Clinical & Experimental Ophthalmology

Volume 47, Supplement 1, November 2019

ISSN 1442-6404

The Royal Australian and New Zealand College of Ophthalmologists

51st Annual Scientiﬁc Congress

8 – 12 November 2019

International Convention Centre (ICC), Sydney

PROGRAM AND ABSTRACTS The Royal Australian and New Zealand College of Ophthalmologists

51st Annual Scientific Congress

8 – 12 November 2019

International Convention Centre (ICC), Sydney

PROGRAM AND ABSTRACTS

CEO_13622.indd 715 10/22/19 2:27 PM Clinical & Experimental Ophthalmology

The Royal Australian and New Zealand College of Ophthalmologists 51st Annual Scientific Congress 8 – 12 November 2019

Contents Volume 47 Supplement 1 November 2019 Committees ...... 3

Past Lecturers and Briefs for the Named Lectures: RANZCO Annual Scientific Congress ...... 4

Scientific Program ...... 8

Invited Speakers ...... 15

Saturday 09 November ...... 24 Speakers, Symposia, Courses and Free Papers Abstracts

Sunday 10 November ...... 39 Speakers, Symposia, Courses, and Free Papers Abstracts

Monday 11 November ...... 57 Speakers, Symposia, Courses, and Free Papers Abstracts

Tuesday 12 November ...... 76 Speakers and Symposia

Film Abstracts ...... 78 Films will be shown throughout the Congress and during the Film and Poster Viewing Session at 5:30 – 6:30pm on Sunday 10 November 2019.

Poster Abstracts ...... 82 Principal authors will be available to discuss their posters at the Film and Poster Viewing Session at 5:30 – 6:30pm on Sunday 10 November 2019 and during the times listed on their poster cards.

Author Index ...... 165

The contents contained herein are correct at the time of printing and may be subject to change.

This abstract supplement has been produced using author-supplied copy. Editing has been restricted to some corrections for spelling and style where appropriate. No responsibility is assumed for any claims, instructions, methods or drug dosages contained in the abstracts: it is recommended that these are verified independently.

CEO_13622.indd 716 10/22/19 2:27 PM DOI: 10.1111/ceo.13623

The Royal Australian and New Zealand College of Ophthalmologists 51st Annual Scientific Congress

8 – 12 November 2019

International Convention Centre (ICC), Sydney

ORGANISING COMMITTEE SCIENTIFIC PROGRAM COMMITTEE – REVIEWERS Dr Andrew Chang (Congress Convenor) Dr Clare Fraser Dr Alina Zeldovich (Congress Convenor) Dr Graham-Hay Smith Ms Sarah Stedman (RANZCO) Prof Alex Hewitt Mrs Alex Arancibia (RANZCO) Dr Amy Cohn Ms Denise Broeren (Think Business Events) Dr Andrea Ang Dr Simon Skalicky SCIENTIFIC PROGRAM COMMITTEE – EXECUTIVE Dr Mei Hong Tan Dr Colin Clement Dr Christine Younan (Chair) Dr Adrian Fung A/Prof Shuan Dai Prof Helen Danesh-Meyer A/Prof Samantha Fraser-Bell Prof Tim Sullivan Dr Elsie Chan Prof Gerard Sutton RANZCO CONGRESS ORGANISERS Dr Brett O'Donnell Dr Ridia Lim Think Business Events A/Prof James Elder Level 1, 299 Elizabeth St A/Prof Andrew Symons Sydney NSW 2000 A/Prof Nitin Verma (RANZCO Board) Tel: +61 2 8251 0045 A/Prof Heather Mack (RANZCO President) Fax: +61 2 8251 0097 Email: [email protected]

Clin Experiment Ophthalmol. 2019;47 (Supp 1):3. wileyonlinelibrary.com/journal/ceo 3 DOI: 10.1111/ceo.13624

Past Lecturers and Briefs For the Named Lectures: RANZCO Annual Scientific Congress

1. THE NORMAN MCALISTER GREGG LECTURE (ESTABLISHED 1958)

The Norman McAlister Gregg Lecture was established by the Council of the Ophthalmological Society of Australia in recognition of the outstanding contribution made to ophthalmology by Sir Norman Gregg. The lecture covers a clinical topic that has clinical relevance and may cover some facet of work not previously published. The lecture becomes the property of the College. A “Gregg Medal” has been struck and is presented, together with a certificate, to the lecturer at the conclusion of the lecture.

1961 Sir Lorimer Dodds 1964 Prof Ida Mann 1967 Prof Ramon Castroviejo 1970 Prof Lorenz E Zimmerman 1973 Prof Gustav Nossal 1975 Prof William F Hoyt 1981 Prof Robert M Ellsworth 1984 Prof Barrie Jones 1986 Dr Thomas Mandel 1987 Prof Ian Constable 1988 Prof Colin Blakemore 1989 Dr R Machemer 1990 Prof Ian Gust 1991 Prof Doug Coster 1992 Prof Stephen Drance 1994 Prof Harry A Quigley 1995 Prof Richard Larkins 1996 Prof George Waring 1997 Prof Susan Lightman 1998 Prof Richard Collin 1999 Prof Edward Stone 2000 Prof Stuart Fine 2000 Prof Yasuo Tano 2001 Mr John Hungerford 2002 Justice Michael Kirby 2003 Prof Caroline MacEwan 2005 A/Prof David Mackey 2006 Prof David Apple 2007 Prof Jost B Jonas

4 wileyonlinelibrary.com/journal/ceo Clin Experiment Ophthalmol. 2019;47 (Supp 1):4–7. 51ST ANNUAL SCIENTIFIC CONGRESS 5

2008 Prof Charles McGhee 2009 Mr Geoffrey Rose 2010 Prof Paul Mitchell 2011 Prof Elizabeth Engle 2012 Prof Brenda Gallie 2013 Dr David Chang 2014 Prof Hugh R Taylor AC 2015 Prof Peter McCluskey 2016 Prof Denis Wakefield AO 2017 Dr Noel Alpins AM 2018 Prof Robyn Guymer AM 2019 Prof Tien Y Wong

2. THE COUNCIL LECTURE (ESTABLISHED 1963)

The Council Lecture was established to honour members (Fellows) engaged in original work, or to establish a means whereby members may receive an authoritative and distinguished paper on a subject of which the lecturer has particular experience or knowledge. The lecture becomes the property of the College. A certificate is presented to the lecturer at the conclusion of the lecture.

1963 Dr Adrian Lamb 1965 Dr David Waterworth 1965 Dr KG Howsam (OSA) 1967 Dr EJ Donaldson 1967 Dr R Hertzberg 1968 Dr W Deane-Butcher 1969 Dr a'B Travers (ACO) 1970 Dr PA Rogers 1971 Dr Ronald Lowe 1973 Dr R Hertzberg 1975 Dr JW Hornbrook 1979 Dr Shirley Sarks 1980 Dr CH Greer 1981 Dr BG Wilson 1982 Dr JEK Galbraith 1984 A/Prof Fred C Hollows 1985 Prof Frank A Billson 1986 Dr Bruce Crawford 1987 Dr Peter J Graham 1988 Dr Alex Hunyor 1990 Dr BD Coote 1991 Prof Fred Hollows 1992 Dr Frank Taylor 1993 Dr Gordon Wise 1994 Prof Hugh R Taylor 1995 Dr Bill Gillies 1996 Prof Richard Cooper 1997 Dr David Moran 6

1998 Dr Mark Harrison 1999 A/Prof David Mackey 2000 A/Prof Peter McCluskey 2001 Dr Jamie La Nauze 2002 Professor Tony Molteno 2003 A/Prof Mark Elder 2004 Dr Alan McNab 2005 Dr Bill Glasson 2006 A/Prof Robyn Guymer 2007 A/Prof Helen Danesh-Meyer 2008 A/Prof Robert Casson 2009 A/Prof Timothy Sullivan 2010 Dr Noel Alpins 2011 Dr Stephen Best 2012 Prof Mark Gillies 2013 A/Prof Julian Rait 2014 A/Prof Mark D Daniell 2015 A/Prof John Grigg 2016 Prof Gerard Sutton 2017 Prof Jonathan Crowston 2018 Prof Stephanie Watson 2019 A/Prof Penelope Allen

3. THE DAME IDA MANN MEMORIAL LECTURE (ESTABLISHED 1988)

The Dame Ida Mann Memorial Lecture was established by the Council of the College in recognition of the outstanding contribution made to ophthalmology by Dame Ida Mann. The presentation shall cover an important topic that is oriented to the basic sciences of ophthalmology with clinical relevance. Questions or discussion will form no part of the proceedings. The lecture becomes the property of the College. A certificate is presented to the lecturer at the conclusion of the lecture.

1988 Prof John D Pettique 1989 Dr D Potter 1991 Dr Adam Locket 1992 Dr Mark Florence 1993 Dr Robert Buttery 1995 Prof Trevor Lamb 1996 Prof Val Alder 1997 Prof Ian Constable 1998 A/Prof Denis Stark 1999 Dr Kerryn Williams 2000 Prof Charles McGhee 2001 Prof Grant Sutherland 2002 Dr Ian Morgan 2003 Prof Harminder Dua 2004 Dr Stuart Graham 2005 Dr Peter Kaiser 2006 Prof Harry Quigley 2007 Prof Paul McMenamin 51ST ANNUAL SCIENTIFIC CONGRESS 7

2008 Prof John McAvoy 2009 Prof Jonathan Crowston 2010 A/Prof Jamie Craig 2011 Prof Justine Smith 2012 Prof Colin Green 2013 Prof Jan Provis 2014 Prof Minas T Coroneo 2015 Prof Dao-Yi Yu 2016 Prof Maarten P Mourits 2017 Prof Trevor Sherwin 2018 Dr Russell Van Gelder 2019 Prof John Marshall

4. THE FRED HOLLOWS LECTURE (ESTABLISHED 1999)

The Fred Hollows Lecture was instituted to recognise the work Professor Fred Hollows did with indigenous people and in raising the profile of ophthalmology. The presentation will address a topic of applied public health research with a community focus. The lecture becomes the property of the College. A certificate is presented to the lecturer at the conclusion of the lecture.

1999 Dr William Morgan 2000 A/Prof Paul Mitchell 2001 A/Prof Glen Gole 2002 Prof John Mathews 2003 Dr Ivan Goldberg 2004 Dr AR Moodie 2005 Prof Ravi Thomas 2006 Prof Minas Coroneo 2007 Prof Lyle Palmer 2008 Prof Hugh R Taylor AC 2009 Dr Mark Loane 2010 A/Prof Henry Newland 2011 Prof Jill Keeffe OAM 2012 Prof Geoffrey Tabin 2013 A/Prof Nitin Verma 2014 Dr Garry Brian 2015 Dr Neil Murray 2016 Dr James Muecke 2017 Dr Geoffrey Cohn OAM 2018 A/Prof Angus Turner 2019 Dr Anasaini Cama DOI: 10.1111/ceo.13625 Scientific Program

SATURDAY 9 NOVEMBER

0645-0800 Allergan Hosted Morning Symposium Venue: C4.5

0830-1000 ANNUAL GENERAL MEETINGS Venue: Darling Harbour Theatre

0830-0900 Australian Society of Ophthalmologists (ASO) AGM

0900–0930 Royal Australian and New Zealand College of Ophthalmologists (RANZCO) AGM

0930-1000 Ophthalmic Research Institute of Australia (ORIA) AGM

1000-1030 Morning Tea

1030-1100 RANZCO CONGRESS OPENING LECTURE Prof Lisa Harvey-Smith Venue: Darling Harbour Theatre Topic: Eyes on the Skies: How Astronomy is Transforming our Vision of the Universe Chair: Dr Christine Younan

1100-1130 THE NORMAN MCALISTER GREGG LECTURE Prof Tien Y Wong Venue: Darling Harbour Theatre Topic: Artificial Intelligence in Ophthalmology: Concepts, Progress, Challenges and Myths Chair: Prof Stephanie Watson

1130-1200 PAEDIATRICS UPDATE LECTURE Prof David A Plager Venue: Darling Harbour Theatre Topic: IOL Use in Children Under Age 2 Years – What Have we Learned? Chair: A/Prof James Elder

1200-1330 Lunch

1330-1500 CONCURRENT SESSIONS

COURSE – Teaching and Learning Cataract Surgery Venue: C4.1 Chair: Dr Jacqueline Beltz

SYMPOSIUM – Neuro-Ophthalmic Emergencies: Help! It’s a Neuro Patient, What Do I Do Now? Venue: Darling Harbour Theatre Chairs: A/Prof Celia Chen and A/Prof Clare Fraser

8 wileyonlinelibrary.com/journal/ceo Clin Experiment Ophthalmol. 2019;47 (Supp 1):8–14. SCIENTIFIC PROGRAM 9

SYMPOSIUM – Ocular Manifestation of Genetic Syndromic Diseases: When to Look Beyond the Eyes? Venue: C4.4 Chairs: Prof Alex Hewitt and Dr Fred Chen

SYMPOSIUM – Emerging Therapies in Retinal Diseases: the Bionic Retina, Gene Therapy and Stem Cells Venue: C4.5 Chair: A/Prof Matthew Simunovic

FREE PAPERS – Glaucoma Venue: C4.6 – C4.7 Chairs: Dr Stephen Best and A/Prof Anne Brooks

1500-1530 Afternoon Tea

1530-1700 CONCURRENT SESSIONS

SYMPOSIUM – Posterior Capsule Rupture Management and IOL Options in Compromised Capsule Support Venue: C4.1 Chair: Dr Minu Mathen

COURSE – Ocular Oncology Update: Catching the Rare Killers and Troublesome Spots Venue: C4.4 Chair: Dr Michael Giblin

SYMPOSIUM – Diabetic Retinopathy - Integrating Care for Diabetes and Eye Health (Local and International Perspectives) Venue: Darling Harbour Theatre Chairs: Dr Anthony Bennett-Hall, Dr Jennifer Arnold and Dr Sophia Zagora

SYMPOSIUM – Paediatric Retina in a Nutshell 2019 Venue: C4.5 Chairs: Prof Glen Gole and A/Prof Geoff Lam

FREE PAPERS – Anterior Segment Venue: C4.6 – C4.7 Chairs: Dr Elaine Chong and Dr Richard Mills

1700-1745 Pre Drinks for Graduation and Awards Ceremoney and President's Reception Venue: Parkside Ballroom, International Convention Centre

1745-1915 Graduation and Awards Ceremony and President’s Reception Venue: Parkside Ballroom, International Convention Centre

1915 Zeiss Hosted Evening Symposium Venue: International Convention Centre 10 SCIENTIFIC PROGRAM

SUNDAY 10 NOVEMBER 0645-0800 Bayer Hosted Morning Symposium Venue: C4.5

0830-1000 PLENARY Best Paper Presentations: Gerard Crock and John Parr Trophies Venue: Darling Harbour Theatre Chairs: A/Prof Heather Mack and Dr Christine Younan

1000-1030 Morning Tea

1030-1100 RETINA UPDATE LECTURE Dr Emily Y Chew Venue: Darling Harbour Theatre Topic: Macular Telangiectasia Type 2, an Update of the Mac Tel Research Group, a 15-Year Journey from an Exam to Global Connections Chair: A/Prof Samantha Fraser-Bell

1100-1130 THE COUNCIL LECTURE A/Prof Penelope Allen Venue: Darling Harbour Theatre Topic: The Path to an Australian Bionic Eye Chair: Dr Diana Semmonds

1130-1230 PLENARY – ORIA UPDATE Venue: Darling Harbour Theatre Chair: Prof Mark Gillies

1230–1400 Lunch

1400-1530 CONCURRENT SESSIONS

SYMPOSIUM – RANZCO, Past, Present and Future Venue: C4.9 Chairs: A/Prof Heather Mack and Dr Justin Mora

SYMPOSIUM – ANZGS Symposium 2019: When Worlds Collide - Approaching Glaucoma from a Different Perspective (Part 2) Venue: Darling Harbour Theatre Chair: A/Prof Graham Lee Co-Chairs: Dr Ridia Lim, A/Prof Anne Brooks, Dr Guy D'Mellow and Prof David (Ted) Garway-Heath

SYMPOSIUM – Multimodal Assessment (MMA) for Diagnosis, Management and Prognostication of Retinal and Macular Disease Venue: C4.1 Chairs: A/Prof Nitin Verma AM and Prof Peter McCluskey

COURSE – Neuro-Ophthalmology Challenges: Survival Guide to Diagnosing and Managing Neuro- Ophthalmic Conditions Venue: C4.4 Chair: Prof Helen Danesh-Meyer SCIENTIFIC PROGRAM 11

FREE PAPERS – Cataract / Ocular Oncology Venue: C4.6 – C4.7 Chairs: Dr Li-Anne Lim and Prof Charles McGhee

1530-1600 Afternoon Tea

1600-1730 CONCURRENT SESSIONS

COURSE – Microtribes, Immunotribes: Microbiomes and Microbes in Ocular Infection, Autoinflammation and Autoimmunity. How Immune Make-up Determines our Microbial Self. How one Microbe Triggers Many Ocular Diseases. When to Fight the Bugs and How to Manage the Inflammation Venue: C4.1 Chairs: Dr Jo Richards and Dr Sophia Zagora

SYMPOSIUM – Tackling Presbyopia with IOLs for the Cataract Surgeon Venue: C4.4 Chair: Dr Con Moshegov

COURSE – Update on Microbial Keratitis Venue: Darling Harbour Theatre Chair: Dr Matthew Green

COURSE – Strabismus Case Studies: Diagnosis and Management Strategies Venue: C4.5 Chairs: A/Prof Shuan Dai and A/Prof Geoff Lam

FREE PAPERS – Epidemiology / Genetics / Oculoplastic Venue: C4.6 – C4.7 Chairs: A/Prof Andrea Vincent and Prof Tim Sullivan

LDP Session Convenor: Dr Catherine Green AO Room: C4.9

1730-1830 Film and Poster Viewing Session Venue: Foyer, Level 4, International Convention Centre

1830-2130 Alcon Hosted Evening Symposium Venue: Ballroom, Sofitel

MONDAY 11 NOVEMBER 0645-0800 Novartis Hosted Morning Symposium Venue: C4.5

0830-1000 PLENARY Clinical Controversies Venue: Darling Harbour Theatre Chair: Dr Brad Horsburgh 12 SCIENTIFIC PROGRAM

1000-1030 Morning Tea

1030-1100 CATARACT UPDATE LECTURE Prof Soon-Phaik Chee Venue: Darling Harbour Theatre Topic: State-of-the Art Intraocular Lens Fixation Chair: Dr Elsie Chan

1100-1130 THE FRED HOLLOWS LECTURE Dr Anasaini Cama Venue: Darling Harbour Theatre Topic: Hollows Influence: Research, Programs and Universal Eye Health Coverage in the Pacific Chair: A/Prof Nitin Verma AM

1130-1230 RANZCO PLENARY Launch of the RANZCO Reconciliation Action Plan Venue: Darling Harbour Theatre

1230-1400 Lunch

1400-1530 CONCURRENT SESSIONS

SYMPOSIUM – International Development: The Continuing Challenge. To Inform and Challenge Those Involved or Interested in Working in Low Resource Countries Venue: C4.1 Convenors: Dr Mark Ellis and A/Prof Geoffrey Painter

COURSE – Controversies in Cataract Surgery Venue: C4.4 Moderator: Dr Elsie Chan Panellist: Dr Rosie Dawkins

SYMPOSIUM – Cataract Surgery and the Cornea: Pre-Operative Management and Post-Operative Considerations Venue: Darling Harbour Theatre Chairs: Dr Jacqueline Beltz and Prof Bennie Jeng

SYMPOSIUM – Thyroid Eye Disease Management in a Multi-Disciplinary Clinic Venue: C4.5 Chair: A/Prof Raf Ghabrial

FREE PAPERS – Retina / Uveitis Venue: C4.6 – C4.7 Chairs: A/Prof Andrew Symons and Dr Jo Sims

1530-1600 Afternoon Tea

1600-1730 CONCURRENT SESSIONS

COURSE – OCT Angiography in Neovascular Age-Related Macular Degeneration and Diabetic Reti- nopathy - How to Interpret and Use this New Technology Venue: C4.4 Chair: Prof Paul Mitchell AO SCIENTIFIC PROGRAM 13

SYMPOSIUM – Artificial Intelligence Will Replace Ophthalmologists in the Future: Fact or Fiction? Venue: C4.5 Chair: A/Prof Nitin Verma AM Co-Chairs: Dr Andrew Crawford and A/Prof Peter Van Wijngaarden

SYMPOSIUM – Management of Herpetic Eye Disease Venue: Darling Harbour Theatre Chairs: Dr Jo Sims and A/Prof Lyndell Lim

FREE PAPERS – CPD Audit Venue: C4.1 Chair: Dr Sukhpal Sandhu Co-Chairs: Dr Jennifer Fan Gaskin, Dr Alok Sharma and Dr Andrea Ang Panel: Dr Sukhpal Sandhu, Dr Jennifer Fan Gaskin, Dr Alok Sharma, Dr Andrea Ang and Dr Anasaini Cama

FREE PAPERS – Paediatrics / Strabismus / Neuro-Ophthalmology Venue: C4.6 – C4.7 Chairs: A/Prof Shuan Dai and Prof Helen Danesh-Meyer

1900-2300 Congress Dinner Venue: Doltone House

TUESDAY 12 NOVEMBER 0645-0800 ANZGS Morning Symposium sponsored by Allergan Prof David (Ted) Garway-Heath Title: Corneal Biomechanics: Do They Really Matter? Venue: Room C4.5 Chair: A/Prof Anne Brooks

0830-1000 PLENARY SYMPOSIUM Normal Tension Glaucoma: An Update on Current Management and Future Directions Venue: Darling Harbour Theatre Chair: A/Prof Mitchell Lawlor

1000-1030 Morning Tea

1030–1100 GLAUCOMA UPDATE LECTURE Prof David (Ted) Garway-Heath Venue: Darling Harbour Theatre Topic: Lessons from the United Kingdom Glaucoma Treatment Study (UKGTS) and Laser In Glaucoma and Ocular HyperTension (LiGHT) Study Chair: Dr Ridia Lim

1100-1130 THE DAME IDA MANN MEMORIAL LECTURE Prof John Marshall Venue: Darling Harbour Theatre Topic: Light and the Eye: Chronic Insult or Therapeutic Dream? Chair: Prof Gerard Sutton 14 SCIENTIFIC PROGRAM

1130-1200 OCULOPLASTICS UPDATE LECTURE Dr Santosh G Honavar Venue: Darling Harbour Theatre Topic: Oculoplasty and Ocular Oncology – What New am I Doing this Year? Chair: Dr Brett O’Donnell DOI: 10.1111/ceo.13626 Invited Speakers

L01: RANZCO CONGRESS OPENING LECTURE, significant interest and shown substantial potential to be used SATURDAY 9 NOVEMBER 2019 to address a range of healthcare and clinical problems. The application of AI and DL techniques in ophthalmology have Prof Lisa Harvey-Smith been increasing, and include screening and diagnosis of major eye diseases such as diabetic retinopathy (DR), age-related Eyes on the Skies: How Astronomy Is macular degeneration (AMD) and glaucoma, applied to Transforming Our Cision of the Universe datasets that include retinal photographs, optical coherence tomography (OCT) scans and clinical data. Compared to older Synopsis: technology using traditional “pattern recognition” techniques to detect specific patterns, DL uses much larger datasets and a In this talk she describes how Australian convoluted neural networks (CNN or “black box”) approach to astronomers are leading the world in creating mine, extract and learn patterns and/or features to determine a innovative new “eyes” through which to study the universe disease state or condition. Recently, researchers from Google and how artificial intelligence and supercomputers are part using DL learning technology have reported high sensitivity of that incredible journey. and specificity in detecting referable DR from retinal photographs, and another group has had a DL algorithm for DR Brief Curriculum Vitae: screening that has had FDA approval. For translational impact, Prof Lisa Harvey-Smith is an astronomer, author of “When AI and DL technology should be validated in “real-world” clin- Galaxies Collide” and a popular public speaker, based at the ical settings, where datasets and images have varying qualities, University of New South Wales. She has a national role in pro- and in patient populations of different characteristics and eth- moting inclusion in science and technology as the Australian nicity. Even as AI technology evolves and becomes increas- Government's Women in STEM Ambassador. Lisa has pres- ingly popular, with performance approaching and surpassing ented major television series including Stargazing Live on the human-level specialists performance, there remain significant ABC. Her first book for children, “Under the Stars: Astrophys- technical, clinical and medico-legal challenges in the field, ics for Bedtime” launches on 1 October 2019. including overcoming “black box” phenomenon, which may prevent AI and DL systems from easy translation from the lab- Contact Details: oratory to real-world clinical practice, and patient and physician acceptance issues. There continues to be myths surrounding University of New South Wales, Australia. AI. Understanding these issues and challenges are critical for Email: [email protected] physicians, researchers, health administrators and policy makers to embrace and use AI in ophthalmology.

L02: THE NORMAN MCALISTER GREGG Brief Curriculum Vitae: LECTURE, SATURDAY 9 NOVEMBER 2019 Prof Wong is Provost Chair Professor of Ophthalmology and Medical Director of SNEC, one of the largest tertiary Prof Tien Y. Wong MBBS, FRANZCO, FRCSE, MPH, PhD eye hospital in Asia. Prof Wong was previously Executive Director of the Singapore Eye Research Institute (SERI), Artificial Intelligence in Ophthalmology: Chair of the Department of Ophthalmology at the National Concepts, Progress, Challenges and Myths University of Singapore, Head of the Department of Oph- thalmology at the University of Melbourne and Managing Synopsis: Director of the Centre for Eye Research Australia (CERA). Prof Wong is a retinal specialist with a clinical practice Artificial intelligence (AI) is a high profile dis- focusing on major retinal diseases including diabetic retinop- ruptive technology that has vast potential to impact on medi- athy, age-related macular degeneration and myopic macular cine and healthcare. In the past few years, a sub-set of AI degeneration. He has a broad-based research program com- technology, known as deep learning (DL), has generated prising epidemiological, clinical and translational studies

Clin Experiment Ophthalmol. 2019;47 (Supp 1):15–23. wileyonlinelibrary.com/journal/ceo 15 16 INVITED SPEAKERS of these retinal diseases, and the use of retinal imaging to surgery by the same IATS surgeons at the same time the predict disease risk. He has published >1000 peer-reviewed IATS study was conducted. This study confirmed that the papers, including papers in the New England Journal of adverse events reported in the IATS cohort was related to Medicine and the Lancet, and given >300 invited plenary, the very young age of the babies. symposium and named lectures globally. He has received The TAPS study has also looked at results of bilateral cata- >US$50 million in grant funding as Principal Investigator. ract surgery in these same two age groups. Prof Wong has been recognized nationally and internation- This talk will summarize what we have learned from these ally with numerous awards, such as the Sandra Doherty studies that to date have produced over 60 publications. Award from the American Heart Association, the Alcon Research Institute Award, the Novartis Prize in Diabetes, Brief Curriculum Vitae: the Australian Commonwealth Health Minister's Award, Dr. Plager is currently a Professor of Ophthalmology and and the Arnall Patz Medal from the Macula Society. He Director of the Section of Paediatric Ophthalmology and received the National Clinician Scientist Award, the Presi- Adult Strabismus at Indiana University Medical Center in dent's Science Award and the President's Science and Tech- Indianapolis. He is a graduate of Stanford University, com- nology Award, the highest awards for scientific pleted medical school and residency at Indiana University contribution in Singapore. and a fellowship in paediatric ophthalmology and strabismus at Children's Hospital National Medical Center in Contact Details: Washington DC. Dr. Plager has delivered over 250 lectures nationally and Singapore National Eye Centre, Singapore internationally on a wide range of topics in paediatric oph- Email: [email protected] thalmology: from cataracts to glaucoma to vascular mal- formations and on a wide range of strabismus topics- he has a particular interest in the treatment of oblique muscle dys- L03: PAEDIATRICS UPDATE LECTURE, function. He has published or coauthored over 90 scientific SATURDAY 9 NOVEMBER 2019 articles in peer-reviewed journals, 15 book chapters and was editor and co-author of the textbook Strabismus Surgery: Prof David A. Plager MD Basic and Advanced Strategies. He has received research grants for work in ROP, paediatric cataracts and paediatric IOL Use in Children Under Age 2 Years : glaucoma. What Have We Learned? He served as President of the American Association for Pae- diatric Ophthalmology and Strabismus (AAPOS) in 2011 Synopsis: and has been awarded the Honour, Senior Honour and Life- time Achievement awards from AAPOS. He has also been The Infant Aphakia Treatment Study (IATS) awarded the Achievement, Senior Achievement, Lifetime is a prospective, randomized, multi-centre Achievement and Secretariat awards from the American study designed to determine the proper role of IOLs in Academy of Ophthalmology. Other leadership activities in infants undergoing unilateral cataract surgery at <7 months ophthalmic societies include being a charter member of the of age. The study was initiated in 2004, completed enrol- Paediatric Clinical Committee of the ASCRS, a member of ment in 2009 and the 10-year follow up results are being the Board of Directors of the Children's Eye Foundation, released in 2019. At 5 years, the comparison between the President of the American Eye Study Club and he is cur- two study groups - IOL vs contact lens - showed that the rently the Secretary-Treasurer of the International Strabismus visual outcome in the two groups was nearly identical, but Association. In his spare time, he serves as ophthalmologist the reoperation and complication rates were significantly for the Indianapolis Colts who awarded him Super Bowl higher in the IOL group. In addition, many pseudophakic rings in 2006 and 2009. children had already developed high degrees of myopia by age 5. This led to the study group recommending that IOLs Contact Details: not be implanted in infants <7 months of age unless there are extenuating circumstances. Indiana University Medical Centre, Glick Eye Insti- The Toddler Aphakia and Pseudophakia Study (TAPS) ret- tute, USA rospectively examined the results of cataract surgery in a Email: [email protected] slightly older age group (7-24 months) undergoing cataract INVITED SPEAKERS 17

L04: RETINA UPDATE LECTURE, SUNDAY 10 She is also the Chief of the Clinical Trials Branch within NOVEMBER 2019 the Division. Emily received her medical degree and her ophthalmology training at the U. of Toronto, School of Med- Dr Emily Y. Chew MD icine, in Toronto, Canada. She completed her fellowship in Medical Retina at the Wilmer Eye Institute, the Johns Macular Telangiectasia Type 2, an Hopkins Medical Institutes and the U. of Nijmegen, the Update of the Mac Tel Research Group, Netherlands. a 15-Year Journey From an Exam To Her research interest includes phase I/II clinical trials and Global Connections epidemiologic studies in retinovascular diseases such as age- related macular degeneration, diabetic retinopathy, ocular Synopsis: diseases of von Hippel-Lindau Disease and others. She worked extensively in large multi-centred trials headed by Idiopathic macular telangiectasia Type 2 (Mac Tel Type 2), the staff of DECA including the Early Treatment Diabetic once a poorly characterized and understood retinovascular Retinopathy Study, the Age-Related Eye Disease Study and entity, known then as idiopathic juxtafoveal telangiectasia, is the Age-Related Eye Disease Study 2, which she chairs. She now considered to be a neuro/vasculo/glial degenerative dis- also chairs the Actions to Control Cardiovascular Risk in ease. Our understanding of Mac Tel Type 2 has increased sig- Diabetes (ACCORD) Eye Study in participants with type nificantly because of the establishment of a large, multinational 2 diabetes, working in collaboration with colleagues at the collaborative research project studying the pathogenesis and National Heart, Lung, and Blood Institute/NIH. Emily is the potential treatment for Mac Tel Type 2. Clinicians from director of the clinical program in the Macular Telangiecta- 31 international sites and investigators from a dozen basic sci- sia Project (Mac Tel Project) which is an international study ence laboratories located in United States, Europe and conducted in 22 clinics in 7 countries along with several Australia are funded generously by the Australian-based Lowy basic science laboratories. She also chairs the current inter- Medical Research Institute. national study, known as the AMD Ryan Initiative Study Mac Tel type 2 characteristic lesions include retinal opacifi- (ARIS), which evaluates the natural course of early AMD cation, perifoveal telangiectatic vessels, right angle vessels, and reticular pseudodrusen, crystalline deposits, retinal pigment epithelial hyperpigmen- Along with the team in the Clinical Trials Branch, she pro- tation, abnormal fundus autofluorescence imaging and spectral vides the clinical training as well as education in conducting domain optical coherence tomography, where hypo-reflective clinical trials to the medical students and the fellows training inner and outer retinal cavities, as well as ellipsoid zone or in medical retina. She served on the editorial board of Inves- inner segment/outer segment losses, are found. Macular pig- tigative Ophthalmology and Vision and served as the editor ment loss is evident and neovascularization originating from of the Transactions of the American Ophthalmological Soci- the retinal circulation can occur, forming retinal-choroidal anas- ety. She is currently on the editorial boards of Ophthalmol- tomoses. The MacTel research group have discovered a genet- ogy and Retina. ic/metabolic component with a defect in serine/glycine Emily Chew has received recognition from the American metabolism and noted defects in Mueller cells of the retina. A Academy of Ophthalmology with the Lifetime Achievement large natural history study has provided data to develop a new Award, the Helen Keller Prize in Vision Research, Bressler classification and outcome measurements such as ellipsoid Award for Vision Research, the Alcon Research Institute zone loss that correlates well with functional changes in micro- Award, the Retina Society's Award of Merit, and the Macula perimetry. Both Phase 1 and Phase 2 clinical trials in Mac Tel Society's Donald Gass Medal and Lawrence Singerman Type 2 have been successfully completed using a ciliary neuro- Medal. She is a fellow of Association for Research in Vision trophic factor implant. The results of this remarkable 15 years and Ophthalmology (ARVO) (gold). of collaborative research will be highlighted.

Brief Curriculum Vitae: Contact Details: Emily Chew is the Director of the Division of Epidemiology and Clinical Applications (DECA), at the National Eye Insti- National Eye Institute/National Institutes of Health, USA. tute, the National Institutes of Health in Bethesda, Maryland. Email: [email protected] 18 INVITED SPEAKERS

L05: THE COUNCIL LECTURE, SUNDAY Vision Science and Technology grant to Bionic Vision 10 NOVEMBER 2019 Australia (BVA) and has ongoing research support from the NHMRC, ORIA and the CASS foundation. She is the co- A/Prof Penelope Allen MBBS, FRANZCO recipient of an NHMRC excellence award. The Path to An Australian Bionic Eye A/Prof Allen was key to the developing the surgical technique for the suprachoroidal retinal prosthesis, resulting in the first Synopsis: clinical trial of this device in three human patients. This collaboration has resulted in 2 licenced patents. Acknowledge- At the 2020 summit in 2008, the development of this was her inclusion in the shortlist for an Australian ment of a bionic eye was seen as an aspira- Eureka prize for interdisciplinary research. Dr Allen's tional goal by the group looking at Long term National research and publications on endophthalmitis have resulted in Health Strategy and funding was allocated by the Australian the development of protocols for the management of Research Council for this purpose. Our collaborative group endophthalmitis at the Royal Victorian Eye and Ear Hospital was one of the successful applications for this funding. and also resulted in a strategy to reduce the incidence of Iterative development of a suprachoroidal retinal prosthesis endogenous endophthalmitis in injecting drug users that was was undertaken to provide proof of concept that electrical utilized across Victoria. In addition, she was asked to advise stimulation in the suprachoroidal space could produce reli- regarding the endophthalmitis guidelines for the Epworth able phosphenes in patients with severe visual loss due to Hospital. retinal dystrophies. A human grade device was utilized in a A/Prof Allen has been on the organizing committee of three proof of concept trial in 2012-2014 in three patients and in national conferences. She has been the invited session chair 2018 four patients were implanted with a second-generation for a retinal prosthesis session at the Association for device to attempt to demonstrate improved functionality Research in Vision and Ophthalmology (ARVO) in the US with use of the device at home. and invited speaker at APAO, Euretina and APVRS. She has The initial clinical trial demonstrated that the surgical presented over 50 other conference posters and talks and has approach was safe and reliable phosphenes could be pro- published more than 60 peer reviewed journal articles. Dr duced in all three patients and two of the three patients could Allen is member of five professional associations including navigate with the device. The current clinical trial with four the Royal Australian and New Zealand College of Ophthal- patients is confirming the safety and stability of the approach mology, Association for Research in Vision and Ophthal- and the reliability of the devices. All four patients are per- mology and the Retina Society. forming well on Orientation and Mobility (O and M) tasks and Activities of Daily Living (ADL). Contact Details: This work demonstrating that electrical stimulation of these devices can produce phosphenes within safe charge limits Centre for Eye Research, Australia and provide visual information that patients can use to Email: [email protected] improve performance in O and M and ADL activities opens the way to a commercial device. L06: CATARACT UPDATE LECTURE, MONDAY Brief Curriculum Vitae: 11 NOVEMBER 2019 A/Prof Allen received a Bachelor of Medicine and Sur- gery in 1986 from the University of Melbourne and spe- Prof Soon-Phaik Chee MD cialized in Ophthalmology. She then sub-specialized in Vitreoretinal surgery and Medical Retina, completing fel- State of the Art Intraocular Lens Fixation lowships at the Royal Victorian Eye and Ear Hospital and Moorfields Eye Hospital in London. A/Prof Allen Synopsis: was the lead surgeon for Bionic Vision Australia and is a Research Fellow at the Centre for Eye Research This talk will cover a variety of current and Australia, with clinical appointments at the Royal Victo- innovative approaches to fixation of the rian Eye and Ear Hospital and the Alfred Hospital. She intraocular lens (IOL) in the absence of capsular support. holds an honorary research associate position with the The least invasive technique of iris fixation is shown with Bionics Institute. pearls on how to obtain a round pupil. When managing lens A/Prof Allen was a PI on the Australian Research Council implant fixation in the elderly who are intolerant to a long (ARC) through its Special Research Initiative in Bionic surgical procedure, the retropupillary iris-clip IOL is a good INVITED SPEAKERS 19 option. However, securing the IOL to the sclera produces a Tuberculosis, Dengue Maculopathy and Vogt-Koyanagi more stable fixation. In the past, scleral fixation using fine Harada disease. polypropylene sutures resulted in subluxation of implants She has authored over 200 peer reviewed scientific papers less than a decade after surgery. The use of thicker polypro- and many book chapters. She serves as a member of several pylene or polytetrafluoroethylene sutures are recommended editorial boards including Journal of Cataract and Refractive today. Single piece acrylic haptics within the capsular bag Surgery, Ocular Inflammation and Immunology and Journal can safely be directly sutured to the sclera. Premium IOLs of Ophthalmic Inflammation and Infection. She was the Edi- may be salvaged by inserting a capsular tension device. tor for the book “Emerging Infectious Uveitis”. She was also Intrascleral haptic fixation, popularized as the “Glued IOL” the guest editor for the supplementary journal to Ocular and more recently, a flanged haptic technique not requiring Inflammation and Immunology that collated the Epidemiol- conjunctival dissection are the current favoured techniques ogy of Uveitis in Asia Pacific. that result in an IOL without donesis. The latter is seemingly She is a much sought out speaker at numerous international, simple to perform, yet consistently achieving a perfect out- regional and national conferences and has made many pre- come may be difficult to achieve. Tips on getting it right will sentations on uveitis and cataract and has delivered several be shared. The latest technique using thick polypropylene named lectures and won medals for her surgeries. She has sutures to create flanges to anchor the IOL to the sclera will performed numerous “live surgeries” and conducted many be shown. In addition, the speaker's preferred technique will instruction courses locally and internationally. In 2000, she also be demonstrated. was given the Best Teacher Award in SNEC and in 2005, she became an Asia Pacific Association of Cataract and Refrac- Brief Curriculum Vitae: tive Surgery Certified Educator (A.C.E). She was conferred Chee Soon Phaik, MD, is a Professor at the National by SingHealth, the Outstanding Clinician 2011 Award and University of Singapore and Duke-National University of the Singapore Health Quality Service Award 2014 (Gold) for Singapore Medical School, Singapore. She is a Senior her significant contributions to national healthcare. In Oct Consultant and heads both the Cataract Subspecialty Ser- 2017, she was admitted as a fellow of the Academy of Asia- vice and Ocular Inflammation and Immunology Service at Pacific Professors of Ophthalmology (AAPPO). the Singapore National Eye Centre (SNEC). In addition, Prof Chee also serves as group lead member of the Cata- Contact Details: ract research team at the Singapore Eye Research Institute. National University of Singapore, Singapore She obtained her Master of Medicine (Ophthalmology) at Email: [email protected] the National University of Singapore and was admitted as a Fellow of the Royal College of Surgeons of Glasgow, and Edinburgh and the College of Ophthalmologists, UK. She L07: THE FRED HOLLOWS LECTURE, MONDAY subsequently completed her fellowship in Uveitis and 11 NOVEMBER 2019 Oculoplastics, Lacrimal and Orbital Surgery at Moorfield's Eye Hospital, London in 1993. Dr Anasaini Cama MBBS (Fiji), MSc Ophthal (Melbourne), Prof Chee's research interests in cataract include the manage- PGDO (Fiji), PGDVRDED (Fiji), MPH (Fiji) ment of complicated cataracts such as the dense posterior polar cataract, subluxated cataracts, premium intraocular lens Hollows Influence: Research, Programs implants and femtosecond laser assisted cataract surgery. In and Universal Eye Health Coverage in addition to innovations in surgical techniques, she has also the Pacific designed intraocular instruments which greatly augment surgeons' abilities to overcome difficulties and improve the out- Synopsis: comes in these highly demanding cases. Most recently, she was admitted to the International Intra-Ocular Implant Club. Prof Frederick Cossom Hollows: New Zealand In the field of uveitis, she has been the President of the Asia- born Australian; recipient of many health and humanitarian Pacific Intraocular Inflammation Study Group (APIISG) awards including the Australian of the Year Award in 1990; since 2013 and a member of the International Uveitis Study a brilliant and outspoken ophthalmic surgeon, and a humani- Group and an International Council member of the IOIS. tarian who recognized the disparity in eye health delivery She has published extensively on Cytomegalovirus infection and worked tirelessly to correct this - first in Australia then of the anterior segment in the immunocompetent, Ocular reaching out to Asia and Africa. Perhaps if given more time, 20 INVITED SPEAKERS he would have visited the Pacific. Although succumbing to commendable professionalism and warmth. Ana has built strong illness, Prof Hollows' work lives on through his legacy. networks in the Pacific Sub-region and beyond, and is a trusted The Pacific - part of the vast blue continent; developing expert and hard-worker. island nations rich in culture and religion. A holiday haven Ana became a Trachoma Master Grader in 2015 and this for tourists, a challenge for eye health delivery. Surrounded paved the way for her current work with The Fred Hollows by fast developing or developed countries in Asia, Australia, Foundation of Australia. Now working as a consultant for New Zealand and the Americas, the Pacific is catching up in the Foundation since 2016, Ana is the lead for the Pacific its bid to attain universal eye health coverage. Trachoma Initiative Program, coordinating work aimed at Recent years have seen good developments in eye health eliminating trachoma as a public health problem from Fiji, across the Pacific, largely through the efforts and partnership Kiribati, Solomon Islands and Vanuatu. She works closely of the Ministries of Health with NGOs, Academic Institu- with Ministry of Health Ophthalmology and NTD sectors, tions and RANZCO to name a few. Research has also WHO and NGOs in water and sanitation, and has shared her increased in the Pacific, informing on policy and guiding trachoma expertise in PNG and other Pacific countries. eye health program development and progression, whilst Ana is the only Certified Rapid Assessment of Avoidable endeavouring to keep within recognized standards of care Blindness Trainer from the Pacific, and has trained and and meeting global targets. assisted PNG and Solomon Islands to plan and conduct their Pacific research and its outcomes on Cataract, Diabetic Reti- RAAB survey. nopathy, and Trachoma Programmes will be highlighted in Over many years, she has made an outstanding contribution this talk, as the Pacific addresses the right to sight and strives to the development of eye health services in Fiji and across to attain universal eye health coverage. the Pacific Islands. A leader, practitioner and advocate for low vision services in the Pacific, Dr Ana Cama has the full Brief Curriculum Vitae: support of her family. Dr Ana Cama graduated with a Bachelor of Medicine and Bachelor of Surgery from the University of the South Pacific Contact Details: in 1996 and joined the Eye Department at Fiji's Colonial War Memorial Hospital in 1999. Graduated with Master of The Fred Hollows Foundation, New Zealand Science in Ophthalmology (by dissertation) from University Email: [email protected] of Melbourne in 2008 after completing research on low vision under the Centre for Eye Research Australia (CERA). She returned to Fiji and as an in-service postgrad student, L08: GLAUCOMA UPDATE LECTURE, TUESDAY successfully completed her Post-graduate Diploma in Oph- 12 NOVEMBER 2019 thalmology in 2010 and Post-graduate Diploma in Vit- reoretinal and Diabetes Eye Disease in 2011 from the Pacific Prof David (Ted) Garway-Heath MD, FRCOphth, FARVO Eye Institute and Fiji National University. When her family moved to New Zealand in December 2011, Ana changed her Lessons From the United Kingdom Glau- focus slightly to public health ophthalmology. She enrolled coma Treatment Study (UKGTS) and as a part time student and graduated with a Master in Public Laser in Glaucoma and Ocular Hyperten- Health (Honours) from Fiji National University in 2016. sion (Light) Study From 2012-2015, Ana was the Coordinator for the Interna- tional Agency for the Prevention of Blindness based in Suva, Synopsis: supporting work to develop national plans for eye health across the Pacific Islands. Through her work with IAPB and The UKGTS was the first randomized, masked, placebo- its members, Ana has been an effective advocate for blind- controlled trial assessing the benefit of topical medical treat- ness prevention and low vision clinical services. ment in reducing vision loss in open angle glaucoma. The From 2013-2015, Ana was president of the Pacific Eye Care primary outcome was time to visual field (VF) deterioration. Society (PacEYES), a professional body for eye nurses and doc- Secondary objectives included an analysis of risk factors for tors in Pacific Island Countries. With her leadership - as well as VF deterioration, the utility of optical coherence tomography support from the Fred Hollows Foundation New Zealand and (OCT) imaging as a trial outcome measure and an evaluation the Royal Australian and NZ College of Ophthalmologists of new tonometry devices. (RANZCO) - PacEYES is now a stronger and more sustainable The UKGTS provides strong evidence for the vision- advocate for eye health workforce issues across the sub-region. preserving benefit of intraocular pressure (IOP) lowering She has always approached her work with a smile and with with a topical prostaglandin analogue (latanoprost). Analysis INVITED SPEAKERS 21 of the IOP measurements from the new tonometers provided drug. The findings reported in The Lancet indicated that the evidence that latanoprost causes a softening of the cornea study design enabled a considerable reduction in the period and a consequent clinically relevant over-estimation of IOP needed to identify treatment effects, thus increasing the like- reduction by >1 mmHg. lihood of bringing new drugs more quickly and more cost- Measurements of retinal nerve fibre layer thickness (RNFLT) effectively to patients. with OCT were able to distinguish between the treatment groups, capturing the effect of treatment on the more clini- Contact details: cally relevant outcome of VF loss. The addition of OCT RNFLT to VF measurements may increase the power of Moorfields Eye Hospital/UCL Institute of future trials of new therapies. Ophthalmology, UK Risk factors for progression in the UKGTS included the Email: [email protected] level of IOP and presence of disc haemorrhages; history of smoking was a protective factor. The LiGHT study compared two treatment pathways, one L09: THE DAME IDA MANN MEMORIAL starting with selective laser trabeculoplasty (SLT) and the LECTURE, TUESDAY 12 NOVEMBER 2019 other starting with drops to lower IOP, with health-related quality of life (HRQoL) as the primary outcome and cost- Prof John Marshall MBE, BSc (Hons), PhD, FMedSci, effectiveness and clinical parameters as secondary out- FRCPath, FRSB, CSci, DSc2(Hon) FRCOphth (Hon), FCOptom comes. HRQoL was similar between pathways. 74% of (Hon), FARVO, FLIA, FRSA patients starting with SLT were at treatment target for at least 3 years without the need for drops. The SLT-first Light and the Eye: Chronic Insult or pathway was more cost-effective and clinical outcomes Therapeutic Dream? tendedtobebetter. Synopsis: Brief Curriculum Vitae: David Garway-Heath is President of the European Glaucoma Ageing of an individual is a process whose Society (EGS), Vice President of the Imaging and Perimetry rate constants are governed by interactions Society (IPS), and Chair of the Membership Committee of between multiple genes and numerous environmental factors. the Glaucoma Research Society (GRS). He has been recipi- There is growing evidence that our lifetime exposure to opti- ent of the Alcon Research Institute Award and the World cal radiation may be a risk factor in age-related changes in Glaucoma Association Senior Clinician Scientist Research the eye and in particular in the lens and the retina. Evolu- Recognition Award, and is one of only few Senior Investiga- tionary pressures have developed repair mechanisms but tors in Ophthalmology of the UK National Institute for these in turn may result in problems of waste disposal of Health Research. He has been consecutively voted onto The toxic products contributing to the transition from the physi- Ophthalmologist Top 100 power list, which recognizes the ology of ageing into overt pathology. Biochemical and bio- achievements of people who have made the biggest impact physical studies have resulted in improved understanding of in the field of ophthalmology. these mechanisms and highlighted possible means of thera- In addition to his clinical work, Prof Garway-Heath leads peutic intervention. The advent of the Laser in 1960 research in visual assessment and imaging at the Biomedical heralded an era whereby light could be exploited in terms of Research Centre of the UK National Institute for Health therapeutic procedures. By the 1970s it had revolutionized Research (NIHR). His research focuses on the development the treatment of diabetic retinopathy and went on to change and evaluation of the techniques for effective diagnosis, clinical practice in the treatment of glaucoma and cataract monitoring and management of glaucoma, the identification surgery. The 1990s saw a second revolution whereby of risk factors for glaucoma progression, and decision- Excimer systems created a new field of ophthalmology in support systems for healthcare delivery services. His work terms of scientifically based refractive surgery. This lecture has contributed to the understanding of structure-function will review the development of laser technology and high- relationship in glaucoma, and his pioneering work in imag- light the science behind recent advances. Particular attention ing has contributed to an ever-increasing use of the tech- will be given to the potential role of novel lasers for treating nique in glaucoma management. He conducted the first conditions in the anterior eye using ultrashort pulses and randomized placebo-controlled trial to show visual field ultraviolet radiation and for AMD by rejuvenating transport preservation in glaucoma patients with an IOP-lowering 22 INVITED SPEAKERS pathways between the choriocapillaris and the photoreceptor use of anti-personnel laser weapons. He was the Chairman of cells. the Medical and Scientific Advisory Board and Trustee of the Brief Curriculum Vitae: British Retinitis Pigmentosa Society 1973-2011, and until Prof John Marshall is the Frost Professor of Ophthalmology 1995 he was Co-Chairman of the Medical and Scientific at the Institute of Ophthalmology in association with Advisory Board of the International Retinitis Pigmentosa Moorfield's Eye Hospital, University College London. He is Association. He is the scientific adviser and Vice President of Emeritus Professor of Ophthalmology at Kings College the National Eye Research Centre. He is a Fellow of the London, Honorary Distinguished Professor University of Royal College of Pathologists, a Fellow of the Association Cardiff, Honorary Professor the City University and Honor- for Research in Vision and Ophthalmology and has been elec- ary Professor Glasgow Calendonian University. His research ted a Fellow of the Academy of Medical Sciences and a Fel- over the past forty years has ranged over a number of ocular low of the Royal Society of Biology. He is also an Honorary problems but has concentrated on the inter-relationships Fellow of the Royal College of Ophthalmologists, an Honor- between light and ageing, the environmental mechanisms ary Fellow of The College of Optometrists, a Fellow and underlying age-related, diabetic and inherited retinal disease, Director of the Laser Institute of America, a Fellow of the and the development of lasers for use in ophthalmic diagno- Royal Society of Arts and an Honorary Fellow of Cardiff sis and surgery. This work has resulted in over five hundred University. He has a Senior Achievement Award of the research papers and 44 book chapters and 7 books. He American Academy of Ophthalmology and the Euretina invented and patented the revolutionary Excimer laser for Award of the European Society of Retinal Surgeons. In 2009 the correction of refractive disorders with in excess of 60 mil- he was honoured with a Lifetime Achievement Award by the lion procedures now having been undertaken worldwide. He International Society of Cataract and Refractive Surgery and also created the world's first Diode laser for treating eye the American Academy of Ophthalmologists. He is a Fellow problems of diabetes, glaucoma and ageing. He is editor and of several national ophthalmological societies, as well as co-editor of numerous international journals. He has success- being elected to the European Academy of Ophthalmology. fully trained 60 students for higher doctorates. He has been During 2011-2012 he was the Master of the Worshipful Com- awarded the Nettleship Medal of the Ophthalmological Soci- pany of Spectacle Makers. In 2013 he was awarded the MBE ety of the United Kingdom, the Mackenzie Medal, the in the 2013 New Year Honours List for services to Ophthal- Raynor Medal, the Ridley Medal, the Ashton Medal, the Ida mology and an honorary DSc from Glasgow Caledonian Uni- Mann Medal and the Lord Crook Gold Medal of the Wor- versity. In 2015 he was awarded an honorary DSc by the shipful Company of Spectacle Makers, the Doyne Medal of London Metropolitan University. Elected Chartered Scientist the Oxford Congress, the Barraquer Medal of the Interna- by Royal Society of Biologists 2017. tional Society of Cataract and Refractive Surgery, the Kelman Innovator Award of the American Society for Contact Details: Refractive and Cataract surgery, the Lim Medal of the Sin- gapore National Eye Centre and the Junius-Kuhnt award and Moorfield's Eye Hospital, University College London, UK Medal for his work on AMD. In 2014 he was awarded the Email: [email protected] Zivojnovic award by the European Vitreo Retinal Society, a lifetime achievement award by the UK & Irish Society for Cataract & Refractive Surgery and delivered the Bowman L10: OCULOPLASTIC UPDATE LECTURE, Lecture and received the Bowman Medal. He was also voted TUESDAY 12 NOVEMBER 2019 17th in The Ophthalmologist Power List 2014 of the most influential people in world ophthalmology,and the only sci- Dr Santosh G. Honavar MD, FACS entist. He has been visiting professor at numerous universi- ties on every continent. Oculoplasty and Ocular Oncology: What He has more than thirty patents and has held posts chairing New Am I Doing This Year? the medical advisory boards of many international companies and was a director of Diomed for some years, this being the Synopsis: leading supplier of diode laser systems for surgery. He has sat on and chaired many national and international committees* TBC concerned with protecting the public against the possible Brief Curriculum Vitae: damaging effects of lasers and other artificial light sources Dr Honavar had his basic medical education at the Bangalore and played the leading role with the ICRC and addressed the Medical College, Bangalore, India. He received residency United Nations to obtain a Geneva Convention banning the training in Ophthalmology, followed by subspecialty INVITED SPEAKERS 23 training in Ophthalmic Plastic Surgery and Ocular Oncology oncology. Dr Honavar's overall research contributions that at the Dr Rajendra Prasad Center for Ophthalmic Sciences, have had very significant impact on the diagnosis and manage- All India Institute of Medical Sciences, New Delhi, India. Dr ment of retinoblastoma and its outcome. Some of the major Honavar further trained in Ocular Oncology and was mentored awards and honours to his credit include Col Rangachari Gold by Profs JA Shields and CL Shields at the Wills Eye Hospital, Medal by the AIOS, 1992; Best Resident Award by the Dr Philadelphia, PA, USA. He thereafter established the Ocular Rajendra Prasad Center for Ophthalmic Sciences, All India Oncology Service at the LV Prasad Eye Institute, Hyderabad, Institute of Medical Sciences, New Delhi, 1995; ARVO- the first such facility in the country. The comprehensive Santen International Fellowship by the ARVO, 1996; Zeigler multispecialty Children's Eye Cancer Center that he has International Fellowship by the Orbis International, New York, established has done pioneering work. He currently leads the USA, 1999; Young Scientist Award by the Indian Society of Medical Services team at the Centre for Sight, and also heads Oncology, 2000; Best of Show Award for the video film by CFS Education. Dr Honavar leads the International Council of the American Academy of Ophthalmology, 2002 and 2006; Ophthalmology fellowship curriculum development committee Achievement Award by the American Academy of Ophthal- and the oculoplasty section of the residency curriculum devel- mology, 2002; Dr Siva Reddy International Award by the opment committee, while being on the ICD11 panel as well. AIOS, 2007, Shanti Swarup Bhatnagar Award by the Govern- He is currently the Program Coordinator of the Oculoplastics ment of India, 2010, Prof MA Matin Award by the Association of India, Editor of the Indian Journal of Ophthal- Bangladesh Academy of Ophthalmology, 2013 and Jerry mology, Program Committee member of the American Acad- Shields International Award by APAO, November 2013. emy of Ophthalmology and the President of Asia Pacific Society of Ocular Oncology and Pathology. Dr Honavar has Contact Details: extensively published in peer reviewed journals (over 220 man- uscripts) and has written several book chapters, while being a Centre for Sight, Hyderabad, India reviewer for all the major journals in ophthalmology and Email: [email protected] DOI: 10.1111/ceo.13627 Saturday 09 November

0645−0800 H01 – Allergan Hosted Morning Symposium Venue: C4.5

0830–0900 P01 – ASO AGM AUSTRALIAN SOCIETY OF OPHTHALMOLOGISTS AGM Venue: Darling Harbour Theatre

0900–0930 P02 – RANZCO AGM ROYAL AUSTRALIAN AND NEW ZEALAND COLLEGE OF OPHTHALMOLOGISTS AGM Venue: Darling Harbour Theatre

0930–1000 P03 – ORIA AGM OPHTHALMIC RESEARCH INSTITUTE OF AUSTRALIA AGM Venue: Darling Harbour Theatre

1000–1030 MORNING TEA

1030–1100 L01 – RANZCO Congress Opening Lecture Eyes on the skies: how astronomy is transforming our vision of the universe Prof Lisa Harvey-Smith Chair: Dr Christine Younan Venue: Darling Harbour Theatre Synopsis: In this talk she describes how Australian astronomers are leading the world in creating innovative new ‘eyes’ through which to study the universe and how artificial intelligence and supercomputers are part of that incredible journey.

1100–1130 L02 – The Norman McAlister Gregg Lecture Artificial intelligence in ophthalmology: Concepts, progress, challenges and myths Prof Tien Y Wong Chair: Prof Stephanie Watson Venue: Darling Harbour Theatre Synopsis: Artificial intelligence (AI) is a high profile disruptive technology that has vast potential to impact on medicine and healthcare. In the past few years, a sub-set of AI technology, known as deep learning (DL), has generated significant interest and shown substantial potential to be used to address a range of healthcare and clinical problems. The application of AI and DL techniques in ophthalmology have been increasing, and include screening and diagnosis of major eye diseases such as diabetic retinopathy (DR), age-related macular degeneration (AMD) and glaucoma, applied to datasets that include retinal photographs, optical coherence tomography (OCT) scans and clinical data. Compared to older technology using traditional “pattern recognition” techniques to detect specific patterns, DL uses much larger datasets and a convoluted neural networks (CNN or “black box”) approach to mine, extract and learn patterns and/or features to determine a disease state or condition. Recently, researchers from Google using DL learning technology have reported high sensitivity and specificity in detecting referable DR from retinal photographs, and another group has had a DL algorithm for DR screening that has had FDA approval. For translational impact, AI and DL technology should be validated in “real-world” clinical settings, where datasets and images have varying qualities, and in patient populations of different characteristics and ethnicity. Even as AI technology evolves and becomes increasingly popular, with performance approaching and surpassing human-level specialists performance, there remain significant technical, clinical and medico-legal challenges in the field, including overcoming “black box” phenomenon, which may prevent AI and DL systems from easy translation from the laboratory to real-world clinical practice,

24 wileyonlinelibrary.com/journal/ceo Clin Experiment Ophthalmol. 2019;47 (Supp 1):24–38. SATURDAY 09 NOVEMBER 25

and patient and physician acceptance issues. There continues to be myths surrounding AI. Understanding these issues and challenges are critical for physicians, researchers, health administrators and policy makers to embrace and use AI in ophthalmology.

1130–1200 L03 – Paediatrics Update Lecture IOL use in children under age 2 years: What have we learned? Prof David A Plager Chair: A/Prof James Elder Venue: Darling Harbour Theatre Synopsis: The Infant Aphakia Treatment Study (IATS) is a prospective, randomized, multi-center study designed to determine the proper role of IOLs in infants undergoing unilateral cataract surgery at <7 months of age. The study was initiated in 2004, completed enrolment in 2009 and the 10-year follow up results are being released in 2019. At 5 years, the comparison between the two study groups - IOL vs contact lens - showed that the visual outcome in the two groups was nearly identical, but the reoperation and complication rates were significantly higher in the IOL group. In addition, many pseudophakic children had already developed high degrees of myopia by age 5. This led to the study group recommending that IOLs not be implanted in infants <7 months of age unless there are extenuating circumstances. The Toddler Aphakia and Pseudophakia Study (TAPS) retrospectively examined the results of cataract surgery in a slightly older age group (7-24 months) undergoing cataract surgery by the same IATS surgeons at the same time the IATS study was conducted. This study confirmed that the adverse events reported in the IATS cohort was related to the very young age of the babies. The TAPS study has also looked at results of bilateral cataract surgery in these same two age groups. This talk will summarize what we have learned from these studies that to date have produced over 60 publications.

1200–1330 LUNCH

1330–1500 CONCURRENT SESSIONS

1330–1500 S01 – COURSE Teaching and learning cataract surgery Chair: Dr Jacqueline Beltz Email: [email protected] Venue: C4.1 Course Objective: Attendees will see modern techniques and learn different methods by which microsurgical skills and phacoemulsification may be learnt and taught. Particular attention will be given to addressing the non technical skills of surgery. Course Description: Course will use video and description to demonstrate techniques for teaching and developing microsurgical skills and transitioning those skills to the learning of phacoemulsification. Dif- ferent types of simulation will be discussed, as well as the transition to live surgery. The importance of continuing this education through a surgeons career will be emphasized, as well as particular focus on the non technical skills of surgery and complication training. The importance of regular and detailed feedback will be emphasized, with strategies outlined. Different methods for assessment of both trainees and supervisors will be discussed, as well as the management of high performance. Speakers and Topics: Dr Jacqueline Beltz – Introduction, basic concepts, and curriculum Dr Danielle Buck – Lab Training: Wet, Dry, Virtual Reality and Mind Dr Catherine Green AO – Trainer and Trainee Feedback Dr Rahul Chakrabarti – Surgical Assessment at RVEEH Dr Tiffany Lo – Trainee perspectives and attributes of an excellent trainer Dr Bernardo Soares – Complication Training Dr Jacqueline Beltz – Mind skills – striving for excellence Audience discussion and participation 26 SATURDAY 09 NOVEMBER

1330–1500 S02 – SYMPOSIUM Neuro-ophthalmic emergencies: Help! It's a neuro patient, what do I do now? Chairs: A/Prof Celia Chen and A/Prof Clare Fraser Email: [email protected] Venue: Darling Harbour Theatre Synopsis: The urgent neuro-ophthalmic patient can strike fear into the hearts of the general ophthalmologist (and even sub-specialists). This symposium covers life-threatening scenarios that a general ophthalmologist might encounter and is designed to help the ophthalmologist make emergency triage decisions for initial evaluation and treatment of potentially vision- or life-threatening conditions. In this symposium we will cover the main neuro-ophthalmic emergencies as “presenting complaints” approach rather than a disease-based approach. Illustrative cases will be used, to demonstrate the best evidence-based care to the neuro-ophthalmic patient. We will focus on the early presentation, immediate investigations and how to get them, same day and early management. Speakers and Topics: Prof Helen Danesh-Meyer – Unilateral optic disc swelling • Outline the pathogenesis that can lead to unilateral disc swelling • Discuss the serious systemic disorders that present with unilateral disc swelling • Highlight differences in frequencies and clinical features of unilateral disc swelling in different age groups that can help to accurately determine cause and predict outcome A/Prof Celia Chen – Bilateral optic Disc swelling • Highlight the diagnostic pathway in bilateral optic nerve swelling including systemic causes, cerebral disease and venous sinus diseases • Discuss the investigation and management algorithm in bilateral optic nerve swelling A/Prof Mitchell Lawlor – Sudden onset anisocoria • Outline of the anatomy and pathogenesis that can lead to acute onset anisocoria • Discuss the clinical presentations and important signs accompanying dangerous anisocoria • Discuss the investigation pathway in sudden onset aniscoria Dr Ioanne Anderson – Sudden onset double vision • Present a systematic diagnostic approach in acute onset double vision • Highlight the features of dangerous diplopia • Provide a decision pathway for acute investigation and management in sudden onset double vision A/Prof Andrew Lee – Transient monocular blindness and TIA • Discuss the presentation and epidemiology of transient monocular visual loss to cerebrovascular event • Highlight the recommended RANZCO management pathway developed jointly by stroke neurologist and ophthalmologist in transient visual loss

1330–1500 S03 – SYMPOSIUM Ocular manifestation of genetic syndromic diseases: When to look beyond the eyes? Chairs: Prof Alex Hewitt and Dr Fred Chen Email: [email protected] Venue: C4.4 Synopsis: Ocular signs and symptoms may be the first presenting feature of a genetic syndrome that could have significant systemic co-morbidity. Conversely, the diagnosis of a genetic syndrome may depend on specific ophthalmic signs that require expertise in ocular phenotyping. Although individually rare, genetic eye disease as a group is the most common cause of irreversible blindness in the working age population. In this era of genomic revolution, ophthalmologists play an increasingly important role in ocular phenotyping and assisting genotype–phenotype correlation for establishment of a genetic diagnosis. The opportunity to investigate systemic associations of a genetic eye disease comes at (1) the time of initial presentation and (2) when a syndromic genetic defect is confirmed following pathogenicity assessment. The purpose of this symposium is to increase awareness of the various syndromic conditions that are associated with common and rare ocular phenotypes, including anterior segment dysgenesis, glaucoma, retinal dystrophy, phakomatosis and micro-ophthalmia. Ocular features of genetic collagen and connective tissue diseases will also be discussed. SATURDAY 09 NOVEMBER 27

This symposium will focus on unique clinical presentation and key ocular phenotype features that point towards the need for systemic evaluation. Certain syndromic genes may be identified in the course of genetic work-up in a patient with isolated genetic eye disease. Although systemic features may not be obvious on first presentation, these genes will direct specific systemic evaluation. We will discuss referral to a genetic eye clinic for further assessment and possible genetic testing. This will assist with refining the diagnosis, referral for additional investigations and provide genetic counselling for affected patients and their families. It can also assist patients to link into current research avenues and clinical trials. The outcome from this symposium is a greater awareness of key phenotype and genotype that warrants a “look beyond the eyes” and understanding of the importance of segregation analysis in genetic workup. This symposium brings expertise from clinical genetics, ophthalmic phenotyping and imaging, paediatrics ophthalmology, molecular genetics and genetic counselling from across Australia and the US. The session will conclude with cases highlighting the importance of recognizing rare signs that warrant a thorough systemic and genetic evaluation. Speakers and Topics: Prof Alex Hewitt: Introduction Dr Emmanuelle Souzeau: Glaucoma and genetic syndromes Dr Alan Ma: Anterior segment dysgenesis / micro-ophthalmia and genetic syndromes Prof Robyn Jamieson: Syndromic retinal dystrophy Prof David A Plager: Phakomatosis and systemic workup Ms Lisa Kearns: Genetic counselling in ocular syndromic diseases Dr Fred Chen: Clinical case examples and discussions

1330–1500 S04 SYMPOSIUM Emerging therapies in retinal diseases: The bionic retina, gene therapy and stem cells Chair: A/Prof Matthew Simunovic Email: [email protected] Venue: C4.5 Aim: Retinal degeneration is the chief cause of blindness registration in developed countries. The objective of this course is to provide an up-to-date overview of the current status of emerging treatments of retinal degenerative disease, including the bionic retina, gene therapy (causative gene-specific and gene-independent) and stem cell therapies. Speakers and Topics: A/Prof Penelope Allen – Bionic Retina A/Prof Allen will review epiretinal, sub-retinal and suprachoroidal approaches to retinal implants. In addition to summarizing the findings from studies investigating approved devices (Argus II, Retina AG), A/Prof Allen will give an overview of her work on the Australian bionic eye. Dr Thomas Edwards – Retinal gene therapy Dr Thomas Edwards will give an overview of retinal gene therapy with particular reference to the recent FDA approval of Luxturna for Leber Congenital Amaurosis secondary to mutations in RPE65 as well providing updates of gene therapy for choroideremia and X-linked retinitis pigmentosa. A/Prof Matthew Simunovic – Causative gene-independent approaches Around 30% of patients with presumed inherited retinal degeneration have no causative gene identified. In addition to the bionic eye, biological causative gene-independent approaches are emerging as possible future treatments for this group of patients. A/Prof Simunovic will review optogenetic approaches, photo- switches and stem cell therapies. Prof John Marshall – Emerging laser interventions in inherited retinal degenerations and ARMD Increased understanding of the biophysics of laser tissue interactions coupled with elucidation of the biochemical processes involved in maintaining healthy function in the outer retina have led to some successful interventions in delaying the progressive changes associated with inherited dystrophies and ARMD. Success has been demonstrated in those conditions where genetic defects and ageing have resulted in abnormal accumulation of debris within Bruch's membrane and these will be presented and discussed. 28 SATURDAY 09 NOVEMBER

1330–1500 SO5 FREE PAPERS – Glaucoma Venue: C4.6 – C4.7 Chairs: Dr Stephen Best and A/Prof Anne Brooks

individual surgeon data, allows collection of high‐quality S0501 real‐world outcome data on safety and efficacy. Ongoing The fight glaucoma blindness! registry: Design, data collection will allow long‐term assessment of safety and baseline characteristics and early outcomes of efficacy of glaucoma surgical outcomes. combined cataract surgery with iStent inject S0502 Mitchell Lawlor1,2 Colin Clement1, Helen Danesh‐Meyer3, Serum TH1 AND TH17 related cytokines and Anne Brooks4, Jamie Craig5, Ivan Goldberg1, Stuart Gra- the activation of complement system in patients ham6, John Grigg1, Frank Howes7, Ridia Lim2, Simon with Posner‐Schlossman syndrome Skalicky4, Andrew White1, George Kong4, Phuc Nguyen1 1University of Sydney, Sydney, Australia, 2Sydney Eye Hos- Jun Zhao1,2, Wenchieh Chen2,1, Xiaosheng Huang1,2, pital, Sydney, Australia, 3University of Auckland, Auckland, Shiming Peng1,2,YeYe1, Jiamin Cai1, Tianhui Zhu2 New Zealand, 4Royal Victorian Eye and Ear Hospital, Mel- 1Shenzhen Eye Hospital, School of Ophthalmology & bourne, Australia, 5Flinders University, Adelaide, Australia, Optometry Affiliated to Shenzhen University, Shenzhen, 6Macquarie University, Sydney, Australia, 7Eye and Laser China, 2Shenzhen Eye Hospital Affiliated to Jinan Univer- Centre, Southport, Australia sity, Shenzhen Eye Institute, Shenzhen, China Email: [email protected] Email: [email protected] Purpose: Fight Glaucoma Blindness! (FGB) is a web‐based Purpose: To investigate the relationship respectively glaucoma registry allowing clinicians to audit their glau- between serum Th1 and Th17 related cytokines or the acti- coma surgical outcomes and compare results against their vation of complement system and Posner‐Schlossman syn- peers. The registry gathers real world outcomes of patients drome (PSS). undergoing glaucoma surgery. This paper describes baseline Methods: A prospective case‐controlled was designed. characteristics and early outcomes for patients with com- Peripheral blood serum samples were collected from 81 bined cataract surgery with iStent Inject. patients with PSS and 97 gender‐ and age‐matched healthy Method: An independent registry team provides training, sup- blood donors. The common activated components in three port, and ensures anonymity of individual surgeon data. Sur- complement activation pathways and major Th1 and Th17 geons input personal data and aggregated anonymised data related cytokines were detected by immuno‐scatter tur- regarding combined cataract with iStent inject is presented here. bidmetry and ELISA in the PSS patients and the controls. Results: The registry is currently tracking 502 combined Results: Serum levels of IL‐1β,IL‐12, TNF‐α and IL‐6 and cataract with iStent G2 procedures, of which 280 eyes of 20 serum complement factor Bb level in PSS patients were sig- surgeons have completed at least 6 months follow up. The nificantly lower than those in controls, and the differences most common glaucoma subtypes included are POAG were statistically significant (all P < 0.05). Serum levels of (62%), NTG (10%) and ocular hypertension (15%). The C3, C4, C1q, FCN2, C3a, sC5b‐9 in PSS patients were sig- average Humphrey mean deviation at surgery was −4.4 dB, nificantly higher than those in controls, and the differences with mean preop IOP of 16.5 mmHg. The mean number of were statistically significant (all P < 0.05). Serum C3a con- topical antihypertensive agents was 1.4. tent was positively correlated with the content of serum At 6 months mean IOP was 12.9 mmHg (22% reduction) sC5b‐9 in PSS group (r = 0.832, P < 0.001). with mean number of topical antihypertensive agents being Conclusions: Serum Th1 and Th17 related cytokines, 0.7 (53% reduction). Complications included 3 patients including IL‐1β,IL‐12, TNF‐α and IL‐6 might play an (0.6%) developing choroidal effusions and 1 patient devel- important role in the pathogenesis and progression of PSS. oping hyphaema requiring washout. One patient required The serum complement system is activated in PSS patients. secondary glaucoma surgery within the 6 month follow up, Complement alternative pathway might be involved in the which was a trabeculectomy. alternative process of complement system, and classical Conclusion: FGB is a robust web‐based registry with good pathway and lectin pathway of complement system also clinician uptake. The design ensuring anonymity of could not be excluded in patients with PSS. SATURDAY 09 NOVEMBER 29

S0503 S0504 Clinical phenotypes of glaucoma patients Corneal manifestations associated with variants stratified by an intraocular pressure polygenic in FOXC1 and PITX2 genes in anterior risk score segment dysgenesis

Ayub Qassim1, Emmanuelle Souzeau1, Owen Siggs1, Mark Mallika P. Senthil1, Emmanuelle Souzeau1, Jamie Craig1 Hassall1, Xikun Han2, Puya Gharahkhani2, Alex Hewitt3, 1Flinders University, Adelaide, Australia Stuart MacGregor2, Jamie E Craig1, Andrew J Lotery4, Email: [email protected] Colin E Willoughby5, Neeru A. Vallabh6 Purpose: Anterior segment dysgenesis encompass a spec- 1Flinders University, Oaklands Park, Australia, 2QIMR Ber- trum of developmental disorders affecting the anterior cham- ghofer Medical Research Institute, Brisbane, Australia, ber structures. Although several gene variants have been 3Menzies Institute for Medical Research, Hobart, Australia, identified, variations in FOXC1 and PITX2 genes are the 4Clinical and Experimental Sciences, Faculty of Medicine, main cause for these disorders. Variants in FOXC1 and University of Southampton, Southampton, SO16 6YD, UK, PITX2 lead to ocular manifestations that are indistinguish- 5Biomedical Sciences Research Institute, Ulster University, able from each other. This study aims to compare the corneal Coleraine, BT52 1SA, Northern Ireland, UK, 6University of abnormalities between FOXC1 and PITX2 variants. Liverpool, Liverpool L6 8TX UK Methods: This cross‐sectional study involved 54 individuals Email: [email protected] from 24 families with disease associated FOXC1 or PITX2 Purpose: To characterize the clinical phenotype of primary variants registered with the Australian and New Zealand open angle glaucoma (POAG) in individuals stratified by Registry of Advanced Glaucoma (ANZRAG). their burden of genetic risk for raised intraocular pres- Results: The mean age of the cohort was 39 years (range 3 sure (IOP). to 85 years; females, 54%). More than half the patients (n = Method: Using summary statistics obtained from a recent 32) showed variation in FOXC1 gene. The overall preva- UK Biobank genome‐wide association study of IOP, we lence of glaucoma was 74%. Among the individuals with developed an IOP polygenic risk score (PRS) comprising glaucoma, 22 had primary open angle glaucoma (POAG) 146 single‐nucleotide polymorphisms (SNPs). 2386 study and 12 had childhood glaucoma (CG). Childhood glaucoma participants with POAG were sampled from the Australian was more common in FOXC1 variants and POAG was more and New Zealand Registry of Advanced Glaucoma common in PITX2 variants. Corneal abnormalities were (ANZRAG) and stratified into three tiers based upon their more common in the FOXC1 variants than the PITX2 vari- IOP PRS. The highest quintile of the PRS was defined as ants carriers (P = 0.030). Megalocornea was the most com- high‐risk, the middle three quintiles as intermediate‐risk, and mon corneal abnormality among the FOXC1 variants the lowest quintile as low‐risk. Clinical data were compared carriers. Corneal decompensation was more commonly seen between the three IOP PRS risk strata. in CG than in POAG. Results: Participants from the high IOP genetic risk group Conclusions: Corneal abnormalities are more common in demonstrated 1.4 mmHg higher maximum recorded IOP FOXC1 than PITX2 variants and often associated with (95%CI: 0.46‐2.3 mmHg; P = 3.7x10‐4), and were more childhood glaucoma. Patients with FOXC1 variation would likely to present with high IOP (IOP >21 mmHg; OR = require close follow‐up and monitoring throughout infancy 1.7; 95%CI 1.2‐2.2; P = 1.0x10‐3) when compared to the and into adulthood. Genetic diagnosis, therefore, can provide intermediate‐ and low‐risk groups. High‐risk status also a useful indicator of the risk of clinical complication. predicted younger age at diagnosis (P = 4.0x10‐4), more family members affected by glaucoma (P = 1.8x10‐5), S0505 worse visual field mean deviation (−1.5 dB; 95%CI ‐2.52 The relative impact of monogenic and to −0.44; P = 5.0x10‐3), and higher likelihood of having polygenic risk variants on age at glaucoma undergone trabeculectomy (OR = 1.3; 95%CI 1.1‐1.6; P diagnosis = 0.018). Conclusion: The IOP polygenic risk score was positively Owen Siggs1, Emmanuelle Souzeau1, Xikun Han2, Ayub correlated with maximum IOP and disease severity, Qassim1, Jonathan Ruddle3, Andrea Vincent4, Stephen supporting clinical utility. Further refinements will include Best5, Robert Casson6, Stuart Graham7, Alex Hewitt8, David additional POAG and disc morphology SNPs. Mackey8, Stuart MacGregor2, Jamie Craig1 30 SATURDAY 09 NOVEMBER

1Department of Ophthalmology, Flinders University, Ade- 1Prince of Wales Hospital, Sydney, Australia, 2Uniiversity of laide, Australia, 2QIMR Berghofer Medical Research Insti- New South Wales, Sydney, Australia, 3Sydney Eye Hospital, tute, Brisbane, Australia, 3Centre for Eye Research Sydney, Australia, 4Westmead Hospital, Sydney, Australia Australia, University of Melbourne, Melbourne, Australia, Email: [email protected] 4Department of Ophthalmology, University of Auckland, Purpose: Clinical audits provide valuable insight for sur- Auckland, New Zealand, 5Eye Department, Greenlane Clini- geons beyond formal clinical trials, with wide inclusivity cal Centre, Auckland District Health Board, Auckland, New and reflecting real‐world decision‐making. We evaluated the Zealand, 6South Australian Institute of Ophthalmology, Uni- population and disease characteristics for the Hydrus micro- versity of Adelaide, Adelaide, Australia, 7Faculty of Medi- stent (Ivantis Inc) from the SPECTRUM registry for guid- cine and Health Sciences, Macquarie University, Sydney, ance on practice in our region. Australia, 8Menzies Institute for Medical Research, Univer- Methods: Study population comprised all cases (without sity of Tasmania, Hobart, Australia exclusion) of all surgeons (14) in all Australian & New Email: [email protected] Zealand centres (9) implanting Hydrus from 2014. Micro- Purpose: Glaucoma can occur at any age, with age at diag- stents were implanted with cataract surgery or standalone. nosis dictated in part by one's genetic background. Those Data entered into global SPECTRUM registry included diagnosed earlier in life typically inherit one or two rare baseline demographics, medications, IOP, HVF MD, prior pathogenic variants in a single gene (monogenic), while ocular surgery and serious adverse events. those diagnosed later usually harbour a large burden of com- Results: 1116 eyes underwent Hydrus implantation; 295 mon glaucoma risk variants across many genes (polygenic). (26%) standalone (SA), 821 (74%) combined with cataract We sought to compare the influence of monogenic and poly- surgery (CC). Average age and sex was similar (72‐74 years, genic risk variants upon age at glaucoma diagnosis. female 55‐60%). SA cohort glaucoma severity greater by VF Method: Advanced and non‐advanced glaucoma cases of all MD (−9.6 vs −6.1 dB), baseline IOP (21.4 ± 7.6 vs 18.4 ± ages from the Australian and New Zealand Registry of 5.9 mmHg), medications (2.8 ± 1.1 vs 2.1 ± 2.2), prior SLT Advanced Glaucoma were stratified by their burden of 2673 (38% vs 20%) and glaucoma surgery (19% vs 4%). IOP polygenic glaucoma risk variants, or where known, by the reduction greater in SA cases at 3 years (35% vs 22%, p < presence of monogenic variants in the myocilin (MYOC) or 0.05) though with less medication reduction (47% vs 50%, p CYP1B1genes. Cumulative glaucoma incidence curves were < 0.05). Significant adverse events: transient iritis (5%) and generated for each stratum, and compared by log‐rank PAS (8.9%), associated with device obstruction in 7.3%. testing. Conclusion: In a real‐world clinical setting, population char- Results: Among participants with glaucoma (N = 3922), acteristics were similar for standalone and combined cata- those with pathogenic variants in CYP1B1had the youngest ract‐Hydrus microstent cases. Standalone patients had more median age at diagnosis (4 years [95% CI: 0‐20]), followed advanced disease than combined, with better IOP outcomes, by MYOC (49 years [45‐54]), and those without a mono- though on slightly more medications, at 3 years. Our local genic diagnosis (61 years [60‐62], P < 0.0001). Those in the experience mirrors global outcomes and may help guide top decile of polygenic risk (58 years [56‐60]) had a similar future use of MIGS, especially as standalone‐glaucoma median age at diagnosis as those carrying the most common procedures. glaucoma‐associated MYOCvariant (Gln368Ter, 54 years [52‐60], P = 0.33). S0507 Conclusion: The combined influence of many polygenic Minimally invasive glaucoma surgery (MIGS) glaucoma risk variants is similar in magnitude to the effect as a standalone procedure for glaucoma in of the single most common monogenic glaucoma variant Australia and New Zealand (MYOCGln368Ter). This highlights the large collective 1,2 1,3 1,4 impact of polygenic risk variants, and supports further Eleanor Hall , Jenny Hepschke , Ashish Agar 1 2 exploration of their use in clinical care. University of New South Wales, Sydney, Australia, Prince Wales Hospital, Sydney, Australia, 3Prince of Wales Hospi- S0506 tal, Sydney, Australia, 4Prince of Wales Hospital, Sydney, Population, disease characteristics and Australia outcomes for the hydrus microstent MIGS in Email: [email protected] Australia & New Zealand Purpose: The use of MIGS is rising and may provide an opportunity to lower IOP and medications without riskier Ashish Agar1,2, Eleanor Hall2, Colin Clement3, Ridia Lim3, and more conventional invasive surgery. MIGS can be used Andrew White4, Paul Healey4 as a standalone (SA) procedure or combined with cataract SATURDAY 09 NOVEMBER 31 surgery. However, combined cataract‐MIGS is currently the in comparison to 29 (88%) fellow unaffected eyes; p = only funding option for most devices in Australia. Our aim 0.001. Scans of 54 (90%) healthy eyes and 3 (9%) fellow is to determine if SA treatment is at least as efficacious as PCG eyes revealed a direct communication of anterior por- combined cataract MIGS surgery. tion of the SC with the anterior chamber. Among the fellow Method: We utilized the Save Sight Fight Glaucoma Blind- eyes, a communication of the supraciliary space with ante- ness Registry, Ivantis Worldwide Hydrus registry, and surgi- rior chamber could be discerned in 26 eyes (79%). cal centres in Australia & New Zealand to collect data on Conclusion: Anterior segment SDOCT can be useful for patients aged 18 years that have undergone MIGS proce- monitoring fellow eyes of unilateral PCG patients. While dures (XEN, iStent and Hydrus) between 2014‐2019. most fellow eyes have angle dysgenesis, outflow channels Patients had a minimum of 6 months follow‐up with IOP, such as the uveoscleral or a patent SC communication might medications and visual‐acuity recorded at each visit. Data play a role in preventing the development of glaucoma in was stored, de‐identified on Redcap and analysed these eyes. Existence of these communications with the ante- using SPSS. rior chamber, that assist in aqueous outflow, needs further Results: Final data on >400 patients are expected by August evaluation. 2019, but preliminary data shows an effective reduction in IOP and medications for SA MIGS. Hydrus data (n = 295), S0509 demonstrated an IOP reduction of 30% and medication Systemic vascular risk factors and IOP reduction of 38%.Xen data (n = 15) demonstrated a medica- determine the location of initial structural and tion reduction from 3.5 to 1.2 and IOP reduction from 22.7 functional deficit in early glaucoma to 17.7, with 3 patients requiring conventional surgery. 1 1 1 Conclusion: Our data suggests MIGS surgery can provide Henry Marshall , Nicholas Andrew , Mark Hassall , Ayub 1 1 1 an effective avenue for reducing IOP and medications in Qassim , Emmanuelle Souzeau , Bronwyn Ridge , Thi 1 1 1 patients with Glaucoma, independent of its use as standalone Nguyen , Jude Fitzgerald , Mona Awadalla , Kathryn 2 3 4 5 or in combined surgery. We propose therefore that funding Burdon , Paul Healey , Ashish Agar , Anna Galanopoulos , 2 6 1 and accessibility should not be dependent on the patient's Alex W Hewitt , Stuart Graham , John Landers , Robert 5 7 lens status. Casson , Jamie E Craig 1Flinders University, Bedford Park, Australia, 2University of S0508 Tasmania Menzies Institute for Medical Research, Hobart, The trabecular meshwork and schlemm's canal Australia, 3University of Sydney Discipline of Ophthalmol- in unilateral primary congenital glaucoma: ogy, Sydney, Australia, 4Sydney, Sydney, Australia, 5The New anatomical openings University of Adelaide, Adelaide, Australia, 6Macquarie University, Sydney, Australia. 7Flinders University, Bedford Viney Gupta, Ishan Pandya, Seema Sen, Shikha Gupta, Park, Australia Bindhu Somrajan Email: [email protected] All India Institute of Medical Science, New Delhi, India Purpose: To investigate whether systemic and ocular char- Email: [email protected] acteristics influence whether an eye demonstrates Purpose: Characterize features of the trabecular meshwork glaucomatous structural defects first on mGCIPL or pRNFL and Schlemm's canal in fellow eyes of patients with unilat- baseline Optical Coherence Tomography (OCT) imaging, eral primary congenital glaucoma. and correlate associated risk factors to visual field loss. Methods: This cross sectional observational study analysed Design: A baseline analysis of 2026 eyes from 1013 patients Trabecular meshwork scans on SDOCT of both eyes of chil- from the PROGRESSA study. dren with unilateral PCG (n = 66) and healthy children (n = Participants: 283 eyes showed solely mGCIPL structural 60). Subgroup analysis was done for presence/ absence of defects and 309 eyes showed solely pRNFL structural angle dysgenesis, defined by presence of abnormal tissue/ defects at baseline. hyper‐reflective membrane within angle recess and/or Methods: Mixed effects modelling compared the systemic absence of Schlemm's canal (SC). Other anatomical land- and ocular characteristics of eyes demonstrating solely marks differentiating the fellow eye from the glaucomatous mGCIPL structural defects to eyes demonstrating solely eye were evaluated by two independent glaucoma specialists pRNFL structural defects. and compared with healthy subjects. Outcome Measures: OCT structural defects were correlated Results: Presence of abnormal tissue at the angle were seen with systemic and ocular characteristics. in all affected PCG eyes (100%), and in 21 (63%) unaffected Results: Eyes with solely mGCIPL structural defects had fellow eyes; P = 0.001. SC could be seen in 8 (24%) affected significantly higher rates of cerebrovascular disease (Stroke/ 32 SATURDAY 09 NOVEMBER

TIA, OR: 7.28; 95%CI:[2.13‐24.89]; P < 0.001), myocardial summary statistics (Mean Deviation, MD, Pattern Devia- Infarction (OR:2.89; 95%CI: [1.58‐5.32]; P < 0.001), hyper- tion, PD). tension (OR: 1.52; 95%CI:[1.09‐2.13]; P < 0.001) and Results: The average number of tests performed over the depression (OR:1.65; 95%CI:[1.042.62]; P < 0.001) than 6 week period was 5.1 ± 2.2, with 69% of patients com- eyes with solely pRNFL structural defects. Eyes with solely pleted ≥4 test at home. The MD values for study eye pRNFL structural defects had a significantly higher age ranged from −28.77 dB to +0.95 dB (average − 6.23 dB). (mean difference: 5.23 years; 95%CI: [3.31‐7.15]; P < Pearson's correlation (r) between self‐directed MRF test 0.001) and baseline IOP (mean difference: 2.09 mmHg; 95% performed at home and HFA was 0.86 for MD and for PD CI: [1.19‐2.98]; P < 0.001). Eyes with solely mGCIPL struc- 0.76. 95% LoA for test‐retest variability of MD values tural defects were 5.54 times more likely to show solely obtained by MRF was higher compared to HFA (±7.24 dB paracentral field defects (95%CI: [1.07‐28.76]; P = 0.041). vs 6.08 dB). The presence of stroke/TIA (OR: 3.99; 95%CI: [1.12‐14.15]; Conclusions: Visual field test performed at home has good P = 0.023) and myocardial infarction (OR:3.02; 95%CI: compliance and is able to produce comparable outcomes to [1.06‐8.65]; P = 0.0319) significantly increased the likeli- those obtained in the clinic. Future longer‐term home moni- hood of paracentral visual field defects at baseline. toring study of disease progression may be feasible. Conclusion: Systemic characteristics, particularly those per- taining to cardiovascular disease, influence the site of initial S0511 structural defects and location of first visual field loss in Automating glaucoma diagnosis through early glaucoma convolutional neural networks (AI)

S0510 Samuel Marks1, Andrew White1,2,3,4,5,6,7, Paul Mitchell1 Reliability of self‐directed home monitoring of 1University of Sydney, Sydney, Australia, 2Westmead Hospital, visual field with tablet perimeter Sydney, Australia, 3Community Eye Care Centre, Sydney, Aus- tralia, 4Sydney Eye Hospital, Sydney, Australia, 5Westmead George YX Kong1,2,3, Mingguang He2, Selwyn Prea2, Algis Institute for Medical Research, Sydney, Australia. 6UNSW, Syd- Vingrys3 ney, Australia, 7Save Sight Institute, Sydney, Australia 1Royal Victorian Eye and Ear Hospital, Melbourne, Austra- Email: [email protected] lia, 2Centre for Eye Research Australia, Melbourne, Austra- Purpose: By 2020, approximately 65.5 million people will lia. 3Department of Optometry & Vision Sciences, The have glaucoma [1]. There are only 200 000 ophthalmologists University of Melbourne, Melbourne, Australia worldwide [2]. Email: [email protected] An alternative to ophthalmologists is needed. Optometrists Purpose: To examined the short‐term compliance and reli- also diagnose glaucoma, but not as accurately as ophthal- ability of visual field testing on iPad at home using Mel- mologists. In addition, optometrists in some countries con- bourne Rapid Fields app (MRF). duct medical management. Methods: 70 patients with either controlled glaucoma (n = Method: Developing an AI system brings ophthalmologists' 66) or normal (n = 4) were recruited. Each patient had visual diagnoses into the hands of all. This has the potential to field assessment using the HFA, the MRF test in clinic and solve both the issue of low numbers of ophthalmologists and was given a 20‐minute training session. Each patient was the inconsistent quality of optometry. then asked to perform monocular MRF test at home on a Algorithms for diagnosing glaucoma have been developing weekly basis for 6 weeks using a loan iPad. A notification using the BMES [3] corpus. was sent to the patients each week. Exclusion criteria were: Results and Conclusion: Our novel open‐source con- non‐English speaking, acuity worse than 6/12, intraocular volutional neural network achieves >79% accuracy (AUC). surgery in past 6 months. Comparisons were made by esta- Compared to 83% for glaucoma expert ophthalmologists [4], blishing correlations (Pearson) and using Bland–Altman and 16% less for accredited glaucoma optometrists [5] methods (Bias, 95% Limits of Agreement, LoA) for the respectively.

