20/20 in 2020: The Lens

Main symposium highlights state-of-the art in lens-based refractive surgery

Cheryl Guttman Krader

Posted: Wednesday, September 30, 2020

Roberto Bellucci MD

The Saturday afternoon main symposium during the ESCRS Congress features an international faculty of experts in cataract refractive surgery who will be presenting on topics pertinent to the theme “20/20 in 2020: The Lens”.

Filomena Ribeiro MD, PhD, Lisbon, Portugal, and Roberto Bellucci MD, Verona, Italy, are co-chairing the session. Dr Bellucci said that while the virtual format creates new challenges for meeting organisers and presenters, there is a positive side to an online meeting.

“The COVID-19 pandemic has impacted the medical community in many ways, including the approach to education, and perhaps the 2020 Winter Meeting in Marrakech will be the last ESCRS meeting held in the pre-COVID format,” he remarked.

“However, ESCRS is ready to carry on its tradition of excellent education in the form of a webcast virtual meeting that will have the potential to reach a wider audience than ever. While we all regret not meeting in person, I believe we can transform the ‘problem’ into an opportunity.”

Continuing, he drew a parallel between the session content and its online delivery.

“The ‘20/20’ main symposia, which include the session on the lens and another on cornea-based refractive surgery, were conceived to provide updates on the most recent techniques in cataract and refractive surgery. Now, speakers will deliver the information using the most innovative communication method available,” Dr Bellucci said.

In planning the symposium, Dr Bellucci said that he and Dr Ribeiro were tasked with having to choose a finite number of topics and from among a long list of experts in the field.

“I believe we have put together a very interesting programme featuring speakers who are renowned for their work in lens-based surgery,” he said.

The symposium is beginning with a talk on “The quest for emmetropia”. It is being given by Giacomo Savini MD, Bologna, Italy, who will discuss biometry, IOL power calculation, and how to reduce the pseudophakic refractive error to <0.5D.

“Minimising postoperative refractive error is of utmost importance in cataract surgery today. Especially as we are operating on more post-LASIK patients who enjoyed spectacle independence for decades and want to maintain it after cataract surgery,” said Dr Bellucci.

In the next talk, “Correcting astigmatism”, Adi Abulafia MD, Jerusalem, Israel, will explain methods to address another modifiable factor that can limit postoperative unaided vision.

“Far from considering it useful for pseudo-accommodation, we will learn how to minimise astigmatism by appropriately evaluating the anterior and the posterior corneal surfaces,” Dr Bellucci said.

The question, “Restoring accommodation with IOLs: have we made progress?” will be addressed in a talk by Gerd U Auffarth MD, PhD, Heidelberg, Germany. Dr Auffarth will discuss pseudo-accommodation and the most recent optic technologies using novel modalities to exploit the distribution of incoming light.

“I think we will hear that we are probably close to obtaining seamless vision in the pseudophakic state, which is an option that is becoming increasingly attractive for middle-aged patients looking for spectacle independence,” Dr Bellucci said.

Continuing with the topic of IOL optics, Scott M MacRae MD, Rochester, NY, USA, will review “Lens refractive indexing”. Dr McRae will share his views on this approach and results being achieved with new types of refractive IOLs that are modified using laser energy.

The focus of the last portion of the symposium is on optical disturbances and quality of vision. Even patients with full uncorrected vision may experience dysphotopsia that can prompt them to ask for lens exchange, noted Dr Bellucci.

“The presentation ‘Pseudophakic dysphotopsia’ by Gre Luyten MD, PhD, Leiden, The Netherlands, is important for surgeons because it will describe both preventive and corrective strategies for these optical disturbances as well as the potential for their occurrence with newer optical designs that increase the depth of focus of monofocal IOLs,” he said.

Concluding the session, Béatrice Cochener-Lamard MD, PhD, Brest, France, will speak about “Quality of vision: Beyond 20/20”, as a critical determinant of patient satisfaction. Previewing her talk, Dr Cochener-Lamard noted that there have been spectacular advances in cataract surgery over the past two decades that collectively have elevated the procedure to the rank of true refractive surgery.  With the refinements that have occurred, “Supervision”, which considers vision quality in addition to 20/20 visual acuity, has become the targeted outcome for cataract surgery, Dr Cochener-Lamard said.

In her talk, Dr Cochener-Lamard will discuss the many metrics by which quality of vision is characterised as well as the importance of optimising the ocular surface.

“The ideal outcome is to offer patients a level of satisfaction such that they “forget their eyes” throughout their daily activities,” she said.

Dr Bellucci said that at the end of the symposium, it will be clear why lens-based surgery is increasingly popular as a method for refractive correction.

“In conjunction with the cornea refractive symposium, the lens symposium will provide a comprehensive review of the latest practical information on patient selection and surgical methods. These sessions fulfill the purpose of ESCRS symposia, which is to provide good scientific content that is readily understood by practitioners and easy to implement into their daily routines,” Dr Bellucci said.