41 minute read
Conquering Presbyopia with Innovative IOL Technologies
TECNIS® IOLs take the lead with breakthrough technology for high-quality visual
With innovations in Intraocular Lens (IOL) technologies, the aim of presbyopia treatment has shifted from mere improvement in functional vision to total visual rehabilitation with reduced dependence on glasses, minimal refractive errors and improved quality of functional vision.1 The use of digital technology encompasses a significant portion of our daily activities today, making goodquality intermediate vision a necessity. The importance of intermediate vision in presbyopia correction is further highlighted by its requirement for potentially risky daily activities such as driving cars and navigating stairs.2
Traditional monofocal IOLs do not improve intermediate vision and patients often require bifocal/ multifocal glasses for intermediate and near activities.3 However, these come with safety concerns, as bifocals have been associated with falls and hip fractures, a serious consequence for the elderly.4
Surgical success factors
The key to success in surgical correction of presbyopia lies in choosing the most suitable IOL and optic design for a particular patient. In the past, increasing the depth of field with presbyopia- correcting IOLs compromised visual quality and caused dysphotopsias.5 However, the TECNIS® platform from Johnson & Johnson Vision is made of superior optic material and has a unique design for high-quality visual outcomes. The optical material (mid-index, low dispersion) used induces the lowest amount of chromatic aberrations and provides the highest image contrast under all lighting conditions. The wavefront-designed optic corrects spherical aberrations to almost zero and provides a sharp quality of vision. Furthermore, the design and optic material are not associated with glistenings and minimize light scatter. Less capsular phimosis has been observed with IOLs based on the TECNIS® platform resulting in minimal IOL decentrations and improved vision quality.6
Though monofocal IOLs are the most widely used option for cataract surgery, they do not provide adequate intermediate vision. Further, despite meticulous biometry and power calculation, the refractive targets are often not met. The TECNIS EyhanceTM is a next generation monofocal IOL which extends the depth of focus to improve intermediate vision while maintaining distance vision similar to that of a standard aspheric monofocal IOL.7 The power in the TECNIS EyhanceTM increases continuously from the periphery to the centre of the lens, resulting in enhanced intermediate vision than a standard aspheric monofocal IOL.8 While the distance vision is maintained comparable with that of a monofocal IOL, there is no statistical difference in rates of photic phenomenon.9 Due to its larger landing zone it is more forgiving to inaccuracies in biometry, providing the patient with good uncorrected visual acuity even if emmetropia is not achieved.10
Innovations that enhance
While multifocal IOLs offer greater spectacle-independence compared with monofocal IOLs, they are associated with symptomatic glare and reduced contrast sensitivity. Within multifocal IOLs, diffractive IOLs are associated with better near vision and decreased symptomatic glare and halos, compared to refractive ones. However, it is seen that extended depth-of-focus (EDOF)
presbyopia-correcting IOLs provide a superior or similar intermediate visual acuity, with similar or reduced rates of glares and halos compared with diffractive multifocal IOLs.11 The TECNIS SymfonyTM is an EDOF IOL with a proprietary diffractive echelette design, which elongates the depth of focus and provides an extended range of vision. The near and intermediate visual acuity is improved, while the distance visual acuity maintained is comparable to an aspheric monofocal IOL.12 In addition, the proprietary ChromAlignTM technology corrects chromatic aberrations and enhances the image contrast.13 As a result, the TECNIS SymfonyTM IOL is associated with a low incidence of glare and halos. Patients enjoy a continuous range of highquality vision from functional near to far, with no visual gaps between focus points, as seen with multifocal IOLs.14 Additionally, increasing penetration of LED lighting into our homes and offices poses a challenge to presbyopia correction. LED lighting produces a higher level of scatter due to the emission of shorter violet wavelengths resulting in dysphotopsias.15
Working with light
TECNIS SynergyTM IOL is an innovation in presbyopia-correcting IOL technology to combat this challenge. It combines the EDOF and multifocal technologies along with a proprietary violetlight filtration system. The result is continuous high-contrast 20/25 vision from far through near without any vision gaps as experienced with other multifocal IOLs. Its performance at near vision is outstanding, even at a distance of 33cm.16,17 The ChromAlignTM technology corrects chromatic aberrations and optimizes vision contrast. The IOL’s violet-light filtration system blocks the shortest wavelengths of light (violet), resulting in reduced light scatter, and consequently decreased halos. However, it allows transmission of the longer wavelengths of light for improved scotopic sensitivity and better low- light/night-time vision. The resultant superior low-light contrast delivers high-quality vision that patients need day and night. In clinical studies, violet-light filtration has been associated with improved daytime and nighttime driving.18 Additionally, the action of TECNIS SynergyTM IOL is pupil- independent, which translates into the best low-light performance compared to leading trifocal IOLs.19
The performance of TECNIS SynergyTM IOL has been praised by Dr. Francesco Carones, Medical Director and Physician CEO of Carones Vision, Italy who observed that “the TECNIS SynergyTM IOL smooths out visual gaps and continues to perform even as the light dwindles”. Dr. Frank Kerkhoff, Scientific advisor to Johnson & Johnson Surgical Vision endorsed the same view. After implanting the TECNIS SynergyTM IOL, he noted that his patients were able to read in low and dim-light conditions, which is unseen with other PC-IOLs. As Dr. Con Moshegov of George St. Medical Centre Sydney, Australia, attests for the continuous vision provided, “With the TECNIS SynergyTM IOL, seeing computer screens, dashboards, sheets of music and people’s faces across a small table is easy!”20 The TECNIS® family of IOLs continues to provide innovative solutions to cater to the visual needs of all patients with its revolutionary breakthroughs in presbyopia-correcting IOL technologies.
