presentation was given by Dr. Eric Donnenfeld, a renowned cataract specialist from Long Island, New York, who reported that dropless cataract surgery is the way forward. We’re all familiar with poor patient compliance after all, and he started his speech by inviting the audience to “ask their patients to demonstrate how they apply eye drops,” if they wanted to enjoy a good laugh.
s the attendees made their way into Day 3 of the 40th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2022) they were met at the doors by a wall of raucous pop music from a nearby concert. The fact that many of the day’s visitors had chosen to swap their more formal footwear for sneakers (with many a pair of white Adidas in sight) tied in well with the day’s apparent theme of energy and vitality. The day was all about getting moving, boosting things and clearing volumes.
Eye drop-free = stress-free
3ISSUE 09 | 19 | 22 CAKE MAGAZINE’S DAILY CONGRESS NEWS ON THE ANTERIOR SEGMENT cataract • anterior segment • kudos • enlightenment
thanks to
Pearls for Optimizing Workflow and Outcomes High CataractVolumeSurgery
His point made, Dr. Donnenfeld said the best approach is to aim for a minimal amount of eye drops or go fully dropless altogether, and one of the solutions he recommends is the nepafenac
High Volume Cataract Surgery featured some of ESCRS’s most prominent figures, including current President Prof. Dr. Oliver Findl and Past President Prof. Dr. Rudy Nuijts — but some of the biggest stars were the speakers. The first Cont. do rabbits and children have in common? Recent studies on CXL, to begin with...
Chief Editor Brooke
Three days with Teleon: Behind the cataract surgery ZEISS & Nguyen COO & CFO
Editor Maricel Salvador GraphicWritersDesigner Andrew Sweeney Matt Herman Customer Care Ruchi Ranga InternationalDevelopmentBusiness Brandon Winkeler Robert Anderson Adam Angrisanio Media MICE Pte. Ltd. 6001 Beach Road, #09-09 Golden Mile Tower, Singapore 199589 Tel.: +65 8186 7677 Email:www.mediaMICE.comenquiry@mediamice.com Published cakemagazine.orgby
Gloria D. Gamat Herron
by Andrew Sweeney
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Integrated digital ecosystems are everywhere these days, from the smartphones in our pockets to computers we work and play on. And for Prof. Dr. Oliver Findl, birds of the same feather work together to make life better for surgeons and patients alike in the ZEISS Cataract Workflow with integrated digital
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The integrated workflow with the EQ Workplace is not only a massive time saver, but also cuts out transcription errors by drawing data directly from diagnostics. Prof. Findl specifically mentioned that errors induced by manual input of data for IOL calculation or surgery planning are simply not there anymore, thanks to the paper-less workflow. Also, it is still possible to have a digital PDF version or a printout for additional
by Matt Herman
Higher efficiency, byte by bit
Prof.solutions.Findl
Medical devices are, by contrast and out of necessity, all function and no form. The rickety elevator and gas-guzzling roadster have their charm, but innovation must be embraced in medicine for the universal betterment of human health. And in a ZEISS symposium on Sunday morning at ESCRS 2022, presenters showed exactly how ZEISS is using the digitalization revolution to push the boundaries of medicine into a new era.
The rubber met the road for the digitalization of cataract surgery in a ZEISS breakfast symposium at ESCRS 2022
Revelation IntegrationThroughinCataract Workflow Optimization
here’s no other city in the world quite like Milan, Italy, the host of the 40th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2022). A large part of the city’s charm is its effortless blending of the timeless and the modern. Classic automobiles share quaint city streets with hypermodern, sleek sports cars; a mechanical wood-paneled elevator opens into a fully digitalized smart apartment.
brought up toric IOLs as an example illuminating the workflow efficiency advantages of the ZEISS digital cataract workflow. From data entry, to ordering and to positioning the IOL, toric IOLs are from start to finish simply less efficient, but this all changes with a solution from ZEISS: the ZEISS EQ Workplace.
Dr.flexibility.Wolfgang
19 September 2022 | Issue #32
Mayer then dove into the data on how streamlined digital solutions like the ZEISS EQ Workplace and ZEISS CALLISTO eye make perioperative life easier for all. Preoperatively, surgeons face a litany of limitations — reproducibility of measurements, streamlining diagnostics and workflow, IOL formulas and lens choice, and estimating lens position, among others.
