OPH the RECORD P u b l i s h e d b y O P H TE C BV /// ESC RS Edition 2014 /// #10
ESCRS Congress in London 3 young ophthalmologists Portraits IN THIS ISSUE: 4 Dr Hyo Soon Park My journey with OPHTEC & their products - article
12 Eyes on London The ultimate LondonOphthalmologicalSightseeing Tour
16 Precizon Toric
Fred Wassenburg, Director Technology and Operations - interview
/// Visit us at our booth (H12) at the ESCRS congress
23 Meet the experts An overview of all speakers at OPHTEC’s booth during ESCRS
www.ophtec.com
Events & Congresses 2014 / 2015 September 13-17
London
UK
ESCRS
September 25-28
Leipzig
Germany
DOG
October 1-4
Bilbao
Spain
SEO
October18-21
Chicago
USA
AAO
November 12-15
Rome
Italy
SOI
November 13-16
Jaipur
India
APACRS
November 26-28
Brussels
Belgium
OB
November 28-29
Rotterdam
The Netherlands
NIOIC/NGRC
January 17-23
Maui
USA
Hawaiian Eye
February 5-7
Elche
Spain
Faco Elche
February 5-8
Delhi
India
AIOS
February 20-22
Istanbul
Turkey
W-ESCRS
February TBC
Seoul
Korea
Korean Ophthalmologists Association
March 12-15
Drakensberg
South Africa
OSSA
March 25-27
Groningen
The Netherlands
NOG
April 1-4
Guangzhou
China
APAO
April TBC
Kwangju City
Korea
Korean Ophthalmological Society
April 17-21
San Diego
USA
ASCRS
May 9-12
Paris
France
SFO
May 14-16
Las Palmas, Gran Canaria
Spain
SECOIR
June 11-13
Leipzig
Germany
DOC
July 4 - 5
Chennai
India
IIRSI
July 19-21
Tokyo
Japan
JSCRS
July TBC
Seoul
Korea
Korean Surgery Cataract Refractive Symposium
August 5-8
Kuala Lumpur
Malaysia
APACRS
August 20-23
Cape Town
South Africa
SASCRS
September 5-9
Barcelona
Spain
ESCRS
Dear reader, September 2014. This time the ESCRS will be held in London, a wonderful location for all of you. The scientific program will be full of new ideas, innovations, results of clinical studies and scientific research. And the exhibitors will get the opportunity to show their newest products. I’ve gone to an innumerous number of congresses year after year during my days at OPHTEC BV. I remember how inspiring it was and how thrilled we were about some of the new innovations. Although my husband and I are retired right now, we still love to hear the ins and outs of these congresses; my husband is still interested in the scientific part and I am personally focussing on the latest news happening in the exhibitor area; how OPHTEC has promoted the newest products and how well they have been received. I look at today’s OPHTEC booth and see huge screens showing beautiful high definition surgical videos. I see a booth with a speakers corner, where ophthalmologists are presenting their experience with new products and I see a well-equipped wet-lab space, where the implantation technique of the ARTISAN lenses can be practiced. I can’t help thinking of the old days, when we had just started OPHTEC and wanted to present our first products. The booth looked a lot more primitive than the OPHTEC booth nowadays. It makes you smile today.
CONTENT 4. Dr Hyo Soon Park
My journey with OPHTEC & their products - Article
8. 3 young ophthalmologists
Portraits
12. All eyes on London
The ultimate LondonOphthalmological-Sightseeing-Tour
15. Moorfields Eye Hospital 16. Precizon Toric
Interview Fred Wassenburg
18. Dr Tiago Bravo Ferreira on the Precizon Toric During our first congress in Paris we had a small booth; with a rustringremover, microsponges and intraocular lenses which could be viewed at higher magnification with a microscope. Red tulips to show that we came from the Netherlands. It couldn’t be more primitive! The first time we had a congress in the Netherlands was in Maastricht. To draw the attention of the doctors we had asked a harpist to play in our booth. The music was fantastic and could be heard everywhere in the exhibit hall. It has drawn the attention of the public and the other exhibitors and since then more often music was heard during a congress. The booth has changed through the years, the profession ophthalmology as well, but one thing will definitely stay the same: the inspiration that comes from hearing colleagues talk about their ideas, from seeing the new products and join a few days together with your colleagues. Enjoy the XXXII congress of the ESCRS in London! A. M. Worst van Dam Management Consultant
Interview
20. Distributor in the spotlights
Interview Jackie Handley; Spectrum UK
23. Meet the experts Colofon OphTheRecord is published by OPHTEC BV E-mail: r.den.besten@ophtec.com Artwork: www.mennoschreuder.nl Print: Scholma Druk, Bedum All rights reserved. © OPHTEC BV 2014 Postbus 398 | 9700 AJ | Groningen T: +31 50 525 1944 | F: +31 50 525 4386 www.ophtec.com facebook.com/ophtec youtube.com/ophtecbv twitter.com/ophtecint
Prof. Jan Worst (l) en dr Camille Budo
OPH THE RECORD 3
Dr Hyo Soon Park
My journey with OPHTEC & their products 4 OPH//THE//RECORD
In March, 2002, I arrived in Groningen, the Netherlands after a long, hard journey with three different planes and one train. Groningen was dark and cold. But my determination to learn the implantation skills of the iris claw IOL was shining more brightly than ever before. And, I consoled myself with the idea that this was a very good chance to visit the Netherlands, famous for Hendrik Hamel, author of ‘Korea to Western countries’ and Vincent van Gogh, the genius artist. by: Dr Hyo Soon Park, Director of Nunevit Eye Center, Busan, Korea; Professor of Inje University College of Medicine
a scleral fixation IOL. But then, since I was trained to implant Artisan, I unquestionably suggested an Artisan Aphakia IOL implantation to the patient and received an agreement. Like any works on this world, the starting part is a crucial point in surgery also. My first case of Artisan Aphakia was an astonishing experience. Before my first Artisan implantation, I had performed about fifty cases of scleral fixation. So I could authentically feel the difference. The first surprise was the convenience of surgery and the second one was the high patient satisfaction. I’m sure that any surgeon who has experienced the difference between those lenses will agree with me.
