EyeWorld Asia-Pacific June 2012 Issue

June 2012 47 EWAP NEWS & OPINION ASCRS 2012 onward: Education, Charity, Professionalism T he American Society of Cataract & Refractive Surgery-American Society of Ophthalmic Administrators (ASCRS•ASOA) Symposium & Congress, this year attended by more than 7,000 ophthalmologists from all over the world, was held from 21 to 24 April 2012 at the McCormick West Convention Center, Chicago, Illinois. Here we present some of the highlights of EyeWorld’s coverage of the meeting. ASCRS general session honors several Incoming American Society of Cataract & Refractive Surgery (ASCRS) president David F. Chang, MD , said at the ASCRS general session that he was “deeply honored” to be the incoming president, and cited three core values he hopes his presidency will embrace and foster: teaching others, performing charity work, and promoting professional ethics. He spoke about the Global Site Alliance (funded by ASCRS) which matches volunteer ophthalmologists with philanthropic organizations that need eye care services. Dr. Chang replaced Edward J. Holland, MD , as president of ASCRS. Louis Braille and Jack T. Holladay, MD , were both inducted into the ASCRS Hall of Fame. Dr. Holladay received a standing ovation and was visibly moved by the honor. “In my wildest dreams, I never thought I’d be up here receiving an honor like this,” he said, especially after having been comatose for eight days post-aorta surgery two years ago. Binkhorst Lecturer Randall Olson, MD , spoke about what makes patients unhappy. In a study that will be presented in greater detail later during the conference, he said “dysphotopsia is the strongest and only factor that correlates with patient satisfaction.” What can improve patient satisfaction outcomes in the future is the ability to better predict refractive errors in the post-cataract patient. He suggested effective lens position can adversely affect vision quality; when using intraoperative aberrometry, “the aphakic measurement is the most important.” He presented data from H. Burkhardt Dick, MD , on the light-adjustable lens (LAL) that showed “superior results” at 18 months. “In their study, 0.5 D off target was an outlier,” he said. Lastly, he advised surgeons to pay attention to refractive index shaping, as it has the potential to be used on every IOL material and can correct cylinder and sphere up to 2D. CSCRS updates The European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) has issued guidelines for cataract surgeons including that it “should be possible to achieve a corrected distance visual acuity of 0.5 or better for at least 97% of all best case eyes”, said Mats Lundstrom, MD, PhD, Sweden. Further, capsule complications of under 2% should be possible and for biometry predictions, absolute mean errors of 0.6D or less should be possible, and 87% should be within 1D. Dr. Lundstrom added the final guidelines/recommendations will be published in the June issue of Journal of Cataract & Refractive Surgery. According to Rudy M. Nuijts, MD, PhD, The Netherlands, ESCRS has begun a randomized, prospective study in diabetic and non-diabetic patients to determine the best strategies for preventing cystoid macular edema (PREMed study). There will be 2,400 patients without diabetes and 520 with diabetes enrolled. Treatment arms in the non-diabetic group include corticosteroids with non-steroidals, subconjunctival corticosteroids, and topical corticosteroids; treatments in the diabetic arm includes steroids, subconjunctival, bevacizumab, and combination. “The goal is to determine what the added value of non-steroidals is,” Prof. Nuijts said. Roger F. Steinert, MD , Irvine, Calif., USA, updated attendees about late dislocating IOLs. In cases of weak zonules or total zonular failure, “we’re beginning to see more patients with more than six clock hours of zonules,” he said. “Is this just the beginning of an epidemic?” In those eyes, late dislocating IOLs may require pars plana vitrectomy and IOL exchange. He recommends surgeons opt for a “lasso suture” with 10-0 prolene and an Ethicon CTC-6 or STC-6 needle. “You need a long needle, but even then, you can barely make it all the way across,” he said. He also recommends suturing both sides of the wound. “If there are weak zonules in one spot, there are weak zonules everywhere.” Editors’ note: None of the physicians has a financial interest related to their comments. Presbyopia challenges in corneal refractive surgery Presbyopia presents a particular challenge to refractive surgeons. Historically, lamellar refractive surgery has taken various forms, including keratophakia, myopic keratomileusis, keratomileusis in situ, epikeratoplasty, automated lamellar keratoplasty, and LASIK. More recently, attempts have been made to alter the eye’s refractive power at the level of the cornea to compensate for the loss of accommodation of presbyopia using implantable devices that operate on various mechanisms, including subtracting tissue, adding mass (either “refractive” or “simple”), bending the cornea, and creating a pinhole effect. John F. Doane, MD , Kansas City, Mo., USA, examined two devices employed as solutions for presbyopia that utilize these mechanisms: The KAMRA Corneal Inlay (AcuFocus, Irvine, Calif., USA) and the VUE+ Inlay (ReVision Optics, Lake Forest, Calif., USA). The ideal refractive procedure is accurate, effective, stable, and safe. Corneal inlays have the added advantages of being removable, adjustable, and they can be used to complement other procedures and as an intermediary procedure. Michael Gordon, MD , San Diego, Calif., USA, presented another approach to presbyopia: presbyLASIK. According to Dr. Gordon, there are two different philosophical approaches to the correction of presbyopia: the active approach, which includes accommodative IOLs and involves the functionality of the ciliary muscle; and the passive, bypassing the functionality of the ciliary muscle. Corneal inlays take the passive approach; so does presbyLASIK. Dr. Gordon called presbyLASIK an “exciting addition to the presbyopic toolkit.” It currently comprises 10% of the volume of laser procedures at his clinic. Editors’ note: Dr. Doane has financial interests with ReVision Optics, Bausch + Lomb (Rochester, NY, USA), Carl Zeiss Meditec (Dublin, Calif., USA), Ocular Therapeutix (Bedford, Mass., USA), Calhoun Vision (Pasadena, Calif., USA), and LenSx (Alcon, Fort Worth, Texas, USA/Hünenberg, Switzerland). Dr. Gordon has financial interests with Alcon, Avedro (Waltham, Mass., USA), and Presbia (Los Angeles, Calif., USA). Challenging cataract cases This year’s “Complicated and Challenging Cases in Cataract Surgery Video Symposium” offered videos and commentary on such diverse topics as rupture/repair of a cystic bleb during cataract surgery and spontaneous globe rupture. The eventual winner of the Golden Apple Award, “Pediatric BB Gun Injury with Open Capsule by EyeWorld Staff