HONG KONG OPTOMETRY - HKSPO 7th.pdf · HONG KONG OPTOMETRY P2 HKSPO Official Newsletter April 2017 Optical Coherence Tomography Angiography (OCTA) – A new era of retinal care Cho,

Categorization of date domainsC-Common S-Situational NA-Not Applicable

H O N G KO N G O P T O M E T RYHKSPO Official Newsletter April 2017

H O N G KO N G O P T O M E T RYHKSPO Official Newsletter April 2017 P1P1

Electronic Health Record (eHR) System update

The Government is implementing an electronic Health Record (eHR) system. All the electronic health records will be stored and retrieved by different healthcare providers. In respect to the privacy concern raised by the LegCo and patient associations, the Food and Health Bureau would like to set up a Role Based Access Control (RBAC) measurement on the eHR system. HKSPO was invited by the Food and Health Bureau to input and share opinions on the RBAC. The original idea of eHR system is for sharing data between private and government sectors in order to stream patients accordingly. Due to the “bi-directional” nature of the system, the healthcare profes-sionals can upload and download the clinical data of their own patients. There are two main stages for the eHR system establishment: “Hospital-based” and “Community-based”. For the first hospi-tal-based stage, in order to get opinion on the RBAC from broad spectrum of optometrists in different workplace settings, HKSPO formed a working group with input from the colleagues in School of Optometry, private hospitals, Hospital Authority (HA) and Department of Health (DH) etc. There are 13 categories of patient data in the eHR system. The RBAC is mainly for the privacy protec-tion of the public. Among these 13 categories, medical doctors, dentists and nurses are authorized to access all sorts of data. After a few meetings with the Bureau and other healthcare professional associ-ations, the RBAC of optometrists on those 13 categories of data was summarized in the following table.

It is recommended that healthcare professionals would be able to access those data domains catego-rized as “C-Common” without any limitations; For data domains which are categorized as “S-Situa-tional”, it is still accessible after the healthcare professionals provide a justification (which would be logged and subject to audit). For the data domains, which are categorized as “NA-Not Applicable”, would be kept locked up and be inaccessible. The recommended access control will be reviewed from time to time after its implementation.

Below is a brief summary of information of the eHR system:

IN THIS ISSUE :IN THIS ISSUE :

Councillors:• Mr. Bruce Chin• Ms. Cecilia Tong• Dr. Gordon Tang• Mr. Kelvin Wan• Ms. Manki Chan• Ms. Patti Chan• Mr. Peter Chung• Ms. Rita Sum • Dr. Thomas Lam

Councillors:• Mr. Bruce Chin• Ms. Cecilia Tong• Dr. Gordon Tang• Mr. Kelvin Wan• Ms. Manki Chan• Ms. Patti Chan• Mr. Peter Chung• Ms. Rita Sum • Dr. Thomas Lam

President:• Ms. Victoria Law Vice President:• Dr. Patrick Chu Secretary (Int.):• Dr. Jenny Lung Secretary (Ext.):• Dr. Patrick Ting Treasurer:• Dr. Forrest NgImmediatePast President:• Mr. Jack Wong

President:• Ms. Victoria Law Vice President:• Dr. Patrick Chu Secretary (Int.):• Dr. Jenny Lung Secretary (Ext.):• Dr. Patrick Ting Treasurer:• Dr. Forrest NgImmediatePast President:• Mr. Jack Wong

• Dr. Lung Chun Yee, Jenny (Chairperson) email : [email protected]• Mr. Chung Chi Lik, Peter email : [email protected]• Dr. Lam Chuen, Thomas email : [email protected] • Dr. Chu Chin Hung, Geoffrey email : [email protected] • Dr. Lo Ka Kin, Tomy email : [email protected]

• Dr. Lung Chun Yee, Jenny (Chairperson) email : [email protected]• Mr. Chung Chi Lik, Peter email : [email protected]• Dr. Lam Chuen, Thomas email : [email protected] • Dr. Chu Chin Hung, Geoffrey email : [email protected] • Dr. Lo Ka Kin, Tomy email : [email protected]

HKSPO Council (2015-2017)HKSPO Council (2015-2017)

The HKSPO Newsletter CommitteeThe HKSPO Newsletter Committee

Published By The Hong Kong Society of Professional Optometrists.

All rights reserved.