Meeting the unmet phacoemulsificationin
The integration of the ZEISS CALLISTO eye and the QUATERA 700 is a handmeets-glove match sorely needed in the computer-assisted cataract surgery system, according to Dr. Liem Trinh. The effortless efficiency of going from biometry with the IOLMaster 700 to the cloud, to IOL calculation with the EQ Workplace, to the surgery room with CALLISTO eye and phaco with the QUATERA 700, there simply is no peer in the cataract and refractive surgery equipment space.
ZEISS and their ZEISS Cataract Workflow, and Drs. Liem Trinh of France and Nic Reus of the Netherlands
CAKE Magazine’s Daily Congress News on the Anterior Segment 3
His published data shows just how effective digital solutions are. Data checking, IOL calculation and reference image export streamlining saw a 55.5 second time savings compared to manual methods; reference image import and imagine matching saved 74.9 seconds; and intraoperative IOL alignment saved 8 seconds. Overall this adds up to a whopping four minutes of time savings per procedure, and surgeons around the world don’t need much imagination to know what this Postoperatively,means.theefficiency narrative continues. It’s all about data evaluation, and ZEISS shines brightly in this department. Dr. Mayer mentioned a diverse array of improvements from refractive outcomes, to optimization of lens constants and creation of treatment nomograms. All time-consuming and tedious tasks in days past — all made simple by ZEISS and the digital workflow revolution.
“Thisfeatures.phaco system is efficient, even for hard cataracts,” Dr. Trinh noted. “It’s very comfortable for me … I feel at home when using the complete integrated ZEISS Cataract suite.”
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the best is also effortless using the Surgery Optimizer’s automatic synchronization feature. “You can see how you can actually improve your surgical skills compared to the best surgeons,” Dr. Sriganesh commented. She was able to compare her own surgeries with legendary mentor Dr. Sri Ganesh, pointing out differences in technique as she reviewed one of her own early
The ZEISS-patented QUATTRO pump is what puts the QUATERA 700 over the edge also for ESCRS Council Member Dr. Nic Reus. Traditional venturi pumps and peristaltic pumps limit the surgeon by being only vacuum-based or flowbased, respectively; the QUATTRO pump provides the best of both worlds by being either vacuum or flow controlled, and the level of control achieved is unrivaled.
showed the seamless integration of the QUATERA 700 into the digital realm.
Dr. Trinh also praised the innovative features of the QUATERA 700. He particularly loved the control offered by the foot pedal, particularly when used to activate the CALLISTO eye assistance
the videos directly on the cloud cuts out transfer times of bulky HD surgical videos. Not only this, but the AI automatically chops the surgery up into phases, so surgeons can identify and view individual pieces like capsulorhexis and hydrodissection for finding a room for Learningoptimization.from
automatic fine Italian sports car sounds like blasphemy, so too does settling for anything less than the QUATTRO pump with a cutting-edge phaco system. “It’s really controlled, but in a fast way,” Dr. Reus concluded. “You just have to use it.”
For surgeons of all levels, video review of surgeries is critical to development. The credo is to observe yourself and observe the best, and the ZEISS Surgery Optimizer delivers this like nothing else on the Viewingmarket.
“It is like driving a sports car with a clutch versus an automatic,” he enthused. If tearing around the streets of Milan in an
speak for themselves. Using the Surgery Optimizer, Dr. Sriganesh was able to reduce her surgical time from 12-13 minutes to about 6.5 minutes. “Reducing your surgical time by 50% is huge,” she reported. But this is just par for the course with the ZEISS EQ Workplace, QUATERA 700 and the Surgery Optimizer — efficiency and patient outcomes are the end goal, and the unparalleled optimization that digitalization with the ZEISS Cataract Workflow brings is changing the game.
The machine learning-human relationship can be a bit one-sided these days. Humans feed data to deep learning algorithms, and artificial intelligence (AI) “learns” as a result. But ZEISS has harnessed the power of artificial intelligence to give back to the surgeon, and Dr. Supriya Sriganesh talked about how the AI-enabled ZEISS Surgery Optimizer blasted her surgical skills through the stratosphere.
With all the hubbub surrounding femtosecond laser assisted cataract surgery (FLACS), it may sometimes seem like phacoemulsification is going the way of the horse and carriage. Though those in the know realize that this is patently false, medical equipment manufacturers continue to leave phaco devices by the side of the road in the rush to
AI-powered education
complain if they are off target afterward because we’re able to better manage their expectations. They know what their vision will look like afterwards and they fully understand the whole process,” he concluded.
