EyeWorld Asia-Pacific September 2015 Issue

56 EWAP NEWS & OPINION September 2015 technique, he believes, is necessary to address global cataract blindness. While cataract surgery rates (CSR) around the world are “actually getting better,” Dr. Ruit estimated the cataract backlog to be about 121 million operable cataracts. This, he said, combined with other challenges both intrinsic (stage and complexity of cataract, capsular changes, varieties of nucleus, zonular status) and extrinsic (work conditions, team, equipment and instrumentation, volume) to cataracts, as well as the fact that the technique helps surgeons learn and develop skills that can aid in the management of special situations during cataract surgery, makes MSICS an essential skill for cataract surgeons. The MasterClass detailed the technique in all its steps: wound construction, capsulotomy, nucleus delivery, lens implantation, and, in Dr. Ruit’s particular variant of the technique, capsulectomy. Confronting challenges in pediatric ophthalmology The Keshmahinder Singh Oration, an annual event held by the Malaysian Society of Ophthalmology, was established in 1997 to honor Malaysian ophthalmologist Keshmahinder Singh (1921-2007). Frank J. Martin, MD , Sydney, Australia, gave the lecture on “Challenges in Pediatric Ophthalmology,” outlining his approach to diagnosing vision loss in infants and children and how to effectively communicate visual defects with both the patient and the family. Pediatric ophthalmology presents unique challenges because the patient often cannot give the physician a history, Dr. Martin said. These challenges put the ophthalmologist’s diagnostic skills to the test, but by applying a certain method to each case, managing these patients does not have to be difficult. How do you diagnose the cause of poor vision in an infant? Visual defects in babies can be due to a variety of issues, from anterior segment abnormalities and optic glioma to even congenital motor or idiopathic nystagmus. Visual development begins immediately after birth, and most babies can blink within several days and make eye contact with a parent by about 6 weeks of age. Visual defects usually present when the infant is 2-4 months old, and lack of eye contact is what prompts parents to seek medical attention most often. The etiology of poor vision in infants can sometimes be subtle and difficult to detect, so ophthalmologists should approach this issue as if it were any other medical problem—observe the infant, take a history, and do an examination. When taking a history, be sure to include the pre-, peri-, and postnatal history as well as that of the family. Babies recognize contours, not details, Dr. Martin said, so the best way to assess vision is to have the baby look at the mother’s face. Nystagmus is the most important clinical sign when assessing a baby with potential visual defects, Dr. Martin said, because the presence or absence of nystagmus will determine whether the defect is anterior or posterior to the optic chiasm. If nystagmus is present and the infant has poor vision, the defect is anterior to the chiasm. If nystagmus is present but the infant has a normal eye exam and good vision, the nystagmus is most likely a congenital motor defect or idiopathic, but this is only a diagnosis by exclusion, Dr. Martin said. If nystagmus is absent but the child has poor vision and a normal eye exam, the defect is posterior to the chiasm and is most likely due to cortical visual impairment or a delay in visual maturation. In these situations, it’s important to counsel and reassure the family, Dr. Martin said. Follow up with a phone call the next day to make sure the parents understand the situation and that they are adequately coping with the child’s vision problem. Thursday, 6 August 2015 The APACRS meeting held its opening ceremony and APACRS LIM Lecture, as well as other key sessions on Thursday. Opening ceremony The annual meeting of the Asia- Pacific Association of Cataract and Refractive Surgeons (APACRS) held its opening ceremony on Thursday. Graham Barrett, MD , Perth, Australia, the president of the APACRS, spoke, first noting the beginning of his journey with APACRS. In 1989, Dr. Barrett attended his first APACRS meeting, which was the 2nd annual meeting of the society. He presented on the topic of phaco vs. manual extracap. What really changed his life, he said, was meeting Prof. Arthur Lim, who had held the first meeting the year before in Singapore. Prof. Live reports - from page 55