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Scottdale Inpatient Drug and Alcohol Rehab Facilities
If you're looking to help yourself or someone you love struggling with a drinking or drug abuse problem in Scottdale, GA, Rehabs.com maintains a sizable Internet database of luxury exclusive facilities, as well as a wealth of other alternatives. We can assist you in finding addiction treatment programs for a wide variety of addictions to OxyContin, crack cocaine or any addictive substance or alcohol. Search for a perfect rehab facility in Scottdale now, and set out on the path to healthy living.
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They worked hard to educate the clients on abuse and keep the minds on the lord. Offered a family d...
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30, 60, 90-Day Inpatient Vs. Outpatient Rehabilitation in Scottdale, Georgia
Getting sober from Librium, Orlaam, alcohol or any other drug you or your loved one is addicted to takes an individualized treatment strategy. Two options of substance treatment facilities in Scottdale can help you succeed: either Residential or Out-patient Rehab. Residential therapy offers lasting benefits with an extended stay in a highly-rated rehab center. Outpatient plans may be more suitable, but lack the support and resources of 3 month programs to get clean. Ultimately, the decision is yours, and we are here to help you choose the one that will be best for you.
Let me tell you why I do what I do. I do it because I know the struggle you are facing, and I know there is hope for you. I do it because there are many more people like you who are secretly hoping for a treatment program that will finally make a difference in their lives. I do it because Elevate Re...
Elevate Recovery Center
A retired trial attorney, James Krah, entered the recovery industry over ten years ago as a therapist intern. Since then he has held a variety of management positions during his recovery career, including designing and implementing outpatient programs for some of the largest healthcare organizations...
Desert Hope Treatment Center - Outpatient
Dr. Jennifer Golick received her M.A. from Sonoma State University, where she graduated with honors as part of Chi Sigma Iota Honor Society. For many years, Jennifer worked as a therapist in a nonprofit mental health agency, working with underinsured and uninsured children and families. Jennifer als...
Muir Wood Adolescent & Family Services
Dual diagnosis refers to a person who is simultaneously battling both drug or alcohol abuse issues and a behavioral or mental problem. For instance, an addiction to Oxycodone, Ambien or Norco combined with compulsive shopping or an eating disorder. For these cases, a residential rehab center becomes even more desirable, incorporating quality inpatient therapy with group support, such as one might see in Alcoholics Anonymous. Luxury drug rehabs in Scottdale, Georgia will provide the latest treatment with upscale amenities for anyone requiring the very best drug rehab, just as Scottdale alcohol rehab centers will help those battling alcohol addiction to get sober.
Note About Insurance for Addiction Treatment: First Care, Group and Pensions Administrators and UnitedHealth Group usually offer at least some coverage for your addiction treatment, and you can find out more about your own coverage or benefit status here.
Our large online database provides many alternatives in Scottdale, GA to help you become sober. Once you have decided to get clean, you've taken the initial step to success. Our toll-free hotline advisors can then help you move to the next phase to recover from substance abuse with the highest-quality centers in Scottdale.
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The sixth offshore casino vessel MV Lucky Seven, promoted by Golden Globe Hotel Private Limited (GGHPL), owned by former Haryana minister Gopal Kanda, is finally being allowed to dock in the River Mandovi. In its petition before the Bombay High Court at Goa, Golden Globe Hotels Private Limited had prayed for direction to the Goa government to allow the vessel to be moored in River Mandovi, which was stationed in the sea and was being damag.......... [Read More]
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Rummy Operators Challenge Telangana Gaming Ordinance in High Court
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WSOP 2017: James Moore, Nadar Kakhmazov, Thomas Reynolds, Joe McKeehen & Rifat Palevic Win Bracelets
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APT Macau 2017: Choong Kian Weng Takes Down Main Event For HK$521,000; Shravan Chhabria Finishes Third
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5/16"-18 x 5" Black Oxide Steel Double End Threaded Studs, 2 pk.
TE-CO| Zoro #: G1938745| Mfr #: 40408
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Technical Specifications
|Zoro #: G1938745 Mfr #: 40408
|Thread Direction: Right Hand
|Material: steel
|Finish: Black Oxide
|Min. Tensile Strength (PSI): 125, 000
|Thread Type: UNC
|Item: Double End Threaded Stud
|System of Measurement: Inch
|Shank Type: Round
|Thread Size: 5/16"-18
|Rockwell Hardness: C27
|Class: 2A
|Thread Size: 5/16"-18
|Overall Length: 5"
|Thread Length (A): 1-1/8"
|Thread Length (B): 1-1/8"
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|Country of Origin (subject to change): United States
Product Description
Double End Threaded Stud, Thread Size 5/16-18, Overall Length 5 In, Steel, Thread Length Type Equal, Black Oxide Finish, UNC Thread Type, Thread Length 1 1/8 In, Thread Length Opposite End 1 1/8 In, Shank Type Round, Right Hand Thread Direction, Rockwell Hardness 27RC, Min Tensile Strength 125,000 PSI, Class 2A, Package 2


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Fire of fuel tank kills 123 people in Pakistan - TVWorld June 25, 7:58
Muslims worldwide celebrate Eid al-FitrSociety & Culture June 25, 5:18
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RIO DE JANEIRO, August 5 /TASS/. About 40 heads of state and government will attend the opening ceremony of the 2016 Olympic Games in Rio de Janeiro. The opening ceremony will take place at the Maracana stadium on August 5, a Brazilian government source told TASS on Thursday.
"We expect about 40 heads of state and government," the source said. The Brazilian Foreign Ministry press service said, in turn, that the ministry was not disclosing the exact number of the world leaders who are planning to be present at the opening ceremony for security reasons.
Late in July, Brazilian Foreign Minister Jose Serra told journalists that 45 heads of state and government had confirmed their presence at the Olympics opening ceremony in Rio. They include the presidents of France and Argentina; the Italian prime minister. US Secretary of State John Kerry will represent the United States. He is to meet the Brazilian foreign minister on the Games' opening day.
Serra told TASS that the decision to start the impeachment procedures against Dilma Rousseff and her suspension from office had not affected the world leaders' decision to attend the opening ceremony.
"There have been no signals that anybody is not coming or has changed their minds because of that (the impeachment process - TASS). I have not heard anything even about informal dialogues on this subject," the Brazilian foreign minister said.
Earlier, the Brazilian media reported that some world leaders had been slow in confirming their presence because of political uncertainty. Many of them had received invitations from Dilma Rousseff. However, Brazil's Acting President Michel Temer will be the one who will officially represent the country at the opening ceremony.
At least 69 world leaders attended the opening ceremony of the London Olympic Games in 2012. At least 50 heads of state and government arrived for the winter competitions in Sochi in 2014.
The 31st Summer Olympic Games, the very first for Latin America, will be held in the resort city of Rio de Janeiro between August 5 and 21. The 2016 Summer Paralympic Games will take place between September 7 and 18.