Dr.group.Donnenfeld
After her presentation, Prof. Findl polled the audience about whether or not they used ISBCS, with a few attendees stating they used the technique pre-COVID-19. Then, a larger number (though still a significant minority) reported using ISBCS during the pandemic, and a smaller number (estimated by Prof. Findl at around 20%) reported that they continue using the technique to this day.
By optimizing the workflow of one’s clinic and making it easier for patients to benefit from technologies like telehealth, cataract specialists can also reduce the volume of their surgeries. That’s according to Mr. Arthur Cummings, MD, medical director of Wellington Eye Clinic in Dublin, Ireland.
patients, resulting in a significantly decreased surgical volume. This includes customizable online forms to track medical histories; interactive videos where doctor and patient can discuss, highlight and mark legal paperwork online; and a Visual Behavior Wearable Sensor that tracks a patient’s ocular activity for over 36 hours at home. The latter tool sends data to the consulting optometrist, who can then draw up diagrams, charts and more, that accurately display how the patient’s vision will look after their surgery. Not only has this proved popular with patients, said Mr. Cummings, it’s also boosted his clinic’s “Patientsoperations.are
His clinic has pioneered the use of telemedicine and interactive multimedia to provide streamlined service for
An accurate depiction of eye drop application?
Immediately sequential bilateral cataract surgery (ISBCS), where cataracts are removed from both eyes during the same procedure, became more prevalent during the COVID-19 pandemic. So, should ISBCS become standard practice? That was the question posed by Dr. Lindsay Spekreijse, an ophthalmologist at Maastricht University, the Netherlands.
Dr. Spekreijse concluded that in healthcare systems where cataract surgeries are not organized as outpatient procedures, ISBCS is cost-effective and safe. However, whether or not it will prove popular is up for debate.
In fact, the only difference was in a slightly higher number of cases of anisometropia in DSBCS patients. The only main observable difference was that EUR 400 was saved in operating costs per ISBCS procedure.
not just patients, they’re consumers, they’re customers. By going through consent forms in detail with patients on screen, making interactive notes on the same screen, using diagrams, etc., we provide a service and make it very easy to understand,” said Mr. “PatientsCummings.never
Dr. Spekreijse studied whether utilizing the non-typical ISBCS technique was associated with any reduction in visual outcomes and patient satisfaction. She found that there was no observable difference between the two techniques regarding complications, and no cases of endophthalmitis occurred whatsoever.
punctal plug delivery system (N-PPDS). It’s cosmetically invisible, can be placed and removed easily in the clinic, and can offer “sustained and consistent efficacy” according to one study that also found that best corrected visual acuity (BCVA) at 14 days post-implantation reached 65% compared with 29% in a placebo
19 September 2022 | Issue #34
also spoke favorably about intracameral techniques and he described intracameral antibiotics as an “idea whose time has come.” He also spoke about a drug he said that’s used routinely in the United States and has Food and Drug Administration (FDA) approval, intracameral Phenylephrine 1%/ Kerotolac 0.3%, which he believes should be frequently utilized in Europe.
Two birds with one stone, two eyes with one scalpel
Interactive paperwork
>> Cont. from Page 1
The standard practice of cataract procedures involving both eyes is usually delayed sequential bilateral cataract surgery (DSBCS), which often results in the surgeries being spread over a four-week period (on average).
“Using this treatment is beneficial as it maintains pupil size, and there’s nothing more debilitating than when a patient’s pupil size comes down to 3 or 4 mm while we’re working,” Dr. Donnenfeld said.
t wouldn’t be a CAKE POST without at least one poster session … so dear reader, you are truly in luck. On Day 3 of ESCRS 2022 in Milan, the assembled visitors got a chance to hear about some of the most critical developments in keratitis and keratoconus, in a session titled Corneal-Crosslinking 1. Featuring everything from white rabbits to pediatrics, it was truly poster session perfection.
improvement was seen in Group B (P < 0.001). The conclusion? Highfluence PACK-CXL total ultraviolet A fluence of 7.2 J/cm2 is effective in treating mycotic keratitis.
