PL2－1
Bright light might outfight night sight: Good visualization is the key to successful vitrectomy
Yasuo Tano, MD

At the dawn of modern vitreous surgery, our armamentarium was limited only to 17 gauge vitrector sheathed with fiber light sleeve of ø2.3 mm.  The surgeon had to prepare the worst possible complications such as massive hemorrhage, iatrogenic retinal tear, collapse of the eye and so forth.  Introduction of three port system had remarkably expanded surgeon’s capability yet the endo-illumination from the 20 gauge light guide had been even dimmer than full-function system.  However, days of nightmare is gone by now with overwhelming advancement and sophistication of instrumentations and techniques over the last 30 years.  Among such prominent progresses in surgical environment, drastic improvement of endo-illumination has brought a revolution in modern vitreous surgery.  Xenon endo-illumination systems have become available which can provide extraordinary bright illumination compared to the conventional illumination system with Halogen or Metal-halide lamp.  These systems can provide satisfactory illumination with 25 gauge light pipe, 25 or 27 gauge chandelier illumination, 25 gauge illuminated infusion cannula, and various illuminated forceps and scissors.  All of these new instrumentations have drastically changed the surgical capability.  Surgeons are able to employ true bimanual techniques under sufficient illumination provided by 25 or 27 gauge sutureless chandelier illuminations.  Notoriously dim 25 gauge light pipe can deliver as bright illumination as previous 20 gauge illumination.  Panoramic viewing is guaranteed throughout a homogeneously illuminated surgical field.  Good observation has always been the key to a successful surgery.  New techniques and instrumentations will further evolve based on the revolutionarily bright endo-illumination systems.

PL2-2

OPEN ACCESS SITES AND SOURCES FOR OPHTHALMOLOGY AND VISION

Pamela C. Sieving, MA, MS
Biomedical Librarian/Informationist
National Institutes of Health
Bethesda, Maryland USA

The number and range of online resources to support education, clinical care and research in ophthalmology and vision continue to grow.  This presentation will cover:
PubMed, Google Scholar and other indexes:
Unique features
Best search strategies
Open-access journals:
 Identifying the information you need
 Choosing where to publish your own research.
Genetic, molecular and bio-informatics resources:
  Resources for researchers, clinicians and patients
Digital repositories:
What are they?
How can you use them?

PL2-3
Seize The Opportunity – Influencing World Opinion

Professor Arthur Lim, Md (Hon), Frcs
Clinical Professor, Dept Of Ophthalmology, National University Of Singapore
Director, Eye Clinic Singapura International
Chairman, Singapore Eye Research Institute
Founding Director, Singapore National Eye Centre

You are at a point of history when great things are occurring.  The economic growth of china has influenced the world in everything.  With economic growth comes the responsibility of success for all.  You must seize this wonderful opportunity for your decisions in ophthalmology would influence the development of ophthalmology not only throughout asia, but also the world.  Let us discuss a few main developments.

1.Education and training
Education and training is the most important single factor for development of ophthalmology.  You have exciting opportunities through education and your progress is only limited by your determination and your ability.

2.Community work
While you embrace success, you must not forget the less fortunate.

3.Quality and talents
You must continually improve on what you are doing.  You must compare the quality of your research and service with those in other countries.  In addition, you must applause quality and recognise quality.

4.Say what should be said
There is a tendency to avoid saying what should be said in most countries.  My opinion is that for progress, the leaders of the nations and organisations must listen to the opinions of everyone.  Accordingly you must express honestly what you feel is right for your organisation, even if this may incur displeasure.  This is important for our progress.

5.Human rights
Human rights have been introduced worldwide, especially pushed by the Americans.  I agree that human rights should be considered provided that the rights are introduced carefully and the rights will benefit your country.

6.Growing affluence
With the spectacular economic growth in China, you will have more leisure time.  The way you use your leisure time is important.  It is well-known that one of the reasons for the fall of the great Roman Empire was the misuse of the leisure time by theirs leaders and people.  One way is to promote the arts – visual arts, performing arts and the various forms of cultural activities and international exchange of arts.

Conclusion
There are exciting developments in China in the 21st century.  Remember your association belongs to you.  You must accept the challenges of tomorrow and remember the future is there for you to mould.  You must remember the need for quality education and training, remember that with growing affluence you have more money and more time – but money is only of value if used wisely.  Most of all for progress you need good government and you need good leaders.  It is important that you must support them.

In another 10 years, many of you will emerge as important leaders, you have the grave responsibility to fight for what you believe is right for your country and your association.  You must also remove what you believe is wrong. 

I wish you luck in your great venture.

PL2-4
Implementing Clinical Practice Guidelines in China: Examining the Motivators and Barriers

Richard L. Abbott, M.D.
Guidelines Coordinator: International Council of Ophthalmology
Secretary for Quality of Care and Guidelines Development
American Academy of Ophthalmology

Although clinical practice guidelines are generally accepted as “best practices” throughout the world, wide use by practitioners is difficult to achieve. Research findings demonstrate that even with educational programs and incentives for compliance, practitioners fail to use guidelines in daily practice.  Clinical Guidelines are developed to insure cost-effective, high quality patient care. The challenge facing the Chinese Ophthalmologic Society (COS) is to now widely disseminate these Guidelines to Ophthalmologists throughout China and to have them used in daily practice.   

Preferred Practice Clinical Guidelines unique to Ophthalmic practice in China were adapted from the American Academy of Ophthalmology and the International Council of Ophthalmology Guideline documents in 2005.  These Guidelines are recommendations for clinical care from world-wide evidence-based clinical studies extracted from the peer reviewed literature. After careful consideration and evaluation by some of the leading Chinese Professors and educators in each of the major Ophthalmic sub-specialty areas, consensus was achieved to adapt these Guidelines and use them as Benchmarks to improve the quality and consistency of care for all patients in China.