For more information visit the new Johnson & Johnson Surgical
Vision Hub.
References:
1. Talley-Rostov A. Patient-centered Care and Refractive Cataract Surgery. Curr Opin
Ophthalmol. 2008;19(1):5-9. 2. Data file on PP2019CT5038, The Burden of
Cataracts 3. Ibid. 4. World Health Organization, (2004). What are the Main Risk Factors for Falls Amongst
Older People and What are the Most Effective
Interventions to Prevent These Falls? Retrieved from https://www.euro.who.int/__data/assets/ pdf_file/0018/74700/E82552.pdf 5. Balgos MJTD, Vargas V, Alió JL. (2018).
Correction of Presbyopia: An Integrated Update for the Practical Surgeon. Taiwan J Ophthalmol. 2018; 8(3): 121–140. 6. Data file on PP2020CT4825, TECNIS® Portfolio of IOLs 7. McNeil R. (2019) New generation IOL platforms designed for high quality visual performance after cataract surgery. Eye News Volume 25,
Issue 6. Retrieved from: https://www.eyenews. uk.com/features/ophthalmology/post/newergeneration-iol-platforms- designed-for-highquality-visual-performance-after-cataract-surgery 8. Data file on PP2019OTH4059, TECNIS
Eyhance launch workshop 9. Ibid. 10. McNeil R. (2019) New generation IOL platforms designed for high quality visual performance after cataract surgery. Eye News Volume 25,
Issue 6. Retrieved from: https://www.eyenews. uk.com/features/ophthalmology/post/newergeneration-iol-platforms- designed-for-highquality-visual-performance-after-cataract-surgery 11. Sieburth R, Chen M. Intraocular Lens
Correction of Presbyopia. Taiwan J Ophthalmol. 2019;9(1):4-17. 12. Data file on PP2018CT5730, Getting Started
Guide TECNIS Symfony TM IOL and TECNIS
Symfony TM Toric IOL 13. Ibid. 14. Data file on PP2020CT4825, TECNIS® Portfolio of IOLs 15. Data on file PP2019CT5141 TECNIS Synergy™
KOL Deck 16. Johnson & Johnson Vision (2019). Johnson &
Johnson Vision Introduces TECNIS Synergy™
IOL, a Continuous-Range-of-Vision Intraocular
Lens (IOL) at the ESCRS 2019 Congress 17. Data on file PP2019CT4746, TECNIS
SynergyTM IOL Limited Launch (Emea) Message
Map Guidance Document 18. Ibid. 19. Ibid. 20. Johnson & Johnson Vision (2019). Johnson &
Johnson Vision Introduces TECNIS Synergy™
IOL, a Continuous-Range-of-Vision Intraocular
Lens (IOL) at the ESCRS 2019 Congress
PP2020CT5522
An Industry Adjusts Pandemic Impacts, One Year On by Brooke Herron
Unfortunately, 2020 will be forever known as the year that brought us COVID-19. With new common phrases like “Disruptions in
Treatment,” “Emergent Procedures
Only,” and “This Congress is Virtual” — both ophthalmologists and industry partners were left to navigate the pandemic’s new normal in the quest to deliver eye care.
2020: What the heck happened?
In January 2020, the coronavirus was busy making its jump from China. It would then spread ruthlessly throughout the world, crippling healthcare systems and economies along its way. However, even then, not many of us realized COVID-19’s full “potential” — and that one year later, we still wouldn’t be out of the woods.
Below, we speak with ophthalmology and industry experts to learn more about the pandemic’s impacts on anterior segment practice.
Let’s talk cash flow
Dr. Lisa Nijm is a board certified ophthalmologist at Warrenville EyeCare and LASIK in Illinois, USA. She said that overall, as a specialty, surgical and in-office volumes are still not at pre-pandemic levels. “We have all had to make financial adjustments from the pandemic — ophthalmology has been hit harder than other specialties because of the
greater proportion of our patients who are elderly, and therefore in a high risk category for COVID,” said Dr. Nijm.
Dr. Harvey Uy is the medical director at the Peregrine Eye and Laser Institute in Makati, Philippines. He said that COVID-19 and the ensuing lockdowns hit practices like a freight train in the second quarter of 2020. Like elsewhere in the world, patient visits and surgeries decreased substantially. These devastating effects are still being felt a year later.
“The pandemic hit both sides of the financial statement,” said Dr. Uy. Revenues plummeted at the start of the lockdown as patients were afraid of contracting COVID-19, while operational costs increased for things like added disinfection, personal protective equipment (PPE), and transportation. “Due to early shortages, the cost of these items was very high at the start.”
Thanks to additional safety measures, he said they have been able to bring their practice back to a sustainable level. “Over time, business has improved and I believe we will end the year at least breaking even,” shared Dr. Uy.
Dr. Cynthia Matossian, M.D. is the founder and CEO of Matossian Eye Associates, a combined ophthalmology and optometry practice with offices in New Jersey and Pennsylvania, USA. She said the pandemic has impacted her practice in incalculable ways. “The lockdown last March, which lasted a few months, created an unanticipated disruption in our cash flow as we were restricted to only see urgent and emergent vision-threatening cases,” shared Dr. Matossian. She said that today, all physicians are currently working longer hours to make up for the months their practice was closed.
