Improving the paediatric eye examination can be achieved with several small steps, according to Mr Jeff Locke, a past co-president of the Canadian Orthoptic Society. Mr Locke is an orthoptist/instructor and team lead in the visual electrophysiology lab at IWK Health in Halifax, Nova Scotia, Canada.

“We can streamline things and make the examination 1% better by being more competent in assessing visual acuity, checking for binocular single vision, and knowing what visual electrophysiology can do in this age group,” he said.

For vision to be normal, stimuli need to get through our optics to the retina, for the retina to relay to the optic nerve and for the optic nerve to relay to the cortex. “Acuity can be based on what aspects of the pathway are stimulated,” Mr Locke explained.

To benchmark 20/20 vision in an infant, the testing types and acuity being measured need to be altered. “We need to shift to more detection-based acuity versus recognition,” he said. In pre-verbal children, forced-choice preferential looking (FPL) tests such as Cardiff and Teller are not the most accurate in detecting and managing amblyopia, he pointed out. He noted that it is easy to become complacent with FPL tests and stop documenting those earlier learned tests.

As a child reaches more visual milestones as they age from newborn to 1 year, the physician can perform more complex testing. “It does not mean that those tests administered during earlier milestones [when a child was younger] are no longer useful,” he explained. “They can add great qualitative aspects to your vision examination.”

Indeed, vision testing in infants needs to have qualitative more than quantitative assessments, Mr Locke explained. A quantitative test such as the FPL test serves as a benchmark for normal vision in infants and provides a value over time, he noted. That said, qualitative tests are quick to perform and can aid in detecting asymmetry in vision, he added.

In terms of vision assessment tests, Mr Locke pointed to research which concluded that optokinetic nystagmus induction methods have been found to be suboptimal in determining visual acuity thresholds. He noted, however, that they can be a great qualitative indicator of the visual pathway since intact pursuit and saccadic centres are needed, as is normal cranial nerve innervation to the extra-ocular muscles.

Mr Locke pointed out that more recent research

 has suggested a strategy for a paediatric visual acuity examination. “[The study authors] advised for best compliance to start with binocular visual acuity with Cardiff at 50 cm, followed by induced tropia,” he said.

“Once these are successfully completed, you can then try monocular visual acuity at 50 cm with your FPL Cardiff [test]. Their view was that assessing both FPL Cardiff at 50 cm and induced tropia allows for more accurate visual assessment and allows practitioners to obtain more information should they lose cooperation [from the paediatric patient].

An educated assumption is being made based on observational data and detection-based acuity with paediatric examinations, Mr Locke explained. “When trying to make a comparison between detection type of acuities, like with forced-choice preferential looking, we are likely overestimating acuity, and it becomes challenging to detect mild to moderate levels of amblyopia,” he said.

“Each detection type of acuity has shown validity in assessing the paediatric population, but the sensitivity in detecting amblyopia is variable among tests. None appear to be as robust as crowding-based testing.”

The goal needs to be to maximise the visual examination by combining multiple methods of detection-based testing, not only to increase the sensitivity but also to gain more general knowledge of the paediatric patient’s ocular health, Mr Locke said. “Do as much as you can binocularly [assessment] while the child is getting comfortable with you, but at the same time, you are extracting data.”

The eye lane triangle method is demonstrated, including positions for the examiner and patient. (Image courtesy of Mr Jeff Locke)

Mr Locke stressed that the FPL test outcome should not be the only endpoint in a paediatric vision assessment. “Make your exam 1% better by adding a qualitative measurement into the mix,” he said. And for those who do not use the FPL test, Mr Locke advised setting a grading standard across the clinic for fixation testing to help follow amblyopia over time, noting that children do not need to be old enough to respond verbally before binocularity is assessed.

There are, however, some objective methods being employed to provide a sense of binocularity. “We can test motor fusion capability in infants, and newer investigations in the use of the FPL test in stereopsis are emerging,” he said. Detecting stereopsis will help to guide a care plan and add confidence to the visual acuity assessment, Mr Locke noted.

He said that the challenge with visual electrophysiology in paediatrics is that most of the tests require an infant or toddler who is being assessed to cooperate for accurate results to be obtained; this means the tests are not always practical, with the exception of the electroretinogram (ERG), which can be done under sedation.

“The ERG is our bread and butter, but they cannot localise dysfunction specifically to the macula,” he said. Visually evoked potentials (VEPs) offer an objective measurement at the cortex, but anomalies at any level of the optic pathway (optics, macula, optic nerve, optic pathway) can result in VEP pathology, he noted.

Another clinical pearl that Mr Locke offered is that assessors should avoid having their backs turned to their paediatric patients. He suggested placing the computer screen where information is being inputted in such a way as to maintain a line of sight to the child being assessed.

This article is based on a presentation at the virtual 31st annual Jack Crawford Day paediatric ophthalmology update. Mr Locke has no financial disclosures related to this content.

1. Kutschke PJ. Preverbal assessment for amblyopia. Am Orthopt J. 2005;55:53-61.

2. Nanda KD, Blaha B, Churchfield WT, et al. Induced tropia test and visual acuity testing in nonverbal children. J Binocul Vis Ocul Motil. 2018;68:134-136.

Articles

New strategies are considered for obtaining information from visual assessments while ensuring compliance from paediatric patients.

Finding ways to finesse eye examinations in paediatric patients

Extensive preclinical data show that inhibition of the protein angiopoietin-2 (Ang-2) can lead to reduced endothelial barrier breakdown, vascular leakage, inflammatory responses and neovascularisation, as well as increased pericyte coverage.

