EyeWorld Asia-Pacific December 2011 Issue

7 EW NEWS & OPINION December 2011 In his talk, Stephen Lane, MD, Stillwater, Minn., USA, discussed the differences and pros and cons of multifocal IOL offerings in the US, such as the Tecnis (AMO) and ReSTOR (Alcon) lenses. “The biggest advantage of multifocal lenses is their capacity to give very sharp near and distance vision,” Dr. Lane said. “They are capable of doing that because of the way in which the mechanism of action works. Essentially, it’s a splitting of light. The splitting of light can lead to visual disturbances that seem to be more prevalent in some patients than others. The problem is it’s very difficult to know ahead of time which ones are going to have a problem and which ones are not. A lot of it depends on the patient’s social needs and desires.” Prof. Tchah introduced attendees to neuroadaptation in his talk, “Multifocal IOLs: Binocular vs. Monocular.” He went over the results of a study comparing and contrasting the two, concluding that both monocular and binocular multifocal IOL implantation showed good distance and near uncorrected visual acuity. Halo and glare were not severe and were well tolerated. “To implant multifocal IOLs in patients with monocular cataract seems to be a good option,” he said. In the presentation “Ocular Surface Considerations in Presbyopia and Astigmatism Correction,” Sonia H. Yoo, MD , Miami, Fla., USA, explained how to manage patients with common ocular surface diseases, specifically dry eye. “It is estimated that 11% of patients between ages 30 and 60 suffer from dry eye,” she said. “One of the problems is tear film deficiency can interfere with the ability to accurately measure keratometry. It can be very difficult to gain an accurate IOL calculation.” Because patients can be asymptomatic, Dr. Yoo recommended looking for autoimmune diseases such as Lupus, a history of radiation, and prescription drug usage such as antidepressants and Parkinson’s disease agents. Dr. Gatinel discussed the different types of intracorneal lenses, including the FlexivueMicrolens (Presbia, Los Angeles, Calif., USA), the KAMRA (AcuFocus, Irvine, Calif., USA), and the Vue+ (Revision Optics, Lake Forest, Calif., USA). The KAMRA has well- known principles and “improves near vision but has a limited impact on distance vision,” Dr. Gatinel said. Benefits of the KAMRA are that it has a reproducible technique, a broad indication range, and is adjustable. Longer-term studies are needed, he said. Ophthalmologists take top honors at Film Festival Japanese ophthalmologist Makoto Kishimoto, MD, won the Grand prize award Saturday night at the APACRS Film Festival Awards, with his title, “The Mechanism of Bubble Production in Cataract Surgery.” Dr. Kishimoto, Department of Ophthalmology, Kishimoto Clinic, Japan, showed that the mechanism of bubble production was different between an infusion aspiration and ultrasound handpiece. In Dr. Kishimoto’s film, surgeons were able to capture the top of the chip of the US handpiece by using a highspeed camera, while a skeleton handpiece was used to investigate the flow of intraocular irrigating solution for the I/A tool. “The bubble production process is different depending on the composition of the material of the periphery of the chip and composition of intraocular irrigating solution in the case of the US handpiece,” Dr. Kishimoto said in his entry. Other winners at the film festival were Jun Hun Lee, MD, Kyungpook National University Hospital, Korea, winning the Cataract/Implant Surgery category with his film, “Real Time Surgical Marking System for Ophthalmic Microsurgery”; Keiki Rustom Mehta, MD, Mehta International Eye Institute, India, who won the Cataract Complications/Challenging Cases category with his film, “The Hema Life Boat for Stabilizing the Nucleus and Fragments in a Capsular Break or Subluxation, Permitting Safe Phacoemulsification”; and Atsushi Hirota, MD, Hirota Eye Clinic, Japan, who won the general interest category for his film, “Evidence of a Check Valve Mechanism by the Anterior Hyaroid Membrane in Infusion Misdirection Syndrome (IMS), Ciliary Block Syndrome (CBS) and Secondary Angle Closure Glaucoma (SACG)”. ‘All the Presidents’ Men’ During the planning sessions of the 2011 APACRS/KSCRS meeting, Prof. Tchah had an inspiration. Seeing the number of anterior segment ophthalmology society presidents attending the meeting, he thought it would be a good idea to find out what they have to say. Prof. Tchah tasked them to talk about “something they feel passionate about in the pursuit of perfection,” said Prof. Barrett. The Presidents’ Symposium, one of the highlights of this meeting, was born. The session, said Prof. Barrett, has never been done before at any meeting and is unique in that the presidents of all the societies involved rarely get the chance to come together in one meeting. “It is gratifying to see all the presidents come together for this session as it reflects the growing relevance of our meeting and the meeting’s importance in the calendar year,” he said. Boris Malyugin, MD, Moscow, Russia, kicked off the symposium with a talk on “Cataract Surgery Techniques in Small Pupils.” Despite the obvious challenges posed by small pupils, Dr. Malyugin said that any experienced surgeon can “absolutely” perform successful cataract surgery in such cases. Creating a small capsulorhexis following the outline of the pupil and holding the instruments at the center of the anterior chamber without going under the iris, any surgeon, he said, can complete the surgery while maintaining reasonably low infusion and aspiration settings. Surgeons do need to keep in mind the attendant risks, iris damage, damage to the anterior capsulorhexis and post- operative capsular phimosis, and incomplete cortical removal. To minimize these risks, Dr. Malyugin recommended a step-wise approach, assessing the eye after each step to determine what needs to be done next. At some point, depending on the size of the pupil and the biomechanical properties of the iris tissue, as in cases of intraoperative APACRS-KSCRS - from page 5