The survey highlighted some surprising contrasts among the concerns of small companies versus larger companies. While both groups
Interestingly, neither doctors nor non-doctors appeared to have major concerns about COVID restrictions or resurgence.
Ophthalmologists and industry representatives both cited increased regulation and decreasing reimbursement as major concerns. Non-doctors showed an elevated concern for supply chain issues, while doctors showed slightly more concern about more economic issues—recession and inflation.
expressed ongoing concern about increased regulation, larger companies were somewhat more concerned about supply chain issues, whereas smaller companies were more concerned about finding and keeping employees than their larger counterparts.
Doctors Non-doctors
ESCRSToday
ESCRS Today is a daily newspaper packed with highlights of the day’s main events and industry symposia.
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In what two clinical areas would you invest the greatest amount of resources toward future innovation at the moment?
Clinical ophthalmologists have a lot on their minds, and so do the industry leaders that provide the tools they use, a new survey suggests. The findings come from a survey of 203 pre-registered attendees of the ESCRS iNovation Day meeting this past Friday.
Survey shows concerns among clinicians and industry
i NOVATION
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Smaller company/Startup Larger company/Strategic
In what two clinical areas would you invest the greatest amount of resources toward future innovation at the moment?
19th SEPTEMBER | ESCRSToday 3
When asked, “What two areas would you invest the greatest amount of resources toward future innovation?”, clinicians put presbyopia at the top of the list, followed by digital ophthalmology (EMR, visualisation, AI) and cataract extraction. The industry response was similar, but with a greater emphasis on Largeglaucoma.and small companies showed some divergence when asked the same question. Larger companies expressed a greater interest in developing presbyopia and digital ophthalmology resources, and smaller companies appeared to be more interested in developing glaucoma treatments.
Overall, smaller companies appeared to be significantly more
optimistic than larger companies. Two-thirds of the smaller companies believe investment in ophthalmic innovation will either increase or significantly increase between 2022 and 2023, compared to slightly more than half of the larger companies. Some 14% of larger companies expressed concern about decreasing investment in the next year compared with 7% of the smaller companies.
The eighth annual ESCRS Clinical Trends Survey is underway. That survey asks ESCRS members key questions on current issues they face in their practices. As the name suggests, it also shows which procedures are gaining in popularity and which are fading, and why.
POSTER HIGHLIGHTS
The researchers conducted a systematic review of the two most commonly used app stores—the Google Play Store and the Apple App Store. They used the key term “eye anatomy”, excluding apps unrelated to ophthalmology and those not offering a 3D function that could rotate 360 degrees. All relevant apps were evaluated by three parameters: 3D features, highlights of individual anatomical features, and cost.
The Google Play Store generated 250 results, of which 20 were relevant. The Apple App Store generated 211 results, of which 12 were relevant. Between the Play Store and App Store, there was an overlap of 7 apps. These apps offered a variety of 3D features, including 360 rotation, X-ray and animation modes, and virtual/augmented/mixed reality options. Of the relevant 25 Google and Apple apps, 76% offered a function
ESCRSToday | 19th SEPTEMBER4
An improved model of 3D representation is required to improve communication and, thus, patient understanding. We consider 3D anatomical applications as the up-and-coming tool due to their versatility and accessibility.
It can be challenging to explain the complex anatomy of the eye to worried patients. Smartphone apps could help, but are they ready for prime time? George Liu MD and colleagues looked at what’s available in app stores now.
3D Apps Could Benefit Patients and Clinicians alike
“Patient education and understanding have been shown to improve outcomes by enabling engagement. Information relating to ophthalmic disease and surgery is often complex, pertaining to microanatomy of the eye and adnexa. The use of three-dimensional anatomical models in clinical consultations is one method that can improve patients’ understanding of their ophthalmic condition(s) and procedure(s),” the researchers note in a presented poster.
Dr Liu is at Anglia Ruskin University, Chelmsford, UK. His colleague Dr Hasan Naveed is at Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK. Colleague Christopher Liu is at Sussex Eye Hospital, Brighton and Sussex University Hospitals, NHS Trust, Brighton, UK.
