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Moving on from medication “stacks” and the old-school reactive approach

Glaucoma specialists take back treatment compliance

Over the last 15 years, biosimilars have become a major feature of the health care landscape. Physicians in many disciplines, particularly oncology and immunology, have embraced biosimilars. However, access to educational resources on these powerful biologics can be inconsistent, and in turn, some ophthalmologists who could benefit from the adoption of biosimilars are left in the dark.

The real-world application of biosimilars was the focus of discussion for Martin Zinkernagel, MD, PhD, chair of the Department of Ophthalmology at the University Hospital of Bern, Switzerland, and Paolo Lanzetta, MD, professor of ophthalmology and chairman of the Department of Medicine-Ophthalmology at the University of Udine in Italy. In their discussion, the experts addressed several common questions, framed around the phase 3 clinical trial for biosimilar SB11 (BYOOVIZ) from Biogen. SB11 is approved in Europe and the United Kingdom. Like the reference product ranibizumab (Lucentis), SB11 is approved for the treatment of retinal disease including neovascular age-related macular degeneration (nAMD).

Addressing physicians’ levels of familiarity with biosimilars, Dr Lanzetta attributed much of the variation to regulatory discrepancies. “The uptake of biosimilars varies throughout Europe by country and by product,” he said. “Obviously, variation in the uptake of biosimilars [is] influenced by government involvement, reimbursement issues and tender procurement policies.” Recent survey data have revealed gaps in awareness across Europe and in the United States on the efficacy and safety of biosimilars for retinal diseases, Dr Lanzetta said, especially in terms of “real-world data.”

In a clinical application, Dr Lanzetta said, biosimilars may exhibit minor differences from the reference products, but they aren’t considered to have significant impact on the efficacy or safety profile. Typically, the biosimilar and reference medicine must have the same posology and route of administration, with few exceptions, he added.

Dr Lanzetta also said that in the last 10 years, the European Medicines Agency (EMA) has approved the highest number of biosimilars worldwide.

 “And this means, to us physicians, having both the possibility to have experience on their use in terms of safety and evaluating the efficacy after that,” he explained.

One common misconception about biosimilars is that these therapeutics are interchangeable with the idea of generic medicines. But there is a key indicator that biosimilars are unique: the cost. “While generic medicines are marketed at a significantly lower price than name brand ones, why do we not see the same level of cost savings with biosimilars?” Dr Zinkernagel asked.

Dr Lanzetta explained that biosimilars are developed via a rigorous, complex and highly regulated manufacturing process. “Generics are simple chemical medicines or agents, which is not the case for biosimilars and biologics,” he said. “Unlike generics, biologics, and therefore biosimilars as well, are very complex; they’re very difficult to copy. And the development processes are patented and proprietary to the originators.” The proprietary nature of biologic development, he added, is why biosimilars may have differences from their originators.

Prof Zinkernagel and Dr Lanzetta used data from the SB11 phase 3 trial to expand upon the capabilities of biosimilars. Prof Zinkernagel detailed the study: over 700 patients were included in the randomised, double-masked, parallel-group multicentre trial. Over 52 weeks, investigators evaluated the efficacy and the safety profile of this biosimilar SB11 in comparison with monthly ranibizumab for the treatment of nAMD.

“Patients with neovascular AMD were included, [with a] visual acuity range between 20/40 and 20/200,” Prof Zinkernagel said. “[Patients] were randomised in a 1:1 ratio to either have the originator or the biosimilar every 4 weeks from baseline up to week 48.”

Primary end-points were change from baseline in best corrected visual acuity at week 8 and change from baseline in central subfield thickness at week 4. The pre-specified secondary efficacy end-points included longer-term assessments of change from baseline in visual acuity, and the proportion of participants who lost fewer than 15 letters or who gained 15 or more letters in visual acuity from baseline at weeks 24 and 52.

“Other secondary end-points included, of course, change from baseline in central subfield thickness and central retinal lesion thickness at week 24, as well as change from baseline in choroidal neovascularisation [CNV] size and proportion of participants with active CNV leakage seen via OCT [optical coherence tomography] at week 24,” Prof Zinkernagel continued. Describing the results, he said, “When you look at the visual acuity improvements, it’s really equivalent. You have equivalence between the originator and the biosimilar, and the same holds true for a decrease in central retinal thickness. So the curves are basically the same, and also the secondary end-points.”

