Day 1 - 18 November 2020
Welcome Speech by Consultant of World Health Organization (WHO), Vision Programme
How the optometrist involvement more effectively to responses globally uncorrective particular in our regionI suggest that optometrists first evaluate the current system to deliver refractive and optical services effectively in their own country. They may contact WHO to support them with this analysis, as some tools have been developed by WHO to support this. The analysis should assess how available, affordable and accessible these services are, ie can everybody that requires spectacles in my country access them? Based on the findings, the optometrists may then advocate to their government about appropriate steps to improve the situation, e.g. changes in policy, training of human resources, changes in the level of insurance cover for spectacle provision, private public partnerships etc. In my countries, there is a lack of government acknowledgement of the role that optometrists play in the provision of health care. Again, you may contact your WHO country office or the WHO HQ vision programme for more information.
The Challenges Of Achieving Best Corrected Visual Acuity
I want to ask about ARMD. How can we treat for giving a spectacle in ARMD which is have a scotoma central as a visual impairment in elderly people?Dry AMD. There is no treatment. We may give low vision glasses for those patient. These glasses provide high powered magnification to reduce the size of blind spots.
We give anti-VEGF (vascular endothelial growth factor) injection for the patients with wet AMD regularly. But central scotoma may present due to permanent damage of AMD.
A Decade of Blue : Panel Discussion
1Some of the more advanced smartphones and/or laptops in the market already have blue light filter/night light filter setting. Are these settings already effective enough to block the blue light?Chui Wen Juan: There are several sources of blue light, not just digital devices. Indoor light (white LED, white fluorescent etc), sunlight, white LED street lamps. In fact, the amount of blue light from smaller digital screens may be less than other sources of bright white light (blue is a component of all white light). Sunlight is the most major source of blue light – so when considering blue light protection, we must consider outdoor daytime protection too. Sunlight is the most major source of blue light – so when considering blue light protection, we must consider outdoor daytime protection too.
2I would like to know if there is any difference in terms of the blue light protection coating lenses, blue light protection lens material and transition lens? If yes, which would be better?Chui Wen Juan: The better blue light blockers would be the ones that selectively filters out wavelengths 415-455nm. This is the blue-violet spectrum.
Colin Madigan: Blue filtering should be up to 455nm so as not to interfere with 465-495.
3Which is the best and maximum for digital and everyday eye protection, the blue cut lens or blue uv lens?Chui Wen Juan: Eye protection includes blue light as well as other factors – correct prescription, visual distance, binocular vision, dry eyes, impact protection etc.
So even if we prescribe blue cut or uv protection and ignore other forms of protection for the eyes, then we are not giving the best holistic protection for the eyes.

Blue light and UV protection are both important and are one of the easiest factors to upgrade or alter (as in a blue filtering lens for digital eyestrain) but not the only considerations for best protection.
4How the effectiveness is the blue control lens? In which condition can should that blue control lens is effective?Chui Wen Juan: Blue filtering lenses should be discussed with every patient. Patients should know what these lenses can or cannot do. It is important to ask the patient about their occupation, lifestyle, environment, risk factors and how many hours they spend looking at screens at work and socially and if they experince tired eyes at the end of the day.
5Many Blue lenses are seen Online Market now. How can the Industry protect the public and how sure are we that the Public are safe from this Lenses being sold rampantly in the websites.Chui Wen Juan: Not all blue filtering lenses are the same – there are products which we don’t know how much and what wavelengths of blue that are filtered. The public and our patients need to know that it’s not just about blue light protection that is important – other things such as proper prescription, visual habits, binocular vision, impact protection, UV protection, dry eye management etc.
6In your opinion, how do we educate customers or patients who often use digital, for example using computers up to 8 hours per day?Chui Wen Juan: Not all blue filtering lenses are the same – there are products which we don’t know how much and what wavelengths of blue that are filtered. The public and our patients need to know that it’s not just about blue light protection that is important – other things such as proper prescription, visual habits, binocular vision, impact protection, UV protection, dry eye management etc.
In addition: advise regular rest breaks – every 20mins near work, 20 second rest by looking at a distance of 20 feet or 6m away. Minimum 2 hours daily outdoor time.
7Is it true that blue coated lenses cause sleepiness?Chui Wen Juan: It depends on what wavelength and intensity that is filtered out. Any wavelength of light exposure may potential disrupt the sleep wake cycle, but some wavelengths eg the shorter wavelengths tend to have more effect.

