Eyeworld

139 March 2017 EW MEETING REPORTER of the All India An important consideration for beginner cataract surgeons wishing to convert from SICS to phaco is patient selection. Sanjib Baner- jee, MD, Kolkata, India, discussed "Choosing the Ideal Patient." Among the considerations, Dr. Banerjee said that the right eye is preferable for learning purposes to avoid obstruction from the nose; a grade III nuclear sclerosis is ide- al; and a well-dilated pupil, clear cornea, and deep-seated anterior chamber are ideal. He also cautioned that a shallow anterior chamber and hypermetropic eyes are more diffi- cult to work with for beginners. Which IOL? Which patient? In his practice, if there's one thing Dandapani Ramamurthy, MD, Coimbatore, India, has learned, it is that spectacle independence translates to greater patient satis- faction. Following cataract surgery, every patient, he said, will display at least a bit of disappointment when handed a pair of glasses or pre- scribed contact lenses. To date, it remains generally accepted that multifocal IOLs offer the typical solution for spectacle independence. However, Dr. Rama- murthy said, all multifocal IOLs op- erate on the same principle, creating distinct foci for near and distance, leaving the visual cortex to discern between them; thus, he said, there is always "an amount of negative signals that impinge on quality of vision." Dr. Ramamurthy discussed strategies for addressing these issues and enhancing the use of multifo- cal IOLs at an instructional course Thursday on "Which IOL, for Which Patient, and When?" Acknowledging the availability of other options, such as implants that extend and enhance depth of focus, Dr. Ramamurthy said that he considers a number of "Cs" for en- hancing the use of multifocal IOLs in his practice: cylinder and residual refractive error; capsular opacities; cornea and ocular surface disease; cystoid macular edema and other macular problems; centration of the IOL; and "crazy patient." Refining surgical technique based on careful measurements and IOL power calculations is thus essential for enhancing outcomes with multifocal IOLs, but Dr. Rama- murthy further adds strategies such as micromonovision and implanting IOLs of different, complementary powers. At the same session, Viraj Vasa- vada, MD, Ahmedabad, India, said that "astigmatism is a reality, and if we can correct it, all the better." Any astigmatism greater than 0.5 D, she said, "matters." Following cataract surgery, toric IOLs, she said, make the most sense. Apart from the cost of the IOL, she does not think toric IOLs should be considered a "premium" technolo- gy—all patients with astigmatism, she said, deserve toric correction. She believes toric IOLs should be considered a routine part of cataract surgery, offering astigmatism treat- ment that is accurate and predict- able, with no regression that can, if necessary, be reversed. Implementing toric IOLs as a routine surgical tool, she said, begins with understanding astigmatism and measuring keratometry. Sur- geons, she said, should understand that astigmatism is the summation of preexisting astigmatism and surgically induced astigmatism; meanwhile, although we don't really know which instrument works best, Dr. Vasavada recommended that surgeons use whichever works best in their hands, looking for interpa- tient and intrapatient correlations and consistency. Ideally, she added, surgeons should use more than one keratometer. With all this in mind, ses- sion chair Abhay Vasavada, MD, Ahmedabad, India, ultimately said there is no one answer to "which IOL." While patients might insist on a "straight," immediate answer to the question, Dr. Vasavada reminded surgeons that they must first con- sider the patient, their personality, their visual and nonvisual needs, the condition of their eyes, and a wide variety of other factors before telling their patients "which IOL" they should have. AIOC organizers and guests light lamp for platinum jubilee Following tradition, the inaugu- ration ceremony of the 75th An- nual Conference of the All India Ophthalmological Society (AIOC) began by "paying obeisance to the Almighty"—symbolized by the light- ing of a lamp by the organizers and their guests. The conference, attended by more than 8,000 delegates from all over the subcontinent and over 500 from abroad, is a "big scientific feat" for which the organizers "left no stone unturned" and "shed tears and sweat," said Pavan Shorey, MD, Jaipur, India. Dr. Shorey and fellow Chairman of the Organizing Committee P.K. Mathur, MD, Jaipur, India, welcomed attendees at the inauguration. At the inauguration ceremony, Outgoing President Dr. Ramamurthy offered thanks for his last year as president. In his speech, Dr. Ra- mamurthy provided a summary of highlights and challenges he faced in the last year as president of AIOS. The inauguration ceremony was attended by Chief Guest Shri J.P. Nadda, MD, Union Minister of Health and Family Welfare of India and other guests of honor and spe- cial guests. In his speech, Dr. Nadda took a positive view of health work in India. Considering the challeng- es faced by the health sector in a country with such a vast popula- tion, spread out to remote areas across the subcontinent, Dr. Nadda applauded India's health workers for their efforts and achievements, and called on delegates to be "ambassa- dors," letting people know that the health sector is working to make India healthier, better, and stronger. Because of his position as minister, members of the society also called on him to legalize some off-label uses of medication beneficial to patients and allow the society to participate in policy making—de- mands which he took gracefully and with the promise to make an effort to accommodate. Incoming President Dr. Gopal, in his first presidential speech to the society, held a similarly posi- tive view, but with both a broader focus on India in general—which he called by its ancient name "Bharata Varsha," a name he said the country held for over 8,000 years, himself a "Bharathiya"—and a tighter one on the society in particular. He called freethinking "the soul of India," placing the AIOS in its context. Dr. Gopal went on to outline his plan for the future of AIOS, which includes ensuring future confer- ences are held only in states with adequate existing infrastructure, and that the surplus proceeds from annual meetings be shared across all affiliated societies rather than just to hosting societies—thus ensuring that even those affiliates too small to host annual meetings will benefit and have the opportunity to grow and develop. The ceremony continued with the handing out of various honors— scientific awards, the society's young researchers awards, and the Indian Journal of Ophthalmology awards— and the presentation of numerous mementos among the organizing heads and guests. continued on page 140

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