PL1-1

　　The ICO/IFOS History and Programs

　　Bruce E. Spivey, MD

　　The history of ophthalmology is a long and distinguished one.  As the first true specialty in medicine, ophthalmology began to flower with the development of the ophthalmoscope in 1851.  In 1857, International Ophthalmology held its first Congress, which has persisted to the present day as the longest continuous international meeting in medicine.

　　It was at the end of World War One when ophthalmic leaders decided to develop what is now the International Council of Ophthalmology (1927), and the International Federation of Ophthalmological Societies was created in 1933.

　　The fundamental mission of the International Council is to elevate the level of ophthalmic education in developing countries while providing a forum for communication and education for all ophthalmologists.

　　Today, the World Ophthalmology Congress occurs every other year, and the International Council meets annually.  A number of new programs available to all ophthalmologists worldwide have been created in the last decade.  The lecturer will describe the present ICO programs, its structure, leaders, and evolving plans for the future.

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　　Reforming & Repositioning Continuing Medical Education

　　Bruce E. Spivey, MD

　　That Continuing Medical Education (CME) needs fundamental reform is not news to those who read the educational literature.  Classic CME (lectures in large dark halls) fails to produce change in physician behavior.  However, most physicians are comfortable with present approaches.  During a five year dialogue and planning effort, 14 major stakeholders of CME in the United States came together to form a Conjoint Committee (led by the speaker) and agreed both on the need for change and the initial plan to achieve it.  

　　Fundamental system wide changes must occur in CME affecting educational methodology and physician capability, particularly in self-assessment, as well as in: accreditation; certification; credentialing; licensure; and credit reporting, recording and funding.

　　The multiple involved parties who “control” various aspects of CME agreed to focus on the physician end user and to create a revised CME system.  This “new CME” would also include simplified and standard reporting of CME experiences for the individual physician, as well as create a simplified and more rational system of credit.

　　A series of recommendations, next steps and action plans to accomplish the objectives were agreed upon and have been assigned to organizations according to relevant historical interest and commitment.  The paper includes arguments for change and outcomes if change is made.

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　　NanoMedicine in Ophthalmology

　　Paul A. Sieving, M.D., Ph.D.

　　Director, National Eye Institute / NIH

　　NanoMedicine is the application of nanotechnology to biology and medical problems.  Nanotechnology works with materials at the nanometer scale, at which biophysical properties are strongly affected by near-quantum behavior.  This is also the scale at which biology operates on a subcellular level.  Nanotechnology can apply to cellular structures and processes such as the lipid bilayer membranes, proteins that form ion channels to regulate the intracellular and extracellular environment, and membrane surfaces that include holes, ridges, and bumps.  Cellular processes work on the nanometer scale and hence can be manipulated by nanotechnology, including controlling DNA replication and viral packaging using molecular motors.  This talk will introduce a field and will describe some of the applications at the cellular level that could lead to medical therapy.

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　　The Case for Initial Surgery:  Results From the Collaborative Initial Glaucoma Treatment Study (CIGTS)

　　Paul R. Lichter, M.D.

　　W.K. Kellogg Eye Center

　　University of Michigan

　　The Collaborative Initial Glaucoma Treatment Study was originally conceived to evaluate, in newly diagnosed patients with open-angle glaucoma, whether the preferred initial treatment is with medications or with trabeculectomy.  Visual field (VF) loss was the primary outcome variable.  There were 14 clinical centers and 607 patients were enrolled.   Three hundred patients underwent initial trabeculectomy and 307 patients were treated initially with medication.

　　Collective data from randomized, controlled clinical trials in glaucoma have shown that visual field loss is greatly reduced by a marked reduction in intraocular pressure (IOP) from baseline by at least forty percent. In fact, in the CIGTS, relatively little VF loss occurred when IOP was reduced to such an extent.  In our report of the interim data—following five years of follow-up—there was no significant difference in VF loss between the medically and surgically treated groups.  However, we have recently analyzed our data to determine whether the extent of VF loss at baseline might make a difference in whether or not the initial treatment approach matters in terms of ultimate VF loss.

　　We found that patients with a minor amount of VF loss at baseline (mean deviation of -2 dB or better field) had similar VF results whether treated initially with medications or with surgery.  However, in those patients with more extensive VF loss at baseline (mean deviation of -10 dB or worse) initial treatment with trabeculectomy resulted in significantly less VF loss over time than did initial treatment with medications.

