each arm) on corticosteroids at baseline,
the dose was significantly lower at 1 year in the pegIFN α2b (6.5(5,15) mg/day) compared with the non-IFN
group (10(8.25,16.5)mg/day) (p=0.039). There was increased quality of life and decreased immunosuppressive
medications in the pegIFNα2b group up to year 3. There was a significant rise in Tregs on IFN only which was
still present at 1 year.
Conclusion: Adding pegIFN α2b to patients with BS on baseline steroids resulted in a significant reduction in
dose with improved quality of life and trend to reduced other drugs required. The effect was seen at 1 year and
was associated with a rise in regulatory T cells suggesting a mode of action.
199. Long Term Outcome of Repeat Ozurdex Implantations in Non-Infectious Uveitis
Oren Tomkins-Netzer, Simon Taylor, Asaf Bar, Albert Lula, Satish Yaganti, Lazha Talat, Sue Lightman
Introduction: Uveitis can be controlled using systemic or local immunosupression agents. There have been
limited reports on long term outcome of treating uveitis with repeat Dexamethasone (Ozurdex) implants.
Purpose: To describe the long term outcome of eyes with uveitis following repeated treatment with Ozurdex
implants.
Method: Patients with non-infectious uveitis that were treated with Ozurdex implants were included in the
study. Anatomical and functional outcomes, as well as ocular complications were gathered retrospectively up
to 24 months after treatment was started.
Results: Thirty eight eyes of 27 patients with uveitis were treated with 61 Ozurdex implants. Average follow-up
was 17.3±1.8 months after the first implant (range 3-54.5 months, 54.65 eye years), with 24 (63.1%) receiving
multiple implantations. Following the first implantation average best corrected visual acuity (BCVA) improved
from 0.47±0.05 LogMAR to 0.27±0.07 LogMAR (p<0.001) and central retinal thickness (CRT) decreased by
263±44.22μm (p=0.003). The average duration of therapeutic effect was 8.6±1.7 months, with a similar
response achieved after each repeat implantation. The accumulated effect of repeat implantations resulted in
continued improvement in BCVA (R2=0.91, p<0.0001) with significant improvement and stabilization of CRT.
Two eyes had progression of posterior subcapsular opacities, though none required surgery. There were seven
instances of raised intraocular pressure, all of which responded to pharmacological treatment.
Conclusion: The accumulated effect of repeat Ozurdex implantations improves retinal thickness and resolves
ocular inflammation resulting in restoration of ocular function. Ocular complications were minimal with no
eyes requiring surgery for increased ocular pressure or progression of cataract.
200. Visual outcome and treatment strategies among patients with ischaemic retinal vasculitis
Lazha Talat, Oren Tomkins-Netzer, Sue Lightman
Moorfields Eye Hospital / UCL Institute of Ophthalmology
Introduction: Ischaemic retinal vasculitis is a rare but serious cause of visual loss. However, the long term
outcomes have only been addressed in a limited number of studies using small sample of cohorts.
Purpose: To examine the long term visual and clinical outcome following the diagnosis of ischaemic retinal
vasculitis.
Method: This was a retrospective study of 60 eyes from 40 patients with ischaemic retinal vasculitis whilst
under the care of a single uveitis clinic at Moorfields Eye Hospital. Demographic and clinical data were
collected at onset of retinal ischaemia (Baseline) and annually till the last visit.
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Results: Following a median follow-up time of 55 months, the median visual acuity showed no significant
difference from baseline up to five years and at final visit (0.18 versus 0.18 Logmar, p=0.123; Wilcoxon Ranks
test). Compare to baseline, 24 eyes (40%) gained at least one line of vision, including 12 eyes that gained ≥
three lines. Ten (17%) lost at least one line of vision from baseline, including five eyes that lost ≥ three lines.
Severe visual loss (≥ 6/60) occurred in 23 eyes (38%), mainly due to chronic macular oedema (26%) and
macular ischaemia (21%). Retinal laser photocoagulation was not required in 14 eyes (23%), used alone in 10
(16%), or combined with systemic steroid (26%) or immunosupressants (25%).
Conclusion: Early treatment with retinal photocoagulation and immunomodulatory medications can regain
vision in a considerable number of cases. However, severe and irreversible visual loss secondary to macular
involvement remains a challenge.
VITREO-RETINAL DISEASE & SURGERY
201. Ocriplasmin for Pharmacologic Resolution of Vitreomacular Adhesion: Meta-analysis of anatomical and
functional outcomes
Andrew Lotery, Benedicte Lescrauwaet, Kerry Gairy
University of Southampton
Introduction: Two Phase III, multicenter, randomized, placebo-controlled trials (MIVI-TRUST 006-007)
studying ocriplasmin as treatment for vitreomacular traction were conducted, identical in design apart from
randomization ratios and region. The pre-specified integrated analysis of the combined data demonstrated
favorable effects of ocriplasmin in primary and secondary outcomes.
Purpose: Compare results of the pre-specified integrated analysis with meta-analysis of anatomical and
functional endpoints using technology appraisal methods as required by the National Institute for Health and
Care Excellence.
Method: VMA resolution at Day 28 and Month 6, macular hole (MH) closure and 2 or 3-line visual acuity (VA)
gain at Month 6 and avoidance of vitrectomy outcomes from each of the trials were pooled, with effects
measures expressed as risk difference and risk ratio in random and fixed effect models. Heterogeneity between
trials was assessed using Cochrane’s Q test and I2 statistic.
Results: In a random effects model, risk difference (95% confidence interval) was 0.07 (0.02-0.11) for 3-line
VA gain and 0.11 (0.04-0.18) for 2-line gain; 0.25 (0.10-0.39) for MH closure; 0.17 (0.12–0.23) and 0.14
(0.07-0.20) for VMA resolution at Day 28 and Month 6, respectively; and 0.08 (0.01-0.16) for avoided
vitrectomy. Risk ratio result confirmed findings from the integrated analysis. None of the meta-analysis results
showed heterogeneity assessed by a Q statistic of p< 0.05 or an I² of >50%. Details of meta-analysis are
discussed.
