Monday, October 13, 2008

Unity brings progress in society and ophthalmology

Letter from Berlin

by Howard Larkin

In a 1991 afterward to his classic history The Germans, Stanford University scholar Gordon A Craig wrote, “there is every indication that the united Germany will be the strongest pillar” of a strengthened European community. One has only to walk the streets of Berlin – or listen in on a few ESCRS scientific symposia – to grasp the prescience of this assessment. Indeed, evidence of the benefits Germany has reaped from reunification, and its contributions to the world as a result, are evident throughout this city of 3.4 million people.

In Potsdamer Platz, €4bn worth of sleek buildings have sprung up where nothing existed but a barren strip of no-man’s land divided by the Berlin Wall during the Cold War. Recent developments include the Arkaden, one of Europe’s largest shopping centres, and the modern architectural landmark Sony Center, as well as the Daimler Benz complex and several luxury hotels. While the impact of Sony’s and Daimler’s recent sales of their Berlin properties remains to be seen, these developments have restored the area to its former position as one of Europe’s most vibrant commercial and entertainment zones.

Other commercial areas throughout the eastern part of the city also have been rejuvenated, including Hackescher Market, which has become a thriving artistic and cultural centre, and the area around the New Synagogue. In the west, all it takes is a look down the TauentzienStrasse, another of Berlin’s most prosperous commercial districts, toward the ruin of the Kaiser Wilhelm church’s bell tower, preserved as a war memorial, to see how far Berlin has come in a few short decades. Major construction continues across the city, a testament to the power of what an open society can accomplish.

In his opening speech to the XXVI Congress of the European Society of Cataract and Refractive Surgeons at the International Congress Centrum here, ESCRS President Paul Rosen, FRCOphth, acknowledged the ongoing contributions of German ophthalmologists to the ESCRS. “In 2003 the Congress was held in Munich. We are delighted to return to Germany five years later to the vibrant city of Berlin.”

As befitting its location as the traditional crossroads of east and west, the Berlin Congress produced plenty of the healthy debate that has strengthened the field of ophthalmic surgery so much over the past few decades. As at past ESCRS meetings, ophthalmologists aired differing views on a number of issues – like increasing the use of topical anaesthetics and using toric lenses to control more-severe astigmatism. That debate also touched more raging controversies, such as the impact of blue-blocking IOLs on patients and the use of intracameral antibiotics in cataract surgery.

In the true spirit of respectful listening and learning that is the hallmark of open societies, some progress was evident. For example, surgeons on both sides of the intracameral antibiotic injection controversy agreed that introduction of a single-use, unit dose of cefuroxime would go a long way toward overcoming objections to the procedure, particularly in the US. The role of keeping the eye surface clean and treating prophylactically with antibiotic eye drops, and even going back to suturing cataract incisions to prevent the influx of infectious agents after surgery were also put forward by presenters from Japan and Mexico.

Also on display were several examples of the technical and business innovations produced by the open business environment, technical traditions, and entrepreneurial spirit of Germany. Among the innovators is Carl Zeiss Meditec. Based in Jena in the former East Germany, the firm recently sold its 10,000th optical coherence tomography diagnostic system. This same company that invented the IOLMaster and recently released a surgical microscope that offers higher contrast and better depth perception for better visualisation of delicate ocular tissues during surgery. The firm also recently acquired Acri.Tec, manufacturer of advanced intraocular lenses in a suburb of Berlin. “In every product we offer we want to fulfil our brand promise,” said Michael Kaschke, Zeiss’ new CEO. “We want to be known for superior technology and optics precision.”

Not to be outdone, WaveLight, the German manufacturer of excimer lasers and other ophthalmic devices acquired last year by Alcon, released a new biometry device known as the Allegro Biograph. It uses optical low coherence reflectometry to precisely measure axial length and anterior chamber measurements in a few seconds without touching the eye. WaveLight lasers continued to expand their market share in Europe while expanding in a US market still overwhelmingly dominated by AMO’s VISX.

On another business front, Schwind eye-tech-solutions of Kleinostheim, Germany, and Ziemer Ophthalmic Systems of Port, Switzerland, announced an alliance to market Schwind’s advanced Amaris excimer laser and Ziemer’s Femto LDV systems as an integrated package to refractive surgeons looking for an all-laser LASIK solution. “With the combination of these two state-of-the-art lasers, a new level of quality of LASIK surgery has been achieved,” said Rolf Schwind, Schwind’s CEO. Both companies will continue to offer their products separately as well. The alliance is a response in part to the integrated all-laser approach now heavily marketed by AMO.

Intriguing as these technical debates, innovations, market manoeuvres and geopolitics may be, perhaps the real value of it all was best expressed by Nigel Morlet, MD, of Royal Perth Hospital in Western Australia. He presented a retrospective of cataract surgery outcomes from 1980 to 2001 in Western Australia that showed a 67 per cent decrease in major complications including endophthalmitis, lens displacements, pseudophakic bullous keratopathy, and retinal detachments that required a second operation.

Dr Morlet chalked up the progress to technical innovations, most especially the introduction of phacoemulsification. “We all should be proud of this because attending meetings like this is where we learn how to do things better and then go home and try to do the best for our patients, and this is reflected in these numbers. The surgery we do today is not just our own capabilities, but the capabilities of our colleagues who teach us new approaches and techniques.”

Such are the multiple benefits of opening the doors between east and west.

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