1500–1530 AFTERNOON TEA

1530–1700 CONCURRENT SESSIONS

1530–1700 S06 SYMPOSIUM Posterior capsule rupture management and IOL options in compromised capsule support Chair: Dr Minu Mathen SATURDAY 09 NOVEMBER 33

Email: [email protected] Venue: C4.1 Synopsis: This symposium will discuss the common risk factors and management strategies for posterior capsule rupture associated during Phacoemulsification. Video based lectures and panel discussion will include risk factors, prevention, early diagnosis and management of these complications including choice of IOLs in these situations The postoperative care and outcome will be emphasized. The attendees will understand the basic principles of managing this common and important complication, including basics of anterior vitrectomy (limbal and pars plana routes), nucleus management in open posterior capsule and IOL placement options in compromised capsule support. Speakers and Topics: Dr Minu Mathen – Strategies to prevent posterior capsule tear Prof Soon-Phaik Chee – Nucleus management, in presence of PC rupture, at different stages during phacoemulsification Dr David Lubeck – Cortex Removal and Basics of Anterior Vitrectomy Techniques A/Prof Nitin Verma AM – Principles of Pars Plana approach for anterior Vitrectomy for the anterior segment surgeon Dr Elias Jacob Veepanat – Posterior chamber and Anterior chamber IOL options in cases with compromised capsule support Dr Vignesh Raja – Iris and scleral sutured IOLs Dr Minu Mathen – Glued Scleral fixated IOL Dr Rodney John Morris – Glueless, sutureless Scleral fixated IOLs Panel – Case based discussion on videos of various scenarios of PC rupture and IOL placement options led by Dr Minu Mathen.

1530–1700 S07 COURSE Ocular oncology update: Catching the rare killers and troublesome spots Chair: Dr Michael Giblin Email: [email protected] Venue: C4.4 Aim: To provide an update on ocular oncology topics and promote discussion of interesting and challenging cases. Speakers and Topics: Dr Lindsay McGrath – Conjunctival and orbital tumour update Dr Li-Anne Lim – What's new in retinoblastoma Dr Tim Isaacs – Uveal melanoma update Dr Sunil Warrier – Vitreoretinal lymphoma made clear Dr Daniel McKay – Other oddities Dr Michael Giblin, Dr William Glasson AO, Dr John McKenzie, Dr Peter Hadden, Dr James Muecke, A/Prof Max Conway – Panel on Interesting cases

1530–1700 S08 SYMPOSIUM Diabetic retinopathy – integrating care for diabetes and eye health (local and international perspectives) co-sponsors: RANZCO international development committee (IDC), Australian and New Zealand Society of Retinal Specialists (ANZSRS) Chairs: Dr Jennifer Arnold, Dr Anthony Bennett Hall and Dr Sophia Zagora Email: [email protected] Venue: Darling Harbour Theatre Synopsis: RANZCO's mission is to drive improvements in eye health care in Australia, New Zealand and the Asia-Pacific region through exceptional training, education and advocacy. Through the IDC they help implement these improvements. The Australian and New Zealand Society of Retinal Specialists (ANZSRS) is the RANZCO special interest group representing retina specialists in Australian and New Zealand. 34 SATURDAY 09 NOVEMBER

The burden of Diabetes and its associated health problems is growing in our region affecting Australians and the peoples of the Pacific. In 2013, the International Diabetes Federation (IDF) estimated that 382 million people had diabetes worldwide, and by 2035, this was predicted to rise to 592 million. Eighty percent live in low- and middle-income countries, and of the total, more than 60% live in Asia, with almost one-third in China. Detecting diabetic retinopathy in a timely fashion requires the integration of eye health and diabetes care. Speakers and Topics: This symposium will: • Discuss the principles of Integrated Diabetes and Eye Health Care • Highlight efforts addressing Aboriginal and Torres Strait Islander health inequality. Discuss progress in integrating eye care into an integrated primary health care system. • Describe progress in DR screening and treatment in the pacific. • Discuss opportunities for teaching, training and ophthalmic development in our region. Part 1: Integrated Diabetes and Eye Health Care • Discussing the Principles: Centred on people, equity, quality, collaboration, Finding the evidence. • Dr Emily Y Chew – Epidemiology of diabetic eye disease/screening/treatment in USA • Prof Tien Wong – The evidence, collaborative care “Singapore's war on diabetes: Evidence, collaboration, population health” • Questions /discussion Part 2: The Australian experience: incorporating both urban and rural careà what is working and what is not • A/Prof Andrew White – The diabetic epidemic in Sydney and people's access to healthcare • A/Prof Gerald Liew – Epidemiology of patients with DME, vision threatening diabetic retinopathy disease in Australia Part 3: Training – Driving enduring change • Opportunities for development: Training of primary care workers. Training of subspecialists. in- country vs external training, the importance of effective partnerships, stakeholder engagement, the role of telemedicine: Case studies of training from Australasia. • Dr Harris Muzammil Ansari – MR/VR training Pacific Eye Institute Fiji and Myanmar • A/Prof Peter Van Wijngaarden – Is there a role for Artificial Intelligence in medical retina in rural/ remote Australia/developing countries/Asia Pacific? Part 3: Conclusions/Questions/Discussion

1530–1700 S09 SYMPOSIUM Paediatric retina in a nutshell 2019 Chairs: Prof Glen Gole and A/Prof Geoff Lam Email: [email protected] Venue: C4.5 Aim: To provide an overview of retinal disorders in children for both the paediatric ophthalmologist and the general ophthalmologist who sees children. Speakers and Topics: A/Prof Geoff Lam – Retinopathy of prematurity screening Dr Rasha Altaie – Treatment options in ROP Dr James Smith – Premature Baby Follow up and Why A/Prof Shuan Dai – Neuro-ophthalmic masquerades of paediatric retinal disease A/Prof James Elder – current retinoblastoma management Dr Susan Carden – the infant with nystagmus – what to do Dr Michael Jones – My 8 yo child cannot see – why? Dr Rosie Dawkins – Ocular Collagenopathies and their management

1530–1700 S10 FREE PAPERS – Anterior Segment Venue: C4.6 – C4.7 Chairs: Dr Richard Mills and Dr Elaine Chong SATURDAY 09 NOVEMBER 35

S1001 2St John of God Eye Clinic, Perth, Australia, 3Department Clinical characteristics in dry eye disease of Ophthalmology, University of New South Wales, Sydney, according to changes of ground‐level air Australia, 4National Centre for Epidemiology and Popula- pollution tion Health, Australian National University, Canberra, Aus- tralia, 5Garvan Institute, Sydney, Australia Dong Hyun Kim1, Yoon Hyeong Choi2 Email: [email protected] 1Department of Ophthalmology, Gachon University College Purpose: Conjunctival Ultraviolet Autofluorescence of Medicine, Gil Medical Center, Incheon, Republic of (CUVAF) is an objective measure of ocular sun exposure. In Korea, 2Department of Preventive Medicine, Gachon Uni- cross‐sectional studies, CUVAF area is strongly associated versity College of Medicine, Incheon, Korea, Republic of with pterygium. We aimed to longitudinally evaluate this Email: [email protected] relationship. Purpose: To analyse the changes of clinical features in dry Methods: Participants of the Western Australia Pregnancy eye patients according to Ground‐level air pollution Cohort (Raine) Study, had colour and CUVAF photographs Methods: From January 2016 to June 2018, a prospective of the nasal and temporal bulbar conjunctiva of each eye observational study was conducted on patients with dry eye taken at the age 20‐ and 27‐year follow‐ups. Pterygium sta- disease (DED) who had been treated with the same ocular tus was determined from colour photographs and CUVAF treatments. Patients visited three times every 2-month inter- area was measured. Using eyes as the unit of analysis, logis- vals and OSDI, tear secretion, tear‐film breakup time tic regression within a generalized estimating equation was (TBUT), and corneal fluorescein staining score were mea- used to assess the association between mean CUVAF area at sured in each visit. Mean PM10, PM2.5, and ozone concen- age 20 years and lifetime prevalence of pterygium at age 27 trations for 1 day, 1 week and 1 month before the years or incidence of pterygium between ages 20 and 27‐ examination date were used as air pollution exposure. The years, after adjusting for sex. relationships between air pollutants and DED were analysed Results: Eye colour photos were available for 1071 partici- in single‐pollutant and multi‐pollutant models using linear pants at the 27‐year follow‐up. Of these, the lifetime preva- mixed model. lence of pterygium was 1.5% (n = 33 eyes of 25 Results: Forty three patients were included in this study. participants) and 1.0% (15 eyes of 11 participants) devel- The mean age was 55.3 ± 10.5 years. In single‐pollutant oped a new pterygium between the 20‐ and 27‐year follow‐ model, OSDI score was increased and tear secretion was ups. Lifetime prevalence of pterygium at 27‐years was asso- decreased with higher ozone exposure for 1 day, 1 week, ciated with mean CUVAF area at 20‐years (OR = 2.20, 95% and 1 month. (each p < 0.05) Interestingly, higher CI: 1.52, 3.18, per 10 mm2 increase). Greater mean CUVAF PM10exposure for 1 day, 1 week, and 1 month was related area at age 20‐years was associated with increased odds of with decreased TBUT(each P < 0.01) In multi‐pollutant incident pterygium between 20‐ and 27‐years (OR = 3.51, model, OSDI score was increased with higher ozone and 95% CI: 2.52, 4.90, per 10 mm2 increase). PM2.5exposure for 1 day and 1 week. (each P < 0.05) A Conclusion: This longitudinal study demonstrates a rela- similar decrease was shown in TBUT with higher tionship between CUVAF area at age 20 years and risk of PM10exposure for 1 day, 1 week, and 1 month. (P = 0.001/ pterygium. CUVAF imaging could be used to identify 0.001/0.018) patients at risk of pterygium. Conclusion: The increase of ground‐level ozone and PM2.5concentration lead to ocular discomfort, and the S1003 increase of PM10 aggravated tear film stability. Mechanisms Orthokeratology for arrest of myopia, and of action in DED seem to be different between ozone, PM10 longevity of effects following treatment and PM2.5. discontinuation: A systematic review

S1002 Damien Hunter1,2, Mai Linh Vo2, Chameen Greater ocular sun exposure, measured Samarawickrama1,2,3 objectively, is associated with increased risk of 1Westmead Institute of Medical Research, Westmead, Aus- future pterygium in young adults tralia, + University of Sydney, Sydney, Australia, 3Depart- ment of Ophthalmology, Westmead, Australia Gareth Lingham1, David Mackey1, Charlotte McKnight2, Email: [email protected] Minas Coroneo3, Robyn Lucas4, Seyhan Yazar1,5 Purpose: While there is modest evidence that ortho- 1Lions Eye Institute, Centre for Ophthalmology and Visual keratology (ortho‐K) limits progression of myopia in chil- Science, University of Western Australia, Perth, Australia, dren, longevity of benefit following discontinuation of 36 SATURDAY 09 NOVEMBER treatment is unclear. This information is necessary to deter- Results:2900 eyes were included in the analysis. The mean mine whether benefits outweigh risks associated with over- age was 32.8 years. The mean preop spherical equivalent night contact lens wear. was −5.49 ± 2.01D. The mean absolute difference from Methods: We conducted a systematic review to assess refractive target was 0.25 ± 0.28D. 92.4% of eyes reached 6/ effects of ortho‐K on myopia progression during use and fol- 6 or better unaided distance visual acuity and 99.4% reached lowing discontinuation of ortho‐K treatment. Inclusion 6/9 or better. Postoperative complications will be discussed. criteria: patients age > 5 years, myopia −0.75 D to −6.00 D, Conclusion: SMILE provides excellent refractive outcomes and absence of underlying ocular disease. All studies meet- across a range of myopic and astigmatic errors. Patient selec- ing inclusion criteria were retrieved, to assess overall quality tion remains essential to the safety and success of the surgi- of literature. All articles screening, Risk of Bias assessment cal procedure. and data extraction occurred independently, with disagree- ment resolved by consensus. S1005 Results: Of 235 full texts retrieved, quality of evidence was ‐ ‐ overwhelmingly poor (55% case‐series studies). 22 RCT full The long term outcomes from corneal cross texts were screened, and 15 included, describing outcomes linking: A save sight keratoconus registry study from 8 trials. Comparator treatments in these studies were Stephanie Watson1 1 1 heterogeneous, including soft or rigid contact lenses (n = 4 , Alexander Ferdi , Vuong Nguyen , 2 1 1 studies), spectacles (n = 2) and ortho‐K + atropine combina- Marco Abbondanza , Marco Garcia , Himal Kandel , Fight 3 tion treatment (n = 2). Ortho‐K treatment alone did not Corneal Blindness Group 1Save Sight Institute, Sydney, Australia, 2Abbondanza Eye reduce rate of axial growth (3 trials, N = 156 eyes, mean dif- Centre, Milan, Italy, 3Save Sight Registries, Sydney, ference = −0.09 [95%CI ‐0.19‐0.01], P = 0.08), and there Australia was rebound in axial growth rate following discontinuation Email: [email protected] (2 trials, N = 79 eyes, mean difference = 0.07 mm greater Purpose: To report the 5‐year outcomes of 113 eyes under- following discontinuation [95%CI 0.05‐0.08], p < 0.001). going corneal cross‐linking (CXL) for keratoconus in routine Conclusion: Analysis is ongoing, but preliminary results clinical practice across Australia, New Zealand and Europe. suggests that ortho‐K does not limit progression of myopia, Methods: Patients with keratoconus who had CXL enrolled and an acceleration in myopia progression is seen on discon- in the prospectively designed Save Sight Keratoconus Regis- tinuation of the lenses. try with a follow‐up between 4‐6 years were included. Index S1004 visit characteristics, such as visual acuity (VA, in Logarithm of the Minimal Angle of Resolution [logMAR] letters), max- Smile: A multi‐centre, retrospective analysis of imum keratometry (Kmax), pachymetry, as well as treatment 2900 eye undergoing smile laser refractive parameters (epithelial status, riboflavin type, UV duration), surgery in New South Wales, Australia outcomes (VA, Kmax, pachymetry) and adverse events were recorded. Index visit characteristics associated with the VA 1,2 1,2 3 Gerard Sutton , Michael Lawless , Colin Chan , Patrick outcome were identified using mixed effects linear 4 5 1,2,6 Versace , Tess Huynh , Chris Hodge regression. 1 2 Vision Eye Institute, Chatswood, Australia, The University Results: Mean change in VA after 5‐years was 5.7 logMAR 3 of Sydney, Sydney, Australia, Vision Eye Institute, letters (95% confidence interval [CI], 2.6, 8.7); Kmax −0.6 4 Chatswood, Austria, Vision Eye Institute, Bondi Junction, D (95% CI, −1.8, 0.6) and pachymetry −8.3 (95% CI, 5 6 Australia, Vision Eye Institute, Hurstville, Australia, Uni- −14.3, −2.3) microns. There was no significant difference in versity of Technology Sydney, Sydney, Australia change in Kmax (P = 0.304); significant improvement in Email: [email protected] VA (P < 0.001) and reduction in pachymetry (P = 0.007). Purpose: SMILE represents an additional opportunity for VA at the index visit was the strongest predictor for the 5‐ surgeons and patients undertaking corneal laser refractive year outcomes. surgery. With several years of experience, we discuss the Epithelial off treatment was performed in 111 cases; short‐ refractive and safety outcomes across a group of practices duration UV exposure (10 minutes) in 35 eyes and long (30 and discuss the place of SMILE within refractive surgery. minutes) in 78. Adverse events were clinically significant Methods: retrospective analysis of consecutive patients haze (n = 30), microbial keratitis (n = 4), persistent epithe- undergoing SMILE laser refractive surgery across a group of lial defect (n = 3), recurrent corneal erosion (n = 2), scarring practices. Refractive and safety parameters will be assessed (n = 9) and sterile infiltrates (n = 2) from a total of 19 eyes. and included in analysis. SATURDAY 09 NOVEMBER 37

Conclusions: These findings indicate that corneal cross‐ S1008 linking may improve vision, stabilize keratometry and pro- To study the efficacy of air descemetopexy in duce corneal thinning after CXL in routine clinical practice. the management of various types of Descemet membrane detachment based on anterior S1006 segment optical coherence tomography and to PACK‐CXL: A boon to tertiary eye care centre know the role of 14% C3F8, 20% SF6 in failed cases of air descemetopexy WITHDRAWN SP Singh1, BK Singh1, Vinod Singh1, Kamaljeet Singh1 S1007 1M.L.N Medical College, Allahabad, India Development of a printable collagen ink for Email: [email protected] corneal wound treatment Purpose: To study the efficacy of air descemetopexy in the management of various types of Descemet membrane. 1 1,2 1,3,4,5 Yihui Song , Jingjing You , Gerard Sutton Methods: After ethical committee approval, clinical data of 1 Save Sight Institute, the University of Sydney, Sydney, 40 patients during the period of December 2017 to Decem- 2 Australia, School of Optometry and Vision Science, The ber 2018, who developed DMD after cataract surgery were 3 University of New South Wales, Sydney, Australia. NSW analysed. 4 Tissue Bank, Sydney, Australia, Sydney Eye Hospital, Results: Majority of patients (n = 32, 80%) had severe gen- 5 Sydney, Australia, Vision Eye Institute, Chatswood, Australia eralized corneal oedema, n = 4 had moderated corneal Email: [email protected] oedema & n = 4 had localized mild corneal oedema. Only Purpose: Corneal injury is common in daily life and may air was sufficient to reattach DMD in majority of the patients lead to loss of vision if not treated properly. Collagen is a (n = 36,90% cases), only 4 patients who had very large dmd major component of the human cornea, which makes it an failed to attach by air. In these patients repeat des- ideal material for corneal wound treatments. The aim of this cemetopexy by 14% C3F8 gas was done which lead to study is to examine the effect of a printable collagen ink on attachment of Descemet membrane with improvement of treating corneal wounds. visual acuity in 3 cases. Complications due to increase intra- Method: A printable collagen ink was prepared using ocular pressure were noted with these gases. bovine collagen I. The transparency of the crosslinked colla- Conclusion: Air descemetopexy is a safe & efficacious gen was examined by a spectrophotometer. An ex vivo option for DMD repair in most of the cases and it is associ- model with an intraocular pressure at 22 mmHg using por- ated with less postop complications. cine cornea was established. Two types of wounds were created: a stromal wound at a depth of 250 um and a 0.8 mm S1009 perforation. The collagen ink was printed to these two types Descemet stripping automated endothelial of wounds and crosslinked. Adhesiveness and sealing condi- keratoplasty with intrascleral haptic fixated tions were examined. Corneal epithelial cells and stromal intraocular lens: Sequential vs simultaneous cells were used to test the cell compatibility of the collagen approach ink in vitro. Results: The obtained collagen ink is printable by extrusion WITHDRAWN printing, and the crosslinked collagen ink has over 90% of transmittance of visible light. Ex‐vivo experiments show that S1010 crosslinked collagen ink can fill the stromal defect and seal Corneal neurotisation for neurotophic the corneal perforation at an intraocular pressure of 22 keratopathy: A multicentre experience mmHg. The collagen ink also supports the proliferation of corneal epithelial and stromal cells. Jaskirat Aujla1, David Curragh1, Yugesh Caplash2, Mark Conclusion: The collagen ink is printable, transparent, and Chehade2, Krishna Tumuluri3, Chameen Samarawickrama3, cell compatible. It has the ability to seal the perforation. It Inbal Avisar4, Dinesh Selva1 could be used as an ocular sealant with the potential of 1South Australian Institute of Ophthalmology, Adelaide, accelerating the corneal wound healing. Australia, 2Royal Adelaide Hospital, Adelaide, Australia, 38 SATURDAY 09 NOVEMBER

3Westmead Children's Hospital, Sydney, Australia. 4Rabin S1011 Medical Center, Petah Tikva, Israel Clinical presentation and complications of Email: [email protected] herpes zoster ophthalmicus Purpose: The purpose of this study is to report our multicentre experience and outcomes for the surgical treatment of Rachael Niederer1, Kevin Liu2, Helen Danesh‐Meyer2 neurotrophic keratopathy with corneal neurotisation. 1Auckland District Health Board, Auckland, New Zealand, Method: Eight cases across 3 centres in Australia and Israel 2University of Auckland, Auckland, New Zealand are reported. Corneal neurotisation surgery was performed Email: [email protected] in combination by oculoplastics and plastic surgeons using 2 Purpose: To examine the clinical presentation and compli- techniques ‐ direct neurotisation using the contralateral cations of herpes zoster ophthalmicus (HZO). supraorbital nerve, or by use of an interpositional sural nerve Method: Retrospective review of all subjects with HZO graft to either the ipsilateral or contralateral supraorbital/sup- seen between January 2006 and December 2016 at Auckland ratrochlear nerves. Main outcome measures were change in District Health Board. corneal sensibility (measured by the Cochet‐Bonnet Results: 869 subjects were included in the study with a aesthesiometer), visual acuity and corneal health. median follow up of 6.3 years (total 5504.4 patient‐years fol- Results: Over a mean follow‐up period of 29 months, mean low up). Median age was 65.5 years, 52.6% were male and corneal sensibility improved from 8.4 ± 9.9 mm to 30.9 ± 20.6 71.5% were Caucasian. 421 subjects (48.5%) were aged <65 mm. 5 of 8 patients had an improvement in at least 2 out of the 3 at presentation. 83 subjects (9.6%) were immunosuppressed main outcome measures. 5 patients (62.5%) showed an improve- and 102 subjects (11.7%) were diabetic. Conjunctivitis was ment in visual acuity; 4 patients (50%) showed an improvement present in 76.1%, corneal involvement in 445 subjects in average corneal sensibility; and 6 patients (75%) showed an (51.2%) and uveitis in 413 subjects (47.6%). Cranial nerve improvement in corneal health. No patient suffered deterioration palsy occurred in 30 subjects (3.5%), optic neuropathy in 15 in condition, or an intraoperative or postoperative complication. subjects (1.7%) and proptosis in 3 subjects (0.3%). Topical The average surgical time was 4 hours. steroid was required in 437 subjects (50.4%). A total of 551 Conclusion: Corneal neurotisation is an emerging surgical recurrences of disease occurred over the study period with treatment option for the management of neurotrophic 200 subjects (23.0%) having at least one recurrence. Corneal keratopathy. With appropriate case selection outcomes are scar occurred in 151 (17.4%), neurotrophic keratopathy in 58 favourable for a condition that is otherwise challenging to (6.7%) and band keratopathy in 13 (1.5%). Corneal melt manage. occurred in 22 subjects (2.5%), corneal perforation in 5 subjects (0.6%) and 2 required enucleation or evisceration. Mod- erate visual loss (≤ 6/15) occurred in 169 subjects (19.7%) and severe visual loss (≤6/60) in 65 subjects (7.6%). Conclusion: HZO is common and associated with significant ocular morbidity. The zoster vaccine is funded in New Zealand from age 65 and will thus miss 48.5% of the population affected by HZO.

1915 H02 – Zeiss Hosted Evening Symposium Venue: Foyer, Pyrmont Theatre, International Convention Centre DOI: 10.1111/ceo.13628 Sunday 10 November

0645−0800 H03 – Bayer Hosted Morning Symposium Venue: C4.5

0830−1000 PO4 – PLENARY: BEST PAPER PRESENTATIONS Gerard Crock and John Parr Trophies Chairs: A/Prof Heather Mack and Dr Christine Younan Room: Darling Harbour Theatre a 96.6% sensitivity, 98.0% specificity, and 97.3±0.7% accu- P0401 racy. AUROC was 0.99. Within the independent set, the Development of a deep learning algorithm for algorithm achieved a 93.9% sensitivity, 80.7% specificity automated diagnosis of retinopathy of and 95.8% negative predictive value. Following operating prematurity plus disease point optimisation, the algorithm diagnosed plus disease Zachary Tan1,2, Samantha Simkin3, Connie Lai4,5, Shuan with a 97.0% sensitivity and 97.8% negative predictive Dai3,6 value. 1Save Sight Institute, The University of Sydney, Sydney, Aus- Conclusion: ROP.AI is a deep-learning algorithm able to tralia, 2Faculty of Medicine, The University of Queensland, automatically diagnose plus disease with high sensitivity Brisbane, Australia, 3Department of Ophthalmology, New and negative predictive value. With ROP's growing global Zealand National Eye Centre, Faculty of Medical and disease burden, its future development may allow for novel Health Sciences, The University of Auckland, Auckland, models of screening and care. New Zealand, 4Queen Mary Hospital, Hong Kong, Hong P0402 Kong, 5Department of Ophthalmology, The University of Cognitive assessment in normal‐tension and Hong Kong, Hong Kong, Hong Kong, 6Department of Oph- high‐tension glaucoma thalmology, Queensland Children's Hospital, Brisbane, Australia Sean Mullany1, Lewis Xiao1, Emmanuelle Souzeau1, Jamie Email: [email protected] Craig1 Purpose: Blindness from retinopathy of prematurity (ROP) 1Flinders Centre for Ophthalmology, Eye and Vision is largely preventable with timely detection and treatment. Research, Adelaide, Australia Treatment is predominantly indicated by the presence of Email: [email protected] plus disease, defined by posterior retinal vessel tortuosity Purpose: To compare the prevalence of cognitive impair- and dilation. ment in patients with normal tension glaucoma (NTG) and This study describes the development of a deep-learning high tension glaucoma (HTG). algorithm, ROP.AI, able to automatically diagnose plus dis- Methods: Cross‐sectional study. Patients with NTG aged ease in fundal images. 65‐95 years of age and appropriately age‐ and sex‐matched Methods: ROP.AI was trained using 6974 fundal images HTG counterparts were sampled from the Australian and from Australasian image databases. Each image was New Zealand Registry of Advanced Glaucoma (ANZRAG). assigned a diagnosis per real-world routine ROP screening Cognitive screening was performed in these individuals and classified as nil plus or plus disease. The algorithm was using the Telephone Version of the Montreal Cognitive trained using 80% of the images and validated against its Assessment (T‐MoCA). 148 participants with HTG, and 142 remaining 20% within a holdout test set. Performance in participants with NTG underwent T‐MoCA cognitive diagnosing plus disease was evaluated within an indepen- screening. Participants were assigned to a cognitively‐ dent set of 90 images. As a screening tool, the algorithm’s impaired group based upon achieving a score below 11/22 operating point was optimised for sensitivity and negative on the T‐MoCA. predictive value, and performance re-evaluated. Results: Logistic regression analyses were performed com- Results: Of 6974 fundal images, 5336 (76.5%) were graded paring the prevalence of cognitive impairment in NTG and as nil plus and 1638 (23.5%), plus disease. For plus disease HTG. Adjustments were made to account for advancing age diagnosis within the holdout test set, the algorithm achieved which is strongly associated with low T‐MoCA scores. An

Clin Experiment Ophthalmol. 2019;47 (Supp 1):39–56. wileyonlinelibrary.com/journal/ceo 39 40 SUNDAY 10 NOVEMBER association was observed between NTG and cognitive P0404 impairment (P = 0.013; OR = 2.9[95%CI = 1.3‐6.9]), which Multitrait analysis of glaucoma, intraocular remained after adjustment for age (P = 0.022; OR = 2.8 pressure and vertical cup to disc ratio identifies [95%CI = 1.2‐6.7]). many new loci and enables a polygenic genetic Conclusions: This study supports the notion that NTG could risk score strongly predictive of disease at least in part represent an ocular manifestation of global susceptibility in the population, and disease neurodegenerative disease, and may share patho‐aetiological progression and treatment intensity in the features with late‐onset dementing diseases such as clinic Alzheimer's Disease. Further investigation is required to rep- Jamie Craig1, Xikun Han2, Ayub Qassim1, Mark Hassall1, licate this finding and elucidate the nature of the observed Robert Casson3, Stuart Graham4, John Landers1, Colin Wil- relationship between NTG and cognitive impairment. loughby5, Andrew Lotery6, Janey Wiggs7, Owen Siggs1, Anna Galanopoulos8, Paul Mitchell9, Richard Mills1, Ashish P0403 Agar10, Paul Healey9, Andrea Vincent11, David Mackey12, Wellington keratoconus study (WELKS): the Emmanuelle Souzeau1, Alex Hewitt13, Stuart MacGregor2 prevalence of keratoconus among secondary 1Flinders University, Adelaide, Australia, 2QIMR, Brisbane, school students in Wellington, New Zealand Australia, 3Adelaide University, Adelaide, Australia, Alistair Papali'i‐Curtin1, Rachel Cox2, Tiffany Ma1, Lisa 4Maquarie University, Sydney, Australia, 5University of Woods3, Albie Covello1, Reece Hall1 Ulster, Ulster, Ireland, 6University of Southampton, South- 1CCDHB, Wellington, New Zealand, 2Capital Vision ampton, United Kingdom, 7Mass Eye and Ear Infirmary, Research Trust, Wellington, New Zealand, 3Victoria Univer- Boston, USA, 8Royal Adelaide Hospital, Adelaide, Australia, sity, Wellington, New Zealand 9Sydney University, Sydney, Australia, 10UNSW, Sydney, Email: [email protected] Australia, 11University of Auckland, Auckland, New Purpose: To determine the prevalence of keratoconus Zealand, 12LEI, Perth, Australia, 13U TAS, Hobart, among high school students in Wellington, New Australia Zealand (NZ). Email: [email protected] Method: The Wellington Keratoconus Study (WELKS) was Purpose: To generate an effective polygenic risk score a population based prospective cross‐sectional study of two (PRS) for glaucoma associated with disease prediction in the cohorts in Wellington: Cohort 1 (Year 9 students, mean age population, and evaluate performance in predicting progres- 13.9 years old) and Cohort 2 (Year 11 students, mean age sion and treatment in the clinic. 15.5 years old). Method: In the discovery stage, a multi‐trait analysis was Results: A total of 1916 students with a mean age of 14.6 conducted combining data from the UK Biobank (UKBB) years participated from 20 schools in the region. glaucoma case–control GWAS (7947 cases vs 119 318 con- Keratoconus was found in 1:191 (0.52%) participants overall trols), VCDR (including data we graded on 67 040 UKBB and in 1:45 Maori (2.25%). In participants with Keratoconus, participants, and International Glaucoma Genetics Consor-

Pentacam mean Kmax of 48.7D (Cohort 1, 45.5D; Cohort 2, tium [IGGC] data N = 23 899), and IOP (103 914 UKBB 49.9D), thinnest pachymetry 494.05 μm (Cohort 1, 479.0 participants and from IGCC N = 29 578). Newly associated μm; Cohort 2, 499.5 μm), posterior elevation at the thinnest SNPs were validated in two independent case‐control point 23.4 (Cohort 1, 15.2; Cohort 2, 26.6), Belin‐Ambrosio cohorts. Then a PRS for glaucoma was constructed with a enhanced ectasia Display overall D value (BAD‐D) 4.30 final associated set of 2673 SNPs. This was evaluated for (Cohort 1, 3.2; Cohort 2, 4.7). In those with keratoconus 8 disease prediction and clinical covariates in independent of 10 had visual impairment of 0.2 LogMAR or worse in the case‐control studies (ANZRAG and British replication better eye; 7 of 10 did not use visual aids; atopy was present cohorts), and the prospective PROGRESSA study. in 7 of 10; 6 of 10 were from a low school decile. In those Results: Multivariate modelling identified 107 glaucoma without keratoconus, 43.8% had atopy. loci (49 novel), with high concordance in independent glau- Conclusion: Keratoconus may affect up to 1 in 191 New coma cohorts. The PRS enabled effective risk stratification. Zealand adolescents, and 1 in 45 Maori adolescents. In advanced glaucoma; risk was 15‐fold greater in the top vs Keratoconus appeared to be associated with Maori ethnicity, bottom decile of PRS, and 21‐fold greater for high tension atopy, lower school decile, visual impairment and the under- glaucoma. The PRS predicted surgical intervention in utilization of visual aids. A nationwide screening pro- advanced disease (P < 3.6x10‐6), and is associated with gramme may have a role in reducing the burden of disease escalating intensity of medical therapy and disease progres- associated with keratoconus. sion in early glaucoma. SUNDAY 10 NOVEMBER 41

Conclusion: Genetic risk profiling delineates individuals in Conclusions: When used during cataract surgery and as the population at high risk of developing glaucoma, more required post‐operatively, both TA and BVB improve rapid disease progression, and the requirement for medical BCVA in eyes with DME. However, only TA resulted in a therapy, SLT and surgery. Glaucoma PRS profiling is likely sustained reduction in CMT, with a substantially lower treat- to enable earlier screening and treatment for high risk indi- ment burden, over the 12 months after surgery. viduals, with reduced screening and monitoring for lower risk individuals. P0406 A retinal imaging biomarker of Alzheimer's P0405 disease Twelve month results of the DIMECAT trial: a Peter van Wijngaarden1,2, Xavier Hadoux1,2, Flora Hui1,2, prospective, randomized clinical trial of Jeremiah Lim2, Christine Nguyen2, Bang Bui2, Jonathan intravitreous bevacizumab vs triamcinolone in Crowston1 patients with diabetic macular oedema at the 1 time of cataract surgery Centre for Eye Research Australia, East Melbourne, Aus- tralia, 2University of Melbourne, Parkville, Australia Lyndell Lim1,2,3, Sophie Rogers1, Marios Constantinou1, Email: [email protected] Sukhpal Sandu1,2,3, Sanjeewa Wickremasinghe1,2,3, Salmaan Background: Amyloid‐beta (Ab) deposition in the brain is a Al‐Qureshi1,2,3 diagnostic marker for Alzheimer's disease (AD), but current 1Centre for Eye Research Australia, Melbourne, Australia, tests are costly and not widely available. Evidence from 2University of Melbourne, Melbourne, Australia, 3Royal Vic- transgenic rodent models and post‐mortem human tissues torian Eye and Ear Hospital, Melbourne, Australia suggest that retinal accumulation of Ab may serve as a surro- Email: [email protected] gate marker of brain Ab levels. As Ab has a wavelength‐ Purpose: To compare intravitreous bevacizumab (BVB, dependent effect on light scatter, we investigated the poten- Avastin) vs triamcinolone (TA, Triesence) at the time of cat- tial for in vivo retinal hyperspectral imaging to serve as a aract surgery and as required post operatively, in patients biomarker of brain Ab. with Diabetic Macular Oedema (DME). Purpose: To develop and validate a retinal imaging bio- Methods: Prospective, single‐masked, randomized clinical marker of Alzheimer's disease. trial. Eyes with cataract and centre‐involving DME or previously Methods: We performed human retinal hyperspectral imag- treated DME were randomized 1:1 to BVB 1.25 mg or TA 4 mg ing on individuals with high Ab burden on brain PET imag- during cataract surgery, and as required over 12 months. ing and mild cognitive impairment (cases; n = 15), and age‐ Results: Sixty‐one eyes from 58 patients were initially rec- matched PET‐negative controls (n = 20). Image analysis ruited, but only 40 eyes reached 12 months of follow‐up. At methods were developed and validated on a second group of baseline, BCVA and CMT were similar between the BVB participants with and with (n = 4) and without (n = 13) eyes (n = 28) and TA eyes (n = 33) (P > 0.2), and this moderate‐to‐high brain Ab burden and on transgenic mice remained so with the 40 eyes (20 BVB, 20 TA) that reached (5xFAD) known to accumulate retinal Ab. 12 months (P > 0.05). Results: We show significant differences in retinal reflec- At 12 months, both groups gained vision from baseline tance spectra between cases and controls in both cohorts (mean + 18 (95CI 12, 25) letters with TA, +16 (95CI 9, 23) (AUC ROC = 0.82, P = 0.001, 95% CI: 0.67‐0.97). There letters with BVB, with no difference between the groups (P was a moderate positive linear correlation between retinal = 0.90). However, only TA was associated with a sustained imaging scores and brain Abburden (r = 0.46, 95%CI: 0.13‐ reduction in CMT from baseline (−46um (95CI ‐100,+8) 0.69, P = 0.008).The technique also enabled discrimination compared to BVB (+7um, 95CI ‐31, +45), P = 0.015. of AD‐model mice from wild‐type controls. Additionally, 66% of the TA group avoided further re‐treat- Conclusion: We have developed a novel retinal imaging ments post‐operatively, compared to 39% in the BVB group method to distinguish people with moderate‐high brain Ab (P = 0.0017). Five eyes in each group experienced an IOP load from those without. This approach may have value for >21 mmHg; 3 TA eyes required treatment for IOP. the diagnostic confirmation of AD. 42 SUNDAY 10 NOVEMBER

1000–1030 MORNING TEA

1030–1100 L04 – Retina Update Lecture Macular telangiectasia type 2, an update of the Mac Tel research group, a 15-year journey from an exam to global connections Dr Emily Y Chew Chair: A/Prof Samantha Fraser-Bell Venue: Darling Harbour Theatre Synopsis: Idiopathic macular telangiectasia Type 2 (Mac Tel Type 2), once a poorly characterized and understood retinovascular entity, known then as idiopathic juxtafoveal telangiectasia, is now considered to be a neuro/vasculo/glial degenerative disease. Our understanding of Mac Tel Type 2 has increased significantly because of the establishment of a large, multinational collaborative research project studying the pathogenesis and potential treatment for Mac Tel Type 2. Clinicians from 31 international sites and investigators from a dozen basic science laboratories located in United States, Europe and Australia are funded generously by the Australian-based Lowy Medical Research Institute. Mac Tel type 2 characteristic lesions include retinal opacification, perifoveal telangiectatic vessels, right angle vessels, crystalline deposits, retinal pigment epithelial hyperpigmentation, abnormal fundus autofluorescence imaging and spectral domain optical coherence tomography, where hypo-reflective inner and outer retinal cavities, as well as ellipsoid zone or inner segment/outer segment losses, are found. Macular pigment loss is evident and neovascularization originating from the retinal circulation can occur, forming retinal-choroidal anastomoses. The MacTel research group have discovered a genetic/metabolic component with a defect in serine/glycine metabolism and noted defects in Mueller cells of the retina. A large natural history study has provided data to develop a new classification and outcome measurements such as ellipsoid zone loss that correlates well with functional changes in microperimetry. Both Phase 1 and Phase 2 clinical trials in Mac Tel Type 2 have been successfully completed using a ciliary neurotrophic factor implant. The results of this remarkable 15 years of collaborative research will be highlighted.

1100–1130 L05 – The Council Lecture The path to an Australian bionic eye A/Prof Penelope Allen Chair: Dr Diana Semmonds Venue: Darling Harbour Theatre Synopsis: At the 2020 summit in 2008, the development of a bionic eye was seen as an aspirational goal by the group looking at Long term National Health Strategy and funding was allocated by the Australian Research Council for this purpose. Our collaborative group was one of the successful applications for this funding. Iterative development of a suprachoroidal retinal prosthesis was undertaken to provide proof of concept that electrical stimulation in the suprachoroidal space could produce reliable phosphenes in patients with severe visual loss due to retinal dystrophies. A human grade device was utilized in a proof of concept trial in 2012-2014 in three patients and in 2018 four patients were implanted with a second-generation device to attempt to demonstrate improved functionality with use of the device at home. The initial clinical trial demonstrated that the surgical approach was safe and reliable phosphenes could be produced in all three patients and two of the three patients could navigate with the device. The current clinical trial with four patients is confirming the safety and stability of the approach and the reliability of the devices. All four patients are performing well on Orientation and Mobility (O and M) tasks and Activities of Daily Living (ADL). This work demonstrating that electrical stimulation of these devices can produce phosphenes within safe charge limits and provide visual information that patients can use to improve performance in O and M and ADL activities opens the way to a commercial device.

1130–1200 P05 – PLENARY – ORIA UPDATE Chair: Prof Mark Gillies Email: [email protected] SUNDAY 10 NOVEMBER 43

Venue: Darling Harbour Theatre Speakers and Topics: Prof Mark Gillies – Serine metabolism in the retina Prof Nick Di Girolamo – A multicoloured Confetti mouse for studying corneal homeostasis, wound-healing and limbal stem cell deficiency Dr Mona Awadalla – The role of Icare Home tonometry in glaucoma research and clinical practice Prof Alex Hewitt – Dissecting the genetics of giant cell arteritis Prof Robyn Jamieson – Gateways to genetic therapies for the retinal dystrophies

1230–1400 LUNCH

1400–1530 CONCURRENT SESSIONS

1400–1530 S11 SYMPOSIUM RANZCO, past, present and future Chairs: A/Prof Heather Mack and Dr Justin Mora Email: [email protected] Venue: C4.9 Synopsis: This symposium will take the audience through a journey of RANZCO’s past, present and future. Hear about the origins of the College, the creation of the College as we now know it, the work currently being done and where we are headed. This is an excellent opportunity to understand how and why the Col- lege functions and to understand the enormous efforts being carried out by Fellows for the benefit of all our patients and our profession. The session will include discussion on the work of the Medicare Advisory, Workforce, Younger Fellows and Leadership committees, as well as a discussion of what ophthalmology may look like in 30 years. If you have ever wanted to know how we came to be where we are, and where we are heading, this is the session for you. Speakers and Topics: A/Prof Heather Mack and Dr Justin Mora – Welcome from Chairs Dr David Kaufman, Dr Frank Martin and Dr Bruce Hadden – RANZCO past A/Prof Heather Mack – RANZCO present Dr Brad Horsburgh, Dr Catherine Green AO and Dr Justin Mora – College Committee Update Dr Chameen Samarawickrama and Dr Genevieve Oliver – RANZCO Future A/Prof Heather Mack – Close

1400–1530 S12 SYMPOSIUM ANZGS symposium 2019: when worlds collide – approaching glaucoma from a different perspective (part 2) Chairs: A/Prof Graham Lee Co-chairs: Dr Ridia Lim, A/Prof Anne Brooks, Dr Guy D'Mellow and Prof David (Ted) Garway-Heath Email: [email protected] Venue: Darling Harbour Theatre Synopsis: Glaucoma is encountered in many aspects of ophthalmology. Indeed it is often the end-stage of many disease states. Both medical and surgical aspects of glaucoma touch on other sub-specialties. The aim of this symposium is to approach glaucoma from the perspective of experts in other fields. Speakers and Topics: Prof Keith Martin – JRA, HLA-B27, role of trabeculectomy/MIGS/GDD Dr Richard Symes – Diabetic retinopathy/CRVO and NVG, ocular ischaemic syndrome, IVI pressure spikes Prof Timothy Sullivan – Tight orbits, thyroid eye disease, floppy eyelid syndrome, orbital fractures A/Prof Graham Lee – ICE syndrome, blunt trauma/cleft/hypotony, tube endothelial decompensation, corneal transplantation in glaucoma patients Dr Ridia Lim – Summary 44 SUNDAY 10 NOVEMBER

1400–1530 S13 SYMPOSIUM Multimodal assessment (MMA) for diagnosis, management and prognostication of retinal and macular disease Chairs: A/Prof Nitin Verma and Prof Peter McCluskey Email: [email protected] Venue: C4.1 Synopsis: Over the years an increasing number of sophisticated techniques have been used in ophthalmology to provide detailed insight into retinal disease. Not only do these modalities provide very useful information about the anatomy but also the function of retinal structural components in health and disease. Multimodal imaging and tests of retinal function are critical for making an accurate diagnosis but, as we have become more aware of the correlation between structure and function, they are also increasingly important in monitoring the results of therapy and determining the likely outcomes of treatment and overall prognosis. In this session the use of different imaging techniques including: colour fundus photography(standard, wide field and ultra widefield), infra red digital imaging, autofluorescence, fluorescein and indocyanine green angiography, optical coherence tomography(spectral domain, enhanced depth imaging, OCT angiography [including wide field OCTA]) is discussed and correlated with tests of retinal function such as: electrophysi- ology, perimetry and microperimetry, dark adaptation and contrast sensitivity. The availability and use of these tests is rapidly increasing. Many of these technologies which were previously considered research tools are now being used routinely in general ophthalmic practices. This course is designed to help comprehensive ophthalmologists understand the use of these modalities in their day-to-day practice to improve diagnosis and outcomes of treatment for their patients. Speakers and Topics: Dr Sophia Zagora – MMA in infectious and non-infectious uveitis Dr Elisa Cornish – MMA in genetically determined eye disease Dr Emily Chew – MMA in macular disease Prof Ian McAllister – MMA in retinal vascular disease Dr William Glasson – MMA in Ocular Oncology Dr Wilson Heriot – MMA is surgical conditions of the retina

1400–1530 S14 COURSE Neuro-ophthalmology challenges: survival guide to diagnosing and managing neuro-ophthalmic conditions Chair: Prof Helen Danesh-Meyer Email: [email protected] Venue: C4.4 Synopsis: This is an interactive course in which case – based presentation will be used to review techniques essential to diagnose neuro-ophthalmic conditions and discuss appropriate investigations and practical advise on management. Ten cases spanning basic to complex neuro-ophthalmic cases will be presented. The emphasis on working through the cases from presentation through clinical investigations and ordering appropriate tests. The course will highlight areas in which common clinical mistakes occur and how to avoid them. The course emphasizes neuro-ophthalmologic emergencies and conditions that are often difficult to diagnose. Speakers: Prof Helen Danesh-Meyer and Dr Peter Savino

1400–1530 S15 FREE PAPERS – Cataract and Ocular Oncology Venue: C4.6 – C4.7 Chairs: Dr Li-Anne Lim and Prof Charles McGhee SUNDAY 10 NOVEMBER 45

Methods: Patients with successful cataract surgery follow- S1501 ing previous corneal laser refractive procedures were identi- Accuracy of total corneal topographic fied. Using the values obtained from the IOLMaster 700 astigmatism (CORT total) compared to total (total keratometry) and available no‐history formulas, the keratometry (TK) absolute refractive prediction error, variance in prediction error and percentage of eyes within ±0.5D and 1.0D were Noel Alpins1,2,3, James Ong3, George Stamatelatos4 back‐calculated. 1NewVision Clinics, Melbourne, Australia, 2University of Results: There were 51 eyes without prior laser refraction Melbourne, Melbourne, Australia, 3Assort Surgical Manage- information that were included in the analysis (24 prior ment Systems Software, Melbourne, Australia. 4NewVision hyperopes, 27 prior myopes). The median absolute refractive Clinics, NewVision Clinics, Australia prediction error for the Haigis‐L formula was 0.34 ± 0.60 for Email: [email protected] standard keratometry and 0.33 ± 0.55 for total keratometry Purpose: To compare the ocular residual astigmatism values representing the lowest value. There was no statistical (ORA) using total corneal topographic astigmatism (CorT difference between Haigis‐L, Shammas and Barrett True‐K Total) to total keratometry (TK) measured from the Zeiss formulas however. The mean prediction error in TK patients IOL Master 700. shifted towards more myopia in prior myopes and towards Method: The CorT parameter (CorT Total) is calculated hyperopia in prior hyperopes. This was statistically signifi- using all the data captured during tomography, including cant. The variances in prediction errors was lower for TK posterior cornea. The CorT Total generated from the CSO values in prior myopes but there was no difference in prior Sirius was then compared to the TK calculated from the hyperopes. Zeiss IOL Master 700. The comparisons were made using Conclusion: Post corneal laser refractive patients represent a the spread of the ocular residual astigmatism (ORAsd), challenge for surgeons when choosing the IOL power. The ‐ which quantifies corneo refractive differences. A low addition of TK in prior myopes suggests less overall varia- ORAsd indicates a low variability between corneal astigma- tion however the results suggested an increase in predicted tism and refractive cylinder. A low mean of the ORA magni- undercorrection. Prior hyperopic cases predicted outcomes tude indicates a close correlation of refractive and corneal shifted towards hyperopia endpoints. IOL formulas may astigmatism magnitudes. benefit from further optimization for TK use. Results: The mean ORA magnitude for the CorT Total measured by the Sirius (n = 122) was 0.59D, the ORAsd was S1503 0.34D and for the TK was 0.63D and 0.33D respectively. Outcomes of 1stQ toric supplementary There was a significant difference in the ORA magnitude. intraocular lenses for residual astitmatic Conclusion: The CorT Total displayed a better ORA magni- refractive error in pseudophakic eyes tude than the total keratometry (TK) from the IOL Master Cameron McLintock1, James McKelvie2, Andrew Apel3 700 but was equivalent with the ORAsd. The CorT Total 1Department of Ophthalmology, Princess Alexandra Hospi- can be used as an accurate measure and benchmark of total tal, Brisbane, Australia, 2Department of Ophthalmology, corneal astigmatism when planning toric IOL and corneal University of Auckland, Auckland, New Zealand, 3The Eye surgery. Health Centre, Brisbane, Australia Email: [email protected] S1502 Total keratometry (TK) in post‐LASIK eyes: Purpose: To evaluate rotational stability, visual outcomes efficacy comparison study and refractive outcomes in pseudophakic eyes with residual astigmatism following cataract surgery. Michael Lawless1,2, Gerard Sutton1,2, Tim Roberts1,2, Colin Methods: A retrospective interventional case series was Chan1,2, David Ng1, James Jiang2, Chris Hodge1,2,3 conducted across 2 sites, the Eye Health Centre, Brisbane, 1Vision Eye Institute, Chatswood, Australia, 2The University Australia and the Corneoplastics unit and Eye Bank, East of Sydney, Sydney, Australia, 3University of Technology Syd- Grinstead, United Kingdom. Patients with residual refractive ney, Sydney, Australia astigmatic refractive error following cataract surgery with Email: [email protected] unsatisfactory unaided vision were offered 1stQ supplemen- Purpose: Total keratometry, which considers both the ante- tary intraocular lens (IOL) insertion if satisfactory vision rior and posterior corneal surfaces, which may lead to more was achieved with stable subjective refraction. accurate IOL selection, particularly in patients with a prior Results: After a minimum follow up period of 3 months history of refractive surgery. (mean 5.4 months), 34 eyes of 28 patients were included in 46 SUNDAY 10 NOVEMBER the study. 18 patients were female and 10 were male. S1505 Unaided distance visual acuity (UDVA) improved from Moderate monovision with monofocal 0.41logMAR to 0.12 logMAR (P = 0.023). Refractive astig- intraocular lenses vs mini‐monovision with a matism improved from 1.74D to 0.32D (P = 0.014). Post small‐aperture intraocular lens: a comparative operative rotation of greater than 10° occurred in 5 eyes analysis (14.7%) and IOL repositioning was required. 1 1 Conclusion: 1stQ supplementary IOL implantation results Bernardo de Padua Soares Bezerra , Jacqueline Beltz 1 in good visual and refractive outcomes. IOL rotation may Royal Victorian Eye and Ear Hospital, Melbourne, occur, requiring repositioning, however overall rotational Australia stability was satisfactory. Email: [email protected] Purpose: Comparison of visual and patient outcomes S1504 between standard monovision and monovision with a small A comparison of contrast sensitivity between a aperture IOL. monofocal and an extended range of vision Methods: Prospective single‐site study. Group 1 (N = 20) intraocular lens patients received aspheric monofocal or monofocal toric IOLs with a refractive target of plano and − 1.25 D in the 1,2 2 Nicholas Dewhurst , Bernadette Ward , Daniel dominant and non‐dominant eyes. Group 2 (N = 19) 1,2 2 1,2 Hogarty , Deborah Russell , Peter Burt received aspheric monofocal or monofocal toric IOL in the 1 2 Bendigo Eye Clinic, Bendigo, Australia, Monash Univer- dominant eye and an IC‐8 IOL in the non‐dominant eye with sity School of Rural Health, Bendigo, Australia refractive targets of plano and − 0.75 D, respectively. Mon- Email: [email protected] ocular and binocular visual acuity for distance (UDVA), Purpose: Multifocal intraocular lenses (IOL) implanted in intermediate (UIVA), and near (UNVA) were reported at 6 cataract surgery provide better near vision than monofocal months. Patient symptoms and satisfaction were evaluated IOLs. However, many studies suggest that patients with using a 5‐point scale. multifocal IOLs have reduced contrast sensitivity compared Results: At Month 6, mean monocular UDVA, UIVA, and to those with monofocal IOLs. Manufacturers of the UNVA in the non‐dominant eye for Group 1 was 0.37 ± extended range of vision (ERV) IOL claim, by correcting 0.19, 0.76 ± 0.27 and 0.59 ± 0.25 and 0.64 ± 0.23, 0.79 ± chromatic aberration, the ERV IOL provides near vision 0.27 and 0.53 ± 0.22 for the IC‐8 eye in Group 2. UDVA in without any associated reduction in contrast sensitivity. This the IC‐8 eye was significantly better than the monofocal eye study tests these claims by comparing contrast sensitivity at (P < 0.05). Binocularly, patients in Group 1 achieved 0.97 different lighting levels in patients implanted with mono- ± 0.18, 0.80 ± 0.26 and 0.64 ± 0.24 for UDVA, UIVA, and focal or ERV IOLs. UNVA. Group 2 achieved binocular UDVA of 1.01 ± 0.10, Method: Retrospective cohort study tested monocular and UIVA of 0.87 ± 0.28 and 0.58 ± 0.21. Visual symptoms binocular contrast sensitivity at 0.1, 200, 500 and 800 lx on improved in both groups. There was no difference in patient the Pelli‐Robson contrast sensitivity chart. Generalized esti- satisfaction between both groups. mating equation models were used to detect differences in Conclusion: Mini‐monovision with small‐aperture IOL monocular contrast sensitivity between groups whilst con- achieved similar near and intermediate visual outcomes and trolling for the unknown correlation between monocular superior distance vision compared to moderate monovision vision in participants' left and right eyes. Mann‐Whitney U with bilateral monofocal IOL's. Both groups had high satis- tests were used to compare binocular contrast sensitivity. faction rates. Results: 112 eyes from 56 participants attending an ophthalmology clinic in Victoria who had undergone monofocal or S1506 ERV IOL implantation were included. There were no significant differences in participant age, months since surgery or Outcomes of one hundred and fifteen consecutive scleral fixated intraocular lenses distance visual acuity between groups. IOL power was sta- using the ‘yamane’ flanged intrascleral haptic tistically significantly greater in the ERV IOL group which fixation technique was consistent with the IOL setting of micro‐monovision. No difference in monocular or binocular contrast sensitivity John Rocke1, William Atkins1, Myra McGuinness2, Lewis was found between the two groups at any light level. Fry1, Jack Kane1, David Fabinyi1, Jonathan Yeoh1, Daniel Conclusion: Our findings suggest that the ERV IOL pro- Chiu1, Rohan Essex1,3, Edward Roufail1, Amy Sheridan1, vides comparable contrast sensitivity to the monofocal IOL Thomas Edwards1,2,4 SUNDAY 10 NOVEMBER 47

1Royal Victorian Eye and Ear Hospital, Melbourne, Austra- May 2017 and October 2018 were scored retrospectively lia, 2Centre for Eye Research Australia, Melbourne, Austra- using two risk stratification systems: an updated United lia, 3Academic Unit of Ophthalmology, Australian National Kingdom Cataract National Dataset Stratification (UKCND) University, Canberra, Australia, 4Ophthalmology, Depart- system, and the New Zealand Cataract Risk Stratification ment of Surgery, University of Melbourne, Melbourne, (NZCRS) system. Cases identified as high‐risk which were Australia assigned to registrars were excluded to simulate the effects Email: [email protected] of case‐allocation. Purpose: Scleral fixation of a posterior chamber intraocular Results: In total, the UKCNDS and NZCRS systems classi- lens (IOL) is an established surgical approach in cases where fied 25.2% (n = 386) and 8.0% (n = 122) cases as high‐risk capsular support has been lost or compromised. We assessed respectively. 142 (9.3%), and 40 (2.6%) high‐risk cases ‐ a sutureless approach that utilized a flanged intra scleral assigned to registrars were excluded from analysis of the ‐ haptic fixation technique (FIHFT) to secure a three piece UKCNDS and NZCRS respectively. The intraoperative IOL to the scleral wall. complication for random allocation, the UKCNDS and ‐ Methods: Retrospective consecutive case series. To assess NZCRS systems were not significantly different (P = 0.011) ‐ outcomes from scleral fixated IOLs using the FIHFT by sur- with rates of 9.4%, 8.9% and 9.2% respectively; the posterior geons of the Vitreoretinal Unit of the Royal Victorian Eye capsular rupture rate was 2.9%, 2.8% and 3.0% respectively, and Ear Hospital. Comparative retrospective data were also and the one‐month postoperative best‐corrected‐visual acuity collected from a consecutive series of ‘in‐the‐bag’ cataract was 0.30 logMAR (6/12) or better in 85.3%, 85.9% and operations (n = 100) and anterior chamber IOL (ACIOL) 85.7% respectively. insertions (n = 54). Mean prediction error (MPE) was calcu- Conclusion: Both the UKCNDS and NZCRS were effective lated by subtracting the predicted refraction, based on ocular in identifying high‐risk cases for complications and worse biometry, from the post‐operative spherical equivalent. visual outcomes. Despite this, the scoring systems did not Results: A total of 115 FIHFT cases were evaluated with a definitively decrease any complication rates or improve mean follow‐up duration of 4.7 months (range 1.0‐16.5 visual outcomes. Even though cases are not allocated by a months). There was no statistically significant difference definite and validated system, this hospital's current case between the MPE of an ‘in‐the‐bag’ placement vs the FIHFT allocation method produces outcomes comparable with the (P = 0.185), however, the MPE for ACIOLs was significantly greater than both ‘in‐the‐bag’ and the FIHFT surger- UKCNDS and NZCRS. ies (p = <0.001). Final best corrected visual acuity was 0.30 S1508 ± 0.35 logMAR [6/12] for all FIHFT cases and 0.19 ± 0.21 To evaluate the visual outcome of cataract logMAR [6/9] for those with no ocular‐comorbidities. surgery in uveitis Cystoid macular oedema was seen at greater frequency in the ACIOL group compared to the FIHFT group (12.8% vs Sudarshan Khokhar1, Chirakshi Dhull1, Alkesh Chaudhry2, 27.8%, P = 0.018). Amber Amar Bhayana3 Conclusions: This study demonstrated that scleral fixation 1RPCENTRE AIIMS, New Delhi, India, 2MD Eye Institute, of a three‐piece IOL using the FIHFT had an acceptable New Delhi, India, 3Dr Rajendra Prasad Center for Ophthal- safety profile and produced predictable refractive outcomes mic Science, New Delhi, India based on an assumed ‘in‐the‐bag’ lens position. Email: [email protected] Purpose: To evaluate the visual outcome of cataract surgery S1507 in uveitis. Cataract surgery outcomes after retrospective Methods: It was a retrospective review of patients 18‐60 application of risk stratification systems years with chronic uveitis who underwent cataract surgery ‐ Muhammad Khan1, Chameen Samarawickrama1,2 (Jan 08 Jan 19) after control of inflammation were included 1University of New South Wales, Sydney, Australia, 2Univer- and best corrected visual acuity (BCVA) and postoperative sity of Sydney, Sydney, Australia complications were recorded retrospectively. Email: [email protected] Results: 103 eyes of 78 patients with median followup of 3 Purpose: To assess complication rates and visual outcomes years, with anterior (54.3%), intermediate (24.2%) and of phacoemulsification cataract surgery in a public teaching panuveitis (21.3%) were included. Mean best BCVA was hospital using two validated risk stratification systems for 0.28 ± 0.51. The final BCVA was significantly worse in case allocation. panuveitis patients especially VKH and Behchet's disease Method: One thousand five hundred and thirty eyes under- than anterior uveitis. IOL was put in the bag (89.3%), sulcus going cataract surgery at Westmead Public Hospital between (5.8%) or left aphakic (4.8%). Complications included visual 48 SUNDAY 10 NOVEMBER axis opacification in 13.6%, glaucoma in 26.8%, retinal discrepancy, on average, when compared with standard ac problems in 28.2% (macular oedema/epiretinal membrane). testing. Conclusion: Uveitis have good outcomes post Cataract surgery with optimum control of inflammation and adequate S1511 management of glaucoma and retinal complications. Iris melanoma and other suspicious iris lesions Micah Rapata1, William Cunningham2,3, Dipika Patel1,2, S1509 Jie Zhang1, Peter Hadden1,2,3, Charles McGhee1,2,3 3D high resolution optical coherence 1University of Auckland, Auckland, New Zealand, 2Eye tomography to detect pre existing posterior Department, Greenlane Clinical Centre, Auckland District capsular defect in posterior polar cataracts Health Board, Auckland, New Zealand, 3Eye Institute, Auck- undergoing femtolaser assisted cataract land, New Zealand surgery Email: [email protected] WITHDRAWN Background: This is the largest study of iris melanoma in New Zealand/Aotearoa (NZ). It provides important informa- S1510 tion regarding diagnosis, treatment, and outcomes and Accuracy of visual acuity assessment using a allows comparison with international studies. Iris melanoma novel smartphone‐coupled device in patients is a rare intraocular malignancy representing the smallest with eye pathology subgroup of uveal melanomas. In NZ the incidence is approximately 0.09/100000 per year. To date there have James McKelvie1, Cameron McLintock2, Daniel Scott3 been no large studies of uveal melanoma in NZ. 1University of Auckland, Auckland, New Zealand, 2Princess Methods: Retrospective study of patients with iris Alexandra Hospital, Brisbane, Australia, 3Tauranga Hospi- melanocytic tumours referred to Greenlane Clinical Centre tal, Tauranga, New Zealand and Eye Institute in Auckland, NZ. All patients (n = 51) pre- Email: [email protected] senting with iris tumours from January 1999 to December Purpose: Accurate visual acuity assessment requires time, 2018. Demographics, tumour characteristics, histology, trained staff, specialized equipment and clinic space. This genetic analyses, treatment modalities and survival rates. ‐ study investigates the accuracy of self administered visual Results: The median age at presentation was 58.0 years. Iris acuity testing that can be completed without trained staff or tumours involved a median of two clock hours. The most specialized facilities. This study aimed to validate the accu- common associated clinical feature was ectropion uveae ‐ racy of self administered visual acuity assessments using a (41.2%). Patients were predominantly managed by observa- mobile application and a smartphone coupled vision‐screen- tion (54.9%). Local recurrence, melanoma‐related metastasis ing (scd) device in patients with eye pathology. and mortality occurred in two patients. Iris melanomas were Methods: Institutional review board approval was obtained histologically confirmed in sixteen patients. Monosomy prior to commencement of the study. Patients with ophthal- three was seen in four patients. The median follow‐up was mic pathology attending a tertiary hospital corneal clinic 2.4 years, and the median visual acuity at two years post were invited to participate. Visual acuity was assessed using intervention was 6/7.5. a standard LogMAR acuity chart (ac) and a self‐adminis- Conclusions: This study was the first to extensively exam- tered test using the smartphone coupled device (scd). Data ine iris melanocytic tumours in NZ. The results are largely were analysed using R statistical software. concordant with international studies and will assist the cur- Results: From 13 July to August 13, 2018, 251 eyes of 135 rent and future management of iris melanoma in NZ. Proton patients were included in the study. Mean age was 49 years beam radiotherapy usage is anticipated to increase as it (range 9 to 89 years). Mean refractive error (spherical equiv- becomes available in the Southern hemisphere. alent) was −0.59D (range −16.4D to +7.4D). Minimum, mean, and maximum LogMAR acuity were −0.19, 0.31, S1512 1.06 (ac), and −0.16, 0.35, 1.28 (scd). The mean difference Intravitreal melphalan for vitreoretinal in LogMAR acuity scores was 0.04 LogMAR units. Bland lymphoma Altman upper and lower limits of agreement and bias were Li‐Anne Lim1,2,3,4, Lauren Dalvin 5,4, David Ancona‐ 0.43, −0.34, 0.04 LogMAR units respectively. Lezama4, Michael Chang4, Arman Mashayekhi6, Carol Conclusion: Visual acuity can be tested using a scd in Shields4 patients with eye pathology over a wide range of age and 1Chatswood Eye Specialists, Sydney, Australia, 2The Uni- refractive error. LogMAR acuity assessment using a scd versity of Sydney, Sydney, Australia, 3Save Sight Institute, demonstrate clinically acceptable accuracy with a two‐letter Sydney, Australia, 4Wills Eye Hospital, Philadelphia, USA, SUNDAY 10 NOVEMBER 49

5Mayo Clinic, Rochester, USA, 6Wills Eye Hospital, Phila- injections requiring a change in treatment to intravitreal delphia, USA methotrexate. Four eyes (36%) had vitreous disease recur- Email: [email protected] rence whilst on no ocular or systemic treatment. Compari- Purpose: To assess the efficacy and adverse effects of intra- son between eyes with vitreous lymphoma (n = 5) and vitreal melphalan for treatment of vitreoretinal lym- those with vitreous and sub‐RPE lymphoma (n = 8) rev- phoma (VRL). ealed no difference in likelihood of response to treatment Methods: Retrospective review of medical records of VRL (80% vs 88%, P = 0.99). At mean final follow‐up of 16 patients treated with monthly intravitreal melphalan from months (median 10, range 5‐38), 12 eyes (92%) had September 2015 to January 2019. regressed disease and one eye (8%) had stable active dis- Results: There were 13 eyes of 7 patients diagnosed with ease. Four eyes (31%) developed cystoid macular oedema VRL at mean age of 70 years (median 68, range 59‐91 during the course of treatment, that resolved with medical years). Eyes were treated with melphalan 10 μg/0.05 ml for therapy without reduction in visual acuity. a mean of 5 injections (median 6, range 1‐14) for a mean Conclusions: Intravitreal injections of melphalan at a dose duration of 8 months (median 5, range 0–30 months). Fol- of 10 μg/0.05 mL resulted in complete or partial regression lowing a mean of 3 (median 3, range 1–8) melphalan injec- of VRL in 11 (85%) of 13 treated eyes. Further studies are tions, 11 eyes (85%) responded to treatment. Two eyes needed to determine the optimal dosage and interval (15%) showed disease progression after 2 melphalan between injections.

1530−1600 AFTERNOON TEA

1600–1730 CONCURRENT SESSIONS

1600–1730 S16 COURSE Microtribes, immunotribes:microbiomes and microbes in ocular infection, autoinflammation and autoimmunity. how immune make-up determines our microbial self. How microbes trigger ocular disease according to “immunotribe”. When to fight the bugs and how to manage the inflammation. Chairs: Dr Jo Richards and Dr Sophia Zagora Email: [email protected] Venue: C4.1 Synopsis: This session aims to provide a very clinically relevant update on new concepts in ocular inflammation. It will present an introduction to the interaction between microbes, microbiomes and individual immune make-up, illustrating where inflammatory eye diseases fit into the immunologic big picture. Clini- cians including generalists and subspecialists from different fields will gain a new perspective which will help them to approach investigation and treatment of ocular inflammation with greater insight. There will be a mix of ocular surface and intraocular inflammation cases and topics. Time has been allowed for questions and we will have some fun with live polling across the whole audience. Speakers and Topics: Dr Jo Richards and Uveitis SIG – Immunotribes: Immunology 101 for ophthalmologists in 3 slides. Cases to make you think… with live polling and panel discussion: Kill the bug? / treat the autoinflammation? / manage the autoimmunity? Prof Mark Willcox – Ocular microbiome- an Antipodean perspective – Ocular microbiome by 16S vs culture techniques: microbial populations on normal and inflamed eyes and lids. Prof Denis Wakefield – Immunotribe-Microtribe: Mechanisms of inflammation in ophthalmic disease: HLA and the gut microbiome. Systemic microbiomes triggering inflammation. Implications for disease prevention and management. Dr Richard Symes – Drugs for Bugs: Prophylaxis / Full Antimicrobial Treatment / Immunosuppression? Managing the risk, eliminating microbial triggers, and controlling the immunologic response: Cases and lessons from the Tuberculosis spectrum. Faculty and audience – discussion

1600–1730 S17 SYMPOSIUM Tackling presbyopia with IOLs for the cataract surgeon Chair: Dr Con Moshegov Email: [email protected] 50 SUNDAY 10 NOVEMBER

Venue: C4.4 Synopsis: The course is geared towards the general ophthalmologist performing cataract surgery. Monofocal lenses induce absolute presbyopia. The course presents the strategies available to overcome this. Monofocal intraocular lenses (IOLs) in a monovision configuration, Extended Depth of Focus (EDOF) and multifocal IOLs. Speakers and Topics: Course Faculty comprised of Dr Smita Agarwal, Dr Tess Huynh, Dr Sara Crowe, Dr Michael Goggin, Dr Ilan Sebban, Dr David Lubeck and Dr Con Moshegov – The pros and cons of each strategy are to be presented. Faculty speakers to present on determining the best strategy for a particular patient, how to optimize outcomes, best lens choices and dealing with patient expectations. The use of multifocal IOLs in the absence of a refractive laser in a practice is to be discussed.

1600–1730 S18 SYMPOSIUM Update on microbial keratitis Chair: Dr Matthew Green Email: [email protected] Venue: Darling Harbour Theatre Synopsis: The course is submitted on behalf of the Australian and New Zealand Cornea Society. This course will update the general ophthalmologists on key learnings for the management of microbial keratitis. Importantly to help in the diagnosis the trends in the epidemiology of keratitis will be discussed. Recent antimicrobial surveillance studies in Australia will be presented along with current treatment recommendations. The use of steroids in keratitis will be outlined as their use remains controversial despite the findings from the Steroids in Ulcerative Keratitis treatment trial. The principles of surgery in microbial keratitis will be presented and finally a useful review of microbiological principles in microbial keratitis will be given. At the end of the symposium the attendee will have a good understanding of how to manage patients with microbial keratitis that will be encountered in general ophthalmology as well as highlighting new and emerging presentations. Speakers and Topics: Dr Matthew Green – Update on epidemiology of Microbial Keratitis in Australia Prof Stephanie Watson – Microbial Keratitis treatment recommendations Dr Andrew Apel – Steroid treatment of microbial keratitis Dr Chameen Samarawickrama – Surgical management of Microbial Keratitis Dr Jenny Robson – A Microbiologist's insights on Microbial Keratitis: “What we have forgotten from med school”

1600–1730 S19 COURSE Strabismus case studies: diagnosis and management strategies Chairs: A/Prof Shuan Dai and A/Prof Geoff Lam Email: [email protected] Venue: C4.5 Objectives: Strabismus, irrespective of in childhood or adult, is one of the common ophthalmic diseases that the general ophthalmologists manage in their routine practice. The purpose of this course is to provide practical guidance both for the diagnosis and management of common strabismus disorders using real clinical cases Outline: A series of common, challenging strabismus cases will be presented. The course will involve audience interaction. The cases will address common practical issues in strabismus management including: Diag- nosis and treatment options relating to a number common strabismus entities encountered in children and adult population Speakers and Topics: A/Prof Shuan Dai, Prof Glen Gole, Dr Geoff Lam, Dr Craig Donaldson, Dr Heather Russell, Dr Deepa Taranath 1 year old with esotropia – when to operate? Intermittent exotropia in a 6 years old child – if and when to operate? SUNDAY 10 NOVEMBER 51

Duane syndrome in an adult Adult with vertical diplopia and head tilt Double elevator palsy – indication for surgery and when Strabismus in an adult with thyroid toxicosis – when to operate?

1600–1730 S20 FREE PAPERS – Epidemiology / Genetics / Oculoplastic Venue: C4.6 – C4.7 Chairs: A/Prof Andrea Vincent and Prof Tim Sullivan

S2001 Long term outcomes of upper eyelid loading advantages of allowing postoperative adjustability, being with modular platinum segment chains for thinner, inducing less visible prominence and being less lagophthalmos: an adjustable approach to likely to induce allergy than gold. They are an ideal first‐line eyelid loading loading implant for lagophthalmos.