 An investigational bispecific antibody, faricimab (Roche), works by neutralising Ang-2 and vascular endothelial growth factor A (VEGF-A) via simultaneous and independent binding. This dual approach might offer benefits beyond anti-VEGF monotherapy in the management of chronic retinal disease.

Primary 1-year results from global Phase 3 comparator-controlled trials investigating faricimab in diabetic macular oedema (DMO) and neovascular age-related macular degeneration (nAMD) were presented during Bascom Palmer Eye Institute’s Angiogenesis, Exudation, and Degeneration 2021 Meeting in February and further reviewed in presentations at The Association for Research in Vision and Ophthalmology (ARVO) 2021 Annual Meeting.

The drug candidate demonstrated sustained efficacy and the potential for extended durability, with the majority of participants on treatment intervals of at least every 12 weeks at 1 year (Table 1).

 The studies supporting these findings are discussed as follows.

Data quality and integrity were of acceptable standard for filing despite COVID-19 pandemic.

Abbreviations: BCVA, best corrected visual acuity; DMO, diabetic macular oedema; nAMD, neovascular age-related macular degeneration; PTI, personalised treatment interval; Q12W, every 12 weeks; Q16W, every 16 weeks.

The YOSEMITE and RHINE DMO trials, enrolling 1,891 participants across 353 study sites, met the primary endpoint for vision change from baseline at 1 year. Gains in best-corrected visual acuity (BCVA) from baseline (averaged over Weeks 48, 52 and 56) with faricimab 6 mg, dosed every 8 weeks (Q8W) after four monthly loading doses—or personalised treatment interval (PTI) up to every 16 weeks (Q16W) after six loading doses—were non-inferior to aflibercept (Eylea, Regeneron) 2 mg administered Q8W after five loading doses in patients with DMO.

Although neither faricimab treatment arm demonstrated superiority over aflibercept for vision change, improved anatomic outcomes were observed. Change in central subfield thickness (CST) from baseline consistently favoured faricimab, and more faricimab-treated patients achieved absence of both DMO and intraretinal fluid. Rates of absence of subretinal fluid were high and comparable between faricimab and aflibercept, and the proportion of patients showing improvement in diabetic retinopathy severity was similar across treatments.

Patients in the faricimab PTI arm were treated using a standardised objective regimen based on the treat-and-extend concept, with dosing interval adjusted (4-week increments up to a maximum of 16 weeks) based on treatment response as measured by CST and BCVA. In the faricimab PTI arm, 72% were on quarterly or longer dosing intervals, with 52% on 4-monthly dosing intervals, at Week 52. Across both Phase 3 studies throughout Year 1, faricimab demonstrated non-inferior vision gains, improved anatomic outcomes and the potential for extended dosing using the PTI algorithm.

TENAYA and LUCERNE are global Phase 3 studies evaluating the efficacy and safety of faricimab dosed up to Q16W after four initial monthly doses compared with aflibercept given Q8W after three monthly loading doses in 1,329 treatment-naive patients with choroidal neovascularisation secondary to AMD. The trials are taking place across 271 sites worldwide.

CST values obtained at site will be entered into the interactive voice or web-based response system (IxRS) at Weeks 12, 16, 20 and 24.

Abbreviations: BCVA, best-corrected visual acuity; CST, central subfield thickness; nAMD, neovascular age-related macular degeneration; OCT, optical coherence tomography.

The studies have two treatment arms: faricimab 6 mg given at fixed intervals of every 8, 12 or 16 weeks after four monthly loading doses, based on disease activity assessment (BCVA and CST criteria as well as investigator’s evaluation) at Weeks 20 and 24, and aflibercept 2 mg given at fixed Q8W intervals after three initial monthly doses (Table 2).7 After assignment to the respective treatment interval group, no subsequent interval adjustments nor rescue injections were permitted.

The faricimab treatment protocol was informed by results from the Phase 2 STAIRWAY clinical trial for nAMD, where 65% of faricimab-treated patients had no disease activity 12 weeks after the last loading dose.8 Vision gains were fully maintained up until Week 52 with faricimab dosed up to Q16W and Q12W and were comparable to monthly ranibizumab, suggesting extended disease stability after faricimab treatment.

In TENAYA and LUCERNE, mean gains in BCVA from baseline for faricimab dosed up to Q16W were non-inferior to aflibercept Q8W in patients with nAMD at 1 year, averaged over Weeks 40, 44 and 48: +5.8 letters versus +5.1 letters respectively in TENAYA and +6.6 letters for both treatments in LUCERNE. A comparable proportion of patients gained or maintained vision with faricimab and aflibercept, with meaningful and comparable reductions in CST from baseline until Week 48.

The proportion of faricimab patients on at least Q12W dosing intervals was 79% and the proportion on Q16W dosing intervals was 45% during the first year. The median number of injections was six with faricimab and eight with aflibercept.

Vitreo-retinal specialist Dr Arshad M. Khanani commented: “For me, the biggest unmet need in patients with nAMD is durability. Data from numerous studies reveal that patients with nAMD are not receiving the injections they need in the real world, with undertreatment and inferior vision outcomes compared with clinical trials.”

He added: “Data from the global Phase 3 trials of faricimab in nAMD demonstrate better durability than the current available anti-VEGF agents, with eight out of ten patients achieving sustained vision gains on quarterly or longer treatment intervals and with a well-tolerated safety profile. This is great news for physicians and patients that we may have a more durable option in the future to decrease treatment burden for patients with nAMD.”

