ESCRS Today - 7 September 2024

THE INNOVATION ISSUE

From Insight to Foresight

Barcelona Congress to serve a veritable tablao of ophthalmic advancements.

SATELLITE SYMPOSIUM

September 5.

Functional IOL Classification: Achieve Excellence with evidence-based IOL selection

Clinical experiences with an extended depth of focus intraocular lens utilizing wavefront linking technology

. Right on target with a novel toric EDOF intraocular lens: A pilot study from Australia

Custom Match: Blending Strengths of Trifocal and EDOF Lenses for optimized surgical outcomes

. Broadening the horizon: Innovative applications with AddOn® lenses to finesse IOL conundrums

Alison Chiu 2. Happy patient formula: Pearls to select a trifocal IOL candidate.

Guadalupe Cervantes-Coste

Johann Kruger

Brian Harrisberg

7th September 2024, Saturday 10:30-10:50

Joaquín Fernández

Prof. Sathish Srinivasan

Johann Kruger Jh

Guadalupe Cervantes-Coste

Guadaldlupe Srinivasan

Prof. Sathish Chiu

Alison Joaquín Fernández

Brian Harrisberg

Ike Ahmed (Chairperson)

Welcome from the President

On behalf of the ESCRS, I am very excited to welcome you to the 2024 Congress at the heart of the vibrant and cosmopolitan city that is Barcelona.

This Congress will be a new opportunity to share the latest advances and innovations in ophthalmology, get to know the latest industry offerings, and network with colleagues and experts from around the world.

As in past years, the Congress programme will feature main symposia, instructional courses, wet labs, video sessions, posters, oral presentations, and our continued efforts to innovate new conference experiences.

For example, we are celebrating the implantation of the first IOL by Harold Ridley 75 years ago with several activities, including a timeline wall and a tunnel museum featuring artefacts from the era.

We are also introducing Tablao, named for the dance floor used in flamenco. Running from Saturday to Monday, each Tablao will feature an intro workshop, a debate, and a discussion forum. On Monday, the intro workshop will showcase live presentations of Surgical Simulators!

With Tablao, we are trying to bring a cultural focus to this year’s programme in an educational format with big debates and forums for discussing current topics in our field.

For a fun learning experience, you might also try the ESCRS Escape Room. Team up with new friends as you uncover clues and solve exciting mysteries. It’s perfect for sharpening your problem-solving skills and a great way to take a fun break from the Congress buzz.

I also want to invite attendees to visit the Surgical Training Lab in the Exhibit Hall, which will feature 17 training devices from three manufacturers: Haag-Streit, Alcon, and HelpMeSee. Attendees can register for up to three sessions, each guided by a team of expert trainers using a curriculum developed by the manufacturer. The sessions are free and available during Exhibit Hall hours—highlighting our Congress as a global model for training and inclusion. It is

something we really want to push for future Congresses: to bring more training opportunities to young people and deliver networking moments that can only be experienced face-to-face in a multicultural environment.

We recognise 2024 as an important year for ESCRS in raising awareness about diversity, equity, and inclusivity (DEI) issues in ophthalmology. The Congress programme incorporates many activities addressing these issues, including the first dedicated symposium on Saturday. We will also conduct a survey of our members to assess the real obstacles to DEI issues and offer numerous opportunities for mentorship and networking.

This year exhibits our international outreach symposium in conjunction with the American Society of Cataract and Refractive Surgery (ASCRS) and the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS), a mini-symposium with the American Academy of Ophthalmology (AAO), and a session with the Pan American Association of Ophthalmology. Industry will join us by presenting at an EU Clinical Trial Spotlight Session. Our Global Refractive Summit—another first for ESCRS, organised with the International Society of Refractive Surgery (ISRS) and the Brazilian Association of Cataract and Refractive Surgery (BRASCRS)—should also not be missed.

We are really delivering a global programme by coordinating with these international societies and taking a global view of large clinical trials the industry is promoting in the EU. Barcelona is the first time we will present this model, and we are very excited about it.

Filomena Ribeiro MD, PhD, FEBO President of the ESCRS

Cutting-edge Ophthalmic Technology at ESCRS iNovation Day 2024

Technology solutions to the most pressing anterior segment surgery challenges was the ESCRS iNovation Day 2024 theme on Friday, just before the ESCRS Congress main programme began. Doctors, industry leaders, investors, regulators, and researchers shared perspectives in panel discussions on technology innovation, capital and commercial market changes, and reimbursement and regulatory trends affecting ophthalmology. The event also featured networking opportunities and a look at new survey data.

In a session called “The Innovators Den: Eye Care Pioneers,” doctors discussed exciting concepts they are developing. iNovation also featured emerging companies presenting technologies that could change the face of many aspects of ophthalmic practice. Here’s a glimpse of some entering or near clinical use.

Eye-tracking amblyopia treatment

Treating amblyopia could be as easy as watching streaming content with CureSight (NovaSight, Airport City, Israel). The system is the only treatment proven to be as effective as eye patching in children. Goggles track the gaze of the dominant eye in real-time and blur its centre of vision, keeping the rest of the image sharp and providing the amblyopic eye with a normal image—stimulating the brain to complete the blurred image from the amblyopic eye. The device is already in use in Italy and the US.

Optical measure of tissue elasticity and viscosity

Early diagnosis of corneal diseases, screening for vision correction and customisation of refractive and cataract procedures, and corneal cross-linking all could be aided with the Brillouin Optical Scanning System, or BOSS (Intelon Optics, Woburn, Massachusetts, US). The non-contact biomechanical information it provides could help reduce astigmatism by guiding arcuate keratotomy and limbal relaxing incisions and cross-linking based on corneal stiffness. Approved in the EU, Canada, and Korea, the device is working its way towards approval in the US, China, and Australia.

Automated slit-lamp

An automated slit-lamp that captures images of the entire exam and can be operated by technicians has been developed by Lightfield Medical (Minneapolis, Minnesota, US). This could allow ophthalmologists to view images offline, much as retinal images have been for decades, potentially improving ophthalmic service efficiency and extending them to underserved areas.

First neurophthalmoscope

Eye movement exams, helpful for diagnosing and monitoring neurological conditions—including multiple sclerosis, Parkinson’s disease, and brain tumours—may now be conducted automatically by technicians in as little as 10 minutes instead of the 45–60 minutes required today. Neos (machineMD, Bern, Switzerland), the world’s first neurophthalmosope, uses a headset that automatically presents patients with diagnostic images and records eye movements and pupillary function for remote analysis. The technology could significantly reduce misdiagnoses and waiting times for exams.

In-office IOL adjustment

VaLens (EyeMed Technologies, Ramat Gan, Israel) is a foldable intraocular lens that can be adjusted for spherical power and astigmatism axis in a non-invasive office procedure after implantation and wound healing. Its nitinol mechanism, placed in a haptic-optic cradle, can be rotated in 1-degree steps and moved in 0.25 D steps forward or backward to correct residual refractive error using a green laser. It has been tested in rabbit eyes.

HOWARD LARKIN REPORTS

Hydrogel regenerative therapies

TissueGUARD (Dresden, Germany) has developed hydrogel materials for culturing donor-like grafts of tissues, including corneal endothelium grafts with preformed Descemet-like membranes and retinal pigment epithelium with preformed Bruch’s membranes. The technology not only addresses the critical shortage of donor tissues but also paves the way for comprehensive regenerative therapies for limbal, endothelial, and retinal dysfunctions.

Corneal endothelial cell therapy

Already approved in Japan, Aurion Biotech (Seattle, US) is testing its cell therapy for corneal oedema due to corneal endothelial disease in the US and Canada, expecting top line results early next year. Featuring cultured human corneal endothelial cells boosted with a Rho kinase inhibitor, the therapy enables hundreds to be treated with one donor cornea, potentially revolutionising corneal dystrophy treatment.

Ultraviolet infectious keratitis treatment

Corneal infections of unknown origin could be treated with two 5-second treatments from a handheld ultraviolet-C device in development by Photon Therapeutics (Birmingham, UK). On track for commercial use in animals early next year, a human version could be clinically available in 2027.

The technology could significantly reduce misdiagnoses and waiting times for exams.

Non-invasive keratoconus and refractive surgery

Theranostic technology (RegenSight, Rome, Italy) combines real-time diagnostics with targeted ultraviolet-A and riboflavin treatment to reshape corneas. Molecular imaging technologies provide immediate feedback on how the cornea responds to treatment, enabling quick and accurate adjustments. Due to the lack of incisions or tissue removed, risks of infection and corneal scarring are minimised. Keratoconus is the short-term goal, with refractive procedures to come.

Multifocal IOL try-out

Previewing glare, halos, and other photopic effects could help patients make more informed choices among presbyopia-correcting IOLs. Already commercially available, the SimVis Gekko (2EyesVision, Madrid, Spain) is a head-mounted simulator that helps patients with this preoperative decision before cataract or refractive surgery.

Restoring crystalline lens accommodation

A low-power femtosecond laser treatment (Kejako, Saint-Etienne, France) has proven safe in softening the crystalline lens

in rabbits, potentially restoring up to 1.5 D accommodation in presbyopic patients ahead of a planned first-in-human test.

Enhanced intermediate vision IOL

Precizon Go (Ophtec, Groningen, Netherlands) uses a patented dioptre profile with combined aspherical aberrations in three distinct areas to create an IOL with excellent distance and defocus up to -2.0 D. So far, patient satisfaction has been high with good visual acuity results, the company says.

Accommodating IOL

The JelliSee IOL (Jellisee Ophthalmics, McLean, Virginia, US) provides up to 7.0 D accommodation up to 15 months after implantation in primate tests and a similar range of vision in early human tests. The liquid-filled foldable lens changes the shape of its anterior optic to accommodate with very little radial force.

