EyeWorld Asia-Pacific September 2012 Issue

September 2012 59 EWAP MEEting REPoRt before adding anti-VEGF therapy. “You have to continue this treatment as long as the underlying issue is there,” he said. Cataract surgery and macular disease Surgeons at the ESCRS/ EURetina Symposium, which focused on cataract surgery and macular disease, discussed whether phacoemulsification accelerates conversion to wet AMD and whether prophylactic anti-VEGF therapy should be administered in high-risk dry and wet AMD patients at the time of cataract surgery. One of the most common questions Sebastian Wolf, MD , Bern, Switzerland, receives is whether cataract surgery is safe for someone with AMD. Patients often worry that having the surgery will worsen their disease, he said. “There is no clear evidence that cataract surgery promotes AMD progression,” he said. “And there is no proof for increasing disease activity in the presence of wet AMD either.” Anti-VEGF therapy also has not been proven to have a prophylactic effect on either dry or wet AMD. If signs and symptoms are suggestive of choroidal neovascularization, clinicians should perform an SD-OCT and fluorescein angiography before cataract surgery. Wet AMD should be treated until BCVA is stable before cataract surgery is performed, Prof. Wolf said. Frank G. Holz, MD , Bonn, Germany, said prophylactic anti-VEGF therapy may counteract stimuli for increased disease activity induced by cataract surgery, including hyperpermeability, growth of CNV, retinal pigment epithelial tear in the presence of retinal pigment epithelial detachment, and new hemorrhages. Blue light controversy In her talk, Fiona Cuthbertson, MD , London, discussed whether blue-light filtering IOLs work to decrease scotopic sensitivity in patients with AMD. Experimental data shows that the retina can be damaged by short wavelength, or blue, light. “Application of a blue filter seems to reduce this damage,” she said. “It would seem sensible to reduce this.” Also, theoretical and clinical data suggests that side effects from the lenses are unlikely, she added. Day 2 Ophthalmologists should hold less stock in randomized controlled trials because they often don’t include comorbidities, according to the 2012 ESCRS Ridley Medal lecturer. “We must always question the external validity of these randomized controlled trials,” Mats Lundstrom, MD , Sweden, told a packed audience Sunday, which was opening day of the ESCRS Congress. Prof. Lundstrom oversees the Swedish National Cataract Registry, one of the most comprehensive and longest running ophthalmic registries in the world. “The only way to reflect what is going on is to go to these quality registries,” he said. Prof. Lundstrom said he was struck by the similarities between cataract surgery and fly fishing, a hobby he took up 30 years after learning the eye procedure. “In both disciplines, you will be involved in endless discussions about materials and technologies. However, the only thing that counts in both disciplines is the outcomes,” he said. Prof. Lundstrom said patients mostly want to know what will happen to them. It’s the surgeon’s responsibility to know his or her own outcomes, he stressed. “Knowing your results is part of the job,” he said. “We as surgeons should learn from the outcomes of our patients. To quote Howard Fine, ‘Surgeons who don’t count, don’t count.’” Prior to the Ridley Lecture, ESCRS President Peter Barry , FRCS , Dublin, welcomed delegates to the Congress, noting that there were more than 6,700 attendees from 180 countries. Dr. Barry announced that Roberto Bellucci, MD , Verona, Italy, was elected as the next president of ESCRS. Controversies in cataract and refractive surgery Debates continued during a spirited yet friendly discussion Sunday afternoon—this time about the advantages and disadvantages of using a femtosecond laser during cataract surgery. Pro-femto speaker Burkhard Dick, MD , Bochum, Germany, faced off against Steve A. Arshinoff, MD , Ontario, Canada, who readily admitted that he admired the technology but has problems with certain aspects of it. Prof. Dick said key advantages to femto technology include better outcomes in corneal incisions, capsulotomy, low to zero ultrasound, and improved visual acuity. “For me, it’s the indication in challenging cases,” he added. Prof. Dick asserted that femto technology offers better CCC parameters and IOL centration, as well as fewer internal aberrations and better optical quality. Surgeons also can expect a lower deviation from target refraction as well as better predictability of IOL power, less corneal trauma and swelling. While he said the technology is intriguing, Dr. Arshinoff said he has two major problems with it. “Femtosecond lasers are less adaptable to unusual circumstances than the hand of a surgeon,” he said. “They remove a large part of the art from cataract surgery.” The devices also are still too expensive right now, Dr. Arshinoff argued. continued on page 60