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Resiste is a french indie label, established in Paris, reborn in 2016, and managed by Ulrich 'Yul' Vantillard. It is focusing on producing electronic music records, audio fictions and original material for both theatre plays and film documentaries. We're distributed digitally by Kuroneko.…
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AlienVault® Unified Security Management™ (USM™) is an innovative approach to security monitoring, delivered in a unified platform. The USM platform includes five essential security capabilities that provide resource-constrained organizations with everything they need for effective threat detection, incident response, and compliance management, in a single pane of glass.Advertisement
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Hot topics in Site Management Softwarebluefish bluefish for kali linux confuse-2.7.tar.gz zope bluefish editor for linux apk creator software blowfish editor credit union software scripting tools aplikasi php
Ganglia is a scalable distributed monitoring system for high-performance computing systems such as clusters and Grids. It is based on a hierarchical design targeted at federations of clusters. Supports clusters up to 2000 nodes in size.371 weekly downloads
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ButterflyCP ButterflyCP aims to be THE graphical user interface for all popular open source server technologies. Our goal is to solidify server management, from email and domain setup to database management and software updates.
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UnityCA COCA X.509 Certificate Authority
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The cvs+ project seeks to provide a you would never know that its cvs layer on top of the cvs protocol to make the system easier to use for novices and easier to setup for administrators. This would be based on a perl-tk and text-based cvs client that
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The project is not hosted here anymore. This repository remains only because sourceforge refuses to delete projects. Please see http://manalogs.tekwire.net NEVER DOWNLOAD ANYTHING FROM SOURCEFORGE !
mod_blosxom module for Apache
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Running Dog on The clearing of the weed trees at Chimborazo Park
James River (1936)
August 10, 2016 6:30 pm by John M
From @vintage_richmond on Instagram:
An aerial view of Richmond, Virginia from above Fulton Hill after "The Saint Patricks Day Flood" of March 1936. The only great flood in Richmond history not caused by a tropical storm or hurricane but rather a combination of heavy rains and rapid snow melt in The Blue Ridge Mountains. The gasometer at Fulton Gas Works, still in use then, can be seen to the middle right side of the photo. credit: The Richmond Times Dispatch.
TAGGED: 1930s, historic photos, old Fulton, Rocketts Landing


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Women of Influence 2014: Food for thought from Portland Public Schools' Gitta Grether-Sweeney
With our Women of Influence awards taking place Thursday, we're hoping to introduce you a bit more to some of the region's top business minds.
Tickets for the event, at the Hilton Hotel in downtown Portland, are still available by clicking here. In the meantime, you can meet some of our honorees in this and other stories we're running in advance of the event.
Click here for our full gallery of 2014 Women of Influence winners
Here's a bit more from Gitta Grether-Sweeney director of nutrition services for Portland Public Schools. (Our full Women of Influence publication, with interviews and features, will be released Friday.)
So where, besides PPS's cafeterias, do you like to eat? I love to try new restaurants, but I find that the best food is made at home. I love trying and experimenting with new recipes more than new restaurants.
How would you describe your leadership or management style? I tend to have a collaborative style of leadership. I feel it is important to get different perspectives before the team makes a decision. However, when necessary, I will make the final decision. I also feel that I have the responsibility to mentor the next generation of directors.
What's the biggest business challenge you expect to face this year? It is a constant challenge to comply with changing regulations without compromising food quality or service.
Andy is the Portland Business Journal's digital managing editor, overseeing the daily digital news operation. Sign up here to receive the free news-packed emails he curates every day.


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'Silicon Valley' Review: The Most Awkward Moment in 'Server Error'
Posted on Monday, June 26th, 2017 by Alex Riviello
(Each week, we're going to kick off discussion about Silicon Valley season 4 by answering one simple question: what was the most awkward moment of the week?)
Do you remember that moment when you finally realized that Breaking Bad was following a villain's origin story? We get almost the equivalent in this season finale of Silicon Valley, when we see Richard Hendricks breaking down over the prospect of losing everything he's been working for. Yes, again.
This is the moment where we realize that Richard cares about Pied Piper and no one else. Not Gilfolye or Dinesh, without whom he would have had no product. Not Jared, who makes sure everything runs and is done correctly. And especially not his oldest pal Bighead, who he sees as a dummy he can strongarm into doing whatever dumb thing someone smarter than him wants him to.


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Irish Shortbread Cookies
READY IN: 2hrs 10mins
Recipe by Anissa Wolf
This is the most amazing shortbread ever. Flaky and rich, and very very simple; I've never had a shortbread that compares to it. Note: I use salted butter. If you use unsalted, you may want to add a pinch of salt.
Top Review by BlackIrish
I thought something was missing and realized it's a pinch of salt. Salted butter may be what is needed. Otherwise these are easy and delicious. Thank you so much for this recipe.
Ingredients Nutrition
- 1 cup butter
- 2⁄3 cup sugar
- 1⁄2 cup cornstarch
- 2 cups flour
Directions See How It's Made
- Cream butter and sugar together until light and fluffy.
- Sift in cornstarch and flour; mix well.
- Press into a 10 3/4 by 7 inch pan.
- Prick all over with a fork.
- Bake in preheated 275 F oven for 30 minutes, then reduce heat to 250 F and bake 1 to 1 1/2 hours longer.
- Remove from pan and sprinkle with powdered sugar. Cut into 20 finger shaped cookies.


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We have a joke in Ireland about summer being our favourite day of the year. While that may be a bit of an exaggeration, it has to be said that Ireland isn't the driest or sunniest place in the world. So when that blue sky rolls along, the sun shines bright and the temperatures hit the high teens (yes, you read that right), you can bet your ass the pasty brigade will be out in force.
Every good weather day in Ireland has to be taken advantage of. And that means…
It was time to finally check out Lough Gur, a little place not too far away that I'd been hearing about for years, but never got around to. Being a short drive from Limerick City, it's perfect for a day trip. Picnic in hand, off we headed.
It's crazy how quickly the city of Limerick turns into lush green countryside. Within half an hour, we were already pulling over at our first destination:
I was so surprised when I found out that Western Europe's largest and oldest stone circle was so close to where I live. Sitting right next to the road on the western side of Lough Gur, the stone circle is on private property, but the landowner is more than happy to show it to the growing number of tourists that rock up. Timothy Casey rambles on in a barely-intelligible drawl (even to other Irish people), but his passion for the history of the land is clear. He only asks for a small donation to help with the upkeep of the fencing and the circle itself. His disbelief at my offer of a fiver goes to show that he really doesn't get much from the other visitors. As a way of thanks, he gave us a postcard of the summer solstice taken at the circle. I really wanted to offer to take a better picture to replace the blurry mess he has, but it was really sweet of him, so I kept quiet!
The Grange Stone Circle is around 4000 years old – that's older that the later portions of Stonehenge, for reference. Neolithic pottery has been found inside it and it's believed that it is aligned with the festival of Samhain, the ancient Irish start of winter (and the precursor to Hallowe'en!). Apparently, locals don't like to go there at night because of the spirits that still live there. Nothing spooky about it in the bright sunlight!
The circle is also home to some seriously cute calves.
Spring flowers, warm sunshine and a dose of incredible Irish history = major photo shoot ops.
Another 15 minutes drive around the lake takes you to stop number 2:
Lough Gur is a really popular hang-out spot for locals and tourists alike, so it's no surprise it was pretty busy on such a nice day. The small lake is surrounded by rolling green hills and a whole lot more history. The Heritage Centre has displays on the story of pre-Celtic settlers in the area dating back 6000 years, as well as reconstructions of dwellings from that era. While we didn't visit the Centre, the stroll around the lake and up Knockadoon Hill was more than enough to keep us occupied for a few hours.
