EuroTimes

Strawberry Visual Fields Forever

2011-11-04T12:19:00.002Z

In the wake of the untimely death of Apple computer founder Steve Jobs, Dale K Heuer MD, chairman and professor of ophthalmology at the Medical College of Wisconsin, Milwaukee, US, reported on some of the firm’s contributions to medicine as well as a real breakthrough for ophthalmologists – the recent availability of classic Beatles songs on iTunes. Glaucoma specialists’ favorites include “Trabby Road,” “Strawberry Visual Fields Forever” and “Blue Eyes Yellow Submarine.”

Dr Heuer, speaking at the recent meeting of the American Academy of Ophthalmololgy in Orlando, Florida ended his tribute with a rendition of the immortal “Yesterday”:

Yesterday.

Loss of vision seemed so far away

Then I had trabeculecto-may

Oh, how I long for Yesterday.

Suddenly

My vision’s half of what it used to be

There’s a shadow hanging over me

Oh vision loss came suddenly.

Why I needed more flow

I don’t know

She wouldn’t ne say

My field had something wrong

Now I long for yesterday.

Yesterday

Faking drops was such an easy game to play

Now my vision has all gone away.

Oh how I long for yesterday

It's all about the data for ophthalmologists

2011-11-04T12:05:00.001Z

AAO is looking to national outcomes registries to defend the specialty from marauding insurance companies, politicians and optometrists.

“It’s all about the data,” AAO Executive Vice President and CEO David W Parke III MD told several thousand attendees of the opening session of this year’s annual meeting.

AAO has taken several steps to generate better information to document the complexity and value of care ophthalmologists provide. These include developing new ICD-9 diagnosis codes that more precisely describe ocular conditions, which were implemented by the Medicare program this year. Continued development of AAO’s Preferred Practice Patterns is also essential because they incorporate evidence-based care processes, said AAO President Richard L Abbott MD (pictured above)

“Using clinical practice guidelines is not the same as ‘cookbook medicine,” he said. Rather, guidelines, including the AAO PPPs, provide a general pattern of practice which physicians must apply to individual patients using their professional judgment, clinical intuition and unique training. He pointed to the AAO’s analysis of the impact second-eye cataract surgery on patients’ quality of life, which led to a favorable national coverage decision, as an example of how good data can demonstrate the quality and value of the services ophthalmologists provide.

Dr Parke noted that other specialties in the US, notably cardiovascular surgeons, have successfully used national registries not only to improve care but to advocate for adequate reimbursement for services. This is a key issue for both preserving payments in the national Medicare system for older Americans, but also in private insurance companies. Many already profile physicians based on claims data, which do not take into account issues such as the difficulty of treating patients with advanced disease, multiple co-morbidities and other complications. As a result, some insurers have unilaterally lowered ophthalmology payments to levels reflecting uncomplicated routine care. Some states have even expanded the scope of practice for optometrists to include surgical procedures for which they are not trained.

Capturing the true level of service provided by individual ophthalmologists and the specialty as whole requires a national ophthalmology database that covers all subspecialties AAO President-Elect Ruth Williams said. Through its Hoskins research center, AAO is developing a guidelines-based database in collaboration with other ophthalmology societies.

Dr Williams envisions that the database will be linked to electronic medical records in ophthalmologists’ offices. These systems will also allow the integration of independent ophthalmic practices with larger risk-bearing delivery systems promoted by the US health reform bill passed last year, as well as by private insurance firms.

Steve Jobs RIP

2011-10-06T15:52:00.009+01:00

To some ophthalmologists, the name Steve Jobs won't mean a lot. He died today aged 56 with pancreatic cancer.

So why should eye surgeons, or indeed any other health professionals, remember him?

Older ophthalmologists may find it hard to adapt to the new world order which has seen Apple's and Jobs's iPhones and iPads transform the way that we create and share information. But for young opthalmologists in training today, I would suspect that these products have become essential tools of their trade.

Recent research carried out by EuroTimes has shown that the majority of ophthalmologists still prefer to get the latest news on ophthalmology from the printed magazine. But there is a growing number of ophthalmologists who are looking to Apps or other applications, not only to share information, but also to help them in their day to day work.

Of course it should be pointed out that Steve Jobs alone wasn't responsible for this technological revolution, but he became a cheerleader for a new generation that wanted and continues to want to look at new ways of seeing, hearing and speaking.

The Apple website http://www.apple.com simply states: "Apple has lost a visionary and creative genius and the world has lost an amazing human being. "

Steve Jobs, rest in peace.

Vienna or Bust

2011-09-16T14:30:00.001+01:00

By Howard Larkin

Evidence of its imperial past, as well as the outsize personalities of its rulers, artists and warriors is never more than a short walk away in this eminently walk-able city of Vienna, site of the XXIX Congress of the ESCRS. There’s something for every interest. But watch out for horse-drawn fiacres on the narrow cobblestone lanes of the ancient city center.

Rising dramatically from the tunnel-like strasses of the city center is the Gothic cathedral Stephansdom. It’s hard to miss the gigantic Habsburg coat of arms emblazoned in green, white, red and black tiles on the roof. The foundations of this house of worship date back to the 12^th Century. Since then friezes, frescos, alcoves, alters, pulpits, sarcophagi, and entire naves and towers have been added by a succession of patrons.

Many commemorate triumphs over evil in scenes mirroring Christ’s triumph over death in the resurrection. The Pulpit of Johannes Capistrano outside features a cherubim-bedecked gilt sunburst glorifying the enraptured Franciscan warrior standing over a writhing Turk. Nearby, a pious couple kneel beneath the risen Christ astride writhing demons. Inside, the master designer Pilgram looks out over his work, tools in hand.

Marble portraits of Kaisers past, including Mathias, Maximilian, Leopold I and Karls II & IV, along with Marie Antoinette, look over the crowds at the Kunsthistorisches Museum. Oil portratins and allegorical paintings by Reubens, Cranach the Edler, Rembrandt and more line the walls. The triumph of good over evil resonates throughout, from the allegorical Theseus defeating a centaur to the mythical St. George slaying the dragon to the literal Judith with the head of Holoferens.

On the campus of the University of Vienna, the Pathologisch-Anatomisches Museum chronicles the history of medicine. Samples of tubercular organs, venereal diseases and some of the oldest hip prostheses are on display. Domiciled in the former home of the psychiatric ward of the General Hospital, the barred windows and thick stone walls give further testimony to how far medicine has advanced in the past century.

And there’s Mozart and Strauss and Harry Lime. Get out and see it. Just a short walk.

2011-09-09T16:14:00.000+01:00

There's eight days to go before the XXIX ESCRS Congress in Venice, Austria. Visit this blog for the latest news and views on this excitng event.

Ophthalmology - the next generation

2011-07-20T15:06:00.002+01:00

Helen Tynan, Head of Human Resources for Google Ireland spoke recently at a "Commmerce and Cornflakes" breakfast , organised by the National College of Ireland and sponsored by cereal manufacturers Kellogs.

Ms Tynan told attendees at the breakfast that Google as a company has its pluses and minuses but there were things that worked for them that could be transferred to other companies.

What she didn't say, but what is true, that there are things that work for Google that could also work for ophthalmologists, particularly in the way they run and manage their practices.

To get inside the mindsite of Gen Y workers she asked the audience to think of teenagers aged 16 and 17 and young adults in the early 20s.

“They don’t sit, they land, they sprawl. When you are talking to them they are texting at the same time or checking their Facebook status or surfing the net. When they’re watching TV they have their laptops and they’re surfing at the same time. ake that and think about trying to put those people into a workforce and getting the best out of that generation.”

Google, said Ms Tynan, is a young company entering its teenage years and has grown up with Gen Y and the majority of its employees and managers are Gen Y so they don’t have the same challenges of assimilating this new generation of employees as older more established companies. Google was not set up as a traditional company and was never intended to become one.

So how does this philosophy transfer to the Google workforce. A typical Google workplace would include laptops everywhere,foosball, pool tables, volleyball courts, assorted video games, pianos, ping pong tables, and gyms that offer yoga and dance classes. Healthy lunches and dinners are provided for all staff at a variety of cafés. and break rooms are packed with a variety of snacks and soft drinks to keep Googlers going.

http://www.google.com/about/corporate/company/culture.html

But, said Ms Tynan, it’s not just fun for fun’s sake, it’s fun because it works and it encourages people to collaborate, get together and share ideas.

“It’s not all about beanbags and foosbol tables They work and they work fantastically well in a culture that has evolved around them,” she said. “Our intellectual property is our employees and from the very beginning part of the culture of Google was to take care of employees and to reward them for innovation and creativity.”

One area of particular interest, she said, is that in Google employees are allowed to spend 20 per cent of their time working on projects outside of their core working task. This is usually Google related which encourages them to come up with ideas for new products or improvements in existing products.

Gmail was one of successful products to come out of this 20 per cent model.

Google spends a lot of its time on the hiring process and most employees will go through four or five interviews before they are recruited. They hire very bright people, said Ms Tynan, and provide them with an infrastructure to get the best out of them. “We don’t have a lot of formalities or policies. We try to let people get on with their jobs, improve their jobs and come up with new ideas. Every day we try to see what people are capable of and it’s amazing what people can do if you stay out of their way.”

So how can this translate to other companies? They should take risks with their employees and not become overreliant on policies and procedures. “Give employees freedom and give them trust and if it’s abused handle the cases individually . What we sometimes do in human resources is to legislate for five per cent of abuse rather than the 95 per cent of people who can be trusted.”

Good recruitment is also essential. “If you hold tough and hire the best people for your company and your culture you will reap the benefits of it,” said Ms Tynan. “This is not about academic brilliance, this is about someone who is going to demonstrate the values that are important to your culture and your team.” Even if you are desparate to fill a vacancy, she said, don’t hire someone who is not good enough and hold out for the best candidate for the job.

Openness is also important, she said, and staff should be briefed and consulted as often as possible and if they ask questions they are answered. “If you work for Google, you are trusted with information,” she said. “Confidential information is shared extensively internally.”

Focus on the future of ophthalmology in ancient Japan

2010-12-10T11:04:00.001Z

Sean Henahan has just returned from Kyoto where more than 500 cornea specialists from throughout Asia and beyond gathered for the 2nd Asia Cornea Society Biennial Scientific Meeting.

Japan's ancient capital, showing its best autumn colour, served as backdrop for the conference, the theme of which was An Enlightening Focus on the Future.

"For 40 years, not much was happening in cornea, there was PK and that was about it. But now it has become one of the most exciting fields in ophthalmology. We are seeing a major paradigm shift over the past few years. The rationale for creating the society was to provide opportunities for networking among the Asian countries and the international societies, and to allow for networking, education and research," Donald Tan MD, president of the Asia Cornea Society, told EuroTimes.

The meeting served as an occasion for the announcement of two major initiatives by the Asia Cornea Society. The first of these is the creation of Association of Eye Banks of Asia (AEBA). The concept of this programme is to create standards for the collection, preparation, storage and delivery of donor corneas throughout Asia. The first phase, now under way, involves revamping the Sri Lanka Eye Bank, historically one of the leading centres in Asia.

"Asia has the highest rate of corneal blindness in the world. So we are taking a problem solving approach to this. That is the rationale for the AEBA. The ultimate goal is to create high quality local eye banks that are able to procure local donors and make corneas available locally, and eventually to be able to export any excess tissue."

The second initiative announced at the conference was Asian Cornea Society Infectious Cornea disease Study (ACSICS). The one-year prospective observational study will involve 11 sites in eight countries. These will document the extent and impact of keratitis in the region. Researchers aim to learn more about risk factors, aetiology, regional characteristics, antibiotic resistance etc. This will ultimately allow for the creation of meaningful practice guidelines, Dr Tan said.

The four-day meeting served up everything from essential basic research to the latest therapeutic strategies for the full spectrum of corneal disease.

Cornea specialists were probably the first to use stem cells therapeutically, by way of cell transplantation for ocular surface reconstruction. There have been considerable advances in that field, with major contributions from Japanese investigators. Attendees heard about current efforts to use cell sheet transplantation. In addition to cultivated limbal epithelial transplantation, researchers are now using cultivated oral mucosal epithelial cells, autologous nasal mucosal cells, and even ear perichondrium cells for ocular surface reconstruction.

Keratoconus continues to be a bread and butter issue for cornea specialists. Joseph Colin MD, Bordeaux, France, presented the latest findings on treating the disease with Intacs, and collagen cross-linking, alone and in combination.

Contact lens related ocular infection also continues to be a problem. Prof John Dart of Moorfields Eye Hospital in London presented a large-scale epidemiological study of contact lens related keratitis. The largest study of its kind, it details differences in rates of Acanthamoeba keratitis, which is almost unheard of in continental Europe, but is an ongoing problem in England. More than 90 per cent of cases of contact lens related keratitis could be prevented with proper patient education and hygiene, he reported.

Conference delegates also got an update on corneal and lenticular refractive surgery. Hiroko Bissen-Miyajima MD, Tokyo, Japan discussed LASIK enhancement in patients who have received multifocal IOLs. She also presented information on new IOLs available for microincision cataract surgery.

The genetics of corneal dystrophies was another topic of interest, with considerable advances in screening for these disorders. Akira Murakami MD described early work using a hydrogel contact lens as a device for single gene transfer. He reported early success in animal work delivering a gene via a special contact lens a single gene disease. This approach also has broader potential for treatment of various corneal disorders, he noted.

Look for comprehensive coverage from the conference in upcoming issues of EuroTimes.

EuroTimes wins design award

2010-12-10T10:20:00.002Z

Paddy Dunne, senior designer, EuroTimes, has won the Designer of the Year (Business Magazines) award 2010.

The judges of the award presented by Magazines Ireland said they saw evidence of major design innovation and excellence with a refreshing new look for the magazine following its redesign earlier this year.

"I believe the rebranded issue of EuroTimes vastly improves on the previous template," said Paddy in his submission for the award.

"Reader feedback on our new look has been very positive. With every issue since June 2010, we strive to make further improvements giving our readers a much more satisfying reading experience. This rebrand has given our product a massive reinvigoration and it is for these reasons that I believe EuroTimes eligible for Best Designer in B2B."

After accepting his award Paddy also paid tribute to EuroTimes assistant designer Janice Robb who played a major factor in the 2010 redesign.

Colin Kerr, executive editor, EuroTimes, said that winning the award was a major recognition for the magazine.

"This was very much a team effort and I would also like to thank the editorial and marketing team at EuroTimes and our international Editorial Board headed by Dr Emanuel Rosen, chairman of the ESCRS Publications Committee," he said.

For more information visit http://www.ppa.ie

ESCRS symposium on emerging lenticular options at AAO/ISRS refractive subspecialty day

2010-10-22T10:08:00.000+01:00

Light-adjustable lenses that may be used to achieve emmetropia in post-LASIK cataract patients or increase binocular depth of field through selective manipulation of asphericity in mini-monovision were among the growing list of lenticular refractive options presented at the ESCRS symposium at the 2010 AAO annual meeting refractive subspecialty day sponsored by the International Society of Refractive surgery.

As in laser vision correction, a slight negative asphericity in the eye targeted for near in mini-monovision also has been shown to increase depth of field in pseudophakic patients, noted Jose Guell MD, Barcelona, Spain. “It can be a very useful tool for presbypoia improvement,” he said.

However, there are important limitations in applying it for IOLs, Dr Guell said. The tolerance for spherical aberration is limited to about 0.2 microns and achieving this level of precision can be difficult. For one, the degree of asphericity is related to the degree of residual astigmatism, so an accurate spherocylindrical correction is essential. The effects of lens decentration, tilt or rotation also affects asphericity and other higher order aberrations, and small lens movements could increase aberrations beyond the tolerable range.

Light-adjustable lens may be one way to address these issues, Dr Guell suggested. The power and asphericity of the lens can be adjusted after surgery. Laser corneal enhancements are another option and may be possible in conjunction with light-adjustable lenses, he added.

In a study presented by Roberto Bellucci MD, Verona, Italy, 20 eyes implanted with light-adjustable lenses were found to have higher levels of spherical aberration, resulting in their aberration-derived Strehl rations being similar to those seen in spherical monofocal lenses. He believes the increased asphericity, which averaged 0.118 +/- 0.044 microns for the eye, was most likely due to the reshaping of the lens with ultraviolet pulses after surgery. This resulted in a myopic shift of about 0.9 dioptre with an increase in pupil size from 4 mm to 6 mm.

However, and somewhat unexpectedly, the light-adjustable lenses did not result in higher levels of coma or other asymmetrical aberrations, Dr Bellucci noted. “From a clinical point of view all our patients were satisfied and reported good uncorrected vision. It can be postulated that the increased depth of focus involved with the high spherical aberration played an important role in this satisfaction.”

A study of 26 eyes implanted with the Crystalens HD accommodative IOL by Ioannis Pallikaris MD PHD, Crete, Greece, (pictured above with the other ESCRS presenters) found that the lenses produced a good range of vision even when implanted in the sulcus. Mean uncorrected distance vision improved from 0.41 +/- 0.21 to 0.70 +/- 0.19 on a decimal scale, and corrected vision improved from 0.66 to 0.87. At intermediate distances 80 per cent of patients achieved J1 and at near 70 per cent were J3 or better. The three patients with sulcus-implanted lenses also demonstrated accommodation, Prof Pallikaris said.

Joaquim Neto Murta MD, Coimba, Portugal, presented results on a new rotationally nonsymmetrical multifocal lens without Fresnel lines. The pupil independent lens has an aspheric asymmetrical distance zone combined with a sector near zone with a +3.0 add to minimize light loss and light sensations. The lenses provided adequate vision, were stable and provided good contrast sensitivity, he said.

Also presenting were Oliver Findl MD, Vienna, Austria, on add-on lenses to correct residual sphere and cylinder error and Beatrice Cochener MD, Brest, France on refinements in toric implantation. She emphasised the importance of meticulous technique, including removing all viscoelastic from the chamber, to help minimize lens rotation after surgery.

EuroTimes is on Facebook

2010-09-08T12:18:00.001+01:00

EuroTimes now has its own Facebook page. Make sure to visit us and let us know what you think of the paper.

ESCRS celebrates 20th anniversary of LASIK with new consumer website

2010-09-08T12:07:00.002+01:00

Marking the 20th anniversary of LASIK and the European Year of LASIK, the ESCRS has launched “LASIK Safe in Our Hands” (www.LASIKSafeinOurHands.com), a consumer-oriented website dedicated to getting out the facts about LASIK surgery. The website is the centrepiece of a new campaign to address through education lingering concerns about the procedure held by many who have not had LASIK.

European patients who have experienced the benefits of LASIK surgery are nearly unanimous in their enthusiasm for the procedure. A staggering 98 per cent confirmed they would recommend it to someone else, according to an international survey conducted this spring by the well-known Opinion Health poll.

Even so, four out of five respondents who had not had LASIK still had concerns – even though 69 per cent agreed that eye surgery is a safe and well-established procedure. Of those expressing reservations, the greatest number, 30 per cent, said they needed more information. Another 24 per cent didn’t think they could afford it. Potential side effects were the major worry of 17 per cent while 11 per cent said they would not consider the procedure.

“LASIK can be a life-changing procedure, but these survey results show that people do not understand just how safe and effective modern LASIK is in the hands of a well-qualified and experienced laser surgeon. We hope that our new campaign will help bridge the information gap so that more people might benefit from good vision without glasses or contact lenses,” said ESCRS president Jose Guell MD, Barcelona.

Dr Leigh Speilberg wins EuroTimes writing prize for young ophthalmologists

2010-09-06T13:07:00.002+01:00

The winner of the 2010 John Henahan Prize is Dr Leigh Spielberg. The writing prize for young ophthalmologists is sponsored by EuroTimes on a specially chosen theme. This year’s theme was “The Outstanding Memory of My Residency.”

Dr Emanuel Rosen, the chairman of the judging panel, presented Dr Spielberg with his prize during the Young Ophthalmologists’ Forum. He said that the standard of entries had been very high, but in the end there could be only one winner.

“A physician colleague once commenting upon the importance of taking a detailed history observed that this aspect of medical management was an equally important principle in ophthalmology as in medicine in general,” said Dr Rosen. “He then went on to comment on an ophthalmologist colleague who achieved this end by asking of a patient ‘which eye?’

