EyeWorld India June 2017 Issue

June 2017 10 EWAP NEWS & OPINION surgery, and Dr. Tabin said people “blossomed back to life.” Dr. Tabin called his old professor, Dr. Weidman, who had previously tried to convince him to enter ophthalmology. Dr. Weidman told Dr. Tabin there was an opening for an ophthalmology residency at Brown University. “If I hadn’t had that research on Everest, I probably wouldn’t have gotten this competitive position,” Dr. Tabin said. Dr. Tabin held a cornea and external disease fellowship in Australia and later joined Sanduk Ruit, MD, for an expedition in Nepal. The pair performed 224 cataract surgeries in 3 days; Dr. Tabin acknowledged he only performed about 2 dozen, while Dr. Ruit performed the rest. “The joy was palpable,” Dr. Tabin said, adding that the results appeared as good as phaco surgery for a cost of about $25. “I told Dr. Ruit, I want to join you in this.” With that the pair formed the Himalayan Cataract Project. Dr. Tabin has since focused his career on bringing quality eyecare, not just cataract surgery, to the places that need it most. Dr. Tabin said they joined forces with Alan Crandall, MD , who had been performing the highest volume of cataract surgery in Ghana, expanding access to eyecare in Ethiopia, Rwanda, South Sudan, Tibet, Myanmar, and more. “We all need to realize that blindness is preventable and treatable for 18 million cataract patients on our planet,” Dr. Tabin said. Dr. Tabin called on his fellow ophthalmologists to join him in bringing these numbers to zero. “Elimination of avoidable blindness is something we can do,” he said. Symposium provides tips for ‘Avoiding Unexpected Outcomes’ A symposium late Saturday morning highlighted different factors to help ensure optimal optical outcomes. Topics included cataract surgery and diabetic retinopathy, preoperative and intraoperative imaging, astigmatism management, astigmatic refractive surprise, cataract surgery in post- keratoplasty patients, and more. Wong Tien Yin, MD , Singapore, focused his presentation on cataract surgery and diabetic retinopathy. Diabetes is obviously a major problem affecting many people around the world, he said. Recently, he added, there has been more interest in diabetic macular edema (DME) and not just diabetic retinopathy. The history of DME, he said, is that it’s a slow, chronic disease. It doesn’t happen overnight, Dr. Wong said. For many years, the laser has been used as the treatment of choice, he said. But more recently, treatment options have shifted to include intravitreal steroids and now intravitreal anti-VEGF treatment. Dr. Wong noted that if the DME is not centered, lasering at the area of the DME continues to be the standard of care. If you have center DME, he said, anti-VEGF treatment is the standard of care. Anti-VEGF therapy reduces DME and improves vision, he added. Many patients now have severe DME, and even bilateral disease, and may need intensive treatment over time. There are over 50 randomized trials looking at anti- VEGF treatment for DME, he said. Dr. Wong then highlighted several key points relating to DME. First, he said, we need to understand the natural history of DME. The decline in vision is not dramatic, he stressed. Because of this, surgeons should take the time to talk to patients and family. Switching patients from a routine yearly or half yearly follow-up to an intensive monthly treatment may be a good option, he said. The next point that Dr. Wong highlighted was that vision improvement with treatment is slow. The concept of a “3-loading dose” does not apply for DME, he said. Instead, the chronicity of DME is reflected in the “5–6 loading dose.” The maintenance of DME is less intensive over time. Dr. Wong said this is good news for patients because the burden is less over time. You need to treat early, he said, but then you need less treatment over time. Next, he touched on the potential differences between the three agents used. In eyes with poorer visual acuity (VA) at baselines, aflibercept appears superior to ranibizumab and bevacizumab in year 1, Dr. Wong said. All anti-VEGF agents are efficacious, he said, but surgeons may want to consider aflibercept in eyes with poor VA. He then stressed the continued role for the laser for DME. Laser is still required, he said, and for non- center involving DME. Next, Dr. Wong highlighted common questions from cataract surgeons about DME and pearls from a retinal surgeon’s perspective. In conclusion, Dr. Wong said that cataracts are a common comorbidity of patients with diabetes, and systemic control helps to prevent cataracts. Cataract surgery is associated with increased risk of diabetic retinopathy, DME, and pseudophakic CMO, he said. With a mild cataract, the priority is for treatment of diabetic retinopathy/DME, Dr. Wong said. With a moderate cataract, adequate laser and a course of anti-VEGF treatment should be done before cataract surgery. And for a severe cataract, early retinal follow-up and treatment may be needed. Adjunctive therapy during cataract surgery is useful if DME is present, Dr. Wong said, but is not needed if DME is absent. He added to beware of subtle DME, macular ischemia, and macular atrophy. Symposium shows ‘the way forward’ with new innovations The theme of whole 30th APACRS Annual Meeting is about “finding the right path.” The theme of Saturday morning’s symposium was all about “the way forward,” highlighting new innovations and technologies that might change how ophthalmologists practice. Lin Haotian, MD, PhD , Guangzhou, China, presenting on behalf of Liu Yi-Zhi, MD, PhD , Guangzhou, China, discussed research that shows promise in lens regeneration with endogenous stem cells in pediatric cataract patients. Richard Packard, MD , London, U.K., discussed new methods for creating a capsulotomy. The first time the lens capsule was opened was in 1747, and since then, Dr. Packard said, the technique has remained mainly manual until recently with the introduction of the femtosecond laser-created capsulorhexis and other newer technologies. While the femtosecond laser creates truly circular capsulotomies of a consistent size and position with little risk of tear-outs, Dr. Packard APACRS – from page 9 continued on page 8