Colin Madigan: Lets be very clear about this. The circadium rhythm is reliant on the presence of blue light 465-495nm. This part of blue light should not be interferred with at all or as little as possible. Blue filtering lenses will not disrupt sleep cycles. Looking at a lot of light at night (screens and light of 465-495) may be telling the body to stay awake. But there is no evidence that blue filtering lenses effect sleep. this is a myth that is utilised on the internet to engage in customers. It is a message that ECPS myst be clear about and I think this can help with question 5.
8Is blue lenses effective for children?Chui Wen Juan: Children whose crystalline lenses are clear and pupils are large should be advised to have protection against high energy blue and UV.

Colin Madigan: Blue light filtering lenses can provide more comfort with learning using screens.
9Does Blue Filter works on Colorblind Patients? Do you have Special Lenses for them with Blue Filter with EnChroma?Chui Wen Juan: Blue filters do not treat congenital or acquired color vision deficiencies.
10Is blue filter in handphone comparetible with blur light filter lenses?Chui Wen Juan: There are several sources of blue light, not just digital devices. Indoor light (white LED, white fluorescent etc), sunlight, white LED street lamps… in fact, the amount of blue light from smaller digital screens may be less than other sources of bright white light (blue is a component of all white light)

Sunlight is the most major source of blue light – so when considering blue light protection, we must consider outdoor daytime protection too.
11Hi, my phone have Reading Mode, its make the screen very comfortable while reading . Is it like blue filter or no?Chui Wen Juan: Some digital devices have modes that reduces the whiteness of the background, or change the colour of the words to a light colour against a dark background. Both approaches reduce glare, which would help with comfort.

Therefore the secondary advantage of blue filters is glare reduction, which gives subjective comfort to some people.
12What is blue light?Chui Wen Juan: Light that is wavelength 450-485nm
13Why are we still promoting and push the blue lens to the patient/ customer if it makes confusing information between the optometrist and ophthalmologist?Chui Wen Juan: It is precisely because there is a lot of misinformation about blue light hazards and eye protection that we need to do these 2 things.

1) Optometrists need to know the evidence about blue light – what is harmful, what is not, where we can get blue light exposure, and how to mitigate risks.

2) Optometrists and ophthalmologists should work together to address eye hazards and eye protection. We need to think longterm, not just short term protection and hazards.

Colin Madigan: The biggest issue is the medical claim of blue filtering lenses versus reducing asthenopia. If Optoms continue to talk about asthenopia then there will be alignment.
14What's the theory behind transition lenses able to provide blue light filter?Colin Madigan: No theory. Transitions photochormic dyes filter 20% blue up to 460nm and balance the colour bye utilising complementary dyes.

Chui Wen Juan: Any filter that cuts coloured light will reduce blue light transmission. However, this type of filter will cut all coloured light, and is not selective against higher energy wavelength light.
15How blue light does with patinet who have cataract?Chui Wen Juan: A cataract lens is a natural internal blue light filter. It offers some protection for the retina and macular, but no protection for the crystalline lens itself. So external protection is important for corneal and lens health.