I
The first speaker we would like to highlight (not just because it was the writer’s first time watching animal vivisection in the name of science) was Dr. Ramy Elbassiouny from the University of Alexandria, Egypt, with Comparison Between Three Different High Fluence Ultraviolet A Levels In Corneal Collagen Cross-Linking For Treatment Of Experimentally Induced Fungal Keratitis In Rabbits. The study examined the antifungal efficacy of high-fluence corneal cross-linking (CXL) in the treatment of induced fusarium corneal ulcers. The infection was induced in six eyes of eight [poor little] rabbits via intrastromal corneal
CAKE Magazine’s Daily Congress News on the Anterior Segment 5
Looking into CXL childrenratesfailurein
CXL, keratitis and rabbits
Sometimes in life, things showcase:postertheandwaynecessarilydon’tgothetheyshould,thatwasinpartthemeofthesecondwe’dliketo
were divided into two groups with Group A receiving no treatment and Group B receiving a single high-fluence PACK-CXL session. After six days the rabbits were observed for results: A statistically significant deterioration was found in Group A (P = 0.003), while a statistically significant clinical
Work: Why and When? Ably presented by Mr. Samer Hamada, MD, Queen Victoria Hospital (East Grinstead, England), the poster highlighted that 2.9% of CXL fails in adults, but there is “limited reporting” on failure rates among children, warranting further examination of both failures and risk factors.
Mr. Hamada performed a retrospective study that lasted eight years with a minimum follow-up of four years at his hospital, examining 135 patients in total. Out of this number he said that six (4.4%) patients had documented keratoconus progression after primary CXL and that 22% had further
keratoconus progression despite repeat CXL (with this group likely to require further procedures like corneal Furthermore,transplant).
Theinjection.rabbits
Mr. Hamada reported that the primary risk factors for progression in the failure group were being male and between the ages of 14-16, being a “prolific eye rubber,” and having a history of atopy. Observing that keratoconus was more likely to be aggressive in younger patients, he highlighted the need for further research to supplement his own. Good call, doc’!
WhiteCXL, Rabbits and Kids
by Andrew Sweeney
When Pediatric Cross-LinkingCornealDoes Not
Three Days with Teleon Surgical at ESCRS 2022
signature green displays around the clock to see the latest innovations in IOLs and medical devices, and your correspondent was on hand throughout the first three days to see what the buzz was all about.
2:00 p.m.
Upon entering the exhibition, TELEON’s bold green signage at the heart of the hall towered above the rest, and crowds had already begun forming around the booth in anticipation of what was to come.
Upon drawing nearer, the booth was cleverly designed to showcase the company’s products, as well as offer a comfortable respite to delegates in a lounge area. Adorning the walls of the booth, were images of Milan as seen through TELEON’s IOLs — like the
2:50 p.m.
LENTIS Mplus, where the city’s streets at sunset are on display within the lens. And in the middle of it all, a LENSAR Ally Adaptive Cataract Treatment System (more on that later). With curiosity piqued and an overwhelming urge to relax in one of the lounge chairs, your correspondent settled in to watch the action…
edia MICE was live at ESCRS 2022 in Milan, Italy to check out the booth scene from one of Europe’s most innovative manufacturers.
19 September 2022 | Issue #36
But cutting-edge design wasn’t just limited to what attendees were wearing, and nowhere else was this more evident than at the TELEON Surgical booth. Attendees flocked to the company’s
The masses were unleashed and TELEON’s booth was a hive of activity amidst the din of the exhibition hall. A camera crew set up shop and checked microphones as featured speaker Dr. Florian Kretz joked with attendees during the first of four Booth Talks the company would host over the coming days. The crowd began to spill out into the aisle as headsets were distributed, and anticipation built up to the moment Dr. Kretz strolled up to the screen.
M
It is an at-times bewildering milieu of classic cool and avant-garde design here in the world’s fashion and design capital of Milan, Italy, host city of the 40th Congress of the European Society of Cataract and Refractive Surgeons (ESCRS 2022). Skirts and dresses festooned with modern and brightly-colored patterns swished amongst the clean lines and moda classica of days long gone in Exhibition Hall 4 of the Milano Convention Center in the year’s most stylish ophthalmic conference yet.
Day 1 (17 Sept. 2022)
by Matt Herman
Out of breath from a grueling jog in dress shoes apparently not up to the task, your correspondent arrived huffing and puffing to a throng of spectators at TELEON’s Booth 32. All were awaiting Dr. Patrick Versace’s Booth Talk, ALLY and FEMTIS IOL — the perfect match for highest demands and excellent results
3:00 p.m.
