In October 2017, Canadian investment firm LCG Capital signed an option with AAA Trichomes to acquire an interest in a new cannabis processing facility to be built in Quebec. Canadians who have been authorised by their healthcare practitioner are allowed purchase or produce limited amounts of cannabis for their own medical purposes. At present there are 69 producers licensed by Health Canada, and following investments in Australia and South Africa, LGC are hoping to make inroads into this growing market.
Several states worldwide have decriminalised cannabis use for medical reasons, without defining clearly what conditions warrant its use. Since the 1970s it has been suggested that cannabis use can help treat glaucoma. This has been disputed for almost as long, however. In short, smoking marijuana has proven to be effective for lowering intra-ocular pressure (IOP), a key element in glaucoma treatment. Its effects last for just three-to-four hours, and patients need a 24-hour reduction in pressure, so one would have to be smoking six-to-eight times per day.
In a study carried out to observe the effects of cannabis on IOP, researchers noted that seven of nine participants lost any beneficial effect of the drug due to tolerance. Furthermore, smoking can have negative effects, such as dizziness, sleepiness, distortion of perception and anxiety.
“Synthetic analogues of cannabinoid with more potency and longer duration of action, sensible utilization of novel drug delivery systems namely nanoparticle approaches, and combination of cannabinoids with other conventional drugs to control glaucoma could be alternative solutions,” write the authors of a detailed paper entitled The arguments for and against cannabinoids application in glaucomatous retinopathy.
In another study, entitled Cannabinoids and glaucoma, researchers pointed out the difficulties of attempting to administer cannabis via eye drops. “After instillation of an eye drop of any medication, loss of the instilled solution via the lacrimal drainage system and poor drug penetration results in only <5% of an applied dose reaching the intraocular tissues,” the authors write. As well as this, natural cannabinoid extracts “are highly lipophilic and have low aqueous solubility”, making effective application even more difficult.
While cannabis has proven effective as an appetite stimulant, a spasticity relief and pain relief for a variety of conditions, it remains the case that more traditional remedies such as eye drops or surgery, based on current research, may continue to be appropriate for the treatment of glaucoma.
Meditation is not for everybody, but it may help to relieve stress. Maryalicia Post reports
At a party recently the question of ‘stress’ came up.. who had it, what they do about it. When I was asked if I suffered from stress – my first reaction was to say ‘no’.. After all I’m not an air traffic controller – or an eye surgeon! The most stressful thing I would normally face is a long queue at airport security or a cancelled flight.
So for a moment I thought I might just say ‘no’.. but somehow that seemed pretentious.. as if I were implying I was too well organised to experience stress. Or perhaps it would suggest I was a lady of leisure, which I’m not.. So I said ‘yes.. and then the young man who’d asked the stress question had the chance to ask another.
“Have you thought about meditation?’
Now I could say ‘no’ without a second thought..
‘I’m not sure what religion it’s based on,’I explained, ‘but it’s not mine’.
‘Okay…said he…’you don’t need any specific spiritual belief. I don’t practice a religion and meditation works for me.’
’Well,’ I confessed.. ‘I can’t imagine sitting still – trying not to think about anything – for any length of time. It would drive me crazy.’
Turns out that’s a common misconception. He assured me it’s not about stopping your thoughts… Its about becoming more aware of them but not dwelling on them. You focus on your breath and on your sense perceptions. You let your thoughts pass by like clouds. Label them and let them go.
‘It’s a gentle procedure.. ,’ he added..”not sombre at all.’
I asked him what he’d gotten out if it.
‘In my case- it varies with the individual -after about a month I noticed my mind was clearer and I had developed a heightened sense perception. Ultimately, I experienced a feeling of relaxation, of being uplifted.’
‘Sounds great,’ I stonewalled, ‘but I wouldn’t have the time…’
‘Ten or 15 minutes a day…’
Since that evening I’ve been noticing the posters – taped to trees along the footpath, pinned up in my local supermarket and in the Post Office – offering ‘meditation’ sessions in my locality. And, at www.goodreads.com, I came upon a book called Teach Yourself To Meditate by Eric Harrison which got great reviews.