Prof Zinkernagel also spoke about the immunogenicity outcomes of the SB11 trial, as immunogenicity reactions have been a common problem in past assessments of anti–vascular endothelial growth factor (VEGF) agents. Along with detrimental effects to visual acuity, immunogenicity reactions can also lead to vasculitis and vitritis.

“Now, in this trial, the overall cumulative incidence of anti-drug antibodies, antibodies reacting against this specific drug up to week 52, was very low,” Prof Zinkernagel said. “For the SB11 biosimilar, it was 4.2%, and for the originator it was 5.5%. So very, very similar.”

He also noted that most antibodies were non-neutralising, which generally indicates a weak antibody response. “Furthermore, no statistical or clinically relevant differences in the incidence of anti-drug antibodies and neutralising antibodies were observed between treatment groups at any of the time points,” Prof Zinkernagel explained.

Dr Lanzetta highlighted the unique potentialities for anti-VEGF therapies as an area where physicians can consider treating patients with a biosimilar. “You can either switch a patient from the originator, obviously, or you can also consider treating with a biosimilar treatment-naive patients who may benefit…from being treated with that reference agent or originator agent,” he said. When to deploy a biosimilar will depend on many factors, including the locality where a patient is being treated. “Europe has different countries, different health care systems,” Dr Lanzetta said. “You may consider treating with the biosimilar patients who may not be strictly adherent to the cost of therapy and the frequency of treatment because of some cost issues.”

Just as education on biosimilars is vital to practitioners, awareness and education resources for patients are vital, too. “We spend a lot of time with our patients in letting them know that biologics did undergo a very rigorous approval process through studies, efficacy and safety studies,” Dr Lanzetta emphasised. This education is vital to getting patients on board with biosimilars, and it sparks enthusiasm about the potential benefits. “Once they do understand that, I think they will be very prone to receive a biosimilar; [it’s] in their interest and in the interest of the community, the whole community of patients, and in the interest of the health care system,” Dr Lanzetta said.

1. Biosimilars in the EU: information guide for healthcare professionals. European Medicines Agency. Updated December 2, 2019. Accessed October 3, 2023. 

https://www.ema.europa.eu/en/documents/leaflet/biosimilars-eu-information-guide-healthcare-professionals_en.pd

Editor’s note: A prior version of this article contained a misspelling of the product name BYOOVIZ. It has been corrected. We regret the error.

How biosimilars expand treatment options for patients with retinal disease

Myopia is one of the most common ocular pathologies. The cause of the onset and progression of myopia is not fully understood, but its prevalence is increasing globally. If the number of cases of myopia continues to rise at the current rate, it is estimated that by 2050 approximately five billion people will be myopic.

 As a result, myopia warrants national and international collaborative efforts as the cost and public health consequence are massive and frequently underrated in trends.

A retrospective study was conducted from 2019 to 2023 in accordance with the principles of the World Medical Association’s Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. The aim of the study was to assess the effectiveness of treatment and prevention of the progression of uncomplicated acquired myopia through physiotherapeutic methods. It was initiated only after obtaining informed consent from all participants, following an explanation of the applied methods and the consequences of the research.

The study included 80 participants, all of whom were aged 6 to 11 years. These participants were divided into two groups of 40 eyes each: the base group, which underwent physiotherapeutic treatment, and the control group, whose patients used single-vision spectacle lenses. Furthermore, the eyes in each group were randomised into two subgroups based on the degree of myopia (low or moderate); these subgroups were further divided into two groups, depending on the presence of a familial factor. For the comparative assessment of the dynamics of the studied indices, the clinical cases were evaluated before treatment and after 1 and 2 years of treatment to align with the annual gradient of myopia progression.

 This method aims to stimulate the somato-vegetative functions of the body reflexively by applying transcutaneous electrical current to biologically active points (peripheral reflex zones) (

Low-intensity laser stimulation of the ciliary muscle:

 This method involves stimulating the ciliary muscle using low-intensity helium-neon laser radiation, employing infrared laser light. Low-intensity helium-neon laser radiation enhances biosynthetic and proliferative processes in the conjunctival tissue of the ciliary body, thereby improving the vascularisation of the ciliary muscle, which positively influences the accommodation reflex (

Electropuncture plus low-intensity laser stimulation of the ciliary muscle is a patented method.