Future long-term outcome data, including second-year results from the faricimab Phase 3 programme and the planned 2-year extension studies, will provide additional important insights into better understanding the benefits of dual Ang-2/VEGF inhibition and resulting vascular stability.

1. Regula JT, Lundh von Leithner P, Foxton R, et al. Targeting key angiogenic pathways with a bispecific CrossMAb optimized for neovascular eye diseases. 

2. Joussen AM, Ricci F, Paris LP, et al. Angiopoietin/Tie2 signalling and its role in retinal and choroidal vascular diseases: a review of preclinical data. 

3. Wykoff CC, Abreu F, Basu K, et al. Faricimab in diabetic macular edema (DME): YOSEMITE and RHINE study results. Presentated at: Bascom Palmer Eye Institute Angiogenesis, Exudation, and Degeneration. 12–13 February 2021; virtual.

4. Heier JS, Basu K, Ives J, et al. Faricimab in neovascular age-related macular degeneration: TENAYA and LUCERNE study results. Presentated at: Bascom Palmer Eye Institute Angiogenesis, Exudation, and Degeneration. 12–13 February 2021; virtual.

5. Wells JA, Wykoff CC, Willis JR, et al. Efficacy, durability, and safety of faricimab in diabetic macular edema (DME): one-year results from the phase 3 YOSEMITE and RHINE trials. Presented at: The Association for Research in Vision and Ophthalmology. 1–7 May 2021; virtual.

6. Khanani AM, Heier J, Ruiz CQ, et al. Faricimab in neovascular age-related macular degeneration: 1-year efficacy, safety, and durability in the phase 3 TENAYA and LUCERNE trials. Presented at: The Association for Research in Vision and Ophthalmology. 1–7 May 2021; virtual.

7. Guymer RH, Ruiz CQ, Willis JR, et al. Dual angiopoietin-2 and VEGF-A inhibition with faricimab in neovascular age-related macular degeneration: phase 3 TENAYA and LUCERNE trial design. Presented at: The Association for Research in Vision and Ophthalmology. 1–7 May 2021; virtual.

8. Khanani AM, Patel SS, Ferrone PJ, et al. Efficacy of every four monthly and quarterly dosing of faricimab vs ranibizumab in neovascular age-related macular degeneration: the STAIRWAY phase 2 randomized clinical trial. 

Results from Phase 3 trials of bispecific antibody faricimab demonstrate that it is more durable than currently available agents, and it has a good safety profile. 

Investigative antibody shows sustained efficacy in retinal disease studies

Swinging open its doors to ophthalmologists and industry, the RAI Convention Centre in Amsterdam greeted those who chose to attend the 39th Congress of the European Society of Cataract and Refractive Surgeons in person on 8th to 12th October and the, albeit somewhat scaled down, event did not disappoint. I felt privileged to be amongst those able to attend the hotly anticipated schedule of Symposia, Courses, Papers and Programmes in person; the 38th ESCRS had originally been slated for Amsterdam last year too, before being replaced with a fully virtual format when the coronavirus pandemic continued to cling on.

After two long years of conferences being confined to computer screens, it was a somewhat reassuring experience to witness delegates once again take to podiums, exhibition booths and coffee tables, sit together in the halls and discuss the latest advancements in ophthalmology face to face. And exciting too: the buzz of finally being able to conduct business interactions and share research findings in real life seemed to be putting a spring in everyone’s steps.

Despite attendees being provided with complimentary ESCRS-branded face masks when registering and collecting their name badges, fewer people chose to sport them in the congress centre than I had anticipated, even when networking within the confines of a fairly small (and much smaller than in previous years — perhaps to the relief of those with a less-than-perfect sense of direction) Exhibition Hall. Social distancing was also clearly now a thing of the past, and hands were shaken despite the occasional sign asking people to refrain (the elbow bump greeting must have JUST been a fleeting idea during lockdown).

Perhaps the setting had something to do with the relatively relaxed attitudes: I noticed fairly few anti-Covid-19 measures in place in Amsterdam in general whilst there, which is no doubt testament to the fact the Dutch, like many countries, are seeing the positive effects vaccination has had on society. I had a real taste of the changing times at a packed concert at the Het Concertgebouw which I attended on the Friday evening: hundreds of people gathered inside the famous venue to enjoy Berlioz’ Symphonie fantastique and Stravinsky’s Firebird and there wasn’t a covered nose-and-mouth in sight.

That’s not to say the conference organisers at RAI did not take precautions to ensure those entering were deemed a low risk: I had to show my double-vaccination status and ID every time I wanted to enter the building. I also noticed that some exhibition booths had signs requesting that people sanitise their hands before entering.

One thing I had pondered as I collected my badge at on Day 1 was how the ‘hybrid’ nature of it, i.e., part-in-person, part-virtual, would work in practice. This was my first time physically attending such a unique format of conference since the pandemic began, so I was intrigued. According to figures released by the ESCRS, of the 7,122 registrations for the event, a whopping 3,000 of these had opted to participate virtually.

And I was impressed by how seamlessly the two formats were combined during the Symposia; when it was the turn of an off-site ophthalmologist to speak, a video of their talk appeared on the huge screens at the front of the Hall. Some of these had been pre-recorded (this did not ruin my enjoyment of them, as it was still effectively the first time they were being shown).