“An improved model of 3D representation is required to improve communication and, thus, patient understanding. We consider 3D anatomical applications as the up-andcoming tool due to their versatility and accessibility. We hope to identify a simple yet effective software that can be used globally, anywhere, and in any setting (e.g., in clinics or virtual consultations) to bridge the gap between a patient’s understanding and the doctor’s,” Dr Liu said.
This 20-minute training experience will allow trainees to see the surgical field in stereo and high-resolution, while operating with life-like surgical instruments.
to highlight individual anatomical features and 29% to view pathology.
Cataract surgery virtual reality (VR) training experience
About one-third of these apps were free. The remaining apps ranged in price from €1 to €42, averaging €11 per app.
None of the apps had verified studies to confirm correct anatomy. The researchers concluded that further improvements and content regulation from specialists are required to maintain a high standard of content.
19th SEPTEMBER | ESCRSToday 5 VisitboothB86/B78atESCRS2022
ESCRS delegates are invited to attend a ‘Cataract surgery virtual reality (VR) training experience’, and witness some of the exciting features of the Eyesi Surgical Simulator, first-hand.
Places are limited, visit https://tinyurl.com/ye7az4v6 to secure your place, or visit booth B86/B78 to check availability.
https://tinyurl.com/ye7az4v6
EYESI SURGICAL
ESCRSToday | 19th SEPTEMBER6
The developers’ goal was to create a free online tool that helps ophthalmologists aggregate the major online IOL calculators in one site, allowing them to get multiple results with only one data entry session.
The developers used a technique called web scraping. This is the sort of thing seen when using a hotel or air travel search engine. Web scraping uses bots to extract content from several websites and sends it to a single site. The user can then compare results from seven current calculators: Barrett Universal II, Cooke K6, Evo, Hill-RBF, Hoffer QST, Kane, and PEARL GDS. The site also “scraped” a comprehensive
ESCRS launches online IOL calculator
The ESCRS online IOL calculator is now live at iolcalculator.escrs.org.
“This will reduce typing mistakes, provide a better view, and allow users to compare results, eventually helping to get better refractive outcomes,” Dante Luis Buonsanti told ESCRS Today
CATARACT AND REFRACTIVE
“When you have surgeries scheduled for next week, you must have the most recent information when choosing the IOL power. This new calculator will revolutionise our daily or weekly calculations. Users can now start using the site. They can see all the features and be ready for the next updates of toric and post-refractive calculations. It will be a great online tool for all ophthalmologists to use, and it is as easy as loading the patient data and choosing the desired IOL,” he added.
“They put an added value to the calculator with their knowledge and helped get all major online formulae on board with the project, allowing us to use their formulae in the new calculator. The ESCRS was the perfect match, and Dr Kenneth Hoffer was a key player in building the project,” Dr Buosanti said.
“You load all the patient data into the ESCRS calculator one time. Then the site automatically goes to each online IOL calculator, loads the same exact data, and brings back the results. So you have a clean list to compare all results with only one data entry. Since there is no internal calculation, you don’t need to do any updates. If the formula is improved or changed, the calculator will be updated automatically,” Dr Buosanti explained.
list of IOLs with optimised constants from IOL.com.
The ESCRS online calculator came about when Dr Kenneth Hoffer put Dr Buosanti together with ESCRS board members Drs Oliver Findl, Filomena Ribeiro, and Nino Hirnschall.
This will reduce typing outcomes.betterhelpingresults,usersview,providemistakes,abetterandallowtocompareeventuallytogetrefractive
The Practice Management and Development Workshops take place today from 08.30 – 18.00 in Room Brown 1.
What advice would you give to an ophthalmologist starting their private practice?
We do not ask too much, but one thing that is useful to start with, to get the patient in a positive mood, is “What did you like about the service?” And we also ask, “What about the service could be improved upon?”