Conclusion: Meta-analysis of anatomical and functional outcomes confirmed the previously reported results,
supporting validity of integrated analysis.
202. Recovery of visual symptoms following ocriplasmin therapy – further evidence from MIVI trials for
ocriplasmin in vitreomacular traction
Niro Narendran, Yit Yang, on behalf of the MIVI-TRUST Study Group
International Multi-Site Studies
Introduction: Ocriplasmin is approved by NICE in the UK for the treatment of patients with severe symptoms
due to vitreomacular traction (VMT), without epiretinal membrane (ERM) or macular hole >400 μm. In the
phase III MIVI studies (MIVI 6/7 NCT00781859 and NCT00798317), efficacy was demonstrated for VMT
resolution at Day 28 (26.5% ocriplasmin vs 10.1% placebo; p<0.001). However, the overall percentage of
patients experiencing vision alteration adverse events over the study period was higher in ocriplasmin-treated
patients.
Purpose: To further understand the evolution of visual events over time following intravitreal ocriplasmin.
Method: Using MIVI 6/7 data, comparisons were made between the frequencies of visual events reported
within the first 7 days post-injection and from Day 8 through to Month 6.
Results: In the first 7 days, the respective frequencies of events in ocriplasmin and placebo groups were: ≥2line reduced acuity (7.7% vs 1.6%), visual impairment (3.2% vs 0%), floaters (12.9% vs 2.7%), blurred vision
(6.5% vs 0.5%), and photopsia (10.1% vs 1.1%). By Month 6, the frequencies of these events were
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considerably lower in the ocriplasmin group: persistent reduced acuity following initial ≥2-line vision decrease
(1.3% vs 1.1%), visual impairment (2.2% vs 1.1%), floaters (3.9% vs 4.8%), blurred vision (1.9% vs 2.7%), and
photopsia (1.7% vs 1.6%).
Conclusion: Initial visual disturbances following ocriplasmin injection tend to recover well over time. This
observation was not reported in detail in previous publications and should be of use to clinicians in their
implementation of this new therapy.
203. Visual function improvements with resolution of vitreomacular adhesion in patients receiving
ocriplasmin
Tim Jackson, On behalf of the MIVI-TRUST Study Group,
International multi-center study
Introduction: Ocriplasmin is indicated in the EU for treatment of vitreomacular traction including when
associated with a macular hole ≤400 μm.
Purpose: To determine whether resolution of vitreomacular adhesion (VMA) at Day 28 (primary endpoint) was
associated with improved visual function.
Method: Data from the MIVI-TRUST (Microplasmin for Intravitreous Injection – Traction Release without
Surgical Treatment) pivotal phase III MIVI-6 and MIVI-007 studies were analysed.
Results: VMA resolution at Day 28 occurred in 26.5% of ocriplasmin-treated participants compared with
10.1% placebo-injected participants (p<0.001). At Month 6, 44.7% and 20.3% of participants receiving
ocriplasmin who achieved VMA resolution at Day 28 gained ≥2 and ≥3 lines in best-corrected visual acuity
(BCVA), respectively, compared with 22.0% and 9.4% of participants who did not achieve VMA resolution at
Day 28 (p=0.077).
The mean change from baseline in visual function questionnaire (VFQ-25) composite score was +3.4 points in
the ocriplasmin group and +0.7 points in the placebo group (p=0.007) at Month 6. For patients who achieved
the primary endpoint, the mean change from baseline in the VFQ-25 composite score was +5.7 in the
ocriplasmin group and –0.2 for the placebo group (p=0.029). For patients who did not achieve the primary
endpoint, these values were +2.6 and +0.7 for the ocriplasmin and placebo groups, respectively (p=0.075).
Conclusion: VMA resolution at Day 28 following ocriplasmin injection was associated with an improvement in
BCVA and vision-related function.
204. Measuring Metamorphopsia in Macular Disease
Gerry McGowan, Tsveta Ivanova, David Yorston , Niall Strang, Velitchko Manahailov
Introduction: Metamorphopsia affects many patients with Vitreoretinal conditions such as macular hole,
epiretinal membrane, and macula off retinal detachment.
Purpose: Currently, it is difficult to quantify metamorphopsia. We present a novel, simple, inexpensive method
of measuring metamorphopsia
Method: D-charts consist of 4 groups of 6 charts. 4 areas of the macula are tested: 0-1.5 degrees from fixation,
1.5-3. 3.5-7 and 7-12 degrees. Each chart is composed of an octagonal ring composed of squares arranged in
straight lines. The separation of the squares in each chart ranges from 0.4 to 1.5 degrees. Patient indicates
which of the 8 segments of the chart appear didtorted, and a metamorphopsia score is calculated from the
total number of segments affected, and the maximum separation of the squares in degrees. The test
alsoidentifies the area affected by metamorphopsia and results presented graphically.
Results: 31 eyes FTMH and 27 eyes ERN tested. Median metamorphopsia score was 8.9 for FTMH and 4.9 for
ERM, this was not significantly different (Mann-Whitney U-test, p=0.41). Pre and post op scores conducted in
14 patients. There was a significant reduction from median of 3.05 to 0.7 post-op (Mann-Whitney U-test,
p=0.009).
Conclusion: The test has been administered successfully to patients with visual acuiries ranging from 6/9 to
6/60, and proven feasible to use in busy NHS clinic. D-charts offer simple and prqctical means of measuring
metamorphopsia.