“Dr Spielberg’s account of his outstanding memory of his residency confirms that not only does he write very well and maintain the readers’ interest throughout his essay, but that as a budding ophthalmologist he shares empathy with his patient. He was meticulous in his documentation of the particular disorder and managed personal follow-up of his patient, an action not always possible in a busy ophthalmic department where care is shared amongst colleagues.

“Dr Spielberg is correct in recognising that ophthalmology is not only the medicine of the organ of sight but is dependent more than most medical specialties on diagnosis being mainly dependent on visual observations notwithstanding his recognition of the value of historical detail,” he said.

Dr Rosen also thanked the other members of the judging panel: Jose Güell, president of the ESCRS; Oliver Findl, chairman of ESCRS Young Ophthalmologists’ Forum; Sean Henahan, editor of EuroTimes; Paul McGinn, editor of EuroTimes and Robert Henahan, contributing editor of EuroTimes.

Dr Spielberg is an ophthalmology resident at the Rotterdam Eye Hospital in the Netherlands. Originally from Long Island, New York, Dr Spielberg studied medieval and ancient history at Yale University before completing his medical studies in Belgium. After medical school, he conducted two years of vitreo-retinal imaging and therapy research in the departments of ophthalmology in the Leuven University Hospital and New York Eye & Ear Infirmary. His interests include travel, photography, alpine skiing and medical writing.

“Participating in the EuroTimes John Henahan essay competition gave me the opportunity to write about the medical profession and the doctor-patient relationship in a freestyle manner for a select readership of ophthalmologists. I am very honoured to have been selected for this year’s prize,” he said after receiving his award. Dr Spielberg’s prizewinning essay will be printed in the October edition of EuroTimes.

ESCRS president Jose Guell highlights spirit of collaboration at Opening Ceremony

2010-09-06T13:01:00.002+01:00

Welcoming delegates to Paris at the official Opening Ceremony of the XXVIII Congress of the European Society of Cataract and Refractive Surgeons (ESCRS), Jose Guell, president of the ESCRS, said that the success of this year’s meeting looks set to mark a new stage in the evolution of the society.

“On behalf of the ESCRS, I would like to say how pleased we are to be holding the first ever joint meeting of our own Congress alongside that of the European Society of Retina Specialists (EURETINA). Although both organisations have their own significant programmes, several joint symposia have been organised, emphasising the spirit of collaboration and cooperation between our two organisations for the benefit of all our members,” he said.

Dr Guell noted that joint meetings such as this year’s ESCRS/EURETINA one offers delegates a compelling proposition in difficult economic times and with an increasingly crowded ophthalmic calendar.

“At a time when we all have to choose carefully which congresses to attend, this model of offering delegates two complementary meetings seems very valuable, with almost 6,000 delegates registered for the ESCRS and around 2,800 for EURETINA this year,” he said.

Building on the success of this year’s joint meeting, Dr Guell informed delegates that next year’s ESCRS Congress in Vienna will take place in conjunction with the second EUCORNEA meeting.

“I hope that this collaboration of two subspeciality organisations that have such close links will also prove beneficial for our members and delegates,” he said.

At the Opening Ceremony Dr Guell presented the Ridley Medal to Dr David Spalton (see picture). Dr Guell also announced that the ESCRS Board had unanimously decided to elect Dr Peter Barry from Ireland as the next President of the Society, taking office at the beginning of 2012.

Japanese doctor wins ESCRS Video competition for ophthalmologists

2010-09-06T13:00:00.002+01:00

Dr Junsuke Akura, Japan, was presented with the Overall Prize in the Annual ESCRS Video Competition from Dr Jose Guell. There were 120 entries for the competion and the judges chose Dr Akura’s video on “Advanced KITARO WetLab –Development of High Quality Artificial Lens for Phaco Surgery Training" as the outstanding entry.

Paris welcomes delegates to the 10th EURETINA Congress and XXVIII ESCRS Congress

2010-09-02T14:07:00.002+01:00

Thousands of delegates have arrived in Paris, France, for the 10th EURETINA Congress and XXVIII ESCRS Congress.

In a special guest editorial in September's EuroTimes Béatrice Cochener MD, president of the French Society of Ophthalmology (Société Française d’Ophtalmologie – SFO) welcomed delegates to both meetings.

"Outstanding scientific programmes are planned, with numerous lectures, presentations, courses, posters and videos. Leading experts of these two sub-specialities (or “hyper”-specialities), will present the latest scientific knowledge in research and state-of-the-art of ophthalmology,” she said.

“This 'ecumenical' pursuit towards reliable standards of treatment in medical science, the importation of knowledge and skills through modern methods and the rational policy in affording care services, is an important point that ophthalmologists of different expertise are striving for,” said Prof Cochener.

EuroTimes is offering delegates a bumper 6o-page issue of Europe’s leading ophthalmology magazine. Eight thousand copies of the issue will be inserted in delegates' bags at the conferences.

Berlin celebrates WOC ® 2010 in spectacular style

2010-06-06T16:18:00.000+01:00

DRAWING inspiration from the past, present and future of ophthalmology, delegates from all over the world gathered yesterday for the spectacular Opening Ceremony of the World Ophthalmology Congress® (WOC®) 2010.

Over the course of five days, Berlin, the celebrated capital of Germany, is set to provide the perfect backdrop for the WOC 2010, sponsored by the International Council of Ophthalmology (ICO) and organised in conjunction with the German Society of Ophthalmology (DOG) and the German Academy of Ophthalmology (AAD).

Welcoming delegates in his role as WOC® 2010 president, Prof Gerhard K Lang said that he was honoured and delighted that the prestigious WOC® 2010 was taking place in Berlin.

“It is wonderful and rewarding to see so many ophthalmologists from all over the world make their way to Berlin for WOC® 2010. May I take this as an expression of your sympathy to share the different challenges we are all facing as ophthalmolgists. For instance, in some countries, one single ophthalmologist covers the eye care of a million or more people with more or less adequate equipment,” he said.

Dr Lang said that whatever the difficulties faced by the ophthalmological profession in the future, those involved in eye care should never forget that a major source of strength and inspiration lies in the common bond that united all ophthalmologists.

“Among the eye doctors present at this meeting and coming from over 140 countries, there are many of us practising with different methods, on different levels with different equipment and with different training. However, although there may be many challenges in the life and work of ophthalmologists around the world, there is one thing that we should always keep in mind and that is the wonderful profession of ophthalmology and its community which always brings us together,” he said.

Bruce E Spivey MD, current president of the ICO, also welcomed delegates to Berlin for what he said should prove to be the most stimulating and rewarding WOC Congress to date.

“It is an honour to be here with you in Berlin, a truly international city of history, sophistication, beauty and charm. Berlin provides all the scientific and social sustenance to this 32nd International Congress of Ophthalmology meeting, the World Ophthalmology Congress® of 2010. This congress promises to be a marvellous experience for us all,” he said.

Dr Spivey paid special tribute to the individuals who had put together a first-class Scientific Program for the WOC® 2010.

“The world is shrinking and ophthalmology is an international family that brings us together closer than ever before. On behalf of the over 150,000 ophthalmologists in the world, I want to congratulate Dr Stephen Ryan and Dr Gabriele E. Lang on the excellent Scientific Program they have developed for this meeting. We owe them both a debt of gratitude for their work,” he said.

Dr Spivey also reminded delegates of the ophthalmologists’ noble goal to reduce the burden of blindness worldwide and called for greater solidarity in delivering eye care to those areas in the world where it was needed most.

During the Opening Ceremony, several prestigious international awards, including the International Duke Elder Medal, Gonin Medal, Jules Francois Golden Medal, Bernardo Streiff Gold Medal and the Naumann Award were presented to Mohammad Daud Khan MD, Alan Bird MD, Gisele Soubrane MD, Gullapalli N Rao MD and Ursula Schlötzer-Schrehardt MD respectively for their services to ophthalmology.

Delegates were also treated to some stunning high-definition video sequences of the eye compiled by Karl Brasse MD and the team at Eyeland Design. A fulsome tribute was also paid to Albrecht von Graefe, pioneer of the ophthalmoscope and perhaps the most celebrated German ophthalmologist of the 19th century.

Award winning film director premieres Going Blind in Berlin

2010-06-05T12:19:00.001+01:00

GOING BLIND is a new documentary by New York based Peabody Award-winning director and vision advocate Joseph Lovett. Joseph Lovett has lost considerable vision from glaucoma. and he has decided to premiere his film at WOC®2010 .

Filmmaker Joe Lovett and producer Logan Schmid will be present at the screening, which is being held at 4pm on Tuesday, June 8 in the Stockholm Room.

GOING BLIND is paving the way for an international national grass roots campaign aimed at preventing blindness by treating eye diseases effectively, educating the general public on how to learn to adapt to various forms of vision loss and illustrating the effectiveness of low vision therapy. The World Ophthalmology Congress is the longest continuous international medical meeting, which consists of the top speakers and experts in the field of eye-care.

The film follows Joe through five years of struggle to save his remaining vision. During that time he seeks out people who have already lost their vision from diseases like art teacher Jessica Jones (Diabetic Retinopathy), architect Peter D’Elia (Age-related Macular Degeneration), Seeing Eye Outreach Coordinator Ray Kornman (Retinitis Pigmentosa), Veterans Administration worker Patricia Williams (Glaucoma and Traumatic Injury), 11 year old Emmet Teran (Strabismus) and Iraq War Veteran Steve Baskis (Road-side bomb attack).

“GOING BLIND is an essential first step in taking action to preserve the gift of sight and address one of the prevailing health issues affecting millions of people worldwide,“ said Lovett. “We are pleased by all of the interest the film has received thus far, particularly by our inclusion in The World Ophthalmology Congress,” he added.

The World Premiere in Berlin will be followed later this month by an exclusive screening at Harvard Medical School and the Massachusetts Eye and Ear Infirmary Vision Rehabilitation Center in Boston, Massachusetts, with leading eye-care professionals. GOING BLIND will then platform into additional local communities across the United States with the support of various vision advocacy leaders and organizations, culminating in the celebration of World Sight Day on October 14.

GOING BLIND draws attention to the importance of sight loss and low vision therapy issues by seeking to raise awareness through several platforms, including the development of an online education tool kit, sponsored panels hosted by prominent vision leaders, and much more.

Major supporters of the film to date include: The National Eye Institute (USA), Readers Digest Partners for Sight Foundation, Pfizer Ophthalmics, The Allergan Foundation, Allene Reuss Memorial Trust, and The Gibney Family Foundation.

For more information or interviews, visit: www.goingblindmovie.com

Art Auction at WOC® 2010

2010-06-05T11:43:00.003+01:00

Delegates attending WOC® 2010 have the opportunity to purchase modern works centered on the theme of “Art in the Art of Healing”. In the works of art donated by Georg Thieme Verlag, renowned contemporary artists have dealt with the fascination of the human body, and also its fragility and limitations. This has resulted in the creation of impressive works of art, which are available for purchase as hand-signed, numbered serigraphs (limited edition of 250).

Founded in 2008 by the German Society of Ophthalmology (DOG), Stiftung Auge is dedicated to fighting avoidable blindness and serious visual impairment. Its commitment is to raising awareness, training and the promotion of research to preserve vision. If you would like to support the work of Stiftung Auge, join the bidding and see what delights your eye.

The artists featured in the auction are Peter Halley, New York,Rosemarie Trockel, Cologne (whose picture is featured above), Marc Francis, London,Laurence Weiner, New York and Matt Mullican, New York

Their work will be on exhibition in the main foyer of the ICC next to the Stiftung Auge stand. The value of each work is estimated at at least 1,300 Euro. Delegats can join the auction by making an opening bid of 300 Euro.

Should you wish to bid in the auction, you can have your name entered on a list of bidders at the Stiftung Auge stand.

WOC 2010 offers something for everybody

2010-06-02T14:45:00.001+01:00

The World Ophthalmology Congress (WOC) 2010 promises to offer something for every one of the expected 10,000 international delegates coming to Berlin from all corners of the globe.

WOC president Prof Gerhard K Lang, Ulm University Clinic, Ulm Germany, in an interview with ET Today, the official newsletter of the Congress, said the diversity of the meeting makes it so special.

"Every country has its own set of problems and challenges in ophthalmology. What unites us all, however, regardless of where we come from and which challenges face us, is the conviction that we share the most interesting, aesthetic, and elegant specialty, ophthalmology,” Prof Lang said.

Prof Lang believes that eye doctors who travel from far away to attend the WOC have a right to expect a sterling scientific program. Also, colleagues should be able to discuss topics of interest and hear different viewpoints. Exchanging experiences is highly beneficial and makes the world congress a unique setting for learning and meeting new challenges, he said.

“The challenges met by the pioneering German ophthalmologist Albrecht von Gräfe involved separating ophthalmology from surgery, as its own area of specialisation. Those were very exciting times. Today our challenges are new and different. Today, the ophthalmic industry is so vast and progressive that we have to find ways to pay for the high level of refinement we have achieved. We have worked beyond excimer laser surgery and have now reached the frontiers of macular degeneration and presbyopia. There is hardly another specialty that can keep up with the advancements seen in ophthalmology. We too are living in very interesting times,” he noted.

For the full interview get your copy of ET Today which will be distributed free to delegates on Saturday June 5 in the Congress Centre.

Dr Emanuel Rosen is ASCRS honoured guest

2010-04-30T11:18:00.003+01:00

Emanuel S Rosen MD, FRCSE, FRCOphth was one of two honoured guests of the American Society of Cataract and Refractive Surgery (ASCRS) annual meeting in Boston.

Dr Rosen, picture receiving his award from R Doyle Stulting Jr MD, incoming ASCRS president, was recognised for his role in advancing anterior segment surgery as founding co-editor of the Journal of Cataract and Refractive Surgery (JCRS).

“In 1995 Emanuel Rosen was editor of the European Journal of Implant and Refractive Surgery,” Dr Doyle told the congress’ opening session. “He and Steve Obstbaum, then editor of the Journal of Cataract and Refractive Surgery agreed to combine their respective journals to produce the definitive peer-reviewed publication of anterior segment surgery. After approval was received from the ASCRS and ESCRS Boards, the new journal was launched in January 1996 with Dr Rosen and Dr Obstbaum as co-editors. Today the journal is edited by Drs Rosen and Mamalis.”

Dr Rosen credited the many colleagues and staff members who have contributed to his own development as a surgeon, and helped build JCRS into the influential publication it is today.

A full report on Dr Rosen's presentation will appear in the June edition of EuroTimes.

AAO-PAAO joint meeting is big draw for industry

2009-10-25T14:01:00.003Z

The success of an international ophthalmological meeting can be gauged not only by the strength and depth of the scientific presentations but also by the number of industry exhibitors who take space in the exhibition hall.

The popularity of this year's AAO meeting can be gauged by the fact that the exhibition is spread over three venues in Moscone North, South and West where over 400 companies are showcasing their latest products and ideas.

Among them are Abbott Medical Optics, Alcon, Canon, Carl Zeiss Meditec, Croma, DORC, Haag Streit, Nidek, Oculus, Opko, Oertli and Rayner.

Make sure to try and pay a visit to all of the exhibitors, including the European Society of Cataract and Refractive Surgeons whose booth is in Moscone North N4046.

Early birds

2009-10-24T22:55:00.005+01:00

For many attendees the meeting starts before the meeting starts, in a manner of speaking. That is to say, the subspecialty sessions begin in advance of the general conference, offering a smorgasbord of debate and didactic material in the areas of refractive surgery, retina, glaucoma, and paediatrics. Your EuroTimes reporter spent most of the time camping at the refractive subspecialty day sessions. This consisted of two full days of lectures and debates covering all aspects of the field. The sessions provided a great overview of current debates in many controversial areas including paediatric refractive surgery, refractive surgery on keratoconus suspect eyes, problems with multifocal IOLs, femtosecond laser approaches to cataract surgery, intrastromal implants, and the latest info on collagen cross-linking.

Did you wash your hands?

2009-10-24T22:49:00.003+01:00

H1N1 precautions are in effect, as conventions are an ideal germ-sharing opportunity.

Sunny and warm

2009-10-24T22:43:00.003+01:00

Attendees at this year’s AAO might be forgiven for missing a session or two to grab some rays outside, as the city experiences near tropical weather, blues skies and 25° C. Add to that the many popular tourist activities, the cable car to Fishermen’s wharf, shopping at Union Square, dim sum in Chinatown, bay cruises, it is no surprise that SF continues to be a favourite convention destination for people from around the world.

This weekend alone, visitors have endless nightlife opportunities as well. Whatever your musical tastes, you can hear opera,the Black Eyed Peas, David Sanborn on sax, Neil Young at a fundraiser, and blues great John Lee Hooker laying it down.

Challenging times for ophthalmologists in San Francisco

2009-10-23T21:46:00.005+01:00

EuroTimes will be reporting from the 2009 joint meeting of AAO/PAAO in San Francisco from Friday October 23 to Tuesday October 27.

As you can see from our picture (taken outside the Moscone Convention Centre on the corner of Howard and 3rd) the sun is splitting the stones but that won't deter delegates from attending a packed schedule of lectures and instructional courses.

Meeting highlights will be reported in the December/January and February issues of the magazine and also on our website at www.eurotimes.org in our Breaking News section.

This has been a difficult time for some ophthalmologists who are facing increasing pressure in the face of the global economic recession.

One of the highlights of this year's AAO/PAAO session will be the Practice Management programme which will help advise doctors, practice managers and other practice partners on how they can tackle some of the financial challenges they are facing and will continue to face in the future.

As always, however, the major focus will be on how ophthalmologists can improve their clinical services and patient care and this meeting promises to offer many new insights into new techniques and new technologies.

Surgical simulator demonstration wins ESCRS Video Competition

2009-09-16T10:43:00.002+01:00

The overall winning entry of this year’s ESCRS Video competition was a presentation by Jansuke Akura MD Japan, titled “KITARO, Handy Surgical Simulator for Dry Lab and Wet Lab”. Dr Akura’s video described the KITARO system and illustrated its potential as a tool for teaching phacoemulsification surgery. The design of the surgical simulator allows students to practise instrument manipulation at the desk prior to wet lab instruction. It also provides a useful alternative to porcine eyes for practising phacoemulsification in the wet lab.

Dr Akura is pictured above receiving his award from ESCR President Dr Paul Rosen and incoming President Dr Jose Guell.

See http://eurotimes.org/newsinfo.asp?id=599

ESCRS President Dr Paul Rosen says society will continue to grow

2009-09-16T10:40:00.001+01:00

Significant investments in education and support for trainee doctors, joint meetings with sister ophthalmologic societies and the successful launch of the online European Registry of Quality Outcomes for Cataract and Refractive Surgery (EUREQUO) are all elements of ESCRS’s continuing commitment to meet the changing needs of surgeons and patients, ESCRS President Paul Rosen FRCS, FRCOpth, told delegates at the opening ceremony of the XXVII Congress in Barcelona.
To address the requirements of a changing membership base and establish clear policies on issues such as education and engagement with emerging and developing markets, the ESCRS Board last year led a review of the society’s structure and strategy.
“As a result of this exercise,” said Dr Rosen, “the new committees have this year begun working with new aims and goals which will, I hope, enable the ESCRS to continue to grow and to successfully meet the needs and expectations of its members. This includes significant investment in education, including e-learning opportunities and support for trainee doctors, especially from emerging European markets,” he said.
See http://eurotimes.org/newsinfo.asp?id=598
…..