Colin Madigan: As a person ages the crystalline lens yellows - this in fact is a natural blue filter. However with age, the yellowing can increase significantly and along with white opacities in the lens can start to reduce vision. there is no evidence that Blue filtering lenses will slow down cataract development. A mature patient with mature, vision altering cataracts who is not having surgery should have a lens with the maximum transparency along with the best AR coat- not a blue filtering lens.
16With the current blue light protection lenses available, are they able to protect against natural blue from the sun or only protecting artificial blue light?Chui Wen Juan: Current blue light filters do not cut out all the blue light, because it will affect colour perception. So whether it is natural or artificial sources of blue light, we need to balance adequate protection and acceptable visual function.
Another consideration of blue light and UV protection is internal protection – the macula has pigments that are protective against oxidative effects of UV and high energy light – these pigments can only be manufactured by the body if there are sufficient lutein and zeaxanthin in the diet. So patients should have a balanced diet of antioxidants for eye (and general health) protection.

Colin Madigan:
1. There is no difference in light wavelengths from sun or artificial sources
2. It is well excepted that a diet high in antioxidants can be beneficial to the eye and also many other body functions. However the link between increasing luetin and zeaanthin in diet is questionable. Note the most common antioxidant is Vitamin C or Zinc I think. Please rethink this line of thought.
17I am wondering why it cost more to have the blue coating...a lot more! The blue coating could just be achieved by adjusting interference of wavelength via the thickness of the coating in relation to the material that is being coated. I remember in the early year, Hoya anti reflection coating was blue. Later some company produces coating that is purple purportingly to reflect the red and blue end of the spectrum giving the full benefit to the visible spectrum of light.Colin Madigan: This is a very good question. The technology that utilises refelction technology of blue ight goes against the developed technology of AR coats that are designed to reduce refelction so it is in fact a new technology category. There is a big shift now to embed blue filtering technology in the lens rather than adding this into the AR coat because of cosmetic issues. The challenge with all blue filtering lenses is to keep the lens looking clear to the wearer- this is not so easy to do considering that when you take any colour out of white light- you no longer have white light. The same goes for the appearence of the lens. A lot of technology goes into the balancing the filtering to prvide effectiveness but also make the lens look aestheically clear.

Chui Wen Juan: Cost of production will have to be addressed by the manufacturers. But we also have to consider the cost of rigorous testing of products, scientific research into such technology.
18Can you explain why some myopic patient complaint of more digital eye strain while wearing contact lens than wearing glasses?Colin Madigan: There could be many reasons - but accommodative demand is higher for a CL wearer as compared to Spec wearer because of vertix distance of correction. this is why early myopic presbyopes that wear CL will experince the symptoms earlier than if they wore spectacle.
19Beneficial / Non-Beneficial Blue Light?Chui Wen Juan: All blue light is useful in some way, e.g. colour perception, colour temperature of lights.

But because the higher energy blue light can also cause oxidative damage, it is commonly labelled as bad blue or non-beneficial.
Therefore, we should aim to reduce our cumulative exposure to higher energy blue, and / or improve our protection against chronic exposure to such blue light.
20Is the blue control coating significantly evidance-based proven to reduce the symptoms of VDU such as dry eyes and eye strains?Chui Wen Juan: If you’re referring to blue light filters in general, rather than specific brands or products, blue filters do not reduce symptoms of dry eye, but for discomfort glare eye strain. Blue filters does not address refractive and binocular vision issues that can also cause digital eye strain or computer vision syndrome.
Keratoconus
1I suspect that our sedentary lifestyle especially in the young is leading to an increase in Keratoconus. What is your opinion?The Keratoconus usually presents during puberty and is considered rare in young children, but isn’t all lifestyle in the young to and increase the disease. Some pt present with allergic conjunctivitis and persistent eye rubbing is most common.
2In your opinion, when/ how is the keratoconic pt’s conditions would you recommend for a surgery?We will recommend for surgery for below conditions :
(a) If pt have progressive thinning to the periphery
(b) Corneal scar
(c) CL intolerances despite good vision or comfortable CL fit
The Optometrist Arsenal in Myopia Control Management: A Concise Review
1If you use collyre Atropine 0,01% in management of myopia, it's really useful or unuseful?Thank you for your question. Personally, I have never use Atropine 0.01% as the literature had shown that the effect of myopia reduction provided by this concentration is minimal. To be more precise, 0.01% are still able to reduce myopia progression. However, the effect is not as good compared to a higher concentration of Atropine.
2Which concentration of atropine is the best for patient in myopia control ?Thank you for your question. There is no simple answer as there are many factors that need to be taken into consideration. However, researchers had shown that currently, the 0.05% Atropine offers the best myopia control treatment, with the least amount of side effect, compared to higher doses of Atropine.
3How long should a child rely on atropine treatment to ensure there is no rebound phenomenon ?Thank you for your questions. There is definitely a rebound phenomenon when using atropine for myopia control. In general, the longer the child stays on atropine, the better for myopia control. However, this needs to be balanced with any problems or complications that might arise due to atropine use. Unfortunately, there is no finalized guideline for the use of atropine on children, with regards to the duration of use. However, the AAO suggest the use of atropine on children to be somewhere between the range of 15 to 18 years of age. Researchers also noticed that they could taper the dosage to reduce the rebound phenomenon. To learn more, feel free to read the link below.