Automatic glaucoma pressure valve

The Stergio Valve glaucoma drainage device (Rheon Medical, Lausanne, Switzerland) automatically maintains intraocular pressure in a prescribed range, preventing hypotony immediately after surgery and maintaining pressure after bleb development without intervention in pre-clinical tests. A pilot human test is planned.

FS laser glaucoma treatment

The ViaLuxe Laser System (ViaLase, Aliso Viejo, California, US) non-invasively creates drainage channels in Schlemm’s canal, reducing mean intraocular pressure of 34.6% at 24 months in a clinical test. Registration is in process for both the CE Mark and FDA 510(k) clearance.

Self-regulating glaucoma drainage

The CorNeat eShunt (CorNeat Vision, Raanana, Israel) features automated pressure regulation via its valve design, is composed of a non-immunogenic material and positioned in the intraconal space to prevent fibrosis, requires no bleb, and can be implanted in about 20 minutes in patients with severe or refractory glaucoma. The device has proven effective in animal tests.

Extended-release glaucoma implant

In a clinical test, the Eye-D Insert (Bio-Light, Ramat Gan, Israel) maintained IOP similar to topical latanoprost for 3 months via a subconjunctival implant, which is a potentially safer location than existing extended-release implants. A biodegradable version is under development in an animal model. FDA approval may be possible in about 3 years with adequate development funding.

Artificial corneal endothelial layer

The EndoArt artificial corneal endothelial layer (EyeYon Medical, Rehovot, Israel) provides a solution for patients who have failed endothelial grafts, are at high risk due to conditions such as glaucoma or an anterior chamber IOL, or prefer a non-human transplant. In limited release in the EU, some human recipients have had the graft for 5 years. Registration efforts are underway in China and the US.

ESCRS Visits Barcelona for the Fifth Time

Catalonia eye experts remain a major influence on ophthalmology.

Catalonian eye surgeons have played significant roles in ophthalmology, both historically and contemporarily. This, along with the excellent food and culture, could perhaps help explain why the ESCRS has met in the region four times since 2002—twice for the Winter Meeting and twice for the Annual Congress.

For example, prominent ophthalmic figure Dr José Güell is particularly known for his contributions to corneal surgery, cataract surgery, and the treatment of complex anterior segment diseases. Dr Güell received his medical degree from the Autonomous University of Barcelona and completed his residency in ophthalmology at the Barraquer Ophthalmology Centre. He is the current president of EUCORNEA and former president of the ESCRS. He is also Coordinator of Anterior Segment at the European School for Advanced Studies in Ophthalmology (ESASO; USI in Lugano).

His areas of interest are lamellar and endothelial keratoplasty, complex cataract surgery, reconstructive procedures for the anterior segment (including keratoprosthesis), refractive surgery (particularly excimer and femtosecond laser), and implantation of intraocular phakic lenses (Artisan-Artiflex) and intrastromal corneal rings.

Dr Carlos Vergés is another notable Catalonian ophthalmologist. Currently head of the ophthalmology service at the Dexeus University Hospital in Barcelona, he graduated in medicine and surgery from the University of Barcelona before completing a PhD in biology at Harvard University. He has made important contributions in the area of ocular surface disease.

Dr Carlos Mateo, who also studied in Barcelona, has

made important contributions to retinal surgery. He works in the retina and vitreous department of the Institute of Ocular Microsurgery (IMO) and as part of the faculty of medicine at the Autonomous University of Barcelona. His main areas of interest are the pathology of high myopia, retinal detachment, severe ocular trauma, and diabetic retinopathy. He introduced macular translocation techniques in Spain, such as subretinal neovascularisation in age-related macular degeneration (AMD) and high myopia.

The Barraquer legacy

The Barraquer name is well established in the world of ophthalmology. Beginning in the early 20th century, Ignasi Barraquer (1884–1965) innovated several surgical techniques, including the first effective method for intracapsular cataract extraction. He also developed many surgical instruments still in use, such as the Barraquer needle and the modern surgical microscope.

His son Dr José Ignacio Barraquer (1916–1998) is known as the father of refractive surgery. Founder of the Barraquer Institute, he pioneered several techniques in cataract and refractive surgery, including keratomileusis and the keratome.

Dr Joaquín Barraquer (1927–2016) continued the family tradition, making additional contributions to cataract and refractive surgery, particularly in phacoemulsification.

Catalonian Hermenegildo Arruga (1886–1972) was a pioneer in the intervention of cataracts. He designed many ophthalmological surgical instruments, of which the Arruga capsular forceps—used for extracting the opaque cataract or crystalline lens—is best known.

Preoperative Attention to OSD Essential for Cataract Surgery Patient Satisfaction

Ocular surface disease (OSD) is prevalent and frequently underdiagnosed in the cataract patient population, which needs to be screened for and addressed preoperatively because OSD can significantly affect keratometry and biometry, leading to a refractive postoperative surprise and patient dissatisfaction following cataract surgery, said Dr Allan R Slomovic.

“If you tell the patient about their OSD before surgery, they own it. If the patient becomes aware of it after surgery, you caused it,” Dr Slomovic noted. “In the final analysis, a happy patient equals a happy doctor.”

At the first session of Cornea Day focused on cataract surgery in patients with ocular comorbidity, Dr Slomovic discussed considerations for performing cataract surgery in patients with pterygium, epithelial membrane basement dystrophy (EBMD)/Salzmann’s nodular degeneration, and dry eye disease (DED).

As an overarching recommendation, Dr Slomovic said that surgeons should tell patients they have two separate problems—an OSD and a cataract. Then, he recommended a staged approach to surgical management by first taking care of the ocular surface and waiting 8 to 10 weeks before repeating biometry and topography to check for stability prior to planning surgery.

Understanding how to effectively deal with a patient who has a pterygium requires understanding this growth affects topography, causes irregular with-the-rule astigmatism, and increases higher-order aberrations. Dr Slomovic recommended performing pterygium removal with a conjunctival autograft before cataract surgery and repeating biometry after 6 to 8 weeks to check for stability.

He also advised performing superficial keratectomy in eyes with EBMD or a Salzmann’s nodule, illustrating the impact of the surgery in a case presentation involving a

patient referred for cataract surgery because of decreased BCVA (20/80). The patient had irregular astigmatism associated with two central Salzmann’s nodules. After uncomplicated superficial keratectomy, the corneal topography improved, as did the BCVA (20/25), allowing cataract surgery to be at least postponed.

Discussing DED, Dr Slomovic cautioned that this condition is particularly prevalent in cataract surgery populations because these typically older patients may be on several topical ophthalmic medications. Performing cataract surgery in an eye with untreated DED can result in delayed visual recovery, refractive surprises, and patient dissatisfaction because of persistent or worsened DED symptoms and suboptimal vision. Additionally, the risk of infection increases.

A study Dr Slomovic and colleagues conducted illustrated the impact of treating DED before cataract surgery. In this investigation, patients treated for DED with topical lifitegrast twice daily for 6 weeks achieved significant improvements in their subjective complaints and corneal staining.

“Importantly, calculated IOL power changed by 0.5 D in 33% of eyes,” he reported.

Dr Slomovic also cautioned about the potential for harm associated with topical nonsteroidal anti-inflammatory drug (NSAID) use in the perioperative period in eyes with severe DED.

“NSAIDs in the setting of severe DED can result in corneal melts and perforation,” he said. “There are at least 10 studies in the literature reporting on the association of NSAIDS and corneal melts in the setting of cataract surgery.”

Allan R Slomovic MSc, MD is Marta and Owen Boris Endowed Chair in Cornea and Stem Cell Research and Professor of Ophthalmology, University of Toronto, Canada. allan. slomovic@utoronto.ca

Glaucoma for the Non-Glaucoma Specialist

Professor Luis Pinto, Secretary of the European Glaucoma Society, offers tips on glaucoma events during the ESCRS Congress.

The ESCRS Congress is upon us. And for the glaucoma specialist, it starts with Glaucoma Day on Friday, 6 September. This is always a great opportunity for the non-glaucoma specialist to catch an update on what’s going on in the glaucoma world. The European Glaucoma Society (EGS) and ESCRS worked together on a programme that focuses on practical aspects of glaucoma management while also hinting at novelties—covering artificial intelligence to the frontiers of glaucoma surgery.

We accomplished this in a lively, interactive manner— with voting and debate from renowned faculty—aiming to interest the general ophthalmologist and glaucoma specialist alike.

Throughout the conference, several sessions will present data from large, long-term multicentric surgical studies in what is an effort to keep a foot on evidence-based medicine and the other on the hot topic of the moment, minimally invasive glaucoma surgery (MIGS), providing an overview on its strengths and caveats. There will be an interesting session on how glaucoma specialists look at innovation as a whole and how to determine if ‘new is always better’. The challenges of investigating these new surgeries—how to assess their efficacy, safety, and relationship with cataract surgery—will be covered by instructional courses on MIGS and bleb-forming devices.

After a successful European Glaucoma Society meeting in Dublin three months ago, where the focus was on quality of data and the importance of critical assessment of data and reporting (highlighted in the EGS’ Guide on Surgical Innovation), the glaucoma specialist will hopefully find a

complementary evidence-based medicine vibe in these ESCRS discussions.

Luis Abegão Pinto MD, PhD is an Assistant Professor of Ophthalmology in the Faculty of Medicine at Lisbon University, Portugal.

