CAKE & PIE POST (C&PE 2021 Edition) - ISSUE 3

Andrew Sweeney

Chris Higginson

Hazlin Hassan

Joanna Lee

Sam McCommon

Maricel Salvador

Russian Irises, and Retinal Oopsies

Myopia on Motorbikes

by Andrew Sweeney

Everybody that felt a little bit bananas at the first ever CAKE & PIE Expo, please say “Aye”. “Aye”. Is it just me? I don’t think so. Well, that’s just the way we like it. And we have to say we’re pretty happy with how the first-ever CAKE & PIE Expo turned out. We got to bring together some of our favorite ophthalmologists from around the world, and also make some new friends from emerging societies and new markets.

From starting the day with cool cataracts, to ending the day with a marvelous masterclass in managing myopia, Day 2 of the Expo had it all. We set up a video vault to keep you completely engrossed with reams of content about all aspects of ophthalmology, perfect for those locked down or looking for some light viewing before bed. The exhibition hall was bursting with virtual booths, and we hope you dropped by to say hello to the Media MICE team. (We locked a couple team

members in there and frankly, we forgot the login information to get them back out, so they’re probably getting lonely and hungry at this point.)

As you’ve probably noticed by now though, Media MICE likes to get noticed and our outlandish costumes and quirky character is definitely a marketing

strategy and a pretty cool one at that. Marketing yourself and your company in ophthalmology is crucial to getting ahead, which was what our very own CEO Matt Young talked about when he hosted the Expo’s Marketing Session: Get Noticed Now, covering all aspects of marketing that people working in our field should know about. The featured guests include Nikki Hafezi, managing director and board member of EMAGine AG (Zug, Switzerland); head of Strategy, Business Development and Licensing at The ELZA Institute (Zurich, Switzerland); and co-founder and managing partner of the Light for Sight Foundation (Zurich, Switzerland), as well as optometrist, social media influencer and brand ambassador Dr. Kristie Nguyen. For now you can watch the recording of this lively session at Media MICE’s YouTube Channel

From Russia with insight into the iris

Now the Media MICE team has a lot of hidden talents, even if they cannot successfully extricate themselves from a virtual booth. Your current writer sadly doesn’t have any superhuman abilities (besides his ability to tell any single malt whiskey apart by smell alone), but he can speak Russian. Therefore he was very excited to attend the Russian Ophthalmology Society (ROS) Presents Reconstructive Surgery and More! while

perusing through the day’s events. Russia’s ophthalmology expertise is extraordinary, and it was awesome to welcome the ROS to attend our Expo, so we hope you were able to drop by their booth in the exhibition hall!

A particular highlight of this symposium was the first presentation by Dr. Marina Shanturova of the S. Fyodorov Eye Microsurgery Federal State Institute (Irkutsk, Russia). She focused on the perils of damage to the iris, including diaphragmatic dysfunction, double vision and reduced visual acuity, and provided some fascinating insight into the history of Russian contributions to iridoplasty development. She recommended localizing iris defects, identifying the presence of synechiae, and monitoring changes in the actual structure of the iris.

One of the last events of the day was ORBIS Singapore Session: The Myopia Epidemic in Asia Pacific, and you’ll know from our recent content just how much of an issue short-sightedness is in the region. It’s an emerging epidemic of staggering proportions, and it was awesome to see some of the brightest minds in myopia management coming together to share their experiences and ideas about what can be done to tackle this disease. It was also pretty cool to see our CEO Matt Young change in a phone booth from his banana suit in the marketing session to his “candyland” suit in an Orbis-supported session. As for which is the superocular costume – well,

we’re still scratching our heads at that – and that a phone booth even exists in 2021.

Prevention really is the best cure

Dr. Nathan Congdon, a professor at the Queen’s University Belfast in Northern Ireland, spoke about how glasses are a first line of defence against myopia, and that providing free glasses can help to slow visual decline if administered early. He described how India has a national policy of free vision screening in children, which highlights the country’s correct strategy of focusing on prevention. He also pointed to a study called STABLE in which young myopia motorbike drivers are provided with free glasses to reduce road injuries and deaths in Vietnam, and if successful, will lead to tougher vision requirements for licensure.

A special shoutout to our friends at the Vitreo Retina Society of India (VRSI) who held their own in a session titled, When Retinal Disasters Happen, and More, which covered some fascinating aspects of retinal treatment. We already wrote a specific review about this event (which you can find on page 16), so make sure you give it a read and watch the session.

The same goes for all the participants of both sessions entitled Get Smart: On Education & Attitudes in Ophthalmology, which offered some fascinating perspectives on ophthalmic treatment. We learned that chocolate could have a role in glaucoma treatment, and consumed some brutal yet highly informative reports on ocular trauma in South Africa. These sessions are not to be missed, you can find them on Track 1 of Saturday’s streams.

So kudos to all for attending what we’re hoping will become the global premiere event in ophthalmological awesomeness, where everyone can come together to trade the latest news about everything, from cataracts to macular edema, and where everyone will be compelled to wear a banana suit costume. Remember, the revolution will be available on our social media channels, so make sure you keep following our Facebook and LinkedIn accounts for the latest news on all things eyeballs. In the meantime, it’s been marvelous friends, and thank you for coming.

We’re not sure this is the most effective way to control myopia…

Rolling out Retina Updates with Dexamethasone, iOCT and AI

There is adequate evidence to support the use of intravitreal dexamethasone in diabetic macular edema (DME), according to an expert panel on DME management in the Asian population.

The findings were presented during Saturday’s session on Rolling Out Updates in Retina, moderated by vitreoretinal surgeon Dr. Kenneth Fong, from OasisEye Specialists in Kuala Lumpur, Malaysia.

The right therapy for the right patients

An expert panel of 12 retinal specialists from Singapore, Malaysia, the Philippines, India and Vietnam found that dexamethasone treatment particularly applies to patients who are pseudophakic; those who are anticipated to have poor compliance in follow-up; patients who have been previously vitrectomized; or who have undergone cataract surgery, said Dr. Augustinus Laude, from National Healthcare Group Eye Institute in Singapore.

Intravitreal (IVT) dexamethasone implants are effective in treating persistent DME, both in vitrectomized and nonvitrectomized eyes, and vitrectomy does not influence the efficacy and safety profile of IVT dexamethasone.

He advised that patients who receive IVT dexamethasone should be informed and counseled about possible cataract formation, which typically will become evident about one to two years following treatment.

