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EN
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林慧茹 Hui-Ju LinTaiwan
Moderator
Advances in Artificial Intelligence Models and Algorithms in Amblyopia and Strabismus Review of Artificial Intelligence (AI) models that detect strabismus and amblyopia risk factors from smartphone photos, videos, and images, facilitating large-scale, accessible community screening. Discussion on how AI is personalizing amblyopia therapy, thereby maximizing efficacy and engagement. Critical appraisal of the requirements for clinical validation, regulatory approval, and the ethical integration of these AI tools into standard ophthalmic practice.
AI is poised to fundamentally reshape the management of strabismus and amblyopia by introducing unprecedented levels of objectivity, accessibility, and personalization. the knowledge to understand, evaluate, and eventually integrate these powerful technologies into their practice to improve patient outcomes. AI screening and diagnosis to treatment optimization and monitoring.
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蔡忠斌 Chong-Bin TsaiTaiwan
Speaker
Could Botulinum Toxin Be an Effective Primary Treatment for Infantile Esotropia?Introduction: To report the long-term success rate of botulinum toxin as the primary treatment for infantile esotropia. Methods: A single-center, retrospective review examined botulinum toxin use in children with esotropia onset before 12 months and presented by age 48 months. Success was defined as ocular alignment within 10 prism diopters (PD) of orthotropia. Results: A total of 35 children received botulinum toxin as primary treatment (1 injection: 63%; 2 injections: 17%; 3 injections: 14%; 4 injections: 6%). Of these, 20 (57%) had only botulinum toxin (BT group), while 15 (43%) had both botulinum toxin and surgery (BT+OP group). The mean deviation at initial presentation was 46.5 ± 13.8 PD in the BT group and 47.3 ± 11.3 PD in the BT+OP group. The mean age for initial botulinum toxin treatment was 1.8 ± 0.8 years for the BT group and 1.5 ± 0.8 years for the BT+OP group. The average follow-up time was 37.3 ± 22.6 months for the entire group. The success rate was 75% (15 of 20) for the BT group and 53% (8 of 15) for the BT+OP group, with no significant difference in success rates between the groups. Conclusions: Botulinum toxin demonstrated a notable long-term success rate as a primary treatment for infantile esotropia. These findings suggest botulinum toxin is an effective initial treatment option, with sustained results observed over an average follow-up of over three years.
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王安國 An-Guor WangTaiwan
Speaker
Upshooting Eye After TED IR Myectomy: How Do We Manage? Two TED patients received IR myectomy for hypotropoia. They developed upshooting eyes with severe limitation of infraduction postoperatively. We collaborated with ENT surgeon using endoscopic surgery with navigation system to identify the proximal stump of IR, and repair with non-absorbable suture. Both patients recovered their binocular vision after the operation.
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Zia ChaudhuriIndia
Speaker
High-Resolution Orbital MRI in strabismus and myopia: A Fascinating Journey of DiscoveryMagnetic resonance imaging (MRI) provides in vivo visualization of the static and dynamic configuration of extraocular muscles (EOM) and their connective tissues, aiding delineation of their anatomy and physiological functions. Defining the normal is of relevance because it aids extrapolation of the abnormal, which has translational relevance for the appropriate diagnosis and management of strabismus. This evaluation has also been found to be of high informative relevance in myopia, which has assumed pandemic stature in the east Asian population and now, also in the south Asian population. In addition, high-resolution surface coil orbital MRI techniques with suitable positioning of the eyeballs in different target-controlled positions aids knowledge of the actions of EOMs in different positions of conjugate gaze, as well as during convergence at near. Dr Chaudhuri was trained in the acquisition and analysis of these high-resolution orbital images in strabismus under the direct supervision of Prof Joseph Demer at JSEI, UCLA and has subsequently continued this research in India, thus making her an investigator from both sides of the ocean, so to say, and in different ethnic populations. This presentation will specifically provide an overview of high-resolution, surface-coil orbital MRI of the EOMs and ocular adnexa with due emphasis on congenital and acquired strabismus and myopia, including the enigmatic condition of myopic anisometropia, where despite similar genetics and environment, the two eyes grow asymmetrically.
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Stephen KraftCanada
Speaker
Adult Strabismus Surgery: Do Adjustable Sutures Increase the Success of Surgery?Studies comparing strabismus surgical cases using adjustable sutures (AS) to non-adjustable procedures (NA) have focused on the rate of re-operations as well as the alignment results. The majority of the articles, encompassing hundreds of patients, show that AS improve success from both the reoperation rate and alignment aspects. However, systematic reviews point out that prospective controlled studies are lacking, and so conclusions cannot be drawn about the effectiveness of AS.
This presentation will provide a brief review of the main articles in the literature comparing success rates with AS versus NA cases, as well as the five goals of an eye muscle operation. Following this introduction, the talk will illustrate the technique the author uses for his AS. Finally, the author will present three lines of evidence confirming the improved alignment success of using AS versus NA cases. This evidence derives from his over 40 years of experience and which is published in several articles from his centre.