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205. Anatomical and visual outcomes of posterior segment ocular trauma requiring vitreo-retinal surgery
Koushik Basu, Yog Raj Sharma, Raj Vardhan Azad , Parijat Chandra, Koushik Tripathy
Dr. Rajendra Prasad Centre For Ophthalmic Sciences, India
Introduction: There remains a need to evaluate the outcomes of posterior segment trauma requiring state of
the art vitreo-retinal surgerical intervention , as a single entity, as the currently available data on both
anatomical and visual outcomes is scanty.
Purpose: To analyze the anatomical and visual outcomes of patients with posterior segment trauma requiring
vitreo-retinal surgical intervention at a tertiary care center.
Method: Prospective nonrandomized study. 104 patients with posterior segment ocular trauma during a period
of one year were studied with post-surgery day 1&7; 1, 3 & 6 month follow up.
Results: Out of 104 eyes, 41 had open globe injury (OGI). Males are predominantly involved (87%).the most
common cause for OGI was hammer and chisel (44%) and cricket ball (36.5%) for CGI. 61.9% of close globe
injury (CGI) had retinal detachment and 85 % of them had single break and inferotemporal break being the
most common break(33.33%). Main cause of redetachment was proliferative vitreoretinopathy. Anatomical
success rate (complete retinal attachment) was 86% in retinal detachment cases after two surgery. Preoperative
BCVA were 2.275769±.97 (m ± SD) and post-surgery BCVA were 1.167212±.895 (m ± SD) (p-value<0.0005).
Functional success(>5/200) was possible in 70% cases. Poor outcomes are related with presence of RAPD,
endophthalmitis, increased time between trauma and surgery, initial poor visual acuity.
Conclusion: Vitreo-retinal surgery outcomes are excellent in posterior segment ocular trauma
206. Development of the surgical procedure for cell transplantation treatment for age-related macular
degeneration (AMD)
Christopher Jump
Introduction: AMD is characterised by deterioration of retinal pigment epithelial (RPE) cells and their
underlying Bruch’s membrane. Current treatment options are limited and unsatisfactory. Subretinal
implantation of a monolayer of RPE cells is a possible therapeutic option. For this treatment to be successful
the cell monolayer must avoid damage and maintain its morphology during the surgical procedure.
Purpose: This study investigated whether an intact monolayer of morphologically normal aRPE-19 cells can be
implanted subretinally using vitrectomy techniques in ex vivo porcine eyes.
Method: aRPE-19 cells were cultured on 20µ m thick polyurethane membranes until confluent. Membranes
were either 6mm discs or 3mm x 5mm strips. Five of each were precut prior to cell culture and the same
number cut after culture using a trephine. Ultrathin gelatin encapsulation was used on some membranes to
protect cells. 3-port 23-gauge vitrectomy was performed on ex vivo porcine eyes and the membranes inserted
subretinally. The effect of using a 16-gauge transcleral chute on cell morphology was also investigated.
Cellular morphology and nuclei distribution were assessed using phalloidin and DAPI staining.
Results: Use of strips rather than circular membranes and pre-cut membranes before cell culture resulted in
less disturbance to cell morphology. Ultrathin gelatin encapsulation consistently protected cells during
implantation. Use of the transcleral chute provided better maintenance of cellular morphology in all
membrane types and showed less cell damage than without.
Conclusion: This study has provided a better understanding towards development of an improved surgical
technique for subretinal transplantation for translational in vivo studies.
207. Comparison of efficacy and safety outcomes between EU and US patients in MIVI6/7 studies on
ocriplasmin for vitreomacular traction
Zachariah Koshy, on behalf of MIVI TRUST study Group
Multiple
Introduction: The MIVI 6/7 trials studied ocriplasmin in vitreomacular traction (VMT) with and without full
thickness macular holes (FTMH). The results revealed a distinct variation in efficacy and adverse event
reporting between the US and EU populations
Purpose: To describe the regional differences in efficacy and safety outcomes and identify factors for causation
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Method: Post hoc analysis (logistic regression model) of MIVI 6/7 trial data. These were two multicenter,
randomized, double-blind, phase 3 clinical trials to compare a single intravitreal injection of ocriplasmin (125
µ g) with a placebo injection in patients with symptomatic vitreomacular adhesion
Results: The proportion (EU/US in % of n) of patients with total PVD (6.7/16.1), gain in visual acuity > 2 lines
(23.1/30) and non-surgical closures of the FTMHs (32/43.2) was lower in the EU region compared to the US
region. There were differences between the two populations in positive predictors for VMT resolution namely,
age<65, absence of epiretinal membrane (ERM) and FTMH<250microns. There was a higher reporting of
adverse events in the US (81.6%) compared to the EU (64.2%)
Conclusion: There are clear differences in outcomes between the US and EU study populations. When
differences in the distribution of positive predictive baseline variables are accounted for, similar treatment
effects are observed in the EU and US for all outcomes measures.
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DVDs
1.
Video of goniotomy, with tips for the assistant that allow better surgical access, and an optimal
surgical arc.
Gordon Lau, Ayad Shafiq
Introduction: In a goniotomy procedure, the role of the assistant is crucial to the surgeon, since the eye needs
to be effectively held and rotated to provide optimal access for safe and effective surgery. We set out to
demonstrate the equipment that would optimise the assistant role.
Purpose: This video demonstrates the equipment and technique required by the assistant as well as
demonstrating the surgical technique.
Method: This video was recorded via an operating microscope. Its duration is 6 minutes.
Results: The operating surgeon operates from the baby s temproal side using a tilted microscope. The surgeon
holds a Barkan lens in one hand and a 23 gauge needle attached to a syringe of viscoelastic in the other. The
assistant uses locking forceps at the limbal conjunctiva to adduct the eye and rotate the eye for optimal
cleavage arc of drainage angle.
Conclusion: A change from a paediatric Clark speculum to a Baraquer wired speculum allowed for easier and
smoother rotation, avoiding unintentional 'squeezing' of the globe during surgery.This video provides a helpful
example of equipment that facilitates the assistants role in this surgery, where optimal surgical preparation is
critical to success.