What have I got to lose? A few Euro for a book – or a course, and 15 minutes a day. I’m thinking about it……
EuroTimes Contributing Editor explains how he made the transition from writing about football to covering ophthalmology meetings
Former Republic of Ireland international soccer player Fran Stapleton(left) being interviewed by former Tallaght Echo reporter Dermot McGrath in 1991 outside The Burlington Hotel, Dublin, Ireland. Image courtesy of Brian MacCormaic.
My son has never really forgiven me for becoming a medical journalist. My mistake was telling him that I used to be a sports writer, or perhaps more accurately “a fan with a typewriter”. Why on earth would anyone give up watching and writing about sport, he wondered. Telling his friends in school that his dad was a sports writer seemed vaguely cool, whereas telling them that he wrote about eye diseases was considerably less cool and definitely more “nerdy”.
Yet this nerd has no regrets about career choices, even if I understand my son’s point of view only too well. This year’s gathering in Lisbon marks the 35th Congress for the ESCRS and the 15th for yours truly.
It’s an adventure that began on a freezing February in Rome in 2003 when George W. Bush was in the White House and Ulf Stenevi was ESCRS President. I was ushered into a darkened hall at the ESCRS Winter Meeting where some live surgery was being relayed by video link from a nearby hospital. It was a cataract operation and I managed not to faint as the eye was prepped and the phaco needle worked its magic. “So, do you think you can write about this stuff?” my editor asked with a smile.
I managed to hold on to my lunch, sat in later on a few sessions and soon did my very first EuroTimes story. It was a short article on vitreous floaters, a persistent problem then as now for many patients. I went to interview the doctor concerned, hoping he wouldn’t realise how clueless I was.
When things got too technical, I hit him with my failsafe, fall-back question: “Okay, that’s fine, but what will this mean for the average patient?”. His answer to that very question provided the backbone for the article and the “average patient” question has served me well ever since – it often serves to scythe through the extraneous detail and marketing hype to get to the heart of the topic at hand.
A lot has changed in the 15 years since my initial floaters article. The ESCRS Congress has evolved from a principally European gathering to a truly global event. Some “hot” new technologies and surgical techniques have come and gone.
Femtosecond lasers are now a routine part of ocular surgery. The keratoplasty field seemed to gain a new acronym every few years (DALK, DMEK, DSAEK etc). Anti-VEGF drugs revolutionised the treatment of AMD. Cataract incisions continued to shrink as IOL materials and designs improved. Gene therapy and retinal implants are no longer the stuff of science fiction.
Through all this evolution, watching and reporting from the sidelines on everything from A-constants to zonuloysis has been a fascinating and educational experience. It might not excite my son’s imagination, but the perennial game of science versus pathology played on that smallest of pitches, the human eye, compels its own respect.
The “players” – those ophthalmologists, surgeons and researchers that take to the field every day in an effort to save sight, improve vision, treat disease and improve the quality of life of their patients – deserve every support and recognition for their endeavours. After all, they’re playing on behalf of all of us, even if occasionally they still need to be asked that irksome question “so, what does this mean for the average patient?”
It’s a question I hope to keep asking for a good while longer.
- Dermot McGrath is a Contributing Editor with EuroTimes
Take a break from technology – and your phone – and enjoy interactions with colleagues in Lisbon
Everything I needed to do to be present in Lisbon for the ESCRS meeting, I did with my phone. I sent an email to our department secretary to request a few days off, and when my conference visit was approved, I notified my colleagues via WhatsApp that I would be absent this weekend. I booked my flight via the Momondo app, downloaded a barcoded e-ticket on to my phone and, the day before my flight, checked in remotely.
I found and booked an apartment on Airbnb and, upon arrival, received an SMS with the code to the apartment’s front door lock. I checked the weather (very nice!) via the weather app so I would know what to pack. Once I got on the plane, I put on my noise-cancelling headphones and read The Economist on my phone while listening to a drum & bass playlist that I had created on Spotify and downloaded on to my phone.