I did a course in the US called “Physician CEO” in 2017. This course would have been nice to do at the beginning of my career. I’ve made a lot of changes in my practice since then. I learned very useful business principles. In medicine, we always learn about minimising risk, but running a business requires taking risk. An independent practice, because it involves costs and needs to be profitable to keep going, is a business. As physicians, we immerse ourselves in the medical literature, but there is a lot to learn about running a business.
Actually, that’s one thing we could improve upon in our practice. We want to develop a better review system. We tend to publish on social media when we get a nice, positive review, but eliciting more patient reviews is something I want to do. That’s what I’ll be taking away from the Practice Management Masterclass— what Shareef Mahdavi has to say on reviews!
People have also become a lot more discerning—there is no question about that. They’ve become more aware of their health and approach costs related to their health differently. Whereas previously, they were more conscious of costs in deciding on a premium lens implant, now they want the feeling a premium IOL will give them.
EuroTimes reporter Clare Quigley MD talked with Arthur Cummings MD, FRCS about the state of practice management in ophthalmology. Dr Cummings is a consultant eye surgeon at the Wellington Eye Clinic in Dublin, Ireland.
PRACTICE MANAGEMENT WORKSHOPS
abc@wellingtoneyeclinic.com
CLARE QUIGLEY
Experts stand ready to address your questions
In the workshops, a panel including Paul Rosen, Amanda Carones, Sheraz Daya, Sharif Mahdavi, Colin Kerr, and Arthur Cummings, among others, will explore bedside manner, practical office management, sustainability, and related topics. The session culminates in an “Ask the Experts” forum where delegates can ask questions about the challenges they face in managing their practices.
ESCRSToday | 19th SEPTEMBER8
we don’t learn something from the survey and implement it somewhere. About twice a year, we have a “secret shopper”. That’s when someone—like a colleague or someone from the industry—will drop in, sit in as a patient, and let us know what the experience is like.
What is useful to ask patients, when getting feedback?
How do you go about getting feedback on the service?
We do a couple of things. On a very regular basis—about once a month—we send out a SurveyMonkey. That goes out to patients who are thinking about surgery, those who’ve had surgery, and those who’ve had a postoperative visit. We learn a lot from it, and there’s always space for the patient to tell us what they’re thinking. I can’t think of a single month where
There have been significant changes in what patients expect in a service and what outcomes they look for from surgery. People are more demanding since COVID. They don’t want to spend a huge amount of time waiting around in the clinic. For example, filling out forms and paying for the visit—these are processes done more and more outside the clinic setting. Progress in the patient service that could have taken years has happened a lot more quickly because of COVID.
What has changed in practice management in 2022?
What about reviews?
The Practice Management and Development Course returns to the ESCRS Congress in Milan for the first time since 2019. A daylong masterclass on Sunday preceded the workshop session today.
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A retrospective study analysing data from the cataract surgery service at a tertiary care hospital in England shows a significant early impact from the stand-down mandated early in the COVID-19 pandemic and some residual effects into the following year.
“Our study identifies that the ongoing pandemic impacted cataract surgery, particularly in its beginning phase. Gradual relaxation of the COVID-19-induced lockdown with the national vaccination drive and steps taken by the hospital have helped in alleviating the pandemic impact to some extent. However, I am sure we are going to feel the effects of the pandemic for at least the next two to three years,” Dr Sehgal said.
ESCRSToday | 19th SEPTEMBER10
and May to October 2021. It compared rates of intraoperative and postoperative complications, waiting times, cataract grade, surgeon grade, and preoperative and postoperative visual acuity (VA) for the patient groups represented by the three study periods.
The research, presented by Akshay Sehgal MD, University Hospitals Coventry and Warwickshire, NHS Trust, United Kingdom, included data of all patients undergoing cataract surgery during May to October 2019, May to October 2020,
Temporal analysis characterises cataract surgery during the COVID-19 era
Comparisons across the three study groups showed no differences in sex distribution (41%–44% males) and mean patient age (about 75 years).
