Up for debate: Clinicians take on hot topics at the Congress on Controversies in Ophthalmology

Though its name may seem intimidating, the Congress on Controversies in Ophthalmology (COPHy) welcomes the conflict-averse clinician. Held this year in Seville, Spain, on 4 and 5 April, the 16th annual edition of COPHy will pit some of the greatest ophthalmic leaders against each other on a global stage.

The head-to-head “combat” may seem a little startling to the uninitiated—scientific congresses do not usually embrace the often contradictory elements of research. But co-chairs Baruch Kuppermann, MD, PhD, and Anat Loewenstein, MD, told Ophthalmology Times Europe that the COPHy meeting is built around the circumstances real physicians face every day.

Our March/April cover story

This article is the cover story in the March/April 2025 issue of Ophthalmology Times Europe. To see the full online version of this issue, click here, or subscribe today for the print edition.

“What is very unique about COPHy is that, in your daily management of patients, you deal with topics that are controversial,” said Prof Loewenstein, who is head of the Department of Ophthalmology at the Tel Aviv Medical Center in Tel Aviv, Israel. “So, the meeting is structured in a way that attracts clinicians who are open to change, and who want to learn more about clinically significant topics that are widely interesting.”

Prof Kuppermann, who is the director of the Gavin Herbert Eye Institute at the University of California Irvine, echoed that sentiment, saying that COPHy serves to highlight the abundance of clinical and technological choices available to modern-day clinicians. “We want it to be as collegial as possible. We don’t do a pre- and post-debate vote,” he noted. “We are trained to be thoughtful, and to keep an open mind, but also a critical mind.”

Why the COPHy format works

The session format at COPHy grants each participant in a debate 10 minutes to establish their “yes” or “no” position. The questions largely focus on medical and surgical retina topics, though the meeting is expanding its coverage beyond the retina speciality. The debate speakers may address long-standing practices (“Is steroid therapy for diabetic macular oedema still relevant in the era of new-generation anti-VEGF agents?”) or questions of the near and distant future (“Can artificial intelligence [AI] predict the success of retinal detachment surgery?”).

A factor which makes COPHy debates unique is that there is no rebuttal period, Prof Kuppermann said. In most academic or scientific debates, the participants are granted a brief rebuttal to defend their initial opinions and challenge the theories posited by their competitors. Instead, at COPHy, the debate is followed by a 10-minute discussion, moderated by a neutral expert in the topic at hand.

“The discussion is the most important part of the meeting,” said Prof Loewenstein. “It’s really a resource for education. The moderator is usually someone with a lot of experience, who can summarise both sides and reach some sort of a conclusion.”

Keeping the focus on a “yes” or “no” question, restricting the argument to two opposing viewpoints, is also key to the success of a COPHy debate, she said. It illuminates the clinical questions at hand, helping practitioners glean the most valuable insights for their own practices.

“We structure the debate so there is a clear, legitimate pathway for arguing the ‘no’ position,” Prof Kuppermann added. “We want the debate to be thoughtful and let there be nuance. We demonstrate that there is more than one way to look at a clinical situation, but keep the debate focused, so we aren’t addressing every way to approach the question.”

Because the debates are developed with intention, Prof Kuppermann said, it also allows the co-chairs and faculty to refine the role industry plays in COPHy programming. Some debates are sponsored by a “topic-agnostic,” objective industry partner, and there are also industry symposia as well as a sponsored speaker’s corner. This year, companies also have the opportunity to sponsor specific debate topics—alone or alongside other players in the ophthalmic industry—without any authority over the agenda.

This new multi-sponsor model is especially effective in areas where there is a lot of recent research or rapid growth, said Prof Loewenstein. “When the topic is sponsored by a few different companies, it gives additional validity, credibility and objectivity [to the discussion],” Prof Loewenstein said. “You see so many companies now which are working with device-based drug-delivery implants, or many companies exploring genetic treatment. The combined sponsorships give us a chance to explore those topics and also help us gauge interest in them.”

Expanding the expert base

Historically, the scientific programme at COPHy has focused on retina care. Prior forays into the anterior segment were temporary. Recent additions to the programming—uveitis, glaucoma and neuro-ophthalmology—reflect an expanding interest in the meeting and a shift in clinicians’ interests. Prof Loewenstein and Prof Kuppermann both expressed gratitude to Bahram Bodaghi, MD, PhD, FEBO, and Zohar Habot-Wilner, MD, who organise the uveitis section; Francesca Cordeiro, MBBS, PhD, FRCOphth, who organises the
glaucoma section; and Andrew G. Lee, MD, who organises the neuro-ophthalmology section.

“Neuro-ophthalmology and uveitis are things that really intrigue people, intellectually,” Prof Kuppermann said. “Those are, in many ways, our most complex sub-specialities within ophthalmology, and we all want to learn more from the leaders in those fields.”

“Francesca [Cordeiro] approached us about adding glaucoma as a topic, and we had it in 2024,” said Prof Kuppermann. He described glaucoma as a topic with “hybrid” appeal to attendees and sponsors, and Prof Loewenstein said it is a topic that has received positive feedback from scientists attending and participating in the programme. “Glaucoma has vocal proponents, and we would love to have this be a regular part of our meeting,” Prof Kuppermann said. “We’re going to see how much sponsorship we can attract to make it an ongoing part [of COPHy].”