　　The reason for this finding may be that initial treatment with trabeculectomy results in less longitudinal variability in IOP than does　initial treatment with medications.  We found that our patient cohort showed greater VF loss when there was greater IOP fluctuation over time.
In summary, clinicians should consider initial treatment with

　　trabeculectomy in newly diagnosed open-angle glaucoma patients who present with substantial visual field loss.

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　　Prevention of Blindness in Children

　　Akira Nakajima

　　JuntendoU 2-1-1 Hongo, Bunkyoku,Tokyo 113-8421 Japan.

　　Prevention of avoidable childhood blindness is included in the VISION 2020 started by WHO and IAPB in1999. the setting up of system of pediatric ophthalmology service is basic for the successful prevention of preventable blindness in babies and children. National Center for Child Health, regional center for child health, and key hospitals will plan the flow of child care and training of ophthalmologists, pediatricians and OBGY doctors as well as pegnant mothers for early diagnosis of treatable eye diseases such as retinopathy of premturity, buphthalmos, squint, amblyopia, lacrimal duct stenosis, etc. for prevention of diseases, immunization in babies and children is essential. In addition, immunization of rubella in the mother is important in the prevention of congenital rubella syndrime. Prevention of measles is important to prevent possible corneal involvement caused by vitamin A deficiancy. Prvention of blindness by prematurity depends on the care of premature children at the centers and quick reference patients from the place of birth to the centers. Good care of pregnancy is essential.

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　　Long term outcomes of angle closure attacks and fellow eyes
David Frideman

　　Wilmer Eye Institute,USA

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　　Challenge in Ophthalmology in the 21st Century

　　Patrick He

　　The 21st century marks rapid changes and advancement in all fields of human endeavours with new theory, new technology and new orders emerging in medicine Ophthalmology, and visual sciences spanning from diagnosis, therapy, rehabilitation, prevention to research. Emphasis of development is also gradually shifting from treating blindness, to treating eye conditions, to safeguarding eye health, to improving the quality of vision and to prevention of visual deterioration. This presentation reviews the various dynamics and forces underpinning these changes.

　　"Challenge in Ophthalmology in the 21st Century" The 21st century marks rapid changes and advancement in all fields of human endeavours with new theory, new technology and new orders emerging in medicine Ophthalmology, and visual sciences spanning from diagnosis, therapy, rehabilitation, prevention to research. Emphasis of development is also gradually shifting from treating blindness, to treating eye conditions, to safeguarding eye health, to improving the quality of vision and to
prevention of visual deterioration. This presentation reviews the various dynamics and forces underpinning these changes

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　　MICROGLIAL ACTIVATION IN HUMAN DIABETIC RETINOPATHY

　　HUI-YANG ZENG1,2       W. RICHARD GREEN2          MARK O.M. TSO1,2

　　Peking University Eye Center The Third Teaching Hospital, Peking University1 and the Wilmer Eye Institute, Johns Hopkins University2

　　The study was undertaken to investigate microglial activation at various stages of human diabetic retinopathy and to further define the role of microglia in this disease process. Paraffin sections from 21 eyes of 13 patients with diabetic background, pre-proliferative or proliferative retinopathy and 10 normal eyes of 9 individuals were studied with immunolabeling of microglia with HLA-DR, CD45 or CD68 antibodies. Our study showed that in diabetic retinopathy, the microglia were significantly increased in number and became hypertrophic at various stages of the disease. These cells clustered around leaking blood vessels, microaneurysms, intra-retinal hemorrhages, cotton-wool spots, dilated veins and neovasculization of optic nerve, retina and vitreous. In the retina with cystoid macular edema, the microglia were seen to infiltrate the outer retina and subretinal space. The cells in the epi-retinal membrane were also labeled with the three-microglia markers. In diabetic retinopathy, the optic nerves were also infiltrated with hypertrophic microglia. These observations indicated that microglia were activated in the various stages of human diabetic retinopathy and optic neuropathy. Microglial peri-vasculitis was a prominent feature of the disease process and microglia may play an important communicating role between diabetic vasculopathy and diabetic neuropathy.

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