While the walk up the hill by the lake might only take 20 minutes, you'll feel the burn in your legs (Just us? Okay…). But that'll be completely forgotten the moment you crest the summit and see Lough Gur lying below. The many shades of the Irish countryside stretch out for miles and miles, right up to the blue mountains sitting on the distant horizon. It's simply breathtaking.
I love how Ireland keeps reminding me how gorgeous it is, something I often forget when I'm exploring abroad.
Love to get great Instagrammable shots? Lough Gur's got you covered. Lake shores, wizened trees and crumbling stone walls abound…it's paradise for photographers of any level.
On your way home, make sure to check out the small wedge tomb, graveyard and church ruin, all along that windy country road before the lake.
What do you think of Lough Gur? Looks like a gorgeous road trip destination on a sunny day, doesn't it? Tell me your thoughts in the comments below.
Dearbh x
Like this post? Pin it!
Over three months now on my Australian roadtrip and I'm definitely not ready to stop anytime soon (although that may have to happen – funds are starting to run low!).
2013 was a pretty big year for me. I graduated university with the best results I could have hoped for. I moved to Chicago for the summer and learned how
It's views like this that bring me back to Ireland consistently. I really enjoyed spending time discovering areas around LImerick and Tipperary and hopefully one day will get to make the area my home.
Yes, it's a really beautiful part of the country. I love hearing when people enjoy Ireland – thank you! Maybe you will make a home here one day, I'll keep my fingers crossed for you! Thank you for reading and your kind words.
Dearbh x
I'm a traveller and zoologist who is passionate about seeing the world and the incredible creatures who inhabit it. I love planning new adventures, working with wildlife around the world and promoting ethical animal encounters and volunteer opportunities.
Whether you're looking for a little bit of wanderlust inspiration, backpacking tips or information on wildlife encounters, you've come to the right place. Dig in!


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The 26-Year-Old Couch-Surfing After a Breakup
A steal at $85 bucks a night.By Madison Malone Kircher
A big step for the company which has come under fire in recent months.By Madison Malone Kircher
Governor Andrew Cuomo signed a law today that doles out a heavy fine for people who advertise illegal short-term rentals.By Jen Kirby
It comes with a quesadilla "butler."By Clint Rainey
It makes finding an apartment harder.By Adam Banicki
#AirbnbWhileBlack strikes again.By Madison Malone Kircher
Short-term rentals are driving out longtime residents.By Brian Feldman
$610 a night.By Hilary Weaver
Going with a group means you can afford a seaside villa. But will you all like each other by the end of the trip?By Alexis Swerdloff
It's all about gaming the algorithm.By Seth Porges
Ever wonder where pornographers get those lavish mansions they always seem to film in?By Eric Levitz
What do you do when a giant internet company steals your style?By Kyle Chayka
"We cool now?"By Nathan Pemberton
Tech is eating media, and Medium CEO Ev Williams is burping.By Max Read
"The party kept raging in the street afterward. The kids were too drunk to care."By Eric Levitz
Dear Airbnb, stop being such entitled tech-douches. Love, San Francisco.By Nathan Pemberton
What better place for a "sharing economy" than a communist country that's slowly embracing a more capitalist way of doing business?By Adam K. Raymond
Here we go.By Joe Coscarelli
According to a report by the state attorney general that the company is not disputing.By Joe Coscarelli
The Great Drake Bell–Josh Peck Feud Just Keeps Getting Pettier
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Watch the Bellas Play for the Troops in the First Trailer for Pitch Perfect 3
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How Will & Grace's Revival Is Dealing With the Dramatic Series-Finale Time Jump
Doctor Who Recap: Genesis of the Cybermen
The Perverse Presidency of Donald Trump
Dan Harmon Implores Us All to Be Patient for Rick and Morty's Next Season
The Secret to Small Talk
Which Pretty Little Liars Character Said It? Take Our Quote Quiz


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Number 1 university in the UK for journalism
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The social implications of genre in historical news language
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Present European Union (EU) policies restrict imports of genetically modified food and the release of genetically engineered living organisms into the environment. Revisions under discussion would allow modified imports, but require that they be labelled as such. In Europe where agricultural landscapes and local products are highly valued, experience with mad cow disease has highlightened distrust of large-scale, industrialized farming. U.S. officials contend that such attitudes are irrational and that EU regulations are not based on scientific evidence. ...
One Sahelian out of two lives below the poverty line, and every day one out of three experiences the pangs of hunger and malnutrition. Nearly 3 billion people in the world live with less than two dollars a day and more than 800 million people still suffer from hunger.
Jane Eyre
Jane Eyre, the narrator of the story, is an orphan who was received by her uncle. But her uncle's wife, Mrs. Reed, and his children did not love her. So she was maltreated by her aunt and cousins, especially John, after her uncle's death.
Bac 2013 (Séries E-F1-F2-F3-F4)
Photovoltaic solar panels convert energy from the sun into electricity directly and require no mechanical energy. Photons of light hit electrons (often in silicon) bumping them into a higher energy state and generating electricity. Initially used to power satellites in outer space, solar power is now used to generate electricity on earth. Photovoltaic panels do not use electromagnetic induction.
Bac 2013 Séries C et D
Man and the other vertebrates, like the model air plane, have a very efficient system of support in the form of an internal skeleton, or endoskeleton. As for the arthropods, they have exoskeletons. Man's body framework gives him the greatest support with the least amount of weight. This framework also permits more efficient movement than any other type of framework.
Baccalauréat Professionnel - Agroalimentaire - Structures Métalliques - Génie Civil/C - Génie Civil/TP - MVA - MAVELEC - Electrotechnique
Visitors to Kenya's capital are often horrified by the homicidal minibuses called matatu. They go around post-holes, seldom signal and use their uncertain brakes only at the last second. They are therefore an ideal subject for a video game, which is why Planet Rackus, a Nairobi start-up, released "Ma3Racer" last year.


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Day 1 :
Keynote Forum
Samer Hamada
Cornea surgeon, The Eye Clinic London, UK
Keynote: Ocular Surface Reconstruction: Current and Future
Time : 10:00 AM - 11:00 AM
Samer Hamada, MD, is an ophthalmologist and cornea surgeon performing eye surgeries at his practice, the Eye Clinic London. With nearly two decades' experience, Mr. Hamada is recognised as a leading expert in the field of cataract, refractive lens exchange (RLE) and corneal surgeries, and is frequently asked to lecture at international eye conferences. He has performed thousands of cataract surgeries and RLE surgeries using the latest technological advancements in ophthalmology. Mr. Hamada offers laser cataract surgery with the option of artificial lenses, called intraocular lenses (IOLs), to replace the natural eye lens that has been clouded by a cataract. These IOLs are used for the restoration of near, intermediate and far vision. He is one of the very few eye surgeons who offer trifocal intraocular lens implants. Patients who prefer to be less dependent on glasses or contact lenses, even without a significant amount of clouding due to cataracts, could choose laser or non-laser RLE, both of which are very similar to cataract surgery.
