SOE Charamis Medal winner Dr Richard Collin discusses new frontiers in oculoplastic surgery

Nothing is impossible.

This was the keynote message from Dr Richard Collin, after he was awarded the Charamis Medal by SOE president Gabriel van Rij (see picture above) at the opening ceremony of the 17th Congress of the European Society of Ophthalmology in Amsterdam, The Netherlands.

Dr Collin's theme was the Past, Present and Future of Oculoplastic Surgery. As Dr Collin pointed out Oculoplastic Surgery is as old as civilisation itself.

"Why can I make that claim?" asked Dr Collin. "Oculoplastic Surgery is tied in with trachoma which has been the blinding scourge of civilisation since civilisation has existed."

The knowledge of the early pioneers has been passed on over the centuries and now the future of oculoplastic surgery may be reshaped by a new educational paradigm that will deliver care into areas of the world where the procedures are most needed, said Dr Collin.

Dr Collin, head of the adnexal service, Moorfields Eye Hospital, London, UK suggested that by adapting Internet-based teaching methods, it might be possible to remotely train operators to perform bilamellar tarsal rotation, the currently favoured, evidence-based procedure for surgical intervention. The operators, who may not even need to be doctors, will be taught, assessed, and monitored by world experts on the faculty at leading teaching institutions, said Dr Collin.

In addition to using Internet-based learning tools, the educational experience would involve practice using surgical simulators that are designed first to identify areas of competency and deficiency based on assessment of the operator’s hand movements and then to suggest necessary corrective measures.

“With trachoma we have learned to control the disease process with hygiene and azithromycin, and we can cure cicatricial entropion surgically, but that still requires a suitably trained operator,” said Dr Collin.

“Thanks to the help of congresses such as the SOE and collaboration with the ICO, we are trying to bring this type of Internet-based learning to improve the standard of surgery delivered away from the major institutions,” said Dr Collin.

In his look to the future, Dr Collin also suggested that with effective treatments to control primary disease processes, the need for reconstructive oculoplastic surgery in the management of some conditions may even be eliminated. Progress in this area is already being made.

For example, there are positive reports regarding medical treatment with the topical immune response modifier imiquimod for lentigo maligna, and understanding of the genetic basis of basal cell naevoid syndrome has led to the exciting possibility of halting tumour development based on targeting the PTCH gene.

In addition, early intervention with immunosuppressive therapy can sometimes prevent the need for orbital decompression in patients with thyroid disease-related orbitopathy, said Dr Collin.

SOE embraces diversity and development

Diversity and development.

These were two of the key themes highlighted by Gabriel van Rij at the opening ceremony of the 17th Congress of the European Society of Ophthalmology (SOE) in Amsterdam, the Netherlands.

These are challenging times for ophthalmology and ophthalmologists but Dr van Rij is optimistic about the future of the profession.

In his keynote address to delegates, he said the aims of the society were to promote ophthalmology, stimulate cooperation between ophthalmologists and the national organisations, and above all, to provide the best possible treatments for patients.

Dr van Rij acknowledged that the diversity between European countries with respect to language, resident training systems, and medical care systems creates some challenges. However, the SOE remains focused on its goals, he said.

“The meeting is very important for us and we are very glad you came. The programme is excellent because many subspecialty societies are helping us, and the sponsors are very important as well or there would not be meetings like this,” said Dr van Rij.

The need for co-operation among national organisations was echoed by Dr Saskia Imhof, president of the Dutch Ophthalmological Society and by Dr Michael Brennan, president of the American Association of Ophthalmology.

“We are convinced, in the context of European unification crossing borders of medical services, the SOE can contribute to a high standard of ophthalmological care and scientific development,” said Dr Imhof.

Dr Brennan extending greetings from the American society’s membership and Board of Trustees acknowledging that modern ophthalmology has its roots in Europe and congratulated the SOE for its educational programmes, especially those focusing on engaging young physicians and women, as well as for its efforts toward fostering the continued exploration of new passageways in science and technology.

Next year the international community of ophthalmologists will gather in Berlin, Germany. Gerhard Lang, MD incoming president of World Ophthalmology Congress (WOC) 2010, extended an invitation to SOE delegates to attend the upcoming meeting, which is being held in Berlin between June 5-9, 2010.