Elad Ben Artsi1,2, Katja Ullrich1, Luca Brusasco1,3, Raman S2002 Malhotra1 Mucoceles involving the orbit: a retrospective 1Corneoplastic Unit, Queen Victoria Hospital NHS Trust, review East Grinstead, United Kingdom, 2OPAL unit, Royal Victo- rian Eye and Ear Hospital, Melbourne, Australia, 3Depart- Allister Lee1,2, Timothy Sullivan1,2 ment of Surgical Sciences, Eye Clinic, University of Torino, 1University of Queensland, Brisbane, Australia, 2Royal Bris- Turin, Italy bane and Women's Hospital, Brisbane, Australia Email: [email protected] Email: [email protected] Purpose: reporting outcomes of a 5‐year series of individu- Purpose: To report the spectrum of mucoceles involving the ally sutured platinum segment chains for upper eyelid orbit encountered in a tertiary referral centre with respect to loading. presentation, risk factors, management and outcomes. Methods: Prospective cohort study. Platinum segments of Methods: A retrospective chart review was performed on all 0.4 g and 0.2 g were assembled to create a desired weight adult patients with mucocele involving the orbit from 2004 and placed in supratarsal location after levator aponeurosis to 2017 in a tertiary setting. recession. Primary outcome measures included Results: 32 cases of mucoceles involving the orbit were lagophthalmos on blink, gentle and forced eyelid closure, included in this series. Common risk factors included previ- upper eyelid margin to reflex distance (MRD1), corneal ous craniofacial surgery or trauma, smoking, chronic staining, static and dynamic validated scoring for facial rhinosinusitis or mass lesion. The frontal and ethmoid palsy patients and complications. Secondary outcome mea- sinuses were frequently involved whereas maxillary and sures were visual acuity, occurrence of induced ptosis, need sphenoid sinus involvement was rare. Most common pre- for further surgery, cosmesis and quality of life evaluation. senting features included pain, proptosis, diplopia, peri- Results: During 2013‐2018, a total of 122 upper eyelids of orbital swelling and ophthalmoplegia. Rare sequelae 117 patients received platinum segment chains (mean weight included optic neuropathy, branch retinal vein occlusion and 1.2 ± 0.2 g, range 0.8‐1.6 g) for lagophthalmos. Median fol- seizures. Drainage was performed via endoscopic approach low up was 17.4 months. All grades of lagophthalmos were in 14 patients, external approach in 7 patients, and combined reduced (P < 0.001) with mean reduction of 3.6, 2.5 and 1.5 approach in 2 patients. Mean follow‐up was 14 months and mm on blink, gentle and forced closure correspondingly. recurrence rate was 23% (excluding patients lost to follow‐ Mean MRD1 was reduced by 1.4 mm (P < 0.001). Overall, up and with predisposing mass lesion). 28 eyelids (23.0%) underwent revision surgery 9.1 ± 9.2 Conclusion: A large series of mucoceles involving the orbit months after implantation. Of them, 6 (5.0%) required 2 or has been presented. Any of the sinuses may be involved, more procedures. No platinum allergy occurred. The chain although the fronto‐ethmoid sinus is the most common ori- was graded as having no prominence in 77.5% of eyelids; gin. The disease may present with a range of orbital symp- the eyelids were graded as having normal contour in 70.8% toms and signs, and in rare cases it is potentially vision or of cases. life‐threatening. Recurrence is common. Diagnosis and man- Conclusions: Platinum segments are FDA approved and agement by a multidisciplinary team of ENT and orbital sur- provide benefits of platinum chains with the additional geons may be required. 52 SUNDAY 10 NOVEMBER

S2003 1University of Auckland, Auckland, New Zealand, 2 Quantitative assessment of orbital Greenlane Clinical Centre, Auckland, New Zealand decompression surgery for thyroid eye disease Email: [email protected] using three‐dimensional stereo Purpose: This study was conducted to describe the epidemi- photogrammetric imaging ology of Thyroid Eye Disease (TED) in New Zealand. The condition has not been studied in detail in this population Jonathan Hyer1, Fabiola Murta1, Anjana Haridas1, Geo- with most data available from the northern hemisphere. ffrey Rose1,2, Daniel Ezra1,2 Method: Subjects with TED seen over a 14-year period in 1Moorfields Eye Hospital, London, United Kingdom, 2UCL an Ophthalmology-Endocrinology clinic in Auckland were Institute of Ophthalmology NIHR Biomedical Research Cen- used a database in this retrospective study. Data such as age, tre for Ophthalmology, London, United Kingdom ethnicity, gender, clinical activity score and smoking status Email: [email protected] were analysed. Purpose: To evaluate the volumetric change in the peri- Results: Our study had 161 subjects. Age at onset 47.0 ± orbital region using three dimensional (3D) stereo photo- 15.1 years and 77.6% were female. Crude yearly incidence grammetric imaging after orbital decompression surgery for of TED (per 1,000,000) was 12.6 in non-smokers and 67.3 thyroid eye disease (TED). To compare the resulting data to in smokers (p<0.001). On univariate analysis, female gen- the reduction in proptosis as measured with the Hertel der, Maori ethnicity and smoking were associated with inci- exophthalmometer. dence of thyroid eye disease. However, on multivariate Method: A total of 33 adults with TED undergoing orbital analysis, female gender and smoking status were associated decompression surgery were recruited at Moorfields Eye with risk of TED, and the difference in ethnicity was Hospital. Subjects had photographs taken using the explained by smoking status. Maori subjects with TED were VECTRA M3 imaging system before surgery and at least 3 significantly more likely to be current smokers (72.7%) com- months after surgery, with eyes closed. The change in peri- pared to European (39.2%), Pacific Peoples (33.3%), Asian orbital volume was calculated, following a previously vali- (8.3%) and Other (12.5%). Median clinical activity score – dated method, using the VECTRA 3D Analysis software. was1(IQR0 3). Maori ethnicity and current smokers were Periorbital volume change was compared with the change in associated with a higher clinical activity score at presentation (p = 0.049 and p = 0.027). measurements using a Hertel exophthalmometer. The Pear- Conclusion: A strong association was demonstrated with son Product–Moment Correlation Coefficient was used to female gender and smoking status and rate of TED. Maori assess the strength of the linear relationship. have increased rates of TED however this difference was Results: A total of 42 orbits underwent lateral wall decom- explained by smoking status. Eliminating smoking would pression and 10 orbits underwent 2.5 wall decompression. result in at least a 28.1% reduction in TED incidence in New The mean volumetric change in the periorbital region using Zealand. 3D image reconstruction was 1.95 mL for lateral wall decompression and 4.6 mL for 2.5 wall decompression. This S2005 corresponded with a reduction in proptosis of 3.7 mm and Establishing human lacrimal gland cultures 7.6 mm respectively. There was a significant positive corre- from biopsy sized samples lation between volumetric change in the periorbital region using 3D image reconstruction and Hertel exophthal- Luke Halliday1,2,3, John Wood1, Dinesh Selva3,2,1, mometry (r = 0.713, P < 0.0001). Michelle Sun3,2,1 Conclusion: Volumetric change in the periorbital region fol- 1University of Adelaide, Adelaide, Australia, 2Royal Ade- lowing decompression surgery can be accurately quantified laide Hospital, Adelaide, Australia, 3South Australian Insti- using 3D image reconstruction. Resulting data is signifi- tute of Ophthalmology, Adelaide, Australia cantly correlated with the reduction in proptosis as measured Email: [email protected] with the Hertel exophthalmometer and therefore sufficiently Purpose: Dry eye disease produces significant morbidity in sensitive to accurately reflect changes in orbital volume. affected patients and no curative therapies are currently available. The purpose of this study was to develop a tech- S2004 nique of culturing the human lacrimal gland to regenerate The epidemiology of thyroid eye disease in New lacrimal tissue in vitro. Zealand Method: Biopsy‐sized samples of human lacrimal gland were harvested from healthy participants; specimens were Lize Angelo1,2, Rachael Niederer1,2, Richard Hart1,2 digested to produce clusters of acinar cells and SUNDAY 10 NOVEMBER 53 myofibroblasts. Cells were seeded onto coverslips coated 0.064). Thus no statistically significant difference was found with Type I Collagen, then incubated at 37oC with 5% CO2 in the rhinostomy size at one year of follow‐up. Synechiae for up to 28 days. The identification of specific cell between the ostium and middle turbinate were found in 5 populations was achieved by immunocytochemistry and out of 30 patients which did not interfere with ostium Western Blot techniques using primary antibodies against function. Lysozyme, Vimentin and α‐Smooth Muscle Actin. Conclusion: A 10 mm x 10 mm osteotomy opening has Results: A mixed cell culture was established, containing comparable success rates as 15 mm × 15 mm osteotomy. acinar and myofibroblast cell populations. Cells attached Reduction in osteotomy size does not increase intraoperative within 48 hours of being plated, began proliferating from 7‐ or postoperative complications. A 10 mm x 10 mm bony 14 days and reached confluence after approximately 21 days opening is large enough to allow mobilization and approxi- in vitro. Acinar cells grow in clusters which are surrounded mation of mucosal flaps. by myofibroblasts. The secretory acinar cells develop multiple cytoplastic vesicles which stain positively for Lysozyme. S2007 Myofibroblasts demonstrate positive staining for Vimentin Optimal management in optic nerve sheath and α‐Smooth Muscle Actin. meningioma – a multi‐centre study and pooled Conclusion: We have developed a method of culturing the data analysis human lacrimal gland using biopsy‐sized samples of lacri- 1 2 3,4, mal tissue. When grown in vitro, acinar cells grow in clus- Christopher Ovens , Benjamin Dean , Cecelia Gzell 5,6 7,5,6 5 ters that are surrounded by myofibroblasts and develop a Nitya Patanjali , Benjamin Jonker , Michael O'Connor , 5 3 8,4 morphology that resembles native lacrimal tissue. Acinar Patrick Estoesta , Tatiana DeMartin , Clare Fraser 1 cells maintain synthetic function, as multiple Lysozyme pos- Discipline of Ophthalmology and Eye Health, the Sydney itive cytoplasmic vesicles over time. In the future, this tech- Medical School, the Faculty of Medicine and Health, The 2 nique may be used to regenerate the lacrimal tissue to treat University of Sydney, Sydney, Australia, School of Medi- patients with dry eye disease. cine, Sydney, The University of Notre Dame Australia, Syd- ney, Australia, 3GenesisCare, Sydney, Australia, 4 5 S2006 Macquarie University, Sydney, Australia, Chris O'Brien Surgical outcome of small osteotomy vs Lifehouse, Sydney, Australia, 6Royal Prince Alfred Hospital, conventional osteotomy in external Sydney, Australia, 7RPA Institute of Academic Surgery, Uni- dacrocystorhinostomy versity of Sydney, Sydney, Australia, 8Save Sight Institute, Faculty of Health and Medicine, The University of Sydney, Akash Raut1, Sushil Kumar1, Ruchi Goel1, Mohit Chhabra1, Sydney, Australia Ayushi Agarwal1 Email: [email protected] 1Guru Nanak Eye Center, New Delhi, India Purpose: Optic Nerve Sheath Meningiomas (ONSMs) are Email: [email protected] rare, benign neoplasms accounting for 2% of orbital Purpose: To compare the surgical outcomes of small osteo- tumours. Radiotherapy is generally preferred over surgery or tomy vs conventional osteotomy in external observation, however the optimal radiotherapy modality has dacryocystorhinostomy. not been established. Methods: A Randomized Control Trial was conducted at a Methods: We performed a retrospective analysis of visual tertiary care centre from November 2017 to April 2019 in outcomes and side effects in ONSM patients treated with patients diagnosed with primary acquired naso‐lacrimal duct radiotherapy at three centres in Sydney, Australia, between obstruction. 30 patients were equally divided into two 2000 and 2016 (n = 15). We also performed pooled data groups where group A underwent small osteotomy (10 × 10 analysis of available studies, comparing different radiother- mm) and Group B, conventional osteotomy (15 × 15 mm). apy subtypes. Postoperative patency and endoscopic examination of Results: In our patients, a significant majority experienced rhinostomy (area and height) were assessed. Success was improved visual field outcomes (10/13 > 3 dB mean devia- defined as patency on syringing at the end of one year of fol- tion improvement, P = 0.046), and stable or improved visual low‐up. acuity (1/13 > 1 Snellen lines decline, P = 0.0017) and col- Results: Both groups had100% anatomical success. The our vision (0/6 Ishihara plate decline, P = 0.015) after frac- average area of rhinostomy in group A was 11.56 ± 7.31 tionated radiotherapy (mean follow up = 46.5 months). Two mm2and group B was 24.14 ± 21.46 mm2 (P‐ value = fractionated stereotactic methods were employed in our 0.057). The mean height of rhinostomyin group A was 1.9 patients, VMAT and IMRT, which were equivalent. Pooled ± 0.71 mm and group B was 2.62 ± 1.11 mm (p‐ value = data analysis with strict inclusion criteria revealed poorer 54 SUNDAY 10 NOVEMBER visual acuity in 3D‐CRT compared to fractionated stereotac- were vulnerable to ransomware with the exception of Carl tic radiotherapy (fSRT). When all published studies were Zeiss Cirrus with forum. included, stereotactic radiosurgery (SRS) was equivalent to Conclusion: Ophthalmology practices and imaging systems fractionated methods (3D‐CRT, FSRT, IMRT) in visual out- are increasingly vulnerable to crypto‐ransomware attacks. comes. Rates of long‐term side effects were lowest with Hardware vendors must work with practices and profes- SRS, and 3D‐CRT had significantly higher rates of lacrimal sional medical associations to help mitigate this threat. dysfunction and cataract. IMRT was more likely to improve visual outcomes, while FSRT and SRS were more likely to S2009 ‐ stabilize visual outcomes. Pre clinical validation of in vitro gene therapy Conclusion: Our results favour fSRT, IMRT or VMAT over for bietti crystalline dystrophy 3D‐CRT. SRS appears to be a viable treatment option for ‐ 1 1 1 ONSM patients despite higher radiation doses. Jiang Hui Wang , Monica Hu , Doron G. Hickey , Michelle E. McClements2, Timothy D. Colgan1, Thomas L. 1,3 S2008 Edwards 1Centre for Eye Research Australia, Royal Victorian Eye Crypto‐ransomware threatening optical and Ear Hospital, Melbourne, Australia, 2Department of coherence tomography systems: a growing Clinical Neurosciences, Nuffield Laboratory of Ophthalmol- problem ogy, University of Oxford, Oxford, United Kingdom, 3Oph- thalmology, Department of Surgery, University of 1 2 3,4 Jason Ha , Olivija Tsaketas , Marc Sarossy Melbourne, Melbourne, Australia 1 2 Alfred Health, Melbourne, Australia, Essendon Eye Clinic, Email: [email protected] 3 Essendon, Australia, Centre for Eye Research Australia, Purpose: Bietti crystalline dystrophy (BCD) is an inherited 4 East Melbourne, Australia, Royal Victorian Eye and Ear retinal disease (IRD) caused by mutations in the CYP4V2 Hospital, East Melbourne, Australia gene. It is one of the most common IRDs in east Asia and Email: [email protected] typically leads to blindness by middle age. The disease has a ‐ Purpose: The threat of crypto ransomware to medical prac- number of characteristics that make it an ideal candidate for tices is increasing. The reliance on proprietary imaging hard- retinal gene augmentation therapy. This study sets out to ware and software such as OCT scanners, especially within perform a series of essential precursor in vitro experiments ophthalmology practices, greatly increases that risk. In this to validate this therapeutic strategy. ‐ work, we analyse the crypto ransomware threats detected by Methods: A human CYP4V2 transgene was cloned into a a major metropolitan ophthalmology practice, the vulnerabil- mammalian expression plasmid (p.CYP4V2) with additional ities of oct systems, and explore ways to mitigate this grow- DNA regulatory elements. p.CYP4V2 was packaged into ing problem. adeno‐associated virus (AAV) for viral transduction experi- Method: All intrusion attempts rejected by the firewall ments. Human embryonic kidney (HEK293) cells and cul- (fortigate 60E) during a 24 hour period (March 20, 2019). tured human fibroblasts from BCD patients were transduced At the Essendon eye clinic public subnet of 4 IP addresses with AAV.CYP4V2. Protein expression was assessed by were logged. Logging included source and destination IP immunocytochemistry and Western blot. Functionality of address, port, destination and time. Analysis was conducted CYP4V2 in transduced cells was investigated using a non- in r using the rgeolocate package and the maxmind GEOIP2 selective cytochrome P450 enzyme assay. ex vivo transduc- database. Commercial OCT systems (Heidelberg spectralis, tion efficacy of AAV.CYP4V2 was assessed in cultured Carl Zeiss Cirrus freestanding and forum, NIDEK, human retinal explants. OPTOVUE and TOPCON) were analysed for vulnerability Results: Viral‐mediated expression of CYP4V2 was demon- to ransomware compromise. strated in both HEK293 cells and in patient‐specific BCD Results: There were 15126 intrusion attempts over the 24 fibroblasts, as assessed by immunocytochemistry and West- hour period equating to ~630 per hour. Well‐known ports ern blot. Indirect evidence of enhanced CYP4V2 enzymatic and vulnerabilities were targeted: telnet (1818) and SSH activity after treatment with AAV.CYP4V2 was confirmed (349) were most attacked, but remote access RDP (162) and in both cell lines. Moreover, we observed CYP4V2 protein VPN systems (Softether 124 and pptp 40 attempts) were also expression in human retina explant transduced with AAV. systematically probed. 44% of attempts probed all 4 IP CYP4V2. addresses in the range. 53% of attempts originated FROM Conclusions: We have demonstrated robust viral‐mediated the Russian Federation. All installations of OCT hardware expression of exogenous CYP4V2 in multiple cell models SUNDAY 10 NOVEMBER 55 and human retinal explants, providing encouraging support S2011 for a future clinical trial of gene augmentation to treat BCD. Smoking and treatment outcomes of S2010 neovascular age‐related macular degeneration over 12 months Epidemiology of diabetic retinopathy and maculopathy in Auckland, New Zealand: a Harshil Dharamdasani Detaram1, Nichole Joachim1, regional photo‐screening program 2006‐2018 Gerald Liew1, Kim Van Vu1, George Burlutsky1, Paul Mitchell1, Bamini Gopinath1 Sophie Hill1, Peter Mullins2, Ole Schmiedel3, Moaz 1Centre for Vision Research, The Westmead Institute for Alshaikhi4, Ehsan Vaghefi5, David Squirrell1 Medical Research, The University of Sydney, Sydney, 1Department of Ophthalmology, University of Auckland, Australia Auckland, New Zealand, 2Department of Statistics, Univer- Email: [email protected] sity of Auckland, Auckland, New Zealand, 3Service Clinical Purpose: To assess the association of smoking with age of Director of Auckland Diabetes Centre, Auckland, New onset of neovascular age‐related macular degeneration Zealand, 4Department of Ophthalmology, University of (nAMD), visual acuity (VA), central macular thickness Auckland, Auckland, New Zealand. 5Auckland Bioengineer- (CMT) and the presence of fluid in nAMD patients. ing Institute and School of Optometry and Vision Sciences, Methods: 547 nAMD patients were recruited from a tertiary University of Auckland, Auckland, New Zealand eye clinic during 2012‐2015, of these, 490 patients were Email: [email protected] followed up 12 months later. Clinical diagnosis of nAMD Purpose: To determine, the incidence, severity, and progres- was confirmed by a retinal specialist. Smoking was deter- sion of diabetic retinopathy in the Auckland population mined from self‐reported history as never, past or current. (Auckland and Counties Manukau DHB) based on the reti- Age of onset was defined as date of first recorded diagnosis nopathy and maculopathy grades from photo‐screening of nAMD in either eye or date of first anti‐vascular endothe- examinations. lial growth factor injection. CMT and presence of fluid were Methods: A cohort study of 63 625 people with Type 1 and recorded from Spectral Domain optical coherence tomogra- Type 2 diabetes who had retinal photo‐screening between phy (OCT) images. VA was recorded as number of letters 2006 and 2018. Preliminary analysis focusing on the inci- read at 3 m dence of diabetic retinopathy and maculopathy in the Auck- Results: After multivariable adjustment, current smokers land population; severity of diabetic retinopathy and developed nAMD on average 5.5 years younger compared maculopathy at first screening presentation and self‐reported to never smokers and 4.4 years younger compared to past concurrent health conditions. smokers (P < 0.0001 and P = 0.0008, respectively). At base- Results: Mean age of the cohort was 59 years, 52% were line, adjusted mean CMT was significantly higher in current male. 81% of the patients had Type 2 diabetes mellitus; with compared to past smokers (259.2 μm vs 231.9 μm, respec- 65% on oral medications, 16% on insulin therapy and 14% tively, P = 0.04). Current smokers vs never smokers had diet controlled. At first photo‐screening presentation 42 235 greater odds of subretinal fluid being present at 12‐month patients did not have any diabetic retinopathy, and 45 413 follow‐up: multivariable‐adjusted OR 1.99 (95% CI 1.09‐ patients had no diabetic maculopathy. 19 667 patients had 3.67). Smoking status was not significantly associated with non proliferative diabetic retinopathy and 15 515 had no VA over 12 months. sight threatening maculopathy. Only 1723 (2.7%) patients Conclusions: Current smoking was associated with a youn- had proliferative diabetic retinopathy (PDR) at first presenta- ger age of AMD onset and key treatment outcomes such as tion for diabetic screening. While 2967 (4.2%) had potential higher mean CMT and greater odds of subretinal fluid pres- sight threatening maculopathy. At first screening, 52% of ence. These findings suggest that smoking cessation may patients had self‐reported hypertension, and 51% benefit patients being treated for nAMD. dyslipidaemia. 6% of the cohort were current smokers. Pro- gression to sight threating retinopathy over five years was S2012 rare (<5%). Conclusions: The majority of patients at first presentation to Dietary intake profile of age‐related macular photo‐screening have no identifiable diabetic retinopathy or degeneration (AMD) patients as determined by maculopathy. With only 2.7% of patients presented with a short dietary questionnaire PDR and 4.2% with potential sight threatening maculopathy. A significant proportion of the screening population is Diana Tang1,2, Paul Mitchell1,2, Gerald Liew1,2, George affected by concurrent hypertension and dyslipidaemia. Burlutsky2, Victoria Flood1,3, Bamini Gopinath1,2 56 SUNDAY 10 NOVEMBER

1The University of Sydney, Sydney, Australia, 2The Results: There were 2.4% (n = 6 eyes) of participants with Westmead Institute for Medical Research, Sydney, Australia, early AMD and the remaining had late AMD (wet: N = 198 3Westmead Hospital, Sydney, Australia eyes, 70.2%; vs dry AMD: N = 32 eyes, 16.2%). Treatment for Email: [email protected] wet AMD included: 66.7% with Eylea; 32.7% with Lucentis; Purpose: Diet is an important modifiable risk factor to pre- and 0.6% with Avastin. Both questionnaires indicated sub‐opti- vent and delay AMD progression. A short dietary question- mal average daily intakes of vegetables (FFQ = 3.3 serves vs naire (SDQ) could assist eye‐care practitioners to effectively SDQ = 2.1 serves) and fruit (1.7 serves vs 1.8 serves); and ade- screen and identify patients in need of dietary behavioural quate average weekly intakes of seafood (2.8 serves vs 2.1 support. serves), and eggs (2.1 serves vs 2.8 serves). Between question- Methods: AMD patients were recruited from Sydney‐based naires, correlation coefficients (P‐value <0.05) were highest for private eye clinics (N = 152; 58% female; 67 ± 7 years). The eggs, alcohol, nuts, seafood: <80 years: 0.32, 0.83, 0.51, 0.38; SDQ was adapted from a validated questionnaire. The SDQ ≥80 years: 0.50, 0.81, 0.54, 0.59, respectively. was compared against a validated food frequency question- Conclusion: AMD patients have poor adherence to the die- naire (FFQ). Dietary data from both questionnaires were cat- tary recommendations for vegetable and fruit intake. An egorized into relevant food groups and stratified by age SDQ can help to effectively identify patients in need of fur- (<80 years vs ≥80 years). Statistical analyses were con- ther dietary behavioural support. ducted using SAS.

1600–1730 S21 – Leadership Development Committee Convenor: Dr Catherine Green AO Email: [email protected] Venue: C4.9 Synopsis: Convened by the Leadership Development Committee chair Catherine Green, this session will com- mence with an address by RANZCO President A/Prof Heather Mack on “Leadership” followed by a rapid-fire session. Participants of the RANZCO Leadership Development Program will present their projects to a panel of reviewers, Prof David Mackey, Prof Stephanie Watson, Dr Christine Younan and Dr Shenton Chew. Speakers and Topics: Dr Will Cunningham – Identifying factors that encourage or deter Maori and Pasifika doctors from pursuing formal Ophthalmology training in New Zealand Dr Genevieve Oliver – Encourage policies and practices that support the health and wellbeing of ophthalmologists within RANZCO Dr Rahul Dubey – Integrating non-mydriatic fundus cameras (NMC) into multidoctor GP practices – facilitating effective screening of at-risk populations at point of care. Dr Tanya Karaconji – Evaluation of the deficiencies in the final year of the Vocational Training Program (VTP) of Ophthalmology Trainees transitioning to a Consultant. Dr Andrea Ang – Trialling of New Surgical Assessment in the Western Australian training network Dr Jacqueline Beltz – GENEYE Surgical. Next generation surgical training Dr Hamish Dunn – Glaucoma runs in families. Public awareness event-based screening Dr Elaine Chong – Re-establish a corneal service at the RMH, which is the referral site for complicated cases which require other multidisciplinary medical/surgical inputs. Dr Vivek Pandya – To develop an independent vitreoretinal surgical service at Liverpool Hospital, Sydney Dr George Kong – Fostering of modern clinical audit practices for Glaucoma units in Australia

1730–1830 Film and Poster Viewing Session Venue: Foyers, Level 4, International Convention Centre

1830–2130 H04 – Alcon Hosted Evening Symposium Venue: Ballroom, Sofitel DOI: 10.1111/ceo.13629 Monday 11 November

0645−0800 H05 − Novartis Hosted Morning Symposium Venue: C4.5

0830–1000 P05 – PLENARY Title: Clinical Controversies Chair: Dr Brad Horsburgh Room: Darling Harbour Theatre using FLACS. It will argue that FLACS makes surgery safer P0501 and easier to convince the attendee the benefits of FLACS. Treatment of infantile haemangiomas – is propranolol the answer for all? P0504 Pigment Dispersion Syndrome: to PI or not Prof David A Plager to PI? Synopsis: Propranolol burst on the scene serendipitously as a treatment for infantile haemangiomas in 2008. News of its Prof David (Ted) Garway-Heath nearly miraculous effects spread virally and within 2 years at Synopsis: Reverse pupillary block has been proposed as a least 17 papers had been published just related to treatment mechanism contributing to pigment dispersion syndrome of peri-ocular haemangiomas! Literally hundreds more (PDS) and subsequent glaucoma. Peripheral iridotomy has papers have been published since that time touting its useful- been suggested as a treatment to relieve the pupillary block ness for tumours throughout the body. and prevent further pigment dispersion. There are only two However, should we abandon completely other therapeutic randomized clinical trials reporting the results of peripheral options that had been shown previously to be effective for iridotomy in patients with PDS and they give apparently treatment of sight threatening vascular lesions such as ste- opposite results. The conflicting results may be explained roid injection or surgical resection or do they still have a role in a large part by the differing stages of disease treated in to play? each trial. The trials and their results will be presented and the implications of the results for clinical practice discussed. P0502 Topical therapy for ocular surface squamous P0505 neoplasia − when, and when not Genetic testing in age-related macular degeneration (AMD) – is it necessary for Dr Santosh G Honavar clinical care? Synopsis: TBC Dr Emily Chew P0503 Synopsis: Genetic testing in AMD is important in the basic I do not need FLACS! understanding of the pathobiology of the disease and hopefully will provide clues for future therapies. How important Prof Soon-Phaik Chee is it to conduct genetic testing in AMD prior to initiating Synopsis: FLACS has not been shown to improve visual therapies such as intravitreous injections of anti-vascular outcomes nor refractive accuracy. It does reduce the effec- endothelial growth factor (VEGF) injections for neovascular tive phaco time and loss of endothelial cell count but appears AMD or antioxidant vitamins and minerals (Age-Related to increase postoperative complications. So, what is so great Eye Disease Study 2 [AREDS2] supplements) for treating about FLACS? intermediate AMD or unilateral late AMD? There were differ- However, the speaker is fairly reliant on FLACS when it ing opinions on the results of the analyses on the potential comes to managing complex cases. This is where the true genetic interaction with the response to therapies for AMD. value of FLACS lies. This talk will demonstrate numerous This controversy resulted in National Institutes of Health videos of complex cases managed manually compared to leadership requesting the collaboration of three independent

Clin Experiment Ophthalmol. 2019;47 (Supp 1):57–75. wileyonlinelibrary.com/journal/ceo 57 58 MONDAY 11 NOVEMBER research groups who were charged with conducting replications American Academy of Ophthalmology to NOT conduct of the previously published studies on genetic interaction using genetic testing for AMD for clinical care, at least not yet. This the AREDS data. The conclusion from the final publication of demonstrates the importance of replication in science and these 3 groups supported the current recommendations of the emphasizes the continued need for genetic testing in research.

1000–10:30 MORNING TEA

1030–1100 L06 CATARACT UPDATE LECTURE State of the art intraocular lens fixation Prof Soon-Phaik Chee Chair: Dr Elsie Chan Venue: Darling Harbour Theatre Synopsis: This talk will cover a variety of current and innovative approaches to fixation of the intraocular lens (IOL) in the absence of capsular support. The least invasive technique of iris fixation is shown with pearls on how to obtain a round pupil. When managing lens implant fixation in the elderly who are intolerant to a long surgical procedure, the retropupillary iris-clip IOL is a good option. However, securing the IOL to the sclera produces a more stable fixation. In the past, scleral fixation using fine polypropylene sutures resulted in subluxation of implants less than a decade after surgery. The use of thicker polypropylene or polytetrafluoroethylene sutures are recommended today. Single piece acrylic haptics within the capsular bag can safely be directly sutured to the sclera. Premium IOLs may be salvaged by inserting a capsular tension device. Intrascleral haptic fixation, popularized as the ‘Glued IOL’ and more recently, a flanged haptic technique not requiring conjunctival dissection are the current favoured techniques that result in an IOL without donesis. The latter is seemingly simple to perform, yet consistently achieving a perfect outcome may be difficult to achieve. Tips on getting it right will be shared. The latest technique using thick polypropylene sutures to create flanges to anchor the IOL to the sclera will be shown. In addition, the speaker's preferred technique will also be demonstrated.

1100–1130 L07 THE FRED HOLLOWS LECTURE Hollows influence: research, programs and universal eye health coverage in the Pacific Dr Anasaini Cama Chair: A/Prof Nitin Verma AM Venue: Darling Harbour Theatre Synopsis: Professor Frederick Cossom Hollows: New Zealand born Australian; recipient of many health and humanitarian awards including the Australian of the Year Award in 1990; a brilliant and outspoken ophthalmic surgeon, and a humanitarian who recognized the disparity in eye health delivery and worked tirelessly to correct this – first in Australia then reaching out to Asia and Africa. Perhaps if given more time, he would have visited the Pacific. Although succumbing to illness, Professor Hollows' work lives on through his legacy. The Pacific – part of the vast blue continent; developing island nations rich in culture and religion. A holiday haven for tourists, a challenge for eye health delivery. Surrounded by fast developing or developed countries in Asia, Australia, New Zealand and the Americas, the Pacific is catching up in its bid to attain universal eye health coverage. Recent years have seen good developments in eye health across the Pacific, largely through the efforts and partnership of the Ministries of Health with NGOs, Academic Institutions and RANZCO to name a few. Research has also increased in the Pacific, informing on policy and guiding eye health program development and progression, whilst endeavouring to keep within recognized standards of care and meeting global targets. Pacific research and its outcomes on Cataract, Diabetic Retinopathy, and Trachoma Programmes will be highlighted in this talk, as the Pacific addresses the right to sight and strives to attain universal eye health coverage. MONDAY 11 NOVEMBER 59

1130–1230 P07 − RANZCO PLENARY Launch of the RANZCO reconciliation action plan Venue: Darling Harbour Theatre

1230–1400 LUNCH

1400–1530 CONCURRENT SESSIONS

1400–1530 S22 SYMPOSIUM International development – the continuing challenge. to inform and challenge those involved or interested in working in low resource countries Convenors: Dr Mark Ellis and A/Prof Geoffrey Painter Email: [email protected] Venue: C4.1 Synopsis: Australian Ophthalmologists, Ophthalmic Nurses and Orthoptists have a long and proud history of working overseas to provide ophthalmic care, teaching, research and infrastructure development in low resource settings in many countries worldwide. The aim of this Symposium is to inform and challenge those who are involved or interested in becoming involved in international development to enable them to be better educated about what is involved in working in these areas. This will enable them to be more prepared for working in international development. We will hear from a number of people, from a wide range of backgrounds, who have first hand knowledge of what it is like to be involved in international development and how they have achieved their goals. We will examine the reasons behind volunteering, the practicalities involved and some of the difficulties encountered. These principals will be illustrated by selected case histories. We will also learn about the RANZCO guidelines for good development practices and hear what international projects the College is currently involved in. Speakers and Topics: Dr Bill Glasson – Why be Involved in International Development A/Prof Nitin Verma AM – What are the Different Types of Involvement in Development Projects Dr Anthony Bennett-Hall – Where Does RANZCO Fit in? John Kennedy – The Role of the Australian and New Zealand Eye Foundation Dr Anasaini Cama – International Development from the Recipients Perspective Tani Brown – Preparing to Work in the International Development Sector Mrs Kerrie Legg – Creating the Team: Doctors, Nurses and Allied Health Professionals Some Existing Programmes Showcased: Dr James Muecke – Sight For All in Myanmar Mark Ellis – The Sumba Eye Project A/Prof Nitin Verma AM – Lessons Learnt from Timor-Leste Questions and Discussion

1400–1530 S23 COURSE Controversies in cataract surgery Moderator: Dr Elsie Chan Email: [email protected] Venue: C4.4 Purpose: This course discusses current controversies in cataract surgery using an interactive, evidence- based, ‘debate’ format. Audience response questions will gauge current practice among attendees. Speakers and Topics: Panellist: Dr Rosie Dawkins 1. Glaucoma patients undergoing cataract surgery should be offered MIGS For: Dr Nathan Kerr 60 MONDAY 11 NOVEMBER

Against: Dr Sam Kain 2. Patients having a toric IOL should all have corneal topography performed pre-operatively For: Dr Chameen Samarawickrama Against: Dr Alex Tan 3. Anterior chamber IOLs are a safe option in the absence of a capsular bag For: A/Prof Mark Daniell Against: Dr Matthew Green 4. Topical antibiotics are not necessary after routine cataract surgery For: Dr Anton van Heerden Against: Dr Sing-Pey Chow 5. NSAIDs should be used routinely after cataract surgery For: Dr Georgia Cleary Against: Dr Elaine Chong

1400–1530 S24 SYMPOSIUM Cataract surgery and the cornea: pre-operative management and post-operative considerations Chairs: Dr Jacqueline Beltz and Prof Bennie Jeng Email: [email protected] Venue: Darling Harbour Theatre Course Objective: Attendees will see modern techniques and learn different methods by which phacoemulsification may be undertaken in patients with corneal disease. Particular attention will be given to pre- and post-operative considerations in these patients. Speakers and Topics: Dr Jacqueline Beltz, Prof Bennie Jeng, Prof Gerard Sutton, Dr Michael Lawless, Prof Michael Belin and Dr Peter Zloty 1) pre-operative corneal considerations (including managing the irregular cornea) 2) corneal considerations for premium IOL's 3) IOL selection in KCN 4) IOL selection following corneal/refractive surgery 5) operative considerations in patients with corneal disease 6) approach to residual refractive error after cataract surgery

1400–1530 S25 SYMPOSIUM Thyroid eye disease management in a multi-disciplinary clinic Chair: A/Prof Raf Ghabrial Email: [email protected] Venue: C4.5 Synopsis: The multi-disciplinary thyroid eye disease clinic at Royal Prince Alfred Hospital has been in operation for two years. We present the challenges and advantages of running such a clinic. Speakers and Topics: Prof Peter McCluskey – Overview Ms Tharini Ganess – organizing the clinic, pre workup Dr Ash Gargya − The Endocrinology of Graves' Disease A/Prof Roger Garsia − The Immunology of Graves' Disease Dr Geoff Parker − Radiological findings in Graves' Disease Dr Santosh G Honavar – (Peter Rogers Lecture) Medical and Minimal Interventional management for thyroid Eye Disease – Current Status A/Prof Chris Milross − Radiotherapy for Graves' Disease A/Prof Raf Ghabrial − Surgical options in Graves' Disease Dr Ross Fitzsimons − Strabismus treatment in Graves' Disease MONDAY 11 NOVEMBER 61

1400–1530 S26 − FREE PAPERS Title: Rapid Fire Session- Retina / Uveitis Chairs: A/Prof Andrew Symons and Dr Jo Sims Venue: C4.6 and C4.7

photoreceptors which are capable of driving visually‐guided S2601 behaviour. Optogenetic restoration of vision with breaches S2602 ‐ Matthew Simunovic1,2, Weiyong Shen1, Dylan Kilpatrick3,Dario Multi input artificial intelligence design for ‐ Protti3, Catherine Leamey3, Lay Khoon Too1, Mark Gillies1,2 multi modal retinal imaging diagnosis of 1Save Sight Institute, University of Sydney, Sydney, Austra- intermediate dry age related macular lia, 2Sydney Eye Hospital, Sydney, Australia, 3Department degeneration of Physiology, University of Sydney, Sydney, Australia Sophie Hill1, Ehsan Vaghefi2, Hannah Kersten3, David Email: [email protected] 1 Purpose: To restore vision in a murine model of severe reti- Squirrell 1Department of Ophthalmology, University of Auckland, nal degeneration using an adeno‐associated vector (AAV) Auckland, New Zealand, 2Auckland Bioengineering Institute encoding bReaChes, a red‐shifted channelopsin and School of Optometry and Vision Sciences, University of Methods: 35 mice were studied: 11 transgenic (DTA176 Auckland, Auckland, New Zealand, 3School of Optometry mice) and 6 wild‐type (WT) mice underwent bilateral intra- and Vision Sciences, University of Auckland, Auckland, New vitreal injections of AAV2‐CaMKIIα‐bReaChes tagged with Zealand yellow fluorescent protein (YFP). As controls, 9 transgenic Email: [email protected] and 9 WT mice were injected bilaterally with AAV encoding Purpose: To determine if using multi‐modal imaging com- YFP alone. YFP expression was assessed via fundus fluores- bined with multi‐input AI can improve the accuracy of a cent photography. Conversion of retinal ganglion cells into diagnosis of intermediated dry age related macular degenera- novel photoreceptors was evaluated by patch‐clamp record- tion (iAMD). ings. Restoration of visual function was assessed using a Method: Seventy‐five participants divided into three cohorts standardized looming stimulus paradigm. were recruited; Young Healthy (YH) group, Old Healthy Results: Strong expression of bReaChes‐YFP was found at (OH) group and patients with iAMD. Colour fundus photog- ‐ ‐ 6 and 28 weeks post injection. Patch clamp recordings con- raphy, OCT and OCT‐A was performed. firmed conversion of retinal ganglion cells into novel photo- A multi‐input AI based on the original INCEPTION‐ receptors capable of following flicker at up to 30 Hz. RESNET‐V2 design was trained on multiple image modali- Finally, behavioural testing confirmed restoration of visual ties. Firstly only a single image modality was used. Further ‐ α‐ function in transgenic mice treated with AAV2 CaMKII training episodes combined both OCT and OCTA image ‐ bReaChes YFP. In the looming stimulus paradigm, control data. The last training episode utilized multi‐modal image ‐ ‐ α‐ ‐ wild type, AAV2 CaMKII bReaChes YFP treated WT and analysis from OCT, OCTA and colour fundus photographs. transgenic mice demonstrated a freeze response to looming Results: The CNN trained using OCT alone showed a diag- stimuli, whilst transgenic mice receiving the control viral nostic accuracy of 94%, whilst the OCTA trained cnn vector did not. Consequently, transgenic mice treated with achieved an accuracy of 91%. When OCT and OCTA the control vector exited the stimulus enclosure more rapidly images were combined the CNN accuracy increased to 96%. than control WT and AAV2‐CaMKIIα‐bReaChes‐YFP The diagnostic power of the multi‐modal image trained treated WT and transgenic mice (F[3, 27] = 3.219, P CNN (OCT, OCTA and colour fundus photographs). = 0.038). Achieved an overall accuracy of 99%. In the iamd cohort Conclusions: Intravitreal injection of AAV2‐CaMKIIα‐ images the sensitivity and specificity of the multimodal bReaChes‐YFP resulted in bReaChes‐YFP expression in a image trained CNN was 100% and 99% respectively. murine model of severe early‐onset retinal degeneration at Conclusion: In this study we demonstrate that the diagnostic up to 28 weeks post‐injection. Furthermore, this expression accuracy of a CNN is incrementally increased if a multi‐ resulted in the conversion of retinal ganglion cells into novel modal image analysis approach is employed. This approach 62 MONDAY 11 NOVEMBER is more in keeping with the multi‐modal image interpretation 96. Brolucizumab achieved better fluid control with more used by retinal specialists within the clinical environment. patients remaining fluid‐free at Week 96 compared with aflibercept. S2603 Visual and expanded anatomical outcomes for S2604 brolucizumab vs aflibercept in patients with 5-year visual acuity outcomes for intravitreal neovascular AMD: 96‐week data from HAWK therapy in bilateral neovascular age‐related and HARRIER macular degeneration – fight retinal blindness (FRB!) project Paul Mitchell1, Chirag Jhaveri2,3,4, Pravin Dugel5, Charles Wykoff6, Rishi Singh7, Frank Holz8, Robin Hamilton9, Elisa Cornish1,2, Kelvin Teo3,1, Vuong Nguyen1, David Jahangir Alam10 Squirrel4, Stephanie Young5,6, Mark Gillies1,2, Daniel 1University of Sydney, Westmead Institute of Medical Barthelmes7 Research, Sydney, Australia, 2Retina Consultants of Austin, 1The University of Sydney, Sydney, Australia, 2Sydney Eye Austin, USA, 3Retina Research Center, Austin, USA, 4Dell Hospital, Sydney, Australia, 3Singapore National Eye Cen- Medical School, Austin, USA, 5Retinal Consultants Arizona, tre, Singapore, Singapore, 4University of Auckland, Auck- Phoenix, USA, 6Retina Consultants of Houston & Blanton land District Health Board, Auckland, New Zealand, Eye Institute, Houston Methodist Hospital, Houston, USA, 5Repatriation General Hospital, Concord, Sydney, Austra- 7Ophthalmology i‐32, Cole Eye Institute, Cleveland, USA, lia, 6Gladesville Eye Specialists, Sydney, Australia, 7Univer- 8Department of Ophthalmology, University of Bonn, Bonn, sity Hospital Zurich, Zurich, Switzerland Germany, 9Moorfields Eye Hospital, London, United King- Email: [email protected] dom, 10Novartis Pharmaceutical, East Hanover, USA Purpose: Second eye involvement of neovascular Age‐ Email: [email protected] Related Macular Degeneration (nAMD) is usually detected Purpose: To report the expanded outcomes over 96 weeks earlier in the disease process. We compared treatment inten- in HAWK and HARRIER, two Phase III, prospective studies sity and mean adjusted visual acuity (VA) gains for 1st‐ and that assessed the efficacy and safety of brolucizumab vs 2nd‐affected eyes over the first 5‐years of treatment. We aflibercept in patients with nAMD. studied the cumulative incidence of second eye involvement Methods: Patients were randomized 1:1:1 to brolucizumab over 5‐years. 3 mg (n = 358), brolucizumab 6 mg (n = 360) or aflibercept Method: We analysed data from Australia, New Zealand, 2 mg (n = 360) [HAWK], or 1:1 to brolucizumab 6 mg (n = Switzerland and Singapore through the FRB! Project data- 370) or aflibercept 2 mg (n = 369) [HARRIER]. After three base. All patients treated from 2005 to 2013 with bilateral loading doses, brolucizumab patients were treated q12w, nAMD where both eyes had ≥5 years follow‐up on treat- with the option of q8w as determined by disease activity ment where included. assessment. Aflibercept was dosed q8w. Results: 170 patients were included in this 5‐year analysis. Results: In both studies, brolucizumab was non‐inferior to The mean baseline VA of 2nd‐affected eyes was signifi- aflibercept at Week 48 and visual gains were maintained to cantly higher than that of 1st‐eyes (67 vs 55 letters, P < Week 96. Brolucizumab achieved superior CST reductions 0.01) and more eyes had baseline VA > 69 letters (62% v compared with aflibercept from baseline to Week 16 and 30%). 2nd‐affected eyes with VA > 69 lost significantly Week 48, and these were also maintained at Week 96. The more letters (mean [SD]) compared to 1st‐affected eyes proportion of patients with presence of IRF and/or SRF and (−10.7 [18] letters vs −3.8 [17.6] letters, p = 0.02) after 5‐ sub‐RPE fluid at Week 96 was lower in brolucizumab‐ years of treatment. First‐affected eyes received more injec- treated compared to aflibercept‐treated patients. The propor- tions than the 2nd‐affected eyes (27 vs 25, p = 0.03) particu- tion of patients who were fluid‐free (absence of SRF, IRF larly those with VA > 69 letters. The cumulative prevalence and sub‐RPE) at Week 96 was higher for brolucizumab 6 of 2nd eye involvement was 13% at 12 months, 24% at 24 mg than aflibercept in HAWK. These outcomes were months and 54% at 5‐years. achieved with over 75% of brolucizumab 6 mg patients who Conclusion: We found that 2nd‐affected eyes with nAMD completed Week 48 on a q12w interval remaining on a had better VA at diagnosis and received fewer treatments q12w interval until Week 96. over the 5‐year follow up. 2nd‐affected eyes with VA > 69 Conclusion: The superior anatomic outcomes seen at Week letters did not maintain VA as well as 1st‐affected eyes with 16 and 48 along with the comparable vision gains with good vision. Care should be taken to avoid an apparent ten- brolucizumab 6 mg vs aflibercept were maintained at Week dency to under‐treat 2nd‐affected eyes. MONDAY 11 NOVEMBER 63

S2605 S2606 Outcomes of suspending VEGF inhibitors for Comparison of macular atrophy in eyes with ‐ ‐ neovascular age related macular degeneration neovascular age related macular degeneration when lesions have been inactive for 3 months treated with VEGF inhibitors using a treat‐ and‐extend or pro re nata regimen: 4-year 1 1 1,2 Vuong Nguyen , Anagha Vaze , Samantha Fraser‐Bell , results of the MANEX study Jennifer Arnold3, Rohan Essex4, Daniel Barthelmes5, Mark Gillies1 Kimberly Spooner1,2, Samantha Fraser‐Bell1,2, Mariano 1Save Sight Institute, Sydney, Australia, 2Sydney Eye Hospi- Cozzi3, Davide Monteduro3, Kehui Luo4, Thomas Hong2,1, tal, Sydney, Australia, 3Marsden Eye Specialists, Parra- Marion Munk5, Alessandro Invernizzi3,1, Giovanni matta, Australia, 4Australian National University, Staurenghi3, Andrew Chang1,2 Canberra, Australia, 5University Hospital Zurich, Zurich, 1Save Sight Institute, University of Sydney, Sydney, Austra- Switzerland lia, 2Sydney Retina, Sydney, Australia, 3Eye Clinic, Depart- Email: [email protected] ment of Biomedical and Clinical Science “Luigi Sacco”, Purpose: There is currently limited evidence that it is ever University of Sydney Milan, Milan, Italy, 4Department of safe to suspend anti‐VEGF treatment for nAMD. We Mathematics and Statistics, Faculty of Science and Engi- assessed the outcomes of eyes that have suspended treatment neering, Macquarie University, Sydney, Australia, 5Depart- with vascular endothelial growth factor (VEGF) inhibitors ment of Ophthalmology, Bern, Inselspital, Bern University for neovascular age‐related macular degeneration (nAMD). Hospital, University of Bern, Bern, Switzerland Methods: Data were obtained from the Fight Retinal Blind- Email: [email protected] ness! registry. Eyes were considered to have suspended Aim: To observe the incidence and progression of macular treatment if they received at least 5 injections, followed by atrophy on fundus autofluorescence (FAF) in eyes with a ≥ 3 month period of inactivity of the choroidal neovascular nAMD being treated with anti‐VEGF agents using either a lesion with no treatments administered. treat‐and‐extend regimen (T&E) or pro re nata (PRN) over Primary outcome measures were the proportion of eyes 4 years in a clinical setting. Methods: Treatment naive resuming treatment due to lesion re‐activation, change in ‐ patients with nAMD received anti VEGF therapy according visual acuity (VA) at time of re‐activation and recovery of to a T&E or PRN regimen. All eyes underwent FAF and vision 12 months after resuming treatment. OCT using Heidelberg Spectralis. Data was collected from Results: We identified 434 eyes suspending treatment and patient charts. Statistical regression analyses were performed tracked for 12 months thereafter. An estimated 41% of eyes to evaluate the association between treatment strategy and re‐activated in the first year, increasing to 79% by the fifth MA incidence and progression over 4 years. year. The median time to re‐activation was 504 days. Of the ‐ Results: At 4 years, mean change in VA was 0.56 ± 13.81 275 eyes whose lesion re‐activated following treatment sus- letters in the T&E group and a loss of 3.94 ± 18.48 letters in pension, there was a mean loss of 4.2 letters from the last the PRN group, (P = 0.003). Eyes in the T&E group injection at time of re‐activation; vision recovered by +1.2 ‐ received a mean 33.1 ± 9.5 injections over 4 years and eyes letters after resuming treatment. Median time to re‐activation in the PRN group 17.46 ± 6.15 injections (P < 0.001). There was greater when eyes had lower VA at time of suspension was no statistically significant difference in the risk of devel- or were on treatment for at least 3 years prior to suspension. oping MA between the 2 groups (P = 0.584). The mean MA Conclusions: Fewer than half of eyes suspending treatment area progressed by a rate of 0.92 ± 0.80 and 0.62 ± 0.48 re‐activated in the first year, but most re‐activated by the 2 mm /year in the T&E and PRN groups respectively (P = fifth year. Caution should be exercised to avoid suspending 0.03). Among the 205 eyes without MA at baseline, MA treatment prematurely. developed in 55 (27%) eyes. Conclusion: VA gains were greater in the T&E group com- S2607 pared to the PRN group. Eyes treated using a T&E regimen Beyond anti‐VEGF: Treatment of diabetic received greater number of injections, however, this was not retinopathy through neuropeptides associated with a significant difference in the incidence and progression of macular atrophy. Lei Liu1,2,3, Kepeng Ou1, Stefan Schrader4, Andrew Dick1 64 MONDAY 11 NOVEMBER

1University of Bristol, Bristol, United Kingdom, 2RVEEH, Results: A total of 249 eyes were included, of which 102 Melbourne, Australia, 3The Alfred, Melbourne, Australia, were treated at baseline and 147 observed. During the follow 4University of Duesseldorf, Duesseldorf, Germany up period, 155 were treated and 94 continued to be Email: [email protected] observed. Most eyes maintained vision (VA gain or VA loss Purpose: To interrogate whether Substance P (SP) and neu- < 5 letters) at 12 months (treated: 58.1%; non‐treated: ropeptide Y (NPY) protect against N‐methyl‐D‐aspartate 73.4%). In non‐treated eyes with stable VA within the first 6 (NMDA)‐induced excitotoxic apoptosis of retinal ganglion months, VA was maintained throughout the follow‐up cells (RGC) and VEGF‐induced vessel leakage in diabetic period in the majority of eyes (86.3%). In non‐treated eyes retinopathy. with VA loss ≥ 5 letters within 6 months (36.7%), further Method: Tight junctional protein expression and a Vascular observation led to worse visual outcome than treatment Permeability Image Assay were used to determine vascular (−4.2 vs −7.8 letters, P = 0.01). integrity in vitro. ERG and OCT also have been performed Conclusion: In a real‐world setting, the majority of DMO to interrogate the function of retina in vivo. The protective patients with very good VA maintained vision at 12 months, effect of SP and NPY on RGC was established in ex viv- regardless of whether treatment was initiated on presentation oretinal explants and in vivo diabetic models. or observed. This study supports close observation of eyes Results: After NMDA administration, a reduction in with DME and very good VA with consideration of treat- TUNEL+ cells and a maintained number of Brn‐3a + cells ment if a one line drop in vision occurs. were found, indicating an inhibition of RGC apoptosis mediated by SP and NPY. Additionally, both neuropeptides S2609 maintained endothelial tight junctions, decreased VEGF‐ Functional vision outcomes with the second‐ induced vascular permeability and enhancement of neuro- generation suprachoroidal retinal prosthesis: vascular microenvironment in diabetic mice. Tabletop object search and identification task Conclusion: Administration of SP and NPY protects against 1 1 2,3 NMDA apoptosis of RGC and VEGF‐induced endothelial Maria Kolic , Elizabeth K Baglin , Samuel A Titchener , 2,3 1 1,4 barrier breakdown in diabetic retinopathy. Jessica Kvansakul , Kiera A Young , Carla J Abbott , Myra B McGuinness1, Rosie C H Dawkins1, Daniel Chiu1, S2608 Jonathan Yeoh1, Janine G Walker5,6, David A Nayagam2,3, Outcomes of observation vs treatment of eyes Nick Barnes5,6, Matthew A Petoe2,3, Lauren N Ayton1,4,7, with diabetic macular oedema and very good Chi D Luu1,4, Penelope J Allen1,4 visual acuity. Results from a multi‐centre real‐ 1Centre for Eye Research Australia, The Royal Victorian world study Eye and Ear Hospital, East Melbourne, Australia, 2Bionics Institute, East Melbourne, Australia, 3Medical Bionics Samantha Fraser‐Bell1,2, Catharina Busch3, Adrian Fung4, Department, University of Melbourne, Parkville, Australia, Dinah Zur5, Patricio Rodriguez6, Matus Rehak3 4Department of Surgery (Ophthalmology), University of 1Sydney Eye Hospital, Sydney, Australia, 2University of Syd- Melbourne, Parkville, Australia, 5The Australian National ney, Sydney, Australia, 3University Hospital Leipzig, Leip- University, Canberra, Australia, 6Data 61, Commonwealth zig, Germany, 4Macquarie University, Sydney, Australia, Scientific and Industrial Research Organization, Canberra, 5Sourasky, Tel Aviv, Israel, 6Tecnológico de Monterrey, Australia, 7Department of Optometry and Vision Sciences, Nuevo Leon, Mexico University of Melbourne, Parkville, Australia Email: [email protected] Email: [email protected] Purpose: The DRCRNet recently published the results of Purpose: The second‐generation suprachoroidal retinal Protocol V of eyes with diabetic macular oedema (DMO) prosthesis follows on from the initial proof of concept study and very good vision. They reported no significant differ- (NCT01603576). The current clinical trial is assessing the ence in vision loss at 2 years whether eyes were randomized efficacy and capability of the device (NCT03406416). This to initially receive aflibercept, laser photocoagulation or study investigated participant outcomes with a tabletop observed and given aflibercept only if visual acuity (VA) object search and identification task. worsened. We aim to present real world data comparing the Method: The second‐generation suprachoroidal retinal pros- functional and anatomical outcomes of eyes with DMO and thesis device was implanted unilaterally in four participants very good vision which were observed vs treated. with advanced RP in 2018. After a period of visual rehabili- Method: A12‐month, retrospective, multicentre, observa- tation training, participants were assessed; week 17 (W17), tional cohort study, including eyes with DMO and VA≥6/ week 20 (W20) and week 32 (W32). The participants were 7.5 and central subfield thickness > 300 μm. required to locate, name and point to touch, one of six MONDAY 11 NOVEMBER 65 randomly selected table top objects on one of the nine grid 1Department of Ophthalmology, Auckland District Health locations. Participant data was pooled and compared Board, Auckland, New Zealand, 2Moorfields Eye Hospital, between device on and device off via logistic and linear London, United Kingdom, 3Institute of Ophthalmology, Uni- regression analysis, and robust standard errors calculated to versity College of London, London, United Kingdom account for within‐participant correlation. Email: [email protected] Results: Locating objects was better with device on com- Purpose: To evaluate the long‐term risk of permanent vision pared to device off at all time points; W17 P = 0.004, W20 loss in subjects with anterior uveitis. P = 0.003 and W32 P < 0.001. Naming object type was sig- Method: Retrospective data was gathered on 2526 eyes of nificantly better with device on at W32 P = 0.009 but not at 1814 participants attending uveitis clinic at Auckland Dis- W17 P = 0.702 nor W20 P = 0.783. Distance from finger trict Health Board and Moorfields Eye Hospital between when pointing to touch object was shorter with device on at 2008 and 2018. A standardized proforma was used to collect all time points, reaching significance at W20 P = 0.027. information from medical notes. Conclusion: This interim outcome measure data for the sec- Results: The mean duration of follow‐up was 6.8 years. Mod- ond‐generation suprachoroidal retinal prosthesis indicates erate vision loss (MVL) occurred in 240 eyes (9.5%), of which the device can improve accuracy for locating, naming and 97 (3.8%) was due to uveitis. The most common cause of per- reaching for common table‐top objects. manent MVL due to uveitis was uveitic glaucoma (31.3%), followed by cystoid macular oedema (CMO) (27.1%) and cor- S2610 neal scar (21.9%). Severe vision loss (SVL) occurred in 80 Spectral domain optical coherence tomography eyes (3.2%), of which 39 (1.5%) was due to uveitis. Uveitic in active toxoplasmic retinochoroiditis glaucoma was the most common cause of permanent SVL due to uveitis (36.1%) followed by CMO (25.0%) and corneal 1 2 2 Genevieve Oliver , Barbara Vieira , Sigrid Arruda , scar (19.4%). Multivariate analysis showed chronic anterior 2 1 1 2 Michelle Araújo , Jill Carr , Justine Smith , João Furtado uveitis (CAU), infectious aetiology and presenting best‐ 1 College of Medicine & Public Health, Flinders University, corrected visual acuity (BCVA) were all risk factors for both 2 Adelaide, Australia, Division of Ophthalmology, Ribeirão moderate and severe permanent vision loss due to uveitis. Preto Medical School, University of São Paulo, Ribeirão Conclusion: Long‐term visual outcome in anterior uveitis is Preto, Brazil good, with stable vision in most subjects. Although vision Email: [email protected] loss is an uncommon complication, the risk is greatest in Purpose: Toxoplasmic retinochoroiditis (TRC) is a poten- those with CAU, infectious aetiology and poor presenting tially blinding disease. We sought to define the spectrum BCVA. Uveitic glaucoma is the most common cause of and frequency of spectral domain optical coherence tomog- vision loss, accounting for around a third of cases. Regular raphy (SD‐OCT) signs of active TRC and identify associa- glaucoma screening, early initiation of treatment and careful tions with visual acuity outcome. Method:90 eyes (90 monitoring is essential for optimizing visual outcomes. patients: 15 T. gondii IgM+, 35 first ocular disease, 8 HIV +) with active TRC were imaged with the Heidelberg SPEC- S2612 TRALIS OCT + HRA at presentation and during follow‐up Occlusive vasculitis in Sydney (27 months). Results: TRC commonly presented with a thickened (65%), hyperreflective (61%) retina, associated Noor Ali1, Sophia Zagora1,2, Richard Symes1,2, Elisa Cor- with hyperreflective dots (80%), thickening (35%) and nish1, Christine Younan1, Peter McCluskey1,2 deposits (36%) in the vitreous, and choroidal thickening 1Sydney Eye Hospital, Sydney, Australia, 2University of Syd- (55%) and hyporeflectivity (61%). Retinal hyporeflectivity ney, Sydney, Australia was rare (6%), but was associated (Fisher's exact, p 20/200 Email: [email protected] (p Conclusion: SD‐OCT imaging of the retina provides in Purpose: To review the clinical features of patients with vivoultrastructural detail of pathological signs that predict inflammatory occlusive retinal vasculitis, and describe the poor outcomes in TRC. Future SD‐OCT studies should treatment, prognosis, complications and visual outcomes. address mechanisms of visual loss. Method: Patients with occlusive retinal vasculitis were identified from a uveitis database comprising 1860 patients. S2611 Results: The prevalence of occlusive retinal vasculitis was Vision loss in anterior uveitis 2.25% (42/1860). The median age at presentation was 33 years. The ethnic composition was 31% Caucasian, 31% Haya Al‐Ani1, Joanne Sims1, Oren Tomkins‐Netzer2, Sue South East Asian, 16.7% Indian, other 21.3%. TB‐related vas- Lightman3, Rachael Niederer1 culitis (38.1%) and Behcet disease (31.0%) were the most 66 MONDAY 11 NOVEMBER common aetiologies. Initial treatment with high dose oral vitreous haemorrhage in 29.9%, retinal detachment in 4.5% prednisone was given in 80.9% of patients. The median follow and neovascular glaucoma in 1.4%. Pan‐retinal photocoagula- up time was 1.79 years (range 0‐13.6 years). At last follow up, tion for neovascularisation or ischaemia was done in 46.3% of 40.5% were on a second line immunosuppressive agent, eyes, intra‐vitreal Anti‐VEGF treatment was given in 13.4%, 28.6% were on a biologic gent, 38.1% were on maintenance and vitrectomy for vitreous haemorrhage in 11.9% of eyes. oral prednisone, with 13/16 on <10 mg per day. Patients had Conclusion: Occlusive retinal vasculitis is an uncommon anti‐TB therapy where indicated. The median presenting but serious manifestation of uveitic entities. Early treatment visual acuity was 6/12 (IQR 6/6 to 6/30). The median visual of active disease with immunosuppression, and acuity at final follow up was 6/7.5 (IQR 6/6 to 6/18). Compli- neovascularisation with PRP and anti‐VEGF injections, can cations included: retinal neovascularization in 31.3% of eyes, help preserve central visual acuity.

1530–1600 AFTERNOON TEA

1600–1730 CONCURRENT SESSIONS

1600–1730 S27 COURSE OCT angiography in neovascular age-related macular degeneration and diabetic retinopathy − how to interpret and use this new technology Chair: Prof Paul Mitchell AO Email: [email protected] Venue: C4.4

1600–1730 S28 SYMPOSIUM Artificial intelligence will replace ophthalmologists in the future: fact or fiction? Chair: A/Prof Nitin Verma AM Co-Chairs: A/Prof Peter Van Wijngaarden and Dr Andrew Crawford Email: [email protected] Venue: C4.5 Synopsis: RANZCO's mission is to drive improvements in eye health care in Australia, New Zealand and the Asia-Pacific region through appropriate training, education and advocacy. Digital technology, machine learning and artificial intelligence (AI) are slowly but surely making their way into all aspects and branches of medicine and ophthalmology is no exception. RANZCO has been following the emergence of AI and associated technologies with great interest and has an expert group constituted to assess its impact in the management of eye diseases and the profession. In fact a number of diagnostic systems have already been approved for use by the FDA. Arti- ficial intelligence platforms are designed to perform tasks for which a human brain is normally considered necessary and there is a feeling in the community as well as among professionals, that AI enabled devices will ultimately replace medical and allied health professionals. The use of AI enabled platforms and devices results in large amounts of data being collected and this is necessary as it allows the system to learn and improve the precision of the process. This of course raises a lot of questions and issues which include data quality, standards, pri- vacy, data ownership, safety and medicolegal aspects. In addition, the costs for these systems could be an issue. Speakers and Topics: Dr Andrew Crawford – An AI primer: the technology and terminology A/Prof Peter Van Wijngaarden – AI in medicine: where are we at? Dr Sebastian Waldstein – AI in the screening and diagnosis of eye conditions A/Prof John Grigg – AI in the research arena Dr Weng Onn Chan – AI in the treatment arena Dr Leo Scheck – The big players in AI: where are they taking us? A/Prof Farah Magrabi – Ethical and legal considerations in the use of AI in medicine Dr Narme Deva, Chandrashan Perera and A/Prof Nitin Verma AM – Sum up and panel discussion

1600–1730 S29 SYMPOSIUM Management of herpetic eye disease Chairs: Dr Jo Sims and A/Prof Lyndell Lim MONDAY 11 NOVEMBER 67

Email: [email protected] Venue: Darling Harbour Theatre Synopsis: This symposium will provide an overview of diagnosis and management of herpetic eye disease, from the front to the back of the eye. Speakers and Topics: Prof Soon-Phaik Chee − CMV anterior uveitis, diagnosis and management Prof Stephanie Watson − The cornea and herpes viruses Dr Rachael Niederer − Herpes zoster and the eye (anterior segment manifestations) Dr Jo Sims − Viral retinitis, diagnosis and management Dr Nathan Kerr − Management of glaucoma in herpetic eye disease Dr Tony Hall − The effect of the zoster vaccine on rates of herpetic eye disease

1600–1730 S30 − FREE PAPERS Title: Rapid Fire Session: CPD Audit Chair: Dr Sukhpal Sandhu Co-Chairs Dr Jennifer Fan Gaskin, Dr Alok Sharma and Dr Andrea Ang Panel: Dr Sukhpal Sandhu, Dr Jennifer Fan Gaskin, Dr Alok Sharma, Dr Andrea Ang and Dr Anasaini Cama Venue: C4.1

Results: Most participating Ophthalmologists were self‐tau- S3001 ght and were keen to learn more. Satisfactory answers to RANZCO WA collaborative OCT audit 69% of images in the pre‐test showed that skills were good 1 1 1,2 but that there was room for improvement. Results of the Mengchen Suo , Josephine Richards , Jane Khan ‐ 1Royal Perth Hospital, Perth, Australia. 2Centre for Oph- clinical case submissions and post test will be presented. thalmology and Visual Science, The University of Western Recommendations: The audit highlighted the lack of formal Australia, Perth, Australia OCT education provided for RANZCO fellows, and demon- Email: [email protected] strated that targeted OCT education can potentially promote Background: During the emergence of OCT over the past improved imaging strategies and interpretation. two decades, ophthalmologists have acquired skills in the modality in an ad‐hoc manner. Junior doctors have better S3002 access to teaching and training than their senior colleagues. An audit of the predisposing factors of late in‐ This audit allowed ophthalmologists to benchmark their the‐bag posterior chamber intraocular lens OCT practices and skills against those of their subspecialist (PCIOLs) dislocations and outcomes following colleagues as well as providing an educational opportunity surgical repair at a single site comprehensive for them to upskill where needed. regional practice

Benchmarking/Standard: RANZCO Clinical Curriculum 1 2 3 − Peter Macken ,I‐Van Ho , Sophia Macken Performance Standards Sept 2014 plus additional consul- 1 2 tation with relevant subspecialists. University of Wollongong, Wollongong, Australia, Sydney 3 Methods: Our audit cycle consisted of a de‐identified regis- Eye Hospital, Sydney, Australia, University of NSW, Syd- tration survey, pre‐test, education modules, case submissions ney, Australia and post‐test with opportunities for reflection at all stages. Email: [email protected] ‐ ‐ The pretest, a 30‐minute online survey, required interpreta- Background: In the bag PCIOL dislocations is a rare but seri- tion of images considered important in each subspecialty. ous complication following routine cataract surgery. It occurs Educational modules were prepared by invited subspecialists due to progressive zonular dehiscence and often requires surgi- based on needs identified in the pre‐test. Material presented cal intervention. Several surgical approaches to correct this at WA branch meetings was recorded to allow regional col- complication are described. This audit will focus on PCIOL leagues to participate. Participants submitted 10 cases with explantation and anterior chamber IOL (ACIOL) insertion. reflections on how they planned to change their imaging Benchmarking/Standard: The main outcomes measured strategy and interpretation. The post‐test re‐tested questions were the interval between cataract surgery and dislocation, where fewer than 75% of participants had submitted correct predisposing factors, postoperative corrected distance visual answers. acuity (CDVA) and complications. 68 MONDAY 11 NOVEMBER

Methods: A review was conducted of 12 eyes of 11 patients Kimberley, Goldfields and Pilbara. Treatment coverage was who had surgical management of dislocated PCIOLs at a found to be 28%, 20% and 47%, and average injections per single site regional comprehensive practice. The surgical patient in 2018 were found to be 2.5, 2.1 and 4.6 in the Kim- repair involved explantation of the PCIOL and placement of berley, Goldfields, and Pilbara respectively. an ACIOL. Conclusion: This audit demonstrates the need for improved Results: PCIOL dislocation occurred on average 10.7 years coverage and frequency of injections in rural Western Aus- (range 4‐22 years) after the original cataract surgery. Prior to tralia in the treatment of DMO. This condition represents the PCIOL dislocation, 8 eyes had glaucoma, 6 eyes had leading cause of visual loss in the working age population. pseudoexfoliation (PXF), 6 eyes had PCIOL pseudo- A proposed Northwest hub and spoke model offers a logisti- phacodonesis and 3 eyes had trans pars plana vitrectomies cal and service access solution to improve the delivery of (TPPV) for retinal pathology. intravitreal therapy in rural Western Australia. The mean interval between cataract surgery and dislocation, S3004 and predisposing factors were similar to published data. Fol- Antimicrobial stewardship 2019. Collaborative lowing surgical repair, 12 eyes (100%) had improved CDVA audit of antimicrobial practice of RANZCO and 10 eyes (83%) had a best CDVA of 6/12 or better. The fellows only significant complication was against the rule astigma- 1 1 1 tism (> 2.5 dioptres), which occurred in 6 eyes. These Jessica Ong , Josephine Richards , Nigel Morlet , Simon 2 results compared favourably with published data. Janda 1 2 Recommendations: Surgical repair of late in‐the‐bag Royal Perth Hospital, Perth, Australia, RANZCO, Sydney, PCIOL dislocation with insertion of an ACIOL was safe and Australia resulted in improved CDVA. However, significant against Email: [email protected] the rule astigmatism can occur postoperatively. Background: Antimicrobial stewardship aims to optimize the use of antibiotics and reduce drug resistance. The S3003 antimicrobial stewardship audit began in 2017 and con- Intravitreal injections for diabetic macular cludes this year. The comprehensive program examined oedema in rural Western Australia – a antimicrobial practices and encouraged self‐evaluation. population‐based needs analysis of treatment Focused educational sessions were held at the 2017 and coverage in 2018 2018 RANZCO Congresses. The 2017 post‐test demonstrated important changes in understanding with a higher 1,2 1 1 Joos Meyer , Annabelle Baker , Andrew Nguyen , Shah percentage of correct answers compared to the identical 1 1 Vaibhav , Angus Turner pre‐test. 1 2 Lions Outback Vision, Perth, Australia, The Royal Mel- Benchmarking/Standard: Participants were asked to state bourne Hospital, Melbourne, Australia the benchmark or standard from which their prescribing Email: [email protected] practice was derived. Responses were compared to evi- Purpose: To Determine population‐based needs for treat- dence‐based standards in educational sessions and these ment of diabetic maculopathy with intravitreal injections in resources were highlighted. three regions of Western Australia. A 2018 audit of intra- Methods: Participants were required to submit ten prospec- vitreal injections was analysed to determine the treatment tive or retrospective cases where antimicrobials might be coverage and injection. used via Survey Monkey. Analysis of submissions examined Methods: Lions Outback Vision (LOV) is the sole ophthal- prescribing trends and took into consideration the source mology provider in the Kimberley, Pilbara and Goldfields. from which practices were derived. A retrospective audit was conducted of all intravitreal injec- Results: 322 cases were submitted in 2018. Subgroup analy- tions delivered by Lions Outback Vision during 2018. sis of behaviour change from those who participated in 2017 Demographic and injection data were extracted from a cen- and new participants was performed. The main changes were tralized database. Patients from 17 locations across 3 regions an increase in surgeons not prescribing routine post‐opera- where LOV is the sole ophthalmic healthcare provider were tive drops after intraocular surgery, a decrease in post‐injec- included in the final analysis. Population‐based need was tion antibiotics used at home and a decrease in routine estimated using ABS census data and known diabetes and fluoroquinolone use. The 2018 post‐test results will be diabetic macular oedema prevalence rates for Aboriginal and discussed. non‐Aboriginal Australians. Recommendations: Teaching aimed to address common Results: The 2018 audit revealed that 1326 injections were prescribing misconceptions and provide evidence and delivered to 301 patients across 25 locations. Of these, 371 resources to encourage participants to improve their pre- injections were for 106 patients with DMO in the scribing patterns with confidence. Participants were MONDAY 11 NOVEMBER 69 encouraged to utilize benchmark resources, avoid topical 1The University of Sydney, Sydney Medical School, Disci- fluoroquinolones as prophylaxis and to consider forgoing pline of Clinical Ophthalmology and Eye Health, Save Sight the use of routine post‐operative antibiotic eye drops. Institute, Sydney, Australia, 2Marsden Eye Specialists, Par- ramatta, Sydney, Australia, 3Gladesville Eye Specialists, S3005 Gladesville, Sydney, Australia, 4Nepean Valley Eye Sur- Cataract surgery outcomes at a tertiary geons, Sydney, Australia, 5Department of Ophthalmology, hospital in Australia University Hospital Zurich, University of Zurich, Zurich, Muhammad Khan1, Min Sung Kwon2, Tajrian Amin1, Switzerland Damien Hunter3, Chameen Samarawickrama1,2 Email: [email protected] 1University of New South Wales, Sydney, Australia, 2Univer- Purpose: Ranibizumab and aflibercept are both rec- ‐ sity of Sydney, Sydney, Australia, 3Westmead Institute for ommended for neovascular age related macular degeneration ‐ Medical Research, Sydney, Australia (nAMD) treatment. Here we compare three year treatment Email: [email protected] outcomes of the two in routine clinical practice. ‐ Purpose: To assess the visual acuity outcomes and Methods: Treatment naïve eyes starting either ranibizumab intraoperative and postoperative complication rates of cata- or aflibercept for nAMD from December 1, 2013 to Decem- ract surgery in a metropolitan teaching hospital. ber 31, 2015 tracked in the Fight Retinal Blindness! Registry Method: Retrospective audit of all cataract operations per- were identified. The outcomes of interest were mean change ‐ formed at Westmead Public Hospital (Sydney) between May in visual acuity (VA), number of injections and visits at 3 2017 and October 2018. year from the start of treatment. ‐ ‐ Results: Of the 2207 eyes who had a cataract operation, Results: A total of 965 (Ranibizumab 499, Aflibercept phacoemulsification was the preferred technique (99.1%) 466) eyes were identified. The mean VA and the type of the and a significant proportion had an ocular comorbidity choroidal neovascular (CNV) lesion at the start of treatment (30.1%) or were surgically complex (39.6%). One or more were similar in the two groups. Ranibizumab was preferred intraoperative or postoperative complications occurred in in older patients. The crude mean [95% CI] VA change in 8.3% and 11.0% of eyes respectively. The most common the ranibizumab (+1.5 letters [0, 3.1]) and the aflibercept intraoperative and postoperative complications were poste- (+1.6 letters [−0.2, 3.3]) groups at 3‐year was similar (P = rior capsular tear (2.4%) and cystoid macula oedema (4.3%) 0.97) as was the adjusted mean VA change (+0.3 [−1.5, respectively. The median and mean one‐month postoperative 2.0] vs+1.0 [−0.7, 2.8] letters; P = 0.66). Eyes completing unaided visual acuity (UCVA) were 0.18 logMAR (6/9) and 3‐year of treatment in each group received a median of 18 0.30 ± 0.36 logMAR (6/12) respectively and 72.9% of eyes injections from a median of 21 visits. The adjusted propor- achieved a UCVA of 0.30 logMAR (6/12) or better. The tion of visits when CNV was graded active over 3‐year was median and mean one‐month postoperative best‐corrected similar between the two (43% vs 51%, p = 0.9). There were visual acuity (BCVA) were 0.18 logMAR (6/9) and 0.19 ± more switches from ranibizumab to aflibercept (p < 0.001) 0.31 logMAR (6/9) respectively and 85.8% of eyes achieved than vice versa. The proportion of eyes discontinuing treat- a BCVA of 0.30 logMAR (6/12) or better. One‐month ment before 3‐year in each of the group was similar (P BCVA worsened postoperatively in 118 eyes (6.4%) which = 0.21). reduced to 32 eyes (1.8%) after 1 year. Conclusions: No difference in the VA outcomes and treat- Conclusion: This is the second Australian study to report ment frequency was observed at 3‐year between phacoemulsification cataract surgery outcomes. It affirms ranibizumab and aflibercept for nAMD. Westmead Public Hospital's standard of visual outcomes and complications as being comparable with other Australian S3007 and international institutions, especially when considering Evaluation of refractive and visual acuity this study's relatively higher proportion of ocular pathology. outcomes in cataract patients Brian Harrisberg1 S3006 1Central Sydney Eye Surgeons, Sydney, Australia. Royal 3 years real‐world treatment outcomes of Prince Alfred Hospital, Sydney, Australia ranibizumab vs aflibercept for neovascular Email: [email protected] age‐related macular degeneration: Data from Background: To evaluate the refractive and visual acuity the fight retinal blindness! registry outcomes following toric intraocular lens implantation using Sanjeeb Bhandari1, Vuong Nguyen1, Jennifer Arnold2, the online Barrett toric calculator. Stephanie Young3, Gayatri Banerjee4, Mark Gillies1, Daniel Benchmarking Standard: The Haigis formula and the man- Barthelmes1,5 ufacturer's online toric calculator used in my practice 70 MONDAY 11 NOVEMBER showed that 74.1% of patients had a spherical equivalent Median final visual acuity was count fingers (IQR 6/21 ‐ outcome within 0.50DS of the intended target. perception of light). Final visual acuity was strongly associ- Method: A retrospective analysis was performed on the ated with presenting visual acuity (P < 0.001). There was no refractive and visual outcomes in 115 eyes of 97 patients association with vitrectomy or with positive culture. that had micro‐incision lens extraction and IOL implantation Conclusions: Trabeculectomy endophthalmitis, although an with Medicontur 677TA toric IOL's. This is a single centre, uncommon complication, is associated with poor clinical single surgeon, single IOL audit of outcomes. All IOL calcu- outcomes and in particular final visual acuity. A range of lations were performed prior to surgery using the online organisms appear to be involved, but streptococcus is the Barrett toric calculator with measurements obtained from most common. Vitrectomy or positive culture did not appear IOL Master 700 biometry. Corneal topography was per- to affect final outcomes. formed in each case to exclude irregular astigmatism cases. Digital marking and alignment of the IOL were used to S3009 ensure precise alignment of the IOL with the intended axis. Selective laser trabeculoplasty: Outcomes of Post‐operative alignment of the toric IOL was recorded on multiple repeat treatments the slit lamp. Subjective refractions, uncorrected visual acu- Peiyun Wang1, Sarmad Akkach2, Nicholas Andrew1,3, ‐ ities and best corrected visual acuities were measured post- Anthony Wells1,3 operatively in the consulting rooms. 1Capital and Coast District Health Board, Wellington, New Results: The difference between actual and predicted post- Zealand, 2Royal Victoria Eye and Ear Hospital, Melbourne, operative spherical equivalent refractive error was within Australia, 3Capital Eye Specialists, Wellington, New 0.50DS in 84.8% of cases and within 1.17DS within 100% Zealand of cases. The residual postoperative cylinder was within Email: [email protected] 0.50D in 97.0% of cases and within 1.00D in 100.0% of Purpose: Characterize the efficacy of IOP reduction, effect cases. duration and side effect profile of repeat SLT (three times in Recommendations: Digital marking and toric alignment total) as primary standalone treatment for OAG. combined with the use of the Barrett toric calculator, IOL Investigate covariates associated with SLT treatment Master 700 biometry yielded more predictable outcomes in response. this study. Method: Single surgeon retrospective review of treatment naïve OAG patients, who received multiple repeat SLT treat- S3008 ments as standalone glaucoma therapy. IOP reduction and Post trabeculectomy endophthalmitis effect duration following each SLT were compared. Patients presenting to Auckland District Health Board were classified as “treatment responders” if they had≥20% 2006‐2019 IOP reduction at 4–8 weeks. Effect duration was the interval Hussain Patel1,2, Rachael Neiderer2, Rahul Dwivedi1,2 between SLT and the time point where IOP control became 1University of Auckland, Auckland, New Zealand, 2Auckland suboptimal, necessitating re‐treatment. Individuals were District Health Board, Auckland, New Zealand excluded if they had intraocular surgery within the study Email: [email protected] period. Aim: To describe the clinical presentation, microbiology Results: 71 eyes were included. Mean age at SLT1 was 58 and outcomes of post trabeculectomy endophthalmitis years, with 50% male, and 94% phakic. First and repeat Methods: Retrospective review of all cases of post SLTs all resulted in mean 27% IOP reduction at 4–8 weeks. trabeculectomy endophthalmitis seen in Auckland District Response rate was 76% for SLT1, 76% for SLT2 and 82% Health Board between January 2006 and June 2019. for SLT3, but the difference was not statistically significant. Results: 34 cases of post trabeculectomy endophthalmitis Response to repeat SLT was not significantly associated were identified over this time period. Median age was 70.9 with previous SLT outcome. years (IQR 57.9‐80.7) and 20 subjects (58.8%) were female. Effect duration was 23.8 months post‐SLT1, 33.7 and 30.9 Median visual acuity at presentation was hand movements months post‐SLT2 and SLT3 respectively. This was signifi- (IQR 6/48 ‐ perception of light). Positive culture was cantly longer after SLT2 (P = 0.0007) and SLT3 (P = obtained in 15 eyes (44.1%). Over half of the positive cul- 0.0269) compared to SLT1. tures were streptococcus (8 eyes), Haemophilus influenzae Gender, lens status and OAG subtypes were not significantly in 3 eyes, Moraxella species 2 eyes, Pseudomonas associated with SLT response. aeruginosa 1 eye, serratia marsecens 1 eye, Staphylococcus Conclusion: For primary standalone treatment in OAG, first aureus 1 eye and coagulase negative staphylococcus 1 eye. and repeat SLTs produce comparable IOP reduction, but One subject had 3 organisms cultured from the vitreous. repeat SLTs have longer effect duration. MONDAY 11 NOVEMBER 71

Response to SLT was not predictive of the response to for each model was calculated using hospital and industry repeat SLT. estimates for staffing, equipment, infrastructure, and supplies per encounter. Using a weighted kappa, we calculated the S3010 agreement between optometrist diagnosis/management and ‐ ‐ Community eye care (C EYE C): Improving virtual ophthalmologist review. access and reducing costs through collaborative Results: Westmead Eye Clinic received 264 new low‐risk care for diabetic retinopathy diabetic retinopathy referrals in 2016/2017, 90 were allo- Belinda Ford1, Blake Angell2, Gerald Liew3, Andrew cated to hospital care (2016) and 174 allocated to C‐EYE‐C White3, Lisa Keay4 (2017). There was no difference in attendance across both 1The George Institute for Global Health/Westmead Hospital models (72% vs 78%, P = 0.719). C‐EYE‐C demonstrated a Ophthalmology Department, Sydney, Australia, 2The shorter median wait‐time from referral to appointment (88 George Institute for Global Health, Sydney, Australia, days vs 124 days). The majority of patients (59%) attending 3Westmead Hospital Ophthalmology Department, Westmead C‐EYE‐C did not need hospital follow‐up; 30% needed oph- Institute for Medical Research, Sydney, Australia, 4The thalmologist review for retinopathy. For hospital care the George Institute for Global Health, UNSW School of average cost was $171 per patient, for C‐EYE‐C it was Optometry and Vision Science, Sydney, Australia $109. The diagnostic agreement between C‐EYE‐C optome- Email: [email protected] trists and virtual ophthalmologist was 75% (k = 0.61, CI Purpose: This study assessed service efficiency and costs of 0.51‐0.72); management agreement was 74% (k = 0.57, CI a community‐based model of care (C‐EYE‐C) based on col- 0.46‐0.67). laborative care for patients with low‐risk diabetic retinopathy Conclusion: Under the C‐EYE‐C model, hospital capacity between community optometrists and ophthalmologists improved and there were reduced wait‐times and lower compared to hospital care. costs to the health system (−38%). Optometrists and oph- Methods: A medical record audit of new patients referred thalmologists assessments were in good agreement, but for diabetic retinopathy was conducted for both standard indicate that specialist oversight is essential in collaborative ‐ ‐ ‐ hospital care and C EYE C. Attendance, wait time, diagno- care. sis and management were recorded. The health system cost

1600–1730 S31 − FREE PAPERS Title: Rapid Fire Session: Paediatrics / Strabismus / Neuro-Ophthalmology Chairs: A/Prof Shuan Dai and Prof Helen Danesh-Meyer Room: C4.6 – C4.7

model group treated with citicoline 50, d) 100, and e) 200 S3101 mg/kgBW/day given for a week on the third week. This Citicoline reduces matrix metalloproteinase‐2 study evaluated the axial length using electronic digital calli- expression in scleral tissue of rat myopic model per and MMP‐2 expression using immunohistochemistry method. All data were analysed by one way ANOVA, Tukey Eka Rahmawati1 test, Pearson correlation, and simple linear regression. 1Ophthalmology Department, Universitas Brawijaya, Results: There were significant differences for axial elonga- Malang, Indonesia tion 0.000 (P < 0,05) and 0,000 (P < 0,05) for MMP‐2 Email: [email protected] expression among 5 groups. The treatment group of Purpose: To investigate the effect of citicoline on matrix citicoline 100 mg/kgBW and 200 mg/kgBW showed remark- metalloproteinase‐2 (MMP‐2) expression in scleral tissue of able differences in axial elongation (P < 0,05) and MMP‐2 rat myopia model as a candidate agent to control the progres- expression (P < 0,05), whereas at a dose of 50 mg/kgBW no sivity of myopia significant difference was found (P > 0,05). Pearson correla- Methods: This research was an in vivo experimental study tion showed there were strong and negative correlation in 4‐week‐old male rats (n = 25). The rats were treated with between the dosage of citicoline and axial length elongation lens induced myopia (LIM) with −10.00 D lens for 3 weeks (P = 0.012, r = −0.628) as well as the dosage of citicoline and divided into a) negative control group, b) myopic model and MMP‐2 expression (P = 0.013, r = −0.626). group without citicoline as a positive control, and c) myopic 72 MONDAY 11 NOVEMBER