When I arrived in Lisbon airport, I took one look at the long line of people waiting endlessly for a taxi and immediately summoned a car via Uber. I reserved a Harley Davidson motorcycle online and then used Google Maps to get from my apartment to the rental agency and from there to the conference centre, where I downloaded the ESCRS app to help plan my days at the conference.
I wrote this column on my computer (sorry, writing on a phone is just too slow) and I could probably find many of the presentations online after the conference. It’s all so simple, all so convenient. So why am I even here? What motivates me to fly to continental Europe’s westernmost capital (according to my phone’s Wikipedia) to attend a conference?
I guess it’s for the human connection, the discussions, the interpersonal interaction that can only occur when I put down my phone, take off my headphones, close my computer and look around at who’s sitting across from me during lunch, who’s walking towards me in the exhibition area, who’s standing behind me in the line to get an espresso.
Maybe it’s because I’m sure I’ll bump into Nic Reus, the cataract specialist who supervised my first complete phaco early in my residency, and Bart Zijlmans, a surgical mentor whom I credit with upgrading my phaco skills from “beginner” to “intermediate” in just a few months. I think it’s important to maintain some sort of contact, however brief, with mentors and those with whom I trained, not only via Facebook but also in real life.
I’ll also meet up with Thierry Derveaux, my current colleague at Ghent University and, for my combined phaco-vitrectomies, my IOL-power-calculator extraordinaire. It’s thanks to his calculations that patients referred to me after complicated cataract surgery often end up emmetropic, even after vitrectomy and retropupillary enclavation of an iris-claw lens.
I always find it fun to see people in a different environment. Especially if that environment happens to have outdoor restaurants with ocean views, vinho verde and aromatic olive oil.
We appreciate the opportunities and conveniences that technology has made possible. But we all came to Lisbon to take a break from technology and enjoy interactions with colleagues in an enjoyable environment.
- Dr Leigh Spielberg is a vitreoretinal and cataract surgeon at Ghent University Hospital in Belgium and a Medical Editor of ESCRS EuroTimes
THE French have an expression that says Lever le nez du guidon. It’s perhaps unsurprising that the country that gave us Le Tour de France also gave us this gem, but for me it truly captures the spirit of the ESCRS summer meeting.
Literally translated, it means “To raise your nose from the handlebars”, and it couldn’t be more visually representative of its figurative meaning, which is to take a moment to pause and reflect on a situation that you are actively involved in. Taking a step back, as it were, and looking at the bigger picture. I always picture a heroic cyclist making his way through one of the gruelling mountain stages of the Tour de France. Bent deeply over his steering wheel, tirelessly chipping away metre after metre of a seemingly never-ending strip of asphalt draped like spaghetti over the French Alps. After they’ve made it around yet another hairpin turn (they are the steepest parts!) they raise up their upper body to for a brief moment to stretch their backs, glancing out to the formidable challenge still ahead, but also looking back to the road below them that they’ve already conquered.
A life in ophthalmology can feel like a mountain stage. Training to perform surgery is a long and winding road, and when you consider exams and fellowships and all the sacrifices that you make, there’s a lot more uphill than downhill, to say the least. As you are bent over the steering wheel of your career with yet another mountain to climb ahead of you, it’s important to remember to stretch your back, as it were, to take stock of what’s ahead, and take a moment to appreciate the road you’ve already travelled. You remember the first incision your trainer let you do alone, the first capsulorhexis you weren’t embarrassed by, and the first case you completed yourself even though you were so nervous that your sweat made your scrubs stick to you.
The ESCRS meeting gives you time to think and reflect, something that is often missing from our hectic clinics. The coffee breaks between sessions are there for a reason – they let you meet and chat with your peers and your idols. This will help you realise that while your goals lie further up the mountain, the hairpin turns you have conquered still lie ahead for many of your younger colleagues. Trainees flock to the meetings, and helping them to success in their wetlabs and courses can give the same sense of achievement as the first time you did it yourself. Even though I am not a trainee any more, I am still learning. We all depend on those ahead of us to show us the right way to go. We owe at least that to the riders behind us.