Even an inexperienced surgeon will be able to finish Artisan Aphakia surgery in half of the time needed for a scleral fixation IOL. And, you don’t need to worry about complications such as bleeding and IOL tilting anymore, which bothered me during scleral fixation so often. Patient satisfaction improves as a result. I have said farewell to sclera fixation IOLs years ago without any hesitation. In addition, the pool of patients I could I did about six crazy things in my life so far. Among those manage was expanded and my colleagues were freed six the most outstanding one was this trip to Groningen, from worrying about intractable cataract surgery and with bearing loss of income from my clinic and opposition posterior capsule rupture also. Of course, this doesn’t of my partner surgeon. But, because of this one decision, mean that I make posterior capsule rupture on purpose. I came into contact with ‘OPHTEC’ and became inspired Every surgeon has at least one indelible patient. In my by Dr. Jan Worst’s ophthalmic enthusiasm. He and his products, Iris Claw Lenses, have taught me that surgery case this is a female patient who suffered from Marfan’s syndrome. Her crystalline lenses were unusually subluxated for a surgeon is something that has to be polished to each superotemporal side. Besides that, she was also continuously in the same way as we deal with our life. He also has inspired me to generate more creative ideas suffering from amblyopia, nausea, and vertigo. I am still wondering how a patient like that came to my clinic right after gaining confidence in Artisan Aphakia implantation. If you have a fifty four years old Marfan’s syndrome patient who has defective vision due to lens subluxation, which treatment would you choose? I have removed the crystalline lens of her left eye which had more progressed lens subluxation, through ICCE, and the right one through lensectomy. For both eyes, of course, I have performed an Artisan Aphakia implantation, so I didn’t have to worry about recession of the anterior segment which is considered necessary for Marfan’s syndrome patients. I was only and to manage crisis situations calmly during surgery, which is inevitable for any surgeon. By using this paper anxious at iridodonesis, but it wasn’t that serious to treat the stability of the Artisan Aphakia IOL. The patient was it allows me, to share concrete examples and to explain why I think this tough journey to Groningen was one of happy, and this success linked me to her pretty daughter also suffering from Marfan’s syndrome after six months. the best choices I made in my life. Artisan Aphakia implantation is still my ace in the hole, and I would like to recommend it to surgeons starting The first iris claw lens I have implanted was an Artisan Artiflex implantations. It might be a very useful tool for Aphakia lens. The aphakic patient had a distorted pupil retina surgeons also. Last year, a junior stepped in our toward the 2 o’clock direction with the shape of a keyclinic, Nunevit eye center, requested help for the treatment hole. He had already undergone a lensectomy and partial of a young cataract patient with coloboma. How did I vitrectomy due to an injury suffered about two years solve it? Artisan Aphakia of course! >> earlier. In the pre-OPHTEC time I would have implanted The next day, I attended the ‘Skill Transfer Course for Artisan implantation’ at OPHTEC headquarter together with thirty other surgeons from all over the world. A German surgeon sitting next to me was shocked by the fact that it took me 21 hours to get to Groningen. The first question he asked me was simple: ‘Are you crazy?’
“My first case of Artisan Aphakia was an astonishing experience”
OPH//THE//RECORD 5
“RingJect has rescued me many times from critical situations” Hyo Soon Park, PhD (left) together with OPHTEC President & CEO Erik-Jan Worst
A Phakic Artisan implantation is much easier to perform than an Aphakic Artisan implantation. You might be able to guess the reason easily. My first phakic lens, the lens that made me excited was an Artisan Hyperopia lens. Previously, I only had two incomplete treatments to get rid of thick reading glasses. Those were lensectomy which removes accommodation force inevitably and LASEK which need to get an agreement about possibility of hyperopia recurrence and glare & halo effect from corneal opacity. Artisan hyperopia implantation allowed me to add one
‘However a driver has very competent driving skills; the result might be different between driving with and without the knowledge about the road’ more option to my repertoire, and it became the main menu right away. I also have used an Artisan Toric IOL for a forme fruste keratoconus patient with astigmatism and it didn’t give me disappointment as I expected.
Artiflex requires more in clinical experience, know-how, and concentration compared to ICL. So I personally think that Artiflex is somewhat similar to an untamed bronco or a sports car touch to control. But Artiflex is as attractive as it is difficult to handle. An essential prerequisite for Artiflex implantation is a study about anatomy, pathology, and physiology of the iris and understanding about space and structure of the anterior chamber for each patient. Mid-peripheral anterior chamber space where the enclavation needs to be conducted is especially important. It is quite common to have shallow mid-peripheral ACD even though central ACD measured from IOL master / pentacam / ultrasound is sufficient for Artiflex implantation. This is due to undulation of mid-peripheral iris, and it can also explain the phenomenon mid-peripheral ACD is different by parts. Therefore, in order to find the optimal space for Artiflex implantation, analysis about mid-peripheral ACD must be preceded before pre-op inspection with mydriasis of the iris. It is good to have anterior chamber OCT like Tomey ‘CASIA’ for this. But if you don’t have it, you can use slit lamp microscope. I would like to discuss more about this at the OPHTEC Booth Speaking section during this coming ESCRS, 2014.
Anyhow, understanding of patient’s spatial characteristic for the anterior chamber is like inspection of the road before you drive a super-car named ‘Artiflex’ publishing the slogan of ‘one size fits all.’ However a driver has very Artiflex! I have much to say about this. Before I start talking competent driving skills; the result might be different about Artiflex, I would like to disclose that I did perform between driving with and without the knowledge about ICL implantation since 2002 and still think it is an excellent the road. invention. Currently, Nunevit Eye Center explains both Artiflex and ICL to phakic IOL implantation subjects, and focuses on helping them to make a right decision.
6 OPH//THE//RECORD
Artisan Aphakia
OPHTEC is planning to launch a pseudo accommodative phakic Artiflex lens in a few years for presbyopia patients. For me who has experienced presbyopic LASIK, it is easy to anticipate this iris claw lens can provide higher patient satisfaction no matter which mechanism they use. That is because it can locate on the closest place from entrance of the pupil, and centering is also reversible. Although it will take much time to produce one with high level of completion, I really wish this lens to be ready as early as possible.