Conclusion: Citicoline controls axial elongation and 1Royal Darwin Hospital, Darwin, Australia decreases MMP‐2 expression significantly in scleral tissue Email: [email protected] of rat myopic model. Purpose: To review the incidence, outcomes, risk factors and the prognosis of Indigenous and non‐Indigenous babies S3102 screened by the Retinopathy of Prematurity (ROP) service at Effect of surfactant administration with Royal Darwin Hospital (RDH). different oxygen levels and retinopathy of Methods: A retrospective study of patients screened by the prematurity risk: Real‐world results from a 14‐ ROP service at RDH from January 2008 to December 2017 year cohort in NICU in Malaysia inclusive. Screening had been performed on all babies who May May Choo1,2, John Grigg1, Elizabeth Barnes1, met criteria from STOP ROP and ETROP studies. The medi- Khalidin Nurliza2, Frank Martin1 cal records of these cases were analysed with respect to 1University of Sydney, Sydney, Australia, 2University of demographics, gestational age, birth weight, exposure to ‐ Malaya, Kuala Lumpur, Malaysia supplementary oxygen, and co morbidities. Email: [email protected] Results: 599 babies were screened,102 babies developed Purpose: To investigate effect of surfactant on ROP inci- ROP, and 6 required treatment. For the babies screened for dence following changes in higher oxygen levels for better ROP the mean gestational age was 26.27 weeks ±2.07 with ‐ infant survival. Surfactant reduces risk of respiratory distress no statistical significance between Indigenous and non syndrome. However, the risk of ROP associated with surfac- Indigenous babies (P = 0.457), the mean birthweight was tant has been ambiguous[1] and myo‐inositol which 922.7 g ± 287.4 with Indigenous babies being smaller with − increases surfactant synthesis was shown to increase inci- (mean difference of 36.44 g; P = 0.044). Of the babies dence of Type 1 ROP. Higher oxygen administration has identified with ROP the mean gestational age and been preferred by neonatologists for better outcomes. birthweight were not significant; with P = 0.491 and P = Methods: A prospective cohort of premature infants under- 0.400 respectively. The mean time to regression for ROP went ROP screening and staging by ICROP guidelines, over babies was 15.7 weeks ±6.1 with no statistical significance a14‐year period(2003‐2016). Two groups were observed between Indigenous and non‐Indigenous babies (P = 0.457). due to changes in the practice for oxygen delivered to the Interestingly the odds ratio of non‐Indigenous babies devel- infants. Epoch I received oxygen between 89‐94%, whereas oping ROP was 1.45 times greater than Indigenous babies. Epoch II infants were on 89‐99% to improve survival and Conclusion: For patients screened for ROP the mean reduce morbidity. The incidence of ROP cases, ROP cases birthweights for Indigenous babies were lower. For ROP requiring treatment and severe ROP cases, were analysed. babies no difference was demonstrated between Indigenous Surfactant use was compared between the 2 groups for its and non‐Indigenous babies mean gestational age, effect on ROP incidence. birthweight, and time to regression. Non‐Indigenous babies Results: Two groups of infants were compared, Epoch 1 screened for ROP are 1.45 times more likely to develop (2003‐2009)n = 307 and Epoch 2(2010‐2016)n = 344. The ROP compared to Indigenous babies. incidence of ROP were 30.6%(Epoch 1) and 29.4%(Epoch 2) (P = 0.73). Treated cases reduced significantly, 14.3% vs 5.9% S3104 (P = 0.0005). Higher oxygen improved survival(P < 0.0001), Tackling retinopathy of prematurity via reduced sepsis (P < 0.0001) cases. ROP progression was less telescreening in rural India in lower oxygen group (P < 0.006). Surfactant use significantly Narendran Venkatapathy1, Parag Shah1 increased ROP cases (P = 0.006 and P = 0.0002) in both 1Aravind Eye Hospital, Coimbatore, India epochs. Relative risk for ROP with surfactant treatment was Email: [email protected] 1.16 (P = 0.0064) and 2.08 (P = 0.0004) respectively. Purpose: To do retinopathy of prematurity (ROP) screening Conclusion: Surfactant resulted in higher percentage of in the underserved and rural areas by a trained technician ROP cases. Higher oxygen exposure did not increase the (non‐ophthalmologist) using Retcam Shuttle camera. overall incidence of ROP. Methods: Fundus images are transmitted by the trained technicians to a remote ROP expert (via 4G Network) and S3103 babies identified with blinding ROP are immediately Retinopathy of prematurity in the top end: Are referred to the base hospital for treatment or if the child is indigenous babies resistant to development too sick to travel, prompt onsite treatment is done by the of ROP? ROP expert by visiting the NICU within 3 days. Ario Wilson‐Pogmore1, Sweetha Sukumaran1, Nishantha Results: The turnaround time for each report is around 12‐ Wijesinghe1 15 minutes. Every week the team covers 52 NICU's in 12 MONDAY 11 NOVEMBER 73 districts of South Indian states of Tamilnadu and Kerala cov- trauma and provide valuable insight into the prevention of ering a population of 50 million, over an area of approx. 50 such presentations. 000 km. From August 2015 to May 2019 a total of 19 002 babies (10 396 new +8606 review) have been screened S3106 (8462 new and 6945 review). Of these 4439 babies (23%) Exercise‐induced diplopia had any stage ROP and 337 babies (8%) were treated for Juliette Duck1,2, Julie Green1,2, James Elder1,2 Type 1 blinding ROP. Laser was given to 333 eyes of 183 1The Royal Children's Hospital, Melbourne, Australia, 2The babies, anti VEGF injection in 292 eyes of 147 babies and 3 University of Melbourne, Melbourne, Australia eyes of 6 babies required vitrectomy. Email: [email protected] Conclusion: Telescreening is a successful strategy for Purpose: To report a series of exercise‐induced diplopia in screening of ROP in remote setups. children, and discuss the classification, investigation, and possible pathogenesis of this rare and poorly understood condition. S3105 Method: Three patients (8‐15 years of age) with exercise‐ Patterns of paediatric ocular trauma. A 10‐year induced diplopia were referred to The Royal Children's Hos- retrospective review at the John Hunter pital Melbourne between 2008 and 2018. All underwent an Children's Hospital, NSW, Australia exercise test, comprising an intensive run up and down stairs 1,2,3 1 ‐ Andrew Burbidge , Mona Khoshkhesal or around the park for 15 20 minutes, and cranial magnetic 1School of Medicine and Public Health, University of New- resonance imaging (MRI). ‐ castle, Newcastle, Australia, 2Hunter Medical Research Results: We describe the first known case of exercise Institute (HMRI), Newcastle, Australia, 3Hunter New induced diplopia secondary to an arachnoid cyst, and two ‐ England Area Health Service NSW Health, Newcastle, cases of exercise induced diplopia secondary to Chiari I Australia deformity. In each case, symptoms resolved or improved Email: [email protected] upon definitive treatment of the underlying cause. Purpose: Paediatric ocular trauma is highly preventable. Conclusions: Synthesis of the hallmarks of exercise-induced Consequences of profound visual impairment and secondary diplopia suggests a compressive basis, and prompts the fol- psychosocial ramifications may last a lifetime. The aim of lowing recommendations: this study is to report the demographics and mechanisms of 1. Classify exercise-induced diplopia as primary or second- paediatric ocular trauma from a regional setting in NSW, ary, signifying the absence or presence of an identifiable structural abnormality. Australia, comparing data with the 2018 UK Paediatric Ocu- 2. Establish the exercise test as the principal clinical test for lar Trauma Study (POTS 2). exercise-induced diplopia. Method: A single‐centre 10‐year retrospective case‐note 3. Introduce contrast-enhanced cranial MRI as the first-line review was conducted at a large regional tertiary‐referral investigation for exercise-induced diplopia to exclude intra- paediatric hospital in Newcastle, NSW, Australia, for all pre- cranial pathology. senting cases of ICD‐10 coded ocular trauma in children aged 16 years and younger. S3107 Results: A total of 166 cases of paediatric ocular trauma Surgical outcomes of plication vs resection in presented between 1st January 2009 and 1st January 2019. intermittent exotropia: A comparative study The median patient age at presentation was 9 years (range: 0‐16), with a male to female ratio of 1.9:1. Most injuries WITHDRAWN were unilateral (left = 52.8%, right = 44.4%). Closed‐globe injuries represented 94.4% of cases and were rarely associ- S3108 ated with acute and long‐term loss of visual acuity. A total The use of optical coherence tomography to of 50% of injuries occurred during play, and 41.7% took evaluate the elevated optic disc in children place in public outdoor environments. Motor bike accidents Matthew McMahon1, Anu Mathew2,3,4, Shivanand were involved in 20.5% of cases. Sharp implements (pencils, Sheth2,5,6, James Elder1,2,4 plants, toys) were involved in 8.3% of cases. 1University of Melbourne, Melbourne, Australia, 2The Royal Conclusion: We report the mechanisms and demographics Children's Hospital, Melbourne, Australia, 3The Royal Mel- of paediatric ocular trauma from an Australian regional set- bourne Hospital, Melbourne, Australia, 4The Royal ting, comparing outcomes with data from the UK POTS 2. Women's Hospital, Melbourne, Australia, 5The Royal Victo- The findings of this study highlight a number of significant rian Eye and Ear Hospital, Melbourne, Australia. 6Can- clinical predictors of visual outcomes in paediatric ocular berra Hospital, Canberra, Australia 74 MONDAY 11 NOVEMBER

Email: [email protected] the first 400 subjects, enrolled from multiple sites in 8 coun- Purpose: Differentiating papilloedema from the more tries, provides the largest prospective uniformly‐collected benign causes of an elevated optic disc is a diagnostic dataset on this disorder. dilemma in paediatric ophthalmology. The aim of this inves- Methods: We describe presentation data, for participants tigation was to identify the OCT parameters which differen- with acute NAION enrolled in a double‐masked randomized tiate papilloedema from other causes of an elevated optic clinical trial, including comprehensive medical history, labo- disc in the paediatric population. ratory studies, ECG, ophthalmic evaluation including optical Methods: 40 subjects with papilloedema (40 eyes), 63 sub- coherence tomography (OCT) and 24‐2 threshold perimetry. jects with optic disc drusen (63 eyes), and 44 normal sub- Results: Of the first 400 enrollees (121 women, 279 men), jects (44 eyes) were evaluated in this retrospective cohort with average age 61 years, 46% had hypertension, 24% dia- study of paediatric subjects. For each subject, spectral betes, 46% hyperlipidemia, 25% cardiac disease, 2.5% ische- domain‐OCT radial scans centred over the optic disc, were mic brain disease (with wide variability by country). The manually re‐segmented for the following retinal layers: inter- fellow eye had prior NAION in 18%. Vision evaluations at nal limiting membrane (ILM), retinal nerve fibre layer screening and day 1 (mean separation 1.9 days) were similar, (RNFL) and Bruch's membrane. Author developed software as visual acuity (r = 0.90) and the average fovea threshold was applied to this OCT retinal layer data to calculate OCT of the visual field (r = 0.89) for each correlated (p = 0.01). variables of interest in differentiating papilloedema from OCT measured retinal nerve fibre layer (RNFL) thickening other causes of an elevated optic disc. mildly correlated with the average visual field threshold but Results: Preliminary results have identified that the follow- not with visual acuity. ing OCT parameters differentiate between paediatric pap- Conclusions: These results confirm the relevance of sys- illoedema (PO) and optic disc drusen (ODD) subjects: temic disorders in NAION, but it appears that hyperlipid- Asymmetry Score in Total B‐Scan Area (PO 95% CI: 6.890‐ emia is more frequent and cerebrovascular disease less 7.364, ODD 95% CI: 7.380‐7.896, P = 0.004), Inferior Disc common than previously recognized. Optic disc swelling Segment Maximum Optic Nerve Protrusion Length (PO correlates with visual field deficit but not loss of visual 95% CI: 0.833‐0.949 mm, ODD 95% CI: 0.754‐0.823 mm, P acuity. = 0.003), Temporal Disc Segment ILM Gradient (PO 95% CI: 852.7‐2002.0, ODD 95% CI: 318.4‐652.5, P = 0.003), S3110 and Temporal Disc Segment Peripapillary Total Retinal Quantitative retinal vascular complications in Area (PO 95% CI: 0.244‐0.299 mm2, ODD 95% CI: 0.200‐ 2 obstructive sleep apnoea: A follow up study 0.229 mm , P = 0.0005). investigating the response to CPAP therapy Conclusion: We believe we have identified OCT parameters that can differentiate papilloedema from optic disc drusen in Brendon Wong1,2, Jessica Tong1, Angela Schulz1, Stuart the paediatric population. Graham1,3, Claude Farah4, Clare Fraser1,3 1Macquarie University Ophthalmology, Sydney, Australia, S3109 2University of Sydney, Sydney, Australia, 3Save Sight Insti- 4 Presentation features for a multi‐national tute, Sydney, Australia, Macquarie Respiratory and Sleep, treatment trial of non‐arteritic anterior Sydney, Australia ischemic optic neuropathy Email: [email protected] Purpose: Obstructive sleep apnoea (OSA) is associated with Clare Fraser1, Mark Kupersmith2, Neil Miller3, Leonard systemic vascular dysregulation that can increase the risk of Levin4, Mays El‐Dairi5, Sharon Klier6 diabetes, hypertension and stroke. It was recently shown that 1Save Sight Institute, Sydney, Australia, 2Mount Sinai quantifiable retinal vascular changes occur in patients with Health, New York, USA, 3John Hopkins Hospital, Baltimore, OSA, which correlate with disease severity. In this follow‐ USA, 4McGill University, Montreal, Canada, 5Duke Eye up study, we examine the response of retinal vascular Center, Durham, USA, 6Quark Pharmaceuticals, New- changes in OSA patients receiving continuous positive air- ark, USA way pressure (CPAP) treatment. Email: [email protected] Methods: Participants of the original study were adult Purpose: Awareness of presenting features and systemic patients who underwent diagnostic polysomnography. They factors associated with acute non‐arteritic anterior ischemic were stratified into four groups according to Apnoea‐ optic neuropathy (NAION) is based on data from one pro- Hypopnoea Index (AHI); controls, mild, moderate and spective treatment trial, with 258 participants and cases severe OSA. At baseline and follow up, static retinal vascu- series. The Quark / NORDIC NAION treatment trial will lar calibre was derived from fundus photos and dynamic vas- recruit approximately 800 participants and the attributes for cular pulsation amplitudes were measured on video MONDAY 11 NOVEMBER 75 fundoscopy. In the patients prescribed CPAP, data regarding diagnostic tools in diagnosing OMG. The study evaluates duration and compliance to treatment was obtained from statistical efficacy, accessibility and safety of AChR‐Abs test their CPAP machines. in an outpatient setting. Results: 79 patients participated in this follow up study; 9 Methods: This was a retrospective, observational chart controls, 18 mild, 21 moderate and 31 severe. 25 patients review on 114 OMG suspects who underwent serum testing had commenced CPAP after the original study. In the severe for the AChR‐Abs at the Royal Victorian Eye and Ear Hos- group, patients not on treatment showed progressive pital in Victoria, Australia during the period of 2nd of Janu- narrowing of retinal arteries from baseline, while those on ary 2016 to 30th of December 2017. Data were extracted CPAP showed a slight improvement (mean 171.3 μmto from medical records. 165.1 μm and 171.2 μm to 174.0 μm respectively, P = Results: Fifteen (13.16%) out of 114 OMG suspects were 0.012). Results for mild/moderate severity were less pro- diagnosed with OMG after longitudinal neuro‐ophthalmol- nounced (mean 178.0 μm to 177.6 μm for non‐CPAP and ogy follow‐up (average 2.8 months). The other 99 patients 177.6 μm to 179.1 μm for CPAP, P = 0.46). CPAP did not have received an alternative diagnosis (86.84%). Twelve out appear to have a significant impact on vascular pulsatility. of the fifteen confirmed OMG patients had positive serologi- Conclusion: In patients with OSA, CPAP may attenuate cal results for AChR‐Abs (>0.4 nmol/L). One out of ninety‐ progressive retinal arterial narrowing. The effect seems more nine patients who received an alternative diagnosis tested pronounced with more severe OSA. positive for AChR‐Abs. This gives a sensitivity of 80% (95% CI, 51.91% to 95.67%), specificity of 98.99% (95% CI, S3111 94.50% to 99.97%), positive predictive value of 92.31% The usefulness of anti‐acetylcholine receptor (95% CI, 62.68% to 98.85%) and negative predictive value antibody (ACHR-ABS) testing in diagnosing of 97.03% (95% CI, 92.23% to 98.90%). Conclusion: The study has demonstrated a higher sensitivity ocular myasthenia gravis (OMG) in an ‐ outpatient setting of AChR Abs testing (80%; 95% CI, 51.91% to 95.67%) in diagnosing OMG than previously reported (44–66%). In Young Chung1, Shivanand Sheth2, Kristen Wells2, AChR‐Abs test also has a high specificity (98.99%; 95% CI, Thomas Campbell2 94.50% to 99.97%) and positive predictive value (92.31%; 1Austin Health, Melbourne, Australia, 2Royal Victorian Eye 95% CI, 62.68% to 98.85%) in diagnosing OMG. This and Ear Hospital, Melbourne, Australia suggested the higher utility of AChR‐Abs serology test in Email: [email protected] diagnosing OMG than previously described. Purpose: The article aims to assess the usefulness of Anti‐ Acetylcholine antibody (AChR‐Abs) testing among other

1900–2300 Congress Dinner Venue: Doltone House DOI: 10.1111/ceo.13630 Tuesday 12 November

0645−0800 H06 – ANZGS Glaucoma Symposium Sponsored by Allergan Title: Corneal Biomechanics: Do They Really Matter? Prof David (Ted) Garway-Heath Venue: C4.5 Chair: A/Prof Anne Brooks Synopsis: It has been known since the 1950s that corneal biomechanics would affect the accuracy of intraocular pressure (IOP) measurements by applanation tonometry. However, it was not until the publication of the results of the Ocular Hypertension Treatment Study that the potential importance of the effects came to the fore. There is no doubt that measurement of central corneal thickness (CCT) is helpful for risk profiling, but controversy remains as to whether CCT is itself a risk factor for glaucoma progression or just a confounder of IOP measurement. New tonometry devices make measurements of aspects of the biomechanics of the cornea. Like CCT, there is controversy over whether the corneal biomechanics are a risk factor for glaucoma or simply contribute to IOP measurement error. Recent evidence suggests that some treatments for glaucoma alter the corneal biomechanics, resulting in an over-estimation of their IOP-lowering efficacy. These issues will be discussed in depth with reference to the current literature.

0830–1000 P08 – PLENARY SYMPOSIUM Normal tension glaucoma: An update on current management and future directions Venue: Darling Harbour Theatre Chair: A/Prof Mitchell Lawlor Synopsis: Glaucoma is the leading cause of irreversible blindness worldwide, affecting 2% of the Australian population over the age of 40. It can be a challenging disease to diagnose, which accounts for that fact that approximately 50% of those with glaucoma are as yet undiagnosed. The recognition that in some populations over 90% of glaucoma occurs with statistically normal pressures, has mandated examination of the optic nerve head and visual field as part of glaucoma assessment. This symposium begins by highlighting that instead of being the rare cousin of POAG, NTG prevalence is much higher than previously thought. Discussion will follow of recent studies further highlighting the role of systemic hypotension as a contributing factor in NTG. The practical implications of this will be highlighted as part of an update on medical and surgical management of NTG. Clinicians rightly worry about missing a sinister diagnosis and mistaking it for NTG - a number of optic neuropathies also cause changes of the optic nerve head with visual field abnormalities. A part of the symposium is dedicated to helping clinicians make sure they are indeed dealing with glaucoma and not another optic neuropathy. The second part of the symposium will look toward future treatment options. The first major trial of a neuroprotection agent, memantine, was completed over a decade ago but only published in 2018. One of the study co-investigators will present the results of this trial and the implications for future research. The symposium provides a comprehensive review of NTG, from practical clinical tips, through to the latest published research of future directions to assist in best managing our patients. Speakers and Topics: 1. Dr Jennifer Fan Gaskin − NTG: more common than you think? 2. A/Prof Mitchell Lawlor − Medical and surgical treatment of patients with NTG 3. Prof Helen Danesh-Meyer − Are you sure it is NTG? 4. Prof Ivan Goldberg − The memantine neuoprotection trials: what did they tell us? 5. Prof David (Ted) Garway-Heath − The UKGTS results: implications for neuroprotection trials

1000–1030 MORNING TEA

76 wileyonlinelibrary.com/journal/ceo Clin Experiment Ophthalmol. 2019;47 (Supp 1):76–77. TUESDAY 12 NOVEMBER 77

1030–1100 L08 – Glaucoma Update Lecture Lessons from the United Kingdom Glaucoma Treatment Study (UKGTS) and LASEr In Glaucoma and Ocular HyperTension (LiGHT) STUDY Prof David (Ted) Garway-Heath Venue: Darling Harbour Theatre Chair: Dr Ridia Lim Synopsis: The UKGTS was the first randomized, masked, placebo-controlled trial assessing the benefit of topical medical treatment in reducing vision loss in open angle glaucoma. The primary outcome was time to visual field (VF) deterioration. Secondary objectives included an analysis of risk factors for VF deterioration, the utility of optical coherence tomography (OCT) imaging as a trial outcome measure and an evaluation of new tonometry devices. The UKGTS provides strong evidence for the vision-preserving benefit of intraocular pressure (IOP) lowering with a topical prostaglandin analogue (latanoprost). Analysis of the IOP measurements from the new tonometers provided evidence that latanoprost causes a softening of the cornea and a consequent clinically relevant over-estimation of IOP reduction by >1 mmHg. Measurements of retinal nerve fibre layer thickness (RNFLT) with OCT were able to distinguish between the treatment groups, capturing the effect of treatment on the more clinically relevant outcome of VF loss. The addition of OCT RNFLT to VF measurements may increase the power of future trials of new therapies. Risk factors for progression in the UKGTS included the level of IOP and presence of disc haemorrhages; history of smoking was a protective factor. The LiGHT study compared two treatment pathways, one starting with selective laser trabeculoplasty (SLT) and the other starting with drops to lower IOP, with health-related quality of life (HRQoL) as the primary outcome and cost-effectiveness and clinical parameters as secondary outcomes. HRQoL was similar between pathways. 74% of patients starting with SLT were at treatment target for at least 3 years without the need for drops. The SLT-first pathway was more cost-effective and clinical outcomes tended to be better.

1100–1130 L09 – The Dame Ida Mann Memorial Lecture Light and the eye: Chronic insult or therapeutic dream? Prof John Marshall Venue: Darling Harbour Theatre Chair: Prof Gerard Sutton Synopsis: Ageing of an individual is a process whose rate constants are governed by interactions between multiple genes and numerous environmental factors. There is growing evidence that our lifetime exposure to optical radiation may be a risk factor in age-related changes in the eye and in particular in the lens and the retina. Evolutionary pressures have developed repair mechanisms but these in turn may result in problems of waste disposal of toxic products contributing to the transition from the physiology of ageing into overt pathology. Biochemical and biophysical studies have resulted in improved understanding of these mechanisms and highlighted possible means of therapeutic intervention. The advent of the Laser in 1960 heralded an era whereby light could be exploited in terms of therapeutic procedures. By the 1970s it had revolutionized the treatment of diabetic retinopathy and went on to change clinical practice in the treatment of glaucoma and cataract surgery. The 1990s saw a second revolution whereby Excimer systems created a new field of ophthalmology in terms of scientifically based refractive surgery. This lecture will review the development of laser technology and highlight the science behind recent advances. Particular attention will be given to the potential role of novel lasers for treating conditions in the anterior eye using ultrashort pulses and ultraviolet radiation and for AMD by rejuvenating transport pathways between the choriocapillaris and the photoreceptor cells.

1130–1200 L10 – Oculoplastics Update Lecture Oculoplasty and ocular oncology – What new am I doing this year? Dr Santosh G Honavar Venue: Darling Harbour Theatre Chair: Dr Brett O'Donnell TBC DOI: 10.1111/ceo.13631 Film Abstracts

CATARACT Zepto capsulotomy system provides consistent, high quality anterior lens capsulotomies during cataract surgery in a conve- 1. Vascularised congenital cataract removal nient, cost-effective, disposable format. One of the key features is a collapsible super-elastic nitinol capsulotomy ring element Colby Hart1, James Elder1, John McKenzie1, Evan to create the unique and strong Zepto capsulotomy edge. It also 1 1 Heinecke , Anu Mathew has a clear silicone suction cup to enable suction and generate Email: [email protected] Zepto's proprietary capsulotomy action and to allow centration 1 Royal Children's Hospital, Melbourne, Australia on the patient's individual visual axis using Purkinje images. Zepto integrates into the routine steps of cataract surgery Persistent foetal vasculature is a rare congenital disorder char- with phacoemulsification. acterized by failure of regression of the primary vitreous and The video demonstrate the use of Zepto capsulotomy in hyaloid vasculature. We present a fascinating case of persis- complex cataract cases and in conjunction with premium tent foetal vasculature engulfing the posterior lens capsule of IOLs showing perfect 360 overlapping. an infant who presented with leukocoria and congenital cata- It will also highlight potential pitfalls / complication during ract. This video displays the complex vascular network dem- the learning curves and appropriate patient selection. onstrated through fluorescein angiography. We also provide footage of the complex surgical technique required to remove the vascularised cataract, including use of intra-ocular dia- 4. Management strategy in the event of Argentinian flag thermy, vitrector-based capsulorhexis and intra-ocular scis- sign during conventional phacoemulsification sors to prevent recurrence and capsular phimosis. Sunil Thangaraj1, Geoffrey Cohn2 Email: [email protected] 2. Approaching traumatic cataracts 1Lions Eye Hospital, Garividi, India, 2Department of Ophthalmology, University of New South Wales, Sydney, Jacqueline Beltz1, Bernardo Soares1, Mohamed El Australia Nahrawy1 This is a series of three cases of Intumescent Mature Cata- Email: [email protected] racts posted for Phacoemulsification wherein the “Argentin- 1Royal Victorian Eye and Ear Hospital, Melbourne, Australia ian Flag Sign” occurred on initiation of the capsulorhexis. This educational film (surgical technique category) will pro- The first two cases demonstrate adjustments of technique to vide descriptions and surgical examples to highlight the allow successful completion of Phacoemulsification and importance of preparation and forward planning when implantation. The third case shows how converting to Man- approaching traumatic cataract surgeries. Five pearls for suc- ual Small Incision Cataract Surgery (SICS) is an alternative cessful outcomes for these complex cases will be discussed to achieve a similar outcome. including: forward planning, capsulorhexis, managing The video shows that one can complete Phacoemulsification zonular instability, managing traumatic iris defects, and in the event of this (Argentinian Flag Sign) complication, planning for and managing vitreous loss. and also shows conversion to Manual SICS as an effective alternative technique.

3. Zepto precision pulse capsulotomy CORNEA

1 Son Chau-Vo 5. Keratoplasty nightmares: how to avoid and manage Email: [email protected] challenging surgical scenarios 1Bankstown Hospital, Sydney, Australia, Sydwest eye specialists, Sydney, Australia WITHDRAWN

78 wileyonlinelibrary.com/journal/ceo Clin Experiment Ophthalmol. 2019;47 (Supp 1):78–81. ABSTRACTS 79

EPIDEMIOLOGY/PUBLIC HEALTH of the angle surgery, then tiled back to its vertical position after. This requires a total 30-40 wrist rotations which can 6. Telescreening for retinopathy of prematurity in rural lead to repetitive strain injury. We present a low cost India “Microscope Tilting Aid” device made from a jar opener and a rubber band that acts as a lever to reduce wrist strain. WITHDRAWN –“No more twists, good for wrists.”

GLAUCOMA 10. Window to the soul: Partial thickness scleral 7. What's so zen about MIGS? windows to treat uveal effusion syndrome

Graham Lee1 Joobin Hooshmand1,NoorAli1, Sophia Zagora1,John Email: [email protected] Grigg1 1City Eye Centre, Highgate Hill, Australia Email: [email protected] 1Sydney Eye Hospital, Sydney, Australia MIGS or Minimally Invasive Glaucoma Surgery is often promoted as a straightforward, quick glaucoma drainage A 45-year-old male was referred by his optometrist with right technique. Things go well and there are good surgical out- macula on “retinal detachment”. He was found to have a comes. In the perfect world, this would happen in every suprotemporal retinal elevation with no obvious retinal case, but unfortunately we all know that s**t happens. This breaks, anterior displacement of iris/lens complex and video is a tribute to all my fellow colleagues who have strug- extreme hyperopia with an axial length of 16 mm. He was gled through challenging moments, pulling out all stops for diagnosed with hydrostatic uveal effusion secondary to their patients and coming out on top (most of the time). extreme hyperopia and presumed abnormally thickened sclera. Two, 3 × 3 mm partial thickness scleral windows were placed inferiorly between inferior rectus and medial rectus, 8. Stenting the flow – A novel surgical technique for inferior rectus and lateral rectus, extending posteriorly from chronic glaucoma drainage device hypotony the level of the muscle insertions to drain the uveal fluid. Corey Rowland1, Graham Lee1 Email: [email protected] 11. How to insert the iStent inject (G2) 1City Eye Centre, Brisbane, Australia

The management of hypton following glaucoma drainage Lance Liu device insertion can be a major challenge. We present a case Email: [email protected] 1 of a 30 year old female with a history of uveitic glaucoma RVEEH, Melbourne, Australia and glaucoma drainage device (GDD), performed many This surgical technique video is a step-by-step guide on how years previously. She developed clinically significant hypo- to insert the iStent Inject (G2) with some tips on how to tony maculopathy, requiring revision of the GDD. This achieve a successful outcome. After performing preoperative video shows a novel technique of ab externo stenting of the gonioscopy, one needs to maximize the intraoperative view tube, ligation and re-insertion with subconjunctival position- of the patient's angle to identify the anatomical landmarks ing of the stent for adjustment in clinic if required in future. before inserting the iStent aided by endpoints illustrated in the video. At the end of the case, one may then overfill the 9. “Microscope tilting aid”: A low cost device to assist anterior chamber to improve the function of the iStent. the tilting of the surgical microscope during glaucoma angle surgery 12. Surgical pearls for optimal implantation of the XEN Gabriella Kalofonos1, Anesa Blanco2, Jason Cheng3,4 glaucoma microstent Email: [email protected] 1Vision Eye Institute, Sydney, Australia, 2Metwest Eye Clinic, Nicholas Andrew1 Sydney, Australia, 3Liverpool Hospital, Sydney, Australia, Email: [email protected] 4University of New South Wales, Sydney, Australia 1University of Toronto, Toronto, Canada

The ophthalmic microscope requires manual tilting to per- This film illustrates key surgical pearls and pitfalls for opti- form angle surgery. The microscope is tilted 30 at the start mal placement of the XEN gelatin glaucoma microstent. 80 ABSTRACTS

Emphasis is placed on the ab interno technique, however all difficult situations such as associated corneal opacity, sublux- methods of implantation are addressed including ab externo ation, secondary IOL placement. Special aniridic IOLs and open implantation and ab externo trans-conjunctival implan- there placement techniques will also be discussed. Despite tation. The aim is to educate the viewer on common errors having comorbidities such as foveal hypoplasia, glaucoma in surgical technique that can impair successful and consis- and optic disc abnormalities, cataract surgery should be per- tent surgical outcomes. formed in such cases for visual rehabilitation.

OCULOPLASTIC/ORBIT RETINA

13. Transcaruncular medical canthal tendon plication 15. Crystalline lens capsule transplant in management of – and lower lid suture sling with retractor recession – refractory macular holes A novel technique A narrated surgical video Anant Bhosale1, Vignesh Raja1, Rodney Morris2, 2 Katja Ullrich1, Raman Malhotra1 Veerappan Sarvanan Email: [email protected] Email: [email protected] 1 2 1Queen Victoria Hospital, East Grinstead, United Kingdom Sir Charles Gairdner Hospital, Perth, Australia, Aravind Eye Hospital, Coimbatore, India Purpose: Patients with facial nerve palsy (FNP) often require extensive stabilization of the lower eyelid, in order to protect Standard Macular Hole surgery involves vitrectomy ILM their cornea and negate the ongoing descent of the midface peel and expansile gas. Macular Holes not closing after this with gravity. We developed a technique previously described surgery need additional intervention. in detail in the literature, the plicates the medial canthal tendon We describe an innovative technique of using Crystalline (MCT) to the medial orbital wall, and then suspends the lower anterior or posterior lens capsule aided bridging of macular lid with a “hammock” type suture sling to the lateral orbital hole edge, facilitating hole closure. In patients with failed pri- wall. This is combined with a recession of the lower lid retrac- mary surgery, harvested Lens capsular flap(Anterior during tors to reduce the downward pull and elevate the lower eyelid. cataract surgery or Posterior capsule in pseudophakic patient) Method: We show a surgical narrated video (6 minutes) of is trimmed to a size slightly larger than the macular hole and the above technique. placed on the hole using a micro-forceps. Lens capsule has an Results: MCT plication with suture sling and retractor reces- advantage over ILM transplant as it is thicker but still pliable, sion elevates and stabilizes the lower eyelid in patients has higher specific gravity, can be easily harvested and is with FNP. sleek for manoeuvrability. The proven mitotic activity of lens Conclusion: This technique is useful for the oculoplastic cells helps in bridging the hole edges. Thus, this novel and surgeon's repertoire. effective technique of using lens capsules can aid in successful closure of refractory macular holes with good visual outcome. PAEDIATRIC OPHTHALMOLOGY 16. The patient experience following implantation of the 14. Surgical challenges in cataract with aniridia scharioth macula lens in patients with different maculopathies Sudarshan Khokhar1, Chirakshi Dhull1, Manish Mahabir1, 2 1 Alkesh Chaudhry , Manasi Tripathi Brian Harrisberg1 Email: [email protected] Email: [email protected] 1 2 RPCENTER AIIMS, New Delhi, India, MD Eye Hospital, 1Central Sydney Eye Surgeons, Sydney, Australia, Royal New Delhi, India Prince Alfred Hospital, Sydney, Australia

Aniridia is a rare condition with variable degree of hypopla- The Scharioth Macula Lens (SML) is a secondary supple- sia or absence of iris. Cataract extraction is indicated in mentary sulcus fixated intraocular lens that is designed to patients with visually significant cataracts. Cataract surgery improve near visual acuity in patients with various macu- comes with a unique set of difficulties in aniridia due to lack lopathies. This video includes footage of implantation of the of iris, Zonular laxity and aniridia associated keratopathy. We SML along with interviews with two different patients during are going to discuss management of typical aniridia cases the postoperative period following implantation of the SML. with cataract (including anterior and posterior polar cataracts) These interviews provide insight into the practical everyday with IOL in bag placement. We will also discuss management experience of a patient with Age Related Macular Degenera- of zonular laxity with CTR placement with IOL in bag and tion and a patient with Vitelliform Macular Dystrophy. ABSTRACTS 81

17. Peel back the layers – The use of intraoperative Suprachoroidal Haemorrhage Drainage (SCH) has been optical coherence tomography in epiretinal membrane conventionally invasive, making multiple sclerotomy inci- surgery sions after localized peritomy. We propose a simple and safe transconjunctival technique with a 25 gauge cannula Corey Rowland1, Lawrence Lee1,2 of SCH drainage. A 58 year old male patient underwent Email: [email protected] right eye(RE) trabeculectomy. On first post-operative day 1City Eye Centre, Brisbane, Australia, 2University of there was shallowing of anterior chamber with loss of red Queensland, Brisbane, Australia reflex. On ultrasound(USG) RE revealed choroidal mounds with mild to moderate reflectivity inside. Diagno- Surgical management of epiretinal membrane (ERM) with vit- sis of RE late suprachoroidal haemorrhage (SCH) was rectomy and membrane peeling has been performed solely with made. Patient underwent RE SCH drainage. Anterior en face visualization of the tissues by the surgeon. Intraoperative chamber was maintained with AC maintainer. Trans- OCT (iOCT) permits real-time imaging of retinal architecture. conjuctival 25 gauge cannula was inserted at 4 mm from We present a case of a 50-year-old female with Lamellar Macu- the limbus angled parallel to the sclera in the area of maxi- lar Hole (LMH) who underwent 25-Gauge 3 Ports Pars Plana mum height of CD. Trocar was retracted slowly which was Vitrectomy (PPV) and ERM peeling. This video demonstrates followed by a gush of dark coloured blood through the the use of the Zeiss OPMI Lumera and Rescan Intraoperative cannula. Similar procedure was done in other quadrant. OCT to help visualize macular pathology, the presence and Intra-operatively return of fundal glow suggested receding extent of ERM intraoperatively and to assess retinal architectural of the choroidal mounds. Post-operatively, resolution of changes during and following membrane peeling. CD was noted clinically as well as on USG. Drainage via trocar cannula has been described earlier, however trans- conjuctival drainage done at 4 mm has not been reported 18. Neil's story thus far.

James Muecke1, Nicholas Muecke2 20. An unusual presentation of total retinal detachment Email: [email protected] 1South Australian Institute of Ophthalmology, Adelaide, Yu-Chieh Hung1, Antony Bedggood1, Logan Robinson1, Australia, 2Helm Studio, Adelaide, Australia Lewis Lam1 Diabetes is the leading cause of blindness amongst working Email: [email protected] age adults in Australia. Neil's Story reveals the devastating 1Christchurch Hospital, Christchurch, New Zealand outcome when eye checks are neglected. This powerful A 7-year-old boy with a background of high myopia pres- 30 second TV commercial was screened nationally on Chan- ented with a dense cataract, anterior uveitis, vitritis and a nel 7 in late 2018. cystic lesion in the vitreous of his right eye. He underwent right lens aspiration, vitrectomy, and resection of the lesion, which although initially felt to represent ocular cysticercosis, 19. Transconjunctival suprachoroidal haemorrhage was actually a giant retinal cyst from right total retinal drainage via 25 gauge cannula detachment. The following year, he developed a left retinal detachment, and underwent left vitrectomy and retinal Shorya Azad1, Pradeep Venkatesh1, Rohan Chawla2 detachment repair with scleral buckle, endolaser, and sili- Email: [email protected] cone oil. 1Dr.R.P.Centre, AIIMS, New Delhi, India, 2Dr.R.P. CENTRE, AIIMS, New Delhi, India DOI: 10.1111/ceo.13632 Poster Abstracts

CATARACT

1. Analysis of predictability and accuracy of position or capsular phimosis. There was high patient satis- 6 intraocular lens power calculation formulas faction and spectacle independence.

WITHDRAWN 3. Evaluation of surgical skills in ophthalmology residents using ICO- OSCAR for Small Incision 2. Visual performance and positional stability of a rhexis Cataract Surgeries: An assessment, feedback and fixated EDOF IOL much more…

Erica Darian-Smith1,2, Patrick Versace1,3 Soumya Venkatesh1, Premnath Raman1, Rajendra Email: [email protected] Rajarathnam1 1Prince of Wales Hospital, Department of Ophthalmology, Email: [email protected] Sydney, Australia, 2Sydney University Medical School, 1JSS AHER, Mysuru, India Sydney, Australia, 3Vision Eye Institute, Sydney, Australia Surgical competency is the most important attribute of an Purpose: To look at the 6 month outcomes of visual perfor- ophthalmic resident that has a direct impact on patient out- mance and positional stability following cataract surgery come. These skills are never assessed in their exit exams. performed using FLACS capsulotomy with a capsule-fixated Purpose: This study aims to assess the surgical skills of intraocular lens FEMTIS Comfort MF15, extended depth of residents using International Council of Ophthalmology- focus (EDOF) version (OSD Medical, Germany). Ophthalmology Surgical Competency Assessment Rubric Design: Prospective, open label, post registration data (ICO-OSCAR) and also analyses the perceptions of students collection. about the same. Methods: Three-month and 6 month outcomes were mea- Methods: All the steps of 63 small incision cataract surgeries sured including: visual function, stability of IOL position, performed by nine ophthalmic residents of JSS Hospital, and quantitative measurement of glare and halo. Subjective Mysuru, Karnataka, India between November 2018 and patient satisfaction and spectacle independence rates were January 2019 were assessed by a single faculty using ICO- documented with a subjective questionnaire. A computer OSCAR which categorizes trainees into novice, beginner, simulator was used to quantify the incidence and severity of advanced beginner and competent and assigns points for each step in each category. The student also self-evaluated their unwanted visual phenomena allowing comparison with other surgeries using ICO- OSCAR. The rubric is administered EDOF and multifocal IOLs. repetitively to see the improvement in their surgical skills. Results: 44 eyes, of 25 patients, were included in the study. The trainee and trainer assessment scores are compared. Stu- There were 19 bilateral cases with 13 females and a mean dents ‘feedback about the implementation of ICO -OSCAR patient age of 62.5 years. The median shift in IOL position were taken. Results were analysed using Wilcoxon, paired over 6 months (from surgery to 6 months) was 0.095 and independent t tests. ± 0.09 mm. There was a marked improvement in UCVA Results: Significant difference (p- 0.023) between the mean and BCVA from the pre-operative to the 6-month mark. scores of all students for the first (69.56) and the last case Patient satisfaction and spectacle independence levels were (76.00) noted with second years showing marked improve- high. There were no cases of problems with IOL enclevation, ment (p-0.008). Residents opined that ICO -OSCAR as a negative dysphotopsia, decentration or capsular phimosis. formative assessment tool helped them to assess and learn Conclusions: This is the first study to report outcomes fol- their surgical skills better. lowing insertion of the FEMTIS capsulorhexis fixated Conclusions: ICO -OSCAR, as an assessment and learning EDOF IOL. This IOL offers excellent refractive predictabil- tool helped residents to identify their strengths and weak- ity, functional range of vision and minimal unwanted visual nesses in surgeries. It helped faculty to recognize residents’ phenomena. The attachment to the anterior capsulorhexis is flaws in surgical skills and undertake remedial measures to shown to be stable over time with no significant shift in the achieve good visual outcome.

82 wileyonlinelibrary.com/journal/ceo Clin Experiment Ophthalmol. 2019;47 (Supp 1):82–164. ABSTRACT 83

4. Phacoemulsification surgery skill transfer – progress 6. Phacoemulsification training for small manual incision and proficiency: Our experience with ICO-OSCAR cataract surgery experienced Nepalese surgeons: A joint rubrics project of Queensland ophthalmologists and Lumbini Eye Institute Khurshed Bharucha1, Vivek Adwe1, Atul Hegde1, Rahul Deshpande1, Madan Deshpande1 Anil Sharma1,2, Graham Lee3, Govinda Ojha2 Email: [email protected] Email: [email protected] PBMA's HV Desai Eye Hospital, Pune, India 1Royal Brisbane and Women’s Hospital, Brisbane, Australia, 2Central lakes Eye Clinic, Brisbane, Australia, Purpose: 3 To assess the efficacy of ICO-OSCAR rubrics City Eye Centre, Brisbane, Australia score as an indicator of surgical progress and proficiency in phacoemulsification training. Many surgeons in developing countries are embracing Method: We evaluated trainees undergoing short-term Phacoemulsification surgery for its excellent results. Given the (1 month) phacoemulsification training using the ICO- significantnumberofcataractpatients,thenumberofPhaco OSCAR rubrics over a 10 months period. 52 trainees per- surgeons in Nepal, like in many developing countries is lim- formed a total of 1300 surgeries (avg. 25 each). Step-wise ited. Most Nepalese Ophthalmology residency programs do surgical scores were recorded on ICO-OSCAR rubrics on not have focussed syllabus on Phacoemulsification. Few insti- 20 steps/indices by trainer immediately after the surgery. tute deliver ad hoc trainings. A joint collaboration of Queens- Independent completion rates and complications were also land Ophthalmologists, Australia and Nepal Netra Jyoti Sangh recorded. (NNJS) was initiated to develop Phacoemulsification training Results: The mean age of trainees was 30.98 ± 2.44 years. for qualified Nepalese Ophthalmic surgeons at Lumbini Eye Pre-training and post- training mean scores were derived from Institute (LEI) from 2017 to 2020. The purpose of the project the mean scores of first 5 cases and last five cases respectively. is to upgrade the phacoemulsification surgical skill of Nepalese The mean pre-training score was 45.53% ±2 and post-training Ophthalmologists. mean score was 91.03% ±2. A team of Consultant Ophthalmologists from Queensland Independent completion rates (ICR) and complication rates visit Lumbini Eye Institute twice a year for on-site intensive were also calculated and statistically analysed. Pre-training supervision on voluntary basis. Trainee surgeons are identi- ICR was 50.76% ±2.5 and post-training ICR was 80.63% fied by Medical Committee of LEI. Before conducting actual ±3.1. Complication rates reduced from 22.69% to 8.8% from supervised surgical training in hospital settings, the basic pre-training to post-training stage. knowledge of the trainees is established with web-based por- Independent completion rate and complication rate have tal, followed by multiple-choice-question tests. The outcome been traditionally used parameters for surgical profi- of training at the end of each training day for each trainee is ciency. We looked for correlation between ICO-OSCAR evaluated with Ophthalmology Surgical Competency scores and ICR. We found a strong statistical correlation Assessment Rubric of the International Council of Ophthal- between the two indicators (P = 0.0004). ICO-OSCAR mology (ICO-OSCAR) which assesses each step in rubrics scores also correlated statistically with the Phacoemulsification surgery, intra-operative complications, complication rate. complexity of cases and takeovers by the supervising Con- Conclusion: Objective assessment of surgical progress and sultants. The candidates are issued course completion certifi- proficiency is usually difficult. The ICO-OSCAR rubric is a cates after they submit the audit of the cases. detailed, objective mark-sheet for each step of phacoemulsi- Two weeks of intensive surgical supervision with about fication surgery. Its scores correlate strongly like ICR and 50-60 Phacoemulsification surgeries on an average per can- complication rates. We strongly recommend ICO-OSCAR didate have been carried out in the last 2 training visits. rubrics be used in phacoemulsification surgical skill transfer programs. 7. To study visual outcome, endothelial cell loss and complications after retropupillary Iris claw lens implantation in patients with deficient posterior capsule 5. Hybrid technology extended range of vision intraocular lens for senile cataract S. P. Singh1, B. K. Singh1, Vinod Singh1, Anand Shukla1 Email: [email protected] WITHDRAWN 1MLN Medical College, Allahabad, India 84 POSTER ABSTRACTS

Purpose: To study visual outcome, endothelial cell loss and Purpose: To evaluate visual performance of myopic cataract complications after retropupillary Iris claw lens implantation patients treated with a small aperture intraocular lens in the in patients with deficient posterior capsule. non-dominant eye and a monofocal intraocular lens in their Methods: This prospective study included 33 patients who dominant eye. underwent retropupillary iris claw lens implantation in Method: Retrospective, single surgeon review was under- patients with posterior deficient capsule. taken of sixteen myopic patients implanted with an IC-8 Result: The mean Preop LogMAR was 0.5338 while it (AcuFocus) in the nondominant eye. The IC-8 IOL eyes improved to 0.3149, 3 month postoperatively which is equiv- were targeted for a refractive outcome between −1.00 D to alent to 6/12. The mean endothelial cell loss was 14.95%. −1.25 D and the fellow eyes were targeted for plano with There was no significant increase in IOP. Macular oedema monofocal lenses. The pre-op range of corneal astigmatism was observed in 18 (54.54%) cases which decreased in fol- in the IC-8 eyes was 0.00 D to 2.10 D. One month visual low up, pigment dispersion was seen in 12 (36.36%) cases. and refractive results will be presented. No disenclavation was seen in any case. Results: At 1 month, patients achieved a mean manifest refrac- Conclusion: Retropupillary Iris Claw lens implantation is tive spherical equivalent (MRSE) of −1.33 D ± 0.59 in the less time consuming, cost effective, predictable and safe pro- IC-8 eye and − 0.13 D ± 0.32 in the fellow monofocal IOL cedure capable of delivering good visual outcomes and asso- eye. Mean monocular uncorrected near visual acuity ciated with fewer complications. (UCNVA) and uncorrected distance visual acuity (UCDVA) wasN5.2±0.4and0.73±0.24(Snellan6/8)intheIC-8eyes, 8. Endocapsular ring implantation for subluxated respectively. In the fellow monofocal eyes, mean UCDVA at cataract: Modified technique 1Monthwas0.99±0.23(Snellan6/6).Binocularly,UCDVA of 6/6 (Snellan) was achieved in 87%, and UCNVA of N5 in B. K. Singh, S. P. Singh, Kamaljeet Singh, Anand Shukla, 80% of the patients. No significant adverse events were noted. Vinod Singh Conclusion: Early results show myopic cataract patients Email: [email protected] achieved good range of vision in the IC-8 IOL eye, even in MLN Medical College, Allahabad, India the presence of clinically significant astigmatism. Combined with a monofocal IOL in the dominant eye, the IC-8 is a Purpose: To establish the modifications in techniques for end- promising option for implantation in the nondominant eye of ocapsular ring insertion and its scleral fixation in subluxated myopic patients. cataract that causes minimal stress to capsulo-zonular complex. Methods: The study population consisted of 29 eyes with various degree of subluxated cataract that underwent end- 10. Re-intervention rate and visual outcomes following ocapsular ring implantation with techniques modified by us zonular dehiscence followed by phacoemulsification and implantation of intraocular lens (IOL) in the capsular bag. Harry Yip1, Sarmad Akkach1,2, Robin Meusemann1 Results: We could implant the intended endocapsular ring in Email: [email protected] 28 out of 29 eyes (96.55%). Mean preoperative BCVA was 1The Alfred Hospital, Melbourne, Australia, 2Royal +0.68 ± 0.22 log MAR (24 eyes). Mean postoperative Victorian Eye and Ear Hospital, Melbourne, Australia BCVA at final followup was +0.27 ± 0.16 log MAR (28 eyes). In 2 eyes (7.14%) mild IOL decentration was Purpose: To assess the re-intervention rate and visual out- noted. Other complications included cystoid macular oedema comes of patients with zonular dehiscence (ZD) noted dur- in 1 eye (3.57%), and mild uveitis in 3 eyes (10.71%). ing phacoemulsification surgery. Conclusion: With our modified techniques for endocapsular Method: A retrospective audit of all patients who underwent ring insertion and its scleral fixation, we could smoothly and cataract surgery at The Alfred hospital over a 10 year period safely implant the endocapsular rings in subluxated cataract. (July 2008 - June 2018). All eyes with ZD occurring intraoperatively, with or without associated posterior capsule (PC) tear were enrolled in the study. 9. Small aperture intraocular lens in myopic cataract Results: During the pre-defined study period, 83 cases of patients ZD were identified from 13 124 phacoemulsification cases (rate 0.63%). Of these cases, 38 (45.8%) had a capsular ten- Alexander Poon1 sion ring (CTR) inserted, whilst the remaining 45 (54.2%) Email: [email protected] did not receive a CTR. Concurrent posterior capsular 1RVEEH, Melbourne, Australia (PC) tears occurred in 14 of the 83 cases (16.9%). ABSTRACT 85

Of the cases of ZD analysed, 65.6% had ≤3 clock hours of Conclusion: Although there were no significant differences ZD, while 34.4% had >3 clock hours of ZD. The rate of in most retinal parameters, the presence of ocular risk factors CTR insertion was 66.7% in eyes with ≤3 clock hours and in PCME patients reduced the possibility of achieving vision 27.7% in eyes with >3 clock hours. Best corrected visual of 6/6. As the longest follow up of any PCME study to date, acuity (BCVA) of 6/12 or better at 3 months was achieved these results can assist with guiding postoperative patient in 76.2% of cases with ≤3 clock hours and 54.5% of cases discussion regarding visual recovery. with >3 clock hours. The re-intervention rate was 9.5% in eyes with ≤3 clock hours and 36.3% in eyes with >3 clock hours. 12. Comparison of an optical low-coherence Conclusion: Our findings suggest that while the incidence rate interferometry and a Scheimpflug imaging combined of ZD is low, cases affecting greater than 3 clock hours are less with partial coherence interferometry biometers in likely to be amenable to CTR use, confer suboptimal visual cataract patients outcomes and a significantly higher re-intervention rate. Eui S. Han1,2, Moonjung Kim1,2 Email: [email protected] 1 11. Prognosis and impact of ocular risk factors in Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, UAE, 2 pseudophakic cystoid macular oedema following Seoul National University Hospital, Seoul, Republic of femtosecond laser assisted surgery Korea Purpose: To evaluate the agreement between the biometers 1 2 2 3,4,5 Edward Xu , Lewis Levitz , Chris Hodge , Chris Lim measured by optical low-coherence interferometry (OLCI, Email: [email protected] Aladdin), and those measured by Scheimpflug imaging com- 1 2 Monash University, Clayton, Australia, Vision Eye bined with partial coherence interferometry (Pentacam 3 Institute, Victoria, Australia, Department of AXL) in cataract patients. Ophthalmology, Royal Melbourne Hospital, Melbourne, Method: The axial length (AXL), corneal power (K), ante- 4 Australia, Department of Ophthalmology, National rior chamber depth (ACD), and corneal astigmatism were 5 University Health System, Singapore, Singapore, School of measured with the 2 devices in patients with cataract. The Optometry and Vision Sciences, University of New South difference and correlation was evaluated with a paired t test Wales, Sydney, Australia (p) and the Pearson correlation coefficient (r), respectively. Purpose: To investigate the prognosis of pseudophakic Results: One hundred sixty-four eyes of 89 patients were cystoid macular oedema (PCME) following femtosecond analysed. The OLCI mean AXL showed excellent agreement and correlation (OLCI 23.26 mm, Pentacam AXL 23.24 mm, laser assisted cataract surgery (FLACS) and discuss the P = 0.076, r = 0.990). However, OLCI measured a lower potential impact of ocular factors on final visual outcome. corneal power with high correlation (flat K -0.08 Diopters Method: A single centre, single surgeon, prospective, obser- [D], steep K -0.02 D, and mean K -0.05 D, P = 0.043, 0.585, vational study was undertaken on 1762 consecutive eyes and 0.107, r = 0.945, 0.953 and 0.961, respectively). The undergoing FLACS between 2012-2017. Pre-operative OLCI measured a shallower mean ACD (−0.08 mm, visual acuity and ocular coherence tomography were per- P = 0.000, r = 0.830). Vector analysis showed a statistically formed. Monthly follow up with visual acuity, OCT imaging significant difference in astigmatism measurements. and slit lamp examination were performed until visual acuity Conclusion: Although the OCLI and Pentacam AXL returned to baseline or had stabilized. showed strong correlation for AXL, K, ACD, and corneal Results: 30 eyes from 25 patients were identified to have astigmatism in cataract patients, there were the small but sta- developed PCME following FLACS, creating an incidence tistically significant differences in flat K, ACD, and corneal of 1.74%. Mean time to stability was 4.9 months (1 to astigmatism. The 2 devices are not interchangeable for cal- 34 months).Of the 17 patients who underwent bilateral cata- culating the intraocular lens power. ract surgery, 5 went on to develop bilateral PCME (29%). 10 patients (40%) had pre-existing ocular risk factors and 10 (40%) systemic risk factors. The presence of co-existing 13. The final visual outcomes following cataract surgery ocular risk factors influenced visual outcomes as 83% of at outreach camps in rural area in Timor-Leste eyes without ocular risk factors achieved 6/6 or better at final visit against 58% of eyes with ocular risk factors. Frenky R. De Jesus1 86 POSTER ABSTRACTS

Email: [email protected] Results: Over the 10-year period, there were 130 PC tears in 1Hospital Nacional Guido Valadares, Dili, Timor-Leste 12 746 phacoemulsification cases (rate 1.0%). The incidence rates for consultants and registrars were 1.3% and 0.9%, Purpose: The purpose of this study was to determine the respectively. Key risk factors for PC tear were age > 65 years final visual outcomes of patients who undergo cataract sur- old and presence of dense cataract. Tears most frequently gery through outreach services in Timor-Leste. occurred in phacoemulsification (60.0%) and irrigation and Method: The study began with a week of cataract surgical aspiration (26.7%) stages of surgery. BCVA of 6/12 or better outreach in remote area in Timor-Leste. Data were collected post-operatively was achieved in 68.8% of cases. from all patients who had cataract surgery during the pro- Recommendations: The rate of PC tears was acceptable gram from June 2018-May 2019. Patients were identified by when compared to other published studies at major teaching the surgery sheets. Results: Total of 424 cataract surgery performed in 10 differ- hospitals. BCVA of 6/12 or better was achieved in only ent locations. Of these, 66,3% was Male and 33,7% was 68.8% and therefore PC tears remain an important complica- female. In the other hand, 56,4% and 44,6% were right eye tion of phacoemulsification as they may confer sub-optimal and left eye respectively. Of the total, 412 had uncompli- visual outcomes. Clinicians should be cognizant of key risk cated cataract surgery, while 12 required anterior vitrectomy factors for PC tears, including; age > 65 years old and pres- and ACIOL insertion. For accurate of interpretation of the ence of dense cataract. visual outcome, patients were divided into three group depending on the first day of post-operation. Vision 6/18 or better consisted of 214 patients, regular (6/24-6/60) and poor 15. Evaluation of refractive and visual acuity outcomes vision (<3/60) were 118 and 92 patients respectively. The in cataract patients reasons for regular and poor visual outcomes were due to corneal edema, hyphema, cortex retained, macular degenera- Brian Harrisberg1,2 tion, glaucoma and previous trauma. Email: [email protected] Conclusion: cataract surgery outreach was successfully and 1Central Sydney Eye Surgeons, Sydney, Australia, 2Royal improved the vision of patients in rural area. Prince Alfred Hospital, Sydney, Australia

Purpose: To evaluate the refractive and visual acuity out- 14. Ten-year audit of posterior capsule tear complication comes following toric intraocular lens implantation using the rates and visual outcomes following phacoemulsification online Barrett toric calculator. Method: A retrospective analysis was performed on the Sarmad Akkach1,2, Harry Yip3, Robin Meusemann2 refractive and visual outcomes in 115 eyes of 97 patients Email: [email protected] that had micro-incision lens extraction and IOL implantation 1Royal Victorian Eye and Ear Hospital, Melbourne, with Medicontur 677TA toric IOL’s. This is a single centre, Australia, 2The Alfred, Melbourne, Australia, 3The Alfred, single surgeon, single IOL study. All IOL calculations were Melbourne, Australia performed prior to surgery using the online Barrett toric calculator with measurements obtained from IOL Master Background: An audit to evaluate PC tear rates and visual 700 biometry. Corneal topography was performed in each outcomes after phacoemulsification, analyze risk factors case to exclude irregular astigmatism cases. Digital marking contributing to PC tears, and compare results of consultants and alignment of the IOL were used to ensure precise align- and registrars. ment of the IOL with the intended axis. Post-operative align- Benchmarking/Standard. ment of the toric IOL was recorded on the slit lamp. The incidence of PC tears has been reported between 0.7%- 2.6% in various clinical studies. Subjective refractions, uncorrected visual acuities and best- Methods: Retrospective study of consecutive patients who corrected visual acuities were measured postoperatively in underwent phacoemulsification between July 2008 and June the consulting rooms. 2018 at Alfred Health, Melbourne. All eyes with PC tears Results: The uncorrected mean visual acuity improved from occurring intra-operatively were included in the study. Eyes 0.39 (decimal) pre-surgery to 0.91 (decimal) post-surgery. with poor prognosis pre-operatively were excluded. Demo- The best corrected mean visual acuity improved from 0.57 graphic data, surgeon type, pre-disposing risk factors, stage (decimal) pre-surgery to 1.03 (decimal) post-surgery. The of surgery, complications, and best-corrected visual acuity difference between actual and predicted postoperative spher- (BCVA) at 3 months were recorded. PC tear rates of consul- ical equivalent refractive error was within 0.50DS in 84.8% tants and registrars were also compared. of cases and within 1.17DS within 100% of cases. The ABSTRACT 87 residual postoperative cylinder was within 0.50D in 97.0% Email: [email protected] of cases and within 1.00D in 100.0% of cases. 1Royal Darwin Hospital, Darwin, Australia, 2Save Sight Conclusion: Digital marking and toric alignment combined Institute, University of Sydney, Sydney, Australia with the use of the Barrett toric calculator, IOL Master Purpose: Complicated cataracts are common in the Top End 700 biometry and Medicontur 677TA toric IOL’s yielded predictable outcomes in this study. due to the incidence of trauma and delayed presentations especially in the Aboriginal and Torres Strait Island populations. Often, these go undetected during the pre- 16. A case series of subretinal lenticular material operative assessment due to factors including; low self- reported trauma, language barriers, poor dilation of dark Christopher Go1,2, Samantha Bobba1, Jay Chandra1 irises, and low tolerance for delay or wait time. Email: [email protected] Methods: This is a case series of 8 complicated cataracts 1Westmead Hospital, Sydney, Australia, 2Save Sight managed by a single surgeon at Royal Darwin Hospital over Institute, The University of Sydney, Sydney, Australia 18 months. Result: These 8 patients were aged 30-70 (median 60), with Purpose: Subretinal lenticular material is a rare condition with 5 males and 3 females, 7 identified as Aboriginals or Torres only eight reported cases; two from blunt trauma and six from Strait Islanders, and 5 are from remote communities. Pre- various surgical techniques including phacoemulsification and operatively, 3 had reported trauma, 1 had a posterior capsu- vitrectomy. We report two unusual cases of subretinal lenticular defect and 3 had phacodenesis; 4 more were identified lar material. To our knowledge, this is the first reported case of intraoperatively. A variety of surgical techniques were used; subretinal intraocular lens. 4 had scleral tunnel with intracapsular extraction (ICCE) and Results: Case One is a 27 year old male referred for left sub- ACIOL, 3 had converted ICCE via limbal wound extension luxed intraocular lens after cataract surgery. The operation and 1 had routine phacoemulsification. Post-operatively, all “ ” was difficult but uncomplicated and lens repositioning day patient’s visual acuity (VA) improved and 4 had significant one post-operatively was performed. On examination, IOL improvement. 1 was lost to follow-up from day 1 and 5 had was not identifiable with B scan demonstrating a retinal missed appointments. detachment. A subretinal IOL was found during planned vit- Conclusion: This case series describes a learned experience rectomy and removed with intraocular forceps. of cataract managements unique to the Top End including Case Two is a 74 year old male referred following for high suspicion of traumatic cataract with zonular dehiscence. dropped nucleus following a posterior capsule tear (PCT) The authors also advocate for the use of scleral tunnel inci- during phacoemulsification. On examination, he had a 180 sion to mitigate the risks of infection and induced astigma- circumferential giant tear with radial extension to the optic tism in the setting of unreliable follow up. Subconjunctival disc, and RPE burn beneath the radial extension. There were dexamethasone is also preferred intra-operatively given dif- several dislocated lens fragments, including one sub- ficulties with compliance and accessibility in remote retinally which was initially mistaken as a choroidal detach- communities. ment. This was later removed in subsequent surgery. Conclusion: Vigorous vitreous manipulation is considered the likely pathogenesis for subretinal nucleus, which is con- 18. Lens Epithelial Cell Outgrowth (LECO): An sistent with Case Two. However, a PCT was not observed in occurrence with the Clareon AutonoMe Case One, and the mechanism is still unknown. It may be related to lens repositioning or an undetected pre-operative Chloe F. T. Ting1,2, Chee F. Chong3, Anthony Yao4, Henry giant retinal tear. This case series demonstrates how impera- Liu1,2 tive it is to undergo an extensive dilated examination prior to Email: [email protected] cataract surgery and be mindful of the risks of surgical 1Dubbo Eye Centre, Dubbo, Australia, 2Orange Eye Centre, revision. Orange, Australia, 3Tauranga Eye Specialists, Tauranga, New Zealand, 4Western Health, Melbourne, Australia

17. Case series of complicated cataract management Purpose: To report the incidence of lens epithelial cell out- unique to the Top End growth (LECO), in patients implanted with the Clareon hydrophobic acrylic intraocular lens (IOL). Christopher Go1,2, Ario Wilson-Pogmore1, Susith Methods: Retrospective audit of postoperative outcomes of Kulasekara1 patients implanted with the Clareon hydrophobic acrylic 88 POSTER ABSTRACTS

IOLs by a single experienced surgeon at 1 day, 1 week and 1%; Chi Square value, X2 =1.70,P = 0.19). The incidence of 1 month. LECO was significantly higher with Clareon (26 cases, 24.8%, Results: 105 eyes from 91 patients received the Clareon VS 0 cases; Chi Square value, X2 = 30.99, P < 0.001). PCO IOL following uncomplicated cataract extraction. Outgrowth data collection is currently ongoing. of the lens epithelial cells was detected in 26 eyes (24.8%) Conclusion: Preloaded hydrophobic lenses differ in delivery from 24 patients - of which 2 patients (4 eyes) had bilateral and post-operative outcomes, highlighting the need for Clareon IOLs that formed LECO, and 2 bilateral ongoing development of the delivery systems. pseudophakic patients had LECO in the Clareon IOL implanted eye while the contralateral eye with AcrySof IQ SN60WF and AcrySof IQ SN6AT IOLs did not show evi- 20. Impact of different types of IOL implantation during dence of LECO. cataract surgery on the quality of sleep – A prospective Conclusion: This finding suggests that up to 25% of patients study implanted with the Clareon hydrophobic acrylic IOL developed LECO. It is uncertain as to the predisposing patient Sucheta Parija1, Aparajita Banerjee1 factors that lead to the development of LECO. Further stud- Email: [email protected] ies are required to determine factors that influence the devel- 1All India Institute of Medical Sciences Bhubaneswar, opment of LECO and its long-term effects. Bhubaneswar, India Purpose: This study aimed to analyze the effect of different types of intraocular lens implantation, a blue-filtering lens or 19. Clareon AutonoMe vs AcrySof IQ AU0 0 T0 a UV-blocking lens on the quality of sleep after cataract UltraSert: A comparison of intraoperative and postoperative characteristics surgery. Methods: A prospective study was conducted on 100 1,2 3 4 patients undergoing uneventful cataract surgery at a tertiary Chloe F. T. Ting , Chee F. Chong , Anthony Yao , Henry Liu1,2 hospital in year 2018.Patients were divided into two groups Email: [email protected] according to the IOL implantation. Group I (Blue filtering, 1Dubbo Eye Centre, Dubbo, Australia, 2Orange Eye Centre, BF-IOL) 52 cases and Group II (Ultraviolet blocking, UVB- Orange, Australia, 3Tauranga Eye Specialists, Tauranga, IOL) 48 cases. Pittsburgh Sleep Quality Index (PSQI) ques- New Zealand, 4Western Health, Melbourne, Australia tionnaires were administered in the two groups preoperative, 7th day, 1 month, 6 months and 9 month follow-up. Statisti- Purpose: To compare the performance of two recent cal analysis with Chi-square and One way ANOVA was preloaded hydrophobic intraocular lenses (Clareon Auto- used to evaluate the difference in the two groups. noMe and AcrySof IQ AU0 0 T0 UltraSert). Results: Quality of sleep was better in UVB-IOL in 1st Methods: We reviewed up to 215 eyes that underwent routine month period (P < 0.05) compared to BF-IOL but not at phacoemulsification surgery with implantation of either the 9 months (P > 0.05). Few components of PSQI mainly day- Clareon or AU0 0 T0 lenses by a single experienced surgeon. time disturbances and sleep latency has improved in both the Delivery characteristics were assessed, with the main outcome groups. The PSQI overall scores improved significantly in being lens delivery into the capsular bag via the preloaded both the groups during postoperative follow-up at both injector without “major” or “minor” issues (depending on 6 months and 9 months (P < 0.01). damage causing requirement to replace device or lens, and Conclusion: The quality of sleep improved, irrespective of requirement for additional manipulation for lens positioning). the type of IOL implanted after cataract surgery in all cases. Post-operative characteristics was evaluated by the presence of These data concludes BF-IOL does not produce a negative Lens Epithelial Cell Outgrowth (LECO) on the anterior cap- effect on the sleep cycle. sulorhexis margins and presence of posterior capsular opacity (PCO) up to 6 weeks after the operation. Results: 105 and 110 patients received the Clareon and 21. Effectiveness of using dexmedetomidine as an AU0 0 T0, respectively. Clareon experienced a significantly adjunct to local anaesthesia in peribulbar block in ocular higher proportion of major incidents in comparison to the surgeries AU0 0 T0 (5 cases, 4.8%, VS 0 cases; Chi Square value, X2 = 5.36,P = 0.02). However, AU0 0 T0 lenses had a higher Sonalika Gogia1, Arvind K. Morya1, Anushree Naidu1, proportion of minor incidents in comparison to Clareon, though Sujeet Prakash1 this difference was not significant (4 cases, 3.6% VS 1 case, Email: [email protected] ABSTRACT 89

1All India Institute of Medical Sciences, Jodhpur, Jodhpur, were recorded. Parameters included were cataract grade, cen- India tral corneal thickness, axial length, keratometry readings, intra-ocular pressure, AS-OCT parameters. Intra-operatively Purpose: To evaluate the effect of dexmedetomidine, a cen- pupillary dilatation and complications were recorded under trally acting α2-adrenergic receptor agonist as an adjunct to the headingsiris prolapse, pupillary miosis, iris billowing, local anaesthetics in peribulbar block in ocular surgeries. floppy iris, iatrogenic iris injury, rhexis extension, posterior Methods: 60 patients of either gender undergoing cataract, capsular rent without vitreous leak, posterior capsular rent squint, glaucoma surgeries under local anaesthesia (peribulbar blockade) willingly giving consent to participate in with vitreous leak, zonular dialysis, iridodialysis, cortex this study were divided into two groups of 30 each - Group drop, nucleus drop and aphakia. A receiving - 3 mL lignocaine+2 mL bupivacaine+150 IU Results: Demographic parameters showed remarkable vari- hyaluronidase+25mcg dexmedetomidine; Group B receiving ability where Male: Female 3:1, age 54-78 no association -3 mL lignocaine+2 mL bupivacaine+150 IU hyaluronidase. with consanguinity and diabetes mellitus as opposed to We evaluated the effect of dexmedetomidine on onset and already known facts. Eight cases had iris prolapse, 8 cases of duration of block, intraocular pressure, heart rate, mean arte- pupillary miosis, 8 patients had floppy iris, 9 patients had rial pressure, Oxygen saturation. Pain score was assessed iris billowing, Zonular weakness and dialysis was noted in using visual analogue scale and surgeon satisfaction was 3 cases. Correlation with anterior segment parameters was assessed using a 5-point likert like verbal rating scale. done using chi square test for categorical variables and Results: Time of onset of action was shortened and duration unpaired t-test for continuous variables using SPSS version of block was increased significantly in group A as compared 22. It was found that denser the grade of the cataract more to group B. The intraocular pressure and pain score was likely the chance of iris being floppy. significantly decreased in the dexmedetomidine group. How- Conclusion: PEX though well described in cold climate is ever, group A showed more changes in blood pressure- also prevalent in tropical country like India with distinct immediate increase followed by a significant decrease in demographic characteristics and is also associated with blood pressure. floppy iris syndrome, the risk for this being cataract grade. Conclusion: Addition of dexmedetomidine to lignocaine and bupivacaine in a peribulbar block significantly shortened onset time, decreased the IOP, and prolonged the duration of 23. Short-course topical ocular corticosteroids do not anaesthesia that lead to increased patient cooperation and alter corneal curvature or refraction surgeon satisfaction. Also, the blood pressure reducing effects makes it more beneficial in hypertensive patients and Hannah Frazer1, Daniel Schlosberg2, Keith Ong3 a contraindication to use in cases of hypotension especially Email: [email protected] glaucomatous individuals. 1Save Sight Institute, Sydney Medical School, University of Sydney, Sydney, Australia, 2University of Notre Dame, Sydney, Australia, 3University of Sydney, Sydney, Australia 22. A perquisition for clue to preventing complications in cases of pseudoexfoliationsyndrome (PEX) undergoing Purpose: Anecdotal evidence reports topical corticosteroids phacoemulsification surgery induce a refractive change of variable magnitude between patients. We aimed to analyse spherical equivalent by 1 1 1 Anushree Naidu , Arvind K. Morya , Sujeet Prakash , keratometry and refraction in pseudophakic-eyes pre- and 1 Sonalika Gogia post-steroids following posterior laser capsulotomy. Email: [email protected] Methods: In this single-centre, single-operator, case- All India Institute of Medical Sciences, Jodhpur, Jodhpur, crossover study using retrospective deidentified data from India July 2016 and April 2017, in Sydney, Australia, test-eyes Purpose: Correlation of pre-operative anterior segment underwent YAG laser (Ellex Tango, Adelaide, Australia) parameters with intra-operative complications in cases of capsulotomy for posterior capsule opacification and were PEX undergoing phacoemulsification surgery. then administered one drop of dexamethasone (Maxidex, Methods: Demographic details and anterior segment param- Alcon) 0.1% three-times daily for 3 weeks. Control-eyes eters of 51 cases of cataract from May 2018 to May 2019 were non-capsulotomy eyes from the same patient. Pre- and and diagnosed to have PEX based on slit-lamp bio- post-steroid keratometry and refractive measurements of microscopy examination undergoing phacoemulsification test- and control-eyes were compared using t-tests and gen- surgery willingly giving consent to participate in the study eralised estimating equations (GEE). 90 POSTER ABSTRACTS

Results: 121 test- and control-eyes were included. Mean other plausible risk factors were identified. Following participant age and duration of steroids were 73.9 ± 8.49 review, the source of distilled water was changed in addition (±SD) years and 21.9 ± 7.06 days, respectively. 50.4% of to the steriliser preparation protocol. Several further recom- test-eyes were participants’ left eye. Mean baseline spherical mendations were made upon external review which will fur- equivalents by keratometry of test- and control-eyes were ther be discussed. 44.15 ± 1.75 and 44.1 ± 1.66 dioptres, respectively. Mean baseline spherical equivalents by refraction of test- and control-eyes were − 0.952 ± 0.781 and − 0.96 ± 0.764, 25. Safety and effectiveness of the panoptix trifocal IOL: respectively. There was no statistically significant difference A multi-surgeon and multi-centre retrospective cohort between pre- and post-steroid spherical equivalents by study keratometry or refraction when test- and control-eyes were 1 2 2 compared, nor after allowing for steroid duration, partici- Uday Bhatt , Michael Lawless , Chris Hodge pants’ age, and the eye tested. Email: [email protected] 1 2 Conclusions: Three weeks of topical corticosteroids did not Vision Eye Institute, Melbourne, Australia, Vision Eye significantly alter corneal curvature or refraction. Further Institute, Sydney, Australia evaluation involving more participants, phakic eyes, and Purpose: To determine the safety and efficacy of the longer steroid duration may be required. ALCON AcrySof IQ PanOptix trifocal intraocular lens (IOL) in a consecutive, multi-surgeon cohort. Methods: 400 eyes of 202 patients were assessed at mini- 24. Investigation of Toxic Anterior Segment Syndrome mum 3 months following bilateral implantation of the Pan- (TASS) in a day surgery centre Optix IOL. Uncorrected and corrected visual acuity at far, intermediate and near distances and mean absolute differ- Timothy Roberts1,2, Sharon McIntyre3 ence from target values were analysed. Adverse events were Email: [email protected] recorded as required. 1Vision Eye Institute, Chatswood, Australia, 2The University Results: Mean age of patients was 64.1 years and 88.8% of of Sydney, Sydney, Australia, 3Vision Eye Institute, patients had a hyperopic refraction prior to cataract surgery. Melbourne, Australia The mean absolute deviation from target refraction was Background: Although the incidence of TASS following 0.21 ± 0.22D. 96.4% of eyes achieved uncorrected distance cataract surgery remains minimal, if present TASS repre- vision of 6/9 or better and 88.4% achieved uncorrected near sents a significant complication requiring additional treat- vision of N6 or better. 84.7% of patients achieved 6/6 or bet- ment. The cause of TASS is often difficult to confirm and ter binocularly with 90.3% and 54.2% achieving N5 binocu- consideration of all possible individual and surgical causa- larly at near and intermediate distance respectively. There tive factors is essential to minimise further cases. We under- were no adverse events leading to loss of corrected vision or take an audit of suspected TASS cases in a busy ophthalmic requiring additional surgical intervention. day surgery. Conclusion: The PanOptix Trifocal IOL offers patients an Benchmarking/Standard: RANZCO TASS guidelines. effective alternative to glasses following lens based surgery. Methods: Following reported TASS cases in an ambulatory The IOL provides an adequate range of optical independence day surgery centre, a local review was undertaken including at all distances without compromising safety outcomes. analysis of sterilisation resources. An additional external review incorporating the existing RANZCO guidelines and a broader literature search was undertaken to assess potential 26. Five-year review of complication rates for open heart patient and surgical risk factors and to deliver further recom- international/foresight Australia ophthalmology surgical mendations if appropriate. trips to Santiago City, Philippines Results: Mean age of patients was 73.3 years. A history of sys- 1 2 3 temic disease was found in the majority of patients. There did not Dominic McCall , Michael Were , Kerri Legg , Sara 4,3 4,3 appear to be a correlation between surgery time, staff availability, Booth-Mason , Geoffrey Painter direct sterilisation procedures or instrumentation. On initial moni- Email: [email protected] 1 toring, sterilisation units exceeded acceptable levels of endotoxins Sydney Eye Hospital and Westmead Hospital, Sydney, 2 corresponding to similar finding in the distilled water. Australia, Open Heart International, Sydney, Australia, 3 4 Recommendations: Increased endotoxins in distilled water Sydney University, Sydney, Australia, Gordon Eye appeared to represent a likely contributing factor however Surgery, Sydney, Australia ABSTRACT 91

Purpose: To review 5 years of operative data from Open Method: Eyefficiency, a new international cataract surgi- Heart International/Foresight Australia Ophthalmology Sur- cal services auditing tool that enables carbon emission gical trips to Santiago City, Philippines. calculations per surgical case, was used to quantify associ- Methods: Retrospective review of 640 procedures con- ated greenhouse gas (GHG) emissions in terms of kilo- ducted over five ophthalmological surgical trips between grams of carbon dioxide equivalents (kg CO2e) for 2013 and 2017 to an area with one of the highest rates of cataract surgeries conducted in an outpatient centre in the avoidable blindness in the Philippines. US. These include emissions from supplies, energy, and Results: A total of 640 procedures were conducted on reusable instruments in an average case. This site also 616 patients over the five-trip period. In total 59.3% (380) conducted audits of pharmaceutical waste disposal to were Extracapsular Cataract Extractions (EECEs), 20% determine the quantity of unused and wasted products at (128) were Small Incision Cataract Surgeries (SICs), the end of an average case. 19.22% (123) Phacoemulsification + lens insertions (CE Results: Preliminary Eyefficiency data shows that a majority + IOL), 1.09% (7) Intracapsular Cataract Extractions of this sites’ GHG emissions from cataract surgery are gen- (ICCEs) and 0.31% (2) penetrating eye injury repairs. Pri- erated from procurement (production) of single use products mary PCIOL insertion was achieved in 98.12% (626), and pharmaceuticals, electricity used in the operating theatre, ACIOL in 1.88% (12). No complications were found in and travel of staff. Of GHGs from pharmaceutical produc- 94.5% (603). Posterior Capsule tears were noted in 1.72% tion, 60% can be attributed to unused drugs that are disposed (11), zonular loss/dehiscence occurred in 1.25% (8) of cata- of after the case. ract cases, iridodialysis was noted in 0.2% (1), iris prolapse Conclusion: There are many avenues available to reduce 0.78% (5), hyphema 0.31% (2), PCIOL decentration 0.63% resource consumption and GHG emissions from cataract sur- (4), wound dehiscence and retrobulbar bleed both 0.2% gical care, but quantifying and understanding the sources of each (1 and 1). emissions is an important first step. Conclusion: Posterior Capsule Tears and zonular loss/ dehiscence were the most common intraoperative complications among 640 procedures at 1.72% and 1.25% respec- 28. Eyefficiency tool: A global cataract surgical services tively. This incidence is similar to the recently published auditor for productivity, costs, and carbon National Ophthalmology Database Audit of Cataract Sur- gery for 2016-2017 of any complication at 3.2% and PCT Cassandra Thiel1, Hena Goel1, Andy-Cassels Brown2,3, 4 4 5 at 1.4%. Ingeborg Steinbach , Rachel Stancliffe , Peter Thomas Email: [email protected] 1NYU Langone Health, New York, USA, 2Raigmore 27. Identifying sources of greenhouse gas emissions in Hospital, NHS, Inverness, UK, 3Leeds Teaching Hospitals cataract care in the United States: Opportunities for Trust NHS, Leeds, UK, 4Center for Sustainable Healthcare, resource efficiency in the operating theatre Oxford, UK, 5Moorfields Eye Hospital, London, UK

Purpose: Eyefficiency is a cataract surgical services Jenna Tauber1, Jonathan Kahn1, Ljeoma Chinwuba1, auditing tool that aims to help units worldwide improve their Michael Rothschild1, David Kleyn2, Sara Coulon1, Dinah surgical productivity and reduce their costs, waste genera- Chen1, Cassandra Thiel1,3 tion, and carbon footprint. Email: [email protected] Phase 1 pilot tested in India, UK and Africa in 2017; while 1NYU Langone Health Department of Ophthalmology, Phase 2 had two rounds of beta testing with sites participat- New York, USA, 2Hunter College, New York, USA, 3NYU ing from 6 WHO/IAPB regions. Langone Health Department of Population Health, Method: Eyefficiency has been through 3 rounds of testing, New York, USA pilot tests at 4 sites in 2017 and two rounds of beta testing Purpose: Operating theatres are some of the most energy with sites from 6 WHO/IAPB regions in 2018-2019. Test and resource intensive areas for medical treatment. As a sites entered facility-level data (staffing, pathway steps, costs result of resource production, use, and disposal, emissions of supplies, and energy use) on the Eyefficiency website. are generated that harm the environment and human health. They entered time-and-motion data on Eyefficiency app New tools are emerging to quantify these emissions and this from 30 consecutive cases or 1 week of cataract surgery. study seeks to understand the footprint of cataract surgery at Eyefficiency uses descriptive statistics and environmental a US facility and to identify opportunities for reducing Life Cycle Assessment (LCA) to quantify productivity, emissions. costs, and carbon footprint. 92 POSTER ABSTRACTS

Results: Eyefficiency testing was completed by 10 surgical significantly lower (P < 0.0001). The E-FABP concentration facilities (in Swaziland, Chile, South Africa, Mexico (2), in the tears was significantly lower in the NOD mice com- Guatemala, New Zealand, India, UK, and Hungary). Per bed pared to the wild type mice (P < 0.01). case duration ranged from 13 minutes to 73 minutes with Conclusion: The E-FABP concentration in the tears may be the majority of the time at all sites spent operating. Cases used as a novel biomarker in the diagnosis of SS. per hour ranged from 0.9 to 4.5. A majority of costs appear to come from the purchasing pharmaceuticals, disposable surgical supplies and energy; while carbon emissions 30. Efficacy and safety of Conjunctival Cystectomy using appear to come largely from manufacturing of supplies and high-frequency radio-wave electrosurgery transportation. Conclusion: Results show variability in cataract surgery Min J. Ji1, Seung-Jun Lee1, Sang B. Han1 efficiency metrics across the world, with lessons to be learnt Email: [email protected] from sites with higher throughput, lower costs, and reduced 1Kangwon National University Hospital, Chuncheon, resource use. Republic of Korea

Purpose: To evaluate the efficacy and safety of conjunctival CORNEA cystectomy using high-frequency radio-wave electrosurgery. Method: This retrospective study included 11 patients who underwent conjunctival cystectomy using high-frequency 29. Epidermal fatty acid-binding protein (E-FABP): radio-wave electrosurgery and had a follow-up of at least A novel biomarker in the diagnosis of dry eye disease – 6 months. Briefly, conjunctival opening with a diameter of The experience from the non-obese diabetic (NOD) mice 1 mm was made with using high-frequency radiowave electro-surgery (Ellman Surgitron; Ellman International, Murat Dogru1,2, Takashi Kojima1, Cem Simsek1, Taeko 1 1 Inc., Hewlett, NY) in cut mode. The cyst was then extracted Nagata , Kazuo Tsubota Email: [email protected] using a non-toothed forceps through the opening without 1 rupture. Medical record of the patients was reviewed. Keio University School of Medicine Department of 2 Results: In all the 11 patients, conjunctival wound healed in Ophthalmology, Tokyo, Japan, Tsurumi University Department of Ophthalmology, Tsurumi, Japan 1 week without any complication. No recurrence was detected in any patients over the 6-month follow-up. Purpose: Sjögren’s syndrome (SS) is a chronic inflamma- Conclusions: Conjunctival cystectomy with the adjunctive tory autoimmune disease. Its pathogenesis is not fully under- use of high-frequency radio-wave electrosurgery was shown stood, and further study of early detection tools is required. to be effective and safe. E-FABP is expressed in the oral mucosa, the ocular surface, and the exocrine glands and has been reported to have functions in relation to the immune system, oxidative stress, 31. Demographic and clinical profile, surgical outcome inflammatory responses in the tissues, cell differentiation and quality of life in patients who underwent bilateral and apoptosis. In this study, we compared the concentrations lamellar corneal grafts of E-FABP in the saliva, serum, and tears of NOD mice with wild type mice to investigate the usefulness of E-FABP as a WITHDRAWN diagnostic marker for SS. Methods: Ten age and sex matched 10-week old Non-Obese Diabetes (NOD) and Wild type (WT) mice were studied. 32. Xtra focus pinhole IOL(Morchers GMBH) a novel Saliva, serum, and tear specimens were collected. The oph- approach for anterior segmentreconstruction addressing thalmological tests included corneal vital stainings with fluo- irregular astigmatism and irregular pupils rescein (FS) and lissamine green (LG), and tear quantity assessment using Phenol Red test. The E-FABP concentra- Prateek Agarwal1, Samuel navon1, Neha Mithal2 tion in the tears, saliva, and serum was measured by Email: [email protected] enzyme-linked immunosorbent assay (ELISA). 1Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE, 2Ahaliya Results: There were significant differences between the Eye Care Centre, Abu Dhabi, UAE NOD and WT groups in all ophthalmological test results Purpose: Patients with irregular astigmatism and irregular with the FS and LG staining scores being significantly pupil present. higher in the NOD mice and the tear quantity being ABSTRACT 93 with highly compromised vision needing anterior segment EMBASE, Scopus and Web of Science were searched reconstruction. We describe the sulcus implantation of xtra focus utilising their entire year limits (1950-2019). pinhole IOL (Morchers GMBH) in 3 patients who had previous Results: 688 species representing 271 genera from 145 fami- cataract surgeries presenting with irregular dilated pupils and lies were implicated in microbial keratitis. Fungal pathogens large refractive errors associated with irregular astigmatism. demonstrated the greatest diversity with 393 species from Methods: Under topical anaesthesia 2.4 mm temporal clear 169 genera were found to cause microbial keratitis. Further- corneal incision was fashione and the xtra focus pinhole IOL more, 254 species of bacteria from 82 genera, 27 species of was implanted in the ciliary sulcus. Uncorrected distance visual amoeba from 11 genera, and 14 species of virus from 9 gen- acuity, uncorrected intermediate visual acuity, and uncorrected era were also identified as pathogens of microbial keratitis. near visual acuities were assessed using the Snellen’s vision Conclusions: The spectrum of pathogens implicated in chart. The entire patients underwent preoperative ultrasound microbial keratitis is extremely diverse. In comparison to the biomicroscopy ensuring an adequate anteriorchamber depth of review published in 2012, a further 456 pathogens have been 3.5 mm and pre-existing intraocular lens in the bag. identified as causative pathogens of microbial keratitis. Results: In all three cases uncorrected visual acuity improved Therefore, the current review provides an important update to 20/30 intermediate uncorrected visual acuity improved to on the potential spectrum of microbes, to assist clinicians in 20/30 and uncorrected near visual acuity improved to J3. The the diagnosis and treatment of microbial keratitis. glare and photophobia resolved completely. Subjectively the patient was satisfied with the visual outcome. Conclusions: Xtrafocus pinhole device uses a novel 34. The Keratitis Anti-microbial Resistance Surveillance approach to tackle a complex anterior segment pathology Program (KARSP): Results from 2017-2018 presenting with irregular astigmatism with concurrent iris defects with a simultaneous single step surgical approach Maria Cabrera-Aguas1,2, Monica M. Lahra3, Pauline using xtra focus pinhole IOL. Pupilloplasty and artificial Khoo1,2, Stephanie Watson1,2 iris processes can only tackle irregular pupils, without Email: [email protected] addressing irregular corneal astigmatism. Topo guided Laser 1The University of Sydney, Save Sight Institute, Discipline of vision correction which is use to correct irregular corneal Ophthalmology, Sydney Medical School, Sydney, Australia, astigmatism is limited by the availability and cost combined 2Sydney Eye Hospital, Sydney, Australia, 3The Division of with unpredictable surface healing in an elderly patient. Bacteriology, Department Microbiology, South Eastern Area Laboratory Services, Sydney, Australia

