CAKE Issue 16: The ebook version (The Hybrid Conference Issue)

Let's Get Familiar

Online meetings kept us going, but it's the interactions at the in-person meetings that are the real McCoy

Rather than breeding contempt, familiarity breeds connections. Friendships. Relationships. If you could remember your experiences as a baby, the first time you heard a new noise, saw a new face, or were presented with a new toy, chances are that it would scare you. You'd have cried. But repeated exposure to the sound/toy/face soon led to familiarity, a lack of fear, then a liking of said face or object. It's the same with music. Play people some crazy, unfamiliar music. At first, they will hate it. But repeat it often enough, people start to like it, simply because it's familiar.

What humans like more is meeting people. The fact that you met someone once before is enough to open doors the next time you meet them. This familiarity breeds ease with the other person. They're not a stranger. Even better, if they've remembered your name, then clearly you're a person that left a lasting impression on the person. It's the genesis of almost all networking, and the start of pretty much every meeting of great minds in history. For most of the post-industrial revolution period, humans have been brought together in increasingly urban locations, and for most of that time, that's not been a bad thing. People in a town or city have their local shops, restaurants, bars — and random interactions happen. Familiarity is bred — “didn't I see you at the bar last night?” — and a community is born. It's wonderful stuff.

This all goes to explain why I love in-person conferences. You mix together a bunch of smart people, all of whom share a lot in common, into a building, and they all interact. Sure, those with podium power get more of the peer recognition goodness from the event, but the interactions at the foot of the podium after a session finishes, at the posters, or even in the queue for a coffee are all good for the soul ... and good for everyone's real-life social network. Then there are the actual networking events, the restaurants, the bars — all in an agreeable city with fun venues where the city lights guide you back to your hotel room that's 15 stories high at 3 o'clock in the morning. You could not engineer a better recipe for intellectual intercourse and forging friendships — and the occasional rivalry, too. Absolutely fabulous. Never better. But then, COVID happened.

We were not going out anywhere. Everything changed. We all learned to live with Zoom (and if you're less fortunate, experience Microsoft Teams). We've seen pre-recorded talks streamed to our PCs and phones wrapped in the once-mighty international congress branding, on their websites. And this was not a bad thing. It massively dropped our collective carbon footprint. It dropped the cost of entry and expanded access to more people who would ordinarily not have participated. Speakers and delegates got to spend more time with their families, and less time earning status miles on airline rewards schemes. The high life it was not, but ... they became familiar. We didn't mind. I'm sure introverts loved it. But to me, it felt like low-fat, plastic-like cheese compared to the good stuff. Hersheys instead of Sprüngli. American Budweiser compared with Czech Budweiser. I mean, I would prefer online attendance at a congress over no attendance, but I'd much prefer to be there in person. A junkie might see the online meeting as something akin to methadone, when what they are really thinking is gimme gimme gimme the heroin of a good APAO or AAO.

Joking apart, it's the back-and-forth of audience members questioning the speakers that I think online meetings truly fail to capture. It's great to experience smart people vigorously debating when they're in the thick of it during a plenary session or at a poster presentation. Harvesting questions from a box on a webpage or the Zoom chat function works ... but it's too disconnected for debate to flow. There's no real-time coupling of the interlocutors. I also think that if you're attending a conference from a desk at work, you're far more likely to be distracted by other things going on in the office.

So now we're in an era of hybrid meetings. You get all of the benefits of wider content dissemination and allow more people to participate and ask questions. But honestly, if you're still game to travel and attend the conferences in person, you're going to get far more out of it. It's far easier to become familiar with others, and others get to become familiar with you. In the long run, those connections make a difference. So start booking your flights and hotels for the 2023 season, and who knows — maybe I'll see you at the next one!

Mark Hillen

Hillen, PhD Director of Communications ELZA Institute, Zurich, Switzerland Editor-At-Large | CAKE

Mark

Dr. Harvey S. Uy

University of the Philippines; Peregrine Eye and Laser Institute Manila, Philippines harveyuy@gmail.com

Dr. Chelvin Sng

Chelvin Sng Eye Centre, Mount Elizabeth Novena Hospital Singapore chelvin@gmail.com

Dr. George H.H. Beiko

University of Toronto; McMaster University Ontario, Canada george.beiko@sympatico.ca

Dr. Boris Malyugin

S. Fyodorov Eye Microsurgery Institution Moscow, Russia boris.malyugin@gmail.com

Prof. Jodhbir S. Mehta Singapore Eye Research Institute (SERI); Singapore National Eye Centre (SNEC) Singapore jodmehta@gmail.com

SOCIETY FRIENDS

Dr. William B. Trattler

Center For Excellence In Eye Care Miami, Florida, USA wtrattler@gmail.com

Arunodaya Charitable Trust (ACT)

IOL Choice with an Aussie Legend

by Matt Herman

In the Cataract Update Lecture on Day 3 of RANZCO 2022, a new go-to IOL king was crowned by optics wizard Dr. Graham Barrett…

In any case, Dr. Barrett finally came to the topic of extended depth-of-focus (EDoF) lenses, a term he coined himself. He reviewed various optical principles (diffractive, refractive, aspheric surface, pinhole optics, rotational asymmetrical optics) behind EDoF lenses, before arriving at his main conclusion. The faustian bargain with optical quality in multifocal lenses simply isn’t worth it, and the age of EDoF lenses is upon us.

EDoF your caps

There is no one reason for this, in Dr. Barrett’s eyes, but the decision comes down to the way the dust has settled for vision needs and the criticality of patient satisfaction in our modern world.

As the final day of the 53rd Annual Scientific Congress of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO 2022) wound down, something – or someone – seemed missing before your man on the scene trudged into the Thunderdome (Great Hall 2) for his final series of lectures. It would hardly seem like a RANZCO Congress without a sighting of one of the region’s brightest stars, the usually-omnipresent Dr. Graham Barrett. And finally, after much anticipation and a glowing introduction from Cataract Update Lecture chair Dr. Jacqueline Beltz, Dr. Barrett took the stage and all was right in Brisbane, Australia again.

Changing of the guard

There is no better choice for laying down the law on IOLs and optics than Dr. Barrett, inventor of the eponymous Barrett series of IOL calculation formulae, amateur astronomer, and all around class-act. And as per usual, Dr. Barrett’s lecture announced yet another massive shift in the IOL landscape.

It started innocently enough, with a review of the current galaxy of IOL choices, which at this point must rival the amount of stars in the sky (kidding, obviously). Dr. Barrett began by describing the hype, and his own excitement, surrounding the invention of the first multifocal lens. “It may surprise you, but I was one of the first surgeons to use multifocal IOLs, but the optical imperfections, the compromise in optical quality, soon became apparent – and my enthusiasm has waned,” he admitted.

Pleased to meet you, won’t guess my name

After an in-depth review of the optical quality pitfalls inherent in multifocal IOLs, he quoted a little-known song by some band called The Rolling Stones. Something about not being able to always get what you want. Your correspondent’s voice recorder was muffled, but it seems like this music group might be worth checking out.

Of course multifocal IOLs offer unparalleled spectacle independence at all distances, but this should no longer be prioritized over all-important patient satisfaction, which is what truly suffers with multifocal lenses. And according to Dr. Barret, the needs of the modern world with regards to intermediate and near vision (think mobile phones and electronic devices) can still be met by EDoF lenses without the sacrifice in visual quality necessitated by multifocal lenses.

“When I look at the tradeoff between these factors – spectacle independence versus quality of vision, it seems to me that a combination of extended depthof-focus and an element of monovision may be a preferred solution,” he asserted. “There’s no doubt that an extended depth-of-focus lens provides better quality vision… And I think it’s this quality of vision parameter which is the reason why patients with extended depth-of-focus IOLs are highly satisfied,” he added.

Editor’s Note:

A version of this article was first published in Issue 4 of CAKE & PIE P0ST, 53rd RANZCO 2022 Edition. The 53rd RANZCO 2022 was held on October 28 - November 1 in Brisbane, Australia. Reporting for this story took place during the congress.

Behold the Silver Lining in Cataract Care

Inspired Artistry and Surgical Wonders

At the recent CAKE & PIE Expo 2.0 Expo in Da Nang, Vietnam, attendees were treated to a session with four of ophthalmology’s major industry influencers to discuss complications in cataract and refractive surgery.

Dr. Soosan Jacob showcased advances in her groovy technique of customizable intrastromal ring segments. A short while after, Dr. Arun Gulani, with his trademark pizazz, cut to the chase on surgical kudos defined by artistry, care and vision. Not to mention Prof. Jorge Alió who, with fine academic scrutiny, allayed fears over bilateral cataract surgery. All this before Dr. Uy dazzled with a report on a combined femto-laser and phaco machine … all before heading to the beach! Read the full report below.

Slice it as you like it

Intrastromal corneal ring segments (ICRS) using synthetic implants are not always trouble-free. Seeking a simpler solution, Dr. Soosan Jacob hit upon the idea of replacing synthetic rings with allogenic tissue, calling it CAIRS (or corneal allogenic intrastromal ring segments).

Allogenic tissue is a good way of dodging complications such as anti-stromal necrosis and corneal thinning, or keratoconus. In other words, it avoids fixing one problem with another. These rings can also be implanted at a closer depth of 50% which results in a more stable cornea.

But, the real beauty lies in how the tissue

by Roger Shitaki

can be (artistically) cut and shaped into various thicknesses, tapered segments and arcs to realign topographical corneal irregularities. This technique further lends itself to steeper and thinner corneas, and what’s more, the postoperative cornea sparkles with a natural aesthetic.

Studies show significant improvements in UVCA and BCVA, as well as decreased visual distortion, but long-term results are still forthcoming.1 So far, it has proven a safe and simple treatment for post-LASIK ectasia, keratoconus and other ectatic disorders.

Don’t look back in anger

The next presentation by Dr. Arun Gulani

was about Correcting Nightmares to 20/20. The expressed purpose was to demonstrate a radically fresh approach to refractive eye surgery, partly in the context of dealing with postoperative complications.