The lower number of patients who underwent cataract surgery in 2020 compared to 2019 can be explained by many cataract theatres standing down during the peak of the pandemic. Staff sickness, self-isolation absence, and patient anxiety were also likely contributing factors.
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“The [lower] number of patients who underwent cataract surgery in 2020 compared to 2019 can be explained by many cataract theatres [standing] down during the peak of the pandemic. Staff sickness, self-isolation absence, and patient anxiety were also likely contributing factors,” Dr Sehgal said.
“If we do not tackle this, we can potentially see higher rates of complications with a potential impact on postoperative VA outcomes and overall quality of life of our most vulnerable patient cohorts,” he said.
A similar pattern appeared in the temporal analysis of VA outcomes that showed the percentage of patients achieving improved VA after cataract surgery fell from 93% in 2019 to 86% in 2020 and rebounded in 2021.
RESPONDING TO THE SITUATION
Case volume dropped significantly from 1,342 in 2019 to 651 in 2020 and rose to 1,375 in 2021.
A complications review showed a greater incidence of posterior capsular rupture (PCR) in 2020 than 2019. This difference could possibly be attributed to more advanced grades of cataracts due to longer waiting times among patients operated on during the pandemic in 2020 compared to 2019, said Dr Sehgal, adding that the PCR rate fell in 2021.
Discussing steps the hospital took to respond to the pandemic’s impact on the cataract surgery service, Dr Sehgal mentioned the introduction of additional cataract theatre sessions and staff deployment. Moreover, the hospital performs appropriate allocation of surgeon grade based on case complexity and is believed to have helped decrease the complication rate.
However, Dr Sehgal noted the wait time for cataract surgery in 2021 remains longer than in 2019.
“Many of the doctors in our hospital are resorting to performing immediate sequential bilateral cataract surgery, which has been found to be safe and effective in many studies and can help further reduce waiting time for surgery.”
“This was a great surprise. The team is passionate about sustainability in Europe. This was the culmination of two years of work reviewing how we construct our booth as well as looking at how we manufacture our products, what we can do better, what can we do to protect the Earth,” said Erin McEachren, Regional Vice President, Europe, Middle East & Africa, Johnson & Johnson Surgical Vision.
Our vision is that by 2023, we will have a Congress with zero waste to landfills, zero net carbon emissions, and we will be a role model for social responsibility.
The award-winning exhibitor is reinforcing sustainability targets across three distinct areas of focus: tackling climate change, reducing waste, and protecting natural resources. The company is on track to meet its global climate goal of achieving carbon neutrality by 2030. Its manufacturing facility in the Netherlands has been Zero Waste to Landfill for several years. Johnson & Johnson Vision’s aims include only using electricity from renewable resources, limiting landfill contributions, and reducing the use of paper and plastic wherever possible.
Johnson & Johnson Vision has been awarded the inaugural ESCRS Sustainable Exhibitor Award. The award recognises the company’s “outstanding efforts in innovative booth design and communication leading up to and during the conference.”
Johnson & Johnson Vision produced a series of videos leading up to this year’s Congress providing an overview of its sustainability efforts and progress to date. Half of its booth in the exhibit hall was made from recycled or recyclable sources, and the company plans to use 90% of the booth again. The company also purchased offset to account for 100% of predicted CO2 emissions from the energy used at booth and team travel.
Inaugural Sustainable Exhibitor Award
ESCRSToday | 19th SEPTEMBER12 SUSTAINABLE EXHIBITOR AWARD
All exhibitors at the Milan Congress were asked to participate in sustainability efforts. The ESCRS provided a Sustainable Exhibiting Guide, prepared in collaboration with the GDSMovement consulting firm, to give the context of the overall goals for the Congress to create an active response to challenges posed by global climate change.
“Our vision is that by 2023, we will have a Congress with zero waste to landfills, zero net carbon emissions, and we will be a role model for social responsibility. This means we have to work collaboratively to support the wellness of our event participants, give back to local and global communities, regenerate ecosystems, and inspire sustainability action from our event participants,” said Oliver Findl, ESCRS President.
