New ASCRS chief lays out agenda of education and advocacy
This and other special presentation highlights from the annual meeting are below.
SAN DIEGO — Richard L. Lindstrom, MD, announced his plans for enhancing education, improving recruitment and retention, and advancing member advocacy efforts upon assuming the presidency of the American Society of Cataract and Refractive Surgery.
Dr. Lindstrom laid out his agenda for his tenure as president during the opening session of the society’s annual meeting. He was introduced by outgoing ASCRS President Samuel Masket, MD.
“You will rarely find an individual with the incredible combination of talent and drive,” Dr. Masket said.
Dr. Lindstrom, who is Chief Medical Editor of Ocular Surgery News, said he accepts his new role “with great humility.”
He spoke of the upcoming challenges involved with upholding the mission of the ASCRS, specifically noting its core: “To advance the art and science of ophthalmic surgery and the knowledge and skills of ophthalmic surgeons.”
Touting Web- and print-based initiatives, he committed himself and the society to a new level of education for its members.
Images: Altersitz K, OSN
In addition, Dr. Lindstrom said an initiative called Members First will aim to increase recruitment and retention through an increased involvement of subspecialties such as cornea and glaucoma and will also seek to address the needs of ophthalmologists just starting out in the field.
To best serve its members, Dr. Lindstrom also committed ASCRS to continue to work with the government and the American Academy of Ophthalmology to address issues such as the sustained growth rate and the Bush administration’s pay-for-performance initiative. “We are committed to see that pay-for-performance is voluntary and non-punitive,” he said.
Following are other highlights of special presentations from the ASCRS. All of these items appeared first as daily coverage of the meeting on OSNSuperSite.com.
Newly inducted ASCRS Hall of Famer calls for continued research into IOL pathology
David J. Apple, MD, called for an infusion of new energy into research on IOL pathology upon being recognized as the newest inductee of the ASCRS Ophthalmology Hall of Fame.
“Who will take over when I retire or die?” Dr. Apple asked.
Dr. Lindstrom noted Dr. Apple’s more than 20 years of research and called him a “true pioneer” in the study of IOL pathology, including his breakthrough study that showed the ideal placement of early IOLs to avoid posterior capsular opacification.
Dr. Apple, who trained under Lorenz E. Zimmerman, MD, and was a devoted admirer of the work of Sir Harold Ridley, MD, recently celebrated the 25th anniversary of his own “Apple Korps” of trainees.
Still, he voiced concerns over not having a true successor to continue studying the pathological implications of the constantly evolving IOL technologies, both current and future designs.
“I want this to keep going and not be stagnant and die,” said Dr. Apple, who received a standing ovation for his work.
Latest technology allowing laser vision correction in naval aviators
The combination of wavefront-guided technology and femtosecond flap creation has produced such positive clinical results that certain naval aviators may now undergo LASIK, according to a surgeon.
Steven C. Schallhorn, MD, presented an overview of the evolution of refractive surgery in the U.S. Navy during the Cornelius D. Binkhorst Lecture.
Dr. Schallhorn and colleagues have conducted numerous studies since the 1990s to ascertain which procedures and technology produced the best clinical results, he said.
They learned from their initial studies that conventional LASIK induced a non-recoverable decrease in contrast sensitivity. In a further comparative study, he found this decrease was five times less pronounced with wavefront-guided LASIK.
In a second comparative study, he found that femtosecond laser-created flaps led to faster visual recovery and better contrast sensitivity than microkeratome-created flaps, he said.
In night driving tests, which mimic aircraft landing scenarios, naval aviators who were treated with femtosecond laser-assisted wavefront-guided LASIK demonstrated an improvement in their performance. In contrast, those aviators who underwent conventional, microkeratome-assisted LASIK experienced, on average, a decline in performance, he said.
As a result of these studies, the U.S. Naval Medical Center now performs LASIK with a VISX Star S4 CustomVue laser platform and the IntraLase femtosecond laser (Advanced Medical Optics), he said.
In 2006, the U.S. Naval Medical center performed LASIK on the first naval aviator in history. Within 4 hours postop, he had achieved uncorrected visual acuity of 20/20. By the next day, UCVA had improved to 20/16.
Naval aviators can typically return to the cockpit by 1 month postop, Dr. Schallhorn said. Ongoing studies will look at ways to reduce this recovery time to 1 to 2 weeks, he said. Shorter recovery times could translate into cost savings, he said.
Key to prevention of PCO lies in capsular bend, accommodative IOLs
In the future, the cataract surgeon’s ability to protect against posterior capsular opacification will hinge upon innovative new designs and placement of IOLs, according to the surgeon who delivered the Charles D. Kelman, MD, Innovator’s Lecture.
Okihiro Nishi, MD, described his theory behind avoiding PCO and introduced his latest idea for an accommodative lens design at the meeting.
“The capsular bend induces contact inhibition of migrating lens epithelial cells regardless of materials of an IOL,” Dr. Nishi explained, showing images and diagrams of both round- and square-edged IOLs.
He said that without this bending effect, the cells can migrate to the posterior chamber and cause PCO. He explained that bending is best caused by square-edged IOLs but is not guaranteed.
Next, Dr. Nishi introduced his novel design combining one posterior and one anterior square-edged IOL and filling the space between with gel. The anteriorally placed IOL is designed with a hole through which the gel can be inserted. The hole rotates to lie under the iris and prevent leakage, he said.
In theory and in a rabbit model, the accommodation occurs with the forward movement of the anterior IOL. Dr. Nishi said the next step is to test the theory in a primate.
“In conclusion, the procedure using the novel accommodative IOL securely prevented leakage,” he said. “The procedure is simple, safe and highly reproducible. … It can be a breakthrough.”
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