CONFERENCE HIGHLIGHTS APACRS 2019 Coverage
Elegance and Innovation Showcased at the APACRS 2019 in
by Matt Young
R
ight after the Paris runway at the 37th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2019), CAKE magazine next landed in the beautiful city of Kyoto, the former capital of Japan, to discover innovations in the fields of cataract and refractive surgery at the Annual Meeting of the Asia-Pacific Association of Cataract and Refractive Surgeons (APACRS 2019). Aptly themed Elegance and Innovation, the APACRS 2019 presented the latest cutting-edge products and techniques in this ever-evolving field, shared by renowned ophthalmologists from around the world. Located in a venue rich in history and tradition, the titles of the APACRS symposia reflected the Japanese culture. Among them include the ‘Sumo’ session on the challenges in refractive surgery and the ‘Umami’ session, which tackled astigmatism correction in cataract surgery and other non-phaco and intraocular lens (IOL)related issues. Below are some insights from the intriguingly titled session: ‘Katana’ on ‘The Cutting Edge in Phaco and IOLs’. So, what exactly is a katana? In days of yore, the heroic samurai of ancient and feudal Japan relied on the katana, a Japanese sword with a curved, single-edged blade. According to Western historians, the katana was among the finest cutting weapons in world military history. Eye surgeons, on the other hand, can count on their trusty surgical instruments.
The cutting-edge katanas of cataract surgery According to Dr. Oliver Findl from the Vienna Institute for Research in Ocular Surgery, and Hanusch Hospital,
Vienna, Austria, one can also rely on measurements to enhance toric outcomes. He said that different corneal measurements cannot be used interchangeably. He also advised to use a combination of different measurement methods for toric IOL calculation. Swept-source optical coherence tomography (SS-OCT) appears to be more accurate compared to Scheimpflug imaging. Dr. Findl noted that the main source of error in toric-IOL calculation is the corneal measurement. His advice? “Use three different devices and at least two different measurement techniques.” “Doubt your corneal measurements and repeat them, if necessary,” he urged, especially for patients with conditions such as dry eye, and irregular cornea. Meanwhile, Professor Soon-Phaik Chee, from the Singapore National Eye Centre (SNEC), talked about the CAPSULaser, a selective non-contact non-pulsatile laser that creates a capsulotomy in less than a second. She said that problems with femtosecond laser-assisted cataract surgery (FLACS) included the cost. It also requires additional room and an additional set of staff, while also affecting patient flow. Meanwhile, ZEPTO, the precision pulse capsulotomy device from Mynosys (Fremont, CA, USA), requires un-scrubbed staff to assist, one of its limitations. She concluded that the CAPSULaser has its advantages including its selective thermal laser capsulotomy and it does not disrupt the patient flow. Some biomaterials are purer than others, said Professor Gerd Auffarth from the International Vision Correction Research Centre, Germany, during the session.
Kyoto
He noted that a purity study on hydrophobic acrylic IOL material comparing Hoya’s Vivinex, Alcon’s SN60WF and J&J Vision’s Tecnis showed that hydrophobic-acrylic IOL models differ in their resistance to develop glistenings and glistening patterns. Glistenings do not reduce visual acuity but increase ‘straylight’, which can cause patients to be blinded by oncoming car headlights and hazy vision. In the study, an accelerated aging protocol was used to induce glistenings, or microvacuoles, in hydrophobic acrylic IOLs. The IOLs were warmed to 45°C and then cooled to 37°C. “Although less severe, the glistening problem needs to be addressed by the IOL manufacturer through either the introduction of new materials or by continuous improvement of the manufacturing process,” concluded Prof. Auffarth.
Of rapid innovations and wider treatment options Rapid innovation in medical devices and medications has resulted in a wider and better range of treatment options in cataract surgery. This allows cataract surgeons to plan and design treatments accordingly to help to meet patient expectations, as well as improve vision and quality of life. Dr. Hiroyuki Arai from the Queen’s Eye Clinic, Japan, discussed selecting appropriate intraocular lenses (IOLs) for individual patients in a paper called Optimize Outcomes with the Choice of IOLs and Innovations. IOL options have expanded with the emergence of multifocal and extended depth of focus (EDoF) lens. In this vein, Dr. Arai introduced a new IOL – the LENTIS Comfort – which
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