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“If younger patients have pretty good vision and see they have a higher percentage risk of RRD in the next few years, I think many will postpone their surgery for later.”
Dr Thylefors, Skånes University Hospital, Lund, Sweden, suggested that when discussing the risk of RRD with patients, there is a tendency for cataract surgeons to quote data from the literature indicating the incidence of RRD is about 1 in 10,000 in the general population and increases to about 1 in 1,000 after cataract surgery.
FREE PAPER SESSION
The study included 58,624 eyes that underwent cataract surgery, of which 298 (0.51%) developed an RRD during a mean follow-up of 4.7 years. Compared to the entire population of eyes, cases developing RRD involved significantly younger patients (65.4 versus 74.0 years). In addition, the eyes that developed RRD represented a significantly higher proportion of males than the overall population of cases (69% versus 42%) and had a significantly longer axial length (25.13 versus 23.73 mm).
An analysis of data from the Swedish National Cataract Register shows that younger age, male sex, and longer axial length are risk factors for rhegmatogenous retinal detachment (RRD) following cataract surgery. Cataract surgeons should use this information to provide each patient with an individualised risk assessment, according to Joakim Thylefors MD.
“However, there must be a discussion of the real risk and benefit of surgery. In our study, we found a real increase in risk for RRD among patients aged less than 60 years, a slight increase for patients aged 60 to 75 years, and no increase in risk for those older than age 75,” Dr Thylefors said.
ESCRSToday | 19th SEPTEMBER14
A Kaplan-Meier analysis showed that during the follow-up period, patients younger than age 60 undergoing cataract surgery had a 2.4% rate of RRD. For patients younger than 60 with an axial length greater than 25 mm, the rate increased to 6.4%, and considering males younger than age 60 with an axial length greater than 25 mm, the RRD rate rose to 9.5%.
Dr Thylefors said the preoperative discussion with patients should also consider surgery benefits. Preoperative data analyses for patients’ worse-seeing eye (the one undergoing cataract surgery) showed while visual acuity was 0.8 or better in only 8.3% of all eyes, the percentage with good preoperative vision was higher among the subgroups of patients who developed an RRD, regardless of the number of risk factors. Analysis showed a similar difference comparing visual acuity in the fellow, better-seeing eye for all eyes versus the various subgroups developing RRD.
The observational cohort study analysing the rate of RRD following cataract surgery and associated risk factors used data for patients undergoing cataract surgery in Region Skåne, southern Sweden, from 2015 to 2017. The researchers then cross-referenced those cases with cases of RRD surgery
performed at the Skåne University Hospital in Lund, Sweden, from 2015 to 2020.
Cataract surgery patients owed a personalised discussion of retinal detachment risk
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Dr Ogilvie-Graham connected with Ukrainian ophthalmologists to get an idea of what supplies were most urgently required and where they were most needed.
Ophthalmology in Conflict Zones
Noting that every conflict zone is different, Dr OgilvieGraham explained how healthcare systems in these situations are often corrupt—with medical supplies very often ending up in the wrong hands or never reaching the patient. Medical aid is particularly vulnerable to corruption because of its high value.
Tom Ogilvie-Graham, managing director of the ESCRS, will lead a discussion called “Bringing Medical Aid to Conflict Zones”. Dr Ogilvie-Graham will speak from experience, as he visited Ukraine to assess the situation shortly after the Russian military invasion in February. His earlier military career and subsequent work with different medical charities have given him opportunity to visit a number of conflict zones.
UKRAINE
Orbis, the international eyecare charity, returns to the ESCRS this year in Milan, offering a symposium entitled “Innovative Ophthalmology in Conflict Zones”, Tuesday at 8:00, Space 1.
He notes while supporting big NGOs such as Médecins Sans Frontières and the International Red Cross does provide some safeguards against corruption in a conflict zone, it does not necessarily result in delivering the most needed specialist support into the right hands at the right time.