Glaucoma Events

Courses: Schlemm’s Canal Surgery from Basic to Advanced Saturday, 11:00–12:30, Room 8.0 J

Innovative Glaucoma Surgery— a Guide to New Users Sunday, 11:00–12:00, Room 8.0 C

The New Era of Glaucoma—Mastering MIBS Monday, 16:00–17:30, Room 8.0 E

Free Papers: Cataract and Glaucoma Surgery: A Combined Approach

Sunday, 08:30–10:00, Podium 3

Minimally Invasive Glaucoma Surgery (MIGS)

Monday, 16:30–18:00, Podium 3

Green and clean

Innovative eco-design saves resources

Less waste and lower disposal costs

Swiss made Medicel quality

Course Looks at Secondary Implantation without Capsular Support

Key opinion leaders give pearls on secondary implantation in aphakic eyes today.

TIMOTHY NORRIS

REPORTS

The 2024 ESCRS Congress presents a fresh edition of “Different Ways of Secondary Implantation without Capsular Support,” an all-star instructional course presented by Dr Matteo Forlini with other international opinion leaders on advanced cataract surgery.

Starting Saturday, 7 September at 16:00 CEST in room 8.0 G, this course considers any possible variation and option for the surgeon dealing with IOL implantation in eyes with aphakia or posterior capsular rent (PCR).

It is quite easy to encounter a patient whose capsular bag is damaged or absent, due to traumatic or iatrogenic causes. Vitreoretinal consultant surgeon Dr Forlini noted just a simple error during a routine surgery—or an unexpected complication—can lead to a situation where the capsular bag can no longer sustain an intraocular lens. From that moment, a standard procedure in anterior surgery branches into a maze of options and alternatives to solve the issue. The course aims to explain and evaluate these paths, from the Yamane technique to the Carlevale lens, to provide insights and give pearls to younger ophthalmologists and experts who wish to improve their techniques.

“If you are looking for a full menu, you will have the whole menu,” Dr Forlini said, underlining the importance of providing colleagues with different tools and letting them choose the best suited for each case. Every speaker will explain the pros and cons of a chosen technique and confront them with the others—which Dr Forlini likened to going into an automotive showroom to find which car better suits needs and expectations.

Joining Dr Forlini are a group of influential experts from all around the globe, including Dr Gabor Scharioth, the one

and only pioneer of the sutureless intrascleral IOL fixation technique. His work has inspired surgeons like Amar Agarwal and Shin Yamane to improve their intrascleral fixation techniques, which are used today. Another noted speaker will be Dr Carlo Carlevale, the well-known inventor of the sutureless scleral fixation Carlevale lens.

“Dr Carlevale is a dear colleague and friend, who deserved his international fame for the brilliant invention of this innovative lens,” Dr Forlini added.

The instructional course will also feature Dr Andreas Mohr, one of the pioneers of the Artisan iris-claw lens, and former ESCRS president and experienced and prestigious surgeon Dr Roberto Bellucci. Last but not least, the course line-up includes glaucoma surgeon Dr Ike Ahmed, who is an expert in the anterior segment, with a focus on secondary implants and iris suturing.

An aphakic eye is not uncommon, and it is something that happens all over the world, Dr Forlini said. For this reason, it is very important to provide colleagues with all the information needed to deal with this kind of patient: different solutions based on the case itself, the healthcare programme, and, of course, the surgeon’s preferences. Many of the techniques taught during the course are not practised on a global level and are sometimes unknown in countries independent of their development. All colleagues are invited to join to have a taste of the state of the art, the pros, the cons, and to hear the most influential and known experts in the field, Dr Forlini concluded.

Matteo Forlini MD is a vitreoretinal consultant surgeon at the ISS State Hospital of San Marino. matteoforlini@gmail.com

MIGS Masterclass to Offer Grand Rounds and Wet Labs in Barcelona

After a successful debut in 2023, ESCRS is again offering a masterclass in minimally invasive glaucoma surgery (MIGS) in 2024.

The masterclass, led by Ziad Khoueir MD—a visiting consultant ophthalmologist specialising in adult glaucoma and cataract surgery at Moorfields Eye Hospital, Dubai—will provide doctors with direct access to world-class mentors, opportunities to learn from online modules and webinars taught by leading faculty, and hands-on instruction through case grand rounds and wet labs.

The goal of the MIGS masterclass (as with all ESCRS masterclasses) is to improve practice patterns and clinical outcomes and significantly increase the number of patients treated. Up to 50 students will be able to participate in the following exclusive activities:

• mentor-guided didactic workshops;

• interactive live webinars;

• in-person case grand rounds at the ESCRS Annual Congress; and

• in-person wet labs at the Annual Congress. Each participant who completes all of these components

and passes the exam will receive a certificate of completion and a credit to apply to future ESCRS registration and membership fees. There is no cost to participate in the masterclass, although applicants must bear all travel costs.

The MIGS masterclass is targeted toward cataract surgeons who meet the following criteria:

• have practised ophthalmology for more than 5 years post-training;

• conduct at least 200 cataract surgeries per year (preferably have conducted >1,000 cataract surgeries as a primary surgeon);

• see glaucoma patients;

• have begun to implant MIGS devices or intend to start doing so immediately after this masterclass; and

• are based in a surgical facility where MIGS devices are available.

Participants are required to be present and participate in the live components of the masterclass.

IME symposia at ESCRS

Sessions will cover hot topics in cataract and refractive surgery. CATARACT/REFRACTIVE

Delegates will find a stimulating variety of clinical discussions by leading ophthalmic surgeons in the Independent Medical Education (IME) Symposia during the Congress. These sessions aim to provide balanced, non-branded, category-based education with expert faculty presenting meaningful, independent content for sincere peer-to-peer education. A common thread running through the various sessions is the use of information gained from the ESCRS Clinical Surveys.

Maximizing Visual Quality Through Enhanced Precision and Safety

Saturday, September 7th | 16:30 - 17:30 CEST

Room 8.0 B | Fira Barcelona Gran Via, Spain

Refractive Surgery IME Forum:

Location:

8.0 B, Fira Barcelona Gran Via

Date:

Saturday, 7 September, 2024

Time:

16:30–17:30 CET

Grant Supporters: Johnson & Johnson Vision (Gold), Zeiss (Bronze), STAAR Surgical (Bronze)

RIOL IME Forum:

Location:

8.0 B, Fira Barcelona Gran Via

Date:

Sunday, 8 September, 2024

Time:

9:30–10:45 CET

Grant Supporters: Alcon (Platinum), Johnson & Johnson Vision (Bronze), Zeiss (Bronze)

Phaco IME Forum:

Location:

8.0 J, Fira Barcelona Gran Via

Date:

Monday, 9 September, 2024

Time:

9:00–10:15 CET

Grant Supporters: Alcon (Platinum), Zeiss (Bronze), Bausch + Lomb (Bronze)

Toric IME Forum:

Location:

8.0 J, Fira Barcelona Gran Via

Date:

Monday, 9 September, 2024

Time:

13:00–14:00 CET

Grant Supporters: Alcon (Platinum), Zeiss (Bronze)

The Highs and Lows of AI in Glaucoma

AI could be useful in glaucoma, but there are some challenges ahead, according to Professor Luís Abegão Pinto.

As it applies to glaucoma treatment, there are many questions to answer. “Can AI help us diagnose? Can it help us guess who’s going to progress? Can it change the way we work?” he asked, adding AI needs to learn to work properly.

Prof Pinto further explained trained deep learning AI can detect patterns that humans cannot see, such as through heatmaps, revealing subtle changes such as RNFL thinning. AI could be useful in clinical practice, especially in complex cases like high myopia, helping the physician make decisions.

“High myopic patients are very difficult for us to diagnose because the disc is morphologically changed,” he said. “If you look at the heatmaps, which are outside the optic disc, very likely we can use the AI to help us diagnose these complex cases—where [it would otherwise] take years of stable exams to diagnose whether it is there or not. Perhaps this could speed up the process.”

Moreover, he said AI could be useful for extrapolating data, as ophthalmology already has a huge number of databases. “For instance, you can ask the machine, ‘How would this retinography look like in an OCT?’ So perhaps in the future, you do not have to do all the exams.”

Prof Pinto also noted this technology could be useful particularly for those underserved areas or countries: AI could predict disease progression and understand if the physician is dealing with a fast progressor patient or not, as shown by many studies. Or, physicians could train the AI using different databases to understand if a patient needs surgery or not or train it to help physicians conduct cost-effective screenings.

Furthermore, Prof Pinto remarked AI would certainly change the way doctors work and the way patients approach their disease, starting with chatbots like ChatGPT. Some studies showed some patients used AI for diagnosis confirmation or a second opinion, even uploading their OCT or fundus images for analysis.

“AI is not always right because it depends on the quality of what it learned,” he emphasised. “The risk is when you have cases with grey areas, comorbidities, or poor quality of images, the machine—depending on the algorithm—will underperform, and you end up in trouble.”

So, there are three main challenges to consider: ophthalmologists do not have control over big retrospective databases; ophthalmologists only know the outcomes and not the reasoning behind them; and finally, those models are generalised, so they do not consider the differences between patients. However, AI is already a part of life.

“This paradigm is going to stay. It will help us change clinical pathways and circuitry. There are ethical and legal aspects not fully clear yet and need to be addressed,” Prof Pinto concluded, quoting Dr Eric Topol on AI. “AI will not replace doctors, but doctors who do not use the AI will likely be replacing others.”

