OPH the RECORD Published by OPHTEC BV /// 2016 / 2017 Edition
The Clinic NIIOS in Rotterdam, The Netherlands
Memories of
Prof. Dr Jan Worst Prof. Dr Rudy Nuijts
AND: 9 Meet the experts
Dr David Sung Yong Kang, Seoul, Korea
10 Dr Vinícius Ghanem:
‘I decided to have Artisan lenses implanted in my own eyes’
16 OPHTEC distributor
Herbert Lugbauer looking back at three decades of Askin & Co.
www.ophtec.com
Events & Congresses 2016 / 2017 June 24 - 26
Kyoto
Japan
JSCRS
June 27 - 30
Nusa Dua
Indonesia
APACRS
September 10 - 14
Copenhagen
Denmark
ESCRS
September 21 - 24
Malaga
Spain
SEO
Sept/Oct 29 - 2
Berlin
Germany
DOG
October 7
Groningen
The Netherlands
ArtiLens training
October 15 - 18
Chicago
USA
AAO
November 4 - 6
Ilsan
Korea
Autumn KOS
November 23 - 25
Brussels
Belgium
OB
November 25 - 28
Rome
Italy
SOI
December 1 - 3
Vilamoura
Portugal
SPO
February 10 - 12
Maastricht
The Netherlands
ESCRS Winter Meeting
March 1 - 5
Singapore
Singapore
APAO
March 29 - 31
Maastricht
The Netherlands
NOG
March 14 - 18
Düsseldorf
Germany
AAD
May 5 - 9
Los Angeles
USA
ASCRS
May 6 - 9
Paris
France
SFO
May 11 - 13
Nurnberg
Germany
DOC
May 24 - 27
Milan
Italy
SOI
June 1 - 4
Hangzhou
China
APACRS
September 7 - 11
Lisbon
Portugal
ESCRS
2017
Colophon OphTheRecord is published by OPHTEC BV Interviews: Mathijs Deen; Tekst & Training, Amsterdam Marij Thiecke; Concept & Copy, Haren E-mail: r.den.besten@ophtec.com Design: www.mennoschreuder.nl Print: Scholma Druk, Bedum Cover photo: Øresund Bridge, Copenhagen/Malmö All rights reserved. © OPHTEC BV 2016 P.O. Box 398 | 9700 AJ | Groningen T: +31 50 525 1944 | F: +31 50 525 4386 www.ophtec.com
In t h i s i s s u e :
10 Dr Vinícius Ghanem:
‘I decided to have Artisan lenses implanted in my own eyes’
4
The Clinic
NIIOS in Rotterdam, The Netherlands. The story of a unique ophthalmic clinic.
Meet the experts
9
Dr David Sung Yong Kang, Seoul, Korea
12
Three generations of ophthalmic dedication. An interview with Dr Vinícius Ghanem.
‘He was the man with the big ideas’ Memories of Prof. Dr Jan Worst Prof. Dr Rudy Nuijts, MUMC, interviewed
OPHTEC distributor
Herbert Lugbauer looking back at three decades of Askin & Co.
18. OPHTEC Short
Dr Vinícius Ghanem
3 OPH//THE//RECORD
16
/// The Clinic • NIIOS Rotterdam, The Netherlands
NIIOS, Rotterdam Author Mathijs Deen visits the NIIOS in Rotterdam for our series ‘The Clinic’
The NIIOS in Rotterdam is one of a kind. Not only because it is here that some 1000 DMEK corneal transplants have already been performed but also because, in addition to a clinic, the buildings of the Netherlands Institute for Innovative Ocular Surgery also house an eye tissue bank, a research department and an Academy institute. All of this with Dr Gerrit Melles, the inventor of the DMEK methods, in attendance.
It is a sunny day, but windy; the sort of day when seagulls sail swiftly between the high buildings and the proximity of the sea cannot be ignored. The city is all bustle and transport. The modest boardroom of the NIIOS looks out over the river and the ships steaming past on the sparkling water. Two of the three Board members, Kim Herders and Hanneke van Bergen, are taking in the view. I asked them if it is by chance that the NIIOS is located in Rotterdam. It is not. The river is crossed by the Erasmus Bridge, the symbol of this sober and enterprising city. ‘That’s what we like too,’ says Kim Herders. ‘We have a sober outlook on the world, without any fuss, but we are certainly ambitious.’ She points at the ships passing by. ‘And the whole world comes to our door,’ she says. ‘Just like the ships on the river.’ All these people come for one thing in particular: DMEK; the corneal transplant procedure devised and developed by Dr Melles. Most of the patients who come to Rotterdam are suffering from Fuchs endothelial dystrophy or more complex corneal conditions. DMEK
OPH//THE//RECORD 4
from left to right: Hanneke van Bergen, Kim Herders and Gerrit Melles.
differs from the traditional treatment in that it does not replace the entire cornea but just the endothelium, like a layer of wallpaper that is just one cell deep, a mere 20 µm. During the operation, the anterior chamber of the eyeball is filled with air, not solely to check
‘Those people who enjoy it a little to be thrown off balance during an interview are the ones who will also enjoy working here’ that the affected endothelium is removed correctly and completely but also to allow the donor tissue to be rolled out and manoeuvred into position.
