CAKE & PIE POST (C&PE 2021 Edition) - ISSUE 1

A Bird, a Plane? No, it’s An Eyeball Expo Coming to You!

by Andrew Sweeney

ome one, come all, and prepare to be amazed by the most marvelous and creative ophthalmology expo you will have ever seen. Yes, it’s here, the first-ever CAKE and PIE Expo (C&PE) on 18th-19th June 2021, 2 pm - 8 pm SGT (UTC/GMT+8). Make sure to mark the date if you have not already, because it is going to be awesome, outstanding, and absolutely bursting full of the best in ophthalmology.

C&PE is an unconventional digital conference (I mean, it’s us, so naturally), and we are fully committed to bringing content to the ophthalmology industry that cannot be found elsewhere. We are going to show you the very best in our industry, from the delicious staple foods we all enjoy, to the freshest of perspectives on new concepts as well as the strange and stupefyingly rare. As you would imagine there will be a focus on the AsiaPacific region, but no part of the world can escape our grasp and we will be delighted to welcome guests from a number of countries and ophthalmological societies and groups.

For example, this is how our cookie is going to crumble. On day one of the extraordinary expo, we will start with What’s Cooking in Cataract?

– a symposium on one of the most fascinating anterior segment conditions out there – as well as Problem Solving in Business, Clinics and Life, an educational insight into management best practices which we could all benefit from in the wake of COVID-19. We are really excited to welcome some extraordinary speakers

during our first day (especially experts in their fields from among our society friends: AOS, ADEH and Retinawesome), and we strongly recommend you begin tuning in at 2 pm on the dot.

The second day is just as superbly smackbang filled with ophthalmology, oozing with interesting subjects and seminars. We are starting out with a riveting read on retinas and medical research cresting the wave of the day with thoughts from the very best of the future of ophthalmology in India, Russia and China, and coming to shore later in the day (imagine a beautiful beach and cocktails here) with Enhanced Refractive Screening with Scheimpflug Imaging and ORBIS Singapore Session: The Myopia Epidemic in the Asia Pacific

So wherever you are, do not miss it because years from now people will be asking you where you were during the very first C&PE, what you did during this incredible time, and how you were affected by it … Is this hyperbole? Well perhaps, but it is still going to be an awesome weekend where we can all enjoy the absolute best of the medical field we all love together. Grab a cocktail, a cup of tea, a coffee, or even a jar of eye anesthetic (Editor’s note: No, don’t do that!), sit back and enjoy the most educational carnival around with Media MICE CEO Matt Young and the rest of his assorted teammates. See

@ CAKE & PIE EXPO

by Sam McCommon

The first ever CAKE & PIE Expo (C&PE) is upon us, and we’re so thrilled we can hardly sit still. We’ve been working hand over fist to get this Expo done right — this is our debut online conference. We can only shake our heads in amazement to consider how far things have come in the last year and a half in the ophthalmic conference space.

This ophthalmic shindig will be on June 18-19, from 2-8 PM Singapore time, or UTC/GMT +8.

Before we get too deep and start tooting our own horn, we need to thank all the doctors who are working with us to put this show together. It wouldn’t be possible without them, and they deserve and have earned our eternal gratitude.

The C&PE will feature 80+ ophthalmologists speaking, representing every continent except Antarctica — where there is currently a notable

dearth of both supply and demand in ophthalmology. Many of our speakers come from the Asia-Pacific region, which we’re constantly striving to connect with the rest of the ophthalmic world.

We’ll also have an exhibition hall with 20+ virtual booths so you can stop and say hi to your favorite exhibitors. They’re looking forward to meeting you too.

We’re honored to be supported by ten ophthalmic societies, one of which is launching at the conference: the Subthreshold Ophthalmic Laser Society (SOLS). Such an auspicious beginning could only lead to a successful future, and we wish them the best of luck.

We’re also fortunate to have wonderful sponsors, including our Platinum sponsor, OCULUS Optikgeräte GmbH (Wetzlar, Germany) . They’ve helped us make this possible and we’re delighted to partner with them. Our official charity is the Orbis Flying Eye Hospital, which is

about as cool of a concept as we could imagine.

This conference has been a long time coming, but it was never written in the stars. It took grit, determination, luck, and a whole lot of funky go-with-the-flowness to get this together. Let’s take a quick look at just how we got here — and what you can expect from the C&PE.

How did we get here?

We used to make ourselves known at ophthalmic conferences through our unique style: wearing banana suits and other funky outfits at a conference is certainly a good way to get noticed. We love, then and now, meeting our colleagues in the industry in person and seeing familiar, friendly faces. But, well, you know what happened.