Luís Abegão Pinto MD, PhD, FEBOS-G is Head of the Glaucoma Clinic of the Department of Ophthalmology at the Centro Hospitalar Lisboa Norte, Portugal. abegao.pinto@ ulssm.min-saude.pt

LAURA GASPARI REPORTS

SATELLITE SYMPOSIUM

Today: Saturday, September 7th

16:00–17:00, Room 8.0 F

Unveiling Precision:

Swept Source OCT Imaging in Refractive Surgery & Early Detection of Ectasia

Moderator: Steve Thomson

Dr Jaime Aramberri (Spain):

Corneal Epithelium Measurements –The Need for Precision and Accuracy

Prof Cynthia Roberts (USA): The Corneal Contribution to Stress

Dr Robert Herber (Germany):

Corneal Stress Maps and Epithelium Thickness Maps in Keratoconus

Dr Alain Saad (France): ICL Vault Prediction from SS-OCT Images

Visit us during exhibition hours! 6-9 SEP, 2024 · Booth 7.G35

Know Your Nomenclature

An ESCRS working group recently announced a major step forward towards the goal of developing common nomenclature standards that describe IOLs. The announcement appeared in the August 2024 issue of the Journal of Cataract and Refractive Surgery, which featured three important pieces on the nomenclature and categorisation of intraocular lenses.

The different optical designs and ranges of focus of IOLs can be a source of confusion for surgeons when deciding which lens will suit which patient in terms of their desired visual outcomes. Indeed, since the implantation of a PMMA IOL by Harold Ridley 75 years ago, more than a hundred IOLs made of various materials and offering different features have come to market.

“Along with the vast choices come a variety of IOL classification systems, making it increasingly more complicated to understand which lens will perform in what desired function,” notes Professor Thomas Kohnen in the journal’s guest editorial. “The preoperative planning of IOL selection is significantly more time-consuming than most refractive procedures, in large part because the lenses are not easily comparable.”

In the announcement, the ESCRS Functional Vision Working Group suggests an evidence-based functional classification of simultaneous vision IOLs—such as multifocal and extended depth of field IOLs, according to the endpoints described in the most recent update from the International Organization for Standardization (ISO 11979-7, 2024). The classification system is based on an objective, comprehensive review of the scientific literature using data extracted from various studies for various functional endpoints. The cluster analysis found two metrics were enough to classify IOLs: (1) the increase in visual acuity (VA) from intermediate to near in the event of a non-monotonic decrease in VA from far to near and (2) the range of focus from CDVA to 0.2 or 0.3 logMAR VA cut-offs.

Evidence supports enhanced monofocals as standard of care

Enhanced monofocal IOLs fit the criteria for a standard of care lens for cataract patients, according to the ESCRS Functional Vision Working Group. The team performed a literature review on PubMed, Scopus, and Web of Science to analyse the level of scientific evidence on enhanced monofocal IOLs and found three reviews and 66 articles published in the primary

The preoperative planning of IOL selection is significantly more time-consuming than most refractive procedures, in large part because the lenses are not easily comparable.

literature from 2020 to 2024. Excluding those not comparing conventional monofocal with enhanced monofocal IOLs, those not including a visual performance analysis, and those involving pathological eyes left one meta-analysis and systematic review, one scoping review, and 19 clinical studies to be considered for analysis. Most of the studies reviewed, including the randomised controlled trials, confirmed the superiority of enhanced monofocal IOLs over conventional monofocal IOLs in intermediate visual function and interchangeable results in distance vision compared with conventional monofocal IOLs.

For complete information on this project, see the JCRS, August 2024, Volume 50, Issue 8 at https://journals.lww.com/jcrs/ toc/2024/08000.

A New Era of Intraocular Surgery: Introducing the Intensity Pentafocal Lens

Author: Yoram Gonen, CEO Hanita Lenses

For over 40 years, Hanita Lenses has been at the forefront of manufacturing high-quality IOLs, competing successfully and achieving consistent global growth. In the last 15 years, we have transitioned from a local, conservative company into a dynamic, premium, and innovation-focused organization. This transformation, driven by a talented, cohesive, and energetic team with strong engineering and manufacturing expertise, has allowed us to bring new and exciting solutions to ophthalmologists who seek the most advanced and reliable products - ultimately providing patients with true spectacle independence

The INTENSITY Pentafocal Lens, based on our proprietary Dynamic Light Utilization (DLU) technology, exemplifies the spirit of innovation that has become a cornerstone in how we think and create. Over 30,000 patients worldwide have experienced its outstanding optical performance, enjoying smooth vision at all distances with minimal disturbances. This success has been demonstrated time and again in patient satisfaction surveys and clinical studies. The overall feedback is nothing less than WOW.

"A patient that gets the Intensity lenses enjoys a life that is uncompromised. With the Intensity Pentafocal IOL, the patient forgets about their lenses because vision is a non-issue."

— Prof. Dr. med. Gerd

Auffarth

These studies show that the Intensity lens delivers photopic and mesopic vision levels comparable to the phakic population, with patients reporting freedom from glasses and the ability to engage in any activity. A particularly notable study from Japan looked at the number of patients satisfied with night driving – the number of Intensity patients was twice as high as the patients using older presbyopiacorrecting lenses.

The Intensity lens delivers photopic and mesopic vision levels comparable to the phakic population, with patients reporting freedom from glasses and the ability to engage in any activity.

Defocus Curve

Visual Acuity(logMAR)

Monocular (356 eyes) Binocular (241 patients)

Defocus (D)

Figure 1: real-world data reveals that from distance to 40 cm, patients achieve a visual acuity of 0.1 LogMAR or better without any drop in visual performance across the full range of vision - a common limitation in older-generation lenses.

Guided by our belief that "Everyone deserves to see the world's beauty," we are committed to developing technologies and solutions that provide unique added value to patients. We collaborate with our global advisory board, university experts, and research institutions to stay at the forefront of medical advancements in the field.

Monocular VA at different distances

Visual Acuity(logMAR)

Distance (cm)

Figure 2: monocular visual acuity, real-world outcomes of 1118 eyes. High visual acuity is maintained along the whole visual range.

To better support our high-end premium clients, we have established five subsidiaries in key markets across Europe and Asia. In 2025, we will launch a second advanced manufacturing site to meet the demands of our fastgrowing Asian markets.

We strive for excellence in every aspect of our business, eager to succeed, and ready to embrace the challenges ahead.

While the 75th anniversary of IOL implantation is receiving plenty of attention this year, 2024 also marks another important ophthalmic surgery anniversary: 25 years since the introduction of corneal cross-linking (CXL) to clinical practice. Since then, CXL has revolutionised the treatment of keratoconus and other corneal ectatic diseases, and its list of indications has expanded far beyond its original scope. Invented in Dresden, Germany, and pioneered in Zurich, Switzerland, the story of how CXL was invented by Professors Theo Seiler and Eberhard Spoerl is one of lateral thinking, inspiration from outside sources, and a little bit of luck.

Prior to CXL, few treatment options were available for corneal ectasias. The visual symptoms could be (somewhat) corrected by special contact lenses, but this did nothing to halt the progression of the underlying disease. Once the ectasia had progressed to a point where hydrops kept occurring, risking perforation, the final treatment option was keratoplasty.

CXL represented the first (and remains the only) treatment method proven to halt ectasia progression. It is worth noting that, in the first three years since its introduction, CXL had dramatically reduced the need for keratoplasties: it was calculated to have reduced the number of corneal transplantation procedures performed in the Netherlands by 25%.

Seiler and Spoerl’s early work

The concept emerged in the 1990s when Seiler and Spoerl

sought methods to halt the progression of corneal ectasias, particularly keratoconus. At that time, it was already known that keratoconic corneas were approximately 60–70% weaker than normal corneas and contained significantly fewer crosslinked collagen fibrils in the cornea’s principal structural layer, the stroma. Seiler and Spoerl knew corneal stiffness increases with age and, thanks to the formation of advanced glycation end-products, occurred at a far faster rate in people with diabetes compared with people without the condition.

Could chemical agents cross-link and, therefore, perhaps stiffen the cornea? To find out, they investigated a range of chemical agents capable of inducing covalent cross-links in stromal collagen and extracellular matrix proteins. Among these, glutaraldehyde and aldehyde sugars showed the most promise, but they presented challenges in localising the effect to just the cornea (i.e., avoiding leaks) and required impractically long times to achieve any significant stiffening.

Seiler’s “eureka!” moment came during a dental appointment. He noticed his dentist used ultraviolet (UV) light to solidify the dental resins used as fillings. This ultimately gave him the idea of using UV light with a chromophore to catalyse the chemical cross-linking process. The advantages were clear: catalysis speeds the chemical process, and light limits the reaction to the region being irradiated.

Riboflavin (vitamin B2) was soon identified as the chromophore of choice for CXL. Unless photoactivated, riboflavin is

Farhad Hafezi MD, PhD, FARVO; Mark Hillen PhD; and Emilio Torres-Netto MD, PhD, FWCRS

relatively inert and has a broad absorption spectrum, particularly in the UV-A range (300–370 nm). The only drawback is that riboflavin is a large molecule with a high molecular weight of 376.36 g/mol.

Terminology

The terminology used today (corneal cross-linking/CXL) was defined by consensus at the 2008 annual CXL Experts’ Meeting in Zurich. The adoption of ‘CXL’ has since been widely accepted in both academic literature and clinical practice, providing a consistent and accurate reference for discussing and comparing cross-linking protocols and outcomes. But it wasn’t always like this.

In the early days, ‘CCL’ (corneal collagen cross-linking) and ‘X-linking’ were used, and ‘C3-R’ (a commercial trademark) was adopted by some surgeons as a general term for the procedure, particularly in India and some centres in the US. Seiler and his colleagues originally called the procedure ‘corneal collagen cross-linking’ to emphasise the interaction between photoactivated riboflavin and the collagen fibres in the cornea. This was reconsidered after it was understood that cross-links form not only within collagen fibres but also between collagen and proteoglycans; the name did not fully capture the complexity of the biochemical interactions. A

Images beyond

single, standardised name was necessary, and CXL was how the ‘CXL experts’ defined it.