In other words, you don’t have to know everything before you’re allowed to share something. You’ve already made part of the journey, and others who are behind you are more than happy to hear from you. At the ESCRS this year why not try to encourage the trainees to speak up. They are the future
of the Society, and if we want the future to be bright we have to make them even better than we are.
- Sorcha Ní Dhubhghaill is an anterior segment surgeon and guest lecturer at Antwerp University Hospital in Belgium.
Maryalicia Post has some words of wisdom for delegates attending the XXV Congress of the ESCRS in Lisbon.
The other day I was surfing the net for a pair of ‘travelling shoes’.. the kind that slip off easily for the security check in the airport.. and I came upon some with a hidden compartment built in for credit cards and cash. Not a bad idea.I’ve kept one card and some cash separate from the rest ever since I first lost my wallet to a pickpocket on Las Ramblas.
Most people who travel have some experience of pickpockets; after decades on the go, my personal score is Bad Guys 2, Me 2.
Yes, someone did fish my wallet out of the bottom of my backpack so adroitly I never felt a thing. But also in Barcelona a cab driver parked his vehicle and chased me down Las Ramblas on foot to return a camera I’d left in his taxi.
A thief in New York’s La Guardia airport snatched my handbag from the trolley (while I was wrestling my case from the carousel).. With it went passport, eye glasses, credit cards, cash.
But on the other hand, when my wallet slipped out of my bag in a London taxi it was returned by post with every single item in it intact. My offer of a reward was refused. “I was raised to be honest,” the driver said. I sent flowers to his wife.
Did I learn anything from all this? Yes I did. In terms of time wasted, stress and inconvenience losing a passport is a major travel catastrophe – and filling up all the forms for replacing travel documents without eyeglasses more than doubles the challenge. I don’t plan to go through that again- I pack a spare pair of glasses and I keep the passport on me.
To do that, I first tried one of those pouches that clasps around the waist; it felt bulky and uncomfortable and was a nuisance to take off for security.. Currently I have a slim wallet that hangs around my neck; it makes me feel like a pilgrim with a scapular but it’s easy to get on and off and has slots for couple of credit cards.
A photo copy of the passport ID page and credit cards (both sides) stays in my suitcase. And I try to keep one credit card and some cash separate from the rest. Where? That’s why I’m thinking about those shoes.
EuroTimes travel writer Maryalicia Post says delegates preparing to attend the XXXVth ESCRS Congress should go armed with some good books.
To the usual pre-travel checklist (notify Visa, leave key with neighbour, charge phone/camera) I add ‘books’… this means buy a book for reading when devices must be turned off, say in the plane before take off, and download a book or two on the Kindle app for late nights in the hotel room.
As I really enjoy those ’aha’ moments – when I recognise a place that was a scene in a book I’ve read – ‘books’ also starts me reading something set in the next city I’m heading to. Right now it’s Night Train to Lisbon by Pascal Mercier.
This novel, made into a film starring Jeremy Irons in 2013, has drawn enough people to Lisbon to support a popular tour following in the footsteps of Gregorius, the staid Swiss professor who suddenly upends his life and travels to Lisbon on the night train. His journey of self-discovery in the city ranges from the Barrio Alto down to the old quarter of Alfama. (A private tour for one or two people costs€70. Details of when and where on the website. https://lisbonliterarytours.com/english/night-train-to-lisbon.)
My more ambitious download for Lisbon is Diary of Disquiet by the great modernist Portuguese poet, writer and philosopher Fernando Pessao. Lisbon Literary Tours have him covered too. Their Pessao tour is described as ‘a walk through Lisbon in the 1920s and 1930s.’