“Used as adjunctive or combined with intravitreal dexamethasone following cataract surgery is a good option, and helps manage post-surgery recovery quicker, and also minimizes or reduces the risk of postoperative worsening of macular edema in diabetic patients,” he said.

by Hazlin Hassan

In addition, some patients are non-responders to anti-VEGF, he noted. Switching from anti-VEGF to dexamethasone has been shown to provide better improvement compared to switching within anti-VEGF class.

Next generation iOCT

The next generation EnFocus (Leica, Wetzlar, Germany) intraoperative optical coherence tomography (iOCT) helps surgeons by providing better precision and speed during surgeries, said Dr. Barbara Parolini from Eyecare Clinic, Bresica, Italy, during her presentation on The beauty and usefulness of imaging with intraoperative OCT

“With the Leica system, the surgeon has more freedom to use it with the foot pedal, and the scans are long with different shapes and sizes, so you can play with your notes,” she said.

EnFocus iOCT provides greater insight during eye surgeries, allowing surgeons to see what lies underneath the surface. This helps surgeons overcome uncertainties during eye surgeries in order to achieve the best possible patient outcome.

EnFocus iOCT can also help answer questions, such as: Is there residual subretinal fluid? Is the glaucoma drainage device in the correct position? Is the corneal graft in the correct orientation?

Further, one of the greatest challenges in vitreoretinal surgery is how to judge residual retinal traction. The EnFocus helps ophthalmic surgeons focus on perfection during surgery, with better visibility compared to the microscope.

“The advantages of the EnFocus iOCT is confirmation of what we see with the microscope, as well as the ability to see what we do not see with the microscope,” she added. “It can really change the strategy of your surgery and improve your surgery.”

Bring on the AI

More algorithms for detecting uncommon retinal diseases are in the works as artificial intelligence (AI) applications are increasingly being used in ophthalmology — especially at a time when face-to-face consultations may be limited.

Models for predicting diabetic retinopathy (DR) progression to increase screening intervals are important in the post COVID-19 era, said Dr. Paisan Ruamviboonsuk from the Rajavithi Hospital in Bangkok, Thailand, during his talk on Updates in artificial intelligence for retinal diseases

Currently, the use of AI primarily concentrates on diseases with a high incidence, such as DR, age-related macular degeneration (AMD), glaucoma, retinopathy of prematurity, age-related or congenital cataract, and retinal vein occlusion.

AI plays a role in common retinal diseases as a screening tool for DR or AMD in populations at risk, as an assisting tool for DME and wet AMD detection, as well as monitoring and decision-making in clinics and research.

For AMD, OCT images still play a major role in AI with the aim of early detection of wet AMD conversion or monitoring treatment.

“More algorithms on detecting other relatively uncommon retinal diseases are on the way,” concluded Dr. Ruamviboonsuk.

Be An Artist, and Eat Chocolate for Glaucoma

by Andrew Sweeney

We all know that ophthalmology is characterized by the intelligence of its practitioners — no medical field has bigger brains. You, the reader, are definitely one of the smartest fellows around (and we know this because you’re reading an article about the CAKE & PIE Expo). So thanks for that, because we only want to bring the next level of knowledge to our friends out there.

While we can all agree that our industry is bursting full of absolute clever clogs there’s one other idea we should all hold the same perspective on, and that is further education.

Like Tyrion Lannister said in Game of Thrones (remember how good that show was until the writers butchered it?), “a mind needs a book like a sword needs a whetstone”. The best way to keep our next-level minds as sharp as a blade is to keep educating them.

Get Smart: On Education & Attitudes in Ophthalmology, Part 1, was one of the first symposiums on the Day 2 of our Expo. This session, which is available to view online (so go and watch it, it’s awesome) offered a deep dive into further education in ophthalmology, the best theories on treating trauma patients, and alternative toolkits for dealing with common diseases. The latter point included a recommendation for chocolate which was pretty cool.

A surgical maverick

The first presenter was Dr. Arun Gulani of the eponymous Gulani Vision Institute (Jacksonville, Florida). Described on his website as “the James Bond of eye surgery,” Dr. Gulani presented From Surgeon to Artist to Maverick, an overview of his experience and the lessons he’s learned from interacting with patients. He emphasized that patient satisfaction — and not surgical landmarks or

chart indexes — should be the most important mark of success.

Dr. Gulani emphasized the importance of artistry in ophthalmic surgery, describing transplants as often being brutal, and warned against the overuse of stitches and automated procedures. Furthermore, Dr. Gulani used the analogy of going from Orlando to Paris via Iceland while explaining his surgical process to patients, as sometimes vision might diminish before getting better at the end of the treatment process. Overall he strongly emphasized the importance of creating strong emotional bonds with patients.

Nobody wants a knife to the eye

Dr. Sanushka Moodley of the Pretoria Eye Institute (Pretoria, South Africa) was up next, speaking about her time working in rural South Africa. She worked in the O.R. Tambo District, which is blighted with high levels of alcohol-fueled crime. Of the traumatic injuries she frequently deals with, penetrating trauma and blunt injuries caused by knives and bottles were most frequently encountered.

Dr. Moodley stated that these wounds have high morbidity and blindness risks due to late referral and distance

from medical facilities: Of 398 emergency ophthalmology admissions over two years, she reported that 63.7% were open globe injuries and 73.5% were due to assault. Dr. Moodley concluded that the regulation of alcohol consumption is necessary to reduce the amount of trauma.

Go ahead, eat more chocolate

Dr. Moodley’s presentation was very informative but rather gory, so after viewing it you may find yourself wanting to comfort yourself with some chocolate. Well fortunately for you, the session’s last speaker, Dr. Sahil Thakur, from the Singapore National Eye Centre, was on hand to help. His presentation was all about how chocolate, tea and meditation can be used to help alleviate glaucoma.

For starters, Dr. Thakur pointed out that in one study, patients administered with dark chocolate experienced an increased dilation of retinal vessels. For tea, one study found that one cup of hot tea per day reduced the risk of glaucoma by up to 74%. Finally, he said that meditation has been linked with lower intraocular pressure and higher quality of life in glaucoma patients.

On Global Education, Keratoconus and the Many Hats of Ophthalmology

by Brooke Herron

Although “democratize” can mean a democratic system, it can also mean making something accessible to everyone — in this case, education, said Dr. Ken Nischal, division chief of Pediatric Ophthalmology, Strabismus and Adult Motility at UPMC Children’s Hospital of Pittsburgh (Pennsylvania, USA). He is also the executive co-director of the World Society for Pediatric Ophthalmology and Strabismus (WSPOS).

