EyeWorld Asia-Pacific June 2011 Issue

46 EW NEWS & OPINION June 2011 CSCRS 2011: Near and far, today and tomorrow by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer The Combined Symposium of Cataract & Refractive Societies maintains its reputation as a rapid-fire symposium at the 2011 ASCRS•ASOA Symposium & Congress T he Alliance of Cataract and Refractive societies held a rapid-fire, no-nonsense Combined Symposium of Cataract and Refractive Societies (CSCRS) at the recently concluded 2011 ASCRS•ASOA Symposium & Congress, held in San Diego, Calif., USA. Twelve distinguished speakers from the APACRS, the American Society of Cataract and Refractive Surgery (ASCRS), the European Society of Cataract and Refractive Surgeons (ESCRS), and the Latin American Society of Cataract and Refractive Surgery (ALACCSA-R/ LASCRS), were given a total of 90 minutes to explore the latest advances and trends in the management of presbyopia. The result? A highly information-dense symposium from which audience members took home the following key points: 1. The ideal approach to multifocal ablation, said Dan Reinstein, MD, London Vision Clinic, London, UK, is manipulation of natural (spherical) aberration to induce a kind of “micro- monovision.” Inducing spherical aberration within the limits of neuroadaptation, he said, increases depth of focus without adversely affecting contrast sensitivity. 2. Corneal approaches might not necessarily be best for presbyopia, said Cesar Carrizzo, MD, Institute de la Vision, Buenos Aires, Argentina, but IntraCor (Technolas Perfect Vision, St. Louis, Mo., USA/ Munich, Germany)—controlled modification of corneal shape using a femtosecond laser—is a safe alternative, providing faster recovery and stable results, albeit with mild side effects. 3. Published literature suggests that the PresbyLens (ReVision Optics, Lake Forest, Calif.) is the best corneal approach in terms of visual outcomes in near and intermediate vision, while presbyLASIK provides the best outcomes in terms of distance vision, said Roger F. Steinert, MD, Irving H. Leopold professor, chair of ophthalmology, director, Gavin Herbert Eye Institute, University of California, Irvine, Calif., USA. 4. Luis Izquierdo Jr., MD, Universidad Nacional Mayor de San Marcos, Lima, Peru, called presbyopic scleral surgery “polemical”, requiring further research, but suggested that the procedure provides 5-7 years of visual comfort. Laser scleral expansion surgery is based on the Schachar theory of accommodation. 5. While multifocal lenses aren’t necessarily the answer to the problem of presbyopia, at present, said Ronald Yeoh, MD, Singapore National Eye Centre, Singapore, they provide a “reasonably good” alternative for patients. This is due in part to the very precise biometry measurements surgeons can now perform, and surgical techniques that significantly lower the risk of complications. And since cataracts, he said, “have to come out eventually”, replacing it with a lens that restores a good range of focus makes sense. However, surgeons need to have a standard for addressing any issues that may arise post-op. 6. Effective accommodation requires a focus shift of 2mm, said Oliver Findl, MD, Moorfields Eye Hospital, London, UK. No accommodating lens has yet achieved this; still, 40% of patients successfully do away with glasses with proper motivation; 100% of “unmotivated” patients go back to wearing glasses.