Some patients have their sight totally restored within a week of the operation. After six months, 80% of patients have 80% or more sight. It is not just patients who come to Rotterdam to undergo the operation, ophthalmologists from all over the world also arrive to learn the technique at the NIIOS from the founders themselves. Because this is a new procedure, or rather, it has been performed in Rotterdam about 1000 times since Melles tried it for the first time ten years ago. But DMEK is not yet common practice everywhere because this sort of thing simply takes time. When Melles first presented his idea for the new method to his colleagues in 1998, Jan Worst, the founder of OPHTEC, predicted that it would take 20 years before it would become common practice in the rest of the Netherlands. As is often the case with an innovative organisation, the NIIOS is a united group of pioneers and it is important to Melles that it remains so. ‘I posted a vacancy just today,’ says Hanneke van Bergen. ‘And I asked Gerrit Melles yesterday what sort of a person he is looking for. His response was: someone alert and resourceful. Not an employee but a co-worker, someone who doesn’t simply carry out instructions but goes looking for new connections or who recognises them when they present themselves.’ >>
5 OPH//THE//RECORD
/// The Clinic • NIIOS Rotterdam, The Netherlands
Clinical images displaying the centration and unfolding of a DMEK-graft inside the recipient anterior chamber. A small air-bubble is positioned in between the upward folds of the ‘double DM-roll’ (A). Note the blue coloration halfway the cannula, indicating that the cannula is in part positioned ‘underneath’ one of the peripheral folds (Moutsouris sign, arrow). By applying gently strokes with the cannula onto the outer corneal surface, the DMEK-graft is then rotated into the largest, i.e. horizontal meridian of the eye. To start unfolding the DM–roll, light taps onto the corneal surface are used, as well as manipulations with the small air bubble on top of the graft (Dapena maneuver) (B,C). The air bubble is enlarged to further unroll the DMEK-graft, and, still using the cannula at the outer corneal surface, the graft is centered (D,E). The air bubble is enlarged to completely unfold the DMEK-graft, and to position it onto the iris (air bubble in between graft and cornea) (F,G). After approximately ten seconds, the air bubble is aspirated and the cannula is positioned underneath the graft to inject air at the pupillary margin (air in between iris and graft) (H,I). An ‘inward fold’ of the DMEK-graft is visible at the 4 o’clock surgical position, that is repositioned, i.e. unfolded, using a ‘Bubble-bumping maneuver’: pushing the air-bubble away from the fold induces an aqueous flow that unfolds the graft’s peripheral edge (I-K). Once completely unfolded, the anterior chamber is filled with air for approximately one hour.
The question is how you find such a person. At the NIIOS it starts with the interview. ‘We are looking for a particular type of people,’ says Hanneke van Bergen, ‘People whom we have learned to recognise well by now. Their background doesn’t matter. Our priority is whether he or she will fit into the team.’ ‘We present them with examples from clinical practice immediately,’ adds Kim Herders, ‘and that way we quickly find out whether someone is solution-oriented or more likely to wait and see.’ ‘And we try to throw them off balance,’ Hanneke jumps in again. ‘If it says on their CV that they speak English and German very well, we will suddenly switch to those languages. Because you have to change gears fast and often here. So we test them for that. Those people who enjoy it a little to be thrown off balance during an interview are the ones who will also enjoy working here. And those are the people with whom we will enjoy working.’
OPH//THE//RECORD 6
‘The NIIOS style of thinking is ‘out of the box’, enterprising and off the beaten track,’ Kim decides. I look around, in search of traces of Dr Gerrit Melles. He is further inside the building, talking to patients, and if we go into the clinic we will certainly run into him. Above one of the desks hangs a finished jigsaw puzzle of a painting of Napoleon and his troops. The scene is the surrender of the city of Ulm, painted in 1815 by Charles Thévenin. ‘It is indeed his,’ says Kim Herders when asked. ‘It was given to him by his parents when he was a child. He has a thing about Napoleon.’ We walk into the clinic. The building is a mixture of professionalism and informal domesticity. The whole place is a hive of activity; there is no concealment of what is going on here: consultations and treatment. We pass consulting rooms, an examination room with a Pentacam, an endothelial camera, OCT and two slit lamps. ‘We are researching the effectiveness and applicability of DMEK,’ explains medical biologist Lisanne Ham, whose doctorate was on DMEK. Another door leads to operating rooms; not fully equipped theatres but spaces set up far more sparingly with SurgiCubes, another of Melles’ inventions. They are a type of open cube, in which a column of sterile air is created, like an extractor in reverse, in which surgery can be performed. Close by is the tissue bank where medical biologist Jessica Lie is preparing corneas; tiny, almost invisible, double coils of rolled-up cells in a nutrient-rich liquid the colour of strawberry lemonade.