Marfan’s syndrome
I still use an enclavation needle for iris claw lens implantation. Since in my hometown Busan, Korea it is seldom snowing, I have never removed snow myself. So it took a while to understand ‘snow plow’ technique for enclavation. I don’t enclavate much iris for implantation. It shows a tendency of myopic shift if the enclavation is too thick. I perform iridectomy during surgery with ocutome set vacuum 110 & cutting 900. At first time, I sometimes failed to make the right size of the hole, but now I can make a very small iridectomy stably. For incomplete iridotomy, I use nd-YAG laser set at power of 1.5 MJ. One shot is good enough. Ringject also cannot be skipped to mention. I routinely use it for both traumatic cataract cases with zonule dialysis and also pseudo accommodative multifocal IOL implantation. Like Peter Drucker has saved many doctors suffering from financial problems, RingJect has rescued me many times from critical situations.
A few days ago, I read an ophthalmic article about the flying eye hospital from Orbis international. Several enterprises such as Omega, Fedex, Alcon, Zeiss, etc. are supporting them. They fly to remote villages where it is tough to receive medical service, and perform surgery for ophthalmic patients, especially pediatric cataract patients. I believe that they might meet many pediatric cataract patients who need Artisan Aphakia lenses. OPHTEC produces small sized Aphakic Artisan IOLs of 6.5 and 7.5 mm diameter. Of course, OPHTEC users from all over the world would gladly join this project because they are the ones with lion hearts.
MEET THE EXPERTS Dr Hyo Soon Park will be speaking at OPHTEC’s booth speakers event at the ESCRS in London; “New approach to ACD indication in Phakic IOL implantation”
ARTISAN Aphakia ®
Easiest, safest, quickest, longest history OPH//THE//RECORD 7
3 young ophthalmologist
Portraits The Ophthalmic study always attracts new students, sometimes even to their own
amazement. What is the reason for a medicine student to choose this specialty? Where are they from? What do they like about it and what new ophthalmic developments do they hope to witness during their career?
Jeronimo Asencio (33) & Cinta Murcia (31) Jeronimo Asencio (33) and Cinta Murcia (31) both from Spain just finished their study and opened their own practice a year ago. Where are you from? Cinta: ‘We are both from Valencia. Jero was born in Elche and later he moved to Sagunto. I was born in Valencia and have always been in Valencia. Our respective parents were neither doctors nor ophthalmologists’ Where did you study Medicine and Ophthalmology? Jero: ‘We both studied Medicine at the University of Valencia and after that we started our ophthalmic specialty at the University Hospital ‘Doctor Peset Aleixandre’ (2008-2012). Cinta continued her ophthalmic study at the University Hospital ‘la Fe de Valenci’, and the ‘Microsurgery Ocular Institute of Barcelona’ (IMO). I continued my study at the ‘Edwards S. Harkness Eye Institute’, in New York. We finished our hospital training two years ago and at this moment we are both working in the Hospital ‘Francesc de Borgia’ in Gandia.
8 OPH//THE//RECORD
Jeronimo Asencio (left) and Cinta Murcia Cinta deals with the strabismus and oculoplastia section. I am in charge of the lacrimal via and oculoplastia section. Besides this we opened our own doctor’s practice of ophthalmology in Sagunto a year ago. It is really very satisfying to open a personal project where you have the opportunity of practicing what you love most.’
Why did you open a practice together? Cinta:’ We worked together in one of the hospitals during our promotion. We were a good team and we got along well with each other. Surgically we trusted and complemented each other. When we had finished our study there was not much work available in Valencia. That was the reason why we thought ‘let’s give it a try’ and open a clinic of our own. After one year we can conclude that this was the right choice.’ You chose to become an ophthalmologist. Was there a special reason for this? Cinta: ‘I chose ophthalmology because it combines medical and surgical treatments, using a very precise surgery. Also, because of the wide range of specialties in ophthalmology’
“The only possibility to acquire this knowledge is in private clinics and during conferences dealing with this item” Jero: ‘During my childhood I was impressed by my mother. She worked for the Spanish Blind Organization (ONCE). She had a low vision herself due to a corneal dystrophy of Schnyder. When I was ten years old she was operated with a penetrating Keratoplasty and she was able to recover her vision. That was incredible for me. From that moment on I decided to become a doctor and, if possible, an ophthalmologist.’ What ophthalmic specialty has your interest? Cinta: ‘We both are lucky to be able to work in the ophthalmic sections we love most. During our hospital training we rotated in different hospitals to enlarge our knowledge of oculoplastia, lacrimal system and strabismus. At this moment it is difficult to alternate our work with training but we both try to participate in all ophthalmic specialty courses and conferences that are interesting for us.’ ‘Refractive surgery has our special interest also, but we had difficulties in preparing ourselves in this field because it is not largely implanted in the Spanish Public System. The only possibility to acquire this knowledge is in private clinics and during conferences dealing with this item.’
Do you have mentors? Jero: ‘We are lucky to be able to consider all our former teachers as our mentors nowadays. We do ask them for help sometimes. Also we are working together with very experienced ophthalmologists who are always open to help us. We profoundly recognize their patience and attention.’ What do you think, will be the most interesting developments in ophthalmology during your career? Jero: ‘The ophthalmology is one of the medical specialties in medicine with one of the quickest developments. We are getting in touch with new treatments and new technologies year after year. When we began our Hospital training in 2008 the anti-angiogenic treatment appeared as a promising intravitreal therapy. Some years ago we could begin to use intravitreal implants of prolonged liberation of dexamethasone. This all happened in the last decade. It is not strange to imagine that we can count on new intravitreal alternatives, new more precise lasers, retina transplants, etc. in the near future. It is possible to dream about a transplant of the ocular globe or an artificial eye. These developments may be closer than we think.’ Are you ‘online’ a lot? Cinta: ‘Nowadays it is important to be connected to the rest of the world via Internet. Personally we prefer and use facebook.’ Hobbies? Jero: ‘We both love travelling, practicing sports and spending time with our families. Next to that I love to walk in the mountains and paddling. Unfortunately our jobs do not allow us to do these activities very often.’