The Dresden protocol: the original blueprint for CXL

The first method of performing CXL, known as the ‘Dresden protocol,’ was effective at halting ectasia progression. Remarkably, it has stood the test of time, remaining the ‘gold standard’ method for performing CXL for most of the procedure’s existence. Studies have shown its ability to halt the progression of progressive keratoconus persists for more than 15 years.

The future of CXL probably encompasses further optimisation of existing techniques, either when used alone or in combination with other procedures, but one exciting prospect may be two-photon CXL, in which a femtosecond laser can selectively cross-link parts of the cornea at specific points in three-dimensional space. What value this might have—perhaps as a treatment for myopia and astigmatism in general, or rehabilitating irregular corneas—remains to be seen. But CXL appears to have a great deal of potential yet to be revealed.

This article is an excerpt from a longer piece by Drs Hafezi, Hillen, and Torres-Neto that will appear in an upcoming issue of EuroTimes

From Barraquer to KLEX—a Journey Through Refractive Surgery

Timothy Norris reports

Legendary ophthalmologist Lucio Buratto shared his experience leading and observing a lifetime of advancements from the legacy of Jose Barraquer to the most modern and precise refractive surgery during the Global Refractive Summit at the 2024 ESCRS Congress in Barcelona.

Starting with a visit to the United States in 1984, Dr Buratto connected the refractive surgery of that time with the desire to observe and learn from the first pioneers in this discipline. The techniques were vastly different—all manual and with no laser involved, he said. “There was a lot to improve, a lot to understand about this new world, and a lot to discover regarding the tissues surgeons of the time were dealing with,” he said.

At that time, Dr Barraquer was not only considered the father of refractive surgery but a mentor who actively participated in many congresses—such as the first and unique congress on keratomileusis (which he organised), an experience that Dr Buratto said enriched him with the experience and wisdom of a great master of ophthalmology. And, he added, this was before the introduction of the laser in refractive surgery and the birth of new techniques like PRK, which changed refractive surgery.

There was a lot to improve, a lot to understand about this new world, and a lot to discover regarding the tissues surgeons of the time were dealing with.

he used to remove the tissue from the back of the lamella, a technique he decided to replicate on 22 patients with good results. “A period of many advancements but also many mistakes,” he said.

A great turning point was the introduction of LASIK by Ioannis Pallikaris in 1991, a technique Dr Buratto was eager to master.

“LASIK really changed the world of surgery,” he observed. “Between LASIK and the new lenticule extraction procedures, there was FLEX, developed by Walter Sekundo, another way to improve and revolutionise refractive surgery. This led to KLEX, the peak of modern refractive surgery.”

There have been so many improvements in 40 years, it might be easy to think ophthalmology has reached the peak of what can be obtained from refractive surgery and the maximum that can be offered to patients, with better and more proficient results, Buratto said. However, he concluded this is not the end, but the beginning of a new generation.

Lucio Buratto MD is the director of the Centro Ambrosiano Oftalmico – Camo S.p.A. (Ophthalmic Microsurgery Centre) in Milan, Italy.

It is important, however, to remember how Barraquer’s Law of Thickness is still the base of all modern practices, he observed. The degree of complexity in the mid-twentieth century was surely much greater and more expensive, struggling to find success in the world of ophthalmology. When Dr Svyatoslav Fyodorov invented the first keratotomy, the procedure became a little bit easier, relieving physicians from the burden of a complicated technique.

The excimer laser marked the real turning point of modern refractive surgery. Surgeons were now able to cut microns with unprecedented degrees of precision, Dr Buratto said, remembering the first time he performed a PRK in 1989. During that historic surgery, Buratto and colleagues were afraid of causing iatrogenic corneal opacities and long-term postoperative issues.

Dr Buratto also remembered learning keratomileusis with a non-frozen technique from Jorg Krumeich and how

It’s Time for the

Timelines

This year’s ESCRS Congress sees the launch of two interactive timelines on our website. The first takes you on a self-paced journey through the history of cataract surgery. Starting in ancient Babylon to the present, the "History of Cataract Surgery" demonstrates a comprehensive overview of the milestones that shaped one of the oldest and most transformative medical procedures in human history. Whether you are a medical professional, a student, or simply someone interested in the history of medicine, this timeline offers an engaging and informative exploration of cataract surgery’s rich heritage.

The second timeline walks you through the "History of Refractive Surgery," delving into the ascinating advancements that have transformed the way we correct vision. From early methods to the latest cutting-edge technologies, uncover the key milestones in the quest for perfect vision.

Join us as we trace the remarkable journey of refractive surgery, celebrating the technological advancements and scientific breakthroughs that have made clear vision accessible to millions.

The ESCRS timeline web page also features video interviews with some of the pioneers of the 20th century. In the first interview, Sean Henahan (EuroTimes) and Dr Richard Packard (Packard Medical Practice) sit down with Professors Thomas Neuhann (EuroEyes Clinic Group) and Hans-Reinhard Koch (University of Bonn) to discuss IOL visionaries past and present. Profs Neuhann and Koch recount the evolution of IOL surgery from perilous to commonplace, describing early phaco surgery uncertainties, industry struggles, and the genius of visionaries like Dr Charles Kelman and Dr Richard P Kratz. Get ready for a whole lot of insight—sprinkled with a pinch of laughter!

While at the Barcelona Congress, you won’t want to miss the ESCRS Heritage Tunnel Walk, where you can get a close look at the technical changes that got us where we are today.

Use this QR code to dive into the rich history of ophthalmology.

Cataract Surgery in Eyes with Keratoconus

Considerations for optimising refractive outcomes.

Eyes with keratoconus pose difficult challenges for IOL power calculation. Therefore, when performing cataract surgery in these cases, patient counselling is critical. Even then, it is always better to underpromise and overdeliver, said Dr Mor M Dickman.

Speaking at Cornea Day, Dr Dickman recommended using several devices for obtaining preoperative measurements along with several IOL power calculation formulas.

Nevertheless, “there is no magic formula that will solve all our problems in these patients,” he cautioned.

Dr Dickman highlighted the difficulty of achieving good refractive outcomes in eyes with keratoconus by reviewing results from published studies on this topic. For example, whereas the benchmark in ‘normal’ eyes is for the achieved outcome to be within 0.5 D of the intended target in about 80% of cases, a study published in 2019 assessing the performance of different standard IOL power calculation formulas in eyes with keratoconus found they had much lower prediction accuracy.

“Obtaining accurate corneal refractive power is the main challenge to achieving better results,” he explained. “We know there are factors like asymmetry of the corneal curvature, low repeatability for measurements, and changes in the posterior-anterior corneal curvature ratio in eyes with kerataoconus.”

Other challenges relate to inaccurate prediction of the effective lens position and obtaining a reliable postoperative refraction.

When planning implantation of a monofocal IOL in eyes with keratoconus, Dr Dickman suggested three keratoconus-adjusted power calculation formulas: Holladay consulting software, Kane formula for keratoconus, and Barrett True-K for keratoconus with the option for entering a direct measurement of the posterior corneal curvature.

“Unfortunately, published data regarding the prediction of these formulas is limited,” he observed.

Toric IOL decisions

Another important issue when performing cataract surgery in eyes with keratoconus is whether a toric IOL is a suitable option.

“Eyes with kerataconus have significant corneal astigmatism, and more and more patients are asking about a toric IOL,” Dr Dickman said. “However, whether to implant a toric IOL in these cases is a controversial topic.”

His perspective is that toric IOLs are suitable for selected patients. The criteria to consider include having mild to moderate stable keratoconus, a history of satisfactory vision with glasses before cataract development, contact lens intolerance, and no central corneal scarring.

“You do not want to implant a toric IOL in an eye with progressing keratoconus,” Dr Dickman said.

When planning to implant a toric IOL in an eye with keratoconus, Dr Dickman said surgeons should not use a toric IOL calculator based on standard mathematical models.

“These calculators already include assumptions about predicted corneal astigmatism from normal eyes. If we use them, we are combining mistakes,” he said.

Options for toric IOL calculation in eyes with keratoconus include the Kane toric calculator for keratoconus or toric calculators that use measurements of the posterior cornea—e.g., the EVO or Barrett True-K keratoconus toric calculators.

“But remember to ignore the spherical equivalent prediction,” Dr Dickman said.

Mor Dickman MD, PhD is Professor of Ophthalmology at University Eye Clinic, Maastricht UMC, Netherlands. m.dickman@maastrichtuniversity.nl

CHERYL GUTTMAN KRADER REPORTS

Free Textbook on IOL Power Calculations

The IOL Power Club (IPC) has just published its first textbook by Springer Nature in their cataract series, Intraocular Lens Calculations. In 72 chapters, it covers every aspect of the subject, including formulas, biometers, and special situations. The editors are Jaime Aramberri, Kenneth J Hoffer, Thomas Olsen, Giacomo Savini, and H John Shammas.

The IPC has made the book open access, and any or all the chapters may be downloaded to a computer or phone completely free, anywhere in the world. A hardcover textbook is also available.

The link for the free download is https://link.springer.com/ book/10.1007/978-3-031-50666-6#toc, which can also be reached at www. IOLPower.Club.

The IPC is a private international non-profit organisation dedicated to advancing the science of optimised intraocular lens power selection algorithms and technology. In addition to organising membership activities, IPC provides a forum for leading scientists and physicians to share information and ideas to promote the development of practical applications of vision science.

Meet the Precizon Family: best-in-class IOLs for any cataract challenge. Monofocal, enhanced intermediate vision and full range of vision lenses with patented CTF technology. Regular and Toric. With a natural fit and ingenious optics that deliver extraordinary results. For successful surgery and perfect natural vision.

ophtec.com/precizon-family

Precizon Family

New ESCRS Guidelines for Cataract Surgery

After an exhaustive study and review process, the ESCRS has announced new cataract surgery guidelines, which provide practical, evidence-based recommendations to improve care quality and decision making.