(A) Slit-lamp photograph 1 year after DSEK. Despite complete corneal clearance and minimal interface opacity, the patient’s BCVA never improved beyond 20/100. Image (B) shows the same eye following a secondary DMEK for reasons of low visual acuity. After DMEK, vision improved to 20/25 at 1 month post-operatively. (from: Parker J, Parker JS, Melles GRJ. Descemet membrane endothelial keratoplasty (DMEK): A review. US Ophthalmic Review 2013;6:29-32.)
Jessica Lie
Tissue bank
Everything under one roof, everything within reach, and everything under the supervision of the team, so that the manner in which the corneas are prepared is completely attuned to DMEK.
‘If someone says: that’s not possible, that won’t work, then you want to say: we’ll just see about that’ And suddenly Gerrit Melles himself appears; cheerful, with a warm handshake and prepared to link his former fascination with Napoleon to the organisation he has built up. It seems to me that, like Napoleon, you enjoy exploring uncharted territory with a group of close associates, people you can really count on. ‘That’s nicely put,’ says Melles. ‘But Napoleon was able to do that particularly because - unlike
his opponents - he was able to recruit not just from the aristocracy but could also surround himself with young people who were good at what they did, regardless of their origin. And that’s the way it is here too.’ Why have everything in one building? ‘The component parts strengthen one another. The people working in the eye bank also come to work in the clinic and so they can see that the cornea they have prepared is put into the eye of a real person with a name. That produces far greater involvement and a greater sense of responsibility.’ It is striking how often this unity and involvement comes up in the conversations. But that mainly has a lot to do with the fact that Melles is looking for new ways of doing things. And this leads to resistance. ‘Sometimes the resistance is so great that I get discouraged,’ he says. ‘But after all, if someone says: that’s not possible, that won’t work, then you want to say: we’ll just see about that. Then, if someone criticises you, you have a look to see if the criticism is justified. You go and evaluate things and assess whether what you want to do has long-term potential. There is no point in fighting an all-out war over something you do not believe in yourself. The noise and the opposition from outsiders brings unity within the organisation. That is what has been happening here.
7 OPH//THE//RECORD
Transitional Conic Toric IOL
Results in Focus
1 line better than other toric IOLs* // Precizon Toric online presentations: Prof. George Beiko, Canada Initial experience with toric lens tolerant of misalignment.
Prof. Tae-Im Kim, South Korea Korean experience of Precizon Toric IOL.
Dr Tiago Ferreira, Portugal How to improve results with the Precizon Toric by evaluating astigmatism with a new color-LED topographer.
Dr João Paulo Cunha, Portugal Evaluation of a Precizon Toric IOL. Stability and Aberrometry.
Dr Eunice Guerra, Portugal Visual Performance and Stability of a Monofocal Toric IOL - Precizon by OPHTEC.
Dr Emilio Segovia, Spain 12 months experience with the Precizon Toric intraocular lens.
Videos can be found: www.youtube.com/ophtecbv playlist: Precizon Toric * ‘Visual and optical outcomes of a new monofocal toric intraocular lens. By: Tiago B. Ferreira, MD; ESCRS 2015 ‘Comparison of the Visual Outcomes and OPD-Scan Results of AMO Tecnis Toric and Alcon Acrysof IQ Toric Intraocular Lenses’ Tiago B. Ferreira, MD; Ana Almeida, MD. J Refract Surg. 2012 Aug;28(8):551-5
/// Meet the experts
Dr David Sung Yong Kang, Expert in specialized PIOL implantation
Dr David Sung Yong Kang, EYEREUM EYE CLINIC Gangnam, Seoul is worldwide recognized as an expert in Artiflex Toric lenses. He has implanted the largest number of these lenses in 2015. He shares his experience by publications in leading scientific magazines and presentations on the major worldwide congresses. Korea is well-known for a prevalence ratio of excessive myopia. According to a recent report from the Korean Ophthalmology Society, an increasing number of 80% of the Korean teenagers, aged between 12-18, have high myopia. This is about 4 times higher than the percentage of high myopia by senior citizens over 60 years old. 70% of those high myopic teenagers are patients with an extreme myopia. This report also indicates that the eye sight of 80% of the Korean teenagers can be surgically corrected once the myopia stabilizes at the age of 18 years. The prevalence ratio of high myopia could explain the rise in eye sight correction surgery cases and high-speed development of related medical techniques. Phakic IOL implantation which is suddenly gathering attention in other Asian countries such as China has already been actively performed for more than 15 years in Korea. This is one of the reasons that there is a lot of knowledge and expertise of this procedure in Korea.
