The Official Congress News of APAO 2021 ISSUE1

09 | 06 | 21 VIRTUAL CONGRESS by &

HIGHLIGHTS

Innovations in cataract 06 surgery are coming to Asia! APAO 2021 Anti-VEGFs and wide-field 08 OCTA dominate updates in DR treatment and Opening Day imaging. Highlights We are still in a COVID-19 09 era ... new approaches in patient management Named Lecture come in handy... Awards by Tan Sher Lynn Published by

Matt Young CEO & Publisher Hannah Nguyen COO & CFO he award lectures are a major highlight the demand for services required for the of the 36th Asia-Pacific Academy of management of ROP,” he said. Robert Anderson Media Director TOphthalmology Virtual Congress (APAO 2021). Below, we delve into the presentations With the results of the study, Prof. Azad and his Gloria D. Gamat Chief Editor from those experts recognized for their vast team tried to establish the guidelines for ROP contributions toward ophthalmic advances in screening in APAC, based on criteria such as Brooke Herron Editor the Asia-Pacific (APAC) region. existing healthcare, geographical location and accessibility to care, awareness, and clinical Brandon Winkeler International Business picture. Development Jose Rizal Medal Award Lecture: He noted the challenges that exist in the Writers Challenges and Opportunities in Andrew Sweeney region. These include barriers to effective Elisa DeMartino Scaling ROP Services in the Asia- screening, early detection and treatment; Hazlin Hassan Pacific Region awareness among parents, neonatologists and Jillian Webster Joanna Lee ophthalmologists; and lack of trained manpower Sam McCommon In this lecture, Prof. Rajvardhan Azad from to tackle the disease. “Our study showed that Tan Sher Lynn India talked about the Asia Retinopathy of the lack of screening underlines most stage 5 Maricel Salvador Prematurity (ROP) study, participated by nine retinopathy cases in a large tertiary care center Graphic Designer countries: Bangladesh, China, India, Indonesia, in India. Among 354 infants, 115 are in stage Mongolia, the Philippines, Taiwan, Thailand 5. The mean principal component analysis and Vietnam. (PCA) at first visit is 54.6 weeks and the mean Media MICE Pte. Ltd. 6001 Beach Road, #19-06 delay is 24.7 weeks. A common risk factor is Golden Mile Tower, Singapore 199589 According to him, good human resources can oxygen therapy (103 babies; 89.6%), and 109 Tel. Nos.: +65 8186 7677 | +1 302 261 5379 Email: [email protected] be found in China, Thailand and India, with babies were never screened (89.8%). mediaMICE.com the number of doctors who can screen for piemagazine.org ROP being 200, 900 and 200, respectively. “Another challenge is the understanding of cakemagazine.org “Nonetheless, this is not enough to meet the disease among ophthalmologists. Even cookiemagazine.org 2 06 September 2021 | Issue #1