Optical-reflex treatment of accommodation:

 Spherical positive lenses relax the ciliary muscle (

In the base group with low myopia and a family factor, after the first year, the annual myopia progression rate based on the spherical equivalent (AMPRS) value decreased from –0.68 plus or minus 0.05 D to –0.18 plus or minus 0.01 D (with –0.50 D, 

< .01). In the control group, this value remained unchanged at –0.72 plus or minus 0.06 D 

.05). After the second year, the AMPRS value in the base group remained the same as after the first year at –0.18 plus or minus 0.01 D 

.05), while in the control group, the AMPRS value decreased from –0.72 plus or minus 0.06 D to –0.56 plus or minus 0.04 D (with –0.16 D, 

In the base group with low myopia without a family factor, after the first year, the AMPRS value decreased from –0.58 plus or minus 0.04 D to –0.17 plus or minus
0.01 D (with –0.41 D, 

< .01); in the control group, this value remained approximately the same as initially, at –0.63 plus or minus 0.05 D 

> .05). After the second year of the study, the AMPRS value in the base group was nearly the same as that after the first year, at –0.16 plus or minus 0.01 D 

> .05), compared with the control group in which the index decreased from –0.63 plus or minus 0.05 D to –0.56 plus or minus 0.04 D 

In the base group with moderate myopia and a family factor, after the first year, the AMPRS value decreased from –1.08 D plus or minus 0.09 D to –0.30 plus or minus 0.02 D (with –0.78 D, 

< .01). In the control group, this value decreased from –1.13 plus or minus 0.09 D to –0.97 plus or minus 0.08 D (with –0.16 D, 

< .01). After the second year of the study, in the base group, the AMPRS value was similar to that after the first year, at –0.20 plus or minus 0.01 D 

> .05). In the control group, the AMPRS value decreased from –0.97 plus or minus 0.08 D to –0.51 plus or minus 0.04 D (with –0.46 D, 

In the base group with moderate myopia without family factor, after the first year, the AMPRS value decreased from –1.03 plus or minus 0.07 D to –0.16 plus or minus 0.01 D (with –0.87 D, 

< .01); in the control group, this value decreased from –1.04 plus or minus 0.06 D to –0.66 plus or minus 0.05 D (with –0.38 D, 

< .01). After the second year, in the base group, the AMPRS value decreased further to –0.07 plus or minus 0.01 D while in the control group, it decreased
to –0.51 plus or minus 0.04 D. There was no statistically significant differ­ence between the 2 groups (with –0.15 vs –0.09 D, respectively; 

In the base group with low myopia and a family factor, after the first year of treatment, the annual myopia progression rate based on the axial length (AMPRAL) value decreased from 0.32 plus or minus 0.02 mm to 0.10 plus or minus 0.01 mm (with 0.22 mm, 

< .01), while in the control group, this value remained unchanged at 0.34 plus or minus 0.02 mm 

.05). After the second year, in the base group, the AMPRAL value remained nearly the same as after the first year, at 0.13 plus or minus 0.01 mm 

.05), compared with the control group in which the value decreased to 0.26 plus or minus 0.02 mm (with 0.08 mm, 

In the base group with low myopia without family history, after the first year of treatment, the AMPRAL value decreased from 0.27 plus or minus 0.02 mm to 0.08 plus or minus 0.01 mm (with 0.18 mm, 

< .01), whereas in the control group, this value remained similar to its initial one at 0.30 plus or minus 0.02 mm and 0.32 plus or minus 0.01 mm, respectively. After the second year, the base group showed a similar AMPRAL value as after the first year, at 0.07 plus or minus 0.01 mm and 0.08 plus or minus 0.01 mm 

.05), respectively, while in the control group, the AMPRAL value decreased from 0.30 plus or minus 0.02 mm to 0.26 plus or minus 0.02 mm (Figure 3).