Dr David Sung Yong Kang, Clinic Director • EYEREUM Ophthalmic Clinic Director • Graduated YonSei University College of Medicine • YonSei University College of Medicine, Sinchon Severance Hospital Eye Specialist • YonSei University College of Medicine, Sinchon Severance Hospital Ophthalmology Fellowship • Seoul Asan Hospital, Ophthalmology Clinical Instructor.
Dr David Sung Yong Kang is one of the experts. He is clinical director at the EYEREUM EYE CLINIC, located in Gangnam, a district of South Korea’s capital Seoul. This clinic is well known not only for the correction of high myopia and astigmatism but also for complication treatment after PIOL implantation. Dr Kang implanted the most Artilfex Toric lenses in 2015. A large percentage of his patients have extremely high myopia, of over -15 D. He thoroughly investigates the risk factors of cataract and glaucoma prior to any surgery. To provide highest level of safety he scrutinizes each patients unique factors, and may decide not to perform the surgery, even if he sees only a 1% chance that a complication occurs. Dr Kang considers it important to share his knowledge on this procedure. That is why he often receives colleagues from other Asian countries to show details of his surgery technique. He also shares his surgical videos showing his surgical skills. Dr Kang has published many papers in peer review journals on phakic intraocular lenses in three consecutive years; 2014 and 2015 in the Journal AJO (American Journal of Ophthalmology), and in 2016 a paper will appear in the Peer Review journal YMJ (Yonsei Medical Journal) This paper ‘Comparison of toric foldable iris-fixated phakic intraocular lens implantation and limbal relaxing incisions for moderate-to-high myopic astigmatism’ is a co study done in cooperation with the Severance Medical School. Through this study, Dr Kang has proven that Artiflex Toric can provide superior astigmatism correction in addition to the minimization of night glare and dry eyes, common complications with LRI.
Dr Kang’s ‘Meet the expert’ presentation can be found on youtube.com/ophtecbv. Playlist 2105 ESCRS booth speakers.
9 OPH//THE//RECORD
Dr Vinícius Ghanem:
‘I decided to have Artisan lenses implanted in my own eyes’ Three generations of ophthalmic dedication at the Brazilian Sadalla Amin Ghanem Eye Hospital
Brazil isn’t just about the immense Olympic Games, the seemingly endless Amazon river, or eternal promises of amazing summers. In the small city of Joinville (in the south of this immense country), the Sadalla Amin Ghanem Eye Hospital saw the light in 1942. Over the years, it has developed into a thriving family owned business that breathes dedication and passion - towards patients, towards ophthalmology, and towards maintaining and strengthening family bonds within three generations. In their shared aim for even better eye care, the Ghanem family experienced a full circle moment when Vinícius Ghanem had Artisan lenses implanted in his own eyes, by his father.
By: Marij Thiecke
OPH//THE//RECORD 10
Vinícius Amin Ghanem is the grandson of the visionary founder of the hospital. Ghanem: ‘My grandfather was an otolaryngologist and ophthalmologist who decided to start a small clinic to accommodate his polysyllabic dreams ambitions. In 1972, my father joined the clinic, as did my mother. The three of them created the first ophthalmologic group of our state; a group that has grown and developed ever since. Today, our family owns an eye hospital of 10,000 m2 that employs more than 30 full time, fully specialized ophthalmologists. The number of employees totals around three hundred, and we perform more than 1,300 surgeries each month. We use the whole line of Artisan and Artiflex lenses, including the Artisan for aphakia. I’ve been working at the hospital for 15 years now. My parents still work at the hospital, and the ophthalmic virus has spread to my brother and sister-in-law as well. I hope my two small sons will follow the tradition. They are 1 and 3-years-old now. Let’s see what the future brings’. Close-knit Working together as a family - what good can come from that? Ghanem: ‘Working together as a family is truly fantastic! We are a very close-knit family that obviously gets on very well together. I am very dedicated to my family, and to the hospital. We always discuss the difficult cases together, and with our ophthalmologists at the hospital. It is wonderful to have this kind of support and dedication but it would have been almost impossible not living the life I live now. I grew up hearing my parents talk about their patients and treatments and about how wonderful it is to help people see again or see better. Actually, I haven’t ever thought of doing anything besides
Dr Vinícius Ghanem
ophthalmology. That was actually good, because when I went to medical school I was already focusing on being an ophthalmologist. That focus put me some steps ahead of many others.’