Enhance your subthreshold laser treatments thanks to the new Mosar ® imaging system:

- Import patient’s diagnosis images for treatment planning

- Perform subthreshold laser macular treatments thanks to Easyret® SubLiminal® mode

- Take pictures or record treatment videos to document your treatments

- Prepare and record advanced treatment reports including diagnosis images

- Improve your patient’s follow-up

Subliminal® laser therapy is a tissue sparing treatment mode for the treatment of DME and CSC

Learn more about clinical aspects on www.subliminal-laser-therapy.com

Headquarters: Tel: +33 (0)4 73 745 745

contact@quantelmedical.fr

North America: Tel: +1 877 782 6835 info@quantelmedical.com www.quantel-medical.com

577nm FIBER TECHNOLOGY LASER

DME treatment - Images courtesy of Alejandro Filloy Rius, MD. Ph.D – Tarragona Spain

The Argument for Laser in 2021

Clear Benefits and Good Outcomes

by Brooke Herron

When discussing treatment for macular pathologies like diabetic macular edema (DME) and central serous chorioretinopathy (CSCR), injection burden is a term that often appears. This, of course, is in reference to the monthly anti-VEGF injections required to keep disease progression at bay, a treatment that can come at a high cost to both patients and physicians.

Thankfully, there are other treatments available that are both safe and effective — specifically, subthreshold lasers like the Easyret® SubLiminal® laser from Quantel Medical (France).

Dr. Kenneth Fong is a vitreoretinal surgeon and managing director of OasisEye Specialists in Kuala Lumpur and the co-founder of the newly formed Subthreshold Ophthalmic Laser Society (SOLS). He recently discussed the benefits of subthreshold laser and its value as a treatment option in 2021 and beyond.

Personal experience shows clear results

“Subthreshold laser has been around

for about 10 years and Quantel Medical is one of the companies to pioneer this treatment,” said Dr. Fong. “It has a durable effect, and can also be combined with anti-VEGF injections or implants,” he continued.

Subthreshold laser works by changing the microenvironment through stimulation of RPE cells. This therapy offers a similar efficacy to classic laser photocoagulation, while preserving the retinal tissues.

“The benefit of the Easyret® laser is that is uses the 577nm wavelength, which is the ideal wavelength for treating the macula because of low xanthophyll absorption, good penetration through opacities like cataract and the need for very low power,” he explained.

With the Easyret®, users can choose between SingleSpot, MultiSpot or SubLiminal® mode. “I use the MultiSpot mode most commonly because I have many proliferative diabetic retinopathy (PDR) patients who need peripheral treatments like panretinal photocoagulation (PRP),” he said. “If I’m doing PRP, I can use MultiSpot mode and patients have very little discomfort.”

SubLiminal® laser for DME and CSCR

Switching gears to SubLiminal® laser for DME, Dr. Fong says three types are suitable for treatment with subthreshold laser: “The first is extrafoveal macular edema; the second is fovea-involving mild edema but with good vision; and finally — and what I use most commonly — is combination treatment for thick macular edema, where I inject anti-VEGF first and then do laser two months later.”

He then presented several DME patient cases who received laser treatment — all showed no scarring, good vision and resolution of edema at three-month follow-up.

CSCR can be treated as well, using the same protocols for DME, said Dr. Fong. “For patients with CSCR, the yellow subthreshold laser has a more beneficial effect on visual acuity than half dose PDT (photodynamic therapy) — it’s also cheaper and more convenient for the patient.”

He continued that it’s relatively easy to learn to perform, it will help patients with DME or CSCR rely on fewer intravitreal injections, and can be repeated. “There’s no discomfort at all with subthreshold laser — but patients need to wait at least three months to see a treatment effect in reducing edema,” said Dr. Fong.

Is 2021 the year of the laser?

Although anti-VEGF has replaced laser as the main treatment option for macular diseases, we still need laser, said Dr. Fong. “Many countries, like Malaysia where I work, cannot continue giving unending anti-VEGF injections …

there are also many cases of DME and CSCR that do not respond to anti-VEGF injections,” he shared.

However, the acceptance rate of laser as a treatment remains low. This is due to the prolific use of anti-VEGF injections worldwide and the cost barrier in purchasing a suitable laser machine, explained Dr. Fong.

“There are also different protocols used by different laser machines and a learning curve,” he added. This is one of the reasons that the Subthreshold Ophthalmic Laser Society (SOLS) was created: To raise awareness and educate

physicians on the rising role of laser as an effective and safe alternative to antiVEGF for macular disease.

