One-day CME Janakpurdham

C M E J a n a k p u r e - A b s t r a c t | 1 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties

C M E J a n a k p u r e - A b s t r a c t | 2 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties 1. Message from Organising Chairperson …………………3 2. Message from Organising Secretary ……………………4 3. Message from NOS President …………………………. 5 4. Message from NAO President ………………………… 6 5. Message from NOAS President ……………………….. 7 6. Program Schedule …………...………………………….8 7. Organising Committee ….……………………………... 11 8. Speakers and moderators ……………………………….12 9. Abstract of topics ……………………………………… 13 10.Sponsors ……………………………………………….. 28 11.Organising Committee members in action ……………. 29 12.Feedback from social networks ……………………….. 30 Content

C M E J a n a k p u r e - A b s t r a c t | 3 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties Dear esteemed colleagues and participants, I am delighted to extend my warmest greetings to each one of you to this One-day Continuing Medical Education (CME) program in Janakpurdham, with the theme "Comprehensive Updates in Ophthalmic Specialties." Ophthalmology, as a specialty, is continuously evolving with groundbreaking research and innovative techniques emerging at a rapid pace. Keeping up with these advancements is crucial for all healthcare professionals involved in eye care. Our CME program is designed to provide you with the most up-to-date information, evidence-based practices, and insights from leading experts in the field. This CME program is unique and the first of its kind in Janakpur, where all members of the ophthalmic fraternity, including Ophthalmologists, Optometrists, Ophthalmic Assistants, and all other ophthalmic health professionals, will share a common scientific platform under one roof. Our main objective is to enhance our understanding through knowledge exchange, which will ultimately help us elevate the quality and efficiency of the services we provide. We are excited about this opportunity to come together, learn from each other, and collectively contribute to the advancement of ophthalmic care. We believe that this will also foster stronger bonds and collaboration among members of our ophthalmic fraternity. The abstract book for this event is a valuable resource that contains a collection of brief summaries and take home messages of the presentations from esteemed speakers. I encourage you to make the most of this abstract book as it will serve as a guide throughout the event and a reference for your future practice. I would like to express my heartfelt gratitude to the organizing committee, faculty, and sponsors for their support and dedication in making this CME program a reality. Together, we aim to create an enriching educational experience that will have a lasting impact on the quality of eye care in our region. And I believe this program will set an example for the future to maintain harmony among the ophthalmic fraternity. Thank you for your participation and dedication to the field of ophthalmology. Warm regards, Dr Sabin Sahu Organising Chairperson CME Organising committee Message from Organising Chairperson

C M E J a n a k p u r e - A b s t r a c t | 4 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties Dear friends, As face of the organizing committee and on behalf of each one of them, it is indeed a very great pleasure for me to welcome each one of you and your family to first one day CME with theme “Comprehensive updates in ophthalmic specialties” organized by Nepalese Association of Optometrist in association with Nepal Ophthalmic Society and Nepal Ophthalmic Assistant Society held at Janakpurdham on 23rd September 2023 with motto “SHARE & LEARN TOGETHER”. Each and every member of ORGANISING COMMITTEE have put their best of efforts to make this CME a memorable one. Along with good scientific sessions, you can enjoy delicious foods!! Apart from that you can visit Janaki temple and various places and do shopping in and around Janakpurdham. Kindly use the occasion and enjoy the maximum! Regards, Ravi Shankar Chaudhary Organising Secretary CME Organising committee Message from Organising Secretary

C M E J a n a k p u r e - A b s t r a c t | 5 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties I am really pleased for the upcoming CME on “Comprehensive update in ophthalmic specialties” which is going to be conducted in beautiful, culturally rich city of Janakpur where SITA was born. This CME is a joint effort of Nepal Ophthalmic Society (NOS), Nepalese Association of Optometrists (NAO) Madesh Pradesh & Nepal Ophthalmic Assistant Society (NOAS). The theme of the CME which is in regards to updates in ophthalmic specialties will help in alleviating blindness in Nepal. The structure of Nepal Eye Care Program which involves ophthalmologists, optometrists & ophthalmic assistants at different levels to provide eye care to patients is one of the best model in the world. Thus, I would like to congratulate & give my best wishes to the organizing team. Knowledge & culture will go hand in hand & everybody will benefit from this CME. Warm regards, Prof. Dr. Meenu Chaudhary President Nepal Ophthalmic Society Message from President NOS