In the base group with moderate myopia and a family factor, after the first year of treatment, the AMPRAL value decreased from 0.51 plus or minus 0.04 mm to 0.14 plus or minus 0.01 mm (with 0.37 mm, 

< .01), while in the control group, this value remained unchanged at 0.51 plus or minus 0.04 mm and 0.54 plus or minus 0.03 mm (

 > .05). After the second year, the base group showed similar AMPRAL values to those after the first year at 0.09 plus or minus 0.01 mm 

.05), whereas in the control group, the AMPRAL value decreased to 0.26 plus or minus 0.02 mm (with 0.25 mm, 

In the base group with moderate myopia without family factor, after the first year of treatment, the AMPRAL value decreased from 0.49 plus or minus 0.04 mm to 0.06 plus or minus 0.01 mm (with 0.43 mm, 

< .01), while in the control group, this value decreased from 0.49 plus or minus 0.04 mm to 0.34 plus or minus 0.02 mm (with 0.15 mm, 

< .01). After the second year, in the base group the AMPRAL values remained the same as after the first year, at 0.04 plus or minus 0.01 mm and 0.06 plus or minus 0.01 mm 

.05), while in the control group, the AMPRAL value decreased from 0.34 plus or minus 0.02 mm to 0.23 plus or minus 0.02 mm (with 0.11 mm, 

The comprehensive clinical-functional examination demonstrated a significant efficacy of physiotherapy in the treatment and prevention of myopia progression across all studied groups. The rate of reduction in myopia progression for patients who underwent physiotherapeutic treatment compared with those with single-vision spectacle lenses was 69.7% in the low-myopia group and 73.5% in the moderate-myopia group.

Additionally, the effectiveness of physiotherapeutic treatment was highest in the moderate-myopia group without a family factor, in which the reduction rate of myopia progression was 86.30%. In the low-myopia group, the slower rate of myopia progression was similar regardless of the presence of a family factor, averaging 72.90% (

1. Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. 

. 2016;123(5):1036-1042. doi:10.1016/j.ophtha.2016.01.006

2. Nouraeinejad A. More than fifty percent of the world population will be myopic by 2050. 

2021;6(4):255-256. doi:10.14744/bej.2021.27146

3. Bilba R, Ghifirimischi T, inventors; Bilba R, Ghifirimischi T, Bendelic E, assignees. Method for treating the acquired noncomplicated progressive myopia. Republic of Moldova patent application MDS20090029A. March 3, 2009.

Patients underwent electropuncture, low-intensity laser stimulation of the ciliary muscle, combined therapy and optical-reflex treatment of accommodation

Efficiency of physiotherapy in treating and preventing uncomplicated acquired myopia

Elizabeth Cohen, MD, discusses the Zoster Eye Disease study at the 2024 AAO meeting

At this year's American Academy of Ophthalmology congress, Elizabeth Cohen, MD, discussed recent findings from the Zoster Eye Disease study. Here are her highlights from the research, which focused on suppressive valacyclovir use and results for patients with keratitis and iritis.

Editor's note: The below transcript has been lightly edited for clarity.

 My name is Elizabeth Cohen, and I am Professor and Vice Chair of the Department of Ophthalmology at NYU Grossman School of Medicine, NYU Langone Health. So the Zoster Eye Disease study has just come out with its results, and the main takeaways are that if we treat patients or study participants who have shingles in the eye and have eye involvement, and we put them on a low dose of valacyclovir, 1000 milligrams daily for a year, we will reduce the likelihood of flare ups of their keratitis or iritis, statistically significant at 18 months. In addition, at both 12 and 18 months, we prevent people from having multiple flare ups of keratitis or iritis, which is very important, because those people can go on to chronic and recurrent disease and loss of vision. 

The other take home point is that we look to see the benefit for this treatment with regard to post-herpetic neuralgia of chronic pain syndrome, as well as pain-related shingles, and we found very significantly that treatment with low dose of valacyclovir reduces the need for neuropathic pain medicine, which are very poorly tolerated. They make people tired, and valacyclovir is much better tolerated. There also were other benefits with regard to the amount of pain, the duration of pain, and the prevalence of postherpetic neurology in some groups, but overall, the biggest benefit with regard to pain was reducing the need for these pain medicines. So we really hope that ophthalmologists will lead the way and that their doctors will evaluate the use of suppressive valacyclovir to reduce pain related to Zoster in other locations. 

