Simulated operation practice, artificial intelligence diagnostics dominate discussion on final day of ESCRS 2021

On the final day of this year’s European Society of Cataract and Refractive Surgeons (ESCRS) congress, Monday 12th October, the number of delegates at the RAI Centre in Amsterdam were starting to thin out and the Exhibition Hall was also closed that day, but the relatively smaller audience in the speaker halls by no means reflected any lessening of the quality of the talks, and I came away with some interesting insights.

One particular session I had looked forward to attending following a couple of recommendations by the Ophthalmology Times Europe® Editorial Advisory Board ahead of the meeting was the Orbis one in Hall 11. Orbis International is a non-profit organisation that since 1982 has delivered sight-saving treatments to developing countries through training programmes, public health education, local partnerships and advocacy. It is perhaps best known for its Flying Eye Hospital — a custom-designed aircraft complete with operating theatre that can deliver sight-saving eye care where it is needed most.

Although the focus of the Orbis Symposium was advancements in technology and training, and how artificial intelligence (AI) and simulation are changing global ophthalmology, Dr Albanderi Alhamzah of the College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia, presented her research team’s findings on the dangers of laser eyebrow removal at the podium in a sort of ‘warm-up act’ to the main event.

She described the case of a lady who had undergone this procedure without being offered eye protection and gone on to suffer from, thankfully short-lived, uveitis. It was thought the laser had caused damage to the iris but not to the retina. Her presentation was gratefully received: this was clearly an issue that a few of the ophthalmologists in attendance (both in person and virtually) had not come across before; indeed, one or two appeared not to have heard of laser eyebrow removal as a beauty treatment at all, so it sparked plenty of discussion.

After a short break, Mr John Ferris, a consultant ophthalmologist based at Gloucestershire Eye Unit in the UK kicked off the Orbis session itself with his presentation on use of simulation to teach ocular surgery in the developing world. Mr Ferris described today’s pressures on surgical training, including the shorter duration of training programmes, reduced surgical opportunities, the costs incurred and the drive for greater theatre efficiency.

Despite these challenges, it is important for surgeons to engage in “sustained deliberate practice” throughout their careers, Mr Ferris said. Famous musicians spend hours per week practising their instruments, he argued — it should be no different for surgeons.

“Simulation does not have to be high-tech or expensive,” he assured. Indeed, ophthalmologists starting out have a lot of cheap and freely available tools at their disposal when practising surgical techniques. Take the humble apple. It turns out it’s not just for eating; glaucoma patients due to undergo a trabeculectomy might be reassured to know that the more junior ophthalmologists will have spent hours honing their flap cutting techniques on this fruit before doing their first procedure on a human eye.

Foam, too, can provide trainees with a handy way of simulating releasable sutures on flaps, Mr Ferris explained, pointing to photos of bright yellow foam ‘eyeballs’ being carefully operated on. And for those who need further convincing, the statistics speak for themselves: surgical complication rates were reduced by 72%, Mr Ferris pointed out, when simulation cataract surgery training was employed, and ophthalmologists’ scores of confidence in their glaucoma surgical skills doubled after they took a simulation course.

Meanwhile, supervision of students does not have to take place in person. A remotely supervised corneal suturing practice, demonstrated in a short video depicting Mr Ferris mentoring his students over live video feed from his home, was another interesting learning point during the presentation.

Equitable access to artificial intelligence in eyecare was the topic of the next talk by Dr Nicolas Jaccard, principal AI architect at Orbis. In this engaging talk, Dr Jaccard introduced Orbis’ Cybersight AI-enabled platform, whereby more than 20 machine learning algorithms detect sight-threatening conditions. Results can be available in fewer than 10 seconds and the service is free in low-and middle-income countries.

Bath-based consultant ophthalmologist Mr Rob Walters, who was chairing the session, posed the question that is no doubt an issue at the forefront of many people’s minds when they consider the use of AI in diagnostics: how do you deal with the problem of false negatives? Dr Jaccard provided the reassurance that they try to get the rate by which patients are incorrectly screened out of the healthcare system below the 3–5% mark. However, he admitted that the occurrence of false negatives is a “fundamental problem” in AI systems and one they are working on.

But does any rate of false negatives in an AI system justify its use at all? This is a question that no doubt many listeners were pondering, and it remains to be seen whether modern algorithms such as these will ultimately be able to overcome such limitations in the future.

Best of the Best

The final Symposium at this year’s ESCRS, the ‘Best of the Best’ was surprisingly busy, given that no doubt at this late stage in the Congress many delegates were already on their way home, but it was clear why as the series of videos shown during this session—some with upbeat music soundtracks—stimulated lively discussion and debate amongst a panel of ophthalmologists sat in a row of comfortable-looking armchairs across the stage.

The footage was mostly quite topical as well. For example, one video featured new protocols that had been put in place at one European hospital as a result of the COVID-19 pandemic. This led to the panel discussing the safeguards they put in place at their own clinics, which varied from country to country. It was interesting to hear, first-hand, how the differing levels of severity of the pandemic in the first few months in different countries (Italy, for example, was particularly badly hit) affected the ophthalmologists and their clinics.

I was pleased to hear that long-term sustainability touched on (the pandemic resulted in a greater use and disposal of plastic in hospitals), and the discussion was rounded up on a positive note, with the panel members acknowledging the state of preparedness clinics and hospitals now find themselves in post-pandemic: the healthcare sector is now armed and ready to tackle any future surges in infections.

Moving to specific treatments in the cataract and refractive space next, one video showcased the benefits of the dexamethasone intraocular suspension 9% (Dexycu, Eyepoint Pharmaceuticals) for the treatment of postoperative inflammation following cataract surgery. The panel had a lot to say about this.

Dr Rudy Nuijts was the first to give his input, remarking that it is too expensive to use in the Netherlands despite the concept being ‘very attractive.’ Avoiding drops post-surgery is the future direction cataract surgery is taking, he added.

Other videos during the Best of the Best Symposium demonstrated scleral fixation of IOLs, which provoked the panel into debating scleral flap techniques, and topography-guided PRK and CXL for keratoconus, which prompted a discussion on the merits of topography guided methods.

All in all, the final session I attended at this year’s ESCRS was fascinating and topical and rounded up the event nicely. As I continue to digest the wealth of information I came away from the conference with, it only remains to be said that I look forward to the 40th Congress that will take place in the beautiful city of Milan (Italy) next year. See you there!

Related Content: ESCRS 2021 Overview | ESCRS 2021 Part 1 Coverage | Cataract & Refractive | Conference Coverage