Loes van den Borne (28) Loes van den Borne from the Netherlands is a 5th year ophthalmology resident at the UMC Utrecht the Netherlands. In the family of Loes van den Borne (28) there has never been an ophthalmologist, not even a general practitioner. Together with her twin-sister she is the youngest of four sisters, who grew up a stone’s throw from the city of Eindhoven. Her mother has been trained as qualified nurse and works with mentally handicapped people, who live more or less independently. Her father works in youth welfare work. Although there has not been any family tradition of medical profession, 3 of the 4 sisters Van den Borne started a medical study. Loes started to become fascinated with the medical world as a little child, when she had to go to the hospital for a pair of glasses. She did not feel that instinctive aversion towards that house of illness and pain, on the contrary. ‘In retrospect it struck me as exciting and heroic. I wanted to be part of it, although I could not describe it precisely at that moment of course.’ >>
OPH//THE//RECORD 9
Finally she got rid of the glasses, but the fascination remained. At the end of primary school she knew for sure: she wanted to become a doctor. If she had any idea about the kind of specialist she wanted to become, her choice was cardiologist. She started her studies in Utrecht and noticed the motivation of the students around her. Most of them wanted to become a general practitioner, a cardiologist, a surgeon or an internist. Ophthalmologist was not the most natural choice. And during your study it takes a while before you get in contact with ophthalmology. But once that had happened, she felt extremely attracted by the profession; especially the self-reliance, the independence, and the wide range of application, cherished by almost all ophthalmologists; The fact that you are personally responsible for everything. Once she had started with the practical training she became more and more fascinated by the organ itself. ‘Originally I was afraid that I might be bored by the eye’ she says, ‘but the opposite is true, it gets more and more interesting all the time.’
Loes van den Borne
“It is not an easy operation to learn. If you have done it without any complication, it gives you a kick”
10 OPH//THE//RECORD
She does not say that the person, who looks someone in the eye, looks into someone’s mind, but she had never thought that it was possible to see so many details in an eye. ‘So many things converge in the eye,’ she says, ‘you do not see just the organ itself, but it can tell you as well about disorders like diabetes, hypertension and some autoimmune disorders. This is why a neurologist asks an ophthalmologist to have a look in the eyes of his patient. ‘Ophthalmology is certainly not a minor specialty’ she says, not as a reaction to self-assured surgeons or internists, but simply because it is true. ‘An ophthalmologist is also a surgeon’, she states. Actually Loes wants to study orbital and oculoplastic surgery. She is performing cataract surgery and wants to add this new challenge. ‘It is not an easy operation to learn. If you have done it without any complication, it gives you a kick. On the other hand you can help a lot of people. Cataract surgery is the most performed surgery in our country.’ It is remarkable how often Loes involves the patient in her considerations. Not only in her initial choice for orbit-pathology (the way your eyes look is very important to a patient; it is the first thing people look at...’) but also when she thinks about the future of the profession. Of course she would like to see that disorders of the optic nerve can ever be cured, but her main concern is, if the patient with the increasing demand of health care in an ageing population, can keep its central position. This is really the challenge for the managers: the ‘onestop-shop’ and the clinical pathways, but it does not frighten her. ‘I am not someone, who criticizes from the side line and subsequently does not act at all’, she says. ‘That is an attitude which I really detest’
RingJect
™
Preloaded Capsular Tension Ring in a single use injector
Key Opinion Leaders from around the world routinely use Capsular Tension Rings (CTRs) with all premium IOLs; guaranteeing bag and IOL stability, centration and reduced PCO
C.K Joo MD, Korea:
J.L. Alió MD, Spain:
“CTR have been shown to inhibit posterior capsule opacification,
may play a role in the stability and positioning of multifocal IOLs,
“I routinely use CTRs in my premium IOL, cataract and lens surgery. The reasons for this are 4: More stable
and may prevent IOL rotation caused by capsular bag contraction,
IOL; less induction of aberrations; a second chance for the patient
thus providing good centration. The more complex the optics, the greater the
3 years; delayed posterior capsule opacity.”
help achieve. And some studies show that CTR can help achieve a postoperative
- to explant the IOL and subs is feasible with a CTR even after 2 or
need for perfect IOL positioning and centration, which the use of a CTR may refraction close the planned refraction without the need to augment the
planned postoperative refraction. This supports the hypothesis that the CTR
S. Shah MD, UK:
plays a role in stabilizing the IOL and improving outcomes.”
“I use CTRs routinely for my premium IOL patients as
I beleive this ensures good 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.”
F. Wiley MD, US:
“I use OPHTEC CTRs regularly on my premium lens cases, CTRs
allow for short and long term rotational stability for toric IOLs, and positional stability for presbyopic IOLs. Furthermore CTRs give extra
assurance in the rare instance a toric IOL has to be adjusted or presbyopic
E. Mertens MD, Belgium:
“I use CTRs with all of my Premium IOLs’. I have tried different types of CTR, but my favorite one is the
OPHTEC CTR, which is easy to implant and gives the
best results.”
IOL needs to be exchanged. For these reasons, I have never regretted a prophylactic placement of a CTR.”
The ultimate LondonSightseeing Tour // Compiled for you by OPHTEC
The London Eye British Museum >> Faience Wedjat eye
A giant Ferris wheel on the South Bank of the River Thames
St Thomas’ Hospital Commemorating the first implanted IOL
Egypt, Third Intermediate Period, 1069945 BC. An Egyptian healing symbol The wedjat is associated with Horus, the god of the sky, who was depicted as a falcon or as a man with a falcon’s head. In a battle with Seth, the god of chaos and confusion, Horus lost his left eye. But the wound was healed by the goddess Hathor and the wedjat came to symbolise the process of ‘making whole’ and healing - the word wedjat literally meaning sound. The left eye of Horus also represented the moon. The waxing and waning in the lunar cycle therefore reflected Horus losing and regaining his sight.
The London Eye is a giant Ferris wheel on the South Bank of the River Thames in London. Also known as the Millennium Wheel. It was opened by then Prime Minister Tony Blair on 31 December 1999, but it was not opened to the public until 9 March 2000 because of technical problems. The London Eye has captured the public’s imagination. Since opening, millions of visitors have enjoyed unparalleled views over the capital, and it has also made a significant contribution to the regeneration of the South Bank area. The entire structure is 135 metres (443 ft) tall and the wheel has a diameter of 120 metres (394 ft). It is currently Europe’s tallest Ferris wheel and the most popular paid tourist attraction in the United Kingdom.
www.britishmuseum.org
www.londoneye.com
Great Russell Street London WC1B 3DG
12 OPH//THE//RECORD
Westminster Bridge Road London This round plaque, remembering the implantion of the first intraocular lens for the treatment of cataract, can be seen in the Central Hall of St Thomas’ Hospital in London. The surgical procedure was performed in St Thomas’ by Harold Ridley and his theatre nurse Mrs Doreen Ogg on 8th February 1950.