‘The next day I was able to see without thick glasses or contact lenses: a truly amazing experience’ Like father, like son Seen in the light of previous revelations, Ghanem’s specialty is not very special, but brims with passion nonetheless: ‘My specialty lies in refractive surgery including phakic lenses, cataract and cornea. We have the Schwind Amaris 1050 Hertz equipped with the best technology available. We have implanted hundreds of multifocal IOLs each year ever since they first arrived in Brazil in 2005. I chose this specialty because my father does the same thing, and right from the beginning I loved it. We really can help people to see better in a question of minutes.’
The stuff legends are made of The ultimate proof of trust must be to have a family member meddle with your eyes. Legends could be written about that fact. Actually, they probably were but for now, let’s stick to the facts with a first-hand story. Ghanem: ‘About 2 and half years ago, I decided to have Artisan lenses implanted in my own eyes. I’d been using contact lenses for 25 years, and I was ready for a permanent alternative. As an ophthalmologist, the importance of vision is something occupying most of your professional life. So before I decided to have the Artisan lenses implanted in my eyes, I studied all literature I could lay my hands on – not because of lack of trust but because I wanted to be absolutely certain about my choice. I had 9 degrees of myopia, and I knew that the Artisan lens would give me a better quality of vision than laser refractive surgery. But maybe there were innovations that I had failed to notice somehow. There weren’t. And besides: how much proof do you need when your own father has learned how to perform the surgery from Jan Worst in 1997? Exactly. Moreover, it would have been strange to neglect the fact that I myself had been implanting the lenses with confidence since 2002 (with no explants to date). And of course, the design had already stood the test of time. This classic has been used for the last thirty years with hardly any design changes. How much proof does one need!’ No ripples ‘The procedure itself was not worth mentioning – I was very calm and everything went by without the slightest ripple or discomfort. What is worth mentioning though, are the results. The following day already proved wonderful because I was able to see without thick glasses or contact lenses: a truly amazing experience. Moreover, my vision improved in the days that followed as the astigmatism improved. My corrected vision was 20/25 before surgery and now is 20/15 without correction. Fantastic! I did experience some glare for about a month, but that slight discomfort subsided. (Just to make it clear: I have no financial interest in this technology.)’ Confident ‘Of course, the fact that my father would perform the procedure was truly unique. I knew that his responsibility would be immense, but I trusted him. I am sure that it is not easy to operate on your own son. Today, having experienced the patient position makes me feel even more confident about using Artisan lenses. And I notice that my experience helps my patients as well – I can describe everything vividly, from the procedure itself to the initial glare, to the amazing feeling of having (re)gained your vision, especially if you suffer from high myopia. My message has become more relevant and genuine, and probably adds to the experience we offer to our patients as a whole.’
11 OPH//THE//RECORD
Prof. Dr Jan Worst
Memories of Prof. Dr Jan Worst Professor Dr Jan Gerben Frans Worst, the inventor of the iris claw lens, passed away last year on 25 September 2015. Mathijs Deen has reported for this journal in many different ways in recent years on the applications of Worst’s lenses in practice. He travelled to Maastricht to ask Professor Dr Rudy Nuijts about his personal memories of Jan Worst, and his importance for the development of refractive surgery. By: Mathijs Deen
OPH//THE//RECORD 12
Virtually everyone who worked with Professor Dr Jan Worst, who knew him or even just came into a short contact with him, has a vivid memory of him. Such memories can often be traced back to an unusual incident or an unconventional twist in a conversation. And this memory, even decades later, will almost always bring a smile to the lips or a sparkle to the eyes. During a radio programme for the Groningen regional broadcasting company, when I was conducting a live interview with someone who knew Jan Worst well, Worst turned up in person at the studio at the end of the programme. He had brought along a pair of barely worn men’s shoes because he had heard that my guest was short of money and that his only remaining pair of shoes was worn out. It was winter. At his funeral, one of his colleagues remembered that she had once told him that a new desk had been placed rather awkwardly for her and that she had bumped into it
so often that it had given her bruises. Shortly thereafter, Jan Worst brought a saw in from home and simply sawed a corner off the desk. Problem solved! Anyone collecting these incidents and attempting to understand what links them will find a number of features that are totally characteristic of Jan Worst: he was unconventional, insatiably curious in a scientific manner, resourceful and averse from status and false pretensions. Not only did he have a belief that was sometimes difficult to refine as to how things should be, he also had a warm heart with an eye for the needs of those around him, regardless of their status, and a weakness for the outcast. This is what makes the Worst stories more than merely a collection of curious events. They are also characteristics of a talent and a personality that were inseparably linked to his scientific insights and success. He strove for elegance in simplicity, for the lowest threshold that would produce the clearest effect. Of course he was well aware of his own unconventionality and made good use of it. But it did result in an implant lens that is still just as bright and new as the day he created it.
