- Binkhorst Lecture featured in Saturday Main Stage programming
- X-Rounds returns
- ASOA Opening General Session: recognitions, awards, and keynote on ‘you management’
- Additional sessions
Binkhorst Lecture featured in Saturday Main Stage programming
In Saturday’s Main Stage program, Eric Donnenfeld, MD, delivered this year’s Binkhorst Lecture and received the corresponding award. “ASCRS has been such an amazing part of my life,” he said, adding that it’s part of the foundation of where he is today. In his lecture, he shared his story of family, friends, and a passion for the ophthalmic profession.
He began by talking about the road to innovation. “I have stood on the shoulders of giants,” he said, noting a number of ophthalmologists he has worked with and been inspired by. Where does the road to innovation begin? In Dr. Donnenfeld’s case, it was with his parents. He noted the most important qualities in raising a child to become an innovator: unconditional love, high expectations, and irrational confidence.
Dr. Donnenfeld said that ASCRS changed his journey, inspiring him to reinvent himself several times over to become a better person and better ophthalmologist. He started as a corneal specialist but had many opportunities. He added that his background in cornea allowed him to innovate in refractive surgery. Dr. Donnenfeld got involved with research on the excimer laser and LASIK.
Innovators often fail, but you keep trying, Dr. Donnenfeld said. He highlighted crosslinking to address keratoconus. He joked that, “I will steal from anyone,” discussing borrowing from retina research, taking patients with corneal abrasions and using a non-steroidal and putting a bandage contact lens on. This technique was later applied to PRK and crosslinking, he said.
Innovation can exist in the simplest of procedures, sharing a case study on LRI. He understood the value of LRIs and wanted to make them better. He designed a nomogram to make them simpler, and it’s now used all over, Dr. Donnenfeld said. “I also wanted to make limbal relaxing incisions more accessible.” For this, Dr. Donnenfeld helped to design a website (lricalculator.com). He also wanted to make these LRIs more efficient, by being able to do them in the office. And then he highlighted getting more precise, specifically mentioning the femtosecond laser astigmatic incision. This helped to automate surgery, he said.
Throughout Dr. Donnenfeld’s career, he applied his background in dry eye to refractive surgery. All advances in technology are lost with even minimal disruption of the ocular surface, he said. Then, he referenced a number of publications that discuss the effect the ocular surface and dry eye can have on refractive procedures and vice versa, as well as ways to manage dry eye.
Dr. Donnenfeld said innovation has helped him expand to treat across many specialties, including cataract, refractive, cornea, and glaucoma.
He also highlighted what he called an important teaching moment in his career when he testified at the LASIK FDA hearing in 2008. He said that listening to unhappy patients helped to make him a better doctor. “What I heard from the patients was overwhelming that they were unhappy with their results, but what made them angry is they felt that they were abandoned by their doctors.” We must acknowledge our complications, embrace the complications of others, and never allow a patient to feel abandoned, he said.
Innovation is collaborative, Dr. Donnenfeld said, and he counts himself fortunate to have found a number of friends in ophthalmology. “We love innovating in ophthalmology,” he said, acknowledging Stephen Lane, MD, Edward Holland, MD, and Kerry Solomon, MD. Friends in industry are also important, he said.
In conclusion, Dr. Donnenfeld said that innovation is everywhere. With innovation comes the responsibility to help our patients, he said. Innovation stands on the shoulders of giants but is nurtured at an early age. It borrows ideas from other specialties and is collaborative. Innovation embraces opportunity, expands indications, and is often trial and error. Innovation also requires the support of colleagues, industry, friends, and family, but especially significant others, Dr. Donnenfeld said. It recognizes unmet needs and solves problems. It is rarely disruptive but incremental and makes patient care simpler, more effective, and accessible, he said. He said his greatest innovation was convincing his wife to marry him. “My journey through ophthalmology has been a long and winding road,” he said. “I wish all of you the pleasure, the purpose, the passion I’ve had of waking up every single morning and being proud and happy to be an ophthalmologist and every night looking forward to coming home to my family.”
Editors’ note: Dr. Donnenfeld has financial interests with a variety of ophthalmic companies.
X-Rounds returns
X-Rounds—Refractive Surgery to the Max is an annual symposium at the ASCRS Annual Meeting. It was back this year as a fast-paced session featuring, what moderator Eric Donnenfeld, MD, said is “the latest and greatest in cataract and refractive surgery.” During the session, the panelists each gave 2.5-minute presentations answering different questions. The audience then voted for their favorite presentation in each category.
The participants included Nicole Fram, MD, John Hovanesian, MD, Cathleen McCabe, MD, Kerry Solomon, MD, and Elizabeth Yeu, MD.
