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Reporting from the 2016 World Ophthalmology Congress, February 5–9, Guadalajara, Mexico EW MEETING REPORTER 124 equipment in the future but will also be available on a dedicated website, Dr. Packard said. Also related to IOL calculations, technology such as intraoperative optical coherence tomography that can help surgeons find the patient's effective lens position has been a game changer, Dr. Packer said. Other advances in cataract surgery that Dr. Packard highlight- ed included improved toric IOL calculations, mobile femtosecond lasers, better dilation and pain relief with Omidria (phenylephrine and ketorolac injection, Omeros, Seattle), and new IOLs that can help patients with age-related macular degenera- tion. Finally, Peter McDonnell, MD, Baltimore, shared recent advance- ments within refractive surgery. One issue is presbyopia, which affects up to 2 billion people. The approval of the first lamellar corneal inlay in the U.S., the KAMRA (AcuFocus, Irvine, Calif.), was a major advancement, he said. The KAMRA is mostly used in patients in their early 50s. A 2014 study in the Journal of Refractive Surgery found that one-eighth of KAMRA patients did not need any reading glasses at 2 years postop; other patients reduced their use. Some concerns with KAMRA in- clude epithelial ingrowth, decentra- tion, and infections, Dr. McDonnell of Landmark Achievements (2014– 2016): Cornea and External Eye Disease, Cataract Surgery, Nano- technology and Bioengineering, and Refractive Surgery." Although not yet approved in the U.S., CXL is used abroad to treat keratoconus as well as infec- tious keratitis, Dr. Atherton said. A meta-analysis published this year in Cornea found that CXL was effective in treating bacterial, Acanthamoeba, and fungal keratitis, but it was not effective for herpes simplex and resulted in corneal melt in the latter patient group. There are some con- cerns with CXL treatment and resur- gence and perforation. "Crosslinking may strengthen the cornea but may create a reservoir for microorganisms to persist," she said. Limbal stem cells are increas- ingly studied and have become a hot topic for use in ocular surface reconstruction as well as other appli- cations. Epigenetics is a buzz word these days in medical research, and its study may one day reveal clues on how to treat and prevent corneal disease, Dr. Atherton said. Dr. Atherton also discussed exosomes, which are cell-derived vesicles that may ameliorate or ex- acerbate disease. "Some reports say they could be used to circumvent the hurdles of stem cells," she said. Cataract surgery has seen a plethora of advancements in a short time period, said Richard Packard, MD, London. One ad- vance is a new approach to IOL calculations that is based on artifi- cial neural networks. The approach was presented by Warren Hill, MD, Mesa, Ariz., at last year's American Academy of Ophthalmology (AAO) meeting in Las Vegas. In a study of more than 3,400 eyes, research from Dr. Hill and collaborators found that 95% of patients came within 0.5 D of the intended target. "That's a remarkable achievement compared with anything we've done before," Dr. Packard said. "I think this will revolutionize refractive outcomes." The new IOL calculation method presented originally by Dr. Hill will be part of the LENSTAR (Haag-Streit, Koniz, Switzerland) said. Up to 10% of patients require removal of the inlay. Another area that has been researched heavily in the past few years is corneal biomechanics, Dr. McDonnell said. Detecting early signs of keratoconus via a better un- derstanding of corneal biomechanics can help patients avoid problems after refractive surgery. Researchers are analyzing the corneal shape, cor- neal biomechanical properties, and tomography to glean clues in this area. Clinicians are also reviewing the results of CXL treatment and the small incision lenticule extraction procedure—known as SMILE—to analyze their role in helping ectasia. A third hot topic within re- fractive surgery is the neurotrophic cornea, Dr. McDonnell said. How- ever, there is much that remains to be done. "Our limited knowledge translates into a limited ability to prevent and treat this," he said. Clinicians highlight advances in ocular oncology, regenerative disease, and pediatric care Until recently, there were no promis- ing treatments for uveal melanoma, said Jasmine Francis, MD, New York. Although up to 98% of patients can be metastasis-free at diagnosis, March 2016 View videos from WOC 2016: EWrePlay.org Shamira Perera, MD, discusses several indications for laser iridoplasty. continued on page 126

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