Dr. Sudhir Singh is a senior consultant and head of ophthalmology at the Global Hospital and Research Centre in Mount Abu, India. He shared that the COVID-19 pandemic has changed medical practice significantly. “Now, we have ‘new normal’ protocols for office patients, and for medical and surgical treatments, which are more time and money consuming than before COVID-19,” said Dr. Singh. In addition, the number of medical and surgical patients has decreased.
Working for a not-for-profit organization, there were limited opportunities to raise fund during the pandemic. To continue their charitable work, salaries were cut for six months. Dr. Singh shared that he has managed well during the pandemic due to his lifestyle, which is based on minimum necessities in his professional and personal life.
“My fraternity in private practice had a substantial impact on their practices and business for the first six months of the pandemic. Most of them have had some financial strain to meet their expenses,” said Dr. Singh.
Dr. Sibylle Scholtz is an international science correspondent and associate senior research fellow at the Institute of Experimental Ophthalmology, Saarland University, in Homburg, Germany. She, along with Prof. Achim Langenbucher, described the pandemic’s impacts in regard to IOLCon, an international platform with data on intraocular lens (IOL) characteristics and optimization of lens constants.
In her line of work, Dr. Scholtz said COVID-19 has led to fewer patient visits and treatments, and less time to enhance lens biometry and lens power calculations while quality control systems were established.
“Planning just isn’t possible as regulations are changing day-byday,” she said. However, Dr. Scholtz and colleagues have found time to establish and enhance internal standards. This includes the use of databases for transferring the best formula constants to get the best visual performance after cataract surgery. They have also presented information about IOLCon at several international webinars.
Does anyone remember the “old” normal?
In addition to financial losses, much time was spent to create the “new normal” in ophthalmology. This included hours spent developing protocols for the “new way” of seeing patients, as well as completing government financial relief documents.
“Since most physicians are not accountants, nor do they have expertise in this area, many ophthalmologists found the completion of these documents to be very stressful,” said Dr. Matossian. Further, supplies like hand sanitizer, masks, PPE, and gloves were in short supply, as everyone was scrambling to procure these items simultaneously. Mail and distribution disruptions also caused them to run out of other commonly used products.
In the Philippines, Dr. Uy agreed: “Resources were directed towards screening for COVID-19, sourcing PPE, instituting aggressive disinfection practices — all at a time when everyone was simultaneously pursuing the same items.” Thankfully, they were fortunate to receive PPE donations from patients and disinfectant from the Department of Health.
He said that his greatest challenge was ensuring the safety of patients and staff as they formulated and implemented more stringent antiinfection policies and procedures. Dr. Uy credits the ophthalmic societies for being proactive and sharing information, which he said was “immensely helpful for formulating pandemic countermeasures”.
Back in the United States, Dr. Nijm
said they were challenged to rethink each step of the patient journey to be more efficient and reduce waste. Further, constant mask-wearing posed its own set of problems: “From a patient perspective, many people rely on lip reading to assist with hearing — this has presented challenges when our lips are covered with a mask. From a physician and staff perspective, wearing a mask is an absolute necessity but it makes something as simple as drinking water throughout the day an extra chore.”
Telemedicine offers a lifeline
Telemedicine has also become a popular necessity to maintain patient care. And while ophthalmologists generally don’t shy away from new technology (at least as it relates to eyeballs), Dr. Matossian said that learning about telehealth and integrating it into practice within one to two weeks was quite a hurdle to clear.
Meanwhile, Dr. Uy said they focused on developing a more “friendly” telemedicine system. Improvements included a dedicated mobile phone number for scheduling consults, an increased number of available telemedicine platforms, and more payment modes.
Even so, telemedicine couldn’t cover everything. Many patients still needed to come in for diagnostic testing and a thorough eye exam, said Dr. Uy, who noted that home visits have also increased.
Dr. Nijm said that since they’ve resumed office visits, the use of telemedicine has dropped. However, the door remains open for technology that enhances patient care.
“I have been impressed with the number of patients who are willing to learn how to utilize technology,” she shared. “As holding family gatherings over Zoom has become more of the norm, patients who might not otherwise have been keen to use their smartphone or computer to connect with their doctor now consider that a reasonable option.” She has also incorporated more digital education, which allows patients to learn more about their condition from the comfort of their home. “I also have conducted hybrid visits that allow patients to come in for testing and examination, while having most of the discussion via phone or video call,” shared Dr. Nijm.
Safety matters: Keep your COVID to yourself
Around the world, ensuring the safety of both patients and staff has been paramount during the pandemic. New safety measures included limiting patients on-site, both in the waiting and operating rooms.
According to Dr. Uy, they created a “surveillance system” that involved rapid testing to screen and monitor patients and staff for potential infection. “Patients appreciated the rapid testing we instituted to screen for surgery — no one objected to the additional cost,” shared Dr. Uy. “We also designed and transferred Peregrine Eye and Laser Institute to a new and larger ambulatory surgery center [with more room for] social distancing.”
Dr. Nijm also said that all patients must be preoperatively tested for COVID-19. “In the clinic, we have also employed additional precautions to protect patients and staff — from conducting screenings over the phone and temperature checks, to hand washing and social distancing in the office,” she said, adding that her patients appreciate the additional precautions. “They have been grateful for the extra time and attention to detail to ensure their safety.”
Patients’ desire to make in-person office visits correlates with their condition, added Dr. Matossian. Those needing cataract or cosmetic blepharoplasty surgeries are waiting, while patients with progressive, sightthreatening conditions like age-related macular degeneration (AMD) are
keen to come in for their scheduled anti-vascular endothelial growth factor (VEGF) treatments.
