Eyeworld

81 July 2017 EW MEETING REPORTER "Many of the problems I was facing were public health issues ... things individual doctors couldn't make that much of a difference in," Dr. Tabin said. Edmund Hillary, one of the first two confirmed people to reach the top of Everest, was a hero of Dr. Tabin's not only for his climbing fame, but because of how he gave back to the people of Nepal. "As a doctor, I wanted to do some- thing to give back." The village Dr. Tabin was work- ing in at the time had public health issues like a lack of clean water and vaccinations. "Then, I saw the mira- cle of cataract surgery," he said. This was a culture where it was accepted that when you get old your hair turns white, your eyes turn white, then you die, he said. Then a Dutch team came in to perform cataract surgery, and Dr. Tabin said people "blossomed back to life." Dr. Tabin called his old profes- sor, Dr. Weidman, who had previ- ously tried to convince him to enter ophthalmology. Dr. Weidman told Dr. Tabin there was an opening for an ophthalmology residency at Brown University. "If I hadn't had that research on Everest, I probably wouldn't have gotten this competitive position," Dr. Tabin said. Dr. Tabin held a cornea and ex- ternal disease fellowship in Australia and later joined Sanduk Ruit, MD, Weidman, MD, said Dr. Tabin was an idiot because there was no way Harvard would give him a leave of absence to climb a mountain. It would, however, he learned from Dr. Weidman, give him credit if he was doing research. That's when Dr. Weidman signed Dr. Tabin on to do research on high altitude reti- nopathy. Dr. Tabin took photos of all team members' retinas before, during, and after their 1983 climb. Dr. Tabin said that 19 of the 34 team members developed retinal hemor- rhages, and there were cases of high altitude cerebral edema. Dr. Tabin was the youngest per- son on the team, which he said was the first ascent of Everest without native support and included tech- nical climbing not done on Mount Everest before. "The route has never been re- peated," Dr. Tabin said. Five years later, Dr. Tabin had the opportunity to climb Everest again with a team that was accom- panying the first American woman to make the climb. This 1988 ascent was much easier with native sup- port, which meant he and the other climbers could focus on just that— climbing—which Dr. Tabin said was wonderful. He recalled reaching the highest place on Earth just after 8:00 a.m. He was alone at the peak for 40 minutes. There he thought about what he was doing with his medical career. opacity, with large pterygium, with significant conjunctival chalasis, in uncooperative or fearful patients, and if there is a cost concern, Dr. Chee said. Special lecturer describes journey climbing Mount Everest and its impact on his career in ophthalmology An unexpected phone call and climb to the peak of Mount Everest —29,028 feet above sea level—on a never-before-traversed, still-unre- peated route up the east side of the mountain led Geoffrey Tabin, MD, into ophthalmology. In the APACRS Special Lecture, "Mountains, the Eye, and Me," Dr. Tabin described his experience with climbing and how it influenced his personal journey into ophthalmol- ogy. Dr. Tabin is the fourth person in the world to ascend to the tallest peak on all seven continents. He is co-founder of the Himalayan Cataract Project, professor of oph- thalmology and visual sciences, and director of the division of interna- tional ophthalmology, John A. Mo- ran Eye Center, University of Utah, Salt Lake City. Dr. Tabin started climbing as a teenager. Eventually, he started do- ing ice climbs on frozen waterfalls. Though he never thought at the time about climbing a summit like Everest, this was his training ground for that and another daring ascents. A scholarship after college took Dr. Tabin to Europe where he had the opportunity to expand his climbing horizons. He wrote a few articles in climbing journals and gave lectures at climbing organizations. After he had started at Harvard Medical School, Dr. Tabin was of- fered a fully funded trip by National Geographic and ABC Sports to climb the east side of Everest, something that hadn't been attempted since George Leigh Mallory and Andrew Irvine disappeared in their attempt up the northeast side in 1921. Dr. Tabin applied for a leave of absence from Harvard to do the climb. "I received a phone call from a guy that changed my life," Dr. Tabin recalled. The caller, Michael For example, brunescent cata- racts require increased phaco time, Dr. Chee said, and patients are at a higher risk for thermal and me- chanical injury to the cornea and corneal edema. Intumescent cata- racts are another challenging case. High intralenticular pressure due to liquefaction of the cortex causes the Argentinian flag sign, she said. Using femto enables the surgeon to create a circular capsulotomy of optimal size. Posterior polar cataracts and severely subluxated cataracts were other types of challenging cases that Dr. Chee discussed. Not all eyes can be handled with the femtosecond laser, and there are some contraindications. Dr. Chee discussed evidence of specific eye features, facial features, and body structure that may be contraindica- tions. Eye features include previous glaucoma or corneal surgery, severe corneal scars, and severely displaced lenses. Facial features that are con- traindications include deep-set eyes, prominent nose, and prominent eyebrows. Contraindications relating to body structure could include obesity, skeletal anomalies like a pronounced kyphosis, tremor, or restless legs syndrome. New indications for femto may include for posterior capsulotomy to prevent PCO, for rescue capsulot- omy (to enlarge a markedly smaller capsulotomy or treat capsular phi- mosis), and for an IOL that is fixated to the capsular bag rim. One main issue, she said, is the cost. Studies have shown that issues relate to location, logistics, and scheduling; a longer time for the procedure; and the cost of the patient interface. For standard cases, the visual outcomes are not different between traditional phaco and femto, Dr. Chee said. Ultimately it is surgeon preference and conviction. Femto can be used with low endothelial cell count, in capsular fibrosis, for big eyes, with a thick hard nucleus, for a shallow anterior chamber, for subluxated lenses, and to create arcuate incisions. Avoid femto in eyes that are difficult to dock, in advanced glaucoma, with small pupils, with significant corneal View videos from APACRS 2017 EWrePlay.org Abhay Vasavada, MD, discusses the management of malpositioned IOLs. continued on page 82

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