A fast paced weekend of education in Sydney saw no less than 26 Australian ophthalmologists share their knowledge with colleagues at Alcon’s Synergeyes conference from 30 June to 1 July.
Alcon gave ophthalmologists free reign to discuss broad ranging issues of eye health at the annual Synergeyes conference. This year’s program of education was developed by faculty members Assoc. Prof. Tim Roberts, Assoc. Prof. Chandra Bala, Assoc. Prof I-Van Ho, Dr. Anton Van Heerden and Dr. Nathan Kerr.
Presentations by individual speakers were followed by panel discussions about diverse approaches to complex cases in vitreoretinal surgery, glaucoma management, cornea and cataract surgery and cataract and glaucoma surgery. Generous audience participation ensured the event was lively and informative.
Presentations by individual speakers were followed by panel discussions about diverse approaches to complex cases
A presentation by Professor Stephanie Watson on corneal disease highlighted the fact that the World Health Organization (WHO) now recognises antimicrobial resistance as a growing threat to public health. Antibiotic resistance occurs when bacteria change in response to the use of medicines, and according to WHO, this means the world urgently needs to change the way it prescribes and uses antibiotics. Prof. Watson said over the counter use of chloramphenicol has been cautioned by the Royal Australian New Zealand College of Ophthalmologists (RANZCO), which recently introduced a statement regarding its use.
Prof. Watson also drew attention to a RANZCO position statement regarding stem cell treatment. In the United States, patients recently lost sight following stem cell treatment for an eye disease, having incorrectly believed the treatment to be part of a study advertised on the government clinical trials website. Reflecting on the case, Prof. Watson said the position statement from the College would help patients understand what real stem cell treatments are. “It’s important to have innovations and new treatments, but we need to know they work and we need to protect the patient,” she said.
Dr. Greg Moloney spoke about advances in corneal transplants. He said being a less invasive procedure, Descemet’s membrane endothelial keratoplasty (DMEK) offered significant advantages over Descemet’s stripping endothelial keratoplasty (DSEK), in patient recovery time and visual outcomes. Dr. Moloney went on to describe complex corneal cases due to significant scarring that required prosthesis. One patient with scarring due to chemical trauma required Boston keratoprosthesis (a collar button design keratoprosthesis) and another patient with no eye lid required osteo-odonto-keratoprosthesis (OOKP). This involves removal of a patient’s tooth to house an optic or cylindrical lens. The bone/lens was transplanted into the patient’s cheek and left for three months to gain a vascular supply and tissue coating then transplanted onto the front of the patient’s eye ball. Dr. Moloney said although some question the longevity of such a procedure, a colleague in Italy recently reported to him on a patient who underwent OOKP 40 years ago and continues to have useful vision. He said with time, such complex procedures may not be required, thanks to work being undertaken in areas of stem cell cultivation.
CATARACT AND GLAUCOMA
Topics surrounding treatment of cataract patients with glaucoma, were followed by an interactive discussion about minimally invasive glaucoma surgery ahead of cataract surgery by a panel comprising Assoc. Prof. Smita Agarwal, Dr. Isabel McLean and Dr. Ashish Agar, and chaired by Dr. Nathan Kerr.
Dr. Ashish Agar described the work of Professor Minas Coroneo to invent Alcon’s Cypass. He said Cypass, iStent (Glaukos) and the Hydrus (Ivantis) all have their place in the glaucoma paradigm.
Currently MIGS device surgery is only Medicare rebateable when used to treat patients with glaucoma who are to undergo cataract surgery. Dr. Agar said the Australian Society of Ophthalmologists was advocating to have this inequity changed to allow standalone use. However, he said the increasing use of MIGS would be extremely costly to government and the health sector if allowed to continue without guidelines. “The concern is over-use and as a profession we have to manage it – we have to self-regulate and if we don’t, the government will.” The panel debated whether MIGS should be offered to all appropriate glaucoma patients and to glaucoma patients undergoing cataract surgery, whether or not the procedure is Medicare rebateable or they have private health insurance. “If a patient isn’t uninsured, it doesn’t mean they can’t afford it – we should inform the patient and let them choose,” said Dr. Agarwal. Dr. Nathan Kerr added, “many of my patients are uninsured but happy to pay for the device.”
EXPERIMENTING WITH TECHNOLOGY
A dry lab in Alcon’s trade exhibition, which was set up alongside the conference, allowed ophthalmologists to implant the Cypass into a model eye. Another station enabled ophthalmologists to experience the company’s Ngenuity 3D visualisation system for retinal surgery. At a third station, ophthalmologists were able to experiment with the new Clareon IOL AutonoMe delivery system, which was launched at an Alcon dinner during the Synergeyes conference.