13 OPH//THE//RECORD
Pioneers of ophthalmology; in the middle Jan Worst (l) and Harold Ridley
A young Jan Worst in bare handed surgery
Professor Dr Rudy Nuijts, professor of cornea transplantation and refractive surgery in Maastricht, also experienced such characteristic moments. And, of course, he too is unable to suppress a smile when he recalls them. ‘I would actually like to tell you about two occasions,’ he says. ‘Both of them important to me and both also typical of Jan Worst.’ He is looking in a bookcase and shows me a dissertation headed by a photo of a cloudy cornea. ‘I started my career in ophthalmology with this,’ he says. ‘An investigation of the problems that had arisen in operations at Maastricht University Hospital where corneas had become opaque because an instrument had been used that had not been properly cleaned. Shortly afterwards I attended a conference at which Worst was also present. I was a total novice in ophthalmology, still wet behind the ears, but he came right up to me and said: ‘I read what you wrote, I like it.’
‘Oh yes, a fascinating storyteller. Yet he also delighted in pulling the wool over your eyes if he could’ Nuijts leaves a pause to underline the special nature of that moment and then explains why it meant so much to him at the time. ‘It shows he had an interest in what people were doing, regardless of their name, background or status. And don’t forget that this was a man who could be imposing, particularly for young ophthalmologists. Because if he disagreed with you, you had to stand very firm if you wanted to give a reply. But he showed a genuine interest in me, he wanted to talk to me about sterility and cleaning procedures, and so on. If you are a very young researcher and you are given that sort of interest, it has an effect on you. It creates a bond.’ The other event, that has stayed with Nuijts, took place during his fellowship in Rotterdam. He dropped in on Worst to see him at work. It was totally different from anywhere else, as would soon become clear.
OPH//THE//RECORD 14
‘He was performing an operation, looked up, made room for me and said: ‘Wash your hands and come and sit down.’ Nuijts starts to laugh as though he still finds it difficult to believe. ‘I was hardly inside,’ he says, ‘and was suddenly implanting his claw lens. Perhaps he had heard that I was fairly skilful and that I would manage it well. But the fact that he put so much trust in me is unprecedented. Of course that wouldn’t happen anywhere else, only with Jan Worst.’ He shakes his head. ‘And you can think what you like: Surely not? Was that wise? But his mind-set was always concerned with continually teaching people about things and passing on his boundless enthusiasm. I’m going to use a buzzword here: he was passionate.’ It is difficult to talk about Worst’s place in ophthalmology without mentioning the idea of fixing a plastic lens implant to the iris in the eye. The inspiration for making an iris claw lens, which Nuijts describes as a ‘brilliant idea’, came from the brain of a classic innovator. Nuijts spreads his hands and describes ophthalmology as an organisation. ‘He was the man with the big ideas,’ he says. ‘They are indispensable in an organisation. Alongside them are the people who are good at executing the ideas and finally those who can implement them. Jan Worst was at the start of the chain. That was his great strength. He thought outside the box.’ When you place Jan Worst in time, as part of the generation that also includes Harold Ridley and Cornelius Binkhorst, you soon understand that tenacity and faith in one’s own idea were essential in order to achieve anything at all. ‘These were people who were able to swim against the current,’ says Nuijts. ‘Also in the Netherlands, Binkhorst and Worst were told fairly frequently by established ophthalmologists that what they had in mind, a plastic lens in the eye, would cause permanent damage to the cornea. Ophthalmologists who strongly discouraged the ophthalmologists attending annual meetings from pursuing the ideas of Worst and Binkhorst. That was what it was like. And in that situation it was useful that they were totally convinced because they had seen that it worked. That probably gave him the idea: but just look at what we can achieve. And that made the group of pioneers to which he belonged totally united. They strengthened one another in their idea: it simply had to happen, one way or another. Jan Worst was like that too. And he succeeded.’ How would you sum up in a few sentences who Jan Worst was? ‘A man with a huge passion for his profession, genuinely interested in what you were doing, tremendously well-read, an all-rounder, contrary, a true inventor and innovator. And then, as though he has just remembered: ‘And, oh yes, a fascinating storyteller. Yet he also delighted in pulling the wool over your eyes if he could.’ And then he laughs again, as so often occurs when people recollect Jan Worst.
The ARTISAN Family Complete Range of Iris Fixated IOLs
Corrects Myopia, Hyperopia, Aphakia & Astigmatism
VacuFix
™
ARTIFLEX®
vacuum system for a perfect enclavation a Fixed reproducable amount of iris tissue, a Best positioning and centration of the (P)IOL
ARTISAN®
ArtiLens
certification courses To obtain the best results with Artisan and Artiflex (A)phakic intraocular lenses, OPHTEC continuously conducts ArtiLens certification courses throughout the world. By providing lenses to certified professionals only, OPHTEC guarantees the constant high quality of the results with the product. The ArtiLens courses will provide surgeons with the essential theoretical knowledge and practical experience needed for the implantation of the Artisan and Artiflex IOLs. They are given by experienced surgeons who have implanted the lenses for many years. The courses run from: OPHTEC’s head office in The Netherlands, OPHTEC subsidiaries, Medical Centers and major worldwide ophthalmic congresses.
