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First Joint Singapore eye research institute andarvo meeting on research in vision in ophthalmology
February 6-9, 2003, Singapore
Peng Khaw
The SERI ARVO meeting held in Singapore was the first time that ARVO held a meeting outside the USA. The intention of the joint meeting was to encourage more individuals from the region to carry out research, in the hope that ultimately they would visit the main ARVO meeting in the USA.
The main research meeting was preceded by courses in basic science research, design, and conduct of clinical research, and writing successful grant and scientific papers. The feedback from the attendees regarding this day was extremely positive, including the basic science research section. This was in part due to the fact that researchers also talked about the philosophy and inspiration behind their research which resulted in very 'inspirational' courses.
The remainder of the meeting was a mixture of keynote talks by various
local and international speakers, and research presentations. There was
a stunning array of keynote speakers, all the way from basic genomics, gene
therapy and stem cell biology, to large-scale epidemiology. At one point,
there were three former directors of national institutes on the same program!
These talks were greatly appreciated by the audience.
From the perspective of glaucoma, it was interesting to speculate on the
role of the SERI ARVO meeting compared to the main ARVO meeting in Florida.
There were approximately 70 glaucoma-related abstracts at this meeting compared
with the approximately 700 submitted to the main ARVO meeting. It appears
that only about ten to 20 percent of the abstracts submitted to the Singapore
meeting were also submitted to the USA ARVO meeting, which shows that this
meeting is indeed featuring research presentations that would not otherwise
have been presented at ARVO.
Looking at the sources of the abstracts themselves, it is not surprising that the largest contribution came from the Singapore Eye Research Institute (16%), several of these in collaboration with researchers from the United Kingdom and the USA. This number was closely followed by India (14%) and China (13%). Nearby Malaysia contributed about 7% of the abstracts, as did Japan.
When talking to the various attendees, it became clear that many of them would be prepared to make the trip to the USA, based on the encouragement gained at this meeting. However, given the current situation in the world today, some 20 percent of the attendees at the SERI ARVO meeting would simply not be able to gain entry to the USA, and therefore this would be their only opportunity to present a paper at an ARVO sponsored meeting. Therefore, this meeting certainly performed a unique role.
Glaucoma presentations
Epidemiology
In the glaucoma program itself, Zhao Jia Liang from China presented some extrapolations from local epidemiological studies, quoting a figure of at least five million glaucoma patients and 800 thousand having become blind due to glaucoma in China. Even higher figures have been suggested: up to 17 million blind persons. The majority of these patients have angle-closure glaucoma.
Quality of Life
Gazzard, working between Singapore and London, evaluated the quality of life in Chinese patients with glaucoma. In these patients, the quality-of-life ratings were lower in patients with a long duration of the disease, those with a more severe visual field loss, and those with high intraocular pressure. The quality-of-life ratings were higher in patients who had undergone glaucoma surgery.
Angle-closure
David Friedmann presented papers highlighting the changing definitions
of different categories of angle-closure including narrow angles, primary-angle
closure (PAC) and angle-closure glaucoma (ACG). Paul Foster presented cross-sectional
data on the changes in gonioscopic anatomy in the large scale Tanjong Pagar
Singaporean study, showing decreasing angle width with age and also an increase
in pathological iris configurations, including plateu iris. Intriguingly,
he also speculated on the increasing incidence of myopia seen in Singapore,
which results in an increase in axial length and deepening of the anterior
chamber. However, at the very best, this would probably only reduce the
number of people in the highest risk group with very narrow angles by one-third
in the next 30 years, given the possible changes in eye morphology.
Aung Tin presented the results of a genome-wide linkage scan for primary-angle
closure glaucoma. These results were from collaborative work between Singapore
and London, and reported the identification of a first locus for primary
angle-closure glaucoma on chromosome 2. Aung Tin also presented a collaborative
project between Singapore and Baltimore on the long-term outcomes in Asians
after acute-angle glaucoma. Several years after angle-closure glaucoma,
17.8% of the subjects examined were blind in the attack eye, 47.8% had glaucoma,
with 15% having markedly cupped optic nerve discs cd 0.9 or greater (cd
ratio greater than 0.9). Fifty-eight percent had corrected vision of less
than 6/9, with cataract being responsible for half these reductions in vision.
Steve Smith and colleagues from Cleveland found that ocular coherence tomography
(OCT) and UBM correlate well with go
nioscopy in patients with narrow angles. They found OCT advantageous because
it is a non-contact examination.
Pseudoexfoliation
Arvind from Chennai in India reported pseudoexfoliation in the rural population in 3.79% of patients, with raised intraocular pressures being seen in 16.7%.
Surgery
Xu from Peking found that lens extraction and vitreous extraction could
stimulate proliferation and collagen production in tenon's capsule fibroblasts,
and suggested that these may play a role in the failure of glaucoma filtration
surgery in aphakic patients.
Steve Seah presented the results of a novel slow release dexanethasone-impregnated
pellet (Surodex"!) placed beneath the standard scleral flap at the end of
surgery. The implants appeared to be safe and well-tolerated, and a prospective
randomized trial is planned.
