EyeWorld India June 2017 Issue

June 2017 EWAP NEWS & OPINION 7 MEETING reporter APACRS at the Crossroads Live reports from the 30th APACRS Annual Meeting held from 1 to 3 June 2017 in Hangzhou, China Reaching out to those ‘left behind’ While most of the scientific program of the 30th Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS) annual meeting is focused on advanced and cutting- edge cataract and refractive surgery techniques and technologies and the various related controversies, one symposium Thursday morning stands out. APACRS President Ronald Yeoh, MD , Singapore, wanted to set aside some time for what remains a significant problem in the world today, particularly in the Asia-Pacific region: Cataract blindness. As its title suggests, “Cataract Blindness – Practical Solutions” was a symposium that aimed to recommend practical solutions to addressing mass cataract blindness, from surgical technique to logistics. The symposium positioned cataract blindness—particularly mass cataract blindness—as a tragedy of this supposedly modern age. “We are now doing fantastic cataract surgery,” said Geoffrey Tabin, MD , Salt Lake City, Utah, U.S. “The numbers are going up of cases being done. People are using the femtosecond laser.” And yet, he said, mass cataract blindness remains a significant problem in developing countries. “Worldwide, there are 18 million people—18 million!—who cannot do the acts of daily living because they are totally blind from cataract. “These people are increasing,” he added. “As the population ages, the number of people blind from cataract is growing.” It is, he said, “a huge devastation to our world,” citing the impact of cataract blindness socially and economically, not just on the patients who are themselves blind from cataracts, but on the people who rely on them and who they rely on to care for them. “Even though we’re doing more and more good surgery,” he said, “the people who are having surgery are those who can pay [who have] early cataracts.” These patients, he said, might only have blurred vision; “Those who are truly blind are getting left behind.” Those who are “left behind,” he said, remain in perpetual poverty. As a simple indication of the impact of blindness, life expectancy in these patients is only a third that of age and health matched people. However, beyond simply dwelling on these grim realities, Dr. Tabin offered some practical solutions to addressing the problem. In terms of technique, Dr. Tabin touted the use of manual small incision cataract surgery (MSICS)—which, he said, he personally prefers calling sutureless small incision cataract surgery (SSICS); SSICS, he said, is a sexy procedure. Considering the extremely mature and hard cataracts encountered in developing countries, Dr. Tabin said that phaco—the supposed gold standard for cataract surgery—can be difficult to do: What would be a 5-minute MSICS/SSICS procedure might take 30 minutes with phaco, with postop day 1 results marred by significant corneal edema. In order to make a significant impact, however, a team approach is necessary: Surgeons and other related eye and healthcare workers must think and work collectively to reach the poorest of the poor. Going into specifics, Dr. Tabin broke down the components and stages of this team approach, describing a work flow resembling a factory assembly line. For the anesthesia stage, the team requires a doctor and a senior nurse; preparing the patient for surgery requires a running nurse; draping and applying the speculum requires continued on page 8