Dr. Nijm agreed with Dr. Matossian: Patients’ comfort level has been significantly affected. “I have had many patients who delayed seeking treatment for various eye conditions during the height of the pandemic,” she shared. “While most of them have returned, there are some who still do not leave the house very much and are not comfortable enough to have their second eye cataract surgery or glaucoma check.”
Unfortunately for some conditions, not seeking treatment can have devastating consequences.
“We witnessed many heartbreaking cases of patients with macular degeneration, uveitis, and acute glaucoma permanently losing vision because of delayed access to eye care — these cases spurred us on to continue operations. Much credit goes to our frontline staff for braving the dangers and coming in to help care for patients,” said Dr. Uy.
Meanwhile, in India, ophthalmologists face similar circumstances. “It is a challenge for medical professionals to serve society [during the pandemic]. We have lost thousands of medical professionals worldwide. We have lost hundreds of medical doctors in India, too,” said Dr. Singh. “It was an unprecedented challenge for me, like other medical professionals, to stay physically and mentally strong to serve society.”
According to Dr. Matossian, these staff shortages are a continuing ramification of COVID-19. “Many of our staff either did not wish to return to work since they live in a multi-generational household and were concerned about bringing COVID home, or they felt the need to stay home to help their children with virtual school.
“Some of our staff had compromised medical conditions themselves, and did not wish to take the risk of working closely with patients. For all of the reasons mentioned, we are short staffed. And according to many of my colleagues and experts in the field, this is a nationwide trend,” shared Dr. Matossian.
Silver linings appear, despite COVID-19’s best efforts
Even though it may have felt that 2020 dealt us a bad hand, the year that brought us COVID also brought some positives, like more time with family. And this reduction in workload left many ophthalmologists with extra time on their hands — perhaps for the first time in a long time!
“The greatest opportunity presented by the pandemic was the increased time to bond with family members and to focus on improving health and wellness. Many of our staff lost weight, exercised more, and had better interactions with their families,” shared Dr. Uy.
“The pandemic taught us that what really matters is family support and basic amenities,” agreed Dr. Singh, who has spent more time with family doing activities like going for nature walks, taking wildlife photography, and growing vegetables in the garden. He also used time during the lockdown to connect with his MBBS and MS mates, which wouldn’t have been possible preCOVID due to their busy schedules: “It was so refreshing and a stress-buster for us.”
Besides doing clinical work, Dr. Singh said he also used the downtime to catch up on studying, editing, and archiving surgical videos, and mentoring his postgraduate ophthalmology student’s research. “I evaluated free papers and video films for our All India Ophthalmological Society’s upcoming conference in 2021 and contributed to some of the national ophthalmology webinars,” he added.
Dr. Nijm also used the downtime productively: “I took advantage of the extra time during the height of the pandemic to design my first clinical trial. A quiet office was the perfect opportunity to set up the infrastructure needed for success in research.”
Additionally, Dr. Nijm launched a new website to help physicians improve their negotiation skills: www. MDNegotiation.com. “The pandemic highlighted the need for physicians to not only focus on lean practices, but to sharpen their business skills as well. After coaching and teaching negotiation skills for a number of years, I made the decision to launch this new educational venture to help ophthalmologists improve this crucial life skill during the pandemic,” she shared.
Another silver lining? More efficiency and creativity with visits to ensure patients receive the highest level of care, all while minimizing the risk of exposure to COVID-19. “I also think this pandemic has challenged us to be better prepared for future unexpected interruptions in practice. I have spent a lot of time working with my staff to ensure we are well prepared to care for our patients should a resurgence of COVID occur in the future,” said Dr. Nijm.
Further, Dr. Uy saw the benefits of shifting physical meetings to an online format. “Physicians were able to learn just as much — or even more — by attending some of the countless webinars, virtual congresses and accessing online learning resources,” he said, noting the environmental benefits as well.
Meanwhile, Dr. Matossian said at her practice they’re looking forward to a less stressful work environment in 2021. “Our goal is to exceed our pre-COVID levels by working in a more streamlined fashion and by shortening the patient throughput by compartmentalizing the non-diagnostic portions of the visit and completing those online beforehand in a HIPPAsecure manner.”