-OphthalmologicalBritish Optical Association Museum
Feast your eyes on the world’s oldest historic collection of spectacles and vision aids.
Model eye with everted lid showing cysts, one of a collection of models depicting external eye diseases or malformations of the eye, thought to date from the 1880s.
Science Museum >> Anatomical model of an eye, Italy, 1601-1700
The College of Optometrists 42 Craven Street London Founded by Mr J. H. Sutcliffe of the British Optical Association in 1901, this is a remarkable museum collection comprising over twenty thousand outstanding objects and archival items relating to the history of ophthalmic optics (optometry), the human eye and visual aids, as well as the representation of these subjects in art. Many of the objects in the museum are rare or unique. They’re certainly eye-catching! When the BOA voluntarily disbanded in 1980 the Museum was entrusted to the care of the new College of Optometrists. Now in its second century, it continues to be recognized as the oldest and one of the best optical museum collections in the world.
Exhibition Road, South Kensington, London, SW7 2DD
All visits are by guided tour and all tours must be booked in advance (+44 (0)20 7766 4353)
This model of the eye is made from horn, ivory, wood and glass. The glass is used to show the eyeball, although no iris is present. The model can also be dismantled to show the optic nerve at the back of the eye. Anatomical models were important teaching aids, especially because of the shortage of bodies available for dissection. They could also be used to highlight specific parts of the body, often by making them larger than life-size.
www.college-optometrists.org/museum
www.sciencemuseum.org.uk/
Moorfields Eye Hospital
The first hospital in the world devoted to the treatment of eye disease
162 City Road, London
>>
OPH//THE//RECORD 13
TRANSITIONAL CONIC TORIC IOL
PRECIZON™ Toric Model 565 Lens type:
One piece IOL, In the bag fixation
Body:
6.0 mm | Transitional Conic Toric | Biconvex
Material:
Hydrophilic Acrylic
Overall Ø:
12.5 mm
Angulation:
0˚
A-Constant:
118.5 (IOL Master; SRK T) | 118.7 (IOL Master; SRK II)
P Transitional Conic Toric surface* more tolerant of misalignment
1.020 (IOL Master; Haigis aO) | 0.400 (IOL Master; Haigis a1) 0.100 (IOL Master; Haigis a2)
P 2.2 mm micro incision
118.0 (A Scan)
5.26 (IOL Master; Hoffer-Q pACD) 1.51 (IOL Master; Holladay 1 sf) Available Powers:
+1.0 D to +34.0 D (0.5 increments) Cylinder 1.0 D to 10.0 D (0.5 increments)
Refractive index:
1.46
IOL Spherical Aberration:
360˚ | 0 µm
14 OPH//THE//RECORD
P Proven stability
* Patent pending
>>
Moorfields Eye Hospital The first hospital in the world devoted to the treatment of eye diseases
‘London Ophthalmic Infirmary’ in lower Moorfields A brief history At the beginning of the 19th century, ophthalmology was an unknown science - historically the treatment of eye disease was the domain of itinerant quacks and charlatans. That all changed in the early 1800s as many soldiers returned from the Napoleonic wars suffering with trachoma. With the epidemic as an impetus John Cunningham Saunders, a surgeon from Devon, founded the first hospital in the world devoted to the treatment of eye disease in October 1804. He founded the ‘London Eye Infirmary’; out of compassion for the pitiful state of many soldiers returning from the Egyptian campaign afflicted with military ophthalmoplegia and trachoma infections’. Saunders remained the director of the hospital, from its founding in 1805 until his death. A few months after Saunders had obtained funding for the dispensary, a similar institution opened in the West End of London. In 1816, renowned army surgeon George James Guthrie founded the ‘Royal Westminster Ophthalmic Hospital’ in Mayfair and, in 1843, a third London eye hospital, the ‘Central London Ophthalmic Hospital’, was founded by a ‘few zealous gentlemen’ in Bloomsbury. Moorfields’ original location was Charterhouse Square in West Smithfield, but the hospital moved in 1822 to a purpose-built building in Lower Moorfields, close to what is now Liverpool Street station, it was renamed the ‘London Ophthalmic Infirmary’. The land was cheap and the new infirmary cost only £5,500 to complete. In 1837 Queen Victoria gave the hospital in Lower Moorfields its Royal Charter. Although it was renamed the ‘Royal London Ophthalmic Hospital’, everyone continued to call it Moorfields.
At the end of the 19th century it became apparent that the Lower Moorfields location was too small. A plot to build a new hospital was found a mile to the north of Liverpool Street, in City Road, the current location. On 28 May 1897, the Prince of Wales laid the foundation stone for the new hospital and two years later the building opened. The new building included ‘state-of-the-art’ features, including air conditioning and central heating in the outpatient department, an operating theatre designed to encourage asepsis, electric lighting and, most strikingly, an x-ray department. In 1947, an amalgamation took place between Moorfields, the Royal Westminster, and the Central London Ophthalmic Hospital. With the forming of the NHS (National Health Service) in 1948, this new organization became a postgraduate teaching hospital. At the same time, an ‘Institute of Ophthalmology’ was established by the UCL (University of London). This, together with the appointment in 1963 of Barrie Jones as professor of clinical ophthalmology heralded a revolution in Moorfields’ fortunes. Professor Jones not only invigorated the progress of clinical research, but rapidly introduced the hospital to microsurgery and to the concept of sub-specialization. Specialist clinics sprang up overnight and included the virus clinic, the lid clinic, the orbital clinic, and the corneal clinic, all staffed by enthusiastic young doctors keen to develop their unique expertise. In the late 1960s the retinal diagnostic service was founded and the technique of using fluorescein dye to demonstrate abnormalities in the retina was introduced. This was soon complemented by the use of lasers. As the 1970s progressed, this revolution in ophthalmology became an explosion. Whatever the condition, Moorfields had an expert.
Children’s Eye Centre opened in 2008 Today, Moorfields is one of the world’s leading eye hospitals, providing expertise in clinical care, research and education. The main hospital base can still be found in London’s City Road, 21 other sites, in and around the capital enable Moorfields to provide expert care closer to patients’ homes. Moorfields Recently opened both the world’s largest children’s eye center adjacent to the main hospital in City Road, and an overseas branch in Dubai.