C M E J a n a k p u r e - A b s t r a c t | 6 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties It’s great pleasure to express my gratitude towards the effort that Nepalese Association of Optometrists (Madhesh Province) is taking to serve the public and make people and officials aware about the Optometry profession in the province. The upcoming CME and collaboration among Nepalese Association of Optometrists (NAO), Nepal Ophthalmic Society (NOS), and Nepal Ophthalmic Assistant Society (NOAS) is certainly satisfying and will uplift the eye care service and our common voice in the different forum like Government and Non-Government agencies. The theme “Comprehensive Updates in Ophthalmic Specialties” is convincing and need of the hour. I am sure all Ophthalmologists, Optometrists and Ophthalmic Assistants attending the CME will be benefitted by the presence of esteemed panel of speakers. I expect similar programmes and organized in regular intervals to share our knowledge among different eye care professionals. I wish success to the program and overwhelming participation. Niraj Dev Joshi President Nepalese Association of Optometrists Message from President NAO

C M E J a n a k p u r e - A b s t r a c t | 7 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties This is a great pleasure and privilege to know about one day CME on “Comprehensive Update in Ophthalmic Specialties” going to be held on 23rd September, 2023 in Janakpurdham. We as a professional body of Ophthalmic Assistants in Nepal always want each of us to be competent, qualitative and supportive in the prevention and control of blindness in the country. This CME will definitely be an inspiration to all working in the field of eye care in updating knowledge and skills so that to reach out the persons with eye problems to eliminate avoidable blindness in the country. This is also great to know that you are also publishing an e-abstract book as reference for the participants. On behalf of Nepal Ophthalmic Assistant Society, I would like to congratulate the organizing committee members for organizing the CME and publishing an e-abstract book. Wish this CME a great success. Thanking you and with best regards. Bimal Poudyal President Nepal Ophthalmic Assistants Society Message from President NOAS

C M E J a n a k p u r e - A b s t r a c t | 8 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties ONE DAY CME at Janakpurdham Organized by Nepalese Association of Optometrists (NAO), Madhesh Pradesh in association with Nepal Ophthalmic Society (NOS) and Nepal Ophthalmic Assistant Society (NOAS) Registration and Breakfast: 8AM – 10AM SECTION 1: Opening Ceremony (10 AM to 11.45 PM) Host – Optom Abhinash Jha, Optom Rekha Yadav 1. Chief Guest: Honorable Minister of Health & Population, Madhesh Pradesh 2. Guests: Secretary of Health & Population Ministry, Madhesh Pradesh President of Public Service Commission NOS / NAO / NOAS representatives Dr Damodar Pradhan, Dr Hem Chandra Jha SECTION 2: CORNEA & REFRACTIVE SURGERY SESSION (12:00 PM to 1:00 PM) Moderator: Optom Jyoti Gupta Topic Speaker Time 1. Cultivating awareness: Corneal transplantation and Eye donation Prof. Dr Meenu Chaudhary (President NOS) 10 min 2. Visual quality assessment and its importance in refractive surgery Dr Kishore Raj Pradhan (Consultant Cornea and Refractive surgery) 8 min 3. Updates in Myopia Control Dr Rohit Dhakal (Optometrist, Ph.D) 8 min 4. Keratoconus and its management Krishna Kumar Dhankhoti (Optometrist) 8 min 5. Updates in Dry eyes evaluation Manish Panjiyar (Optometrist, M.Optom) 8 min 6. Speciality Contact Lenses in different eye conditions Amit Kumar Singh (Optometrist) 8 min Discussions 5-10 min Program Schedule