The View from Within: Industry Insights from Geuder
Mr. Hamadi El-Ayari is vice president of sales and marketing at Geuder AG in Heidelberg, Germany. Geuder is a leading manufacturer of ophthalmic surgical instruments, devices and ultrapure biomaterials. As an industry partner, Mr. ElAyari shared his perspective on the pandemic’s implications. Mr. El-Ayari said the biggest impact is the loss of resources. “Geuder went into a government-sponsored ‘short-time working program’ to counterbalance the decline in demand,” he explained. “Many of our service and cooperation partners lacked resources, which caused delays in various projects and affected innovation. Implementation of the new medical device regulations has consumed resources, too.” Looking at specific segments, we’d likely see COVID-19’s impacts on an individual country basis. For example, when did the virus arrive, when did the government lock down, and which surgeries were elective, continued Mr. El-Ayari. “The number of phaco surgeries declined significantly in some regions (because they were postponed or cancelled). DMEK and corneal surgeries recovered rather fast, but we see a lack of donor availability in some countries. While vitrectomy was less affected, as many posterior pathologies are progressive, it’s not recommended to delay those surgeries,” he explained. “I believe refractive surgery experienced a boom as everybody got sick of foggy glasses while wearing masks.” Although physicians may embrace the virtual meetings and webinars, industry partners may find them to be less efficient and personal. “Ophthalmology and its technologies are complex. A personal conversation, wetlab, OR visit, or a hands-on discussion is difficult to replace with a video call,” said Mr. El-Ayari. He credits Geuder’s longevity — the company celebrates its 70th anniversary this year — with its success during this challenging time. “We maintain excellent and longlasting personal contacts with many ophthalmologists around the globe, as well as with our distribution and cooperation partners.” He said this has likely made it easier for Geuder to move into the more non-personal online realm versus a start-up, which may not have those established relationships. However, he said that as a mid-sized company, personal contact is also a key to their success. “You can’t have a chat with Mr. Zeiss, Mr. Alcon or Mr. Bauch & Lomb — but you can talk to Mr. Geuder.” So, how has the absence of physical congresses impacted Geuder’s business? Mr. El-Ayari said it’s difficult to measure, though it’s certainly had an impact. “Ideas for innovative new products always came from cooperation and personal conversations with surgeons… and the virtual alternatives did not really focus on personal exchange and communication. The visitor might follow the session live, or months later offline, but it’s more challenging for companies to directly interact with the key opinion leaders (KOLs),” he explained. “In a real conference, we are all there at the same time and place. We do not only meet at scheduled meetings, but we also meet casually [throughout the venue]. ‘Live’ is all about communication.” “Ultimately, we miss the personal contact very much and we look forward to the next bigger conference in order to feel like a fish in the water again,” said Mr. El-Ayari. Like the physicians we spoke with, industry folk are also optimistic about new opportunities in ophthalmology. Mr. El-Ayari said Geuder has recently launched various exciting innovations. This includes a comprehensive suture portfolio for glaucoma, like the Kodomskoi suture-probe for nonfiltrating glaucoma surgery — which has shown significant reduction of intraocular pressure (IOP) and offers a price-sensitive, state-of-the-art alternative to stent insertion, and the bi-manual intraocular micro-suture technique for IOL fixation or iris reconstruction, developed by Prof. Hattenbach. “We launched new highly efficient phaco tips that reduce surgery time and a revolutionary multifunctional phaco distal chopper in cooperation with Dr. Jacobovitz,” shared Mr. ElAyari. “We also have a new DMEKunfolding cannula developed with Dr. Saad and have established the game-changing Descemet membrane endothelial keratoplasty (DMEK)RAPID preloading system — the first CE-certified system to preload a human donor Descemet-membrane, directly at the cornea bank.” Geuder has also enhanced its portfolio for posterior segment products. “There is so much more to come — and this is why we’re missing the personal communication and in-person meetings, and to celebrate our 70th anniversary and share our innovations,” he continued. “I do hope we will get back to inperson meetings, where you can meet the publishing doctor in front of his poster, drop your forceps for repair at the Geuder booth, or have a drink and chat and share gossip about God knows what — as this is vital, too,” concluded Mr. El-Ayari.
Editor’s Note:
Mr. El-Ayari recently survived COVID-19 and we at CAKE Magazine are glad to hear it and wish him all the best.
Contributor
Mr. Hamadi El-Ayari is vice president of sales and marketing at Geuder AG in Heidelberg, Germany. He also serves on the company’s executive board. In this role Mr. El-Ayari is responsible for the entire interface between Geuder and its customers, including its sales force in Germany and distributors in 120 countries, and serves as board director for the two sales subsidiaries in Singapore and India. He attended the University of Applied Sciences Frankfurt, Technical Engineering, where he focused on biotechnology, synthetics and polymer technologies and thermodynamics. In addition, Mr. El-Ayari holds six patents, with three pending.
hamadi.el-ayari@geuder.de
Looking toward optimism and innovation in 2021
At press time, COVID-19 vaccines are in various stages of development and distribution around the world — but there is still a long way to go until things can return to “normal”.
Until then, there is plenty of space for ophthalmic innovation. In 2021, Dr. Singh shared that, as a firm believer and proponent of affordable health for all, he will continue to focus on innovative surgical techniques that eliminate the need for expensive machines and technologies without compromising outcomes. “This was my focus, even before the pandemic,” he said. Dr. Singh invented an intratunnel phacofracture MSICS technique. It costs about US$10 and eliminates the need for expensive phaco machines and consumables.
While the pandemic continues, there are also opportunities in home diagnosis, monitoring, and sustained release drugs, said Dr. Uy. “There will also be a need for affordable, portable OCT, high-resolution fundus cameras, long-acting intravitreal medications, and drug eluting medical devices. Artificial intelligence will also be needed to interpret remotely generated images,” he continued. Further, home COVID-19 testing, such as saliva tests, will be the dominant method for screening patients in the future; while automated chatbots will take over routine practice queries and appointment scheduling. “There will likely be at least a short-term shift from tertiary hospital eye care to smaller, out-patient clinics,” concluded Dr. Uy.
Dr. Nijm said she is looking forward to new developments and innovations in diagnosis and treatment of myopia, presbyopia, and dry eye. “These are three very common diseases that affect a huge portion of the population worldwide and what I have seen coming down the pipeline is very exciting,” she shared. “In the surgical arena, I think the incorporation of AI, virtual reality and visualization will elevate the next generation of IOLs and cataract surgery. And as the number of patients with cataracts rises, we will need these advancements in technology to provide much needed care for these patients.”