...This study was modeled after the Herpetic Eye Disease Study, [an] acyclovir prevention trial that looked at low-dose acyclovir for reducing recurrences of herpes simplex virus disease, and we use the same approach to study herpes zoster caused by a different herpes virus, the varicella zoster virus. And in the head study on HSV disease, there was benefit at 12 months, but not at 18 months. And here we saw a greater benefit at 18 months, both regarding the eye as well as regarding the pain. So that was a little surprising, in how much—the difference in benefit for the eye wasn't that great, but enough of a difference to be between statistically significant and not significantly significant. So we still think there's benefit, period, for the eye manifestations, with regard to the post herpetic neuralgia and the pain, 12 and 18 months were equal endpoints, whereas for the eye problem, 12 months was the primary endpoint. So with regard to the pain, I think the greater benefit at 18 months may be because it takes nerves that are injured and inflamed time to heal. And when I'm asking myself, "Why do we have greater benefit with the eye disease," the benefit wasn't that much greater, but it also we had a lot of a number of early endpoints around 3 months into the study, and it may take more time for the suppressive treatment to kick in its benefits.

Research indicates suppressive valacyclovir could help patients avoid keratitis and iritis flare-ups

AAO 2024: Main takeaways from the Zoster Eye Disease study

Glaucoma specialists worldwide face numerous challenges daily, from early detection to accurate diagnosis and ongoing patient management. The Heidelberg Engineering Glaucoma Workflow Solution is designed to provide the tools you need to deliver the best care to your patients. It offers dynamic visualization of parameters, efficient data management, precise imaging, and robust monitoring capabilities. Find out how glaucoma experts around the world are leveraging these advanced technologies to enhance the patient journey, increase diagnostic confidence, streamline workflows, and improve patient outcomes.

“It was a surprise as I didn’t feel my vision had been hindered in any way. At that point, I didn’t know that glaucoma was rampant in my family on both my mother’s and father’s sides. When I shared the news of my glaucoma with my late mother, she did not miss a beat, replying, ‘Oh honey, your father and I have had glaucoma for years’. To which I could only say, ‘Really Mom, maybe you and Dad could’ve mentioned that […] like 20 years earlier.” PHILLIP VAN LEAR, diagnosed at 48 

One of the most significant challenges in glaucoma management is detecting the disease early, as it often progresses without symptoms. “

Early glaucoma has no symptoms,” explains Christian Mardin, Consultant Ophthalmologist at Friedrich-Alexander-Universität, Erlangen, Germany. “Every person over 40 should go to their optometrist or ophthalmologist to get their optic nerve head checked

Continue reading Prof. Mardin’s insights on early glaucoma detection here.

The electronic medical record platform HEYEX EMR helps streamline this process by managing and presenting comprehensive ophthalmic patient records through an intuitive interface. It provides access to high-quality, structured data, aiding in efficient reporting and auditing. Dr. Hackl of Hanusch Hospital, Vienna, recalls how HEYEX EMR helped the hospital streamline their workflow and allowed access to patient records in over five locations.

“There was a need to have a paperless medical record which could be seen in all five locations and met our main requirements: a continuous medical record, a patient summary for quick overview, as well as planning and documentation…when a system like HEYEX EMR supports structured data the possibilities to use the data are unlimited.

Read the full story on how Hanusch Hospital, Vienna, used HEYEX EMR to streamline their workflow.

As early detection becomes more efficient, the next step is ensuring accurate diagnosis, where the 

The Glaucoma Module Premium Edition (GMPE)

 provides detailed imaging and analytics of the optic nerve head and retinal nerve fiber layer. Using the Anatomic Positioning System (APS) ensures an accurate anatomical setup for optimal comparison with the normative reference database. These tools equip you with the information needed to support confident diagnostic decisions. 

Download the SPECTRALIS Glaucoma Toolkit here.

 allows for non-contact assessment of iridocorneal angles and anterior segment anatomy, providing precise measurements and automatic identification of the scleral spur to enhance your early detection capabilities. 

Dr. Benjamin Xu, Chief of the University of Southern California's Glaucoma Service, presents a webinar on using non-invasive anterior segment imaging, including ANTERION® technology and AI, to detect and treat angle closure glaucoma. 

