Steve Jobs RIP

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

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.

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

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

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

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

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.