ESCRS 2023: Binkhorst Medal lecture addresses the future of cataract and refractive surgery

Jorge Alio, MD, PhD, FEBOpthhal spoke with our team about the future of cataract and refractive surgery while at the 2023 ESCRS meeting in Vienna, Austria. On Saturday, he delivered the Binkhorst Medal Lecture, titled Corneal Regeneration: The Future of Corneal Surgery.

Video Transcript

Editor's note - This transcript has been edited.

Hello, my name is Jorge Alio. I am Professor and Chairman of Ophthalmology at Miguel Hernandez University in Alicante, Spain. I'm here the ESCRS 2023 – 41st meeting in Vienna. Happy to be with Ophthalmology Times. ESCRS is the largest meeting on...surgery that we have in Europe, and one of the largest worldwide. It is really worthwhile to come here. Even if you can be from far away, because you will have a lot of a professionals in contact with the other ophthalmologists, you will have a lot of information and non-biased commercial interest. And...you will have an innovative program in which you can find anything you need for your professional life and for your medical education. So it's a learning experience, a professional experience. And finally, it is in a lovely place like Vienna, where you can enjoy a lot about the history and the life of the European area.

Having said that, the program of ESCRS is very diverse, you know. My presence this year as a cataract, cornea and refractive surgeon is about exactly these topics. I am involved in sessions of cataract, sessions of cornea and sessions of refractive surgery. I am conducting as well the annual international refractive surgery symposim during the meeting. And finally, I have the Binkhorst Medal Lecture which is one of the largest major events from my personal life, which is the recognition of this society to the world I have done along many years in which I have participated also in the leadership of their society. My topic, the one that I choose, is a topic that is emerging, certainly that is going to be the present and especially the future, and will be the future for the following 20 years. So something that is emerging as it was emerging the intraocular lenses about 50 years and look where we are today. And the topic is about corneal regeneration.

Corneal graft is a procedure that is practiced worldwide in the different diversities in which it is practiced today, either lamellar or penetrating. And we know that the [inaudible] this agrees very much a successful procedure. We cannot forget that these are successful, but with many pitfalls as well. One that before this about 10 years later, about 40% of the corneas, some studies said, failed anatomically. And during [these] years, about 30% of the penetrating grafts, and the deep anterior lamellar grafts, have less than a .4 best corrected visual acuity (BCVA). But it means that they have a problem with a graft [inaudible] and refraction, and so you have anatomical failures and optical failures. With this dual perspective we have LBJ, a technique that is good for many, many patients. But it's going to be at this moment looking for a new solution. And we're looking for new solutions by the use of advancing therapies. Advancing therapies is the use of missing tumor cells. And by engineering to create a new cornea. We can create a new cornea, from the surface to the back of the cornea from the cornea epithelium to the corneal endothelium. And in between, the corneal stroma. Researchers in Europe has been focused on on corneal surface epithelial regeneration, and I have shown the evidence that we have today about this this topic, about the use of stem cells from the limbus from the same patient. The second eye [inaudible], or from other donors as beginning material. But we are convinced that the future is in the mission in the secondhand cells taken from the patients or from banks in the future and which apply these cells for the purpose.

Corneal stroma we have been working on that and actually we have been conducting...a clinical extension on human patients about corneal stroma, regeneration using adult stem cells and solar laminates. And we have demonstrated that it's not only visual to increase the corneal thickness by revitalising the cornea in keratoconus...[inaudible] we can create a much better environment for the cornea in order to get resolution in a safe [way]. And finally, the corneal endothelium has been extensively studied in Japan but also by us in Spain. And we have a 2 reasons: One is that we're not endothelium cells from donors. And we won't connect you can supply endothelium material for 1,000 patients, which is [inaudible], but we can get the cells cost of one initial [inaudible] sources that is not from the eye that will make this procedure be much more universal.

Finally, the idea and the goal is to create an organoid. Corneal organoid, so it's a bi-construct in which we have the surface, the stroma and endothelium created from the stem cells. And this way we shall have a all of this, this procedure to adequately control in terms of safe and in corneal power to be adapted to the patient. And finally we shall get ready for cornea transplant and this might be for the next 20 years.