By Sofia Rokerya, MBBS, MRCOphth, FRCSI
Speakers at MIGS (L-R) Subash Suthar, Divya Mathews, Sajjad Ahmed, Dan Lindfield and Boris Malyugin.
This two-day international conference encompassed various subjects pertinent to glaucoma. After the welcome brief was extended by hosts Keith Barton and Nick Strouthidis, the meeting kicked off.
Day 1 – Session 1: ‘Glaucoma as the political football’. Leon Herdnon of Duke Eye Centre, USA gave an insight into the American Health System, Prof Ningli Wang spoke about the exploding demand of eye care in China and Boris Malyugin highlighted the Russian innovations in ophthalmology. Declan Flanagan, the Medical Director of Moorfields Eye Hospital, voiced the unanimous anxiety on NHS staffing post-Brexit, urging the government and GMC to adopt a more flexible approach towards the recruitment of international health workers.
Session 2: ‘Glaucoma as a worn-out nerve’. Mark Moster compared the apoptotic neurodegeneration in Glaucoma to Alzheimer’s and Parkinson’s, while Jost Jones from Heidelberg discussed the variety of PPAs in eyeballs with long axial length. He also talked about the dynamics between CSF pressure and glaucoma, emphasising the association of low CSF pressure in NTG. Michael Gerard from Singapore presented his eyebrow-raising research of biomechanical damage to glaucomatous optic nerve related to ocular movement.
Session 3: ‘Glaucoma as a business’. Dan Lindfield from Surrey advocated NHS and private provider collaboration for service delivery, Diani Siriwardena advocated virtual clinics and artificial intelligence to solve the workload crises and Divya Mathews eloquently defended the efficiency of integrated NHS in wales. Later, Winnie Nolan highlighted the challenges of a limited resource global setting and Micheal Coote gave us his pearls of how to run a glaucoma private practice.
Session 4: The Debates. Here the participants disputed the following motions: IOP is balderdash; Phaco is detrimental to the success of glaucoma surgery; Trab has no role in angle closure; and Standalone MIGS is the first line surgery for POAG. The house was divided in opinion and each one of the motions had its opponents and supporters.
Day 2 - Session 1: ‘Forget OCT, glaucoma is an anterior segment disease’. Ocular Surface Disease current and future treatments were highlighted by Sajjad Ahmed. Boris Malyugin furnished useful tips on phacodynamics and pupil dilating devices useful in glaucomatous eyes. Tom Samuelson advocated microinvasive glaucoma devices, for lowering IOP and Marlene Moster of Wills Eye Institute Philadelphia spoke about an innovation – a sensor placed in the angle for 24-hour IOP monitoring. Chelvin Singh, a Fellow from Singapore, spoke about challenges and barriers to innovation, sharing the experience as the team set about to develop the Paul Glaucoma Implant. The last speaker of this session, Micheal Coote spoke about cost-effectiveness of change.
Session 2: ‘Will the Skynet glaucoma module ever be self-aware?’ The first speaker of this session was Adnan Tufail. He gave a comprehensive talk on how the data could help us apply benchmarks, monitor outcomes and apply prediction in improving patient outcomes and bring change to our practice. Anthony Khwaja explained how genetic data could be utilised to identify glaucoma risk. David Crabb, an optometrist, spoke about the value of data in identifying high-risk glaucoma. Micheal Gerard spoke about the structural deformity of optic nerve head and glaucoma progression. Danny Mitri of Royal Free Hospital spoke about crowdsourcing, and Felipo Medeiros did a presentation about his innovative device of portable N goggle perimetry. We felt that the practical use of this device remains questionable.
Session 3: ‘Case based nightmares and clinical dilemmas’. The newer kids on the block presenting their cases were Andrew Scott, Sally Ameen, Ahmed El Karmouty, Jing Wang, Jibran Mohammad Noriega, and the senior panellists offering advice and guidance were Keith Barton, Micheal Coote, Mark Moster, Nick Strouthidis, Leon Herndon and Marlene Moster.
Each of the sessions was followed by a chair-led interactive discussion. During the conference there was a talk highlighting the role of International Glaucoma Association in support of patients and clinicians given by Subash Suthar. The meeting was funded via the educational initiative of Thea Pharmaceuticals. The reverberating theme was broadening horizons and international collaboration. The participants shared information, technology and skills hoping to bring about better and safer future outcomes for glaucoma patients around the globe.