It is hoped that after this presentation, both novice and experienced strabismus surgeons will feel comfortable incorporating AS into their cases. They will also understand that the additional time and effort in using AS will be justified in improving the success rate of their surgery.Pearls and Tips from 43 Years in StrabismologyIn addition to a careful history, a complete strabismus evaluation involves careful measuring of the alignment in the diagnostic gaze positions and noting the eye muscle actions in the cardinal positions of gaze. The prism measurements and the eye movement gradings must be consistent with each other, so that an appropriate differential diagnosis can be developed. A good refraction is also a vital component of the work-up.
This presentation comprises a selection of pearls and tips learned and applied over several decades in the author’s strabismus practice. These tips have helped improve diagnostic skills as well as treatment of both basic and advanced strabismus cases. These items will be discussed in 3 categories: diagnostic testing, non-surgical management, and surgical management.
Some items are referenced in various sources, while others have not, to the presenter’s knowledge, been published before.
At the end of each section, the specific pearl(s) for the audience will be noted as well as the application of that information. It is hoped that these tips will prove useful for novice as well as seasoned strabismus practitioners.
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蔡忠斌 Chong-Bin TsaiTaiwan
Moderator
Could Botulinum Toxin Be an Effective Primary Treatment for Infantile Esotropia?Introduction: To report the long-term success rate of botulinum toxin as the primary treatment for infantile esotropia. Methods: A single-center, retrospective review examined botulinum toxin use in children with esotropia onset before 12 months and presented by age 48 months. Success was defined as ocular alignment within 10 prism diopters (PD) of orthotropia. Results: A total of 35 children received botulinum toxin as primary treatment (1 injection: 63%; 2 injections: 17%; 3 injections: 14%; 4 injections: 6%). Of these, 20 (57%) had only botulinum toxin (BT group), while 15 (43%) had both botulinum toxin and surgery (BT+OP group). The mean deviation at initial presentation was 46.5 ± 13.8 PD in the BT group and 47.3 ± 11.3 PD in the BT+OP group. The mean age for initial botulinum toxin treatment was 1.8 ± 0.8 years for the BT group and 1.5 ± 0.8 years for the BT+OP group. The average follow-up time was 37.3 ± 22.6 months for the entire group. The success rate was 75% (15 of 20) for the BT group and 53% (8 of 15) for the BT+OP group, with no significant difference in success rates between the groups. Conclusions: Botulinum toxin demonstrated a notable long-term success rate as a primary treatment for infantile esotropia. These findings suggest botulinum toxin is an effective initial treatment option, with sustained results observed over an average follow-up of over three years.
王安國 An-Guor WangTaiwan
Moderator
Upshooting Eye After TED IR Myectomy: How Do We Manage? Two TED patients received IR myectomy for hypotropoia. They developed upshooting eyes with severe limitation of infraduction postoperatively. We collaborated with ENT surgeon using endoscopic surgery with navigation system to identify the proximal stump of IR, and repair with non-absorbable suture. Both patients recovered their binocular vision after the operation.
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Stephen KraftCanada
Speaker
Adult Strabismus Surgery: Do Adjustable Sutures Increase the Success of Surgery?Studies comparing strabismus surgical cases using adjustable sutures (AS) to non-adjustable procedures (NA) have focused on the rate of re-operations as well as the alignment results. The majority of the articles, encompassing hundreds of patients, show that AS improve success from both the reoperation rate and alignment aspects. However, systematic reviews point out that prospective controlled studies are lacking, and so conclusions cannot be drawn about the effectiveness of AS.
This presentation will provide a brief review of the main articles in the literature comparing success rates with AS versus NA cases, as well as the five goals of an eye muscle operation. Following this introduction, the talk will illustrate the technique the author uses for his AS. Finally, the author will present three lines of evidence confirming the improved alignment success of using AS versus NA cases. This evidence derives from his over 40 years of experience and which is published in several articles from his centre.
It is hoped that after this presentation, both novice and experienced strabismus surgeons will feel comfortable incorporating AS into their cases. They will also understand that the additional time and effort in using AS will be justified in improving the success rate of their surgery.Pearls and Tips from 43 Years in StrabismologyIn addition to a careful history, a complete strabismus evaluation involves careful measuring of the alignment in the diagnostic gaze positions and noting the eye muscle actions in the cardinal positions of gaze. The prism measurements and the eye movement gradings must be consistent with each other, so that an appropriate differential diagnosis can be developed. A good refraction is also a vital component of the work-up.
This presentation comprises a selection of pearls and tips learned and applied over several decades in the author’s strabismus practice. These tips have helped improve diagnostic skills as well as treatment of both basic and advanced strabismus cases. These items will be discussed in 3 categories: diagnostic testing, non-surgical management, and surgical management.
Some items are referenced in various sources, while others have not, to the presenter’s knowledge, been published before.
At the end of each section, the specific pearl(s) for the audience will be noted as well as the application of that information. It is hoped that these tips will prove useful for novice as well as seasoned strabismus practitioners.
