The South African Glaucoma Society (SAGS) annual congress is an event eagerly anticipated by many South African ophthalmologists.
The 2018 congress was attended by 149 delegates and was held at Spier Wine estate nestled in the foot of the Hottentots Holland mountains in Stellenbosch.
The SAGS congress always has two main highlights which include the international guest speakers and the registrar presentations. Another relatively new highlight is an industry sponsored wetlab session on the first day. This year delegates thoroughly enjoyed honing their MIGS skills under the intense scrutiny of their peers. They were also impressed by the highly intuitive NGenuity 3D Visualization System.
The international guest speakers at the 2018 SAGS congress were Professor Paul Foster from Moorfields, United Kingdom and Dr Devesh Varma from Toronto, Canada. Professor Foster gave an awe-inspiring account of the work being done by the UK Bio-Bank where researchers use deep learning algorithms to extract new knowledge from retinal fundus and ocular coherence tomography images. The following breakthrough findings have been uncovered so far:
• Retinal pigment epithelial basement membrane thickness appears to be linked to IOP.
• A clear relationship has been demonstrated between thinner RNFL and poor cognitive function.
• Cardiovascular risk factors such as age, gender, smoking status, systolic blood pressure and major adverse cardiac
events can be identified using only fundus images.
Genome analysis is also performed at the BioBank and this has identified 112 genomic loci associated with IOP, 68 of which are newly identified. The data suggests that angiopoietin- receptor tyrosine kinase signalling,lipid metabolism, mitochondrial function and developmental processes play a strong role in determining IOP.
Dr Varma’s MIGS talks were a crowd favourite. He gave attendees a glimpse into the future of MIGS devices where we can potentially expect the following revolutionary features:
Drug eluting components, combined mechanisms of action, individualised patient customisation, IOP sensing and IOP responsiveness.
Dr Varma also gave the delegates his tips on how to select the ideal MIGS patient. For the iStent he recommended patients with mild glaucoma controlled on topical medications who are undergoing cataract surgery. Dr Varma uses the Kahook Dual Blade in pseudophakic patients with moderate glaucoma which may or may not be controlled on topical
medications. He recommended reserving the Xen GelStent for patients with uncontrolled advanced glaucoma, in the presence of a healthy conjunctiva.
Dr Varma’s OCT talk was also found to be useful by the delegates as he highlighted some of the potential causes for false positive retinal nerve fibre layer thinning. These included motion artefacts, split bundles, curve shifts and signal loss.
At the gala dinner Dr Varma shared his personal experiences and life lessons learned during his fellowship years under Professor Ike Ahmed. This inspirational and heart felt talk will be remembered by everyone present, in spite of the Cabernet.
The registrar case presentations are always hotly contested as registrars compete for the accolade of best registrar presentation. The 2018 candidates did not disappoint. Dr Ashvira Moodley took second prize with an interesting case of Axenfeld-Rieger syndrome. She discussed the genetics, differential diagnosis, classification and management difficulties
associated with this rare condition. Dr Sanushka Moodley claimed first prize with her interesting case of a patient with normal tension glaucoma which was progressing despite adequate IOP lowering. The patient was referred for 24-hour ambulatory blood pressure monitoring which demonstrated significant blood pressure dips at night. Dr Moodley
highlighted the importance of identifying the underlying ocular perfusion pressure problem in these patients. She recommended addressing blood pressure dips and harnessing the beneficial effects of Nitric Oxide through medication and diet to prevent progression.