Focus: Two Conferences in One Cataract and Refractive, and Vitreoretinal

Alcon recently hosted its annual symposium, titled Focus. This year the event was expanded to three days with the addition of a dedicated vitreoretinal program, alongside the established cataract and refractive meeting.

Penny Stewart, Cluster Franchise Head, Surgical and Country Manager ANZ, said the Focus event, held in Sydney, was an “opportunity to bring together some of Australia and New Zealand’s most respected ophthalmologists”.

“As one of the leaders in eye health, hosting events like Focus provides fantastic opportunity to collaborate and hear from others within our industry,” she said.

The Focus Cataract and Refractive Symposium comprised presentations and panel discussions centred around the management and optimisation of outcomes for patients. Discussions included patient counselling tips, patient selection, how to reduce the risk of refractive surprises, and how to handle dissatisfied patients.

Alcon also took the opportunity to launch its latest intraocular lens, Clareon Vivity, which Ms Stewart said, “completes our Clareon collection in the ANZ market”.

Designed and delivered by surgeons for surgeons, the cataract and refractive symposium was led by Associate Professor Smita Agarwal (Wollongong Eye Specialists, University of Wollongong), Dr Ben LaHood (Adelaide Eye and Laser Centre, University of Adelaide), and Dr David Gunn (Queensland Eye Institute). Professor Andrew Chang AM (Sydney Retina Clinic and Day Surgery), Professor I-Van Ho (Sydney Eye Hospital), and Dr Sarah Welch (Auckland Eye Hospital) led the vitreoretinal symposium.

Opening the combined session, Prof Chang said, “This is a really unique opportunity to have anterior and posterior segment surgeons sit in a room and cover areas that are going to be very important in future directions for our patients, for our industry… and our communities.”

COMPLEX RETINAL DETACHMENTS AND DIABETES

At the Vitreoretinal Symposium, keynote speaker Dr Steve Charles, Clinical Professor of Ophthalmology at the University of Tennessee in Memphis in the United States, spoke about managing complex retinal detachments before moving on to speak about common mistakes when managing tractional retinal detachment in patients with diabetes.

He recommended extended vitreous base laser in all retinal detachment cases, including highrisk patients. Although combined pars plana vitrectomy and scleral buckle is considered gold standard by many ophthalmologists, he believes it increases many complications.

“Listen to your colleagues and aim for dropless, pain-free white eyes that are emmetropic and (complication-free)… we ought to do all we can as vitreoretinal surgeons,” he said.

In his second presentation, Dr Charles explained why surgeons should not create a posterior vitreous detachment (PVD), undertake membrane peeling or use silicone oil when operating on a retinal traction detachment in a person with diabetes.

He said the idea that first you create a PVD is wrong because “you’re absolutely asking for iatrogenic retinal breaks if you pull on the vitreous”. Similarly, membrane peeling is responsible for a “high incidence of iatrogenic retinal breaks”.

“It’s crucial to do a 360º dissection of the cortex (of the eye) using vitrectomy scissors but don’t pull on the cortex, don’t do a forceful PVD creation… don’t do vitrectomy membrane peeling… do everything you can with a vitrectomy probe without making iatrogenic retinal breaks,” he observed.

Dr Charles is firmly against the use of silicone oil in the case of iatrogenic retinal breaks occurring in these procedures because he said it markedly reduces inner retinal oxygenation and sequesters reactive Müller cells, basic fibroblast growth factor, vascular endothelial growth factor (VEGF), and cytokines at the retinal surface. It also prevents an anti-VEGF agent from gaining access to the retina.

In short: “Do everything that you can to avoid silicone oil.”

AI AND CATARACT SURGERY

Dr Michael Lawless (Sydney), who has performed over 35,000 cataract procedures, presented an engaging presentation on ‘The now and the near future for cataract surgery and what to do with AI (artificial intelligence)’.

He said there is no need to be fearful of AI and highlighted a French study¹ that found ChatGPT achieved a 91% success rate on the French Board Exams for ophthalmology. “AI provided correct answers across all question categories, indicating a strong understanding of basic sciences, clinical knowledge, and clinical management. The AI model also answered questions rapidly, taking only a fraction of the time needed by human test-takers.”

He said while some may find this distressing after years of study, “you are the only person who can really interpret and make use of that knowledge”.

Dr Lawless described another study that compared the responses of humans to GPT-4 from OPEN AI when asked to respond to questions about glaucoma and retina questions and make assessments for 20 deidentified patient cases.² The study reported “AI matched humans in accuracy and thoroughness of medical advice and assessments and even ‘demonstrated superior performance in response to glaucoma questions and case-management advice, while reflecting a more balanced outcome in retina questions, where AI matched humans in accuracy but exceeded them in completeness’.”

“Why wouldn’t you… make your decision then add to that decision process by using ChatGPT-4?” Dr Lawless asked. “It’s early days but you’ve just got to do it (and if you don’t) patients will do it anyway.”