Purpose: Antimicrobial resistance (AMR) is a global health 33. The spectrum of Microbial Keratitis: An updated threat. We report the spectrum and AMR of bacteria isolated review from cornea scrapings in bacterial keratitis. Method: A retrospective analysis of bacteria isolated from Christopher Bartimote1, John Foster2, Stephanie Watson3 cornea scrapings from patients with bacterial keratitis at Email: [email protected] Sydney Eye Hospital from 1 January 2017 to 31 December 1Royal North Shore Hospital, Sydney, Australia, 2University 2018 was conducted. All specimens were processed at NSW of Alabama, Huntsvillle, USA, 3Save Sight Institute, The Health Pathology. University of Sydney, Sydney, Australia Results: 376 organisms were grown on 297 of 471 inocu- Purpose: In microbial keratitis, infection of the cornea can lated plates. (63% positive culture rate). 282 (75%) Gram- threaten vision through permanent corneal scarring and even positive and 94 (25%) Gram-negative organisms were iso- perforation resulting in loss of the eye. A literature review lated. Coagulase-negative staphylococci (CoNS) 61% was conducted by Karsten, Watson and Foster (2012) to (173/282), Staphylococcus aureus 14% (43/282), including determine the spectrum of microbial keratitis. Since this pub- six methicillin resistant (MRSA), and Pseudomonas lication there have been over 2600 articles published investi- aeruginosa 54% (50/94) were the most common organisms. gating the causative pathogens of microbial keratitis. An The number of MRSA increased from one in 2016 to six in updated comprehensive review of the causal organisms is 2017-2018. required to provide clinicians with current data to guide In 2017, resistance was found for: CoNS to cefalotin 20%, empiric therapy. chloramphenicol 16%, gentamicin 10%, and ciprofloxacin Methods: An exhaustive literature review was conducted of 3%; methicillin sensitive Staphylococcus aureus (MSSA) to all the peer-reviewed articles reporting on microbial patho- chloramphenicol 9%; MRSA to ciprofloxacin 75% and gen- gens implicated in keratitis. Databases including MEDLINE, tamicin 25%. 94 POSTER ABSTRACTS

In 2018, resistance was found for: CoNS to cefalotin 19%, made. Updated lanyard cards were provided, and A4-size chloramphenicol 10%, gentamicin 7%, and ciprofloxacin posters placed in emergency and outpatient consultation 3%; MSSA to ciprofloxacin 8% and chloramphenicol 4%; rooms. MRSA to ciprofloxacin 100% and gentamicin 100%. All Conclusion: The guideline contributed to the reduction of Gram-positive organisms were susceptible to vancomycin. HSK recurrence at the hospital. Ongoing review, education No AMR was found for Pseudomonas aeruginosa. and dissemination can be utilised in a sustainability plan for Conclusion: CoNS were most commonly isolated from the guideline. cases of bacterial keratitis. Of these, one-fifth were resistant to cefalotin. Increasing number of MRSA were noted with resistance to ciprofloxacin and gentamicin. Monitoring of 36. Microbial keratitis in Australia and New Zealand: AMR in ocular infections is important for informing both A meta-analysis clinical decision making and empiric therapy strategies. Mia Zhang1,2, Maria C. Aguas1,2, Chameen Samarawickrama1, Stephanie Watson1,2 Email: [email protected] 35. Evaluation and sustainability of guidelines for the 1University of Sydney, Sydney, Australia, 2Save Sight management of herpes simplex keratitis at the Sydney Institute, Sydney, Australia Eye Hospital Purpose: Microbial keratitis is a potentially sight threaten- Maria Cabrera-Aguas1,2, Yves Kerdraon1,2, Stephanie ing ophthalmological emergency. Prompt diagnosis and Watson1,2 treatment are crucial to the management of microbial kerati- Email: [email protected] tis. However, geographical differences in microbial keratitis 1University of Sydney-Save Sight Institute, Sydney, make implementing empirical treatment a challenging task. Australia, 2Sydney Eye hospital, Sydney, Australia Methods: MEDLINE, Proquest, and Science Direct were last searched on 24 April 2019. All retrospective cohort Purpose: To compare the clinical outcomes in patients with studies, cross-sectional and surveillance studies conducted in herpes simplex keratitis (HSK) before and after implementa- Australia or New Zealand with culture proven microbial ker- tion of the local HSK treatment guideline, and to describe atitis since 1950 were included. A meta-analysis was con- the sustainability plan for the guidelines at Sydney Eye ducted by climate zones, as defined by the 2018 Köppen- Hospital. Geiger climate classification. Method: An audit of all HSK cases aged 18 years and Results: Eight retrospective studies from 1986-2018 were above, from 1 June to 30 November 2017 was conducted to included for a total of 1289 cases of microbial keratitis, with assess adherence to new guidelines, and disease outcomes in study sizes ranging from n = 53-291. Climate zones ranged patients. Outcome was determined when the initial anti-viral from 51% (n = 661 cases) in oceanic climate (Sydney, Mel- therapy was stopped or changed, and classified as clinically bourne, and Auckland), 8.5% (n = 111) in savannah climate resolved, partially resolved or worsened for therapeutic use; (Darwin), 19.6% (n = 253) in humid subtropical climate and success or failure for prophylaxis. A sustainability plan (Brisbane), 16.4% (n = 211) in warm summer climate was formulated via consultation with key stakeholders. (Adelaide), and 4.1% (n = 53) in hot summer climate Results: The audit included 85 patients. For the therapeutic (Perth). The mean age was 51 years old (range group, 19 patients (48%) had an improved outcome, 40.6-60.4 years old). The average culture positivity rate was 19 (48%) a partially resolved outcome and 2 (5%) a wors- 61% (range 37.4%-73%) with the average distribution of ened outcome. There was no significant association between causal organisms: 83% bacteria, 7.9% viral, 7.3% fungal, and outcomes and adherence to evidence-based recommenda- 1.9% acanthamoeba; with no significant temporal trend. Hot tions before and after implementation of local HSK guide- summer climate had 10.6% of acanthamoeba keratitis and line with therapeutic use (P = 0.4), but significant oceanic climate had 9.1% of viral keratitis. association with prophylactic use (P = 0.009). Conclusion: There were no climatic variations for bacterial A sustainability plan included continual education, audits, or fungal keratitis. Acanthamoeba keratitis was highest in and annual meetings with the consensus group. As a result the hot summer climate and the highest rates of viral keratitis of the annual meetings the guideline was revised with new occurred in oceanic climates. However, further studies recommendations for epithelial HSK and endothelial HSK would be needed to establish robust climate trends. ABSTRACT 95

37. The octopus strap – friend or foe? Recent trends in Results: The meibography method was easy to use and read- octopus strap related eye injuries in Melbourne, Victoria ily integrated into a busy oculoplastic clinic. Patient tolerabil- ity was excellent, being reported as “acceptable” or “perfectly Philip Rothschild1,2, Thomas Campbell1 acceptable” throughout. Kappa values of three different grad- Email: [email protected] ing scales of the images were poor to fair, confirming that the 1Royal Victorian Eye and Ear Hospital, Melbourne, interpretation of meibography using currently available grad- Australia, 2Barwon Health, Geelong, Australia ing scales remains somewhat subjective. Conclusions: Reliable, patient friendly and cost-effective Purpose: To assess the rate of eye injuries caused by Octo- image-capture method for meibography can be performed using pus straps and other elastic straps at the RVEEH (Royal Vic- a standard SLR camera and an infrared lens filter. However, torian Eye and Ear Hospital). regardless of method used for image capture, an improved vali- Method: We assessed the number of patients presenting to dated grading assessment scale for interpretation of images, with the Eye Emergency Department (ED) of the RVEEH with octopus strap and other strap-related injuries, from 2006 to higher kappa values and coefficient of variation is required. 2018. Search terms used in the ED database to identify these patients were: “(occ* OR bunge* OR octop*) AND strap”. Results: 174 patients (146 male and 28 female) presented to 39. Effect of laser peripheral iridotomy on corneal the RVEEH ED from 2006 to 2018. Of these presentations, endothelial cell density there were eight perforated globes, all of which required surgical intervention. The most common injuries post strap- Luke Moriarty1, Keith Ong1 related injury were traumatic hyphaema and corneal abrasion Email: [email protected] at 69 and 46 presentations, respectively. 1The University of Sydney, Sydney, Australia Conclusion: Octopus strap and other strap-related injuries remain a significant part of the cohort of unusual eye injuries Purpose: To evaluate the impact of laser peripheral at the RVEEH. Further preventative efforts are needed to iridotomy on corneal endothelial cell density. lessen the likelihood of eye injuries caused by octopus straps. Method: This retrospective cohort study investigated 66 patients (117 eyes) who underwent laser peripheral iridotomy using a YAG laser 1064 nm. Corneal endothelial 38. Evaluating a simpler method of non-contact infrared cell densities were measured immediately pre-procedure, meibography using still photography and one-month post-procedure using specular microscopy. Results: A change in mean cell density of 12.8 cells/mm2 Katja Ullrich1, Raman Malhotra2, Nikhil Cascone2,We 2 2 was observed between the pre-procedure cell density (2484 Fong Siah , Andre Litwin ± 321 cells/mm2) and post-procedure cell density (2471 Email: [email protected] ± 320 cells/mm2), however this change was not statistically 1 Queen Victoria Hospital, East Grinstead, United States significant (P = 0.471). Minor Outlying Islands 2Queen Victoria Hospital East , , No statistically significant correlation was found between Grinstead, UK amount of laser energy used for the procedure and change in Purpose: Whilst clinicians have used a variety of surrogate mean cell density (Pearson coefficient: -0.061, P = 0.513). markers for assessing Meibomian gland function, only Conclusion: For patients undergoing laser peripheral meibography can produce an objective assessment of iridotomy, no statistically significant change in corneal endo- Meibomian gland morphology. Until now, meibography has thelial cell density was observed. Furthermore, no statistically been of limited use in clinical practice due to the cost of significant correlation was found between amount of laser instrumentation, clinician time required for image acquisi- energy used for the procedure and change in cell density. tion, selection of still images from video and then image These findings suggest laser peripheral iridotomy has negligi- evaluation. ble impact on corneal endothelial cell density. Methods: We trialed a non-contact technique for meibography utilising a still photography camera and commonly available equipment. The participants completed an Ocular Surface Dis- 40. Is pterygium an indicator of an increased risk of ease Index (OSDI) questionnaire. Standard clinical dry eye developing cutaneous melanoma? – Retrospective study assessment included Schirmer's tear test, tear film break-up in the UK time and biomicroscopy. Meibography images were obtained using a standard SLR camera with an attached infrared filter. WITHDRAWN 96 POSTER ABSTRACTS

41. Retinal photocoagulation using a 532 nm laser does 1University of New South Wales, Sydney, Australia, 2Save not cause corneal endothelial changes Sight Institute, Sydney, Australia, 3Sydney Eye Hospital, Sydney, Australia Aran Kanagaratnam1, Keith Ong1 Purpose: To compare the management of Herpes Zoster Email: [email protected] Ophthalmicus (HZO) in a quaternary referral hospital 1Sydney Medical School, Sydney, Australia with treatment guidelines derived from randomised Purpose: During retinal photocoagulation (RP) laser trials. energy traverses the cornea to reach the retina. A retro- Methods: A review of the literature was conducted to iden- spective cohort study was performed to determine if tify evidence based ‘guidelines’ for the management of there were quantitative and morphological changes on HZO. A retrospective case series was conducted of patients corneal specular microscopy to the corneal endothelium treated for HZO at Sydney Eye Hospital between 2013 and after RP. 2017 with a positive PCR result for Varicella Zoster Virus Methods: 132 eyes from 74 consecutive patients who under- DNA (n = 182). Data on management and outcomes were went RP were included. Corneal specular microscopy was extracted from medical records. performed immediately before and after each procedure and Results: The antiviral dose prescribed matched the derived “ ” at 1-month post-procedure. Microscopy data included quan- guidelines in 113 (74%) patients and both the dose and ‘ ’ titative measures such as cell density and central corneal duration aligned with guidelines in 90 (63%) patients. Only 49% of patients had presented to SEH and 42% of all thickness (CCT), and morphological measures including per- patients had been commenced on oral antivirals within centage of hexagonal cells (pleomorphism) and coefficient 72 hours of symptom onset. There was no difference in final of variation in cell area (polymegathism). visual acuity or persistence of ocular lesions when antivirals Results: The mean endothelial cell density pre-RP was 2559 were initiated within or outside of 72 hours (P > 0.05). The ± 308 cells/mm2, which was unchanged at 2549 ± 287 cells/ average age of the patient at the first episode of HZO was mm2 post-RP and 2549 ± 307 cells/mm2 at 1 month 53.4(+19.2); 131 (63%) patients were < 60 years old. (P > 0.05). The mean CCT was 541 ± 34 μm pre-RP, and this Conclusions: Management of acute HZO was inconsistent was unchanged post-RP and at 1 month (P >0.05). with guidelines from randomised trials in a third of cases. The mean coefficient of variance of cell area was 38.1 ± 5.5 Patients often presented and commenced antiviral treatment pre-RP, 40.2 ± 6.8 post-RP and 39.4 ± 6.4 at 1 month. There outside of 72 hours, however this was not found to correlate P was a significant increase ( = 0.001) between pre-RP and with inferior outcomes. Prospective clinical trial evidence post-RP but no significant change between pre-RP and 1 month and local guidelines are needed to optimise the management μ (P > 0.05). The baseline CCT was 541 ± 34 mpre-RP,and of HZO. there were no significant changes post-RP or at 1 month. Conclusion: RP was not associated with changes to corneal endothelial cell density, CCT or pleomorphism. It was asso- 44. Comparison of the effect of human platelet lysate and ciated with a small, transient increase in polymegathism that foetal bovine serum on human corneal endothelial cell did not persist to 1 month. cultivation

42. Immunohistochemical study of corneal epithelial cells Li Wen1, Monira Hoque1, Meidong Zhu1,2, Jingjing You2, following autologous limbal stem cell transplant in Gerard Sutton1,2, Constantinos Petsoglou1,2,3 chemical burns Email: [email protected] 1New South Wales Tissue Banks, New South Wales Organ WITHDRAWN and Tissue Donation Service, Sydney, Australia, 2Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Camperdown, Australia, 3Corneal Unit, Sydney 43. Clinical translation of recommendations from clinical Eye Hospital, Sydney, Australia trials for the management of Herpes Zoster Ophthalmicus Purpose: To explore the possibility of human platelet lysate (hPL) to replace foetal bovine serum (FBS) in human cor- 1 2 neal endothelial cell storage and culture. Neeranjali Jain , Maria Cabrera-Aguas , Stephanie 2,3 Method: B4G12, an immortalizing human corneal endothe- Watson Email: [email protected] lial cell line and primary human corneal endothelial cells ABSTRACT 97

(HCEnCs) were used in this study. Human platelet lysate 5% Results: Seventeen eyes from 17 patients (mean age (hPL) or foetal bovine serum 5% (FBS) were supplemented 68 [IQR 63-76], 47% male) were included. All eyes had to cell culture media respectively. Incucyte Zoom, ala- CCh (one-location [n = 4], two-locations [n = 6], whole-lid marBlue and Brdu assay were used to observe the cell prolif- [n = 7]). Slit-lamp and keratograph measurements of CCh eration and viability. LDH assay was applied to examine the extent and height correlated (P < 0.001). One-location-CCh cell death. Immunofluorescence staining and western blot involved temporal- (n = 3) or nasal-conjunctiva (n = 1), were employed to assess the expression of human corneal while all two-location-CCh involved both. Whole-lid-CCh endothelial cells specific markers Na/K ATPase, ZO-1 and had greater fold-height at each location vs one- and two- N-cadherin under each culture media. location-CCh. CCh extent positively correlated with nasal- Results: The results from IncucyteZoom and alamarBlue (P = 0.012) and middle-CCh fold-height (P < 0.001). shown the cell growth rates are similar when (HCEnCs) cul- Increased CCh extent (one-location vs two-location vs tured in either media supplemented with 5% hPL or 5% whole-lid) was associated with higher average OSDI (23.2, FBS. The results from Brdu and alamarBlue assays, and 28.2, 29.5 respectively) and bulbar injection (1.3, 1.6, 1.7 Incucyte Zoom analysis shown that the proliferation and respectively). Qualitative grading of temporal- and nasal- growth rate of HCEnC are similar in both conditions. Immu- CCh height (c.f. TMH) correlated with quantitative measure- nofluorescent staining and Western Blot results shown a ments (millimetres) using the keratograph (P = 0.003 and similar expression of Na/K ATPase, ZO-1 and N-cadherin P = 0.025 respectively). on both different culture condition. Conclusion: The keratograph is a novel tool for evaluating Conclusion: This in vitro experiment demonstrated that CCh. Further evaluation of its relationship with OSD param- the HCEnCs were able to be grown healthily with culture eters will assist in developing a quantitative grading scale medium supplemented with hPL instead of FBS. It sug- for this common condition. gests that hPL can be considered as a supplement for HCEnC culture thus being able to replace an animal derived product with human sourced product of equiva- 46. Keratoconus in Down syndrome: Hidden in plain sight! lent efficacy.

Joyce Mathan1, Akilesh Gokul1, Samantha Simkin1, Jay Meyer1, Dipika Patel1, Charles McGhee1 45. A prospective evaluation of conjunctivochalasis in Email: [email protected] cataract patients utilising the OCULUS keratograph 5 M 1Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand King F. C. Leung1,2, Jessica Xiong1,2, Pauline Khoo1, Kenneth G.-J. Ooi1, Stephanie L. Watson1,2 Purpose: Keratoconus affects approximately 0.05% of the Email: [email protected] general population, while, international evidence suggests 1University of Sydney, Save Sight Institute, Sydney, keratoconus may affect 0%-71% of individuals with Down Australia, 2Sydney Eye Hospital, Sydney, Australia Syndrome (DS). This study aimed to investigate the prevalence of keratoconus among individuals with DS in Purpose: Current conjunctivochalasis (CCh) grading scales New Zealand. are qualitative. We aimed to evaluate the keratograph as a Method: Participants in this prospective observational study novel tool to quantify the presence of CCh in patients under- underwent corneal tomography with the Pentacam AXL going cataract surgery. (Oculus, Wetzlar, Germany), corneal topography with the Method: A prospective observational study of patients Tomey TMS-4 N (Topographic Modelling System, Tomey, undergoing routine cataract surgery at Sydney Eye Hos- USA) and auto-refraction. Participant demographics were pital was conducted. Pre-operative CCh and ocular sur- collected. Keratoconus or suspect cases were determined by face disease (OSD) parameters were evaluated using slit- an anterior segment specialist Ophthalmologist. lamp biomicroscopy and keratography. The location of Results: The study is ongoing and preliminary data is pres- CCh (nasal/middle/temporal inferior bulbar conjunctiva), ented. Forty participants were recruited, 11 were excluded extent (number of locations involved), and height of from analysis due to inability to undergo imaging or CCh folds at each location (in millimetres and compared unreliable results. Mean age of those included was 21 with tear meniscus height [TMH]) were recorded. The ± 11 years, 66% were male and 69% were European. Eight Ocular Surface Disease Index (OSDI) questionnaire was (27.6%) participants had keratoconus or were classified as administered. suspects. Mean maximum keratometry was higher in the 98 POSTER ABSTRACTS keratoconus/suspect group than the non-keratoconus group, Patients with UL meiboscore 1-3 had higher OSDI (32.7 55.6 ± 12.7D and 46.8 ± 1.7D (P = 0.01), respectively. ± 22.8 vs 3.3 ± 5.8, P = 0.001). Mean minimum pachymetry for the keratoconus/suspect and Conclusion: The keratograph was able to evaluate features non-keratoconus groups was 445 ± 73 μm and 502 ± 39 μm of MGD in pre-CS patients. Further studies are needed to (P = 0.093), respectively. Mean spherical equivalent for the establish its clinical utility in identifying patients at risk of keratoconus/suspect and non-keratoconus groups was dry-eye post-CS. −1.69 ± 6.58D and − 0.45 ± 6.69D (P = 0.693), respectively. Of the participants in the keratoconus/suspect group that underwent auto-refraction, 5/6 individuals were 48. Topical corticosteroid use as adjunctive therapy for hyperopic. bacterial keratitis Conclusion: Keratoconus was detected or suspected in 1 1 27.6% of individuals with DS. Corneal tomography is ideal Pauline Khoo , Maria Cabrera-Aguas , Stephanie 1,2 but is challenging in a population with intellectual disability. Watson A hyperopic refraction may not preclude an individual with Email: [email protected] 1 DS from requiring keratoconus screening. The University of Sydney, Save Sight Institute, Sydney, Australia, 2Depatment of Ophthalmology, Sydney Eye Hospital, Sydney, Australia

47. Meibomian gland dysfunction in cataract surgery: A Purpose: To report the usage patterns of topical steroids as novel evaluation using the oculus keratograph 5 M adjunctive therapy for bacterial keratitis and to analyse the clinical features and patient outcomes. Jessica Xiong1,2, King F. C. Leung1,2, Pauline Khoo1, Methods: A retrospective case-series included all patients Kenneth G.-J. Ooi1, Stephanie L. Watson1,2 with a positive corneal scrape from January 2012 to Email: [email protected] December 2016 at the Sydney Eye Hospital. Cases were iden- 1University of Sydney, Save Sight Institute, Sydney, tified from pathology results and ICD-10 coding, and data Australia, 2Sydney Eye Hospital, Sydney, Australia collected from medical records. Visual acuity (VA) was converted from Snellen to logMAR. Outcome was determined Purpose: To utilise the keratograph to evaluate the presence based on final VA and any complications during treatment. of meibomian gland dysfunction (MGD) in patients prior to Results: 313 cases in 308 patients with median age of cataract surgery (CS). 51 years (IQR 36-72) and 48% female were included. Topi- Methods: A prospective cohort study was conducted. cal steroids were used as adjunctive therapy in 192 (61%) Patients undergoing age-related CS at Sydney Eye Hospital cases. Median time until implementation of steroid use was were included. Patients completed the Ocular Surface Dis- 4 days (IQR 3-7). High-dose was prescribed in 22 (11%) ease Index (OSDI) and were evaluated with keratography cases, regular-dose in 86 (45%), low-dose in 84 (44%). (lipid-layer thickness (LLT) graded normal/thick/thin based Median VA at initial presentation was 1 logMAR (IQR on Oculus reference images, and meibomian-gland 0.5-1.8). 81% of cases had an epithelial defect, with a (MG) dropout via meiboscore for upper (UL) and lower lids median size of 4 mm2(IQR 1-10). Change in VA was 0.33 (LL)) and slit-lamp (tear break-up time [TBUT] and meibum (IQR 0.08-0.7) vs 0.30 (IQR 0.08-0.7), steroid vs no steroid expression). Meiboscore was graded from 0-3 (0 = no loss, group, respectively (P = 0.620). Healing time was 11 days 1 = 1/3 loss (mild), 2 = 1/3-2/3 loss (moderate) and (IQR 5-23) vs 6.5 (3-12), steroid vs no steroid group, respec- 3= > 2/3 loss (severe)). tively (P = 0.001). Patient outcome was insignificant in the Results: Seventeen patients, median age of 67 years (IQR univariate analysis (P = 0.439). 63-76) and 47% males, were included. The median OSDI Conclusion: The study showed significantly shorter healing and TBUT were 23 (IQR 7-55) and 8.5 seconds (IQR 7-11) time in no steroid group, but no significant difference with respectively. With keratography, the LLT was thin in 41%, change in VA or patient outcomes with the use of topical normal in 41% and meiboscore of UL and LL were > 0 for steroid as adjunctive therapy for bacterial keratitis compared 82% and 53% respectively. Patients with thin LLT had to no steroid group. higher OSDI than those with normal LLT (38.9 ± 24.2 vs 18.2 ± 8.1, P = 0.09). Meibum expression was abnormal in 41%, with 12% of patients’ meibum inexpressible. Of these 49. iFixInk has the potential to act as a wound sealant 12%, all had LL meiboscore = 3. Moderate-severe dropout for corneal injuries and in surgery was seen in UL and LL for 35% and 53%, respectively. ABSTRACT 99

Hannah Frazer1, Adam Taylor2, Chris Hodge3,4, Con 1University of Sydney, Sydney, Australia, 2Save Sight Petsoglou1,3, Pierre Georges3, Jingjing You1,5, Gordon Institute, Sydney, Australia, 3Vision Eye Institute, Wallace2, Gerard Sutton1,4,3 Chatswood, Australia, 4NSW Tissue Bank, Sydney, Email: [email protected] Australia, 5University of Technology, Sydney, Australia 1Save Sight Institute, Sydney Medical School, University of Purpose: Keratoconus (KC) is a multifactorial disease, Sydney, Sydney, Australia, 2Intelligent Polymer Research affecting 1/2000 individuals. Currently there is little consen- Institute/AIIM Faculty, University of Wollongong, Sydney, sus on the aetiology of KC or a model of accurate progres- Australia, 3Lions NSW Tissue Bank, Sydney, Australia, sion prediction. This research was undertaken to consider 4Vision Eye Institute, Sydney, Australia, 5School of Optometry and Vision Science, University of New South the role of multifactorial variables in KC as a first step in Wales, Sydney, Australia developing a progression index. Methods: A retrospective study [HREC 2013/2041] of Purpose: Corneal injuries represent the most common oph- 124 Australian Keratoconus patients was undertaken to thalmic emergency presentation in Australia. We have previ- examine characteristics of the disease, with specific focus on ously developed a novel bioink (iFixInk) that is transparent, variables affecting disease progression. Variables considered biocompatible, biodegradable, 3D-printable and successfully included gender, ethnicity, eye rubbing, atopy, family his- promotes epithelial regeneration. This bioink can also be tory of keratoconus, age at diagnosis, presence of bio- used as a carrier for 3D cell-printing. We have now evalu- microscopic slit lamp signs and corneal topography. ated its potential to act as a sealant for complete corneal Results: Among recruited patients, 63% were male and 45% perforations. were females. The average age was 37.9 (±10.9). The study Methods: A wound of approximately 1.5 mm in diameter determined eye rubbing was significantly related to gender was created centrally in human corneas obtained from the with 60.8% of KC eye rubbing patients being male and 35.6% Lions NSW Tissue Bank. The corneas were then placed in a female (P = 0.009). Also significant was the relationship Hanna artificial anterior chamber (AAC). iFixInk (n = 3), between earlier mean age at diagnosis and eye rubbing Histoacryl (n = 3) or no sealant (n = 3) were administered (P = 0.002). There was a significant inverse relationship on the wounds and subjected to increasing pressures. The between atopy and pachymetry, where 84% of patients with- pressure at which perforated corneas with no sealant out atopy had thinnest pachymetry of <470 μm(P =0.004). exhibited stable leaking was measured and taken as the base- Conclusion: Eye rubbing is a key factor associated with line pressure inherent in the system. Failure of the sealant keratoconus, however our results indicated that it is also was determined to be when the wound was observed to leak associated with gender. It may be possible eye rubbing and and the burst pressure was calculated as the recorded pres- gender should be a combined indicator for keratoconus. Fur- sure at this time point with the baseline pressure subtracted. thermore, we observed an inverse relationship between Results: Stable leaking with no sealant was observed at 58 atopy and pachymetry in keratoconus which has not been ± 4 mmHg. The iFixInk remained intact when subjected to reported before. This suggested atopy could have a distinct burst pressures that well exceed intraocular pressure (97 role in keratoconus development, with further in-depth stud- ± 21 mmHg). The seal between the cornea and the AAC ies required. began leaking before the Histoacryl seal burst (395 ± 24 mmHg). Conclusion: These preliminary results demonstrate that 51. Age impact on corneal endothelial cell density and iFixInk can be used not only to promote epithelial regenera- viability preserved with organ culture method in New tion and as a cell therapy, but also as a sealant for small cor- South Wales tissue banks neal perforations and as a biocompatible alternative to cyanoacrylate glue. Melvin Ling1, Jaime Juarez1, Pierre Georges1, Christopher Hodge1, Jane Treloggen1, Gerard Sutton1,2, Con Petsoglou1,2, Meidong Zhu1,2 50. Analysing key multifactorial variable relationships in Email: [email protected] keratoconus 1New South Wales Tissue Banks, Sydney, Australia, 2Save Sight Institute, the University of Sydney, Sydney, Australia Nicole Hallett1,2, Ashima Aggarwala2, Mario D’Souza1, Chris Hodge2,3,4,5, Gerard Sutton2,3,4, Jingjing You1,2 Purpose: The purpose of this study was to determine the Email: [email protected] influence of donor age upon corneal endothelial cell density 100 POSTER ABSTRACTS and cell viability for corneas stored in organ culture This study aimed to identify risk factors for progression of medium. in keratoconus. Method: Donor corneas stored in organ culture medium at Methods: Untreated keratoconus patients enrolled in the the New South Wales Tissue Banks between 1 April 2014, prospectively designed Save Sight Keratoconus Registry and 31 December 2018 were reviewed retrospectively. Cor- with data from June 2000 to June 2019 were included. neas were divided into groups of low endothelial cell density The proportion of eyes with sustained progression of ≥10 letters (<2200 cells/mm2) and adequate endothelial cell density VA loss, ≥1.5D Kmax or ≥ 20 μm pachymetry increase within (≥2200 cells/mm2), as well as low cell viability (≤70%) and 3 years was estimated. Sustained progression was defined as adequate cell viability (>70%). Two-sample t-test was used maintained across 2 consecutive visits. The baseline predictors to compare age between these groups. Pearson’s correlation of VA, Kmax and pachymetry progression were evaluated using coefficient was used to investigate linear relationships across random-effects Cox-proportional hazards models. age, endothelial cell density, cell viability and endothelial Results: 2777 eyes of 1627 patients (mean age 26.3 years) cell loss. were included. There were 128 VA-progressors, 196 Kmax- Results: A total of 3203 corneas were included in this anal- progressors, 172 pachymetry-progressors and 2377 eyes that ysis. Of these, 4.2% (136/3203) were discarded due to were stable in all-parameters. There were 41 VA + Kmax- either low endothelial cell density, low cell viability, or progressors, 41 VA + pachymetry-progressors, 74 Kmax both. The mean endothelial density was 2997.9 ± 432.18 +pachymetry-progressors and 22 all-parameter-progressors. cells/mm2 and the mean viability was 94.56 ± 6.56%. A The risk of VA-progression increased by 14.5% with a significant difference (P < 0.001) was identified between 1-line increase in baseline VA (P = 0.005) and 9.6% with a the donor age for corneas with low endothelial cell density 1D increase in baseline Kmax (P < 0.001); of Kmax- (mean 69.28 ± 11.86 years) compared to those with progression increased by 7.2% for every 1-year younger age satisfactory endothelial cell density (mean 62.39 ± at baseline (P = 0.001); and risk of pachymetry-progression 14.18 years). There was a significant positive correlation decreased by 7.2% with a 1-line increase in baseline VA μ between final endothelial cell density and viability (P = 0.046) and increased by 14.5% for every 10 m (r = 0.617, P < 0.001). increase in baseline pachymetry (P < 0.001). Conclusion: Corneas with low endothelial cell density were Conclusion: Higher baseline Kmax, pachymetry, and youn- obtained from significantly older donors compared to cor- ger age were predictors of progression. Higher baseline VA neas with satisfactory endothelial cell density. Further stud- was a predictor of VA progression but protective for ies are warranted to investigate the other impact factors on pachymetry progression. These patients should be followed low cell density and viability. up closely and considered for CXL.

52. Corneal collagen crosslinking in keratoconus using 54. Retrospective study on prevalence of HIV-AIDS sero- rapid treatment protocol: A regional centre experience positivity among patients with conjunctival squamous cell carcinoma in port Moresby General Hospital Eye Clinic from 2005 to 2012 WITHDRAWN

Waimbe Wahamu1 53. Who needs cross-linking? Predictors of progression Email: [email protected] 1 in untreated keratoconus: A Save Sight Keratoconus Mt Hagen, PNG, Papua New Guinea Registry study Purpose: To determine the prevalence of HIV-AIDS Sero- positivity among patients with conjunctival squamous cell 1 1 1 1 Alex Ferdi , Vuong Nguyen , Himal Kendal , Jeremy Tan , carcinoma who attended Port Moresby General Hospital Stephanie Watson1 (PMGH) Eye clinic from 2005 to 2012. Email: [email protected] Method: Total of 43 clinical files of patients with abnormal con- 1 Save Sight Institute, Sydney, Australia junctival lesions who attended PMGH Eye clinic were retrieved. Purpose: Identifying keratoconus patients at high-risk of HIV-AIDS sero-positivity result for each patient were also progression is important in monitoring and can facilitate followed up. A case was defined as HIV-AIDS positive patient timely corneal cross-linking (CXL), but evidence for this is with histologically proven conjunctival squamous cell carcinoma. emerging. Results: Eleven patients had HIV-AIDS screening done of which seven were confirmed to be infected while four were ABSTRACT 101 negative. More males were infected (55%) than females Emmanuel Marinos1,2, Maria Cabrera-Aguas1,2, Stephanie (45%). Majority(57%) of cases were in the early thirties. Watson1,2 Conclusion: Conjunctival squamous cell carcinomas are Email: [email protected] more frequent in HIV-AIDS infected patient. HIV -AIDS 1Sydney Eye Hospital, Sydney, Australia, 2The University of sero-prevalence rate is 64% affecting the productive popula- Sydney, Sydney, Australia tion in early thirties. Majority (74%) of patient were not Purpose: To find correlations between viral and patient tested for HIV- AIDS. Greater need exist to do more HIV - characteristics on disease outcomes and to assess the rates of AIDS screening on all patients on initial presentation. antibiotic and steroid use in patients with viral conjunctivitis prior to and after assessment by ophthalmology trainees. EPIDEMIOLOGY /PUBLIC HEALTH Methods: Retrospective single-centre case series of 368 eyes of 224 patients diagnosed with viral conjunctivitis at the Sydney Eye Hospital from 1 January – 31 March 2017. 55. Rapid assessment of avoidable blindness in Kabul, Patients were identified from hospital records or polymerase Afghanistan chain reaction results. Results: 368 eyes of 224 patients, median age 35.3 (range 1 Qais Nasimee 7-82) and 59.8% males, were included. 152 (67.9%) patients Email: [email protected] presented already on antibiotic treatment. Most patients 1 Afghanistan Society of Ophthalmology, Kabul, Afghanistan (83.5%) had no previous ocular history aside from 35 (15.6%) who were regular contact lens wearers. PCR was performed in Purpose: The overall objective of this survey is to assess the 170 (75.9%) patients, with 92 (54.1%) positive for adenovirus, magnitude of blindness and visual impairment, its causes and 7 (4.1%) for HSV. The average duration of symptoms prior and the impact of existing eye care services in Afghanistan to presentation was 6.3 days. 177 (78.0%) patients presented by using epidemiologically sound survey methodology. This within 1 week of symptom onset and these patients were more information’s is expected to cater the need of evidence based likely to be adenovirus positive on PCR (OR = 2.37). Patients planning of eye care services in the country. with symptoms of longer duration were more likely to have Methods: RAAB6 survey methodology was used for survey bilateral involvement (OR = 1.78), photophobia (OR = 2.96), design and data collection in this survey. The survey was car- and have had steroid treatment (OR = 3.80). ried out by creating sampling frame covering Kabul Province. Conclusions: Contact lens wearers were over-represented in A total of 3850 people age 50 and over were enrolled in our sample, but further studies are required to suggest a cor- 77 clusters selected according to population proportionate relation between contact lens wear and viral conjunctivitis. to size. Topical antibiotics were frequently given to patients with Results: The study achieved over all 97.4% response rate. viral conjunctivitis suggesting misdiagnosis or overtreatment The survey estimated sample prevalence of blindness (PVA). of viral conjunctivitis in these patients. The survey estimates that there are 9014 people having severe visual impairment and 28 388 people with moderate visual impairment in Kabul province. Similarly prevalence 57. Eye trauma due to firecracker in the eve of Diwali of early visual impairment (PVA). (festival of light) in Coastal Odisha and their Conclusion: The result shows that Kabul province has high management prevalence of blindness in this age group compare to other neighbouring countries. A big back log of bilateral blind and WITHDRAWN visual impairment due to cataract is estimated in this province. The cataract surgical coverage and visual outcome of cataract surgery needs further improvement. Along with cat- 58. Sumba eye program update aract there are other problem such as age related macular degeneration, glaucoma, diabetic retinopathy and corneal Mark Ellis1,2, Peter Lewis3, Peter Stewart3,4 lesion as either emerging or persistent issues to be resolved. Email: [email protected] 1FRANZCO, Melbourne, Australia, 2FRACS, Melbourne, Australia, 3BOptom, UNSW, Australia, 4Bsc, Sydney, 56. Viral conjunctivitis: A retrospective study in an Australia Australian hospital Purpose: The Sumba Eye Program (SEP) is fully voluntary eye care program, whose purpose is to provide ophthalmic 102 POSTER ABSTRACTS and optometric eye care to the under resourced East Indone- Results: 270 presentations (F = 150, M = 115) were identi- sian Island of Sumba. It has expanded to involve. fied, with a mean age of 81 years (range 65-102). Most falls 1.) Service delivery of mainly cataract surgery and provision occurred at home. The most common primary ocular diagno- of spectacles. ses were orbital fracture (n = 189), subconjunctival 2.) Education and sponsoring local Eye Care Nurses (ECN). haemorrhage (n = 55), globe rupture (n = 22), retrobulbar and haematoma (n = 21) and lid laceration (n = 14). 91% 3.) Collaboration with Indonesian Ophthalmologists from (n = 245) of patients required admission. 29% (n = 77) the Ophthalmology Department, Hasanuddin University, require surgical management of their ocular injuries. The Makassar, Sulawesi (UNHAS) and the Ophthalmology most commonly associated injuries were intracranial Department, Udayana University, Denpasar, Bali. haemorrhage and fractures (including rib, vertebral and Method: The SEP conducts six monthly eye camps on the long bone). island of Sumba. One is a screening camp, where the SEP Conclusion: Elderly falls may be associated with sight members put the ECNs though intense update in their train- threatening ocular injuries. Falls with ocular trauma appear ing. Both camps are conducted in conjunction with the Indo- to be associated with more severe injuries and high admis- nesian ophthalmologists. The ECNs measure the visual sion rate. Examination in these unwell patients is challeng- acuity of the patients after surgery and go to the villages to ing and distracting injuries are commonly present. Any find who they can as a follow up at 3 months. suggestion of ocular trauma requires prompt ophthalmic Results: In service delivery since 2007 to 2018, there opinion to ensure timely management of ocular injuries. have been. 1131 operations – 886 cataract extractions. – 9853 screened 7707 spectacles dispensed. 60. Seasonal variation in human adenovirus In the 2018 camp, there were follow up on uncorrected conjunctivitis: A 13-year observational study visual acuities of 61 cataract extraction patients. 89% were worse that 6/60 prior to surgery and at 3 months follow up Yi Fan (Eva) Tang1, Georgia Cleary1 all except one patient has 6/60 or better. Email: [email protected] Conclusion: The Sumba Eye Program is a comprehensive 1The Royal Victorian Eye and Ear Hospital, Melbourne, eye program achieving the aims of service delivery, training Australia of the local nurses in eye care and working in collaboration with the Ophthalmologists of Indonesia. Purpose: The aim of this project is to identify the caseload and seasonal variation of adenovirus conjunctivitis in a single specialised tertiary centre. To review the initial manage- 59. Ocular trauma associated with falls in the elderly: ment of patients diagnosed with viral conjunctivitis. A 10-year review Method: Patients presenting to Royal Victorian Eye and Ear Hospital (RVEEH) Emergency Department (ED) with a Philomena McNamara1, Wen-Shen Lee1, Robin diagnosis of viral conjunctivitis from January 2006 to March Meusemann1 2019 were identified from clinical coding records. Demo- Email: [email protected] graphics, other diagnoses and initial management offered in 1The Alfred Hospital, Melbourne, Australia ED were recorded and analysed. Positive polymerase chain reaction swabs during that period of time were also Purpose: Falls are the leading cause of injury related emer- analysed. gency presentations, hospital admissions and deaths in Results: 21134 patients were identified. 52% were male and Australians over 65. Elderly falls are an increasing public the average age of the patients was 40 years (range, health issue with the number of hospital admissions for fall- 7 months-96 years). 3426 (16.2%) microbiology swabs were related injuries increasing by an average of 3.6% per annum performed on the patients. The number of patients diagnosed between 2004 and 2014. Head strike occurs in 37% of elderly with viral conjunctivitis (clinically and swab positive) were falls placing this population at risk of associated ocular trauma. highest in November to January. The most commonly pre- Method: A retrospective review of all patients over 65 years scribed treatment was topical lubricants only (40.3%) of age referred to the Ophthalmology Department of a ter- followed up by a combination of different treatment includ- tiary referral hospital following a fall from standing height ing topical/oral antibiotics, topical/oral anti-histamines, oral between January 2009 and December 2018 to determine non-steroidal anti-inflammatories, anti-glaucoma drops and demographics, accident settings, injuries, interventions and cycloplegics (25.1%). A total of 2802 (13.3%) patients with outcomes of ocular trauma secondary to falls. ABSTRACT 103 a single diagnosis of viral conjunctivitis were prescribed top- 62. Pattern of ocular trauma at primary eye care centre ical antibiotics. in Bangladesh Conclusion: Awareness of the seasonal variation of adenovirus conjunctivitis will aid in earlier correct diagnosis of the Mohammed A. R. Akonjee1, Farzana A. Mishu2 condition, avoiding other excessive investigation and reduce Email: [email protected] antibiotic prescriptions. This study will inform physicians to 1Mugda Medical College Hospital, Dhaka, Bangladesh, be more aware of adenovirus conjunctivitis in patients pre- 2Birdem General Hospital, Dhaka, Bangladesh senting with a red eye during the months of November Purpose: To identify the population at risk, sources of eye through January. injuries and the common barriers for their early management at rural area of Bangladesh. Methods: This prospective study includes a total of 100 eyes 61. Smartphone applications in ophthalmology in 94 patients with the history of ocular injury presented at the emergency centre of a primary eye care centre of Daniel Hogarty1, Joseph Hogarty1, Alex Hewitt1,2 Bangladesh from June 2018 to December 2018. Informed Email: [email protected] consent was taken and approval was obtained from the Ethi- 1Centre for Eye Research Australia Melbourne Australia , , , cal Review Committee of the medical centre. Data were col- 2Menzies Institute for Medical Research, Hobart, Australia lected by interview and detail examinations and documented Purpose: Many ophthalmology-related smartphone applica- using a preformed data sheet including the demographic tions are available to the general public. It is important for data, sources of injury, types of injury, the interval between the clinician to understand what is available for their clinical the occurrence and presentation at the centre. We used the practice, as well as what is available for patients. This study Ocular Trauma Classification Group (OTCG) and the Bir- describes the nature and the spread of ophthalmology-related mingham Eye Trauma Terminology system (BETT) to classify different ocular trauma. smartphone applications. Results: Age ranges were 1.5 years to 75 years. Male were Method: Two investigators independently searched the 78.35% & female were 21.65%. 56% injuries were accidental Google Play and Apple App Store in May-June 2019 with occupational injuries. Common sources of eye injury the following search terms: “Visual acuity,”“Low vision,” included sharp objects used in occupational activities 43%, “Amblyopia,”“Strabismus,”“Squint,”“Lazy eye,”“Cornea,” blunt objects 23%, Chemicals 7%, Projectile objects 8%,Bird- “Diabetic Retinopathy,”“Anterior segment eye,”“Uveitis,” beak-5%, agricultural trauma 3% and miscellaneous 11%. “Toric,”“Retina,”“Ophthalmoscopy,”“Glaucoma,”“Macular Conclusion: Young adult males engaged in industrial, Degeneration.” Each result was independently assessed by mechanical, agricultural or domestic works are at particular reviewing the application information page and recorded if it risk for ocular trauma. Poverty, ignorance, indigenous treat- was relevant to the topic and the inputted search term. ment, remote communications and lack of supervised and Results: 271 and 170 ophthalmology-related smartphone collaborative management seems to be the possible barriers applications were found in the Google Play and Apple App for the early management of ocular injuries. Preventive mea- Store respectively (Google - 240 free, paid price range sures are recommended to adopt not only in the workplaces $1.39-199.00/month; Apple - 113 free, paid price range but also in domestic, recreational, sports and transport $1.49-109.99). There were smartphone applications for test- settings. ing visual acuity (45 Google; 23 Apple), assisting low vision users (86 Google; 55 Apple) and managing and diagnosing the sequelae of strabismus (45 Google; Apple 30). There 63. KeepSight may have limited impact in rural Western were also applications addressing anterior segment (32 Goo- Australia given poor uptake of National Diabetes gle; 17 Apple) and posterior segment issues (63 Google; Services Scheme registry 45 Apple). There were many unvalidated claims used for advertising many applications which could result in harm to Matthew Lee1, Angus Turner1, Mark Chia1 patients. Email: [email protected] Conclusion: A variety of clinical and patient-based ophthal- 1Lions Outback Vision, WA, Australia mology smartphone applications are available in the Google Purpose: KeepSight was launched to remind Australians Play and Apple App Store. Improved governance of the with diabetes mellitus (DM) to receive eye examinations at medical applications will be required to improve patient appropriate intervals. The programme leverages the National safety. Diabetes Service Scheme registry (NDSS), a national 104 POSTER ABSTRACTS registry of 1.3 million Australians with DM. The purpose of resulting algorithms were tested against four independent this study is to evaluate how representative the NDSS is for datasets for accuracy, sensitivity and specificity. guiding screening efforts in northern Western Results: The CNV neural network was 98.3% accurate, Australia (WA). 96.6% sensitive 100% specific. The drusen neural network Method: DM prevalence rates overall and amongst Indige- was 97.1% accurate, 95.5% sensitive and 98.7% specific. nous people according to the NDSS registry were extracted The DME neural network was 97.5% accurate, 98% sensitive from https://map.ndss.com.au/. Data was examined from and 97% specific. The learning curve shows a logarithmic northern WA, nationally, and a site with similar barriers pattern with steepest gains between sample size 10 and 200. to healthcare – Alice Springs. This was compared to the Conclusion: We present a learning curve extrapolation method self-reported rate of DM amongst Indigenous and non- to estimate the required training data size for OCT-based deep Indigenous Australians according to the National Eye Health learning. The learning curve is extremely steep with sample Survey (NEHS) (37% vs 13.9% respectively). sizes of 10 and 200. This theoretical learning curve can be a ref- Results: Registration rates in northern WA ranged from erence to determine the sample size needed for image-based 2.0-6.4% overall, and 2.5-9.4% amongst the Indigenous pop- deep learning. We conclude that a sample size of at least 200 is ulation, which were approximately 3.5x less and 6x less than the minimum required per class for OCT-based deep learning. NEHS estimations respectively. Nationally, registration rates were 5.1% overall and 4.7% amongst the Indigenous population, which were approxi- 65. Common ocular pathologies among paediatric age mately 2x less and 8x less than NEHS estimations group belonging to rural and backward community of respectively. North-East India In contrast, prevalence rates in Alice Springs were aligned 1,2 1,2 both overall (11.2% NDSS, 13.9% NEHS) and amongst the Harsh V. Singh , Iva R. Kalita Indigenous population (35.5% NDSS, 37% NEHS). Email: [email protected] 1 Conclusion: The study highlights the discrepancy between Aravind Eye Hospital & Post-Graduate Institute, 2 estimated prevalence of DM in northern WA and nationally Pondicherry, India, Regional Institute of Ophthalmology, when comparing data from NEHS to NDSS. In order for the Guwahati, India NDSS to be a reliable registry for Keepsight to guide appro- Purpose: The worldwide prevalence of childhood blindness priate eye screening, further work needs to be done to is estimated to be 1.4 million with India being the largest improve registration rates. inhabitant of blind children. The prevalence of childhood blindness in India is about 320 000, with 40-50% belonging to treatable blindness. As the knowledge of the prevalence & 64. Deep learning in optical coherence tomography: type of ocular morbidities is important for planning health Sample size requirements services. So, we aimed to report the prevalence of ocular morbidities & the common ocular pathologies prevalent in 1 1 1 Shong M. Voon , Sheng C. Hong , Kirsten Cheyne children (aged 8-15 years) belonging to backward commu- Email: [email protected] nity of Assam. 1 Southern District Health Board, Dunedin, New Zealand Methods: Population based, cross-sectional study conducted Purpose: Deep learning and convolutional neural networks in four randomly selected extremely backward communities can be used to analyse Optical Coherence Tomography of North-east India fulfilling the National Planning commis- (OCT) images to support decision making for a range of sion norms & 1244 children (aged 8-15 years) were screened ophthalmic pathologies. The aim of this study is to determine for ocular pathologies. Of which, 92 children with some and predict the sample size needed for OCT based deep form of ocular morbidities were further evaluated. Compre- learning for diabetic eye disease and macular degeneration. hensive ocular examination were done. Visual acuity were Methods: An Otago OCT database with 24 000 images was categorised into normal, low vision & visually blind (based used, with 3000 additional images from ImageNet. Four on NPCB criteria). Ocular morbidities were grouped into independent neural network architectures were designed functional, adnexal, anterior, posterior segment & whole with different sample sizes to detect CNV, DME, and macu- globe pathologies. Results: Overall prevalence of ocular morbidities was found lar drusen. The neural networks were trained with 10 differ- to be 7.4% (92 out of 1244) with the proportion of ocular ent data sets (10, 20, 30, 50, 100, 200, 500, 1000, 5000, and morbidities belonging to visually blind & low vision group 8000) using the Tensorflow Inception V3 framework. The were 10.9% & 46.7% respectively. The commonest ocular ABSTRACT 105 morbidities were traumatic cataract, corneal opacity, adnexal 67. The potential effects of the statins on the incidence infections and uncorrected refractive error. and progression of age-related macular degeneration Conclusion: Preventable childhood ocular diseases with potentially blinding effects are more common in these popu- Kenneth Ooi1, Pauline Khoo1, Veronika Vaclavik2 lation mostly because lack of access to basic health services. Email: [email protected] Proper awareness with assess to health services will signifi- 1Save Sight Institute, Sydney, Australia, 2Jules Gonin Eye cantly reduce preventable blindness in these groups. Hospital, Lausanne, Switzerland

Purpose: To review the effectiveness of the statins (HMG- CoA reductase inhibitors) in reducing either the incidence or 66. Prevalence of diabetic retinopathy in various ethnic progression of age-related macular degeneration (ARMD). groups and associated risk factors in patients attending a Methods: We searched MEDLINE, EMBASE, Cochrane tertiary care centre in North-East India library and PubMed from 1991-2019. We included all studies where statins were assessed for an effect on either the Harsh V. Singh1,2, Iva R. Kalita1,2 incidence or progression of ARMD. The primary outcome Email: [email protected] measures were a reduction in incidence and/or progression 1Aravind Eye Hospital & Post-Graduate Institute, of ARMD. Pondicherry, India, 2Regional Institute of Ophthalmology, Results: 22 studies were identified (981 149 patients). Guwahati, India Seven reported prospective data and of these 3 were random- Purpose: To describe the prevalence & severity of diabetic ized control trials. retinopathy among different ethnic groups of Northeast Seven studies showed a reduction in incidence ARMD with India & to study associated risk factors. 2 of these demonstrating a reduction of late ARMD with soft Design: Hospital based cross-sectional study. drusen and 1 a reduction of wet ARMD. Three studies, how- Methods: Total of 7133 cases among the age group of ever, showed an increase in wet ARMD incidence. Nine 20-79 years, attending the OPD, were screened for presence studies showed no effect on AMD incidence. of Diabetes Mellitus (HbA1c > 7 mg/dL or previously diag- Two studies reported a statin reduction in progression nosed). Of which, 780 (10.94%) had diabetes, who were ARMD with one a reduction of intermediate ARMD with evaluated for presence of any retinopathy (based on fundus Simvastatin 40 mg (maximal dose) daily over 3 years. photograph & fluorescein angiography), it’s grade (based on Another documented Atorvastatin 80 mg daily (maximal dose) regression of large soft drusen and associated pigment International diabetic retinopathy severity scale) and risk epithelial detachments with visual acuity gain (+3.3 letters, factors. DR cases were further grouped into different ethnici- P = 0.06) in 10 patients over >12 months. Four studies ties (Assamese, Bengali, Minor tribes, & other immigrants). reported no progression reduction. Results: Of the 780 diabetes, the overall prevalence of dia- Conclusion: Oral statins may reduce the incidence and pro- betic retinopathy was 30.0%, with Vision-threatening gression of ARMD as well as induce regression of drusenoid retinopathy & maculopathy being 10.00% & 4.49% respec- deposits. These effects may be attributable to their lipid low- tively. The prevalence of retinopathy ranges was highest ering as well as anti-inflammatory, antioxidant and anti- (50.00% among type 1 DM & 44.93% among type 2 DM) in vascular endothelial growth factor pleiotropic properties. ’ the immigrants group & lowest (16.67% among type Further work is needed to assess the long-term differential 1 DM & 22.35% among type 2 DM) in the tribal groups. effects of different maximally dosed statins. The risk factors with significant association (P-value <0.05) with presence of DR were longer diabetes duration, older age, family history of diabetes, higher HbA1c level, associ- 68. Effect of healthcare screening system on early ated hypertension, hypertriglyceridemia & pregnancy state. detection of glaucoma patients Conclusion: Every third diabetic pts had some form of DR with VTDR affecting every tenth pt. There was also wide Hyuk J. Choi1 variation in the prevalence of DR among ethnic groups & Email: [email protected] this difference cannot be attributed to variation in the known 1Seoul National University Hospital Healthcare System measurable risk factors among different ethnic groups. Thus, Gangnam Center, Seoul, Republic of Korea signifying the role of ethnicity in occurrence & severity of DR. Purpose: To investigate whether mass glaucoma screening relative to opportunistic case finding at a primary eye clinic is helpful for early detection of glaucoma. 106 POSTER ABSTRACTS

Methods: Subjects referred by glaucoma screening (by non- application programming interfaces. The distance and driv- contact tonometry and non-mydriatic fundus photography; ing times were calculated for each patient to travel to their group A, n = 220) and from a primary eye clinic (group B, referring optometrist. Analysis of driving time and visual n = 327) were retrospectively recruited. The positive predic- acuity was performed with subsequent multivariate regres- tive value (PPV) for glaucoma and the rate of glaucoma sion analysis incorporating ethnicity, first/second eye sur- awareness were compared. Also, for the newly diagnosed gery, gender, and deprivation. glaucoma (“definite glaucoma”) patients, the demographics Results: A total of 1264 patients were included for analysis. and structural and functional severities of glaucoma were Patients of Maori ethnicity were referred with significantly compared. worse visual acuity than NZ Europeans (LogMAR 0.979 vs Results: The PPV for definite glaucoma was 25.5% for group 0.621), and worse binocular visual acuity (LogMAR 0.309 A and 52.4% for group B. The rate of false-positive for “glau- vs 0.294). Maori reported significantly poorer quality of life. coma referral to tertiary hospital” was significantly higher in Driving time and distance to the referring optometrist aver- group A than for group B (38.6% vs 18.3%, P < 0.001). aged 50% longer for Maori compared with NZ Europeans Among the definite-glaucoma patients (group A: n = 56; (24.8 vs 16.6 km, 23.5 vs 16.8 minutes). group B: n = 182), the proportion of glaucoma awareness Conclusions: Maori present with lower visual acuity, and was significantly higher in group B (69.2%) than in group A poorer quality of life at time of referral for cataract surgery. (8.9%, P < 0.001). The mean deviation (MD) of visual field There is a geographic barrier for Maori to access ophthalmic (VF) was significantly higher in group A than in group B care and referral to tertiary services within the Waikato

(−3.08 ± 3.99 vs -6.70 ± 7.29 dB, Padjusted = 0.040), and the District. inferior and inferotemporal ganglion cell-inner plexiform layer (GCIPL) thicknesses tended to be greater in group A than in group B, with marginal significance (Padjusted <0.10). 70. Applied field epidemiology in the investigation of Conclusions: Glaucoma screening can be helpful for early adverse events of ophthalmic medical devices detection of glaucoma. However, improvement of the 1,2 1 2 screening strategy is needed in order to enhance its specific- Mario Vittorino , Ben Polkinghorne , Simon Singer ity for glaucoma. Email: [email protected] 1ANU, Canberra, Australia, 2TGA, Canberra, Australia

Purpose: Intraocular lens (IOL) opacification is a rare com- 69. Evaluating barriers to access for cataract surgery in plication after cataract surgery. However, it constitutes an New Zealand: Analysis of calculated driving distance important adverse event which can significantly reduce the and visual acuity at time of referral vision of affected patients, resulting in explantation or exchange of the medical device. We report an investigation Ben Wilkinson1, James McKelvie2,3 of an “outbreak” of cases that occurred in Australia, detected Email: [email protected] by the vigilance system of the Therapeutic Goods Adminis- 1Tairawhiti District Health Board, Gisborne, New Zealand, tration (TGA). 2Department of Ophthalmology, Faculty of Medical and Method: This is a descriptive case series which explores the Health Sciences, University of Auckland, Auckland, applicability of the standard 10 steps of disease outbreak New Zealand, 3Waikato District Health Board, Hamilton, New Zealand investigation within the regulatory environment of medical devices. Purpose: Access to healthcare is an important determi- Results: After detecting three incident reports for the same nant of health which is influenced by geographic loca- product implanted during a period of 5 months, an investigation. This cross-sectional study aimed to investigate tion of relevant adverse event reports was instigated accord- whether geographic proximity to primary and secondary ingly. During a period of less than 1 year, 11 cases of IOL ophthalmic services is associated with patient demo- opacification were reported to the TGA. The adverse event graphics and visual acuity at the time of referral for cat- notification rate in Australia was higher than the worldwide aract surgery. figure. The manufacturer of the device conducted additional Methods: Demographics for all patients referred within the investigations in the material and the manufacturing pro- Waikato District within the last 12 months that met threshold cesses. No root cause has been identified to date. No new for cataract surgery were analysed. GPS coordinates for all cases have been identified since 2018. patient and optometrist addresses were obtained from refer- Conclusion: It is important to understand the difficulties and ral data using R and the OpenStreetMap and Google Maps roadblocks in applying the methods to investigate infectious ABSTRACT 107 diseases outbreaks to medical devices. There are several limita- PHCs. Telephone interviews will be conducted from July to tions in the data available from adverse events reports related to improve response rates. IOLs, but by following a consistent method for investigation, a clearer perspective of the problem can be made, and the likelihood of understanding a medical device “outbreak” directly 72. The DR SPOC study: Diabetic retinopathy screening affecting the ophthalmological community is increased. in an outreach model

Lakni Weerasinghe1, Hamish Dunn1,2,3, Wah Cheung2,3, Glen Maberly2,4,5, Christian Girgis 2,3, Gerald Liew2,3, 71. Evaluating the efficacy of a diabetic retinopathy Helen Do2,3, Tien-Ming Hng4,5, Rajini Jayaballa4,5, Alison screening service in rural and remote primary health Pryke3, Belinda Ford1,3,6, Seema Gurung3, Sian Bramwell4, care clinics (PHCs) in Australia: A pilot study Manyu Shi3, Ramy Bishay4,5, Sumathy Ravi4, Gideon Meyerowitz-Katz4, Lisa Keay7,6, Andrew White2,3,7 1,2 1,3 3,4 Ivy Jiang , Muhammad A. Khan , Vincent Khou , Email: [email protected] 3,4 1,2 Barbara Zangerl , Ashish Agar 1 Faculty of Medicine, University of New South Wales, Email: [email protected] 2 Sydney, Australia, Faculty of Medicine & Health, 1 Faculty of Medicine, University of New South Wales, University of Sydney, Sydney, Australia, 3Westmead 2 Sydney, Australia, Department of Ophthalmology, Prince Hospital, Sydney, Australia, 4Blacktown Hospital, Sydney, 3 of Wales Hospital, Sydney, Australia, Centre for Eye Australia, 5School of Medicine, Western Sydney University, Health, University of New South Wales, Sydney, Australia, Sydney, Australia, 6The George Institute for Global Health, 4 School of Optometry and Vision Science, University of New UNSW Sydney, Sydney, Australia, 7School of Optometry and South Wales, Sydney, Australia Vision Science, UNSW Sydney, Sydney, Australia

Purpose: To determine current PHC screening and referral Purpose: Diabetic retinopathy (DR) is the leading cause of practices and outline the barriers and enablers to the Provi- blindness and visual disability in working-age adults and sion of Eye Health Equipment and Training (PEHET) affects 1-in-3 people with diabetes mellitus (DM). While programme. timely diagnosis and intervention can prevent vision-loss in Method: 75 PHC personnel who had completed PEHET up to 90% of at-risk patients, national screening uptake is online training at least three months prior were invited to com- low. This study aims to determine the diagnostic utility of an plete a survey through PEHET online platform. easily-accessible outreach DR screening model at tertiary Results: Following three rounds of electronic mail-outs since point-of-care settings for high-risk populations. 7 March 2019 responses (9%) were received. 14 contacted Method: Cross-sectional, opportunistic, instrument-validation emails were inactive. Preliminary results, from multiple study on diabetic patients attending integrated-care or foot- response questions answered by 6 general practitioners and ulcer clinics at Blacktown or Westmead Hospitals, between 1 Aboriginal health worker, indicated images were assessed by optometrists (75%), general practitioners (57%), and oph- February-August 2019. DR-status was assessed using two- thalmologists (43%). Optometrists were the preferred referral field non-mydriatic fundus photography and electroretino- pathway in suspected or confirmed cases of diabetic retinopa- gram/pupillometry (ERG) [RetinaVue 100 & RETeval, Welch thy (DR). In severe forms of DR, PHCs were equally likely Allyn], with mydriatic photographs used as the reference stan- to refer to ophthalmologists and optometrists (43%). All per- dard. Results were graded by an ophthalmologist. sonnel agreed that retinal photography was “relevant” and Results: Recruitment, as of June 2019, was 188 patients, “effective” for screening, but only four believed screening 129 of whom had been assessed. Photographs on average was an “efficient use of time”. Barriers remain in low patient took only 4.6 minutes, while ERG took 3.7 minutes. Over- numbers to practice skills, limited scheduled time for non-GP all, 48 (37.2%) were diagnosed with any DR, while screening, and technical concerns. Enablers include strong 18 (14%) had vision-threatening DR (VTDR); 31 (64.6%) support by local or visiting optometrists and improved com- and 14 (77.8%) of which were previously undiagnosed, pliance in diabetes management. respectively. This prevalence is significantly greater than Conclusion: Optometrists are the predominant graders of community rates of DR (28.5%) and VTDR (4.5%), as retinal images. Despite widespread training in retinal camera reported by the 2014-2015 National Eye Health Survey. use, GPs perceive time and technical limitations in as bar- Conclusion: Outreach DR-screening at tertiary point-of-care riers to screening. More concerning, is the low response rate settings demonstrates a model of care which is easily- from trained practitioners, calling into question the actual accessible and successfully detects high levels of contribution of PEHET to improving DR screening rates in 108 POSTER ABSTRACTS undiagnosed DR, highlighting the value of targeted screen- Purpose: Open globe injuries are an important cause of ing for high-risk diabetic populations. blindness and visual impairment, however the epidemiology of open globe injuries in Tasmania has not previously been reported. 73. Ocular trauma in the Top End Method: A retrospective chart review was performed on all patients presenting to The Royal Hobart Hospital with open 1 2 1 Ario Wilson-Pogmore , Elysia Jongue , Hema Karthik globe injuries from 1 June 2009 to 30 April 2019. Email: [email protected] Results: 55 cases of open globe injury were identified in 1Royal Darwin Hospital, Darwin, Australia, 2Flinders 55 patients. Most patients were male (n = 44; 76.4%), and School of Medicine, Darwin, Australia average age at presentation was 43.3 (range: 3.1 to 92.4). Falls were the most common mechanism of injury (n = 15; Purpose: To report the epidemiology, aetiology and out- 27.3%). Delayed presentation (≥24 hours) occurred in comes of eye injuries at the Royal Darwin Hospital from 4 cases (7.3%). 2017-2018. There were 29 (52.7%) penetrating eye injuries, 24 (43.6%) Methods: A 2-year retrospective analysis was performed on globe ruptures, and 2 (3.6%) perforating eye injuries. Pre- all patients presenting to the Royal Darwin Hospital with senting visual acuity was <6/60 in 39 cases (70.9%). An eye injuries. Patients were identified using emergency diag- intraocular foreign body was present in 10 cases (18.2%), nostic codes. These medical records were analysed with 45 (81.8%) had a hyphaema, 22 (40.0%) had a lens-capsule respect to patient demographics, Indigenous status, mecha- breach, 33 (60.0%) had uveal tissue prolapse, and nism of injury, and visual acuity (VA) outcomes. Results: 169 eye injuries were identified. The mean age was 26 (47.3%) had a retinal detachment. 34.72 (±14.83), 79.4% were male, and 33.3% identified as 51 cases (92.7%) underwent a primary repair, 3 (5.5%) a pri- Indigenous. Notably, 52.12% injuries had an orbital fracture, mary evisceration, and 1 (1.8%) an enucleation. Of cases 11.5% were a result of chemical injury and 4.8% of were open undergoing primary repair, 17 (33.3%) had a subsequent globe injuries (OGI). The annual incidence of OGI was 5.38 in pars plana vitrectomy, 3 (5.9%) an enucleation, and 1 (2.0%) 100 000. 12.24% of injuries recorded VA of logMAR 1.00 or an evisceration. worse on presentation with 6.9% recording NPL; 52% of these Average follow-up was 11.2 months. Final visual acuity was patients improving to VA better than logMAR 1.00 on follow <6/60 in 33 cases (60.0%). Three delayed presentation cases had ≥ up. Overall mean VA improved by logMAR 0.27 (P = 0.023) visual acuities 6/12. There were no cases of endophthalmitis. Conclusion: from presentation. This study highlights the epidemiology and 50% of injuries were alleged assaults. Indigenous patients comparatively good visual outcomes of open globe injuries were identified to have a relative risk 2.26 times greater than in Hobart, Tasmania. non-Indigenous patients for assault related injuries. 12.7% patients were intoxicated at the time of injury with 85.7% of these injuries from an assault. 75. Surgical rehabilitation of ocular trauma in an Conclusion: 1 in 8 eye injuries present with a VA of 6/60 or Australian tertiary centre: A 10-year review of clinical worse. Most injuries occurred in men. 33.3% of presenta- outcomes and economic costs tions Identified as Indigenous-congruent with the Northern 1,2,3 4 Territory population. Indigenous patients were more likely Brendon W. H. Lee , Damien Hunter , Dana 1,3 1,2,3,4 to have sustained ocular injury from an assault. Majority of S. Robaei , Chameen Samarawickrama injuries associated with intoxication were related to assaults. Email: [email protected] 1Sydney Medical School, University of Sydney, Sydney, Australia, 2Faculty of Medicine, University of New South 3 74. Open globe injuries presenting to The Royal Hobart Wales, Sydney, Australia, Department of Ophthalmology, 4 Hospital : A 10-year retrospective study Westmead Hospital, Sydney, Australia, Westmead Institute of Medical Research, Sydney, Australia 1 1,2 1,2,3 Damien Ling , Thomas Bonnelame , Nitin Verma Purpose: Ocular trauma is a significant public health issue. Email: [email protected] In Australia, it accounts for 50 000 work-related injuries 1 Department of Ophthalmology, The Royal Hobart Hospital, annually totalling $60 million and is responsible for 16.7% 2 Hobart, Australia, Hobart Eye Surgeons, Hobart, of unilateral blindness. Australia, 3School of Medicine, University of Tasmania, Hobart, Australia ABSTRACT 109

This study investigated clinical outcomes and associated diabetic retinopathy (DR) in endocrinology and Aboriginal healthcare costs of ocular trauma at a tertiary referral centre Medical Services (AMS). in Sydney. Method: Adults with diabetes were recruited and screened for Methods: Retrospective, consecutive review of 156 injuries referable DR by local clinic staff. Participants underwent non- that presented to Westmead Hospital from December 2008 mydriatic, single field fundus photography and images were to November 2018. uploaded to a clinician interface for automated grading and real Injuries were classified using the Birmingham Eye Trauma time reporting of results. Patient and clinician acceptance were Terminology system. Clinical and demographical data were assessed using questionnaires and one-on-one interviews. extracted at initial, each follow-up, and final visit. The Ocu- Assessment of staff training, and image acquisition were used lar Trauma Score (OTS) was utilised as a prognostic tool. to determine feasibility. All images were manually graded by Results: Median age was 47 (range = 16-99), and 79.5% two retinal specialists to determine disease detection rates. were male. 55 (35.3%) were work-related with 89.1% wear- Results: 233 participants were screened for referable ing no eye protection. A high proportion of elderly were DR. Ninety-four percent of participants reported that they were injured from falls (46.7%). either satisfied or very satisfied with the automated screening Presenting mean LogMAR BCVA was 1.984 ± 0.083 model and 92% reported that they were likely or extremely (6/580) [95%CI = 1.818-2.150]. At final visit, it was 1.402 likely to use the service again. One-on-one interviews showed ± 0.093 (6/150) [95%CI = 1.218-1.586] with 46.2% attaining that overall, clinicians had positive experiences with the ≥6/60 and 6.2% requiring enucleation. The OTS effectively screening model and trusted the accuracy of the AI. The sensi- prognosticated visual outcomes (r = 0.782, P < 0.001). tivity, specificity and area under the curve of the algorithm for The median injury resulted in five hospitalised days correct referral was 84.4%, 87.6% and 0.86 respectively. (IQR = 5, range = 2-97), two theatre visits (95% Conclusion: Screening for referable DR using AI in real- CI = 1.7-2.1), and nine follow-up appointments (IQR = 10, world settings is accurate, feasible and well accepted by range = 1-45) over 5 months (IQR = 1.1, range = 0.06-120), patients and clinicians. This technology offers potential to equating to a healthcare cost of $33 150. increase the efficiency and accessibility of DR screening Conclusions: Ocular trauma has a high visual and economic programs. burden. Encouraging stricter safety policies could prevent workplace injuries. Cost-effective public health initiatives to improve visual function in the elderly, such as frequent 77. Causes of blindness in the Indigenous population of vision checks, visual aids, and cataract surgery when North Western Australia: A retrospective analysis needed, should be implemented to ameliorate the rising trend Sebastian Derham1 1 1 of injuries due to falls. , Steven Bartnik , Angus Turner Email: [email protected] 1Lions Outback Vision, Perth, Australia

76. Artificial intelligence assisted opportunistic screening Purpose: To assess the causes of blindness among Indige- for referable diabetic retinopathy: From algorithm to nous persons living in the region of North Western real world application Australia. Methods: In a retrospective observational study, clinical 1 1,2,3 1 Jane Scheetz , Mingguang He , Myra McGuinness data from over 25 000 clinical consultations was assessed. Email: [email protected] Consultations occurred between 2005 and 2018 with out- 1 Centre for Eye Research Australia, Royal Victorian Eye & reach optometry services in the geographical regions of Pil- 2 Ear Hospital, Melbourne, Australia, Ophthalmology, bara and Kimberley in Western Australia. Descriptive University of Melbourne, Department of Surgery, analysis was performed to assess the causality and distribu- Melbourne, Australia, 3State Key Laboratory of tion of blindness. Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat- Results: 9.6% of the population were blind (731 unilateral sen University, Guangzhou, China and 263 bilateral from 10 398 individuals). Mean age of Purpose: Prior to the widespread adoption of artificial intel- Unilateral Blindness was 62.0 ± 11.7 years, 50.3% female ligence (AI) systems in clinical care they must first be vali- (n = 368) and 49.7% male (n = 363). Mean age of Bilateral dated in real-world settings. The aim of this study was to Blindness was 64.6 ± 11.9 years, 57% female (n = 149). evaluate feasibility, end-user acceptance and accuracy of a Indigenous males in the Pilbara (10.4% of study population, deep learning algorithm for the detection of referable n = 109) were younger for unilateral (59.8 ± 9.4 years) and bilateral (58.7 ± 10.0 years) blindness. Refractive error was 110 POSTER ABSTRACTS excluded from analysis due to variability in the recording of clinicians at RVEEH on the incidence of adenoviral con- the data. Cataract was the cause of 41% of Unilateral Blind- junctivitis in the emergency department. This will highlight ness (n = 346) with Corneal Opacity (including Trachoma) the need to reduce the length of stay for each patient, and the causing 9.5% (n = 81) and Enucleation (n = 69) 8%. No need for appropriate conservative management and contact cause was recorded for 18% (n = 156). Cataract was the precautions. largest cause of Bilateral Blindness (42%, n = 134). Corneal Opacities (including Trachoma) accounted for 15% (n = 49) and Retinal causes (including Diabetic Retinopathy) 79. Performance of an “offline” deep-learning algorithm 8% (n = 26). on a smartphone vs manual ophthalmic grading for Conclusion: Cataract remains the leading cause of blindness detecting referable diabetic retinopathy in a large scale, in North Western Australia. Remote Australians still experi- prospective study using health workers, with no prior ence substantial barriers in accessing specialist services. Fur- experience in retinal imaging in Mumbai, India ther analysis will be performed to assess the factors associated with blindness in this population. Sundaram Natarajan1, Radhika Krishnan1, Astha Jain1, Ashwini Rogye1 Email: [email protected] 78. An analysis of adenoviral conjunctivitis presentations 1Aditya Jyot Eye Hospital, Mumbai, India to the Royal Victorian Eye and Ear Hospital, Melbourne Purpose: To evaluate the performance of the smartphone based Medios AI – an offline artificial intelligence algo- Lawrence Kwok1,2, Shivanand Sheth1,3, Kristen Wells1 Email: [email protected] rithm, to detect referable diabetic retinopathy (RDR) on images taken on Remidio Fundus on Phone (NM FOP 10), a 1Royal Victorian Eye and Ear Hospital, Melbourne, Australia, 2Mater Private Hospital, Sydney, Australia, smartphone-based non-mydriatic retinal camera, in a large 3Royal Children’s Hospital, Melbourne, Australia scale prospective, clinical trial, using health workers with no prior experience in fundus imaging. Purpose: Viral conjunctivitis a common presentation to the Methods: Diabetic Patients visiting various municipality emergency department at the Royal Victorian Eye and Ear dispensaries of greater Mumbai study from August 2018 to Hospital (RVEEH), Melbourne. Adenovirus is the most May 2019 were included. 1378 patients consented to being common viral pathogen in these patients and given its highly screened. The images taken on Remedio camera were then contagious features, it is important to identify, isolate, and analysed by ophthalmologist and subjected to the Medios manage appropriately. The purpose of this audit is to exam- offline AI system for detection of RDR. ine the incidence of adenoviral conjunctivitis in a given year Results: A total of 1378 patients (mean age: 54.9+/−- and analyse the work-up and management of these patients 10.4 years., mean duration of diabetes: 6.2+/−5.3 years, in the emergency department. mean FBS 152+/−58) were screened post dilation using Methods: All presentations coded as “Viral Conjunctivitis” 1 drop of 1% tropicamide. Fundus images from 1181 presenting to the emergency department from January 2017 patients were analysed-the rest being excluded due to to December 2017 at the RVEEH were analysed. Presenta- ungradable(3.5% in both eyes, 11.8% in one eye)/hazy tions were cross referenced with the viral PCR swabs that (1.8%)/no images(<0.1%). The sensitivity and specificity of were ordered through pathology for each encounter. The the offline AI in diagnosing RDR was 98% and 86.9% length of stay in the emergency department of each individ- respectively and of any diabetic retinopathy as 89.8% and ual with confirmed adenovirus was also calculated. 90.7% respectively, compared to Ophthalmologist grading. Results: 1653 presentations of viral conjunctivitis presented Only one case of moderate non-proliferative diabetic reti- to the emergency department during above period. 1472 nopathy was missed by the AI. were swabbed (89.1%) and 447 had positive results of a viral Conclusions: This is the first of its kind study, assessing pathogen (30.3%). Adenovirus was the most common patho- the performance of an AI algorithm on images taken by gen isolated with 56.6% of all positive swabs being adenovi- health workers in a large-scale prospective trial. The results rus. Each encounter was further analysed on the clinical show great promise in the use of an offline AI with features on presentation and the instituted management smartphone based retinal imaging, in community screening choice. for RDR. Conclusion: Conservative management and contact precautions are the mainstay of treatment for individuals with adenoviral conjunctivitis. Results of this audit will inform ABSTRACT 111