To amp up the theme of making things easier and simpler, or getting down with less, Dr. Gulani showcased his own patented LaZrPlastique surgery — a non-invasive alternative to LASIK.2 This technique also opens doors to patients excluded from LASIK by preoperative screening.

LaZrPlastique, however, is only one tool in the box. For Dr. Gulani, it’s all about vision first, surgery second and technology last. The goal is to bring every patient to 20/20, which in turn means rising to the challenge with surgical vision and artistry.

Surgical artistry is backdropped by the ambience, aesthetics and comfort that puts patients at ease. Procedures should avoid barbaric surgery, pain and anesthesia. In most cases, numbing eye drops are used and dialogue is maintained with the patient as their visionary field is normalized.

In practical terms, any refractive surgery starts with stabilizing the cornea and making it measurable. Then, mix-and-matching techniques and micro-surgeries with architectural skill help patients realize the dream of 20/20 vision.

In one instance, Dr. Gulani even took a step back by making a patient myopic with a piggyback lens. The reason being that the one surgery that would fix a myriad of problems was myopic laser surgery, but the patient was hyperopic! A maverick solution, but one that got to 20/20 vision without getting bogged down in pathologies or surgical acrobatics.

Outdoing doubts with details

Next up was Prof. Jorge Alió from Spain and his fine academic scrutiny of tiptoeing around immediately sequential

bilateral cataract surgeries (ISBCS).

ISBCS, despite showing better visual outcomes and higher patient satisfaction than DSBCS (deferred), is still not hugely popular.3 This is often due to perceived risks or lack of incentive — despite significantly reduced costs, clinical visitations, lost work hours and less extraneous co-morbidity risk to patients.

As for intraoperative risks, vitreous hemorrhaging can occur in any intraocular incisional surgery.

In the post-op analysis, ISBCS showed negligible risk of corneal decompensation. Other complications showed no difference compared to DSBCS.

combines two big tools in one innovative device.

Both phaco and femto-laser assisted cataract surgery (FLACS) have decades of accumulated success. So why not put them together? Indeed, the new ALLY system from Lensar (Orlando, Florida, USA), combines femto-laser and phacovitrectomy into one device. Two-for-one is always a great sell, but how exactly did this one pan out?

In short, performance analysis showed nine minutes per case was saved using ALLY. It also showed improved safety, better clinical outcomes and greater efficiency. Specifically, corneal incision times and treatments were four times faster.

A big time saver for sure — plus its compact footprint and the fact that it can be placed anywhere within a 240-degree radius of the patient adds further benefit. And speaking of impressive feats, imaging for surgical planning is almost instantaneous with six independent cameras operating across multiple planes. What’s more, there is no compromise on the functional advantages of the original machine.

References

Furthermore, the most feared risk of bilateral endophthalmitis was recorded in only four instances, all in breach of surgical protocols. The established protocol is to treat each surgery as a separate case including the use of fluidics, instruments and surgical attire.

Overall, the academic review concluded that the benefits of ISBCS far outweigh the risks when strict protocol is followed matched to surgical competence.

A man and the machine

Finally, the session ended on a high note by rolling out the latest in cool, funky tech. Dr. Harvey Uy had the pleasure of showcasing the new ALLY system, which

1. Jacob S, Patel S, Agarwal A, Ramalingam A, Saijimol AI, Raj JM. Corneal Allogenic Intrastromal Ring Segments (CAIRS) Combined With Corneal Cross-linking for Keratoconus. J Refract Surg. 2018;34(5):296-303.

2. Gulani AC. Corneoplastique™: Art of vision surgery. Indian J Ophthalmol. 2014;62(1): 3-11.

3. Lansingh VC, Eckert A, Strauss G. Benefits and risks of immediately sequential bilateral cataract surgery: a literature review. Clin Exp Ophthalmol. 2015;43(7):666-672.

Editor’s Note:

The CAKE & PIE Expo 2.0 was held in-person in Da Nang, Vietnam from August 20-21, 2022. Reporting for this story took place during the expo.

Glaucoma Smart

Diagnostic Funk, Dropping the Drops & the Future Fantastic

by Roger Shitaki

At the recent CAKE & PIE Expo 2.0 in Da Nang, Vietnam, a glaucoma symposium came packed with new paradigms in diagnostics, interventions and management strategies. These ranged from deploying smart technologies using machine learning (ML), deep learning (DL) artificial intelligence (AI) algorithms, and battling drops from reformulation, to sneaky delivery systems and MIGS surgery.

More to a pic than meets the eye

Dr. Sahil Thakur from the Singapore Eye Research Institute dropped knowledge on various smart glaucoma diagnostic and management tools.

One example he mentioned is Selena (the Singapore Eye Lesion Analyzer), which is finishing its pilot in Singapore and is to be released further afield in

Asia. Basically, healthcare providers upload retinal pictures to the cloud and then receive — within minutes — an accurate algorithmic analysis. The targeted diagnoses are diabetic retinopathy, glaucoma and age-related macular degeneration (AMD).

Dr. Thakur shared that it’s an excellent tool for GP’s and early glaucoma prognosis. Selena can also read changes in retinal blood vessels to assess cardiovascular risks. Talk about a double punch!

Experience the funk online

Online diagnostic and management tools are now popping up, like the adjustment of Cirrus OCT parameters by signal strength. This tool uses a deep learning algorithm to adjust for poor OCT signal strength. By uploading test data, you can receive corrected values for age-related

changes for OCT retinal nerve fiber layer thickness and macular thickness.

SPARCS is an online tool that assesses both central and peripheral contrast sensitivities. Results can differentiate between mild, moderate and advanced glaucoma, and also alert to an early diagnosis. You can access the SPARCS webpage using a unique patient ID.

Tablet-based and remote testing

Melbourne Rapid Field visual field test is now the most advanced tablet-based app for full visual field, AMD, glaucoma and macular testing. It includes testing for diabetic retinopathy, as well as for neurological conditions affecting the visual field. As the app is tablet-based, it’s easy to disinfect in clinical situations and can be used in the remote field, or by patients at home. Patients can share

results online with their healthcare provider.

Bleb pics and the new sexy

Another front-line technology is smartphone-based bleb photography. Compared to a 2021 study, this technology now features improved documentation of bleb evolution, advanced ability to spot fibrosing, and a deep learning algorithm to grade blebs.1 A new research paper is pending.

Smartphone imaging apps are in development for predicting anterior chamber depth, AS-OCT parameters and gonioscopic angle closure, thus providing an alternative to bulky machinery. Visual field prediction with deep learning using OCT and fundus images is also looking promising.

Getting patients involved with tech gets results

Getting patients involved in their own glaucoma management is something often missed. However, one project already up and running is the paperbased Children’s Glaucoma Passport.

Its successes led to a similar web-based diary tool for adult patients. Monitoring of symptoms, voicing concerns and divulging mental states in between short clinical visits has proven extremely valuable, although further development is needed.2

MIGS and ‘Top Gun’ surgery

After the tech razzmatazz, Dr. Vikas Singh took the remote floor with an impassioned review of MIGS surgeries. MIGS, or microinvasive glaucoma surgery, have a high safety record and quick recovery rate with limited tissue trauma.

An overview of MIGS procedures from iStent to canaloplasty showed overall success in stabilizing and lowering IOP into the mid-teens. In many cases, this led to a reduced need for topical medications but more studies, especially on multiple procedures, are needed. 3

The takeaway was the all around benefit of early intervention in glaucoma, not only to improve quality of life for patients, but to stave off or even avoid more serious interventions like trabeculotomy.

Back to the drawing board

Dr. Indu Pal Kaur is a formulation scientist specializing in nano drug delivery systems. Her current research is nano vesicle BMT delivery or BMTNV. Bimatoprost (BMT), the popular IOP-lowering drug, is not without its limitations.

In an effort to overcome unique ocular structure and bio-absorption barriers, nano-vesicle BMT drops go beyond typical vesicular delivery systems which use liposome and niosome. BMT-NV drops are further encapsulated into a reformulated in-situ gel delivery mechanism. Talk about smart thinking!

Pre-clinical trials showed that one drop can control IOP for up to eight days.4 Hence the title of her talk, Sunday Brunch Glaucoma Drops — although brunch may have to wait a while for clinical trials to conclude.

Delivering drops into the future

Drops, as we know, tend to get a bad rap, but Dr. Constance Okeke outlined the many emerging alternatives — and the hope of dropping drops off the radar altogether.

The nano dropper, for one, is a fixture that delivers a more manageable 10µl drop. This reduces droppage waste, over-medication, side effects, as well as costs.

Alternatively, the Optejet (still in the pipeline), will deliver a fine micromist onto the eye. Acustream is a similar product in the works, and both these evolving technologies can be researched online.

Inserts and biodegradable implants!

— although not much is available for glaucoma patients at the present time — the future looks promising.

An intracameral implant (Durysta; Allergan) came out in 2020 which carries a 10 mcg bimatoprost payload in a biodegradable matrix. Although quite efficacious, it’s currently only approved for one-time use.

The first punctal plug (Ocular Therapeutix) for delivering dexamethasone (0.4 mg over 30-days) was FDA approved in 2021. A phase 2 trial for a similar latanoprost system (Mati Therapeutics) for open-angle glaucoma (OAG) or ocular hypertension (OHT) patients is underway. The plugs dissolve and absorb into the nasolacrimal system. A couple of implants for travoprost and bimatoprost releasing contact lenses (Mediprint) are also in final test phases.

Takeaway fries

There’s a lot of cheer for a future of easier, more affordable glaucoma screening. And, while patients still have to battle dreary drops, there are alternatives and therapies are metamorphosing as we speak.

References

1. Kalra G, Ichhpujani P, Thakur S, Sharma U, Optom B. Ideal illumination for smartphonebased trabeculectomy bleb photography. J Ophthalmic Vis Res. 2021; 16(3): 357–366.

2. McDonald L, Glen F, Taylor D, Crabb D. Selfmonitoring symptoms in glaucoma: A feasibility study of a web-based diary tool. J Ophthalmol. 2017; 2017: 8452840.

