Eyeworld

83 June 2015 EW MEETING REPORTER Nonetheless, Dr. Barrett ar- gued against multifocals. While he informs patients of all available op- tions, he strongly recommends his particular iteration of monovision— modest monovision, which limits myopic defocus to about –1.25 D. He thinks that the multifocal option is inherently flawed—while some lenses provide better vision at particular points of focus, the vision they provide is never perfect at any point of focus. This is because these lenses split light, resulting in loss of energy, and reduction in quality. Even with all the refinements in multifocality, Dr. Barrett thinks these lenses are aiming for a "mov- ing target," constantly shifting. Offering his patients modest monovision, he argues, is offering his patients what he believes to be the single best solution with the least compromise. Editors' note: Dr. Chee has financial interests with Abbott Medical Optics and Bausch + Lomb (Bridgewater, N.J.). Dr. Masket has financial interests with Alcon. Dr. Yeoh has financial interests with Abbott Medical Optics and Alcon. Drs. Barrett, Fam, and Ti have no relevant financial interests. APACRS LIM Lectures then and now At the first of the SNEC 25th An- niversary International Meeting's tripartite tribute to the center's late founder, Prof. Arthur Lim, who passed away last year in August, recipients of the prestigious APACRS Lim Lecture award reflected on their respective lectures and how things have changed since then. In some cases—as in "Improving the Refractive Outcomes of Cata- ract Surgery," originally given in 1995 by APACRS President Graham Barrett, MD, Nedlands, Western Australia, and "The Changing Face of Cataract & Refractive Surgery," originally given in 2005 by Ronald Yeoh, MD, Singapore—the progress has been remarkable, even if the fundamental concerns remain the same; in others—"New Viscoless Preloaded Injector," originally given in 2007 by Kimiya Shimizu, MD, Japan, and "My Insight on Multi- focal IOL," originally given in 2011 by Hiroko Bissen-Miyajima, MD, Japan—the doctors' conclusions have not changed. Finally, in the remaining talks—"Surgical Correc- tion of Ectopia Lentis," originally given in 2010 by Abhay Vasavada, MD, India, and "Modulation of Cor- neal Wound Healing After Surface Ablation," originally given in 2013 by Hungwon Tchah, MD, South Korea—the changes have been incremental, mostly though not exclusively in terms of refinement of techniques, material, and equipment already available at the time of the original lectures. Dr. Barrett's reflection also served as this year's Arthur Lim International Lecture. Going back to his original presentation—archived in the form of slides for a carousel slide projector—he found that while much has changed, his concerns and structured approach then and now remain very much the same. In 1995, Dr. Barrett said that the overriding philosophy for cataract surgery was for the procedure to be safe and painless, with good spher- ical equivalent outcomes; preopera- tive measurements were made with a handheld keratoscope, the optical biometer yet to be invented; predic- tion errors were the result of errors in the measurement of axial length (54%), anterior chamber depth (3%), astigmatism (10%), and unknown factors; and keeping the incision small meant an upper margin of 3.0 mm, and was only then being made possible by the introduction of foldable IOLs (phacoemulsification allowed reduction of the incision size, but contemporary IOL designs initially prevented reducing the incision size below 6 mm). Today, Dr. Barrett said, our con- cerns remain very similar: Despite now having the optical biometer, re- fractive surprises still occur, though instead of axial length or corneal curvature the confounding factor is mainly effective lens position. To address this, Dr. Barrett finds himself still very much involved with mathematical formulae for refractive prediction, with his Universal II formula improving upon the 1995 original but remain- ing, he said, fundamentally the same formula. "Improving refractive outcome remains quite relevant," he conclud- ed. Editors' note: The physicians have no relevant financial interests. Opening and tribute to Prof. Arthur Lim The SNEC 25th Anniversary Inter- national Meeting officially opened with a moving ceremony that in- cluded the second symposium in the tripartite tribute to Prof. Arthur Lim. SNEC Medical Director Wong Tien Yin, MD, Singapore, began the ceremony with reflections on the lessons he learned from work- ing with Prof. Lim at SNEC. These lessons traced the center's 25-year progress from "vision to reality." Dr. Wong then asked for 1 minute of silence for Prof. Lim. Following the silent tribute, Guest of Honor Gan Kim Yong, minister of health, Singapore, gave his welcome address. In Singapore's 50-year history, Mr. Gan said, the establishment of SNEC is recognized as a major milestone. SNEC's achievements mirror Singapore's progress through nation building, he said. Graham Barrett, MD, Ned- lands, Western Australia, Sir Peng Tee Khaw, MD, U.K., and Clement C.Y. Tham, MD, Hong Kong, each gave a touching tribute to Prof. Lim. "His passing leaves us all dimin- ished," Dr. Barrett said. He encapsu- lated Prof. Lim's wisdom in a series of aphorisms: "I hear and I forget. I see and I remember. I do and I understand." "Everything has beauty, but not everyone sees it." "Choose a job you love, and you will never have to work a day in your life." For his tribute, Dr. Khaw quoted the famous inscription written by Christopher Wren Jr., for his father, Christopher Wren, architect of St. Paul's Cathedral: "If you seek his monument—look around you." Of all of Prof. Lim's great legacies, Dr. Tham said it has been "breathtaking to see what SNEC has achieved." He added that while Prof. Lim's legacy and achievements are storied, he would best be remembered by those who knew him for his "very special, often personal, relationship to all of us." "He will continue to lift our hearts for many generations to come," he said. Also at the opening ceremony, Donald Tan, MD, Singapore, pro- vided a comprehensive summary of the last 25 years of progress in cor- neal surgery and external diseases, including a brief look ahead into the future of the field in his SNEC 25th Anniversary Lecture on "Cornea Development in Singapore: The Path is Clear." In his lecture, Dr. Tan intro- duced a new piezoelectric cornea knife (patent pending) he and his colleagues are currently developing. The device is a blunt dissector that he and his colleagues believe will be a game changer. Dr. Tan and his colleagues are also working on designing new antimicrobial molecules against ocular pathogens (AMOP) to address continued on page 84

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