A Meeting of Minds APAO Congress 2024

The Asia Pacific region, with its vast population and diversity of eye disease, contributes to some of the world’s most important research into eye health, making the APAO conference an important meeting of global minds on the annual calendar.

mivision went along to soak up the atmosphere and catch up with local ophthalmologists and suppliers.

From the line-up of taxis and mini vans outside the Bali Convention Centre, to the throngs of ophthalmologists manoeuvring their way through the tightly packed exhibition space, and queuing to attend lectures and wet labs presented across 17 conference rooms by hundreds of speakers, it was clear that APAO 2024 was going to be an event to be remembered.

Themed ‘Beyond all limits’, the conference officially opened with a vibrant cultural performance that expressed “the voice of Bali” before Dr Mohamad Sidik, Congress President, welcomed delegates to “the biggest ophthalmology congress in 2024”.

Dr Sidik described APAO as an “opportunity to share knowledge, exchange ideas and create a network by building lasting relationships and partnerships”.

Professor Ava Hossain, President of the APAO, described the scientific program as “exceptionally educational and world class”.

Budi Gunadi Sadikin, Minister of Health for the Republic of Indonesia was the guest of honour at the official congress opening. A nuclear scientist by training, he was a banker before becoming Health Minister 18 months ago and said the government role had opened his eyes to the extent of vision impairment and blindness in the world and also in Indonesia. In Indonesia, he reported there are over 8 million people with vision impairment and 1.6 million with blindness.

Minister of Health Budi detailed “the biggest Indonesian healthcare reform”, which includes reforming primary health by equipping villages with digitised screening tools (15 million people have already been screened and a target has been set to screen 200 million people by the end of this year); reforming hospitals by equipping them for early disease screening that will enable the implementation of prevention strategies; making it easier (and more attractive) to conduct clinical trials and research; reducing the cost of healthcare, medical devices and medicines to improve access to health care; building the health care resources (currently across 540 cities, only 150 have ophthalmologists); and digitising healthcare data in an effort to create population-based data that will enable evidence-based change.

Concluding his speech on an inspirational note he quoted Helen Keller: “The only thing worse than being blind is having sight without vision”.

SCIENTIFIC PROGRAM

APAO provided delegates with an extraordinary scientific program, described by Scientific Program Committee Chair Professor Dennis Lam as “the heart and soul of the meeting”.

Over 3.5 days, delegates were able to take a deep dive into areas of interest with presentations and wet labs presented by peers from around the world.

Despite almost 8,000 delegates in attendance, with 17 educational streams running concurrently alongside an extensive trade exhibition, many of the sessions were intimate enough to enable easy sharing of ideas.

Professor Andrew Chang AM, who holds the role of Deputy Secretary General of the APAO executive, said there is growing global interest in the scientific research emanating from, and real-life clinical experiences of ophthalmologists in the Asia Pacific region.

“Eye disease affects eyes in different ways. For example, whereas age-related macular degeneration is common among Caucasian eyes, in Asia patients are more likely to develop polypoidal choroidal vasculopathy.  “And Asian populations are increasing in all regions of the world, making it necessary for ophthalmologists working in Australia, New Zealand, Europe, the United States, and the Asia Pacific region to have access to this knowledge,” he said.

“We also have a lot to learn from ophthalmologists performing small incision cataract surgery in developing countries with high need and stretched resources. We can also learn from the strategies adopted by Asian countries managing the massive challenges of conditions like myopia and diabetes.”

Interest in the region is not just among practitioners. Pharmaceutical companies are increasingly running large population-based studies in the Asia Pacific population.

SPOTLIGHT ON THE PACIFIC

While it’s easy to focus on the vast population of Asian countries, Prof Chang said it is important not to forget about our Pacific neighbours.

“One of the roles of the APAO is to advocate for eye health services and education in the Pacific, which is so under resourced. RANZCO had a prominent presence at APAO and was actively advancing the focus on countries like Fiji and Tonga.”

PLENARY LECTURES

The plenary lectures were presented by some of the world’s most noteworthy ophthalmologists, among them Professor Martine J. Jager, from Leiden University in the Netherlands, who is recognised for actively developing ophthalmology internationally and throughout the Asia Pacific region. Prof Jager referenced the global world we live and study in, using this as a stepping stone to her work, which has explored the influence of iris colour on the behaviour of uveal melanoma (UM).

In the Netherlands, UM is common and it kills 50% of patients. World-wide, people with blue eyes have a higher chance of getting UM.

There is no clinical difference in the characteristics of people with blue and brown eyes, however, chromosome 3 and 8q aberrations had a larger influence on survival in patients with a light iris than those with a brown iris. Seventy to 80% of people who have monomsomy 3 (i.e. just one chromosome 3) will die of ocular melanoma, however we don’t know exactly why. She said iris colour should be taken into consideration when calculating a patient’s risk for developing metastases.¹

Bringing it back to her audience at APAO, the majority of whom were Asian, she said just because light eye colour is especially characteristic in Europe, that doesn’t negate relevance in Asia. “Survival of people with brown eyes is better than in blue, however people are getting older so we will see more disease in Asia, they will have less chance of dying from these tumours, but it is important to be aware that this tumour is a dangerous one and very difficult to diagnose in people with a dark eye.”