“Our ethos [at WSPOS] is that expertise resides all over the world … make it so everyone feels like they have a voice that needs to be heard,” said Dr. Nischal, adding that the WSPOS membership is free — and that’s democratization. “Everybody has an equal voice.”

WSPOS holds webinars and having speakers from local, individual regions not only increases local pride but also the desire to exchange ideas and train each other, he continued.

“Democratizing global education has been a seismic shift thanks to WSPOS: There is no membership fee, it has nontraditional funding streams, it has no president or secretary with a shallow slope of hierarchy,” he shared. “If we are going to democratize education, it has to be free, participants have to feel valued and therefore, expertise must be recognized to be equal all over the world.”

Keratoconus to 20/20: Think outside the cone!

“Keratoconus shouldn’t scare you,” began Dr. Arun Gulani, chief surgeon and founding director of Gulani Vision Institute in Jacksonville, Florida,

before delving into some of the cases he’s encountered.

“Crosslinking confusion is tremendous — I have patients who come to me, angry at what’s been done to them at different places in the world,” he said. “You don’t want to crosslink any level of cornea and put the patient in a contact lens — that’s not a service. Crosslinking and leaving patients dependent on contact lenses and disabled vision is not an achievement at all.”

Therefore, he says to raise the bar: “If you still need residual contact lenses that’s fine — but at least aim for the patient’s vision freedom … and there’s no level of astigmatism or keratoconus that you cannot correct.”

He then shared his Gulani 3T System: I always look at my vision Target first, then I decide what Technique I want to do, and last of all is Technology Further, he described his “5S” system for patient examination which includes: sight, scar, shape, strength and site. “You want to do the least intervention with the best vision outcomes.”

“In my 5S system, to correct all these issues (hyperopia, presbyopia, astigmatism, anterior corneal scar, high keratometry, pseudophakia without open capsule) I need one particular surgery and that’s myopic laser ablation.”

Further, every keratoconus case can be divided into structural and visual. “Do not confuse yourself with gradings and severities, and what you can and cannot do,” he continued.

From fez to fedora: The many hats of ophthalmology

“There’s a lot of different ways you can provide ophthalmic care and make an impact in our industry,” said Dr. Cathleen McCabe, chief medical officer at Eye Health America in Easley, South Carolina.

These “hats” include: research; teaching/mentoring; medicine and surgery; specialty organization involvement/leadership; developing technology/industry partnership; expert opinion and consulting; and community outreach and missions.

She shared that giving back is the most fulfilling thing she does: “Missions, in my opinion, allow you to hone your skills by having to be comfortable in a variety of environments,” she said, adding that these trips often inspire new ideas and approaches. One such organization is Sight for Life, which helps the underserved in St. Vincent and the Grenadines.

“In the end, you want to find the hat (or hats) that fit you best: Find your passion and try on as many hats as you can to find the one that you find most fulfilling,” she concluded.

Experts Shed Light on Some Hot Anterior Segment Topics

In the Piping Hot Anterior Segment Topics session, four ophthalmologists shared their wisdom and experience on the best tricks they’ve found in treating anterior segment conditions. We cover the highlights below.

On presbyopia management

During her presentation, Dr. Sheetal Brar from Nethradhama Eye Hospital in Bangalore, India, focused on how she manages presbyopia in her practice.

Previously, Dr. Brar’s clinic used conductive keratoplasty, but they found that this technique had a high rate of regression, with almost complete reversal in patients after 12-15 months. Today, Dr. Brar uses PRESBYOND® LBV (Carl Zeiss Meditec, Jena, Germany) to treat presbyopia. This therapy uses an increased depth of focus and a micromonovision protocol where the dominant eye is targeted for emmetropia, and the non-dominant eye is targeted for myopia of approx. -1.5 D.

By correcting the depth of focus of the dominant eye (allowing it to focus nearer) and also correcting the depth of

by Chris Higginson

focus the non-dominant eye (allowing it to see distance), this technique creates an intermediate zone between the two eyes, known as a “blended zone,” where both eyes can see well.

In addition, because the brain receives two images — one with good near vision and one with good distance vision — the brain is able to merge both images to provide a single, clear image overall.

Unusual situations in cataract surgery

During his presentation, Dr. George Beiko from the University of Toronto, Canada, shared six tips for unusual situations in cataract surgery.

For example, to minimize induced astigmatism with an internal corneal incision, use a 6 mm L-Shaped scleral pocket incision. This allows for a stable anterior chamber (AC) and controlled wound management — and most importantly, does not cause significant postoperative astigmatism.

When making a corneal incision there are three standard procedures: a 6 mm

straight incision; a 6 mm frown incision; and a 6 mm inverted V incision — all of which cause around a diopter of astigmatism. However, it’s possible to make a L-shaped scleral pocket incision and avoid the risk of astigmatism.

To do this, first make a 3 mm incision at the limbus, then extend 3 mm to create the first L. Next, dissect into the cornea a further 3 mm, then laterally 6 mm, posteriorly 6 mm and medially 3 mm, creating a large L shape (or a square with one quarter missing). Fortunately, sutures are rarely needed to close this incision as it is fairly self-sealing. The result in closely followed cases showed no induced corneal astigmatism with this technique.

Plus, it’s safe, allows for a stable anterior chamber and controlled wound management, as well as no significant induction of postoperative astigmatism, continued Dr. Beiko.

Another tip he covered was how to manage corneal astigmatism in patients with no access to toric IOLs. Dr. Beiko shared that corneal astigmatism is prevalent in the cataract population; however, not all patients can afford or have access to toric IOLs.

Therefore, there are two strategies to employ depending on the amount of astigmatism. For the smaller amounts, Dr. Beiko recommends using opposite clear corneal incisions, which is a simple and effective technique that can deal with low levels of astigmatism.

In patients with larger amounts of corneal astigmatism, he recommends using the Conoid of Sturm and targeting refraction so that the post-op sphere is 0.25 D greater than the cylinder. Using this approach, good distance and near vision can be achieved, with distance vision at 20/50 or better uncorrected.

He continued that every year in the U.S. alone, approximately 250,000 radial keratotomy (RK) procedures are done, creating a lot of headaches for surgeons. RK is particularly challenging because it flattens both the anterior and posterior corneal surfaces in the small, central optical zone. Thus, the effective optical zone diameter is significantly smaller than the measurement zone of standard keratometry.

