Annual Meeting Brighton 2010 review
The Annual Meeting in Brighton on 11th and 12 November was very successful with over 400 delegates attending the 2 day event.
UKISCRS Annual Meeting 2010
by Gary Finnegan (ESCRS/Eurotimes) in Brighton
The 34th annual meeting of the UKISCRS was held in Brighton and addressed a range of issues facing cataract and refractive surgeons. Milind Pande, society President, said meetings continue to go from strength to strength and he hoped to help UKISCRS growth during his time at the helm.
Bilateral consecutive surgery
The two-day event began with a robust debate on the merits of performing immediate sequential bilateral cataract surgery. Richard Packard opened the discussion by noting that operating on both eyes on the same day is highly contentious and “raises significant animosity” among experts. However, he said his view is that bilateral consecutive lens surgery is preferred by patients, saves times and cuts costs without compromising safety.
Addressing a session co-sponsored by the International Society of Bilateral Cataract Surgeons ISBCS – an advocacy group set up in 2008 – Mr Packard said patients prefer to have both eyes done on the same day.
“It requires just one hospitalisation, incurs lower costs and means less travel. It also allows more efficient use of operating theatres. Of course, we wouldn’t even consider these things if it compromised patient care,” he said.
This view was echoed by Steve Arshinoff, a Canadian-based surgeon and founding president of the ISBCS, who said the society had drawn up principles that will help ensure safe bilateral surgery.
However, David Smerdon who practices in Middleborough, UK, was not convinced. He said that while those in favour of same-day surgery mean well, the safety rates would probably be worse if performed by less skilled surgeons who were not as committed to promoting the procedure.
Mr Smerdon said a number of studies had shown increased risk of endophthalmitis and he did not accept that the convenience highlighted by advocates makes it worth taking a chance.
Christopher Liu weighed in with a compromise. “You can’t say you should never do it and you can’t say you must always do it. So my view is that it can be done sometimes.”
He said reducing the risks is essential and surgeons should never proceed with a second procedure if there have been complications with the first. “Firstly, let’s improve our standards before proposing that we all jump to this,” Mr Liu said.
Charles Cloue said doctors should listen to patients, most of whom have a favourable view of bilateral cataract surgery. He said there are no legal obstacles to the procedure and wryly noted that reducing the need for patients to travel will reduce road deaths and cut carbon emissions.
Refractive Surgery Day
Following an enlightening discussion about practice development, the debate on refractive surgery moved on to phakic interocular lenses (IOLs). Thomas Kohnen, Goethe-University, Frankfurt, said problems can occur with phakic IOLs depending on positioning but the long-term results for all major kinds of IOL are generally excellent.
“The question of which is best centres on the question of which gives fewest complications,” he said, before discussing the pros and cons of the most popular lenses on the market. Dr Kohnen said anterior chamber phakic implants have an advantage in that they are easy to implant but he advised surgeonsto monitor these lenses after implantation and to advise patients in advance that they may need “touch up” laser surgery after the procedure.
Bruce Allan said phakic IOLs have become an integral part of ophthalmology and give patients renewed confidence. The most important feature for surgeons to consider is long-term safety and endothelial loss, he said. Other issues include glare which can affect around 20% of patients but Mr Allan said he has never had to remove a lens for that reason as patients tend to tolerate it reasonably well.
The session went on to look at astigmatism management in cataract surgery and laser vision correction (LVC) for hyperopia. Julian Stevens argued for wide limits when operating on hyperopic eyes, while Mark Wevill made the case for wider limits in an effort to stimulate debate.
Rayner Medal Lecture
This year’s Rayner Medal Lecture was delivered by Dr David Chang, an established US-based surgeon who will take over the presidency of the American Society for Cataract and Refractive Surgery in 2012.
He delivered an inspiring address on innovative approaches to cataract surgery in the developing world where increasing speed and cutting costs are paramount. The quest for efficiency has led Indian surgeons to turn operating theatres into an assembly line modelled on McDonald’s fast food chain, he said.
The demand for surgery is so great in poorer nations that it has forced a rethink of how services are organised in order to treat as many people as possible at the lowest. In a well-received lecture, Dr Chang said ophthalmic surgeons are a scarce resource in the developing world, yet blindness is rising as the world population ages.
“Very few medical interventions can match cataract surgery in both cost-effectiveness and its impact on human suffering. What we need is a way to maximise the productivity of scarce surgeons,” he said.
In India, charities are taking rural patients to “eye camps” where they are treated by the dozen. “Surgeons there have incredible skills, stamina and speed. I was blown away by the quality and speed of the operations,” Dr Chang said.
Costs are kept to a minimum by reusing disposables and availing of locally-made medicines, sutures and inter-ocular lenses. The whole procedure can be done in five minutes at a cost of US$15.
“The real genius of the system is how they deliver high quality care very quickly. It was modelled on McDonald’s and their idea of having to produce a high volume service to the highest possible standard,” explained Dr Chang.
Surgeons in some Indian clinics perform one operation while a second patient is prepared for surgery. As soon as the first procedure is complete, the surgeon turns 180° and does the same surgery with a new patient.
“It’s like an assembly line run with military precision,” he said, before discussing developments in Nepal and China where outcomes have been improved thanks to advances in training supported by charitable organisations. In one Chinese city, an obstetrician and a GP have been trained to perform cataract surgery and are now training colleagues due to the high demand arising from the popularity of the life-altering procedure.
