Eyeworld Daily News

EW SHOW DAILY 4 ASCRS News Today Monday, May 8, 2017 the ISS for a year to study the long- term effects of spaceflight on the human body. People often ask him what the best part of flying in space is: Is it the launch, the landing, floating at zero gravity, looking at Earth from above? But none of those are Cap- tain Kelly's favorite part. "All those things are great, but for me, the best part about this expe- rience is that it's really hard," he said. "For me, doing the hard things … required me to have a goal and a plan. It was about taking risks, being willing to fail, being willing to make mistakes. It was about focusing on things that I could control and ignore what I couldn't. It was about testing the status quo, and about working as a team. Because for me as an astronaut and a pilot, when I was able to put all these things togeth- er, I realized that the sky is not the limit." EW Editors' note: Captain Kelly has no financial interests related to his com- ments. At that time, there were no fe- male police officers in their town of West Orange, New Jersey. To qualify, Mrs. Kelly had to take and pass the same physical fitness exams as male recruits. Mr. Kelly, who was already a police officer, helped his wife train by building an obstacle course for her in their backyard. One task involved scaling a wall that was 7 feet, 4 inches tall. At first, she could barely make it a foot up the wall, but she quickly devised a plan she could follow with small, manageable steps. After several months of work, Mrs. Kelly was able to climb the wall, and when she took her physical exam, she scaled the wall in half the time that the male recruits did. "This was the first time in my life and my brother's life that we saw the power of having a very lofty goal and a plan with small, manageable steps to get there," he said. Mrs. Kelly became one of the first female police officers in New Jersey, and her success strategy always stuck with her son as he grew up. Although he was a poor student academically, Captain Kelly attend- ed college and one day spotted The Right Stuff, a book by Tom Wolfe that documented the stories of the first Project Mercury astronauts se- lected for the NASA space program. "I recognized traits in these guys that I had in myself," he said. "This book became my spark that got me moving in a positive direction." Captain Kelly decided to be- come an astronaut and to break the task down into many small, man- ageable steps like his mother had done. He taught himself how to pay attention, how to study, and how to do well in school. He joined the Navy, was accepted to flight school and became a fighter pilot. As a stu- dent aviator, however, he realized he was not a particularly good pilot. "But I did, however, know how to work really hard," he said. "I studied … to compensate for the fact that I didn't know how to fly." After failing to properly land his plane on an aircraft carrier for the first time, Captain Kelly was paired with a pilot who told him he was getting too comfortable in the cock- pit, and that was his problem. "This guy taught me, if I wasn't making positive corrections all the time, things were naturally going to get worse," he said. "This philos- ophy of testing the status quo, of never being comfortable with how things are … was able to help me land on the ship at night and qual- ify the very first time and become a fighter pilot." After being accepted as a Navy test pilot, in 1996 Captain Kelly applied for and was accepted to the NASA space program, along with his brother. He spent several years learning to fly the space shuttle and took his first trip to space in Decem- ber 1999 on a mission to repair the Hubble Space Telescope. After sever- al more trips to space, Captain Kelly was selected for a long-duration flight NASA was planning, where two astronauts would be stationed at Taking risks continued from page 1 Correction In "Update on presbyopia" on page 14 of the Sunday edition of EyeWorld Daily News, the first sentence of the last paragraph should have read: "Dr. LiVecchi explained that 80% of doctors do not use inlays, that they are his 'most expensive procedure,' and that the average patient satisfaction rate is 93%." nologies that could propel cataract surgery in the future. Reflecting on the past It's well-known in the ophthalmic community that Dr. Kelman, who had been researching alternative methods for cataract surgery to reduce incision size and improve recovery, got the idea for using ul- trasound to emulsify the cloudy lens while getting his teeth cleaned by a dentist who used an ultrasonic tool. By 1967, in secrecy, Dr. Kelman performed the first phacoemulsifica- tion on a consenting patient's eye, which was already destined for enu- cleation, at Manhattan Eye, Ear, and Throat Hospital. Jack Dodick, MD, New York, recalled being at the hos- pital that day, seeing warning signs on the locked OR door and a shade drawn over the observation window. "I never got into the room, but I was there," Dr. Dodick said. The phaco portion of the procedure took more than an hour and the results were not ideal, but Dr. Kelman returned to his lab and a couple of years later came out with the Kelman-Cavitron phaco unit. Reception to the new tech- nique was critical, however, and it wouldn't be until the 1980s that phacoemulsification established itself as the new gold standard for cataract surgery. Dr. Dodick said he thinks the turning of this tide came with the advent of the "Mazzocco taco" for foldable IOLs. Stephen Obstbaum, MD, New York, said he thinks the drive toward phaco was gradual. "Once [physicians] adopted ex- tracapsular cataract surgery, moving from manual I/A to machine I/A, they recognized they could work inside the eye … and the machines were getting better," Dr. Obstbaum said. "I think that combined with the small incision IOL is what pro- pelled us." Richard Lindstrom, MD, Min- neapolis, Minnesota, said he thinks some of the adoption was patient driven. The panelists reflecting on phaco's past also spoke about how ASCRS has been integral over the years for the sharing of ophthalmic ideas. "IOL implantation and phaco went hand-in-hand in terms of our educational efforts at ASCRS," Dr. Obstbaum said. Though the reception of phaco was not immediately all positive, Dr. Kelman was later awarded the National Medal of Technology by George H.W. Bush, was inducted into the National Inventors Hall of Fame, and received the Albert Lasker Award for Clinical Research, along with recognition from various medi- cal organizations. In addition to this procedure impacting all of ophthalmology, Dr. Dodick said Dr. Kelman's work has made him the grandfather of all small incision surgery in the human body. Looking toward the future Eric Donnenfeld, MD, Rockville Centre, New York, spoke about new technology that he thinks could move the field beyond phacoemulsi- fication as the standard for cataract surgery. "Why do we need something new? Phaco works great. It's an amazing procedure, but there are some issues. We need something with more safety," he said, adding that phaco complications that need addressing include endothelial cell loss, wound burn, iris damage, and capsular opacification. Nanolaser technology, using an Nd:YAG laser, Dr. Donnenfeld said, could be the answer. Nanosecond laser cataract surgery delivers 10% of the total energy to the eye compared to ultrasound, Dr. Donnenfeld said. As such, he cited studies that have found it to result in less endotheli- al cell loss and less damage to the surrounding tissues. What's more, nanosecond laser allows the sur- geon to polish the posterior capsule, removing a layer that could lead to posterior opacification, Dr. Donnen- feld said. Richard Kent Stiverson, MD, Lakewood, Colorado, spoke about combining innovative processes to bring about positive outcomes to more patients. This, he said, in- cluded office-based cataract surgery, immediately sequential bilateral cataract surgery, dropless cataract surgery, and more. He also said he thinks we "might be entering the twilight of phacoemulsification. … I do not see transformational tech- nology for phaco that will be able to keep pace with the advances of new technology," which he referenced as laser-assisted cataract surgery with I/A. EW Editors' note: The physicians have no financial interests related to their comments. Phaco's 50th continued from page 1

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