However, none of the standard calculations and formulas for RK are perfect, as they all involve taking averages from measurements surgeons are able to take. Dr. Beiko said that the OCT-based formula and True K were comparable to the Double-K Holladay 1 method on the ASCRS calculator, so all three can be used — although no formula was able to predict 80% of eyes within 1 D of target refraction at more than 3 months postoperatively.

We should bear in mind that RK incisions tend to swell even after the gentlest of phaco surgeries; this causes transient central flattening of the cornea and hyperopic error, he continued. Therefore, ophthalmologists should aim for myopic initial postoperative refraction. It’s important to remember that intraoperative aberrometry is not helpful; to use monofocal IOLs; and to do the non-dominant eye first, then adjust the dominant eye, depending on outcome.

In summary, use IOLmaster K’s (Alcon, Geneva, Switzerland) and enter the value into “average central power” on the ASCRS calculator. Target myopia should be based on the number of incisions and allow one week per incision for refractive stability — and be prepared for subsequent surgeries.

Further, Dr. Beiko shared a quick way to extend the measurement range of manual keratometers. Simply tape a trial lens sphere in front of the aperture. By placing a +1.25 D sphere in front, the range can be increased from 52 to 59 — and by placing a –1 D sphere in front,

we can increase the range from 36 to 31. Easy!

“Occasionally we have patients who make it difficult to measure their K’s,” said Dr. Beiko. In order to deal with this problem, Dr. Beiko has created a formula using a mixture of population averages and measurements from the patient: 43.5 (the average pop K) – patient’s true refraction pre-cataract + measured axial length = patient’s keratotomy estimation.

When Dr. Beiko checked his calculations, he found that in 75% of cases the calculated cases were within 2 D of measured K.

Thanks to a recent study, we know that the keratoconus induces steeper corneas which creates a greater hyperopic effect, so we need to target more myopia. For example, in a patient with a K of 53, we may need to target between 2.5 and 3 D of myopia in order to have a good outcome.

Exchanging IOLs

Dr. Harvey Uy, medical director at Peregrine Eye and Laser Institute in Makati, Philippines, spoke about the role of modular and exchangeable intraocular lenses (IOLs).

He said that an IOL is needed that allows us to exchange the optic at any time after the primary procedure. This

allows surgeons to correct premium IOL optic intolerance, visual disturbance or areas of refraction. The concept is a multi-piece design, where the refractive element can be exchanged for another with the correct power, or to a monofocal or multifocal lens, if necessary. By using an IOL with an exchangeable base, the lens can be swapped without removing the base component and therefore maintaining the same effective lens position.

Dear glaucoma diary...

Dr. Sahil Thakur from the Singapore Eye Research Institute (SERI) shared how glaucoma diaries can improve drug compliance and patient outcomes.

He said that a physical glaucoma diary is a low-tech solution to recording glaucoma problems, treatment and medication, and often works well in the developing world where patients don’t always have access to a computer. Useful information, like a log, patient and physician information, as well as FAQs, and a guide to how to administer eye-drops should be included; there are versions for both children and adults, as well. There is also an online diary, which has all the function of a physical diary, but also includes prompts for appointments, informative videos that increase compliance, as well as links to more information.

All colors of the rainbow are exhibited here. Nice work C&PE exhibitors! Thanks for coming!

Enhanced Refractive Screening with Scheimpflug Imaging

Getting the Whole Picture

by Sam McCommon

Getting optical imaging right has always been one of the most important challenges in ophthalmology. Now, we’re blessed with the most advanced tools the world has ever seen. The OCULUS Pentacam® (Wetzlar, Germany) is an ophthalmic miracle, and allows for imaging abilities that our ancestors could have only dreamed of. When used in conjunction with the OCULUS Corvis® ST, ophthalmologists have access to biometric data, including tomography and topography, that can be paired with new AI systems to help detect eye defects before they begin.

Three speakers led us through this fascinating discussion: Prof. Renato Ambrosio, who manages his own clinic in Rio de Janeiro and is professor at the Federal University of the State of Rio De Janeiro; Prof. Rohit Shetty, vice chairman at Narayana Nethralaya, Bangalore, and Dr. Riccardo Vinciguerra, of the Humanitas San Pio X Hospital in Milan, Italy.

Together, these doctors led us through some fascinating cases of enhanced refractive screening techniques, and showed us that what appears to be readily apparent isn’t what’s always true.

Diagnostics for refractive surgery

Prof. Ambrosio first led us through enhanced diagnostic methods for ectasia — which, while rare, certainly is still an

issue. A large part of his talk focused on ectasia susceptibility, which he helps diagnose with the OCULUS Pentacam®

For reference, the Pentacam® provides a very appealing user interface and allows for significant customizability. It certainly has helped Prof. Ambrosio make advances in determining the risk factors for ectasia.

The pathophysiology of ectasia depends on biomechanical decompensation of the cornea. This comes from innate corneal resistance and impact from the environment, including laser vision correction (LVC) procedures and eye rubbing.

Eye rubbing, you say? Yes, surprisingly. Eye rubbing came up multiple times during this discussion — eye rubbing leads to a greater incidence of ectasia and keratoconus than, well, not eye rubbing. A study presented later on the topic even compared two identical twins, one of whom had developed keratoconus — attributed to eye rubbing. Sometimes, in medicine, the simple answer is the correct one.

The OCULUS tools used provide biometric, topographic and tomographic data. Together, these doctors rely on all three measurements to determine potential cases for ectasia and keratoconus. In many cases, a patient may be susceptible to ectasia despite

apparent normality — and biometric data gathered can help determine the risk factor.

New metrics: The CBI-LVC Index

Dr. Riccardo Vinciguerra has developed a new, valuable index to help determine risk cases for ectasia: the Corvis Biometric Index-Laser Vision Correction (CBI-LVC) index. This can be found in the updated version of the OCULUS Corvis® ST, and helps doctors make rapid decisions as to who might be a risk factor for ectasia.

It’s pretty amazing how the data for the algorithm was created. Dr. Vinciguerra had to find 685 stable post-LVC patients and 51 post-LVC patients with ectasia — and then measure the differences. The results may appear subtle, but they stand out to the algorithm like a red flag.

A semi-automatic approach using the technology can help a doctor combine their own observations with the algorithm’s insights; the fully-automatic version requires only biometrics, and not tomography.

Biomechanics and collagen

Prof. Shetty led us through a discussion of collagen and biometrics — and how biometrics can come to the rescue. As he described it, he’s attempting to decode confusion in biometrics — there’re multiple blind men trying to describe an elephant by feeling its parts, but no one is getting the full picture.