ESCRS declares 2010 European Year of LASIK

2009-09-16T10:33:00.002+01:00

In celebration of the 20th anniversary of the first LASIK surgeries, ESCRS has designated 2010 as the European Year of LASIK. Approximately 3.5 million LASIK surgeries are performed every year for the correction of myopia, hyperopia and astigmatism.
The European Society of Cataract and Refractive Surgeons, the leading professional society for European refractive surgeons is uniquely placed to lead this celebration, said ESCRS President Paul Rosen.
LASIK pioneer Ioannis Pallikaris, past ESCRS President and Binkhorst Medal lecturer at this year ESCRS Congress in Barcelona, will highlight European Year of LASIK with an Anniversary Congress in Crete, Greece in July 2010.
The ‘father’ of modern LASIK, Greek ophthalmologist Ioannis Pallikaris MD, PhD, said that the decision of the ESCRS to designate 2010 as the Year of LASIK is an important recognition of the significance of LASIK in the history of ophthalmology.
"I am very pleased that the ESCRS has designated 2010 as the Year of LASIK. This was something I have been in favour of for some time now and I fully support this initiative to celebrate what was essentially a European breakthrough,” said Dr Pallikaris.
Dr Pallikaris, who was the first surgeon to use the hinged flap technique in 1990, said that 2010 is a particularly opportune time to mark this important event.
“In July next year we will be holding the 10th Aegean Cornea Meeting and the celebration of the 20th anniversary of Vardinoyiannion Eye Institute of Crete (VEIC), and it is fitting that these events coincide with the 20th anniversary of the first LASIK procedure here in Crete. This will be an opportunity for ophthalmologists and researchers to take stock of the past, present and future of LASIK in particular and developments in anterior segment surgery in general. I think we should see this Year of LASIK as an opportunity to recognise and celebrate what was essentially a European breakthrough and I have no doubt that the ESCRS will play an active role in promoting the Year and helping to raise awareness about this achievement,” he said.

* Dr Pallikaris is pictured above at the Binkhorst Medal presentation with Dr Paul Rosen

Dr Kaladevi Ranganathan of India wins EuroTimes John Henahan prize

2009-09-13T17:14:00.003+01:00

This year’s recipient of the John Henahan Prize is Indian ophthalmologist, Kaladevi Ranganathan MD.

The prize is named in honour of the founding editor of EuroTimes, who edited the magazine from 1996 to 2001. The competition is open to ophthalmologists under 40 years of age and the prize is awarded to the author of the winning essay on a given theme.

Dr Ranganathan’s entry, "Judgement comes from experience", concerned her experience with the case of a six-year-old girl who very nearly had a disabling and stigmatising loss of vision in one eye following a fireworks accident, but who through timely and resourceful intervention now has normal vision and a good quality of life.

Dr Emanuel Rosen, chairman ESCRS Publications Committee, said the the standard of the entries for the 2009 EuroTimes John Henahan Prize was if anything even higher than the impressive 2008 entries and all the authors should be congratulated on their efforts.

"The prize will not only bring satisfaction to the winner and credit to all the contributors but may enhance all their prospects of pursuing a medical writing aspect to their future careers. We look to their further contributions to EuroTimes and the Journal of Cataract & Refractive Surgery,"

Dr Rosen, who is pictured above presenting Dr Ranganathan with her prize.

2009-09-13T17:10:00.003+01:00

Thousands of delegates gathered in Barcelona, Spain this week for the XXVII Congress of the ESCRS.

This year’s congress, which also incorporated the World Congress of Paediatric Ophthalmology and Strabismus (WCPOS), was held in the CCIB Congress Centre in the vibrant capital of Catalonia.

The event attracted a record number of delegates with over 5,500 delegates attending the ESCRS congress and over 900 delegats at the WCPOS Congress.

WCPOS and ESCRS bring the best people together in one room

2009-09-13T17:06:00.004+01:00

This year’s ESCRS meeting in Barcelona offers an unprecedented opportunity for ophthalmologists from around the world to avail of interactive learning with their paediatric specialist colleagues. The meeting marks a first, collaboration with paediatric ophthalmology in the form of the first World Congress of Paediatric Ophthalmology and Strabismus (WCPOS).

This is a lively time in the field of paediatric ophthalmology, with important new studies in many key areas including genetics, strabismus, retina, cataract and refractive surgery. The WCPOS meeting highlights controversies and innovations in the field that will be of interest to specialists and general ophthalmologists alike.

“The idea of putting the best people together in one room to talk about paediatric ophthalmology was irresistible. This is the beginning of what we hope will be regular opportunities for people to get together and talk. By getting together we can communicate with each other, take the skills and techniques that the adult [ophthalmologists] have, and the information that the paediatric specialists have, put those together and end up with something even better,” David Granet MD, director of the Ratner Clinic, University of California, San Diego, and co-director of WCPOS, told EuroTimes.

Dr Ken Nischal, consultant ophthalmic surgeon at Great Ormond Street Hospital for Children and Moorfields Eye Hospital (Hon) and co-director of WCPOS concurred.

“We all have strengths in different areas. Refractive surgeons are very good at refractive surgery, but in the child, it’s the visual rehabilitation after the refractive surgery that contributes to the success of the operation that the refractive surgeon has performed,” said Dr Nischal. “By increasing communications or links with paediatric ophthalmologists, who are good at visual rehabilitation in children, the refractive surgeons can increase the outcome or success of their own procedures,” he said.

The WCPOS offers a full menu of scientific sessions, keynote lectures, instructional courses, and satellite symposia over its two-day run. While planning the programme Dr Granet and Dr Nischal were careful to invite speakers from around the world in order to provide the widest possible perspective on current issues in the field. As a result the conference, with registrations far exceeding expectations, should prove to be an excellent gauge of trends and current and future concerns in paediatric ophthalmology.

“We’re very excited by the level of freedom that the ESCRS has given us to be able to have controversies, case presentations and discussions - every manner of learning experience - at the conference. We’re giving moderators the freedom to run sessions the way they would want to experience them if they were in the audience. We’re going beyond the format of just getting up and talking at people for 10 minutes, we’re making it more dynamic and interactive. We have experts from every region moderating the sessions. What we are doing has never been done before,” noted Dr Granet.

Research papers and posters are only a small part of what’s on offer. In addition to hundreds of free papers, lectures and posters there are three simultaneous tracks of instructional courses each day. These cover all areas of the field, including strabismus techniques, controversies in nystagmus, amblyopia, genetic disease, uveitis and beyond. The meeting was organised so that common areas of interest wouldn't conflict in the schedule, allowing attendees to visit both lectures and courses of interest.

The duties of ‘adult’ ophthalmologists and paediatric specialists overlap in different ways in different parts of the world, creating some controversies. Those controversies were discussed on Saturday in a joint symposium of the ESCRS/WCPOS on Paediatric Cataract & Refractive Surgery.

“We wanted to get the best people from both worlds together. To me the controversy is not that controversial because the people who can do this are the ones who should be doing it. There is no doubt that the paediatric people know the paediatric side better and the cataract people know the cataract side better. But there is a way to communicate better, and that is what this is about. We might not talk so much about where we disagree or differ, but actually where we can get together. We want to find the common ground, and help each other develop the skills, so that the child ends up with the best possible care,” said Dr Granet.

One area that is of great interest to both paediatric and adult ophthalmologists is refractive surgery. Refractive surgery is still considered something of a taboo on the paediatric side of ophthalmology, but that is changing. For example, early clinical experience indicates that laser refractive surgery can be very useful in correcting higher order aberrations in children for whom no other options exist. Laser refractive surgery is also finding a place in the treatment of high refractive errors, amblyopia and anisometropia.

“We may wake up in 15 years and find that refractive surgery is the standard of care in paediatric ophthalmology. The problem is getting from where we are to where we need to go. We need to talk to refractive surgeons who are very comfortable with refractive surgery, and get them together with paediatric surgeons who are uncomfortable with refractive surgery. We’re worried about these kids who will have to live with this for 70 years. We are worried that once we open that door that there will be a stampede of parents running through the door who want their 11-year-old kids to get rid of their glasses for mild myopia. We want to avoid lasering anyone too frequently, too young and in the wrong settings,” emphasised Dr Granet.

* Dr Granet and Dr Nischal are pictured above at the opening ceremony of WCPOS

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

2009-06-14T08:59:00.010+01:00

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.

EuroTimes breaking the latest news from SOE

2009-06-13T13:15:00.005+01:00

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

2009-05-26T12:45:00.003+01:00

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

2009-05-16T11:09:00.005+01:00

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

2009-05-15T13:32:00.005+01:00

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

2009-04-08T11:28:00.003+01:00

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.

Patrick Condon receives Honoured Guest award from ASCRS

2009-04-05T20:33:00.005+01:00

ESCRS founding member and former Board member Patrick I Condon MD, Waterford, Ireland, was recognised today for his life-long contributions to the profession with an Honoured Guest award at the ASCRS opening ceremony. “He is noted for his contributions to anterior segment binocular surgery,” said Alan S Crandall MD, Salt Lake City, Utah, US, incoming ASCRS president.

“My wife and I thank you so much,” said Dr Condon. He also thanked the ASCRS for its participation in the annual ESCRS-ASCRS joint forum, which is always a source of lively debate and differing opinions over current ophthalmic surgery controversies. Following the ceremony Dr Condon departed the stage to tickle the ivories with his jazz band, Paddy Condon and the White Stars, for the enjoyment of all outside the exhibition hall.

Also honoured was Endre A Balazs MD, originally from Budapest, who was inducted into the ASCRS Hall of Fame for his groundbreaking work in identifying the chemistry of the vitreous body, leading to the development of viscoelastics.

MEACO delegates get ready for Barcelona

2009-04-05T16:18:00.004+01:00

The ESCRS booth in the exhibition centre at Manama, Bahrain saw plenty of traffic during the 10th MEACO Congress.

Pictured above is Rachel Wiseman who was busy fielding enquiries from delegates who are looking forward to attending the XXVII ESCRS Congress in Barcelona, Spain.

For further information on Barcelona and all other ESCRS activities, visit the ESCRS website at www.escrs.org.

Coordinated effort needed to fight blindness

2009-04-04T15:53:00.002+01:00

A major coordinated effort is needed to tackle the underlying causes of blindness in children, particularly in poorer and underdeveloped regions where the needs are greatest, according to a leading expert in the field.

Prof Clare Gilbert, International Centre for Eye Health at the London School of Hygiene and Tropical Medicine, told delegates attending the MEACO Congress that blindness in children is a major, lifelong problem in every part of the world, impacting not just the affected children, but also their families, their communities and countries.

“It is the greatest problem where resources are least,” said Dr Gilbert, who said that WHO statistics show that there are about 1.4 million blind children in the world.

“When we consider that the total figure for adult blindness is 45 million, this figure looks like a very small number. But one has to bear in mind that these children have a lifetime of blindness ahead of them.”

Dr Gilbert said that successive studies have demonstrated the clear link between childhood blindness and poverty.

“More than 70 per cent of these blind children live in poor and very poor countries and there are two principal reasons for this: first, the population of children in poorer regions is much higher, and secondly, the prevalence of blindness in children in these countries is also much higher,” she said.

She noted that the available evidence seems to suggest that the majority of these 1.4million children are either born blind or become blind before six years of age.

“This tells us that in terms of controlling childhood blindness that we really need to focus our efforts and resources on children aged zero to five,” she said.

Record attendance at 10th MEACO Congress

2009-04-04T15:05:00.003+01:00

Ophthalmologists from around the world gathered in Manama, Bahrain for the 10th International Congress of the Middle East African Council of Ophthalmology (MEACO).

The congress was officially opened by Dr Faisal bin Yacoob Alhamer, Minister of Health of the Kingdom of Bahrain, who said his country was very proud and gratified to be hosting such a prestigious international meeting and he looked forward to similar fruitful cooperation with MEACO in the future.

The chairman of the MEACO Board, His Royal Highness Prince Abdulaziz Ahmed Al Saud, welcomed the assembled delegates to the Kingdom of Bahrain and expressed his belief that the five-day meeting would prove a fruitful and informative forum for the international ophthalmic community. He noted that with almost 3,000 delegates registered for this year’s meeting, the congress continues to go from strength to strength.

Next to address the delegates was Dr Abdulaziz AlRajhi, president of MEACO (pictured above) who stressed the importance of forging partnerships both regionally and internationally in pursuit of excellence. He highlighted the strong collaboration between MEACO and associations such as the American Academy of Ophthalmology (AAO), the International Council of Ophthalmology (ICO) and the European Society of Cataract and Refractive Surgeons (ESCRS).

“Our aim is to bring the best that the world has to offer to our members in the region in order to expand their knowledge and experience and contribute to the advancement of eye care services in the Middle East and Africa,” he said.

After thanking the local organisers and all of the generous sponsors for their continuing support for MEACO, Dr AlRajhi concluded his speech by stressing that actions, not words, are the true hallmark of achievement.

“Napoloeon Bonaparte once said that if you wish to be a success in the world, promise everything and deliver nothing. But in MEACO we like to say that people may doubt what we say, but they will believe what we do,” he said.

Bruce Spivey MD, president of the ICO, then addressed the assembly.

Stressing the strong bonds that have been built up over the years between the ICO and MEACO, he said that such cross-currents underscore the vitality of a discipline such as ophthalmology.

“We have all, as never before, borne witness to the dynamic relationships of the social and economic realities of the present-day world. The ICO is apolitical by conscious decision and behaviour. This meeting in Bahrain, a place inhabitated since ancient times and a crossroads to many cultures, is a wondeful reflection of the beauty and cosmopolitan nature of this region,” he said.

Dr Michael Brennan, speaking on behalf of the AAO, said that MEACO is perpetuating the proud tradition of the Gulf region and Mesopotamia as the crucible of medical science.

“This tradition continues as MEACO, and its forerunner PAACO, celebrates 20 years of providing the infrastructure for ophthalmologists to assemble to share knowledge and skill. More distinctively over recent years, MEACO has expanded its range of services and value to members and affiliate organisations in a variety of ways,” he said.

In addressing the communication challenges of globalisation and the technological revolution, Dr Brennan saluted MEACO’s efforts to collaborate with the AAO and the ICO in introducing a variety of international educational and informational content to its members.

Concluding the opening ceremony, Dr Ebtisam Al Alawi, chairperson of the Local Organizing Committee, said that the number of participants registered for the 2009 MEACO Congress, estimated in excess of 2,000 delegates, had surpassed all expecations.

“The meeting continues to evolve and develop. This distinguished gathering allows us to share experiences and exchange knowledge regarding the latest advances in ophthalmology and covers all the subspecialties of ophthalmology including epidemiology and prevention of blindness. I am very pleased to see delegates representing countries from all over the world, which shows how truly international this meeting has become,” she said.

Rock 'n' roll phaco hits the right note

2009-02-07T15:05:00.018Z

An alternative phacoemulsification procedure, dubbed "rock 'n' roll phaco" by its originator, offers surgeons faster emulsification of the nucleus of the lens without compromising safety, according to a German study.

Detlef Uthoff MD told delegates attending the 13th ESCRS Winter Meeting in Rome that the "rock 'n' roll" technique is the culmination of over 30 years of experimenting with different approaches to phacoemulsification.

“This is my favourite technique for both mono and bimanual phacoemulsification. It is characterized by primarily fragmenting or sculpting the nucleus, which is then nudged 180 degrees and rotated along its sagittal axis with the help of the phacoemulsification tip. Later the nucleus is stabilised by a spatula and then emulsified from its posterior side. During emulsification the nucleus is held under the iris with the help of spatula,” he said.

Dr Uthoff said that the technique, which demands a slightly longer learning curve to master than traditional methods, permits a faster and safer emulsification of the lens nucleus and can be used with all grades of cataract. He estimated that his modified technique reduces the ultrasound time by up to 30 per cent.

Cornea Day was officially opened by Dr Jose Guell (pictured above), chairperson of the ESCRS Congress Committee.

For further updates read the March and April issues of EuroTimes and visit our Breaking News section on www.eurotimes.org

Femtosecond laser enhances keratoplasty

2009-02-07T15:02:00.004Z

The femtosecond laser offers several clear advantages for lamellar and penetrating keratoplasty procedures, according to an Italian surgeon speaking at the 13th ESCRS Winter Meeting in Rome, Italy.

Opening the first session at the annual Cornea Day, Emilio Balestrazzi MD gave an overview of how the femtosecond laser is changing the face of lamellar and penetrating keratoplasty surgery.

“The IntraLase femtosecond laser (AMO) is a dynamic surgical tool which enables surgeons to perform valid, safe and repeatable lamellar and penetrating keratoplasty techniques. However, we must be cautious in the application of this exciting technology and remember that it is still a work in progress,” he said.

For femtosecond laser assisted deep anterior lamellar keratoplasty (femto-DALK) procedures, Dr Balestrazzi said that the goal is to utilise a surgical option that could be compared in results to manual DALK, preserving the health and integrity of the corneal endothelium.

Using this approach, a clear graft was achieved in all patients one week after surgery and confocal microscopy evaluation showed no significant differences in pre- and postoperative endothelial pattern and density. Two patients experienced a perforation during the IntraLase cut which required a subsequent penetrating keratoplasty.

Turning to femtosecond laser assisted penetrating keratoplasty, Dr Balestrazzi said that this technique is designed to create a simpler and repeatable surgical technique to generate less astigmatism, greater scar strength and faster visual recovery times.

In addition, any cut configuration and angulation can be chosen, the cut quality is excellent and the prepared donor transplant nestles perfectly in the recipient eye.

Abbott seeks to cash in on growing global vision-care market with AMO acquisition

2009-01-22T09:51:00.001Z

By Howard Larkin

Looking to seize a leadership position in the €17bn global vision-care market, Abbott Laboratories is acquiring Advanced Medical Optics (AMO). Valued at nearly $2.8bn, or about €2.1bn, in cash and assumed debt, the deal was approved by the boards of both firms. Pending regulatory approvals, Abbott officials expect the sale to close in the first quarter of 2009.

Abbott’s move comes just 18 months after AMO attempted to acquire Bausch & Lomb, and six years after AMO was spun off from Allergan. The acquisition is the 120-year-old firm’s first venture in ophthalmology.

Abbott approached AMO with the deal because it offers an opportunity for Abbott to further diversify its growing medical device business, Abbott spokesman Scott Stoffel told EuroTimes. “Our global presence will help fuel growth opportunities internationally, particularly in emerging markets where there are favourable demographics and growing demand for advanced eye care products.”

With revenues of nearly $26bn in 2007, Abbott dwarfs AMO. Indeed, Abbott’s blockbuster immunotherapy biologic Humira alone generated $4.4bn. That’s roughly four times AMO’s total revenue for the year.

One might expect that AMO could easily disappear into such a dominant partner. But that is not Abbott’s plan, Mr Stoffel said. “Once the deal closes, the idea would be that [AMO] would continue to operate as a separate division of Abbott. I can’t speak directly on the idea that every process and procedure will remain the same, but the focus will be on serving the needs of patients and doctors in a way that is effective for them.”

Mr Stoffel confirmed that Abbott intends to retain the AMO management team and production facilities led by AMO Chairman and CEO Jim Mazzo. “Let me assure you that we remain fully committed to providing a full complement of superior refractive, cataract and corneal products and services. We intend to make this transaction as seamless as possible to you and, as always, the entire AMO organisation stands ready to deliver life-enhancing vision to eye care professionals and their patients,” Mr Mazzo said in a written statement to AMO customers.

Since Abbott Chairman and CEO Miles D White took over in 1999, Abbott has pursued a strategy of diversifying into new pharmaceutical and medical device markets through acquisitions, Mr Stoffel said. These include Knoll Pharmaceutical in 2001, which gave the firm Humira, and Guidant’s vascular business in 2006, which resulted in Abbott taking the leading position in the global market for vascular stents. Many of these acquisitions, including the Guidant operations and Nutrition International, continue to work as independent units within the company.

Abbott also has pursued an increasingly global strategy. In 2007, more than half the firm’s revenues came from outside the US for the first time, and that share continues to grow. Some of Abbott’s latest acquisitions, including Nutrition International and Guidant, are strongly focused on international growth.

The global recession and the resulting downturn in demand for laser vision correction created the conditions for the AMO buyout. With laser vision correction volume down 35 per cent in the third quarter, AMO’s stock briefly fell below $3 a share from a 2008 high of just over $24. After AMO announced a small profit for the third quarter due to rising cataract sales, the stock gradually climbed back to almost $9 in the session before Abbott announced the acquisition offer of $22 per share. While cataract surgery is AMO’s biggest market segment, the firm is much more highly exposed to the volatile laser refractive market than competitors such as Alcon and Bausch & Lomb.