Indeed, the ESCRS looked at working with international NGOs and the UN to deliver aid but found the process too bureaucratic. Instead, it tapped into a trustworthy network of local support with the invaluable help of Dr Lyubomyr Lytvynchuk and assistance from many others, including Dr Volodymyr Melnyk. This ensured the equitable distribution of the items most needed to the people who would make the best use of them.
ESCRSToday | 19th SEPTEMBER16
19th SEPTEMBER | ESCRSToday 17 VisitboothB86/B78atESCRS2022 www.haag-streit.com/im910
Dr Lytvynchuk will also speak at the Orbis symposium on “Ophthalmic care in response to the Ukrainian conflict”.
“Feedback from Ukrainian ophthalmic surgeons was essential in identifying what was most needed. The ESCRS was then, right from the start, able to approach our industry partners with specific requests and they responded very generously. Well over a million euros of equipment has been distributed so far,” Dr Ogilvie-Graham said.
The symposium features an additional presentation by Robert Walters, Chairman of Orbis in the Middle East, on “Eyecare amongst refugees fleeing from conflict”. Also on the programme, Dr Abishek Mehras will discuss “The Pandemic and impact on glaucoma patients”.
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HOW TO HELP
• We can accept these donations through bank transfer. If you are an ESCRS member and wish to contribute, please simply log in to https://donate.escrs.org using your membership details to access information on how to donate, which is a straightforward process.
• ESCRS has established a fund to accept financial donations that will be directed exclusively to support ophthalmology-related relief efforts arising from the conflict in Ukraine. We can accept donations to the fund from ESCRS members, industry partners, and fellow societies.
• For industry partners or fellow societies, please email escrs@mci-group.com for information on how to make your donation.
Ideas and initiatives such as clinical research into the use of specific medical treatments and surgeries, clinical research on the pharmaco-economic analysis of particular treatments, or research into the optimal management of national and global healthcare systems in ophthalmology may be eligible for consideration in the Awards.
Two principal types of research funding are currently available from the ESCRS: the Clinical Research Awards and the Pioneer Awards. To these, the ESCRS has recently added the Systematic Review Awards and the Digital Research Awards as two new categories.
CLINICAL RESEARCH AWARDS
EDUCATION AND RESEARCH ESCRSToday | 19th SEPTEMBER18
The Clinical Research Awards aim to support and encourage independent clinical research in cataract and refractive surgery. The amount of funding awarded to a successful applicant is up to €750,000, which is open to clinicians and researchers
Open to young ophthalmologists aged 40 or younger, the Pioneer Awards support and encourage independent clinical research in cataract and refractive surgery. Applicants are invited to introduce and develop a body of clinical research work addressing a challenging “problem” to devise a practical “solution” for the benefit of patients.
ESCRS research projects driving innovation
with a current ESCRS membership who have been a member for at least the last three consecutive years. Applicants must hold a full-time clinical/research post at an EU-based clinical or academic centre.
Education and research have always been at the heart of the ESCRS’s mission to serve its members and advance patient care in the field of cataract and refractive surgery.
PIONEER AWARDS
It’s a commitment that takes concrete form in a number of ESCRS research awards regularly open for competition, which offer substantial funding for the best research projects as decided by an expert evaluation panel.
1) Broader Toric meridian designed to be more tolerant of misalignment. White paper: Evaluation of a new toric IOL optic by means of intraoperative wavefront aberrometry (ORA system): the effect of IOL misalignment on cylinder reduction. By Erik L. Mertens, MD Medipolis Eye Center, Antwerp, Belgium 2) The misalignment tolerance and the use of segments instead of concentric rings reduces photic phenomena, helping patients to adapt more naturally to their new vision. 3) The central zone of 1.4 mm in diameter is larger than most available mIOLs and allows a wider tolerance so that the visual axis passes through the wider central segment avoiding visual disturbances. 4) In cases of tilt or misalignment, the patient can still benefit from good near and far vision, as the segmented zones allow a balanced far/near light distribution in a steady optical platform. OPHTEC | Cataract Surgery REDUCE GLARE & HALOS1 TOLERATE THE KAPPA ANGLE2 TOLERATE DECENTRATION 3 TOLERATE MISALIGNMENT 4 CTF/TCT optic designed to:
The 2022 ESCRS Systematic Review Awards (“SRA”) is a new initiative sponsored by the Society to produce a high-quality body of research intent on preparing, collating, analysing, synthesising, and reporting medical research.