The biometrics are getting closer, however, and biomechanics may have the full picture indeed. As he described it, the truth of a patient’s situation lies at the crux of biomechanics, topography, and polarized-sensitive optical coherence tomography (PSOCT). This gives a full view of not just the topographic or the tomographic structure of the eye, but the collagen structure that binds it all together as well. In some cases, what looks like a problem may not be — and vice versa.

All in all, the data and value provided by the two OCULUS tools is indisputable, and we heap the highest kudos on these physicians for their explanations of its uses. This is a whiff of what’s to come, and we can’t wait for more.

A puzzle only makes sense if you can see all the pieces.

The Next Generation

NEW Pentacam ® AXL Wave

The first device to combine Scheimpflug Tomography with Axial Length + Total Wavefront + Refraction + Retroillumination

The new Pentacam® AXL Wave is a reliable partner for your refractive and cataract practice, creating the best prerequisites for surgery, based on pre-op metrics, and providing post-op measurements for reliable monitoring, in just one device ! With high-end hardware and software for optimum treatment and satisfied patients, the new Pentacam® AXL Wave makes no compromises on quality.

A Spoonful of Ophthalmic Research? More Like a Wheelbarrow!

by Sam McCommon

discussed. However, Dr. Volker Patzel, assistant professor at National University Singapore (NUS), led us down a completely different — and fascinating — rabbit hole.

Dr. Indu Pal Kaur is the real deal. She has multiple patents in India and the U.S. to her name, six of which are in ocular delivery. She was also a U.S. Fulbright Fellow in 2017, and was awarded the women’s best scientist award in 2018 by the Organization of Pharmaceutical Producers of India. She’s got plenty of other awards and publications under her belt. The point here? When she talks, we listen.

Controlling IOP with novel patented nano-designed implants/gels

Dr. Kaur shared two of her patented technologies with us for glaucoma treatment. One major problem she set out to tackle was the weakness of conventional ocular formulations. For example, many eye drops have poor bioavailability due to many factors — for example, simply blinking — or from lackluster patient compliance to treatment regimens. There are plenty of other factors, including corneal factors, but the point is the method of administration could be better. Similarly, ointments lead to blurred vision or partitioning, and suspensions can lead to irritation when particles are bigger than 10 nm.

To improve these problems, Dr. Kaur proposed nano-colloidal ocular drops as a solution — and it makes a lot of sense.

These drops act as controlled-release systems that maintain therapeutic drug concentrations over a prolonged period of time. There are minimal systemic losses due to the good bioadhesive properties found in the nano structure and polymers, which increase the residence time of the drug on the corneal surface. This helps overcome the need for repeat administration, leading to better compliance — which also makes them cheaper.

They’re easy to administer as drops, or can be used as injections or implants, which can extend the release of the drug

up to several weeks or months.

A good example of this is the in situ gelling mucoadhesive systems of Timoptic XE, which form a semi-solid gel on the ocular surface.

Dr. Kaur has developed Autoclavable Nanovesicular Composition to improve issues related to nano vesicular systems. One of the most valuable aspects of this system is that it produces sterile products. The ones she made were specifically characterized for ocular suitability and were confirmed for safety in vitro and in vivo. The example medicine she used was Bimatoprost (BMT), which is a well-tolerated and cost-effective choice for glaucoma. They can lower IOP by 6.5-8.9 mmHg. However, there’s poor patient adherence to frequent dosing instruction.

The autoclavability of BMT as a preservative-free, single-use gel will avoid the side effects of repetitive application of drops containing BAK, which include irritation.

Another system Dr. Kaur developed is solid lipid nanoparticles (SLNs). We’ll need to delve into these more in another, full article, but here’s a brief overview.

These lipid particles are dispersed in water, leading to significant drug loading of both hydrophilic and lipophilic drugs, which leads to enhanced drug permeability. These are biodegradable, safe, economical, and rely on simple production techniques. They freely disperse in the aqueous. They interact with glycoproteins of the cornea and conjunctiva to form a depot of the drug, and interact with the outer lipid layer to increase their residence in the conjunctival sac.

Mitochondrial DNA therapy of optic neuropathies

Most people assume nuclear DNA is the topic at hand when gene therapy is being

Mitochondrial DNA (mDNA) encodes 37 genes as compared to the roughly 47,000 in nuclear DNA. It’s maternally inherited. For a fun fact, there’s a concept in the anthropology/ biology community of a “Mitochondrial Eve,” meaning the ancestral mother of all living humans.

For now, there are no robust DNA repair mechanisms for mDNA. As Dr. Patzel pointed out, however, 1 in 5,000 people are affected by mitochondrial diseases, which primarily affect the brain, muscles, heart, and eyes. While mitochondrial gene therapy could provide treatments, it doesn’t yet exist due to the lack of an efficient mitochondrial delivery vector.

A solid example of an ocular mitochondrial disorder is Leber’s Hereditary Optic Neuropathy (LHON), which we’ve covered before. For reference, there’s a prevalence of 1:30,000 to 1:50,000 in Europe — so while not common, it’s not exceedingly rare either.

So, how do you target mDNA? It’s a tall order.

Consequently, Dr. Patzel introduced us to the concept of computationally designed vectors to deliver large circular singlestranded DNA — i.e. RNA — into the mitochondria of HEK293T cells. Notably, no upper size limit has been observed for the vector or its cargo.

Dr. Patzel has also investigated a nonviral dumbbell-shaped DNA delivery vector to change mDNA — which shows significant promise. Its minimal size leads to improved delivery, while its lack of free ends leads to exonuclease resistance. It’s not immunotoxic and is redosable, and has no extragenic sequence, leading to no transgene silencing.

We really look forward to getting deeper into this in a further look in PIE or CAKE magazine. Be sure to stay tuned, because there’s much more to come here.

Fear, Frustration and Staying Sane During COVID-19 Period

by Hazlin Hassan

The session by the Young Ophthalmologists Society of India (YOSI) brought together young surgeons from around the world for a lively and enlightening panel discussion on Ophthalmology Training, Education and Practice During A Pandemic.

One devastating side effect of the COVID-19 lockdowns is that they have caused the aggravation of the severity of eye conditions in some people.The worst impact has been seen in cases where delayed treatment has led to vision loss.

Eye disease worsened

“I lost an eye and a life during the pandemic, because during the first few weeks of the lockdown in March 2020 I was scared to go out, so I cancelled my clinics. I finally decided to retrofit my clinic with air purifiers, exhaust fans and vents. Then on my first clinic day, a patient with orbital lymphoma came in with more extensive lymphoma and he had no vision anymore,” said Dr. Charisse Sanchez-Tanlapco, from the Philippine Network of Young Ophthalmologists.