Other doctors were speaking live from their home country and thus were also able to participate in the Q&A sessions following their talks. I even attended a Session in which the Chair himself was sitting comfortably in his home study back in the UK, introducing the speakers from there, his well-stocked bookcase and criss-cross floral patterned wallpaper providing a visually appealing change of scenery to the usual off-white background you see in congress centres.

Video conferencing formats rarely come without some element of danger, but the technical difficulties were few and only minor; needless to say, they still sparked some sniggering in the crowds: speakers appearing to silently mime their talks (we’ve all heard the line “You’re on mute” enough times to last a lifetime, but there’s no sign those three little words are going away any time soon) or disappearing from view entirely (in one comical moment, an attendee eagerly awaited an answer to his question from the microphone he stood before at the front of the hall only for the presenter to go offline immediately — a mishap that prompted the Chair to suggest, in jest, of course, that the question had not gone down well!)

Overall, the blending of videos with in-person talks added another interesting dimension to the Symposia and by no means lessened the quality or accessibility of the information being disseminated. It’s a format that I suspect may be here to stay even in the post-Covid world, since there will always be reasons that people wishing to attend and/or present at congresses cannot participate in person: it seems better that they can do so in some sort of capacity than not at all, after all.

In the next part of my review of this year’s ESCRS, published next week, I’ll cover a few of the Symposia I had the pleasure of attending over the four days. Stay tuned to find out more!

A melting pot of curious minds congregate in-person and virtually at this year’s ESCRS

Vision is one of life's greatest gifts, providing the opportunity to enjoy the azure skies, vibrant sunsets and the smiling, laughing faces of our children, spouses and other loved ones.

Today marks the 21st World Sight Day, an annual day of awareness, held on the second Thursday of October, to focus global attention on blindness and vision impairment. Coordinated by the International Agency for the Prevention of Blindness (IAPB), this year’s call is for everyone to “Love Your Eyes.”

As part of its efforts, the IAPB and its members are working together to increase public awareness on vision issues and blindness, calling for a focus on vision issues and eye health.

The IAPB launched its campaign over the summer in advance of World Sight Day to urge people to commit to vision screenings. As part of its campaign, it has been urging eye care professionals, including ophthalmologists and optometrists, to get involved.

“Almost everyone on the planet will experience an eye health issue in their lifetime, yet more than a billion people worldwide do not have access to eye care services,” Peter Holland, CEO of IAPB said in a statement. “This is a global issue, but one that starts with us.”

Today, IAPB is promoting a global challenge to unite the world, bringing people across the globe together to have their eyes tested.

Answering the call, a number of groups and businesses are stepping up to promote vision.

OneSight is partnering with the IAPB and other vision care supporters who are committed to bringing vision care access to the 1.1 billion people worldwide who need it.

Leading up to today’s event, OneSight set a goal of executing 25,000 eye exams and vision screenings through vision clinics, sustainable vision centers and activities that will connect tens of thousands of people around the world to vision access and education.

According to K-T Overbey, president and executive director of OneSight, more than 1 billion people around the world lack access to vision care.

“This outage can hold individuals back from education, employment, and the ability to achieve their full potential,” Overbey said. “Eye exams and glasses act as powerful tools that can play a significant role in helping lift people out of poverty."

Overbey noted that the company is kicking off an integrated global initiative that will bring vision care to people all around the world.

“Everyone can help support this mission for both short-and long-term impact by donating time, skills or even just making a financial contribution,” Overbey said.

As part of its World Sight Day activities, OneSight has hosted vision programs to educate local communities on the importance of eye health and vision care, including vision clinics in Pittsburg, Pa.; Des Moines, Iowa; Kansas City, Mo.; and a clinic in Brooklyn, N.Y., which concludes on Sunday.

OneSight and the IAPB will host a vision screening today at the United Nations headquarters in New York, providing eye screenings and examinations to United Nations members.

Other initiatives OneSight has been promoting include the Framing the Future children’s campaign with Nickelodeon and the #ShareTheLove social media campaign.

OneSight also was among a group of global vision organisations launching a global landmark activation, where consumers across the world can see eye checks at some of the most recognisable landmarks around the world, from Tanzania’s Mount Kilimanjaro and the London Tower Bridge to The Gateway to India and New York’s Brooklyn Bridge.

“While these landmarks represent some of the most recognisable sights in the world, more than 1 billion people globally lack the ability to see them clearly,” Overbey said. “This vision care gap can hold individuals back from education, employment and the ability to achieve their full potential.”

According to OneSight, to date, more than 471,443 eye checks/eye exams have been committed.

In the weeks leading up to World Sight Day, Alcon is among the companies to be active in promoting vision care.

Alcon, through its Dallas-Fort Worth-based American headquarters, conducted free eye exams for children at Clifford Davis Elementary and screenings at other local schools as part of 

, a companywide day of community volunteering.

Prevent Blindness invites everyone to take three sight-saving steps for themselves, for others and for their communities by scheduling an eye exam for themselves; donating to organisations to help fund sight-saving services; and by urging members of Congress to support vision and eye health policies by becoming a part of the Congressional Vision Caucus. 

As part of World Sight Day, Prevent Blindness is partnering with leading companies on social media-based awareness and fundraising programs, including Zenni, an online eyewear retail leader, will donate $1 per share of every Zenni #WorldSightDay Instagram post to @prevent_blindness, up to $15,000. Followers are encouraged to share the post, with #LoveYourEyes and tell how they prioritise their eye health.

