June 2019


Highlights from the 2019 ASCRS ASOA Annual Meeting

by Vanessa Caceres EyeWorld Contributing Writer

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From the Binkhorst Lecture: “The quest for tear stability”

Stephen Pflugfelder, MD, Houston, said tear stability is maintained by the lacrimal functional unit. Tear instability is a common feature of all types of tear dysfunction and a defining feature of dry eye. It causes inflammation, increases blinking, degrades visual function, and stimulates corneal nociceptors. He said that there are increasing therapeutic options with different mechanisms of action to improve tear stability.
Tear instability can be caused by a variety of factors, including neuropathy, systemic medications, cosmetic surgery, diet, environment, LASIK, eye drops, and aging.
Conjunctival chalasis is a common cause, particularly in age-related tear instability.


From the ASCRS Lecture on Science, Medicine and Technology

Any speaker can make his or her message stick in an audience’s mind by adding emotion, prioritizing meaning, and dividing the information into discrete chunks, according to John Medina, PhD.
“It’s not aversive stimuli that cause stress; it’s the ability to feel in control of the aversive stimuli,” Dr. Medina said. “The more out of control the patient feels over the aversive stimuli coming at them, the more likely they are to not remember anything the doctor said and as a direct result, start the litigation process.”


From the Opening General Session

“Every minute I was captured, I thought about being a physician,” said Hal Kushner, MD, during the ASCRS Opening General Session. Dr. Kushner, who has been an ASCRS member for 40 years, received the first ASCRS Distinguished Member Award. He was a prisoner of war for 5 years and the only physician among 591 American prisoners during the Vietnam War. He said he had plenty of time to choose what specialty of medicine to go into and ophthalmology was the best decision he ever made.


From The Voice of Ophthalmology

Tal Raviv, MD, New York, with coach Iqbal “Ike” Ahmed, MD, Toronto, Canada, was voted the winner of the second season of The Voice of Ophthalmology for his presentation on endophthalmitis prophylaxis with intracameral antibiotics.
Major points from Dr. Raviv’s presentation included:
• Several studies showed no additive effect of topical antibiotics after intracameral antibiotics were used, and a 2016 AAO Preferred Practice Pattern supports the role of intracameral antibiotics.
• With low adoption of intracameral antibiotics among U.S. surgeons, concern could stem from there not being an FDA-approved product and the association of intracameral vancomycin with HORV.
• Compounding pharmacies and the commercially available topical formulation of
moxifloxacin are options for intracameral antibiotics.


From the Charles D. Kelman Innovator’s Lecture

Collaborative innovation can happen between technologies where a particular technology can reach a certain level of adoption, then additional technologies further it, according to Ron Kurtz, MD.
Dr. Kurtz described moving femtosecond laser technology into the realm of refractive cataract surgery. Refractive cataract surgery really began in the 1960s, driven by the large pool of patients who, thanks to Medicare, would not have had access to these innovations otherwise. Innovations included the first implantable IOLs, followed by phaco, viscoelastic, keratometry, biometry, and IOL power calculation formulas.
Dr. Kurtz shared his efforts on the Light Adjustable Lens (RxSight). “I was intrigued by the ability to have an office-based system that could optimize patient vision after the cataract had been removed,” he said.


Thomas Samuelson, MD (right), passes the ASCRS presidency to Nick Mamalis, MD.

From the Steinert Refractive Lecture:
“Myths, Misconceptions, and Reality of LASIK”

The 2019 Steinert Refractive Lecture at the 2019 ASCRS Refractive Day was presented by Eric Donnenfeld, MD. He dispelled the following myths:
• Myth #1: Physicians would not have LASIK on their own eyes. Refractive surgeons, one study showed, were four times more likely to have laser vision correction than the general
• Myth #2: The long-term effects of LASIK are not known. Long-term studies have shown both refractive stability and safety of the procedure.
• Myth #3: Contact lenses are safer than LASIK. Published research presented by Dr. Donnenfeld reports that daily contact lens wear for 30 years is less safe than LASIK.
• Myth #4: LASIK increases the risk of glare and halo compared to glasses. While LASIK can induce such visual abnormalities in a minority of patients, Dr. Donnenfeld showed data that found modern LASIK can actually cure such problems.
• Myth #5: The safety and efficacy of LASIK has not improved over time. Dr. Donnenfeld highlighted a paper that showed a 10-year history of continuous improvement of the procedure.
• Myth #6: Dry eye is extremely common after LASIK. Research has shown that dry eye is common after LASIK in the first 3 months postop, but largely resolves after 6 months.