New Society on the Block: SOLS

In April 2021, ophthalmologists gained a new resource in the subthreshold laser sphere in the form of SOLS — or Subthreshold Ophthalmic Laser Society.

SOLS was created to raise awareness of subthreshold laser as a viable option for macular diseases like DME; to encourage further global research in this area; and

to formulate standardized protocols for treatment, based on consensus from global key opinion leaders in this area, explained Dr. Fong.

Members can expect education and engagement from SOLS. Their website will host guidelines and meetings, and the society will participate in regionally planned webinars and symposia at major ophthalmology and retina meetings.

“SOLS was set up by clinicians to further research in this area and any ophthalmologists who wish to join are most welcome,” said Dr. Fong.

Dr. Kenneth Fong

Dr. Victor Chong

Dr. Lihteh Wu

Dr. Alejandro Filloy Rius

>> Cont. from Page 3

The ophthalmic conference world was turned upside down over the past year and a half. Things are slowly getting back to normal, but we’ve come a long way and learned a lot. Perhaps most notably, we’ve learned that online conferences can be wonderful ways to learn, stay connected, and generally keep the ophthalmic community together. Moving conferences online was a move of necessity at first, but we get the feeling it’ll be a move of preference and convenience starting essentially now.

In many ways, the pandemic we’ve all gone through has kickstarted extant digital trends — and pushed them forward by several years at least. The explosion in digital conferencing and online meetings in all areas of business meant that pretty much everyone had to get better at meeting online. We applaud the efforts of the ophthalmic community to stay up to speed with trends — we know it’s not easy to keep up with the breathless pace of technological development.

We’ve learned a lot over this recent period, just like everyone else. We were the only media exhibitors at the American Society of Cataract and Refractive Surgery (ASCRS) 2020 annual meeting, as well as the only media at ESCRS (European Society of Cataract and Refractive Surgeons) and EURETINA (European Society of Retinal Specialists) congresses of the same year. We had the honor of being named official media partner of the World Ophthalmology Congress (WOC) 2020 event. We’d sure looked forward to traveling to Cape Town, but it wasn’t in the cards — for us and for anyone else.

Over that time, we’ve gotten a much better feel for what makes an online conference special — so we figured we’d throw our hats in the ring and give it a go. We saw an opportunity to do things our way: our unique, different, funky way. And, well, here we are. It’s about time to pull the curtains back. But what’s different about the C&PE?

What makes CAKE & PIE Expo different

Because we get to do things our way, this conference will be a bit different than others. For one thing, we’re going for a

more relaxed and personal feel — our speakers can wear whatever the heck they want and express themselves as freely as they like.

Next, we’re not charging registrants to sign up for the conference. Our goal here was to take pressure off our attendees so they didn’t feel stressed out about getting their money’s worth or worrying about conflicts of schedule. We wanted to dial the whole thing back and aim for an easygoing feeling for both presenters and attendees.

During the conference, we’ll have two tracks available so you can choose whichever speaker suits you more at the time. And if you want to watch both, all content will be available for free on demand for 30 days after the conference.

One thing we’ve learned is that excellence does not have to be partnered with anxiety and pressure. Rather, it’s easier for a person to do their best work when they’re feeling loose and are able to be themselves.

Surgeons, of all people, should know this: The state of flow a surgeon enters when they’re really in the zone is the same one elite athletes, artists, musicians, and the like experience. Background concerns can drag a person out of the state of flow — and all we want to see is our presenters and attendees in the zone and having a good time.

Bringing the funk

We want to make this Expo as fun, funky, informative, and valuable as possible. There’s a lot of competition for eyeballs and attention in the digital space these days, and we hope you’ll find the C&PE will be a good time for all.

As of this writing, we’ve got upwards of a thousand attendees signed up — so you’ll be in good company. Come on in, kick off your shoes, and join the celebration of everything ophthalmic. We look forward to seeing you there.

It was a winding path through the woods to get here.

“Posters abound in this, and that, congress...”

We can’t keep track anymore of how many times we published that line.

“And here are the highlights...” or “From the poster alley, these caught our eye...”

What’s a congress without posters? At CAKE & PIE Expo (C&PE), we do have posters too. The funky and humorous kind. Among those we came up with, this is the best: The Editor’s top pick!

[Watch out, we might turn this into a “competition” next time...]

Structur and Function of the Retina

e

Much to Say about Near ly Nothing (1868)

A Humorous Poster by Media MICE, based loosely on the full text of Br Foreign Med Chir Rev. 1868; 42(84): 329–358.*

Introduction

It cannot be expected that the medical practitioner already overtasked by the demands of a many-sided science should follow very closely the laborious advance of retinal anatomy.