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Precizon Toric OPHTEC recently introduced a new toric IOL: ‘Precizon Toric’ with a ‘transitional conic toric surface’. Fred Wassenburg explains what it means for ophthalmology.
Fred Wassenburg, Director Technology & Operations
What is a ‘transitional conic toric surface’? Standard lenses have a spherical surface. We can compare a spherical surface with the surface of a ball cut in half. The curvatures have the same radius in all directions. The sharpness of the image is not optimal in these IOLs. This has been the reason for generally changing the design of cataract lenses into an asferical shape in order to improve the sharpness of the image. In ‘standard’ toric IOLs on the market, the aspherical correction has not been implemented in an optimal way, resulting in a less optimal image. When designing the Precizon Toric, we calculated the curvature of the side with the toric cylinder in relation to the other side of the IOL. This way the curvature is constantly changing over the surface of the IOL. It results in a transition of the radius and in this way the dioptric power remains constant along the total surface of the lens.
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What is the value of a toric IOL with this special surface? The value is that the lens has a broader vision zone. It maintains the same dioptric power at all points on the lens surface, independent of the pupil size, decentration or tilting of the lens. The lens behaves better in case of misalignment or some rotation as compared to ‘standard’ toric lenses. During surgery it is very difficult to position the lens exactly in the proper cylinder-axis. The Precizon Toric lens is remarkably stable. The combination of these two features (broader vision zone and stable) have shown us very positive clinical postop results. Our results have shown that the practical experience corresponds with the theory. This is always a very exciting experience for the team who worked on the development of the product. How does an invention as this one come into being? As a sudden idea by one person or as a project which has to be worked on by a team? As an innovative research group you learn constantly from what you are doing. Sometimes it can be used right away, sometimes it is useful for another project. Concerning the Precizon Toric it has been clear from the beginning that we wanted the lens to be less sensitive to
OPHTEC SHORT rotation. We have some excellent engineers and specialists who have a close relationship with the ophthalmologists and who are able to translate practice to theory. The developments in the company can be called the innovative power and ability of OPHTEC. This is not based on coincidence. It is the spirit of the organization, which has been educated by Professor Worst.
‘The euphoria is great when during the clinical studies it appears that the data of the postop controls are excellent, or in this case, above the expectations of the ophthalmologist himself’ Once you know, that the idea corresponds with the theory, the first lenses have to be implanted. That must have been very exciting. Yes indeed. We have to rely on the engineers and others who have given us their word that the product functions correctly and is safe. The ophthalmologist and the patients well-being are continuously on our mind once a lens is implanted. The euphoria is great when during the clinical studies and later on during regular work, it appears that the data of the postop controls are excellent, or in this case, above the expectations of the ophthalmologist himself. How perfect the testing machines, the simulation software and measuring systems function, what really counts is the satisfaction of the patient. What about the preliminary results of the postmarket study? The results we receive at present, confirm the results of the clinical study. The lens has an excellent behaviour postop. It shows little rotation and behaves like the best hydrophobic lenses, although they are made of hydrophilic material. Hydrophilic has the reputation to easily rotate after implantation. Our Precizon Toric however has been designed from the beginning in such a way that rotation has been prevented. Deformation and decentration after compression is prevented due to the special shape of the haptics. During the research projects you work increasingly together with universities. Has the Precizon Toric been the result of such a cooperation? Yes indeed, we work a lot with universities, but the Precizon Toric has been our own invention. For specific knowledge on special subjects it is better to work with other institutes than to try and do it on your own. For large companies this is already difficult, but what about a company like OPHTEC. These institutes often dispose of test facilities we can only dream of. Can we await an Artiflex with a ‘transitional conic surface’in the future? Yes, of course! And even much more! I will be pleased to inform you about this in the future.
Meet Mike Jongelie, General Manager Germany & The Netherlands After 20 years with another ophthalmic company, it was time for a new step in his career and to look for new opportunities. This new opportunity he found with OPHTEC accepting the responsibility for sales and marketing for two countries; The Netherlands and Germany. ‘On the 2nd of June 2014 I started with OPHTEC GmbH in Emmerich Germany,’ says Mike in his new office. ‘The GmbH has moved from Hamburg to Emmerich, a German village just on the border of the Netherlands and Germany, so I will be able to travel easily between the two countries.’ Mike will be assisted in the office by Christiane van de Klashorst. Christiane is originally from Germany and has worked in sales assistance roles for many years. Excellent service is very important to our customers and we want to keep the high service level that people are used to. Furthermore, the German sales team will be enforced; currently we are hiring 2 new account managers for the southern and the western part of Germany.’ Parallel to his German activities Mike will take the lead of the Dutch sales team. ‘We are very strong in the refractive IOLs at OPHTEC, but not every customer is aware of OPHTEC’s current cataract portfolio. We will be more present in the Dutch market with an extended cataract portfolio. OPHTEC is (as far as I know) the only company that can supply all IOL materials to the cataract surgeons. With the new aberration free hydrophobic preloaded LUNA IOL, inserted through a 2mm incision, we do have a unique IOL,’ according to Mike Jongelie. The new address of OPHTEC GmbH: ‘s-Heerenberger Str. 348, 46446 Emmerich am Rhein
Dr. Andreas Mohr, Artisan Ambassador 2013 The Artisan Ambassador Award is a certificate which is presented annually to a doctor who has made particular efforts to promote the Artisan concept. In 2013 the certificate was presented to Dr. Andreas Mohr, Germany. Dr. Mohr has developed the retro-pupillary Artisan implantation technique: ‘It was the difficulty of the standard procedure that made me start implanting the iris claw lenses retro-pupillary, first in 1998 as an alternative’, according to Dr. Andreas Mohr. The celebratory presentation took place during the OPHTEC ESCRS ‘booth speaker’ event in Amsterdam last year.
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Dr Tiago Ferreira on the Precizon Toric
Dr. Ferreira (second left), Sandra Bayan, manager Ophtec Portugal (right) Dr. Tiago Bravo Ferreira, lives in Lisbon, Portugal. He works in Egas Moniz Hospital since 2004. It is the same hospital where he did his residency in ophthalmology. Since Dr. Ferreira finished his residency in 2009, he became more focused on the anterior segment and currently both his clinical practice and research are mostly in corneal and refractive surgery. He coordinates the corneal and refractive surgery department in the hospital as well as in two other private clinics.
contact with a great number and variety of pathologies. The Hospital itself is near the Tropical Medicine Laboratories and the Library of Old Portuguese Colonies. With such neighbours and with the help of the Marquis of Valle-Flor Foundation, some ophthalmologists from our hospital perform pro bono cataract, glaucoma and emergency surgeries in São Tomé and Príncipe (Gulf of Guinea), with our hospital always available to receive the most complicated cases.