ESCRS is offering up to five SRAs in 2022–23, with funding up to €10,000 for each applicant.
DIGITAL RESEARCH AWARDS
Support of up to €500,000 is available over a maximum of three years for a project with suitable infrastructure and experience leading to the collection of high-quality healthcare data in routine clinical practice and/or the development of open access data sets for clinical research either from prospective data collection or the transfer of existing anonymized data sets to the public domain.
The initiative will provide a new scholarly output in cataract and refractive surgery or medicine focused on the methodology created by the Cochrane Library. The competition is open to all ophthalmologists (MD, and/or PhD, or experienced ophthalmic nurses) holding a fulltime clinical/research post at an EU-based clinical or academic centre.
The Pioneer Awards target funding any new initiative, which may include: a novel research idea for development of clinical trial studies, a noninterventional or observational study, a natural history/epidemiological study, a comprehensive series of retrospective case-control studies, and a patient or disease registry.
Projects may be small or large, with clear goals and a well-designed plan for project execution. Researchers should be able to frame at least one important clinical research question that appropriate analysis of collected data will ultimately help answer.
The Awards are open to ESCRS members who have been a member for at least the last three consecutive years and who hold a full-time clinical/ research post at an EU-based clinical or academic centre. The amount for funding awarded to a successful applicant is between €5,000 and €50,000 (maximum) for a project with a duration no longer than two years.
SYSTEMATIC REVIEW AWARDS
This latest ESCRS initiative is designed to support and encourage research leading to digital transformation in cataract, refractive, and corneal surgery. The competition is open to all clinicians and researchers.
PRESBYOPIA & ASTIGMATISM CORRECTION REINVENTED
27 th ESCRS WINTER MEETING
The prospective randomised study involved 130 eyes of 65 patients. Each was randomly implanted with an 11.00 mm Zeiss 409M plate haptic IOL and an Ophtec 276 13/11 mm CTR in one eye and the lens only in the fellow eye.
10–12 MARCH 2023 TIVOLI MARINA, VILAMOURA ALGARVE PORTUGAL 20 23
Capsular tension rings (CTR) are designed to increase the stability of intraocular lenses (IOL) in the capsular bag. However, a study of rotation, tilt, and decentration of a plate haptic IOL found no overall difference in rotation between lenses implanted with or without a CTR, while tilt and decentration were actually higher in the CTR group, Daniel Schartmüller MD said at a free paper session Sunday.
“There was no difference in mean absolute rotation but significantly lower proportion of outliers in the CTR group. There was no correlation between absolute overall rotation and lens thickness, axial length, and lens equatorial diameter. A decrease in rotation in the CTR group was observed within the first postoperative hour,” said Dr Schartmüller of the Medical University of Vienna, Austria.
ESCRSToday | 19th SEPTEMBER20
Capsular tension ring may increase tilt and decentration of plate haptic IOL
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Regarding rotation, no lens in the CTR group rotated more than 5 degrees in the first hour after surgery, while four non-CTR lenses did, with one rotating nearly 24 degrees. Mean rotation was 1.3 degrees in the CTR group and 2.1 degrees in the non-CTR
Lens decentration and tilt were secondary results, Dr Schartmüller said. Both were measured in absolute terms and compared with measurements of tilt and decentration of the crystalline lens before surgery.
group, though the difference was not statistically significant. Mean rotation was also similar between the two groups at one week, one month, and six months after surgery, though there were more outliers in the non-CTR group at one month.