Methods Results

By looking beyond this drudgery of anatomical detail … we have equal reason to congratulate ourselves on the great progress made toward a satisfactory settlement of the anatomical basis on which the future physiology of vision may rest.

Amidst an embarrass des richesses [embarrassment of riches/confusing abundance] arising from the research works of so many independent observers, a clear insight into our present position is to be obtained.

Meanwhile discoveries multiply, and the reader, whose point of view is that of a past period of fact and opinion, and who is dependent on such chance literature as may fall in his way, finds himself in the midst of a past period of fact and opinion.

Standing super antique vias [standing upon old ways] he is more disposed to remain laudatory tempers acti [as one who praises the past times] than to join in any forward movement.

We propose, therefore, in the present article, to attempt a brief summary of the results hitherto achieved, in the hope of supplying thereby a want which may be felt by many of our readers.

It will be at once obvious that by far the largest portion of the subject is referable to the general physiology of the brain and nerve-system, which does not further concern us here.

Conclusion

The excitation of the retinal nerves by whatever means effected, results in the sensation of light. The excitation of the retina is therefore neither the perception itself, nor is it always necessary to this perception. We must conclude our summary of the retinal structure, which is, from want of space, incomplete in many details.

*No authors listed. Structure and Function of the Retina. Br Foreign Med Chir Rev. 1868;42(84):329-358.

[Warning: Don’t take this poster seriously!]

OCULUS Introduces Pentacam® AXL Wave Next Generation

by Andrew Sweeney

We know that you must be positively pulsating with excitement with the upcoming CAKE & PIE Expo (June 18th-19th 2021, 2 pm - 8 pm SGT (UTC/GMT+8) in case you forget the specifics) and of course you would be. It is going to be jam-packed full of outstanding ophthalmology, amazing anterior segment stories, and positively smashing posterior segment symposiums. What else would you expect from the Media MICE team after all.

In the run-up to the excellent expo we have planned, we wanted to share some news with you about OCULUS Optikgeräte GmbH (Wetzlar, Germany), one of the companies working at the cutting-edge of technology in our field. The German geniuses recently announced the release of the Pentacam® AXL Wave, a new eye measurement tool. It received its name for five key aspects it offers; wavefront aberrometry of the entire eye; objective refraction; retro-illumination; optical biometry, and Scheimpflug-based tomography.

OCULUS describes the Pentacam as offering “unrivaled pre-operative care for patients,” and offers an incredibly in-depth examination of the eye. It is particularly attractive to refractive and cataract practice clinicians and can generate a considerable amount of data that can be used when selecting anything from spherical to toric multifocal intraocular lens (IOLs). In fact, its internal IOL Calculator includes a continually updated database of up to 500 different IOLs – which makes it a solid choice for clinicians interested in customized IOL power calculation.

The devices’ centration facility was designed specifically to maximize

patient comfort and reduce the length of time required for the full screening process to less than five minutes. The Pentacam also generates readily understood reports and supports the user in discovering early ectatic disease including forme fruste keratoconus and Fuchs endothelial dystrophy amongst others. It also offers a clearly arranged overview display showing all parameters for corneal screening, its aforementioned ability with IOL selection, and implantable collamer lens selection and calculation.

Editor’s Note:

The Pentacam is all about ergonomic and simple to use design, and while we would not say that it is so simple a child could use it (well, maybe a kid with a doctorate…) it is certainly incredibly intuitive. It is also sleek and stylish, easily placed in any clinic comfortably, and looks as good as it is smart. Also, as it has “Internet of Things’’ properties, it can perform searches (for the IOLs for example) and connect with other nearby devices.

Total wavefront aberrometry and objective refraction allow assessment, documentation and presentation of vision quality after cataract or refractive surgery.

To learn more, visit www. pentacam.com/axl-wave and visit the Oculus booth at CAKE & PIE Expo (C&PE) on June 18 to 19, 2021.

BIOMECHANICS MEETS TOMOGRAPHY

HEY CORVIS ST

I just took a look at the tomography. These values call for caution. I don’t think I would operate.

HI PENTACAM

The biomechanics looks good, though. The cornea is very stable. I don’t see any problem with operating.

O.K. TOGETHER NOW Tomography and corneal biomechanics together make the decision easier: Surgery could be an option.

Corvis® ST meets Pentacam®: Combined measurement results for a safe decision on surgery

Benefit from the combination of biomechanical data from the Corvis® ST and tomographic data from the Pentacam®. Provide surgical care to more patients safely!

Want to learn more about corneal biomechanics? Check out www.corneal-biomechanics.com for more information, scientific material and lectures from the experts.