Abbott sees the AMO acquisition as a long-term investment, Mr Stoffel said. Abbott projects that the acquisition will break even in 2009 and will begin generating a profit in 2010. The firm intends to continue supporting development of new vision technology, he added.

“One thing Abbott has been effective in as it manages through acquisitions is to take the best of the existing culture and maintain it, and use Abbott’s resources to enhance the business,” Mr Stoffel said. “Together with Abbott, AMO will be even stronger.”

The sky is not falling - ophthalmology will survive

2008-12-15T09:50:00.003Z

The Obama feel-good factor was not shared by all of those attending the joint meeting of the American Academy of Ophthalmology (AAO) and the European Society of Ophthalmology (SOE) in Atlanta, Georgia, US.

Big drops in the share price of the leading ophthalmic companies and reports from individual doctors of a reduction of more than 40 per cent in LASIK procedures in the last three months have put a dampener on the post-election celebrations for some doctors.

The global economic meltdown is showing up on the bottom line of finance companies specialising in LASIK and other discretionary medical procedures. Capital One and Care Credit both reported a slowdown in business in the past two months. Tightening credit standards mean it’s getting harder to qualify some patients for loans and default rates on outstanding commitments are climbing.

But every cloud has a silver lining and one of the biggest growth areas in the next 12 months will be the market for practice management consultants and practice management seminars.
Ophthalmologists in the desperate search for a bang for their buck can expect to be bombarded with literature inviting them to pay top dollar for seminars on topics including, "Good news in a depression" and "The sky is not falling".

But ophthalmology, like other medical disciplines, should not be just about money and while doctors should also listen to the advice of practice management experts and other economic consultants, they should also set themselves standards that they will strive to achieve in good times and bad times.

This point was emphasised at the Meet the Masters presentation, sponsored by AMO, where residents attending the AAO/SOE meeting were invited to hear pearls of wisdom from Dr Michael Colvard (pictured above), Dr Bobby Osher and Dr Ralph Chu.

We won't go into a speaker-by-speaker check list of the individual messages from the masters but below are some of the pearls of wisdom they offered to the young doctors attending the meeting.

* Never ridicule anyone's new idea.
* People will forget everything you tell them but they will never forget how you make them feel.
* It's a very small world. Be honest when you speak.
* Always ask yourself what do you like doing and be passionate about what you do.
* It's not always about economic gain.
* Don't allow yourself get stale.
* Treat your patients like you would treat your families.
* You can't always cure but you can always comfort.
* Nobody can train you how to develop emotionally as a doctor.
* Never get cocky about your surgical skills.

Ophthalmology in the new Europe

2008-12-15T09:45:00.008Z

This month EuroTimes looks at ophthalmology in the new Europe. Among those featured is Levon Barseghyan, MD, professor and head of the Ophthalmology Department of the National Institute of Health in Armenia.

Dr Barseghyan (pictured above) says his country faced a lot of difficulties after the break-up of the Soviet Union, but ophthalmologists have continued contacts with the major centres in Moscow and Ukraine.

Dr Barseghyan, who studied at the Filatov Eye Institute in Odessa, Ukraine and in Moscow, says that while contacts among Russian-speaking ophthalmologists are not as frequent as before, they continue. And that is why the Fyodorov meeting is so important, he says.

Other major influences on Armenian ophthalmology come from outside the region. One such influence is Roger Ohanesian, MD, the founder of the Armenian EyeCare Project. Dr Barseghyan explains that Dr Ohanesian has brought doctors to Armenia from abroad, helped to train Armenian doctors in the US, and donated such equipment as phaco machines. “He has also brought a mobile hospital to Armenia, which is very well equipped,” Dr Barseghyan adds.

While older ophthalmologists continue to promote ophthalmology in their countries, the future of the specialty lies with a new generation of young Armenian ophthalmologists, Dr Barseghyan says.

“There are better opportunities for our young ophthalmologists than there was in my time,” he says. “They can travel to international conferences, they can gather information from the Internet. By getting more knowledge, they can become better doctors.”

Ophthalmologists are never at war

2008-12-15T09:40:00.003Z

Political tensions may continue to cast a shadow over relations between Russia and some of the other countries that were once part of the Soviet Union. Despite such clouds, the clear message from the delegates attending the recent IXth International Congress of the Russian Society of Ophthalmologists is that the international brotherhood and sisterhood of ophthalmology is, if anything, growing stronger.

This point is strongly borne out by Merab Dvali, MD, professor and chief of the Eye Department at the Tbilisi State Medical University Ophthalmology Department in Georgia.

“Years ago we were one big country with a common education, the same teachers and the centre of ophthalmology in the Soviet Union was Moscow,” Dr Dvali remembers during a break in the congress at the Fyodorov Complex in Moscow.

“I worked in Moscow for 19 years, and it continues to be a very important centre. Unfortunately, over the last 12 months, we have had political differences with Russia but I think the doctors in both of our countries have stayed friends. We were, and will be, brothers and sisters. We have no borders. Ophthalmologists never war. I hope our governments will take the same approach."

Dr Dvali says for Georgian ophthalmologists it is very important to have close links both with Russia and other European countries.
“It is very difficult for our patients to go abroad and get treatment. We are a small country and we do not have enough eye surgeons, but we are doing our best and we try to use the latest technologies.”

While state-funded clinics in Georgia often struggle for funds, an increasing number of private clinics are being developed, says Dr Dvali. Young ophthalmologists in Georgia are also being encouraged to travel overseas for training. “We are supporting one young doctor who we have sent to India to get training in vitreo-retinal surgery. He knows the theory, but he needs practical experience and in India he will get that experience. Another doctor has gone to Spain to study keratoplasty surgery.”

So what should be the model for developing ophthalmology in Georgia? While Dr Dvali is full of admiration for the work done at the Fyodorov Complex, he does not think that a complex of that size should be replicated in his country.
“It is my opinion that eye clinics should not be as big as Fyodorov. Under the old socialist system it was possible to build a big clinic like Fyodorov, but I do not think it is necessary to have a complex of that size,” he says. “For example, my own clinic is a 200-square-metre outpatient clinic. We do laser, we do phaco, and we do all surgery in this clinic. The most important thing is good equipment and good doctors.”

In 1999, Prof Dvali bought the first excimer laser into his clinic. “It was very difficult to raise the money,” he recalls. “But I was able to raise the finance with the help of five friends who were not ophthalmologists. They believed in me and they supported me and that was very important.”

Because of the lack of resources in government clinics – like the one he runs – Dr Dvali is using his private clinic to train his residents.
He notes that in many western European countries, ophthalmologists are concerned about the growth of the private ophthalmology sector at the expense of the public sector. In Georgia, however, private clinics are essential for the development of ophthalmology, he says.

“Public and private patients get the same treatment,” he says. “We also have a mobile clinic that allows us to go to small villages and carry out surgery. If a patient does not have money, he does not get a poor service.”

* A full report on Ophthalmology in the new Europe will be published in December EuroTimes. You can also visit our website at www.eurotimes.org

ESCRS booth draws a crowd

2008-11-10T20:12:00.005Z

The ESCRS Winter Meeting in Rome is attracting lots of interest from ophthalmologists attending the AAO/SOE meeting in Atlanta. Doctors from the US and elsewhere are flocking to the booth to sign up for the ESCRS Winter Meeting, the EURETINA meeting in Nice and the 2009 Congress in Barcelona.

The high quality of the scientific content of all three programmes are big draws for US ophthalmologists and the recent decline of the euro against the dollar and lower costs for airfare are making the trip more attractive for folks on this side of the pond.

Ophthalmologists check out new WaveLight laser

2008-11-10T20:10:00.004Z

Though it won’t be available until the end of 2009, demonstrations of WaveLight’s just-revealed UltraFlap femtosecond laser concept platform drew a steady stream of interested ophthalmologists – as well as a few spies from the competition – throughout the day. The 200 kHz system will be capable of cutting a LASIK flap in under 15 seconds, matching or bettering the performance of the fastest lasers currently on the market, according to Mario Klafke, WaveLight’s director of product management for ophthalmology.

Designed to enhance quality, safety, comfort and efficiency, the laser’s high repetition rate, small focal area and low pulse energy produce exceptionally smooth flap surfaces with sharp edges that make flap lifting easy, Mr Klafke added. Tests on pig eyes show low standard deviation in flap thickness. The UltraFlap integrates seamlessly with the Allegretto excimer platform. The two can be placed side by side, allowing the patient to be rotated from one to the other during a procedure in an office space as small as nine square metres. They also share data, enabling safety features such as a warning if the surgeon chooses a flap size too small to accommodate the ablation zone. UltraFlap also supports other surgical applications, including sub-Bowman keratomileusis, intracorneal ring segments, lamellar keratoplasty, penetrating keratoplasty and self-sealing keratoplasty.

Faith affects treatment compliance in glaucoma

2008-11-09T17:59:00.007Z

A broad awareness among ophthalmologists regarding the religious beliefs of the patient groups they treat will allow them to formulate management plans in keeping with these beliefs without compromising care, according to research presented at the joint meeting of the American Academy of Ophthalmology (AAO) and the European Society of Ophthalmology (SOE) in Atlanta, Georgia.

Increasingly, ophthalmologists care for patients of diverse backgrounds and this trend is accelerating the need for reliable information on the interaction of religious beliefs and compliance with prescribed treatments.

The effectiveness of glaucoma treatment, in particular, often depends on patients’ ability and willingness to self-administer eye drop medications on a regular schedule over months or years. Glaucoma patients often notice no symptoms in the early stages of the disease, which poses challenges for physicians in motivating patients to stick to treatment regimens. If patients neglect treatment until their vision noticeably declines, the damage is often irreversible.

Many of the world’s religions practise obligatory or voluntary fasting (abstaining from food and often also fluid) during periods that can last from a few days to more than a month, on an annual basis. Researchers led by Nishant Kumar, MBBS, of the University Hospital, Liverpool, UK, studied patient compliance in relation to fasting by analysing 350 surveys completed by members of the world's major faiths: Islam, Hinduism, Jainism, Christianity, Judaism, Bahai, and Buddhism (50 surveys per religion) — the first study of its kind, the researchers believe.

Population reports show that approximately 20 per cent of the world’s people are Muslim and about 15 per cent are Hindu; fasting is important to both religions. It is mandatory during the daylight hours of the month of Ramadan for Muslims; for Hindus fasting is generally voluntary.
Dr Kumar’s team previously surveyed Muslim patients on their use of prescribed eye drops during Ramadan and concluded that treatment compliance was significantly reduced in patients who kept the fast. If patients reduced or stopped their glaucoma treatment for an extended period, such as the month of Ramadan or other continuous fasting periods, their vision could be adversely affected.

In the new survey, the majority of patients self-identified as Hindus, Muslims and Jains stated that the use of eye drops during their fasting hours would break their fast, and therefore they would not use drops while fasting. However, these patient groups said they would be more likely to use drops while fasting for painful eye conditions or if vision was affected. The majority of Christian, Buddhist, Bahai and Jewish survey respondents did not believe that using drops would break their fasts, and stated that they would use eye drops during their fasting periods.
“A broad awareness among ophthalmologists regarding the religious beliefs of the patient groups they treat will allow them to formulate management plans in keeping with these beliefs without compromising care,” said Dr Kumar.

Unity brings progress in society and ophthalmology

2008-10-13T12:55:00.005+01:00

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.

Controversy continues over intracameral antibiotic injection

2008-09-15T16:25:00.004+01:00

To hear Ireland’s Peter Barry, MD, tell it, the evidence in favour of intracameral injections of cefuroxime to prevent endophthalmitis is incontrovertible. The 2006 ESCRS study showed a rate of 0.05 per cent in 8,000 patients receiving injections and antibiotic drops compared with a rate of 0.35 per cent in patients receiving placebo drops and no injection. Further, a 2007 study examining 225,000 patients from the Swedish registry, most of whom received cefuroxime injections, showed a similar endophthalmitis rate of 0.048 per cent, Dr Barry told a symposium on global practice choices at the XXVI Congress of the ESCRS. Similarly, those patient who were not treated with intracameral antibiotic injections showed infection rates very similar to the placebo group in the ESCRS study.

While these results have driven many European ophthalmologists to intracameral injections, they haven’t in many other parts of the world. For example, Dr Bissen-Miyajima reported that surgeons in Japan do not use intracameral antibiotic injections at all because there are no agents approved. Nonetheless, endophthalmitis rates in Japan also are in the 0.05 per cent range. Dr Bissen-Miyajima attributed much of it to the use of prophylactic antibiotic eyedrops. Her own research suggests that this cuts down on the bacterial load on the surface of the eye that is thought to be the root cause of most endophthalmitis infections. She also noted that most Japanese surgeons prefer a scleral incision because it has been shown in some studies to reduce endophthalmitis rates compared with clear corneal incisions.

Nick Mamalis, MD, of the US also emphasised the importance of both reducing infectious agents on the surface of the eye before surgery and carefully constructing incisions, particularly clear corneal incisions, to seal them against ingress of bacteria from the surface of the eye. A similar strategy was voiced by Jose Villar-Kuri, MD, who reported that many Mexican surgeons suture the incision to prevent infection. He reported a series of 12,000 cases without a single case of endophthalmitis by surgeons using this technique.

Dr Mamalis also pointed out that the fourth-generation flouroquinolones available in the US penetrate the surface of the eye, reducing the chances of infection. He also expressed concerns among US physicians about the lack of single-dose ophthalmic preparations of antibiotics leading to toxicity resulting from errors in dilution and preparation. However, he believes that should a single-use ophthalmic preparation become available, many US surgeons would use it.

Dr Barry commented that such preparations are being considered, but that maintaining stability of a solution in such minute quantities is difficult. He does believe the obstacle can be overcome. “The writing is on the wall. Let us read it and move on to the manufacture of cefuroxime in a single sterile FDA-approved unit dose for ophthalmic use.”

Dr Rosen pledges ESCRS support for surgeon education in developing countries

2008-09-15T16:23:00.002+01:00

A new strategic plan being developed by the ESCRS Board will include new support for an ophthalmology training programme, said ESCRS President Paul Rosen, FRCOphth, at the opening session of the XXVI ESCRS Congress on Sunday evening. The commitment is the result of an ongoing strategic review process designed to identify and address future needs of European cataract and refractive surgeons, Dr Rosen said.

“Over the coming months the Board will formalise a strategic plan for the next three to five years,” Dr Rosen told the more than 5,000 delegates attending this year’s Congress. “This will include a significant investment to educate and support the training of new doctors, the future lifeblood of the society, especially from emerging European markets. It is my hope the process will enable the Society to continue to grow and meet the expectations of its members.”

The plan will be the product of an ongoing strategic review initiated by the Board under Dr Rosen’s leadership. “In recent years the Society has been tremendously successful,” Dr Rosen noted. “But the Board agreed there is a need to review structure and strategy to ensure we can continue to grow. We want to create a plan to ensure the Society addresses the requirements of a changing and expanding membership base, and establishes clear policies on issues such as education and engagement of the emerging and developing markets.”

The strategic review has been conducted in consultation with the Board, ESCRS Committee Members, industry, world opinion leaders and society members, Dr Rosen said. “If you haven’t yet had your say, please do so and contribute online.”

EU grant to support pan-European outcomes registry

Dr Rosen also outlined plans for a new European outcomes registry. “I am delighted to announce the ESCRS has received a substantial grant from the European Union. The purpose is to develop the European Registry of Quality Outcomes for Cataract and Refractive Surgery.” In addition to ESCRS, the project involves 12 European national societies. Funding is for three years and data collection begins in April 2009.

“ESCRS firmly believes that a continuing audit of surgical outcomes is needed to ensure the best care for our patients,” Dr Rosen said. He encouraged delegates to visit the project's booth on the ICC convention floor for more information.

Dr Rosen also highlighted the need for cataract and refractive surgeons to develop their business skills and highlighted ESCRS efforts to help out. “One of our new initiatives of the Congress has been the EuroTimes Practice Management Resource Centre, which offers a series of lectures on business topics such as marketing risk management and reimbursement. I think these topics are a vitally important adjunct to our meeting. It is important for ophthalmologists today to enable them to thrive and remain independent. It is our intention to build on this programme in future meetings. We will be working on this project with the London School of Business, the number one business school in Europe.”

Dr Rosen also acknowledged the ongoing contributions of German ophthalmologists to the ESCRS and invited delegates to enjoy the cultural and entertainment attractions of Berlin. “In 2003 the Congress was held in Munich. We are delighted to return to Germany five years later to the vibrant city of Berlin.”

Toric IOL add-on offers new option for reducing pseudophakic astigmatism

2008-09-14T14:55:00.002+01:00

BERLIN
Secondary implantation of a toric IOL is an effective method for correcting pseudophakic astigmatism, reported Haiying Jin MD at the XXVI Congress of the ESCRS.

Dr Jin spoke on behalf of his colleagues at the University of Heidelberg where a toric IOL has been used as an add-on implant in selected pseudophakic eyes with astigmatism related to either corneal toricity or rotation of a primarily implanted toric IOL. The implant used is a MicroSil toric IOL designed for piggyback implantation into the ciliary sulcus. Its spherical power, toric power, and alignment axis are determined based on calculation of the optical properties of the pseudophakic eye using a modification of the Holladay-Cravy-Koch vector analysis method.

Dr Jin demonstrated the utility of the piggyback toric IOL implantation in a case of a 72-year-old-man who received a toric IOL at cataract surgery and was found 20 months later to have more than 5 D of refractive astigmatism and almost 4 D of corneal astigmatism associated with a 60-degree off-axis rotation of the primary toric IOL.

“Repositioning of the primary implant would be challenging in this eye because it is 20 months post-surgery, and laser ablation is also not a good option considering the very high astigmatism and because the treatment axis and steep axis of corneal astigmatism are different,” noted Dr Jin.

“It is known that secondary IOL implantation is an effective approach for correcting refractive surprises after cataract surgery. To our knowledge, this is the first report of using a toric IOL as a piggyback implant to correct pseudophakic astigmatism.”

Near vision gains impressive after intrastromal femtosecond laser treatment for presbyopia

2008-09-14T14:53:00.002+01:00

Preliminary results suggest intrastromal treatment using the Femtec femtosecond laser (20/10 Perfect Vision) is a promising new approach for presbyopic correction, said Sinan Goker, MD at the XXVI Congress of the ESCRS.

This flap-free, intracorneal procedure was developed by Luis Ruiz MD, Bogota, Colombia, in 2007. Dr Goker reported that he has been using the Femtec femtosecond laser since 2004 for flap creation and various other applications and has performed the intrastromal presbyopic treatment in 86 eyes of 51 patients since February 2008. All eyes were either emmetropic or slightly hyperopic, and each was treated with a customised photodisruption pattern based on keratometry, refraction, age and central corneal thickness. All patients were seen at one week and one month post-treatment, and two eyes had follow-up to six months.

Comparisons of baseline and postoperative data showed significant improvements were achieved in both mean UCNVA (from J13.3 to J2.3) and mean UCDVA (from 0.64 to 0.80). Whereas patients needed an average near add of +2.6 D to read J1 preoperatively, the same level of near vision was achieved at three months with a mean add of only +0.92 D.
BSCVA remained unchanged in 88 per cent of eyes, while one eye lost two lines and three eyes lost one line. Two of the latter cases resolved with treatment for dry eye. Mean BSCVA was slightly but significantly reduced from 0.99 to 0.95.

Corneal imaging using the Pentacam (Oculus) showed the intrastromal treatment caused no change in central corneal thickness while K1 as well as anterior and posterior surface asphericity were slightly increased.

“This is a very fast, non-invasive treatment for presbyopia with potential safety advantages relating to the absence of any flap or surface ablation, and unlike other presbyopia treatments, it does not disturb distance vision,” said Dr Goker, an ophthalmologist at Istanbul Surgery Hospital, Turkey.

“However, these are early results. Further follow-up in more eyes is needed to determine the long-term stability and predictability, and we are also developing nomograms for treating presbyopia in myopic and astigmatic eyes.”

Botulinum toxin injection plus refractive surgery play complementary roles

2008-09-14T14:48:00.002+01:00

Berlin

Botulinum toxin injection can be a useful adjunct to refractive surgery used either before surgery to treat existing oculomotor anomalies or postoperatively to address a secondary deficit of motor fusion, said Silvia Brogelli, MD at the XXVI Congress of the ESCRS.