though 86% of babies were referred by performed studies on the risks for a study and found that intravitreal ophthalmologists, the correct diagnosis ROP, wrote editorials in journals, bevacizumab (IVB) monotherapy, as is only 4.3%,” he said. provided training for ROP screening and compared with conventional laser treatment, and held conferences with therapy, showed significant benefits for “ROP screening is an essential part of neonatal intensive care units (NICU). infants with zone I ROP. However, no modern neonatal care. The mean period Three ROP incidence studies in Beijing statistical differences were found for to develop treatable ROP is variable were done in 1993, 2002 and 2005, zone II lesions. Unfavorable outcomes across the world and APAC region. respectively, showing a decrease from (progressing into stages 4 and 5) is Screening guidelines vary from country 20.3% (1993) to 17.3% (2002) and 18.5% for the laser group, and 3.7% for to country, and developing countries 10.8% (2005). the IVB group. do not recommend screening of larger babies. Current international screening “With the guideline for ROP screening It was also found that fibrosis occurred guidelines need to be modified according in 2004, oxygen concentration control in the eye just one week after the to local scenarios. For a more focused has been improved, but just in big administration of anti-VEGF. Hence, approach to ROP care, we need to have hospitals. Birth weight remained at Prof. Li and her team did a study on training and manpower, education and 1000-1500g. We realized that there the relationship between anti-VEGF awareness, advocacy, documentation had been an unbalanced improvement and fibrosis cells in order to obtain on pediatric fundus cameras, and of NICU in China. So, we requested the a better understanding of it. Based accessibility for ROP regression,” he Ministry of Health hold a meeting with on the studies, they are currently stressed. the NICU experts for discussion and then developing an expert consensus for ROP generated new guidelines separately,” treatment, which includes terminology, she said. indication for single treatment of Holmes Lecture: Prospective anti-VEGF, indication for combination on ROP Care in China The new ROP screening guidelines treatment with laser, indication for iris in 2014 included maintaining the neovascularization, and para-intravitreal Prof. Xiaoxin Li from the People Eye screening criteria of 2004, with initial injection systemic care. Center of Peking University People’s exams starting from 4-6 weeks after Hospital in China, noted that the birth (gestational age 31-32 weeks). incidence of ROP increased in China Intervention criteria includes threshold ICO Mark Tso Golden Apple after 1990 because at that time neonatal lesion or pre-threshold lesion of Type Award Lecture: Treatment of awareness was expanding and improving. 1, within 72 hours. The guidelines also The use of unmonitored supplemental included follow-up intervals and criteria Intra-Ocular Tumor with Local oxygen was common and some babies for stopping follow-up. Resection Combined with received oxygen unnecessarily. Vitreo-Retinal Surgery To evaluate whether laser or anti-VEGF To promote ROP prevention, Prof Li is better at treating ROP, Prof. Li did Prof. Wenbin Wei from the Beijing Tongren Eye Center, Capital Medical University, China, said that local resection is effective for the treatment of intraocular tumors as it reduces the rate of enucleation. However, experienced surgical skill and good psychological endurance is required.

He presented a few cases of local resection combined with vitreoretinal surgery and said that before the surgery, the surgeon should evaluate the patient’s ocular condition and conduct an individualized surgery design. “One must also be aware of the complications that can happen during surgery, such as bleeding, extremely low IOP and suprachoroidal hemorrhage; as well as post-surgery, such as retinal detachment, proliferative vitreoretinopathy, tumor recurrence and metastasis.

“In general, the prognosis for this treatment is good. Basic vision is preserved, the patient retains normal appearance and has good living quality, as well as stable long-term outcomes,” he concluded. The Official Congress News of APAO 2021 3

>> Cont. from Page 1 4 06 September 2021 | Issue #1

Going Above & Beyond Next Generation Phaco with the VERITAS™ Vision System by Elisa DeMartino

cutting-edge phacoemulsification phacoemulsification systems, Dr. Schwam level of physical ability and stay on top device was rolled out by Johnson and his cohorts at Johnson & Johnson of their nutrition and physical health to A & Johnson Vision (Santa Ana, know that safety and stability remain be at their best. And sometimes, both California, USA) just this summer — a challenging priority. That’s why the end up sacrificing their bodies for their and what better time to present it to R&D team “emphasized ergonomics and professions.” However, this doesn’t Asia’s eye surgeons than the first day human factors” during development. have to be the case for the modern of the 36th Asia-Pacific Academy of The device focuses on surgeon comfort ophthalmologist. Virtual Congress (APAO and well-being, ensuring comfort and 2021)? avoiding muscular strain. Oftentimes people forget the ergonomic sacrifices surgeons make for their With the company’s Whitestar Part of this is accomplished by an patients. Those people might also Signature® Pro released only a few industry-first lightweight swivel hand- be the ones designing products for short years ago, practitioners may find piece, accompanying foot pedal with surgeons! Ergonomics play a vital themselves wondering what makes their programmable top and side switches, role in a surgeon’s well-being — and, newest VERITAS™Vision System so Advanced Tubing System (ATS), and consequently, in a patient’s. innovative. To address that question, surge-minimizing technology. These are this industry-sponsored session featured all new features in comparison to the If you perform lots of procedures in a Dr. Brian Schwam, senior director of company’s previous comparable device. dedicated time block and experience Medical Affairs at Johnson & Johnson Naturally, the company carried over its musculoskeletal pain, you aren’t alone. Surgical Vision (JJSV), and Mr. Adam leading WHITESTAR technology for ultra- Seventeen percent of surgeons report Toner, senior R&D manager for System smooth cutting, even in dense cataracts. hand or wrist pain, 52-80% report back Integrations at JJSV, along with two or neck pain, and 15% report being ophthalmic surgeons who have already limited in their work due to pain. tested out the product. What do surgeons and professional athletes have in In the case of phacoemulsification systems for cataract surgery, the hand “Your surgical day just got common? piece and foot pedals should require only easier” Mr. Adam Toner posed the question minimal movement; meanwhile, audible during his panel — and he didn’t leave cues or tones are needed to manipulate Despite the overall success of us to wonder. “Both need to maintain a the tools, because a surgeon can’t be The Official Congress News of APAO 2021 5