ESCRS formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The guideline-development process used a Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach and a GRADE Evidence to Decision framework—supported by a team of methodologists. The panel agreed on recommendations concerning 31 questions for patient pathways for cataract management. Key recommendations of these guidelines include (according to level of evidence):

1. An intracameral injection should be used (e.g., cefuroxime 1 mg in 0.1 mL) at the end of the cataract surgery to lower the risk of postoperative endophthalmitis. (GRADE +++)

2. Topical anaesthesia appears to be the most used anaesthesia technique during cataract surgery, if suitable for the patient. (GRADE ++/+++) For further reducing pain during the cataract surgery, an additional intracameral lidocaine injection can be considered. (GRADE ++/+++)

3. Toric IOLs should be considered in eyes with a degree of corneal astigmatism of 1.0 D or more, with strong evidence for corneal astigmatism above 2.0 D, moderate evidence for corneal astigmatism above 1.5 D, and may be beneficial above 1.0 D. (GRADE ++)

4. The selection of a specific target refraction highly depends on the selected IOL, expectations, and preferences of the patient. The patient and ophthalmologist should take the shared decision for IOL target selection. (GRADE ++)

5. The primary treatment options for CME after cataract surgery are topical NSAIDs or steroids. However, there is a lack of sufficient evidence to establish the optimal treatment approach for this condition. (GRADE ++)

6. Both conventional cataract surgery (CCS) and femtosecond laser-assisted cataract surgery (FLACS) can be used, as they are both safe and effective procedures. (GRADE +/++). They give comparable visual acuity and refractive outcomes and overall intraoperative and postoperative complication rates. (GRADE +/++)

7. A combination of NSAIDs and corticosteroid eye drops is more effective to use after routine cataract surgery to prevent inflammation and CME compared to monotherapy. (GRADE +/++)

8. In diabetic patients without diabetic retinopathy, it is recommended to use a combination of corticosteroid and NSAID eye drops to prevent cystoid macular oedema. (GRADE +/++) In patients with diabetic retinopathy, a supplementary depot of triamcinolone should be considered to reduce this risk. Intraocular pressure must be monitored postoperatively when using a triamcinolone depot. (GRADE +)

9. Immediate Sequential Bilateral Cataract Surgery (ISBCS) is effective and safe, has a high degree

of patient satisfaction, and can be considered in patients without complication-inducing ocular comorbidities. (GRADE +)

10. EDF IOLs or pseudophakic monovision can be recommended for patients who desire a good intermediate visual acuity, with significantly less dysphotopsia compared to patients who received multifocal IOLs. (GRADE +)

11. In general, posterior segment OCT in cataract surgery should be used when there is a clinical indication, such as age-related macular degeneration, diabetic retinopathy, glaucoma, or when the visual acuity is worse than expected. (GRADE +)

12. Patient selection for pseudophakic presbyopia-correcting IOLs should be based on the presence of ocular comorbidities, the desire for spectacle independence, and realistic patient expectations. (GRADE +)

13. In the case of a toric IOL implantation, the preoperative assessment should encompass not only general mandatory evaluations but also corneal topography and/or tomography. (GRADE +) Methods that include measurements of factors such as additional posterior corneal astigmatism and effective lens position are preferred for toric IOL calculation. (GRADE +)

14. Specific IOL formulas are recommended for eyes with certain conditions to ensure accurate outcomes. In extreme long and short eyes, new-generation formulas are recommended. (GRADE +)

15. Postoperative remote care after cataract surgery might replace short-term clinical examination to better allocate hospital resources and increase time and cost efficiency. Accuracy and validity of remote care and telemonitoring are still to be evaluated. (GRADE +)

Visit OASIS at ESCRS Booth #6.F10

Ref # QTY/BoxDescription

5122 6 20,000 cps

510826 8,000 cps

by

HPMC VISCOELASTIC (Hydroxypropyl

Methylcellulose)

A sterile, hydroxypropyl methylcellulose (HPMC) solution for use in anterior segment surgical procedures including cataract extraction and intraocular lens implantation.

Intended Use: VISCO SHIELD HPMC Viscoelastic is intended for use as a surgical aid by protecting the corneal endothelial cells and maintaining a deep anterior chamber during ophthalmic surgical procedures.

• 2ml filled syringe with cannula

• Stores at room temperature

Scan here to view the International Catalog

To order/learn more or to see if this product is available in your country, please contact international@oasismedical.com

Annual ESCRS Clinical Trends Survey Underway: Your Participation is Essential!

Survey participants will be entered into a raffle to receive free delegate registration for the 2025 ESCRS Annual Congress in Copenhagen and a summary report before publication.

The 10th annual ESCRS Clinical Trends Survey is launching at the 2024 Congress in Barcelona. This survey builds upon the success of prior surveys, which have included more than 14,000 participants.

The survey asks ESCRS delegates key questions regarding issues they regularly face in their practice. The 2024 edition seeks to build on previous results by adding questions about evolving clinical and technology areas such as retina.

Data from prior surveys have helped develop content for many of the symposia at this year’s ESCRS Clinical Forum IME programmes. Information from the upcoming survey will continue to drive these efforts and discover new areas of education.

The 2024 ESCRS Clinical Trends Survey includes a wide range of contemporary topics, such as:

• Cataract extraction

• Presbyopia correction

• Astigmatism management

• Ocular surface disease

• Glaucoma

• Cornea- and lens-based refractive surgery

• Retina

• Medical education

Use this QR code to take the survey.

How to participate

The survey can be completed in person at the ESCRS Congress in Barcelona at the Survey Lounge in Exhibit Hall 6 on 6–8 September. Seating and refreshments will be provided to those who participate. If you are unable to complete this survey during the Congress, we encourage you to take this 15-minute survey by going to tfgedu.questionpro.com/ESCRS2024. Please complete the survey as soon as possible, as it will close in October.

By completing the survey and filling in an email address, respondents will be entered into a raffle to win free registration for the 2025 ESCRS Congress in Copenhagen. Additionally, every participant will be emailed a summary of the data shortly after it’s compiled. Finally, and most importantly, by completing the survey, respondents will provide essential data that helps drive future education programming. Respondents can remain anonymous, if desired, and still give ESCRS important feedback.

First-Ever Speed Mentoring Sessions to Debut at ESCRS

The Building Our Sustainable, Inclusive Society (BOSS) team will introduce the first-ever Speed Mentoring Sessions at ESCRS 2024. Scheduled 6–9 September, these sessions offer a new format for professional development by facilitating brief, focused interactions between emerging talent and more than 40 experienced experts in ophthalmology.

Founded by ESCRS President Filomena Ribeiro, 2024 also marks the inaugural launch of the ESCRS inclusivity initiative. “The purpose of BOSS is to foster an environment within ESCRS where everyone feels they have a place,” said Kristine Morrill, ESCRS consultant and BOSS member. “We’ve created a year-round programme that gives opportunities for members to network and create an environment for career and personal development.”

Each mentorship session will last one hour and allow mentees ten-minute discussion rotations with six mentors, offering the opportunity to benefit from diverse perspectives and expertise with mentors coming from various domains within ophthalmology, including ESCRS leadership, prominent ophthalmologists, and industry innovators. The overwhelming interest in these sessions has already led to a complete booking of all available spots, reflecting the high demand for mentorship opportunities at the Congress.

“We’ve been really surprised and grateful by the response,” explained Morrill. “The mentors are senior leaders in the industry, key opinion leaders from all around the world, and even the first and second female presidents of ESCRS, Marie-José Tassignon and Béatrice Cochener-Lamard.”

These interactions are designed to provide valuable career advice, share insights into various sub-specialties, and offer guidance on navigating the ophthalmic field. Mentees can expect personalised feedback and answers to specific questions during the one-on-one discussions.

The sessions will cover a range of topics, including the latest trends in ophthalmology, research advancements, and career development strategies. This tailored approach ensures participants gain relevant insights to stay ahead in their profession and can help foster networking connections that could benefit their careers for years to come.

Expected to be a standout feature, the introduction of Speed Mentoring at ESCRS 2024 highlights the importance of mentorship in professional development. Studies have consistently shown mentorship plays a crucial role in career success, and these sessions provide mentees with the opportunity to build their professional networks.

In addition to the speed mentorship, BOSS has organised a series of events designed to foster inclusivity and networking among attendees, including the BOSS Networking Mocktail Party. This new initiative underscores the Society’s dedication to supporting the growth and development of the next generation of ophthalmology professionals.

Get to know its outstanding features:

+ Complete set of threshold, supra-threshold, and kinetic tests

+ Goldmann I to V stimulus size

+ Advanced eye-tracking

+ Comprehensive test reports and progression analysis

+ 17 HD capacitive touch screen

+ Patient audio guide

Know Thy Enemy

HARRY ROSEN REPORTS

KThe rise in burnout is multifactorial. Figures 2 and 3 illustrate the recent rise in workload and dramatic drop in satisfaction among doctors in the UK. Among ophthalmologists alone, 53% of trainees say they work overtime daily or weekly (42% average among other specialties), 42% feel short of sleep at “

now thy enemy,” said Sun Tzu, military strategist and philosopher. Trainees accept that burnout is an ugly, embedded part of modern training. Meanwhile, senior surgeons are often confused, even exasperated in trying to understand it. Most of us struggle to even define burnout. It is imperative we recognise and understand burnout, to make changes to prevent it.

Burnout is the damaging trajectory that occurs when exhausted, dissatisfied professionals in any field become sequentially disengaged, often to a point of no return. Figure 1 illustrates some of the key interactions between exhaustion, dissatisfaction, and disengagement and the multitude of factors that contribute.