15 years of stem cell research has led to breakthrough in reconstructing the cornea and ocular surface. We are now able to use allogenic or autogenic stem cells for corneal Limbal stem cell deficiency. The latest and most favourable method of reconstructing the ocular surface is the Mouth to Eye Epithelial Transplantation (MEET). It has the advantages of replacing the deficient corneal stem cells as well as creating a microenvironment that would increase the success rate of any future ocular reconstructive procedures. I will present my approach to rehabilitate a damaged ocular surface through various examples and share my experience with MEET both in adults and children
- Ocular Oncology
Session 1
Session Introduction
Fawzia Bardag-Gorce
Los Angeles Biomedical Research Institute at Harbor UCLA Medical Center, USA
Title: Cultured Autologous Oral Mucosa Epithelial Cell Sheet (CAOMECS) For Corneal Epithelial Regeneration
Dr. Bardag-Gorce has been studying ocular surface disease for the last 6 years, and has since published and co‑authored 6 peer-reviewed publications in the field. She began her research on the treatment of limbal stem cell deficiency using cultured autologous oral mucosa epithelial cell sheet (CAOMECS). During these six years, and under her supervision and guidance, her lab has successfully completed pre-clinical studies related to the efficacy and safety of CAOMECS cell-based therapy [see above cited publications]. She is currently directing a new study approved by the Institutional Research Board in which subjects are being recruited for the human oral mucosal epithelial cell sheet characterization. The long-term goal of this study is to regenerate corneal epithelium in patient with severe ocular surface diseases using autologous oral mucosa epithelial cell sheet grafts.
Statement of the Problem: Corneal limbal stem-cell deficiency (LSCD) caused by ocular trauma or by eye disease leads to impaired corneal epithelial regeneration and conjunctivalization, neovascularization, which often results in significant vision impairment. Patients with bilateral or unilateral LSCD are currently treated with ex vivo cultured allogeneic or autologous transplant of limbal stem cells. Allogenic grafts requires immunosuppression, and autologous grafts are associated with other risks.
The purpose of this study is to use a carrier-free cultured autologous oral mucosal epithelial cell sheet (CAOMECS) graft as a therapeutic approach to improve the health and transparency of the corneal epithelium.
Methodology & Theoretical Orientation: Using a small biopsy from the buccal cheek, epithelial cells were isolated and cultured for two weeks on a temperature responsive surface (CellSeed Inc. Japan). CAOMECS was harvested and grafted onto the cornea of rabbits with experimentally induced LSCD.
Findings: Both rabbit and human CAOMECS grafts resulted to a multi‑stratified epithelium similar to corneal epithelium with basal cell positive for DeltaNp63 (a marker of progenitor stem cell). CAOMECS grafts had a healthy extra‑cellular matrix including balanced pro- and anti‑angiogenic factors and upregulated levels of adhesion molecules necessary for the epithelial integrity. CAOMECS grafting onto corneas of rabbits with LSCD successfully re‑epithelized the ocular surface, reduced cornea vascularization and reduced fibrotic tissue re-growth. We also demonstrated that diseased corneas with LSCD showed little or no staining for adhesion molecules, while CAOMECS-grafted corneas showed normal expression of adhesion molecules and junctional complexes, which is indicative of a non-migratory behavior of cells in CAOMECS.
Conclusion & Significance: Carrier-free CAOMECS grafting improved the ocular surface in a rabbit model of LSCD. CAOMECS grafts renewed corneal epithelial cells, including basal cells positive for progenitor stem cells, acted as a barrier to conjunctivalization and neovascularization, and conferred anti-inflammatory as well as anti-fibrotic effects.
Samer Hamada
Cornea surgeon, The Eye Clinic London, UK
Title: Multifocal intraocular lenses: Keys to Success!
Samer Hamada, MD, is an ophthalmologist and cornea surgeon performing eye surgeries at his practice, the Eye Clinic London. With nearly two decades' experience, Mr. Hamada is recognised as a leading expert in the field of cataract, refractive lens exchange (RLE) and corneal surgeries, and is frequently asked to lecture at international eye conferences. He has performed thousands of cataract surgeries and RLE surgeries using the latest technological advancements in ophthalmology. Mr. Hamada offers laser cataract surgery with the option of artificial lenses, called intraocular lenses (IOLs), to replace the natural eye lens that has been clouded by a cataract. These IOLs are used for the restoration of near, intermediate and far vision. He is one of the very few eye surgeons who offer trifocal intraocular lens implants. Patients who prefer to be less dependent on glasses or contact lenses, even without a significant amount of clouding due to cataracts, could choose laser or non-laser RLE, both of which are very similar to cataract surgery.
Cataract surgery is becoming a refractive surgery. The requirements of our patients are changing and most of our patients are looking for glasses independence after cataract surgery. Refractive lens exchange as well has increased in our practice due to expanding awarness among patients about refractive options past the age of 45. The key elements to success are choosing the most suitable patients, perfect planing, knowledge of available technologies and appreciating the differences so choice to meet patients requirements and life style, surgical techniques, measuring outcomes, and auditing own results.
- Ophthalmology and Vision Science
Session Introduction
Miguel Rechichi
Eye Center Catanzaro, Magna Graecia University, Catanzaro
Title: New perspectives in non-invasive keratoconus treatment: single or conbined surgical strategy to improve vision through cornea reshaping.
Miguel Rechichi has completed his training in ophthalmology and his PhD from Magna Graecia University and Diploma of Specialist Superior in Ophthalmology from University of Lugano (Switzerland). He's actually founder of corneal and refractive Surgery service of Eye Center Clinic in Catanzaro, Italy. He was a pioneer of crosslinking clinical application and actually is involved in developing new accelerated cxl protocols and topography guided crosslinking for which he's invited as opinion leader to several meetings. He has published several papers in reputed journals and has been serving as an editorial board member of repute.
Corneal collagen cross-linking (CXL) is being used worldwide as a first- line treatment for keratoconus, pellucid marginal degeneration, and post-LASIK ectasia. CXL has been shown to be both safe and effective and nowadays patients as young as 10 routinely undergo this form of treatment when they are first diagnosed with keratoconus. As expected, CXL in the early stages of disease is more successful than in the advanced stages.Treatment may help prevent the corneal thinning and apical scarring typical of advanced keratoconus. After CXL, many patients can resume wearing their contact lenses in a few days or a few weeks. Their vision gradually improves weeks to months after treatment, as the cornea undergoes remodeling. In some cases, improvement continues for many years. Evolution of cxl machines alone was incredible and in the near future topography-guided cxl treatment will be available. More than this several procedures that can be actually combined with CXL, such as topography-guided PRK, intracorneal ring segments, and phakic IOLs. The actual target of cxl research is to evaluate various methods of cross linking to provide better option to patients not only for halting keratoconus but, when possible, to improve corrected and uncorrected visual acuity.
Faisal Fayyad
Senior Vitreo-retinal surgeon, Jordanian Hospital, Jordan
Title: Management of Severe Eye Trauma and Retained Intraocular Foreign Bodies (IOFBs).
Senior Vitreo-retinal consultant at the Jordanian Hospital in Amman. Fayyad graduated from Rome University (La Sapienza) in 1976, and completed his residency program in ophthalmology at the same university between 1977 and 1981 with honors. He then traveled to Canada and completed a two year fellowship program in clinical Retina, at the department of ophthalmology at Ottawa University. He served at the Jordanian ministry of health hospitals and the King Hussein Medical Center as well as at the Jordan University Hospital.An examiner at the Jordanian Board of Ophthalmology. Fayyad is involved in training ophthalmologists in Vitreo-retinal surgery.