watching the screen while they operate. With the lightweight swivel handpiece, The Hybrid fluidics technology removes he can find the correct position for his surge, too. Meanwhile the elliptical The VERITAS™ system, Mr. Toner hands. Plus, Dr. Tavolato recalled, the ultrasound and WHITESTAR micropulse asserts, boasts all of these features, first handpiece for such equipment technology give it exceptional efficiency. complete with an 18-inch touch screen was 2.5 kilograms. “I don’t know how “This thing can go through any density monitor that has 15-degree up and down we did that!” It’s easy for him to laugh lens, and that’s the beauty of it,” Dr. tilt and 40-degree side-to-side rotation. about the old days when he has the most Dewey chimed. comfortable tool at hand (literally) now! “Veritas maximizes comfort and reduces He demonstrated a recording showing fatigue, so surgeons feel a noticeable But the biggest difference for him, precise peristaltic efficiency with difference,” he said. he said, is actually in the new tubing hardware control during surgery. system. He found it less pliable to work On screen next to the show was an with, and more stable. “We also have aspiration graph and foot pedal graph. The verity in VERITAS™ a pressurized infusion technology that As the machine applied higher levels of gives us more stability of the anterior vacuum and higher levels of aspiration, Dr. Marco Tavolato, head of the Eye chamber. But the big advance is given major chamber stability was evident. Centre at Chioggia Hospital (Italy), takes by the new tubing system,” Dr. Tavolato pride in his expertise using the various explained. Dr. Dewey has worked with WHITESTAR phaco machines in today’s market. In Signature Pro for the past six years. fact, he frequently — sometimes daily — While the chamber stability was good, switches between devices in order to, as It’s like riding first class with the VERITAS™ he can run 50 he puts it, “stay in alert mode.” ccs of aspiration, or a vacuum of 600 Dr. Steven Dewey, eye surgeon at the mmHg, which he wasn’t able to do This cataract refractive and vitreoretinal Colorado Springs Eye Clinic and creator previously. Moreover, with the VERITAS™ surgeon agrees that during phaco of the Dewey Radius Tip, chimed in on he doesn’t see any chamber bounce surgery, one of his bigger issues is that the Advanced Tubing System with Hybrid whatsoever. of ergonomics. “I, by myself, perform fluidics technology, which he asserted 30 cataract surgeries every day. The delivered exceptional chamber stability The biggest benefit is the effectiveness position for the surgeon is not so good ... through a combination of ATS, dual of the machine, he pointed out, because the surgeon has to stop many times,” he pump and advanced infusion. “There’s after all, the less time you spend in the explained during his panel. “It’s a very less fluid volume so you can control the operating room — the less chance of an short surgery, but you have to stay in a anterior chamber much more precisely adverse incident. very strict position.” than you could before.”