The scale of the problem

Burnout is an acutely worsening problem. In the case of the UK, ophthalmology has the fastest growing rate of “high-risk” burnout compared to any other specialty. 22% of ophthalmology trainees were at high risk of burnout in 2023, a 50% increase from 2022.1 Taken from the 2023 GMC survey of 70,000 responses, 93% of these stated they are likely to make a career change. Burnout and dissatisfaction were offered as the two main modifiable justifications for leaving.

Burnout is not a partisan nor polarising problem between trainees and experienced trainers. Rates of “high-risk” burnout among senior trainers has also seen a significant rise over the last 3 years. Similar trends among ophthalmologists exist worldwide.2

Why are we burnt out and why now?

work, and 40% find the work emotionally exhausting.1

Patients are living longer, and resources available per patient are decreasing. Due to the geriatric, “high-flow” nature of our patient footfall, ophthalmology is particularly sensitive to these demographic changes. Traditionally, this workload was offset by forgiving on-call and inpatient commitments. These silver linings are being overshadowed by increasing workload and a failing primary care sector.

As a competitive, vocational career, ophthalmologists have other unique challenges. Like myself, many trainees move hundreds of miles to take up training posts, leaving behind friends, families, and support networks.

What should be done?

We need specific, material, affordable changes we can implement locally. Each of the following changes could increase the retention of doctors. This would exponentially ease the burden of burnout, as quickly as the problem grows.

1. Mentoring. David Lockington recently wrote a powerful piece on burnout. for The Ophthalmologist, hailing the protective benefits of time management, diversity, resilience, and autonomy. Mentors such as these could guide trainees to develop these skills in both life and work. As he writes, Maslow’s hierarchy of needs states that “self-actualisation” is the very peak of personal wellness. A trusted mentor is the best way to strive towards this, helping to set goals and guide trainees towards achieving them.

2. The Team. One of the greatest recent losses among hospital workplaces is a sense of culture, camaraderie, and loyalty. Despite the noble intention of standardising patient care, medical practice has edged towards centralised, impersonal bureaucracy. Simple solutions could include regular social events, comprehensive inductions, longer (at least 12-month) rotational periods, and consistent theatre/clinic team members. These interventions not only improve patient care but also make work life enjoyable, efficient, and productive.

3. Prioritising teaching and learning. Curiosity and learning are often the first things we sacrifice in a busy operating list or clinic. These are the aspects that bring character and colour to the work we do. Likewise, the faster a trainee can practice independently, the lower the workload will be for the team. Maintaining a focus on continuous career learning both reinvigorates clinical practice and reduces our workload by developing competent trainees.

4. Resources. Any fresh-faced management consultant can tell you that appropriately resourced and happy staff will be more productive. Rest spaces (which aren’t used as backup filing storage), parking, coffee/food/drink access, access to outdoor space, appropriate changing facilities, childcare,

How frequently, if at all, over the last year have you experienced the following…?

Worked beyond my rostered hours

Found it difficult to take breaks due to the intensity of my workload

Felt unable to cope with my workload

n = 3,386 (all doctors), the Barometer survey 2021 QC1_1/CT_5/CT_2. Excluding don’t know and prefer not to say.

n = 4,269 (all doctors), the Barometer survey 2022 QC1_1/CT_5/CT_2. Excluding don’t know and prefer not to say.

Figure 2: Workload amongst junior doctors in the UK, 2023 GMC survey.

To what extent are you satisfied or dissatisfied with your day to day work as a doctor?

Proportion of doctor satisfied

n = GPs (1,079), specialists (2,188), doctors in training (269), SAS/LE doctors (325), the Barometer survey 2019 QA1.

n = GPs (1,001), specialists (1,917), doctors in training (493), SAS/LE doctors (278), the Barometer survey 2020 QA1.

n = GPs (895), specialists (1,759), doctors in training (337), SAS/LE doctors (366), the Barometer survey 2021 QA1.

n = GPs (995), specialists (1,270), doctors in training (1,055), SAS/LE doctors (869), the Barometer survey 2022 QA1.

Figure 3: Satisfaction amongst all grades, 2023 GMC Survey Report

flexible rota patterns, etc. are all low-cost interventions to protect staff well-being. Perhaps more importantly, they make staff feel valued by the organisation and motivated to do their best for patients.

Conclusion

There is no doubt that burnout is a growing and complex problem. Here, I have outlined the true nature of burnout, its root causes and some simple practical solutions to build resilient trainees for the future. As many have done already, all that remains is for leaders to take action.

Dr Rosen submitted the winning essay for the 2024 John Henahan Writing Prize answering the prompt ‘Burnout is a chronic issue in ophthalmology, leading a growing number to abandon the field early in their careers. What should be done to reduce unnecessary stress in training and practice, allowing for a successful long-term career?’. He is a Year 1 Specialty Trainee at Portsmouth Hospitals University NHS Trust in the UK. harrysrosen@gmail.com

References

1. GMC’s 2023 annual training survey shows progression improving for ophthalmologists in training, alongside concerns over burnout and access to independent sector | The Royal College of Ophthalmologists. https://www.rcophth.ac.uk/news-views/gmcs2023-annual-training-survey-shows-progression-improving-for-ophthalmologists-in-training-alongside-concerns-over-burnout-and-access-to-independent-sector/.

2. Cheung R, Yu B, Iordanous Y, and Malvankar-Mehta MS. “The Prevalence of Occupational Burnout Among Ophthalmologists: A Systematic Review and Meta-Analysis,” Psychol Rep 124, 2139–2154 (2021).

Home Visual Field Testing for Glaucoma Patients

Home visual field is useful to help monitor glaucoma and decrease the burden on patients, physicians, and clinics, according to an ESCRS Congress session from Glaucoma Day.

According to Professor David Crabb, ophthalmologists have a “healthy obsession” with measuring IOP to monitor glaucoma, but he believes the visual field is probably the most important measurement, as it gives the idea of patients’ visual function.

However, a study conducted by Professor Crabb himself suggested patients found visual field approach a challenge because of some problems in testing, like supervision or noises, and in understanding the results—indicating a home testing solution as a good compromise.

“We have been trying to develop a sort of portable type of perimetry that won’t replace Humphrey Visual Field or the Octopus, but the one that might augment our practice,” Prof Crabb noted.

The device developed with these perimeters, Eyecatcher® by Irida Health, has been tested by researchers over the last decade. The first version ran on a tablet and could measure the visual field using eye movements and saccades. The study showed good results, leading Prof Crabb to test it in the real world.

“We actually took this portable perimetry into clinics, and we did test within a waiting room, showing that this technique was pretty good at screening those patients that needed to do home visual fields,” he said, adding they

We have been trying to develop a sort of portable type of perimetry that won’t replace Humphrey Visual Field or the Octopus, but the one that might augment our practice.

decided in 2019 to test Eyecatcher® at home, letting patients do their own visual field testing. “The type of perimetry we designed was cheaper, the kind you would buy in a marketplace.” It was based on a tablet, but the patients needed to press a button to start the test, with a clever webcam use for acquisition and patient reliability. The idea was to have a threshold test simulating a Humphrey test.

The results on 20 UK glaucoma patients between 62 and 78 years old tested both at the clinic and at home showed the device was generally well accepted, and the data gathered by home testing was good and similar to those acquired with a standard Humphrey test.

An evolution of the device consists of a sort of VR set, with wearable glasses and driven by a phone. As Prof Crabb anticipated, a new set of studies plan to bring this portable perimetry test to harder-to-reach communities within and beyond the UK. But a new clinical trial from Singapore on nicotinamide will use Eyecatcher on some of its participants, which could demonstrate reliable research in the use of home visual field testing.

Prof Crabb suggested physicians should rely on their patients when these kinds of technologies are in place. “I think we kind of underestimate how invested our patients are, and how sort of keen they are to sort testing themselves,” he concluded.

David Crabb PhD is Professor of Statistics and Vision Research at City, University of London, UK.

Therapeutic Refractive Surgery to Improve Quality of Life

TIMOTHY NORRIS REPORTS

Surprising and effective ways to improve visual quality of patients through therapeutic refractive surgery were presented by Dr Farhad Hafezi during the Global Refractive Summit held at the 2024 ESCRS Congress in Barcelona.

“It is all about visual acuity versus visual quality, and this makes a universe of difference for the patient,” Dr Hafezi observed. “Therapeutic refractive surgery covers the increase of vision with glasses, and, most importantly, an increase in vision quality. This means tackling corneal aberrations through a precise treatment plan.”

He noted ophthalmologists can nowadays analyse the anterior and posterior corneal wavefront, but not treat the isolated total wavefront. To get the desired results, surgeons would need to go to the ocular wavefront, even if the problem lies within the cornea in many cases, he said. Nowadays, however, there is a possibility of analysing and creating ablation profiles for anterior cornea, posterior cornea, total, and ocular.

Showing some cases to demonstrate, the first case was simple and straightforward, he said: a scar after keratitis. Patient showed an evident opacity, but that could induce a resident into mistakenly considering it the main issue, Dr Hafezi observed. The issue was the traction, the irregular astigmatism caused by the scar. Releasing some of the traction, then waiting for a better topography before opting for a wavefront-guided surface ablation to improve the quality of vision after 6–12 months was what he determined as the best course of action.

For the two following cases with keratoconus, wavefront-guided surface ablation was applied to 40 to 55 microns of tissue to avoid destabilising the protein, followed by cross-

linking to strengthen the tissue immediately post-ablation, gaining still a decent refractive error, but with an increase in CDVA. Dr Hafezi noted some of his patients do increase only one line but feel a whole lot better in terms of quality.

