Eyeworld Daily News

EW SHOW DAILY 50 Meeting Reporter Sunday, April 19, 2015 by Chiles Aedam R. Samaniego EyeWorld Asia-Pacific Senior Staff Writer W here do you begin when you talk about innovation? The force behind the cutting edge tech- nology of the present? The same force that drives these technologies forward into the future? For Eric D. Donnenfeld, MD, Rockville Centre, N.Y., the answer is to look into the past. Dr. Donnenfeld, in an EyeWorld Corporate Education event, "Oph- thalmology Time Machine! How Lessons from the Past Can Drive Technology of the Future," went on an "official mission" for ASCRS with perennial partner Mike Carboni to "discover the roots of ophthal- mology." In order to understand where we stand now and thus better appreciate the current state of cataract surgery, Dr. Donnenfeld sent Mr. Carboni through the "Transmitotron"—an elaborate device consisting of futuristic stage dressing, projection mapping, lasers, and snazzy sound effects—to 1975, where he got to observe a "young" Dr. Donnenfeld in consultation with a potential cataract surgery patient. The young Dr. Donnenfeld de- scribed the procedure to the hapless patient, beginning with the incision he would make with a von Graefe cataract knife. "Basically," he said with almost sinister enthusiasm, "I cut your eye in half, peel it back, and scoop the lens out." He went on to boast about how the technique had cut his vitreous loss rate down to 50%. When asked about visual out- comes, young Dr. Donnenfeld said "visual acuity isn't that important." Regarding phaco, the young Dr. Donnenfeld scoffed. "Phaco? A passing fad," he said. "What can a dental drill do that I can't do with my hands?" The young Dr. Donnenfeld punctuated his spiel with claims that this was, by far, the best tech- nique for cataract surgery—"I can't imagine better." A horrified Mr. Carboni crept away, out of 1975, back through the Transmitotron, into the (relatively, particularly in terms of cataract sur- gery) paradisiacal present of 2015. Back in the present, Dr. Donnenfeld and Mr. Carboni caught up with Keith Walter, MD, Winston-Salem, N.C., who at the time was lounging in Cyberspace. "I can't think of the world with- out the Internet," Dr. Walter said. He then went on to discuss innova- tions in cataract surgery in terms of the Catalys Precision Laser System (Abbott Medical Optics, AMO, Ab- bott Park, Ill.). Specifically, he talked about the streaming OCT—which provides the surgeon with almost real-time OCT images during sur- gery—and integral guidance system that allows the surgeon to identify all the important landmarks for sur- gery, such as the capsulorhexis edge. Dr. Walter also discussed the la- ser system's use in cataract fragmen- tation. The Catalys laser, he said, can even ablate outside the capsulotomy zone, allowing segmentation and softening so complete that at times phaco is no longer necessary to aspi- rate the lens. In this way, he said, the system "brings back the clock a few years," to a time when cataract surgery was driven by fluidics rather than ultra- sound energy. Speaking of fluidics, Dr. Walter went on to tout the bene- fits of the Catalys system's Fusion pump, which allows surgeons to switch between peristaltic—for better holdability—and Venturi— for better followability. After an Adam Westian Bat-Fight with the nefarious Dr. Dellusional (Steven Dell, MD, Austin, Texas) and an accidental visit to the 2035 ASCRS meeting where Robert Cionni, MD, Salt Lake City, has been president for 20 years, Dr. Donnenfeld consulted Wallace Chamon, MD, São Paolo, Brazil, on the Catalys system's precision and accuracy. "When it comes to precision, accuracy, nowhere does it matter more than when you're driving at 300 miles per hour," Dr. Chamon said. This, he said, is where cataract surgery with the Catalys is at today: a cutting-edge procedure requiring— and achieving—a high degree of precision and accuracy. "It's not just important, it's crucial," he added. This, however, does not mean the Catalys is as difficult to learn as a Formula-1 race course. Dr. Chamon's residents, he said, adapt to the system brilliantly. "Considering how intuitive it is, it is no problem," he said. Dr. Chamon may not be as good as Ayrton Senna on the racetrack, but he definitely does better cataract surgery. Finally, Dr. Donnenfeld used the Transmitotron to bring Daniel Chang, MD, Bakersfield, Calif., and Elizabeth Yeu, MD, Norfolk, Va.— who were, at the time, getting on a plane to Europe on vacation—onto the stage to discuss the Tecnis iTec Preloaded Delivery System as well as the latest range of Tecnis multifocal and toric multifocal IOLs (all AMO). Dr. Chang said that the preload- ed system allows surgeons to deliver a lens without compromise, provid- ing optimal predictability, efficiency, and safety. Still, "what really matters is what we put in there," and the key, he said, is the optic. Dr. Donnenfeld confessed he had grown skeptical of multifocals over the years, but with this latest range of Tecnis IOLs, "I'm jazzed again. "This family of IOLs is a game changer." At the end of the symposium, Dr. Donnenfeld, dazzled by the future technology he'd seen, used the Transmitotron to return to 2035; Mr. Carboni, together with Drs. Chang and Yeu, returned to the 60s where—the state of cataract sur- gery notwithstanding—everything "looked trippy." EW Editors' note: This event was sponsored by Abbott Medical Optics. To the Transmitotron! The past as context for present technology Dr. Yeu (left) and Dr. Chang, who were on their way to a vacation in Europe, emerge from the Transmitotron to discuss the latest family of multifocal IOLs from Abbott Medical Optics. Dr. Donnenfeld (left) talks Mr. Carboni into going back in time to gain a better appreciation for modern cataract surgery.

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