Six months after surgery, the mean tilt in the CTR group was 6.66 degrees compared with 5.55 degrees in the non-CTR group, a statistically significant finding. Tilt increased more in the CTR group as the capsule fibrosed. There were also more outliers in the CTR group, with lenses tilted up to 17.7 degrees six months after surgery.
Six months after surgery, mean absolute decentration in the CTR group was 0.28 mm and in the non-CTR group 0.24 mm, which was not statistically significant. However, compared with preoperative measurements, the CTR group was significantly more decentred at a mean of 0.29 mm compared with 0.18 mm in the non-CTR group. The decentration increased at one month and six months after surgery as the capsules fibrosed, Dr Schartmüller said.
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“We see a negative impact on decentration and tilt when using a capsular tension ring with an 11.00 mm plate haptic IOL,” Dr Schartmüller concluded.
The innovator has performed live surgery sessions at more than 200 international congresses. He has also designed and produced 136 instruments for ocular surgery. He has authored many books, ranging from the essential LASIK: Principles and Techniques to his collaborations with Dr Richard Packard, The History and Evolution of Modern Cataract Surgery and The History of Refractive Surgery
Why did Binkhorst and Worst decide to fix the IOLs with sutures? And why then to switch from ICCE to ECCE to fix the IOL to the capsular leaf?
A History of the Pseudophakic IOL
Why was Ridley’s disc lens later abandoned by Ridley himself?
Why did Strampelli and Barraquer—and subsequently Dannheim and Choyce (among others)—design and implant anterior chamber IOLs?
Dr Buratto’s lecture will be driven by videos—documenting the evolution of the pseudophakic intraocular lenses since Dr Harold Ridley implanted the first IOL in 1949 up to the present. After discussing aphakia and problems related to the correction with glasses, he will describe the design of the first IOL and why Dr Ridley implanted the IOL in the posterior chamber.
The lecture will answer many questions, such as:
What’s next?
The lecture then finds Dr Buratto as a tour guide through a time machine of videos, with stops along the way to consider how cataract surgical techniques and IOL technology evolved. The road was not always smooth, as new techniques and devices brought new problems. He will discuss how these problems were solved.
ESCRS HERITAGE LECTURE
Pioneering cataract and refractive surgeon Dr Lucio Buratto will deliver this year’s ESCRS Heritage Lecture. His talk will cover the long arc of the history of the pseudophakic IOL.
ESCRSToday | 19th SEPTEMBER22
The current Director of CAMO–Centro Ambrosiano Oftalmico in Milan, Dr Buratto has played no small part in the development of cataract and refractive surgery. He made history himself in 1989 as the first surgeon to use the excimer laser for intrastromal keratomileusis. He was also a pioneer in using PRK techniques to treat low myopia. In 1996 he introduced a new technique called “Down-Up LASIK,” which improved the LASIK procedure for the correction of myopia.
Why did Epstein, Binkhorst, and then Fyodorov decide to fix the IOL to the iris?
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41 Ernst Fuchs was born in this European capital in 1851 (6)
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27 Acronym for common complication of IOLs obscuring vision (3)
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31 Thomas , German ophthalmologist and past president of the ESCRS (7)
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38 Syndrome, common genetic condition that affects both vision and hearing (5)
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25 Congenital absence of pigmentation in the eyes and skin and hair (8)
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23 Dutch ophthalmologist who gave his name to a measure of visual acuity (7)
7 Photoreceptors responsible for low light vision (4)
2 Italian operatic composer (5)
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24 Rudy MMA , past president of the ESCRS (6) layer, a membrane in the cornea (7)
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12 John , visionary founder of Eurotimes magazine (7)
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43 Fashion mogul associated with Milan (7)
28 It was built across the Nile in the 1960s (5,3)
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EuroTimes
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MOMENTS IN MILAN24
MOMENTS IN MILAN 25
ESCRSToday | NOTES26 notes MISSDON’TPresbyopiaWorkshop Tuesday 8:00 Auditorium Best of the Best Tuesday 12:45 Auditorium
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