Dr Brogelli presented findings from a retrospective review that identified 50 adult patients who had been treated between 1988 and 2008 with botulinum toxin injections into hyperactive extraocular muscles and also underwent refractive surgery.

The series represented two subgroups. Group 1 comprised 31 patients who had previously received one or more botulinum toxin injections for ocular misalignment or nystagmus and subsequently underwent refractive surgery. Group 2 included 19 patients with a history of refractive surgery who were subsequently treated with botulinum toxin to improve ocular motility. Cases with blind deviated eyes were excluded.

Considering that the benefit of botulinum toxin is time-limited and permanent stable binocular cooperation is reached in few cases, the time interval between repeated injections was used as a surrogate measure of comfortable binocular single vision and the criterion for measuring treatment efficacy.

There were no complications associated with the combination treatment. In patients who were receiving botulinum toxin as primary treatment for ocular misalignment, the mean interval between subsequent injections increased significantly after refractive surgery. Among the patients who received botulinum toxin to treat a secondary deficit of motor fusion after refractive surgery, all attained stable binocular cooperation either permanently (63 per cent) or with annual botulinum toxin injections (37 per cent).

“The sensorial changes caused by refractive surgery can affect oculomotor balance. Considering the well-recognised beneficial role of correcting hypermetropia in treating refractive accommodative esotropia, this change may be useful. On the other hand a potential for strabismic complications after refractive surgery exists,” said Dr Brogelli, Centro Oculistico, Firenze, Italy.

“Our experience shows that improving vision with refractive surgery in patients with intermittently deviated eyes being treated with botulinum toxin enhances fusion. In addition, botulinum toxin treatment provides patients the opportunity to be considered candidates for refractive surgery if they have been excluded because of poor binocular vision associated with hyperactive extraocular muscles.”

Gender factors into the equation for satisfaction after multifocal IOL implantation

2008-09-14T09:55:00.001+01:00

Berlin

Gender should be another factor to take into account when planning multifocal IOL implantation, according to the findings of a study presented by German ophthalmologist Magda Rau MD.

Dr Rau analysed possible gender-related differences in patient acceptance and satisfaction after multifocal IOL implantation using data from patients who underwent bilateral surgery with one of four different multifocal implants between 1999 and 2007. The IOLs were used during successive time periods and represented different optics designs. Between 1999 and 2001, 40 patients received the refractive Array multifocal IOL (AMO). From 2000-2001, 40 patients received the MF4 (Zeiss), a refractive multifocal lens with a near dominant zone. The diffractive Tecnis multifocal IOL (AMO) was implanted in 11 patients who underwent refractive lens exchange between 2004 and 2005, and the refractive ReZoom IOL (AMO) was implanted in 80 patients between 2005 and 2006.

Based on ratings of satisfaction, explantation rates, and complaints about near vision, far vision, and dysphotopsias, Dr Rau concluded implantation of a diffractive IOL in women is associated with higher satisfaction whereas men are more satisfied with their vision after implantation of a multifocal IOL with a refractive design.

“Men are hunters and women gatherers. Women attach more importance to reading print without glasses, but with their shorter arms, they also prefer a shorter reading distance. In contrast, men place more importance on clear distance vision and seem to be more troubled by problems with glare and haloes. In fact, the only patients who underwent explantation because of unsatisfactory distance vision, glare, and haloes were men,” said Dr Rau.

“Thorough counselling is important for all patients receiving a multifocal IOL, but this information suggests the patient education must be even more careful in men.”

INTACS show excellent long-term results for keratoconus

2008-09-13T16:38:00.003+01:00

BERLIN-

Patients with keratoconus may derive long-term benefit from the implantation of intracorneal ring segments (INTACS, Addition Technology) in order to stabilise the progression of the disease and improve their visual outcomes, according to Joseph Colin MD.

Addressing delegates at the XXVI Congress of the ESCRS during a special clinical research symposium on keratoconus, Dr Colin said that the results of eight-year follow-up with INTACS suggests that they provide surgeons with a viable therapeutic alternative for ectatic diseases affecting the cornea.

“Our study demonstrated that INTACS segments are a safe and efficacious option for the treatment of patients with moderate to severe keratoconus who are contact lens intolerant. The improved functional vision associated with this treatment modality can defer or potentially eliminate the need for corneal transplantation,” he said.

Dr Colin, Hopital Pellegrin, Bordeaux, France, said that the broad goals of intracorneal rings in keratoconus are to stabilise the corneal topography, improve uncorrected- and best-corrected visual acuity, improve contact lens tolerance and spectacle use and delay the need for penetrating or deep lamellar keratoplasty.

Discussing the properties of the INTACS segments, Dr Colin noted that the clear micro-thin PMMA inserts are hexagonal in cross-section, with an arc length of 150°. The new model of the segments allows for an optical zone of 6.0mm compared to 7.0mm previously.

Reviewing the results of patients treated at CHU Bordeaux, Dr Colin said that the outcomes have been positive in 60 out of 65 eyes and have remained stable up to eight years after implantation. He also noted that penetrating keratoplasty could be carried out if necessary, as was the case for five patients in this study.

Dr Colin said that one of the clear advantages of INTACS implantation is that it is a fully reversible procedure.

“Removing INTACS is relatively straightforward once you follow the same steps as for the initial procedure. Using a diamond knife, you cut to two-thirds depth, reopen the incision and use Sinskey hooks to pull out the segments. You can then proceed with penetrating or lamellar keratoplasty in the same procedure,” he said.

Looking to the future, Dr Colin said that developments such as femtosecond-assisted creation of the channels for Intacs implantation, and synergistic approaches using ultraviolet collagen crosslinking to strengthen the cornea also hold considerable promise for the diagnosis and treatment of keratoconus.

Excellent long-term outcomes for ICL implant

2008-09-13T16:36:00.003+01:00

BERLIN-

Long-term clinical experience with the Visian Implantable Collamer Lens (ICL, Staar Surgical) demonstrates consistently high rates of refractive success, good safety and patient satisfaction, according to Carlo F Lovisolo MD.

“This lens has proved its viability and safety over the long-term with over 100,000 ICLs now implanted worldwide. From this experience and my own clinical experience of over 1,000 implantations, we can say that chronic IOP rise is not an issue with this lens nor are there any problems with chronic uveal inflammation. Once the proper sizing indications have been respected the ICL is safe for the corneal endothelium,” he said, speaking at the XXVI Congress of the ESCRS.

Dr Lovisolo, medical director, Quattroelle Eye Centre in Milan, Italy, said that three generations of the Staar ICL were implanted over the course of the 15-year study, the majority of which were the latest model, the V4, with improved vaulting to reduce the possibility of contact with the crystalline lens.

Dr Lovisolo noted that most late postoperative complications associated with ICL implantation, such as after-cataract and iridopathy, are size-related and can be thus avoided with proper anatomical measurements.

“We now know that sizing cannot be based on external anatomy as white-to-white measurements correlate poorly with internal dimensions. To correctly predict implant-to-tissue clearances, the ICL must be customised to the individual size and shape of the whole anterior segment as obtained with VHF echography,” he said.

Dedicated software to predict intraocular compression and vault height is also needed and implanted eyes should be monitored yearly after implantation, he concluded.

Corneal transplants safer and more efficient with femtosecond laser

2008-09-13T16:30:00.003+01:00

BERLIN-

IntraLase-enabled keratoplasty (IEK) represents the biggest advance in corneal transplantation in the last 30 years, said Yaron Rabinowitz MD, speaking at the XXVI Congress of the ESCRS.

“Using the femtosecond laser to perform corneal grafts leads to quicker visual rehabilitation, faster wound healing and safer surgery. It represents an excellent and safer new treatment option for keratoconus patients who are contact lens intolerant and is the only viable option when combined with LASIK or ICL implants for patients who want to become completely independent of contact lenses,” he said.

Dr Rabinowitz, director of ophthalmology research at Cedars-Sinai Medical Centre, Los Angeles, US, told delegates that the procedure results in high patient satisfaction and is easy to learn and to perform.

He noted that the femtosecond laser-assisted approach overcomes many of the inherent drawbacks of traditional corneal transplantation techniques such as long intraoperative duration, long visual recovery and the fact that many patients are left with residual postoperative astigmatism because the donor button has been sutured by hand.

IntraLase, which received FDA approval for full thickness penetrating cuts in July 2005, allows the user to perform three different cut segments, noted Dr Rabinowitz.

Discussing some of these cut profiles in more detail, Dr Rabinowitz cited the mushroom-shaped incision, which preserves more host endothelium than the traditional trephine approach. Another variation, he said, is the top-hat-shaped incision that allows for the transplantation of large endothelial surfaces, as well as a lamellar step for stronger healing and a reduced anterior surface area that is further from the limbus, possibly reducing rejection risk.

Yet another incision profile, popularised by Roger Steinert MD, is the zig zag–shaped incision providing a smooth transition between host and donor tissue and allowing for a hermetic wound seal. This type of incision provides oblique planes of contact and may potentially improve the strength of wound healing, said Dr Rabinowitz.

“This is my preferred cut. It can be performed on a larger surface area, promotes stronger and quicker wound healing and delivers an extremely smooth graft interface,” he said.

DLKP with bubble technique safe and effective to treat keratoconus

2008-09-13T16:27:00.003+01:00

BERLIN-

Deep lamellar keratoplasty (DLKP) using the injection of an air bubble appears to be a safe and effective procedure to correct keratoconus, Mohamed Alaa El-Danasoury MD told attendees at the XXVI Congress of the ESCRS.

“There is no endothelial rejection with DLKP, the procedure is safer in high-risk cases, it is reproducible and it enables a planned and controlled baring of Descemet’s membrane. Other benefits include the fact that there is no host-donor stromal interface, hence no endothelial rejection, it does not require excellent donor tissue and the refractive outcome can also be improved at a later date if required,” he said.

Disadvantages of the procedure include the learning curve needed to master the techniques involved and the fact that it cannot be performed when there are breaks in Descemet’s membrane, he added.

Dr El-Danasoury and colleagues at the Magrabi Eye Hospital, Jeddah, Saudi Arabia, reported on their results using the big bubble procedure to treat keratoconus in 87 patients.

He noted that the prevalence of the disease appears to be on the rise in his region.

“In the Middle East and Saudi Arabia, the prevalence of keratoconus is very high compared to countries in the west. We are seeing an average of four to five new cases every day and it is the foremost indication for corneal transplantation in our region,” he said.

In terms of patient selection for DLKP, Dr El-Danasoury stressed the importance of acting promptly to avoid the need for penetrating keratoplasty at a later stage.

“We do not let the patient wait until he is no longer a good candidate for lamellar keratoplasty. Our main concern is that we do not want the disease to progress to the point where the patient needs a full thickness graft. There is a very big difference between doing a lamellar graft versus a penetrating graft in these young patients with keratoconus because we are effectively nullifying the risk of having an endothelial graft rejection for the rest of their life,” he said.

The air-bubble technique was used in 113 eyes of 87 patients. All of them had moderate or advanced keratoconus and were dissatisfied with their corrected vision and/or hard contact lens wear, and all of them had intact Descemet’s membrane.

“We achieved Descemet’s separation using the big bubble technique in 91 per cent of the cases, with micro-perforations in seven per cent and we did not have to convert to a penetrating keratoplasty in any of the patients,” he said.

One year after the surgery, 84 per cent of patients recorded an uncorrected visual acuity of 20/40 or better, and 80 per cent were 20/40 or better three months after removing the sutures, concluded Dr El-Danasoury.

ESCRS welcomes delegates to Berlin

2008-09-13T07:21:00.001+01:00

Delegates attending the Welcome Reception for the XXVI ESCRS Congress enjoyed an excellent selection of smooth sounds and international food and refreshments.

The reception, sponsored by AMO, was hosted at the Axel Springer Passage, close to the historic Berlin landmark Checkpoint Charlie. The Axel Springer Passage is home to the Axel Springer publishing company.

Axel Springer, established by the publisher of the same name in 1946, is Germany’s largest publisher with titles including Die Welt and Bild.

Dr Emanuel Rosen to announce winner of John Henahan prize in Berlin

2008-09-12T09:52:00.005+01:00

The winner of the John Henahan Prize will be announced at the XXVI ESCRS Congress in Berlin on Saturday 13th September at 15.55 in Hall 15/2 as part of the Young Ophthalmologists programme.

Dr Emanuel Rosen, chairman of the Publications Committee of the ESCRS, will present a specially commissioned trophy to the winner.

Due to the high standard of a number of entries, two commendations will also be announced.

The winning entry will be published in the special Congress edition of EuroTimes on Sunday 14th September.

For further information also go to our website at www.escrs.org

Judging for Henahan Prize begins

2008-08-01T14:23:00.003+01:00

The judges have started work on deciding who will be the inaugural winner of the John Henahan prize for young ophthalmologists.

A distinguished panel of ophthalmologists and medical writers including Emanuel Rosen,FRCS, Jose Guell, MD, Sean Henahan, editor, EuroTimes and Paul McGinn,editor, EuroTimes will judge the entries from members of the ESCRS who are under 40 years of age.

Entrants were invited to write a 1,000-word article on “Why I became an ophthalmologist”.

The winning entrant will receive a prize of €1000 that will be awarded at the XXVI ESCRS Congress in Berlin,2008 in September. We will publish the winning entry in the October edition of EuroTimes.

Thanks to everyone who entered the competition. No correspondence will be considered once the judges have announced their decision.

Two weeks left to enter the John Henahan Prize

2008-07-17T12:29:00.002+01:00

There are only two weeks to go before the closing date for the John Henahan prize.

A distinguished panel of ophthalmologists and medical writers including Emanuel Rosen,FRCS, Jose Guell, MD, Sean Henahan, editor, EuroTimes and Paul McGinn,editor, EuroTimes will judge the entries.

John Henahan 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 “Why I became an ophthalmologist”.

The article should give a brief introduction into why the individual ophthalmologist decided on his or her career path and should include reference to his early education,including mentors and role models. The article should also look at issues and controversies in ophthalmology, including changing demographics and evidence based medicine. The closing date for entries is Friday,August 1,2008.

The winning entrant will receive a prize of €1000 that will be awarded at the XXVI ESCRS Congress in Berlin,2008 in September. We will publish the winning entry in the October edition of EuroTimes.

To apply, please e-mail your article, to Colin Kerr, executive editor, EuroTimes at colin.kerr@escrs.org. Your e-mail should include your full name,home address and phone number,your date of birth and ESCRS membership number.

•Entries received after August 1 will not be considered. The decision of the judges is final and no correspondence will be considered once they have announced their decision.

Four’s a crowd - femtosecond lasers compared

2008-06-30T09:16:00.009+01:00

Femtosecond laser refractive surgery first entered the clinic in 2001 with the FDA approval of the IntraLase system. That system is now in its fifth iteration, and has since been joined by three other femtosecond laser platforms. EuroTimes got an update on the features, performance, and applications of the individual lasers at a refractive surgery session at the WOC.

Comparing and contrasting

Holger Lubatschowski PhD, Germany, began the session by providing an overview of basic principles of femtosecond laser performance and a side-by-side comparison of the technical features of each of the four commercial platforms. All of the femtosecond lasers use photodisruption to cut through corneal tissue, and they all operate at a wavelength of about 1040 nm, but they differ in a number of technical respects.

The Femtec (20/10 Perfect Vision) and IntraLase have a high pulse energy, the LDV (Ziemer) has a very low pulse energy, and the VisuMax (Zeiss) lies somewhere in between. With the IntraLase, Femtec, and VisuMax, the cutting process is directly visible to the operator, whereas it is seen only on the monitor using the LDV. The Femtec and VisuMax have a spherical contact interface to the cornea, while the VisuMax has a contact glass for corneal fixation.

The LDV delivers its laser beam through a mirror arm that fits under all excimer lasers and consists of just an oscillator without an amplifier. Therefore, the LDV can be used without moving patients during the surgical process, and it is also the smallest of the devices.

The four femtosecond lasers also differ in pulse width, which ranges from 250 femtoseconds for the LDV to 500 femtoseconds for the IntraLase and Femtec. The repetition rate is in the MHz range for the Femtec and in the kHz range for the other platforms, while pulse energy is in the nanoJ range for the LDV and in the milliJ range for the others.

IntraLase

Perry Binder, MD, US, presented worldwide clinical experience with the IntraLase femtosecond laser. Since the introduction of the first generation system, the IntraLase platform has been used to perform more than two million procedures, including over 500 IntraLase-enabled keratoplasties. Other uses have included astigmatic keratotomy, wedge resection, lamellar keratoplasty, penetrating keratoplasty, creation of INTACS channels, and corneal biopsy.

The recently introduced 5th generation device provides a number of important features and benefits. This 150 KHz femtosecond laser allows reductions in time for flap creation and total energy delivery. It also permits unique methods of flap customisation, including a bevel-in sidecut angle, which has been shown in various studies to result in stronger flap healing.

The newest IntraLase laser also offers a high-resolution video microscope for increased depth of focus during surgery, a touchscreen user interface, and digital video output.

“We think the fifth-generation IntraLase laser enables most of the idealised goals of LASIK surgery better than any currently existing femtosecond laser while placing all the tools necessary for customising the flap within the hands of the surgeon,” Dr Binder said.

Femtec

The Femtec is a highly capable workstation that is also able to perform roles beyond LASIK flap creation, said Julian Stevens, MD, UK.

A key feature of this platform is that it has a curved patient interface that is important because it translates into less distortion of the cornea and less compression of the eye. Therefore, IOP is minimally increased.

The Femtec also features excellent diagnostic graphics on the video screen that are particularly useful for monitoring shape when cutting corneal grafts, a torque feature that detects patient head movement, and a direct diagnostic link with customised treatments.

In addition to having proven itself as a capable flapmaker, the Femtec laser has been used for astigmatic keratotomy, intrastromal astigmatic keratotomy, and cutting corneal grafts.

However, the capability that most distinguishes it from other existing platforms is its potential to be used to perform intrastromal refractive surgery with no flap.

“The Femtec laser is a very capable workstation with excellent software. It is one of the most sophisticated and advanced systems available today and may bring us to the Holy Grail of femtosecond lasers, which is to use this technology to put energy into the cornea in order to achieve a shape change without cutting a flap,” Dr Stevens said.

LDV

Theo Seiler MD, PhD, Switzerland, discussed the Ziemer LDV based on his experience over the last two years. His presentation delivered three messages relating to precision, safety, and platform dependability.

After proposing that a femtosecond laser has a role in refractive surgery for procedures where flap dimension precision truly matters, Dr Seiler reported that in a series of 92 eyes undergoing creation of flaps with an attempted thickness of 110 microns, the mean ± SD thickness was 109 ± 3.7 microns with a range from 101 to 116 microns. Flap diameter outcomes also showed sufficient precision and reproducibility, although Dr Seiler noted that the desired flap diameter is obtained only if the suction is complete.

Safety has been excellent. Complications encountered in the last 200 patients consisted of strong adhesion necessitating manual cut in two eyes, failure of the scan in one eye, too small flap diameter in one eye, and inability to perform two treatments because of a small eye and deep orbit. There were no air bubbles in the anterior chamber or eyes with transient light sensitivity, and eyes with Sands of Sahara have been very infrequent.

The LDV has also proven itself to be an easy-to-use and dependable workhorse, he noted.

“We have had to cancel only one surgery session over the last two years and consider this platform a Volkswagen, not a Ferrari. There is no need for a technician, no calibration, and no extra temperature and humidity controls. We know that with the LDV, we can just turn it on, and it goes,” Dr Seiler said.

VisuMax

As described by Marcus Blum MD, the VisuMax platform (Zeiss) is an integrated solution combining a femtosecond laser and excimer laser. It uses a spherical contact interface system to the cornea with low suction pressure so there is no vision loss during suction, and treatment positioning is precise as the patient fixates on a blinking light within the system.

A study using high-frequency digital ultrasound to measure flap thickness showed it performs reliably and precisely for flap creation. In a series of eyes with an attempted thickness of 110 microns, the mean achieved was 112 microns, 25 per cent of eyes were within two microns of intended, and 88 per cent were within 10 microns.

