Eyeworld

Reporting from the Asia-Pacific Academy of Ophthalmology (APAO) Congress 2016, March 24–27, Taipei, Taiwan EW MEETING REPORTER 172 The overall prevalence of blindness in the country is 1.53%, Dr. Hossain said, which includes 675,000 blind adults. There is no formal health insurance system in Bangladesh and only about 1,000 ophthalmologists. Strategies for tackling these issues include strengthening advo- cacy, infrastructure and technolo- gy development, human resource development, reducing disease burden, improving coordination and partnerships with GOs and NGOs, and monitoring and evaluation. There are a number of oppor- tunities in the country, Dr. Hossain said, such as improvement of the cataract surgical rate, introduction of free cataract surgery in public district hospitals, side financing in eyecare in the public sector for the poor, the National Childhood Blindness Reduction Program, and introducing vision centers in select- ed sub-district public health facilities and private hospitals. Some of the many challenges, however, include inadequate human resources and infrastructures in hard to reach/underserved areas of the country, retaining skilled eyecare providers at the rural level, mainte- nance of eyecare equipment at sec- ondary and primary eyecare service centers, and under utilization of the Department of Ophthalmology of the academic institutions. direct impact of ultrasonic energy, and indirect impact by free radicals. For endothelial protection, Dr. Tjia said to cover the endothelium with dispersive viscoelastic, which coats and protects the cornea. He rec- ommended reinstalling the visco- elastic barrier as often as required by injecting dispersive viscoelastic underneath the cornea. Injecting viscoelastic more often than needed will not do any harm, he added. In terms of a surgical strategy, Dr. Tjia said to choose a technique to reduce the risk of affecting the visco barrier. Phaco away from the cornea as much as possible, he said, and do "in the bag" phaco. Dr. Tjia also offered tips on fluidics settings in these cases. He cautioned to be aware of aspirated air. Editors' note: Dr. Tjia has no related financial interests. Prevention of blindness During a session focusing on chal- lenges and opportunities of blind- ness prevention in the Asia-Pacific region, Ava Hossain, MD, Bangla- desh, gave the Arthur Lim Award Lecture on "Strategy, Challenges, and Opportunities of the National Eye Care Program of Bangladesh." She discussed the government health care system in Bangladesh, as well as strategies, opportunities, and challenges in the country. Toric calculators Toric IOLs have become the stan- dard of care in cataract surgery, said Arup Chakrabarti, MD, Kerala, India, and toric calculators play a significant role when implanting these lenses. How do surgeons decide which toric calculator to use? Dr. Chakrabarti detailed some of the desirable elements of a toric calcu- lator. First, he said that it should be comprehensive in order to meet all toric needs. This includes having options for preoperative planning and refractive surprise analysis. Also look for one that is resi- dent on the biometric device, he said, because it is more convenient and user friendly. Another feature that is important is universality, he said, which means that it would be able to calculate the toric power for all the popular toric lenses that are available globally. According to Dr. Chakrabarti, there are 3 popular calculators that meet this criteria: Assort, Barrett, and Holladay. The fourth important factor is for the toric calculator to have a dynamic display of the calcula- tor variables. Other key elements are alert on axis flip, factoring in the influence of AL and K on the astigmatic power of the toric IOL, and factoring in posterior corneal astigmatism. Finally, Dr. Chakrabarti said that the toric calculator should be accurate and reliable. Editors' note: Dr. Chakrabarti has no related financial interests. European approach to difficult cataract surgical conditions A European Society of Ophthalmolo- gy symposium highlighted European approaches to difficult cataract sur- gical conditions. Khiun Tjia, MD, Zwolle, the Netherlands, highlighted cataract surgery in the presence of a compromised cornea. With a compromised cornea, there may be endothelial dystrophy, but the patient is not yet eligible for a procedure like DMEK or DSEK, he said. The main focus should be to protect that fragile cornea endothe- lium. Endothelial damage may be caused by excessive fluid streams, April 2016 View videos from APAO 2016: EWrePlay.org Kathryn Rose, MD, discusses risk factors for the development of myopia and population level impacts.

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