Eyeworld

SUMMER 2024 | EYEWORLD | 31 Contact Ambrósio: dr.renatoambrosio@gmail.com Dr. Ambrósio delivers the Lindstrom Lecture at the Annual Meeting. Source: ASCRS which alluded to the two-hit pathophysiology of ectasia: the innate properties and the environ- mental impact. He noted screening, character- ization of ectasia susceptibility, confirming the diagnosis, staging, and classifying. Dr. Ambrósio mentioned the Violet June Global Keratoconus Awareness Campaign 2 he initiated and said that one of the most important ways to avoid ectasia is to tell patients not to rub their eyes. He emphasized that it is essential to go beyond, not over, front surface topography. The quest is to characterize the cornea's susceptibil- ity to developing ectasia with enhanced multi- modal diagnostics. Considering that we aim to detect keratoconus and ectasia early, we must include biomechanical assessment and molecu- lar biology. Dr. Ambrósio cited his American Ophthal- mological Society thesis, published in July 2023. The integration of Scheimpflug tomography and biomechanics with the optimized Tomog- raphy and Biomechanical Index provides the most accurate approach, considering the 84.4% sensitivity for detecting abnormality among 551 normal topography eyes from patients with very asymmetric ectasia, with 90.1% specificity. 3 Also, "beyond" ectasia susceptibility char- acterization, Dr. Ambrósio highlighted the role of understanding the biomechanical impact with artificial intelligence to quantify the impact of laser vision correction in a relational thick- ness-altered. The integration of ectasia suscep- tibility and the impact is further characterized in the enhanced ectasia susceptibility score, which will be available on the BrAIN (Brazilian Artificial Intelligence Networking in Medicine). He mentioned the work by Roger Zaldivar, MD, using artificial intelligence to improve the plan- ning for sizing to predict the postoperative vault of the ICL and the anterior chamber angle. He referred to the Steinert Lecture at the 2023 ASCRS Annual Meeting given by Vance Thompson, MD. Dr. Thompson asked the ques- tion, "What is the difference between standard cataract surgery and refractive cataract sur- gery?" Dr. Ambrósio responded that the differ- ence is refractive planning. Furthermore, ectasia assessment is relevant for refractive cataract surgery because it impacts the accuracy of IOL power calculation, the quality of vision after premium IOLs, and the safety and efficacy of secondary corneal laser vision correction. "We are looking at a revolution in the evolution of OCT, and I think it's crucial to distinguish corneal OCT and anterior segment OCT. There are many machines available and great opportunities for artificial intelligence," he said. He highlighted the Pentacam Corneal OCT (Oculus), which combines rotating Scheimpflug and ultra high-definition OCT. There is a syner- gism between Scheimpflug imaging to quantify the amount of opacity and OCT to detail and qualify the layers and the depth of the opacity so that we can plan how to handle those with therapeutic procedures. He concluded by thanking ASCRS for the great honor of giving the lecture and receiving the award from Dr. Lindstrom. He said that re- fractive surgery is a mindset that is summarized in a poem that he wrote in 2021: "We are all here to learn to continuously evolve toward the best version of ourselves."

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