APAO Beijing - issue 2 by Media MICE

APAO Beijing 2010 Daily_Friday_0428 EWDaily_01-21 ASCRS NEWS_11x15-dl.qxd 9/16/10 5:57 AM Page 1

5th Anniversary Edition The News Magazine of APACRS and COS

Friday, September 17, 2010

Structure vs. function in the diagnosis of glaucoma By Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer

n the first glaucoma session of the 25th APAO Congress, experts took a closer look at the relationship between structure and function in the diagnosis of the disease. Structural evaluation of the optic disc for the diagnosis of glaucoma includes quantitative and qualitative methods, said Liang Xu, M.D., professor, University of Zurich, Switzerland, of the Beijing Institute of Ophthalmology. Quantitative methods, he said, require less experience for the clinician, are easier to explain to the patient, and offer objective results. However, there is a significant overlap between normal and abnormal results. Qualitative methods, on the other hand, offer comprehensive evaluation and may detect other,

non-glaucomatous conditions of the eye. However, these methods require more experience to use and have not been standardized. Dr. Xu described the characteristic pattern of rim loss in glaucoma using what he called the ISNT rule. According to the rule, glaucomatous rim loss is characteristically vertical, preferring inferior (I) and superior (S) rim thinning over nasal (N) and temporal thinning (T). The pattern of rim loss is therefore a good way to differentiate glaucomatous changes from both normal and non-glaucomatous pathologic changes. Ultimately, said Dr. Xu, followup is “most important” in the evaluation of the optic disc for the diagnosis of glaucoma. It can be hard to distinguish glaucomatous from non-

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Beyond ophthalmology: Chinese surgeons perform

Dealing with keratectasia in teens by Matt Young EyeWorld Contributing Editor

ven after one day, the 25th APAO Congress has been many things to many different attendees. There’s one thing it hasn’t been: dull. Theo Seiler, M.D., Ph.D., proved that Thursday during his presentation titled, “Management of post corneal refractive ectasia.” He started by painting a picture of how young the LASIK population has become worldwide, which poses a unique set of challenges. “In young people below 18 years old, LASIK is starting to become considered as risky,” Dr. Seiler said. And yet it’s typical in Cairo, Egypt, for example, for a 16-year-old to opt

for LASIK. “You have to have in your mind that you may oversee a lot of keratectasia,” when operating on a younger patient population, Dr. Seiler said. Today, there are many ways to deal with keratectasia successfully, Dr. Seiler said. Corneal collagen crosslinking (CXL) is an option, as are using stromal rings, he said. “Contact lens wear could work,” he said. “But these patients underwent LASIK because they did not like or could not tolerate contact lens wear.” Corneal transplant procedures (such as anterior lamellar keratoplas-

ty) followed by refractive surgery also are options, he said. Dr. Seiler believes that astigmatism is less than a challenge in these patients than previously. “In penetrating keratoplasty, we would have to leave in sutures for 1.5 years,” Dr. Seiler said. “Now they’re out in a week or so after anterior lamellar keratoplasty.” One way or another, keratectasia has to be dealt with, Dr. Seiler said. “Once you make a decision that there is a progressive central steep island, it means you have to treat it,” Dr. Seiler said. “Otherwise, it will go on and show significant progression.” Dr. Seiler had many good things

to say about CXL, but he also suggested it may be the first in a series of steps to address optimal refractive outcomes after keratectasia. “Crosslinking helps not only to stabilize, but in 40% of cases the conus really is reduced,” Dr. Seiler said. In fact, research has shown that CXL stops keratoconus progression in all cases, he said. Then again, some patients need more than CXL. Dr. Seiler outlined a case in which a LASIK patient received a 3.5 D correction, although there were warning signs. The patient developed keratectasia and then under-

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APAO Beijing 2010 Daily_Friday_0428 EWDaily_01-21 ASCRS NEWS_11x15-dl.qxd 9/16/10 5:59 AM Page 2

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APAO Beijing 2010 Daily_Friday_0428 EWDaily_01-21 ASCRS NEWS_11x15-dl.qxd 9/16/10 6:00 AM Page 3