80. Atopic dermatitis is associated with high myopia in Method: A retrospective audit of all injections was per- the adult Korean population formed in the Pilbara and Kimberley between January and December 2018. Outcome measures included total injec- Gyeong-Hun Park1, Sunmi Kim2 tions, number of injection patients, rates of patients LTFU Email: [email protected] by region, Aboriginal and Torres Strait Islander (ATSI) sta- 1Department of Dermatology, Dongtan Sacred Heart tus and diagnosis. The audit was extended to include the first Hospital, Hallym University College of Medicine, 6 months of 2019 to ensure further treatment plan time- Hwaseong, Republic of Korea, 2Deparment of Family frames had lapsed. Medicine, Kangwon National University Hospital, Results: A total of 140 patients received injections resulting Chuncheon, Republic of Korea in 346 injections. 10 patients were excluded due to reloca- tion to another region and 3 patients were deceased. Purpose: The present study sought to investigate the associ- 17 patients were lost to follow up (12.1%). ation between atopic dermatitis and refractive error in the Of those LTFU, 14.3% were in Pilbara and 10% Kimberley. adult Korean population. Similar rates with respect to Indigenous status with 12.6% Method: A cross-sectional study was conducted using data identifying as Aboriginal and 11.4% not. 15.8% were treated from 17 889 subjects aged 19 years or older who partici- for diabetic macular oedema and 3.8% for age-related macu- pated in the fourth and fifth Korean National Health and lar degeneration. Nutrition Examination Survey performed in 2008-2012. Conclusion: In the context of outreach clinics which have Multiple linear and logistic regression analyses were used to been reported to have 51% non-attendance (Copeland 2017), estimate the mean spherical equivalents and the odds ratios of myopia and high myopia between those with and without the loss to follow up is low and represents good coordination atopic dermatitis with adjustment for potential confounding and administration. The logistics of providing appropriate factors including age, sex, level of education, and outdoor intravitreal therapy including scheduling timely visits and activities. working in hospital and community-controlled settings, Results: After adjusting for potential confounders, the mean requires a specific focus on those needing intravitreal treat- spherical equivalents were significantly lower in participants ment. Further research into the understanding of multifacto- with atopic dermatitis than in those without this diagnosis rial barriers to injection attendance is needed to adequately (mean ± SE − 0.97 ± 0.09 and − 0.76 ± 0.02 respectively; provide the standard of care. P = 0.023). The odds of myopia was not significantly different between those with and without atopic dermatitis (odds ratio 1.09 [95% confidence interval 0.89-1.32]; P = 0.409). 82. Demand and wait-times for non-cataract procedures However, the odds of high myopia was significantly higher in telehealth patients of Western Australia in those with atopic dermatitis than in those without this 1 2 diagnosis (odds ratio 1.37 [95% confidence interval Andrew Nguyen , Angus Turner 1.01-1.86]; P = 0.047) after adjusting for confounders. Email: [email protected] 1 2 Conclusion: The present results suggest the association Lions Eye Institute, Perth, Australia, Lions, Perth, between atopic dermatitis and high myopia. Further investi- Australia gations will be required to determine the relationship Purpose: Lions Outback Vision (LOV) provide a tele- between these conditions. ophthalmology service to regional, rural and remote populations covering all Western Australia (WA). Telehealth facilitates for timely eye assessments, pharmacological treat- 81. Intravitreal injection compliance in the Northwest of ments and cataract repairs (McGlacken-Byrne 2019). How- Western Australia: Identifying patients lost to follow up ever, non-cataract procedural interventions ensuing telehealth has been lesser explored. Andrew Nguyen1, Angus Turner1 Method: A 12-month retrospective audit was performed Email: [email protected] between September 2017 and August 2018. Patients were 1Lions Eye Institute, Perth, Australia referred by optometrists operating in rural WA to the LOV Purpose: The logistics to provide timely and appropriate telehealth service. Outcome measures included demographic intravitreal therapy in remote areas require extensive coordi- profile, total non-cataract procedures, procedure type and nation efforts. This audit addresses intravitreal injection wait-times for non-cataract procedures. compliance by identifying patients lost to follow up (LTFU) Results: Non-cataract procedural requests accounted for in Northwest WA in 2018. 37.6% (n = 233) of all ophthalmological procedure referrals 112 POSTER ABSTRACTS following telehealth. 24.9% of patients were Aboriginal gold-standard diagnosis. Diagnostic accuracy was compared (n = 58). 99.6% were from regional or remote WA (n = 232). between DR severity levels, age, cataract status and Indige- The most common non-cataract procedure referrals were nous status. intravitreal injections 27.9%, pterygium repair 22.7%, YAG Results: Data were available for 183 participants (48% male; laser 20.6%, blepharoplasty 3.9% and retinal detachment sur- aged 19-87 years, 24% with referable DR [≥ moderate DR gery 3.0% requiring urgent transfer to Perth. or diabetic macular oedema]). The diagnostic odds ratio was The mean wait-time for intravitreal injection was 43.2 days, pte- approximately five times greater among Indigenous partici- rygium repair 137.4 days, YAG laser 62.0 days, blepharoplasty pants than non-Indigenous participants (51.0 vs 10.1), twice 167.0 days and retinal detachment surgery 1.0 day. The mean as high in younger participants compared to older partici- wait-time for Aboriginal patients was 126.5 days and for non- pants (31.1 vs 16.1) and similar between those with and Aboriginal patients was 75.6 days for non-cataract procedure. without cataract (19.1 vs 12.8). For any level of DR (≥ mild Conclusion: The significance of timely non-cataract related DR) the sensitivity was 82.3% (95% CI 70.5-90.8) and speci- procedures and surgery is often overlooked given the preva- ficity was 73.6% (95% CI 64.8-81.2). lence of cataract repair. Our most urgent telehealth referrals Conclusion: The DLA has good diagnostic accuracy for the requiring immediate transfer to Perth for surgery were all detection of DR in clinical settings. Importantly, we found non-cataract related. increased diagnostic accuracy among an Indigenous popula- Non-cataract eye pathologies requiring procedural manage- tion, where DR screening tools have the potential to provide ment by a specialist may lead to preventable blindness if not the most benefit. addressed in a timely manner and thus worth further research in future. 84. Age-related macular degeneration: Patient perspectives regarding accessing eye care 83. Assessing characteristics that impact diagnostic accuracy of artificial intelligence when screening for Upeka Nanayakkara1,2, Isabelle Jalbert2, Gerald Liew3,4, diabetic retinopathy in real world settings Bamini Gopinath4, Paul Mitchell5,4, Lisa Keay1,2 Email: [email protected] Dilara Koca1,2, Jane Scheetz2, Myra B. McGuinness1,2, 1The George Institute for Global Health, Faculty of Mingguang He2,3,4 Medicine, UNSW, Sydney, Australia, 2School of Optometry Email: [email protected] and Vision Science, Faculty of Science, UNSW, Sydney, 1Centre for Epidemiology and Biostatistics, Melbourne Australia, 3Retina Associates, Sydney, Australia, 4Westmead School of Population and Global Health, University of Institute for Medical Research, University of Sydney, Melbourne, Melbourne, Australia, 2Centre for Eye Research Sydney, Australia, 5Sydney West Retina, Sydney, Australia Australia, Royal Victorian Eye & Ear Hospital, East Purpose: Despite the effectiveness and availability of ther- Melbourne, Australia, 3Department of Surgery apy for age-related macular degeneration (AMD) manage- (Ophthalmology), University of Melbourne, Melbourne, ment, there is uncertainty about uptake and adherence in Australia, 4State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Australia. We explored patient attitudes regarding the deci- Guangzhou, China sion to access and continue eye care and treatment. Methods: Seven face-to-face focus group discussions, with Purpose: Grading of retinal photographs for diabetic reti- thirty-seven AMD patients, were conducted by a trained nopathy (DR) using artificial intelligence (AI) has been pro- facilitator in Sydney, Cleveland and Brisbane. Axial coding posed as an efficient and cost-effective screening tool to was utilised to identify common themes and compared with reduce the burden of vision loss in Australia. However, how Levesque’s model of access to healthcare. This model high- well AI performs in differing clinical settings is unknown. lights patient and service factors that influence stages of Therefore, the aim of this study is to assess characteristics accessing healthcare. that impact the diagnostic accuracy of an AI deep learning Results: The data supported the first aspect of Levesque’s algorithm (DLA) in the detection of DR. model whereby patients described their perceived need to Method: Non-mydriatic, macular centred retinal photo- seek care as being triggered by personal events especially graphs were captured at two endocrinology clinics and one vicarious experience such as family or friends who had lost Aboriginal Medical Service in Australia. Images were auto- sight from nAMD. A key finding was that patients often matically graded using a DLA and also graded by a retinal struggled to physically reach treatment, the third aspect of specialist (masked to AI grading), acting as a proxy for Levesque’s model. They reported that they rely on public ABSTRACT 113 transport and support services, catalysing a sense of depen- Results: Immunolabelling of cultured human retinal dence and frustration. Whilst cost is a significant barrier, explants transduced with AAV2.CYP4V2 demonstrated strategies including Medicare Safety Net and veterans sup- robust expression of CYP4V2 in photoreceptors, which was port were identified as beneficial. While engagement is facil- absent in the untransduced controls. Transduced retina did itated with a strong support network, common barriers not show clear signs of AAV-mediated toxicity. include low motivations, out-of-pocket cost and pain associ- Conclusion: These pilot data demonstrate viral-mediated ated with injections. expression of a CYP4V2 transgene in human retinal tissue Conclusion: This analysis of focus groups highlighted steps and support the further development of gene therapy for involved in accessing care. To meet patient needs and pro- BCD, a progressive blinding disease. vide effective care, services must be accessible and education should be provided to motivate individuals to access treatment. This study will be supplemented with further 86. Towards gene therapy in the retinal dystrophies semi-structured interviews. Christopher Watson1,2 GENETICS Email: [email protected] 1Eye Genetics Research Unit, Children’s Medical Research Institute, The Children’s Hospital at Westmead, Sydney, 85. Looking towards gene therapy: Characterisation of Australia, 2Save Sight Institute, University of Sydney, ex vivo AAV2.CYP4V2 gene therapy in human retinal Sydney, Australia explants Purpose: Phosphodiesterase 6B (PDE6B)is one of the most commonly mutated genes causing autosomal recessive reti- Monica Hu1,2, Jiang-Hui Wang1, Doron G. Hickey1,3,Kanmin nitis pigmentosa (RP), which leads to progressive visual Xue3, Michelle E. McClements4, Thomas L. Edwards1,2,3 loss. PDE6B plays a crucial role in the phototransduction Email: [email protected] cascade. This work aims to develop a disease model for RP 1Centre for Eye Research Australia, Royal Victorian Eye due to variants in PDE6B, and to evaluate our human and Ear Hospital, Melbourne, Australia, 2Ophthalmology, Department of Surgery, University of Melbourne, induced pluripotent stem (iPS) cell retinal organoids as a Melbourne, Australia, 3Royal Victorian Eye and Ear model for approaches to gene replacement therapy. Hospital, Melbourne, Australia, 4Nuffield Laboratory of Method: We created a plasmid with a CRISPR/Cas9 Ophthalmology, University of Oxford, UK sequence for knock in of the PDE6Bmutation c.1798G > A in target cells. Next, we transfected iPS cells with the plas- Background: Bietti’s crystalline dystrophy (BCD) is an mid, and we plan to create retinal organoids carrying the incurable inherited retinal disease (IRD) caused by mutations mutation as a disease model. Lastly, we created an adeno- in the CYP4V2 gene that results in progressive degeneration associated virus (AAV) vector to induce PDE6B gene expres- of the retinal pigment epithelium and photoreceptors, leading sion in the organoids and our Pde6b mutant mouse model. to blindness by middle age. Clinical trials investigating Results: This work has formed a successful proof of concept adeno-associated virus (AAV)-mediated gene delivery to the for the use of CRISPR/Cas9 in PDE6Bgene editing. Variant retina for other IRDs have reported compelling data on safety and therapeutic impact will now be tested and compared in and efficacy. Pre-clinical cell culture studies are required to the retinal organoid and mouse model systems. assess the in vitro efficacy of a viral expression system. This Conclusion: The PDE6Bgene is a suitable target for gene study aims to utilise human retinal explants obtained during editing, and the PDE6B model of RP may benefit from gene routine vitreoretinal surgery to investigate the efficacy of therapy. AAV2.CYP4V2 transduction in an ex vivo model. Methods: Human retinal explants were collected during surgery from consenting patients. Explants of at least 1 mm 87. Dry eye disease identified in a prospective study of diameter were cultured and transduced with 1.43 x 10^10 vg ocular manifestations in Inherited Epidermolysis Bullosa of AAV2.CYP4V2, or left untransduced as a negative con- and Autoimmune Blistering Diseases trol. After 7 days, explants were fixed, frozen and cryosectioned. Immunohistochemistry was performed using Brendon W. H. Lee1,2,3, Jeremy C. K. Tan2, Melissa immunolabels for CYP4V2 and retinal cell markers (rhodop- Radjenovic3, Lien Tat2, Dedee F. Murrell1,3, Minas sin, calbindin, protein kinase C alpha) to assess toxicity and T. Coroneo1,2 transduction efficacy in human retina. Email: [email protected] 114 POSTER ABSTRACTS

1Faculty of Medicine, University of New South Wales, Purpose: To investigate the relationship between nighttime Sydney, Australia, 2Department of Ophthalmology, Prince blood pressure reduction and ophthalmologic examination in of Wales Hospital, Sydney, Australia, 3Department of patients with glaucoma. Dermatology, St George Hospital, Sydney, Australia Setting/Venue: Retrospective comparative study in South Korea. Purpose: Inherited Epidermolysis Bullosa (EB) and Autoim- Methods: 56 eyes with glaucomatous visual field defects mune Blistering Diseases (AIBD) are a heterogeneous group were divided into the dipper and non-dipper group according of chronic blistering dermatoses that cause mucocutaneous to 24-hours blood pressure test. The visual acuity, intraocu- lesions including the ocular surface. This is the first study in lar pressure, refractive error, and the results of optical coher- EB and second in AIBD to prospectively examine the range ence tomography and visual field test were compared and severity of ocular manifestations in an Australasian cohort. between two groups. Method: 61 patients with immunohistochemically con- Results: The mean value of global RNFL thickness in the firmed diagnoses were recruited from a Dermatology sub- non-dipper group was 68.34 ± 18.05 μmand80.40 specialty centre and the Australasian registry. ± 20.74 μm in the dipper group (P < 0.05). In segmental com- Participants underwent a comprehensive ophthalmic exami- parison, the non-dipper group were thinner than the dipper nation according to a standardised protocol, including an group in nasal and superonasal segments (P < 0.05). In the Ocular Surface Disease Index (OSDI) questionnaire, slit Humphrey Automatic Visual Field Test, the percentage of lamp and tear-film examination, and confocal imaging. patients with central field defect was 72% (n = 21) in non- Results: 122 eyes of 61 patients (female = 54.1%), aged dipper group and 41% (n = 11) in dipper group (P < 0.05). 2-88, were examined. 57 patients (93.4%) exhibited one or Conclusions: The mean, nasal and superonasal thickness of more symptoms of Dry Eye Disease (DED). Mean OSDI the retinal nerve fiber layer in the non-dipper group was was 13.63 (range = 0-100) with 24.6% of patients graded found to be thinner on the 24-hour blood pressure test in moderate-severe. Best-corrected visual acuity was >20/60 in patients with glaucoma. In the non-dipper group, there were 57.4%, with the rest >20/20. a significant number of cases with central field defect. Examination demonstrated blepharitis (50.8%, n = 62), conjunctival/corneal scarring (20.5%, n = 25), limbal broaden- ing (17.2%), symblepharon (8.2%, n = 10), trichiasis (5.7%, 89. Effect of combined minimally invasive glaucoma n = 7), and ectropion/entropion (3.3%, n = 4). surgery and phacoemulsification on intraocular pressure 95.1% of patients tested had a reduced tear break-up time vs phacoemulsification alone and 92.4% had an abnormal Schirmer's test. Furthermore, 57.9% exhibited significant corneal staining and 59.4% had Philomena McNamara1, Christopher Go1, Nitin Verma1 elevated tear osmolarity (>308 mOsm/L). Email: [email protected] Conclusion: DED was found on patient-reported symptoms, 1Royal Hobart Hospital, Hobart, Australia OSDI and objective assessment. This is novel in EB. Ophthalmologists working as part of a multidisciplinary Purpose: Minimally invasive glaucoma surgery (MIGS) team should be aware of the potential for ocular manifesta- offers a surgical procedure to reduce intraocular pressure tions in these genetic and acquired blistering dermatoses and (IOP) with minimal disruption to anatomy but questions their negative effect on quality-of-life, risk of scarring, and remain regarding efficacy and long term outcomes. In subsequent visual impairment. Australia MIGS is rebatable only in combination with phacoemulsification. Given phacoemulsification reduces IOP GLAUCOMA by 2-4 mmHg, this is a potential confounder when assessing MIGS efficacy. This study aims to determine if MIGS offers an additional IOP or medication reduction. 88. Correlation between 24-hour blood pressure and Methods: A retrospective review of patients undergoing sur- ophthalmologic examination in patients with glaucoma gery at a single practice between 2014 and 2018 comparing IOP and medication use following MIGS/phacoemulsification Seunguk Lee1, Sungil Im1, Sujin Kim2, Jieun Lee2 to the same outcomes following phacoemulsification alone. Email: [email protected] Results: 292 eyes of 172 patients (146 MIGS/phacoemul- 1Kosin University, College of Medicine, Kosin University sification and 146 phacoemulsification alone) were analysed. Hospital, Busan, Republic of Korea, 2Pusan National There was no statistically significant difference in age, glaucoma University, College of Medicine, Pusan National University severity, IOP or medication use between groups preoperatively. YangSan Hospital, Yangsan, Republic of Korea iStent (26%) and iStent inject (74%) were used in this study. ABSTRACT 115

There was a trend toward greater IOP reduction in the MIGS/ 91. The assessment of colour vision with the Ishihara test phacoemulsification cohort (3.1 mmHg at 6 months, 2.8 mmHg in patients with glaucomatous optic neuropathy at 12 months, 2.5 mmHg at 24 months, 2.6 mmHg at 36 months) compared to phacoemulsification alone (2.3 mmHg, Pei-Fen Lin1, Shanil Dhanji2,3, Gus Gazzard1, Ana 2.4 mmHg, 1.7 mmHg and 2.0 mmHg at the same time points) Quartilo1, Mitchell Lawlor2,3 but this difference was not statistically significant at any time Email: [email protected] point. There was a statistically significant difference in medica- 1Moorfields Eye Hospital, London, UK, 2Sydney Eye 3 tion use between the two groups with less medications used at Hospital, Sydney, Australia, Save Sight Institute, Sydney, 6 months, 12 months and 36 months in the MIGS/phacoemul- Australia sification group. Purpose: Although a range of colour vision tests have been Conclusion: Patients achieved a similar reduction in IOP with evaluated in glaucoma patients, there is limited published lower medication use following combined MIGS/phacoemul- data regarding the most widely used, relatively inexpensive sification. Significantly more patients were medication free at and easy to administer colour vision assessment, the Ishihara 36 months following MIGS/phacoemulsification than phacoe- test. This study assessed how the Ishihara score varies in mulsification alone. patients with glaucoma, and whether it is influenced by the severity or location of glaucomatous visual field defects. Method: Consecutive patients seen in a glaucoma clinic at 90. Glaucoma surveillance in intravitreal injection Moorfields Eye Hospital were assessed. Patients with an patients in a regional eye clinic: An audit Ishihara score of less than 12 out of 14 plates were considered abnormal. Visual fields were assessed with a 24-2 Jie (Jenny) Song1, EeLin Ong1, Madeleine Adams1,2 Email: [email protected] Swedish interactive threshold algorithm (SITA) standard on the Humphrey visual field (HVF). Statistical assessment was 1Sunshine Coast Hospital and Health Services, Caloundra, Australia, 2The University Of Queensland, Brisbane, used to evaluate whether Ishihara colour abnormalities were Australia related to the severity or location of the glaucomatous visual field defect. Purpose: To audit the methods used to monitor glaucoma Results: 218 eyes of 109 patients were recruited. 80% had development or progression in patients receiving intravitreal primary open-angle (POAG), 13% chronic angle closure and injections (IVI). To audit the methods used to alleviate intra- 7% secondary glaucoma. 33 (15%) eyes had an abnormal ocular pressure (IOP) rise post IVI. Ishihara score. No correlation was found between the Methods: Retrospective audit conducted on all patients Ishihara score and either the HVF mean deviation (MD), or receiving IVI over a 4 week period in a regional eye clinic reduced sensitivity at any of the four paracentral test points. in Queensland, Australia. Data collected include: IVI his- Conclusion: the Ishihara test is not uncommonly abnormal tory, diagnosis of glaucoma, glaucoma investigations per- in patients with GON. Routine use of Ishihara colour vision formed within 12 months, measures taken to alleviate post testing in glaucoma patients appears to be of limited benefit, IVI IOP rise. as it is frequently abnormal, and the degree of colour deficit Results: In 100 patients, 12 had diagnosed glaucoma. Whilst does not correlate with severity or location of visual all glaucoma patients received OCT RNFL in the past field loss. 12 months, less than half (39%) of IVI patients without glaucoma had these scans. Of those who had intervention post- IVI to alleviate the effect of IOP rise, 22% had AC 92. Early outcomes of subtenon semi-open ab interno paracentesis. technique of XEN stent insertion compared to standard Conclusion: Glaucoma surveillance was incompletely per- technique formed in more than half of the patients in this study. The outcomes highlight the need for increased awareness of George YX Kong1,2,3, In Young Chung4 glaucoma surveillance in this population of patients. Further Email: [email protected] research into the relationship between chronic IVI therapy 1Royal Victorian Eye and Ear Hospital, Melbourne, and IOP changes with time will assist in identifying an opti- Australia, 2Centre for Eye Research Australia, Melbourne, mal monitoring strategy for patients who are at higher risk Australia, 3Monash Hospital, Melbourne, Australia, 4Austin of developing glaucoma. Hospital, Melbourne, Australia 116 POSTER ABSTRACTS

Purpose: To evaluate early outcomes of subtenon semi-open combined with cataract surgery. Baseline demographic ab interno technique (Semi-open) compared to Standard information, pre-operative, intra-operative and post- insertion technique of XEN stent glaucoma filtration system operative outcomes were collected and analysed. Primary (Allergan Inc). success was defined as an IOP of ≤18 with zero medications Method: Novel Semi-open technique involves the formation at 12 months. of a subtenon pocket through a small posterior incision Results: 245 eyes from 148 patients with a confirmed diag- (1-2 mm in length, ~8 mm from limbus) and insertion of nosis of POAG, aged 53-89 years, were assessed. There XEN stent into the pocket ab interno. A retrospective analy- were 145 eyes in the iStent and 100 eyes in iStent inject sis of Xen stent using Semi-open technique (n = 16) or Stan- groups. The mean pre-operative IOP was 18.9 (SD 5.2). dard technique (n = 25) was performed. All cases received Eighty-seven eyes (35.5%) failed to achieve an IOP of ≤18 subconjunctival injection of 0.1 mL of mitomycin C with zero medications at 12 months. The failure of iStent/ (0.01-0.02%). iStentinject was not associated with underlying glaucoma Results: The two groups had similar IOP at baseline (Semi- severity when VCDR, PSD, and central corneal thickness open 21.9 ± 1.9 mmHg vs Standard 22.7 ± 1.8 mmHg, were used as surrogates. A pre-operative IOP of P = 0.76), postoperative day 1 (6.4 ± 1.3 mmHg vs 7.9 16-20 mmHg had a relative risk of failure of 1.70, and an ± 1.0 mmHg, P = 0.34) and week 1 (7.7 ± 1.6 mmHg vs IOP > 20 mmHg had a relative risk of failure of 2.73, com- 9.9 ± 0.9 mmHg, P = 0.20). By week 2, IOP for Standard pared to a pre-operative IOP of ≤15 mmHg, respectively. group increased to low teens (13.9 ± 1.6 mmHg) while The adjusted relative risk for ≥2 pre-operative hypotensive Semi-open group remained stable (9.4 ± 2.1 mmHg, agents was 1.65, compared to those eyes with zero or one P = 0.13). The IOP were statistically different for postopera- pre-operative agent. tive week 4 (Semi-open 9.8 ± 1.1 mmHg vs Standard Conclusion: Both iStent and iStent inject were most effec- 15.9 mmHg, P = 0.01) and month 2 (Semi-open 11.5 tive in achieving a post-operative IOP of ≤18 mmHg with ± 2.0 mmHg vs Standard 16.2 ± 1.3 mmHg, P = 0.05). zero topical hypotensive agents at 12 months in patients with Semi-open technique had lower needling rate compared to a pre-operative IOP of ≤15 mmHg who were treated with Standard technique (19% vs 60%). Semi-open group had less than 2 topical hypotensive agents prior to the procedure. more transient choroidal effusion (31%) compared to Stan- dard group (16%). Standard technique had 2 eyes with stent erosion and required bleb revision in 5 cases. 94. Effect of leukotriene antagonist on wound healing Conclusion: Early outcomes show Semi-open technique after glaucoma implant surgery in rabbits achieved lower IOP compared to Standard technique for 1 XEN stent with lower needling and bled revision rates. Younhea Jung Longer-term assessment is required to assess the safety and Email: [email protected] 1 outcome profiles of this new technique. Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Republic of Korea

Purpose: The purpose of this study was to investigate the 93. Variables correlating with the success or failure of antiscarring effect of leukotriene antagonist (montelukast) trabecular micro-bypass stents, iStent and iStent inject, on glaucoma drainage implant surgery in a rabbit model. when combined with cataract surgery Methods: After Ahmed valve implantation, we injected montelukast intraperitoneally daily in 12 New Zealand white Philip Rothschild1,2,3, Joobin Hooshmand1,4, Penny rabbits. In control group, saline was injected intraperitone- Allen1,3, Brendan Vote1,3, Tze’Yo Toh1,5 ally. We measured IOP using TonoVet. Histochemical Email: [email protected] staining and immunohistochemistry was done. 1Tasmanian Eye Institute, Launceston, Australia, 2Barwon Results: Degree of cellularity was smaller in the monte- Health, Geelong, Australia, 3Launceston Clinical School, lukast group than the control group at post op 2 weeks and Launceston, Australia, 4Sydney Eye Hospital, Sydney, 4 weeks. Inner collagen-rich layer was thinner in the monte- Australia, 5Launceston Eye Doctors, Launceston, Australia lukast group than the control group at post op 4 weeks and Purpose: To identify the pre-operative variables that best 8 weeks. Area of alpha-smooth muscle actin expression was predict the success of trabecular micro-bypass stents com- smaller in the montelukast group at post op 4 weeks and bined with cataract surgery. 8 weeks. Methods: A prospective, interventional case series of Conclusion: Intraperitoneal montelukast injection following 245 eyes undergoing trabecular micro-bypass stent insertion glaucoma drainage implantation showed reduced fibrosis in ABSTRACT 117 rabbits. Montelukast may be useful as an antiscarring agent 1Royal Brisbane and Women’s Hospital, Brisbane, Australia after tube surgery. Purpose: Common glaucoma procedures include glaucoma filtration surgery, insertion of drainage devices such as the 95. Outcomes of uveitic glaucoma treatment Molteno tube, goniotomy, MIGS, laser iridotomy and trabeculoplasty. This paper aimed to assess the utilization of Tiffany Ma1, Joanne Sims1, Sonya Bennett1, Shenton these procedures in Australia and their respective Chew1, Rachael Niederer1 demographics. Email: [email protected] Methods: Item numbers 42 746, 42 752, 42 758, 42 705, 1ADHB, Auckland, New Zealand 42 785, 42 782 Medicare Benefits Schedule (privately billed data) was assessed. Analysis from 2009 to 2019 assessed the Purpose: This study aimed to examine the presentation and overall trend across Australia, and the demographics of results of medical and surgical management of a large cohort patients requiring the services. of uveitic glaucoma patients in the tertiary centre of Auck- Results: Over the last decade glaucoma filtration surgery, land, New Zealand. Molteno tube insertion, laser iridotomy and laser Methods: A retrospective chart review of all uveitis patients trabeculoplasty has steadily increased in Australia. NSW seen between 1 January 2008 and 1 June 2018 was con- appears to perform the greatest number of surgeries, and the ducted. Subjects were included if they had ocular hyperten- age demographic is largely within the 65-74 age group. sion (OHT) requiring pressure-lowering treatment for There is no significant difference in gender distribution. three months or more, or if they developed uveitic Interestingly there appears to be a spike in goniotomy proce- glaucoma. dures from 2015 to 2017 after which there is a dramatic Data collected included: age, gender, ethnicity, visual acuity decline (162%). This corresponds to the new rebate for and intraocular pressure (IOP) at diagnosis, mechanism of MIGS in 2017 which concurrently shows a 90% increase in elevated pressure, presence of steroid response, optic nerve MIGS procedures. Goniotomy was no longer allowed to be damage and visual field defects, treatments received, and used for the insertion of MIGS and so subsequently dropped any complications or surgical failure. considerably. Results: 188 eyes of 139 subjects were included for analy- Conclusion: There is a substantial glaucoma burden in sis. Median age at uveitis diagnosis was 50.5 years and Australia and surgical options continue to grow in demand. median IOP at diagnosis was 35 mmHg. The advent of MIGS brought a slight difficulty in using the Non-infectious aetiology was more common than infectious, product and attaining a rebate for patients. With the new 140 eyes (74.5%) and 48 eyes (25.5%) respectively. The most rebate 42 705, the process has become far more streamlined common diagnoses were idiopathic (27.5%), sarcoidosis and more patients are able to access this treatment option. It (10.9%), herpes zoster (8.7%) and HLA-B27-associated (6.6%). will also help monitor the trajectory of this therapeutic 144 eyes (77.0%) developed glaucomatous optic neuropathy. procedure. 75 glaucoma surgeries were performed in 68 eyes of 56 subjects (50 trabeculectomies, 18 tubes and 6 minimally invasive glaucoma surgeries). Mean preoperative IOP was 97. A review of the efficacy of first generation iStent in 31.3 mmHg. Complete failure occurred in 12 and partial fail- patients with glaucoma at Auckland City Hospital ure in 26 surgeries. Conclusion: Uveitic glaucoma is aggressive in presenta- Simone Freundlich1, Kaliopy Matheos1, Shenton Chew1 tion and may be associated with high IOP. Glaucoma sur- Email: [email protected] gery is sometimes unavoidable in these patients. Despite 1Auckland District Health Board, Auckland, New Zealand aggressive anti-inflammatory and IOP-lowering interventions, vision loss from glaucoma remains a significant poor Purpose: To review the efficacy of minimally invasive glau- outcome. coma surgery (MIGS) involving the placement of first generation iStents combined with phacoemulsification in the Ophthalmology department at Auckland City Hospital. 96. Trend analysis of common glaucoma procedures over Method: A retrospective audit of intraocular pressure in the last decade patients with a diagnosis of Glaucoma, who underwent iStent implantation combined with phacoemulsification Sarah Chaudhry1 between 2016 and 2018 at Auckland City Hospital in Auck- Email: [email protected] land, New Zealand. 118 POSTER ABSTRACTS

Results: A retrospective audit of 51 patient charts who under- Inferior Flux index significantly correlated with inferior went MIGS, with the placement of first generation iStents RFNL (P = 0.034, r2 = −0.966). combined with phacoemulsification at Auckland City Hospital Conclusion: The cause and clinical relevance of optic disc between 2016 to 2018 was completed. The average patient age haemorrhage in glaucoma remains unknown. Mechanical was 75 years. Primary open angle glaucoma was the most disruption and ischaemic vascular dysregulation are two common indication for MIGS (n = 30), followed by normal likely drivers of the condition. Observation of the micro vas- tension glaucoma (n = 7), pseudoexfoliation glaucoma (n = 6) culature via direct or serial OCT-A imaging may provide and primary angle closure glaucoma (n = 5). At presentation further improved evidence. In a small intra-individual case- the average IOP was 19.84 mmHg (range = 9-32 mmHg). At control cohort we show that OCT and OCT-A parameters listing, the average IOP was 18.62 mmHg (n = 51) with indicate more severe glaucomatous disease in the eye with patients on 1-2 pressure lowering drops (average = 1.6, ODH although this did not reach significance. Greater num- n = 51). One-month post-surgery IOP decreased by bers and longitudinal assessment will further identify the 3.81 mmHg, with an average IOP of 15.3 mmHg (n = 49). At clinical impact of this technology. the 3- and 12-month follow-up, IOP remained lower than IOP at listing with an average of 14.96 mmHg (n = 33) and 15.58 mmHg respectively (n = 31). A slight reduction in the 99. In vivo trabecular meshwork morphology in average number of pressure lowering drops was also noted congenital glaucoma, juvenile and adult onset open angle with an average of 1.4 drops post surgery (n = 49, range 0-3). glaucoma: a comparative study Conclusion: This audit found that IOP after 12-months following surgery using first generation iStents and WITHDRAWN phacoemulsification, was lower than both the presenting and listing IOP with an average reduction of 3.68 mmHg at 100. Optimizing yoga postures for lifestyle management 12 months. in glaucoma

Arvind Morya1, Pradeep Dwivedi1, Sujeet Prakash1, Sahil 98. OCT Angiography in Optic Disc Haemorrhage Bhandari1, Kanchan Solanki1, Kalpit Jangid1, Anushree (ODH): Intra-individual case-control comparison of D. Naidu1, Sonalika Gogia1 glaucoma patients Email: [email protected] 1 Raj Pathmaraj1, Christopher Hodge2, Uyen Vu1, Liu Lei1 All India Institute of Medical Sciences, Jodhpur, India Email: [email protected] Purpose: To evaluate the effect of various common mudras 1 2 Vision Eye Institute, Melbourne, Australia, Vision Eye or asanas in YOGA on intraocular pressure (IOP) in healthy Institute, Sydney, Australia individuals. Methods: Purpose: To analyse micro vasculature changes using a HD- 120 volunteers above 18 years of age, who were practicing various yoga asana’s/ exercises (Kapalbhaati, OCT platform in a group of patients with unilateral ODH. Methods: 10 patients with unilateral ODH undertook Anulomvilom, Shirshashna and Pranayam), each for OCT-A imaging. The non-ODH eye served as a comparison. 5 minutes/day (50 minutes. of yoga/day) for at least 5 days General demographic, health and clinical parameters were in a week, for total duration of 12 weeks and willingly giving consent were included in this study. IOP measurement collated and compared. Results: Mean age of patients was 73.2 years and mean was done at every 4 weeks before and after each asana by ’ duration of glaucoma 7.4 years. All patients were previously Perkin s Tonometer. Results: On pre-post comparative analysis, all the asanas on at least one glaucoma medication. Eight patients had at have significant mean decrease in IOP either at baseline or least one systemic risk factor for OHD. The location of the at 12th weeks of study, except shirshasana & pranayama, ODH was superior in 6 eyes and inferior in the remaining which increases IOP. On comparison of baseline to 12th 4 eyes. Mean C/D ratio was larger and Retinal Nerve Fiber week data, there was no statistically significant change in Layer (RNFL) thinner in ODH eyes although this did not mean difference of IOP. reach significance. Mean superior and inferior Angioplex Conclusions: Lifestyle modification like optimizing the perfusion values and mean superior and inferior flux index yoga postures and avoiding yoga asanas like shirshasana and values were lower in ODH compared to the non-ODH eye pranayama can have significant impact in control of intra- however these were not statistically significant differences. ocular pressure in the management of glaucoma. ABSTRACT 119

101. Pronase E improves gene transduction of retinal Email: [email protected] ganglion cells 1Macquarie University, Sydney, Australia, 2Flinders University, Adelaide, Australia Mark Hassall1,2, Liu Guei-Sheung3, Mammone Teresa2, Wood John2, Jack Ao2, Alex Hewitt3,4, Robert Casson2, Purpose: To compare two spectral-domain optical coher- Jamie Craig1, Glyn Chidlow2 ence tomography (OCT) systems for measurement of Email: [email protected] (i) combined ganglion cell and inner plexiform layers 1Flinders University, Adelaide, Australia, 2University of (GCLIPL), and (ii) retinal nerve fibre layer (RNFL) thick- Adelaide, Adelaide, Australia, 3University of Tasmania, Hobart, nesses and progression rates in glaucoma patients. Australia, 4University of Melbourne, Melbourne, Australia Methods: 100 eyes from 52 glaucoma suspects/patients underwent OCT imaging of the macula and optic nerve. Purpose: Intravitreal injection is used for gene delivery to Images were acquired using Cirrus (Carl Zeiss) and Spec- retinal ganglion cells, but has low efficiencies of transduc- tralis (Heidelberg Engineering) systems at the same visit. A tion. The aim of the present study was to optimise recombi- subset of 34 PROGRESSA study participants had 6 reviews nant adenovirus-associated vector (rAAV)-mediated gene over 3 years. Average GCLIPL and RNFL thicknesses were transduction of retinal ganglion cells by co-administration manually calculated based on the automated segmentation of with proteolytic enzymes. each device for matched superior, inferior and global μ Method: Female Sprague-Dawley rats (n = 4) received a 5 L regions, then used to calculate rate of change. intravitreal injection containing 5e+9 genome copies Results: At baseline, RNFL thicknesses did not differ signif- (gc) rAAV. The rAAV contained a bistronic cassette icantly between systems (P = 0.683), however, Cirrus expressing green fluorescent protein (rAAV2/2.CAG.NGB. GCLIPL was significantly thicker than Spectralis by ~12 μm HA.IRES.GFP.pA). Further groups received co-administration (P < 0.001). Progression rate (μm/yr) analysis determined of Pronase E (n = 6) or Heparinase III + Hyaluronidase no significant differences between OCT systems for (n = 8). The fellow eye received a vehicle injection. Retinal GCLIPL (P > 0.05), yet Spectralis percentage change from function was analysed at 2 weeks by scotopic electroretinogra- baseline was significantly faster (P = 0.006). For RNFL, phy (ERG). At 3 weeks, GFP expression was assessed in vivo Cirrus progression rates were faster than Spectralis within using a confocal scanning laser ophthalmoscope (cSLO). Ani- the inferior quadrant (μm/yr: P = 0.01, % change: P = 0.02). mals were then euthanized for whole mount retinas. For both OCT systems, RNFL loss (μm/yr and % change) Results: The mean in vivo GFP expression on cSLO fundal progressed faster than GCLIPL, particularly inferiorly. images in rAAV + Pronase E eyes (360 of fundus ±0 ) Conclusion: Despite baseline differences in GCLIPL thick- was significantly greater than rAAV + Hep/Hyal (70 nesses, Cirrus and Spectralis provided similar progression ±35;P < 0.001) or rAAV alone (200 ±47;P < 0.001) rates for GCLIPL and RNFL in glaucoma and can be consid- eyes. Analysis of retinal whole mounts supported this pattern ered comparable, though not interchangeable, for progres- of increased transduction with Pronase E. The ERG b-wave sion studies. Further analysis is needed to determine if of PBS-injected eyes (1195 ± 59 μV) was not different from RNFL progresses faster than GCLIPL in glaucoma, particu- rAAV-only injected eyes (1246 ± 101 μV; P = 0.46), rAAV larly within the inferior region, and whether one precedes + Pronase E eyes (1004 ± 105 μV; P = 0.18) or rAAV + the other. Hep/Hyal eyes (1150 ± 64 μV; P = 0.33). Conclusion: Retinal ganglion cell transduction by rAAV was enhanced by co-administration of Pronase E. Importantly, 103. U-shaped association between intraocular pressure this effect was not associated with increased retinal toxicity, and eating frequency in the adult Korean population as assessed by electroretinography. The use of pronase E should be considered for delivery of candidate neuro- Sunmi Kim1, Gyeong-Hun Park2 protective genes to retinal ganglion cells. Email: [email protected] 1Department of Family Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea, 102. Comparison of RNFL and GCLIPL thicknesses and 2Department of Dermatology, Dongtan Sacred Heart progression characteristics using two OCT systems: The Hospital, Hallym University College of Medicine, PROGRESSA Study Hwaseong, Republic of Korea

Danit Saks1, Angela Schulz1, Jamie Craig2, Stuart Purpose: We sought to estimate the levels of intraocular Graham1, the PROGRESSA Study Group1,2 pressure according to eating frequency. 120 POSTER ABSTRACTS

Method: This cross-sectional study used the data of the Longitudinal IOP measurements from each visit were 9596 subjects aged 19 years or older who participated in the used; within-eye correlation was adjusted for using two- fourth Korean National Health and Nutrition Examination level random intercepts per patient, then per eye, using a Survey in 2008-2009. Using multiple linear regression ana- linear mixed-effects model. lyses, we estimated the levels of mean intraocular pressure Results: In 224 eyes of 145 patients from 9 clinics across according to eating frequency with adjustment for potential Australia (cases), cataract surgery achieved mean reduction confounding factors including age, sex, and total calorie in IOP of 1.37 mmHg (SD = 2.68, P < 0.001), with intake. 41 (18%) achieving at least a 20% reduction. Elevated base- Results: The level of mean intraocular pressure with adjust- line IOP was strongly predictive of a larger reduction in IOP ment for age, sex, and total calorie intake was the lowest in post cataract surgery (P = 1.1x10-11). In those with pre- the group with eating frequency of four (mean ± SE 13.8 operative maximum IOP >23 mmHg, mean reduction was ± 0.0 mmHg). However, there was an increasing trend of 2.9 mmHg (SD = 0.67, P < 0.001). For each 1 mmHg the adjusted mean intraocular pressure levels when the eat- increase in baseline IOP, there was an estimated 0.29 mmHg ing frequency decreased to less than three (mean ± SE 13.9 IOP reduction post cataract surgery. Using 224 control eyes ± 0.0 and 14.0 ± 0.1 mmHg when eating frequencies were (matched by age, gender, baseline IOP, duration of follow- three and less than three respectively) or increased to five or up, and medical treatment), cataract surgery was associated more (mean ± SE 13.9 ± 0.1 mmHg). with a mean IOP reduction of 0.77 mmHg (95%CI Conclusion: These results suggest the possible association 0.49-1.06; P = 9.7x10-8). between the level of intraocular pressure and eating fre- Conclusion: Cataract surgery has a confirmed, albeit small, quency. Further studies will needed to elucidate the relation- effect in reducing IOP, which is likely to be clinically signif- ship between intraocular pressure and eating habits. icant in those with higher preoperative pressures.

104. The effect of phacoemulsification cataract surgery 105. Higher incidence of incisional glaucoma surgery in on intraocular pressure in early glaucoma: a prospective Mendelian vs non-Mendelian glaucoma multi-site study Shilpa Kuruvilla1, Owen Siggs1, Emmanuelle Souzeau2, Ayub Qassim1, Mark Walland2, John Landers1, Stuart Jonathan Ruddle3, Alex Hewitt4, David Mackey5, Stuart Graham3, Paul R. Healey4, Ashish Agar5, Anna Macgregor6, John Landers1, Richard Mills1, Jamie Craig2 Galanopoulos6, Robert Casson7, Mona Awadalla1, Thi Email: [email protected] Nguyen1, Angela Schulz3, Bronwyn Ridge1, Jamie E. Craig1 1Flinders Medical Centre, Adelaide, Australia, 2Flinders Email: [email protected] University, Adelaide, Australia, 3University of Melbourne, 1Flinders University, Oaklands Park, Australia, 2Royal Melbourne, Australia, 4University of Tasmania, Hobart, Victorian Eye and Ear Hospital, Melbourne, Australia, Australia, 5University of Western Australia, Perth, 3Macquarie University, Sydney, Australia, 4Westmead Australia, 6Queensland Institute of Medical Research, Institute for Medical Research, University of Sydney, Brisbane, Australia Sydney, Australia, 5Prince of Wales Hospital, Randwick, Purpose: Glaucoma can have Mendelian or non-Mendelian Australia, 6Royal Adelaide Hospital, Adelaide, Australia, inheritance. This study examined a cohort of individuals 7University of Adelaide, Adelaide, Australia with advanced glaucoma to determine whether those with Purpose: Evaluate the effects of cataract surgery on intraoc- Mendelian inheritance differed from the rest with regard to ular pressure (IOP) in early glaucoma cases in a multi-site surgical management of their disease. longitudinal case-control study design. Method: All individuals with advanced glaucoma and with Method: Participants were enrolled in the PROGRESSA data on incisional surgery (n = 2297) were identified from study (Progression Risk Of Glaucoma; RElevant SNPs the Australian and New Zealand Registry of Advanced with Significant Association): A multicentre prospective Glaucoma (n = 6209). 118 patients had pathogenic genetic cohort study of progression risk in glaucoma. All partici- variants causing Mendelian glaucoma and were compared pants had open angles and optic nerve head changes with the rest of the cohort. Various demographic factors and consistent with early glaucoma. We compared the IOP the number of eyes requiring glaucoma surgery in participants who underwent cataract surgery (trabeculectomy or glaucoma drainage implant) were (phacoemulsification with posterior chamber intraocular analysed in each group and student t-test was used to com- lens insertion) during follow-up to a matched control. pare the two. ABSTRACT 121

Results: The mean age at diagnosis was significantly lower MRF at detecting a moderate or advanced field defect were in the Mendelian subgroup compared to the rest (38.63 75.0% and 73.3% respectively. Qualitative feedback showed ± 22.52 years vs 58.75 ± 16.21 years, P < 0.0001). The the test to be simple and comfortable, producing an overall maximum intraocular pressure measured was higher in the positive test experience. Mendelian group. A higher percentage of individuals in the Conclusion: Preliminary analysis indicates high utility of Mendelian group required incisional glaucoma surgery com- the MRF iPad test as a screening tool for glaucoma within pared to the rest (74.8% vs 52.5%, P < 0.0001). The individ- rural areas. The test produces reasonable measures of perfor- uals with Mendelian glaucoma had an average of 1.18 mance compared with reference standards, and delivers a ± 0.83 eyes that underwent incisional glaucoma surgery, positive test experience, in contrast to conventional field-test which was significantly higher than the rest of the cohort perceptions. This has particular application within rural and (0.76 ± 0.82 eyes). remote areas where cost, usability, and transportation logis- Conclusion: Among individuals with advanced glaucoma, tics are of relevance. those with pathogenic genetic variants causing Mendelian glaucoma had a higher number of eyes requiring glaucoma surgery compared to those without. This has prognostic 107. High-throughput CRISPR-based morphological implications for individuals at risk of advanced glaucoma profiling of IOP-associated genes in primary trabecular and knowledge of genetic status could lead to more effective meshwork cells management of their disease. Peter Lu1, Sandy Hung2, Connor Greatbatch1, Helena Liang2, Rick Liu1, David Mackey3, Anthony Cook4, Stuart 106. Validation of an iPad visual field test to screen for MacGregor5, Jamie Craig6, Alex Hewitt1 glaucoma in rural and remote settings Email: [email protected] 1Menzies Institute for Medical Research, Hobart, Australia, Mark Chia1, Angus Turner1,2, George Kong3, Ashish 2Centre for Eye Research Australia, Melbourne, Australia, Agar4,5, Edward Trang5 3Centre for Ophthalmology and Visual Science, Perth, Email: [email protected] Australia, 4Wicking Dementia Research & Education 5 1Lions Eye Institute, Perth, Australia, 2University of Western Centre, Hobart, Australia, QIMR Berghofer Medical 6 Australia, Perth, Australia, 3Royal Victorian Eye and Ear Research Institute, Brisbane, Afghanistan, Department of Hospital, Melbourne, Australia, 4Prince of Wales Hospital, Ophthalmology, Adelaide, Australia Sydney, Australia, 5University of New South Wales, Sydney, Introduction: Primary open angle glaucoma (POAG) is Australia one of the most heritable human diseases and a leading Purpose: Melbourne Rapid Fields (MRF) is an iPad applica- cause of blindness worldwide. Intraocular pressure (IOP) tion which was designed as an inexpensive and portable is currently the sole modifiable risk for POAG, and method of assessing visual fields. This study assesses the recently a genome-wide association study identified utility of MRF’s shortened screening module for detecting 101 statistically independent single nucleotide polymor- glaucoma in non-metropolitan settings. phisms (SNPs) which influence this trait in the general Method: Prospective, multi-centre, cross-sectional valida- population. In this study, we sought to combine the tion study with participants recruited from multiple sites power of CRISPR/Cas-mediated gene knockout with cell through two separate clinical services: Lions Outback painting to allow the functional follow-up of genes impli- Vision, WA and Outreach Eye Services, NSW. Participants cated in IOP and glaucoma. were tested using the 90 second screening module of MRF Methods: Low passage primary trabecular meshwork cells and compared with a reference standard; either Humphrey were harvested and characterized. Two sgRNAs targeting SITA 24-2 or Haag-Streit Octopus 24-2. Major outcome 62 genes across 49 loci were designed. An additional measures were sensitivity and specificity at detecting moder- 10 sgRNAs, which are known not to target the human ate and advanced field defects (<−6 Mean Defect). Qualita- genome were also selected. sgRNAs were individually tive feedback was obtained using Likert scales to determine cloned into a novel CRISPR/Cas construct and underwent user acceptability. lentiviral packaging. Following transfection and puromycin Results: Preliminary analysis to date included 52 eyes of selection, trabecular meshwork cells were stained (Hoechst 27 participants: 9 glaucoma, 6 glaucoma suspect, and 12 nor- 33342, Concanavalin A, Syto 14 green, Phalloidin/Wheat- mal individuals. Six eyes failed to meet reliability criteria germ Agglutinin, and MitoTracker Deep red) and imaged due to high false positives. Sensitivity and specificity of using a Zeiss Celldiscoverer 7 across five channels. 122 POSTER ABSTRACTS

Results: A total of 20 160 images at 20X magnification 109. Incidence of XEN-related endophthalmitis were captured, across 210 wells of 96-well plates. Morpho- logical profiling using the CellProfiler/Analysis suite Alice Dutton1,2, Nicholas Toalster2, Jennifer F. Gaskin2, allowed the separation of cellular organelles. All control Ghee Soon Ang2 samples were found to have increased MYOC expression Email: [email protected] following dexamethasone exposure, and distinct patterns of 1Parke Street Specialist Centre, Katoomba, Australia, intracellular morphology were elucidated across genes at 2Royal Victorian Eye and Ear Hospital, Melbourne, distinct IOP-associated loci. Australia Conclusion: The combination of CRISPR/Cas-gene pertur- Purpose: To estimate the incidence of XEN-related bation with cellular morphological profiling offers the endophthalmitis. unique ability for high-throughput functional screening. Method: Retrospective case series. Patients with XEN Gel Stents implanted in 2017 and 2018 in Victoria, Australia. 108. Hydrus Microstent: Surgical modality for Data provided by Allergan PLC estimated total number of management of glaucoma XEN Gel Stents implanted in the 2-year period. Cases of endophthalmitis were identified from coding records at ter- Waseem Henein1, Matthew Green1, Brendan Cronin2 tiary referral hospitals managing all cases of endophthalmitis Email: [email protected] in the state of Victoria. 1Gold Coast University Hospital, Gold Coast, Australia, Results: Three cases of endophthalmitis presented during 2Queensland Eye Institute, Brisbane, Australia 2017 and 2018. A total of 488 XEN stents were estimated to have been inserted in the same timeframe, giving an approx- Purpose: To assess the effects of Hydrus microstent inser- imate incidence of 0.3% per annum. There were no cases of tion on intraocular pressure and number of ocular hypoten- early-onset endophthalmitis. sive medications in patients with glaucoma or ocular Conclusion: Late-onset endophthalmitis is a serious compli- hypertension. cation following implantation of the XEN Gel Stent. Oph- Method: A retrospective study of all patients who under- thalmologists should always remain vigilant for infection as went combined Hydrus microstent insertion and it can occur at any time after surgery. phacoemulsification by two Ophthalmologists (BC, MG) in Queensland, Australia. Patients were included if they had a diagnosis of glaucoma or ocular hypertension and had con- 110. Analysis of lamina cribrosa intensity according to sistent post-operative follow-up of greater than 24 months. glaucoma severity using swept-source optical coherence Patient’s pre-operative and post-operative data were collated tomography in glaucoma retrospectively from medical records and analysed. Main outcomes assessed included intraocular pressures, number of Jiyun Lee1, Kyoung I. Jung1, Chan K. Park1 ocular hypotensive drops required, associated complications, Email: [email protected] and need for secondary surgery. Complete surgical success 1Seoul St.Mary’s Hospital, The Catholic University of was defined as IOP ≤18 without medications, in accordance Korea, Seoul, Korea, Republic of with the World Glaucoma Association definition. Results: A total 65 eyes of 42 patients with a mean age of Purpose: To explore the relationship between lamina 73 ± 7.1 were included in the study. There was a significant cribrosa (LC) intensity and glaucoma severity in glaucoma. reduction (85%) in the mean number of ocular hypotensive Design: Cross-sectional study. drops used (pre-op 0.3 ± 0.7 vs post-op 1.7 ± 1.1, Methods: LC intensity and LC thickness were measured P < 0.001). There was also a significant reduction in the using Image J software in B-scan images obtained using mean IOP (15%, pre-treatment 15.0 mmHg ± 4.7 vs post-op swept-source optical coherence tomography. The measured 17.5 mmHg ± 5.6, P < 0.05). Complete surgical success values were normalized by using vitreous and retinal pig- was achieved in 47 eyes (70%) post-operatively. ment epithelium signal. Each measurement was performed Conclusion: Hydrus microstent insertion significantly at 3 locations (mid superior, centre, and mid inferior) by reduced the mean number of ocular hypotensive drops and 2 examiners. the mean intraocular pressure in this patient group. The Results: 76 eyes from 76 subjects (29 glaucoma suspect, results highlighted the efficacy of the Hydrus microstent as a 25 mild glaucoma, and 22 moderate/advance glaucoma) surgical intervention option for patients with glaucoma or were included in the study. Although significant differences ocular hypertension. in RNFL thickness and visual field test parameters were in ABSTRACT 123

3 groups, no significant differences in mean LC intensity at 1Austin Health, Melbourne, Australia, 2Royal Victorian Eye 3 locations were found. and Ear Hospital, Melbourne, Australia Conclusions: LC intensity was not correlated with the sever- Purpose: The diagnosis of OMG is often challenging ity of the glaucoma. because other diseases such as cranial nerve palsy can have similar ocular signs and symptoms as OMG. This article aims to assist the clinical diagnosis process of true OMG 111. Microscope tilting aid vs manual tilting of the patients from OMG-suspects by elucidating clinical fea- operating microscope: A comparison study tures (demographics, presenting symptoms and comorbidities). Gabrielle Kalofonos2, Eagle Ngo1, Jason Cheng4,5, Anesa Methods: This was a retrospective, observational chart Blanco3 review on 114 OMG suspects who underwent serum testing Email: [email protected] for the AChR-Abs at the Royal Victorian Eye and Ear Hos- 1Queensland University, Brisbane, Australia, 2Vision Eye pital in Victoria, Australia during the period of 2 January Institute, Sydney, Australia, 3Metwest Eye Centre, Sydney, 2016 to 30 December 2017. These patients were followed Australia, 4Liverpool Hospital, Sydney, Australia, up with an average of 2.8 months of the neuro- 5University of New South Wales, Sydney, Australia ophthalmology clinic before given the final diagnosis. Data Purpose: To introduce a low-cost device to assist the tilting such as demographics, clinical features (ptosis only, diplopia of the operating microscope when performing glaucoma only or ptosis and diplopia), and co-morbidities were angle surgery and to compare it to manual tilting. extracted from medical records. Method: A jar opener and rubber band is combined to create Results: The study demonstrates the complexities and this device. The device attaches to the microscope tilting dial uncertainties inherent in the clinical diagnosis of OMG. It to act like a wrench to reduce the force required to turn the has reconfirmed the previously reported finding that ptosis dial. The device is compared to traditional manual tilting in and diplopia (60%) are the most common presenting com- terms of satisfaction and pain score. The microscope is plaints of true OMG patients. Novelly, however, it has dem- rotated to 30 tilt, and then back in a single cycle using both onstrated how poor the positive predictive value of this the device and manual mode. The cycle is repeated 3 times combination of findings is (less than 50%). Furthermore, it to simulate 3 angle surgery cases in a row. A linear score has demonstrated that the common risk factors for OMG mimics (such as cranial nerve palsies) are common amongst system of 0-10 is used with 10 being high satisfaction or those who truly suffer from OMG. high pain. Conclusion: This study highlights that, in the absence of Results: Microscope tilting aid scored 8.3 in the satisfaction serological confirmation, the diagnosis of OMG will con- score compared to 4.5 for the manual tilt. The pain score for tinue to rely on clinical acumen and a gestalt clinical picture the microscope tilting aid and manual tilt was 0 and 2.6 rather than on binary tests. respectively after a single cycle, 1.0 and 4.6 after 2 cycles. The participants were unable to complete the manual tilt for a third cycle due to wrist strain and but were able to com- 113. The presentation, treatment and complications of plete it using the microscope tilting aid with a pain score herpes zoster ophthalmicus: A study from a tertiary eye of 1.0. hospital in Australia Conclusion: The microscope tilting aid has a higher satisfaction score compared to the manual tilt. It also reduces Rahul Chakrabarti1, Grace George2, Kristen Wells1, wrist pain especially if more than a single cycle is required. Carmel Crock1 Email: [email protected] NEURO-OPHTHALMOLOGY 1The Royal Victorian Eye and Ear Hospital, Melbourne, Australia, 2The University of Newcastle, Newcastle, UK

112. Differentiating clinical features of ocular Purpose: Herpes zoster ophthalmicus (HZO) is the myasthenia gravis (OMG) from OMG-suspects oculocutaneous reactivation of latent varicella-zoster virus (VZV) affecting the ophthalmic division of the trigeminal In Y. Chung1, Shivanand Sheth2, Kristen Wells2, Thomas nerve. The challenge remains with timely diagnosis, institu- Campbell2 tion of appropriate antiviral treatment and management of Email: [email protected] complications. We aimed to analyse the demographics, clinical features, incidence of complications and treatment 124 POSTER ABSTRACTS practice patterns of patients with HZO referred to a tertiary 95% CI 1.02-11.86, P = 0.046) and average OCT (odds ratio eye hospital in Australia. 1.02 per unit, 95% CI 1.01-1.03, P = 0.006). For dis- Methods: A retrospective audit from the first 100 consecu- tinguishing true papilloedema from pseudopapilloedema, tive cases presenting to the Royal Victorian Eye and Ear findings associated with true papilloedema were average Hospital (RVEEH) emergency department with HZO from OCT (odds ratio 1.02 per unit, 95% CI 1.01-1.03, July 2017 to June 2018 was performed. P = 0.008) and signs of IIH on MRI (odds ratio 5.56, 95% Results: 71% of patients referred to the RVEEH with HZO CI 1.11-27.89, P = 0.037). were commenced on systemic antivirals within 72 hours of Conclusion: A variety of approaches are used in the diagno- rash development. The most common clinical features were sis of the suspected papilloedema patient. We suggest a dermatomal rash (92%), pain (63%), and conjunctival injec- structured approach that may improve diagnostic yield and tion (62%). Common ophthalmic signs at time of presenta- reduce unnecessary burden to our patients. tion included conjunctivitis (40%), uveitis (26%), and keratitis (20%). 51% of patients were started on systemic anti-viral at the time of presentation. Famciclovir was the 115. Neurological sequelae of herpes zoster ophthalmicus most commonly used anti-viral agent (54%). However 93% of patients were prescribed the incorrect dose of famciclovir. Kevin Liu1, Helen Danesh-Meyer1, Rachael Niederer2 Conclusion: This study provides evidence that primary care Email: [email protected] and emergency department guidelines need to be clear on the 1University of Auckland, Auckland, New Zealand, importance of early management of HZO, aiming to have all 2Greenlane Clinical Centre, Auckland District Health patients on treatment in <72 hours. Further education needs Board, Auckland, New Zealand to be provided to health care professionals in clinical assessment, including being aware of ophthalmic complications Purpose: To describe the prevalence of neurological com- and the timely correct management of patients with HZO. plications following herpes zoster ophthalmicus (HZO) and its risk factors. Method: Retrospective medical record review of patients 114. Papilledema: A review of cases presenting to the seen in Greenlane Eye Clinic, Auckland District Health Royal Victorian Eye and Ear Hospital Board from 1 January 2006 and 31 December 2016 with a first episode HZO clinical diagnosis. Lily Vu1,2, Kristen Wells1, Shivanand Sheth1, Thomas Results: 869 subjects presenting with HZO were included 1 Campbell for analysis. Median age was 65.5 years (IQR 52.9-75.4), Email: [email protected] 52.5% were male and 72.6% were Caucasian. Median follow 1 Royal Victorian Eye and Ear Hospital, Melbourne, up was 6.3 years (IQR 3.7-8.9) with a total of 5504.4 2 Australia, Eastern Health, Melbourne, Australia patient-years of follow up. Zoster optic neuropathy was seen in 15 subjects (1.7%) and cranial nerve palsy in 30 subjects Purpose: Papilledema can be the first manifestation of dev- (3.5%). 19 subjects developed cerebrovascular accident astating conditions. True papilloedema however can also be mimicked by a variety of harmless conditions. This study (CVA) within 12 months of HZO (2.2%) and 3 subjects had aims to provide a descriptive overview of the diversity of giant cell arteritis (0.3%). Median age of cranial nerve palsy approaches currently in practice at the Royal Victorian Eye (71.9 years) was found to be older than those not developing and Ear Hospital (RVEEH) and to suggest a standardised cranial nerve palsy (P = 0.008). Subjects who developed approach to the care of these often-complex patients. optic neuropathy were more likely to be immunosuppressed Methods: This is a retrospective case series of 101 patients pre- (26.7% vs 9.3% P = 0.023). Hazard of CVA was highest senting to the RVEEH emergency department in 2017 and 2018. immediately following HZO with median time to CVA A review of the case files in ED database including all investiga- 2.7 months (IQR 1.5-6.4) months. On multivariate analysis, tions was carried out. Stata was used for statistical analysis. age at onset of HZO was associated with increased risk of Result: Of the 101 eligible patients, 40 had true pap- CVA (HR 1.053 P = 0.005) and prompt acyclovir was asso- illoedema. 22 (22%) of the 101 patients were asymptomatic, ciated with a reduced risk of CVA (HR 0.307 P = 0.023). incidental findings and 79 (78%) presented with symptoms. Conclusion: Patients who are elderly are at greater risk of Among the entire sample, findings associated with a diagno- stroke following HZO. Treatment with prompt antivirals sis of IIH were full marks on Ishihara test (odds ratio 3.48, was associated with lower CVA risk. ABSTRACT 125

116. Visual outcome and clinical profile of pituitary Purpose: This poster provides a historical perspective of the adenoma following trans-sphenoidal surgery ophthalmotrope and its usefulness in early strabismus surgery. Sucheta Parija1, Lalitha Channamgere Shivadevappa1 The ophthalmotrope is a 19th century invention of Christian Email: [email protected] Georg Théodore Ruete a pioneering German ophthalmolo- 1AIIMS Bhubaneswar, Bhubaneswar, India gist. It was a device used to display the kinematics of ocular movements and comprehend the extra-ocular muscles Purpose: The study reports the clinical profile and visual responsible for individual movements. outcome of pituitary adenoma (PA) in patients treated by His first version in 1845 displayed Listings Law and his sec- trans-sphenoidal surgery (TSS). ond version in 1857 conceptualised both Donder's and List- Method: A retrospective analysis of 38 cases of pituitary ing’s law. Many versions were later created by others. These adenomas that had undergone total or subtotal resection by complex configurations of strings and brass weights were trans-sphenoidal route between January 2015-2017 in ter- useful in highlighting the principles of squint correction. tiary hospital were included in this study. Visual patterns Methods: A PubMed medical historical review will show- before and after surgery were evaluated and correlated with case the development and clinical application of the early age, duration of symptoms, pre-operative and post-operative versions of the ophthalmotrope by Ruete and others. This visual acuity, and visual fields (VF). The patients were poster combines historical perspectives, photographs, and followed up for 1 year period. discusses the underlying principles of Listers and Donder's Results: There were 23 females and 15 males detected with law's relating to ocular movements. primary pituitary adenoma with a mean age of 42.7 years. Results: A visually appealing and historically interesting 22 patients presented with visual symptoms ranged from poster will provide insightful background into the early pio- decreased visual acuity and VF defect to complete blindness. neers in ophthalmology and their attempts to conceptualise Improvement in vision after trans-sphenoidal surgery was the complexity of ocular movements. Additionally we high- 75%. Visual acuity in 14 cases showed significant improve- light the creativity of scientific ophthalmic invention and ment. VF defect recovered in 65.5% of the affected eyes. engineering. Providing a platform to hopefully inspire future Best prognosis was seen with symptoms less than 1 year knowledge and invention. duration and age less than 50 years. Conclusions: This poster provides a historical background Conclusion: Trans-sphenoidal surgery is a safe procedure on the opthalmotrope and perspective on its usefulness in for pituitary adenoma patients with visual impairment. teaching ocular movements and planning surgical correction. Awareness among ophthalmologists regarding reversibility “Sometimes in order to keep moving forward, we must be of visual loss needs to be increased so that timely neurosur- willing to look back occasionally. Looking back lets us gical intervention can save both life and sight. know if we are moving in the right direction”.

117. Association between visual exam findings and visual 119. Same day bilateral cataract surgery in bilaterally outcome in retinal artery occlusion blind cases in very remote surgical eye outreaches in rural Papua New Guinea WITHDRAWN David Pahau1 NON SCIENTIFIC Email: [email protected] 1Wewak General Hospital, Wewak, East Sepik Province, Papua New Guinea 118. The ophthalmotrope. A historical review Purpose: The purpose is to share the experiences in the pro and cons of same day bilateral cataract surgery on special Andrew Burbidge1,2.3 blind cases in very remote Surgical Eye Outreaches in rural Email: [email protected] Papua New Guinea (PNG). 1School of Medicine and Public Health University of , Method: Cases of same day bilateral cataract surgery in Newcastle, Newcastle, Australia, 2Hunter Medical Research bilaterally blind patients were reviewed to asses the indica- institute, Newcastle, Australia, 3Hunter New England Area tions for these decisions and the associated risks that are Health Service NSW Health, Newcastle, Australia likely to happen. 126 POSTER ABSTRACTS

Results: About 10 special cases of such were reviewed and OCULAR ONCOLOGY the indications were determined. All cases had reasons for the surgery to be done and then being followed up by a health worker to review the cases and report on the post 121. The result of excisional biopsy with amniotic operative visual status and any risks or signs of infection. membrane transplantation and postoperative adjuvant This may have been the only time in their lives for this sight topical mitomycin C eye drops in ocular surface restoring opportunity which may never come again and it neoplasia is100% highly likely they will die blind. Post operative patients for follow up is always a challenge in WITHDRAWN rural PNG where transport costs and access to health care is always an obstacle. Conclusion: It is very challenging to make a critical deci- 122. Maintaining quality of life: Electrochemotherapy sion on whether to do same day bilateral cataract surgery on for palliative periocular malignancy bilaterally blind patients in a very remote rural areas in PNG but it can make a difference in a life that can see again and Katja Ullrich1, Brian Bisase1, Siva Kumar1, Raman live for many more years to come. Malhotra1 Email: [email protected] 1Queen Victoria Hospital, East Grinstead, UK 120. A novel, simple, and cost effective technique to support eye drop compliance Background: Electrochemotherapy (ECT) has been used successfully for treatment of recurrent head and neck skin Sonia Huang1, Nick Andrew1 cancers and skin metastasis. It combines both electroporation Email: [email protected] and chemotherapy. 1South Australian Institute of Ophthalmology, Adelaide, Recurrent metastatic periocular tumours can be not only Australia painful but also cause diplopia and obstruction of the visual axis. Purpose: To describe a novel technique developed by a Method: We report four patients, who all had metastatic patient to improve their eye drop adherence. periocular malignancy. These patients were palliative with Method: Description of technique. widespread metastatic malignancy. All patients had either Result: A cable tie is placed around the eye drop bottle, already had multiple procedures or declined other treatment tightened, and the excess trimmed. Evenly spaced marks are options. drawn on the side of the bottle according to how many times We report technique and outcomes. the eye drop need to be administered each day. At the start Results: Patient 1 is a 83 year old man with recurrent malig- of the day, the cable tie should be located at the top of the nant melanoma (MM) nodules in the left medial orbit and bottle. As each dose is administered, the cable tie is slid medial canthal area . down to the next mark. A cable tie at the bottom of the bottle Patient 2 is 72 year old man with metastatic MM and he indicates that all drops for the day have been administered. The bottle is placed in a prominent position in the home to developed painful and unsightly metastatic nodules on the act as its own visual reminder. The cable tie informs the right and left forehead and the left medial canthus. patient of how many drops are still due to be administered. Patient 3 is a 93 year old man with background of wide- At the end of the day, the cable tie can be reset back to spread multiple myeloma and a forehead SCC with peri- the top. neural invasion, clinically apparent as a fungating ulcer. Conclusion: This novel technique is inexpensive, elegant, Patient 4 is a 91 year old woman with metastatic sebaceous and requires minimal dexterity once constructed. It is cell carcinoma of the left lower eyelid obstructing her vision. helpful for patients with short term forgetfulness, and She refused further workup. some individuals may find it easier than setting alarms or All patients experienced an improvement in their pain and drawing a dosing calendar. Eye health care practitioners quality of life (Q of L) None of the patients developed sig- may find it to be a useful tool to suggest to their nificant periocular inflammation or adverse complications patients. reducing their (Q of L). ABSTRACT 127

Conclusion: Electrochemotherapy may be a useful palliative Purpose: Facial nerve palsy (FNP) often significantly treatment for periocular tumours. It improves pain and affects eyelid position and blink. After platinum segment reduces tumour volume. chain placement, patients often also report an improvement in nocturnal lagophthalmos, however, debate exists as to the OCULOPLASTIC /ORBIT effectiveness of weights placed in the supratarsal location when the patient lies supine. Methods: Prospective case series of patients with FNP fol- 123. Periosteal graft for fornix reconstruction lowing PSC insertion. Lagophthalmos on blink, gentle and forced closure was observed in the seated position, lying flat Katja Ullrich1, Raman Malhotra1 supine at 0, lying supine with one thin pillow underneath Email: [email protected] the head and lying on the side, with the non-facial palsy side 1Queen Victoria Hospital, East Grinstead, UK to the pillow. Results: 20 eyes with PSC for facial palsy related Purpose: Fornix and socket reconstruction can be lagophthalmos. a challenge, regardless as to whether the cause is socket Lagophthalmos sitting up was mean 1.3 mm gentle closure. contraction or cicatrising disease. Options for large grafts Lagophthalmos lying supine (no pillow) was mean 2.2 mm with other than oral mucosa are limited and difficult to gentle closure. obtain. Lagophthalmos lying supine with one pillow was mean Periosteal flaps have been used for lid reconstruction, they 2.2 mm gentle closure. conjunctivalise well and are friendly to the ocular surface. Lagophthalmos lying on the side, with the non facial palsy We describe the use of periosteum as a graft for fornix side to the pillow was mean 1.9 mm gentle closure. reconstruction and report our results. No statistical difference in the amount of lagophthalmos Methods: We report a retrospective case series of 5 patients between sitting up and lying flat. undergoing fornix reconstruction with use of periosteal Clinically, 12 out of the 20 eyes had no change in grafts. lagophthalmos on gentle closure when sitting up compared All patients had previously undergone buccal mucosa to supine (no pillow). The remaining 8 eyes had an increase grafting, and had now contra-indication for the use of our of lagophthalmos of mean 2.3 mm (range 1-6 mm). routinely preferred method of using oral mucosal grafts. Conclusion: In our study, the prevalence of lagophthalmos Results: All patients underwent harvesting of periosteal increasing on gentle closure when supine is 40%, with a flaps from the crown of their head or superiorly on the fore- mean increase of 2.3 mm. Provided patients use nocturnal head as part of the harvest of a pericranial flap. There were lubricant, they remain asymptomatic and do not require tap- no harvest site related discomfort affecting daily activities. ing or surgery. Graft sizes of 4-5 cm were utilised, but could easily be sized up if required. All patients had deepening of their fornices. 125. Recognising meibomian gland inversion in patients Patients were comfortable post-operatively but all had signif- with facial palsy to improve the ocular surface icant swelling that took more than 6 weeks to resolve. The first (paediatric) patient developed an infectious kerati- Katja Ullrich1, Elad B. Artsi1, Raman Malhotra1 tis, possibly related to the use of a bolster. In the remaining Email: [email protected] cases, a fornix deepening bolster was not used. 1Queen Victoria Hospital, East Grinstead, UK Conclusion: We present our experience with periosteal grafts for posterior lamella replacement and fornix recon- Purpose: Facial nerve palsy (FNP) is known to worsen struction. Periosteum can be considered as an alternative to Meibomian gland dysfunction on the affected side. Chronic oral mucous membrane in selected cases. Meibomian gland dysfunction leads to a variant of upper eyelid margin entropion associated with excessive tarsal curling, but not always associated with lash ptosis, termed 124. Does lagophthalmos change on lying supine after Meibomian gland inversion (MGI). Surgical correction with upper eyelid platinum segment chain loading? grey line split, tarsoplasty and anterior lamellar repositioning (GLS surgery) appears to further improve the ocular surface 1 1 Katja Ullrich , Raman Malhotra in these patients who have previously undergone upper eye- Email: [email protected] lid loading. 1Queen Victoria Hospital, East Grinstead, UK 128 POSTER ABSTRACTS

Methods: Retrospective, 3 year, non-comparative, single- Conclusion: Blepharoplasty is a widely practiced successful centre study of patients with FNP identified as having MGI operation. The potential for complications exist cause and treated by GLS surgery under the supervision of a single because of lacking of knowledge of the complex structure surgeon. and function of the eyelids. Complications can be avoided We present specific examination findings and a useful test to with appropriate case selection, thorough discussion with determine suitability for GLS surgery. surgical candidates, and careful surgical technique. We assessed changes in symptoms and CADS score, along with cosmetic grading of lash loss and contour and report complications. 127. Surgical management of upper eyelid retraction and Results: 23 patients with acquired FNP underwent GLS sur- its complications in Vietnam gery for MGI with or without lash ptosis. 17 out of the 23 patients (74%) demonstrated an improve- Hien N. T. Thu1,2, Van P. T. Khanh2, Anh B. T. Van1,3, ment in their CADS score after GLS surgery. Seven patients Van P. Hong1,2, Van P. Trong2 had insufficient records with scores missing and no conclu- Email: [email protected] sion could be reached for this group. Improvement of cor- 1Vietnam National Institute of Ophthalmology, Hanoi, neal staining, static and dynamic symmetry were all Vietna, 2Hanoi Medical University, Hanoi, Vietnam, 3 statistically significant. No patient worsened. Vietnam National University, Hanoi, Vietnam The cosmetic outcome including lashes, lid contour and lid Purpose: The procedure consists of disinserting the distal margin appearance is acceptable. levator aponeurosis from the tarsal plate and excising Conclusion: We report outcomes of MGI treatment and use- Muller’s muscle. A turn-over septal flap has been used as a ful diagnostic features. spacer for levator lengthening. This study report the preliminary results of this techniques in a series of patients with upper-lid retraction from moderate to severe. 126. Complications of upper blepharoplasty double fold Methods: Retrospective study of 25 eyelids of 25 patients eyelid in Vietnam with upper-lid retraction from moderate to severe undergo- 1 2 2 ing a transcutaneous levator-lengthening techniques using Van Pham Trong , Cuong Hoang , Hien N. T. Thu , Van P. Hong2, Lien M. Hong2 the reflected orbital septum as a spacer, combine with Email: [email protected] Mullerectomy. Change in palpebral aperture (PA) and con- 1Hanoi Medical University, Hanoi, Vietna, 2Vietnam tour, position of skin crease (SC), symptoms of exposure National Institute of Ophthalmology, Hanoi, Vietnam keratopathy (EK), and complications were recorded. Results: At an average of 3 months postoperative, PA was Purpose: Describe some complications from mild to severe reduced by 3,25 mm on average. The position of the SC was of upper blepharoplasty double fold eyelid and management. within 1 mm of the desired position in all cases. EK resolved Method: Case series report of 69 complications after upper in all cases. Complications included 8 cases ptosis, 4 case blepharoplasty in Vietnam National Institute of Ophthalmology recurrent but acceptable, and 3 cases of recurrent lateral in 2018 and prevention and management of complications. flare. Results: Complications including: asymmetry (15), ocular Conclusions: The levator-lengthening techniques combine surface injury (corneal conjunctivitis, corneal ulcer, corneal with Mullerectomy maybe a viable option as an autologous erosion) (12), artefact rejection (11), inflammation in eyelid spacer for the treatment of upper-lid retraction from moder- (7), granuloma (6), ptosis (6), lagophthalmos (4), hematoma ate to severe. (3), upper eyelid retraction (2), lost needling during operation (2), wound dishence (1). Almost cases of complications with inflammation in eyelid and ocular surface need medical 128. Clinical profile and management of orbitopalpebral treatment first (antibiotic oral and eye drops, anti inflamma- neurofibromatosis type 1 at a tertiary care centre tion) and suture removal with or without reconstruction surgery. Three cases of hematoma need to removal blood. Mandeep Bajaj1, Neelam Pushker1, Seema Kashyap1, Complications of asymmetry, artefact rejection, upper eyelid Seema Sen1, Rachna Meel1 retraction and gralunoma need to reconstruction. Two cases Email: [email protected] of needling lost during operation need in emergency R P Centre, All India Institute of Medical Sciences, New surgery. Delhi, India ABSTRACT 129

Purpose: To retrospectively study the clinical presentation, whereas canaliculo-dacryocystorhinostomy with bicanaliular imaging findings and surgical management of silicone intubation was carried out in Group 2. The tubes orbitopalpebral Neurofibromatosis Type 1 in a large series were kept in situ for 3 months. Improvement in epiphora of patients who presented to our institute during a 5 year was evaluated using subjective and objective parameters. period 2011-2015. Lacrimal patency was assessed with the help of a diagnostic Methods: The demographic data, clinical presentation, syringing, probing and Fluorescein dye disappearance test. imaging findings and surgical interventions were studied. Results: Mean age was 41.06 years in group 1 and 48.8 year Imaging included high resolution computed tomography, sin group 2. Sex ratio(M:F) was 2.75:1and 1.5:1 in groups magnetic resonance imaging and ultrasonography. Surgical 1 and 2. 12 patients(80%) in the group 1 (P = 0.005) and interventions and their outcomes were recorded in histopath- 11 patients(73.3%) in group 2(P = 0.009) had patent syring- ologically confirmed cases. ing at 6mths. 10 patients(66.6%) in group 1 and 8(53.3%) in Results: 76 patients were included in this review. The mean the group 2 had no epiphora. FDDT showed functional suc- age at presentation was 12.8 years (range 2-43 years) with cess of 66.6% in both groups. Mean duration of surgery in an average follow up of 3.8 years. 52(68.4%) patients were group 1 was 23.1 minutes. and 57.4 minutes. in group male and 24(31.6%) were female. 54(71.1%) patients pres- 2. Tube extruded in one patient of each group. ented with ptosis, 11(14.5%) with proptosis, 28(36.8%) with Conclusion: Common canalicular obstruction is a challeng- strabismus, 34(44.7%) with visual impairment, 10(13.1%) ing clinical entity. We found Canalicular trephination with with sphenoid dysplasia and 2(2.6%) patient had associated mono-canalicular stenting to be a minimally invasive and optic nerve glioma. 63(82.9%) patients underwent surgery. equally effective alternative to canaliculodacryocystectomy. Surgical interventions included ptosis correction in It also has the advantage of being a less time consuming and 51(67.1%), tumour debulking in 49(64.5%), lateral canthal cosmetically superior procedure. fixation in 33(43.4%) and strabismus surgery in 23(30.3%). 5(6.6%) patients had an enucleation for a disfigured blind eye. 48(63.2%) patients had a satisfactory cosmetic outcome 130. CoSMid: Conjunctival splitting in the middle for whereas 42(55.3%) had adequate visual rehabilitation. fornix deepening as a technique of socket rehabilitation Conclusion: Orbitopalpebral Neurofibromatosis type 1 has 1 1 1 a complex and varied clinical presentation. A detailed ocu- Deepthi E. Kurian , Jayanthi Peter , Satheesh Solomon lar, orbital and systemic evaluation of each patient is essen- Email: [email protected] tial. The management is challenging and has to be 1Christian Medical College, Vellore, India customised to tackle various components of the condition, to Purpose: To evaluate if conjunctival splitting without mem- achieve optimal functional and cosmetic rehabilitation. brane grafts is as effective in retaining prosthesis in contracted sockets as dermis fat grafts. Methods: Retrospective review of all socket reconstructions 129. Evaluation of canalicular trephination and from one centre over 9 years was done. The aim of recon- monocanalicular stenting vs struction was to alter architecture of the contracted socket so canaliculodacryocystorhinostomy in lacrimal common as to retain prosthesis. The two procedures done were canalicular obstruction dermis-fat graft (DFG) and conjunctival splitting as per the surgeon’s choice. The split conjunctiva was left to re- Mandeep Bajaj1, Neelam Pushker1, Rachna Meel1 epithelialize under cover of topical antibiotics and steroids. Email: [email protected] Results: Out of 24 patients treated during the study period, 1R P Centre, All India Institute of Medical Sciences, New 16 patients with mean (SD) age 35.5 (15.6) years underwent Delhi, India conjunctival splitting technique while 8 patients aged 24.1 Purpose: To compare the outcomes of canalicular trephina- (18.4) years underwent DFG. The M: F ratio was 7:9 in the tion with mono canalicular stentplacement vs cana- conjunctival splitting group and 5:3 in DFG group. The most liculodacryocystorhinostomy with intubation in patients with common cause of anophthalmic socket was enucleation for common canalicular obstruction. tumour in the DFG group and evisceration for trauma in the Methods: A Prospective comparative interventional ran- conjunctival splitting group. There was no difference domized study in which 30 adult patients having common (P = 1.0) between DFG and conjunctival splitting in terms canalicular obstruction were enrolled and randomized into of good prosthesis retention. In those who underwent DFG, two equal groups. In Group 1, canalicular trephination and 6(75%) achieved a good prosthesis fit and 2 required a sec- monocanalicular silicone stent placement was performed, ondary procedure while in those who underwent 130 POSTER ABSTRACTS conjunctival splitting, 4 were lost to follow, 4 had an amni- 132. Use of penile full thickness skin grafts in complex otic membrane graft (excluded) and among the remaining eyelid burns reconstructions to avoid sight threatening 8 patients, 5(62.5%) achieved good prosthesis retention. corneal exposure None had post-operative infection. Conclusion: * The technique of conjunctival splitting with WITHDRAWN bare conjunctiva is a safe and equally effective first line option of socket rehabilitation. 133. Validating three-dimensional imaging for volumetric assessment of periorbital tissue 131. Traumatic orbital haemorrhage: A 15-year review at a tertiary trauma centre Jonathan Hyer1, Fabiola Murta1, Valerie Juniat1, Daniel Ezra1,2 Allister Lee1,2, Timothy Sullivan1,2 Email: [email protected] Email: [email protected] 1Moorfields Eye Hospital, London, UK, 2UCL Institute of 1University of Queensland, Brisbane, Australia, 2Royal Ophthalmology NIHR Biomedical Research Centre for Brisbane and Women’s Hospital, Brisbane, Australia Ophthalmology, London, UK

Background/Purpose: To report the characteristics of trau- Purpose: To evaluate the accuracy and interobserver vari- matic orbital haemorrhages encountered at a tertiary trauma ability of three-dimensional (3D) stereo photogrammetric centre and incidence of orbital compartment syndrome imaging for volumetric assessment in the periorbital region requiring lateral cantholysis. and to propose a methodology for measurement. Methods: A retrospective chart review was performed on all Methods: A cross-sectional study of morphologically nor- patients who presented to the Royal Brisbane and Women’s mal subjects had photographs taken using the VECTRA M3 Hospital Emergency Department between 2003-2017 with imaging system on two separate occasions with eyes open post-traumatic orbital haemorrhage confirmed on computed and closed. Changes in volume were compared between the tomography scan. different permutations (registration method, eyes open or Results: 100 orbits from 98 patients were included in the closed, eyelids measured separately or together, extension of study. The majority of patients were male (73%) and 16% area measured to include mid-face). The study was per- were anticoagulated. Mechanism of injury included falls formed in single centre teaching hospital. The primary study (39%), direct blunt trauma (30%) and road traffic collisions outcome measurement was change in mean surface volume (29%). 80 of the haemorrhages were extraconal and 20 were (mL) in the periorbital region, as generated by different per- intraconal. Extraconal haemorrhages were most commonly mutations of analysis. Accuracy was defined as the agree- located in the superior orbit and reported haematoma thick- ment between paired images with no calculated volume ness ranged from 2 to 17 mm (mean 5.13 mm). Approxi- difference (0 mL). The agreement between observers was mately 50% of all patients also suffered from an intracranial assessed using Bland-Altman plots. haemorrhage and 85% had at least one orbital wall fracture. Results: 58 adult subjects were analysed. There was a statis- There were 8 cases (8%) of orbital compartment syndrome tically significant difference (P < 0.0001) between different requiring lateral cantholysis with varying patient and permutations with registration of images having the most haemorrhage characteristics. Decompression was performed effect (partial eta squared 0.229). A mean change in volume after imaging in all but one patient. of 0.11 ± 0.13 mL was reported for the most accurate Conclusion: Orbital compartment syndrome from post- method. Agreement between observers was confirmed traumatic orbital haemorrhage is uncommon. Diagnosis and (highest Intraclass Correlation Coefficient 0.63). decompression is often delayed, particularly in the setting of Conclusions: Assessment of volumetric change in the peri- multitrauma with other injuries. Radiological features of orbital region using 3D image reconstruction, is accurate orbital haemorrhages varied and were not accurate predictors with good interobserver repeatability and is suitable for clin- of OCS. Patients that did not develop OCS generally had ical use. A methodology for data acquisition using the favourable visual outcomes in the absence of other ophthal- VECTRA M3 is proposed. 3D image reconstruction holds mic injuries. promise to enable diagnosis, treatment monitoring, and surgical outcome evaluation in ocular adnexal disease. ABSTRACT 131

134. Case series of orbital crystal storing histiocytosis Method: Retrospective observational cases series evaluating radiographic findings over a period of 7 years in a tertiary Caroline Wilde1, Hooman Sherafat1 eye centre. The HSDJ morphology was identified and corre- Email: [email protected] lated with syringing and DCG findings. 1Kingston Eye Hospital, London, UK Results: 120 patients were included in this study. Of the 120 patients (240 eyes), 15 (12.5%) had one or both lacrimal Purpose: Crystal storing histiocytosis (CSH) is a rare disor- sacs with HSDJ. In total, there were 21 lacrimal sacs der in which reactive histiocytes filled with cytoplasmic (8.75%) with HDSJ. 5/21 nasolacrimal systems (23.8%) immunoglobulin crystals accumulate in the bone marrow demonstrated abnormality on syringing. and numerous other extramedullary sites. It can affect any Conclusion: We report the prevalence of an anatomical vari- organ site but the head and neck is most common. In 90% of ant of the lacrimal sac and NLD, observed on DCG, in a cases, it is associated with an underlying lymphoproliferative population of patients with epiphora, where the NLD origi- or plasma cell disorder (LP-PCD). We present the first nates from the inferior aspect of the medial wall of the lacri- reported case of ocular CSH occurring in isolation. mal sac. We found this high sac duct junction (HSDJ) Methods: The UCL Institute of Ophthalmology archives morphology of the NLD in 8.75% of imaged nasolacrimal were searched over a period of 30 years. systems. Further studies are needed to correlate this ana- Results: Four cases of orbital CSH were identified. Three tomic variation with symptoms and management outcomes. cases were associated with MALT lymphoma. The fourth case was of a 76-year-old Caucasian man who presented with a large medial conjunctival mass with dilated tortuous 137. Endoscopic orbital decompression by oculoplastic vessels. Biopsy confirmed the diagnosis of CSH. Systemic surgeons for proptosis in thyroid eye disease assessment and investigation did not identify any further foci of CSH or underlying malignancy, He remains under Valerie Juniat1, Laura Abbeel2, James A. McGilligan3, observation. David Curragh1, Dinesh Selva1, Saul Rajak2 Conclusion: This case illustrates a very rare example of con- Email: [email protected] junctival CSH with no underlying malignancy identified at 1Royal Adelaide Hospital, Adelaide, Australia, 2Sussex Eye 18 months follow up. It is important to have a high index of Hospital, Brighton, UK,3Princess Royal Hospital, Haywards suspicion and to investigate patients for LP-PCD. CSH may Heath, UK precede the diagnosis of a LP-PCD, and therefore patients should be kept under a period of surveillance. Purpose: Orbital decompression is an established surgical treatment option for a range of orbital conditions. Tradition- ally, ENT surgeons have adopted the endoscopic route while 135. Efficacy of perforated punctal plugs in unilateral/ ophthalmologists operate via an external approach. We bilateral punctal stenosis due to ocular allergy report the outcomes of endonasal decompression performed by oculoplastic surgeons experienced in endonasal WITHDRAWN techniques. Method: This was a retrospective case series of patients who underwent endoscopic orbital decompression for prop- 136. High nasolacrimal sac-duct junction tosis secondary to thyroid eye disease across two hospital “malpositioning”: Retrospective review of sites between January 2011 and July 2018. Inclusion criteria dacryocystography images were patients who had endoscopic decompression for proptosis in inactive thyroid eye disease or active disease without 1 1 1 1 Valerie Juniat , David Curragh , Paul Sia , Dinesh Selva dysthyroid optic neuropathy. Information collected include Email: [email protected] patient demographics, diagnosis, surgical details, pre- and 1 Royal Adelaide Hospital, Adelaide, Australia post-operative clinical findings (including visual acuity, colour vision, exophthalmometry readings, palpebral aperture, Purpose: To describe a “malpositioning” of the intraocular pressure, ocular motility, diplopia, visual field), nasolacrimal duct, termed as high sac duct junction (HSDJ) complications and further treatment. morphology, that is seen on dacryocystography (DCG). Results: There were 70 cases of endoscopic decompression. Knowledge of this anatomic variant may have management The majority of patients had endoscopic medial and poste- implications for patients with epiphora as it may make rior medial wall/floor decompression (44.3% - 31/70 cases). nasolacrimal intubation more technically difficult. 132 POSTER ABSTRACTS