PRESBYOPIA CORRECTION

Keynote speaker Dr David Lubeck – a US cataract, corneal, refractive, and advanced anterior segment surgeon and Assistant Clinical Professor of Ophthalmology at the University of Illinois Eye and Ear Infirmary, Chicago – spoke on opportunities for improved presbyopia correction outcomes with new intraocular lens (IOL) and surgical technologies. He believes presbyopia IOLs are underutilised globally because of surgeons’ reticence, citing their lack of understanding, their fear of managing undesirable outcomes, and the paucity of presbyopia specific instruments to measure outcomes and inertia.

He said a lack of patient education, cost, and availability, and ‘memory of earlier technologies’ also comes into play.

“Most patients having cataract surgery are unaware of presbyopia correcting IOLs,” he said, and yet if there was greater awareness, more patients would choose them. Dr Lubeck said presbyopia correction should be considered as a possible goal for most cataract patients. Surgeons have an obligation to educate patients on cataract surgery and IOL outcomes, and when presbyopia correcting IOLs are successfully integrated, he said “the practice of ophthalmology is more gratifying and interesting”.

Dr Lubeck went on to describe the performance of different presbyopia correcting IOLs and patient selection. He said surgeons need to involve their patients in surgical decision making, and choose an IOL to suit the patient’s anticipated lifespan and long-term ocular health. He said surgeons should be prepared to mitigate unexpected or unsatisfactory outcomes, but most importantly, they need to “shift from reticence to satisfaction by mastering another therapeutic skillset and providing patients more choice in surgical outcomes”.

CELEBRATING CLAREON VIVITY

Dr Tanya Trinh (Sydney) hosted the celebratory launch of the Clareon Vivity Extended Vision IOL, describing it as Alcon’s “latest technology to be introduced as part of the Clareon collection, which comprises monofocal, toric, the market leading trifocal (PanOptix) IOL and now the market leading extended depth of focus lens, the Vivity”.

She said Vivity IOLs recently surpassed one million implants worldwide, which is “a testament to the lens design”.

Early insights, presented by Dr Lubeck, Dr Alex Tan (Melbourne) and Dr Armand Borovik (Sydney), were followed by a panel discussion.

Dr Lubeck described Clareon Vivity as “a platform and a lens design that will outlive our patients”. He said the Clareon material – a hydrophobic, bioadhesive acrylic IOL – is “desirable” because it delivers exceptional long-lasting glistening free clarity, precision edge design, exceptional axial rotational stability. A US Clareon investigator in 2007, he is still seeing patients with Clareon IOLs and continues to be impressed by the clarity of this material.

He said by combining the material of Clareon with Vivity platform design, Alcon’s new extended depth of field IOL gives a good range of vision in most patients, and a halo and dysphotopsia profile similar to monovision IOLs. He said real world data shows 90% of patients reported no visual disturbances.

“It’s the perfect combination of materials that will last more than a lifetime and an optical design that will serve our patients well,” he said.

Dr Lubeck said the Clareon Vivity is suitable for patients who seek reduced spectacle dependence for most activities, those with mild ocular surface disease, glaucoma or macular changes, patients who have had “previous refractive surgery with less than perfect corneas”, and those who are risk averse or “don’t want to deal with dysphotopsias”.

RETINA FILM FESTIVAL

During the event, Alcon hosted the Retina Film Festival, with the delicate artistry and precise craft of vitreoretinal surgery coming to life through the lens of cinematic storytelling. The festival was designed to ignite panel and audience discussion.

A COLLEGIATE ENVIRONMENT

Attendees at the Focus conference spoke about the collegiate environment and the value of being exposed to new technologies.

Dr Borovik said he always looks forward to Focus. “It is a fantastic opportunity… to discuss the latest trends in not only cataract surgery but broader ophthalmology as well. It is an extremely collegiate environment and there is always excellent discourse around the presentations.”

Additionally, he said, it was “a privilege to be invited to be part of an early access group for a new technology – particularly when that technology combines my preferred lens platform in Clareon and preferred presbyopia correcting optics in Vivity”.

For Assoc Prof Agarwal, presentations dealing with real life current ophthalmic issues were particularly valuable, as were the good networking opportunities. “Alcon runs (the conference) in a very relaxed and interactive format, and everybody gets to share their honest opinion,” she said.

Consultant ophthalmologist Dr Rahul Chakrabarti, who is also the Director of Training for the Victorian Network of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO), described Focus as being all about “inquisitiveness, innovation, and insight”. He said it enabled delegates to learn “about applications of new technologies from the experts in our field in a collegial environment”.

Alcon has more symposiums planned for this year: TropSat will take place at the Australasian Society of Cataract and Refractive Surgeons conference on Hamilton Island next month and the Alcon Symposium will take place at RANZCO’s annual Scientific Congress in Adelaide in November.

References

1. Panthier, C., Gatinel, D., Success of ChatGPT, an AI language model, in taking the French language version of the European Board of Ophthalmology examination: A novel approach to medical knowledge assessment. J Fr Ophtalmol. 2023 Sep;46(7):706–711. DOI: 10.1016/j. jfo.2023.05.006.
2. Mount Sinai, Artificial intelligence matches or outperforms human specialists in retina and glaucoma management, Mount Sinai study Finds (media release, 22 Feb 2024), available at: mountsinai.org/about/newsroom/2024/ artificial-intelligence-matches-or-outperforms-humanspecialists-in-retina-and-glaucoma-management-mountsinai-study-finds [accessed April 2024].