EyeWorld Asia-Pacific Today / September 17, 2010

Structure vs. function - continued from page 1 glaucomatous changes, but newer methods including the use of OCT devices hold the potential of providing a way to identify not just glaucoma, but other conditions, both ophthalmic and systemic. Current technological developments make use of the methods described by Dr. Xu, and three devices for glaucoma assessment were described in the same session by Ki Ho Park, M.D., Seoul National University College of Medicine, Seoul, Korea He described digital retinal nerve fiber layer (RNFL) photography, the confocal scanning laser ophthalmoscope, and optical coherence tomography (OCT). Digital RNFL photography, said Dr. Park, is a semi-objective method that allows close evaluation of glaucoma, immediate interpretation, and direct adjustment of brightness and contrast. The confocal scanning laser ophthalmoscope images thin slices of the optic structures that allow a three-dimensional reconstruction of the optic nerve head. The problem with this device is that it requires a reference plane. Finally, Dr. Park described time domain OCT, which he said correlates with RNFL photography. The latest development is the spectral domain OCT, which examines all frequencies at once, resulting in higher resolution acquired in less time.

Optic nerve cupping with peripapillary atrophy Source: William Trattler, M.D.

In the functional assessment of glaucoma ocular blood flow has been implicated in glaucoma development and progression. Michael Kook, M.D., Department of Ophthalmology, Asia Medical Center, The Universityof Ulsan, Seoul Korea, examined the role of ocular blood flow (OBF) and glaucoma. Recent studies, he said, provide supporting evidence for such a role, although knowledge of the precise relationship between OBF and glaucoma pathology hasn’t been straightforward. For instance, earlier studies implicated hypertension as a risk factor for glaucoma. Later studies, however, such as the Barbados Eye Study, which looked at patients over nine years of follow up, revealed contrary results: the study implicated lower systemic blood pressure with a higher incidence of glaucoma.

Even more recently, experts have been evaluating the importance of nocturnal hypotension in glaucoma development and progression. Nocturnal hypotension, said Dr. Kook, has a definite negative prognostic impact on glaucoma. Nocturnal hypotension perhaps correlates with optical perfusion pressure (OPP), lower levels of which have been associated with an up to six times greater risk of glaucoma development and progression. Even more important may be the variations in OPP that occur over 24 hours. Dr. Kook noted the limitations of the studies whose results have led experts to this conclusion. For one thing, none of the studies have yet been able to determine whether blood flow changes are primary or secondary in the disease. For another, devices used to measure OBF have their own limitations; specifically, different types of imaging devices are needed to assess different vascular beds in glaucoma. We still don’t know, he said, which vascular beds are most relevant. The development of functionspecific perimetry has given clinicians a new tool for evaluating glaucoma. Lingling Wu, M.D., Peking Univesity Third Hospital, Beijing, China, described two function-specific perimetry developments: frequency-doubling technology perimetry (FDP) and short wave-

length automated perimetry (SWAP). Glaucomatous neuropathy, said Dr. Wu, is essentially retinal ganglion cell death. There are, however, three types: parvocellular, magnocellular, and bi-stratified cells. Standard automated perimetry (SAP), she said, is non-specific for these RGC types. FDP is specific for magnocellular RGCs; SWAP for bistratified RGCS Both FDP and SWAP, she said, detect visual field losses that SAP is unable to detect. However, she added, no single technology is superior in all patients. The same goes for methods used in the analysis of the data gathered with these devices. Chris Johnson, M.D., University of Iowa Hospital and Clinics, looked at various statistical and analytical methods used in studies to detect progression with perimetry. The problem, he said, is that sequential perimetry measurements can sometimes show alternating improvement and worsening of glaucoma. Methods need to be developed to reduce variability, demonstrate larger differences between sequential results, and overall find better ways to analyze the data. For now, he said, all clinicians can do is use all the methods available and include all the information pertaining to each case.

“They are not well educated regarding the cornea and remodeling of the cornea.” Yet during the last eight years, there has been a paradigm shift in corneal surgery to give it much more of a refractive twist, Dr. Seiler said. From CXL to ring segments to anterior lamellar keratoplasty, surgeons have many options to improve keratectasia and leave patients with optimal vision, he said. “Crosslinking is the basis to get a stable situation,” Dr. Seiler said. “If you perform cuts in a diseased cornea, results are very unpredictable.” But if you perform CXL first, and then start to remodel the cornea, things are much more optimistic. “We can stop it [keratectasia],”

Dr. Seiler said. “And we can remodel it [the cornea],” Dr. Seiler said. There are some risks associated with CXL, Dr. Seiler said. “It’s a surgery so you do have some risks,” Dr. Seiler said. “The risks outweigh the benefits by far. And you will end up in a transplant situation if you don’t do anything.” Speaking on a related topic, Dr. Seiler also mentioned that he believes a lot of keratoconus is caused by eye rubbing, which can be passed down from generation to generation. “The father rubbed so the son rubs,” Dr. Seiler said. Therefore, he said, if someone presents with keratoconus, you can help them avoid eye rubbing by giving them fluorometholone for a period of time. “You can make the eye calm enough for the kid to stop rubbing,” Dr. Seiler said.