However, ongoing research using the VisuMax femtosecond laser for femtosecond lenticule extraction (FLEx) as a new method of refractive surgery is what is distinguishing this platform, said Dr Blum.

He presented data from six months of follow-up of more than 100 eyes showing good safety, refractive stability, and reasonable accuracy but with slight overcorrections in lower myopes.

“We have been very grateful to use this system because it works perfectly for LASIK flap creation. However, we have tried to take the VisuMax beyond the point where it is only a flap maker. Obviously there is a learning curve, but we expect the outcomes with FLEx will become more precise as the technique is refined, and this approach would have the advantage of eliminating the need for two lasers,” said Dr Blum.

Novel application

The various femtosecond lasers are being used for a number of different indications in corneal surgery. Diverging from that path, Ronald Krueger, MD, US, described research he has been conducting using a femtosecond laser to cause intralenticular photodisruption as a method for restoring accommodation.

The basic concept is to use an ultrashort pulse laser to cause photo-phaco-modulation in order to alter lens elasticity.

“The idea for this procedure is that creating small laser microperforations within the hardened lens nucleus would enhance the sliding of fibres within the lens and thereby increase lens flexure,” he explained.

An early study in cadaver eyes showed that treatment of a lens from a 54-year-old donor with 100 suprathreshold pulses in an annular pattern was associated with increased deformation when submitted to strain. Subsequent studies have focused on identifying the mechanism for that change, identifying the best pattern for the laser treatment, evaluating the potential to induce cataract, and determining what happens to the bubbles created.

So far, animal studies showed the treatment did not cause cataract, alter light scattering, or result in thermal damage into the peripheral lens tissue. Using a finite element model, it was determined that the procedure works because of sliding fibres within the lens and that layered shells are the best potential pattern so far. With the use of lens tissue cultures, it was seen that the bubbles disappear, and using an instrument to evaluate relative lens resistance to displacement with gradient steps of applied compression force, the results achieved were seen to be repeatable. These data are now being used to determine the parameters for achieving an accommodative effect.

“So far, our studies show accommodation restoration with intralenticular femtosecond lens treatment is theoretically possible and experimentally feasible. With sufficient clinical efficacy, laser lens modulation could become a new strategy in the quest for presbyopic correction,” Dr Krueger said.

More Info-----

For more information on femtosecond lasers in the clinic, listen to a EuroTimes podcast with Michael Knorz MD.

Medical journals join the 21st Century at WOC

2008-06-30T06:13:00.004+01:00

In a time of instant messaging, online interaction, and easy access to information online, medical journals often seem soooo last century. EuroTimes listened in on a session given at the World Forum of Ophthalmological Journal Editors in which editors discussed issues they face in the 21st century.

Open-access publishing

Cost issues, commercial influence scandals, and a call for public access to government-funded studies all helped create demand for new models of peer-reviewed medical information delivery. In particular Biomedcentral and the Public Library of Science have quickly gained support and have forced traditional journals to re-evaluate their methods.

However, the concept of what should be open access in the medical field is controversial because while it offers advantages, it can also result in a variety of threats, said Thomas J Liesegang MD, editor-in-chief, American Journal of Ophthalmology.

Quality of content and its interpretation are two major concerns about open access.

“Access to information is crucial to the health and economic wellness of people in all countries, but I maintain that health information is not the same as other information on the web. It needs to be vetted and I also maintain the average consumer does not have the skill to discern good from bad science,” Dr Liesegang said.

There is also the concern that historical scientific literature may be lost as there may not be enough resources to support both traditional and open-access systems simultaneously and continuously. Some journals may not be able to afford to appear in open access and the result could be the termination of small non-profit scientific journals or societies, Dr Liesegang explained.

Open access can be supported by a pay-to-publish model. However, some authors, especially in developing countries, cannot afford the fees, and institutions will have to decide which researchers to support. The result may be that journals become filled with articles supported by commercial interests.

Quality of research published is another issue as some start-up journals in need of material may be willing to accept any manuscript.

“The old subscription-based model has worked well and should not be abandoned until another form of communication is vetted and proven successful,” Dr Liesegang said.

EuroTimes looked at these issues in an earlier article,
Click to read article.

Evidence-based medicine

Randomised clinical trials are considered the gold standard of medical knowledge, and yet the high costs of developing this evidence-based medicine are making it affordable only to multinational drug and device company sponsors, said Francesco Bandello MD, Chinese Journal of Ophthalmology.

The result is a potential for publication of biased and misleading information. And even when the study is high quality, questions remain about how far and to which populations the results can be generalised.

Dr Bandello acknowledged he has no answers to the existing issues. He proposed it may be useful to have trials conceived, designed, and planned by physicians and sponsored by public, independent bodies. Importantly, it is also critical that trials with negative results be published.

“Perhaps we need to pay greater attention to small, smart, independent studies and to focus more on the substance of the research and not just the methods,” he said.

Citation analysis

Citation analysis methods assume more influential articles are cited more often, and these data are being widely used in research environments and by institutions. However, the information can be misleading, said Charles McGhee MD, PhD, editor, Clinical & Experimental Ophthalmology.

Dr McGhee discussed how the perception created by such statistics as citation counts and journal impact factor can differ from reality, and he also reviewed a new parameter – the H factor and provided an example to show it can be misconstrued when comparing two authors.

“The sole reliance on citation data provides at best an incomplete and often shallow understanding of research, an understanding that is only valid when reinforced by other judgments. Numbers are not superior to sound judgment,” said Dr McGhee.

Clinical trial registration

Andrew Schachat MD, editor-in-chief, Ophthalmology, discussed registration of clinical trials, noting that this issue gained attention due to concerns about publication bias favouring clinical trials with positive results. The idea behind registration is to get all trials out into the public record and it is required by all International Committee of Medical Journal Editors' member journals.

While three years ago registration was the exception; it is now becoming the rule. This is a change for the better. However, there is still room for improvement, said Dr Schachat.

“Registration facilitates the dissemination of information among clinicians, researchers, and patients. It also helps to assure trial participants that the information accrued as a result of their altruism will become part of the public record. However, key challenges remain, including problems with duplicate registrations and a need for better search engines,” he noted.

Reviewer issues

For peer-reviewed journals, the present system an editor uses to decide whether a submitted manuscript should be accepted, revised, or rejected depends on his or her review of comments provided by two or three reviewers who are “experts” in the field and anonymous to the author(s). However, problems plaguing this system have driven interest in an open system of review where the reviewers’ identity is made known to the author(s).

“The open system seems to make more sense because it would level the playing field and result in a review that is fair, just and constructive. However, it may be more difficult to find reviewers, and those who accept may tend to be less critical, resulting in higher acceptance rates for already overburdened journals,” said Arun Singh MD, editor, British Journal of Ophthalmology.

Studies evaluating open systems show these fears are well founded, and Dr Singh noted that while reviewers for papers submitted to the British Journal of Ophthalmology are offered the option for open review, only 15 per cent accept.

“We must move towards an open system of review, and newer technology, like Internet blogs, may make this easier. While we are not there yet, I think we may get there sooner than some think,” he said.

Continuing with the topic of reviewers, Alexander Brucker MD, editor-in-chief, Retina, discussed the challenges and opportunities for their selection that have emerged in the computer age. While the number of manuscripts being submitted to journals has increased thanks to the ease of online submission and recent growth in the number of journals, the number of reviewers has not kept pace with the demand, Dr Brucker said.

On the positive side, the Internet has made it easier to identify and contact potential reviewers, and it has also facilitated the reviewing task itself. However, potential reviewers receiving an email message soliciting their cooperation are also finding it easier to refuse by simply selecting the “decline” button, noted Dr Brucker.

“These are exciting times for medical journal editors. We face a number of challenges, but also have opportunities to seize that can result in an improved final product that is better for our consumers,” he said.

WOC debates the future of refractive surgery

2008-06-29T07:07:00.005+01:00

The World Ophthalmology Congress (WOC) got rolling in earnest with a number of sub-specialty sessions. We report from the Cataract and Refractive Surgery programme.

Seven well-known researchers offered their prognostications for what refractive surgery might look like in 2020.

Luis Ruiz MD, a true LASIK pioneer, described a new procedure he has developed which promised to dramatically alter the treatment of presbyopia. The technique, which he calls intraCOR, provides flapless intrastromal ablation using the Femtec femtosecond laser (20/10 Perfect Vision) to achieve reshaping of the cornea without touching epithelium, endothelium, Bowman’s membrane, or Descemet’s membrane.

Compared with existing refractive surgery techniques, intraCOR has multiple advantages that include simplicity, speed and safety. The procedure would avoid complications related to flap ablation and surface ablation, can be performed in thin corneas, does not weaken corneal biomechanics nor induce dry eye, and has a reduced risk of infection.

Dr Ruiz has experience with intraCOR in more than 700 patients who have been treated for presbyopia, myopia, hyperopia and astigmatism using customised patterns. Although this new procedure is still being refined, he presented results from a study of presbyopia treatment that included 45 eyes treated with an identical ablation protocol. All had at least one month of follow-up with a range up to six months. Simultaneous UCVA distance and near results showed 100 per cent of eyes achieved 20/25 or better and J2 or better. At three months no patient had lost even one line of distance best corrected visual acuity. Contrast sensitivity was improved in both photopic and mesopic conditions.

Safety data are encouraging – hysteresis was increased, the corneal resistance factor was unchanged, and there were no changes in endothelial cell density or corneal thickness.

“It would be difficult to find an easier or more effective procedure, and in my experience with refractive surgery for presbyopia, I have never seen such amazing safety and quality of vision,” said Dr Ruiz.

The wavefront data provide an explanation for the outstanding results and reveal the treatment results in a true multifocal corneal with a decrease of defocus that results in a myopic shift and an increase in spherical aberration yielding increased depth of field.

Dr Ruiz concluded his talk by acknowledging the need for further studies, but Jorge Alio MD, PhD, chairman of the session commented that if the promising outcomes being achieved with this important innovation are confirmed in subsequent research, it will completely change the way refractive surgeons approach the treatment of presbyopia.

Myopia prevention

Donald Tan MD, Singapore, discussed prevention of myopia progression in schoolchildren using a treatment called Neurovision. This approach is particularly relevant in Singapore where myopia progression in children occurs at a rate of about 100 degrees per year so that by age 18, about 80 per cent of Singaporeans are myopic.

“As myopia progresses in young children, their spectacles fail to keep up with the progression rate and visual acuity is suboptimal. Neurovision aims to enhance visual acuity without changing the refraction so that theoretically, visual acuity can be shifted toward a more normal level. And, maybe if we are successful in preventing myopia evolution, we will not need to perform so much refractive surgery in the future,” he said.

The approach involves a computerised, Internet-based program that uses visual stimuli to optimise image processing by the visual cortex, enhancing contrast sensitivity by neural adaptation and repetitive visual memory exercise to result in enhanced visual acuity. The exercises use a visual psychophysics tool and are performed every other day for a total of 30 sessions.

More than 1,300 patients have been treated with the Neurovision approach to date both in clinical trials and commercially. Patients have included mild myopes, children and adults with amblyopia, presbyopes, post-refractive surgery patients, and people with high functional visual demands aiming for sharper vision. Results have been published in the literature showing consistently that patients gain more than two lines of ETDRS visual acuity and maintain a majority of the benefit after 12to 18 months.

Its efficacy in reducing myopia progression in schoolchildren was evaluated in a pilot study that had a prospective non-comparative design. Thirty children ages seven to nine years performed the sessions using a treatment adapted to a computer game and were followed for 18 months after completing the program.

The results were consistent with other studies in showing a mean improvement of logMAR visual acuity of about 2.2 lines along with improvement in contrast sensitivity that enabled the children to wear spectacle undercorrection and still get good vision.

“This may be the first effective treatment modality to reduce myopia progression in children without medical or surgical treatment. The results of this pilot study provide the basis for a large-scale, placebo-controlled randomised clinical trial that will be launched in four schools this year,” said Dr Tan.

Ultra-thin corneal inlays

Placement of a corneal inlay represents another approach under investigation for the treatment of presbyopia. Relative to some other techniques, it has a major advantage of being reversible and exchangeable, said Perry Binder MD, US.

Dr Binder discussed the ACI 7000 (AcuFocus) corneal inlay, a small, ultra-thin device placed within a pocket that works via a pinhole effect to increase depth of focus. The goal of this procedure is to create less of a blurred image on the retina up close without interfering with distance vision. The surgery takes just five minutes and cosmesis is excellent.

Almost 400 eyes have been implanted with this inlay and up to three years of follow-up is available. Results show no change in distance uncorrected visual acuity but a significant improvement in near vision with most eyes achieving J1 or better. Similarly positive results are being achieved in a smaller series of patients who have received a thinner model inlay (5 vs 10 microns thick).

“Lots of questions need to be answered, including what is the best material to use, what is the best method to centre the device, and should it be placed through a flap or pocket. However, we have found patients are happy and achieve the benefit of a +1.5 D lens without handicapping their distance visual acuity,” Dr Binder said.

Considering that it takes 10 to 12 years between the time an investigational IOL is first implanted in human eyes and then achieves approval by the US FDA, David F Chang, MD, US, reviewed four accommodating IOLs that have the potential to be available in 2020 because they have already entered clinical trials.

Accommodative IOLs

The Synchrony dual optic accommodating IOL (Visiogen) combines a +32 D moving front optic with a posterior optic of variable minus power based on the individual patient’s needs. It is a silicone, bag-filling IOL that comes pre-loaded in an injector system for delivery through a small incision. The implant is designed to work according to the Helmholtz theory and delivers +2 to +2.5 D of accommodation.

A Phase III US FDA trial including 475 eyes was completed in November 2007. While data are not available from that study, Ivan Ossma, MD, has reported a randomised clinical trial comparing the dual optic accommodating IOL with the ReSTOR multifocal IOL (Alcon Laboratories) in 100 patients. Its results favoured the dual optic IOL for better intermediate vision, contrast sensitivity, reading speed, and problems with haloes. High-definition UBM studies confirm movement of the anterior optic, said Dr David Chang.

Two shape-changing lenses (NuLens, Power Vision) have the potential to provide +8 to +10 D of accommodation. The NuLens features a deformable substance between two rigid plates that is pushed forward through a small aperture by ciliary muscle contraction to create a change in lens curvature. The anticipated commercial design will consist of a haptic unit and a base unit assembled inside the eye.

Jorge Alio MD, PhD, has conducted a pilot trial in 10 blind eyes with BSCVA of 20/200or worse and showed attainment of up to +10 D of accommodation that provided enough magnification so patients could read large print.

The Power Vision accommodating IOL is based on movement of fluid from a reservoir and has been evaluated in five blind eyes. Proof of concept has been demonstrated by anterior segment OCT imaging after pharmacological stimulation of accommodation.

Based on the unexpected finding that a patient implanted with the Light Adjustable Lens (Calhoun Vision) achieved J1 reading vision after treatment for residual myopia, this platform is also being considered as a presbyopia-correcting lens. The algorithm would involve creation of an aspheric design that is gradually sloping off into the periphery with a blend, like a Varilux lens, to create a multifocal lens without discrete rings.

“This approach would reduce problems with glare or haloes and would simultaneously allow guaranteed treatment of residual sphere and cylinder,” Dr Chang said.

Future directions in science, and marketing

Ioannis Pallikaris MD, PhD, Crete, discussed the emerging field of “Presby-optics”. He described evolving knowledge of the underlying physiology of presbyopia that has developed as a result of improved technology for studying the dynamic accommodative process.

“Understanding Presby-optics is about merging this basic knowledge and clinical experience and then applying it to identify the best overall solution for each patient,” he said.

Richard Lindstrom MD, US, concluded the session by providing his thoughts on the future directions for market growth in IOLs for presbyopia correction. Currently, monofocal implants account for 95 per cent of the pseudophakic market with multifocal IOLs accounting for four per cent and the remaining one per cent represented by accommodating IOLs. Looking ahead, Dr Lindstrom expects to see a significant market share shift as monofocal IOLs undergo a steady decline, multifocoal IOLs enjoy an initial surge but then disappear completely, and accommodating IOLs enjoy increasing growth to account for 20 per cent of implants by the year 2020.

“While revenue growth in the cataract IOL market has been occurring at a rate of about three per cent a year, 59 per cent of the growth in IOL revenue in 2006 came from presbyopia-correcting lenses. I expect we will continue to be seeing these new growth patterns into the future. However, surgeons should also remember that monovision with monofocal IOLs remains a popular option that should be offered to patients,” Dr Lindstrom said.

Dr Lindstrom is not alone in his belief that multifocal IOLs are the future of presbyopia-correcting implants. In the 2007 survey of ASCRS members, 76 per cent of respondents said they would favour an accommodating IOL for themselves if they had a presbyopia-correcting lens.

There is also clinical trial evidence that accommodating IOLs can generate satisfactory objective and subjective patient outcomes when used symmetrically or asymmetrically with other types of implants. His outlook for an advance in accommodating IOL market share is also based on the promise of IOLs in development that can provide a greater range of accommodative amplitude.

Dr John Chang appointed medical editor of EuroTimes China at WOC in Hong Kong

2008-06-27T13:15:00.003+01:00

Dr John Chang has been appointed medical editor of EuroTimes China. Dr Chang, who takes up his position from today, June 27, will have responsibility for the editorial content of the magazine working with the newly appointed Editorial Board of EuroTimes China.

The appointment was announced to coincide with the WOC meeting in Hong Kong.

“We are delighted to invite Dr Chang to join our editorial team," said Dr Emanuel Rosen, chairman of the International Editorial Board of EuroTimes. “EuroTimes China is published by the ESCRS and offers Chinese ophthalmologists a forum for discussion, learning and the development of global ophthalmology,” said Dr Rosen.

“EuroTimes China has now reached 8,000 circulation and is still growing and we are confident that with Dr Chang’s guidance we will enhance the communication between the European and Chinese ophthalmologists,” he said.

Dr Chang said he was honoured to accept the position. “EuroTimes China is highly regarded in the ophthalmological community, and I hope to build on its growing reputation, working closely with the ophthalmologists of great talent, influence and learning on the EuroTimes China editorial board,” said Dr Chang.

The members of the Editorial Board of EuroTimes China are:

Dr Yansheng Hao, Dr Ningli Wang, Dr Ying Li, Dr Yuegou Chen, Dr Haike Guo, Dr Yizhi Liu, Dr Jian Ge, Dr Zheng Wang, Dr Dong Fangtian, Dr Xiaoxin Li, Dr Chenjin Jin, Dr Gezhi Xu,Dr Xun Xu, Dr Peiquan Zhao, Dr Zhenping Huan, Dr Jinsong Zhang, Dr Yi Lu, Dr Zinghuai Sun, Dr Jingcai Lian, Dr Xingtao Zhou, Dr Kanxing Zhao, Dr Yan Wang, Dr Ke Yao, Dr Ye Shen, Dr Qinmei Wang, Dr Yaohua Sheng, and Dr Yuehua Zhou.

For more information contact Mr Colin Kerr, executive editor of EuroTimes, at 00 353 86 0473478.

ESCRS symposia at WOC in Hong Kong

2008-06-26T15:27:00.002+01:00

The ESCRS is hosting two symposia at the World Ophthalmology Congress in Hong Kong, which runs from 28 June until 2 July.
On Sunday 29 June, from 9am to 10.30am, Paul Rosen will chair a session on The Cutting Edge of Cataract Surgery. This will be followed on Sunday afternoon from 4pm to 5pm with a discussion on IOL Based Refractive Surgery chaired by Ioannis Pallikaris.

