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3 EW SHOW DAILY 2018 ASCRS•ASOA Annual Meeting, Washington, D.C. patients move forward in this field. Finally, I want to thank the ASCRS Executive Committee for selecting this award. It's an especially nice honor because I'm a retinal surgeon being honored by an anterior seg- ment community." EW Editors' note: Dr. Charles has financial interests with Alcon. "I went into medicine to do microsurgery and do engineering for medical devices," Dr. Charles ex- plained, and his lecture focused on the synergistic relationship that can exist between these two fields. "Techniques do not work without technologies. You can't do phaco without surgical technologies. The thing that I want to emphasize is the evolutionary nature of the process, the iterative nature, the col- laborative nature of the process. … If surgeons and engineers collaborate, multiple surgeons and engineers, and we keep the patient and patient outcomes in mind, that's when good things happen," Dr. Charles said. "There are hardly any techniques that exist in isolation where one person thought of it. What happens is complexity goes up." He said the collaboration among industry, engineers, and surgeons is "tantamount to progress." This was the theme of Dr. Charles' lecture, as he took attendees on a "whirlwind tour through vitre- oretinal surgery." Dr. Charles went through the evolution of various ad- vances that have occurred over the years in this field, showcasing where the technology or technique started and how it was improved and added onto in subsequent iterations. Aspiration fluidics, for example, started with a manual syringe op- erated by an assistant developed by Robert Machemer, MD. From there Dr. Charles developed a rack and pinion syringe device that was oper- ated by the surgeon. This was built upon by Conor O'Malley, MD, and Ralph Heinz with foot pedal con- trol with an on-off aspiration. Dr. Charles and Carl Wang, PhD, then improved upon that with a faster response time processor, followed by Dr. Charles creating the company InnoVision (acquired by Alcon, Fort Worth, Texas) to create a smaller, faster, auto-emptying chamber in a real-time operating system that would become the Accurus Surgical System (Alcon). This all accumulated to the Constellation Vision System (Alcon), which includes an aspira- tion chamber with three proportion- al values (two vacuum, one pressure) and it is servo controlled with a fluid level that's optically sensed for flow control and auto emptying. The development of Accurus and Constellation came with sys- tems innovation and Dr. Charles' drive to take all of the prior func- tions that he previously discussed and put them all into one box with one control and a smarter user interface. Similarly, Dr. Charles described the evolution of epiretinal mem- brane peeling. Membrane peeling was initially done with a bent needle. The problem was that the needle could penetrate the reti- na; this led to the development of membrane peeling with a pick. Membrane peeling with a pick could be difficult, however, because the epiretinal membrane could slip off the needle or pick. This is what led Dr. Charles to develop forceps that were truly grasping for peeling in a single step procedure. It didn't stop there, though. The membrane could slip out of the forceps as well, so Dr. Charles developed diamond-coated forceps. In that instrument, however, dia- monds recessed from the tip, which led someone else to develop an instrument with fine end grasping. That instrument had a squared-off 20-gauge tip that could actually damage the retina; this led Dr. Charles to develop conformal for- ceps, followed by Alcon/Grieshaber developing 23-, 25-, and 27-gauge DSP IML forceps. Dr. Charles gave other examples to show just how detailed the evolu- tion of techniques and technologies can be and all of the people who are involved in that process. "The relationship between surgery and engineering has been a tremendous boon to the field," Dr. Charles said. "I want to thank the engineers I've worked with over the years at Alcon. I encourage all of you to collaborate with industry, not just with your reps but with the engineering people that develop the products that we all need to help Steve Charles continued from page 1 Advancing CATARACT SURGERY LenSx ® LASER ® CENTURION ® VISION SYSTEM IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. As part of a properly maintained surgical environment, it is recommended that a backup IOL Injector be made available in the event the AutoSert ® IOL Injector Handpiece does not perform as expected. INDICATION: The Centurion ® Vision System is indicated for emulsification, separation, irrigation, and aspiration of cataracts, residual cortical material and lens epithelial cells, vitreous aspiration and cutting associated with anterior vitrectomy, bipolar coagulation, and intraocular lens injection. The AutoSert ® IOL Injector Handpiece is intended to deliver qualified AcrySof ® intraocular lenses into the eye following cataract removal. The AutoSert ® IOL Injector Handpiece achieves the functionality of injection of intraocular lenses. The AutoSert ® IOL Injector Handpiece is indicated for use with the AcrySof ® lenses SN6OWF, SN6AD1, SN6AT3 through SN6AT9, as well as approved AcrySof ® lenses that are specifically indicated for use with this inserter, as indicated in the approved labeling of those lenses. WARNINGS: Appropriate use of Centurion ® Vision System parameters and accessories is important for successful procedures. Use of low vacuum limits, low flow rates, low bottle heights, high power settings, extended power usage, power usage during occlusion conditions (beeping tones), failure to sufficiently aspirate viscoelastic prior to using power, excessively tight incisions, and combinations of the above actions may result in significant temperature increases at incision site and inside the eye, and lead to severe thermal eye tissue damage. Good clinical practice dictates the testing for adequate irrigation and aspiration flow prior to entering the eye. Ensure that tubings are not occluded or pinched during any phase of operation. The consumables used in conjunction with ALCON ® instrument products constitute a complete surgical system. Use of consumables and handpieces other than those manufactured by Alcon may affect system performance and create potential hazards. AES/COMPLICATIONS: Inadvertent actuation of Prime or Tune while a handpiece is in the eye can create a hazardous condition that may result in patient injury. During any ultrasonic procedure, metal particles may result from inadvertent touching of the ultrasonic tip with a second instrument. Another potential source of metal particles resulting from any ultrasonic handpiece may be the result of ultrasonic energy causing micro abrasion of the ultrasonic tip. ATTENTION: Refer to the Directions for Use and Operator's Manual for a complete listing of indications, warnings, cautions and notes. © 2016 Novartis 12/16 US-CNT-16-E-5196 US-CNT-16-E-5196_PI_EWDN.indd 1 4/6/18 2:03 PM Are you a fan of EyeWorld? Like us on Facebook at: Facebook.com/EyeWorldMagazine

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