Prevent Blindness also is partnering with Horizon Therapeutics, which will donate $1, up to $5,000, for every like or share of their new thyroid eye disease awareness video, “#LoveYourEyes, Know Your Risks.”

"World Sight Day offers an incredible opportunity to continue to educate the public about the importance of good vision, the need for equitable access to eye care, and the benefits of continued vision research," said Jeff Todd, president and CEO of Prevent Blindness. “We also thank our generous partners for their commitment and support of our programs which make a difference in the vision health of Americans every day.”

Orbis International is marking World Sight Day with a number of initiatives, including a 30-second public service announcement titled “See What You’d Miss,” which focuses on why it’s important to get your eyes checked and is being shared on broadcast and social media channels.

According to Orbis, there is a common misconception that eye exams are only for getting a pair of glasses. To dispel that myth, the company is promoting accessible and proper vision care around the globe by providing training to all types of healthcare workers and by educating communities about their eye health

Johnson & Johnson Vision has completed its Global Eye Health Survey, finding that while people are not taking measures to keep their eyes healthy and protect their vision, sight remains the sense people fear losing the most.

According to the company, 70 percent of adults do not plan to get their eyes examined this year, despite acknowledging the critical importance of eye health. These new findings come from a comprehensive, large-scale Johnson & Johnson Vision Global Eye Health Survey announced in advance of World Sight Day.

This year’s survey revealed key insights around the impact of the pandemic on eye health, misbeliefs about vision correction options for ageing eyes, the intersection between eye health and beauty, and the high potential for missed early intervention for children with vision correction needs.

Serving as the cornerstone of J&J Vision’s “Prioritise Your Eyes” campaign, the survey was launched in advance of World Sight Day in an effort to raise awareness about the importance of getting an annual eye exam, both for adults and children alike.

Shlomi Nachman, group chairman, Cardiovascular and Specialty Solutions Group and Johnson & Johnson Vision, said the company is committed to changing the trajectory of eye health, and that starts with getting an annual comprehensive eye exam.

“This year’s survey shows that, globally only 3 in 10 people have scheduled or plan to schedule an annual eye exam as eye care offices have reopened,” Nachman said.

Nachman noted that a goal of the “Prioritise Your Eyes” campaign is to highlight the importance of seeing an ophthalmologist or optometrist regularly for eye health.

The survey found that 86 percent of the world’s adult population fear losing their sight above any other sense. It is likely for this reason that globally, 88 percent of people view eye health maintenance a priority for their overall health.

Despite recognising the importance of vision and eye health, only 52 percent of respondents say they get annual eye exams.

The Johnson & Johnson survey reveals more than one-third of respondents believe their vision has deteriorated since the start of the pandemic. However, despite this reported awareness, 70 percent of all respondents said they do not plan to schedule an eye exam in the year ahead—the single most important step to protect your eyes.

Survey results show that although three-in-four (75 percent) parents indicate they believe it is more important for their child to receive an eye exam than it is for them—and the majority (61%) of parents indicate they’re concerned about their children being diagnosed as nearsighted (myopic)—only one-quarter (27 percent) plan to schedule an annual eye exam for their children.

Astonishingly one-in-four respondents (27 percent) indicated they’re more concerned about how their eyes look than the health of their eyes. Nearly 30 percent of respondents indicated they would change the colour of their eyes for a day if they could.

For those with ageing eyes, three in 10 (29 percent) worry wearing glasses will make them look old or impacts their self-confidence (30 percent), yet only 37 percent of respondents know contact lenses are available as an alternative to multifocal glasses as they age.

Moreover, 72% of respondents who had a cataract surgery said if they would have known how much better their vision would be after cataract surgery, they would have done it sooner. And 56% did not realise how bad their vision was until after surgery.

With 94 million people affected by cataracts worldwide

 the survey revealed that people may be delaying cataract treatment due to misbeliefs about the procedure. Less than half of all respondents (46%) realised cataract surgery is outpatient and only 31% realised the procedure can take less than 10 minutes to perform.

CooperVision is marking World Sight Day with a new video highlighting the prevalence of myopia among children.

In the video, which will goes live today, Dan McBride, president of CooperVision, and Juan Carlos Aragón, OD, president of CooperVision Specialty EyeCare, discuss the company’s myopia management portfolio, as well as its partnership with the World Council of Optometry to help drive a standard of care for myopia management.

The company will focus on the “Love Your Eyes" theme with posts on the CooperVision Facebook, Twitter, and LinkedIn channels.

To raise advocacy, awareness, and knowledge of the importance of proper eye health services in schools, CooperVision also has made a $40,000 investment to support IAPB’s 2022 forthcoming Focus on School Eye Health Initiative, which is composed of a series of webinars, events, blog posts, and video content.

CooperVision also is holding events at its offices around the globe to raise money for World Sight Day.

As the world comes together to shine a global spotlight on blindness and vision impairment on World Sight Day, several global organizations and companies are stepping up to increase awareness of eye health, including the importance of regular examinations by an ophthalmologist or optometrist.

World Sight Day 2021: How the eye care industry is celebrating #LoveYourEyes

Every second Thursday of October, the globe celebrates World Sight Day. Created by the International Agency for the Prevention of Blindness (IAPB), World Sight Day raises awareness of blindness and vision impairment.

This year's theme is #LoveYourEyes. We've asked ophthalmologists, optometrists, retina specialists, and members of the 

 team to share what their vision means to them and what they would miss seeing the most if they were to lose their vision.