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莊怡群 Ann Yi-Chiun ChuangTaiwan
Moderator
Small-Optical-Zone Ortho-K in Myopia Control 小光心角膜塑型片於近視控制中的應用Orthokeratology (Ortho-K) represents the foundation of modern optical myopia control through the induction of peripheral myopic defocus. Subsequent optical interventions, including myopia-control spectacle and soft contact lenses, were developed based on the same principle. A newer advancement in this field is the small-optical-zone overnight Ortho-K design, exemplified by the myOK-pro lens. This approach preserves the advantages of conventional Ortho-K while enhancing myopia-control efficacy by reducing the central treatment zone to generate greater peripheral myopic defocus.
Traditional Ortho-K tends to provide stronger control in higher prescriptions, whereas low-myopia patients often experience limited defocus and consequently weaker outcomes. For children who are unsuitable for or unwilling to wear spectacles or soft lenses, this presents a therapeutic gap. Small-optical-zone designs aim to address this need by improving defocus magnitude for low-myopia patients. However, simply reducing the optical zone in older designs may increase visual disturbances such as flare and halo. Modern small-optical-zone lenses seek to overcome these limitations, offering optimized visual quality alongside improved myopia-control performance.
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林慧茹 Hui-Ju LinTaiwan
Speaker
Advances in Artificial Intelligence Models and Algorithms in Amblyopia and Strabismus Review of Artificial Intelligence (AI) models that detect strabismus and amblyopia risk factors from smartphone photos, videos, and images, facilitating large-scale, accessible community screening. Discussion on how AI is personalizing amblyopia therapy, thereby maximizing efficacy and engagement. Critical appraisal of the requirements for clinical validation, regulatory approval, and the ethical integration of these AI tools into standard ophthalmic practice.
AI is poised to fundamentally reshape the management of strabismus and amblyopia by introducing unprecedented levels of objectivity, accessibility, and personalization. the knowledge to understand, evaluate, and eventually integrate these powerful technologies into their practice to improve patient outcomes. AI screening and diagnosis to treatment optimization and monitoring.
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蔡紫薰 Tzu-Hsun TsaiTaiwan
Speaker
Facts and Myths: What We Need to Know About Atropine Eye DropsA study conducted in Taiwan during the 1990s demonstrated that atropine reduced myopia progression in a dose-dependent manner. Since that time, the clinical use of atropine in school-aged children has been widespread in Taiwan for more than two decades. Owing to this long history of high-concentration atropine prescriptions, Taiwan represents a distinctive setting in which to evaluate the long-term safety of atropine use. Using data from a large cohort within the NHIRD, we found that the incidence of ocular complications was higher among individuals with myopia compared with those without. However, among participants with myopia, the incidence of these complications did not differ between atropine users and nonusers, and higher cumulative doses of atropine were not associated with increased risk.
The long-term efficacy of atropine eye drops for myopia control also merits further investigation. The LAMP clinical trial demonstrated that continuous treatment with 0.05% atropine effectively controlled myopia progression over five years. In contrast, the ATLAS from Singapore reported that topical atropine use during childhood was not associated with long-term ocular complications; however, its long-term efficacy in myopia control was less conclusive. Furthermore, recent randomized clinical trials have yielded inconsistent findings regarding the effectiveness of low-dose atropine, and regulatory approval by the U.S. FDA remains pending. Further research is therefore warranted to refine atropine treatment strategies, including the optimal timing of initiation, adjustment of concentration, duration of therapy, and methods and timing of discontinuation. Most importantly, future work should aim to clarify the ultimate clinical significance and long-term benefits of atropine therapy for myopia control.
接軌國際：IMI 近視前期定義與台灣經驗分享Pre-myopia is an emerging concept in myopia prevention, referring to children within a specific age range who exhibit refractive errors that, along with certain risk factors, place them at increased risk of developing myopia and who may benefit from early intervention. This presentation focuses on the international definitions of pre-myopia and utilizes public health survey data and clinical evidence from Taiwan to analyze the prevalence of pre-myopia and explore issues related to myopia development.
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彭智培 Calvin PangHong Kong, China
Speaker
Genomic investigations on the progression of childhood myopiaCalvin CP Pang彭智培
Department of ophthalmology and visual sciences, The Chinese University of Hong Kong, Hong Kong, China
Myopia, the commonest ocular disorder in most populations estimated to affect a half of the world’s population in 2050, is prevalent and serious in East Asians with a steep rising trend in Caucasian and other Asian populations. More than 200 associated loci spreading all chromosomes are associated with myopia. While children of myopic parents across most populations are more prone to develop myopia, lifestyles in near work and outdoor time also cast strong influence. After onset of myopia, progression is different among children. In our cohorts of Chinese trio families, school children at different severities, and children receiving atropine, we conducted whole genome association studies (GWAS) and whole exome sequencing (WES) to investigate genetic loci in association with myopia progression based on quantitative traits, myopia progression over 3 years and lifestyle parameters. Based on our three stage GWAS of children myopia, there are associations of scleral equivalent and axial length with SNPs in MIR4275, LOC101928911, TENM3 and FAM135B. We calculated children’s genetic risk score (GRS) and found myopia severity increased with both near work and GRS levels, higher GRS showed a greater decrease in SE with the same amount of near work. More genomic information will be revealed as our data analysis continues.
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