“There is no better place than the WOC to focus on the current state and future of our profession,” said Dr Lang.

EuroTimes breaking the latest news from SOE

The EuroTimes team is in Amsterdam, The Netherlands today where we are producing our daily newsletter, ET Today, and daily Breaking News online from the 17th Congress of the European Society of Ophthalmology (SOE).

The hot topics from the congress will be posted in the Breaking News section on our website www.eurotimes.org. Full reports on some of the most important presentations will be covered in the September and October issues of EuroTimes.

Win a travel bursary for the XXVII ESCRS Congress in Barcelona

The John Henahan Prize for 2009 was launched at the 13th ESCRS Winter Meeting in Rome. John was the visionary editor and guiding light of EuroTimes from 1996 to 2001 and his work has inspired a generation of young doctors and journalists, many of whom continue to work for EuroTimes.
Ophthalmologists who are members of the ESCRS and who are under 40 years of age are eligible to apply for the prize. Entrants are invited to write a 1,000-word article on the theme My Best Patient; My Worst Patient. The closing date for entries is Friday June 26, 2009.
Dr Emanuel Rosen, chairman ESCRS Publications Committee, Dr Jose Guell, medical editor, EuroTimes, Mr Sean Henahan, editor, EuroTimes, Robert Henahan, contributing editor, EuroTimes and Paul McGinn, editor, EuroTimes will judge the entries.
The winning entrant will receive a travel bursary worth E1, 000 to attend the XXVII ESCRS Congress in Barcelona, 2009 in September and the winner will be presented with a special trophy at the Young Ophthalmologists Programme in Barcelona. We will publish the winning entry in the October edition of EuroTimes.
Entries, which must be accompanied by an ESCRS membership number, should be sent to Colin Kerr, Executive Editor, and EuroTimes at colin.kerr@escrs.org. The decision of the judges is final and no correspondence will be considered once they have announced their decision.

•The winner of the John Henahan Prize for 2008 was Dr Shiu Ting Mak of Hong Kong. Dr Mak is pictured above receiving her prize from Dr Emanuel Rosen

EURETINA lecturer calls for new research initiatives

Professor Eberhart Zrenner MD, Director of the institute for ophthalmic research and the Centre for Ophthalmology and head of the neuro-ophthalmology unit in Tuebingen Germany and chairman of the European Vision Institute, presented his EURETINA lecture which sought to answer the question of whether Can We Overcome the Fragmented European Research Space in Ophthalmology?

Dr Zrenner noted that ophthalmologists have reached a defining moment in the history of their discipline not only because there are so many new possibilities for diagnosis and therapy offered by new discoveries in molecular and cell biology, but also because the world’s aging population means that there will be a greater number of people than ever before with sight-threatening diseases.

However, he said that the ability of ophthalmology to answer that growing problem is compromised by the fragmentary nature of ophthalmic research in Europe, and by the lack of awareness among healthcare policy makers of the contribution ophthalmic research can make, and of the dire consequences that will likely occur if that field of endeavour is neglected due to lack of funds.

He noted that a Carlos Von Bonhurst, a consultant for European Community in Brussels, has said that there is no other field in medicine that is more fragmented in Europe than Ophthalmology. In fact, there are more than 40 national and international ophthalmological associations in Europe. While those organisations are essential for the continuity of clinical research, what is lacking is an organisation to provide a single voice to defend the interests of ophthalmological research before the EU.

“The result of this plethora of ophthalmic societies is a low impact of ophthalmology in the making of research policies. We have a low visibility compared with other area, like neuroscience oncology or vascular sciences. There is a lack of structured proposals that will enable us to get enough money to form huge networks working together on European-wide trials,” Dr Zrenner said.

Another type of fragmentation that occurs in ophthalmic research is a lack of communication between those engaged in basic science inspired by clinical findings in ophthalmological practice and those engaged in clinical research.