The secret to ergonomics: “Are you going to sit in the back of an old SUV on a cross country trip or are you going to ride first class?” — Dr. Steven Dewey 6 06 September 2021 | Issue #1

Innovative Cataract Technologies and

ursting with new tips on Techniques things like lenses to Bsurgical techniques, any ophthalmologist who manages cataract patients will find these items to be essential knowledge in the quest for better vision and patient satisfaction. by Joanna Lee

Advances in capsulotomy

devices have been innovations in monofocal category a bit of a competition, but In Capsulotomy — Where Are We and presbyopia-correcting lenses, with are still inferior although they have Now?, Prof. Dr. H. Burkhard Dick from toric options now available and with advantages in the dysphotopsia profile University Eye Hospital in Bochum, hybrids of both categories in sight. (like monofocal IOLs). New EDOF Germany, asked if continuous circular He cited a few new innovations in lenses like Alcon’s AcrySof IQ Vivity capsulorhexis (CCC) could be the the market including the Clareon IOL attempt to reduce side effects of distal evolutionary endpoint in capsular (Alcon, Geneva, Switzerland), which focus, while hybrid optical technology opening techniques? He discussed boasts one of the lowest levels of combining EDOF/multifocal diffractive three types of capsulotomy (CT) surface glistenings and haze. Other pattern like Johnson & Johnson’s devices: the Precision Pulse CT (Zepto, innovations include the Tecnis Toric Tecnis Synergy gives strong near vision Minnesota, USA), CAPSULaser (Beye, II IOL (Johnson & Johnson Vision, performance and optimized vision in Pennsylvania, USA) and femtosecond Florida, USA) which was developed low light conditions. Hybrid EDOFs like laser CT, but focused attention on the to improve the rotational stability Belgium-based Physiol’s FineVision advantages of femtosecond laser CT. of its first generation toric IOL lens Triumf, without lateral chromatic “It’s effective on white intumescent using frosted and squared haptics aberration (LCA), improves night vision cataracts and outstanding for pediatric for increased friction in the capsular and reduces dysphotopsia. cataracts, and has perfect capsulotomy bag. He also discussed the TECNIS quality,” he said, adding it has already Eyhance IOL, AcrySof and Vivity had an impact on femto-IOLs. (all from Alcon) and the ISOPURE Premium IOLs (and other (BVI Medical, Massachusetts, USA). technologies) are coming to This CT could also be used for While this is still a field in constant biomorphometric alignment for toric development, he said: “There is still a Asia IOLs where toric IOLs are centered limitation in terms of optical properties The light adjustable (LAL) IOL by according to capsule marks. “The wherein a delicate balance is reached RxSight (California, USA) allows primary posterior laser-assisted between quantity and quality of surgeons to change the shape of the capsulotomy is safe with no single PCO vision.” lens postoperatively using specific over the years of follow up. It is easy patterns of UV light. It is not available to include at the end of the procedure. Continuing the train of thought on yet in Asia, but it is still exciting to You don’t need manual capabilities lenses, Prof. Dr. Gerd Auffarth, from hear about its potential — especially in and can keep the anterior hyaloid Heidelberg University Hospital, removing barriers to greater adoption membrane intact,” he said. Germany, shared on what’s new with of premium refractive IOLs. Dr. David extended depth of focus (EDOF) Chang expounded on the advantages of and multifocal IOLs, zeroing in on the LAL IOL which includes the ability IOLs lead the way monofocal+ IOLs, EDOFs and trifocal to achieve LASIK-like outcomes and (hybrid) lenses. He said the new having no side effects from diffractive Dr. Robert Ang, from the Asian Eye next-generation type of enhanced IOLs. There’s no need for UV glasses Institute in the Philippines, said there monofocal+ lens may give the EDOF and they’re able to preview mini- The Official Congress News of APAO 2021 7