Dealing with keratectasia - continued from page 1 went CXL. The patient was stable, but still complaining about the issue. Upon requesting further improvement, the surgeon decided to insert a stromal ring segment, creating channels for it with the femtosecond laser. UCVA then improved from 0.3 to 0.8. If the patient wasn’t satisfied, surface ablation could have been an additional option, but he “decided it was good enough,” Dr. Seiler said. So Dr. Seiler considers CXL to be a form of primary management for keratectasia, specifically to stop progression. Secondary management includes contacts, stromal inlays and lamellar keratoplasty that includes customized surface ablation. Remember, after a keratectasia patient undergoes lamellar keratoplasty, they have sufficient tissue then to undergo an additional

refractive procedure like surface ablation. Still, Dr. Seiler said, the best way to manage keratectasia is to prevent it in the first place. Surgeons really must be careful to examine corneal topography before a procedure like LASIK, Dr. Seiler said. In a series of 16 cases of patients that underwent CXL because they had LASIK that resulted in keratectasia, Dr. Seiler said 13 had undiagnosed keratoconus. That means the LASIK surgeon missed this red flag, he said. Pregnancy was an additional factor in two of these CXL cases. In an exclusive interview with EyeWorld immediately following his presentation, Dr. Seiler added that in today’s world, the refractive surgeon is not often a through-and-through corneal surgeon. “That is a pity,” Dr. Seiler said.

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EyeWorld Asia-Pacific Today / September 17, 2010

Bon Appétit in Beijing by Faith Hayden EyeWorld Staff Writer

estaurants in Beijing ooze style and class, even more so than Manhattan or downtown Las Vegas. Dining out is not always cheap, but with good reason; service in Beijing is known to be prompt, attentive, and observant. Beijing may be famous for its Peking Duck and editable oddities such as fried pigs trotters and duck tongue, but the city has considerably expanded its world cuisine offerings in recent years. Just because they’ve built it doesn’t mean you should come, however. Below is a list of restaurants by cuisine that are known to be safe bets for an excellent meal.

bar selections such as lobster, oysters, and shrimp; and a rotating prefix menu.

French

Traditional Chinese

Maison Boulud Location: 23 Qianmen Dong Dajie, Dongcheng District Phone: (10) 6559-9200 Hours: Monday through Friday, Lunch: 11:30 AM to 2 PM; Monday through Sunday, Dinner: 6 PM to 10 PM; Saturday and Sunday (Brunch), 11 AM to 4 PM Website: www.chienmen23.com Price: $$$$ Located in the former American Embassy building, Maison Boulud is a French/American-inspired restaurant from the genius of New York City-based Michelin-starred chef Daniel Boulud. In addition to the restaurant, Maison Boulud features an exquisite bar and lounge decorated in wood and leather, colored by deep mahogany hues and accented with Asian décor. The menu boasts a superb wine list; seafood and raw

Red Capital Club Location: 66 Dongsi Jiutiao, Dongcheng District Phone: (10) 8401-6152 Hours: Monday through Sunday, 6 PM to 11 PM Website: www.redcapitalclub.com.cn Price: $$$ Patrons will feel like they are dining with the Emperor at the Red Capital Club, and that’s exactly what this establishment is going for. Set in a regal old country home that’s decorated to capture a 1950s China with communist paraphernalia from Madame Mao’s red-flag limo to Zhou Enlai’s radios, Red Capital serves imperial fare in a truly unique setting. Patrons can also choose to eat outside in the elaborate courtyard. Reservations are highly encouraged.

Parfum French Restaurant Location: 3/F, Bldg 19, China Central Place, 89 Jianguo Lu, Chaoyang District Phone: (10) 6530-5799 Hours: Monday through Sunday, 11 AM to 11 PM Price: $$$ Parfum is designed for those wanting a full four-course French meal, as the portion sizes are small but the food is savory and well-presented. The décor is all white and super stylish and the waitstaff has a reputation of speaking excellent English.