What am I doing differently this year?: Dr. Yeu was voted best presentation of this section for her talk about achieving great pseudophakic outcomes with post-RK patients. She showed several recent RK patients who received the IC-8/Apthera IOL (Bausch + Lomb), all of whom were thrilled with their uncorrected vision postop. She also showed its utility in a keratoconus patient.
Dr. Fram said she was looking at new IOL calculations for atypical eyes. For long eyes, she said the formulas doing well are Kane, Barrett Universal 2, and the Wang-Koch adjustment. Short eyes, the two formulas performing well are the Zeiss artificial intelligence and Cooke K2, she said. Post-corneal formulas she’s using are the Barrett True-K TK, the EVO 2.0, and the ASCRS calculator. For irregular astigmatism, Dr. Fram mentioned the Barrett True-K KCN, Hill-RBF, Holladay 1, SRK-T, Kane, and she said that IC-8 could be helpful as well.
Dr. Hovanesian said his change was taking the EyeSustain pledge and considering all the areas that his practice and OR could become more sustainable. “The good news is, if we work together, you can make a difference,” he said. Dr. McCabe presented on how she’s integrated small-aperture technology and the Light Adjustable Lens (RxSight). Dr. Solomon shared how he performed an EVO on a pseudophakic patient who was not a candidate for LASIK or PRK due to prior refractive surgery and too thin of a cornea.
New technology on the horizon: The audience also voted for Dr. Yeu’s presentation of low-energy cataract surgery with MICOR (MICOR Industries). This is a paradigm shift, she said. The technology doesn’t use thermal energy, ultrasound energy, or cavitation. Instead it uses mechanical agitation to dissolve the lens. There is minimal fluid through the eye but it maintains incredible chamber stability, firing 1,000 times less frequently than phaco at the same amplitude. She said the technology is easy to use, finger-controlled (no foot pedal), has a small footprint, and features cataract removal, capsular polish, and vitrectomy all in one handpiece.
Dr. Fram presented on the latest advancements in phaco technology, like the Centurion with Active Sentry (Alcon) and Quatera 700 (Carl Zeiss Meditec), which achieves chamber stability, efficiency, and safety at higher flow rates. Dr. Solomon presented on this technology and the CT Lucia 621 (Carl Zeiss Meditec). Dr. Hovanesian presented on a new option for situations where the patient has the wrong IOL. AccuraSee (Onpoint Vision) is a nonpowered lens with 10 D of add in the center that, in its current generation, is being used for patients with AMD. He said, however, that it has possible applications for other situations: refractive adjustments, multifocality, drug delivery, and addressing dysphotopsias. This lens sits on top of an existing IOL. Dr. McCabe shared information on Vista 1-Step (Vista Ophthalmics), a single-use vitrector that serves as the needle into the eye and the vitrector with the ability to cut in both directions. She also presented on iDose (Glaukos), which is currently being investigated as long-term travoprost-eluting implant for IOP lowering.
My best pearl for astigmatism management
Dr. Fram was voted the winner for her presentation in this category. The best pearl she said is to make sure you go behind the lens and get all the viscoelastic out, then move the lens into the proper location. She taps the toric IOL to the posterior capsule a little, then goes in with BSS or intracameral moxifloxacin and pulses it into the AC. If you don’t see the IOL move, you know you’ve gotten all the visco. If you do see it move, you’ve got to go in and get the viscoelsastic out.
Dr. Hovanesian presented his thoughts on the utility of Apthera for low astigmatism. Dr. McCabe spoke about iris registration with toric alignment, using technologies like Veracity and Verion (Alcon) and LenSx (Alcon). Dr. Solomon’s presentation was similar to Dr. McCabe’s but he emphasized the importance of being consistent with what you do. Dr. Yeu said she thinks the preoperative planning is the most important part of astigmatism management, because when you put garbage in, you get garbage out.
My favorite treatment for presbyopia at the time of cataract surgery: Dr. Yeu won this session as well, sharing her favorite presbyopia treatment is planning for the first eye, reassessing, and then reconfirming for the second eye. She said you have to pause after the first eye and reassess whether the prediction error was within target and if the patient was satisfied. Then you can move forward with the second eye. If those were not achieved though, you can tailor vision with either a Vivity (Alcon) or Eyhance (Johnson & Johnson Vision) and/or adjust IOL power to account for a refractive miss.
Dr. Fram spoke about using the Light Adjustable Lens for customized monovision, while Dr. Hovanesian talked about the using the latest IOL designs and materials. Dr. McCabe said her preferred option, especially for younger patients where the future of their eye health is uncertain, is nondiffractive IOLs, and Dr. Solomon spoke about mixing and matching presbyopia-correcting IOLs.