Visual acuity remained stable in 98.6% (69/70). There was Email: [email protected] an average reduction in proptosis of 3.5 ± 1.2 mm (SD) in 1Westmead Hospital, Sydney, Australia the endoscopic medial wall only group, 3.9 ± 0.9 mm Purpose: External dacryocystorhinostomy (DCR) is per- (SD) in endoscopic medial wall and posterior medial portion formed in patients with epiphora secondary to nasolacrimal of the floor group, and 7.6 ± 2.1 mm (SD) in the 3-wall duct obstruction (NLDO). This is most commonly due to decompression group. Motility improved in 11.4% (8/70) stenosis, inflammation and infection, but there are a number and worsened in 2.9% (2/70). of unexpected pathologies which can mimic primary There were no significant intraoperative or postoperative acquired NLDO. These unexpected pathologies can lead to complications associated with endoscopic surgery. failure of external DCR. We aim to review the incidence of Conclusion: Oculoplastic surgeons experienced in endo- these unexpected pathologies that mimic NLDO. nasal techniques can perform endoscopic orbital decompres- Method: We retrospectively reviewed the medical records sion with outcomes comparable to the literature. of 253 patients who underwent endoscopic DCR at one institution in Boston, MA from January 2012 until October 2017. Of these 253 patients, 18 had been referred due to fail- 138. Patients undergoing endoscopic ure of external DCR and required revision surgery. We dacryocystorhinostomy: An unusually high incidence of reviewed the histopathology results of these patients to get sinus disease the tissue diagnosis. Results: One of the 18 patients (5.5%) had a pathology other Jagdeep Cheema1 than NLDO. This patient was a 74-year-old female who Email: [email protected] failed her initial external DCR. Histopathology of the tissue Westmead Hospital, Sydney, Australia revealed that this patient had chronic lymphocytic leukaemia Purpose: The nasolacrimal apparatus is located in the lateral (CLL) infiltrates, an unexpected pathology that mimicked wall of the nasal cavity, in close proximity to the paranasal primary acquired NLDO. sinuses. Although these are anatomically related regions, lit- The remaining 17 patients (13 female, 4 male; average age tle is known about the relationships between nasolacrimal 65) had histopathology revealing chronic lacrimal duct disorders and chronic rhinosinusitis (CRS). We aim to inflammation. investigate the association between CRS and acquired Conclusion: It is not unusual to have pathologies mimicking nasolacrimal duct obstruction (NLDO). primary acquired NLDO which contribute to failure of exter- Method: We retrospectively reviewed the medical records nal DCR. It is important for the ophthalmologist to have an of 241 patients who had NLDO who underwent endoscopic index of suspicion and a thorough evaluation of patients referred to them for epiphora. dacryocystorhinostomy (DCR) at one institution in Boston, MA from January 2012 until October 2017. We reviewed each medical record to identify a history of sinonasal symp- 140. Demographics of patients with nasolacrimal duct toms, diagnosis of CRS, whether concomitant sinus surgery obstruction who underwent surgical intervention was performed and the histopathology of the nasal mucosa. Results: Of the 241 patients, 130 patients (53.9%) had Jagdeep Cheema1, Oliver Chow1 sinonasal symptoms, 131 patients (54.4%) had a diagnosis of Email: [email protected] CRS without nasal polyps, 16 patients (6.6%) had a diagnosis 1Westmead Hospital, Sydney, Australia of CRS with nasal polyps, 175 patients (72.6%) underwent endoscopic sinus surgery with the DCR and 213 patients Purpose: To assess the demographics of patients with (88.4%) had histopathology diagnosis of chronic rhinosinusitis. nasolacrimal duct obstruction (NLDO) who underwent sur- Conclusion: A high percentage of patients with NLDO gical intervention, as well as to assess patient characteristics exhibit features consistent with CRS, showing that there is a that can contribute to acquired NLDO. close relationship between the two diseases. Further research Method: We retrospectively reviewed the medical records showing the exact relationship would yield beneficial. of 241 patients who had NLDO who underwent surgical intervention (endoscopic dacryocystorhinostomy) at one institution in Boston, MA from January 2012 until October 139. Features of patients failing external 2017. We reviewed each medical record to identify patient dacryocystorhinostomy demographics and characteristics. Results: There was a total of 241 patients who had NLDO Jagdeep Cheema1 who underwent surgical intervention. The average age at ABSTRACT 133 time of surgery was 58.4; 184 were female (76.3%), 57 were shares a number of similarities to another large cohort publi- male (23.7%); 101 had surgery on the right (41.9%), 91 had shed in this area. This is a major public health issue that surgery on the left (37.8%), 49 had surgery bilaterally needs community awareness to reduce long term morbidity. (20.3%), 39 were undergoing revision surgery (16.2%); 202 had histopathology diagnosis of lacrimal inflammation 142. Stereotactic navigation for orbital surgery (83.8%), 57 were smokers (23.7%), 147 had formal diagnosis of sinus disease (61%), 52 had allergies (21.6%), 25 had Kailing Yong1, Matthew Cranstoun1, Timothy Sullivan1 asthma (10.4%) and 8 had immunodeficiencies (3.3%). Email: [email protected] Conclusion: This study provides a detailed analysis of fea- 1RBWH, Brisbane, Australia tures of patients with NLDO who underwent surgical intervention. Purpose: To define the role of Stereotactic Navigation for Orbital Surgery. Stereotaxy uses Cartesian coordinates to define a point in computerized 3-dimensional space. 141. Ocular and periocular dog bite injuries: A Frameless stereotactic navigation, uses CT or MRI studies for retrospective cohort at the Children’s Hospital co-registration with patients bony landmarks. Signal can be Westmead optical (LED) or electromagnetic (EMR) and is used for Pre- operative virtual-reality planning and Real time Intraoperative 1 1 1 Megha Kaushik , William Yates , Christopher Go , Navigation. 1 1 Subhashini Kadappu , Krishna Tumuluri Method: Utilisation of Stereotactic Navigation for Orbital Email: [email protected] Surgery was assessed by retrospective analysis of the tech- 1Children’s Hospital Westmead, Sydney, Australia nique and outcomes in both multidisciplinary and purely orbital surgeries. 12 orbital decompressions, 6 orbital Purpose: To determine the severity of dog bite injuries in a tumours, and 22 sphenoid wing meningiomas were per- large metropolitan paediatric centre and compare to the pub- formed utilizing Stereotactic Navigation. lished literature. Results: Stereotactic Navigation facilitated both multi- Introduction-periocular dog bite injuries in the paediatric disciplinary and purely orbital surgery. Stereotactic Naviga- population often require surgical intervention and can leave tion required additional operative set up time but his was devastating consequences including visual loss, epiphora performed while surgical nursing protocols were being and poor cosmesis. followed and did not add to surgical time. Intraoperative Methods: Patients records were identified by Australian teaching was facilitated by the use of Stereotactic Navigation. Refined Diagnosis Related Groups for the period of Conclusion: Stereotactic navigation facilitates orbital sur- 1998-2018. Detailed medical chart review included patient gery and has the potential to improve patient safety and out- demographics, surgical intervention, periocular injuries, and comes. Stereotactic navigation provides intraoperative post-operative results. Data was collected using a certainty which improves patient safety and surgical out- deidentified database and statistical analysis was performed comes. Stereotactic navigation provides an additional bonus with generalised linear models and STATA 15 to compare in enhancing surgical teaching for Fellows and Registrars. outcomes including risk factors for canaliculus injury. Com- parisons to published literature were made using utilised PAEDIATRIC OPHTHALMOLOGY non-parametric statistical tests. Results: 140 patients were included. Median age of injury was 4.3 (IQR 3.4 to 5.9) with a slight male predominance 143. Analysis of short-term vision training by binocular 54%. The median hospital stay was 1.6 days. Of the perceptual stimulation network platform in amblyopia 133 patients requiring surgical intervention, 41 (31.5%) treatment involved the eyelid margin and 33 (25.4%) required canalic- uli repair. 80 patients had other injuries including lip lacera- Hongwei Deng1,2, Huahong Zhong1 tions (18), orbital fractures (2), trochlear injury (1), and soft Email: [email protected] tissue amputation (4). Smaller dog size conferred a higher 1Shenzhen Eye Hospital, Shenzhen, China, 2Shenzhen risk of eyelid injury (OR 1.25 95% 1.04-1.42). There were University of Medicine, Shenzhen, China no obvious underlying associated factors predicting canaliculus injury. Purpose: By using the binocular visual perception stimula- Conclusion: This retrospect review demonstrates that dog tion platform on internet to treat amblyopia for 3 months, bites can cause significant periocular injuries. This cohort analysis the related factors affecting best corrected visual 134 POSTER ABSTRACTS acuity improvement and to explore the effectiveness of vari- 146. Utilising optos fundus photography in paediatric ous training contents. patients Methods: 75 Amblyopic patients, 20 ametropic amblyopia, 16 anisometropic amblyopia, 6 strabismus amblyopia, 2 Jason Daley1,2, Verlyn Yang1, Heather Russell1 form deprivation amblyopia, mean age 5.95 (+2.37), were Email: [email protected] enrolled in this study for 3 months, all of them have online 1Gold Coast University Hospital, Gold Coast, Australia, binocular visual perception stimulation training twice a day, 2Bond University, Gold Coast, Australia 15 minutes per time. The correlation between visual acuity Purpose: Fundus photography in paediatric patients, espe- improvement, age, various training contents, refractive status cially those aged between 0 and 3 years, is a challenging change, amblyopia type, etc. was analysed. The influencing task. In order to achieve optimal images on the Optos factors of visual acuity improvement and the efficacy of var- P200DTx, a confocal scanning laser ophthalmoscope that ious training contents were analysed. has seen greater usage in infants, specific techniques need to Results: After 3 months of training, the average improve- be utilised. These techniques involve modifying the equipment of visual acuity was 0.2±0.13 (P < 0.01). The eyeglass ment, changing holds and positions, and overall, a tailored lens decreased by 0.22 ± 0.98 (P = 0.15). There is no statis- approach for the age of the child. tical difference between visual acuity improvement and age. In this poster, we present the modifications required to cap- The visual acuity improvement is highly related to pre-train- ture images in age groups of 0-1 year old, 1-3 years old and ing vision, that is, the higher the training improvement of children above 3 years old. poor visual acuity before training (Y = -0.271 X + 0.338, Method: A systematic literature review of techniques used the regression equation is significant P = 0.001). Compari- to image paediatric patients on the Optos P200DTx was con- son of various training content(fine stimulation, visual skills, ducted, case reports studied, and expert opinions consulted. Gabor, contrast sensitivity, information extraction) with the For primary data collection, parents were consented for clini- improvement of vision found: except fine stimulation(P = cal digital images and video recordings to be taken of their 0.014) and contrast sensitivity (P = 0.025); Except for 0.05), child undergoing Optos imaging in a tertiary hospital oph- the coefficients of the other items and the increase in vision thalmology clinic. The subsequent media was analysed and were not statistically significant. The number of training compared with the current literature, to develop specific times was standardized, and the gradual regression analysis techniques for each age group, 0-1 year, 1-3 years including the cross-items of each training project was and > 3 years old. obtained. Gabor's cooperation with information extraction, Results: Photos displaying the specific techniques were fine stimulation, and contrast sensitivity had a certain impact illustrated, accompanied by step-by-step descriptions of the on the improvement of vision. methodology. The “Flying Baby” position, “Back-to-front” Conclusions: Binocular perceptual stimulation network plat- position, “Rear headlock” position and seated/standing posi- form is effective for improving amblyopic vision, and the tion, were employed for each respective age group. more serious the amblyopia is, the more significant it is to Conclusion: These results support the use of the Optos use the platform for treatment. The key to improve vision is P200DTx for fundus photography in paediatric patients of targeted fine stimulation and contrast sensitive content all ages, provided, tailored techniques are utilised. training.

147. Retrospective review of retinoblastoma 144. Performance of spot photoscreener in large-scale management and outcomes at Children’s Hospital screening in Chinese pre-school and school age children Westmead from 2008-2019

WITHDRAWN Julia Starte1, Michael Jones1, Craig Donaldson1, Luciano Dalla-Pozza1, Bhavna Padhye1, Amir Taher1, Madeleine Powys1 145. Performance of automatic binocular vision tester Email: [email protected] YY-VTI in detecting accommodative functions in 1Children’s Hospital Westmead, Sydney, Australia Chinese school age children attending an eye clinic Purpose: Children’s Hospital Westmead in Sydney (CHW) WITHDRAWN is referred every case of retinoblastoma in NSW as well as ABSTRACT 135 patients from overseas who required more complex multi- vision (or were better than 6/12) at most recent follow-up disciplinary management than is available in their home (n = 16). 30% achieved acuity of 6/12 or better at most country. In total this hospital manages approximately 7 new recent follow-up (n = 9). Tube related complications were cases per year. This study aims to audit the management and recorded in 13 cases (40%) and included; corneal touch outcomes of these cases. (n = 5, 16%), tube retraction (n = 2, 6%), iris contact (n = 1, Methods: A retrospective analysis of consecutive cases of 3%), motility disturbance (n = 1, 3%), hypotony (n = 1, 3%) retinoblastoma diagnosed and treated at CHW between 2008 and progression to NPL (n = 3, 9%). Eleven cases (34%) and 2019 was performed. needed further tube surgery; the five corneal touch cases Results: There were a total of 79 patients included in the were repositioned, the two tube retraction cases were study. We have collected data on demographics, mode of extended, and 16% (n = 5) required second surgery due to presentation, clinical and pathological classification, imag- failed IOP control. Three eyes were eviscerated as they were ing, genetics, treatment, follow-up, morbidity and mortality. blind and painful, one eye became phthisical. There has been only one death in this cohort in a patient Conclusion: The Molteno tube is effective in childhood glau- who had trilateral disease and only one patient who devel- coma with outcomes comparable to Ahmed and Baervedlt oped metastatic disease. tubes. Complication rates are high and often require further Conclusion: This is study is crucial for benchmarking our surgery. treatment, auditing outcomes and providing a better understanding of retinoblastoma as a disease. We are able to compare our results to a previous retrospective study performed 149. Optic disc tilt in myopic children at this institution. Preliminary results confirm that we are maintaining a standard of care that is on par with other ter- Loren Rose1, Angela Schulz1, Stuart Graham1 tiary centres around the world. As newer, more targeted Email: [email protected] treatment modalities for retinoblastoma such as intra-arterial 1Macquarie University, Sydney, Australia and intra-vitreous chemotherapy come of age, it is important to have a robust benchmark for comparison to ensure that Purpose: Optic disc tilt (ODT) is associated with high myo- we maintain our excellent standard of care of these patients. pia. It is unclear if tilt is a feature of myopia severity, patient age, or a combination of both. Assessment of ODT has been based on disc photography, which has limitations. This 148. Long-term outcomes of Molteno tube implants in study reports preliminary findings on a prospective longitu- childhood glaucoma dinal observational study of ODT in myopic children using optical coherence tomography (OCT). Tiki Ewing1, Matthew J G Watson2, William H Morgan2, Method: Subjects were measured at baseline with refraction, Antony Clark1,2 axial length, anterior chamber depth, OCT, and corneal Email: [email protected] topography, then reviewed at 6-12 month intervals. Optic 1Perth Children’s Hospital, Perth, Australia, 2Lions Eye nerves were analysed with OCT (Spectralis, Heidelberg) ’ Institute, Perth, Australia using the termination of Bruch s membrane opening to define ONH tilt in 6 meridians. Average and maximum Purpose: To evaluate long term outcomes in Molteno glau- ODT was calculated using Image software. coma implants for childhood glaucoma. Results: 27 subjects enrolled to date, mean age 10.4 Method: Retrospective chart review of children (<16 years) ± 2.7 years (range 5-15). Fifty-three eyes (mean refractive who underwent Molteno tube insertion in Western Australia error − 3.2DS, axial length 24.5 mm) were analysed. Base- between 2000-2016. Success was defined as intraocular line mean average ODT was −0.13and mean maximum pressure (IOP) less than or equal to 21 mmHg with >20% absolute tilt 1.5. The maximum tilt was observed at the reduction in IOP from baseline, with or without IOP lower- superior oblique and horizontal naso-temporal meridians. ing medications. Fifteen subjects have 12 months follow up. Results: 32 eyes from 25 patients were included. Mean fol- The amount of ODT at baseline did not show any association low up was 6.35 years (range 1-18 years). Post-operative with age, axial length or refraction, and ODT did not show cumulative success by Kaplan-Meier survival curves was any statistically significant change over the initial 12 months. 90% at 1 year, 73% at 5 years, and 47% at 9 years. Mean Conclusion: ODT was not identified as a characteristic fea- IOP pre-operatively was 35.3 mmHg and reduced to ture of juvenile myopia at diagnosis and no significant pro- 15.7 mmHg at most recent follow-up. For those with visual gression was noted with age or refraction in the first acuity documented pre-operatively; 70% maintained their 12 months. Longitudinal analysis may reveal changes 136 POSTER ABSTRACTS relating to refractive or structural parameters and if tilt 152. Does size really matter? Aniseikonia in changes with myopia progression. anisometropia and amblyopia

Jay South1, Tina Gao1, Andrew Collins1, Jason 150. Ocular profile of children with congenital Turuwhenua1, Joanna Black1 hypothyroidism Email: [email protected] 1School of Optometry and Vision Science, The University of Maansi Sethi1, Rajesh Jain1, Sarita Beri1, Anju Seth2, Rajiv Auckland, Auckland, New Zealand Garg1 Email: [email protected] Purpose: Refractive guidelines for amblyopia recommend 1Lady Hardinge Medical College, New Delhi, India, full correction of anisometropia, but ignore potential differ- 2Kalawati Saran Children’s Hospital, New Delhi, India ences in image size between eyes. Clinically, aniseikonia is often neglected in anisometropic amblyopia due to assumed Purpose: To evaluate the ocular profile of children with measurement difficulties, and we currently lack evidence on Congenital Hypothyroidism (CH). whether correction of aniseikonia is beneficial. This study Method: A cross-sectional study to evaluate the ocular pro- aimed to examine the relationship between subjective anisei- file of children with CH and to compare it with that of age- konia and anisometropia with or without amblyopia. matched clinically healthy children. 200 eyes of 100 children Methods: Participants (17-52 years) with Anisometropic (5-18 years) diagnosed with CH (euthyroid on thyroxine Amblyopia (n = 6), Anisometropia without amblyopia supplement) were studied for anterior and posterior segment (n = 4) and Isometropic Controls (n = 4) were recruited. abnormalities and compared with normal children. Both Subjective aniseikonia was tested using three clinical tech- groups were divided into age-based subgroups (5-12 and niques: Robertson Technique (RT) (penlight and Maddox 13-18 years). Special emphasis was given to strabismus, rod), Aniseikonia Inspector Version 3 (AI3), and the New refractive errors and dry eye. Anthropometry, Axial Length Aniseikonia Test booklet (NAT); and a psychophysical (AL), Central Corneal Thickness (CCT) and Intra-ocular adaptive method called the Contrast-balanced Aniseikonia pressure (IOP) were also measured in both groups. Propor- Test (CAT), where dichoptic contrast was adjusted to com- tion of children with ocular morbidities in cases were com- pensate for any suppression. pared with normal children. Results: 13 participants completed all tests, one Anisome- Results: Prevalence of strabismus was significantly higher tropic Amblyopia group participant could only complete the (P-value<0.001) in patients (24%) over normal children CAT and NAT due to loss of fusion. Generally, the Aniso- (8%). All the patients had divergent squint. Younger age- metropic Amblyopia group showed the most aniseikonia group had significantly decreased mean AL (21.78 (range − 1.5 − +10.4%) followed by Anisometropic Con- μ ± 0.80 mm) and mean CCT (541.86 ± 18.48 m) compared trols (range − 3.3 − +4.5%) and Isometropic Controls to the AL (22.73 ± 0.46 mm) and CCT (547.54 (range − 1.5 − +2.6%). There was an apparent trend of μ ± 16.32 m) of normal peer group. Mean IOP was higher in more subjective aniseikonia with increasing amounts of older subgroup of patients (14.67 ± 2.77 mmHg) than youn- anisometropia across all four tests (AI3 r = 0.608, ger (11.51 ± 2.31 mmHg) and the difference was statisti- P = 0.028; NAT r = 0.589, P = 0.027; RT r = 0.490, cally significant. Two patients were noted to have greyish, P = 0.089; CAT r = 0.502, P = 0.67). There was variability smaller optic disc. Telecanthus and epicanthus inversus were between the four tests, but all aniseikonia measures were sig- found 4 and 2 patients respectively. Refractive errors were nificantly correlated (r > 0.58, P < 0.036). comparable in both the groups. Conclusions: Subjective aniseikonia can be reliably mea- Conclusions: Children with CH have significantly higher sured in patients with anisometropia and amblyopia. The rate of ocular abnormalities than age-matched normal chil- increase in subjective aniseikonia with increasing anisome- dren. Ophthalmic assessment, especially squint should be tropia did not follow the 1% per Dioptre clinical rule. included in the evaluation of such patients.

153. Excessive smartphone use may cause acute acquired 151. Evaluation of functional outcome and stability of comitant esotropia sutureless scleral tunnel fixated IOLs (SSTIOL) in children with subluxated lens Xueliang Feng1,2, Shuan Dai3 Email: [email protected] WITHDRAWN ABSTRACT 137

1Shanxi Eye Hospital, Taiyuan, China, 2Shanxi Medical third grade, the differences were statistically significant University, Taiyuan, China, 3Children’s Health Queensland (χ(2) = 862.28, P < 0.05). The prevalence of myopia varied Hospital and Health Service, Queensland, Australia from regions. Pupils in provincial capital cities have the highest prevalence of myopia, followed by non-capital cities, Purpose: To investigate if and how excessive smartphone and rural areas lowest, the difference was statistically signifi- use is related to the development of acute acquired comitant cant (χ(2) = 539.57, P < 0.05). Single factor and multivari- esotropia (AACE). ate analysis showed that the grade, parents’ myopia, outdoor Methods: The medical records and history of smartphone activities, continuous closing reading, exposure to electronic use of 26 patients with AACE between February 2016 and October 2017 were retrospectively reviewed. Duration, products, and extracurricular reading time were the influenc- intensity of smartphone use, angle of esodeviation and treating factors for myopia. (P < 0.05). Conclusions: ment outcome were analysed. Pre- and post-operation devia- The prevalence of myopia among primary tion and Stereotest Titmus Results for all patients who had school students in Hubei Province is 24.15%. The preva- underwent strabismus surgery were studied statistically. lence of myopia varied from regions and increased with Results: 20 out of the 26 patients with the diagnosis of grade obviously. Myopia is associated with both genetic fac- AACE used a smartphone for more than 5 hours daily over a tors and individual eye health related behaviours. period of several months prior to presentation to the hospital. All patients had comitant esotropia with an average angle of 46.48 prism diopters (PD) for distance and 42.08 PD for 155. Correction of recurrent paediatric ptosis with poor near; 24 were myopia with spherical equivalent of −4.33 levator function: A modified pentagon frontalis ± 2.63D in the right eyes and − 4.13 ± 2.59 D in the left suspension eyes (ranging from −1.50D to −11.00D). All the patients had normal neurologic examination and normal MRI scan. WITHDRAWN Strabismus surgery were needed for all patients to resolve the esotropia and diplopia. 156. Red reflex: Is there an easier way? Conclusion: Excessive smartphone use may contribute to the development of AACE in adolescents and young adults. Evan Heinecke1, Susan Carden1,2,3 Email: [email protected] 1 ’ 2 154. The myopia investigation of primary school The Royal Children s Hospital, Melbourne, Australia, The students in Hubei province, China Royal Victorian Eye and Ear Hospital, Melbourne, Australia, 3Department of Paediatrics, University of Lianhong Zhou1, Yanfang Meng2 Melbourne, Melbourne, Australia Email: [email protected] Purpose: Screening of infants with the direct ophthalmo- 1 Renmin Hospital of Wuhan University, Wuhan, China, scope to look at the red reflex to detect abnormalities has 2 Wuhan University, Wuhan, China been a standard for many years. The direct ophthalmoscope Objective: To investigate the visual acuity and the incidence can be difficult to use, and many screeners resort to a torch. of myopia among primary school students in Hubei Prov- The modern streak retinoscope provides a light source that is ince, and to study the influencing factors for myopia. easier to use to find red reflex anomalies. The retinoscope is Method: This study involved 16 955 (grade 1 to 3) primary designed to elicit a red reflex, while the direct ophthalmo- pupils from 26 primary schools of Hubei Province, China. scope is designed to provide a magnified view of the fundus. The questionnaire survey and eyesight test were conducted Method: A random sample of paediatric trainees and con- among all the students selected. Children underwent cyclo- sultants who perform neonatal checks were surveyed as to plegic refraction with an auto-refractometer. Pearson chi- their method for performing the red reflex check. square test and binomial logistic regression analysis were Those surveyed were asked to compare the findings using done to identify the prevalence of myopia and influencing both direct ophthalmoscope and streak retinoscope on factors for myopia in students. undilated adult pupils. Results: The prevalence of myopia among primary school Results: The streak retinoscope was found to be comparable students surveyed was 24.15%. The prevalence of myopia to the direct ophthalmoscope and all those surveyed felt it increased with grade obviously. The prevalence was 12.67% was easy to use to evaluate the red reflex for abnormalities. in the first grade, 24.91% in the second grade, 34.95% in the The learning curve is short. 138 POSTER ABSTRACTS

Conclusion: Using a streak retinoscope attachment rather Email: [email protected] than a direct ophthalmoscope attachment may improve red 1Spark Therapeutics, Inc., Philadelphia, USA, 2University of reflex assessment during newborn screening assessments. Iowa, Iowa City, USA, 3Children’s Hospital of Philadelphia, Philadelphia, USA, 4Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA 157. Jak-ROP, the pioneer of ROP screening program in Jakarta: A preliminary report Purpose: To report the 4 year results of voretigene neparvovec (VN) administration in subjects with biallelic 1 1 1 RPE65 mutation-associated inherited retinal disease (IRD). Nabila Aljufri , Hans K. Pramono , Apul S. Napitupulu , Methods: Subjects were randomized to either original Julie D. Barliana1, Dian E. Yulia1, Rita S. Sitorus1 intervention (OI:bilateral subretinal VN at baseline; n = 20) Email: [email protected] or delayed intervention (DI:VN after 1 year; n = 9). Pri- 1Department of Ophthalmology, Faculty of Medicine mary endpoint was bilateral performance on the Multi- Universitas Indonesia, Jakarta, Indonesia Luminance Mobility Test (MLMT) at 7 standard light Background: Jakarta–Retinopathy of Prematurity program levels measured by a change score. Additional endpoints (Jak-ROP) is a mobile screening program that actively were full-field light sensitivity threshold (FST) testing, approaches ROP high-risk babies in Jakarta–Indonesia. Jak- visual acuity (VA), Goldmann kinetic VF (GVF) and safety ROP reaches district hospital (RSUD Koja) to screen high-risk outcomes. babies and discuss the examination result via telemedicine with Results: The MLMT mean (SD) bilateral light level change the paediatric ophthalmology consultant at the national referral score in OI patients at Yr4 (n = 20) and DI patients at Yr3 hospital (Cipto-Mangunkusumo Hospital). ROP-requiring treat- (n = 8) was 1.7 (1.1) and 2.4 (1.5) levels, respectively. Sub- ment babies were referred to Cipto-Mangunkusumo Hospital. sequent to the 1 year outcomes, a change of 1 light level Purpose: To describe the preliminary finding of Jak-ROP occurred in 5 patients; none were below pre-treatment per- screening program. formance. Mean change in white light FST in log10 (cd.s/ 2 − Method: Data from Jak-ROP screening program during m ) averaged over both eyes was 1.90 (1.33) log10 at Yr4 − September 2018-May 2019 was collected. The data includes fun- for OI patients (n = 19) and 2.91 (1.05) log10 at Yr3 for dus retinal images taken by a wide-field digital camera, gestational DI patients (n = 8). Mean change in VA (Holladay scale) − age, post-menstrual age (PMA), birth-weight, and other neonatal averaged over both eyes (logMAR) was 0.00 (0.75) for OI − risk factors as recommended by the Indonesian guideline. and 0.06 (0.24) for DI patients, whereas mean change in Results: There were 167 high-risk infants (334 eyes) screened, GVF III4e sum total degrees was 197.7 (282.7) for OI and 157.9 (325.3) for DI patients. Safety profile was consistent including 95 girls (56,9%) and 72 boys (43,1%). Mean birth with surgical administration procedures. weight was 1747,6 ± 383,9 g, mean gestational age was 35 Conclusions: Improvements in ambulatory navigation, light ± 2,4 weeks, mean PMA was 37.1 ± 2.7 weeks. Of sensitivity and VF are maintained 4 years after VN adminis- 334 screened-eyes, 286 eyes (85,6%) the retina were immature, tration in OI subjects. Improvements in DI subjects were 15 eyes (4,4%) were mature, 31 eyes (9,3%) from 20 infants consistent with those observed in OI subjects. were ROP (at any stage). Of those 31 eyes with ROP, 13 eyes (8 infants) require further treatment for one or both eyes. Conclusion: Jak-ROP program showed the incidence of ROP 159. Traumatic nasolacrimal duct obstruction in Chinese in North Jakarta and its significant contribution to combat children: Clinical characteristics, managements, and ROP-related childhood blindness. It is important to expand this outcomes program to all hospitals with NICU facilities across Jakarta, then other provinces in Indonesia to actively screen all high- Wen Liu1, Chengyue Zhang1 risk babies and promotes a better understanding of ROP. Email: [email protected] 1Ophthalmology Department of Beijing Children’s Hospital, National Center for Children’s Health, Beijing, China 158. Four-year results for the phase 3 voretigene neparvovec (VN) study in biallelic RPE65 mutation- Purpose: To review clinical characteristics, managements, associated inherited retinal disease and outcomes in cases of traumatic nasolacrimal duct obstruction (NLDO) in Chinese children. Daniel Chung1, Stephen Russell2, Jean Bennett3,4, Katherin Method: A retrospective analysis of 21 patients who were A. High1, Arlene Drack2, Zi-Fan Yu1, Kathleen Z. Reape1, admitted to Beijing Children’s hospital from February 2008 Albert M. Maguire3,4 to December 2011 with the diagnosis of traumatic NLDO ABSTRACT 139 was performed. Demographic features and type of injury, children’s hospital. variables collected included age, sex, clinical features, investigations (dacryocystography), man- physical examination findings, volume of orbital or sub- agements, outcomes were reviewed. periosteal abscess (mm3), presenting vital observations, time Results: Among the 21 children seen, 16 (76.2%) were to surgery, length of intravenous antibiotic therapy, duration males, and the mean age of the patients was 5.59 of hospital stay, and need for re-operation. ± 3.14 years (range 1.42-10.58). The most common Results: 31 cases were identified. The mean age was 8.7 aetiology was accidental fall or contusion (33.3%), followed +/−3.9 years and 20 (55.6%) patients were male. Mean by motor vehicle accidents (28.5%) and animal bite (19.0%). duration of ocular symptoms and non-ocular symptoms prior Twelve patients (57.1%) with bony lacrimal passage dam- to presentation were 2.1 and 5.3 days respectively. Mean age, including nasolacrimal fossa fracture (3 patients), presenting temperature, white cell count and c-reactive pro- nasolacrimal canal fracture or obstruction (3 patients), com- tein level were 37.5+/−1.0 degrees celsius, 15.4 bined fractures of both the fossa and canal (6 patients), were +/−6.3 × 109/l and 85.0+/−73.7 respectively. Mean abscess treated with nasal endoscopic dacryocystorhinostomy (NES- volume was 0.93mm3 and 9.31% as a percentage of orbit DCR). Nine patients (42.9%) without bony damage were volume. The commonest species isolated from an managed with Ritleng lacrimal intubation. The total effective intraoperative swab was streptococcal (16 cases, comprising rate was 85.7%, cure rate was 61.9%, among which the cure strep pneumoniae and pyogenes species) and Staphylococ- rate was only 50.0% in the patients with bony lacrimal pas- cus aureus (10 cases). Mean duration of hospital stay was sage damage. 8.8 +/− 0.9 days. 2 cases required a return to operating the- Conclusion: Accidental fall or contusion, motor vehicle atre for re-drainage of the orbital abscess and were associ- accidents and animal bite are the main causes of traumatic ated with older age of the patient. NLDO in Chinese children. Combined fracture of both Conclusion: This study describes the presenting clinical and nasolacrimal fossa and canal is common. Dacryocystography radiological features, microbiological isolates, management provides to be performed to confirm the bony lacrimal pas- and outcomes of paediatric orbital abscess. sage injury condition and to choose the appropriate treatment modalities. The overall therapeutic effect is satisfactory, but the prognosis of patients with bony damage 162. Microcystic macular oedema (MME) seen in optical is poor. coherence tomography (OCT) scans in paediatric optic atrophy

1 1 1,2 160. Low levels of docosahexaenoic acid and arachidonic Lachlan Knight , Deepa Taranath , Susie Luu acid are associated with low platelet counts in preterm Email: [email protected] infants 1Flinders Medical Centre, Adelaide, Australia, 2Women’s and Children’s Hospital, Adelaide, Australia WITHDRAWN Purpose: To report on two paediatric cases with MME secondary to progressive optic atrophy. Method: Two case reports of MME with OCT scans. 161. Outcomes of paediatric orbital and subperiosteal Results: A 9-year-old boy with a history of pilocytic astrocy- abscess at a tertiary paediatric hospital toma of the optic chiasm diagnosed at 9 months old with consequent craniotomy, chemotherapy and bilateral optic Jeremy Tan1,2, Jayraj Bhatti1, Simren Kaur1, Helmut Yu1,2, neuropathy is presented. Another 11-year-old boy with a his- Lourdes Lubrin2, Geoffrey Wilcsek1,2, Kimberley Tan2 tory of intraventricular haemorrhage at birth and a VP shunt Email: [email protected] with bilateral optic atrophy is also reported. Both cases have 1Prince of Wales Hospital, Sydney, Australia, 2Sydney the finding of bilateral MME on OCT scans of the macula seen Children’s Hospital, Sydney, Australia as microcystic changes affecting the inner retinal layers. Purpose: To describe the presenting features and outcomes Conclusion: MME secondary to optic atrophy is a rare of paediatric orbital and subperiosteal abscess requiring sur- occurrence. It can be a sign of severe optic atrophy and an gical drainage at a tertiary paediatric hospital. indicator of poor visual acuity. It occurs more commonly in Method: In this retrospective case series, we reviewed the hereditary optic neuropathy and neuromyelitis optica spec- medical records of children less than 18 years of age who trum disease. These cases suggest other likely causes of were diagnosed with and underwent surgery for an orbital or compressive and radiation optic neuropathy. The causative subperiosteal abscess between 2010 and 2017 at Sydney mechanism remains undetermined. MME should also form 140 POSTER ABSTRACTS an important differential diagnosis of macular retinoschisis cases of HOYA VIVINEX toric IOL inserted between and cystoid macular edema. October 2018 to April 2019. This was compared to our previously published data on Rayner T-flex toric IOLs. Results: 91 HOYA toric IOLs were inserted in this period. 163. Vernal keratoconjunctivitis and serum vitamin D A misalignment greater than 10 was observed in 4.4% of levels in children: A prospective study cases (4/91) compared to 14.6% (31/226) with Rayner toric IOLs (P = 0.02, Fisher’s exact test). Surgical repositioning 1 1 Sucheta Parija , Saswati Sen was required in 1.1% of HOYA torics (1/91) compared to Email: [email protected] 5.3% (12/226) with Rayner torics (P = 0.12). 1 AIIMS Bhubaneswar, Bhubaneswar, India Conclusion: HOYA VIVINEX toric IOLs demonstrated a Purpose: To evaluate the serum 25-hydroxyvitamin D significantly lower incidence of misalignment and a trend (25 OH D3) levels in children suffering from vernal kerato- towards lower incidence of repositioning surgery compared conjunctivitis (VKC) in children. to Rayner T-flex toric IOLs. Method: All the 30 children suffering from VKC and undergoing treatment at a tertiary care hospital in the year 2018 RETINA were included in this study. Another group of 58 healthy non-atopic children was also included in the control arm. Serum Vitamin D3 levels were estimated and compared in 165. DEMac (Direct E-referrals to Macular service): A both the groups and a P-value of <0.05 was considered as referral refinement initiative to optimise resources in the statistically significant. macular service in Cornwall, UK Results: Mean serum 25 (OH) D3 levels were significantly lowerintheVKCgroupofchildrencomparedwiththecontrol Annika Quinn, Nadir Ali, Koushik Roy, Ashish group (10.08 ng/mL and 15.99 ng/mL, respectively);P <0.05. Patwardhan Severe Vitamin D deficiency was detected in 52.8% of cases Email: [email protected] of VKC children as compared to healthy children 18.6% 1Royal Cornwall Hospitals NHS Trust, Truro, UK (P = 0.017). VKC children reported less outdoor activities and less exposure to sunlight as compared to the control group and Purpose: Due to increasing demand on the macular service, showed a significant correlation with serum vitamin D3 levels. coupled with difficulty in recruiting doctors and allied health Conclusion: Children suffering from VKC have the added professionals, it has become essential to optimise available risk of suffering from vitamin D deficiency and this aware- resources. Having a process to ensure that referred patients ness is needed among the paediatricians and general ophthal- are seen in the correct clinic at the correct interval, as well as mologist for taking preventive care and proper counselling avoid reviewing patients in the clinic with no macular of these cases. pathology, frees up resources for more urgent cases. Methods: A referral form consisting of 8 questions was REFRACTIVE SURGERY designed. All referral forms were faxed by optometrists to the macular service. Patients were then booked into a screening clinic, which consisted of visual acuity test, pupil dilata- 164. Comparing the incidence of HOYA VIVINEX and tion, multicolour fundus photos, fundus autofluorescence, Rayner T-Flex toric intraocular lens misalignment and OCT macular scan and OCT angiography. These images repositioning surgery were reviewed in a virtual clinic by a trained ophthalmic technician who signposted patients to urgent or routine ret- Jessica Tang1, Bernardo Soares1, Anton Van Heerden1 ina clinic, other subspecialist clinic or discharge. Email: [email protected] Results: Data was gathered from November 2017 to June 1The Royal Victorian Eye and Ear Hospital, Melbourne, 2018. There were a total of 438 referrals. 91 (20.8%) patients Australia were discharged without clinic review. 59 (13.5%) patients were booked into other subspecialty clinics. 288 (65.8%) Purpose: To review the rotational stability of HOYA patients were booked into medical retina clinic, of which Vivinex toric intraocular lens (IOL) and to compare the inci- 89 (30.9%) patients had conditions requiring anti-vascular dence of misalignment and repositioning surgery with endothelial growth factor injections. DEMac referral refine- Rayner T-flex toric IOLs. ment reduced unnecessary review in the macular service by Methods: Single-centre retrospective observational case 150 (34.2%) patients. series. An independent observer assessed the clinical data of ABSTRACT 141

Conclusion: This initiative has optimised resources by excavation. Concomitant retinal disorders at the initial pre- reducing new referrals to the macular service by 34.2%. sentation were identified. In cases without retinal disorders, the development of retinal disorders during follow-up was also evaluated. 166. Longitudinal evaluation of retinal structure in Results: 45 eyes in 45 patients were examined in this study. epiretinal membrane using optical coherence Focal choroidal excavation was accompanied with retinal tomography disorders in 16 eyes (35.6%). In the remaining 29 eyes, only focal choroidal excavation was noted without any accompa- 1 Jae H. Lee nying retinal disorders. The accompanying retinal disorders Email: [email protected] included choroidal neovascularization (n = 8), central serous 1Department of Ophthalmology, Uijeoungbu St. Mary's chorioretinopathy (n = 4), epiretinal membrane (n = 1), Hospital, Uijeoungbu, Republic of Korea macular hole (n = 1), branch retinal vein occlusion (n = 1), and uveitis (n = 1). Of the 29 eyes without retinal disorders, Purpose: To evaluate the change of visual acuity (VA), cen- 22 were followed up for a mean period of 33.5 tral foveal thickness (CFT), disruption of external limiting ± 18.2 months. Consequently, choroidal neovascularization membrane (ELM), disruption of inner/outer Segment junc- was found to have developed in one eye at 59 months, and tion (IS/OS junction), growth of ectopic inner retinal tissue subretinal fluid had developed in two eyes at 17 and for idiopathic epiretinal membrane (iERM) without surgery. Methods: We tracted 49 patients(49 eyes) with iERM with- 28 months, respectively. out surgical treatment, retrospectively for over 6 months Conclusions: Focal choroidal excavation was accompanied from January 2016 to January 2018. VA, CFT, disruption of by retinal disorders in 35.6% of the included patients. In ELM, disruption of IS/OS junction, growth of ectopic inner patients without retinal disorders, the development of a reti- retinal was reviewed. nal disorder was noted in some eyes, suggesting the need for Results: The average follow-up duration was 13 months long-term regular follow-up in patients diagnosed with focal (range 6-24 months). From first visit to final visit, choroidal excavation. VA(LogMAR) changed from 0.22 ± 0.04 to 0.23 ± 0.46, CFT changed from 331.22 μm to 334.22 μm not showing clinically significant changes(P = 0.383, P = 0.607). Disrup- 168. Medium-term tamponade with vitrectomy and tion of ELM, growth of ectopic inner retinal tissue did not perfluorodecalin for the management of complex retinal show clinically significant changes (P = 0.063,P = 0.157). detachments Disruption of IS/OS junction showed significantly difference 1 1 1 1 at follow-up period (P = 0.001). Luke Chehade , Brad Guo , Weng Chan , Jaqjit Gilhotra Conclusions: Clinically significant change of the disruption Email: [email protected] 1 of IS/OS junction was observed during the average follow- South Australian Institute of Ophthalmology, Adelaide, up duration of 13 months. It is known that damage of inner Australia retina is more sensitive indicator than outer retina to surgical Purpose: To describe the clinical presentation, anatomical results. However, due to the change of outer retina during and visual outcome of a series of patients in our department average of 13 months, early surgical approaches would be with complex retinal detachments, managed with vitrectomy recommended for relatively good prognosis. and Perfluorodecalin (PFD) for medium-term tamponade. Subject/Methods: Retrospective analysis of the medical records of all patients in the last 6 years presenting with 167. Clinical presentations of focal choroidal excavation complex retinal detachment managed with vitrectomy where and results of long-term follow-up PFD was used as a medium-term tamponade. Results: A total of 85 eyes in 85 patients were included in Seokhyun Lee1 the study, with a mean follow up period of 16.0 Email: [email protected] ± 2.67 months (range 3-59). 26 detachments presented with 1KIM’s Eye Hospital, Seoul, Republic of Korea associated PVR-C, and 10 had giant retinal tears. The loca- Purpose: To evaluate the clinical presentations of focal cho- tion of the retinal detachment was inferior in 40% of cases, roidal excavation and to report long-term outcomes of cases and total in 18.9% of cases. Anatomical success, defined as without retinal disorders at the initial presentation. retinal reattachment at 12 months, was achieved in 98.8% of Methods: A retrospective review of medical records was cases, and there was a mean improvement in BCVA of performed for patients diagnosed with focal choroidal logMAR 0.64 ± 0.20, which was statistically significant (p. 142 POSTER ABSTRACTS

Conclusions: In this case series, we have demonstrated a improved clinic flow and reduced the “bottle neck” occur- 98.8% anatomical success and significant improvement in ring at the OCT scanner. BCVA, with no reports of retinal toxicity. Medium-term tamponade PFD appears to be an efficacious and safe technique for management of a variety of complex retinal detachments, 171. Visual prognosis after development of submacular including those secondary to GRT, the presence of PVR-C, haemorrhage according to age-related macular inferior location, tractional, traumatic and re-detachments. degeneration subtypes

Kook Lee1, Young-Hoon Park1 169. Intravitreal anti-VEGF monotherapy vs intravitreal Email: [email protected] anti-VEGF combined with low dose triamcinolone 1Department of Ophthalmology and Visual Science, Seoul (2 mg) in central retinal vein occlusion St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea WITHDRAWN Purpose: The purpose of this study was to compare the visual outcome after development of submacular haemorrhage among each subtypes of age-related macular 170. Rates of OCT use in the Royal Perth Hospital intravitreal injection clinic following institution of a new degeneration (AMD). imaging protocol Methods: We retrospectively reviewed medical records of 67 patients who were treated due to submacular Joel Mudri1,2,3, Jane Khan1, Chandrashan Perera1 haemorrhage associated with AMD. The demographic Email: [email protected] parameters, visual acuity (VA) and anatomical features were 1Royal Perth Hospital, Perth, Australia, 2Sir Charles analysed between each AMD subtypes: typical AMD, poly- Gairdner Hospital, Nedlands, Australia, 3University of poidal choroidal vasculopathy (PCV) and retinal angioma- Western Australia, Nedlands, Australia tous proliferation (RAP). Results: In PCV eyes, post-treatment best-corrected VA was Purpose: To determine the effect that a new imaging proto- significantly better than in typical AMD and RAP eyes. col used in the Royal Perth Hospital injection clinic had on Conclusions: PCV patients showed better visual prognosis the rates of OCT use and the effect on patient care. than other AMD subtype patients after development of sub- Method: Following the institution of the protocol, data on macular haemorrhage. patient injections and OCT use was recorded at Thursday morning injection clinics for 8 weeks. OCT usage rates were then calculated. Only patients receiving anti-VEGF agents 172. Adherence to the recommended diabetic (bevacizumab, ranibizumab, aflibercept) were included. The retinopathy screening guidelines in pregnant women medical records of patients who received injections at visits with type 1 and type 2 diabetes without OCT scans were examined over 6 months to assess the effect on patient outcomes at the next subsequent visit Felicia Widyaputri1,2,3, Sophie Rogers2, Alison when an OCT scan was performed. Nankervis4,5, Jennifer Conn4,5, Xavier Fagan6,7, Daryl Results: In 8 weeks, 112 anti-VEGF injections were adminis- Guest8, Alexis Shub9,10, Andrew Symons8,11,12, Lyndell 1,2,7 tered. OCT scans were not performed on 47% of occasions Lim due to the new protocol compared to 100% in the previous pro- Email: [email protected] 1 tocol. 4% of patients were sent back from the injection theatre Ophthalmology, Department of Surgery, University of 2 to have an OCT scan, when they should have had one Melbourne, Melbourne, Australia, Centre for Eye Research according to protocol. On follow up of patients who did not Australia, Royal Victorian Eye and Ear Hospital, East 3 receive OCT scans, 3 patients (7%) had shortening of injection Melbourne, Australia, Department of Ophthalmology, times due to recurrence of subretinal fluid on subsequent OCT, Faculty of Medicine, Public Health, and Nursing, 3 patients (7%) did not attend follow up in the recommended Universitas Gadjah Mada, Yogyakarta, Indonesia, 4Department of Diabetes and Endocrinology Royal followupperiodand36patients(86%)hadnoincreasein , Melbourne Hospital, Melbourne, Australia, 5Diabetes and injection frequency at the subsequent appointment. Endocrine Service, Royal Women’s Hospital, Melbourne, Conclusion: This protocol has halved the number of scans Australia, 6Department of Ophthalmology, Austin Hospital, requested and has not adversely impacted patient care. It has Heidelberg, Australia, 7Royal Victorian Eye and Ear ABSTRACT 143

Hospital, Melbourne, Australia, 8Department of Optometry Email: [email protected] and Vision Sciences, University of Melbourne, Melbourne, 1Save Sight Institute, Sydney, Australia, 2Sydney eye Australia, 9Department of Obstetrics and Gynecology, hospital, Sydney, Australia, 3Children’s Medical Research Mercy Hospital for Women, Heidelberg, Australia, Institute, Westmead, Australia 10Department of Obstetrics and Gynecology, University of Melbourne, Melbourne, Australia, 11Department of Purpose: To investigate impairment in cone-mediated func- Ophthalmology, Royal Melbourne Hospital, Melbourne, tion and disease progression in retinitis pigmentosa Australia, 12Department of Surgery, University of (RP) patients by analysing full field (ffERG) and pattern Melbourne, Melbourne, Australia electroretinogram (PERG), ocular coherence tomography (OCT), and correlating with visual acuity (VA). Purpose: Diabetic Retinopathy (DR) can deteriorate during Methods: Clinical records (2008-2018) from a referring cen- pregnancy. Current guidelines recommend at least one oph- tre were reviewed. RP patients were identified. Their ERG thalmic review during pregnancy, ideally one per trimester. recordings were collected from the first and last visit. OCT Here we report adherence of pregnant women with pre- scans confirmed cystoid macular oedema (CME) and existing diabetes to recommended eye-screening guidelines assessed the ellipsoid layer (EL). ERG and OCT features in a prospective cohort study. were correlated with VA using Pearson’s correlation. Methods: Pregnant women with type 1 (T1DM) or type Results: 126 eyes from 63 patients (33 females) with mean 2 diabetes (T2DM) were recruited from two tertiary mater- age of 35 years (3-76 years) were included. The duration nity hospitals in Melbourne. Barriers to attending eye- between two visits was 3 years (1-9 years). The mean screening were assessed using the Compliance with Annual change in VA was 0.20 ± 0.28 LogMAR. CME was present Diabetic Eye Exams Survey. in 15.8% of eyes. Results: Of the 163 patients approached, 136 (83.4%) partic- The global cone function decreased by average of 18.6% ipated. Mean age was 33.8 years (range 19-47). Sixty every year. The percentage change in fused flicker amplitude women (44%) had T1DM (median duration 16.5 years), (P = 0.55, P < 0.005, P = 0.53, P < 0.005) strongly corre- while 56% had T2DM (median duration 3 years). Ophthal- lated with VA. mic assessments were performed at least once during preg- PERG P50 and N95 (15 and 30 ) reduced by 41%, 31% and nancy in 108 women (79.4%) and 15 women (11%) were 42%, 32% respectively and correlated with both-eyes VA assessed in each trimester. DR was present in 34 (31.5%) changes (r = 0.46, P < 0.05, r = 0.31, P < 0.05). The yearly women. Competing priorities (P = 0.015) and confidence rate of EL shortening and thinning was 4.8% and 4.4% regarding blood glucose control (P = 0.002) were the rea- respectively. The EL layer showed a correlation with VA in both eyes (P = 0.256, P < 0.05, P = 0.46, P < 0.05). sons given for non-attendance. Women who failed to attend Conclusion: Structural changes on ERG and OCT correlated any eye-screening were more likely to think that there was with VA. This study identified the natural long-term decline no treatment for DR (P = 0.011). Obstetrics and endocrinol- in cone function and also recognises a set of parameters that ogy appointments were cited as the highest priorities for could represent outcome biomarkers in therapeutic clinical attendance, with ophthalmic appointment ranked second last trials for RP patients. (median rank 5th). Conclusion: Despite the risk of DR during pregnancy, only 15 of 136 pregnant women with diabetes adhered to screen- 174. To study ocular morbidity and correlation with the ing guidelines, and women ranked eye health as a low prior- CD4 cell count in HIV patients ity. More proactive efforts to increase awareness of the importance of DR screening and integrate care are needed to Vinod Singh1, SP Singh1, Kamaljeet Singh1, Anand prevent vision loss in this growing demographic. Shukla1, BK Singh1 Email: [email protected] 1MLN Medical College, Allahabad, India 173. Assessing residual cone function in retinitis pigmentosa: Electrophysiological and optical coherence Methods: All HIV patients with known CD4 cell count tomography findings and their correlation with visual were retained in the study each patient had exhaustive ocular acuity examination through slitlamp, direct ophthalmoscopy, indirect ophthalmoscopy and fundusphotoghaph. Tasneem A. Arsiwalla1,2, Elisa E. Cornish1,2,3, Clare Results: In this study, all 387 HIV patients were on L. Fraser1, Phuc V. Nguyen1, Robyn V. Jamieson1,3, John HAART. Of these patients 17.30% (67) had ocular compli- R. Grigg1,3 cations. Out of 67 patients 44(68.7%) had ocular 144 POSTER ABSTRACTS manifestations among which HIV microangiopathy18 Australia, 3Save Sight Institute, University of Sydney, (26.9%), CMV retinitis 17 (25.4%), uveitis 3 (4.5%), HZO Sydney, Australia, 4Sydney Eye Hospital, Sydney, Australia 2 (3.0%), Active tuberculoma 2 (3.0%), complicated cata- Purpose: To determine the door-to-needle (DTN) time – ract & corneal opacity 1 (1.5%) each. The median CD4 T- and factors affecting it—in patients presenting with cell in symptomatic group was cells/μL significantly differ- suspected endophthalmitis at the Royal Victorian Eye and ent from the asymptomatic group 278 cells/μL. In our study Ear Hospital (RVEEH). most of them ophthalmic manifestations were Methods: Patients with a discharge diagnosis of associated with. endophthalmitis who presented between 1 May 2015 and 30 Conclusion: We concluded that ocular complications were May 2018 (inclusive) were identified. The DTN time was strongly associated with low CD4 cell counts. determined as well as time of presentation, triage category, presence or absence of a referral letter, time to nursing assessment and time to medical assessment. Patients in 175. High resolution optical coherence tomography whom the DTN could not be calculated were excluded. angiography in the evaluation of chorioretinal changes in Results: A total of 98 patients with a documented DTN time acute posterior multifocal placoid pigment epitheliopathy were included in the study. Intravitreal injections (36.7%) were the main aetiology for suspected endophthalmitis, Corey Rowland1, Lawrence Lee1,2, Sonia Moorthy3 followed by cataract surgery (24.5%) and glaucoma sur- Email: [email protected] 1 2 gery (22.4%). City Eye Centre, Brisbane, Australia, University of The median DTN time over the 3-year period was Queensland Brisbane Australia 3Cairns Eye & Laser , , , 130 minutes [range 20-471; IQR 93.3]. 10.2% of patients Centre, Cairns, Australia met the DTN target of 1 hour. Purpose: We report a case of acute posterior multifocal Multivariate analysis demonstrated a statistically significant placoid pigment epitheliopathy (APMPPE) and the applica- association of the presence of a referral letter (P = 0.021) tion of high-resolution optical coherence tomography angi- and time to doctor assessment (P < 0.001) with shorter DTN ography (OCT-A) in assessing for chorioretinal changes. times. Method: A patient with acute APMPPE underwent multi- Conclusion: DTN times at our institution exceeded the tar- modal imaging, including OCT-A with the Zeiss Plex Elite get time and did not change over the 3-year period. Consis- and fundus fluorescein angiography (FFA). tent referrer notification or early nursing and doctor Results: A diagnosis of APMPPE was confirmed with initial assessment reduced DTN time. Further strategies include a hypofluorescence and later hyperfluorescent of the retinal higher index of suspicion amongst nursing and medical staff lesions on FFA. OCT-A revealed outer retinal and retinal in post-procedural patients with blanket assignment of triage category 2 on arrival and early escalation. pigment epithelium (RPE) hyper-reflective lesions with attenuated OCT signalling in the underlying choriocapillaris layer, suggesting the possibility of choriocapillaris hypo- 177. Incidence and visual outcome of infectious perfusion in the pathogenesis of APMPPE. These changes endophthalmitis in a tertiary government hospital: corresponded to the location of the placoid retinal lesions. A 3-year retrospective study Conclusion: This case demonstrates RPE changes and choriocapillaris flow abnormalities observed in acute APMPPE Jan P. Chu1, Egidio Fortuna1, Ronaldo Jarin1 on high-resolution OCT-A, correlating with findings on Email: [email protected] FFA. The application of OCT-A can aid in enhanced under- 1Quirino Memorial Medical Center, Quezon City, standing of the aetiology, evolution and resolution of Philippines APMPPE. Purpose: To determine the incidence and visual outcome of patients with endophthalmitis in a three-year period. 176. Emergency management of endophthalmitis Methods: This is a retrospective case study of the 3-year incidence and visual outcome of infectious endophthalmitis Gursimrat Bhullar1, Rosie Dawkins1,2, Matthew patients in a tertiary government hospital in the Philippines. Simunovic3,4, Penelope Allen1,2, Sukhpal Sandhu1,2 Results: During the 3-year period, there were 25 cases of Email: [email protected] infectious endophthalmitis identified out of 2382 patients at 1The Royal Victorian Eye and Ear Hospital, Melbourne, risk. This yields an overall 3-year incidence rate of 1.05%. Australia, 2Centre for Eye Research Australia, Melbourne, Median age is 51 (age range, 3-89). 18 were male and 7 were ABSTRACT 145 female. All had unilateral involvement. Individual incidence 0.436) or perfusion (0.4 treated; control 0.392) between rate was highest in penetrating ocular injury (0.42) followed treated and untreated eyes. This finding persisted when only by phacoemulsification (0.17) and infectious keratitis (0.13). on patients who had undergone >12 injections were Only 6 cases were culture positive endophthalmitis. The iso- included. There was no difference in retinal nerve fibre layer lated organisms include Klebsiella pneumoniae, Enterobacter thickness between the eyes (84.17um treated; 82.72um cloacae, Sphingomonas paucimobilis and Pantoea untreated). Pre-treatment acuity was 6/21, post-treatment agglomerans. Among the aetiologies of endophthalmitis, 6/15. IOP pre-treatment was 14.4 mmHg, post-treatment endogenous cases were the only ones found to have a statisti- IOP 13.6 mmHg. cally significant difference among their incidence rates per Conclusions: In this study there does not seem to be any year, but this is because no such case was seen in 2017 and change in optic nerve vessel density or retinal nerve fibre the small number of subjects. 44 percent of patients had a layer thickness following unilateral anti-VEGF but data col- visual acuity of no light perception upon presentation. Either lection is ongoing and we will continue to increase our sam- enucleation or evisceration was performed in 16 patients, pars ple size to confirm this finding. plans vitrectomy in 8 patients and intravitreal antibiotic injection in 1 patient. Only 3 patients had a final visual acuity of 20/200 or better. 179. Glucose-regulated protein 78 in the aqueous Conclusion: Infectious endophthalmitis is an uncommon humour of patients with diabetic macular oedema ocular disease. It is important to identify the clinical manifestations because early management would largely affect Minhee Kim1, Jin-woo Kwon2 the visual outcome. However, it may still have devastating Email: [email protected] outcomes despite aggressive treatment. 1Department of Ophthalmology, Yeouido St. Mary’s Hospital, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea, 2Department of 178. The effect of anti-VEGF on optic nerve vessel Ophthalmology, St. Vincent’s Hospital, College of Medicine, density and capillary perfusion Catholic University of Korea, Suwon, Republic of Korea

1 1 1 Purpose: We explored the associations between levels of Philomena McNamara , Camille Collins , Lei Liu , Jason Tan1 aqueous glucose-regulated protein 78 (GRP78) and systemic Email: [email protected] or ocular factors in patients with diabetic macular 1The Alfred Hospital, Melbourne, Australia oedema (DME). Methods: We measured the aqueous concentrations of Purpose: Reduced ocular blood flow and optic nerve perfu- GRP78, interleukin (IL)-1β, IL-2, IL-8, IL-10, and IL-17, sion pressure are risk factors for glaucoma. The purpose of placental growth factor, and vascular endothelial growth fac- this study was to evaluate if optic nerve vessel density and tor (VEGF). We explored the associations between aqueous capillary perfusion are affected by anti-vascular endothelial GRP78 levels and those of other aqueous factors, optical growth factor (anti-VEGF) therapy. coherence tomography (OCT) findings, and systemic param- Methods: Optical coherence tomography (OCT) and OCT eters in DME patients. angiography (OCT-A) images were obtained from patients Results: In multivariate regression analysis, aqueous GRP78 undergoing monocular anti-VEGF therapy. Optic nerve ves- levels were associated with aqueous VEGF levels, the ellip- sel density and retinal nerve fibre layer thickness in the soid zone (EZ) disruption grades on OCT, and duration of treated eye was compared to the untreated eye. Patients with diabetes (P = 0.011, P = 0.001 and P = 0.003, respec- a diagnosis of glaucoma or IOP (intraocular pressure) greater tively). However, no significant relationship was observed than 21 were excluded. between GRP78 levels and those of other systemic and ocu- Results: OCT-A images were collected from both eyes of lar factors, or with anti-VEGF responsiveness. 18 patients (M = 13, F = 5) who had undergone unilateral Conclusions: Aqueous GRP78 levels correlated with VEGF anti-VEGF injections. Conditions necessitating injections levels in aqueous humour and EZ disruption on OCT. How- were macular degeneration (n = 12), diabetic macula ever, GRP78 levels were not associated with those of oedema (n = 2) and retinal vein occlusion (n = 4). Patients inflammatory biomarkers in DME patients. The results underwent a mean of 19 injections (range 5 to 54). There imply that aqueous GRP78 levels may reflect retinal ische- was no difference in overall flux (treated 0.434; control mic status in DME. 146 POSTER ABSTRACTS

180. Visual outcome following modified internal limiting Methods: 43 eyes diagnosed with branch retinal vein membrane (ILM) flap technique for large-diameter occlusion(BRVO) with macular oedema were recruited. Var- macular holes: A retrospective case series ious parameters to measure the capillary non-perfusion (CNP) areas were recorded using optical coherence tomogra- Yiran Tan1, Weng O. Chan1, Jagjit Gilhotra1 phy angiography(OCTA). Patients were treated with intra- Email: [email protected] vitreal anti-Vascular endothelial growth factor (anti-VEGF) 1Royal Adelaide Hospital, Adelaide, Australia or steroids. Values obtained at the initial visit were compared with values at the end of 3-month follow-up. Purpose: To determine whether adequate restoration of Results: 6x6mm en face area scans depicted a mean change outer retinal structures such as the inner segment/outer seg- in vessel density of 4.43 ± 4.41 and perfusion density of ment (IS/OS) junction and external limiting membrane 4.86 ± 6.72. There was a significant improvement (P value (ELM) is a pre-requisite for visual recovery following modi- <0.001) in both vessel density and perfusion that did not fied inverted internal limiting membrane (ILM) flap tech- depend on number of injections (P value >0.05) 81.4% had nique for management of large macular holes. an improvement in macular thickness of 131.35 Method: Retrospective case series of 25 eyes in 25 consecu- ± 112.66 μm while 18.6% had only <10% change in thick- tive patients. ness. 25.5% did not have improvement in the final vision Results: Anatomica lMH closure was successfully achieved which was attributed to macular ischemia confirmed by in all 25 patients(100%) with the modified ILM flap technique. Restoration of the IS/OS junction layer and ELM Fluorescein angiography (FA) and non-resolving oedema. were achieved in 26% (6/23) and 43.4% (10/23) of eyes Change in vision was statistically significant (P value respectively. 41.2% (7/17) of patients with discontinuous <0.001) co-relating the increase in vessel density and perfu- IS/OS achieved 6/12 or better vision, compared to 83.3% sion along with decrease in macular oedema. (5/6) in patients with continuous IS/OS. There was no statis- Conclusion: OCTA can be used as a non-invasive imaging tical difference in instances of 6/12 or better vision with modality to prognosticate the CNP areas at various levels of ELM restoration (P = 0.510) or IS/OS junction restoration retina. This eliminates the challenges of invasive nature of (P = 0.076). At final follow-up, mean BCVA (SD) was 0.45 FA. However a software must be developed to negate the (0.37) LogMAR (range, 0.10 to 1.80). 52% (13/25) of segmentation, projection and motion artefacts present in cur- patients had Snellen VA equivalent of 6/12 vision or better. rent machines. The mean (SD) vision gained following modified ILM Flap procedure was 0.46 (0.56) LogMAR (range, −1.0 to 1.9 LogMAR). 182. Prognostic factors in open globe injury Conclusion: Despite most patients having disrupted outer 1 1 1 2 retinal structures, there was still significant visual gain post Hao C. Ho , Samantha Bobba , Christopher Go , Joe Li , 1,2,3 MH closure with the modified ILM flap technique. There- Adrian Fung fore, outer retina restoration is not a pre-requisite for visual Email: [email protected] 1 2 recovery following modified ILM flap technique. Westmead Hospital, Sydney, Australia, Save Sight Institute, The University of Sydney, Sydney, Australia, 3Faculty of Medicine and Health Sciences, Macquarie 181. Comparative analysis of retinal extent of capillary University, Sydney, Australia non-perfusion areas pre and post treatment in patients Purpose: To identify prognostic factors for visual outcome diagnosed with branch retinal vein occlusion using after open globe injury. optical coherence tomography angiography: A Methods: Retrospective data analysis was performed on all longitudinal study patients presenting to Westmead Hospital, Sydney, with open globe injury over a 12-year period from 1 January Apoorva Nagendra1, Sri Ganesh1, Kadri Venkatesh1 2005 to 31 December 2017. Data collected including demo- Email: [email protected] graphic data, details of ocular injury, treatment approach, 1Nethradhama Super speciality Eye hospital, Bangalore, initial and final visual acuity. India Results: A total of 104 eyes of 104 patients met the inclusion Purpose: To analyse the extent of capillary non-perfusion criteria, with 4 eyes excluded due to referral to other tertiary areas before and after treatment in patients diagnosed with institutions. The mean age was 43 years (range, 19-89 years) branch retinal vein occlusion using optical coherence tomog- and 84.6% of subjects were male. The most common cause of raphy angiography over a period of one year. injury was from a hammer or chisel (34.3%), followed by ABSTRACT 147

‘other’ (26.9%), alleged assault (13.9%), falls (11.1%), motor sufficiently aggressively, a ceiling effect was also observed vehicle accidents (7.4%) and explosions (4.6%). Based on multi- with many patients who had good vision at baseline variate analysis, statistically significant indicators of poor visual maintaining vision throughout treatment. prognosis were poor presenting visual acuity (P < 0.001), globe rupture (P = 0.013), and retinal detachment (P = 0.011). Lid laceration (P = 0.197), uveal prolapse (P = 0.667), pars plana 184. Trend analysis of common intravitreal injections vitrectomy as primary surgery (P = 0.526) had no statistically over the last 5 years significant impact on final visual outcome. Conclusion: This retrospective case series identified key charac- Sarah Chaudhry1 teristics and prognostic features in patients presenting with open Email: [email protected] globe injury to a large tertiary institution in Western Sydney. 1Royal Brisbane and Women’s Hospital, Brisbane, Australia Poor presenting visual acuity, globe rupture and retinal detach- Purpose: Common intravitreal injections (IVI) in ophthal- ment were significantly associated with a poor visual prognosis. mology include aflibercept, ranibizumab, bevacizumab, This data could be utilised by clinicians to guide discussions ocriplasmin and dexamethasone implants. This paper aimed with patients regarding visual prognosis pre-operatively. to assess the utilization of these medications in Australia and their respective demographics. Methods: Item numbers 10947E, 10114H, 10373Y, 183. Efficacy of intravitreal avastin for the treatment of 10 505X and 10943Y from the Pharmaceutical Benefits centre involving diabetic maculopathy in a real-world setting (Auckland DME study II) Scheme (PBS), publicly billed data, was assessed. Analysis from 2014-2017 assessed the overall trend in IVIs across 1 2 1 Australia, and the demographics of patients requiring the Sepehr Sadeghi , Haya Husam Al-Ani , Sophie Hill , Moaz Alsheikhi1, Ehsan Vaghefi1, David Squirrell1 services. Email: [email protected] Results: After their introduction on the PBS and their increased prescription from 2014 to 2016 there has been a 1The University of Auckland, Auckland, New Zealand, 2The University of Auckland, Auckland, New Zealand reduction in the use of ranibizumab (30%) nationally, and bevacizumab (9%) nationally excluding NSW. Newcomers to Purpose: To determine the efficacy of intravitreal avastin the PBS ocriplasmin, and dexamethasone implants have had for the treatment of centre involving diabetic maculopathy a 5-fold and 1.5-fold increase respectively in prescription (DME) in the real world setting of a large tertiary centre in since late 2016. Interestingly aflibercept had a 40% increase Auckland, New Zealand. in usage from 2016 to 2018 and another 25% increase from Method: All patients who had been treated for centre 2017 to 2018. This may be due to the use of aflibercept as a involving DME between 2013-18 and who had received ≥3 preferred drug in neovascular AMD and BRVO (1-3), and injections in the first 6 months with ≥12 months follow up some studies indicating its efficacy in retinal macular oedema were analysed. Visual acuity, central macular thickness over ranibizumab and bevacizumab (2, 4). NSW performs (CMT) and number of treatments at baseline, 6, 12, 18 and the majority of ranibizumab and aflibercept, and VIC appears 24 months were recorded. to utilise bevacizumab predominantly. Result: 231 eyes were identified. 95% of patients had Conclusion: The demand for intravitreal injections is longstanding type 2 diabetes. Mean baseline visual acuity increasing with greater medical awareness. and CMT was 66 letters and 428 μm. Mean gain of 4,4,2,1 We are beginning to understand the trends that these medica- letters, and − 36, −32, −33, −46 μm CMT were observed tions are having on the population. With new drugs consis- from baseline at 6,12,18, and 24 months respectively. The tently entering the PBS it will be interesting to follow their mean cumulative number of injections was 3,5,7, and 9 at trajectories to understand this may alter our prescribing 6,12,18 and 24 months. Patients with initial VA below trends. 65 were noted to gain more letters (9,8,7,6 at 6,12,18, 24 months) compared to participants who had initial VA better than 65 (1,0,1,1 letter gain). 60% of patients who had a 185. An analysis of pneumatic retinopexy vs vitrectomy VA of ≥75 of letters at baseline maintained their vision over in the treatment of retinal detachments the duration of treatment. Conclusion: In the real-world setting, modest improvements Sarah Chaudhry in both visual acuity and CMT were observed. Whilst the Email: [email protected] results suggest that we are not treating some patients 1Royal Brisbane and Women’s Hospital, Brisbane, Australia 148 POSTER ABSTRACTS

Purpose: A recent paper on rhegmatogenous retinal detach- were taken as control, group II A as disease control and ments (PIVOT trial) illustrated that the visual acuity out- group II B as case. Blood glucose, Hb A1C, Serum Zn and comes of patients post pneumatic retinopexy exceeded that Serum Mg were estimated by hexokinase method, ion-using of patients post Pars Plana Vitrectomy (PPV) (6). In this high performance liquid chromatography, colorimetric paper we aim to identify the trends in PPV and pneumatic method and enzymatic method respectively. retinopexies in the treatment of retinal detachments in Results: Mean value of serum Zn (μg/dl) and Mg (mmol/L) Australia. in Group I, IIA and IIB were 82.70 ± 10.72(μg/dl) and 0.87 Methods: Using the Medicare Benefits Schedule (private ± 0.06 (mmol/L), 72.32 ± 12.70 (μg/dl) and 0.76 ± 0.08 billing data), item numbers 42 725 and 42 773 were (mmol/L), 56.35 ± 14. 82(μg/dl) and 0.71 ± 0.09 (mmol/L) analysed. We performed a trend analysis between respectively. It was observed that mean value of Zn and Mg 2009-2019 based on states and demographics. were significantly lower (P ≤ 0.05) in Group IIB and Group Results: Overall, rates of vitrectomies have increased at an IIA than Group I. average annual rate of 4.8% over the past decade, and pneu- Conclusion: The results of this study could be helpful to matic retinopexy has respectively reduced by 4%. Interest- establish a biomarker for early screening of diabetic retinop- ingly pneumatic retinopexy rates have increased by 15% in athy in Bangladesh and may help to prevent diabetes related the last 2 years. In general, a state-based analysis showed blindness by supplementation of the deficit. that New South Wales performed the greatest number of procedures. The groups to have the most vitrectomies and pneumatics were in the 65-74 groups. Approximately 3% 187. Natural history and clinical biomarkers of more men undergo pneumatic retinopexy over women, how- progression in X-linked retinitis pigmentosa: An ever there is no gender discrepancy seen in PPV rates. This Australian perspective data also does not account for patients undergoing PPV for alternative indications. Mark Zada1, Elisa E. Cornish1,2,3, Clare L. Fraser1, Robyn Conclusion: There appears to be a surgical preference for V. Jamieson1,2, John R. Grigg1,2 PPV in the treatment of retinal detachment’s in the privately Email: [email protected] billed patients in Australia. Given the new research indicat- 1Save Sight Institute Discipline of Ophthalmology Faculty of ing the visual outcome superiority of Pneumatic Retinopexy Medicine and Health The University of Sydney, Sydney, vs PPV it will likely shift treatment in the public manage- Australia, 2Genetic Eye Research Unit Children’s Medical ment of RRD. It will be interesting to follow the trends of Research Institute, Save Sight Institute Faculty of Medicine the procedure in the ongoing private setting also. and Health The University of Sydney and Children’s Hospital Westmead, Sydney, Australia, 3Sydney Eye Hospital Foundation, Sydney, Australia 186. Study of serum zinc and magnesium level among Purpose: X-linked retinitis pigmentosa (XLRP) accounts for diabetic patients with and without diabetic retinopathy a significant proportion of the inherited retinal disorders attending in tertiary care hospitals of Bangladesh which together are the commonest cause of certifiable blindness in working-age adults. The main objective of this study Mohammed A. R. Akonjee1, Farzana A. Mishu2 was to determine the natural history and progression of dis- Email: [email protected] ease in this condition in an Australia population. A secondary 1Mugda Medical College Hospital, Dhaka, Bangladesh, objective was to identify any correlation between structural 2birdem General Hospital, Dhaka, Bangladesh and functional biomarkers to explore which structural bio- Purpose: This study was conducted with an objective to markers may be used as surrogates for retinal function. evaluate the serum Zn and Mg level in diabetic patients with Methods: A retrospective analysis of longitudinal data of 14 and without retinopathy and to compare them with healthy affected males (mean age at baseline of 12.7 years) was under- individuals who are controls in this study. taken. Outcomes assessed included optical coherence tomography Method: This cross-sectional study was conducted in ter- (OCT) ellipsoid zone (EZ) width and central macular thickness tiary care hospital in Bangladesh. Total 300 subjects were (CMT), fundus autofluorescence outer ring area, electroretinogra- taken according to inclusion criteria and divided into three phy (ERG) parameters, visual field metrics and visual acuity. equal groups. Among them 100 healthy individual were Results: This study demonstrated a mean annual progressive taken as Group I, 100 participants with type 2 DM without loss of 288.3 μm per year for EZ width on OCT. ERG b- retinopathy as group II A and 100 participants with type wave latencies for maximal and cone responses increased by 2 DM with retinopathy as group II B. In this study group I 4.00 and 6.61 ms per year, respectively. Progressive ABSTRACT 149 reduction in Humphrey visual field index occurred at 0.09 Compared with aflibercept, fewer brolucizumab 6 mg per year. Additionally, EZ width and CMT on OCT corre- patients had fluid (intraretinal and/or subretinal or sub-RPE lated well with functional metrics including visual acuity fluid) present at Week 48 and at Week 96. and ERG parameters driven by the cone system. Conclusions: In a cohort of 89 patients with PCV, robust Conclusion: We have identified three other potentially use- and consistent BCVA gains were observed with ful functional biomarkers for monitoring progression and, brolucizumab treatment across 96 weeks with the majority for the first time in this cohort of patients, have demon- of brolucizumab 6 mg patients maintained on q12w after strated that structural biomarkers of the macula including EZ loading. Fewer brolucizumab 6 mg-treated patients had fluid width on OCT correlated with cone-driven ERG parameters. present compared with aflibercept-treated patients.