2.
TREACHER COLLINS WINNER 2014
Trabeculecomy Bleb Dysaesthesia - Review of how to prevent & how to treat
Dan Lindfield, Saurabh Goyal
St Thomas', London
Introduction: Trabeculectomy is the most common glaucoma procedure in the UK. Dysaesthesia is rare but
whilst surgeons target low pressures and safety, patients desire tolerability and comfort.
Purpose: This video presentation discusses the causes and methods of preventing and treating bleb
dysaesthesia. Large, nasal, overhanging blebs uncovered by lids are more likely to cause bleb dysaesthesia.
There is cyclotorsion of eye during supine position hence it is important to mark the eye to guide placement of
flap during surgery.
Method: The eye is marked at 12 O’clock using a hypodermic needle on the slit lamp prior to anaesthesia and
surgery. A larger area of anti-metabolite application helps to ensure diffuse blebs. Edge to edge secure
conjunctival to corneal closure helps to avoid overhanging blebs.
Results: Using these techniques none of our over 200 patients in the last 3 years have needed a bleb revision
for bleb dysesthesia.
We discuss management of patients referred to us with bleb dysesthesia including surgical techniques like
partial bleb excision, compression sutures, and autologous blood injection.
Conclusion: Diffuse blebs that are completely covered by lids can be achieved by modern trabeculectomy
techniques and improve patient experiences of glaucoma surgery.
3.
'When it just won't fit'! Transcameral pull-through suture to enable watertight anterior chamber tube
entry
Avi Kulkarni, Dan Lindfield
Kings College Hospital, London
Introduction: The need to avoid early post-operative hypotony has forced many changes to glaucoma drainage
device technique. Non-valved tubes are frequently ligated or stented.
Purpose: Despite preventative measures entry site leak can still occur causing early hypotony which can be
difficult to manage.
Method: Traditionally a 23-gauge (blue) needle was recommended for anterior chamber entry. A 23-gauge
needle has a 0.64mm outer diameter which theoretically allows a perfect fit for both the Baerveldt (0.64mm
external diameter) & Ahmed (0.635mm) tubes. However, in reality the conduit created by a 23-gauge needle
often exceeds 0.64mm especially in myopic eyes. A 25-gauge (orange) needle has a 0.51mm external diameter
allowing a tight and watertight fit for Baerveldt insertion. However, due to the tight fit insertion is often difficult.
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Results: This video illustrates the use of a 10/0 double-armed Prolene suture on a straight needle to “pullthrough” the tube tip into the anterior chamber transcamerally.
Conclusion: This technique is quick, easy and safe. It allows both Baerveldt and Ahmed tubes to be reliably
and consistently passed through 25-gauge incisions. The result is a watertight fit and less risk of early postoperative hypotony and infection.
4.
IOL haptic exchange through small incision
Daniel Dragnev
Hywel Dda Health Board
Introduction: I present a case of phacoemulsification in which during the implantation of folded 3-piece
silicone IOL (AMO) the trailing haptic broke. The case was managed through small incision by replacing the
PMMA haptic with another taken from the same type of IOL.
Purpose: The purpose of the video is to demonstrate an alternative to extraction of the whole 3-piece IOL in
cases with broken haptic.
Method: A phacoemulsification was performed on a dense nuclear cataract. A 3-piece silicone IOL was folded
by the nurse and was implanted. The trailing haptic was caught between the arms of the implantation forceps
and broke. The IOL was in the anterior chamber and the trailing haptic at the incision. The broken haptic was
extracted from the optic of the IOL. A haptic from another IOL was extracted and it was inserted in the optic
without taking the IOL out of the eye. The IOL was positioned in the bag.
Results: Postoperatively the IOL was in the bag and was centrally positioned.The patient’s visual acuity with
the operated eye was 6/9 unaided, improving to 6/6 with a pinhole.
Conclusion: IOL haptic exchange is a useful alternative to explantation of the whole 3-piece IOL in cases with
damaged haptic.
5.
Iris clip Secondary IOL implantation technique - comparison of needle Vs Vacuum assisted enclavation
Hidayat Ullah Bhutto, Siddhartha Goel
Diana Princess of Wales Hospital Grimsby
Introduction: Aphakia is a devastating condition in those patients who can’t tolerate contact lenses or have
problems with strong glasses. Options for visual rehabilitation include sulcus fixed IOLs if there is a reasonable
capsular remnant, and in the absence of capsular support, scleral fixed IOLs or A/C IOLs. Scleral IOLs are
technically challenging to insert and cause problems including migration, inflammation, suture related
problems at the sclera, stability issues etc. Standard angle supported ACIOLS have problems like damage to
angle structures, glaucoma, uveitis, hyphaema etc (UGH syndrome). Iris clip IOLs are increasingly becoming
popular because like ACIOLs they are relatively easy to insert and are fairly stable over time with minimum
risk of angle damage and glaucoma. They do need reasonable iris integrity though. The main difficulty is the
enclavation of the iris into the claws.
Purpose: Demonstrate surgical technique that vacuum enclavation is a safe and effective alternative to needle
enclavation in the application of iris clip lenses
Method: We present 2 videos. In one we demo the technique of needle enclavation and in the other we demo
a new vacuum enclavation technique which makes the process far easier and safer for surgeons considering
the use of iris clip lenses
Results: The 2 options for enclavation of iris fixated IOLs (needle and vacuum) are demonstrated
Conclusion: Vacuum enclavation is a safe and effective alternative to needle enclavation in the application of
iris clip lenses
6.
Macular hole eruption during pars plana vitrectomy
Paul Rainsbury, Emily Gosse, Jonathan Lochhead
St Mary's Hospital, Isle of Wight
Introduction: Macular hole surgery is a commonly performed procedure. The complication rate for this surgery
has been found to be approximately 8%, with iatrogenic peripheral retinal tears making up the majority of
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these cases.