Dr. Kretz delivered his talk on Refractive EDOF and multifocal technologies: Blended vision with MF15 & MF30 optical designs. It revolved around TELEON’s high-tech LENTIS family of IOLs for presbyopia correction, and Dr. Kretz noted that this family of lenses was clearly designed with TELEON’s signature patient-centric approach. The world is diverse, and patients have a variety of needs, Dr. Kretz observed. TELEON’s patient-first approach has delivered a family of lenses evolving constantly to embrace this diversity, and the patient outcomes Dr. Kretz shared speak to the effectiveness of this approach.
elaborated on the seamlessness of using TELEON’s FEMTIS IOLs. Lenses like FEMTIS deliver accurate, predictable results from everything to post-op refraction goals to reliable alignment due to lens fixation in the capsulorhexis. The proven results with TELEON’s asymmetrical refractive lens designs are a no-brainer according to Dr. Versace, and the crowd couldn’t help but nod in agreement.
was a live demo of TELEON’s new iDea, a powerful diagnostic tool designed to meet the ever-rising needs of patients with dry eye. A technician took crowds through the device’s advanced tear film monitoring capabilities, tear composition analysis, and ability to peek at all layers for unparalleled accuracy in diagnosing dryeye type.
Day 2 (18 Sept. 2022)
It was another sprint to the booth as your correspondent arrived just in time to wrangle a set of headphones for Dr. Andreas Borkenstein’s Booth Talk: Enhanced monofocal technologies — LENTIS & ACUNEX Quantum
Data-driven analysis of LENTIS and ACUNEX Quantum monofocal IOLs was on the menu for Dr. Borkenstein, as he focused on holding up TELEON’s impressive claims to the cold, hard light of data. “Are the statements of the company true or not,” Dr. Borkenstein asked rhetorically and then proceeded to dissect the data from the optical bench to the clinic to see if these lenses were up to
3:00 p.m.
A more relaxed schedule meant an earlier arrival at Booth 32 in the hopes of catching up with Dr. Cathleen McCabe, presenter of the final Booth Talk, ALLY: First Impressions and Technical Details But your correspondent’s attention was drawn immediately to a swelling crowd surrounding the LENSAR ALLY Laser System, which was presently being demonstrated to an eager audience. The skilled technician deftly scanned QR codes and showcased the ALLY’s integrated femto and phaco functionalities, which fit perfectly with Dr. McCabe’s presentation.
For Dr. McCabe, ALLY is all about the marriage of convenience and technological prowess. The platform is the cataract laser to integrate important preoperative settings. “It knows you. It knows your technique,” Dr. McCabe reported. This customizability, along with the convenience of the ALLY’s combined femto and phaco functionalities make the device a disruptive, cost-effective and efficient addition to any surgeon’s cataract surgery arsenal.
9:58 a.m.
A spot underneath a giant rotating crosssectioned replica of an eye implanted with a FEMTIS IOL was fittingly chosen as an observation post, and the talk began. With multiple gestures to the LENSAR ALLY to the speaker’s right, Dr. Versace
Even for problematic patients, the LENTIS and ACUNEX were up to snuff, and members of the audience with horror stories of their own murmured to each other in Immediatelyadmiration.following
Day 3 (19 Sept. 2022)
was a resounding “yes” as Dr. Borkenstein transitioned smoothly from a chart barrage to case study. Of particular interest was a 78-year-old former biology professor and self-styled “Google expert” who came in with sky-high expectations.
1:45 p.m.
Dr. McCabe’s final thought was a particularly prescient way of summing up TELEON and their presence at ESCRS 2022. “This is technology that works as it was designed to perform,” she said. And doctors who popped by the booth all found out that TELEON’s optical designs are made for optimal, efficient and effective surgical outcomes with an emphasis on embracing the diversity in patient and surgeon needs.
CAKE Magazine’s Daily Congress News on the Anterior Segment 7
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19 September 2022 | Issue #38 6001 Beach Road, #09-09 Golden Mile Tower, Singapore 199589 www.piemagazine.org www.cakemagazine.org www.cookiemagazine.org www.mediamice.com/expo CONTENT MARKETING + ADVERTISING + MEDICAL WRITING + EVENTS Phone: +65 8186 7677 E-mail: enquiry@mediamice.com Web: www.mediamice.com Request our 2022 Agency Kit Now! Write enquiry@mediamice.com for a copy
