Eyeworld Daily News

10 | EYEWORLD DAILY NEWS | MAY 4, 2019 ASCRS NEWS ASCRS ASOA ANNUAL MEETING by Vanessa Caceres EyeWorld Contributing Writer P hysicians in developed countries may think their country is leading the way in health and vision care. Yet what if devel- oping countries actually had lessons to help bring progress to ophthalmology else- where? That was the theme behind the 2019 Stephen A. Obstbaum, MD, Honored Lecture, given this year by Alan Robin, MD, Balti- more. The lecture was part of the 2019 ASCRS Glaucoma Day. Despite clinical advances in countries like the U.S., there are still racial disparities when it comes to glaucoma's prevalence, as well as many problems with the cost of treatment. Dr. Robin focused on his experience working with Aravind Hospital in India and lessons learned from there. "India is the perfect place for disruptive technology," he said. The Aravind system began in 1976 with 11 beds. It now has 71 primary care centers and six tertiary care centers, the latter of which see 1,000 to 3,000 patients a day. In 2017 to 2018, Aravind performed 4.1 million outpatient exams and treated 91,432 cata- racts. The system also now has a global reach with 344 hospitals in 28 countries, Dr. Robin said. Women compose 60% of the workforce at Aravind. In fact, 300 or more high school females are selected each year to train to work with Aravind and perform a vari- ety of tasks so surgeons can focus on what they do best. The women "become well-respected communi- ty leaders," Dr. Robin said. The criticism of healthcare costs in the U.S. is a daily reality, with many patients not knowing what they will pay. "We need to have accountability," Dr. Robin said. At Aravind, surgical costs are presented in advance in detail. Aravind has also been in- volved with many research studies to help identify surgical trends. For instance, one study in press in Ophthalmology that took place with Aravind data found the tipping point for better outcomes after cataract surgery is when a surgeon performs 350 or more cataract surgeries a year, Dr. Robin said. This helps support the idea of high-output clinics where surgeons can perform in high vol- ume, according to the study. Other studies with Aravind have focused on surgical errors, endophthalmi- tis trends, and posterior capsule opacification. With a constant demand for more patient care, Aravind now has 67 vision centers with employ- ees who can measure vision and blood pressure, and even perform a urinalysis. The female trained staffers who see patients at these locations can detect glaucoma with their exam. However, patients also have a telemedicine conference with a doctor. "It's an impressive system," Dr. Robin said. Another area of research and effort at Aravind involves surgical waste. A study that Dr. Robin co-authored found that a single phaco procedure in the U.S. generates the same amount of greenhouse gases as driving 453 miles, compared to a much smaller amount at Aravind. Editors' note: Dr. Robin has no finan- cial interests related to his comments. Obstbaum lecturer: Vision care in developing countries can provide lessons for the U.S. and others A role for connexin 43 in glaucoma treatment by Vanessa Caceres, EyeWorld Contributing Writer A future glaucoma treatment may have to modify the retinal ganglion cell environment to help save the neuron, and con- nexin 43 (Cx43) may be part of it, said Helen Danesh-Mey- er, MD, Auckland, New Zealand. Dr. Danesh-Meyer led the session "International Guest Speaker – The Optic Nerve: Chal- lenging Dogma" at the 2019 ASCRS Glaucoma Day. Because existing research into neuroprotection has failed, further treatment avenues have to take different approaches, Dr. Danesh-Meyer said. She discussed Cx43, an expressed isoform part of the connexin family. In the retina, it is prevalent in astrocytes. Dr. Danesh-Myer addressed the role that Cx43 has in several acute diseases, such as stroke, trauma, and infection. It also has a role in several chronic diseases, including multiple sclerosis and migraines. Current research is investigating the role that Cx43 has in the optic nerve. The majority of the research is still preclinical. "Is there a role to modify Cx43 hemichannels for therapy? It's certainly an area that neurologists are interested in," she said. Published studies have focused on Cx43 and its role in Parkinson's disease and vascular cognitive disease, for example. Connexin 43 could also potentially be part of glaucoma treat- ment, combining downregulation of the hemichannel opening with other hemiprotective strategies. Editors' note: Dr. Danesh-Meyer has no financial interests related to her comments. Dr. Robin receives an award from Dr. Rhee for delivering the 2019 Stephen A. Obstbaum, MD, Honored Lecture during ASCRS Glaucoma Day.

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