Sessions on Monday at the ASCRS Annual Meeting included the Innovators General Session, the Winning Pitch Challenge, and various other symposia. The ASOA Annual Meeting held its second General Session.
Kelman Lecture features ‘innovation for the rest of us’
Stephen Slade, MD, was honored to deliver the Charles D. Kelman, MD, Innovator’s Lecture Monday morning. He focused his talk on “innovation for the rest of us,” the end users of innovation.
“Innovation doesn’t happen unless we pick it up and actually use it. We take a product, process, or somebody’s idea and put it into a practical reality,” Dr. Slade said.
Innovation is the creation of value, he explained, adding that it also needs to produce financially to succeed and often needs to replace something worse. “Where I do think that I had, and all of us have, the opportunity to create value to innovate is in education,” he said, giving several examples from his experience.
When Dr. Slade chooses to get involved with a particular technology, he said he asks the following questions: Is it unique, elegant? Does it meet an unmet need and/or have commercial potential? Do you have relevant experience and expertise? Will you enjoy this?
Patients play a role in making innovation successful as well, Dr. Slade said, explaining that just because something gets FDA approval doesn’t mean it will get real-world approval. “If there is a choice, the patients will really guide us.”
The facets for successful innovation include the industry, financing, the invention, and an early adopter-educator, Dr. Slade said.
He said being asked to give the Charles D. Kelman, MD, Innovator’s Lecture “couldn’t have made me happier.”
“When I look at the people who have won this award, we talk about standing on broad shoulders, this is like a freeway of shoulders for us to stand on,” Dr. Slade said. “I have so much gratitude and humility.”
Stay tuned for the September issue of EyeWorld for more from this session.
Editors’ note: Dr. Slade has no financial interests related to his comments.
ASOA attendees learn how to eliminate team drama
The ASOA General Session on Monday, “No More Team Drama: Ending Gossip, Cliques, & Other Crap That Damage Workplace Teams,” featured Joe Mull.
Mr. Mull said you cannot completely eliminate team drama from the workplace. “The biggest reason for that is because … people,” he said.
Mr. Mull said that when he’s discussing “no more team drama,” he’s not promising that it won’t show itself again. There’s no way to eliminate it completely, he said. But rather he means no more team drama at the level where it causes harm and drives away talent.
When asking the audience who in the room has experienced team drama, essentially everyone in the room raised their hand.
What is team drama? Mr. Mull agreed with various suggestions from the audience that gossip, jealousy, picking favorites, bullies, and more all constitute team drama. “Every one of these fits the bill,” he said.
Mr. Mull said that even after writing a book on team drama, he still struggles to capture it in a single-sentence definition. The definition he has come up with is “actions and reactions that harm morale, relationships, and culture in the workplace.”
Mr. Mull said that if you can move the needle a bit and reduce how often this team drama happens at work, people are happier, performance is higher, and outcomes are better.
Mr. Mull highlighted four things teams have to get good at to overcome bias:
- Courtesy
- Camaraderie
- Conflict
- Cause
Stay tuned for the September issue of EyeWorld for more from this session.
The Winning Pitch Challenge
The Winning Pitch Challenge gives ophthalmologist entrepreneurs the opportunity to share innovative ophthalmic solutions with leading experts in the field. Three candidates presented their 5-minute pitch, followed by a series of questions from judges. This year, the first place $25,000 winner was Jim Ellis, MD.
He shared information on the JelliSee IOL, a model of an accommodating IOL that works in the eye. The JelliSee lens is a “dis-accommodating” design that is based on the lens of a child, he said.
The JelliSee IOL has a firm but flexible anterior surface; a liquid-filled lens; haptics apply tensile force to the anterior surface; it has a relatively flat anterior surface; it does not rely on retained capsular elasticity; and the eight haptic design optimizes optical quality.
Dr. Ellis said the proof of concept has been tested in bench testing, and studies have just begun in primates. Human trials are planned to start this fall and winter, he said. Dr. Ellis was seeking $5 million in investments.
Stay tuned for the September issue of EyeWorld for more from this symposium.
Cataract Essentials symposium provides education in areas of need
The Cataract Essentials symposium used the 2019 ASCRS Clinical Survey to identify areas of educational need to inform presentation topics.
One of the topics covered was vitreous loss and posterior capsule rupture. As Mitchell Weikert, MD, presented, more than 80% of surgeons experienced this complication within the last year, according to the survey, and half are not extremely confident in their approach to managing these cases.
