Caroline Richards, editor, Ophthalmology Times Europe®

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This transcript has been lightly edited for clarity.

 So thank you for joining me here Professor Bostanci. I understand you've given quite a few presentations at this year's ESCRS, and it's lovely to meet you here in Milan. I'm the editor of Ophthalmology Times Europe, and I would love to hear more about EDOF lenses and the key takeaway points from your presentation.

 Thank you, I will be more than glad to answer this question. So I am Basak Bostanci, an associate professor of ophthalmology from Istanbul, as you said, and here in Milan, there was a great discussion about EDOF lenses as an option for presbyopia correction.

So, in the past, these trifocals diffractive, optic trifocal lenses, were only given as a solution to people who had the most wonderful ocular surface and ocular anatomy. So people with some dry eye issues and people with compromised corneas were not eligible. With EDOF lenses, we have a slight chance to offer them a premium solution for giving them a functional vision, which is arm-length vision.

So intermediate vision is very important in our daily lives, we are checking our telephones, we are cutting something on the table, we are preparing meals for our children. So functional vision is really depending on how we see far and how we see at arm distance. So these EDOF lenses provide us intermediate vision.

And because most of them are not verging on a refractive principle, we can offer them also to our dry eye patients, to our patients who had received refractive surgeries.

So what I love about these lenses are if the patient doesn't have a fully compromised cornea, or geographic atrophy in the retina, or severe glaucomatous damage, now we can offer them a premium lens option to make their lives easier.

 Yeah, yeah. Oh, that sounds really good. I mean, there's so much information in the field at this conference. And is there anything that you would say you're most excited about going forward to the future?

 Yeah, I like walking through the technology. So these EDOF lens technologies are very different from one another. So I love in those congresses, the best part of those congresses is we can go ahead, meet the inventors of these wonderful intraocular lenses, and we can compare one to another and find a good option for our particular patients. So thank you for asking me this question.

 Oh, no problem. You're welcome. Well, it was really lovely to speak to you and I'm sure our readers and subscribers to OTE will be very interested to hear what you have to say. And thank you very much.

Videos

Assistant Prof. Basak Bostanci discusses her ESCRS presentation, “Extended Range Of Vision In Unusual Cases” and how EDOF lens technology is evolving to include a wider pool of candidates.

EDOF lens tech is evolving to help more patients with intermediate vision

 This transcript has been lightly edited for clarity.

So thank you for joining me, Professor Dirisamer. I understand you participated in an instructional course on refractive surgery. I'm Caroline, editor of Ophthalmology Times Europe, and I would love to hear more about the key takeaways from that instructional course.

Thanks for the kind invitation to talk to you. Yeah, what we tried to say or to transport in this instructional course, are, where are the limitations and indications for the specific treatment options we have in refractive, in modern refractive surgery, either with laser refractive surgery or lens based surgery like phakic IOLs or refractive lens exchange.

Excellent. And what would you say the main challenges are that people have to pay attention to?

Yeah, since we get more and more precise pre-operative assessments, we get nicer and very precise devices based on different technologies like OCT-based, or like, [audio unclear]-based, and also epithelial mapping, for example. So there are many, many parameters for refractive surgeons have to keep in mind and have to look into their decision whether the patient gets refractive surgery and which kind of refractive surgery. This is very important since this kind of an elective procedure. So there's no medical need for that. You have to be more precise, and rule out the suspicious cases. That sounds easy, but it's tricky.

Exactly, there's not really a certain rule. Now you can really say, Okay, this is safe or it's not safe. There are some, but it remains the decision by the surgeon what we do.

And I suppose with more experience, it becomes easier to...

And it's, of course, an individual decision for each surgeon because someone may feel more comfortable with this technology, the other one with the other techniques. So we try to cover the latest publication and latest scientific works and see what changed.

There are some changes. So we are very happy to have epithelial mapping. So this is a tool that it's getting more precise to rule out suspicious corneas.

Yeah, I think we are getting close to zero complication rates.

No, but close enough. I was going to ask you what you're most excited about in the field, but I would imagine it's epithelial mapping. Or is there anything else?

Well, in terms of diagnostic, I think epithelial mapping is pretty, pretty cool. But there was a biomechanical measurements, which are coming more and more in terms of surgical techniques. I think the SMILE technique, which is a femtosecond laser lenticule extraction, I think this becomes the future of cornea and refractive surgery. Yes. Many, many companies are now providing this technique. So let's developing tool we have in our armamentarium.

Yeah, yeah. How long, how long has that been around now? It's just a few years, isn't it?

More than 10 years. Yeah, we probably see next year or so hyperopic treatments for SMILE and cyclotorsion compensation and so on. So this, yeah I'm looking forward to that.

Professor Dirisamer, that was really interesting. Thank you very much for sharing your insight.

Prof. Martin Dirisamer speaks with Editor Caroline Richards about his ESCRS instructional course, "Mastering laser refractive surgery: Indications and outcomes."