Upcoming courses in 2016: September 17
Linda-a-Velha, Portugal
October 7
Groningen, The Netherlands
October 22
Bilbao, Spain
November 12-13
Berlin, Germany
November 12
Barcelona, Spain
Please contact us for other dates, locations or registration: marketing@ophtec.com.
15 OPH//THE//RECORD
/// OPHTEC Distributor • ASKIN & CO, Austria
Askin & Co, Austria More than three decades after founding ASKIN & Co. in 1979 OPHTEC’s Distributor Herbert Lugbauer has decided to hand over the company to his children and start enjoying a well-deserved retirement. An interview.
ASKIN & Co OPHTEC’s Distributor, the Austrian firm ASKIN & CO is one of the leading companies in ophthalmic equipment. ASKIN & CO covers parts of central and eastern Europe, as well as Russia, including the GUS-States. Askin has been OPHTEC’s distributer since 2003.
You will retreat from the position of sole associate. How difficult was the decision? It was not easy and of course with a lot of melancholy. The company was my baby. I established it over the years to a marketleading enterprise. But at the same time it was a victory for common sense: the next generation, my daughter Mariella and my son Ralph, have been running the business already for years. Finally it was a logic step that they take over the full responsibility as partners. How did it all start? My career began with the revolution in ophthalmology: the modern cataract surgery, the implantation of intraocular lenses. Overnight the conservative field became a high-technology surgical field. It opened up new opportunities. I was part of it from the very start.
OPH//THE//RECORD 16
Has your company from the start been engaged behind the former ‘Iron curtain’. Was this a risk? Yes, from the start but I never perceived it as a risk. But of course today it is different. For a business trip to Bratislava, one hour by car from Vienna, you needed to consider an overnight stay. You needed to have a visa, hours of waiting due to customs control. At that time there was no internet. That’s why I went then to the first telephone booth which I was able to find in Czechoslovakia. I took the phone book to get the addresses and phone numbers of hospitals. However at that time I also recognized that the difference on the medical-scientific level was surprisingly low. Of course the economic system in the West was significantly higher, which was expressed in Eastern Europe by a missing device technology. This was the big chance. Looking back at all the years: What was your personal highlight? For me the one and only highlight does not exist. Looking back I am really proud of the continuity of the company through the years. In spite of fierce competition we could successfully develop ASKIN & Co to a market-leading company and we have succeeded to bring high technology first to Austria. How does it help to be an Austrian company? Ophthalmology is at the highest scientific level in Austria. Our Austrian ophthalmologists are always right at the front with the latest developments. This opens a market for highest-order devices for us. We are proud to be frequently involved in cooperation with Austrian hospitals to make our contribution to the development of prototypes. Your company is not only known as export oriented middlesized company but also as a family enterprise. Did you urge your children to take over the business? No, not at all. The vocational choice was up to them. I did not want to influence them at all. But both of them showed early interest in their dad’s business. I remember quite well, my daughter Mariella started playing with surgical instruments in the age of four at our
And you will really fully retire from the business? I will definitely not act as decision maker any longer. But of course I will be available in an advisory capacity for my children. Due to our business in Central Asia I was appointed to the position of president of the Austrian-Uzbek Friendship Society. I would like to take care of the bilateral relations, in the humanitarian as well as in the economic field.
Left to right: Ralph Lugbauer, MariĂŤlla Lugbauer and Herbert Lugbauer.
booth on occasion of an exhibition in the Vienna Hofburg. Nowadays she is leading our headquarters in Vienna with 22 employees. She has especially set herself the task of personal customer service and the selection of our product portfolio. Ralph was always impressed that I travelled to the East. He successfully runs our subsidiaries with 85 employees and leads the project management of complete eye clinics from the planning to the hand-over of keys. Furthermore he is coordinating the education of the physicians. His perfect Russian language skills helps a lot. I am very proud of my children.
ASKIN & CO has been working with OPHTEC since 2003. In your opinion, what is the basis for good collaboration? Due to the extraordinary design of the ARTISAN Family IOLs OPHTEC represents a special unique selling point in the field of intraocular lenses. The proven and at the same time innovative design provides an excellent solution for patients. Beside the technological aspect, continuity, integrity and contract compliance perfectly complete our collaboration. I am wishing both companies to continue the successful and future oriented work! What kind of relationship connects you with The Netherlands? Indeed I have a special relationship with the business in The Netherlands. When I was a young engineer I was working in the field of construction of industrial plants. My first international independently managed project was in Delfzijl, a port near OPHTEC’s home base Groningen. I was responsible for the installation and commissioning of the mechanical foundry equipment delivered from Austria. In my function I had to coordinate the team of Austrian technicians with the Dutch assembly firm. During this work taking several months I learnt to appreciate the professional, reliable and straight working method of Dutch people. It would not have taken much and I would have stayed in Delfzijl.