Though COPHy is broadening its coverage, rigorous standards still apply to the debate topics and the questions explored on-stage, Prof Loewenstein said. “When you look at the programme, you can see that it is clinically oriented and focused on how to treat specific patients,” she said. “We expanded the programme because we want it to be valuable to the general ophthalmologists who come from all over the world, and particularly for the clinicians in our host country.”

A regional advisory board helps Prof Loewenstein and Prof Kuppermann make the most of each year’s COPHy sojourn. This year, Patricia Udaondo, MD, PhD, FEBO, is the local chair for the meeting. Dr Udaondo is the co-founding director and head of the retina division of Aiken Ophthalmological Clinic in Valencia, and part of the medical-surgical retina division at University and Polytechnic Hospital La Fe, Valencia, both in Spain.

“Dr Udaondo is a leader in this field and within Spain, and she contributes so much to the programme and to the meeting,” Prof Loewenstein said. “Our Spanish colleagues are leaders in many areas of ophthalmology, especially within retina, and Spain has some of the best retinal surgeons in the world. We look forward to learning from them in the surgical retina sessions.”

Prof Kuppermann noted that the regional advisory board not only helps organise the logistics of the meeting, but also imbues each annual COPHy meeting with unique takeaways that the global audience may otherwise not encounter. “Dr Udaondo has helped guide us by letting us know what’s of interest in Spain. There is a surprising amount of regional variation within clinical practices, and we always try to design a few debates that are of particular interest to the host country,” he said.

Beyond Retina

Image credit: ©Jim – stock.adobe.com

Neuro-ophthalmology

•Two sessions, both on Saturday, 5 April

•Session topics include the use of high-dose corticosteroids in treating optic neuropathy, temporal artery ultrasounds versus biopsies, functional vision loss plus case presentations on the efferent and afferent pathways

•Chaired by Andrew G. Lee, MD

Uveitis

•Two sessions, both on Saturday, 5 April

•Session topics include the use of biosimilars in uveitis, prophylactic laser retinopexy and early pars plana vitrectomy, systemic therapy for uveitic macular oedema and more

•Chaired by Bahram Bodaghi, MD, PhD, FEBO, and Zohar Habot-Wilner, MD

Glaucoma

•Two sessions, both on Friday, 4 April

•Topics include stand-alone phaco versus phaco plus MIGS, the use of AI in clinical decision-making in glaucoma, whether glaucoma drops should be preservative-free from the first line and the shifting roles of comprehensive ophthalmologists in comparison with glaucoma specialists

•Chaired by Francesca Cordeiro, MD, PhD, FRCOphth

One controversy endures across decades

Debates are the core of COPHy, but the first day of the meeting closes out with a panel, a format which might be more familiar to attendees of other conferences. This anomaly is no mistake. The panel features a roster of global leaders in retina care discussing a topic which Prof Kuppermann and Prof Loewenstein both characterised as one of the “most controversial” of different years.

That panel will focus on expert opinions on the use of new treatment regimens with extended injection intervals. Prof Kuppermann said the discussion is decades in the making.

“The anti-VEGF era started 20 years ago. It was the 2005 American Society of Retina Specialists (ASRS) meeting in Montréal, Quebec, Canada,” Prof Kuppermann said. At that year’s ASRS meeting, said Kuppermann, the ophthalmic community was introduced to the research findings for intravitreal use of bevacizumab and ranibizumab for treatment of age-related macular degeneration (AMD). “At that podium, in July 2005, was the ‘hallelujah’ moment for AMD,” he said.

“Anti-VEGF therapy for retinal disease, and exactly how we should use it, has always been a controversial issue,” Prof Loewenstein agreed. “At first, the argument was ‘Use this one drug over the other drug.’ Then it became a question of regimens, and slow-release devices, and now higher doses and whether we need to implement other mechanisms.”

Over the 16 years of the COPHy meeting, Prof Loewenstein noted, the use of anti-VEGF agents is a thread that has been picked up again and again. The volume of research is what necessitates a panel discussion on new treatment regimens, she and Prof Kuppermann both said. “We have so much data already on this topic, and there is more coming out, constantly,” Prof Loewenstein said. “You have so much data, so many therapies available now, and so many therapies coming out. It’s in the best interests of the patients to keep the discussion here more comprehensive.”

Prof Kuppermann said he was surprised by the continuing relevance of the extended injection interval discussion. “I don’t think that, in 2005, most of us would have believed that [anti-VEGF] agents would be the mainstay therapy, and still be so popular,” he said. “Here we are, 20 years later, still giving regular injections, and the debates still continue.”

There are still many mysteries related to AMD, he said, and the best measures for individual patients’ treatment goals. “There are emerging debates, too, about geographic atrophy, about genetic therapies,” he said. “This helps you realise that it’s often not a matter of what is controversial, but more a question of how we can best meet patients’ unmet needs.”

Prof Loewenstein concluded by thanking all the clinicians who are willing to share their perspectives, in debates and on the panel, even when it means going against the grain. It is all in service to the patients, she added, and if each attendee takes just one lesson or clinical pearl back to their practice, she will be satisfied.

“We want people to leave this meeting and say ‘You know, I heard this debate, and I heard these positions, and ultimately, I was convinced,” Prof Loewenstein said. “When we open up these discussions, we can give so much knowledge, and so many tools, to clinicians.”