APACRS 2021 Daily News (Sunday, 1 August 2021)

What’s New Ahead in Cornea In the Saturday session, “What’s New Ahead in Cornea,” Rajesh Fogla, DNB, FRCSEd, FRCOphth, FACS, India, began the pre- sentation discussing how deep anterior lamellar keratoplasty (DALK) should be considered as the procedure of choice for patients with corneal disease with a healthy endothelium. Dr. Fogla provided tips on how to ensure great success using the big bubble technique and showed his methods through case presentations. “To reach the ideal plane for air injection,” he says, “look at the reflection against the air bubble in the anterior chamber and also look at the wrinkles in the posterior layer.” Looking at where we stand today regarding artificial descemet membrane endothelial keratoplasty (DMEK) procedures, it is becoming increasingly more popular to utilize artificial corneas. This is due to an increasing global cornea shortage in which 12.7 million people around the world are waiting for corneal tissue from a donor. Gerd Auffarth, MD, PhD, FEBO, Germany, believes that “an artificial DMEK layer could help treat chronic corneal edema temporarily or permanently, especially in coun- tries with limited access to donor tissue.” With more challenging DMEK cases on the rise, Donald Tan, FRCSE, FRCSG, FRCOphth, FAMS, Singapore, approaches complex cases by first reconstituting the anatomy of the cham- ber by removing the abnormal iris and replacing it with an arti- ficial iris. With this approach, “DMEK can be more easily per- formed as a second stage,” says Dr. Tan. Another promising advancement discussed in this session was human corneal endothelial cell injection (hCEC-injection) therapy proposed by Shigeru Kinoshita, MD, PhD, Japan. “Conceptual- ly, one donor cornea can provide cells for 300 patients and is a safe and speedy procedure,” says Dr. Kinoshita. He specifically targets very mature differentiated cells for this type of cell injec- tion therapy by utilizing rho-kinase inhibitors. Jod Mehta, BSc, MBBS, PhD, FRCOphth, FRCSEd, FAMS, Singapore, ended the session discussing new developments in artificial intelligence (AI) in the world of cornea. Dr. Mehta ex- plained the various uses of AI in a multitude of corneal diseases, stating that “AI allows us to see what we cannot see.” In corneal dystrophy, AI can assist in assessing a patient’s imaging results by analyzing slit-lamp photographs. With high accuracy and pre- cision, AI offers much promise as both a time and cost effective way to manage patients. Asia-Pacific Association of Cataract & Refractive Surgeons Sunday, 1 August 2021 EWAP Daily News - 5 The Future of Ophthalmic Nursing In this session, nurses from different institutions in the UK, Singapore, and Australia spoke about the development and future of the ophthalmic nursing career. Tara Matare, Advanced Nurse Practitioner, UK, explained that the many challenges of nursing come from the global nursing short- age, capacity issues, and backlogs due to Covid-19. In the UK, there are 8,000 patients currently waiting for an oph- thalmic appointment due to these challenges. Ms. Matare said, “the future in ophthalmic nurses depends on how we align roles, job plans, and investment in education and training. It requires nurses to have the professional devel- opment they need to adapt to changing circumstances.” Becky Chia, Staff Nurse, Singapore, provided her own perspective on the nurse-led intravitreal (IVT) injection pro- gram in Singapore. At the Singapore National Eye Center (SNEC), there are currently 14 trained IVT nurse injectors who have performed an estimated 40,000 injections since 2018. The new initiative for the IVT injection program began due to an increase in the burden of the disease and longer patient wait times. SNEC sees approximately 2,000 cases monthly. Additionally, chronic eye conditions are projected to increase significantly by 2040 and include diseases such as retinal vein occlusions, age-related macular degener- ation, and diabetic retinopathy. SNEC’s practical training program consists of an observatory phase (conducted on 20 patients), a preparatory phase (20 patients), and a performance phase (100 patients). With this program, Ms. Chia has seen an increase in patient satisfaction, trust, and an acknowledgement in nursing skills from patients.