C M E J a n a k p u r e - A b s t r a c t | 9 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties SECTION 3: GLAUCOMA and UVEITIS SESSION (1:00 PM to 1:30 PM) Moderator: OA Khusbu Jha Topic Speaker Time 1. Will early diagnosis and referral of glaucoma help the patient? Dr Bhaskar Jha (Glaucoma Specialist) 8 min 2. Angle, IOP and Corneal thickness, can they guide in uveitis treatment? Dr Ranju Kharel Sitaula (Uveitis Specialist) 8 min Discussions 5 min Sponsor talk 5 min Token of love and certificates for Speakers (Cornea + Glaucoma & Uveitis session) 5-10 min LUNCH BREAK (1:30 PM to 2:00 PM) SECTION 4: OCULOPLASTY SESSION (2:00 PM-3:00 PM) Moderator: Optom Rabina Chaudhary Topic Speaker Time 1. Thyroid Eye Disease Management and Overview of NepTED Registry Dr Puja Rajbhandari (General Secretary, NESOS) 10 min 2. Management of CNLDO and Canalicular injury: Restoring smile without tearing Dr Sabin Sahu (Oculoplastic Surgeon) 8 min 3. Significance of Socket Evaluation for Optimal Clinical and Aesthetic Results Dipesh Ram (Ophthalmic Officer) 8 min 4. Revitalizing the Anophthalmic Socket: Surgical Options for Normal and Contracted Cases Dr Aashish Raj Pant (Oculoplastic Surgeon) 8 min 5. Custom Ocular Prosthesis- Best cosmetic solution for blind eye Ravi Shankar Chaudhary (Optometrist, Ocularist) 8 min Discussions 5-10 min Sponsor talk 3 min Token of love and certificates for Speakers (Oculoplasty session) 5 min INTERVAL / TEA BREAK (3:00AM – 3:15PM)

C M E J a n a k p u r e - A b s t r a c t | 10 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties SECTION 5: ORTHOPTICS + CONJUCTIVA + COMMUNITY OPHTHALMOLOGY SESSION (3:15 PM to 4:00 PM) Moderator: Optom Rekha Yadav Topic Speaker Time 1. Vision Therapy in Amblyopia Asmita Pokhrel (Vision therapist) 10 min 2. Management of conjunctivitis in high volume set-up Dr Amit Kumar Yadav (Ophthalmologist, NOS Member) 8 min 3. Role of Ophthalmic assistants in eliminating avoidable blindness in Nepal Ramesh Pradhan (General Secretary, NOAS) 8 min 4. Exploring challenges and opportunities in Pediatric Optometry Practice Sneha Baidhya (Optometrist) 8 min Discussions 5 min Sponsors talk 3 min Token of love and certificates for Speakers 5 min SECTION 5: Closing ceremony (4:00 PM to 4:30 PM) Moderator: Abhinash Jha Felicitation and certificates to sponsors Closing Remarks: Organizing Chairperson, Dr Sabin Sahu

C M E J a n a k p u r e - A b s t r a c t | 11 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties Organising committee

C M E J a n a k p u r e - A b s t r a c t | 12 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties Speakers and Moderators

C M E J a n a k p u r e - A b s t r a c t | 13 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties 1. Cultivating awareness: Corneal transplantation and Eye donation Cornea donation & its awareness in Nepal Speaker: Prof. Dr Meenu Chaudhary Affiliation: Professor & HOD, Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal Brief Summary: Nepal shoulders one of the largest burdens of global blindness with around 600,000 people to be blind or partially sighted. Ocular trauma and corneal ulceration causing corneal scars are serious public health problems leading to monocular / bilateral blindness in children and young adults in Nepal. Sight restoring corneal transplants should be done in patients with corneal scars to decrease blindness. But, due to lack of awareness regarding corneal donation the number of people suffering from corneal blindness has not come down. Two means of overcoming the acute global shortage in quality corneas are encouraging voluntary donation and exploring newer sources for cornea procurement. Voluntary Eye donation is a result of realization of one's social responsibility towards the corneal blind. In Nepal another method of cornea collection is through Hospital Cornea Retrieval Program. Take home message: Two means of overcoming the acute global shortage in quality corneas are encouraging voluntary donation and exploring newer sources for cornea procurement. Abstracts of presentations