Atropine Cessation Leads to Rebound (reviewofoptometry.com)

How to Use Low-Dose Atropine to Slow Myopic Progression in Kids - American Academy of Ophthalmology (aao.org)
4I would like to ask about myopia control modalities. Beside atropine, is there any rebound effect from other technique?Thank you for your questions. Yes, there is also a rebound effect on ortho-K for myopia control, which has been mentioned by researchers. To learn more, please click the link below.

Orthokeratology for slowing progression of myopia | Contact Lens Update

Myopia and orthokeratology for myopia control - Cho - 2019 - Clinical and Experimental Optometry - Wiley Online Library
Something’s Blooming in the World of Myopia : Introducing the 1st CE-Approved OK Lens Specifically for Myopia Control
1Are Menicon Bloom Day in SiHy material? Is it available in the Malaysian market?Menicon Bloom Day lenses are currently only available as a Hydrogel material. It is not available in the Malaysian market yet, but we hope to have it there soon.
2In your opinion, what is the best myopia control method? Which method has the best control rate, by how many percent? To be honest, the best myopia control method is the one that works for your patient. There are many things to consider when prescribing for a myopic patient: how fast their myopia progression is, age, patient maturity, parental preference, among other factors. Remember that control rates are averages, there are patients that sometimes do better or worse than the average. It is up to us as practitioners to monitor patients closely to ensure that whatever method we have prescribed for them is working the way we expect it to, this is precisely the reason why we have created a more robust patient monitoring feature with our Menicon Bloom system.
3Is the tool sufficient for practitioners who do not have axial length device in the practice in monitoring the efficacy of bloom?Absolutely! We can monitor efficacy with axial length or with the patient’s refraction in our Bloom system. Either way will help you determine if you should stay the course or perhaps change your treatment method.
Day 2 - 19 November 2020
Vision 2020, Where are we now?
What is our role as RO / optometrist practitioners in the prevalence of myopia rates which experience significant progression in the next few decades towards 2020 right to sight vision?Thank you for your question.
There have been many kinds of research conducted on myopia, and many suggestions on how to overcome the significant progression. Our roles as optometrists can be described in these few possible actions:
1. Perform eye-screening in schools to detect uncorrected refractive errors and other possible eye conditions, and at the same time educate the students about Myopia and Eye Health.

2. Set up Myopia Clinics in cities showing a high rate of Myopia. The Myopia clinic can be part of our usual optometry practice, where we received referrals of Myopic cases and perform regular follow-up, eg. during school holidays.