Once a confident diagnosis is achieved, effective management relies on seamless referrals and data sharing, which is where the integration of HEYEX EMR with the 

 platform becomes indispensable. Effective glaucoma management necessitates streamlined referrals and data sharing throughout your clinic. This system centralizes patient information, minimizing duplication and manual data entry errors.

HEYEX 2 Cloud Exchange facilitates secure, peer-to-peer transfer of images and data over the internet, eliminating the need for VPN connections. This feature enables efficient and encrypted data transfers, ensuring timely communication with other healthcare providers and enhancing your referral process. Learn to start using Cloud Exchange and transfer data after setting it up on 

 enhances your diagnostic workflows by enabling side-by-side review of images and reports from both eyes, consolidating all pertinent data for comprehensive analysis, in one single view.

“I have chanced upon signs which masquerade as glaucoma on an OCT scan. Branch retinal artery occlusions or cotton wool spots — small infarcts or blood vessel closures — can result in an initial swelling in the nerve fibre layer. They are transient and disappear in a few weeks, and are often caused by high blood pressure or kidney disease.” 

PROF. SANJAY ASRANI, Duke Eye Center, North Carolina, USA 

Accurate glaucoma diagnosis hinges on comprehensive examination techniques. The SPECTRALIS GMPE provides accurate measurements and visualization of key parameters involved in glaucoma diagnosis such as the optic nerve head, retinal nerve fibre layer, and macular ganglion cell layer, via OCT imaging. Tools like Bruch’s Membrane Opening – Minimum Rim Width (BMO-MRW) offer objective, geometrically accurate measurements of the neuro-retinal rim, aiding your early detection efforts. The reference database further guides your analyses.

Learn to integrate the power of OCT imaging and SPECTRALIS GMPE in your daily practice in this educational webinar by Dr. Swarup Swaminathan. 

Sometimes glaucoma needs to be differentiated from other conditions with similar presentations. Recognizing these nuances ensures your accurate diagnosis and effective treatment planning.

Regular monitoring is critical for managing glaucoma patients. The HEYEX 2 Multimodality Viewer supports ongoing data sharing and displays follow-up examinations across multiple locations, allowing you to access previous images and reports easily. Post-surgery, the ANTERION Metrics App provides precise measurements and visualizations of the anterior chamber and the anterior chamber angle, crucial for effective patient management.

Integration with the SPECTRALIS core technologies, such as TruTrack Active Eye Tracking and AutoRescan, ensures accurate monitoring of disease progression. These tools enable follow-up scans in the exact anatomical locations as previous exams, allowing you to detect minute changes with high precision.

, the world's first fully digital microscope, offers unparalleled precision through its 3D visualization technology. It provides exceptional image quality, ergonomics, and educational features, significantly benefiting your surgical practice.

The Heidelberg Engineering Glaucoma Workflow Solution is designed to integrate seamlessly into your patient care routine, supporting unparalleled diagnostic confidence and efficiency. By leveraging these advanced tools and technologies, you can overcome the challenges in glaucoma management, improving patient outcomes and engagement.

Delve deeper into how these solutions can transform your practice.

Enhancing the Patient Journey: Solutions to Overcoming Challenges in Glaucoma Management

For a patient undergoing cataract surgery, the primary post-operative expectation is improved vision. As a surgeon, achieving the desired refractive outcome involves several critical steps: conducting precise preoperative measurements, selecting the appropriate IOL technology and power, and performing surgery with accuracy.

Heidelberg Engineering’s advanced diagnostic imaging solutions support you in enhancing the cataract patient journey, from initial assessment and diagnosis to preoperative planning and postoperative monitoring. Throughout this interactive supplement, leading surgeons share their experiences with and discuss the advantages of these advanced diagnostic imaging solutions, as Dr. James Lewis does in this video 

A major challenge for cataract surgeons is the vast number of patients. Addressing this backlog is crucial to prevent vision impairment and improve the quality of life for those affected. The electronic medical record, Heidelberg Eye Explorer 

, helps to streamline the cataract workflow by optimising patient data management, enhancing communication, and improving surgical planning.