Alternatively, I could simply track places associated with Pessao and other Lisbon writers via an online DIY guide; click on A Literary Tour of Lisbon at https://theculturetrip.com
You don’t have to be familiar with any Lisbon-based books or authors at all to enjoy a literature-themed experience. The one offered by the aptly named Lisbon Chill-Out Tours sounds like a walk with a friend with literary asides thrown in. Currently, this tour requires pre-booking, preferably 72h in advance. It’s available on Wednesday, Saturday or Sunday. There’s ‘no problem providing the tour for just one person’. http://lisbonfreetour.blogspot.pt . Tour is free, tip ‘according to your satisfaction’.
As for airport reading, I’ll have A Small Death in Lisbon in my hand luggage. Author Robert Wilson interweaves two stories: in this novel: the death of young girl in the city and the tale of a Nazi officer sent to Lisbon during WW2. That should set up plenty of aha moments.
Conferences and scenery can fly by so fast when you’re not prepared
I rented a cherry red Ducati motorcycle to explore Barcelona during the hours when I’m not attending sessions at EURETINA. But I wouldn’t recommend you do the same. I once took a wrong turn and ended up on the highway to Girona, at night, in the drizzling rain. In my mind, I mistook “Girona” for a combination of “Genoa” and “Verona,” and thought to myself, “Goodness, I’m on the road to Italy!” I composed myself and took the next exit and sought the security of Barcelona.
So, wrong turns aside, why wouldn’t I recommend you hop on a two-wheeler? Because on a motorcycle, everything flies by so quickly – you might see everything in the city, you can’t really take anything in. You can’t absorb it.
That is, unless you plan your visit, map in hand, the same way we plan our conference visits, EURETINA app in hand. Just like the city of Barcelona, the EURETINA conference is too big to take it all in at high speed unplanned, but we select that which we want to see, hear, learn, take in, enjoy.
We attend some presentations because we want to learn a specific diagnostic or surgical technique. A new ILM flap technique? No problem. Sometimes all it takes is a reassurance that it’s not quite as difficult as one might think.
There are other presentations, like Dr Micol Alkabes’ talk on macular buckling in high myopia, that we attend for the same reason we might watch an acrobat in Cirque du Soleil: to be impressed by the skills of the performer, and to be slightly afraid of what might happen if it were to go wrong. And although I watched our society’s current president, Jan van Meurs, successfully perform macular buckling several times during my vitreoretinal surgery fellowship, I don’t plan on attempting it anytime soon. Maybe later, when I’m training fellows of my own.
For every conference that I attend, I select a particular theme to help guide my session selections. This year, it’s “peeling”: puckers, the ILM, remnants of posterior hyaloid and dreaded PVR. I like the singular focus on one topic. It concentrates my mind and helps me assimilate all I’ve learned into a coherent whole.
After hours, on the Ducati, this week’s theme is “climbing”. Cruising up to the city’s highest points right after the last session is a great way to escape the post-conference, rush-hour bustle down below. I ride up, stop somewhere high and explore the area until the city calms down in the early evening. Montjuïc Castle provided me with spectacular views of the city on one side and the port and Mediterranean on the other. Tibidado, which I’m planning for this evening, is apparently even better.
But I digress! I urge you to enjoy the last 1.5 days of the conference, whether it’s at today’s EURETINA Update on neovascular AMD or tomorrow’s instructional course on managing submacular haemorrhages. And, if you see a shiny red Italian machine parked outside the conference centre, take a closer look and consider getting your motorcycle license so you can join me for a ride next year. Just don’t forget to plan ahead. Conferences and scenery can fly by so fast when you’re not prepared.
And so, it begins.
EURETINA has returned to the beautiful city of Barcelona for the third time. Barcelona was the venue for the 2nd EURETINA Congress, which was attended by 200 delegates in 2002. In 2005, when the congress returned to Barcelona, there were 850 delegates in attendance. This year the society expects to welcome up to 5,000 delegates from more than 100 different countries for the 17th EURETINA Congress.
This year’s congress will provide delegates with a veritable feast of activities with 11 main sessions, 41 instructional courses, 31 international society symposia, 392 free papers and 909 posters. To find out what is on, go to the EURETINA Programme and also make sure to download the EURETINA app from the App Store
or at m.euretina.org.