The International Agency for the Prevention of Blindness has set a goal for 1 million people to pledge to get their eyes tested. Eye exams are one of the most effective ways to fight vision loss as clinicians can detect diseases early and begin sight-saving therapies.

 to get your eyes examined, and share your pledge to encourage others to do the same!

About the International Agency for the Prevention of Blindness

The International Agency for the Prevention of Blindness coordinates international blindness prevention activities and resources.

IAPB began in the mid-1970’s when Sir John Wilson and his colleagues drew attention to the growing issue of global blindness. In 1975, the IAPB was born, with Sir John Wilson at the helm as the Founder President. Additional founding members were the International Council of Ophthalmology (ICO) and the World Blind Union (WBU).

From the beginning, IAPB set its sights on linking professional bodies, non-governmental organisations, educational institutions and individuals in the fight against blindness. Today, it organises events, programmes and campaigns to combat vision loss.

World Sight Day is one of the IAPB’s largest initiatives every year, but they host events, educational resources and opportunities to fight blindness year-round. To learn more about how you can get involved in their fight against vision loss and impairment, visit their 

Videos

On October 14, we celebrate World Sight Day by pledging to receive annual eye exams, preventing or slowing vision loss, and showing love for our eyes.

How you #LoveYourEyes: clinicians, media, educators weigh in on World Sight Day 2021

The American Society of Retina Specialists (ASRS) hosted its 39th Annual Scientific Meeting from October 8-12, 2021, at the JW Marriott San Antonio Hill Country Resort and Spa in San Antonio, Texas.

The 2021 scientific program offered attendees innovations in retina science, clinical practice, and surgery with 148 papers, 165 posters, 46 papers on demand, and 69 films, as well as a wide range of networking opportunities and the chance to exchange ideas and perspectives with peers. Here is a review of the presentations covered by 

Managing NPDR: The PANORAMA study and variables to watch

Dr W. Lloyd Clark discusses retinal nonperfusion and leakage areas when managing patients with nonproliferative diabetic retinopathy in context of the results of the PANORAMA study.

Dr Caroline Baumal spoke with Sheryl Stevenson about her presentation.

Results from phase 3 YOSEMITE and RHINE trials on faricimab in DMO

Dr Caroline Baumal provides an overview of the efficacy, safety and durability of faricimab in diabetic macular oedema (DMO).

Beyond the VISTA/VIVID studies: Timing DMO resolution with intravitreal aflibercept

Dr Rishi Singh reports on the pooled data from the VISTA and VIVID clinical trials on the use of intravitreal aflibercept injections (IAI) to treat diabetic macular oedema at the ASRS 39th Annual Scientific Meeting.

PDS with ranibizumab in nAMD offers similar results to ranibizumab monthly injections

Dr Arshad Khanani reported at ASRS 2021 that the Port Delivery System with ranibizumab, an investigational product that continuously delivers ranibizumab intravitreally, achieved results similar to those in patients treated with monthly ranibizumab injections for nAMD.

Intravitreal pegcetacoplan proves useful for geographic atrophy: Phase 3 results of OAKS and DERBY studies

At ASRS 2021, Dr David Boyer reported that pegcetacoplan used to treat geographic atrophy and administered in monthly or every-other-month regimens was well tolerated in patients in the phase 3 DERBY and OAKS studies.

HAWK study: Higher order OCT analysis for inflammatory signal biomarkers

Dr Justis P. Ehlers discusses the findings from a higher-order OCT analysis for inflammatory signal biomarkers in the HAWK Study.

Using commercial OCT to track macrophages in the macular circulation

Dr Richard B. Rosen reported that clinical optical coherence tomography (OCT) can image and measure macular surface macrophage cells.

Retina industry insights from Alcon on display at Ophthalmology Innovation Summit

Paul Hallen discusses the Retina Industry Insights panel at the Ophthalmology Innovation Summit in San Antonio, Texas.

Dr Ankur Shah discusses key highlights of his presentation.

Chronic non-infectious posterior uveitis: Dissecting real-world registry study of YUTIQ

Dr Ankur Shah discusses key highlights of his presentation titled "YUTIQ CALM: a real-world registry study of the fluocinolone acetonide intravitreal implant 0.18 mg in chronic non-infectious posterior uveitis," during ASRS 2021.

Universal masking may lower risk of endophthalmitis after intravitreal anti-VEGF injections

During the ASRS Annual Scientific Meeting, Dr Sunir Garg reported that the risk of presumed infectious endophthalmitis following administration of anti-VEGF injections does not increase and universal masking may actually decrease the risk of culture-positive endophthalmitis.

The relationship between MIGS procedures and endophthalmitis

Dr Yoshihiro Yonekawa reported that the prevalence of endophthalmitis following MIGS is similar to the prevalence rates of endophthalmitis after other incisional glaucoma surgeries.

A review of studies, presentations and discussions at ASRS 2021 in San Antonio, Texas.

ASRS 39th Annual Scientific Meeting: A review of findings reported

Dr Ankur Shah, Prairie Eye Center, Springfield, IL, discusses the key highlights of his presentation titled "YUTIQ CALM: a real-world registry study of the fluocinolone acetonide intravitreal implant 0.18 mg in chronic non-infectious posterior uveitis," during the American Society of Retina Specialists' annual meeting in San Antonio, Texas. 

Find out what the results may mean for the future of patient care.

The American Society of Retina Specialists (ASRS) is hosting its 39th Annual Scientific Meeting from 8-12 October 2021, at the JW Marriott San Antonio Hill Country Resort and Spa in San Antonio, Texas.