Beijing Dadong Kaoya Dian Location: Tuanjie Hu Beikou 3, Chaoyang District Phone: (10) 6582-2892 Hours: Monday through Sunday, 11 AM to 10 PM Price: $$ If you’d rather skip the history lesson but still want traditional Chinese cuisine, look no further than Beijing Dadong Kaoya Dian. The restaurant is especially known for its roast duck, which comes in either whole or half portions and includes a side of creative condiments such as garlic, green onion, and radish. Every meal comes with a free fruit plate and dessert. Another bonus: Dadong Kaoya Dian has a nonsmoking room; a rarity in Beijing. Reservations are highly encouraged.

Italian Danieli’s Location: St. Regis Hotel, 21 Jianguomenwai Dajie, Chaoyang District Phone: (10) 6460-6688 ext 2440 Hours: Monday through Sunday, 11:30 AM to 9:30 PM Website: www.stregis.com/beijing Price: $$$ If pasta is more your thing, head on over to Danieli at the St. Regis Hotel where the linguine is homemade by Executive Chef Daniel Kuser. The setting is elegant and demure and an excellent choice for business meetings thanks to its highly attentive waitstaff. The menu is constantly changing but be prepared for traditional Italian pasta dishes such as ravioli, gnocchi, and risotto. Don’t forget to save room for dessert and coffee.

Assaggi Location: Sanlitun Bei Xiao Jie 1, Chaoyang District Phone: (10) 8454-4508 Hours: Monday through Sunday, 11 AM to 11 PM Price: $$ Assaggi spans two floors and is famous for its patio and outdoor terrace and bright and cheerful atmosphere, thanks to its tree-lined roof garden. The décor is minimalist, with stark white furniture and neutral tones used throughout. Assaggi serves moderately priced Italian food, including prefix menus and a la carte items.

Mediterranean Sureño Location: The Opposite House hotel, 11 Sanlitun Road, Chaoyang District Phone: (10) 6410-5240 Hours: Monday through Friday and Sunday 12 PM to 10:30 PM; Saturday 6 PM to 10:30 PM Website: www.surenorestaurant.com Price: $$ Located in the boutique hotel The Opposite House, Sureño is a super trendy restaurant that caters to a young, urban, artsy crowd. The décor is sleek and modern, with dark leather sofas featuring patentleather covered accent pillows and Swedish-style chairs peppered throughout. Sureño offers a wide range of southern Mediterranean cuisines and New World wines. On the menu you’ll find tapas style tuna tartar and foie gras, as well as wood-fired pizza and rack of lamb. Reservations are encouraged.

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EyeWorld Asia-Pacific Today / September 17, 2010

Avoiding 20/20 unhappy patients by Matt Young EyeWorld Contributing Editor

here are unhappy patients – even ones with “good” results - and that’s unavoidable, but it’s important to still seek their satisfaction. That’s according to Michael Lawless, FRANZCO, Vision Eye Institute, Sydney, Australia, who presented on “The 20/20 unhappy patient after LASIK” at the 25th APAO Congress on Thursday. “Make sure they are 20/20,” Dr. Lawless said. Examine residual refractive error, the tear film, the potential for irregular astigmatism, higher-order aberrations, and lens and macula pathology. “Are they contributing to poor quality of vision?” Dr. Lawless said. These are good questions to ask, he said. “By far, the biggest driver of unhappiness is residual refractive error,” Dr. Lawless said. This may be relatively trivial to the surgeon, but it isn’t to the patient, he said. It’s also the major cause of patient unhappiness, he said. If a patient has residual astigmatism, for instance, fix it – for free, he said. If they are unhappy with monovision, further follow-up is warranted, he said. “Some people even after months don’t deal with monovision properly,” Dr. Lawless said. “Sort it out with further contact lens trials. Work out what is their happy point and put them there. Don’t make them live with a result that they wanted to achieve, did achieve, but it was the wrong result for them.” Diagnosing and fixing dry eye issues also is important, Dr. Lawless said. Consider whether they have night halos, Dr. Lawless said. “Deal with the pupil issue,” he said. Consider whether these patients may need a topographicbased retreatment, he said. When things “get ugly,” get a second opinion for the patient, and offer to pay for that opinion, he said. Part of dealing with potentially unhappy patients is recognizing who they are from the get-go, Dr. Lawless said. “Patients with higher scores on depression and negativity scales had a 3-times greater likelihood of being less satisfied with their quality of vision one month after LASIK,” Dr. Lawless said.