C M E J a n a k p u r e - A b s t r a c t | 14 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties 2. Updates in Myopia Control Speaker: Dr Rohit Dhakal, PhD Brief summary: Almost half of the worlds’ population will be myopic by 2050, if the current rate of myopia incidence continues. This incurs huge socio-economic burden to individual, family, and country. However, several treatment options are available to prevent or reduce myopia development and its progression. This talk will highlight the major theories related to myopiagenesis, and treatment modalities to counteract it. The treatment options are majorly categorized into optical, pharmacological, and photo-biomodulators. Take home message: There are options available to prevent/slow myopia development and progression. Photo-biomodulators are currently gaining interest among researchers in the field. 3. Keratoconus and its management Speaker: Krishna Kumar Dhankhoti (Consultant Optometrist and Orthokeratologist) Affiliation: Matrika Eye Center Kathmandu, Nepal Brief summary: Keratoconus is a vision disorder that occurs when the normally round cornea (the front part of the eye) becomes thin and irregular (cone) shape. The abnormal shape prevents the light entering the eye from being focused correctly on the retina and causes distortion of vision. About 1 out of 10 people with keratoconus have a parent who has it too. Keratoconus is also associated with: Eye Allergies, Excessive eye rubbing, and Connective tissue disorders like Marfan syndrome and Ehlers-Danlos syndrome. Keratoconus often starts when people are in their late teens to early 20s. The vision symptoms slowly get worse over a period of about 10 to 20 years. Keratoconus often affects both eyes, and can lead to very different vision between the two eyes. Symptoms can differ in each eye, and they can change over time. In the early stage, keratoconus symptoms can include: mild blurring of vision, slightly distorted vision where straight lines look bent or wavy, increased sensitivity to light, glare, eye redness or swelling. Take home message: High astigmatism have a risk of keratoconus.

C M E J a n a k p u r e - A b s t r a c t | 15 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties 4. Updates in Dry eyes evaluation Speaker: Mr. Manish Panjiyar, M. Optom Affiliation: Contact Lenses/Binocular Vision Department, Birtamode Eye Hospital, Nepal Brief summary: Dry Eye Disease (DED) is one of the most common disease worldwide that can lead to a significant impairment of quality of life. The diagnosis and treatment of the dry eyes are often challenging because of lack of correlation between signs and symptoms, limited reliability of diagnostic tests, and absence of established consensus on the diagnostic criteria. With the recent advances in science and technology, dry eye examination techniques have progressed rapidly, which has greatly improved dry eye diagnosis and treatment. In this review, we evaluate previous examinations of dry eye, analyze the recent views and research hotspot, and provide a reference for the diagnosis and management of dry eye. Take home message: Dry Eye can be managed when diagnosed properly using accurate techniques. 5. Speciality Contact Lenses in different eye conditions Speaker: Amit Kumar Singh (M.Optom), Consultant Optometrist & Orthokeratologist Affiliation: Head of Department, Mechi Eye Hospital, Birtamode, Jhapa Nepal Brief Summary: Irregular cornea resulting from the eye conditions such as corneal dystrophy, keratoconus, pellucid marginal degeneration, ocular surface disorders, ocular trauma and post refractive surgeries etc. reduces the quality as well as quantity of vision. Here I have discussed different types of cases in which rehabilitation was carried out using scleral contact lens in ocular surface disorders and other corneal disorders for visual as well as therapeutic, Ortho-K lenses for myopia control and scleral regeneration lens in case of Nevus of Ota for cosmesis. Take Home Message: Speciality contact lens requires special cases and special cases are not only irregular cornea but also regular cornea where Speciality contact lens gives satisfactory results.