Contributing Doctors
Dr. Sibylle Scholtz is a biologist, chemist, Ph.D. in medicine, international science correspondent, and associate senior research fellow at the Institute of Experimental
Ophthalmology, Saarland University Faculty of Medicine in Germany. She has long-standing experience in the ophthalmic medical device industry and in national and international medical device law.
sibylle.scholtz@gmx.de]
Dr. Cynthia Matossian, M.D., FACS, is the founder and medical director of Matossian Eye Associates, a practice with three offices in Pennsylvania and New Jersey. She is a consultant to numerous pharmaceutical and medical device companies and is on the leadership team of the American College of Eye Surgeons, the NY IOL Implant Society, and Women in Ophthalmology. She serves on multiple editorial boards, has published numerous articles, received the prestigious Ophthalmic World Leaders Visionary Award, and was included in the Ocular Surgery News’ Premier Surgeon 300 list. She is a clinical assistant professor of ophthalmology (adjunct) at Temple University School of Medicine.
cmatossian@cmassociatesllc.net] Dr. Lisa Nijm is a boardcertified ophthalmologist at Warrenville Eyecare and LASIK, a licensed attorney, and an assistant clinical professor of ophthalmology at University of Illinois Eye and Ear Infirmary in Chicago. She also serves as the CEO of Women in Ophthalmology, mentors physicians through www.MDNegotiation. com, and advises leading medical device and pharmaceutical companies on new innovations in ophthalmology. She was the first surgeon in central Illinois to perform femtosecond LASIK, has taught over 2500 ophthalmologists as co-director of the Osler National Ophthalmology Board Review, and has received numerous honors and awards — including being named one of the top 50 most influential ophthalmologists in the world on The Ophthalmologist’s Power List in 2019.
lmnijm@uic.edu]
Dr. Sudhir Singh is a renowned ophthalmologist and is currently senior consultant and department head at JW Global Hospital Research Centre in Mount Abu, India. He completed his MBBS and SMS, M.S. Ophthalmology from Medical College Jaipur. He was trained in pediatric ophthalmology and strabismus by Orbis International. Dr. Sudhir Singh has been an invited speaker for various national and international conferences and has performed live surgeries at various conferences as well. He has intratunnel phacofracture technique MSICS, SquintMaster software, and many other innovations to his credit. He has more than 30 national and international publications to his name, and is an awardee of the All India Ophthalmological Society’s prestigious “International Ophthalmic Hero Award 2020.
drsudhirsingh@gmail.com]
Dr. Harvey Uy, M.D., is a clinical associate professor of ophthalmology at the University of the Philippines, and medical director at the Peregrine Eye and Laser Institute in Makati, Philippines. He completed fellowships at St. Luke’s Medical Center and the Massachusetts Eye and Ear Infirmary and has been a pioneer in femtosecond cataract surgery, accommodation restoration by lens softening, modular intraocular lenses, and intravitreal drugs. He has published over 30 peer reviewed articles and is on the editorial board of American Journal of Ophthalmology Case Reports. He is a former president of the Philippine Academy of Ophthalmology and current council member of the Asia Pacific Vitreo Retina Society.
harveyuy@gmail.com
The Roller Coaster Ride of 2020One thing is for certain: 2020 was one roller coaster of a year. Now, as we embark on a new year, many of the previous year’s challenges persist — the main challenge, of course, is COVID-19 and its related consequences. Throughout 2020, Media MICE CEO Matt Young kept in virtual touch with both surgeons and ophthalmic industry partners as part of the Q&A from Quarantine video series. Below, we take a look at some of those highlights.
On twists and turns:
— Scott Korney, COO, Avellino
— Kuntal Joshi, director, Asia -Pacific, SIFI Group
“[Practices should] stay solvent and look carefully at cash flow because it is going to be somewhat reduced. Now is not the time to go out and make a major purchase. I think that’s also going to impact the industry a little bit and that many of us probably won’t be buying the next instrument or diagnostic device right away ... most of us are going to be pretty careful about capital
expenditures.” — Dr. Richard Lindstrom, founder and attending surgeon, Minnesota Eye Consultants, USA
On reaching new heights:
“Smart people who utilize this time and reinvent themselves probably will create new business models to add value to customers. [For example], in optometry, going away from lenses and frames to focusing on healthcare is a business model people should look at. From an ophthalmology point of view, business will have to go back to normal because patients will still need care.”
— Shane Hage, regional director for AsiaPacific, Icare Finland
“We’re trying to look at what we can do to support our customers, ophthalmologists and patients. And I think we’ll end up with a bunch of best practices that we’ll continue to provide.[Medications to lower treatment burden] are going to be a major focus for our research and development teams... to look at areas where we can actually help ophthalmologists and patients to relieve burdens. I think that if you look over the next five to 10 years, the products coming from Allergan will have a major focus on lessening burden and helping patients.”
— Charles Holmes, former associate VP and former head of Eyecare Global for AbbVie
“You can do an awful lot without being in the office, and I think that’s going to be the new norm going forward. We are going to be living in a new era post-COVID. And I think it’s been a big eye opener for all of us, the whole world. Virtual care is going to become a standard of care for a lot of us. It’s not going to ever fully replace being in person — obviously we still have to do surgery, we still have to see people for certain things — but we’re going to be doing a whole lot of virtual visits. I find it to be very intriguing, very fascinating, and I certainly hope to help innovate it to some degree in this field going forward.”
