2009 heralded more interesting developments for ophthalmology. OTEurope asked some of Europe's leading key opinion leaders for their thoughts on the news and developments that generated most excitement or had most significance in the Cataract & Refractive sector
Jorge L. Alió, MD, PhD
Instituto Oftalmologico de Alicante, Alicante, Spain
Johan Blanckaert, MD
Eye & Refractive Centre, Leper, Belgium.
Paolo Fazio, MD
Centro Catanese di Medicina e Chirurgia (CCHC), Catania, Italy
Erik L. Mertens, MD, FEBO
Antwerp Eye Center, Antwerp. Belgium
David Spalton, MD
St Thomas' Hospital & King Edward VII's Hospital, London, UK
Rafael Barraquer, MD
Institut Universitari Barraquer and Centro de Oftalmología Barraquer, Barcelona, Spain
Christoph Faschinger, MD
Medical University of Graz, Clinic of Ophthalmology, Graz, Austria
Günther Grabner, MD
University Eye Clinic Salzburg, Salzburg, Austria
Pavel Kuchynka, MD
Charles University, Prague, Czech Republic
Sunil Shah, FRCOphth, FRCSEd, FBCLA
Birmingham and Midland Eye Centre, Midland Eye Institute, Solihull, UK
Paolo Vinciguerra, MD
Istituto Clinico Humanitas, Rozzano, Milan, Italy
Imaging & Diagnostics – what allows you to make the most accurate assessments and judgements?
Dr Omid Kermani: "...and the winner is...for me it is the Spectralis OCT by Heidelberg Instruments. We bought it in 2008 and in 2009 it worked under full load. If your doctors do overhours and you see them sitting with a bright smile behind the screen of a computer at unusual times of the day than there could be something wrong. Not so, if the screen belongs to the Heidelberg OCT. It´s a great support in the retinal office and everybody loves to work with it."
Dr Rafael Barraquer: "Clinical judgement remains a very complex but seemingly instantaneous – and almost unconscious - process taking place in the doctor's mind. No doubt, this is helped by accurate and reliable data as provided by the newer imaging and diagnostics technologies. However, in many cases – especially the difficult ones – this is no substitute for the 'softer' information – a careful history and examination, personal experience and that of others through literature, etc.–, all of which has to be integrated for a sensible decision. In some areas the dependency is greater, such as topography for refractive surgery: Today, we would never indicate a procedure without it – in the first visit, not waiting until the preoperative assessment. The discussion has migrated to specialised issues as the advantages of Scheimpflug vs. Placido systems – or possibly both - and the like. OCT is definitely here to stay and improving with the new Fourier-domain based machines (one more toy though!), while others like O.R.A., which we use in every refractive patient, struggle to leave the limbo of usefulness vs. data noise. Where we really need newer ideas is in the assessment of biomechanics – my wish: a topographically precise measurement of corneal mechanical properties."
Dr Sunil Shah: "A combination of aberrometry/topography and biometry."
Dr David Spalton: "The pentacam is the new instrument of choice for corneal/ac assessment and the Zeiss spectral OCT for glaucoma F/U, macula diagnosis.