C M E J a n a k p u r e - A b s t r a c t | 16 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties 1. Will early diagnosis and referral of glaucoma help the patient? Speaker: Dr Bhaskar Jha, MD (Glaucoma Specialist) Affiliation: Medical Director, Bhaskar Eye Care, Biratnagar Brief summary: Glaucoma leads to irreversible blindness if not diagnosed and treated early as it is usually asymptomatic. Once diagnosed, glaucoma can be successfully managed and treated. The key to diagnosis is recognition of morphological changes to the optic nerve head and retinal nerve fiber layer, but in some patients, functional abnormalities are detected first. Glaucoma usually shows no symptoms until significant damage has already been done to your eyes the central and effective way to prevent glaucoma is to have a comprehensive eye exam once a year, at a minimum, including screening and tests for glaucoma, so that signs and risk factors of glaucoma can be identified early. Glaucoma is detected through a comprehensive eye exam that includes a visual acuity test, visual field test, dilated eye exam, tonometry and pachymetry. A visual acuity test measures vision at various distances. A visual field test measures peripheral vision. Recent medical advances in retinal scanning and glaucoma screenings have allowed for earlier detection of glaucoma than ever before. Take home message: In the developing country like Nepal where the availability and access to the glaucoma specialist is very less, the early detection and referral could help us in preventing the irreversible blindness. 2. Angle, IOP and Corneal thickness, can they guide in uveitis treatment? Speaker: Dr. Ranju Kharel Sitaula, MD, FAICO (Uvea) Speaker affiliation: Associate Professor & Uveitis Specialist, Department of Ophthalmology, B. P. Koirala Lions Centre for Ophthalmic Studies, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal

C M E J a n a k p u r e - A b s t r a c t | 17 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties Brief summary: Anterior uveitis is the most common form of manifestation, accounting for approximately 61.8% of all cases in the Nepalese population. Acute anterior uveitis can affect nearby ocular tissues like the corneal endothelium, ciliary process, and trabecular meshwork. The inflammation in the anterior chamber can lead to the increased corneal thickness, narrowing of iridocorneal angle and altered intraocular pressure. Thus, the corneal thickness assessment, measurement of iridocorneal angle and intraocular pressure can guide on the disease activity of anterior uveitis. Take home message: Assessing the changes in the angle, cornea and IOP will not only elucidate the effect of anterior uveitis on them but also guide us to manage the anterior uveitis cases effectively. 1. Thyroid Eye Disease Management and Overview of NepTED Registry Speaker: Dr Puja Rajbhandari Affiliation: Oculoplastic surgeon, Nepal Plastic Cosmetic and Laser Centre, Kathmandu, Nepal Brief summary: Modalities of management of TED vary not only from stage, severity and level of thyroid hormone but also its impact on psychosocial state of the patients. Before starting any specific treatment the extent of the disease needs to be evaluated which is done by blood investigations like Thyroid function test, thyroid autoantibodies, thyroid peroxidase antibody, TSH receptor antibody, Thyroglobulin antibodies and Radiological imaging of orbit which shows occupancy of orbit because of fat or muscle hypertrophy. Treatment includes ocular and systemic treatment along with psychosocial stability. Hence TED management requires multidisciplinary approach. Endocrinologists have a key role in managing systemic sign and symptoms whereas Psychiatrists can counsel the patients if they are having psychological symptoms due to different appearance and social stigmas.