Dr. Hackl from Hanusch Hospital in Vienna recalls how HEYEX EMR streamlined their workflow and provided access to patient records across more than five locations.

“There was a need to have a paperless medical record which could be seen in all five locations and met our main requirements: a continuous medical record, a patient summary for a quick overview, as well as planning and documentation…when a system like HEYEX EMR supports structured data the possibilities to use the data are unlimited." 


Read the full story on how Hanusch Hospital, Vienna, used HEYEX EMR to streamline their workflow.

 image and data management platform into your clinic workflow allows for improved efficiency. All patient information is centrally recorded and can be accessed anywhere in the clinic. Images and data are immediately available on your desired device, viewing station, and in the patient record.

Visualising all relevant data and images from the cataract workup contributes to an optimal diagnostic workflow, facilitates confident decisions, and assists you in easily identifying potential sources of complication.

Precise ocular biometry is critical for determining the power of IOLs being implanted. Leveraging advanced Swept-Source OCT technology, 

 provides you with a comprehensive, all-in-one solution for optical biometry and IOL power prediction. In a single imaging session, the Cataract App provides precise and accurate measurements traditionally delivered by several devices, including axial length, cornea topography and tomography, anterior chamber depth, lens thickness, white-to-white, and central corneal thickness.

“I was looking to upgrade my methods and equipment, especially in intraocular lens calculation, explains Dr Arturo Chayet, ophthalmologist and founder of CODET Vision Institute in Tijuana, Baja California, Mexico. At the time, I was using the IOLMaster500 for calculations, but I was looking for a bridge to swept-source OCT technology. We knew it was crucial to not only measure axial length and various parameters of the eye but also to understand the anterior chamber, specifically the effective lens position. I was struck by the capability of ANTERION and was very impressed with the expertise Heidelberg Engineering has in the field. Our experience with SPECTRALIS was excellent as well.” 
- Dr. Arturo Chayet, M.D. 

For refractive IOL procedures, where presbyopia-correcting IOLs are implanted, and in challenging cases, accessing additional data is essential for patient selection and satisfaction. ANTERION provides a comprehensive analysis of the cornea and includes details on astigmatism and corneal wavefront. 

Learn more about the significant role ANTERION plays in premium IOL selection here.

ANTERION’s high-resolution imaging of the anterior segment can help you prevent unexpected results by identifying complex ocular properties relating to anatomy, visual quality, and atypical geometry of the anterior segment. The high-quality images also provide visual aids that can be used to explain your patient’s condition and the planned surgical procedure, enhancing their understanding and compliance.

Listen to Dr. Pooja Kumar, Consultant, Khetarpal Hospital, New Delhi, India 

, as she explains how she uses ANTERION’s high-resolution swept-source OCT images to identify complex cases like posterior polar cataracts. She also explains how she utilizes these images to counsel her patients in preparation for surgery.

OCT imaging of the retina before cataract surgery lets you assess pathologies that may limit visual outcomes. 

 allows you to choose between 20kHz, 85kHz and 125KHz depending on your needs. 20 kHz scan speed offers high-quality retinal imaging also in eyes with media opacities often caused by cataracts. 

Read more about the benefits of retinal OCT before cataract surgery here

 provides a comprehensive overview by combining data and images from all devices 

. This consolidated information ensures you have all relevant diagnostic details, enhancing your confidence in surgical planning.

 delivers next-generation image technology to revolutionise your surgical practice. It brings together innovative design and 3D technology to set new standards in surgical precision and surgeon comfort during procedures.

 as he shares his initial impressions and discusses the benefits of SeeLuma, explaining why he eagerly anticipates incorporating it into his practice soon.

High-Resolution Imaging for Postoperative Evaluation

 supports you in visualising the success of surgical procedures by comparing pre- and post-op images and measurements. Detailed anterior chamber information from high-resolution SS-OCT images helps you assess cataract surgery outcomes, including IOL placement, ensuring optimal patient care and satisfaction 

Watch this Healio video interview with Dr. Mitchell W. Dul, OD, 

where he explains how he uses the ANTERION Metrics App to show his patients their pre-op and post-op configurations, helping them become more invested in their care.

