8 EyeWorld Asia-Pacific | September 2024 FEATURE Highlights from the 36th APACRS - 24th CSCRS Joint Meeting Chengdu, 2024 by Christina Chintanaphol and Michelle Dalton Pathways To Precision And Perfection This year’s Combined Symposium of the Cataract & Refractive Societies (CSCRS) — a joint symposium of the APACRS, ASCRS, and ESCRS — explored three areas of contention in cataract and refractive surgery. Top surgeons argued their case for either Light Adjustable Lens (LAL) or IOL formulae, manual phacoemulsification or Femtosecond Laser-Assisted Cataract Surgery (FLACS), and Small Incision Lenticule Extraction (SMILE) or LASIK. LAL vs. IOL Formulae In the USA, ASCRS representative David F. Chang, MD (USA) has performed many surgeries using the LAL and noted its rapid adoption in the United States. Although LALs cannot guarantee perfect vision, they can be customized as close to the patient’s needs as possible rather than with selecting a non-adjustable IOL. “I like multifocal IOLs, but their use can come with a whole host of problems,” Dr. Chang said. For example, patients with non-adjustable IOLs could experience night time halos or reduced contrast sensitivity while maintaining high expectations for a high-performing lens. “LALs let patients try out the options,” he said. There is also no need for patients to comprehend preoperative counseling, and they can decide their vision goals after surgery, reducing overall anxiety. Results have been positive with 97% of patients in one study presenting with 20/25 or better uncorrected binocular distance vision after LAL implantation. On the other hand, APACRS representative Graham Barrett, AM, MBBch, FRANZCO (Australia) argued for sticking to the precision of using IOL formulae. Even though LAL has excellent outcomes, “I find that with my predictions using formulae, I come close to 90% accuracy for both sphere and cylinder,” he said. Other disadvantages of LAL that Prof. Barrett described included the high cost of LAL surgery, concerns with ultraviolet light, anecdotal reports with unusual adverse events, and the need to avoid photosensitizing medications after LAL implantation. “I like precision,” Prof. Barrett said. “Measure twice, cut once. It is better to get things right the first time than fixing after the fact. This is the reason I would suggest predicting with biometry as the pathway to better outcomes.” Phaco vs. FLACS Nic Reus, MD, PhD (Netherlands), representing ESCRS, presented his stance on sticking with conventional cataract surgery rather than performing FLACS, primarily because both procedures have similar, if not the same, clinical results and phacoemulsification requires less operating time and is less expensive. If both phaco and FLACS both result in similar surgically-induced astigmatism, postoperative refractive error, and endothelial cell loss, he asked, why not stick with phaco? David Chang Graham Barrett Nic Reus
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