Eyeworld

EW NEWS & OPINION 24 April 2017 Insights by J.C. Noreika, MD, MBA As it did in 1982, the ASCRS Annual Symposium & Congress continues to embrace progress, innovation, surprise, and great theater. "When I was younger, I could remember anything, whether it had happened or not." —Mark Twain O phthalmologists from around the globe will soon convene at the Los Angeles Convention Cen- ter for the ASCRS Annual Symposium & Congress. Thirty-five years ago, I attended my first ASCRS meeting. It wasn't the ASCRS then, but the AIOIS, the American In- tra-Ocular Implant Society. The organization had just emerged from a turbulent birthing to develop into a boisterous toddler: brash, noisy, and cheeky. In 1982, nearly half of today's physicians weren't old enough to drive. They missed a helluva ride. That 1982 meeting's program consisted of six folded sheets of paper postmarked Santa Monica, California. It announced that the 5th U.S. Intraocular Lens Sympo- sium would be held on April 21–23, 1982, at the Century Plaza Hotel in Los Angeles. The registration fee for members was $400 ($995 in today's currency). Then, ophthalmologists could afford to leave their offices for 3 or 4 days. If you didn't go, the sole means of gleaning the latest from cutting-edge masters was to purchase audio cassettes. You could listen to these on that latest magic from Japan, Inc.—the Sony Walkman. This was not my first rodeo. I had attended earlier American Academy of Ophthalmology (AAO) meetings during residency and fel- lowship. In 1980, the AAO was held in Chicago at the Palmer House. The meeting halls, exhibits, and posters fit inside the hotel. But the 1982 AIOIS was my first conclave as a "real" doctor. I was 32. I required little sleep, got by on caffeine and the largesse of kind souls springing for taxis and meals, and was a tabula rasa, no preconceptions or frame of reference. I also had hair. The program listed the Exec- utive Committee, Past Presidents (there were four), the Scientific Advi- sory Board, International Honorary Members, and the Binkhorst Medal Lecturers. In the revolutionary transformation of cataract surgery, these were the household names familiar to journal club members everywhere. The faculty of the scientific sessions comprised about 100 MDs and two PhDs. Presentations were arranged by theme and were 5 to 8 minutes long. Moderators comprised a who's who of this burgeoning new forum. There was a smattering of instructional courses and symposia. Course topics spanned "Nonauto- mated Planned ECCE" to "Automat- ed Planned ECCE" to "Phacoemul- sification." All had champions, acolytes, and detractors. Symposia featured titles such as "Techniques of ECCE" and "ICCE vs. ECCE." Intracapsular cataract extraction was the profession's gold standard. Prophets spoke on in-the-bag implantation, outpatient cataract surgery, scleral step incisions, the use of Healon, UV blocking implants, astigmatism-avoiding techniques, secondary lens implantation, the nonessential peripheral iridectomy, bilateral implant monovision, and computers in ophthalmology. There were intimations of problems. Corneal endothelial cell loss was enumerated upon as were vitrectomy techniques. Lens ex- changes were described. Discussion rates for posterior capsular opacifica- tion clamored for better technology. One paper described a "Noninvasive Capsulectomy Using a Pulsed Infra- red Laser," another the use of the YAG-laser in ECCE foreshadowing its ultimate application. Challeng- es confronting industry regarding manufacturing techniques and to surgeons regarding biometric IOL power calculation were deliberated. There were exhibitor-sponsored seminars. These were held on Satur- day, April 24, after the main festivi- ties ended. IOLAB Corporation's vice president of research and develop- ment reviewed "the submission data on the recently approved Shearing Planar Lenses 101, 101B, and 101T. The first posterior chamber lenses to receive pre-market approval." Step right up! On the exhibi- tion floor, there was an intoxicating mix of innovation, competition, and money. There were around 60 companies showcasing their wares. Palpable excitement emanated from those flaunting the latest intraocu- lar lens designs. Anterior chamber lenses competed for attention with newer posterior chamber lenses. There were implants that looked like Sputnik and so named, IOLs made of glass, one-size-fits-all lenses. Clothes Elegy to the Buccaneers J.C. Noreika, MD, MBA hangers were sacrificed to illustrate the importance of haptic design. Most of those companies—Cilco, Coburn, Iolab, ORC, Copeland, Intermedics, IOPTEX, McGhan Med- ical/3M, Surgidev—are unfamiliar to today's ophthalmologists. It was a carnival midway, a cacophony of people and sound, each company's booth a side-show hawking wares, touting advantag- es, stage-lighting its paladin whose name branded its implant. Some of these men—they were all men—at- tained iconic status, a few became fabulously wealthy, and others are lost to the sands of time. One or two even served time. To buttoned-down medicine, these were "buccaneers," swashbuckling surgeons pillaging for gold in them thar eyeballs at the expense of naïve innocents. In the end, they revolutionized cataract surgery and reformulated the very prospect of growing old gracefully. Side note: Buccaneer surgeons such as Alexandre Exquemelin (1645– 1707) contributed importantly to the historical record of New World seafaring if not medical progress. I trust critics of the IOL did not know this. I doubt if ophthalmology will witness another epoch of compara- ble energy, unbridled chutzpah, and raw rivalry. Like people, professions and their organizations mature, be- come circumspect and risk-averse. The ASCRS meeting still retains some of that audacious spirit. That's why I keep returning. Surely, this year's production will provoke and surprise. Thousands of attendees will hang on the words of wizards, be entertained by world-class speakers, and covet the latest technology. Yet, 1982 will be the standard against which I measure all conventions. Selective memory? Certainly. But I defer to the Bard: "Praising what is lost makes the remembrance dear." It was a helluva ride. EW Editors' note: Dr. Noreika has prac- ticed ophthalmology since 1981. He has been a member of ASCRS for more than 35 years. Dr. Noreika would like to thank Pattye Whitmer at ASCRS for her resourcefulness in finding the 1982 program. Contact information Noreika: JCNMD@aol.com Source: ASCRS

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