Purpose: In this video we present footage of a previously undescribed and potentially serious intraoperative
complication during macular hole surgery. We propose a hypothesis as to why it happened, and suggest a
simple solution to reduce the risk of it occurring again.
Method: The patient shown was undergoing routine 25-gauge macular hole surgery when, following removal
of ILM forceps from a non-valved port, a high pressure jet of fluid from the infusion cannula entered the
macular hole causing it to erupt.
Results: This resulted in an iatrogenic tear around the macular hole. A cautious internal limiting membrane
peel was then performed, followed by routine C3F8 gas tamponade. Post-operatively the patient’s macular
hole closed and his visual acuity on discharge was 6/24.
Conclusion: We believe that the jet of fluid may have been generated by the rapid release of pressure from a
partially blocked infusion line, following removal of the ILM forceps from a non-valved port.
Surgeons performing macular hole surgery should be aware of the possibility of extreme pressure surges during
vitrectomy when using non-valved ports, and consider using valved ports as an alternative.
7.
Capsule supported phacoemulsification in a case of subluxed cataract
Siddharth Goel, Hidayat Ullah Bhutto
Diana Princess of Wales Hospital Grimsby
Introduction: Zonular dehiscence can be problematic while doing phacoemulsification. If fairly small (<1/4)
the bag can be stabilized by simply using an endocapsular tension ring before proceeding with standard but
cautious surgery. In substantial dehiscence(>3/4) an ICCE will probably be required. In those patients between
(¼-3/4) an enhanced bag stabilsation procedure during and after phaco is preferred. For less than ½ we
recommend bag stabilsation using iris hooks during phaco/IA and then multiple ECTRs post IA. This avoids the
need for complex Morschers segments needing scleral fixation. From ½ to ¾ Morschers segments are
inevitable for a safer outcome.
Purpose: Demonstrated surgical technique that capsular stabilization with iris hooks enables successful
completion of phacoemulsification
Method: We present a case demonstrating the use of iris hooks to keep the capsular bag in position during
phaco/IA(in a patient with ¼-1/2 dehiscence) followed by multiple ECTRs to enable a successful outcome.
Results: The surgical steps are demonstrated and discussed.
Conclusion: Capsular stabilization with iris hooks enables successful completion of phacoemulsification in a
case of a subluxed cataract with ¼-1/2 zonular weakness
8.
Transconjunctival scleral flap oversew for hypotony following trabeculectomy with mitomycin C - a
novel technique
Pavi Agrawal, Dilani Siriwardena
Introduction: Despite modern safer surgical trabeculectomy techniques, post-operative hypotony can still be
problematic. When conservative measures have failed, formal bleb revision surgery via a fornix-based
conjunctival flap remains the standard technique, but has the risk of stimulating scarring and causing bleb
failure.
Purpose: To present an alternative surgical technique for the management of hypotony following
trabeculectomy.
Method: A 38 year-old man with glaucoma underwent routine trabeculectomy surgery augmented with
mitomycin. An initial marked wound healing response reduced aqueous drainage. He underwent early
removal of a releasable suture but developed hypotony unresponsive to conservative management. Over a few
weeks the visual acuity dropped from 6/6 to 6/60 due to hypotony maculopathy and his pressure was
persistently low at 2 mmHg. A trans-conjunctival oversew revision was performed as the scleral flap
parameters were identifiable in the overdraining bleb. Four 10-0 nylon sutures were applied through the
conjunctiva into the scleral flap and the adjacent sclera. They were knotted tightly over the conjunctiva. He
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was commenced on G.Dexamethasone and G.Chloramphenicol QDS post-operatively.
Results: At day 1 and week 1 the intraocular pressure was 6 mmHg. The visual acuity improved to 6/18. At
week 3 the intraocular pressure was 16 mmHg and he underwent argon suture lysis to increase outflow. The
pressure has stabilized at 14 mmHg with 6/6 vision by 6 weeks.
Conclusion: We describe an effective and minimally invasive technique to treat hypotony maculopathy
following trabeulectomy. It is especially useful when the margins of the flap are identifiable preoperatively and
avoids unnecessary opening of the conjunctiva.
9.
A Novel Technique in Predicting Efficacy of Lateral Tarsal Strip
Huw Oliphant, Ali Hassan, Paul Baddeley
Introduction: Lateral tarsal strip (LTS) is a well established surgical procedure used in the treatment of epiphora
secondary to horizontal lower eyelid laxity. Difficulty often arises in predicting the potential benefit of such
eyelid tightening procedures.
Purpose: Currently no slit lamp technique can be used to predict the potential benefits of an LTS. We have
designed a simple and effective fluorescein aided slit lamp technique for determining the potential benefit of
carrying out LTS, in patients with a patent nasolacrimal duct (NLD).
Method: With the aid of video and still images we will demonstrate this quick and effective in clinic predictor
of whether a lateral tarsal strip is likely to be effective. 2% fluorescein is instilled into the lower fornix, and the
eyelid is held in an artificially elevated and horizontally tightened position. The tear film height is measured at
0 seconds, 30 seconds and 1 minute. Disappearance of the 2% fluorescein in the new lid position acts an
indicator for the efficacy of Lateral Tarsal Strip.
Results: Our slit lamp based videos demonstrate the disappearance of fluorescein dye in a lid position
simulating that following LTS. It also helps to demonstrate the importance of ocular movement and blinking in
the lacrimal drainage process.
Conclusion: We feel this very simple, but new technique could be of significant value to ophthalmologists in
the treatment of epiphora, particularly where the underlying cause is not fully understood.