3. Chang EK, Gupta S, Chachanidze M, Hall N, Chang TC, Solá-Del Valle D. Safety and efficacy of microinvasive glaucoma surgery with cataract extraction in patients with normal-tension glaucoma. Sci Rep. 2021;11(1):8910.

4. Yadav M, Guzman-Aranguez A, Perez de Lara MJ, Singh M, Singh J, Kaur IP. Safety data on in situ gelling bimatoprost loaded nanovesicular formulations. Data Brief. 2019;25:104361.

Editor’s Note:

The CAKE & PIE Expo 2.0 was held in-person in Da Nang, Vietnam from August 20-21, 2022. Reporting for this story took place during the expo.

In terms of sustained release implants

A Focus on Eyes, To Help Change Lives

Making a remarkable impact on people’s lives has always been at the heart of everything AbbVie, a research-based global biopharmaceutical company, does. And making Allergan a part of AbbVie is in line with the company’s mission to protect and preserve vision for better quality of life.

From strength to strength

Eye care is a core component of AbbVie’s portfolio, according to AbbVie’s Regional Vice President for Asia, Peggy Wu. In May 2020, AbbVie completed the acquisition of Allergan, a pharmaceutical company with a long legacy in eye care. This move further strengthens AbbVie’s position as a leader in the industry.

“AbbVie builds on Allergan’s more than 70-year legacy of leadership in eye care – in bringing 125 products to market and to continue to develop medicines for today’s most prevalent eye conditions,” noted Ms. Wu. “The

integration with AbbVie allows us the scale to bring patients groundbreaking medicines. Today, more than ever, we are well-positioned with resources and focus to deliver on our commitments and turn possibilities into reality for more patients. This also allows us to advance our innovative science pipeline to help address the needs of people and communities around the world,” she added.

With the integration of Allergan, AbbVie has an expanded global footprint. One key geographic area is Asia. According to Ms. Wu, AbbVie’s mission in eye care in Asia remains to protect and preserve vision for a better quality of life for the millions of people who experience vision loss and impairment.

“Our eye care medicines treat the patients living with glaucoma, retinal disease and dry eye across Asia. The integration of the Allergan Eye Care has grown the business by over 30% in this region with the introduction of a new therapeutic expertise,” she said.

Asia, with a diverse workforce and dynamic portfolio, represents one of the fastest growing geographies for eye care. India and Asia emerging markets such as Thailand and Philippines have expanded capabilities to reach more patients and increase diagnosis rate across the region.

“Our treatments have been taking care of many patients with glaucoma, retinal disease and dry eye, leading many markets across Asia. Allergan’s rich heritage, expertise, and experience in eye care with innovative products and services for our patients now coupled with AbbVie can help continue to push the boundaries of what’s possible in eye care. The integration of AbbVie and Allergan has brought more resources and capability to help fuel continued investment to advance the pipeline and reach more patients across the Asia region. We seek to bring innovation to find new treatments and solutions that address unmet needs and new approaches to help treat preventable blindness,” she emphasized.

This is a paid advertorial produced by AbbVie. For Healthcare Professionals Only.

On a different note, Ms. Wu said that the COVID-19 pandemic has impacted patients’ interactions with medical providers due to a reduction in hospital visits. This has led to overall less frequent engagements with healthcare practitioners (HCPs).

“Given this situation, I think the pharmaceutical industry should focus even more on reconnecting patients with care and helping to fill the experience and treatment outcome gaps in the healthcare ecosystem,” she commented.

As for the future, it is foreseeable that the company will only grow from strength to strength in delivering its mission. “The global scale of AbbVie contributes to expanded geographic reach and investments that increase our capacity for innovation, enabling us to realize our mission and aim to help meet the needs of all patients we serve. We will continue to strengthen our leadership in eye care by accelerating strategic partnerships to drive innovation to support emerging and developing markets,” Ms. Wu noted.

Eyes on China

China is one of the most important markets for AbbVie. “We are committed to making a remarkable impact on patient’s lives and enhancing the development of healthcare system in China,” said Vice President and General Manager of AbbVie China, Tony Au.

“AbbVie is dedicated to long-term partnerships that enable growth of all partners and promote a sustainable healthcare system ultimately benefiting the broader population in China. This includes establishing long-term and stable partnerships with clinical scientists, industry partners and academic research institutions, aiming to support healthcare professionals through innovative models, and ultimately

References

promoting in-depth cooperation, stimulating mutual growth, and creating a healthier and more sustainable medical ecosystem,” Mr. Au explained.

In China, AbbVie is deeply engaged in areas with the highest unmet needs, including ophthalmology, immunology, oncology, neuroscience, and medical aesthetics. “Through continuous investment, accumulation and iteration, we are committed to exploring more targeted and efficient innovative medicine treatments.”

Mr. Au noted that China has tremendous unmet needs for ophthalmic care. “The country is home to approximately onethird of the world’s blind population1 and the greatest number of diabetes patients2 and is seeing rising numbers of people with glaucoma, retinal disease and dry eye across Asia.3-5 AbbVie is committed to providing innovative solutions and reaching more patients living with retinal diseases, glaucoma and dry eye diseases in China,” he said.

“We continue to explore and practice innovative business models to be able to reach more patients in China. Our glaucoma and dry eye disease drops have launched e-commerce channels and provided online disease education live streaming to facilitate patients’ disease management,” shared Mr. Au.

“Given the strong legacy and innovation pipeline of Allergan Eye Care, we are confident that AbbVie will accelerate in introducing more innovative eye care treatments to benefit Chinese patients,” he concluded.

Date of Preparation October 2022

Approval Date December 2022

ALL-ABBV-220433

1. The International Agency for the Prevention of Blindness (IAPB). Available at: https://www.iapb.org/learn/ vision-atlas/inequality-in-vision-loss/region-inequality/ Accessed October 2022.

2. Hu C, Jia W. Diabetes in China: Epidemiology and Genetic Risk Factors and Their Clinical Utility in Personalized Medication. Diabetes. 2018;67(1):3-11.

3. Xu T, Wang B, Liu H, et al. Prevalence and causes of vision loss in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019. Lancet Public Health. 2020;5(12):e682-e691.

4. Hospital Management. Available at: https://www.hospitalmanagement.net/comment/total-prevalentcases-dry-eye-syndrome-soar-china/ Accessed October 2022.

5. White Paper on Eye Health in China, National Health Commission of the People's Republic of China (NHC) on June 5, 2020. Available at: http://www.nhc.gov.cn/xcs/ s3574/202006/1f519d91873948d88a77a35a427c3944.shtml Accessed October 2022.

Contributors

Peggy Wu is Vice President, Asia at AbbVie Pte. Ltd. Based in Singapore where the regional office is located, Peggy manages fourteen markets in the region including Korea, Taiwan, South East Asia, India region and Asia emerging markets, leading commercial and product strategy, marketing and P&L. Currently, Asia is the number one region of revenue for AbbVie globally. Ms. Wu was most recently General Manager at AbbVie Taiwan. She joined Abbott Taiwan in 2011 as General Manager. She started her career with Eli Lilly Taiwan, advancing to several management positions across different functions and countries covering sales, marketing, regulatory and human resource. She also played a part in an international marketing role based in Indianapolis and led the company’s operations in Thailand and Vietnam as general manager before moving to Abbott. She holds an MBA from National Cheng Chi University in Taiwan after earning a Bachelor’s degree in pharmacy from Taipei Medical University.

Vice President and General Manager of AbbVie China, Tony Au , has been the leader of AbbVie China since the company was founded in 2013. Under his leadership, AbbVie China has been awarded Top Employer by the Top Employers Institute for 8 consecutive years and many other recognitions in areas such as innovation, drug safety, customer trust and corporate social responsibilities. He entered the industry in 1993 and has more than 20 years of experience in sales and marketing in the pharmaceutical industry in Greater China. Before joining AbbVie, he worked as Head of Marketing and Strategy, then as Vice President of Launch Excellence and Customer Solutions in Merck Sharpe & Dohme (MSD), China. Prior to MSD, he held various executive positions in sales and marketing at Bristol-Myers Squibb, including leadership of business units in Mainland China, Hong Kong SAR and Taiwan Region. Mr. Au began his career as a medical representative in Hong Kong and then moved to managerial roles at various organizations including Eli Lilly and Amgen. Mr. Au is from Hong Kong SAR. He earned a Bachelor of Science Degree in Mathematics from The Chinese University of Hong Kong.

CONTACT

Krystal Bruno Director International Public Affairs, Eye Care

Krystal.bruno@abbvie.com

Cutting-Edge Solutions for Presbyopia Correction with Alcon’s Advanced Technology IOLs and ARGOS Biometer

by Hazlin Hassan

With rising visual demands and an active lifestyle among older patients, the need for functional vision and spectacle independence at near, intermediate and distance vision is increasingly important today.

Alcon offers innovative approaches to presbyopia correction with its market-leading intraocular lens (IOL) technologies, as well as the ARGOS® swept source optical coherence tomography (SS-OCT) biometer as a smart planning solution.

During a session called Alcon Innovations in Advancing Patient Outcomes during the 34th Annual Meeting of the AsiaPacific Association of Cataract and Refractive Surgeons (APACRS) in June 2022, renowned international experts shared their views on Alcon’s AcrySof® IQ Vivity, Clareon® PanOptix trifocal IOL, Clareon® Monofocal IOL on the new Monarch® IV Delivery System as well as ARGOS® – Alcon’s Biometer.

AcrySof® IQ Vivity: The first of its kind presbyopia correcting IOL, with X-WAVE wavefront shaping technology

The optical designs and materials used in Alcon's IOLs provide patients with a variety of options to see better, thanks to its commitment to innovation. One example of this is their AcrySof® IQ Vivity IOL: The first of its kind presbyopiacorrecting IOL with wavefront-shaping technology and a clinically-proven, exceptionally low rate of visual disturbances.1

Dr. Rudy Nuijts, MD, professor of ophthalmology and director of the Cornea Clinic and the Center for Refractive Surgery at the Department of

Ophthalmology, University of Maastricht, the Netherlands, discussed how the AcrySof® IQ Vivity IOL meets the needs of diverse patients.