Although it’s difficult to determine which patients may be depressed, it requires a discussion. Remember, “chair time” with a patient prior to surgery is preferable to chair time after surgery, he said. Dr. Lawless also suggested that the informed consent paperwork should do more than provide a surgeon with legal protection. It helps to provide a framework for discussion with a patient preoperatively, he said. Although a surgeon’s view of LASIK may be that it is a streamlined process of consultation/clinical exam, procedure, and follow-up, it’s much more than that to a patient, he said. “From the patient’s view, this is a powerful emotional experience full of hope and anxiety,” Dr. Lawless said. “Patients value communication.” Although surgeons may impart technical expertise to their refractive surgery candidates, they may not be aware of both the verbal and nonverbal communication manners they use with patients, he said. “You have to listen more than talk,” Dr. Lawless advised. “Consider a patient’s nonverbal behavior. This is time well spent.” What’s the single worst thing you can say to a 20/20 unhappy patient? “You should be happy with the result,” Dr. Lawless said.

“We say that because we feel defensive,” Dr. Lawless said. “Hope is precious. Give them future options.” In fact, there are more options than ever for refractive surgery candidates. Dr. Lawless cited recent research by Karl G. Stonecipher, M.D., which is a two-part study on myopia and hyperopia topography-guided LASIK. The study found that 73.9% of patients had a cumulative gain in one or more lines of BSCVA. This is important because many patients – if asked – will say that their BSCVA is not perfect with glasses or contact lens wear preoperatively. Yet Dr. Stonecipher found that BSCVA can be improved remarkably, Dr. Lawless said, to the delight of patients. The study also found after topography-guided LASIK decreases in light sensitivity, fluctuation of vision, glare and halos. “Quality of vision was better on a whole line of parameters that correlate with unhappiness,” Dr. Lawless said. Dr. Lawless is excited to see this as part of a drive toward making LASIK as good as “phaco quality.” Meanwhile, Srinivas K. Rao, M.D., senior consultant, Apollo Hospitals, Chennai, India, com-

mented on the “Role of advanced surface ablation,” on Thursday. Similar to Dr. Lawless’s presentation, Dr. Rao’s presentation outlined the many options that refractive patients have available to them for optimal results. Types of surgery discussed included LASIK, LASEK, PRK, EpiLASIK, advanced surface ablation, and others. He suggested that the use of alcohol and also mitomycin C (MMC) during surface ablation can lead to good results. He recommended, for example, using absolute alcohol in a 20% dilution to achieve good results, although there is some technical complexity involved in the procedure. He also said using a solution of 0.02% MMC for 30 to 120 seconds helps promote good outcomes without haze or scarring. In cases of haze or previous haze, Dr. Lawless opts for three minutes of MMC. Others also have reporting using a brushstroke of 0.01% MMC with success, he said. MMC also allows for surgeons to treat beyond 6 D, which would not be possible with surface ablation otherwise, he said. Efficacy and predictability for these higher diopter patients is excellent after use of MMC, he said.

Surgeons have a different view of LASIK than patients, who feel more emotionally impacted by the procedure Source: Michael Lawless, FRANZCO

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EyeWorld Asia-Pacific Today / September 17, 2010

How to stop worrying and love the RCT by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer

t is a constant struggle for clinicians to keep track of the ever-growing volume of information in the medical sciences. Each succeeding generation of clinician has exponentially more information to assimilate than any previous generation. This has resulted in an increased focus on evidence-based medicine; to this end, randomized controlled trials (RCTs) serve a dual purpose: RCTs are constantly being conducted to provide the information that forms the basis for practice, while also providing clinicians with a relatively convenient way to access that information. Paul Palmberg, M.D., Bascom Palmer Eye Institute, began by relating an experience he had as an ophthalmology fellow. Prior to graduating, Dr. Palmberg wanted to be sure

he was ready for practice as a glaucoma specialist. Towards the end of his fellowship, he decided to review the hospital records of his professors’ patients. After studying all the cases, Dr. Palmberg came to the conclusion that advanced cases of glaucoma did better over longer periods with greater, more consistent IOP reductions. If he had looked at the literature, he said, he would have saved himself a lot of effort: he would have found that Paul Chandler had published similar conclusions as early as 1960. At the time, said Dr. Palmberg, Dr. Chandler’s views weren’t very popular, but over time, the science has come to back up his conclusions.

In particular, Dr. Palmberg cited evidence from three RCTs: EMGT, CIGTS, and AGIS. The EMGT study, he said, found that more than 80% of untreated glaucoma cases worsened, and that IOP reductions of less than 35% of baseline constituted sub-optimal treatment, unable to prevent glaucoma progression. Meanwhile, both CIGTS and AGIS found no net progression in visual function defects with IOP reductions of at least 35% of baseline. AGIS further found that consistently maintaining IOP below 14 mm Hg produced better outcomes. Treatment that allowed IOP to fluctuate to levels above 14 mm Hg— even if on average the IOP remained below this level—was suboptimal, allowing net progression of visual field defects.