Leveraging Heidelberg Engineering's advanced diagnostic tools and technologies, including high-quality OCT imaging, precise biometry, and corneal topography and tomography, enhances your diagnostic accuracy, surgical planning, and postoperative evaluation. Whether dealing with standard, refractive IOL, or challenging cases, these tools and technologies can help you improve patient outcomes and engagement, streamline workflows, and flag potential surgical complications.

Enhancing the Patient Journey: Solutions for Streamlining Success in Cataract Surgery

AAO 2024, Kelman Lecture, medical education evolution, AI in medicine, robotics, continuous clinician education, "See One, Do One, Teach One" model, healthcare training innovation, Bonnie An Henderson, ophthalmology education

AAO 2024: Advancing medical education with AI, robotics, and diverse learning methods

At this year’s American Academy of Ophthalmology meeting, Bonnie An Henderson, MD, delivered the Kelman Lecture, where she explored innovative approaches to medical education in her talk titled Enhancing the Paradigm of ‘See One, Do One, Teach One’ With Technology

 Henderson shared insights from her career in ophthalmic education, focusing on how teaching methods have evolved from textbooks and in-person lectures to digital resources like YouTube, simulators, and artificial intelligence and robotics. She highlighted the importance of blending traditional techniques with modern tools to create adaptable learning environments. Henderson emphasised that while online tutorials are valuable, hands-on experience remains essential for building skills in professions like ophthalmology. Her lecture offered a look at the journey of educational methods and a glimpse into the future of training for the next generation of clinicians.

Henderson, who is a clinical professor at Tufts University School of Medicine in Boston, Massachusetts, shares some of the key takeaways with the Eye Care Network.

Editor’s note: The below transcript has been lightly edited for clarity.

I’m so thrilled to be participating in the Academy and especially giving the Kelman Lecture. It’s such an honor. I’m so thrilled to be doing it. So grateful. Thank you for asking about it. As you said, the title really is about education. I’ve spent my career really focusing on education, whether it’s actually delivering education, or really trying to discover ways to make it more efficient and more effective. And I wanted to really focus my lecture on how the evolution of education has changed, even in my career. And I’m taking it all the way from when before the internet was created, which is really not that long ago. When I went through residency, we didn’t have all of these special toys and tools that we have, like YouTube. So I’m really describing the educational journey from when we used to teach by textbooks and lectures, and then what labs were created, and then simulators were created and and ultimately, AI and robotics.

I’m going to take the audience through the whole evolution, and really give a little bit of a preview of what I think education will be as we move forward.

What advice would you give a resident today?

I think what we’ve learned is that you actually need different modes of education, and it’s really fascinating that people learn in different ways, and every individual is so different. What may work for one person may be really different than for another person. I think it’s really good to really remember all the traditional ways to learn as well as the new ways. People are so used to seeing really short clips of videos. I think a lot of people turn to channels like YouTube to find out how to do a surgical procedure, but it’s really important to remember that it’s not sufficient just to watch a video. People still need the hands-on, whether it’s in a wet lab with an animal eye or a synthetic eye or a simulator, those skills, the hand-eye coordination, those physical skills, are still really important. I think it’s important to remember the old-fashioned ways as well as the new ways that people are learning. I think with AI, I mean, it’s going to be a remarkable journey, the things that we’re learning nowadays, the speed at which programs can actually accumulate all the knowledge very quickly. And, you know, really find it in a very bite-sized way that we can actually focus on what’s important is going to be really fascinating to watch as the educational evolution changes again in our lifetime. I mean, what will happen in 20 or 30, years from now? It’ll be phenomenal compared to what we did 20 or 30, years ago.

What would be a key takeaway for all clinicians in terms of what they can put in the practice when they return from the Academy?

The key takeaway I would give is that there are so many ways to continue learning now, whether it’s online, whether it’s in person meetings. I think it’s really crucial to keep educating someone, to keep learning about the new devices, the new techniques, the new medications. All of these things are rapidly changing every six months, and it’s really, really important for each clinician to make sure that they’re up to speed on what’s been changing.

In her Kelman Lecture presentation, Bonnie An Henderson, MD, highlights the importance of continuous education for clinicians.

By Hattie Hayes; Reviewed by Leon Au, MBBS, BSc, FRCOphth

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