Data showed that good uncorrected distance visual acuity (the primary performance endpoint) was observed at 3 to 6 months after AcrySof® IQ Vivity IOL implantation, said Dr. Nuijts. An average of -20/20 Snellen (0.14 to 0.035 logMAR) was demonstrated in the overall cohort,2 according to results from the Vivity Registry Study looking at the real-world performance of the AcrySof® IQ Vivity and Vivity Toric IOLs in routine clinical practice.

Further, exploratory performance outcomes at 3 to 6 months after AcrySof® IQ Vivity IOL implantation demonstrated an average of ~20/20 to 20/25 (0.074 to 0.099 logMAR) for uncorrected intermediate visual acuity (VA) and an average of ~20/32 to 20/40 (0.204 to 0.271 logMAR) for uncorrected near VA.2

Results reveal that the AcrySof® IQ Vivity has led to positive outcomes for both monovision and glaucoma patients. 2 Patients can achieve good VA with a high chance of being spectaclefree, with the monovision approach. More patients meeting the criteria for monovision reported that they were able to read a newspaper without difficulty compared with the overall cohort. Using it on glaucoma patients also showed good results, similar to the overall cohort – 83.3% or 15 out of 18 patients in this cohort were very satisfied with their sight. No patients with glaucoma reported starburst, and most reported no halo or glare. Overall, 91.5% of patients were reported to be satisfied, with the majority of patients having no visual disturbances at 3 to 6 months 2 after AcrySof® IQ Vivity IOL implantation.

He also shared his personal experience of a case involving a 26-year-old male, one of his first using the AcrySof® IQ Vivity. The patient had a steroid-induced cataract and anterior uveitis and was very happy with the results at the 3 month follow-up: uncorrected distance VA of 20/20, uncorrected intermediate VA of 20/25, and uncorrected near VA of 20/40. He experienced no visual disturbances.

Clareon® PanOptix offers full range of vision

The Clareon® family of intraocular lenses delivers excellent vision, exceptional clarity and predictable refractive outcomes. These IOLs offer sharp, crisp vision with a proprietary edge designed to help reduce glare and posterior capsular opacification.3 Plus, the lens’ unique and proven STABLEFORCE® haptics provide superior axial and rotational stability.4-8

The Clareon® PanOptix trifocal is made from a glistening-free IOL material that has among the lowest levels of haze and subsurface nano glistenings (SSNGs) compared to leading competitor IOLs.9-10

According to Dr. Myong Joon Kim from Renew Seoul Eye Center, Seoul, South Korea, Clareon® PanOptix provides the full range of vision – bifocal IOLs often provide poor intermediate vision, while trifocal IOLs offer unsatisfactory intermediate vision. Newer trifocal IOLs offer a full range of vision especially within arm’s length, the optimal distance for daily intermediate vision tasks for most people. “Although the Vivity is a fast-growing rookie, the PanOptix is a proven star and the PanOptix is still evolving,” Dr. Kim said.

He said he has used 100 Clareon® PanOptix lenses, and his first impressions are that “the refractive outcomes were excellent” and he used the Alcon online toric calculator which worked “very well.”

Clareon® Monofocal IOL delivers uncompromising outcomes

The Clareon® IOL is Alcon’s newest material formulation that combines

advanced lens design with exceptional visual performance, building on the proven success of the AcrySof® IQ biomechanics and bio-optics.

Clareon® monofocal IOLs provide extraordinary clarity, delivering longlasting refractive outcomes that monofocal patients expect.9-10 Clareon® IOLs are inserted using the nextgeneration, reusable Clareon Monarch® IV Delivery System, which provides precise and controlled implantation and that, was designed specifically for the new Clareon® material.

For Dr. Terry Kim, MD, professor of ophthalmology at the Duke University School of Medicine, USA, Clareon® is the “uncompromised IOL platform of choice.”

Its enhanced IOL design has a fully usable 6 mm aspheric optic dedicated to sharp, crisp distance vision from edge to edge.

“Alcon’s newest hydrophobic biomaterial of optimized clarity is glistening-free with the lowest levels of haze and SSNGs,” 9-10 said Dr. Kim, adding that no glistening and surface light scattering reported in a study makes it “a truly pristine IOL.”

Its ultra-smooth optic delivers among the lowest levels of surface haze of competitive monofocal IOLs. The Clareon® IOL is also designed for maximum refractive predictability and superior axial stability. 4,11

The Clareon® IOL features a precision edge design that guards against posterior capsule opacification (PCO), and minimizes Nd-YAG rates. The IOL improves upon the low Nd-YAG rates of AcrySof® lenses. 12-13

“This lens platform has excellent rotational stability, 4,14 which is of course very critical,” he added.

“In summary, it's exciting to see Alcon give to us another step of improvement in terms of monofocal IOLs, and with the Clareon® IOL, you are going to see not only the glistening-free optic, but also lower PCO rates, and rotational stability, as well as actual stability with that fully usable optic that will give us superior results.”

Faster, easier, better – with ARGOS Biometer

The ARGOS® biometer offers accuracy, efficiency and connectivity in biometry, said Dr. David Lubeck, MD, founder of Arbor Centers for EyeCare, USA.

It takes less than a second for the ARGOS® to capture data including antechamber depth, keratometry, corneal diameter, central corneal thickness, axial length, aqueous depth, pupil size, lens thickness, limbal registration, visual axis and pupil centration,15 he said.

“Also incredibly impressive is the acquisition rate in dense cataracts and with this device, there is a 41% higher acquisition rate in grade four cataracts than the IOLMaster 700,”16 he said.

Results from a real-world study demonstrate that the ARGOS® delivers significant time efficiency for dense and non-dense patients in cataract evaluation, surgical planning and outcome management. 17

“This technology provides faster and more accurate biometric measurements, robust surgical planning, intraoperative data transfer and integration guidance,” he said.

Image guidance by Alcon uses a patient’s eye reference image — its unique iris and limbal landmarks — in order to provide real-time navigation for the precise execution of a surgical plan. It also reduces the risk of transcription errors, and enhances refractive outcomes.

In short, the ARGOS® biometer provides faster preoperative measurements than market-leading biometers with built-in image guidance, and has better acquisition rates through dense cataracts.

It’s also fully integrated with the Alcon Cataract Refractive Suite for greater efficiency and provides easier access to planning data with convenient, onetouch software.

“The ARGOS® improves the way we execute and implement preoperative surgical planning and postoperative outcomes management,” said Dr. Lubeck.

References

1. Bala C, Poyales F, Guarro M, et al. Multicountry clinical outcomes of a new nondiffractive presbyopia-correcting IOL. J Cataract Refract Surg. 2022;48(2):136-143.

2. Alcon Research LLC ILE871-P001 second interim database lock. Data on file. 2022.

3. Das KK, Werner L, Collins S, Hong X. In vitro and schematic model eye assessment of glare or positive dysphotopsia-type photic phenomena: Comparison of a new material IOL to other monofocal IOLs. J Cataract Refract Surg. 2019;45(2):219-227.

4. Lane S, Collins S, Das KK, et al. Evaluation of intraocular lens mechanical stability. J Cataract Refract Surg. 2019;45(4):501-506.

5. TDOC-0054028 (2017) - Clareon SY60WF Axial Displacement Study at Varied Compressions.

6. Kramer BA, Hardten DR, Berdahl JP. Rotation Characteristics of Three Toric Monofocal Intraocular Lenses. Clin Ophthalmol. 2020;14:4379-4384.

7. Lee BS, Chang DF. Comparison of the Rotational Stability of Two Toric Intraocular Lenses in 1273 Consecutive Eyes. Ophthalmology. 2018;125(9):1325-1331.

8. Oshika T, Fujita Y, Hirota A, et al. Comparison of incidence of repositioning surgery to correct misalignment with three toric intraocular lenses. Eur J Ophthalmol. 2020;30(4):680-684.

9. Lehmann R, Maxwell A, Lubeck DM, Fong R, Walters TR, Fakadej A. Effectiveness and Safety of the Clareon Monofocal Intraocular Lens: Outcomes from a 12-Month Single-Arm Clinical Study in a Large Sample. Clin Ophthalmol. 2021;15:1647-1657.

10. Werner L, Thatthamla I, Ong M, et al. Evaluation of clarity characteristics in a new hydrophobic acrylic IOL in comparison to commercially available IOLs. J Cataract Refract Surg. 2019;45(10):1490-1497.

11. Clareon Toric IOL DFU. Alcon Data on File TDOC 0054028 12. Clareon Monofocal IOL DFU SY60WF (v1.0). Alcon Data On File TDOC 0053598 13. AcrySof IQ DFU. Clareon Toric IOL DFU. Alcon Data On File TDOC 0054028 14. Clareon Monofocal IOL DFU SY60WF (v1.0). Alcon Data On File TDOC 0053598 15. Alcon Data on File. 16. Tamaoki A, Kojima T, Hasegawa A, et al. Clinical evaluation of a new swept-source optical coherence biometer that uses individual refractive indices to measure axial length in cataract patients. Ophthalmic Res. 2019;62:1123. 17. Multack S. Time Efficiency Metrics of an Innovative Swept Source OCT Biometer (SS-OCT) for Cataract Evaluation: A Comparative Timeand-Motion Study. ASCRS, Washington D.C. 22 April 2022.

Editor’s Note:

The Alcon Lunch Symposium was held on June 12, 2022 during the 34th Annual Meeting of the AsiaPacific Association of Cataract & Refractive Surgeons (APACRS 2022). Reporting for this story took place during the event.

SLT as Frontline Therapy

Selective laser trabeculoplasty (SLT) has come a long way in the last few years. The practice is gaining adherents as a first-line treatment for open-angle glaucoma for multiple reasons. And to give SLT a boost and provide an uber-coherent overview of the reasons in favor of SLT, Dr. Paul Singh spoke on its behalf at ESCRS 2022 in Milan. For reference, Dr. Singh is the president of the Eye Centers of Racine and Kenosha (Wisconsin, USA) as well as a surgical instructor at the Chicago Medical School. As he noted, he’s been around for a bit, and has seen a lot of the philosophy and practice behind glaucoma practice change.