C M E J a n a k p u r e - A b s t r a c t | 18 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties Thyroid eye disease has a spectrum of eye manifestations ranging from dry eye, proptosis, lid retraction, lagophthalmos, corneal involvement, diplopia to blindness. Therefore, medical therapeutic options might range from only medical treatment like lubricating eye drops, anti-inflammatory eye drops, oral or injectable systemic steroids to immunomodulators. Others might require surgical treatment like tarsorrhaphy, blepharotomy, supratarsal injectable steroid. In severe cases to restore the sight fat reduction with blepharoplasty and orbital wall decompression might be the choice of treatment. Take home message: TED is an autoimmune disease and its pathology is well known. Its management requires multidisciplinary approach. According to the stage and severity of the disease eye treatment commences and Oculoplastic surgeons play a major role in surgical management and restoring appearance of patient. About NepTED (Nepal Thyroid Eye Disease Registry): NepTED is the national level project initiated by Nepalese society for Oculoplastic Surgeon (NESOS) 2023- 2024. This is a first kind of project in South East Asia collaborated with NHRC. This project includes 71 Hospitals and eye centers from all over Nepal using specifically predesigned performa incorporating symptoms, signs, management along with the quality of life of TED patients. Hence this registry is basically collecting data on Nepalese Thyroid eye disease patients to know real burden of disease in Nepal, course of the disease, its psychosocial impact in their life and to develop a national management guideline. 2. Management of CNLDO and Canalicular injury: Restoring smile without tearing Speaker: Dr Sabin Sahu, MS (PGI, Chandigarh) Affiliation: Medical Director, Jyoti Eye Hospital, Janakpurdham; Assistant Professor and HOD, Department of Ophthalmology, Janaki Medical College and Teaching Hospital, Ramdaiya, Janakpurdham

C M E J a n a k p u r e - A b s t r a c t | 19 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties Brief summary: The management of Congenital Nasolacrimal Duct Obstruction (CNLDO) and canalicular injuries is crucial for restoring a patient's eye health and ensuring they can smile without tearing. CNLDO, a common pediatric condition, often resolves on its own during the first year of life, with minimal interventions like lacrimal sac massage and occasional antibiotic support. But if it persists, interventions like lacrimal probing can be considered. Early probing is now considered to be safe and effective for optimal outcomes. I have been performing the lacrimal probing for CNLDO under topical anesthesia in OPD basis with excellent outcome. I will sharing the techniques and my experience in lacrimal probing in the presentation. For canalicular injuries, prompt evaluation and repair are essential to prevent tearing and maintain eye function. Depending on the extent of the injury, surgical repair and stenting may be required. I have been performing canalicular injury repair with a monocanalicular stent for several years with excellent anatomical and physiological outcome. I will discuss about the technique and my experience about this as well. Take home message: Timely diagnosis and early intervention with appropriate care are key to achieving successful outcomes in these cases of congenital nasolacrimal duct obstruction and canalicular injuries to restore normal tear drainage and, ultimately, a tear-free smile for the patients. 3. Custom Ocular Prosthesis - Best cosmetic solution for blind eye Speaker: Ravi Shankar Chaudhary Affiliation: Janakpur Netralaya Eye Hospital, Zeromile (opposite buspark), Janakpurdham-7 Brief summary: An ocular prosthesis or artificial eye is a type of craniofacial prosthesis that replaces an absent natural eye following an enucleation, evisceration, or trauma. Many of the patients are satisfied by the outcomes obtained from custom ocular prosthesis cosmetically but few of them have still facing difficulty psychosocially. Despite the disfiguring nature and difficult management of such conditions, the psychological consequences of living with an ocular prosthesis are poorly

C M E J a n a k p u r e - A b s t r a c t | 20 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties understood. A custom ocular prosthesis has advantage of close adaptation to the tissue bed, provides maximum comfort and restores full physiological function to the accessory organs of the eye. Take home message: Prosthesis can be boon for blind eye, make them confident to face the world socially, morally and physiologically. 4. Significance of Socket Evaluation for Optimal Clinical and Aesthetic Results Speaker: Dipesh Kumar Ram Affiliation: Ophthalmic Officer, Jyoti Eye Hospital, Zeromile (Near Old traffic police post), Janakpurdham-7 Brief summary: Socket evaluation is a critical aspect of ophthalmic care, involving the assessment and management of conditions related to the eye socket (orbit) and its surrounding structures. Proper clinical evaluation is essential for practitioners to effectively address the challenges encountered in this specialized field. Complex cases often necessitate multidisciplinary collaboration, with participation from ophthalmologists, oculoplastic surgeons, and maxillofacial specialists. Various clinical conditions, such as anophthalmos, microphthalmos, phthisical eye, contracted sockets, etc., will be discussed along with their clinical evaluation. Take home message: Understanding proper details about socket evaluation plays important role for effective management of spectrum of clinical conditions from anophthalmos to contracted sockets. 5. Revitalizing the Anophthalmic Socket: Surgical Options for Normal and Contracted Cases Speaker: Dr Aashish Raj Pant, MBBS, MD, ChM Affiliation: Consultant ophthalmologist with specialization in Cataract, Orbit and Oculofacial plastic surgery, Sagarmatha Eye Hospital, Rajbiraj, Nepal Brief summary: "Revitalizing the Anophthalmic Socket: Surgical Options for Normal and Contracted Cases” presents a comprehensive exploration