The full timetable is:

Sunday 29 June

09.00 – 10.30
The Cutting Edge of Cataract Surgery
Chairperson: Paul Rosen UK

09.00 Charlotta Zetterstrom Norway
Paediatric cataract surgery

09.10 Marie-Jose Tassignon Belgium
Bag-in-the-lens in a child’s eye

09.20 Peter Barry Ireland
ESCRS Endophthalmitis Study – further results

09.30 Clive Peckar UK
Toric IOLs

09.40 Richard Packard UK
Phacodynamics

09.50 Gerd Auffarth Germany
Multifocal IOLs

10.00 Jorge Alio Spain
Quality of incision in cataract surgery

10.10 Ioannis Pallikaris Greece
Apodized versus aspheric multifocal IOLs

10.20 Discussion

10.30 End of session
..........

Sunday 29 June

16.00 – 17.30
IOL Based Refractive Surgery
Chairperson: Ioannis Pallikaris Greece

16.00 Ioannis Pallikaris Greece
Introduction

16.08 Klaus Ditzen Germany
Overview of different IOLs in refractive surgery

16.16 Jose Guell Spain
Veryflex Phakic IOL and LAL Light Adjustable Lens: Two years' follow-up

16.24 Joseph Colin France
Update on anterior chamber and posterior chamber IOLs

16.32 Camille Budo Belgium
Artiflex lens

16.40 Michael Knorz Germany
Keys to LASIK in monofocal and multifocal pseudophakes

16.48 Matteo Piovella Italy
Nine pearls to improve outcome in advanced multifocal IOL implantation

16.56 Rudy Nuijts Netherlands
Astigmatism management in cataract surgery with Toric Intraocular Lenses

17.04 Manfred Tetz Germany
Refractive Lens Exchange: Short and long term results

17.12 Discussion

17.30 End of session

EURETINA gets ready for Nice

2008-05-24T08:21:00.003+01:00

The success of the 8th EURETINA Congress in Vienna will inspire the organisers of next year's conference in Nice, France, to host an even bigger and better conference.

That is the view of EURETINA president Dr Jose Cunha Vaz. "The challenge is always to produce a better conference next year," Dr Cunha Vaz told EuroTimes. "One of the most notable aspects of this year's conference has been the attendance of a large number of younger retina specialists and I am very encouraged by that," he said.

The 9th EURETINA Congress will be held in the Nice Acropolis Centre from 14 May to 17May 2009.

EuroTimes will be providing regular updates on EURETINA in the future so watch this space.

Austrian ophthalmologists honoured to host EURETINA Congress in Vienna

2008-05-23T16:53:00.006+01:00

By Dermot McGrath

As the celebrated crossroads of Europe, Vienna provides the perfect backdrop for this year's gathering of clinicians and researchers interested in the research and treatment of retinal and macular diseases.

Speaking on behalf of the Austrian Ophthalmological Society (ÖOG) at the opening ceremony, Susanne Binder MD, the current president of AOS, said that her organisation was honoured that the EURETINA Congress was taking place in Vienna. She noted that attendance at the annual congress is increasing each year with over 1,500 delegates from 74 countries attending this year's event.

Dr Binder noted that the ÖOG has a long and rich history and some of the most famous names in ophthalmology have been counted among its ranks. The society was officially founded in 1954, with Prof Dr Anton Pillat, head of the First University Eye Clinic in Vienna, serving as its first president.

Among some of the pioneers in retinal research who have close associations with Vienna, Dr Binder cited Georg Joseph Beer who gave the first clinical description of a detached retina in 1817, Karl Lindner who helped to popularise scleral resections in the 1930s after Muller had introduced it in 1903, and Karl Hruby who made great advances in retinal detachment surgery.

More recently, Dr Binder said that people such as Heinz Freyler, Hans Gottinger, Ursula Schmidt-Erfurth, Andreas Wedrich and Nikolaos Bechrakis, were continuing Austria's proud tradition in the field of retinal research.

Turning to the aims of the ÖOG, Dr Binder said that the organisation has continued to evolve since its foundation in 1954 and is continually seeking to better serve the needs of its members.

“Our organisation provides information and exchange about the latest research and state-of-the-art treatments, organises continuing education, licenses examinations, sets guidelines for therapies and defends the interests of its 930 members. We are also building greater links with other ophthalmological organisations and have recently joined the European Board of Ophthalmology, and the Vision 20/20 programme in order to improve our international education and training,” she said.

The ÖOG holds its own three-day meeting every year, usually in May or June, which is designed to showcase state-of-the-art treatments as well as the latest developments in research and clinical practice. The organisation also has its own scientific journal Spektrum für Augenheilkunde, which publishes a wide range of articles on all aspects of ophthalmology as well as reports of the society's meetings.
In her concluding remarks, Dr Binder thanked the ophthalmic industry for its ongoing support of the EURETINA Congress and said she looked forward to seeing even more delegates at next year's gathering in Nice, France.

1,500 retina specialists attend 8th EURETINA Congress in Vienna, Austria

2008-05-22T15:36:00.008+01:00

More than 1,500 delegates have registered to attend the 8th EURETINA Congress in Vienna.

Over the past years EURETINA has grown and expanded its activities. Attendance at the annual congress is increasing each year with 973 delegates from 63 countries attending the 2007 EURETINA Congress in Monte Carlo.

The increase in the number of delegates at the 2008 Congress reflects the growing importance of EURETINA as an organisation but also the strength of the scientific programme at the Congress.

The European Society of Retina Specialists (EURETINA) is an organisation comprising clinicians, scientists and researchers interested in treating macular and vitreoretinal diseases. It was founded as a non-profit organisation in 2000.

Over the next few days, the EuroTimes weblog will feature some of the highlights from the programme and some of the messages from the key speakers attending the congress.

We welcome the views and opinions of EuroTimes readers and delegates attending this year's congress, so please feel free to comment on any matter of interest to you.

Jose Cunha-Vaz

EURETINA president

EURETINA goes from strength to strength

2008-05-21T11:49:00.007+01:00

EURETINA is celebrating its eighth year in existence with the Vienna meeting. There is a lot to be proud of and this organisation is going from strength to strength.

From what started as a small special-interest group a few years back, EURETINA has evolved into a truly international organisation.

There is no room for complacency and there are always ways in which things can be improved, so we’ll certainly be looking to build on this foundation in the years ahead.

There are several reasons for the growing success of the organisation. Firstly, there is the high quality of the congress itself, which has improved tremendously over the past three years. We are continually looking for new ways to make the experience even better for the delegates. For instance, the introduction of surgical-skills courses is attracting great interest. Furthermore, the scientific programme is of a very high standard and there is a broad range of topics to reflect the latest developments in the field.

It is also vital to stress that while we have excellent participation from the ophthalmic industry, with a first-rate exhibition and many sponsored symposia and so forth, the meeting is not industry-driven and has maintained its reputation for scientific credibility and independence. Another factor is that it is not only retinal specialists who are attending the meeting. Intravitreal injection has opened the door to a lot of new therapies and even general ophthalmologists are beginning to get very interested in the possibilities of these treatments. All of these factors together are helping to increase interest and helping the organisation to expand rapidly.

EURETINA has helped to fill an obvious gap in Europe by bringing retinal clinicians together in the region. After all, Europe is expanding at a rapid rate and it is particularly encouraging to see so many new colleagues joining from eastern Europe, now that the door has been opened to them to attend this kind of meeting. There is also a great thirst for knowledge and innovation in many of the new European Member States and I think that is helping to drive the interest in EURETINA as well.

* Jose Cunha-Vaz, president of EURETINA,in an interview with Dermot McGrath. The full interview will be published in the special EUROTIMES EURETINA Daily supplement which will be published on Saturday May 24th

EuroTimes to post daily EURETINA weblogs

2008-05-21T11:38:00.004+01:00

I will be in Vienna with EuroTimes' contributing editor Dermot McGrath posting daily weblogs from the 8th EURETINA Congress. If you wish to comment or leave suggestions for articles, please feel free to do so.

Dr James MacCallum: Canadian ophthalmologist and friend of the Group of Seven

2008-05-12T14:29:00.004+01:00

The XXVI Congress of the European Society of Cataract and Refractive Surgeons will be held in Berlin from September 13 to September 17.

In recent issues of EuroTimes, we have looked forward to the Berlin congress by profiling some of the great German philosophers who have shaped the future of ophthalmology including Goethe and Helmholtz.

Dr James MacCallum (1860-1943 does not fit automatically into this category but his influence on the arts merits a closer look at his life and career.

MacMCallum is indelibly linked to the work of The Group of Seven, a group of Canadian landscape painters in the 1920s, originally consisting of Franklin Carmichael, Lawren Harris, A Y Jackson, Frank Johnston, Arthur Lismer, J E H MacDonald, and Frederick Varley.

Tom Thomson (who died in 1917) and Emily Carr were also closely associated with the Group of Seven, though neither were ever official members. The Group of Seven is most famous for its paintings of the Canadian landscape. It was succeeded by the Canadian Group of Painters in the 1930s.

I was lucky to see some of the Group of Seven’s work when I recently visited The McMichael Canadian Art Collection in Kleinburg, an idyllic rural setting, approximately 30 kilometres northwest of downtown Toronto.

Of 10 artists who were members of the Group of Seven, six are buried in a small cemetery on the McMichael grounds: Arthur Lismer, Frederick Varley, Lawren Harris, Frank Johnston, AJ Casson and A Y Jackson.

MacCallum was friend, patron and mentor to the Group of Seven and without his financial support, they would not have enjoyed the influence they do today. He was particularly close to Lawren Harris who studied in Berlin from 1904 to 1907.
His time in Berlin may have helped Harris learn his craft as an artist but it also may have reinforced his deep love of the Canadian landscape which was reflected in his subsequent work on his return to Canada.

Harris shared his love of the Canadian wilderness with MacCallum who promoted the Group of Seven by buying their work and also by encouraging others to do so.

In an essay in the Canadian Medical Association Journal (CMAJ) “Dr James MacCallum: patron and friend of Canada’s Group of Seven” (Can Med Assoc J 1996;155: 1333-5) Roger Burford Mason, notes that MacCallum’s keen delight in painting and in helping artists, expanded the borders of Canadian art.

MacCallum received a BA from the University of Toronto in 1881 and also spent two years studying in Moorefield’s Hospital in London, England before returning to Toronto in 1888 where he spent the next 50 years as one of Toronto’s most respected ophthalmologists.

In a letter to the CMAJ, Dr Graham E Trope, MB professor and head of the University of Toronto and ophthalmologist-in-chief of The Toronto Hospital points out that while he has been rightly honoured for his contribution to the development of Canadian art, in his time, MacCallum was also considered the most outstanding ophthalmologist in Ontario.

He was professor of ophthalmology at the University of Toronto from 1914 to 1929, published widely on ophthalmologic conditions and represented the university on the council of the College of Physicians and Surgeons of Ontario.

And that is where it ends for now, but I'd be glad to hear from any readers of this weblog who have more information on James MacCallum.

References:

Thanks to Mike Keenan whose website whattravelwriterssay.com/kleinburgontario has excellent information on Kleinburg.

The information on Dr James MacCallum is sourced from the website of the Canadian Medical Arts Journal at: cmaj.ca, and from Roger Burford Mason’s article: “Dr James MacCallum: patron and friend of Canada’s Group of Seven” (Can Med Assoc J 1996;155:
1333-5).

EuroTimes in Toronto

2008-05-12T12:03:00.003+01:00

I'm just back from a week's holiday in the beautiful city of Toronto.

For any doctors or ophthalmologists who are interested in intelligent radio programmes about medicine, check out an excellent series on Canadian radio called White Coat, Black Arts.

The link is www.cbc.ca/whitecoat/2008

EuroTimes Practice Management Resource Centre - Developing a vision for your practice

2008-04-23T12:13:00.001+01:00

Great ophthalmologists do not necessarily make great business experts.

That is why EuroTimes has decided to invite business and management experts to address the EuroTimes Practice Management Resource Centre workshops at the XXVI Congress of the ESCRS in Berlin from Saturday September 13 to Monday September 15.

These workshops will be run every year and will be an integral part of the EuroTimes Practice Management Resource Centre service which aims to help ophthalmologists develop a vision for their practices.

At these workshops we will look at the challenges that ophthalmologists face and the opportunities that are available to them.

The knowledge they acquire at these workshops will assist them in delivering the highest level of services to their patients

For many ophthalmologists, the prospect of establishing and managing a practice can be daunting. These workshops will explain the nuts and bolts of running a successful practice and will also offer ophthalmologists and their practice staff the opportunity to discuss their personal experiences in practice development with their colleagues.

Further information about these workshops will be available on this weblog, in the May issue of EuroTimes and also on our website at www.escrs.org.

EuroTimes Podcasts with Dr Thomas Kohnen, Dr Emanuel Rosen and Dr Joseph Colin

2008-04-22T13:40:00.001+01:00

One of the most exciting innovations on the EuroTimes website (www.eurotimes.org) has been the launch of a podcasting facility.

We did our first podcast in September 2007 with an interview at the XXV ESCRS Congress in Stockholm where we talked to Dr Thomas Kohnen about Phakic IOls. We have now revisited the subject with an interview with Dr Joseph Colin.

EuroTimes editor Sean Henahan has also interviewed Dr Emanuel Rosen about the promising results from the solid-state laser system known as the Pulzar Z1 from CustomVis.

In the coming weeks we will be posting more podcasts on our website, so watch this space.

A maverick ‘doesn’t stab you in the back – he stabs you in the FOREHEAD’

2008-04-07T18:26:00.008+01:00

By Howard Larkin

The “maverick” in question is, of course, Arizona Senator John McCain, the presumptive standard-bearer of the Republican Party in the November US presidential election.

The characterisation comes courtesy of Tony Snow, erstwhile chief flack for the current US President, George W Bush.

Tony graphically amplified his opinion of how Senator McCain has treated his fellow Republicans with a gesture involving a fist and a forearm. He’s still pretty sore about stuff like McCain supporting political campaign financing reform, and opposing tax cuts for the rich and torturing prisoners of war.

Your humble blog-o-spondent can only apologise for not having camera at the ready. Maybe you can download the tape from the American Society of Cataract and Refractive Surgery’s new EyeSpaceMD (Note: link to http://www.eyespacemd.org/ResourceLibrary/SearchPage.aspx?Search=government+relations )? Hard for me to say without a password, but it appears to be there.

Tony was the featured speaker at the ASCRS Government Relations Committee’s general session at the society’s annual meeting in Chicago. You might more expect this kind of gesture along the docks in the Windy City’s Calumet Sag than on a tony stage in McCormick Place, one of the largest and highest priced convention centres in America, if not the world. Well, maybe not the world these days. Y’all come down to America, now, it’s gittin’ cheap. Well, cheaper, anyway.

Tony admits that the US economy isn’t looking so good at this instant. How could he when just two days ago the US Bureau of Labor Statistics reported a 3/10ths per cent increase in unemployment to 5.1 per cent in March alone?

But Tony points out that more people made more money in the US under George W Bush than in any period in history – an unprecedented 52 months of uninterrupted economic expansion and job growth, in fact.

Never mind that for most of those months jobs added fell well below the estimated 150,000 needed to keep up with population growth. Or that peak median household income during the current economic expansion didn’t exceed the peak during the previous business cycle for the first time since such statistics have been kept. Or that the US government only considers you “unemployed” if you have no job income at all and have actively looked for a job during the past month.

In other words, if you make $100 a month babysitting or have just given up looking for work after months of no luck, you’re not unemployed you’re just lazy, I guess. Add in the 4.9 million who are working part-time for “economic” reasons, a figure that has jumped more than 629,000 in the past year, and the 400,000 who are “discouraged,” meaning they are not looking for work because they don’t think jobs are available, and the unemployment rate jumps to a not-so-impressive 8.5 per cent.

Tony also failed to mention that for the most part, unemployed Americans also have no health insurance coverage. About 20,000 of the 47 million uninsured in the US die every year because they cannot get adequate care without coverage, according to studies by the Institute of Medicine and other researchers.

Still, Tony believes that the US remains the engine of economic development in the world. We are still the country where people come to make their fortunes, he says. And even though 81 per cent of Americans believe the country is on the wrong track, he says that about the same percentage say they themselves are doing just fine. As I go online, I’m having no trouble verifying the 81 per cent on the wrong course figure, but so far have yet to find the other data Tony vaguely refers to. But I’m sure it’s out there.

Anyway, if it seems a bit indecorous for a guy who fronted for the top Republican to bash the heir apparent like Tony does, just consider what he has to say about the Democrats.

Hillary Clinton: “When [Bill Clinton] walks into the room he is the focal point of everyone’s attention. When [Hillary Clinton] walks into the room, you ask ‘who turned up the air conditioner?’”

Bill Clinton: “I love to watch Bill Clinton for the same reason I watch the Indianapolis 500. I want to see what happens when he hits the wall at 200 miles per hour.”

Barack Obama: “Obama has Bill Clinton’s gift for telling people what they want to hear. …Hope and change? Raise your hand out there, who’s against hope?”

Tony even thumps his ex-boss George W: “He speaks English and Spanish in the same way – they’re both second languages.”

Very funny stuff. Standing ovation stuff.

Tony believes the real problem in America is that the political establishment, in the words of George W, “misunderestimates” the American people. The entire political establishment, on both sides, lacks a “governing ideology.”

Tony doesn’t say what that ideology should be beyond suggesting that it should reflect the spirit of freedom that America embodies. Apparently, it has something to do with standing together and shouting “USA, USA, USA,” like several thousand American citizens of all national origins did at Ground Zero in New York City several weeks after the 9/11 terrorist attacks. More substantively, it should promote technology and business growth somehow. I think.

Tony says he doesn’t think that any of the three prospective presidents has the oomph to break through the poisonous partisanship that has paralysed Washington. He thinks that this time around, Obama and McCain will slug it out, McCain will win the presidency, the Democrats will take large majorities in both houses of the US Congress, and the stalemate will continue. A “transcendent political leader” will be needed to break the gridlock and that might happen in the 2012 election cycle, if we’re lucky, says Tony.

Tony also notes that everyone expected Hillary Clinton to have the nomination in hand by now, and no one expected McCain to get the Republican nomination. Barack Obama, with his perfect political pitch, came out of nowhere, Tony says. With a superbly organised national campaign, I might add.

Democracy broke out, Tony says. And for once, he’s right. Maybe we won’t need to wait for 2012 to get away from personal attacks and obscene gestures as part of our political discourse. Though somehow, I doubt it.

Dr Peter Barry answers critics of ESCRS Endophthalmitis Study

2008-04-06T20:42:00.007+01:00

Dr Peter Barry offered a spirited defence of the European Society of Cataract and Refractive Surgeons(ESCRS)Endophthalmitis study at an ASCRS Symposium today.

Dr Barry, who was part of the ESCRS team that took part in The Around The World in 90minutes symposium, was discussing antibiotic prophylaxis with a number of colleagues from the American Society of Cataract and Refractive Surgery(ASCRS) the Asian Pacific Association of Cataract and Refractive Surgeons (APACRS) and the Latin American Society of Cataract and Refractive Surgery (ALACSA/LASCRS).

From the results of the ESCRS study, Dr Barry and his co-investigators recommended that intracameral cefuroxime should be adopted worldwide. They said its use could save many thousands of eyes from potential blindness due to postoperative bacterial endophthalmitis following cataract surgery with IOL implantation.

The study enrolled 15,971 subjects from 23 clinics in nine European countries. The study found that the rate of endophthalmitis ranged from 0.05 per cent to 0.35 per cent

Dr Barry referred to criticism of the study in the American literature and particularly by the editor of Ophthalmology who had stated that this rate was "extraordinarily high".

"I would challenge that comment, " said Dr Barry, "because in Sweden where the standard practice is intracameral cefuroxime and no antibiotics, in their intracameral cefuroxime group their endophthalmitis rate is almost identical to our intracameral rate."

Dr Barry said the March 2007 editorial in Ophthalmology was titled Making The Most of the Evidence. "I would say to the editor of Ophthalmology that he is not making the most of the evidence, " said Dr Barry.

The other members of the ESCRS team who presented at the meeting were Dr Jose Guell (astigmatism) Dr Thomas Kohnen (IOL optics), Dr Simonetta Morselli (phaco fluidics), Dr Richard Packard (coaxial versus biaxial phacoemulsification) and Dr Paul Rosen (multifocal versus monovision).

ends

* A report on the ESCRS Endophthalmitis study will be featured in the May edition of EuroTimes. We are also preparing a podcast on the subject at www.escrs.org featuring an interview with Dr Peter Barry

Rolling Stones Start Up Binkhorst Lecture

2008-04-05T17:56:00.001+01:00

They weren't there in the flesh but The Rolling Stones got the Binkhorst Lecture off to a lively start when their classic track "Start Me Up" pumped out from the audio system to introduce Dr Edward Holland on stage.