To begin, Dr. Singh asked the crowd how many used SLT as a first-line treatment — with a mixed response. Toward the end of Dr. Singh’s talk, a panelist simply and rhetorically asked why SLT hasn’t been adopted as a frontline treatment more. That’s a microcosm of the paradigm shift Dr. Singh is describing. Indeed, Dr. Singh made some excellent points, as have other proponents of SLT in recent years. So, let’s get to the itty bitty nitty gritty of why SLT can be so effective.

Bigger toolbox, better tools

There are lots of glaucoma treatments these days. From a proliferation of drops to laser treatments, minimally-invasive glaucoma surgery (MIGS) and a variety of safe surgeries, plenty of tools are in a modern glaucoma specialist’s toolkit. But, like a woodworker, mechanic, or even golfer, surgeons have their favorite tools they return to because they know they work. For Dr. Singh, that tool is SLT, and for many reasons.

While each tool has its use, few have as many concurrent uses as SLT. It’s the Swiss Army Knife of open-angle glaucoma treatments in that it tackles lots of problems at once.

As Dr. Singh put it, there’s been a significant paradigm change in glaucoma treatment to interventional treatment. The reason is simple: We no longer have to choose between controlling IOP and maintaining quality of life. Similarly, we no longer have to choose between addressing compliance and maintaining high safety.

Patient adherence: Herding cats

Dr. Singh didn’t mince words when it came to compliance with medications. As he explained, “The idea and reason why we’re seeing such a proliferation of technology is because we understand compliance sucks. It is so hard keeping patients taking medications, and being compliant, being adherent, coming back to follow up, paying money for medications — it’s very difficult.”

To get a clear picture of the issue with patient compliance with drops, Dr. Singh suggested doctors ask their patients to demonstrate in office just how they put in their eye drops. The results will probably lead some doctors’ eyebrows to jump off their faces in surprise.

Besides poor patient practices, there are significant barriers to getting medications in the eye. Dr. Singh explained that only about 5% of the drop actually gets into the eye. And in addition to simply losing effectiveness, medication remaining on the eye can lead to dry eye disease (DED) as well as other ocular surface disorders. Patients

Lasers, not Silver Bullets by Sam McCommon

with DED conditions are only 63% compliant with their glaucoma meds, as compared with 89% of those without DED.

So, patients have a lot of viable excuses for not using drops as intended. Maybe they’re hard to get into the eye, or the drops make their eyes uncomfortable, or the patient just plain forgot. It happens. Patients aren’t always honest with their doctors about their compliance either, so doctors need to look for clues to indicate non-compliance. Something as simple as the patient not remembering the color of the cap can be a red flag.

If you were to explain that to a patient, a good analogy might be that you’re simply cleaning out the leaves blocking their eye’s gutter. “I tell patients we are rejuvenating the natural drainage system,” shared Dr. Singh. Maintaining IOP is as simple as allowing aqueous humor to drain correctly, and getting the trabecular meshwork to do its job correctly can tackle open-angle glaucoma pretty darn effectively.

SLT as primary therapy

So, can SLT really work as a primary therapy for open-angle glaucoma? You bet, and the studies back it up. Here are some numbers and facts to play with:

And that’s just the bits we could put in here before we ran out of breath.

There’s yet another, non-medical bonus to SLT: It saves money. Because it’s a one-time treatment, patients and insurance companies won’t have to shell out for constantly-used medications. Doctors may also appreciate that SLT saves time: Each medication reduced from a patient’s regimen saves four minutes of tech time. That really adds up.

Right, so, there’s a problem of adherence with drops. Can you guess what treatment helps to address adherence? You probably can — it’s SLT.

SLT is a fast, safe, in-office procedure that patients can walk right out of without any significant post treatment restrictions. It induces the trabecular meshwork to function properly. SLT addresses the primary source of resistant to outflow in a majority of POAG patients. Specifically, SLT targets pigmented trabecular meshwork endothelial cells, which then release cytokines that bind with Schlemm’s canal endothelial cells and remove the barrier to proper drainage.

Best of all, the modern lasers used in SLT cause no damage, which itself is pretty amazing. A pulse rate of 3 nanoseconds, a wavelength of 532 nm, and a diameter of 400 microns mean this thing is fast and tiny — powerful enough to get the job done but not enough to leave a burn.

• 74.2% of SLT patients reached their target IOP and were drop-free at 36 months¹

• SLT patients experienced 5 times less medication drop-related adverse events

• SLT therapy provided IOP reduction that tracked dead even with the popular IOP medication Latanoprost in one study, and did even better in another²

• SLT patients enjoyed long-term IOP reduction, with average IOP reduced by 30% from baseline at 18 months and even up to 5 years³

• SLT results in consistent nighttime control of IOP, whereas topical medications wear off overnight⁴

• SLT can be repeated as necessary to help patients control IOP without leaning on medications over a long period of time

References

1. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al., LiGHT Trial Study Group. Laser in Glaucoma and Ocular Hypertension (LiGHT) trial. A multicentre, randomised controlled trial: design and methodology. Br J Ophthalmol. 2018;102(5):593-598.

2. McIlraith I, Strasfeld M, Colev G, Hutnik CM. Selective laser trabeculoplasty as initial and adjunctive treatment for open-angle glaucoma. J Glaucoma. 2006;15(2):124-30.

3. Melamed S, Ben Simon GJ, Levkovitch-Verbin H. Selective laser trabeculoplasty as primary treatment for open-angle glaucoma: a prospective, nonrandomized pilot study. Arch Ophthalmol. 2003;121(7):957-60.

4. Lee AC, Mosaed S, Weinreb RN, Kripke DF, Liu JH. Effect of laser trabeculoplasty on nocturnal intraocular pressure in medically treated glaucoma patients. Ophthalmology. 2007;114(4):666-70.

5. Latina MA, Sibayan SA, Shin DH, Noecker RJ, Marcellino G. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology. 1998;105(11):2082-8; discussion 2089-90.

Nothing is a silver bullet, of course: Around 30% of patients are low or nonresponders to SLT, with an IOP decrease of 20%.5 SLT is great for open-angle glaucoma and ocular hypertension, for example, but not for narrowangle glaucoma, angle recession, or neovascular glaucoma.

But what we have here is a huge step forward in the glaucoma world that can help reduce the drop burden for our patients while helping to control IOP at the same time. That’s even better than a silver bullet — we’re in the future and using lasers, after all.

Contributing Doctor

Dr. Paul Singh , MD, is a glaucoma specialist at the Eye Centers of Racine & Kenosha, USA, founded in 1981 by his father, Dr. Kanwar Singh. He is also a clinical professor at the Chicago Medical School. He completed his residency at Cook County Hospital Division of Ophthalmology, his internship at Michael Reese Hospital Department of Medicine, and his fellowship in glaucoma at Duke University. Dr. Singh is actively involved in clinical research and has published papers in many ophthalmology journals. He is a member of several societies and groups. He is the founder and president of the International Ophthalmic Floater Society (IOFS) and on the board of directors for the Glaucoma Forum. He was the first ophthalmologist in Wisconsin to implant the iStent, a device designed to treat glaucoma. He has also pioneered the use of in-office lasers to remove visually significant floaters. He enjoys giving lectures and teaching seminars around the globe to help other doctors adopt newer technologies and techniques. Dr. Singh balances his passion for music with his family and his career.

SLT to the rescue: No adherence required

Celebrating the

Return of In-Person Ophthalmic Conferences

A lot has changed in the past two years

by Matt Herman

Ophthalmology congresses are back on the menu and novel opportunities abound.

The pandemic daze is over and the halcyon days of in-person meetings and congresses are back in a big way. Doctors, researchers and industry professionals have emerged bleary-eyed from under the COVID-19 rock to jet off to meetings around the globe.

Passports have been dusted off. Professional from the waist up has been waylaid, and proper trousers are experiencing a renaissance. Zoom cameras are collecting dust.

Mostly. Those of us, including your correspondent, who have been champing at the bit to see friends and colleagues have noticed that things are not quite as they always have been. And not all of the changes can be laid completely at the feet of everyone’s favorite spike-proteined pal. Some developments have predictably been given a shot in the arm by the pandemic. Online meetings have gone from novelty to necessity, for instance.

But other seismic changes have emerged. And from the test laboratory of the pandemic has emerged a new paradigm for the way ophthalmology creates and shares knowledge and technology.

The true mother of invention

An evolution of the ophthalmic space has always been inevitable. Ophthalmology often gets a bum rap for being generally stodgy and slow to change. From a medical standpoint, the eye is delicate and sight vital, and an industry-wide “if it ain’t broke, don’t fix it” credo makes sense when vision is at stake. But just as with the dinosaurs, the time to adapt or perish always comes.

At the onset of the pandemic, a perishing of sorts was certainly on the table. Research, innovation and communication were stymied across the broader scientific world. A poll conducted by Gao et al. in Nature found that new (non-COVID related) publications were down by 9% in 2020 compared with 2019; submissions took a 15% hit, and new collaborations were down by a staggering 35%.1 The scientific world at large, and the eye care world along with it, seemed to stop spinning.

But life, and the exchange of ophthalmic knowledge, found a way forward through digitization. At this point, everyone is all too familiar with online classes, conferences and meetings. According to Dr. Kenneth Fong, president of the upcoming 38th Asia-Pacific Academy of Ophthalmology (APAO 2023) Congress, the switch to digitization would not have taken place sans COVID-19. “Without the pandemic, we wouldn't have hybrid meetings or virtual meetings,” he commented. And for a variety of reasons, the field of ophthalmology is better for it.