Early treatment may prevent metastases and belzupacap sarotalocan is a new virus-like drug with promise, especially when combined with light activation.

Associate Professor Jason Yam, from the Chinese University of Hong Kong, presented the De Ocampo lecture.

Recognised as an expert on myopia and children’s eye diseases, Assoc Prof Yam has pioneered work on low dose atropine eye drops in myopia control and myopia onset in children.

He said because of the complications associated with high myopia, “When we are doing myopia control, we are helping to prevent future blindness”.

Assoc Prof Yam’s research team conducted a population-based study looking at the myopia prevalence of children aged six to eight, covering the periods before, during, and after COVID-19 restrictions. Results showed the prevalence of myopia in young school children in Hong Kong reached a record high after the strict pandemic rules were lifted, with the rate doubling in children aged six.²

He listed the four major interventions to slow myopia progression as being increased outdoor time, pharmaceuticals, optical methods, and red light therapy. His team has launched a study to investigate the efficacy and safety of combining low-concentration atropine eyedrops with red light therapy on young children aged four to 12.

RECOGNITION AND AWARDS

Dr Deepshikha Agrawal from India was recognised for her extraordinary contribution to countering cataract blindness, helping make eye care accessible for all and contributing to the eradication of blindness in central India. She co-founded the MGM Eye Institute in India, which has examined 800,000 patients and performed 100,000 surgeries. Dr Agrawal presented the Susrtuta Lecture.

Professor Syed Modasser Ali was presented with the Arthur Lim award by Sydney’s Prof Chang. Recognised as an ophthalmologist with exemplary leadership, teaching and training skills, Prof Modasser Ali was described as “a pioneer in many ways”. He is the author of the first textbook on eye health, editor in chief of the Bangladesh Ophthalmic Journal; and cofounder of the first private ophthalmology clinic in Bangladesh. Prof Modasser Ali delivered the Arthur Lim lecture and, despite being 82 years of age, it was clear that his passion for improving eye health for Bangladesh’s marginalised population remains undiminished.

Bangladesh has a population of 169.6 million, the majority (61%) is aged 15–64 years with just 5.18% over 65 years and 27.21% 0–14 years. Around 30 million people in Bangladesh live below the poverty line. While increased literacy has helped improve health outcomes, Prof Modasser Ali said there is much to be done at a community level, and this is slowly happening with the establishment of community clinics and local training.

Concluding the lecture, Prof Modasser Ali quoted Prof Lim, “If you operate on one man you restore vision to one man, but if you teach your colleagues how to perform quality cataract surgery, they will solve the problem of cataract blindness in the world”.

LOCALS IN ACTION

With around 60 Australian and New Zealand ophthalmologists speaking at the Congress, there was plenty of local influence. At a Medcontur symposium, Dr Brian Harrisberg joined Dr Mun Wai Lee from Malaysia and Dr Joaquín Fernández Pérez from Spain to discuss their experiences with a range of intraocular lenses (IOLs). Comparing the Liberty EPS 1.0 and EPS 2.0 for presbyopic correction, Dr Harrisberg said 33% of patients with Liberty 1.0 still require glasses for computer use whereas everyone is glasses free with Liberty 2.0. Patients with Liberty 2.0 experience less dysphotopsia and enhanced intermediate vision when compared with EPS 1.0. There’s no escaping some glare, however in his experience this is the least amount of glare in multifocals due to the fact that there are only seven defractive rings in the Liberty lens, and patients adapt. However, he emphasised the need to know the details of the patient’s cornea pre-operatively because not all patients are suitable for multifocal IOLs, particularly if they have higher corneal aberrations.

In a second presentation at the symposium, Dr Harrisberg described the 1stQ AddOn IOL as “your get out of jail card” that can be implanted in the sulcus when a patient has an IOL in the capsular bag which is not providing satisfactory vision. It comes in a toric design or a multifocal design as well as sphere-correcting for refractive errors. The 1stQ has four haptics for reliable fixation, which stops rotation. Dr Harrisberg advised to implant it cautiously and slowly to ensure each haptic unfolds.

Dr Patrick Versace, from Sydney, presented at a Johnson and Johnson sponsored symposium alongside Professor Tae-Young Chung from Korea, Dr Rohit Shetty from India, and Dr Mahipal Sachdev from India.

The panel members discussed their experiences with the Elita platform, which is used to perform SILK – a laser eye surgery that creates a thin lenticule of tissue below the surface in the cornea, which is then removed through a small incision.

