Regional EuroTimes
Date Posted 14/06/2009
Glimpse into the future finds opportunities for expanding and eliminating oculoplastic procedures
The future of oculoplastic surgery may be reshaped by a new educational paradigm that will deliver care into areas of the world where the procedures are most needed, said Richard Collin MD, at the 17th Congress of the European Society of Ophthalmology (SOE).
Dr Collin, head of the adnexal service, Moorfields Eye Hospital, London, UK, spoke during the opening ceremony where he was awarded the Charamis Medal for excellence in ophthalmic surgery.
Focusing on the management of trachoma-related cicatricial entropion, Dr Collin suggested that by adapting Internet-based teaching methods, it might be possible to remotely train operators to perform bilamellar tarsal rotation, the currently favoured, evidence-based procedure for surgical intervention. The operators, who may not even need to be doctors, will be taught, assessed, and monitored by world experts on the faculty at leading teaching institutions, said Dr Collin.
In addition to using Internet-based learning tools, the educational experience would involve practise using surgical simulators that are designed first to identify areas of competency and deficiency based on assessment of the operator’s hand movements and then to suggest necessary corrective measures.
“With trachoma we have learned to control the disease process with hygiene and azithromycin, and we can cure cicatricial entropion surgically, but that still requires a suitably trained operator,” said Dr Collin.
“Thanks to the help of congresses such as the SOE and collaboration with the ICO, we are trying to bring this type of Internet-based learning to improve the standard of surgery delivered away from the major institutions,” said Dr Collin.
In his look to the future, Dr Collin also suggested that with effective treatments to control primary disease processes, the need for reconstructive oculoplastic surgery in the management of some conditions may even be eliminated. Progress in this area is already being made.
For example, there are positive reports regarding medical treatment with the topical immune response modifier imiquimod for lentigo maligna, and understanding of the genetic basis of basal cell naevoid syndrome has led to the exciting possibility of halting tumour development based on targeting the PTCH gene.
In addition, early intervention with immunosuppressive therapy can sometimes prevent the need for orbital decompression in patients with thyroid disease-related orbitopathy, said Dr Collin.
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