Interview with Dr. Barraquer

Interview with Dr. Rafael I. Barraquer The surname Barraquer is one which is most directly associated with excellence in ophthalmology, both in our country and worldwide. Several generations dedicated to eye health; working and caring for their patients, researching and developing both new products and surgical techniques.

Interview with Dr. Rafael I. Barraquer for KC Solutions The surname Barraquer is one which is most directly associated with excellence in ophthalmology, both in our country and worldwide. Several generations dedicated to eye health; working and caring for their patients, researching and developing both new products and surgical techniques.

Interview with Dr. Rafael I. Barraquer for KC Solutions

Dr. Rafael Barraquer Medical co-director of the Barraquer Ophthalmology Centre (Barcelona, Spain) and head of the “J.Barraquer” chair at the Autonomous University of Barcelona, is world renowned anterior segment, cornea and refractive surgery specialist. His interests include the treatment and correction of keratoconus and other irregular corneas. When we asked him to collaborate with the KC Solutions project, he accepted immediately and some of the new products being developed are based on his ideas in this field. We had the opportunity to talk to him in Oviedo during the last congress of the Spanish Ophthalmological Society. © Archivo Centro de Oftalmología Barraquer

KC: Could you sum up your career for us?

My training in ophthalmology was primarily with in the realm of our Institute, with a number of not very prolonged but varied stays abroad. My practice is primarily oriented to the fields of anterior segment, cornea and refractive surgery, with some special minor interests such as intraocular tumour surgery. This also includes dedicating part of the time to teaching and research, whichcomes out naturally as an integral part of the profession concept within our family tradition.

KC: Speaking of this family tradition, when did the Barraquer saga begin? What great memories do you keep of the past generations?

The history of our ophthalmological saga dates back to over century ago with my great-grandfather, José Antonio Barraquer-Roviralta, who was the first professor of ophthalmology in Spain. The figure of my grandfather, Ignacio Barraquer, is probably the first to be well known worldwide. In 1917 he invented the erysiphake or vacuum cup for the cataract, which largely solved the problem of intracapsular extraction without breaking the capsule. This was complemented by the discovery of enzymatic zonulolysis my father Joaquín Barraquer in 1958. His elder brother, José Ignacio, is recognized as the father 3

Interview with Dr. Rafael I. Barraquer for KC Solutions

Professionals of Clínica Barraquer during a surgery. © Archivo Centro de Oftalmología Barraquer

The relevance of a project like KC Solutions is consistent with the problem it is attempting to solve, so such an effort by the industry is most welcome.

of corneal refractive surgery. When I chose to follow this vocation and to take part in this tradition, I knew it implied a big responsibility. However, I try not to think too much about that burden and instead to dedicate myself to this great profession,looking forward into the future. And the fifth generation is now on its way.

KC: Where did your interest in irregular corneas come from?

The cornea field has always been a central aspect of my career. I have to credit the influence of my father, who created in 1962 the first Eye Bank in continental Europe. This fact (and his outstanding work) would lead our institution to becoming an international reference for corneal transplants.

In recent years, this field has progressed a lot, not only because of the new keratoplasty techniques and those borrowed from refractive laser surgery, but –and especially in the field of keratoconus and other corneal ectasiawith the appearance of conservative techniques such as collagen crosslinking and intracorneal segment implants. These new possibilities are appealing by themselves, with the additional charm of the complexity arising from the challenging terrain and the multiplicity of new options.

KC: How do you see the current status of keratoconus management?

In our region, including Spain and the remaining Mediterranean countries, keratoconus has always been one of the major corneal pathologies. For decades it was the leading cause of corneal transplant (as well as the most successful), which clearly differs from the series in northern and central Europe or USA. That’s another reason why these new treatment options are particularly interesting here.

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Interview with Dr. Rafael I. Barraquer for KC Solutions

KC: KC Solutions is an innovative platform in comprehensive solutions for keratoconus. What strong points have led you to participate actively in this project?

For a long time, IMEX and particularly Pere del Campo, have been a major driving force which has promoted interest for these techniques in our region. The relevance of a project like KC Solutions is consistent with the problem it is attempting to solve, so such an effort by the industry is most welcome. It is for me a great satisfaction to be collaborate with it for the benefit of our patients.

KC: You are one of the doctors who will participate in the first operations with the new instruments and segments. In a few days, the “Barraquer Implanter” instruments will be available, which bears your name because it originates from a design you suggested. What do these instruments consist of and what benefits will they provide?

The instruments are simple tools, behind which comes the hand (and then the brain) of the surgeon. In general, I have not been particularly inclined to designing new instruments as long as I could manage with the ones available. The idea of this intracorneal segment implanter arose from the difficulties I found during surgery, especially after manual dissection but also in some cases after femtosecond laser tunnelling. Basically the idea is to mount the implant on the “pigtail” dissector or spatula itself and from

“It is for me a great satisfaction to be collaborate with KC Solutions for the benefit of our patients”

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Interview with Dr. Rafael I. Barraquer for KC Solutions

It is therefore paramount to involve all those taking part in the care of these patients, from the optician or optometrist, the contact lens specialist and the general ophthalmologist, to the cornea surgeon.