Best surgical save of the year: The best surgical save of the year went to Dr. Fram, who showed a video of a patient who had been hit in the eye at with a baseball at his son’s ballgame. His cornea was deformed, and he had significant iris damage. She shared her concerns about doing an artificial iris procedure open sky and said that in this case she was going to attempt to do most of the work with the artificial iris before opening the eye for a penetrating keratoplasty. The video showed Dr. Fram preparing the lens she was going to suture the iris onto. “I wanted a big optic with big haptics, because I want to keep the eye formed while I’m doing the PKP,” she said. After successfully suturing the artificial iris in place, Dr. Fram performed the PKP, and the patient ended up 20/60 uncorrected. “And it’s really a great day for him,” she said.
Editors’ note: The speakers have financial interests with various ophthalmic companies.
ASOA Opening General Session: recognitions, awards, and keynote on ‘you management’
The ASOA Annual Meeting held its Opening General Session, which featured keynote speaker, Colette Carlson, CPAE Speaker Hall of Fame, who spoke on the topic of “You Management.”
“Ever since I got booked, you’ve been on my mind. So much so that since we inked the paperwork, I had a chalazion, retinal tear, and blepharitis. … That’s how much you’ve been on my mind,” she said to everyone’s laughter.
She asked the audience to think about where their exhaustion and stress get in the way of them showing up as the best versions of themselves for the people they serve, support, lead, and even love. Those times when you’re so tired, you’ve forgotten to pause and take a breath, and the next thing you know you’re reacting instead of responding. And you’re not alone. Ms. Carlson said that 48% of employees report they are exhausted, 78% say stress negatively impacts their work performance, and 71% say stress at work negatively impinges their home life.
“When you think about it, here you are, responsible for creating this beautiful environment where patients are your guests. They come in and feel safe, seen, secure, and you give them the utmost in care. How can you do that when you’re exhausted?”
ASOA heard these statistics, she said, and they’ve been listening to you. That’s why she and other speakers were focusing on this topic.
While our home lives and careers are not likely to demand less of us, the key is “you management,” and learning to control the controllable, Ms. Carlson said. Stress is the stories that we attach to feelings and thoughts that we have in those moments. When you decide something is stressful, your body kicks in. And when your body sends you a signal, pause, take a break, and ask yourself: 1) What am I feeling and what triggered this emotion? 2) Is any element of this trigger in my control?
If any element is in your control and if you take control, even a small step, your body realizes that you’re doing something about it and thus needs to stress about it less, Ms. Carlson explained.
A few examples of things we can control are our management of our expectations, taking care of ourselves (just 10 minutes of vigorous walking reduces stress), our time (putting some of your biggest priorities on your calendar rather than a larger to-do list where they’ll likely not get done), and thinking about whether something needs to be perfect or if good is good enough.
“We talked about how to do less but what about less perfectly?” Ms. Carlson asked. She said this is a struggle for many of us but perfectionism not only stresses ourselves but it can also stress out those who surround us.
When something is deemed out of our control, the only solution is to let it go, Ms. Carlson said. Does stressing about things make it go away? Does ingesting bad energy into it change anything? Yes, she said, it changes you—your body chemistry and physiology.
“Every time we practice doing something either constructive or destructive, we get better at it because we’re shaping the structure of our neural networks and brain,” she said. “Therefore, when we practice worrying, the worry circuits of our brain are reinforced.”
Ms. Carlson challenged whether we want to be laying down new neural pathways to help us get better at something that is bothersome. She later shared data from a meta-analysis of 61 studies that involved 221,000 people, which showed that health was predicted more by the absence of pessimism rather than the presence of optimism. In other words, it’s about making sure you don’t assume the worse, she said.
Providing more techniques that can help reset your mindset in moments of stress, she mentioned breathing techniques, which can reset the parasympathetic nervous system, meditation, practicing her 5×5 rule (if something is not going to matter in 5 years, don’t invest more than 5 minutes being upset. Be upset, then let it go), take breaks (breaks create breakthroughs), and practice a physical anchor (a movement that can interrupt the pattern in your brain to reset your mindset).
A lot of these things, we know to do, Ms. Carlson said, but do we do them? “No, because sometimes the things that are easy to do are just as easy not to do.”
Editors’ note: Ms. Carlson does not have financial interests related to her comments.
Additional sessions
During the Main Stage session, David Chang, MD, who is stepping down as ASCRS Foundation Chair, was recognized for his many years of service to ASCRS.
“ASCRS has always been a special organization on many levels,” Dr. Chang said, adding that it was founded 49 years ago by four ophthalmologists in private practice in California, and no one knew who they were. Our field of cataract and IOLs has advanced largely in part from having societies that educate and encourage innovation, he said.
Dr. Chang said he thinks what draws together those who volunteer with the Society is a love for ophthalmology. For Dr. Chang, his love for ophthalmology started as a medical student. “It was a real gift to know that was what I wanted to do, and that’s what I’m doing 45 years later,” he said.
For further coverage of other ASCRS Annual Meeting sessions, see the Sunday edition of the EyeWorld Daily News.
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