Following that, she saw a pediatric patient with retinoblastoma and recurrent retinoblastoma who also failed to undergo treatment due to the lack of public transport during the lockdown.

“Because of that, I vowed never to miss my clinic again, despite periodic lockdowns, despite surges in COVID-19 cases here in my country, because we have them every now and then. It’s like a vicious cycle.”

Training and education was disrupted

Disruptions arising from the COVID-19 pandemic have also caused difficulties

for ophthalmology students, due to fewer face-to-face interactions.

“Among my residents, I think the normal stresses of personal and professional life have been compounded with the fears and anxieties of the pandemic,” said Dr. Sanchez-Tanlapco. “I’ve seen an initial decline in their academic performance, and I think that the learning curves are much steeper, with less face-to-face interactions, fewer cases and surgeries, because we’ve been cutting back on surgeries.”

New roles and hobbies emerged

Dr. Wong Chee Wai (Dr. Wong) from the Singapore Society of Ophthalmology, talked about his experience in being deployed to screen asymptomatic patients for COVID-19.

“We were seeing about 100 patients a day, and about 90% of these turned out to be positive for COVID. There was actually a lot of anxiety and fear among us, in terms of whether we would actually catch COVID-19 ourselves, but I guess our infectious control procedures were quite rigorous and we were safe,” he shared.

While the pandemic has caused a lot of upheaval, one benefit is that more people found time to discover new hobbies, which helps to offset pandemic-related stress and improve one’s mental health.

Dr. Hung-Da Chou from Taiwan, said he was an outdoor person before the outbreak and focused on marathons, triathlons and mountain climbing.

“It never occurred to me that I would be doing yoga at home. During the past few months, I have taken up many online yoga courses, and I found it to be extremely helpful. It not only trains your

core muscles, but it also calms the mind, and improves posture.

“If you take a walk around the operation room, you’ll find most of the ophthalmologists, their posture during the surgery is very bad,” he continued.

After practicing yoga, he found himself adjusting his posture during clinics and operations, resulting in less stress neck and muscle aches.

“There are many good applications online, so you can just use your phone and do yoga, at any time, in your own home. It’s a very good exercise for the whole pandemic era.”

Meanwhile, Dr. Mayse Alkilany from the Young Ophthalmologists of Jordan, said: “I believe, during the pandemic, ophthalmology students just tried to keep ourselves centered and sane, and tried to find a bit of serenity, amid all the chaos that was going on. I found myself reading more, catching up on my fictional reading.

“I found out that I really like to do a lot of deadlifts, so I’ve been increasing my weights. I have started painting, I’m not that good at it but it is just some catharsis and keeps you centered and takes your mind off of stuff.”

And those are some really good tips on how to stay sane and positive during these challenging times.

Myopia in China Management

Perspectives from Young Ophthalmologists

by Brooke Herron

Worldwide, myopia is an epidemic — however, it’s most prevalent in Southeast Asia and China. During the session Eye Care Thought Leadership from Chinese Young Ophthalmologists — (supported by He Vision Group), five ophthalmologists shared their thoughts on its causes, prevention and treatment.

Can youth visualize the future?

“In the year 2050, myopia prevalence will reach nearly 70% globally — this is quite alarming and it worries me a lot. Not only from the clinical perspective, but it’s also a big economic burden to countries who have large myopic populations,” said Dr. He Xingru.

In China, the rate of college-aged students with myopia is 60%, and that’s steadily increasing. “I don’t have direct evidence that it comes from this technology [smart phones and devices], but undoubtedly, smart devices really changed the way we use our eyes … and I personally believe there is some association in the increase in myopia before and after 2008 [when smartphones were introduced],” he shared.

The eye and stem cells: The path to treating blindness

Could stem cells be the answer to treating the myopia epidemic? During her presentation, Dr. Zhang Mingqi discussed the possibility of using human retinal progenitor cells to counteract the

threat of serious eye conditions associated with high myopia.

“Intravitreal injection of human retinal progenitor cells (hRPCs) is a safe and effective way to delay the process of retinal degeneration, which may be via the paracrine function of transplantation of hRCPs,” she said.

Myopia susceptibility and gene screening in China

Gene screening is one tool to determine who might become myopic. The causes of myopia are multifactorial, and Dr. Hu Lan shared that there are two main factors that lead to myopia: genetic/ nature (i.e., ethnicity and family history) and environment/nurture (i.e., near work, posture, illumination, lifestyle and nutrition). For example, if both parents are myopic, the chance of their children being myopic is seven times higher.

“If we combine the genetic factor of two myopic parents with the factor of ‘higher education’ the risk factor is an astonishing 52 times higher than those without those risk factors,” she shared. Higher education is often associated with more near work using computers and reading.

But who should pay more attention to environmental factors and which factors should be changed first? “This is where gene testing can help us,” said Dr. Hu Lan.

China’s national training base for the prevention of blindness

During her presentation, Dr. Yan Chunhong explained the various issues with access to eye care in China. In addition, training and education of optometrists and ophthalmologists is also not consistent.

Because of these issues, in 2012, the first China National Training Center for the Treatment and Prevention of Blindness was established in the He Eye Hospital, which is supported by the government, as well as NGOs. Here, surgeons receive vital training in different surgical techniques including cataract, as well as refractive training.

“Now, we would like to join hands with other organizations, not only in China, but also NGOs from other countries to duplicate this Chinese model in other countries,” concluded Dr. Yan Chunhong.

Ora in China

ORA is the world’s leading ophthalmic research organization, which is expanding into China.

“Our vision for the future is to create vision beyond what we can see and to use our company as a force for good,” said Dr. Peng Wang, vice president of Ora China. “We would like to expand our ophthalmic global expertise into the Chinese market and bring true value to customers, to bring innovative products to meet unmet medical needs for Chinese patients.

“To achieve this goal, first we will provide high quality data compliant with local regulatory requirements. Second, we will provide specific study design with innovation and skills. Third, we will expand OraNet into China … lastly, we will apply our worldwide learnings in China working with our global teams,” added Dr. Wang.

The Russian Ophthalmology Society (ROS) Arrives in Splendor

by Sam McCommon

We were honored to be supported and visited by the Russian Ophthalmology Society (ROS), one of the world’s oldest and most prestigious societies, dating back to 1885. None other than their Society President Prof. Boris Malyugin, joined us today to fill us in on the society’s background and current status.

