Eyeworld

EW MEETING REPORTER 88 Reporting from the American Academy of Ophthalmology (AAO) meeting, October 15–18, Chicago As for treatment, Dr. Karcioglu said improved and targeted chemo- therapy treatments have and are still being developed. There have also been improvements in radia- tion therapy, localized treatment techniques, surgical techniques, and reconstruction with prosthetic devices that can "achieve aesthetic and functional perfection thanks to microchip engineering and new material use." Dr. Karcioglu said he thinks treatment for orbital tumors will only become more precise in its delivery, minimizing unwanted side effects. But, "we may soon not need any of this stuff I talked about," Dr. Karcioglu said, making one further prediction—that gene editing might someday make even these enhanced diagnosis and treatment technolo- gies obsolete. Though he never studied under Lorenz Zimmerman, MD, Dr. Karcioglu said he considers him the "single greatest influence on my career because of his massive impact on all aspects of ophthalmology." Editors' note: Dr. Karcioglu has no financial interests related to his comments. Changes in imaging From the anterior segment to the posterior segment, there has been a paradigm shift caused by chang- es in ophthalmic imaging. Optical coherence tomography in particular is driving much of this change. "OCT is challenging the anatomical underpinning of our clinical concepts," said Balwantray Chauhan, PhD, Halifax, Nova Sco- tia, in the symposium cosponsored by the Association for Research in Vision and Ophthalmology. In glaucoma, for example, OCT is now being used to measure all the parameters of disease progression, said Christopher Kai-shun Leung, MD, Hong Kong. Progressive retinal nerve fiber layer thinning as detected with OCT, for example, is relevant to managing glaucoma patients, Dr. Leung said, noting that these eyes also have a higher risk of subsequent visual field progression. Y. Ralph Chu, MD, Blooming- ton, Minnesota, presented on two accommodating IOLs that are in the works. One is the FluidVision (PowerVision, Belmont, California), which is a shape-changing, fluid- driven IOL, relying on the ciliary muscle to change the optic's shape and drive accommodation. Another by Perfect Lens involves refractive index shaping where a laser is used to change asphericity, toricity, and refractive error in vivo. Editors' note: Dr. Carones has financial interests with Abbott Medical Optics, AcuFocus (Irvine, California), and Al- con. Dr. Kohnen has financial interests with Abbott Medical Optics, Alcon, Oculus (Lynnwood, Washington), Carl Zeiss Meditec, and Ziemer. Dr. Chu has financial interests with Bausch + Lomb, PowerVision, Refocus Group (Dallas), and ReVision Optics. Diagnosis and treatment of ocular tumors and adnexa The symposium cosponsored by the American Association of Ocular On- cologists and Pathologists covered diagnosis, pathology, and treatment of uveal melanoma, retinoblastoma, basal cell carcinoma, and intraocular lymphoma with updates on diagnos- tics and therapies. The highlight of the sympo- sium was the Zimmerman Lecture presented by Zeynel Karcioglu, MD, Charlottesville, Virginia, who spoke about changes in the diagnosis and treatment of orbital tumors within the last 50 years, also making predic- tions for where the field is going. Dr. Karcioglu said in the first half of his career change in the field was slow. In the second half, particu- larly the last 15 years, change has increased rapidly. Advances in imaging that will lead to better diagnosis of orbital tumors, Dr. Karcioglu said, include functional MRI, magnetic resonance elastography, advances in molecular MRI/nano particle MRI for "in vivo biopsy," and combined modality methods. He predicted that tumor cell monitoring with proteomics will become the mainstay of diag- nosis and management for the early detection of disease, identification, behavior, and treatment response. Office-based cataract surgery: Successful results in one study Cataract surgeons at Kaiser Perma- nente in Colorado have successfully performed cataract surgery in more than 21,000 eyes in a minor proce- dure room instead of a traditional operating room, said Mark Packer, MD, Boulder, Colorado, during "Hot Topics 2016." The retrospective study of office-based cataract proce- dures involved the largest retrospec- tive consecutive series of cataract surgeries analyzed together, said Dr. Packer, who led the study along with three Kaiser Permanente employees. Study authors found no cases of endophthalmitis and low rates of adverse events (iritis in 1.53% and edema in 0.53%); 0.70% of eyes required a secondary surgery within 6 months. Surgeons did not use any IV antibiotics, and about half of patients in the study had bilateral cataract surgery. Editors' note: Dr. Packer has no finan- cial interests related to his comments. Technology not yet in the U.S. A session cosponsored by ASCRS featured technology from around the world that is not yet available in the U.S. Multifocal toric IOLs were dis- cussed by Francesco Carones, MD, Milan, Italy. He presented data that suggested these IOLs are bringing patients closer to target without ad- ditional surgical maneuvers. He said research shows patients receiving a toric IOL are more satisfied with the result than limbal relaxing incisions (LRI). In his practice, Dr. Carones said he uses toric IOLs 99% of the time over LRIs. Thomas Kohnen, MD, Frank- furt, Germany, presented on trifocal IOLs, none of which are available in the U.S. yet. Dr. Kohnen was asked about the visual disturbances of these IOLs compared to bifocals, and said he thinks the patients are forgiving of these disturbances because they are so pleased with the intermediate vision. Eric Donnenfeld, MD, Rockville Centre, New York, said he worries American patients could be more sensitive and less forgiving to glare and halo than their European counterparts. November 2016 continued on page 90 Sponsored by

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