— Dr. Christopher Starr, ophthalmologist at Weill Cornell Medicine, New York, USA
On ups and downs:
“A lot of the dry eye procedures are premium, cash procedures. Now, patients may say that ‘I’m going to use artificial tears, warm compresses, baby shampoo, tissues, etc.’ — then I might think about paying for a more premium procedure. As for cataract surgeries, you’re still going to have the Baby Boomers who are retired and whose finances didn’t really take much of a beating, unlike the working class — those of us under 65 to 70-years-old who are working toward retirement. I think that it will be the younger group that will be more conservative, financially. Those who are 40 to 50-years-old, they might not be coming in for LASIK or LipiFlow as often.”
— Dr. Francis Mah, advanced corneal, cataract and refractive surgeon, California, USA
“How do you stay in touch with surgery when you’re not in the operating room as much as you want or need to be? There is a lot of anxiety about this — and there’s a lot of different ways we’re adapting to it. I tell people it’s like riding a bike: You’re gonna be okay. You’ll feel funny for your first couple of days back and then you get right back to it. We’re making sure that when there are surgical cases, our residents and fellows are in the operating room, so that they’re getting exposure to the limited amount of surgery that’s going on right now. For young eye surgeons that is by far the biggest concern that they’re facing during the COVID-19 pandemic, preserving their surgical skills.”
— Dr. Julie Schallhorn, ophthalmologist, San Francisco, California, USA
“In order to launch a product, historically, it required having individual conversations, professional education discussions, etc.
Typically, these things happen at an in-person congress such as ASCRS, where we had plans to launch some products. Along with the safety of our people, having the right empathy for our customers is also very important. We would much rather try to understand how we can partner today and prop up ophthalmology. Then we can come together and help patients as we go forward — that is really the focus for us, and I want to make sure that our customers hear that.”
— Warren Foust, worldwide president, surgical vision,
Johnson & Johnson Vision
Back to Work Amid COVID-19
Developing Safety Practices & Effective Business Measures
by Tan Sher Lynn
As restrictions ease in some parts of the world amid the ongoing COVID-19 pandemic, many are eager to get back to life and business. Nevertheless, there are various considerations in this new normal for doctors and ophthalmologists to take note of in order to resume their practices safely and efficiently.
Kudos to the brave frontliners, medical practitioners and ophthalmologists around the world who have paved the way and established safety protocols for the rest of us to follow. During the American Academy of Ophthalmology (AAO) 2020 Virtual, US-based CEOs and ophthalmologists shared some of the effective protocols and business measures they’ve instituted to get back to practice safely and successfully amid the still ongoing threat of the pandemic.
Managing finances in a reduced service environment
According to Dr. Ann M. Hulett, CEO of EyeHealth Northwest in Oregon, USA, ophthalmologists face various challenges as they prepare to reopen their practice.
“For me, the challenge is to resist the urge to plan as though this is a brief practice closure after which all patient volume, cash flow, staffing and processes will return to previous levels. This is not likely to happen,” shared Dr. Hulett.
Instead, she recommended adopting a philosophy of zero-based budgeting — looking at purchasing and staffing anew, based on the business you have or will have in the next few months, as opposed to last year or what you hope to have in the coming years.
“The most valuable staff members you have are those who can and are willing to fill multiple roles in your smaller volume practice, such as techs who can triage and scribe, and surgery schedulers who can staff the phones and check in patients,” she said.
She also stressed the importance of knowing one’s current financial state (regardless of the point in the recovery process). This includes being aware of account balances and lines of credit, keeping track of and projecting cash flow, as well as knowing how much stimulus money has been used, and when it needs to be repaid.
Transforming patient experience
For Dr. Sonny Goel from Maryland, USA, in the post-COVID new normal, it’s important to make changes to increase the safety of employees, physicians and patients.
“Patients won’t come to the clinic if they don’t feel safe. So, how can we do this? Some ways include communicating this goal to employees and patients, maximizing the use of telehealth, ensuring in-office precautions are in place and limiting patient movement, as well as time in the clinic,” said Dr. Goel.
Pre-COVID, patient histories and examinations were done in-office, exam results were discussed, and the patient called if they had any questions. But post-COVID, Dr. Goel suggested that physicians take patient history in advance via telemedicine, then educate and discuss surgery online.
“When patients arrive at the clinic, the examination is done to confirm the diagnosis and discuss consent. The patient will make three stops at the clinic: at the door for a temperature check, at the technician room and
finally, the examination room before exiting. This ensures a smooth flow and minimizes the time they spend in the clinic,” he added. In terms of the office environment, Dr. Goel suggested placing fewer chairs in the waiting room, installing plexiglass screens at the front desk, using air purifiers, removing magazines, and limiting visitors by asking them to wait in the car.
Safety tips for reopening
According to Dr. Julia Lee, CEO of Vantage EyeCare, USA, as physicians resume their operations, it’s essential to understand federal guidelines as well as regional implementation, and check for updates early and often, as not every change is announced.
As for staffing, Dr. Lee shared: “After years of staffing for efficiency and optimization, we suddenly find ourselves having to staff for safety,” noting that higher risk of transmission from infected individual comes from close contact (within six feet), prolonged contact (greater than 10 to 15 minutes), and unprotected contact (without universal masking).
She added that the effort is about mitigating the risk of transmission. This means assuming that everyone is COVID-19 positive, screening for signs and symptoms with enhanced universal precautions; and finding out if the patient has recent exposure to people who are COVID-19 positive. She also advocated controlling the pace of patient flow and adopting social distancing within the facility, as well as enhancing environmental cleaning.
Dr. Lee suggested that for patients coming for appointments, cloth masks are sufficient, but they should be clean and secure over the mouth and nose. Meanwhile, health care workers who are in direct contact with patients should wear medical or surgical masks.