From the ASCRS Film Festival

Boris Malyugin, MD, PhD, took home this year’s Grand Prize at the 2019 ASCRS Film Festival for his film “Intraoperative Aqueous Misdirection Syndrome: The New Risk Factor for PC Rupture During Phacoemulsification.”


From the 2019 Cornea Day

With the ASCRS Preoperative OSD Algorithm, the goal of the ASCRS
Cornea Clinical Committee was to create a “true algorithm” that was
consensus- and evidence-based, that could be integrated into preoperative surgery visits, had reliance on tech and objective testing to reduce chair time, and that identified all visually significant subtypes of OSD prior to surgery, said Chris Starr, MD, New York.


From the 2019 Refractive Day

Refractive enhancements are often a part of a patient’s surgical journey. Though you may want to nail it the first time, it’s important to have a plan to finish, according to John Berdahl, MD, Sioux Falls, South Dakota, who described his three-step process of surgery, YAG, and enhancement.



From the 2019 Glaucoma Day

A preoperative evaluation is incredibly important when performing cataract surgery on a pseudoexfoliation glaucoma patient. You should note the signs of pseudoexfoliation, degree of pupillary dilation, and degree of zonular laxity, said Amy Zhang, MD, Ann Arbor, Michigan.


From the ASCRS symposia

• Julie Schallhorn, MD, San Francisco, commented on anterior vitrectomy during the Young Eye Surgeons (YES) Clinical Committee symposium. When you notice a break and vitreous coming forward, take out your second instrument but leave irrigation in to maintain the anterior capsule. Put in viscoelastic at the break first, then fill.
• “If you have a patient with a large amount of astigmatism, even 1 clock hour off can be devastating, and a small rotation can lead to perfect vision once again,” said Kendall Donaldson, MD, Plantation, Florida.
• According to Timothy Olsen, MD, Rochester, Minnesota, intravitreal injections carry risks and should be done by eye doctors only.
• “A lot of people will insert or inject the IOL into the anterior chamber and that’s reasonable, but I find it an extra step because then you have to go in with forceps and grasp that leading haptic and insert it into your 30-gauge needle,” said Jeremy Kieval, MD, Lexington, Massachusetts, commenting on the Yamane technique.
• Adi Abulafia, MD, Jerusalem, Israel, shared pearls for choosing toric IOLs: validate your data, use several measuring devices, take the posterior cornea into account, don’t use mathematical models with total corneal measurement, and don’t rely on mathematical models in unusual corneas.
• Speakers in the Government Relations symposium, including Steve Forbes, MA, and Harold Miller, MS, highlighted potential benefits of designing APMs from the “bottom up” rather than the current “top down” approach.
• Bala Ambati, MD, Eugene, Oregon, took first place at the Winning Pitch Challenge for his idea for a pharmacologic, nonsurgical option for keratoconus treatment.


TOPGUN symposia cataract pearls category winners

Phaco pearls: Arnaldo Espaillat, MD, Santo Domingo, Dominican Republic, showed a video of intumescent white cataract management. Stain the capsule with trypan blue, insert cohesive OVD, and aspirate the milky fluid while you penetrate the capsule. Chop the nucleus with torsional ultrasound in pulse mode.
IOL pearls: Ronald Yeoh, MD, Singapore, offered four tips for IOL injection:
1) Follow the picture of the IOL on the cartridge for proper loading with an adequate amount of OVD.
2) Depress the optic to create a concavity for the haptics.
3) Watch the IOL as it travels down the injector.
4) Maintain adequate forward pressure for wound-assisted implantation.
Complex case pearls: Kendall Donaldson, MD, Plantation, Florida, shared several tips for pars plana vitrectomy. These included viscoelastic used to maintain the chamber and prevent further vitreous prolapse; stain with triamcinolone for visualization; insert the vitrector 3.5 mm posterior to the limbus; use a three-piece IOL in the sulcus or with optic capture; and suture the wound closed and use acetylcholine chloride.
Miscellaneous pearls: Sri Ganesh, MD, Bangalore, India, described a technique for posterior capsule rescue, which entailed creating a “vacuum rhexis.” He used coaxial I/A to create the rhexis in the posterior capsule when the PCR was less than 3 mm and did not have vitreous loss.


From the ASOA General Sessions

“When we focus on that basic truth that we are people serving people, it will make you happier,” said Brad Montgomery, CSP, during the ASOA Opening General Session.
“Everyone is hiring these days. Today, people are not
just job hopping, they are career hopping and industry hopping,” said Cara Silletto, MBA, during the ASOA Sunday General Session.

For EyeWorld’s complete coverage of the 2019 ASCRS ASOA Annual Meeting, go to daily.eyeworld.org.

Highlights from the 2019 ASCRS ASOA Annual Meeting Highlights from the 2019 ASCRS ASOA Annual Meeting
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