Complications of refractive surgery
After the Rayner Medal Lecture, attention returned to refractive surgery where David Gartry highlighted factors contributing to over- or under-correction. Auditing one’s results is central to ensuring that lasers “deliver what you expect”, he said, noting that audit is a large part of the Royal College of Ophthalmologists certificate in laser refractive surgery.
Mr Gartry stressed the value of the Internet Based Refractive Analysis system, an online tool which helps surgeons understand their results and compare with colleagues. He compared some of the laser technology currently in use and concluded that both had provided excellent outcomes based on data collected in 2009.
However, Mr Gartry noted that studying outcomes is essential to keeping high standards and getting the most out of lasers. This can only be achieved by collecting and analysingdata, he said.
Bruce Allan discussed some of the common – and not-so-common – complications that arise after refractive surgery. Laser vision correction is a “feel-good speciality” where most patients enjoy great results. Nonetheless, there will be occasions when things do not go as planned which is upsetting for patients and surgeons alike.
The final session of the refractive programme looked at the array of new innovations available to solve long-standing challenges facing refractive surgeons, as well as discussing some of the ongoing difficulties for which solutions would be welcome.
In parallel, the first day of the meeting wrapped up with a debate on dealing with posterior capsular rupture and vitreous loss, and a separate discussion on how the NICE guidelines affect the work of ophthalmologists.
Young surgeons scoop prizes
The second day of the annual meeting began with the free paper session where some of the society’s most promising young members competed for cash prizes. The prize for best overall paper and the Founders Medal was presented to William Tucker for his study of the forces required to use preservative-free dry-eye treatments. As part of the research, Mr Tucker compared the force needed to squeeze a drop of artificial tear from 20 commercially available containers and found significant variation. The results point to potentially lower compliance with products that require large force to dispense a drop.
This year’s best cataract surgery paper went to Imran Yusuf for an intriguing presentation which shows SLO/OCT scanners are capable of identifying retinal features through occlusive IOLs. This, according to Mr Yusuf, suggests occlusive IOL insertion may represent a safer treatment option than previously considered.
The award for best refractive surgery paper went to Anish Shah for a randomised prospective study investigating the efficacy of corneal collagen cross-linkage (CXL) in halting keratoconus progression. The study found CXL to be safe and effective in arresting keratoconus.
Best video prize went to Dan Lindfield for a video entitled “Endoscopic Cyclophotocoagulation (ECP) & Trans-Scleral Cyclodiode: Endoscopic illustration showing two completely disparate treatment modalities”.
There was also a prize for best poster which went to Richard Symes’ presentation of scheimpflug imaging, while the runner-up in the poster competition was Christopher Hemmerdinger for his study of pachymetry in glaucoma referral refinement.
Practice makes perfect
The highlight of the second day was Larry Benjamin’s lecture on the future of training, in honour of Neil Dallas. Mr Dallas, was the first President of UKISCRS and oversaw the development of the society from its humble beginnings.
Mr Benjamin paid tribute to Mr Dallas, saying he had shown commitment to training new generations of surgeons throughout his time with the society.
In a detailed look at how to improve surgical skills, Mr Benjamin said hospitals that are committed to training young surgeons should embrace the best technology available as well as incorporating new research on how trainees learn.
He also stressed the need to “train the trainers” given that not all surgeons are natural teachers and many have only a limited understanding of how we learn.
“We all think we’re good trainers, but some are not. What’s changed is that we now understand that not everyone is natural teacher,” Mr Benjamin said.
Developing cognitive skills has become a key component of modern training, according to
Mr Benjamin. New surgical simulators are “absolutely brilliant” and allow trainees to practice on very detailed and realistic models, he said. In addition biofeedback can significant improve technique, Mr Benjamin said, but practice is at the heart of improving standards.
“The future of training is necessarily structured and innovative. I think every training unit should have a wet lab and a simulator. They say it takes 10,000 hours to become an expert.
At three hours a day, that is ten years. There is no question that increase time spent practising will speed up surgical prowess,” said Mr Benjamin.
New UKISCRS President Milind Pande said he was humbled to have been elected to lead a society which had nurtured his own professional growth and given him many friends.
“I’ll do my best to continue these traditions and will work with officers, directors and
council to grow the society to meet the needs of its members,” he said, paying tribute to his predecessor, Mr TayoAkingbehin, who successfully guided the society for 18 months.
The new President committed to completing the review of the memorandum and articles of the society which was initiated by Mr Akingbehin as part of his strategies for modernising UKISCRS.
Mr Pande thanked those who organised sessions for the annual meeting, as well as the speakers, moderators and commercial partners. He added a special word of thanks for the secretariat led by Titia Dorgeat for “her outstanding effort and graceful manner” in making the meeting a success.
Charles Claoue, secretary of the society, said the current membership stands at 425 which represents a slight reduction on last year. The consultant membership for this year is higher than the average for the last five years, he said, adding that the number of trainees among UKISCRS membership has fallen by 50%. “We think this is partly due to uncertainties of currenteconomy. However, we would be very grateful if all of you could remind your trainees thatwe encourage them to submit papers and posters for 2011,” Mr Claoue said.
Treasurer Som Prasad said the fall off in membership had a slight impact on the society’s finances but the financial reserves remain healthy.