EyeWorld India June 2017 Issue

June 2017 EWAP NEWS & OPINION 9 and corneal edema. Additionally, intumescent cataracts were another challenging case that Dr. Chee discussed. High intralenticular pressure due to liquefaction of the cortex causes Argentinian flag sign, she said. Using femto enables the surgeon to create a circular capsulotomy of optimal size, she added. Posterior polar cataracts and severely subluxated cataracts were other types of challenging cases that Dr. Chee discussed. Not all eyes can be handled with the femtosecond laser, she said. And there are some contraindications. Dr. Chee discussed evidence of specific eye features, facial features, and body structure that may be contraindications. Eye features included previous glaucoma or cornea surgery, severe corneal scars, and severely displaced lens. Facial features that are contraindications include deep-set eyes, prominent nose, and prominent eyebrows. And contraindications relating to body structure could include obesity, skeletal anomalies like a pronounced kyphosis, tremor, or restless legs syndrome. New indications for femto, Dr. Chee said, may include for posterior capsulotomy to prevent PCO, for rescue capsulotomy (to enlarge a markedly smaller capsulotomy or treat capsular phimosis), and for an IOL that is fixated to the capsular bag rim. One main issue, she said, is the cost. Studies have shown that issues relate to location, logistics, and scheduling; a longer time for the procedure; and the cost of the patient interface, Dr. Chee said. For standard cases, the visual outcomes are not different between phaco and femto, she said. Ultimately it is surgeon preference and conviction. Femto can be used with low endothelial cell count, in capsular fibrosis, for big eyes, with a thick hard nucleus, for a shallow anterior chamber, for subluxated lenses, and to create arcuate incisions, she said. Avoid femto in eyes that are difficult to dock, in advanced glaucoma, with small pupils, with significant corneal opacity, with large pterygium, with significant conjunctival chalasis, in uncooperative or fearful patients, and if there is a cost concern, Dr. Chee said. Special lecturer describes climbing Mount Everest, its impact on his career An unexpected phone call and climb to the peak of Mount Everest—29,028 feet above sea level—on a never-before-traversed, still-unrepeated route up the east side of the mountain led Geoffrey Tabin, MD , Salt Lake City, Utah, U.S., into ophthalmology. In the APACRS Special Lecture Friday morning, “Mountains, the Eye, and Me,” Dr. Tabin described his experience with climbing and how it influenced his personal journey into ophthalmology. Dr. Tabin is the fourth person in the world to ascend to the tallest peak on all seven continents. He is co-founder of the Himalayan Cataract Project and is John A. and Marva M. Presidential Endowed Chair, professor of Ophthalmology, Visual Sciences and Director of the Division of International Ophthalmology at the John A. Moran Eye Center, University of Utah, Salt Lake City. Dr. Tabin started climbing as a teenager. Eventually, he started doing ice climbs on frozen waterfalls. Though he never thought at the time about climbing a summit like Everest, this was his training ground for that and another daring ascents. Dr. Tabin climbed a lot of routes and walls in America. A scholarship after college took him to Europe where he had the opportunity to expand his climbing horizons. He wrote a few articles in climbing journals and gave lectures at climbing organizations. After he had started at Harvard Medical School, Dr. Tabin was offered a fully funded trip by National Geographic and ABC Sports to climb the east side of Everest, something that hadn’t been attempted since George Leigh Mallory and Andrew Irvine disappeared in their attempt up the north-east side in 1921. Dr. Tabin applied for a leave of absence from Harvard to do the climb. “I received a phone call from a guy that changed my life,” Dr. Tabin recalled. The caller, who turned out to be Michael Weidman, MD , called Dr. Tabin an idiot, a complete moron. There was no way Harvard would give him a leave of absence to climb a mountain. It would, however, he learned from Dr. Weidman, give him credit if he were doing research. And that’s when Dr. Weidman signed Dr. Tabin on to do research on high altitude retinopathy. Dr. Tabin took photos of all team members’ retinas before, during, and after their 1983 climb. Dr. Tabin said, 19 of the 34 team members developed retinal hemorrhages, and there were cases of high altitude cerebral edema. Dr. Tabin was the youngest person on the team, which he said was the first ascent of Everest without native support and included technical climbing not done on Mount Everest before. “The route still has never been repeated,” Dr. Tabin said. Five years later, Dr. Tabin had the opportunity to climb Everest again with a team that was accompanying the first American woman make the climb. This 1988 ascent was much easier with native support, which meant he and the other climbers could focus on just that—climbing—which Dr. Tabin said was wonderful. He recalled reaching the highest place on Earth just after 8 a.m. He was alone at the peak for 40 minutes. There he thought about what he was doing with his medical career. “Many of the problems I was facing were really public health issues ... things individual doctors couldn’t make that much of a difference in,” Dr. Tabin said. Edmund Hillary, one of the first two confirmed people to reach the top of Everest, was a hero of Dr. Tabin’s not only for his climbing fame, but because of how he gave back to the people of Nepal. “As a doctor, I really wanted to do something to give back.” The village Dr. Tabin was working in at the time had public health issues like a lack of clean water and vaccinations. “Then, I saw the miracle of cataract surgery,” he said. This was a culture where it was accepted that when you get old your hair turns white, your eyes turn white, and then you die, he said. Then a Dutch team came in to perform cataract continued on page 10