Putting facts first
Prof Rudy MMA Nuijts MD PhD will be delivering the Ridley Medal Lecture at the 36th Congress of the ESCRS in Vienna
I am very honoured and humbled to have been asked to give the Ridley Medal Lecture: what more can you expect from a scientific career? There’s been only one Medal lecture delivered by a Dutch ophthalmologist at an ESCRS Congress before, Jan Worst, who delivered the Binkhorst lecture in 2000, and to be put on a similar level as a giant like him is incredibly honourable.
The title of my lecture will be “Facts First”. The idea behind it is to point out the value and importance of evidence-based medicine in anterior segment surgery. A core principle of modern medicine is to base treatment and policy decisions on the highest-quality, openly and objectively derived scientific data. Together with my research team I have tried to design studies that give us answers to the intriguing questions we have.
The answers to these questions are gaining increasing importance in the context of cost-effectiveness and value based health care. So, for example, is a toric lens better than a monofocal IOL, and up to which level of astigmatism? We found out that, although the toric IOL was very effective for the patient in terms of improving distance uncorrected vision, it was not cost-effective, at least in the Netherlands.
Other questions that I’ve tried to answer in my career are in the fields of refractive surgery and corneal surgery. For example, during the years 2005 to 2010 we investigated the practicality of making endothelial grafts with the femtosecond laser.
Our idea was that it might be very cost-effective to have a femtosecond laser in an eye bank where you could make all the endothelial grafts that were needed and then distribute them to all the corneal surgeons in the country. But it turned out that, at that time, although astigmatism was significantly lower, quality of vision provided by a graft made by the femtosecond laser was actually not better than what we could achieve with penetrating keratoplasty.
Later on, we compared endothelial grafts created with a femtosecond laser with those produced manually with a microkeratome and we found that the microkeratome actually produces smoother grafts with better visual outcomes. So sometimes, a fancy technological innovation does not bring us in every aspect what we expect from it.
Another example of femtosecond laser technology is its use in cataract surgery. The EUREQUO femtosecond laser-assisted cataract surgery (FLACS) study led by Prof Mats Lundström, in which I was also involved, and the FEMCAT study showed us again that FLACS has not brought us what we expected. On the other hand, FLACS has given us very innovative solutions when doing very complex cataract surgery.
So, expectations and outcomes are sometimes at variance with one another, and that is why we as ophthalmologists have to communicate to our peers what the evidence is for certain scientific claims that are being made by doctors and also by the industry. I believe that academia has a very important role in designing those kinds of studies and also coming up with answers. That is what we try to do here on a consistent basis. A final example of course is the ESCRS PREMED study, where we tried to find the best approach for preventing cystoid macular oedema after cataract surgery in routine phaco and in patients who have diabetes.
Registries are also important in terms of evidence-based medicine and I have been involved in establishing the European Cornea and Cell transplantation registry (ECCTR). The format and the backbone are being created and now the database is being filled with data from countries that have already national registries like in Scandinavia, the United Kingdom and the Netherlands, and we are having discussions with France and Germany and some eastern European countries. Registries provide real-world big data and can sometimes answer questions on a wider perspective, but when it comes to measuring the effect of specific interventions I believe that randomised clinical trials remain an invaluable instrument.
Rudy Nuijts was interviewed by Roibeard Ó hÉineacháin, Contributing Editor, EuroTimes