As for hand hygiene, gloves are recommended for all contact with patients and should not be reused. “Gloves should not be washed or sanitized between use. If gloves are in short supply, use it for the dominant hand only and do not touch the patient with your ungloved hand. Wash both hands immediately after,” she said.
Dr. Lee also recommended having frequent “hand hygiene breaks” for staff, keeping nails no longer than one quarter inch beyond the fingertips and discouraging artificial nails on healthcare workers, and wiping down all high touch surfaces and objects frequently.
Human resource considerations
Dr. Benjamin M. Higginbotham, chief operating officer of West Coast Retina, USA, recommended paying staff bonuses and using pandemic-related incentives to compensate for the added risk of returning to the office.
“Having a flexible work schedule can help alleviate some of the stress that staff who are parents face, as schools may be closed. And even if they are open, it may take more time to drop off or pick up their children due to social distancing,” Dr. Higginbotham shared.
“It’s also time to reimagine your workflow. Discuss this with your employees. Will you continue to work from home? What can and should you automate? What can you do to limit the time your patients spend in your office? Should you outsource? Will you be deleting or adding roles, for example, hiring a daytime cleaning staff?”
According to Dr. Higginbotham, hiring, training and retention of staff are expensive. “Making the decision to terminate an employee causes shortterm savings but a long-term increase in expenses. However, one bad apple does spoil the whole barrel. Forcing a negative employee to come back early could hamper your recovery efforts,” he added.
“Lastly, take breaks. You don’t have to have all the answers all the time. Share the responsibility whenever possible. Remember to take time for yourself to prevent burn out,” he advised.
Editor’s Note:
The American Academy of Ophthalmology annual meeting (AAO 2020 Virtual) was held from November 14 to 17, 2020. Reporting for this story took place during the event.
with COVID-19. What made this outstanding was that it was published according to the hybrid format, too, vastly increasing consumption opportunities. The 200-page document is still available to be read online.
This effort was achieved in tandem with other stakeholders, including the Oculoplastic Society of India and other subspecialty societies. Another note for optimism is an increase in non-emergency ophthalmological procedures, which were stymied by the pandemic. Dr. Sharma said clinics are reporting more activity and more procedures are planned.
“I think ophthalmology is getting back to normal, say to about 70% of normality. When the pandemic is over, there will also be a bounce effect, so I am optimistic. Once the physical world comes back, the online world will be able to supplement it too,” Dr. Sharma concluded.
Hybrid Conference Format — Here to Stay
by Andrew Sweeney
The nature of ophthalmology’s various conferences abruptly changed this year. In fact, we are now all experts in webinars and online networking. And we all know that when any change is repeated over a long period of time, it has the habit of becoming permanent. Thus, it’s safe to say that expert webinars and other online events are set to become a permanent feature in the postCOVID-19 world.
Old-school, but hybrid
However, this does not mean that this is the end of old-school, in-person conferences. Far from it — there is still considerable demand for real world events, as the recent Evolving Practice of Ophthalmology Middle East Conference (EPOMEC) held last month in Dubai, United Arab Emirates, proved. “Real world” conferences will continue to go ahead, they will just be somewhat different.
EPOMEC was organized and held according to a hybrid format — that is to say the conference was still organized in-person with the usual symposiums, concession stands, and schmoozing. But it was also held online. Visitors were able to check into the virtual lobby from around the world without having to endure a diminished experience. This allowed both those living under travel or financial restrictions to attend and enjoy the full EPOMEC experience. It is this last factor in particular that will likely make the hybrid model permanent in the coming years, as it opens up ophthalmology conferences to new audiences. That is according to Dr. Namrata Sharma, Hon. General Secretary of All India Ophthalmological Society (AIOS) and professor of ophthalmology at the All India Institute Of Medical Sciences (AIIMS), New Delhi.
Contributing Doctor
Slowly and steadily getting back to normal
Sitting down with Media MICE CEO Matt Young, Dr. Sharma revealed AIIMS’ conference plans for this year.
“The future meeting that we plan to hold is in 2021, and it is going to be held on a hybrid platform, as most will now be. Some halls are going to be physical and some are going to be virtual. We made this decision as people from overseas may not be able to travel to India,” shared Dr. Sharma.
“With a click of a button, you would still be able to learn and educate yourself on whatever you wanted — the nuances of surgery or procedures or investigative modalities, etc. It really opens up the ophthalmological field,” she said.
Dr. Sharma reported that AIIMS renewed its educational efforts for staff during the pandemic, producing guidelines on many aspects of coping
Prof. Namrata Sharma is a professor of Cornea, Cataract and Refractive Surgery Services at Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India. She has done her fellowship at Moorfields Eye Hospital in London, UK. She is Hon. General Secretary of All India Ophthalmological Society, as well as Regional Secretary of Asia-Pacific Academy of Ophthalmology (APAO). Prof. Sharma has two patents under her belt (Natasol & Natamatrix), and is a brand ambassador for The Tear Film and Ocular Surface Society (TFOS-DEWS II) in India. Among her international awards include the following: Senior Achievement Award, American Academy of Ophthalmology ( AAO); International Ophthalmologist Education Award, AAO; Best Video awards by ESCRS, RANZCO and “Best of Show” awards 6 times by AAO; APAO Leadership award; and APAO Achievement Award. Prof. Sharma has also published 450 publications in international peer reviewed journals and authored 17 books and instruction courses at several International and national platforms. In addition, Prof. Sharma is a principal investigator in many multicentric international, FDA trials, and RCTs which, have changed the clinical practice.
secretary@aios.org