HKSPO Newsletter Editorial Board,If you have any enqueries about the Newsletter please contact : Dr. Jenny Lung

HKSPO香�眼科視光師學會�

www.hkspo.org.hk

P. 1 Electronic Health Record (eHR) System updateP. 2-3 OCTA- A new era of retinal care P. 3 HKSPO Student's Award P.5-6 Launch Ceremony of the "Vision of Love Mobile Eye Care Project" 「看見愛流動護眼計劃」開展儀式 P.8 Public Education Committee Update

Healthcare providers can access the data without uploading their own clinical findings. They can even refuse the use of eHR.

There will be 4 phases for implementation of the eHR system. It can be simplified as: Phases 1A, 1B, 2A and 2B.

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The only liability for the healthcare professionals in eHR implementation is the issue of privacy control.There will be free basic software provided by the government for the implementation of eHR system.The implementation of phase 1A and the discussion of RABC of phase 2 (for “community-based” optometrists) will be in early 2017.

1A: “Hospital-based”, HA and DH will share the data to all authorized “hospital-based” professionals (including professionals in the public and private hospitals).1B: Colleagues from private hospitals can share and upload the data to eHR system.2A: “Community-based” professionals can download and view eHR of their patients. 2B. “Community-based” professionals can share and upload data to eHR system.

H O N G KO N G O P T O M E T RYHKSPO Official Newsletter April 2017

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Optical Coherence Tomography Angiography (OCTA) – A new era of retinal care

Cho, Axon KwanBSc (Hons) Optom

Intraretinal edema or subretinal haemorrhage can occur subsequent to the development of abnormal blood vessels associated with retinal hypoxia, which are the sight threatening complications in some eye diseases. Fluorescein angiography (FA) and indocyanine green angiography (ICGA) are the current angiographic gold standards for the detection of retinal neovascularization or vascular leakage. Howev-er, they are invasive tests that require intravenous dye administration and long retinal imaging time.1-2

Optical coherence tomography angiography (OCTA) is a novel non-invasive microvasculature imaging technology without the use of dye, which can highly improve the speed of imaging and the contrast of images. This article is going to introduce the special features of the OCTA technology and its applica-tions in specific ocular pathologies. OCTA – An OverviewThe OCTA technology can detect the motion of scattered moving particles, e.g. red blood cells, on the same retinal location at different time points rapidly in order to reveal the retinal vasculature though inability to show leakage. The en-face technology also provides transverse images of retinal or choroi-dal layers at any specified depth instead of cross-sectional images produced by the traditional OCT. The OCTA offers the 2D maps representing the retinal vasculature in particular layers and it allows

building up a series of slabs to represent the 3D structure of the entire retina including superficial retina, deep retina, avascular retina, choriocapillaris and choroid. Therefore, OCTA is able to visualize vessels of different retinal and choroidal layers. It is particularly useful in detecting or monitoring the vascular abnormality and neovascularization in age-related macular degeneration (AMD), diabetic retinopathy (DR), retinal vein occlusion, and macular telangiectasia type 2 and glaucoma.3-9 However, high imaging speed is crucial because low scanning speed results in constricted field of view, poor image quality, and long scanning time.

Figure 2: Choroidal neovascularization (CNV) in age-related macular degeneration (AMD)

AngioplexTM Maps reveal choroidal neovascularization (CNV) in AMD

Case Example

Comparing OCTA with FA and ICGAFA and ICGA provide 2D image sets that allow for dynamic visualization of blood flow with wide field of view. Patterns of dye leakage, pooling, and staining can be appreciated and are well-documented in the literature.10 However, there are some drawbacks. The invasive nature, long examination time and potential adverse reactions such as nausea and anaphylaxis limit its clinical applications. In contrast, OCTA is a non-invasive technique and is able to acquire volumetric 3D angiographic information within a few seconds. Although leakage, pooling and staining are not appreciable, it can be benefit for those patients who need longitudinal monitoring or are allergic to the dye.

ConclusionOCTA provides a more convenient method to study the ocular microvasculature. It can be used to examine the optic nerve, particular retinal and choroidal layers.11 This technology enhances the visualization of microvasculature of the eye, and which may be useful for understanding many eye diseases. It is possibly that the OCTA may replace the traditional angiography some day because of its high quality image, ease of application and short acquisition time.

Figure 3: Neovascularization elsewhere (NVE) in the vitreo-retinal interface (VRI) in diabetic retinopathy (DR)

AngioplexTM Maps visually isolate the neovascularizationelesewhere(NVE) located in the vitreo-retinal interface(VRI)

Figure 1: OCTA 2D maps of superficial, deep and avascular retina.

