NOV 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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November 2013 treatment for CME, she said. The ESCRS PreMED Study could help with establishing the best regimens, Dr. Lobo said. She listed the most frequent risk factors for pseudophakic CME as follows: iris trauma, posterior capsule rupture, vitreous loss or incarceration, dislocated IOL, use of iris-fixed lenses, active uveitis, and diabetes. Diabetic patients are an important risk group, she said, and should be carefully monitored when having surgery. "These patients have a higher risk of worsening macular edema after cataract surgery," Dr. Lobo said. Clinician: Accommodation possible in elderly patients Restoration of accommodation is possible in older patients, with some IOLs showing real potential, said Adrian Glasser, PhD, Houston, Texas. Dr. Glasser presented on the topic at the "Basic Research on the Crystalline Lens and IOLs Restoring Accommodation" Clinical Research Symposia. "Efforts are underway to attempt to restore accommodation using a variety of different approaches," he said. "These of course include accommodating IOLs, or AIOLs, some of which are designed to be placed in the bag, some of which are designed to be placed in the sulcus, and some of which are designed to be responsive to pupil constriction rather than an accommodative contraction of the ciliary muscle." He said other possibilities for achieving accommodation in older patients are the use of a femtosecond laser to restore the "accommodative capacity" to the natural crystalline lens. Pharmacological softening of the lens is another avenue being investigated, Dr. Glasser said. Scleral procedures are a possibility, but he said he does not have much confidence in this particular approach. He spoke mainly about A-IOLs, which include dual optic and fluid filled lenses, and described the way that accommodation works. He said it is an "active and dynamic" process, not just a distance-corrected eye that sees clearly at near. Dr. Glasser said he believes that accommodation in older patients is not only possible, in a few cases, it has happened. "It has already been achieved with accommodative IOLs, but only in a very limited number of cases," he said. "Can significant accommodation be restored? That remains the question, and I believe the biggest challenges are the biological challenges associated with the postoperative healing response of the eye," Dr. Glasser concluded. Femtosecond laser might play role in presbyopia treatment Holger Lubatschowski, PhD, Lubeck, Germany, presented at the same symposium as Dr. Glasser, but examined femtosecond laser possibilities for accommodation restoration. He discussed the Rowiak (Hanover, Germany) femtosecond laser device that is under study now. Dr. Lubatschowski is CEO of the company. "Based on [findings of how accommodation works], we tried to restore the lens elasticity by generating sliding planes into the crystalline lens by femtosecond laser," he said. "These sliding planes are made to reduce the inner friction inside the crystalline lens." The procedure does not require the eye to be opened. As a result, it does not need a sterile operating room and can be performed as an in-office procedure, a true advantage, Dr. Lubatschowski said. Sunday, Oct. 6 ESCRS kicks off XXXI Congress with Opening Ceremony ESCRS President Peter Barry, MD, Dublin, Ireland, welcomed attendees to this year's congress, outlining the many works of the society, including his own work as president this year. "My three focuses have been youth, education, and research," he said. Another feature of this year's meeting that he highlighted was a book on the history of ESCRS, which he edited with Emanuel S. Rosen, MD, Manchester, U.K. He said he and Dr. Rosen edited the book to capture the story of the society while older members were still able to share the full history. Leading French ophthalmologist remembered by colleague He was born on the extreme point of the extreme west of France, "where the wind and the sea continuously fight with the land." "A very special birthplace, for a very special destiny," said Philippe Sourdille, MD, Paris, France. Dr. Sourdille gave a tribute at the Opening Ceremony to Joseph Colin, MD, who died in February at the age of 63 after an illness. Dr. Colin had a starring role in the ophthalmology profession in France and was a global leader in refractive and cataract surgery. He was the ophthalmology department chair at the Bordeaux University Medical School, France. He was feted with top honors by ophthalmology societies throughout his life, and was knighted in France in 2011. He was also one of the youngest professors of ophthalmology in the country ever, at the age of 32. His beginning in the west of France matched how he lived, however, according to Dr. Sourdille. "People from the island of Ouessant are special. Attracted by the open sea as sailors and travelers, they also stand up under any circumstance, as Joseph did, during his life, and during the last months of his life, when he was totally conscious of what would happen and faced it bravely," he said. Dr. Colin specialized in the anterior segment, examining many issues in that space. He had a singular dedication to the profession and his patients. "[Dr. Colin] was a great surgeon but never forgot to comprehensively consider our patients' eyes, never forgetting the posterior segment consequences of innovative anterior segment surgical approaches," Dr. Sourdille said. EW MEETING REPORTER 63 Binkhorst Lecture highlights the ablated cornea Corneal ablation is a successful procedure with many benefits, but it also causes changes to the cornea that are not completely understood and requires continued research to determine the most successful way forward. "To build on our already excellent outcomes, we need to further improve the entire ablation process," said Douglas D. Koch, MD, Houston, Texas. "[That includes] measurements, planning and monitoring corneal changes and with treatments, we want to increase the optical zone sizes, reduce induction of unwanted aberrations, predictably lower some aberrations, and predictably produce some aberrations." Dr. Koch gave the Binkhorst Medal Lecture 2013, "The ablated cornea: what have we done?" at the Opening Ceremony. He said that there are 10 changes that must be recognized to maximize the longterm visual results of ablation surgery, and he outlined each change in the lecture. He touched on those changes first as anatomical: in ablating the cornea, not only is tissue removed from the anterior stromal surface, he said, but the endothelial thickness profile is also altered, and "we induce biomechanical changes anteriorly and posteriorly." He, as well as others, have examined such changes using Fourier-domain OCT. For instance, following hyperopic LASIK, OCT shows that central thinning is up to 8 µm with annular thickening up to 24 µm. There is some correlation with attempted correction, he said. OCT and other evolving technologies have provided clinically useful ways of monitoring and modulating changes including the refractive impact, predictability, stability, and effect on treatment strategies, Dr. Koch said. He also said that accurate measurements of all key parameters, which should include and incorporate the posterior corneal curvature, are important.

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