3. Increase public awareness of Myopia and other Eye Conditions.
Sports Optometry: Vision & Performance
1An archery athlete has problems in the depth of eye perception. Are there any eyeglasses or contact lenses to improve the depth of perception?Depth perception is a vision problem. We need to identify which vision problem causes the depth perception issue so it can be corrected. Once diagnosed we will know if contact lenses or eyeglasses or vision therapy can resolve the depth perception issue.
2Is this sport lens wear is very effective and made comfortable in his vision of my patient everyday with its size of : 

R: S-12:00 C-1.00 X 65
L: S-5.00 C1-00 5:00 X 45?For this type of refractive error, only contact lenses can provide the best visual performance because thick eyeglasses and anisometropia causes double vision which will affect depth perception.
Optometry and Innovation
1What is your opinion on the proposal by U.K government initiative to move Optometry education out of Universities in to Students only learn thru Apprentice in Optom Practices only?According to my opinion, optometry program should be run by the university because if run by other state holders control of this program is not possible and clinical exposure of the student will be a difficult task and licencing of this student will be a greater risk for mankind.
2Please comment on the use of video screen devices and it effect on eyes.Most of the video screen devices are inbuilt anti reflective coating to reduce the eye strain but due to change in luminance level of this devices and also usage of this device are also increasing day by day will causes the eye stain. So yes, it will effect the eye if you did not follow the instruction which is given by optometrist or ophthalmologist.
3What is the level of knowledge assimilation by online Technology based learning in present Covid times?It has both advantages and disadvantages but at present covid time, we have to approach this technology to learn and to deliver the continuity of the education.
4How to implement clinical and practical teaching using technology or hybrid teaching in the times of pandemic where face to face teaching is prohibited? Is there any available solution on this?The practical session can be pre-recorded and posted to students on google classroom or any other portal available, where students can be assessed and also one to one basis we can clarify the outcome of the clinical skills. At present, we can teach the students with the help of a simulator, presently retinoscopy and fundus simulator are available online which can be used to deliver the clinical teaching but all the procedure is not possible but to a certain extent we can train the students.
A Single Spark Can Start a Prairie Fire : Practice of Personnel Promotion Patterns of China Optometry Development Education Program
I am optometrist outside China. How should i do if i want to follow the forum as you mention in your presentation?You may visit https://bit.ly/COOAOfficialWebsite for more information.
Recognition of a New Profession
How old optometry profession in vietnam already?It's 6 years already.
What Do You Need to Become a Myopia Specialty Practice
1How to maximize myopia patients the first time without having to reduce his actual size?I’m assuming this question is asking about reducing myopia in patients without reducing axial length. If that’s the case, reducing risk factors such as environmental risks and lifestyle risks may in certain way help in reducing myopia in children for example reducing near work activities and increasing outdoor activities may help in reducing myopia progression in children. But if these activities are coupled together with a non-invasive, easy-to-wear and effective myopia control aid such as MiYOSMART, myopia control will work better.
2Do you think managing IOP as well can help deter axial length thereby deterring myopia increase?There are a number of studies on this matter, hence there’s room for discussion pertaining to this topic.
3Please let us know if miyo smart lens is also applicable to patient of high astigmatism only?As high astigmatism is not the main focus of our MiYOSMART clinical research, we can’t comment much. However, our MiYOSMART lenses can be ordered up to a max -4.00D cyl. This is indeed an interesting question which I hope research in the future can look into this matter.
4Is this myopia management technology is available in Pakistan and Saudi Arabia by Hoya?We are looking at opportunities of having it in the future.
A New Daily Disposable Silicone Hydrogel Contact Lens, PRECISION1™ with SMARTSURFACE™ Technology
Who is more suitable to wear Dailies Total 1 and who is more suitable to wear Precision 1? In addition, other than different material and vision, what are the other differences?Dailies Total1 : for those who want the ultimate experience, a lens that feels like nothing, and are willing to pay a premium for it.
Precision1: For those who want long lasting performance and the latest technology at a mainstream price
Asia Optometric Congress