H O N G KO N G O P T O M E T RYHKSPO Official NewsletterApril 2017

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陳羽欣 Yu Yan Chan, Natalie

HKSPO Student's Award

首先，我要衷心感謝HKSPO，作為HKSPO獎學金獲得者，我

很高興與大家分享我的感受!

很高興可以跟大家分享自己在大學四年，就讀眼科視光學的

一點一滴。相信現在就讀的同學或已畢業的師兄師姐都能感

受到我們這科有多「chur」，上堂、溫習筆記已經佔去我們

大部份時間，但我認為要成為一位眼科視光師，除了要有扎

實的知識，更要有一顆樂於服務人的心，亦需有良好的溝通

能力。

在讀書期間，我除了在家溫習筆記，更走進社區，參與不同

的眼睛視力普查義工活動，能用自己的專業知識幫助別人之

餘，自己亦有所裨益，因為參與這些活動能增強我的溝通能

力以及對不同眼病的認識。我記得有一次在柬埔寨的視力普

查中，有一名當地人因曾撞傷腦部，失去分辨方向能力，又

試過為新疆一名有900度近視，但從未戴過眼鏡的小學生配

眼鏡，她戴上眼鏡後那滿足的笑容我仍印象深刻，每次活動後，我得到的往往比想像中更多，通過和參與者的交流，了解

他們的問題和需要，使我逐漸建立一份服務他人的使命感。

在實習期間，我會遇到不同的案例，由度數問題至眼病，慢慢累積經驗，學習如何診斷及處理這些大大小小的問題，正因

為遇到不同的病例，使我更有求知和求真的心，去翻查不同的書本、筆記及研究論文去尋找答案，這總比只盲目背筆記內

容好。我亦要學會怎樣把書本上的複雜的概念，用淺白的字眼，簡而精的向病人說明，更要學習面對不同年齡階層的人士

時需要有不一樣的說話技巧。

如今，我已經由學生，成為一位眼科視光師，亦是「社會大學」一年級生，既要獨當一面之餘，亦要繼續學習，不要讓病

人比自己知道更多！希望大家都能保持熱誠，莫忘初衷！

Novotny HR, and Alvis DL (1961). A method of photographing fluorescence in circulating blood in the human retina. Circulation, 24(1): 82-86. Yannuzzi LA, Slakter JS, Sorenson JA, Guyer DR, Orlock DA (1992). Digital indocyanine green videoangiography and choroidal neovascularization. . Retina, 12(3): 191-223. Coscas G, Lupidi M, Coscas F, Francais C, Cagini C, Souied EH (2015). Optical coherence tomography angiography during follow-up: qualitative and quantitative analysis of mixed type I and II choroidal neovascularization after vascular endothelial growth factor trap therapy. Ophthalmic research, 54(2): 57-63.Coscas G, Lupidi M, Coscas F, Cagini C, Souied EH (2015). Optical coherence tomography angiography versus traditional multimodal imaging in assessing the activity of exudative age-related macular degeneration: a new diagnostic challenge. Retina, 35(11): 2219-2228. Jia Y, Bailey ST, Wilson DJ, Tan O, Klein ML, Flaxel CJ, Potsaid B, Liu J, Lu C, Kraus MF, Fujimoto JG, Huang D (2014). Quantitative optical coherence tomography angiography of choroidal neovascularization in age-related macular degeneration. Ophthalmology, 121(7): 1435-1444. Matsunaga D, Yi J, De Koo L, Ameri H, Puliafito C, Kashani A (2015). Optical coherence tomography angiography of diabetic retinopathy in human subjects. Ophthalmic Surgery, Lasers and Imaging Retina, 46(8): 796-805.Wolff B, Basdekidou C, Vasseur V, Sahel J, Gaudric A, Mauget-Faysse M (2014). En face” optical coherence tomography imaging in type 2 idiopathic macular telangiectasia. Retina, 34(10): 2072-2078. Kuehlewein L, An L, Durbin M, Sadda S (2015). Imaging areas of retinal nonperfusion in ischemic branch retinal vein occlusion with swept-source OCT microangiography. Ophthalmic Surgery, Lasers and Imaging Retina, 46(2): 249-252.Chen C, Gupta D, Wen J, Mudumbai R, Johnstone M, Chen P, Bojikian D, Zhang Q, Huang Y, Wang R (2015). Optic disc perfusion in glaucoma with optical microangiography (OMAG). Investigative Ophthalmology & Visual Science, 56(7): 1310-1310. Johnson R, Fu A, McDonald H, Jumper M, Ai E, Cunningham E, Lujan B. Fluorescein Angiography: Basic Principles and Interpretation. In: Ryan SJ, Sadda SR, Hinton DR, editors. Retina. London: Elsevier Saunders; 2013. p. 2–50Sakata L, Deleon-Ortega J, Sakata V, Girkin C (2009). Optical coherence tomography of the retina and optic nerve–a review. Clinical & experimental ophthalmology, 37(1): 90-99.