Dr Ankur Shah discusses key highlights of his presentation titled "YUTIQ CALM: a real-world registry study of the fluocinolone acetonide intravitreal implant 0.18 mg in chronic non-infectious posterior uveitis," during ASRS 2021. 

On the final day of this year’s European Society of Cataract and Refractive Surgeons (ESCRS) congress, Monday 12th October, the number of delegates at the RAI Centre in Amsterdam were starting to thin out and the Exhibition Hall was also closed that day, but the relatively smaller audience in the speaker halls by no means reflected any lessening of the quality of the talks, and I came away with some interesting insights.

One particular session I had looked forward to attending following a couple of recommendations by the 

® Editorial Advisory Board ahead of the meeting was the Orbis one in Hall 11. Orbis International is a non-profit organisation that since 1982 has delivered sight-saving treatments to developing countries through training programmes, public health education, local partnerships and advocacy. It is perhaps best known for its Flying Eye Hospital — a custom-designed aircraft complete with operating theatre that can deliver sight-saving eye care where it is needed most.

Although the focus of the Orbis Symposium was advancements in technology and training, and how artificial intelligence (AI) and simulation are changing global ophthalmology, Dr Albanderi Alhamzah of the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, presented her research team’s findings on the dangers of laser eyebrow removal at the podium in a sort of ‘warm-up act’ to the main event.

She described the case of a lady who had undergone this procedure without being offered eye protection and gone on to suffer from, thankfully short-lived, uveitis. It was thought the laser had caused damage to the iris but not to the retina. Her presentation was gratefully received: this was clearly an issue that a few of the ophthalmologists in attendance (both in person and virtually) had not come across before; indeed, one or two appeared not to have heard of laser eyebrow removal as a beauty treatment at all, so it sparked plenty of discussion.

After a short break, Mr John Ferris, a consultant ophthalmologist based at Gloucestershire Eye Unit in the UK kicked off the Orbis session itself with his presentation on use of simulation to teach ocular surgery in the developing world. Mr Ferris described today’s pressures on surgical training, including the shorter duration of training programmes, reduced surgical opportunities, the costs incurred and the drive for greater theatre efficiency.

Despite these challenges, it is important for surgeons to engage in “sustained deliberate practice” throughout their careers, Mr Ferris said. Famous musicians spend hours per week practising their instruments, he argued — it should be no different for surgeons.

“Simulation does not have to be high-tech or expensive,” he assured. Indeed, ophthalmologists starting out have a lot of cheap and freely available tools at their disposal when practising surgical techniques. Take the humble apple. It turns out it’s not just for eating; glaucoma patients due to undergo a trabeculectomy might be reassured to know that the more junior ophthalmologists will have spent hours honing their flap cutting techniques on this fruit before doing their first procedure on a human eye.

Foam, too, can provide trainees with a handy way of simulating releasable sutures on flaps, Mr Ferris explained, pointing to photos of bright yellow foam ‘eyeballs’ being carefully operated on. And for those who need further convincing, the statistics speak for themselves: surgical complication rates were reduced by 72%, Mr Ferris pointed out, when simulation cataract surgery training was employed, and ophthalmologists’ scores of confidence in their glaucoma surgical skills doubled after they took a simulation course.

Meanwhile, supervision of students does not have to take place in person. A remotely supervised corneal suturing practice, demonstrated in a short video depicting Mr Ferris mentoring his students over live video feed from his home, was another interesting learning point during the presentation.

Equitable access to artificial intelligence in eyecare was the topic of the next talk by Dr Nicolas Jaccard, principal AI architect at Orbis. In this engaging talk, Dr Jaccard introduced Orbis’ Cybersight AI-enabled platform, whereby more than 20 machine learning algorithms detect sight-threatening conditions. Results can be available in fewer than 10 seconds and the service is free in low-and middle-income countries.

Bath-based consultant ophthalmologist Mr Rob Walters, who was chairing the session, posed the question that is no doubt an issue at the forefront of many people’s minds when they consider the use of AI in diagnostics: how do you deal with the problem of false negatives? Dr Jaccard provided the reassurance that they try to get the rate by which patients are incorrectly screened out of the healthcare system below the 3–5% mark. However, he admitted that the occurrence of false negatives is a “fundamental problem” in AI systems and one they are working on.

But does any rate of false negatives in an AI system justify its use at all? This is a question that no doubt many listeners were pondering, and it remains to be seen whether modern algorithms such as these will ultimately be able to overcome such limitations in the future.

The final Symposium at this year’s ESCRS, the ‘Best of the Best’ was surprisingly busy, given that no doubt at this late stage in the Congress many delegates were already on their way home, but it was clear why as the series of videos shown during this session—some with upbeat music soundtracks—stimulated lively discussion and debate amongst a panel of ophthalmologists sat in a row of comfortable-looking armchairs across the stage.

The footage was mostly quite topical as well. For example, one video featured new protocols that had been put in place at one European hospital as a result of the COVID-19 pandemic. This led to the panel discussing the safeguards they put in place at their own clinics, which varied from country to country. It was interesting to hear, first-hand, how the differing levels of severity of the pandemic in the first few months in different countries (Italy, for example, was particularly badly hit) affected the ophthalmologists and their clinics.

I was pleased to hear that long-term sustainability touched on (the pandemic resulted in a greater use and disposal of plastic in hospitals), and the discussion was rounded up on a positive note, with the panel members acknowledging the state of preparedness clinics and hospitals now find themselves in post-pandemic: the healthcare sector is now armed and ready to tackle any future surges in infections.