A quantum shift

Whether the pandemic was the true inflection point or simply an accelerator, the post-COVID conference landscape represents a significant change from the past. For Dr. Oliver Findl, president of the European Society of Cataract and Refractive Surgeons (ESCRS), the fundamental role of the conference has changed forever

“I think the core functions [of conferences] have changed, because early in my career, congresses had one major function — to meet and discuss of course, but really, to get information,” he noted.

Internet databases and online publications are not new, of course, but the pandemic woke the ophthalmic space up to the true power of a constant stream of information. “Now you have a lot

of websites out there on demand — information which you always have at your fingertips,” said Dr. Findl. And it is this shift away from conferences being primarily about obtaining new knowledge to something decidedly different that has flipped the script forever.

Watching the watchmen

With new research and techniques available at the speed of light through a fiber optic cable, conferences are no longer a one-way conduit of information. Information democratization in the ophthalmic space is in full swing, and it's a good thing.

“I remember my first conference really well because I gave a paper on optical biometry,” recalls Dr. Findl, a smile creeping into his face. “Wolfgang Haigis was a chair of the session and he was really into ultrasound biometry. He gave me a really hard time, even though it was one of my first talks.” The faraway look in his eyes abruptly changes to laughter. “That’s a really good memory I have. Well, not a good memory. But a memory.”

With the advent of remote discourse, this nerve-wracking trial by fire has gone the way of the horse and carriage. Flamegrilling by authority has become more of an open discussion by consensus, and the ophthalmic world is reaping the benefits of abolishing the gatekeeper. “[Before] there was a sort of fish bowl situation [during presentations]. Now we are looking at more interaction — there’s much more of a discussion happening,” Dr. Findl continued.

“I think the core functions [of conferences] have changed, because early in my career, congresses had one major function — to meet and discuss, of course, but really, to get information.”

— Dr. Oliver Findl, president of the European Society of Cataract and Refractive Surgeons (ESCRS)

And when it comes to innovation and advancing the field, more discussion is a good thing. More ideas are heard, new perspectives are gained, and nuance becomes the new norm instead of no’s.

“Many years ago in the ‘90s, there were personalities that had issues with each other, and in some cases, there were situations where they were real enemies,” Dr. Findl reflected. With more information out in the open, the days of factional infighting and outsized personalities are going by the wayside, too.

Balance and tolerance of out-of-thebox ideas without the thumbs up of ophthalmology Caesars are in. Modern conferences are less the exclusive purview of the select few and more forum for all to share in. And when oceans of new ideas can be evaluated more rapidly and on their individual merits more, innovation and adoption of critical new tech are the main byproducts.

Reckless driving on the information highway

But with ophthalmic research traveling further and faster down the information highway than ever before, traffic police are still needed to keep it moving along. Quantity over quality is rarely a good thing, especially in science, and Dr. Fong knows this all too well from his experiences organizing APAO 2023. “You need to make sure that only the best are shortlisted and worth people’s time to come and view and discuss,” he commented. At some point, limitations on quality and relevance must be imposed. “You need to curate it. You need to have moderation,” he concluded.

But conferences are adapting to the large influx of information in creative and astounding new ways to regulate information streams without suffocating them altogether. Meeting specialization is one way. All-encompassing megameeting marathons on the whole eye are giving way to more specialized meetings split into subspecialties like retina, cataract, refractive, and so on. Digital meetings are also rife with potential for smaller, more targeted fields of knowledge, and Dr. Fong has

an idea of what that might look like. “Smaller meetings can transition to digital versions or try to work together with bigger meetings and have them as satellite meetings,” he suggested.

More targeted meetings mean higher participation from both doctors who can contribute the most, and those who need it most. Lectures on critical niche topics like geographic atrophy (GA) might be a poorly attended yawner at a massive meeting. But they get a massive jolt in the arm by going online and attracting more experts around the world who can attend without sacrificing critical time and money to fly to a large conference for just one meeting. And even now, hybrid conferences allow cutting-edge researchers to share their findings with a conference room across the globe through sophisticated teleconferencing capabilities put to the test during the pandemic.

Shorter but sweeter?

The implications for such changes on the modern congress landscape are massive in scope and impact. For one, says Dr. Findl, conferences are generally getting shorter than they were in the past. “Our (ESCRS) congress, for example, used to be four-and-a-half days. Now, it’s essentially three-and-a-quarter, so we reduced it by 20% ... and I think others are doing the same,” he said.

On the one hand, this is a massive boon for conference participation. Shorter meetings mean smaller hotel bills, less of a time commitment, and in general, higher participation. This is good news in a world with soaring healthcare costs, increasing appointment wait times, and a notoriously grim work/life balance.

“It’s a little more difficult for people to stay away for longer times now,” Dr. Findl observed. “People just can’t take the time off anymore.” And for the vast majority of doctors who are starved for time, shorter in-person meetings with programs reduced to what is absolutely necessary to do in-person are a sorely needed change.

Following the money

Conferences, of course, don’t magically

appear from thin air. As doctors trying to find funds for flights, food and lodging know, they run on money and the support of industry. And the place of industry in the conference constellation has also undergone a cataclysmic change for players of all sizes.

In days past, titans of industry threw around their weight to distinguish themselves among well-established competition and put their products to the forefront. Lavish parties and raucous entertainment for doctors and purchasing managers were part of a courtship ritual ubiquitous in the business world. The medical device and pharmaceutical industry was certainly no exception.

But it is now, and Dr. Fong has seen just how industry mainstays have been challenged by the new look of post-pandemic congresses, resulting in macroeconomic and regulatory headwinds. “There’s a lot less entertainment done by industry because of compliance and things like that,” he said with just the faintest hint of sadness in his voice. “Industry budgets have definitely been affected badly, too. So sponsors are a lot more careful how they spend their money.”

And what of small-to-medium enterprises (SMEs)? TJ Waggoner of Waggoner Diagnostics, an independent American company selling all things color vision, knows what it's like for the underdogs of the cutthroat exhibition hall world. “Attending conferences allows doctors to see your devices and organization. It legitimizes the device and the company.” In this sense, the congress story is a tale of two exhibition halls — one where ubiquitous major players compete with one another to be the loudest voice in the room, and one where small players must stand on the shoulders of giants for credibility.

Unfortunately, this slight wing-clipping of the great ophthalmic raptors has not allowed smaller birds of paradise like Waggoner Diagnostics to thrive in treacherous skies. At least, not exactly. “With the introduction of resources such as Shopify, Facebook/Google Advertising, etc., it makes it possible for SMEs to compete with the 800-pound gorillas,” said Mr. Waggoner.

But while the digitization decentralization coursing through the veins of ophthalmic exhibition halls may trickle down to the industry landscape, Mr. Waggoner thinks these effects are limited. “I never expect the ‘good ole days’ of doing business to go away … dinners and entertainment are a triedand-true method of selling devices and pharmaceuticals,” he lamented. But in the end, he does think the newfound post-pandemic spirit of innovation of opportunity shows some promise. “The old tactics will stick around but the companies that are nimble and innovative will always come up with solutions to get the attention of decisionmakers.”

The times, they are (kind of) a-changin

In the end, ophthalmic conferences have a distinctly different flavor from the days of old. Congresses have seen a change in the way people think about

Contributing Doctors

Dr. Kenneth Fong is recognized as an ophthalmologist in the United Kingdom, Australia and Malaysia. He graduated with a medical degree from the University of Cambridge in 1998 and trained to be an eye surgeon in London. Dr. Fong then spent two more years training in the U.K. and at the Royal Perth Hospital in Australia to subspecialize in retina. After 18 years of working in the U.K. and Australia, he returned to Malaysia in 2009 to serve as associate professor, consultant ophthalmologist and retinal surgeon at the University of Malaya in Kuala Lumpur. He is currently the managing director of OasisEye Specialists in Kuala Lumpur. Dr. Fong is the president of the Malaysian Society of Ophthalmology and serves as a council member for the APVRS.

kcsfong@gmail.com

research, what research is shared, and how doctors around the world access it. A healthy dose of flexible, innovative thinking enabled and fostered by the technological wizardry emerging from the ashes of the pandemic is the main result, and patients and the industry as a whole is better.

But for many things, the song remains the same, and that’s not necessarily a bad thing. The pillars of industry undergirding research have shown cracks in the face of regulatory and macroeconomic forces of nature. Damaged as they are, however, Dr. Fong doesn’t see any radical changes to the status quo on the horizon.

“Ophthalmology in particular is very focused on technological advances, pharmaceutical advances,” he argued. “You need to interact with industry to drive innovation.”

And despite worldwide hysteria around the creeping permanence of the workfrom-home movement, neither Dr.

Fong nor Dr. Findl think that in-person conferences are ever going to be fully off the table. “We need the face-toface component because there's so many things that colleagues discuss outside the meeting hall, during the coffee breaks or dinner time, or in a hotel lobby,” noted Dr. Fong. “[In these situations] doctors are actually more free, able to discuss things more easily because they're not weighed down by work or being at home.”

Dr. Findl concurs. “I don't think inperson conferences are going to be replaced. That's what I thought at the beginning of Covid,” he admitted. “But I think we learned very quickly within a year, year-and-a-half, that people just don’t want to sit in front of their computer all the time.”

Reference

1. Gao J, Yin Y, Myers KR, Lakhani KR, Wang D.. Potentially long-lasting effects of the pandemic on scientists. Nat Commun. 2021;12:6188.