10. Needling revision of severely scarred blebs: Description of the technique
Rory Nicholson, Charalambos Tossounis, Hannaa Bobat , James Kirwan
Queen Alexandra Hospital, Ophthalmology Department,
Introduction: The needling of severely scarred blebs can be a challenging and difficult surgical glaucoma
procedure.
Purpose: We demonstrate a bleb needling technique that can be very effective on severely scarred blebs that
always pose a surgical challenge
Method: Topical anaesthesia is achieved with Tetracaine Hydrochloride 1% eye drops. A sub-conjunctival
injection of an antimetabolite, mixed with Vision Blue (DORC) for better visualisation of the broad area of
distribution, is performed a few millimetres superiorly to the edge of the bleb. 3-minutes later the solution is
diluted with lidocaine 2%.
By using a Glaucoma Revision Pick, angled at 60° (Lederer, 27G, BD Vistec™) attached to a 2 ml syringe filled
with HEALON® OVD (AMO), a careful dissection and opening of the planes is done. Initially, a subconjunctival injection of healon between the bleb and the entry point of the pick is performed.
With a clear plane of action now, we use an angled 23G MVR blade through the same path. The blade is very
sharp and carefully dissects the scarred tissue slowly advancing to the anterior chamber.
After an effective bleb is constructed the anterior chamber is reformed and a sub-conjunctival injection of an
antibiotic and steroid is done.
Results: Good intraocular pressure after the procedure with a reformed bleb.
Conclusion: The utilisation of sub-conjunctival injection of healon improves visualisation of tissues and
enhances safety during the needling procedure. The angled MVR blade is sharp and provides easy access to
severely scared blebs. However, it needs to be used with considerable caution.
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11. A ‘No-speculum’ Technique for Intravitreal Injections
Shwan Kadare, Huw Oliphant, Tony Leong
Introduction: Intravitreal injections remain one of the most commonly performed procedures in most
ophthalmology departments. It is felt that the use of the lid speculum reduces contact with lashes and the
eyelid itself, and therefore reduces the risk of endophthalmitis. It is also felt, however, that the lid speculum
can be a source of discomfort. Previously bimanual no speculum techniques have been described to achieve
adequate exposure, but these require two operators.
Purpose: The purpose of this DVD is to demonstrate a safe, no speculum technique which can be performed
by a single operator. This reduces the time taken to perform intravitreal injections, and reduces discomfort felt
by patients.
Method: The eye to be injected is cleaned with povidone iodine. The middle or ring finger of the injecting
hand is used to keep the upper eye lid retracted and steady. The non dominant hand holding the marker is
used to measure the appropriate distance from the limbus for the injection site, and also to depress the plunger
on the syringe.
Results: We find this to be a rapid and safe technique for delivering intravitreal injections. Using a
combination of still and motion pictures we will demonstrate this no speculum injection technique.
Conclusion: While the lid speculum used in intravitreal injections is thought to be useful in preventing
infection, we find it to be a significant contributor towards discomfort for patients. Using this technique a
single operator can perform an intravitreal injection without speculum.
12. Removing a dropped IOL and implanting an ARTISAN aphakic lens: The float and suck technique
Charalambos Tossounis, Rory Nicholson, Richard Newsom
Queen Alexandra Hospital, Ophthalmology Department
Introduction: Safely removing a dropped intraocular lens (IOL) can be a challenging procedure. The ARTISAN
aphakic IOL (OPHTEC) implantation can be tricky and performed with different techniques.
Purpose: We demonstrate a technique where the dropped IOL is removed with no instrument contact and
minimal risk of injury. A less traumatic way of iris fixation of the ARTISAN lens is also demonstrated.
Method: A 23G pars-plana vitrectomy is performed. The dropped IOL is a single-piece acrylic lens, located at
the posterior pole. By injecting the heavy liquid, perfluorocarbon (Bausch&Lomb), the IOL is pushed to the
side of the vitreous cavity and flipped onto the already formed sheet of heavy liquid. Then it is floated up to
the pupillary level.
A self-sealing, 6mm corneal incision is constructed superiorly and two paracentesis at the positions of 3 and 9
o’clock. The IOL is removed through the pupil with the capsular forceps.
Healon GV is used and the ARTISAN lens is implanted and dialed at the appropriate position. A straight 23G
aspiration cannula is connected to the aspiration tube of the phacoemulsification machine. The lens is held
centrally and a vacuum is created to clip a precise and replicable amount of iris tissue between the haptics. A
peripheral iridectomy is performed and the corneal incision is closed with interrupted sutures.
Results: The dropped IOL was effectively and safely removed. The ARTISAN lens was implanted with minimal
iris manipulation.
Conclusion: The use of heavy liquid to flip and float up a dropped IOL is a safe and effective technique. The
vacuum enclavation system described with the ARTISAN lens is easy to perform with minimal iris injury and
inflammation.
13. Ultrathin (UT) DSAEK: a novel Non-double-pass technique
Paul Chua, Vikas Shankar, Aravind Reddy
Introduction: Ultrathin(UT) DSAEK achieves visual outcomes comparable to those of Descemet’s Membrane
Endothelial Keratoplasty (DMEK). Complexities of graft preparation and high detachment rates with DMEK
make UT-DSAEK a very promising technique. Double-pass technique described by Busin involves the use of
micro-keratome heads of various cut-depths and intra-operative micro-pachymetry
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Purpose: To describe a novel non-double-pass surgical technique to prepare an UT graft and to demonstrate
the technique of UT DSAEK
Method: The video describes the surgical technique in a step-wise manner including a list of the surgical
instruments and equipment needed
Results: This surgical technique has been used to prepare UT grafts over an 18-month period at Aberdeen
Royal Infirmary by a single surgeon (ARR). The mean graft thickness was 93.3 microns. The visual outcomes,
graft detachment rate and graft failure rates are comparable to UT grafts prepared with a double-pass
technique
Conclusion: This technique has the advantage to provide uniformly thin corneal grafts of thickness
<100microns that are easy to handle surgically. The surgical procedure is simple and cost-effective and does
not involve a steep learning curve
14. Subjugation of Black Nucleus by Intramural Phacoemulsification - a simplified technique
Mrinal Rana, Ranjeet Kishore Rana, Kunal Rana , Nidhi Mittal
Introduction: Black nuclei (Cataracta Nigra) differ in their enormous size, stony hard consistency, cohesive
leathery cortex, lax posterior capsule and zonular system. The phacoemulsification of black nucleus evokes
phobia because of high incidence of intraoperative complications and poor visual outcome.