monovision and bilateral visual acuity. cornea and allows the passage of “double flanged polypropylene He also discussed refractive counseling, central and paracentral rays that technique” by sharing 10 surgical tips. why he might choose trifocal lenses enhance visual acuity and image His innovative technique first debuted versus LAL mini-mono’s depending on quality. Second, the Stiles-Crawford in 2017 when he won an award for the patients’ personalities. For his practice, effect is a phenomenon when light double flanged haptic and capsular they offer LAL as a bilateral same day entering the eye near the edge of the tension ring or segment for sutureless surgery. pupil produces lower photoreceptor fixation in zonular instability. In 2018, response compared to light of equal he introduced the double flanged Another interesting development came intensity entering near the center of transscleral bag fixation method. It was from India in the form of pinhole the pupil, while vignetting was another only in 2019/2020 that the double pupilloplasty (PPP), “a technology principle. “The principles of small flanged prolene Canabrava technique without cost.” aperture optics have been placed at became more widely used. Showing the level of the cornea and at the the ropes with the suturing, his tips “For achieving the pinhole effect, level of the lens to correct presbyopia covered the basics like the materials pupilloplasty is a cost-effective and by enhancing the depth of focus,” needed, polypropylene testing, and efficient method and has no specially Dr. Agarwal explained. Using these marking 2mm from the limbal. He also designed devices needed,” Dr. Amar principles, they created this surgical emphasized the importance of creating Agarwal said. This method of making technique which was demonstrated a long scleral tunnel and the need to the pupils less than 1.5 mm is effective during this session while also push the prolene into the eye when for corneal astigmatism and high discussing its limitations. removing it with the needle. One must astigmatism that occur due to radial also hold the base of the polypropylene keratotomy, penetrating keratoplasty, with some tension, and thereafter, cut corneal injuries, and intracorneal ring The double flanged prolene 1.2 mm or 1.5 mm and dry the prolene. segments or keratocones. The pinhole Canabrava technique His other tips were to use a small pupilloplasty operates on several flange, the need to bury the flange and principles: First, the pinhole blocks Capping the session was Dr. Sergio to be careful when piercing the IOL. light emanating from the peripheral Canabrava who demonstrated his 8 06 September 2021 | Issue #1

PDR or center-involving diabetic macular edema (CI-DME) with vision loss. “Results show that among eyes with Treatment and moderate to severe NPDR, the proportion that developed PDR or CI-DME was lower with periodic aflibercept treatment Imaging compared with sham through at least by Tan Sher Lynn 2 years. However, through 2 years, preventative treatment with aflibercept did not confer visual acuity (VA) benefits compared with anti-VEGF initiated after PDR or DME development. Four-year results will be important for determining whether preventing PDR and CI-DME improves long-term VA benefit,” he said.

Potential of wide-field OCTA

According to Dr. Gavin Tan from the Singapore National Eye Centre (SNEC), OCTA is a non-invasive technique for the visualization of retinal microvasculature. “It can be used to quantify retinal capillary microvasculature in diabetes, Experts discussed the use of anti- changes in RNP within the macular microvascular and macrovascular VEGF and wide-field optical coherence region,” he said. complications, and potentially its tomographic angiography (OCTA) in outcomes,” he said. diabetic retinopathy (DR) on the first Meanwhile, Dr. Michael Ip from the day of the 36th Asia-Pacific Academy of University of California, USA, shared “We now have newly available wide-field Ophthalmology Virtual Congress (APAO about updates of DRCR Retina Networks’ OCTA that provides more information. 2021). Protocol W, which investigates the use of The extended field imaging (EFI) swept- intravitreal aflibercept for the prevention source (SS)-OCTA could image additional of vision-threatening complications of areas of non-perfusion as well as fundus Anti-VEGF therapy DR. fluorescein angiography (FFA).”