>> New platform for cataract surgery
Transitional Conic Toric IOL
>> Perfect distance vision
Corneal Marking system
>> Avoid refractive surprises by knowing the True Total Corneal Astigmatism
>> Easy and Precise mark of the axis of implantation or reference
OPHTEC Short Artisan Ambassador 2015
OPHTEC receives the Groningen Enterprise Award 2015
Dr Hiroyuki Arai, is one of the most experienced surgeons in the field of Phakic IOLs in Japan and promoter of the Artisan concept.
OPHTEC wins Groningen Enterprise Award 2015 The ‘Groningen Enterprise Award’ is a Dutch business prize that is annually awarded to a company in the Dutch province of Groningen. The jury was impressed by OPHTEC’s clear focused business strategy and innovation.
Therefore he was awarded the 2015 OPHTEC ‘Artisan Ambassador Award’.
Dr Hiroyuki Arai
Special cases Artisan Aphakia as add-on IOL By: Dr Valentin Apostolov A lady was referred a couple of years ago to me, she had a +9.25 D refraction of the right eye after a cataract extraction with implantation of a +30.0 Acrysof IOL (the highest available power from Alcon at the time of the operation).
OPHTEC President & CEO Erik-Jan Worst received a commemorative plaque, as an Honorary Award for Prof. Dr Jan Worst’s contribution to Refractive Surgery from the Spanish Society of Refractive Implant Surgery. He received this reward during the SECOIR 2016 in Murcia, Spain.
In her left eye she had a cataract and a hyperopic refraction of +12 D. For this eye I ordered a custom PC530 +44.5 from OPHTEC. The implantation resulted in postoperative refraction of +0.5. For her right, pseudofakic eye I could find 3 companies producing add-on IOLs but none of them had the needed plus power. So I implanted an Artisan Aphakia +14.0 and now she has a refraction of -0.5 in this eye.
USER Meeting ESCRS in Copenhagen Den Bla Planet, Denmark’s famous Aquarium is the Location of OPHTEC’s 2016 ESCRS user meeting. Den Bla Planet is Northern Europe’s largest and most modern aquarium and also a unique architectural landmark. Den Bla Planet OPH//THE//RECORD 18
RingJect
™
Preloaded Capsular Tension Ring in disposable injector
Why do key opinion leaders
routinely use Capsular Tension
Rings (CTRs) with all premium IOLs?
Prof. J.L. Alió, Spain:
Prof. C.K Joo, South Korea*:
lens surgery. The reasons for this are 4: More stable
‘I routinely use CTRs in my premium IOL, cataract and
IOL; less induction of aberrations; a second chance for
the patient - to explant the IOL is feasible with a CTR even after 2 or 3 years; delayed posterior capsule opacity.’
Prof. S. Shah, UK*:
patients as I believe this ensures good
‘I use CTRs routinely for my premium IOL
positioning of multifocal IOLs, and may prevent IOL
opacification, may play a role in the stability an
rotation caused by capsular bag contraction, thus providing good centration.
The more complex the optics, the greater the need for perfect IOL positioning and centration, which the use of a CTR may help achieve. And some studies
refraction without the need to augment the planned postoperative refraction. This supports the hypothesis that the CTR plays a role in stabilizing the IOL and improving outcomes.’
centration and prevents late movement
from capsule contraction. In the rare occurrence that the lens
needs to be explanted, it also facilitates surgery as the bag opens up very easily.’
Dr F. Wiley, USA:
‘I use OPHTEC CTRs regularly on my premium lens cases, CTRs
allow for short and long term rotational stability for toric IOLs, and
Dr E. Mertens, Belgium:
assurance in the rare instance a toric IOL has to be adjusted or presbyopic
different types of CTR, but my favorite one is the
prophylactic placement of a CTR.’
‘I use CTRs with all of my premium IOLs. I have tried OPHTEC CTR, which is easy to implant and gives the
‘CTR have been shown to inhibit posterior capsule
show that CTR can help achieve a postoperative refraction close the planned
positional stability for presbyopic IOLs. Furthermore CTRs give extra
IOL needs to be exchanged. For these reasons, I have never regretted a
best results.’
* Video presentations on youtube.com/ophtecbv
Think Smart, Think ARTISAN! ARTISAN APHAKIA
The right option for complicated cases
Don’t waste precious time with sutured or glued IOLs! >> Artisan Aphakia video library
youtube.com/ophtecbv Playlist Artisan Aphakia
www.ophtec.com