Another case included a patient who had a strong horizontal coma due to bad PRK in the 1990s. Repairing complications arising from surgery gone awry is a subspecialty per se, Hafezi observed. Nowadays, surgeons in such a case can recentre and enlarge the zone, positively impacting quality of vision.

One of the most striking cases was of a patient with CDVA 0.2 in both eyes due to an unusually anachronistic surgery with microkeratome for +3.00 performed in 2023, without any post-surgical action taken by the surgeon other than steroid and NSAID prescriptions—meaning the patient had a massive rejection, Dr Hafezi observed. He said the patient accepted a second surgery after a few more days, but the flap was already decomposed, falling to pieces during surgery. Dr Hafezi then opted for a bilateral amputation of the flaps. With a little help from nature, the patient restored vision acuity to 0.7 OD and 0.9 OS before Dr Hafezi opted to wait and give the patient the time to heal naturally. The decision paid out and the patient, despite a small myopic error, showed nice results.

“Sometimes, you can avoid going into too much detail,” he said. “With the combination of effective therapeutic approaches and effective laser treatment, it not only helps with corneal disease, but also makes patient’s quality of life better.”

Farhad Hafezi MD, PhD FARVO is a professor of the Faculty of Medicine at University of Geneva, Switzerland.

Thinking of Selling Your Practice?

Planning an exit strategy is best begun early in your career.

The unrelenting progress of years eventually brings all practising surgeons to a day when they must consider transitioning to a new phase of life, less active in the surgical sphere. The various exit strategies to consider were the topic of a webinar held by the Leadership, Business, and Innovation (LBI) committee of the ESCRS.

Negotiating a sale

Dr Omid Kermani noted that when he began his refractive and cataract surgery practice in 1993, laser refractive surgery was in its infancy. As an early adopter, his primary strategy was to offer his patients the latest and best procedures in refractive and cataract surgery and thus lead his practice to success.

His primary focus was to make his clinic a successful venture, and he had the foresight to see the importance of branding his clinic in a way to pass it on as a going concern. By 2010, the comprehensive practice was performing around more than 10,000 procedures per year. When he reached the age of 55, he realised he would have to consider an exit strategy. Possibilities included passing it on to one of his sons, but as they had taken different professions, the other option was to sell it.

He noted, however, that selling his practice was not easy, and the first attempt failed. The initial offer from potential investors he and his partner received was tempting but was connected to numerous side deals and restrictions.

After some sleepless nights, he eventually decided not to go through with the deal, leaving the potential investors disappointed and angry.

“They give you the feeling that you owe them because of the time they had spent in their due diligence, but I told my partner since we are still relatively young and let’s say they pay us maybe 10 years of profit in advance, what is after that?” he said. “And also, imagine if we grow over the next 5 or 10 years—if we sell, we can get a much better bargain.”

That expectation was confirmed a few years later when they received offers for their practice that were an order of magnitude higher. They bought back their junior partners’ shares at a good price, and they are still working at the clinic and happy with the new situation that is a triple-win for him and his partner, the investor, and, most importantly, his patients.

LBI activities in Barcelona include a symposium on Sunday with talks geared towards clinic administrators and their teams. For this symposium and a new lunchtime workshop on Sunday, the LBI Committee is joining forces with ESONT (European Society of Ophthalmic Nurses & Technicians). The lunchtime symposium will focus on “Successful Implementation of New Technology.” The LBI Committee will also co-sponsor a symposium on “Leadership and Mentoring” on Monday with the Society’s new inclusivity initiative, Building Our Inclusive, Sustainable Society (BOSS).

New Tool Calculates Patient Travel Carbon Footprint

A new tool available on the ESCRS website will help ophthalmologists understand the carbon footprint associated with patient travel and encourage sustainable practices within the cataract and refractive surgeon community.

The Patient Travel Carbon Calculator assesses factors such as postoperative visits, travel distance, and transportation mode to help ophthalmologists understand the overall carbon footprint of their practice and make informed decisions. Additionally, the calculator lets doctors estimate the portion (typically about one-third) of the carbon footprint caused by cataract surgery, with the other main portion arising from surgical disposables.

Cataract surgery emits roughly 75 kilograms of carbon dioxide (CO2) per surgery, equivalent to the amount of CO2 absorbed by three trees per year. In Europe alone, cataract surgery is performed about 4.5 million times annually. As physicians, we can make a significant impact by reducing avoidable patient travel through changes in our practice patterns.

Using the Patient Travel Carbon Calculator in combination with the ESCRS SIDICS calculator will provide ophthalmologists with the tools needed to analyse their surgical practices and work towards a more sustainable climate. Join us in prioritising sustainability and minimising our ecological footprint—calculate your impact today.

Call Open for Pioneer Research Award

The European Society of Cataract & Refractive Surgeons (ESCRS) is inviting ophthalmologists to submit applications for the Pioneer Research Award (PRA), which aims to support and encourage independent clinical research in the field of anterior segment surgery.

The competition is open to ophthalmologists and visual scientists up to the age of 45. Eligible participants must hold a full-time clinical or research position at a clinical or academic centre in the European region.

The purpose of the Pioneer Award is to—

• Support, encourage, and fund individuals interested in starting clinical research activities in the field of cataract and refractive surgery;

• Introduce and develop a body of clinical research work, addressing a challenging problem to devise a practical solution; and

• Facilitate and support an independent culture of study for the ultimate benefit of patients.

The Pioneer Award aims to fund various new initiatives, which may include:

• A novel research idea for the development of clinical trial studies;

• A non-interventional or observational study;

• A natural history/epidemiological study;

• A comprehensive series of retrospective case-control studies; and/or

• A patient or disease registry.

Successful applicants will receive up to €50,000 for a project with a project duration of no longer than two years.

How to Apply

Interested applicants are invited to submit their expressions of interest through the ESCRS PRA web page. An applicant to a PRA application requires clear reference to a current systematic review and meta-analysis, if available, published on the topic to which the applicant wishes to apply. Supervision of an established researcher is requested by ESCRS.

Deadline

Interested ophthalmologists have until 13:00 CET on 15 October 2024 to submit an application for the ESCRS Pioneer Research Award. Further details and the application form can be found on the ESCRS website. For additional information, please contact clinical.research@research.escrs.org.

The best of

Barcelona

Memorable moments from the ESCRS 2024 Congress, capturing key connections and collaborations.

PHOTOS BY: BITO CELS, GABRIELE MEROLLI, XAVIER CRUELLS, BERTA TIANA

Can't-miss symposia!

Join the fun at the ESCRS Escape Room! Can you crack all the codes and escape?

Unravel the enigmatic riddles of our unique Escape Room exclusively at the ESCRS Annual Congress in Barcelona.

Team up with new friends as you uncover clues and solve exciting mysteries. Perfect for sharpening your problem-solving skills and a great way to take a fun break from the Congress buzz.

Each Escape Room will have six participants, randomly assigned according to registration.

Registration is complimentary and on a first-come, firstserved basis.

Don’t Miss!

Video Awards – Sunday, 8 September, 14:00–16:00 CEST Plenary Hall

Don’t miss the 2024 Video Awards session taking place on Sunday. Convening at 14:00 in the Plenary Hall, this session is always a highlight of the meeting. Join Jorge Alió, Richard Packard, and many other video stars and witness the unveiling of the winning submissions that showcase ground-breaking advancements in the captivating world of cataract and refractive surgery.

Debate and Discussion on the Dance Floor

Following the successful launch of the ESCRS Arena at the 2023 Congress in Vienna, this year’s Congress will feature another innovative concept, incorporating the local flavour of Spain into the scientific delivery of content. Don’t miss the ESCRS Tablao!

The programme will run from Saturday to Monday, starting the days with the successful “Surgical Pearls.” The Tablao will feature an intro workshop, a debate, and a discussion forum. On Monday, the intro workshop will feature live Surgical Simulator presentations!

The four winners of the competition will be awarded the following prizes:

1st Prize

1 MicroREC Optical System, 1 Beam Splitter, and 1 Semester of MicroREC Connect Medical Data Management Platform

2nd Prize

1 MicroREC Optical System, 1 Semester of MicroREC Connect

3rd Prize

1 OptiREC Adapter Optical System, 1 Semester of MicroREC Connect

4th Prize

1 Year of MicroREC Connect

Today’ s Congress Highlights

The 2024 ESCRS Annual Congress officially starts today at 10:00 with the Opening Ceremony in the Plenary Hall, but you can get a jump on the action by attending one of the more than two dozen sessions that will take place earlier in the morning.

Not sure what else to attend today? Check out these featured presentations.

Hidden Bias in Science (BOSS Symposium) 08:45 – 09:35

Opening Ceremony / Ridley Medal Lecture: Late Decentration of IOLs — An Enigma

10:00 – 11:00

Room 8.1 N

Surgical Pearls: Refractive Intraocular

08:30 – 09:10

Surgical Pearls: Refractive Cornea

09:10 – 09:50

Sustainability Arena 11:00 – 11:45

Cataract Refractive Pro/Con: My First Option is EDOF IOLs 14:30 – 15:30

The Surgeon-Industry Exchange: What Doctors Want to Know from Industry and What Industry Wants to Know from Doctors 15:35 – 16:05

CLINICAL RESEARCH SYMPOSIA

Room 8.1 L

New Insights in Corneal Pathology and Neuropathic Pain

08:00 – 10:00

Bringing Deep Learning to the Anterior Segment 11:00 – 13:00

Predicting and Simulation Post-Op Visual Function 14:00 – 16:00

Unlocking Precision: IOL Power Calculation Strategies Post-Corneal Refractive Surgery 16:15 – 18:15

PLENARY HALL

TABLAO ARENA

KXL® System