Dr. Srinivas Sadda from the Doheny Eye The DRCR Retina Network was formed Limitations to this technology include Institute, USA, talked about anti-VEGF in 2002 and funded by the National variable reproducibility and repeatability, therapy and retinal non-perfusion (RNP), Institutes of Health (USA). It currently poor inter-machine comparability of as investigated in the RECOVERY Study. includes over 160 participating sites quantitative metrics, image artifacts with over 500 physicians throughout that can lead to inaccurate image “Anti-VEGF therapy has been suggested the U.S. and Canada, and has been interpretation, and poor vision associated to slow RNP progression but does it responsible for landmark clinical trials, with poor image quality. reverse it?” he asked. including Protocols I, T and S. Nevertheless, he noted that wide-field He shared that the Phase 2 RECOVERY “Anti-VEGF treatment can improve DR, OCTA can replace FFA in evaluating trial shows that at the primary 1-year but can it prevent vision-threatening diabetic macular ischemia and endpoint, in eyes with proliferative complications in high-risk eyes, and peripheral retinal perfusion, as well as diabetic retinopathy (PDR) without if so, is there any benefit (2 and 4 identifying neovascularization. Changes diabetic macular edema (DME), monthly years) associated with preventing these on wide-field OCTA also correlates well administration of aflibercept 2mg was complications?” he asked. with DR severity and other microvascular associated with less RNP progression complications. compared with quarterly treatment. Protocol W is a randomized multicenter clinical trial across 64 sites involving “OCTA in diabetic retinopathy may “Overall, non-perfusion progresses patients who are 18-years-old and older have prognostic significance for DR despite apparent improvement in with type 1 or 2 diabetes and severe progression and the development of diabetic retinopathy severity scale non-proliferative diabetic retinopathy DME. The role of wide-field OCTA (DRSS) score. Despite overall progression (NPDR) in at least one eye. Three remains to be determined. In this aspect, of RNP, some zones of apparent hundred and ninety-nine eyes were much more research and longitudinal reperfusion were noted both on ultra- randomized to receive 2 mg intravitreal prospective studies are required before widefield (UWF) fluorescein angiography aflibercept versus sham injection. these biomarkers will become the (FA) as well as OCTA. OCTA was limited The primary outcome investigates the standard of care,” he commented. to the macula and did not identify cumulative probability of developing The Official Congress News of APAO 2021 9

education and popularization, and AI applications. Prof. Dr. Haotian Lin said the “ZOC Internet Hospital” concept implemented at the Zhongshan Ophthalmic Center of the Sun Yat-sen University suspended patient visits but allowed emergency cases to be admitted. The internet hospital involved AI pre- screening using a medical chatbot, virtual live consultation, and an online pharmacy. They found that patients had three major demands: new symptom complaints (mostly young patients), chronic disease management, and prescription renewals (mostly elderly patients). Their AI consultation recorded three times more night time “visits” than at daytime and four times of face-to- face clinic consultations. Primary health institutions should also be included in the loop. Future explorations include seeing first-visit patients online, fully New Approaches to securing operation supervision and internet security, and turning short-term services into long-term solutions as the Patient Management in pandemic continues.