Eye trauma including retained IOFBs carries many challenges in the management and prognosis depends on the severity of the initial trauma.Traditional good prognostic factors include; small foreign bodies with anterior location, clear media, no afferent pupillary defect and good vision at presentation. Traditional poor prognostic factors are; globe rupture, large retained IOFBs with posterior location, afferent pupillary defect, media opacity and poor vision at presentation. No light perception (NLP) is not a contra-indication for surgery, unless a combined lesion involving the optic nerve is present. There are possible causes of permanent NLP vision in the injured eye, including total destruction of the eyeball, loss of posterior retina and major optic nerve trauma. There are many possible causes of potentially reversible NLP vision in the injured eye and this includes patients with altered mental status, severe lid edema with inability to open, corneal wound with edema, Hyphema, traumatic cataract, severe vitreous hemorrhage, retinal edema with hemorrhage, retinal detachment, subretinal hemorrhage and suprachoroidal hemorrhage. In the management of eye trauma there is no specific protocol to follow, and the choice of treatment depends on personal experience and experience of others. In perforating eye injuries closure of the posterior wound is often impossible, with the risk of retinal incarceration. Primary surgery includes the closure of the entrance and exit wounds if it is anterior to the equator, with anterior segment reconstruction if needed and limited PPV to remove the vitreous traction between the entrance and exit wounds. Secondary surgery to follow within 100 hours. Chorioretinectomy lowers the PVR rate, prevents retinal folds and improves prognosis. The final goal of our treatment should be to restore the best possible vision and to prevent immediate and late complications.
Douglas Borchman
University of Louisville, School of Medicine, USA
Title: Whales, lifespan, phospholipids and the cause and cure for cataracts
Dr. Borchman is a Professor of Ophthalmology and Visual Sciences at the University of Louisville. He is also an adjunct Professor in the Departments of Chemistry, and Physiology and Biophysics. He earned a Ph.D. in Chemistry from Wayne State University and is the author of over 100 peer reviewed articles. He is/was principal or co-investigator on seven major peer awarded grants totaling over 10 million dollars to study cataract and dry eye. His 1st and last major NIH grants scored in the top 5% and 2% of the nation, respectively. He has given over 250 scientific presentations around the world.
Our study addresses the question why do rats get cataracts at two years, dogs at eight years and whales do not get catarcts for over 200 years? The cholesterol and phospholipid content of bow head whale lenses were measured using 1H and 31P NMR spectroscopy, respectively. Lens lipid structure was measured using FTIR spectroscopy. Whale lens lipid phase transitions were compared to the lipid phase transitions of rabbit, guinea pig, bovine, camel and human lenses. The major phospholipids of the whale lens were sphingolipids which composed 60 to 100 % of the total phospholipid. The average molar cholesterol/phospholipid ratio for all four samples was similar 10 moles cholesterol per mole phospholipid. There was a linear correlation between the percentage of lens sphingolipid and lens lipid hydrocarbon chain order until about 60 % sphingolipid. The percentage of lens sphingolipid correlated with the lens lipid phase transition temperature. The expected lifespan of the bowhead whale (200 y) and the percentage of whale lens sphingolipid fit well in the correlation between the percentage of lens sphingolipid and expected lifespan measured for other species. In conclusion, bowhead whale lens membranes have a high sphingolipid content that confers resistance to oxidation, allowing these lenses to stay clear for a relatively longer time than is the case in many other species. If human lenses could be made to have a lipid composition similar to bowhead whales, like the whale, one could hope humans would not develop cataracts for over 200 years.
Rajamani Lakshminarayanan
Singapore Eye Research Institute, Singapore
Title: Membrane Selective Cationic Polymers as Biocides for Treating Topical Infections
Dr. R. Lakshminarayanan obtained his PhD from the Department of Chemistry at the National University of Singapore. He was a recipient of the Singapore Millennium Foundation Postdoctoral Fellow and then obtained further postdoctoral training at the University of Southern California. Since 2009, he has been working as a Principal Investigator II at the Singapore Eye Research Institute. His major interests include antimicrobial polymers and peptides, antimicrobial coatings for medical devices, new crosslinking methods for electrospinning of hydrogel polymers and protein aggregation diseases. He has published more than 80 papers in reputed journals and 3 book chapters.
In the era of increasing evolution of antimicrobial resistance to antibiotics treatment, there is a perceived need for antiseptics with high biocompatibility index for the management of topical infections. Since the fitness cost for a microbes to modify microbial membranes is higher, agents that target cytoplasmic membranes of prokaryotes are attractive alternatives for combating antimicrobial resistance. Cationic antimicrobial polymers have been shown to elicit rapid bactericidal action by targeting cytoplasmic membrane of the bacteria, but their cytotoxicity for mammalian cells limited their therapeutic potential. In this work, we tested the antimicrobial activity and mammalian cell cytotoxicity of cationic polymers with varying back bones and side chain functional groups. Among the various polymers compared, polymers with ethylenimine (Polymer1) or isopeptide (Polymer 7) backbones displayed good selectivity for microbial cell membranes over mammalian cell membranes. Both the polymers abrogated the adverse effects of bacteria or bacterial secretomes on cell morphology and cell migration, respectively. Polymer 7 displayed broad-spectrum antimicrobial properties which includes carbapenem-resistant enterobacteriocae, vancomycin-resistant enterococcus, MRSA, multi-drug resistant Pseudomonas aeruginosa and filamentous fungal pathogens. The polymer elicits rapbid bactericidal activity, antibiofilm properties and inhibits fungal hyphae as well. Topical instillation of the polymer (0.3% w/v in PBS) restored the re-epithelialization in a rabbit corneal scratch wound model, indicating good biocompatibility. In a rabbit model of bacterial keratitis, topical instillation of Polymer 7 decreased the bacterial bioburden, conreal edema and conjuntival redness when compared to topical antibiotics. Together, these results establish excellent safety and efficacy of the polymer for treating topical infections.
Tsioumas G. Sotiris
Eye surgeon – Oculoplastic, President of Hellenic Society of Aesthetic Medicine and Non Invasive Surgery, Prof of University of Camerino for Aesthetic Medicine, Greece
Title: New treatment with Plasma Exeresis for non- surgical blepharoplasty
Dr. Tsioumas is a surgeon Opthamologist and graduate of the Medical School of the University of Modena in Italy. He is a master in Aesthetic Medicine , having completed his specialization at the "Agios Savvas" Oncology hospital; , and his areas of specification include toxins , fillers , mesotherapy , peels , threads , tumour removal and painless , bloodless and suture-free blepharoplasty with Plexr. Dr Tsioumas is also a lecturer at the University of Camerino and President of S.A.M.N.A.S (Society Aesthetic Medicine Non Ablative Surgery. Moreover his persistent research and devotion on Aesthetic Medicine made him write his first book "Manual of Aesthetic Medicine " that was translated in three languages.