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Reference :

["HKSPO has no commercial interest in any materials discussed in this article"]

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H O N G KO N G O P T O M E T RYHKSPO Official Newsletter April 2017

H O N G KO N G O P T O M E T RYHKSPO Official Newsletter April 2017 P5P5

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The Hong Kong Polytechnic University (PolyU) launched the "Vision of Love Mobile Eye Care Project" (the Project) in January 2017. With a mobile optometric unit, the Project is reaching out to the community and bringing vision screening and eye health education to the doorsteps of people in need. The Project also serves as a platform to further engage the students of PolyU's School of Optom-etry (SO) to work hand-in-hand with the PolyU volunteers in serving the community through Service-Learning.

Launch Ceremony of the "Vision of Love Mobile Eye Care Project"「看見愛流動護眼計劃」開展儀式

The "Vison of Love Fund" (the Fund) is established with the generous support of Miss Cally Kwong, PolyU University Fellow and members of the Governing Committee of the PolyU Foundation, with a focus on community vision care. A launch ceremony for the Project was held on 12 January 2017.

PolyU was the first university in Hong Kong to incorporate Service-Learning subject into its core academic pedagogy. Since 2014, SO has offered a Service-Learning subject titled "Learning through Providing Eye Care and Vision Health to the Community" to encourage students to apply their professional knowledge to serve the community. Over the past three years, more than 900 students from different disciplines have participated in providing vision screening and eye care education for over 16,000 people in Hong Kong, Mainland Chinese, Cambodia and Vietnam. With the Funds support of the project, a seven-seater has been turned into a mobile eye care utility equipped with advanced vision screening equipment, which will enable PolyU to further extend its outreach service to different districts in Hong Kong. It is estimated that 5,000 vision screenings can be conducted in the first year of service, a big increase over the 3,000 screenings done annually in the past.

Professor Timothy W. Tong, PolyU President, expressed heartfelt gratitude on behalf of PolyU and the beneficiaries of the Project, to Miss Kwong and her friends for their generous donation of HK$3.8 million to the Fund. Addressing the launch ceremony, he said, "In providing community services, our profession-al optometry team finds that many people, especially the underprivileged, due to ignorance, financial or time constraints, often neglect the importance of regular vision screening. Even when problems are found, they would forgo timely follow-ups, thus leading to deterioration of eyesight. With the launch of this Project, our optometry experts and students can further outreach to the community to provide early prevention and intervention of vision problems. The support of Miss Kwong and other donors for the Project through the Vision of Love Fund is indeed a very meaningful and timely gift for PolyU's 80th anniversary."

Speaking at the ceremony, Miss Kwong said, "I always have great concern about the welfare of the underprivileged and the elderly. I greatly appreciate PolyU's efforts in promoting Service-Learning and I can see that they have achieved many impressive outcomes. It is my pleasure to raise funds for the establishment of the Vision of Love Fund to support this meaningful mobile eye care project. I am confident that the Project would be sustainable in providing the most professional and quality services to the needy and at the same time offering more Service-Learning opportunities to our PolyU students."

Professor To Chi-ho, Head of School of Optometry, introduced the Project at the ceremony. "With a mobile vision screening utility, our outreach Project can provide vision screening to more people in need in various districts. Those screened having eye problems will then be provided with comprehensive eye examination, vision rehabilitation and follow-ups with PolyU facilities. Under this Project, SO will also analyze the data collected for further research into myopia prevalence and myopia related issues."

The PolyU volunteers, comprising PolyU students, staff and alumni, will also participate in the Project to provide caring visits to the needy, such as people in elderly or disabled centres. They will also be trained by SO professionals to provide basic vision screening onsite.