Purpose: To evaluate the efficacy, safety and efficiency of a new simplified phacoemulsification technique
called Intramural phacoemulsification in successful fragmentation of black nucleus.
Method: 59 eyes of 59 patients who underwent phacoemulsification for cataracta nigra over a period of 2years
were retrospectively analyzed. Phacoemulsification was done with a modified 3 step technique- nuclearcavitation, intramural-chopping and intramural-fragmentation. Outcome was measured by successful surgery,
postoperative visual acuity and corneal status.
Results: Success rate was seen in 58 eyes (98.4%) with only 1 case (1.6%) showing a partial zonular
dehiscence. No case of tissue notching and fish mouthing of main incision seen. Stromal oedema was seen in
16 eyes (27%) in varying degrees, which resolved in 14/16 (87.5%) after 4 months and persisted causing
corneal decompensation in 2(12.5%). After 6 months the BCVA was 6/9 or better in 53 eyes (89.8%), 6/126/36 in 4 (6.8%) and 6/60 or worse in 2 (3.4%). Patients’ satisfaction was achieved in 57 patients (96.6%) due
to extremely poor pre-operative vision.
Conclusion: A successful phacoemulsification can be performed in black cataracts by ophthalmic surgeons
with reasonable skills. Phobia associated with phacoemulsification in such cases can be converted into
sensible fear by following a modified phacoemulsification technique to get a good outcome.
15. Descemet's stripping endothelial keratoplasty using needle-push on Fichman Glide
Robert Nadler, Rebecca Davie, Henry Perry , Tom Butler, Allon Barsam
Luton & Dunstable University Hospital
Introduction: There are various methods of inserting donor graft material during endothelial keratoplasty this
video shows a safe new technique in practice
Purpose: To describe a new technique for donor graft posterior lenticule insertion in Descemet’s stripping
endothelial keratoplasty
Method: Novel surgical technique for graft insertion using needle push resulting in minimal trauma to the
endothelial cells
Results: This video shows a safe new technique in practice
Conclusion: This video highlights an alternative method of introducing donor graft material into a patient
during endothelial keratoplasty. The advantages of which include no manipulation of the donor tissue is
required; it is very cost-effective when compared with many existing glide techniques. Also no infusion
cannula or sideport are needed as the infusion can be delivered via an introducing syringe with a 30 gauge
needle.
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Seminar Calendar 2014
THURSDAY 19TH &
FRIDAY 20TH JUNE 2014
SKILLS IN RETINAL IMAGING, DIAGNOSIS & THERAPY
Venue: Royal College of GPs, London
Chair: Professor Heinrich Heimann & Professor Yit Yang
FRIDAY 27TH JUNE 2014
GLOBAL OPHTHALMOLOGY
Venue: Royal College of Physicians, London
Chair: Mr. William Dean & Mr Saul Rajak
TUESDAY 16TH SEPTEMBER 2014
GLAUCOMA SURGERY – BALANCING SAFETY & SUCCESS
Venue: Royal College of Physicians, London
Chair: Mr. Nick Strouthidis
WEDNESDAY 24TH SEPTEMBER 2014
FRONTLINE NEURO-OPHTHALMOLOGY
Venue: University Hospital Birmingham
Chairs: Mr. Mike Burdon & Miss Susan Mollan
TUESDAY 7TH OCTOBER 2014
NIHR MASTER CLASS FOR INDUSTRY
SUPPORTED RESEARCH
Venue: RCOphth, London
Chair: Mr. Faruque Ghanchi
WEDNESDAY 15TH OCTOBER 2014
PAEDIATRIC RETINA
Venue: Royal College of Obs & Gynae, London
Chair: Mr. CK Patel
TUESDAY 18TH NOVEMBER 2014
HOW TO BE A RESEARCH ACTIVE OPHTHALMOLOGIST
Chair: Professor Andrew Lotery
FRIDAY 21ST NOVEMBER 2014
EYELID SURGERY FOR THE TEAR FILM
Chair: Mrs Carol Lane
FRIDAY 5TH DECEMBER 2014
ELIZABETH THOMAS SEMINAR
Venue: East Midland Conference Centre, Nottingham
Chair: Mr. Winfried Amoaku
Visit the website for programmes, information and registration www.rcophth.ac.uk/seminars
or contact us at [email protected] or telephone 020 7935 0702
Take action against VMT with JETREA®
r Vitreomacular traction (VMT), including macular hole (MH),
can be progressive and may put patients at risk of central
vision loss1–4
r To date, there have been only two options to treat VMT
and MH
– Watch and wait
– Vitrectomy
r JETREA® (ocriplasmin) Intravitreal (IVT) Injection is the first
and only pharmacological treatment of its kind5,6
JETREA®(ocriplasmin) is now approved by
NICE as an option for treating VMT in adults,
only if:
r an epiretinal membrane is not present and
r they have a stage II full-thickness MH with a diameter
of 400 micrometres or less
AND/OR
r they have severe symptoms
r This once only injection has been shown to provide
resolution of VMT in adults, including when associated
with MH of diameter ≤400 microns5,6
and
JETREA®
0.5mg/0.2ml concentrate for solution for
injection (ocriplasmin) Prescribing Information (Refer to full
Summary of Product Characteristics (SmPC) before prescribing)
Presentation: Type I glass vial containing 0.2ml concentrate for
solution for injection. After dilution with 0.2ml sodium chloride
0.9% solution for injection, 0.1ml of the diluted solution
contains 0.125mg ocriplasmin. Indication(s): Treatment
of vitreomacular traction (VMT) in adults, including when
associated with macular hole of diameter less than or equal
to 400 microns. Posology and method of administration:
Adults including the elderly: Intravitreal injection of
0.125mg (0.1ml of the diluted solution) to the affected eye
once only as a single dose. Children and adolescents: Not
recommended. Hepatic and renal impairment: No dosage
adjustment necessary. Contra-indications: Hypersensitivity
to ocriplasmin or any of the excipients. Active or suspected
ocular or periocular infections. Warnings and precautions:
Proper aseptic injection techniques must always be used
and patients should be monitored for any side effects such
as intraocular inflammation/infection and elevation in IOP.