The survey aims to highlight new noninvasive techniques on Oculoplastic focusing on the eyelid. Research and test object were 80 patients, age range 40-78 years, who had problems of small, medium and high degree of ptosis and problems from older surgical blepharoplasties. Common factor and 80 cases were surgical avoidance desire, due to cost and fear in the process. The method of solving the mentioned problems was the bloodless blepharoplasty using Plasma Exeresis. For the evaluation of the results through Plasma Exeresis method, set a satisfaction scale of 1 to 5 (1 = not at all satisfied - 5 = completely satisfied). All patients have described the results of treatment as 5 .
- Vision and Cognition
Session Introduction
Sergio Ozan
CEPROC Centro Prótesis Oculares y Contactología especializada. Mendoza. Argentina
Title: JUMAT Orbit Implant
Optician, University of Buenos Aires, Argentina. Specialist in Contact Lenses. Specialist and manufacturer of ocular prosthesis. Scientific adviser for ocular prosthesis in APO (Asociación Profesional de Optómetras in Argentina). Precursor and creator of multiperforated orbital implant, JUMAT. Precursor and creator of expander orbit asmotic hydrogel filling for microophthalmia. Director of CEPROC. Director of Ocular Prosthesis Division in Perfect Vision, Santiago, Chile. Developer of one-hour customized ocular prosthesis method, unique in Latinamerica. Precursor and creator of the first prosthetic sclera lens
This implant was created considering the good qualities of previous ones and improving their flaws. To start the fabrication I looked for material that was easy to get in the market and with low cost. JUMAT is made with hypoallergenic high-density polymethylmethacrylate. It is made in different sizes, from 10 mm to 22 mm. This is really helpful for the surgeon as he counts with different sizes at the operation theater and can select on site the most suitable one. This is essential for the successful adaptation of the implant.
JUMAT Orbit implant has multiple perforations of different diameters, being the principal one, the one that marks the implant axis and crosses it completely. This perforation has larger diameter in the back area and smaller in the front one. All other perforations connect with the principal one and interconnect among themselves too. This system of perforations is essential to foster an excellent vascularization. Within ten days of surgery the patient is ready to start with the testing for the adaptation of a prosthethic eye.
As from 2010 to present time, 235 JUMAT implants have been implanted with only two expulsions reported. These cases were studied in detail. It was observed that both cases involved children with retinoblastoma. They were enucleated and were implanted with JUMAT.
These two children were derived to Children's Garrahan Hospital in Buenos Aires, leading children's hospital in Argentina. They were under radiotherapy and chemotherapy. These two processes avoided tissue vascularization by necrosia, which determined the expulsion of the implant.
Considering material, cost of material, availability of various implant dimensions, surgeon possibility of choosing exact measure during operation, JUMAT implant proves to be the best option.
- Visual Impairment
Session Introduction
Petar Markov
Cardiff University, UK
Title: Hitting the Bullseye: Computer Models for Treating Vision Disorders
Petar Markov is currently doing his PhD at Cardiff University as part of a joined project between the Schools of Optometry and Vision Sciences, Biosciences and Engineering. Previously an Erasmus student, he completed his Master's thesis at the Institute of Genetics and Molecular and Cellular Biology (IGBMC) in Strasbourg, France. Having a background in Molecular biology and Biophysics, respectively his Bachelor's and Master's degrees from Sofia University benefits his investigation of the role of ocular fibroblasts in determining tissue biomechanics in healthy and diseased eyes. Petar is also a member of the Cardiff Institute of Tissue Engineering and Repair (CITER), which coincides with his interests in further studying ocular diseases and developing new treatments.
Statement of the Problem: Over 300 million people worldwide are affected by vision impairment. Thus, extensive research efforts are being directed towards developing new and improved treatments. The sclera (white of the eye) is vital for healthy vision because it maintains the eye's structural stability and shape, properties which are compromised in prevalent conditions such as myopia and glaucoma. To better comprehend the disease mechanisms we aim to create biomechanical computer models of the eye that incorporate physiological data on both the scleral cell cytoskeletal and extracellular matrix (ECM) components. Specifically, we targeted the scleral region bordering the optic nerve, a key region in glaucoma and myopia development.
Methodology & Theoretical Orientation: Because body physiology slows down with time we required specimens from closely-matched young adult age. This is particularly problematic when dealing with human tissues. Therefore, we compared several mammal species to find a suitable human analogue. Wide-angle X-ray scattering (WAXS) was used to map the scleral collagen orientation and distribution, while multi-photon microscopy provided clarity on the depth profile. The geometry of the eyeball was acquired from video motion capture imaging of specimens that were inflated under simulated eye pressure. Planned experiments include studies of fibroblast cytoskeletal reorganisation under simulated eye pressure (mimicking glaucoma).
Findings: After comparing 11 mammal species our results revealed that the peripapillary sclera of the bovine has a tissue structure closely resembling that of humans, including the important annular structure around the optic nerve, which is vital for its mechanical support. Furthermore, we have optimized protocols for bovine fibroblasts, which will be used to study their pressure-controlled mechanotransduction pathways.
Conclusion & Significance: ECM and cytoskeletal structural information will be used along with geometric data to create integrated models of the eye for driving future scleral-targeted treatments for glaucoma and myopia.
Kristin Smedley
President & Co-Founder, Curing Retinal Blindness Foundation (CRB1 LCA/RP Patient Organization), USA
Title: The Bridge From Diagnosis To Potential Treatment: The Crucial Role Clinicians Play in Success For Blind Individuals
Kristin Smedley, from Bucks County, Pennsylvania, is an award winning non-profit leader, TEDx speaker, and author - but she never planned on any of that. Kristin did plan to be a really great third grade teacher, however her personal path to greatness took an unexpected turn when two of her three children were diagnosed as blind. She had to learn the tools of blindness and build a team of experts that would help her navigate this path that she had not been trained for. Kristin's two blind sons are now thriving as gifted high school and middle school students, elected student council officials, baseball championship winners, International Braille competition finalists, and social butterflies.
In 2011 Kristin founded the Curing Retinal Blindness Foundation (www.crb1.org), the only patient organization in the world for her sons' blindness, CRB1 LCA/RP. Kristin has led the CRBF to raise over $1 Million, introduced the first ever legislation in the United States in Braille, and has moved rare eye diseases from rarely talked about to being discussed in key circles worldwide. In 2017 Kristin published her first book, Thriving Blind: Stories of Success Without Sight.
Kristin enjoys speaking about her journey and pointing out where she can find the fun in fundamentally challenging situations life delivers. Kristin's inspirational and humorous style leaves audiences of all sizes wanting to hear more.
This dynamic session will provide concrete examples of how connecting blind individuals to resources creates a bridge from diagnosis to potential treatment, thereby enabling the individual to lead a successful life without sight.
A diagnosis of blindness is devastating. Whether it is an adult that finds out they are losing their sight or a parent finding out their baby has no sight, it is a traumatic experience. Typically, clinicians say nothing more than "I'm sorry" to the patients and their caregivers. Parents' dreams for their child are destroyed and they feel hopeless, which usually causes them to completely alter the way in which they parent that blind child. Adults that lose their sight often end up unemployed and depressed. In fact, 70% of blind adults are unemployed. Although the impact of blindness is affecting more and more people, most sighted people have no idea of what blind individuals are capable of and therefore a stigma of sadness and pity is misappropriated to the blind community. This stigma creates a vicious cycle of low expectations, under achievement and dependence for blind individuals.