As Dr. Weikert put it, you don’t want this to happen, but it’s inevitable if you’re doing cataract surgery. When it occurs, you need a methodical approach to handling it, with the goals of minimizing traction on the vitreous, getting complete removal of the vitreous from the anterior capsule, and maintaining as much capsule support as possible.
Early signs include the pupil snap sign, intraoperative miosis, change in the red reflex, deepening of the anterior chamber, difficulty rotating nuclear material, poor followability, difficulty emulsifying nuclear material, and occlusion with no material at the tip.
Once identified, Dr. Weikert said to prevent shallowing of the anterior chamber by filling with dispersive OVD, tapenade the vitreous through the capsule opening, insert the cannula, come off irrigation, and inject OVD (while not irrigating). Then withdraw instruments, get a good look to assess the situation, and always fill with OVD prior to instrument removal, Dr. Weikert said.
When removing nuclear material in the setting of a PC rupture, use low-flow settings, consider a conversion to an ECCE, or use supracapsular phaco, elevating pieces with OVD, use a Sheet’s glide, or consider an IOL scaffold. If a piece of nuclear material falls, “don’t go fishing” for it, Dr. Weikert said.
When it comes to vitrectomy, Dr. Weikert said to use a bimanual approach with separate infusion and vitrector. Consider suturing the temporal incision, use a high cut rate, and place anterior infusion via a paracentesis. Cut first, then aspirate, Dr. Weikert advised, later reminding to use triamcinolone to identify remaining vitreous.
Aspirate cortex with the vitrector, setting up the foot pedal to turn the cutter on and off, Dr. Weikert continued. Use a one-piece IOL in the capsule if the PC tear is small, but a three-piece IOL in the sulcus should be used for larger PC tears and anterior/posterior tears.
Editors’ note: Dr. Weikert has financial interests with Alcon and Bausch + Lomb.
‘Refractive Bachelor(ette)’ … finding the perfect IOL for life
A pithy symposium with a light-hearted title sought to help four patients on their journey to find the perfect IOL for life in “The Refractive Bachelor(ette) in 20/Happy Paradise.”
Terry Kim, MD, represented one of the bachelors, a 59-year-old engineer who is very detail oriented, hates glasses, and enjoys biking and gaming. The options presented to him were trifocal IOLs, EDOF IOLs, and monovision. Dr. Kim ultimately decided to give Dr. Weikert the final rose for monovision. In an update though, Dr. Kim said he ended up not liking monovision’s anisometropia, loss of balance, and depth perception issues. He convinced Dr. Weikert to do an IOL exchange for a monocular IOL. While he loved his distance vision, he missed his near vision, and he revoked his rose, offering it to Preeya Gupta, MD, with her option for EDOF IOLs.
Marjan Farid, MD, represented one of the bachelorettes, a 57-year-old divorcée and businesswoman, who loves outdoor sports and doesn’t want glasses. She had myopic LASIK 10 years prior and her exams showed dry eye. She was offered the Symfony Optiblue EDOF IOL (Johnson & Johnson Vision), the Light Adjustable Lens (RxSight), and the IC-8 (AcuFocus). She offered Roger Zalidvar, MD, with his IC-8 the final rose.
Editors’ note: Dr. Weikert and Dr. Gupta have financial interests with various ophthalmic companies. Dr. Zaldivar has financial interests with AcuFocus.
Other Monday symposia
In an afternoon cornea session, Elizabeth Yeu, MD, presented on conjunctivochalasis and shared information on its diagnosis and management.
Dr. Yeu sought to debunk several conjunctivochalasis myths: first that conjunctivochalasis is a conjunctival disease; second that it only interferes with the tear meniscus; and third that conjunctivochalasis dry eye can be managed just like aqueous tear deficiency dry eye.
Conjunctivochalasis is actually a Tenon’s disease, she said. It obstructs the tear meniscus and obliterates the tear reservoir. It also changes the anatomy of the tear reservoir, which can’t be fixed by drops or plugs, Dr. Yeu said, adding that surgery is the only solution.
Symptoms vary and are numerous, she said. Cautery can be used for mild disease. Primary closure with tissue glue or sutures can also be used. A multi-layer amniotic membrane transplant is another way to address conjunctivochalasis, she said.
Editors’ note: Dr. Yeu has financial interests with a variety of ophthalmic companies.
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