EyeWorld India June 2015 Issue

67 EWAP NEWS & OPINION June 2015 distances to the clinic. If individual surgeons do choose to offer immediately sequential surgery, patient choice and informed consent are essential, she said. The second eye must always be optional, there must be separate consent forms for bilateral surgery, and the surgeon must have complete aseptic separation of the right and left eyes, she said. Femtosecond laser-assisted cataract surgery complicates the issue, Dr. Braga-Mele added. Should both eyes be docked and lasered before going to the OR? What happens if there are complications during phaco in the first eye? These issues will need to be addressed before moving forward, she said. Douglas D. Koch, MD , Houston, presented “IOL Design—Is This the Best We Can Do?” The IOL features available now are high quality optics, toric IOLs that meet our needs, improving pseudoaccommodative designs, and square edges that retard posterior capsular opacification (PCO), but some features are still missing, he said. His “wish list” of IOL design includes elimination of PCO, elimination of dysphotopsias, a more precise definition of IOL power, true accommodative designs, and drug delivery. While we are making strides in these areas, it may be time for an entirely new approach, Dr. Koch said. “Why are we still either prescribing drops or injecting drugs through the zonules?” he asked. Having the lens elute drugs would reduce the need for both of these therapies. When it comes to a truly accommodative IOL, the ultimate solution is a long way down the road, he concluded. Editors’ note: Dr. Donnenfeld has financial interests with Abbott Medical Optics, AcuFocus, Alcon, Allergan, AqueSys, Bausch + Lomb, Elenza, Glaukos, Icon Biosciences, Kala Pharmaceuticals, Katena, Mati Therapeutics, Merck, Mimetogen Pharmaceuticals, NovaBay Pharmaceuticals, Odyssey Medical, Omeros, Pfizer, PRN, RPS, Shire Pharmaceuticals, Strathspey Crown, and TearLab. Dr. Koch has financial interests with Abbott Medical Optics, Alcon, i-Optics, ReVision Optics, TrueVision, and Ziemer. Dr. Braga- Mele has financial interests with Abbott Medical Optics, Alcon, and Allergan. Leveraging technology to drive the future of health and medicine When it comes to technology, physicians are still practicing old school medicine, but it is time to change their way of thinking, said Daniel Kraft, MD , San Francisco, this year’s speaker at the ASCRS Lecture on Science and Medicine. A renowned physician- scientist, Dr. Kraft has 20 years of experience in clinical practice, biomedical research, and healthcare innovation. He holds numerous medical device, immunology, and stem cell-related patents and has founded several information technology and biotechnology companies. Rather than reacting to rapidly advancing technologies, physicians should take a proactive role, leveraging technology to provide the best care for their patients, Dr. Kraft said. This is what will bring healthcare into the modern era. “We need to think differently if we’re going to reinvent healthcare and address some of the grand challenges we have in whatever field we’re in,” he said. “Technology can be disruptive, but we should be the disrupters, not the disruptees.” Some of the biggest challenges in delivering healthcare are cost, access to care, and variations in clinical practice, Dr. Kraft said. In addition, physicians are unable to harness the wealth of healthcare data stuck in paper records. In the United States, physicians face challenges with the U.S. Food and Drug Administration (FDA) not knowing how to accelerate new technologies and challenges with payers not knowing how to reimburse or cover costs. The good news is that physicians can leverage existing technology to overcome some of those challenges and can help shift our system from a reactive system to a proactive one, Dr. Kraft said. When Apple debuted the iPod in 2001, the technology for digital music already existed, but Apple’s genius was in bundling those technologies into the right package, he said. The same idea can be applied to healthcare to provide better, preventive, personalized, proactive care. “The future is already here, it’s just not evenly distributed,” he said. Editors’ note: Dr. Kraft has no financial interests related to his comments. Can progression of myopia be stopped? Spectacles, multifocal contact lenses, overnight corneal reshaping, and anti-muscarinic eye drops have all been studied as methods to halt myopic progression, but anti-muscarinic eye drops are the only treatment shown to have a significant effect. Donald T.H. Tan, MD , Singapore, shared results from the studies conducted at the Singapore Eye Research Institute (SERI) on the use of atropine, an anti-muscarinic agent, for myopic prevention in the Richard L. Lindstrom Lecture, “The Use of Atropine for Myopia Prevention.” Atropine 1% eye drops have been available for more than 40 years and have been used in East Asian countries to slow the progression of myopia since the 1990s, Dr. Tan said. Atropine’s mechanism of action is unclear, but studies have shown that it does not work by blocking accommodation. Dr. Tan and colleagues performed two randomized controlled trials at SERI to determine atropine’s effectiveness in halting distance visual acuity decline and axial elongation. The first study, named ATOM1, compared 1% atropine to placebo drops in 400 children studied over 3 years. The second study, ATOM2, compared the effects of lower doses of atropine—0.5%, 0.1%, and 0.01%—to placebo drops in 400 children over a period of 5 years. The major conclusions from these studies are that atropine drops slow myopia progression and axial elongation in children in a dose-related manner, but a rebound effect occurs with higher doses—axial length and myopia increase again after the drops are stopped. Atropine 0.01% has the best therapeutic index, slowing progression of myopia by as much as 50–60%. There are many more questions to be answered, but Dr. Tan believes that this is a huge step forward. “It’s fascinating that now we’re reaching a time when a lot of these studies are showing promise,” he concluded. E ditors’ note: Dr. Tan has financial interests with Carl Zeiss Meditec, Eye-Lens Pte Ltd., Network Medical Products, and Santen Pharmaceutical. continued on page 68