Changing The Blindness/Visual Impairment Diagnosis Delivery:
Kristin Smedley is raising two sons that are blind due to CRB1 LCA/RP. In the seventeen years she has been a parent of blind children she has connected with many successful blind adults to guide her in raising her expectations of her boys and getting all the resources they need to level the educational and social playing field of their peers. She connected with other families raising CRB1 LCA/RP children to share resources. Smedley leads the Curing Retinal Blindness Foundation, the only patient organization in the world for CRB1 LCA/RP. The CRBF is a leader in the rare eye disease community. The CRBF has created a resource toolkit for clinicians, educators, and caregivers to change the way a blindness/visual impairment diagnosis is delivered such that patients are empowered to lead a full life.
Due to consistent exposure to blind role models and proper resources as well as maintaining high expectations for a full life, Smedley's two blind sons have achieved success much greater than many blind children their age: baseball and swimming championships, elected student council executives, International Braille competition awards, gifted programs in regular public schools and more. In addition, the CRBF has forged collaboration in the rare eye disease community where multiple organizations are combining resources to affect many more patients, clinicians, researchers and caregivers for a positive impact worldwide.
- Diabetic Retinopathy
Session Introduction
Rashidul Haque
Emory University School of Medicine, Atlanta, USA
Title: MicroRNA and the ocular Renin-Angiotensin System
He has more than 20 years of experience in molecular biology research. His research interest includes retinal circadian biology as well as ocular microRNA. He is interested in characterizing microRNA molecules and investigating their role in the expression of genes related to ocular diseases like age-related macular degeneration, diabetic retinopathy, and retinal vascular diseases. He is a member of the Association for Research in Vision and Ophthalmology.
Angiotensin (Ang) II is the most physiologically active component of RAS that mediates its effect through two G-protein coupled receptors, Ang II type 1 or type 2 (AT1R and AT2R), having different functional properties and signal transduction mechanisms. Most of the known cardiovascular effects of Ang II are mediated by AT1R. Prorenin has long been considered as an inactive precursor of renin, without any biological function of its own. However, prorenin binding to a receptor called (pro)renin receptor (PRR) has recently been reported to exert biological effects in the neuronal retina and retinal pigment epithelium (RPE). All the components of the RAS including PRR are expressed in RPE, retinal endothelial cells, and other ocular cell types. It is also known now that Prorenin is highly elevated in ocular fluid of diabetic patients with proliferative retinopathy, which all suggest that Prorenin and the system RAS are very important in the eye. Using RNA interference tools, we have shown that both the receptors are implicated in hyperglycemia-induced increase of vascular endothelial growth factor (VEGF), VEGFR2, and transforming growth factor beta (TGFβ1). In order to block the effect of Ang II through AT1R and AT2R, in our experiments we inhibited angiotensin converting enzyme (ACE) by perindopril, where Ang II formation is blocked. We have shown that the increased prorenin synthesis due to hyperglycemia has been attributed to the activation of PRR and VEGF by a mechanism involving NADPH oxidase activity, miRNA-21, HIF1-α and NF-κB. Furthermore, we have demonstrated that the downstream targets of miR-21 are three important genes Smad7, an inhibitor of TGF-β1-induced VEGF expression, Pten, a negative regulator of PI3 kinase/Akt signaling pathway, and Spry1, a negative regulator of ERK signaling pathway. The PRR-mediated induction of VEGF under hyperglycemic conditions occurs via Rac1 signaling by regulating miR-21 expression. Our studies suggest that hyperglycemica-induced PRR signaling may play a role in the VEGF-induced angiogenesis that may lead to proliferative diabetic retinopathy, wet AMD and other vascular complications in the eye.
Nilufer Koyluoglu
Liv Hospital Adnan Saygun St Canan st no 5 Ulus - Beşiktaş, Turkey
Title: WHAT & WHEN WOULD YOU KNOW?
She graduated from Istanbul University, Istanbul School of Medicine in 1997. She was completed her residency in Ophthamology, Istanbul Universtiy, Cerrahpasa School of Medicine, Department of Ophthalmology in 2002. She has worked in Turkish Diabetes Hospital since 2002. She has held the position of Medical Retina Specialist and deputiy Chief Physician in Dünyagöz Hospital between 2005-2016. She coordinated the first bionic eye operational procedures in Turkey; incorporating the Frankfurt World Eye Hospital in Germany as scientific committe initiative and a board member of Dünyagöz Foundation. She initiated the projects Dunyadiyabet and Athletic Eye Health in order to contribute to 'Retina Awareness' as a clinical scientist to prevent the loss of resources that would be used for keeping patients healthy. She aims that the eye would be a symbol organ/logo for the preventive medicine globally, starting from athletes. She is the consultant ophthalmologist for the Association of Turkish Family Medicine and the Turkish Family Medicine Federation and active member of AAO, Euroretina, ARVO, Board member of Turkish Medicine Academy, Turkish Society of Pharmacogenomic and Personalized Medicine, Turkish Diabetes Association and Turkish Association of Ophthalmology. She works with the international program of the Orbis, married with two children.
Over 382 million people in the World have diabetes, 46% of globally diabetes population is undiagnosed. Up to 50% of diabetes is detected with a clinical complication. Diabetic population will increase 54% while the number of ophthalmologists will increase by 2%. Will present activities address the magnitude of the issues that are coming up? This massive problem requires a high level solution. The average lag between onset and diagnosis of type 2 diabetes is 7 years. If diabetes cannot be prevented, the best way to ensure better patient outcomes is to detect early and manage continuously. Fortunately technological developments can make a significant difference in perception.
Advanced glycation end products (AGEs) are proteins that become glycated as a result of exposure to sugars. AGEs affect nearly every type of cell and molecule in the body. In the blood stream glucose sticks to the haemoglobin to make a 'glycosylated haemoglobin' molecule, called haemoglobin A1C (HbA1c) which is most recognised one among the large molecular family of AGEs. HbA1c is measured primarily to identify the three-month average plasma glucose concentration. The HbA1C test is currently one of the best ways to check diabetes is under control.
In a similar way fructosamine testing, typically reflect albumin glycation that is rarely used in clinical practice, because albumin has a half-life of approximately 20 days, the plasma fructosamine concentration reflects relatively recent (1-2 week) changes in blood glucose.
Although most proteins in living system turn over with sufficient rapidity to avoid signficant accumuation of AGEs, published evidence shows that with the appearance of glucose in the blood, glucose also appears in the aqueous humor of the eye and is subsequently transported within the crystalline lens. These glucose molecules are still "sticky," with the same affinity for protein, including collagen within the lens. The non-enzymatic, chemical bonding between glucose and lens proteins forms irreversible glyco-protein aggregates. AGEs accumuate in these proteins over a persons lifetime.
Lens autoluorescence may have a clinical utility is suggested by its physiological basis, which is the accumulation of AGEs, a heterogenous family of yellow-brown and fluorescent proteins that have been modified by glycation.
