EyeWorld Asia-Pacific June 2012 Issue

June 2012 49 EWAP NEWS & OPINION APAO/SOE Busan 2012 seeks sustainable solutions by EyeWorld Staff T he 27th Asia- Pacific Academy of Ophthalmology Congress, held in conjunction with the 20th European Society of Ophthalmology Congress and the 107th Korean Ophthalmological Society Congress (APAO/SOE Busan 2012) attracted over 3,000 delegates from all over the region and other parts of the world. The congress was held from 13 to 16 April 2012 at the COEX Convention Center in Busan, South Korea. Here we present some of the highlights of EyeWorld’s coverage of the meeting. A sustainable solution to cata- ract blindness During a session on blindness in the elderly, Dennis Lam, MD, China, offered a possible solution for the problem of cataract blindness in Asia. Until now, geographic, cultural and financial barriers have been preventing patients from getting sight-saving cataract surgery in the Asia Pacific region, Dr. Lam said. “In China we still have more than 900 million village people,” he said. “We do have good urban development, but we have the city/ village barrier. Either the service is not available, or if you go to a city, it is not affordable.” Dr. Lam said well-established surgeons have gone out into outlying areas in China and trained county hospital doctors to perform basic cataract surgery. They also do lectures, workshops and wet labs, he said. It takes from one to three months to train the new surgeons. The surgeons perform manual, sutureless, small incision ECCE procedures which can be done in very high volumes at low procedural cost. “We ask trainees to do the procedure 100 times (on animal eyes) before touching human eyes,” Dr. Lam said. “The key to the success of the whole program depends on the outcomes of the trainees. The results have been very encouraging.” So far, there are 21 centers in 6 Chinese provinces. More than 60 cataract surgeons have been trained, and 70,000 cataract surgeries have been performed. The program, called Project Vision, charges the surgeons a small fee for the courses, but has changed the payment model for patients. The old model required that all patients pay a very low cost for the surgery, but the new model charges more to patients who can afford it and gives it free to those who cannot. “This is a meaningful endeavor and a sustainable program that is at least effective in China,” Dr. Lam said. Femto laser cataract surgery ‘the way of the future’ The “actual presence” of femtosecond lasers, said Tim Roberts, MD , Vision Eye Institute, Sydney, Australia, is not new; the technology has been available for various applications, most particularly (but not exclusively) in LASIK. What is new, he said, is the use of femtosecond lasers in automating parts of cataract surgery. Femtosecond laser cataract surgery was the focus of the first session of the APAO/SOE 2012 Congress’s Cataract Subspecialty Day. From his own experience, Dr. Roberts said that “laser-phaco” is definitely different from “manual- phaco”, and the new technology as applied in cataract surgery represents a definite paradigm shift that some experts already equate to the introduction of phacoemulsification during the time of extracapsular cataract extraction (ECCE). One indication of this paradigm shift is the emergence of capsular block syndrome as a complication of femto cataract surgery. Dr. Roberts said that the gas generated by femto laser cataract surgery leading to an intraoperative increase in bag volume combined with a perfectly sealed laser capsulotomy among other factors related to the new procedure creates a “perfect storm” situation for this complication not seen in standard phaco. Experts at the session all seem to agree that femtosecond laser cataract surgery is, as Benjamin Cabrera, MD, American Eye Center, Manila, Philippines, put it, “the way of the future”. However, there remain barriers to acceptance, including a significant learning curve. Cesar Espiritu, MD, American Eye Center, offered some tips for “beating the learning curve”. He said that the keys to overcoming the learning curve are knowing the machine – including all the details usually left for technicians; adopting modifications to surgical technique that include taking into consideration the laser incision, the placement of cuts, and the use of intracameral dilators and prophylactic anti-inflammatory medication since the laser could induce inflammation resulting in miosis; a properly trained staff to serve as a patient management team; and marketing, which includes the creation of new patient packages, the initiation of clinical studies and publication of results. The learning curve, said Dr. Espiritu, “isn’t really that difficult” to overcome. One thing that helped in both his and Dr. Roberts’s experience is the fact that they introduced the procedure into group practices, thus helping with logistical considerations including the optimization of workflow through their respective surgeries. Editors’ note: Dr. Espiritu is on the Speakers Boards of Alcon (Fort Worth, Texas, USA/Hünenberg, Switzerland), Allergan (Irvine, Calif., USA), and Bausch + Lomb (Rochester, NY, USA). Dr. Roberts has no financial or proprietary interests related to his lecture. New paradigms, innovative techniques In just two out of their first 50 cases of cataract surgery performed with the femtosecond laser, Tim Roberts, MD, Australia, and his colleagues, encountered what was, at the time, something completely new: intraoperative capsular block syndrome. Dr. Roberts presented one of those cases at a Cataract Grand Round conducted by the International Council of Ophthalmology (ICO). During the surgery, after the femto laser incisions were completed and Dr. Roberts was initiating hydrodissection, he was surprised by a pupil snap— signaling posterior capsular rupture. An image of the dropped lens—complete with gas bubble on the anterior surface beneath the still attached anterior capsule— accompanies their publication of the case. What’s interesting—and significant—about this case, said Dr. Roberts, is that it shows that the laser did exactly what it was meant to do, but that cataract surgery had definitely shifted into a new paradigm. What intraoperative capsular block syndrome represents, he said, continued on page 50