Eyeworld

Reporting from the 2017 ASCRS•ASOA Symposium & Congress, May 5–9, 2017, Los Angeles EW MEETING REPORTER 86 June 2017 Sponsored by into the National Inventors Hall of Fame, and received the Albert Lasker Award for Clinical Research, along with recognition from various medi- cal organizations. In addition to this procedure impacting all of ophthalmology, Dr. Dodick said Dr. Kelman's work has made him the grandfather of all small incision surgery in the human body. Editors' note: The physicians have no financial interests related to their comments. Case-based presentations on decision-making in corneal transplantation A symposium sponsored by the Cornea Society focused on decision- making in corneal transplantation, with case-based presentations. To kick off the session, Francis Price, MD, Indianapolis, discussed managing corneal edema with mod- erate Fuchs' dystrophy in a 50-year- old patient. When making decisions, you have to consider patient symptoms, potential surgery, and objective find- ings on the exam, Dr. Price said. The treatment choices have evolved over the years as to when to graft with Fuchs' dystrophy. What you do depends on your options, Dr. Price said. Options will phaco unit. Reception to the new tech- nique was critical, however, and it wouldn't be until the 1980s that phacoemulsification established itself as the new gold standard for cataract surgery. Dr. Dodick said he thinks the turning of this tide came with the advent of the "Mazzocco taco" for foldable IOLs. Stephen Obstbaum, MD, New York, said he thinks the drive toward phaco was gradual. "Once [physicians] adopted ex- tracapsular cataract surgery, moving from manual I/A to machine I/A, they recognized they could work inside the eye … and the machines were getting better," Dr. Obstbaum said. "I think that combined with the small incision IOL is what pro- pelled us." Richard Lindstrom, MD, Min- neapolis, said he thinks some of the adoption was patient driven. The panelists reflecting on phaco's past also spoke about how ASCRS has been integral over the years for the sharing of ophthalmic ideas. "IOL implantation and phaco went hand-in-hand in terms of our educational efforts at ASCRS," Dr. Obstbaum said. Though the reception of phaco was not immediately all positive, Dr. Kelman was later awarded the National Medal of Technology by George H.W. Bush, was inducted Phaco's 50th takes the stage at Sunday Summit The second half of the Sunday Summit after the ASCRS Lecture on Science, Medicine and Technology honored the 50th anniversary of the first phacoemulsification on a human patient by Charles Kelman, MD. In 1967, the preferred cataract surgery technique was intracapsular cataract extraction with loops, a large incision, and a lengthy recov- ery, said Edward Holland, MD, Cincinnati. "Charlie knew there had to be a better way," Dr. Holland added. Al- though it would take multiple failed attempts to figure out how to break the lens and remove it through a small incision, a trip to the dentist's office gave Dr. Kelman the idea for phacoemulsification cataract sur- gery. Even after the first phaco, there was considerable pushback and slow adoption, Dr. Holland said. The Sunday Summit honored phaco with a video on the history of the technique and its legacy, and included a discussion among some of the early phacoemulsification pioneers and presentations of tech- nologies that could propel cataract surgery in the future. It's well-known in the ophthal- mic community that Dr. Kelman, who had been researching alterna- tive methods for cataract surgery to reduce incision size and improve recovery, got the idea for using ul- trasound to emulsify the cloudy lens while getting his teeth cleaned by a dentist who used an ultrasonic tool. By 1967, in secrecy, Dr. Kelman performed the first phacoemulsifica- tion on a consenting patient's eye, which was already destined for enu- cleation, at Manhattan Eye, Ear, and Throat Hospital. Jack Dodick, MD, New York, recalled being at the hos- pital that day, seeing warning signs on the locked OR door and a shade drawn over the observation window. "I never got into the room, but I was there," Dr. Dodick said. The phaco portion of the procedure took more than an hour and the results were not ideal, but Dr. Kelman returned to his lab and a couple of years later came out with the Kelman-Cavitron View videos from ASCRS•ASOA Los Angeles: EWrePlay.org Douglas Koch, MD, discusses IOL calculation issues in the context of corneal ectasia and in post-keratoplasty eyes.

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