The ROS has 80 regional divisions and more than 8,000 members across the vast expanse of the country. In a thoughtful move, the ROS brought us ophthalmologists from the Asian reaches of Russia — from Khabarovsk to Irkustk, to Novosibirsk and Yekaterinburg.

For reference, the ROS meeting is the biggest ophthalmic event in Russia, occurring every four years. It usually attracts between 1,500 to 2,000 attendees — though in 2020 more than 6,400 ophthalmologists participated in the first ROS online conference. Hey, we’re all getting into the online conference thing, right?

The ROS is a full member of the International Council of Ophthalmology (ICO). They’re closely tied with many other national societies, including those in China, India, Israel, and Brazil.

For reference, their website is www.oor.ru. We recommend you pay them a visit.

Iris damage and treatment options

You may not be surprised to learn that you need your iris to see. Doctors from the ROS provided us with significant information and treatment options for damaged irises, with Dr. Marina Shanturova leading the charge.

Iris damage is no joke. It can lead to diaphragmatic dysfunction, spherical and chromatic aberrations, double vision, photophobia, reduced visual acuity, cosmetic defect, and, unexpectedly, psychological effects.

Iris defects have two sources: congenital and acquired. Tactics for iridoplasty include the nature and localization of the defect, pupil diameter and shape change, the presence of synechiae as well as their extent and localization, and changes in the structure of the iris.

U-shaped iridoscleral sutures for iridodialysis corrections, and the sewing machine technique for the same condition — the name of which we just love. She also shared a video of an artificial iris implantation of aniridia, which is truly impressive. For reference, iridoplasty is one of the main stages of complex surgical treatments of traumatic injuries of the eye — a crucial step to say the least. Words can’t do these videos justice, so, y’know … watch the techniques. They’re seriously impressive.

Primary inferior oblique muscle overaction

The enchanting Dr. Varvara Pushchina next led us to an overview of eye movement abnormalities, especially related to strabismus. Essentially, the inferior oblique muscle can pull the eye to over-elevation in adduction. This is known as Classification of Eye Movement Abnormalities and Strabismus (CEMAS) and can lead to eyes that look, well … off.

There can be no vertical deviation in primary cases, or significant vertical deviation in secondary cases. The onset of a primary case, for example, is usually around 1-2 years of age. She noted that if amblyopia is present, it’s safer to restrict surgery to the amblyopic eye.

Surgical options depend on the degree of adduction. At less than 15°, chemorecession is the preferred option. Between 15-19°, Z-shaped or double marginal myotomy is the way forward. From 20-22°, W-shaped or triple marginal myotomy is suggested — and upwards of 22°, myectomy is the choice.

Dr. Shanturova won an award at the Asia-Pacific Association of Cataract and Retina Specialists (APACRS) for her presentation on challenging cases and cataract complications in micro-invasive surgery in the treatment of patients with congenital coloboma of the iris and cataract. So, she deserves our full attention.

She presented several techniques that we highly recommend watching. These include knot sutures and whipstitch cerclage suture for mydriasis correction,

The success rate of all these procedures hovers around 90%, with chemorecssion being 91.6% successful, marginal myotomy 86.8% successful, and myectomy 93.9% successful. These procedures all led to minimal side effects.

We look forward to delving further into the presentations from our Russian friends in later articles — and can’t wait to meet them again at our next conference.

VRSI Insights on Retinal Errors and the Use of Glue

by Andrew Sweeney

We all make mistakes and one of the best ways we can improve ourselves is by learning from our errors. It’s a normal part of life, and even though ophthalmology is bursting full of nextlevel geniuses, sometimes mistakes do happen. What’s important is two key factors: Firstly, how we react to a foulup (ideally with a calm and humble attitude); and secondly, what we learn from the experience.

This way we can improve as an individual, and everyone from writers to ophthalmic surgeons can become better. With that sentiment in mind, the Vitreo Retina Society of India (VRSI) held When Retinal Disasters Happen and More, a session covering how retina specialists can learn from worst-case scenarios, as well as avoid them. If you work in this field (or any other area of ophthalmology) and want to understand how best to act in medical adversity, this seminar is something you’ll want to watch.

Those sneaky IOLs

The first speaker was Dr. Hussain Khaqan of the Lahore General Hospital in Pakistan, who discussed his work on providing emergency surgery to solve acute issues, including cataracts and displaced intraocular lenses (IOL). One case he covered showed a procedure to retrieve an errant IOL, which was difficult as it included a risk of seriously damaging the patient’s eyesight. However, it was performed successfully with a good visual acuity outcome. Dr. Khaqan also reported on successful procedures he carried out to retrieve a dropped nucleus, again with success.

Just use glue

Dr. Mudit Tyagi, head of Uveitis & Ocular Immunology Services at the LV Prasad Eye Institute in Hyderabad, India, followed with Glue Assisted Vitreoretinal Surgery for Rhegmatogenous Retinal Detachments, which he called GuARD. Dr. Tyagi described how this process uses tamponade agents to provide surface tension across retinal breaks to prevent further fluid flow into the subretinal space. He recommended the use of fibrin glue, which is a mixture of aprotinin, fibronectin, and plasminogen.

Retinal disease and COVID-19

Next up was Dr. Ritesh Narula, a senior consultant in vitreoretina at the Centre for Sight in Delhi, India, who described his facility’s efforts to cope with the added pressure of the COVID-19 pandemic. He stated that several retinal conditions were reported in tandem with infection with the coronavirus, including venous stasis retinopathy and acute macular retinopathy, as well as optic neuropathy. He recommends performing fundus examination in post-COVID-19 patients, especially in those who had been on prolonged steroids or with visual symptoms like blurred vision or floaters.

Mapping the best IOL location

Last but by no means least, was Dr.

Vishal Agrawal, an ophthalmologist based in Jaipur, India, who described how the different techniques used to glue an IOL are best summed up by the old maxim “all roads lead to Rome.” Dr. Agrawal emphasized that the best location to place an IOL is always in the capsular bag and that intraoperative complications, subluxated lenses and congenital conditions can lead to insufficient capsular bag support, so these are issues that clinicians should be mindful of.

With regard to the glue that leads to the Italian capital, he stated that sutureless IOL fixation techniques are the future of secondary IOLs as they offer reduced morbidity and decreased postoperative adjustment.

