Should you have any questions of any of the talks, please write the questions on the slido below.

Keynote 1 – Prof James Wolffsohn:

Question 1

What is recommendation which Questionnaires could be used to diagnose dry eyes?
The recommended questionnaires for the diagnosis of dry eye disease are the OSDI and DEQ-5, both freely available from the TFOS website.

Question 2

What are the best pharmacologic and non-pharmacologic methods for management DED?
The best pharmacological and non-pharmacological treatments for dry eye along with the evidence base for them are listed in https://www.tfosdewsreport.org/public/images/TFOS_DEWS_II_Management_ther.pdf

Plenary 1 – Dr Monica Jong

Question 1

0.01% atropine is less effective compare to 0.25% in terms of myopia control? Thank you.
There was a typo on the slide it should be 0.025% and I would have said that at the time seaport  the slide typo.
Yes based on the evidence  0.01 % atropine  is less effective in myopia control as atropine has a dose dependent response i.e higher concentration the better the slowing in axial length but the higher the concentration the greater the adverse effects. However 0.025% and 0.05% are reported to have little side effects but we do need to monitor our patients carefully.  Still 0.01% is widely used as it is still considered to show some efficacy at this stage and is a valid treatment until shown otherwise. More work needs to be done in determining optimum concentration.

Question 2

Is it appropriate to prescribe amblyopic children with myopia control lens, (bifocal/multifocal) Which should be tackle first, amblyope or myopia progress?
For amblyopic children, we need to always treat the amblyopia first before doing any myopia control. Myopia control is only performed when you have excluded any other conditions that could be causing the myopia.

Plenary 1 – Afzam Shah

Question 1

Is it crucial to measure axial length in myopia control management. Can we just use myopia power increment to justify the progression?.
The Brien Holden Vision Institute (BHVI) had recently mentioned that the best way to diagnose myopia on children is with cycloplegic refraction. Once the presence of myopia is confirmed, proper myopia management should entails utilizing all the appropriate protocols. When discussing about the monitoring of myopia progression in children, practitioners sometimes just measure the changes in RX. However, according to the BHVI, this is not the best way, particularly because subjective refractions are only about +0.50D accurate. In contrast, axial length measurements are more precise and with certain optical biometers; these can be as accurate as 0.12D (0.04mm changes in axial length). As such, it is recommended that the best method to monitor myopia progression is via optical axial length measurements.

Plenary 2 – Dr Mohd Radzi Hilmi

Question 1

Hai assalamualaikum I want to ask, is it eyemo is classified as artificial tears? Is it true that the constituents in the eyemo may harm the eye? Thank you.
Eyemo is not considered as artificial tears, it just rather an ocular lubricant. Eyemo does not cause harm to the eye, however, it does not provide benefits to the eye other than lubricate it. This is due to its ingredient/formulation in which does not support either treating, protect or even restore the ocular surface. Thus, eyecare professionals should not recommended eyemo to patients as we always want the best for our patients.

Question 2

Based on current research, what is normal TBUT value?
Based on the current research, the normal TBUT value ranges form 4-6 seconds. However, it is worth to note that TBUT are varies especially in low/high humidity environment. We should not took into account the notion of TBUT less than 10 seconds is considered as dry eye. This is because that figure came from western population, in which the climates, environment and working style are different from our population. We need to refer to our own data in order to set the Standard. And I would like to highlight that normal TBUT does not meant the patient is free from ocular surface disorders, and TBUT less than 5 seconds does not meant the patient is having dry eye. A long list of ocular surface disorders does have similar clinical signs of TBUT is low. Please do not over-generalised the meaning of TBUT value, as it just a number. The actual and comprehensive examination of ocular surface more important to note than just relying on TBUT alone.

Question 3

What is the optimum percentage of the HA to increase the viscosity,Dr?
This is a very good question. To explain it here, it would be too technical as it involves the molecular weight (MW) of HA. In a glance, artificial tear containing higher-MW HA might have a greater therapeutic potential, sufficient viscosity, providing hydration, lubrication, and anti-inflammatory properties to protect the ocular surface. Examples of these artificial tears are Optive, Systane and Vismed products, just to name a few.

Viscosity is depending on the co-polymer being incorporated in the formulation. To specifically point what is the optimum percentage of HA to increase viscosity is difficult to answer as each artificial tears comprised of many components, and high percentage (ranges from 0.1% to 0.5%) of HA does not meant it will surely improves viscosity. Glycerin-based viscoelastic components are now showing great potential in improving viscosity (Eg. Optive and Vismed products). Although higher viscosity would provide better protection of ocular surface, it is worth to note that it should stay and remain under the blur threshold (20- to 30-cP). Blur threshold is where patients perceive/report blurry of vision after instilling the artificial tears, which we want to avoid it.

In summary, among artificial tear formulations containing HA, there is great variability in the characteristics of HA. This variability makes it possible to choose the ideal HA-based artificial tear for a patient’s clinical condition. A high-MW HA and higher viscosity without exceeding the 20- to 30-cP blur threshold should, for example, be preferred when patients present with high levels of ocular surface inflammation and epithelial damage. The presence of additional synergistic polymers and a low sodium concentration (within the formulation) may also increase viscosity and performance and, thus, be beneficial. The initial objectives of treatment with artificial tears are to relieve symptoms of discomfort, heal the epithelium, and reduce inflammation, followed by efforts to maintain the tear film quality. The optimal formulation should, thus, be reevaluated as/if the ocular surface changes during follow-up. For instance, higher viscosity products may be desirable to treat ocular surface damage, whereas lower viscosity products may be preferred to maintain tear film stability, but a formulation that can achieve both is likely to be preferred by patients. I would like to apologise for not being able to answer this question straightforward or in simple sentence as there are many things to consider. Feel free to email me at mohdradzihilmi@iium.edu.my if you have any questions.
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Plenary 2 – Prof Chen Ai Hong

Question 1

What are the suggestions to improvise the awareness among optometrist about the importance of seeking continue education throughout the practice?
I always believe that awareness comes from within. When the time comes, we will mature and need to make certain wise decisions to move forward. In addition to that, professional associations and teaching institutions can also play important roles to create awareness. Nevertheless, we have to be innovative and creative in engaging that during this era of big data and IoT. Conventional ways of continuous education might not as impactful as before. Time to do something different.