Prof. Joaquín Barraquer along with Dr. Barraquer, 4th generation of one of the best-known ophthalmological families. Š Archivo Centro de Oftalmología Barraquer

there we just deposit the implant fairly long-term desideratum, patient precisely at the intended position. education is important: Never rub your eyes! As for treatment, I would KC: Once you have the prototype be pleased if no keratoconus reached in your hands, how will we know the point of corneal transplant, which if the instruments live up to their is something we can attain with early expectations? detection and widespread application With these instruments, we hope to of the new treatments. It is therefore facilitate implantation and improve paramount to involve all those taprecision in the positioning of the king part in the care of these patients, implants. The former will be seen from the optician or optometrist, the immediatelywith their use, the la- contact lens specialist and the tter will require an analysis of the general ophthalmologist, to the results, comparing them with the cornea surgeon. previous experience.

KC: Finally, what would you like to see for the future of keratoconus?

Certainly, that it should no longer be the health problem it is right now. This will require advances on many fronts.

First, that of prevention: here, apart from gene therapy, which is still a 6

With its running windows aglow, the Barraquer’s Centro meets us with dynamic architectural features reminiscent of a ship docked in one of the sloping streets of Barcelona. A ship carrying the story of a family dedicated for generations to excellence in ophthalmology.

An enduring passion for Ophthalmology

© Archivo Centro de Oftalmología Barraquer

The Centro de Oftalmología Barraquer materializes more than a century of dedication of the Barraquer family to eye care, research and teaching in ophthalmology. Founded in 1941, its conception and design followed the ideas of rationalism and functional integration of architecture and medical services, in order to offer the optimal environment for a comprehensive and specialized eye car of the highest level. It soon became a world reference.

The modern practice of ophthalmology requires a high degree of specialization and constant adaptation to the sophisticated and rapidly changing technologies. The Centro was conceived to meet these requirements. Its medical team is organized in departments covering all areas of the specialty, currently comprising 30 ophthalmologists of outstanding recognition in their respective fields. The facilities dispose of the most advanced equipment for diagnosis, surgical and laser treatment. In fact, a long list of instruments, surgical

systems and techniques have been invented or developed at home. This allows an annual turnover of over 120.000 visits and 12.000 surgical procedures, including over 300 corneal transplants. A particular dedication and longstanding interest in the diseases of the cornea, including the creation in 1962 of the first Eye Bank in continental Europe, explains the international prominence of Barraquer in this field.

Although established as a private clinic, Barraquer has always provided top eye care for all members of the community

While modern ophthalmology requires state of the art technology, the importance of the personal touch in the treatment of every patient cannot be overemphasized.

irrespective of their social and economic status, following the philosophy of its founders, as well as for the many foreign patients coming from around the world. The same integrated concept of the practice of medicine could not exclude research and teaching: In 1947, the Instituto Barraquer was created as a scientific association to promote those ends and immediately initiated specialty training programs and courses. Today, Barraquer is officially credited for the training in ophthalmology of up to 20 residents at a time, and has stable relations with a number of universities for teaching programs ranging from pre-graduate to post-doctoral, masters programs and CME courses.

These attract specialists from many continents. Research and innovation in ophthalmology at the center is today channeled through the “Joaquín Barraquer Chair” of the Autònoma University of Barcelona.

In a globalized world, the social-conscious approach to medicine that impregnates this institution from its beginnings naturally had to find its way to extend its action to the less favored regions of the planet. To this end, the Barraquer Foundation was created in 2003, and currently supports charity eye care expeditions and training programs in ophthalmology in 15 locations of 8 African countries and India.

While technology is a necessary engine for progress, medical care remains an activity based on human relations.

Barraquer has always stressed the importance –and even the therapeutic value- of personal care, which has resulted in a very special attitude and approach to treating patients with “the Barraquer touch”. This way of thinking and working is implicit in the original motto of the founder, Ignacio Barraquer: “LET’S TREAT THE PATIENT IN THE WAY WE WOULD WISH TO BE TREATED OURSELVES”.

The “Barraquer Saga” in ophthalmology originates from mid-XIX century with José Antonio Barraquer Roviralta (1852-1924), appointed to the first university chair in ophthalmology in Spain in 1888. His son Ignacio Barraquer Barraquer (1881-1965) achieved world fame by developing the vacuum spoon technique for cataract extraction (facoéresis), and founded the Centro de Oftalmología.

In the third generation, José I. Barraquer Moner (1916-1998) is regarded as the father of modern refractive corneal surgery, working in Bogotá, Colombia. His younger brother Joaquín (1927) has directed the Centro during the crucial years of progress and technological change, contributing with discoveries as the “enzymatic zonulolisis” for cataract removal, pioneering the development of intraocular lenses and the popularization of corneal transplants. The saga continues in the Americas with three children of José: Francisco (1944), Carmen (1946) and José I. Jr. (1964), and in Barcelona with two of Joaquín: Elena (1954) and Rafael I. Barraquer Compte (1956), who also share the same passion for ophthalmology.

And a fifth Barraquer generation is up and running too.