Moving to specific treatments in the cataract and refractive space next, one video showcased the benefits of the dexamethasone intraocular suspension 9% (Dexycu, Eyepoint Pharmaceuticals) for the treatment of postoperative inflammation following cataract surgery. The panel had a lot to say about this.

Dr Rudy Nuijts was the first to give his input, remarking that it is too expensive to use in the Netherlands despite the concept being ‘very attractive.’ Avoiding drops post-surgery is the future direction cataract surgery is taking, he added.

Other videos during the Best of the Best Symposium demonstrated scleral fixation of IOLs, which provoked the panel into debating scleral flap techniques, and topography-guided PRK and CXL for keratoconus, which prompted a discussion on the merits of topography guided methods.

All in all, the final session I attended at this year’s ESCRS was fascinating and topical and rounded up the event nicely. As I continue to digest the wealth of information I came away from the conference with, it only remains to be said that I look forward to the 40th Congress that will take place in the beautiful city of Milan (Italy) next year. See you there!

Ophthalmologists gather to discuss artificial intelligence and the issue of false negatives, practice for surgeons and Best of the Best at the European Society of Cataract and Refractive Surgeons congress.

Simulated operation practice, artificial intelligence diagnostics dominate discussion on final day of ESCRS 2021

With the onset of the COVID-19 pandemic, glaucoma specialists had to make marked changes to their well-established clinical practice routines on the fly to ensure patient follow-up. “We had to make changes to several aspects of clinical flow and patient interaction, especially regarding diagnostic testing and disease monitoring, with the emphasis on visual field (VF) testing,” said Dr Oluwatosin U. Smith, Glaucoma Associates of Texas, Dallas, United States.

Before the pandemic, long clinic waiting times for patients were commonplace for routine follow-up visits. Because of the pandemic, Dr Smith pointed out, testing and visits were separated and testing centres were designated in some facilities.

Regarding VF testing, new requirements for cleaning equipment and ensuring adequate time between patients after each VF test resulted in prolonged delays in the clinic. In an effort to reduce the waiting times, virtual VF testing and home VF tests were implemented.

“When considering perimetry needs,” Dr Smith said, “a number of factors are considered that include the reliability, reproducibility and quantitativeness of the test; the efficiency and safety for physicians and patients; affordability; comfort; and ease of both use and cleaning. Virtual reality and home VF tests meet some of those criteria.”

Available virtual reality and home technology

Various devices are available commercially. They include head-mounted devices, referred to as virtual reality perimetry, such as the VisuALL S for clinic use and the VisuALL H for home use (both from Olleyes), IMO (Crewt Medical Systems) and the C3 Field Analyzer (Remidio).

The visual acuity assessment is usually included in most available VF testing systems, as is threshold/suprathresold testing. However, the size V stimulus test is not currently available. Specific devices can administer both adult and paediatric tests, depending on requirements.

The VisuALL system, a head-mounted device that can be bought or rented, has the advantages of being lightweight and portable; it offers goggle technology, with each eye stimulated by an individual flat screen, and threshold and suprathreshold strategies. The web-based test included with the system is similar to the in-clinic test. Patient instruction and training are required.

Dr Smith referred to a recent study that compared this system with standard automated perimetry.

 The study included 102 eyes of 25 healthy patients and 26 patients with mild-to-moderate glaucoma. All participants were evaluated with both tests.

The authors reported that the test time was longer than with the Humphrey Field Analyzer (HFA) for both the normal subjects (6.13 minutes) and the patients (9.28 minutes) (P = 0.02 and P < 0.001, respectively). The investigators found a significant correlation in the global mean sensitivity of the HFA and VisuALL in normal subjects (P = 0.001) and patients (P < 0.001). The VisuALL mean sensitivity had a greater receiver operating characteristic curve than the HFA mean sensitivity for discriminating normal eyes from glaucomatous eyes (P = 0.06).

Dr Smith said the VisuALL system had lower peak brightness and background illumination than the HFA and an eye tracker that was similar in technology to the Octopus 600 (Haag-Streit). It provided full threshold testing versus standard automated perimetry testing but required more time than the HFA because of the absence of a normal database and a frequency-of-seeing curve.

The print-out of the VisuALL system is formatted like that of the HFA print-outs. Using the system, either one eye alone or both eyes simultaneously can be tested. The system provides a full threshold test, which the IMO does not; the IMO has a special algorithm that helps improve the accuracy and speed of testing.

The important advantages of virtual reality field tests are efficiency (the devices are easy to clean after each use and multiple devices can be used at the same time), safety and the ability for devices to be worn over glasses. Ease of use is another draw since it facilitates more frequent testing, which can rapidly detect VF progression.

In addition, it is not necessary for a technician to monitor use of the devices, although someone can be available if needed. The testing can be performed in any position and location.

The major disadvantages include the potential for patient disorientation when wearing the goggle headset, preference for standard perimetry, possible high cost and the fact that further clinical studies are needed to test the device with advanced glaucoma and with size V test objects. Studies to determine patient preferences with the tests, repeat test performance, clinical utility and normal database are under way.

Home testing technology is proving to be a key advancement in monitoring and screening glaucoma patients.

Simulated operation practice, artificial intelligence diagnostics dominate discussion on final day of ESCRS 2021

Taking a step forward in diagnostic testing and disease monitoring

Patient-centric healthcare, combined surgeries and cost-effectiveness considered at ESCRS