C M E J a n a k p u r e - A b s t r a c t | 21 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties of surgical solutions for individuals with anophthalmic socket. This presentation shall highlight the distinct surgical approach necessary for normal and contracted anophthalmic sockets with an emphasis on the indications for surgical intervention. With a focus on patient-centered care, the session unfolds a diverse array of surgical strategies, from implantbased volume restoration to the intricate art of mucous membrane grafts for surface reconstruction. This CME offering equips ophthalmic practitioners with the knowledge to deliver tailored, life-enhancing care to anophthalmic patients, ultimately enhancing their quality of life and overall well-being. Take home message: Every anophthalmic patient deserves personalized, meticulous care. Understanding the distinctions between normal and contracted sockets, along with precise indications for surgical intervention, is paramount. By offering a diverse range of surgical solutions, we can significantly enhance the quality of life for these individuals, restoring not only function but also their sense of self-esteem and confidence. 1. Vision Therapy in Amblyopia Speaker: Ashmita Pokhrel Brief summary: Amblyopia can be generally defined as a monocular (less commonly, binocular) reduction of visual acuity for which no organic cause can be found. It results from a prolonged period of inadequate visual experience during the early years of life, commonly due to one or more amblyogenic factors such as strabismus (ocular misalignment), anisometropia (refractive imbalance), or both (combined).The global prevalence of amblyopia is 2–5% and it is second only to refractive error as the most common cause of vision loss in infants and children. Although landmark clinical trials such as the Pediatric Eye Disease Investigator Group (PEDIG) trials have concluded occlusion therapy to improve acuity

C M E J a n a k p u r e - A b s t r a c t | 22 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties in approximately 70% of patients by 0.2logMAR or more. Children with amblyopia are known to have abnormal stereo acuity (a binocular function) and binocular summation. An imbalance of inter-ocular suppression which favors the dominant eye over the amblyopic eye during binocular viewing was demonstrated in experimental studies. Therefore, amblyopia is intrinsically a binocular problem, rather than a monocular one. Binocular vision therapy is based on simultaneous binocular visual stimulation (dichoptic treatment) and improves overall binocular function, visual acuity and stereo acuity. Such therapies often involve oculomotor activities, anti-suppression activities, activities that improves visual efficiency and eye hand coordination trained both in In-office and home settings. In this presentation, we aim to describe the various binocular vision therapies and review the available literature on the same. Take home message: Binocular vision therapy has led to lasting improvements in visual acuity and can be a useful adjunct, if not replacement, to the conventional treatment of amblyopic individual regardless of their age. 2. Management of conjunctivitis in high volume set-up Speaker: Dr Amit Kumar Yadav Affiliation: MD (BPKLCOS, IOM, TU). Shree Janaki Eye Hospital, Janakpur Brief summary: Conjunctivitis is the most common cause of red eye. The cause can be diagnosed through a detailed patient history and careful examination and treatment is based on the underlying etiology. Because there is no specific diagnostic test to differentiate VIRAL from BACTERIAL conjunctivitis, most cases are treated using broad spectrum ANTIBIOTICS. In high volume set up the most and primary thing is TRIAGE the patient. As conjunctivitis is highly communicable, patient are treated in emergency basis. The treatment protocol is made which can be effective in such set up. Take home message: Hygiene is very important with no direct touching of eyes and frequent washing of hands.