Dr Holland explained that he hoped his choice of music would help keep the audience awake but there was no danger of anyone dozing off as he delivered an absorbing address on Innovations in Corneal Surgery:Beyond Penetrating Keratoplasty.

The past few years have brought tremendous innovations in corneal surgery as new surgical procedures target the specific layer of pathology rather than replacing the entire cornea for all disorders. Endothelial disease is no longer managed by penetrating keratoplasty but rather the more precise techniques of endothelial keratoplasty. Anterior corneal disorders can be treated with the newer deep anterior lamellar keratoplasty techniques.

Dr Holland explained how patients requiring penetrating keratoplasty have better refractive outcomes because of laser vision correction surgery in the grafts as well as femtosecond assisted keratoplasty surgery. These techniques have resulted in much improved uncorrected as well as best corrected visual acuity.

The most challenging corneal patients, he said, are those with limbal stem cell failure. These patients benefit from the ever improving ocular surface transplant procedures as well as new advances in keratoprosthetic devices.

These new procedures have resulted in our ability to treat more corneal patients than ever before with a more rapid recovery and better visual outcomes.

A full report on Dr Holland's address will be published in a forthcoming issue of EuroTimes

Glaucoma experts accentuate the positive

2008-04-05T14:40:00.005+01:00

Keep hope alive.

That was the message from Reay H Brown, MD, at the ASCRS Glaucoma Day held yesterday.

Dr Brown, addressing a session on The Business of Glaucoma, said the biggest challenge for doctors treating glaucoma patients was staying positive.

"Patients fear they are going blind," said Dr Brown. "Let us break the fear cycle and replace it with a hope cycle."

Dr Brown told delegates that most of the news on glaucoma outcomes was positive. Treatment is successful, most patients maintain vision and doctors can make a huge difference, he said.

He called on doctors to enjoy glaucoma care by recognising the challenges.
"Doctors fear they are not doing enough," he said. "We don't pay enough attention to patient fears and our own fears."

The key to breaking the fear cycle, he said, was for doctors to control the conversations with their patients. They should emphasise the success of glaucoma therapy, he said, and stay positive when talking to patients.

"If we feel optimism and hope," he said, "patients will too."

Dr Brown concluded his presentation by encouraging doctors to leave the patients with hope.

"Create a hope cycle," he said. "Giving hope to patients will give you hope too."

EuroTimes brings the sun to Chicago

2008-04-05T14:30:00.006+01:00

The Windy City can be very pretty but it can also be very cold and wet.

The EuroTimes team flew into Chicago from Dublin late Thursday evening for the 2008 ASCRS/ASOA symposium and congress where we were greeted with the incessant rain that has been a depressing feature of the Irish and European landscape over the last few months.

Happily, the sun is now shining and Chicago is looking forward to its hottest weekend in three months, according to the weather forecasters.

That should cheer up the delegates at the conference in the McCormick Centre who are looking forward to hearing presentations on the cutting edge of innovation and excellence in ophthalmic surgery and practice.

The highlights of the debates will be published in EuroTimes in our June and July issues but you can get a snapshot of what is going on in this weblog every day.

As always, we welcome your comments and opinions so watch this space.

EuroTimes Announces Judging Panel for John Henahan Prize for Young Ophthalmologists

2008-03-06T10:04:00.004Z

A distinguished panel of ophthalmologists and medical writers including Emanuel Rosen,FRCS, Jose Guell, MD, Sean Henahan, editor, EuroTimes and Paul McGinn,editor, EuroTimes will judge the entries for the John Henahan Prize.

John Henahan 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 “Why I became an ophthalmologist”.

The article should give a brief introduction into why the individual ophthalmologist decided on his or her career path and should include reference to his early education,including mentors and role models. The article should also look at issues and controversies in ophthalmology, including changing demographics and evidence based medicine. The closing date for entries is Friday,August 1,2008.

The winning entrant will receive a prize of €1000 that will be awarded at the XXVI ESCRS Congress in Berlin,2008 in September. We will publish the winning entry in the October edition of EuroTimes.

To apply, please e-mail your article, to Colin Kerr, executive editor, EuroTimes at colin.kerr@escrs.org. Your e-mail should include your full name,home address and phone number,your date of birth and ESCRS membership number.

•Entries received after August 1 will not be considered. The decision of the judges is final and no correspondence will be considered once they have announced their decision.

EuroTimes Announces Launch of €1000 John Henahan prize for young ophthalmologists

2008-02-25T09:32:00.003Z

EuroTimes is delighted to announce the launch of the John Henahan Prize, which will be awarded annually to a young ophthalmologist.

John Henahan 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 “Why I became an ophthalmologist”.

The article should give a brief introduction into why the individual ophthalmologist decided on his or her career path and should include reference to his early education , including mentors and role models (where appropriate). The article should also look at issues and controversies in ophthalmology, including changing demographics and evidence based medicine. The closing date for entries is Friday August 1 2008.

The winning entrant will receive a prize of €1,000 that will be awarded at the XXVI ESCRS Congress in Berlin, 2008 in September. We will publish the winning entry in the October edition of EuroTimes

To apply please e-mail your article, to Colin Kerr, Executive Editor, EuroTimes at colin.kerr@escrs.org. Your e-mail should also include your full name, home address and phone number, your date of birth and ESCRS membership number.

• Entries received after August 1 will not be considered. The decision of the judges is final and no correspondence will be considered once they have announced their decision.

EuroTimes Journalists Meet In Dublin

2008-02-14T13:33:00.005Z

EuroTimes Writers from America, Canada and Europe flew into Dublin today to attend a special Writers Meeting which will help us review our progress and develop an editorial plan for the coming year.

Last year, research carried out by ASE showed that EuroTimes,compared to its key competitors, has the greatest reach among ophthalmic surgeons in Europe.

The research also showed that it has the highest awareness and readership levels of all competing publications and is read more thoroughly, more often and by more readers than any other publication in its competitive set.

Since that research was carried out, EuroTimes has been voted best Business-to-Business specialist magazine of the year by the Periodical Publishers Association of Ireland (PPAI).

The last 12 months have seen the magazine go from strength to strength both in terms of design and content. A number of recent initiatives are beginning to bear fruit, including recent launches of customised local market editions in India and China and an online edition in Russia. A Podcast was launched in 2007 (see www.escrs.org) and an e-zine is now being published on a regular basis.

The Writers Meeting which will be held tomorrow, Friday February 15th, will give our journalists, in consutltation with the senior EuroTimes editorial team, a chance to put forward proposals which we believe will cement our dominance in the market.

If any of our readers have any suggestions as to how we can improvethe magazine, we will be delighted to post your opinions on this weblog.

Presbyopia - the new frontier

2008-02-09T08:26:00.000Z

Afer a very successful Cornea Day yesterday, the second session at the 12th ESCRS Winter Refractive Surgery Meeting in Barcelona today offers participants a selection of three Free Paper sessions.

First on the list is a session on the perennial issue of astigmatism and cataract surgery (14.00-15.30, Room H2). Topics include incisional techniques, new IOLs, and corneal laser approaches.

Presbyopia has become the new frontier for refractive surgeons. A Free Paper session today, dedicated to this subject, includes updates on the ever-increasing variety multifocal IOLs now available to surgeons, as well as some products in the pipeline. (14.00-15.30, Room HJ).

On the laser side, another Free Paper session will look at a variety of topics ranging from pre-operative diagnostics to femtosecond laser techniques. (14.00-15.30. Room F). Additional topics including problems associated with PRK, and early clinical results with new laser platforms will be discussed at Sunday’s Free Paper session on laser refractive surgery (8.00-10.30, Room HJ).

This afternoon features a Focus Session on Laser Refractive Surgery: Surface, Stromal or In Between (16.00-18.00, Room HJ).

It's a very busy schedule and even if you can't get to attend all the sessions, we will be reporting on all the hot topics in EuroTimes in the coming months.

EuroTimes Crosslinking Debate Is One of Highlights of ESCRS Annual Cornea Day.

2008-02-08T15:16:00.000Z

EuroTimes hosted a special roundtable debate on Crosslinking on the opening day of the 12th European Society of Cataract and Refractive Surgeons (ESCRS) Winter Refractive Surgery Meeting in Barcelona.

Dr Jose Guell and EuroTimes Editor Sean Henahan moderated the forum which featured contributions from Dr Joseph Colin, Dr Francois Malecaze and Dr Theo Seiler.

The doctors participating in the session took time out from their busy schedules to take part in a lively and informative discussion which looked at some of the major issues in Crosslinking.

EuroTimes readers can look forward to some fascinating insights when the discussion is published in the coming months, so watch this space for further details.

Barcelona is a beautiful city but, unfortunately, we haven't got to see very much of it so far because of the workload that surrounds hosting a major international conference.

The ESCRS staff deserve special credit for the hard work they have done in making sure that the meeting attended by more than 800 delegates, one of the highest attended winter meetings in recent years, runs smoothly and efficiently.

The meeting started with VII International Corneal Surgery and Diseases meeting held in conjunction with the annual ESCRS Cornea Day.

The all-day event covered a range of topics, including corneal collagen cross-linking, the latest in high risk keratoplasty procedures, therapeutic applications of limbal stem cells, and the uses of the femtosecond laser in lamellar surgery.

Today also saw the first of three Focus Sessions, which considered the merits of various corneal and lenticular approaches to presbyopia. Clinical experts from around the world discussed the latest laser based treatments such as advanced monovision, multifocal ablation, the role for conductive keratoplasty, the utility of refractive lens exchange, as well as techniques based on scleral expansion.

Tomorrow offers participants a selection of three Free Paper sessions. First on the list is a session on the perennial issue of astigmatism and cataract surgery (14.00-15.30, Room H2). Topics include incisional techniques, new IOLs, and corneal laser approaches.

Attendees interested in the subject also won’t want to miss Sunday’s Focus Session on “How to Correct Astigmatism in Cataract Surgery” (11.00-13.00, Room HJ).

Presbyopia has become the new frontier for refractive surgeons. A Free Paper session tomorrow, dedicated to this subject, includes updates on the ever-increasing variety multifocal IOLs now available to surgeons, as well as some products in the pipeline. (14.00-15.30, Room HJ).

On the laser side, another Free Paper session will look at a variety of topics ranging from pre-operative diagnostics to femtosecond laser techniques. (14.00-15.30. Room F). Additional topics including problems associated with PRK, and early clinical results with new laser platforms will be discussed at Sunday’s Free Paper session on laser refractive surgery (8.00-10.30, Room HJ).

Saturday afternoon features a Focus Session on Laser Refractive Surgery: Surface, Stromal or In Between (16.00-18.00, Room HJ) and on Sunday morning there will be a Free Paper session on the latest in presbyopia treatment on the keratectasia, bioptics, solid-state lasers (08.00-10.30 Room F).

It's a very busy schedule and even if you can't get to attend all the sessions, we will be reporting on all the hot topics in EuroTimes in the coming months.

No Sleep Till Barcelona

2008-02-07T13:15:00.000Z

At EuroTimes, we never sleep.

Having just returned from the All India meeting in Bangalore, following a fifteen hour flight back to Dublin, we have headed straight to Barcelona for the 12th ESCRS Winter Refractive Surgery Meeting.

This year's meeting promises to be a lively affair with some excellent presentations from some of Europe's top cataract and refractive surgeons.

This is the third time the meeting has taken place in this exciting and vibrant city and early registration figures suggest that the Barcelona meeting will be one of the best attended meetings in recent years.

On Friday, the 7th International Corneal Surgery and Diseases Meeting is being held in conjunction with the ESCRS Annual Cornea Day.

EuroTimes will also be holding a Roundtable Forum on Crosslinking which will be moderated by Dr Joseph Guell.

On Saturday, as a special service for delegates, EuroTimes will also be publishing ET Today with the latest news from the conference. Make sure to visit the ESCRS stand when you get a chance and if you have any news or views you want included in the magazine.

EuroTimes visits Bangalore

2008-02-02T08:42:00.000Z

Dermot McGrath reports from Bangalore where over 5,000 eye surgeons from the Indian subcontinent and neighbouring regions such as Bangladesh and Sri Lanka have gathered for the 66th annual conference of the All India Ophthalmological Society (AIOS). We will carry a full report on the conference in the April edition of EuroTimes.
..............
At the formal opening of the conference, Professor Rajvardhan Azad, Secretary of the AIOS, reviewed the history and mission of the organization, noting that its broad goal is to cultivate and promote the study of the ophthalmic sciences, foster scientific knowledge and raise standards of ophthalmology and patient care.

“From only four members back when the AIOS was founded in 1930, we have today grown to an organization with 11,563 members. Much of that growth has been added over the past 4 to 5 years with an average of 500 ophthalmologists a year joining our ranks, which is a very healthy development,” he said.

Among the various components and activities of the AIOS, Dr Azad highlighted the work of the scientific committee, the academic and research committee, the publication of the official Indian Journal of Ophthalmology, the annual conference, and increasing collaboration with other national and supra-national organizations as key priorities for the organization.

He paid tribute to the sterling work over recent years of outgoing President, Dr Taraprasad Das, and said he was sure that the good work would continue under the leadership and guidance of the incoming President, Dr K.P.S. Malik.

During the opening ceremony, AIOS lifetime achievement awards were presented to Dr Kanti V. Mody, Consultant Ophthalmologist at Jaslok Hospital and Research Centre, Mumbai, and also to Dr P. Namperumalsamy, who spent over 23 years at Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Madurai, which is affiliated to Tamilnadu Dr M.G.R. Medical University, Chennai.

Dr Azad noted that with over 5,000 delegates registered for this year’s event, the AIOS annual meeting continues to go from strength to strength.

“The annual conference is our flagship event and over the last few years we have seen a tremendous increase in the number of delegates. We expect the numbers to grow in coming years, and I think this reflects the fact that our delegates appreciate that our meeting is a genuine forum for exchange and education,” he said.

He added that next year’s annual conference will be held in Jaipur, followed by Calcutta in 2010, with the latter meeting being held in association with the International Council of Ophthalmology.

World Medical Association warning to ophthalmologists on cash for tissues

2008-01-21T16:13:00.001Z

The world’s leading body of physicians has lent its weight against the sale of corneal tissue, according to Paul McGinn, writing in the February edition of EuroTimes.

In its “Statement on Human Tissue for Transplantation,”the World Medical Association has warned ophthalmic surgeons and all other physicians who transplant tissue to oppose transplants where a donor’s family receives cash for donated tissue.

“Financial incentives such as direct payments for donating tissue for transplantation are to be rejected – in the same way that they are in connection with organ transplants. All other steps, such as the procurement, testing, processing, conservation, storage and allocation of tissue transplants, should likewise not be commercialised,” reads the statement, which the association adopted at its annual meeting in Copenhagen last October.

The adoption of the statement follows by seven years a similarly worded association statement that banned physicians from transplanting organ purchased from donors or their families.

Although the statement of itself does not legally bind a physician to follow it, physician regulatory bodies throughout the European Union often rely on such statements in deciding whether physicians have acted unethically. Some statements, notably the association’s Declaration of Helsinki – which sets ethical parameters for clinical trials – have been adopted by a number of physician regulatory bodies into their own codes of ethical conduct and as such, can carry the force of law.

According to the Statement on Human Tissue for Transplantation, physicians involved in harvesting, processing and transplanting tissue must balance the rights of the tissue recipients with the rights of the families of the deceased donors, the statement adds.

“Physicians are fundamentally obliged to treat patients according to the best of their knowledge and expertise. However, this obligation must not be taken to the point where, for example, the human tissue necessary for therapy is procured in an unethical or illegal manner,” the statement reads.

“Tissue must always be procured with due consideration for human rights and the principles of medical ethics. To secure the provision of tissue for transplantation, physicians should inform potential donors and/or their family members about the possibility of tissue donation. In the event of combined organ and tissue donation, information should be provided, and consent obtained, in one step,” the statement adds.

In addition to its ban on the sale of tissue, the new statement also bans the use of corneal tissue donations from prisoners, the nomination of specific recipients for donated corneal tissue, and the coercion of potential donors or their families.

“The voluntariness of tissue donation must be ensured. The informed and non-coerced consent of the donor or his/her family members is required for any use of human tissue for transplantation. Free and informed decision-making is a process requiring the exchange and understanding of information and the absence of coercion,” the statement reads.

In addition, the statement also specifies that:

1. Risk of disease and infection “must be minimized through appropriate testing that does not merely comply with sufficient standards, but additionally reflects the respective, nationally implemented state of medical science and technology”;

2. If there is any delay in diagnosing an infectious disease or malignancy in the donor, “an alert should immediately be reported to all tissue recipients in order to institute the appropriate precautionary steps”;

3. Physicians and all other personnel involved in removing, storing, processing and transplanting tissue must take all necessary steps to avoid contamination;

4. Physicians should allocation tissue only according to the medical indication, urgency and prospects of success of the transplant.

5. All experimental and clinical studies involving tissue must be conducted in accordance with the Association’s Declaration of Helsinki. In addition, scientists and physicians should continuously inform the public about developments in tissue medicine and its therapeutic options.

6. Physicians and their national and specialty medical associations should lobby their respective state agencies and governments to ensure they regulate the international exchange of tissue for transplantation according to appropriate standards.

7. Any information about tissue donors that is stored or maintained by national transplant organizations or tissue banks should be provided only if the living donor or family of the deceased donor provides free and informed consent to such release.

..
For more information about the new statements from the World Medical Association, visit www.wma.net. For more stories from EuroTimes, visit www.escrs.org

A Journey Through Bereavement

2008-01-11T12:19:00.000Z

Maryalicia Post will be best known to readers of EuroTimes as an explorer and journalist whose Eye On Travel feature has become an integral part of the paper.

She has recently published a book After You which recounts how after thirty years of marraige her husband Jack died and she began the hardest journey of her life.

After You is a series of poems by Maryalicia, illustrated by Ben Ecclestone, that confront the despair, confusion and gratitude that washed over her after her bereavement.

The book should be available in all good bookshops and can also be ordered through Amazon.com

Patients Deserve The Best Care

2008-01-10T13:06:00.000Z

Dr Michael O'Keefe writing an editorial in the February issue of EuroTimes says patients must come first in every situation. These are his comments

........
There has been huge progress in the last fifty years in ophthalmology through innovations such as microsurgery, intraocular lenses and the new frontiers in macular degeneration, stem cell retinal pigment transplantation and synthetic keratoprosthesis. But at the same time there is a danger that we will create the public expectation that everything can be cured, that surgery does not carry risks any more. Nothing could be further from the truth.
Eighty five per cent of all refractive surgery in Britain is done in commercial clinics. Doctors are no longer masters of what they do. They are employed by business people.
In my practice, out of every ten people I see, probably four should not have any laser done. If I were involved in a commercial clinic, I would be under pressure to reduce that. I think it is a worrying trend.
The other thing that is happening which I think is really alarming is that doctors are appearing more with patients for the first time on the day of surgery. They never see them before, they never see them after and they appear over them on the day to do the surgery. I think that is frightening. I would never allow that to be done to me, I would not allow it to be done to my relations.
We are now becoming technicians. Do you need an MD degree anymore? You could train a technician now to do a lot of the laser work or to do the cataracts.
We are selling ourselves out and that is bad for medicine, it is bad for people. You don’t talk to people before, you don’t talk to them afterwards. This could lead to an increase in litigation because patients will lose confidence in doctors.
There is a danger that we will drive standards down and we are going to shoot ourselves in the foot. We will not need to be doctors anymore, because some of the business people who have taken over the running, will say: We can get nurses or laboratory technicians and train them. This is a spin-off from the privatisation of the public system.
We need to lay down certain standards. Nobody should operate on patients unless they have examined them before hand and unless they are prepared to follow them up afterwards. That is a standard that we should not throw away. I don’t think we should over-regulate people because then you end up not being able to practice. There is a fine balance.Michael O’Keefe is a consultant ophthalmologist and organiser of the International Refractive Meeting, which will be held in Dublin, Ireland in October 2008.