Prof. Oliver Findl is a professor of ophthalmology and chairs the Department of Ophthalmology at the Hanusch Hospital, Vienna, Austria. He founded and heads the Vienna Institute for Research in Ocular Surgery (VIROS). Prof. Findl’s research fellowship at Children’s Hospital in Boston was followed by residency and an anterior segment surgery fellowship at the Medical University of Vienna. He was a consultant ophthalmic surgeon at Moorfields Eye Hospital, London, UK, for several years. His research interests are in the fields of optical biometry, presbyopia correcting IOLs, posterior capsule opacification and the pathogenesis of myopia. Dr. Findl has authored over 350 articles in international peer-reviewed journals and is currently the president of the European Society of Cataract and Refractive Surgeons (ESCRS) as well as the treasurer of the Austrian Ophthalmological Society.

oliver@findl.at

Terrace L. Waggoner Jr (who goes by TJ), has been developing medical devices for approximately 10 years. T.J. Waggoner has an undergraduate degree in psychology, a master’s in Business Administration, and a master’s in industrial/ organizational psychology from the University of West Florida. T.J. has completed his coursework for a PhD in organizational behavior but he continues the painful process of checking all the boxes to finally obtain his PhD from Claremont Graduate University. You may be wondering how T.J. fell into ophthalmic medical devices, and he owes the pleasure to his awesome father, Dr. Terrace Waggoner. T.J. believes that not having an educational background in engineering or medicine has allowed him to think outside the box and create devices where other individuals saw too many constraints.

tj@waggonerdiagnostics.com

Media MICE traveled over the brightest in ophthalmology — and three continents to meet the best and we have the photos* to prove it

The 40th Congress European Society of Cataract and Refractive Surgeons (ESCRS 2022) in Milan, Italy

The American Academy of Ophthalmology (AAO 2022) annual meeting in Chicago, Illinois

The Royal Australian and New Zealand College of Ophthalmologists 53rd Annual Scientific Congress in Brisbane, Australia

*All photos provided by Media MICE CEO Matt Young

Ophtha lmology No Longer a Boys’ Club

by Andrew Sweeney

The question “who really runs the world?” is pondered by many an Internet sleuth, but it’s perhaps Beyoncé (or the Queen B) who has solved the riddle via song lyric: “Who run the world? Girls (girls).”

Wise words indeed, girls (ahem, women) do indeed run this world — or at least, are represented in higher positions in greater numbers than ever before, and this holds true in ophthalmology as much as any other medical field. In every issue of CAKE magazine, we scour the globe to find the very best role models for women in the field to follow. In our latest edition of this series, we spoke with Dr. Samita Moolani, a second-generation ophthalmologist from Pune, India.

Girls not allowed

Dr. Moolani practices general ophthalmology with a special focus on cataract and cornea at her father’s 32-year-old private practice. Providing medical treatment to families and those from more disadvantaged backgrounds is a passion of Dr. Moolani, and she runs two referral clinics for charity to help patients from low-income households. She believes there’s never been a better time to be a woman in ophthalmology, and that the future holds even greater promise.

“It is an incredible time to be a woman in ophthalmology, especially in India. More and more women are embracing

this field and creating waves across the world. We are seeing more women in leadership positions in ophthalmology, leading scientific publications, and emerging as innovators,” Dr. Moolani said.

“Medicine and surgical fields have historically been ‘boys’ clubs’ and there is no question that for women, balancing a career, family and other responsibilities makes it appear to our male counterparts that our commitment to work is not the same as theirs. Breaking through this stereotype is challenging. Many inspiring women from all over the world have shattered the glass ceiling,” she said.

“The attitude shift is visible in every domain in ophthalmology, from national and regional societies, journals, conferences and in apex eye centers. I salute the women in ophthalmology who have paved the way over the past few decades … the shift has been dramatic. But we still have a long way to go!”

“It is an incredible time to be a woman in ophthalmology, especially in India. More and more women are embracing this field and creating waves across the world. We are seeing more women in leadership positions in ophthalmology, leading scientific publications, and emerging as innovators.”

– Dr. Samita Moolani

Challenging old stereotypes

Dr. Moolani faced her own challenges when she began working alongside her father at his clinic. Despite her educational achievements and the full support of her family, some patients found it difficult to take her seriously as an ophthalmologist due to both her gender and her young age. Cultural stereotypes are often deeply ingrained in the popular psyche and are difficult to shift; however, she reports that she no longer experiences difficulty with respect in her daily practice.

Dr. Moolani believes that by providing more leadership initiatives and programs for female ophthalmologists the entire field will benefit, especially in countries with high patient-to-practitioner ratios like India. She highlights the work of societies dedicated to women

in ophthalmology as a good start, but that more needs to be done to boost the representation of female ophthalmologists at national and global levels. She also believes that something women can do themselves, today, is to devote energy to planning their careers as best as possible.

“Build your resume and experience. Nothing can shake you down if you have attended a good fellowship and training, both of which help establish a solid backbone for your career,” said Dr. Moolani.

“Don’t be in a hurry to start your own practice. Find mentors, learn, and even when you are working, keep learning. Embrace a ‘student for life’ attitude,” she said.

“Planning is the cornerstone of your career. Marriage, children and other life events should be mapped strategically when possible to maximize your time spent on training and your career. Of course, life is unpredictable, but even if you take a break, get back into it. It is never too late to jumpstart or restart learning, and take back control of your career,” she said.

Go to the shows!

she does recommend our flagship conference series, the CAKE & PIE Expo (C&PE), which focused on building a bridge between optometry and ophthalmology.

“We need to remember that optometrists and ophthalmologists are working toward the same goal, which is the best possible vision for a patient,” she said.

Dr. Moolani attended C&PE 2.0 in Da Nang, Vietnam, earlier this year and thoroughly enjoyed her experience, as well as the opportunity to network with ophthalmologists from around the world. This, she said, is a crucial aspect for new doctors starting out: They should make as many connections as they can across the medical sphere.

“My experience at CAKE & PIE Expo was eye-opening (pun intended). In addition to meeting many leaders in ophthalmology and some of my favorite mentors, I realized how essential and valuable the hybrid format is,” she concluded.

Dr. Samita Moolani is a secondgeneration ophthalmologist from Pune, India. She practices general ophthalmology with a special focus on cataract and cornea; she also runs two referral clinics for charity to help patients from low-income households. She is a trustee of Hope foundation, a trust that focuses on education and healthcare. Dr. Moolani has trained in Pune, Mumbai, Ahmedabad and Singapore at prestigious eye hospitals. During her post-graduation and fellowship, she also was the creative coordinator with the Indian Journal of Ophthalmology, responsible for helping the journal go digital via apps. She has also organized numerous research methodology workshops under the journal. In 2018, she had the honor of joining Orbis as a medical volunteer in Ethiopia to train students to perform manual small incision cataract surgery in the wet lab. Apart from ophthalmology, Dr. Moolani is also a passionate traveler, scuba diver, and loves fashion.

Contributing Doctor

Ukrainian Docs Cover Combat-related Ocular Trauma at ESCRS 2022

by Andrew Sweeney

As the war against Ukraine continues, it has become apparent that the Russian Federation's illegal invasion of the country will be a defining event in history, akin to 9/11 or the Vietnam War. The casualties are catastrophic, as well as the destruction of civilian infrastructure by Russia. It is an appalling war waged by a nation bent on recreating an empire and has rightly drawn international condemnation.

The European Society of Cataract and Refractive Surgeons (ESCRS) has devoted resources to supporting the Ukrainian ophthalmology community. Delegates at ESCRS 2022 will have

noticed a large number of participants from Ukraine, many of whom attended entirely for free thanks to the society. With many dressed in Ukrainian national costumes, their presence was emblematic, as was the number of symposia relevant to the war in Ukraine. One of these covered a regrettable, yet crucially important subject: the impact of ocular trauma injuries sustained in combat.

Eye injuries affect society and the patient alike

Ocular Trauma in 2022: Ukrainian

Support Session was held on Sept. 19 and featured a panel of mainly Ukrainian ophthalmologists, some of whom had traveled to Milan immediately from treating soldiers with frontline injuries. One of the most insightful speakers was Dr. Nataliia Grubnyk, of the Filatov Institute of Eye Disease and Tissue Therapy (Odesa, Ukraine). Her presentation, Reconstructive Surgery of War Eye Injuries, provided an excellent overview of combat-related eye trauma, which she described as a “major socioeconomic problem as much as a medical one, as such injuries usually affect young men of working age, requiring prolonged treatment and rehabilitation.”

Dr. Grubnyk said that the major cause of ocular trauma in combat situations is explosive blasts — and when these occur, an ocular injury is likely to affect the involved party in 28% of cases. The increased power of modern explosives, along with decreased size and greater sophistication, means that ocular injuries are more likely than ever, with a corresponding increase in the severity of morbidity of said injuries. Unfortunately for the affected party, she said that explosive blast-originated ocular injuries are more likely to be bilateral (with a rate of up to 56% of cases being reported) due to the higher explosive and fragmentation power of modern weapons.

Predicting visual outcome after the patient reaches the hospital is highly variable due to the unpredictable nature of ocular trauma injuries sustained in combat. It depends on a number of factors, including: the level of immediate first aid care received and transportation time from the battlefield, among others. However, Dr. Grubnyk did report that closed globe injuries usually have a better outcome than open globe injuries. She also said that other factors associated with a poor visual outcome include: visual acuity of no light perception, the presence of relative afferent pupillary defect, central corneal opacity, retinal detachment, endophthalmitis, macular scarring and optic atrophy.

Have a plan for every surgical situation

Another speaker who shared his experience of operating on soldiers was Dr. Volodymyr Melnyk, MD, PhD, head of the Society of Ukrainian Ophthalmic Surgeons and chief doctor of the Visiobud Clinic (Kyiv, Ukraine). His presentation, Cases of Traumatic Cataract in Ukrainian Militaries, highlighted some of his most challenging cases. Some of the injuries he’s treated include: traumatic cataract with a partial rupture of the ciliary zonule caused by an explosive mine; another case of the same, but this time with traumatic mydriasis and scarring of the upper eyelid; and a contusion of the ocular globe with subluxation of the lens ciliary zonule rupture.

Dr. Melnyk shared his plan for these cases, which he described “as the best method for the best surgical result,” starting with a minimal corneal incision of no more than 2-2.5 mm. He said that there must be “an undamaged capsular bag and the implantation of a one-piece intraocular lens (IOL) into the bag, an undamaged ciliary band and no penetration of the vitreum into the anterior chamber, and the implanted IOL must meet the patient's specific needs and wishes.”

He then added that one can also minimize the risk of postoperative

inflammation by ensuring the eye is prepared preoperatively (which can be difficult in some wartime scenarios) and that the damaged lens tissue is removed entirely.