To promote sustainable development, a campaign of collecting used eyeglasses will be launched throughout PolyU campus. Collected eye glasses will be screened and adjusted by PolyU's optometry team before redistributing to people in need.

H O N G KO N G O P T O M E T RYHKSPO Official Newsletter April 2017

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Scope of services of the mobile optometric unit

• Vision Screening and Education – Professionals and students of PolyU reach out and provide vision screening and eye care educa-tion to people in need.

• Outreach Comprehensive Eye Examination and Follow-up Evaluation – PolyU team extend its outreach vision screening service to various districts in Hong Kong.

• Vision Training / Vision Rehabilitation – To help the low vision people to cope with their daily tasks such as reading, writing and studying.

• Eyeglasses Recycling – To promote sustainable development and environmental protection.

Service Beneficiaries

• Elderly • School children (especially pre-school, kindergarten and primary school students)• New immigrants• Low-income families• Members of ethnic minorities• Special needs populations• Disabled or wheelchair users• People with visual impairments

Courtesy of The Hong Kong Polytechnic University".

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Optical Coherence Tomography Angiography (OCTA) – A new era of retinal care

H O N G KO N G O P T O M E T RYHKSPO Official Newsletter April 2017

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Public Education Committee Members : Manki Chan, Kelvin Cheung ,Bruce Chin

Public Education Committee Updates

HKSPO has been putting a lot of effort in educating the public not only about the importance of comprehensive eye examination, but also the role of optometrist as gate keeper in primary eye care. In recent years, the capability of clinical care for optometrist in HK is starting to be recognized by the public. Yet, we are still far away from routinely providing full scope of optometric care.

It is not uncommon to obtain feedback from patients who report the "novel” experience in eye examination. And they don’t aware that optometrists are able to check their ocular health. Many patients equate “Refraction” as their eyes check-up and underestimate the importance of ocular health. HKSPO has been educating and reinforcing the role of optometrist in primary eye care for the past 20 years. However, it cannot be done without the support of all members. Instead of offering solely "Refraction", we should proac-tively offer primary eye care and show the value of optometry for our clients, patients and bosses! We are a healthcare profession focusing on vision and ocular health. Optometry’s scope of service includes evaluation of visual functions, binocular vision, ocular health as well as diagnosing and managing abnormal eye conditions. Currently the HKSAR government recognizes optometrist as a health care provider in the Elderly Health Care Voucher (HCV) Scheme. Let’s encourage our clients and patients to make an appoint-ment for a primary eye care examination!

The following table shows the recent two public education activities for promoting primary eye care services .

www.hkspo.org.hk

中西區區議會醫療衞生及復康服務工作小組2016年11 月5日(星期六)及6日(星期日)

上午10時至下午5時上環皇后大道中345號, 上環體育館12樓公 眾約 350 人

將軍澳全民驗眼日中西區健康節

主辦單位日期: 時間: 場地:對象:

服務人數:眼科講座:

檢查項目:

眼科視光師義工:

(排名不分先後)

贊助:

(排名不分先後)

[年紀大 = 眼曚曚?] 講者- Mr. Bruce Chin1) Fundus Photo2) Amsler Grid3) Near VA

05/11/2016 1) Dr. Patrick Chu 2) Dr. Tomy Lo3) Dr. Helen Eng4) Ms. Manki Chan

1) Bausch + Lomb (Hong Kong) Limited2) Carl Zeiss Far East3) CooperVision Hong Kong Ltd4) Hoya Lens Hong Kong Ltd

將軍澳青年力量2016 年11 月13日 (星期日)

下午2時 至下午6時寶琳邨文娛活動會堂公 眾約 200人[年紀大 = 眼曚曚?] 講者- Ms. Victoria Law1) Fundus Photo2) Amsler Grid3) Near VA

4) Distance VA5) Stereotest6) Ishihara

13/11/2016

1) Ms. Victoria Law 2) Ms. Lorraine Leung3) Ms. Cecilia Tong4) Ms. Manki Chan

1) Carl Zeiss Far East2) CooperVision Hong Kong Ltd3) Hoya Lens Hong Kong Ltd

06/11/2016

1) Ms. Victoria Law 2) Mr. Kelvin Cheung 3) Ms. Manki Chan 4) Mr. Bruce Chin

5) Dr. Dede Chan6) Mr. Patrick Chiu

中西區健康節 將軍澳全民驗眼日