Critical steps for physicians to incorporate clinical guidelines into their everyday practice behavior include: Awareness of the Guidelines, Agreement with the general recommendations, Adoption of the Guidelines, and finally Adherence to the Guidelines.   A plan to evaluate their use in education and clinical practice is being developed, as well as a method to demonstrate the impact on outcomes of care delivered to patients.

PL2-5
How to achieve international excellence in ophthalmology in the age of globalization – an experience from Hong Kong

Prof. Dennis S.C. LAM

Medical work is a commitment to serving humanity and quality is a journey.  We have to dream about achieving excellence before we can actually push the medical frontier further out.  Hong Kong has evolved from a fishing port to an international city in the past decades.  Ophthalmology in Hong Kong has gone through rapid stages of development.  We believe that good is not good enough and good is probably the biggest enemy of great.  In this age of globalization and era of information technology, it is much easier to know what is happening around the world.  However, it may not be as simple as it looks when we are talking about technology and skill transfer.  This presentation will cover some of Hong Kong’s experience in developing new procedures like SLIMCE (sutureless large incision manual cataract extraction), DLEK (deep lamellar endothelial keratoplasty), DSEK (Descemet’s stripping endothelial keratoplasty), and OOKP (osteo-odonto-kerato-prosthesis), etc.  We believe that the world of tomorrow belongs to those who have the vision today.  We must be visionary about our future.  We must have both vision and action.  Vision without action is a daydream; action without vision is a nightmare.  If we can have both vision and action, whatever imaginable would be achievable and today’s unthinkable could become tomorrow’s inventions.  Let’s work both hard and smart to build a better tomorrow for our patients!

PL2-6
East-West Differences In The Epidemiology Of Eye Diseases
Professor Tien Y Wong，Professor and Deputy Head，Centre for Eye Research Australia, University of Melbourne, Australia

Up to 20 million people are estimated to be blind in Asia, a figure that is expected to increase as the population ages. In Western populations, the prevalence of visual impairment and its major causes have been well described. In the past decade, several large population-based studies have provided new information on the epidemiology of visual impairment and the major eye diseases in Asia. These include epidemiological studies from China, India, Taiwan, Mongolia, Singapore and Japan. In particular, the epidemiology of myopia and glaucoma has been well characterized and have shown significant differences in prevalence and risk factors as compared to Western populations. These East-West differences have provided important insights into the underlying causes of these conditions, as well as the relative public health implications of these conditions in different countries. In contrast, the epidemiology of cataract appears to be similar between Western and Asian populations. There are fewer population-based data on diabetic retinopathy and age-related macular degeneration in Asia, two conditions that are likely to have important racial/ethnic differences. New epidemiological studies in Asia will provide information on these conditions to allow comparison of East-West differences.

PL2-7
Age related macular degeneration:what is new
Marshall
St Thomas' Hospitals, University of London

PL2-8
Commercially available ocular hypotensive prostaglandin-analogues and prostanoid receptors

Makoto Araie, Makoto Aihara, and Takashi Ota
Department of Ophthalmology, University of Tokyo Graduate School of Medicine

Purpose: To study the involvement of prostanoid FP and EP receptor in the IOP lowering effects of commercially available prostaglandin-related compounds, latanoprost, travoprost, bimatoprost and unoprostone.
Method: FPKO, EP1KO, EP2KO, EP3KO and wild-type (WT) mice were bred and acclimated under a 12-hr light-dark cycle. IOP was measured under general anesthesia by a microneedle method.  To evaluate the effects of each drug, a single drop (3 micro liter) of each drug solution was applied topically in a masked manner to a randomly chosen eye. IOP reduction was evaluated by the difference in IOP between the treated and untreated control eye in the same mouse.
Result: The baseline IOP in WT and FPKO, EP1KO, EP2KO  and EP3KO mice were the same and higher baseline IOPs were observed at night.  Maximum IOP reduction was seen in WT mices 3 hours after latanoprost instillation during the day and night.  Three hours after instillation, latanoprost (10.9 and 23.2 % on average, daytime and nighttime, respectively), travoprost (15.9 and 26.1 %), and bimatoprost (8.8 and 19.8 %) significantly reduced IOP in WT mice both during the day and at night. Unoprostone significantly reduced IOP at night (13.7%), and tended to reduce IOP during the day (5.3 %).  In FPKO mice, latanoprost, travoprost, bimatoprost and unoprostone showed no significant IOP reduction. Bunazosin, a selective alpha-1 blocker, which reduces the IOP by increasing uveo-scleral outflow, significantly reduced IOP in both WT and FPKO mice (22.1 and 22.2 %).  Each of the 4 drugs also reduced IOP in EP1KO and EP2KO mice to similar extent as in WT mice, whereas a significantly smaller effect was induced by latanoprost, travoprost and bimatoprost in EP3KO mice.  Pretreatment with topical diclofenac NA significantly attenuated in WT, but not in EP3KO mice.
Conclusion: As far as the effect of a single application in mice is concerned, prostanoid EP1 and EP2 receptors are not involved in the prostaglandin-related compounds-induced-induced IOP reduction, and prostanoid FP receptor plays a crucial role in the IOP reducing mechanism of all tested prostaglandin-related compounds.  Further, endogenous prostaglandin secondary produced by the direct stimulation of FP-receptors may partially contribute to the IOP-reducing effect of these prostaglandin-related compounds through EP3 stimulation.

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