188. The efficacy and safety of brolucizumab compared 189. Time to dry analysis of brolucizumab vs aflibercept with aflibercept in polypoidal choroidal vasculopathy in patients with neovascular AMD: 96-week data from (PCV): 24-month results from the HAWK study the HAWK and HARRIER trials

Andrew Chang1,2,3, Yuichiro Ogura4, Won K. Lee5, Ian McAllister1, Eric Souied2, Carl Regillo3, David Gemmy Cheung6, Glenn Jaffe7, Divya D’Souza8, Jahangir Brown4, Frank Holz5, David Tanzer6, Jahangir Alam6, Alam8, Adrian Koh9 Pravin Dugel7 Email: [email protected] Email: [email protected] 1Sydney Retina Centre, Sydney, Australia, 2Sydney Institute 1Lions Eye Institute, Nedlands, Australia, 2Department of of Vision Science, Sydney, Australia, 3Save Sight Institute, Ophthalmology “Hospital Intercommunal de Creteil” and University of Sydney, Sydney, Australia, 4Graduate School “Henri Mondor hospital”, Paris, France, 3Wills Eye of Medical Sciences, Nagoya City University, Nagoya, Hospital, Philadelphia, USA, 4Retina Consultants of Japan, 5St Mary’s Hospital, Catholic University of Korea, Houston, Houston, USA, 5University of Bonn, Bonn, Seoul, Republic of Korea, 6SingHealth Duke NUS Academic Germany, 6Novartis Pharmaceutical Corporation, East Medical Center, Singapore, Singapore, 7Duke University Hanover, USA, 7Retinal Consultants of Arizona, School of Medicine, Durham, USA, 8Novartis Arizona, USA Pharmaceuticals Corporation, East Hanover, USA, 9Eye Purpose: To compare the 96-week treatment outcomes with and Retina Surgeons, Camden Medical Centre, Singapore, Singapore respect to time to achieving sustained dryness (absence of fluid for ≥2or≥ 3 consecutive visits) with brolucizumab vs Purpose: To report results from Japanese patients enrolled aflibercept in patients with nAMD. in HAWK who were diagnosed with PCV. Methods: Patients were randomized 1:1:1 to brolucizumab Methods: Patients were randomized globally 1:1:1 to 3 mg (n = 358), 6 mg (n = 360) or aflibercept 2 mg brolucizumab 3 mg (n = 358), 6 mg (n = 360) or aflibercept (n = 360) in the HAWK study and 1:1 to brolucizumab 2 mg (n = 360). Indocyanine green videoangiography was per- 6 mg (n = 370) or aflibercept 2 mg (n = 369) in the HAR- formed at screening. After three loading doses, brolucizumab RIER study. After three loading doses, brolucizumab patients were treated q12w, with the option of q8w as deter- patients were treated q12w, with the option of q8w as determined by disease activity assessment. Aflibercept was dosed mined by disease activity assessment. Aflibercept was q8w. The primary endpoint was non-inferiority of dosed q8w. brolucizumab to aflibercept in best-corrected visual acuity Results: The cumulative incidence rate (%) in study eyes (BCVA) change from baseline to Week 48. Secondary end- with sustained dryness was greater for brolucizumab com- points included anatomic, visual and safety outcomes. pared to aflibercept at Week 48 (≥ 2/≥ 3 visits: HAWK Results: Of the 154 Japanese patients in HAWK, PCV was [Bro 3 mg, 82.9/77.1; Bro 6 mg, 86.4/79.1; Afl, 76.4/67.6]; present in 89 (58.6%). Mean change in BCVA (±SE) from HARRIER [Bro 6 mg, 91.5/85.9; Afl-81.2/72.7]). The 50th baseline to Week 48 for brolucizumab 3 mg (n = 20), 6 mg percentile for sustained dryness was achieved earlier for (n = 39) and aflibercept (n = 30) was 11.4(2.6), 10.4(1.5) brolucizumab, with most achieving dryness at ≥2/≥ 3 visits and 11.6(1.4) ETDRS letters, respectively. BCVA gains by Week 8/8 in HAWK and Week 4/4 in HARRIER com- were maintained to Week 96. pared to aflibercept (≥ 2/≥ 3 visits: HAWK, Week 8/12; The majority of brolucizumab 6 mg patients with PCV were HARRIER: Week 8/8). The 75th percentile was also maintained on q12w dosing immediately following loading achieved earlier with brolucizumab compared to aflibercept phase through Week 48 (76%) and Week 96 (68%). (≥ 2/≥ 3 visits: HAWK [Bro 3 mg, Week 24/40; Bro 6 mg, 150 POSTER ABSTRACTS

Week 16/32; Afl-Week 40/not achieved]; HARRIER [Bro Conclusions: Eyes with nAMD may achieve satisfactory 6 mg, Week 8/20; Afl, Week 20/not achieved). long-term visual outcomes if they receive adequate treat- Conclusions: Patients treated with brolucizumab were more ment. Visual outcomes were better in eyes from ANZ, likely likely to achieve sustained dryness than those treated with because they received more injections. aflibercept in HAWK and HARRIER. Brolucizumab also achieved better fluid control faster than aflibercept. 191. Anatomic endpoints support sustained outcomes with faricimab 16 weekly dosing (q16w) in the stairway 190. 10-year treatment outcomes of neovascular age- phase 2 trial for neovascular age-related macular related macular degeneration from two regions degeneration (nAMD)

Mark Gillies1, Jennifer Arnold2, Sanjeeb Bhandari1, Rohan Tien Y. Wong1, Hugh Lin2, Karen Basu2, David W. Essex3, Stephanie Young4, David Squirrell5,6, Vuong Silverman3, Stefan Scheidl4, Carlos Quezada Ruiz2, Zdenka Nguyen1, Daniel Barthelmes1,7 Haskova2 Email: [email protected] Email: [email protected] 1The University of Sydney, Sydney Medical School, 1Singapore Eye Research Institute, Singapore National Eye Discipline of Clinical Ophthalmology and Eye Health, Save Center, Singapore, Singapore, 2Genentech, Inc., South San Sight Institute, Sydney, Australia, 2Marsden Eye Specialists, Francisco, USA, 3Roche Products Limited, Welwyn Garden Parramatta, Sydney, Australia, 3Academic Unit of City, UK. 4F. Hoffmann-La Roche Ltd., Basel, Switzerland Ophthalmology, Australian National University, Acton, Purpose: Faricimab is a bispecific antibody designed to Australia, 4Gladesville Eye Specialists, Sydney, Australia, 5Department of Ophthalmology, University of Auckland, simultaneously bind and inhibit vascular endothelial growth Auckland, New Zealand, 6Auckland District Health Board, factor A (VEGF-A) and angiopoietin-2 (Ang-2). Ang-2 inhi- Auckland, New Zealand, 7Department of Ophthalmology, bition may prolong the anti-permeability effects via vascular University Hospital Zurich, University of Zurich, Zurich, stabilizing properties and demonstrate a sustained effect on Switzerland pathological outcomes. STAIRWAY (NCT03038880) is a Phase 2 trial which assessed intravitreal faricimab for treat- Purpose: Vascular endothelial growth factor (VEGF) inhibi- ment of nAMD. tors are beneficial for neovascular age-related macular Methods: Patients were randomized 2:2:1 to 6.0 mg far- degeneration (nAMD) in the short-term, but many eyes with icimab q16w flex or 12 weekly dosing (q12w) fixed (both nAMD in real-world clinical practice have now been treated with 4 monthly [q4w] loading doses) or 0.5 mg ranibizumab for over 10 years. This study reports 10-year treatment out- (RBZ) q4w. At Wk24, all faricimab q16w flex-assigned comes of VEGF inhibitors for nAMD. patients without protocol-defined disease activity continued Methods: Treatment-naïve eyes starting anti-VEGF treat- on the q16w regimen. Faricimab flex-assigned patients with ment for nAMD between 1 January 2006 and 31 December disease activity at Wk24 received q12w until study end. 2008, in Australia and New Zealand (ANZ) and Switzerland Results: At Wk52, the change from baseline in total lesion tracked in the Fight Retinal Blindness! Registry were identi- area was −4.2, −5.4, and − 4.5 mm2for faricimab q16w fied. The main outcome was mean change in visual acuity flex, faricimab q12w, and RBZ q4w arms, respectively; the (VA, logMAR letters) from baseline at 10-year of treatment. change from baseline in choroidal neovascularization (CNV) Results: A total of 712 eyes (ANZ - 474; Switzerland - 321) component area was −4.3, −5.6, and − 4.8 mm2, respec- were identified. The mean (95% CI) VA change in 132 eyes tively; and the change from baseline in leakage area was (28%) from ANZ completing 10-year of treatment was 0.9 −4.6, −5.6, and − 5.3 mm2, respectively. Vision was − letters ( 4.9, 3.1; P = 0.7) at 10 years, 42% achieved maintained with about half as many injections with far- ≥ 20/40, while the 37 eyes (12%) from Switzerland lost 14.9 icimab q16w flex/q12w fixed vs RBZ q4w dosing. − − ≥ letters ( 24, 5.7; P < 0.001) with 35% achieving 20/40. Conclusion: In this Phase 2 trial, faricimab dosed at Eyes from ANZ received more median injections (53 vs 42) extended q16w/q12w intervals provided sustained anatomic from fewer visits with better disease control (proportion of outcomes of reduction in leakage and CNV area, along with visits with active disease: 38% vs 69%), suggesting a treat- maintenance of comparable visual gains achieved with fewer and-extend regimen vs pro re nata. Macular atrophy and sub- intravitreal injections vs RBZ q4w. retinal fibrosis were the main reasons for 10 letter loss. The mean VA of eyes from both regions that discontinued treatment fell below the baseline at their final visit. ABSTRACT 151

192. Suprachoroidal Triamcinolone injection for Methods: A 20 point questionnaire was specially designed macular oedema secondary to vascular pathology and by three retinal surgeons for the study. The questionnaire non-infectious uveitis: Efficacy and safety of the novel consisted of eleven multiple choice questions, six yes/ no technique questions, two questions about subjectively grading the impact of the disease on their life (systemic and ocular) and Pavan Shroff1, Arun Bhargav1, Aneesha Lobo1 one question about the difficulty level of performing daily Email: [email protected] tasks before and after receiving the injections. All patients 1Retina Specialty Hospital, Indore, India receiving intravitreal injections at the hospital between September 2017 and February 2018 for any indication Purpose: To describe a novel method of suprachoroidal except infectious causes were administered the question- injection of Triamcinolone Acetonide (SCTA). To study the naire. Patients receiving the injection for the first time or efficacy and safety of SCTA in cases of macular edema sec- those who were unable to complete the questionnaire were ondary to vascular pathology or non-infectious excluded from the study. inflammation. Results: 104 patients completed the survey. Average age Methods: Prospective, interventional study conducted was 58.3 years. 42.3% patients had received 1-3 injections, between July 2018 and June 2019. A special injector was 30.7% 4-6 injections, 11.5% had received 7-10 injections, designed using 26 gauge and 30 gauge needles. Fifty treat- 15.3% had received >10 injections. The most common reac- ment naive eyes of 51 patients of macular oedema were tion of patients was fear (54.8%).While 76.9% patients took given 2 mg of SCTA under topical anaesthesia. Pain during the injection instantly, 15.3% took a second opinion. Main SCTA was graded by patient on a scale of 1 to 10. Best factor influencing choice of injection was doctors’ sugges- corrected visual acuity (BCVA), Intra ocular pressure (IOP) tion (75.9%). The burden of ocular morbidity on quality of and Central macular thickness (CMT) were measured before life was graded as 3.58 on a scale of 1-10. the injection and 1 month following injection. Any adverse Conclusions: For better patient compliance and optimum events were noted and appropriately treated. results, we must look beyond the data comprising of only Exclusion criteria: safety and efficacy of the injections. The psychosocial and High Myopia. financial burden of disease is quite significant. Doctors plays a Infectious pathology. crucial role in patient compliance with intravitreal injections. Thin sclera. Previous glaucoma surgery. Results: The mean BCVA improved from 0.84 logMAR to 194. Preservation of photoreceptor function in a retinal 0.63 logMAR at 1 month (P = 0.001). The mean IOP degeneration model following chronic electrical increased from 12.31 mmHg to 14.3 mmHg at 1 month stimulation with an implantable electrode (P = 0.107). However, only 2 patients (3.9%) needed glau- μ coma treatment. The average CMT dropped from 432 mto Carla Abbott1,2, David Nayagam3,4, Owen Burns3, Helen μ 334 m at 1 month. Only 1 patient (1.9%) had an inadvertent Feng3, Ceara McGowan3, Robyn Guymer1,2, Chris injection of TA in the intravitreal cavity and one patient had Williams3,5, Penelope Allen1,2, Chi Luu1,2 TA in the anterior chamber. Average pain scale turned out to Email: [email protected] be 7.1. Carla Abbott1,2, David Nayagam3,4, Owen Burns3, Helen Conclusion: SCTA shows promise in terms of safety and Feng3, Ceara McGowan3, Robyn Guymer1,2, Chris efficacy but requires to be studied in greater detail, on a Williams3,5, Penelope Allen1,2, Chi Luu12 larger population with long term follow-up. The modified 30 gauge needle serves as an inexpensive SCTA injector. Purpose: To determine if chronic low-level electrical stimulation with an implantable electrode preserves retinal function in a transgenic model of retinal degeneration. 193. Intravitreal injections: A patient's perspective Method: P23H-3 (rhodopsin mutation) retinal degeneration rats were divided into 3 groups; control (n = 6), passive Pavan Shroff1, Arun Bhargav1, Aneesha Lobo1 (n = 6) and active stimulation (n = 7). Passive and active Email: [email protected] stimulation groups had a platinum electrode implanted mon- 1Retina Specialty Hospital, Indore, India ocularly in each animal at 7 weeks of age. Passive and control groups did not receive stimulation. Animals in the active Purpose: To assess the burden and psychosocial impact of stimulation group received 1 hour of chronic micro-electrical intravitreal injections on patients’ lives. stimulation (100 μA, 1 Hz) twice per week for 4 weeks. 152 POSTER ABSTRACTS

Full-field electroretinography (ERG) was performed at 6- sight threatening diabetic retinopathy from non-sight threat- (baseline) and 12- (post-treatment) weeks of age as a surro- ening disease was 95% and 91% respectively. gate measure of photoreceptor survival. Conclusion: Using un-curated images obtained from real Results: In the active stimulation group, the ERG a-wave world diabetic eye-screening program our custom-built response amplitude at 12 weeks of age was slightly reduced CNN accurately graded retinopathy beyond the level in the stimulated eyes (83.8 ± 33.7, P = 0.413) but mark- required by a national eye-screening program. Using a CNN edly reduced in the non-stimulated fellow eyes (38.1 ± 19.7, to perform primary grading would create improved effi- P < 0.001), compared to the baseline value at 6 weeks of ciency within the NZ diabetic eye-screening program. We age (100.3 ± 29.9). The ERG a-wave amplitude of both eyes are in the process of externally validating these results in the control and passive groups were markedly reduced at against images and data yet unseen by the network. 12 weeks of age compared to the baseline value (P < 0.001). Histology confirmed a thicker outer nuclear layer in stimulated relative to fellow eyes. 196. Quantitative assessment of foveal avascular zone Conclusion: Chronic low-level electrical stimulation using and distribution of capillary dropout in patients with an implanted electrode preserved photoreceptor function in retinal vascular diseases using optical coherence the P23H-3 rat model of retinal degeneration. Stimulation tomography angiography with projection artefact with an implantable electrode has potential as a neuro- removal protective strategy in photoreceptor degeneration and should 1,2 1,3 2 be investigated further. Noha Ali , Danuta Sampson , Sharaf Mohamed , Shehata Mohamed2, Gamal Nouby2, Moreno Menghini4, Alex Hansen4, Fred Chen5,6 195. Primary grading of diabetic retinopathy from Email: [email protected] 1 retinal images using a custom designed CNN: The Centre for Ophthalmology and Visual Science Auckland experience (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, Australia, 2Department of David Squirrell1, Sophie Hill1, Eric Song2, Li Xie2, Moaz Ophthalmology, Faculty of Medicine, Assuit University, 3 Alshaikhi1, Ehsan Vaghefi3 Assuit, Egypt, Surrey Biophotonics, Centre for Vision, Email: [email protected] Speech and Signal Processing and School of Biosciences 1Department of Ophthalmology, University of Auckland, and Medicine, The University of Surrey, Guildford, UK, 4 Auckland, New Zealand, 2School of Optometry and Vision Department of Ophthalmology, Sir Charles Gairdner 5 Sciences, University of Auckland, Auckland, New Zealand, Hospital, Nedlands, Australia, Centre for Ophthalmology 3Auckland Bioengineering Institute and School of Optometry and Visual Science (incorporating Lions Eye Institute), The and Vision Sciences, University of Auckland, Auckland, University of Western Australia, Western Australia, 6 New Zealand Australia, Department of Ophthalmology, Royal Perth Hospital, Perth, Australia Purpose: To determine the accuracy of our custom-designed Convolutional Neural Network (CNN), used to perform pri- Purpose: To analyse foveal avascular zone (FAZ) and distri- mary grading in the context of a NZ Diabetic retinopathy bution of capillary dropout in retinal vascular diseases using screening program. optical coherence tomography angiography (OCTA). Method: 160000 retinal images labelled with the appropri- Methods: 142 OCTA images (3 × 3 mm)from patients with ate outcome grade (R0-R5 and M0-M5) was obtained from diabetic retinopathy (DR, 73 eyes), retinal vein occlusion the ADHB diabetic retinopathy screening program. These (RVO, 16 eyes), adult coats disease (ACD, 7 eyes) and un-curated but high quality images, which represented all healthy controls (46 eyes) were included. The area, perime- screening episodes between 2009 and 2018, were split 80/20 ter, and acircularity index (AI) of the FAZ, vessel density μ to training and validations sets respectively, and used to train within 300 m wide region of the FAZ (FD-300), superficial a neural network based on modified INCEPTION-RESNET- vascular complex (SVC) and deep vascular complex (DVC) V2 architecture. densities were calculated by the built in AngioVue software Results: Our AI achieved an overall accuracy of 98%. The of RTVue XR device. sensitivity and specificity of the CNNs to differentiate nor- Results: There was a significant difference in the FAZ area mal and abnormal images was 98% and 99% respectively. (P = 0.001), FAZ perimeter, AI and FD-300 (P < 0.001) The sensitivity and specificity of the CNN to differentiate between diseased and control eyes. DR and RVO eyes had lower SVC and DVC densities across all regions of macula ABSTRACT 153

(P < 0.001, and P = 0.046 to <0.001, respectively) with the 198. Vascular changes in patients of diabetes mellitus greatest difference in DVC density in eyes with RVO. In with no diabetic retinopathy ACD, SVC density was significantly lower in sup-hemi parafoveal (P = 0.015) and superior parafoveal zones Shorya Azad1, Nawazish Shaikh2, Rohan Chawla2, Vinod (P = 0.003), while DVC density was lower in the entire Kumar2, Rajpal Vohra2, Atul Kumar2 macular region (P = 0.026 to <0.001). In diseased eyes, Email: [email protected] visual acuity was significantly correlated with FAZ perime- 1Dr.R.P.Centre, AIIMS, New Delhi, India, 2AIIMS, New ter, AI and FD-300 (P = 0.014 to 0.028). FD-300 was sig- Delhi, India nificantly correlated with the severity of DR (P = 0.001). Purpose: To assess the vascular changes in patients of dia- Conclusions: OCTA-derived FAZ parameters may be supe- betes mellitus(DM) with no diabetic retinopathy (DR) using rior to FAZ area in predicting visual acuity. FD-300 is corre- Optical Coherence Tomography – Angiography (OCTA). lated with DR severity. DVC is preferentially involved in Method: 60 eyes of 37 patients with history of DM with no RVO and ACD. DR were included. All eyes underwent colour fundus photography and OCTA (ZEISS AngioplexTM). Vascular changes such as microaneurysms and capillary non- 197. Comparison between optical coherence perfusion areas (CNP)/capillary drop out/increased inter- tomography-angiography and fluorescein angiography capillary distance in patients of DM with no DR were in patients with diabetic retinopathy assessed and evaluated by two different retina specialists and Nawazish Shaikh1, Shorya Azad2, Rohan Chawla1, Vinod their inter-rater reliability (Kappa) coefficient was analysed. Kumar1, Rajpal Vohra1, Atul Kumar1 Results: Microaneurysms and CNP areas were picked up Email: [email protected] using OCT-A in patients with no clinically evident 1AIIMS, NEW DELHI, India, 2Dr.R.P.Centre, AIIMS, New DR. Observer 1 (RC) identified microaneurysms in 9 eyes DELHI, India out of 60 and CNP areas in 34 eyes out of the 60. Observer 2 (SVA) identified microaneurysms in 11 eyes out of the Purpose: To analyse the clinical features of diabetic retinop- 60 and CNP areas in 35 eyes out of 60. Total of 16.66% eyes athy using OCT-A and FA. showed microaneurysm and 57.5% eyes showed capillary Methods: Total of 37 eyes with NPDR and 60 eyes with PDR non-perfusion areas (CNP)/capillary drop out/increased were imaged using optical coherence tomography (ZEISS inter-capillary distance. Kappa coefficient for micro- AngioplexTM) (OCTA) and Fluorescein angiography (Heidel- aneurysms was 0.820 and suggestive of good strength of berg Spectralis) (FA). A qualitative comparison was done agreement whereas for CNP areas, it was 0.880 and between OCT-A and FA. Clinical features such as suggested very good strength of agreement between the two microaneurysm, foveal avascular zone (FAZ) and capillary observers. non-perfusion (CNP) areas in post pole and periphery were Conclusion: OCT-A is a non-invasive modality for identify- compared. ing subclinical changes of DR. Although, microaneurysms Results: Out of the 97 eyes, OCT-A picked up at least one are heralded as the first sign of DR, CNP/capillary drop out/- micro-aneurysm in all eyes but fewer in number as com- increased inter-capillary distance were more regular and ear- pared to the FA. FAZ size and shape was defined using lier sign in clinically no DR. This provides us with a new OCT-A in all 97 eyes whereas FA failed to demonstrate the insight into the pathogenesis of DR. FAZ size, shape and regularity in 2(37) NPDR eyes and 13(60) PDR eyes. CNP areas at the post pole were seen in all 97 eyes using the OCT-A whereas FA demonstrated CNP 199. Surgical intervention for carotid artery stenosis in areas in 17/37 eyes and 36/60 eyes. FA remained the only patients with ocular arterial occlusive disorders test to evaluate the peripheral CNP areas as OCT-A was limited due to its small field of view. Leah Kim1,2, John Crozier3 Conclusion: OCT-A is a unique non-invasive modality that Email: [email protected] can successfully demonstrate the clinical features of diabetic 1University of New South Wales, Sydney, Australia, 2Sydney retinopathy. It is limited in use due to its small field of view Eye and Sydney Hospital, Sydney, Australia, 3Liverpool and inability to demonstrate leakage and macular edema as Hospital, Liverpool, NSW, Australia compared to FA. 154 POSTER ABSTRACTS

Purpose: Carotid artery stenosis produces ischemia in ocu- FRB! software was used to record real-world outcomes over lar arterial occlusive disorders by causing emboli or 12 months and results were compared with the BRIGHTER restricting perfusion to the ocular vasculature. This study and VIBRANT RCTs. compares the incidence and severity of carotid artery disease Results: There were 45 eyes that completed 12 months of in Amaurosis Fugax (AF), Branch and Central Retinal anti-VEGF monotherapy for BRVO at RFLNFT. The Artery Occlusions (BRAO and CRAO respectively), Ocular 17 eyes that received ranibizumab for 12 months had mean Ischemic Syndrome (OIS), and Non-arteritic Anterior Ische- VA gain of 10 letters after a mean of 6 injections. In mic Optic Neuropathy (NAION). The clinical value of com- BRIGHTER, eyes receiving a mean of 9 ranibizumab paring the visual outcomes of carotid endarterectomy (CEA) injections over 12 months gained 15 letters. The 28 eyes and carotid artery stenosis (CAS) was also assessed. that received aflibercept at RFLNFT for 12 months gained Methods: Retrospective cohort study of patients with ocular a mean of 10 letters after a mean of 7 injections. In arterial occlusive disorders presenting to a single tertiary VIBRANT, eyes receiving aflibercept gained a mean 17 let- hospital between the years 2007-2017. ters at 12 months after a mean of 9 injections over Results: 65 patients presented with an ocular arterial occlu- 48 weeks. Mean time from baseline visit to first injection sive disorder - 58.5% AF, 16.9% CRAO, 12.3% OIS, 7.7% was different between RFLNFT and RCTs. There were no BRAO, and 4.6% NAION. Carotid stenosis was most preva- serious adverse events reported in the RFLNT dataset. The lent in AF (n = 24), BRAO/CRAO (n = 7), and OIS (n = 4). RFLNFT cohort was older and had worse baseline vision 26 patients received surgical intervention - 52.6% of patients than the RCTs. with AF (n = 20; 12 CEA vs 8 CAS), 25% of OIS (n = 2; Conclusion: Patients receiving intravitreal anti-VEGF ther- 1 CEA vs 1 CAS), and 25% of BRAO/CRAO (n = 4; all apy for BRVO in a UK real-world setting achieved signifi- had CEA). The most common complication of carotid surgi- cant VA gains at 12 months. However, the extent of visual cal intervention was post-operative hypotension. There was gains was less than reported in RCTs. This may relate to dif- insufficient data on the visual outcomes of CEA and CAS. ferent baseline characteristics and higher injection numbers Conclusion: Carotid artery stenosis was present in at least in the RCTs. 50% of patients in each ocular arterial occlusive disorder where data was available. Statistically meaningful conclusions could not be made on the operative complications 201. Detailed phenotypic profile of bietti crystalline and improvements in vision from CEA and CAS. dystrophy in an Australian cohort Standardising documentation practices would assist in the assessment of visual outcomes of CEA and CAS in these Fleur O'Hare1, Lauren Ayton1, Monica Hu2, Kearns Lisa2, patients. Hickey Doron2, Jonathan Ruddle2, Alex Hewitt2, Jason Charng3, Fred Chen3, Richard Smallwood4, Matthew Ayres4, Thomas Edwards2 200. Real-world outcomes in patients with macular Email: [email protected] oedema secondary to branch retinal vein occlusion 1Departments of Optometry and Vision Sciences, and receiving intravitreal anti-VEGF therapy in a UK public Surgery (Ophthalmology), Melbourne, Australia, 2Royal hospital setting Victorian Eye and Ear Hospital, Centre for Eye Research Australia, Melbourne, Australia, 3Centre for Ophthalmology Juan L. Ang1, Sarah Ah-Moye1, Pardis Zalmay1, Vuong and Visual Science (Incorporating Lions Eye Institute), The Nguyen2, Mark Gillies2, Hemal Mehta1,2 University of Western Australia, Perth, Australia. 4Royal Email: [email protected] Victorian Eye and Ear Hospital, Melbourne, Australia 1Royal Free London NHS Foundation Trust, London, UK, Purpose: Bietti crystalline dystrophy (BCD) is an autosomal 2Macular Research Group, Save Sight Institute, Sydney, recessive inherited retinal disease (IRD) caused by mutations in Australia the CYP4V2 gene. It has a characteristic fundus phenotype fea- Purpose: To assess real-world outcomes of anti-VEGF ther- turing crystalline deposits throughout the posterior pole. We pre- apy for branch retinal vein occlusion (BRVO) in a UK pub- sent a detailed phenotypic description from an observational lic hospital. case series of 10 patients with genetically confirmed BCD. Methods: Retrospective analysis of all treatment-naïve These data inform our understanding of the natural history of patients receiving intravitreal aflibercept or ranibizumab the disease as well as provide prognostic information to patients. monotherapy for macular oedema secondary to BRVO at Methods: Patients underwent a complete ophthalmic exami- Royal Free London NHS Foundation Trust (RFLNFT). nation including visual function, multimodal retinal imaging, ABSTRACT 155 electroretinogram (ERG) assessment and vision-related qual- VA (2.34 vs 1.89 LogMAR, P < 0.0001) and better ity of life (Vis-QOL and IVI) questionnaires. improvement in VA compared to those who received late or Results: Patients ranged in age from 27 to 71 years (median no vitrectomy (1.46 vs 1.04 LogMAR, P = 0.008). No sta- 54 years), with a visual acuity of 6/5 to perception of light tistically significant difference in final VA was found (median 6/9; logMAR 0.2). Microperimetric macular sensitivity between groups (0.869 vs 0.814 LogMAR, P = 0.584). thresholds were reduced. Fundus autofluorescence imaging Conclusions: We conclude that patients with worse pre- showed classical BCD signs of well-defined areas of retinal pig- senting vision are being selected for early vitrectomy. How- ment epithelium (RPE) loss, with corresponding areas of outer ever, there is no difference in final VA, as compared to retinal atrophy shown on spectral domain ocular coherence those who had no vitrectomy or late vitrectomy. Further- tomography (SD-OCT). SD-OCT imaging showed retinal crys- more, a greater improvement in VA was achieved with early tals to be principally located on or in the RPE/ Bruch’s membrane vitrectomy. Whilst further research is required, this data complex, with some evidence of migration into the inner layers. appears to be suggestive of a benefit of early vitrectomy in Cases with extensive RPE degeneration had ERGs consistent endophthalmitis. with generalised rod and cone dysfunction. All patients reported restriction of daily activities due to their vision impairment. Conclusions: This report provides a detailed examination of 203. Aflibercept in macular oedema secondary to retinal BCD clinical presentations, enabling examination of natural vein occlusion refractory to previous bevacizumab or history data to support future interventions including retinal ranibizumab: 48 week outcomes gene therapy. Kimberly Spooner1,2, Samantha Fraser-Bell1,2, Thomas Hong1,2, Andrew Chang1,2 202. Early vitrectomy in endophthalmitis Email: [email protected] 1Save Sight Institute, University of Sydney, Sydney, Rodger Paul1, Matthew Simunovic2,3, Rosie Dawkins1,4, Australia, 2Sydney Retina, Sydney, Australia Gursimrat Bhullar1, Rohan Essex1,5, Andrew Chang2,3, Aim: To evaluate the efficacy of switching to aflibercept as Penny Allen1,4 management of macular oedema secondary to retinal vein Email: [email protected] occlusion (RVO) recalcitrant to prior bevacizumab and/or 1Royal Victorian Eye and Ear Hospital, Melbourne, ranibizumab. Australia, 2Sydney Eye Hospital, Sydney, Australia, 3Save Methods: This prospective, open-label, clinical trial recruited Sight Institute, University of Sydney, Sydney, Australia. eyes with persistent macular oedema despite a minimum of 4Centre for Eye and Ear Research Australia, Melbourne, 4 previous intravitreal bevacizumab/ranibizumab injections. Australia. 5Academic Unit of Ophthalmology, Australian Three loading doses of intravitreal aflibercept were adminis- National University, Canberra, Australia tered every 4 weeks, thereafter every 8 weeks until week 48. Purpose: To compare visual acuity outcomes following Best corrected visual acuity (BCVA) and central macular early vitrectomy vs late, or no, vitrectomy, in patients who thickness (CMT) as measured by spectral domain optical developed endophthalmitis following intravitreal injection or coherence tomography (SD-OCT) every 4 weeks. cataract surgery presenting to the Royal Victorian Eye and Results: Eighteen eyes of 18 patients were recruited. Ear Hospital (RVEEH) or Sydney Eye Hospital (SEH) from Patients had underwent a mean of 40.0 ± 17.8 intravitreal 2014-2019. bevacizumab/ranibizumab injections prior to switching to Methods: Patients who presented with endophthalmitis fol- aflibercept. At week 48 following the switch to aflibercept, lowing cataract surgery or intravitreal injection and for the mean BCVA improved by 21.1 ± 5.1 letters in the whom complete data was able to be collected were included BRVO group and 18.8 ± 5.9 letters at in the CRVO group in the study. To better understand various treatment out- (P < 0.001 for both groups). There was a reduction in the comes, we focussed on two patient groups: those who mean CMT by 87.6 ± 48.8 μm and 191.0 ± 128.3 μm, in received early vitrectomy (<24 hours); vs late, or no, the BRVO and CRVO groups respectively (P < 0.001). vitrectomy. Using linear regression analyses, a higher number of previ- Results: From 2014-2019 there were 316 cases of ous intravitreal ranibizumab/bevacizumab injections and endophthalmitis following intravitreal injection or cataract thicker pre-switch CMT were correlated with greater visual surgery that could be included in the study. 32% received gains. early vitrectomy, 68% late or no vitrectomy. Patients who Conclusion: Changing anti-VEGF therapy to aflibercept in received early vitrectomy had significantly worse presenting cases of chronic, and resistant macular oedema was 156 POSTER ABSTRACTS associated with anatomical improvement demonstrated in 48/84 using DO (specificity: 57%); and 82/93 when using most eyes. This effect is more obvious in eyes with a greater NMFP (specificity: 88%). CMT prior to the switch. Conclusions: NMFP alters EPs management plans for a significant proportion of appropriate ED patients, and has superior diagnostic accuracy compared with DO. Whilst ophthalmic 204. Fundus photo deep transfer learning algorithms diagnostic support is still required, these results emphasise that generalise with variable performance across devices NMFP should become standard practice in the ED.

WITHDRAWN 206. Protective efffects of Ginkgo biloba extract on blue light retinal injury through suppression of endoplasmic 205. Non-mydriatic fundus photography in a regional reticulum stress in a rat model Australian emergency department Jong-Hyun Oh1 Samuel Browning1, Hamish Dunn1,2,3, David Thomson1, Email: [email protected] 1,2 4 2,4,4,6 Will Yates , Lisa Keay , Andrew White , Peter 1Department of Ophthalmology, Dongguk University Ilsan 2,6 4,6 McCluskey , Clare Fraser Hospital, Goyang, Republic of Korea Email: [email protected] 1Rural Clinical School, Faculty of Medicine, University of Purpose: Cumulative exposure to blue light may play an eti- New South Wales, Sydney, Australia, 2Faculty of Health and ological role in age-related macular degeneration (AMD). Medicine, The University of Sydney, Sydney, Australia, Endoplasmic reticulum (ER) stress is involved in the patho- 3Westmead Hospital, Sydney, Australia, 4School of genesis of AMD. In this study, we investigated the effects of Optometry and Vision Sciences, University of New South Ginkgo biloba Extract (GBE) on the retinal injury and the Wales, Sydney, Australia, 5Westmead Hospital, Sydney, ER stress of the retinal cells in rats exposed to blue light. Sydney, Australia, 6Save Sight Institute, Faculty of Health Methods: Rats were exposed to blue light at 1000 lx for and Medicine, The University of Sydney, Sydney, Australia 6 hours per day during 4 weeks. In the treatment group, rats were orally feed 100 mg/kg of GBE daily. The outer nuclear Purpose: Previous FOTO-ED trials demonstrated that layer (ONL) thickness of the retina was measured in the histo- fundoscopic signs of blinding and life-threatening conditions pathology. Expressions of binding protein/glucose-regulated are missed in 10-17% of metropolitan emergency department protein 78 (BiP/GRP78) and C/EBP homologous protein-10 (ED) patients. We aimed to evaluate the extent to which (CHOP) mRNA were measured using quantitative real-time non-mydriatic fundus photography (NMFP) altered ED phy- polymerase chain reaction (qRT-PCR). BiP/GRP78 and sician’s (EP) management of appropriate patients in a CHOP protein levels were assessed with Western blot. regional setting. Results: Compared with control group, ONL thickness Method: We conducted a prospective study of patients pre- decreased and levels of BiP/GRP78 mRNA and CHOP pro- senting to the Port Macquarie Base Hospital ED with head- tein increased in the group exposed to blue light (BL group). ache, visual impairment, neurological deficits, or hypertensive In the group treated with GBE (BL + GBE group), the ONL crisis. Fundus images were obtained using a portable non- thinning was reduced and the expressions of both mRNA mydriatic fundus camera (RetinaVue, WelchAllyn). EP’s and the protein of BiP/GRP78 and CHOP reduced compared direct ophthalmoscopy (DO) findings and management was with the BL group. recorded, then NMFP images were provided and any change Conclusion: This study suggests that GBE can protect the ret- in management was documented. Sensitivity and specificity ina from blue light-induced damage by mitigating ER stress. was calculated by comparison with independent review of NMFP images by an ophthalmic team. Results: Interim data from 117 enrolled patients found a 207. Comparing morphological outcomes between clinically gradable fundus in 66 using DO and 114 using ranibizumab and afliberept for the treatment of NMFP. EPs reported a change in management due to NMFP neovascular age-related macular degeneration amongst 26 patients (22%; 95%CI 15-30%). Fundus images identified 21 acute pathologies (18%; 95%CI 12-26%). EPs Thomas Hong1,2, Long Phan1,3, Kimberly Spooner1,2, correctly identified acute pathology using DO in 2/21 cases Andrew Chang+ (sensitivity: 9.5%), and when using NMFP in 8/21 cases Email: [email protected] (sensitivity: 38%). Normal fundi were correctly identified in ABSTRACT 157

1Sydney Institute of Vision Science, Sydney, Australia, Method: A retrospective analysis was performed on the 2Univeristy of Sydney, Sydney, Australia, 3University of clinical outcomes in three eyes of three pseudophakic Technology, Sydney, Australia patients that had implantation of the A45SML plano powered IOL with central +10.0D addition. One patient had Purpose: To compare anatomic outcomes in patients receiv- dry AMD, another patient had AMD and controlled wet ing either ranibizumab or aflibercept for neovascular age- AMD with regular anti-VEGF treatment and the third patient related macular degeneration (nAMD) over 12 months of had Vitelliform Macular Dystrophy. This is a single centre, treatment. single surgeon, single IOL study. All patients were evaluated Methods: A retrospective study was performed between prior to receiving the SML implant against a checklist pro- 2013-2017 on naïve patients who were initially treated with vided by Medicontur to ensure suitability for the procedure. aflibercept or ranibizumab monotherapy for nAMD. Patients Surgery was performed through a 2.4 mm temporal incision with a minimum of 12 months treatment were identified in all cases. The SML was implanted into the Ciliary Sulcus. using a pharmacy dispensing database from a single ophthal- Subjective refractions, uncorrected visual acuities at dis- mology practice. Outcome variables collected include; tance, best-corrected distance and near visual acuities, mac- Visual acuity (VA), central macular thickness (CMT), sub- ula OCT and anterior segment OCT were tested retinal fluid (SRF) height, intra-retinal fluid diameter (IRF) preoperatively and postoperatively in the clinic. and pigment epithelial detachment (PED) height measured Results: Improvement was noted with near visual acuity in with Spectral-domain optical coherence tomography. Times the treated eye of each patient when tested at a reading dis- when fluid resolved and duration of fluid-free status were tance of 15 to 18cms. Most improvement was observed compared between groups. 2 months after surgery and postoperative visual training. Results: 134 eyes (88 aflibercept, 46 ranibizumab) were Distance visual acuity did not change in any of the patients. included in this analysis. Patients who received ranibizumab The macula OCT examinations remained stable after SML gained more letters than those who received aflibercept after implantation. the first injection (5.0 vs 1.4 letters, P = 0.034), however Conclusion: The SML appears to be a safe option that can this disparity disappeared after 12-months (all P > 0.05). provide useful near vision in pseudophakic patients with After 12 months, all morphological features (SRF/IRF/PED) maculopathies such as AMD and Vitelliform Macular improved similarly between groups (all P > 0.05). Whilst a Dystrophy. similar proportion of patients became fluid-free throughout the 12 months (64.8% in aflibercept vs 67.4% in ranibizumab), patients receiving aflibercept achieved fluid- 209. Photoreceptor migration after successful macular free status faster (2.7 vs 4.0 months, P = 0.072) and hole closure: An adaptive optics study remained fluid-free for a longer duration than those receiving ranibizumab (5.4 vs 2.5 months, P = 0.008). Ashish Markan1, Rohan Chawla1, Vinay Gupta1, Manasi Conclusion: Efficacy was similar among both drugs in improv- Tripathi1, Anu Sharma1, Atul Kumar1 ing anatomic outcomes associated with nAMD after 12 months Email: [email protected] of treatment. Eyes receiving aflibercept were fluid-free for lon- AIIMS, New Delhi, India ger compared to eyes receiving ranibizumab. Objective: To study photoreceptor changes after successful macular hole surgery using adaptive optics. 208. Clinical outcomes in patients following implantation Materials and Methods: A pilot study was conducted on of the scharioth macula lens 3 patients who underwent a successful macular hole surgery. Cone density, spacing and number of nearest neighbours Brian Harrisberg1 were analysed at 2 and 4 of eccentricity in all four quad- Email: [email protected] rants using adaptive optics. 1 Results: All three patients gained a visual acuity better than Central Sydney Eye Surgeons, Sydney, Australia. Royal Prince Alfred Hospital, Sydney, Australia logMAR0.477 (Snellen equivalent 6/18) at 6 months following successful macular hole surgery. Following successful Purpose: To evaluate the clinical outcomes in pseudophakic closure of the macular hole, photoreceptors were appreciated patients with dry Age Related Macular Degeneration (AMD) at 2 and 4 of eccentricity from the centre. However, as com- and Vitelliform Macular Dystrophy following implantation pared to the fellow normal eye, cell density was reduced of the new Scharioth Macula Lens (SML) manufactured by significantly in the inferior (12 929.33 ± 2047.50 vs Medicontur. 23 839.67 + 3711.16 cells/mm2 at 2) and temporal 158 POSTER ABSTRACTS quadrant (13 890 + 3424.26 vs 22 578.67 + 5651.34 cells/ 211. Agreement on diabetic retinopathy grading on mm2 at 2) and intercell spacing was increased significantly fundus photographs by allied medical personnel as in inferior (9.6 + 0.92 vs 7.14 + 0.545 um) and nasal quad- compared to ophthalmologist at community diabetic rant (8.83 + 0.39 vs 7.49 + 0.42 um). Number of nearest retinopathy screening in Nepal neighbours were unaffected after the hole closure. 1,2 1 Conclusion: Post operative recovery of vision after success- Raba Thapa , Govinda Paudyal ful closure of the hole occurs due to migration or shifting of Email: [email protected] cells from parafoveal retina towards the centre. Cells nearest 1Tilganga Institute of Ophthalmology, Kathmandu, Nepal, 2 to the hole margin (at 2 eccentricity) appear to shift more as Tilganga Institute, Kathmandu, Nepal compared to cells which are further away. Purpose: Diabetic retinopathy (DR) is an emerging cause of blindness worldwide. This study aimed to assess the accuracy of DR grading using fundus photographs by the allied 210. Prevalence, pattern and risk factors of retinal medical personnel (AMP) as compared to retina specialist. diseases among elderly population of Nepal Method: Fundus photographs were graded by six AMP after training and one retina specialist. A total of 1344 fundus Raba Thapa1 photographs of each eye were graded twice at 2 weeks inter- Email: [email protected] val by the AMP at 3 months and 6 months of training. 1Tilganga Institute of Ophthalmology Kathmandu Nepal , , Agreement was assessed using kappa coefficient. Purpose: Retinal diseases are the leading cause of blindness Results: The intra-rater agreement of AMP at 6 months was globally. This study aims to explore the prevalence, pattern substantial to almost perfect on normal vs abnormal retina, and risk factors of retinal diseases in Nepal. retinal haemorrhage, exudates at macula. The agreement was Method: This is a population-based, cross-sectional study almost perfect for detection of DR vs no DR and moderate conducted from 2013 to 2015 AD. Sample size estimated to substantial for clinically significant macular edema was 2100 subjects at the age 60 years and above from (CSME) and other vision threatening DR (VTDR). 30 clusters of Bhaktapur District. Detailed history, visual There was substantial inter-rater agreement at 6 months on normal vs abnormal retina. The agreement was moderate for acuity, anterior and posterior segment examinations were retinal haemorrhage, exudates at macula. The inter-rater done. Blood sugar and blood pressure were measured. agreement was substantial for detection of DR vs no DR, Results: Complete information was available for 1860 and moderate to substantial for CSME and VTDR. (88.57%) subjects. Mean age was 69.64 ± 7.31 years, The agreement results were comparable at 3 months and ranged from 60 to 95 years. The overall prevalence of any 6 months for both the intra-rater agreement and inter-rater retinal disorder was 52.37% (95% Confidence Interval [CI]; agreement. 50.07%- 54.66%) in the study subjects. Age related macular Conclusion: The inter-rater agreement of AMP as compared degeneration (AMD) was the most common (35.43%) retinal to retina specialist on fundus photo grading was substantial disorder in study subjects followed by hypertensive retinopa- in detecting DR and moderate to substantial agreement for thy (4.35%), epiretinal membrane (ERM) (3.66%), branch detecting VTDR. AMP could be utilized under the physician retinal vein occlusion (BRVO) (2.95%), and diabetic reti- to integrate DR screening in comprehensive diabetes man- nopathy (DR) (2.15%). In multivariable logistic regression agement in low resource countries. analysis, pseudophakia (Odds Ratio [OR], 1.71; 95% CI: 1.32-2.22, P < 0.001) and systemic hypertension (OR, 1.21; 95% CI: 1.001-1.47, P = 0.049) were significantly associ- 212. An audit of referrals for diabetic retinopathy in a ated with retinal disorders. public hospital ophthalmology service in Western Conclusion: Prevalence of retinal disorder was 52.37% at Sydney, Australia the age 60 years and above in Bhaktapur district, Nepal. AMD, hypertensive retinopathy, ERM, BRVO, and DR Belinda Ford1,2, Lisa Keay3,4, Gerald Liew1,5, Andrew were the most common retinal disorders. Pseudophakia and White1,2,5 hypertension were the significant risk factors. Emphasis has Email: [email protected] to be given for retinal diseases screening, control of blood 1Westmead Hospital Ophthalmology Department, WSLHD, sugar and high blood pressure, and regular eye check-up to Sydney, Australia, 2The George Institute for Global Health, avoid irreversible visual impairment. UNSW Sydney, Sydney, Australia, 3The George Institute for ABSTRACT 159

Global Health, UNSW, Sydney, Australia, 4School of Purpose: Intravitreal injections have been reported to pro- Optometry and Vision Science, UNSW, Sydney, Australia, duce acute IOP spikes, causing transient reductions in macu- 5Westmead Institute for Medical Research, University of lar and peri-papillary perfusion density. The retinal ganglion Sydney, Sydney, Australia cell layer (RGCL) relies on the superficial macular plexus for perfusion, and is especially vulnerable. The macular Purpose: Diabetic patients require retinopathy screening by RGCL is also the primary location of early glaucomatous optometrists or general practitioners every 2 years depending damage, and has shown good diagnostic performance for on their risk level. RANZCO recommends patients with at pre-perimetric glaucoma. This study was designed to assess least moderate non-proliferative diabetic retinopathy (NPDR) the cumulative effect of chronic anti-vascular endothelial be referred to an ophthalmologist, however, poorly targeted growth factor (anti-VEGF) therapy on RGCL thickness. referrals to public ophthalmology departments are leading to Methods: Post-hoc analysis was performed on data collected access blocks for patients needing treatment. We assessed the from a single-centre prospective treatment-naïve cohort. Patients completeness and targeting of diabetic referrals to a large who received continuous intravitreal aflibercept in one eye for urban public ophthalmology service. neovascular age-related macular degeneration over a minimum Methods: A cross-sectional audit of medical records was carried of 24 months were included. Automatic segmentation was per- out for new patients at Westmead Eye Clinic in 2016 to deter- formed on macula OCT scans with a standard ETDRS grid mine the completeness of medical and ophthalmic information in overlay. RGCL thickness was quantified at baseline and after referrals and subsequent patient diagnosis and management. repeated injections; and compared to the patients’ untreated fel- Results: In 2016, 144 diabetes referrals were received, of low eye. Correlations were sought with age, BCVA, IOP, cup- which 7% were declined, and 13% transferred to a private disc ratio, injection number and duration of therapy. ophthalmologist (bulk-billed) for Anti-VEGF treatment Results: 103 patients (55 female, mean age 81.8 years) with which is unavailable at the hospital. Information was incom- an average of 32 ± 13 aflibercept injections over 45.3 plete for diabetes (>60%), medical (>50%) and ophthalmic ± 10.5 months were included. RGCL thickness decreased (>70%) indicators, including visual acuity (>60%). GP refer- significantly in the study eye compared to the untreated fel- rals (42%) better recorded medical, and optometrists (37%) low eye (P < 0.05), with a preference for the temporal sector ophthalmic information. Imaging was rarely included (reti- (mean difference 5.68 μm, P = 0.036). Significant correla- nal photos <1%; OCT <3%). Median appointment waiting tion was found between change in RGCL thickness and time was 124 days (n = 116) and 78% attended. Only 11% number of injections (r = 0.35, P < 0.025). of patients received treatment (laser) in this or the following Conclusion: Progressive RGCL thinning may be a sentinel encounter (48% were diagnosed with No/Mild NPDR and marker for the onset of incipient glaucoma, and should prompt 10% transferred for Anti-VEGF treatment). the commencement of glaucoma surveillance in these patients. Conclusions: The quality and targeting of diabetic retinopathy referrals to public hospitals needs to be improved. Edu- cation, feedback, and collaborative care mechanisms should 214. Factors associated with the duration of action of be considered to improve referral and screening in primary dexamethasone intravitreal implants in diabetic macular care. Access to Anti-VEGF treatments in NSW public hospi- oedema patients tals should be considered. WITHDRAWN

213. Longitudinal retinal ganglion cell thickness change STRABISMUS in patients receiving intravitreal anti-vascular endothelial growth factor for neovascular age-related macular degeneration 215. Outcomes of medial rectus elevation and creation of a V-pattern for the management of large angle Eelin Ong1,2, Kimberley Spooner1,2,3, Thomas Hong1,2, divergence insufficiency type esotropia Andrew Chang1,2,3,4 Email: [email protected] Rahul Chakrabarti1,2,3,4, Lionel Kowal1 1Sydney Retina Clinic, Sydney, Australia, 2Sydney Institute Email: [email protected] of Vision Science, Sydney, Australia, 3The University of 1The Royal Victorian Eye and Ear Hospital, East Sydney, Sydney, Australia. 4Sydney Eye Hospital, Sydney, Melbourne, Australia, 2The Royal Children’s Hospital, Australia Melbourne, Australia, 3Northern Health, Melbourne, 160 POSTER ABSTRACTS

Australia, 4The University of Melbourne, Melbourne, collapse the V pattern. The remaining patient had 7 pd right Australia hypertropia with asymmetric bilateral IOOA. Right inferior oblique myectomy and the left IOMBT were performed. Aims: Describe the technique and outcomes for bilateral Horizontal rectus muscle surgery unilateral recess-resect medial rectus elevation in the treatment of large angle dis- (R&R), was performed at the same stage if need. The angle tance esotropia without creating near exotropia and of deviation in upgaze and downgaze was measured pre- and compromising single vision for near. postoperatively. The degree of IOOA was also assessed pre Methods: A retrospective, non-randomised case file audit of patients who underwent bilateral medial rectus elevation by and post-operation. The amount of V pattern was the amount a single surgeon in the period from August 2013 to of difference in deviation angle between upgaze and down- December 2018 was conducted with a minimum follow up gaze. The change of the amount of V pattern was compared of 1 month. Data collected included prism-bar cover test postoperatively. measurements, radiological features, and fusion range. In all Results: All the patients had complete resolution of the V cases the medial rectus was elevated and draped from the pattern. Changes in preoperative and postoperative amount upper pole of the original medial rectus insertion. Success of V pattern were from 18.92 ± 4.310 prism diopters to was defined as attaining orthotropia at distance, without cre- 3.462 ± 1.854 prism diopters. The mean degrees of preoper- ating near exotropia in primary position, and preservation of ative and postoperative IOOA were 1.92 ± 0.54 and 0.12 single vision at near. ± 0.33. No superior oblique overaction or consecutive A Results: A total of 18 patients treated for distance esotropia pattern was found after surgery. were included. Preoperative esotropia at distance ranged Conclusions: IOMBT can successfully eliminate the V pat- from 14D to 40D. Mean bilateral medial rectus recession tern in patients with mild V pattern esotropia or exotropia performed was 4.3 mm (range of 3.5 to 5.5 mm). Sixteen of with mild to moderate inferior oblique overaction. This pro- eighteen patients (88%) had successful correction of distance cedure appears to be a useful addition to our inferior oblique esotropia, without post-operative exotropia and preserved surgical armamentarium. single vision at near. Conclusion: In patients with large angle distance esotropia consistent with a divergence insufficiency type esotropia, 217. Clinical observation: The changes of dominant eyes elevation of the medial rectus to the upper pole of its original before and after operation in patients with intermittent insertion in conjunction with bilateral medial rectus reces- exotropia sion the induction of a V-pattern can achieve excellent distance alignment with preservation of single vision at near. WITHDRAWN This technique may overcome the otherwise real risk of inducing near exotropia with diplopia for patients with large angle distance esotropia. 218. Clinical and genetic analysis for the Chinese patients with congenital cranial dysinnervation disorders (CCDDs) 216. Inferior oblique belly transposition for V pattern strabismus WITHDRAWN

Shiqiang Yang1, David R. Tien2, Xin Guo1 Email: [email protected] 219. Clinical profile, management and treatment 1Tianjin Eye Hospital and Eye Institute, Tianjin, China, outcomes of Acquired Brown Syndrome: Case series 2Warren Alpert Medical School at Brown University, from a tertiary eye care centre in India Providence, USA WITHDRAWN Purpose: To evaluate the efficacy of inferior oblique muscle belly transposition (IOMBT) in treating V pattern strabismus with mild to moderate inferior oblique muscle overac- 220. Clinical profile and surgical outcomes of strabismus tion (IOOA). associated with thyroid eye disease in an Indian Methods: The medical records of 14 patients who under- population went IOMBT procedure from January 2017 to December 2018 were reviewed. In 13 of the patients, there was no or WITHDRAWN trace vertical deviation. Bilateral IOMBT were performed to ABSTRACT 161

221. Muscle transplantation for large angle horizontal 224. Quality of life in patients with Graves’ disease sensory strabismus 1 year after the strabismus surgery

WITHDRAWN Shih-Wen Wang1, I-Chan Lin1 Email: [email protected] Department of Ophthalmology, Shuang Ho Hospital, Taipei 222. Comparison of bilateral lateral rectus recession vs Medical University, New Taipei, Taiwan unilateral recess and resect for intermittent exotropia in Jakarta, Indonesia Purpose: Strabismus surgery is frequently required in patients with Graves’ disease, but postoperative quality of WITHDRAWN life has not been well investigated. We aimed to evaluate the improvement in quality of life among patients with Graves’ disease 1 year after receiving strabismus surgery using a 223. Periosteal muscle fixation for large angle incomitant questionnaire. exotropia Method: A cohort of Graves’ disease patients undergoing strabismus surgery between June 2016 and December 2018. Sarah Hull1, Tarang Gupta1, Geoffrey Rose1, David A quality-of-life questionnaire composed of the functional Verity1, Gill Adams1 GO-QOL questionnaire was utilized in this study. The ques- Email: [email protected] tionnaires were completed by patients before the surgery and 1Moorfields Eye Hospital, London, UK 1 year postoperatively. The main outcome measures were the scores of two GO-QOL subscales: visual functioning and Purpose: To describe the evolution of a modified surgical appearance. technique for correcting large angle incomitant Results: The cohort exhibited 17 patients (1 men/16 exodeviations. women). The mean age was 42.6 years old and all patients Methods: A consecutive series of 26 patients with predomi- were operated for the first time for strabismus. Eight patients nantly third nerve palsy (n = 21, medial rectus palsy = 2, (47%) reported a history of surgical orbital decompression. exotropia = 2, Moebius = 1) were operated on between The preoperative and postoperative QOL scores for the sub- 2005-2018 by a joint Strabismus/Adnexal team. Retrospec- scales of visual functioning were 57.2 ± 25.4 and 67.7 tive analysis included prism dioptre (PD) deviations and ± 16.7 respectively (mean ± SD, P = 0.079). The preopera- complications. tive and postoperative QOL scores for the subscales of Results: Three patients missed follow up leaving 23 patients appearance were 45.6 ± 20.1 and 58.8 ± 20.0, respectively mean age 37.8 years (range 4-79). All had minimal medial (mean ± SD, P = 0.027). The degree of diplopia was rectus function. Twelve had undergone prior surgery. Pre assessed objectively by the Worth four dots test, and subjec- operative exotropia ranged from 45 to >115 PD. There were tively by the Gorman scale. The QOL scores for the appear- 29 operations (19 patients = 1, 4 patients >1) with the ance subscale were correlated with the degree of diplopia. medial rectus insertion anchored to retrocaruncular perios- Conclusion: This study showed that strabismus surgery sig- teum. The lateral rectus was disinserted then fixated to the nificantly improved the quality of life among patients with lateral orbital rim except for 2 recessions and 5 botulinum Graves’ ophthalmopathy, especially in the subscales of toxin injections (4 performed 2005-6). Medial traction appearance. sutures were inserted in 21 of 29 surgeries (8 without performed 2005-9) for a mean of 5 weeks (range 2-8). Final review was at a mean 32 months (range 2 to 130) with a 225. Study on binocular visual function in intermittent mean reduction in deviation of 44 PD (range 10 to 79). The exotropia patients 5 toxin procedures had a mean reduction of 22 PD. There was one complication of exposed ethibond suture that Yongqing Guan1, Liqun Ren2 required trimming. Email: [email protected] Conclusion: Large angle incomitant exodeviations present a 1Hebei Medical University, Shijiazhuang, China, 2Hebei difficult surgical challenge. We advocate a combined bi- Medial University, Shijiazhuang, China rectus fixation approach with traction sutures to hold the globe in the primary position. Previous surgery does not pre- Purpose: To investigate the possible mechanism of intermit- clude further surgery with this technique. tent exotropia. 162 POSTER ABSTRACTS

Method: Measured the fusion range of the object, converged posterior uveitis (5.9% vs 32.0% eyes P = 0.033). No differ- fusion and diverged fusion, as well as near and distant ence was observed in anterior and intermediate uveitis stereoscopy. between the groups and no difference in resolution or Results: There was no statistical significance in diverged inflammation or recurrence. fusion between the intermittent exotropia group and the nor- Conclusions: Syphilis uveitis is common in New Zealand, mal control group (P > 0.05). The converged fusion in the occurring in 1 in 55 subjects seen in consultant uveitis intermittent exotropia group was significantly smaller than clinics. Significant differences exist in the presentation of that of the normal control group (P < 0.01).The distant hori- older Pacific Peoples with positive treponemal serology. zontal diverged fusion in the intermittent exotropia group These differences may be due to chronicity of disease or due was significantly larger than that of the normal control to false positives secondary to Yaws. group. The difference showed statistical significance between the two groups (P < 0.01).The distant horizontal converged fusion in the intermittent exotropia group was 227. Seasonal hyperacute panuveitis (SHAPU) and significantly lower than that of the normal control group. MOTH SAGA The difference showed statistical significance between the two groups (P < 0.01).The distant stereopsis in the intermit- Ranju K. Sitaula1, Pratap Karki1, Sagun N. Joshi1, Anu tent exotropia group was significantly lower than that of the Manandhar2, Madan P. Upadhyay3 control group. The difference showed statistical significance Email: [email protected] between the two groups (P < 0.01). 1Institute of Medicine, B. P. Koirala Lions Centre for Conclusion: (1) Discrete fusion of hyperfunction may be Ophthalmic Studies, Kathmandu, Nepal, 2Tilganga Institute one of the mechanisms of intermittent exotropia. (2) The ste- of Ophthalmology, Kathmandu, Nepal, 3BP Eye reoscopic visual impairment of intermittent exotropia might Foundation, Children’s Hospital for Eye, ENT and firstly occur in the distant stereoscopic vision. Rehabilitation Services (CHEERS), Kathmandu, Nepal Purpose: Seasonal Hyperacute Panuveitis (SHAPU) is a UVEITIS devastating eye disease of unclear aetiology reported only from Nepal, occurring cyclically during the autumn of odd years, since 1975. It’s unilateral, mostly affecting healthy 226. Syphilis uveitis in New Zealand: Is it possible to children, causing sudden and profound loss of vision within discriminate from Yaws? a week. So, this study was aimed to confirm the role of moths in SHAPU cases. Hannah Gill1, Helen D. Meyer2, Jo Sims1, Rachael Method: Case-Control (1:3 ratio) multicentric study con- Niederer1 ducted during 2017 SHAPU outbreak. Univariate and multi- Email: [email protected] variate analysis were performed. 1Auckland DHB, Auckland, New Zealand, 2The University Results: A total of 35 cases and 105 controls identified of Auckland, Auckland, New Zealand across the country. Mean age was 11 years and 71% of cases Aim: To describe the spectrum of syphilis uveitis in were children <16 years (38-day-infant to 50-year-old). New Zealand. Affected male>female (57.1%vs 42.9%) and 82.6% of cases Methods: Retrospective review of subjects seen in uveitis occurred during August-September. and neuro-ophthalmology clinics at Auckland District SHAPU cases were 8.7 times more likely to report exposure Health Board between January 2006 and June 2019. to white moths (95% Confidence Interval). The unusual flow Results: 2493 subjects were reviewed, of whom 46 were of white moths present in 74.3% SHAPU cases before con- diagnosed with syphilis uveitis (1.8%). Mean age was 56.5 tracting the disease. Contact history with moth was present ± 14.8 years and 35 (76.1%) were male. Ethnicity was in 48.8% of cases and 11.4% of controls. Bushes around the Pacific Peoples in 17 (37.0%), Caucasian in 16 (34.8%), home and physical contact with livestock animals were also Asian 6 (13.0%) and Maori in 2 (4.4%), and other 5 (10.9%). more commonly reported among SHAPU cases compared to Pacific Peoples were older at presentation (P = 0.0005) with controls. 76.5% over 60 years compared to 24.1% of other ethnicities Conclusion: The white moths remain the strongest risk fac- (P = 0.001). Comparing Pacific People aged >60 to the rest tor for SHAPU causation. Future studies on moth lifecycle, of the cohort, older Pacific subjects had lower RPR titres toxin analysis, hypersensitivity reactions, genotyping, (median 4 vs 32 P = 0.028), less likely to have optic nerve phenotyping and identifications of the biomarkers are swelling (0% vs 28% eyes P = 0.014), and less likely to have needed to solve the mystery of moth saga. ABSTRACT 163

228. Evaluation of RETeval portable electroretinogram Purpose: To determine associations between HLA-B27 positive in patients with birdshot chorioretinopathy uveitis, ethnicity and different seronegative spondylarthropathies (SpA) in a New Zealand (NZ) population. Anna Waldie1,2,3, Elisa Cornish1,2,3, Vuong Nguyen1,2, Method: Retrospective review of uveitis patients at Auck- Clare Fraser1,2,3, Peter McCluskey1,2,3, John Grigg1,2,3 land District Health Board from 2006-2018. Email: [email protected] Results: We identified 499 HLA-B27 positive uveitis 1Save Sight Institute, Sydney, Australia, 2The University of patients; 301 were male (60.3%) and median age was Sydney, Sydney, Australia, 3Sydney and Sydney Eye 37.8 years (IQR 29.7-50.0). Ethnicities were Caucasian Hospital, Sydney, Australia (n = 304, 60.9%), Asian (n = 110, 22.0%), Maori (n = 41, 8.2%) and Pacific Peoples (n = 40, 8.0%). Uveitis anatomi- Purpose: Birdshot chorioretinopathy (BCR) is a rare form cal classification was anterior (n = 481, 96.4%), intermediate of chronic, bilateral, posterior uveitis with a distinctive phe- (n = 35, 7.0%), panuveitis (n = 11, 2.2%) and scleritis notype, and a strong association with HLA-A29. Diagnosis (n = 3, 0.6%). Maori or Pacific ethnicity was associated with and treatment is frequently delayed, and management intermediate or panuveitis (P = 0.003). Ankylosing spondy- involves aggressive long term systemic and local immuno- litis (AS) was observed in 147 patients (30.0%) and more suppressive therapy to minimise visual loss. ERG testing is frequent in younger patients (OR 0.979, P = 0.004) and critical for making the diagnosis and following the response males (OR 1.964, P = 0.002). There was no difference in to treatment. The purpose of this study was firstly to deter- AS by ethnicity or uveitis classification. Inflammatory bowel mine the capability of a handheld RETeval electroretino- disease (IBD) occurred in 19 patients (3.8%), none of which gram (ERG) for detecting disease activity in birdshot were Maori or Pacific ethnicity (P < 0.001). There was no chorioretinopathy (BCR) in comparison with association with IBD diagnosis and age, gender or uveitis conventional ERG. classification. Psoriatic arthritis (PsA) occurred in 16 patients Method: This retrospective study included eleven patients (3.2%) with no association between gender or ethnicity and with an established diagnosis of BCR who had undergone PsA. Patients were more likely to be diagnosed with PsA if standard clinical and RETeval ERG evaluation. Five control they were older (OR 1.036, P = 0.033), and had intermedi- participants underwent RETeval ERG to establish standard ate or panuveitis (OR 3.88 P = 0.018). Reactive arthritis values for comparison. was observed in 15 subjects and no association with age, Results: The RETeval 30 Hz flicker amplitude and implicit gender, ethnicity or classification of uveitis. time was positively associated with conventional ERG. Conclusions: This cohort of NZ based HLA-B27 positive There was a statistically significant difference between the uveitis patients shows a difference in age and ethnicity in the RETeval 30 Hz flicker amplitude and implicit time in types of uveitis and SpA. patients with BCR compared to controls. The ERG parameters that were significantly correlated with BCVA were: photopic bright flash (LA3.0) a- and b-wave amplitudes, 230. Ocular sarcoidosis in Australia conventional photopic 30 Hz flicker implicit time, RETeval 30 Hz flicker implicit time, and 30 field pattern ERG N95 Jessica Xiong1,2, Peter McCluskey1,2, Anthony Sammel2,3,4, amplitude. Sophia S. L. Zagora1,2 Conclusion: This is the first study to evaluate RETeval Email: [email protected] 30 Hz flicker electroretinography in a cohort of BCR 1University of Sydney, Save Sight Institute, Sydney, patients. Our findings indicate that the RETeval device has Australia, 2Sydney Eye Hospital, Sydney, Australia, 3Prince the potential to be used to screen for BCR disease activity 4 of Wales Hospital, Sydney, Australia, Royal North Shore and monitor treatment response where conventional ERG Hospital, Sydney, Australia systems are not available. Introduction: Sarcoidosis is an uncommon, but well recognised cause of uveitis in Australia. Making a definitive 229. Associations between HLA-B27 positive uveitis and diagnosis of ocular sarcoidosis is often challenging. The seronegative spondylarthropathy subtypes in a ocular presentation is often the first presentation of the dis- New Zealand population ease, leading to a systemic diagnosis. Ocular sarcoidosis accounts for approximately 5% of patients attending the uve- Ruhella R. Hossain1, Jo Sims1, Rachael L. Niederer1 itis unit at Sydney Eye Hospital (SEH). Email: [email protected] Methods: We reviewed the real-world data of clinical fea- 1Auckland District Health Board, Auckland, New Zealand tures, treatment and visual outcomes of patients with sarcoid 164 POSTER ABSTRACTS related uveitis from the SEH uveitis database of more than 8 year old with uveitis and Adie’s pupil and a 16 year old 2050 patients seen between 2009-2019. with optic neuritis. One subject developed uveitic glaucoma Results: There were 108 patients (192 eyes) with ocular following primary varicella. Only two subjects had vision manifestations consistent of sarcoid. Using the Revised loss secondary to primary varicella ocular complications, International Diagnostic criteria – 32 patients were definite both of these presented with disciform keratitis. (tissue diagnosis), 37 patients were presumed (abnormal CT Conclusion: Ocular sequelae of primary varicella are rare. chest) and 39 patients were probable sarcoid. The average Subjects with primary varicella should not be routinely age was 47 years (range 21-84 years). There were more reviewed, but referred if they have visual symptoms or females than males. Most presentations were bilateral and develop preseptal cellulitis secondary to infected pox. Disci- chronic. The most common presentations were with anterior form keratitis secondary to primary varicella carries a higher (38%), intermediate (28%), pan (22%) and posterior (12%) risk of visual impairment. uveitis. The most common complications were cataracts (35 eyes, 18%), "IOP (33 eyes, 17%), CME (28 eyes, 14%) and optic neuropathy (10 eyes, 5%). Seventy-four (69%) 232. Outcome of peripheral iridotomy in subjects with patients received oral prednisone and 39 (36%) had addi- uveitis tional immunosuppressive drug therapy. Most patients maintained good vision between 6/6-6/12-75% at presenta- Tom Betts1,2, Joanne Sims2, Sonya Bennett2, Rachael tion and 80% at final review. Niederer2 Conclusion: Sarcoid uveitis is common. Patients with ocular Email: [email protected] sarcoidosis can present with a wide range of clinical mani- 1CDHB, Christchurch, New Zealand, 2ADHB, Auckland, festations. A multidisciplinary approach is crucial for diag- New Zealand nosis and to achieve the best visual and systemic outcomes. Purpose: Peripheral iridotomy (PI) may be required in subjects with uveitis to manage iris bombe, seclusio pupillae, 231. Ocular complications of primary varicella infection and primary angle closure glaucoma. The aim of this study was to identify risk factors for failure of both laser and surgi- Aaron Yap1, Jo Sims1, Rachael Niederer1 cal peripheral iridotomies in patients with uveitis and deter- Email: [email protected] mine survival durations. 1 Method: ADHB, Auckland, New Zealand Retrospective study of subjects with a history of uveitis undergoing YAG or surgical PI at Auckland District Health Purpose: To determine the rates of ocular complications Board over an 11 year period. Failure of PI was defined as loss arising from primary varicella (chickenpox) infection. To of patency or recurrence of iris bombe. A mixed effects shared describe chronic or severe cases of ocular involvement sec- frailty model was constructed with PI nested within eyes ondary to primary varicella infection. nested within patients, to examine time to failure. Method: A retrospective case series study of 28 patients Results: 131 PI were performed in 52 eyes of 39 subjects referred to the Greenlane Eye Clinic with ocular complica- during the study period (111 YAG PI and 20 surgical PI). tions from primary varicella was undertaken. The study Median age at time of PI was 46.6 years and 60.5% of sub- period was from March 2009 to March 2019. The patients jects were female. HLAB27 positive uveitis was the most were identified from clinical coding. common diagnosis (25.6% of subjects). Median survival Results: 33 eyes of 28 subjects were included in the study. time was 70 days for YAG PI and 11.0 years for surgical Median age at presentation was 6.1 years (IQR 3.8-15.7) PI. On multivariate analysis, younger age at time of PI and the median duration between onset of rash and develop- (HR 0.933 P < 0.001), and iris bombe (HR 2.180, ment of ocular signs was 4 days (IQR 1-10). Presentation P = 0.046) were associated with risk of failure. Surgical PI was unilateral in 22 subjects and bilateral in 5 (17.9%). The was associated with a lower risk of failure (HR 0.151, most common presentation was with conjunctivitis in 13 sub- P < 0.001) compared to YAG PI. Glaucoma developed in jects (46.4%). Anterior uveitis was observed in 9 subjects 19 eyes (36.5%), of whom 13 required glaucoma surgery. (32.1%), disciform keratitis 2 subjects (7.1%), periorbital cel- Conclusion: Surgical PI had longer survival than YAG PI, lulitis 2 subjects (7.1%) and isolated lid involvement 2 sub- and should be considered in subjects presenting with iris jects (7.1%). Two subjects had neurological sequelae; an bombe and in young subjects with uveitis. DOI: 10.1111/ceo.v47.Supp 1

AUTHOR INDEX

Abbeel L 131 Ayton LN 64 Burns O 151 Abbondanza M 36 Azad S 81, 153 Burt P 46 Abbott C 151 Baglin EK 64 Busch C 64 Abbott CJ 64 Bajaj M 128, 129 Cabrera-Aguas M 93, 94, 96, 98, 101 Adams G 161 Baker A 68 CaiJ28 Adams M 115 Banerjee A 88 Campbell T 75, 95, 123, 124 Adwe V 83 Banerjee G 69 Caplash Y 37 Agar A 30, 31, 40, 107, 120, 121 Barliana JD 138 Carden S 137 Agarwal A 53 Barnes E 72 Carr J 65 Agarwal P 92 Barnes N 64 Cascone N 95 Aggarwala A 99 Barthelmes D 62, 63, 69, 150 Casson R 29, 31, 40, 119, 120 Aguas MC 94 Bartimote C 93 Chakrabarti R 123, 159 Ah-Moye S 154 Bartnik S 109 Chan C 36, 45 Akkach S 70, 84, 86 Basu K 150 Chan W 141 Akonjee MAR 103, 148 Bedggood A 81 Chan WO 146 Al HH-Ani 147 Beltz J 46, 78 Chandra J 87 Alam J 62, 149 Bennett J 138 Chang A 63, 149, 155, 156, 159 Al‐Ani H 65 Bennett S 117, 164 Chang M 48 Ali N 65, 79, 140, 152 Beri S 136 Charng J 154 Aljufri N 138 Bernardo de Bezerra PS 46 Chau-Vo S 78 Allen P 116, 144, 151, 155 Best S 29 Chaudhry A 47, 80 Allen PJ 64 Betts T 164 Chaudhry S 117, 147 Alpins N 45 Bhandari S 69, 118, 150 Chawla R 81, 153, 157 Al‐Qureshi S 41 Bhargav A 151 Chee S-P 57 Alshaikhi M 55, 152 Bharucha K 83 Cheema J 132 Alsheikhi M 147 Bhatt U 90 Chehade L 141 Amin T 69 Bhatti J 139 Chehade M 37 Ancona‐Lezama D 48 Bhayana AA 47 Chen D 91 Andrew N 31, 70, 79, 126 Bhosale A 80 Chen F 152, 154 Ang GS 122 Bhullar G 144, 155 Chen W 28 Ang JL 154 Bisase B 126 Cheng J 79, 123 Angell B 71 Bishay R 107 Cheung G 149 Angelo L 52 Black J 136 Cheung W 107 Ao J 119 Blanco A 79, 123 Chew E 57 Apel A 45 Bobba S 87, 146 Chew S 117 Araújo M 65 Bonnelame T 108 Cheyne K 104 Arnold J 63, 69, 150 Booth-Mason S 90 Chhabra M 53 Arruda S 65 Bramwell S 107 Chia M 103, 121 Arsiwalla TA 143 Brooks A 28 Chidlow G 119 Artsi EB 127 Brown A-C 91 Chinwuba L 91 Artsi EB 51 Brown D 149 Chiu D 46, 64 Atkins W 46 Browning S 156 Choi HJ 105 Aujla J 37 Brusasco L 51 Choi YH 35 Avisar I 37 Bui B 41 Chong CF 87, 88 Awadalla M 31, 120 Burbidge A 73, 125 Choo MM 72 Ayres M 154 Burdon K 31 Chow O 132 Ayton L 154 Burlutsky G 55 Chu JP 144

Clin Experiment Ophthalmol. 2019;47 (Supp 1):165–170. wileyonlinelibrary.com/journal/ceo 165 166 AUTHOR INDEX

Chung D 138 Dick A 63 Gilhotra J 141, 146 Chung IY 123 Do H 107 Gill H 162 Chung IY 75, 115 Dogru M 92 Gillies M 61, 63, 69, 150, 154 Clark A 135 Donaldson C 134 Girgis C 107 Cleary G 102 Doron H 154 Go C 87, 114, 133, 146 Clement C 30 Drack A 138 Goel H 91 Clement MLC 28 Duck J 73 Goel R 53 Cohn G 78 Dugel P 62, 149 Gogia S 88, 89, 118 Colgan TD 54 Dunn H 107, 156 Gokul A 97 Collins A 136 Dutton A 122 Goldberg I 28 Collins C 145 Dwivedi P 118 Gopinath B 55, 112 Conn J 142 Dwivedi R 70 Graham S 28, 29, 31, 40, 74, 119, Constantinou M 41 Edwards T 46, 154 120, 135 Cook A 121 Edwards TL 54, 113 Greatbatch C 121 Cornish E 62, 65, 163 El‐Dairi M 74 Green J 73 Cornish EE 143, 148 Elder J 73, 78 Green M 122 Coroneo M 35 Ellis M 101 Grigg J 28, 72, 79, 163 Coroneo MT 113 Essex R 46, 63, 155 Grigg JR 143, 148 Coulon S 91 Essex RW 150 Group FCB 36 Covello A 40 Estoesta P 53 Guan Y 161 Cox R 40 Ewing T 135 Guei-Sheung L 119 Cozzi M 63 Ezra D 52, 130 Guest D 142 Craig J 28, 29, 39, 40, 119, 121 Fabinyi D 46 Guo B 141 Craig JE 120 Fagan X 142 Guo X 160 Craig JE 29, 31 Fan (Eva) Tang Y 102 Gupta S 31 Cranstoun M 133 Farah C 74 Gupta T 161 Crock C 123 Feng H 151 Gupta V 31, 157 Cronin B 122 Feng X 136 Gurung S 107 Crowston J 41 Ferdi A 36, 100 Guymer R 151 Crozier J 153 Fitzgerald J 31 Gzell C 53 Cunningham W 48 Flood V 55 Ha J 54 Curragh D 37, 131 Ford B 71, 107, 158 Hadden P 48 D’Souza D 149 Fortuna E 144 Hadoux X 41 D’Souza M 99 Foster J 93 Hall E 30 Dai S 39, 136 Fraser C 53, 74, 156, 163 Hall R 40 Daley J 134 Fraser CL 143, 148 Hallett N 99 Dalla-Pozza L 134 Fraser‐Bell S 63, 64, 155 Halliday L52 Dalvin L 48 Frazer H 89, 99 Hamilton R 62 Danesh‐Meyer H 28, 38, 124 Freundlich S 117 Han ES 85 Darian-Smith E 82 Fry L 46 Han SB 92 Dawkins R 144, 155 Fung A 64, 146 Han X 29, 40 Dawkins RCH 64 Furtado J 65 Hansen A 152 De Jesus FR 85 Galanopoulos A 31, 40, 120 Haridas A 52 Dean B 53 Ganesh S 146 Harrisberg B 69, 80, 86, 157 DeMartin T 53 Gao T 136 Hart C 78 Deng H 133 Garcia M 36 Hart R 52 Derham S 109 Garg R 136 Haskova Z 150 Deshpande M 83 Garway-Heath D 57 Hassall M 29, 31, 40, 119 Deshpande R 83 Gaskin JF 122 He M 32, 109, 112 Detaram HD 55 Gazzard G 115 Healey P 30, 31, 40 Dewhurst N 46 George G 123 Healey PR 120 Dhanji S 115 Georges P 99 Heerden AV 140 Dhull C 47, 80 Gharahkhani P 29 Hegde A 83 AUTHOR INDEX 167

Heinecke E 78, 137 Jones M 134 Kurian DE 129 Henein W 122 Jongue E 108 Kuruvilla S 120 Hepschke J 30 Jonker B 53 Kvansakul J 64 Hewitt A 29, 40, 103, 119, 121, 154 Joshi SN 162 Kwok L 110 Hewitt AW 31 Juarez J 99 Kwon J 145 Hickey DG 54, 113 Jung KI 122 Kwon MS 69 High KA 138 Jung Y 116 Lahra MM 93 Hill S 55, 61, 147, 152 Juniat V 130, 131 Lai C 39 Hng T-M 107 Kadappu S 133 Lam L 81 Ho HC 146 Kahn J 91 Landers J 31, 40, 120 Ho I 67 Kalita IR 104, 105 Lawless M 36, 45, 90 Hoang C 128 Kalofonos G 79, 123 Lawlor M 115 Hodge C 36, 45, 85, 90, 99, 118 Kanagaratnam A 96 Leamey C 61 Hogarty D 46, 103 Kandel H 36 Lee A 51, 130 Hogarty J 103 Kane J 46 Lee BWH 108, 113 Holz F 62, 149 Karki P 162 Lee G 79, 83 Honavar SG 57 Karthik H 108 Lee J 114, 122 Hong LM 128 Kashyap S 128 Lee JH 141 Hong SC 104 Kaur S 139 Lee K 142 Hong T 63, 155, 156, 159 Kaushik M 133 Lee L 81, 144 Hong VP 128 Keay L 71, 107, 112, 156, 158 Lee M 103 Hooshmand J 79, 116 Kendal H 100 Lee S-J 92 Hoque M 96 Kerdraon Y 94 Lee S 114, 141 Hossain RR 163 Kersten H 61 Lee W-S 102 Howes F 28 Khan J 67, 142 Lee WK 149 Hu M 54, 113, 154 Khan M 47, 69 Legg K 90 Huang S 126 Khan MA 107 Lei L 118 Huang X 28 Khanh VPT 128 Leung KFC 97, 98 Hui F 41 Khokhar S 47, 80 Levin L 74 Hull S 161 Khoo P 93, 97, 98, 105 Levitz L 85 Hung S 121 Khoshkhesal M 73 Lewis P 101 Hung Y-C 81 Khou V 107 Li J 146 Hunter D 35, 69, 108 Kilpatrick D 61 Liang H 121 Huynh T 36 Kim DH 35 Liew G 55, 71, 107, 112, 158 Hyer J 52, 130 Kim L 153 Lightman S 65 Im S 114 Kim M 85, 145 Lim C 85 Invernizzi A 63 Kim S 111, 114, 119 Lim J 41 Jaffe G 149 Kleyn D 91 Lim L 41, 48, 142 Jain A 110 Klier S 74 Lim R 28, 30 Jain N 96 Knight L 139 Lin H 150 Jain R 136 Koca D 112 Lin I 161 Jalbert I 112 Koh A 149 Lin P-F 115 Jamieson RV 143, 148 Kojima T 92 Ling D 108 Janda S 68 Kolic M 64 Ling M 99 Jangid K 118 Kong G 28, 121 Lingham G 35 Jarin R 144 Kong GYX 32, 115 Lisa K 154 Jayaballa R 107 Kowal L 159 Litwin A 95 Jhaveri C 62 Krishnan R 110 Liu H 87, 88 Ji MJ 92 Kulasekara S 87 Liu K 38, 124 Jiang I 107 Kumar A 153, 157 Liu L 63, 79, 145 Jiang J 45 Kumar S 53, 126 Liu R 121 Joachim N 55 Kumar V 153 Liu W 138 John W 119 Kupersmith M 74 Lobo A 151 168 AUTHOR INDEX

Lotery A 40 Miller N 74 O'Hare F 154 Lotery AJ 29 Mills R 40, 120 Ojha G 83 Lu P 121 Mishu FA 103, 148 Oliver G 65 Lubrin L 139 Mitchell P 32, 40, 55, 62, 112 Ong E 115, 159 Lucas R 35 Mithal N 92 Ong J 45, 68 LuoK63 Mohamed S 152 Ong K 89, 95, 96 Luu C 151 Monteduro D 63 Ooi K 105 Luu CD 64 Moorthy S 144 Ooi KG-J 97, 98 Luu S 139 Morgan WH 135 Ou K 63 Ma T 40, 117 Moriarty L 95 Ovens C 53 Maberly G 107 Morlet N 68 Padhye B 134 MacGregor S 29, 40, 120, 121 Morris R 80 Pahau D 125 Macken P 67 Morya A 118 Painter G 90 Macken S 67 Morya AK 88, 89 Pandya I 31 Mackey D 29, 35, 40, 120, 121 Mudri J 142 Papali'i‐Curtin A 40 Maguire AM 138 Muecke J 81 Parija S 88, 125, 140 Mahabir M 80 Muecke N 81 Park CK 122 Malhotra R 51, 80, 95, 126, 127 Mullany S 39 Park G-H 111, 119 Manandhar A 162 Mullins P 55 Park Y-H 142 Marinos E 101 Munk M 63 Patanjali N 53 Markan A 157 Murrell DF 113 Patel D 48, 97 Marks S 32 Murta F 52, 130 Patel H 70 Marshall H 31 Nagata T 92 Pathmaraj R 118 Martin F 72 Nagendra A 146 Patwardhan A 140 Mashayekhi A 48 Nahrawy ME 78 Paudyal G 158 Mathan J 97 Naidu A 88, 89 Paul R 155 Matheos K 117 Naidu AD 118 Peng S 28 Mathew A 73, 78 Nanayakkara U 112 Perera C 142 Mc MBGuinness 64 Nankervis A 142 Peter J 129 McAllister I 149 Napitupulu AS 138 Petoe MA 64 McCall D 90 Nasimee Q 101 Petsoglou C 96, 99 McClements ME 54, 113 Natarajan S 110 Phan L 156 McCluskey P 65, 156, 163 navon S 92 Plager DA 57 McGhee C 48, 97 Nayagam D 151 Polkinghorne B 106 McGilligan JA 131 Nayagam DA 64 Poon A 84 McGowan C 151 Neiderer R 70 Powys M 134 McGuinness M 46, 109 Ng D 45 Prakash S 88, 89, 118 McGuinness MB 112 Ngo E 123 Pramono HK 138 McIntyre S 90 Nguyen A 68, 111 Prea S 32 McKelvie J 45, 48, 106 Nguyen C 41 Protti D 61 McKenzie J 78 Nguyen P 28 Pryke A 107 McKnight C 35 Nguyen PV 143 Pushker N 128, 129 McLintock C 45, 48 Nguyen T 31, 120 Qassim A 29, 31, 40, 120 McMahon M 73 Nguyen V 36, 62, 63, 69, 100, 150, Quartilo A 115 McNamara P 102, 114, 145 154, 163 Quinn A 140 Meel R 128, 129 Niederer R 38, 52, 65, 117, 124, Radjenovic M 113 Mehta H 154 162, 164 Rahmawati E 71 Meng Y 137 Niederer RL 163 Raja V 80 Menghini M 152 Nouby G 152 Rajak S 131 Meusemann R 84, 86, 102 Nurliza K 72 Rajarathnam R 82 Meyer HD 162 O'Connor M 53 Raman P 82 Meyer J 68, 97 Ogura Y 149 Rapata M 48 Meyerowitz-Katz G 107 Oh J-H 156 Raut A53 AUTHOR INDEX 169

Ravi S 107 Sheridan A 46 Sutton G 36, 37, 45, 96, 99 Reape KZ 138 Sheth S 73, 75, 110, 123, 124 Symes R 65 Regillo C 149 Shi M 107 Symons A 142 Rehak M 64 Shields C 48 Taher A 134 Ren L 161 Shivadevappa LC 125 Tan J 100, 139, 145 Richards J 67, 68 Shroff P 151 Tan JCK 113 Ridge B 31, 120 Shub A 142 Tan K 139 Robaei DS 108 Shukla A 83, 84, 143 Tan Y 146 Roberts T 45, 90 Sia P 131 Tan Z 39 Robinson L 81 Siah WF 95 Tang D 55 Rocke J 46 Siggs O 29, 40, 120 Tang J 140 Rodriguez P 64 Silverman D 150 Tanzer D 149 Rogers S 41, 142 Simkin S 39, 97 Taranath D 139 Rogye A 110 Sims J 65, 117, 162, 164 Tat L 113 Rose G 52, 161 Simsek C 92 Tauber J 91 Rose L 135 Simunovic M 61, 144, 155 Taylor A 99 Rothschild M 91 Singer S 106 Teo K 62 Rothschild P 95, 116 Singh BK 37, 143 Teresa M 119 Roufail E 46 Singh BK 83, 84 Thangaraj S 78 Rowland C 79, 81, 144 Singh HV 104, 105 Thapa R 158 Roy K 140 Singh K 37, 84, 143 Thiel C 91 Ruddle J 29, 120, 154 Singh R 62 Thomas P 91 Ruiz CQ 150 Singh SP 37, 143 Thomson D 156 Russell D 46 Singh SP 83, 84 Thu HNT 128 Russell H 134 Singh V 37, 83, 84, 143 Tien DR 160 Russell S 138 Sitaula RK 162 Ting CFT 87, 88 Sadeghi S 147 Sitorus RS 138 Titchener SA 64 Saks D 119 Skalicky S 28 Toalster N 122 Samarawickrama C 35, 37, 47, 69, Smallwood R 154 Toh T 116 94, 108 Smith J 65 Tomkins‐Netzer O 65 Sammel A 163 Soares B 78, 140 Tong J 74 Sampson D 152 Solanki K 118 Too LK 61 Sandhu S 144 Solomon S 129 Trang E 121 Sandu S 41 Somrajan B 31 Treloggen J 99 Sarossy M 54 Song E 152 Tripathi M 80, 157 Sarvanan V 80 Song J 115 Trong VP 128 Scheetz J 109, 112 Song Y 37 Trong VP 128 Scheidl S 150 Souied E 149 Tsaketas O 54 Schlosberg D 89 South J 136 Tsubota K 92 Schmiedel O 55 Souzeau E 29, 31, 39, 40, 120 Tumuluri K 37, 133 Schrader S 63 Spooner K 63, 155, 156, 159 Turner A 68, 103, 109, 111, 121 Schulz A 74, 119, 120, 135 Squirrel D 62 Turuwhenua J 136 Scott D 48 Squirrell D 55, 61, 147, 150, 152 Ullrich K 51, 80, 95, 126, 127 Selva D 37, 52, 131 Stamatelatos G 45 Upadhyay MP 162 Sen S 31, 128, 140 Stancliffe R 91 Vaclavik V 105 Senthil MP 29 Starte J 134 Vaghefi E 55, 61, 147, 152 Seth A 136 Staurenghi G 63 Vaibhav S 68 Sethi M 136 Steinbach I 91 Vallabh NA 29 Shah P 72 Stewart P 101 Van ABT 128 Shaikh N 153 Sukumaran S 72 van Wijngaarden P 41 Sharma A 83, 157 Sullivan T 51, 130, 133 Vaze A 63 Shen W 61 SunM52 Venkatapathy N 72 Sherafat H 131 Suo M 67 Venkatesh K 146 170 AUTHOR INDEX

Venkatesh P 81 Weerasinghe L 107 Yap A 164 Venkatesh S 82 Wells A 70 Yates W 133, 156 Verity D 161 Wells K 75, 110, 123, 124 Yazar S 35 Verma N 108, 114 Wen L 96 Ye Y 28 Versace P 36, 82 Were M 90 Yeoh J 46, 64 Vieira B 65 White A 28, 30, 32, 71, 107, 156, 158 Yip H 84, 86 Vincent A 29, 40 Wickremasinghe S 41 Yong K 133 Vingrys A 32 Widyaputri F 142 You J 37, 96, 99 Vittorino M 106 Wiggs J 40 Younan C 65 Vo ML 35 Wijesinghe N 72 Young KA 64 Vohra R 153 Wilcsek G 139 Young S 62, 69, 150 Voon SM 104 Wilde C 131 Yu H 139 Vote B 116 Wilkinson B 106 Yu Z-F 138 Vu KV 55 Williams C 151 Yulia DE 138 Vu L 124 Willoughby C 40 Zada M 148 Vu U 118 Willoughby CE 29 Zagora S 65, 79 Wahamu W 100 Wilson‐Pogmore A 72, 87, 108 Zagora SSL 163 Waldie A 163 Wong B 74 Zalmay P 154 Walker JG 64 Wong TY 150 Zangerl B 107 Wallace G 99 Wood J 52 Zhang C 138 Walland M 120 Woods L 40 Zhang J 48 Wang J-H 113 Wykoff C 62 Zhang M 94 Wang J 54 Xiao L 39 Zhao J 28 Wang P 70 Xie L 152 Zhong H 133 Wang S-W 161 Xiong J 97, 98, 163 Zhou L 137 Ward B 46 Xu E 85 Zhu M 96, 99 Watson C 113 Xue K 113 ZhuT28 Watson MJG 135 Yang S 160 Zur D 64 Watson S 36, 93, 94, 96, 98, 100, 101 Yang V 134 Watson SL 97, 98 Yao A 87, 88