Japan is often portrayed as a world apart from many other countries, and given its unique and complex culture, this assumption is perhaps understandable. The “Land of the Rising Sun” has many wonderful traditions that are its own, from sumo wrestling to the cherry blossom festival, and the Festival of the Iron Phallus, which, yes, is not figurative. The four islands are a treasure trove of originality, but in an increasingly interconnected world, new traditions have made their way in.
For example, did you know that in Japan, the American fast-food chain KFC is heavily associated with Christmas? Japanese single malt whisky, painstakingly created to match and also exceed the quality of the original Scottish variety, is globally popular — and trust your correspondent, it’s the good stuff. And on New Year’s Day, it’s now traditional to sing Beethoven’s Ode to Joy, an idea that originated when Japanese soldiers guarding German prisoners of war in WWI were enamored with this particular festival singing.
No wonder therefore, when the World Glaucoma e-Congress (WGC 2021) couldn’t proceed with this year’s conference in the ancient Japanese capital of Kyoto, they adopted a more international theme. The name of this year’s event, Beyond Borders, sums up this spirit and Day 2 provided more specificity. The day’s proceedings featured a number of symposiums by ophthalmological societies from various countries and regions, starting with the Asia-Pacific Glaucoma Society’s Dilemmas in Glaucoma Management: The Asia-Pacific Perspective.
How high do you power your laser?
The first speaker during this symposium was Dr. Clement Tham, a professor in ophthalmology and visual science at the Chinese University of Hong Kong, who spoke about acute primary angle closure (APAC). His approach to treating APAC is to begin treatment immediately with laser peripheral iridoplasty (LPI), followed by early lens extraction, if required. Dr. Tham recommended when using LPI treatment, the laser parameters should be set to a 500 micron spot size for brown irides and 200 for light irides, for 0.5 seconds, and 150mW for brown and 200-300mW light irides, respectively.
Later on in the symposium, Dr. Paul R. Healey, PhD, MD, from the University of Sydney (Australia), made the case for monitoring over intervention when treating an optic-disc hemorrhage in normal-tension glaucoma. Dr. Healey argued that it is intraocular pressure (IOP) — and not the actual hemorrhage that can cause progression — therefore, clinicians should focus on lowering IOP first. Disc hemorrhages are common in open-angle glaucoma, he said and are a sign of stress on the optic nerve, so it’s best to monitor and watch for treatable consequences.
Seeing the Patient in Your Office Smartphone
Now, do you remember when the pandemic began in earnest, and all of a sudden everyone was talking about telemedicine? It’s certainly revolutionized ophthalmology, especially in countries with high levels of technological infrastructure like Singapore. So it’s no surprise that the issue was covered in detail during Glaucoma Association of Singapore’s Telemedicine for Glaucoma. The symposium covered some of the lessons learned during the COVID-19 period, as well as how telehealth can be applied to glaucoma treatment.
Dr. Vivien Yip, a clinical lecturer with the Yong Loo Lin School of Medicine, National University of Singapore, reported on how Singapore’s hospitals continued to treat glaucoma patients during the pandemic. She said that issues with social distancing led to the creation of the Virtual Ophthalmology Service (TVOS), designed to screen glaucoma patients. For those clinicians who want to implement a similar system, it’s worth noting TVOS’s exclusion/inclusion criteria.
The inclusion criteria includes any type of glaucoma, target IOP met over two visits and stable optical coherence tomography; versus exclusion criteria including recent glaucoma surgery, significant media opacity, research patients and new referrals.
Telemedicine is part of the vanguard of ophthalmology-focused technological development and other forms of technology based on imaging are also making virtual waves. If you peer into the abstracts section on WGC 2021’s virtual platform, you can find abstract P:001, Sex Judgement Using Color Fundus Parameters in Kumejima Population Study. This refers to biological sex rather than the adult variety (which is a shame … that subhead would have been fun to write).
Designed to test whether artificial intelligence could determine the sex of an individual just from ocular color fundus photography (OCFP), the Japanese researchers behind the study examined 1,655 right eyes of normal subjects with measurements of fundus parameters. The tessellation fundus index (TFI) was calculated by TFI=R/(R+G+B) using the mean value of red-green-blue intensity in the eight locations around the optic disc and macular region. They found that the discrimination accuracy rate was 80.4%, the ovality ratio and retinal artery angles in women were significantly smaller than in men, and that the presence of structural difference of eye between males and females could be observed.
TAKE YOUR MEDS: The App
Keeping the theme of telemedicine going was another paper: P:017 Effectiveness of a New Medication Reminder Mobile Phone Application in Improving Adherence in Glaucoma Patients. Certainly this abstract’s name is a bit of a mouthful, but it followed the use of the “TAKE YOUR MEDS” app, which was created to encourage medication compliance among glaucoma patients. The researchers from Universiti Kebangsaan Malaysia in Kuala Lumpur monitored 61 subjects with glaucoma who took topical anti-glaucoma medications and were also Android mobile phone users.
The study found that factors associated with improvement in medication adherence were male gender; age; Malay ethnicity; marriage; secondary level of education; using one, three and four anti-glaucoma medications; and participants who have glaucoma for more than 5 years. While finding that TAKE YOUR MEDS usage had a limited effect on compliance, it did however significantly correlate with increased patient satisfaction and comfort. Finding the right way to achieve better compliance and satisfaction would be a real boon for our industry, and the Malaysian researchers called for further study.
All this awesome content was just during Day 2 and there are two more days still to come — so make sure you stay signed. And while you’re here, check out our reporting from yesterday’s proceedings to make sure you didn’t miss out on anything. In the meantime, stay bananas y’all.
