Newsmaker Interview

ESCRS

NEWSMAKER

INTERVIEW

WITH ROBERT OSHER MD

Perhaps no medical specialty relies on video as part of the learning process as ophthalmology does. Standard cases can be demonstrated, surgeries can be reviewed, and the latest techniques and technology can be highlighted straight from the microscope to the surgeon—from the beginner to the seasoned expert. EuroTimes Editor-in-Chief Sean Henahan caught up with Robert Osher MD, the surgeon who pioneered video recording in ophthalmic surgery and filmed every one of his cases since 1980.

Forty years—that is a lot of videos! The technology has changed considerably over the decades. Can you give an idea of how you got started and what it was like in the early VHS days?

My love affair with video goes back even before VHS. I had finished three fellowships at Bascom Palmer and Wills Eye Hospital, but I still felt very timid and insecure. My dad, a private practitioner in Cincinnati, said, “You’ve completed all these fellowships—come spend just six months with me.” The first cataract surgery I saw there, I was hooked: beautiful, elegant surgery with such happy patients. This was 1980, and he was performing intracapsular surgery.

But I wanted to be in the 1% of phaco surgeons, so I decided to visit every top-notch phaco surgeon in the United States. There were only a handful at that time. Over many months, I visited Dick Kratz and Bob Sinskey on the West Coast, Norm Jaffe and Henry Clayman in Florida, Jim Little in Oklahoma, and the highlight was travelling to New York to meet the man himself, Charlie Kelman.

I spent a lot of time flying around. It took me away from my family and my practice. It was expensive and time consuming. That’s when I had the idea, “I should start a video journal!” We would record the surgeries on 3/4-inch tape, then edit on 1-inch tape. Around that time, I came up with a concept of a video symposium of challenging cases and surgical complications. No one had done this before. Cataract surgeons just showed their perfect cases at the meetings, so the video symposium was a dramatic shift.

Both the video journal and the video symposium have stood the test of time. I brought each to Europe almost four decades ago when first invited by Emanuel Rosen and Paddy Condon. I had to carry suitcases full of 3/4-inch tape wherever I went. It was miserable. The video journal would send hundreds of VHS tapes to Europe, with all the attendant problems of different frame rates and colour issues.

Fortunately, the technology improved vastly over the years. We went from VHS to Betacam, SuperBeta, Super VHS, DV cam, digital videotape, digital disk, and ultimately the internet. Now I just carry a few thumb drives to the meetings!

What advantages does video offer in ophthalmology training?

I’ve always loved video education. You can’t teach surgery through a textbook, or from a podium—you have to see it. That is the beauty of the video journal. We can eliminate long delays associated with publishing bringing new ideas, techniques, and technologies to our viewers. We are a free member benefit of nearly every cataract society on the planet. I watch every video from every competition around the world to arrive at our quarterly programmes. For example, the most recent issue focuses on learning Yamane intrascleral haptic fixation and its many variations. The journal is very academic, not allowing advertising or promotion. Our editor board includes George Waring in refractive, Michael Snyder in anterior segment,

Ike Ahmed in glaucoma, and Graham Barret in cataract. We also get extra perspectives from some ESCRS surgeons I respect and admire, including Richard Packard in the United Kingdom, Lucio Buratto in Italy, Ehud Assia in Israel, and Boris Malyugin in Russia. In addition, I’ve just worked with ESCRS surgeons Jorge Alió from Spain and Burkhard Dick from Germany in publishing a book loaded with videos.

OPHTEC | Cataract Surgery

Over the decades, you have built up such a vast amount of material, a historical record. What about using this content for research projects such as longitudinal studies of a given topic over time?

The video library is open to our 16 residents who enjoy clinical research. George Waring recently put together an issue on the history and evolution of contemporary refractive surgery, and Mike Snyder organised one on the history of prosthetic iris implantation. The American Academy of Ophthalmology invited me to present a series on the evolution of phaco surgery over the last 40 years, and I’ve been collaborating with the JCRS on a new monthly column. So many historical treasures are in our video library.

What do you think of the trend towards 3D video?

We were involved in 3D video from the early stages. I found it was frustrating because it was impossible to edit in 3D. It also proved challenging to lecture in 3D, with the special screen and the glasses. The technology has been tried multiple times over the years, but never stuck because of cost issues and technical issues.

But technology has evolved with options like Ingenuity and Artevo. The young surgeons without cervical disease are going to benefit from this. For older surgeons like me who have been working for 40 years with a microscope, I’m comfortable, although I’ve been told I’m a “pain in the neck”!

Videography is now a key skill for a young ophthalmologist. Do you have any suggestions for novices?

Yes! First, it is essential to invest in a good camera system with an excellent monitor. It is really important to learn how to stay in focus and centred. A good file system is critical so you can recall cases for editing or for studies. You want to turn the video on at the beginning of surgery and let it run the whole time because you never know when something unexpected will happen. It’s the best way to understand cause and effect to prevent recurrences. And video will forever be the best way to teach residents, fellows, and staff.

CTF/TCT optic designed to:

 REDUCE GLARE & HALOS1

 TOLERATE THE KAPPA ANGLE2

 TOLERATE DECENTRATION3

 TOLERATE MISALIGNMENT4

Dr Osher is Medical Director Emeritus of the Cincinnati Eye Institute and Professor of Ophthalmology at the University of Cincinnati, Ohio, US. He is founder of the Video Journal of Cataract, Refractive, & Glaucoma Surgery. Dr Osher’s own video productions have won more than 40 international awards at the ASCRS Film Festival and ESCRS Video Competition. His many awards include the Education Award from the ESCRS, the Binkhorst Award and the Innovator’s Award from the ASCRS, and the Kelman Award and the Lifetime Achievement Award from the American Academy of Ophthalmology. Among his recent publications are books Cataract Surgery: Advanced Techniques for Complex and Complicated Cases; What I Say; and The Real ABCs: Achievement, Balance, and Contentment.

PRESBYOPIA & ASTIGMATISM CORRECTION REINVENTED

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 benefi t from good near and far vision, as the segmented zones allow a balanced far/near light distribution in a steady optical platform.