Why did you choose to become an ophthalmologist? Since I was a little boy I role-played with my cousins as a doctor. These must have had some effect, since all of us became doctors. After the third year in University I became very interested in ophthalmology. First of all, I did not want to be only a doctor or a surgeon but a combination of both and ophthalmology seemed like the perfect combination. I was always addicted to gadgets and I loved the technology involved in practicing ophthalmology. As I was discovering its different areas, it soon became a passion.
Currently, the ophthalmology department in our hospital has 14 ophthalmologists. We are divided in departments of different sub-specialities and performed nearly all kinds of treatments and surgical procedures. In 2013, our department performed about 30000 consultations, 10000 emergency consultations and 3000 surgeries, from which about 1600 were cataract surgeries.
Could you describe the Egas Moniz Hospital? My hospital, which is named after the Portuguese medicine Nobel Prize winner, Professor Egas Moniz, is located in Lisbon in a beautiful area of the city, near Tagus River. Although the hospital is not very big, about 400 beds, its area of influence is large, with about 400.000 people. This gives us an affluence of all kinds of patients from very different backgrounds. Since residency, this allowed us to have
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How do you experience the cooperation with OPHTEC Portugal? I am working with OPHTEC Portugal since its establishment, in 2012, although I had used products from OPHTEC before. I work with OPHTEC mostly because I have always had good and consistent results with their products. From the long track of efficacy and safety of the Artiflex/Artisan family, we continued our collaboration with the new Precizon Toric IOL. Cooperation has always been excellent with a fast and effective response from OPHTEC Portugal to my sometimes hard requests, like difficult calculations and last minute IOLs.
You are one of the first ophthalmologists to use the Precizon Toric IOL in Portugal. What are the advantages of this lens according to you? I think that the new Precizon Toric IOL offers some advantages over other toric IOLs. For me, the most important differences are constant dioptric power from the center of the IOL to the periphery and the broader toric meridian, with higher tolerance to misalignment. What is the indication for a Precizon Toric? My current indication for a Precizon Toric IOL is a cataract patient with regular corneal astigmatism over 1.00 D. Ideally, I look for an agreement between the several different methods I use to measure astigmatism. I think there shouldn’t be a large amount of irregular astigmatism and posterior corneal astigmatism should be known and maybe considered.
‘The new Precizon IOL is a very easy to implant and stable in-the-bag platform with excellent outcomes’ Is this lens easy to implant? The lens is very easy to implant through very small incisions, with a very controlled opening inside the capsular bag. How are the outcomes? I’ve had great visual and refractive outcomes with the Precizon Toric IOL. In my first 20 cases, 90% of the eyes achieved an uncorrected distance visual acuity of 20/30 and the refractive predictability was excellent, with 95% of the eyes within ±0.50 D of the target. Rotational stability has also been remarkable, with a mean rotation at 3 months post-operatively inferior to 2 degress. Do you use the Capsular Tension Ring (CTR) as well? In standard cases, I have never used a CTR for toric or multifocal IOLs. I have used them and still implanted a toric IOL in the bag in cases where I have had a very small zonular dehiscence or in some pseudoexfoliation patients, although I usually do not implant torics in these patients. Is there a big difference between hydrophobic and hydrophilic lenses? Although there were problems in the past, current materials and manufacturing techniques are not comparable. Nowadays, I use both materials interchangeably. In my hands, the PCO rate is very similar between them. I particularly like the possibility of implanting the hydrophilic IOLs through a very small incision due to their highly compressible material.
What other OPHTEC products do you use? I have used almost all the OPHTEC products. Most of my phakic IOLs are Artisan/Artiflex and I’ve used the prosthetic iris implant and aniridia lenses in the past. I also use a lot of Artisan Aphakia IOLs. I’ve used OPHTEC lenses since shortly after I started performing ocular surgery, while still in my residency. I’ve started using Precizon IOLs at the end of 2013. I used the Artiflex/Artisan family of phakic IOLs because of the ‘one size fits all’ advantage and the security that the iris fixation gives me for toric implants. The Artisan Aphakia offers me a safe and easy surgery, without the possible complications and extra surgical time of scleral fixation. The new Precizon IOL is a very easy to implant and stable in-the-bag platform with excellent outcomes. What major developments in ophthalmology do you think will happen during your career? Although my career is not very long, I have seen great development in IOL technologies in the last years, with torics, multifocals and multifocal toric models. I think the greatest development of the last years in ophthalmology has been the introduction of the femtosecond laser in both corneal and cataract surgery. I think we will continue to see an increased use of these lasers in ocular surgery, with new applications. I also think we will still hear about accommodative IOLs in the future. We will perform less invasive cataract surgery with a different biomaterial to fill the bag. What product would you like OPHTEC to develop in the near future? I was always interested in the early presbyopic patients for whom CLE (Clear Lens Exchange) is not yet indicated. For these patients, when there is concomitant ammetropia, the concept of a presbyopic phakic IOL would be very interesting. I’d also like to have the possibility of choosing an OPHTEC corneal implant for presbyopia. What do you do in your free time? Although my free time is getting less every year, I always try to keep some time for me and my loved ones. Mostly, I love to travel, which I to do as often as I can. I also love cars and motorsports and dedicate some of my free time to this passion.
MEET THE EXPERTS Dr Ferreira will be speaking at OPHTEC’s booth speakers event at the ESCRS in London; “Visual outcomes with the new Precizon Toric intraocular lens in a multicenter clinical trial”
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Distributor in the spotlights Spectrum UK team members during their OPHTEC visit in June 2014. OPHTEC’s Tiago Guerreiro (far right) joins them.
Spectrum UK OPHTEC Distributor, Spectrum UK, is the leading independent ophthalmic distributor for surgical and diagnostic products and services covering England, Scotland, Wales, Northern Ireland and Eire. OPHTEC products are distributed by Spectrum since 2003. Jackie Handley tells us about Spectrum, about the cooperation with OPHTEC and how she looks upon a London ESCRS this year.
