Eyeworld

30 | EYEWORLD | SUMMER 2024 ASCRS NEWS "We are all here to learn to continuously evolve toward the best version of ourselves." —Renato Ambrósio Jr., MD, PhD, from a poem he wrote in 2021 References 1. Maeda N, et al. Neural network classification of corneal topog- raphy. Preliminary demonstra- tion. Invest Ophthalmol Vis Sci. 1995;36:1327–1335. 2. Ambrósio R. Violet June: The Global Keratoconus Awareness Campaign. Ophthalmol Ther. 2020;9:685–688. 3. Ambrósio R, et al. Optimized artificial intelligence for en- hanced ectasia detection using Scheimpflug-based corneal tomography and biomechan- ical data. Am J Ophthalmol. 2023;251:126–142. Relevant disclosures Ambrósio: Alcon, Carl Zeiss Meditec, Mediphacos, Oculus, physician CEO of BrAIN by Ellen Stodola Editorial Co-Director cine with ophthalmology as a prerequisite, Dr. Ambrósio said, mentioning the World College of Refractive Surgery & Visual Sciences. Also, these are not solely elective procedures but involve therapeutic approaches for different diseases, such as keratoconus. "I think about vision and optics optimization every time I see a refractive patient," he said. It's foremost that we customize or individ- ualize the best approach for each eye of each patient, Dr. Ambrósio said, mentioning that along with optimizing the efficacy, each case should be planned to prevent complications like progressive keratectasia, tear dysfunction/oc- ular pain, interface epithelialization, quality of vision symptoms, and over/under sizing phakic IOLs. Dr. Ambrósio expanded on the "beyond" theme to discuss imaging in refractive surgery. We started talking about multimodal corneal imaging but demonstrated the concept of mul- timodal refractive diagnostics. He highlighted several modalities of tests since anamnesis, slit lamp biomicroscopy, corneal topography (Placido), corneal and anterior segment tomog- raphy with Scheimpflug and OCT, high-frequen- cy ultrasound, ocular wavefront, axial length, ocular surface imaging, specular and confocal microscopy, and molecular biology and genetics. Considering the plethora of data, he mentioned the role of artificial intelligence in data integra- tion and enhancing clinical decisions. Physicians should talk to the patient before everything to understand what the patient feels and needs, and this is where patient question- naires can be valuable. He cited work by Stephen Klyce, PhD, on using neural networks for interpreting Placido disc-based topography as an example of a pio- neer application of artificial intelligence in med- icine. 1 He expanded the concept of assessing ectasia risk before refractive corneal procedures, evolving from screening and detecting mild forms of keratoconus and ectatic corneal disease to characterizing the susceptibility for ectasia progression. He said that 1998 was a pioneer year for ectasia because of the first reports of ectasia after LASIK by Theo Seiler, MD, PhD, R enato Ambrósio Jr., MD, PhD, pre- sented the Richard L. Lindstrom, MD, Lecture at the 2024 ASCRS Annual Meeting, calling it "one of the high- lights of my career." He began the lecture by sharing quotes from other ophthal- mologists about the impact that Dr. Lindstrom has had on the ophthalmic field. We are celebrating 50 years of ASCRS, he said, noting that the 25th anniversary meeting was the second ASCRS Annual Meeting that he attended, in Seattle, Washington. Before the meeting, he visited the University of Washing- ton, where he met Steven Wilson, MD, who he ultimately trained under. "Dr. Wilson taught me to be a clinician-scientist," he said. "I see myself today as a refractive surgeon-scientist." Dr. Ambrósio's lecture focused on refractive surgery, specifically highlighting the concept of going "beyond." Refractive surgery evolved to become a scientific subspecialty of ophthalmolo- gy, focusing on elective procedures that aim for refractive correction. But what is the goal? Re- fractive surgery aims to provide patient satisfac- tion by improving quality of life, and quality of vision is fundamental along with patient expec- tations. We have to value and enhance patient education, he said. These excellence standards are based on three major aspects: technology, knowledge, and patient care. We should consider that refractive surgery should eventually evolve into a specialty medi- Richard L. Lindstrom, MD, Lecture highlights refractive surgery

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