Describing the Elita as “a platform for the future”, Dr Versace said its success comes down to the delivery of energy to the cornea: “energy optimisation is so important”. By minimising the spread of energy, the Elita minimises any disturbance to the corneal structure, so “we get happier and calmer corneas”, which ultimately enhances healing and achieves better vision.

He said the platform is “wide open now for development because of the ability to move the lenticule once you’ve docked (the laser)”. With SILK refractive surgery this enables the lenticule to be aligned with the visual access and to compensate for astigmatism, which is “super important to improve predictability”. Additionally, it opens the door to a second lenticule for enhancement if needed “because you now can align your second lenticule perfectly with the first one… rather than doing PRK enhancement”.

With the ability to move the position of the cuts once you’ve docked, the Elita could potentially be used for intralase enabled keratoplasty, corneal ring implantation, and hyperopia correction.

Optometrist Jennifer Rayner spoke at a symposium on dry eye. The co-owner of Alleve Dry Eye clinic in Adelaide, Ms Rayner described dry eye as “the disease of the century” and the second cause of ophthalmologic consultation after visual acuity. She said patient education and early treatment are both essential to avoid severe dry eye. All patients affected by dry eye disease should be treated, including those undergoing glaucoma treatment with drops, contact lens wearers, patients with allergy, patients in pre- and post- ocular surgery, patients under intravitreal injections, menopausal women, screen workers, and teenagers with excessive screen use. Dr Rayner went on to discuss Lumibird Medical’s full suite of dry eye products for diagnosis and treatment, which includes the C.Diag for diagnosis, C-Stim intense pulsed light device, treatment accessories, and tools for patient communication.

Alongside the lectures, as Dr Colin Chan from Sydney said, there was valuable learning to be had in the hallways and trade exhibitions, where delegates would bump into colleagues and exchange ideas about their experiences with, and approaches to, different aspects of ophthalmology.

ON SHOW

With almost 8,000 delegates in attendance, Congress exhibitors had the Asia Pacific market in the palm of their hands.

Johnson and Johnson MedTech Vision launched the Tecnis PureSee intraocular lens (IOL) with Tecnis Simiplicity Delivery System at APAO 2024 in Bali. The Country Manager of Surgical Vision ANZ, Blake Thomas described this purely refractive presbyopia correcting, extended depth of focus (EDOF) lens as “designed for peace of mind. It’s easy to use, giving patients high image contrast when it counts, in all lighting conditions with a low level of dysphotopsia.

We have also seen high patient satisfaction scores post implant,” he said.

Developed with assistance from clinical investigator eye surgeons in Australia and New Zealand, who have been quoted as citing this lens as a “game changer” at APAO, Mr Thomas said he was excited at the prospect of launching the IOL to the ANZ market towards the middle of the year and is already having positive conversations with ophthalmologists who are eager to find out more about its potential.

Topcon Healthcare was promoting a new ultra-widefield attachment for its Triton optical coherence tomography device. While currently only available in Japan, this attachment will be available in other regions and countries soon. The company was also showcasing its Eye-light Espansione, a non-invasive treatment for most ocular surface conditions from dry eye disease induced by meibomian gland dysfunction, to Sjögren’s syndrome.

Mary Gazis, Global Clinical Training Specialist at Topcon Healthcare, said the event was an excellent opportunity to bring Topcon’s product specialists, application specialists, sales representatives, distributors, and dealers together from around the world for training and team building, and to provide a meeting point for the doctors.

“The doctors come to our stand to specifically meet their sales reps or distributors and have product demonstrations,” she said.

Babak Asgari from Optain said APAO was the best trade show he’d experienced during his 20- year career. Describing the flow of delegates as “non-stop”, he said he’d come to APAO hoping to find two or three potential distributor leads for the company’s artificial intelligence screening platform, but had come away with many more, and was looking forward to signing them on in the coming weeks.

INDIA AND BEYOND

APAO moves to a different country each year and in 2025 will take place in New Delhi, India. With increasing global interest in variants of eye diseases common among people from Asia Pacific, Prof Chang said we can expect that future congresses will continue to grow and to attract ophthalmologists from around the world.

References

1. Wierenga, A.P.A., Brouwer, N.J., Jager, M.J., et al., Chromosome 3 and 8q aberrations in uveal melanoma show greater impact on survival in patients with light iris versus dark iris color, Ophthalmology, 2022 Apr;129(4):421–430. DOI: 10.1016/j.ophtha.2021.11.011.
2. Chinese University of Hong Kong, CUHK study reveals prevalence of myopia in children has reached record high in Hong Kong Number of myopic children aged six is double after COVID-19 restrictions Low-concentration atropine eyedrops with red light therapy study launched (media release, 30 August 2023), available at: med.cuhk. edu.hk/press-releases/cuhk-study-reveals-prevalence-ofmyopia-in-children-has-reached-record-high-in-hong-kongnumber-of-myopic-children-aged-six-is-double-after-covid- -19-restrictions-low-concentration-atropine-eyedrops-withred-light-therapy-study-launched [accessed March 2024].