Investigating better indications and outcomes in laser refractive surgery

 Thank you for joining me today, Dr Lubeck, to discuss your presentation on endothelial cells, which I understand you just gave, in fact. It's lovely to meet you here in sunny Milan. I'm Caroline, editor of Ophthalmology Times Europe. Could you please tell me more about your presentation and what the key takeaway points were?

Caroline, we and surgeons who have done MIGs surgery have been drawn more and more to the possible consequences of damaging corneal epithelium as we do our procedures. There's much still to be learned about how these procedures affect the epithelium over the long term.

Canaloplasty, which is procedure I've been doing for about seven years, there was little to no data on its effect on the endothelial. Two years ago, Robert Noecker and I began a prospective study to determine the effects of canaloplasty on the cornea...

We found very, very strongly that canaloplasty has no negative impact on the corneal epithelium compared to cataract surgery alone. So essentially, it has minimal impact to no impact on the health of the cornea.

 Where do you see this research going in the future?

We hope to extend the current study up to 5 years, but we've also embarked on a much bigger data registry project called the iTrack Glaucoma [Global] Data Registry. It's being housed in the ISGR, the National Glaucoma Surgery Registry. And we hope to enrol up to 1,000 patients in that over a fairly short period of time, and then have a much more comprehensive look at knowing the efficacy, safety profiles and the nuanced elements of the procedure.

 It sounds like it will be really valuable data when that comes through.

It's essential. We don't have for this procedure. We don't have a single, large database, and it's been around for a long time.

 Well is anything else you would like to add, anything you're really excited about at present? Or have we covered everything?

The procedure is attractive in the beginning because it's non-destructive, there's no stents left behind. And from a Bayesian standpoint, or reasoning, it makes sense in terms of what it does for glaucoma, and the treatment. It has tremendous implications for the future.

Once we understand not only the biomechanics, but the bio-physiology of glaucoma, I believe that this technology is going to have a future application to different modalities of treatment.

 Oh really? Oh, that sounds excellent. Well, thank you very much for your insights today, Dr Lubeck.

It's a pleasure. Thank you very much, Caroline.

Dr David Lubeck talks with Caroline Richards of Ophthalmology Times Europe about his ESCRS presentations, touching on surgical effects on corneal epithelium and the iTrack Global Registry for glaucoma.

Investigating the effects of canaloplasty on corneal epithelium

 So thank you for joining me at this year's ESCRS, Professor Dirisamer. I understand tomorrow you're due to present on DMEK. I would love to hear more about that. Could you tell me the key takeaways from the instructional course?

 Yeah, thank you for the kind invitation. Yeah, we are having a course about DMEK and how to avoid mistakes in converting to DMEK because it was like a kind of transformation from PK and DSAEK. And, you know, obviously, mistakes we made, we try to [make it so] the younger people do not have to do the same mistakes. Well, it's about the indication, how to start and what are the key points where I can avoid complications, and to get together the perfect outcomes.

So it's, I think, very important for a beginner to start with DMEK, to pick up easy cases. So not start with challenging cases. But pick easy cases. And from there, follow certain rules. So if you follow these rules, and these suggestions, I think it could do this transformation pretty easily.

 And so do you think that'll be a good uptake on DMEK in and amongst the younger ophthalmologists?

 Yes, I think it's, at least in German-speaking countries, I think the most popular transportation. And so I think the younger colleagues, they started with us; in my case, it was the same thing. So I think you can kind of overtake the other data procedures that don't have to DSAEK anymore. They can start right away with DMEK.

And, yes, so we tried to give them a kind of stepwise approach to solve problems we have to face in the beginning with DMEK. And, yeah, I think this could work out for most people. Of course, you need some surgical skills, you need some surgical training as well. But you also should be aware of the theory behind.

 Yeah, that's I think that for younger people and younger colleagues, I think this might be a good basis.

 Yeah. And what would you say the main challenges in performing this procedure? What goes wrong most often?

 I would say the most the most challenging part is that it's basically a two-step surgical procedure, so you have to prepare your graft, sometimes on your own. Of course, there's prepared tissue available, but in many parts of the world, there is not. So you have to prepare the tissue both by yourself; this is the first challenge. You have a challenge already, and the surgery part hasn't even started.

 Of course, you have to know how to store this tissue, how to stain it. And so it's a combination of many things. I would say complication number one, if you make a sealed [audio unclear] detachment. But on the other, the other side, it's not a big complication. You can solve it pretty easy. But it's better to avoid it. So we do everything that we can to not get a complication, and there's some tips and tricks, how you can do that.

 All right. Well, it sounds like it would be a great course for ophthalmologists to attend tomorrow. I'm sure they're very much looking forward to learning more.

 Yeah, oh well, I can imagine. It sounds really interesting. Thank you very much for sharing that with me here.

Prof. Martin Dirisamer discusses his instructional course on common mistakes when performing DMEK and how to avoid them at ESCRS.

Author | Caroline Richards, editor, Ophthalmology Times Europe®

Articles

Investigating better indications and outcomes in laser refractive surgery

Investigating the effects of canaloplasty on corneal epithelium

Avoiding errors when converting to DMEK

EDOF lens tech is evolving to help more patients with intermediate vision