Eyeworld

131 March 2016 EW MEETING REPORTER Also competing in the Olympics session was the Asia-Pacific team featuring Gerard Sutton, MD, Australia, Mohan Rajan, MD, India, Arup Chakrabarti, MD, Thiruva- nanthapuram, India, and Tetsuro Oshika, MD, Tokyo, Japan. David Chang, MD, San Fran- cisco, and Abhay Vasavada, MD, Ahmedabad, India, moderated the inaugural Olympics session. Latin American ophthalmologists, researchers aim to reach more visually impaired patients Latin American ophthalmologists must grapple with the changing challenges of blindness and visual impairment, particularly among poorer regions, said speakers at "The Challenge of Screening, Treating, and Training for DR, Glaucoma and AMD in Latin America." The prevalence of blindness in Latin America is 0.7% to 3% depend- ing on the country, said Juan Carlos Silva, MD, Bogotá, Colombia, of the Pan-American Health Organization and World Health Organization. The leading causes of blindness are cataracts (44% to 63%), glaucoma (10% to 15%), and diabetic retinop- athy (0% to 16%), Dr. Silva reported. As one might expect, blindness and visual impairment are more likely to affect poorer people with lower levels of literacy and education, Dr. Silva said. However, some countries, such as Paraguay, have made prog- ress in their treatment for patients with eye disease. One change the researchers have seen in recent years is the growth in diabetes, which can obviously affect the eyes as well. Some challenges in the coming years will be the changing epidemi- ological profile of blindness/visual impairment, strengthening the public sector to reach the poor, and getting more ophthalmologists into rural and other areas. "There are still areas that don't have any ophthal- mologists, which is incredible," Dr. Silva said in Spanish. Programs must also focus on incorporating eyecare throughout the continuum of life, including neonatal care, school health, and among adults, he said. Enrique Graue-Hernández, MD, Mexico City, outlined the 10 strategies used by the Prevention of Blindness Committee in Mexi- co. The committee, which began in 2009, plays an advisory role in helping to treat eye disease as 80% of blindness causes can be prevent- ed, said Dr. Graue-Hernández, citing information from the World Health Organization. Some strategies used by the committee include the creation of a National Registry System of Ocular Diseases, screening of refractive errors in children, screening for retinopathy of prematurity, and improving the National Registry of Corneal Transplants. One trend the committee has seen is the growth of diabetes in Mexico, which now affects a sizable chunk of the population. Although better diabetic retinopathy screen- ing is a goal of the committee, such screening is currently suboptimal, Dr. Graue-Hernández said. Pedro Gómez Bastar, MD, Montemorelos, Mexico, focused on the results of population-based rapid assessment of avoidable blindness studies in Mexico and presented data from 3 analyses, 2 done in the state of Nuevo Leon in 2005 and 2014 and 1 done in Chiapas in 2015. Two of the studies have results published in the British Journal of Ophthalmology. The third is in the process of being published. The studies revealed a blindness prevalence of 1.5% in Nuevo Leon and 2.3% in Chiapas. Blindness from cataract was 32% in the most recent Nuevo Leon study and 63% in the Chiapas study. The prevalence of diabetic retinopathy was 16.3% in Nuevo Leon versus 36.2% in Chiapas; the lower number in Nuevo Leon is likely due to better access to care and medicines, Dr. Gómez Bastar said. The studies identified better quality cataract care at charity and private hospitals compared with government hospitals. With 20% to 30% of diabetics having diabetic retinopathy and a rise of type 2 diabetes in Mexi- co, further analyses must focus on tracking and preventing these health problems. Going forward, clinicians and researchers should also consider how to improve the quality of cataract surgery and how to reduce its cost, Dr. Gómez Bastar said. Tips for using CTRs In "IOL Fixation with Deficient Capsular Support," Alan Crandall, MD, Salt Lake City, shared "the original" information on capsular tension rings (CTR). CTRs were designed to maintain the capsule's contour and stretch the posterior capsule when there is zonular dehiscence or a rupture occurs after blunt or penetrating injury or surgical trauma, he said, or when inherent zonular weakness is present. "The original CTR came in a number of different sizes," Dr. Crandall said. "The CTR can be inserted at any point during the surgery depending on what your surgical need is at the time," he added. To insert the CTR, a Geuder injector or manual insertion may be used. Grieshaber iris hooks may be needed to suspend the bag prior to insertion of the CTR, Dr. Crandall said. Additional- ly, slow motion phaco is necessary, and cortical cleanup may be more difficult in the presence of a CTR. A Cionni CTR requires suture fixation with 9-0 prolene or GORE-TEX, he added. A complete cortical cleaving hydrodissection and removal of the anterior cortex with I/A is necessary if placing a CTR prior to phaco, Dr. Crandall said. There are a number of instances where a CTR may be appropriate. These indications include with pseu- doexfoliation, high myopia, previ- ous ocular trauma, post vitrectomy, previous glaucoma filtration surgery, previous RK, and intraoperative zonular damage. In terms of the mechanism of the CTR, Dr. Crandall said "the ring diameter is greater than the capsu- lar bag." This puts the force on the fornix, he said, and distributes focal forces circumferentially. This facili- tates surgery and promotes early and late IOL centration. Dr. Crandall offered clinical tips for inserting the ring. Fractionate the anterior chamber with viscoelas- tic, he recommended. "If you have known areas of weakness, it's better to start your tear toward the area of weakness," he said. If you go toward the defect, you're utilizing the good zonules, Dr. Crandall added. On an average day, he might use 5 to 6 CTRs. EW Now online ... Watch the experts discuss clinical tips & techniques filmed live at WOC 2016 www.EWrePlay.org

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