“The challenge is really to improve our acceptance of vision research among the scientific community we are not just a little eye which may be a part of the brain we are more and we can make that point only if we speak with a loud voice and in a harmonized focused manner in order to avoid fragmentation. We have to avoid duplication of research with multiple small trials examining identical issues instead of one large trial. We also have to merge the two cultures of basic science on the one hand and clinical science on the other,” Dr Zrenner said.

To that end, Dr Zrenner and his associates have founded the European Vision Institute, an organization whose aim is to lobby for research funding for ophthalmology, establish study protocols, and foster collaboration between different research organizations. The fruits of their labour so far include EVI-Genoret and RETNET, projects investigating the genetic factors of retinal disease.

More recently they have obtained funding for and have established Eurovisionet which aims to provide a scientific integration of European vision research and have established an online portal to which all engaged in ophthalmic research can contribute.

“Yes, we can overcome the fragmented nature of ophthalmic research in Europe if we want to and we get together.

Presenting Dr Zrenner with his EURETINA lecture award, EURETINA co-founder and general secretary Gisbert Richard MD (see picture above with EURETINA president Jose Cunha Vaz)noted that the Clare Jung foundation that sponsored the award do so because they are convinced that the greatest success in fighting blindness will be found in the field of retina and optic nerve research.

EURETINA is getting bigger and better

In his opening speech at the opening ceremony of this year’s EURETINA Congress, the president of the European Society of Retina Specialists, Professor José Cunha-Vaz MD (pictured above with incoming president Bill Aylward) expressed his satisfaction with the growth of the society and the continuing improvement of the Congress from year to year.

“I am particularly pleased with the way our society has expanded and that it is offering participants what they want and we would like to continue going in that direction. Bill Aylward from the UK, who will assume the presidency next year, will certainly carry that work further with even better congresses,” he said.
He credited the Congress organisers Agenda with making the congress run more smoothly and efficiently. He noted that in a move to integrate the different fields of ophthalmology next year’s EURETINA meeting will be held in PARIS directly before and at the same venue as the Annual Congress of the European Society of Cataract and Refractive surgeons

“The fact that the largest subspecialty societies are coming together will be an impressive opportunity for the industry and for anterior and posterior segment surgeons to gain more exposure to each other’s disciplines.

He noted that the European Society of Retina Specialists has recently signed an agreement for Ophthalmologica, one of the oldest and most prestigious European scientific journals in ophthalmology to become the society’s official scientific journal. Starting in 2010 it will have Professor Cunha-Vaz as its editor in chief.
“This is something we can offer our members to allow us to express our scientific studies and somehow create a better, solid basis for our scientific development, he added.

There followed a Musical Interlude by young Portuguese pianist João Bettencourt da Câmara. Born in 1988, he has been performing piano recitals since the age of seven. During his first international tour to the USA in 2007 he received much enthusiastic critical acclaim, being compared to a young Sviatoslav Richter, widely acknowledged as the greatest classical pianist of the 20th century. For his first performance during the EURETINA opening ceremony he performed Schumann’s famous Etudes Symphonique, a piece which takes a simple theme into variations that range in mood and tempo from sombre to playful and concludes with a jubilant allegro brillante based on a new theme.

Aberrations provide important cues for accommodation

Natural accommodation is a dynamic process that is aided by aberrations that give the eye cues as to which direction to focus, Ioannis G Pallikaris MD, PhD told attendees of the innovator session at the 2009 ASCRS annual meeting held at the Moscone Centre (pictured above) in San Francisco, US.

“Aberrations are necessary to guide accommodation,” Dr Pallikaris said. The defocus images of lenses without aberrations are identical whether they are over or under corrected, where as they are different in a lens with aberrations, he explained. Astigmatic, higher order, spherical and chromatic aberrations all play a role.

In patients with presbyopia, accommodation is slower and less stable than in younger patients. This leads to fatigue in older patients and the image on the retina is rapidly and constantly changing, particularly in near vision. This constantly changes the refractive qualities and aberrations in the lens.

Presbyopic correction with multifocal or accommodative lenses is a static compromise that cannot duplicate this process, Dr Pallikaris noted. It results in acceptable distance and near visual acuity at the expense of vision quality. “Achieving super vision is not a goal,” he said. Ophthalmologists must use their understanding and judgement to make the lens choice that best meets patient needs.