In discussing how to manage AMD the Era of COVID-19 better during a pandemic, Dr. Raymond by Joanna Lee Wong, from the Chinese University of Hong Kong, reminded attendees that administering anti-VEGF injections at ocial distancing, constant vigilance which saw video consultations for appropriate intervals is crucial to prevent in personal hygiene and avoiding emergency teleophthalmology care progression and improve vision in wet Sclose contact have certainly created and , like providing drops AMD patients. Delays or discontinuation unprecedented challenges for patient through mail with scheduled follow-ups. of treatment can lead to permanent care. Perspectives from around the world vision loss. Fear and anxiety over might lend a broader understanding of contracting the virus during clinical how ophthalmologists are facing the Telemedicine and home visits, especially among the elderly challenges of providing quality eye care monitoring patients, is something that eye care and managing patients’ needs. professionals should be aware of, Dr. Photography of patients’ eyes with Wong said, in order to better tailor their clipped-on lenses on their phones approaches. Some measures proposed Virtual triage finds its footing enabled second opinions for senior include counseling over phone or during opinions to be monitored remotely. A slit clinical visits, and stricter measures The “power of virtual triage” seems lamp adapter, smartphone and secure implemented surrounding health facility to be the way to go at Moorfields Eye cloud-based video conferencing software visits. For telemedicine, smartphone Hospital in the United Kingdom. Dr. has enabled second opinion services as images could aid Dawn Sim, consultant ophthalmologist, well. Dr. Sim also cited the example of in the monitoring or detection of AMD, director of telemedicine and associate the drive-through IOP clinics in Belfast, as well as the use of digital monitoring professor at the UCL Institute of Ireland. Telemedicine has also seen devices such as ForeseeHome (Notal Ophthalmology, shared how the hospital success in the area of periocular lesion Vision, Virginia, USA), myVisionTrack is using “forward triage” to improve assessment, in oculoplastic and adnexal (Vital Art and Science Inc., Texas, USA) access to care. This method hinges on surgery. She also spoke about remote and Alleye. good risk stratification based on a clear monitoring and self-care via apps like the minimum dataset. For ophthalmology, Alleye (Oculocare, Zurich, Switzerland) they included elements of clinical home vision test. Home monitoring during history, objective measurements (like COVID-19 visual acuity, intraocular pressure), In Guangzhou, the “internet hospital” and imaging (photographs, OCT, visual has created an important role for Dr. Kelvin Teo from the Singapore Eye field) to determine the criteria. One of ophthalmic patients in China, covering Research Institute (SERI) shared the their most successful endeavours during areas like medical treatment, public Singaporean perspective on a study of the pandemic was their asynchronous health, family doctors, drug supply, home-monitoring risky group patients and synchronous telemedicine efforts medical insurance settlement, medical for acute vision loss during the first 10 06 September 2021 | Issue #1

COVID-19 lockdown period in April (like visual field) and structural testing detectable SARS-CoV-2 RNA in ocular 2020. They used Alleye with backend (OCT). The options for tele-glaucoma secretions. support provided by the Singapore visits include treatment compliance National Eye Center (SNEC) Ocular checks, like using the phone or mobile The study covered how centers from Reading Center (SORC). When an alert apps. Home tonometers are not easy about 50 countries around the world was triggered, personnel from SORC to distribute and are also expensive. protected their ophthalmologists and arranged access to SNEC retinal clinics. Another challenge for glaucoma care patients, and the digital health solutions Their study observed that younger telemedicine is the difficulty in obtaining they used. “We saw there was a general patients living with family who have IOP measurements and other testing. In de-escalation of measures in 2021, poor vision with one eye with longer the future, Dr. Friedman said we could particularly in PPE requirements, deferment, who receive active treatment consider methods like drive-by fundus and many centers have ceased and have a diagnosis of AMD, were more photography. “Telemedical and in-person routine temperature monitoring for likely to sign up for the service. Knowing care for different patient groups are ophthalmologists and patients,” he said. about the profile of the groups less likely both needed along with a care-delivery However, certain measures remained to sign up would allow them to use better model based both on disease and patient universal like the masks and use of slit- strategies to target them in the future. factors,” he said. However, he cautioned lamp shields. The study’s result also suggested the that we have to be mindful of potential monitoring program was sensitive enough exacerbation of disparities. Beyond 2021, Dr. Tan said significant to detect changes before a significant challenges are ahead with resurgent drop in vision. To capture a worldwide view of how infection waves, unequal access to ophthalmology has been practiced vaccines, and emergent new variants. In Glaucoma Management in COVID-19, during the pandemic, Dr. Tan Tien-En “But we believe it is still possible to Dr. David Friedman from Massachusetts shared findings from his studyGlobal provide high quality ophthalmic care Eye and Ear’s Glaucoma Center of Ophthalmology Practice Patterns in while safely mitigating risks related to Excellence, part of the Harvard Medical COVID-19: What Has Changed in 2021? COVID-19,” he said. “We feel the best Teaching Hospital, shared about the The study, an update from its 2020 way to do this is to greater international American experience in telemedicine for version, spanned from mid-2020 to collaboration, sharing of best practices glaucoma care. For monitoring glaucoma May 2021, tracing the development of between institutes, as well as continued patients, the key data necessary are COVID-19 discoveries, especially related innovation primarily in the digital health visual acuity, eye pressure, functional to the eye (like conjunctivitis) and sphere.”

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