The 25th APAO Congress kicked off yesterday...

RCTs, said Dr. Palmberg, have other practical uses. In the clinic, he said, he can use relevant RCTs to educate his patients and give them a clearer idea of the steps in the management of their condition. With his lecture on Thursday, Dr. Palmberg kicked off “Glaucoma randomized controlled trials - how have they changed my practice?,” a glaucoma symposium that was a kind of ode to the RCT. At the symposium, experts described in detail how they have refined and continue to refine their practices according to the evidence RCTs provide. In some cases, RCTs provide answers to very specific questions. Discussing cases of normal tension glaucoma (NTG), for instance, Kyung Rim Sung, M.D., Asan Medical Center, Seoul, Korea, sought RCTs to answer the follow-

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EyeWorld Asia-Pacific Today / September 17, 2010

ing questions, each one relevant to her clinical decision making in specific cases: What is the natural history of NTG? Is IOP a primary risk factor? Is IOP reduction effective in preventing glaucoma development and progression? What can be done besides IOP reduction? RCTs, she said, have provided the following answers: NTG progresses without treatment, and RCTs have shown the progression rate of untreated cases; IOP reduction is effective in stopping development and progression of glaucoma; NTG and other types of glaucoma have variable clinical courses, and RCTs have shown some of the risk factors that affect these courses; and prostaglandin analogs, beta-blockers and other agents are effective for lowering IOP.

There is, however, still quite a bit of information that RCTs aren’t yet able to provide, said Dr. Sung. For instance, although RCTs have looked into alternative agents such as ginkgo biloba, she said that IOP lowering remains the main mode of action for the medical treatment of glaucoma. Perhaps most importantly, Dr. Sung pointed out that RCTs on Asian populations are rare, creating a significant gap in medical knowledge. Taking things a step further, Ho Ching-Lin, M.D., Singapore National Eye Centre, and Jimmy Lai, M.D., Eye Institute, The University of Hong Kong, presented specific examples illustrating the effect RCTs have had on their respective clinical practices.

Drs. Ho and Lai each began by presenting their original preferred treatment algorithms for particular cases. Dr. Ho talked about how she used to treat acute primary angle closure (APAC), and Dr. Lai discussed his approach to chronic angle closure glaucoma (CACG). After sifting the literature for relevant information, Drs. Ho and Lai used the new information to refine their treatment algorithms. As with Dr. Sung, neither doctor found everything they would have liked to find in the literature. For the treatment of APAC, Dr. Ho recommended some future directions for clinical trials. She recommended looking into neuroprotection in APAC, understanding the optimal timing of lens extraction in cases of APAC with cataract, and delving

into the role of goniosynechialysis in these cases. At the beginning of his lecture, Dr. Palmberg described the “perfect” RCT. Such an RCT, he said, should address important clinical questions, have an adequate sample size and duration, and should prove that what doctors are doing is beneficial to their patients. However, no matter how technically perfect an RCT may be, it can’t be expected to answer all the questions that arise in the clinic. So, as Dr. Lai said of his own practice at the end of his lecture, all that clinicians can do is continue to refine their approach to treating patients as more RCTs become available.

...with lots of energy, education and entertainment

APAO '" Beijing 2010 Daily_Friday_0428 EWDaily_01-21 ASCRS ( $& % ! "& #) NEWS_11x15-dl.qxd 9/16/10 6:04 AM Page 8

China National Convention Center BEIJING CHINA 2010

Saturday, September 18

Sunday, September 19

Maximizing Cataract Technologies for Today's Surgeon

Refractive Surgery - Driving Superior Patient Outcomes Function Hall B (Level 1)

Room: 309A (Level 3) 12:45 – 13:00 PM Registration and Reception 13:00 – 14:00 PM Program

12:45 – 13:00 PM Registration and Reception 13:00 – 14:00 PM Program

Moderators

Han Bor FAM, MD and Ke YAO, MD, PhD

Moderators

Michael C. KNORZ, MD and John CHANG, MD

Faculty

Y. Ralph CHU, MD Martin A. MAINSTER, MD, PhD, FRCOphth. George H. BEIKO, BM, BCh, FRCSC

Faculty

Zheng WANG, MD, PhD Tong SUN, MD, PhD Marguerite B. McDONALD, MD, FACS

Agenda

13:00