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Issue link: https://daily.eyeworld.org/i/124062
4 EW SHOW DAILY Sunday, April 21, 2013 ASCRS News Today Binkhorst Lecture details history, future of IOLs by Erin L. Boyle EyeWorld Senior Staff Writer F rom its start during the Second World War to its current technology-advancing safety and design, the intraocular lens has had a varied and exciting history since its inception, Nick Mamalis, MD, Salt Lake City, said in the Binkhorst Lecture, "Intraocular Lens Evolution: What a Long, Strange Trip it's Been." "Intraocular lens surgery has undergone a tremendous evolution in the past 60 years," said Dr. Mamalis. "But when we look at intraocular surgery with intraocular lenses, we have to go back to Sir Harold Ridley [MD]." Dr. Mamalis outlined the history of the IOL, starting with its creation by Sir Ridley. During the Blitz in World War II, some Royal Air Force pilots involved in accidents had bits of shattered cockpit in their eyes. Sir Ridley observed that the material did not cause inflammation—and had the added benefit of not being rejected by the eye, Dr. Mamalis said. The cockpit was made of Plexiglas, or PMMA, the original material used in IOLs. "[Sir] Ridley had the foresight to look into this material and actually design the first intraocular lens to go into the eye out of PMMA," Dr. Mamalis said. Sir Ridley implanted the first IOL in a successful operation in England in 1950. Following that surgery, the IOL was improved across Europe in the 1960s and 1970s, reaching the U.S. during that time. IOL background Nick Mamalis, MD, delivers the Binkhorst Lecture. Dr. Mamalis outlined how Sir Ridley's lens was implanted in the posterior chamber. Those early IOL designs were not "terribly successful," Dr. Mamalis said, and future research led to better innovations. The Binkhorst Lecture itself, which Dr. Mamalis delivered at this year's annual meeting, honors an innovator in IOLs, he said. Cornelius Binkhorst, MD, designed variations on iris-fixated IOLs, fixating the implant to the iris. The evolution of modern cataract surgery, with a small incision phacoemulsification procedure with foldable IOLs, also assisted in the improvement in lenses and efficacy, Dr. Mamalis said. He discussed different IOL materials, designs, and technologies on the market, and the pros and cons of multifocal and accommodative lenses. Achieving excellent vision at all distances is the major goal in current and future IOL design, he said. Future of lenses The future of IOLs is promising, Dr. Mamalis said. New kinds of materials and lenses could improve efficacy. Technologies such as electromechanical accommodating IOLs, injectable IOLs, and light adjustable lenses could provide improvements in IOL design, he said. "The future is bright in the area of intraocular lenses and in the area of providing our patients the best possible vision they can have," he said. "I'm very excited to see what we're going to be talking about 20 years from now." EW Editors' note: Dr. Mamalis has financial interests with Abbott Medical Optics (Santa Ana, Calif.), Alcon (Fort Worth, Texas), Allergan (Irvine, Calif.), ARC Laser (Nuremberg, Germany), Anew Optics (Newton, Mass.), Bausch + Lomb (Rochester, N.Y.), Calhoun Vision (Pasadena, Calif.), MBI (Pomona, Calif.), Medennium (Irvine, Calif.), NuView (San Diego), Ophthalmic Innovations International (Ontario, Calif.), and OptiMedica (Sunnyvale, Calif.). continued from page 1 he said. The Affordable Care Act is the new blueprint for the future of healthcare in America, he said, but with everything that is new in healthcare, we need to realize that the economic reality is that we will be bombarded with legislative and regulatory changes. "Our collective challenge is to minimize the negative impact on patient care and the economic health of our practices," Dr. Chang said. "ASOA remains focused on helping us all to navigate the increasingly complex demands of the medical practice administration." Administrators and practice managers enable eye physicians and surgeons to care for patients, which Dr. Chang said "requires constant problem solving in the face of unending new regulatory challenges." Ms. Parrott said that today we are faced with more challenges than ever before in healthcare. It is important to have good communication with doctors because at this point in time, they can't afford to not be involved in the business side of a practice. ASOA has a variety of resources, including a new website, webinars and online courses, and Ms. Parrott stressed the importance of encouraging everyone to participate with ASOA. Being involved with ASOA allows you to get to know many other administrators on another level, she said. Ms. Parrott said ASOA is like a tent in the "healthcare circus," and it providea tools to move practices forward. More than just managing practices, she said it is really about the relationships formed through the organization. "ASOA is here for you." To close out ASOA's Opening General Session, Nancey McCann, ASCRS director of government relations, spoke briefly about the future of Medicare reform. She said the current ASCRS and ASOA plan is to try to modify the Affordable Care Act. With the election now behind us, she said, the important thing now is to work toward modifications. The key priority issues she highlighted were the need to repeal the sustainable growth rate formula (SGR), to adopt Medicare private contracting, to repeal the independent payment advisory board (IPAB), and to repeal the Physician Quality Reporting System (PQRS), eRx, EHR penalties, and the value-based payment modifier. She described a variety of plans and proposals currently in motion to accomplish this. Ms. McCann said it's extremely important for Congress to hear about issues from people in their district, specifically physicians expressing their concerns. "The important thing is the impact on patient care," she said. EW