Eyeworld

EW MEETING REPORTER 84 June 2015 Reporting from the Singapore National Eye Centre (SNEC) 25th Anniversary International Meeting, May 22–24, 2015, Singapore Foulds said, it's probably not worth undertaking. Editors' note: The physicians have no relevant financial interests. Grace under pressure At the live surgery symposium, Dandapani Ramamurthy, MD, In- dia, demonstrated "superior surgical skill," said Terry Kim, MD, Durham, N.C. Dr. Ramamurthy was operat- ing on a 56-year-old patient with cataract, nuclear sclerosis 3+, using the Verion image-guided system (Alcon) and with a plan to implant a ReSTOR toric IOL (Alcon). The procedure was broadcast live from the operating theater of SNEC. At first the operation proceeded uneventfully. After a prerecorded video in which Dr. Ramamurthy demonstrated how the Verion platform is used for preoperative planning using a separate unit for image capture on which the various measurements in relation to ocular surface landmarks (primarily iris features and limbal vessels) are ac- quired, the surgeon proceeded with the operation. He began with 2 side ports—Dr. Ramamurthy prefers the bimanual irrigation/aspiration (I/A) tech- nique—and a 2.2-mm main port incision. After injecting viscoelas- tic to protect the endothelium, he proceeded with the capsulorhexis, aiming for a slightly smaller 5.5-mm rhexis following the 5.7-mm guide overlay. Dr. Kim, speaking from the pan- el on stage at the Suntec Singapore Convention & Exhibition Centre, noted how refreshing it was to see the lack of ink markings, which also saves some steps preop. Dr. Ramamurthy used a pre- chopper to divide the lens, then proceeded with phacoemulsification, successfully removing all the frag- ments with a CDE of 3.54. It was when he shifted to bi- manual I/A that he noticed a slight complication: an anterior capsule rent. Fortunately, Dr. Ramamurthy said with complete calm as he con- tinued with the case—barely slowing his pace though visibly increasing the precision of his movements—the an exciting prospect to explore for glaucoma management. On the second part of Prof. Lim's triple mission, there could have been no better person to reflect on Prof. Lim's legacy than J.F. (Barry) Cullen, FRCS, Singapore. Back in 1986, Prof. Lim sought the help of Dr. Cullen—then chair- man of the Ophthalmic Committee of the Royal College of Surgeons of Edinburgh—to bring ophthalmology training and education to Singapore. Their work together, said Dr. Cullen, marked a milestone in academic training in Singapore. He had since remained closely involved in SNEC's training program, until deciding it was time to retire and return to Scotland this year. At the end of his talk, the audi- ence, including residents and staff from SNEC, bid Dr. Cullen farewell with a standing ovation. Wallace S. Foulds, MD, Sin- gapore, concluded the Memorial Symposium's reflection of Prof. Lim's triple mission with a consider- ation of ophthalmic research in the region. Dr. Foulds was co-director and adviser of the Singapore Eye Re- search Institute (SERI) in 2000, and currently serves as senior consultant advisor. Successful clinical and basic research can generate new treat- ments and improve patient care, he said. While ophthalmic research is "rarely life-saving," he said, sight restoration remains a goal worth pursuing—something to remember when seeking grant support for your research proposal. The research being done at SERI, he said, runs the gamut from epidemiology, to the establishment of biomarkers, and "lots of omics": genomics, proteomics, and metabo- lomics, among others. In research, he subscribed to Karl Poppers' "black swan"—"only negative findings could be proved by observation": A thousand white swans doesn't mean all swans are white; observing just one black swan invalidates the positive statement, validates the negative. As a consequence of this, researchers should be open to any outcome any given study produces: If you're certain of the outcome, Dr. progressively increasing rates of antimicrobial resistance. Dr. Tan also paid tribute to Prof. Lim, saying that SNEC's 25-year progress up to and including all the work he and his colleagues are cur- rently doing "is truly his legacy." The opening ceremony con- cluded with Singaporean pop singer Richard "Dick" Lee Peng Boon's moving rendition of his song "Life Story," accompanying a slide show that took the audience through Prof. Lim's life. Mr. Lee said that when he was 21 years old, Prof. Lim saved his vision. Editors' note: The physicians have no relevant financial interests. Arthur Lim Memorial Symposium The SNEC 25th Anniversary Interna- tional Meeting's tripartite tribute to Prof. Arthur Lim concluded with the Arthur Lim Memorial Symposium in which distinguished experts spoke on topics that loosely reflected Prof. Lim's "triple mission": clinical care, education, and research. Sir Peng Tee Khaw, MD, U.K., discussed exciting prospects in glaucoma care, but first brought the audience back 25 years to show how much things have progressed. In the '90s, he said, "we had a lot less" in terms of options for managing glaucoma. At the time, even the role of IOP in the disease was still being debated. Since then, major prospective studies such as the Ocular Hyper- tension Treatment Study (OHTS), the Early Manifest Glaucoma Trial (EMGT), and even the Normal-Ten- sion Glaucoma Study (NTGS) have demonstrated the importance of controlling IOP. One interesting prospect for future glaucoma care Dr. Khaw briefly touched upon was his "ener- gy theory" of glaucoma. Dr. Khaw and his colleagues propose that the sustained rise in IOP in glaucoma results in retraction of fortified as- trocytes, depriving retinal ganglion cells of their energy supply, subse- quently resulting in axotomy. The possibility of "repower- ing" the optic nerve head, he said, although yet to be determined, is

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