Jackie Handley, National Business Manager - Glaucoma / Specialist Products
for not only ophthalmic surgical products but also ophthalmic diagnostic technologies. Spectrum was founded in 1987 and the directors are still very much hands on after almost 30 years. Spectrum employs more than 30 persons and prides itself in bringing innovation for both surgical and diagnostic areas.’
How do you experience the cooperation with OPHTEC? ‘We started to represent OPHTEC in 2003 and we have always admired OPHTEC’s focus in the areas of refracJackie: ‘I joined Spectrum in 1998 as a Territory Representative for the North West of England. Prior to joining tive and innovative surgical products. We have worked over the past 11 years with various country managers all Spectrum I was employed as a Legal PA physician assistof whom have helped us to focus in the niche areas of ant and a PA to a firm of surveyors. However I always felt I was capable of becoming a professional sales representa- OPHTEC’s innovative expertise.’ tive and I applied to Spectrum who gave me my first ‘OPHTEC can be defined as one of the highest quality chance in Medical Device Sales and 16 years later I am suppliers for ophthalmic surgical products in the still loving Ophthalmology.’ world today. OPHTEC’s attention to improving existing technologies enhances the ophthalmic surgeon’s ability Could you describe the company? ‘Spectrum is located in the heart of England in Maccles- to provide patients with superior outcomes following various ophthalmic surgical procedures.’ field, Cheshire. Spectrum operates on a divisional basis
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Head office Spectrum UK in Macclesfield, Cheshire
You and your team just visited OPHTEC, for a Precizon-training. What is your opinion of this new lens? What makes it unique? ‘Our team recently visited OPHTEC’s manufacturing plant and it was fascinating to see the time and expertise that goes into making the lenses implanted in patients eyes. I am very excited by the technology, the Precizion toric lens is the first of its kind to manufacture a unique optic which takes into account any rotation within the eye offering patients superior outcomes.’
“the Precizion Toric lens is the first of its kind” Is the Phakic Artisan / Artiflex a well-known implant in the UK? ‘Over the past decades there has been a slow but positive progression towards understanding the advantages of iris supported implants. Artisan and Artiflex refractive products have been widely used in the UK market and now surgeons are seeing the advantages of iris supported lenses for not only refractive correction but also for complex secondary aphakic cases which can include
VacuFix
™
VR procedures, cataract cases and paediatric patients. Patients will benefit greatly by the introduction of an Artisan lens for an aphakic condition’ This year the ESCRS takes place in London. How special is that for you and your company? Have you planned any special events? ‘We are delighted that the ESCRS is returning to London. This gives all UK ophthalmologists the chance to attend not only the congress but to see firsthand the exhibition where our suppliers are seen (in all their glory).’ Do you have a London sight-seeing or restaurant tip for the ESCRS visitors? ‘London hosted the Olympic Games in 2012 and the world had an insight into what a fantastic capital city the United Kingdom has. To fully appreciate London’s various cultures and ethnic diversities we would advise all visitors to spend a day on the London red bus excursion which would cover the main attractions. I would also most definitely suggest taking time out to visit at least one of the main theatres/shows in the West End. This opportunity should not be missed and from one girl to another: Selfridges, 400 Oxford Street, London, is a must for shopping!’
Vacuum enclavation for perfect positioning and centration of all ARTISAN® family IOLs
P Vacuum enclavation for best positioning and centration of the (P)IOL P The VacuFix tip with aspiration hole creates a perfect iris bridge • Fixed amount of iris tissue
• Reproducible amount of iris tissue
P Preformed curves of the vacufix tip make it easy to reach the enclavation site P The VacuFix is compatible with all phaco machines OPH//THE//RECORD 21
ArtiLens,
a new name for Artisan & Artiflex PIOLs, used in consumer communication only
FAQ on insertable lenses
#9 Skydiving, diving, bungee jumping...
All is possible?
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London ESCRS booth speakers An overview Dr A. Anbari, Syria
Dr K. A. Becker, Germany
Dr J. Cazal, Spain
Retroiridis fixation of Aphakic ARTISAN: Why, When, & How?
Artisan aphakia- retropupillary fixation
Precizon Toric: management of immediate post-op rotation
Sunday 12:20
Sunday 14:00
Monday 11:40
Dr T. Ferreira, Portugal
Dr R. FernĂĄndez-Buenaga, Spain
Dr C. Forlini, Italy
Visual outcomes with the new Precizon Toric intraocular lens in a multicenter clinical trial
Young Surgeon: Why ArtiLens is my Phakic lens of choice
Acrobatics in the secondary IOL implantation. Iris claw in severe damaged iris in combination with artificial iris
Saturday 12:20
Sunday 10:20
Sunday 12:40
Dr S. Hamada, UK
Dr Park Hyo Soon, Korea
Prof J.L. GĂźell, Spain
Precizon Toric
New approach to ACD indication in Phakic IOL implantation
Long term evaluation of unilateral implantation
Saturday 11:20
Sunday 10:40
Saturday 12:40
Prof M. P. Holzer, Germany
Dr J. Kanellopoulos, Greece
Dr Kang Sung Yong, Korea
Preoperative specifics and experiences with the Precizon toric IOL
Artisan Aphakia applications in complicated Anterior Segment Cases
Artiflex Toric versus LRI
Saturday 13:20
Sunday 10:00 | Monday 13:40
Sunday 11:20
Prof Kim Myoung Joon, Korea
Dr D. Lake, UK
Dr T. Monteiro, Portugal
Tolerance of Toric IOLs to rotation
Artiflex Toric versus LRI
Saturday 11:40
Monday 11:20
Precizon Toric IOL - a new concept of precision for astigmatism management after cataract surgery Monday 12:00
Prof M. Pojaritski, Russia
Dr M. Sbordone, Italy
Prof S. Shah, UK
Zero astigmatism outcomes in Phakic IOL implantation
Precizon Toric
RingJect preloaded CTR
Sunday 13:40
Saturday 11:00
Saturday 13:40
Prof M. Tetz, Germany
Dr F. Ribeiro, Portugal
Dr N. Trap, The Netherlands
My preferred Phakic IOL
Precizon Toric pupil independence for night vision and aberrations
A rational approach to explant an Artisan PIOL in case of cataract formation
Saturday 14:20
Monday 12:20
Saturday 12:00
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OPHTEC
Global Speakers Tour ESCRS / Amsterdam 2013 ESCRS / London 2014