Patients should be instructed to report symptoms of intraocular
inflammation/infection or any other visual/ocular symptoms
without delay. Concurrent administration to both eyes or
repeated administration in the same eye is not recommended.
Clinical data is not available on concomitant use with VEGFinhibitors. Treatment is not recommended in patients with a
large diameter macular hole, high myopia, aphakia, history of
rhegmatogenous retinal detachment, lens zonule instability,
recent ocular surgery or intraocular injection (including
laser therapy), proliferative diabetic retinopathy, ischaemic
retinopathies, retinal vein occlusions, exudative age-related
macular degeneration (AMD) and vitreous haemorrhage.
There is potential for lens subluxation or phacodonesis.
Exercise caution if treating patients with non-proliferative
diabetic retinopathy, history of uveitis or significant eye
trauma. Ocriplasmin efficacy is reduced in patients with an
epiretinal membrane or a diameter of VMA > 1500 microns.
Due to potential increase in tractional forces, there is a risk
of occurrence of new or enlarged macular holes. There is a risk
of significant but transient loss of visual acuity during the first
week after the injection. Interactions: Formal studies have not
been performed. Systemic interactions are not anticipated.
Administration in close temporal association, in the same eye
as other medicinal products may affect the activity of both
products and is not recommended. Pregnancy and lactation:
Do not use unless clearly necessary. Fertility: No fertility data
are available. Effects on ability to drive and use machines:
If visual disturbances occur, wait until vision clears before
driving or operating machinery. Undesirable effects: Very
common: vitreous floaters, eye pain, conjunctival haemorrhage.
Common: reduced visual acuity, visual impairment, blurred
vision, increased intraocular pressure, metamorphopsia,
conjunctival oedema, eyelid oedema, photopsia, conjunctival
hyperaemia, ocular hyperaemia, retinogram abnormal,
eye irritation, dry eye, foreign body sensation in eyes, eye
pruritus, ocular discomfort, photophobia, chromatopsia.
Serious: retinal haemorrhage, vitreous haemorrhage,
retinal tear, retinal detachment, macular hole, macular
degeneration, retinal degeneration, macular oedema,
retinal oedema, retinal pigment epitheliopathy, vitreous
adhesions, vitritis, anterior chamber cell, anterior chamber
flare, iritis, vitreous detachment, transient blindness, lens
subluxation, scotoma, visual field defect, hyphaema, pupils
unequal, corneal abrasion, anterior chamber inflammation.
In addition: diplopia, miosis, eye inflammation, conjunctival
irritation. Prescribers should consult the SmPC in
relation to the side effects. Overdose: Clinical data
are limited. If an overdose occurs, close monitoring is
recommended. Incompatibilities: Must not be mixed with
other medicinal products except for the specified diluent.
Special Precautions for Storage: Store frozen at –20°C ±5°C.
Legal Category: POM. Package Quantities and Basic NHS
Costs: 1 x 0.2ml vial £2,500. Ireland Price: €3,099. MA
Number(s): EU/1/13/819/001. Further information available
from the MA holder: ThromboGenics NV, Gaston Geenslaan 1,
B-3001 Leuven, Belgium. Distributor: Alcon Laboratories (UK)
Limited, Frimley Business Park, Frimley, Camberley, Surrey,
GU16 7SR. Date of preparation: June 2013 (V2).
References: 1. Jaffe NS. Vitreous traction at the
posterior pole of the fundus due to alterations in
the vitreous posterior. Trans Am Acad Ophthalmol
Otolaryngol. 1967; 71(4):642–652. 2. Reese AB et
al. Macular changes secondary to vitreous traction.
Tr Am Ophth Soc. 1966; 64:123–134. 3. Akiba
J et al. Risk of developing a macular hole. Arch
Ophthalmol. 1990; 108:1088–1090. 4. Sebag J, Wang
MY. Combined spectral-domain optical coherence
tomography/scanning laser ophthalmoscopy imaging
of vitreous and the vitreo-retinal interface. In:
Holz FG, Spaide RF, eds. Medical Retina: Focus on
Retinal Imaging. Berlin, Germany: Springer-Verlag;
2010; 157–168. 5. JETREA® Summary of Product
Characteristics. ThromboGenics NV. Belgium; January
2013. 6. Stalmans P et al. Enzymatic vitreolysis with
ocriplasmin for vitreomacular traction and macular
holes. N Engl J Med. 2012; 367:606– 615.
Adverse events should be reported. Reporting forms and
information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to Alcon Medical
Information. Tel: 0871 376 1402. Email: [email protected]
(ocriplasmin)
Concentrate for solution
for injection, 0.5mg/0.2ml
©2014 Novartis JETREA is a registered trademark of ThromboGenics N.V, licensed to Alcon.
Date of publication: January 2014 JET/OCR: HCP 002:03/14:AL

flex - the Royal College of Ophthalmologists

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