Ocular protection is key for prevention

A broader perspective of the challenges currently faced by Ukraine’s ophthalmologists was provided by the Ukrainian Vitreoretinal Society President Dr. Andrii Ruban. In his presentation, Challenges in Treating Patients During the Ukraine-Russian War , the audience learned more about the numerous problems Ukrainian doctors face while working under combat conditions. For example, Dr. Ruban said that surgeons are faced with a number of issues like suboptimal lighting conditions; having to work on complex procedures requiring the skills of anterior, posterior, and oculoplastic specialists at the same time with a shortage of staff; and a high rate of complications, such as hemorrhages and proliferative vitreoretinopathy.

In the course of his research, Dr. Ruban also made a stark discovery: In all of the severe cases of ocular trauma he oversaw at the National Military Hospital in Kyiv, none of the patients had been wearing prospective eye equipment when they were injured. This included the 1 in 3 soldiers who lost sight in one eye, and the 1 in 10 who had lost sight in both. Dr. Ruban emphasized the crucial importance of wearing protection like polycarbonate goggles, stating that it was possible that a significant number of the blinded patients would not have been so if they were wearing the glasses.

Editor’s Note:

The 40th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2022) took place in Milan, Italy, from Sept. 16-20. Reporting for this story took place during the congress.

Wearing proper protective goggles could save their sight.

New Tech is Coming

Reporting from the AAO Exhibition Hall

by Brooke Herron

Team Media MICE was on the ground during the American Academy of Ophthalmology (AAO 2022) Congress, held in Chicago, Illinois, from Sept. 30 to Oct. 3. During the show, we filmed and interviewed exhibitors and experts to hear all about the latest tech in the anterior segment. Here are a few snippets from those talks…

Diagnostics integration and iris registration with ALLY

At the LENSAR booth, we found Dr. Greg Parkhurst, an ophthalmologist from San Antonio, Texas. Turns out, he’s a long-time Lensar user, and has had the company’s newest ALLY Adaptive Cataract Treatment System for about a month.

He shared that they love the general platform, thanks to its capabilities in astigmatism management with iris registration — but the biggest thing that sets it apart from other femto systems is its ability to integrate diagnostics.

“What this integration does … is give you the corneal topography, the steep axis of corneal cylinder and an iris photo — and that axis of cylinder is affiliated with the specifics of an iris photo,”

said Dr. Parkhurst. “So then when the patient is docked under the ALLY, there's another photo taken of the iris and it'll line up the image to place the astigmatism treatment on the exact axis from the topographer — and that's really sophisticated.”

He added that the ALLY is a gamechanger and said: “It's very similar to iris registration when we do LASIK eye surgery — the laser’s ability to track movements of the eye — so I would say that for me, that is the biggest [thing] about this laser.”

On the ML7 microkeratome from Med-Logics

At the Med-Logics booth, Media MICE CEO Matt Young stopped by to chat with Dr. Jonathan Woolfson from the Woolfson Eye Institute in Atlanta, Georgia. He spoke to Matt about his work, using femto, and why he believes the ML7 Microkeratome from Med-Logics could be a game-changer in patient outcomes.

“I’ve gone through many different generations of keratomes and I really do think that the ML7 that we’re using is the best one and it’s worked really well for us. We’re able to make flaps that are

very thin, very smooth and consistently safe,” he shared.

Dr. Woolfson said they still do some femto flaps but they do more with the keratome — and as a data-driven practice, the numbers they’ve collected have shown ML7 to be consistent and safe, with a very low standard deviation.

“We focus on patient experience, and we noticed that there seems to be less pressure on the eye for patients. By the time we start and finish the eye to completion, it’s just a few minutes,” he added.

Would you like your company or product to be covered by Media MICE at an upcoming conference?

Email enquiry@mediamice.com for more information about our professional, on-site video, writing and content creating capabilities.

Med-Logics CEO Rod Ross and Dr. Jonathan Woolfson talk about game-changing patient outcomes from the ML-7 Microkeratome at AAO 2022

Transitioning

to the Control Era

by Matt Herman

CooperVision’s new data from the world’s longest-running contact lens study may mark a turning point in the fight against myopia.

With the inexorable rise of myopia, the stigma around glasses has largely disappeared in our modern world. But the glitz of increasingly fashionable eyewear and high-tech contact lenses is just a distraction from a glaring truth –dealing with myopia has largely meant mitigating its effects instead of dealing with the underlying condition.

CooperVision (California, USA) believes this era is over. In a presentation of data from one of the worlds longest-running contact lens studies, the company’s optometrists presented a bevy of data on their myopia-busting MiSight® contact lenses at the 2022 Asia-Pacific Myopia Management Symposium (APMMS) at the Park Royal Collection Marina Bay in Singapore.

In an hour-long presentation at the event, sponsored by CooperVision and the Singapore National Eye Centre (SNEC), Mrs. Elizabeth Lumb, director of global professional affairs in myopia management at CooperVision and Mr. Paul Chamberlain, director of research programs at CooperVision, claimed that a monumental shift is upon us. They believe that the days of cowering in fear and putting out fires after myopia has done its destructive deeds are over, and the dawn of myopia control is here.

Myopia go go?

If it all sounds grandiose – this idea of taming myopia before it becomes a full-grown monster – that’s only because it is. Eyeglasses have been around for centuries, and myopia has become a burden that we have simply learned to tolerate. But Mrs. Lumb thinks those days are behind us. “Correcting children with single vision glasses should no

longer be the first line of treatment,” she stated. “We should be thinking much more along the lines of making myopia control the standard of care.”

To make myopia management the dominant approach, doctors need the tools and data to support the switch. And CooperVision’s seven-year tripartite MiSight 1 day study was designed to provide doctors with arguments supporting the shift to myopia control at an early age.

In the first part, children aged 8-12 were divided into two groups – one group was given MiSight 1 day myopia-controlling contact lenses (T6), and the other, Proclear 1 day lenses (T3). After three years, the T3 group was switched to MiSight 1 day for the second part of the study, and after three more years, all subjects were switched back to Proclear 1 day for one year.

The questions posed by the study were

fivefold, according to Mr. Chamberlain and Mrs. Lumb: to isolate the anomaly treated with myopia, to determine how to assess efficacy and whether or not treatment works for all eyes equally, to establish when and for how long eyes should be treated, and to find out what happens when treatment stops. CooperVision believes that by answering these questions, the levy holding back doctors from flooding into the myopia control camp will break.

Axial length and efficacy

The eye care world already knows that myopia is all about spherical equivalent change and axial length elongation. The first round of data on MiSight 1 day was an attempt to show that progression in these two variables can be controlled.

Ultimately, the research showed significant gaps in mean spherical equivalent cycloplegic autorefraction change and mean axial length change achieved by MiSight in the T3 and T6 groups. After 36 months, the mean change in spherical equivalent for the MiSight group was -0.50, compared to a nearly -1.25 change for the Proclear group. Axial length change, a wellestablished biomarker for myopia progression, told a similar story. The T6 group mean change in axial length was about 0.30 mm, compared to just over 0.60 mm for the T3 group, a 52% slower growth rate for the MiSight group.

The 6-year data was used to illuminate efficacy, and the first evidence for efficacy was the comparison between the T3 and T6 groups after 36 months. The T3 group saw significant slowing after starting treatment, but in order to differentiate this from the slowing effect expected in older eyes, a cohort

comparison was needed to compensate for the lack of a control group.

Through the use of mathematical modeling, a virtual control group was constructed from previous studies, and the efficacy compared to this virtual control was clear. When compared to age-normal axial length, the MiSight 1 day group saw a growth slowing comparable to normal emmetropic eyes. “The MiSight lens seemed to have slowed growth – not 100 percent – but it is at levels similar to what we might classify as perfect emmetropic eyes at the same age,” Mr. Chamberlain reported.

The who, how long and when of it all

While switching the T3 group presented challenges to the study in determining efficacy, this decision demonstrated clear advantages when trying to answer the key question of what eyes MiSight is suitable for.

Eyes switched onto MiSight could be compared to their pre-switch growth rates, and the effect of the contact lens on individual eyes discerned.

The numbers here also indicated a clinically significant effect with MiSight. When fitted with a scaled response model accounting for differing growth rates, 90% of eyes responded to treatment. The biggest changes were seen in faster progressing eyes, with some of the slower-growing eyes even stopping growth during treatment.

So, knowing that MiSight 1 day is highly effective for the vast majority of eyes, the investigation then turned to the maximization of the treatment effect.

It has been established time and time again that axial length growth is at its hottest when children are younger. Logic, then, would dictate that lenses like MiSight are more effective when started early. The per-year effect was a sustained 50% compared to patients of that age, but this 50% effect is a lot greater at, say age 7 when the annual change in axial length is at its peak in the control group of about 0.34 mm.

The rebound effect

A final piece of evidence came in answer to the question of what happens when MiSight treatment is stopped. Fears of a rebound effect where axial length growth would rebound turned out to be unfounded, however. After displaying a graph with a shaded area indicating what a rebound effect and returning to regular levels of myopic growth would look like, it was clear as day that no members of the T3 or T6 groups experienced a rebound effect. “None of the [data points] are in that warning sign area,” Mr. Chamberlain explained. “The good news is that there’s no indication that they fell into that category.”

All in all, Mr. Chamberlain’s and Mrs. Lumb’s assertion that the time for myopia control has arrived is supported by a strong cohort of data from the world’s longest contact lens study. With clearly demonstrated efficacy on all types of eyes, and especially from earlier ages, CooperVision believes there’s no reason not to take the fight to myopia with this advanced technology. “There are still a number of more questions that we still want to answer in myopia control,” Mr. Chamberlain mused in closing. “But we remain committed to doing good research and sharing it publicly to help this space move forward.” Bad news for myopia, but good news for clear vision worldwide.

Editor’s Note:

The Asia-Pacific Myopia Management Symposium (APMMS) was held on Nov. 11, 2022 at the Park Royal Collection Marina Bay in Singapore. Reporting for this story took place during the event.