You won’t be able to attend every session, so it’s important to plan your day in advance. To learn more about EURETINA and the services it provides to members, make sure to visit the EURETINA Resource Centre at Booth 119 in the Exhibition Hall.
Wi-fi is available free of charge throughout the congress centre on the EURETINA network (password: EYELEA2017).
Delegates can also join in the conversation on social media by visiting the EURETINA Facebook
page and by following us on Twitter
And don’t worry if you miss some of the sessions you had hoped to attend. Reports on the major sessions will be published in EuroTimes and also on the EuroTimes website at www.eurotimes.org.
All of the presentations can be accessed on EURETINA on Demand, which is free of charge to all EURETINA members, and the EURETINA player will provide exclusive video interviews with some of the key opinion leaders attending the congress. Also make sure to visit elearning.euretina.org, an online space that allows EURETINA members to learn in their own space and time.
My good friend and colleague Dr Leigh Spielberg once observed that the conference centre at a major ophthalmological congress is like an Olympic village, with superb facilities, food and drinks and support staff for the doctors, who have come to give their best performances.
But unlike the Olympic Games, EURETINA is not a competition,
and everybody who attends the congress is a winner.
For some delegates, especially the younger delegates attending their first congress, the experience can be daunting.
They may wonder if they will ever reach the level of expertise of some of the key opinion leaders who will discuss the cutting-edge technologies and therapies that are helping to advance our understanding of the retina and the treatment of patients.
I suggest they consider these words of wisdom from the great Irish writer Samuel Beckett.
In one of his last works,
Worstward Ho (1983), Beckett wrote:
“All of old. Nothing else ever. Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.”
Beckett’s work is often misinterpreted, but it is possible to argue that what he is suggesting here is that there is no such thing as absolute success or failure.
We can only do the best we can and if we do not succeed in meeting all of our goals, we should always reflect not only on the journey, but the destination.
Dr Leigh Spielberg looks forward to the 17th EURETINA Congress which takes place in Barcelona from 7-10 September.
I will attend the 17th annual EURETINA Congress in Barcelona both as a delegate retinal surgeon and as a reporter for EuroTimes magazine and ET Today, the daily newspaper produced on site at the conference.
This dual role creates both tension and excitement. I’ll be there to make sure I’m personally up to date regarding new developments in retinal treatment. I’ll also be there to report on these developments, selecting the presentations that I think matter most to our readers. Hopefully these two roles will coincide to a great degree.
It has been two years since I finished my vitreoretinal surgery fellowship, and I now feel comfortable in most situations. But I have developed a distinct desire to fill in whatever gaps remain in my knowledge. Fortunately, the gaps have become few and far between, but there are still some points that I want to hear from the experts. I’ll be attending Thursday’s “Instructional Course 10: Surgical Controversies in Vitrectomy for Retinal Detachment,” which will discuss whether ILM peeling is necessary and whether leaving some sub retinal fluid at the end of retinal detachment surgery does any harm.
My practice is limited to surgical retina, so I don’t regularly care for patients with medical retina problems. But I find it necessary to stay up to date regarding treatment paradigms for the more common pathologies that affect my retinal surgery patients. Attending “Instructional Course 21: Management of Proliferative Diabetic Retinopathy” on Friday will certainly help me treat more of these patients myself rather than having to refer them to my colleagues in the medical retina department.
I also always attend at least one free paper session. I enjoy the great variety of topics covered, as well as the enthusiasm of the many early-career presenters. New this year is the Young Retina Specialists (YOURS) Day on Friday, which aims to address the concerns of these early-career specialists, both medical and surgical.
I’m looking forward to arriving, not only for the medical & scientific learning, but also for the social aspect of a big European meeting. I’ve made plans to meet up with ex-colleagues from the other places I’ve worked, both at the conference and in the city. And of course, Barcelona is a draw in and of itself. I plan on renting a motorcycle to cruise around and visit a museum or two.
- Dr Leigh Spielberg is a vitreoretinal surgeon at the Department of Ophthalmology, Ghent University Hospital