EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW MEETING REPORTER 88 Reporting from the 2015 ASCRS•ASOA Symposium & Congress, April 17–21, 2015 San Diego Another case presented during the symposium focused on the role of CXL to treat keratoconus. A majority of attendees—72%—said they would recommend keratoconus for any patient showing signs of pro- gression, while 15% said they would recommend it for all keratoconus cases. Ten percent said they don't know enough about CXL to recom- mend it, and 2% said they would not advise it due to lack of evidence. Editors' note: Drs. Holland and Kim have financial interests with Alcon, Bausch + Lomb, and other ophthalmic companies. Can progression of myopia be stopped? Spectacles, multifocal contact lenses, overnight corneal reshaping, and anti-muscarinic eye drops have all been studied as methods to halt myopic progression, but anti-mus- carinic eye drops are the only treatment shown to have a signifi- cant effect. Donald T.H. Tan, MD, Singapore, shared results from the studies conducted at the Singapore Eye Research Institute (SERI) on the use of atropine, an anti-muscarinic agent, for myopic prevention in the Richard L. Lindstrom Lecture, "The Use of Atropine for Myopia Preven- tion." Atropine 1% eye drops have been available for more than 40 years and have been used in East Asian countries to slow the progres- sion of myopia since the 1990s, Dr. Tan said. Atropine's mechanism of action is unclear, but studies have shown that it does not work by blocking accommodation. Dr. Tan and colleagues per- formed 2 randomized controlled trials at SERI to determine atropine's effectiveness in halting distance visual acuity decline and axial elongation. The first stud , named ATOM1, compared 1% atropine to placebo drops in 400 children studied over 3 years. The second study, ATOM2, compared the effects of lower doses of atropine—0.5%, 0.1%, and 0.01%—to placebo drops in 400 children over a period of 5 years. The major conclusions from these studies are that atropine drops slow myopia progression and axial elongation in children in a dose-re- lated manner, but a rebound effect occurs with higher doses—axial length and myopia increase again after the drops are stopped. Atropine 0.01% has the best therapeutic in- dex, slowing progression of myopia by as much as 50–60%. There are many more questions to be answered, but Dr. Tan believes that this is a huge step forward. "It's fascinating that now we're reaching a time when a lot of these studies are showing promise," he concluded. Editors' note: Dr. Tan has financial interests with Carl Zeiss Meditec, Eye-Lens Pte Ltd., Network Medical Products, and Santen Pharmaceutical. X-Rounds: 'Rookie of the Year,' new FDA approvals, MIGS This year's "X-Rounds: Refractive Cataract Surgery to the Max" was dominated by newcomer panelist Bonnie An Henderson, MD, Bos- ton. The X-Rounds symposium is a climactic, rapid-fire session that offers a concise summary of the best of the ASCRS•ASOA Symposium & Congress framed as a competition between members of the panel, judged by the audience. "This is the most interesting session for me," said Eric D. Donnenfeld, MD, Rockville Centre, N.Y. This year, Dr. Henderson gar- nered her first win in the first ca - gory of the symposium on what new things the surgeons have been doing in the last year by suggesting a new approach to preventing negative dysphotopsias. When using IOLs with sharp truncated edges of high refractive index materials such as acrylic, she recommended orienting the optic/ haptic junction in the infero-tempo- ral quadrant to decrease the percent- age of available edge where light can strike. For the "New Technology" cat- egory, Dr. Henderson was also voted favorite for presenting a new oint- ment that addresses what she called a common complaint of refractive cataract patients—an increase in periorbital fat after surgery. She said that "certain XAF-type prostaglandins act pharmacological- ly on adipocytes and reduce adipose tissue in animal models." Applied topically, the XAF5 ointment currently being developed by Topokine (Boston), she added, delivers XAF5 across the skin and achieves micromolar concentrations in subcutaneous fat. A phase 2 trial of the ointment has been completed and the pos- itive results were presented at the continued on page 90 May 2015 View videos from Tuesday at 2015 ASCRS•ASOA: EWrePlay.org Rosa Braga-Mele, MD, Toronto, discusses the current state of affairs in immediately sequential bilateral cataract surgery. Supported by