Like many of our Expo events this particular session ran overtime — which to be honest, we’re flattered about, as it highlights just how engaged the participants were, so kudos! We wanted to highlight the presenters in particular, but also, shout outs to moderator Dr. Subhendu Boral for leading the discussion at the end of the event, as well as Drs. Shobhit Chawla, Raja Narayanan, and Dr. Anand Rajendran for their spirited contribution.

Addressing the Myopia Epidemic in Asia-Pacific

by Brooke Herron

Eye care practitioners in Asia-Pacific are well aware of the myopia epidemic and its resulting impacts on society. Below, we explore some of these implications.

Myopia: A call to action

“Myopia is one of the biggest health challenges in the 21st century,” began Dr. Monica Jong, executive director of the International Myopia Institute, BHVI, in Sydney, Australia.

Uncorrected refractive error (URE) matters because people are pushed into poverty — they cannot work and they cannot get educated because they cannot see properly, she continued.

“Today MMD is a major cause of permanent blindness in China, Taiwan, Japan, Denmark and the Netherlands,” said Dr. Jong. High myopia is a risk factor for myopic macular degeneration — where every diopter of myopia increases the risk of vision impairment and blindness.

Myopia epidemic: Managing the long game

“Quality of life is all about health, wealth and quality of life,” said Mr. Richard White, managing director of OCULUS Asia. “If we don’t have good health, we don’t have any money and we don’t have a good quality of life.”

So, what can be done? “The governments have to get involved, mass screenings need to be done and we need to start managing these patients,” he continued, noting initiatives already underway by government leadership in China, Vietnam and the Philippines. “As we see throughout Asia, the governments are getting involved and this is what needs to continue.”

Who should be screened? “As soon as they hit that school-level age of 6-yearsold, this is really when we need to get them in. The more you screen, the earlier you can catch it and the more you can

start working to fix these things,” said Mr. White.

Why eyeglasses?

“My team has been working to achieve sustainable development goals (SDGs) for many years now,” shared Prof. Nathan Cogdon with ORBIS International and Zhongshan Ophthalmic Center in Guangzhou, China.

His presentation focused on ENGINE: Eyecare Nurtures Good health, Innovation, driviNg safety and Education, which aims to assess the specific ways in which eye care delivered at crucial moments across the life-course can help achieve SDGs.

“As we talk about this, it’s important to ask ‘why glasses?’ when eyecare involves so many interventions,” he continued. This is because the majority of the target population needs either near or distance refractive care and doing trials for diabetic retinopathy (DR), glaucoma, or even cataract, would be impractical. Prof. Cogdon then provided details on frou ongoing trials: CLEVER in India, STABLE in Vietnam, THRIFT in Bangladesh and ZEAL in Zimbabwe (check out his presentation on demand for more!).

Pathologic myopia and its complications

Dr. Wong Chee Wai, a consultant in surgical retina at Singapore National Eye Centre (SNEC), presented on complications of pathologic myopia. These can include posterior staphyloma, myopic macular degeneration (MMD), myopic CNV, and myopic foveoschisis and macular hole. He then showed how these complications appear in various imaging platforms, as well as their potential therapies.

“You can see staphyloma in up to 50% of all eyes with high myopia,” he explained, adding that there are various causative factors and unfortunately there

are still no specific treatments for this condition.

Regarding MMD, it is the main sight-threatening complication of high myopia; meanwhile myopic CNV can be treated with antiVEGF. For patients with myopic foveoschisis, surgery is indicated when complicated by foveal detachment.

The future in optical management

Australia-based optometrist Dr. Oliver Woo — who rocked an awesome panda costume during his talk — discussed optical options for myopia management in 2021 and beyond. One option? Contact lens correction, which includes orthokeratology and soft contact lenses.

“When we look at orthokeratology lenses, they definitely require proper training and understanding in lens design and fitting procedures,” explained Dr. Woo. To fit these lenses, both a topographer and slit lamp are required.

“The main purpose of orthokeratology is the reduction of axial length and refractive error progression,” he continued. Results have shown that these lenses provide significant results in slowing down myopia progression — which can also prevent retinal and ocular health complications.

Working together for the greater good

“It’s critical that optometrists, as well as ophthalmologists, work together to combat myopia. In Singapore, we’ve been working quite well synergistically in managing childhood myopia because orthokeratology has been practiced by our optometrists and then our ophthalmologists essentially focus more on the atropine aspect of therapy, so both sides focus on different aspects of myopia control,” shared Dr. Wong. “If optometrists and ophthalmologists work closely, then we can monitor patients for side effects and complications, particularly in regard to orthokeratology and atropine use.”

“I believe optometrists and ophthalmologists can really work together and learn from each other [in myopia management],” concluded Dr. Woo.

Dr. Vaibhab Sethi

Dr. Reena Sethi

Prof. Gemmy Cheung

Prof. Mark Gillies

Dr. Alejandro Filloy Rius

Dr. Jay Chhablani

Dr. He Wei

Dr. Victor Chong

Dr. Ken Fong

Dr. Sjakon Tahija

Dr. Alay Banker

Dr. Saad Waheeb

Dr. Sahebaan Sethi

Dr. Athanasius Nikolakopoulos

Prof. Dr. S. Natarajan

Dr. Richard Packard

Dr. Waiching Lam

Dr. Aditya Sethi

Dr. Hudson Nakamura

DAY 2 Did this many speakers come to C&PE? What were they thinking? Run, run away while you virtually still can!

Dr. Paisan Ruamviboonsuk

Dr. Renato Ambrósio

Dr. Rohit Shetty

Dr. Sanushka Moodley

Dr. He Xingru

Dr. Yan Chunhong

Dr. Mayse Alkilany

Dr. Apoorva Ayachit

Dr. Volker Patzel

Dr. Augustinus Laude

Dr. Barbara Parolini

Dr. Arun Gulani

Dr. Sahil Thakur

Dr. Zhang Mingqi

Dr. Hu Lan

Dr. Charisse Sanchez-Tanlapco

Dr. Jubaida Aquino

Dr. Indu Pal Kaur

Dr. Raja Narayanan

Dr. Anand Rajendran

Dr. Ritesh Narula

Dr. Hung-Da Chou

Dr. Jeremy Kwok

Dr. Diva Kant Misra

Dr. Digvijay Singh

Dr. Vishal Agrawal

Dr. Hussain Khaqan

Dr. Mudit Tyagi

Dr. Shobhit Chawla

Dr. Wong Chee Wai

Dr. Sonal Kalia

Dr. Ashraful Huq

Dr. Subhendu Boral

Dr. Monica Jong

Richard White