Studies of the autoflurescence of the human crytalline lens have established that lens autofluorescence intensity increases with the age of the subject and that lens autofluorescence is further increased in patients with diabetes mellitus. Thus lens autofluorescence as a noninvasive measure of AGE accumulation, can be regarded as a measure of cumulative tissue damage due to elevated sugar in plasma and interstitial fluids. The clinical application of lens autofluorescence with a scanning confocal lens fluorescence biomicroscope enables the clinican to measure lens autofluorescence in routine examinations. Patients with lens fluorescence significantly higher then expected for their ages may have accelereted accumulation of AGEs and increased risk for the pathologies associated with diabetes and AGEs. AGEs throughout the body, including lenticular AGE's, are higher in people with diabetes and pre-diabetes than the rest of the population. An interesting characteristic of AGE's is that they will fluoresce when exposed to light, and the amount of fluorescence can be detected by an optical sensor. The transparency of the ocular media (cornea, aqueous and lens) provides a unique opportunity to shine an excitatory light source on fluorescent AGEs within the human lens and correlate that fluorescence with the degree of AGE deposition. The only technology available in the U.S. cleared by the U.S. Food and Drug Administration (FDA) for the non-invasive measurement of lens autofluorescence is the CLEARPATH DS-120™, manufactured by Freedom Meditech, Inc. (San Diego, CA).
The CLEARPATH DS-120™ accurately measures a person's lenticular fluorescence and reports if the result is at normal, high, or low limits versus age-adjusted normative data. Thus, since the glycation process in the lens has been reported to be irreversible, one can think of lens autofluorescence as a tool to obtain information about a person's glucose excursions over a lifetime. Over 60 peer-reviewed published studies have shown a significant correlation between higher than average age-dependent lens autofluorescence, associated degenerative changes in the lens, and the presence of AGE's, which are considered a hallmark of uncontrolled glucose. Patients with measurements above the 95% prediction interval should be referred by the clinician to primary care for a follow-on glycemic control evaluation. For patient's whose measurements fall between the 80% and 95% prediction intervals, the clinician may decide to perform a clearpath evaluation annually to monitor if a patient's fluorescence ratio moves up to the 95% prediction interval. Patients with an autofluorescence measure below the 80% prediction interval are suggested for a clearpath evaluation again in three years time. By placing a patients's lens autofluorescence measure the clinician can identify patients with lens fluorescence that is higher than expected as red or orange line. Patients with measurements above the 95% prediction interval should be referred by the clinician to primary care for follow on glycemic control evalution. Above the red line means that is highly likely they will receive a differential diagnosis of prediabetes or diabetes. Orange colour code means the patient has higher than expected AGE accumulation again. It is likey they have had poor glucose control over their lifetime. Green line means the patient is likely within normal range and has had less than expected AGE accumulation, if the subject has diabetes, it is possible their glucose levels have been under good control such as diabetic patients with normal HbA1c. It is also possible the patient has latent autoimmune diabetes in adults or other metabolic issues such as pancreatitis, infections, and certain drugs maybe in green due short duration of out of control glucose. On the other side, lens autofluorescence measurement can identify patients with lens fluorescence lower than expected as under the green line. Thus fluorescein ratio provides information on the mobility of the person, the calories they get / the calories burned and
it should be investigated by further studies whether it will be an athletic performance indicator such as an athlete's pulse.
The clinical data indicated that the fluorescence ratio could provide better discrimination between individuals with and without diabetes than fluorescence intensity. This new parameter expresses metabolic control as longterm for patients with or without diabetes. Whereupon the crystalline lens has a new dimension which is providing information other than its own function related to visual function and cataract, as HbA1c that provides information other than haemoglobin's own function If we think of fasting blood sugar and postprandial blood sugar as photograph, HbA1c as fragman, fluorescein ratio can be considered as whole film of life until cataract operation and it should be considered as a metabolic credit note of the person. Noninvasive measurements of lens autofluorescence may have clinical utility for general health beyond the diabetes and its complication.
- Visual Neuroscience
Session Introduction
Haisheng Zhao
He University, China
Title: A comparison of None-staining of the internal limiting membrane vitrectomy outcomes for high myopic patients with macular hole (MH) and control patients with idiopathic MH
Dr Haisheng Zhao has his expertise in optic nerve injury and regeneration, neuroprotection on retinal ganglion cells. He has published 6 peer-reviewed journal articles in this aspect. He also has his research interests on maculopathy and age-related macular degeneration, and he has published 2 peer-reviewed journal articles in this aspect. Based on15 years of research accumulation, he has given 13 international seminar and conference presentations. His conference contribution "Expression of Thy1 in rat retinal ganglion cell cultures is regulated by LEDGFp52"and "A comparison of None-staining of the internal limiting membrane vitrectomy outcomes for high myopic patients with macular hole (MH) and control patients with idiopathic MH" represent his recent research results both in basic and clinic interests. These two results will provide some new looks on RGCs neuroprotection and MH surgery skills.
Statement of the Problem: To evaluate None-staining of the internal limiting membrane vitrectomy outcomes for high myopic patients with macular hole (MH) and to compare these outcomes with those of control patients with idiopathic MH.
Methodology & Theoretical Orientation: The study was designed as a retrospective chart review. We performed a retrospective chart review of consecutive cases that underwent None-staining of the internal limiting membrane vitrectomy for MH from 2016.1 through 2017.2. 36 eyes of 36 patients were selected to participate in this study. They were divided into 2 groups: 9 study eyes with high myopic MH and 27 control eyes with idiopathic MH. The main outcomes were preoperative, postoperative best-corrected visual acuity (BCVA), MH closure rates, and abnormal IOP complications in both groups.
Findings: There was a closure rate of 88% in the study group and 85% in the control groups, and no cases of reopening were reported during the follow-up visits. After surgery, there were significant improvement of mean BCVA in the study group(88%)and in the control group (85%). The aplitude of postoperative BCVA in the study group was significantly higher than that in the control group. Abnormal IOP complications taken place in the study group was 33%,while in the control group was 11%. Conclusion & Significance: None-staining of the internal limiting membrane vitrectomy results in satisfactory anatomical and visual acuity improvement in patients with high myopic MH and in patients with idiopathic MHs. However,abnormal IOP complications taken place in the high myopic MH group was higer than that in the idiopathic MHs group. Therefore,pay much more attention to control and regulate IOP in the duration and post of surgery.


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5 night get-away: Freedom of the Seas Cruise Review by sailingsue1
Overall Member Rating
5 night get-away
Destination: Western Caribbean
Embarkation: Tampa
There was a crying (screaming) baby in the late (8:30) seating and the staff would do nothing. The rules state that age 7 and younger are to use the early sitting. At the customer relations desk, a woman told me that some people have different customs and the baby was allowed. There is a baby sitting service on board but these people chose to not use it. This child was clearly unhappy and it was stressful to see this sadness.
On the positive side, the stateroom attendents are wonderful and bend over backwards to help. The food was good, and the public areas clean.
By the way, the shows are not at all Broadway quality. There was a skilled More and funny juggler there and I hope that he finds his way to a ship that is worthy of his talent. Less
Published 01/02/13
Cabin review: F3524 Large Oceanview Stateroom
Room too small, closet cramped, lots of counter storage spaceRead All Large Oceanview Stateroom (F) Reviews >>
Port and Shore Excursions
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Awesome week on the Norwegian ...
Crowded and noisy!
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Great experience.
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Wonderful time on the Grandeur
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