C M E J a n a k p u r e - A b s t r a c t | 23 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties 3. Role of Ophthalmic assistants in eliminating avoidable blindness in Nepal Speaker: Ramesh Pradhan Affiliation: BPKLCOS, Maharajganj Brief summary: History of eye care services in Nepal starts immediately after the Nepal Blindness Survey (NBS) conducted in 1981. There were only one eye hospital in Kathmandu and four eye departments for the entire Nepal with a total of 7 Ophthalmologists. NBS showed the prevalence of blindness 0.84% and to support the prevention of blindness and to clear the backlog of cataract blind a huge support from INGOs received for the development of eye care services in the country. However, to cope with the problem of blindness there was insufficient eye care human resources especially the midlevel eye care human resource. The leadership realized the immediate need of developing mid-level eye care human resource to better serve people in need of eye care services at the community level, promote and prevent blindness and refer cataract to clear the backlog of cataract blind to the Ophthalmologists. The first batch of 40 Ophthalmic Assistants (OA) was started in the year 1981 and two more bathes in the following years totaling 120 Ophthalmic Assistants produced to cater the present need of mid-level human resource. At present there are a total of 2100 OAs serving at all 77 districts as primary eye care service providers, assisting Ophthalmologists in performing all kinds of surgeries and working as a multipurpose eye care workers for the elimination of avoidable blindness in the country. Take home message: OAs are considered as a backbone of eye care services in the country and working as a multipurpose eye care service providers closely working and giving respect to other eye care human resources in Nepal.

C M E J a n a k p u r e - A b s t r a c t | 24 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties 4. Exploring challenges and opportunities in Pediatric Optometry Practice Speaker: Sneha Baidhya Affiliation: Sudarshan Eye Hospital, Gaur, Nepal Brief summary: Eye care services in Nepal are made available through a diverse workforce, which encompasses ophthalmologists, optometrists, ophthalmic assistants, ophthalmic nurses, and orthoptists. Since its inception in 1997 with the launch of Bachelor of Optometry program, optometry education in Nepal has had over two decades to evolve, yet the profession still finds itself in its early stages of growth. Even today, a common misconception persists among health professionals, reducing optometry to the narrow perception of merely 'prescribing eyeglasses' without recognizing its comprehensive role. Remains lesser-known to many is the fact that "The scope of optometry practice is expansive and filled with fascinating opportunities." Within the diverse field of optometry, Pediatric optometry stands out as a significant scope. Pediatric optometry focuses on the eye care and visual health of children, from infants to adolescents. They play a crucial role in ensuring that children have clear and comfortable vision, as well as addressing any eyerelated issues that may impact their learning and overall well-being. Challenges- Pediatric optometry is challenging due to many reasons such as Communication with Young Patients, Diagnosing Non-Verbal Children, Special Needs Patients, Parental Compliance, Limited Attention Span and many more. Practicing pediatric optometry in Nepal, as in many other countries, comes with its own set of challenges due to the unique healthcare landscape, socioeconomic factors, and healthcare infrastructure in the region such as Limited Access to Eye Care Services, lack of awareness and education, Socioeconomic Factors, Infrastructure and Equipment, Public Health Priorities, Lack of Data and Research and many more. Opportunities -On the positive side, pediatric optometry presents numerous opportunities alongside its challenges. Opportunities in practicing pediatric optometry in Nepal are significant and can have a positive impact on children's eye health and overall well-being. These include- Early Intervention, Increased Awareness, Technological Advances, Vision Therapy, Professional Development, Community Outreach, Satisfaction in Helping Children and Policy Advocacy.

C M E J a n a k p u r e - A b s t r a c t | 25 One-day CME Janakpurdham Comprehensive Updates in Ophthalmic Specialties Take home message: Pediatric optometry practice, despite its inherent difficulties, presents a unique opportunity to positively impact children's lives by identifying and addressing vision problems early, thus enhancing their visual health and overall quality of life. "Young minds are the foundation of a nation's future, and those with clear vision contribute to the creation of a thriving nation."

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